• Fregoli syndrome after cerebral infarction

      De Pauw, Karel W. (1987)
      A case of a rare form of delusional misidentification, the Fregoli syndrome, is described. Although usually occurring in the setting of primary or secondary schizophrenic psychoses, delusional misidentification has been reported in affective, neurological, and toxic-metabolic disorders. In this instance a diagnosis of paranoia (delusional disorder) secondary to predominantly right hemisphere pathology, rather than schizophrenia, seemed more appropriate.
    • Lithium carbonate in chronic schizophrenia — a brief trial of lithium carbonate added to neuroleptics for treatment of resistant schizophrenic patients

      Larkin, Emmet P.; Shubsachs, Alexander P. W. (1991)
      The value of lithium carbonate as an adjunctive treatment of resistant schizophrenia was tested in a 4‐week clinical trial using a single‐blind, randomized, consent design. Treatment and control groups were drawn from a population of detained patients in an English special (maximum security) hospital. The 2 groups were comparable in terms of age, sex, severity of symptoms, length of hospitalization and concurrent neuroleptic dosage. The addition of lithium carbonate to the treatment regimen did not result in symptomatic improvement in patients completing the treatment protocol. The ethical and practical difficulties raised by the trial are discussed. Copyright © 1991, Wiley Blackwell. All rights reserved
    • Mentally Abnormal Homicide — a review of a special hospital male population

      Larkin, Emmet P. (1993)
      The clinical, criminological and demographic characteristics of a Special Hospital population of male patients convicted of homicide are described. The results confirm much previous work on mentally abnormal homicide. Typically the patients come from a disadvantaged social background with poor employment records, a prior history of aggressive behaviour and a diagnosis of schizophrenia. Victims were usually known to the patient and often came from within his circle of family and friends. Only 25% of the patients were receiving treatment at the time of the offence. These findings are discussed in the light of the current literature. © 1993, The British Academy of Forensic Sciences. All rights reserved.
    • Schizophrenia, violence, clozapine and risperidone: A review

      Delal, Brian; Huckstep, Bernard; Larkin, Emmet P. (1996)
      There is no longer much doubt that there is a small but real association between psychosis and violence directed at others, as well as between psychosis and self-directed violence, including suicide. Schizophrenia and the affective psychoses appear to have a similar order of association with suicide (Caldwell & Gottesman, 1990), but schizophrenia is more likely to be associated with serious other-directed violence. The evidence for the effect of schizophrenia comes from three main directions. There are two substantial cross-sectional USA community studies (Swanson et al, 1990; Link et al, 1992), respectively showing a significant quantitative association between schizophrenia and violence. Comparative studies of illness and offending careers (Lindqvist & Allebeck, 1990; Hodgins, 1992; Coid et al, 1993; Taylor, 1993; Wessely et al, 1994), all show different patterns of violent offending by people with schizophrenia compared with those without a psychotic illness, the 1993 studies confirming that the onset of violence is almost invariably after the onset of illness. The third type of evidence is from phenomenology. Taylor (1985) and Link & Stueve (1994) have shown a strong association between delusions and serious violence, the former demonstrating a specific effect of acting on delusions. (For a more extended discussion see Taylor, 1995.)
    • Psychiatric manifestations of normal-pressure hydrocephalus: A short review and unusual case

      Pinner, Gill; Johnson, Hazel; Bouman, Walter P.; Isaacs, Jo (1997)
      Presents the case of a 68-yr-old male with paranoid psychosis and mild cognitive impairment, but no neurological signs or classic triad. Gait disturbance and urinary incontinence developed later in the course of illness after the diagnosis of normal-pressure hydrocephalus had already been made on CT scanning. A lumbo-peritoneal shunt was performed, followed by full remission of psychotic symptoms, as well as considerable improvement in functioning, continence, and gait. This case demonstrates the need to consider normal-pressure hydrocephalus when older patients present with psychotic symptoms, particularly in the presence of cognitive impairment, gait disturbance, or incontinence. It is asserted that CT scanning of the brain is an important investigation in older patients presenting with both functional and organic disorders. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Lifetime risk of suicide in affective disorders

      Davies, Steffan (1998)
      Comments on the H. M. Inskip et al (see record 1998-00590-008) study on the lifetime risk of suicide for affective disorder, alcoholism, and schizophrenia. While Inskip et al propose that we revise the lifetime risk of suicide in patients with affective disorders from 15% to 6%, the current authors take this argument further, and suggest that this 6% mortality expectation should refer to patients from undefined catchment areas with 2 or more admissions for affective disorder. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
    • Substance misuse and violence: A comparison of special hospital inpatients diagnosed with either schizophrenia or personality disorder

