Panic attacks in chronic schizophrenia
Article Abstract:
Panic disorder, which is included as a distinct diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R), has been the subject of much recent research. A primary feature of panic disorder, panic attack, often occurs in conjunction with other illness, notably anxiety, depression, and personality disorders, raising questions about the status of panic disorder as a diagnostic category. To shed light on the relationship between panic disorder and panic attacks that accompany schizophrenia, 20 outpatient schizophrenics were interviewed concerning panic attacks. Follow up interviews were conducted at least four times within the next 12 months. The average age of the subjects was about 40; 15 were men. Four men and three women from the group experienced regular panic attacks, between once a day and once a week. The fears accompanying the attacks were typical: being alone, away from home, and feeling unsafe. (Brief summaries of the seven cases are presented.) The prevalence of panic disorder among these schizophrenics suggests that clinicians may have overlooked the concomitant illness because of the more impressive psychotic symptoms. No general cause for these attacks could be ascribed to this subgroup, although heightened arousal may have been a factor. In one case, the attacks were believed to result from excessive caffeine consumption. The results of this small study provide further support for the notion that panic attacks can occur outside of pure panic disorder. The author cautions that treatment of panic attacks that accompany psychosis using antipsychotic medication may actually aggravate the attacks. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1990
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A comparative study of psychiatric services in Japan and England
Article Abstract:
Attitudes toward mental illness, as well as the nature of psychiatric services and government policy reflecting those attitudes, differ greatly between Japan and England. In recent years, severe criticisms of Japan's large, closed mental hospitals, poor community care, and infringement on the rights of patients have led to significant reform, but problems implementing these reforms remain. Using government statistics, a comparison of the utilization of psychiatric services in England and Japan was performed. Statistics compared were: rates of inpatients per 100,000 in the population; rates of admission to mental hospitals; ratio of admissions to numbers of beds available; duration of stay; and rates of outpatient attendance. While in England the annual rate of inpatient admissions per 100,000 declined from 344 in 1954 to 141 in 1984, in Japan it rose from 32 in 1953 to 260 in 1984. Over the last 25 years or so, the rates of admission have been fairly stable, with Japan having about half the rate of England. The ratio of admissions to beds, however, has increased in England, but has decreased in Japan since 1970. Patients are discharged much more quickly in England: in 1983, almost half the patients in Japan had been in the institution for more than five years, compared with 36 percent in England in 1984. It is concluded from these and related facts that attitudes towards mental illness are much less tolerant in Japan, and that government policy is largely responsible for the observed differences in services. The Mental Health Act instituted in Japan in 1988 should eventually enable that country to develop better community-based care for the mentally ill. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: British Journal of Psychiatry
Subject: Health
ISSN: 0007-1250
Year: 1990
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