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Query: UMLS:C0155339 (Brown)
 12,436 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

There is evidence from genetic and clinical studies, especially from therapeutic response to biological treatments, that endogenous or constitutional factors are important in some types of depressive illnesses. Unipolar depression is inherited differently from bipolar depression; monozygotic twins have a higher concordance rate than dizygotic twins. Endogenous depressions are cyclic in nature: the length of phases as well as the length of cycles are log-normally distributed. The effectiveness of antidepressants and ECT in endogenous depression points to a biochemical disorder. The author discusses the distinction between endogenous and exogenous depressions or between psychotic and neurotic depressions by reporting the work of Brown and others on "significant vs. stressful" events and on increased vulnerability.
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PMID:Depression and endogenicity. 648 41

Recent studies show that obsessive-compulsive symptoms may occur in many patients with schizophrenia and may predict a poor prognosis. Pilot studies have shown that some schizophrenic patients may improve if a serotonin reuptake blocker is added to their neuroleptic. We have performed a pilot, double-blind, crossover study of clomipramine (CMI) or placebo, added to maintenance psychotropic medication. Six schizophrenic patients with obsessive-compulsive symptoms were studied in a double-blind CMI versus placebo crossover protocol. The patients met DSM-III-R criteria for chronic schizophrenia, experienced obsessive-compulsive symptoms, and had been previously stabilized on their psychiatric medication. The patients were rated at baseline and longitudinally through the study with the Positive and Negative Symptom Scale for Schizophrenia (PANSS) and the Yale Brown Obsessive-Compulsive Scale (YBOCS). An analysis of covariance was used to compare the drug versus placebo effect at the final visit with the baseline rating as a covariate. Ratings on both the YBOCS and the PANSS showed that patients improved significantly more on CMI than on placebo. No patients experienced an exacerbation of psychotic symptoms. Preliminary findings from this double-blind, crossover, pilot study of CMI and placebo, designed to assess the effect of CMI in the treatment of schizophrenic patients with obsessive symptoms, suggest that CMI is superior to placebo in the treatment of obsessions and compulsions and improves overall schizophrenic symptoms. Further studies with larger samples and longer follow-up period are necessary to confirm these preliminary findings.
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PMID:Treatment of obsessive-compulsive symptoms in schizophrenic patients with clomipramine. 763 98

A controversial issue that was debated for DSM-IV is whether body dysmorphic disorder (BDD)--a preoccupation with an imagined defect in appearance--can be psychotic. BDD is classified separately from its delusional counterpart (delusional disorder, somatic type) in DSM-IV, but does it have a psychotic variant that overlaps with, and may even be the same diagnostic entity as, its delusional disorder variant? One hundred consecutive patients with DSM-III-R-defined BDD or its delusional variant were assessed with a semistructured interview, the Structured Clinical Inverview for DSM-III-R, and a modified version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The 48 patients with nondelusional BDD were compared with the 52 patients with delusional BDD (i.e., delusional disorder, somatic type). The two groups did not differ significantly in terms of most variables examined, including demographics, phenomenology, course, associated features, comorbidity, and treatment response. Thus, BDD may have a psychotic subtype that significantly overlaps with, and may even be the same disorder as, its delusional disorder variant. However, delusional subjects had higher total scores on the modified Y-BOCS, suggesting that the delusional variant of BDD may be a more severe form of the disorder. Although preliminary, these findings have implications for BDD's treatment and classification, suggesting that inclusion of a delusional (psychotic) subtype of BDD should be considered for future editions of DSM.
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PMID:A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. 783 53

Schizophrenia is a disease characterized by cognitive, psychophysiological, and interpersonal deficits that result in a marked vulnerability to stress (Dawson and Neuchterlein 1984; Nuechterlein 1977; Strauss et al. 1987). Episodes of illness occur in vulnerable individuals who experience stressful life events (G. W. Brown and Rutter 1966; Lukoff et al. 1984) or stressful interactions with family members (G. W. Brown et al. 1972; Imber Mintz et al. 1987; Leff and Vaughn 1985). Similarly, overstimulating therapeutic environments have been shown to exacerbate psychosis (Drake and Sederer 1986; Liberman 1982; Linn et al. 1980; Van Putten 1976). A full understanding of disease-specific deficits resulting from stress and vulnerability is necessary for developing psychosocial treatment programs that augment pharmacotherapies in significantly ameliorating the symptoms and disabilities of schizophrenia.
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PMID:Designing new psychosocial treatments for schizophrenia. 841 5

