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Michael Schoenbaum - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis of Schizophrenia: consistency across information sources and stability of the condition.
Schizophrenia Research, 2012Co-Authors: Philip D. Harvey, William T. Carpenter, Robert K. Heaton, Michael F. Green, James M. Gold, Michael SchoenbaumAbstract:article i nfo Background: The Social Security Administration is considering whether Schizophrenia may warrant inclusion in their new "Compassionate Allowance" process, which aims to identify diseases and other medical conditions that almost always qualify for Social Security disability benefits simply on the basis of their confirmed presence. This paper examines the reliability and validity of Schizophrenia Diagnosis, how a valid Diagnosis is established, and the stability of the Diagnosis over time. A companion paper summarizes evidence on the empirical association between Schizophrenia and disability, thus leading to this paper that evaluates how valid clinical diagnoses of Schizophrenia are. Methods: Literature review and synthesis, based on a workplan developed in an expert meeting convened by the National Institute of Mental Health and the Social Security Administration. Findings: At least since the introduction of the 3rd edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-III) in 1980, diagnoses of Schizophrenia made by mental health specialists are valid, reliable, and stable over time, across community as well as academic practice settings, and across different assessment methods. These analyses are particularly valid during the time-frame relevant to social security awards: at least 2 years after the initial stages of illness. We could not find studies that have evaluated the validity or reliability of Schizophrenia diagnoses made exclusively by primary care providers (vs. mental health professionals). Discussion: In the post-DSM-III era, Schizophrenia Diagnosis—using modern diagnostic criteria—is valid and reliable when performed by doctoral-level mental health specialists (i.e., psychiatrists and psychologists), in community as As we note in the accompanying white paper, it is our position that the presence of Schizophrenia is consistently associated with the occurrence of impairments in the ability to function adequately in everyday life. In this paper, we present information regarding the accuracy with which Schizophrenia in established cases with an extended duration of illness can be identified by mental health clinicians in regular community settings. We also consider the reliability of the identification of Schizophrenia as a Diagnosis across different sources of diagnostic information, using different methods, and across individuals who may be generating these diagnoses (typically, doctoral-level mental health professionals). We also consider whether there are any specific procedures that may be required to generate a valid and reliable Diagnosis of Schizophrenia. of particular interest is the duration of illness after which the Diagnosis of Schizophrenia and its associated disability can be con- sidered stable. The SSA requires a continuous duration of illness and disability of 2 years before considering a person with the illness for disabilitycompensation.Thus,thecritical focus is not prior to the illness (the prodome), or at the first episode, or after accrual of a minimal treatment history, but rather after there is an established illness. Much of the data that we review is older, but still supportive of the conclusion that after a certain initialperiod of evaluation and treatment, a clinically derived Diagnosis is likely to betemporally stable andobtainable from a variety of medical records generated by mental health professionals.
Adrian J. Stanley - One of the best experts on this subject based on the ideXlab platform.
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The efficacy and safety of treating hepatitis C in patients with a Diagnosis of Schizophrenia.
Journal of viral hepatitis, 2014Co-Authors: M. Z. Mustafa, J. Schofield, Peter R. Mills, M. Priest, Ray Fox, J. Morris, Ewan H. Forrest, R Gillespie, S. Datta, Adrian J. StanleyAbstract:SUMMARY. Treating chronic hepatitis C with pegylated interferon alpha may induce or exacerbate psychiatric illness including depression, mania and aggressive behaviour. There is limited data regarding treatment in the context of chronic Schizophrenia. We sought to establish the safety and efficacy of treating patients with Schizophrenia. Patient and treatment data, prospectively collected on the Scottish hepatitis C database, were analysed according to the presence or absence of a Diagnosis of Schizophrenia. Time from referral to treatment, and the proportion of patients commencing treatment in each group, was calculated. Outcomes including sustained viral response rates, reasons for treatment termination and adverse events were compared. of 5497 patients, 64 (1.2%) had a Diagnosis of Schizophrenia. Patients with Schizophrenia (PWS) were as likely to receive treatment as those without [28/61(46%) vs 1639/4415 (37%) P = 0.19]. Sustained viral response (SVR) rates were higher in PWS [21/25 (84%) vs 788/ 1453 (54%) P < 0.01]. SVR rates by genotype were similar [4/8 (50%) vs 239/684 (35%) Genotype 1 (P = 0.56), 17/17 (100%) vs 599/742 (81%) non-Genotype 1 (P = 0.09)]. Adverse events leading to cessation of treatment were comparable [2/25(8%) vs 189/1453 (13%) P: 0.66]. Patients with Schizophrenia are good candidates for hepatitis C treatment, with equivalent SVR and treatment discontinuation rates to patients without Schizophrenia.
