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Journal of the American Academy of... May 2023Adults living with schizophrenia have prominent and widespread alterations in brain structure and function, but until recently little was known about the developmental...
Adults living with schizophrenia have prominent and widespread alterations in brain structure and function, but until recently little was known about the developmental timing and course of such changes. Prospective studies of individuals at elevated risk for developing psychosis, termed clinical high-risk (CHR) or psychosis risk syndrome patients, can address these questions, thus providing clues into neurobiological mechanisms that occur prior to illness onset. In this issue, Fortea et al. present the results of a prospective longitudinal brain imaging investigation of 107 adolescents at CHR for developing a psychotic disorder (23% of whom developed psychosis over the follow-up period) and 102 typically developing controls. Participants were scanned at baseline and at 18-month follow-up or at the time of conversion to psychosis. Using linear mixed-effects models to measure cortical surface area over time, the authors found that youth who developed a psychotic disorder during the follow-up period experienced greater loss of cortical surface area in bilateral parietal and right frontal regions compared to CHR youth who did not develop psychosis, and in left parietal and occipital regions compared to healthy controls. Findings were not accounted for by antipsychotic medication use, cannabis use, or general intelligence. Thus, these observations suggest that emerging psychosis may have an impact on typical neuromaturational changes that occur during adolescence.
Topics: Adult; Adolescent; Humans; Prospective Studies; Psychotic Disorders; Schizophrenia; Brain; Frontal Lobe; Prodromal Symptoms
PubMed: 36773697
DOI: 10.1016/j.jaac.2023.02.003 -
BMJ Case Reports Aug 2020A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19....
A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.
Topics: Adult; Antipsychotic Agents; Betacoronavirus; COVID-19; Coronavirus Infections; Diagnosis, Differential; Female; Humans; Pandemics; Pneumonia, Viral; Psychotic Disorders; SARS-CoV-2
PubMed: 32784244
DOI: 10.1136/bcr-2020-236940 -
Zeitschrift Fur Kinder- Und... Nov 2021Psychotic disorders in ICD-11: the revisions This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders"... (Review)
Review
Psychotic disorders in ICD-11: the revisions This article provides an overview of the main changes to the chapter "Schizophrenia or Other Primary Psychotic Disorders" (6A2) from ICD-10 to ICD-11 and compares them with the psychosis chapter of DSM-5. These changes include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one must be a positive symptom) in the definition of "Schizophrenia" (6A20) and the allowance for bizarre contents in "Delusional Disorder" (6A24), which now includes "Induced Delusional Disorder" (F24). Further introduced are the focus on the current episode, the restriction of "Acute and Transient Psychotic Disorder" (6A23) to the former Polymorphic Disorder Without Schizophrenic Symptoms (F23.0), the diagnosis of delusional "Obsessive-Compulsive or Related Disorders" (6B2) exclusively as Obsessive-Compulsive Disorders, the specification of "Schizoaffective Disorder" (6A21), and the formulation of a distinct subchapter "Catatonia" (6A4) for the assessment of catatonic features in the context of several disorders. In analogy to DSM-5, ICD-11 now includes the optional category "Symptomatic Manifestations of Primary Psychotic Disorders" (6A25) for the dimensional quantification of symptoms. Again, developmental aspects remain unattended in in the ICD-11-definitions of psychotic disorders.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Psychotic Disorders; Schizophrenia
PubMed: 33287579
DOI: 10.1024/1422-4917/a000777 -
Schizophrenia Research Mar 2022Psychotic episodes occur in a substantial proportion of patients suffering from major mood disorders (both unipolar and bipolar) at some point in their lives. The nature... (Review)
Review
Psychotic episodes occur in a substantial proportion of patients suffering from major mood disorders (both unipolar and bipolar) at some point in their lives. The nature of these episodes is less well understood than the more common, non-psychotic periods of illness and hence their management is also less sophisticated. This is a concern because the risk of suicide is particularly high in this subtype of mood disorder and comorbidity is far more common. In some cases psychotic symptoms may be signs of a comorbid illness but the relationship of psychotic mood to other forms of psychosis and in particular its interactions with schizophrenia is poorly understood. Therefore, our targeted review draws upon extant research and our combined experience to provide clinical context and a framework for the management of these disorders in real-world practice - taking into consideration both biological and psychological interventions.
