Somatotypic characteristic of schizophrenic patients

AIM: Introduction of quantitative metric methods of somatotype assessment in schizophrenic patients to make clinical diagnosis more objective, the diagnosis being otherwise based exclusively on the clinical interview and assessment of the mental status of patients and thus involving certain subjectivity. MATERIAL AND METHODS: The study included 67 schizophrenic inpatients (38 men, 29 women) consecutively admitted to the Clinic of Psychiatry in Plovdiv. Their mean age was 31.47 years (SD = 9.43, range 16-56), mean duration of illness 6.86 (SD = 6.09, range 1-27), mean number of hospitalizations 4.22 (SD = 4.08, range 1-19). The patients satisfied DSM-IV criteria for a diagnosis of schizophrenia (American Psychiatric Association, 1994). The control group comprised 69 subjects (36 men, 33 women) with a mean age 39.24 years (SD = 10.18, range 22-68) and socioeconomic background matching that of the patients. RESULTS: The data showed statistically significant differences in the three somatotype component and in almost all somatotypological variables between male schizophrenic patients and control subjects. The somatotype categories were more extensively presented in the schizophrenic patients. There was a tendency to higher frequency of the ectomorphic categories (ectomorphic mesomorph, mesomorphic ectomorph and endomorph-ectomorph). No statistically significant differences were found in the somatotype components and somatotypological variables between the female schizophrenic patients and control subjects. CONCLUSION: The data of the examination of the somatotype of schizophrenic patients and control subjects evince a definite sexually related body constitution characteristic that differentiates the groups. Schizophrenic patients and control subjects are clearly determined somatotypically only in the group of males.     

Psychiatric illness in patients presenting for obesity treatment

The prevalence of DSM-III-R Axis I psychiatric disorders was investigated in a sample of 54 obese patients at the time of presentation for weight reduction treatment. Patients were interviewed using the Structured Clinical Interview for DSM-III-R Axis I diagnosis (SCID-I) designed to probe for the major Axis I syndromes. High rates of affective disorders, particularly those with depressive symptomatology, were found. Twenty-six percent of patients were in the midst of a current Axis I affective disorder at the time of examination. Forty-eight percent had a history of affective disorder, and 57% had at least one lifetime Axis I diagnosis. Only one patient met criteria for an Axis I eating disorder. Patients with psychiatric diagnoses could not be discriminated from those without on the basis of Body Mass Index. However, the former had significantly more impairment as measured by the Beck Depression Inventory and the Global Assessment of Functioning. These findings may have implications for the assessment and treatment of obese patients in clinical and research settings.     

Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands

BACKGROUND: It is well established now that the incidence of schizophrenia is extremely high for several ethnic minority groups in western Europe, but there is considerable variation among groups. We investigated whether the increased risk among these groups depends upon the degree to which they perceive discrimination based on race or ethnicity. METHODS: We studied the incidence of psychotic disorders over 7 years in The Hague, a city with a large and diverse population of ethnic minorities. To compare the incidence of schizophrenic disorders (DSM IV: schizophrenia, schizophreniform disorder, schizoaffective disorder) in each ethnic minority group with the incidence in native Dutch, we computed incidence rate ratios (IRRs). Based on a population study and on rates of reported incidents of discrimination in The Hague, the degree of perceived discrimination of ethnic minority groups was rated: high (Morocco), medium (Netherlands-Antilles, Surinam and 'other non-western countries'), low (Turkey) or very low ('western or westernized countries'). RESULTS: The age- and gender-adjusted IRRs of schizophrenic disorders for ethnic minority groups exposed to high, medium, low, and very low discrimination were 4.00 (95% CI 3.00-5.35), 1.99 (1.58-2.51), 1.58 (1.10-2.27), and 1.20 (0.81-1.90), respectively. When not only schizophrenic, but all psychotic disorders were included in the analysis, the results were similar. CONCLUSIONS: These results suggest that discrimination perceived by ethnic minority groups in western Europe, or some factor closely related to it, may contribute to their increased risk of schizophrenia.     

