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The International Journal of Social... Aug 2023The treatment of psychiatric patients has suffered a major change over the last decades, with long-term hospitalizations being replaced by short-term stays and... (Review)
Review
BACKGROUND
The treatment of psychiatric patients has suffered a major change over the last decades, with long-term hospitalizations being replaced by short-term stays and appropriate aftercare in outpatient services. Some chronically ill patients exhibit a pattern of multiple hospitalizations, designated as the Revolving Door (RD) phenomenon.
AIMS
This review aims to analyse the existing literature regarding sociodemographic, clinical and other factors associated with multiple hospitalizations in psychiatric facilities.
METHOD
The search performed in the PubMed database for the terms revolving[Title] AND (psyc*[Title] OR schizo*[Title] OR mental[Title]) presented 30 citations, 8 of which met the eligibility criteria. Four other studies found in references of these articles were also included in the review.
RESULTS
Albeit the use of different criteria to define the RD phenomenon, it is more likely to be associated with patients who are younger, single, with low educational level, unemployed, diagnosed with a psychotic disorder, particularly schizophrenia, and with alcohol and/or substance use. It is also associated with a younger age on disease onset, suicidality, noncompliance and voluntary type of admission.
CONCLUSION
Recognizing patients with a RD pattern of admissions and prediction of rehospitalization can help the development of preventive intervention strategies and identify potential limitations in existing health care delivery systems.
Topics: Humans; Mental Disorders; Hospitalization; Psychotic Disorders; Patient Readmission; Schizophrenia
PubMed: 37209104
DOI: 10.1177/00207640221143282 -
Current Topics in Behavioral... 2022Any attempt to compare the definitions of symptoms listed for "primary psychoses" with those adopted in studies of psychoses in patients with epilepsy (PWE) will...
Any attempt to compare the definitions of symptoms listed for "primary psychoses" with those adopted in studies of psychoses in patients with epilepsy (PWE) will encounter problems of heterogeneity within both conditions. In this manuscript, five psychotic illnesses listed in Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), that is, brief psychotic illness, schizophreniform disorder, schizophrenia, delusional disorder, and schizoaffective disorder are compared with postictal (or periictal) and interictal psychotic disorders in PWE. After examining definitions of primary psychoses, definitions of psychoses adopted in the papers dealing with postictal and interictal psychoses are summarized. Further, diagnostic criteria of five types of psychotic disorders in PWE proposed in 2007 by Krishnamoorthy et al. are also discussed, which include postictal psychosis, comorbid schizophrenia, iatrogenic psychosis caused by antiepileptic drugs (AEDs) (AED-induced psychotic disorder: AIPD), and forced normalization. Evidently, a comparison between postictal psychosis and schizophrenia is pointless. Likewise, schizophrenia may not be an appropriate counterpart of forced normalization and AIPD, given their acute or subacute course.Based on these preliminary examinations, three questions are selected to compare primary psychoses and psychoses in PWE: Is postictal psychosis different from a brief psychotic disorder? Does epilepsy facilitate or prevent the development of psychosis or vice versa? Is interictal psychosis of epilepsy different from process schizophrenia? In conclusion, antagonism between psychosis and epileptic seizures in a later stage of active epilepsy seems not to be realized without reorganization of the nervous system promoted during an earlier stage. Both genetic predisposition and the summated effects of epileptic activity must be taken into consideration as part of a trial to explain interictal psychosis. Interictal psychosis is an aggregate of miscellaneous disorders, that is, co-morbid schizophrenia, AED-induced psychotic disorders, forced normalization, and "epileptic" interictal psychosis. Data are lacking to conclude whether differences exist between process schizophrenia and "epileptic" interictal psychosis in terms of negative symptoms, specific personal traits, and the "bizarre-ness" of delusory-hallucinatory contents. These discussions may shed light on the essence of process schizophrenia, thus allowing it stand out and receive increased focus.
