The forgotten caregivers: Siblings of schizophrenic patients

Objective. The situation of caregivers of psychiatric patients is mostly focussed on burdens of parents or spouses of patients. The burden of siblings due to the illness, however, is mostly underestimated and disregarded. Methods. Thirty-seven narrative interviews with siblings of schizophrenia inpatients were analysed by using a summarizing content analysis. The founded global statements were quantitatively analysed. Regression-analysis as well as regression trees were used to evaluate the data linked with sociodemographic and disease-related variables of the patient and siblings. Results. The results showed a high proportion of siblings engaged in caregiving activities. A total of 492 individual statements were summarized in 26 global types of statements. The three most often reported burdens by the healthy siblings are: “Handling the symptoms of illness” (100%), “Emotional burden due to the illness of the sibling” (100%) and “Uncertainty in judging what amount of stress the patient can cope with” (81.1%). Linear regression and regression tree analysis show predictors for higher burdened siblings. Conclusion. Siblings of schizophrenia patients are burdened in various aspects and in a specific matter. Their special needs will therefore have to be recognised before they can receive appropriate intervention.     

Non-linear dynamic analysis of clozapine-induced electroencephalographic changes in schizophrenic patients--a preliminary study

1. In order to find the electroencephalographic (EEG) parameters that reflect the effect of clozapine in schizophrenic patients, the authors applied various non-linear analyses on multi-channel EEG data drawn from patients before and after a therapeutic trial of clozapine. 2. The correlation dimension was difficult to extract from our limited time series EEG data and the authors did not find a meaningful association with clozapine use. The primary Lyapunov exponent could be reliably calculated but also did not reflect the effect of clozapine. 3. However, the mutual cross-prediction (MCP) algorithm showed potentially meaningful results. The driving system was shifted to the frontal channels after a 4-week trial with clozapine. Moreover, MCP might have a value as a predictor of treatment response. 4. Although preliminary in nature, the MCP might have greater power for interpreting complex changes from channel to channel in EEG induced by clozapine.     

Serum neuroleptic activities required to inhibit relapse in schizophrenic patients--a study by radioreceptor assay

1. The serum levels of antidopaminergic (anti-D2), anti-alpha-adrenergic (anti-NA) and antiserotonergic (anti-5HT2) activities of neuroleptics were determined in schizophrenic patients on maintenance treatment. 2. The patients whose conditions remained stable had significantly higher serum levels of anti-D2 and anti-5HT2 activities than those who were considered to be in unstable conditions after a period of remission. 3. However, the serum levels of anti-5HT2 activity in patients whose conditions remained stable varied as much as those of anti-NA activities did, so it appeared that from a pharmacological viewpoint anti-D2 activity of neuroleptics was the most important in preventing a relapse in schizophrenic patient. 4. The serum levels of anti-D2 activity required to prevent relapses differed for each neuroleptic. 5. The frequency of side effects increased concordant with increasing serum levels of anti-D2, anti-NA and anti-5HT2 activities, and unfortunately even minimum effective serum levels of anti-D2 activity elicited slight side effects in the majority patients.     

Empirical studies of sexual behavior of psychotic patients--a review

The review is based upon the observation that the topic of sexuality so far seems to be underrepresented in psychiatric research and practice. The present empirical studies concerning aspects of sexual behavior and experiences of patients with affective and schizophrenic psychoses are summarized in this paper. First, studies related on characteristics of the premorbid sexual behavior of the patient groups are considered. A summary of investigations concerning changes in the sexual life due to the psychiatric illness is divided into results on the changes in the frequency of sexual activities and changes in sexual appetence, results on sexual deviant acts, on sexual activities of psychiatric inpatients, and results on sexual orientation, especially for patients with paranoid symptoms. The review ends with a report of the most important results concerning characteristics of the sexuality specific for the disease and results on the frequency of sexual dysfunctions in different groups of patients. As the review shows, our knowledge about the sexual life of psychiatric patients so far seems very incomplete. More thoroughly performed empirical studies will help to counteract the distribution of stereotypic beliefs.     