Schizophrenia

The diagnostic criteria for schizophrenia have been extensively changed by the third edition of the Diagnostic and Statistical Manual of Mental Disorders, recently adopted by the American Psychiatric Association (DSM III). To receive this diagnosis, the patient must have onset of illness before age 45 years, have had a chronic course, manifest the presence of characteristic symptoms, such as delusions, hallucinations, or loose associations during a phase of the illness, and have experienced a downhill social and vocational course; affective disorders and organic brain syndrome must be carefully excluded. The utilization of this "narrow" definition has caused a major shift toward increasing the diagnosis of affective disorders and decreasing the diagnosis of schizophrenia in the United States. The etiology of schizophrenia is still uncertain, but recent research has elucidated one subgroup of schizophrenic patients who have subtle indices of neurological damage and a clinical course similar to that found in dementia. Dopamine excess in the mesolimbic system is the predominant inferred cause for the majority of schizophrenia cases, and antipsychotic medications all rely on dopamine receptor blockade for their efficacy. Antipsychotic medications are effective in schizophrenia but are less potent against such negative symptoms as apathy, neglect of personal hygiene, and social withdrawal.     

Mental disorders and ecological structure in Nottingham

This paper presents the findings of a specifically geographical investigation of the incidence, distribution and social/environmental correlates of mental disorder in Nottingham. Three diagnostic groups were examined, namely schizophrenia and paranoia, the effective psychoses (or manic depression) and the non-psychotic mental disorders. Analysis of two distinct cohorts of first contact patients for both the schizophrenia and affective psychoses diagnoses yielded markedly dissimilar incidence rates. It is therefore suggested that observed variations in the incidence of specific mental disorders between cities probably reflect such nosocomial (i.e. service related) factors as diagnostic accuracy and the levels of local psychiatric services. It is therefore dangerous to ascribe the variations solely to the contrasting social/environmental milieux found in these cities. The spatial distributions of the selected mental disorders within Nottingham were analysed in the context of a set of 12 distinct ecological areas. These areas were derived from a matrix comprising 105 sub-areas and 40 variables via principal components analysis and a non-hierarchical clustering algorithm. Marked spatial variation in the incidence of all the mental disorders was demonstrated via both traditional mapping and probability mapping techniques. Pearson product-moment analysis revealed that the distributions of the two diagnostically distinct schizophrenia and affective psychoses cohorts were virtually identical. The relationships between the inception rates for the mental disorders and social/environmental attributes were analysed. Stepwise multiple regression models for both the principal components and the individual census variables revealed strong and systematic relationships with all the mental disorders. Although such ecological analysis has limited explanatory power it nevertheless provides useful insights into mental disorder-environmental relationships. It is argued that these can be subsequently best examined at a disaggregated (i.e. behavioural) level.     

Impact of ethnicity on the prevalence of psychiatric disorders among migrants in germany

Objectives. Studies on psychiatric disorders among migrants have described higher rates, especially of schizophrenia. Some evidence points to the possibility of misdiagno‐sis for this higher rate; other studies point to the underrepresentation of migrants in psychiatric services, leading to artefactual epidemiological data.

Methods. All admission records of migrants to a psychiatric clinic from 1993 to 1995 were assessed for diagnosis, symptomatology and treatment.

Results. Admissions of 408 migrants, 8.1 % of total admissions, were assessed. Of these, 38.7% received a diagnosis of a schizophrenic disorder, significantly more than the other clinic patients. The mean age at admission was 34.0 years, at onset of illness 28.6 years and at time of migration 20.4 years. Only 8.3% were mentally ill at the time of migration. Language problems correlated with the diagnosis of a schizophrenic disorder.

Conclusion. An underrepresentation of migrants shows differences in the use of psychiatric services. Some evidence from the mental status and reported language problems may explain the higher rate of schizophrenia due to misdiagnosis.     

Symptom heterogeneity in comorbid alcohol disorder

The heterogeneity of signs and symptoms of alcohol disorder was examined in a community sample of 1,955 persons with either alcohol disorder alone or alcohol disorder plus one of four categories of major mental disorder (antisocial personality disorder, schizophrenia, affective disorder, anxiety disorder). When all diagnostic categories were combined, persons with comorbid mental and alcohol disorders showed evidence of more severe alcohol-related symptoms than did persons with alcohol disorder alone. Distinct symptom patterns distinguished the four diagnostic groups, reflecting heterogeneity in the manifestation of comorbid alcohol disorder. Most notably, comorbid antisocial personality disorder and schizophrenia were associated with higher levels of alcohol consumption and more severe social consequences of alcohol use. These findings substantiate the need for development of specialized dual diagnosis programs and suggest that additional specialization may be required to address diagnostic group differences in the characteristics of comorbid alcohol disorder.     

