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Acta Psychiatrica Scandinavica Aug 2023Genetic studies of bipolar disorder (BD) have shown varied results, which is in part because of the heterogeneity of the disorder. Identifying clinical phenotypes of BD... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Genetic studies of bipolar disorder (BD) have shown varied results, which is in part because of the heterogeneity of the disorder. Identifying clinical phenotypes of BD could reduce variability and benefit research. Since BD has a robust genetic component, studies can investigate clinical traits that cluster in families to identify phenotypes with a probable genetic basis.
METHODS
We conducted a systematic review of the current literature on familial clinical traits of BD. Text screening and data extraction were performed independently by two reviewers, and random effects meta-analysis was used.
RESULTS
Of 1117 unique records, 16 studies met inclusion criteria. These studies indicated 14 potentially familial traits of BD: age of onset (OR: 4.50; 95% CI: [3.25, 6.22]), bipolar type (OR: 2.05 [1.50, 2.79]), lithium response (OR: 3.71 [1.28, 10.82]), polarity at onset (OR: 1.17 [1.03, 1.34]), psychotic features (OR: 2.20 [1.51, 3.20]), mood-incongruent psychosis (OR: 2.52 [1.66, 3.83]), puerperal psychosis (OR: 6.54 [2.55, 16.77]), rapid cycling (OR: 4.95 [0.96, 25.40]), suicide attempt (OR: 1.04 [0.65, 1.67]), alcoholism (OR: 1.53 [1.09, 2.16]), obsessive-compulsive disorder (OR: 3.10 [1.31; 7.09]), panic disorder (OR: 2.69 [1.12; 6.48]), social anxiety disorder (OR: 1.00 [0.39, 2.55]), and specific phobia (OR: 1.94 [0.95; 3.96]). For most traits, tests of heterogeneity were significant and publication bias was likely.
CONCLUSION
The results of our review and meta-analysis highlight the lack of studies investigating familial clinical traits of BD, despite the need to address heterogeneity. The large degree of variability between studies must be reduced for future research.
Topics: Humans; Bipolar Disorder; Phenotype; Psychotic Disorders; Obsessive-Compulsive Disorder; Panic Disorder
PubMed: 37190775
DOI: 10.1111/acps.13569 -
Substance use and psychotic-like experiences in young people: a systematic review and meta-analysis.Psychological Medicine Jan 2023This study aimed to systematically review and synthesise the available evidence on the prevalence and associations between psychotic-like experiences (PLEs) and... (Meta-Analysis)
Meta-Analysis Review
This study aimed to systematically review and synthesise the available evidence on the prevalence and associations between psychotic-like experiences (PLEs) and substance use in children and adolescents aged ⩽17 years, prior to the typical age of development of prodromal symptoms of psychosis. As substance use has been associated with earlier age of psychosis onset and more severe illness, identifying risk processes in the premorbid phase of the illness may offer opportunities to prevent the development of prodromal symptoms and psychotic illness. MEDLINE, PsycINFO, and CINAHL databases were searched for chart review, case-control, cohort, twin, and cross-sectional studies. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist, and pooled evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Searches identified 55 studies that met inclusion criteria. Around two-in-five substance users reported PLEs [rate = 0.41, 95% confidence interval (CI) 0.32-0.51; low quality evidence], and one-in-five with PLEs reported using substances (rate = 0.19, 95% CI 0.12-0.28; moderate-to-high quality evidence). Substance users were nearly twice as likely to report PLEs than non-users [odds ratio (OR) 1.77, 95% CI 1.55-2.02; moderate quality evidence], and those with PLEs were twice as likely to use substances than those not reporting PLEs (OR 1.93, 95% CI 1.55-2.41; very low quality evidence). Younger age was associated with greater odds of PLEs in substance users compared to non-users. Young substance users may represent a subclinical at-risk group for psychosis. Developing early detection and intervention for both substance use and PLEs may reduce long-term adverse outcomes.
