Sucht und Schizophrenie - Nosologische, klinische und therapeutische Fragestellungen

Soyka, Michael

doi:10.1055/s-2007-996658

Cited by 25 publications

(3 citation statements)

References 85 publications

(108 reference statements)

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“…Only one -socially favourable -behavioural item was significantly more frequent in women: overadaptiveness/conformity. The cumulative prevalence of drug and alcohol abuse, too, was significantly more frequent in men, as shown by several other studies (Mueser et al, 1990b(Mueser et al, , 1992Soyka, 1994;Kessler et al, 1994;Jenkins et al, 1997;Kandel, 2000). Restlessness was the only further item that showed a significantly higher frequency in women.…”

Section: Gender Differences In Illness Behaviour (Domain 6)supporting

confidence: 64%

“…Jablensky et al, 1992;Häfner and an der Heiden, 1997). But the same does not apply to rates based on diagnoses requiring a 6-month symptom persistence or social decline prior to first contact, as for example do DSM-III-R and -IV diagnoses of schizophrenia (APA, 1987;1994). In addition, it is not clear whether the rates would converge if schizophrenia-like delusional disorders of old age (late paraphrenia etc.…”

Section: Domain 1: Diagnoses Subtypes Symptoms Type Of Coursementioning

confidence: 99%

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Schizophrenia: do men and women suffer from the same disease?

Häfner¹

2002

Rev. psiquiatr. clín.

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This article reviews the literature on normal brain development and behavioural development in men and women as well as on aetiological risk factors for schizophrenia, such as pre-, peri-and postnatal complications.The male-female comparisons of age and type of onset, symptomatology, course and outcome were based on a population-based sample of 232 first illness episodes -the ABC Schizophrenia Study sample. The probands were assessed using the IRAOS interview and other instruments retrospectively at first admission and prospectively at six cross sections over five years after first contact. A representative subsample of 130 first admissions or 115 first illness episodes were compared with 130 controls, matched by age, sex and area of residence.Women, 3 to 4 years older than men at illness onset, showed a second peak of onsets in age group 45 to 50 years. After animal experiments and a controlled clinical study this finding was explained by a protective effect of oestrogen persisting until menopause. The underlying neurobiological mechanism consisted in a sensitivity reducing effect of oestrogen on D2 receptors in the brain. The effect of oestrogen, meanwhile confirmed in randomised control trials, also includes genomic effects as well as interactions with free-radical detoxifying systems, thus demonstrating the neuroprotective capabilities of oestrogen.Postmenopausal schizophrenia was more frequent and more severe in women. Men fell ill more frequently and more severely at young age and less frequently and more mildly later in life. Illness course, too, was more unfavourable in postmenopausal women than in their male peers.The protective effect of oestrogen in women depended on the degree of their predisposition to the illness: the higher the familial load for schizophrenia, the weaker the protection by oestrogen. The more favourable illness course in premenopausal women resulted from their higher level of social development at illness onset -determined by their higher age at onset -and from their socially more adaptive behaviour. The illness behaviour of young men showed a significant excess of socially negative behaviours with an unfavourable impact on their early illness course. In contrast, older men were socially better adjusted. With genetic and morphological findings considered the subtypes of schizophrenia did not differ between men and women.Gender differences in symptomatology and course of schizophrenia obviously are not explained by differences in the disease process. They seem to be determined by a complex pattern of interaction between disease variables, hormonal and behavioural differences and their consequences for age at onset and illness course.

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Section: Gender Differences In Illness Behaviour (Domain 6)supporting

confidence: 64%

Section: Domain 1: Diagnoses Subtypes Symptoms Type Of Coursementioning

confidence: 99%

Schizophrenia: do men and women suffer from the same disease?

Häfner¹

2002

Rev. psiquiatr. clín.

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“…1990;Soykaet al. 1993;Soyka. 1994).Avariety of hypotheses have been proposed to explain this phenomenon, including the so-called 'self-medication hypothesis".…”

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confidence: 99%

Successful Treatment with Flupenthixol Decanoate of a Patient with both Schizophrenia and Alcoholism

