Coping With Schizophrenia and Psychosis

The Schizophrenia-free Package

What are you going to find in the Schizophrenia-FreeYour New Life Begins Today e-book: Relationships and Friends: In this chapter, I share with you my way of thinking about friends and relationships. I provide my point of view about how I see this interesting issue. I also give you some tips about how to get friends, deal with friends, and treat relationships. About Schizophrenia and Getting Well: In this chapter, I describe my way of thinking about schizophrenia and other similar mental illnesses. Living on Your Own and Being Independent: In this chapter, I share my perspective about our independence as sufferers and how to live on our own and be independent. Other Sufferers' Recovery Examples: I decided to share other sufferers' stories so you won't feel alone in your illness. Finding Your Mate and Getting Married: Having a mate is one of the most important pillars in your life as a sufferer. In this chapter, you learn some of the most important basics in this matter. Preventing Future Seizures and Getting Help: This chapter shows how to reduce the chance of having future psychotic disorder seizures and, even if you experience one, how to make it as minimal as possible. Dieting and Exercising: This chapter demonstrates how to acquire easy life habits in order to survive your years to come in the healthiest manner possible. Living by Yourself and Earning Your Own Money: This chapter shows how to earn your own money and live by yourself as a result. Ways of Getting Support: There is nothing like a good support system in order to rehabilitate in the best matter possible. This chapter discusses the most basic and powerful ways of getting support. Quitting Smoking: In this chapter, you learn the basic principles of why and how to quit smoking. Learning a Profession and Finding a Job: In this chapter, you learn the most important factors for learning a profession and finding a job.

The Schizophreniafree Package Summary

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Substance Abuse And Schizophrenia

Only recently has the high prevalence of alcoholism in schizophrenia been noted. Likewise, the recognition of high rates of other substance abuse in the schizophrenic population was not appreciated until the 1980s. A review of published estimates of the prevalence of alcohol abuse in schizophrenia reported a range of 8.4 to 47 percent (Mueser, 1990). Stimulant abuse in this review was reported between 4 and 15 percent. The question of whether substance abuse induces a chronic schizophrenic-like psychosis even after the drugs are stopped is still open to debate. It is generally held, however, that individuals who develop schizophrenia coupled with drug abuse would most likely have developed schizophrenia regardless, but the abuse may have caused an earlier onset. The early drug use may represent efforts at self-treatment. Treatment of the schizophrenic with drug abuse presents a major clinical challenge. Such patients tend to be disruptive, prone to frequent relapse of psychosis and...

General Treatment of Psychosis

The management of the psychotic PD patient begins by searching for correctable causes, including infection, metabolic derangements, social stress, and drug toxicity. Infections may not always cause fevers in the geriatric population, so a search for urinary tract infections or pneumonias is warranted. Some PD patients who did not manifest psychotic symptoms at home may decompensate upon moving into the hospital environment. In many of these cases, moving the patient into a secure familiar environment or treating the underlying medical illness may ameliorate psychotic symptoms (19). Finally, medications with CNS effects may cause or exacerbate psychosis in PD and are often overlooked. These medications include pain or sleeping medications such as narcotics, anxiolytics, hypnotics, and antidepressants. If psychotic symptoms persist despite identification and correction of the above factors, antiparkinsonian medications are slowly reduced and if possible discontinued. Antiparkinsonian...

Atypical Psychosis The Other Boundary of Bipolar Disorder

Although DSM-IV is generally used in research and education in Japan, many psychiatric experts are still influenced by traditional clinical diagnostic practice. In particular, the traditional diagnosis of atypische Psychose (atypical psychosis) still has some impact on clinical practice, especially in the Western part of Japan. The concept of atypical psychosis was proposed by Mitsuda 1 in Japan based on his hypothesis that there is a genetically different category between schizophrenia and manic-depressive illness. Its conceptual framework was subsequently established by Hatotani 2 in the 1960s. The Japanese concept of atypical psychoses focuses on the alteration of consciousness and the nosological relationship to epilepsy. This concept is close to bouff e d lirante (French traditional diagnosis), Degenerationspsychose (according to Kleist), or zykloide Psychosen (according to Leonhard). These categories are characterized by acute onset, phasic course, complete remission between...

Pathophysiology of Psychosis and Risk Factors

The pathophysiology of psychosis in PD is poorly understood, but dopaminergic and serotonergic mechanisms have been proposed. One theory is that chronic excessive stimulation of dopamine receptors, particularly in the mesolimbic mesocorti-cal pathways, causes hypersensitization, resulting in psychosis when patients are treated with dopaminergic agents (36). However, exogenous dopamine supplementation by itself is not the only factor in the development of psychosis since all PD medications (anticholinergics, dopaminergics, and amantadine) can induce similar hallucinations despite their different mechanisms of action (25), and PD psychosis was described prior to the use of levodopa (37). Serotonin has been implicated because the atypical antipsychotic drugs are purported to work through their high affinity for 5-HT2 compared to D2 receptors. However, PD patients with psychosis have decreased serotonin content in the brainstem at autopsy (38). Potential explanations for this finding...

Long Term Outcome of Treatment for Psychosis

Goetz and Stebbins (5) described 11 PD patients in a nursing home with hallucinations, all of whom were never discharged from the nursing home and died within two years. In an open-label extension of the U.S. double-blind clozapine trial, only 25 of completers died over a 26-month observational period. Forty-two percent were in nursing homes, 68 were demented, and 69 were still psychotic (4). A separate study of 39 parkinsonian patients, treated with clozapine for psychosis, found that only 15 had died over a span of five years and 33 had been admitted to nursing homes (115). There are few studies looking at whether or not patients can be weaned off their antipsychotic medications. Fernandez et al. tried to wean off clozapine or que-tiapine in psychiatrically stable PD patients with a history of drug-induced psychosis. The study had to be aborted after enrolling only six patients, who had all been on their antipsychotics for an average of 20 months (116). Five experienced worsened...

Psychosis

Psychosis is a disorder characterized by hallucinations, delusions, or disorganized thinking (13), and is estimated to occur in 20 to 40 of PD patients (14,15). The most common manifestations of psychosis in PD are visual hallucinations (14,16-18). Although visual hallucinations are a common feature of patients with dementia with Lewy bodies (DLB), and may occasionally occur in demented PD patients who are not taking medications, the vast majority of PD patients who develop psychotic symptoms do so on antiparkinsonian therapy, and may return to their nonpsychotic baseline if the PD medications are discontinued (19-21). All antiparkinsonian drugs, not just dopaminergic agents, have been demonstrated to cause psychosis (22-25). Visual hallucinations in PD may occur at any time, and may be vivid and realistic, or out of focus. Patients may experience presence hallucinations (the sensation that someone or something is in the room) or passage hallucinations (brief visions seen in the...

Schizophrenia

Folate has been Implicated in the causality of schizophrenia since the 1950s and aberrations of one-carbon metabolism were proposed as a distinct hypothesis at around the same time (Regland 2005). With our current knowledge linking the two there has been renewed interest in the role of folate in this disorder. One key issue relates to a controversial association between low folate levels and schizophrenia incidence (Muntjewerff & Blom 2005). A review of seven case-control studies concluded that three of these demonstrated a relationship, although overall the evidence was undermined by methodological shortcomings (Muntjewerff & Blom 2005). In spite of this, elevated homocysteine and a high incidence of the MTHFR C677T genotype are reportedly frequent findings in this population (Kemperman et al 2006, Regland 2005), with several case reports of success using 1 5-30 mg folate in combination with B12 injections (1 mg every 10 days) and N-acetyl cysteine (200 mg twice daily) (Regland 2005).

The Diagnostic Bible DSMIV

The DSM-IV helps mental health professionals diagnose all emotional, behavioral, and mental conditions, including depression, anxiety, hyperactivity, and schizophrenia. All specific diagnoses are included within categories for example, depression falls within the Mood Disorders category, while phobias fall under the Anxiety Disorders category. The category that contains the autism spectrum disorders is called Pervasive Developmental Disorders. 1 This umbrella term was used by the authors of the DSM to differentiate autism spectrum conditions from more specific developmental disorders, like learning disabilities. Children with pervasive developmental disorders, including Asperger syndrome and high-functioning autism, experience difficulty across multiple (or pervasive ) areas of development (social, communication, behavior, cognition, sometimes even motor skills). In contrast, children with specific developmental disorders, like dyslexia, have problems in only one specific learning...

