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.

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How the Phases of Schizophrenia Affect Consumers Lives

To experience the phases of a schizophrenic episode only once would be very disruptive to one's life. Unfortunately, many individuals experience this dreaded sequence of phases repeatedly, resulting in numerous and unpredictable disruptions to their lives. Persistent negative symptoms during long residual phases with occasional bursts of positive symptoms may dominate the person's existence, making it difficult to concentrate or focus, even on simple day-to-day tasks. Functional deficits associated with the disorder interfere with goal-directed behavior involving one's career and lifestyle. Thus, a disproportionately large number of people with schizophrenia are chronically unemployed, have not finished their education, do not reside in their own homes, are unmarried, and are estranged from their relatives. Later in this book we will address how the interventions of psychiatric rehabilitation can help these individuals to cope more effectively, regain control over their lives, and...

Paranoid type Schizophrenia

Paranoid type schizophrenia is characterized by the absence of prominent disorganization of speech, disorganized or catatonic behavior, or flat or inappropriate affect. B. Disorganized type Schizophrenia is characterized by prominent disorganized speech, disorganized behavior, and flat or inappropriate affect. C. Catatonic type Schizophrenia is characterized by at least two of the D. Undifferentiated type Schizophrenia meets criteria for schizophrenia, but it cannot be characterized as paranoid, disorganized, or catatonic type. E. Residual type Schizophrenia is characterized by the absence of prominent delusions, disorganized speech and grossly disorganized or catatonic behavior and continued negative symptoms or two or more attenuated positive symptoms.

Treatmentof Schizophrenia

Antipsychotic medications reduce core symptoms and are the cornerstone of treatment of schizophrenia. C. A complete discussion of the treatment of Schizophrenia can be found on page 101. E. Electroconvulsive therapy is rarely used in the treatment of schizophrenia, but may be useful when catatonia or prominent affective symptoms are present.

Schizophrenia and Other Psychotic Illnesses

There have been a few studies that have looked at this issue. Kinzie et al. 5 found schizophrenia in 16 of the Indo-Chinese refugee population, similar figures were found among Cambodian refugees by Somasundaram et al. 19 , and a slightly lower figure of 13 was found in refugees in GuineaBissau by de Jong 18 . Lavik et al. 6 opined that stress and traumatization connected with the refugee situation itself do not have a decisive impact on the development of psychotic symptoms, which may instead be related to other conditions or constitutional factors. However, certain traumatic experiences, like sensory deprivation, can cause psychotic symptoms. The stress-vulnerability model of schizophrenia also suggests a link between stress and schizophrenia in susceptible persons. So it is not unusual to find a higher prevalence of psychotic illnesses in refugee populations, though studies are lacking on the time of onset of the disorder, making it difficult to attribute to the refugee status the...

Types and Treatment of Schizophrenia

Because no one symptom is sufficient for a diagnosis of schizophrenia, patients vary in the numbers and intensity of their symptoms. Four subtypes of schizophrenia are recognized the differentiation among them is based upon the symptom profile, and the criteria are clearly described in DSM-IV-TR. Catatonic schizophrenia is predominantly characterized by abnormal motor behavior. The patient may be in a catatonic stupor, which means that he or she shows a marked reduction in movement and is sometimes mute. Other catatonic schizophrenic patients adopt a rigid posture (catatonic rigidity), which they will maintain despite efforts to move them. In disorganized schizophrenia, the primary symptoms are incoherence, catatonic behavior, and flat or inappropriate affect. In paranoid schizophrenia, the predominant symptom is a preoccupation with a systematized delusion. The label undifferentiated schizophrenia is applied to cases that do not meet the specific criteria for catatonic, disorganized,...

Potential Involvement in Schizophrenia

Keywords Prefrontal cortex, dopamine, glutamate, membrane potential, ensemble coding, schizophrenia, animal model, synaptic plasticity, in vivo intracellular recording, in vitro whole cell recording. Abstract The prefrontal cortex has been implicated in executive functions, and it can become dysfunctional in psychiatric disorders such as schizophrenia. Prefrontal pyramidal neurons exhibit dynamic membrane potential activity in vivo, which depends on local microcircuits and synaptic inputs from other brain structures and may define neural ensembles encoding information. Mesocortical dopamine modulates these membrane potential states, allowing for long-term synaptic plasticity in the prefrontal cortex. Dopamine-mediated ensemble coding reinforcement may therefore be important for associative learning and executive functions. Dysfunction of associative learning and neural plasticity induced by dopamine abnormalities in the prefrontal cortex may be central components in the...

Psychopathological Implications of Intentional Attunement Schizophrenia

In schizophrenia, self and other are no longer mutually interrelated, but tend to diverge and crystallize into segregated, incomprehensible and impenetrable realms. In spite of this lack of interpersonal relatedness, the self can experience dramatic loss of its boundaries, as epitomized by Schneiderian positive symptoms such as thought insertion, auditory hallucinations, and delusion of action control. Social and personal identities are both disrupted. The problem of psychopathology is therefore to reconcile all these different psychotic articulations within a coherent explanatory frame. Schizophrenia, as pointed out by Terenius 69 , has so far been an elu sive target for research. Furthermore, the current DSM-IV-inspired operational diagnostic criteria provide a much clearer picture of what schizophrenia is not than of what it is. A possible reason accounting for this elu-siveness could be the fact that a comprehensive account of schizophre-nia-but the same could be said of all...

Efficacy of Antipsychotic Medication

A large body of evidence supports the efficacy of antipsychotic medication in the treatment of schizophrenia, with more than 100 well-controlled studies showing that 50 to 85 of persons will improve significantly with reductions in hallucinations, delusions, thought disorders, and bizarre behavior (Lehman & Steinwachs, 1998). Those who experience symptom relief with an antipsychotic medication typically will be prescribed this medication for at least 1 year after the acute symptoms have been reduced (Lehman & Steinwachs, 1998). The purpose of this long-term treatment is to reduce the risk of relapse or the worsening of positive symptoms. Medications are used in the acute phases of an illness such as schizophrenia, in the residual phases to keep symptoms from recurring, and also in the prodromal phases to avert relapse. In the case of most serious mental illnesses, medications are also used during periods of remission. Summarizing studies that looked at the outcomes of more than 2,300...

The Symptoms of Schizophrenia

Schizophrenia is the most common disorder of persons who utilize psychiatric rehabilitation services (Arns, 1998). Diagnosing schizophrenia is difficult and takes time, in part because the symptoms of schizophrenia are so varied and numerous. As yet, there is no single definitive sign that indicates schizophrenia is present. Other serious disorders must be ruled out first. For example, many drug reactions look strikingly like schizophrenia during the acute phases of the illness, hence the term, psychedelic drug, which refers to a class of drugs that causes psychotic-like symptoms. Unlike the symptoms of schizophrenia, these drug-induced conditions are short lived and have a very different impact on the individual. The symptoms of severe and persistent mental illness are ongoing rather than transient experiences. In the case of schizophrenia, an individual's most serious symptoms may last several days to many years, waxing and waning in intensity. As of yet, there are no laboratory...

Atypical or Second Generation Antipsychotic Medication

Clozapine, first introduced in the 1950s, but not widely used in the United States until the 1990s, and a number of other antipsychotics are a heterogeneous group of medications that are commonly referred to as the atypical antipsychotics. The atypicals differ significantly from one another in terms of the neurotransmitter receptors that they occupy, such as different types of dopamine receptor and serotonin receptors. However, they all act as dopamine antagonists to some extent (see Chapter 2). In addition to affecting other neurotransmitter systems, they have a reduced risk of both the early and late emerging movement disorders, which are among the many side effects of antipsychotic medications (Marder et al., 2002). In addition, clozapine has been shown to be highly effective for treatment-resistant schizophrenia. However, its use is generally confined to individuals whose psychotic symptoms have not responded to one or more antipsychotic medications, because of its potentially...

History of the Concept of Schizophrenia

Eugene Bleuer

The disorders that are now called schizophrenia were first characterized in the nineteenth century. Emil Kraepelin first grouped these disorders, referring to them by the collective name dementia praecox, in 1893. Many early neurologists and psychiatrists thought these dementias were organic conditions. This view changed, however, after Swiss psychiatrist Eugen Bleuler published his classic work on the disorder in 1911. Bleuler proposed that the primary characteristic of the condition was a splitting of intellect from emotions. He introduced the term schizophrenia (literally, split mind ). Bleuler, influenced by the psychodynamic theories of Freud, believed that the bizarre content of schizophrenic thoughts and perceptions represented a breaking away from an external reality that was too painful or frightening. His ideas became especially influential in the United States. Attempts to treat schizophrenia with traditional psychotherapies were, however, unsuccessful. Success rates rarely...

