Suicide risk in schizophrenia: an analysis of 17 consecutive suicides.
(1/97)
The aim of this study was to investigate interactional factors related to the recognition of suicide risk in patients with schizophrenia. The study focused on 17 schizophrenia patients who had committed suicide during the National Suicide Prevention Project in Finland between April 1, 1987, and March 31, 1988, in the province of Kuopio. Consensus case reports were assembled by using the psychological autopsy method. Study methods included structured and in-depth interviews of next of kin and interviews of health care or social services workers who had treated the suicide victims. Male and female patients with schizophrenia committed suicide in equal proportions. Most had suffered from schizophrenia for more than 15 years; all but one had been receiving psychiatric treatment at the time of suicide. Retrospective assessment indicated that 59 percent of the patients were clinically depressed at the time of suicide. In 76 percent of the cases, the mental health professionals involved in treatment had not believed that there was a risk of suicide during their last contact with the patient. In 29 percent of the cases, the patient's paranoid ideas concerning treatment personnel had increased. Patients' withdrawal from human relationships because of depression was related to loss of the treatment professionals' concern for the patients. The findings in this descriptive study suggest that withdrawal by a patient with schizophrenia and an increase in the patient's paranoid behavior should be regarded as signals of risk of suicide. (+info)
Screening for hypothyroidism in elderly inpatients.
(2/97)
Routine biochemical screening for hypothyroidism in 2000 geriatric inpatients proved valuable and practicable and yielded 46 cases (2.3%). A non-specific clinical picture was particularly common, with less than a third of the cases showing "typical" signs and symptoms. Psychiatric manifestations, especially depression, were important and frequent and responded well to thyroxine. There was a preponderance of female cases of hypothyroidism and a strong association with other autoimmune diseases, notably pernicious anaemia and rheumatoid arthritis. (+info)
Hypocalcaemic myopathy with paranoid psychosis.
(3/97)
A description is given of a patient with idiopathic hypoparathyroidism and a paranoid psychosis. Changes in muscle, electromyograms, and blood enzyme levels were related to hypocalcaemia. Reference is made to the elevations of these enzyme levels found in other cases of psychosis. (+info)
Delusional parasitosis as 'folie a deux'.
(4/97)
Delusional parasitosis is characterized by the unshakeable belief of being infested with tiny (microscopic) insects. Patients spend much time trying to get rid of the bugs and suffer from these symptoms. Patients prefer to go to dermatologists because they have a strong conviction over the presence of a somatic disease and do not accept any psychiatric advice for their complaints. Folie a deux or shared psychotic disorder (SPD) is a relatively rare syndrome, which has long attracted clinical attention. Delusional parasitosis is associated in 5-15% of SPD and can run within a family. We experienced delusional parasitosis as Folie a Deux between a mother and her son and successfully treated them through early psychiatric intervention. We believe that attention should be drawn to DP with SPD. (+info)
Neuroleptic sensitivity in patients with senile dementia of Lewy body type.
(5/97)
OBJECTIVE: To determine the outcome of administration of neuroleptics to patients with senile dementia of Lewy body type confirmed at necropsy. DESIGN: Retrospective analysis of clinical notes blind to neuropathological diagnosis. SETTING: Specialist psychogeriatric assessment units referring cases for necropsy to a teaching hospital neuropathology service. PATIENTS: 41 elderly patients with diagnosis of either Alzheimer type dementia (n = 21) or Lewy body type dementia (n = 20) confirmed at necropsy. MAIN OUTCOME MEASURES: Clinical state including extrapyramidal features before and after neuroleptic treatment and survival analysis of patients showing severe neuroleptic sensitivity compared with the remainder in the group. RESULTS: 16 (80%) patients with Lewy body type dementia received neuroleptics, 13 (81%) of whom reacted adversely; in seven (54%) the reactions were severe. Survival analysis showed an increased mortality in the year after presentation to psychiatric services compared with patients with mild or no neuroleptic sensitivity (hazard ratio 2.70 (95% confidence interval 2.50-8.99); (chi 2 = 2.68, p = 0.05). By contrast, only one (7%) of 14 patients with Alzheimer type dementia given neuroleptics showed severe neuroleptic sensitivity. CONCLUSIONS: Severe, and often fatal, neuroleptic sensitivity may occur in elderly patients with confusion, dementia, or behavioural disturbance. Its occurrence may indicate senile dementia of Lewy body type and this feature has been included in clinical diagnostic criteria for this type of dementia. (+info)
EFFECT OF CHLORPROTHIXENE IN PATIENTS WITH PARANOID SYMPTOMS.
(6/97)
Chlorprothixene, a thioxanthine derivative, claimed to have broad-spectrum antipsychotic properties, was compared with phenothiazine derivatives in the setting of a psychiatric admission service and aftercare clinic.In 32 female patients with paranoid symptoms, chlorprothixene in high dosage ranges (200 to 1200 mg. daily) was found to be as effective as similar doses of chlorpromazine in controlling the symptoms; fewer side effects were noted. (+info)
PREFRONTAL LEUKOTOMY: A FIVE-YEAR CONTROLLED STUDY.
(7/97)
One hundred and eighty-three patients who had received prefrontal leukotomy over a period of several years were compared with a closely similar group who had not undergone the operation. No significant differences in rate of hospital discharge after a five-year follow-up period were found between the two groups. The groups showed no consistent difference in outcome in relation to diagnosis, chronicity vs. intermittency of illness, heredity, education, family attitude, premorbid adjustment, or degree of insight on the part of the patients. It is concluded that prefrontal leukotomy does not produce any rate of remission significantly beyond that to be expected without the operation. (+info)
TEMPORAL LOBE EPILEPSY: A CLINICAL STUDY OF 47 CASES.
(8/97)
Clinical features of 47 cases of temporal lobe epilepsy are analyzed and treatment of this disorder is outlined. Twenty-four per cent of all cases of epilepsy seen by one of the authors over a two-year period were of this type. Fifteen of these 47 patients had a history of birth injury. Care must be taken to distinguish the symptoms of temporal lobe epilepsy from those of acute anxiety or hysteria and to differentiate the short-lived temporal lobe attack from centrencephalic petit mal.Interictal personality disturbances were identified in 11 of 24 persons with temporal lobe epilepsy, four of 35 with focal epilepsy from all other areas, and one of 17 with centrencephalic epilepsy. Personality deviations most frequently encountered were irritability, aggressiveness, bouts of depression, paranoid tendencies and exhibitionism. Medical or surgical treatment often improves the personality abnormalities concomitantly with control of seizures. (+info)