Complex central nervous system input

It is not rare that mental disorders are associated with inappropriate water intake. Both insufficient and excessive water intake occur. Excessive water intake (up to 201 day) is most often attributable to schizophrenia ( Assouly-Besse et al 1996), Hypodipstc Hypernatremia (elevated plasma sodium concentration w ith a lack of urge to drink) may be due to brain injury (Nguyen em I 2001 ). viral destruction (Keunekc et al 1999), or vascular damage ( Schaad et al 1979). Assouly-Bcsse F, Seletti B. I. a marque I. Flgho i D. Pctitjcan F. Le syndrome polydipsie. hyponatremie intermittenec et psychoses diagnostic el conduite iherapeutiquc a propos d'un cas. (im Wedico-Psychotogiques 1996 154 259 -63 Bourque CW. Olict SH, Osmoreceptors in the central nervous system. Annu Res Physio 1997 59 60 19

Attention in the Human Brain

Goldberg and Bloom (1990) proposed a dual premotor system hypothesis of volitional movement. This theory, which attributes an executive function to the anterior cingu-late and the supplementary motor area, was developed to explain the alien hand sign. The alien hand sign is the performance of apparently purposive movements that the patient fails to recognize as self-generated. The theory posits a lateral premotor system (LPS Area 6), that organizes motor behavior in reaction to external stimulus, and a medial premotor system (MPS anterior cingulate, supplementary motor area, and basal ganglia loops), which underlies intentional behavior. MPS underlies volitional movement by inhibiting the LPS. If a lesion occurs in MPS, LPS is released and obligatory dependence on external information emerges. The patient develops compulsive automatisms, which are not perceived as self-generated. The inhibitory effect of MPS over LPS during volitional movement resembles the inhibitory effect of MPS...

Personality Disorders

The key distinction is to separate paranoia associated with psychotic disorders from paranoid personality disorder, especially because paranoia associated with psychotic disorders is generally responsive to antipsychotic medications. There is some evidence to suggest increased prevalence of schizoid personality disorder in relatives of persons with schizophrenia or schizotypal personality disorder. Unloving or neglectful parenting is hypothesized to play a role. Schizoid personality disorder can be distinguished from avoidant personality disorder (see below) and social phobia by the fact that schizoid individuals do not desire relationships. Avoidant and socially phobic persons desire and may seek relationships, but their anxiety handicaps their capacity to achieve related-ness. Schizophrenia, autistic disorder, and Asperger's disorder (a less severe variant of autism) are also differential diagnostic conditions. Schizotypal personality disorder is best thought of as similar to...

What other factors are used to determine if a person is a good candidate for bariatric surgery

Finally, if you have long-standing psychiatric difficulties such as schizophrenia or manic depression you are unlikely to be a good candidate for weight loss surgery. I would like to emphasize that these criteria are simply rules of thumb nothing is in stone. Each person has a unique set of circumstances. The final decision is ultimately up to you, your personal physician, and your bariatric surgeon.

Other Magnetic Resonance Methods

Changes in relaxation times may reflect anomalous cerebral development, as recently demonstrated in schizophrenia (Andreasen et al., 1991 Williamson et al., 1992 Yurgelun-Todd et al., 1995). Alternatively, alterations in cerebral perfusion may lead to small changes in T2 which can be detected using echo planar imaging (Teicher et al., 2000). In the area of substance abuse, relaxation time measurements have also been used to assess brain hydration. In general, as brain water content decreases, relaxation times become shorter.

Wernicke and Korsakoffs Syndromes

Wernicke's encephalopathy and Korsakoff's psychosis, or the Wernicke-Korsakoff syndrome, result from nutritional deficiencies, particularly thiamine deficiencies. The syndrome can be precipitated by glucose administration to thiamine-deficient alcoholics. These syndromes are not exclusive to alcoholism, having been documented with MR imaging in nonalcoholic individuals with severe nutritional deficiencies (Doraiswamy et al., 1994) and in patients with thalamic lesions not resulting from alcoholism (Cole et al., 1992). Early studies of alcoholic Korsakoff's syndrome patients indicated increased whole brain and frontal white matter T1 values (Christie et al., 1988 Besson et al., 1989). T1 increases also have been described in several other brain regions in Korsakoff's patients including parietal white matter, caudate nucleus, and thalamus (Emsley et al., 1996).

The Bipolar Spectrum

A critical example is that of a clinician observing a patient whose most evident symptoms are the manic and depressive ones. Presumably, he will not feel the need to go further in gathering the subtler clinical phenomenology, which would make his choice of therapeutic approach a wiser one. These considerations arise very clearly from recent research and clinical data supporting a broader bipolar concept. A major problem is the difficulty of recognizing subthreshold clinical expressions of this complex clinical entity. This is not a new issue. For long have several authors, like Weitbrecht 1 , emphasized the need to search and evaluate hypomanic oscillations in the past history of the endogenous depressive patients . Also Storring 2 described an uncomplete manic syndrome , pointing out the difficulties in establishing a clear-cut separation from the depressive clinical picture. According to this author, some clinically relevant aspects of bipolarity might already be present weeks,...

Did His Mothers Unconscious Wish Make Willie A Violent

In Snyder and Rogers' review, they discussed the role of childhood neglect and abuse in forming aggressive behavior. These experiences are said to lead to an overstimulated hyper aroused internal state that gets in the way of psychological development, and causes the person to be less able to contain violent impulses. Snyder and Rogers cited a secondary source that advanced the view that the unconscious desires of the parent may be critical in determining whether aggression is directed outwards, against other people or objects, or against the person's own mind as in psychosis (p. 241). They also discussed the possibility that the children of violent parents may find that their own violence provides them with a bond to that parent.

General Treatment of Dementia

Similar to the guidelines governing the general treatment of psychosis, any sudden change in cognition or behavior is most likely due to a medical cause. Therefore, infections, metabolic and endocrine derangements, and hypoperfusion states should be considered and treated if present. A switch to an unfamiliar environment may also precipitate an acute deterioration in cognitive status, and can be helped to a small degree with reassurance and frequent orientation. Substance abuse, including reliance on over-the-counter preparations containing antihistamines, is another factor that may be commonly overlooked. A review of the medication list is necessary

Substance Abuse And Other Complications

Acquired Immunodeficiency Syndrome (AIDS). Intravenous drug use, needle sharing, and high-risk sexual practices among drug users are major risk factors for AIDS. Psychiatric manifestations of AIDS may present in a number of ways, including mood disorders, dementia, psychosis, and behavioral impairment. Suicide risk among AIDS victims is high. In evaluating the substance abuser with neuropsychiatric changes, HIV testing should be completed and treatment for AIDS should incorporate educating the patient about these risks. Mueser, K. T., Yarnold, P. R., & Levinson, D. F. (1990). Prevalence of substance abuse in schizophrenia Demographic and clinical correlates. Schizophrenia Bulletin, 16, 31-56.

Structural Imaging Studies

Some more recent studies have confirmed this finding, while others have not. Recent investigations have shown that this part of the cerebellum is abnormal in people without autism too. Children with leukemia who have undergone radiation treatment often have a vermis smaller than normal, as do some children with psychosis (a condition involving bizarre behavior that appears out of touch with reality) and children with certain genetic syndromes.

Prognosis When and for Whom

For contemporary psychiatrists, what is the relevance of the literature on prognosis to clinical practice The answer to this question will depend on when a psychiatrist is asked to make a prognosis for bipolar illness. Frequently, patients and their families wish to know the prognosis when the illness is first diagnosed. As Marneros and Brieger point out, it is clear that good prognosis and bad prognosis do not invariably distinguish affective disorders and schizophrenia. For bipolar illness, the spectrum of outcomes is broad, from sustained, total remission to sustained, total disability, with significant numbers at either extreme. But the psychiatrist is asked to provide a prognosis for an individual, not a population. In light of this fact, the literature might not be particularly helpful, except to alert all interested parties to the diversity of possible outcomes.

Violence and Aggression

First imaged in mice, rats, or baboons and then in normal humans and eventually in patients with mental disorders, such as schizophrenia or depression. Biomarkers used by (1) FDA (2) NIH (3) academia and (4) industry are based on assessing metabolism, cell proliferation, apoptosis, angiogenesis, cellular invasion, and intra- and intercellular communication.

