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Case Records of the Massachusetts General Hospital
Case 11-2012 — A 60-Year-Old Man with Weakness, Rash, and Renal Failure
Presentation of Case. Dr. Pritha Sen (Medicine): A 60-year-old man with a history of schizophrenia was admitted to this hospital in late spring because of weakness, rash, and renal failure. The patient was in his usual state of health until several days before admission, when fatigue and myalgias…
- CME
Original Article
Long-Acting Risperidone and Oral Antipsychotics in Unstable Schizophrenia
The most common and potentially remediable cause of treatment failure in patients with schizophrenia is lack of adherence to prescribed oral medications. By ensuring sustained levels of drug in the blood, long-acting injectable delivery may improve adherence and symptom control and reduce the rate…
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Case Records of the Massachusetts General Hospital
Case 31-2009 — A 26-Year-Old Man with Abdominal Distention and Shock
Presentation of Case. Dr. Jeffrey S. Ustin (Trauma, Emergency Surgery, and Surgical Critical Care): A 26-year-old man was admitted to this hospital because of abdominal distention and shock. The patient had been well until the evening before admission, when mild abdominal pain developed, shortly…
A 26-year-old man was admitted to this hospital because of abdominal distention and shock. He had been well until the previous evening, when mild abdominal pain developed; the next day, the pain became severe, and he was unresponsive. In the emergency department, he was hypotensive, with a rigid, distended abdomen. Imaging revealed marked distention of the colon, without focal obstruction. He had a history of schizophrenia and was taking several medications.
Correspondence
Electroconvulsive Therapy for Depression
To the Editor: Lisanby (Nov. 8 issue) reports, in her Clinical Therapeutics article, on the use of electroconvulsive therapy (ECT) in patients with depression. ECT is rarely recommended in patients with schizophrenia (except for those with acute catatonia). In the guidelines of the German Medical…
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Editorial
The Choice of Drugs for Schizophrenia
Schizophrenia is a serious chronic illness that requires lifelong medication. In some patients, the illness is refractory to even highly effective medications such as clozapine, and these patients desperately need more effective treatment regimens. Less dopamine is blocked with clozapine than with…
Original Article
Clozapine Alone versus Clozapine and Risperidone with Refractory Schizophrenia
Even with adequate treatment, as little as 20 percent of patients with schizophrenia have a complete resolution of symptoms, whereas up to one third have a clinically inadequate response. Poor response of psychotic symptoms to single antipsychotic drugs has been cited as the most common reason for…
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Patients with schizophrenia are often treated with multiple antipsychotic drugs, but the benefits are not known. In this eight-week randomized, controlled trial in patients with severe schizophrenia and a poor response to clozapine, the combination of clozapine and risperidone did not achieve better control of symptoms than clozapine alone. The findings of this small, short-term study do not support the addition of risperidone to clozapine for patients with severe schizophrenia.
Editorial
The Choice of Antipsychotic Drugs for Schizophrenia
Since the discovery of the effects of chlorpromazine in the 1950s, treatment of schizophrenia has relied on antipsychotic drugs that target dopamine D2 receptors. The effectiveness of these agents in reducing the intensity of patients' delusions and hallucinations permitted outpatient treatment…
Original Article
Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia
Antipsychotic drugs have become the cornerstone of treatment for schizophrenia. The first-generation "conventional" antipsychotic drugs are high-affinity antagonists of dopamine D2 receptors that are most effective against psychotic symptoms but have high rates of neurologic side effects, such as…
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This study compared the effectiveness of four second-generation antipsychotic agents (olanzapine, risperidone, quetiapine, and ziprasidone) with that of an older agent, perphenazine, in patients with chronic schizophrenia. Olanzapine was the most effective agent but was associated with greater weight gain and more adverse metabolic changes. Perphenazine was as effective as risperidone, quetiapine, and ziprasidone.
Original Article
Hospitalization for Mental Illness among Parents after the Death of a Child
The death of a child is one of the most stressful events in a parent's life. Several small cross-sectional and follow-up studies have suggested high rates of symptoms of anxiety and depression in parents who have lost a child.– However, prospective data are lacking to support an association…
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In a large study that made use of national registers in Denmark, the authors show that the relative risk of a first hospitalization for psychiatric illness was significantly higher among parents who lost a child than among those who did not and was higher among bereaved mothers than among bereaved fathers.
