ABSTRACT
Unified service systems for the chronic mentally ill are frequently proposed yet rarely implemented. This paper presents a program developed specifically to meet the needs of young people with schizophrenia and their families. The program's evolution and design, from its origins in a hospital to its eventual base in the community, are described. The implications of a clinical teaching unit affiliated with a university are outlined. The experience of a typical patient and his family provides a view from a clinical context. Hypotheses arising from this case study point to future empirical work in the development of model programs in the care of the long term mentally ill.
Subject(s)
Community Mental Health Services , Hospitalization , Schizophrenia/rehabilitation , Schizophrenic Psychology , Activities of Daily Living/psychology , Adult , Chronic Disease , Combined Modality Therapy , Continuity of Patient Care , Humans , Male , Ontario , Patient Care TeamABSTRACT
Regions of the brain involved in language and attention were studied using [18F]-fluorodeoxy-glucose in PET. In nine chronic DSM-III schizophrenic patients who had persistent auditory hallucinations, ten who had recovered from hallucinations and ten normal controls. In none of the regions examined was metabolic activity significantly different in hallucinating patients compared with that in other groups. However, a pattern of seven significant correlations of metabolic activity between language regions and between frontal and parietal cortex characterised the hallucinating but not the other groups. Three of the seven correlations were significantly greater in hallucinating patients than in the two other groups, and six were greater in hallucinating patients than controls. Metabolism in Broca's region and its right-hemisphere homologue correlated positively and significantly in the hallucinating group, as it did in anterior cingulate and left superior temporal areas, and in right frontal and parietal areas. Hallucination ratings correlated with metabolism in the anterior cingulate region.
Subject(s)
Auditory Perception/physiology , Blood Glucose/metabolism , Brain/physiopathology , Energy Metabolism/physiology , Hallucinations/physiopathology , Schizophrenia/physiopathology , Schizophrenic Psychology , Adult , Brain/diagnostic imaging , Brain Mapping , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/physiopathology , Chronic Disease , Deoxyglucose/analogs & derivatives , Deoxyglucose/metabolism , Dominance, Cerebral/physiology , Fluorodeoxyglucose F18 , Hallucinations/diagnostic imaging , Hallucinations/psychology , Humans , Neurons/physiology , Psychiatric Status Rating Scales , Schizophrenia/diagnostic imaging , Tomography, Emission-ComputedABSTRACT
The authors describe the first case report in the psychiatric literature of death from an overdose of amantadine hydrochloride used to treat neuroleptic induced extrapyramidal side effects. The pharmacology, adverse reactions and risks of using amantadine are briefly reviewed.
Subject(s)
Amantadine/poisoning , Schizophrenia/drug therapy , Adult , Amantadine/therapeutic use , Drug Therapy, Combination , Flupenthixol/analogs & derivatives , Flupenthixol/therapeutic use , Humans , Male , Schizophrenic Psychology , Suicide/psychologyABSTRACT
The authors describe a case in which flupenthixol decanoate and imipramine were co-administered to a patient with schizophrenia, resulting in extremely high levels of imipramine and its metabolite, desipramine. The literature on the co-administration of neuroleptics and antidepressants is reviewed and guidelines for limiting possible iatrogenic effects of the combination are suggested.
Subject(s)
Flupenthixol/administration & dosage , Imipramine/administration & dosage , Schizophrenia, Paranoid/drug therapy , Thioxanthenes/administration & dosage , Adult , Antidepressive Agents, Tricyclic/administration & dosage , Antipsychotic Agents/administration & dosage , Desipramine/blood , Drug Interactions , Flupenthixol/analogs & derivatives , Humans , Imipramine/blood , Male , Trazodone/administration & dosageABSTRACT
In nine schizophrenic patients on drug holiday, growth hormone (GH) response to apomorphine HCl 0.75 mg (APO) was compared with normal control data. Patients were tested at two month intervals for up to 14 months. Seven patients relapsed, and of these, five had exaggerated GH responses to APO at that time. Of these five, three had exaggerated GH responses to APO prior to clinical deterioration. Further work is required to determine whether this test can be a useful predictor of relapse.
Subject(s)
Apomorphine , Growth Hormone/metabolism , Schizophrenia/diagnosis , Adult , Antipsychotic Agents/therapeutic use , Dose-Response Relationship, Drug , Female , Growth Hormone/blood , Humans , Longitudinal Studies , Male , Recurrence , Schizophrenia/blood , Schizophrenia/drug therapy , Schizophrenia/physiopathologyABSTRACT
Currently, many schizophrenic patients fare poorly outside of hospital. Family physicians consider it impractical to follow this population in their office practice. Two clinical vignettes serve to illustrate realistic management based on the particular course of schizophrenic illness. Early warning signs of serious complications like relapse and depression are addressed.
ABSTRACT
The literature has long demonstrated an association between certain behavioral problems and EEG abnormalities, particularly the association of aggressive and sometimes violent behavior with foci in the temporal lobes. The concept of "dyscontrol syndromes" has also been established and it is possible that some instances of the dyscontrol syndrome arise from an abnormal sensitization of the limbic system, due to disturbance in or near the temporal lobes. Carbamazepine is an interesting new drug, with both anticonvulsant and psychotropic properties, for which both the behavioral effects and pharmacological actions have been defined. The properties of carbamazepine for blocking polysynaptic reflexes and suppressing post-tetanic potentiation are discussed with respect to this limbic system dysfunction in the dyscontrol syndrome. It is also proposed that this drug might be considered for its psychotropic effect in certain instances of dyscontrol, with or without clinical diagnosis of epilepsy. An illustrative case is cited.
