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Current Psychiatry Reports Apr 2012In recent years, there have been increasing efforts to develop early detection and prevention strategies for patients at risk of the development of psychotic disorders.... (Review)
Review
In recent years, there have been increasing efforts to develop early detection and prevention strategies for patients at risk of the development of psychotic disorders. These efforts have led to improved recognition and characterization of psychotic symptoms in youth. This review focuses on the evaluation of children and adolescents with psychotic symptoms who are experiencing functional impairment but who do not meet current criteria for schizophrenia. For this article, emphasis is placed on the evaluation of symptoms, differential diagnosis, and consideration of potential interventions.
Topics: Adolescent; Antipsychotic Agents; Child; Child, Preschool; Cognitive Behavioral Therapy; Diagnosis, Differential; Female; Humans; Male; Psychiatric Status Rating Scales; Psychotic Disorders; Risk Factors; Schizotypal Personality Disorder; Social Support
PubMed: 22350543
DOI: 10.1007/s11920-012-0258-y -
Tijdschrift Voor Psychiatrie 2024Background Patients with psychotic disorders have a higher risk of physical illnesses on account of genetic predisposition, poorer access to...
Background Patients with psychotic disorders have a higher risk of physical illnesses on account of genetic predisposition, poorer access to healthcare, medication use, environmental factors and lifestyle. Because healthy lifestyle behaviour is established at young age, it is important to signal problems in good time. A lifestyle screening might be useful in this respect. Aim To describe the lifestyle characteristics of patients in a mental health clinic for young adults (age: 18-28 years) with early psychotic disorder based on parts of the instrument ‘Lifestyle-in-the-picture’ compared to healthy controls. We also discuss experiences of lifestyle coaches in applying ‘Lifestyle-in-the-picture’. Method Lifestyle characteristics and lifestyle behaviour of 90 patients with a psychotic disorder and 137 young adults from the general population were compared quantitatively. Additionally, interviews were held with lifestyle coaches as to the use of the instrument ‘Lifestyle-in-the-picture’. Results The young adult patients had considerably poorer results on lifestyle aspects than controls: increased body mass index (BMI 53% versus 18%), smoking, addiction and unhealthy eating and activity patterns. They were more dissatisfied with their physical and mental health. According to the lifestyle coaches, the ‘Lifestyle-in-the-picture’ instrument was a good starting point to work on improvement with patients since the instrument provided insight in the healthy and unhealthy aspects of their lifestyle and gave directions to set goals. Conclusions Young adults with a psychotic disorder have an unhealthy lifestyle and also more risk factors compared to controls. Lifestyle screening programmes are important to discuss health risks in time and which steps for improvement can be taken. The step from insight to actual more healthy behaviour is challenging.
Topics: Humans; Young Adult; Adolescent; Adult; Psychotic Disorders; Life Style; Health Behavior; Behavior, Addictive; Emotions
PubMed: 38512145
DOI: No ID Found -
Medicina (Kaunas, Lithuania) Feb 2023Even though since the beginning of the COVID-19 pandemic, the literature became more and more abundant on data and hypotheses about the various consequences on people's... (Review)
Review
Even though since the beginning of the COVID-19 pandemic, the literature became more and more abundant on data and hypotheses about the various consequences on people's lives, more clarity needs to be added to the existing information. Besides the stressful experiences related to the COVID-19 pandemic, SARS-CoV-2 infection has been proven to impact brain functioning through direct and indirect pathogenic mechanisms. In this context, we report a case of a patient presenting with a first episode of psychosis following COVID-19. In our case, a 28-year-old male patient with no personal or family psychiatric history developed psychotic symptoms (delusions, hallucinations, and disorganized behaviour) that required antipsychotic treatment and inpatient hospitalization one week after he was discharged from the hospital after COVID-19. At the six-month and one-year follow-up, the patient was in remission without any psychotic signs or symptoms. A brief review of the literature is also provided. The case presented in this article outlines the possibility that the post-COVD-19 recovery period might be a crucial time for the onset of acute psychotic disorder, and therefore, routine psychiatric assessments should be carried out during all phases of the disease. A clearer picture of the impact of the COVID-19 pandemic on mental health will most likely be revealed in the future as many consequences need long-term evaluation.
Topics: Male; Humans; Adult; COVID-19; Pandemics; SARS-CoV-2; Psychotic Disorders; Hallucinations
PubMed: 36837609
DOI: 10.3390/medicina59020408 -
Adicciones Jul 2023Several hypotheses have been proposed to explain the comorbidity between psychotic disorders and substance use, one of them being the capacity of some to induce... (Observational Study)
Observational Study
Several hypotheses have been proposed to explain the comorbidity between psychotic disorders and substance use, one of them being the capacity of some to induce psychotic symptoms, although the transition from psychotic episodes induced by substances to schizophrenia has been less studied. In this study, differential variables between patients with induced and non-induced psychosis are determined, and the evolution and change of diagnosis of those induced to schizophrenia in the follow-up is analyzed. This is an observational case-control study with 238 patients admitted to the acute care unit for psychotic episodes between December 2003 and September 2011. The group of non-substance-induced psychotic disorders (NSIPD) included 127 patients, with 111 in the substance-induced (SIPD) group, according to the International Classification of Diseases. Sociodemographic and clinical characteristics, personal and family history, substance use, diagnostic stability and progression were compared. The NSIPD group showed higher scores in severity and in negative symptoms and more family history of psychosis. The SIPD group presented more personal history of personality disorder and family history of addictions and more positive symptoms At 6 years of follow-up, 40.9% of ISDP changed to a diagnosis of schizophrenia, presenting more family history of psychotic disorders and worse progression with more visits to the emergency department and readmissions, than subjects who maintained diagnostic stability. Therefore, special attention should be paid to this group of patients because of the potential severity and the increased risk of developing a chronic psychotic disorder.