Psychiatric comorbidity of eating disorders in men: a national study of hospitalized veterans

OBJECTIVE: This study examined eating disorders and their psychiatric comorbidity in a national sample of hospitalized male veterans. METHOD: Review of discharge summaries for 466,590 male patients from Veterans Affairs medical centers for fiscal year 1996 resulted in the identification of 98 men with a current ICD-9-CM diagnosis of an eating disorder. For the comorbidity analyses, eating disorder cases were matched with controls drawn randomly from the pool of male patients without an eating disorder, using age and race as matching variables. RESULTS: There was a high rate of comorbid substance use and mood disorder for men with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS). Men with AN were also at high risk for comorbid schizophrenia/psychotic disorder, men with BN were at risk for comorbid personality disorder, and men with EDNOS were at special risk for comorbid organic mental disorder and schizophrenia/psychotic disorder. DISCUSSION: For each eating disorder, there was a distinct pattern of psychiatric comorbidity that deserves further study.     

The nosological position of transsexualism

Transsexualism, a behavioral state assuming increasing contemporary significance, is examined here as to its nosological position within psychiatry. Clinical features are compared with schizophrenia, affective psychoses, neuroses, personality disorders, perversions, and paranoid syndromes. Transsexualism is also compared to other disorders with regard to sexual drive, erotic interests, and responses to castration and behavior therapy. No standard psychiatric category of mental disorder comfortably embraces the syndrome of transsexualism. Its nosological uniqueness characterizes our dilemma over etiology, diagnosis, and treatment.     

Recurrence in affective disorder: analyses with frailty models

The risk of recurrence in affective disorder is influenced by the number of prior episodes and by a person's tendency toward recurrence. Newly developed frailty models were used to estimate the effect of the number of episodes on the rate of recurrence, taking into account individual frailty toward recurrence. The study base was the Danish psychiatric case register of all hospital admissions for primary affective disorder in Denmark during 1971-1993. A total of 20,350 first-admission patients were discharged with a diagnosis of major affective disorder. For women with unipolar disorder and for all kinds of patients with bipolar disorder, the rate of recurrence was affected by the number of prior episodes even when the effect was adjusted for individual frailty toward recurrence. No effect of episodes but a large effect of the frailty parameter was found for unipolar men. The authors concluded that the risk of recurrence seems to increase with the number of episodes of bipolar affective disorder in general and for women with unipolar disorder.     

Seasonal depressive disorder: a controlled study in Tunisian psychiatric sample

Seasonal affective disorder is considered as a clinical subtype of major depression. The criteria for seasonal pattern has been recently described in the international classification of mental disorders. The aim of this study was to compare the clinical characteristics of patients with major depression and with a seasonal and a non seasonal pattern. The study was conducted at the psychiatric ward at Monastir university hospital. 16 inpatients with major depression and seasonal pattern, diagnosed with DSM-IV criteria, were matched in age, sex and diagnostic sub-type to 32 inpatients with non seasonal mood disorders. Clinical symptoms and short term course during the most recent depressive episode were obtained. The onset of the depression with seasonal pattern was frequently in winter. It was marked by significantly higher rates of anxiety. The patients with seasonal depression had significantly higher rates of dysphoria, atypical vegetative symptomatology and lower rates of psychotic characteristics and suicidal thoughts. No differences were found as to the psychiatric family histories or the age at the first depressive episode. This study could focus of the novel psychiatric entity and may lead to the development of the genetic and neurobiologic research related to seasonal affective disorder.     

Psychopathology and psychosocial causes in adult deliberate self-poisoning in Plovdiv region, Bulgaria

INTRODUCTION: The percentage of deliberate self-poisoning among acute intoxications continues to be high in the medical practice worldwide; in Plovdiv region it reaches 64% of all acute poisoning cases. MATERIAL AND METHODS: A representative retrospective study of 311 acute deliberate self-poisoning cases over 14 years of age, treated in the Regional toxicological center of Plovdiv region between 01.01.1990 and 31.12.1998 was carried out. The following factors were studied: gender, age, type of poisoning, psychiatric diagnosis and psychosocial stressors. The classification criteria of Diagnostic and Statistical Manual--4th edition (DSM-IV) of the American Psychiatric Association were applied. RESULTS: We identified a first attempt of deliberate self-poisoning in 237 patients (71.6%) and a second consecutive attempt in 62 patients (18.7%). Thirty two (9.7%) of the attempts were committed in a state of alcohol intoxication. The percentage of women was statistically significantly higher. The age group of 14-19 years represented the highest percentage (27%). In 168 patients (50.8%) a psychiatric disorder was diagnosed. Adjustment disorder (53.57%) and depressive and schizophrenic disorders (26.79%) were the leading diagnoses among adults committing deliberate self-poisoning. The problems with primary support group (in 61.8% as a single stressor and in 13.71% in combination with other stressors) were the most common psychosocial factors for deliberate self-poisoning. CONCLUSIONS: To reduce the number of adult deliberate self-poisonings, measures including harmonization of the relationships in the primary support group and active treatment of patients with depressive and schizophrenic disorders are needed.     