      Corbett, Mark; Duggan, Conor; Larkin, Emmet P. (1998)
      There is increasing interest in the relationship between schizophrenia, substance misuse and serious violence. We compared the pattern of substance misuse in inpatients with schizophrenia convicted of serious offences with that of a matched group with personality disorder. We also compared those with and without a history of substance misuse in their use of drugs or alcohol at the time of their violent index offence. We matched 75 substance misusing patients with schizophrenia with a group of patients with personality disorder and compared the types of substances misused in both groups. We compared these two groups with a larger sample of inpatients without a history of substance misuse to determine the presence of substance misuse at the time of the index offence. No differences were found between the matched groups in their choice of drugs. Drug abusing male inpatients with a personality disorder were significantly more likely to have consumed alcohol at the time of the violent offence compared with the other groups. Although the reporting of substance misuse was unexpectedly low, our data (a) showed no evidence that patients with schizophrenia preferentially choose to misuse specific types of drugs compared with personality disordered patients and (b) that intoxication with alcohol at the time of the violent offence may be important in male patients with a personality disorder and a history of substance misuse.
    • Psychiatric aspects of criminal homicide in Nigeria

      Mafullul, Yakubu M. (2001)
      OBJECTIVES: To investigate the Psychiatric aspects of homicide in Nigeria, and, the psychosocial and forensic background of homicide offenders in Nigeria; to determine the role of the mental health services in the disposal of the accused by the criminal justice system.
    • Aggressive incidents in first-episode psychosis

      Milton, John (2001)
      Background: Recent research has reported increased risk of aggressive incidents by individuals with psychotic illness. Aims: To examine acts of aggression in first-episode psychosis. Method: Subjects with a first-episode psychosis were ascertained from a defined catchment area (Nottingham, UK) and reassessed at 3 years (n=166) using clinical interview, informants, health care and forensic records. Results: Of the subjects, 9.6% demonstrated at least one act of serious aggression (defined as weapon use, sexual assault or victim injury) during at least one psychotic episode and 23.5% demonstrated lesser acts of aggression (defined as all other acts of aggression). For all aggressive subjects (33.1%), unemployment (OR=3.6, 95% CI 1.6-8.0), comorbid substance misuse (OR=3.1, CI 1.1-8.8) and symptoms of overactivity at service contact (OR=6.9, CI 2.7-17.8) had independent effects on risk of aggression. Conclusions: We confirmed some previously reported demographic and clinical associations with aggression in first-episode psychosis but no relationship with specific psychotic symptoms or diagnostic groups was observed. Declaration of interest: Support was received from the National Health Service Executive (Trent Research & Development).
    • Mentally disordered parricide and stranger killers admitted to high-security care. 1: A descriptive comparison

      Baxter, Helen; Duggan, Conor; Larkin, Emmet P.; Cordess, Christopher; Page, Kim (2001)
      Parricide is an uncommon crime, so that many of the descriptive studies suffer from methodological shortcomings of small sample sizes and a non-representative ascertainment. We describe a consecutive series of mentally disordered offenders convicted of parricide who were admitted to high-security care and we compare their index characteristics with a group convicted of killing one or more strangers. The main findings were that the parricides were more likely to suffer from schizophrenia but less likely to have had a discrupted childhood and criminal history, as compared with those who had killed a stranger. Those in the parricide group had made a previous attack on their victim in 40% of cases. Overall, the study confirmed some of the differences that one might expect between these two groups of homicides, which had entirely different relationships to their victims.
    • Antidepressants for people with both schizophrenia and depression

