Social withdrawal

Which of the following agents is effective in minimizing emotional bluntness and social withdrawal seen in schizophrenia ... 

After the acute psychotic episode has resolved, the patient typically has residual features (e.g., anxiety, suspiciousness, lack of volition, lack of motivation, poor insight, impaired judgment, social withdrawal, difficulty in learning from experience, and poor self-care skills). Patients often have comorbid substance abuse and are nonadherent with medications. 

Major depression is one of the most common mental disorders. It has a lifetime prevalence of 17% in the general population, and a current prevalence of 4.9%, constituting a significant public health problem (Blazer et al. 1994). It is characterized by intense sadness and cognitive impairments most notable in concentration, worry, pessimism, and lowered self-esteem (American Psychiatric Association 1994). Interpersonal relationships may suffer and social withdrawal occurs. Physio-... 

The term psychotomimetic was coined to compare the effects of hallucinogens to the symptoms of schizophrenia and other psychotic conditions. However, the effects produced by hallucinogens and mental illness are qualitatively different. While drug-induced hallucinations tend to be more visual, auditory hallucinations are most common in schizophrenia. The hallucinogenic drugs discussed here may induce positive symptoms (e.g., hallucinations), but do not induce the negative symptoms (e.g., cognitive deficits, social withdrawal) of schizophrenia. 

BZ is undeniably psychotomimetic, but only in the broad sense that it causes a true loss of contact with reality. It also lacks most of the distinguishing features of the natural psychoses. Schizophrenia, for example, rarely produces visual hallucinations. BZ, on the other hand, seldom produces well-organized delusions (as may occur with LSD). BZ does not produce persistent social withdrawal, as seen in chronic schizophrenia, nor does it create the annoying overfriendliness of the manic phase of bipolar disorder. 

There are two general classes of clinical characteristics of schizophrenia. First, there are the positive symptoms that include auditory hallucinations (voices) and delusions, often paranoid. Second, there are the negative symptoms these include disorganization, loss of will, inability to pay attention, social withdrawal, and flattening of affect. The relative roles of positive and negative symptoms for a particular victim vary over time. The positive symptoms may predominate for a period to be followed by one in which the negative symptoms are more prominent. About 10% of people with schizophrenia commit suicide. 

Negative Symptoms. Although the odd nature of positive symptoms draws the most attention, the negative symptoms are perhaps the most disabling. These hinder a schizophrenia patient s desire and ability to maintain relationships or hold employment. The negative symptoms include poor motivation (avolition), a bland expressionless face (flattened affect), minimal speech (alogia), and social withdrawal. 

Cluster A Personality Disorders (Schizotypal PD, Schizoid PD, Paranoid PD). These are the odd and eccentric personality disorders. They all share certain features in common with schizophrenia, but schizotypal PD in particular appears to be most closely related to schizophrenia. The schizophrenia-like symptoms of these personality disorders (e.g., magical thinking, paranoia, social withdrawal) are less severe and generally don t impair social or employment function as severely as schizophrenia. 

Major Depressive Disorder (MDD) with Atypicai Features. The anhedonia of MDD is often manifested by social withdrawal. In contrast to social anxiety disorder, the social withdrawal of MDD is desired by the patient, at least during the major depressive episode, and does not persist when the episode remits. Atypical depression is characterized by another symptom reminiscent of social anxiety disorder—a longstanding pattern of sensitivity to interpersonal rejection. The interpersonal sensitivity associated with atypical depression is often characterized by stormy relationships and overly emotional responses to perceived slights. Such social lability is seldom observed in patients with social anxiety disorder. 

Avoidant Personality Disorder (APD) and Social Anxiety Disorder. These illnesses share the tendency toward social withdrawal and isolation with the Cluster A disorders. There is, however, a critical difference that can help make the distinction. The patient with social anxiety disorder is greatly troubled by the fact that (s)he may have so few friends or feel uncomfortable around them. (S)he would, in general, much prefer to feel more at ease in a social setting. This differs from the Cluster A personality disorders. The patient with SPD is indifferent to the fact that (s)he has few friends in fact, (s)he prefers to not have any. The patient with STPD is in a somewhat more intermediate position, feeling very anxious around others and perhaps preferring to have more friends, but also finds it easy to withdraw into a life of isolated fantasy. 

TFIC is usually consumed via smoking cannabis, but it can also be ingested orally. Cannabis intoxication is typically characterized by an initial period of euphoria, followed by a period of drowsiness or sedation. Impaired motor coordination, anxiety, a sensation of slowed time, impaired judgement, social withdrawal, conjunctival injection, increased appetite, dry mouth, and tachycardia are frequently observed during cannabis intoxication. Use of excessive amounts has been associated with development of panic attacks and paranoia. 

Preschoolers Child Behavior Checklist/ 2-3 100 items rated 0—2, 6 subscales social withdrawal, depressed, sleep problems, somatic problems, aggressive, destructive P Achenbach et ah, 1992... 

Emotional symptoms and changes in social functioning include blunted affect, mood disturbances such as irritability, fearfulness, and suspicion, negative symptoms such as marked apathy, paucity of speech, or incongruity of emotional responses resulting in social withdrawal and lowering of social performance. 

Schleifer et al., 1975 MPH 26 (26) 3-5 Hyperactive Crossover MPH 2.5 mg/day to 30 mg/day 28-42 days Improved on mother, not teacher, report and not on neuropsychiatric measures Increased dysphoria and social withdrawal... 

An open pilot comparison of olanzapine to haloper-idol in 11 children with FDD showed that both agents were effective in reducing problematic behaviors such as social withdrawal, hyperactivity, anger, lability, and stereotypic behaviors. The olanzapine-treated group gained significantly more weight (Malone et ah, 2000). 

There also has been great interest in the use of stimulants to treat depressive symptoms. Small case series suggest the potential usefulness of adding stimulants to antidepressant therapy in treatment-resistant depression (Masand et al. 1998 Stoll et al. 1996). Stimulants also have been used in the treatment of depressive symptoms in medically ill elderly patients (see reviews by Challman and Lipsky 2000 and Masand and Tesar 1996). Short-term use of stimulants may rapidly improve symptoms of apathy and social withdrawal in these patients. 

Behavioral symptoms, such as social withdrawal, excessive dependency, and phobic avoidance... 

Marked increases in weight, as well as more typical symptoms, such as decreased energy or fatigue and social withdrawal... 

Major depression with social withdrawal Panic disorder with agoraphobia Social phobia... 

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