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S M Strakowski

Publications and source records attributed to S M Strakowski.

At least 91 records · Page 5Linked to original sources
PubMed1996

New developments in the pharmacologic treatment of schizoaffective disorder.

BACKGROUND: Schizoaffective disorder is a common, chronic, and frequently disabling psychiatric disorder. However, the pharmacologic treatment of this disorder has not been well studied. METHOD: The authors reviewed the available literature regarding the acute and prophylactic pharmacologic treatment of schizoaffective disorder RESULTS: Fourteen controlled studies, and only 10 using modern criteria to define the disorder, reported on the efficacy of typical antipsychotics, thymoleptics, or the combination in the acute treatment of schizoaffective disorder. In acute treatment studies of schizoaffective disorder, bipolar type (manic), typical antipsychotics and lithium were comparable in efficacy except in agitated patients for whom antipsychotics were superior. The combination of lithium and antipsychotics appeared to be superior to antipsychotics alone in this patient subtype. In the only controlled study of the acute treatment of schizoaffective disorder, depressive type, combined treatment with antipsychotics and antidepressants was not superior to treatment with antipsychotics alone. CONCLUSION: Although combination treatment with antipsychotics and thymoleptics is common practice in the prophylactic management of schizoaffective disorder, the efficacy of this strategy has not been studied in controlled trials. Recent preliminary data from open trials suggest that the mood stabilizers valproate and carbamazepine and the novel antipsychotics clozapine and risperidone may be promising new treatments for schizoaffective disorder. Evidence implicating 5-HT2 receptor blockade as an important mechanism underlying possible thymoleptic activity for clozapine and risperidone is also reviewed.

Antidepressive Agents↗
PubMed1996

Differences in thyroid function studies in acutely manic adolescents with and without attention deficity hyperactivity disorder (ADHD).

The purpose of this study was to compare basal thyroid indices in adolescent (ages 12 to 18) bipolar patients with and without attention deficit hyperactivity disorder (ADHD). On the basis of earlier studies, the authors hypothesized that bipolar patients with comorbid ADHD would have lower serum triiodothyronine (T3) and thyroxine (T4) concentrations and higher serum thyroid stimulating hormone (TSH) concentrations compared with patients with bipolar disorder alone. Thirty adolescents who met DSM-III-R criteria for bipolar disorder and were hospitalized for the treatment of acute mania were assessed. Twenty patients (66%) had comorbid ADHD. The mean serum T4 concentration in this group was significantly lower than it was for patients with bipolar disorder alone. There were no significant differences between groups in serum T3 or TSH concentrations. Although, these data are preliminary and require further investigation, this may have important implications regarding the potential benefits of thyroid supplementation in adolescents with bipolar disorder and comorbid ADHD who do not respond to mood stabilizers alone.

Adolescent↗
PubMed1995

Affective state dependence of the Tridimensional Personality Questionnaire.

The authors administered the Tridimensional Personality Questionnaire (TPQ) on two occasions separated by more than 1 month to 30 patients with psychotic disorders to examine hypothesized relationships between affective symptomatology and the TPQ dimension Harm Avoidance. As predicted, changes in Harm Avoidance scores demonstrated a robust correlation with changes in depression ratings and a less robust association with changes in mania ratings. The TPQ dimensions Novelty Seeking and Reward Dependence demonstrated minimal associations with symptom measures. This study supports the hypothesis that Harm Avoidance scores are strongly associated with depression.

Adolescent↗
PubMed1995

Outcome and comorbidity in first- compared with multiple-episode mania.

The aim of this study was to examine the outcome and comorbidity of patients with bipolar disorder presenting with first-episode as compared with multiple-episode mania. Based on studies from the prepharmacological era and the sensitization model of bipolar disorder, we hypothesized that compared with multiple-episode mania, first-episode mania would be associated with better outcome, milder severity, and less psychiatric comorbidity. Seventy-one hospitalized patients, age 12 years and older and meeting DSM-III-R criteria for bipolar disorder, were recruited over a 1-year period. Thirty-four (48%) first-episode and 37 (56%) multiple-episode patients were compared regarding demographics, phenomenology, comorbidity, family history, and short-term course. Compared with multiple-episode mania, first-episode mania was associated with significantly shorter hospitalization and a higher rate of comorbid impulse control disorders. These data provide indirect support for the sensitization model of bipolar disorder.

Adult↗
PubMed1995

Attention deficit hyperactivity disorder in adolescent mania.

