Full Text Available Although depressive symptoms in first episode psychosis have been associated with cannabis abuse, their influence on the long-term functional course of FEP patients who abuse cannabis is unknown. The aims of the study were to examine the influence of subclinical depressive symptoms on the long-term outcome in first episode-psychosis patients who were cannabis users and to assess the influence of these subclinical depressive symptoms on the ability to quit cannabis use.64 FEP patients who were cannabis users at baseline were followed-up for 5 years. Two groups were defined: (a patients with subclinical depressive symptoms at least once during follow-up (DPG, and (b patients without subclinical depressive symptoms during follow-up (NDPG. Psychotic symptoms were measured using the Positive and Negative Syndrome Scale (PANSS, depressive symptoms using the Hamilton Depression Rating Scale (HDRS-17, and psychosocial functioning was assessed using the Global Assessment of Functioning (GAF. A linear mixed-effects model was used to analyze the combined influence of cannabis use and subclinical depressive symptomatology on the clinical outcome.Subclinical depressive symptoms were associated with continued abuse of cannabis during follow-up (β= 4.45; 95% confidence interval [CI]: 1.78 to 11.17; P = .001 and with worse functioning (β = -5.50; 95% CI: -9.02 to -0.33; P = .009.Subclinical depressive symptoms and continued cannabis abuse during follow-up could be predictors of negative outcomes in FEP patients.
Rössler, Wulf; Hengartner, Michael P; Ajdacic-Gross, Vladeta; Haker, Helene; Gamma, Alex; Angst, Jules
Not all persons identified in the early stages to be at risk for psychosis eventually cross the threshold for a psychotic illness. However, sub-clinical symptoms may not only indicate a specific risk but also suggest a more general, underlying psychopathology that predisposes one to various common mental disorders. Analyzing data from the prospective Zurich Cohort Study, we used two psychosis subscales - "schizotypal signs" and "schizophrenia nuclear symptoms" - derived from the SCL-90-R checklist that measured sub-clinical psychosis symptoms in 1979. We also assessed 10 different diagnoses of common mental disorders through seven interview waves between 1979 and 2008. This 30-year span, covering participant ages of 19/20 to 49/50, encompasses the period of highest risk for the occurrence of such disorders. Both psychosis scales from 1979, but especially "schizotypal signs", were significantly correlated with most mental disorders over the subsequent test period. Higher values on both subscales were associated with an increasing number of co-occurring disorders. Our data demonstrate that sub-clinical psychosis generally represents a risk factor for the development of common mental disorders and a liability for co-occurring disorders. This refers in particular to dysthymia, bipolar disorder, social phobia, and obsessive-compulsive disorder. Proneness to psychosis could signal a fundamental tendency toward common mental disorders. Copyright © 2011 Elsevier B.V. All rights reserved.
Rössler, Wulf; Hengartner, Michael P; Ajdacic-Gross, Vladeta; Haker, Helene; Angst, Jules
The study objective was to examine childhood adversity in association with intra-individual changes and inter-individual differences in subclinical psychosis in a representative community cohort over a 30-year period of observation. We analyzed two psychosis syndromes derived from the SCL-90-R - schizotypal signs and schizophrenia nuclear symptoms - in 335 participants. Participants were repeatedly assessed between 1978 (around age 20) and 2008 (around age 50). We focused specifically on inter-individual differences and intra-individual changes over time by applying structural equation modeling, generalized linear models, and generalized estimating equations. Several weak inter-individual differences revealed that increased schizotypal signs are related to various childhood adversities, such as being repeatedly involved in fights and parents having severe conflicts among themselves. We also found a significant positive association between schizotypal signs and the total number of adversities a subject experienced. This pointed toward a modest dose-response relationship. The intra-individual change in schizotypal signs over time was rather weak, although some adjustment did occur. In contrast, inter-individual schizophrenia nuclear symptoms were mainly unrelated to childhood adversity. However, some striking intra-individual changes in distress were noted over time, especially those linked with severe punishment and the total adversity score. In conclusion, we have confirmed previous positive findings about the association between childhood adversity and subsequent subclinical psychosis symptoms: An increase in adversity is weakly related to an increase of the psychosis symptom load. However, depending on the kind of adversity experienced the psychosis symptom load decreases gradually in adult life. Copyright © 2014 Elsevier B.V. All rights reserved.
Rössler, Wulf; Hengartner, Michael P; Ajdacic-Gross, Vladeta; Haker, Helene; Angst, Jules
Sex differences in schizophrenia have long been reported. They are found within almost all aspects of the disease, from incidence and prevalence, age of onset, symptomatology, and course to its psycho-social outcome. Many sex-related hypotheses have been developed about the biology, psychology, or sociology of that disease. A further approach to study sex differences would be to examine such differences in sub-clinical psychotic states as well. If factors related to full-blown psychosis were equally meaningful over the entire psychosis continuum, we should expect that "true" sex differences could also be identified in sub-clinical psychosis. Here, we studied sex differences in sub-clinical psychosis within a community cohort in Zurich, Switzerland. This population was followed for over 30 years and included males and females between the ages of 20/21 and 49/50. We applied two different measures of sub-clinical psychosis representing schizotypal signs and schizophrenia nuclear symptoms. Using cross-sectional and longitudinal analyses, we found no significant sex differences in sub-clinical psychosis over time with respect to age of onset, symptomatology, course, or psycho-social outcome. Thus it appears that sex differences in psychosis manifest themselves at the high end of the continuum (full-blown schizophrenia) rather than within the sub-threshold range. Possibly males and females have separate thresholds for certain symptoms because they are differently vulnerable or exposed to various risk factors. Copyright © 2012. Published by Elsevier B.V.
Rössler, Wulf; Ajdacic-Gross, Vladeta; Müller, Mario; Rodgers, Stephanie; Haker, Helene; Hengartner, Michael P
Several studies have demonstrated that expression of a psychosis phenotype can be observed below the threshold of its clinical detection. To date, however, no conceptual certainty has been reported for the validity and reliability of sub-clinical psychosis. Our main objectives were to assess the prevalence rates and severity of various psychosis symptoms in a representative community sample. Furthermore, we wanted to analyze which latent factors are depicted by several currently used psychosis questionnaires. We also examined how those latent factors for sub-clinical psychosis are linked to psychosocial factors, normal personality traits, and coping abilities related to chronic stress. Most of the eight subscales from the Paranoia Checklist and the Structured Interview for Assessing Perceptual Anomalies had a very similar type of distribution, i.e., an inverse Gaussian (Wald) distribution. This supported the notion of a continuity of psychotic symptoms, which we would expect to find for continuously distributed symptoms within the general population. Sub-clinical psychosis can be reduced to two different factors - one representing odd beliefs about the world and odd behavior, and the other one representing anomalous perceptions (such as hallucinations). Persons with odd beliefs and behavior are under greater burden and more susceptible to psychosocial risks than are persons with anomalous perceptions. These sub-clinical psychosis syndromes are also related to stable personality traits. In conclusion, we obtained strong support for the notion that there is no natural cut-off separating psychotic illness from good health. Sub-clinical psychosis of any kind is not trivial because it is associated with various types of social disability. Copyright © 2014 Elsevier B.V. All rights reserved.
Full Text Available Considerable data support the phenomenological and temporal continuity between subclinical psychosis and psychotic disorders. In recent years, neurocognitive deficits have increasingly been recognized as a core feature of psychotic illness but there are few data seeking to elucidate the relationship between subclinical psychosis and neurocogntive deficits in non-clinical samples. The goal of the present study was to examine the relationship between subclinical positive and negative symptoms, as measured by the Community Assessment of Psychic Experiences (CAPE and performance on the MATRICS Consensus Cognitive Battery (MCCB in a large (n = 303 and demographically diverse non-clinical sample. We found that compared to participants with low levels of subclinical positive symptoms, participants with high levels of subclinical positive symptoms performed significantly better in the domains of working memory (p < .001, verbal learning (p = .007 and visual learning (p = .014. Although comparison of participants with high and low levels of subclinical negative symptoms revealed no differences in MCCB performance, we found that individuals with high levels of subclinical negative symptoms performed significantly better on a measure of estimated IQ (WRAT-3 Reading subtest; p = .02 than those with low levels of subclinical negative symptoms. These results are at odds with prior reports that have generally shown a negative relationship between neurocognitive functioning and severity of subclinical psychotic symptoms, and suggest some potential discontinuities between clinically significant psychotic symptoms and sub-syndromal manifestations of psychosis.
Martín-Santiago, Oscar; Suazo, Vanessa; Rodríguez-Lorenzana, Alberto; Ruiz de Azúa, Sonia; Valcárcel, César; Díez, Álvaro; Grau, Adriana; Domínguez, Cristina; Gallardo, Ricardo; Molina, Vicente
Subclinical psychotic symptoms are associated to negative life outcomes in the general population, but their relationship with cognitive performance is still not well understood. Assessing the relationship between performance in cognitive domains and subclinical psychotic symptoms in the general population may also help understand the handicap attributed to clinical psychosis, in which these alterations are present. Subclinical and cognitive assessments were obtained in 203 participants from the general population by means of the Community Assessment of Psychic Experiences, the Brief Assessment of Cognition in Schizophrenia, the Wechsler Adults Intelligence Scale and the Wisconsin Card Sorting Test. The positive and negative subclinical symptoms and their relationship with age and cognition were examined, followed by assessing the influence of subclinical depression scores on the possible relationships between those subclinical psychotic symptoms and cognitive deficits. Inverse relationships were found between frequency in the Community Assessment of Psychic Experiences positive dimension and motor speed, and frequency and distress in the Community Assessment of Psychic Experiences negative dimension and motor speed. A direct relationship was also found between distress scores of the positive dimension and executive functions. Both positive and negative subclinical symptoms were related to depression scores. Psychotic symptoms, similar to those in the clinical population, may be associated with cognitive deficits in the general population. Copyright © 2015 SEP y SEPB. Published by Elsevier España. All rights reserved.
Full Text Available We used Support Vector Machine (SVM to perform multivariate pattern classification based on brain activation during emotional processing in healthy participants with subclinical depressive symptoms. Six-hundred undergraduate students completed the Beck Depression Inventory II (BDI-II. Two groups were subsequently formed: (i subclinical (mild mood disturbance (n = 17 and (ii no mood disturbance (n = 17. Participants also completed a self-report questionnaire on subclinical psychotic symptoms, the Community Assessment of Psychic Experiences Questionnaire (CAPE positive subscale. The functional magnetic resonance imaging (fMRI paradigm entailed passive viewing of negative emotional and neutral scenes. The pattern of brain activity during emotional processing allowed correct group classification with an overall accuracy of 77% (p = 0.002, within a network of regions including the amygdala, insula, anterior cingulate cortex and medial prefrontal cortex. However, further analysis suggested that the classification accuracy could also be explained by subclinical psychotic symptom scores (correlation with SVM weights r = 0.459, p = 0.006. Psychosis proneness may thus be a confounding factor for neuroimaging studies in subclinical depression.
Rössler, Wulf; Hengartner, Michael P; Ajdacic-Gross, Vladeta; Haker, Helene; Angst, Jules
Our aim was to deconstruct the variance underlying the expression of sub-clinical psychosis symptoms into portions associated with latent time-dependent states and time-invariant traits. We analyzed data of 335 subjects from the general population of Zurich, Switzerland, who had been repeatedly measured between 1979 (age 20/21) and 2008 (age 49/50). We applied two measures of sub-clinical psychosis derived from the SCL-90-R, namely schizotypal signs (STS) and schizophrenia nuclear symptoms (SNS). Variance was decomposed with latent state-trait analysis and associations with covariates were examined with generalized linear models. At ages 19/20 and 49/50, the latent states underlying STS accounted for 48% and 51% of variance, whereas for SNS those estimates were 62% and 50%. Between those age classes, however, expression of sub-clinical psychosis was strongly associated with stable traits (75% and 89% of total variance in STS and SNS, respectively, at age 27/28). Latent states underlying variance in STS and SNS were particularly related to partnership problems over almost the entire observation period. STS was additionally related to employment problems, whereas drug-use was a strong predictor of states underlying both syndromes at age 19/20. The latent trait underlying expression of STS and SNS was particularly related to low sense of mastery and self-esteem and to high depressiveness. Although most psychosis symptoms are transient and episodic in nature, the variability in their expression is predominantly caused by stable traits. Those time-invariant and rather consistent effects are particularly influential around age 30, whereas the occasion-specific states appear to be particularly influential at ages 20 and 50. © 2013.
Rössler, Wulf; Angst, Jules; Gamma, Alex; Haker, Helene; Stulz, Niklaus; Merikangas, Kathleen R; Ajdacic-Gross, Vladeta
The interplay of psychotic and affective symptoms is a crucial challenge in understanding the pathogenesis of psychosis. In this study, we analyzed the interplay between two subclinical psychosis symptoms dimensions, and one depression symptoms dimension, using longitudinal data from Zurich. The Zurich study started in 1979 with a representative sample of 591 participants who were aged 20/21. Follow-up interviews were conducted at age 23, 28, 30, 35, and 41. The psychiatric symptoms were assessed with a semi-structured interview and the SCL 90-R. In this study, we analyzed three SCL-90-R subscales: the depression symptoms dimension and two distinct symptoms dimensions of subclinical psychosis, one representing a schizophrenia nuclear symptom dimension, the other representing a schizotypal symptoms dimension. Modeling was done with hybrid latent growth models, thereby including simultaneous and cross-lagged effects. The interplay between the two subclinical psychosis symptoms dimensions and the depression symptoms dimension includes several intertwined pathways. The schizotypal symptoms dimension has strong direct effects on the schizophrenia nuclear symptoms dimension, but also on the depression symptoms dimension. The latter has for its part an effect on the schizophrenia nuclear symptoms dimension. The main driving force within the dynamic interplay between depression and psychosis symptoms is a schizotypal symptoms dimension, which represents social and interpersonal deficiencies, ideas of reference, suspiciousness, paranoid ideation, and odd behavior. It does not only directly influence subclinical nuclear schizophrenia symptoms but also the symptoms of depression.
Rössler, Wulf; Ajdacic-Gross, Vladeta; Müller, Mario; Rodgers, Stephanie; Kawohl, Wolfram; Haker, Helene; Hengartner, Michael P
Evidence is growing that persons along the schizophrenia spectrum, i.e., those who also display subclinical psychotic symptoms, exhibit deficits across a broad range of neuropsychological domains. Because sex differences in the association between cognitive deficits and psychosis have thus far been mostly neglected, we believe that ours is the first study specifically focused upon those differences when examining the relationship between subclinical psychosis and processing speed. Using a sample of 213 persons from the general population from Zurich, Switzerland, psychotic symptoms were assessed with three different questionnaires including the Schizotypal Personality Questionnaire, an adaptation of the Structured Interview for Assessing Perceptual Anomalies, and the Paranoia Checklist. Processing speed was assessed with the WAIS digit-symbol coding test. Two higher-order psychosis domains were factor-analytically derived from the various psychosis subscales and then subjected to a series of linear regression analyses. The results demonstrate that in both men and women associations between subclinical psychosis domains and processing speed were weak to moderate (β ranging from -0.18 to -0.27; all p0.30). In conclusion, it appears that sex differences in psychosis manifest themselves only at the high end of the continuum (full-blown schizophrenia) and not across the sub-threshold range. The small magnitude of the effects reported herein conforms to the etiopathology of the disorder. Since schizophrenia and related disorders from the spectrum are assumed to be multifactorial diseases, it follows that many etiological components of small effect are involved. Copyright © 2015 Elsevier B.V. All rights reserved.
Sönmez, Nasrettin; Røssberg, Jan Ivar; Evensen, Julie
AIMS: The present study examined if any patient characteristics at baseline predicted depressive symptoms at 10 years and whether patients prone to depressive symptoms in the first year of treatment had a different prognosis in the following years. METHOD: A total of 299 first-episode psychosis...... (FEP) patients with schizophrenia spectrum disorders were assessed for depressive symptoms with PANSS depression item (g6) at baseline, and 1, 2, 5 and 10 years of follow up. At 10 years, depressive symptoms were also assessed with Calgary Depression Scale for Schizophrenia (CDSS). A PANSS g6 ≥ 4......: Depressive symptoms are frequent among FEP patients at baseline but decrease after treatment because their general symptoms have been initiated. Patients with poor social functioning in childhood and alcohol use at baseline are more prone to have depressive symptoms at 10 years of follow up. Patients...
Unterrassner, Lui; Wyss, Thomas A.; Wotruba, Diana; Haker, Helene; Rössler, Wulf
The interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate between different subtypes of psychotic-like experiences (PLE) although they may not have the same significance for mental health. In order to gain information on the subclinical interplay between specific PLE and other symptoms as well as the significance of PLE for mental health, we investigated their specific associations in 206 healthy individuals (20–60 years, 73 females) using correlational and linear regression analyses. PLE were assessed with the Magical Ideation Questionnaire, the revised Exceptional Experiences Questionnaire, and subscales of the Schizotypal Personality Questionnaire (SPQ). The revised Symptom Checklist 90, the SPQ, and the Physical Anhedonia Scale were used to measure subclinical negative symptoms, affective symptoms, and other symptoms such as, emotional instability. As hypothesized, we found that (1) most affective symptoms and all other subclinical symptoms correlated positively with all PLE, whereas we found only partial associations between negative symptoms and PLE. Notably, (2) magical ideation and paranormal beliefs correlated negatively with physical anhedonia. In the regression analyses we found (3) similar patterns of specific positive associations between PLE and other subclinical symptoms: Suspiciousness was a specific predictor of negative-like symptoms, whereas ideas of reference, unusual perceptual experiences, and dissociative anomalous perceptions specifically predicted anxiety symptoms. Interestingly, (4) ideas of reference negatively predicted physical anhedonia. Similarly, paranormal beliefs were negatively associated with constricted affect. Moreover, odd beliefs were a negative predictor of depression, emotional instability, and unspecific symptoms. Our findings indicated that
Unterrassner, Lui; Wyss, Thomas A; Wotruba, Diana; Haker, Helene; Rössler, Wulf
The interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate between different subtypes of psychotic-like experiences (PLE) although they may not have the same significance for mental health. In order to gain information on the subclinical interplay between specific PLE and other symptoms as well as the significance of PLE for mental health, we investigated their specific associations in 206 healthy individuals (20-60 years, 73 females) using correlational and linear regression analyses. PLE were assessed with the Magical Ideation Questionnaire, the revised Exceptional Experiences Questionnaire, and subscales of the Schizotypal Personality Questionnaire (SPQ). The revised Symptom Checklist 90, the SPQ, and the Physical Anhedonia Scale were used to measure subclinical negative symptoms, affective symptoms, and other symptoms such as, emotional instability. As hypothesized, we found that (1) most affective symptoms and all other subclinical symptoms correlated positively with all PLE, whereas we found only partial associations between negative symptoms and PLE. Notably, (2) magical ideation and paranormal beliefs correlated negatively with physical anhedonia. In the regression analyses we found (3) similar patterns of specific positive associations between PLE and other subclinical symptoms: Suspiciousness was a specific predictor of negative-like symptoms, whereas ideas of reference, unusual perceptual experiences, and dissociative anomalous perceptions specifically predicted anxiety symptoms. Interestingly, (4) ideas of reference negatively predicted physical anhedonia. Similarly, paranormal beliefs were negatively associated with constricted affect. Moreover, odd beliefs were a negative predictor of depression, emotional instability, and unspecific symptoms. Our findings indicated that
Full Text Available The interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate between different subtypes of psychotic-like experiences (PLE although they may not have the same significance for mental health. In order to gain information on the subclinical interplay between specific PLE and other symptoms as well as the significance of PLE for mental health, we investigated their specific associations in 206 healthy individuals (20–60 years, 73 females using correlational and linear regression analyses. PLE were assessed with the Magical Ideation Questionnaire, the revised Exceptional Experiences Questionnaire, and subscales of the Schizotypal Personality Questionnaire (SPQ. The revised Symptom Checklist 90, the SPQ, and the Physical Anhedonia Scale were used to measure subclinical negative symptoms, affective symptoms, and other symptoms such as, emotional instability. As hypothesized, we found that (1 most affective symptoms and all other subclinical symptoms correlated positively with all PLE, whereas we found only partial associations between negative symptoms and PLE. Notably, (2 magical ideation and paranormal beliefs correlated negatively with physical anhedonia. In the regression analyses we found (3 similar patterns of specific positive associations between PLE and other subclinical symptoms: Suspiciousness was a specific predictor of negative-like symptoms, whereas ideas of reference, unusual perceptual experiences, and dissociative anomalous perceptions specifically predicted anxiety symptoms. Interestingly, (4 ideas of reference negatively predicted physical anhedonia. Similarly, paranormal beliefs were negatively associated with constricted affect. Moreover, odd beliefs were a negative predictor of depression, emotional instability, and unspecific symptoms. Our findings
Lisa Kathinka Barbara Holper
Full Text Available A psychosis phenotype can be observed below the threshold of clinical detection. The study aimed to investigate whether subclinical psychotic symptoms are associated with deficits in controlling emotional interference, and whether cortical brain and cardiac correlates of these deficits can be detected using functional near-infrared spectroscopy (fNIRS. A data set derived from a community sample was obtained from the Zurich Program for Sustainable Development of Mental Health Services. 174 subjects (mean age 29.67 ± 6.41, 91 females were assigned to four groups ranging from low to high levels of subclinical psychotic symptoms (derived from the Symptom Checklist-90-R. Emotional interference was assessed using the emotional Stroop task comprising neutral, positive, and negative conditions. Statistical distributional methods based on delta plots (behavioral response time data and quantile analysis (fNIRS data were applied to evaluate the emotional interference effects.Results showed that both interference effects and disorder-specific (i.e., group-specific effects could be detected, based on behavioral response times, cortical hemodynamic signals (brain correlates, and heart rate variability (cardiac correlates. Subjects with high compared to low subclinical psychotic symptoms revealed significantly reduced amplitudes in dorsolateral prefrontal cortices (interference effect, p < 0.001 and middle temporal gyrus (disorder-specific group effect, p < 0.001, supported by behavioral and heart rate results. The present findings indicate that distributional analyses methods can support the detection of emotional interference effects in the emotional Stroop. The results suggested that subjects with high subclinical psychosis exhibit enhanced emotional interference effects. Based on these observations, subclinical psychosis may therefore prove to represent a valid extension of the clinical psychosis phenotype.
Holper, Lisa K B; Aleksandrowicz, Alekandra; Müller, Mario; Ajdacic-Gross, Vladeta; Haker, Helene; Fallgatter, Andreas J; Hagenmuller, Florence; Kawohl, Wolfram; Rössler, Wulf
A psychosis phenotype can be observed below the threshold of clinical detection. The study aimed to investigate whether subclinical psychotic symptoms are associated with deficits in controlling emotional interference, and whether cortical brain and cardiac correlates of these deficits can be detected using functional near-infrared spectroscopy (fNIRS). A data set derived from a community sample was obtained from the Zurich Program for Sustainable Development of Mental Health Services. 174 subjects (mean age 29.67 ± 6.41, 91 females) were assigned to four groups ranging from low to high levels of subclinical psychotic symptoms (derived from the Symptom Checklist-90-R). Emotional interference was assessed using the emotional Stroop task comprising neutral, positive, and negative conditions. Statistical distributional methods based on delta plots [behavioral response time (RT) data] and quantile analysis (fNIRS data) were applied to evaluate the emotional interference effects. Results showed that both interference effects and disorder-specific (i.e., group-specific) effects could be detected, based on behavioral RTs, cortical hemodynamic signals (brain correlates), and heart rate variability (cardiac correlates). Subjects with high compared to low subclinical psychotic symptoms revealed significantly reduced amplitudes in dorsolateral prefrontal cortices (interference effect, p < 0.001) and middle temporal gyrus (disorder-specific group effect, p < 0.001), supported by behavioral and heart rate results. The present findings indicate that distributional analyses methods can support the detection of emotional interference effects in the emotional Stroop. The results suggested that subjects with high subclinical psychosis exhibit enhanced emotional interference effects. Based on these observations, subclinical psychosis may therefore prove to represent a valid extension of the clinical psychosis phenotype.
Romm, Kristin Lie; Rossberg, Jan Ivar; Berg, Akiah Ottesen; Barrett, Elizabeth Ann; Faerden, Ann; Agartz, Ingrid; Andreassen, Ole A; Melle, Ingrid
The aims of this study were to examine the prevalence and pattern of lifetime Diagnostic and Structural Manual of Mental Disorders (fourth version) major depressive episodes, and the relationship between patient characteristics and current severity of depressive symptoms in first episode psychosis patients (FEPP). A total of 122 FEPP from the ongoing longitudinal thematically organized psychosis research study were included at first treatment. A total of 58 patients (48%) had experienced one or more major depressive episodes; 21 (17%) before onset of psychosis and 37 (30%) during or after onset of psychosis. Poor premorbid childhood adjustment, substance abuse, and excitative symptoms at start of treatment were statistically significant associated with higher current severity of depressive symptoms. Alcohol use was significantly associated with current severity of depression in men, while excitative symptoms were associated in women. Thus depressive symptoms are frequent among FEPP, with indications of gender specific differences in patient characteristics that might imply different approaches to treatment.
Blum, Manuel R; Wijsman, Liselotte W; Virgini, Vanessa S
on the association of persistent subclinical thyroid dysfunction and depression, subclinical hypothyroidism was not associated with increased depressive symptoms among older adults at high cardiovascular risk. Persistent subclinical hyperthyroidism might be associated with increased depressive symptoms, which...... adults aged 70-82 years with pre-existing cardiovascular disease or known cardiovascular risk factors, TSH and free T4 levels were measured at baseline and repeated after 6 months to define persistent thyroid function status. Main outcome measures were depressive symptoms, assessed with the Geriatric...... Depression Scale 15 (GDS) at baseline and after 3 years. All analyses were adjusted for age, gender and education. RESULTS: Among 606 participants (41% women, mean age 75 years) without anti-depressant medication, GDS scores at baseline did not differ for participants with subclinical hypothyroidism (n = 47...
Arciniegas, David B
Psychosis is a common and functionally disruptive symptom of many psychiatric, neurodevelopmental, neurologic, and medical conditions and an important target of evaluation and treatment in neurologic and psychiatric practice. The purpose of this review is to define psychosis, communicate recent changes to the classification of and criteria for primary psychotic disorders described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and summarize current evidence-based approaches to the evaluation and management of primary and secondary psychoses. The DSM-5 classification of and criteria for primary psychotic disorders emphasize that these conditions occur along a spectrum, with schizoid (personality) disorder and schizophrenia defining its mild and severe ends, respectively. Psychosis is also identified as only one of several dimensions of neuropsychiatric disturbance in these disorders, with others encompassing abnormal psychomotor behaviors, negative symptoms, cognitive impairments, and emotional disturbances. This dimensional approach regards hallucinations and delusions as arising from neural systems subserving perception and information processing, thereby aligning the neurobiological framework used to describe and study such symptoms in primary psychotic disorders with those used to study psychosis associated with other neurologic conditions. This article provides practicing neurologists with updates on current approaches to the diagnosis, evaluation, and treatment of primary and secondary psychoses.
Collip, D; Wigman, J T W; van Os, J; Oorschot, M; Jacobs, N; Derom, C; Thiery, E; Peeters, F; Wichers, M; Myin-Germeys, I
Altered social reward functioning is associated with psychosis irrespective of stage and severity. Examining the role of social reward functioning prospectively in relation to psychotic experiences before these become persistent and potentially disabling can aid in elucidating social mechanisms that induce shifts toward more severe psychotic states, without the confounding effects of clinical disorder. In a longitudinal general population sample (N = 566), the experience sampling method (repetitive random sampling of momentary emotions and social context) was used to assess daily life social functioning at baseline. Persistence of subclinical psychotic experiences was based on the Community Assessment of Psychic Experiences assessed three times over 14 months. Analyses examined to what degree i) social context and ii) appreciation thereof differentiated between those who did and did not develop persistent psychotic experiences. Although individuals with persistent psychotic experiences did not differ in overall level of positive effect, the amount of time spent alone or the level of social satisfaction compared to individuals without persistent psychotic experiences, they were more sensitive to the rewarding effects of social company. Alterations in social reward experience may form one of the mechanisms that precede the development of the extended psychosis phenotype over time. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Grano, Niklas; Lindsberg, Jenni; Karjalainen, Marjaana; Gronroos, Peter; Blomberg, Ari-Pekka
Evidence of association between duration of untreated psychosis (DUP) and negative symptoms of schizophrenia in first-episode psychosis (FEP) patients is inconsistent in the recent literature. In the present study, DUP, schizophrenia symptoms, duration of medication, and diagnosis were obtained from hospital archives in a sample of FEP patients.…
Blanchard, Mathieu M; Jacobson, Sarah; Clarke, Mary C; Connor, Dearbhla; Kelleher, Ian; Garavan, Hugh; Harley, Michelle; Cannon, Mary
Neuropsychological impairment is a core feature of schizophrenia. Adolescents reporting subclinical psychotic symptoms are considered to be at greater risk of developing a psychotic illness later in life than adolescents who do not report such symptoms and, thus, may represent an at-risk group for further study. We wished to investigate neuropsychological functioning in early adolescence in relation to reports of psychotic symptoms. Participants were recruited from local primary schools after a two-stage screening and parental consent process. In brief, 277 adolescents were screened and 37 attended for testing. Seventeen adolescents who were deemed to report 'definite' psychotic symptoms after clinical interview and 20 control adolescents underwent a clinical interview and a one-hour neuropsychological battery. Adolescents who report psychotic symptoms exhibited significant impairments in receptive language (as measured by the British Picture Vocabulary Scale), motor function (as measured by the Pegboard test) and executive function/speed of processing (as measured by the Trail-Making test). There were no significant differences between the groups on measures of attention, memory or expressive language, abstract reasoning or overall scholastic ability. Taken together with the results from birth cohort, genetic high risk and prodromal studies, these findings are consistent with a neural inefficiency/disconnectivity hypothesis in those at risk for psychosis. These results highlight the need to investigate developmental brain circuits subserving language and motor function and processing speed and how these change over time in at-risk adolescents. Copyright © 2010 Elsevier B.V. All rights reserved.
Derks Eske M
Full Text Available Abstract Background Schizophrenia is a complex psychiatric disorder characterized by high phenotypic heterogeneity. Previous studies have distinguished between familial and sporadic forms of schizophrenia and have suggested clinical differentiation between patients and relatives from sporadic and multiplex families. We will introduce a more refined method to distinguish between family subtypes based on psychosis dimension profiles in the relatives of schizophrenia patients. Methods Positive, negative, disorganization, mania, and depression scores were assessed in 1,392 relatives. Mixed Model Latent Class Analysis was used to identify family subtypes. A family subtype is a relatively homogeneous group of families with similar symptom profiles in the relatives in these families. Next, we investigated in 616 schizophrenia patients whether family subtype was associated with symptom profiles, IQ, cannabis dependence/abuse, or age of onset of psychosis. Results Based on the data of relatives, we identified two different family types: “healthy” and “at risk for psychiatric disorder”. Patients from at risk families obtained higher positive scores compared to patients from healthy families (Wald(1 = 6.6293, p = 0.010. No significant differences were found in any of the remaining variables. Conclusions Our findings confirm the existence of high-risk families and although we did not establish an etiological basis for the distinction between family types, genetic studies might reveal whether family subtype is associated with genetic heterogeneity.
Modinos, Gemma; Mechelli, Andrea; Pettersson-Yeo, William; Allen, Paul; McGuire, Philip; Aleman, Andre
We used Support Vector Machine (SVM) to perform multivariate pattern classification based on brain activation during emotional processing in healthy participants with subclinical depressive symptoms. Six-hundred undergraduate students completed the Beck Depression Inventory II (BDI-II). Two groups
Collip, D.; Wigman, J. T. W.; Van Os, J.; Oorschot, M.; Jacobs, N.; Derom, C.; Thiery, E.; Peeters, F.; Wichers, M.; Myin-Germeys, I.
ObjectiveAltered social reward functioning is associated with psychosis irrespective of stage and severity. Examining the role of social reward functioning prospectively in relation to psychotic experiences before these become persistent and potentially disabling can aid in elucidating social
... prescription drugs, such as steroids and stimulants Some types of epilepsy Stroke Psychosis may also be found in: Most people with schizophrenia Some people with bipolar disorder (manic-depressive) or severe depression Some personality disorders
Henquet, C.J.; Krabbendam, L.; Spauwen, P.H.M.; Kaplan, C.; Lieb, R.; Wittchen, H.U.; Os, J. van
OBJECTIVE: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence. DESIGN: Analysis of prospective data from a population based sample. Assessment of substance use,
Bechtold, Jordan; Hipwell, Alison; Lewis, David A; Loeber, Rolf; Pardini, Dustin
Adolescents who regularly use marijuana may be at heightened risk of developing subclinical and clinical psychotic symptoms. However, this association could be explained by reverse causation or other factors. To address these limitations, the current study examined whether adolescents who engage in regular marijuana use exhibit a systematic increase in subclinical psychotic symptoms that persists during periods of sustained abstinence. The sample comprised 1,009 boys who were recruited in 1st and 7th grades. Self-reported frequency of marijuana use, subclinical psychotic symptoms, and several time-varying confounds (e.g., other substance use, internalizing/externalizing problems) were recorded annually from age 13 to 18. Fixed-effects (within-individual change) models examined whether adolescents exhibited an increase in their subclinical psychotic symptoms as a function of their recent and/or cumulative history of regular marijuana use and whether these effects were sustained following abstinence. Models controlled for all time-stable factors (default) and several time-varying covariates as potential confounds. For each year adolescent boys engaged in regular marijuana use, their expected level of subsequent subclinical psychotic symptoms rose by 21% and their expected odds of experiencing subsequent subclinical paranoia or hallucinations rose by 133% and 92%, respectively. The effect of prior regular marijuana use on subsequent subclinical psychotic symptoms persisted even when adolescents stopped using marijuana for a year. These effects were after controlling for all time-stable and several time-varying confounds. No support was found for reverse causation. These results suggest that regular marijuana use may significantly increase the risk that an adolescent will experience persistent subclinical psychotic symptoms.
Ten Velden Hegelstad, Wenche; Haahr, Ulrik; Larsen, Tor K
Poor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients continue to have positive and/or negative symptoms after ten years.......Poor symptom outcome remains a challenge in psychosis: At least 50% of first-episode patients continue to have positive and/or negative symptoms after ten years....
Carr, Sarah Christina; Hardy, Amy; Fornells-Ambrojo, Miriam
There is growing evidence for the role of attachment in psychosis, however, to date there has been no quantitative review of the prevalence of insecure attachment in psychosis. The current study sought to systematically appraise studies investigating the prevalence of insecure attachment and the association with psychosis-spectrum experiences using meta-analytic techniques. A systematic search of studies carried out between January 1980 and 30th November 2015 found 25 papers eligible for inclusion. The meta-analysis showed that the prevalence of insecure attachment style was significantly higher in individuals with psychosis (76%) than in non-clinical samples (38%), with fearful attachment being the most prevalent. Across the continuum, there was a small but significant relationship between positive symptom severity and insecure attachment and a significant relationship between negative symptom severity and insecure attachment in the non-clinical analysis. This relationship was not found in the clinical group. The prevalence of insecure attachment appears to be high in psychosis, however, the relationship between symptom severity and attachment is small. Attachment theory may provide greater understanding of the development of positive symptoms than previously thought, however, research needs to include more at-risk samples and longitudinal research to fully understand the dynamics of this relationship. Copyright © 2017 Elsevier Ltd. All rights reserved.
Trauelsen, Anne Marie; Gumley, Andrew; Jansen, Jens Einar
There is growing evidence that metacognitive abilities which include the ability to synthesize knowledge regarding mental states in self and others and use this ability to solve problems are impaired in non-affective psychosis and associated with positive and negative symptom severity. We sought...... to (a) investigate the severity of metacognitive impairments in first-episode psychosis (FEP) compared to non-clinical controls and (b) explore associations with positive and negative symptom profiles. Ninety-seven people with FEP were compared to 101 control persons. Metacognition was assessed...... with interviews and the Metacognitive assessment scale-abbreviated. Four groups based on positive and negative symptoms were identified by cluster analysis and compared on metacognition, childhood adversities, duration of untreated psychosis and premorbid social and academic adjustment. Those with high levels...
Lecomte, Tania; Leclerc, Claude; Wykes, Til
Group cohesion has been linked to positive changes in self-esteem and in symptoms during group psychotherapy in people with psychosis. These changes may be linked to changes in symptoms as fluctuations in self-esteem have been linked to symptom fluctuations. We aimed to determine the relationship between these three factors - group cohesion, self-esteem, and symptoms - during group cognitive behaviour therapy for psychosis (GCBTp). We hypothesized that group cohesion would precede changes in symptoms and self-esteem and that improvements in self-esteem would precede improvements in symptoms. This is an uncontrolled longitudinal study recruiting from a convenience sample within two early psychosis clinics. Sixty-six individuals from first episode of psychosis treatment programmes participated in this study and received 24 sessions of a validated GCBTp protocol. Participants answered a brief questionnaire at the end of each session, measuring their group cohesion, self-esteem, and perception of their symptoms as worse, same, or better than usual. Orthogonal polynomial contrasts for time effects were estimated with a mixed model for repeated measures with a random cluster effect and revealed a quartic trend regarding changes in symptoms over the 24 sessions. Self-esteem, symptoms, and group cohesion were strongly linked during a given session. Also, self-esteem changes predicted changes in symptoms up to two sessions later, and symptoms changes predicted self-esteem changes at the next session. Group cohesion preceded improvements in both self-esteem and symptoms; self-esteem also predicted improvements in group cohesion. These results suggest that self-esteem and symptoms influence each other during therapy, with improvements in one leading to improvements in the other. Group cohesion also appears to be an essential prerequisite to positive changes in self-esteem and symptoms during GCBTp. This study emphasizes the interrelation between self-esteem improvements and
Collip, Dina; Wigman, Johanna T W; Lin, Ashleigh; Nelson, Barnaby; Oorschot, Margreet; Vollebergh, Wilma A M; Ryan, Jaymee; Baksheev, Gennedy; Wichers, Marieke; van Os, Jim; Myin-Germeys, Inez; Yung, Alison R
Cross-sectional studies have indicated that alterations in social functioning, particularly interpersonal functioning, are associated with the occurrence of psychotic symptoms and experiences at different levels of the extended psychosis phenotype (ranging from population psychometric expression of liability to overt psychotic disorder). However, more research is needed on the development of this association over time. Cross-lagged path modeling was used to analyze bidirectional, longitudinal associations between 4 dimensions of subclinical psychotic experiences (persecutory ideation, bizarre experiences, perceptual abnormalities, and magical thinking) and interpersonal functioning in an adolescent general population sample (N = 881 at T1, N = 652 at T2, and N = 512 at T3) assessed 3 times in 3 years. All symptom dimensions showed some association with interpersonal functioning over time, but only bizarre experiences and persecutory ideation were consistently and longitudinally associated with interpersonal functioning. Poorer interpersonal functioning predicted higher levels of bizarre experiences and persecutory ideation at later measurement points (both T1 to T2 and T2 to T3). Poor interpersonal functioning in adolescence may reflect the earliest expression of neurodevelopmental alterations preceding expression of psychotic experiences in a symptom-specific fashion.
Brown, Stephen; Schiraldi, Glenn R.
Mental health has been declining among college students in recent years. Reports indicate that even sub-clinical symptoms of anxiety and depression can negatively influence life satisfaction and performance. Mental health experts are calling for more efforts to address these concerns among college and general populations. This study examined the…
Malakar, Partha; Basu, Jayanti
The aim of the study was to determine whether the general intelligence, cognitive processes, school achievement, and intelligence-achievement relationship of adolescents with subclinical levels of obsessive-compulsive symptoms differed from those of their normal counterparts. From an initial large pool of 14-year-old Bengali students in eighth…
de Castro-Catala, Marta; Peña, Elionora; Kwapil, Thomas R; Papiol, Sergi; Sheinbaum, Tamara; Cristóbal-Narváez, Paula; Ballespí, Sergi; Barrantes-Vidal, Neus; Rosa, Araceli
Childhood trauma has been associated with a heightened risk for presenting clinical and non-clinical psychopathology in adulthood. Genes related with the stress response, such as the FK506 binding protein 51 (FKBP5), are plausible candidates moderating the effects of childhood trauma on the emergence of such symptoms later on. The present study aimed to explore the moderating role of FKBP5 genetic variability on the association of different types of childhood trauma with subclinical psychosis, depression and anxiety in a non-clinical sample. Schizotypy, psychotic-like experiences, depression and anxiety symptoms and childhood trauma were assessed in 808 young adults. Two FKBP5 haplotypic blocks were detected: block 1 (rs3800373 - rs9296158 - rs1360780) and block 2 (rs9470080 - rs4713916). Subjects were classified in two groups according to whether they carried or not the risk haplotype previously described in the literature (block 1: CAT and block 2: TA). Linear regression analyses were used to study (i) the main effects of childhood trauma and FKBP5 haplotype blocks and (ii) their interaction effects on the mentioned forms of psychopathology. All childhood trauma scales, except sexual abuse, were associated with schizotypy, psychotic-like experiences, depression and anxiety symptoms. None of the analysed symptoms was associated with the main effects of FKBP5 genetic variability. However an interaction effect between block 1 and physical abuse was observed on anxiety, with lower scores in CAT carriers. This effect was driven by SNP 1 and 2. Moreover, an interaction effect between block 2 and physical abuse was identified on the variables tapping depressive and anxiety symptoms. Specifically, non-TA carrier subjects who were exposed to physical abuse were found to be at higher risk for depressive and anxiety symptoms. These effects were driven by SNP 5. No interaction effect was observed for the other variables. Our data suggest that exposure to childhood physical
Osler, Merete; Sørensen, Lauge; Rozing, Maarten
exclusion of men (n = 3) with scores in the range of clinical depression the inverse correlation between depressive symptoms and hippocampal volume became insignificant (r = -13, p = .08). Depressive symptoms at age 59 correlated positively with hippocampal and amygdala texture-potential early markers...... of atrophy. Inverse relations with total gray matter and pallidum volumes lost significance when the analysis was adjusted for intracranial volume. In men, depressive symptoms at age 51 were associated with a reduced volume of the hippocampus at age 59 independent of later symptoms. Amygdala and hippocampal...
Østefjells, Tiril; Melle, Ingrid; Hagen, Roger; Romm, Kristin L; Sönmez, Nasrettin; Andreassen, Ole A; Røssberg, Jan Ivar
Previous studies have shown that individuals with schizophrenia exhibit higher levels of unhelpful metacognitive beliefs than healthy controls, but no studies have explored metacognitive beliefs in early psychosis. We examined i) differences in levels of unhelpful metacognitive beliefs between psychosis spectrum disorders, and healthy controls, and ii) to what extent demographic and clinical characteristics predicted levels of metacognitive beliefs in the early treated phases of psychotic disorders. Patients were included within two years of first treatment for a psychotic disorder (N=92). They were assessed on premorbid adjustment, psychotic symptoms, anxiety/depression, and self-reported metacognitive beliefs (MCQ-30). Ninety-seven controls also completed MCQ-30. Predictors of metacognitive beliefs were explored with multiple linear regression analyses. Patients scored significantly higher than controls on all metacognitive subscales except positive beliefs about worry. The regression model explained 14-38% of the variance on each metacognitive subscale. Current affective symptoms explained a significant amount of variance on all subscales, except positive beliefs about worry. Childhood (premorbid) social adjustment predicted a significant amount of the variance on all subscales, except cognitive confidence. Duration of untreated psychosis contributed significantly to more unhelpful beliefs about cognitive confidence. Negative symptoms predicted lower scores on cognitive self-consciousness. Affective symptoms and childhood social adjustment could be important predictors of unhelpful metacognitive beliefs in the early treated phases of psychosis, indicating potential psychopathological relationships that warrant further investigation for clinical relevance. Copyright © 2015 Elsevier B.V. All rights reserved.
Barajas, Ana; Pelaez, Trinidad; González, Olga; Usall, Judith; Iniesta, Raquel; Arteaga, Maria; Jackson, Chris; Baños, Iris; Sánchez, Bernardo; Dolz, Montserrat; Obiols, Jordi E; Haro, Josep M; Ochoa, Susana
Both the nature and number of a wide range of prodromal symptoms have been related to the severity and type of psychopathology in the psychotic phase. However, at present there is an incomplete picture focused mainly on the positive pre-psychotic dimension. To characterize the prodromal phase retrospectively, examining the number and nature of prodromal symptoms as well as their relationship with psychopathology at the onset of first-episode psychosis. Retrospective study of 79 patients experiencing a first-episode psychosis of less than 1 year from the onset of full-blown psychosis. All patients were evaluated with a comprehensive battery of instruments including socio-demographic and clinical questionnaire, IRAOS interview, PANSS, stressful life events scale (PERI) and WAIS/WISC (vocabulary subtest). Bivariate associations and multiple regression analysis were performed. Regression models revealed that several prodromal dimensions of IRAOS (delusions, affect, language, behaviour and non-hallucinatory disturbances of perception) predicted the onset of psychosis, with positive (22.4% of the variance) and disorganized (25.6% of the variance) dimensions being the most widely explained. In addition to attenuated positive symptoms, other symptoms such as affective, behavioural and language disturbances should also be considered in the definitions criteria of at-high-risk people. © 2017 John Wiley & Sons Australia, Ltd.
Eslami, Ali; Jahshan, Carol; Cadenhead, Kristin S.
Predictors of social functioning deficits were assessed in 22 individuals “at risk” for psychosis. Disorganized symptoms and executive functioning predicted social functioning at follow-up. Early intervention efforts that focus on social and cognitive skills are indicated in this vulnerable population.
Beauchamp, Marie-Chantal; Lecomte, Tania; Lecomte, Conrad; Leclerc, Claude; Corbière, Marc
This study aimed to determine personality profiles of individuals with early psychosis based on the Five Factor Model of personality and assess the predictive value of personality traits or profiles on therapeutic outcomes of two group treatments for recent onset psychosis: cognitive behaviour therapy or skills training for symptom management. One hundred and twenty-nine individuals with early psychosis were recruited to participate in a randomized controlled trial. The participants were randomized to one of two group treatments or to a wait-list control group. Measures included a personality inventory (NEO Five Factor Inventory) and outcome measures of symptomatology (Brief Psychiatric Rating Scale-Expanded) and coping strategies (Cybernetic Coping Scale). Cluster analyses revealed three different personality profiles (based on the Five Factor Model) - none specifically linked to psychotic symptoms. No links were revealed between personality traits and symptom change scores. Personality traits were linked to therapeutic improvements in active coping strategies, with extraversion accounting for 17% of the variance. Neuroticism was linked to increased use of passive coping strategies. Active coping strategies were also predicted by profile 1 (holding the highest openness score) with 26% of the variance explained and by profile 3 (the highest extraversion score), with 14% of the variance explained. Individuals with early psychosis can present with distinct personality profiles as would be expected in a non-clinical population. Personality traits do not appear to influence symptomatic treatment outcomes but are linked to behavioural changes, such as the use of coping strategies. © 2010 Blackwell Publishing Asia Pty Ltd.
González-Ortega, Itxaso; de Los Mozos, Vanesa; Echeburúa, Enrique; Mezo, Maria; Besga, Ariadna; Ruiz de Azúa, Sonia; González-Pinto, Asunción; Gutierrez, Miguel; Zorrilla, Iñaki; González-Pinto, Ana
The relationship of neurocognitive course with clinical and functional outcomes in psychosis is not well known, especially in the long term. The aim of the study was to examine the clinical and neuropsychological course of first-episode psychosis patients at 5-year follow-up and analyze the relationship of cognitive performance with clinical and functional outcome. The 5-year follow-up was conducted with 26 first-episode psychosis patients. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale, manic and depressive symptoms by the Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by the Functioning Assessment Short Test. The cognitive domains were assessed by the Wechsler Adult Intelligence Scale, the Wisconsin Card Sorting Test, the Trail Making Test, the Verbal Fluency Test, the Stroop Colour-Word Test and the Wechsler Memory Scale. Patients showed symptomatic improvement in the follow-up except in negative psychotic symptoms. There was also improvement in most cognitive domains except in working memory and processing speed in the follow-up. Working memory impairment was associated to negative psychotic symptoms and poor functional outcomes. Negative symptoms mediated the relationship between working memory and outcome. Therefore, negative symptoms should be a primary target of treatment to improve functional outcomes. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Swan, Sarah; Keen, Nadine; Reynolds, Nicola; Onwumere, Juliana
Individuals with severe mental health problems, such as psychosis, are consistently shown to have experienced high levels of past traumatic events. They are also at an increased risk of further traumatisation through victimization events such as crime and assault. The experience of psychosis itself and psychiatric hospitalization have also been recognized to be sufficiently traumatic to lead to the development of post-traumatic stress (PTS) symptoms. Rates of post-traumatic stress disorder (PTSD) are elevated in people with psychosis compared to the general population. The current guidance for the treatment of PTSD is informed by an evidence base predominately limited to populations without co-morbid psychiatric disorders. The systematic review therefore sought to present the current available literature on the use of psychological treatments targeting PTS symptoms in a population with a primary diagnosis of a psychotic disorder. The review aimed to investigate the effect of these interventions on PTS symptoms and also the effect on secondary domains such as psychotic symptoms, affect and functioning. Fifteen studies were identified reporting on cognitive behavior therapy, prolonged exposure, eye movement desensitisation and reprocessing and written emotional disclosure. The review provides preliminary support for the safe use of trauma-focused psychological interventions in groups of people with severe mental health problems. Overall, the interventions were found to be effective in reducing PTS symptoms. Results were mixed with regard to secondary effects on additional domains. Further research including studies employing sufficiently powered methodologically rigorous designs is indicated.
van Rooijen, Geeske; Isvoranu, Adela-Maria; Meijer, Carin J.; van Borkulo, Claudia D.; Ruhe, Henricus G.; de Haan, Lieuwe
Current diagnostic systems mainly focus on symptoms needed to classify patients with a specific mental disorder and do not take into account the variation in co-occurring symptoms and the interaction between the symptoms themselves. The innovative network approach aims to further our understanding
Bang, Minji; Park, Jin Young; Kim, Kyung Ran; Lee, Su Young; Song, Yun Young; Kang, Jee In; Lee, Eun; An, Suk Kyoon
To improve strategies for the early identification of individuals at a heightened risk for the development of psychosis, we investigated the relationships and interactions between 3 psychosis-proneness dimensions for the development of schizophrenia spectrum psychosis: schizotypy, basic symptoms and the ultra-high risk (UHR) criteria. Seventy-seven UHR individuals and 79 healthy controls were assessed for schizotypy and basic symptoms using self-report questionnaires at baseline. UHR participants were monthly assessed for conversion to psychosis over a mean period of 25.8 months. Sixteen UHR participants (20.8%) converted to schizophrenia spectrum psychosis. In stepwise Cox regression, the interaction between basic symptoms and physical anhedonia was selected as a sole predictor of conversion in UHR participants, whereby the self-reported number of the 8 basic symptoms significantly increased the risk for conversion in those with pronounced physical anhedonia. Our findings suggest that questionnaire-assessed basic symptoms, irrespective of their predictive validity, may predict a psychotic breakdown in pre-identified UHR individuals who are with genetic vulnerability to schizophrenia. Including all 3 psychosis-proneness dimensions into prediction models might help establish a more valid pathogenetic model of schizophrenia, and moreover, may provide some clues about course alteration strategies in hopes of preventing UHR individuals from converting to psychosis. © 2017 John Wiley & Sons Australia, Ltd.
Malcolm, Charlotte P; Picchioni, Marco M; DiForti, Marta; Sugranyes, Gisela; Cooke, Elizabeth; Joseph, Candice; McQueen, Grant; Paparelli, Alessandra; Stilo, Simona; O'Connor, Jennifer; Morgan, Craig; Murray, Robin M; Hodgins, Sheilagh
Early cannabis use has consistently been associated with an increased risk for the later development of psychosis. Studies suggest that Conduct Disorder (CD) is more common amongst young people who later go on to develop psychosis. CD has been associated with greater and earlier cannabis use in general population samples. Based on this evidence, we hypothesised that among patients experiencing their first episode of psychosis, the presence of CD symptoms prior to age 15 would be associated with cannabis use. 102 patients experiencing a first episode of psychosis were interviewed to assess CD symptoms prior to age 15 and use of cannabis and other substances. The number of CD symptoms was significantly associated with lifetime cannabis use (odds ratio=5.41 (1.76-16.57), p=0.03) and with first use of cannabis before age 14 (odds ratio=1.46 (1.12-1.92), p=0.006), after controlling for stimulant/hallucinogen use and level of education. Among patients experiencing a first episode of psychosis, CD symptoms were significantly associated with use of cannabis and with use by age 14. Among individuals vulnerable for psychosis, CD symptoms may independently increase the likelihood of cannabis use which in turn increases the risk of psychosis. Copyright © 2010 Elsevier B.V. All rights reserved.
Morcillo, C; Stochl, J; Russo, D A; Zambrana, A; Ratnayake, N; Jones, P B; Perez, J
Individuals at clinical high risk (CHR) for psychosis represent a heterogeneous group with a high rate of comorbid psychiatric disorders. There is little information on whether certain qualitative aspects of psychotic symptoms among CHR individuals may be predictive of future psychosis. This study focused on describing the prevalence of first-rank symptoms (FRS) among a sample of CHR individuals and its association with future transition to psychosis and, from a neurodevelopmental perspective, the level of adjustment of individuals at CHR during their childhood was also analysed. Participants comprised 60 individuals at CHR (according to the Comprehensive Assessment of At-Risk Mental States, CAARMS) at the time of their referral to an early intervention service and 60 healthy volunteers (HVs). All subjects were assessed by senior research clinicians using the Mini International Neuropsychiatric Interview (MINI), and the Positive and Negative Syndrome Scale (PANSS). FRS were defined according to Kurt Schneider's original classification, and information was collected from PANSS, CAARMS and clinical reports. Early premorbid functioning was measured using the Premorbid Adjustment Scale (PAS). We grouped individuals by number and type of FRS and analysed transitions to full-blown psychosis over a 2-year follow-up period. We also correlated the general social and functional adjustment of these individuals during their childhood (6-11 years of age) with the future development of mental states at CHR and FRS. Over 69% of CHR individuals had more than one DSM-IV psychiatric diagnosis, mainly within the affective and anxiety diagnostic spectra. At least one FRS was present in 43.3% of CHR individuals, and 21.6% of these had more than one. Auditory hallucinations and passivity experiences were the most commonly reported. Only 10% of individuals at CHR made a transition to first-episode psychosis (FEP) over 2 years and, except for passivity experiences, the presence of one or
Schizophrenia is increasingly viewed as a neurodevelopmental process caused by an interaction between genetic factors and environmental stressors. Prospective studies and retrospective research using objective data indicate that behavioural deviations can be dated to early infancy and cut across...... multiple behavioural domains. In adolescence, preschizophrenics exhibit subtle changes in cognition and affect as well as a variety of anomalous subjective experiences (so-called 'basic symptoms'), suggesting 'trait' status of these features. Prodromal symptoms occur in a substantial proportion...
Austin, Stephen; Mors, Ole; Budtz-Jørgensen, Esben
OBJECTIVE: Knowledge about course of illness can help clinicians to develop effective interventions and improve treatment outcomes. The goal of this study was to construct positive and negative symptom trajectories based on structured clinical assessments collected over 10years within a cohort.......05) and substance abuse (OR 3.47-5.90, psymptom trajectories (higher levels of psychotic symptoms) while poor social functioning (OR 1.34-5.55, psymptoms (OR 2.01-2.38, pdiagnosis (OR 5.70-8.86, p... with poorer negative symptom trajectories (higher levels of negative symptoms). A proportion of people displayed significant changes in symptoms several years after diagnosis. CONCLUSIONS: Trajectories of illness for positive and negative symptoms were heterogeneous among people with first episode psychosis...
Sevilla-Llewellyn-Jones, Julia; Cano-Domínguez, Pablo; de-Luis-Matilla, Antonia; Peñuelas-Calvo, Inmaculada; Espina-Eizaguirre, Alberto; Moreno-Kustner, Berta; Ochoa, Susana
Personality in patients with psychosis, and particularly its relation to psychotic symptoms in recent onset of psychosis (ROP) patients, is understudied. The aims of this research were to study the relation between dimensional and categorical clinical personality traits and symptoms, as well as the effects that symptoms, sex and age have on clinically significant personality traits. Data for these analyses were obtained from 94 ROP patients. The Millon Clinical Multiaxial Inventory and the Positive and Negative Syndrome Scale were used to assess personality and symptoms. Correlational Analysis, Mann-Whitney test, and, finally, logistic regression were carried out. The negative dimension was higher in patients with schizoid traits. The excited dimension was lower for those with avoidant and depressive traits. The anxiety and depression dimension was higher for patients with dependent traits. The positive dimension was lower for patients with histrionic and higher for patients with compulsive traits. Logistic regression demonstrated that gender and the positive and negative dimensions explained 35.9% of the variance of the schizoid trait. The excited dimension explained 9.1% of the variance of avoidant trait. The anxiety and depression dimension and age explained 31.3% of the dependent trait. Gender explained 11.6% of the histrionic trait, 14.5% of the narcissistic trait and 11.6% of the paranoid trait. Finally gender and positive dimension explained 16.1% of the compulsive trait. The study highlights the importance of studying personality in patients with psychosis as it broadens understating of the patients themselves and the symptoms suffered. Copyright © 2017 Elsevier Inc. All rights reserved.
Markeljević, Jasenka; Sarac, Helena; Rados, Marko
Lyme borreliosis is a multisystem disorder caused by Borrelia burgdorferi (Bb). Neurological symptoms such as lymphocytic meningoradiculoneuritis (Bannwart's syndrome), cranial neuritis (II,III,IV,V,VI), encephalitis, transverse myelitis are found in about 10% of cases during the second phase of the disease. In the chronic stage, many months or years after the initial infection, other neurologic complications may occur, such as encephalomyelitis, epileptic crises, cognitive impairment, peripheral neuropathy and psychiatric disturbances such as depression, anxiety, panicc attacks, catatonia, psychosis etc. Some patient continue to experience symptoms of fatigue, insomnia or psychiatric disorder in the post borrelia syndrome. We describe here a patient with a triad of unusual symptoms in chronic LNB including tremor, seizures and psychosis. Standardized medical interview, neurologic examination, neuroimaging, serum and CSF serology as well as EEG and EMNG evaluation were performed. The patient was treated with intravenous ceftriaxone and doxycycline and responded with rapid clinical and functional improvement.Newertheless, he suffered from multiple systemic and neurologic sequelas that influenced his daily activities in post treatment period. Emphasis is placed on the atypical onset and evolution, the difficulties encountered in formulating diagnosis, early treatment and the uncertainties concerning the sequelae after treatment. In patients with non-specific long lasting symptoms in the absence of overt clinical signs suggesting CNS involvement, routine treatment with i.v. ceftriaxone is not to be encouraged.
Jonathan G. Leung
Full Text Available One underrecognized adverse event of clozapine is the emergence or worsening of obsessive-compulsive symptoms (OCS. OCS, particularly violent thoughts, can be inaccurately described as psychosis and result in a misdiagnosis. We report a case of a 42-year-old man, initially diagnosed with schizoaffective, who was placed on clozapine for the management of “violent delusions.” However, clozapine led to a worsening of these violent thoughts resulting in suicidal ideation and hospitalization. After exploration of the intrusive thoughts and noting these to be egodystonic, clearly disturbing, and time consuming, an alternative diagnosis of obsessive-compulsive disorder (OCD was made. Clozapine was inevitably discontinued resulting in a significant reduction of the intrusive thoughts without emergence of psychosis or adverse events. While an overlapping phenomenology between OCD and psychotic disorders has been described, clozapine and other antiserotonergic antipsychotics have been implicated with the emergence or worsening of OCS. Unique to our case is that the patient’s obsessions had been treated as psychosis leading to the inadequate treatment of his primary illness, OCD. This case highlights the potential for OCD to masquerade as a psychotic disorder and reminds clinicians that clozapine may worsen OCS.
Glenthøj, L B; Jepsen, Jens Richardt Møllegaard; Hjorthøj, Carsten
and social skills act as mediators between neurocognition and functional outcome in UHR individuals. METHODS: Ultrahigh risk participants (N = 84) underwent neurocognitive testing using the Brief Assessment of Cognition in Schizophrenia. Social skills and negative symptoms were assessed using the High......OBJECTIVE: Neurocognition is known to impact functioning in individuals at ultrahigh risk (UHR) for psychosis, but studies investigating potential mediators of this relationship are scarce. Building on evidence from schizophrenia spectrum disorders, the study tested whether negative symptoms......-Risk Social Challenge task and the Scale for the Assessment of Negative Symptoms respectively. Four instruments were used to assess overall functioning, and one instrument assessed quality of life encompassing social functioning. RESULTS: The cross-sectional analyses revealed that neurocognition was related...
Bomhof-Roordink, Hanna; Seldenrijk, Adrie; van Hout, Hein P J; van Marwijk, Harm W J; Diamant, Michaela; Penninx, Brenda W J H
Stress experienced during childhood or adulthood has been associated with cardiovascular disease (CVD), but it is not clear whether associations are already prevalent on a subclinical cardiovascular level. This study investigates associations between indicators of life stress and subclinical CVD, and whether these are mediated by depression and anxiety. Subjects were 650 participants of the Netherlands Study of Depression and Anxiety, aged 20-66 years, with or without (27.5%) depressive and anxiety disorders. Life stress included childhood trauma, negative life events and recently experienced daily hassles or job strain. Subclinical CVD was measured as 1) carotid atherosclerosis (intima-media thickness and the presence of plaques) using B-mode ultrasonography, and 2) central arterial stiffness (heart rate normalized augmentation index) using calibrated radial applanation tonometry. Increased central arterial stiffness was shown in subjects who had experienced childhood trauma (per SD increase: β=.07; p=.01), or reported recently experienced daily hassles (per SD increase: β=.06; p=.02), negative life events (per SD increase: β=.05; p=.03), or job strain (high versus low: β=.09; p=.01). Associations between life stress and arterial stiffness appeared to be partly mediated by severity of depressive and anxiety symptoms. No significant associations were found for childhood life events, nor between indicators of life stress and carotid atherosclerosis. Childhood trauma and recent life stress were associated with increased central arterial stiffness. This suggests that life stress - partly via depression and anxiety - might enhance the development and progression of CVD. Copyright © 2015 Elsevier Inc. All rights reserved.