Outcome in Bipolar Disorder How Much Have We Learned

Perhaps an aspect that has not been emphasized enough is the value of observing patients starting at the onset of their illness, which could be labelled a complete longitudinal approach. In recent years, there has been an emphasis in the non-affective psychosis, primarily schizophrenia, to conduct first-episode or prodromal studies. Research groups in the US, Europe and Australia have been conducting first-episode or prodromal studies for more than a decade. However, there are few first-episode studies of bipolar

Which form is the least common

What is the most predictive of overall prognosis in schizophrenia Overall, schizophrenia is associated with repeated psychotic episodes, and a chronic downhill course. What features are associated with a somewhat better prognosis Are patients with schizophrenia at risk of suicide What is the primary treatment for schizophrenia Abnormal movements of the face, trunk, extremities, and mouth that may happen after prolonged exposure to antipsychotic medications. How could you differentiate between a mood disorder with psychotic symptoms (eg, major depressive disorder MDD with psychosis or Bipolar Mania) from schizoaffective disorder Must meet criteria for either a major depressive episode, a manic episode, or a mixed episode at the same time as meeting characteristic symptoms of schizophrenia. The schizophrenic symptoms must persist in the absence of mood symptoms. A person that has a mood disorder with psychotic symptoms will not have psychosis without a mood disturbance. Schizoaffective...

Poor Clinical Course and Suicide Risk for Bipolar Disorders

Affective disorders are not the only ones with increased risk for suicide. Both patients with affective disorders and schizophrenia show a high rate of suicide. Data from the Chicago Follow-up Study 2, 3 and from other major research groups indicate a 10 risk for completed suicide in schizophrenics, a high suicide risk among substance abusers, and possibly some other disorders as well 1 . Clearly, even in patients who suicide who do not have full depressive syndromes, depressive types of symptoms (e.g., despair, hopelessness and disappointment over failed-life expectations) can be an influence. The high risk for suicide in patients with schizophrenia and in substance abusers raises questions about what other factors are involved and why they increase risk for completed suicide. As one example of factors which may be involved, data indicating a high risk for suicide in early, young schizophrenics has led to the hypothesis that one factor is the contrast between previous higher...

Methodological Issues

In so far as possible this review takes an evidence-based approach in recommending treatments for bipolar disorder. The levels of evidence are divided into four categories. Category I, also referred to in the final summary as consistent evidence , includes treatments whose efficacy and safety are supported by at least one randomized, double-blind, parallel-group, placebo-controlled study, conducted with a sufficient number of patients that at least one of the major planned analyses provided over a 50 likelihood of identifying a significant difference between groups. Category II has the same criteria as level I, except that no placebo control is required. Category III includes prospective, open trials that employ systematic inclusion and exclusion criteria, utilize behavioural ratings for which raters are trained, and involve a sufficient number of subjects that planned comparisons between two or more groups are possible. These allow comparison, for example, of patients with and...

Treatment Strategy Mania

It is unclear whether this represents one coherent subgroup, or two or more subgroups that may have differing treatment response to antimanic drugs. Also, evidence of psychotic symptoms needs to be established, as does current rapid cycling. Severity of symptoms, especially in terms of irritability, agitation and psychosis needs to be determined. Concurrent medical or psychiatric disorders need to be identified. Past treatment, and response thereto must be clarified. Current medications need to be reviewed. With this set of information, a rational treatment plan can be implemented. In general, lithium may be a reasonable choice in patients with classical symptomatology and relatively mild manic severity. Divalproex, or other forms of valproate, may be considered over lithium in patients with mixed mania, psychotic mania or more severe forms of mania. Divalproex may also be suitable for classical forms of mania. Divalproex may be preferable where rapid control...

Gender Differences in Psychopathology

Eysenck (1995) suggested that the dispositional trait underlying schizophrenia is an important ingredient of creativity and noted that the incidence of schizophrenia is higher in men than women. The Diagnostic and Statistical Manual of Mental Disorders (4th ed.) (DSM-IV) (American Psychiatric Association, 1994) stated, however, that although men tend to be institutionalized at a greater rate, community-based studies have suggested an equal gender ratio between the men and women who have schizophrenia. As I mention in the chapter on neurotransmitters (chapter 8), enhanced creativity appears to be associated with affective disorders. According to the dSm-IV, bipolar disorders are also equally distributed between men and women. Major depressive disorders, however, are reported more frequently with women. Although the higher incidence of depression in women might be related to an ascertainment-reporting bias (e.g., men are less likely to go for professional help), the incidence of mood...

Psychedelics or Hallucinogens

So heated is the debate over whether these drugs are good or evil that it's hard even to find a neutral name for them. When they first came to the attention of scientists in Europe and America in the 1950s, they were called psychotomimetics, based on the belief that they made people temporarily insane. (Psychiatrists now recognize that psychosis and the states induced by these drugs are very different.)

Substance Abuse Neuroimaging and Crime

Among the criminal population.34 The relationship between crime and substance abuse appears to hold for male and female offenders and across age groups and ethnicities.35 Although cocaine, amphetamine, and heroin abuse are recognized correlates of crime, alcohol also appears to be a substantial and perhaps underrecognized predisposing factor to aggressive behavior and violence.36 Neuropsychological studies and psychiatric research suggest that the association between substance abuse and criminal behavior may be mediated at the neurocognitive level by the disinhibiting or euphorigenic effect of acute intoxication, by cravings or withdrawal-induced delirium or psychosis, or by permanent cognitive impairment resulting from a substance-related dementing illness or amnestic syndrome.37

Monitoring Mental Activity

In performing complex tasks, regional cerebral blood flow to the anterior cingulate and supplementary motor cortices increased less in schizophrenic patients than in normal persons (Henry Holcomb et al., Am. J. Psychiatry 157 1634-1645, 2000). The normal control subjects also had progressively greater increases in blood flow to the frontal cortex than did schizophrenic patients, who had lower blood flow and slower response times. The failure to increase cingulate and frontal blood flow suggests that patients with schizophrenia cannot effectively activate frontocingulate neuronal systems involved in performing complex tasks.

Electroconvulsive Therapy ECT

ECT (formerly known as electric shock therapy) is one of the oldest and most effective treatments for major depression. ECT also has some efficacy in refractory mania and in psychoses with prominent mood components or catatonia. ECr appears to work via the induction of generalized seizure activity in the brain. The peripheral manifestations of seizuie activity aie blocked by the use of paralytics, and memory for the event is blocked by the use of anesthetics and by seizure activity. Modern ECT produces short-term memory loss and confusion. Bilateral ECT is more effective than unilateral ECT but produces more cognitive side effects.

Challenges for the Experimental Therapeutics of Bipolar Disorder

A central problem in experimental therapeutics for bipolar disorder is prevention of recurrences of depression. For most proposed alternatives to lithium, evidence for long-term protection against recurrences of bipolar depression remains very limited compared to recurrent unipolar major depression 1, 4 . Indeed, bipolarity, psychosis or mixed states, and suicid-ality are typical exclusion criteria in antidepressant trials, but are matters of particularly pressing clinical and public health concern 1, 3, 5 ,6 . Lithium appears to be effective long term against recurrent depression in both bipolar I and II disorders 1, 3 . There is also extensive evidence of reduced long-term risks of suicide during lithium maintenance therapy that is unmatched by any other treatment in contemporary psychiatry 5, 6 .

Addiction and Overdose

Illegal use of amphetamines and methylphenidate causes a terrible and powerful withdrawal syndrome. The syndrome is even worse if the drugs have been smoked or injected. When people try to stop using these drugs, they have strong cravings for them. They also may feel depressed and anxious, and might feel like killing themselves. Some people become very tired and lose interest in the things they once enjoyed. Others become angry or aggressive. Drug withdrawal can also lead to paranoia, psychosis (losing touch with reality), hallucinations, and delusions. This withdrawal syndrome can last anywhere from a few days to several years. To prevent these feelings, people often go back to using the drug.

New Frontiers Old Concepts

In contemporary times, one of the changes has been a re-expansion of the definition of bipolar disorder (BD) to include a broader spectrum of symptoms. An example of this was the lack of inclusion of BD patients with psychotic symptoms as having BD vs. schizophrenia in the 1970s, particularly in the US 1 . The current perspective views psychotic symptoms as more nonspecific, and other features of the illness to be the defining characteristics 2, 3 . This change of diagnostic perspective to include potentially more severely ill patients may provide a partial explanation of the more limited long-term efficacy, in contrast to earlier ideas, of lithium treatment. While clearly still an important and clinically useful medication, as noted by Charles Bowden, lithium is not the hoped for panacea. More recently, Hagop Akiskal, Jules Angst, and others have expostulated and expanded on the concept of bipolar spectrum, wherein soft bipolar symptoms are seen as a continuum of illness to more...

Whatever Happened to the Calcium Channel Blockers

The interest arose from research evidence linking abnormalities in calcium metabolism to mood disorders. It has long been recorded that disorders of calcium metabolism are associated with psychiatric symptoms. Delirium, anxiety, irritability, psychosis, depression and mania may be caused by hypocalcaemia. Hypercalcaemia is commonly associated with depression and stupor 3 .

