Lars Hansen

Schizophrenia can and should be renamed

Lieberman and First make the case against renaming schizophrenia on the grounds that changing the term would not change the stigma attached to the underlying condition.1 Yet renaming is a key strategy used by marketing and public relations industries to improve image, alongside attitude change and …

Effect of chronic treatment with NNC 756, a new D-1 receptor antagonist, or raclopride a D-2 receptor antagonist, in drug-naive Cebus monkeys: dystonia dyskinesia and D-1/D-2 supersensitivity

When given subcutaneously in gradually increasing doses, up to 1 mg/kg, NNC 756, a dopamine (DA) D-1 antagonist, failed to produce dystonia in eight drug-naive Cebus monkeys. In contrast, raclopride, a DA D-2 antagonist, produced dystonia at low doses (0.010-0.015 mg/kg). Following pre-treatment with raclopride, NNC 756 also induced dystonia at low doses (0.015-0.025 mg/kg), but continued treatment caused tolerance, and increasing doses of NNC 756 could be administered without induction of dystonia. NNC 756 induced a dose-dependent parkinsonism (slow, stiff movements and tremor), and more sedation than raclopride. After treatment for 14 weeks, withdrawal of raclopride (0.01 mg/kg) led to mild oral dyskinesia (tardive dyskinesia), while withdrawal of NNC 756 (1.0 mg/kg) led to a special grooming syndrome, but no dyskinesia. Withdrawal of raclopride as well as NNC 756 led to behavioural D-1 and D-2 dopamine supersensitivity in the form of increased dyskinesia (including grooming after NNC 756) induced by D-1 agonist (SKF 81297) and increased arousal induced by D-2 agonist (quinpirole). These results indicate that D-1 antagonists such as NNC 756 elicit fewer extrapyramidal symptoms (both acute and tardive) than D-2 antagonists such as raclopride, although extremely high doses may cause a special grooming withdrawal syndrome.

Acute dystonic reaction in an elderly patient with mood disorder after titration of paroxetine: possible mechanisms and implications for clinical care

The administration of a serotonin reuptake inhibitor may lead to extra pyramidal signs, as reported in the literature. The risk seems to be increased in elderly people. We describe a case of acute dystonic reaction to paroxetine treatment in an elderly patient, who presented with a bipolar affective disorder. The underlying mechanism, possibly generated in the subcortical motor areas, is linked to changes that occur in the pharmacokinetic variables, the decreased neuroplasticity of ageing neurones and to previous exposure to neuroleptic medications.

No association between akathisia or Parkinsonism and suicidality in treatment-resistant schizophrenia

Akathisia and drug-induced Parkinsonism have traditionally beenassociated with depression and suicidality based on case study evidence. In this subanalysis, patients with treatment resistant schizophrenia were rated on the Comprehensive Psychopathological Rating Scale, Barnes Akathisia Scale and Simpson–Angus extrapyramidal side-effect scale at two time points (n = 86 at first assessment; n = 67 at secondassessment). At no time point was there any significant relationship between akathisia and depression/suicidality or distress associated with akathisia and Parkinsonism with suicidality. These preliminary findings warrant further investigation.

Consistency in Suicide Rates in Twenty-Two Developed Countries by Gender over Time 1874–78, 1974–76, and 1998–2000

To determine whether the relative levels of suicide rates among the 22 developed countries were consistent over time 1974–76 v 2000–02 and to compare Durkheims 11 European countries 1874–78 with their modern counterparts, including the 1984–86 period associated with the European recession. Data from the WHO of All Age “General Population Suicide Rates” (GPSR) by sex were calculated to obtain 3-year averages for the end-points. To determine the consistency of the levels of suicides a series of Spearman Rank Order correlations are calculated for each period. Highly significant correlations are found for men, women and total suicide rates between 1974–76 and 1998–2000, and for the Durkheim countries for the three review periods, indicating despite within-national variations over time, the relative rates between countries was consistent. This consistency suggests a certain national “suicide tradition” based on a complex interaction between cultural, sociological, recording/administrative, and genetic factors.

The relationship between self‐esteem and psychotic symptoms in schizophrenia: A longitudinal study

The relationship between self‐esteem and psychotic symptoms is unclear. We have conducted a secondary analysis of an 18‐month study of 66 people with schizophrenia to investigate the longitudinal relationship between self‐esteem and psychotic symptoms. We investigated associations between positive and negative psychotic symptoms and self‐esteem at baseline, after controlling for the effect of mood and other covariates using multiple regression. We then investigated the relationship between change in symptom measures and change in self‐esteem. We found ideas of grandeur significantly associated with self‐esteem at baseline. In the longitudinal regression analysis we found that a reduction in severity of negative symptoms was significantly associated with improvement in self‐esteem (and vice versa). These findings have therapeutic implications.

Examining undetermined and accidental deaths as source of 'under-reported-suicide' by age and sex in twenty western countries

AbstractObjectives ‘Undetermined’ (UnD) and accidental deaths (AccD) are explored as possible sources of ‘under-reported-suicides’ (URS) in 20 Western countries.Methods WHO mortality rates per million of AccD, UnD and suicides analysed. UnD:suicides ratios of <1:5 calculated as likely URS versus ratios >1:10 unlikely URS and all correlated by sex and age.Results Male URS likely in 7 countries and in 11 for females. URS in AccD likely in 5 countries for both sexes only UnD and suicide rates the elderly (75+) significantly correlated.ConclusionStrong indication of URS in the UK, Portugal, Switzerland, Sweden, Denmark and Germany with likely URS in AccD in Greece, Portugal, Switzerland and USA. These findings have important implications, indicating that, with the exception of France and Japan, official reported suicide rates contain a degree of under-reporting, and especially for women yet it is essential to have accurate suicide data to ensure adequate service provision.

Combining Cognitive Therapy and Pharmacotherapy for Schizophrenia

Cognitive therapy (CT) is now recognized as an effective intervention for schizophrenia in clinical guidelines developed in the United States (APA, 2006; Lehman et al., 2004) and Europe (e.g., National Institute of Clinical Excellence, 2002). However, empirical studies of CT for schizophrenia, cited as the evidence base for these recommendations, have been conducted solely with patients treated with concurrent medication. It has been a priority in some studies to enhance collaboration with the use of medication and insight into the illness for the individual patient (Kemp, Hayward, Applewhaite, Everitt, & David, 1996); and in most studies, such collaboration has been an integral part of the CT intervention. This article discusses potential interactions between medication and therapy, briefly outlines commonly used medication regimens for schizophrenia, details possible methods to improve adherence to pharmacotherapy, and explores issues encountered in collaboration in combined pharmacotherapy and CT. Finally, we discuss strategies for managing situations in which clients do not want to take medication.

Rating Suicidality in Schizophrenia: Items on Global Scales (HoNOS and CPRS) Correlate with a Validated Suicidality Rating Scale (InterSePT)

The use of general scales such as the Health of the Nation Outcome Scale (HoNOS) and the Comprehensive Psychopathological Rating Scale (CPRS) are widespread. Both scales contain non-validated items on suicidality. This study aimed to establish whether an association between these suicidality items and the validated scale, InterSePT exists. Forty patients with a diagnosis of schizophrenia or schizo-affective disorder were assessed using the three scales. A highly significant association between the two items and the validated scale was found. The suicidality items from HoNOS and CPRS appear to be strong indicators of suicidality in this patient population. The findings allow for use of the suicidality items in clinical assessments and re-investigation of suicidality of other studies where these general rating scales have been used.

Fluoxetine dose-increment related akathisia in depression: implications for clinical care, recognition and management of selective serotonin reuptake inhibitor-induced akathisia

We report the case of a 22-year-old woman presenting major depressive episode with severe akathisia after an increase in fluoxetine. The patient developed severe restlessness andde novosuicidal ideation approximately 1 week after the dosage of fluoxetine was doubled, 1 year on from when the drug was first introduced. This case illustrates the importance of being alert to movement disorders in patients treated with selective serotonin reuptake inhibitors. The clinical implications are discussed. A management strategy based on the evidence in the existing literature is suggested.