Topics: Humans; Case-Control Studies; Psychoses, Substance-Induced; Psychotic Disorders; Substance-Related Disorders; Schizophrenia
PubMed: 36975062
DOI: 10.20882/adicciones.1291 -
Molecular Psychiatry Jan 2022Early identification and treatment significantly improve clinical outcomes of psychotic disorders. Recent studies identified protein components of the complement and... (Review)
Review
Early identification and treatment significantly improve clinical outcomes of psychotic disorders. Recent studies identified protein components of the complement and coagulation systems as key pathways implicated in psychosis. These specific protein alterations are integral to the inflammatory response and can begin years before the onset of clinical symptoms of psychotic disorder. Critically, they have recently been shown to predict the transition from clinical high risk to first-episode psychosis, enabling stratification of individuals who are most likely to transition to psychotic disorder from those who are not. This reinforces the concept that the psychosis spectrum is likely a central nervous system manifestation of systemic changes and highlights the need to investigate plasma proteins as diagnostic or prognostic biomarkers and pathophysiological mediators. In this review, we integrate evidence of alterations in proteins belonging to the complement and coagulation protein systems, including the coagulation, anticoagulation, and fibrinolytic pathways and their dysregulation in psychosis, into a consolidated mechanism that could be integral to the progression and manifestation of psychosis. We consolidate the findings of altered blood proteins relevant for progression to psychotic disorders, using data from longitudinal studies of the general population in addition to clinical high-risk (CHR) individuals transitioning to psychotic disorder. These are compared to markers identified from first-episode psychosis and schizophrenia as well as other psychosis spectrum disorders. We propose the novel hypothesis that altered complement and coagulation plasma levels enhance their pathways' activating capacities, while low levels observed in key regulatory components contribute to excessive activation observed in patients. This hypothesis will require future testing through a range of experimental paradigms, and if upheld, complement and coagulation pathways or specific proteins could be useful diagnostic or prognostic tools and targets for early intervention and preventive strategies.
Topics: Biomarkers; Humans; Longitudinal Studies; Psychotic Disorders; Schizophrenia
PubMed: 34226666
DOI: 10.1038/s41380-021-01197-9 -
European Archives of Psychiatry and... Oct 2009The association between cannabis use and psychosis has long been recognized. Recent advances in knowledge about cannabinoid receptor function have renewed interest in... (Review)
Review
The association between cannabis use and psychosis has long been recognized. Recent advances in knowledge about cannabinoid receptor function have renewed interest in this association. Converging lines of evidence suggest that cannabinoids can produce a full range of transient schizophrenia-like positive, negative, and cognitive symptoms in some healthy individuals. Also clear is that in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. The mechanisms by which cannabinoids produce transient psychotic symptoms, while unclear may involve dopamine, GABA, and glutamate neurotransmission. However, only a very small proportion of the general population exposed to cannabinoids develop a psychotic illness. It is likely that cannabis exposure is a "component cause" that interacts with other factors to "cause" schizophrenia or a psychotic disorder, but is neither necessary nor sufficient to do so alone. Nevertheless, in the absence of known causes of schizophrenia, the role of component causes remains important and warrants further study. Dose, duration of exposure, and the age of first exposure to cannabinoids may be important factors, and genetic factors that interact with cannabinoid exposure to moderate or amplify the risk of a psychotic disorder are beginning to be elucidated. The mechanisms by which exposure to cannabinoids increase the risk for developing a psychotic disorder are unknown. However, novel hypotheses including the role of cannabinoids on neurodevelopmental processes relevant to psychotic disorders are being studied.
Topics: Association; Cannabis; Cognition Disorders; Humans; Marijuana Abuse; Neurotransmitter Agents; Psychotic Disorders; Schizophrenia
PubMed: 19609589
DOI: 10.1007/s00406-009-0024-2 -
Translational Psychiatry Oct 2023Accumulating evidence suggests individuals with psychotic disorder show abnormalities in metabolic and inflammatory processes. Recently, several studies have employed...