Topics: Bipolar Disorder; Comorbidity; Depressive Disorder, Major; Humans; Mood Disorders; Psychotic Disorders
PubMed: 35139458
DOI: 10.1016/j.schres.2022.01.047 -
Schizophrenia Bulletin Jan 2023Psychotic disorders have been associated with not being in education, employment, and training (NEET). There is a lack of knowledge on the importance of risk markers for...
BACKGROUND AND HYPOTHESIS
Psychotic disorders have been associated with not being in education, employment, and training (NEET). There is a lack of knowledge on the importance of risk markers for NEET among people with psychotic disorders and what rehabilitation they receive.
STUDY DESIGN
We based our research on the register-based 1987 Finnish Birth Cohort study, which included all live births in Finland during that year. The study cohort were 288 people who had been diagnosed with psychotic disorders during 2004-2007, when they were 16-20 year old, and 55 883 who had not. We looked at the national register data for those subjects in 2008-2015, when they were 20-28 year old, and compared any associations between sociodemographic factors and NEET status.
STUDY RESULTS
NEET for more than 5 year affected 2.2% of those without psychosis, 35.8% of those with any nonaffective psychotic disorder, and 57.0% of those with schizophrenia or schizoaffective disorders. Family-related risk factors were weaker predictors of long-term NEET in subjects with psychotic disorders than other cohort members. Having a psychotic disorder plus long-term NEET was associated with not applying for upper secondary education, not finishing upper secondary education, parents receiving welfare benefits, being diagnosed with schizophrenia or schizoaffective disorders and being hospitalized for psychosis. Only 24.3% with psychotic disorders had participated in vocational rehabilitation.
CONCLUSIONS
A diagnosis of psychosis in adolescence is independently associated with serious long term functional disability. Among those with psychotic disorders, educational problems are markers for adverse labor market outcomes. Despite this, vocational rehabilitation is seldom provided.
Topics: Humans; Adolescent; Young Adult; Adult; Cohort Studies; Psychotic Disorders; Educational Status; Employment; Rehabilitation, Vocational
PubMed: 36305161
DOI: 10.1093/schbul/sbac151 -
Current Opinion in Psychology Feb 2021Even though the borderline concept has historically been intertwined with psychosis, psychotic symptoms in people with borderline personality disorder (BPD) have long... (Review)
Review
Even though the borderline concept has historically been intertwined with psychosis, psychotic symptoms in people with borderline personality disorder (BPD) have long been marginalized as somehow not real, transient, or 'pseudo' in nature. Dispelling this myth, we summarize recent research indicating that (a) psychotic symptoms in general and auditory verbal hallucinations in particular in people with BPD show more similarities than differences with those symptoms in people with psychotic disorders, and (b) that the co-occurrence of BPD and psychotic symptoms is a marker of severe psychopathology and of risk for poor outcome (e.g. suicidality). We propose the period from puberty to the mid-20s, when both BPD and psychotic features usually emerge for the first time, constitutes a critical time window for early intervention to prevent the development of severe mental disorders in the future. Implications for the treatment of psychotic symptoms in BPD and future research directions in this field are discussed.