Phases of Schizophrenia

The duration (see Box 2.2, Criterion C) of an episode of schizophrenia must persist for at least 6 months for an accurate diagnosis to be made (APA, 2000). The symptoms a person experiences during an episode may vary considerably depending on which phase of the illness is present. The prodromal phase (before the full syndrome) is a period of deterioration in functioning and increase of symptoms, both positive and negative. In The Story of Paul, from Chapter 1, Paul's inability to focus on college lectures, his suspicious feelings about his roommate and professors, and his increasingly withdrawn behavior were all indicative of the prodromal phase of schizophrenia. Diagnostic Criteria for Schizophrenia Excerpted from DSM IV-TR (APA, 2000, p. 312)

Schizophrenia And Other Cognitive Disorders

Disorders of cognition have traditionally been classified into psychoses and dementias. Other disorders of cognition include delirium and amnestic disorders. Psychoses were deemed to occur at an earlier age, to be biochemical genetic in nature and to be at least partially reversible pharmacologically. Dementias were deemed to occur at a more advanced age, be degenerative in nature and to be mostly irreversible. The prototypical examples of psychoses were the schizophrenias, and the prototype dementia was AD. These distinctions are becoming strained and blurred as we learn more about the underlying pathophysiology, nowhere more so than in geropsychiatry. It is now being increasingly recognized that degenerative changes underlined by cell loss occur in schizophrenias, and that partially correctable biochemical neurotransmitter abnormalities occur in dementias. Moreover, other mental disorders such as mood and anxiety disorders, in addition to neurological disorders such as Parkinson's...

Associative Learning and Prefrontal Synaptic Plasticity Dysfunction in Schizophrenia

The altered glutamatergic and DA transmission proposed for schizophrenia may affect synaptic plasticity mechanisms in the PFC. A reduction of dendritic spines in PFC pyramidal neurons has been reported in schizophrenia brains (Glantz and Lewis, 2000) as well as in animals with a neonatal VH lesion (Lipska et al., 2001a), suggesting reduced excitatory synaptic inputs in this area. Decreases of N-acetyl aspartate (NAA) in schizophrenia (Bertolino et al., 1999) and in this animal model (Bertolino et al., 1997) also indicate that excitatory inputs to the PFC are reduced. Administration of NMD A antagonists such as MK-801 or phencyclidine (PCP) induces schizophrenia-like symptoms (Luby et al., 1959 Heresco-Levy and Javitt, 1998 Jentsch and Roth, 1999), These conditions would result in an impairment of LTP and LTD induction in the PFC. A number of factors known to modulate plasticity are affected both in schizophrenia and in animals with a neonatal VH lesion. For example, brain-derived...

How Are Schizophrenia and Mood Disorders Different

While schizophrenia is characterized by its psychotic symptoms, and a mood disorder is characterized by its emotional or affective symptoms, the distinction between the two diagnostic categories is not always so clear. For example, both Robert and Mark who were diagnosed with bipolar disorders experienced grandiose delusions. They said their thoughts raced quickly, and Mark said that at times he heard voices. Consider what happened to Dave Dave had racing thoughts, imagined he was a Mafiosi and, at other times, a saint. He spoke quickly and incoherently. At times he would suddenly become sullen and withdrawn. He was treated with antipsychotic medication for many years, without much improvement and many side effects. He died in the state hospital. Later on, when his daughter was diagnosed with bipolar disorder, manic type, it occurred to the other members of the family that their father may have been incorrectly diagnosed as having schizophrenia and, therefore, improperly treated all...

Placing Schizophrenia In The Spanish Media Agenda

As part of the implementation of the WPA's program Schizophrenia Open the Doors'' in Spain, the team coordinating it, led by the author of this chapter, has followed the coverage of mental health issues in general, and schizophrenia in particular, in the Spanish press. This press coverage analysis was undertaken to allow the evaluation of the program's media campaign, and the detection of sources of stigmatization. The objective of this analysis was to evaluate the effects of the media campaign designed as part of the Schizophrenia Open the Doors'' implementation steps for Spain. In this program's action plan, according to the new strategic model developed, the media were to be used selectively and mainly as vehicles to reach the program's target audiences patients, their relatives and the mental health professionals closest to the disorder. Of course, the full results of this analysis focus on schizophrenia and how it is portrayed in Spanish media. Nevertheless, some of the more...

Prospective Memory in Schizophrenia

Overview Schizophrenia is a psychopathological disorder that is associated with neuropsychological dysfunctions in the areas of attention, retrospective memory, working memory, and executive functioning (Aleman, Hijman, de Haan, & Kahn, 1999 Egeland et al., 2003 Hoff & Kremen, 2003 Kremen, Seidman, Faraone, & Tsuang, 2001 Meissner, Hacker, & Heilemann, 2001), possibly due to subtle damage of the medial temporal lobes and prefrontal cortex. On the basis of these impairments, it was expected that schizophrenia patients would also exhibit substantial problems in performing prospective memory tasks (Shum, Leung, Ungvari, & Tang, 2001). Relevant Findings A handful of studies have consistently revealed that schizophrenia is associated with deficits in performing time-, event-, or activity-based intentions (Elvevag, Maylor, & Gilbert, 2003 Kumar, Nizamie, & Jahan, 2005 Meissner et al., 2001 Shum, Ungvari, Tang, & Leung, 2004), with a somewhat pronounced difficulty in time-based tasks that...

Alteration of Prefrontal Response to Dopamine in a Developmental Animal Model of Schizophrenia

A neonatal VH lesion in rodents and primates has been proposed as a developmental animal model of schizophrenia. These animals exhibit abnormal behaviors such as exaggerated locomotion in response to DA agonists (Lipska et al., 1993), NMDA antagonists (Al-Amin et al., 2001), or stress (Lipska et al., 1995), but only after puberty. This time course is similar to what is observed in the onset of symptoms in schizophrenia (Weinberger, 1995). In addition, cognitive deficits in working memory (Lipska et al., 2002), latent inhibition (Grecksch et al., 1999), or sensory gating (Lipska et al., 1996), and reduction of social interactions (Sams Dodd et al., 1997) are commonly observed in animals with neonatal VH lesion as well as in schizophrenia patients. Thus, this animal model stresses the link between early-life limbic compromise (Lipska and Weinberger, 2000) and delayed symptom onset in schizophrenia. Because the VH has a massive projection to the PFC (Jay et al., 1989 Jay and Witter,...

Possible Network Mechanism of Prefrontal Dysfunction in Schizophrenia

Hypofrontality is a major component in schizophrenia pathophysiology (Weinberger et al., 1994). It has been linked to the severity of negative symptoms (i.e. social withdrawal and lack of affect) (Wolkin et al., 1992), as well as to a variety of cognitive deficits observed in this disorder (Carter et al., 1998). But what really is hypofrontality Traditionally, it is viewed as lack of PFC activation during tasks that would normally engage this brain region, measured as changes in regional cerebral blood flow (Fig. 5A) (Weinberger et al., 1994 Andreasen et al., 1997). This causes deficits in working memory resembling those seen in PFC lesions (Muller et al., 2002). Our finding of enhanced firing in PFC neurons during VTA-evoked depolarizations in animals with a neonatal VH lesion would suggest that in those animals, the PFC becomes hyper-, but not hypo-, active upon DA activation. Figure 5 Relations between working memory capacity or D, receptor activation and PFC activation. A....


The most frequently reported findings from qEEG studies in subjects with schizophrenia include an increase of slow (delta and theta) and fast (beta) activities, and a decrease in alpha power 68-79 . This pattern was initially attributed to the effects of neuroleptic treatment, since some drugs may induce a general slowing of EEG activity. However, this explanation has been ruled out by studies showing that slow wave activity is even more pronounced in untreated patients 74 , and it is also present in children at genetic risk for schizophrenia 68 . Although some authors have found these abnormalities as a pattern, others have reported the presence of only some of them (e.g. increase of slow activities and decrease of alpha), or discrepant findings (increase of alpha or lack of differences) 73, 80, 81 . EEG characteristics of schizophrenic patients appear to be stable over time 82, 83 . The majority of studies carried out in subjects in their first episode of schizophrenia have...

The Experience of Mental Illness

Chapter 1 begins with the story of Paul, a young man diagnosed with a severe mental illness, schizophrenia. After reading about Paul you will cover basic definitions of severe mental illness, disability, and stigma. Most importantly, this chapter will introduce you to the field of psychiatric rehabilitation, an evolving set of methods, strategies, and concepts for the community treatment of persons with severe mental illness. The final section of the chapter discusses how psychiatric rehabilitation knowledge is developed, the identification of evidence-based practices, and the sources of that knowledge for professionals and students.