Topics: Child; Adolescent; Humans; Aged; Cross-Sectional Studies; Prodromal Symptoms; Psychotic Disorders; Substance-Related Disorders; Risk Factors
PubMed: 36377500
DOI: 10.1017/S0033291722003440 -
Schizophrenia Research Aug 2020Schizotypy is a multi-dimensional personality construct that putatively indicates an individual's liability to psychosis. Schizophrenia is associated with significant... (Meta-Analysis)
Meta-Analysis Review
Schizotypy is a multi-dimensional personality construct that putatively indicates an individual's liability to psychosis. Schizophrenia is associated with significant deficits in theory of mind (ToM). However, previous studies investigating the relationship between schizotypy and ToM provided inconsistent findings. Following the systematic review of all relevant schizotypy studies between January 1, 1980 and June 30, 2019, a meta-analysis of the relationship between ToM and schizotypy was conducted. Current meta-analysis included 24 studies consisting of 4162 healthy individuals. Overall, there was a significant but a small negative relationship between ToM and schizotypy (d = -0.23, CI = -0.14-0.33). Schizotypy scores were negatively associated with both reasoning (d = -0.24, CI = -0.11-0.38) and decoding (d = -0.21, CI = -0.09-0.32) aspects of ToM. The relationship between ToM and schizotypy was more significant in the studies using extreme-group design (d = -0.31, CI = -0.17-0.45) than non-extreme-group design (d = -0.17, CI = -0.04-0.29). ToM abnormalities were significantly related to both positive and negative schizotypy. Current findings support the continuum between schizotpy and schizophrenia. ToM abnormalities might be vulnerability markers for psychosis.
Topics: Humans; Psychotic Disorders; Schizophrenia; Schizotypal Personality Disorder; Theory of Mind
PubMed: 32461089
DOI: 10.1016/j.schres.2020.04.024 -
Psychological Medicine Oct 2022Schizophrenia (SZ) is a complex brain disorder linked to cognitive and neurostructural abnormalities that involves genetic and environmental factors with obstetric... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Schizophrenia (SZ) is a complex brain disorder linked to cognitive and neurostructural abnormalities that involves genetic and environmental factors with obstetric complications (OCs) at birth conferring a high risk for the disease. Indeed, current research in the general population describes the deleterious effect of OCs on cognitive performance in adulthood. With this rationale, we aim to review the relationship between OCs and cognition in SZ and related psychotic disorders.
METHODS
A systematic review and meta-analysis describing cognitive function and OCs in patients with SZ and related disorders were conducted. PubMed, EmBase, SCOPUS, and the Cochrane Library were systematically searched to identify eligible studies up to January 2022. We calculated the effect sizes (Hedges' g) of cognitive domains within each study and quantified the proportion of between-study variability using the statistic. Homogeneity was assessed using the -statistic (). The study was registered on PROSPERO (CRD42018094238).
RESULTS
A total of 4124 studies were retrieved, with 10 studies meeting inclusion criteria for the systematic review and eight for meta-analysis. SZ subjects with OCs showed poor verbal memory [Hedges' = -0.89 (95% CI -1.41 to -0.37), < 0.001] and working memory performance [Hedges' = -1.47 (95% CI -2.89 to -0.06), = 0.01] in a random-effect model compared to those without OCs.
CONCLUSIONS
OCs appear to have a moderate impact on specific cognitive such as working memory and verbal memory. Our findings suggest that OCs are associated with brain development and might underlie the cognitive abnormalities described at onset of psychosis.
Topics: Infant, Newborn; Humans; Adult; Schizophrenia; Cognition; Psychotic Disorders; Memory, Short-Term; Brain Diseases; Memory Disorders
PubMed: 35979824
DOI: 10.1017/S0033291722002409 -
Journal of Psychosomatic Research Dec 2022The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders. (Review)
Review
OBJECTIVE
The aim of this study was to analyze physicians' and medical students' (MS) beliefs and attitudes toward people with psychotic disorders.
METHODS
This systematic review follows the PRISMA guidelines. It was conducted on 5 databases (Pubmed, PsycINFO, Pascal & Francis, Scopus and EMBASE) with a keyword string combining words for physicians' and students' professional status, attitudes toward people, and psychotic disorders. No limitations on publication dates were imposed.
