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Ignore them or blunt their impact on their lives. If your interview gets to the point where you and the patient can comfortably discuss voices or delusions, it can frequently be useful to ask, Have you developed any tricks over the years to keep the voices or delusions from bothering you as much as they did in the beginning Knowing these tricks and supporting the patient in using them at stressful moments can be a useful part of treatment. Irma was in her teens when she was admitted for her...

Basic Concepts

A period of acute psychotic illness can herald the diagnosis of schizophrenia, bringing to light both positive and negative symptoms that may have developed over a period of months or years. Although such individuals may be referred to as first-episode or new-onset schizophrenic patients, it is important to recognize that it may be only the recognition of symptoms that is new significant psychopathology may have been present for a considerable period (1,2). Left untreated, psychosis tends to...

Q

Treatment of Negative Symptoms, Depression, and Cognitive Deficits Using First-Generation Antipsychotic Drugs The efficacy of first-generation antipsychotic drugs for the treatment of negative symptoms is probably related to the degree to which such drugs cause acute neurological side effects. In other words, firstgeneration drugs capable of causing substantial pseudoparkinsonsim are unlikely to have any efficacy for the treatment of negative symptoms (35,45). As pointed out above, the...

John Lauriello William P Horan and Juan Bustillo

University of New Mexico Albuquerque, New Mexico Schizophrenia is a chronic mental illness that has a severe impact on patients and those who are close to them. Kraepelin's classic description of schizophrenia (dementia praecox) as a unitary degenerative disease that inevitably results in a grossly deteriorated end state has been refuted on empirical grounds, with contemporary research supporting a more optimistic prognostic picture. However, schizophrenia is a disorder that persists across the...

Cet

Cognitive functioning Incorporates awareness of cognitive functioning Step-by-step process starting with very basic principles May address non-specific Requires considerable clinical skill and patience Labor-intensive intensive Generalizability may be limited Individual differences may affect outcome Labor-intensive Limited learning capacity Limited learning capacity Limited learning capacity resources Lack of community resources

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...

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...

Summary

It is important for the psychiatrist to realize that about half of patients with schizophrenia also have a substance use disorder see Table 4 . Because patients may not give a complete history of their chemical 1. About half of schizophrenic patients have substance use disorder. 2. Nonpsychotic symptoms, neuroleptic side effects, and social isolation appear to be important treatable risk factors for substance abuse. 3. It is important to differentiate the patient with a psychosis independent of...

Introduction

Schizophrenia is a chronic, severe mental disorder that occurs in about 1 of the population and has equal prevalence in men and women. The etiology of the disorder has not been clearly elucidated however, genetic factors and early brain injury from prenatal and obstetric complications have been implicated. Hypotheses have been formulated involving dysfunction of the dopamine and glutamate neurotransmitter systems 1 . Onset is usually occurs between the late teens and the mid-30s. The illness is...

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...