The Causes of the Severe Mental Illnesses

The pathological processes that cause these conditions are still poorly understood (Anthony & Liberman, 1986 Walker et al., 2004). Nevertheless, there is growing consensus that these conditions have a strong biological component (Dincin, 1990 Torrey, 2001). With the development of increasingly sophisticated soft tissue and metabolic imaging techniques such as CAT, PET, and MRI scans, researchers have been able to demonstrate actual changes in brain tissue and brain functioning corresponding with psychotic episodes (Taylor, 1987 Torrey, 2001 see also Andreasen, The Broken Brain, 1984). At the same time, researchers have looked at the contribution of genetics by comparing the life spans of individuals whose parents have schizophrenia with those whose parents do not have schizophrenia (Marcus et al., 1987) and studying identical and fraternal twins when one of the twins has the disorder (e.g., Torrey, 1994). These studies provide strong evidence that genetics play an important role when...

The Emergence of Psychiatric Rehabilitation

Practitioners of PsyR are united in believing that persons with severe and persistent mental illness can achieve greater independence and a better quality of life with the help of psychiatric rehabilitation services. This assumption, that persons with psychiatric disabilities can participate in a successful rehabilitation process, is in marked contrast to the beliefs of many mental health professionals only a few generations ago and some today. Until the late 1970's and early 1980's, the conventional wisdom about severe mental illness was that it took an insidious downward course with little or no hope of recovery. Prior to 1987, the DSM-III (Diagnostic and Statistical Manual of Mental Disorders, third edition) published by the American Psychiatric Association (1980) stated that the most common course of schizophrenia consisted of acute episodes followed by increasing residual impairments (p. 185). In contrast to this pessimistic view, recent research has demonstrated that, even for...

The Mental Health Care System And Its Components

Since age of onset of mental illnesses is inversely correlated with the delay in first treatment contact, as shown by the studies of Olfson et al. 11 and Kessler et al. 12 , early-onset illnesses, frequently leading to lifelong disabilities at an early stage, are particularly slow to receive treatment. The Age, Beginning and Course (ABC) Schizophrenia Study 13 showed that in Germany, despite the availability of a tight network of health and mental health services, three-quarters of the cases of schizophrenia have a prodromal phase of an average length of five years and a psychotic prephase of one year before coming in contact with treatment services. It is in this early illness stage before first contact that most of the social consequences of schizophrenia manifest themselves 14 .

Persistence of Symptoms over Time

Individuals who experienced these disorders were often insensitively referred to as chronics. Fortunately, this terminology has fallen out of favor for the following reasons First is the emergence of person-first language (e.g., a person with schizophrenia rather than a schizophrenic ) second is that chronic, which simply means lengthy, has gradually become equated with low functioning and hopeless. The overall negative associations with this label turned out to be not only inaccurate, but also very harmful (Harding, Zubin, & Strauss, 1992). In Chapter 3 we will discuss evidence about the inaccuracy of the chronic label.

Hypotheses and Prediction

What is trivial to one ecologist is the major problem of ecology to another. What can we do about this unsatisfactory state of affairs In the long run, history sorts out these issues, but for ecologists facing biodiversity issues now, history will take too long. We cannot escape these judgments and more discussion ought to be devoted to them in ecological journals. If medical research councils devoted equal amounts of money to acupuncture and schizophrenia research, we would be alarmed at the poor judgment. We should not hesitate to make similar value judgments for ecological research. No person or group is infallible in their judgments, and this call for discussion of the relative importance of ecological questions must not be misinterpreted as a call for the regimentation of research ideas.

The Experience of Symptoms

Rachel, a meek and mild, middle-aged woman, who has suffered from schizophrenia for most of her life, recalled how she lost the custody of her children more than 10 years ago because she responded to a delusion. She thought her crying infant son had been sent by the devil, so she threw him out of the window. Fortunately, he survived, but she lost custody of all three of her children. Since that time she not has committed any violent acts. Over the years she has developed a good, but generally long-distance, relationship with her children. She has held several jobs and has some close friends. In retrospect, she could not believe what she had done, particularly since she rarely acts in response to her symptoms now. Today, occasionally she feels hostile, angry, or a bit suspicious, but she knows that this is often a sign that she needs some assistance.

DSMIV diagnostic criteria

Schizoaffective disorder is an illness which meets the criteria for schizophrenia and concurrently meets the criteria for a major depressive episode, manic episode, or mixed episode. A. Symptoms of schizophrenia are present, but also associated with recurrent or chronic mood disturbances. B. First-degree biological relatives of schizoaffective disorder patients have an increased risk of schizophrenia as well as mood disorders. A. Schizophrenia. In schizophrenia mood symptoms are relatively brief in relation to psychotic symptoms. Mood symptoms usually do not meet the full criteria for major depressive or manic episodes.

Neurotransmitters and Mental Illness

The systems of two of the neurotransmitters, dopamine and serotonin, seem to be involved in schizophrenia. In persons with this disease, dopamine appears to be overactive and serotonin underactive, although the full explanation for these actions is far more complicated. Nevertheless, the disorders in these systems lead directly to the symptoms of schizophrenia.

The Role of Genetic Factors

Researchers, including Sigmund Freud, hypothesized that schizophrenia and the other severe mental illnesses were inherited. There is no doubt that the risk of developing schizophrenia is greatly increased if one's biological or blood relatives have the illness. Numerous studies have found that even if you have never had any contact with your biological relative who is affected by schizophrenia, and have never shared the same environment, you have an elevated chance of developing this disease (Kendler & Deihl, 1993).

Fetal Development and Early Infancy

Events that occur in utero seem to be another factor that contribute to the development of schizophrenia. The importance of fetal development in the prenatal environment is highlighted by other findings from twin studies. When twins develop in the same chorion, that is, the same sac in their mother's womb, the concordance rate for schizophrenia is higher than when they develop in separate chorions. Birth during the winter months, maternal infections during the second trimester of pregnancy (a time of extensive brain development), lower birth weights, and complications in the delivery of the child are all associated with a higher incidence or likelihood of developing schizophrenia among those at genetic risk (Cannon, Jones, & Murray, 2002 Torrey, 2001). Biological factors affect the risk of developing schizophrenia or other severe mental illnesses among people at genetic risk. Their genetic heritage may make the brain more vulnerable to viruses during fetal development or infancy....

Psychotic Disorder Caused a General Medical Condition

Rule out with history, physical exam and labs. CBC to rule out an infection leading to delirium and psychosis. 2. Routine chemistry labs to rule out electrolyte imbalances or hepatic encephalopathy RPR to rule out neurosyphilis HIV to rule out psychosis due to encephalitis in at risk patients. C. Schizophreniform Disorder or Schizophrenia. Schizophreniform disorder must last for over a month and schizophrenia must have a six-month duration.

Dsmivtr Criteria for Bipolar I Disorder

Only one Manic Episode and no past Major Depressive Episodes Manic Episode not better accounted for by Schizoaffective Disorder and not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified Specify mixed if symptoms meet criteria for Mixed Episode Specify for current or most recent episode Severity Psychotic Remission Specifiers with Catatonic Features with Postpartum Onset Episodes not better accounted for by Schizoaffective Disorder and not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified psychotic symptoms such as delusions, severe paranoia, and hallucinations may accompany a manic episode. These symptoms may lead to a misdiag-nosis of another psychotic disorder such as schizophrenia. However, skilled clinicians can make a differential diagnosis between schizophrenia and bipolar disorder.

The Myth of the Myth of Mental Illness

The views of Thomas Szasz (1976) were popular in the 1960s and 1970s. He proposed that rather than being an actual disease, mental illnesses, including schizophrenia, were artifacts or creations of psychiatry. In short, he believed that mental illness does not really exist. The extensive biological evidence that an active disease process exists has discredited this theory. Szasz built his theory on a single observation, which was undoubtedly true at the time, but reached a conclusion that was undoubtedly false. Szasz believed that all assertions about human behavior (including diagnoses) by psychiatrists and psychologists are subjective observations based on value judgments, not scientific judgments. In short, judgments, like diagnoses and competency, were solely matters of opinion rather than scientific facts. There is a body of research that supports this contention (Rosenhan, 1973). Szasz's position was simple He believed that we should not define mental illness as a disease unless...

Short Term Course of These Diseases

What is the probable short-term prognosis for someone suffering from a severe mental illness For some, accurate diagnosis and effective treatment take place rapidly. But for others, this process can be difficult, making the time it takes to receive effective treatment extremely lengthy. Certainly, for most persons who develop schizophrenia the initial phase before effective treatment has begun can be the most devastating and the most frightening. As you will see, determining how to treat these diseases can be a very complicated process. In addition, during the initial stages of the disease the individual is often very unstable, making an accurate diagnosis even more difficult (Chen, Swann, & Johnson, 1998 Wiersma et al., 1998). For example, many people who are given a diagnosis of a mood disorder will later be diagnosed with schizophrenia. At the same time, those with a diagnosis of schizoaffective disorder are most likely to have their diagnosis changed at a subsequent psychiatric...