Bourdeau, Geneviève; Lecomte, Tania; Lysaker, Paul H
This study sought to explore the links between recovery stages, symptoms, function, and narrative development among individuals with a recent onset of psychosis. A qualitative longitudinal study was conducted including quantitative data at baseline. Forty-seven participants were administered the Indiana Psychiatric Illness Interview three times over 9 months and content analysis was performed. Participants also completed the Social Functioning Scale, the Brief Psychiatric Rating Scale--Expanded, the California Verbal Learning Test, and the Trailing Making Test at baseline. Descriptive discriminant analysis was performed. Results suggested that participants were mostly in the first two stages of recovery (moratorium, awareness) and that being in the awareness, rather than moratorium, stage was associated, to a different extent, with richer narrative development, better levels of psychosocial function, less negative and positive symptoms, and more years of education. Furthermore, recovery appeared to be a stable process over the assessment period. Recovery is a complex concept including objective and subjective aspects. In the recovery path of persons recently diagnosed with psychosis, social engagement, narrative development, and occupational functioning seem to be particularly important aspects. This study is a first step, and future research is needed with larger and more diverse participant pools, and assessments conducted over longer periods of time. As greater level of social engagement was the most robust predictor of membership in the awareness versus moratorium stage, treatment of early psychosis should include interventions targeting social relations and social skills. As greater narrative development was the second most robust predictor, enhancing it via psychotherapy could be a pertinent clinical goal. © 2014 The British Psychological Society.
Kravariti, Eugenia; Russo, Manuela; Vassos, Evangelos; Morgan, Kevin; Fearon, Paul; Zanelli, Jolanta W; Demjaha, Arsime; Lappin, Julia M; Tsakanikos, Elias; Dazzan, Paola; Morgan, Craig; Doody, Gillian A; Harrison, Glynn; Jones, Peter B; Murray, Robin M; Reichenberg, Abraham
Associations between symptom dimensions and cognition have been mainly studied in non-affective psychosis. The present study investigated whether previously reported associations between cognition and four symptom dimensions (reality distortion, negative symptoms, disorganisation and depression) in non-affective psychosis generalise to a wider spectrum of psychoses. It also extended the research focus to mania, a less studied symptom dimension. Linear and non-linear (quadratic, curvilinear or inverted-U-shaped) associations between cognition and the above five symptom dimensions were examined in a population-based cohort of 166 patients with first-onset psychosis using regression analyses. Negative symptoms showed statistically significant linear associations with IQ and processing speed, and a significant curvilinear association with verbal memory/learning. Significant quadratic associations emerged between mania and processing speed and mania and executive function. The contributions of mania and negative symptoms to processing speed were independent of each other. The findings did not differ between affective and non-affective psychoses, and survived correction for multiple testing. Mania and negative symptoms are associated with distinct patterns of cerebral dysfunction in first-onset psychosis. A novel finding is that mania relates to cognitive performance by a complex response function (inverted-U-shaped relationship). The associations of negative symptoms with cognition include both linear and quadratic elements, suggesting that this dimension is not a unitary concept. These findings cut across affective and non-affective psychoses, suggesting that different diagnostic entities within the psychosis spectrum lie on a neurobiological continuum. Copyright © 2012 Elsevier B.V. All rights reserved.
Posttraumatic stress disorder is common among patients with psychotic disorders. The present study examined the internal reliability and comparability of the Impact of Event Scale (IES) in a sample of 38 patients with first-episode psychosis and 47 controls exposed to severe physical and\\/or sexual abuse. The IES total score and both subscales showed high internal consistency in both groups (Cronbach\\'s alpha coefficients of approximately 0.9 or higher). Given their equivalent trauma reporting, the lack of differences in IES scores between patients and controls seems to indicate that patients are likely to report accurately and neither exaggerate nor minimize their posttraumatic symptoms. Overall, the findings suggest that the IES can be used to assess symptoms of posttraumatic stress in patients with psychotic disorders as in other populations.
The relevance of negative symptoms across the diagnostic spectrum of the psychoses remains uncertain. The purpose of this study was to report on prevalence of item and subscale level negative symptoms across the first episode psychosis (FEP) diagnostic spectrum in an epidemiological sample, and to ascertain whether items and subscales were more prevalent in a schizophrenia spectrum diagnoses group compared to an \\'all other psychotic diagnoses\\' group. We measured negative symptoms in 330 patients presenting with FEP using the Scale for Assessment of Negative Symptoms (SANS), and ascertained diagnosis using the Structured Clinical Interview for DSM IV. Prevalence of SANS items and subscales were tabulated across all psychotic diagnoses, and logistic regression analysis determined which items and subscales were predictive of schizophrenia spectrum diagnoses. SANS items were most prevalent in schizophrenia spectrum conditions but frequently presented in other FEP diagnoses, particularly substance induced psychotic disorder and Major Depressive Disorder. Brief psychotic disorder and bipolar disorders had low levels of negative symptoms. SANS items and subscales which significantly predicted schizophrenia spectrum diagnoses, were also frequently present in some of the other psychotic diagnoses. Conclusions: SANS items have high prevalence in FEP, and while commonest in schizophrenia spectrum conditions are not restricted to this diagnostic subgroup.
Dragt, Sara; Nieman, Dorien H.; Becker, Hiske E.; van de Fliert, Reinaud; Dingemans, Peter M.; de Haan, Lieuwe; van Amelsvoort, Thérèse A.; Linszen, Don H.
Objective: Increasing interest in the prodromal stage of schizophrenia over the past decade led us to perform our study to monitor people at high risk for developing a psychosis. We hypothesized that cannabis use or a cannabis use disorder at a younger age relates to high-risk symptoms at a younger
Full Text Available An unavoidable reciprocal influence characterizes mother-infant’s dyad.Within this relationship,the presence of depression,somatization,hostility,paranoid ideation and interpersonal sensitivity symptoms at a subclinical level and their possible input on infant motor competences has not been yet considered.Bearing in mind that motor abilities represent not only an indicator of infant’s health-status,but also the principal field to infer his/her needs, eelings and intentions,in this study the quality of infants’movements were assessed and analyzed in relationship with the maternal attitudes.The aim of this research was to investigate if/how maternal symptomatology may lead infant's motor development during his/her first year of life by observing the characteristics of motor development in infants aged 0-11months.Participants included 123 mothers and their infants (0-11months-old.Mothers’ symptomatology was screened with SymptomChecklist-90-Revised(SCL-90-R,while infants were tested with Peabody Developmental Motor Scale-Second Edition.All dyads belonged to a non-clinical population, however,on the basis of SCL-90-Rscores, mothers’sample was divided into two groups: normative and subclinical.Descriptive,T-test,correlational analysis between PDMS-2scores and SCL-90-R results are reported,as well as regression models results.Both positive and negative correlations were found between maternal perceived symptomatology,Somatization(SOM,Interpersonal Sensitivity(IS,Depression(DEP,Hostility(HOSand Paranoid Ideation(PARand infants’motor abilities.These results were then further verified by applying regression models to predict the infant motor outcomes on the basis of babies’ age and maternal status.The presence of positive symptoms in SCL-90-Rquestionnaire (subclinical group predicted good visual-motor integration and stationary competences in the babies.In particular,depressive and hostility feelings in mothers seemed to induce an infant
Full Text Available This cross-sectional study aimed at identifying the most common attributions of their mental disorder in a Mexican patients who have experienced psychosis and their relatives and exploring how having experienced or not characteristic psychotic symptoms and their present clinical status might affect their etiological attributions. Past and current symptom profiles of 66 patients were as assessed with the SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders and the PANSS (Positive and Negative Syndrome Scale, respectively. The etiological attribution of psychosis of patients (n=62 and the relatives (n=65 was assessed with the Angermeyer and Klusmann scale comprising 30 items into five categories: biology, personality, family, society, and esoteric. Patients and relatives attribute psychosis mainly to social factors. Relatives’ attributions were not influenced by clinical profile of patients, whereas in the case of patients it was only current clinical status that showed a difference, with those in nonremission scoring higher personality and family factors. Acknowledging patients’ and relatives’ beliefs about mental disorders at onset and later on is particularly important in psychosis, a mental condition with severe and/or persistent symptoms, in order to promote better involvement in treatment and in consequence efficacy and recovery.
This cross-sectional study aimed at identifying the most common attributions of their mental disorder in a Mexican patients who have experienced psychosis and their relatives and exploring how having experienced or not characteristic psychotic symptoms and their present clinical status might affect their etiological attributions. Past and current symptom profiles of 66 patients were as assessed with the SCID-I (Structured Clinical Interview for DSM-IV Axis I Disorders) and the PANSS (Positive and Negative Syndrome Scale), respectively. The etiological attribution of psychosis of patients (n = 62) and the relatives (n = 65) was assessed with the Angermeyer and Klusmann scale comprising 30 items into five categories: biology, personality, family, society, and esoteric. Patients and relatives attribute psychosis mainly to social factors. Relatives' attributions were not influenced by clinical profile of patients, whereas in the case of patients it was only current clinical status that showed a difference, with those in nonremission scoring higher personality and family factors. Acknowledging patients' and relatives' beliefs about mental disorders at onset and later on is particularly important in psychosis, a mental condition with severe and/or persistent symptoms, in order to promote better involvement in treatment and in consequence efficacy and recovery. PMID:27413550
Montreuil, Tina C; Malla, Ashok K; Joober, Ridha; Bélanger, Claude; Lepage, Martin
In psychotic disorders, a limited number of studies have documented the presence of symptoms of anxiety, especially in first-episode psychosis (FEP). There is a growing interest in better understanding how these symptoms may affect the severity of psychotic symptoms and clinical outcome. This study examined the association between symptoms of anxiety, as measured by the Hamilton Anxiety Rating Scale (HARS) and the Positive and Negative Syndrome Scale (PANSS), and short-term clinical outcome. We first examined the potential association between anxiety symptom severity among FEP patients and remission. A secondary objective explored the relation between the PANSS single item subscale 'anxiety' item and the total score value of the HARS. Data were collected on 201 FEP patients divided into remitted and unremitted groups based on clinical data at 6 months. Anxiety ratings were compared between 67 remitted and 99 unremitted patients with the HARS, and for 72 remitted and 103 unremitted patients with the (G2) PANSS. A significant interaction Time × Group was observed on the HARS and on the PANSS G2 item. Looking at the two time points specifically, groups did not significantly differ at baseline on either the HARS or the PANSS. At 6 months, these two groups were significantly different on both anxiety rating scores - HARS [t(170) = 3.48, P = 0.001)] and PANSS G2 [t(173) = 2.51, P = 0.013)]. Anxiety severity is marked in FEP, and appears to be linked to poor short-term clinical outcome. The PANSS single item (G2) seems to represent a good indicator of anxiety as it significantly correlates with a more systematic measure of anxiety, namely the HARS score. Anxiety severity appears to vary across diagnosis type. © 2013 Wiley Publishing Asia Pty Ltd.
Rössler, Wulf; Vetter, Stefan; Müller, Mario; Gallo, William Thomas; Haker, Helene; Kawohl, Wolfram; Lupi, Gianpiero; Ajdacic-Gross, Vladeta
We investigated risk factors for subclinical symptoms of psychosis, and focused on two psychosis dimensions previously identified in the Zurich Study, namely "schizophrenia nuclear symptoms" and "schizotypal signs". We examined the data from 9814 Swiss conscripts from 2003. The psychosis symptom dimensions were derived from the Symptom-Checklist-90-R (SCL-90-R), and were regressed on a broad range of known risk factors for psychosis. Risk factors typically assigned to schizophrenia and other psychotic disorders - cannabis use, childhood adversity, reading and writing difficulties, attention deficit hyperactivity disorder (ADHD), psychiatric disorders and addiction in parents and the extended family - are relevant also at subclinical levels. Our analyses suggested that specific risk factors may be assigned to distinct psychosis dimensions, as previously determined in an analysis from the Zurich Study. If there are different pathways to psychosis characterized by specific symptom dimensions and risk factors, they mostly co-exist and interact at different symptom load levels. Copyright © 2011 Elsevier Ltd. All rights reserved.
Millman, Zachary B; Pitts, Steven C; Thompson, Elizabeth; Kline, Emily R; Demro, Caroline; Weintraub, Marc J; DeVylder, Jordan E; Mittal, Vijay A; Reeves, Gloria M; Schiffman, Jason
Research suggests that social stress exposure influences illness presentation and course among youth at clinical high-risk (CHR) for psychosis, though less is known about the extent to which self-reported perceptions of social stress relate to the severity of positive symptoms. Importantly, despite the notion that youth at CHR are especially susceptible to elevations in positive symptoms under conditions of stress, no study has examined this presumption relative to other psychiatric groups. Extending previous work demonstrating that perceived social stress was higher in a CHR group than in a clinical group of non-CHR, help-seeking controls, the current study aimed to: (1) examine whether perceived social stress is related to the severity of attenuated positive symptoms in the full sample (N=110); and (2) determine whether CHR status moderates the stress-symptom relation. Exploratory analyses examined relations of perceived social stress to negative, disorganized, and general symptoms. Greater perceptions of social stress were associated with more severe positive symptoms in the entire sample; however, although positive symptoms and perceived social stress were higher in the CHR group, the strength of this relation was statistically indistinguishable across groups. No differential effect of perceived social stress was observed for any symptom domain. Results provide some support for the diathesis-stress model of psychosis, while also suggesting that social stress and symptomatology are related independent of clinical vulnerability to psychosis. Future research would benefit from longitudinal studies of stress-symptom relations across CHR and help-seeking control groups. Copyright © 2017 Elsevier B.V. All rights reserved.
Kloos, M W; Tiemens, B G; Hutschemaekers, G J M
Our study was motivated mainly by the results from nemesis-2 which showed that four out of ten patients in ambulantory mental health care had not had any mental disorder in the previous 12 months. A dsm-iv classification of the symptoms of patients is required for receiving insured mental health care. To find out whether patients who attended a mental health generalistic or specialised clinic had a dsm-classified mental disorder and to assess the severity of these patients' symptoms. We have given specific attention to the characteristics of patients with subclinical symptoms who turned up at the mental health care clinics. dsm-iv disorders of patients in mental health care were studied by means of the mini 5.0.0 (n = 3072). The oq-45 was used to determine the severity of symptoms in both generalistic (n = 2255) and specialised mental health care (n = 5009). Logistical regression was used to determine the differences between the characteristics of patients who had clinical scores and those of patients who had subclinical scores. For this purpose we also used anonymised data from the personal health records. During the intake procedure at specialised mental health care clinics only 14.3 % of patients failed to meet the diagnostic criteria of a dsm-iv disorder. Also, 56.5 % of patients seen by a mental health generalist and 70,9 % of patients seen by a mental health specialist had high or very high symptomatic distress, according the oq-45. The proportion of patients with a dsm-iv disorder varied from 52.9 % for patients with subclinical oq-45 scores to 94.8 % for patients with very high oq-45 scores. Predictors of patients with subclinical oq-45 scores were similar in generalistic and specialised mental health care. Only a small number of patients in specialised care did not have an axis 1 dsm-iv diagnosis. Most patients in generalistic and specialised mental health care reported severe symptomatic distress. Symptoms mentioned by patients with subclinical oq
Bomhof-Roordink, Hanna; Seldenrijk, Adrie; van Hout, Hein P. J.; van Marwijk, Harm W. J.; Diamant, Michaela; Penninx, Brenda W. J. H.
Background: Stress experienced during childhood or adulthood has been associated with cardiovascular disease (CVD), but it is not clear whether associations are already prevalent on a subclinical cardiovascular level. This study investigates associations between indicators of life stress and
Garner, Belinda; Phassouliotis, Christina; Phillips, Lisa J; Markulev, Connie; Butselaar, Felicity; Bendall, Sarah; Yun, Yang; McGorry, Patrick D
Dehydroepiandrosterone (DHEA) and its sulphate form (DHEA) are neuroactive steroids with antiglucocorticoid properties. An imbalance in the ratio of cortisol to DHEA(S) has been implicated in the pathophysiology of stress-related psychiatric disorders. This study prospectively investigated circulating cortisol, DHEAS and their ratio in first-episode psychosis (FEP) patients compared to healthy controls, and their relationship to perceived stress, psychotic, negative and mood symptoms. Blood cortisol and DHEAS levels were obtained in 39 neuroleptic-naïve or minimally-treated FEP patients and 25 controls. Twenty-three patients and 15 controls received repeat assessments after 12 weeks. Perceived stress was assessed using the Perceived Stress Scale and symptoms were assessed in patients using standard rating scales. At baseline, no differences were observed in cortisol, DHEAS or the cortisol/DHEAS ratio between patients and controls. There were also no group differences in the change in these biological variables during the study period. Within FEP patients, decreases in cortisol and the cortisol/DHEAS ratio over time were directly related to the improvement in depression (r = 0.45; p = 0.031, r = 0.52; p = 0.01), negative (r = 0.51; p = 0.006, r = 0.55; p = 0.008) and psychotic symptoms (cortisol only, r = 0.53; p = 0.01). Perceived stress significantly correlated with DHEAS (r = 0.51; p = 0.019) and the cortisol/DHEAS ratio (r = -0.49; p = 0.024) in controls, but not patients, possibly reflecting an impaired hormonal response to stress in FEP patients. These findings further support the involvement of the stress system in the pathophysiology of psychotic disorders, with implications for treatment strategies that modulate these neurosteroids. Copyright Â© 2010 Elsevier Ltd. All rights reserved.
Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES). Results Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression. Conclusion There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations. PMID:21854599
Full Text Available Abstract Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis research study (TOP were included at first treatment. The Positive and Negative Syndrome Scale (PANSS was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS and self-esteem by the Rosenberg Self-Esteem Scale (RSES. Results Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression. Conclusion There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations.
Maraj, Anika; Anderson, Kelly K; Flora, Nina; Ferrari, Manuela; Archie, Suzanne; McKenzie, Kwame J
To assess variability in symptom presentation and explanatory models of psychosis for people from different ethnic groups. Clients with first-episode psychosis (n = 171) who identified as black African, black Caribbean or white European were recruited from early intervention programmes in Toronto and Hamilton. We compared results by ethnic group for symptom profiles and explanatory models of illness. Clients of black Caribbean origin had a lower odds of reporting that they were speaking incomprehensibly (OR = 0.36; 95% CI: 0.14-0.90) and black African clients had a greater odds of reporting persistent aches or pains (OR = 2.92; 95% CI: 1.32-6.50). Black African clients had a lower odds of attributing the cause of psychosis to hereditary factors (OR = 0.41; 95% CI: 0.19-0.89) or to substance abuse (OR = 0.29; 95% CI: 0.13-0.67) and had a lower odds of assigning responsibility for their illness to themselves (OR = 0.41; 95% CI: 0.19-0.89). Understanding the differences in illness models for ethnic minority groups may help improve the cultural competence of mental health services. © 2015 Wiley Publishing Asia Pty Ltd.
Bozikas, Vasilis P; Ntouros, Evangelos; Andreou, Christina; Nazlidou, Elena-Ioanna; Floros, George; Tsoura, Ekaterini; Garyfallos, George
The aim of the present study was to investigate the effects of comorbid obsessive-compulsive symptoms (OCS) on the perception of insincere speech (e.g., sarcasm and white lies) in patients with first-episode psychosis. Participants were 65 patients with nonaffective first-episode psychosis (FEP) and 47 healthy controls. The patient group was divided into two subgroups, those with (FEP+; n= 38) and those without OCS (FEP-; n = 27). The ability to process sarcasm and lie was assessed with the Perception of Social Inference Test (PESIT). Severity of psychotic symptoms and OCS was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), respectively. Deficits in the perception of sarcasm and lie were confirmed in patients with nonaffective first-episode psychosis compared to healthy controls. In patients, comorbidity with OCS was associated with worse performance on certain aspects of insincere speech (i.e., lie) compared to FEP- patients. Y-BOCS scores correlated significantly with the perception of lying. The cognitive factor of the PANSS predicted accuracy on the perception of sincere speech, paradoxical sarcasm, and white lies, while the presence of OCS predicted accuracy on the perception of sincere speech and white lies. Our finding of impaired counterfactual information processing in patients with first-episode psychosis suggests that these deficits are already present at illness onset. Presence of OCS appears to have additional deleterious effects on the successful interpretation of intentional lying, further supporting that these patients are characterized by more extensive cognitive impairment.
Carré, Arnaud; Gierski, Fabien; Lemogne, Cédric; Tran, Eric; Raucher-Chéné, Delphine; Béra-Potelle, Céline; Portefaix, Christophe; Kaladjian, Arthur; Pierot, Laurent; Besche-Richard, Chrystel; Limosin, Frédéric
Social anxiety disorder (SAD), which is characterized by the fear of being rejected and negatively evaluated, involves altered brain activation during the processing of negative emotions in a social context. Although associated temperament traits, such as shyness or behavioral inhibition, have been studied, there is still insufficient knowledge to support the dimensional approach, which assumes a continuum from subclinical to clinical levels of social anxiety symptoms. This study used functional magnetic resonance imaging (fMRI) to examine the neural bases of individual differences in social anxiety. Our sample included participants with both healthy/subclinical as well as clinical levels of social anxiety. Forty-six participants with a wide range of social anxiety levels performed a gender decision task with emotional facial expressions during fMRI scanning. Activation in the left anterior insula and right lateral prefrontal cortex in response to angry faces was positively correlated with the level of social anxiety in a regression analysis. The results substantiate, with a dimensional approach, those obtained in previous studies that involved SAD patients or healthy and subclinical participants. It may help to refine further therapeutic strategies based on markers of social anxiety. © The Author (2013). Published by Oxford University Press. For Permissions, please email: email@example.com.
Benning, Stephen D; Ait Oumeziane, Belel
Multiple models of aberrant emotional processing in depression have been advanced. However, it is unclear which of these models best applies to emotional disturbances in subclinical depressive symptoms. The current study employed a battery of psychophysiological measures and emotional ratings in a picture-viewing paradigm to examine whether the underarousal, low positive emotion, heightened negative emotion, or emotion context insensitivity model of emotional dysfunction in subclinical depressive symptoms received greatest support. Postauricular reflex and skin conductance response potentiation for pleasant minus neutral pictures (measuring low positive emotion), overall skin conductance magnitude and late positive potential (LPP) amplitude (measuring underarousal), and pleasant minus aversive valence ratings (measuring emotion context insensitivity) and aversive minus neutral arousal ratings (measuring heightened negative emotionality) were all negatively related to depressive symptomatology. Of these, postauricular reflex potentiation and overall LPP amplitude were incrementally associated with depressive symptoms over the other measures. Postauricular reflex potentiation, overall skin conductance magnitude, and aversive minus neutral arousal ratings were incrementally associated with depressive symptomatology after controlling for other symptoms of internalizing disorders. Though no model was unequivocally superior, the low positive emotion and underarousal models received the most support from physiological measures and symptom reports, with self-report data matching patterns consistent with the emotion context insensitivity model. © 2017 Society for Psychophysiological Research.
Seddon, Jennifer L; Birchwood, Max; Copello, Alex; Everard, Linda; Jones, Peter B; Fowler, David; Amos, Tim; Freemantle, Nick; Sharma, Vimal; Marshall, Max; Singh, Swaran P
The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode of psychosis (FEP) and the link with symptomatic course and outcome over 1 year post psychosis onset. One thousand twenty-seven FEP patients were recruited upon inception to specialized early intervention services (EIS) for psychosis in the United Kingdom. Participants completed assessments at baseline, 6 and 12 months. The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psychosocial functioning. Continued use of cannabis following the FEP was associated with poorer outcome at 1 year for Positive and Negative Syndrome Scale total score, negative psychotic symptoms, depression and psychosocial functioning, an effect not explained by age, gender, duration of untreated psychosis, age of psychosis onset, ethnicity or other substance use. This is the largest cohort study of FEP patients receiving care within EIS. Cannabis use, particularly "continued use," was associated with poorer symptomatic and functional outcome during the FEP. The results highlight the need for effective and early intervention for cannabis use in FEP. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Seddon, Jennifer L.; Birchwood, Max; Copello, Alex; Everard, Linda; Jones, Peter B.; Fowler, David; Amos, Tim; Freemantle, Nick; Sharma, Vimal; Marshall, Max; Singh, Swaran P.
Objective: The use of cannabis during the early stage of psychosis has been linked with increased psychotic symptoms. This study aimed to examine the use of cannabis in the 12 months following a first-episode of psychosis (FEP) and the link with symptomatic course and outcome over 1 year post psychosis onset. Design and Setting: One thousand twenty-seven FEP patients were recruited upon inception to specialized early intervention services (EIS) for psychosis in the United Kingdom. Participants completed assessments at baseline, 6 and 12 months. Results: The results indicate that the use of cannabis was significantly associated with increased severity of psychotic symptoms, mania, depression and poorer psychosocial functioning. Continued use of cannabis following the FEP was associated with poorer outcome at 1 year for Positive and Negative Syndrome Scale total score, negative psychotic symptoms, depression and psychosocial functioning, an effect not explained by age, gender, duration of untreated psychosis, age of psychosis onset, ethnicity or other substance use. Conclusion: This is the largest cohort study of FEP patients receiving care within EIS. Cannabis use, particularly “continued use,” was associated with poorer symptomatic and functional outcome during the FEP. The results highlight the need for effective and early intervention for cannabis use in FEP. PMID:26536902
Rund, Bjørn Rishovd; Melle, Ingrid; Friis, Svein
The authors examined the relationship of neurocognitive function with duration of untreated psychosis, premorbid illness factors, and clinical symptoms to determine whether long duration of untreated psychosis independently compromises cognitive function.......The authors examined the relationship of neurocognitive function with duration of untreated psychosis, premorbid illness factors, and clinical symptoms to determine whether long duration of untreated psychosis independently compromises cognitive function....
Russo, Debra A; Stochl, Jan; Hodgekins, Joanne; Iglesias-González, Maria; Chipps, Penelope; Painter, Michelle; Jones, Peter B; Perez, Jesus
Evidence suggests that attachment styles may influence subclinical psychosis phenotypes (schizotypy) and affective disorders and may play a part in the association between psychosis and childhood adversity. However, the role of attachment in the initial stages of psychosis remains poorly understood. Our main aim was to describe and compare attachment styles in 60 individuals at ultra high risk for psychosis (UHR) and a matched sample of 60 healthy volunteers (HV). The HV had lower anxious and avoidant attachment scores than the UHR individuals (p attachment. In the HV group, depression, anxiety, schizotypy paranoia, and social anxiety were correlated with insecure attachment. This difference and some discrepancies with previous studies involving UHR suggest that individuals at UHR may compose a heterogeneous group; some experience significant mood and/or anxiety symptoms that may not be explained by specific attachment styles. Nonetheless, measuring attachment in UHR individuals could help maximize therapeutic relationships to enhance recovery. © 2017 The British Psychological Society.
Full Text Available Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their pathophysiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble
Full Text Available Here we report the results of a pilot study investigating the relative and combined effects of a 12 week course of clozapine and CBT in first-episode psychosis patients with prominent ongoing positive symptoms following their initial treatment. Patients from our early psychosis service who met the inclusion criteria (=48 were randomized to one of four treatment groups: clozapine, clozapine plus CBT, thioridazine, or thioridazine plus CBT. The degree of psychopathology and functionality of all participants was measured at baseline then again at 6, 12 and 24 weeks, and the treatment outcomes for each group determined by statistical analysis. A substantial proportion (52% of those treated with clozapine achieved symptomatic remission, as compared to 35% of those who were treated with thioridazine. Overall, those who received clozapine responded more rapidly to treatment than those receiving the alternative treatments. Interestingly, during the early treatment phase CBT appeared to reduce the intensity of both positive and negative symptoms and thus the time taken to respond to treatment, as well having as a stabilizing effect over time.
D'Souza, Deepak Cyril; Radhakrishnan, Rajiv; Sherif, Mohamed; Cortes-Briones, Jose; Cahill, John; Gupta, Swapnil; Skosnik, Patrick D; Ranganathan, Mohini
There is growing interest in the relationship between cannabis and psychosis. The link between cannabis use and psychosis comprises three distinct relationships: acute psychosis associated with cannabis intoxication, acute psychosis that lasts beyond the period of acute intoxication, and persistent psychosis not time-locked to exposure. Experimental studies reveal that cannabis, tetrahydrocannabinol (THC) and synthetic cannabinoids reliably produce transient positive, negative, and cognitive symptoms in healthy volunteers. Case-studies indicate that cannabinoids can induce acute psychosis which lasts beyond the period of acute intoxication and persisting as long as a month. Exposure to cannabis in adolescence is associated with an increased risk for later psychotic disorder in adulthood; this association is consistent, somewhat specific, shows a dose-response, and is biologically plausible. The link between cannabinoids and psychosis is greater with earlier age of exposure to cannabinoids, childhood abuse and genetic vulnerability. However, cannabinoids are neither necessary nor sufficient to cause a persistent psychotic disorder. More likely cannabinoids are a 'component cause' interacting with other known (family history) and unknown factors to result in psychosis outcomes. While more research is needed to better understand the relationship between cannabinoid use and psychosis, and the neural underpinnings of this link, clinicians should be mindful of the potential risk of psychosis especially in vulnerable populations, including adolescents and those with a psychosis diathesis. Copyright© Bentham Science Publishers; For any queries, please email at email@example.com.
Haug Elisabeth; Hansen Charlotte; Rossberg Jan; Romm Kristin; Andreassen Ole A; Melle Ingrid
Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis...
McHugh, M J; McGorry, P D; Yung, A R; Lin, A; Wood, S J; Hartmann, J A; Nelson, B
Cannabis use shows a robust dose-dependent relationship with psychosis risk among the general population. Despite this, it has been difficult to link cannabis use with risk for transitioning to a psychotic disorder among individuals at ultra-high risk (UHR) for psychosis. The present study examined UHR transition risk as a function of cannabis use characteristics which vary substantially between individuals including age of first use, cannabis abuse severity and a history of cannabis-induced attenuated psychotic symptoms (APS). Participants were 190 UHR individuals (76 males) recruited at entry to treatment between 2000 and 2006. They completed a comprehensive baseline assessment including a survey of cannabis use characteristics during the period of heaviest use. Outcome was transition to a psychotic disorder, with mean time to follow-up of 5.0 years (range 2.4-8.7 years). A history of cannabis abuse was reported in 58% of the sample. Of these, 26% reported a history of cannabis-induced APS. These individuals were 4.90 (95% confidence interval 1.93-12.44) times more likely to transition to a psychotic disorder (p = 0.001). Greater severity of cannabis abuse also predicted transition to psychosis (p = 0.036). However, this effect was mediated by higher abuse severity among individuals with a history of cannabis-induced APS. Findings suggest that cannabis use poses risk in a subpopulation of UHR individuals who manifest cannabis-induced APS. Whether this reflects underlying genetic vulnerability requires further study. Nevertheless, findings reveal an important early marker of risk with potentially significant prognostic utility for UHR individuals.
Arzu Yagiz On
Full Text Available Background: Post-polio syndrome (PPS is a condition that affects polio survivors decades after recovery from an initial acute attack. It is a well-known entity that limbs thought to be nonaffected by polio survivors commonly demonstrate electromyography (EMG evidence of prior polio. Although the diagnosis of PPS requires a remote history of acute paralytic polio, clinically unapparent damage caused by poliovirus can be associated with PPS later in life. Objective: To evaluate EMG abnormalities and late progressive symptoms in limbs thought to be nonaffected by polio survivors, in order to determine the prevalence of subclinical motor neuron involvement in those fulfilling criteria for PPS comparing to those without such symptoms. Materials and Methods: Clinical and EMG findings of 464 limbs in 116 polio survivors who had been admitted to our clinic were analyzed. Affection of the limbs by polio was classified based on the patient′s self-report on remote weakness during the acute phase of poliomyelitis, muscle strength measured by manual muscle testing, and four-limb needle EMG. Results: Seventy-six of the patients (65.5% met the criteria of PPS. Needle EMG studies revealed subclinical involvement in 122 out of 293 (42% limbs with no history of remote weakness during the acute phase of poliomyelitis. Prevalence of subclinical involvement was found 47% in polio survivors who met the criteria of PPS compared to 33% in those without PPS (P = 0.013. Among the limbs that had developed new weakness in PPS patients, 33.5% had subclinical involvement. Discussion and Conclusion: Subclinical involvement is common in limbs thought to be nonaffected by polio survivors, and this is especially present in those fulfilling criteria for PPS. New muscle weakness may develop in apparently nonaffected, subclinically involved muscles. Thus we believe that four-limb EMG studies should be performed in all polio survivors, especially in those with the symptoms of PPS.
Jessica A. Bernard
Full Text Available Prospective longitudinal evaluation of adolescents at ultra-high-risk (UHR for the development of psychosis enables an enriched neurodevelopmental perspective of disease progression in the absence of many of the factors that typically confound research with formally psychotic patients (antipsychotic medications, drug/alcohol dependence. The cerebellum has been linked to cognitive dysfunction and symptom severity in schizophrenia and recent work from our team suggests that it is a promising target for investigation in UHR individuals as well. However, the cerebellum and cerebello-thalamo-cortical networks have not been investigated developmentally or with respect to disease progression in this critical population. Further, to date, the types of longitudinal multimodal connectivity studies that would substantially inform our understanding of this area have not yet been conducted. In the present investigation 26 UHR and 24 healthy control adolescents were administered structured clinical interviews and scanned at baseline and then again at 12-month time points to investigate both functional and structural connectivity development of cerebello-thalamo-cortical networks in conjunction with symptom progression. Our results provide evidence of abnormal functional and structural cerebellar network development in the UHR group. Crucially, we also found that cerebello-thalamo-cortical network development and connectivity at baseline are associated with positive symptom course, suggesting that cerebellar networks may be a biomarker of disease progression. Together, these findings provide support for neurodevelopmental models of psychotic disorders and suggest that the cerebellum and respective networks with the cortex may be especially important for elucidating the pathophysiology of psychosis and highlighting novel treatment targets.
Spidel, Alicia; Lecomte, Tania; Kealy, David; Daigneault, Isabelle
Acceptance and Commitment Therapy (ACT) has shown effectiveness for individuals with psychosis and individuals with a history of childhood trauma, but has not been investigated with people with psychosis who also have a history of childhood trauma. This study aims at determining the efficacy of a mindfulness-based ACT with this clientele in diminishing psychiatric symptoms, trauma-related symptoms, as well as in improving treatment adherence. Fifty participants meeting our inclusion criteria were recruited and randomized to take part in either 10 sessions of ACT group, or Treatment as Usual (TAU). Using RCT it was found that symptom severity, for both overall symptoms (BPRS) and anxiety (GAD), decreased over the course of the treatment, and participants' ability to regulate their emotional reactions (i.e., accept them) increased. The study also found that treatment engagement increased with regards to help-seeking for those in the ACT group, compared with the TAU controls. Acceptance and Commitment Therapy offered in a group appears a promising treatment for those with psychosis and history of trauma. To understand the benefits of ACT with those who suffer from psychosis and a history of trauma. To further the understanding of the effectiveness of ACT. © 2017 The British Psychological Society.
Veling, W; Counotte, J; Pot-Kolder, R; van Os, J; van der Gaag, M
Childhood trauma is associated with higher risk for mental disorders, including psychosis. Heightened sensitivity to social stress may be a mechanism. This virtual reality study tested the effect of childhood trauma on level of paranoid ideations and distress in response to social stress, in interaction with psychosis liability and level of social stress exposure. Seventy-five individuals with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) and 95 individuals with lower psychosis liability (42 siblings and 53 controls) were exposed to a virtual café in five experiments with 0-3 social stressors (crowded, other ethnicity and hostility). Paranoid ideation was measured after each experiment. Subjective distress was self-rated before and after experiments. Multilevel random regression analyses were used to test main effects of childhood trauma and interaction effects. Childhood trauma was more prevalent in individuals with higher psychosis liability, and was associated with higher level of (subclinical) psychotic and affective symptoms. Individuals with a history of childhood trauma responded with more subjective distress to virtual social stress exposures. The effects of childhood trauma on paranoia and subjective distress were significantly stronger when the number of virtual environmental stressors increased. Higher psychosis liability increased the effect of childhood trauma on peak subjective distress and stress reactivity during experiments. Childhood trauma is associated with heightened social stress sensitivity and may contribute to psychotic and affective dysregulation later in life, through a sensitized paranoid and stress response to social stressors.
Riehle, Marcel; Lincoln, Tania M
The negative symptoms of schizophrenia are related to lower social functioning even in non-clinical samples, but little is known about the distinct social consequences of motivational and expressive negative symptoms. In this study we focused on expressive negative symptoms and examined how these symptoms and varying degrees of pro-social facial expressiveness (smiling and mimicry of smiling) relate to the social evaluations by face-to-face interaction partners and to social support. We examined 30 dyadic interactions within a sample of non-clinical participants (N = 60) who were rated on motivational and expressive negative symptoms with the Clinical Assessment Interview for Negative Symptoms (CAINS). We collected data on both interaction partners' smiling-muscle (zygomaticus major) activation simultaneously with electromyography and assessed the general amount of smiling and the synchrony of smiling muscle activations between interaction partners (mimicry of smiling). Interaction partners rated their willingness for future interactions with each other after the interactions. Interaction partners of participants scoring higher on expressive negative symptoms expressed less willingness for future interactions with these participants (r = -0.37; p = 0.01). Smiling behavior was negatively related to expressive negative symptoms but also explained by motivational negative symptoms. Mimicry of smiling and both negative symptom domains were also associated with participants' satisfaction with their social support network. Non-clinical sample with (relatively) low levels of symptoms. Expressive negative symptoms have tangible negative interpersonal consequences and directly relate to diminished pro-social behavior and social support, even in non-clinical samples. Copyright © 2017 Elsevier Ltd. All rights reserved.
Full Text Available Abstract Background Neuropsychiatric symptoms such as psychosis are prevalent in patients with probable Alzheimer’s disease (AD and are associated with increased morbidity and mortality. Because these disabling symptoms are generally not well tolerated by caregivers, patients with these symptoms tend to be institutionalized earlier than patients without them. The identification of protective and risk factors for neuropsychiatric symptoms in AD would facilitate the development of more specific treatments for these symptoms and thereby decrease morbidity and mortality in AD. The E4 allele of the apolipoprotein E (APOE gene is a well-documented risk factor for the development of AD. However, genetic association studies of the APOE 4 allele and BPS in AD have produced conflicting findings. Methods This study investigates the association between APOE and neuropsychiatric symptoms in a large sample of clinically well-characterized subjects with probable AD (n=790 who were systematically evaluated using the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD Behavioral Rating Scale for Dementia (BRSD. Results Our study found that hallucinations were significantly more likely to occur in subjects with no APOΕ4 alleles than in subjects with two Ε4 alleles (15% of subjects and 5% of subjects, respectively; p=.0066, whereas there was no association between the occurrence of delusions, aberrant motor behavior, or agitation and the number of Ε4 alleles. However, 94% of the subjects with hallucinations also had delusions (D+H. Conclusion These findings suggest that in AD the Ε4 allele is differentially associated with D+H but not delusions alone. This is consistent with the hypothesis that distinct psychotic subphenotypes may be associated with the APOE allele.
Full Text Available Few studies have examined the trajectories of symptom severity in first episode psychosis (FEP and their impact on functioning. This study aimed to identify discrete trajectories of positive, negative and general psychopathological symptoms and functioning, determine predictors of the identified symptom trajectories and subsequently investigate the relationship between symptom and functioning trajectories over the 2-year follow-up period.Data were extracted from the Singapore Early Psychosis Intervention Programme clinical database. Trajectories of the Positive and Negative Syndrome Scale and Global Assessment of Functioning (GAF scale over the two-year follow up were modelled using latent class growth curve modelling.Two distinct trajectories (early response and stable trajectory and delayed response trajectory for positive symptoms, four distinct trajectories (early response and stable trajectory, early response and relapse trajectory, slower response and no response trajectory and delayed response trajectory for negative and general psychopathology symptoms and three distinct trajectories for functioning (high functioning trajectory, moderately stable functioning trajectory and deterioration in functioning trajectory were identified in our sample. Compared to individuals in the early response and stable trajectory, those in the delayed response trajectory for positive and negative symptoms, early response and relapse for negative and general psychopathology symptoms and slower response and no response trajectories for general psychopathology symptoms were significantly associated with higher odds of having deterioration in functioning over time. Poor symptom trajectories were also significantly predicted by younger age, male gender, unemployed and economically inactive status, lower education, longer duration of untreated psychosis and diagnosis of schizophrenia spectrum and delusional disorders.The results confirm that the symptoms
Abdin, Edimansyah; Chong, Siow Ann; Vaingankar, Janhavi Ajit; Peh, Chao Xu; Poon, Lye Yin; Rao, Sujatha; Verma, Swapna; Subramaniam, Mythily
Few studies have examined the trajectories of symptom severity in first episode psychosis (FEP) and their impact on functioning. This study aimed to identify discrete trajectories of positive, negative and general psychopathological symptoms and functioning, determine predictors of the identified symptom trajectories and subsequently investigate the relationship between symptom and functioning trajectories over the 2-year follow-up period. Data were extracted from the Singapore Early Psychosis Intervention Programme clinical database. Trajectories of the Positive and Negative Syndrome Scale and Global Assessment of Functioning (GAF) scale over the two-year follow up were modelled using latent class growth curve modelling. Two distinct trajectories (early response and stable trajectory and delayed response trajectory) for positive symptoms, four distinct trajectories (early response and stable trajectory, early response and relapse trajectory, slower response and no response trajectory and delayed response trajectory) for negative and general psychopathology symptoms and three distinct trajectories for functioning (high functioning trajectory, moderately stable functioning trajectory and deterioration in functioning trajectory) were identified in our sample. Compared to individuals in the early response and stable trajectory, those in the delayed response trajectory for positive and negative symptoms, early response and relapse for negative and general psychopathology symptoms and slower response and no response trajectories for general psychopathology symptoms were significantly associated with higher odds of having deterioration in functioning over time. Poor symptom trajectories were also significantly predicted by younger age, male gender, unemployed and economically inactive status, lower education, longer duration of untreated psychosis and diagnosis of schizophrenia spectrum and delusional disorders. The results confirm that the symptoms trajectories among
Gaudiano, Brandon A.; Herbert, James D.; Hayes, Steven C.
Cognitive and behavioral interventions have been shown to be efficacious when used as an adjunct to pharmacotherapy for psychotic disorders. However, little previous research has investigated potential mediators of change in psychological treatments for psychosis. Acceptance and mindfulness-based therapies do not focus on directly reducing the psychotic symptoms themselves, but instead attempt to alter the patient’s relationship to symptoms to decrease their negative impact. The current study examined this issue with data from a previously published randomized trial comparing brief treatment with Acceptance and Commitment Therapy (ACT) versus treatment as usual for hospitalized patients with psychotic symptoms (Gaudiano & Herbert, 2006a). Results showed that the believability of hallucinations at post-treatment statistically mediated the effect of treatment condition on hallucination-related distress. Hallucination frequency did not mediate outcome. The current study is a first step toward understanding the potential mechanisms of action in psychological treatments for psychosis. PMID:21035617
Compton, Michael T; Potts, Amy A; Wan, Claire Ramsay; Ionescu, Dawn Flosnik
Remarkably little is known about patterns of emergence of specific symptoms in the early course of nonaffective psychotic disorders. Some 159 well-characterized first-episode psychosis patients were categorized into those with: (1) delusions only (n=29, 18.2%); (2) delusions that emerged at least 1 month before hallucinations (n=31, 19.5%); (3) hallucinations that began at least 1 month before delusions (n=26, 16.4%); and (4) delusions and hallucinations that emerged concomitantly, within the same month (n=73, 45.9%). These four groups were compared across a number of clinical features, including duration of untreated psychosis, symptom severity, insight, and functioning, while controlling for potential confounders. Patients with delusions and hallucinations emerging within the same month had a shorter duration of untreated psychosis than those in whom one psychotic symptom emerged greater than one month before the other. The delusions-only group had significantly less severe positive, negative, and general psychopathology symptom scores, as well as better social and occupational functioning. Replication and further elucidation of specific patterns of symptom emergence would deepen the field's understanding of early-course phenomenology, and may inform efforts to improve upon nosology, prognostication, and treatment selection. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Koutra, Katerina; Triliva, Sofia; Roumeliotaki, Theano; Basta, Maria; Lionis, Christos; Vgontzas, Alexandros N
The aim of the present study was to assess the relationship between illness-related characteristics, such as symptom severity and psychosocial functioning, and specific aspects of family functioning both in patients experiencing their first episode of psychosis (FEP) and chronically ill patients. A total of 50 FEP and 50 chronic patients diagnosed with schizophrenia or bipolar disorder (most recent episode manic severe with psychotic features) and their family caregivers participated in the study. Family functioning was evaluated in terms of cohesion and flexibility (FACES IV Package), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Patients' symptom severity (BPRS) and psychosocial functioning (GAS) were assessed by their treating psychiatrist within 2 weeks from the caregivers' assessment. Increased symptom severity was associated with greater dysfunction in terms of family cohesion and flexibility (β coefficient -0.13; 95 % CI -0.23, -0.03), increased caregivers' EE levels on the form of emotional overinvolvement (β coefficient 1.03; 95 % CI 0.02, 2.03), and psychological distress (β coefficient 3.37; 95 % CI 1.29, 5.45). Family burden was found to be significantly related to both symptom severity (β coefficient 3.01; 95 % CI 1.50, 4.51) and patient's functioning (β coefficient -2.04; 95 % CI -3.55, -0.53). No significant interaction effect of chronicity was observed in the afore-mentioned associations. These findings indicate that severe psychopathology and patient's low psychosocial functioning are associated with poor family functioning. It appears that the effect for family function is significant from the early stages of the illness. Thus, early psychoeducational interventions should focus on patients with severe symptomatology and impaired functioning and their families.
Gindt, Morgane; Chanquoy, Lucile; Garcia, René
In adults, pathologies of anxiety such as posttraumatic stress symptoms (PTSS) involve deficits in information processing that may reflect hypervigilance and deficient inhibitory control, specifically for negative information. However, little is known about inhibitory processing in children, particularly regarding the inhibition of emotional information. This study investigated whether children with PTSS or anxiety show impairments in executive control in an inhibition task. A total of 45 children (M age = 9.2 year, SD = 0.7, range: 8-11) completed an inhibition task involving emotional-happy, angry, and fearful-and neutral stimuli and clinical scales for PTSS and anxiety. The results indicated that the percentage of correct answers was modulated by PTSS status, particularly in the happiness task. PTSS and anxiety altered the inhibition of fearful information in children. These data suggest different types of inhibitory deficits depending on clinical symptoms, and implications are discussed. © The Author(s) 2016.
Perlman, Greg; Kotov, Roman; Fu, Jinmiao; Bromet, Evelyn J; Fochtmann, Laura J; Medeiros, Helena; Pato, Michele T; Pato, Carlos N
Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Whitton, Alexis E; Henry, Julie D
Comorbid obsessive-compulsive (OC) symptoms in individuals with a primary diagnosis of schizophrenia are related to poorer cognitive performance and functional outcomes, but no study to date has assessed whether this comorbidity might also have implications for social cognition. The aim of the present study was to provide the first test of this possibility. Individuals with schizophrenia (n = 34) and demographically matched non-clinical controls (n = 44) were assessed on two of the most important aspects of social cognitive function (1) facial affect recognition and (2) theory of mind, alongside more standard measures of cognitive function. The presence of OC symptoms was related to poorer performance on some of the cognitive measures, as well as one of the social cognitive measures (facial affect recognition). However, these relationships disappeared after controlling for scores on more general indices of schizophrenia psychopathology. The presence of OC symptoms in schizophrenia is not only associated with increased cognitive impairment but also increased difficulties with at least some aspects of social cognitive function. However, these relationships appear to reflect the elevated levels of psychopathology seen in this cohort more generally, rather than being uniquely attributable to OC symptomatology. © 2012 The British Psychological Society.
Veling, Wim; Pot-Kolder, Roos; Counotte, Jacqueline; van Os, Jim; van der Gaag, Mark
The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 siblings of patients with psychosis, and 53 controls walked 5 times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Paranoia about virtual humans and subjective distress in response to virtual social stress exposures were measured with State Social Paranoia Scale (SSPS) and self-rated momentary subjective distress (SUD), respectively. Pre-existing (subclinical) symptoms were assessed with the Community Assessment of Psychic Experiences (CAPE), Green Paranoid Thoughts Scale (GPTS) and the Social Interaction Anxiety Scale (SIAS). Paranoia and subjective distress increased with degree of social stress in the environment. Psychosis liability and pre-existing symptoms, in particular negative affect, positively impacted the level of paranoia and distress in response to social stress. These results provide experimental evidence that heightened sensitivity to environmental social stress may play an important role in the onset and course of psychosis. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Jorien van der Velde
Full Text Available Alexithymia is a personality construct denoting emotion processing problems. It has been suggested to encompass two dimensions: a cognitive and affective dimension. The cognitive dimension is characterized by difficulties in identifying, verbalizing and analyzing emotions, while the affective dimension reflects the level of emotional arousal and imagination. Alexithymia has been previously proposed as a risk factor for developing psychosis. More specifically, the two alexithymia dimensions might be differentially related to the vulnerability for psychosis. Therefore, we examined the two dimensions of alexithymia, measured with the BVAQ in 94 siblings of patients with schizophrenia, 52 subjects at ultra-high risk (UHR for developing psychosis, 38 patients with schizophrenia and 109 healthy controls. The results revealed that siblings and patients had higher levels of cognitive alexithymia compared to controls. In addition, subjects at UHR for psychosis had even higher levels of cognitive alexithymia compared to the siblings. The levels of affective alexithymia in siblings and patients were equal to controls. However, UHR individuals had significantly lower levels of affective alexithymia (i.e. higher levels of emotional arousal and fantasizing compared to controls. Alexithymia was further related to subclinical levels of negative and depressive symptoms. These findings indicate that alexithymia varies parametrically with the degree of risk for psychosis. More specifically, a type-II alexithymia pattern, with high levels of cognitive alexithymia and normal or low levels of affective alexithymia, might be a vulnerability factor for psychosis.
Berg, Akiah Ottesen; Andreassen, Ole A; Aminoff, Sofie Ragnhild; Romm, Kristin Lie; Hauff, Edvard; Melle, Ingrid
Immigrants have heightened risks of psychotic disorders, and it is proposed that migration influences symptom profiles. The purpose of this study was to investigate if either migration experience and/or visible minority status affected symptom profiles, using a cross-culturally validated five-factor model of the Positive and Negative Syndrome Scale (PANSS), in patients with broadly defined psychotic disorders. PANSS was assessed in a large catchment area based sample of patients with psychotic disorders verified with the Structured Clinical Interview for DSM-IV (n = 1,081). Symptom profiles based on Wallwork et al. five-factor model were compared for Norwegians (73 %), white immigrants (10.5 %), and visible minority groups (16.5 %). Visible minorities were significantly younger, had less education, more often a schizophrenia diagnosis and higher PANSS positive, negative and disorganized/concrete factor scores than Norwegians and white immigrants. After controlling for confounders only the items "Delusions" and "Difficulty in abstract thinking" differed between groups. Multivariate analyses indicated that these items were not associated with immigration per se, but rather belonging to a visible minority. We found mostly similarities in psychotic symptoms between immigrants and Norwegians when using a cross-culturally validated five-factor model of the PANSS. Immigration did not directly influence psychotic symptom profiles but visible minority groups had higher levels of "Delusions" and "Difficulty in abstract thinking", both symptoms that are partially context dependent.
Giacco, Domenico; McCabe, Rose; Kallert, Thomas; Hansson, Lars; Fiorillo, Andrea; Priebe, Stefan
Having friends is associated with more favourable clinical outcomes and a higher quality of life in mental disorders. Patients with schizophrenia have fewer friends than other mentally ill patients. No large scale studies have evaluated so far what symptom dimensions of schizophrenia are associated with the lack of friendships. Data from four multi-centre studies on outpatients with schizophrenia and related disorders (ICD F20-29) were included in a pooled analysis (N = 1396). We established whether patients had close friends and contact with friends by using the equivalent items on friendships of the Manchester Short Assessment of Quality of Life or of the Lancashire Quality of Life Profile. Symptoms were measured by the Brief Psychiatric Rating Scale or by the identical items included in the Positive and Negative Syndrome Scale. Seven hundred and sixty-nine patients (55.1%) had seen a friend in the previous week and 917 (65.7%) had someone they regarded as a close friend. Low levels of negative symptoms and hostility were significantly associated with having a close friend and contact with a friend. Overall, almost twice as many patients with absent or mild negative symptoms had met a friend in the last week, compared with those with moderate negative symptoms. Higher levels of negative symptoms and hostility are specifically associated with the lack of friendships in patients with psychotic disorders. These findings suggest the importance of developing effective treatments for negative symptoms and hostility in order to improve the probability of patients with schizophrenia to have friends.
... what is not. Symptoms of psychosis include delusions (false beliefs) and hallucinations (seeing or hearing things that ... and work, strained family relations, and separation from friends. The longer the symptoms go untreated, the greater ...
Clausen, L; Hjorthøj, C R; Thorup, Anne A.E.
(24.6 years v. 27.4 years, p p = 0.001] and lower levels of the Global Assessment of Functioning (difference 8.......26, 95% CI 2.13-14.39, p = 0.01). Those who stopped using cannabis between entry and 5-year follow-up had a significantly lower level of psychotic symptoms at 5-year follow-up even after controlling for baseline level of psychotic symptoms and for insufficient antipsychotic medication (adjusted...... difference in psychotic dimension -1.04, 95% CI -1.77 to -0.31, p = 0.006). CONCLUSIONS: Continuous cannabis use was associated with higher levels of psychotic symptoms after 5 years, and this association was only partly explained by insufficient antipsychotic medication....
Shrivastava, Amresh; McGorry, P D; Tsuang, Ming; Woods, Scott W; Cornblatt, Barbara A; Corcoran, Cheryl; Carpenter, William
Schizophrenia is a common disorder, affecting approximately 1 out of every 100 people, with a typical onset during adolescence and early adulthood. The personal and societal costs of schizophrenia are extremely high. Prevention of schizophrenia, would offer substantial benefits to patients, their family members, and the community at large. The prodromal phase of schizophrenia has been recognized since the 19th century. At-risk individuals for psychosis and schizophrenia are the subjects who can provide information for intervention prior to development of frank psychosis. This approach is currently being investigated. The question remains, however, whether it can be a diagnostic category by itself. The proposal for including the risk syndrome is one of the recommendations by the working group on schizophrenia and psychotic disorders for the forthcoming DSM-V. There are differing views in academia regarding this proposal. Prior to becoming fully psychotic, a consistent literature demonstrates that patients generally had suffered from accelerating attenuated symptoms and distress. It is important that the prodromal phase be accurately recognized in order to accomplish the goal of prevention. We can then purposefully engage in early intervention aiming toward prevention. A recent strong resurgent interest in this area stems largely from two developments: First, the identification of the neurobiological deficit processes associated with the severity and chronicity of schizophrenia, and second, the development of reliable criteria for diagnosis. Although the general at-risk construct appears to offer great potential to advance both the treatment and research dealing with psychotic illnesses, it seems premature to many researchers to include the syndrome as an established entity in the text of the new DSM-V. It would be far more appropriate to include this proposed syndrome in the appendix and evaluate the many contemporary issues in future studies. The main issues
Moritz, Steffen; Berna, Fabrice; Jaeger, Susanne; Westermann, Stefan; Nagel, Matthias
Clinicians and patients differ concerning the goals of treatment. Eighty individuals with schizophrenia were assessed online about which symptoms they consider the most important for treatment, as well as their experience with different interventions. Treatment of affective and neuropsychological problems was judged as more important than treatment of positive symptoms (p experience with Occupational and Sports Therapy, only a minority had received Cognitive-Behavioral Therapy, Family Therapy, and Psychoeducation with family members before. Patients appraised Talk, Psychoanalytic, and Art Therapy as well as Metacognitive Training as the most helpful treatments. Clinicians should carefully take into consideration patients' preferences, as neglect of consumers' views may compromise outcome and adherence to treatment.
Ira, Elisa; De Santi, Katia; Lasalvia, Antonio; Bonetto, Chiara; Zanatta, Gioia; Cristofalo, Doriana; Bertani, Mariaelena; Bissoli, Sarah Saviana; Riolo, Rossana; Gardellin, Francesco; Morandin, Idana; Ramon, Luana; Tansella, Michele; Ruggeri, Mirella; Tosato, Sarah
COMT Val(158)Met moderates the effect of stress on psychotic symptoms. Exposure to stress is also associated with mesolimbic dopamine release in individuals experiencing low maternal care. We therefore test the hypothesis that recent stressful life events are associated with more severe positive symptoms (associated with mesolimbic dopamine release) in first-episode psychosis (FEP) patients who experienced low maternal care during childhood. We hypothesized that COMT Val(158)Met moderates this association. A total of 149 FEP patients recruited within the Psychosis Incident Cohort Outcome Study (PICOS) participated in the present study. Maternal care was assessed by the Parental Bonding Instrument (PBI), stressful life events were collected by the List of Events Scale and positive symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). We found that low maternal care and recent stressful life events were associated with higher level of positive symptoms at the onset (analysis of variance [ANOVA], p = 0.012), and that patients who were also homozygotes for the COMT Val(158) allele had the highest level of positive symptoms (ANOVA, p = 0.024). Low maternal care and severe stressful life events may contribute to a symptomatology characterized by more severe positive symptoms at the onset, possibly due to an increased mesolimbic dopamine release. Homozygosity for the COMT Val(158) allele seems to confer a biological predisposition to the stress-related hyperactivity of the mesolimbic dopaminergic system. The data imply that the mesolimbic dopaminergic system is involved in the mediation/modulation of the effect of stressful events on the vulnerability for psychosis.
Wils, Regitze Sølling; Gotfredsen, Ditte Resendal; Hjorthøj, Carsten
attended the 10-year follow up and 30% of these had remission of psychotic symptoms at the time of the 10-year follow up with no current use of antipsychotic medication. This outcome was associated with female gender, high GAF-F score, participation in the labour market and absence of substance abuse...
Isvoranu, Adela-Maria; van Borkulo, Claudia D.; Boyette, Lindy-Lou; Wigman, Johanna T. W.; Vinkers, Christiaan H.; Borsboom, Denny
Childhood trauma (CT) has been identified as a potential risk factor for the onset of psychotic disorders. However, to date, there is limited consensus with respect to which symptoms may ensue after exposure to trauma in early life, and whether specific pathways may account for these associations.
de Toffol, B
In epilepsy patients, psychotic states are related to a group of psychotic disorders with a specific phenomenology in which potential pathophysiological mechanisms are believed to be closely related to the epileptic disorder itself. Postictal psychosis is a very specific syndrome in relation to seizure activity: a clear temporal relationship exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures, with a characteristic lucid interval which lasts from two to 120h. The psychotic state may be related to the withdrawal of anticonvulsants, often in connection with video-EEG monitoring. The phenomenology of the psychotic state is often pleomorphic, with abnormal mood, paranoid delusions and hallucinations, with some clouding of consciousness or no evidence of impaired consciousness. The outcome is characterized by a remission of the psychotic symptoms over several days (mean: 1 week), with or without neuroleptic treatment. The majority of the patients suffer from complex partial seizures with frequent psychic auras that secondarily become generalized. In the majority of cases, prepsychotic EEG abnormalities persist during the psychosis. Frequent bitemporal foci are recorded on the EEG and MRI abnormalities (including mesial temporal sclerosis) are seen in more than half of the cases. The results of clinical, morphologic and metabolic available studies will be briefly discussed.
Johnstone, Stuart J; Roodenrys, Steven J; Johnson, Kirsten; Bonfield, Rebecca; Bennett, Susan J
Previous studies report reductions in symptom severity after combined working memory (WM) and inhibitory control (IC) training in children with AD/HD. Based on theoretical accounts of the role of arousal/attention modulation problems in AD/HD, the current study examined the efficacy of combined WM, IC, and neurofeedback training in children with AD/HD and subclinical AD/HD. Using a randomized waitlist control design, 85 children were randomly allocated to a training or waitlist condition and completed pre- and post-training assessments of overt behavior, trained and untrained cognitive task performance, and resting and task-related EEG activity. The training group completed twenty-five sessions of training using Focus Pocus software at home over a 7 to 8-week period. Trainees improved at the trained tasks, while enjoyment and engagement declined across sessions. After training, AD/HD symptom severity was reduced in the AD/HD and subclinical groups according to parents, and in the former group only according to blinded teachers and significant-others. There were minor improvements in two of six near-transfer tasks, and evidence of far-transfer of training effects in four of five far-transfer tasks. Frontal region changes indicated normalization of atypical EEG features with reduced delta and increased alpha activity. It is concluded that technology developments provide an interesting a vehicle for delivering interventions and that, while further research is needed, combined WM, IC, and neurofeedback training can reduce AD/HD symptom severity in children with AD/HD and may also be beneficial to children with subclinical AD/HD. Copyright © 2017 Elsevier B.V. All rights reserved.
Palmier-Claus, Jasper; Dunn, Graham; Drake, Richard; Lewis, Shôn
Self-esteem has been implicated in the development of psychotic phenomena, especially paranoia. Recent findings suggest that it may be useful to assess the instability of self-esteem instead of the mean score. We examined this construct as two separate factors: positive beliefs about the self (PBS) and negative beliefs about the self (NBS). Theoretical models have implicated NBS in the development of paranoia, whereas research studies have sometimes found an association between PBS and negative symptoms. The first aim of this study was to investigate associations between change in PBS and NBS, and subsequent change in paranoia and negative symptoms. The second aim was to examine whether fluctuations in PBS and NBS predicted mean paranoia levels. Data from a large sample of individuals with first-episode psychosis (n = 256) assessed at baseline, 6 weeks, 3 months and 18 months was analysed. The data suggest that changes in both PBS and NBS in the early stages of disorder are related to change in negative symptoms, but not paranoia. PBS variability and NBS mean scores significantly predicted average paranoia levels when taken from across all four time points, suggesting potential differences in the associations with psychosis of these two constructs. Self-esteem boosting interventions administered in the first 6 weeks after admission to healthcare services may improve the subsequent course of negative symptoms.
