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. Continue reading...

The Schizophreniafree Package Overview


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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...

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...


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...


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...

Adult Children Of Alcoholics

Carry an increased risk of severe alcohol problems themselves (a probability of two to four times that of children of nonalcoholics). Probabilities also indicate that they are not more vulnerable to severe psychiatric disorders (such as schizophrenia or manic depressive disease) and that they do not carry a heightened risk for severe problems with some drugs of abuse (such as heroin). Nevertheless, it is possible that when children of alcoholics reach adolescence or adulthood, they might be slightly more likely to have problems with marijuana-type drugs or with stimulants (such as cocaine or amphetamines). It has also been observed that if their childhood home has been disrupted by alcohol-related problems in either or both parents, the children may have greater difficulties with a variety of areas of life adjustment as they mature or go off on their own.

Fightor Flight Response

Serotonin has been implicated in cognition, affecting memory, perception and attention, mood, aggression, sexual drive, appetite, energy level, pain sensitivity, endocrine function, and sleep. Patients with schizophrenia are thought to have abnormal dopamin-ergic and serotonergic neurotransmission. Their cerebral ventricles may be enlarged, and their temporal lobe volume decreased, but such structural manifestations are not specific. The focus was initially on dopamine. The NMDA hypothesis, called the glutamatergic dysfunction hypothesis, of schizophrenia is based on the action of glutamate on NMDA receptors on GABAergic, serotonergic, and noradrenergic neurons that inhibit two major excitatory pathways in the retrosplenial cortical neurons. (Coyle, 1996). Schizophrenia is manifest by impaired cognition and failure of appreciation of reality. Patients with schizophrenia have positive symptoms, such as hallucinations, mood disorders, or negative symptoms, such as impaired interpersonal...

Alcohol And Drug Abuse In The Elderly

Alcohol, itself a drug, mixes unfavorably with many other drugs, including those purchased over the counter. In addition, use of certain prescription drugs may intensify the older person's reaction to alcohol, leading to more rapid intoxication. Alcohol, when combined substantially and quickly with certain groups of drugs, can dangerously slow down performance skills such as driving, running machinery, and even walking. It lessens judgment, and reduces alertness when taken with drugs such as those prescribed against psychosis, those meant to lessen anxiety, sedative-hypnotics, pain-killers derived from opium, antihistamines, and certain blood-pressure medicines (Table 1). Large amounts drunk quickly reduce the clearance of confusion, blurred vision, and psychosis

Alcohol And Mindaltering Drugs

When alcohol is combined with mind-altering (psychotropic) drugs such as those prescribed to fight psychosis and depression, the combined effects of alcohol and the medicine are less predictable than with other drugs. Antipsychotic drugs inhibit the metabolism of alcohol and may thus markedly increase its effects on the CNS in the elderly. Antidepressants increase the response to alcohol and harm one's control over one's mo-

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

Caveats in Interpreting Electrophysiologic Data in Substance Abuse Research

Similarly, even though the reductions in P300 amplitude observed during withdrawal from either heroin, cocaine or ethanol (Poijesz et al., 1987 Kouri et al., 1996 Bauer, 1997 Noldy and Carlen, 1997) are very similar to those observed in a number of psychiatric disorders including dementia (Pfefferbaum et al., 1984) schizophrenia (Roth et al., 1980), depression (Diner et al., 1985) and borderline personality disorder (Kutcher et al., 1987), this lack of diagnostic specificity of the P300 has provided important information on the similarities between acute withdrawal from drugs of abuse and these other psychiatric disorders.

Essential Fatty Acids

There is a body of evidence suggesting that dietary supplementation with docosahexanoic acid (DHA 22 6, n-3) and arachidonic acid (AA 20 4, n-6) is effective in reducing the symptoms of clinical depression and schizophrenia. These fatty acids are also important for the development of the central nervous system in mammals. Recent work has demonstrated that maternal supplementation with these particular fatty acids during pregnancy significantly improves children's IQ at age 4 compared with children whose mothers took corn oil during pregnancy. There is no convincing evidence yet concerning the effects of essential-fatty-acid supplementation on the cognitive function of the elderly, although one study has found a correlational link between n-3 fatty-acid intake and the risk of developing Alzheimer's dementia. The proposed modes of action of these fatty acids involve their antithrom-botic and anti-inflammatory properties in addition to their being a primary component of membrane...