RESULTS
This review includes 39 articles, among which quantitative studies are in the majority, and general practioners are mainly represented. Schizophrenia is the main condition used to illustrate psychotic disorders and measure stigmatizing attitudes. Physicians' and MS' beliefs toward people with psychotic disorders are mainly represented by dangerousness and unpredictability. They can be reinforced with socio-demographic criteria (age and female gender) or physicians' beliefs about the disease's etiology. The desire for social distance is higher toward patients with schizophrenia compared to other psychiatric disorders, and medical care could be impacted with a tendency to refer them at psychiatric specific care or to anticipate their difficulties and to modify their treatment plan. Stigma scores remain globally high during medical training. Even if specific anti-stigma trainings have a positive impact on beliefs and attitudes, these effects do not last in time.
CONCLUSION
This review highlights the importance to explore physicians' and medical students' representations about patient with psychosis to understand better their difficulties in the management of these patients.
Topics: Humans; Female; Students, Medical; Psychotic Disorders; Social Stigma; Schizophrenia; General Practitioners; Attitude of Health Personnel
PubMed: 36272378
DOI: 10.1016/j.jpsychores.2022.111054 -
Medicina (Kaunas, Lithuania) Jun 2024: Radicalization, a complex and multifaceted phenomenon, has been a subject of increasing concern in recent years, particularly due to its potential connection to acts... (Review)
Review
: Radicalization, a complex and multifaceted phenomenon, has been a subject of increasing concern in recent years, particularly due to its potential connection to acts of mass violence and terrorism. This systematic review examines the intricate link between radicalization and psychotic disorders, utilizing various sources such as observational studies, case reports, and series. It aims to highlight the prevalence of schizophrenia spectrum and other psychotic disorders among radicalized individuals and to define the role of mental health professionals in dealing with this issue, contributing to the development of prevention and treatment strategies. : The methodology involved an extensive literature search across PubMed, Scopus, and APA PsycINFO up to 1 February 2024, adhering to PRISMA guidelines. The study focused on radicalization and psychotic disorders as defined by DSM-5 criteria, excluding other mental disorders. A population sample of 41 radicalized individuals diagnosed with psychotic disorders was selected, among which schizophrenia was identified as the predominant condition. : It was observed that 24% of these individuals passed away soon after committing their crimes, leading the researchers to rely on retrospective data for their diagnoses. The use of diverse assessment tools for psychiatric diagnosis and the lack of a standardized method for diagnosing or assessing involvement in the radicalization process were also noted. Despite limitations like reliance on observational studies and case reports, which result in low evidence quality and varied methodologies, our work provides a valuable contribution to clarifying the relationship between radicalization and psychotic disorders. However, further clinical studies are needed to delve deeper into these aspects. : In conclusion, our review points out that individuals with psychotic disorders do not have a higher crime rate than the general population and warns against associating crimes with mental illness due to the stigma it creates. The lack of uniform psychiatric diagnostic tools and radicalization assessment highlights the need for more standardized risk assessment tools and validated scales in psychiatric diagnosis to better understand the relationship between radicalization and psychotic disorders and to develop integrated protocols.
Topics: Humans; Psychotic Disorders; Schizophrenia; Terrorism
PubMed: 38929543
DOI: 10.3390/medicina60060926 -
The Lancet. Psychiatry May 2020Prenatal and perinatal insults are implicated in the aetiopathogenesis of psychotic disorders but the consistency and magnitude of their associations with psychosis have... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Prenatal and perinatal insults are implicated in the aetiopathogenesis of psychotic disorders but the consistency and magnitude of their associations with psychosis have not been updated for nearly two decades. The aim of this systematic review and meta-analysis was to provide a comprehensive and up-to-date synthesis of the evidence on the association between prenatal or perinatal risk and protective factors and psychotic disorders.
