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Schizophrenia Bulletin Mar 2024Individuals with psychotic symptoms experience substantial morbidity and have shortened life expectancies; early treatment may mitigate the worst effects. Understanding... (Review)
Review
BACKGROUND
Individuals with psychotic symptoms experience substantial morbidity and have shortened life expectancies; early treatment may mitigate the worst effects. Understanding care preceding a first psychotic disorder diagnosis is critical to inform early detection and intervention.
STUDY DESIGN
In this observational cohort study using comprehensive information from the Massachusetts All-Payer Claims Database, we identified the first psychotic disorder diagnosis in 2016, excluding those with historical psychotic disorder diagnoses in the prior 48 months among those continuous enrollment data. We reviewed visits, medications, and hospitalizations 2012-2016. We used logistic regression to examine characteristics associated with pre-diagnosis antipsychotic use.
STUDY RESULTS
There were 2505 individuals aged 15-35 years (146 per 100 000 similarly aged individuals in the database) with a new psychotic disorder diagnosis in 2016. Most (97%) had at least one outpatient visit in the preceding 48 months; 89% had a prior mental health diagnosis unrelated to psychosis (eg, anxiety [60%], depression [60%]). Many received psychotropic medications (77%), including antipsychotic medications (46%), and 68% had a visit for injury or trauma during the preceding 48 months. Characteristics associated with filling an antipsychotic medication before the psychotic disorder diagnosis included male sex and Medicaid insurance at psychosis diagnosis.
CONCLUSIONS
In this insured population of Massachusetts residents with a new psychotic disorder diagnosis, nearly all had some healthcare utilization, visits for injury or trauma were common, and nearly half filled an antipsychotic medication in the preceding 48 months. These patterns of care could represent either pre-disease signals, delays, or both in receiving a formal diagnosis.
Topics: United States; Humans; Male; Antipsychotic Agents; Psychotic Disorders; Early Diagnosis; Logistic Models; Psychotherapy; Observational Studies as Topic
PubMed: 37606279
DOI: 10.1093/schbul/sbad125 -
Semergen Oct 2021
Topics: Acne Vulgaris; Dermatologic Agents; Humans; Isotretinoin; Psychotic Disorders
PubMed: 34257010
DOI: 10.1016/j.semerg.2021.06.004 -
Psychiatria Danubina 2022Immunopsychiatry is based on the assumption that schizophrenia, bipolar disorders, and major depressive disorders are related with atypical immune reactions or...
Immunopsychiatry is based on the assumption that schizophrenia, bipolar disorders, and major depressive disorders are related with atypical immune reactions or inflammatory processes. It has also been suggested that the neurotoxic effects of COVID-19 due to the perverted autoimmune reaction could offer fresh acumens into psychotic process. Even acute psychotic symptoms have a subtle pre-psychotic phase and unless treatments are aimed at this preceding phase, newer therapies are not going to achieve their targets. Identifying biosignatures of psychotic disorders lead to better understanding of the etiological mechanism involved in such disorders and aid early diagnostic assays. Interestingly, the search for biomarkers also stimulates new experimental treatment strategies as evidenced by the experiments of newer immunological therapies for psychotic disorders. Characterizing biosignatures are thought to play a significant role in the early detection, treatment, and implementation of preventive strategies in psychotic disorders. The search for identifying biosignatures should go hand in hand with newer experimental therapies for psychotic disorders for the benefit of introducing treatments at an early stage of psychosis development. The identification of biomarkers may lead to a shift from symptom based diagnostic category into subtypes based on immunological alterations and brain biology and such a change might have an advantage to make more precise diagnosis aiding better treatment. The field of immunopsychiatry requires more research to put their findings in context.
