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OBJECTIVE Patients with schizophrenia and comorbid alcohol use disorder remain understudied. This post hoc analysis evaluated data from Phase 1 of the Clinical Antipsychotic Trials of Intervention Effectiveness in Schizophrenia study (January 2001-December 2004). METHODS Patients without substance abuse (except marijuana use) in the month before study entry were categorized into those with a history of alcohol use disorder (SZ + AUD) within 5 years before study entry and those without alcohol use disorder (SZ-only) per DSM-IV criteria. Time to first and recurrent exacerbations and hospitalizations were compared between disease states and between olanzapine and perphenazine, quetiapine, risperidone, and ziprasidone. RESULTS A total of 1,338 patients (SZ + AUD = 22.6%; SZ-only = 77.4%) were included. Time to first exacerbation of SZ was significantly shorter in the SZ + AUD versus SZ-only population (median = 5.4 vs 6.4 months; hazard ratio [HR] = 1.20 [95% CI, 1.01-1.42]; P = .039). Similar findings were observed for first hospitalization (HR = 1.63 [95% CI, 1.20-2.22]; P = .002) and recurrent hospitalizations (HR = 1.60 [95% CI, 1.18-2.15]; P = .002). The most common reasons leading to exacerbation in both groups were an increase in symptom severity and lack of efficacy. In patients with SZ + AUD related or unrelated to marijuana, perphenazine, quetiapine, risperidone, and ziprasidone were associated with significantly shorter time to first exacerbation versus olanzapine. CONCLUSIONS This post hoc analysis confirmed that patients with SZ + AUD had a worse illness course than patients with SZ-only and suggests that olanzapine may be associated with a longer time to first and recurrent exacerbations versus other antipsychotics in this difficult-to-treat population. Further research is needed to identify effective treatments for this important yet understudied patient population. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00014001. © Copyright 2020 Physicians Postgraduate Press, Inc.OBJECTIVE Research supports the importance of emotional symptoms in adults with attention-deficit/hyperactivity disorder (ADHD), which are not reflected in the DSM-5 or ICD-10 criteria. The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) assesses these symptoms, plus inattention, hyperactivity, and impulsivity. This scale allowed us to divide adult ADHD into 2 subtypes in a 2015 publication ADHD inattentive presentation and ADHD emotional dysregulation presentation. The present study refines this observation using a larger, more diverse sample. METHODS Eight double-blind adult ADHD clinical trials (encompassing 1,490 subjects) were selected because they included assessment with the WRAADDS; a second, alternative ADHD measure; and the Clinical Global Impressions-Severity of Illness scale (CGI-S). These data were subjected to confirmatory factor analyses, and ADHD presentations were compared, including treatment response. RESULTS The original factor structure fit poorly with these new data. However, an alternative 2-factor solution fit both the original and the new subjects. ADHD inattentive presentation (n = 774) was defined by the inattention factor, and ADHD emotional dysregulation presentation (n = 620) was defined by additional elevation of the emotional dysregulation factor. The proportion of ADHD emotional dysregulation presentation ranged from 25% to 73% across the 8 studies. The emotional dysregulation presentation was associated with both a greater severity as measured by the CGI-S (P less then .001) and more manifestations of childhood ADHD as measured by the Wender Utah Rating Scale (P less then .001). CONCLUSIONS Factor analytic results supported the validity of 2 adult ADHD presentations based on levels of emotional dysregulation. This system offers a more clinically relevant approach to the diagnosis of ADHD in adults than does the DSM system. © Copyright 2020 Physicians Postgraduate Press, Inc.Objective To investigate the self-esteem and defense mechanisms in patients diagnosed with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). Methods This prospective, cross-sectional study included 29 patients diagnosed with HIV/AIDS admitted to inpatient or outpatient clinics between March 2018 and January 2019 and 29 healthy subjects. Participants were assessed using a sociodemographic and clinical data form, the Rosenberg Self-Esteem Inventory (RSEI), the Defense Style Questionnaire (DSQ), and the Beck Anxiety Inventory (BAI). Results Patients with HIV/AIDS had significantly higher scores on the fantasy, psychosomatic symptoms, and parental interest subscales of the RSEI. There was no significant difference between the groups on the other subscales, including the self-esteem subscale. There was no correlation between the duration of the disease and self-esteem. The neurotic defense mechanism and immature defense mechanism subscale scores of the DSQ were significantly higher in the HIV/AIDS group compared to the control group (P less then .01). Undoing and reaction formation scores in neurotic defense mechanisms and projection, devaluation, autistic fantasy, and splitting scores in immature defense mechanisms were significantly higher in the HIV/AIDS group compared to controls (P less then .05). ZCL278 in vivo There was no significant difference between the groups based on the mature defense mechanisms subscale scores. Conclusions No difference was found in the self-esteem scores of the HIV/AIDS and control groups, and this finding could be associated with the stability of the self-esteem concept. It was also determined that patient group members utilized neurotic and immature defense mechanisms more often compared to the healthy group, and there was no difference between the groups based on mature defense mechanisms. © Copyright 2020 Physicians Postgraduate Press, Inc.This corrects the article DOI 10.4088/JCP.20lcx13316. © Copyright 2020 Physicians Postgraduate Press, Inc.This corrects the article DOI 10.4088/JCP.18r12475. © Copyright 2020 Physicians Postgraduate Press, Inc.Objective To identify the prevalence of secondary schizophrenia (organic psychosis causing a schizophrenia-like syndrome) in patients with a prior diagnosis of schizophrenia presenting to Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal. Methods Two hundred files were retrospectively assessed through paper and electronic records of patients admitted to the hospital with an International Classification of Diseases, Ninth Edition diagnosis of schizophrenia (eg, code 295.x) in a 1-year time span (September 1, 2015-September 1, 2016). Results One-fourth of patients (n = 50, 25%) received a new organic psychosis (secondary schizophrenia) diagnosis epilepsy-related schizophrenia-like psychosis (9.5%), dementia-related schizophrenia-like psychosis (9.5%), brain mass (3.5%), stroke-related schizophrenia-like psychosis (2.0%), and encephalitis-related schizophrenia-like psychosis (0.5%). Among patients with organic psychosis (secondary schizophrenia), the mean delay until correct diagnosis was 12 years. Conclusions The most striking feature of this study was the high prevalence of incorrect diagnosis of schizophrenia, with patients not receiving the minimum correct assessment before that diagnosis, resulting in negative consequences.
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