Topics: Borderline Personality Disorder; Hallucinations; Humans; Psychopathology; Psychotic Disorders
PubMed: 32771980
DOI: 10.1016/j.copsyc.2020.07.003 -
Translational Psychiatry Aug 2023Diagnosis of a clinical high-risk (CHR) state enables timely treatment of individuals at risk for a psychotic disorder, thereby contributing to improving illness... (Review)
Review
Diagnosis of a clinical high-risk (CHR) state enables timely treatment of individuals at risk for a psychotic disorder, thereby contributing to improving illness outcomes. However, only a minority of patients diagnosed with CHR will make the transition to overt psychosis. To identify patients most likely to benefit from early intervention, several studies have investigated characteristics that distinguish CHR patients who will later develop a psychotic disorder from those who will not. We aimed to summarize evidence from systematic reviews and meta-analyses on predictors of transition to psychosis in CHR patients, among characteristics and biomarkers assessed at baseline. A systematic search was conducted in Pubmed, Scopus, PsychInfo and Cochrane databases to identify reviews and meta-analyses of studies that investigated specific baseline predictors or biomarkers for transition to psychosis in CHR patients using a cross-sectional or longitudinal design. Non-peer-reviewed publications, gray literature, narrative reviews and publications not written in English were excluded from analyses. We provide a narrative synthesis of results from all included reviews and meta-analyses. For each included publication, we indicate the number of studies cited in each domain and its quality rating. A total of 40 publications (21 systematic reviews and 19 meta-analyses) that reviewed a total of 272 original studies qualified for inclusion. Baseline predictors most consistently associated with later transition included clinical characteristics such as attenuated psychotic and negative symptoms and functioning, verbal memory deficits and the electrophysiological marker of mismatch negativity. Few predictors reached a level of evidence sufficient to inform clinical practice, reflecting generalizability issues in a field characterized by studies with small, heterogeneous samples and relatively few transition events. Sample pooling and harmonization of methods across sites and projects are necessary to overcome these limitations.
Topics: Humans; Cross-Sectional Studies; Databases, Factual; Psychotic Disorders; Meta-Analysis as Topic; Systematic Reviews as Topic
PubMed: 37640731
DOI: 10.1038/s41398-023-02586-0 -
Psychiatria Danubina 2022Medication-induced psychotic disorder (MIPD) is a diagnostic term for a syndrome with symptoms such as hallucinations and delusions directly related to drug intake. The... (Review)
Review
BACKGROUND
Medication-induced psychotic disorder (MIPD) is a diagnostic term for a syndrome with symptoms such as hallucinations and delusions directly related to drug intake. The purpose of this review is to report and comment on the current knowledge about pathomechanisms, risk factors, symptoms, and treatment of MIPD caused by selected widely used medications.
METHODS
PubMed, Scopus, and Google Scholar databases were searched for articles on MIPD published prior to January 2021 using search terms 'psychosis' OR 'psychotic disorder' AND 'side effects' combined with certain medications group. The initial search was then narrowed to medications with more pathomechanisms than only direct dopamine-inducing activity that are widely used by clinicians of various medical specialties.
RESULTS
Steroids, antiepileptic drugs, antimalarial drugs, and antiretroviral drugs can induce psychosis with persecutory delusions and auditory hallucinations as the most frequently reported symptoms. Mood changes and anxiety may precede psychosis after steroids and antimalarials. Psychiatric history and female sex are risk factors for most of the MIPD. Treatment involves cessation of the suspected drug. Administration of atypical antipsychotic drugs may be helpful, although there is insufficient data to support this approach. The latter should be done with careful consideration of pharmacokinetic and pharmacodynamic interactions.
CONCLUSIONS
MIPD is a rare condition. The appearance of psychotic symptoms during systemic treatment may be associated with administered medications, psychiatric comorbidity, or be a part of the clinical picture of a certain disorder. Furthermore, sometimes it may be challenging to distinguish MIPD from delirium. Therefore, we consider that the key to proper management of MIPD is a thorough differential diagnosis.
Topics: Anticonvulsants; Antipsychotic Agents; Delusions; Female; Hallucinations; Humans; Psychotic Disorders
PubMed: 35467605
DOI: 10.24869/psyd.2022.11 -
L'Encephale Oct 2021Attention Deficit with/without Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with frequent comorbid psychiatric disorders. Several studies have... (Review)
Review
OBJECTIVES
Attention Deficit with/without Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with frequent comorbid psychiatric disorders. Several studies have underlined the increased risk of developing a psychotic disorder subsequent to a childhood ADHD. The aim of our review is not only to clarify this association and the related physiopathology but also to understand the consequences for therapeutic management.
