Schizophrenia duration

For approximately 20% to 30% of people with schizophrenia, drug treatment is ineffective. A standard definition of treatment resistance includes patients who have persistent positive symptoms despite treatment with at least two different antipsychotics given at adequate doses (at least 600 chlorpro-mazine equivalents) for an adequate duration (4 to 6 weeks). In addition, patients must have a moderately severe illness as defined by rating instruments, and have a persistence of illness for at least 5 years.40 These patients are often highly symptomatic and require extensive periods of hospital care. 

Velakoulis, D., Wood, S. J., Smith, D. J. et al. Increased duration of illness is associated with reduced volume in right medial temporal/anterior cingulate grey matter in patients with chronic schizophrenia. Schizophr Res. 57 43-49, 2002. 

The diagnostic criteria for schizophrenia have evolved considerably (Table 4.1). In DSM-IV, there are three symptom domains including symptom characteristics, social/occupational dysfunction due to these symptoms, and symptom duration. In... 

Other Symptoms. Although they are not reflected in the DSM-IV criteria, it now appears that mood and cognitive symptoms also hinder the patient with schizophrenia. Depressed mood, often short of the duration or severity needed to diagnose major depression or schizoaffective disorder, is an all too common problem. Because the negative symptoms of the illness and certain antipsychotic side effects resemble depression, this was long overlooked. Indeed, depressed mood may in part explain the extremely high rates of attempted and successful suicides by those with schizophrenia. 

Brief Psychotic Disorder. This diagnosis also differs from schizophrenia by virtue of the duration of symptoms. The symptoms mnst last less than 1 month, and the patient must return to his/her previous level of social functioning when the illness subsides. Formerly called brief reactive psychosis, an episode of this illness usually arises in reaction to some markedly stressfnl event, thongh this is not always the case. 

Neurochemical imaging and MRS techniques have obvious, although longterm studies of neurochemistry in vivo have yet to be applied to schizophrenia. One correlate of the neurodegenerative process proposed in the NMDA receptor hypofunction hypothesis is demonstrated in the relationship between anterior cingulate NAA deficits and disease duration (Ende et al., 2000). A... 

Schizophreniform disorder in DSM-FV is somewhat different from schizotypal disorder in ICD-10. The diagnosis of schizophreniform disorder requires the identical criteria of schizophrenia (criterion A), except for two differences the total duration of the illness is at least 1 month, but less than 6 months (criterion B), and impaired social or occupational functioning during some part of the illness is not required. The delusional disorder in DSM-IV corresponds more or less to the category persistent delusional disorder of ICD-10, and brief psychotic disorder (DSM-IV) is similar to the ICD-10 category acute and transient psychotic disorder, whereas the shared psychotic disorder of DSM-IV corresponds to induced delusional disorder of ICD-10. 

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). 

Loebel AD, Lieberman JA, Alvir JMJ, et al Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 149 1183-1188, 1992... 

Muller and Schoneich (1992) also reported on favorable experience with intensive outpatient psychotherapy combined with antipsychotic drug treatment. On the basis of a before-and-after comparison over 2x5 years in a university outpatient clinic, they were able to show that the duration of rehospitalizations required by 89 patients could be reduced from a mean of 10 weeks to 2 weeks per year when a special schizophrenia outpatient service offering individualized psychotherapy and psychosocial treatment was available to the patients instead of the routine psychiatric outpatient service. A beneficial effect of psychotherapy was demonstrated both in those patients taking antipsvchotics continuously for long-term prophylaxis and in those taking the drugs intermittently when prodromal symptoms appeared in order to prevent relapse. 

This third edition essentially retains the structure of the second edition but its contents have been revised, with considerable changes in some parts. Thus, account is taken of the fact that a new generation of antidepressants has been available for some years, that concepts of the mechanisms of neuroleptic action have altered several times and have led to products with new mechanisms of action, and that therapeutic advances have even been recorded in a field that was only recently considered to be hopeless, namely Alzheimer s disease. New methodological developments, especially in the use of imaging techniques in psychiatry, and changes in opinions on the best possible use of psychopharmaceuticals and their duration of use in schizophrenia and depression have been suitably taken into account. 

This category is attributed to Kahibaum and Kraepelin, who saw paranoia as a chronic, unremitting system of delusions distinguished by both the absence of hallucinations and the deterioration seen in schizophrenia. This disorder is characterized by one or more nonbizarre delusions of at least 1 month s duration. 

Johnson DAW. Further observations on the duration of depot neuroleptic maintenance therapy in schizophrenia. Br J Psychiatry 1979 135 524-530. 

Rosen and colleagues (48) administered a structured interview, based on the Schedule for Affective Disorders and Schizophrenia (SADS) to 89 bipolar I patients, to compare psychotic and nonpsychotic manic patients on a number of clinical outcome and demographic variables (i.e., age, age at first treatment, and duration of illness). Overall, the psychotic manic group had a significantly poorer outcome in terms of social functioning. 

The prevalence of hyperprolactinemia in patients with chronic schizophrenia taking long-term haloperidol has been studied in 60 patients in Korea (28 women illness mean duration, 15.5 years) (472). There was hyperprolactinemia, defined as a serum prolactin concentration over 20 ng/ml in men and 24 ng/ml in women, in 40 the prevalence of hyperprolactinemia in women (93%) was significantly higher than in men (47%). There was also a... 

In contrast, in a study sponsored by Eli Lilly, there was improvement in 21 hospitalized elderly patients with schizophrenia or schizoaffective disorder who were taking olanzapine, mean final dose 13 mg/day. There was no significant weight gain (mean baseline weight 73.6 kg, mean final weight, 72.8 kg mean treatment duration around 10 months) (888). However, the propensity for studies that are sponsored by pharmaceutical companies to be more favorable to their drug is well known (889). 

The Diagnostic and Statistical Manual of Mental Disorders lists several distinct criteria necessary for a diagnosis of schizophrenia.5 These criteria include a marked disturbance in the thought process, which may include bizarre delusions and auditory hallucinations (i.e., hearing voices ). Also, a decreased level of function in work, social relations, and self-care may be present. Other factors include the duration of these and additional symptoms (at least 6 months) and a differential diagnosis from other forms of mental illness (such as affective disorders and organic brain syndrome). 

Fig. 1. Schematized hypnogram demonstrating most of the sleep disorders described in the literature using laboratory recordings of untreated persons with schizophrenia. One category of sleep disorders in schizophrenia is the insomnia type , with long sleep latency, numerous and/or long awakenings, and short sleep duration. Another type of sleep disorders is more concerned with sleep organization, e.g.., short duration of SWS and/or short latency to the onset of REM sleep. Not all disorders are found in every study since variables such as symptoms or diagnosis subtype, severity and chronicity may influence the results (see text). REMS, REM sleep. A REM sleep period is defined as a succession of REM sleep epochs not interrupted for more than 15 min.

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