Psychiatric diseases predated the occurrence of Parkinson disease: a retrospective cohort study

PurposeThe influence of mental illness early in life on the subsequent risk of Parkinson disease (PD) and its clinical picture remain obscure. This study investigated the effects of psychiatric diseases on a subsequent PD diagnosis.MethodsWe used the Longitudinal Health Insurance Database 2000 of Taiwan to identify 73,597 patients who visited ambulatory care centers or were hospitalized with a first-time diagnosis of anxiety, affective disorders, or schizophrenia between 2001 and 2003 as the study cohort. We also randomly selected 220,791 enrollees matched with the study cohort for comparison. Each patient was individually tracked for 6 years to identify a subsequent PD diagnosis. Stratified Cox proportional hazard regressions were performed for the analysis.ResultsThe incidence rate of PD per 1000 person-years was 4.91 (95% confidence interval [CI], 4.71–5.12) and 1.63 (95% CI, 1.56–1.70) for the psychiatric and comparison groups, respectively. Patients with psychiatric illnesses were more vulnerable to developing PD than nonpsychiatric individuals, exhibiting a 2.38-fold increased risk (95% CI, 2.23–2.53) after other covariates were considered. Furthermore, patients with schizophrenia exhibited the highest risk for developing PD.ConclusionsWe suggest effective monitoring of patients with psychiatric disturbances for potential long-term neurodegenerative diseases.     

The association of psychiatric disorders and HIV infection in the correctional setting

PURPOSE: Psychiatric disorders, such as bipolar disorder, schizophrenia, and depression, have been associated with both HIV-associated risk behaviors and HIV infection. While the US prison population is reported to exhibit elevated rates of HIV/AIDS and most psychiatric disorders, scarce information currently exists on the association of these conditions in the prison setting. The present study examined the association of six major psychiatric disorders with HIV infection in one of the nation's largest prison populations. METHODS: The study population consisted of 336,668 Texas Department of Criminal Justice inmates who were incarcerated for any duration between January 1, 1999 and December 31, 2001. Information on medical conditions and sociodemographic factors was obtained from an institution-wide medical information system. RESULTS: Inmates diagnosed with HIV infection exhibited elevated rates of major depression, dysthymia, bipolar disorder, schizophrenia, schizoaffective disorder, and non-schizophrenic psychotic disorder. These rates persisted in stratified analyses and in a multivariate analysis that statistically adjusted for gender, race, and age category. CONCLUSION: The present cross-sectional study's finding of a positive association between HIV infection and psychiatric diagnoses among inmates holds both clinical and public health relevance. It will be important for future investigations to prospectively assess the underlying mechanisms of these associations in the correctional setting.     

Psychiatric disorders in elderly patients admitted in a general hospital]

STUDY OBJECTIVE. To determine the prevalence of psychiatric disorders, especially depressive illness, in elderly medical inpatients. SETTING. University Hospital Leiden. DESIGN. Two-stage design. PATIENTS AND METHODS. In six somatic wards a series of 250 patients were randomly selected and screened with two self-rating scales for depression (Beck Depression Inventory, Geriatric Depression Scale) and one screening scale for cognitive dysfunctions (Mini-Mental State Examination). The 52 drop-outs differed significantly from the other patients only in a greater general illness severity, and a higher prevalence of a psychiatric history. Eighty-two patients were selected for a diagnostic procedure with a standardised, semi-structured psychiatric interview, and were classified according to the DSM III-R. Fifty-nine of them were probable cases according to the screening instruments, 23 were selected at random from the probable non-cases. RESULTS. A psychiatric disorder was detected in 25 patients, all but one patient with schizophrenia were found in the group of probable cases. Only five patients were classified as major depression, which lead to a prevalence rate of 2.9% (95% CI 0.4-5.4%). We found evidence of many psychiatric disorders in the group of 52 drop-outs, but these were mostly organic psychiatric disorders, and just one mood disorder. CONCLUSION. The prevalence of major depression is lower than found until now among elderly medical inpatients.     

Mentally disordered women in jail: who receives services?

