Open-trial reports of substantial clinical improvement in most schizophrenic patients on hemodialysis for their psychiatric condition prompted the present study to determine the efficacy of hemodialysis under double-blind, controlled conditions. Fifteen schizophrenic outpatients were randomly assigned to either a real-sham or sham-real dialysis treatment sequence. Presented in detailed, graphic form, results of repeated measurement and other analyses of symptom and behavioral data collected initially, at crossover, and at the end of treatment revealed no differential effects between real and sham dialysis. These results provide important experimental evidence of the lack of therapeutic efficacy of hemodialysis in schizophrenia.
Patients with schizophrenia frequently present with negative symptoms and cognitive impairments for which no effective treatments are known. Agents that act at the glycine site of the N-methyl-D-aspartic acid (NMDA) glutamatergic receptor have been suggested as promising treatments for moderate to severe negative symptoms and cognitive impairments.The Cognitive and Negative Symptoms in Schizophrenia Trial (CONSIST) was a 16-week double-blind, double-dummy, parallel group, randomized clinical trial of adjunctive glycine, D-cycloserine, or placebo conducted at four sites in the United States and one site in Israel. The participants were 157 inpatients and outpatients who met DSM-IV criteria for schizophrenia or schizoaffective disorder and retrospective and prospective criteria for moderate to severe negative symptoms without marked positive, depressive, or extrapyramidal symptoms. The primary outcome measures were the average "rate of change" of Scale for the Assessment of Negative Symptoms (SANS) total scores and change in the average cognitive domain z scores.There were no significant differences in change in the SANS total score between glycine and placebo subjects or D-cycloserine and placebo subjects. A prespecified test for the site-by-treatment-by-time interaction was significant in post hoc tests. One site had greater reduction in the SANS total score for patients receiving D-cycloserine relative to patients receiving placebo. A second site had greater reduction in the SANS total score for placebo patients compared with glycine patients. There were no significant differences between glycine and placebo or D-cycloserine and placebo subjects on the average cognition z score.The study results suggest that neither glycine nor D-cycloserine is a generally effective therapeutic option for treating negative symptoms or cognitive impairments.
In the past 20 years there has been a marked increase in the number of studies examining the neuroanatomy of schizophrenia. This increase has been paralleled by even greater advances in our understanding of the structure and function of neurons and the brain. These advances in our knowledge of schizophrenia and the brain, in combination with the development of more sophisticated structural and functional imaging and postmortem analytic techniques, promise a more decisive study of the neuropathology of schizophrenia in the future. This issue of Schizophrenia Bulletin provides a review of the status of research on the neuroanatomy of schizophrenia, the nature of the evidence implicating specific brain regions, and which brain regions are best candidates for hypothesis-testing studies.
THE DISTRIBUTION OF CASES AMONG THE SEVERAL PRODUCERS IN EPIDEMICS OF NON-MILK-BORNE INFECTIOUS DISEASE William T. Carpenter, Bacteriologist CopyRight https://doi.org/10.2105/AJPH.2.4.296 Published Online: August 30, 2011
Schizophrenia conceptualized as a specific disorder has resulted in substantial knowledge but has not been validated as a disease entity. An alternative concept of schizophrenia as a heterogeneous clinical syndrome requiring deconstruction. Syndrome status and implications was proposed over 40 years ago and is formally stated in DSM-5. The modest progress in understanding pathophysiological mechanisms and limited progress in therapeutics has resulted in the development of new paradigms for discovery. Four paradigms sensitive to heterogeneity and to across diagnostic boundaries are currently engaged in opening new views and scientific approaches to understanding psychopathology and will be represented in the panel presentations. Each has the potential to increase knowledge on psychopathology and guide future modifications in nosology and diagnostic concepts [think DSM-5.1, DSM-5-2, etc.] 1. Roman Kotov will present on reconceptualization of schizophrenia from the HiTOP perspective including continuity with normal functioning, heterogeneity within the disorder, and its relations to mania, schizotypy, and other conditions. This new paradigm has immediate implications for research and clinical care. New data will be presented from an epidemiologic study of psychosis. 2. Aristotle Voineskos will illustrate the RDoC paradigm with the study of social cognition as a single dimension including deficit schizophrenia, non-deficit schizophrenia and non-ill participants. Several emerging findings from an ongoing RDoC initiative show that a dimensional approach coupled with multivariate analytics, can be successfully used to identify brain-behavior subtypes related to social impairment cutting across a full spectrum of individuals from non-ill participants through to people with schizophrenia who are most impaired. 3. Brett Clementz will illustrate the B-SNIP paradigm showing that deviation in level of intrinsic neural activity (present in ongoing signals recorded from humans with EEG/MEG) is observed in psychosis. Translational models of intrinsic activity deviations hold promise for identifying multiple distinct physiological mechanisms for psychosis manifestation. B-SNIP data show that psychosis Biotypes, but not DSM diagnoses, differ on level of intrinsic activity, and that clozapine treatment enhances this signal, bringing Biotype-1 cases closer to normal and taking Biotype-2 cases farther from normal. Such results yield information about how to predict psychosis cases that can benefit from this specific treatment. 4. Alan Anticevic will present a multivariate linear and nonlinear framework for mapping of neuro-behavioral relationships in dimensional geometric embedding (N-BRIDGE), which will be linked to effects of neuropharmacology, biophysical computational models and transcriptomic effects in humans. Each presentation will include new data. Sarah Morris will discuss these paradigms including their role in research funding and regulatory issues.
The authors present a rationale for establishing emergency psychiatric facilities during mass demonstrations. Special aspects or attributes such as trust, confidentiality, the authoritarian role of the physician, legal complications, the management of potentially violent patients, and the evaluation of thought processes are discussed. The low incidence of psychiatric casualties and the relative rarity of adverse drug reactions during the November 1969 March on Washington are documented: the majority of the most disturbed patients came to Washington for idiosyncratic reasons and did not regard themselves as antiwar protestors.
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