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Tijdschrift Voor Psychiatrie 2011It may be possible to improve the prognosis of psychotic disorders by the timely recognition and treatment of the early stages of these disorders. Since the first... (Review)
Review
BACKGROUND
It may be possible to improve the prognosis of psychotic disorders by the timely recognition and treatment of the early stages of these disorders. Since the first psychotic episode is often preceded by a period of non-specific symptoms and functional decline, it could be worthwhile investigating whether this early phase can be detected.
AIM
To review existing diagnostic approaches and clinical instruments that are currently used for prospective identification of the prodromal phase.
METHOD
We searched the literature between 1995 and 2009 using the search terms 'prodromal' or 'ultra high risk' in combination with 'psychosis' or 'schizophrenia' and 'assessment'.
RESULTS
In international literature we found four diagnostic approaches to ultra high risk of psychosis: the attenuated positive symptom approach, the basic symptom approach, the clinical high risk approach and the strictly phenomenological approach. Within each of these approaches specific screening instruments had been developed and tested with regard to their ability to correctly predict a first psychotic episode.
CONCLUSION
None of the current diagnostic approaches produces a sufficiently reliable prediction of the risk of a first psychotic episode. Within the group of persons assumed, based on screening, to be at very high risk, only a small percentage will actually develop a psychotic disorder.
Topics: Behavioral Symptoms; Early Diagnosis; Humans; Psychiatric Status Rating Scales; Psychotic Disorders; Risk Assessment; Risk Factors
PubMed: 21404172
DOI: No ID Found -
The Journal of Nervous and Mental... Aug 2022The involvement of certain recreational drugs, namely, hallucinogens, in the development of hyperactive syndromes is well known, but not well studied. In this report, we...
The involvement of certain recreational drugs, namely, hallucinogens, in the development of hyperactive syndromes is well known, but not well studied. In this report, we expand on this relationship by documenting the development of substance-induced psychosis in a young patient who used a large amount of psilocybin and developed symptoms of a first psychotic and manic episode, complicated by violent behavior and rhabdomyolysis. We further evaluate the association between psilocybin use and rhabdomyolysis and explore this understudied phenomenon and differentiate it from the diagnoses of other hyperactive syndromes seen in psychiatry. This case exemplifies the need for increased vigilance in psilocybin microdosing therapy and for physicians to be mindful of how each patient responds to its use to prevent life-threatening hyperactive syndromes in its wake.
Topics: Agaricales; Humans; Psilocybin; Psychotic Disorders; Rhabdomyolysis; Substance-Related Disorders
PubMed: 35900779
DOI: 10.1097/NMD.0000000000001489 -
Psychopathology 2014Misidentification phenomena, including the delusion of 'imposters' named after Joseph Capgras, occur in various major psychiatric and neurological disorders but have...
BACKGROUND
Misidentification phenomena, including the delusion of 'imposters' named after Joseph Capgras, occur in various major psychiatric and neurological disorders but have rarely been studied systematically in broad samples of modern patients. This study investigated the prevalence and correlated clinical factors of Capgras' phenomenon in a broad sample of patient-subjects with first-lifetime episodes of psychotic affective and nonaffective disorders.
METHODS
We evaluated 517 initially hospitalized, first-episode psychotic-disorder patients for the prevalence of Capgras' phenomenon and its association with DSM-IV-TR diagnoses including schizophreniform, brief psychotic, unspecified psychotic, delusional, and schizoaffective disorders, schizophrenia, bipolar-I disorder and major depression with psychotic features, and with characteristics of interest including antecedent psychiatric and neurological morbidity, onset type and presenting psychopathological phenomena, using standard bivariate and multivariate statistical methods.
RESULTS
Capgras' syndrome was identified in 73/517 (14.1%) patients (8.2-50% across diagnoses). Risk was greatest with acute or brief psychotic disorders (schizophreniform psychoses 50%, brief psychoses 34.8%, or unspecified psychoses 23.9%), intermediate in major depression (15%), schizophrenia (11.4%) and delusional disorder (11.1%), and lowest in bipolar-I (10.3%) and schizoaffective disorders (8.2%). Associated were somatosensory, olfactory and tactile hallucinations, Schneiderian (especially delusional perception), and cycloid features including polymorphous psychotic phenomena, rapidly shifting psychomotor and affective symptoms, pananxiety, ecstasy, overconcern with death, and perplexity or confusion, as well as rapid onset, but not sex, age, abuse history, dissociative features, or indications of neurological disorders.
CONCLUSIONS
Capgras' syndrome was prevalent across a broad spectrum of first-episode psychotic disorders, most often in acute psychoses of rapid onset.
Topics: Adult; Capgras Syndrome; Delusions; Diagnostic and Statistical Manual of Mental Disorders; Female; Hallucinations; Hospitalization; Humans; Male; Psychopathology; Psychotic Disorders; Young Adult
PubMed: 24516070
DOI: 10.1159/000357813 -
Schizophrenia Research Jun 2020
Topics: Borderline Personality Disorder; Humans; Psychotic Disorders; Schizotypal Personality Disorder
PubMed: 32305167
DOI: 10.1016/j.schres.2020.03.065 -
American Journal of Medical Genetics.... Jun 2017We investigated the clinically derived hypothesis of a relatively high incidence of delusional and psychotic disorders in adolescents with juvenile Myotonic Dystrophy...