METHODS
We processed a narrative review of available literature based on a research of the PubMed database. Articles related to ADHD and psychotic disorder on a genetical, clinical or biological level were selected by one of the authors.
RESULTS
ADHD and psychotic disorders share neonatal, environmental, and genetic risk factors. On a neurobiological level, both disorders are concerned by a dysfunction of the dopaminergic system with an abnormal regulation of dopaminergic neurons' phasic and tonic activity. Our review aims to explain the « dynamic » model of dopaminergic dysfunctions and propose some guidance for pharmacological treatment of ADHD, with or without psychotic disorder. This model offers a better understanding of why methylphenidate is not associated to an increased risk of psychotic disorder and could act as a protective factor. Association between ADHD and psychotic disorders could be explained by some comorbidities such as substance use disorders which are frequently associated with both conditions and could act as mediator in the genesis of psychotic disorders following ADHD during childhood. Our review also focuses on an epidemiological bias that could be found in some studies such as possible diagnostic errors, as some non-specific clinical signs could be found in both late diagnosed ADHD and in "at risk mental state" of psychosis.
CONCLUSION
ADHD and psychotic disorders share common risk factors, neurobiological pathways and clinical symptoms. Perspectives for future studies are proposed considering a dimensional aspect of psychiatric disorders using, for example, Research Domain Criteria and exploring the link between the two conditions.
Topics: Attention Deficit Disorder with Hyperactivity; Comorbidity; Humans; Infant, Newborn; Methylphenidate; Psychotic Disorders; Risk Factors
PubMed: 33994156
DOI: 10.1016/j.encep.2021.01.008 -
Irish Journal of Psychological Medicine Dec 2022Meditation is associated with health benefits; however, there are reports that it may trigger or exacerbate psychotic states. In this review, we aim to collate case... (Review)
Review
BACKGROUND
Meditation is associated with health benefits; however, there are reports that it may trigger or exacerbate psychotic states. In this review, we aim to collate case reports of psychotic disorders occurring in association with meditative practice and to discuss the relationship between psychosis and meditation.
METHODOLOGY
We performed case-based analysis of all the existing studies published in English language using PubMed, PsycINFO, Cochrane, Scopus, EMBASE, CINAHL and Google Scholar with the search terms; 'Psychosis' OR 'Psychotic Symptoms' OR 'Schizophrenia' AND 'Meditation.'
RESULTS
A total of 19 studies and 28 cases were included in the review. The patients described had an age range of 18-57 years; there was equal distribution of males and females. The diagnoses included acute psychosis in 14 cases, schizophrenia in 7 cases, mania with psychotic symptoms in 3 cases, and schizoaffective disorder in 1 case. The types of meditation described were Transcendent, Mindfulness, Buddhist Meditation like Qigong, Zen, and Theraveda, and others like Bikram yoga, Pranic Healing, and Hindustan Type meditation. Of the 28 cases reported, 14 patients had certain precipitating factors like insomnia, lack of food intake, history of mental illness, stress, and psychoactive substance use.
CONCLUSION
There are case reports of psychotic disorder arising in association with meditative practice; however, it is difficult to attribute a causal relationship between the two. At the same time, there is a body of research describing the beneficial effect of meditative practice in clinical settings for patients with psychotic disorders. Appropriately designed studies are needed to further investigate the relationship between meditative practice and psychosis.
Topics: Male; Female; Humans; Adolescent; Young Adult; Adult; Middle Aged; Meditation; Psychotic Disorders; Schizophrenia; Substance-Related Disorders; Mindfulness
PubMed: 31668156
DOI: 10.1017/ipm.2019.47