OBJECTIVE: The purpose of this study was to examine the rate of attention deficit hyperactivity disorder in adolescents with bipolar disorder and to explore the potential effects of comorbid attention deficit hyperactivity disorder on the phenomenology of adolescent bipolar disorder. METHOD: The authors assessed the rate of attention deficit hyperactivity disorder for adolescents with bipolar disorder who were hospitalized for treatment of acute mania or hypomania. RESULTS: Eight (57%) of 14 adolescent bipolar patients also met DSM-III-R criteria for attention deficit hyperactivity disorder. Patients with both disorders were more likely to be male and Caucasian and to have mixed rather than manic bipolar disorder. Patients with attention deficit hyperactivity disorder had a higher mean total score on the Young Mania Rating Scale than patients with bipolar disorder alone. CONCLUSIONS: Although preliminary, these findings may have important implications regarding the potential relationship between bipolar disorder and attention deficit hyperactivity disorder.

Adolescent↗
PubMed1995

Somatic treatment of catatonia.

OBJECTIVE: The authors reviewed the recent literature regarding the treatment of catatonia as a syndrome of multiple etiologies. Given the historical and clinical association of catatonia with schizophrenia, the authors' examined the assumption that the first-line treatment of catatonia is antipsychotic medication. METHODS: Articles published between January 1, 1985 and December 31, 1994 were located using the Paperchase medical literature search system. Additionally, references from those identified articles were examined for possible inclusion in this review. To be included in this review, articles had to be written in English and report specific symptoms of catatonia to determine, retrospectively, if DSM-IV criteria for catatonia were met. RESULTS: Seventy publications met inclusion criteria and reported on a total of 178 patients and included 270 separate treatment episodes. Most of the articles were case-reports, although a few case-series were identified. Multiple causes of catatonia were identified in these reports. The most commonly reported treatment for catatonia was with benzodiazepines which were effective in 70 percent of the cases, with lorazepam demonstrating the highest frequency of use and a 79 percent complete response rate. Electroconvulsive therapy (ECT) was also efficacious (85%) and was more likely to provide a positive outcome in cases of malignant catatonia. Antipsychotics demonstrated poor efficacy. CONCLUSIONS: Catatonia is a nonspecific syndrome with multiple etiologies. Treatment of catatonia should be based on the underlying cause when it is identifiable. Lorazepam appears to offer a safe, effective first-line treatment of catatonia. ECT should be considered when rapid resolution is necessary (e.g., malignant catatonia) or when an initial lorazepam trial fails.

Anti-Anxiety Agents↗
PubMed1995

The comorbidity of attention-deficit hyperactivity disorder in adolescent mania: potential diagnostic and treatment implications.

The frequency of attention-deficit hyperactivity disorder (ADHD) was assessed in 20 adolescents with DSM-III-R bipolar disorder hospitalized for the treatment of acute mania. Thirteen (65%) patients met DSM-III-R criteria for ADHD. Patients who met criteria for both disorders were more likely to be Caucasian and male, and to have mixed rather than pure mania. Patients with ADHD also had a higher mean total Young Mania Rating Scale score and lower serum thyroxine concentrations than patients with bipolar disorder alone. These results suggest that prior histories of ADHD or ADHD symptoms may be common in adolescents hospitalized for mania, and that patients with both disorders may have more severe manic symptoms than patients with mania alone. These findings may have important implications, especially in determining the optimal pharmacologic treatment of patients who meet criteria for both disorders, because standard treatments for ADHD and bipolar disorder have been assumed to exert opposing effects.

Adolescent↗
PubMed1995

Clinical predictors of acute risperidone response in schizophrenia, schizoaffective disorder, and psychotic mood disorders.

BACKGROUND: In studies of patients with schizophrenia, the atypical antipsychotic risperidone has been shown to be comparable in efficacy to haloperidol and, at dosages of 4 to 8 mg/day, to have a lower rate of extrapyramidal side effects. However, little is known about the efficacy of risperidone in patients with schizophrenia refractory to treatment with typical antipsychotics, schizoaffective disorder, and psychotic mood disorders. The purpose of this study was to assess the efficacy of risperidone in the treatment of these disorders and to identify clinical factors associated with risperidone response. METHOD: By surveying treating clinicians and chart data, we assessed response to risperidone and factors associated with response to risperidone in 144 consecutive patients treated with the drug for at least 2 weeks at a regional state psychiatric hospital. RESULTS: Patients displaying a moderate-to-marked response to risperidone were more likely to be younger; receive diagnoses of bipolar disorder or schizoaffective disorder, depressive type; and have a shorter duration of illness and shorter length of stay prior to risperidone treatment. Response to risperidone was sufficient to allow discharge in 26% of patients with treatment-refractory schizophrenia hospitalized for at least 10 weeks prior to risperidone and in 11% of patients with treatment-refractory schizophrenia hospitalized for greater than 1 year. CONCLUSION: Risperidone may be a useful alternative or adjunctive treatment for patients with schizophrenia refractory to treatment with standard antipsychotic agents, schizoaffective disorder (especially the depressive type), and bipolar disorder when used in conjunction with mood stabilizers.