Early Use In The United States

''no serious reactions had been observed.'' Between 1932 and 1946 the pharmaceutical industry developed more than three dozen generally accepted clinical uses for amphetamines, among them the treatment of schizophrenia, morphine and codeine addiction, tobacco smoking, heart block, head injuries, infantile cerebral palsy, radiation sickness, low blood pressure, seasickness, and persistent hiccups. It was not until several decades later that the addictive properties and psychiatric complications of amphetamines were fully recognized by the medical community.

Schizoaffective Disorder

Although current molecular genetic data have revealed intriguing links between some forms of schizophrenia and bipolar disorder 214 , circa 2001, their clinical differentiation does not seem to pose as much trouble According to ICD-10, the concept of schizoaffective disorder should be restricted to recurrent psychoses with full affective and schizophrenic symptoms occurring nearly simultaneously during each episode. Research by the present author 16 has shown that such a diagnosis should not be considered in a bipolar psychosis where mood-incongruent psychotic features can be explained on the basis of one of the following a) affective psychosis superimposed on mental retardation, giving rise to extremely hyperactive and bizarre manic behaviour b) affective psychosis complicated by concurrent cerebral disease, substance abuse, or substance withdrawal, all of which are known to give rise to numerous Schneiderian symptoms c) mixed episodes of bipolar disorder, which are notorious for...

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 area...

What causes newonset GERD

In addition to weight, dietary issues, alcohol consumption, and anatomic factors, other medical conditions or medications for other problems can also lead to GERD symptoms. As they age, people tend to take more medications, and many medications can affect stomach acid production, the speed at which the stomach empties, and the ability of the LES to maintain its strength. High blood pressure medications called calcium channel blockers, such as nifedipine, can relax the LES. Drugs used for depression such as tricyclic antidepres-sants and drugs for psychosis impair stomach emptying.

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...

Borderline intellectual functioning An IQ

Borderline personality disorder (BPD) affects one in 50 children in the United States. The name borderline personality disorder was given because experts once thought the condition fell somewhere between neurosis and psychosis on the mental illness continuum. Professionals who are educated about the BPD all agree that the name should be changed as it does in no way describe the disorder.

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.

Tolerance And Physical Dependence

PHYSICAL Dependence results from adaptive changes in the nervous system that may be related to the development of tolerance. Dependence of this sort can be detected by the appearance of a characteristic abstinence or WITHDRAWAL syndrome when chronic administration of a drug is either abruptly discontinued or after the administration of an antagonist to the drug that has been taken for a prolonged period of time (Ciraulo & Greenblatt, in press). Individuals who are treated chronically with benzodiazepines may exhibit signs and symptoms of withdrawal when the administration of these drugs is discontinued. Minor symptoms of withdrawal include ANXIETY, insomnia, and nightmares. Less common and more serious symptoms include psychosis, death, and generalized seizures. Signs of withdrawal may become evident twenty-four hours after the discontinuation of a benzodi-azepine that is rapidly eliminated from the blood. Peak abstinence symptoms may not appear until two weeks after...

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.

Development of the Cerebral Cortex

Neurons (the cells of the cortex that are involved in processing information) are formed before birth during the sixth to eighteenth weeks after conception. In the cerebral cortex, neurons find their way to the correct position by moving along the long fibers of radial glia cells, which are like ropes extending from the inner to the outer surface of the brain. The length that neurons must travel is especially long for those that will end up in the frontal lobes, and this may increase the likelihood that they will end up in the incorrect position and disrupt information processing. Schahram Akbarian and his colleagues suggested in a 1993 paper that such errors might contribute to schizophrenia.

