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. Read more here...

The Schizophreniafree Package Overview


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Cognitive Impairment In Schizophrenia

Kraepelin (1913) and Bleuler (1911), the psychiatrists who originated the concept of schizophrenia, were also responsible for the view that intellectual function was not affected. Kraepelin believed that the dementia of his term dementia praecox predominated in the emotional and volitional spheres and that memory, in particular, was comparatively little disordered. Part of Bleuler's stated reason for renaming dementia praecox as schizophrenia was that he considered the connotation of intellectual impairment to be misleading. According to him, lack of motivation, withdrawal, distraction by psychotic symptoms and other more esoteric factors could and did cause patients to perform poorly on certain tests at certain times, but all mental faculties remained fundamentally intact underneath. With respect to memory, Bleuler (1911) was emphatic Notwithstanding these assertions, psychological studies carried out in the early part of the century quickly established that patients with...

Memory Impairment In Schizophrenia

Credit for the first detailed exploration of memory in schizophrenia belongs to Calev and co-workers (Calev, 1984a, 1984b Calev et al., 1983, 1987a, 1987b). In a series of studies carried out mainly on chronic schizophrenic patients, they found evidence of substantial impairment in verbal and nonverbal episodic memory tasks. The deficits affected both recall and recognition, although the former appeared to be of considerably greater magnitude. Evidence of retrograde amnesia was also found. modern diagnostic criteria for schizophrenia and compared patients with well-matched normal controls on a range of memory measures. Eight of the 10 studies found significantly impaired performance on some or all of the tests used (Calev et al., 1987b Gruzelier et al., 1988 Gold et al., 1992b Goldberg et al., 1993 Landro et al., 1993 Elliott et al., 1995 Paulsen et al., 1995 Rushe et al., 1999) and only two studies failed to find any differences (Shoqeirat & Mayes, 1988 Morrison-Stewart et al.,...

The Functional Consequences Of Memory Impairment In Schizophrenia

While poor performance on memory, executive and other cognitive tests is established beyond reasonable doubt in schizophrenia, the degree to which this translates into corresponding failures in daily life is less certain. This is not an trivial issue, because for most of the twentieth century it was believed that there was no genuine cognitive impairment in the disorder, a dogma that was undoubtedly shored up by a lack of obvious forgetfulness or other cognitive difficulties in the majority of patients encountered in everyday clinical practice. This could, of course, merely reflect the fact that memory impairment only becomes obvious in the most severely and chronically ill patients, where it is easy to overlook amidst their multiple other symptoms. But other interpretations are possible, one of which is Bleuler's (1911) original assertion that cognitive impairment in schizophrenia is fundamentally different in nature from that seen in brain damage or dementia. Green (1996 Green et...

Neuregulin1 and Susceptibility to Schizophrenia

Schizophrenia is a severe psychiatric disorder with a lifetime risk of 0.5-1 . The disease is characterized by psychotic symptoms, reduced interest and motivation, altered emotional reactivity, and disorganized behavior. Affected individuals often show subtle cognitive and social deficits preceding the first manifestation of disease, which can occur in early childhood. Typically, schizophrenia is a relapsing disorder with episodes of only partial remission and produces life-long disability (Owen et al. 2005). Early onset of initial symptoms and the lack of obvious signs of neurodegeneration in affected individuals have lead to a revised view of the pathology of schizophrenia, which is now more often considered to be a neurode-velopmental disorder (Corfas et al. 2004). Although family and twin studies have unambiguously demonstrated an increased risk of illness for relatives of patients suffering from schizophrenia, with heritability rates as high as approx. 80 , it is clear that...

Schizophrenia and the Limbic System

Schizophrenia is a mental disorder that features a disturbance of cognitive and sensory processes leading to hallucinatory experiences, delusions, and disturbances of thought. In addition, the illness shares many features such as paranoia, suspiciousness, and unrealistic thinking. This serious disorder is characterized by a loss of contact with reality (psychosis). mine from this cortex has effects similar to that of lesions. Disturbances of the dopaminergic systems are presumed to contribute to the symptoms of schizophrenia. Current thinking concerning the etiology of schizophrenia involves a genetic component and combinations of prenatal and postnatal insults to the developing brain. A series of damages occurring in the developing dopa-minergic system is thought to contribute to the clinical symptoms of hallucination and delusions by the release of excessive amounts of dopamine. One theory accounting for the symptoms of schizophrenia involves the interactions of disturbed...

Schizophrenia and Delusional Disorder Somatic Type

In schizophrenia, the patients complaints center around a delusional belief of ill health. Unlike anxious patients who are fearful of illness, delusional patients (whether with schizophrenia, delusional disorder, or major depression) are convinced they are ill, often with a bizarre or unusual infestation, poisoning, metabolic derangement, or physical malformation. The diagnosis of schizophrenia is suggested by a history of previous episodes of hallucinations or delusions in clear consciousness and by the absence of evidence of coarse brain disease or major depression. The prevalence of schizophrenia in primary care settings is less than 1 percent. A psychiatric evaluation revealed a disheveled woman who admitted to several psychiatric admissions because of voices since her early twenties. Examination of her mental state revealed the delusional belief that her itching was caused by small worms that had infiltrated her skin. She scratched some skin debris from her arm and gave it to the...


Callosal Morphometry People with schizophrenia exhibit subtle and diffuse alterations in cerebral structure as revealed by evidence from postmortem and in vivo imaging studies. However, none of these neuroanatom-ical abnormalities have been shown to be requisite for diagnosis (Stevens, 1998). Nevertheless, technological advances in structural and functional imaging protocols and improvements in quantitative methods for measuring brain morphology and activation continue to increase the sensitivity with which deviation of neuro-anatomical and functional norms can be detected. In spite of novel imaging techniques and applications, mor- phometric findings in schizophrenic populations frequently lack consensus and fail to expose reliable patterns of structural variation within and across schizophrenia subtypes compared to normal. In fact, the reported morphometric differences appear to be as variable as patient symptomatology. Imaging studies designed to detect macroscopic alteration of...

Hallucinations Illusions and Delusions

Hallucinations and delusions are rare among people living in the community, and their presence should lead the physician to consider disorders such as delirium, dementia, manic-depressive illness, schizophrenia, and drug abuse. Hallucinations are perceptions without stimuli and can occur in any sensory modality. Auditory and visual hallucinations are the most common types, and the physician can ask about them while reviewing the patients hearing and vision (e.g., Have you been hearing noises or voices that people who were with you couldn't hear Have you been seeing things with your eyes open that people who were with you couldn't see ). Remember that hallucinations are experienced as real perceptions, so questions such as Did you ever hear see feel something that wasn't there may not elicit an accurate response.

The Corpus Callosum And Clinical Investigations 389

19 Using the Corpus Callosum as an Effective Anatomical Probe in the Study of Schizophrenia Patricia E. Cowell, Victor Denenberg, Gary Boehm, Andrew Kertesz, and Henry Nasrallah 433 20 Interhemispheric Abnormalities in Schizophrenia and Their Possible Etiology Robert W. Doty 445

Mental Health of Hispanics in the United States

Showed that African Americans reported somewhat higher rates of any disorder, with substantially higher rates of phobias, schizophrenia, and cognitive impairment, than did other groups. Hispanics had very high scores on depression and alcohol abuse or dependence (Holzer et al. 1995). Table 1 -3 illustrates some of the differences in psychiatric disorders between whites, blacks, and Hispanics. Schizophrenia

American Parkinson Disease Association

American Schizophrenia Association A national support group for health professionals, patients, and their families that seeks the cure and prevention of schizophrenia through research into its biochemical and genetic causes. It supports research, seeks to educate the public, and encourages formation of local support groups (Schizophrenic Anonymous).

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.

Refractory Hyponatremia with Lung Cancer

Past history is significant for schizophrenia diagnosed 15 years ago and for oat cell carcinoma of the left lung diagnosed 3 years ago with the patient subsequently undergoing left pnuemonectomy followed by chemotherapy. One month prior to this admission, CT scan of the chest and abdomen revealed recurrent oat cell carcinoma of the left hemithorax that is currently being treated by radiotherapy. CT scan of the head at the time revealed no evidence of brain metastasis. Physical examination revealed a confused, agitated, and moderately obese white female. Vital signs temperature 36.7 C, respiratory rate 24, blood pressure 150 90 mm Hg, pulse 104 bpm. Slight ankle edema was noted, but the remainder of the physical examination was unremarkable. Relevant laboratory investigations at admission revealed the following

Antipsychotic drugs neuroleptic drugs Group

Of drugs sometimes referred to as major tranquillizers. Used short term to calm or sedate disturbed patients, to control acute symptoms of mania and relieve severe positive symptoms of schizophrenia. Most act by reducing levels of the neurotransmitter dopamine in the central nervous system (e.g. chlorpromazine, haloperidol, flupentixol), but the atypical antipsychotics (e.g. risperidone, clozapine) act by interfering with serotonin-based neurotransmission.

