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International Psychogeriatrics Oct 2022The primary aim was to systematically review the literature regarding the effectiveness of clozapine in reducing symptoms of primary psychotic and bipolar disorders in... (Review)
Review
OBJECTIVES
The primary aim was to systematically review the literature regarding the effectiveness of clozapine in reducing symptoms of primary psychotic and bipolar disorders in older adults. The secondary aim was to describe other reported patient and caregiver outcomes of clozapine treatment in older adults.
DESIGN
MEDLINE, Embase, PsychINFO, ProQuest, and PubMed databases were searched according to PRISMA guidelines for original empirical research examining the effectiveness of clozapine in adults aged 65 years or more with primary psychotic and bipolar disorders. Identified studies were assessed for methodological quality using the QualSyst tool.
RESULTS
1121 records were screened, of which 7 studies met the inclusion criteria. In total, 128 subjects participated in the included studies (111 of whom were from a single study), with an age range of 65-86 years, and diagnoses including schizophrenia, schizoaffective disorder, bipolar disorder, and delusional disorder. Indications for clozapine use included treatment resistance and inability to tolerate other treatments. While six out of seven studies reported some improvement on the primary measure of psychopathology after treatment with clozapine, the group effects were modest and based on low-level evidence. Additional reported outcomes included discharge destination, death, and relapse. Most of the included studies were only of adequate methodological quality, with significant risks of bias identified.
CONCLUSIONS
Clozapine may have positive effects for primary psychotic and bipolar illnesses in some older adults, but the group effects reported were modest and based on low-level evidence studies with methodological limitations. Based on these findings, clinical decision-making about whether or not to trial clozapine should involve an individualized analysis of potential benefits and risks in collaboration with patients and their families and caregivers.
Topics: Aged; Aged, 80 and over; Antipsychotic Agents; Bipolar Disorder; Clozapine; Humans; Psychotic Disorders; Schizophrenia
PubMed: 33612141
DOI: 10.1017/S1041610220004172 -
Schizophrenia Research May 2021Emerging data suggest cannabis use is a component cause of psychotic disorders; however, the sequence of processes accounting for this association is poorly understood....
BACKGROUND
Emerging data suggest cannabis use is a component cause of psychotic disorders; however, the sequence of processes accounting for this association is poorly understood. Some clues have come from studies in laboratory settings showing that acute cannabis intoxication is associated with subclinical hallucinations and delusional thinking, i.e., "psychotic experiences". Although psychotic experiences are relatively common, those that are severe and distressing are linked to an increased risk of developing a psychotic disorder. This study aimed to investigate the association between the frequency of cannabis use and psychotic experiences in young adults.
METHODS
1034 U.S. college students completed questionnaires to assess: cannabis use in the past week, delusional ideation (Peters Delusions Inventory), hallucinations (Launay-Slade Hallucinations Scale-Extended), and depression (Beck Depression Inventory).
RESULTS
Participants reporting higher rates of weekly cannabis use were more likely to report hallucinatory experiences and delusional ideation. The relationship between cannabis use and hallucinatory experiences, but not the relationship between cannabis use and delusional ideation, remained significant after controlling for levels of depression. Moreover, those who reported greater amounts of cannabis use had more distressing delusional ideas, that were held with more conviction.
CONCLUSIONS
Cannabis use is linked to the presence of subclinical hallucinations and delusional ideation in U.S. college students.
Topics: Cannabis; Delusions; Hallucinations; Humans; Psychotic Disorders; Students; Young Adult
PubMed: 33887647
DOI: 10.1016/j.schres.2021.04.004 -
General Hospital Psychiatry 2020Delusional disorder is an uncommon psychotic disorder. The first-line treatments for this chronic and resistant condition are antipsychotic medications, usually...
BACKGROUND
Delusional disorder is an uncommon psychotic disorder. The first-line treatments for this chronic and resistant condition are antipsychotic medications, usually associated with several side effects that can exacerbate poor adherence. Conversely, aripiprazole is a well-tolerated antipsychotic drug that is effective in the treatment of other psychotic disorders. Here, we aimed to systematically review and summarize the currently available literature to evaluate the effectiveness and tolerability of aripiprazole in delusional disorders.
