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Sante Mentale Au Quebec 2021Objectives This article aims to contextualize and review interventions for patients with a clinical high-risk (CHR) state for psychosis. Method This review explores the... (Review)
Review
Objectives This article aims to contextualize and review interventions for patients with a clinical high-risk (CHR) state for psychosis. Method This review explores the literature on the CHR state and focuses more precisely on the development of its defining criteria, the evolution of CHR patients, the main interventions studied so far, and the clinical services implemented to date. Results The CHR criteria were developed from observations on the prodrome of psychotic disorders to prevent or delay the onset of psychosis. These criteria help defining three distinct groups of patients who seek help because of significant distress and functional impairments. The diagnostic evaluation remains a critical step that represents a challenge for clinicians. A significant proportion of CHR patients will not develop a psychotic disorder. And the course can be unfavorable even if there is no conversion to a psychotic disorder. In order to improve the clinical conditions of CHR patients, several interventions have been developed and studied. They fall into two main categories: psychosocial approaches and pharmacotherapy. Clinical initiatives to assess and provide support to these patients have emerged around the world, including in Switzerland, in France, and in Canada. The implementation and the integration of these services within existing health care system are influenced by several factors, including the organization of health care structures. Knowing that only a small proportion of CHR patients will progress to a psychotic disorder, it is relevant to offer these interventions in non-stigmatizing and youth-friendly places. These services would possibly be distinct from first-episode psychosis programs. Conclusion Interventions for CHR patients go well beyond the prevention of psychosis. They meet legitimate clinical needs. We must think about how to deploy them adequately in the most appropriate places.
Topics: Adolescent; France; Humans; Psychotic Disorders
PubMed: 35617495
DOI: No ID Found -
The International Journal of Social... Nov 2023Migration is a robust risk factor for developing a psychotic disorder, yet there is a paucity of research on the outcomes of migrants who develop a psychotic disorder....
BACKGROUND
Migration is a robust risk factor for developing a psychotic disorder, yet there is a paucity of research on the outcomes of migrants who develop a psychotic disorder. Identifying sub-groups within FEP cohorts who have a poorer outcome, could assist in the development and delivery of more targeted interventions.
AIMS
There is a paucity of research on the outcomes of migrants who develop a psychotic disorder. This study aimed to evaluate a broad range of outcomes for those with a FEP who migrated to the Republic of Ireland, including: (i) symptomatic; (ii) functional; (iii) hospitalisation and (iv) engagement with psychosocial services.
METHODS
All individuals with a FEP aged 18 to 65 who presented between 01.02.2006 and 01.07.2014 were included. Structured and validated instruments were used to measure positive, negative, depressive symptoms and insight.
RESULTS
Of the 573 individuals with a FEP, 22.3% were first-generation migrants and 63.4% ( = 363) were followed up at 1 year. At this time, 72.4% of migrants were in remission of positive psychotic symptoms compared to 78.5% of the Irish born ( = 0.84, 95% CI [0.50-1.41], = .51). In relation to negative symptoms, 60.5% of migrants were in remission compared to 67.2% of the Irish born ( = 0.75, 95% CI [0.44-1.27], = .283). There was no difference in the severity of positive, negative or depressive symptoms between groups and there was a trend for the Irish born to have better insight ( = .056). The functional outcomes were similar across groups. One third of migrants were admitted to hospital compared to 28.7% of the Irish born ( = 1.24, 95% CI [0.73-2.13], = .426). Just over half of both groups attended CBT and 46.2% of caregivers for migrants attended the psychoeducation programme, compared to 39.7% for the Irish born ( = 1.30, 95% CI [0.79-2.16], = .306).
CONCLUSIONS
These findings demonstrate that migrants have broadly similar outcomes to the native-born populations, however there is still considerable scope for the outcomes for all individuals affected by psychotic disorders to be improved.
