First-episode schizophrenia with long duration of untreated psychosis. Pathways to care

BACKGROUND: The early course of illness in first-episode schizophrenia was examined with special emphasis on the duration of untreated psychosis and pathways to care. METHOD: The consecutively admitted individuals (n = 34) were assessed on premorbid functioning, duration of untreated psychosis, global functioning, symptoms and social network. To clarify the obstacles for receiving earlier treatment, 17 case histories with long duration of untreated psychosis were intensively studied. RESULTS: The duration of untreated psychosis was on average very long (130 weeks), the median value was 54 weeks. The long duration of untreated psychosis group (> 54 weeks) had greater deterioration in the premorbid phase, a weaker social network and were more withdrawn than the short duration of untreated psychosis group (< 54 weeks). The main obstacles for receiving treatment were withdrawal and poor social network. CONCLUSIONS: In order to identify people earlier, a system of detection must be mobile, easily accessible and attentive to early symptoms of psychosis. It seems to be important to educate the social network related to the individual about the importance of early treatment.     

Mood theme and bizarreness of delusions in schizophrenia and mood psychosis.

Narratives of the delusions of 83 schizophrenic and 55 nonschizophrenic Ss were categorized as of 1 or more of 12 types. Narratives were also independently assessed along dimensional scales of bizarreness and mood theme. Schneiderian and grandiose types were found to be more common in schizophrenics and mood psychotics, respectively. Dimensional measures showed that the delusions of schizophrenics were more unlikely and that those of mood psychotics had a stronger mood theme. Regression analysis determined that Schneiderian delusions and a dimensional estimate of mood theme best differentiated schizophrenics from mood psychotics. Assessments along dimensions of other parameters, particularly those represented by Schneiderian delusions, may further discriminate the functional psychoses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dimensionality of schizophrenia concepts in first-episode psychosis

OBJECTIVE: To evaluate the efficacy of unreamed retrograde intramedullary (IM) nailing of fractures of the femoral shaft in a second series of patients using modifications suggested from our initial study. DESIGN: Prospective. SETTING: Level I trauma center. METHODS: Based on the findings of a previous study, we began a clinical series incorporating changes consisting of (a) inclusion of any patient with a femoral shaft fracture amenable to IM nailing (i.e., closed physes), (b) primary use of a split patellar tendon intercondylar distal femoral entry portal, and (c) the use of a full-length femoral implant having variable size availability and dynamization capability. Over a twelve-month period, thirty-four patients with thirty-five femoral shaft fractures were treated. The protocol called for planned dynamization in statically locked stable fractures and unstable fractures showing minimal healing at six to twelve weeks. Functional outcome was assessed by using the Knee Society clinical rating system. RESULTS: Incorporating the concepts of canal fill and early dynamization, there were only two nonunions (6 percent) in this series as compared with 14 percent in the previously reported series with an overall shorter time to union (12.6 versus 15 weeks). There were no infections or malunions. Postoperative complaints of knee pain were minimal (knee score average: 98 points) and knee function was excellent (knee score average: 97 points). CONCLUSIONS: Although not advocated as a replacement for other techniques, unreamed retrograde nailing is presented as a safe and beneficial fracture fixation method that should be added to the orthopaedic surgeon's treatment armamentarium. The operative technique is quick and simple, and blood loss is minimal. Early nail dynamization and early weight-bearing are important in minimizing the risk of nonunion.     

Early intervention, untreated psychosis and the course of early schizophrenia

BACKGROUND: Studies have proved that early intervention can delay psychotic relapses, and prevent psychosocial deterioration in people with schizophrenia and related disorders. METHOD: Our study with young people with recent onset schizophrenia has shown that an intensive intervention programme had a beneficial effect on the occurrence of psychotic relapse and the course of psychotic syndromes. This effect lasted until the end of the 15-month intervention. No significant effect of the two different intervention conditions became apparent. RESULTS: The results of a follow-up study showed that this beneficial effect did not last. Fifteen per cent of the people had a psychotic relapse during the intervention, whereas 64% relapsed during follow-up. CONCLUSIONS: These results show that referral to other mental health agencies after intervention is not sufficient and that more support is required to continue disease management, medication compliance and stress management.     

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents.

