Search PubMed⌕ Search

Biomedical subjects

J R DeQuardo

Publications and source records attributed to J R DeQuardo.

30 records · Page 2Linked to original sources
PubMed1995

Comparison of indices of premorbid function in schizophrenia.

There has been a resurgence of interest in the area of premorbid functioning in schizophrenia as it provides clues to onset and etiology. Most studies rely on retrospective estimates of premorbid status that are incomplete, such as the Premorbid Adjustment Scale (PAS). Even prospective high-risk studies are hampered by the narrow range of premorbid functions assessed and are thus unable to answer crucial questions related to onset of illness. This study was undertaken to assess the relationship between several indices of premorbid functioning. Sixty four in-patients with schizophrenia were assessed at medication-free baseline and post-treatment with BPRS and SANS. PAS scores were derived from all available sources. Premorbid cognitive ability was estimated by the mean of WAIS-R Vocabulary and Information subscale scores. Estimated premorbid IQ was obtained using a demographic regression formula. Years of education and predicted VIQ, PIQ, and FSIQ were found to correlate with estimated premorbid cognitive ability. Predicted VIQ, PIQ, and FSIQ were associated with years of education and PAS childhood, early and late adolescence, and general scores. Each estimate of premorbid ability demonstrated a different pattern of association with clinical ratings, symptom change, and outcome. The results suggest that education, PAS, predicted IQ, and WAIS-R estimates of premorbid cognitive ability assess different but overlapping areas of pre-morbid functioning.

Adult↗
PubMed1995

Tinnitus and ECT.

We report the case of a 69-year-old man with major depressive disorder and occupational tinnitus; both problems were refractory to several different treatment modalities, but were successfully treated with electroconvulsive therapy (ECT). The tinnitus was present for 15-20 years, but had worsened during the 3 years before treatment, causing him significant distress. Extensive organic workup did not identify a treatable etiology for his symptoms. To date, he has been hospitalized four times due to depressive symptoms associated with tinnitus. He has received ECT each time, and has responded well on each occasion.

Aged↗
PubMed1995

Subclinical status epilepticus following ECT.

Subclinical status epilepticus is a rare complication of electroconvulsive therapy (ECT). We describe the case of a 70-year-old man with psychotic depression who developed prolonged subclinical status epilepticus following an initial ECT treatment; he subsequently received a course of ECT without complications. It is important to consider status epilepticus in the differential diagnosis of patients who do not regain consciousness following ECT, even in the absence of overt motor seizure activity. The development of this complication does not preclude the future use of ECT; in fact, ECT has been repeated successfully in individuals who developed this complication, including this case. Identification of potential risk factors, appropriate preventive measures, and early intervention are important in the management of this complication. The literature is reviewed and appropriate preventive and treatment measures are discussed.

Aged↗
PubMed1994

Ventricular enlargement, neuropsychological status, and premorbid function in schizophrenia.

Ventricular enlargement is one of the most consistently documented neurobiological abnormalities in schizophrenia. The timing of the development of this abnormality in the course of schizophrenic illness and its relationship to neuropsychological dysfunction and premorbid adjustment is, however, unclear. To address these questions, we examined the relationship between ventricle-brain ratio (VBR), premorbid adjustment, and neuropsychological function, in 23 acutely exacerbated chronic schizophrenic inpatients. We observed that larger ventricles were associated with better current neuropsychological test performance, better premorbid cognitive ability, greater cognitive deterioration, better childhood premorbid social function, and greater decline in social function from premorbid levels. These data suggest that at least two developmental processes may operate in the genesis of cognitive and social dysfunction in schizophrenia: (1) childhood onset associated with poor premorbid childhood function, low educational achievement, lower intelligence quotient (IQ) and variably with VBR; and (2) adolescent onset associated with relatively normal childhood social function, higher academic achievement and IQ and increased VBR. Ventricular enlargement may reflect a late developmental or degenerative pathological process in schizophrenia.

Adolescent↗
PubMed1992

Effect of anticholinergics on positive and negative symptoms in schizophrenia.

Anticholinergic drugs have been assumed to have no effects on schizophrenic symptomatology. Some studies suggest, however, that anticholinergic agents may antagonize the beneficial effect of neuroleptics on positive symptoms and partially ameliorate negative symptoms. Virtually all studies have been conducted in patients receiving concomitant neuroleptic treatment, raising the possibility that neuroleptics may obscure or modify any "true" anticholinergic effect on schizophrenic symptoms. To evaluate the hypothesis that anticholinergics may increase positive and decrease negative schizophrenic symptoms, we assessed the effect of biperiden on symptoms in the medication-free state. We studied the effect of biperiden 8 mg/day for 2 days on positive and negative symptoms in 40 otherwise drug-free schizophrenic inpatients. Biperiden produced a significant increase in positive symptoms (t = 6.7, p < .001) and reduction in negative symptoms (t = -3.4, p < .01). These data indicate that cholinergic modulation significantly affects positive and negative schizophrenic symptoms and suggest the need for systematic trials of cholinergic and anticholinergic agents in the treatment of positive and negative symptoms of schizophrenia, respectively.