Topics: Humans; Depressive Disorder, Major; COVID-19; Psychotic Disorders; Schizophrenia; Biomarkers
PubMed: 36548873
DOI: 10.24869/psyd.2022.623 -
The Permanente Journal May 2021Amidst a rapidly changing legal landscape, cannabis use in the United States has become increasingly common in the past several years. There is strong evidence to... (Review)
Review
Amidst a rapidly changing legal landscape, cannabis use in the United States has become increasingly common in the past several years. There is strong evidence to suggest that chronic and early cannabis use increases the risk of developing a psychotic disorder, and there is at least moderate evidence that suggests ongoing cannabis use among individuals with a psychotic disorder worsens clinical outcomes (eg, decreased psychiatric medication adherence, more frequent psychiatric hospitalizations). In this Review Article, we provide a focused, clinically oriented overview of the epidemiology and characteristics of cannabis use among individuals with first-episode psychosis; evaluation of cannabis use; and treatment modalities, focusing on behavioral interventions suitable for outpatient primary care settings. We discuss the limited data supporting pharmacologic interventions for cannabis use disorder, specifically among individuals with first-episode psychosis, and the unique potential of cannabidiol to serve as a harm-reduction strategy for individuals who are not able or willing to achieve abstinence for cannabis.
Topics: Analgesics; Cannabidiol; Cannabis; Humans; Marijuana Abuse; Psychotic Disorders
PubMed: 35348056
DOI: 10.7812/TPP/20.179 -
JAMA Psychiatry Dec 2023People with psychosis are more likely to be born and live in densely populated and socioeconomically deprived environments, but it is unclear whether these associations...
IMPORTANCE
People with psychosis are more likely to be born and live in densely populated and socioeconomically deprived environments, but it is unclear whether these associations are a cause or consequence of disorder.
OBJECTIVE
To investigate whether trajectories of exposure to deprivation and population density before and after diagnosis are associated with psychotic disorders or nonpsychotic bipolar disorder.
DESIGN, SETTING, AND PARTICIPANTS
This nested case-control study included all individuals born in Sweden between January 1, 1982, and December 31, 2001, diagnosed for the first time with an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) psychotic disorder or nonpsychotic bipolar disorder between their 15th birthday and cohort exit (December 31, 2016). One sex- and birth year-matched control participant per case was selected. Data analysis was performed from July 2021 to June 2023.
EXPOSURES
The main exposures were quintiles of neighborhood-level deprivation and population density each year from birth to age 14 years and from first diagnosis until cohort exit.
MAIN OUTCOMES AND MEASURES
The main outcomes were the odds of a serious mental illness outcome associated with trajectories of deprivation and population density, before and after diagnosis in cases. Group-based trajectory modeling was used to derive trajectories of each exposure in each period. Logistic regression was used to examine associations with outcomes.
RESULTS
A total of 53 458 individuals (median [IQR] age at diagnosis in case patients, 23.2 [15.0-34.8] years; 30 746 [57.5%] female), including 26 729 case patients and 26 729 control participants, were studied. From birth to early adolescence, gradients were observed in exposure to deprivation and population density trajectories during upbringing and psychotic disorder, with those in the most vs least deprived (adjusted odds ratio [AOR], 1.17; 95% CI, 1.08-1.28) and most vs least densely populated (AOR, 1.49; 95% CI, 1.34-1.66) trajectories at greatest risk. A strong upward mobility trajectory to less deprived neighborhoods was associated with similar risk to living in the least deprived trajectory (AOR, 1.01; 95% CI, 0.91-1.12). Only 543 case patients (2.0%) drifted into more deprived areas after diagnosis; people with psychotic disorder were more likely to belong to this trajectory (AOR, 1.38; 95% CI, 1.16-1.65) or remain in the most deprived trajectory (AOR, 1.36; 95% CI, 1.24-1.48) relative to controls. Patterns were similar for nonpsychotic bipolar disorder and deprivation but weaker for population density.
CONCLUSIONS AND RELEVANCE
In this case-control study, greater exposure to deprivation during upbringing was associated with increased risk of serious mental illness, but upward mobility mitigated this association. People with serious mental illness disproportionately remained living in more deprived areas after diagnosis, highlighting issues of social immobility. Prevention and treatment should be proportionately located in deprived areas according to need.
Topics: Adolescent; Humans; Female; Young Adult; Adult; Male; Population Density; Case-Control Studies; Psychotic Disorders; Bipolar Disorder; Social Deprivation
PubMed: 37672257
DOI: 10.1001/jamapsychiatry.2023.3220 -
Schizophrenia Bulletin Jul 2020Stressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of...