Neutral Cues Cocaine Cues

Laruelle et al. (1995) used the dopamine D2 receptor radioligand 123I IBZM and SPECT to evaluate striatal dopamine release following intravenous (0.3 mg kg) d-amphetamine administration to healthy subjects. They found that striatal dopamine D2 receptor availability decreased by 15 , reflecting increased synaptic dopamine and correlating with the behavioral effects of the drug (Laruelle et al., 1995). Subsequent work by this group suggested that D2 receptor availability decreased more in drug-free schizophrenic patients ( 20 ) than in control subjects ( 8 ) despite similar baseline D2 receptor density. This finding is consistent with the hypothesis of augmented responsiveness of dopaminergic neurons in schizophrenia, although the discrepancy with the previous report of 15 reduction in D2 receptor availability in control subjects is not explained (Laruelle et al., 1996). A recent study confirmed the differential effects of amphetamine in schizophrenics and controls, although the effect...

Depression Epidemiology

In an analysis of 10 studies that used DSM-III criteria to define depression, an aggregate prevalence of 42 was reported for depressive disorders in PD (67). The prevalence rates of dysthymia, minor depression, and major depression in PD patients were 22.5 , 36.6 , and 24.8 , respectively. Studies using DSM-IV criteria and a structured clinical interview reported similar results, with the prevalence of major depression ranging from 20 to 25 in PD (11,68-70). Additionally, depression appears to occur more frequently in the presence of advanced disease, anxiety, cognitive impairment, and psychosis (2,71-74).

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, months...

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.

Atypical Antipsychotics

Atypical antipsychotics are typically used to treat psychosis in PD. Table 1 provides a summary of atypical antipsychotic studies in PD. The United States Food and Drug Administration (FDA) recently asked all atypical antipsychotic manufacturers to add a boxed warning to their product labels, saying that atypical antipsychotics, when used in elderly patients with dementia, were associated with a higher risk of mortality (54). However, since the deaths were primarily due to cardiovascular or infectious causes, it is unclear how the atypical antipsychotics cause increased mortality. Since psychosis can be difficult to treat in PD, it is likely that these agents will continue to be utilized until a direct cause and effect relationship is uncovered. Number of psychosis improved CGIS psychosis scores CGIS psychosis scores Abbreviations-. BPRS, Brief Psychosis Rating Scale CGIS, Clinical Global Impression of Severity NPI, Neuropsychiatrie Inventory PANSS, Positive and Negative Syndrome...

Cholinesterase Inhibitors

In multiple AD trials, cholinesterase inhibitors had mild-to-moderate benefits in both cognition and psychosis (101,102). Cholinesterase inhibitors are also effective for psychosis in DLB patients and are a potential alternative to the atypical antipsy-chotics for PD psychosis. An early open-label study with tacrine showed that five of seven demented PD patients had complete resolution of psychotic symptoms (103) however, the use of this drug has been limited because of hepatic toxicity. Fabbrini et al. (104) administered donepezil (5 mg qhs) to eight nondemented PD patients with visual hallucinations, with or without delusions. At the end of two months, subjects had decreased PPRS scores with hallucinations and paranoid ideation, being the most responsive. However, two patients experienced clinically significant motor decline. Another small open-label study enrolled six patients with PD, dementia, and psychotic symptoms and treated them with 10 mg d of donepezil (105). Five patients...

Electroconvulsive Therapy

Electroconvulsive therapy (ECT) is an effective treatment for primary psychiatric disorders, especially treatment-resistant depression. Experience with ECT for PD psychosis, however, is limited to case studies. ECT has been demonstrated to be beneficial in PD patients with psychosis (112-114), and can transiently improve parkinsonian motor symptoms, but may require a period of hospitalization, and result in significant confusion. ECT should only be considered when patients are resistant to pharmacological therapies.