The Beck Anxiety Inventory (BAI; Beck, A.T., Epstein, N., Brown, G., Steer, R.A., 1988. An inventory for measuring clinical anxiety: psychometric properties. J. Consult. Clin. Psychol. 56, 893-897) is intended to assess clinical anxiety symptoms that are distinct from depressed mood, and there is some preliminary empirical support for this differential assessment. The BAI may serve a useful complementary role when used with the popular Beck Depression Inventory (BDI; Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G., 1979. Cognitive Therapy of Depression: A Treatment Manual. Guilford Press, New York, NY; Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., Erbaugh, J., 1961. An inventory for measuring depression. Arch. Gen. Psychiatry 4, 561-571), in patients with mood and/or anxiety disorders. Accordingly, the present paper reports the results of the first confirmatory factor analysis of the Beck scales in a homogeneous, clinically depressed sample (137 outpatients with non-psychotic major depressive disorder). Results indicated that a multidimensional model of separate anxiety and depression factors had good fit to the data. However, the parameter estimate was very high (0.784) and a unidimensional, single-factor model of negative affectivity approached the criteria for good fit. It was concluded that the Beck Anxiety and Depression Inventories assess distinct anxiety and depression phenomena to a limited extent when used in a clinically depressed sample.
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PMID:Confirmatory factor analysis of the Beck Anxiety and Depression Inventories in patients with major depression. 947 61

Despite the growing research on the etiology of obsessive-compulsive disorder (OCD), and schizophrenia, the clinical distinction between the two disorders is not clearly understood. In the present investigation, we sought to better understand the relationship between OCD and psychotic disorders by examining functional magnetic resonance imaging (fMRI) data from a group of schizophrenic patients with varying degrees of OCD symptomatology, based on results of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the National Institute of Mental Health (NIMH) rating scales of OCD. While subjects performed a cognitive challenge paradigm that included a verbal fluency task, activation data from the left dorsolateral prefrontal cortex were collected and analyzed. We hypothesized that the fMRI signal patterns in schizophrenic patients with high levels of OCD symptomatology would differ from that of schizophrenic patients with a low level of OCD. For the group as a whole, no significant relationship was found for scores of either rating scale and fMRI signal change; however, a significant association was found for a subgroup of patients. For these schizophrenics, there was a negative relationship between OCD symptomatology and activation of the left dorsolateral prefrontal cortex. These results support the suggestion of several researchers that a relationship between OCD severity and neurophysiological activity exists in schizophrenia.
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PMID:Obsessive-compulsive disorder among schizophrenic patients: an exploratory study using functional magnetic resonance imaging data. 977 84

Obsessive-Compulsive (OC) symptoms are observed in a substantial proportion of schizophrenic patients and pose a significant therapeutic challenge. Based on findings of the benefit of the anti-obsessive agent clomipramine, we designed an open-label study to examine the effect of adding the serotonin-selective reuptake inhibitor (SSRI) fluvoxamine to the ongoing antipsychotic regimen of schizo-obsessive patients. The study population consisted of ten neuroleptic-stabilized chronic schizophrenic patients with OC symptoms. Fluvoxamine (up to 150 mg/day) was added to the ongoing antipsychotic treatment, which remained unchanged for the entire 12-week trial period. The patients were evaluated before the trial and at weeks 1, 2, 4, 6, 8 and 12 (end point) with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Schedule for Assessment of Positive Symptoms and the Schedule for Assessment of Negative Symptoms. The results showed a significant improvement in obsessions (P < 0.02) (but not compulsions) and both positive (P < 0.01) and negative (P < 0.05) schizophrenic symptoms. By the end of the trial, three patients showed a more than 50% reduction in the Y-BOCS score, with complete amelioration of the OC symptoms in one of them. Three patients were dropped from the study during the first 4 weeks, two because of aggressiveness and one because of psychotic exacerbation. No exacerbation or new onset of extrapyramidal side-effects (EPS), as measured by the Barnes Akathisia Scale (BARS) and the Simpson-Angus Scale (SAS), was noted during the course of the trial and there were no other significant clinical side-effects of fluvoxamine addition. We conclude that fluvoxamine may be an effective adjunctive agent in some schizo-obsessive patients.
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PMID:Fluvoxamine treatment of obsessive-compulsive symptoms in schizophrenic patients: an add-on open study. 1022 Jan 24