OBJECTIVE
Stressful life events have been implicated in the onset of psychotic disorders, but there are few robust studies. We sought to examine the nature and magnitude of associations between adult life events and difficulties and first-episode psychoses, particularly focusing on contextual characteristics, including threat, intrusiveness, and independence.
METHOD
This study forms part of the Childhood Adversity and Psychosis Study (CAPsy), an epidemiological case-control study in London, United Kingdom. Data on life events and difficulties (problems lasting 4 wk or more) during 1 year prior to onset (cases) or interview (controls) were assessed using the semi-structured Life Events and Difficulties Schedule (LEDS). Data were available on 253 individuals with a first episode of psychosis and 301 population-based controls.
RESULTS
We found strong evidence that odds of exposure to threatening and intrusive events in the 1 year prior to onset were substantially higher among cases compared with controls, independent of age, gender, ethnicity, and social class (ORs > 3). This was consistent across diagnostic categories. We found further evidence that the effect of threatening events and difficulties was cumulative (1 event odds ratio [OR] 2.69 [95% confidence interval (CI) 1.51-4.79]; 2 events OR 4.87 [95% CI 2.34-10.16]; ≥3 events OR 5.27 [95% CI 1.83-15.19]; 1 difficulty OR 3.02 [95% CI 1.79-5.09]; 2 difficulties OR 9.71 [95% CI 4.20-22.40]; ≥3 difficulties OR 12.84 [95% CI 3.18-51.85]).
CONCLUSIONS
Threatening and intrusive life events and difficulties are common in the year pre-onset among individuals with a first episode of psychosis. Such experiences may contribute to the development of psychotic disorders.
Topics: Adolescent; Adult; Adverse Childhood Experiences; Case-Control Studies; Female; Humans; Life Change Events; London; Male; Middle Aged; Prodromal Symptoms; Psychotic Disorders; Young Adult
PubMed: 32047940
DOI: 10.1093/schbul/sbaa005 -
Psychopathology 2022Short-lived psychotic disorders as currently listed under "acute and transient psychotic disorder," ICD-11 Classification of Mental, Behavioural, and Neurodevelopmental... (Review)
Review
Short-lived psychotic disorders as currently listed under "acute and transient psychotic disorder," ICD-11 Classification of Mental, Behavioural, and Neurodevelopmental Disorders, and "brief psychotic disorder," Diagnostic and Statistical Manual of Mental Disorders (DSM-5), constitute a point of divergence in the classification of psychotic disorders between the 2 diagnostic systems, which reveals the lack of knowledge about these conditions. Whether this is due to conceptual shortcomings inherent to the categories themselves and which spill over onto research or reflects a mismatch between the diagnostic criteria used and research techniques needs clarification. This study aimed to examine conceptual issues involved in the development of the above categories and shows that little continuity exists between earlier nosological concepts such as bouffée délirante, cycloid psychosis, and reactive psychosis and modern descriptive categories used to classify short-lived psychotic disorders. It seems likely that shortcomings in terms of symptom completeness, specificity, and heterogeneity, in addition to changes in definition and diagnostic criteria in successive DSM and ICD versions, have hampered empirical research, making it difficult to enhance the understanding of these conditions and achieve a closer concordance between the 2 classificatory systems.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Neurodevelopmental Disorders; Psychotic Disorders
PubMed: 34802004
DOI: 10.1159/000520087 -
The International Journal of Social... Mar 2023Reports of increasing presentations of new cases of acute psychosis both locally, nationally and internationally during the COVID-19 pandemic, warranted further... (Review)
Review
BACKGROUND
Reports of increasing presentations of new cases of acute psychosis both locally, nationally and internationally during the COVID-19 pandemic, warranted further investigation. International case reports almost exclusively reported only clinical outcome (e.g. remission of psychotic symptoms), and fail to report on social precipitants or social outcomes. This is a common omission when investigating new psychosis cases such as acute and transient psychotic disorder (ATPD). In order to assess social impacts and outcomes, we conducted a rapid review of recent evidence.
AIMS
To conduct a rapid review of the recent evidence of social outcomes on new cases of psychosis emerging during the COVID-19 pandemic.