Psychiatric Disorders Genetics

What is the prevalence of schizophrenia 1 in the general population In which gender is schizophrenia more Equal in males and females likely Which persons have a higher likelihood Persons with a close genetic relationship of developing schizophrenia Genetic markers on which chromosome(s) are associated with schizophrenia Does schizophrenia have a familial component Yes the closer a relative you are, the more likely you are to develop schizophrenia but concordance in twins is not 100 . What is the likelihood of developing 10 schizophrenia if you are a first-degree relative of an affected individual will develop schizophrenia if both parents have the disorder monozygotic twin of a patient with schizophrenia will develop the disorder Is the genetic component stronger for Bipolar disorder schizophrenia or bipolar disorder Schizophrenia

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

Antisocial Personality and Alcoholism A

Great deal is known regarding the relationship of antisocial personality disorder and alcoholism. This diagnostic combination is estimated to involve as many as 2 percent of the male population of the United States. Most studies of this combination of illnesses indicate that the antisocial alcoholic has an earlier onset of drinking difficulties, more family history of alcoholism, more social complications of alcoholism, and a greater number of symptoms of other psychiatric disturbances, e.g., drug abuse, depression, mania, schizophrenia, and psychotic symptoms. Antisocial alcoholics have also been reported to attempt suicide more frequently. In addition to these more severe symptoms at the time of initial evaluation, antisocial personality disorder influences the natural history of the substance use disorders and alcoholism. This change in course is demonstrated by the following studies.

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.

Indications Frankincense

Abscess (f HAD) Alzheimer's (1 COX FNF) Anxiety (f BOW) Arthrosis (1 COX FNF) Asthma (f1 HHB X12244881) Backache (f HAD) Bilharzia (f BIB) Bleeding (f BIB HAD) Boil (f DEP) Bronchosis (f1 BIB DEP X12244881) Bruise (f HAD) Callus (f BIB) Cancer (1 COX FNF JLH) Cancer, anus (1 BIB COX) Cancer, breast (1 BIB COX) Cancer, eye (1 BIB COX) Cancer, penis (1 BIB COX) Cancer, spleen (1 BIB COX) Cancer, teat (1 BIB COX) Cancer, testicle (1 BIB COX) Carbuncle (f DEP JLH) Cerebrosis (1 X12244881) Chest ache (f BIB) Colitis (1 FNF X12244881) Congestant (f HAD) Corn (f JLH) Cough (f HAD) Crohn's Diseases (1 X12244881) Dermatosis (f GMH) Dysentery (f BIB) Dysmenorrhea (f BOW) Dyspepsia (f HAD) Edema (1 FNF) Fever (f BIB) Gingivosis (f BOW) Gonorrhea (f BIB) Hemorrhoid (f HAD) Hepatosis (1 PR14 510) Infection (f BOW) Laryngitis (f BIB DEP) Leprosy (f BIB) Leukemia (1 FNF) Mastosis (f GHA JLH) Meningioma (1 FNF) Myelosis (f HAD) Neurosis (f BIB GHA HAD) Ophthalmia (f GHA JLH) Orchosis (f JLH) Pain (f...

Clinical Vignettes

How closely related she is to those family members with schizophrenia. The more genetically similar to them she is, the higher her risk is. A 19-year-old male is brought to the emergency room by his college roommate for delusions, hallucinations, and disorganized speech that has occurred for the last 7 months. The roommate is concerned that the patient may have schizophrenia. The patient's father was diagnosed with schizophrenia at age 22. Not taking into account these new symptoms, what is the lifetime likelihood of this patient developing schizophrenia The patient is a first-degree relative of an affected individual he therefore has a 10 chance of developing schizophrenia.

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.

Differential Diagnosis

In some cases, anorexia nervosa is secondary to a serious, underlying psychiatric illness, with the weight loss being only an added problem. A particular diagnostic and therapeutic dilemma may occur for young women with personality disorder or chronic schizophrenia and anorexia nervosa.