Accumulating evidence suggests individuals with psychotic disorder show abnormalities in metabolic and inflammatory processes. Recently, several studies have employed blood-based predictors in models predicting transition to psychotic disorder in risk-enriched populations. A systematic review of the performance and methodology of prognostic models using blood-based biomarkers in the prediction of psychotic disorder from risk-enriched populations is warranted. Databases (PubMed, EMBASE and PsycINFO) were searched for eligible texts from 1998 to 15/05/2023, which detailed model development or validation studies. The checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) was used to guide data extraction from eligible texts and the Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and applicability of the studies. A narrative synthesis of the included studies was performed. Seventeen eligible studies were identified: 16 eligible model development studies and one eligible model validation study. A wide range of biomarkers were assessed, including nucleic acids, proteins, metabolites, and lipids. The range of C-index (area under the curve) estimates reported for the models was 0.67-1.00. No studies assessed model calibration. According to PROBAST criteria, all studies were at high risk of bias in the analysis domain. While a wide range of potentially predictive biomarkers were identified in the included studies, most studies did not account for overfitting in model performance estimates, no studies assessed calibration, and all models were at high risk of bias according to PROBAST criteria. External validation of the models is needed to provide more accurate estimates of their performance. Future studies which follow the latest available methodological and reporting guidelines and adopt strategies to accommodate required sample sizes for model development or validation will clarify the value of including blood-based biomarkers in models predicting psychosis.
Topics: Humans; Biomarkers; Prognosis; Psychotic Disorders; Risk Factors
PubMed: 37898606
DOI: 10.1038/s41398-023-02623-y -
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 -
BMC Psychiatry Mar 2023Disruptive and aggressive behavior is frequent in patients with a psychotic disorder; furthermore, it is a recurrent reason for compulsory admission. Even during...
BACKGROUND
Disruptive and aggressive behavior is frequent in patients with a psychotic disorder; furthermore, it is a recurrent reason for compulsory admission. Even during treatment, many patients continue to show aggressive behavior. Antipsychotic medication is posed to have anti-aggressive properties; its prescription is a common strategy for the treatment (and prevention) of violent behavior. The present study aims to investigate the relation between the antipsychotic class, according to the dopamine D2-Receptor binding affinity (i.e., "loose" - "tight binding"), and aggressive events perpetrated by hospitalized patients with a psychotic disorder.
METHODS
We conducted a four-year retrospective analysis of legally liable aggressive incidents perpetrated by patients during hospitalization. We extracted patients' basic demographic and clinical data from electronic health records. We used the Staff Observation Aggression Scale (SOAS-R) to grade the severity of an event. Differences between patients with a "loose" or "tight-binding" antipsychotic were analyzed.
RESULTS
In the observation period, there were 17,901 direct admissions; and 61 severe aggressive events (an incidence of 0.85 for every 1,000 admissions year). Patients with a psychotic disorder perpetrated 51 events (incidence of 2.90 for every 1,000 admission year), with an OR of 15.85 (CI: 8.04-31.25) compared to non-psychotic patients. We could identify 46 events conducted by patients with a psychotic disorder under medication. The mean SOAS-R total score was 17.02 (2.74). The majority of victims in the "loose-binding" group were staff members (73.1%, n = 19), while the majority of victims in the "tight-binding" group were fellow patients (65.0%, n = 13); (X(3,46) = 19.687; p < 0.001). There were no demographic or clinical differences between the groups and no differences regarding dose equivalents or other prescribed medication.
CONCLUSIONS
In aggressive behaviors conducted by patients with a psychotic disorder under antipsychotic medication, the dopamine D2-Receptor affinity seems to have a high impact on the target of aggression. However, more studies are needed to investigate the anti-aggressive effects of individual antipsychotic agents.
Topics: Humans; Antipsychotic Agents; Retrospective Studies; Dopamine; Psychotic Disorders; Aggression
PubMed: 36978013
DOI: 10.1186/s12888-023-04692-1 -
International Journal of Environmental... Dec 2021The aim of the current study was to examine the associations between nicotine dependence and quality of life (QOL) among individuals diagnosed with major depressive...
The aim of the current study was to examine the associations between nicotine dependence and quality of life (QOL) among individuals diagnosed with major depressive disorder (MDD) or psychotic disorders. A total of 378 participants diagnosed with either MDD or psychotic disorders were recruited. The Fagerstorm Test for Nicotine Dependence was used to measure the level of nicotine dependence. The SF-12 health survey questionnaire was used to measure the QOL. The prevalence of nicotine dependence was 23.3% in this sample population. For those diagnosed with MDD, moderate level of nicotine dependence was negatively associated with Vitality and Mental Component Score. For those diagnosed with a psychotic disorder high nicotine dependence was negatively associated with Role Emotional, Mental Health and Mental Component Score. Compared to the general population, the prevalence of smoking in this psychiatric population was 2.4 times higher, while that of nicotine dependence was seven times higher. Individuals with psychotic disorder generally reported better QOL as compared to individuals with MDD. QOL differed across diagnostic groups with regards to socio-demographics, such as age, ethnicity, marital status, education, employment status and monthly income. Among individuals with MDD and psychotic disorders, different levels of nicotine dependence resulted in different levels of association with QOL. More research is needed to better understand the differences in QOL among the varying levels of nicotine dependence.
Topics: Depressive Disorder, Major; Humans; Psychotic Disorders; Quality of Life; Surveys and Questionnaires; Tobacco Use Disorder
PubMed: 34948665
DOI: 10.3390/ijerph182413035