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PWE-149 The Efficacy and Safety of Treating Hepatitis C in Patients with a Diagnosis of Schizophrenia
Gut, 2013Co-Authors: Z Mustafa, J. Schofield, Peter R. Mills, M. Priest, Ray Fox, S Dutta, J. Morris, Ewan H. Forrest, R Gillespie, Adrian J. StanleyAbstract:Introduction Treating hepatitis C with pegylated interferon alpha may induce or exacerbate psychiatric illness including depression, mania and aggressive behaviour. There is limited data regarding treatment in the context of chronic Schizophrenia. We sought to establish the safety and efficacy of treatment of patients with a Diagnosis of Schizophrenia amongst patients attending treatment centres in Greater Glasgow Methods Patient and treatment data collected on the Scottish hepatitis C database were retrospectively analysed according to the presence or absence of a Diagnosis of Schizophrenia. Combination antiviral therapy was defined as Interferon (pegylated or standard) and Ribavirin. Treatment outcomes including sustained viral response (SVR) rates, reasons for treatment termination and adverse events were documented Results 5497 patients were recorded on the database, of whom 64 (1.2%) had a Diagnosis of Schizophrenia. Patients with and without Schizophrenia were of similar age at Diagnosis [median 34 (IQR 31–40) vs 36 (IQR 29–41) years, p = 0.85]. Patients with Schizophrenia had higher rates of current or previous intravenous drug use [50/64 (78.1%) vs 3015/5433 (55.5%), p 21 units/week [25/64 (39%) vs 1211/5433 (22.2%), p = 0.02)]. More patients with Schizophrenia had a Diagnosis of cirrhosis [13/64 (20.3%) vs 589/5419 (10.86%), p = 0.02]. of those patients who had attended at least one clinic appointment 1639/4415 (37.1%) of patients without Schizophrenia commenced treatment versus 26/61 (42.6%) of patients with Schizophrenia (p = 0.21). Patients with Schizophrenia took almost three times as long to commence treatment after initial referral [median 1123 (IQR 531–2130) vs 421 (IQR 209–1086) days, p Conclusion Patients with stable Schizophrenia are good candidates for hepatitis C treatment Disclosure of Interest None Declared.
Judith M Ford - One of the best experts on this subject based on the ideXlab platform.
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visual hallucinations are associated with hyperconnectivity between the amygdala and visual cortex in people with a Diagnosis of Schizophrenia
Schizophrenia Bulletin, 2015Co-Authors: Judith M Ford, Vanessa A Palzes, Brian J Roach, Steven G Potkin, Theo G M Van Erp, Jessica A Turner, Bryon A Mueller, V D Calhoun, James T VoyvodicAbstract:Author(s): Ford, Judith M; Palzes, Vanessa A; Roach, Brian J; Potkin, Steven G; van Erp, Theo GM; Turner, Jessica A; Mueller, Bryon A; Calhoun, Vincent D; Voyvodic, Jim; Belger, Aysenil; Bustillo, Juan; Vaidya, Jatin G; Preda, Adrian; McEwen, Sarah C; Functional Imaging Biomedical Informatics Research Network; Mathalon, Daniel H | Abstract: While auditory verbal hallucinations (AH) are a cardinal symptom of Schizophrenia, people with a Diagnosis of Schizophrenia (SZ) may also experience visual hallucinations (VH). In a retrospective analysis of a large sample of SZ and healthy controls (HC) studied as part of the functional magnetic resonance imaging (fMRI) Biomedical Informatics Research Network (FBIRN), we asked if SZ who endorsed experiencing VH during clinical interviews had greater connectivity between visual cortex and limbic structures than SZ who did not endorse experiencing VH.We analyzed resting state fMRI data from 162 SZ and 178 age- and gender-matched HC. SZ were sorted into groups according to clinical ratings on AH and VH: SZ with VH (VH-SZ; n = 45), SZ with AH but no VH (AH-SZ; n = 50), and SZ with neither AH nor VH (NoH-SZ; n = 67). Our primary analysis was seed based, extracting connectivity between visual cortex and the amygdala (because of its role in fear and negative emotion) and visual cortex and the hippocampus (because of its role in memory).Compared with the other groups, VH-SZ showed hyperconnectivity between the amygdala and visual cortex, specifically BA18, with no differences in connectivity among the other groups. In a voxel-wise, whole brain analysis comparing VH-SZ with AH-SZ, the amygdala was hyperconnected to left temporal pole and inferior frontal gyrus in VH-SZ, likely due to their more severe thought broadcasting.VH-SZ have hyperconnectivity between subcortical areas subserving emotion and cortical areas subserving higher order visual processing, providing biological support for distressing VH in Schizophrenia.
William T. Carpenter - One of the best experts on this subject based on the ideXlab platform.
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Diagnosis of Schizophrenia: consistency across information sources and stability of the condition.
