Thalamic nuclear abnormalities as a contributory factor in sudden cardiac deaths among patients with schizophrenia

Patients with schizophrenia have a two- to three-fold increased risk of premature death as compared to patients without this disease. It has been established that patients with schizophrenia are at a high risk of developing cardiovascular disease. Moreover, an important issue that has not yet been explored is a possible existence of a "cerebral" focus that could trigger sudden cardiac death in patients with schizophrenia. Along these lines, several structural and functional alterations in the thalamic complex are evident in patients with schizophrenia and have been correlated with the symptoms manifested by these patients. With regard to abnormalities on the cellular and molecular level, previous studies have shown that schizophrenic patients have fewer neuronal projections from the thalamus to the prefrontal cortex as well as a reduced number of neurons, a reduced volume of either the entire thalamus or its subnuclei, and abnormal glutamate signaling. According to the glutamate hypothesis of schizophrenia, hypofunctional corticostriatal and striatothalamic projections are directly involved in the pathophysiology of the disease. Animal and post-mortem studies have provided a large amount of evidence that links the sudden unexpected death in epilepsy (SUDEP) that occurs in patients with schizophrenia and epilepsy to thalamic changes. Based on the results of these prior studies, it is clear that further research regarding the relationship between the thalamus and sudden cardiac death is of vital importance.

Homicidal behavior in schizophrenics

Few papers reported that schizophrenia predisposes to homicidal behavior. The aim of this paper is to report our experience with homicidal behavior in Schizophrenic patients admitted at Ibin-AL-Haitham a high secure unit, in AL-Rashad Teaching Mental Hospital, Baghdad Homicide offenders are subjected to intensive forensic psychiatric investigations in Iraq. Therefore, it was possible to obtain and review data of 118 homicide offenders admitted in Ibin Al-Hiathim Secure Unit in AL-Rashad Teaching Hospital of Baghdad during period from July 2003 to July 2008. The percentage of schizophrenia in this sample was 44% and 57% of schizophrenic offenders were in the age group [20-40years].There were more males; simply because males are more liable to break the law than females. Higher number of urban living offenders is probably attributed to the fact that psychiatric institutions and services are more accessible, and accurate recording in urban areas than in rural areas. Victims are mostly of first degree relatives of the offenders. According to our experience there is a strong relationship between schizophrenia and homicidal behavior

Mortality among patients with non-affective functional psychoses in a metropolitan area of South-Eastern Brazil

Estudos sobre mortalidade na esquizofrenia e outras psicoses näo afetivas em diversos países industrializados têm consistentemente encontrado índices maiores que aqueles observados na populaçäo geral. A principal causa dessa maior mortalidade é o suicídio, ocorrendo em média 20 vezes mais freqüentemente do que na populaçäo geral. Esse tópico adquire relevância para a saúde pública no Brasil, em funçäo do aumento previsto no número de casos de psicoses no País devido à mudança de estrutura etária da populaçäo, e da política de saúde mental atual, que tem desestimulado a internaçäo psiquiátrica, priorizando o tratamento das psicoses na comunidade. Para investigar essa questäo, realizou-se estudo prospectivo no município de Säo Paulo, SP (Brasil). A amostra consistiu de 120 internaçöes consecutivas em uma regiäo delimitada daquele município, na faixa etária de 18 a 44 anos, com diagnóstico clínico de psicose funcional näo afetiva. A amostra foi seguida por 2 anos a partir da internaçäo psiquiátrica. Ao término desse período, foi possível estabelecer a evoluçäo de 116 pacientes (96,7 por cento). Sete pacientes faleceram (6 por cento dos 116 que completaram o estudo), sendo que 5 (4,3 por cento) cometeram suicídio. Quatro dos casos de suicídio ocorreram durante os primeiros 12 meses após a alta hospitalar. As Razöes de Mortalidade padronizadas para idade e sexo (relativos às taxas de mortalidade para a populaçäo de Säo Paulo) foram 8,4 para mortalidade geral (intervalo de confiança de 95 por cento: 4,0-15,9) e 317,9 para mortes por suicídio (intervalo de confiança de 95 por cento: 125.2-668.3). Os resultados do presente estudo indicam que as psicoses funcionais näo afetivas estäo associadas a uma esperança de vida menor que a observada na populaçäo geral. Vários países vêm priorizando, já por muitos anos, a atençäo psiquiátrica na comunidade. Tanto pacientes e familiares preferem essa alternativa de tratamento ao antigo modelo hospitalocêntrico. No entanto, é necessário que os programas de saúde mental no Brasil forneçam cuidados de saúde adequados aos pacientes que sofrem desses transtornos, particularmente no período que se segue à alta hospitalar, a fim de que se evite ao máximo uma evoluçäo täo desfavorável para os pacientes e seus familiares

Admission outcome of Egyptian schizophrenic patients: a retrospective study after five and thirty years

703 case notes of Egyptian schizophrenic patients, firstly admitted to Abbassia Mental Hospital during the period from 1930 to 1934, were examined to identify their clinical outcome after 5 and 30 years of their initial admission. Findings of the 5-years outcome casted that 13.7% of them died; 37.4% of the survivors had a good outcome, while 22.9% and 39.7% exhibited fair and had outcomes respectively. These figures coincide with similar results of studies done in other developing countries, but were of more favourable outcome than those carried out in the developed countries, which were keeping with the results of the International Pilot Study of Schizophrenia. The 30-years outcome results differed remarkably. 27% died during their admission and only 15% of the living subjects denoted a good outcome, while 60% and 25% had fair and bad outcomes respectively. Inspite of differences in sample characteristics and treatment modalities, these findings were similar to western studies. The existing work referred to its limitations that employed no more than hindsight of the admission outcome. In the light of its results and with regard to accumulated data in pervious studies, the current study afforded explanations of its findings however it favoured no single attribution, and it recommended comtinuing other complementary Egyptian works that adopt longer-term assessments