First acute psychotic episode: Factors associated with evolution to schizophrenia

IntroductionThe acute psychotic episode have often a dramatic expression. Although it is easily diagnosed, it is not easy to predict the evolution and much less the prognosis that are of concern both for the therapist and the patients’ families.AimsTo describe the profile of a population of patients with a first psychotic episode. To identify factors correlated with evolution to schizophrenia.MethodsThis is a retrospective study conducted among 55 patients hospitalized for a first acute psychotic episode, in the psychiatry B department during the period extending between January 2010 and December 2015.ResultsThe average age of patients was 26.5. The majority was single male. The prodromal phase was present with predominantly psychotic symptoms (80%). Schizophrenia was the most frequently encountered scalable diagnosis (38%). Some factors are associated with the evolution to schizophrenia. We can mention male gender (P = 0.004) and premorbid schizoid personality (P = 0.047). About correlated clinical factors, we have found an initial symptomatology dominated by loss of interest (P = 0.05), withdrawal and isolation (P = 0.017), impulsivity (P = 0.011), breaking with the usual functioning (P = 0.04), mental automatism (P = 0.033), the delusions of persecution (P = 0.025) and intuitive mechanism (P = 0.023).ConclusionWhen a first acute delusional experience occurs in a young adult, it is always a test of uncertain outcome. However, schizophrenia remains the most feared evolutionary. A better understanding of poor prognosis and early and appropriate management seem paramount to reduce the prevalence of this dreaded evolution.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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First Psychotic Episode and Predictors of Bipolar Disorder Progression

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1903 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S117-S117

Author(s):

N. Halouani ◽

K. Yaich ◽

F. Guermazi ◽

R. Ennaoui ◽

S. Chouayekh ◽

...

Keyword(s):

Bipolar Disorder ◽

Psychotic Disorders ◽

Demographic Data ◽

Psychotic Episode ◽

Acute Psychosis ◽

Evolutionary Potential ◽

Prodromal Phase ◽

Bipolar Mood Disorder ◽

First Psychotic Episode ◽

Competing Interest

IntroductionMany studies on the identification and early treatment of psychotic disorders have focussed less on a solution to the issue of the evolution of an acute psychosis.ObjectiveTo identify some predictive elements of an evolution to bipolar disorder during a first psychotic episode.MethodsWe proceed with a retrospective study concerning 55 patients having developed a first psychotic episode and admitted in the psychiatry B department during the period extending between January 2010 and December 2015. Data were collected on a predetermined questionnaire exploring the following items (socio-demographic data, personal and psychiatric family antecedent, prodromes and psychotic episode symptomatology).ResultsOur sample was composed by 55 patients divided into 74% (n = 41) men and 26% (n = 14) women with a mean age of 26.5 ± 6.27 years. The evolution to a bipolar mood disorder concerned 22% of patients. The prodromal phase was always present. Prodromes correlated with progression to bipolar disorder are: thymic symptoms 44.1% of patients (P = 0.001), modification of volition 42.9% (P = 0.05), anger/irritability 66.7% (P = 0.032) and sadness 83.3% of patients (P = 0.05). Psychotic episode's symptoms correlated with the evolution towards a bipolar disorder corresponded to thymic symptoms. The latter was present in 44.1% of patients (P = 0.01).ConclusionThrough our study, we were able to identify some factors positively correlated with a progression towards bipolarity during a first psychotic disorder. So it would be important to monitor closely and to educate our patients and their families about the evolutionary potential of a first psychotic episode.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Brief psychotic disorder associated with quarantine and mild COVID-19

BMJ Case Reports ◽

10.1136/bcr-2020-240088 ◽

2020 ◽

Vol 13 (12) ◽

pp. e240088

Author(s):

Peter M Haddad ◽

Majid Al Abdulla ◽

Javed Latoo ◽

Yousaf Iqbal

Keyword(s):

Psychotic Disorder ◽

Physical Symptoms ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Psychiatric Medication ◽

Diagnostic And Statistical Manual ◽

First Psychotic Episode ◽

Episode Psychosis ◽

Brief Psychotic Disorder

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.

