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The Journal of Nervous and Mental... Jul 2022Poor clinical insight is one of the most common features of schizophrenia spectrum disorders and plays a critical role in prognosis and treatment. Considering the...
Poor clinical insight is one of the most common features of schizophrenia spectrum disorders and plays a critical role in prognosis and treatment. Considering the biological and phenomenological overlap between schizophrenia and bipolar I disorder with psychotic features (BID) and increasing incidents of methamphetamine-induced psychotic disorder (MIPD) patients in Iran, it is necessary to have a clear picture of insight among these three groups. The aim of the present study was to compare clinical insight and other aspects of illness among three different disorders: schizophrenia, BID, and MIPD. In addition, we sought to examine the relationship of the severity of psychotic symptoms with clinical insight in each group. A total of 115 male inpatients, including 48 persons diagnosed with schizophrenia, 35 persons diagnosed with BID, and 32 persons diagnosed with MIPD, were selected. All participants completed the Scale to Assess Unawareness of Mental Disorder and the Positive and Negative Syndrome Scale. The results of analysis of variance indicated that schizophrenia patients reported higher rates of illness duration and number of hospital admissions in comparison to the MIPD and BID groups. In addition, persons diagnosed with BID reported more of these outcomes than MIPD groups. However, the three groups showed similar patterns in terms of age of onset and educational, marital, and occupational statuses. The results also revealed that awareness of the disorder was more impaired in schizophrenia patients compared with BID and MIPD patients and in MIPD compared with BID groups. However, the level of awareness of the effect of medication, the awareness of social consequences, and the total score of clinical insight were similar across the three diagnostic groups. As expected, poor clinical insight was correlated with high levels of positive, negative, and cognitive symptoms in the schizophrenia group; with high levels of positive, cognitive, and depressive symptoms in the BID group; and with high levels of positive and excitement symptoms in MIPD. In addition, hierarchical linear regression analyses revealed that only cognitive symptoms in the schizophrenia group and excitement symptoms in the MIPD group significantly predicted the overall score of clinical insight. In the BID group, both cognitive and depressive symptoms significantly predicted clinical insight. These findings suggest that there are differing levels of poor clinical insight in schizophrenia, MIPD, and BID and that poor clinical insight found within each group may have different antecedents.
Topics: Awareness; Humans; Male; Mental Disorders; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology
PubMed: 35766546
DOI: 10.1097/NMD.0000000000001475 -
Comprehensive Psychiatry 2001Although psychotic phenomena in children with disruptive behavior disorders are more common than expected, their prognostic significance is unknown. To examine the...
Although psychotic phenomena in children with disruptive behavior disorders are more common than expected, their prognostic significance is unknown. To examine the outcome of pediatric patients with atypical psychoses, a group of 26 patients with transient psychotic symptoms were evaluated with clinical and structured interviews at the time of initial contact (mean age, 11.6 +/- 2.7 years) and at follow-up 2 to 8 years later. Measures of functioning and psychopathology were also completed at their initial assessment. Risk factors associated with adult psychotic disorders (familial psychopathology, eyetracking dysfunction in patients and their relatives, obstetrical complications, and premorbid developmental course in the proband) had been obtained at study entry. On follow-up examination (mean age, 15.7 +/- 3.4 years), 13 patients (50%) met diagnostic criteria for a major axis I disorder: three for schizoaffective disorder, four for bipolar disorder, and six for major depressive disorder. The remaining 13 patients again received a diagnosis of psychotic disorder not otherwise specified (NOS), with most being in remission from their psychotic symptoms. Among this group who had not developed a mood or psychotic disorder, disruptive behavior disorders were exceedingly common at follow-up and were the focus of their treatment. Higher initial levels of psychopathology, lower cognitive abilities, and more developmental motor abnormalities were found in patients with a poor outcome. Obstetrical, educational, and family histories did not differ significantly between the groups. Through systematic diagnostic evaluation, children and adolescents with atypical psychotic disorders can be distinguished from those with schizophrenia, a difference with important treatment and prognostic implications. Further research is needed to delineate the course and outcome of childhood-onset atypical psychoses, but preliminary data indicate improvement in psychotic symptoms in the majority of patients and the development of chronic mood disorders in a substantial subgroup.
Topics: Adolescent; Adolescent Behavior; Child; Female; Follow-Up Studies; Humans; Male; Prospective Studies; Psychotic Disorders; Saccades
PubMed: 11458307
DOI: 10.1053/comp.2001.24573 -
Psychological Medicine Feb 2023Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and...