Chlorpromazine Trade name Thorazine A

Used to treat schizophrenia and mania and to control severe anxiety and nausea or vomiting. Chlor-promazine also enhances the effects of painkillers and is used to treat terminally ill patients and those undergoing anesthesia. Chlorpromazine works primarily by blocking dopaminergic receptors.

Mandala a Symbol of Psychic Wholeness

Manifest what is latent in the rest of us. Drugs can trigger psychosis by chemically inducing an encounter with images of the archetypal unconscious. Direct experience is dangerous, but the collective unconscious can be approached cautiously, with the aid of symbols and myths.

Cluster headaches See headaches

Cocaine and the brain Cocaine, an alkaloid derived from the coca plant (Erythroxylon coca), produces its stimulating effects by enhancing the activity of dopamine and norepinephrine neurons. (It is dopamine that also plays a key role in the development of schizophrenia and Parkinson's disease.) Cocaine works by not only increasing the release of norepinephrine and dopamine, but also by blocking their reuptake. This overuse of the two systems takes its toll on the brain areas that normally rely on these neurotransmitter systems for function learning and memory areas, and limbic structures. This is why heavy cocaine use leads to emotional and cognitive disorders.

Definition of the Disease

The cause of hypothyroidism may be primary (thyroid dysfunction), secondary (pituitary dysfunction), or tertiary (hypothalamic dysfunction). Primary hypothyroidism is 1000-fold more common than secondary or tertiary causes.1 Hypothyroidism is associated with cold intolerance, weight gain, constipation, dry skin, bradycardia, hoarseness, and slow mental processing.1 In adults, the characteristic signs and symptoms of hypothyroidism may have an insidious onset. Chronic cutaneous changes include dry, puffy skin with a yellowish complexion as well as a thickening of the subcutaneous tissues due to accumulation of mucopolysaccharides. The hair becomes dry and brittle and is often sparse. The voice may deepen in pitch, and hypoventilation has been observed. Hypothyroid patients can show decreased pulse rate, decreased cardiac stroke volume, and decreased myocar-dial contractility that causes decreased cardiac output. Since peripheral metabolism is slowed, arteriovenous oxygen may not show a...

Electrical activity mapping

The next year, he published the results of his first 20 operations on patients who had suffered from anxiety, depression, and schizophrenia. His article was well received despite the fact that his follow-up extended only to a few days after surgery. He described the procedure in the 1936 textbook of psychosurgery, Experimental Surgery in the Treatment of Certain Psychoses. His work inspired American neurologists Walter Freeman and James Watts to perform the first American leucotomies.


If delirium is not recognized as the issue and the root cause is not discovered, then 20 percent of people who have such symptoms typically die of the stress on the central nervous system. Delirium is often mistaken for psychosis or other mental disturbances, and other illnesses or acute conditions must be treated and eliminated before possible mental health issues can be addressed.

Treatment by the Psychiatrist with Medical Followup

The psychiatrist might recommend treatment on an inpatient basis. This is needed for severe depressions with suicidal thinking and is often necessary for schizophrenia with delusions and for hysteria when the patients behavior involves falling or an inability to walk or is associated with drug dependence and a need for detoxification. After discharge, such patients often need continued treatment by the psychiatrist with medical follow-up provided by the primary care physician.

Incidence of Mental Illness

In 1996, a large-scale nationwide mental health and substance abuse epidemiological study was conducted by researchers from the University of Antioquia and the University CES of Medellin. Funded by the Ministry of Health and working with a national team of more than 100 interviewers, the researchers interviewed a random sample of 15,046 individuals older than 12 years of age across the country, using the Clinical Diagnostic Inventory II questionnaire, which is based on the DSM-IV classification. This is the most comprehensive mental health study ever conducted in Colombia. The lifetime prevalence of diagnosable disorders was as follows nicotine dependency, 28 major depression, 19.3 alcohol abuse and dependency (combined), 16.6 posttraumatic stress disorder, 4.5 somatization, 4.3 generalized anxiety, 3.8 and schizophrenia, 1.4 . The lifetime use of marijuana was 7.8 and of cocaine 2.5 (Torres and Montoya 1997). Suicide is also a public health problem in 1995, a total of 58,830 suicides...

Suicide and Psychiatric Disorders

When investigators in different countries examine the medical records and interview the family and friends of people who have died by suicide, they find the same result almost everyone who commits suicide had signs of a psychiatric disorder, and about half had sought psychiatric help in the past. The posthumous diagnoses most often are affective disorders (major depression or bipolar disorder), substance abuse disorders, personality disorders, and schizophrenia. At least two-thirds of persons who committed suicide had symptoms of major depression before death. Clinical and community studies reveal that patients with psychiatric disorders have a remarkably high lifetime risk of completed suicide. Major depression has been associated with a 15-20 percent rate of completed suicide in follow-up of hospitalized patients (who are at higher risk for suicide because suicidal thought and self-injurious behavior are strong indications for hospitalization). Individuals with depression diagnosed...

Definition of Disease

The diagnosis of the case presented above was secondary syphilis with concurrent neurosyphilis. As mentioned, neurosyphilis is no longer considered to be a distinct phase of disease. It is a manifestation of infection that can occur early with the appearance of the chancre, late in disease when blindness and dementia have set in, or at any point in between. Up to 10 of individuals with neurosyphilis will be asymptomatic, and symptomatology may be different depending on the stage of disease with which it is associated.1 The possible symptoms of neurosyphilis include cognitive dysfunction, motor or sensory nerve deficits, ocular or auditory deficits, cranial nerve palsies, meningitis, or seizures, although rare.1 Early neurosyphilis typically presents as meningitis with or without cranial nerve or ocular involvement. Late neurosyphilis involves the brain and spinal cord, leading to general paresis, rapid progressive dementia with episodes of psychosis, bowel and bladder dysfunction, and...

Implementation of the Plan

A history of major withdrawal phenomena (e.g., delirium tremens, acute withdrawal hallucinosis, seizures) calls for inpatient detoxification. Fever or significant medical comorbidity (such as pneumonia or systemic infection, liver or other active gastrointestinal disease, a history of cardiac dysfunction, malnourishment, and recent trauma) is also an indication for inpatient detoxification. Patients with psychiatric disorders (such as major depression, mania, panic disorder, and schizophrenia) or who are using multiple psychoactive drugs are best detoxified on inpatient psychiatric units. Patients with histories of major alcohol withdrawal but who are otherwise healthy can sometimes be safely detoxified in residential treatment facilities that have 24-hour medical supervision. Detoxification in such facilities is indicated for patients who have failed outpatient detoxification,

Marilyn A Davies Chiaoying Chang and Bryan L Roth

This chapter first describes the structural changes involved in genetic polymorphisms, mRNA editing, and alternative mRNA splicing of 5-hydroxytryptamine (5-HT) receptors. These structural changes lead to modifications in the production and characteristics of 5-HT receptors and affect protein expression. Functionally, they affect radioligand binding, signal transduction, and receptor sensitivity, thus affecting interindividual variation in responses to therapeutic agents, particularly antipsychotics and antidepressants. Studies indicate that genetic polymorphic and post-transcriptional modifications of 5-HT receptor structure contribute also to pathological processes related to irritable bowel syndrome, cardio-pulmonary problems, psychiatric illness (i.e., schizophrenia and mood disorders), Alzheimer's disease, problems involving increased food and alcohol intake, and behavioral problems such as impulsivity, self-harm, and aggression. In the second part of this chapter, the 5HT2A,...

Vocabulary Builder

Rauwolfia Alkaloids Alkaloids from Rauwolfia serpentina Benth and other species. The prototype is reserpine, which is a depleter of catecholamines and serotonin from the sympathetic postganglionic fibers and brain areas. They have been used in hypertension and psychoses despite their wide

Genetics and Human Behavior

Most weekly of genetic influence on all aspects of human nature, from neuroses and psychoses to religiosities and ethical persuasions. Few serious researchers expect that complex human behaviors or behavioral disorders typically will conform to the so-called OGOD model one gene, one disorder. More likely, most behavioral and psychological attributes will prove to be influenced by many interacting genes in collaboration with environmental exposures. In dispute are the magnitude and nature of the genetic contributions.