We investigated the clinically derived hypothesis of a relatively high incidence of delusional and psychotic disorders in adolescents with juvenile Myotonic Dystrophy type-1 (DM1). Twenty-seven subjects of age 16-25 with juvenile DM1 and their parents were invited to have a clinical psychiatric interview, and to complete an ASEBA behavior checklist (YSR, ASR, CBCL, and ABCL). We diagnosed a Delusional Disorder in 19% of our patients and a Psychotic Disorder not otherwise specified in another 19%. These two groups of patients had a significantly worse level of clinically defined general functioning. It is clinically relevant to investigate in patients with juvenile DM the symptom of delusions and the presence of a delusional and psychotic disorder, and to consider the presence of juvenile DM in youngsters presenting with such a thought disorder. These disorders compromise the general functioning of the subjects and are often to some extent treatable. © 2017 Wiley Periodicals, Inc.
Topics: Adolescent; Adult; Delusions; Female; Follow-Up Studies; Humans; Male; Myotonic Dystrophy; Prognosis; Psychiatric Status Rating Scales; Psychotic Disorders; Young Adult
PubMed: 28449271
DOI: 10.1002/ajmg.b.32524 -
Schizophrenia Research Oct 2013Despite advances in the treatment of schizophrenia over the past half-century, the illness is frequently associated with a poor outcome. This is principally related to... (Review)
Review
Despite advances in the treatment of schizophrenia over the past half-century, the illness is frequently associated with a poor outcome. This is principally related to the late identification and intervention in the course of the illness by which time patients have experienced a substantial amount of socio-occupational decline that can be difficult to reverse. The emphasis has therefore shifted to defining psychosis-risk syndromes and evaluating treatments that can prevent transition to psychosis in these ultra-high risk groups. To consider the appropriateness of adding psychosis risk syndrome to our diagnostic nomenclature, the psychotic disorders work group extensively reviewed all available data, consulted a range of experts, and carefully considered the variety of expert and public comments on the topic. It was clear that reliable methods were available to define a syndrome characterized by sub-threshold psychotic symptoms (in severity or duration) and which was associated with a very significant increase in the risk of development of a full-fledged psychotic disorder (schizophrenia spectrum, psychotic mood disorder, and other psychotic disorders) within the next year. At the same time, the majority of individuals with "attenuated psychotic symptoms" had one or more other current psychiatric comorbid conditions (usually mood or anxiety disorders, substance use disorder; Fusar-Poli 2012) and exhibited a range of psychiatric outcomes other than conversion to psychosis (significant proportions either fully recover or develop some other psychiatric disorder, with a minority developing a psychotic disorder). Although the reliability of the diagnosis is well established in academic and research settings, it was found to be less so in community and other clinical settings. Furthermore, the nosological relationship of attenuated psychosis syndrome (APS) to schizotypal personality disorder and other psychiatric conditions was unclear. Further study will hopefully resolve these questions. The work group decided to recommend the inclusion of attenuated psychosis syndrome as a category in the appendix (Section 3) of DSM-5 as a condition for further study.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychotic Disorders; Risk Factors; Schizophrenia; Schizophrenic Psychology
PubMed: 23773295
DOI: 10.1016/j.schres.2013.05.004 -
Psychological Medicine Jan 2022Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural...
BACKGROUND
Minority ethnic and migrant groups face an elevated risk of compulsory admission for mental illness. There are overlapping cultural, socio-demographic, and structural explanations for this risk that require further investigation.
METHODS
By linking Swedish national register data, we established a cohort of persons first diagnosed with a psychotic disorder between 2001 and 2016. We used multilevel mixed-effects logistic modelling to investigate variation in compulsory admission at first diagnosis of psychosis across migrant and Swedish-born groups with individual and neighbourhood-level covariates.
RESULTS
Our cohort included 12 000 individuals, with 1298 (10.8%) admitted compulsorily. In an unadjusted model, being a migrant [odds ratio (OR) 1.48; 95% confidence interval (CI) 1.26-1.73] or child of a migrant (OR 1.27; 95% CI 1.10-1.47) increased risk of compulsory admission. However after multivariable modelling, region-of-origin provided a better fit to the data than migrant status; excess risk of compulsory admission was elevated for individuals from sub-Saharan African (OR 1.94; 95% CI 1.51-2.49), Middle Eastern and North African (OR 1.46; 95% CI 1.17-1.81), non-Nordic European (OR 1.27; 95% CI 1.01-1.61), and mixed Swedish-Nordic backgrounds (OR 1.33; 95% CI 1.03-1.72). Risk of compulsory admission was greater in more densely populated neighbourhoods [OR per standard deviation (s.d.) increase in the exposure: 1.12, 95% CI 1.06-1.18], an effect that appeared to be driven by own-region migrant density (OR per s.d. increase in exposure: 1.12; 95% CI 1.02-1.24).