Soyka¹,

Sand²

1995

Pharmacopsychiatry

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There is growing evidence that substance abuse is a major problem in patients with schizophrenia. With respect to alcohol, alledegly the most frequently abused drug among schizophrenics, clinical and epidemiological studies would suggest that the risk of alcoholism is approximately four times greater (Cuffel, 1992; Mueser et al., 1990; Soyka et al., 1993; Soyka, 1994). A variety of hypotheses have been proposed to explain this phenomenon, including the so-called "self-medication hypothesis". Some authors feel that substance abuse in schizophrenics might be due to extrapyramidal and other side-effects caused by neuroleptic treatment or inadequate remission of psychotic symptoms. There remains, at present, an obvious lack of both psychosocial and psychopharmacological studies of treatment in "dual diagnosis" schizophrenics (Mueser et al., 1992). Changes in dopaminergic neurotransmission and dopamine-receptor dysfunction have been linked both to the development of psychotic symptoms and to alcoholism/substance abuse, and thus give rise to the question as to whether some dual diagnosis patients might benefit from neuroleptic treatment in both domains. A number of dopamine receptor subtypes in different regions of the brain seems to be involved in the development of schizophrenia and substance abuse. Modifications of D2-receptor subtype function have been implicated in psychotic symptoms, and changes in the D1- and D2-receptor function in substance abuse such as cocaine abuse and alcoholism (Spealman et al., 1990; 1991; 1992), especially in the mesolimbic dopaminergic reward system. Accordingly, the "ideal" neuroleptic drug for dual diagnosis schizophrenics should be effective in both receptor subtypes.(ABSTRACT TRUNCATED AT 250 WORDS)

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Alkohol und Psychiatrie

Soyka¹

Alkohol Und Alkoholfolgekrankheiten

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Kriterien sowie therapeutische Überlegungen werden mitgeteilt. Wichtig ist auch zu beachten, dass bei Alkoholikern ein erheblich erhöhtes Risiko für Suizidhandlungen besteht.Die wichtigsten neuropsychiatrischen Folgeschäden bei Alkoholabhängigen umfassen die Alkoholintoxikation, den sehr seltenen pathologischen Rausch, alkoholinduzierte Amnesien (sog. Black-outs) sowie das Alkoholentzugssyndrom, das bei den meisten, aber nicht allen Alkoholabhängigen auftritt und von seiner Symptomatik her unspezifisch ist. Zu den Alkoholpsychosen gehören das Delirium tremens, die Alkoholhalluzinose, die häufig schwierig von paranoiden Schizophrenien zu differenzieren ist, der eher seltene alkoholische Eifersuchtswahn sowie neurophsychiatrische Störungen im engeren Sinne wie die Alkoholdemenz, das Wernicke-Korsakow-Syndrom, und die hepatische Enzephalopathie. Die Klinik und die pathophysiologischen Grundlagen der einzelnen Folgeschäden werden dargestellt. EpidemiologieAlkoholismus stellt bei Männern die häufigste psychische Störung dar. Der Pro-Kopf-Konsum reinen Alkohols in der BRD betrug im Jahre 1995 knapp 12 l, wobei sich nach rasantem Anstieg des Pro-Kopf-Konsums in den Jahren nach dem 2. Weltkrieg in den letzten Jahren ein leichter Rückgang des Konsums abzeichnet. Schon der hohe Pro-Kopf-Konsum von Alkohol lässt auf eine starke Alkoholbelastung in der Bevölkerung schließen. Genaue Anhaltspunkte hierfür haben Felduntersuchungen zur Häufigkeit von Alkoholmissbrauch und Abhängigkeit ergeben. Die beiden wichtigsten diesbezüglich durchgeführten Untersuchungen waren die Oberbayerische Verlaufsuntersuchung (Fichter 1990), die bei Männern eine Lebenszeitprävalenzrate für behandlungsbedürftige Alkoholabhängige von 7,1% aufzeigte. Weitere 7,9% wiesen einen leichten Grad von Alkoholismus auf. Für München fanden Wittchen et al. (1992) für Männer eine Lebenszeitprävalenz von Alkoholismus von 13%. Die Sechsmonatsprävalenzen der wichtigen US-amerikanischen »Epidemiological Catchment Area Study« (ECA-Studie; Regier et al. 1988) 38.1 Epidemiologie -496 38.2 Neuropsychologische Defizite bei Alkoholabhängigkeit -497 38.3 Komorbidität von Alkoholismus mit psychischen Störungen -498

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Sucht und Schizophrenie - Nosologische, klinische und therapeutische Fragestellungen

Cited by 25 publications

References 85 publications

Schizophrenia: do men and women suffer from the same disease?

Schizophrenia: do men and women suffer from the same disease?

Successful Treatment with Flupenthixol Decanoate of a Patient with both Schizophrenia and Alcoholism

Alkohol und Psychiatrie

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