The Experience of Hospitalization

After being discharged from the hospital, what is the likelihood of rehospitalization One of the most illustrative articles on this topic was published by Anthony, Cohen, and Vitalo (1978). By comparing the reported recidivism (rehospitalization) rates from the studies available at the time (see Table 3.1), the authors demonstrated that the probability of relapse in the short term (1 to 5 years) is very high. An examination of Table 3.1 reveals that as the follow-up period increases from 3 months to 5 and 10 years, the corresponding cumulative rate of recidivism also increases from 10 to 15 to as high as about 75 . Clearly, if you have been hospitalized because of a serious mental illness, the chance you will need rehospitalization at some point in time is very high. This high risk of relapse is true of schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. In recent years these figures have improved in terms of the proportion of individuals who relapse. For...

Do Rehabilitation Services Matter

The results from the Vermont study (Harding et al., 1987a, 1987b), which looked at the long-term outcome of schizophrenia, have greatly encouraged the psychiatric rehabilitation community. Regardless of how symptomatic individuals are, there is hope that at some future date they will be able to function independently in the community with reduced symptoms and little or no supports. Is this positive prognosis a result of the disease process or is it due to the services that people receive Some of the researchers from the Vermont study set out to answer this question.

Mental Disorders and Public Health

For the clinical psychiatrist, the most disabling and important conditions are schizophrenia, other functional psychoses and dementia. However, from the perspective of public health, depression and anxiety are very common and, though less disabling for the patients, lead in aggregate to more disability in the population as a whole. Of course, there is much evidence for a strong association between depression and disability in both developed and less developed countries 3-5 . Common mental disorders have also been linked to diminished productivity and sickness absence. These statistics reflect observations all too familiar to practising clinicians in primary care and psychiatry.

Biological Somatic Treatments

One of the primary approaches in the treatment of severe and persistent mental illness is to use pharmacological agents to treat acute episodes of psychotic and or mood symptoms (Lehman & Steinwachs, 1998 Leucht et al., 2003 Walker, Kestler, Bollini, & Hochman, 2004). In the treatment of schizophrenia, it is clear that antipsychotic or neuroleptic medications are required for any effective symptom reduction to take place (Lehman & Steinwachs, 1998 Mueser, Torrey, Lynde, Singer, & Drake, 2003). Thus for a disorder such as schizophrenia or another psychosis, antipsychotic medications, which are intended to reduce or eliminate psychotic symptoms, are often used as the first-line treatment (Lehman & Steinwachs, 1998).

Impact Of Genetics On Psychiatry In The Twentyfirst Century

There has been a degree of public concern that the current pace of advance will tend to geneticize common diseases and encourage deterministic attitudes. In particular, worries have been expressed that insurance companies may wish to force DNA testing on individuals thought to be at high genetic risk of disorder. While prediction with a high degree of accuracy is already possible for rare early-onset dementia such as Huntington's disease or the single-gene forms of AD, this is not possible for complex disorders. For example, the apolipoprotein s4 allele, despite the confirmed association with risk of late-onset AD in the general population, is of limited value as a predictor at an individual level 10 . The situation is likely to prove even more complicated with disorders such as schizophrenia. At best, DNA-based tests may be used to modify the predicted risk in individuals who are already at high risk because of having a schizophrenic close relative. However, it is unlikely that risk...

Understanding Course Treatment and Outcome What the Staff and Consumers Dont Know Can Hurt Them

The bewildering and sometimes confusing array of information regarding course, treatment, and outcome highlights the need for consumers and their families, as well as staff, to be informed about medications, symptom relief, and so forth. Illness self-management and recovery strategies such as those mentioned earlier make up an important aspect of the PsyR process. Consider the issue of continuing medication after someone is symptom free. We know that continuing medication during time periods of remission significantly reduces the likelihood of relapse for people with schizophrenia as well as bipolar disorder,

Service for Persons with Developmental Disabilities and Mental Illness

To examine the efficacy of using antipsychotic medication to treat people with a dual diagnosis of intellectual disability and schizophrenia, Duggan and Brylewski (1999) reviewed the literature and found only one relevant randomized clinical trial (Foote, 1958). This study included four people with a dual diagnosis of schizophrenia and intellectual disability, but results were only available for two people. The reviewers found no evidence to guide the use of antipsychotic medication for those with both intellectual disability and schizophrenia. Until the urgent need for randomized controlled trials is met, clinical practice will continue to be guided by evidence from trials involving people with schizophrenia but without intellectual disability.

Nonuniformity Correction

Analysis of group-mapped images provides a way of combining the ability of ROIs to be spatially specific (and thus sensitive) with the ability of histograms to be unbiased. In essence, a set of ROIs is automatically generated at locations across the whole brain, without any bias in where they are located. The image datasets are first spatially normalized to all lie in the same space. Appropriate statistical tests are then carried out on all the ROIs. The technique has been used in studies of child development (Paus et al., 1999), aging (Good et al., 2oo1), schizophrenia (Foong et al., 2oo1 Shapleske et al., 2oo2) and dementia (Scahill et al., 2oo2) (See Figure 2.16 (Plate 1)).

Delusional disorder and other psychotic symptoms

Related to an organic brain syndrome or peripheral degenerative changes that may cause some cutaneous dysaesthesias. A delusional disorder may coexist with a major depressive episode where the patient experiences delusions that are congruent with his or her depressed mood, and typically represent a more severe form of depressive disease. BDD is often associated with delusions of disfigurement. If the delusion or hallucination becomes more bizarre and if they are clearly implausible and not derived from normal life experience (e.g. a complaint that aliens are putting electricity through the body and causing the patient to feel a stinging sensation in the skin) the diagnosis of schizophrenia should be considered.

Behavioral Strategies

A basic principle of behaviorism is that we encourage behaviors by reinforcing them and extinguish behaviors by not rewarding them or punishing them. We accomplish this by using either positive or negative rewards or positive or negative punishments. In this case, think of positive or negative as implying adding something or taking something away, respectively for example, the same way you think of positive (something added) or negative (something lost or taken away) symptoms of schizophrenia. Behavior can be encouraged using positive rewards. For example, if you complete this project, you will

Clinical Comorbidity Underlined by Overlapping Biological Mechanisms

Dopaminergic neurotransmission, illustrates this point 72 . Dopaminergic neurons exert a major modulatory effect on the forebrain. DARPP-32, which is enriched in all neurons that receive a dopaminergic input, is converted in response to dopamine into a potent protein phosphatase inhibitor. Mice generated to contain a targeted disruption of the DARPP-32 gene showed profound deficits in their molecular, electrophysiological and behavioural responses to dopamine, drugs of abuse and antipsychotic medication.

Psychodynamic Psychosocial Alternative and Integrated Theories and Models of Posttraumatic Stress Disorder

Because of the wide range of approaches used to investigate the etiology of PTSD, PTSD perhaps represents the prototype for the use of the Biopsy-chosocial approach to understanding mental disorders. Although many other mental disorders have been approached from each of these three areas (e.g., depression or Schizophrenia), PTSD stands out as one of the most broadly investigated and multidisciplinary-involved disorders in the DSM-IV-TR. PTSD has been heavily investigated by physicians, psychologists, and even sociologists. As we have seen in Chapters 5 and 6, cognitive theories and biological models alike have given us powerful insights into the experience and etiology of PTSD on an individual basis. But like all psychological phenomena, these cognitive and biological processes occur within an interpersonal and social context that plays a powerful role in determining the development and presentation of the disorder. In this chapter, we will look at PTSD with the social and...

Clinical Considerations

With specific reference to anxiety, we can speculate that some clinical forms of neurosis or psychosis, not traceable to recognizable current causes, and thus not reactive, are in fact closely bound up with the unconscious memory. This is where traces of experience remain, not repressed and not remembered, but acted out in symptomatic manifestations, obscuring the higher functions of thought.