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prenatal and perinatal risk factors for schizophrenia, affective psychosis, and reactive psychosis of early onset: case-control study

OBJECTIVE: To examine prenatal and perinatal risk factors for subsequent development of schizophrenia and affective and reactive psychosis. DESIGN: Three population based, case-control studies conducted within a Sweden-wide cohort of all children born during 1973-9. This was done by linking individual data from the Swedish birth register, which represents 99% of all births in Sweden, to the Swedish inpatient register. SUBJECTS: Patients listed in inpatient register as having been first admitted to hospital aged 15-21 years with a main diagnosis of schizophrenia (n=167), affective psychosis (n=198), or reactive psychosis (n=292). For each case, five controls were selected. MAIN OUTCOME MEASURES: Risks of schizophrenia and affective and reactive psychosis in relation to pregnancy and perinatal characteristics. RESULTS: Schizophrenia was positively associated with multiparity (odds ratio 2.0), maternal bleeding during pregnancy (odds ratio 3.5), and birth in late winter (odds ratio 1.4). Affective psychosis was associated with uterine atony (odds ratio 2.2) and late winter birth (odds ratio 1.5). Reactive psychosis was related to multiparity (odds ratio 2.1). An increased risk for schizophrenia was found in boys who were small for their gestational age at birth (odds ratio 3.2), who were number four or more in birth order (odds ratio 3.6), and whose mothers had had bleeding during late pregnancy (odds ratio 4.0). CONCLUSIONS: A few specific pregnancy and perinatal factors were associated with the subsequent development of psychotic disorder, particularly schizophrenia, in early adult life. The association of small size for gestational age and bleeding during pregnancy with increased risk of early onset schizophrenia among males could reflect placental insufficiency.     

A new theory of schizophrenia.

Atheory of schizophrenia is presented by a patient on a closed ward of a VA hospital with a diagnosis of paranoid schizophrenia. "My view is that the schizophrenic has adopted semi-instinctive, insincere strategems in order to escape punishment, one of them being withdrawal from intimacy—which isolation causes a libidinal starvation resulting in an involuntary, neurotic-type outbreak of symptoms based on unconscious, pregenital (perverted libidinal) drives… . He is a terrified, conscience-stricken crook, who has repressed his interest in people, unavowedly insincere and uncooperative, struggling against unconscious sexual perversion." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

One step towards the understanding of hope: a concept analysis

Hope is an essential concept in nursing which has not been satisfactorily explored. The purpose of this article is to elucidate the concept of hope, using a technique of concept analysis described by Walker and Avant (1995). The critical attributes revealed were; future-orientation, positive expectation, intentionality, activity, realism, goal-setting, and inter-connectedness. Various illustrative cases are presented as well as antecedents and outcomes. The discussion highlights some critical aspects of the method used and the results of this analysis may serve as a guide for further empirical research. In order to grasp the true nature of hope, complementary research studies employing a variety of methodological approaches are needed.     

A comparative-developmental approach to schizophrenia.

A comparative-development theory, in order to encompass schizophrenic processes, must introduce constructs which suggest a parallelism of various aspects of schizophrenia with the developmental patterns of childhood. The functions of emotion, perception, learning, thinking and language, socialization, and motor functions are examined from this viewpoint. By showing the essential similarity of structure between young children and schizophrenics, it is concluded that the approach is helpful in understanding schizophrenics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

VBR in schizophrenia: relationship to family history of psychosis and season of birth

Ventricular enlargement has been consistently demonstrated in schizophrenia using both CT and MRI. Despite this, the structural changes that underlie increased ventricle-brain ratio (VBR) and its relationship to environmental factors (intrauterine viral exposure, obstetric complications, etc.) and family history of schizophrenia remain poorly defined. Increased VBR has been shown in some studies to correlate with an absence of family history of schizophrenia and with Winter-Spring birth. In an attempt to obtain a clearer picture of the contribution of environmental and genetic factors to VBR, we studied 54 patients with DSM III-R schizophrenia. VBR was determined from head CT scans via computerized planimetry. Family history of psychosis and non-psychotic mood disorder was determined with the family informant method. Season of birth was encoded in several ways, including season, trimester and dichotomously. Patients without a family history of psychosis had significantly larger VBR than patients with such a history; family history of mood disorder was not related to VBR. Season of birth was not predictive of VBR. Family history of psychosis and season of birth were not related to each other. These results are in line with prior work demonstrating an association between increased VBR and sporadic (non-familial) schizophrenia. We did not find a relationship between VBR and season of birth, which suggests that risk of perinatal viral exposure and other seasonal environmental factors may not account for the ventricular enlargement in non-familial schizophrenia observed in our sample.     

Stepping backward in order to step forward: An acquisition-oriented approach to primary prevention.