Alderman, Tracy; Addington, Jean; Bearden, Carrie; Cannon, Tyrone D; Cornblatt, Barbara A; McGlashan, Thomas H; Perkins, Diana O; Seidman, Larry J; Tsuang, Ming T; Walker, Elaine F; Woods, Scott W; Cadenhead, Kristin S
Examining ethnically related variables in evaluating those at risk for psychosis is critical. This study investigated sociodemographic and clinical characteristics of Latino versus non-Latino clinical high-risk (CHR) subjects and healthy control (HC) subjects in the first North American Prodrome Longitudinal Study. Fifty-six Latino CHR subjects were compared to 25 Latino HC and 423 non-Latino CHR subjects across clinical and demographic variables. Thirty-nine of the 56 CHR subjects completed at least one subsequent clinical evaluation over the 2.5-year period with 39% developing a psychotic illness. Characteristics of Latino CHR subjects who later converted to psychosis ('converters') were compared to those who did not ('non-converters'). Latino CHR subjects were younger than non-Latino CHR subjects and had less education than Latino HC subjects and non-Latino CHR counterparts. Latino CHR converters had higher scores than Latino non-converters on the Structured Interview for Prodromal Syndromes total negative symptoms that were accounted for by decreased expression of emotion and personal hygiene/social attentiveness subsections. Latino CHR converters scored lower on the global functioning:social scale, indicating worse social functioning than Latino non-converters. Based on this sample, Latino CHR subjects may seek treatment earlier and have less education than non-Latino CHR subjects. Deficits in social functioning and impaired personal hygiene/social attentiveness among Latino CHR subjects predicted later psychosis and may represent important areas for future study. Larger sample sizes are needed to more thoroughly investigate the observed ethnic differences and risk factors for psychosis in Latino youth. © 2014 Wiley Publishing Asia Pty Ltd.
Vangkilde, A; Jepsen, J M R; Schmock, H
symptoms, respectively, in a young cohort of 22q11.2DS not diagnosed with schizophrenia. METHODS: The level of social impairment was addressed using questionnaires and objective measures of social functioning (The Adaptive Behavior Assessment System), skills (Social Responsiveness Scale), and cognition......BACKGROUND: Identification of the early signs of schizophrenia would be a major achievement for the early intervention and prevention strategies in psychiatry. Social impairments are defining features of schizophrenia. Impairments of individual layers of social competencies are frequently described...... in individuals with 22q11.2 deletion syndrome (22q11.2DS), who have high risk of schizophrenia. It is unclear whether and to what extent social impairments associate with subclinical negative and positive symptoms in 22q11.2DS, and which layer of social impairments are more correlated with schizophrenia...
de Bont, P A J M; van den Berg, D P G; van der Vleugel, B M; de Roos, C; de Jongh, A; van der Gaag, M; van Minnen, A M
In patients with psychotic disorders, the effects of psychological post-traumatic stress disorder (PTSD) treatment on symptoms of psychosis, depression and social functioning are largely unknown In a single-blind randomized controlled trial (RCT) 155 outpatients in treatment for psychosis (61.3% schizophrenic disorder, 29% schizoaffective disorder) were randomized to eight sessions prolonged exposure (PE; n = 53) or eye movement desensitization and reprocessing (EMDR) (n = 55), or a waiting-list condition (WL, n = 47) for treatment of their co-morbid PTSD. Measures were performed on (1) psychosis: severity of delusions (PSYRATS-DRS), paranoid thoughts (GPTS), auditory verbal hallucinations (PSYRATS-AHRS), and remission from psychotic disorder (SCI-SR-PANSS); (2) depression (BDI-II); (3) social functioning (PSP). Outcomes were compared at baseline, post-treatment, 6-month follow-up and over all data points. Both PE and EMDR were significantly associated with less severe paranoid thoughts post-treatment and at 6-month follow-up, and with more patients remitting from schizophrenia, at post-treatment (PE and EMDR) and over time (PE). Moreover, PE was significantly associated with a greater reduction of depression at post-treatment and at 6-month follow-up. Auditory verbal hallucinations and social functioning remained unchanged. In patients with chronic psychotic disorders PE and EMDR not only reduced PTSD symptoms, but also paranoid thoughts. Importantly, in PE and EMDR more patients accomplished the status of their psychotic disorder in remission. Clinically, these effects are highly relevant and provide empirical support to the notion that delivering PTSD treatment to patients with psychotic disorders and PTSD deserves increasing recognition and acceptance among clinicians.
Full Text Available "n Objective: Poor premorbid adjustment has been reported to be a predictor of more severe psychotic symptoms and poor quality of life in such psychotic disorders as schizophrenia. However, most studies were performed on chronic schizophrenic patients, and proposed the likelihood of recall biases and the effect of chronicity. The aim of this study was to investigate these factors in a sample of first episode psychotic patients, as a part of Roozbeh first episode psychosis project (RooF. "n "n "nMethod: Premorbid adjustment was assessed using Premorbid Adjustment Scale (PAS in 48 patients with the first psychotic episode who were admitted to Roozbeh Psychiatric Hospital. The severity of symptoms was measured using Positive and Negative Scale (PANSS in three subgroups of positive, negative and general subscales. Quality of life was measured using WHO QOL ,and Global Assessment of Functioning (GAF was also measured. "nResults: The mean age was 24 years. Poor Premorbid adjustment in late adolescence was significantly associated with more severe symptoms according to PANSS negative symptoms (p=0.019, r=0.44. Furthermore, sociability and peer relationship domains had a positive correlation with PANSS negative subscale scores (r=0.531, p=0.002 and r=0.385, p=0.03, respectively. There were no significant differences between males and females in premorbid adjustment. Furthermore, this study failed to show any differences between affective and non-affective psychosis in premorbid functioning . "nConclusion: Our study confirms poor premorbid adjustment association with more severe negative symptoms and poor quality of life in a sample of Iranian first episode psychotic patients.
Full Text Available Objective: Recent research has shown high rates of exposure to trauma among people with serious mental illness (SMI. In addition studies suggest that psychosis and mental illness-related experiences can be extremely traumatic. While some individuals develop full blown PTSD related to these experiences, it has been noted that some may also experience posttraumatic growth (PTG. However, few studies have examined PTG as a possible outcome in people who have experienced psychosis. Method: To further understand the relationships between psychosis and PTG, 121 participants were recruited from community mental health rehabilitation centers and administered trauma and psychiatric questionnaires. Results: High levels of traumatic exposure were found in the sample. Regarding our main focus of study we observed that people who endured psychosis can experience PTG, and that PTG is mediated by meaning making and coping self-efficacy appraisal. Psychotic symptoms were found to be a major obstacle to meaning making, coping self-efficacy, and PTG, whereas negative symptoms were found to be significantly related to PTG when mediated by meaning making and coping self-efficacy. Conclusion: The current research provides preliminary evidence for potential role of meaning making and coping self-efficacy as mediators of PTG in the clinical, highly traumatized population of people with SMI who have experienced psychosis. This may have both research as well as clinical practice relevance for the field of psychiatric rehabilitation.
B B Lal
Full Text Available A case of pellagra who had psychosis, dermatitis and gastrointestinal system involvement in the form of constipation has been described. In this case mental symptoms in the form of insomnia appeared prior to dermal lesions. The case was successfully treated both for the mental and skin condition with nicotinamide and other ancillary treatment.
Sit, Dorothy; Rothschild, Anthony J; Wisner, Katherine L
The objective is to provide an overview of the clinical features, prognosis, differential diagnosis, evaluation, and treatment of postpartum psychosis. The authors searched Medline (1966-2005), PsycInfo (1974-2005), Toxnet, and PubMed databases using the key words postpartum psychosis, depression, bipolar disorder, schizophrenia, organic psychosis, pharmacotherapy, psychotherapy, and electroconvulsive therapy. A clinical case is used to facilitate the discussion. The onset of puerperal psychosis occurs in the first 1-4 weeks after childbirth. The data suggest that postpartum psychosis is an overt presentation of bipolar disorder that is timed to coincide with tremendous hormonal shifts after delivery. The patient develops frank psychosis, cognitive impairment, and grossly disorganized behavior that represent a complete change from previous functioning. These perturbations, in combination with lapsed insight into her illness and symptoms, can lead to devastating consequences in which the safety and well-being of the affected mother and her offspring are jeopardized. Therefore, careful and repeated assessment of the mothers' symptoms, safety, and functional capacity is imperative. Treatment is dictated by the underlying diagnosis, bipolar disorder, and guided by the symptom acuity, patient's response to past treatments, drug tolerability, and breastfeeding preference. The somatic therapies include antimanic agents, atypical antipsychotic medications, and ECT. Estrogen prophylaxis remains purely investigational. The rapid and accurate diagnosis of postpartum psychosis is essential to expedite appropriate treatment and to allow for quick, full recovery, prevention of future episodes, and reduction of risk to the mother and her children and family.
Derks, Eske M; Vorstman, Jacob A S; Ripke, Stephan
The presence of subclinical levels of psychosis in the general population may imply that schizophrenia is the extreme expression of more or less continuously distributed traits in the population. In a previous study, we identified five quantitative measures of schizophrenia (positive, negative......, disorganisation, mania, and depression scores). The aim of this study is to examine the association between a direct measure of genetic risk of schizophrenia and the five quantitative measures of psychosis. Estimates of the log of the odds ratios of case/control allelic association tests were obtained from...... the Psychiatric GWAS Consortium (PGC) (minus our sample) which included genome-wide genotype data of 8,690 schizophrenia cases and 11,831 controls. These data were used to calculate genetic risk scores in 314 schizophrenia cases and 148 controls from the Netherlands for whom genotype data and quantitative symptom...
Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene
Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored.......Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored....
Green, Melinda; Rogers, Jennifer; Nguyen, Christine; Blasko, Katherine; Martin, Amanda; Hudson, Dominique; Fernandez-Kong, Kristen; Kaza-Amlak, Zauditu; Thimmesch, Brandon; Thorne, Tyler
The purpose of the present study was threefold. First, we examined whether women with bulimia nervosa (n = 12) and women with subthreshold binge/purge symptoms (n = 20) showed decreased mean R wave amplitude, an indicator of cardiac risk, on electrocardiograph compared to asymptomatic women (n = 20). Second, we examined whether this marker was pervasive across experimental paradigms, including before and after sympathetic challenge tasks. Third, we investigated behavioural predictors of this marker, including binge frequency and purge frequency assessed by subtype (dietary restriction, excessive exercise, self-induced vomiting, and laxative abuse). Results of a 3 (ED symptom status) × 5 (experimental condition) mixed factorial ANCOVA (covariates: body mass index, age) indicated women with bulimia nervosa and women with subclinical binge/purge symptoms demonstrated significantly reduced mean R wave amplitude compared to asymptomatic women; this effect was pervasive across experimental conditions. Multiple regression analyses showed binge and purge behaviours, most notably laxative abuse as a purge method, predicted decreased R wave amplitude across all experimental conditions. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Full Text Available Objectives: An important subset of patients with schizophrenia present clinically significant persistent negative symptoms (PNS. Identifying the neural substrates of PNS could help improve our understanding and treatment of these symptoms. Methods: This study included 64 non-affective first-episode of psychosis (FEP patients and 60 healthy controls; 16 patients displayed PNS (i.e., at least 1 primary negative symptom at moderate or worse severity sustained for at least 6 consecutive months. Using voxel-based morphometry (VBM, we explored for grey matter differences between PNS and non-PNS patients; patient groups were also compared to controls. All comparisons were performed at p<0.05, corrected for multiple comparisons.Results: PNS patients had smaller grey matter in the right frontal medial-orbital gyrus (extending into the inferior frontal gyrus and right parahippocampal gyrus (extending into the fusiform gyrus compared to non-PNS patients. Compared to controls, PNS patients had smaller grey matter in the right parahippocampal gyrus (extending into the fusiform gyrus and superior temporal gyrus; non-PNS patients showed no significant differences to controls. Conclusions: Neural substrates of persistent negative symptoms are evident in FEP patients. A better understanding of the neural etiology of PNS may encourage the search for new medications and/or alternative treatments to better help those affected.
... Traumatic Stress Disorder Bipolar Mood Disorders Postpartum Psychosis Social Support Online Training Tools for Mom Frequently Asked Questions Screening Recommendations Useful Links Media Family International Father’s Mental Health Day Dads for ...
Weinstock, Jeremiah; April, Laura M; Kallmi, Selmi
Gambling disorder and substance use disorders (SUD) overlap in terms of etiology and diagnostic constructs (e.g., preoccupation, loss of control), yet diagnostic thresholds for the disorders are different. Currently, endorsing 2-3 gambling disorder criteria does not warrant a diagnosis while endorsing 2-3 SUD criteria does. The aim of this study was to examine whether subclinical gamblers (i.e., endorsing 2-3 gambling disorder criteria) experience psychosocial dysfunction equivalent to individuals who are diagnosed with mild severity SUD (i.e., 2-3 SUD criteria) and whether this level of dysfunction is significantly different from individuals with no psychopathology. Data are from the first wave of Quinte Longitudinal Study, a large epidemiological sample (N=4121). Psychometrically supported measures assessed for psychosocial functioning and the presence of Axis-I psychiatric disorders. Cross-sectional analysis examined 7 domains of psychosocial functioning using ANCOVA, which allowed for the inclusion of covariates, to test for difference between subclinical gamblers and individuals with no psychopathology and individuals with mild severity SUD. Equivalency testing compared subclinical gamblers in relation to mild severity SUD. Subclinical gamblers reported significantly poorer psychosocial functioning in relation to individuals endorsing no current psychopathology. Subclinical gamblers were also equivalent to and not significantly different from individuals with mild severity SUD. Subclinical gamblers experience similar psychosocial impairment to those individuals who endorse mild severity SUD, and this significantly differed from healthy individuals. The threshold for diagnosis of gambling disorder therefore warrants re-examination. Copyright © 2017 Elsevier Ltd. All rights reserved.
Use of amphetamine and methamphetamine is widespread in the general population and common among patients with psychiatric disorders. Amphetamines may induce symptoms of psychosis very similar to those of acute schizophrenia spectrum psychosis. This has been an argument for using amphetamine-induced psychosis as a model for primary psychotic disorders. To distinguish the two types of psychosis on the basis of acute symptoms is difficult. However, acute psychosis induced by amphetamines seems to have a faster recovery and appears to resolve more completely compared to schizophrenic psychosis. The increased vulnerability for acute amphetamine induced psychosis seen among those with schizophrenia, schizotypal personality and, to a certain degree other psychiatric disorders, is also shared by non-psychiatric individuals who previously have experienced amphetamine-induced psychosis. Schizophrenia spectrum disorder and amphetamine-induced psychosis are further linked together by the finding of several susceptibility genes common to both conditions. These genes probably lower the threshold for becoming psychotic and increase the risk for a poorer clinical course of the disease. The complex relationship between amphetamine use and psychosis has received much attention but is still not adequately explored. Our paper reviews the literature in this field and proposes a stress-vulnerability model for understanding the relationship between amphetamine use and psychosis. PMID:23216941
that two-thirds of the patients had a comorbid personality disorder at two-year follow-up, and schizoid, paranoid and avoidant personality disorder were the most frequent. Schizotypal traits were less prevalent, which in relation to the late follow-up is attributed to uncertainty in differentiating....... Patients with first-episode psychosis had significantly high NEO-PI-R scores for neuroticism and agreeableness, and lower scores for conscientiousness and extroversion. The median time for remission in the total sample was three months. Female gender and better premorbid functioning were predictive of less...... negative symptoms and shorter duration of untreated psychosis (DUP) was predictive for shorter time to remission, stable remission, less severe positive psychotic symptoms, and better social functioning. Female gender, better premorbid social functioning and more education also contributed to a better...
Pollice, Rocco; Bianchini, Valeria; di Mauro, Stefania; Mazza, Monica; Verni, Laura; Roncone, Rita; Casacchia, Massimo
On 6 April 2009, at 3:32 GMT, central Italy was struck by a 6.3-magnitude earthquake with its epicentre near L'Aquila, the capital city of the Abruzzo region. Earthquakes may precipitate psychiatric symptoms. The aim of this study was to investigate cognitive functioning and positive and negative symptoms before and after the 2009 L'Aquila earthquake in patients with first-episode psychosis (FEP) and chronic schizophrenia (CS). A total of 54 FEP patients (34 males and 20 females) and 63 CS patients (39 males and 24 females) were investigated. Psychometric scores were submitted to a 2 × 2 mixed analysis of variance, with group (FEP and CS) as the between-subjects variable and time (pre- and post-earthquake) as the within-subjects variable. Positive symptoms increased significantly from the pre- to the post-earthquake assessment in FEP patients but not in those with CS. There were no significant differences between the pre- and post-earthquake period in terms of negative symptoms in both groups. Compared with the pre-earthquake assessment, FEP patients scored significantly worse at the post-earthquake evaluation in terms of Wisconsin Card Sorting Test categories achieved, immediate verbal memory and delayed verbal memory. However, there were no significant differences in cognitive scores between the pre- and post-earthquake periods in patients with CS. Our findings suggest that a disastrous earthquake has a negative impact on cognitive functioning and positive symptoms in FEP patients, but not in those with CS. © 2011 Blackwell Publishing Asia Pty Ltd.
Simonsen, Erik; ten Velden Hegelstad, Wenche; Haahr, Ulrik Helt
years, 50% of patients were in symptomatic remission. Non-remission was predicted by positive symptoms at inclusion and during the first year of treatment. Of individual symptoms only hallucinations were significantly predictive of ten-year non-remission. Early symptom differences were not reflected...
Full Text Available Explanatory models ascribe to arousability a central role for the development of psychotic symptoms. Thus, a disposition to hyperarousal (i.e., increased arousal predisposition (AP may serve as an underlying vulnerability indicator for psychosis by interacting with stressors to cause symptoms. In this case, AP, stress-response, and psychotic symptoms should be linked before the development of a diagnosable psychotic disorder. We conducted a cross-sectional online study in a population sample (N=104; Mage=27.7 years, SD=11.2, range 18–70. Participants rated their AP and subclinical psychotic symptoms. Participants reported their stress-levels before and after two stress inductions including an arithmetic and a social stressor. The participants with an increased AP generally felt more stressed. However, AP was not associated with the specific stress-response. As expected, positive psychotic symptoms were significantly associated with AP, but this was not mediated by general stress-levels. Its association to subtle, nonclinical psychotic symptoms supports our assumption that AP could be a vulnerability indicator for psychosis. The trait is easily accessible via a short self-report and could facilitate the identification of people at risk and be a promising target for early stress-management. Further research is needed to clarify its predictive value for stress-responses.
Rajabizadeh, Ghodratolah; Kheradmand, Ali; Nasirian, Mansoureh
Background: Tramadol is a centrally acting opioid analgesic used to treat moderate to sever pain. It has more advantage and less opioid adverse effects than conventional opioid analgesia. Case Report: This article reports a patient with tramadol dependency that had psychosis after tramadol withdrawal. Conclusion: By the increase of tramadol usage for relief of chronic pain, tramadol abuse and dependency is increased. Some of tramadol withdrawal symptoms are not related to opioid, for example ...
Bak, Peter; Hjortshøj, Cristel S; Gaede, Peter
OBJECTIVE: Cyanotic congenital heart disease is a systemic disease, with effects on multiple organ systems. A high prevalence of subclinical hypothyroidism (SCH) has been reported in a small cohort of cyanotic congenital heart disease patients. Subclinical hypothyroidism has been associated...... with various adverse cardiovascular effects, as well as an increased risk of progression to overt hypothyroidism. The aim of this study was to examine the prevalence of SCH in cyanotic congenital heart disease patients, consider possible etiologies, and evaluate thyroid function over time. METHODS: First, 90...... follow-up (6.5 ± 1.0 years), SCH (defined as ≥2 consecutive elevated thyroid-stimulating hormone values) was present in 26%. Three patients progressed to overt hypothyroidism. Patients with SCH were younger (34 ± 12 vs 42 ± 16 years; P = .01) and had a lower oxygen saturation (80 ± 5 vs 84 ± 6%; P = .03...
Full Text Available There is increasing evidence pointing toward a continuous distribution of psychotic symptoms and accompanying factors between subclinical and clinical populations. However, for the construction of continuum models, a more detailed knowledge of different types of psychotic-like experiences (PLE and their associations with distress, functional impairment, and demographic variables is needed. We investigated PLE in a sample of healthy adults (N = 206 incorporating the recently developed revised Exceptional Experiences Questionnaire (PAGE-R. For the first time, the PAGE-R was cross validated with PLE, disorganized-, and negative-like symptoms [Schizotypal Personality Questionnaire (SPQ, Physical Anhedonia Scale (PAS]. We subjected the PAGE-R to exploratory factor analyses and examined the resulting subtypes of EE for specific associations with contextual factors, valence ratings, socio-demographic variables, and general psychological burden (Revised Symptom-Checklist-90. Correlational cross-validation suggested that the PAGE-R measures facets of PLE. Importantly, we (1 identified three types of exceptional experiences (EE: Odd beliefs, dissociative anomalous perceptions, and hallucinatory anomalous perceptions. Further, the results suggested that even in healthy individuals (2 PLE and EE are indicative of reduced functioning, as reflected by increased psychological burden and lower educational achievement. Moreover, (3 similar sex-differences might exist as in psychotic patients with women reporting more positive-like symptoms and EE but less disorganized-like symptoms than men. Importantly, (4 EE might be differentially implicated in psychological functioning. We suggest that the PAGE-R holds the potential to complement the current assessment of sub-clinical psychosis. However, whereas our results might point toward a continuity of psychotic symptoms with EE and normal experiences, they require replication in larger samples as well as equivalence
Unterrassner, Lui; Wyss, Thomas A; Wotruba, Diana; Ajdacic-Gross, Vladeta; Haker, Helene; Rössler, Wulf
There is increasing evidence pointing toward a continuous distribution of psychotic symptoms and accompanying factors between subclinical and clinical populations. However, for the construction of continuum models, a more detailed knowledge of different types of psychotic-like experiences (PLE) and their associations with distress, functional impairment, and demographic variables is needed. We investigated PLE in a sample of healthy adults (N = 206) incorporating the recently developed revised Exceptional Experiences Questionnaire (PAGE-R). For the first time, the PAGE-R was cross validated with PLE, disorganized-, and negative-like symptoms [Schizotypal Personality Questionnaire (SPQ), Physical Anhedonia Scale (PAS)]. We subjected the PAGE-R to exploratory factor analyses and examined the resulting subtypes of EE for specific associations with contextual factors, valence ratings, socio-demographic variables, and general psychological burden (Revised Symptom-Checklist-90). Correlational cross-validation suggested that the PAGE-R measures facets of PLE. Importantly, we (1) identified three types of exceptional experiences (EE): Odd beliefs, dissociative anomalous perceptions, and hallucinatory anomalous perceptions. Further, the results suggested that even in healthy individuals (2) PLE and EE are indicative of reduced functioning, as reflected by increased psychological burden and lower educational achievement. Moreover, (3) similar sex-differences might exist as in psychotic patients with women reporting more positive-like symptoms and EE but less disorganized-like symptoms than men. Importantly, (4) EE might be differentially implicated in psychological functioning. We suggest that the PAGE-R holds the potential to complement the current assessment of sub-clinical psychosis. However, whereas our results might point toward a continuity of psychotic symptoms with EE and normal experiences, they require replication in larger samples as well as equivalence testing
Pries, Lotta-Katrin; Guloksuz, Sinan; Menne-Lothmann, Claudia; Decoster, Jeroen; van Winkel, Ruud; Collip, Dina; Delespaul, Philippe; De Hert, Marc; Derom, Catherine; Thiery, Evert; Jacobs, Nele; Wichers, Marieke; Simons, Claudia J P; Rutten, Bart P F; van Os, Jim
An association between white noise speech illusion and psychotic symptoms has been reported in patients and their relatives. This supports the theory that bottom-up and top-down perceptual processes are involved in the mechanisms underlying perceptual abnormalities. However, findings in nonclinical populations have been conflicting. The aim of this study was to examine the association between white noise speech illusion and subclinical expression of psychotic symptoms in a nonclinical sample. Findings were compared to previous results to investigate potential methodology dependent differences. In a general population adolescent and young adult twin sample (n = 704), the association between white noise speech illusion and subclinical psychotic experiences, using the Structured Interview for Schizotypy-Revised (SIS-R) and the Community Assessment of Psychic Experiences (CAPE), was analyzed using multilevel logistic regression analyses. Perception of any white noise speech illusion was not associated with either positive or negative schizotypy in the general population twin sample, using the method by Galdos et al. (2011) (positive: ORadjusted: 0.82, 95% CI: 0.6-1.12, p = 0.217; negative: ORadjusted: 0.75, 95% CI: 0.56-1.02, p = 0.065) and the method by Catalan et al. (2014) (positive: ORadjusted: 1.11, 95% CI: 0.79-1.57, p = 0.557). No association was found between CAPE scores and speech illusion (ORadjusted: 1.25, 95% CI: 0.88-1.79, p = 0.220). For the Catalan et al. (2014) but not the Galdos et al. (2011) method, a negative association was apparent between positive schizotypy and speech illusion with positive or negative affective valence (ORadjusted: 0.44, 95% CI: 0.24-0.81, p = 0.008). Contrary to findings in clinical populations, white noise speech illusion may not be associated with psychosis proneness in nonclinical populations.
Caravaggio, Fernando; Brucato, Gary; Kegeles, Lawrence S; Lehembre-Shiah, Eugénie; Arndt, Leigh Y; Colibazzi, Tiziano; Girgis, Ragy
Metabolic health and positive symptom severity has been investigated in schizophrenia, but not in clinical high risk (CHR) patients. We hypothesized that greater body mass index (BMI) in CHR patients would be related to less positive symptoms. We examined this relationship in CHR patients being treated with 1) no psychotropic medications (n = 58), 2) an antipsychotic (n = 14), or 3) an antidepressant without an antipsychotic (n = 10). We found no relationship between BMI and positive symptoms in unmedicated CHR patients, the majority of whom had a narrow BMI range between 20 and 30. However, in the smaller sample of CHR patients taking an antidepressant or antipsychotic, BMI was negatively correlated with positive symptoms. Although potentially underpowered, these preliminary findings provide initial steps in elucidating the relationships between metabolic health, neurochemistry, and symptom severity in CHR patients.
Damjanović, Aleksandar; Pantović, Maja; Damjanović, Aleksandra; Dunjić-Kostić, Bojana; Ivković, Maja; Milovanović, Srđan; Lacković, Maja; Dimitrijević, Ivan
The association between cannabinoids and psychosis has been known for almost a thousand years, but it is still speculated whether cannabis use may be a contributory cause of psychosis, that is, whether it may precipitate schizophrenia in those at risk. In this paper, we will briefly present the data from individual longitudinal studies in the field, together with the factors that are considered important for the association of cannabis abuse and occurrence of schizophrenia and prevention opportunities in the target population. The reviewed studies clearly suggest that cannabis abuse predicts an increased risk for schizophrenia, particularly in young adults. They underline both the need to create adequate prevention measures and consequently avoid the occurrence of the disease in the young at risk. Particular attention should be additionally devoted toward encouraging the young presenting with psychotic symptoms to stop or, at the very least, reduce the frequency of cannabis abuse. The issues are undoubtedly to be addressed by the health care system in general.
Ullah, M I; Campbell, Douglas G; Bhagat, Rajesh; Lyons, Judith A; Tamanna, Sadeka
Obstructive sleep apnea (OSA) and posttraumatic stress disorder (PTSD) are common in United States veterans. These conditions often coexist and symptoms overlap. Previous studies reported improvement in PTSD symptoms with continuous positive airway pressure (CPAP) therapy for comorbid OSA but its effect has not been assessed in a non-PTSD cohort. We have prospectively assessed the effect of CPAP therapy on clinical symptom improvement as a function of CPAP compliance levels among PTSD and non-PTSD veterans. Veterans in whom OSA was newly diagnosed were enrolled in our study (n = 192). Assignment to PTSD and non-PTSD cohorts was determined by chart review. Each patient completed the military version of the PTSD Checklist (PCL), Epworth Sleepiness Scale (ESS), and reported nightmare frequency (NMF) at baseline and 6 months after CPAP therapy. CPAP adherence was objectively documented from machine compliance data. We had complete data for 177 veterans (PTSD n = 59, non-PTSD n = 118) for analysis. The mean ages were 51.24 years in the PTSD cohort and 52.36 years in the non-PTSD cohort (P = .30). In the PTSD cohort, the mean total PCL score (baseline = 66.06, post-CPAP = 61.27, P = .004, d = -0.34) and NMF (baseline = 4.61, post-CPAP = 1.49, P = .0001, d = -0.51) decreased after 6 months of CPAP treatment. Linear regression analysis showed that the CPAP compliance was the only significant predictor for these changes among veterans with PTSD (PCL score: P = .033, R2 = .65; NMF; P = .03, R2 = .61). Further analysis by CPAP compliance quartiles in this cohort (Q1 = 0% to 25%, Q2 = 26% to 50%, Q3 = 51% to 75%, Q4 > 75%) revealed that mean total PCL score declined in Q2 (change = -3.91, P = .045, d = 0.43), Q3 (change = -6.6, P = .002, d = 0.59), and Q4 (change = -7.94, P = .037, d = 0.49). In the non-PTSD cohort, the PCL score increased despite CPAP therapy in lower CPAP compliance quartiles Q1 (change = 8.71, P = .0001, d = 0.46) and Q2 (change = 4.51, P = .046, d = 0
Full Text Available With the advent of DSM 5 criticism has generally centred on a lack of biological validity of the diagnostic criteria. Part of the problem in describing a nosology of psychosis is the tacit assumption of multiple genetic causes each with an incremental loading on the clinical picture that fails to differentiate a clear underlying pathophysiology of high impact. The aim of this paper is to consolidate a primary theory of deficient muscarinic signalling underlying key clinical features of schizophrenia and its regulation by several important genetic associations including neuregulin, DISC and dysbindin. Secondary reductions in markers for GABAergic function and changes in the levels of interneuron calcium binding proteins parvalbumin and calbindin can be attributed to dysfunctional muscarinic transduction. A parallel association exists for cytokine production. The convergent pathway hypothesis is likewise used to model dopaminergic and glutamatergic theories of schizophrenia. The negative symptom dimension is correlated with dysfunction of Akt and ERK transduction, a major point of convergence. The present paradigm predicts the importance of a recent finding of a deletion in a copy number variant of PLCB1 and its potential use if replicated, as one of the first testable biological markers differentiating schizophrenia from bipolar disorder and further subtyping of schizophrenia into deficit and non-deficit. Potential limitations of PLCB1 as a prospective marker are also discussed.
LUÍS M.T.R. LIMA
Full Text Available ABSTRACT Type 2 diabetes mellitus (T2DM is increasing in prevalence worldwide, and those non-diagnosed or misdiagnosed comprise a significant group compared to those diagnosed. Accumulated scientific evidence indicate that the current diagnostic markers (fasting glycemia, 2h glycemia after an oral glucose load and HbA1c are indeed late diagnostic criteria when considering the incidence of diabetes-related complications and comorbidities, which are also at high risk in some groups among normoglycemic individuals. Additionally, the earlier identification of future risk of diabetes is desirable since it would allow better adherence to preventive actions such as lifestyle intervention, ultimately avoiding complications and minimizing the economic impact/burden on health care expenses. Insulin resistance and hyperhormonemia (insulin, amylin, glucagon are non-disputable hallmarks of T2DM, which already takes place among these normoglycemic, otherwise health subjects, characterizing a state of subclinical diabetes. Insulin resistance and hyperinsulinemia can be computed from fasting plasma insulin as an independent variable in normoglycemia. An overview of the current diagnostic criteria, disease onset, complications, comorbidities and perspectives on lifestyle interventions are presented. A proposal for early detection of subclinical diabetes from routine evaluation of fasting plasma insulin, which is affordable and robust and thus applicable for the general population, is further suggested.
Full Text Available Abnormal functional connectivity (FC at rest has been identified in clinical depressive disorder. However, very few studies have been conducted to understand the underlying neural substrates of subclinical depression. The newly proposed centrality analysis approach has been increasingly used to explore the large-scale brain network of mental diseases. This study aimed to identify the degree centrality (DC alteration of the brain network in subclinical depressive subjects. Thirty-seven candidates with subclinical depression and 34 well-matched healthy controls (HCs were recruited from the same sample of college students. All subjects underwent a resting-state fMRI (rs-fMRI scan to assess the DC of the whole brain. Compared with controls, subclinical depressive subjects displayed decreased DC in the right parahippocampal gyrus (PHG, left PHG/amygdala, and left caudate and elevated DC in the right posterior parietal lobule (PPL, left inferior frontal gyrus (IFG and left middle frontal gyrus (MFG. In addition, by using receiver operating characteristic (ROC analysis, we determined that the DC values in the regions with altered FC between the two groups can be used to differentiate subclinical depressive subjects from HCs. We suggest that decreased DC in subcortical and increased DC in cortical regions might be the neural substrates of subclinical depression.
Gao, Cuihua; Wenhua, Liu; Liu, Yanli; Ruan, Xiuhang; Chen, Xin; Liu, Lingling; Yu, Shaode; Chan, Raymond C K; Wei, Xinhua; Jiang, Xinqing
Abnormal functional connectivity (FC) at rest has been identified in clinical depressive disorder. However, very few studies have been conducted to understand the underlying neural substrates of subclinical depression. The newly proposed centrality analysis approach has been increasingly used to explore the large-scale brain network of mental diseases. This study aimed to identify the degree centrality (DC) alteration of the brain network in subclinical depressive subjects. Thirty-seven candidates with subclinical depression and 34 well-matched healthy controls (HCs) were recruited from the same sample of college students. All subjects underwent a resting-state fMRI (rs-fMRI) scan to assess the DC of the whole brain. Compared with controls, subclinical depressive subjects displayed decreased DC in the right parahippocampal gyrus (PHG), left PHG/amygdala, and left caudate and elevated DC in the right posterior parietal lobule (PPL), left inferior frontal gyrus (IFG) and left middle frontal gyrus (MFG). In addition, by using receiver operating characteristic (ROC) analysis, we determined that the DC values in the regions with altered FC between the two groups can be used to differentiate subclinical depressive subjects from HCs. We suggest that decreased DC in subcortical and increased DC in cortical regions might be the neural substrates of subclinical depression.
Steenhuis, L. A.; Nauta, M. H.; Bockting, C. L. H.; Pijnenborg, G. H. M.
AIMS: The aim of this study was to examine whether non-verbal therapies are effective in treating depressive symptoms in psychotic disorders. MATERIAL AND METHODS: A systematic literature search was performed in PubMed, Psychinfo, Picarta, Embase and ISI Web of Science, up to January 2015.
Steenhuis, Laura A.; Nauta, Maaike H.; Bocking, Claudi L.H.; Pijnenborg, Gerdina H.M.
AIMS: The aim of this study was to examine whether non-verbal therapies are effective in treating depressive symptoms in psychotic disorders. MATERIAL AND METHODS: A systematic literature search was performed in PubMed, Psychinfo, Picarta, Embase and ISI Web of Science, up to January 2015.
Rössler, Wulf; Ajdacic-Gross, Vladeta; Rodgers, Stephanie; Haker, Helene; Müller, Mario
Childhood trauma is a risk factor for the onset of schizophrenic psychosis. Because the psychosis phenotype can be described as a continuum with varying levels of severity and persistence, childhood trauma might likewise increase the risk for psychotic experiences below the diagnostic threshold. But the impact of stressful experiences depends upon its subjective appraisal. Therefore, varying degrees of stress sensitivity possibly mediate how childhood trauma impacts in the end upon the occurrence of subclinical psychotic experiences. We investigated this research question in a representative community cohort of 1500 participants. A questionnaire, comprising five domains of physical and emotional neglect, as well as physical, emotional, and sexual abuse, was used to assess childhood trauma. Based on different symptoms of subclinical psychotic experiences, we conducted a latent profile analysis (LPA) to derive distinct profiles for such experiences. Path modeling was performed to identify the direct and indirect (via stress sensitivity) pathways from childhood trauma to subclinical psychotic experiences. The LPA revealed four classes - unaffected, anomalous perceptions, odd beliefs and behavior, and combined anomalous perceptions/odd beliefs and behavior, that - except for sexual abuse - were all linked to childhood trauma. Moreover, except for physical abuse, childhood trauma was significantly associated with stress sensitivity. Thus, our results revealed that the pathways from emotional neglect/abuse and physical neglect to subclinical psychotic experiences were mediated by stress sensitivity. In conclusion, we can state that subclinical psychotic experiences are affected by childhood traumatic experiences in particular through the pathway of a heightened subjective stress appraisal. Copyright © 2016 Elsevier B.V. All rights reserved.
Laura A Steenhuis
Full Text Available The aim of this study was to examine whether non-verbal therapies are effective in treating depressive symptoms in psychotic disorders.A systematic literature search was performed in PubMed, Psychinfo, Picarta, Embase and ISI Web of Science, up to January 2015. Randomized controlled trials (RCTs comparing a non-verbal intervention to a control condition in patients with psychotic disorders, whilst measuring depressive symptoms as a primary or secondary outcome, were included. The quality of studies was assessed using the 'Clinical Trials Assessment Measure for psychological treatments' (CTAM scale. Cohen's d was calculated as a measure of effect size. Using a Network Meta-analysis, both direct and indirect evidence was investigated.10 RCTs were included, of which three were of high quality according to the CTAM. The direct evidence demonstrated a significant effect on the reduction in depressive symptoms relative to treatment as usual (TAU, in favor of overall non-verbal therapy (ES: -0.66, 95% C.I. = -0.88, -0.44 and music therapy (ES: -0.59, 95% C.I. = -0.85, -0.33. Combining both direct and indirect evidence, yoga therapy (ES: -0.79, 95% C.I. = -1.24, -0.35 had a significant effect on depressive symptoms, and occupational therapy (ES: 1.81, 95% C.I. = 0.81, 2.81 was less effective, relative to TAU. Exercise therapy did not show a significant effect on depressive symptoms in comparison to TAU (ES: -0.02 95% C.I. = -0.67, 0.62. Due to inconsistency of study evidence, the indirect effects should be interpreted cautiously.Non-verbal therapies appear to be effective in reducing depressive symptomatology in psychotic disorders, in particular music therapy and yoga therapy.
This paper reviews the literature on menstrual psychosis and proposes a new classification, adapting that of v. Krafft-Ebing (1902) and Jolly (1914). The world literature consists mainly of case reports; they include a few with data good enough for a statistical demonstration of the link between onset and menses. These well-documented cases include examples of pre-menstrual, catamenial, paramenstrual and mid-cycle onsets, and continuous illnesses with phasic shifts rhythmic with the menstrual cycle. In sufferers, episodes seem to be concentrated around the menarche and after childbirth. The clinical picture resembles that of puerperal psychosis, and there are at least 20 women who have suffered both psychoses at different epochs in their lives. Both seem to fall within the manic depressive rubric, so that menstruation can be another trigger of a bipolar episode. Some work suggests an association with anovulatory cycles. Cases starting before the menarche suggest a diencephalic origin.
Full Text Available Although our understanding of psychotic disorders has advanced substantially in the past few decades, very little has changed in the standard of care for these illnesses since the development of atypical anti-psychotics in the 1990s. Here, we integrate new insights into the pathophysiology with the increasing interest in early detection and prevention. First, we explore the role of N-methyl-d-aspartate receptors in a subpopulation of cortical parvalbumin-containing interneurons (PVIs. Postmortem and preclinical data has implicated these neurons in the positive and negative symptoms, as well as the cognitive dysfunction present in schizophrenia. These neurons also appear to be sensitive to inflammation and oxidative stress during the perinatal and peripubertal periods, which may be mediated in large part by aberrant synaptic pruning. After exploring some of the molecular mechanisms through which neuroinflammation and oxidative stress are thought to exert their effects, we highlight the progress that has been made in identifying psychosis prior to onset through the identification of individuals at clinical high risk for psychosis (CHR. By combining our understanding of psychosis pathogenesis with the increasing characterization of endophenotypes that precede frank psychosis, it may be possible to identify patients before they present with psychosis and intervene to reduce the burden of the disease to both patients and families.
Barron, Henry; Hafizi, Sina; Andreazza, Ana C; Mizrahi, Romina
Although our understanding of psychotic disorders has advanced substantially in the past few decades, very little has changed in the standard of care for these illnesses since the development of atypical anti-psychotics in the 1990s. Here, we integrate new insights into the pathophysiology with the increasing interest in early detection and prevention. First, we explore the role of N -methyl-d-aspartate receptors in a subpopulation of cortical parvalbumin-containing interneurons (PVIs). Postmortem and preclinical data has implicated these neurons in the positive and negative symptoms, as well as the cognitive dysfunction present in schizophrenia. These neurons also appear to be sensitive to inflammation and oxidative stress during the perinatal and peripubertal periods, which may be mediated in large part by aberrant synaptic pruning. After exploring some of the molecular mechanisms through which neuroinflammation and oxidative stress are thought to exert their effects, we highlight the progress that has been made in identifying psychosis prior to onset through the identification of individuals at clinical high risk for psychosis (CHR). By combining our understanding of psychosis pathogenesis with the increasing characterization of endophenotypes that precede frank psychosis, it may be possible to identify patients before they present with psychosis and intervene to reduce the burden of the disease to both patients and families.
Peters, Emmanuelle R; Moritz, Steffen; Schwannauer, Matthias; Wiseman, Zoe; Greenwood, Kathryn E; Scott, Jan; Beck, Aaron T; Donaldson, Catherine; Hagen, Roger; Ross, Kerry; Veckenstedt, Ruth; Ison, Rebecca; Williams, Sally; Kuipers, Elizabeth; Garety, Philippa A
The Cognitive Biases Questionnaire for psychosis (CBQp) was developed to capture 5 cognitive distortions (jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking), which are considered important for the pathogenesis of psychosis. Vignettes were adapted from the Cognitive Style Test (CST),(1) relating to "Anomalous Perceptions" and "Threatening Events" themes. Scale structure, reliability, and validity were investigated in a psychosis group, and CBQp scores were compared with those of depressed and healthy control samples. The CBQp showed good internal consistency and test-retest reliability. The 5 biases were not independent, with a 2-related factor scale providing the best fit. This structure suggests that the CBQp assesses a general thinking bias rather than distinct cognitive errors, while Anomalous Perception and Threatening Events theme scores can be used separately. Total CBQp scores showed good convergent validity with the CST, but individual biases were not related to existing tasks purporting to assess similar reasoning biases. Psychotic and depressed populations scored higher than healthy controls, and symptomatic psychosis patients scored higher than their nonsymptomatic counterparts, with modest relationships between CBQp scores and symptom severity once emotional disorders were partialled out. Anomalous Perception theme and Intentionalising bias scores showed some specificity to psychosis. Overall, the CBQp has good psychometric properties, although it is likely that it measures a different construct to existing tasks, tentatively suggested to represent a bias of interpretation rather than reasoning, judgment or decision-making processes. It is a potentially useful tool in both research and clinical arenas.
Rabe-Jabłońska, Jolanta; Mirek, Marta; Pawełczyk, Tomasz
Amphetamine and its derivates can induce, usually after many intoxications, schizophrenia-like psychosis. These disorders appeared only in part patients with amphetamine dependence. Aim of the study was to establish prevalence of selective risk factors of schizophrenia development in amphetamine users: 1) with amphetamine-induced schizophrenia-like psychosis, 2) with schizophrenia, and 2) without psychotic symptoms. In the study 3 groups of subjects were included: 30 amphetamine users with amphetamine induced schizophrenia-like psychosis, 30 amphetamine users with schizophrenia and 30 amphetamine users without psychotic symptoms (37 female and 53 male in mean age = 17.78 years). Amphetamine dependence, schizophrenia and schizophrenia-like psychosis induced amphetamine were diagnosed according to ICD-10 criteria after at least 1 year of amphetamine abstinence. The next procedure was used: 1) Structured interview with subjects and their mothers/caregivers regarding: a) amphetamines use (duration of abuse, doses of psychoactive substance) b) family history of psychosis (especially schizophrenia) 2) The Questionnaire of Child Development for assessment of prevalence of selected risk factors of schizophrenia development 3) The Premorbid Adjustment Scale (Cannon--Spoor) for assessment of premorbid psychosocial functioning in thelast year before psychosis. Amphetamines users with amphetamine-induced psychosis were more similar in prevalence of selective risk factors of schizophrenia development to subjects with schizophrenia and amphetamine dependence than to amphetamine users without psychosis. Amphetamine-induced psychosis developed more frequently in amphetamine users who used higher amphetamine doses and with familial history of psychosis.
Glasner-Edwards, Suzette; Mooney, Larissa J
Psychotic symptoms and syndromes are frequently experienced among individuals who use methamphetamine, with recent estimates of up to approximately 40 % of users affected. Although transient in a large proportion of users, acute symptoms can include agitation, violence, and delusions, and may require management in an inpatient psychiatric or other crisis intervention setting. In a subset of individuals, psychosis can recur and persist and may be difficult to distinguish from a primary psychotic disorder such as schizophrenia. Differential diagnosis of primary vs. substance-induced psychotic disorders among methamphetamine users is challenging; nevertheless, with careful assessment of the temporal relationship of symptoms to methamphetamine use, aided by state-of-the art psychodiagnostic assessment instruments and use of objective indicators of recent substance use (i.e., urine toxicology assays), coupled with collateral clinical data gathered from the family or others close to the individual, diagnostic accuracy can be optimized and the individual can be appropriately matched to a plan of treatment. The pharmacological treatment of acute methamphetamine-induced psychosis may include the use of antipsychotic medications as well as benzodiazepines, although symptoms may resolve without pharmacological treatment if the user is able to achieve a period of abstinence from methamphetamine. Importantly, psychosocial treatment for methamphetamine dependence has a strong evidence base and is the optimal first-line treatment approach to reducing rates of psychosis among individuals who use methamphetamines. Prevention of methamphetamine relapse is the most direct means of preventing recurrence of psychotic symptoms and syndromes. Long-term management of individuals presenting with recurrent and persistent psychosis, even in the absence of methamphetamine use, may include both behavioral treatment to prevent resumption of methamphetamine use and pharmacological treatment
Dige-Petersen, H; Lassen, N A; Noer, Ivan
The systolic blood-pressure at the ankle and the first toe was measured in 30 patients, mean age 42, who had taken ergotamine regularly for more than a year. With one exception, the patients had no symptoms or signs of arterial insufficiency in the limbs, but all had low-normal or abnormal foot s...
Checking the predictive accuracy of basic symptoms against ultra high-risk criteria and testing of a multivariable prediction model: Evidence from a prospective three-year observational study of persons at clinical high-risk for psychosis.
Hengartner, M P; Heekeren, K; Dvorsky, D; Walitza, S; Rössler, W; Theodoridou, A
The aim of this study was to critically examine the prognostic validity of various clinical high-risk (CHR) criteria alone and in combination with additional clinical characteristics. A total of 188 CHR positive persons from the region of Zurich, Switzerland (mean age 20.5 years; 60.2% male), meeting ultra high-risk (UHR) and/or basic symptoms (BS) criteria, were followed over three years. The test battery included the Structured Interview for Prodromal Syndromes (SIPS), verbal IQ and many other screening tools. Conversion to psychosis was defined according to ICD-10 criteria for schizophrenia (F20) or brief psychotic disorder (F23). Altogether n=24 persons developed manifest psychosis within three years and according to Kaplan-Meier survival analysis, the projected conversion rate was 17.5%. The predictive accuracy of UHR was statistically significant but poor (area under the curve [AUC]=0.65, Ppredict psychosis beyond mere chance (AUC=0.52, P=.730). Sensitivity and specificity were 0.83 and 0.47 for UHR, and 0.96 and 0.09 for BS. UHR plus BS achieved an AUC=0.66, with sensitivity and specificity of 0.75 and 0.56. In comparison, baseline antipsychotic medication yielded a predictive accuracy of AUC=0.62 (sensitivity=0.42; specificity=0.82). A multivariable prediction model comprising continuous measures of positive symptoms and verbal IQ achieved a substantially improved prognostic accuracy (AUC=0.85; sensitivity=0.86; specificity=0.85; positive predictive value=0.54; negative predictive value=0.97). We showed that BS have no predictive accuracy beyond chance, while UHR criteria poorly predict conversion to psychosis. Combining BS with UHR criteria did not improve the predictive accuracy of UHR alone. In contrast, dimensional measures of both positive symptoms and verbal IQ showed excellent prognostic validity. A critical re-thinking of binary at-risk criteria is necessary in order to improve the prognosis of psychotic disorders. Copyright © 2017 Elsevier Masson
Full Text Available Alcohol and cannabis misuse is currently the most frequent co-morbidity disorder of schizophrenia. The following four issues will be dealt with: 1 the neurobiological basis of the psychosis-inducing, pathogenic effects of THC, the agent contained in cannabis products. 2 Can cannabis use - and for comparison alcohol abuse - prematurely trigger or even cause schizophrenia? 3 Are persons genetically liable to schizophrenia, psychosis-prone individuals or young persons before completion of brain development at an increased risk? 4 What consequences does cannabis use have on the symptomatology and further course of schizophrenia? Results from recent literature and the ABC Schizophrenia Study show that the risk for cannabis use in schizophrenia is about twice the size in healthy controls. In most cases cannabis use starts before first admission, in a third of cases before schizophrenia onset. There is an increased affinity to misuse already at the prodromal stage. Cannabis can prematurely trigger schizophrenia onset - on average eight years earlier than in non-use - and cause the illness partly in interaction with predisposing factors. Cannabis use in the course of schizophrenia increases positive symptoms and reduces affective flattening, thus leading to dysfunctional coping in some cases.
Birchwood M, Iqbal Z, Chadwick P, Trower P. Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression. Br J Psychiatry. 2000; 177: 516-521. 23. Oosthuizen P, Emsley RA, Roberts MC, et al. Depressive symptoms at baseline predict fewer negative symptoms at follow-up ...
Elahi, A; Perez Algorta, G; Varese, F; McIntyre, J C; Bentall, R P
There is widespread interest in whether psychosis exists on a continuum with healthy functioning. Previous research has implied that paranoia, a common symptom of psychosis, exists on a continuum but this has not been investigated using samples including both patients and non-patients and up-to-date taxometric methods. To assess the latent structure of paranoia in a diverse sample using taxometric methods. We obtained data from 2836 participants, including the general population as well as at-risk mental state and psychotic patients using the P-scale of the Paranoia and Deservedness Scale. Data were analysed using three taxometric procedures, MAMBAC, MAXEIG and L-MODE (Ruscio, 2016), and two sets of paranoia indicators (subscales and selected items from the P scale), including and excluding the patient groups. Eleven of the twelve analyses supported a dimensional model. Using the full sample and subscales as indicators, the MAMBAC analysis was ambiguous. Overall, the findings converged on a dimensional latent structure. A dimensional latent structure of paranoia implies that the processes involved in sub-clinical paranoia may be similar to those in clinical paranoia. Copyright © 2017 Elsevier B.V. All rights reserved.
Barrantes-Vidal, Neus; Gómez-de-Regil, Lizzette; Navarro, Blas; Vicens-Vilanova, Jordi; Obiols, Jordi; Kwapil, Thomas
The objective of this study was to replicate the association between atypical handedness and psychosis-proneness in a representative sample of adolescents from the general population. It expands previous studies by (1) analyzing a variety of atypical handedness indexes (left, mixed, ambiguous, and inconsistent), (2) measuring comprehensively the multidimensionality of psychosis-proneness, and (3) analyzing the association of different patterns of atypical handedness with nonclinical dimensions of both trait (schizotypy) and sub-clinical symptom (psychotic-like experiences) levels. Seven hundred and twenty-eight adolescents were assessed for handedness by the 12-item self-report Annett Hand Preference Questionnaire and for psychosis-proneness by the Oxford-Liverpool Inventory of Feelings and Experiences and the Community Assessment of Psychic Experiences scales. Writing-hand alone did not detect associations between laterality and psychosis-proneness. Mixed- rather than left-handedness was related to psychosis-proneness, and this was more evident when analyzing subjects with ambiguous handedness exclusively. When analysis was restricted to subjects with non-ambiguous handedness, strong left-handedness was related to psychosis-proneness. The positive dimension showed a stronger association than the negative one with atypical handedness. Results partially support mixed-handedness as a marker of developmental disorders underlying both atypical lateralization and psychosis-proneness. Among various possible mixed-handedness patterns, inconsistent hand use across primary actions, and for the same action across time, seems particularly related to psychosis-proneness and thus requires further exploration. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Srivastava, S; Sharma, I; Bhatia, M S
Psychotic symptoms appear in children and adolescents in the most crucial years, during the individual's career development. The challenges faced by parents of psychotic children are in dealing with their disruptive behaviours, negative symptoms, cognitive deficits, delusions and hallucinations. This paper presents an overview of the childhood psychosis and how parenting can be done effectively for this population. Articles were retrieved from the Medline, Cochrane database, Google Scholar, Medscape; using the search terms 'parenting and childhood psychosis', and 'childhood psychoses; and standard textbooks were consulted. Educating parents how to recognize early symptoms, explaining treatment adherence, side effects of medications along with non-pharmacological measures like dealing with expressed emotions, lowering expectations, enhancing social supports, healthy lifestyle, and making patients independent. Awareness, early identification and effective parenting for psychosis may help bridge the wide gap between scarce skilled mental health professionals, inefficient resources and large paediatric population.
Joa, Inge; Johannessen, Jan Olav; Auestad, Bjørn
The TIPS early intervention program reduced the duration of untreated psychosis (DUP) in first-episode schizophrenia from 16 to 5 weeks in a health care sector using a combination of easy access detection teams (DTs) and a massive information campaign (IC) about the signs and symptoms of psychosis...
To determine the effect of substance abuse on psychosis in terms of onset, duration, severity of symptoms, use of medication ... Subjects in the first-episode psychosis group were more likely to choose cannabis as their substance of abuse than controls. They also started abusing substances at a younger age than controls.
Sullivan, Sarah; Herzig, Daniela; Mohr, Christine; Lewis, Glyn; Corcoran, Rhiannon; Drake, Richard; Evans, Jonathan
There is evidence of associations between social functioning and theory of mind performance and between social functioning and negative symptoms in chronic psychosis. This study investigates these associations in those with first episode psychosis who are unaffected by factors related to long-term mental illness. Our first hypothesis states that there is an association between theory of mind and social functioning. The second hypothesis states that there is no association between symptoms of psychosis and social functioning. Fifty-two individuals with first episode psychosis were assessed for social functioning, theory of mind ability (using the Hinting test with verbal stimuli and the Visual Cartoon test with pictorial stimuli), and symptoms of psychosis. Multivariable logistic regression was used to examine associations. Social functioning and theory of mind were associated when measured by the Hinting test (OR 1.70, 95% CI 1.08, 2.66), but not with the Visual Cartoon test (ToM jokes OR 0.61, 95% CI 0.15, 2.53). There was no association between social functioning and symptoms (psychotic symptoms; OR 0.95, 95% CI 0.81, 1.12; selected negative symptoms; OR 1.33, 95% CI 0.78, 2.25). Theory of mind assessed by verbal stimuli is associated with social functioning in a population with first episode psychosis. These findings may be related to language disorders in psychosis.
In the last decades, schizophrenia has intensively been studied using various brain imaging techniques. However, several potential confounding factors limited their interpretation power (e.g. chronicity, the impact of antipsychotic medication). By considering psychosis as a continuum of changes starting from mild cognitive impairments to serious psychotic symptoms, it became possible to provide deeper insight in the neurobiological mechanisms underlying the onset of psychosis by focusing on at-risk individuals and first-episodes. Recent brain imaging meta-analyses of the first episode psychosis (FEP), noteworthy reported conjoint bilateral structural and functional differences at the level of the insula, the superior temporal gyrus and the medial frontal gyrus, encompassing the anterior cingulate cortex. In the present review, we thus provide an update of brain imaging studies of FEP with a particular emphasis on more recent anatomical, functional and molecular explorations. Specifically, we provide 1) a review of the common features observed in individuals with high risk for psychosis and changes characterizing the transition to psychosis, 2) a description of the environmental and drug factors influencing these abnormalities, 3) how these findings in FEP may differ from those observed in chronic individuals with schizophrenia, and 4) a short overview of new classification algorithms able to use MRI findings as valuable biomarkers to guide early detection in the prodromal phase of psychosis. Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.
Livingstone, Karen; Harper, Sean; Gillanders, David
The emotional experience of individuals who experience psychosis has historically been neglected, possibly due to the divide between the psychoses and neuroses. This study examined emotional experience and regulation in individuals who had experienced psychosis, individuals experiencing anxiety or mood disorders, and non-patient controls. Participants completed validated measures of emotional experience and emotion regulation. Both clinical groups were found to experience similar levels of emotions, and in comparison to the non-patient controls, they experienced greater levels of negatively valenced emotions and lower levels of happiness. Both clinical groups also used similar emotion regulation strategies, and in comparison to non-patient controls, they used significantly more dysfunctional and less functional strategies, suggesting that the emotional experience and emotion regulation strategies of people who have experienced psychosis are more similar to non-psychotic disorders than have previously been thought to be the case. The theoretical and clinical implications of these findings are discussed. *Individuals with psychosis experience similar emotions as individuals with anxiety and mood disorders, namely more unhappiness, fear and less happiness. *People with psychosis attempt to regulate these emotions in similar ways to people with mood and anxiety problems, by using more dysfunctional emotional regulation strategies such as ruminating. *Clinicians may want to pay closer attention to assessing the emotion regulation strategies of those who experience psychosis and consider the implications of these in therapy. *They may also want to consider the role emotional dysregulation may play in the development, maintenance and course of psychosis. *An emotion regulation approach to psychosis may be characterised by focussing on emotional experiences and the individual's response to these, as opposed to psychotic symptoms.
Distress, Psychotic Symptom Exacerbation, and Relief in Reaction to Talking about Trauma in the Context of Beneficial Trauma Therapy: Perspectives from Young People with Post-Traumatic Stress Disorder and First Episode Psychosis.
Tong, Janet; Simpson, Katrina; Alvarez-Jimenez, Mario; Bendall, Sarah
Of young people with first episode psychosis (FEP), over half report exposure to childhood trauma and consequent co-morbid post-traumatic stress disorder (PTSD) or symptoms. Currently no evidence-based interventions exist for PTSD in FEP. Clinicians report concerns that trauma-focused interventions with young people with FEP could result in distress and symptom exacerbation. Scant research suggests that talking about trauma in therapy can be distressing for some people. To explore young people's reactions to a trauma-focused treatment for PTSD in FEP. Semi-structured interviews were conducted with eight participants (age 18-27 years) with co-morbid PTSD and FEP, after completing a trauma-focused intervention. Transcripts were analysed using an interpretative phenomenological approach. Participants' baseline and end-of-treatment PTSD and psychotic symptoms were assessed. Three themes related to participants' reactions were identified from the analysis: (1) distress in session; (2) feeling relieved in and out of session; and (3) symptom exacerbation out of session. All but one participant reported experiencing increased distress in session. Four participants described PTSD, psychotic symptoms and/or suicidal ideation worsening in immediate reaction to talking about trauma in therapy sessions. 86% of participants showed improvement in their PTSD and psychotic symptoms at end of treatment. All participants described the intervention as beneficial and worthwhile. Results suggest that feelings of distress are to be expected from individuals with PTSD and FEP during trauma-focused treatment. Psychotic and PTSD symptom exacerbation can occur in PTSD treatment in FEP. Clinicians should be aware of, plan for, and clearly inform their clients of treatment risks.
Quality of life (QOL) has gained recognition as a valid measure of outcome in first-episode psychosis (FEP). This study aimed to determine the influence of specific groups of depressive symptoms on separate domains of subjectively appraised QOL.
Larsen, T. K.; Melle, I.; Auestad, B.
Background During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This st...
Johanna T W Wigman
Full Text Available Psychotic disorders are thought to represent altered neural function. However, research has failed to map diagnostic categories to alterations in neural networks. It is proposed that the basic unit of psychotic psychopathology is the moment-to-moment expression of subtle anomalous experiences of subclinical psychosis, and particularly its tendency to persist from moment-to-moment in daily life, under the influence of familial, environmental, emotional and cognitive factors.In a general population twin sample (n = 579 and in a study of patients with psychotic disorder (n = 57, their non-psychotic siblings (n = 59 and unrelated controls (n = 75, the experience sampling paradigm (ESM; repetitive, random sampling of momentary mental states and context was applied. We analysed, in a within-person prospective design, (i transfer of momentary anomalous experience at time point (t-1 to time point (t in daily life, and (ii moderating effects of negative affect, positive affect, daily stressors, IQ and childhood trauma. Additionally, (iii familial associations between persistence of momentary anomalous experience and psychotic symptomatology were investigated. Higher level of schizotypy in the twins (but not higher level of psychotic symptoms in patients predicted more persistence of momentary anomalous experience in daily life, both within subjects and across relatives. Persistence of momentary anomalous experience was highest in patients, intermediate in their siblings and lowest in controls. In both studies, persistence of momentary anomalous experience was moderated by higher levels of negative affect, daily stressors and childhood trauma (only in twins, and by lower levels of positive affect. The study of alterations in the moment-to-moment transfer of subtle anomalous experience of psychosis, resulting in their persistence, helps to explain why psychotic and emotional dysregulation tend to cluster in a single phenotype such as
Riches, Simon; Schrank, Beate; Rashid, Tayyab; Slade, Mike
Positive psychotherapy (PPT) is an established psychological intervention initially validated with people experiencing symptoms of depression. PPT is a positive psychology intervention, an academic discipline that has developed somewhat separately from psychotherapy and focuses on amplifying well-being rather than ameliorating deficit. The processes targeted in PPT (e.g., strengths, forgiveness, gratitude, savoring) are not emphasized in traditional psychotherapy approaches to psychosis. The goal in modifying PPT is to develop a new clinical approach to helping people experiencing psychosis. An evidence-based theoretical framework was therefore used to modify 14-session standard PPT into a manualized intervention, called WELLFOCUS PPT, which aims to improve well-being for people with psychosis. Informed by a systematic review and qualitative research, modification was undertaken in 4 stages: qualitative study, expert consultation, manualization, and stake-holder review. The resulting WELLFOCUS PPT is a theory-based 11-session manualized group therapy. (c) 2016 APA, all rights reserved).