The Story of Jill Affinity House Member

Jill, 27 years old, has been a member of Affinity House for 7 months. Diagnosed with schizophrenia at 17, Jill has been in and out of the hospital numerous times, all the while trying to earn a college degree in English and journalism. Two years ago, still a sophomore, she was hospitalized again for 6 months. While getting ready for discharge, a

Principal Publications

Schizophrenia is classified as a psychosis or psychotic disorder that is, it is a severe mental illness that is not only characterized by loss of contact with reality, but also damages the patient's ability to function in society. At the Burgholzli, Jung worked under the supervision of Eugen Bleuler, a world-renowned expert on schizophrenia. Although schizophrenia was then considered to be incurable, Jung came to believe

Advances and Insights from Pharmacological Studies

The interplay between sleep disturbances and mood disorder is underlined, for example, by the use of stimulants to augment antidepressant treatment in patients who have had only a partial response to first-line therapy. Modafinil is a novel psychostimulant that has shown efficacy in, and is marketed for, treating excessive daytime sleepiness associated with narcolepsy. The mechanism of action of modafinil is unknown, but, unlike other stimulants, the drug is highly selective for the CNS, has little effect on dopaminergic activity in the striatum, and appears to have a lower abuse potential. In a retrospective case series of seven patients with DSM-IV depression (four with major depression and three with bipolar depression) in whom modafinil was used to augment a partial or non-response to an antidepressant, all patients achieved full or partial remission within 1-2 weeks 89 . These preliminary results suggest that modafinil may be of use as an augmenter of antidepressants, especially...

Evaluating Case Management

R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness A review of research on case management. Schizophrenia Bulletin, 24(1), 40. From Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness A review of research on case management. Schizophrenia Bulletin, 24(1), 40.

Ethnocultural Aspects of Psychopathology in General

Draguns (1994) states that despite the presence of some psychiatric disorders, such as Schizophrenia and depression, across numerous ethnocultural contexts, there is an extremely wide variety of expressions of symptoms of virtually all other mental disorders. From this perspective, a mental disorder is a mix of universal and culture-specific factors (Stamm & Freidman, 2000, p. 71).

ACT as an Early Intervention Strategy

Increased attention has been directed at the amount of time it takes before someone with psychotic symptoms receives appropriate treatment. The period between when a person becomes psychotic and when they first receive treatment for the psychosis has been labeled duration of untreated psychosis (DUP). Not surprisingly, the DUP for some individuals can be quite long. Studies have found average rates of DUP of about 1 year (McGlashan, 2000). This situation may be partly due to the fact that many of the individuals in question are in their late adolescent or early adult years, which are periods of significant change in one's development (Holloway & Aitchison, 2003) or because many persons with psychosis are unaware of their condition (Amador & Johanson, 2000). Some researchers have theorized that untreated psychosis may have neurotoxic effects (e.g., McGlashan, 1996). In other words, when someone is actively psychotic, he or she may be losing healthy brain neurons (see Chapter 2). Thus,...

The Ethical And Scientific Background Of Community Care

Aspects of the large mental hospitals came to be seen as counter-therapeutic, in particular the application of what was essentially a factory system for dispensing care, whereby economies of scale were adopted without considering their adverse consequences for patients. Because so many of the normal, everyday functions of patients were taken over by the institutions, most patients spent long stretches of time doing absolutely nothing. The ill effects of this were apparent, and led to the introduction of new techniques occupational therapy from 1927 in Burgholzli in Switzerland, and industrial therapy somewhat later. These in turn increased awareness of the deleterious effects of institutions, and resulted in polemics against the asylum 7, 8 . It was argued that institutions were abnormal environments, that abnormal environments induced behavioural abnormalities in the people who lived in them, and that the most extreme behaviour would be seen in the most abnormal environments....

The Consequences Of The Move To Community Mental Health Services For Informal Carers

Living with someone who has schizophrenia is likely to be stressful and upsetting 63 . The term burden has been used to describe the difficulties of living with someone who is mentally ill, although this has a slightly pejorative ring. Hoenig and Hamilton 64, 65 made the important distinction between objective and subjective burden. The objective component relates closely to the level of social performance that patients can manage. However, it is probably the subjective component that is more important for the well-being both of informal carers and of patients. At given levels of objective burden, individual levels of distress show considerable variation 66 . The effects of burden on the social relationships of informal carers have been consistently documented 63 . Likewise, their difficulties are compounded by financial strain consequent on the duties of caring. The effect of burden on carers' own mental health is not inconsiderable. Indeed, Davis and Schultz 67 have established that...

Rehabilitation Within The Community

Social skills training is commonly used in the USA 86 and was strongly advocated in the recent American Psychiatric Association's guideline on the management of schizophrenia 87 . It is less popular in Europe and hardly used at all in the UK, mainly because of concerns about generalisability. The aim of social skills training is to increase social performance and reduce social distress and difficulties of the sort experienced by people with schizophrenia. Many people with schizophrenia experience debilitating problems affecting their ability to interact socially, and these exacerbate their social isolation and stigmatization. This in turn leads to a poor prognosis and quality of life 88 . Social skills training programmes rely on a range of structured psychosocial interventions, which may be carried out either individually or in groups. By enhancing social performance and reducing difficulties in social situations, social skills training may reduce overall symptomatology and, perhaps,...

The Provision Of Specific Treatments By Cmhts

The acknowledgement that the family atmosphere plays a role in relapse in schizophrenia led to a number of evaluations of family interventions e.g., 102-107 . Overall, these interventions have been successful, indicating that it is possible to modify family atmosphere and thus to reduce relapse rates. However, this is probably dependent upon the timing of intervention, the techniques used, and the expertise of the therapists using them. Thus, the Amsterdam study of family treatment in schizophrenia 108 was generally unsuccessful, although it is not clear exactly why. There was an overall low rate of relapse, but this was actually slightly greater in low EE families in receipt of family treatment, raising the possibility that the intervention paradoxically increased stress levels in these families. Hogarty et al. 106 have suggested that the changes leading to a reduction in EE may be a sufficient but not a necessary component of intervention. A useful meta-analysis of these treatments...

Early Intervention Teams

There has recently been a considerable impetus towards intervening early in the treatment of psychosis, and specialist teams for dealing with people in their first episodes, despite their rarity, have received a great deal of attention. The prime example of this sort of service is the Early Psychosis Prevention and Intervention Centre (EPPIC) in Melbourne 126 . There are three main reasons why we might wish to intervene as early as possible in the course of a psychotic illness. The first is common humanity the requirement to curtail suffering does not require any special pleading. However, Kraepelin 127 suggested a course characterized by gradual and enduring deterioration. However, it is not unusual to see patients who have a period of considerable disturbance in the early course of their psychotic illness, but who in later years show some amelioration and restitution of function. McGlashan and Johannessen 128 have concluded that, although some studies did show progressive decline,...

The Primarysecondary Care Interface

It is actually quite difficult to quantify case-loads of severe mental illness in primary care some of this is definitional, but there are other obvious problems 149 . All in all, British data suggest that the average general practice list of 2300 would include eight or nine people with long-standing severe mental illness, but a new case would only be seen once every four years or so. Obviously, this would differ according to the location of the practice. In Britain, a quarter of patients with schizophrenia may be cared for only by the family doctor 150 . Patients who have had a single episode from which they have recovered form part of this group, but probably a small part. Pantelis et al. 151 found that, of patients in an inner London borough who had been seen by the secondary psychiatric services, only 60 were still in contact. Patients with disorganized lifestyles or acute illnesses may not even be registered with GPs 152 . In the recent British National Household Survey of...

Autocorrelation Patterns

Table 10.2 Auto-correlation matrices derived from patients with schizophrenia assessed with the BPRS calculated after fitting two statistical models (Based on Cnaan et al., 1997, Tables IV and V) Table 10.2 Auto-correlation matrices derived from patients with schizophrenia assessed with the BPRS calculated after fitting two statistical models (Based on Cnaan et al., 1997, Tables IV and V)

Endorphins and the Placebo Effect

Endorphins have been shown to play a role in a wide variety of body functions, including memory and learning and the control of sexual impulses. Abnormal activity of endorphins has been shown to play a role in organic psychiatric dysfunctions such as schizophrenia and depression. Deficits in endorphin levels have been observed to correlate with aggressiveness endorphin replacement therapy results in the diminishment of such behavior. Abnormal levels of endorphins in the blood have also been found in individuals suffering from behavioral disorders such as anorexia or obesity.

HPA Axis Alterations in Other Psychiatric Disorders

When depression is comorbid with a variety of other disorders, such as multiple sclerosis, Alzheimer's disease, multi-infarct dementia, Hunting-ton's disease, and others, both CRF hypersecretion and HPA axis hyper-activity are common. In contrast, HPA axis dysfunction has rarely been reported in schizophrenia. Consistent with the role of CRF in both depression-like and anxiety-like behaviours in preclinical animal studies, increased CSF concentrations of CRF have been reported in post-traumatic stress disorder (PTSD) 95 . A recent elegant study that used an in-dwelling cannula in the lumbar space, allowing repeated sampling of CSF several hours after the initial, and presumably stressful, lumbar puncture, demonstrated elevated CSF levels of CRF in combat veterans suffering from PTSD 96 . In contrast, low serum cortisol and urinary free cortisol levels have been repeatedly, yet unexpectedly, detected in PTSD. One possible mechanism that has been proposed by Yehuda et al. 97 suggests...