Prenatal Exposure

Iwanami, A., Kato, N. and Nakatani, Y., P300 in methamphetamine psychosis. Biol. Psychiatry 30 726-730, 1991. Iwanami, A., Suga, I., Kaneko, T., Sugiyama, A. and Nakatani, Y., P300 component of event-related potentials in methamphetamine psychosis and schizophrenia. Prog. Neuropsycho-pharmacol. Biol. Psychiatry 18 465-475, 1994. Iwanami, A., Kanamori, R., Suga, I., Kaneko, T. and Kamijima, K., Reduced attention-related negative potentials in methamphetamine psychosis. J. Nerv. Ment. Dis. 183 693-697, 1995.

Special Syndromes Associated with Alcoholism

H., Cerebral blood flow and its regional distribution in alcoholism and in Korsakoff's psychosis. J. Stud. Alcohol 37 586-597, 1976. Hunter, R., McLuskie, R., Wyper, D., Patterson, J., Christie, J. E., Brooks, D. N., McCulloch, J., Fink, G. and Goodwin, G. M., The pattern of function-related regional cerebral blood flow investigated by single photon emission tomography with 99mTc-HMPAO in patients with presenile Alzheimer's disease and Korsakoff's psychosis. Psychol. Med. 19 847-855, 1989. Moffoot, A., O'Carroll, R.E., Murray, C., Dougall, N., Ebmeier, K. and Goodwin, G.M., Clonidine infusion increases uptake of 99mTc-Exametazime in anterior cingulate cortex in Korsakoff's psychosis. Psychol. Med. 24 53-61, 1994.

Clinical heterogeneity of ASD

Clinical heterogeneity of autism showed three major categories idiopathic autism, autistic spectrum disorder (ASD), and syndromatic autistics that usually resulted from an identified syndrome with known genetic etiology. Traditionally, ASD includes autism, Asperger syndrome, where language appears normal, Rett syndrome and pervasive developmental disorder not otherwise specified (PDD-NOS), in which children meet some but not all criteria for autism. Rett syndrome (RTT), occurring almost exclusively in females, is characterized by developmental arrest between 5 and 18 months of age, followed by regression of acquired skills, loss of speech, stereotypic movements (classically of the hands), microcephaly, seizures, and intellectual difficulties. These disorders share deficits in social communication and show variability in language and repetitive behavior domains 1 . Autistic individuals may have symptoms that are independent of the diagnosis. Mental...

Dissociative Identity Disorder DID

DID is the disorder that is mixed up with schizophrenia in everyday language. It involves multiple (that is, split) personalities. Each personality that develops has its own identity (age, name, characteristics, memories, etc.) and takes control of the person while it is present. Then another takes over. Frequently, the alternative identities have characteristics quite different from the original personality. For example, they might be hostile and aggressive rather than gentle and unassuming.

Hazard Identification

Surgical irrigation solutions of glycine containing 1.5 or 2.2 percent glycine reportedly cause some transient adverse effects (e.g., nausea, diarrhea, and visual disturbances) in patients after transurethral resection of the prostate (Creel et al., 1987 Hahn, 1988 Mizutani et al., 1990 Wang et al., 1989). In patients with schizophrenia, oral doses of approximately 60 g d of glycine for several weeks failed to reveal adverse effects (Leiderman et al., 1996). There have been no chronic dose-response studies with L-glycine in healthy humans.

Predicting the Switch from Unipolar to Bipolar Disorder

Sions, hallucinations, a positive family history of BD, and pharmacologically precipitated hypomania. The cluster of psychomotor retardation, psychosis, and a rapid onset of symptoms characterized 67 of adolescents who developed BD, but only 4 of adolescents who did not. A 2-5 year prospective study by Geller et al 41 , involving 79 children with major depression, supported the finding that a strong family history of major affective disorder (defined as either 3 first or second degree relatives, or three generations with a major affective disorder) predicted subsequent switching to BD. A small Japanese study prospectively examined youth that experienced their first depressive episode between the ages of 10 and 15. Twelve youth subsequently developed BD. Psychotic symptoms were present during the depression in 10 12 of these subjects, and 6 12 had a positive family history of mental illness 42 . Overall, accumulating evidence has identified several risk factors that increase the...

Attention Deficit Hyperactivity Disorder ADHD

Biederman and colleagues in Boston have argued that many children who are diagnosed with ADHD may in fact be suffering from an early form of BD 67 . This view is indirectly supported by the recent finding that adult BD patients with a childhood history of ADHD retrospectively appear to have an earlier age of onset of affective episodes (mean age 12.1 years), as compared to adult BD patients without a childhood history of ADHD (mean age 20.0 years) 68 . Others have argued that manic symptoms represent a non-specific measure of psychopathology and that children and early adolescents with manic symptoms should not necessarily be diagnosed with BD 69 . Carlson et al 66 have proposed that manic symptoms in youth be viewed in a similar manner to psychotic symptoms and schizophrenia. That is, that manic symptoms may be evidence of BD in some individuals, but that there may be other etiologies of the manic syndrome. Despite the debate over nosology, there is general agreement that the...

Borderline personality

The second of the more extreme personality disorders and one that has received considerable attention recently is the borderline personality. It is not very aptly named because it suggests that someone has a personality that is only acceptable in a borderline way. However, the borderline is between neurotic traits (extreme anxiety, emotional instability) and psychotic tendencies (as in schizophrenia).

Questions and possibilities

Which of the various explanations suggested to account for schizophrenia do you consider to be the most likely Have you ever experienced any of the splits with reality that characterise schizophrenia, even in minor form If you have, what do you think might have brought them about

Historical Cultivation And Usage

Nutmeg originated in the Banda Islands of Indonesia, and was discovered by the Portuguese in 1512. The importance of the nutmeg seed was propagated by the Dutch. The name nutmeg is derived from the Latin nux muscatus, meaning musky nut. In India, nutmeg is known as Jaiphal. According to the ethno-medical literature, nutmeg seed oil was used for intestinal disorders by Indians, in embalming by Egyptians, and to cure plague by Italians. In ancient times, nutmeg seeds were used in medicines as an aphrodisiac, abortifacient, and anti-flatulent, a narcotic, and as a means to induce menses. The effect of the nutmeg seeds on the central nervous system was first observed in the early 19th century. Traditional uses of nutmeg seeds include treatment of hemorrhoids, chronic vomiting, rheumatism, cholera, psychosis, stomach cramps, nausea, and anxiety. Nutmeg seed oil also has antiseptic, analgesic, and antirheumatic properties.

Considering a Patient for a Surgical Procedure

Psychiatric symptoms (hypomania, depression, suicide, or impulse control disorders) can be aggravated or induced by functional neurosurgery (33). Patients referred for surgical consideration are usually referred in the knowledge that they have an absence of dementia or active psychiatric symptoms, and yet a recent review revealed that the presence of depression (60 ), anxiety (40 ), and psychosis (35 ) with 23 of the 40 patients assessed requiring preoperative psychiatric management (34).

Behavioral Methodology And The Evaluation Of Abused Drugs

Experiments with drugs and behavior were initiated in Pavlov's laboratory in Russia during the time that Pavlov was studying the development of conditioned respondent procedures (see Laties, 1979, for a review of this early work). Early experiments with the effects of drugs on operant behavior were initiated shortly after Skinner began his pioneering work (Skinner & Heron, 1937). More intensive studies using drugs and operant-condition-ing techniques were not conducted, however, until effective drugs for the treatment of various psychiatric disorders such as Schizophrenia were introduced in the 1950s. These discoveries prompted the development and extension of behavioral techniques to study these drugs, and many of the procedures were subsequently used in the study of abused drugs. From these combined efforts, several key principles evolved that have served as the foundation for understanding and evaluating the effects of abused drugs.

Acute Administration

P., Saunders, R., Carson, R. E., Kolachana, B. S., de Bartolomeis, A., Weinberger, D. R., Weisenfeld, N., Malhotra, A. K., Eckelman, W. C. and Pickar, D., Schizophrenia is associated with elevated amphetamine-induced synaptic dopamine concentrations evidence from a novel positron emission tomography method. Proc. Natl. Acad. Sci. USA 94 2569-2574, 1997. Tibbo, P., Silverstone, P. H., McEwan, A. J., Scott, J., Joshua, A. and Golberg, K., A single photon emission computed tomography scan study of striatal dopamine D2 receptor binding with 123I-epidepride in patients with schizophrenia and controls. J. Psychiatry Neurosci. 22 39-45, 1997. C. H., Charney, D. S., Innis, R. B. and Laruelle, M., Increased striatal dopamine transmission in schizophrenia confirmation in a second cohort. Am. J. Psychiatry 155 761-767, 1998.

