Schizophrenia/Psychosis

Standardized test scores and adaptive functioning will now be used to determine who may be sentenced to death and who may not. Yet, legal and psychiatric experts continue to challenge each other to define mental retardation. Some say that retardation can be feigned and used to weaken the power of the death penalty. Others say the issue will not arise.

Assessing the Violent Patient: An Additional Case of Legal Implications

Medication and psychotherapy or counseling can be safely and effectively combined in patients with substance use and other psychiatric disorders. Differentiating between substance-induced psychiatric disorders and pre-existing psychiatric disorders facilitates the successful treatment of dually diagnosed patients. Find out what the latest research offers in the prognosis of psychiatric disorders and substance use.

Treatment with psychopharmaceuticals may prove problematic for pregnant women. The decision to discontinue medications or to adjust dosages to minimize the risk to the fetus has to be addressed. The dynamic balance of treatment options, maternal concerns and practitioner responsibility depends upon staying abreast of the latest research in psychopharmacology and pregnancy.

The threat that a patient may commit an act of violence challenges psychiatrists to wrestle with the legal system as they attempt to successfully build a therapeutic alliance. Patient history, solid medical care, and the duties to warn and to protect must be successfully balanced to navigate the crossroads between psychiatry and the law.

Despite the widespread, long-standing notion that pregnancy is a time of happiness and emotional well-being, accumulating evidence suggests that pregnancy does not protect women from mental illness. Like their nonpregnant counterparts, pregnant women experience new onset and recurrent mood, anxiety and psychotic disorders.

There is no doubt that the number of applications for disability is rising. How should psychiatrists deal with patients who ask for disability without compromising the therapeutic alliance or the goals of therapy?

Discussions of psychiatric ethics often devolve into discussions of applicable law. Although ethics is often operationalized by a society's laws, ethics differs dramatically in its foundations, framework and purpose.

Patients with Alzheimer's disease and psychosis often have a more severe course of illness, with higher incidence of caregiver burden and hospitalization. Differentiating this disorder from Alzheimer's disease uncomplicated by psychosis is key to maximizing more positive outcomes.

While the deaths of several students have figured prominently in recent news, studies show that college students actually have a lower rate of suicide than their nonstudent peers. What can be done to lower suicide rates even further?

Deficient omega-3 fatty acids can result in myriad pathological changes including altering the central nervous system. Their balance or imbalance changes receptor function, prostaglandin and cytokine production. Understanding the roles of these essential fatty acids is vital to remedying the fatty acid abnormalities found in a number of psychiatric disorders.

College students are far less likely to kill themselves than are nonstudent peers, according to a 10-year research study examining suicide rates at 12 Midwestern campuses.

More women than men are diagnosed with depression. Yet, men who are troubled by depression are also more likely to die, even when suicide is removed from the factors of consideration. Vascular depression, hyperintensities within the brain, physiological changes and late-life onset provide both insight and more questions into the nature of depression and this enigmatic paradox.

Noting the frequent unresponsiveness of posttraumatic stress disorder (PTSD) to standard drug treatments, Stein and colleagues reported results of the first double-blind, placebo-controlled trial of an adjunct to selective serotonin reuptake inhibitors for the treatment of this disorder.

Catatonia is found in at least 10% of patients admitted to acute psychiatric services, so any young patient with stupor, unexplained excitement or persistent motor signs should be formally assessed for this syndrome. From among the 20 to 40 now-identified features of catatonia, its proper diagnosis must be differentiated from other mental illnesses.

In the last third of the 20th century, psychiatry boldly shook off a 120-year-long philosophical funk and rushed to catch up in the thrilling march of medicine. The biopsychosocial model that once sounded trendy now seems to be an indispensable approach. The pioneers of psychopharmacology who once labored at the margins have now been joined by thousands of bright young doctors who treat patients with depression, psychosis and impulsive aggression and realize that a troubled soul is often expressing the cries of a troubled brain. This issue of Psychiatric Times celebrates the stirring giant that is 21st-century neuropsychiatry--a discipline that derives its immense power and scope from the glad embrace of the twin Enlightenment ideals of humanism and the scientific method.

New imaging techniques have shown a dynamic wave of gray matter loss in early-onset schizophrenia. Can this pattern of destruction provide a window of opportunity to combat this disease?

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite. In some patients, an organic mental syndrome can be part of a migraine attack (Davidoff, 1995). In other patients, an acute psychotic condition is the dominating clinical feature. This presentation, with paranoid delusions, hallucinations and anxiety, has been described in families with hemiplegic migraine (Spranger et al., 1999). Migraine is, therefore, an important differential diagnosis in relation to episodic phenomena with a mixture of somatic and psychiatric symptoms. In addition, psychosocial stress is the most common precipitating factor for a migraine attack (Davidoff, 1995).