Discusses the potential contributions of an acquisition-based approach to primary prevention and provides examples from a longitudinal study of the initiation of adolescent cigarette smoking. It is suggested that acquisition-oriented primary prevention combats the specific causes of the target behavior; takes into account the potential functions of target behavior; allows a better prediction of the implications of intervening; provides for the identification of high-risk populations; and guides the tailoring of programs for different subgroups. In a cohort-sequential study, 6th–12th graders (from the midwest and the southwest) were surveyed annually for 3–4 yrs. Findings suggest a stage model of smoking acquisition in which distal personality and perceived environmental variables and smoking environment variables are most important to initial smoking. Attitudes toward smoking appear to be most important in moving adolescents from experimental to regular smoking. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vulnerability: A new view of schizophrenia.

Reviews the 6 approaches to etiology that now preempt the field—ecological, developmental, learning, genetic, internal environment, and neurophysiological models—and proposes a 2nd-order model, vulnerability, as the common denominator. Methods are suggested for finding markers of vulnerability in the hope of revitalizing the field. It is assumed that exogenous and/or endogenous challengers elicit a crisis in all humans, but depending on the intensity of the elicited stress and the threshold for tolerating it (i.e., one's vulnerability), the crisis will either be contained homeostatically or lead to an episode of disorder. Vulnerability and episode stand in a trait–state relation, and markers for each must be provided to distinguish between them. (83 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A bias in the diagnosis of schizophrenia.

Presented to 15 clinical faculty and 2 interns a fictitious case history containing behavioral clues that could be interpreted as moderately consistent with a diagnosis of schizophrenia but that would not be conclusive. Two forms were used: On one form the information was given that the patient had a twin who was schizophrenic. Knowledge that the patient had a schizophrenic twin almost doubled the raters' estimates of the probability that the patient was schizophrenic. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concept of process-reactive schizophrenia: A critique.

A review of current issues, including (1) the dichotomy vs. continuum view of the process-reactive concept, (2) the question of organic involvement in process schizophrenia, (3) the relationship of severity of illness to the concept, (4) the problem of duration of hospitalization, (5) comparability of criteria, (6) adequacy of control groups, (7) sociocultural diversity, and (8) uniformity of process-reactive differences. (2 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

A step backward in the recovered memory debate.

Comments on the critical issues raised in B. P. Karon & A. J. Widener's (see record 1998-12169-012) response to the criticisms of the present authors (see record 1998-12169-009) in response to Karon and Widener's (see record 1997-04849-007) article discussing the memories of WWII veterans in the context of the recovered memory debate. The authors suggest that by treating the lifting of repressions as synonymous with all forms of remembering, and repression as synonymous with all forms of nonreporting, Karon and Widener render the concept of repression so broad as to be virtually meaningless. This is a step backward in the complex debate concerning the existence of repressed and recovered memories of wartime trauma. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Another view of schizophrenia subtypes. A report from the international pilot study of schizophrenia

We studied respiratory mechanics in young volunteers before and after 5-wk training programs limited to the ventilatory muscles. Four strength trainers (S) performed repeated static maximum inspiratory and expiratory maneuvers against obstructed airways. Four endurance trainers (E) performed voluntary normocarbic hyperpnea to exhaustion. Subjects spent 30-45 min each day in these exercises, 5 days a week. Four control subjects (C) did no training. We attempted to minimize the effect of learning. S increased pressure maximums by about 55%, but vital capacity and total lung capacity by only about 4%. Initially all subjects could sustain hyperpnea at about 81% of their control 15-s maximum voluntary ventilation (MVV) for 15 min; E increased this to about 96% and increased their MVV by 14% as well. No other statistically significant changes were recognized in any group. We conclude that ventilatory muscle strength or endurance can be specifically increased by appropriate ventilatory muscle training programs.     

Primary process thinking in myxoedema psychosis: A case study.

Investigated the rapid mental changes taking place in a 17-yr-old female patient suffering from myxoedema psychosis, using the Holt scoring system for measuring primary process from Rorschach responses. As is typical for this condition, treatment with desiccated thyroid resulted in almost immediate improvement. 2 examiners independently scored for primary process the 3 Rorschachs administered over a 7-mo period. Results indicate satisfactory reliability between the 2 scorers. The most important finding was a drop in the amount of over-all formal level primary process thinking, reflecting the improvement in Ss clinical physical and mental state. (French summary) (PsycINFO Database Record (c) 2011 APA, all rights reserved)