We examined the relationships among changes in anxiety, depression, core symptoms of schizophrenia, and subjective quality of life (QL) longitudinally. Fifty-three stabilized outpatients diagnosed with schizophrenia or schizoaffective disorder were assessed for QL and symptoms every 3 months for a period of 1 year. Using mixed effects models, we found that changes in anxiety, as rated on the Brief Psychiatric Rating Scale, were inversely associated with general life satisfaction and satisfaction with many specific domains. These relationships were stronger than the relationships of QL and any other core symptoms of schizophrenia, including depression. Anxiety was also related to some positive and negative symptoms. These findings support the notion that more precise analysis of general psychopathology, and anxiety in particular, is important in clarifying the factors involved in QL in schizophrenia. We explain our findings in the context of current theories of affect and suggest implications for the treatment of schizophrenia.

Longitudinal analysis of subjective quality of life in schizophrenia: anxiety as the best symptom predictor.

Dementia paralytica is a declining disease. Deaths due to it in England and Wales were first recorded by the Registrar General in 1901 and since that year, when the number was 2,272, the annual figure has fallen steadily until in 1957 it was only 68. Moreover, there is evidence (adduced below) that not more than a small part of this decline can be attributed to improvements in medical treatment. The fear that there might be a recrudescence of dementia paralytica as a result of the spread of syphilis during the second world war has not so far been realized and it seems likely that what is now, in Great Britain at all events, an obsolescent disease will soon become a rarity. Yet there are many unsolved problems in its history. We do not know, for example, why the alleged references to this striking disease were so few and so inadequate until the third decade of the nineteenth century. We do not know why its recognition in many countries was so tardy in spite of the clear description given by the French alienists. Nor do we know why the disease, which at the start of the nineteenth century seems to have been predominantly one of males, has gradually—and at different rates in different countries—become much more evenly distributed between the sexes.

The Origin and Spread of Dementia Paralytica

THE CENTRAL objective of this paper is to examine the contributions that epidemiological studies of psychiatric disorders have made to our knowledge about these disorders. Here, I have viewed these studies as a contribution to medical ecology as well as to the larger, general area that has been gradually emerging as social psychiatry. In order to place the review of these epidemiological studies in proper perspective it is essential to (1) explore the various conceptions that have been held concerning the nature of human ecology; (2) show the relationship between the broad field of human ecology and medical ecology; (3) point to the distinguishing characteristics between epidemiology and medical ecology; and (4) examine the obstacles that confront any investigator who studies mental illness from an epidemiological perspective. The term ecology has had an erratic development and also an erratic use, particularly when trying to encompass human life. The term

Epidemiology of Psychiatric Disorders as a Contribution to Medical Ecology

as a technique for discovering the causes of disease were laid down over 100 years ago. The investigations of John Snow and William Budd, which showed that cholera and typhoid fever were conveyed by sewage-contaminated drinking-water, are classic examples of this technique and indeed rank among the greatest triumphs of medicine. It was quickly realized, of course, that the same method might prove useful in studying the causes of mental illness. In 1873 Dr. Maury Deasi, the Medical Superintendent of Macclesfield Asylum, read a paper to the Medico-Psychological Association in which he showed that admission rates to his hospital were higher from towns than from the countryside. He cautiously concluded that perhaps urban conditions were conducive to insanity. (He was right to be cautious, for another explanation is possible. As Hack Tuke pointed out, the Act of 1862 which made pauper lunatics chargeable to a common fund and not, as hitherto, to their own parish led the Boards of Guardians of workhouses-more numerous in the town than in the country-to appreciate that many of the paupers under their care ought, properly, to be described as pauper lunatics. This meant that they should be transferred to the country asylums, where, incidentally, they would cease to be a burden on the rates.) Speaking of &dquo; the modern science of preventive medicine,&dquo; Dr. Deas concluded his address with these words: &dquo; May we not hope that some day the knowledge of such differences (in the distribution of insanity) as I have noticed may lead to the discovery of its causes ? ... Thus would be laid the foundations of a noble branch of preventive medicine which would have for its object, not only to check the ravages of that social scourge, insanity, but to help people to develop their moral as well as their physical nature in accordance with the laws of health and the facts of physiology.&dquo; His was not a voice crying in the wilderness. A few years earlier the Lunacy Commissioners, in their Annual Report, expressed the view that &dquo; the prevention of insanity is a far nobler object than the provision of accommodation after mischief has been done.&dquo; They endorsed this sentiment by adding &dquo; for there is reason to hope that the prevention of insanity would greatly contribute to sap the sources of pauperism &dquo;-

The epidemiology of mental illness.

The purpose of the present study wa to determine the prevalence of antipsychotic polytherapy (use of more than one antipsychotic drug at one time) and its clinical correlates among 300 hospitalized psychotic Asian patients diagnosed with schizophrenia. It was hypothesized that such treatment would be associated with more severe illness than in comparable monotherapy patients, and with higher chlorpromazine-equivalent (CPZ) total daily doses. Clinical and demographic details were obtained from the medical records and direct clinical examinations. Polytherapy was encountered in 215 of the 300 patients (71.7%), with an average number of 1.8 antipsychotics (range 1–4) prescribed at a mean CPZ daily dose of 612 ± 528 mg (median: 464 mg, range: 25–2500 mg). The 215 patients prescribed more than one antipsychotic agents were younger, ill longer, more likely to be taking at least one high-potency agent, in receipt of higher average daily CPZ doses, and more likely to be prescribed anticholinergic agents but with similar admission illness severity rating (Brief Psychiatric Rating Scale) scores compared to the 85 patients given only one antipsychotic drug at one time. The high rate of antipsychotic polytherapy that appeared to be unrelated to current illness severity suggests that this practice may not consistently be based on rational therapeutic principles.

Clinical correlates of antipsychotic polytherapy in patients with schizophrenia in Singapore

http://bjp.rcpsych.org/content/22/97/66.full.pdf

A Visit to an Insane Colony

http://bjp.rcpsych.org/content/bjprcpsych/21/93/61.full.pdf

An Illustration of Local Differences in the Distribution of Insanity

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The Uses and Limitations of Mechanical Restraint as a means of Treatment of the Insane

/pdf/five-years-of-statistics-2jxbzuxw9z.pdf

P. Maury Deas

Papers

A Visit to an Insane Colony

An Illustration of Local Differences in the Distribution of Insanity

The Uses and Limitations of Mechanical Restraint as a means of Treatment of the Insane

Five Years of Statistics