Topics: Epilepsy; Hallucinations; Humans; Psychotic Disorders; Schizophrenia; Seizures
PubMed: 34426945
DOI: 10.1007/7854_2021_234 -
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 -
European Archives of Psychiatry and... Oct 2022The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of 'acute and transient psychotic disorders' (ATPDs) encompassing polymorphic,... (Meta-Analysis)
Meta-Analysis Review
The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of 'acute and transient psychotic disorders' (ATPDs) encompassing polymorphic, schizophrenic and predominantly delusional subtypes, and the forthcoming ICD-11 revision has restricted it to polymorphic psychotic disorder, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed 'brief psychotic disorder' (BPD). To assess the predictive validity and outcome of ATPDs and BPD, relevant papers in English, French and German were searched in PubMed and Web of Science. Where possible meta-analysis of prognostic validators (diagnostic stability, course, outcome and response to treatment) was conducted. Fifty studies published between January 1993 and July 2019 were found. The clinical and functional outcome of ATPDs proved better than in schizophrenia and related disorders, but mortality risk is high, particularly suicide, and treatment trials provide little evidence. Meta-analysis of 25 studies (13,507 cases) revealed that 55% (95% CI 49-62) do not change diagnosis, 25% (95% CI 20-31) converted into schizophrenia and related disorders, and 12% (95% CI 7-16) into affective disorders on average over 6.3 years. Subgroup meta-analysis estimated prospective consistency of polymorphic psychotic disorder (55%; 95% CI 52-58) significantly greater than that of the ATPD subtypes with schizophrenic (OR 1.7; 95% CI 1.4-2.0) and predominantly delusional (OR 1.3; 95% CI 1.1-1.5) symptoms. Moreover, the diagnostic stability of BPD (13 studies; 294 cases) was 45% (95% CI 32-50) over a mean 4.2 years. Although these findings indicate that short-lived psychotic disorders have little predictive validity, significant differences among the ATPD subtypes support the revised ICD-11 ATPD category.
Topics: Acute Disease; Diagnostic and Statistical Manual of Mental Disorders; Humans; International Classification of Diseases; Prospective Studies; Psychotic Disorders
PubMed: 34988647
DOI: 10.1007/s00406-021-01356-7 -
Journal of Epidemiology and Community... Mar 2020Refugees have different experiences of obtaining a refugee status, however it remains unclear if this affects their risk of psychiatric disorders. The aim of this study...
BACKGROUND
Refugees have different experiences of obtaining a refugee status, however it remains unclear if this affects their risk of psychiatric disorders. The aim of this study was to investigate whether risk for non-affective psychotic disorder (NAPD) and post-traumatic stress disorder (PTSD) differs between quota refugees (resettled from refugee camps) and non-quota refugees (former asylum seekers).
METHOD
A register-based cohort with a sample size of 52 561 refugees in Sweden starting 1 January 1997 ending 31 December 2011.
EXPOSURE
refugee status (quota or non-quota refugees). Cox regression models estimated adjusted HRs with 95% CIs for NAPD (International Classification of Diseases, Tenth Revision (ICD-10), F20-29) and PTSD (ICD-10, F43.1) by refugee status.
RESULTS
There were more non-quota refugees (77.0%) than quota refugees (23.0%). In total we identified 401 cases of NAPD, 1.0% among quota refugees and 0.7% among non-quota refugees, and 1070 cases of PTSD, 1.9% among quota refugees and 2.1% among non-quota refugees. Male quota refugees were at increased risk for NAPD compared with male non-quota refugees (HR=1.41, 95% CI 1.09 to 1.82 and HR=0.65, 95% CI 0.42 to 1.00). All quota refugees were at a reduced risk of PTSD compared with non-quota refugees (HR=0.74, 95% CI 0.64 to 0.87).
CONCLUSIONS
This study suggests that risk of NAPD and PTSD varies for quota and non-quota refugees, highlighting the possibility that different experiences of the migration process differentiate the risk of psychiatric disorders among refugees.
Topics: Adolescent; Adult; Child; Child, Preschool; Cohort Studies; Emigration and Immigration; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Psychotic Disorders; Public Health; Refugees; Retrospective Studies; Stress Disorders, Post-Traumatic; Sweden; Young Adult
PubMed: 31767729
DOI: 10.1136/jech-2019-212798 -
Medicine Aug 2022Studies on early onset schizophrenia are limited because of their low prevalence but the reported results stated that early onset is associated with a poorer outcome....