Siblings of handicapped children: A review

Research is critically reviewed and evaluated, first, in order to determine if the presence of a handicapped child in a family uniquely affects the nonhandicapped siblings, and, second, to identify factors mediating the nature and power of those effects. In addition, projects involving sibling therapy, education, and training are described. Currently there are few well-controlled empirical investigations supporting the popular belief that, as a group, siblings are adversely affected by their handicapped brothers or sisters. Rather, only certain siblings appear to be vulnerable to negative reactions, depending on such factors as sibling sex and birth order, family socioeconomic status, and parental responses to the handicapped child. Recommendations are offered for improved research strategies and questions and for the careful evaluation of future educational and support services for siblings.     

The syndromes of oculogyric crisis and paroxysmal perceptual alteration in chronic schizophrenic patients--a clinical inquiry into their pathophysiology]

The syndromes of oculogyric crisis (OGC) and paroxysmal perceptual alteration (PPA) in chronic schizophrenics have been investigated. The perceptual symptoms of PPA are characterized by hypersensitivity of perception, psychedelic experience (brightening of colors, sharpening of contrast, visual distortion, etc.) and a disorder of somatic schema (one feels that one is floating, one's extremities are pulled and elongated, etc.). PPA in chronic schizophrenics occurs abruptly mainly in the evening, often precipitated by fatigue. During the attack patients also suffer from mood and thought alteration (anxiety, agitation, depressive mood and inability to distract their thought from one thing), but they are aware that symptoms of PPA are not real and apprehensive about them. The attack ceases gradually and spontaneously while the patient rests or sleeps. The syndrome of OGC occurs in a similar fashion as in PPA; the attack occurs mainly in the evening and is also associated with a variety of transient mood and thought disturbances similar to those in PPA. Four cases have been described in this study, who experienced both PPA and OGC simultaneously. Among 223 schizophrenic patients admitted to our hospital between April 1987 and September 1988, 18 cases with OGC, 5 cases with PPA, and 4 cases with both PPA and OGC were found. The mean +/- SD dose of neuroleptics (chlorpromazine equivalent) at the latest occurrence of these syndromes was 761 +/- 470 mg (N = 22, ranging from 195 to 2010 mg) for OGC and 773 +/- 587 mg (N = 9, ranging from 227 to 2010 mg) for PPA. The appearance of OGC in cases with 195 mg or more dose (chlorpromazine equivalent) of neuroleptics of OGC in cases with with 195 mg or more dose (chlorpromazine equivalent) of neuroleptics (NLP) is significantly higher (p less than 0.05) than that in cases with less than 195 mg of NLP. Similarly, the appearance of PPA in cases with 277 mg or more dose of NLP was higher (p less than 0.1) than that in cases with less than 277 mg of NLP. In paranoid schizophrenic patients the incidences of OGC and PPA were significantly lower (p less than 0.001 and p less than 0.05, respectively) than those in other types of schizophrenics. In disorganized schizophrenic patients the incidence of PPA was significantly lower (p less than 0.01) than those in undifferentiated, residual and schizoaffective types.(ABSTRACT TRUNCATED AT 400 WORDS)     

Motherhood and schizophrenic illnesses: a review of the literature

OBJECTIVE: To provide an overview of the current knowledge on the impact of motherhood on women with schizophrenia and schizoaffective disorder. METHOD: The published literature was selectively reviewed and assessed, based on a complete MEDLINE and PsychLIT (1971 to current) search, including English and non-English journals and books. RESULTS: Research to date into motherhood and schizophrenic illnesses has been limited by a number of methodological constraints, limiting the ability to draw conclusions and the prevention of relapses and mother-infant difficulties. These constraints have included: a paucity of prospective studies with initial, antenatal recruitment; variable definitions of the length of the puerperium; significant changes in psychiatric classification; the heterogeneity of postpartum psychotic disorders, with the majority being mood or schizoaffective disorder rather than schizophrenia; selection biases inherent in studying mother-baby unit inpatients; difficulties in life events research in general, such as its retrospective nature and confounding, illness factors; and the specificity versus non-specificity of childbirth as a unique or discrete life event. CONCLUSIONS: Further study is required to explore: the impact of child care, parenting and having a partner on the course of women with schizophrenic and schizoaffective disorders during the first postpartum year; whether women with postpartum relapses of these mental illnesses are likely to have slower recoveries than those women with the same diagnoses but without young children; and protective factors against postpartum relapse.     

A review and critique of social skills training with schizophrenic patients

The literature dealing with social skills training of schizophrenic patients indicates that topographical features and self-reports of anxiety and discomfort can be changed for the better by social skills training. Unfortunately, these changes do not occur for every patient and, when they do occur, often do not generalize to new situations. Research must be directed to determining the interaction between patient characteristics and training procedures as they affect outcome. The scope of the procedures must also be expanded if meaningful changes in patients' quality of life are to be effected.     