Case Records of the Massachusetts General Hospital
Case 39-2004 — A 52-Year-Old Woman with Recurrent Episodes of Atypical Pneumonia
Presentation of Case. A 52-year-old woman was admitted to the hospital because of cough and dyspnea. She had smoked two to three packs of cigarettes daily for 35 years. During the two decades before admission, she had been treated for many episodes of pneumonia, often designated as "atypical." Her…
A 52-year-old woman was admitted to the hospital because of cough and dyspnea. She had had several hospitalizations for similar problems in the past decade. She was a long-term heavy smoker and had a schizoaffective disorder. Chest radiographs showed ground-glass opacities and increased interstitial markings and computed tomography of the chest showed a “crazy-paving pattern.” A diagnostic procedure was performed.
Clinical Implications of Basic Research
Psychotomimetic Effects of Drugs — A Common Pathway to Schizophrenia?
Researchers have long been interested in identifying a final, common pathway for psychosis. The existence of such a pathway is implied by the fact that various drug intoxications, schizophrenia and bipolar disorders, psychotic depression, severe sensory deprivation, and Alzheimer's disease can all…
Correspondence
Schizophrenia, Drug Therapy, and Monitoring
To the Editor: In his article on schizophrenia, Freedman (Oct. 30 issue) may have understated the relative benefits of clozapine, which has proven advantages over other antipsychotic drugs in mitigating refractory positive and negative symptoms, aggression, and suicidal behaviors. The risk of…
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Review Article
Drug Therapy: Schizophrenia
Schizophrenia is a chronic, debilitating psychotic mental disorder that affects about 1 percent of people. A new generation of medications and recent developments in neuropathology, brain imaging, and molecular genetics have led to a greater understanding of the pathophysiology of schizophrenia and…
Schizophrenia has varied and ominous symptoms that generally begin in late adolescence or early adulthood and usually continue throughout life. This Drug Therapy article discusses the new generation of antipsychotic medications, as well as recent developments in brain imaging and in knowledge of the pathophysiology and molecular genetics of this devastating disease.
Original Article
Psychiatric Hospitalizations among Survivors of Cancer in Childhood or Adolescence
The diagnosis and treatment of cancer in children can cause substantial stress in the survivors, beginning at an early age, and psychosocial sequelae may also develop later in life. This problem is important, because in Denmark, for example, 1 in 600 persons under 50 years of age will be a survivor…
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Correspondence
Withholding Proven Treatment in Research
To the Editor: In their editorial (Sept. 20 issue), Huston and Peterson discuss developments in the debate about withholding proven treatment in clinical research. Unfortunately, the editorialists, citing the transcript of a television report in which plaintiffs in a pending lawsuit described their…
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Original Article
A Comparison of Risperidone and Haloperidol for the Prevention of Relapse in Patients with Schizophrenia
Schizophrenia is a chronic illness with a lifetime prevalence of 0.7 percent in the United States and with serious physical, social, and economic consequences. The economic burden of schizophrenia on society was estimated as $33 billion in the United States in 1990. Much of this cost was attributed…
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Preventing relapse is an important goal in treating patients with schizophrenia or schizoaffective disorder. This study compared risperidone, a newer, atypical antipsychotic medication, and haloperidol, an older, conventional neuroleptic drug, for the prevention of relapse in clinically stable adult outpatients. Patients treated with risperidone had a lower risk of relapse.
Editorial
Prevention of Relapse in Schizophrenia
Schizophrenia is a devastating mental disorder and a leading cause of disability. It affects between 0.4 and 1.4 percent of people during their lives, usually beginning in adolescence or early adulthood; less than 20 percent of patients maintain full recovery after the first episode. Drug treatment…
Correspondence
Calcium-Channel Blockade and Hypertension
To the Editor: Tuomilehto and colleagues present a post hoc analysis (March 4 issue) of a trial of nitrendipine-based treatment for older patients with isolated systolic hypertension. The authors evaluated the outcome in patients with diabetes, a group that accounted for 10 percent of the…
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Original Article
Effects of Family History and Place and Season of Birth on the Risk of Schizophrenia
Twin and adoption studies strongly suggest that genetic transmission accounts for most of the familial aggregation of schizophrenia. However, little is known about the contribution of familial aggregation to the occurrence of schizophrenia in the general population and the mode of inheritance of…
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