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Secondary Schizophrenia

Posted by plosmedicine on 30 Mar 2009 at 23:43 GMT

Author: Dave Hambidge
Position: Freelance Consultant Psychiatrist
Institution: Self employed
Submitted Date: June 04, 2005
Published Date: June 4, 2005
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

May I respectfully highlight a potential confounding factor to interpreting this otherwise excellent and provoking study.

In their recent over view of secondary schizophrenia, Hyde and Lewis concluded that, overall, there was a prevalence rate of 5-8 per cent
for psychoses of likely identifiable organic aetiology amongst series of relatively unselected patients. They suggest screening procedures
in new cases of psychosis, including schizophrenia, with a battery of blood tests, a urine drug screen (UDS) and an electroencephalogram
(EEG) as first-line investigations.

Between September 2000 and November 2003, I interviewed and studied the medical records of 56 patients in North West England
who were appealing against detention under the Mental Health Act (1983), and who had been admitted for the first time within the last 10
years. They were all referred to me by their solicitors to prepare independent reports for their Mental Health Review Tribunal (MHRT).
For each patient, I recorded which of the organic investigations suggested by Hyde and Lewis, if any, had been undertaken.

Of the 56; 10 were being detained for the first time, 3 female, 7 male, detained on average 39 weeks; 13 had been detained for over one year, 2 female, 11 male, on average for 106 weeks. Whilst all bar 2 of the 56 had some combination of blood tests recorded, 55% did not have UDS and 83% did not have EEG. Syphilis serology was examined for in only 2 of the latter group and none of the former.
Therefore, my findings suggest that secondary schizophrenias may not be investigated for in most detained patients with a schizophrenic like illness in England.

As they are present in 5-8 % of such cases, then some of the variability in rates found by these authors must be related to the differing diagnostic rigour used to exclude secondary causes.

Hambidge, D. M. Detecting organic causes of first-episode psychosis. Progress in Neurology and Psychiatry in press

Hyde, T. M., Lewis, S. W.,(2003). The Secondary Schizophrenias. In Schizophrenia.(eds S.R.Hirsch, and D. R. Weinberger) Oxford: Blackwell Publishing

No competing interests declared.