Pain Insensitivity in Schizophrenia: Trait or State Marker?

Singh, Manpreet K.; Giles, Lisa; Nasrallah, Henry A.

doi:10.1097/00131746-200603000-00004

Cited by 111 publications

(83 citation statements)

References 69 publications

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“…Furthermore, although they replicate previous observations of diminished blood pressor response to cold pressor in these patients (Earle and Earle, 1955), the data (Table 2) appear inconsistent with the broad literature suggestive of pain insensitivity in schizophrenia (Singh et al, 2006). Further studies are required to resolve these issues.…”

Section: Strengths Caveats and Limitationssupporting

confidence: 45%

Neuroendocrine Responses to a Cold Pressor Stimulus in Polydipsic Hyponatremic and in Matched Schizophrenic Patients

Goldman

Gnerlich

Hussain

2006

Neuropsychopharmacol

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Schizophrenia, many believe, reflects an enhanced vulnerability to psychological stress. Controlled exposure to stressors, however, has produced inconclusive results, particularly with regards to neurohormones. Some of the variability may be attributable to the nature and psychological significance of the stimulus and failure to control physiologic confounds. In addition, it is possible that the heterogeneity of schizophrenia is an important factor. In a carefully designed study and in a controlled setting, we measured the neuroendocrine response of eight polydipsic hyponatremic (PHS), seven polydipsic normonatremic (PNS), and nine nonpolydipsic normonatremic (NNS) (ie normal water balance) schizophrenic in-patients as well as 12 healthy controls (HC) to two different stressors: one of which appears to influence neuroendocrine secretion through its psychological (cold pressor) and the other (upright posture) through its systemic actions. Subjects in the three psychiatric groups were stabilized and acclimated to the research setting, and all received saline to normalize plasma osmolality. Following the cold pressor, plasma adrenocorticotropin and cortisol levels showed a more prolonged rise in PHS patients relative to PNS patients. NNS patients, in contrast, exhibited blunted responses relative to both of the polydipsic groups and the HC. Peak vasopressin responses were also greater in PHS and blunted in NNS patients. Responses to the postural stimulus were similar across patient groups. These findings provide a mechanism for life threatening water intoxication in schizophrenia; help to reconcile conflicting findings of stress responsiveness in schizophrenia; and potentially identify a discrete patient subset with enhanced vulnerability to psychological stress.

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Section: Strengths Caveats and Limitationssupporting

confidence: 45%

Neuroendocrine Responses to a Cold Pressor Stimulus in Polydipsic Hyponatremic and in Matched Schizophrenic Patients

Goldman

Gnerlich

Hussain

2006

Neuropsychopharmacol

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“…There is a quite extensive literature on reduced pain sensitivity in people with schizophrenia, which had already been described by Kraepelin (119,120). The data are convincing (120), although two reviews pointed out that pain perception is altered rather than reduced in schizophrenia (121,122).…”

Section: Diseases Of the Nervous System (15 170 Medline Hits)mentioning

confidence: 87%

Physical illness and schizophrenia: a review of the literature

Leucht

Burkard

Henderson³

et al. 2007

Acta Psychiatr Scand

559

358

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Sartorius N. Physical illness and schizophrenia: a review of the literature.Objective: The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method: We searched MEDLINE (1966( -May 2006 combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results: A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion: The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. Summations• According to this review it has been known for decades that incidences physical diseases are frequent in schizophrenia. Nevertheless, some areas such as infectious diseases have not been sufficiently studied.• Psychiatrists are often not trained well enough in the detection and treatment of physical diseases.They must be aware of the frequent medical comorbidities and should play a more active role in their diagnosis, prevention, and treatment.• Other necessary strategies include the education of patients, general practitioners and of doctors working in other medical specialities. The access to medical care of the mentally ill also needs to be improved, among others, by reducing the stigma associated with mental disorders. Considerations• The review covered a broad area of research accordingly, focusing attention to details has not been possible.• Despite the broad search strategy, studies not covered by MEDLINE or not indexed by the MeSH term of schizophrenia could have been missed. • Due to considerable differences in the design and quality of the studies in assorted and diverse areas, quantitative approaches using meta-analysis were not possible, but should be the target of future reviews focusing.