Onset Make a Difference

Biederman et a 32, 33 investigated the overlap between BD and CD in a consecutive sample of referred youth and in a sample of ADHD subjects to clarify its prevalence and correlates. They found a striking similarity in the features of BD regardless of comorbid CD. Both the comorbid and non-comorbid subjects with BD had high rates of major depression, anxiety disorders, oppositional disorder, and psychosis than CD and ADHD

Chronic Administration

H., Lim, K. O., Marsh, L. and Pfefferbaum, A., Patterns of regional cortical dysmorphology distinguishing schizophrenia and chronic alcoholism. Biol. Psychiatry 43 118-131, 1998. Sullivan, E. V., Mathalon, D. H., Lim, K. O., Marsh, L. and Pfefferbaum, A., Patterns of regional cortical dysmorphology distinguishing schizophrenia and chronic alcoholism. Biol. Psychiatry 43 118-131, 1998.

Centralnervoussystem Effects

The actions of the ephedra alkaloids on the central nervous system depend on their ability to penetrate the blood-brain barrier. Ephedrine, similar to amphetamine, readily crosses the blood-brain barrier, and produces a range of central nervous system effects from increased alertness and mood elevation to euphoria, insomnia, and even psychosis. Studies in humans and animals have shown that ( )-ephedrine is a more potent central nervous system stimulant than ( + )-pseudoephedrine (24,43). The anorexigenic effects of ephedrine and norephedrine are believed to be related to a1 activity in the satiety center of the hypothalamus. The mechanism of action of the other central nervous system effects is not entirely clear, but may be related to indirect release of brain norepinephrine and dopamine (44). Insomnia is a well-known side effect of ephedrine taken by patients with asthma. Chronic use and misuse of ephedrine to ''get high'' has also been associated with addictive behavior (45), and...

Childhood ManiaIs it Bipolar Disorder

Currently, there are many more medication choices for the treatment of bipolar disorder than in years past. Atypical antipsychotic medications are frequently used in children for a range of problems (including mania), in part because the risk of tardive dyskinesia is less than with traditional antipsychotics. However, the long-term risks to children of the use of these medications have been inadequately studied. Potential long-term consequences of chronic use of atypical antipsychotics include tardive dys-kinesia, weight gain, and diabetes. Kurmra et a 5 presented data on 23 children and adolescents with schizophrenia, age 6-18, who were treated with olanzapine or clozapine. Over a six-week trial, the average weight gain was 3.4 4.1 kg for subjects on olanzapine, and 5.0 6.0 kg for subjects on clozapine. Clearly, if weight gain continues at that rate it would have serious consequences. Other studies have found similar troubling rates of weight gain for risperidone

Clinical Vignettes

A 62-year-old patient with schizophrenia comes in to inquire about new treatment options. He has been on haloperidol which has controlled his symptoms well. His past medical history includes pre-diabetes, obesity (though he's trying to lose weight), hypertension, and a family history of coronary artery disease. He says that he has heard that some of the new atypical antipsychotics are more effective than his old agent. Patients who have failed multiple other antipsychotic medications may benefit from clozapine though the risk of agranulocytosis and subsequent FDA-mandated laboratory monitoring limit its widespread use.

Why do I go crazy with steroids

In most patients, there is an initial feeling of well-being induced by steroids, particularly at lower doses. However, mood elevation often is replaced by irritability with continued administration, particularly at higher doses. Psychotic behavior may follow simple mood elevation. Frank manic psychosis occurs in a small proportion of patients treated with steroids by any route of administration. Mood elevation can be managed using lithium carbonate and diazepam. Although it is the more common response, other patients may become depressed. ACTH may also occasionally be associated with these mood changes.

Economic And Occupational Illness Burden

Occupational disability remains extensive for many individuals with bipolar illness. For example, at six-month follow-up after an index manic episode, Dion et a 12 found that only 43 of bipolar patients were employed, while only 21 were functioning at expected levels, even though nearly 80 of the cohort was judged to be symptom-free or only mildly ill. Other authors have estimated that, in 1990, bipolar illness and depression collectively accounted for 289 million days of worker absenteeism 13 . Mintz et a 14 observed that the capacity to work may lag significantly after symptom remission from a depressive episode. Goldberg et a 15 found at both two- and five-year follow-ups that fewer than one-quarter of bipolar patients with affective relapses had steady work performance, and that affective relapse led to impaired work functioning more profoundly among bipolar than unipolar patients. Moreover, work-related problems may be more evident and more pervasive among individuals with either...

Misdiagnosis And Illness Detection

The likelihood with which mental health professionals diagnose bipolar illness has varied cross-culturally and internationally over the past several decades. In the 1970s, it became recognized that American psychiatrists were far more likely to diagnose schizophrenia than bipolar disorder as compared to their European counterparts 24 . This trend may have diminished in later years 25 , although in recent assessments of community-

Family And Caregiver Burden

Burdens on family members and caregivers for individuals with bipolar disorder are extensive (over 90 of caregivers report moderate or greater distress 77 ) and may be more profound than occurs with either major depression alone 78 or schizophrenia 79 . Clinicians also have been shown to demonstrate a keener appreciation for the burden experienced by relatives of patients with schizophrenia than with bipolar disorder particularly with regard to patients being delusional or displaying other positive symptoms, or showing lack of insight into the nature of their condition 79 .

The Importance of Boundaries and Comorbidities on Morbidity and Mortality An Urgent Case for Early and Continuous

Given to illnesses in an attempt to organize clinical information, then we can also assume that the occurrence and recognition of manic patients was apparent to clinicians throughout history. When we defined mania and stressed the psychotic symptoms, we were calling attention to an illness with features similar to schizophrenia, but that had an episodic course 1 . This was further elaborated in the textbook that followed 2 . Although the illness is now easily recognized, we are still struggling to define its boundaries. And the boundaries fix not only the prevalence, but also the burden of the illness. Goldberg and Ernst recognize this conflict and try to discuss the burden of the illness in regard to symptoms (pure versus mixed mania, bipolar I and II, psychotic versus nonpsychotic, mania that includes schizoaffective mania, etc.), to age (childhood versus adolescence versus adult), to comorbidity and to select study populations. If we expand the boundaries as we now seem to want to...

Neuropsychopharmacological Drugs

Monoamine Oxidase Inhibitor (MAOI) antidepressants drugs interfere with the enzymatic breakdown of neurotransmitters (such as norepineph-rine) in the brain. Sudden discontinuation after high chronic dosing has been associated with psychosis and delirium consisting of visual hallucinations as well as mental confusion. Milder symptoms consisting of anxiety, vivid dreaming, or nightmares may also occur. The exact mechanism of withdrawal has not been well studied, but it may relate to the way nerve cells regulate the release of neurotransmitters in the brain. Presynaptic receptors serve to provide a message to nerve cells about how much neurotransmitter is present in the Major Tranquilizers. Neuroleptic agents are commonly used in psychiatric practice for the treatment of psychotic disorders such as schizophrenia. These agents all block brain dopaminergic receptors the basis for their effectiveness in treating psychotic illness. These agents also inhibit emesis (vomiting), which is caused...

Autistic adults and adolescents

Some of us may have been diagnosed as children with autism. Some of us may have been diagnosed with attention deficit disorder. Some of us may not have been diagnosed with anything at all, or held other diagnoses. Some of us may have been called 'psychotic'. Some of us may have facial tics left over from decades of antipsychotic medications that did us no good. Some of us may have facial and other tics for no reason other than our neurological make-up. We might now be undiagnosed, be diagnosed with autism, Asperger's Syndrome, atypical autism, or things that have nothing to do with developmental disorders. We may have additional diagnoses of depression, anxiety, psychosis, personality disorders, epilepsy, or many other things. We might think of ourselves as 'cured', or might look forward to 'cure', or might hate the idea of 'cure'. We might have 'a few autistic traits'.

Causes of Personality Disorders

When it comes to schizotypal personality disorder , the evidence is more in line with genetic causes. A variety of family , twin, and adoption studies suggest that schizotypal disorder is genetically similar to schizophrenia (Nigg & Goldsmith, 1994). Moreover, the first-degree relatives of persons with schizophrenia are much mor likely to exhibit features of schizotypal personality disorder than persons in the general population. However, prevalence rates for paranoid and avoidant personality disorders were also elevated among the relatives of the schizophrenia patients, suggesting that these disorders may be genetically related to schizophrenia (Kendler et al., 1993).