Nuclear magnetic resonance NMR See magnetic Resonance Imaging Mri

Nucleus accumbens A region in the limbic system where there are a large number of dopamine neurotransmitters, which are involved in various brain functions, including movement and emotion. Much of the effects of cocaine and amphetamines occur in this part of the brain, which may be permanently damaged by abuse of these drugs. chronic administration of these drugs in animals has produced such permanent damage at its worst, the result may be a psychotic condition much like schizophrenia, which is also believed to be related to dopamine.

Common Expressions of Distress Attitudes and Reactions

Nervous) is probably the most commonly used chief complaint irrespective of eventual underlying disorders. This idiom of distress has been reported in other parts of Latin America and is described extensively by Low (1985). In my experience, this is a neutral phase used to express subjective discomfort regardless of whether the discomfort stems from anxiety, depression, or psychosis. Other phrases are occasionally used, such as ancioso (anxious), desganado (lacking interest or energy), and como si quiero correr (I feel like running agitation). Nervioso or nerviosa is neutral in the sense that it suggests an emotional problem but does not necessarily imply mental illness (enfermo mental) or worse still, locura (psychosis or craziness). It thus makes it easier for the person to accept the patient role and the need for treatment.

Specific Clinical Patterns

Several specific psychopathological patterns are commonly observed clinically. Some have also been systematically observed in other Hispanics. Others have not and are more anecdotal. Escobar (1987) described the tendency to soma-tize in Hispanics, and this certainly occurs in Mexican Americans however, no evidence, clinical or epidemiologic, suggests greater occurrence in the latter group than in other Hispanics. Anecdotally, the occurrence of mild psychotic symptoms accompanying depressive disorders should be mentioned. These symptoms may consist of fleeting shadows or bultos (forms) that occur in the evening and usually are frightening to the patient. They often subside with treatment of the underlying depression or agitation and may not require the administration of antipsychotic medication. The content of delusions may reflect elements of Mexican or Mexican American culture. The Virgen de Guadalupe, the patron saint of Mexico, may figure dominantly in religious delusions, as might...

Theory Of Mind In Atypical And Pathological Developmental Conditions

Further data are available with the numerous studies on schizophrenia in adults (Frith & Corcoran, 1996 Sarfati et al., 1999 Corcoran, 2000 Pickup & Frith, 2001 Mazza et al. 2001 Bruene, 2003), and in developmental age (Pilowsky et al., 2000). More specifically, even if these studies also show that, on the one hand, there are theory of mind difficulties in disorders other than autism, such as schizophrenia, on the other, they prompt further research into the specificity question, as it seems that the theory of mind deficit hypothesis could be extended to schizophrenia, and this is the issue being discussed at present (Davies & Stone, 2003 Gerrans & McGeer, 2003). Intense work is also being carried out, using the vast behavioural, neuro-anatomical and neuro-imaging research now available in the field of pathology, on modelling the different theory of mind disorders observed to date. In these models there is a specific explanation of theory of mind...

Some Traits May Require A Threshold Number Of Deleterious Alleles

If all of this seems less solid or more confusing than simple Mendelian inheritance, it is. The understanding of polygenic traits and of genotype-environment interactions is becoming an increasingly interesting and profitable avenue of inquiry in human genetics. Multifactorial inheritance presumably underlies some of the more clinically important human traits, such as susceptibility to several major diseases or illnesses (e.g., heart disease, stroke, diabetes, schizophrenia). Some data also support the notion that alcoholism may involve multifactorial inheritance. It is also possible, as noted earlier, that this type of inheritance might play a role in establishing some crucial aspects of personality, as well. Thus it is worth considering just how one would recognize multifactorial inheritance in a pedigree.

Relevant Findings Of Preclinical And Clinical Studies

Symptoms of Schizophrenia Symptoms of schizophrenia may be related to hypocretin effects, as suggested by preclin-ical findings of bidirectional interactions with dopaminergic neurons (8) and by observations that both dopamine (DA) and hypocretin enhance attention and wakefulness. Generally DA activates hypocretin, and probably vice versa as well (12). A synergism with DA is evidenced by centrally administered hypocretin, which increases locomotion, stereotypy, and grooming, and is blocked by D2 (haloperidol) and Dj antagonists (SCH23390) (12). The tendency toward weight gain in schizophrenia, as seen also in narcolepsy, is consistent with a deficit hypothesis regarding behavioral activation by hypocretin. However, elevated hypocretin might equally cause excessive behavioral activation and could just as easily be interpreted as agitation causing increased feeding behaviors. Overall, however, schizophrenic patients show normal levels of hypocretin (4,13). Among 13 schizophrenic...

Cyrano and Scheherazade

A classic symptom of paranoid schizophrenia is the belief that alien beings sometimes transmit their thoughts to us through invisible waves that influence our behavior. But every professor of linguistics knows that all ordinary people routinely transmit their thoughts to us through invisible waves that influence our behavior. The linguistics professors sound even more paranoid than the schizophrenics, but they simply have a greater respect for language. Most schizophrenics, like most other people, take language for granted, whereas language researchers recognize it as a signaling system of almost miraculous power and efficiency.

Schizophrenic Memory Impairment A Specific Neuropsychological Deficit

It is clear that memory impairment in schizophrenia is present against a background of overall intellectual impairment, which can be quite severe in some patients. In these circumstances the question arises whether the memory deficit is merely part of a pattern of generally poor cognitive performance, which would show itself on any test, or whether it is present over and above this, and hence sometimes appears as a relatively circumscribed deficit.

The Pattern Of Memory Impairment The Case For A Schizophrenic Amnesia

It is almost a requirement of clinical memory disorders to show dissociations, i.e. a pattern of impairment and preservation of function across the different subdivisions of memory. However, the fact that memory impairment in schizophrenia commonly occurs against a background of some degree of general intellectual impairment will tend to obscure any such pattern, since scoring on all tests will be depressed to some extent. This noise can be reduced by controlling for general intellectual function in the analysis, or alternatively by testing only patients who meet some criterion of overall intellectual intactness. A further strategy that has occasionally been employed is to select patients on the basis that they show substantial levels of general memory impairment and then examine them for areas of spared function. There is no controversy that this memory store is affected by schizophrenia. The vast majority of studies have included (and have often relied exclusively on) long-term...

The Role Of Executive Function In Schizophrenic Memory Impairment

In recent years the concept of abnormal frontal lobe function has dominated schizophrenia research, with most if not all current theoretical approaches invoking some form of executive impairment (e.g. Weinberger, 1987 Gray et al., 1991 Frith, 1992 Andreasen, 1999). The origins of this view can be traced back to claims for hypofrontality in functional imaging studies which began to be carried out in the 1980s. These were followed by a number of structural imaging studies which claimed to find reduced frontal lobe volume in schizophrenic patients. Ten years on, it is apparent that hypofrontality was only ever found in a minority of studies under resting conditions (Chua & McKenna, 1995), and it seems likely that any frontal lobe volume reductions in schizophrenia are no greater than those for the brain as a whole (Lawrie & Abukmeil, 1998 Wright et al., 2000). What survives is a somewhat more consistent body of evidence supporting task-related hy-pofrontality in schizophrenia, i.e....

Traumatic brain injury 313

Antipsychotic drugs work by blocking the action of dopamine, a neurotransmitter acting on the brain. lithium is an antipsychotic drug that is thought to reduce the release of norepinephrine, another neurotransmitter. They are used to treat psychoses, particularly schizophrenia and manic depression. They are also used to calm or sedate those with other mental disorders, such as dementia, who have become agitated.

The Mesocorticolimbic System Mesolimbic System and Nucleus Accumbens

The dopamin-ergic mesocorticolimbic system originates in the VTA and projects to the cortex, particularly to prefrontal and the anterior cingulate gyrus. This system is involved in the positive reinforcement of such activities as feeding, drinking, sexual activity, and drug abuse (cocaine, opiates, alcohol, and marijuana). The prefrontal cortex is involved in the organization of activities associated with rewards, motivation, planning, attention, and social behaviors (Chap. 20). In addition, rostral projections from the amygdala to the anterior cingulate gyrus and the orbitofrontal cortex contribute to arousal and the conscious perception of emotion. Arousal is also enhanced by interconnections with the adrenergic locus ceruleus and the VTA, as well as by connections with the basal nucleus of Meynert. In humans, dysregulation of the MCLS is associated with the positive and negative symptoms of schizophrenia that bear some resemblance to the defects seen after...