CONCLUSIONS
Inequalities in the risk of compulsory admission by migrant status, region-of-origin, urban living and own-region migrant density highlight discernible factors which raise barriers to equitable care and provide potential targets for intervention.
Topics: Cohort Studies; Humans; Involuntary Commitment; Minority Groups; Psychotic Disorders; Sweden; Transients and Migrants
PubMed: 32578529
DOI: 10.1017/S0033291720002068 -
International Review of Psychiatry... 2003This article presents some findings about adults with a psychotic disorder who were identified in the OPCS surveys of psychiatric morbidity. The main aim of the analysis...
This article presents some findings about adults with a psychotic disorder who were identified in the OPCS surveys of psychiatric morbidity. The main aim of the analysis was to identify characteristics associated with differences in the circumstances and health-related behaviour of adults aged 16-64 with psychosis. The analysis covers people who were identified by the various criteria used on the surveys as having a psychotic illness and who were considered to be living in private households. First we describe briefly the survey methods used and how diagnoses of psychosis were derived. We then present results from four topic areas covered in the analysis. These are: use of medication, use of health services, difficulties with activities of daily living, and social support.
Topics: Activities of Daily Living; Adolescent; Adult; Catchment Area, Health; Family Characteristics; Female; Health Behavior; Humans; Life Change Events; Male; Mass Screening; Mental Health Services; Middle Aged; Patient Acceptance of Health Care; Psychotic Disorders; Social Support; Surveys and Questionnaires; United Kingdom
PubMed: 12745314
DOI: 10.1080/0954026021000045985 -
Psychopathology 2014Through conceptualising poor insight in psychotic disorders as a form of anosognosia, frontal lobe dysfunction is often ascribed a vital role in its pathogenesis. The...
BACKGROUND/AIMS
Through conceptualising poor insight in psychotic disorders as a form of anosognosia, frontal lobe dysfunction is often ascribed a vital role in its pathogenesis. The objective of this study was to compare the relation of insight in patients with psychotic illness to that of psychopathology and frontal lobe function.
METHODS
Forty patients with psychotic disorder were selected from those attending the Department of Psychiatry in a tertiary care teaching hospital. The evaluation of insight was carried out using the Schedule for Assessment of Insight (SAI), that of frontal lobe function by the Frontal Assessment Battery (FAB) and psychopathology by the Brief Psychiatric Rating Scale (BPRS). The correlation coefficients were determined.
RESULTS
A negative correlation between SAI and BPRS scores means that the BPRS score is opposite to SAI scores. When the SAI total score was compared with the FAB total score, the correlation coefficient demonstrated a positive correlation. Better insight predicted lesser psychopathology and also that poor insight would exist with greater psychopathology. Better insight predicted a higher functional status of frontal lobes and prefrontal cortex in particular.
CONCLUSION
Insight deficits in schizophrenia and other psychotic illnesses are multidimensional. Integration of different aetiological factors like biological, psychopathological, environmental ones and others are necessary for a better understanding of insight in psychosis.
Topics: Adult; Brief Psychiatric Rating Scale; Female; Frontal Lobe; Humans; Male; Middle Aged; Prefrontal Cortex; Psychopathology; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology; Young Adult
PubMed: 23711569
DOI: 10.1159/000348486 -
The British Journal of Clinical... Mar 2005Current psychological theories state that the clinical outcome of hallucinatory experiences is dependent on the degree of associated distress, anxiety, and depression....
OBJECTIVES
Current psychological theories state that the clinical outcome of hallucinatory experiences is dependent on the degree of associated distress, anxiety, and depression. This study examined the hypothesis that the risk for onset of psychotic disorder in individuals with self-reported hallucinatory experiences would be higher in those who subsequently developed depressed mood than in those who did not.
DESIGN
A prospective cohort study of a general population sample.
METHODS
A sample of 4,670 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At Year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify potential onset of psychotic disorder. Psychotic disorder was specified at three levels; two involving severity of positive symptoms of psychosis, and one using additional clinical judgment of need for care.
RESULTS
Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome at Year 3 was higher in the group with depressed mood at Year 1 than in the group without depressed mood at Year 1 (any level of psychotic symptoms: risk difference 17.0%, 95% CI - 1.7, 35.7; severe level of psychotic symptoms: risk difference 21.7%, 95% CI 3.2, 40.2; needs-based diagnosis of psychotic disorder: risk difference 16.8%, 95% CI 0.4, 33.3).
CONCLUSION
The results are in line with current psychological models of psychosis that emphasize the role of secondary appraisals of psychotic experiences in the onset of clinical disorder.
Topics: Adult; Brief Psychiatric Rating Scale; Cohort Studies; Depression; Diagnostic and Statistical Manual of Mental Disorders; Female; Follow-Up Studies; Hallucinations; Humans; Male; Prevalence; Prospective Studies; Psychotic Disorders; Risk Factors; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires
PubMed: 15826348
DOI: 10.1348/014466504X19767