Hydroxychloroquine Sulfate Plaquenil

Antipsychotic drugs Medications used to treat psychosis. Standard antipsychotic drugs appear to be effective for children and adolescents with schizophrenia. Clozapine is helpful for at least half of those who do not respond to typical drugs. In a few cases psychotic symptoms seem to disappear entirely. unfortunately, children may be more susceptible than adults to the toxic effects of cloza-pine about one-third of them have to stop taking it because of the side effects. Newer antipsychotic drugs that may be safer and just as effective are now being tested.

Acquired immunodeficiency syndrome

Most common side effects include appetite and weight loss, insomnia, and headache. Less frequently, a patient may experience dry mouth and nausea. Rare side effects include dizziness, irritability, stomach pain, increased heart rate, or hallucinations. As with most stimulants indicated for ADHD, there is a possibility of growth suppression and the potential for triggering motor tics and tourette's syndrome in rare cases, worsening of psychosis has been reported.

Drugs Used to Treat Infectious Diseases

Adverse Effects The adverse effects of this drug tend to be dose related and are uncommon on low doses. Concerns over the safety may have been exaggerated by the high doses in some early studies. Severe allergic reactions may occur. Other side effects may include nausea, vomiting, and, rarely, damage to the liver, red blood cells, and nerves. During long-term treatment, blood tests are conducted to monitor liver function and the red blood cell level. Neurological symptoms (such as psychosis) are believed to be dose related those with.a history of psychiatric problems may be more likely to develop mental problems on this drug. quinacrine (Trade name Atabrine) A drug used since World War II to suppress malaria it is now used to treat the intestinal infections, giardiasis, or cestodiasis. It should not be used during pregnancy or together with the drug primaquine, and it should be administered with caution to patients over age 60 or anyone with a history of psychosis.

Pharmacological Uses and Toxicity of Vitamin B6 Supplements

Supplements have also been used empirically, with little or no rational basis, and little or no evidence of efficacy, in the treatment of a variety of conditions, including acute alcohol intoxication, atopic dermatitis, autism, carpal tunnel syndrome, dental caries, diabetic neuropathy, Down's syndrome, Huntington's chorea, schizophrenia, and steroid-dependent asthma.

Clinical Features of Beriberi

Horizontal), ataxic gait, and an abnormal mental state that can range from mild delirium to global confusion. Liver disease and tachycardia occur in more than 50 of cases. Korsakoff's psychosis is characterized by a profound amnesia, disorientation, and often confabulation. The clinical features of Wernicke-Korsakoff syndrome are listed in Table 6.

Glucocorticoid antagonists and depression

Hpa Dysfunction

Schizophrenia (Munro et al, 1984), dementia (Spar and Gerner, 1982) and bulimia (O'Brien et al, Although corticosteroid application can induce a range of psychiatric features, disorders including psychosis, negative changes in affect and cognition, hypomanic, euphoric effects and positive effects on cognition are also reported (Boston survey, 1972 Ling et al, 1981 Carpenter and Gruen, 1982 Wolkowitz, 1994 Plilal et al, 1996), it is the chronically high endogenous levels of glucocorticoids which seem related to depression, particularly to the subgroup of psychotic depression (Nelson and Davis, 1997 Belanoff et al, 2002). Finally, although this brief review has concentrated on directly blocking glucocorticoids, there are reports of positive effects of the glucocorticoid agonist dexamethasone in depression alone or in conjunction with antidepressant therapy (Arana et al, 1995 Dinan et al, 1997 Bouwer et al, 2000 see also earlier work with Cortisol Goodwin et al, 1992) including cognition...

Inflammatory Mediators

Evidence linking IFN-a with neuropsychiatry symptoms in cancer and HCV suggests a potential role for interferon inducible inflammatory cytokines in mediating the cognitive and affective disorders in medically ill patients, particularly persons with rheumatic disorders however, the data exploring the relationship between neuropsychiatry symptoms and IFN-a or inflammatory cytokines in autoimmune disease are very limited. Levels of IFN-a were increased in the CSF of five of six patients with lupus psychosis, and in four of these five patients, the levels in CSF were higher than those in serum. IFN-a levels decreased when the manifestations of lupus psychosis subsided.124 Investigators in the Division of Rheumatic and Autoimmune disease at the University of Minnesota have demonstrated abnormal regulation of type I interferon (IFN-a) inducible genes in association with both SLE and with SS.125,126 Three molecules in the inflammatory IL-1 cytokine pathway regulated by interferon were...

Therapeutic Drug Monitoring TDM

Starting in the 1850s and for the next 150 years, bromide salts were the main ingredient in most over-the-counter and patent medicine sedatives. The half-life of bromide in humans is 12 to 15 days. Toxicity from abuse progresses from delirium, delusions and hallucinations to deep sedation followed by coma. Evelyn Waugh vividly described bromide psychosis in 1957 in his autobiographical novella The Ordeal of Gilbert Pinfold (1). It has been estimated that 2 of all admissions to mental hospitals were once due to bromide psychosis (2). McDanal et al. (3) reported on six cases of bromide psychosis from over-the-counter sedatives in San Diego County, California between 1970 and 1972. By the mid-1970s bromide was removed from all over-the-counter drugs. Miles Pharmaceutical stopped selling Nervine and Emerson Drug took bromide out of Bromo Seltzer . In 1990 the incidence of bromide toxicity was very low (4). Occasional reports of toxicity from imported herbal medicines that contain bromide...

The Tryptophan Load Test

Tryptophan Degradation Test

In patients suffering from a wide variety of unrelated diseases, including Hodgkins' lymphoma, rheumatoid arthritis, schizophrenia, porphyria, renal tuberculosis and aplastic anemia, there is abnormal excretion of kynurenine metabolites after a test dose of tryptophan (Altman and Greengard, 1966 Coon and Nagler, 1969). It is unlikely that such disparate conditions would all be associated with vitamin B6 deficiency. Liver biopsy shows elevated tryptophan

Conclusion And Contraindications

The American Journal of Psychiatry, 150 235-239. Freud, S. (1896). Further remarks on the neuro-psychoses of defense. In James Strachey (Ed.). The Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 3, London Hogarth, 1953. Gabbard G. (1994). Psychodynamic Psychiatry in Clinical Practice. The DSM-IV

Terminology History and Definition of Bipolar Spectrum

This volume of the World Psychiatric Association is devoted to bipolar disorders, making the history of the term and concept of central interest. The terms unipolar and bipolar disorder were coined by Karl Kleist 1 and were taken over by his pupils Neele 2 and Leonhard 3 . Apart from manic-depressive (circular) disorders, Kleist and Leonhard's bipolar concept included the three atypical (cycloid) psychoses. It is important to note that they classified both mania and melancholia as homonomic 4 , unipolar 1, 2 or monopolar 3 disorders in other words, the bipolar concept of the Kleist-Leonhard school excluded mania. Moreover, Kleist and Leonhard assumed the genetic load in monopolar disorders to be much lower than in bipolar disorders, as shown by the monographs of Neele 2 and Leonhard 3 . Kleist and Neele saw bipolar disorders as being a combination of the monopolar forms with a special affinity 5 . Leonhard himself did not follow Kleist completely he accepted the existence of monopolar...

Jim Baumohl Jerome H Jaffe

Hallucinations have been a hallmark of mental illness throughout history. They are an important clinical feature of several psychiatric conditions in which psychosis can occur, such as SCHIZOPHRENIA, manic-depressive illness, major DEPRESSION, and dissociative states. WITHDRAWAL from ALCOHOL can cause visual as well as other sensory hallucinations. In alcoholic hallucinosis, a person dependent on alcohol develops mainly auditory hallucinations that can persist after the person has stopped drinking. Hallucinations may be induced by illicit drugs, such as COCAINE, AMPHETAMINES, and LSD. These hallucinations are usually visual, but they can also be auditory or tactile, as in the sensation of insects crawling up the skin (an example of a haptic hallucination). Occasionally, after repeated ingestion of drugs, some people experience ''flashbacks'' that is, spontaneous visual hallucinations during a drug-free state, often months or years later. The treatment of hallucinations is part of the...

Pregnant Girls Dlavori

Kendell R.E., Chalmers J.C., Platz C. (1987) Epidemiology of puerperal psychoses. Br. J. Psychiatry, 150 662-673. 22. Davenport Y.B., Adland M.L. (1982) Postpartum psychoses in female and male bipolar manic-depressive patients. Am. J. Orthopsychiatry, 52 288-297. 26. Thomsen P.H., Moller L.L., Dehlholm B., Brask B.H. (1992) Manic-depressive psychosis in children younger than 15 years a register-based investigation of 39 cases in Denmark. Acta Psychiatr. Scand., 85 401-406. 98. Stewart D.E., Klompenhouwer J.L., Kendall R.E., Van Hulst A.M. (1991) Prophylactic lithium in puerperal psychosis the experience of three centers. Br. J. Psychiatry, 158 393-397.