      Furtado, Vivek (2002)
      Background: Depressive symptoms, often of substantial severity, are found in 50% of newly diagnosed suffers of schizophrenia and 33% of people with chronic schizophrenia who have relapsed. Depression is associated with dysphoria, disability, reduction of motivation to accomplish tasks and the activities of daily living, an increased duration of illness and more frequent relapses. Objectives: To determine the clinical effects of antidepressant medication for the treatment of depression in people who also suffer with schizophrenia. Search methods: We undertook electronic searches of the Cochrane Schizophrenia Group's Register (October 2000), ClinPsych (1988-2000), The Cochrane Library (Issue 3, 2000), EMBASE (1980-2000) and MEDLINE (1966-2000). This was supplemented by citation searching, personal contact with authors and pharmaceutical companies. We updated this search January 2013 and added 71 new trials to the awaiting assessment section. Selection criteria: All randomised clinical trials that compared antidepressant medication with placebo for people with schizophrenia or schizoaffective disorder who were also suffering from depression. Data collection and analysis: Data were independently selected and extracted. For homogeneous dichotomous data the fixed effects risk difference (RD), the 95% confidence intervals (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, reviewers calculated weighted mean differences. Statistical tests for heterogeneity were also undertaken. Main results: Eleven studies met the inclusion criteria. All were small, and randomised fewer than 30 people to each group. Most included people after the most acute phase of psychosis and investigated a wide range of antidepressants. The quality of reporting varied a great deal. For the outcome of 'no important clinical response' antidepressants were significantly better than placebo (n=209, 5 RCTs, summary risk difference fixed effects -0.26, 95% CI -0.39 to -0.13, NNT 4 95% CI 3 to 8). The depression score at the end of the trial, as assessed by the Hamilton Rating Scale (HAM-D), seemed to suggest that using antidepressants was beneficial, but this was only statistically significant when a fixed effects model was used (n=261, 6 RCTs, WMD fixed effects -2.2 95% CI -3.8 to -0.6; WMD random effects -2.1 95% CI -5.04 to 0.84). There was no evidence that antidepressant treatment led to a deterioration of psychotic symptoms in the included trials. Heterogeneous data on 'any adverse effect' are equivocal (n=110, 2 RCTs, RD fixed 0.11 CI -0.03 to 0.25, Chi square 7.5, df=1, p=0.0062). In one small study extrapyramidal adverse effects were reported less often by those allocated to antidepressant (n=52, 1 RCT, RD fixed -0.28 CI -0.5 to -0.04). Only about 10% of people left these studies by 12 weeks. There was no apparent difference between those allocated placebo and those given an antidepressant (n=426, 10 RCTs, RD fixed 0.04 CI -0.02 to 0.1). Authors' conclusions: Overall, the literature was of poor quality, and only a small number of trials made useful contributions. Though our results provide some evidence to indicate that antidepressants may be beneficial for people with depression and schizophrenia, the results, at best, are likely to overestimate the treatment effect, and, at worst, could merely reflect selective reporting of statistically significant results and publication bias. At present, there is no convincing evidence to support or refute the use of antidepressants in treating depression in people with schizophrenia. We need further well-designed, conducted and reported research to determine the best approach towards treating depression in people with schizophrenia. Note: the 71 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.<br/>Copyright &#xa9; 2013 The Cochrane Collaboration.
    • Experiences of parents with a son or daughter suffering from schizophrenia

      Ferriter, Michael; Huband, Nick (2003)
      Parents of 22 patients diagnosed with schizophrenia, and receiving care in a secure forensic setting, were interviewed to elicit their views on the causes of the disorder, the emotional burden and the helpfulness of others when seeking support. Pathological parenting theories of causation were rated the least important, and biological and life-event models the most. Stress, loss and fear were the most commonly reported reactions. Violence, withdrawal and verbal aggression were most often identified as behaviours causing difficulty. Many participants felt guilt, usually in the absence of being blamed. Family members and self-help groups were recalled as being of most help, and professional staff were considered to be of least help. Parenting a son or daughter with schizophrenia frequently causes considerable emotional distress, often with perception of unhelpful responses from professional staff. Parents often blame themselves for the disorder, even when not blamed by others. Guilt does not appear to arise from belief in a pathological parenting model of schizophrenia. Factors contributing to self-blame in this group are discussed, together with suggestions for appropriate therapeutic intervention.
    • Influence of antipsychotic agents on neurological soft signs and dyskinesia in first episode psychosis

      Boks, Marco P. M. (2003)
      First episode psychosis patients treated with atypical antipsychotics had significantly fewer signs of dyskinesia than patients treated with classical antipsychotics, but there were no significant differences regarding the total number of neurological soft signs (NSS). This suggests that the type of antipsychotic medication does not influence NSS, but that atypical antipsychotics are associated with less dyskinesia in the early stages of treatment.;
    • Objectivity in psychoanalytic assessment of couple relationships