Studies on early onset schizophrenia are limited because of their low prevalence but the reported results stated that early onset is associated with a poorer outcome. The present research analyzed the stability rate of the psychotic-related disorders from childhood to adult life. The study was based on an observational, retrospective, descriptive analysis study. The subjects were selected from patients admitted to the pediatric psychiatry ward of "Alexandru Obregia" Psychiatry Hospital between 2009 and 2018 for a psychosis-related disorder, who were 18 years or older at the moment of data collection and who also had admissions into the adult's psychiatry wards of the hospital. Of the 115 subjects, 93, representing 80.87% of the total, maintained a diagnosis of psychotic spectrum disorder into adulthood. The diagnosis was maintained in 82.4% of cases with onset before 13 years old and 80.6% of cases with onset after the age of 13 years of age. Of the 42 subjects who presented affective symptoms during childhood, 71.43% also presented affective symptoms into adulthood. These findings indicate an important stability rate of psychosis from childhood and adulthood and come in accordance with the theory of overlap between psychotic and affective disorders. The results underline the importance of an accurate diagnosis of early and very early onset schizophrenia (VEOS), the need for early and multimodal intervention, but also the need for long-term management of these patients and continuing research regarding psychotic-related disorders in children and adolescents.
Topics: Adolescent; Adult; Child; Humans; Psychotic Disorders; Retrospective Studies; Romania; Schizophrenia
PubMed: 36042658
DOI: 10.1097/MD.0000000000030288 -
Schizophrenia Research Sep 2023Disorganization, presenting as impairment in thought, language and goal-directed behavior, is a core multidimensional syndrome of psychotic disorders. This study...
BACKGROUND
Disorganization, presenting as impairment in thought, language and goal-directed behavior, is a core multidimensional syndrome of psychotic disorders. This study examined whether scalable computational measures of spoken language, and smartphone usage pattern, could serve as digital biomarkers of clinical disorganization symptoms.
METHODS
We examined in a longitudinal cohort of adults with a psychotic disorder, the associations between clinical measures of disorganization and computational measures of 1) spoken language derived from monthly, semi-structured, recorded clinical interviews; and 2) smartphone usage pattern derived via passive sensing technologies over the month prior to the interview. The language features included speech quantity, rate, fluency, and semantic regularity. The smartphone features included data missingness and phone usage during sleep time. The clinical measures consisted of the Positive and Negative Symptom Scale (PANSS) conceptual disorganization, difficulty in abstract thinking, and poor attention, items. Mixed linear regression analyses were used to estimate both fixed and random effects.
RESULTS
Greater severity of clinical symptoms of conceptual disorganization was associated with greater verbosity and more disfluent speech. Greater severity of conceptual disorganization was also associated with greater missingness of smartphone data, and greater smartphone usage during sleep time. While the observed associations were significant across the group, there was also significant variation between individuals.
CONCLUSIONS
The findings suggest that digital measures of speech disfluency may serve as scalable markers of conceptual disorganization. The findings warrant further investigation into the use of recorded interviews and passive sensing technologies to assist in the characterization and tracking of psychotic illness.
Topics: Adult; Humans; Psychotic Disorders; Language; Thinking; Cognition; Speech
PubMed: 36564239
DOI: 10.1016/j.schres.2022.12.003 -
Comprehensive Psychiatry May 2022Psychotic disorder not otherwise specified (PNOS) is considered part of the psychosis spectrum, together with schizophrenia spectrum disorders (SSD) and psychotic...
INTRODUCTION
Psychotic disorder not otherwise specified (PNOS) is considered part of the psychosis spectrum, together with schizophrenia spectrum disorders (SSD) and psychotic bipolar spectrum disorders (PBD). The atypical clinical presentations of PNOS conditions may lead to uncertainty regarding treatment choices and expected outcomes. PNOS is understudied, and little is known about patients' premorbid characteristics including premorbid adjustment, prevalence of early cannabis use and childhood trauma. Knowledge about early illness phases can increase our understanding of this diagnostic group.
METHODS
We included 1099 participants from the Norwegian TOP-study; 688 with narrow SSD diagnoses (schizophrenia, schizoaffective disorder, schizophreniform disorder), 274 with PBD (psychotic bipolar 1 and bipolar NOS) and 137 with PNOS diagnosed with the SCID-I for DSM-IV. Participants were assessed with the Premorbid Adjustment Scale (PAS) divided into the areas of premorbid academic and social functioning. We obtained information on age at first exposure to cannabis and use of cannabis before the age of 16. The participants also provided information regarding early traumatic experiences using the Childhood Trauma Questionnaire (CTQ).