Topics: Humans; Transients and Migrants; Ireland; Psychotic Disorders; Risk Factors; Hospitalization
PubMed: 37211684
DOI: 10.1177/00207640231174360 -
BMC Psychiatry Mar 2023Disruptive and aggressive behavior is frequent in patients with a psychotic disorder; furthermore, it is a recurrent reason for compulsory admission. Even during...
BACKGROUND
Disruptive and aggressive behavior is frequent in patients with a psychotic disorder; furthermore, it is a recurrent reason for compulsory admission. Even during treatment, many patients continue to show aggressive behavior. Antipsychotic medication is posed to have anti-aggressive properties; its prescription is a common strategy for the treatment (and prevention) of violent behavior. The present study aims to investigate the relation between the antipsychotic class, according to the dopamine D2-Receptor binding affinity (i.e., "loose" - "tight binding"), and aggressive events perpetrated by hospitalized patients with a psychotic disorder.
METHODS
We conducted a four-year retrospective analysis of legally liable aggressive incidents perpetrated by patients during hospitalization. We extracted patients' basic demographic and clinical data from electronic health records. We used the Staff Observation Aggression Scale (SOAS-R) to grade the severity of an event. Differences between patients with a "loose" or "tight-binding" antipsychotic were analyzed.
RESULTS
In the observation period, there were 17,901 direct admissions; and 61 severe aggressive events (an incidence of 0.85 for every 1,000 admissions year). Patients with a psychotic disorder perpetrated 51 events (incidence of 2.90 for every 1,000 admission year), with an OR of 15.85 (CI: 8.04-31.25) compared to non-psychotic patients. We could identify 46 events conducted by patients with a psychotic disorder under medication. The mean SOAS-R total score was 17.02 (2.74). The majority of victims in the "loose-binding" group were staff members (73.1%, n = 19), while the majority of victims in the "tight-binding" group were fellow patients (65.0%, n = 13); (X(3,46) = 19.687; p < 0.001). There were no demographic or clinical differences between the groups and no differences regarding dose equivalents or other prescribed medication.
CONCLUSIONS
In aggressive behaviors conducted by patients with a psychotic disorder under antipsychotic medication, the dopamine D2-Receptor affinity seems to have a high impact on the target of aggression. However, more studies are needed to investigate the anti-aggressive effects of individual antipsychotic agents.
Topics: Humans; Antipsychotic Agents; Retrospective Studies; Dopamine; Psychotic Disorders; Aggression
PubMed: 36978013
DOI: 10.1186/s12888-023-04692-1 -
Early Intervention in Psychiatry Aug 2021There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in...
AIM
There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first-episode psychosis and their association with 1-year psychosis recovery.
METHODS
The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1-year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore.
RESULTS
Out of 180 participants, 50 (27.8%) had clinically elevated above screening-cut off levels of autistic traits on the self-reported 10-item Autism Spectrum Quotient and 8 (4.4%) on the staff-rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1-year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology.
CONCLUSIONS
Autistic traits are common in those with first-episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
Topics: Adult; Autism Spectrum Disorder; Autistic Disorder; Humans; Mood Disorders; Psychotic Disorders; Schizophrenia
PubMed: 32710521
DOI: 10.1111/eip.13021 -
Neuropsychopharmacology : Official... Mar 2020Abnormal neuroanatomic brain networks have been reported in schizophrenia, but their characterization across patients with psychotic disorders, and their potential...