Schizophrenia Research, 2012Co-Authors: Philip D. Harvey, William T. Carpenter, Robert K. Heaton, Michael F. Green, James M. Gold, Michael SchoenbaumAbstract:article i nfo Background: The Social Security Administration is considering whether Schizophrenia may warrant inclusion in their new "Compassionate Allowance" process, which aims to identify diseases and other medical conditions that almost always qualify for Social Security disability benefits simply on the basis of their confirmed presence. This paper examines the reliability and validity of Schizophrenia Diagnosis, how a valid Diagnosis is established, and the stability of the Diagnosis over time. A companion paper summarizes evidence on the empirical association between Schizophrenia and disability, thus leading to this paper that evaluates how valid clinical diagnoses of Schizophrenia are. Methods: Literature review and synthesis, based on a workplan developed in an expert meeting convened by the National Institute of Mental Health and the Social Security Administration. Findings: At least since the introduction of the 3rd edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-III) in 1980, diagnoses of Schizophrenia made by mental health specialists are valid, reliable, and stable over time, across community as well as academic practice settings, and across different assessment methods. These analyses are particularly valid during the time-frame relevant to social security awards: at least 2 years after the initial stages of illness. We could not find studies that have evaluated the validity or reliability of Schizophrenia diagnoses made exclusively by primary care providers (vs. mental health professionals). Discussion: In the post-DSM-III era, Schizophrenia Diagnosis—using modern diagnostic criteria—is valid and reliable when performed by doctoral-level mental health specialists (i.e., psychiatrists and psychologists), in community as As we note in the accompanying white paper, it is our position that the presence of Schizophrenia is consistently associated with the occurrence of impairments in the ability to function adequately in everyday life. In this paper, we present information regarding the accuracy with which Schizophrenia in established cases with an extended duration of illness can be identified by mental health clinicians in regular community settings. We also consider the reliability of the identification of Schizophrenia as a Diagnosis across different sources of diagnostic information, using different methods, and across individuals who may be generating these diagnoses (typically, doctoral-level mental health professionals). We also consider whether there are any specific procedures that may be required to generate a valid and reliable Diagnosis of Schizophrenia. of particular interest is the duration of illness after which the Diagnosis of Schizophrenia and its associated disability can be con- sidered stable. The SSA requires a continuous duration of illness and disability of 2 years before considering a person with the illness for disabilitycompensation.Thus,thecritical focus is not prior to the illness (the prodome), or at the first episode, or after accrual of a minimal treatment history, but rather after there is an established illness. Much of the data that we review is older, but still supportive of the conclusion that after a certain initialperiod of evaluation and treatment, a clinically derived Diagnosis is likely to betemporally stable andobtainable from a variety of medical records generated by mental health professionals.
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Revisiting the Diagnosis of Schizophrenia: Where have we been and Where are We Going?
CNS neuroscience & therapeutics, 2010Co-Authors: William R. Keller, Bernard A. Fischer, William T. CarpenterAbstract:Appropriate and reliable classification of mental illness is crucial for advancing the field of psychiatry as agreement on Diagnosis has broad implications for treatment of mental disorders and research into the etiopathophysiology of mental disorders. Since Schizophrenia was first recognized by Kraepelin (as dementia praecox), there has been much discussion about what does and does not diagnostically constitute the disorder. The importance placed upon different symptoms and course types associated with Schizophrenia has been as heterogeneous as the disorder itself. This article focuses upon the classification of Schizophrenia over the last 100 years, the current Diagnosis of Schizophrenia, changes for Schizophrenia planned in the upcoming DSM 5, future directions for improving the Diagnosis of Schizophrenia, and the implications of a new diagnostic paradigm for the illness.
Holger Jelling Sorensen - One of the best experts on this subject based on the ideXlab platform.
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somatic diseases and conditions before the first Diagnosis of Schizophrenia a nationwide population based cohort study in more than 900 000 individuals
Schizophrenia Bulletin, 2015Co-Authors: Holger Jelling Sorensen, Philip R Nielsen, Michael E Benros, Carsten Bocker Pedersen, Preben Bo MortensenAbstract:Objective: Schizophrenia is associated with excess physical comorbidity. Yet, to our knowledge, large studies are lacking on the associations with somatic diseases before the onset of Schizophrenia. The authors conducted a nationwide study of the full spectrum of treated somatic diseases before the first Diagnosis of Schizophrenia. Method: Nationwide sample of the Danish population consisting of singletons (n = 954351) born 1977–1993 and followed from birth to 2009, during which period 4371 developed Schizophrenia. Somatic diagnoses at all general hospital contacts (admitted or outpatient care at a somatic hospital) from 1977 to 2009 were used as exposures. The incidence rate ratio (IRR) of Schizophrenia was calculated using Poisson regression adjusted for confounders. Results: Among the 4371 persons who developed Schizophrenia from 1992 to 2009, a total of 4180 (95.6%) persons had a previous somatic hospital contact. A history of any somatic hospital contact was associated with an elevated risk of Schizophrenia (IRR = 2.04, 95% CI = 1.77–2.37). A wide range of somatic diseases and conditions were associated with an increased risk of Schizophrenia, including epilepsy (IRR = 2.26, 95% CI = 1.93–2.62), nutritional or metabolic disorders (IRR = 1.57, 95% CI = 1.39–1.77), circulatory system diseases (IRR = 1.63, 95% CI= 1.38–1.92), and brain injury (IRR = 1.58, 95% CI = 1.45–1.72). Conclusions: A wide range of potential etiological factors could have contributed to the observed associations, including genetic or physiological overlaps between conditions, and interacting immunological, behavioral, and neurodevelopmental factors.