History of Treatment

The schizoaffective diagnosis is warranted when the patient at times fulfills criteria for schizophrenia while no mood disturbance is evident but at other times also fulhlls criteria for a major depressive episode or a manic episode. 

Antiquity. The treatment of what we now call schizophrenia probably dates back to prehistoric times. In early cnltures, madness was usually believed to result from some malevolent external force that invaded the person and took possession of the individnal. Treatment efforts would then be directed at enticing or driving out these evil spirits. This would explain the rise of shamanistic exorcisms that existed in a variety of cnltnres and remain prevalent today. In addition, it may be that trepanation (removing a piece of the skull) practiced by Stone Age peoples may have been the hrst psychosnrgery used to allow the evil sprits an avenue of escape. 

Shock Therapy. Insulin coma treatments were used in the early 1900s but offered no tangible improvement. Electroconvulsive therapy (ECT) arose in the 1930s and 1940s and was the hrst treatment to provide some relief from psychosis. However, its effects are only temporary and it proved too costly for continuous use. ECT continues to have some use for life-threatening catatonia, but it is mainly used to treat refractory depression or bipolar disorder. 

Psychosurgery. Erontal lobotomy, and later leukotomy, became popular in state institutions in the 1930s. Like opiates, it calmed agitated, violent patients. It did not relieve psychosis and thankfully was abandoned in the late 1940s. 

Chlorpromazine (Thorazine). The first of the modem antipsychotics was developed in the early 1950s, not as an antipsychotic but as an antihistamine that could be used during surgery to minimize the amount of anesthesia needed. It was hoped that this would lessen the danger of shock (dangerously low blood pressure) during surgery. It was actually quite successful, but it was soon found to have other benefits. Of key importance, it could relieve the positive symptoms of schizophrenia. In the years to follow, this led to the production of other similar antipsychotics collectively known as the typical antipsychotics. 

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The chemical and physical properties of cellulose depend ia large measure on the spatial arrangements of the molecules. Therefore, cellulose stmctures have been studied iatensively, and the resulting information has been important ia helping to understand many other polymers. Despite the extent of work, however, there are stiU many controversies on the most important details. The source of the cellulose and its history of treatment both affect the stmcture at several levels. Much of the iadustrial processiag to which cellulose is subjected is iatended to alter the stmcture at various levels ia order to obtain desired properties. 

The commonly used classes of antidepressants are discussed in the following sections, and information about doses and half-lives is summarized in Table 2-1. The antidepressant classes are based on similarity of receptor effects and side effects. All are effective against depression when administered in therapeutic doses. The choice of antidepressant medication is based on the patient s psychiatric symptoms, his or her history of treatment response, family members history of response, medication side-effect profiles, and comorbid disorders (Tables 2-2 and 2-3). In general, SSRIs and the other newer antidepressants are better tolerated and safer than TCAs and MAOIs, although many patients benefit from treatment with these older drugs. In the following sections, clinically relevant information is presented for the antidepressant medication classes individually, and the pharmacological treatment of depression is also discussed. The use of antidepressants to treat anxiety disorders is addressed in Chapter 3. 

Allergic reactions to insulin were originally thought to be caused by impurities present in the formulation. However, after the introduction of monocomponent insulins and human synthetic insulins, these reactions continued to be seen, even in patients without a history of treatment with other insulins (142). Switching from animal to human insulin can paradoxically cause allergic reactions, which subside when treatment with animal insulin is re-introduced... 

Renal failure has a long history of treatment with protein-restricted diets. Dietary plant protein is a possible therapy mechanism for the treatment of chronic and acute renal failure. 

A 39-year-old woman with a history of treatment-resistant depression developed delusions that her medical attendants were in love with her on two separate occasions when taking venlafaxine in doses of 225 mg and more (17). There was no evidence of mania and no other psychotic symptoms. On both occasions the delusional beliefs subsided when venlafaxine was withdrawn. She was subsequently treated with another antidepressant and made a good recovery. 

Careful recording of the history of treatments and their outcomes and adverse events is cracial. Though beyond the scope of this chapter, considerahon of specific psychological therapies, such as cognitive behavioural therapy, is essenhal. 

The conductivity of these perfluorinated membranes has been found to be affected strongly by the history of treatment of the membrane. As shown in Table 8, the conductivity increases in the order S-form [Pg.484]

Any significant ocular disease (other than CNV) that has compromised or could compromise vision in the study eye and confound analysis of the primary outcome Inability to obtain photographs to document CNV, including difficulty with venous access History of treatment for CNV in study eye other than nonfoveal confluent laser photocoagulation... 

A 43-year-old woman was brought to a hospital emergency room by her brother. Visiting the halfway house in which she lived, he had found her to be lethargic, with slurred speech. The patient had a long history of treatment for psychiatric problems, and the brother feared that she might have overdosed on one or more of the several drugs that had been prescribed for her. 

It appeared that a short questionnaire in combination with physical examination (inspection and palpation of the legs) had a predictive value of 87% (sensitivity 85%, specificity 88%). The short questionnaire consisted of only four items age, weight, history of treatment for phlebological disorders and tired feeling in the legs. With a more extended questionnaire in combination with a physical examination, the predictive value for having CVI increased to 89%. In this way, an alert physician can adequately screen for CVI and select individuals for preventive measures and referral to a specialist, using simple means and without any special equipment. 

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