Abnormal neuroanatomic brain networks have been reported in schizophrenia, but their characterization across patients with psychotic disorders, and their potential alterations in nonpsychotic relatives, remain to be clarified. Participants recruited by the Bipolar and Schizophrenia Network for Intermediate Phenotypes consortium included 326 probands with psychotic disorders (107 with schizophrenia (SZ), 87 with schizoaffective disorder (SAD), 132 with psychotic bipolar disorder (BD)), 315 of their nonpsychotic first-degree relatives and 202 healthy controls. Single-subject gray matter graphs were extracted from structural MRI scans, and whole-brain neuroanatomic organization was compared across the participant groups. Compared with healthy controls, psychotic probands showed decreased nodal efficiency mainly in bilateral superior temporal regions. These regions had altered morphological relationships primarily with frontal lobe regions, and their network-level alterations were associated with positive symptoms of psychosis. Nonpsychotic relatives showed lower nodal centrality metrics in the prefrontal cortex and subcortical regions, and higher nodal centrality metrics in the left cingulate cortex and left thalamus. Diagnosis-specific analysis indicated that individuals with SZ had lower nodal efficiency in bilateral superior temporal regions than controls, probands with SAD only exhibited lower nodal efficiency in the left superior and middle temporal gyrus, and individuals with psychotic BD did not show significant differences from healthy controls. Our findings provide novel evidence of clinically relevant disruptions in the anatomic association of the superior temporal lobe with other regions of whole-brain networks in patients with psychotic disorders, but not in their unaffected relatives, suggesting that it is a disease-related trait. Network disorganization primarily involving frontal lobe and subcortical regions in nonpsychotic relatives may be related to familial illness risk.
Topics: Adult; Brain; Female; Gray Matter; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nerve Net; Psychotic Disorders; Young Adult
PubMed: 31812151
DOI: 10.1038/s41386-019-0586-2 -
Sante Mentale Au Quebec 2021Objectives Comorbidities that are less well known than substance use disorders may occur in individuals experiencing a first-episode psychosis (FEP). This article... (Review)
Review
Objectives Comorbidities that are less well known than substance use disorders may occur in individuals experiencing a first-episode psychosis (FEP). This article reviews the importance of these comorbidities through a synthesis of the literature, informed by the authors' clinical experience. Methods Five main groups of comorbidities are discussed: anxiety and obsessive-compulsive disorders, depression, borderline personality disorder, gambling disorder and attention deficit disorder. For each of these disorders, data on their frequency, their impact on the outcome of affected individuals, their detection and treatment will be discussed and interpreted in light of the authors' clinical experience. Results These comorbidities have been relatively neglected by research, even more so in the specific context of FEP. Nevertheless, the data that are available suggest that they are very common in this population. For example, it is estimated that the prevalence of social anxiety disorder may be as high as 50% and obsessive-compulsive disorder 13.6%. The manifestations of these comorbid disorders are sometimes difficult to dissociate from those of the illness; several manifestations of the psychoses can be encountered in these comorbid disorders and vice versa. For example, the social withdrawal sometimes encountered in anxiety disorders or depression may be confused with negative symptoms; behavioural disturbances resulting from delusional beliefs or behavioural disorganization occurring in psychosis may lead to a misdiagnosis of a personality disorder; psychotic symptoms occurring in a personality disorder share characteristics with those occurring in psychotic disorders; cognitive difficulties associated with an attention deficit disorder may give the impression of being directly related to the psychotic disorder. In some cases, antipsychotic treatment may contribute to the emergence of manifestations of these comorbid disorders, for example, obsessive-compulsive disorder occurring on clozapine, or gambling disorder occurring during treatment with a dopamine agonist. While treatments for these comorbidities have been poorly evaluated in the FEP setting, available data and clinical experience suggest that treatments used in other populations, when adapted to the FEP setting, may be effective. Conclusion Overall, there is little literature addressing these comorbid disorders in FEP. Yet, the available evidence suggests that they are common, and that their detection and treatment can support recovery in individuals coping with FEP. Thus, it is essential to consider them from a recovery-oriented early intervention practice perspective.
Topics: Antipsychotic Agents; Anxiety; Anxiety Disorders; Humans; Obsessive-Compulsive Disorder; Psychotic Disorders
PubMed: 35617503
DOI: No ID Found -
Tijdschrift Voor Psychiatrie 2024Background Patients with psychotic disorders have a higher risk of physical illnesses on account of genetic predisposition, poorer access to...
