摘要:

The treatment and, above all, the prophylaxis of schizophrenic psychoses has made great progress in the last 40 years due to the introduction of the neuroleptics and the use of psychosocial treatment strategies. Unfortunately, the potentialities inherent in neuroleptic relapse prevention are far from being fully utilized. As a consequence, the relapse rate for this severe mental illness is still 3 times higher than it ought to be. In view of the severe consequences of this disease for each individual patient and his family, but also in view of the immense costs incurred by each relapse, we must not rest content with this situation. By use of compliance improving measures and quality assurance it would probably be possible within a few years to increase the efficiency of neuroleptic relapse prevention so far as to reduce the high relapse rates of schizophrenic patients at least by half. It is time we began trying.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05860.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper reviews current evidence in support of dysthymia as a subaffective disorder that precedes major affective episodes, often by more than a decade. In cases beginning in childhood or adolescence, dysthymia is associated with high familial rates of mood disorders, and a recurrent pattern of superimposed major depression. At least two trait‐like markers, sleep electro‐encephalographic and thyroid axis abnormalities — similar to those in major affective disorder — have been reported. These data indicate a common pathophysiological substrate for both dysthymia and major depressive illness. All classes of antidepressants — most recently the serotonin re‐uptake and the reversible MAO inhibitors — have been shown to be effective. Dysthymia was fairly recently included in the US(DSM) and WHO(ICD) classifications of mental disorders, because it characterises a prevalent clinical presentation of depression in both psychiatric and general medical settings. Patients given this diagnosis, instead of presenting with acute or full‐blown episodes, often complain of low‐grade chronic affective malaise for as long as they remember, yet without clinically observable signs of depression. As a result, questions have been raised about its validity, but from fundamentally opposite positions: (i) Is dysthymia better conceptualised as a personality (or neurotic) rather than mood disorder? (ii) Can dysthymia be distinguished from major depressive illness? This paper examines these and related questions along both clinical and external validating strategies, and in particular, the more recent accumulated evidence in support of the utility of the con

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05879.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Definitions of negative symptoms and deficit syndromes are reviewed in this article; rating scale criteria (the Scale for Assessment of Negative Symptoms and the Positive and Negative Syndrome Scale); Crow's type II syndrome; Carpenter's deficit syndrome; and the draft of DSM‐IV. The core negative symptoms identified by these investigators also describe the neuroleptic‐induced deficit syndrome (NIDS). Study designs and assessment methods to distinguish NIDS from the symptoms of schizophrenia are presented. Assessment methods include rating scales and a novel method that uses descriptive symptom vignettes. Designs include neuroleptic discontinuation studies, dose comparisons and comparison of atypical antipsychotic medicines to typical neuroleptic dr

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05827.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Two quasiexperimental and 10 experimental exercise intervention studies have been performed in depressed subjects. Some of the studies have methodological shortcomings, but in all studies the results point in the same direction: aerobic exercise is more effective than no treatment, but not significantly different from other forms of therapy, including various forms of psychotherapy. Aerobic and anaerobic forms of exercise are equally effective. The results are restricted to patients with mild to moderate forms of unipolar depression. Patients appreciate exercise and consider it a useful form of therapy. Physical exercise may be an alternative or adjunct to traditional forms of treatment in mild to moderate forms of unipolar depression.

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05797.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Recent studies have indicated the pernicious nature of dysthymia; its low‐grade chronicity probably contributes most to the problem of undertreatment and misdiagnosis. A high prevalence of morbidity and comorbidity is associated with dysthymia: major depression, alcoholism, anxiety and personality disorders are present in the vast majority of sufferers. It is also very unusual for people with dysthymia to not develop superimposed episodes of major depressive disorder, resulting in a longer time to recover and high rates of recurrence and chronicity. Approximately 3.1% of the population have dysthymia including children and adolescents who, like adults, exhibit a higher risk for new episodes of depressive illness if they have this disorder. Children and adolescents with depressive illnesses have higher rates of scholastic failure and school‐related problems. Dysthymia can affect every aspect of a person's quality of life including relationships with significant others, earning potential and, most importantly, mental and physical well‐being. Available data is not yet sufficient to differentiate dysthymia as a disease entity from the other depressive disorders such as major depression or double depression, or to conclude to what extent dysthymia should be thought of as a personality disorder. However, the DSM‐IV Mood Disorders Field Trial results help identify new criteria for the DSM‐IV Appendix. The relationship between dysthymic disorder and major depression needs more definition, especially in regard to course and severity, so that an accurate diagnosis can lead to expeditious and appropriate

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05880.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Recent research has focused on strategies for optimizing the long‐term treatment of schizophrenia by decreasing relapse rates at the same time that antipsychotic drug side effects are minimized. Studies have suggested that substantially lowering the dose by as much as 80% can result in fewer side effects, less anxiety and depression, and improved compliance. However, dosage reduction can also lead to increases in the vulnerability to mild exacerbation of psychosis. A recent study from our laboratory indicates that supplementing low dose depot antipsychotic medications with oral supplementation at the time of prodromal symptoms may improve the safety of low doses. For patients who are treated with fluphenazine decanoate, monitoring plasma fluphenazine levels may also help to minimize relapse rate

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05861.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

It is pointed out that many published empirical studies on the issue of borderline conditions suffer from methodological shortcomings due to the prevailing empiricist simplification of research. Attention is drawn to the fact that the current psychiatric research in classification issues is dominated by an exaggerated quest for reliability at the expense of concern with validity issues. Concepts of operational criteria, polythetic‐prototypic systems, and epistemic peculiarities of psychiatric, clinical typification are briefly exposed. It is suggested that future scientific progress in the area of personality research must take into account these general methodological considerations: repotentiate clinical‐phenomenological observation, include prototypical approaches, extend studied samples with subjects drawn from the general population and import insights from personality trait research in normal psychology. Some of the claims of Gunderson and Torgersen (this volume) are discus

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05814.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The concept of subjective response to neuroleptics in schizophrenic patients is reviewed in terms of its measurement and validity. Evidence is presented to link negative subjective response to neuroleptics to noncompliance and less favourable therapeutic outcome. The relevance of the construct of subjective responses to neuroleptics is examined in terms of its impact on the functional status and quality of life of patients. There is a great need for improved methods in researching subjective responses as well as better understanding of the factors that contribute to its genesis. The advent of new neuroleptics with superior risk‐benefit ratios should encourage such research development

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05828.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Depot administration of neuroleptic drugs offers several advantages in the long‐term maintenance therapy of chronic schizophrenic patients. The major advantage is the assurance of compliance leading to fewer relapses and rehospitalizations. Depot neuroleptics also eliminate bioavailability problems related to absorption and first pass metabolism and give a stable plasma concentration. Finally, depot neuroleptics assure better and safer possibilities to use the lowest effective dose principle, thereby reducing the frequency of side effects, including the subjectively distressing mental side effects such as akathisia, dysphoria and neuroleptic‐induced deficit syndrome. Disadvantages include delayed disappearance of side effects after discontinuation and, for many patients, a feeling of being controlled. Administered in the proper way, with suitable information to the patient and relatives, depot neuroleptics improve the quality of the antipsychotic treatment, reduce relapse frequency, stabilize the therapeutic effect and diminish the level of side effe

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05862.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1994.tb05844.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY