Natural Causes of Death in Patients With Schizophrenia

An autopsy study from the time when phenothiazine medications were new, roughly 50 years ago, provided a view of death by natural causes (Hussar 1966). Autopsy data from 1,275 chronically hospitalized patients with schizophrenia in a Veterans Affairs (VA) hospital who died at age 40 or older found that heart disease and cancer were the most common causes of death (similar to findings in the general 40+ population of that time). Pneumonia was somewhat overrepresented as a cause of death....

Demographics of Substance Use in Patients With Schizophrenia

The proportion of schizophrenia patients suffering from a comorbid drug or alcohol use disorder varies tremendously in published studies, from as low as 10 to as high as 70 (Mueser et al. 1990). The observed range is partially due to variability in the diagnostic criteria employed for schizophrenia, sample demographic characteristics (e.g., male vs. female, urban vs. rural), the types of patient populations studied (e.g., inpatient vs. outpatient), and different criteria for defining drug and...

Effects of Nicotine and Smoking on Clinical and Cognitive Deficits Associated With Schizophrenia

Several cross-sectional studies have examined the effects of cigarette smoking on psychotic symptoms in schizophrenic patients (Goff et al. 1992 Hall et al. 1995 Ziedonis et al. 1994). Goff and colleagues found that schizophrenic smokers had higher Brief Psychiatric Rating Scale (BPRS) total scores than schizophrenic nonsmokers, and higher subscale scores for both positive and negative symptoms. Ziedonis and colleagues found increased positive symptom scores and reduced negative symptom scores...

Pharmacology of Nicotine and Tobacco Relevance to Schizophrenia

There has been an increasing understanding of the neurobiology of both schizophrenia and nicotine addiction in the past 20 years. For the purposes of this discussion, nicotine is assumed to be the active ingredient in tobacco and cigarette smoking that exerts psychopharmacological effects, though other components of tobacco smoke may also be active in this respect (Fowler et al. 1996a, 1996b). There are three possible reasons for the high comorbidity rates of nicotine addiction in schizophrenia...

Obesity in Schizophrenia

In the pre-antipsychotic era, Kraepelin noted that some patients with schizophrenia exhibited bizarre eating habits, and not uncommonly were obese. The taking of food fluctuates from complete refusal to the greatest voracity. The body weight usually falls at first often to a considerable degree. . . . L ater, on the contrary we see the weight not infrequently rise quickly in the most extraordinary way, so that the patients in a short time acquire an uncommonly well-nourished turgid appearance...

Conventional Antipsychotic Agents Diabetes and Glucose Intolerance

Conventional antipsychotic agents, which have primarily antidopaminer-gic activity, may alter glucose-insulin homeostasis (Hagg et al. 1998). In particular, the low-potency phenothiazines may induce diabetes mellitus or aggravate existing diabetes mellitus (Hagg et al. 1998 Haupt and Newcomer 2001). Because of this finding, chlorpromazine has been used to prevent hypoglycemia in patients with malignant insulinoma. Furthermore, chlorpromazine has been shown to induce hyperglycemia in healthy...

Natural History of HCV Disease

Acute HCV disease is usually asymptomatic, but 25 -35 of patients develop some constitutional symptoms or jaundice. Serum alanine aminotransferase (ALT) levels frequently rise, fluctuate, and fall again, suggesting recovery from the acute phase. Following acute infection, however, HCV is not easily cleared by the immune system, and 75 -80 of acute HCV infections become chronic, as evidenced by persistent or intermittent HCV viremia. Patients infected with HCV should be advised to minimize or...

Pharmacological Treatment of Obesity in Schizophrenia

The literature thus far suggests that some of the novel antipsychotic medications cause less weight gain than others thus it may be possible to switch patients on agents associated with the most weight gain to those with lower weight gain liability (Allison et al. 1999a Wirshing et al. 1999) however, prior to switching, it is important to recall that the most difficult symptoms to control are those of psychosis. A switch of antipsychotic medication makes sense particularly if the patient is...

Mechanisms by Which the Atypical Antipsychotic Agents May Cause Diabetes Mellitus

There are a number of ways in which the atypical antipsychotic medications could lead to hyperglycemia and diabetes mellitus. As discussed earlier in this chapter, decreased sensitivity increased resistance to insulin and decreased insulin secretion as a result of decreased beta cell function are involved in the development of type II diabetes mellitus. A few controlled studies suggest that the atypical antipsychotic medications affect insulin resistance rather than causing a primary defect in...