Background Patients with psychotic disorders have a higher risk of physical illnesses on account of genetic predisposition, poorer access to healthcare, medication use, environmental factors and lifestyle. Because healthy lifestyle behaviour is established at young age, it is important to signal problems in good time. A lifestyle screening might be useful in this respect. Aim To describe the lifestyle characteristics of patients in a mental health clinic for young adults (age: 18-28 years) with early psychotic disorder based on parts of the instrument ‘Lifestyle-in-the-picture’ compared to healthy controls. We also discuss experiences of lifestyle coaches in applying ‘Lifestyle-in-the-picture’. Method Lifestyle characteristics and lifestyle behaviour of 90 patients with a psychotic disorder and 137 young adults from the general population were compared quantitatively. Additionally, interviews were held with lifestyle coaches as to the use of the instrument ‘Lifestyle-in-the-picture’. Results The young adult patients had considerably poorer results on lifestyle aspects than controls: increased body mass index (BMI 53% versus 18%), smoking, addiction and unhealthy eating and activity patterns. They were more dissatisfied with their physical and mental health. According to the lifestyle coaches, the ‘Lifestyle-in-the-picture’ instrument was a good starting point to work on improvement with patients since the instrument provided insight in the healthy and unhealthy aspects of their lifestyle and gave directions to set goals. Conclusions Young adults with a psychotic disorder have an unhealthy lifestyle and also more risk factors compared to controls. Lifestyle screening programmes are important to discuss health risks in time and which steps for improvement can be taken. The step from insight to actual more healthy behaviour is challenging.
Topics: Humans; Young Adult; Adolescent; Adult; Psychotic Disorders; Life Style; Health Behavior; Behavior, Addictive; Emotions
PubMed: 38512145
DOI: No ID Found -
Schizophrenia Research Mar 2018Psychotic experiences are associated with a number of poor clinical outcomes, including multimorbid psychopathology, suicidal behavior, and poor treatment response. We...
Psychotic experiences are associated with a number of poor clinical outcomes, including multimorbid psychopathology, suicidal behavior, and poor treatment response. We wished to investigate the relationship between psychotic experiences and disability, including the following domains: cognition, mobility, self-care, social interaction, role functioning, and days out of role. We used three nationally representative and racially/ethnically diverse samples of the general US adult population: the National Comorbidity Survey Replication (NCS-R), the National Latino and Asian American Survey (NLAAS), and the National Survey of American Life (NSAL). Multi-variable logistic regression analyses were used to assess the associations between lifetime psychotic experiences (visual and auditory hallucinatory experiences and delusional ideation; WHO Composite International Diagnostic Interview psychosis screen) and 30-day impairments in functioning across disability domains (using the WHO Disability Assessment Schedule II). In all three samples, models were adjusted for socio-demographics and co-occurring psychiatric disorders. In the NCS-R, models were also adjusted for chronic health conditions. Across all three studies, our adjusted models showed that people with disability had anywhere from about 1.5 to over 3 times the odds of reporting lifetime psychotic experiences, depending on the domain. This was true for each disability domain, except self-care in the NLAAS and in the NSAL. Psychotic experiences are markers of risk for disability across a wide range of domains. This may explain the elevated rates of service utilization among individuals who report psychotic experiences and supports the need to assess for and respond to psychotic experiences even in the absence of psychotic disorder.
Topics: Adolescent; Adult; Age Factors; Aged; Asian; Cognition Disorders; Delusions; Disabled Persons; Female; Hallucinations; Health Surveys; Hispanic or Latino; Humans; Interpersonal Relations; Male; Mental Health; Middle Aged; Psychiatric Status Rating Scales; Psychotic Disorders; United States; Young Adult
PubMed: 28797526
DOI: 10.1016/j.schres.2017.07.049 -
Translational Psychiatry Jun 2021The insula is a heterogeneous cortical region, comprised of three cytoarchitecturally distinct sub-regions (agranular, dysgranular, and granular), which traverse the...