BACKGROUND
Higher incidence of psychotic disorders and underuse of mental health services have been reported among many migrant populations. This study examines the initiation and continuity of antipsychotic treatment among migrants and non-migrants with a non-affective psychosis during a new treatment episode.
METHODS
This study is based on a nationwide sample of migrants and Finnish-born controls. Participants who were diagnosed with a psychotic disorder in 2011-2014 were identified from the Care Register for Health Care ( = 1693). Information on purchases of antipsychotic drugs in 2011-2015 was collected from the National Prescription Register. The duration of antipsychotic treatment since diagnosis was estimated using the PRE2DUP model. Cox regression analysis was used to study factors that are associated with discontinuing the use of medication.
RESULTS
There were fewer initiators of antipsychotic treatment after being diagnosed with psychosis among migrants (68.1%) than among Finnish-born patients (73.6%). After controlling for sociodemographic background and factors related to the type of disorder and treatment, migrants were more likely to discontinue medication (adjusted hazard ratio 1.28, 95% confidence interval 1.08-1.52). The risk of discontinuation was highest among migrants from North Africa and the Middle East and Sub-Saharan Africa and among recent migrants. Non-use of antipsychotic treatment before being diagnosed with psychosis, involuntary hospitalization and diagnosis other than schizophrenia were associated with earlier discontinuation both among migrants and non-migrants.
CONCLUSIONS
Migrants with a psychotic disorder are less likely to continue antipsychotic treatment than non-migrants. The needs of migrant patients have to be addressed to improve adherence.
Topics: Humans; Antipsychotic Agents; Finland; Psychotic Disorders; Schizophrenia; Middle East
PubMed: 34074352
DOI: 10.1017/S003329172100218X -
Psychiatria Danubina Oct 2012Psychosis in childhood and adolescence are defines as having delusions or hallucinations, with the hallucinations occurring in the absence of insight into their...
INTRODUCTION
Psychosis in childhood and adolescence are defines as having delusions or hallucinations, with the hallucinations occurring in the absence of insight into their pathological nature. A broader definition includes symptoms such as disorganised speech and grossly disorganised or catatonic behavior. Negative symptoms such as alogia, amotivation and anhedonia can be present. Cognitive and mood symptoms may also be present. There are relatively few epidemiological studies on child and adolescent onset psychosis. It is generally held that the incidence of psychosis, and especially of schizophrenia, increases markedly during the teenage years, with a preponderance of male over female patients.
AIM
This is a descriptive review of child and adolescents with psychotic symptoms. It aims to describe their clinical profile, associated risk factors and management strategies utilised.
RESULTS
While psychotic disorders are considered rare in children and adolescents, they may severely affect development and long-term functioning. Early identification and intervention are critical to improving outcome. This review suggests that a considerable number of adolescents presenting with psychosis required lengthy periods of inpatient care.
CONCLUSION
There is often diagnostic uncertainty in the first episode of child and adolescent-onset psychosis. Key diagnostic issues relate to distinguishing schizophrenia from bipolar disorder in psychotic adolescents. The differential diagnosis may include psychotic disorder due to a general medical condition, or a substance-induced psychotic disorder.
Topics: Adolescent; Adolescent Psychiatry; Age of Onset; Child; Female; Humans; Male; Psychotic Disorders; Young Adult
PubMed: 23114822
DOI: No ID Found -
Epidemiology and Psychiatric Sciences Dec 2012The 'at-risk' criteria are a useful paradigm for investigating the psychological, neurocognitive, neurobiological and genetic risk factors for psychosis, specifically...
The 'at-risk' criteria are a useful paradigm for investigating the psychological, neurocognitive, neurobiological and genetic risk factors for psychosis, specifically schizophrenia. To date, the primary outcome of interest in at-risk research has been the development of psychotic disorder, whereby patients are categorized as either having 'transitioned' or 'not transitioned'. Despite the acceptance of this dichotomy, it is important to consider that the threshold at which psychotic symptoms progress from attenuated to frank 'psychotic disorder' is arbitrary and may be incorrect or meaningless in terms of neurobiological and functional changes associated with psychosis. This has implications for clinical care and the search for markers of schizophrenia. We present recent research suggesting that the term 'outcome' needs to be broadened to incorporate non-psychotic diagnoses, functioning and negative symptoms. Shifting the traditional notion of outcome is the future challenge for at-risk research, but the inclusion of outcomes other than psychosis is likely to result in better aetiological models of psychotic illness.
Topics: Humans; Mental Disorders; Prodromal Symptoms; Psychotic Disorders; Risk; Risk Factors
PubMed: 22846110
DOI: 10.1017/S2045796012000388 -
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 -
Asian Journal of Psychiatry Feb 2017Acute and Transient Psychotic Disorder (ATPD) is a psychotic disorder of brief duration with acute onset and uncertain diagnostic stability.