OBJECTIVES: Many jail inmates have severe psychiatric disorders (e.g., schizophrenia, major affective disorders). The courts have mandated that detainees have a constitutional right to treatment. We investigated what proportion of female jail detainees needed mental health services, what proportion received services, and what variables predicted who received services. METHODS: Trained interviewers administered a psychiatric evaluation (the NIMH Diagnostic Interview Schedule) to 1272 randomly selected female jail detainees during jail intake in a large Midwestern city. Project staff then documented whether women subsequently received services, using records and case files. RESULTS: Of the women who needed services, 23.5% received them while they were in jail. Type of disorder, treatment history, and socio-demographic variables all affected the odds of a mentally ill woman's receiving services. CONCLUSIONS: Correctional health care is a growing national public health problem. The magnitude of mental health service needs far exceeds current resources.     

Predicting length of stay for patients with psychoses.

The Computerized Psychiatric Severity Index (CPSI) and 22 patient variables were used to predict length of hospitalization for 304 psychiatric patients in DRG 430 who were diagnosed with schizophrenia or affective disorder and had no secondary diagnoses. Length of stay, which correlated .96 with total charges, was used as the dependent variable (measure of resource use). The patient variables and CPSI score explained 32.5 percent of the variation in length of stay for all of DRG 430 (27.5 percent for affective disorder patients and 70.3 percent for schizophrenia patients). Addition of the treatment variable "receipt of ECT" (electroconvulsive therapy) permitted the regression models to explain 40.9 percent of the variation in length of stay (36.24 percent for affective disorder and 71.22 percent for schizophrenia). In each regression model, maximum CPSI score was significant, indicating that much heterogeneity in DRG 430 can be explained by CPSI. Using one payment for such a diverse group places health care institutions at great risk of financial loss. Our study indicates that a continuing need exists for research in the area of case-mix measures for psychiatric inpatients.     

Schizophrenia, substance use disorders and medical co-morbidity

OBJECTIVES: This study compared medical treatment costs of adults with schizophrenia to adults with both substance use disorders and schizophrenia. METHODS: This cross-sectional observational study used a paid claims data base to identify 6884 adults treated for schizophrenia. Twenty percent of these also had substance use disorder. We report the costs and likelihood of hospitalization for eight common medical diseases, and the categories of injuries and poisoning, and ill defined conditions. Multivariate analyses were used to adjust rates of treatment for age and sex differences in the comparison groups. RESULTS: There were higher rates of treatment for five of the eight medical disorders, higher treatment costs for two of the medical disorders and much higher costs for psychiatric treatment among those with comorbid substance use disorders. Both groups had high rates of treatment in the categories of injury and poisoning and ill defined conditions. CONCLUSIONS: Closer working relationships among mental health and medical professionals are needed to care for those with schizophrenia and substance use disorders: first, greater attention to the treatment of substance use disorders may improve the health status of those with schizophrenia, reduce their costly medical and psychiatric care and stabilize their psychiatric condition, and second, continuity of care among professionals may promote willingness to seek medical attention or alleviate misunderstandings when adults with schizophrenia present with medical problems.     

Functional imaging in mental disorders

Considerable progress has been achieved by functional brain imaging over the past 20 years in uncovering the biological basis of major psychiatric disorders and to more effectively target therapeutics. Radioligand techniques, especially the PET (positron emission tomography) method, are specific and sensitive tools for quantitative in vivo imaging of molecular pathways and molecular interactions within brain tissues. Since 1980s, advances in neuroimaging and neurophysiological techniques have provided tremendous merits for investigations into different psychiatric disorders. PET and SPECT (single photon emission computer tomography) neuroreceptor imaging, especially in schizophrenia has been an extremely fruitful area of research. Evidences from these studies suggest that schizophrenia affects various cortical and subcortical regions involved in cognitive, emotional, and motivational aspects of human behavior. PET and SPECT provide useful data in studying the fundamental neurobiology of mood disorders. Both techniques are playing a central role in studying patients with new methods and ligands for specific receptor subtypes, and are likely to increase the application of PET/SPECT in the development of new pharmacotherapies. Nuclear medicine plays an important role in studying patients with other psychiatric disorders such as obsessive-compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), anxiety, etc. Some forms of OCD seem to share a common genetic etiology with Tourette-syndrome (TS) and to be a facultative part of the TS phenotypic spectrum. In conclusion, PET and SPECT methods seem to be helpful in the diagnosis and management of patients with different psychiatric disorders and may provide a better understanding of clinical symptomatology or the relationship of these physiological parameters to the patient's prognosis. Additionally, radionuclide techniques may improve medical therapy by demonstrating individual biochemical abnormalities of altered brain functions.