The Medicine Of Mental Health

Psychiatry is the field of medicine dedicated to the prevention, diagnosis, and treatment of mental illness. The diseases they treat include depression, bipolar disorder, schizophrenia, addiction, delirium and dementia, anxiety, and personality disorders. Psychiatrists meet an essential need within medicine. Psychiatric disorders, which are extremely common in society, often remain undiagnosed. In a given year, nearly 22 of all Americans over the age of 18 suffer from a diagnosable mental disorder.1 Like physical diseases of the body, these conditions range in severity. They can cause mild social withdrawal, severe occupational impairment, or even be life threatening. Although many patients may not even appear ill, others present with withdrawal, psychosis, or confusion. This wide scope of disease provides intellectual stimulation and daily challenge.

Korsakoffs Syndrome and Ablations of the Hippocampus

Patients with a form of amnesia, known as Korsakoff's syndrome, have pathology in neural complexes associated with the limbic system, namely the mammillary bodies of the hypothalamus and the dorsomedial nucleus of the thalamus. This affliction is the consequence of chronic alcoholism and thiamine deficiency. The patient displays profound memory loss and becomes easily confused. People who have undergone bilateral removal of the anterior temporal lobe, including the amygdala and the hippocampus, also exhibit the symptoms. The patient forgets to answer a question just asked or might reply with an irrelevant answer (called compensatory confabulation). Patients with this psychosis learn slowly, but once the subject matter is mastered, they appear to forget at a normal rate. One concept suggests that the memory deficits are the result, in some degree, of

Ect Treating The Mind With Electricity

When patients struggling with their disease do not respond to mainstay treatment, clinicians sometimes turn to the single procedure available in their therapeutic arsenal electroconvulsive therapy (ECT). Most people's perception of ECT as brutal and cruel comes from movies such as One Flew over the Cuckoo's Nest and A Beautiful Mind, which depict the early use of shock therapy. During the 1940s and 1950s, psychiatrists in the United States usually performed ECT on the most severely disturbed patients, such as those who suffered from schizophrenia or multiple personality disorder. In the early days of the treatment, physicians often conducted ECT at high doses for long periods of time. This method proved harmful to patients, giving ECT its reputation as an abusive treatment, which was compounded by doctors' and nurses' use of it to gain control over unruly patients. Today, psychiatrists turn to ECT as one of the most effective (and safest) treatments available for major depressive...

Reflections On Mental Illness And Psychiatry

Many colleagues in medicine who do not look highly upon psychiatry consider its treatments less effective than those in other areas of medicine. The evidence seemingly refutes this misperception. With its wide array of powerful drugs, treatment in modern psychiatry surpasses conventional therapies found in other areas of medicine. In a study by the National Institutes of Mental Health, the success rates (defined as substantial reduction or remission of symptoms) in treating mental illness were superior to certain medical procedures. It looks like psychiatrists have the edge over cardiologists the success rates for treatment of depression (60 to 65 ), schizophrenia (60 ), and panic disorder (80 ) were significantly higher compared to acute coronary syndromes treated with angio-plasty (40 ) and atherectomy (50 ).3 In a similar study, the success rates of therapy for addictive disorders, such as alcoholism (50 ) and cocaine dependence (55 ), were on the same level as chronic medical...

Clinical Manifestations

Tardive dyskinesia is a form of dyskinesia that occurs in some patients following the chronic administration of phenothiazines (antipsychotic and tranquilizing drugs) as therapy for such psychoses as schizophrenia. The symptoms can include facial grimacing, lip smacking, and choreoathetotic movements of the limbs and trunk. Treatment is to stop giving

David H Farb Janine L Steiger Stella C Martin Maria C Gravielle Terrell T Gibbs and Shelley J Russek

The y-aminobutyric acid (GABA) neurotransmitter acting through ionotropic and metabotropic receptor classes exerts the major inhibitory control in the central nervous system. Therapeutic agents targeting GABA receptors (GABA-R), such as benzodiazepines and baclofen, are used to treat many nervous system conditions, including anxiety and spasticity. The subunit composition of GABA-Rs at the cell surface plays a critical role in determining their physiological and pharmacological properties, and alteration of GABA-R subunit expression has been associated with a number of diseases including schizophrenia, temporal lobe epilepsy, and alcoholism. The ionotropic type A GABA receptor (GABAaR) and type C GABA receptor (GABACR) are pentameric complexes that comprise a ligand gated chloride channel. The metabotropic type B GABA receptor (GABABR) is a heterodimer that couples G protein-signaling to GABA binding. There are eight classes of ionotropic receptor subunits and only two metabotropic...

Peripherally inserted central catheter PICC line

Perphenazine Used to treat acute and chronic psychotic disorders may be used as a tranquilizer to help agitated and disruptive behavior in the absence of true psychosis sometimes used to treat severe nausea and vomiting. By inhibiting dopamine, perphenazine acts to correct an imbalance of nerve impulse transmissions thought to be responsible for mental disorders. Perphenazine belongs to a class of psychoactive drugs called phe-nothiazines, which have potent effects on the central nervous system and other organs. They can reduce blood pressure, stop seizures, control nausea and vomiting, and control the symptoms of psychosis. Perphenazine is available as tablets, oral concentrate, and solution for injection. It is also available in a number of combination products with the tricyclic antidepressant amitriptyline.

Major Dsm Syndromes And Their Clinical Differentiation From Narcolepsy

Schizophrenia A salient feature of the schizophrenias is a prominent deficit in higher thought processing. All four of Bleuler's classically described core symptoms (loosening of associations, affective flattening, autistic features, and ambivalence) can be observed in each of the five subtypes of schizophrenia. Extreme loosening of associations is among the most valuable criteria but must be differentiated from similar symptoms in mania, impaired consciousness, fatigue, or distraction. Bizarre behaviors (posturing, mirror gazing, grimacing) are another key symptom, suggestive of a disturbed integration of reality, and can include true catalepsy (not cataplexy). However, schizophrenia has no pathognomic single symptom, and all symptoms may be observed in at least one other disorder. Dominant distinguishing symptoms in terms of frequency include lack of insight, auditory and verbal hallucinations, ideas of reference, suspiciousness, flat affect, voices addressing the patient,...

Freuds Later Therapeutic Technique

Freud (1933 1964) noted several limitations of psychoanalytic treatment. First, not all old memories can or should be brought into consciousness. Second, treatment is not as effective with psychoses or with constitutional illnesses as it is with phobias, hysterias, and obsessions. A third limitation, by no means peculiar to psychoanalysis, is that a patient, once cured, may later develop another psychic problem. Recognizing these limitations, Freud felt that psychoanalysis could be used in conjunction with other therapies. However, he repeatedly insisted that it could not be shortened or modified in any essential way.

Impact of oxidative stress on spermatozoa

There is now abundant evidence indicating an increased incidence of conditions such as cancer, schizophrenia or dominant genetic mutation in the children of men with DNA damage in their spermatozoa because of their age, lifestyle or occupation (Lewis and Aitken, 2005). Since spontaneous mutation rates in the male germ line are extremely low (Hill et al., 2004), it has been hypothesized that malemediated pathology arises because of the aberrant repair of DNA damage in the early embryo, rather than the direct transfer of mutations from the male germ line to the offspring (Aitken, 1999 Aitken and Krausz, 1991 Aitken and Marshall Graves, 2002 Aitken et al., 2004b) (Fig. 7.4). Clearly, such fundamental issues merit further attention.

Conclusion To Memory Disorders

Nowadays, there can be no real doubt that memory belongs to the cognitive domains which show major impairment in schizophrenia, as Aleman et al. (1999) concluded in their meta-analysis. Whether in this case major means disproportionate to the general intellectual impairment also found in the disorder is a question that remains at the present Beyond this, considerably less is known. The available evidence suggests that cognitive impairment appears to represent an independent dimension of pathology in schizophrenia, which is a function of severity and chronicity of illness but is not closely linked to positive or negative symptoms (Mortimer & McKenna, 1994 De Vries et al., 2001). It is also an enduring feature of the disorder that, as far as is known, does not change significantly over time. A typical profile of IQ and neuropsychological test impairment has been found to be present at the time of first onset of illness, and follow-up studies have uniformly failed to find that the...