Concordance between chart review and structured interview assessments of schizophrenic symptoms

BackgroundIt is unclear whether direct structured interviews are able to capture the full range of psychopathology in schizophrenia, as is required in diagnostic assessments or clinical ratings. We examined agreement between symptom ratings derived from direct patient interviews and from review of casenotes.MethodsThe study sample comprised 1021 schizophrenic subjects collected as part of the Irish Case-Control Study of Schizophrenia. Diagnostic interviews used a modified version of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Symptoms were rated by the interviewer. In addition, the Casenote Rating Scale was used to rate symptoms based on medical record information. For each negative and positive symptom, we calculated the Pearson correlation between the interview and the casenote rating. Using the mean of the interview and casenote rating for each symptom, exploratory factor analysis using Varimax rotation was performed.ResultsThree factors were extracted in factor analysis: positive, negative, and Schneiderian symptoms. The highest correlations between interview and casenote ratings were for negative symptoms, in which all symptoms were significantly correlated. Positive and Schneiderian symptoms were significantly correlated with the exception of thought insertion, thought withdrawal, voices speaking in sentences, and somatic hallucinations. Significant correlations were generally moderate (0.2-0.55).ConclusionMost schizophrenic symptoms, especially negative symptoms, can be assessed by direct interviews as the sole source of information with moderate reliability. However, the presence of some Schneiderian and possibly less prevalent positive symptoms may be difficult to determine without a review of records, which may include longitudinal observations and information from multiple observers.     

Sex-related variations in the course of schizophrenic disease. A review

Based on an extensive literature review the evidence for gender differences in the course of schizophrenia is examined. If gender differences were reported, which was the case in about one half of the studies, they were almost exclusively in favour of female patients. This applied similarly to hospital career, psychopathology, and social adjustment. Unfortunately, due to methodological limitations the results are often difficult to interpret. However, in a number of recent studies of high methodological standard, gender differences could also be shown. It is discussed to what extent a greater vulnerability or exposure to social stress on the part of males and/or better coping resources and greater social support on the part of females might be responsible for this finding.     

Cross-modal reaction time and schizophrenic attentional deficit: a critical review

This article focuses on the cross-modal reaction time paradigm, which has been used to study deviation patterns of shifting attention across stimulus modalities in schizophrenic patients. Cross-modal reaction time research involving pathological and nonpathological populations is reviewed. The influence of sex, stimulus modality, total stimulus energy, the warning signal, psychotropic drugs, psychiatric diagnosis, and preparatory interval on the modality shift effect (the ability of cross-modal retardation to discriminate schizophrenic patients and normal control subjects) is discussed. Theories proffered to account for the modality shift effect are critically evaluated. These theories include Zubin's neural trace theory, the magnitude of difference hypothesis, the expectancy hypothesis, learning theory, general inattention, and psychometric artifact. The article concludes with general comments on attentional research in schizophrenia.     

Siblings relationships of children with autism

This study investigated sibling relationships of children with autism compared to children with Down syndrome and siblings of normally developing children. Ninety siblings (30 per group) between the ages of 8 and 18 participated in this study. Results indicated that sibling relationships in families of children with autism were characterized by less intimacy, prosocial behavior, and nurturance than those of the two comparison groups. Both siblings of children with autism and siblings of children with Down syndrome reported greater admiration of their sibling and less quarreling and competition in their relationships relative to normally developing comparison children.     

Focal Pachypolymicrogyria in Three Siblings

The malformation of focal pachypolymicrogyria might be the manifestation of an X-linked recessive disorder according to the results of this study. Three siblings revealed focal pachypolymicrogyria on magnetic resonance imaging (MRI) and had a strong family history of epilepsy and mental retardation. All three siblings had the same mother; the father of Patient 1 was not related to the mother, but the father of Patients 2 and 3 was related to her. The MRI of the father of Patients 2 and 3 demonstrated focal pachypolymicrogyria. The mother’s MRI was normal. In this family, epilepsy or mental retardation was found mainly in the males (Patient 3 was an exception), and they were all born to female members of this family, not male. Patient 3 was probably a homozygote with an X-linked recessive inheritance, and therefore, she demonstrated the most severe clinical findings.