- N Engl J Med 2021; 385:385-387
Many clinicians are working on the front lines of decarceration, supporting and treating patients who might once have been incarcerated. Models for decarceration involving problem-solving courts and treatment are not perfect, but they allow physicians to do their part.
- N Engl J Med 2021; 384:717-726
The muscarinic receptor agonist xanomeline has antipsychotic properties without dopamine blockade. Cholinergic adverse events limit its use. When xanomeline was combined with trospium to limit peripheral effects, scores were better on measures of schizophrenia than were scores with placebo over a period of 5 weeks.
- N Engl J Med 2020; 382:1497-1506
In a randomized trial involving schizophrenic patients with acute psychosis, a new oral drug that does not have a dopamine D2-receptor–binding mechanism of action led to a greater reduction in the severity of overall symptoms than placebo over 4 weeks. The incidence of extrapyramidal symptoms was 3% with the new...
- N Engl J Med 2020; 382:1555-1556
A French surgeon, Henri Laborit, discovered the first antipsychotic drug, chlorpromazine (Thorazine), in 1952 while experimenting with compounds to enhance anesthesia. Since then, antipsychotic drugs have helped transform the lives of people with schizophrenia, allowing most to live in the community and many to function independently. Although these drugs are...
Case Studies in Social Medicine: Biological Citizenship — A 53-Year-Old Man with Schizoaffective Disorder and PTSD Applying for Supplemental Security IncomeN Engl J Med 2019; 381:1985-1989
A man with multiple mental health conditions stops attending the clinic where he received wrap-around services. Denied Supplemental Security Income because his psychiatrist had documented his improvement, he had ceased taking his medications and ended up hospitalized.
- N Engl J Med 2019; 381:1753-1761
Schizophrenia involves multiple neurochemical pathways and brain circuits. Treatment is directed at ameliorating acute psychosis and reducing relapses. This review also discusses the use of psychosocial interventions and the management of medication effects of acute and tardive movement disorders and metabolic syndrome.
- N Engl J Med 2019; 381:108-109
I was entering my third year of medical school when my brother’s friend called me, saying “I think your brother has schizophrenia.” I packed my suitcase and headed home. The plan was to get him a psychiatry referral and start him on medications. Easy, right?
- N Engl J Med 2018; 379:2293-2295
William was smoking on the shelter’s porch the day we met, looking like hell. When I introduced myself, he exhaled a brick of smoke into my face. I would need to earn his trust. But over time, William would lay the foundation for my education in patient care.
Case Studies in Social Medicine: Medicalization and Demedicalization — A Gravely Disabled Homeless Man with Psychiatric IllnessN Engl J Med 2018; 379:1885-1888
In our first Case Study in Social Medicine, a man presents to the emergency department reporting auditory hallucinations and suicidal thoughts. His case hinges on interpretations of whether his problems are medical in nature and within medical institutions’ scope of practice.
- N Engl J Med 2018; 379:270-280
Psychosis is a syndrome embedded in several disorders, including schizophrenia and bipolar disorder with psychotic features. Dopamine and glutamate are implicated in the pathophysiology of psychotic symptoms. Psychosocial treatments supplement pharmacologic therapy.
- N Engl J Med 2018; 378:1273-1275
Mr. J., a 60-year-old man with schizophrenia and sepsis, rants and refuses tests and treatments. But without scans, daily blood tests, and fretful relatives, his clinicians suddenly have time and the need to talk to the patient, even if he rarely makes sense.
At Risk for Serious Mental Illness — Screening Children of Patients with Mood Disorders or SchizophreniaN Engl J Med 2017; 376:910-912
The lack of attention paid to the millions of children born to a parent with schizophrenia, bipolar disorder, or recurrent major depression is out of phase with the massive need in primary care and the available scientific evidence.
- N Engl J Med 2016; 375:1690-1694
Patients with coexisting serious mental and medical illnesses often don't recognize that they need treatment, and those who do may be unlikely to complete it. Caring for such patients successfully requires dedication, flexibility, collaboration, persistence, and love.
- N Engl J Med 2015; 373:2563-2570
A 40-year-old woman with a history of psychosis was admitted to the hospital from a homeless shelter because of headache and hypertension. Management decisions were made.
- N Engl J Med 2013; 368:1594-1602
In this clinical trial, an 18-month behavioral weight-loss intervention resulted in significant weight loss in persons with serious mental illness. This vulnerable population should not be excluded from weight-loss intervention.
- N Engl J Med 2012; 366:1434-1443
A 60-year-old man from coastal New England was admitted to this hospital because of fever, weakness, rash, and renal failure. An initial measurement of creatine kinase was 20,437 U per liter. A diagnostic test was performed.
- N Engl J Med 2011; 364:842-851
In this comparison of long-acting injectable risperidone with psychiatrists' choice of oral antipsychotic in patients with schizophrenia or schizoaffective disorder, risperidone did not significantly reduce psychiatric hospitalizations or improve symptoms, quality of life, or function.
- N Engl J Med 2009; 361:1487-1496
A 26-year-old man was admitted to this hospital because of abdominal distention and shock. He had been well until the previous evening, when mild abdominal pain developed; the next day, the pain became severe, and he was unresponsive. In the emergency department, he was hypotensive, with a rigid, distended abdomen....
- N Engl J Med 2008; 358:645-646
To the Editor: Lisanby (Nov. 8 issue)1 reports, in her Clinical Therapeutics article, on the use of electroconvulsive therapy (ECT) in patients with depression. ECT is rarely recommended in patients with schizophrenia (except for those with acute catatonia). In the guidelines of the German Medical Association, ECT...
- N Engl J Med 2006; 354:518-520
Schizophrenia is a serious chronic illness that requires lifelong medication. In some patients, the illness is refractory to even highly effective medications such as clozapine, and these patients desperately need more effective treatment regimens. Less dopamine is blocked with clozapine than with other antipsychotic medications, and adding more potent dopamine-blocking...