Luther, Lauren; Lysaker, Paul H; Firmin, Ruth L; Breier, Alan; Vohs, Jenifer L
The deleterious functional implications of motivation deficits in psychosis have generated interest in examining dimensions of the construct. However, there remains a paucity of data regarding whether dimensions of motivation differ over the course of psychosis. Therefore, this study examined two motivation dimensions, trait-like intrinsic motivation, and the negative symptom of amotivation, and tested the impact of illness phase on the 1) levels of these dimensions and 2) relationship between these dimensions. Participants with first episode psychosis (FEP; n=40) and prolonged psychosis (n=66) completed clinician-rated measures of intrinsic motivation and amotivation. Analyses revealed that when controlling for group differences in gender and education, the FEP group had significantly more intrinsic motivation and lower amotivation than the prolonged psychosis group. Moreover, intrinsic motivation was negatively correlated with amotivation in both FEP and prolonged psychosis, but the magnitude of the relationship did not statistically differ between groups. These findings suggest that motivation deficits are more severe later in the course of psychosis and that low intrinsic motivation may be partially independent of amotivation in both first episode and prolonged psychosis. Clinically, these results highlight the importance of targeting motivation in early intervention services. Copyright © 2015 Elsevier B.V. All rights reserved.
van Os, J; Hanssen, M; Bijl, R V; Ravelli, A
Although dichotomously defined for clinical purposes, psychosis may exist as a continuous phenotype in nature. A random sample of 7076 men and women aged 18-64years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview (CIDI). Those with evidence of psychosis according to the CIDI were additionally interviewed by psychiatrists. For the 17 CIDI core psychosis items, we compared a psychiatrist's rating of hallucinations and/or delusions (Clinical Psychosis; sample prevalence 4.2%) with three other possible positive CIDI ratings of the same items: (i) symptom present, but not clinically relevant (NCR Symptom; sample prevalence 12.9%); (ii) symptom present, but the result of drugs or somatic disorder (Secondary Symptom; sample prevalence 0.6%); (iii) symptom appears present, but there is a plausible explanation (Plausible Symptom; sample prevalence 4.0%). Of the 1237 individuals with any type of positive psychosis rating (sample prevalence 17.5%), only 26 (2.1%) had a DSM-III-R diagnosis of non-affective psychosis. All the different types of psychosis ratings were strongly associated with the presence of psychiatrist-rated Clinical Psychosis (NCR Symptom: OR=3.4; 95% CI: 2.9-3.9; Secondary Symptom: OR=4.5; 95% CI: 2.7-7.7; Plausible Symptom: OR=5.8; 95% CI: 4.7-7.1). Associations with lower age, single marital status, urban dwelling, lower level of education, lower quality of life, depressive symptoms and blunting of affect did not differ qualitatively as a function of type of rating of the psychotic symptom, were similar in individuals with and without any CIDI lifetime diagnosis, and closely resembled those previously reported for schizophrenia. Presence of any rating of hallucinations was strongly associated with any rating of delusions (OR=6.7; 95% CI: 5.6-8.1), regardless of presence of any CIDI lifetime diagnosis. The observation by Strauss (1969. Hallucinations and delusions as points on continua function. Arch. Gen
Full Text Available Background. No consensus between guidelines exists regarding neuroimaging in first-episode psychosis. The purpose of this study is to assess anomalies found in structural neuroimaging exams (brain computed tomography (CT and magnetic resonance imaging (MRI in the initial medical work-up of patients presenting first-episode psychosis. Methods. The study subjects were 32 patients aged 18–48 years (mean age: 29.6 years, consecutively admitted with first-episode psychosis diagnosis. Socio-demographic and clinical data and neuroimaging exams (CT and MRI were retrospectively studied. Diagnostic assessments were made using the Operational Criteria Checklist +. Neuroimaging images (CT and MRI and respective reports were analysed by an experienced consultant psychiatrist. Results. None of the patients had abnormalities in neuroimaging exams responsible for psychotic symptoms. Thirty-seven percent of patients had incidental brain findings not causally related to the psychosis (brain atrophy, arachnoid cyst, asymmetric lateral ventricles, dilated lateral ventricles, plagiocephaly and falx cerebri calcification. No further medical referral was needed for any of these patients. No significant differences regarding gender, age, diagnosis, duration of untreated psychosis, in-stay and cannabis use were found between patients who had neuroimaging abnormalities versus those without. Discussion. This study suggests that structural neuroimaging exams reveal scarce abnormalities in young patients with first-episode psychosis. Structural neuroimaging is especially useful in first-episode psychosis patients with neurological symptoms, atypical clinical picture and old age.
Full Text Available The current study aimed to evaluate the potentially traumatic aspects of psychotic symptoms and psychiatric treatment of psychosis using qualitative methods. Participants included 63 people with first episode psychosis or multiple psychotic episodes recruited from an inpatient psychiatric unit and an urban state psychiatric hospital in the North East region of the United States. Quasi-structured interviews were used to explore those aspects of symptoms and treatment that were perceived as traumatic Emotional reactions to the most traumatic aspect of symptoms and treatment, during and after the event, were also examined. Participants described a number of traumatogenic aspects of psychotic symptoms, including frightening hallucinations; suicidal thought/attempts, thoughts/attempts to hurt others; paranoia/delusions and bizarre/disorganized behavior or catatonia. Traumatic aspects of psychosis elicited emotions including anger, sadness and confusion, anxiety, and numbness at the time of event. Furthermore, many participants found aspects of treatment to be traumatic, including: being forced to stay in the hospital for a long time; experiencing upsetting side-effects; coercive treatments, including involuntary hospitalization, use of restraints, and forced medication; being exposed to aggressive patients; and mistreatment by professionals. These experiences elicited emotions of anger, sadness, distrust, and a sense of helplessness. Study findings suggest that the experiences both of psychotic symptoms and psychiatric treatment, potentially traumatic, can be a powerful barrier to engaging people in mental health services and facilitating recovery. Clinical implications were discussed.
A single blind randomized controlled trial of cognitive behavioural therapy in a help-seeking population with an At Risk Mental State for psychosis: the Dutch Early Detection and Intervention Evaluation (EDIE-NL trial
Full Text Available Abstract Background Psychotic disorders are a serious mental health problem. Intervention before the onset of psychosis might result in delaying the onset, reducing the impact or even preventing the first episode of psychosis. This study explores the effectiveness of cognitive behavioural therapy (CBT in targeting cognitive biases that are involved in the formation of delusions in persons with an ultra-high risk for developing psychosis. A single blind randomised controlled trial compares CBT with treatment as usual in preventing or delaying the onset of psychosis. Method/design All help seeking patients aged 14 to 35 years referred to the mental health services in three regions in the Netherlands are pre-screened with the Prodromal Questionnaire during a period of two years. Patients with a score of 18 or more on the sub-clinical positive symptoms items (45 items in total will be assessed with the Comprehensive Assessment of At Risk Mental State (CAARMS. In a different pathway to care model all referrals from the mental health services in Amsterdam to the specialized psychosis clinic of the Academic Medical Centre in Amsterdam are also assessed with the CAARMS. The primary outcome is the transition rate to psychosis according to the CAARMS-criteria. Group differences will be analysed with chi-square tests and survival analyses. Discussion CBT is a highly tolerated treatment. The psycho-educational CBT approach may prove to be a successful strategy since most people with an At Risk Mental State (ARMS are distressed by odd disturbing experiences. Giving explanations for and normalising these experiences may reduce the arousal (distress and therefore may prevent people from developing a catastrophic delusional explanation for their odd experiences and thus prevent them from developing psychosis. Screening the entire help-seeking population referred to community mental health services with a two-stage strategy, as compared with traditional referral
Berg, Akiah O; Melle, Ingrid; Rossberg, Jan Ivar; Romm, Kristin Lie; Larsson, Sara; Lagerberg, Trine V; Andreassen, Ole A; Hauff, Edvard
Immigration status is a significant risk factor for psychotic disorders, and a number of studies have reported more severe positive and affective symptoms among immigrant and ethnic minority groups. We investigated if perceived discrimination was associated with the severity of these symptoms among immigrants in Norway with psychotic disorders. Cross-sectional analyses of 90 immigrant patients (66% first-generation, 68% from Asia/Africa) in treatment for psychotic disorders were assessed for DSM-IV diagnoses with the Structured Clinical Interview for DSM Disorders (SCID-I, sections A-E) and for present symptom severity by The Structured Positive and Negative Syndrome Scale (SCI-PANSS). Perceived discrimination was assessed by a self-report questionnaire developed for the Immigrant Youth in Cultural Transition Study. Perceived discrimination correlated with positive psychotic (r=0.264, panxiety symptoms (r=0.282, pseverity in African immigrants. Multiple linear regression analyses controlling for possible confounders revealed that perceived discrimination explained approximately 10% of the variance in positive and depression/anxiety symptoms in the statistical model. Among immigrants with psychotic disorders, visible minority status was associated with perceived discrimination and with more severe positive and depression/anxiety symptoms. These results suggest that context-specific stressful environmental factors influence specific symptom patterns and severity. This has important implications for preventive strategies and treatment of this vulnerable patient group.
Full Text Available Soo-Hyun Joo, Jong-Hyun Jeong, Seung-Chul HongDepartment of Psychiatry, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, KoreaAbstract: Abnormalities in thyroid function are associated with many psychiatric symptoms. We present a report of a 15-year-old girl who was admitted to the psychiatry inpatient unit with symptoms of suicidal behavior, irritability, and impulsivity. One year previously, she had become more short-tempered, and had started to cut her wrists impulsively. Laboratory tests revealed subclinical hyperthyroidism. She was treated with anxiolytic and antithyroid drugs, and her suicidal ideation and irritability resolved. This case demonstrates that subclinical hyperthyroidism can be associated with suicidal behavior as well as overt hyperthyroidism. Early intervention is required to prevent suicidal behavior in patients with subclinical hyperthyroidism.Keywords: suicidal behavior, subclinical hyperthyroidism, anxiolytics
Brvar, Miran; Mozina, Martin; Bunc, Matjaz
Amanita muscaria has a bright red or orange cap covered with small white plaques. It contains the isoxazole derivatives ibotenic acid, muscimol and muscazone and other toxins such as muscarine. The duration of clinical manifestations after A. muscaria ingestion does not usually exceed 24 hours; we report on a 5-day paranoid psychosis after A. muscaria ingestion. A 48-year-old man, with no previous medical history, gathered and ate mushrooms he presumed to be A. caesarea. Half an hour later he started to vomit and fell asleep. He was found comatose having a seizure-like episode. On admission four hours after ingestion he was comatose, but the remaining physical and neurological examinations were unremarkable. Creatine kinase was 8.33 microkat/l. Other laboratory results and brain CT scan were normal. Toxicology analysis did not find any drugs in his blood or urine. The mycologist identified A. muscaria among the remaining mushrooms. The patient was given activated charcoal. Ten hours after ingestion, he awoke and was completely orientated; 18 hours after ingestion his condition deteriorated again and he became confused and uncooperative. Afterwards paranoid psychosis with visual and auditory hallucinations appeared and persisted for five days. On the sixth day all symptoms of psychosis gradually disappeared. One year later he is not undergoing any therapy and has no symptoms of psychiatric disease. We conclude that paranoid psychosis with visual and auditory hallucinations can appear 18 hours after ingestion of A. muscaria and can last for up to five days.
Feldman, B; Chapman, J; Korczyn, A D
Psychosis is one of the most serious complications of advanced parkinsonism, but many patients are spared. The genetic factors predisposing to psychosis are unclear. To assess the association between apolipoprotein E (APOE) polymorphism and the development of psychosis in patients with Parkinson's disease (PD). Eighty-seven patients with advanced PD were assessed. Psychosis was diagnosed in 50 patients who manifested paranoid delusions, hallucinations without insight, or disorders of perception. Time of onset of psychosis was retrieved from the medical records and caregivers' recall. APOE genotype was determined by restriction enzyme digests of amplified alleles. Cox models of logistic regression and Kaplan-Meier survival curves were used to assess factors determining early development of psychosis. APOE epsilon3/epsilon4 allele was carried by 20 patients (14 with psychosis), epsilon2/epsilon3 by 11 patients (10 with psychosis), epsilon3/epsilon3 by 55 patients (25 with psychosis) and epsilon2/epsilon4 by one patient who had psychosis. The mean age of onset of PD symptoms was 60.0 +/- 12.5 years. The mean duration of motor symptoms at the onset of psychosis was 7.3 +/- 4.3 years for the 15 patients harboring an APOE epsilon4 allele and 10.1 +/- 6.2 years among those who did not carry APOE epsilon4 (n = 35). The APOE epsilon4 allele was significantly associated with earlier onset of psychosis (P dementia were included in the Cox regression model. Carrying the APOE epsilon4 allele was a significant risk factor for earlier appearance of psychosis with a hazard ratio of 3.24 (95% CI 1.62-6.46) while dementia by itself did not increase the risk. Parkinson's disease patients who carry the APOE epsilon4 allele develop psychosis earlier.
Miret, Salvador; Fatjó-Vilas, Mar; Peralta, Víctor; Fañanás, Lourdes
Basic symptoms consist of subtle sub-clinical disturbances subjectively experienced by schizophrenia patients. These are mainly related to drive, affect, thinking and language, perception, memory, motor action, central vegetative functions, control of cognitive processes, and stress tolerance. Initially described by Huber, from a phenomenological approach, basic symptoms are part of the earliest features of schizophrenia, and they can evolve along the course of the disorder. Their assessment during the prodromal phase of the disease (together with ultra-high risk criteria) is one of the 2 main approaches that allow the definition of states of clinical risk for the development of psychosis. The present review provides an updated view of the concept of basic symptoms, highlighting its potential value in establishing neurobiological correlates of interest in aetiopathogenic research. Copyright © 2015 SEP y SEPB. Published by Elsevier España. All rights reserved.
Gunderson, Erik W; Kirkpatrick, Matthew G; Willing, Laura M; Holstege, Christopher P
In this report, we describe a case of intranasal "bath salts"-associated psychosis. Symptoms developed during a 3-week binge and were potentially exacerbated by oral diphenhydramine taken for insomnia. The clinical case conference includes expert discussion from 3 disciplines: emergency medicine toxicology, behavioral pharmacology, and addiction medicine. It is hoped that the discussion will provide insight into the clinical aspects and challenges of addressing acute substituted cathinone toxicity, including acute psychosis, a major adverse effect of bath salts consumption.
Mindfulness treatments and research have burgeoned over the past decade. With psychosis, progress has been slow and likely held back by clinicians' belief that mindfulness may be harmful for this client group...
... Events News & Events Home Science News Events Multimedia Social Media Press Resources Newsletters NIMH News Feeds About Us ... and education teaches family members about psychosis, coping, communication, and problem-solving skills. Family members who are informed and involved are ...
Seshadri, Madhavan; Agius, Mark; Grech, Anton; Zammit, Stanley;
Several studies have established a link between cannabis and psychosis. However the causal role of cannabis in schizophrenia is still not clear. The aim of this paper is to summarise the literature pertaining to whether cannabis causes psychosis, whether the continued use of cannabis by patients with schizophrenia affects the course of the disease and its treatment, and whether it is possible to reduce cannabis use in patients who have a psychotic disorder.
Full Text Available Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone ( TSH and normal free T3 & T4 , without clinical features of hypothyroidism . Clinical significance of SCH remains uncertain and controversial . Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms . There are still controversies surrounding SCH and associated risk of various cardiovascular diseases ( CVDs , pregnancy outcomes , neuropsychiatric issues , metabolic syndrome , and dyslipidemia . This review will summarize the current data related to the effects of SCH on cardiovascular risk , SCH in pregnancy , in dyslipedemia and clinical guidelines on management of this condition . The evidence has been updated by a Pub med search on the risks and treatment of subclinical hypothyroidism of most recent articles published until March 2015
Potvin, Stéphane; Lalonde, Martin
Objectives The comorbidity between psychosis and substance use has attracted wide attention over the years, and a vast literature is now available for meta-analytic treatment. In the field, a majority of authors assume that cannabis smoking is a risk factor for psychosis, that substance abuse is highly prevalent in schizophrenia, that substance abuse worsens the prognosis of schizophrenia, and that integrated treatments have greater efficacy than treatment-as-usual for this complex population. The objective of the current article is to review the meta-analyses that have been published in the comorbidity field in order to determine if the above-mentioned assumptions are substantiated by evidence or not. Methods A search of the literature was performed using PubMed, PsycINFO and EMBASE. The literature search retrieved a total of 25 systematic quantitative reviews, addressing the following issues: etiology, age at onset, prevalence rates, cognition, treatment, as well as psychiatric, neurologic and functional outcomes. Results Evidence shows that the prevalence of tobacco smoking, cannabis smoking and alcohol use is elevated in psychosis. However, this prevalence is likely to be over-estimated since studies have been performed in clinical settings rather than the general population. Reliable evidence also suggests that cannabis smoking is a risk factor for psychosis outcomes. However, the association is rather small and it remains difficult to draw an unequivocal public health message from this literature. In the same vein, evidence suggests that cannabis smoking is associated with an earlier age at onset of psychosis. However, this observation is derived from cross-sectional studies, not longitudinal ones; thus, no undisputable claims on causality can be made from them. On clinical grounds, some evidence also suggests that substance use is associated with self-harm, increased positive and depressive symptoms in psychosis patients, but this evidence is derived from
Reduced inattention and hyperactivity and improved cognition after marine oil extract (PCSO-524®) supplementation in children and adolescents with clinical and subclinical symptoms of attention-deficit hyperactivity disorder (ADHD): a randomised, double-blind, placebo-controlled trial.
Kean, James D; Sarris, Jerome; Scholey, Andrew; Silberstein, Richard; Downey, Luke A; Stough, Con
This study investigated the effects of a marine oil extract (PCSO-524®) on inattention, hyperactivity, mood and cognition in children and adolescents. PCSO-524® is a standardised lipid extract of the New Zealand green-lipped mussel and is an inflammatory modulator that inhibits the 5'-lipoxygenase and cyclooxygenase pathways and decreases concentrations of the pro-inflammatory arachidonic acid (AA). PCSO-524® or a matched placebo was administered for 14 weeks to 144 participants (123 males/21 females; mean age 8.7 years) with high hyperactivity and inattention in a randomised, double-blind, placebo-controlled study. The primary outcome was the Conners Parent Rating Scale assessing parental reports of behavioural problems. Secondary outcomes assessed changes in cognition and mood. The results of the present study did not support the hypothesis that PCSO-524® improves parental reports of hyperactivity, inattention and impulsivity in children ages 6 to 14 years over placebo. Repeated measures ANOVA on post hoc subsample analysis indicated significant improvements in hyperactivity (p = 0.04), attention (p = 0.02), learning (p = 0.05) and probability of ADHD (p = 0.04) with a medium to large average effect size (d = 0.65) in those children who did not meet criteria for combined hyperactivity and inattention. Furthermore, significant improvements in the PCSO-524® group were indicated in a whole sample repeated measures ANCOVA on recognition memory between baseline and week 8 over placebo (p = 0.02, d = 0.56); this difference was not sustained at week 14. The results presented indicate that PCSO-524® may be beneficial in reducing levels of hyperactivity and inattention in a population of children with clinical and subclinical symptoms of ADHD.
Fonseca-Pedrero, Eduardo; Gooding, Diane C; Ortuño-Sierra, Javier; Paino, Mercedes
The reliable early identification of individuals at risk for psychosis requires well-validated screening measures. To date, there is little information about the psychometric properties of the screening measures for psychosis risk in nonclinical adolescents. The main purpose of the present study was to validate the Prodromal Questionnaire-Brief (PQ-B) in a community sample of non-clinical Spanish adolescents. We also analyzed the prevalence, factorial validity, and reliability of the PQ-B scores as well as the relationship between self-reported clinical high risk symptoms and schizotypal traits. Four hundred and forty-nine high-school students participated in a cross-sectional survey. The PQ-B and the Oviedo Schizotypy Assessment Questionnaire (ESQUIZO-Q) were used. Although 85.1% of the total sample reported at least one clinical high risk symptom, only 16% of the adolescents scored above the standardized cut-off. The PQ-B revealed an essentially unidimensional structure. The internal consistency of the PQ-B total score was 0.93. Pearson correlation coefficients indicated a high degree of overlap between self-reported clinical high risk symptoms and Positive and Disorganized schizotypal traits. A Canonical correlation between the PQ-B total score and ESQUIZO-Q dimensions showed that the associated variance between both sets of variables was 45.4% (adjusted R(2)=0.45). The PQ-B is a brief, easy, and reliable tool for screening self-reported clinical high risk symptoms in adolescents from the general population. These results also indicated that self-reported clinical high risk symptoms and schizotypal traits are closely associated at the subclinical level. The assessment of psychosis risk symptoms and their relationship with other distal risk factors, in a close-in strategy, may enhance the early identification of individuals at heightened risk for psychosis spectrum disorders. Copyright © 2016 Elsevier Inc. All rights reserved.
Boydell, J; Bebbington, P; Bhavsar, V; Kravariti, E; van Os, J; Murray, R M; Dutta, R
This study describes the incidence of psychosis in unemployed people and determines whether unemployment has a greater impact on the development of psychosis amongst Black minority groups than White groups. Patients with a first diagnosis of Research Diagnostic Criteria psychosis, in a defined area of London from 1998 to 2004, were identified. Crude and standardised incidence rates of psychosis amongst unemployed people for each ethnic group were calculated. Poisson regression modelling tested for interactions between unemployment and ethnicity. Hundred cases occurred amongst employed people and 78 cases occurred amongst the unemployed people. When standardised to the employed White population of the area, White unemployed people had a standardised incidence ratio (SIR) of 11.7 (95% CI 6.4-19.7), Black Caribbean people had a SIR of 60.1(95% CI 39.3-88) and Black African people had a SIR of 40.7 (95% CI 25.8-61.1). There was no interaction however between ethnicity and unemployment (Likelihood ratio test P = 0.54). Rates of psychosis are high amongst unemployed people in south London and extremely high amongst Black Caribbean and Black African unemployed people. There was no evidence however that the minority groups were particularly sensitive to the stresses, limitations or meaning of unemployment. © 2012 John Wiley & Sons A/S.
The analysis treatment of a psychotic individual presupposes a global problem focus on the causes of psychosis, its structure, its outbreak, and the stages in its development. Here, psychosis is viewed in its specifically psychic dimension, where Lacanian theory, to which the author adheres, places the cause of the sickness: (the "forclusion" of the names of the father). This formula indicates the absence of the paternal function. This lack originates in the fact that a dysfunction of the symbolic order in the family structure presides over the birth of a subject. The locating of the elements (the signifiers) of such symbolic dysfunction is essential because the delusion attempts to repair this defect in the representational order. Against this defect the subject first constructed imaginary assemblings which allow him a provisional articulation, satisfying for him, to others and to social reality. The outbreak of the psychosis results in the collapse of such imaginary scaffoldings. Then after a period of bewilderment and psychic retreat, all the effort of the psychotic is directed at the reconstitution of a new representational order. The work of the analysis consistants of attempting, on the basis of the signifiers put forward by the delusion, to assist the psychotic in his reconstitution of symbolic order. The delusion is the access road to this work in psychosis just as the dream is the royal road to the unconscious in the neurosis. The effort of this article is directed at situating these stages in the treatment of psychosis in their theorical and clinical foundations.
Melle, I; Friis, Svein; Haahr, U
Quality of life (QoL) measures are increasingly recognized as necessary parts of outcome assessments in psychosis. The present paper is a comprehensive study of patients with first-episode psychosis where QoL is measured by the commonly used Lehman Quality of Life Interview (L-QoLI). The aim...... is to examine if the L-QoLI maintain its original structure when used in a group of patients with first-episode psychosis, and to investigate what determines global subjective QoL with a specific emphasis on premorbid adjustment, duration of untreated psychosis (DUP) and clinical symptoms. The study indicates...... of compromised function at this stage produces poor satisfaction with life rather than a downward readjustment of expectations....
Moritz, Steffen; Göritz, Anja S; McLean, Benjamin; Westermann, Stefan; Brodbeck, Jeannette
Affective versus nonaffective psychoses are today no longer regarded as mutually exclusive disorders. Theorists have recently highlighted the role of affective symptoms in the formation of paranoid beliefs, particularly negative beliefs about the self, interpersonal sensitivity, sleep disturbances, and worrying, which exist along a continuum in the general population. For the present study, we tested the bidirectional causal relationships between paranoia and affect. A large population sample (N = 2,357) was examined at three time-points (baseline, six months, two years) as to the severity of subclinical paranoid beliefs (Paranoia Checklist, PCL) and depressive symptoms (Patient Health Questionnaire-9, PHQ-9). Worrying and avoidance were measured with items from the Maladaptive and Adaptive Coping Style Questionnaire (MAX). Depression and paranoid symptoms were strongly cross-sectionally related (r = 0.69) and showed high stability (r > 0.72). Depressive symptoms at T2 predicted paranoid symptoms at T3 (beta = 0.16; no significant relationship from T1 to T2), whereas paranoid symptoms predicted depressive symptoms from T1 to T2 (beta = 0.09; no significant relationship from T2 to T3). Results should be replicated in a sample of paranoid patients, as risk factors for subclinical versus manifest paranoia may differ. Some constructs were measured with single items derived from a new scale. The predictive association of depression to subsequent paranoia was small and confined to the long interval from T2 to T3. Treatments should target both paranoia and depression - irrespective of their causal relationship - particularly as patients with psychosis consider treatment of their emotional problems a priority. Copyright © 2016. Published by Elsevier Ltd.
Ratnakaran, Badr; Punnoose, Varghese P.; Das, Soumitra; Kartha, Arjun
Hypopituitarism can present with psychiatric symptoms. We report a unique case of psychosis in clear consciousness in a case of hypopituitarism due to the secondary empty sella syndrome following a Russell's viper bite which was untreated and presented with psychotic symptoms for past 13 years following the snake bite. After the diagnosis of psychosis due to hypopituitarism was made, the patient was treated with levothyroxine and prednisolone supplements and his psychotic symptoms subsided wi...
Full Text Available Postictal psychosis is characterized by a fluctuating combination of thought disorder, auditory and visual hallucinations, delusions, paranoia, affective change, and aggression including violent behavior. We present a case of homicide following a cluster of seizures. The patient's history and postictal behavior were his consistent with postictal psychosis. Contributing factors resulting in homicide may have included increased seizure frequency associated with a change in his AED regimen seizure frequency. The AED change to levetiracetam may also have increased impulsiveness with diminished mood regulation following discontinuation of carbamazepine. There is evidence that he had a cluster of seizures immediately prior to the murder which may have resulted in the postictal disinhibition of frontal lobe inhibitory systems. This homicide and other violent behaviors associated with postictal psychosis may be avoided with earlier recognition and treatment.
Solimano, Alberto L
Even though Psychiatry and Psychoanalysis share the idea that the basic characteristic of psychosis is a disorder of the relation with reality, the difference is that for psychoanalysis said relation is libidinal, which means that it is essentially based on the object relation. According to these grounds, psychoanalysis considers that psychotic symptoms make sense beyond the deficit and dysfunction, a meaning to be understood through the subject's history. This conception of reality, which includes both the external reality and the psychic one, also determines a specific psychotherapeutic approach as long as the purpose is not "verifying" the external reality, but containing and eventually analysing the psychic reality. There are clinical examples that show the primary failure in the relation with reality and the use of Projective Identification to be deposited into the therapist.
Csillag, Claudio; Nordentoft, Merete; Mizuno, Masafumi
AIM: Early intervention (EI) in psychosis is a comprehensive and evidence-based approach aimed at detection and treatment of psychotic symptoms in their early stages. This paper presents core features and noteworthy aspects of the evidence basis and limitations of EI, the importance of programme ....... Wider dissemination of EI services will probably benefit from better integration of potential funders, promotion of joint targets and shared financial or budgetary incentives....... overcome these difficulties. CONCLUSIONS: Funding for mental health in general and for EI services appears low relative to need. One key argument for better funding for EI can be found in its favourable cost-effectiveness, but not all stakeholders beyond mental health administrators are aware of this...
Ratnakaran, Badr; Punnoose, Varghese P; Das, Soumitra; Kartha, Arjun
Hypopituitarism can present with psychiatric symptoms. We report a unique case of psychosis in clear consciousness in a case of hypopituitarism due to the secondary empty sella syndrome following a Russell's viper bite which was untreated and presented with psychotic symptoms for past 13 years following the snake bite. After the diagnosis of psychosis due to hypopituitarism was made, the patient was treated with levothyroxine and prednisolone supplements and his psychotic symptoms subsided without any psychotropic drugs. Vasculotoxic snake bites can cause hypopituitarism and can present with psychosis. Further research will be needed into the prevalence of this phenomenon.
Georgopoulos, Grace; Stowkowy, Jacqueline; Liu, Lu; Cadenhead, Kristin S; Cannon, Tyrone D; Cornblatt, Barbara A; McGlashan, Thomas H; Perkins, Diana O; Seidman, Larry J; Tsuang, Ming T; Walker, Elaine F; Woods, Scott W; Bearden, Carrie E; Mathalon, Daniel H; Addington, Jean
On average, there is a 10% to 12% likelihood of developing a psychotic disorder solely based on being at familial high risk. However, the introduction of the criteria for clinical high risk (CHR) of psychosis suggested for CHR individuals, 20% to 30% will go on to develop a full-blown psychotic illness within 3 years. Several studies suggest a role for family history in conversion to psychosis among those at CHR. However, we know very little about those who meet the CHR criteria and have a positive family history for psychosis compared to those at CHR with no known family history. The aim of this study was to compare these 2 groups on demographics, clinical symptoms, social and role functioning, IQ, environmental factors and conversion to psychosis. A total of 762 participants met criteria for being at CHR, 119 of whom had a family history (CHR + FH) and 643 without (CHR-FH). Groups were compared on attenuated symptoms, role and social functioning, IQ, past trauma, perceived discrimination and cannabis use. Survival analysis was used to compare groups on conversion rates. There were no major differences between the groups in symptoms, functioning, IQ, cannabis use or in the rate of conversion between the groups. The CHR + FH group reported increased amounts of early trauma. There is a possibility that CHR + FH individuals believe that it is more difficult for them to cope with circumstances such as abuse or potential abuse. Future research on this subject should investigate family environment and its role in conversion to psychosis among CHR + FH individuals. © 2017 John Wiley & Sons Australia, Ltd.
Santos Palacios, Silvia; Pascual-Corrales, Eider; Galofre, Juan Carlos
The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient's medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves' disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation).
Santos Palacios, Silvia; Pascual-Corrales, Eider; Galofre, Juan Carlos
The ideal approach for adequate management of subclinical hyperthyroidism (low levels of thyroid-stimulating hormone [TSH] and normal thyroid hormone level) is a matter of intense debate among endocrinologists. The prevalence of low serum TSH levels ranges between 0.5% in children and 15% in the elderly population. Mild subclinical hyperthyroidism is more common than severe subclinical hyperthyroidism. Transient suppression of TSH secretion may occur because of several reasons; thus, corroboration of results from different assessments is essential in such cases. During differential diagnosis of hyperthyroidism, pituitary or hypothalamic disease, euthyroid sick syndrome, and drug-mediated suppression of TSH must be ruled out. A low plasma TSH value is also typically seen in the first trimester of gestation. Factitial or iatrogenic TSH inhibition caused by excessive intake of levothyroxine should be excluded by checking the patient’s medication history. If these nonthyroidal causes are ruled out during differential diagnosis, either transient or long-term endogenous thyroid hormone excess, usually caused by Graves’ disease or nodular goiter, should be considered as the cause of low circulating TSH levels. We recommend the following 6-step process for the assessment and treatment of this common hormonal disorder: 1) confirmation, 2) evaluation of severity, 3) investigation of the cause, 4) assessment of potential complications, 5) evaluation of the necessity of treatment, and 6) if necessary, selection of the most appropriate treatment. In conclusion, management of subclinical hyperthyroidism merits careful monitoring through regular assessment of thyroid function. Treatment is mandatory in older patients (> 65 years) or in presence of comorbidities (such as osteoporosis and atrial fibrillation). PMID:23843809
Psychosis is one of the most serious among the adverse effects associated with cannabis use. The association between cannabis use and psychosis has been variously explored in a series of recent meta-analyses. The results of these meta-analyses show that persons who develop psychosis experience onset of psychosis about 2-3 years earlier if they are cannabis users; this effect is not observed with alcohol or other substance use. Higher levels of cannabis use are associated with greater risk of psychosis. Current cannabis abuse or dependence (but not past use or lower levels of current use) increases the risk of transition into psychosis in persons at ultrahigh risk of psychosis. About a third of patients with first-episode psychosis are cannabis users, and, at follow-up, about half of these users are found to continue their cannabis use. Continued cannabis use (in those who are treated after developing psychosis) is associated with higher risk of relapse into psychosis, and discontinuation of cannabis use reduces the risk of relapse to that in cannabis nonusers. Finally, persons with psychosis who continue to use cannabis have more severe positive symptoms and poorer levels of functioning. Because experimental studies in humans show that cannabinoids and cannabis can induce psychotic symptoms, it is reasonable to assume that the epidemiologic data indicate a causal effect of cannabis in anticipating, triggering, or exacerbating psychosis in vulnerable individuals and in worsening the course and outcome of the illness in those who continue to use the substance. Given the public health implications of these findings, the trend to legalize medical marijuana must be viewed with concern, and efforts are necessary to educate patients and the public about the serious mental and physical health risks associated with cannabis use and abuse. © Copyright 2016 Physicians Postgraduate Press, Inc.
... an Allergic Reaction to Food Symptoms of an Allergic Reaction to Food Learn about the mild and severe ... the food to which you are allergic. An allergic reaction to food can affect the skin, the gastrointestinal ...
The main goal of this thesis was to further our understanding of current psychosocial models by introducing attachment as a relevant developmental framework. Firstly, attachment theory provides a psychosocial model for a developmental pathway to psychosis. Secondly, after expression of psychotic
Tarulli, A; Devinsky, O; Alper, K
To describe a case series of patients with both postictal psychosis (PIP) and chronic interictal psychosis (IIP). We retrospectively reviewed the records of 43 patients with PIP from a comprehensive epilepsy center to find evidence of both PIP and IIP in the same patient. Six (13.9%) of the 43 patients met all the criteria for both PIP and IIP. Five of our six patients had multiple documented PIPs before they became chronically psychotic. The range of length of time between PIP and IIP was 7 to 96 months. Postictal and interictal psychotic behavior was similar or identical in five of six cases. The results of this study suggest a progression from PIP to IIP: there is a similarity between the symptoms of the two psychoses, a history of multiple PIPs before the first IIP, and a period of months to years between PIP and IIP onset.
Al-Diwani, Adam A J; Pollak, Thomas A; Irani, Sarosh R; Lennox, Belinda R
Psychotic disorders are common and disabling. Overlaps in clinical course in addition to epidemiological and genetic associations raise the possibility that autoimmune mechanisms may underlie some psychoses, potentially offering novel therapeutic approaches. Several immune loci including the major histocompatibility complex and B-cell markers CD19 and CD20 achieve genome-wide significance in schizophrenia. Emerging evidence suggests a potential role via neurodevelopment in addition to classical immune pathways. Additionally, lymphocyte biology is increasingly investigated. Some reports note raised peripheral CD19(+) and reduced CD3(+) lymphocyte counts, with altered CD4 : CD8 ratios in acute psychosis. Also, post-mortem studies have found CD3(+) and CD20(+) lymphocyte infiltration in brain regions that are of functional relevance to psychosis. More specifically, the recent paradigm of neuronal surface antibody-mediated (NSAb) central nervous system disease provides an antigen-specific model linking adaptive autoimmunity to psychopathology. NSAbs bind extracellular epitopes of signalling molecules that are classically implicated in psychosis such as NMDA and GABA receptors. This interaction may cause circuit dysfunction leading to psychosis among other neurological features in patients with autoimmune encephalitis. The detection of these cases is crucial as autoimmune encephalitis is ameliorated by commonly available immunotherapies. Meanwhile, the prevalence and relevance of these antibodies in people with isolated psychotic disorders is an area of emerging scientific and clinical interest. Collaborative efforts to achieve larger sample sizes, comparison of assay platforms, and placebo-controlled randomized clinical trials are now needed to establish an autoimmune contribution to psychosis. © 2017 John Wiley & Sons Ltd.
Haddock, Gillian; Wood, Lisa; Watts, Rachel; Dunn, Graham; Morrison, Anthony P; Price, Jason
A range of outcome measures has been developed to assess psychotic symptoms. Many of these are observer based assessments which rate the presence and severity of broad symptom types. There is a need for service-user generated multi-dimensional scales to assess psychosis. To investigate the psychometric properties of a service user generated, self-report scale to assess recovery in relation to psychotic symptoms. The reliability and validity of the Subjective Experiences of Psychosis Scale (SEPS) was investigated with 100 participants experiencing psychosis against observer rated assessments of psychosis and self report measures of affect, esteem, recovery and functioning. Two factors emerged representing positive and negative aspects of psychotic experiences. Test-retest reliability, internal consistency and sensitivity to change were good and the scales correlated with the PANSS, PSYRATS and measures of affect, esteem, recovery and functioning. The SEPS is a reliable and valid tool which can be used to evaluate outcome from treatment and which reflects the multi-dimensional experience of psychosis. Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.
Langdon, Robyn; Still, Megan; Connors, Michael H; Ward, Philip B; Catts, Stanley V
Attributional biases to externalize blame for negative events (externalizing bias) and to target other people for blame (personalizing bias) may constitute a vulnerability to psychosis. However, most research to date has only examined attributional biases in chronic patients. We examined attributional style, paranoia, and depression in early psychosis patients to assess the primacy of attributional biases in psychosis. A quasi-experimental design was adopted to compare the attributional style of patients and controls. Correlates of attributional style were also examined. Early psychosis patients and age- and gender-matched healthy controls completed the 'Internal, Personal and Situational Attributions Questionnaire'. Paranoid tendencies, suspiciousness, and depression were also assessed in both groups, while severity of current symptoms was assessed in patients. A high proportion of patients had persecutory delusions. These patients, however, did not differ from controls in externalizing or personalizing bias. Whereas suspiciousness and persecutory delusions in patients associated with externalizing bias, no bias measures associated with paranoid tendencies in either patients or controls. Counter to the pattern seen for endogenous depression, depression in patients was associated with an increased tendency to attribute events to self and a decreased tendency to attribute events to circumstances. These preliminary findings raise doubts about the primacy of attributional biases in psychosis. The novel findings with regard to depression warrant further investigation and suggest that young people, who develop depression after the onset of psychosis, may experience a need to re-establish a sense of personal control over life events that appear unpredictable. © 2013 The British Psychological Society.
Highton-Williamson, Elizabeth; Priebe, Stefan; Giacco, Domenico
Online social networking might facilitate the establishment of social contacts for people with psychosis, who are often socially isolated by the symptoms and consequences of their disorder. We carried out a systematic review exploring available evidence on the use of online social networking in people with psychosis. The review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies examined the use of the online social networking by people with an a priori diagnosis of psychosis (inclusive of bipolar disorder). Data from included studies were extracted and narratively synthesised. A total of 11 studies, published between 2005 and 2013, reported data on online social networking in people with psychosis. People with psychosis seem to spend more time in chat rooms or playing online games than control groups. The use of other online tools, such as Facebook or communication through e-mail, is lower or the same than controls. Online social networking was used by patients with psychosis for establishing new relationships, maintaining relationships/reconnecting with people and online peer support. Online social networking, in the form of forums or online chats, could play a role in strategies aimed at enhancing social networks and reduce the risk of isolation in this population. © The Author(s) 2014.
Large, Matthew; Babidge, Nick; Andrews, Doug; Storey, Philip; Nielssen, Olav
Major self-mutilation (MSM) is a rare but catastrophic complication of severe mental illness. Most people who inflict MSM have a psychotic disorder, usually a schizophrenia spectrum psychosis. It is not known when in the course of psychotic illness, MSM is most likely to occur. In this study, the proportion of patients in first episode of psychosis (FEP) was assessed using the results of a systematic review of published case reports. Histories of patients who had removed an eye or a testicle, severed their penis, or amputated a portion of a limb and were diagnosed with a schizophrenia spectrum psychosis were included. A psychotic illness was documented in 143 of 189 cases (75.6%) of MSM, of whom 119 of 143 (83.2%) were diagnosed with a schizophrenia spectrum psychosis. The treatment status of a schizophrenia spectrum psychosis could be ascertained in 101 of the case reports, of which 54 were in the FEP (53.5%, 95% confidence interval = 43.7%-63.2%). Patients who inflict MSM in FEP exhibited similar symptoms to those who inflict MSM later in their illness. Acute psychosis, in particular first-episode schizophrenia, appears to be the major cause of MSM. Although MSM is extremely uncommon, earlier treatment of psychotic illness may reduce the incidence of MSM.
Eisenacher, Sarah; Zink, Mathias
The ability to integrate evidence into a reasoning process is crucial in order to react to changing information, e.g. to adapt one's beliefs according to new evidence or to generate new beliefs when facing better alternatives. Evidence integration ability is thus associated with belief flexibility. A specific bias of evidence integration, a bias against disconfirmatory evidence (BADE), can be found in patients with schizophrenia and has been linked to delusion development and maintenance. Knowledge about whether the BADE occurs already in risk constellations of psychosis can clarify its role in the pathogenesis of psychosis. This article reviews the current literature on BADE. Many studies demonstrate BADE over the course of illness, ranging from healthy controls with subclinical properties of schizotypy, over patients with at-risk mental states (ARMS) and patients with a first episode of psychosis to patients with chronic schizophrenia. These data allow a comparison of competences and deficits over the course of illness. Underlying mechanisms of BADE are discussed, including interrelations with neurocognitive performance and dopaminergic processes. The BADE could be found in different phases of psychosis development and can be regarded as a cognitive marker of the beginning psychotic state. The presented findings are derived from independent cross-sectional studies. So far, no comprehensive longitudinal assessment has been published. Treatments of metacognitive deficits in general and as early as in the ARMS might interfere with the cognitive pathogenesis of psychosis, and thereby ameliorate, postpone or even prevent the transition to psychosis. Copyright © 2016 Elsevier Ltd. All rights reserved.
O'Grady, M J
Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) in association with a normal total or free thyroxine (T4) or triiodothyronine (T3). It is frequently encountered in both neonatology and general paediatric practice; however, its clinical significance is widely debated. Currently there is no broad consensus on the investigation and treatment of these patients; specifically who to treat and what cut-off level of TSH should be used. This paper reviews the available evidence regarding investigation, treatments and outcomes reported for childhood SH.
Korver-Nieberg, Nikie; Berry, Katherine; Meijer, Carin; de Haan, Lieuwe; Ponizovsky, Alexander M.
Attachment theory is a powerful theoretical framework that complements and extents current models psychosis. We tested the hypothesis that attachment anxiety and avoidance are differentially associated with the severity of positive, negative and general psychopathology symptoms in patients with a
Hui, C L M; Li, Y K; Li, A W Y; Lee, E H M; Chang, W C; Chan, S K W; Lam, S Y; Thornton, A E; Sham, P; Honer, W G; Chen, E Y H
Relapse is distressingly common after the first episode of psychosis, yet it is poorly understood and difficult to predict. Investigating changes in cognitive function preceding relapse may provide new insights into the underlying mechanism of relapse in psychosis. We hypothesized that relapse in fully remitted first-episode psychosis patients was preceded by working memory deterioration. Visual memory and verbal working memory were monitored prospectively in a 1-year randomized controlled trial of remitted first-episode psychosis patients assigned to medication continuation (quetiapine 400 mg/day) or discontinuation (placebo). Relapse (recurrence of positive symptoms of psychosis), visual (Visual Patterns Test) and verbal (Letter-Number span test) working memory and stressful life events were assessed monthly. Remitted first-episode patients (n = 102) participated in the study. Relapsers (n = 53) and non-relapsers (n = 49) had similar baseline demographic and clinical profiles. Logistic regression analyses indicated relapse was associated with visual working memory deterioration 2 months before relapse [odds ratio (OR) 3.07, 95% confidence interval (CI) 1.19-7.92, P = 0.02], more stressful life events 1 month before relapse (OR 2.11, 95% CI 1.20-3.72, P = 0.01) and medication discontinuation (OR 5.52, 95% CI 2.08-14.62, P = 0.001). Visual working memory deterioration beginning 2 months before relapse in remitted first-episode psychosis patients (not baseline predictor) may reflect early brain dysfunction that heralds a psychotic relapse. The deterioration was found to be unrelated to a worsening of psychotic symptoms preceding relapse. Testable predictors offer insight into the brain processes underlying relapse in psychosis.
Kim, Hyoun S; Cassetta, Briana D; Hodgins, David C; Tomfohr-Madsen, Lianne M; McGrath, Daniel S; Tavares, Hermano
Recent research suggests that disordered gambling and psychosis co-occur at higher rates than expected in the general population. Gamblers with psychosis also report greater psychological distress and increased gambling severity. However, the mechanism by which psychosis leads to greater gambling symptomology remains unknown. The objective of the present research was to test whether impulsivity mediated the relationship between comorbid psychosis and gambling severity. The sample consisted of 394 disordered gamblers voluntarily seeking treatment at a large university hospital in São Paulo, Brazil. A semistructured clinical interview (Mini-International Neuropsychiatric Interview) was used to diagnosis the presence of psychosis by registered psychiatrists. Severity of gambling symptoms was assessed using the Gambling Symptom Assessment Scale, and the Barratt Impulsiveness Scale-11 provided a measure of impulsivity. Of the sample, 7.2% met diagnostic criteria for psychosis. Individuals with a dual diagnosis of psychosis did not report greater gambling severity. Conversely, dual diagnoses of psychosis were associated with greater levels of impulsivity. Higher levels of impulsivity were also associated with greater gambling severity. Importantly, support for our hypothesised mediation model was found such that impulsivity mediated the association between disordered gambling and psychosis and gambling severity. Impulsivity appears to be a transdiagnostic process that may be targeted in treatment among disordered gamblers with a dual diagnosis of psychosis to reduce problematic gambling behaviours.
Woodberry, Kristen A; Seidman, Larry J; Giuliano, Anthony J; Verdi, Mary B; Cook, William L; McFarlane, William R
Characterizing neuropsychological (NP) functioning of individuals at clinical high risk (CHR) for psychosis may be useful for prediction of psychosis and understanding functional outcome. The degree to which NP impairments are associated with general cognitive ability and/or later emergence of full psychosis in CHR samples requires study with well-matched controls. We assessed NP functioning across eight cognitive domains in a sample of 73 CHR youth, 13 of whom developed psychotic-level symptoms after baseline assessment, and 34 healthy comparison (HC) subjects. Groups were matched on age, sex, ethnicity, handedness, subject and parent grade attainment, and median family income, and were comparable on WRAT-3 Reading, an estimate of premorbid IQ. Profile analysis was used to examine group differences and the role of IQ in profile shape. The CHR sample demonstrated a significant difference in overall magnitude of NP impairment but only a small and nearly significant difference in profile shape, primarily due to a large impairment in olfactory identification. Individuals who subsequently developed psychotic-level symptoms demonstrated large impairments in verbal IQ, verbal memory and olfactory identification comparable in magnitude to first episode samples. CHR status may be associated with moderate generalized cognitive impairments marked by some degree of selective impairment in olfaction and verbal memory. Impairments were greatest in those who later developed psychotic symptoms. Future study of olfaction in CHR samples may enhance early detection and specification of neurodevelopmental mechanisms of risk. Copyright © 2010 Elsevier B.V. All rights reserved.
Cornblatt, Barbara A; Carrión, Ricardo E; Addington, Jean; Seidman, Larry; Walker, Elaine F; Cannon, Tyronne D; Cadenhead, Kristin S; McGlashan, Thomas H; Perkins, Diana O; Tsuang, Ming T; Woods, Scott W; Heinssen, Robert; Lencz, Todd
Risk for psychosis is currently defined primarily on the basis of attenuated positive symptoms (APS), with no inclusion of the functional deficits characteristic of schizophrenia. Impaired social and role functioning have been of interest for reflecting poor outcome but far less is known about the developmental impact of these deficits as vulnerability or risk factors. Age-appropriate social and role functioning were prospectively assessed in 100 individuals at clinical high risk (CHR) for psychosis included in the 8-site North American Prodromal Longitudinal Study database. A nested case-control design was used to compare changes in social and role functioning in 26 individuals converting to psychosis shortly after baseline assessment and 24 converting over a year later. Individuals in each converter subgroup were directly matched to a non-converter at the same site, controlling for time to conversion, age, gender, and severity of baseline symptoms. At baseline, CHR subjects who later became psychotic were significantly more likely to be impaired socially than matched non-converters. Onset of psychosis did not further disrupt social difficulties. Role functioning showed some of the same trends, but the overall pattern was not as consistent as for the social domain. Controlling for neurocognition did not change the pattern of group differences. Early impaired social functioning appears to be a risk factor for psychosis and, added to APS, could potentially contribute to accurate identification of CHR individuals and provide a new direction for early intervention to reduce long-term disability.
Addington, Donald; Berzins, Sandy; Yeo, Maryann
To assess the public's level of mental health literacy for psychosis. A cross-sectional telephone survey using a random phone number selection procedure was conducted to identify a sample of 1685 participants comprised of youth at risk (aged 15 to 39 [corrected] years) and parents of youth at risk of psychosis (aged 35 to 59 years). The Canadian Journal of Psychiatry regrets the error and any inconvenience it might have caused. [corrected]. Participants were asked about their awareness of symptoms and causes of schizophrenia and psychosis, treatment options, and preferred channels for obtaining information about health and mental health. The response rate was 73%. There was a high reported knowledge of the term schizophrenia (76%), but a low reported knowledge of the term psychosis (23%). Ninety-one per cent of participants agreed that medications can control symptoms of schizophrenia. Significant barriers to getting help included not knowing the early signs of psychosis, concerns about being labelled mentally ill or psychotic, and not knowing where to go for help. Preferred communication elements to reach at-risk youth and their families were pamphlets at family physicians' and school counsellors' offices, posters on buses, television and radio advertisements, and information on websites. Whereas there is good knowledge about recognition and treatment of schizophrenia, there is less awareness of the broader concept of psychosis. Barriers to accessing care included recognition of early signs of psychosis and stigma. Public education programs aimed at promoting earlier intervention would need to address information about both psychosis and stigma.
Full Text Available In South Florida, there has been a highly addictive new synthetic drug flooding the streets for people looking for a cheap high. Alpha-PVP, better known as Flakka, is an illegal substance that sells on the streets for as little as $5 a hit and delivers an instant high that can last from hours to days with lingering effects for weeks after it has been ingested. Although people use Flakka for its potential euphoric high, symptoms are known to easily escalate into frightening delusions, paranoid psychosis, extreme agitation, and a multitude of other altered mental states. According to the National Institute on Drug Abuse, Florida appears to be the nation’s hot spot for reports of Flakka. In this case report, a 17-year-old female with no prior psychiatric diagnosis presents to the hospital under a 72-hour involuntary placement for altered mental status with agitation and psychotic behaviors. After multiple days of symptomatic treatment with benzodiazepines and antipsychotics, the patient became coherent enough to give a history of a “friend” putting Flakka in her food at school as a joke. Although she continues to have residual symptoms including psychomotor agitation and slowing of cognition, she was alert, oriented, and able to be discharged home with proper follow-up.
In South Florida, there has been a highly addictive new synthetic drug flooding the streets for people looking for a cheap high. Alpha-PVP, better known as Flakka, is an illegal substance that sells on the streets for as little as $5 a hit and delivers an instant high that can last from hours to days with lingering effects for weeks after it has been ingested. Although people use Flakka for its potential euphoric high, symptoms are known to easily escalate into frightening delusions, paranoid psychosis, extreme agitation, and a multitude of other altered mental states. According to the National Institute on Drug Abuse, Florida appears to be the nation's hot spot for reports of Flakka. In this case report, a 17-year-old female with no prior psychiatric diagnosis presents to the hospital under a 72-hour involuntary placement for altered mental status with agitation and psychotic behaviors. After multiple days of symptomatic treatment with benzodiazepines and antipsychotics, the patient became coherent enough to give a history of a "friend" putting Flakka in her food at school as a joke. Although she continues to have residual symptoms including psychomotor agitation and slowing of cognition, she was alert, oriented, and able to be discharged home with proper follow-up.
Patients with psychosis speak of an uneasy relationship with their body. Between feelings of too little and too much, for them it is a matter of trying to suture an image which is not always unified, a body which they are not always sure they have. The attentive clinician will attempt to support the solutions of each psychotic patient to maintain their body, beyond the death drive which pushes them to tear it apart. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
The present investigation focused on the questions whether previously reported functional brain abnormalities in schizophrenia could be related to the clinical state of the patient (i.e. the degree of psychosis) at time of study, and whether similar findings in patients with schizophrenia, could be made in patients with cycloid psychosis. To this effect, patients were investigated with regional cerebral blood flow measurements and clinical rating on repeated occasions during their most extreme fluctuations during a psychotic episode, i.e. while they were in an exacerbated state and during clinical remission. A subgroup of schizophrenic patients were investigated before and after neuroleptic treatment and during mental activation with a word fluency test. The schizophrenic group has a normal mean hemispheric blood flow irrespective of clinical state and treatment. During exacerbation a highly significant positive correlation was seen between the frontal-occipital (F/O) ratio and the degree of psychosis, suggesting that the more psychotic the patients was, the higher was the ratio. During remission, the F/O ratio decreased. Schizophrenic patients did not activate their prefrontal cortex during exacerbation, but showed a normal frontal response to the word fluency test during remission. The regional cerebral blood flow of the cycloid patients differed clearly from that of the schizophrenic patients. During exacerbation they had elevated mean hemispheric flow levels, and a decreased F/O ration, while rCBF was normal during remission. The findings suggest that variability in the degree of psychosis can be an important factor underlying the heterogeneity of rCBF findings in schizophrenia. (au).
This report highlights psychosis and seizures presenting at two distinct periods of time in the course of Meningioma, in a 43 year old Nigerian medical doctor and buttresses the fact that the risk for post operative seizures and other symptoms include a history of pre-operative seizures and the site of the tumor. The subject ...
Hegelstad, Wenche Ten Velden; Bronnick, Kolbjorn S; Barder, Helene Eidsmo
OBJECTIVE: This study tested the hypothesis that early detection of psychosis improves long-term vocational functioning through the prevention of negative symptom development. METHODS: Generalized estimating equations and mediation analysis were conducted to examine the association between employ...... from a usual-detection area, which seemed to have facilitated vocational careers....
Faber, J; Wiinberg, N; Schifter, S
Hyperthyroidism has profound effects on the cardiovascular system, including reduced systemic vascular resistance (SVR) due to relaxation of vascular smooth muscle cells, enhanced heart rate (HR) and cardiac output (CO) due to an increase in cardiac diastolic relaxation, contractility and heart...... rate. Subclinical hyperthyroidism is characterised by reduced serum TSH levels despite free thyroxine (T4) and tri-iodothyronine (T3) estimates within the reference range, in subjects with no obvious symptoms of hyperthyroidism. We measured haemodynamic changes (using impedance cardiography......) in subjects with endogenous subclinical hyperthyroidism in order to elucidate whether these patients had signs of excess thyroid hormone at the tissue level....
Mark, Peter D; Andreassen, Mikkel; Petersen, Claus L
PURPOSE: The aim of this study was to investigate structure and function of the heart in subclinical hyperthyroidism (SH) before and after obtaining euthyroidism by radioactive iodine treatment, using high precision and observer-independent magnetic resonance imaging (MRI) technology. METHODS......: Cardiac MRI was performed before and after euthyroidism was obtained by radioactive iodine treatment in 12 otherwise healthy patients (11 women and one man, mean age 59 years, range 44-71 years) with a nodular goiter and SH, and compared with eight healthy controls investigated at baseline. Cardiac data...... were expressed as an index, as per body surface area, except for heart rate (HR) and ejection fraction. RESULTS: Post-treatment cardiac MRI was performed in median 139 days after a normalized serum TSH value had been recorded. During treatment, serum TSH increased from (median (range)) 0.01 (0...
Wood, Lisa; Irons, Chris
Low social rank and external shame have been found to be significantly associated with anxiety and depression. However, their relevance to experiences of psychosis has rarely been explored. This study aims to examine the relationship of social rank and external shame to personal recovery, depression and positive symptoms in psychosis. A cross sectional correlational design was adopted to examine the relationship between all variables. Fifty-two service users, aged between 18 to 65 years, with experiences of psychosis were recruited for the study. Participants were administered outcome measures examining social rank, external shame, positive symptoms of psychosis, depression and personal recovery. Multiple regression analyses were conducted on the data. Significant correlations were found between all variables. Low social rank was significantly associated with lower reported personal recovery, and higher levels of external shame and depression symptomology. The relationship between external shame and positive symptoms of psychosis and personal recovery was found to be mediated by participants' level of depression. Findings suggest that social rank and external shame are relevant to those who experience psychosis. Therapeutic approaches may need to focus on perceptions of social rank and external shame in working with experiences of psychosis.
Full Text Available Background. Co-morbidity between substance abuse and psy- chotic disorders is high. Few studies have examined therelationship between first-episode psychosis and substance abuse. Several questions emerge from this common relationship and many of them remain unanswered. Objectives. To determine the effect of substance abuse on psychosis in terms of onset, duration, severity of symptoms, use of medication and outcome. Method. Thirty - three subjects with first-episode psychosis, as well as primary caregivers, were interviewed re g a rding substance abuse and its relation to illness. Thirty-six control subjects were also interv i e w e d . Results. Twenty-seven per cent of subjects abused substances in the 3 months before onset of illness, and 77.8% of the abusers w e re male. Subjects in the first-episode psychosis group were m o re likely to choose cannabis as their substance of abuse than c o n t rols. They also started abusing substances at a younger age than controls. Subjects with first-episode psychosis who abused substances presented at an earlier age than non-abusers. Substances affected symptoms at baseline presentation . Conclusions. Substance abuse has a significant impact on first- onset psychosis as far as age of onset and symptom severity are c o n c e rned. Subjects with an underlying vulnerability to psychosis seem to start abusing substances at an earlier age than the general population. Males are more likely to abuse substances than females.
Rydkjær, Jacob; Jepsen, Jens Richardt Møllegaard; Fagerlund, Birgitte
Background: Schizophrenia and ADHD share a number of attention related symptoms and cognitive impairments. Early onset psychosis may precede a development of schizophrenia and must be distinguished from ADHD. Psychophysiological deficits are studied as endophenotypic markers of psychosis and may...... add valuable information on how to differentiate premature stages of early onset psychosis from ADHD. Aim: To characterize psychophysiological deficits in young adolescents with psychosis or ADHD and compare the profiles of impariments between the two groups. Materials and methods: A cohort of young...... adolescents (age 12-17 years) with either first episode psychosis or ADHD and age and gender matched healthy controls has been recruited. The assessments include a diagnostic interview, psychopathological ratings and psychophysiological assessment of prepulse inhibiton of the startle reflex (PPI) with high...
Langdon, Robyn; Connors, Michael H; Still, Megan; Ward, Philip B; Catts, Stanley
People with chronic psychosis often display theory of mind impairments that are not fully accounted for by other, more general neurocognitive deficits. In these patients, both theory of mind and neurocognitive deficits contribute to poor functioning, independently of psychotic symptoms. In young people with recent-onset psychosis, however, it is unclear the extent to which theory of mind impairment is independent of neurocognitive deficits. The primary aim of this study was to examine the evidence for specific theory of mind impairments in early psychosis. A secondary aim was to explore the relations between theory of mind, neurocognition, symptom severity, and functional outcomes. Twenty-three patients who were within two years of their first psychotic episode and 19 healthy controls completed theory of mind and neurocognitive batteries. Social functioning, quality of life, and symptom severity were also assessed in patients. Patients demonstrated deficits in tasks assessing theory of mind and neurocognition relative to controls. Patients' deficits in theory of mind were evident even after adjusting for their deficits in neurocognition. Neither theory of mind nor neurocognition predicted social functioning or quality of life in this early psychosis sample. Severity of negative symptoms, however, was a significant predictor of both outcomes. While a specific theory of mind impairment was evident in this early psychosis sample, severity of negative symptoms emerged as the best predictor of poor functional outcome. Further early psychosis research is needed to examine the longitudinal progression of theory of mind impairments - independent of neurocognitive deficits - and their impact on psychosocial function.
Redmond, Jonathan D
In contemporary Lacanian psychoanalysis, Verhaeghe's theory of actualpathology psychopathology in psychosis and the Millerian idea of "ordinary psychosis" provide diverging conceptual approaches to psychosis. In this paper, the two approaches to psychosis are examined with a particular emphasis on "mild psychosis" and compensatory mechanisms. Despite the shared focus on similar clinical phenomena, particularly body disturbances, these two theories provide different explanations of psychosis. Verhaeghe's theory of psychosis is a synthesis of Lacanian theory, Freud's idea of actual neurosis and psychoanalytic attachment concepts. Moreover, these ideas are situated in the "schizophrenia/paranoia dichotomy" an important heuristic device utilized in clinical practice with psychosis. In contrast, the Millerian field of ordinary psychosis aims to broaden the idea of psychosis by reviving the idea of "mild psychosis" and the different forms of stabilization possible in psychosis. Clinicians adapting the idea of ordinary psychosis aim to rethink pivotal Lacanian concepts-"untriggered" psychosis and stabilization-beyond the scope of the schizophrenia/paranoia dichotomy. Although the idea of ordinary psychosis requires further development, it promise greater utility than Verhaeghe's model, as it provides a broader and more nuanced approach to the complex vicissitudes of triggering and restitution in psychosis.
Jonathan Douglas Redmond
Full Text Available Abstract:In contemporary Lacanian psychoanalysis, Verhaeghe’s theory of actualpathology / psychopathology in psychosis and the Millerian idea of ordinary psychosis provide diverging conceptual approaches to psychosis. In this paper, the two approaches to psychosis are examined with a particular emphasis on mild psychosis and compensatory mechanisms. Despite the shared focus on similar clinical phenomena, particularly body disturbances, these two theories provide different explanations of psychosis. Verhaeghe’s theory of psychosis is a synthesis of Lacanian theory, Freud’s idea of actual neurosis and psychoanalytic attachment concepts. Moreover, these ideas are situated in the schizophrenia / paranoia dichotomy an important heuristic device utilised in clinical practice with psychosis. In contrast, the Millerian field of ordinary psychosis aims to broaden the idea of psychosis by reviving the idea of mild psychosis and the different forms of stabilisation possible in psychosis. Clinicians adapting the idea of ordinary psychosis aim to rethink pivotal Lacanian concepts - untriggered psychosis and stabilisation - beyond the scope of the schizophrenia / paranoia dichotomy. Although the idea of ordinary psychosis requires further development, it promise greater utility than Verhaeghe’s model, as it provides a broader and more nuanced approach to the complex vicissitudes of triggering and restitution in psychosis.