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“…For example, typical consequences of schizophrenia, such as cognitive impairment, social isolation, suspicion, and possible pain insensitivity may cause schizophrenic patients to be less likely to seek medical help, to promptly report physical symptoms, or to follow prescribed treatment. [15][16][17][18] In addition, owing to their impaired capacity to recognize or articulate the signs of emerging medical illness, these patients often face delays in diagnosis and treatment for somatic comorbidities. [32][33][34] Further, some primary care providers may be unskilled or feel uncomfortable dealing with this population, and some psychotic symptoms, such as somatic delusions, may lead physicians who are less experienced in treating patients with schizophrenia to misdiagnose or delay diagnosis in certain cases.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Avoidable Hospitalization among Patients with Schizophrenia

Lin

Huang²,

Chen

et al. 2011

Can J Psychiatry

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Objective: Some studies suggest that hospitalizations for certain conditions, called ambulatory care sensitive conditions (ACSCs), are potentially avoidable. However, almost no study has addressed the risk of ACSC hospitalizations specifically for patients with severe mental illness. Our study examines the risk of ACSC hospitalizations among patients with schizophrenia in Taiwan, using a 5-year, nationwide, population-based database. Methods:Our study included 2503 patients with schizophrenia and 20 024 matched patients without schizophrenia. Poisson regression analysis was then performed in which the number of ACSC hospitalizations from 2002 to 2006 (including ruptured appendix, asthma, cellulitis, congestive heart failure, diabetes, gangrene, hypokalemia, immunizable conditions, malignant hypertension, pneumonia, pyelonephritis, and perforated or bleeding ulcer) was regressed against the independent variable of whether or not a patient had a schizophrenia diagnosis in 2001.Results: Results show that 9.83% of patients with schizophrenia and 4.71% of patients in the comparison group experienced ACSC hospitalizations from 2002 to 2006. After adjusting for each patient's sex, age, level of urbanization, geographic location of residence within a community, and monthly income, patients with schizophrenia had a 3.26-fold higher (95% CI 3.00 to 3.54, P < 0.001) risk of experiencing ACSC hospitalizations than the comparison participants. After excluding the conditions of diabetes, hypertension, and asthma, patients with schizophrenia independently had a 2.46-fold higher risk of ACSC hospitalizations (95% CI 2.12 to 2.86, P < 0.001), compared with participants in the comparison group. Conclusions:We conclude that schizophrenia patients are at a higher risk for hospitalizations owing to ACSCs, despite a national health insurance system providing universal coverage to citizens. Can J Psychiatry. 2011;56(3):171-178. Clinical Implications• Schizophrenia patients are at a higher risk for hospitalization owing to ACSCs, despite a national health insurance system providing universal coverage to citizens.• Even under the universal national health insurance program, patients with schizophrenia continue to have reduced access to physical health care, and the quality of care they receive is lower than that of the general population.• The development and implementation of a set of guidelines on how to manage somatic morbidity in patients with schizophrenia may improve the quality of care, if these guidelines addressed the deficiencies in physicians for these patients. Limitations• We identified patients diagnosed with schizophrenia from administrative claims data by International Classification of Diseases, Tenth Revision, Clinical Modification code, potentially compromising the validity of diagnoses.• Our study was unable to examine the effects of potential confounders such as the highest educational level, marital status, social support, local health infrastructure, and family cohesion in the regression model, which could comprom...

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Pain Insensitivity in Schizophrenia: Trait or State Marker?

Cited by 111 publications

References 69 publications

Neuroendocrine Responses to a Cold Pressor Stimulus in Polydipsic Hyponatremic and in Matched Schizophrenic Patients

Neuroendocrine Responses to a Cold Pressor Stimulus in Polydipsic Hyponatremic and in Matched Schizophrenic Patients

Physical illness and schizophrenia: a review of the literature

Increased Risk of Avoidable Hospitalization among Patients with Schizophrenia

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