PET in Clinical Practice and Medical Research

In neurology, metabolic tracers are used for monitoring of the brain's residual function in stroke patients and for differential diagnosis and treatment monitoring in Alzheimer's disease 45 . Specific tracers for the dopaminergic pathways are used in Parkinson's disease 46 and other movement disorders as well as in schizophrenia 47 . Enzymatic activity in vivo (i.e., aromatic amino acid decarboxylase) can be assessed via position-specific labeling of L-DOPA, as shown in Fig. 10.13.

Hypothalamicpituitarygonad Axis

Post-partum mood disorders are also common, occurring in approximately 10 of women after childbirth. Both post-partum depression and the less frequent post-partum psychosis show their highest prevalence in the first three months after childbirth 108 . The timing of these syndromes would suggest that neuroendocrine dysregulation may contribute to their expression, but no major abnormalities in HPG axis function were detected in a prospective investigation of post-partum disorders 109 . Additional research on the HPG axis in depression and in other mood states is needed.

Studies Conducted in Areas Where Refugees Have Settled

Mollica et al. 4 , studying an Indo-Chinese group of patients in their clinic, found that 36 suffered from affective disorders, 1.9 from PTSD, 58 from affective disorders and PTSD, and 7.3 from other psychiatric disorders. Kinzie et al. 5 found that, out of 322 Indo-Chinese patients surveyed, 81 suffered from depression, 16 suffered from schizophrenia and 75 fulfilled a current diagnosis of PTSD. Lavik et al. 6 found PTSD in 48 , affective disorders in 16 , adjustment disorders in 10 and anxiety disorder in 6 of the group of refugees surveyed by them in an outpatient clinic in Oslo, Norway. These studies have been summarized in Table 8.1. 81 (depression) 16 (schizophrenia) 75 (PTSD) 48(PTSD) 16 (dysthymia and Diagnostic Interview for Children and Adolescents (DICA) 10 and the Schedule for Affective Disorders and Schizophrenia for School Age Children (KSADS) 11 , it was found that, whereas among the youths the point prevalence was 18.2 for PTSD and 11 for depressive disorders, the...

Psychopharmacological Treatments

Psychopharmacological treatment of PTSD focuses on medications and their efficacy in alleviating symptoms and restoring stability to the biological systems and processes that underlie the disorder. Logically, psycho-pharmacological treatments are intrinsically tied to the brain systems and neurochemical processes that produce symptoms. Many authors have cited that psychopharmacological treatment of PTSD is relatively underdeveloped compared to other disorders and the casual observer might agree, particularly when compared to the medication treatment of Schizophrenia and depression. However, there has been considerable progress over the years for both specific symptoms and the syndrome as a whole. Throughout this chapter, the reader is encouraged to stay focused on three main areas of PTSD that are metatargets for pharmacological treatment deactivation, restoration, and stability. Medications are used to deactivate the hyperaroused and reactive brain systems, help facilitate...

Which Therapy Is Best

Researchers approach the question of which therapy is best in the context of specific disorders. No one therapy is recommended for every disorder. For instance, behavior therapy has proven to be highly successful with phobias, cognitive therapy shows good results with depression, and a trial of medication is usual for schizophrenia and bipolar disorder.

Treatment of Comorbid Disorders and Associated Symptoms

More often than not, PTSD sufferers are plagued by comorbid or other association symptoms and conditions. Matthew Friedman states, people with PTSD exhibit abnormalities in almost every psychobiological system (p. 95). Kessler et al. (1995) estimate that more than 80 percent of individuals with PTSD have a comorbid psychiatric condition. Such disorders and related conditions as depression, Generalized Anxiety Disorder, Panic Disorder, psychosis, substance abuse, and irritability and anger should be addressed with their respective and indicated medications, with proper attention paid to interaction effects and how the treatment of these issues ties into the overall clinical picture. Selective serotonin reuptake inhibitors are implicated for treatment of depression and Anxiety Disorders as well. Effective medications for psychotic symptoms include Zyprexa and Seroquel. Methadone has been effectively used in the treatment of Opioid Dependence. Fluoxetine has been used successfully in the...

Somatic theory of insanity

ECT developed after the 1935 discovery that schizophrenia could be treated by convulsions induced through camphor injection. Soon, convulsion production was accomplished by passage of electric current through the brain, as described in 1938 by Italian physicians Ugo Cerletti and Lucio Bini. ECT was most successful in alleviating depression and is still used for that purpose. In contrast, classic psychosurgery by bilateral prefrontal leu-cotomy (lobotomy) is no longer performed because of its deleterious effects on the physical and mental health of many subjects. These effects included epilepsy and unwanted personality changes such as apathy, passivity, and low emotional responses. It should be remembered, however, that psycho-surgery was first planned to quiet chronically tense, delusional, agitated, or violent psychotic patients.

Diagnosis and Treatment

Diagnosis of a need for psychosurgery is based on observation of symptoms supporting abnormal psychological behavior. Examples are extremes of aggression, anxiety, obsession, or compulsiveness as well as psychoses other than schizophrenia. The exclusion of schizophrenics, except for those having marked anxiety and tension, is based on data supporting poor responses by schizophrenics to lobotomy and other leucotomies. Surveys have shown that good surgical outcomes were only obtained in 18 percent of schizophrenics who underwent lobotomy, as compared with 50 percent of depressives.

Dimensions of the problem

Of the ten leading causes of disease burden in young adults (in the 15A4 year age group) four were neuropsychiatric conditions. In 1998, alcohol dependence, unipolar major depression, bipolar disorder and schizophrenia were among the leading causes of disease burden in adults aged 15A44 years.

Sources for Further Study

Dementia Praecox Or, The Group of Schizophrenias. Translated by Joseph Zinkin. New York International Universities Press, 1957. Original German first published in 1911. A classic book in the field, this provides excellent descriptions of the symptoms and very interesting discussions of possible causal factors. Gottesman, Irving I. Schizophrenia Genesis The Origins ofMadness. New York W. H. Freeman, 1991. An accessible overview for both general and professional readers includes numerous first-person accounts of the experience of schizophrenia from the perspective of patients and family members. Herz, Marvin I., SamuelJ. Keith, andJohn P. Docherty. Psychosocial Treatment of Schizophrenia. New York Elsevier, 1990. This book, volume 4 in the Handbook of Schizophrenia series, examines psychosocial causes of schizophrenia and psychosocial treatment approaches. Discusses early intervention, behavior therapy and supportive living arrangements. Results of long-term outcome...

Indications for Antipsychotic Drugs

Antipsychotics (also known as neuroleptics) are indicated for schizophrenia and may be used for other disorders with psychotic features, such as depression. B. Antipsychotics are the drugs of choice for brief psychotic disorder, schizophreniform disorder and schizophrenia. They also play a prominent role in the treatment of schizoaffective disorder. II. Selection of an Antipsychotic Agent All neuroleptics are equally effective in the treatment of psychosis, with the exception of clozapine, which is more effective for treatment refractory schizophrenia. The newer antipsychotics (risperidone, olanzapine, quetiapine, and ziprasidone) may be more effective than conventional agents.

Psychodynamic Theories

Psychodynamic theories originated with Sigmund Freud, who believed that schizophrenia results when a child fails to develop an attachment to his or her parent of the opposite sex. This causes a powerful conflict (called an Oe-dipal conflict in males) in which unconscious homosexual desires threaten to overwhelm the conscious self. To prevent these desires from generating thoughts and feelings that cause painful guilt or behaviors that would be punished, the ego defends itself by regressing to a state in which awareness of the self as a distinct entity is lost. Thus, the person's behavior becomes so

Multiple Venn Diagrams Decreasing the Size of the Catalog

As another example, positional cloning within the areas identified by genetic studies 15 is difficult unless there are obvious candidate genes. Fig. 8.3 suggests one possible resolution to this problem. Any over- or under-expressed gene found in a locus associated with the disease phenotype would become an obvious candidate, as would any transcription factor located in such a locus and known to control genes showing a clustered expression pattern in the array. Mirnics and collaborators compared expression of mRNA from brains of hospitalized patients with and without schizophrenia with that of patients with an unrelated psychiatric disorder 16 . Monkeys treated with antipsychotic drugs provided a further control. Only one gene, RGS4, showed consistent change in expression. RGS4 was the only gene in their study to map to the major schizophrenia susceptibility locus

Definition Of Cases And Assessment Instruments

Most of the studies of homeless populations used standardized diagnostic interviews for selected diagnoses because an exhaustive interview lasts too long for these populations. The most widely used instruments were first the Diagnostic Interview Schedule (DIS 24 ), and then the Composite International Diagnostic Interview (CIDI 25 ). Odell and Commander 15 used a clinical standardized interview and medical records Gill et al. 6 used the Schedules for Clinical Assessments in Neuropsychiatry (SCAN 26 ), preceded by screening questions on psychoses in a two-step procedure. In an Australian study 3 , psychoses were detected by a screening questionnaire, and individuals rated positively were referred to a psychiatrist for a clinical interview. Psychoses are assessed in almost all studies. Substance-related disorders are also systematically assessed. Personality and cognitive disorders are often included. For specific comparisons, researchers can select some subtypes of disorders. For...

