Adult schizophrenia

Parnas J, Mednick SA and Moffett TE (1981). Perinatal complications and adult schizophrenia. 

Bearden, C.E., Rosso, I.M., Hollister, J.M., Sanchez, L.E., Hadley, T, and Cannon, TD. (2000) A prospective cohort study of childhood behavioral deviance and language abnormalities as predictors of adult schizophrenia. Schizophr Bull 26 395 10. 

Efficacy in short-term treatment. From studies in adult schizophrenia, it is evident that clozapine treatment has at least the same or superior antipsychotic effect, compared to typical antipsychotics. In some studies, clozapine was superior with regard to symptom reduction in severe and acute schizophrenic patients. As the guidelines do not allow the use of clozapine as a first-choice drug, most patients have been treated before with at least two atypical or typical antipsychotics. Only one controlled trial has assessed the efficacy of clozapine in child and adolescent psychiatry. In this study (Kumra et ah, 1996), clozapine was found to be superior to haloperidol in all measures of psychosis, and showed a striking superiority for both positive and negative symptoms. 

Efficacy in maintenance treatment. Studies in adult schizophrenia concerning maintenance treatment have been especially interesting, because the majority of the patients were nonresponders to conventional antipsychotics. These studies demonstrate the superior efficacy of clozapine as maintenance treatment in therapy-refractory psychoses treated by classical antipsychotics. Beyond that, it could be demonstrated that clozapine was effective in reducing recurrence rates and duration of hospitalization. The superior efficacy of clozapine, although not its effects on recurrence or hospital stay, have also been demonstrated in adolescents suffering from chronic schizophrenia (Schulz et ah, 1996, 1997). 

Psychiatric Disorders. The main indications for DA antagonists are the treatment of adult schizophrenia, and childhood psychosis. Haloperidol and chlorpromazine are the most frequently employed. 

Mednick SA, Machon RA, Huttunen MO, Bonett D (1988) Adult schizophrenia following prenatal exposure to an influenza epidemic. Arch Gen Psychiady 45 189—192. 

Jones P, Rodgers B, Murray R, Marmot M. Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort. Lancet 1994 344 1398-1402. 

Brown AS, Susser ES. In utero infection and adult schizophrenia. Ment Retard Dev Disabil Res Rev 2002 8 51-57. 

The expression of many of the genes identified to be related in some way to the appearance of adult schizophrenia is known to be changed by hypoxia. This suggests that hypoxia during fetal brain development may be somehow involved in the etiology of schizophrenia.36... 

But despite the research limitations, a relationship between maternal stress during pregnancy and later adult schizophrenia in offspring has been established at least in outline.37 Considerable evidence shows that maternal stress during the first trimester of pregnancy may be a particularly important risk factor for later onset of this disorder in offspring.38... 

Other possible prenatal factors are neurotoxins Although there has been too little research examining schizophrenia as a possible outcome of fetal lead exposure, it has been proposed that fetal blood levels of lead greater than 15 units (micrograms per deciliter) may double the risk of childhood or adult schizophrenia spectrum disorder.39Another important possibility is that prenatal exposure to endocrine disruptors, such as bis-phenol-A (a polymer environmental pollutant present in many plastic consumer products) can be involved in the etiology of schizophrenia.40 Past research has indeed demonstrated endocrine and neuroendocrine abnormalities in schizophrenics.41... 

The reduction in cortical volume observed in schizophrenia is substantially less than that found in the adult onset primary dementias such as Alzheimer s disease and Huntington s disease. A subject of controversy has been whether the reduction in cortical volume in schizophrenia... 

There are, however, subgroups of young adults who may not mature out of drug problems as easily as others. Those who seem to have problems maturing out usually have other problems that preceded the onset of drug use. For instance, researchers have found that young adults who have a history of Conduct Disorder or who have other psychiatric disorders (such as schizophrenia, Bipolar Disorder, depression, Anxiety Disorder, or a major personality disorder) mature out of drug problems at much lower rates than those who do not have these additional problems. 

In addition to the above behavioral and performance tests, there are a number of well-known tests of personality that may provide useful information in select clinical studies. The most well known of these tests is the Minnesota Multiphasic Personality Inventory (MMPI). This test consists of 550 affirmative statements to which a true or false response is given and requires about one hour to complete. It is given to adults over the age of 16 and is scored for ten scales depression, hysteria, hypochondriasis, psychopathic deviate, masculinity-femininity, paranoia, hypomania, schizophrenia, psychasthenia, and social introversion. 

The symptoms of schizophrenia are so foreign to most of us that it is difficult to appreciate their horror. Patients feel that they have lost control of their minds with thoughts being inserted into their brains. Their delusions are usually terrifying. The common auditory hallucinations are horrifically accusatory. Many psychiatrists characterize the entire adult lives of schizophrenics as a living death. The behavior of schizophrenics is so disruptive that fives of their parents and siblings are often devastated. Thus, whether calculated in terms of dollars lost to a country s economy or human suffering, schizophrenia may well rank as the number one mental illness. 

E. Not autism. Delusions or hallucinations must be present to diagnose schizophrenia in an autistic child or adult. 

Schizophrenia is a psychotic illness and is one of the most common psychotic disorders (a mental illness in which the sufferer loses contact with reality). About half a million people in the UK suffer from schizophrenia. It affects mainly adolescents and young adults, and there is a genetic component to the disease. Lay terms that have been used for the disorder are insanity, lunacy and madness. Hospitals that catered for such patients were formerly known as lunatic asylums. 

Schizophrenia Adjust dosage in adult psychiatric disorders to the response of the individual and according to the severity of the condition. Begin with the lowest recommended dose. Although response is ordinarily seen within a day or 2, longer treatment is usually required before maximal improvement is seen. 

Increased mortality in elderly w/ dementia-related psychosis Uses Schizophrenia Action Dopamine serotonin antagonist Dose Adults. 10-15 mg PO daily 5.25-15 mg for acute agitation Caution [C, -] Disp Tabs, inj SE Neuroleptic malignant synd,... 

Murphy DC, Jones LA, Owen MJ (1999) High rates of schizophrenia in adults with velo-cardio-facial syndrome. Arch Gen Psychiatry 56 940-945... 

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