BACKGROUND
Acute and Transient Psychotic Disorder (ATPD) is a psychotic disorder of brief duration with acute onset and uncertain diagnostic stability.
AIM
To study the diagnostic stability of ATPD during the index episode.
METHOD
140 patients diagnosed with ATPD as per ICD-10, attending a tertiary care hospital in North India were evaluated at follow ups.
RESULTS
Other acute and transient psychotic disorder (ICD10: F23.8) was the most common (69.3%) subtype of ATPD. In 14.28% patients, there was a past episode of ATPD. In our study, 66.3% patient's episodes resolved as ATPD, 32.7% patients converted into either a mood disorder or schizophrenia spectrum disorders.
CONCLUSION
The diagnostic stability of ATPD during the index episode was 66.3% during three months follow up period. Nearly two third of patients with ATPD evolve to either, schizophrenia or mood disorders during the index episode.
Topics: Acute Disease; Adolescent; Adult; Disease Progression; Female; Follow-Up Studies; Humans; India; Male; Outcome Assessment, Health Care; Psychotic Disorders; Tertiary Care Centers; Young Adult
PubMed: 28262127
DOI: 10.1016/j.ajp.2016.10.018 -
Nordic Journal of Psychiatry 2009The purpose was to present the prevalence of all psychotic and bipolar (BP) disorders in a total general population (n=3563), which has been followed from 1947 to 1997.
BACKGROUND
The purpose was to present the prevalence of all psychotic and bipolar (BP) disorders in a total general population (n=3563), which has been followed from 1947 to 1997.
MATERIALS AND METHODS
Best-estimate consensus DSM-IV diagnoses, supported by data from interviews, case notes, registers and key-informants, were assessed. The period prevalence from 1947 to 1997 and the lifetime prevalence (LTP) in 1997, respectively, was calculated.
RESULTS
The period prevalence per 100 was: 4.24 for any psychotic or BP disorder, 2.25 for non-affective psychotic (NAP) disorder, 0.76 for psychotic disorder related to a general medical condition (GMC), 0.62 for affective psychotic (AP) disorder and 0.59 for substance-induced psychotic (SIP) disorder. The LTP per 100 was: 2.82 for any psychotic or BP disorder, 1.38 for NAP disorder, 0.54 for psychotic disorder related to a GMC, 0.48 for SIP disorder and 0.42 for AP disorder. The specific diagnosis with the highest period prevalence 1.43 per 100 and LTP 0.84 per 100, respectively, was schizophrenia. The LTP of psychotic disorder related to a GMC, SIP disorder, schizophrenia and delusional disorder, respectively, was higher than in most recent community studies while the LTP of brief psychotic disorder, schizophreniform disorder and AP disorder, respectively, was lower. However, the findings were in approximate accord with the estimates in the Psychoses in Finland (PIF) Study 1.
CONCLUSIONS
The findings suggest that psychotic disorders are common in the community, and should be considered a major public health concern.
Topics: Adult; Aged; Aged, 80 and over; Bipolar Disorder; Cohort Studies; Cross-Sectional Studies; Diagnostic and Statistical Manual of Mental Disorders; Female; Humans; Incidence; Longitudinal Studies; Male; Middle Aged; Population Surveillance; Psychotic Disorders; Schizophrenia; Schizophrenia, Paranoid; Sweden
PubMed: 19492244
DOI: 10.1080/08039480903009118 -
JAMA Psychiatry Mar 2016The prognostic significance of competing constructs and operationalizations for brief psychotic episodes (acute and transient psychotic disorder [ATPD], brief psychotic... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
The prognostic significance of competing constructs and operationalizations for brief psychotic episodes (acute and transient psychotic disorder [ATPD], brief psychotic disorder [BPD], brief intermittent psychotic symptoms [BIPS], and brief limited intermittent psychotic symptoms [BLIPS]) is unknown.
OBJECTIVE
To provide a meta-analytical prognosis of the risk of psychotic recurrence in patients with remitted first-episode ATPD, BPD, BIPS, and BLIPS and in a benchmark group of patients with remitted first-episode schizophrenia (FES). We hypothesized a differential risk: FES > ATPD > BPD > BIPS > BLIPS.
DATA SOURCES
The Web of Knowledge and Scopus databases were searched up to May 18, 2015; the articles identified were reviewed as well as citations of previous publications and results of a manual search of the reference lists of retrieved articles.