Migraine is characterized by episodes of headache with qualities such as unilateral location, throbbing pain and aggravation by routine physical activity. Additional symptoms include nausea, photophobia and phonophobia. Some patients have aura symptoms, usually visual, before the headache phase (Davidoff, 1995). Prodromal and accompanying symptoms of migraine attacks often are psychiatric in nature, such as depression, elation, irritability, anxiety, overactivity, difficulty thinking, anorexia or increased appetite.

Psychotic episodes following brain injuries can often be mistaken for schizophrenia. How can the presentation of psychotic episodes reframe our understanding of this complex phenomenon?

The World Health Organization (WHO) has distributed for comments the draft of a Manual on Mental Health Legislation as a guide for all the countries of the world. It is to serve as a model for new legislation and as a guide for countries amending their legislation. Given the different legal systems, the cultural diversity and the vast inequalities in economic resources among the nations of the world, one can certainly question the wisdom of the WHO's top-down approach. In addition, everyone who knows the scarcity of competent mental health care professionals and the limited resources in third world countries will recognize that most of the proposals are quite unrealistic. How can nations who cannot feed their poor or meet the basic necessities of public health measures and primary care be expected to provide "incompetent" mental patients with counsel (lawyers) and independent tribunals (courts) before they begin to treat them?

As a psychiatrist working in a state hospital, this author defends the long-term commitment of sexual offenders to institutions and offers insights on factors determining prognosis.

Antidepressant use among children and adolescents is on the rise. What prescribing patterns are being formed? Researchers are suggesting that more research into psychiatric pharmacogenetics may produce better treatment outcomes. Will it one day be possible to predict treatment response?

Advances in basic behavior and neuroscience research have been stunning, but until quite recently, efforts to encourage the clinical application of new knowledge have not kept pace. To aid in applying new knowledge to important public health issues, the National Institutes of Health has placed emphasis on "translational research," which aims to provide a bridge between basic research and clinical care. Particularly promising areas of study are highlighted.

Several confounding factors need to be taken into account before labeling a patient as treatment-resistant. What options are available for treating a patient with schizophrenia who has been diagnosed as such?

For various reasons, up to half of patients stop taking their prescribed antidepressant within three months. Side effects are often the biggest obstacle in maintaining treatment adherence. How can clinicians help patients deal with the sexual dysfunction and weight gain that often accompany psychotropic treatment?

In the 1800s there was widespread concern over the increase in the number of individuals with severe mental illnesses. Evidence from the 20th and 21st centuries is building that shows a similar trend. Why, then, is this increase not being currently addressed?

Jose R. Maldonado, M.D., assistant professor of psychiatry and behavioral sciences at Stanford University, was named the 2001 recipient of the Psychiatric Times Teacher of the Year award. The award was presented to Maldonado at the 14th Annual U.S. Psychiatric & Mental Health Congress in honor of his outstanding achievements in and steadfast dedication to psychiatry. For his work with geriatric psychiatry, Dilip V. Jeste, M.D., has been appointed to the endowed Estelle and Edgar Levi Memorial Chair in Aging at University of California, San Diego (UCSD). Jeste is founder and chief of UCSD's division of geriatric psychiatry and Founding President of the International College of Geriatric Psychoneuropharmacology. He focuses his research on schizophrenia and other psychotic disorders in late life and their successful treatment with the use of safer and more effective drug and psychosocial treatments.Helping people of all ages with schizophrenia to reintegrate into society is the focus of the Eli Lilly and Company-sponsored Reintegration Awards. Recognizing both patient advocates and mental health care professionals, these awards provide grants for their recipients' respective reintegration programs. In the Honorary category, the 2001 "Public Eye Recipient" is Elizabeth Baxter, M.D., a Tennessee-based psychiatrist who, while suffering from psychosis herself, is a mental health advocate on the national level. The 2001 Reintegration Awards were also given in the categories of Advocacy (New Jersey Association for Mental Health Agencies Inc. in Manasquan, N.J.), Clinical Medicine (The Whole Person Family Medicine Clinic in Torrance, Calif.), Education (The Guidance Center Supported Education Program in New Rochelle, N.Y.), Housing (Fred Geilfuss, Scott Reithel, Jack Rosenberg in Milwaukee), Occupational (Restoration Project in Acton, Mass.) and Social Support/Rehabilitation (Fountain House in New York City).

A report released by former Surgeon General David Satcher, M.D., outlines the disparity in mental health diagnoses and treatment between majority and minority ethnic groups. The report also discusses ways of closing the gap in mental health treatment.

Compared with Caucasians, African Americans receive an excess of schizophrenia-spectrum diagnoses. Potential explanations for the ethnic differences in clinical assignment of psychiatric diagnoses are reviewed.