Special Aspects Onset

Manic symptomatology is usually acute in onset, over a number of days, although in some cases long-lasting prodromal signs have been noted 101103 . Quite differently than in schizophrenia, psychotic symptoms in bipolar disorder seem to lead to treatment within a few days 89 . It is evident that schizoaffective bipolar disorders occupy a position between schizophrenia and affective bipolar disorder regarding outcome. However, bipolar schizoaffective disorders are possibly heterogeneous. 7. Crow T.J. (1998) From Kraepelin to Kretschmer leavened by Schneider the transition from categories of psychosis to dimensions of variation intrinsic to homo sapiens. Arch. Gen. Psychiatry, 55 502-504. 9. Perris C. (1966) A study of bipolar and unipolar recurrent depressive psychoses. Acta Psychiatr. Scand., 42 (Suppl. 194) 172-188. 11. Angst J. (1986) The course of schizoaffective disorders. In Schizoaffective Psychoses (Eds A. Marneros, M.T. Tsuang), pp. 63-93, Springer, Berlin. 15. Tohen M., Stoll...

Psychoanalysis and Psychodynamic Psychotherapy

Bipolar disorder attracted the attention of psychoanalysts since the early days of that treatment. Perhaps the most comprehensive review of psychoanalytic thought on bipolar disorder is summarized by Frieda Fromm-Reichmann's group, which undertook extensive study of several cases in an ongoing case supervision seminar 34, 35 , and by the more recent work of Jackson 36 . The common threads through much of psychoanalytic thought about bipolar disorder are the contrast of bipolar disorder with schizophrenia, and the conceptualization of mania as an alternate expression of the basic conflicts that produce depression under other circumstances. As with much psychoanalytic thought, the emphasis is placed on mechanisms related to unconscious conflicts that have their origin in early childhood development, the resolution of which will ameliorate present-day affective symptoms.

Neuroglycopenic Syndromes

The third syndrome is exceedingly rare. It occurs only when the blood glucose concentration remains low, either due to the presence of an insulin-secreting tumor of the pancreas or overzealous treatment of diabetes with insulin for weeks or months on end. It is characterized by mental dysfunction resembling clinical depression, schizophrenia, or dementia, the symptoms of which are not relieved by restoring the blood glucose level to normal. Partial recovery may, however, take place over the

Central Dopamine Dysfunction COMT Gene Disruption

Dopamine plays a critical role in pain perception and pain relief. It is a cate-cholamine neurotransmitter perhaps best known for its various roles in Parkinson's disease, schizophrenia, and drug addiction. It also appears related to Restless Legs Syndrome (RLS), which is a common co-morbidity in patients with FM. The theory of central dopamine dysfunction suggests that the main abnormality responsible for FM symptoms is disrupted dopamine neurotransmission. This conclusion supposes that FM is characterized by low levels of central dopamine resulting from both genetic factors and an exposure to environmental stressors. These stressors might include physical trauma, viral infections, inflammatory disorders like rheumatoid arthritis and SLE, or psychosocial distress. There are three points of reasoning to this theory first, chronic exposure to stress results in

Molecular Theory of Mental Disease

The time has come to create a molecular theory of mental disease. Instead of putting patients into diagnostic pigeon holes, such as depression, Parkinson's disease, or schizophrenia, that are poorly defined, heterogeneous, and nonspecific, we can use molecular imaging to relate a patient's problems to regional brain chemistry.

The Diagnosis of Bipolar Disorder Some Open Issues

Regarding the core symptom construct of mania, Kraepelin identified two clinical dimensions elation and accelerated psychomotor activity. Subsequently, a number of other symptoms, most of them deriving from the initial core symptom, were identified, and resulted in the expansion of bipolarity, which currently ranges from close to normal emotional variations of a temperamental nature to sustained emotional instability, to full-blown bipolar I disorder up to the opposite extreme that includes delusional and other psychotic features often clinically indistinguishable from paranoid schizophrenia.

Biochemical Changes Elicited by Mood Stabilizers

Multiple genes with environmental factors 2 . The link between a genetic predisposition to bipolar disorder and specific neurotransmitter malfunction has arisen from the analyses of patients carrying associated RNA transcripts within the frontal cortex 3 . The RNA transcripts which encode the serotonin transporter and components of the NK-kB transcription factor complex were shown to be increased in bipolar illness and also in some patients with schizophrenia. Such findings could be of relevance to our understanding of the mechanisms whereby mood-stabilizing drugs act.

Disputed Boundaries Of Bipolarity

Until recently, compared to the UK, bipolar disorder was often misdiagnosed as schizophrenia in the US 15, 16, 37 . We are aware of at least one data-based paper on this subject from another country 205 . Current data from the US 206 indicate that schizophrenia no longer tops the list in missed bipolar diagnoses. A national survey of the US Depressive and Manic-Depressive Association 207 recently revealed that disorders within the broader affective range major depressive and comorbid anxiety disorders, and borderline personality with its affective tempests precede for a decade bipolar diagnoses. This change may have occurred because schizophrenia in the US classification is now limited to a deteriorating disorder. On the other hand, the concept of depressive disorders in DSM-IV (as well as in ICD-10) appears over-inclusive, in part reflecting the contemporaneous revolution in antidepressant development. By contrast, bipolar II variants with brief ( 4 days) hypomanic episodes and...

Dietary Sources High Intakes and Antimetabolites

Other claims for megadoses of nicotinic acid or nicotinamide, such as the claim that abnormalities associated with schizophrenia, Down's syndrome, hyperactivity in children, etc. can be reduced, have so far failed to win general acceptance. Clearly nia-cin deficiency or dependency can exacerbate some types of mental illness such as depression or dementia. There have been a number of attempts to treat depression with tryptophan or niacin, or both, on the basis that the correction of depressed brain levels of serotonin would be advantageous. However, these have met with only limited success. Schizophrenics have been treated with nicotinic acid on the basis that their synthesis of NAD is impaired in some parts of the brain, and that the formation of hallucinogenic substances such as methylated indoles may be controlled.

Attention Deficit Information Network Inc A

In a few cases, disorders such as fragile x syndrome, tuberous sclerosis, untreated phenylketonuria (PKU), and congenital German measles cause autistic behavior. other disorders, including tourette's syndrome, learning disability, and attention deficit disorder often occur with autism but do not cause it. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which do not occur in autism.

What is downward drift

There is no difference in the prevalence of schizophrenia between men and women however, the age of onset is affected. Men tend to develop it between 15 and 25 years of age and women between 25 and 35 years of age. Having a first degree relative with schizophrenia increases a patients' risk of schizophrenia tenfold. Being born in the cold winter months or in an area of high population density have also been associated with increased risk (though less so). This is the classic understanding of schizophrenia, which attributes the symptoms of schizophrenia to hyperactivity of the dopaminergic system. Many other theories have been postulated, however, especially involvement of Glutamate.

Familial Parkinsonism

Parkinson Disease Gene Familial

Less common than ARJP are autosomal dominant forms of early onset PD. The best characterized is the Contursi kindred, a familial PD due to a mutation in the a-synuclein gene (62). The pathology of the Contursi kindred is typical Lewy body PD however, given the young age of onset, by the time the individual dies, Lewy body pathology is typically widespread in the brain. Lewy neurites are also prominent in many cortical areas. Some young onset autosomal dominant PD kindreds, such as the Iowa kindred, have atypical clinical presentations and include family members with dementia and psychosis. The Iowa kindred has a multiplication of the a-synuclein gene (63). Families with duplications have a milder phenotype than those with a triplication of the a-synuclein gene, suggesting a role for overexpression of a-synuclein in the pathogenesis of even sporadic PD (64). The pathology in cases with gene triplication is associated with severe Lewy body-related pathology in the cortex, hippocampus,...

The Importance of Natural Course and Depression in Bipolar I Disorder

Of the many demographic, baseline and phenomenological variables tested for their prognostic value, two have emerged as consistently significant depression and psychosis. Admittedly, much of the support for the prognostic value of depression comes from the NIMH Collaborative Study of Depression and is a specific focus of our group. Coryell et a 2 found that persistence of depressive symptoms in the first two years of follow-up predicted poor long-term prognosis, yet persistence of mania did not. This finding is extraordinary and needs further independent replication because

Biological Psychiatry

Today, one third of all prescribed medicines in the United States are given to affect mental function. Drugs affecting the serotoninergic or norepinephrine systems are helpful in treating patients with depression, panic disorder, anxiety, or obsessive-compulsive disorder. Selective serotonin reuptake inhibitors increase the levels of serotonin and norepinephrine in the brain. In patients with schizophrenia, blocking the effects of dopamine diminishes auditory and visual hallucinations as well as paranoia. Fluoxotin (Prozac), fluoxomine, and phenfluoromine dramatically increase serotonin levels. Differences in serotonin synthesis in men and women explains the higher incidence of depression among women.