Demyelinating disorders

Dementia The general decline in all areas of mental ability, including memory, personality, visual skills, spatial relations, and general thinking ability. It may be caused by organic mental disorders (as injury or illness), or it may be a symptom of mental disturbance such as schizophrenia. More than 10 percent of all those over age 65 and 20 percent of those over age 75 have some degree of dementia. As the dementia progresses, the patient may begin to make unreasonable demands or accusations, begin stealing, and even attack others physically. Paranoia, depression, and psychosis may develop as the disease worsens, and personal habits deteriorate. Eventually, demented individuals require total nursing care, including assistance with feeding, toileting, and physical activities.

Adaptation and Adjustment

Including those of Freud, Jung, Adler, Horney, Erikson, Rogers, and Kelly. Others, developed outside the clinical setting, have suggested new forms of therapy. These include the theories proposed by Skinner and Bandura, which suggest improving adaptation by teaching people more effective behaviors and (in cognitive approaches) more effective ways of thinking about oneself and life's tasks. Even Cattell's empirical theory has examined neurosis and psychosis and produced clinical diagnostic questionnaires. A few theorists criticize excessive theoretical concentration on maladjustment. Humanists are particularly concerned with the development of full human potential in adulthood, and they call attention to the more integrated and developed self.

The Atomization of Human Behavior

Schizophrenia, the most common psychosis, involves disorders of the thinking process that lead to delusions and hallucinations, paranoia, and withdrawal of the individual from other people and the outside world. Genetic influence is suggested by the fact that relatives of schizophrenics are at several-fold greater risk for the disease (even when raised separately), and that an identical twin of a schizophrenic is twice as likely as a fraternal twin to display the disorder. Evolutionary speculation has centered on why schizophrenia is so common in diverse societies worldwide (about 1 percent of the population), and whether it may have had some selective advantage.38 However, a clear understanding has yet to emerge. Because of the diverse clinical expressions of schizophrenia and the likelihood that these are due to different kinds of brain damage, schizophrenia now is considered to be a group of mental disorders rather than a single entity. Thus, any genetic contributions to...

Mapping Structural Alterations of the Corpus Callosum During Brain Development and Degeneration

Abstract In this chapter we review current neuroimaging research on the structure of the corpus callosum. The corpus callosum is the main fiber tract connecting the two brain hemispheres, consisting of approximately 200-350 million fibers in humans. Given the corpus callosum's importance in communicating perceptual, cognitive, mnemonic, learned, and volitional information between the hemispheres, it has not surprisingly been a focus of many studies examining structural and functional neuropathology. We and other groups have investigated callosal abnormalities in Alzheimer's disease, multi-infarct dementia, schizophrenia, attention deficit hyperactivity disorder, and multiple sclerosis and during normal and aberrant development. Nonetheless, extreme variations in brain structure make it difficult to design computerized strategies that detect and classify abnormal structural patterns. Intense controversy exists on the question of whether different callosal regions undergo selective...

Automated Analysis of Conserved Syntenies for the Zebrafish Genome

Regions with conserved syntenies among rats, mice, and humans help focus the identification of numerous candidate genes and develop useful laboratory models for human disease. The following are a few examples of candidate genes for human disease, generally identified by linkage analysis, being studied in rodent models to elucidate the mechanisms of disease progression. Disrupted-in-Schizophrenia (Disci) is a candidate gene for schizophrenia. Identification of the gene in rodents facilitates the investigation of Disc1 function and creation of mouse models of DISC1 disruption. Cross-species analysis reveals conservation of the leucine zipper and coiled-coil domains in DISC1 orthologs (Ma et al., 2002). The DISC1 protein is found in the brain, heart, liver, and kidney (Ozeki et al., 2003), and yeast two-hybrid analysis reveals association of DISC1 with a number of proteins of the cytoskeleton and centrosome (Morris et al., 2003 Ozeki et al., 2003). Truncation of DISC1 in a region...

Posttranscriptional Modifications

Seven SNPs are located within the coding region of the 5-HTR2A receptor. Two of the seven SNPs (T102C and C516T) are silent mutations and do not cause a change in the protein (70,71). The T102C variant consists of a thymidine-cytidine substitution. Although the T102C polymorphism is silent, it has been the focus of many association studies examining the expression of psychosis and depression in individuals with schizophrenia (72,73), mood disorders (18,24,74-77), and Alzheimer's disease (AD) (22,23,78,79). Results of associations in schizophrenia are varied with many case-control and family-based studies showing an association between the T102C SNP and the etiology of schizophrenia (73,80-82). In their recent meta-analysis of 31 case-control studies, Abkolmaleky et al. (73) found a significant association of both the C allele and CC homozygosity with schizophrenia in European patients this finding was not confirmed in samples from East Asian countries. Results of a metaanalysis of...

Psychological Disorders

Most of Sullivan's early therapeutic work was with schizophrenic patients, and many of his subsequent lectures and writings dealt with schizophrenia. Sullivan (1962) distinguished two broad classes of schizophrenia. The first included all those symptoms that originate from organic causes and are therefore beyond the study of interpersonal psychiatry. The second class included all schizophrenic disorders Dissociated reactions, which often precede schizophrenia, are characterized by loneliness, low self-esteem, the uncanny emotion, unsatisfactory relations with others, and ever-increasing anxiety (Sullivan, 1953b). People with a dissociated personality, in common with all people, attempt to minimize anxiety by building an elaborate self-system that blocks out those experiences that threaten then security. Whereas normal individuals feel relatively secure in their interpersonal relations and do not need to constantly rely on dissociation as a means of protecting self-esteem, mentally...

Polemics About The Geneticization Of Medicine

Nevertheless, the suspicion has been aroused that even if modern genetics has not had any direct impact on the treatment of diabetes, hypertension or schizophrenia, it has indirectly distorted the spirit of medicine by promoting a dehumanising reductionism, and finding molecular causes, at the expense of providing global care for sick people. Two camps are at loggerheads about this conjecture or thesis that there is a perverse geneticization of medicine (and of Western culture). Philosophers and sociologists with a constructivist tendency have argued in favor

Anatomy and morphometry of the corpus callosum

Schlaug, Y. Huang, and L. Jancke, 1995. Corpus callosum and brain volume in women and men. NeuroReport 6 (7) 1002-1004. Stevens, J. R., 1998. Anatomy of schizophrenia revisited. Schizophr. Bull. 23 (3) 373-383. Stievenart, J. L., M. T. Iba-Zizen, A. Tourbah, A. Lopez, M. Thibierge, A. Abanou, and E. A. Cabanis, 1997. Minimal surface A useful paradigm to describe the deeper part of the corpus callosum Brain Res. Bull. 44 (2) 117 124. Strauss, E., B. Kosaka, and J. Wada, 1983. The neuro-biological basis of lateralized cerebral function. A review. Hum. Neurobiol. 2 (3) 115-127. Strauss, E., J. Wada, and M. Hunter, 1994. Callosal morphology and performance on intelligence tests. J. Clin. Exp. Neuropsychol. 16 (1) 79-83. Sullivan, E. V., P. K. Shear, O. L. Kelvin, R. B. Zipursky, and A. Pfefferbaum, 1996. Cognitive and motor impairments are related to gray matter volume deficits in schizophrenia. Biol. Psychiatry 39 234-240. Swayze, V. W., N. C. Andreasen,...

Attention Deficit Information Network Inc A

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

The Oral Stage

Because the infant's needs are met without effort, he or she is said to feel omnipotent. This feeling passes in normal development but is retained in some psychoses. The feeling of infantile omnipotence normally gives way to realization that needs are satisfied through loved objects in the world, not magically. As the infant learns to associate the mother's presence with satisfaction of the hunger drive, the mother becomes a separate object, and the first differentiation of self from others occurs. Fixation in the first psycho-sexual stage results in development of an oral character personality type, whose traits have traditionally been said to include optimism, passivity, and dependency. Conflicts over these traits can sometimes produce the opposite characteristics for example, because of reaction formation, the person fixated at the oral stage may become pessimistic instead of optimistic, leading to depression (Lewis, 1993).