METHODS
A comprehensive literature search from inception until February 2020 was performed in PubMed, Cochrane Database of Systematic Reviews, and Scopus databases using The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
We identified 21 single cases of delusional disorders, mostly somatic type, treated with aripiprazole. All studies reported patient clinical improvements after the beginning of the treatment with aripiprazole. The average dose of aripiprazole was 11.1 mg/day, and the average time to achieve a clinical response was 5.7 weeks. Few adverse effects were reported, including asthenia, extrapyramidal symptoms, hyperprolactinemia, and insomnia.
CONCLUSIONS
Our findings suggest that aripiprazole may be an effective treatment for delusional disorders with good tolerability. Further studies comparing aripiprazole with other antipsychotics in the treatment of delusional disorders are needed.
Topics: Antipsychotic Agents; Aripiprazole; Humans; Schizophrenia, Paranoid
PubMed: 32650190
DOI: 10.1016/j.genhosppsych.2020.06.012 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2021To analyze a complex of EEG parameters and quantitative clinical evaluations of depressive-delusional conditions in patients with schizoaffective disorder and to clarify...
OBJECTIVE
To analyze a complex of EEG parameters and quantitative clinical evaluations of depressive-delusional conditions in patients with schizoaffective disorder and to clarify their neurophysiological mechanisms.
MATERIAL AND METHODS
A study included 25 female patients, aged 22-40 years, with depressive-delusional conditions. Patients were assessed at baseline and after 4-6 weeks of treatment using HDRS and PANSS. EEG was recorded at each visit.
RESULTS
Significant correlations were revealed between the values of pre-treatment background EEG spectral power in narrow frequency bands and quantitative pre-treatment and post-treatment scores of patient's clinical conditions.
CONCLUSION
The results allow clarifying the brain mechanisms of depressive-delusional disorders and reveal possible EEG-predictors of therapeutic response in its treatment.
Topics: Adult; Brain; Electroencephalography; Female; Humans; Psychotic Disorders; Young Adult
PubMed: 33728850
DOI: 10.17116/jnevro202112102146 -
Psychological Medicine Jul 2022This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with...
BACKGROUND
This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.
METHODS
Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.
RESULTS
JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.
CONCLUSIONS
These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.
Topics: Bias; Decision Making; Delusions; Hallucinations; Humans; Psychotic Disorders; Schizophrenia
PubMed: 33046166
DOI: 10.1017/S0033291720003578 -
Clinical Practice and Cases in... Nov 2019Delusional parasitosis is an uncommon psychiatric disorder that manifests as having parasitic delusions. Due to its rarity, delusional parasitosis is a challenging and...
Delusional parasitosis is an uncommon psychiatric disorder that manifests as having parasitic delusions. Due to its rarity, delusional parasitosis is a challenging and costly diagnosis of exclusion and proves difficult to manage for many providers. Although this syndrome is frequently discussed in psychiatric and dermatology reports, it is not commonly described in emergency medicine (EM) literature. As a result, best practices for workup and treatment remain unclear from an EM perspective. Patients typically return multiple times for medical evaluation and exhaust numerous resources. In this case report we review the appropriate steps for initial evaluation of patients with suspected delusional parasitosis, differential diagnoses, and increase awareness for prudent treatment strategies.
PubMed: 31763595
DOI: 10.5811/cpcem.2019.8.44619 -
Schizophrenia Research Feb 2021Little is known on the effective pharmacological treatment of delusional disorder.
BACKGROUND
Little is known on the effective pharmacological treatment of delusional disorder.
AIMS
Study the comparative effectiveness of pharmacotherapies in the prevention of hospitalization due to psychosis and work disability in delusional disorder.
METHODS
Observational registry based cohort study including everyone in Sweden diagnosed with delusional disorder (N = 9076;mean follow-up time 4.9 years). The primary analysis was Cox Proportional Hazards within-individual analysis. Results are reported as adjusted hazard ratios (HRs).
RESULTS
Among the cohort (4835 males/4241 females;mean [SD] age 44.1 [12.5] years), 2074 persons had at least one hospitalization due to psychosis. Risk for hospitalization due to psychosis was 46% lower when any antipsychotic was used (HR 0.54, 95%CI 0.38-0.77, p < 0.001). Use of clozapine (HR 0.24, 95%CI 0.07-0.77, p = 0.016), any long-acting injectable (LAI; HR 0.28, 95%CI 0.16-0.49, p < 0.0001) and oral olanzapine (HR 0.36, 95%CI 0.20-0.67, p = 0.001) were associated with lowest risk. Among those not on disability pension at start of follow-up (n = 5025), in comparison to no use of antipsychotics, use of clozapine (HR 0.08, 95%CI 0.01-0.52, p = 0.008), any LAI (HR 0.44, 95%CI 0.25-0.79, p = 0.006) and oral aripiprazole (HR 0.52, 95%CI 0.31-0.85, p = 0.009) were associated with lowest risk of work disability.