Prevalence Of Mental Disorders Among Homeless People

In most studies of homeless populations, the lifetime prevalence of mental disorders is 28-37 3.3-5 for severe cognitive disorders (dementia), 7.813 for schizophrenia, 8.2-17.5 for severe depressive disorders, and 5 for bipolar disorder. In addition, a pooled lifetime prevalence estimate from diverse studies indicates that 56 of homeless people in their lifetime will meet criteria for a substance-related disorder 30 .

The Use Of Health Care Services By The Homeless Mentally

Subjects under 25 years old appeared to be undertreated they had six times less contact with the health care system in the case of schizophrenia and alcohol- or drug-related disorders, and four times less in the case of depressive disorder. Suicide attempts were an important factor in being in contact with the system for people with schizophrenia, it multiplied the number of contacts by 20 for people with alcohol problems, by 5 and for drug addicts, by 6.6. The presence of a concomitant physical disease increased contacts for psychiatric symptoms it multiplied the number of contacts by 4 in the case of alcohol-related disorders, and hospitalization was multiplied by 3.7 for homeless people with schizophrenia. The type of contact varied according to the problem homeless subjects suffering from schizophrenia and delusional disorders were those most frequently hospitalized (39 ) and prescribed psychotropic drugs (68.3 ). People suffering from drug-related disorders were also very much in...

Risk Factors For Homelessness In The Mentally

In this study, in one-third of homeless respondents, the onset of psychosis followed the first episode of homelessness, indicating that mental illness was not a contributory factor. Furthermore, contrary to a popular perception that homelessness may be linked to poor treatment compliance, most of those whose illness began prior to becoming homeless had established and maintained contact with psychiatric services. Where there was evidence of comorbidity, substance abuse and behavioural disturbance appeared to be antecedent to both homelessness and the onset of psychosis in most cases. For the authors, these findings suggest a limit to the extent to which psychiatric services may be able to prevent homelessness among people with severe mental illness.

Substance Abuse and Mental Health Statistics

As an example, the Cook County Department of Corrections initiated a longitudinal study which examined what proportion of female and male detainees with mental disorders received treatment while in jail. The Cook County system actually does screen all detainees, although their treatment resources are very limited. Detainees were evaluated using standard instruments, the Brief Psychiatric Rating Scale and the Referral Decision Scale. They were classified as needing treatment if they had been previously diagnosed with schizophrenia or a major affective disorder and were symptomatic within 2 weeks of the interview, had severe cognitive impairment at the time of the interview, or if the subject reported a history of substance abuse and was disoriented at the time of the interview. According to these criteria, 10.7 of detainees needed mental health services. The study subjects were then followed for 6 months, or until their records were disposed of. It was determined that 23.5 of all...

Summary of the Empirical Evidence

People with severe and persistent mental illness (Dixon et al., 2001 Lehman & Steinwachs, 1998). If family members can be engaged, certainly these interventions are among the most effective social techniques that can be employed to improve the course and outcome of illnesses such as schizophrenia (Hogarty, 1993). Family interventions that are primarily psychoeducational are particularly effective (Dixon & Lehman, 1995). Secondly, those that include the patient in the family intervention also appear to be superior. Multiple family groups working together are particularly effective, perhaps because of the mutual emotional support and practical advice they can share (McFarlane et al., 2003). Many of these studies of family interventions began as part of an aftercare program following discharge from a psychiatric hospital. Some others began as families simply providing support to other families in distress. Goldstein, Rodnick, Evans, May, and Steinberg (1978) found that even as few as six...

Familial Strengths and Resilience

As discussed in Chapter 2, the available evidence suggests that schizophrenia and other major mental illnesses, like many other biologically caused disorders such as asthma or hypertension, have a large genetic component. Persons with this genetic component are often vulnerable to environmental stresses or triggers that promote specific biological events, such as changes in neurotransmitter functioning. Some aspects of family life may cause stress, which in turn may trigger relapse or the recurrence of symptoms. In any case, families are neither a necessary nor sufficient cause of serious mental illness. This discussion of the role of stress in the etiology of schizophrenia and other disorders is not to deny the fact that some people with serious and persistent mental illness have had traumatic or difficult childhood experiences involving their families (as have many people who do not have serious mental illnesses). Nor is it to deny that many individuals with serious mental illness...

Brain Imaging Studies

Modern imaging techniques enabling the visualization of in vivo brain structure, neurochemistry and function have literally opened up the living human brain for scientific study. While brain characteristics from postmortem tissue in schizophrenia have been described throughout the twentieth century, the translation of abnormal tissue characteristics into living dysfunction has been difficult. Neuropathology studies often focus on end-of-life neural changes in an illness, whereas in vivo brain imaging studies can be targeted to persons with early and still active illness. Nonetheless, resolution is at the cellular and molecular level with neuropathological techniques, whereas it is only at a 2- to 4-mm resolution with in vivo imaging techniques altogether, making these two techniques highly complementary. While in other body organs, like the heart, the mechanisms of function are reasonably clear from structure, the brain is more subtle in its translation of structure into function....

Psychiatry And The Media Today

Another stereotype that the media share with the rest of the population is the classic distinction between body and mind or body and soul , which leads to the identification of mental disorders as illnesses of the soul , and therefore not to be dealt with as rigorously as other medical disorders. This misunderstanding has deep origins, since the word psyche in Greek means soul . A similar misunderstanding is caused by the origin of the word schizophrenia (in Greek, divided mind ), with the consequent confusion between that disease and multiple personality disorder. These longstanding common beliefs about word meanings are difficult to overcome, especially since most of the diagnostic techniques and treatment developments which are helping psychiatry to become a truly scientific discipline are very recent. Psychiatrists are aware of these misinterpretations, as was shown in the survey carried out in Spain in 1998 for the development of the World Psychiatric Association (WPA)'s program...

Caring For Expatriates In International Settings

Although 'self-care' is necessary, it appears that most do seek help from health care professionals for more complex medical problems. Professional help should also be sought in cases of psychosis, severe depression, suicidal ideation, anorexia nervosa, PTSD, serious difficulties with a child (including the possibility of abuse), or any mental health problem that appears to be getting worse. Organizations could increase the potential for more effective care by fostering a culture that promotes help-seeking behaviour (MMWR, 1999).

Animal Investigations Behavioural Paradigms

Startling stimulus is preceded by a weak prestimulus, there is a suppression of the normal reflex 202 . This so-called prepulse inhibition (PPI) is not a form of conditioning, but rather seems to be a measure of sensorimotor gating that involves descending limbic cortico-striato-pallido-pontine circuitry. PPI has been found to be defective in schizophrenia 203 . Specifically, patients with this disorder show a failure to habituate the startle response and, although this is not specific to this disorder, it provides a useful window into how a complex circuit may be functionally regulated. Defects of PPI like that seen in schizophrenia could involve alterations in the integration of the dopamine, serotonin, glutamate and GABA neurotrans-mitter systems 201 . There are many different behavioural paradigms that could potentially be used in modelling for schizophrenia in rodent studies. Fear conditioning represents a particularly important one, as it measures potentiated startle responses...

Gene Therapy of the Nervous System

Congenital neurologic diseases are among the most devastating human developmental defects. It is believed that most of these disorders are caused by either a single gene defect or combination of multiple genetic defects and environmental factors (72). In the beginning, neurological disorders were not considered prominent candidates for gene therapy due to the complex nature and physical inaccessibility of the nervous system. Recent advancements in molecular genetics have paved the way for understanding the role of different genes in neurological disorders (73). The genetic components of neurological disorders like Huntington's disease (74), Alzheimer's disease (75), adreno-leukodystrophy (76), and a number of others have been reported. Molecular neurologists are optimistic that they will identify the pathogenesis of complex neurologic disorders like Down's syndrome, schizophrenia and bipolar disease at the molecular level (77,79). Stable in vivo gene expression in neurons to correct...