Adult↗
PubMed1995

The effects of race on diagnosis and disposition from a psychiatric emergency service.

BACKGROUND: Previous studies have reported that racial differences exist in patterns of clinical psychiatric diagnoses as well as the distribution of mental health services resources. The psychiatric emergency service serves as an entry point into the mental health system, so it plays a potentially important role in addressing racial disparities in diagnosis and disposition. To address this disparity, the authors studied two specific questions: (1) are there racial differences in diagnosis and (2) are there racial differences in disposition of patients visiting a psychiatric emergency service? METHOD: Demographic and clinical data were obtained by retrospective chart review of 490 patients randomly selected from 9500 visits to a large psychiatric emergency service during a 1-year period. All clinical information had been recorded by the primary treaters who had no knowledge of this study. RESULTS: Black patients were significantly more likely to be diagnosed with schizophrenia and substance abuse than similar white patients, although less likely to be diagnosed with a personality disorder. Black patients were significantly more likely to be hospitalized, particularly at a public hospital, although there were no significant differences in insurance coverage or measures of suicidal or homicidal ideation. CONCLUSION: Despite the availability of DSM-III-R criteria, black patients continue to be disproportionately diagnosed with schizophrenia. In this sample, this diagnosis may have been given in lieu of a personality disorder or affective illness diagnosis. Black patients are also more likely to be hospitalized. These observations suggest that further research is needed to clarify the effects of race on the decision-making process in diagnosis and disposition from the psychiatric emergency service.

Adult↗
PubMed1994

Pharmacologic treatment of schizoaffective disorder.

In contrast to the considerable systematic study of the pharmacologic treatment of schizophrenia and mood disorders, the pharmacologic treatment of schizoaffective disorder has been relatively ignored. The authors reviewed the available literature regarding the pharmacologic treatment of schizoaffective disorder. The total number of controlled studies of the acute and prophylactic treatment of schizoaffective disorder was small and few used modern criteria to define the disorder. In studies of schizoaffective disorder, bipolar type (manic), lithium and antipsychotics produced comparable albeit incomplete responses, except in highly agitated patients when antipsychotics exerted superior efficacy. The combination of lithium and antipsychotics appeared to be superior to antipsychotics alone for schizoaffective, bipolar type patients. In the only controlled study of schizoaffective disorder, depressed type, the presumed superiority of combined antidepressant and antipsychotic treatment to antipsychotic alone was not found. Although combined antipsychotic and thymoleptic treatment represents common prophylactic management of schizoaffective disorder in clinical practice, the efficacy of this strategy has not been studied in controlled trials. Advances in the nosology of schizoaffective disorder, emerging epidemiologic data demonstrating large numbers of patients with this disorder in clinical populations, and preliminary evidence that clozapine may have combined antipsychotic and thymoleptic properties as well as efficacy in both the psychotic and affective components of schizoaffective disorder, suggest that renewed interest in the diagnosis and treatment of this disorder may lead to improved delivery of care for this understudied but seriously ill group of patients.

Antipsychotic Agents↗
PubMed1994

Substance abuse in psychotic disorders: associations with affective syndromes. DSM-IV Field Trial Work Group.

In a sample of 412 patients with psychotic disorders, the authors examined whether comorbid substance use can be reliably diagnosed, is associated with increased rates of affective symptoms and syndromes and specific psychotic symptoms, and is associated with lowered reliability of the DSM-III-R principal diagnosis. Data from the DSM-IV Field Trial for Schizophrenia and Other Psychotic Disorders was analyzed. In this dataset, substance use was scored on a 4-point ordinal scale and reliability was determined using weighted kappa scores. The associations of significant substance use with affective syndromes and symptoms, and psychotic symptoms were analyzed. Kappa statistics were calculated for principal psychotic disorder diagnoses for patients with and without significant substance use. Weighted kappa scores for substance use ratings ranged from 0.27 to 0.96 (median = 0.85). Syndromal depression was significantly associated with current alcohol use in the entire sample and in the subgroup with schizophrenia alone. Grandiose delusions were also associated with substance use. Significant comorbid substance use was not associated with lowered reliability of diagnosing the principal psychotic disorder. These findings support the hypothesis that comorbid substance abuse can be reliably diagnosed and that alcohol abuse is associated with depressive syndromes in patients with psychotic disorders.