The insula is a heterogeneous cortical region, comprised of three cytoarchitecturally distinct sub-regions (agranular, dysgranular, and granular), which traverse the anterior-posterior axis and are differentially involved in affective, cognitive, and somatosensory processing. Smaller insula volume is consistently reported in psychosis-spectrum disorders and is hypothesized to result, in part, from abnormal neurodevelopment. To better understand the regional and diagnostic specificity of insula abnormalities in psychosis, their developmental etiology, and clinical correlates, we characterized insula volume and morphology in a large group of adults with a psychotic disorder (schizophrenia spectrum, psychotic bipolar disorder) and a community-ascertained cohort of psychosis-spectrum youth (age 8-21). Insula volume and morphology (cortical thickness, gyrification, sulcal depth) were quantified from T1-weighted structural brain images using the Computational Anatomy Toolbox (CAT12). Healthy adults (n = 196), people with a psychotic disorder (n = 303), and 1368 individuals from the Philadelphia Neurodevelopmental Cohort (PNC) (381 typically developing (TD), 381 psychosis-spectrum (PS) youth, 606 youth with other psychopathology (OP)), were investigated. Insula volume was significantly reduced in adults with psychotic disorders and psychosis-spectrum youth, following an anterior-posterior gradient across granular sub-regions. Morphological abnormalities were limited to lower gyrification in psychotic disorders, which was specific to schizophrenia and associated with cognitive ability. Insula volume and thickness were associated with cognition, and positive and negative symptoms of psychosis. We conclude that smaller insula volume follows an anterior-posterior gradient in psychosis and confers a broad risk for psychosis-spectrum disorders. Reduced gyrification is specific to schizophrenia and may reflect altered prenatal development that contributes to cognitive impairment.
Topics: Adolescent; Adult; Bipolar Disorder; Cerebral Cortex; Child; Humans; Magnetic Resonance Imaging; Psychotic Disorders; Schizophrenia; Young Adult
PubMed: 34088895
DOI: 10.1038/s41398-021-01461-0 -
BMC Psychiatry Mar 2023Psychotic disorders such as schizophrenia have debilitating effects on health and functioning. Given symptomatic remission's recent emergence as a viable treatment goal,...
BACKGROUND
Psychotic disorders such as schizophrenia have debilitating effects on health and functioning. Given symptomatic remission's recent emergence as a viable treatment goal, the Remission in Schizophrenia Working Group's criteria (RSWG-cr), based on eight items from the Positive and Negative Syndrome Scale (PANSS-8), are frequently used in clinical and research settings. Against that background, we sought to evaluate the PANSS-8's psychometric properties and examine the RSWG-cr's clinical validity among outpatients in Sweden.
METHODS
Cross-sectional register data were collected from outpatient psychosis clinics in Gothenburg, Sweden. Following confirmatory and exploratory factor analyses of PANSS-8 data (n = 1,744) to assess the PANSS-8's psychometric properties, internal reliability was evaluated using Cronbach's alpha. Next, 649 of the patients were classified according to the RSWG-cr and their clinical and demographic characteristics compared. Binary logistic regression was used to estimate odds ratios (OR) and assess each variable's impact on remission status.
RESULTS
The PANSS-8 showed good reliability (α = .85), and the 3D model of psychoticism, disorganization, and negative symptoms presented the best model fit. According to the RSWG-cr, 55% of the 649 patients were in remission; they were also more likely to live independently, be employed, not smoke, not take antipsychotics, and have recently received a health interview and physical examination. Patients living independently (OR = 1.98), who were employed (OR = 1.89), who were obese (OR = 1.61), and who had recently received a physical examination (OR = 1.56) also had an increased likelihood of remission.
CONCLUSIONS
The PANSS-8 is internally reliable, and, according to the RSWG-cr, remission is associated with variables of interest for patients' recovery, including living independently and being employed. Although our findings from a large, heterogeneous sample of outpatients reflect everyday clinical practice and reinforce past observations, the directions of those relationships need to be assessed in longitudinal studies.
Topics: Humans; Schizophrenia; Outpatients; Psychometrics; Reproducibility of Results; Cross-Sectional Studies; Psychotic Disorders; Psychiatric Status Rating Scales
PubMed: 36978160
DOI: 10.1186/s12888-023-04701-3