Depersonalization Disorder DSM code 3006

Experience not occurring exclusively during the course of another mental disorder, such as Schizophrenia, Panic Disorder, Acute Stress Disorder, or another Dissociative Disorder, and not due to direct physiological effects of a substance or general medical condition Dissociative Fugue (DSM code 300.13)

Stages of Change A Case Study Applying Motivational Interviewing

A licensed clinical psychologist and professor of psychiatry at Dartmouth Medical School, through his extensive research and writing, Kim T. Mueser, Ph.D., has added immeasurably to the psychiatric rehabilitation knowledge base. Dr. Mueser effectively combines keen insights from his clinical practice with an ability to design and carry out highly relevant research. A prolific scholar, he has published books and articles on a wide range of topics within psychiatric rehabilitation, some of which include social skills training, dual diagnosis, behavioral family training, coping with schizophrenia, and cognitive approaches. Dr. Mueser is also a highly sought after speaker for gatherings of psychiatric rehabilitation professionals worldwide.

History and Future Directions

Writing in the late 1800's, the eminent physician Emil Kraepelin was among the first to document the symptoms and course of schizophrenia, referring to it as dementia praecox (dementia of early life). Subsequently, Eugen Bleuler applied the term schizophrenia, meaning splitting of the mind, to the disorder. Both Kraepelin and Bleuler assumed that organic factors are involved in schizophrenia. Later research confirmed this assumption brain scans reveal that a significant proportion of schizophrenic patients do have organic abnormalities. The precise nature and cause of these abnormalities remain unknown. In the majority of cases, the onset of schizophrenic symptoms occurs in late adolescence or early adulthood. The major risk period is between twenty and twenty-five years of age, but the period of risk extends well into adult life. For some patients, there are no readily apparent abnormalities prior to the development of illness. For others, however, the onset of schizophrenia is...

The Burdens of Family Living for the Person with Mental Illness

British researchers observed an association between living arrangements and relapses among persons with schizophrenia (Anderson et al., 1986). Independent groups of investigators found that the emotional level within family groups with close ties presented a specific stress. Specifically, consumers whose families manifested high EE as demonstrated by criticism, hostility, and levels of emotional overinvolvement were at higher risk for relapse (sometimes 50 or more over a 9-month period), compared to consumers returning to low EE families (13 to 15 relapse rate). If a consumer had frequent contact (more than 35 hours per week) with a high EE relative, the increased relapse rate occurred even if they were compliant with their regimen of antipsychotics. A high EE environment apparently serves as a trigger for relapse. This negative high EE effect seems to be most relevant for unmarried men living in their parental homes (Harding & Zahniser, 1994). A climate of high EE in one's family or...

Major Issues And Directions For Future Research Toward A Clinical Neuropsychology Of Prospective Memory

Include other brain diseases (e.g., Alzheimer's disease, Parkinson's disease, multiple sclerosis), psychiatric disorders (e.g., schizophrenia, depression), substance abuse (e.g., alcohol, cannabis, MDMA), viral infections (e.g., HIV and Herpes Simplex Encephalitis), and developmental disorders (e.g., ADHD, autism). The patient groups were chosen in these studies mainly because they were reported to have prospective memory problems or because their pathology is related to brain areas that are supposed to be related to prospective memory. Most of these studies compared the performance of clinical groups and matched controls on one or more types of prospective memory (e.g., time-, event-, or activity-based) using tasks developed in the experimental literature. Typically, the results of these studies indicate that these patients tend to be impaired on one or more types of prospective memory (refer to Table 13.1). Among some of the studies reviewed, however, researchers have included...

Physiological Evidence of the Disease Process in the Brain

Psychiatric Rehabilitation

Many persons with schizophrenia and their families attribute the illness to psychological stress alone, a conclusion that is inconsistent with psychiatric research (Holzinger, Kilian, Lindenbach, Petscheleit, & Angermeyer, 2003). However, why would we assume that individuals who experience or observe a condition would necessarily know its origins Does being bald give you insight into the hormonal changes that have taken place to bring about hair loss Certainly not. Summarizing all available evidence on the etiology of schizophrenia, Walker, Kestler, Bollini, and Hochman (2004) reached the conclusion that both genetic and prenatal factors can influence vulnerability to this illness. The same can be said for mental illnesses in general. Subsequent processes, including brain development, that occur during adolescence and exposure to stressful events can trigger the onset of what is known as a major mental illness. The evidence is overwhelming that schizophrenia and similar conditions are...

Course Treatment and Outcome of Severe and Persistent Mental Illnesses

Efficacy of Antipsychotic Medication 79 Atypical or Second-Generation Antipsychotic Medication 80 Reasons Medications Fail 81 Medication Side Effects 82 What Are the Best Antipsychotic An individual's experience of severe and persistent mental illness can be several months to many decades in length. The course of the illness is usually characterized by a significant risk of relapse and may include persistent symptoms. Psychiatric treatments, both pharmacological and psychosocial in nature, are intended to positively impact the course of mental illness by controlling, eliminating, and reducing symptoms and reducing the length, frequency, and severity of relapses. For schizophrenia and mood disorders, psychotropic medications are often the primary treatment. These medications, when properly prescribed and taken by the individual, often result in a less virulent course of the illness. Unfortunately, although many individuals experience a great deal of relief, the outcome is rarely a...

Nicotinic Acetylcholine Receptor Channels

Nicotine Receptor

Tion of membrane excitability in neurons, as well as their ability to integrate synaptic and paracrine signals. Furthermore, nAChR-dependent Ca2+ signals enhance protein kinase activity in myotubes, leading to phosphorylation of the nAChR y-subunit. Because this process is dependent on Ca2+ influx, it can be considered as autoregulation of phosphorylation by nAChRs. Recent results indicate that point mutation in this receptor may abolish desensitization, increase the affinity for agonists, and convert the effects of competitive antagonists into the agonist responses. Such mutations also occur spontaneously in humans and may be involved in diseases such as congenital myasthenia or frontal lobe epilepsy. Nicotinic agonists might also serve as therapeutic agents for Alzheimer's disease, schizophrenia, and Tourette's syndrome.

Egas Moniz Invents Leucotomy

Prefrontal Leucotomy

The somatic theory was shaped most by Emil Kraepelin, the foremost authority on psychiatry in the first half of the twentieth century. Kraepelin distinguished twenty types of mental disorder, including dementia praecox (schizophrenia) and manic-depressive (bipolar) disorder. Kraepelin and his colleagues viewed these diseases as genetically determined, and practitioners of psychiatry developed complex physical diagnostic schema that identified people with various types of psychoses. In contrast, Sigmund Freud was the main proponent of the functional theory. Attempts to help mental patients included ECT as well as surgical removal of tonsils, sex organs, and parts of the digestive system. All these methods had widely varied success rates that were often subjective. Further differences depended on which surgeon used them. By the 1930's, the most widely effective curative procedures were several types of ECT and lobotomy (psychosurgery).

The Story of Paul Continued from Chapter

Paul was nervous about what to expect on his first day at the program. After getting a short tour of the program from one of the members, he was directed to his counselor, Ruth. Ruth invited Paul to have a seat and then chose a seat for herself across from him rather than behind her desk. You know, Paul, you and I have some important and exciting work to do. We have to figure out what you want your life to look like, what your goals are, and how to reach those goals. But before we get started on that, I wonder if you have some questions or concerns I know the first day here can be confusing. Paul was reluctant at first to ask questions, but Ruth encouraged him to be honest with her, so he talked about the people who looked like they'd been at the program forever, about schizophrenia, and about his terrible experience at college. Finally, Paul said I can't believe my life is over. I don't want to come here for the rest of my life. Good, said Ruth, then let's talk about where you do...

The Stress VulnerabilityCoping Competence Model

The stress vulnerability coping competence model was proposed by two individuals who are well known in the field of psychiatric rehabilitation, William A. Anthony and Robert Paul Liberman (1986). An elaboration of the diathesis stress model described earlier, the stress vulnerability coping competence model provides both a theory about the cause of severe mental illness and an explanatory framework for the impact that psychiatric rehabilitation and treatment interventions can have on the symptoms and functional level of people who have psychiatric disabilities. The model proposes the following Individuals inherit or otherwise acquire a vulnerability (sometimes referred to as diathesis) to major mental illnesses such as schizophrenia, major depression, or bipolar disorder. This vulnerability results in abnormal development of brain structures and processes or an unusual type of stress reaction. Cheryl has been coping with schizophrenia for 10 years. For the last 2 years she has been...

Obsolete Etiological Theories

The scientific community has made real progress in its understanding of the etiology of the major mental illnesses. At the same time, the public is still exposed to a number of discredited or obsolete theories about what causes major mental illness. Most of these obsolete theories center on early childhood psychological trauma or abusive family environments as causal factors. Harding and Zahniser (1994) describe the familial role in etiology as one of the great myths about schizophrenia. While a dysfunctional family environment is clearly unpleasant, often stressful, and may be associated with some psychiatric disorders, it apparently is not the primary cause of severe and persistent mental illness. One discredited theory traced the cause of schizophrenia to schizophrenegenic mothers. Supposedly, these mothers caused schizophrenia in their children by giving them mixed messages, for example, simultaneously encouraging independence and engendering