Adult↗
PubMed1994

Diagnostic validity of schizophreniform disorder.

OBJECTIVE: The author examined the validity of schizophreniform disorder as defined in DSM-III and DSM-III-R by critically reviewing the current literature. METHOD: Thirty publications that met specific inclusion criteria were identified and reviewed. To organize information relevant to the question of validity, the data were divided into three general classes of validators: antecedent, concurrent, and predictive. When possible, meta-analyses of specific validators were performed according to the summary odds ratio method of Mantel-Haenszel. RESULTS: The findings of this review failed to provide support for the validity of schizophreniform disorder, as it is currently defined, as a distinct diagnostic entity. In addition, the review did not provide strong support for schizophreniform disorder as representing a subtype of schizophrenia or affective illness. Instead, the data suggest that the current diagnostic criteria for schizophreniform disorder identify a heterogeneous group of patients with new-onset schizophrenia, schizoaffective disorder, and atypical affective disorder and a small subgroup with a remitting nonaffective psychosis. CONCLUSIONS: This review suggests that the diagnosis of schizophreniform disorder has limited clinical utility. Patients meeting criteria for schizophreniform disorder should instead be diagnosed as having psychotic disorder not otherwise specified until additional clinical information (e.g., course of illness) becomes available. Future research will require prospective longitudinal follow-up of patients with new-onset affective and nonaffective psychoses to identify the subgroup with "true" schizophreniform disorder, i.e., a remitting nonaffective psychosis.

Confidence Intervals↗
PubMed1994

Childhood abuse in first-episode psychosis.

Of 38 adult patients admitted for first-episode psychosis, 20 reported childhood abuse, with equal prevalence in men and women. Patients with histories of childhood abuse had significantly more dissociative symptoms, but not more severe psychiatric symptoms. Childhood abuse was not related to rate of recovery and was only marginally related to longer stays in hospital. Although childhood abuse did not affect recovery during first-episode psychosis, it may contribute to a chronic course in some patients.

Adolescent↗
PubMed1994

The co-occurrence of mania with medical and other psychiatric disorders.

OBJECTIVE: The co-occurrence of mania with other medical and psychiatric disorders has been little studied. The authors reviewed the literature in order to clarify the current state of knowledge of this subject and to identify possible areas of future research. METHODS: Published articles which specifically addressed associations of mania with medical disorders and other psychiatric syndromes were identified using the Paperchase medical literature search system and by cross-referencing from other published work. The articles were then organized into three categories: 1) medical disorders associated with secondary mania; 2) medical comorbidity in bipolar disorder; and 3) psychiatric comorbidity in bipolar disorder. RESULTS: The review of medical illness and secondary mania supports the hypothesis that injuries involving right-side and mid-line brain structures are associated with so-called secondary mania. Additionally, an association between bipolar disorder and migraine is identified. Several psychiatric disorders appear to occur with mania at rates higher than expected including obsessive-compulsive disorder, bulimia nervosa, panic disorder, impulse control disorders, and substance abuse. CONCLUSIONS: The authors discuss the potential implications of these findings and suggest research approaches to further examine the relationships between mania and other medical and psychiatric syndromes.

Bipolar Disorder↗
PubMed1994

Diagnostic and treatment implications of psychiatric comorbidity with migraine.

Although an association between migraine and psychiatric disorders has been recognized for over 100 years, this association has been investigated systematically only recently in clinical and community samples. Mechanisms for comorbidity between migraine and psychopathology have also been examined in recent family, pharmacologic treatment, and challenge studies. We review the evidence of an association between migraine and mood, anxiety, and eating disorders and discuss the implications of this association in the diagnosis and pharmacologic treatment of patients with psychiatric disorders and comorbid migraine.

Adult↗
PubMed1994

Neurologic factors predict a favorable valproate response in bipolar and schizoaffective disorders.

The hypothesis that neurologic factors influence the response to valproate (divalproex sodium) in bipolar and schizoaffective disorders was tested. In 115 predominantly lithium-refractory inpatients, neurologic findings were recorded, and blind raters assessed valproate response from the medical record. Patients with a seizure history were much more likely to have a robust response to valproate (70%), when compared with patients without such history (34.6%). History of head injury and abnormal electroencephalographic findings also tended to be more common in those patients with good response. Overall, the group of patients with any neurologic abnormality exhibited a significantly higher rate of good response to valproate (43.6%) than did the neurologically normal group (24.3%). Bipolar or schizoaffective patients with abnormal neurologic features may represent a distinct subtype of illness and appear to be good candidates for valproate therapy.

Bipolar Disorder↗