Psychiatric Treatment

Despite the common use of antidepressants, several double-blind trials have been inconclusive or only slightly favorable. Patients with clear manifestations of depression and the more severe cases seem to benefit more from these medications. Tricyclic antidepressants tend to increase appetite and are more suited for patients with pure anorexia nervosa. Selective serotonin reuptake inhibitors may help decrease binging in patients with associated bulimia. Olanzapine, an atypical antipsychotic medication associated with weight gain, has been shown to be useful in some patients with anorexia nervosa in uncontrolled studies.

Indications Giant Milkweed

Abscess (f HDN) Amenorrhea (f HDN) Anasarca (f DEP KAB PH2) Ancylostomiasis (f HDN) Anorexia (f DEP) Aphtha (f DEP) Apoplexy (f BOU) Arthrosis (f1 DEP HDN HJP) Ascites (f DEP PH2) Asthma (f BOU DEP KAB SUW) Bacillus (1 HDN) Bacteria (1 HDN) Bite (f KAB) Bleeding (f X15922393) Bronchosis (f DEP KAP) Cachexia (f DEP) Cancer (f1 JLH PH2 X15689169) Cancer, abdomen (f1 JLH X15689169) Cancer, liver (f1 JLH PH2 X15689169 X16688796) Cancer, ovary (f1 JLH X15689169) Cancer, skin (1 PH2 X15689169) Cardiopathy (1 FNF HDN) Caries (f HDN) Catarrh (f DEP KAB) Chancre (f HDN) Cold (f SUW) Colic (f HDN) Constipation (f DEP) Convulsion (f1 SEP PH2 X15752643) Cough (f GHA KAB PH2 SUW) Cramp (f1 DEP KAP X15752643) Dermatosis (f DEP JFM SUW) Diabetes (1 X16054794) Diarrhea (f SUW) Dropsy (f DEP HJP KAB) Dysentery (f BOU DEP HJP KAP PH2 SUW) Dysmenorrhea (f HDN) Dyspepsia (f PH2 SUW) Dyspnea (f GHA) Dystocia (f HDN) Earache (f HJP) Edema (f1 HDN X16192673) Elephantiasis (f BOU DEP SUW) Enterosis (f KAB...

Neurological Effects

There is evidence that alterations to n-3 fatty acid metabolism and the composition of the phospholipids in serum and membranes are involved in the pathogenesis of some neurological disorders (Ulbricht & Basch 2006). As a result, there has been much interest in understanding the effects of supplemental n-3 fatty acids in neurological development, cognitive function, depression, schizophrenia, and behavioural problems. Schizophrenia According to a 2003 review, four out of five placebo-controlled double-blind trials of EPA in the treatment of schizophrenia have produced positive results (Peet 2003).

Dextroamphetamine This is the

High-dose chronic use of dextroamphetamine can lead to the development of a toxic psychosis as well as to other physiological and behavioral problems. This toxicity became a problem in the United States in the 1960s, when substantial amounts of the drug were being taken for nonmedical reasons. Although still abused by some, dextroamphetamine is no longer the stimulant of choice for most psy-chomotor stimulant abusers.

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

Thomas F Babor Revised by Amy Loerch Strumolo

DIAGNOSTIC INTERVIEW SCHEDULE (DIS) Developed in the late 1970s for use in large-scale studies of the prevalence of mental disorders in the U.S. population (Regier et al., 1984), the Diagnostic Interview Schedule (DIS) is a highly structured psychiatric interview that carefully specifies the questions that the interviewer must ask to make a DIAGNOSIS. Another version is the DISC, or Diagnostic Interview Schedule for Children. Unlike the DIS, this version allows the re-ordering of questions or sections. Because the DIS requires a minimum of clinical judgment, it can be administered by nonprofessional or nonclinician interviewers who have received a week of intensive training. In addition to alcohol and other substance-use disorders, the DIS provides diagnostic information about DEPRESSION, SCHIZOPHRENIA, and Anxiety disorders eating disorders Anti-social Personality and a variety of other psychiatric conditions. The DIS has been the subject of a number of validation studies showing...