METHOD
Four databases (Medline, Embase, Psychinfo and Cochrane COVID-19) were searched for ATPD, psychosis and social outcomes in adults aged 18+. Duplicates were removed. There were no language limitations. Results: There were 24 papers consisting of 18 original data research papers and 6 reviews. Additionally, 33 papers/letters, reporting on 60 individual cases of psychosis emerging during the COVID-19 pandemic. These two sets of papers were reviewed separately. Many original data research papers and reviews were sub optimal in their quality, with 44% online surveys, with the remainder being routinely collected data.
CONCLUSION
There is a consensus that clinical outcomes of ATPD and other brief psychotic disorders (BPD) are good in the short term. The focus only on symptomatic clinical presentation and outcomes, leaves a gap in our understanding regarding social stressors and longer term social outcomes. ATPD and BPD often may not come to the attention of Early Intervention in Psychosis services, and if they do, are discharged following symptomatic remission. Without an understanding of the social stress factors and social outcomes, opportunities may be missed to prevent increased social disability and future relapse with these presentations.
Topics: Adult; Humans; Pandemics; COVID-19; Psychotic Disorders; Causality; Acute Disease
PubMed: 36047044
DOI: 10.1177/00207640221106681 -
Australasian Psychiatry : Bulletin of... Dec 2019Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other... (Review)
Review
OBJECTIVE
Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other primary psychotic disorders. Misdiagnosis is more common when AVH meet criteria for Schneiderian first rank symptoms (FRS). This paper's objective is to improve diagnostic accuracy by outlining particular clinical features that can assist the distinction between BPD and psychotic disorders in these cases.
CONCLUSION
The overall clinical presentation when AVH occur in BPD can assist in determining a primary diagnosis of BPD when frank psychotic disorder is absent. AVH in BPD cannot be distinguished phenomenologically from AVH in SCZ. Clinical experience and increasing research suggest that AVH in BPD are often dissociative in origin and highly correlated with the presence of FRS, elevated levels of dissociation and a history of childhood trauma. When AVH occur in BPD in the absence of co-occurring psychotic disorder, formal thought disorder is usually absent, negative symptoms minimal or absent, bizarre symptoms absent, affect reactive and the patient retains sociability. Psychotropic medication may be less effective for the AVH in these cases, while they may improve or remit during psychotherapy for BPD.
Topics: Adverse Childhood Experiences; Borderline Personality Disorder; Dissociative Disorders; Hallucinations; Humans; Psychological Trauma; Psychotic Disorders; Schizophrenia
PubMed: 31304765
DOI: 10.1177/1039856219859290 -
Research on Child and Adolescent... Oct 2023Compared to peers, children and adolescents with obsessive-compulsive disorder (OCD) are at increased risk of developing psychotic disorders. Yet very few studies have...
Compared to peers, children and adolescents with obsessive-compulsive disorder (OCD) are at increased risk of developing psychotic disorders. Yet very few studies have examined early indicators of psychosis in pediatric OCD. In the present study, 52 youth with a primary diagnosis of OCD (M = 15.66 [SD = 2.33], 59.6% girls) were interviewed using the Schizophrenia Proneness Instrument Child and Adolescent version (SPI-CY), which is a comprehensive clinical interview assessing both Cognitive-Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS). Associations between COPER/COGDIS symptoms and demographic and clinical characteristics were examined. Findings showed that COPER or COGDIS symptoms were present in 44% of participants, with no significant difference between girls and boys. Psychotic vulnerability was associated with an earlier age of OCD onset, greater OCD severity, poorer insight, and more contamination/cleaning symptoms. Psychotic vulnerability was also strongly associated with worse psychosocial functioning. Findings suggest that early indicators of psychosis are frequent in pediatric OCD and associated with more severe OCD and poorer functioning. Research examining how psychotic vulnerability is associated with short- and long-term outcomes for youth with OCD is needed.
Topics: Male; Female; Humans; Adolescent; Child; Comorbidity; Obsessive-Compulsive Disorder; Psychotic Disorders; Cognitive Dysfunction
PubMed: 37256460
DOI: 10.1007/s10802-023-01089-2