Vollenweider, FX; Leenders, KL; Scharfetter, C; Antonini, A; Maguire, P; Missimer, J; Angst, J
To date, the ketamine/PCP model of psychosis has been proposed to be one of the best pharmacological models to mimic schizophrenic psychosis in healthy volunteers, since ketamine can induce both positive and negative symptoms of schizophrenia. At subanesthetic doses, ketamine has been reported to
Hamada S Ahmad
Conclusion Our findings indicate the presence of subclinical heart failure in these patients. JIA patients with subclinical atherosclerosis, with systemic disease, and with active disease are at greatest risk of developing subclinical heart failure.
Killaspy, Helen; White, Sarah; Lalvani, Nabeela; Berg, Rachel; Thachil, Ajoy; Kallumpuram, Sen; Nasiruddin, Omar; Wright, Christine; Mezey, Gill
People with mental health problems are known to be socially excluded but the contribution of pre-morbid characteristics, symptoms and needs, and the impact on quality of life is unknown. To investigate change in social inclusion after the development of a psychotic Illness and factors associated with this. A cross-sectional community survey of people with psychosis was carried out in three areas of London. Five domains of social inclusion (social integration, consumption, access to services, productivity, political engagement) were assessed prior to the onset of illness and currently using the Social Inclusion Questionnaire User Experience. Quality of life, symptoms and needs were also assessed using standardized measures. Factors associated with change in social inclusion were investigated using multiple regression. Productivity and social integration among the 67 participants reduced after the onset of psychosis. Older age at onset and longer duration of illness were associated with greater reduction in productivity. Less reduction in social integration was associated with greater quality of life. Participants reported barriers to social inclusion that were directly related to symptoms of their illness, low confidence and poor self-esteem. A greater focus on interventions that can facilitate the occupation and the social networks of people with psychosis is required. Interventions that tackle 'self-stigma' may also prove useful in mitigating the social exclusion experienced by people with psychosis.
Magaud, Emilie; Nyman, Karissa; Addington, Jean
Aim Several studies suggest an association between experiences of childhood trauma including bullying and the development of psychotic symptoms. The use of communications technology has created a new media for bullying called ‘cyberbullying’. Research has demonstrated associations between traditional bullying and cyberbullying. Negative effects of cyberbullying appear similar in nature and severity to the reported effects of traditional bullying. Our aim was to examine the prevalence and correlates of cyberbullying in those at clinical high risk (CHR) for psychosis. Methods Fifty young people at CHR for psychosis were administered the Childhood Trauma Questionnaire with added questions about cyberbullying. Results Cyberbullying was reported in 38% of the sample. Those who experienced cyberbullying also reported experiencing previous trauma. Conclusion It is possible that cyberbullying may be a problem for those at CHR of psychosis and due to the vulnerable nature of these young people, may have longitudinal implications. PMID:23343259
Magaud, Emilie; Nyman, Karissa; Addington, Jean
Several studies suggest an association between experiences of childhood trauma including bullying and the development of psychotic symptoms. The use of communications technology has created a new media for bullying called 'cyberbullying'. Research has demonstrated associations between traditional bullying and cyberbullying. Negative effects of cyberbullying appear similar in nature and severity to the reported effects of traditional bullying. Our aim was to examine the prevalence and correlates of cyberbullying in those at clinical high risk (CHR) for psychosis. Fifty young people at CHR for psychosis were administered the Childhood Trauma Questionnaire with added questions about cyberbullying. Cyberbullying was reported in 38% of the sample. Those who experienced cyberbullying also reported experiencing previous trauma. It is possible that cyberbullying may be a problem for those at CHR of psychosis, and due to the vulnerable nature of these young people may have longitudinal implications. © 2013 Wiley Publishing Asia Pty Ltd.
Chang, Anna; Fox, Susan H
Psychotic symptoms are common in Parkinson's disease (PD) and are associated with poorer quality of life and increased caregiver burden. PD psychosis is correlated with several factors, such as more advanced disease, cognitive impairment, depression, and sleep disorders. The underlying causes of psychosis in PD thus involve a complex interplay between exogenous (e.g., drugs, intercurrent illnesses) and endogenous (e.g., PD disease pathology) factors. Current theories of the pathophysiology of PD psychosis have come from several neuropathological and neuroimaging studies that implicate pathways involving visual processing and executive function, including temporo-limbic structures and neocortical gray matter with altered neurotransmitter functioning (e.g., dopamine, serotonin, and acetylcholine). Treatment of PD psychosis requires a step-wise process, including initial careful investigation of treatable triggering conditions and a comprehensive evaluation with adjustment of PD medications and/or initiation of specific antipsychotic therapies. Clozapine remains the only recommended drug for the treatment of PD psychosis; however, because of regular blood monitoring, quetiapine is usually first-line therapy, although less efficacious. Emerging studies have focused on agents involving other neurotransmitters, including the serotonin 5-HT2A receptor inverse agonist pimavanserin, cholinesterase inhibitors, and antidepressants and anxiolytics.
Casey, Brian M; Dashe, Jodi S; Wells, C Edward; McIntire, Donald D; Leveno, Kenneth J; Cunningham, F Gary
Subclinical hyperthyroidism has long-term sequelae that include osteoporosis, cardiovascular morbidity, and progression to overt thyrotoxicosis or thyroid failure. The objective of this study was to evaluate pregnancy outcomes in women with suppressed thyroid-stimulating hormone (TSH) and normal free thyroxine (fT(4)) levels. All women who presented to Parkland Hospital for prenatal care between November 1, 2000, and April 14, 2003, underwent thyroid screening by chemiluminescent TSH assay. Women with TSH values at or below the 2.5th percentile for gestational age and whose serum fT(4) levels were 1.75 ng/dL or less were identified to have subclinical hyperthyroidism. Those women screened and delivered of a singleton infant weighing 500 g or more were analyzed. Pregnancy outcomes in women identified with subclinical hyperthyroidism were compared with those in women whose TSH values were between the 5th and 95th percentiles. A total of 25,765 women underwent thyroid screening and were delivered of singleton infants. Of these, 433 (1.7%) were considered to have subclinical hyperthyroidism, which occurred more frequently in African-American and/or parous women. Pregnancies in women with subclinical hyperthyroidism were less likely to be complicated by hypertension (adjusted odds ratio 0.66, 95% confidence interval 0.44-0.98). All other pregnancy complications and perinatal morbidity or mortality were not increased in women with subclinical hyperthyroidism. Subclinical hyperthyroidism is not associated with adverse pregnancy outcomes. Our results indicate that identification of subclinical hyperthyroidism and treatment during pregnancy is unwarranted. II-2.
Caldieraro, Marco Antonio; Sylvia, Louisa G; Dufour, Steven; Walsh, Samantha; Janos, Jessica; Rabideau, Dustin J; Kamali, Masoud; McInnis, Melvin G; Bobo, William V; Friedman, Edward S; Gao, Keming; Tohen, Mauricio; Reilly-Harrington, Noreen A; Ketter, Terence A; Calabrese, Joseph R; McElroy, Susan L; Thase, Michael E; Shelton, Richard C; Bowden, Charles L; Kocsis, James H; Deckersbach, Thilo; Nierenberg, Andrew A
Psychotic bipolar depressive episodes remain remarkably understudied despite being common and having a significant impact on bipolar disorder. The aim of this study is to identify the characteristics of depressed bipolar patients with current psychosis compared to those without psychosis. We used baseline data of a comparative effectiveness study of lithium and quetiapine for bipolar disorder (the Bipolar CHOICE study) to compare demographic, clinical, and functioning variables between those with and without psychotic symptoms. Of the 482 participants, 303 (62.9%) were eligible for the present study by meeting DSM-IV criteria for an acute bipolar depressive episode. Univariate analyses were conducted first, and then included in a model controlling for symptom severity. The sample was composed mostly of women (60.7%) and the mean age was 39.5±12.1 years. Psychosis was present in 10.6% (n=32) of the depressed patients. Psychotic patients had less education, lower income, and were more frequently single and unemployed. Psychosis was also associated with a more severe depressive episode, higher suicidality, more comorbid conditions and worse functioning. Most group differences disappeared when controlling for depression severity. Only outpatients were included and the presence of psychosis in previous episodes was not assessed. Psychosis during bipolar depressive episodes is present even in an outpatient sample. Psychotic, depressed patients have worse illness outcomes, but future research is necessary to confirm if these outcomes are only associated with the severity of the disorder or if some of them are independent of it. Copyright © 2017 Elsevier B.V. All rights reserved.
Goodby, Emmeline; MacLeod, Andrew K
This study employed the Future Thinking Task (MacLeod et al., 2005, Br. J. Clin. Psychol., 44, 495) to investigate whether future-directed thinking in first-episode psychosis is significantly different from that of matched controls, and to identify its correlates in this patient group. Cross-sectional, mixed-model, case-control design. Participants were 30 patients with first-episode psychosis and 27 matched controls. The Future Thinking Task was used to assess future-directed thinking in both groups. Anxiety and depression were also measured as well as self-report measures of hopelessness, suicide ideation and a measure of negative symptoms. Individuals with psychosis were impaired in future-directed thinking in both positive and negative domains, particularly with respect to the coming year. Increased self-reported hopelessness was associated with reduced positive future thinking and increased negative future thinking. Increased positive future thinking was also associated with reduced severity of negative symptoms, whilst negative future thinking was associated with suicide ideation. Individuals with first-episode psychosis show a reduction in positive future thinking in line with that seen in other clinical groups, but this is accompanied by an unexpected reduction in negative future thinking. The findings suggest a general disengagement with the future in this group that may affect recovery and functioning. Individuals with first-episode psychosis may benefit from interventions to help them engage with their future, in particular in the mid-range, up to 1 year. The Future Thinking Task may be a helpful addition to the assessment of suicide risk in those with first-episode psychosis. Decreased positive future thinking was associated with increased severity of negative symptoms, indicating a potential new treatment angle for this resistant aspect of psychosis. The cross-sectional design of this study does not allow for conclusions about the causal relationship
Redmond, Jonathan D.
Abstract:In contemporary Lacanian psychoanalysis, Verhaeghe’s theory of actualpathology / psychopathology in psychosis and the Millerian idea of ordinary psychosis provide diverging conceptual approaches to psychosis. In this paper, the two approaches to psychosis are examined with a particular emphasis on mild psychosis and compensatory mechanisms. Despite the shared focus on similar clinical phenomena, particularly body disturbances, these two theories provide different explanations of psyc...
Chen, Chih-Ken; Lin, Shih-Ku; Sham, Pak C; Ball, David; Loh, El-Wui; Murray, Robin M
It is not clear why some methamphetamine (MAMP) abusers develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We tested the hypotheses that those users who develop MAMP-induced psychosis (MIP) have greater familial loading for psychotic disorders than users with no psychosis. Four hundred forty-five MAMP users were recruited from a psychiatric hospital and a detention center in Taipei, and were assessed with the Diagnostic Interview for genetic studies (DIGS-C) and the Family Interview for genetic study (FIGS-C). Morbid risk (MR) for psychiatric disorders in first-degree relatives was compared between those MAMP users with a lifetime diagnosis of MAMP psychosis and those without. The relatives of MAMP users with a lifetime diagnosis of MAMP psychosis had a significantly higher MR for schizophrenia (OR = 5.4, 95% CI: 2.0-14.7, P < 0.001) than the relatives of those probands who never became psychotic. Furthermore, the MR for schizophrenia in the relatives of the subjects with a prolonged MAMP psychosis (MIP-P) was higher than in the relatives of those users with a brief MAMP psychosis (MIP-B) (OR = 2.8, 95% CI: 1.0-8.0, P = 0.042). The greater his or her familial loading for schizophrenia, the more likely a MAMP user is to develop psychosis, and the longer that psychosis is likely to last. Copyright 2005 Wiley-Liss, Inc.
Marconi Tassara, J; Diaz, J P; Mourgues, C
The reciprocal balance between the cognitive normal awareness of reality and the cognitive psychotic awareness of reality in schizophrenia, is proposed, on the basis of the structural psychopathological theory of psychoses of the author. This balance points to the dominance of the operant conditioning of psychotic reality over normal reality during the invasion period of the disease, an equilibrium of both aspects during the steady period, and a dominance of normal reality during the residual period. A comprehensive program for secondary and terciary prevention of schizophrenia is outlined, with five levels of function delegation: D1, psychiatrists and psychologists; D2, nurses and social workers; D3, auxiliary nurses; D4, family co-therapist; D5, patients and other relatives. The functions delegated to D5 include the recognition of symptoms, causes and course, and attitudes conducing to secondary handicaps in patients. To D4, are delegate the administration of psychotropic drugs at home and technique for reinforcing normal reality. To D3, are delegated notions on epidemiology, the supervision of the psychopharmacological treatment and of reinforcement programs for normal reality, attitudes and its change, and notions of urgencies in psychosis. The D2 and D1 levels indicate treatment at all levels and treat the more complicated cases in institutions. The efficacy of the program in 36 cases, after a year, indicates a reduction of acute psychotic productivity from 72 to 6% of the patients, and a rate of hospitalization of only 8%.
Tng, Eng Loon
Subclinical hypothyroidism (SCH) represents a mild or compensated form of primary hypothyroidism. The diagnosis of SCH is controversial, as its symptoms are non-specific and its biochemical diagnosis is arbitrary. The treatment of SCH was examined among non-pregnant adults, pregnant adults and children. In non-pregnant adults, treatment of SCH may prevent its progression to overt hypothyroidism, reduce the occurrence of coronary heart disease, and improve neuropsychiatric and musculoskeletal symptoms associated with hypothyroidism. These benefits are counteracted by cardiovascular, neuropsychiatric and musculoskeletal side effects. SCH is associated with adverse maternal and fetal outcomes that may improve with treatment. Treating SCH in children is safe and may improve growth. Importantly, the evidence in this field is largely from retrospective and prospective studies with design limitations, which precludes a conclusive recommendation for the treatment of SCH. Copyright: © Singapore Medical Association.
D. V. Bestaev
Full Text Available Subjects and methods. The study enrolled 61 inpatients diagnosed with RA (according to the 1987 American College of Rheumatology criteria who were treated at the V.A. Nasonova Research Institute of Rheumatology; in so doing, high-resolution computed tomography revealed lung changes as a ground glass pattern in 15 patients, reticular striation, traction bronchoectases, and lung tissue changes as honeycomb ones in 25 patients; no lung abnormalities were found in 21 patients. DAS28 was applied to determine the inflammatory activity of RA. The RA patients underwent X-ray studies of the hand, foot, and chest, by using accordingly X-Ray unit and spiral computed tomography scanner (section thickness, 0.65 mm. External respiration function (ERF indicators were studied with plethysmograph. IgM rheumatoid factor was measured using an immune nephelometer. Serum anti-cyclic citrullinated peptide antibodies were assayed by immunochemiluminescence technique on a Cobas e411 analyzer. The xMAP technology using a BioPlex200 analyzer was employed to determine the serum concentrations of 27 cytokines in 15 patients with subclinical IPI and in 25 with clinical IPI. Results and discussion. The major respiratory signs in patients with IPI proved to be cough (24 %, expectoration (20 %, dyspnea (16 %, and crepitation (64 % on auscultation. Three patients with subclinical IPI were found to have crepitation on auscultation. Respiratory symptoms were absent in the RA patients without IPI. It should be noted that there are a larger number of RA patients with a high smoking index among the RA patients with IPI than among those without IPI (p < 0.05. Investigation of ERF indicators revealed a statistically significantly lower lung diffusing capacity (LDC in the RA patients with subclinical IPI than in those without IPI (p < 0.05. Other ERF indicators showed no significant deviations of the reference values. LDC and total lung capacity appeared to be statistically
Csillag, Claudio; Nordentoft, Merete; Mizuno, Masafumi
AIM: Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges to their implementa......AIM: Early intervention in psychosis (EIP) is a well-established approach with the intention of early detection and treatment of psychotic disorders. Its clinical and economic benefits are well documented. This paper presents basic aspects of EIP services, discusses challenges...... implemented EIP services into the mental healthcare system have generated evidence, concepts and specific strategies that might serve as guidance or inspiration in other countries or systems where EIP is less well developed or not developed at all. Previous experience has made clear that evidence of clinical...... benefits alone is not enough to promote implementation, as economic arguments and political and social pressure have shown to be important elements in efforts to achieve implementation. CONCLUSIONS: Users' narratives, close collaboration with community organizations and support from policy-makers and known...
Recent research shows that psychotic symptoms, or psychotic-like experiences (PLEs), are reported not only by psychosis patients but also by healthy members of the general population. Healthy individuals who report these symptoms are considered to represent a non-clinical psychosis phenotype, and have been demonstrated to be at increased risk of schizophrenia-spectrum disorder. Converging research now shows that this non-clinical psychosis phenotype is familial, heritable and covaries with familial schizophrenia-spectrum disorder. A review of the research also shows that the non-clinical phenotype is associated extensively with schizophrenia-related risk factors, including social, environmental, substance use, obstetric, developmental, anatomical, motor, cognitive, linguistic, intellectual and psychopathological risk factors. The criterion and construct validity of the non-clinical psychosis phenotype with schizophrenia demonstrates that it is a valid population in which to study the aetiology of psychosis. Furthermore, it suggests shared genetic variation between the clinical and non-clinical phenotypes. Much remains to be learned about psychosis by broadening the scope of research to include the non-clinical psychosis phenotype.
Bedi, Gillinder; Carrillo, Facundo; Cecchi, Guillermo A; Slezak, Diego Fernández; Sigman, Mariano; Mota, Natália B; Ribeiro, Sidarta; Javitt, Daniel C; Copelli, Mauro; Corcoran, Cheryl M
Psychiatry lacks the objective clinical tests routinely used in other specializations. Novel computerized methods to characterize complex behaviors such as speech could be used to identify and predict psychiatric illness in individuals. In this proof-of-principle study, our aim was to test automated speech analyses combined with Machine Learning to predict later psychosis onset in youths at clinical high-risk (CHR) for psychosis. Thirty-four CHR youths (11 females) had baseline interviews and were assessed quarterly for up to 2.5 years; five transitioned to psychosis. Using automated analysis, transcripts of interviews were evaluated for semantic and syntactic features predicting later psychosis onset. Speech features were fed into a convex hull classification algorithm with leave-one-subject-out cross-validation to assess their predictive value for psychosis outcome. The canonical correlation between the speech features and prodromal symptom ratings was computed. Derived speech features included a Latent Semantic Analysis measure of semantic coherence and two syntactic markers of speech complexity: maximum phrase length and use of determiners (e.g., which). These speech features predicted later psychosis development with 100% accuracy, outperforming classification from clinical interviews. Speech features were significantly correlated with prodromal symptoms. Findings support the utility of automated speech analysis to measure subtle, clinically relevant mental state changes in emergent psychosis. Recent developments in computer science, including natural language processing, could provide the foundation for future development of objective clinical tests for psychiatry.
Chen, C K; Lin, S K; Sham, P C; Ball, D; Loh, E W; Hsiao, C C; Chiang, Y L; Ree, S C; Lee, C H; Murray, R M
The long-term use of methamphetamine (MAMP) can result in psychosis but it is not clear why some individuals develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We set out to characterize MAMP users and to examine the relationship of pre-morbid personality, pre-morbid social function and other psychiatric disorders to MAMP psychosis. Four hundred and forty-five amphetamine users were recruited from a psychiatric hospital and a detention centre in Taipei, and were assessed with the Diagnostic Interview for Genetic Studies (DIGS). Their parents were interviewed with the Premorbid Schizoid and Schizotypal Traits (PSST) and the Premorbid Social Adjustment (PSA) schedules. Pre-morbid characteristics and psychiatric co-morbidity were compared between the MAMP users with a lifetime diagnosis of MAMP psychosis and those without. The MAMP users with psychosis presented a clinical picture which mimicked the positive symptoms of schizophrenia: 85% had auditory hallucinations; 71% persecutory delusions; 63% delusions of reference. Compared with their non-psychotic counterparts, these MAMP users were younger at first MAMP use, used larger amounts of MAMP, had a significantly higher mean PSST score, and higher rates of major depressive disorder, alcohol dependence and antisocial personality disorder. Earlier and larger use of MAMP was associated with increased risk of psychosis. Our data are also compatible with the view that pre-morbid schizoid/schizotypal personality predisposes MAMP users to develop psychosis, and that the greater the personality vulnerability, the longer the psychosis will persist.
Shi, Jingyu; Wang, Lu; Yao, Yuhong; Chen, Fazhan; Su, Na; Zhao, Xudong; Zhan, Chenyu
The role of protective factors in symptom formation and prognosis in schizophrenia has been shown in many studies, but research in the early phases of psychosis is limited, particularly among the nonclinical subjects. Protective factors associated with the severity of symptoms and clinical outcomes might be meaningful to the establishment of prevention systems and to the development of optimal psychosocial interventions prior to the onset of psychosis. The present study compares self-reported levels of self-esteem, social support and resilience of 32 university students at clinical high risk for psychosis (CHR) and 32 healthy controls in a longitudinal study design. Associations between protective factors with symptoms of psychosis were assessed in the CHR group. Individuals at CHR showed significantly lower self-esteem, social support and resilience compared to healthy controls. In the CHR group, lower social support and lower self-esteem were associated with more severe positive, negative and depressive symptoms. Multiple regression analyses revealed that self-esteem was the only significant determinant for negative, depressive symptoms and global functioning. In addition, we found that subjects who were fully recovered at a 6-month follow-up survey were greater resilient and showed lower depressive symptoms at baseline. The result implied that resilience intervention could be effective on early prevention of the onset of psychosis. Moreover, implications and limitations of this study will be discussed. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Riecher-Rössler, A; Ackermann, T; Uttinger, M; Ittig, S; Koranyi, S; Rapp, C; Bugra, H; Studerus, E
Although several instruments have been developed to identify patients with an at-risk mental state (ARMS) for psychosis and first episode of psychosis (FEP), up to now there were no instruments for a detailed assessment of risk factors and indicators of emerging psychosis and the temporal development of psychiatric symptoms over the whole life span in these patients. We therefore developed the Basle Interview for Psychosis (BIP). The aim of this study is to describe the development of the BIP and to report about its psychometric properties. The BIP is a comprehensive semi-structured interview that was developed for the Basel early detection of psychoses (FePsy) study. Its items were derived from the most important risk factors and indicators of psychosis described in the literature and from several existing instruments. It contains the following six sections: 1) social and physical development and family, 2) signs and symptoms, 3) vulnerability, 4) help-seeking behavior, 5) illness insight, 6) evaluation of the interview. To estimate the inter-rater reliabilities of the items of sections 2 and 3, 20 interviews were conducted and rated by 8 well-trained raters. The factorial structure of the BIP section "signs and symptoms" was explored in a sample of 120 ARMS and 77 FEP patients. On the basis of the discovered factorial structure, we created new subscales and assessed their reliabilities and validities. Of the 153 studied items of sections 2 and 3, 150 (98 %) were rated with sufficiently high agreement (inter-rater reliability > 0.4). The items of section "signs and symptoms" could be grouped into 5 subscales with predominantly good to very good internal consistencies, homogeneities, and discriminant and convergent validities. Predictive validities could be demonstrated for the subscales "Positive Psychotic Symptoms", "Disturbance of Thinking" and the total score. The BIP is the first interview for comprehensively assessing risk factors and indicators of
V. V. Chugunov; I. F. Pirogov
In recent years in the world there is a tendency of quantity of persons who use drugs increase. Free availability of drugs of different groups for population is the main cause. Another trend associated with the consumption of drugs. All these factors led to the increased frequency of psychosis occurrence among consumers of psychoactive substances. In structure of such psychosis there are a variety of symptoms and syndromes. And since the number of drug users is quite broad in its structur...
ffytche, Dominic H.; Pereira, Joana B.; Ballard, Clive; Chaudhuri, K Ray; Weintraub, Daniel; Aarsland, Dag
BACKGROUND: Parkinson's Disease (PD) psychosis refers to the spectrum of illusions, formed hallucinations and delusions that occur in PD. Visual hallucinations and illusions are thought to be caused by specific cognitive and higher visual function deficits and patients who develop such symptoms early in the disease course have greater rates of cognitive decline and progression to dementia. To date, no studies have investigated whether such deficits are found prior to the onset of PD psychosis...
Veling, Wim; Pot-Kolder, Roos; Counotte, Jacqueline; van Os, Jim; van der Gaag, Mark
The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 sibli...
Mairs, Hilary; Lovell, Karina; Campbell, Malcolm; Keeley, Philip
Negative symptoms cause functional impairment and impede recovery from psychosis, not least, because of limited developments in empirically validated treatments. This article details a pilot evaluation of a behavioral activation (BA) treatment with eight people presenting with psychosis and marked negative symptoms. The rationale for this…
Kocyigit, Duygu; Gurses, Kadri Murat; Yalcin, Muhammed Ulvi; Tokgozoglu, Lale
Atherosclerotic cardiovascular disease (CVD) leading to coronary heart disease is the leading cause of morbidity and mortality in the world. Nutrition is one of the key factors in the etiology of atherosclerosis. Micronutrient supplements are widely used to prevent many chronic diseases including atherosclerosis. However, scientific evidence regarding this issue is still insufficient and current data on the association of dietary micronutrients and CVD risk is contradictory. Most of the randomized studies have failed to demonstrate beneficial effects of micronutrient supplementation on markers of subclinical atherosclerosis. In this review, role of each micronutrient on subclinical atherosclerosis will be evaluated thoroughly.
Gaillard, Raphaël; Smadja, Sarah
The concept of acute delirious puff refers to a transient psychotic state characterized by the sudden outbreak of a polymorphic delusional state in its themes and mecha- nisms. Magnan, in the late of nineteenth century, insti- gated the initial description of this concept. Rediscovered by Henri EY, it's current presence in the French psychiatry despite various attempts to dismantle it results from a singularity based on five cardinal points: it affects young adults, its onset is sudden, delusions are polymorphic and not systematic, there is a marked emotional lability and access is rapidly cured. This entity reveals vulnerability and must be understood carefully by the general practitioner, the issue being the prevention of progression to chronic psychosis.
Hui, Christy L-M; Leung, Chung-Ming; Chang, Wing-Chung; Chan, Sherry K-W; Lee, Edwin H-M; Chen, Eric Y-H
Gender-specific treatment strategies for psychosis have been suggested in recent years. Data on gender difference were largely consistent regarding premorbid functioning, age of onset and negative symptoms; however, results regarding neurocognitive function and duration of untreated psychosis were mixed and inconclusive. In this study, we aimed at a thorough examination on the gender differences in 360 Chinese patients with first-episode psychosis in Hong Kong. From June 2009 to August 2011, participants were consecutively recruited from a population-based territory-wide study of early psychosis targeting first-episode psychosis in Hong Kong. Comprehensive data on basic demographics, premorbid functioning and schizoid and schizotypal traits, clinical, functioning, medication side effects and a battery of neurocognitive measures were collected upon entry into the service. In 360 patients with first-episode psychosis aged between 26 and 55 years, 43.6% (n = 157) were male and 56.4% (n = 203) were female. Males had poorer premorbid functioning and adjustment, earlier age of onset, more negative symptoms and poorer functioning in terms of work productivity, independent living and immediate social network relationships at presentation of first-episode psychosis. Interestingly, our data indicate that males tend to be more educated, and also characterized by higher IQ, better neurocognitive performance on visual domain compared with females. Duration of untreated psychosis was not different between the two genders. Data from this homogeneous cohort of Chinese populations enabled tailored and culturally sensitive recommendation on gender-specific treatment strategies, hence improving patients' care and facilitate better diagnostic and interventional decisions for patients with psychosis. © 2014 Wiley Publishing Asia Pty Ltd.
Ekman, Carl Johan; Petrovic, Predrag; Johansson, Anette G M; Sellgren, Carl; Ingvar, Martin; Landén, Mikael
Psychotic symptoms are prevalent in schizophrenia, bipolar disorder, and other psychiatric and neurological disorders, yet the neurobiological underpinnings of psychosis remain obscure. In the last decade, a large number of magnetic resonance imaging studies have shown differences in local gray matter volume between patients with different psychiatric syndromes and healthy controls. Few studies have focused on the symptoms, which these syndromes are constituted of. Here, we test the association between psychosis and gray matter volume by using a sample of 167 subjects with bipolar disorder, with and without a history of psychosis, and 102 healthy controls. Magnetic resonance images were analyzed on group level using a voxel-wise mass univariate analysis (Voxel-Based Morphometry). We found that patients with a history of psychosis had smaller gray matter volume in left fusiform gyrus, the right rostral dorsolateral prefrontal cortex, and the left inferior frontal gyrus compared with patients without psychosis and with healthy controls. There was no volume difference in these areas between the no-psychosis group and healthy controls. These areas have previously been structurally and functionally coupled to delusions and hallucinations. Our finding adds further evidence to the probability of these regions as key areas in the development of psychotic symptoms. © The Author 2016. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: email@example.com.
Sutton, Marie; O'Keeffe, Donal; Frawley, Timothy; Madigan, Kevin; Fanning, Felicity; Lawlor, Elizabeth; Roche, Eric; Kelly, Aine; Turner, Niall; Horenstein, Arielle; O'Callaghan, Eadbhard; Clarke, Mary
The aim of this study was to assess the feasibility of a psychosis information intervention for professionals in contact with young people in Ireland. A quasi-experimental pre- and post-intervention design was used. One thousand and thirty-two professionals received an information intervention designed to improve mental health literacy (MHL) and confidence in providing help to people with psychosis. Seven hundred and fifty-five participants completed the Psychosis Information and Confidence Questionnaire pre- and post-intervention. The information intervention significantly improved participants': (1) knowledge of psychosis; (2) ability to recognize signs and symptoms of psychosis; (3) awareness of how to access services; and (4) confidence in providing help to people experiencing psychosis. Findings provide promising support for the intervention's feasibility and acceptability. The intervention enhanced MHL regarding psychosis among professionals in contact with young people. Further research assessing if such improvements translate to the facilitation of appropriate help seeking, the enhanced early detection of psychosis and a reduction of the duration of untreated psychosis is required. © 2017 John Wiley & Sons Australia, Ltd.
Natália Bezerra Mota
Full Text Available Dreaming and psychosis share important features, such as intrinsic senseperceptions independent of external stimulation, and a general lack of criticism that is associated with reduced frontal cerebral activity. Awareness of dreaming while a dream is happening defines lucid dreaming (LD, a state in which the prefrontal cortex is more active than during regular dreaming. For this reason, LD has been proposed to be potentially therapeutic for psychotic patients. According to this view, psychotic patients would be expected to report LD less frequently, and with lower control ability, than healthy subjects. Furthermore, psychotic patients able to experience LD should present milder psychiatric symptoms, in comparison with psychotic patients unable to experience LD. To test these hypotheses, we investigated LD features (occurrence, control abilities, frequency, and affective valence and psychiatric symptoms (measure by PANSS, BPRS and automated speech analysis in 45 subjects with psychotic symptoms (25 with Schizophrenia (S and 20 with Bipolar Disorder (B diagnosis versus 28 non-psychotic control (C subjects. Psychotic lucid dreamers reported control of their dreams more frequently (67% of S and 73% of B than non-psychotic lucid dreamers (only 23% of C; S > C with p=0. 0283, B > C with p=0.0150. Importantly, there was no clinical advantage for lucid dreamers among psychotic patients, even for the diagnostic question specifically related to lack of judgment and insight. Despite some limitations (e.g. transversal design, large variation of medications, these preliminary results support the notion that lucid dreaming is associated with psychosis, but falsify the hypotheses that we set out to test. A possible explanation is that psychosis enhances the experience of internal reality in detriment of external reality, and therefore lucid dreamers with psychotic symptoms would be more able to control their internal reality than non-psychotic lucid dreamers
Mota, Natália B; Resende, Adara; Mota-Rolim, Sérgio A; Copelli, Mauro; Ribeiro, Sidarta
Dreaming and psychosis share important features, such as intrinsic sense perceptions independent of external stimulation, and a general lack of criticism that is associated with reduced frontal cerebral activity. Awareness of dreaming while a dream is happening defines lucid dreaming (LD), a state in which the prefrontal cortex is more active than during regular dreaming. For this reason, LD has been proposed to be potentially therapeutic for psychotic patients. According to this view, psychotic patients would be expected to report LD less frequently, and with lower control ability, than healthy subjects. Furthermore, psychotic patients able to experience LD should present milder psychiatric symptoms, in comparison with psychotic patients unable to experience LD. To test these hypotheses, we investigated LD features (occurrence, control abilities, frequency, and affective valence) and psychiatric symptoms (measure by PANSS, BPRS, and automated speech analysis) in 45 subjects with psychotic symptoms [25 with Schizophrenia (S) and 20 with Bipolar Disorder (B) diagnosis] versus 28 non-psychotic control (C) subjects. Psychotic lucid dreamers reported control of their dreams more frequently (67% of S and 73% of B) than non-psychotic lucid dreamers (only 23% of C; S > C with p = 0.0283, B > C with p = 0.0150). Importantly, there was no clinical advantage for lucid dreamers among psychotic patients, even for the diagnostic question specifically related to lack of judgment and insight. Despite some limitations (e.g., transversal design, large variation of medications), these preliminary results support the notion that LD is associated with psychosis, but falsify the hypotheses that we set out to test. A possible explanation is that psychosis enhances the experience of internal reality in detriment of external reality, and therefore lucid dreamers with psychotic symptoms would be more able to control their internal reality than non-psychotic lucid dreamers. Training dream
Scott, Alexander J; Webb, Thomas L; Rowse, Georgina
Self-help has been shown to be an effective intervention for a wide range of mental health problems. However, there is less evidence on the efficacy of self-help for psychosis and, to date, there has been no systematic review. A search of bibliographic databases identified 24 relevant studies with a total sample size of N=1816. Ten studies adopted a repeated measures design and 14 an independent group design (including RCTs and quasi-experimental studies). Self-help interventions had, on average, a small-to-medium-sized effect on overall symptoms (d+=0.33, 95% CI: 0.17 to 0.48). Sub-analyses revealed that self-help interventions had a small-to-medium-sized effect on positive symptoms (d+=0.42, 95% CI: 0.13 to 0.72), a small-to-medium-sized effect on negative symptoms (d+=0.37, 95% CI: 0.07 to 0.66), and a small-sized effect on outcomes associated with the symptoms of psychosis such as quality of life (d+=0.13, 95% CI: 0.02 to 0.24). Moderation analysis identified a number of factors that influenced treatment effects including the complexity of the intervention and amount of contact time. Self-help interventions for psychosis have a lot of potential and recommendations for further research are discussed. Copyright © 2015 Elsevier Ltd. All rights reserved.
BDNF gene polymorphism, cognition and symptom severity in a Brazilian population-based sample of first-episode psychosis subjects Polimorfismo do gene do BDNF, cognição e gravidade dos sintomas em uma amostra de base populacional brasileira de indivíduos apresentando o primeiro episódio psicótico
Eduardo Martinho Jr
Full Text Available OBJECTIVE: To investigate the influence of brain-derived neurotrophic factor (BDNF gene variations on cognitive performance and clinical symptomatology in first-episode psychosis (FEP. METHODS: We performed BDNF val66met variant genotyping, cognitive testing (verbal fluency and digit spans and assessments of symptom severity (as assessed with the PANSS in a population-based sample of FEP patients (77 with schizophreniform psychosis and 53 with affective psychoses and 191 neighboring healthy controls. RESULTS: There was no difference in the proportion of Met allele carriers between FEP patients and controls, and no significant influence of BDNF genotype on cognitive test scores in either of the psychosis groups. A decreased severity of negative symptoms was found in FEP subjects that carried a Met allele, and this finding reached significance for the subgroup with affective psychoses (p OBJETIVO: Investigar a influência da variação do gene do fator neurotrófico derivado do cérebro (BDNF no desempenho cognitivo e na sintomatologia clínica durante o primeiro episódio psicótico (PEP. MÉTODOS: Foram realizados a genotipificação das variantes Val66met do BDNF, o teste cognitivo (fluência verbal e repetição de dígitos e as avaliações da gravidade dos sintomas (conforme avaliado pela Positive and Negative Syndrome Scale [PANSS] em uma amostra de pacientes com PEP de base populacional (77 com psicose esquizofreniforme e 53 com psicose afetiva e 191 vizinhos controle saudáveis. RESULTADOS: Não houve diferença na proporção de portadores do alelo Met entre pacientes com PEP e o grupo controle. Não houve influência significativa do genótipo do BDNF sobre a pontuação de cada um dos grupos psicóticos. Foi encontrada uma diminuição da gravidade dos sintomas negativos em sujeitos com PEP portadores do alelo Met, e essa descoberta mostrou-se significativa para o subgrupo com psicose afetiva (p < 0,01, ANOVA. CONCLUSÕES: Os
Papmeyer, Martina; Aston, Jacqueline; Everts-Graber, Judith; Heitz, Ulrike; Studerus, Erich; Borgwardt, Stefan J; Stieglitz, Rolf-Dieter; Riecher-Rössler, Anita
We aimed to determine the prognostic accuracy of the Basel Screening Instrument for Psychosis (BSIP) in terms of specificity, sensitivity, positive and negative predictive value by following up individuals that were initially not considered to be at increased risk of psychosis based on the BSIP. Moreover, clinical characteristics of these individuals were examined given the relative lack of such information in the literature. As part of the "Früherkennung von Psychosen" (FePsy) study, 87 individuals were screened with the BSIP. Of these, 64 were classified at baseline as being in an at-risk mental state (ARMS+) for psychosis using the BSIP and followed up at regular time intervals for at least 2 years to determine a putative transition to psychosis. Twenty-three individuals were classified at baseline as not being in an at-risk mental state (ARMS-) using the BSIP and re-assessed after 4 years. Sensitivity, specificity, positive and negative predictive value of the BSIP were computed. Clinical characteristics of the ARMS- group were analysed descriptively. During the follow-up period, none of the ARMS- individuals, but 21 of ARMS+ had developed psychosis. Sensitivity of the BSIP was 1.0, specificity was 0.35. The majority of ARMS- individuals showed depressive disorders or anxiety disorders and varying levels of functioning. The BSIP has good prognostic accuracy for detecting the prodromal phase of psychosis with an excellent sensitivity and a specificity similar to other risk instruments and the advantage of a relatively short duration. Depressive and anxiety symptoms commonly develop in ARMS- individuals. © 2017 John Wiley & Sons Australia, Ltd.
Albert, Nikolai; Bertelsen, Mette; Thorup, Anne
Introduction This paper aims to investigate the predictors of good outcome after first-episode non-affective psychosis and the clinical and social trajectories of those that recover. Methods A cohort of 255 patients with first-episode non-affective psychosis was interviewed 5 years after first...... that a stable social life with normal social functioning has a predictive value for good outcome. These measures might be influenced by negative symptoms, but in the multivariate analysis with negative symptoms included they have an independent effect. Also our findings suggest that, after first...
Rae, Charlotte L; Davies, Geoff; Garfinkel, Sarah N; Gabel, Matt C; Dowell, Nicholas G; Cercignani, Mara; Seth, Anil K; Greenwood, Kathryn E; Medford, Nick; Critchley, Hugo D
Structural abnormalities across multiple white matter tracts are recognized in people with early psychosis, consistent with dysconnectivity as a neuropathological account of symptom expression. We applied advanced neuroimaging techniques to characterize microstructural white matter abnormalities for a deeper understanding of the developmental etiology of psychosis. Thirty-five first-episode psychosis patients, and 19 healthy controls, participated in a quantitative neuroimaging study using neurite orientation dispersion and density imaging, a multishell diffusion-weighted magnetic resonance imaging technique that distinguishes white matter fiber arrangement and geometry from changes in neurite density. Fractional anisotropy (FA) and mean diffusivity images were also derived. Tract-based spatial statistics compared white matter structure between patients and control subjects and tested associations with age, symptom severity, and medication. Patients with first-episode psychosis had lower regional FA in multiple commissural, corticospinal, and association tracts. These abnormalities predominantly colocalized with regions of reduced neurite density, rather than aberrant fiber bundle arrangement (orientation dispersion index). There was no direct relationship with active symptoms. FA decreased and orientation dispersion index increased with age in patients, but not control subjects, suggesting accelerated effects of white matter geometry change. Deficits in neurite density appear fundamental to abnormalities in white matter integrity in early psychosis. In the first application of neurite orientation dispersion and density imaging in psychosis, we found that processes compromising axonal fiber number, density, and myelination, rather than processes leading to spatial disruption of fiber organization, are implicated in the etiology of psychosis. This accords with a neurodevelopmental origin of aberrant brain-wide structural connectivity predisposing individuals to
Fineberg, S K; Leavitt, J; Deutsch-Link, S; Dealy, S; Landry, C D; Pirruccio, K; Shea, S; Trent, S; Cecchi, G; Corlett, P R
Language use is of increasing interest in the study of mental illness. Analytical approaches range from phenomenological and qualitative to formal computational quantitative methods. Practically, the approach may have utility in predicting clinical outcomes. We harnessed a real-world sample (blog entries) from groups with psychosis, strong beliefs, odd beliefs, illness, mental illness and/or social isolation to validate and extend laboratory findings about lexical differences between psychosis and control subjects. We describe the results of two experiments using Linguistic Inquiry and Word Count software to assess word category frequencies. In experiment 1, we compared word use in psychosis and control subjects in the laboratory (23 per group), and related results to subject symptoms. In experiment 2, we examined lexical patterns in blog entries written by people with psychosis and eight comparison groups. In addition to between-group comparisons, we used factor analysis followed by clustering to discern the contributions of strong belief, odd belief and illness identity to lexical patterns. Consistent with others' work, we found that first-person pronouns, biological process words and negative emotion words were more frequent in psychosis language. We tested lexical differences between bloggers with psychosis and multiple relevant comparison groups. Clustering analysis revealed that word use frequencies did not group individuals with strong or odd beliefs, but instead grouped individuals with any illness (mental or physical). Pairing of laboratory and real-world samples reveals that lexical markers previously identified as specific language changes in depression and psychosis are probably markers of illness in general.
Larsen, Tor K; Melle, Ingrid; Auestad, Bjørn
Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven.......Early intervention is assumed to improve outcome in first-episode psychosis, but this has not been proven....
McGlashan, Thomas H
The psychoanalytic treatment model of neurotic disorders was applied "experimentally," usually without concomitant pharmacotherapy, to psychotic disorders in the mid to late 20th century at a private institution (Chestnut Lodge) in Maryland. A long-term follow-up (by this author) essentially documented such an approach to be ineffective but suggested that initial treatment earlier in the development of disorder might prevent or ameliorate the "dementia" of dementia praecox. The opportunity to actually measure the effect of earlier detection and treatment became apparent to this author on sabbatical leave in Stavanger, Norway. The sectorized Norwegian health care system made it possible to engineer early detection of first psychosis in an "experimental" health care sector and compare their outcome to that of first onset patients from two control "usual detection" health care sectors. Early detection was engineered in the experimental sector with educational campaigns about the signs and symptoms of first psychosis targeting the sector's doctors, educators, and the general public through massive educational campaigns. The result was clear. Early detection and treatment resulted in a significantly better symptomatic, social, and instrumental outcome in the experimental sectors compared with "usual detection" sectors, a difference that lasted up to a 10-year follow-up (and perhaps permanently). These events and findings will be reviewed to assert that intervention timing may be far more important than intervention type in the overall strategy of antipsychotic interventions.
Hegelstad, Wenche Ten Velden; Larsen, Tor K; Auestad, Bjørn
Early detection in first-episode psychosis confers advantages for negative, cognitive, and depressive symptoms after 1, 2, and 5 years, but longitudinal effects are unknown. The authors investigated the differences in symptoms and recovery after 10 years between regional health care sectors with ...
Fusar-Poli, Paolo; Cappucciati, Marco; Borgwardt, Stefan; Woods, Scott W.; Addington, Jean; Nelson, Barnaby; Nieman, Dorien H.; Stahl, Daniel R.; Rutigliano, Grazia; Riecher-Rössler, Anita; Simon, Andor E.; Mizuno, Masafumi; Lee, Tae Young; Kwon, Jun Soo; Lam, May M. L.; Perez, Jesus; Keri, Szabolcs; Amminger, Paul; Metzler, Sibylle; Kawohl, Wolfram; Rössler, Wulf; Lee, Jimmy; Labad, Javier; Ziermans, Tim; An, Suk Kyoon; Liu, Chen-Chung; Woodberry, Kristen A.; Braham, Amel; Corcoran, Cheryl; McGorry, Patrick; Yung, Alison R.; McGuire, Philip K.
Individuals can be classified as being at clinical high risk (CHR) for psychosis if they meet at least one of the ultra-high-risk (UHR) inclusion criteria (brief limited intermittent psychotic symptoms [BLIPS] and/or attenuated psychotic symptoms [APS] and/or genetic risk and deterioration syndrome
Overbey, Gail A.; Snell, William E., Jr.; Callis, Kenneth E.
Objective: To examine how the subclinical symptoms of adult ADHD and those of oppositional-defiant disorder (ODD) affect relationship satisfaction and stress and to determine whether different patterns of coping strategies emerge when undergraduates have symptoms of one or both disorders. Method: Participants (N = 497) complete self-report surveys…
Lewandowski, Kathryn E; Whitton, Alexis E; Pizzagalli, Diego A; Norris, Lesley A; Ongur, Dost; Hall, Mei-Hua
Patients with psychosis spectrum disorders exhibit deficits in social and neurocognition, as well as hallmark abnormalities in motivation and reward processing. Aspects of reward processing may overlap behaviorally and neurobiologically with some elements of cognitive functioning, and abnormalities in these processes may share partially overlapping etiologies in patients. However, whether reward processing and cognition are associated across the psychoses and linked to state and trait clinical symptomatology is unclear. The present study examined associations between cognitive functioning, reward learning, and clinical symptomatology in a cross-diagnostic sample. Patients with schizophrenia (SZ; n = 37), bipolar I disorder with psychosis (BD; n = 42), and healthy controls (n = 29) were assessed for clinical symptoms (patients only), neurocognitive functioning using the MATRICS Battery (MCCB) and reward learning using the probabilistic reward task (PRT). Groups were compared on neurocognition and PRT response bias, and associations between PRT response bias and neurocognition or clinical symptoms were examined controlling for demographic variables and PRT task difficulty (discriminability). Patients with SZ performed worse than controls on most measures of neurocognition; patients with BD exhibited deficits in some domains between the level of patients with SZ and controls. The SZ - but not BD - group exhibited deficits in social cognition compared to controls. Patients and controls did not differ on PRT response bias, but did differ on PRT discriminability. Better response bias across the sample was associated with poorer social cognition, but not neurocognition; conversely, discriminability was associated with neurocognition but not social cognition. Symptoms of psychosis, particularly negative symptoms, were associated with poorer response bias across patient groups. Reward learning was associated with symptoms of psychosis - in particular negative
International best-practice guidelines for the management of first-episode psychosis have recommended the provision of psychoeducation for multifamily groups. While there is ample evidence of their efficacy in multiepisode psychosis, there is a paucity of evidence supporting this approach specifically for first-episode psychosis. We sought to determine whether a six-week caregiver psychoeducation programme geared specifically at first-episode psychosis improves caregiver knowledge and attitudes.
Sehestedt, Thomas; Olsen, Michael H
Traditional cardiovascular risk factors have poor prognostic value for individuals and screening for subclinical organ damage has been recommended in hypertension in recent guidelines. The aim of this review was to investigate the clinical impact of the additive prognostic information provided...... by measuring subclinical organ damage. We have (i) reviewed recent studies linking markers of subclinical organ damage in the heart, blood vessels and kidney to cardiovascular risk; (ii) discussed the evidence for improvement in cardiovascular risk prediction using markers of subclinical organ damage; (iii...... for risk discrimination, calibration and reclassification; and (ii) the economic costs and health benefits associated with measuring markers of subclinical organ damage....
May 2, 2009 ... EL-Safty, I.A.M., GadalIah, M., Shouman, A.E. and. Nessim, D.E. Subclinical nephrotoxicity caused by smoking and occupational silica exposure among. Egyptian industrial workers. Arch. Med. Res. 2003;. 34: 415-421. 4. Ivandic, M., Hofmann, W. and Guder, W.G. The use of knowledge-based systems to ...
Østergaard, Søren Dinesen; Bille, Jim; Søltoft-Jensen, Henrik
Psychotic depression (PD) is classified as a subtype of severe depression in the current diagnostic manuals. Accordingly, it is a common conception among psychiatrists that psychotic features in depression arise as a consequence of depressive severity. The aim of this study was to determine wheth...... the severity of depressive and psychotic symptoms correlate in accordance with this "severity-psychosis" hypothesis and to detect potential differences in the clinical features of PD and non-psychotic depression (non-PD)....
Nixon, Gary; Hagen, Brad; Peters, Tracey
While mainstream psychiatry tends to view psychosis as an enduring and chronic condition, there is growing interest in the possibility of recovery from psychosis. A phenomenological research method was utilized in interviewing 17 individuals who all self-identified as being in recovery from psychosis. The research question was, "What was the lived…
van Winkel, Ruud
Background Familial correlations underlie heritability estimates of psychosis. If gene-environment interactions are important, familial correlation will vary as a function of environmental exposure. Methods Associations between sibling and parental schizotypy (n = 669 pairs, n = 1222 observations), and between sibling schizotypy and patient CAPE psychosis (n = 978 pairs, n = 1723 observations) were examined as a function of sibling cannabis use. This design is based on the prediction that in unaffected siblings who are not exposed, vulnerability for psychosis will remain latent, whereas in case of exposure, latent psychosis vulnerability may become expressed, at the level of schizotypal symptoms, causing the phenotypic correlation between relatives to become “visible” under the influence of cannabis. Results Siblings exposed to recent cannabis use resembled their patient-relative more closely in terms of positive schizotypy (urinalysis(+):B = 0.30, Pcannabis (urinalysis(+):B = 0.78, Pcannabis frequency of use as exposure instead of recent use. Parental schizotypy did not predict cannabis use in the healthy sibling, nor in the patient. Similarly, parental cannabis use was not associated with level of schizotypy in the sibling, nor with psychotic symptoms in the patient, making gene-environment correlation unlikely. Conclusion Familial correlation of psychosis-related experiences varies considerably as a function of exposure to cannabis, confirming the importance of gene-cannabis interaction in shifts of expression of psychosis-related experiences. PMID:26384217
Full Text Available Subramanian Madhusoodanan1, Payal Shah21St John’s Episcopal Hospital Far Rockaway, NY 11691, SUNY, Brooklyn NY, USA. 2SUNY Health Science Center, Brooklyn, NYAbstract: Psychosis of Alzheimer’s disease (AD is characterized by delusions or hallucinations and may be associated with agitation, negative symptoms or depression. There are no psychotropic medications that are approved by the US FDA for the treatment of psychosis of AD. However, atypical antipsychotics have been widely used and recommended by geriatric experts in the management of psychosis of AD in view of the modest efficacy and relative safety until FDA warnings were issued in 2005 and meta-analytic studies showed no significant difference to placebo. The FDA warnings on the cardiac, metabolic, cerebrovascular, and mortality risks have caused serious concerns for the use of atypical antipsychotic agents in elderly patients with dementia. Only a few studies have evaluated prospectively the effects of aripiprazole in psychosis associated with AD. These studies show improvement in the symptoms of psychosis associated with AD with aripiprazole. The safety and tolerability profile of aripiprazole suggests a low potential for negative impact on dementia and overall patient health. Further studies comparing the efficacy and tolerability of aripiprazole vs other atypical antipsychotics in dementia are needed.Keywords: treatment, Alzheimer’s dementia, psychosis, aripiprazole
Reddy, Y C; Girimaji, S R; Srinath, S
Classification of psychosis in childhood and adolescence has always been controversial due to the possible developmental modulation of symptom expression. Major classificatory systems have no special criteria for children, and recommend the use of adult criteria. Hence, this study aimed to study the nosology of psychosis of childhood and adolescence, using adult criteria (ICD-9, ICD-10 and DSM-III-R). Fifty subjects between the age of 5 and 16 years who met the ICD-9 definition of psychosis were studied using the Intake Sheet for Adolescents: cross-cultural study and the Interview Schedule for Children and Adolescents. Most of the subjects could be classified into one of the major functional psychosis categories, indicating the applicability of adult criteria in children and adolescents.
Croes, C F; van Grunsven, R; Staring, A B P; van den Berg, D P G; de Jongh, A; van der Gaag, M
Historically, psychotherapy has focused on the treatment of patients' verbal representations (thoughts) and has proved particularly successful in the cognitive behavioural treatment of psychosis. However, there is mounting evidence that visual representations (imagery) play an important role in the onset and maintenance of psychiatric disorders, including psychotic symptoms. There are indications that heightened emotionality and vividness of visual representations are associated with severity of psychotic experiences. This may imply that a reduction in the vividness and emotionality of the psychosis-related imagery can lessen the suffering and stress, caused by the the psychotic symptoms. To introduce EMDR as a possible type of psychological treatment for patients suffering from psychosis-related imagery. Three outpatients who had a psychotic disorder and suffered from auditory hallucinations and delusions were treated with EMDR in an average of six sessions. Treatment was performed by three therapists in different psychiatric institutions. All three were experienced in administrating CBT and EMDR. Treatment with EMDR reduced patients' level of anxiety, depression and the severity of psychotic symptoms. In addition, patients reported less avoidant behaviour and greater cognitive insight. The results of the study suggest that EMDR reduces the vividness and emotionality of imagery in psychosis which in turn alleviates the patients' psychotic symptoms. Further research into other possible types of interventions for the treatment of imagery in psychosis is recommended.
Wu, Hanjing E; Abdel-Gawad, Noha M; Gharbaoui, Yasmine; Teixeira, Antonio L; Pigott, Teresa A
Arsenic exposure, particularly the chronic type, can lead to poisoning with manifestations presenting in multiple organ systems. However, acute psychosis is not a commonly described manifestation of arsenic exposure. In this report, we present the case of a patient who developed acute psychosis with hallucinations, disorganized thinking, and obsessive-compulsive symptoms following chronic occupational arsenic exposure. The patient was treated with the combination of an antipsychotic and an antidepressant and he responded well with significant improvement in both the acute psychosis and obsessive-compulsive symptoms. The authors concluded that patients can develop atypical symptoms, including acute psychosis, following arsenic poisoning. In the case described in this report, the patient also presented with a new onset of obsessive-compulsive symptoms. Given this rare manifestation of arsenic poisoning for which there is no clearly defined treatment regimen, this case suggests that the use of a combination of an antipsychotic and an antidepressant may be considered in the rare event of psychosis with obsessive-compulsive features following arsenic poisoning.
Pualuan de Gomberoff, L; Gomberoff, M
In this paper the stages are presented in the psychoanalysis of an eight-and-a-half-year-old boy consulting with a worsening symptomatology that has been evolving for more than one year. The trigger element seems to have been the birth of a brother. During the analysis the relation was clear between this brother's birth, the mother's abortions, and the previous death of a brother. The interpretation of the homicidal omnipotent fantasies and the analyst's reception of projective identifications, destructive anxieties, and castrating anxieties of the patient produced, apparently, an unimagined fast improvement of the psychotic symptoms. This took the authors retrospectively to raise the hypothesis that this patient's psychosis could be a disguised child hysteria.
Smita S. Kottagi
Full Text Available Background: Subclinical hypothyroidism is defined as a serum TSH concentration above the upper limit of the reference range when serum T3 and T4 concentrations are within reference ranges. Subclinical thyroid disease is a laboratory diagnosis. Patients with subclinical disease have few or no definitive clinical signs or symptoms of thyroid dysfunction. It has been associated with higher levels of some cardiovascular risk factors. Despite some conflicting results, many studies have found that subjects with subclinical hypothyroidism have total cholesterol and low density lipoprotein cholesterol levels higher than euthyroid subjects. The association between subclinical hypothyroidism and dyslipidemia is well known. Aims and Objectives: This study is an attempt to find the importance of Low Density Lipoprotein – Cholesterol / Higher Density Lipoprotein - Cholesterol (LDL-C/HDL-C ratio rather than measurement of individual lipid profile parameters in bringing to light the dyslipidemic state associated with subclinical hypothyroidism. Materials and Methods: We studied 30 subclinical hypothyroid cases with age above 35 yrs and 30 age matched euthyroid controls. Serum T3, T4, TSH were estimated by ELISA method, serum total cholesterol, HDL Cholesterol by enzymatic CHOD-PAP method, and LDL cholesterol using Friedewald formula. Results: We found the significant increase in the serum levels of TSH (p < 0.001, Total cholesterol (p<0.001, LDL cholesterol (p<0.001, and LDL-C/HDL-C (p<0.001, Systolic blood pressure and diastolic blood pressure (p<0.001. There was no significant change in the levels of serum T3, T4, HDL- cholesterol. Conclusion: Increased levels of total cholesterol, LDL cholesterol and increased LDL-C/HDL-C ratio are seen in patients with subclinical hypothyroidism. LDL-C/HDLC ratio is a better indicator for dyslipidemia in subclinical hypothyroid cases.
Full Text Available Aim: Hypnagogic and hypnopompic hallucinations are characteristic symptoms of narcolepsy, as are excessive daytime sleepiness, cataplexy and sleep paralysis. Narcolepsy patients may also experience daytime hallucinations unrelated to sleep-wake transitions. The effect of medication on hallucinations is of interest since treatment of narcolepsy may provoke psychotic symptoms. We aim to analyze the relation between sodium oxybate (SXB treatment and psychotic symptoms in narcolepsy patients. Furthermore, we analyze the characteristics of hallucinations to determine their nature as mainly psychotic or hypnagogic and raise a discussion about whether SXB causes psychosis or if psychosis occurs as an endogenous complication in narcolepsy.Method: We present altogether four patients with narcolepsy who experienced psychotic symptoms during treatment with SXB. In addition, we searched the literature for descriptions of hallucinations in narcolepsy and similarities and differences with psychotic symptoms in schizophrenia.Results: Three out of four patients had hallucinations typical for psychosis and one had symptoms that resembled aggravated hypnagogic hallucinations. Two patients also had delusional symptoms primarily associated with mental disorders. Tapering down SXB was tried and helped in two out of four cases. Adding antipsychotic treatment (risperidone alleviated psychotic symptoms in two cases. Conclusion: Psychotic symptoms in narcolepsy may appear during SXB treatment. Hallucinations resemble those seen in schizophrenia however the insight that symptoms are delusional is usually preserved. In case of SXB-induced psychotic symptoms or hallucinations, reducing SXB dose or adding antipsychotic medication can be tried.
Full Text Available Cannabis is the most commonly used illicit drug worldwide including India. The role of Cannabis in the causation of psychiatric disorders, especially psychosis remains debatable. Cannabis use has been reported to present with symptoms similar to those of schizophrenia and bipolar affective disorder. The distinction between Cannabis-induced psychoses and primary psychotic disorder is important from management perspective as it would determine the need and duration of antipsychotic medications, as well as relative focus on the management of substance use. At times, however, such a distinction may be difficult to make. We present a case where we were faced with difficulty labeling the origin of psychotic symptoms in a patient who was otherwise a heavy user of Cannabis. Management options considered in the presence of insoluble diagnostic problem have also been discussed.
Goldman, Jennifer G; Holden, Samantha
Parkinson's disease (PD) has been increasingly recognized as having a multitude of nonmotor symptoms including psychosis, cognitive impairment and dementia, mood disturbances, fatigue, apathy, and sleep disorders. Psychosis and dementia, in particular, greatly affect quality of life for both patients and caregivers and are associated with poor outcomes. Safe and effective treatment options for psychosis and dementia in PD are much needed. Antipsychotics with dopamine-blocking properties can worsen parkinsonian motor features and have been associated with increased morbidity and mortality in elderly, dementia patients. For treating PD psychosis, a first step would be eliminating confounding variables, such as delirium, infections, or toxic-metabolic imbalances, followed by simplifying parkinsonian medications as tolerated. If additional treatment is warranted after such interventions, clozapine or quetiapine can be implemented at the low dose levels typically needed by PD patients. Although quetiapine is easy-to-use in clinical settings, does not require blood count monitoring like clozapine, and is anecdotally beneficial, it remains "investigational" in evidence-based medicine reviews. Though not currently available, the novel 5-HT2a inverse agonist, pimavanserin has shown promise in the treatment of PD psychosis. Current treatments for PD dementia are mostly derived from those utilized in Alzheimer's disease, focusing mainly on cholinesterase inhibitors and memantine, a NMDA receptor antagonist. Rivastigmine, the only Food and Drug Administration approved medication for PD dementia, is a reasonable first choice. Other cholinesterase inhibitors and memantine have not yet achieved recommendation status in evidence-based medicine reviews but are well tolerated in studies of PD dementia patients. At present, there are no approved treatments for mild cognitive impairment in PD, but rasagiline, a selective MAO-B inhibitor, and atomoxetine, a serotonin norepinephrine
Murphy, Ruth Ann; Hallahan, Brian
...) dysphonia since 2011. Although receiving ongoing treatment from a Speech and Language Therapist, the patient's symptoms of dysphonia have remained prominent from the time of diagnosis in 2011 and have been particularly...
Bruno Fukelmann Guedes
Full Text Available ABSTRACT Psychosis, impulse control disorders (e.g., pathological gambling and hypersexuality and repetitive behaviors such as punding are known psychiatric complications of Parkinson's disease (PD. Impulsive, compulsive and repetitive behaviors are strongly associated with dopamine-replacement therapy. We present the case of a 58-year-old man with PD and a myriad of psychiatric symptoms. Concurrent psychosis, punding and pathological gambling developed more than six years after the introduction of pramipexole and ceased shortly after the addition of quetiapine and discontinuation of pramipexole. This report emphasizes the importance of monitoring for a wide array of psychiatric symptoms in patients on dopamine replacement therapy.