CONCLUSIONS
Use of antipsychotics was associated with a reduced risk of hospitalization due to psychosis and work disability in delusional disorder, with use of clozapine and long-acting injectables being associated with the lowest risk for these very relevant end-points for both individual suffering and costs to society. Clinical trials with these treatments are urgently needed to make informed clinical treatment recommendations.
Topics: Adult; Antipsychotic Agents; Clozapine; Cohort Studies; Female; Humans; Male; Schizophrenia, Paranoid; Sweden
PubMed: 33548837
DOI: 10.1016/j.schres.2021.01.015 -
Clocks & Sleep Feb 2022While the early identification of insomnia in patients with schizophrenia is of clinical relevance, the use of specific compounds to treat insomnia has been studied less... (Review)
Review
While the early identification of insomnia in patients with schizophrenia is of clinical relevance, the use of specific compounds to treat insomnia has been studied less in postmenopausal women with schizophrenia. We aimed to explore the effects of melatonin, sex hormones, and raloxifene for the treatment of insomnia in these populations. Although melatonin treatment improved the quality and efficiency of the sleep of patients with schizophrenia, few studies have explored its use in postmenopausal women with schizophrenia. The estrogen and progesterone pathways are dysregulated in major psychiatric disorders, such as in schizophrenia. While, in the context of menopause, a high testosterone-to-estradiol ratio is associated with higher frequencies of depressive symptoms, the effects of estradiol and other sex hormones on sleep disorders in postmenopausal women with schizophrenia has not been sufficiently investigated. Raloxifene, a selective estrogen receptor modulator, has shown positive effects on sleep disorders in postmenopausal women. Future studies should investigate the effectiveness of hormonal compounds on insomnia in postmenopausal women with schizophrenia.
PubMed: 35225953
DOI: 10.3390/clockssleep4010007 -
L'Encephale Feb 2021Efforts to improve the prognosis of subjects with anorexia nervosa [AN] through the development of specific therapeutic interventions have yielded unsatisfactory...
Efforts to improve the prognosis of subjects with anorexia nervosa [AN] through the development of specific therapeutic interventions have yielded unsatisfactory results. AN can be perceived as a mental disorder that is clinically composed of disturbed psychopathological dimensions found in major depressive disorder, obsessive compulsive disorder, body dysmorphic disorder, and delusional disorder somatic type. Future treatment strategies of patients with AN might target these multiple psychopathological dimensions. Considering that each of these dimensions is known to be best treated with psychopharmacologic drugs such as antidepressants, mood stabilizers and antipsychotic drugs, AN treatment guidelines may need to consider prescribing them to patients.
Topics: Anorexia Nervosa; Body Dysmorphic Disorders; Depressive Disorder, Major; Humans; Obsessive-Compulsive Disorder; Psychopathology
PubMed: 33041048
DOI: 10.1016/j.encep.2020.06.002 -
PeerJ 2022This article describes the most likely classes of proteins and molecular processes that specifically characterize schizophrenic spectrum disorders such as simple and...
This article describes the most likely classes of proteins and molecular processes that specifically characterize schizophrenic spectrum disorders such as simple and paranoid schizophrenia, schizotypal disorder, and acute polymorphic psychotic disorder (APPD). The identification of patients' serum proteins was carried out using mass spectrometry. For patients with paranoid schizophrenia, the proteins responsible for translation and transcription are characteristic. A significant part of the proteins of patients with simple schizophrenia regulate the cell's main metabolic and transport processes. These are proteins of the receptor system, vesicular transport, and extracellular matrix, which mainly carry out catabolic processes. The proteins of patients with schizotypal disorder mostly coincided with the classes of other patients, apart from chaperone proteins, which were not found in other studied groups. These proteins are mainly involved in anabolic processes. The main classes of proteins found in patients with APPD are responsible for the metabolism of nucleic acids. Active apoptosis processes were also revealed in these patients. These results from our basic knowledge about the molecular mechanisms of the pathogenesis of these disorders.
Topics: Humans; Proteomics; Schizophrenic Psychology; Psychotic Disorders; Schizotypal Personality Disorder; Schizophrenia, Paranoid
PubMed: 36061748
DOI: 10.7717/peerj.13907