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...

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 < 1 month

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...

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.

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 without...

Mental Health and Psycheducational Functioning

Although some CNS events, such as seizure or neuropathies, may be relatively isolated with few long-term sequelae, many CNS events, such as stroke, transverse myelitis, psychosis, or depression, may result in a long-term impact on functional ability. In addition, there is data to suggest that many patients with SLE have subtle cognitive disturbances, which can impact memory (30). These disturbances may result in significant difficulties for adolescents with SLE in school and work, even if they have not had evidence of a major CNS insult. In one study of a cohort of pediatric SLE patients, 48 were found to have neuropsychiatric SLE, which included depression, concentration or memory problems and psychosis (31). Some patients had more than one CNS manifestation. Although a good outcome was reported in these patients, with 90 reported to have recovery, this was analyzed over a short time period. The gradual and subtle long-term impact on neu-ropsychological functioning of these insults...

Putative Treatments For Bipolar Disorder

Many drugs are proposed conceptually, or presented in print as effective, in some aspect of treatment of bipolar disorder. Rarely is it possible to assess adequately a drug for bipolar disorder in other than a placebo-controlled, randomized, parallel-group study, enrolling patients who have common illness characteristics at the start of the study. The inherently changing symptomatology of bipolar disorder probably contributes to a greater likelihood of positive open reports in bipolar disorder than most other mental disorders, but ones wherein the improvement reflects inherent changes in symptomatology, rather than an effect of drug. The following drugs have case reports that suggest efficacy in some patients, but have not been tested in the above paradigms, or have had largely negative studies conducted that may have methodological constraints that reduced capacity to identify drug efficacy. Topiramate is a fructopyranose that has been reported as beneficial principally as add-on to...

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

Legal Applications of Substance Abuse Imaging Data

The appropriate role for brain imaging evidence in establishing either settled insanity or lack of specific intent is unclear. In a legal context, it is cognitive impairment, not brain damage per se, that is relevant to the determinative issues of mental state, intent, judgment, and capacity for self-control. Although the imaging literature does contain reports of various structural and functional brain abnormalities among populations of substance abusers, by no means are current imaging methodologies diagnostic of particular dementias, psychoses, or amnestic syndromes arising from chronic substance abuse. A psychiatric witness who concludes that a defendant lacked the requisite mens rea for a specific intent crime or was unable to appreciate the wrongfulness of his or her conduct must ground this opinion in the results of cognitive assessment. Unless and until the science of neuroimaging advances far beyond its current state, brain scanning is not a proxy for this cognitive testing.

Assessment Approaches And Issues

In contrast, clinical interviews are strictly designed to provide a diagnosis of depression and other psychiatric illnesses. Indeed, structured clinical interviews have traditionally been considered the gold standard for identifying the prevalence, clinical significance, and potential treatment of depression because of their rigorous criteria. Common interviews include the Schedule for Affective Disorders and Schizophrenia (SADS),16 Structured Clinical Interview for DSM (SCID),17 Research Diagnostic Criteria (RDC),18 and the Diagnostic Interview Schedule (DIS).19 In addition, researchers and clinicians have used unstructured clinical interviews in which they diagnose depression based on DSM20,21 or Endicott22 criteria. Unfortunately, clinical interviews are not without limitations. Structured clinical interviews have been criticized for the length of time they take to administer and the amount of

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.

Upper Levels of Niacin Intake

Gram doses of nicotinamide have been used in so-called orthomolecular psychiatry as a treatment for schizophrenia, originally because of the similarities between schizophrenia and the depressive psychosis of pellagra. The underlying rationale for this use is that such high doses of niacin may deplete methyl donors, and at least one of the theories of the biochemical basis of schizophrenia was that the condition is caused by inappropriate methylation of neurotransmitter metabolites to yield psychotogenic compounds (Hoffer et al., 1957). There is no independent confirmation of the efficacy of nicotinamide in the treatment of schizophrenia.

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.