Sullivan, Sarah; Lewis, Glyn; Mohr, Christine; Herzig, Daniela; Corcoran, Rhiannon; Drake, Richard; Evans, Jonathan
There is some cross-sectional evidence that theory of mind ability is associated with social functioning in those with psychosis but the direction of this relationship is unknown. This study investigates the longitudinal association between both theory of mind and psychotic symptoms and social functioning outcome in first-episode psychosis. Fifty-four people with first-episode psychosis were followed up at 6 and 12 months. Random effects regression models were used to estimate the stability of theory of mind over time and the association between baseline theory of mind and psychotic symptoms and social functioning outcome. Neither baseline theory of mind ability (regression coefficients: Hinting test 1.07 95% CI -0.74, 2.88; Visual Cartoon test -2.91 95% CI -7.32, 1.51) nor baseline symptoms (regression coefficients: positive symptoms -0.04 95% CI -1.24, 1.16; selected negative symptoms -0.15 95% CI -2.63, 2.32) were associated with social functioning outcome. There was evidence that theory of mind ability was stable over time, (regression coefficients: Hinting test 5.92 95% CI -6.66, 8.92; Visual Cartoon test score 0.13 95% CI -0.17, 0.44). Neither baseline theory of mind ability nor psychotic symptoms are associated with social functioning outcome. Further longitudinal work is needed to understand the origin of social functioning deficits in psychosis.
Stowkowy, Jacqueline; Perkins, Diana O; Woods, Scott W; Nyman, Karissa; Addington, Jean
Negative beliefs about illness in early psychosis have been shown to have an unfavourable impact on one's quality of life. A shift of focus in psychosis research has been on the detection of individuals considered to be at clinical high risk (CHR) of developing psychosis. Little is known about the impact that beliefs about psychotic like experiences or attenuated psychotic symptoms may have on CHR individuals. To explore these beliefs in a large sample of young people at CHR of developing psychosis using the Personal Beliefs about Experiences Questionnaire (PBEQ). Beliefs about unusual experiences were assessed in 153 CHR individuals with the PBEQ. Prodromal symptoms (measured by the SIPS) and depression (measured by the CDSS) were also assessed. In CHR individuals, holding more negative beliefs was associated with increased severity in depression and negative symptoms. Higher scores on suspiciousness were associated with increased negative beliefs, and higher levels of grandiosity were associated with decreased negative beliefs. Those who later transitioned to psychosis agreed significantly more with statements concerning control over experiences (i.e. "my experiences frighten me", "I find it difficult to cope). The results suggest that targeting negative beliefs and other illness related appraisals is an important objective for intervention strategies.
Rodríguez-Violante, Mayela; Velázquez-Osuna, Salvador; Cervantes-Arriaga, Amin; Corona-Vázquez, Teresa; de la Fuente-Sandoval, Camilo
Psychosis associated with Parkinson's disease is a major neuropsychiatric complication; it has been reported that 60% of patients will develop psychosis during the disease evolution. Its pathophysiology is multifactorial and clinically psychotic phenomena include minor hallucinations and confusional states. We performed a cross-sectional study in patients with Parkinson's disease from a tertiary hospital using a thoughtful neurological and neuropsychiatric evaluation along with specific scales for non-motor symptoms, depression, cognition, and presence and severity of psychotic symptoms and hallucinations. We included a total of 236 patients with Parkinson's disease, of which 33 (13.9%) patients met the criteria for psychosis at the time of the evaluation. Visual hallucinations were the most common symptom. Age (p = 0.004), age at onset of the disease (p = 0.007) and its duration (p = 0.004), use of levodopa (p = 0.02), and use of amantadine (p = 0.004) were the main factors associated with the presence of psychosis. Psychosis in Parkinson's disease is a relatively common manifestation and is mainly associated with clinical and demographic factors. Early recognition will optimize management and improve the quality of life of patients and their caregivers.
Sehestedt, Thomas; Olsen, Michael H
Traditional cardiovascular risk factors have poor prognostic value for individuals and screening for subclinical organ damage has been recommended in hypertension in recent guidelines. The aim of this review was to investigate the clinical impact of the additive prognostic information provided...... by measuring subclinical organ damage. We have (i) reviewed recent studies linking markers of subclinical organ damage in the heart, blood vessels and kidney to cardiovascular risk; (ii) discussed the evidence for improvement in cardiovascular risk prediction using markers of subclinical organ damage; (iii......) investigated which and how many markers to measure and (iv) finally discussed whether measuring subclinical organ damage provided benefits beyond risk prediction. In conclusion, more studies and if possible randomized studies are needed to investigate (i) the importance of markers of subclinical organ damage...
Rund, Bjørn Rishovd; Barder, Helene Eidsmo; Evensen, Julie
A substantial proportion of schizophrenia-spectrum patients exhibit a cognitive impairment at illness onset. However, the long-term course of neurocognition and a possible neurotoxic effect of time spent in active psychosis, is a topic of controversy. Furthermore, it is of importance to find out...
Full Text Available BACKGROUND: Though infections are associated with psychotic symptoms, whether or not subclinical inflammation is associated with hallucinations is not known in Parkinson's disease (PD. PURPOSE: To investigate the association of illusions/hallucinations and plasma CRP levels in PD patients without symptomatic infections. METHODS: PD patients not diagnosed as having infections were assessed for illusions and hallucinations using the Parkinson Psychosis Questionnaire (PPQ. It comprises four-domain questions: PPQ-A for sleep problems, PPQ-B for hallucinations/illusions, PPQ-C for delusions, and PPQ-D for disorientation. Assigning patients with ≥1 points in the PPQ-B score to be cases and others as controls, the association of hallucinations/illusions and clinical features (age, sex, duration of PD, Unified Parkinson's Disease Rating Scale part 3 (UPDRS-3, Mini-Mental State Examination (MMSE score, sleep disturbance (PPQ-A score as well as daily doses of L-Dopa, dopamine agonists, amantadine, and selegiline were analyzed using a case-control design. RESULTS: A total of 111 patients were examined and plasma CRP levels were <0.1-6.0 mg/L. Hallucinations or illusions were detected in 28 (25.2%. There were significant differences in age, UPDRS-3 score, MMSE score, PPQ-A, daily doses of L-Dopa and dopamine agonists and plasma CRP levels between cases and controls. A multivariate logistic regression model revealed that UPDRS-3 scores and plasma CRP levels were significantly associated with hallucinations/illusions with an adjusted odds ratio of 1.96 (95% confidence interval (CI 1.20-3.20 per 10 points and 1.57 (95% confidence interval 1.13-2.16 per two-fold, respectively. Dividing patients into thirds by CRP levels (≤0.2, 0.3-0.6, ≥0.7 mg/L, the prevalence of hallucinations/illusions was 13.2%, 21.6%, and 41.7%, in the bottom-, middle-, and top-thirds, respectively (for trend p = 0.012. CONCLUSIONS: Subclinical elevation of plasma CRP levels was
Sewell, Richard Andrew; Ranganathan, Mohini
The association between cannabis use and psychosis has long been recognized. Recent advances in knowledge about cannabinoid receptor function have renewed interest in this association. Converging lines of evidence suggest that cannabinoids can produce a full range of transient schizophrenia-like positive, negative, and cognitive symptoms in some healthy individuals. Also clear is that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. The mechanisms by which cannabinoids produce transient psychotic symptoms, while unclear may involve dopamine, GABA, and glutamate neurotransmission. However, only a very small proportion of the general population exposed to cannabinoids develop a psychotic illness. It is likely that cannabis exposure is a “component cause” that interacts with other factors to “cause” schizophrenia or a psychotic disorder, but is neither necessary nor sufficient to do so alone. Nevertheless, in the absence of known causes of schizophrenia, the role of component causes remains important and warrants further study. Dose, duration of exposure, and the age of first exposure to cannabinoids may be important factors, and genetic factors that interact with cannabinoid exposure to moderate or amplify the risk of a psychotic disorder are beginning to be elucidated. The mechanisms by which exposure to cannabinoids increase the risk for developing a psychotic disorder are unknown. However, novel hypotheses including the role of cannabinoids on neurodevelopmental processes relevant to psychotic disorders are being studied. PMID:19609589
Full Text Available We report the case of an old man treated with methylprednisolone for chronic lymphoid leukemia. After two months of treatment, he declared an acute steroid psychosis and beat his wife to death. Steroids were stopped and the psychotic symptoms subsided, but his condition declined very quickly. The clinical course was complicated by a major depressive disorder with suicidal ideas, due to the steroid stoppage, the leukemia progressed, and by a sudden onset of a fatal pulmonary embolism. This clinical case highlights the importance of early detection of steroid psychosis and proposes, should treatment not be stopped, a strategy of dose reduction combined with a mood stabilizer or antipsychotic treatment. In addition have been revised the risks of the adverse psychiatric effects of steroids.
Colizzi, Marco; Carra, Elena; Fraietta, Sara; Lally, John; Quattrone, Diego; Bonaccorso, Stefania; Mondelli, Valeria; Ajnakina, Olesya; Dazzan, Paola; Trotta, Antonella; Sideli, Lucia; Kolliakou, Anna; Gaughran, Fiona; Khondoker, Mizanur; David, Anthony S; Murray, Robin M; MacCabe, James H; Di Forti, Marta
Both substance use and poor medication adherence are associated with poor outcome in psychosis. To clarify the contributions of substance use and poor medication adherence to poor outcome in the year following a first episode of psychosis, 205 patients were evaluated for use of tobacco, alcohol, cannabis and stimulants at their psychosis onset, and in a 1-year follow-up. Data on medication adherence and symptom remission were also collected. Patients had high rates of overall substance use before (37-65%) and after psychosis onset (45-66%). 44% showed poor medication adherence and 55% did not reach remission from psychosis. Nicotine dependence and cannabis use after psychosis onset significantly predicted both poor medication adherence and non-remission, and poor medication adherence mediated the effects of these substances on non-remission. In conclusion, medication adherence lies on the causal pathway between nicotine dependence and cannabis on the one hand and non-remission on the other. Copyright © 2015 Elsevier B.V. All rights reserved.
Harrop, Chris; Ellett, Lyn; Brand, Rachel; Lobban, Fiona
To highlight the importance of friendships to young people with psychosis, and the need for clinical interventions to help maintain peer relationships during illness. To structure a research agenda for developing evidence-based interventions with friends. An argument is developed through a narrative review of (i) the proven efficacy of family interventions, and (by comparison) a relative absence of friend-based interventions; (ii) the particular primacy of friendships and dating for young people, and typical effects of exclusion; and (iii) reduced friendship networks and dating experiences in psychosis, in pre-, during and post-psychosis phases, also links between exclusion and psychosis. We put forward a model of how poor friendships can potentially be a causal and/or maintenance factor for psychotic symptoms. Given this model, our thesis is that interventions aiming to maintain social networks can be hugely beneficial clinically for young people with psychosis. We give a case study to show how such an intervention can work. We call for 'friends interventions' for young people with psychosis to be developed, where professionals directly work with a young person's authentic social group to support key friendships and maintain social continuity. An agenda for future research is presented that will develop and test theoretically driven interventions. © 2014 Wiley Publishing Asia Pty Ltd.
Nicholas J. K. Breitborde
Full Text Available Self-determination theory (SDT posits that human well-being depends on the satisfaction of three basic psychological needs: autonomy, competence, and relatedness. Although many scholars have suggested that SDT may be relevant to psychotic disorders, only one empirical study of SDT in individuals with psychosis has been completed to date by Breitborde and colleagues (2012. This study revealed that individuals with first-episode psychosis reported lower satisfaction of the three basic psychological needs as compared to individuals without psychosis. Moreover, greater satisfaction of basic psychological needs was modestly associated with lower general symptoms (e.g., anxiety and depression, greater social functioning, and better quality of life. Thus, the goal of this project was to replicate Breitborde et al.’s (2012 investigation of basic psychological need satisfaction among individuals with first-episode psychosis. Our results supported the conclusion that individuals with first-episode psychosis report lower autonomy, competence, and relatedness than individuals without psychosis. Moreover, our results comport with the finding that greater need satisfaction was associated with less severe symptomatology and better social functioning and quality of life. In total, the findings lend further credence to the hypothesis that SDT may help to inform the development of improved clinical services for individuals with psychotic disorders.
Wong, Agatha W S; Chen, Eric Y H
Growing evidence supporting the use of Cognitive Behavioural Therapy (CBT) to improve outcomes in patients with psychosis has largely originated from American and European countries, its applicability and effectiveness in Chinese patients with psychosis is still under-explored. However, the lack of stable and reliable outcome measures to evaluate the effectiveness of CBT for patients with psychosis hinders further development of psychological intervention in patients with psychosis in the Chinese context. The present study therefore aims to translate selected outcomes measures developed in American and European countries to measure the effectiveness of CBT for psychosis into Chinese and evaluate their psychometric properties. Thirty-three patients with residual psychotic symptoms were recruited in the Department of Psychiatry, Kowloon Hospital, Hong Kong. Participants were asked to complete a set of self-reported questionnaires twice with an interval of a week, including Beliefs About Voices Questionnaire-Revised (BAVQ-R), Beck Cognitive Insight Scale (BCIS) and Southampton Mindfulness Questionnaire (SMQ). The results found that the Chinese versions of BAVQ-R, BCIS and SMQ had excellent test-retest reliability with good to acceptable internal reliability. Generally, all three translated outcome measures were found to be stable and reliable, and were ready for evaluating the effectiveness of cognitive therapy for psychosis in the Chinese population. Further discussions on scoring and interpretations of the Chinese version of SMQ were made. Copyright © 2014 Elsevier B.V. All rights reserved.
Stain, Helen J; Brønnick, Kolbjørn; Hegelstad, Wenche T V; Joa, Inge; Johannessen, Jan O; Langeveld, Johannes; Mawn, Lauren; Larsen, Tor K
Social functioning is an important treatment outcome for psychosis, and yet, we know little about its relationship to trauma despite high rates of trauma in people with psychosis. Childhood trauma is likely to disrupt the acquisition of interpersonal relatedness skills including the desire for affiliation and thus lead to impaired social functioning in adulthood. We hypothesized that childhood trauma would be a predictor of poor social functioning for adults with psychosis and that further trauma in adulthood would moderate this relationship. A first-episode psychosis sample aged 15-65 years (N = 233) completed measures of social functioning (Lehman's Quality of Life Interview and Strauss Carpenter Functioning Scale) and trauma (Brief Betrayal Trauma Survey), as well as clinical assessments. Childhood trauma (any type) was associated with poorer premorbid functioning and was experienced by 61% of our sample. There were no associations with clinical symptoms. Interpersonal trauma in childhood was a significant predictor of social functioning satisfaction in adulthood, but this was not the case for interpersonal trauma in adulthood. However, 45% of adults who reported childhood interpersonal trauma also experienced adulthood interpersonal trauma. Our results emphasize the importance of early relationship experience such as interpersonal trauma, on the social functioning of adults with psychosis. We recommend extending our research by examining the impact of interpersonal childhood trauma on occupational functioning in psychosis. © The Author 2013. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Schifani, Christin; Hafizi, Sina; Da Silva, Tania; Watts, Jeremy Joseph; Khan, M Saad; Mizrahi, Romina
Schizophrenia is a chronic psychiatric disorder generally preceded by a so-called prodromal phase, which is characterized by attenuated psychotic symptoms. Advances in clinical research have enabled prospective identification of those individuals who are at clinical high risk (CHR) for psychosis, with the power to predict psychosis onset within the near future. Changes in several brain neurochemical systems and molecular mechanisms are implicated in the pathophysiology of schizophrenia and the psychosis spectrum, including the dopaminergic, γ-aminobutyric acid (GABA)-ergic, glutamatergic, endocannabinoid, and immunologic (i.e. glial activation) system and other promising future directions such as synaptic density, which are possible to quantify in vivo using positron emission tomography (PET). This paper aims to review in vivo PET studies in the mentioned systems in the early course of psychosis (i.e. CHR and first-episode psychosis (FEP)). The results of reviewed studies are promising; however, the current understanding of the underlying pathology of psychosis is still limited. Importantly, promising efforts involve the development of novel PET radiotracers targeting systems with growing interest in schizophrenia, like the nociceptive system and synaptic density.
Natália B Mota; Mauro Copelli; Sidarta Ribeiro
Diagnosis: Early signs of speech problems indicative of thought disorder Abnormal speech in someone showing early signs of psychosis can help doctors diagnose schizophrenia and its 'negative' symptoms...
Full Text Available There is little evidence on the accuracy of psychosis relapse prediction models. Our objective was to undertake a systematic review of relapse prediction models in psychosis.We conducted a literature search including studies that developed and/or validated psychosis relapse prediction models, with or without external model validation. Models had to target people with psychosis and predict relapse. The key databases searched were; Embase, Medline, Medline In-Process Citations & Daily Update, PsychINFO, BIOSIS Citation Index, CINAHL, and Science Citation Index, from inception to September 2016. Prediction modelling studies were assessed for risk of bias and applicability using the PROBAST tool.There were two eligible studies, which included 33,088 participants. One developed a model using prodromal symptoms and illness-related variables, which explained 14% of relapse variance but was at high risk of bias. The second developed a model using administrative data which was moderately discriminative (C = 0.631 and associated with relapse (OR 1.11 95% CI 1.10, 1.12 and achieved moderately discriminative capacity when validated (C = 0.630. The risk of bias was low.Due to a lack of high quality evidence it is not possible to make any specific recommendations about the predictors that should be included in a prognostic model for relapse. For instance, it is unclear whether prodromal symptoms are useful for predicting relapse. The use of routine data to develop prediction models may be a more promising approach, although we could not empirically compare the two included studies.
, hallucinatory behavior, and suspiciousness were present in one-fifth of bvFTD patients, whereas negative psychotic symptoms such as social and emotional withdrawal, blunted affect, and formal thought disorders were more frequently present. This suggests that negative psychotic symptoms and formal thought disorders have an important role in the psychiatric misdiagnosis in bvFTD; misdiagnosis in bvFTD might be reduced by systematically exploring the broad spectrum of psychiatric symptoms. Keywords: frontotemporal dementia, psychosis, schizophrenia, formal thought disorders
Morse, Megan; Procter, Nicholas
The aim of this paper is to examine high-level evidence in early intervention in psychosis and scope the potential role of the mental health nurse-practitioner in the treatment of management of early psychosis. Psychosis imposes complex symptoms that impact on the individual and their social network, often resulting in long-term disability. As specialised early intervention in psychosis is emerging, the nurse-practitioner role in mental health is also gaining momentum. The background literature highlights several critical synergies between nurse-practitioners' scope of practice and needs of patients with early psychosis. Literature review. Electronic databases including Cochrane Library, CINAHL, Medline, TRIP and EMBASE. Searching was limited to articles published between 1988-2009. Eligible studies were limited to systematic reviews and randomised controlled trials. Two systematic reviews and five randomised controlled trials met the inclusion criteria. No studies were located which specifically addressed the nurse-practitioner role in early psychosis. Specific interventions require further research but there is emerging evidence that specialised intervention for people in the early phase of psychotic illness is achievable and possibly essential. It is within the scope of practice of mental health nurse-practitioners to ensure patient and carer education and support, adherence to medication and other treatments, promotion of social inclusion and social connectedness. Mental health nurse-practitioners have the potential to provide specialist support to meet the needs of this complex group. Central to this is an ability to build an evidence-base around the treatment and management of people with early psychosis and deliver effective education and leadership across clinical, inter-professional and organisational domains. The paper concludes by positing a set of recommendations for nurse-practitioners in the field of early psychosis in the Australian mental health
López, Steven R; Lara, Ma del Carmen; Kopelowicz, Alex; Solano, Susana; Foncerrada, Hector; Aguilera, Adrian
The authors developed and tested a 35-min psychoeducational program with the goal of increasing Spanish-speaking persons' literacy of psychosis. The program uses popular cultural icons derived from music, art, and videos, as well as a mnemonic device--La CLAve (The Clue)--to increase (a) knowledge of psychosis, (b) efficacy beliefs that one can identify psychosis in others, (c) attributions to mental illness, and (d) professional help-seeking. Assessments were conducted before and after administering the program to both community residents (n = 57) and family caregivers of persons with schizophrenia (n = 38). For community residents, the authors observed increases across the 4 domains of symptom knowledge, efficacy beliefs, illness attributions, and recommended help-seeking. For caregivers, increases were observed in symptom knowledge and efficacy beliefs. La CLAve is a conceptually informed psychoeducational tool with a developing empirical base aimed at helping Spanish-speaking Latinos with serious mental illness obtain care in a timely manner.
Krabbendam, Lydia; Janssen, Ilse; Bak, Maarten; Bijl, Rob V; de Graaf, Ron; van Os, Jim
Low self-esteem and high neuroticism are common features in psychosis, but in the absence of longitudinal studies it is unclear whether they represent consequences of the illness or risk factors acting before illness onset. A population sample of 3,929 individuals with no lifetime evidence of psychosis were interviewed with the Composite International Diagnostic Interview and were administered the Groningen Neuroticism Scale and the Rosenberg Self-Esteem Scale at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify incident psychotic or psychosis-like symptoms. Baseline neuroticism and self-esteem predicted first-ever onset of psychotic symptoms at year 3 (neuroticism, OR 1.16, 95% CI 1.09, 1.23; self-esteem, OR 1.09, 95% CI 1.01, 1.18).When adjusted for each other and for level of anxiety and depression, neuroticism was the strongest independent predictor for onset of psychotic symptoms (OR 1.16, 95% CI 1.07, 1.26). Neuroticism increases the risk for development of psychotic symptoms. Mechanisms of risk may involve certain cognitive styles associated with neuroticism, such as beliefs about the uncontrollability of certain events and experiences. The association between low self-esteem and psychosis may involve the area of overlap between self-esteem and neuroticism.
Agüera-Ortiz, L; Reneses-Prieto, B
Late-onset forms of psychosis have been the object of increasing interest in recent years. Despite the fact that there are still many obscure areas, significant advances in the pathophysiology, delimitation of risk factors, clinical presentation, neuropsychology and the pharmacological treatment have been made. Nevertheless, the psychological aspects of both aetiology and treatment of these late forms of psychosis have received much less attention than the rest. In contrast with that, the clinician is confronted with the need to manage patients that are reluctant to take medications and in which the outcome of pharmacological treatments is not always optimal. The elderly psychotic patient should not be excluded from the possibility of receiving any kind of psychological help. He may benefit from adaptations of different psychotherapeutic measures that can include the more classical techniques as psychodynamic oriented and behavioural-cognitive therapies or the newer forms of treatment specially designed for the aged, as reminiscence or psychomotor therapy. In any case, to obtain any result the patient needs to be managed in a way that goes well further the prescription of a neuroleptic drug. In this paper we review some of the most important psychological cues for the understanding of the elderly psychotic patient. Furthermore, we divide the therapeutic relationship over the time in three parts: The initial contact, the central phase and the termination. We offer some keys for the practical management of the patient in each of these phases, with special attention to the adherence to treatment and early identification of treatment-emergent complications like depressive symptoms or hypochondriac concerns.
Risk factors of schizophrenia development in patients with amphetamines dependence and psychosis (amphetamine-induced psychosis and schizophrenia), and without psychosis [Czynniki ryzyka rozwoju schizofrenii u pacjentów uzależnionych od amfetaminy i jej pochodnych z psychozą (pointoksykacyjną lub schizofrenią) oraz bez psychozy
Rabe-Jabłońska, Jolanta; Mirek, Marta; Pawełczyk, Tomasz
Aim. Amphetamine and its derivates can induce, usually after many intoxications, schizophrenia-like psychosis. These disorders appeared only in part patients with amphetamine dependence. Aim of the study was to establish prevalence of selective risk factors of schizophrenia development in amphetamine users: 1) with amphetamine – induced schizophrenia – like psychosis, 2) with schizophrenia, and 2) without psychotic symptoms. Material. In the study 3 groups of subjects were included: 30 amphet...
Mamah, Daniel; Musau, Abednego; Mutiso, Victoria N; Owoso, Akinkunle; Abdallah, Arbi Ben; Cottler, Linda B; Striley, Catherine W; Walker, Elaine F; Ndetei, David M
The schizophrenia prodrome has not been extensively studied in Africa. Identification of prodromal behavioral symptoms holds promise for early intervention and prevention of disorder onset. Our goal was to investigate schizophrenia risk traits in Kenyan adolescents and identify predictors of psychosis progression. 135 high-risk (HR) and 142 low-risk (LR) adolescents were identified from among secondary school students in Machakos, Kenya, using the structured interview of psychosis-risk syndromes (SIPS) and the Washington early recognition center affectivity and psychosis (WERCAP) screen. Clinical characteristics were compared across groups, and participants followed longitudinally over 0-, 4-, 7-, 14- and 20-months. Potential predictors of psychosis conversion and severity change were studied using multiple regression analyses. More psychiatric comorbidities and increased psychosocial stress were observed in HR compared to LR participants. HR participants also had worse attention and better abstraction. The psychosis conversion rate was 3.8%, with only disorganized communication severity at baseline predicting conversion (p=0.007). Decreasing psychotic symptom severity over the study period was observed in both HR and LR participants. ADHD, bipolar disorder, and major depression diagnoses, as well as poor occupational functioning and avolition were factors relating to lesser improvement in psychosis severity. Our results indicate that psychopathology and disability occur at relatively high rates in Kenyan HR adolescents. Few psychosis conversions may reflect an inadequate time to conversion, warranting longer follow-up studies to clarify risk predictors. Identifying disorganized communication and other risk factors could be useful for developing preventive strategies for HR youth in Kenya. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.
Mackie, Belinda S.
Psychoanalysis can provide a conceptual foundation for the treatment of psychosis and for understanding how institutions that care for patients with psychosis function. The research of this thesis aims to examine theoretic, therapeutic and institutional approaches to psychosis. What is of significance is the priority that psychoanalysis places on the individual patient's treatment, how it is conceived psychoanalytically and incorporated in the overall organisation of an institution. Psychoan...
Full Text Available Subclinical hypothyroidism (SH is defined as an elevated thyroid stimulating hormone (TSH associated with normal levels of free thyroxine. In obese persons prevalence of SH is significantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyroxine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.
Januszek-Trzciąkowska, Aleksandra; Małecka-Tendera, Ewa
Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) associated with normal levels of free thyroxine. In obese persons prevalence of SH is significantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyroxine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.
The relationship between religious conversion, as a form of spiritual emergency, and psychosis is one of the fundamental issues at the meeting point of theology and clinical psychology. In the present study, we assessed 53 individuals referred to a psychiatry center with the initial diagnosis of a psychotic episode by focusing on the clinical diagnosis (psychosis vs. spiritual emergency), subjective experiences (basic symptoms), and neuropsychological functions. Twenty-nine individuals meet the diagnosis of schizophrenia-spectrum disorders, but 24 persons experienced only religious and spiritual problems (religious conversion). Both groups reported similar levels of perplexity (e.g., ambivalence, inability to discriminate between own feelings, and hyperreflectivity) and self-disorder (e.g., depersonalization, impression of a change in one's mirror image, and experience of discontinuity in own action). Diminished affectivity, disturbed contact, and perceptual/cognitive disorders were pronounced in psychosis, whereas anxiety and depressive symptoms were more severe in people with spiritual and religious problems. These results indicate that perplexity, self-disorder, and emotional turmoil are common features of turbulent religious conversion and psychosis, but a broader emergence of anomalous subjective experiences and cognitive deficits are detectable only in psychosis.
Madhusoodanan, Subramanian; Shah, Payal
Psychosis of Alzheimer’s disease (AD) is characterized by delusions or hallucinations and may be associated with agitation, negative symptoms or depression. There are no psychotropic medications that are approved by the US FDA for the treatment of psychosis of AD. However, atypical antipsychotics have been widely used and recommended by geriatric experts in the management of psychosis of AD in view of the modest efficacy and relative safety until FDA warnings were issued in 2005 and meta-analytic studies showed no significant difference to placebo. The FDA warnings on the cardiac, metabolic, cerebrovascular, and mortality risks have caused serious concerns for the use of atypical antipsychotic agents in elderly patients with dementia. Only a few studies have evaluated prospectively the effects of aripiprazole in psychosis associated with AD. These studies show improvement in the symptoms of psychosis associated with AD with aripiprazole. The safety and tolerability profile of aripiprazole suggests a low potential for negative impact on dementia and overall patient health. Further studies comparing the efficacy and tolerability of aripiprazole vs other atypical antipsychotics in dementia are needed. PMID:18982919
Michail, Maria; Birchwood, Max; Tait, Lynda
Social anxiety is highly prevalent among people with psychosis and linked with significant social disability and poorer prognosis. Although cognitive-behavioural therapy (CBT) has shown to be effective for the treatment of social anxiety in non-psychotic populations, there is a lack of evidence on the clinical effectiveness of CBT for the treatment of social anxiety when this is co-morbid in psychosis. A systematic review to summarise and critically appraise the literature on the effectiveness of CBT interventions for the treatment of social anxiety in psychosis. Two studies were included in the review assessing the effectiveness of group CBT for social anxiety in schizophrenia, both of poor methodological quality. Preliminary findings suggest that group-based CBT is effective in treating symptoms of social anxiety, depression and associated distress in people with schizophrenia. The evidence-base is not robust enough to provide clear implications for practice about the effectiveness of CBT for the treatment of social anxiety in psychosis. Future research should focus on methodologically rigorous randomised controlled trials with embedded process evaluation to assess the effectiveness of CBT interventions in targeting symptoms of social anxiety in psychosis and identify mechanisms of change.
Full Text Available Considering certain difficulties in subclinical hypercorticism diagnosis, the object of this work is to focus attention of doctors in different areas on the necessity of thorough examination of patients with pathological conditions that may be the manifestation of Cushing’s syndrome (arterial hypertension, obesity, impaired carbohydrate metabolism and osteoporosis. The laboratory diagnosis is the instrument for early subclinical hypercorticism detection.
Joa, I; Johannessen, Jan Olav; Langeveld, J
) and after (n = 189) 18 years on duration of untreated psychosis (DUP), level of symptoms, suicidal behaviour, and other baseline clinical and demographic characteristics. RESULTS: Adolescent onset patients had poorer premorbid functioning, a longer DUP, higher suicidality, and more depressive symptoms....... They also had better cognition, fewer psychotic symptoms, and were more likely to be treated on an out-patient basis. CONCLUSION: Adolescents with first-episode psychosis may have a slower and more silent, i.e. insidious onset, and are at risk of experiencing longer treatment delays than adults. They fit...
Brinkman, W.P.; Veling, W.; Dorrestijn, E.; Sandino, G.; Vakili, A.; Van der Gaag, M.
A virtual reality environment was created to study psychotic symptoms of patients that experience psychosis. In the environment people could navigate through a bar with a gamepad while wearing a head mounted display. Their task was to find five virtual characters that have a small label number on
Kraan, Tamar; van Dam, Daniella S.; Velthorst, Eva; de Ruigh, Esther L.; Nieman, Dorien H.; Durston, Sarah; Schothorst, Patricia; van der Gaag, Mark; de Haan, Lieuwe
Background: Although transition rates in 'ultra-high risk' (UHR) for psychosis samples are declining,many young individuals at UHR still experience attenuated positive symptoms and impaired functioning at follow-up. The present study examined the association between a history of childhood trauma and
Vermeiren, Yannick; Van Dam, Debby; Aerts, Tony; Engelborghs, Sebastiaan; Martin, Jean-Jacques; De Deyn, Peter P.
Introduction: Depression and psychosis are two of the most severe neuropsychiatric symptoms (NPS) in dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). Both NPS have negative effects on cognitive performance and life expectancy. The current study aimed to investigate and compare
Brodsky, Kimberly; Willcutt, Erik G.; Davalos, Deana B.; Ross, Randal G.
Background: Attention-deficit/hyperactivity disorder (ADHD) and childhood-onset psychosis (COP) are chronic, heterogeneous disorders with symptoms that frequently co-occur, but the etiology of their comorbidity is unknown. Studies of each disorder indicate that both ADHD and COP are associated with a range of neuropsychological weaknesses, but few…
Wüsten, Caroline; Lincoln, Tania M
For decades, researchers have attributed the better prognosis of psychosis in developing countries to a host of socio-cultural factors, including family functioning. Nevertheless, it is unknown whether family functioning and its association with symptoms differ across countries. This study assessed family functioning (support, satisfaction with family relations, and criticism) and psychosis proneness in community samples from Chile (n =399), Colombia (n=486), Indonesia (n=115), Germany (n=174) and the USA (n=143). Family functioning was compared between prototypical developing countries (Chile, Columbia, Indonesia) and highly industrialized countries (Germany, USA). Hierarchical regression analysis was used to test for the moderating effect of country on the associations between family functioning and psychosis proneness. Participants from developing countries perceived more support and felt more satisfied. However, they also perceived more criticism than participants from highly industrialized countries. Criticism and family satisfaction were significantly associated with psychosis proneness. Moreover, the relationship between criticism and psychosis proneness was significantly stronger in developing countries compared to highly industrialized countries. Generally, family satisfaction and criticism appear to be more relevant to psychosis proneness than the quantity of family support. Moreover, criticism seems to be more closely related to psychosis proneness in developing countries. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Pesa, Nicole; Hermens, Daniel F; Battisti, Robert A; Kaur, Manreena; Hickie, Ian B; Solowij, Nadia
Cannabis use is prevalent among the early psychosis (EP) population. The event-related potentials, mismatch negativity (MMN) and P3a are reduced in EP. Cannabinoids have been shown to modulate N-methyl-D-aspartate receptors which are involved in MMN generation. This study is the first to investigate the effects of cannabis use on MMN/P3a in EP. EP was defined as a history of psychosis or psychotic symptoms with no progression to date to chronic schizophrenia. Twenty-two EP patients with cannabis use (EP + CANN), 22 non-cannabis-using EP patients (EP-CANN) and 21 healthy controls participated in this study. MMN/P3a was elicited using a two-tone, auditory paradigm with 8% duration deviants. As expected, EP-CANN showed marked reductions in MMN/P3a amplitudes compared to controls. However, EP + CANN showed evidence of a different pattern of neurophysiological expression of MMN/P3a compared to non-using patients, most notably in terms of delayed frontal MMN/P3a latencies. This study provides further evidence that MMN/P3a deficits are present during early psychosis and suggests that this biomarker may have utility in differentiating substance- from non-substance-related psychoses.
Catli, Gonul; Abaci, Ayhan; Büyükgebiz, Atilla; Bober, Ece
Subclinical hypothyroidism (SH) is defined as a serum thyroid-stimulating hormone (TSH) level above the reference range with normal serum free thyroxin (sT4) and free triiodothyronine (sT3) levels. The prevalence of SH in children and adolescents is reported between 1.7% and 9.5%. Hashimoto's thyroiditis is the most prevalent cause of SH in children. Although it has been suggested that SH is entirely an asymptomatic laboratory diagnosis, typical hypothyroid symptoms as well have been reported in some patients. Results of the adult studies on SH revealed that SH had unfavorable effects on cardiovascular system (atherosclerosis); metabolic parameters (dyslipidemia, insulin resistance, etc.); neuromuscular system; and cognitive functions in the long term. The number of studies investigating the effect of childhood SH on growth, bone maturation, lipid parameters, carbohydrate metabolism, neuromuscular system, and cognitive and cardiac function is limited. Knowledge about the natural history of SH is unclear even though there are numerous studies upon this subject. In children and adults, treatment of SH with L-T₄ is still a matter of debate, and there is no consensus on this issue yet.
Sulaiman, Ahmad Hatim; Said, Mas Ayu; Habil, Mohd Hussain; Rashid, Rusdi; Siddiq, Amer; Guan, Ng Chong; Midin, Marhani; Nik Jaafar, Nik Ruzyanei; Sidi, Hatta; Das, Srijit
The objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied. This was a cross-sectional study conducted concurrently at a teaching hospital and a drug rehabilitation center in Malaysia. Patients with the diagnosis of methamphetamine based on DSM-IV were interviewed using the Mini International Neuropsychiatric Interview (M.I.N.I.) for methamphetamine-induced psychosis and other Axis I psychiatric disorders. The information on sociodemographic background and drug use history was obtained from interview or medical records. Of 292 subjects, 47.9% of the subjects had a past history of psychotic symptoms and 13.0% of the patients were having current psychotic symptoms. Co-morbid major depressive disorder (OR=7.18, 95 CI=2.612-19.708), bipolar disorder (OR=13.807, 95 CI=5.194-36.706), antisocial personality disorder (OR=12.619, 95 CI=6.702-23.759) and heavy methamphetamine uses were significantly associated with lifetime methamphetamine-induced psychosis after adjusted for other factors. Major depressive disorder (OR=2.870, CI=1.154-7.142) and antisocial personality disorder (OR=3.299, 95 CI=1.375-7.914) were the only factors associated with current psychosis. There was a high risk of psychosis in patients with methamphetamine dependence. It was associated with co-morbid affective disorder, antisocial personality, and heavy methamphetamine use. It is recommended that all cases of methamphetamine dependence should be screened for psychotic symptoms. Copyright © 2014 Elsevier Inc. All rights reserved.
Kesby, J P; Eyles, D W; McGrath, J J
The stagnation in drug development for schizophrenia highlights the need for better translation between basic and clinical research. Understanding the neurobiology of schizophrenia presents substantial challenges but a key feature continues to be the involvement of subcortical dopaminergic...... dysfunction in those with psychotic symptoms. Our contemporary knowledge regarding dopamine dysfunction has clarified where and when dopaminergic alterations may present in schizophrenia. For example, clinical studies have shown patients with schizophrenia show increased presynaptic dopamine function...... in the associative striatum, rather than the limbic striatum as previously presumed. Furthermore, subjects deemed at high risk of developing schizophrenia show similar presynaptic dopamine abnormalities in the associative striatum. Thus, our view of subcortical dopamine function in schizophrenia continues to evolve...
Papapietro, Daniel J; Barbo, Elizabeth
Much of the literature on filicide explores acute psychosis, sociopathy, or malignant narcissism (psychiatrically ill versus not psychiatrically ill) as primary explanations of why parents kill children. In this issue, Hatters Friedman et al. review the literature on acute psychiatric symptoms in an effort to identify key risk factors for filicide that might have predictive value. In this commentary, we assert the argument that filicide is a complex phenomenon that is the result of more than just psychosis or environmental stressors and that, because not all parents who become psychiatrically ill kill, there may be specific risk factors related to individual underlying psychodynamic conflicts.
tic serotonergic 5-HT2 and 5-HT3 antagonist.Tianeptine differs from. Correspondence: Prof L Sevincok email:email@example.com. ABSTRACT. Psychosis, in vulnerable individuals, may emerge on anti - depressant treatment. Treatment emergent psychosis is reported with two newer generation antidepressants.
Patients with refractory temporal lobe epilepsy who undergo unilateral anterior temporal lobectomy have been observed to develop a de novo psychosis with diminished seizures. This is thought to be an alternative psychosis related to forced normalisation of the EEG.8,12-14. The absence of clear diagnostic criteria for ...
depression and psychosis. If anticonvulsants have recently been changed, this should ... psychosis with thought disorder, delusions, hallucinations. • significant mood change, mania/hypomania or depression ... He denied smoking cannabis or taking any other illicit substance. There was a positive family history of epilepsy, ...
V. V. Chugunov
Full Text Available In recent years in the world there is a tendency of quantity of persons who use drugs increase. Free availability of drugs of different groups for population is the main cause. Another trend associated with the consumption of drugs. All these factors led to the increased frequency of psychosis occurrence among consumers of psychoactive substances. In structure of such psychosis there are a variety of symptoms and syndromes. And since the number of drug users is quite broad in its structure - there are also persons with mental illness. This gives number of diagnostic difficulties. In this regard, the aim of the study was to trace the modern ideas of differential diagnosis of schizophrenia-like psychosis disorders due to the drug use. Materials and methods of research. In this work the content analysis of the modern representations of differential diagnosis of schizophrenia-like psychosis disorders as a result of the use of psychoactive substances was made. The problem of determination of primary and secondary nature of drug addiction in patients with psychotic disorders was indicated. Etiology and psychopathogenesis hypotheses of the addiction from psychoactive substances in the context of their correlation with endogenous mental pathology were defined. In the literature there is no clear diagnostic criteria that would allow distinguishing psychosis due to the use of drugs and endogenous psychosis, which is combined with the admission medicines. However, the attention of clinicians should be concentrated on the premorbid condition: the presence of hereditary family history, pathological behavior in childhood and adolescence. It was found that the majority of substances may cause one or more syndromes - delirium, dementia, and amnestic syndrome, delusional syndrome, hallucinatory syndrome, depressive syndrome, anxiety, and personality disorder, such disorders as schizophrenia-like psychosis disorders are not rare. Special attention was paid to the
Madhusoodanan, Subramoniam; Shah, Payal; Brenner, Ronald; Gupta, Sanjay
Psychosis of Alzheimer's disease (PAD) forms part of the behavioural and psychological symptoms of dementia (BPSD). PAD includes symptoms of psychosis such as hallucinations or delusions, and may be associated with agitation, negative symptoms or depression. Even though the US FDA has not approved any medication for the treatment of PAD, atypical antipsychotics have been widely used and favoured by geriatric experts in the management of the condition in view of their modest efficacy and relative safety. However, the recent FDA warnings regarding the cardiac, metabolic, cerebrovascular and mortality risks associated with the use of these drugs in elderly patients with dementia have caused serious concerns regarding their use. Nevertheless, until an effective and safe medication is approved by the regulatory agencies for PAD, clinicians do not have a better choice than atypical antipsychotics for the management of the serious symptoms of this condition.
Chan, Sherry Kit Wa; Tam, Wendy Wan Yee; Lee, Kit Wai; Hui, Christy Lai Ming; Chang, Wing Chung; Lee, Edwin Ho Ming; Chen, Eric Yu Hai
Public stigma is an important barrier to the recovery of patients with psychosis. This study aimed to explore public stigma associated with a newly adopted Chinese name for psychosis 'si-jue-shi-tiao' in a representative Chinese population in Hong Kong, focusing on factors contributing to public stigma. Exposure to mass media and its relationship with the stigma were explored in detail. Random telephone survey of general population in Hong Kong was conducted. Information including basic demographics, psychosis literacy, recent news recall about psychosis and stigma, measured with the revised Link's Perceived Discrimination-Devaluation Scale (LPDDS) were obtained. Univariate analysis of LPDDS score and demographic variables, news exposure, previous contacts with people with psychosis and knowledge about psychosis were conducted. Further hierarchical regression analysis was performed. A total of 1,016 subjects were interviewed. The sample was comparable with the whole Hong Kong population aged 18 years and above. Those of female gender, with higher educational level and better knowledge about symptoms and treatment of psychosis had higher score of LPDDS. The model significantly explained 8.3% of variance of LPDDS score (F(7, 895) = 12.606, p trend significance in the model. The finding suggested that discrimination among the general public against people with psychosis was still common. Specific strategies will need to be established in targeting media news reporting about psychosis, knowledge disseminating and needs of specific population. Further researches should be conducted to understand the mechanisms of the stigma development in relation to these factors so that more focused and effective strategies could be developed. © The Author(s) 2015.
Edith J Liemburg
Full Text Available Psychotic disorders are among the most complex medical conditions. Longitudinal cohort studies may offer further insight into determinants of functional outcome after a psychotic episode. This paper describes the Psychosis Recent Onset in GRoningen Survey (PROGR-S that currently contains data on 1076 early-episode patients with psychosis, including symptoms, personality, cognition, life events and other outcome determinants. Our goal in this report is to give an overview of PROGR-S, as a point of reference for future publications on the effect of cognition, personality and psychosocial functioning on outcomes. PROGR-S contains an extensive, diagnostic battery including anamnesis, biography, socio-demographic characteristics, clinical status, drug use, neuropsychological assessment, personality questionnaires, and physical status tests. Extensive follow-up data is available on psychopathology, physical condition, medication use, and care consumption. Sample characteristics were determined and related to existing literature. PROGR-S (period 1997-2009, n = 718 included the majority of the expected referrals in the catchment area. The average age was 27 (SD = 8.6 and two-thirds were male. The average IQ was lower than that in the healthy control group. The majority had been diagnosed with a psychotic spectrum disorder. A substantial number of the patients had depressive symptoms (479/718, 78% and current cannabis or alcohol use (465/718, 75%. The level of community functioning was moderate, i.e. most patients were not in a relationship and were unemployed. The PROGR-S database contains a valuable cohort to study a range of aspects related to symptomatic and functional outcomes of recent onset psychosis, which may play a role in the treatment of this complex and disabling disorder. Results reported here show interesting starting points for future research. Thus, we aim to investigate long-term outcomes on the basis of cognition, personality, negative
Sherif, Mohamed; Radhakrishnan, Rajiv; D'Souza, Deepak Cyril; Ranganathan, Mohini
Some of the most compelling evidence supporting an association between cannabinoid agonists and psychosis comes from controlled laboratory studies in humans. Randomized, double-blind, placebo-controlled, crossover laboratory studies demonstrate that cannabinoid agonists, including phytocannabinoids and synthetic cannabinoids, produce a wide range of positive, negative, and cognitive symptoms and psychophysiologic deficits in healthy human subjects that resemble the phenomenology of schizophrenia. These effects are time locked to drug administration, are dose related, and are transient and rarely necessitate intervention. The magnitude of effects is similar to the effects of ketamine but qualitatively distinct from other psychotomimetic drugs, including ketamine, amphetamine, and salvinorin A. Cannabinoid agonists have also been shown to transiently exacerbate symptoms in individuals with schizophrenia in laboratory studies. Patients with schizophrenia are more vulnerable than healthy control subjects to the acute behavioral and cognitive effects of cannabinoid agonists and experience transient exacerbation of symptoms despite treatment with antipsychotic medications. Furthermore, laboratory studies have failed to demonstrate any "beneficial" effects of cannabinoid agonists in individuals with schizophrenia-challenging the cannabis self-medication hypothesis. Emerging evidence suggests that polymorphisms of several genes related to dopamine metabolism (e.g., COMT, DAT1, and AKT1) may moderate the effects of cannabinoid agonists in laboratory studies. Cannabinoid agonists induce dopamine release, although the magnitude of release does not appear to be commensurate to the magnitude and spectrum of their acute psychotomimetic effects. Interactions between the endocannabinoid, gamma-aminobutyric acid, and glutamate systems and their individual and interactive effects on neural oscillations provide a plausible mechanism underlying the psychotomimetic effects of
Full Text Available Background: The aim of this study was the independent psychosis risk factors assessment in a group of subjects fulfilling the criteria of at risk mental state, under specialist outpatient psychiatric care. Participants: Seventy-one patients – 33 women and 38 men, were involved into this study, aged on average 17.34, all under psychiatric care. The patients were recruited into the study in the sequence of their outpatient clinic admission. The criterion to be included into the study was the diagnosis of ultra-high risk state (UHRS – defined according to the Australian research group principles. Subsequently, the patients were divided into subgroups according to the clinical features of their mental state. Method: The author’s demographic questionnaire was applied in the study. Information regarding the family history of psychosis was obtained from patients and/or their relatives or carers. The patients’ mental state was assessed monthly – according to the presence of psychotic symptoms, change of their incidence and duration, presence of depressive symptoms or aggressive behaviour (measured by a three-level scale. On the basis of the obtained information, we evaluated: 1 conversion into psychosis time – measured from diagnosing of UHRS to the development of full-symptom psychosis, 2 therapeutic methods used (psychotherapy, pharmacotherapy or both, 3 use of psychoactive substances after being diagnosed with UHRS, 4 presence of serious life stressors (the patients’ subjective estimation – during the six-month period preceding the conversion into psychosis. Results: 1 In the UHRS group of patients, staying under professional outpatient psychiatric care, the use of marijuana was an independent risk factor of conversion into psychosis. 2 In the investigated group of patients with at risk mental state we did not find any correlation between modulating factors (including: therapeutic methods used, depressive symptoms, aggression or
Blum, Manuel R; Bauer, Douglas C; Collet, Tinh-Hai
IMPORTANCE: Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE: To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION: The databases of MEDLINE...... and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION: Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan....... Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH
van der Zanden, Moniek; Hop-de Groot, Rianne J; Sweep, Fred C G J; Ross, H Alec; den Heijer, Martin; Spaanderman, Marc E A
Women with a history of vascular complicated pregnancy are at risk for developing remote cardiovascular disease. It is associated with underlying cardiovascular risk factors both jeopardizing trophoblast and vascular function. Subclinical hypothyroidism may relate to both conditions. In 372 women with a history of vascular complicated pregnancy, we assessed thyroid function. Subclinical hypothyroidism was diagnosed in 73/372 women (19.6%). It occurred more often when pregnancy ended before 32 weeks of gestation (p = 0.008). In this cohort, subclinical hypothyroidism is more common after very preterm delivery. It may contribute to the elevated risk of remote cardiovascular disease.
Full Text Available We report a case of a 61-year-old woman who presented with acute psychosis as a major manifestation of Legionnaires’ disease in the absence of other neuropsychiatric symptoms. Clinical history revealed dry cough and nausea. Observation showed fever and auscultation crackles in the lower lobe of the right lung. Laboratory testing demonstrated elevated C-reactive protein and lung chest radiograph showed patchy peribronchial and right lower lobe consolidation. Soon after admission, she started producing purulent sputum. Epidemiological data suggested Legionella pneumophila as possible cause of the clinical picture that was confirmed by urinary antigen detection and polymerase chain reaction of the sputum. She was treated with levofloxacin 750 mg/day for 10 days with complete remission of pulmonary and psychiatric symptoms. She has not had further psychotic symptoms.
We present four cases of confirmed anti-NMDA receptor encephalitis; three presented initially with serious psychiatric symptoms and the other developed significant psychiatric symptoms during the initial phase of illness. Brain biopsy findings of one patient are also described. Psychiatrists should consider anti-NMDA receptor encephalitis in patients presenting with psychosis and additional features of dyskinesias, seizures and catatonia, particularly where there is no previous history of psychiatric disorder.
Horikawa, Hideki; Monji, Akira; Sasaki, Masayuki; Maekawa, Toshihiko; Onitsuka, Toshiaki; Nitazaka, Yoko; Hirano, Yoji; Hirano, Shougo; Hashioka, Sadayuki; Kato, Takahiro; Yoshida, Ichiro; Kanba, Shigenobu
We herein report a case of Capgras' syndrome observed in interictal psychosis in which the single-photon emission computed tomography (SPECT) findings before and after the appearance of the psychotic symptoms differed. SPECT with 99mTc-hexamethyl propyleneamine oxine (HMPAO) revealed worsening of hypoperfusion in the entire right hemisphere after onset of the psychotic symptoms. The enhanced hypoperfusion demonstrated by SPECT in the present case seems to indicate a right interhemispheric disconnection resulting in the occurrence of Capgras' syndrome.
Ian, Kelleher; Jenner, Jack A; Cannon, Mary
Our ideas about the intrinsically pathological nature of hallucinations and delusions are being challenged by findings from epidemiology, neuroimaging and clinical research. Population-based studies using both self-report and interview surveys show that the prevalence of psychotic symptoms is far greater than had been previously considered, prompting us to re-evaluate these psychotic symptoms and their meaning in an evolutionary context. This non-clinical phenotype may hold the key to understanding the persistence of psychosis in the population. From a neuroscientific point of view, detailed investigation of the non-clinical psychosis phenotype should provide novel leads for research into the aetiology, nosology and treatment of psychosis.
Hernandez, Maria Y; Mejia, Yesenia; Mayer, Doe; Lopez, Steven R
Narrative communication is effective in increasing public awareness while generating dialogue about varied health topics. The current study utilized narrative communication in the form of a 15-minute motivational film titled La CLAve to help Latinos recognize symptoms of psychosis and begin a discussion about serious mental illness. The study aimed to explore the participants' response to the film and whether the film led to further dialogue about psychosis. Four focus groups were conducted with 40 Spanish-speaking participants, mostly foreign-born Latinas, with a mean age of 49 years. Results indicate that participants engaged with the film as reflected in their ability to recall the storyline in detail. Reports of psychosis knowledge gains included recognition of key symptoms, such as hallucinations and disorganized speech. Participants attributed symptoms of psychosis, observed in a film character, to social stressors and other previously constructed views of mental illness. Many participants discussed the content of the film within their immediate social networks. Other findings include discussions of key barriers and facilitators to seeking mental health treatment among Latino families, such as denial and family support. Results suggest that narrative films offer a promising strategy to stimulate dialogue about serious mental illness among Latinos.
Melle, Ingrid; Larsen, Tor K; Haahr, Ulrik
The duration of untreated psychosis (DUP)-the time from onset of psychotic symptoms to the start of adequate treatment--is consistently correlated with better course and outcome, but the mechanisms are poorly understood.......The duration of untreated psychosis (DUP)-the time from onset of psychotic symptoms to the start of adequate treatment--is consistently correlated with better course and outcome, but the mechanisms are poorly understood....
Health psychology researchers have begun to focus greater attention on people's beliefs about health/illness since these beliefs can clearly affect behavior. This cross-sectional study aimed at (1) identifying the most common factors psychotic patients attribute their illness to and (2) assessing the association between causal attribution and illness perception (cognitive, emotional, and comprehensibility dimensions). Sixty-two patients (56.5% females) who had been treated for psychosis at a public psychiatric hospital in Mexico answered the Angermeyer and Klusmann Illness Attribution Scale and the Brief Illness Perception Questionnaire. Results showed that most patients attributed psychosis onset to social factors and that attribution to their personality might have an overwhelmingly negative effect on their lives. Acknowledging psychotic patient attributional beliefs and considering them in clinical practice could improve treatment efficacy and overall recovery success. This is particularly important in psychosis, since symptoms are often severe and/or persistent and require long-term treatment.
Yolken, R H; Torrey, E F
The infectious theory of psychosis, prominent early in the twentieth century, has recently received renewed scientific support. Evidence has accumulated that schizophrenia and bipolar disorder are complex diseases in which many predisposing genes interact with one or more environmental agents to cause symptoms. The protozoan Toxoplasma gondii and cytomegalovirus are discussed as examples of infectious agents that have been linked to schizophrenia and in which genes and infectious agents interact. Such infections may occur early in life and are thus consistent with neurodevelopmental as well as genetic theories of psychosis. The outstanding questions regarding infectious theories concern timing and causality. Attempts are underway to address the former by examining sera of individuals prior to the onset of illness and to address the latter by using antiinfective medications to treat individuals with psychosis. The identification of infectious agents associated with the etiopathogenesis of schizophrenia might lead to new methods for the diagnosis, treatment and prevention of this disorder.
Osman, Helen; Jorm, Anthony F; Killackey, Eoin; Francey, Shona; Mulcahy, Dianne
The aim of this study was to identify the core competencies required of mental health professionals working in the early psychosis field, which could function as an evidence-based tool to support the early psychosis workforce and in turn assist early psychosis service implementation and strengthen early psychosis model fidelity. The Delphi method was used to establish expert consensus on the core competencies. In the first stage, a systematic literature search was conducted to generate competency items. In the second stage, a panel consisting of expert early psychosis clinicians from around the world was formed. Panel members then rated each of the competency items on how essential they are to the clinical practice of all early psychosis clinicians. In total, 1023 pieces of literature including textbooks, journal articles and grey literature were reviewed. A final 542 competency items were identified for inclusion in the questionnaire. A total of 63 early psychosis experts participated in 3 rating rounds. Of the 542 competency items, 242 were endorsed as the required core competencies. There were 29 competency items that were endorsed by 62 or more experts, and these may be considered the foundational competencies for early psychosis practice. The study generated a set of core competencies that provide a common language for early psychosis clinicians across professional disciplines and country of practice, and potentially are a useful professional resource to support early psychosis workforce development and service reform. © 2017 John Wiley & Sons Australia, Ltd.
Birnbaum, Michael L; Cleary, Sean D; Ramsay Wan, Claire; Pauselli, Luca; Compton, Michael T
The Cannabis Experiences Questionnaire (CEQ) was developed to measure the subjective experiences of cannabis use both during and after intoxication. Despite the need to better understand the nature of the complex and significant relationship between cannabis use and early psychosis, this questionnaire has rarely been used in individuals with first-episode psychosis. We conducted a set of factor analyses using CEQ data from 194 first-episode psychosis patients who used cannabis in order to uncover the underlying factor structure of the questionnaire and thus the overarching types of psychological experiences during/after using cannabis in young people with psychotic disorders. Our exploratory factor analysis identified 4 subscales, including: Distortions of Reality and Self-Perception (Factor 1), Euphoria Effects (Factor 2), Slowing and Amotivational Effects (Factor 3), and Anxiety and Paranoia Effects (Factor 4). Elucidating the underlying factor structure of the CEQ in first-episode psychosis samples could help researchers move towards a deeper understanding of the types of experiences associated with cannabis intoxication among young adults with first-episode psychosis and could inform the development of programs designed to reduce use, improve the course of illness, and possibly delay or prevent the onset of psychotic symptoms in those at risk. © 2017 John Wiley & Sons Australia, Ltd.
Full Text Available Hallucinations are a core diagnostic criterion for psychotic disorders and have been investigated with regard to its association with childhood trauma in first-episode psychosis samples. Research has largely focused on auditory hallucinations, while specific investigations of visual hallucinations in first-episode psychosis remain scarce.The aims of this study were to describe the prevalence of visual hallucinations, and to explore the association between visual hallucination and childhood trauma in a first-episode psychosis sample.Subjects were included from TIPS-2, a first episode psychosis study in south Rogaland, Norway. Based on the medical journal descriptions of the Positive and Negative Symptoms Scale (PANSS, a separate score for visual and auditory hallucinations was created (N = 204. Patients were grouped according to hallucination severity (none, mild, and psychotic hallucinations and multinomial logistic regression was performed to identify factors associated with visual hallucination group.Visual hallucinations of a psychotic nature were reported by 26.5% of patients. The experience of childhood interpersonal trauma increased the likelihood of having psychotic visual hallucinations.Visual hallucinations are common in first-episode psychosis, and are related to childhood interpersonal trauma.
Attard, Angelica; Larkin, Michael
Art therapy enables individuals to use art to creatively express themselves and communicate differently with themselves, others, and their reality. The National Institute for Health and Clinical Excellence guidelines for psychosis and schizophrenia suggest that arts therapies, which include art therapy, are considered to improve negative symptoms of psychosis. We examined the effectiveness of art therapy for people with psychosis and explored whether art therapy is a meaningful and acceptable intervention in this Review. Seven electronic databases were searched for empirical papers that concerned the use of art therapy for adults with psychosis that were published from 2007 onwards. The search identified 18 papers. High-quality quantitative articles provided inconclusive evidence for the effectiveness of art therapy in adults with psychosis. However, high-quality qualitative articles indicated that therapists and clients considered art therapy to be a beneficial, meaningful, and acceptable intervention, although this conclusion was based on a small number of studies. In this Review, we discuss the theoretical, clinical, and methodological issues in light of the development of more robust research, which is needed to corroborate individuals' experiences and guide evidence-based practice. Copyright © 2016 Elsevier Ltd. All rights reserved.
Collip, Dina; Myin-Germeys, Inez; Wichers, Marieke; Jacobs, Nele; Derom, Catherine; Thiery, Evert; Lataster, Tineke; Simons, Claudia; Delespaul, Philippe; Marcelis, Machteld; van Os, Jim; van Winkel, Ruud
FK506 binding protein 5 (FKBP5) has repeatedly been shown to be a critical determinant of post-traumatic stress disorder (PTSD) and depression following childhood trauma. To examine the role of FKBP5-trauma interactions in the partly stress-related psychosis phenotype. In 401 general population twins, four functional polymorphisms were examined in models of psychosis and cortisol, and followed up in models of psychosis in three samples at different familial liability (175 controls, 200 unaffected siblings and 195 patients with a psychotic disorder). The most consistent finding was an interaction between childhood trauma and rs9296158/rs4713916 on psychotic symptoms and cortisol in the twin sample, combined with a directionally similar interaction in siblings (rs4713916) and patients (rs9296158), A-allele carriers at both polymorphisms being most vulnerable to trauma. Trauma may increase the risk of psychosis through enduring changes in the cortisol feedback loop, similar to that for PTSD, suggesting comparable biological mechanisms for psychosis across diagnostic boundaries.
Bechdolf, A; Wagner, M; Ruhrmann, S; Harrigan, S; Putzfeld, V; Pukrop, R; Brockhaus-Dumke, A; Berning, J; Janssen, B; Decker, P; Bottlender, R; Maurer, K; Möller, H-J; Gaebel, W; Häfner, H; Maier, W; Klosterkötter, J
Young people with self-experienced cognitive thought and perception deficits (basic symptoms) may present with an early initial prodromal state (EIPS) of psychosis in which most of the disability and neurobiological deficits of schizophrenia have not yet occurred. To investigate the effects of an integrated psychological intervention (IPI), combining individual cognitive-behavioural therapy, group skills training, cognitive remediation and multifamily psychoeducation, on the prevention of psychosis in the EIPS. A randomised controlled, multicentre, parallel group trial of 12 months of IPI v. supportive counselling (trial registration number: NCT00204087). Primary outcome was progression to psychosis at 12- and 24-month follow-up. A total of 128 help-seeking out-patients in an EIPS were randomised. Integrated psychological intervention was superior to supportive counselling in preventing progression to psychosis at 12-month follow-up (3.2% v. 16.9%; P = 0.008) and at 24-month follow-up (6.3% v. 20.0%; P = 0.019). Integrated psychological intervention appears effective in delaying the onset of psychosis over a 24-month time period in people in an EIPS.
Purdon, Scot E; Purser, Stacey M; Goddard, Kim M
MMPI-2-RF over-reporting scales for physical, cognitive, or psychological symptoms were examined in 130 consecutive referrals to a first-episode psychosis (FEP) clinic. Although acutely ill upon presentation, consistent and responsive profiles were obtained in 79% of the sample. There was no indication of under-reporting on defensive scales, and anticipated elevations were observed on clinical scales sensitive to thought disorder, ideas of persecution, and aberrant experiences. The Infrequent Somatic (Fs), Symptom Validity Scale (FBS-r), and Response Bias (RBS) scales did not indicate somatic or cognitive over-reporting, but the Infrequent Psychopathology Scale (Fp-r) showed a moderate elevation that may suggest a propensity for over-reporting or an effect of clinical symptoms on the over-reporting scale. Clinician ratings of positive symptoms of psychosis were related to the Fp-r. Although the over-reporting classifications with the RBS were relatively low, RBS scores were directly related to positive and general symptoms of psychosis. The MMPI-2-RF appears to have clinical value in an acutely ill FEP sample. The sample was not prone to over-reporting pathology, but associations between both the Fp-r and the RBS with clinical symptoms will warrant further investigation.