STUDY SELECTION
We included original articles that reported the risk of psychotic recurrence at follow-up for patients in remission from first-episode ATPD, BPD, BLIPS, BIPS, and FES.
DATA EXTRACTION AND SYNTHESIS
Independent extraction by multiple observers. Random-effects meta-analysis was performed, and moderators were tested with meta-regression analyses, Bonferroni corrected. Heterogeneity was assessed with the I2 index. Sensitivity analyses tested the robustness of the results. Publication bias was assessed with funnel plots and the Egger test.
MAIN OUTCOMES AND MEASURES
Proportion of patients with baseline ATPD, BPD, BLIPS, and BIPS who had any psychotic recurrence at 6, 12, 24, and 36 or more months of follow-up.
RESULTS
Eighty-two independent studies comprising up to 11,133 patients were included. There was no prognostic difference in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS at any follow-up (P > .03). In the long-term analysis, risk of psychotic recurrence (reported as mean [95% CI]) was significantly higher in the FES group (0.78 [0.58-0.93] at 24 months and 0.84 [0.70-0.94] at ≥ 36 months; P < .02 and P < .001, respectively) compared with the other 4 groups (0.39 [0.32-0.47] at 24 months and 0.51 [0.41-0.61] at ≥ 36 months). There were no publication biases. Sex and exposure to antipsychotic medication modulated the meta-analytical estimates (.002 < P < .03).
CONCLUSIONS AND RELEVANCE
There are no prognostic differences in risk of psychotic recurrence between ATPD, BPD, BLIPS, and BIPS constructs of brief psychotic episodes. Conversely, there is consistent meta-analytical evidence for better long-term prognosis of brief psychotic episodes compared with remitted first-episode schizophrenia. These findings should influence the diagnostic practice and clinical services in the management of early psychosis.
Topics: Acute Disease; Adult; Diagnosis, Differential; Female; Humans; Male; Predictive Value of Tests; Prognosis; Psychotic Disorders; Recurrence; Schizophrenia; Schizophrenic Psychology
PubMed: 26764163
DOI: 10.1001/jamapsychiatry.2015.2313 -
The Medical Clinics of North America Sep 1986Psychiatric disorders are common in medical inpatient and outpatient populations. As a result, internists commonly are the first to see psychiatric emergencies. As with...
Psychiatric disorders are common in medical inpatient and outpatient populations. As a result, internists commonly are the first to see psychiatric emergencies. As with all medical problems, a good history, including a collateral history from relatives and friends, physical and mental status examination, and appropriate laboratory tests help establish a preliminary diagnosis and treatment plan. Patients with suicidal ideation usually have multiple stressors in the environment and/or a psychiatric disorder (i.e., a major affective disorder, dysthymic disorder, anxiety or panic disorder, psychotic disorder, alcohol or drug abuse, a personality disorder, and/or an adjustment disorder). Of all patients who commit suicide, 70% have a major depressive disorder, schizophrenia, psychotic organic mental disorder, alcoholism, drug abuse, and borderline personality disorder. Patients who are at great risk have minimal supports, a history of previous suicide attempts, a plan with high lethality, hopelessness, psychosis, paranoia, and/or command self-destructive hallucinations. Treatment is directed toward placing the patient in a protected environment and providing psychotropic medication and/or psychotherapy for the underlying psychiatric problem. Other psychiatric emergencies include psychotic and violent patients. Psychotic disorders fall into two categories etiologically: those that have an identifiable organic factor causing the psychosis and those that have an underlying psychiatric disorder. Initially, it is essential to rule out organic pathology that is life-threatening or could cause irreversible brain damage. After such organic causes are ruled out, neuroleptic medication is indicated. If the patient is not agitated or combative, he or she may be placed on oral divided doses of neuroleptics in the antipsychotic range. Patients who are agitated or psychotic need rapid tranquilization with an intramuscular neuroleptic every half hour to 1 hour until the agitation and combativeness are under control. Haloperidol (Haldol) is the safest neuroleptic. Chlorpromazine (Thorazine), perphenazine (Trilafon), and, in the elderly, thiothixene (Navane) can also be useful if haloperidol (Haldol) is not effective and more sedation is needed; these drugs, however, produce more side effects. Violent patients need to be physically restrained and then given antipsychotic medication or, in the case of drug abuse or alcohol withdrawal, the appropriate drug management.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Commitment of Mentally Ill; Diagnosis, Differential; Emergencies; Hospitalization; Humans; Mental Disorders; Psychotic Disorders; Risk; Suicide, Attempted; Violence; Suicide Prevention
PubMed: 3736271
DOI: 10.1016/s0025-7125(16)30919-1