Myths and Religion

How can we tap the energies of the unconscious without being destroyed by them That is the function of mythology, religion, and the arts, which provide cultural symbols. Myths provide a means of tapping the deeper, creative levels of human potential, without being destroyed by it (as in psychosis). Jung encouraged people to participate in the religious traditions in which they had been raised. (He discouraged Westerners from switching to Eastern religions, based on his premise that a somewhat different unconscious was represented in each.) Perhaps another caution in cross-cultural religious studies is the danger of distorting other traditions because we see the world through the lens of our own background, as one Jesuit priest is indicted for doing when he interpreted Native Americans' religious tradition of the Sacred Pipe from a Christian viewpoint (Bucko, 2000).


The story of Jungs life shows two episodes when introversion was clearly the dominant attitude. The first was during early adolescence when he became cognizant of a No. 2 personality, one beyond awareness to his extraverted personality. The second episode was during his midlife confrontation with his unconscious when he carried on conversations with his anima, experienced bizarre dreams, and induced strange visions that were the stuff of psychosis (Jung, 1961, p. 188). During his nearly completely introverted midlife crisis, his fantasies were individualized and subjective. Other people, including even Jungs wife, could not accurately comprehend what he was experiencing. Only Toni Wolff seemed capable of helping him emerge from his confrontation with the unconscious. During that introverted confrontation, Jung suspended or discontinued much of his extraverted or objective attitude. He stopped actively treating his patients, resigned his position as lecturer at the University of Z...


Dopamine A chemical messenger (neurotrans-mitter) in the brain and a member of the class of catecholamines that affect the nervous and cardiovascular systems, metabolic rate, and body temperature. Secreted by neurons in the substantia nigra, the midbrain, and the hypothalamus, dopamine is thought to play a role in controlling movements. Parkinson's disease, a degenerative condition characterized by muscle rigidity and tremors, is due to loss of cells in the substantia nigra that release dopamine. in fact, drugs that mimic dopamine are used to treat parkinson's, and drugs that relieve the symptoms of schizophrenia may also cause Parkinsonlike symptoms. Identified in the late 1950s, this neurotransmitter is part of the biosynthetic pathway of the neurotransmitter norepinephrine and is believed to help regulate mood when found in excess amounts in the limbic system, it can contribute to the development of schizophrenia.

Random Selection

Suppose the target population is the 100 patients with schizophrenia who are on a patient list. We then wish to choose N 30 at random from this NPopulation 100 for inclusion in the study. First we number the patients in any order from 01 to 100 but use 00 to represent patient 100. Then using the first two digits in (say) the first column of Table T3 we find the first 30 numbers in the range 00 to 99 are successively 75, 80, 94, 67, , 87, 63. However, 03, 43, 50, 67, 90 and 94 are repeated in this list and so the next six random numbers are taken. These are 73, 69, 64, 31, 35 and 57, but 57 has been used previously so we choose the next which is 50. This too has to be ignored and so the next, which is 48, is taken. Now that the numbered list of 30 is complete, the corresponding patients are then identified from the list and these are examined in the study. Such a procedure is usually only practicable if the target population is not too large, although it can be quickly achieved with a...

Social Interest

Social interest is a core concept for Adler, who says that all neurosis stems from inadequate social feeling. An extreme lack of social feeling occurs in schizophrenia, according to Adler schizophrenics are veiy low in empathy, as one might expect (Zahn-Waxler & Radke-Yarrow, 1990). Criminals, too, lack sufficient social interest, as do those who commit suicide (Adler, 1937 1958). Roy Baumeister (1990, p. 107) lists feelings of responsibility and fear that others will disapprove as one of several deterrents to suicide. Such feelings correspond closely to Adler's concept of social interest, although Baumeis-ter's theory is considerably broader. Some studies report that females have higher social interest than males (Joubert, 1989b Kaplan, 1991)- This is consistent with reports of higher empathy in females, evidenced as early as age 1 to 2 years (Zahn-Waxler, Radke -Yarrow, Wagner, & Chapman, 1992).


Case Example A single young man was hospitalized with a one-month history of weakness of his legs and difficulty walking. Neurologic evaluation was unremarkable, yet the patient persisted in a fearful worry that he had multiple sclerosis. His present illness had started acutely, after he had begun a new job where he felt fearful of his boss, who was critical and demanding. The final straw came after he had begun dating a woman from his office. Although he saw their relationship as casual and platonic, she had begun pressing him for more of a commitment. After a distressing discussion with her one night, he awoke the next morning feeling weak in his legs and unable to walk. By temperament he was a dramatic, perfectionistic, and self-centered person. Examination of the patients mental state did not reveal evidence of major depression, an anxiety disorder, or schizophrenia. His behavior was understood as motivated by both fears of dealing with situations he wished to avoid and a desire...


Among people with diabetes, hypertension or coronary heart disease the prevalence of the metabolic syndrome is considerably higher than among the general population. For example, the prevalence of the metabolic syndrome using WHO criteria was between 76 and 92 per cent in various European populations of people with diabetes (Bruno etal., 2004 Ilanne-Parikka etal., 2004 Relimpio etal., 2004). An exception to this pattern was the relatively low prevalence of the metabolic syndrome found in a small study of people with type 2 diabetes in Nigeria (Alebiosu and Odusan, 2004). This was the only study based in Africa and further data are required to establish whether this finding is replicated in other African populations both with and without diabetes. Among people with mental illness, notably schizophrenia, the prevalence of the metabolic syndrome was higher than among the general population. Symptoms of depression have been associated with each feature of the metabolic syndrome (McCaffery...

Convenience Sample

One might anticipate that the subject pool for a cross-sectional study of patients with (say) schizophrenia is rather small. In such circumstances the study might have to 'make-do' with those patients who are available or what is termed a 'convenience' sample. The study may comprise, for example, all the current patients of the particular clinical investigator. In order for such samples to have validity we have to be convinced that no biases are likely to have occurred in the method of patient selection. Example - convenience sample - latency of the auditory P300 in schizophrenia In this case we need to know whether the patients with schizophrenia in this study are 'typical' of all patients with the condition If they are, then the results of Weir, Fiaschi and Machin (1998) may be generalised to 'all' such patients and the study provides an unbiased estimate of the relevant population parameters. If they are not, then the study merely describes those included in the study.

Simple Random Sample

Suppose the study of Weir, Fiaschi and Machin (1998) were to be repeated, but now in 30 left-handed patients. If left-handed patients are rare, then the investigators will have to study a convenience sample. On the other hand, if left-handed patients are freely available, then the investigator should choose the 30 at random from the larger population of patients by a method such as we described in Chapter 4. In this circumstance, the estimate of b0 obtained on completion of the study is an unbiased estimate of the mean auditory P300 for all left-handed patients with schizophrenia. One of the astonishing facts of statistical methods is that one can make valid inferences about populations (here patients with schizophrenia who are left-handed) without having to examine every member of the population all that is needed is a well-chosen sample. This contrasts with the convenience sample for which we do not know if the estimate is or is not biased. Thus we can rely more readily on the...

Study Size

In many situations, the description of the single group of a cross-sectional study may contain within-group comparisons. For example, in patients with schizophrenia, differences in mean latency of the auditory P300 between males and females may be examined. However, these comparisons are secondary to the main objective which is to describe the group as a whole. In a truly comparative study, two or more groups of subjects are identified and the examination of differences between them is the primary objective of the study. Thus Weir, Fiaschi and Machin (1998) wished to compare patients with schizophrenia with those having major depressive illness. This comparison provides the major research question and any secondary variable, such as the gender of the patients, may then be used as a covariate to see if taking this into account modifies the observed differences between groups with respect to the measures taken.

Studying Memory

Schizophrenia, the most common form of psychosis, affecting 1 percent of the population, has also been linked to memory disorders. However, it is unclear to what extent the memory problems depend on a certain subtype of schizophrenia and to what extent they are the result of the effects of an inability to pay attention to external events.


Specialists in neuroimmunology concentrate on patients with autoimmune neurologic disease, particularly multiple sclerosis. According to the AAN, roughly 350,000 to 500,000 people suffer from multiple sclerosis in the United States. The neuroimmunologist also evaluates and treats patient with other autoimmune neurologic problems, such as myasthenia gravis, lupus, and Sjogren disease. Due to the complexity of these diseases, neuroimmunologists are also knowledgeable in their complications, including depression, psychosis, spasticity, incontinence, sexual dysfunction, and pain.