RESULTS
Participants with PNOS and SSD had poorer premorbid academic functioning than those with PBD (F = 7.81, p < 0.001, η = 0.015). Premorbid social adjustment was significantly worse in the SSD group compared to the PBD group (F = 3.10, p = 0.045, η = 0.006), with PNOS in the middle position. Significantly more of the participants with PNOS (17.5%) and SSD (11.5%) used cannabis before the age of 16 compared with PBD (5.3%, Wald χ = 6.86, p = 0.03). There were no significant differences between the three groups regarding mean CTQ scores or in the proportion of participants who had experienced at least one type of childhood adversity.
CONCLUSIONS
Participants with PNOS appear as more similar to participants with SSD than to those with PBD regarding early premorbid adjustment and early cannabis use. The results indicate that many conditions classified as PNOS have functional impairments and problematic substance use from an early age. The prevalence of childhood adversities are high in all three groups.
Topics: Bipolar Disorder; Cannabis; Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychotic Disorders; Schizophrenia; Social Adjustment
PubMed: 35385814
DOI: 10.1016/j.comppsych.2022.152310 -
European Psychiatry : the Journal of... Mar 2024Psychotic symptoms are relatively common in children and adolescents attending mental health services. On most occasions, their presence is not associated with a primary...
Psychotic symptoms are relatively common in children and adolescents attending mental health services. On most occasions, their presence is not associated with a primary psychotic disorder, and their clinical significance remains understudied. No studies to date have evaluated the prevalence and clinical correlates of psychotic symptoms in children requiring inpatient mental health treatment. All children aged 6 to 12 years admitted to an inpatient children's unit over a 9-year period were included in this naturalistic study. Diagnosis at discharge, length of admission, functional impairment, and medication use were recorded. Children with psychotic symptoms without a childhood-onset schizophrenia spectrum disorder (COSS) were compared with children with COSS and children without psychotic symptoms using Chi-square and linear regressions. A total of 211 children were admitted during this period with 62.4% experiencing psychotic symptoms. The most common diagnosis in the sample was autism spectrum disorder (53.1%). Psychotic symptoms were not more prevalent in any diagnosis except for COSS (100%) and intellectual disability (81.8%). Psychotic symptoms were associated with longer admissions and antipsychotic medication use. The mean length of admission of children with psychotic symptoms without COSS seems to lie in between that of children without psychotic symptoms and that of children with COSS. We concluded that psychotic symptoms in children admitted to the hospital may be a marker of severity. Screening for such symptoms may have implications for treatment and could potentially contribute to identifying more effective targeted interventions and reducing overall morbidity.
Topics: Adolescent; Child; Humans; Mental Health; Autism Spectrum Disorder; Inpatients; Psychotic Disorders; Hospitalization
PubMed: 38439671
DOI: 10.1192/j.eurpsy.2024.23 -
Journal of Psychopathology and Clinical... Feb 2022Evidence suggests that self-esteem is an important mechanism in pathways to psychosis. However, whether low or high self-esteem is associated with psychotic experiences...
Evidence suggests that self-esteem is an important mechanism in pathways to psychosis. However, whether low or high self-esteem is associated with psychotic experiences remains unclear. Besides, a limited number of studies has investigated fluctuations in state self-esteem in psychotic patients. This study investigated cross-sectional and temporal associations of momentary self-esteem and fluctuations in self-esteem with psychotic symptoms in three groups with different levels of (familial) liability to psychotic disorder. Using the Experience Sampling Method (ESM), momentary self-esteem, fluctuations in self-esteem (i.e., variability and instability), and psychotic experiences, paranoia, negative symptoms (i.e., event anhedonia and social anhedonia), intensity of negative affect and altered affective experiences (instability and variability in negative affect) were assessed in 147 psychotic patients, 131 of their siblings and 113 controls. Lower levels of momentary self-esteem were associated with an increased intensity of psychotic experiences, paranoia and negative affect, with the magnitude of the associations for momentary self-esteem being greatest in patients, followed by relatives. Variability in self-esteem was associated with psychotic and paranoid experiences, the magnitudes were greatest in relatives. Furthermore, we found reciprocal effects between momentary self-esteem and psychotic experiences, paranoia, negative affect, and instability in negative affect. These findings suggest that individuals with familial liability to psychosis (patients and their first-degree relatives) might benefit from targeting momentary self-esteem and variability in self-esteem to decrease the intensity of psychotic experiences, paranoia, and negative affect in daily life. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Cross-Sectional Studies; Ecological Momentary Assessment; Humans; Paranoid Disorders; Psychotic Disorders; Self Concept
PubMed: 35230860
DOI: 10.1037/abn0000722