METHODS
In this systematic review and meta-analysis, we searched the Web of Science database for articles published up to July 20, 2019. We identified cohort and case-control studies examining the association (odds ratio [OR]) between prenatal and perinatal factors and any International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) non-organic psychotic disorder with a healthy comparison group. Other inclusion criteria were enough data available to do the analyses, and non-overlapping datasets. We excluded reviews, meta-analyses, abstracts or conference proceedings, and articles with overlapping datasets. Data were extracted according to EQUATOR and PRISMA guidelines. Extracted variables included first author, publication year, study type, sample size, type of psychotic diagnosis (non-affective psychoses or schizophrenia-spectrum disorders, affective psychoses) and diagnostic instrument (DSM or ICD and version), the risk or protective factor, and measure of association (primary outcome). We did random-effects pairwise meta-analyses, Q statistics, I index, sensitivity analyses, meta-regressions, and assessed study quality and publication bias. The study protocol was registered at PROSPERO, CRD42017079261.
FINDINGS
152 studies relating to 98 risk or protective factors were eligible for analysis. Significant risk factors were: maternal age younger than 20 years (OR 1·17) and 30-34 years (OR 1·05); paternal age younger than 20 years (OR 1·31) and older than 35 years (OR 1·28); any maternal (OR 4·60) or paternal (OR 2·73) psychopathology; maternal psychosis (OR 7·61) and affective disorder (OR 2·26); three or more pregnancies (OR 1·30); herpes simplex 2 (OR 1·35); maternal infections not otherwise specified (NOS; OR 1·27); suboptimal number of antenatal visits (OR 1·83); winter (OR 1·05) and winter to spring (OR 1·05) season of birth in the northern hemisphere; maternal stress NOS (OR 2·40); famine (OR 1·61); any famine or nutritional deficits in pregnancy (OR 1·40); maternal hypertension (OR 1·40); hypoxia (OR 1·63); ruptured (OR 1·86) and premature rupture (OR 2·29) of membranes; polyhydramnios (OR 3·05); definite obstetric complications NOS (OR 1·83); birthweights of less than 2000 g (OR 1·84), less than 2500 g (OR 1·53), or 2500-2999 g (OR 1·23); birth length less than 49 cm (OR 1·17); small for gestational age (OR 1·40); premature birth (OR 1·35), and congenital malformations (OR 2·35). Significant protective factors were maternal ages 20-24 years (OR 0·93) and 25-29 years (OR 0·92), nulliparity (OR 0·91), and birthweights 3500-3999 g (OR 0·90) or more than 4000 g (OR 0·86). The results were corrected for publication biases; sensitivity and meta-regression analyses confirmed the robustness of these findings for most factors.
INTERPRETATION
Several prenatal and perinatal factors are associated with the later onset of psychosis. The updated knowledge emerging from this study could refine understanding of psychosis pathogenesis, enhance multivariable risk prediction, and inform preventive strategies.
FUNDING
None.
Topics: Adult; Birth Weight; Congenital Abnormalities; Famine; Female; Fetal Macrosomia; Fetal Membranes, Premature Rupture; Herpes Simplex; Herpesvirus 2, Human; Humans; Hypertension; Hypoxia; Infant, Newborn; Infant, Small for Gestational Age; Male; Malnutrition; Maternal Age; Mood Disorders; Parity; Paternal Age; Polyhydramnios; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Premature Birth; Prenatal Care; Prenatal Exposure Delayed Effects; Protective Factors; Psychotic Disorders; Risk Factors; Seasons; Stress, Psychological; Young Adult
PubMed: 32220288
DOI: 10.1016/S2215-0366(20)30057-2 -
Clinical Psychology & Psychotherapy Jan 2021Childhood onset mental health difficulties are known to be associated with later mental health disorders and worse prognoses in adulthood. Individuals who develop... (Review)
Review
Childhood onset mental health difficulties are known to be associated with later mental health disorders and worse prognoses in adulthood. Individuals who develop schizophrenia present, from childhood onwards, with cognitive deficits, psychotic-like experiences (PLEs) and internalizing and externalizing problems (EPs). People with a diagnosis of a schizophrenia spectrum disorder (SSD) are also more likely than people without this diagnosis to engage in aggressive behaviour towards others. This systematic review examines the evidence base investigating associations between childhood EPs and later psychotic symptoms. Searches were conducted on Ovid (Medline and Psychinfo), Pubmed and Scopus. PRISMA best-practice guidelines for conducting systematic literature reviews were followed. Data were extracted from predefined items and assessed using a quality rating scale. Fifteen studies were identified. Eleven of the 15 studies reported significant associations between childhood externalizing psychopathology and later psychotic symptoms, one study reported an association that did not reach significance, and three studies found no associations. Despite the substantial variations in conceptualization of EP, PLEs and SSD, this review found preliminary evidence for an association between childhood antisocial and aggressive behaviour and the later development of psychotic symptoms. Assessing children with EP for PLEs may be important to inform psychological therapies. More longitudinal studies are needed to better understand outcomes for children with presentations across the EP spectrum.