Pharmacokinetics and Dosing

The bioavailability of amantadine is 86 in the elderly and more than 90 in young adults in oral form (9). It is excreted virtually unmetabolized via the kidneys and has a large volume of distribution. In fasting, healthy patients, peak plasma concentration was found 1 to 4 hours after a single oral dose of 2.5 to 5mg kg. Plasma half-life in healthy elderly men has been reported between 18 and 45 hours, suggesting that steady state may take up to nine days (10). It crosses the blood-brain barrier and the placenta, and is excreted into the breast milk. Serum amantadine levels are not routinely drawn and are probably of limited clinical utility. Pharmacological studies have reported serum levels between 0.2 to 0.9 p,g mL at dosages of 200mg day (11). Fahn et al. (12) reported a patient with psychosis following acute intoxication with amantadine who had a level of 2.37 g mL.

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 .

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.

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.

Implications For Handedness Research

Handedness studies of patients with schizophrenia have further demonstrated the value of careful analysis of the entire spectrum of the handedness range. In a review of the literature, Satz and Green concluded that there is an atypical leftward shift in the handedness distribution of patients with schizophrenia, resulting in an elevated frequency of mixed handedness (Satz & Green, 1999). To the authors, these results suggested an abnormality among schizophrenic patients affecting the left hemisphere, which is consistent with anatomical work (Kwon, McCarley, Hirayasu, Anderson, Fischer, Kikinis, Jolesz, & Shenton, 1999 Shapleske, Rossell, Woodruff, & David, 1999).

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...

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...

Charles Kaplan Revised by Frederick K Grittner

NEUROLEPTIC Neuroleptic includes any of a group of drugs that are also called ANTIPSYCHOTICS. Neuroleptics are used as medications in the treatment of acute psychoses of unknown origin, including mania and SCHIZOPHRENIA. The prototype neuroleptic drugs are chlorpromazine (Thorazine), haloperidol (Haldol), clozapine (Clozaril), lithium (Lithonate), and thioridazine (Mellaril). Some of the newer drugs include risperidone (Risperdal), quetiapine (Seroquel), and olanzapine (Zyprexa). The site of action for these drugs (receptor site) is the central nervous system where they produce antipsychotic effects. These drugs are also used for antianxiety, although other agents are more effective and do not have the long-term side effects that neuroleptics do. Drug therapy alone is not entirely effective in treating psychoses, and it is used in combination with acute and long-term support and medical care. Some neuroleptics are also used in the treatment of nausea, vomiting, alcoholic hallucinosis,...

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.

Phencyclidine Pcp Adverse Effects Widely known as Pcp Phencyclidine

Is an important drug of abuse in the United States, even though its use has declined since the 1980s. PCP is difficult to classify pharmacologically and is considered separately from the hallucinogens. The drug has not been studied systematically in animals, although research done in 1973 and 1980 indicated that it produces dependence in monkeys. As of 1999, its effects on the human central nervous system are poorly understood. It produces a unique type of hallucinatory effect and is used both by smoking and ingestion. Persons under the influence of PCP experience mood changes, perceptual distortions, and feelings of dissociation from their surroundings. Since their judgment is impaired, they may take unnecessary risks. They may become unpredictable and violent. In certain individuals, PCP use, especially if repeated often, can result in the production of a mental disturbance referred to as PCP psychosis. It is not, however, known with certainty whether PCP itself, or a combination of...

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...

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.

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...

Prohibition Of Alcohol

Given the common belief that Prohibition failed utterly to alter the consumption of alcohol or its adverse effects on health, it is appropriate to ask, To what extent did the law reduce alcohol use in the United States First, there is no question that it succeeded in eliminating 170,000 saloons, even if it did not change the attitudes of most Americans about the morality of drinking. And, while some writers have asserted that drunkenness actually increased during Prohibition, most available records point to the opposite conclusion (Aaron & Musto, 1981 Lender & Martin, 1987). The most consistent findings on the impact of Prohibition come from statistics on medical problems known to be linked to alcohol consumption, especially excessive alcohol consumption. Among these problems were hospital admissions for alcoholism and admissions to state mental institutions for alcoholic dementia and alcoholic psychosis. Striking decreases were observed in New York and Massachusetts, two states...