Taha Ghada RA
Full Text Available Abstract Background There were few studies on the outcome of schizophrenia in developing countries. Whether the outcome is similar to or different from developed world is still a point for research. The main aim of the current study was to know if patients with early onset non affective psychosis can behave and function properly after few years from start of the illness or not. Other aims included investigation of possible predictors and associated factors with remission and outcome. Method The study prospectively investigated a group of 56 patients with onset of psychosis during childhood or adolescence. Diagnosis made according to DSM-IV criteria and included; schizophrenia, psychotic disorder not otherwise specified and acute psychosis. Severity of psychosis was measured by PANSS. Measures of the outcome included; remission criteria of Andreasen et al 2005, the children's global assessment scale and educational level. Results Analysis of data was done for only 37 patients. Thirty patients diagnosed as schizophrenia and 7 with Psychotic disorder not otherwise specified. Mean duration of follow up was 38.4 +/- 16.9 months. At the end of the study, 6 patients (16.2% had one episode, 23(62.1% had multiple episodes and 8 (21.6% continuous course. Nineteen patients (51.4% achieved full remission, and only 11(29.7% achieved their average educational level for their age. Twenty seven percent of the sample had good outcome and 24.3% had poor outcome. Factors associated with non remission and poor outcome included gradual onset, low IQ, poor premorbid adjustment, negative symptoms at onset of the illness and poor adherence to drugs. Moreover, there was tendency of negative symptoms at illness start to predict poor outcome. Conclusion Some patients with early onset non affective psychosis can behave and function properly after few years from the start of the illness. Although remission is a difficult target in childhood psychosis, it is still achievable.
Welsh, Patrick; Tiffin, Paul A
There is a long-standing interest in the relationship between patients affected by psychosis and their families. Previous research also suggests that perceived family dysfunction is a factor commonly associated with psychological problems in adolescence. The current study examined the role of self-reported family perceptions in the context of adolescents with an At-Risk Mental State (ARMS) for psychosis. Family perceptions were obtained using the Family Perceptions Scale (FPS) and compared across three groups; an ARMS for psychosis group (n = 44), a first-episode affective/non-affective psychosis group (n = 26) and a control group (n = 140) drawn from a community population. Scores on the FPS Expressed Emotion subscale were significantly higher in the psychosis and ARMS groups, compared to controls (P = 0.039 and P = 0.041, respectively). In contrast, participants in the ARMS group reported poorer perceived problem solving and lower levels of nurturing behaviour in their families compared to controls (P = 0.032 and P = 0.027). Overall, family perceptions were not related to symptom severity in both the ARMS and psychosis groups (except for manic symptomatology and Expressed Emotion). These findings highlight that ARMS patients are likely to report higher levels of perceived family dysfunction compared to a community sample of young people. However, the mechanisms by which family perceptions may contribute to the development of distressing psychotic symptoms remain unclear and require further study. Family work, with a focus upon improving perceived expressed emotion, nurturing behaviours and hostility may at this stage represent a feasible adjunct therapy for those with ARMS. © 2013 Wiley Publishing Asia Pty Ltd.
Ngiralmau, Hilda; Blailes, Francisca; Myles-Worsley, Marina; Ord, Lisa M
We have studied a total of 393 adolescents 14 to 19 years from Palau, where the lifetime morbid risk for broadly defined schizophrenia is 2.67% and cases cluster in large extended families. These Palauan adolescents included 52 offspring of a schizophrenic parent designated as "Genetically Highest Risk" or GHR+ and 61 nieces/nephews of affected sib-pairs/trios, designated "Genetically High Risk" or GHR. The remaining 280 subjects were recruited based on the results of a survey of Palauan high school students that was designed to screen for clinically HR and normal control adolescents with no close affected relatives. Among the selected high school students were 60 adolescents with one affected second or third degree relative who were designated as "Genetically Moderate Risk" (GMR). The remaining 220 subjects with no close affected relatives were designated as "Genetically Low Risk" (GLR). Based on a comprehensive clinical assessment using the K-SADS, we identified a total of 230 Palauan adolescents with early psychosis, 48 or 21% of whom had already transitioned to a DSM-IV psychotic disorder, predominantly schizophrenia. Together, the two highest genetic risk groups contributed 35% of the adolescent-onset DSM-IV psychosis cases and 26% of the prodromals. More than half of the early psychosis cases (55%) had no close affected relatives, indicating that genetic liability provides only a partial explanation of elevated risk. Our results support the value of screening for early psychosis in the high schools, conducting a full-scale clinical assessment to identify adolescents with early "prodromal" symptoms, and initiating a family-based intervention program designed to delay or even prevent the onset of florid psychosis. This intervention program comprises regular symptom reassessments so that referrals for treatment can be made as needed plus family psycho-education designed to engage the family in a program of care and support for the early psychosis patient.
Jyh-Gong Gabriel Hou
Full Text Available In addition to the typical motor symptoms (resting tremor, cogwheel rigidity, bradykinesia, postural instability of Parkinson's disease (PD, non-motor symptoms are sources of considerable burden in people with PD, espe-cially in elderly patients. The usual non-motor symptoms include cognitive declines, psychiatric disturbances (depression, psychosis, impulse control, autonomic failures (gastrointestinal, cardiovascular, urinary, sexual ability, thermoregulation, sleep difficulties, and pain syndrome. This review article discusses the characteristics, pathophysiology, epidemiology, and management of these symptoms.
Zanden, M. van der; Hop-de Groot, R.J.; Sweep, F.C.; Ross, H.A.; Heijer, M. den; Spaanderman, M.E.A.
OBJECTIVE: Women with a history of vascular complicated pregnancy are at risk for developing remote cardiovascular disease. It is associated with underlying cardiovascular risk factors both jeopardizing trophoblast and vascular function. Subclinical hypothyroidism may relate to both conditions.
Lewandowski, Kathryn E; Baker, Justin T; McCarthy, Julie M; Norris, Lesley A; Öngür, Dost
Cognitive dysfunction is a core symptom dimension that cuts across the psychoses. Recent findings support classification of patients along the cognitive dimension using cluster analysis; however, data-derived groupings may be highly determined by sampling characteristics and the measures used to derive the clusters, and so their interpretability must be established. We examined cognitive clusters in a cross-diagnostic sample of patients with psychosis and associations with clinical and functional outcomes. We then compared our findings to a previous report of cognitive clusters in a separate sample using a different cognitive battery. Participants with affective or non-affective psychosis (n=120) and healthy controls (n=31) were administered the MATRICS Consensus Cognitive Battery, and clinical and community functioning assessments. Cluster analyses were performed on cognitive variables, and clusters were compared on demographic, cognitive, and clinical measures. Results were compared to findings from our previous report. A four-cluster solution provided a good fit to the data; profiles included a neuropsychologically normal cluster, a globally impaired cluster, and two clusters of mixed profiles. Cognitive burden was associated with symptom severity and poorer community functioning. The patterns of cognitive performance by cluster were highly consistent with our previous findings. We found evidence of four cognitive subgroups of patients with psychosis, with cognitive profiles that map closely to those produced in our previous work. Clusters were associated with clinical and community variables and a measure of premorbid functioning, suggesting that they reflect meaningful groupings: replicable, and related to clinical presentation and functional outcomes. (JINS, 2017, 23, 1-9).
Bertani, M; Lasalvia, A; Bonetto, C; Tosato, S; Cristofalo, D; Bissoli, S; De Santi, K; Mazzoncini, R; Lazzarotto, L; Santi, M; Sale, A; Scalabrin, D; Abate, M; Tansella, M; Rugger, M
BACKGROUND. This paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females(by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis. METHOD. A large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework – a multi-site research project examining incident cases of psychosis in Italy's Veneto region. RESULTS. Despite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal care givers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.CONCLUSIONS. These findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.
Full Text Available BACKGROUND: Most studies aiming to predict transition to psychosis for individuals at ultra-high risk (UHR have focused on either neurocognitive or clinical variables and have made little effort to combine the two. Furthermore, most have focused on a dichotomous measure of transition to psychosis rather than a continuous measure of functional outcome. We aimed to investigate the relative value of neurocognitive and clinical variables for predicting both transition to psychosis and functional outcome. METHODS: Forty-three UHR individuals and 47 controls completed an extensive clinical and neurocognitive assessment at baseline and participated in long-term follow-up approximately six years later. UHR adolescents who had converted to psychosis (UHR-P; n = 10 were compared to individuals who had not (UHR-NP; n = 33 and controls on clinical and neurocognitive variables. Regression analyses were performed to determine which baseline measures best predicted transition to psychosis and long-term functional outcome for UHR individuals. RESULTS: Low IQ was the single neurocognitive parameter that discriminated UHR-P individuals from UHR-NP individuals and controls. The severity of attenuated positive symptoms was the only significant predictor of a transition to psychosis and disorganized symptoms were highly predictive of functional outcome. CONCLUSIONS: Clinical measures are currently the most important vulnerability markers for long-term outcome in adolescents at imminent risk of psychosis.
Schwarz, Karine; Fontanari, Anna Martha Vaitses; Mueller, Andressa; Soll, Bianca; da Silva, Dhiordan Cardoso; Salvador, Jaqueline; Zucker, Kenneth J; Schneider, Maiko Abel; Lobato, Maria Inês Rodrigues
Gender dysphoria (GD) (DSM-5) or transsexualism (ICD-10) refers to the marked incongruity between the experience of one's gender and the sex at birth. In this case report, we describe the use of LSD as a triggering factor of confusion in the gender identity of a 39-year-old male patient, with symptoms of psychosis and 25 years of substance abuse, who sought psychiatric care with the desire to undergo sex reassignment surgery. The symptoms of GD/psychosis were resolved by two therapeutic measures: withdrawal of psychoactive substances and use of a low-dose antipsychotic. We discuss the hypothesis that the superior parietal cortical area may be an important locus for body image and that symptoms of GD may be related to variations underlying this brain region. Finally, this case report shows that some presentations of GD can be created by life experience in individuals who have underlying mental or, synonymously, neurophysiological abnormalities.
MacDougall, Arlene G; Vandermeer, Matthew R J; Norman, Ross M G
Self-esteem plays a role in the formation and maintenance of symptoms and in the recovery from psychotic illness. This study examines the relative contribution of perceived social dominance and other known predictors in determining self-esteem in 102 individuals in an early intervention program for psychosis. Regression analysis demonstrated that scores on the Perceived Relational Evaluation Scale (PRES), depressed mood, social dominance, gender and positive symptoms significantly contributed to the prediction of scores on the Rosenberg Self-esteem Scale (RSES), whereas self-stigma and negative symptoms did not. Our study suggests that low self-esteem in early psychosis can be understood in part as a reflection of low levels of perceived social value and status. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.
Elkhazen, C; Chauchot, F; Canceil, O; Krebs, M-O; Baylé, F-J
The concept of prodromal symptoms of schizophrenia has frequently been subject to debate. Authors widely admit the existence of early specific and non-specific signs preceding the first psychotic episode; however, they have yet to clearly demonstrate their ability to predict and specify the outbreak of a psychosis. These prodromal symptoms consist of behavioral abnormalities, pseudo-neurotic signs, subtle cognitive and affective changes. All these symptoms vary from patient to patient. In general, it is widely believed that future patients go through a variety of abnormal, subjective experiences that progressively develop during their pre-puberty and puberty periods. However, the limit of this assessment is that an individual could present the same prodromal symptoms without necessarily developing a psychotic illness, as a result of toxic intake, a situational crisis, etc. Furthermore, while the prodrome is a retrospective concept, its value and specificity can only be prospective, given that patients' descriptions of pre-morbid changes may be corrupted by inefficient memory reconstruction. DSM III-R included prodromal symptoms; individual presenting such symptoms would potentially present psychopathological vulnerability to psychosis regardless of associated genetic risk. Several investigations have shed doubts on their measurement's reliability; therefore, this classification is no longer present in the latest version (DSM IV). Moreover, recent neurodevelopemental hypothesis on schizophrenia have paved the way for possible early intervention, especially because early treatments could well improve illness prognosis. This viewpoint is reinforced by the improved tolerance of new anti-psychotic treatment. In this report, we review the key Articles published over the last 15 Years on this matter. We distinguish two schools of thought: on one hand, the German school referring to the validity of particular neuro-psychological symptoms: attention, perception
J P Sytch
Full Text Available Objectives of this retrospective study were to evaluate the natural course of subclinical hypothyroidism (SH and to estimate possible predictable factors of overt hypothyroidism. Population of the study was selected from the patients with spontaneously elevated thyrotropin (TSH and normal free thyroxin (fT4 levels. Overall 87 patients (12 male, 75 female with SH without any therapy with thyroid hormones or iodide drugs or without previous thyroid surgery, thyrostatic therapy, or radioactive iodine therapy were included in the analysis. Results: the main risk factors of overt hypothyroidism in this population were positive thyroid antibodies (odds ratio = 3.99 and high initial level of TSH (>8 mU/l (odds ratio = 4.77. Patient’s age, gender or duration of SH did not affect significantly the risk of overt hypothyroidism. Conclusions: rational substitutive therapy with thyroid hormones was not discussed in this study, however the data suggest that positive thyroid antibodies and relatively high TSH level may be useful to decide upon such therapy in individuals with SH. Key words: hypothyroidism, Hashimotos, thyroiditis, thyrotropin.
There is good evidence that psychotic symptoms segregate into symptom dimensions. However, it is still unclear how these dimensions are associated with risk indicators and other clinical variables, and whether they have advantages over categorical diagnosis in clinical practice. We investigated symptom dimensions in a first-onset psychosis sample and examined their associations with risk indicators and clinical variables. We then examined the relationship of categorical diagnoses to the same variables.
Sündermann, Oliver; Onwumere, Juliana; Kane, Fergus; Morgan, Craig; Kuipers, Elizabeth
To investigate social support and network features in people with first-episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia. Thirty-eight people with first-episode psychosis were recruited for a cross-sectional study. Self-report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted. One-third of the sample (34%) had no confidant [95% CI (18.4, 50.0%)]. The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (0.35 loneliness and paranoia was mediated through anxiety (ab = 0.43, z = 3.5; p Anxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated.
Sündermann, Oliver; Onwumere, Juliana; Kane, Fergus; Morgan, Craig; Kuipers, Elizabeth
PURPOSE To investigate social support and network features in people with first episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia. METHOD Thirty eight people with first-episode psychosis were recruited for a cross-sectional study. Self report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted. RESULTS One third of the sample (34%) had no confidant (95% CI 18.4%, 50.0%). The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (.35loneliness and paranoia was mediated through anxiety (ab=.43, z=3.5; pAnxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated. PMID:23955376
Samudra, Niyatee; Patel, Neepa; Womack, Kyle B; Khemani, Pravin; Chitnis, Shilpa
Parkinson disease psychosis (PDP) is a common phenomenon in Parkinson disease (PD) patients treated with dopaminergic drugs, and is associated with high morbidity and mortality. It also correlates with depression and dementia, and can contribute to considerable caregiver stress and burnout. While symptoms can be relieved by decreasing doses or number of anti-PD medications, this may lead to an unacceptable worsening of motor function. When general medical or psychiatric conditions have been ruled out, and decreasing dopaminergic agents is not effective in treating psychosis, therapies include atypical antipsychotics, primarily clozapine and quetiapine. Of these, clozapine is effective but is associated with a poor side-effect profile and the necessity for frequent blood draws. Clinicians prefer quetiapine for its theoretically better safety profile, although there is no evidence for efficacy in treating psychosis. All atypical antipsychotics are associated with increased mortality in this patient population. Cholinesterase inhibitors can ameliorate psychosis symptoms. The serotonin 5-HT2A receptor inverse agonist pimavanserin was recently approved by the US FDA for the treatment of PDP and may prove to be a more targeted therapy without the downsides of atypical antipsychotics.
Morera, Tirma; Pratt, Daniel; Bucci, Sandra
Mental health services remain largely set up to improve patient outcomes through symptom alleviation, but patient views of recovery are broader than symptom remission. Clinicians influence the nature of treatment patients received, but their views about recovery remain poorly understood. The aim of this study was to systematically review the literature examining staff views about psychosocial aspects of recovery in psychosis. We systematically searched the PsycInfo, EMBASE, MEDLINE, and CINAHL databases. Of the 6,225 articles identified, 15 met inclusion criteria for review. The studies reviewed showed a relatively inconsistent picture. Although there was evidence of staff endorsing psychosocial views of recovery, the majority of studies suggested staff endorsed biomedical models of recovery in psychosis and emphasized the importance of pharmacological, over psychosocial, and interventions. The reviewed studies showed that biomedical views about recovery prevail among multidisciplinary mental health staff, despite recent advancements in patients' broader conceptualization of recovery. Clinical implications are discussed. The psychosocial model of recovery has become widely accepted and now underpins most international recovery policies. Despite a dearth in research, existing studies indicate that mental health staff subscribe to biomedical models of recovery in psychosis, with more emphasis on pharmacological, over psychosocial, and interventions. Robust research targeting staff views about recovery in psychosis is needed. © 2016 The British Psychological Society.
Goulart, Alessandra C; Santos, Itamar S; Bittencourt, Márcio S; Lotufo, Paulo A; Benseñor, Isabela M
The relationship between migraine and coronary heart disease (CHD) remains controversial. We aimed to investigate the association of subclinical atherosclerosis and migraine with or without aura compared to a non-migraine subgroup (reference) in a large Brazilian multicentric cohort study, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Migraine diagnostic was based on International Headache Society criteria, and aura symptoms were validated by a medical doctor in a sub-sample of the ELSA-Brasil, who also underwent coronary artery calcium score (CAC) and carotid intima-media thickness (C-IMT) evaluations. Subclinical atherosclerosis indexes (CAC and C-IMT) were analyzed as dependent variables and migraine (all, with aura, without aura) as an independent variable in the linear and multinomial logistic regression models adjusted for possible confounders. Of 3217 ELSA participants free from CVD at baseline, we found a migraine frequency of 11.9% (5.1% with aura and 6.8% without aura). Overall, migraineurs were mostly women, younger and had lower frequency of CV risk factors, such as hypertension, diabetes and low HDL-cholesterol, compared to non-migraineurs. The strongest inverse correlation between migraine and subclinical atherosclerosis was verified with CAC score. However, all associations lost their significance after multivariate adjustment. In this cross-sectional evaluation of the ELSA study, migraine was not associated with subclinical atherosclerosis, regardless of aura symptoms. © International Headache Society 2015.
Wigman, Johanna T. W.; de Vos, Stijn; Wichers, Marieke; van Os, Jim; Bartels-Velthuis, Agna A.
Our ability to accurately predict development and outcome of early expression of psychosis is limited. To elucidate the mechanisms underlying psychopathology, a broader, transdiagnostic approach that acknowledges the complexity of mental illness is required. The upcoming network paradigm may be
Amir Rezaei Ardani
Full Text Available Worldwide growing methamphetamine abuse is one of the most serious health problems with several different consequences for victims, especially in developing countries. Chronic methamphetamine abuse is associated with several psychiatric problems in all countries which are faced to epidemic methamphetamine abuse. Methamphetamine-induced psychosis is a major medical challenge for clinical practitioner from both diagnostic and therapeutic viewpoints. Stimulant psychosis commonly occurs in people who abuse stimulants, but it also occurs in some patients taking therapeutic doses of stimulant drugs under medical supervision. The main characteristic of meth psychosis is the presence of prominent hallucinations and delusions. Other drugs, such as cocaine and marijuana, can trigger the onset of psychosis in someone who is already at increased risk because they have “vulnerability”.The current literature review attends to explain several aspects of MIP epidemiologically and clinically. Investigators proposed pharmacologically treatment based on recently published data.
Turner, Mark A
Theories of delusions which rely on a combination of abnormal experience and defective belief evaluation and/ or cognitive bias are the subject of an emerging consensus. This paper challenges the validity of these theories and constructs a two factor alternative. The paper starts by identifying the difficulty the current theories have explaining the complex delusions of schizophrenia and then, by considering, first, the aetiology of somatopsychotic symptoms, and second, the literature on the relationship between confabulation and allopsychotic symptoms, demonstrates that the natural solution is to retain the experiential factor whilst replacing the second factor with confabulation. The paper is then able to demonstrate that the resultant two-factory theory can clarify recent work on the aetiological role of autonoetic agnosia and on the relationships between confabulation, delusion, and thought disorder. The theory supersedes currently available theories in terms of its simplicity, fruitfulness, scope and conservatism and represents an advance in the search for unified theory of psychosis.
Nau, Melissa L; McNiel, Dale E; Binder, Renée L
Although mental state defenses frequently are raised in cases of infanticide, legal criteria for these defenses vary across jurisdictions. We reviewed outcomes of such cases in states using M'Naughten or model penal code (MPC) standards for insanity, and the factors considered by the courts in reaching these decisions. LexisNexis and Westlaw searches were conducted of case law, legal precedent, and law review articles related to infanticide. Google and other Internet search engines were used to identify unpublished cases. Despite the differing legal standards for insanity among states, the outcomes of infanticide cases do not appear to be dependent solely on which standard is used. The presence of psychosis was important in the successful mental state defenses. This case series suggests that states that use the stricter M'Naughten standard have not been less likely than states with an MPC standard to adjudicate women who have committed infanticide as not guilty by reason of insanity.
Schreiter, S.; Pijnenborg, G. H. M.; aan het Rot, M.
Background: Depression is associated with problems in social functioning. Impaired empathic abilities might underlie this association. Empathy is a multidimensional construct and involves both affective and cognitive processes. We reviewed the literature to find out to what extent depression may be
Paul Brian eLawrie Birkett
Full Text Available Schizophrenia is a disorder with a large number of clinical, neurobiological, and cognitive manifestations, none of which is invariably present. However it appears to be a single nosological entity. This article considers the likely characteristics of a pathology capable of such diverse consequences. It is argued that both deficit and psychotic symptoms can be manifestations of a single pathology. A general model of psychosis is proposed in which the informational sensitivity or responsivity of a network ("hodological resonance" becomes so high that it activates spontaneously, to produce a hallucination, if it is in sensory cortex, or another psychotic symptom if it is elsewhere. It is argued that this can come about because of high levels of modulation such as those assumed present in affective psychosis, or because of high levels of baseline resonance, such as those expected in deafferentation syndromes associated with hallucinations, for example, Charles Bonnet. It is further proposed that schizophrenia results from a process (probably neurodevelopmental causing widespread increases of variance in baseline resonance; consequently some networks possess high baseline resonance and become susceptible to spontaneous activation. Deficit symptoms might result from the presence of networks with increased activation thresholds. This hodological variance model is explored in terms of schizo-affective disorder, transient psychotic symptoms, diathesis-stress models, mechanisms of antipsychotic pharmacotherapy and persistence of genes predisposing to schizophrenia. Predictions and implications of the model are discussed. In particular it suggests a need for more research into psychotic states and for more single case-based studies in schizophrenia.
Phelps, Randall; Tsai, Anne; Hagen, Arlene; Pinter, Joseph; Smith, Raegan; Stein, Martin T
Isela is an 11-year-old Mexican-American girl with mild intellectual disability. During a vacation with her family, she went swimming with dolphins. A few days later, Isela awoke at night with laughing spells; during the day, she was pacing, aggressive, and had a decline in self-care and communication skills. Her parents attributed the symptoms to the dolphins. She was evaluated by a pediatric neurologist. The sleep-deprived electroencephalogram, brain magnetic resonance imaging, lumbar puncture, and thyroid function tests were normal. A genomic microarray was sent. The neurologist initiated empirical therapy for seizures with lamotrigine, which caused a rash. It was discontinued. She was then treated with oxcarbazepine followed by topiramate for several months without any change in symptoms. Comparative genomic hybridization revealed a small deletion at 14q13.1, which includes the NPAS3 gene. Psychiatry was consulted after several months of persistent symptoms. Isela seemed to be laughing in response to internal stimuli. Owing to the decline in communication and her apparent preoccupation with visual and auditory internal stimuli, Isela could not be interviewed adequately to confirm that she was experiencing hallucinations, but her laughter seemed to be in response to hallucinations. Isela was diagnosed with disorganized schizophrenia with psychosis. Risperidone was prescribed.A psychology evaluation was completed a few months later. Parents noted significant improvement after starting risperidone with reduced inappropriate laughing spells, reduced pacing, as well as improved eating, sleeping, communication, and self-care. Cognitive assessment with the Wechsler Abbreviated Scale of Intelligence-II indicated the following: verbal estimated intelligence quotient (IQ) = 70, perceptual estimated IQ = 71, and full-scale estimated IQ = 68. There was no cognitive decline compared with testing at school 4 years previously. Although psychotic symptoms were significantly
Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence.
B. R. Amar
Full Text Available Aims: The aim of the study was to study the clinical profile of the patients with Parkinson′s disease (PD and psychosis. Settings and Design: This was a prospective, cross sectional, hospital-based study done at the Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India from September 2009 to January 2011. All patients with PD, diagnosed by United Kingdom PD Society Brain Bank criteria, having with features of psychosis as diagnosed by the neuropsychiatric inventory (NPI were included. Patients without a caregiver who could validate the patient′s symptoms were excluded. Results: A total of 40 patients (5 women, 35 men with PD with psychosis (mean age: 54.2 ± 11.5 years, mean duration of illness: 6.5 ± 4.5 years, and mean duration of psychosis: 4.3 ± 4.3 years were included in the study. The Global NPI score was 19.1 ± 11.5. Majority of the patients had pure hallucinations (85%, while the rest had either pure delusions (7.5% or a combination of delusions and hallucinations (7.5%. In those with hallucinations, visual hallucinations were the commonest (60% (pure only in 22.5%, followed by auditory (45%, minor hallucinations (45%, and tactile (20%. Only one person reported having olfactory hallucinations (2.5%. Loss of insight was most often observed during the visual hallucinations (52%, followed by tactile (44.4%, auditory (38.9 %, and minor hallucinations (33.3%. Conclusions: In patients with PD and psychosis, pure hallucinations are common and visual hallucinations are the commonest among the hallucinations. A large proportion of patients have minor hallucinations, which need to be recognized early for effective and early management. The limitations of the study were small sample size, use of a single scale to assess psychosis and subjective assessment of insight.
Levy, Boaz; Medina, Anna Marie; Weiss, Roger D
The current investigation aimed to extend previous findings, which linked psychosis in bipolar disorder (BD) to cognitive impairment during hospital discharge and readmission, by examining the recovery of patients with psychosis who were not re-hospitalized. The study compared mood, cognitive and functional outcomes in patients who had, versus had not, experienced psychosis during a recent psychiatric hospitalization. The hypothesis was that patients admitted to the hospital with psychosis would exhibit more residual symptoms, greater cognitive deficits, and lower psychosocial functioning than patients who presented to care without psychosis. Group differences were expected to emerge both at the time of hospital discharge and at a 3-month follow up. Fifty-five participants (ages 18-59, 25 women, 20 with psychosis) with BD I disorder completed both assessments, which included a clinical and diagnostic interview, functional evaluation, and the administration of mood measures and a neuropsychological battery. The groups were comparable with respect to illness history (e.g., number of previous hospitalizations, age of onset, employment). At discharge and follow-up, the group with psychosis exhibited more mood symptoms, obtained lower GAF scores, and performed more poorly on measures of memory and executive functioning. At follow-up, participants with psychosis exhibited poorer psychosocial adaptation. It is possible that some of the observed group differences in cognitive functioning emerged due to differences in medication efficacy or side effects. The results of this study support the hypothesis that psychosis in BD predicts limited recovery during early remission from mood disturbance, regardless of illness history. Copyright © 2013. Published by Elsevier Inc.
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Turner, David Trevor; van der Gaag, Mark; Karyotaki, Eirini; Cuijpers, Pim
Meta-analyses have demonstrated the efficacy of various interventions for psychosis, and a small number of studies have compared such interventions. The aim of this study was to provide further insight into the relative efficacy of psychological interventions for psychosis. Forty-eight outcome trials comparing psychological interventions for psychosis were identified. The comparisons included 3,295 participants. Categorization of interventions resulted in six interventions being compared against other interventions pooled. Hedges' g was calculated for all comparisons. Risk of bias was assessed using four items of the Cochrane risk of bias tool, and sensitivity analyses were conducted. Researcher allegiance was assessed, and sensitivity analyses were conducted for robust significant findings. Cognitive-behavioral therapy (CBT) was significantly more efficacious than other interventions pooled in reducing positive symptoms (g=0.16). This finding was robust in all sensitivity analyses for risk of bias but lost significance in sensitivity analyses for researcher allegiance, which suffered from low power. Social skills training was significantly more efficacious in reducing negative symptoms (g=0.27). This finding was robust in sensitivity analyses for risk of bias and researcher allegiance. Significant findings for CBT, social skills training, and cognitive remediation for overall symptoms were not robust after sensitivity analyses. CBT was significantly more efficacious when compared directly with befriending for overall symptoms (g=0.42) and supportive counseling for positive symptoms (g=0.23). There are small but reliable differences in efficacy between psychological interventions for psychosis, and they occur in a pattern consistent with the specific factors of particular interventions.
To analyze the differences in the quality of life of patients with psychosis according to the course of the illness. Clinical records and SCID-I interviews were used to establish the course of the illness and to categorize it according to 3 criteria: a) relapses, b) residual symptoms, and c) clinical diagnosis. Subjective quality of life was assessed with the Seville Questionnaire. Sixty one patients (56% women) participated, reporting a mostly adequate quality of life. An illness course characterized by the presence of residual symptoms, rather than by the occurrence of any relapse or the progression of a first-episode psychosis into schizophrenia, showed a negative effect on the perceived quality of life of patients. The clinical services provided to patients with psychosis should focus not only on symptoms remission and relapse prevention, but also achieving a recovery with a satisfactory quality of life. Having identified residual symptoms as a crucial factor negatively affecting quality of life, clinicians must carefully assess them and treat them, in order to achieve the best possible recovery. Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.
Natarajan, Pradeep; Bis, Joshua C; Bielak, Lawrence F; Cox, Amanda J; Dörr, Marcus; Feitosa, Mary F; Franceschini, Nora; Guo, Xiuqing; Hwang, Shih-Jen; Isaacs, Aaron; Jhun, Min A; Kavousi, Maryam; Li-Gao, Ruifang; Lyytikäinen, Leo-Pekka; Marioni, Riccardo E; Schminke, Ulf; Stitziel, Nathan O; Tada, Hayato; van Setten, Jessica|info:eu-repo/dai/nl/345493990; Smith, Albert V; Vojinovic, Dina; Yanek, Lisa R; Yao, Jie; Yerges-Armstrong, Laura M; Amin, Najaf; Baber, Usman; Borecki, Ingrid B; Carr, J Jeffrey; Chen, Yii-Der Ida; Cupples, L Adrienne; de Jong, Pim A|info:eu-repo/dai/nl/287955672; de Koning, Harry; de Vos, Bob D|info:eu-repo/dai/nl/413986004; Demirkan, Ayse; Fuster, Valentin; Franco, Oscar H; Goodarzi, Mark O; Harris, Tamara B; Heckbert, Susan R; Heiss, Gerardo; Hoffmann, Udo; Hofman, Albert; Išgum, Ivana|info:eu-repo/dai/nl/31484984X; Jukema, J Wouter; Kähönen, Mika; Kardia, Sharon L R; Kral, Brian G; Launer, Lenore J; Massaro, Joseph; Mehran, Roxana; Mitchell, Braxton D; Mosley, Thomas H; de Mutsert, Renée; Newman, Anne B; Nguyen, Khanh-Dung; North, Kari E; O'Connell, Jeffrey R; Oudkerk, Matthijs; Pankow, James S; Peloso, Gina M; Post, Wendy; Province, Michael A; Raffield, Laura M; Raitakari, Olli T; Reilly, Dermot F; Rivadeneira, Fernando; Rosendaal, Frits; Sartori, Samantha; Taylor, Kent D; Teumer, Alexander; Trompet, Stella; Turner, Stephen T; Uitterlinden, André G; Vaidya, Dhananjay; van der Lugt, Aad; Völker, Uwe; Wardlaw, Joanna M; Wassel, Christina L; Weiss, Stefan; Wojczynski, Mary K; Becker, Diane M; Becker, Lewis C; Boerwinkle, Eric; Bowden, Donald W; Deary, Ian J; Dehghan, Abbas; Felix, Stephan B; Gudnason, Vilmundur; Lehtimäki, Terho; Mathias, Rasika; Mook-Kanamori, Dennis O; Psaty, Bruce M; Rader, Daniel J; Rotter, Jerome I; Wilson, James G; van Duijn, Cornelia M; Völzke, Henry; Kathiresan, Sekar; Peyser, Patricia A; O'Donnell, Christopher J
BACKGROUND: -The burden of subclinical atherosclerosis in asymptomatic individuals is heritable and associated with elevated risk of developing clinical coronary heart disease (CHD). We sought to identify genetic variants in protein-coding regions associated with subclinical atherosclerosis and the
Effects of group metacognitive training (MCT) on mental capacity and functioning in patients with psychosis in a secure forensic psychiatric hospital: a prospective-cohort waiting list controlled study.
Metacognitive Training (MCT) is a manualised cognitive intervention for psychosis aimed at transferring knowledge of cognitive biases and providing corrective experiences. The aim of MCT is to facilitate symptom reduction and protect against relapse. In a naturalistic audit of clinical effectiveness we examined what effect group MCT has on mental capacity, symptoms of psychosis and global function in patients with a psychotic illness, when compared with a waiting list comparison group.
Langeveld, Johannes; Joa, Inge; Larsen, Tor Ketil; Rennan, Jon Anders; Cosmovici, Elena; Johannessen, Jan Olav
The objective of the study was to investigate high school teacher's literacy on psychosis symptoms and teachers' confidence in the positive effects of psychosis treatment on the mental health of students with psychotic symptoms at two sites: one site with an extensive early detection of psychosis programme including an ongoing information campaign (IC) on early signs of psychosis and a control site with no early detection or IC aimed at psychosis. A cross-sectional comparative design was employed using a using a structured survey questionnaire. Four schools from Rogaland County and four schools from Nord-Trøndelag County were selected by strategic sampling. Teachers at the study site with an ongoing IC and access to an outreaching team for early detection and treatment of psychosis demonstrated a higher level of confidence in the effects of treatment on psychosis. At both sites, we found that teachers who have participated in mental health literacy training programmes do show better mental health literacy. No significant effect of study site on mental health literacy was found. Access to a detection and treatment programme for psychosis can provide more confidence in the effect of treatment for psychosis in young people. Mental health literacy training programmes for teachers seem to have the expected effect: better mental health literacy, including more knowledge on early signs of psychosis.
Full Text Available The adaptive behavior of human beings is usually supported by rapid monitoring of outstanding events in the environment. Some investigators have suggested that a primary attention deficit might trigger symptoms of schizophrenia. In addition, researchers have long discussed the relationship between schizophrenia and the schizophrenia-like psychosis of epilepsy (SLPE. On the basis of these considerations, the objective of the present study was to investigate attention performance of patients with both disorders. Patient age was 18 to 60 years, and all patients had received formal schooling for at least four years. Patients were excluded if they had any systemic disease with neurologic or psychiatric comorbidity, or a history of brain surgery. The computer-assisted TAVIS-2R test was applied to all patients and to a control group to evaluate and discriminate between selective, alternating and sustained attention. The TAVIS-2R test is divided into three parts: one for selective attention (5 min, the second for alternating attention (5 min, and the third for the evaluation of vigilance or sustained attention (10 min. The same computer software was used for statistical analysis of reaction time, omission errors, and commission errors. The sample consisted of 36 patients with schizophrenia, 28 with interictal SLPE, and 47 healthy controls. The results of the selective attention tests for both patient groups were significantly lower than that for controls. The patients with schizophrenia and SLPE performed differently in the alternating and sustained attention tests: patients with SLPE had alternating attention deficits, whereas patients with schizophrenia showed deficits in sustained attention. These quantitative results confirmed the qualitative clinical observations for both patient groups, that is, that patients with schizophrenia had difficulties in focusing attention, whereas those with epilepsy showed perseveration in attention focus.
Melau, Marianne; Jeppesen, Pia; Thorup, Anne
Background The Danish OPUS I trial randomized 547 patients with first-episode psychosis to a two-year early-specialised assertive treatment programme (OPUS) versus standard treatment. The two years OPUS treatment had significant positive effects on psychotic and negative symptoms, secondary subst...
Velthorst, E.; Nieman, D. H.; Klaassen, R. M. C.; Becker, H. E.; Dingemans, P. M.; Linszen, D. H.; de Haan, L.
Objective: The investigation into the course of ultra high risk (UHR) symptomatology of those patients who eventually do not meet the psychosis-threshold criteria within the 3-year timeframe of the study. Method: The course of UHR symptoms, GAF score and employment status was investigated in 57
van Rijn, S.; Aleman, A.; de Sonneville, L.; Sprong, M.; Ziermans, T.; Schothorst, P.; van Engeland, H.; Swaab, H.
Background. By studying behavior, cognitive abilities and brain functioning in adolescents at high risk for psychosis, we can gain an insight into the vulnerability markers or protective factors in the development of psychotic symptoms. Although many high-risk studies have focused on impairments in
Full Text Available We observed 20 women suffering from adiposity and subclinical hypothyroidism. Lipid spectrum, carbohydrate metabolism, BP and insulinresistance, the extent and variants of fat tissue distribution, a test with physical exercise, all research in dynamics (in the beginning and 6 months after normalization of TSH level against the background of substitution therapy with L-T4 were evaluated. The positive shifts revealed during the afore mentioned research allow us to express our opinion in favour of carrying out substitution therapy with L-T4 at subclinical hypothyroidism .
Full Text Available Hypothyroidism is an uncommon cause of ascites. Here we describe a case of a 75 year-old female patient with spontaneous bacterial peritonitis and subclinical hypothyroidism that resolved with thyroid replacement and antibiotic therapy respectively. Ascitic fluid analysis revealed a gram-positive bacterium on gram staining. A review of the literature revealed just one other reported case of myxoedema ascites with concomitant spontaneous bacterial peritonitis and no case has till been reported of spontaneous bacterial peritonitis in subclinical hypothyroidism.
Meyhöfer, Inga; Kumari, Veena; Hill, Antje; Petrovsky, Nadine; Ettinger, Ulrich
Current antipsychotic medications fail to satisfactorily reduce negative and cognitive symptoms and produce many unwanted side effects, necessitating the development of new compounds. Cross-species, experimental behavioural model systems can be valuable to inform the development of such drugs. The aim of the current study was to further test the hypothesis that controlled sleep deprivation is a safe and effective model system for psychosis when combined with oculomotor biomarkers of schizophrenia. Using a randomized counterbalanced within-subjects design, we investigated the effects of 1 night of total sleep deprivation in 32 healthy participants on smooth pursuit eye movements (SPEM), prosaccades (PS), antisaccades (AS), and self-ratings of psychosis-like states. Compared with a normal sleep control night, sleep deprivation was associated with reduced SPEM velocity gain, higher saccadic frequency at 0.2 Hz, elevated PS spatial error, and an increase in AS direction errors. Sleep deprivation also increased intra-individual variability of SPEM, PS, and AS measures. In addition, sleep deprivation induced psychosis-like experiences mimicking hallucinations, cognitive disorganization, and negative symptoms, which in turn had moderate associations with AS direction errors. Taken together, sleep deprivation resulted in psychosis-like impairments in SPEM and AS performance. However, diverging somewhat from the schizophrenia literature, sleep deprivation additionally disrupted PS control. Sleep deprivation thus represents a promising but possibly unspecific experimental model that may be helpful to further improve our understanding of the underlying mechanisms in the pathophysiology of psychosis and aid the development of antipsychotic and pro-cognitive drugs.
Breitborde, Nicholas Jk; Moe, Aubrey M; Ered, Arielle; Ellman, Lauren M; Bell, Emily K
Psychotic-spectrum disorders such as schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features are devastating illnesses accompanied by high levels of morbidity and mortality. Growing evidence suggests that outcomes for individuals with psychotic-spectrum disorders can be meaningfully improved by increasing the quality of mental health care provided to these individuals and reducing the delay between the first onset of psychotic symptoms and the receipt of adequate psychiatric care. More specifically, multicomponent treatment packages that 1) simultaneously target multiple symptomatic and functional needs and 2) are provided as soon as possible following the initial onset of psychotic symptoms appear to have disproportionately positive effects on the course of psychotic-spectrum disorders. Yet, despite the benefit of multicomponent care for first-episode psychosis, clinical and functional outcomes among individuals with first-episode psychosis participating in such services are still suboptimal. Thus, the goal of this review is to highlight putative strategies to improve care for individuals with first-episode psychosis with specific attention to optimizing psychosocial interventions. To address this goal, we highlight four burgeoning areas of research with regard to optimization of psychosocial interventions for first-episode psychosis: 1) reducing the delay in receipt of evidence-based psychosocial treatments; 2) synergistic pairing of psychosocial interventions; 3) personalized delivery of psychosocial interventions; and 4) technological enhancement of psychosocial interventions. Future research on these topics has the potential to optimize the treatment response to evidence-based psychosocial interventions and to enhance the improved (but still suboptimal) treatment outcomes commonly experienced by individuals with first-episode psychosis.
van den Borne, B.H.P.
This thesis aimed to quantify the impact of subclinical mastitis in dairy cattle in the Netherlands and to explore the epidemiologic and economic effects of antimicrobial treatment of recently acquired subclinical mastitis during lactation. First, the occurrence of (sub)clinical mastitis was
van Donkersgoed, R J M; Wunderink, L; Nieboer, R; Aleman, A; Pijnenborg, G H M
Treatment in the ultra-high risk stage for a psychotic episode is critical to the course of symptoms. Markers for the development of psychosis have been studied, to optimize the detection of people at risk of psychosis. One possible marker for the transition to psychosis is social cognition. To estimate effect sizes for social cognition based on a quantitative integration of the published evidence, we conducted a meta-analysis of social cognitive performance in people at ultra high risk (UHR). A literature search (1970-July 2015) was performed in PubMed, PsychINFO, Medline, Embase, and ISI Web of Science, using the search terms 'social cognition', 'theory of mind', 'emotion recognition', 'attributional style', 'social knowledge', 'social perception', 'empathy', 'at risk mental state', 'clinical high risk', 'psychosis prodrome', and 'ultra high risk'. The pooled effect size (Cohen's D) and the effect sizes for each domain of social cognition were calculated. A random effects model with 95% confidence intervals was used. Seventeen studies were included in the analysis. The overall significant effect was of medium magnitude (d = 0.52, 95% Cl = 0.38-0.65). No moderator effects were found for age, gender and sample size. Sub-analyses demonstrated that individuals in the UHR phase show significant moderate deficits in affect recognition and affect discrimination in faces as well as in voices and in verbal Theory of Mind (TOM). Due to an insufficient amount of studies, we did not calculate an effect size for attributional bias and social perception/ knowledge. A majority of studies did not find a correlation between social cognition deficits and transition to psychosis, which may suggest that social cognition in general is not a useful marker for the development of psychosis. However some studies suggest the possible predictive value of verbal TOM and the recognition of specific emotions in faces for the transition into psychosis. More research is needed on these subjects
Vohs, Jenifer L; Lysaker, Paul H; Liffick, Emily; Francis, Michael M; Leonhardt, Bethany L; James, Alison; Buck, Kelly D; Hamm, Jay A; Minor, Kyle S; Mehdiyoun, Nikki; Breier, Alan
Impaired insight is common in the first episode of psychosis (FEP). Although considerable research has examined the factors that are associated with impaired insight in chronic psychosis, less is known about the factors that underlie and sustain poor insight in FEP. Impaired metacognition, or the ability to form integrated representations of self and others, is a promising potential contributor to poor insight in FEP. To explore this possibility, the authors assessed insight and metacognition in 40 individuals with FEP and then examined the relationship between these areas and social cognition domains, neurocognitive domains, and psychotic symptoms. Correlation analyses revealed that improved insight was associated with higher metacognition, better vocabulary and Theory of Mind scores, and fewer symptoms. The domain of metacognitive mastery also predicted clinical insight. Results support the need to develop an integrative therapeutic approach focused on improving metacognition, hence addressing poor insight in FEP.
Okazaki, Kosuke; Makinodan, Manabu; Yamamuro, Kazuhiko; Takata, Tomoyo; Kishimoto, Toshifumi
Methamphetamine (MA) use has recently been associated with high levels of psychiatric hospitalization and serious social dysfunction. MA use causes frequent psychotic symptoms, which can be treated with antipsychotics. However, people with intellectual disabilities (ID) are vulnerable to adverse effects resulting from treatment with antipsychotic medications. We report two cases of MA-induced psychosis (MAP) in patients with ID who were treated with the antipsychotic blonanserin. In both the cases presented, symptoms of psychosis were improved by switching medications from other antipsychotic drugs to blonanserin. Despite the presence of ID in these patients, no significant adverse effects, such as sedation, were detected after treatment with blonanserin. Blonanserin may be an effective and well-tolerated pharmacotherapeutical treatment for patients with MAP comorbid with ID. However, further work is necessary to validate this claim.
Durgesh Prasad Chaudhary
Full Text Available Combined pituitary hormonal deficiency (CPHD is a rare disease that results from mutations in genes coding for transcription factors that regulate the differentiation of pituitary cells. PROP1 gene mutations are one of the etiological diagnoses of congenital panhypopituitarism, however symptoms vary depending on phenotypic expression. We present a case of psychosis in a 36-year-old female with congenital panhypopituitarism who presented with paranoia, flat affect and ideas of reference without a delirious mental state, which resolved with hormone replacement and antipsychotics. Further evaluation revealed that she had a homozygous mutation of PROP1 gene. In summary, compliance with hormonal therapy for patients with hypopituitarism appears to be effective for the prevention and treatment of acute psychosis symptoms.
M. A. Rashed
Full Text Available This article explores an aspect of the cultural modulation of recovery in psychosis. It begins with the idea that recovery hinges on the ability of subjects to relate to their distressing experiences in ways that expand rather than diminish agency. Based on fieldwork in the Dakhla oasis of Egypt and subsequent analysis, it is argued that interpretations of psychosis as spirit possession offer a broader range of intentionality than biomedical interpretations and therefore broader possibilities of relating to psychotic states. Modes of relating to spirits may take active or passive forms, the former consistent with the recovery goal of symptom control. Factors constitutive of the active, agency-expanding mode of relating include: the nature of spirits; the values and beliefs of the subject; the broader cultural/religious discourses which may make it either more or less likely for the subject to achieve the desired state of control over symptoms.
Ravi Philip Rajkumar
Full Text Available Supersensitivity psychosis is a recognized complication of long-term antipsychotic treatment, in which patients develop new or reemergent psychotic symptoms, generally accompanied by dyskinetic movements, due to prolonged dopamine receptor blockade and resultant supersensitivity. Though it is most closely associated with schizophrenia and the use of typical antipsychotic agents, it has also been documented in patients with other diagnoses, and in those receiving atypical antipsychotics. There is no established treatment for this condition. In this paper, we describe a patient with persistent delusional disorder, jealous type, who developed a supersensitivity psychosis characterized by persecutory delusions, auditory hallucinations, and thought insertion in association with mild tardive dyskinesia. These symptoms resolved completely following six weeks of treatment with the second-generation antipsychotic asenapine, 20 mg/day. The mechanisms and implications of the patient’s symptomatology and response are discussed.
Full Text Available Abstract Background It has been reported that lack of insight is significantly associated with cognitive disturbance in schizophrenia. This study examines the longitudinal relationships between insight dimensions and cognitive performance in psychosis. Methods Participants were 75 consecutively admitted inpatients with schizophrenia, affective disorder with psychotic symptoms or schizoaffective disorder. Assessments were conducted at two time points during the study: at the time of hospital discharge after an acute psychotic episode and at a follow-up time that occurred more than 6 months after discharge. A multidimensional approach of insight was chosen and three instruments for its assessment were used: the Scale to Assess Unawareness of Mental Disorder (SUMD, three items concerning insight on the Assessment and Documentation in Psychopathology (AMDP system and the Insight and Treatment Attitudes Questionnaire. The neuropsychological battery included a wide range of tests that assessed global cognitive function, attention, memory, and executive functions. Results After conducting adequate statistical correction to avoid Type I bias, insight dimensions and cognitive performance were not found to be significantly associated at cross-sectional and longitudinal assessments. In addition, baseline cognitive performance did not explain changes in insight dimensions at follow-up. Similar results were found in the subset of patients with schizophrenia (n = 37. The possibility of a Type II error might have increased due to sample attrition at follow-up. Conclusion These results suggest that lack of insight dimensions and cognitive functioning may be unrelated phenomena in psychosis.
Ferrari, Manuela; Flora, Nina; Anderson, Kelly K; Haughton, Asante; Tuck, Andrew; Archie, Suzanne; Kidd, Sean; McKenzie, Kwame
Gender is a critical demographic determinant in first-episode psychosis research. We used data from the ACE Pathways to Care Project, which examined pathways to care in African-origin, Caribbean-origin and European-origin participants, to investigate the role of gender in pathways to early intervention programmes. A qualitative approach was used to examine gender differences in the routes to care. We conducted four focus groups and four individual in-depth interviews with 25 service users of early intervention services from African-origin, Caribbean-origin and European-origin populations. Gender stereotypes negatively influence the first service contact for women, and the early phase of the help seeking process for men. Women reported trying to seek care. However, family members and service providers often questioned their calls for help. Men described having difficulties in talking about their symptoms, as the act of seeking help was perceived as a sign of weakness by peers. The findings of this study suggest that gender stereotypes shape the journey to specialized care in different ways for men and women. Awareness of the impact that gender stereotypes have when a young person is seeking care for psychosis could help to promote a shift in attitudes among health-care providers and the provision of more compassionate and patient-centred care during this critical time. © 2016 John Wiley & Sons Australia, Ltd.
Full Text Available Central pontine myelinolysis (CPM is an acute demyelinating neurological disorder affecting primarily the central pons and is frequently associated with rapid correction of hyponatremia. Common clinical manifestations of CPM include spastic quadriparesis, dysarthria, pseudobulbar palsy, and encephalopathy of various degrees; however, coma, “locked-in” syndrome, or death can occur in most severe cases. Rarely, CPM presents with neuropsychiatric manifestations, such as personality changes, acute psychosis, paranoia, hallucinations, or catatonia, typically associated with additional injury to the brain, described as extrapontine myelinolysis (EPM. We present a patient with primarily neuropsychiatric manifestations of CPM, in the absence of focal neurologic deficits or radiographic extrapontine involvement. A 51-year-old female without significant medical history presented with dizziness, frequent falls, diarrhea, generalized weakness, and weight loss. Physical examination showed no focal neurological deficits. Laboratory data showed severe hyponatremia, which was corrected rather rapidly. Subsequently, the patient developed symptoms of an acute psychotic illness. Initial brain magnetic resonance imaging (MRI was unremarkable, although a repeat MRI two weeks later revealed changes compatible with CPM. This case demonstrates that acute psychosis might represent the main manifestation of CPM, especially in early stages of the disease, which should be taken into consideration when assessing patients with acute abnormalities of sodium metabolism.
Liviu George Crisan; Romana eVulturar; Mircea eMiclea; Miu, Andrei C.
Recent research indicates that subclinical social anxiety is associated with dysfunctions at multiple psychological and biological levels, in a manner that seems reminiscent of social anxiety disorder (SAD). This study aimed to describe multidimensional responses to laboratory-induced social stress in an analog sample selected for social anxiety symptoms. State anxiety, cognitive biases related to negative social evaluation, speech anxiety behaviors, and cortisol reactivity were assessed in t...
Tundo, Antonio; Necci, Roberta
To review available evidence on the use of cognitive behavioural therapy (CBT) for treating obsessive compulsive disorder co-occurring with psychosis. In this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder (OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubMed search using as search string ("obsessive compulsive disorders" or "obsessive compulsive symptoms") and ("schizophrenia" or "schizoaffective disorder" or "psychosis") and ("cognitive behavioural therapy"). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found. The reviewed evidence indicates that CBT is: (1) safe, i.e., does not worsen psychotic symptoms; (2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity; (3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD co-occurring with psychosis; and (4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by second-generation antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size. Our results support the use of CBT for OCD in patients with psychosis.
Danilo De Gregorio; Stefano Comai; Luca Posa; Gabriella Gobbi
d-Lysergic Acid Diethylamide (LSD) is known for its hallucinogenic properties and psychotic-like symptoms, especially at high doses. It is indeed used as a pharmacological model of psychosis in preclinical research. The goal of this review was to understand the mechanism of action of psychotic-like effects of LSD. We searched Pubmed, Web of Science, Scopus, Google Scholar and articles’ reference lists for preclinical studies regarding the mechanism of action involved in the psychotic-like eff...
Jansen, Jens E.; Haahr, Ulrik H.; Lyse, Hanne Grethe
involved. Recent advances in cognitive behavioural therapy seem to converge on the importance of acceptance- and mindfulness based processes. Aims: To examine the impact of psychological flexibility on caregiver distress in the early phases of psychosis, while controlling for known predictors of caregiver...... user symptoms, drug use and global functioning, psychological flexibility was a significant predictor of caregiver distress. Conclusion: Greater level of psychological flexibility in caregivers, seems to be related to lower levels of caregiver distress. This finding corresponds to studies within...
Full Text Available Abstract Background Convenient once-a-week dosing has made mefloquine a popular choice as malaria prophylaxis for travel to countries with chloroquine-resistant malaria. However, the increased use of mefloquine over the past decade has resulted in reports of rare, but severe, neuropsychiatric adverse reactions, such as anxiety, depression, hallucinations and psychosis. A direct causality between mefloquine and severe reactions among travelers has been partly confounded by factors associated with foreign travel and, in the case of therapeutic doses of mefloquine, the central nervous system manifestations of Plasmodium infection itself. The present case provides a unique natural history of mefloquine-induced neuropsychiatric toxicity and revisits its dose-dependent nature. Case presentation This report describes an acute exacerbation of neuropsychiatric symptoms after an unwarranted therapeutic dose (1250 mg of mefloquine in a 37-year-old male previously on a once-a-week prophylactic regimen. Neuropsychiatric symptoms began as dizziness and insomnia of several days duration, which was followed by one week of escalating anxiety and subtle alterations in behaviour. The patient's anxiety culminated into a panic episode with profound sympathetic activation. One week later, he was hospitalized after developing frank psychosis with psychomotor agitation and paranoid delusions. His psychosis remitted with low-dose quetiapine. Conclusion This report suggests that an overt mefloquine-induced psychosis can be preceded by a prodromal phase of moderate symptoms such as dizziness, insomnia, and generalized anxiety. It is important that physicians advise patients taking mefloquine prophylaxis and their relatives to recognize such symptoms, especially when they are accompanied by abrupt, but subtle, changes in behaviour. Patients with a history of psychiatric illness, however minor, may be at increased risk for a mefloquine-induced neuropsychiatric toxicity
Korver-Nieberg, Nikie; Fett, Anne-Kathrin J; Meijer, Carin J; Koeter, Maarten W J; Shergill, Sukhi S; de Haan, Lieuwe; Krabbendam, Lydia
Impaired Theory of Mind (ToM) is found in adults with schizophrenia and is associated with paranoid symptoms. Insecure attachment is proposed to underlie impaired ToM as well as paranoia. Insight into associations between insecure attachment and impaired ToM skills may help clinicians and patients to understand interpersonal difficulties and use this knowledge to improve recovery. This study used a visual perspective-taking task to investigate whether cognitive ToM is already impaired in adolescents with early psychosis as compared to controls. Also investigated was whether perspective-taking and paranoia are associated with insecure (adult) attachment. Thirty-two adolescent patients with early psychosis and 78 healthy controls participated in this cross-sectional study design and completed the level 1 perspective-taking task, psychopathology assessments (CAPE, PANSS), paranoid thoughts (GPTS), attachment style (PAM) and the WASI vocabulary. Patients did not significantly differ in level-1 perspective-taking behaviour compared to healthy controls. No significant associations were found between perspective-taking, paranoia and attachment. Insecure attachment was significantly related to paranoid thoughts, after controlling for illness-related symptoms. No impairment of level-1 perspective-taking was found in adolescent patients with early psychosis compared to healthy controls. Results indicate that level-1 perspective-taking is not impaired during the early stages of psychotic illness. The association between paranoia and attachment support previous findings and provide further insight into the nature of psychotic symptoms. Understanding the role of attachment in paranoia may help patients and their care workers to gain insight into the reasons for the development or persistence of symptoms. Future research should compare early psychosis samples with more chronic samples to explore whether perspective-taking deteriorates during the course of the illness.
Thomas, Neil; Shawyer, Frances; Castle, David J; Copolov, David; Hayes, Steven C; Farhall, John
Cognitive behavior therapy for psychosis has been a prominent intervention in the psychological treatment of psychosis. It is, however, a challenging therapy to deliver and, in the context of increasingly rigorous trials, recent reviews have tempered initial enthusiasm about its effectiveness in improving clinical outcomes. Acceptance and commitment therapy shows promise as a briefer, more easily implemented therapy but has not yet been rigorously evaluated in the context of psychosis. The purpose of this trial is to evaluate whether Acceptance and Commitment Therapy could reduce the distress and disability associated with psychotic symptoms in a sample of community-residing patients with chronic medication-resistant symptoms. This is a single (rater)-blind multi-centre randomised controlled trial comparing Acceptance and Commitment Therapy with an active comparison condition, Befriending. Eligible participants have current residual hallucinations or delusions with associated distress or disability which have been present continuously over the past six months despite therapeutic doses of antipsychotic medication. Following baseline assessment, participants are randomly allocated to treatment condition with blinded, post-treatment assessments conducted at the end of treatment and at 6 months follow-up. The primary outcome is overall mental state as measured using the Positive and Negative Syndrome Scale. Secondary outcomes include preoccupation, conviction, distress and disruption to life associated with symptoms as measured by the Psychotic Symptom Rating Scales, as well as social functioning and service utilisation. The main analyses will be by intention-to-treat using mixed-model repeated measures with non-parametric methods employed if required. The model of change underpinning ACT will be tested using mediation analyses. This protocol describes the first randomised controlled trial of Acceptance and commitment therapy in chronic medication-resistant psychosis
Xu, Ziyan; Müller, Mario; Heekeren, Karsten; Theodoridou, Anastasia; Metzler, Sibylle; Dvorsky, Diane; Oexle, Nathalie; Walitza, Susanne; Rössler, Wulf; Rüsch, Nicolas
Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among young people at risk of psychosis. However, it is unclear whether mental illness stigma contributes to suicidality in this population. We therefore examined the associations of self-labeling and stigma stress with suicidality among young people at risk. Self-labeling as "mentally ill", stigma stress, social isolation, self-esteem, symptoms and suicidal ideation were assessed in 172 individuals at risk of psychosis. Self-labeling and stigma stress were examined as predictors of suicidality by path analysis. Increased self-labeling as "mentally ill" was associated with suicidality, directly as well as indirectly mediated by social isolation. More stigma stress was related to social isolation which in turn was associated with low self-esteem, depression and suicidal ideation. Social isolation fully mediated the link between stigma stress and suicidal ideation. Interventions to reduce the public stigma associated with risk of psychosis as well as programs to facilitate non-stigmatizing awareness of at-risk mental state and to reduce stigma stress among young people at risk of psychosis might strengthen suicide prevention in this population. Copyright © 2016 Elsevier B.V. All rights reserved.
Malik, Amna; Amer, Ahmed Bait; Salama, Mohammed; Haddad, Bander; Alrifai, Muhammad T; Balwi, Mohammed Al; Davies, William; Eyaid, Wafaa
X-linked ichthyosis is a dermatological condition caused by deficiency for the enzyme steroid sulfatase. Previously, X-linked ichthyosis/steroid sulfatase deficiency has been associated with developmental and neurological phenotypes. Here, we show for the first time, that X-linked ichthyosis may be comorbid with an additional psychiatric phenotype (psychosis). We report the case of an 11-year-old Saudi Arabian boy with X-linked ichthyosis associated with psychosis, mental retardation, autism spectrum disorder, inattentive attention deficit hyperactivity disorder, and epilepsy. Genetic analysis revealed a 1.68 Mb deletion encompassing STS in 95% of cells while biochemical analysis revealed correspondingly low steroid sulfatase activity consistent with a diagnosis of X-linked ichthyosis. The psychotic symptoms could be reasonably well controlled by administration of an atypical antipsychotic. This report describes a case of comorbid X-linked ichthyosis and psychosis (most closely corresponding to early-onset schizophrenia) for the first time, and suggests that deficiency for steroid sulfatase and contiguous genes may increase vulnerability to psychosis as well as other psychological disorders.
Abu-Akel, Ahmad M; Wood, Stephen J; Hansen, Peter C; Apperly, Ian A
Difficulties with the ability to appreciate the perspective of others (mentalizing) is central to both autism and schizophrenia spectrum disorders. While the disorders are diagnostically independent, they can co-occur in the same individual. The effect of such co-morbidity is hypothesized to worsen mentalizing abilities. The recent influential 'diametric brain theory', however, suggests that the disorders are etiologically and phenotypically diametrical, predicting opposing effects on one's mentalizing abilities. To test these contrasting hypotheses, we evaluated the effect of psychosis and autism tendencies on the perspective-taking (PT) abilities of 201 neurotypical adults, on the assumption that autism tendencies and psychosis proneness are heritable dimensions of normal variation. We show that while both autism tendencies and psychosis proneness induce PT errors, their interaction reduced these errors. Our study is, to our knowledge, the first to observe that co-occurring autistic and psychotic traits can exert opposing influences on performance, producing a normalizing effect possibly by way of their diametrical effects on socio-cognitive abilities. This advances the notion that some individuals may, to some extent, be buffered against developing either illness or present fewer symptoms owing to a balanced expression of autistic and psychosis liability. © 2015 The Author(s) Published by the Royal Society. All rights reserved.
Beals, K A; Manore, M M
The purpose of this study was to delineate and further define the behavioral, psychological, and physical characteristics of female athletes with subclinical eating disorders. Subjects consisted of 24 athletes with subclinical eating disorders (SCED) and 24 control athletes. Group classification was determined by scores on the Eating Disorder Inventory (EDI), the Body Shape Questionnaire (BSQ), and a symptom checklist for eating disorders (EDI-SC). Characteristics representative of the female athletes with subclinical eating disorders were derived from an extensive health and dieting history questionnaire and an in-depth interview (the Eating Disorder Examination). Energy intake and expenditure (kcal/d) were estimated using 7-day weighed food records and activity logs. The characteristics most common in the female athletes with subclinical eating disorders included: (a) preoccupation with food, energy intake, and body weight; (b) distorted body image and body weight dissatisfaction; (c) undue influence of body weight on self-evaluation; (d) intense fear of gaining weight even though at or slightly below ( approximately 5%) normal weight; (e) attempts to lose weight using one or more pathogenic weight control methods; (g) food intake governed by self-hatred upon breaking a rule; (h) absence of medical disorder to explain energy restriction, weight loss, or maintenance of low body weight; and (i) menstrual dysfunction. Awareness of these characteristics may aid in more timely identification and treatment of female athletes with disordered eating patterns and, perhaps, prevent the development of more serious, clinical eating disorders.