Topics: Adult; Child; Humans; Mental Health; Psychopathology; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Time Factors
PubMed: 32681551
DOI: 10.1002/cpp.2493 -
Dementia and Geriatric Cognitive... 2022Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a...
BACKGROUND
Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a progressive neurological condition which may amplify behavioural disturbances such as aggression. This systematic review aims to evaluate the factors associated with homicide committed by people with dementia in order to inform clinical practice.
SUMMARY
MEDLINE, PsychINFO, Embase, and PubMed databases were searched in accordance with PRISMA guidelines for empirical studies examining the characteristics and circumstances of people with dementia who committed homicides. Data on factors associated with the homicide were extracted and the quality of each study rated using standardized criteria. A total of 499 papers were screened and thirteen studies met the inclusion criteria. Study design included case reports (seven studies), case series (four studies), and two retrospective cohort studies, indicative of low levels of evidence. Sample sizes were 1-70. Study findings were predominantly descriptive. Quality ratings ranged from 50 to 100%. Factors associated with disinhibition such as dysexecutive syndrome, alcohol use, and delirium may predispose to severe impulsive aggression. Psychosis and personality pathology appeared to influence targeted assaults resulting in homicide by people with dementia. Victim vulnerability was also a key element.
KEY MESSAGES
The current evidence examining risk factors for homicide committed by people with dementia is limited. However, there are common characteristics reported in these descriptive studies including psychiatric factors and cognitive states causing disinhibition. Recommendations for clinical practice include early assessment of older people with dementia and changed behaviours to allow management of comorbidities and reversible risk factors, alongside education, and advice to carers (who may be targets of aggression). Specialized geriatric forensic psychiatry services and care settings should be developed.
Topics: Aged; Dementia; Homicide; Humans; Psychotic Disorders; Retrospective Studies; Risk Factors
PubMed: 35306488
DOI: 10.1159/000521878 -
Acta Psychiatrica Scandinavica Jan 2022To evaluate whether accelerated brain aging occurs in individuals with mood or psychotic disorders. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate whether accelerated brain aging occurs in individuals with mood or psychotic disorders.
METHODS
A systematic review following PRISMA guidelines was conducted. A meta-analysis was then performed to assess neuroimaging-derived brain age gap in three independent groups: (1) schizophrenia and first-episode psychosis, (2) major depressive disorder, and (3) bipolar disorder.
RESULTS
A total of 18 papers were included. The random-effects model meta-analysis showed a significantly increased neuroimaging-derived brain age gap relative to age-matched controls for the three major psychiatric disorders, with schizophrenia (3.08; 95%CI [2.32; 3.85]; p < 0.01) presenting the largest effect, followed by bipolar disorder (1.93; [0.53; 3.34]; p < 0.01) and major depressive disorder (1.12; [0.41; 1.83]; p < 0.01). The brain age gap was larger in older compared to younger individuals.
CONCLUSION
Individuals with mood and psychotic disorders may undergo a process of accelerated brain aging reflected in patterns captured by neuroimaging data. The brain age gap tends to be more pronounced in older individuals, indicating a possible cumulative biological effect of illness burden.
Topics: Aged; Bipolar Disorder; Brain; Depressive Disorder, Major; Humans; Psychotic Disorders; Schizophrenia
PubMed: 34510423
DOI: 10.1111/acps.13371