Bipolar Disorder across the Reproductive Life Cycle

The postpartum period has been well established as a time of high risk for women with BD. Nonacs and Cohen 20 reviewed a number of studies, and found that women with BD had a 20-50 risk of relapse during the postpartum period. The risk of postpartum relapse appears to be even higher in women with a past history of postpartum psychosis. The strongest evidence for these findings comes from a well-designed study, in which Kendell et al 21 linked the Edinburgh Psychiatric Case Register to the Scottish maternity discharge database. This study encompassed 54 087 child-births over an 11-year period, and also obtained information about prior psychiatric admissions. Among all women, a psychiatric admission with psychosis during the first 90 days after childbirth was 14.3 more likely than before childbirth. The most striking finding of this study was the degree to which a diagnosis of manic-depressive illness increased the risk of post-partum psychosis. Among the 486 women who had a...

The Eccentric Cluster Ways of Being Different

Schizoid and schizotypal personality disorders both take their root from schizophrenia and are closely tied to the history of this diagnostic category . Schizophrenia as a term literally means a cutting of the mind of f from itself and from reality. It is a serious mental illness that involves hallucinations, delusions, and perceptual aberrations. The personality disorders of schizoid and schizotypal exhibit some low-grade nonpsychotic symptoms of schizophrenia. For example, the schizotype is eccentric and is interested in odd and unusual beliefs, whereas the schizoid displays social apathy. Schizophrenics display both of these characteristics, plus delusions or hallucinations. Thus these personality disorders have much in common with this more severe mental illness. In the case of schizotypal disorders, persons are likely to possess the genotype that makes them vulnerable to schizophrenia. A large proportion of the family members of persons with schizophrenia exhibit odd and unusual...

Requirements and High Intakes

Lithium deficiency reportedly results in depressed fertility, birthweight, and life span, and altered activity of liver and blood enzymes in goats. In rats, lithium deficiency apparently depresses fertility, birthweight, litter size, and weaning weight. Other in vitro biochemical actions suggesting that lithium could possibly act as an essential element include the stimulation of growth of some cultured cells, and having insulinomimetic action. Lithium is best known for its pharmacological properties it is used to treat manic-depressive psychosis. Its ability to affect mental function perhaps explains the report that incidence of violent crimes is lower in areas with high-lithium drinking water.

What is Disordered in Bipolar Disorders

Mania (euphoric or irritable), the clinical hallmark of bipolar disorder, is usually easy to recognize, whereas the limits of hypomania (the criterion for bipolar type II) with normality and mania proper are much more difficult to ascertain. But what is specific of bipolar disorder is still debated. It is not the symptoms according to Kraepelin 1 , all symptoms can be seen in all mental disorders Pope and Lipinski 2 and Brockington et al 3 found schizophrenic symptoms as frequent in mania as in schizophrenia. It is not the prognosis terrible for Falret 4 , good for Kraepelin 1 , and recently bad for Goldberg and Harrow 5, 6 . Finally, course (which was so important for Falret and Kraepelin) should be dropped completely as a criterion for the classification of endogenous psychoses , according to Angst (quoted in 7 ). The core of the disease is rather the instability and cyclicity of psychic processes, with swerves and switches, larger than normal oscillations of mood (and also)...

What are the side effects of Sinemet

Some of the side effects are not entirely side effects of Sinemet. Some (wearing off or on-off) result from progression of PD and the short duration of action of Sinemet some (dystonia, freezing ) can be symptoms of PD (unrelated to drugs) or a side effect of Sinemet some (dyskinesia) are side effects of Sinemet and some (psychosis) are the effects of Sinemet and dopamine agonists temporarily unmasking an underlying dementia. Psychosis. Hallucinations, delusions (believing things that don't exist are real) confusion, daytime drowsiness, nighttime insomnia, agitation, obsessions and compulsions including obsessive interest in sex, eating, gambling, and shopping occurs in people on PD drugs (see Question 55). The people are usually older, 70 plus years of age, and may be incubating a dementia. Amantadine, the anticholinergic drugs, selegiline, the dopamine agonists, and Sinemet, in that order, may unmask the underlying dementia. The psychosis may be decreased by stopping or decreasing...

My husband seespeople in our bedroom Whats happening

Hallucinations may occur in people who are treated with PD drugs. They are usually visual and are often accompanied by delusions. The combination is called a psychosis. It may be difficult or even impossible for you to convince your spouse that there isn't anyone there or that you aren't going to harm him or her. Such symptoms cause distress to families and are the most frequently given reason for placing a patient in a nursing home. Psychosis may occur without dementia as in LSD, amphetamine, or cocaine psychosis, and dementia may occur without psychosis as in LBD or Alzheimer's disease however, in the presence of dementia, psychosis is more likely to appear. Symptoms of psychosis include hallucinations, seeing things that don't exist delusions, a belief in something with no basis in reality and paranoia, a belief that people are seeking to harm you. Obsessions with specific topics such as germs, sex, or death and dying, and compulsions such as gambling, eating, talking, and sex, are...

The Postprandial Syndrome

Symptoms wax and wane during middle life but often remit completely for years or may never recur. They are not progressive and never cause severe neurological dysfunction such as coma, psychosis, or dementia. Hypoglycemia cannot be demonstrated during spontaneous symptomatic episodes in most people with the postprandial syndrome and some other explanation should be sought for them.

Alcohol And Other Drugs

Many elderly patients with adult-onset (Type II) diabetes take antidiabetic pills instead of insulin. When alcohol is taken along with pills such as sulfonylureas, it may cause dangerously low levels of blood sugar, especially in patients whose diet calls for decreasing the eating of carbohydrates. Another problem associated with this combination is an Antabuse-like reaction (fortunately quite rare and usually mild), causing nausea, vomiting, headache, blurred vision, and flushing. However, symptoms of severe Antabuse-like reactions include speeding up of the heart to more than one hundred beats a minute, abdominal distress, sweating, episodes of low blood pressure, death of heart muscle, and tearing of the esophagus brought about by vomiting psychosis may also occur, and fatal reactions have been reported. Use of alcohol at the same time with a variety of other drugs (Table 2) can also lead to an Antabuse-like reaction. Cough medicines may contain a narcotic pain-killer such as

Other than primary psychotic disorders what other types of psychiatric illness often manifest psychotic symptoms

Schizophrenia ( 6 months of symptoms) Personality disorders May be associated with brief (not sustained) periods of psychosis. Cognitive disorders Both delirium and dementia demonstrate psychosis. Often delirium will have visual hallucinations in addition to clouded sensorium. Psychosis due to a general medical conditions such as Vitamin B12 deficiency, Multiple Sclerosis (MS), Systemic Lupus Erythematosus (SLE), uremia, etc. Schizophrenia Schizophrenia. The incidence in the adult population is around 1 . What are the DSM-IV-TR criteria for Schizophrenia What are considered the positive symptoms of schizophrenia How does the criterion of disorganized speech, (also referred to as thought disorder) manifest in schizophrenia What is meant by the prodromal and residual phases of schizophrenia How long must you have symptoms for before schizophrenia can be diagnosed How does schizophreniform disorder differ from schizophrenia What would you call psychosis lasting

Drug Design and Development

Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are now being used widely used in drug design and development to characterize specific molecular abnormalities in different regions of the brain in patients with stroke, epilepsy, Alzheimer's disease, Parkinson's disease, and Huntington's disease, as well as psychiatric disorders, such as schizophrenia, depression, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, and Tourette syndrome.

Major Tranquilizers Thorazine and Relatives

Major tranquilizers revolutionized psychiatry when they were first introduced in the early 1950s. They provided a new and easy way to manage schizophrenia and other severe mental diseases, making patients calm and emotionally quiet. In some cases the major tranquilizers have enabled psychotic persons to lead reasonably normal lives and function outside hospitals. More often, they make them more manageable and docile rather than less crazy.

Daniel X Freedman R N Pechnick

Also thought to be involved in schizophrenia and psychosis since DA-receptor-blocking drugs are clinically useful antipsychotic agents. Another disease, in which DA is lost due to the degeneration of DA-containing neurons, is Parkinson's disease, which can be treated by replacing DA with its precursor, dopa.