Sepede, Gianna; Spano, Maria Chiara; Lorusso, Marco; De Berardis, Domenico; Salerno, Rosa Maria; Di Giannantonio, Massimo; Gambi, Francesco
To provide a systematic review of scientific literature on functional magnetic resonance imaging (fMRI) studies on sustained attention in psychosis. We searched PubMed to identify fMRI studies pertaining sustained attention in both affective and non-affective psychosis. Only studies conducted on adult patients using a sustained attention task during fMRI scanning were included in the final review. The search was conducted on September 10th, 2013. 15 fMRI studies met our inclusion criteria: 12 studies were focused on Schizophrenia and 3 on Bipolar Disorder Type I (BDI). Only half of the Schizophrenia studies and two of the BDI studies reported behavioral abnormalities, but all of them evidenced significant functional differences in brain regions related to the sustained attention system. Altered functioning of the insula was found in both Schizophrenia and BDI, and therefore proposed as a candidate trait marker for psychosis in general. On the other hand, other brain regions were differently impaired in affective and non-affective psychosis: alterations of cingulate cortex and thalamus seemed to be more common in Schizophrenia and amygdala dysfunctions in BDI. Neural correlates of sustained attention seem to be of great interest in the study of psychosis, highlighting differences and similarities between Schizophrenia and BDI. PMID:24976929
Padilla, Eduardo; Molina, Juan; Kamis, Danielle; Calvo, Maria; Stratton, Lee; Strejilevich, Sergio; Aleman, Gabriela Gonzalez; Guerrero, Gonzalo; Bourdieu, Mercedes; Conesa, Horacio A; Escobar, Javier I; de Erausquin, Gabriel A
The duration of untreated psychosis (DUP) is a key determinant in the severity of symptoms in patients with schizophrenia. DUP is a modifiable factor that if reduced can improve patient outcome and treatment response. We sought to decrease DUP in rural Argentina by instituting annual training of local health agents to better identify signs of mental illness and offer earlier intervention. DUP was estimated using Schedules of Clinical Assessment in Neuropsychiatry (SCAN). Ongoing training was correlated with a reduction in DUP. Reducing DUP through better screening can decrease the psychosocial burden of disease and improve the trajectory of psychosis. Copyright © 2014 Elsevier B.V. All rights reserved.
Thorup, A; Albert, Nancy; Bertelsen, M
symptoms at all times, and are more likely to live alone and suffer from substance abuse. Females reach higher levels of social functioning at follow-up, and show a greater tendency to be employed or in education than males. Markedly more women than men live with children. More women than men reach a state......OBJECTIVE: Gender differences in psychosis have been investigated, and the results have contributed to a better understanding of the disease, but many questions are unanswered. In clinical terms, women and men with psychosis differ in terms of access to social support, tendency of substance abuse...
Mallet, Jasmina; Ramoz, Nicolas; Le Strat, Yann; Gorwood, Philip; Dubertret, Caroline
Cannabis use is associated with an increased risk of schizophrenia, and is considered to impact late neurodevelopment. Neurological soft signs (NSS) associated with schizophrenia are considered as markers of early neurodevelopmental impairment. Our study examines the association between heavy cannabis use before the onset of psychosis and clinical, neuropsychological and neurological symptoms, including NSS. In a cross-sectional study, we consecutively included 61 patients with schizophrenia (34 reporting heavy cannabis use before the onset of psychosis and 27 not reporting such use), in the setting of a University Hospital and a Medical Center. Symptoms assessment and substance use disorder were evaluated with the Diagnostic Interview for Genetic Studies. NSS were assessed with the Neurological Evaluation Scale. Psychopathology was assessed with the Positive and Negative Symptom Scale. All patients underwent a battery of neurocognitive tests evaluating attention, memory and executive functions domains. Patients with heavy cannabis use before the onset of psychosis showed significantly less NSS (p cannabis before the onset of schizophrenia. Patients with heavy cannabis use before the onset of schizophrenia may exhibit later neurodevelopmental impairment than those who do not report such use. Schizophrenia associated with heavy cannabis use could represent a specific phenotype.
Bonet, Lucia; Izquierdo, Clara; Escartí, Maria Jose; Sancho, José Vicente; Arce, David; Blanquer, Ignacio; Sanjuan, Julio
There is a growing interest in mobile Health interventions (m-Health) in patients with psychosis. The aim of this study is to conduct a systematic review in order to analysethe current state of research in this area. The search of articles was carried out following the PRISMA criteria, focusing on those studies that used mobile technologies in patients with psychosis during the period from 1990 to 2016. A total of 20 articles were selected from the 431 studies found. Three types of studies are distinguished: 1) Analysis of quality and usability, 2) Improving treatment adherence and reducing hospital admissions, and 3) Analysisof patient symptoms. m-Health interventions are feasible, and are easy to use for patients with psychosis. They evaluate the evolution of psychotic symptoms more efficiently, and improve adherence to treatment, as well as symptoms and hospital admissions. However, a particular strategy does not stand out over the rest, because differences in methodology make them difficult to compare. Copyright © 2017 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.
Kumar, Sanjeev; Kodela, Sreekant; Detweiler, Jonna G; Kim, Kye Y; Detweiler, Mark B
Bupropion is a substituted phenyl-ethylamine that is extensively utilized for the treatment of major depressive disorder and for smoking cessation. It is a reuptake inhibitor of dopamine and norepinephrine, and it also has some nicotinic antagonism. There are concerns that it may increase the risk of psychosis due to its dopaminergic effects. Our objective is to review the literature and analyze the risk of bupropion precipitating a psychotic illness in the general population as well as in the populations with a history of psychotic symptoms. A Medline database search limited to human and English-language studies was conducted using the keywords "bupropion" and "psychosis." A total of 23 articles were selected based on the relevance of the articles and their references. The data from these articles were collated. Collated data show that there is some evidence to suggest that bupropion may cause or worsen psychosis in selected subpopulations. Higher doses of bupropion appear more likely to be associated with the outcome severity. Preexisting psychotic symptoms, substance abuse and drug interactions also seem to increase the risk. Concurrent use of antipsychotics at adequate doses appears to be protective. The literature is incomplete and in some cases contradictory. In selected cases, bupropion appears to be associated with the induction of psychotic symptoms in addition to the precipitation or worsening of an existing psychotic syndrome. Further research including controlled studies is required to clarify the risk of bupropion precipitating a psychotic illness in vulnerable populations. Copyright Â© 2011 Elsevier Inc. All rights reserved.
Full Text Available Recent studies have begun to look at gender differences in schizophrenia and first-episode psychosis in an attempt to explain the heterogeneity of the illness. However, a number of uncertainties remain. This paper tries to summarize the most important findings in gender differences in schizophrenia and first-psychosis episodes. Several studies indicate that the incidence of schizophrenia is higher in men. Most of the studies found the age of onset to be earlier in men than in women. Findings on symptoms are less conclusive, with some authors suggesting that men suffer more negative symptoms while women have more affective symptoms. Premorbid functioning and social functioning seem to be better in females than males. However, cognitive functioning remains an issue, with lack of consensus on differences in neuropsychological profile between women and men. Substance abuse is more common in men than women with schizophrenia and first-episode psychosis. In terms of the disease course, women have better remission and lower relapse rates. Lastly, there is no evidence of specific gender differences in familial risk and obstetric complications. Overall, gender differences have been found in a number of variables, and further study in this area could help provide useful information with a view to improving our care of these patients.
Schultze-Lutter, Frauke; Schmidt, Stefanie J; Walger, Petra; Schimmelmann, Benno G
Developmental Aspects in the Early Detection and Intervention in Clinical High Risk States for Psychosis The early detection and intervention in psychoses, which are a main source of disability-adjusted life years already in children and adolescents, have made good progress within the past years. In particular the attenuated and transient positive symptoms of the ultra-high risk criteria and the basic symptom criterion "Cognitive Disturbances" open promising routes to an indicated prevention and have recently been considered as diagnostic criteria of a psychosis-risk syndrome by the European Psychiatric Association (EPA). However, because their association with a development of psychosis has been weaker in children and adolescents than in adults, only the assessment and monitoring of these risk symptoms was recommended for children and adolescents, while interventions aiming at the prevention of psychoses were discouraged. Furthermore, treatment of comorbid current mental disorders and psychosocial problems over the prevention of a potential future disorder also characterizes the intervention recommendations of the EPA. Furthermore, these give primacy to psychological, in particular cognitive-behavioral interventions over psychopharmacological treatments. Yet, also with regard to an early intervention, current evidence indicates that children and adolescents might benefit less than adults. Overall, age-related or developmental peculiarities in the early detection and intervention in psychoses become more and more apparent and should be more focused in future research in this field.
Lin, Jingxia; Chan, Sherry Kw; Lee, Edwin Hm; Chang, Wing Chung; Tse, Michael; Su, Wayne Weizhong; Sham, Pak; Hui, Christy Lm; Joe, Glen; Chan, Cecilia Lw; Khong, P L; So, Kwok Fai; Honer, William G; Chen, Eric Yh
Impairments of attention and memory are evident in early psychosis, and are associated with functional disability. In a group of stable, medicated women patients, we aimed to determine whether participating in aerobic exercise or yoga improved cognitive impairments and clinical symptoms. A total of 140 female patients were recruited, and 124 received the allocated intervention in a randomized controlled study of 12 weeks of yoga or aerobic exercise compared with a waitlist group. The primary outcomes were cognitive functions including memory and attention. Secondary outcome measures were the severity of psychotic and depressive symptoms, and hippocampal volume. Data from 124 patients were included in the final analysis based on the intention-to-treat principle. Both yoga and aerobic exercise groups demonstrated significant improvements in working memory (Pbenefits in verbal acquisition (Pexercise improved overall and depressive symptoms (all P⩽0.01) after 12 weeks. Small increases in hippocampal volume were observed in the aerobic exercise group compared with waitlist (P=0.01). Both types of exercise improved working memory in early psychosis patients, with yoga having a larger effect on verbal acquisition and attention than aerobic exercise. The application of yoga and aerobic exercise as adjunctive treatments for early psychosis merits serious consideration. This study was supported by the Small Research Funding of the University of Hong Kong (201007176229), and RGC funding (C00240/762412) by the Authority of Research, Hong Kong.
Lombardi, Riccardo; Pola, Marisa
This article explores aspects of the clinical development of a male 17 year-old patient who had four weekly sessions of psychoanalysis during an acute psychotic crisis. In the context of arrested adolescent development, a psychotic crisis can present an opportunity to set the process of maturation in motion again. Adolescent psychosis is examined in the light of Bion's theories of catastrophic change - in which the container/contained relationship becomes explosive and overwhelming - as well as of Ferrari's and Matte Blanco's hypotheses on the mind-body relationship. The authors emphasize the role of denial of the body and its changes in the genesis of adolescent psychotic conflict, and show how the analytic relationship can offer crucial reverie conditions for promoting recognition of the body, bodily sensations and affects, as a prerequisite for the activation of an autonomous mental system. This clinical approach entails recognizing the urgent need to make room for the elaboration of intrasubjective relationships and for mind-body dialogue, transference interpretations being postponed. Clinical material and fragments of analytic dialogue illustrate the authors' hypotheses and demonstrate the patient's development towards recognition of his body and an incipient capacity to think associated with the perception of the limits set by time and reality. Copyright © 2010 Institute of Psychoanalysis.
Manash P Baruah
Full Text Available As autoimmune adrenalitis is fast replacing tuberculosis as the most common etiology cause of adrenal insufficiency, subtler forms of the same are being recognised as subclinical addison′s disease. In this article, we review what is known about this entity till date.
4-fold increase in IgG antibodies to. AGG2,3 and to either PT or FHA or both are shown in Figs. 1 - 3. The subclinical pertussis led to stimulation of antibody responses to multiple antigens of Bordetella perttjssis. Antibody levels attained were significantly higher for all pertussis antibody assays than those detected in' age-.
Frías López, Ma del C; Tárraga López, P J; Rodríguez Montes, J A; Solera Albero, J; Celada Rodríguez, A; López Cara, M A; Gálvez, A
To determine the prevalence of subclinical hypothyroidism in the general population of an urban health center and describe the clinical characteristics and cardiovascular risk factors in patients with subclinical hypothyroidism. An observational study, retrospective, reviewing the medical histories of patients sampled from June 2005 until July 2007. We analyzed the following variables; facts: age and sex. Family history thyroid disease and other diseases. Personal History: cardiovascular pulmonary autoimmune, alterations gynecology obstetric diabetes, hypertension (HT) dislipemia, obesity, psychiatric alterations and haematological. Laboratory data: novel TSH, free T4, antiperoxidase antibodies, total cholesterol and its fractions. The prevalence of the sample of 100 patients collected over 8 months was 3.8% in the general population over 14 years, of which 79 were women and 21 were men. 13% were type 2 diabetics, 23% had HT and 40% had dyslipidemia. Overweight and obesity were present in 26%. The average level of TSH was 6.92 ± 2.29 μU/ml and the average level of free T4 was 1.16 ± 0.16 ng/ml. Prevalence subclinical hypothyroidism was 3.8%. especially in women with a mean age of 46. The incidence of cardiovascular risk factors in the subjects studied is higher in DM (13%), similar to general population in terms of dyslipidemia (40%) and obesity (23%) and lowest in hypertension (23%). In our study we observed a common pattern in the management of subclinical hypothyroidism, requiring the implementation and promotion of practice guidelines in primary care.
Cortes-Briones, Jose A; Cahill, John D; Skosnik, Patrick D; Mathalon, Daniel H; Williams, Ashley; Sewell, R Andrew; Roach, Brian J; Ford, Judith M; Ranganathan, Mohini; D'Souza, Deepak Cyril
Drugs that induce psychosis may do so by increasing the level of task-irrelevant random neural activity or neural noise. Increased levels of neural noise have been demonstrated in psychotic disorders. We tested the hypothesis that neural noise could also be involved in the psychotomimetic effects of delta-9-tetrahydrocannabinol (Δ(9)-THC), the principal active constituent of cannabis. Neural noise was indexed by measuring the level of randomness in the electroencephalogram during the prestimulus baseline period of an oddball task using Lempel-Ziv complexity, a nonlinear measure of signal randomness. The acute, dose-related effects of Δ(9)-THC on Lempel-Ziv complexity and signal power were studied in humans (n = 24) who completed 3 test days during which they received intravenous Δ(9)-THC (placebo, .015 and .03 mg/kg) in a double-blind, randomized, crossover, and counterbalanced design. Δ(9)-THC increased neural noise in a dose-related manner. Furthermore, there was a strong positive relationship between neural noise and the psychosis-like positive and disorganization symptoms induced by Δ(9)-THC, which was independent of total signal power. Instead, there was no relationship between noise and negative-like symptoms. In addition, Δ(9)-THC reduced total signal power during both active drug conditions compared with placebo, but no relationship was detected between signal power and psychosis-like symptoms. At doses that produced psychosis-like effects, Δ(9)-THC increased neural noise in humans in a dose-dependent manner. Furthermore, increases in neural noise were related with increases in Δ(9)-THC-induced psychosis-like symptoms but not negative-like symptoms. These findings suggest that increases in neural noise may contribute to the psychotomimetic effects of Δ(9)-THC. Published by Elsevier Inc.
Rizvi, Sabeen H; Salcedo, Stephanie; Youngstrom, Eric A; Freeman, Lindsey K; Gadow, Kenneth D; Fristad, Mary A; Birmaher, Boris; Kowatch, Robert A; Horwitz, Sarah M; Frazier, Thomas W; Arnold, L Eugene; Taylor, H Gerry; Findling, Robert L
Diagnostic accuracy of the Diagnostic and Statistical Manual of Mental Disorders-oriented Child and Adolescent Symptom Inventory (CASI-4R) Psychotic Symptoms scale was tested using receiver operating characteristic analyses to identify clinically significant psychotic symptoms. Participants were new outpatients (N = 700), ages 6.0 to 12.9 years (M = 9.7, SD = 1.8) at 9 child outpatient mental health clinics, who participated in the Longitudinal Assessment of Manic Symptoms (LAMS) Study baseline assessment. Because LAMS undersampled participants with low mania scores by design, present analyses weighted low scorers to produce unbiased estimates. Psychotic symptoms, operationally defined as a score of 3 or more for hallucinations or 4 or more for delusions based on the Schedule for Affective Disorders and Schizophrenia (K-SADS) psychosis items, occurred in 7% of youth. K-SADS diagnoses for those identified with psychotic symptoms above threshold included major depressive disorder, bipolar spectrum disorder, attention deficit/hyperactivity disorder, posttraumatic stress disorder, psychotic disorders, and autism spectrum disorder. The optimal psychosis screening cut score (maximizing sensitivity and specificity) was 2.75+ (corresponding diagnostic likelihood ratio [DiLR] = 4.29) for the parent version and 3.50+ (DiLR = 5.67) for the teacher version. The Area under the Curve for parent and teacher report was .83 and .74 (both p clinically useful for identifying psychotic symptoms in children because of its brevity and accuracy.
Syed Abbas Raza
Full Text Available Diagnoses of subclinicaal hypothyroidism (SCH is biochemically made, when serum thyroid stimulating hormone (TSH levels is elevated while free thyroid hormone levels are within normal reference range. SCH is diagnosed after excluding all other causes of elevated TSH levels. Symptoms of SCH may vary from being asymptomatic to having mild nonspecific symptoms. The risk of progression to overt hypothyroidism is related to number of factors including initial serum TSH concentration, presence of auto antibodies, family history and presence goiter. Various screening recommendations for thyroid function assessment are in practice. There are still controversies surrounding SCH and associated risk of various cardiovascular diseases (CVDs, pregnancy outcomes, neuropsychiatric issues, metabolic syndrome, and dyslipidemia. Consensus will require more large randomized clinical studies involving various age groups and medical condition, especially in developing countries. All these efforts will definitely improve our understanding of disease and ultimately patient outcomes.
Schizophrenia is increasingly viewed as a neurodevelopmental process caused by an interaction between genetic factors and environmental stressors. Prospective studies and retrospective research using objective data indicate that behavioural deviations can be dated to early infancy and cut across...
Wiescholleck, Valentina; Manahan-Vaughan, Denise
It is postulated that disruptions of glutamatergic signalling may underlie the pathophysiology of psychosis and schizophrenia. A strong body of evidence indicates that antagonism of the N-methyl-d-aspartate receptor (NMDAR) leads to similar molecular, cellular, cognitive and behavioural changes in rodents and/or humans to those that have been identified to occur in psychosis. One of the main loci of change appears to comprise the hippocampus, raising the question as to whether changes in hippocampal glutamatergic transmission may drive changes in GABAergic and dopaminergic-mediated signalling in schizophreniform diseases. NMDAR antagonists such as MK801, PCP and ketamine all elicit similar psychosis-related effects, with MK801 inducing the most potent psychotomimetic reactions. Treatment with MK801 is associated with a loss of hippocampal synaptic plasticity, hippocampus-dependent learning and cognitive deficits. These findings have raised the question as to whether targeting the NMDA receptors or its modulators could prove an effective strategy in treatment of psychosis and schizophrenia. Specifically, the otherwise untreatable negative and cognitive symptoms of schizophrenia currently comprise the highest research priority. A single injection with MK801 has been used to emulate first-episode psychosis in animals. This treatment induces both psychosis-related acute effects but interestingly also persisting consequences, which might be more sensitive as indicators of drug efficacy. Here, we review the current status of the field with regard to the MK801 animal model of first-episode psychosis and its relevance for the glutamate hypothesis of schizophrenia. Furthermore, we argue that synaptic plasticity may be a better assay for assessing novel schizophrenia therapeutics than behavioural evaluation. This article is part of the Special Issue entitled 'Glutamate Receptor-Dependent Synaptic Plasticity'. Copyright © 2013 Elsevier Ltd. All rights reserved.
Full Text Available Over the last twenty years, predicting psychosis has become a priority of both research and policies. Those approaches include the use of the At Risk Mental State category (ARMS and of standardized predictive tools. In comparison to most developed countries, early interventions programs are only little developed in France. However, cases of young patients presenting unclear symptoms that might be a beginning psychosis or might as well reflect some adolescent unease are commonplace in psychiatry. Yet little is known about the routine practices of youth psychiatrists regarding psychosis risk management. Do they anticipate mental disorders?The Grounded Theory is an agreed-upon qualitative method in social science field that links subjective experiences (individual narratives to social processes (professional norms and mental health policies. 12 French youth psychiatrists were interviewed about psychosis early management and their daily prognosis practices with teenagers.If all participants were aware of early intervention programs, most of them did not make use of standardized scales. Psychiatrists' reluctance toward a psychosis risk standardized assessment was shaped by three difficulties: first the gap between theoretical knowledge and practice; second their impossibility to make reliable prognoses; and third, the many uncertainties surrounding medical judgment, adolescence and the nature of psychosis. Nevertheless, they provided their young patients with multiple months follow up without disclosing any risk category.Anticipating a psychosis onset remains a highly uncertain task for psychiatrists. In France, psychiatrists' inconspicuous risk management might be supported by the universal costs coverage that is not conditional on a diagnosis disclosure.
Karatas, F; Aydin, S; Kaygusuzoglu, E; Yildiz, H; Erulas, F A; Ozkan, Y
Hormone ghrelin and orotic acid accelerate wound healing as well as controlling inflammation and immunity. We have, therefore, investigated the serum and milk levels of ghrelin and orotic acid in dairy cows with (n = 21) or without (n = 21) subclinical mastitis. Acylated and des-acylated ghrelin as well as orotic acid concentration were detected by using high performance liquid chromatography (HPLC). The results revealed that ghrelin level in milk and serum was significantly higher in dairy cows with subclinical mastitis than that of dairy cows without subclinical mastitis. This was also the case when the orotic acid concentrations in dairy cows with subclinical mastitis were compared with those dairy cows without subclinical mastitis. In conclusion, ghrelin and orotic acid occur in particularly high concentrations in subclinical mastitis, and might, therefore, be required in greater amounts for tissue repair and may be also used as a indicator for subclinical mastitis.
Koster, Myrthe I M E; de Jong, Mark H; Derksen, Marees Th; Van Gool, Arthur R
A 30-year-old woman, 33 weeks pregnant, without a significant psychiatric history, was admitted for treatment of premature labour. She was treated with betamethasone intramuscularly, with a total dose of 24 mg divided over 2 days, and nifedipine orally with beneficial effect on the contractions. However, within 24 h after completion of tocolytic treatment, she developed a psychosis with delusions and hallucinations necessitating readmission, first to an obstetric ward, later to a psychiatric ward. At least part of this episode may be characterized as delirium. Eventually, she was treated with haloperidol. It is argued that her psychosis was caused by the corticosteroid, since psychiatric disturbance is a well-known complication of corticosteroid therapy. To our knowledge, psychosis during pregnancy as a result of treatment with corticosteroids has not been reported previously.
Ntouros, Evangelos; Bozikas, Vasilios P; Andreou, Christina; Kourbetis, Dimitris; Lavrentiadis, Grigoris; Garyfallos, George
The aim of the present study was to investigate the effects of comorbid obsessive-compulsive symptoms on emotional perception and theory of mind (ToM) in patients with first-episode psychosis. Participants were 65 patients with non-affective first episode psychosis (FEP) and 47 healthy controls. The patient group was divided into two subgroups, those with (FEP+; n=38) and those without obsessive-compulsive symptomatology (FEP-; n=27). Emotion perception and ToM were assessed with the Perception of Social Inference Test. Severity of psychotic and obsessive-compulsive symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), respectively. Deficits in emotion recognition and theory of mind were confirmed in patients with non-affective first-episode psychosis compared to healthy controls. In patients, comorbidity with obsessive-compulsive symptoms was associated with worse performance on certain aspects of social cognition (ToM 2nd order) compared to FEP- patients. Our findings of impaired emotion perception and ToM in patients with first-episode psychosis support the hypothesis that deficits are already present at illness onset. Presence of OCS appears to have further deleterious effects on social cognition, suggesting that these patients may belong to a schizo-obsessive subtype of schizophrenia characterized by more extensive neurobiological impairment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Hodgekins, Jo; Birchwood, Max; Christopher, Rose; Marshall, Max; Coker, Sian; Everard, Linda; Lester, Helen; Jones, Peter; Amos, Tim; Singh, Swaran; Sharma, Vimal; Freemantle, Nick; Fowler, David
Social disability is a hallmark of severe mental illness yet individual differences and factors predicting outcome are largely unknown. To explore trajectories and predictors of social recovery following a first episode of psychosis (FEP). A sample of 764 individuals with FEP were assessed on entry into early intervention in psychosis (EIP) services and followed up over 12 months. Social recovery profiles were examined using latent class growth analysis. Three types of social recovery profile were identified: Low Stable (66%), Moderate-Increasing (27%), and High-Decreasing (7%). Poor social recovery was predicted by male gender, ethnic minority status, younger age at onset of psychosis, increased negative symptoms, and poor premorbid adjustment. Social disability is prevalent in FEP, although distinct recovery profiles are evident. Where social disability is present on entry into EIP services it can remain stable, highlighting a need for targeted intervention. © The Royal College of Psychiatrists 2015.
Gardsjord, Erlend Strand; Romm, Kristin Lie; Friis, Svein
UNLABELLED: Subjective quality of life (S-QoL) is an important outcome measure in first episode psychosis (FEP). The aims of this study were to describe S-QoL-development the first 10-years in FEP patients and to identify predictors of this development. METHODS: A representative sample of 272...... patients with a first episode psychotic disorder was included from 1997 through 2000. At 10year follow-up 186 patients participated. QoL was measured by the Lehman's Quality of Life Interview. Linear mixed model analyses were performed to investigate longitudinal effects of baseline psychiatric symptoms...... and socio-economic variables and the effects of changes in the same variables on S-QoL-development. RESULTS: S-QoL improved significantly over the follow-up period. More contact with family and a better financial situation at baseline had a positive and longstanding effect on S-QoL-development, but changes...
Benros, Michael E; Eaton, William W; Mortensen, Preben B
with genetic markers of the immune system and with excess autoreactivity and other immune alterations. A range of psychiatric disorders, including psychosis, have been observed to occur more frequently in some autoimmune diseases, such as systemic lupus erythematosus and multiple sclerosis. Many autoimmune...... suspected to be caused by inflammation or brain-reactive antibodies associated with the autoimmune diseases. However, the associations could also be caused by shared genetic factors or common etiologic components such as infections. Infections can induce the development of autoimmune diseases...... and autoantibodies, possibly affecting the brain. Autoimmune diseases and brain-reactive antibodies should be considered by clinicians in the treatment of individuals with psychotic symptoms, and even if the association is not causal, treatment would probably still improve quality of life and survival....
Shevlin, Mark; McElroy, Eoin; Christoffersen, Mogens Nygaard
A broad range of biological, genetic, environmental, and psychological riskfactors for psychosis have been reported. However most research studies have tended to focus on one explanatory factor. The aim of this study wasto use data from a large Danish birth cohort to examine the associationsbetween...... psychosis and a broad range of familial (advanced paternal age, family dissolution, parental psychosis), environmental (urbanicity,deprivation) and psychological factors (childhood adversity). Findings indicated that all types of risk factors were significantly associated with psychosis. In conclusion......, large scale cohort studies using the Danish registry system is a powerful way of assessing the relative impact ofdifferent risk factors for psychosis....
Hasnain, Mehrul; Vieweg, W Victor R; Baron, Mark S; Beatty-Brooks, Mary; Fernandez, Antony; Pandurangi, Anand K
Parkinsonism is a characteristic feature of Parkinson's disease and dementia with Lewy bodies and is commonly seen in Alzheimer's disease. Psychosis commonly appears during the course of these illnesses. Treatment of parkinsonism with antiparkinsonian medications constitutes an additional risk factor for the appearance or worsening of psychosis. Conversely, treatment of psychosis with antipsychotic drugs in patients with parkinsonism might worsen the underlying movement disorder, especially in the elderly. In this article, we review parkinsonian conditions in the elderly and offer guidelines to assess and manage comorbid psychosis. We focus on the pharmacologic management of psychosis with atypical antipsychotic medications and briefly review the role of acetylcholinesterase inhibitors.
Behrendt, Hannah F; Konrad, Kerstin; Goecke, Tamme W; Fakhrabadi, Roya; Herpertz-Dahlmann, Beate; Firk, Christine
Dyadic interactions between children and depressed mothers have been characterized as less synchronous and with lower maternal sensitivity, fostering an inharmonious, insecure attachment relationship between mother and child. Thus, these children may experience enhanced early life stress and are at higher risk of disturbed socioemotional development. Recently, this association has also been found in women with mild depressive symptoms. However, potential confounding effects of mother's history of own rearing experiences or infant temperament on the link between depressive symptoms and postnatal mother-to-infant attachment have not yet been investigated. Differences in mother-to-infant attachment (e.g. quality of attachment, absence of hostility, and pleasure in interaction) between mothers with and without symptoms of depression 6-8 months postpartum were analyzed in a low-risk community sample (n = 38, 19 per group). Depressive symptomatology was measured with the Beck Depression Inventory (BDI-II) and the Edinburgh Postnatal Depression Scale (EPDS). Depressed mothers indicated mild-to-moderate depressive symptomatology (mean BDI-II 11.26 ± 3.86) but did not fulfill criteria for a major depressive episode and, thus, were referred to as 'subclinically' depressed. Potential confounders, namely maternal history of own rearing experiences and infant temperament, were explored by multivariate AN(C)OVA. Primiparous mothers with subclinical depression differed significantly from healthy control mothers, i.e. showed poorer mother-to-infant attachment and higher infant-related hostility 6-8 months postpartum. As expected, infant temperament and mother's history of own rearing experiences were both associated with mother-to-infant attachment but did not explain the negative effects of subclinical depression on the mother-infant relationship. Given the high prevalence of maternal depression, the current findings give reason for increased concern for the developing mother
Zislin, J; Kuperman, V; Durst, R
The paper discusses the role of speech in the generation of psychosis. The traditional phenomenological approach describes schizophrenic speech as desocialized, autistic and destructive. Based on 'Speech Act Theory', we argue that patients in an acute psychotic state assign maximal illocutionary force to their utterances and mark these speech acts as felicitous. We hypothesize that the pragmatic approach can serve a special role in bilingual patients, the mother tongue being more pronounced in the generation of the psychosis. This view gains support from clinical experience and case studies and can be used as a treatment strategy for bilingual patients. Copyright 2002 Harcourt Publishers Ltd.
Tomlinson, Eleanor; Onwumere, Juliana; Kuipers, Elizabeth
This study explored the relationship between individuals with early psychosis and first-degree relatives who were carers, to see whether negative and distressing experiences of the patient-carer relationship were associated with social cognition difficulties in both groups. The study had a cross-sectional correlational design. A total of 33 patients with early psychosis (within 3 years of first psychotic episode) and 24 first-degree relative carers (all parents) completed measures of mood, expressed emotion and negative experiences of caregiving. Social cognition measures of theory of mind and emotion recognition were also collected. Patient perceptions of carer criticism were related to increased anxiety and depression. Carer negative experiences of caregiving were related to higher levels of expressed emotion, anxiety and depression. Both patients and carers showed impaired performance on social cognition tasks. However, patient social cognition was not related to perceptions of carer criticism or symptoms. Carer social cognition was not related to expressed emotion or carer burden. Even in the early stages of psychosis, both patients and carers were reporting negative experiences of the caregiving relationship. These were related to higher levels of anxiety and depression. Social cognition difficulties were found in both early psychosis patients and first-degree relatives, but did not relate to caregiving relationships. The findings underscore the importance of providing targeted family interventions to individuals with early psychosis and their carers that address appraisals of the relationship and low mood. © 2013 Wiley Publishing Asia Pty Ltd.
Jeffrey T-J Huang
Full Text Available BACKGROUND: The initial prodromal state of psychosis (IPS is defined as an early disease stage prior to the onset of overt psychosis characterized by sub-threshold or more unspecific psychiatric symptoms. Little is known regarding the biochemical changes during this period. METHODOLOGY/PRINCIPAL FINDINGS: We investigated the metabolic/proteomic profiles of cerebrospinal fluid (CSF of first-onset drug naïve paranoid schizophrenia patients (n = 54 and individuals presenting with initial prodromal symptoms (n = 24, alongside healthy volunteers (n = 70 using proton nuclear magnetic resonance ((1H-NMR spectroscopy and surface enhanced laser desorption ionization (SELDI mass spectrometry, respectively. Partial least square discriminant analysis (PLS-DA showed that 36%/29% of IPS patients displayed proteomic/metabolic profiles characteristic of first-onset, drug naïve schizophrenia, i.e., changes in levels of glucose and lactate as well as changes in a VGF-derived peptide (VGF23-62 and transthyretin protein concentrations. However, only 29% (n = 7 of the investigated IPS patients (who to date have been followed up for up to three years have so far received a diagnosis of schizophrenia. The presence of biochemical alterations in the IPS group did not correlate with the risk to develop schizophrenia. CONCLUSIONS/SIGNIFICANCE: Our results imply that schizophrenia-related biochemical disease processes can be traced in CSF of prodromal patients. However, the biochemical disturbances identified in IPS patients, at least when measured at a single time point, may not be sufficient to predict clinical outcome.
Tarrier, Nicholas; Khan, Sobia; Cater, Joanne; Picken, Alicia
The subjective impact of a psychotic breakdown can be profound, potentially resulting in loss of social roles, hopes and aspirations and leading to stigmatisation, trauma and elevated suicide risk. This study aimed to assess the subjective effect and consequences of suffering a first episode of psychosis. It was hypothesised that suicide behaviour would be associated with the negative consequences of psychosis and co-morbid symptomatic-PTSD. Patients were assessed by means of a semi-structured interview on their reactions and experience of their psychotic episode and its treatment and by means of standardised methods for psychotic (PANSS) and trauma-related (CAPS) symptoms. A total of 35 patients suffering their first episode of psychosis were interviewed. As a result of the onset of their illness, 77% indicated they had suffered loss or disruption to their life, 60% had thwarted future aspirations, 38% had suffered violence or harassment, 53% had suffered stigma and 50% social exclusion. Totally, 80% felt they had been traumatised by their treatment and 38% were cases for symptomatic-PTSD. Symptomatic-PTSD was significantly associated with involuntary hospitalisation but not psychotic symptoms. Positive psychotic symptoms were associated with harassment, stigma and social exclusion. Suicidal ideation was reported by 40% and 31% reported attempting suicide. Suicidal behaviour was greater in those suffering symptomatic-PTSD but this was not significant, suicidal behaviour was significantly associated with the experience of trauma, but not the severity of that trauma, prior to the onset of their psychosis. The negative consequences of a psychotic episode are significant. The potential iatrogenic effect of psychiatric care needs to be considered. Interventions need to be developed to reduce traumatisation and suicide risk.
Ospina, Luz H; Russo, Manuela; Nitzburg, George M; Cuesta-Diaz, Armando; Shanahan, Megan; Perez-Rodriguez, Mercedes M; Mcgrath, Meaghan; Levine, Hannah; Mulaimovic, Sandra; Burdick, Katherine E
Several studies have documented the prevalence and effects of cigarette smoking on cognition in psychotic disorders; fewer have focused on bipolar disorder (BD). Cognitive and social dysfunction are common in BD, and the severity of these deficits may be related both to illness features (e.g., current symptoms, psychosis history) and health-related behaviors (e.g., smoking, alcohol use). The current study assessed the influence of cigarette smoking on general and social cognition in a BD cohort, accounting for illness features with a focus on psychosis history. We assessed smoking status in 105 euthymic patients with BD, who completed a comprehensive battery including social (facial affect recognition, emotional problem-solving, and theory of mind) and general (the MATRICS Consensus Cognitive Battery and executive functioning) cognitive measures. We compared smokers vs nonsmokers on cognitive performance and tested for the effects of psychosis history, premorbid intellectual functioning, substance use, and current affective symptoms. Within the nonpsychotic subgroup with BD (n=45), smokers generally outperformed nonsmokers; by contrast, for subjects with BD with a history of psychosis (n=41), nonsmokers outperformed smokers. This pattern was noted more globally using a general composite cognitive score and on social/affective measures assessing patients' ability to identify emotions of facial stimuli and solve emotional problems. Cigarette smoking differentially affects performance on both general and social cognition in patients with BD as a function of psychosis history. These results suggest that there may be at least partially divergent underlying neurobiological causes for cognitive dysfunction in patients with BD with and without psychosis. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Rüsch, Nicolas; Corrigan, Patrick W; Heekeren, Karsten; Theodoridou, Anastasia; Dvorsky, Diane; Metzler, Sibylle; Müller, Mario; Walitza, Susanne; Rössler, Wulf
When young people at risk of psychosis experience early signs of the disorder or early intervention, they may label themselves as "mentally ill." However, empirical data related to the potentially harmful effects of self-labeling and stigma among young people at risk of psychosis are lacking. This study used a stress-coping model to examine mechanisms by which stigma may exert an impact on young people at risk of psychosis. The authors assessed self-reports of perceived public stigma, shame about having a mental illness, self-labeling, and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of well-being among 172 residents of Zürich, Switzerland, who were between 13 and 35 years old. All participants were at high risk or ultra-high risk of psychosis or at risk of bipolar disorder. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale, and well-being was measured by instruments that assessed quality of life, self-esteem, and self-efficacy. Perceived public stigma, shame, and self-labeling were independently associated with increased stigma stress. More stigma stress, in turn, predicted reduced well-being, independent of age, gender, symptoms, and psychiatric comorbidity. Stigma stress partly mediated the effects of perceived public stigma, shame, and self-labeling on well-being. Perceived public stigma, shame, and self-labeling appear to be associated with stigma stress and reduced well-being among young people at risk of psychosis. With early intervention programs gaining traction worldwide, effective strategies to address the shame and stigma associated with at-risk states and early psychosis are needed.
Corcoran, Cheryl M
The past two decades have marked an increase in research on the prodromal stages of schizophrenia that precede a first episode of psychosis. Criteria for a clinical high risk (CHR) state for psychosis have been validated and included in the DSM-5 as the attenuated psychosis syndrome and as requiring further study. This was hotly debated, given the concern of stigmatizing young people who would receive this psychosis risk label. In this article, I review ethical issues related to the psychosis risk label, including the potential harm of stigma and paternalism if risk labels are withheld in the context of the observed low predictive power of the psychosis risk designation. I review data that supports that the psychosis risk label need not be harmful, and could even confer benefit, and set out strategies for reducing stigma through individualized risk assessment and public health education. © 2016 American Medical Association. All Rights Reserved. ISSN 2376-6980.
Cieslak, Kristina; Pato, Michelle; Buckley, Peter; Pato, Carlos; Sobell, Janet L; Medeiros, Helena; Zhao, Yuan; Ahn, Hongshik; Malaspina, Dolores
Approximately three million individuals in the United States sustain traumatic brain injury (TBI) every year, with documented impact on a range of neurological and psychiatric disturbances including mania, depression, and psychosis. Identification of subsets of individuals that may demonstrate increased propensity for posttraumatic symptoms and who may share genetic vulnerabilities for gene-environment interactions can enhance efforts to understand, predict, and prevent these phenomena. A sample of 11,489 cases from the Genomic Psychiatry Cohort (GPC), a NIMH-managed data repository for the investigation of schizophrenia and bipolar disorder, was used for this study. Cases were excluded if TBI was deemed causal to their mental illness. A k-means clustering algorithm was used to probe differences between schizophrenia and bipolar disorder associated with variables including onset age, hallucinations, delusions, head injury, and TBI. Cases were separated into an optimum number of seven clusters, with two clusters including all cases with brain injury. Bipolar disorder with psychosis and TBI were significantly correlated in one cluster in which 72% of cases were male and 99.2% sustained head injury. This cluster also carried the longest average period of unconsciousness. This study demonstrates an association of TBI with psychosis in a subset of bipolar cases, suggesting that traumatic stressors may have the ability to impact gene expression in a vulnerable population, and/or there is a heightened occurrence of TBI in individuals with underlying psychosis. Further studies should more closely examine the interplay between genetic variation in bipolar disorder and susceptibility to psychosis following TBI. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
Jenkins, Lisanne M; Bodapati, Anjuli S; Sharma, Rajiv P; Rosen, Cherise
The recent dramatic increase in research investigating auditory verbal hallucinations (AVHs) has broadened the former narrow focus on schizophrenia to incorporate additional populations that experience these symptoms. However, an understanding of potential shared mechanisms remains elusive. Based on theories suggesting a failure of top-down cognitive control, we aimed to compare the relationship between AVHs and cognition in two categorical diagnoses of psychosis, schizophrenia and psychotic bipolar disorder. A total of 124 adults aged 21-60 participated, of whom 76 had present-state psychosis (schizophrenia, n = 53; bipolar disorder with psychosis, n = 23), and 48 were non-clinical controls. Diagnosis and hallucination presence was determined using the Structured Clinical Diagnostic Interview for DSM-IV TR. AVHs severity was assessed using the Positive and Negative Syndrome Scale. Participants also completed the MATRICS cognitive battery. The bipolar disorder with psychosis group performed better than the schizophrenia group for cognitive domains of Processing speed, Attention, Working memory (WM), and Visual memory. Hierarchical binary logistic regression found that WM significantly predicted presence of AVHs in both psychotic groups, but diagnosis did not significantly increase the predictive value of the model. A hierarchical multiple linear regression found that schizophrenia diagnosis was the only significant predictor of hallucination severity. The findings of this study-the first, to our knowledge, to compare the relationship between AVHs and MATRICS domains across schizophrenia and bipolar disorder with psychosis-support theories that deficits in WM underly the genesis of AVHs. WM potentially represents a shared mechanism of AVHs across diagnoses, supporting dimensional classifications of these psychotic disorders. However, non-cognitive factors predictive of hallucination severity may be specific to schizophrenia.
Eibye, Simone; Speyer, Helene; Benros, Michael Eriksen
We present a patient with psychiatric symptoms as the first manifestation from an undetected brain tumor. The patient had symptoms of psychosis and a prior history with depression. A slight alteration in consciousness was found but no neurological deficits. Blood tests showed increased infection ...... of physical origin....
Raffaelli, Marco; De Crea, Carmela; D'Amato, Gerardo; Gallucci, Pierpaolo; Lombardi, Celestino P; Bellantone, Rocco
We compared operative and metabolic outcomes in patients with subclinical Cushing syndrome and Cushing syndrome caused by unilateral adrenal lesion, aiming to clarify the role of glucocorticoid replacement treatment in patients with subclinical Cushing syndrome after adrenalectomy. The medical records of all the patients who underwent unilateral adrenalectomy for subclinical Cushing syndrome or Cushing syndrome were reviewed. Diagnostic criteria for subclinical Cushing syndrome were a pathologic dexamethasone suppression test plus 2 additional criteria. Twenty-nine patients with subclinical Cushing syndrome and 50 with Cushing syndrome were identified. No significant difference was found between patients with subclinical Cushing syndrome and Cushing syndrome regarding lesion size, operative time, and hospital stay. Two patients out of 29 with subclinical Cushing syndrome and 3 out of 50 patients with Cushing syndrome experienced Clavien-Dindo grade II complications (P = .87). All the patients required postoperative glucocorticoid replacement that was discontinued within 6 months in 28 of the 29 patients with subclinical Cushing syndrome and in 3 out of 50 Cushing syndrome patients (P Cushing syndrome and Cushing syndrome. Hypercortisolism was resolved in all the cases. Operative and metabolic outcomes of adrenalectomy are similar in subclinical Cushing syndrome and Cushing syndrome. Postoperative glucocorticoid replacement treatment is advisable in all patients with subclinical Cushing syndrome. Prolonged adrenal insufficiency is more frequent in Cushing syndrome patients. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available This paper is a clinical description of the presentation, therapy, and pharmacological management of a 28-year-old woman who had nine admissions to a psychiatry ward, the last four within one year. It became clear that the treatments, which the patient had received concurrently for ten years for a pituitary adenoma and for psychotic symptoms, were counteractive. The case highlights the importance of the role of prolactin in psychosis and of an interdisciplinary team approach when patients present with complex symptoms.
Lars Levi Dutschke
Full Text Available This case report describes a patient with a dysembryogenic neuroepithelial tumor localized in the posterior thalamus and internal capsule, which presented with psychosis including religiously determined severe self-mutilation, auditory hallucinations, and rituals. The patient’s history includes periodic religiousness over decades of her life suggesting that spirituality in this case might be a symptom of tumor progression. Our case reports on the topology-related effect of lesions on different brain networks involved in the phenomenology of the patient’s psychotic symptoms.
Liu, Cindy H; Keshavan, Matcheri S; Tronick, Ed; Seidman, Larry J
Schizophrenia and affective psychoses are debilitating disorders that together affect 2%-3% of the adult population. Approximately 50%-70% of the offspring of parents with schizophrenia manifest a range of observable difficulties including socioemotional, cognitive, neuromotor, speech-language problems, and psychopathology, and roughly 10% will develop psychosis. Despite the voluminous work on premorbid vulnerabilities to psychosis, especially on schizophrenia, the work on premorbid intervention approaches is scarce. While later interventions during the clinical high-risk (CHR) phase of psychosis, characterized primarily by attenuated positive symptoms, are promising, the CHR period is a relatively late phase of developmental derailment. This article reviews and proposes potential targets for psychosocial interventions during the premorbid period, complementing biological interventions described by others in this Special Theme issue. Beginning with pregnancy, parents with psychoses may benefit from enhanced prenatal care, social support, parenting skills, reduction of symptoms, and programs that are family-centered. For children at risk, we propose preemptive early intervention and cognitive remediation. Empirical research is needed to evaluate these interventions for parents and determine whether interventions for parents and children positively influence the developmental course of the offspring. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: firstname.lastname@example.org.
Salo, Ruth; Fassbender, Catherine; Iosif, Ana- Maria; Ursu, Stefan; Leamon, Martin H; Cameron, Carter
The goal of this study was to extend our previous research that reported a significant association between Attention Deficit Hyperactivity Disorder (ADHD)-relevant childhood behaviors and the frequency of methamphetamine (MA)-induced psychotic symptoms in an expanded sample. 190 participants who met DSM-IV criteria for MA dependence were administered the Methamphetamine Experience Questionnaire that assessed MA-induced psychosis. Data related to MA exposure, comorbid drug use, education, familial psychiatric history and assessments of ADHD-relevant childhood behaviors as measured by the Wender Utah Rating Scale (WURS) were collected. Although WURS scores did not differ between 145 MAP+ and 45 MAP-subjects, MAP+ subjects with higher WURS scores were significantly more likely to report more frequent psychosis. Although mean daily MA dosage did not differ between the MAP+ and MAP- subjects, MAP+ who consumed larger doses of MA were significantly more likely to experience frequent psychosis. These data suggest that ADHD-relevant childhood behaviors may interact with MA exposure to reflect a neurobiological vulnerability related to the emergence of frequent MA-induced psychotic symptoms. These results may elucidate factors that contribute to the psychiatric sequelae of MA abuse. PMID:23896355
Full Text Available Kosuke Okazaki, Manabu Makinodan, Kazuhiko Yamamuro, Tomoyo Takata, Toshifumi Kishimoto Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, JapanObjective: Methamphetamine (MA use has recently been associated with high levels of psychiatric hospitalization and serious social dysfunction. MA use causes frequent psychotic symptoms, which can be treated with antipsychotics. However, people with intellectual disabilities (ID are vulnerable to adverse effects resulting from treatment with antipsychotic medications.Method: We report two cases of MA-induced psychosis (MAP in patients with ID who were treated with the antipsychotic blonanserin.Results: In both the cases presented, symptoms of psychosis were improved by switching medications from other antipsychotic drugs to blonanserin. Despite the presence of ID in these patients, no significant adverse effects, such as sedation, were detected after treatment with blonanserin.Conclusion: Blonanserin may be an effective and well-tolerated pharmacotherapeutical treatment for patients with MAP comorbid with ID. However, further work is necessary to validate this claim.Keywords: methamphetamine, methamphetamine-induced psychosis, intellectual disabilities, blonanserin
Lincoln, Tania M; Hartmann, Maike; Köther, Ulf; Moritz, Steffen
Elevated negative affect is an established link between minor stressors and psychotic symptoms. Less clear is why people with psychosis fail to regulate distressing emotions effectively. This study tests whether subjective, psychophysiological and symptomatic responses to stress can be predicted by specific emotion regulation (ER) difficulties. Participants with psychotic disorders (n=35) and healthy controls (n=28) were assessed for ER-skills at baseline. They were then exposed to a noise versus no stressor on different days, during which self-reported stress responses, state paranoia and skin conductance levels (SCL) were assessed. Participants with psychosis showed a stronger increase in self-reported stress and SCL in response to the stressor than healthy controls. Stronger increases in self-reported stress were predicted by a reduced ability to be aware of and tolerate distressing emotions, whereas increases in SCL were predicted by a reduced ability to be aware of, tolerate, accept and modify them. Although paranoid symptoms were not significantly affected by the stressors, individual variation in paranoid responses was also predicted by a reduced ability to be aware of and tolerate emotions. Differences in stress responses in the samples were no longer significant after controlling for ER skills. Thus, interventions that improve ER-skills could reduce stress-sensitivity in psychosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Mazza, Monica; Catalucci, Alessia; Pino, Maria Chiara; Giusti, Laura; Nigri, Anna; Pollice, Rocco; Roncone, Rita; Casacchia, Massimo; Gallucci, Massimo
The "default mode", or baseline of brain function is a topic of great interest in schizophrenia research. Recent neuroimaging studies report that the symptoms of chronic schizophrenia subjects are associated with temporal frequency alterations as well as with the disruption of local spatial patterns in the default mode network (DMN). Previous studies both on chronic and medicated subjects with psychosis suffered from limitations; on this basis, it was hypothesized that the default mode network showed abnormal activation and connectivity in young and neuroleptic-naïve patients with first-episode psychosis. This study investigated emotional responses to pleasant and unpleasant/disgusting visual stimuli by a resting-state analysis of fMRI-data from 12 untreated first-episode psychosis patients with prevalently negative symptomatology versus 12 healthy subjects. We chose this experimental task to explore the functional link between default mode network and hedonic processing which has been proposed as a marker of cerebral dysfunction in psychotic disorder and implicated in its pathophysiology. Independent Component Analysis (ICA) was used to identify the default mode component. Both healthy and first-episode subjects showed significant spatial differences in the default mode network. In first-episode subjects, medial frontal hypoactivity and cerebellar hyperactivity were correlated with the severity of negative symptoms.
Hui, Christy Lai-Ming; Li, Yuet-Keung; Leung, Kwok-Fai; Tang, Jennifer Yee-Man; Wong, Gloria Hoi-Yan; Chang, Wing-Chung; Chan, Sherry Kit-Wa; Lee, Edwin Ho-Ming; Chen, Eric Yu-Hai
Functioning level is one of the major indicators of recovery in schizophrenia. It is important that the assessment of functioning is performed accurately. However, functioning evaluation is difficult due to the absence of specific anchor points in the widely used functioning assessment scales. We aimed to validate a new functioning scale, the life functioning assessment inventory (L-FAI), which assesses the functioning outcome of patients with psychosis in a more objective, and comprehensive manner. L-FAI assesses four life domains including work, social relationships, leisure, and homemaking. Specific and concrete anchor points are set in each of these domains. The reliability and validity of L-FAI were assessed in 32 patients with psychosis. Opinions towards the scale were also obtained from experienced mental health professionals and members of a local advocacy group. Good inter-rater reliability (Cohen's kappa 0.67-0.97) and test-retest reliability (Cohen's kappa 0.67-0.86) were found. The scale has also been found to have good concurrent validity, correlating well with social and occupational functioning assessment scale (SOFAS) and role functioning scale (RFS) (Spearman's r 0.53-0.89). The scale was associated solely with negative symptoms (Spearman's r -0.48) but not with positive symptoms. L-FAI is suited for both clinical and research purposes in evaluating functioning level in patients with psychosis. More research is needed to replicate the current study with a larger sample size.
Kobak Kenneth A
Full Text Available Abstract Videoconferencing has become an increasingly viable tool in psychiatry, with a growing body of literature on its use with a range of patient populations. A number of factors make it particularly well suited for patients with psychosis. For example, patients living in remote or underserved areas can be seen by a specialist without need for travel. However, the hallmark symptoms of psychotic disorders might lead one to question the feasibility of videoconferencing with these patients. For example, does videoconferencing exacerbate delusions, such as paranoia or delusions of reference? Are acutely psychotic patients willing to be interviewed remotely by videoconferencing? To address these and other issues, we conducted an extensive review of Medline, PsychINFO, and the Telemedicine Information Exchange databases for literature on videoconferencing and psychosis. Findings generally indicated that assessment and treatment via videoconferencing is equivalent to in person and is tolerated and well accepted. There is little evidence that patients with psychosis have difficulty with videoconferencing or experience any exacerbation of symptoms; in fact, there is some evidence to suggest that the distance afforded can be a positive factor. The results of two large clinical trials support the reliability and effectiveness of centralized remote assessment of patients with schizophrenia.
Solli, Hans Petter; Rolvsjord, Randi
Previous research studies regarding music therapy and severe mental illness have mainly adopted quantitative methodologies in order to study the effectiveness of music therapy interventions. Studies that have explored service users' experiences of participation in music therapy are small in number, and almost nonexistent in the field of psychosis. This study aimed to explore how mental health patients with a diagnosis of psychosis experienced participation in music therapy, in general, and more specifically how they experienced music therapy in relation to their current mental state and life situation. Nine inpatients with psychosis were interviewed using a semi-structured interview focusing on the participants' experiences of music therapy in individual sessions, groups, and performances. Through the use of interpretative phenomenological analysis, four super-ordinate themes central to the participants' experiences were found: freedom, contact, well-being, and symptom reduction. Based on the findings, mental health recovery, positive mental health, and agency are proposed as constituting a better framework for music therapy in mental healthcare than a primary focus on symptom remission and functional improvement.
Healey, Kristin M; Penn, David L; Perkins, Diana; Woods, Scott W; Addington, Jean
Social cognitive deficits are consistently reported in psychotic populations. Few studies have longitudinally investigated social cognition in clinical high-risk (CHR) populations. Longitudinally examine theory of mind (ToM) and social judgments in a CHR sample to investigate the stability of performance over time and potential ability to predict conversion to psychosis. 147 CHR individuals and 85 help seeking controls (HSC) were assessed for up to 2years; 28 participants developed psychosis across both groups. Generalized linear mixed models for repeated measures were used to examine change over time for ratings on the three social cognitive indices of ToM, trustworthiness, and approachability. Hierarchical regression was used to test whether social cognitive variables explain more variance in conversion than IQ. CHR individuals showed a positive bias in approachability judgments over time compared to HSC. Baseline ToM performance significantly (pIQ scores. These results were attenuated when controlling for baseline symptom level. Although ToM deficits might predate conversion to psychosis, one must consider initial symptoms as well. Social judgments were not associated with conversion to schizophrenia. © 2013 Elsevier B.V. All rights reserved.
De Gregorio, Danilo; Comai, Stefano; Posa, Luca; Gobbi, Gabriella
d-Lysergic Acid Diethylamide (LSD) is known for its hallucinogenic properties and psychotic-like symptoms, especially at high doses. It is indeed used as a pharmacological model of psychosis in preclinical research. The goal of this review was to understand the mechanism of action of psychotic-like effects of LSD. We searched Pubmed, Web of Science, Scopus, Google Scholar and articles' reference lists for preclinical studies regarding the mechanism of action involved in the psychotic-like effects induced by LSD. LSD's mechanism of action is pleiotropic, primarily mediated by the serotonergic system in the Dorsal Raphe, binding the 5-HT2A receptor as a partial agonist and 5-HT1A as an agonist. LSD also modulates the Ventral Tegmental Area, at higher doses, by stimulating dopamine D₂, Trace Amine Associate receptor 1 (TAAR₁) and 5-HT2A. More studies clarifying the mechanism of action of the psychotic-like symptoms or psychosis induced by LSD in humans are needed. LSD's effects are mediated by a pleiotropic mechanism involving serotonergic, dopaminergic, and glutamatergic neurotransmission. Thus, the LSD-induced psychosis is a useful model to test the therapeutic efficacy of potential novel antipsychotic drugs, particularly drugs with dual serotonergic and dopaminergic (DA) mechanism or acting on TAAR₁ receptors.
Danilo De Gregorio
Full Text Available d-Lysergic Acid Diethylamide (LSD is known for its hallucinogenic properties and psychotic-like symptoms, especially at high doses. It is indeed used as a pharmacological model of psychosis in preclinical research. The goal of this review was to understand the mechanism of action of psychotic-like effects of LSD. We searched Pubmed, Web of Science, Scopus, Google Scholar and articles’ reference lists for preclinical studies regarding the mechanism of action involved in the psychotic-like effects induced by LSD. LSD’s mechanism of action is pleiotropic, primarily mediated by the serotonergic system in the Dorsal Raphe, binding the 5-HT2A receptor as a partial agonist and 5-HT1A as an agonist. LSD also modulates the Ventral Tegmental Area, at higher doses, by stimulating dopamine D2, Trace Amine Associate receptor 1 (TAAR1 and 5-HT2A. More studies clarifying the mechanism of action of the psychotic-like symptoms or psychosis induced by LSD in humans are needed. LSD’s effects are mediated by a pleiotropic mechanism involving serotonergic, dopaminergic, and glutamatergic neurotransmission. Thus, the LSD-induced psychosis is a useful model to test the therapeutic efficacy of potential novel antipsychotic drugs, particularly drugs with dual serotonergic and dopaminergic (DA mechanism or acting on TAAR1 receptors.
Gleeson, John; Larsen, T K; McGorry, Patrick
This article aims to overview a broad range of psychosocial treatments for first-episode psychosis, and for the prodromal phase (or so-called at-risk mental state)--the period preceding the first acute episode (Yung and McGorry, 1996). Firstly, an introduction to the empirically based rationale for early intervention in first-episode psychosis is provided. This is followed by a selective review of individual psychotherapies for early psychosis, which then proceeds to a discussion of family-based interventions for first-episode families and the role of group programs. Next, the role of psychological interventions within the newly emerging indicated preventive approach (Mrazek and Haggerty, 1994) for at-risk mental state is examined before some illustrative case material is presented. It is concluded that integrated psychosocial interventions for first-episode psychosis and for prodrome are newly emerging, innovative fields that offer some preventive opportunities. These opportunities, combined with some initial outcome data, warrant continuing research and clinical innovation.
Bachmann, Silke; Resch, Franz; Mundt, Christoph
This article is part of the ISPS (International Society for the Psychological Treatment of the Schizophrenias and other Psychoses) task force report on the PORT (Patients Outcome Research Team) recommendations for treatment of schizophrenia. It reviews psychological treatment approaches in psychosis to date and assesses recent trends. The most influential therapies have been psychoanalytic/psychodynamic, cognitive behavioral (CBT), and supportive therapy.
Dusseldorp, L. van; Goossens, P.J.J.; Achterberg, T. van
The purpose of this literature review is to identify mental health nursing's contribution to the care and treatment of patients with a first episode of psychosis; A systematic literature review was undertaken, with 27 articles selected for study. Five domains were identified: development of
corticosteroids, there are however, few reported cases of catatonia due to steroids. A literature search revealed very few articles written on catatonia due to steroids. We report a case of apparent dexamethasone induced psychosis presenting with features of catatonia. B.O, a 20year old female undergraduate in Nigeria, was.
disorders, delirium and anxiety disorders due to use of corticosteroids, there are however, few reported cases of catatonia due to steroids. A literature search revealed very few articles written on catatonia due to steroids. We report a case of apparent dexamethasone induced psychosis presenting with features of catatonia.
Austin, Stephen; Mors, Ole; Secher, Rikke Gry
Recovery, the optimal goal in treatment, is the attainment of both symptomatic and functional remission over a sustained period of time. Identification of factors that promote recovery can help develop interventions that facilitate good outcomes for people with first episode psychosis....
Seeman, Mary V
Many reports from European countries suggest that acute episodes of psychosis are more frequent among immigrants from the Caribbean than among their non-immigrant peers. The aim of this selective review is to examine how the social correlates of migration to Canada interact with biological mechanisms to contribute to psychosis in the Caribbean population. PubMed and JSTOR social science databases (between 1966 and 2010) were searched using the following search terms: psychiatric genetics; dopamine pathways; Caribbean family structure and child rearing; cannabis and psychosis; obstetric complications and schizophrenia; social defeat; social capital; racial discrimination; urbanicity; immigration; assimilation; and immigration. This was followed by the cross-checking of references pertinent to Canada. There was no information about the prevalence of psychosis in Afro-Caribbean immigrant groups to Canada. There was a suggestion that the form the acute episode takes may differ, depending perhaps on the island of origin. Ethnicity and migration influence susceptibility and response to psychotic illness in a number of distinct and interacting ways depending both on the host country and the country of origin. Understanding the pathways can help to protect the health of immigrants.
Read, John; Fosse, Roar; Moskowitz, Andrew
of this paper, therefore, is to summarize the literature on biological mechanisms underlying the relationship between childhood trauma and psychosis published since 2001. A comprehensive search for relevant papers was undertaken via Medline, PubMed and psycINFO. In total, 125 papers were identified...
Gregg, Lynsey; Barrowclough, Christine; Haddock, Gillian
Around half of all patients with schizophrenia are thought to abuse drugs or alcohol and there is good evidence to suggest that they have poorer outcomes than their non substance using counterparts. However, despite more than twenty years of research there is still no consensus on the aetiology of increased rates of substance use in people with psychosis. There is a clear need to understand the reasons for such high rates of substance use if treatments designed to help patients abstain from substance use are to be successful. This paper provides an update of the literature examining the reasons for substance use by people with psychosis, and includes a comprehensive review of the self report literature. The main theories as to why people with psychosis use substances are presented. There is evidence to suggest that cannabis may have a causal role in the development of psychopathology but not for other substances. The self report literature provides support for an 'alleviation of dysphoria' model of substance use but there is little empirical support for the self medication hypothesis, or for common factor models and bidirectional models of comorbidity. It is likely that there are multiple risk factors involved in substance use in psychosis and more work to develop and test multiple risk factor models is required.