Lithium Lithane Lithonate

Lithium salts are a relatively new treatment for manic-depressive psychosis, a serious mental illness in which people swing back and forth between extremes of mood, from intense elation (mania) to intense depression. Lithium damps out these mood swings and is especially good at preventing manic episodes, although it is also used to treat depression. It has many side effects and can produce serious toxicity in the nervous system, heart, and kidneys. It has no effects on the mind that recommend it for nonmedical use.

NickE Goeders Revised by Nicholas DeMartinis

Psychoactive drugs are used to suppress disorders of movement and to treat anxiety disorders, depression, bipolar disorder (manic-depression), and schizophrenia, among other mental illnesses. In addition, drugs used primarily to treat disorders in peripheral organs can also affect the central nervous system (e.g., beta-blocking agents, used to treat high blood pressure or disorders of heart rhythm, or steroid hormones used to control inflammation). The psychoactive effects of these drugs are generally considered side effects, although some are used for their psychoactive properties as well.

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).

Marian W Fischman Psychopharmacology Psycho

Pharmacology is that branch of science that involves the study of the effects of interactions between drugs that affect the central nervous system (i.e., psychoactive drugs) and living systems. Behavioral and neurobiological effects as well as the mechanisms of actions and side effects of drugs are often examined. Pre-clinical studies of psychoac-tive drugs using animal models and tissue preparations are an important aspect of psychopharmaco-logy, contributing to our understanding of the mechanisms involved in disorders of the central nervous system and mental illness. Clinical psycho-pharmacological investigations include examining the effects of drugs used in treating psychiatric disorders (such as anxiety, depression, schizophrenia, and mania), as well as other dysfunctions within the central nervous system (such as movement disorders, Alzheimer's disease). Also included is study of the effects of psychoactive drugs used non-medically to induce altered states of consciousness, to...

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.

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

Measuring Effects of Drugs on Behavior

People throughout world take drugs such as HEROIN, Cocaine, and ALCOHOL because these drugs alter behavior. For example, cocaine alters general activity levels it increases wakefulness and decreases the amount of food an individual eats. Heroin produces drowsiness, relief from pain, and a general feeling of pleasure. Alcohol's effects include relaxation, increased social interactions, marked sedation, and impaired motor function. For the most part, the scientific investigations of the ways drugs alter behavior began in the 1950s, when chlorpromazine was introduced as a treatment for Schizophrenia. As a result of this discovery, scientists became interested in the development of new medications to treat behavioral disorders as well as in the development of procedures for studying behavior in the laboratory.

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.

What Behaviors Do Drugs Alter

If the effect that follows a given behavior increases the likelihood that the behavior will occur again, then that event is called a reinforcer. Food, water, and heat are common reinforcers. Drug administration is also a reinforcer. It is well known that animals will respond on a lever to receive intravenous injections of morphine, cocaine, and amphetamine, as well as a number of other drugs. Not all drugs are self-administered, however. For example, animals will respond to avoid the presentation of certain nonabused drugs such as the ANTIPSYCHOTICS (medications used in the treatment of schizophrenia). Because there is a good correlation between drugs that are self-administered by ani

Adenosyk Methionine SAMe

Historical note SAMe was first discovered in Italy in 1952. About 20 years later, a stable salt was commercially manufactured and produced for injectable use. At first, it was investigated as a treatment for schizophrenia, for which it proved inappropriate however, successful trials in depressed patients began in the 1 970s and it was inadvertently found to improve symptoms of arthritis. Sincethen, numerous studies have been undertaken to examine the role of SAMe in both depression and osteoarthritis. To date, more than 75 clinical trials have been conducted using SAMe as a therapeutic agent, involving over 23,000 people.

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

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