      Evans, Chris (2003)
      Background: Clinicians claim that partners in a couple can be understood to share a mode of relating, at an unconscious level. Assessment of this depends on inference from observable data. This study tests the viability and reliability of a modification of the Personal Relatedness Profile (PRP) for this purpose. Aims: To test the interrater reliability and construct validity of a joint PRP score for couples. Method: Seven therapists independently rated couples' interactions using the 30-item PRP and segments of videotaped interviews with 19 couples. Results: Interrater reliability was good and correlations between items clearly supported the underlying Kleinian bipolar model used (paranoid-schizoid/depressive positions). Conclusions: Psychoanalytic couple psychotherapists agree in independent judgements of the nature of couple functioning, these judgements being based on envisaging couples in terms of an unconsciously shared state of mind.
    • Minor physical anomalies in schizophrenia: Is age a confounding factor?

      Lloyd, Tuhina (2003)
      Minor physical anomalies (MPAs) occur more frequently in a range of developmental disorders. They are also more frequent in schizophrenia supporting a neurodevelopmental aetiology of the illness. Contemporary MPA scales are yet to be validated for the effects of age. It is hypothesised that the effects of ageing may be confounding when these scales are applied to an elderly population. The distribution of MPAs in a normal elderly population was compared with younger subjects. Fifty subjects over the age of 60, and 50 subjects below the age of 60, with no known major mental illness, were evaluated. MPAs were assessed using a modified Lane scale. Elderly subjects showed an excess of absent trichions due to alopecia short and broad palates and greater ear protrusion relative to young subjects. The differences reported are probably due to hair loss, edentulousness and growth of the auriculocephalic angle with age. These findings question the validity of studies of MPAs in schizophrenia that do not control for age. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    • Clotiapine for acute psychotic illnesses

      Rathbone, John (2004)
      Background: Acute psychotic illnesses, especially when associated with agitated or violent behaviour, require urgent pharmacological tranquillisation or sedation. Clotiapine, a dibenzothiazepine neuroleptic, is being used for this purpose in several countries. Objectives: To estimate the effects of clotiapine when compared to other 'standard' or 'non-standard' treatments for acute psychotic illnesses in controlling disturbed behaviour and reducing psychotic symptoms. Search strategy: We updated previous searches by searching the Cochrane Schizophrenia Group Register (April 2004) Selection criteria: The review included randomised clinical trials comparing clotiapine with any other treatment for people with acute psychotic illnesses. Data collection and analysis: Relevant studies were selected for inclusion, their quality was assessed and data extracted. Data were excluded where more than 50% of participants in any group were lost to follow up. For binary outcomes we calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI). For continuous outcomes, endpoint data were preferred to change data. Non-skewed data from valid scales were summated using a weighted mean difference (WMD). Main results: We identified five relevant trials.None compared clotiapine with placebo, but control drugs were either antipsychotics (chlorpromazine, perphenazine, trifluoperazine and zuclopenthixol acetate) or benzodiazepines (lorazepam).Versus the antipsychotics, the results for 'no important global improvement' did not suggest clotiapine to be superior, or inferior, to chlorpromazine, perphenazine, or trifluoperazine (n = 83, 3 RCTs, RR 0.82 CI 0.22 to 3.05, I-squared 58%). Use of clotiapine when compared with chlorpromazine did change the proportion of people ready for hospital discharge by the end of the study (n = 49, 1 RCT, RR 1.04 95%CI 0.96 to 2.12). Overall, attrition rates were low. No significant difference was found for those allocated to clotiapine compared with people randomised to other antipsychotics (n = 121, RR 2.26 95%CI 0.40 to 13). Weak data suggests that clotiapine may result in less need for antiparkinsonian treatment compared with zuclopenthixol acetate (n = 38, RR 0.43 95%CI 0.02 to 0.98). Compared with lorazepam, clotiapine, when used to control aggressive/violent outbursts for people already treated with haloperidol, did not significantly improve mental state (WMD -3.36 95%CI -8.09 to 1.37). We could not pool much data due to skew or inadequate presentation of results. Economic outcomes and satisfaction with care were not addressed. Authors' conclusions: We found no evidence to support the use of clotiapine in preference to other 'standard' or 'non-standard' treatments for management of people with acute psychotic illness. All trials in this review have important methodological problems.We do not wish to discourage clinicians from using clotiapine in the psychiatric emergency, but well-designed, conducted and reported trials are needed to properly determine the efficacy of this drug. Copyright © 2009 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.