Cocaine abuse among schizophrenic patients

Article Abstract:

Cocaine use is common in the United States, and the effect of this drug is thought to be produced by an increase of the neurotransmitter (chemical link between nerve cells) dopamine. There is also a hypothesis that the psychotic symptoms of schizophrenia are caused by an excess of dopamine in certain areas of the brain. Given this information, it is interesting that cocaine abuse is common among schizophrenic patients. Also interesting is the fact that some researchers have reported improvements in negative symptoms in schizophrenia as a result of drugs that increase dopamine activity. This study compared 17 male cocaine-abusing schizophrenics with 22 male schizophrenics who were not cocaine users. The diagnosis of schizophrenia had preceded cocaine use in the cocaine-using study patients. The cocaine users were more likely have paranoid manifestations of their illness, and to meet criteria for major depression. They also had a history of more hospitalizations. Fifteen of the cocaine users said they used the drug because it improved their mood, and only two said that the cocaine increased their paranoia. The cocaine users also scored higher on the Abnormal Involuntary Movements Scale, which supports the theory that chronic cocaine use may lead to supersensitive dopamine receptors, and that tardive dyskinesia (abnormal muscle movements), a common side effect of drug therapy for schizophrenia, is caused by this supersensitivity. It is concluded that cocaine use among schizophrenics may be an attempt to self-medicate underlying negative symptoms or cause therapeutic drug side effects, but that further study with larger populations is needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Risk factors, Physiological aspects, Substance abuse, Cocaine abuse, Drug use, Schizophrenics, Cocaine

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Late-life onset of panic disorder with agoraphobia in three patients

Article Abstract:

Panic disorder is evidenced by severe attacks of feelings of uncontrollable panic and extreme anxiety. The commencement of panic disorder in combination with agoraphobia late in life is considered to be rare. Agoraphobia is a disorder characterized by overwhelming feelings of anxiety regarding being in situations and (usually public) places from which escape might be difficult or embarrassing. The condition can result in extreme anxiety and can lead to panic attacks, such that to avoid phobic situations, the victim often will not leave his house. It has been previously established that the average age of onset is between 19 and 32 years and first occurrences after the age of 40 are infrequent. Three cases of panic attack with agoraphobia which were diagnosed in women over 65 are described in some detail. Methods for distinguishing depression from agoraphobia as the primary disorder when both are present have not yet been satisfactorily devised. The observations reported are limited by the fact that no systematic research was used in collecting the data and a differential diagnosis was not made. Although major depression was ruled out for all patients, two of the three women showed symptoms that may have indicated depression and the other exhibited symptoms which are associated with depressive neurosis. If these three diagnoses of panic disorder with agoraphobia were correctly made, these conditions should be more frequently considered when making differential diagnoses for patients in this age group. This also may aid in the reduction of the overinclination to attribute panic and agoraphobic symptoms to medical problems in the elderly.

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Three cases of panic disorder and agoraphobia in children

Article Abstract:

Three children aged 8, 11, and 13 were diagnosed with panic disorder accompanied by agoraphobia. Panic disorder is characterized by episodes of intense panic and terror, while the related agoraphobia is symptomized by a fear of being in a situation or location from which escape (ostensibly during an attack of panic) would be difficult or embarrassing. All children were treated and observed over a lengthy period of time and responded well to treatment. Many adults who suffer from these disorders retrospectively report symptoms that occurred in childhood, but to date, panic disorder and agoraphobia in children have not been addressed or studied. The children met all of the criteria as described in the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III-R) for panic disorder and, in part, for agoraphobia. The children all exhibited typical panic anxiety and agoraphobic fears and responded well when given the same medications (imipramine and alprazolam) normally given to adults. Some speculative reasons for the lack of diagnoses made in children are the tendency to look for depression rather than anxiety in troubled children, the fact that children may be more prone to overemphasize physical symptoms, and the general dependent and protected environment of children which may mask behavior and allow symptoms to go unnoticed. Benefits of further study include the ability of early detection to prevent the development of low self-esteem and the establishment of chronic avoidance patterns in children who may suffer from these disorders.

Drug therapy, Behavior disorders in children, Childhood mental disorders, Anxiety in children, Childhood anxiety

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