Schizophrenia case example

Propranolol may have specific antiaggressive effects for mentally retarded, organic, and certain schizophrenic patients with episodic violence. High-dose propranolol in patients with episodic aggression has been recommended, but this is based primarily on case reports. These indications should be distinguished from its use with or without an antipsychotic as a specific treatment for schizophrenia. For example, some open studies using high doses of propranolol (i.e., 500 mg to 2 g) reported success in an occasional schizophrenic patient, but not all studies confirmed this outcome ( 397, 398, 399, 400, 401, 402, 403 and 404). 

Part II of the book outlines several mental-health diagnostic categories schizophrenia, mood disorders, depression, bipolar disorders, and specific anxiety disorders including generalized anxiety disorder and obsessive compulsive disorder. Each chapter provides a case example, consideration in diagnosis, and the interventions utilized. Medications used to treat these disorders and relevant psychosocial interventions are outlined. Each chapter emphasizes the need for accurate treatment planning and documentation and offers suggestions to facilitate this process. 

While the obvious value of in vivo animal models is clear, there also are instances—especially in cases of inflammatory arthritis, behavior, and tumor growth—where they have failed to be predictive of useful clinical activity in humans [51], For example, leukotriene (LTB4) antagonists showed activity in animal models of inflammatory arthritis yet failed to be useful in rheumatoid arthritis [52]. Similarly, dopamine D4 antagonists showed activity in animal behavior models previously predictive of dopamine D2 antagonists in schizophrenia. However, testing of dopamine D4 antagonists showed no efficacy in humans [53]. 

Her case is one of a great many in which some decline in optimal mental function compromises life. These compromises fall into two general categories, whose distinction may be less real than apparent. On the one hand, there are neurological diseases in which there is some detectable, definable lesion in the nervous system. In the last chapter, we met one notable example Alzheimer s disease. As mentioned then, Alzheimer s disease is characterized by amyloid plaques external to neurons and fibrillary tangles within them—clear lesions. On the other hand, there are psychiatric diseases in which the pathology is clear but for which we can detect no lesion in the nervous system. Depression and schizophrenia provide two important examples. 

In the area of metal catalyzed asymmetric sulfoxidation there is still much room for improvement. The most successful examples involve titanium tartrates, but at the same time often require near stoichiometric quantities of catalysts [301, 302]. Recently, this methodology has been successfully used for the production of (S)-Omeprazole by AstraZeneca [303] (see Fig. 4.110). A modified Kagan-pro-cedure [302] was applied, using cumene hydroperoxide as the oxidant. Another example is the sulfoxidation of an aryl ethyl sulfide, which was in development by Astra Zeneca as a candidate drug for the treatment of schizophrenia. In this case the final ee could be improved from 60% to 80% by optimising the Ti tar-trate ratio [304]. 

Furthermore, a diet with low contents of FA may be involved in the development of insulin resistance, which suggests that an appropriate dietary intake of n-3 PUFA is considered protective against metabolic syndrome [183]. In addition, diverse psyquiatric impairs (depression, bipolar disorders, schizophrenia, autism) and neurodegenerative diseases such as Alzheimer disease have been associated to decreased blood levels of n-3 HUFA. Besides, there are many examples about the use of pol)nmsaturated FA as drugs. Thus, EPA has shown efficacy as adjunctive treatment, and in some cases as the only treatment in several psyquiatric disorders [184]. It is suggested that the potential of n-3 FA to prevent recurrence and metastasis of mammary cancer when used in adjuvant therapy is associated with a n-6 to n-3 ratio lower than 2 1 [185], On the other hand, fish intake is considered as a protective factor for preventing prostate cancer in addition, in humans low levels of ALA in mammary adipose tissue are associated with an increased risk of breast cancer in women [186]. 

Objections to these ideas have been raised. For example, if Parkinson s disease and schizophrenia were in a sense incompatible, it would be expected that schizophrenia would rarely develop in patients with Parkinson s disease. A number of cases in which a schizophrenic illness occurred in patients with long-standing Parkinson s disease have been described (25 ). Furthermore, experiments in animals do not suggest a. simple relationship between the effects of neuroleptic drugs and dopamine turnover (24 ). 

The last 20 years have seen severe mental illness treated far better by medication than by psychological treatment many otherwise hopeless cases have been able to return to their homes, and to employment, on maintenance doses of new drugs. More and more, biochemical research on mental illness is suggesting that many cases are caused by purely biochemical changes in the central nervous system (schizophrenia by over-methylation, for example). Hence the hope for more specific drug-based treatments is very bright. 

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