Obsessive-compulsive-related disorders are frequently comorbid with schizophrenia. The existence of obsessive and compulsive symptoms in patients with schizophrenia represents one of the most severe types of psychotic disorders and may predict a poor prognosis in most cases. Previous pilot studies and case reports have shown that the condition of some patients with schizophrenia did not exacerbate and even improved when serotonin reuptake inhibitors (SSRIs) were added to their standard neuroleptic regimen. The aim of this study was to evaluate the efficacy of a combination treatment of an SSRI (fluvoxamine) and standard neuroleptics for the treatment of obsessive-compulsive (OC) symptomatology in patients with schizophrenia compared with administration of neuroleptics only. Thirty inpatients who met DSM-IV criteria for schizophrenia and also had prominent OC symptoms were randomly divided into two groups. Fourteen patients were treated with conventional neuroleptics and fluvoxamine in doses of 100 to 200 mg/day for 8 weeks. Sixteen patients comprised a control group and received only their previous therapeutic neuroleptic therapy. The patients were assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Positive and Negative Syndrome Scale (PANSS), and the Clinical Global Impression Scale (CGI) at baseline and endpoint. Side effects were assessed weekly. The data were analyzed using an analysis of variance. A considerable reduction in PANSS (34.3%) and Y-BOCS (29.4%) scores was noted, and CGI scores decreased moderately in both groups. None of the patients showed an acute exacerbation at the end of the study. Side effects were mild and easily tolerated in most patients. This open, randomized, controlled study reveals that coadministration of fluvoxamine, an SSRI, and neuroleptics in patients with schizophrenia and OC symptoms was associated with specific improvements of these symptoms. Thus, the use of an SSRI in treating a patient with schizophrenia and OC symptomatology may be warranted and safe. Other implications of the findings, including general safety of the combined pharmacotherapy and the use of new antipsychotic medications, are also discussed.
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PMID:Obsessive and compulsive symptoms in schizophrenia: a randomized controlled trial with fluvoxamine and neuroleptics. 1091 1

Obsessive-compulsive (OC) symptoms have been observed in a substantial proportion of schizophrenic patients. In this study, we assessed the rate of occurrence of OC symptoms and the interrelationship between OC and schizophrenic symptoms in 68 hospitalized chronic schizophrenic patients. The patients were interviewed with the Structured Clinical Interview for Axis-I DSM-IV Disorders - Patient Edition (SCID-P) and the appropriate rating scales including the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Barnes Akathisia Scale, the Abnormal Involuntary Movement Scale, and the Social Behaviour Schedule (SBS). Sixteen patients (23.5%) met the DSM-IV criteria for OCD. A comparison of schizophrenic patients with and without OCD showed that the schizo-obsessive patients were significantly (1.7-fold) more impaired in basic social functioning, as reflected by the SBS score. No significant between-group differences for any of the other clinical variables were found. There was no significant correlation between OC and schizophrenic symptoms within the schizo-obsessive subgroup. The mean Y-BOCS score for the patients with both schizophrenia and OCD was within the typical range (22.8+/-1.7) observed in OCD without psychosis. The findings provide further evidence for the importance of the OC dimension in schizophrenia and may have important implications for the application of effective treatment approaches in this difficult-to-treat subgroup of schizophrenic patients.
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PMID:Obsessive-compulsive disorder in hospitalized patients with chronic schizophrenia. 1136 39

Patients suffering from schizophrenia or bipolar affective disorder may progressively worsen and become severely disabled, and may then be classified as suffering from severe and enduring mental illness. Concern about risk to self and others focuses on this patient group, and community psychiatric nurses (CPNs) are under pressure to target patients with this diagnosis. CPNs have been accused of neglecting patients with a severe and enduring diagnosis in favour of other patient groups, but if they restrict services at primary care level this may have serious implications for patients. Patients who have had no previous contact with mental health services may have potentially serious and life threatening conditions. For example, depressed men may not be categorized as severely mentally ill, but the suicide rate amongst this patient group is very high, and they may externalize depression and resort to violence if untreated. Depressed men may lack social support and the means to express psychological distress, and these factors may precipitate or exacerbate depression. Early referral and assessment can prevent crises, deterioration in mental health and suicide. CPNs do not necessarily have to provide ongoing care following assessment, but they do have a significant role to play in primary health care referrals for the non-psychotic mentally ill. CPNs act as a filter for the expertise and resources of multidisciplinary mental health teams. General practitioners will have increasing difficulty accessing the resources of multidisciplinary mental health teams if CPNs are unable to accept primary health care referrals. Primary care interventions are very important for the assessment of depression because they may help men to express psychological distress and assist them to access appropriate services and treatment. The experience of working with depressed men in a primary health care setting revealed that many lack confidants, or do not confide in those close to them. The interview schedule designed by Brown & Harris (1978) to gather data on the relationships of depressed women was used to explore the relationships of depressed men who were attending a Mental Health Day Centre.
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PMID:Depressed men: an exploratory study of close relationships. 1187 96


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