Adult↗
PubMedDate not supplied

Patterns of substance abuse in schizophrenia: nature and significance.

Recent literature suggests that the increasingly prevalent problem of substance abuse may have important implications for the symptoms and course of schizophrenia. To further examine the impact of substance abuse on this disorder, the clinical and research charts of 67 schizophrenic patients admitted to the Schizophrenia Program of the University of Michigan between 1987 and 1990 were reviewed and data on symptomatology, history of substance use, age at onset and first hospitalization, and family psychiatric history were gleaned. This information was analyzed with respect to clinical, demographic, and outcome variables with the following findings: (i) female subjects abused substances at a much lower rate (20%) than male subjects (48%); (ii) substance-abusing patients with schizophrenia had lower pre- and post-treatment Hamilton Rating Scale of Depression scores, poorer post-discharge treatment compliance, and were younger at first hospitalization than were non-abusing patients; (iii) the most often abused substance was cannabis (28%) followed closely by alcohol (21%), with cocaine, hallucinogens, and stimulants all abused by significantly fewer patients; (iv) rates of family history of schizophrenia were similar in substance-abusing and non-substance-abusing schizophrenic patients. These data suggest that substance abuse may not be etiologically related to schizophrenia but influences the onset, course, and symptomatology of schizophrenia.

Adolescent↗
PubMedDate not supplied

Symptom correlates of global measures of severity in schizophrenia.

There is an increasing need for practical instruments that can rapidly and accurately assess the effectiveness of treatments for mental illness in clinical settings. Symptom rating scales used in clinical research are too complex and time-consuming to be useful in these settings. In contrast, single-item global measures of severity such as the Clinical Global Impression-severity scale (CGI) and the Global Assessment of Function scale (GAF) are brief and easy to complete, but little is known about their relationship with the specific symptoms of severe mental illnesses. In this study, we examine the extent to which CGI and GAF scores reflect the severity and the change in severity of positive, negative, depressive, and agitation symptoms in a sample of 102 schizophrenia inpatients at the University of Michigan Medical Center. At admission, positive symptoms were the strongest correlates of both CGI and GAF scores, followed by negative symptoms, and agitation. Depressive symptoms did not correlate significantly with either global measure. The three symptom scores together explained 58% of the variation in CGI and 39% of the variation in GAF. A similar pattern of association was found for the scores measured at discharge and for the relationships between the change in global measures and change in specific symptom clusters. Thus, by demonstrating that single-item global measures, particularly the CGI, can be reasonably good indicators of psychopathology, this study suggests that these measures may be practical tools for routine monitoring of the effectiveness of treatments for severe mental illness in community settings.

Adult↗
PubMedDate not supplied

Do atypical antipsychotic medications favorably alter the long-term course of schizophrenia?

Schizophrenia is characterized by the greatest degree of clinical deterioration in the first decade following onset of psychosis; in fact, deterioration begins even prior to the onset of frank psychotic symptomatology. While somewhat controversial, it appears that effective early antipsychotic treatment might limit the extent of such deterioration. The newer, atypical antipsychotics such as clozapine, risperidone, olanzapine and quetiapine appear to have antipsychotic efficacy at least equal to the traditional neuroleptics, but with a much more favorable side effect profile. Clozapine is also effective in treating neuroleptic-refractory schizophrenic patients. Data suggest that in comparison to conventional agents, treatment with atypical antipsychotics may be associated with a more benign course of schizophrenic illness. Whether these atypical antipsychotics are associated with greater efficacy in limiting clinical deterioration in schizophrenic illness than traditional neuroleptics is, however, unclear. The following questions will be addressed in this paper: (i) Do atypical antipsychotics differ from traditional neuroleptics in modifying the natural course of symptomatology in schizophrenic illness? (ii) Do atypical antipsychotics differ from typical neuroleptics in modifying the natural course of neurobiological and cognitive abnormalities in schizophrenic illness? (iii) Do atypical antipsychotics differ from typical neuroleptics in modifying the natural course of psychosocial dysfunction in schizophrenic illness? (iv) Are there differences between typical and atypical antipsychotics with regard to their effects on the cost of care and resource utilization? The implications of the answers to these questions for the long-term treatment of schizophrenia will be discussed.

Antipsychotic Agents↗