Adverse Effects

In a Dear Doctor letter to 210,000 dermatologists, family doctors, and psychiatrists, the maker of the drug (Roche) wrote that the strengthened depression warning on its boxes was tied to uncommon adverse reactions. But the potential consequences led to label changes, warning physicians that isotretinoin may cause depression, psychosis, and rarely, suicidal ideation, suicide attempts, and suicide. Stopping the drug may not be enough to ease the depression, the label warns.

Mandatory reporting

Mania Any mental disorder, especially when characterized by violent, unrestrained behavior. When used as a suffix, a morbid preference for or an irrepressible impulse to behave in a certain way. The term also refers to one of the two major forms of manic depressive illness. The manic form of manic-depressive psychosis is characterized by an elated or euphoric, although unstable, mood increased psychomotor activity, restlessness, agitation, etc. and increase in number of ideas and speed of thinking and speaking, in which in more severe forms proceed to flight of ideas (rapid shift

Organolead Compounds

In common with other organollead compounds, tetraethyllead has a strong affinity for lipid and nerve tissue and is readily transported to the brain. Symptoms of tetraethyllead poisoning reflect effects on the central nervous system. Among these symptoms are fatigue, weakness, restlessness, ataxia, psychosis, and convulsions. Victims may also experience nausea, vomiting, and diarhhea. In cases of fatal tetraethyllead poisoning, victims may experience convulsions and coma death has occurred as soon as one or two days after exposure. Almost one third of victims acutely exposed to tetraethyllead die, although fatalities from chronic exposure have been comparatively rare, considering the widespread use of tetraethyllead. Recovery from poisoning by this compound tends to be slow.


In these cases, identifying the source of the nightmares guides the treatment. For example, a traumatic event can lead to recurrent nightmares seeing a mental health professional can help the individual deal with the emotional issues triggering the nightmares. Depression and schizophrenia are also associated with frequent nightmares.


Acknowledgments Preparation of this contribution was supported by NIH grants DA09009 and GM37251 to Fred L. Bookstein. I thank John DeQuardo, the University of Michigan, for the subjects and the selection of image planes underlying the schizophrenia data set here (example 1), Christos Davatzikos of Johns Hopkins University for the gerontological data set (example 2), and Ann Streissguth, grant AA10836, and the Fetal Alcohol and Drug Unit at the University of Washington for the fetal alcohol structural and behavioral data (example 3).


Perseveration, a term introduced by Neisser in 1895, refers to the inappropriate continuation or repetition of an earlier response after a change in task requirements. Although individuals without brain damage may display occasional perseverative behaviors (e.g., Ramage et al., 1999), as Allison (1966) pointed out, when perseveration is pronounced, ''it is a reliable, if not a pathognomonic sign of disturbed brain function'' (p. 1029). Indeed, per-severation has been described in association with a variety of neurological and psychiatric conditions, including stroke, head injury, dementia, Parkinson's disease, and schizophrenia.


Candidates will be expected to have a broad knowledge of the theoretical and practical aspects of psychiatry including the clinical approach to the patient. The ability to elicit a comprehensive history and adequately assess the patient's mental state will be necessary. Assessment may include personality development, organic psychiatric syndromes, schizophrenia, the affective disorders, the clinical neuroses, personality disorders, alcoholism and drug abuse, eating disorders, mental handicap, common childhood psychiatric disorders, psychosomatic disorders, forensic psychiatry, psycho sexual problems and common psychiatry.

Mental Health Issues

In terms of diagnostic categories, neurosis, personality disorders, and child psychiatric disorders constituted two-thirds of the disorders compared with only 12 in the general population. Of the subgroup with psychiatric disorders, 29 had a diagnosis of neurosis, 18 had personality disorders, 16 had childhood disorders, 9 had alcoholism, 8 had convulsive disorders, 7 had mental retardation, 6 had psychosomatic conditions, and 6 had psychosis. Of the neuroses, 3.2 were anxiety disorders, 1.3 were somatoform disorders, 1.0 were depressive disorders, and 0.1 were obsessive-compulsive disorder. Among the childhood disorders, anxiety disorders represented 1.8 of the general sample, conduct disorders represented 1.0 , and organic disorders represented 0.2 . Of the psychoses, schizophrenia represented 0.5 of the general sample, bipolar disorders represented 0.7 , and psychotic depression represented 0.6 . A study of hospital epidemiology in Lima showed that the prevalence of substance abuse...

Alan D Baddeley

Schizophrenia is customarily described as a disorder where there are major disturbances in thought, emotion and behaviour, leading in many cases to a state of permanent deterioration. Defined more precisely, it is characterized by a range of positive symptoms, including delusions, hallucinations and incoherence of speech, which occur against a background of negative symptoms consisting of social withdrawal, lack of motivation and emotional unresponsiveness. Positive symptoms typically fluctuate and may drop out of the clinical picture altogether, but the negative symptoms are almost always enduring. A minority of patients who become schizophrenic recover or remain relatively well most of the time. More often there are regular relapses and remissions accompanied by occupational and social decline. In the worst-affected cases, patients become unable to care for themselves, may suffer continual psychotic symptoms, and are quite likely to require indefinite care and supervision. The cause...

Drug Discovery

Traditionally, most affective disorders have been treated with compounds that resemble the neurotransmitters that are deficient or in excess in specific brain regions. The aberrant levels of neurotransmitters (or their receptors), such as norepinephrine, dopamine, acetyl-choline, and serotonin, have correlated with behavioral symptoms of schizophrenia, depression, anxiety, sleep disorders, motor dysfunctions, attention difficulties, and cognitive disorders. Most drugs discovered for these disorders resulted from screening compounds directly in rodent behavioral models that mimic the behavior of the disease. In these cases, the molecular target or mechanism of action was assumed to be the deficiency or excess of a neurotransmitter.

Ptsd 407

Psychosis Loosely, any mental disorder more specifically, the term is used to refer to a particular class or group of mental disorders, particularly to differentiate this condition from neurosis, sociopa-thy, character disorder, psychosomatic disorder, and mental retardation. Traditionally, the psychoses are subdivided into organic brain syndromes, functional psychoses, schizophrenia, affective psychoses (e.g., manic-depressive psychoses), paranoid states, and psychotic depressive reaction. As a result of conflicting usage over time, there is no single acceptable definition of what psychosis is. In general, however, the disorders labeled psychoses differ from the other groups of psychiatric disorders in severity, degree of withdrawal, affectivity, intellect, and regression. The psychoses are major disorders in that they are more severe, intense, and disruptive they tend to affect all areas of the patient's life.

Wernickes area 329

Wernicke-Korsakoff syndrome This acute neurological condition is an uncommon brain disorder almost always due to the malnutrition that occurs in chronic alcohol dependence, although it can also appear in other conditions such as cancer. The disease consists of two stages Wernicke's encephalopathy followed by Korsakoff's psychosis, each characterized by separate symptoms. The second stage (Korsakoff's psychosis, or Korsakoff's syndrome) may follow if treatment is not instituted soon enough. In this stage, sufferers experience severe amnesia, apathy, and disorientation. Recent memories are affected more than distant memory often, patients cannot remember what they did even a few moments ago, and they may make up stories to cover for their loss of memory. Wernicke's encephalopathy is a medical emergency requiring large doses of intravenous thiamine if the diagnosis is even suspected. often, this treatment can reverse the symptoms within a few hours. In the absence of treatment, however,...


The diagnoses were severe posttraumatic stress disorder (PTSD), with brief reactive psychosis and depressed mood. The interventions helped her repair ruptured social bonds, which Herman (1993) described as the central effect of severe trauma. In Ms. N's case, the political nature of the sexual assault

Peptidergic Systems

The implication of NPY and Y1 receptors in depression is also supported by observations on a genetic animal model, in which NPY-immunoreactivity was found to be decreased and Y1 binding increased in the hippocampus (152). Because of increased CSF levels in vivo (153), and an altered morphology of hippocampal NPY terminals postmortem (154), NPY has also been implicated in schizophrenia. Specific changes in CSF concentrations of NPY, somatostatin, and CRF, parallel to clinical recovery, have indeed been measured after effective electroconvulsive therapy in both depressed and schizophrenic patients (155). Since NPY, given systemically to healthy subjects, promotes and improves sleep (156), it will be of interest to determine whether it improves the sleep disturbances so commonly found in depression. New leads for the development of antidepressant drugs are also provided by recent clinical trials demonstrating an improvement of major depression after treatment with SP receptor antagonists...

