The Purpose of this Chapter

This chapter is intended to help you enter into conversations with patients who have schizophrenia (referred to more briefly, if less accurately, in the remainder of this chapter as schizophrenic patients), conversations that will allow the two of you to begin to get to know each other and that might hold the promise of developing the therapeutic alliance on which successful treatment so heavily depends. Treatment includes individual psychotherapy (Chapter 9) structured living, learning, and...

The Middle Phase Stabilization Clinical Characteristics

It is during the middle phase of the illness that patients tend to settle into a characteristic course of illness and adaptive functioning. An accumulation of research suggests that once a nadir in symptomatology and adaptive functioning has been reached (approximately five years following illness onset and treatment) a stabilization of symptoms tends to occur that persists into about the fifth decade of life (1). The clinical course displayed by patients after emerging from the early phase of...

Druginduced Disorders

Several conditions associated with drug abuse or dependence can present with psychotic symptoms such as hallucinations, delusions, and thought disorder. It is important that these conditions be diagnosed as substance-induced psychotic disorder and not as schizophrenia. In general, delirium is likely to be present along with psychosis in disorders associated with drug use. In contrast, disorientation is rare and symptoms do not fluctuate significantly over the course of the day in patients with...

Neophobia and the Fear of Strangers

In his pioneering research at Worcester State Hospital in the 1930s and thereafter, David Shakow (1) concluded that one characteristic of schizophrenic patients was a fear of novelty, of the unknown, a trait he termed neophobia. The interviewer is at first a stranger to the patient, and no matter how much each party hopes that something good may come of their meeting, the interviewer is one more stranger to cope with. Just as 8-month-old infants show stranger anxiety, so do schizophrenic...

Basic Concepts

Like any symptom associated with an illness, cognitive dysfunction in schizophrenia is on a continuum ranging from very mild impairment to very severe impairment. Generally, there is an association of greater severity of illness with greater cognitive impairment across different populations of schizophrenic patients, and degree of cognitive dysfunction will certainly depend on the population of patients studied. For example, our research group has recently found similarities in severity of...

Eps

Italics indicate factors that may be related to organicity. There is evidence of diminished TD risk for clozapine, making it a first choice in this respect. Other SGAs (risperidone, olanzapine, and quetiapine) may share this advantage (38,39), making them reasonable alternatives to clozapine and preferable to conventional antipsychotics. Clozapine, olanzapine, and risperi-done also have been reported to decrease existing tardive movements (38). One would expect quetiapine and ziprasidone to...

Management Of Drug Side Effects During Maintenance Treatment

Side effects can seriously undermine the efficacy of maintenance anti-psychotic drug treatment. Some side effects increase with increasing doses of drug (i.e., they are dose-dependent) and so prevent patients from taking the drug doses needed to optimally treat their symptoms. Other side effects, such as akathisia, can be so distressing to patients that they become unwilling to continue with treatment. For a more detailed discussion of the side effects of antipsychotic drugs, see Chapter 10....

Seizure Disorders

Historically, there has been a long association between psychosis and epilepsy. Epilepsy patients have a 7 to 12 lifelong prevalence of psychotic disorders, which is higher than in the general population (4). Psychotic symptoms can occur interictally, postictally, or less frequently in association with nonconvulsive status epilepticus. In addition, the prodromes of certain types of seizures, such as partial complex seizures, can resemble hallucinations. Finally, it should be kept in mind that...

References

Out of Bedlam The Truth About Deinstitutionalization. New York Basic Books, 1990. 2. Spaulding WD, Fleming S, Reed D, Sullivan M, Storzbach D, Lam M. Cognitive functioning in schizophrenia implications for psychiatric rehabilitation. Schizophr Bull 1999 25(2) 275-289. 3. Harding C, Brooks G, Ashigaga T, Strauss J, Beier, A. The Vermont longitudinal study of persons with severe mental illness. Am J Psychiatry 1987 144 727-735. 4. Jaspers K. General Psychopathology. Manchester,...

Cerebrovascular Events

Psychosis is infrequently reported in the initial presentation of stroke patients. However, this information has been derived mainly from small case series. More recently, a study by Rabins et al. (13) found that five patients who developed psychosis after stroke had right-hemisphere lesions and subcortical atrophy, compared with five patients matched for lesion size who did not develop psychosis. Seizures were also common in this group of patients, especially when the onset of seizures...

Q

Prediction of outcome in first-episode schizophrenia. J Clin Psychiatry 1993 54(13) 7. 30. Edwards J, Maude D, McGorry PD, Harrigan SM, Cocks JT. Prolonged recovery in first-episode psychosis. Br J Psychiatry 1998 suppl 172(33) 107-116. 31. Van Kammen DP, Schooler N. Are biochemical markers for treatment-resistant schizophrenia state dependent or traits Clin Neuropharmacol 1990 13(1) 516-528. 32. Pickar D, Breier A, Keisoe J. Plasma homovanillic acid as an index of central...

Info

Accepts that current beliefs or behaviors aren't working , and finally, demonstrating and rehearsing specific intervention techniques. The development of such techniques involves three phases of self-control, as described by Breier and Strauss 24 1. The patients become aware of the existence of psychotic and prepsychotic symptoms by self-monitoring and identifying target behaviors. 2. Patients recognize the implications of these behaviors and develop a capacity for self-evaluation. At times,...

Susan K Boyer

Washington University School of Medicine and St. Louis Psychiatric Rehabilitation Center St. Louis, Missouri One concept addressed in forensic psychiatry is the assessment of violence. Violence is often a sleeping volcano. A volcano manifests a calm demeanor and occasionally rumbles over months and even years, then suddenly turns into a cataclysmic event. Scientists over time have outlined the evolving behavior of a quiescent volcano becoming active. They have learned through painstaking...