Bruce S Mcewen

One result of the mapping of steroid receptors was the discovery in 1968 that the hippocampal formation has receptors for adrenal steroids (McEwen, Weiss, and Schwartz, 1968). This finding, first in rats and later in primates (Gerlach et al., 1976) and birds (Rhees, Abel, and Haack, 1972), suggested that the adrenal cortex must have a far-reaching influence on this region of the brain. Indeed it does, but it has been only in the past decade that we have begun to elucidate the multiple hormonal influences in hippocampal structure and function, ranging from adaptive plasticity, which is the subject of this article, to pathophysiological changes. The hippocampal formation plays an important role in spatial and declarative memory as well as in contextual memory (Smriga, Saito, and Nishiyama, 1996). Hippo-campal malfunction is implicated in schizophrenia and affective illness (Sheline et al., 1996 Axelson et al., 1993 Bogerts et al., 1993 Arnold et al., 1991 Luchins, 1990). Furthermore,...


Neuregulins (NRGs) comprise a large family of EGF-like signaling molecules involved in cell-cell communication during development and disease. The neureg-ulin family ofligands has four members NRG1, NRG2, NRG3, and NRG4. Relatively little is known about the biological functions of the NRG2, 3, and 4 proteins. In contrast, the NRG1 proteins have been demonstrated to play important roles during the development of the nervous system, heart, and mammary glands. For example, NRG1 has essential functions in the development of neural crest cells and some of their major derivatives, like Schwann cells and sympathetic neurons. NRG1 controls the trabeculation of the myocardial musculature and the ductal differentiation of the mammary epithelium. Moreover, there is emerging evidence for the involvement of NRG signals in the development and function of several other organ systems, and in human disease, including breast cancer and schizophrenia. Many different isoforms of the Neuregulin-1 gene are...

Mcwrh V32

Ma, L., Liu, Y., Ky, B., Shughrue, P. J., Austin, C. P., and Morris, J. A. (2002). Cloning and characterization of Disc1, the mouse ortholog of DISC1 (Disrupted-in-Schizophrenia 1). Genomics 80, 662-672. Miyoshi, K., Honda, A., Baba, K., Taniguchi, M., Oono, K., Fujita, T., Kuroda, S., Katayama, T., and Tohyama, M. (2003). Disrupted-In-Schizophrenia 1, a candidate gene for schizophrenia, participates in neurite outgrowth. Mol. Psychiat. 8, 685-694. Morris, J. A., Kandpal, G., Ma, L., and Austin, C. P. (2003). DISC1 (Disrupted-In-Schizophrenia 1) is a centrosome-associated protein that interacts with MAP1A, MIPT3, ATF4 5 and NUDEL Regulation and loss of interaction with mutation. Hum. Mol. Genet. 12, 1591-1608. Ozeki, Y., Tomoda, T., Kleiderlein, J., Kamiya, A., Bord, L., Fujii, K., Okawa, M., Yamada, N., Hatten, M. E., Snyder, S. H., Ross, C. A., and Sawa, A. (2003). Disrupted-in-Schizophrenia-1 (DISC-1) Mutant truncation prevents binding to NudE-like (NUDEL) and inhibits neurite...


Speech disorders, aphasia, chronic alcoholism, schizophrenia, depression, and mania, as well as right hemisphere damage (RHD) (Duffy, 1995 Myers, 1998 Monnot, Nixon, Lovallo, and Ross, 2001). The term aprosodia, however, typically refers to the prosodic impairments that can accompany RHD from stroke, head injury, or progressive neurologic disease with a right hemisphere focus. Even the disturbed prosody of other illnesses, such as schizophrenia, may be the result of alterations in right frontal and extrapyramidal areas, areas considered important to prosodic impairment subsequent to RHD (Sweet, Primeau, Fichtner et al., 1998 Ross et al., 2001). Ross, E. D., Orbelo, D. M., Cartwright, J., Hansel, S., Burgard, M., Testa, J. A., and Buck, R. (2001). Affective-prosodic deficits in schizophrenia Profiles of patients with brain damage and comparison with relation schizophrenic symptoms. Journal of Neurology, Neurosurgery, and Psychiatry, 70, 597-604. Sweet, L. H., Primeau, M., Fichtner, C....


Chronic administration can result in permanent neurological damage, at least among animals brain damage in humans is still being studied. At its worst, users can experience a frightening psychotic condition known as cocaine psychosis, which may appear similar to schizophrenia. It is believed to be related to dopamine. Scientists know that doctors treat schizophrenia by giving drugs that block dopamine receptors cocaine, which enhances dopamine release, will worsen the condition of schizophrenia. Therefore, a cocaine psychosis may be caused by excessively high dopamine levels in the brain induced by cocaine use. For reasons little understood, cocaine will cause psychosis selectively cocaine poisoning is equally unpredictable. An overdose of cocaine can cause convulsions and death by depressing the brain centers that control breathing and heart activity. In these cases, death can occur so quickly that there is no time to treat the overdose. This type of cocaine poisoning has been the...

Clinical Populations

Researchers have found that various clinical populations have disturbed personal constructs. Different kinds of faulty constructs are characteristic of schizophrenia and paranoia (Lorenzini, Sassaroli, & Rocchi, 1989)- Schizophrenics show impaired perceptions of themselves, as well as of others (Gara, Rosenberg, & Mueller, 1989)- Their constructs about people and psychological phenomena are particularly disturbed, compared to constructs about objects and the physical world (Bannister & Salmon, 1966 McPherson, Barden, & Buckley, 1970 McPherson & Buckley, 1970).

Hological Adjustment

Some of the traits that Cattell measured contribute to a person's psychological adjustment. The terms neurosis and psychosis are already familiar from psychoanalytic theory. Both refer to adjustment difficulties, which are more serious in psychosis. Psychosis is a more serious form of disturbance. There are several different types of psychoses, and Cattell found different patterns of traits for various diagnoses. Schizophrenics have low ego strength, low drive tension, and high introversion. Manic-depres-sives have low intelligence, conservative temperament, and high superego (i.e., an inclination to feel guilty).


Dystonia Abnormal muscle rigidity resulting in painful muscle spasms, fixed posture, or strange movements. Generalized dystonia usually is caused by neurological disorders, such as Parkinson's disease or stroke, or may be a feature of schizophrenia. It may also be a side effect of antipsychotic drugs.

Scoliosis 443

It is an uncommon psychiatric illness in children under age 12, and it is hard to recognize in its early phases in children. schizophrenia is far more common in adolescence, when it occurs in about three out of every 1,000 teens. The behavior of children and teens with schizophrenia may differ from that of adults with this illness. Most schizophrenic children show delays in language and other functions long before their symptoms of hallucinations, delusions, and disordered thinking appear. In the first years of life, about 30 percent of these children have transient symptoms of a PERVASIVE DEVELOPMENTAL DISORDER, such as rocking or arm flapping. There may be uneven motor development, such as unusual crawling. The early warning signs of schizophrenia in children include However, the behavior of children with this illness may change over time. schizophrenic psychosis develops gradually in children, without the sudden psychotic break that sometimes occurs in adolescents and...


The characteristics of dream-work that Freud described (condensation, displacement, and symbolism) represent the functioning of the unconscious more generally. Freud understood not only dreams and psychosis but even aspects of everyday normal behavior as results of unconscious motivation.


Antipsychotic Tending to alleviate the symptoms of psychotic disorders any drug that has such an effect. Major tranquilizers, including especially phenothiazine derivatives such as chlorpromazine (trade name Largactil) and thioridazine, are used primarily in the treatment of schizophrenia and other disorders involving psychotic symptoms. Lithium compounds are used primarily in the treatment of bipolar (manic-depressive) disorder. psychosis is a common manifestation in the late stages of AIDS.

Target Validation

Glutamate receptors have represented attractive drug discovery targets for two decades because glutamate is the major excitatory neurotransmitter in the brain. Antagonists of glutamate receptors, especially NMDA antagonists, have been studied to reduce conditions like schizophrenia, epilepsy, neuropathic pain, and anxiety, but side effects have halted the development of most of these compounds. Are the compounds not sufficiently selective between the different glutamate receptor subtypes Do the compounds provoke other activities related to their structure Are the compounds readily accessible to the critical brain sites Are the NMDA receptors the critical ones related to these disease conditions The recent approval of memantine (Namenda, Forest Pharmaceuticals, St. Louis Axura, Merz+ Germany and Ebixa, Lundbeck Copenhagen) for severe cognitive impairment, but not for mild cognitive impairment, does not unequivocally validate the target because memantine is neither a potent nor a...

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