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Early Diagnosis and Counseling in Adolescents With Subclinical Psychotic Symptoms

The Global Psychotherapist ◽

10.52982/lkj160 ◽

2022 ◽

Vol 2 (1) ◽

pp. 62-68

Author(s):

Veronika Ivanova

Keyword(s):

Early Diagnosis ◽

Medical Model ◽

Psychotic Symptoms ◽

Clinical Psychologist ◽

Psychotic Episode ◽

Clinical Approach ◽

First Psychotic Episode ◽

Psychotherapeutic Techniques ◽

Sexual Identification ◽

Subclinical Psychotic Symptoms

Psychosis is a condition characterized on current diagnostic tests by impairment and may include severe disturbances of cognition, thinking, behaviour, and emotion. The need for early diagnosis and prevention of psychotic episodes in adolescents challenges traditional models of counselling, diagnosis, and treatment. The aim of the present study is to derive the main themes and psychological manifestations in the first psychotic episode in adolescents and to deepen knowledge and raise questions around the specific experiences of psychotic adolescents in order to help the clinical psychologist and psychotherapist in diagnostic and therapeutic counselling. This thus goes beyond the visible behaviour and the medical model that pays little attention to the causal relationships in psychosis and its unconscious components. Thirty-six adolescents (27 girls) with subclinical and clinical psychotic symptoms and 30 adolescents (16 girls) with neurotic symptoms were interviewed. A clinical approach was used – clinical psychological interview followed by psychotherapeutic work. Findings and statements can be found showing that early psychotic signs may change into a more severe adolescent crisis, as well as indications of the nature of anger towards parents, unstable mood and aggressivity. Leading themes in interviews and psychotherapeutic sessions may relate to feelings of insignificance in the world around them, unclear sexual identification, too close a relationship with their mothers, and anxiety about real or symbolic absence such as their mothers’ working away from home for long periods of time. In 79% of the interviews with adolescents with psychotic symptoms, we see a lack of real symbolic play in childhood. suitable for non-psychotic adolescents, in this case to change in the first psychotic episode.****What does this last sentence mean? The importance of early diagnosis is recognized and the known psychotherapeutic techniques must be used. Keywords: early psychosis, adolescent, positive psychotherapy, counselling

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Psychoeducation of early psychosis patient's helps to improve on compliance

European Psychiatry ◽

10.1016/s0924-9338(11)73123-6 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1418-1418

Author(s):

A. Solonenko ◽

I. Khlopina

Keyword(s):

Public Health ◽

Health Services ◽

Medical Rehabilitation ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Control Group ◽

Public Health Services ◽

First Psychotic Episode ◽

Psychopharmacological Treatment ◽

The Given

The given clinical-catamnethetic research was carried out on the basis of the department of the first psychotic epizode in « Specialized Clinical Psychiatric hospital №1» of the Department of Public Health Services of Krasnodar territory, Russia on the sample of 286 patients with the first psychotic symptoms who underwent treatment during 2006–2008 years. The medical-rehabilitation programme included psychopharmacological treatment and psychoeducational studies of both patients and their relatives, and a control group (100 individuals). Psychoeducational studies with relatives of the patients of the control group were not organized.The research shows the evident effectiveness of psycho-education of relatives of the patients with first psychotic episode for better patients’ compliance.

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M192. SENSITIVITY FOR MOTION IS WEAKENED IN FIRST EPISODE PSYCHOSIS

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.504 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S209-S209

Author(s):

Francina Badia ◽

Daniel Linares ◽

Albert Compte ◽

Mireia Rosa ◽

Josep Dalmau ◽

...

Keyword(s):

Motion Perception ◽

Response To Treatment ◽

Psychotic Symptoms ◽

First Episode ◽

Psychotic Episode ◽

Antipsychotic Treatment ◽

Healthy Controls ◽

Exclusion Criteria ◽

Motion Sensitivity ◽

First Psychotic Episode

Abstract Background Perceptual spatial suppression is a phenomenon in which the perceived strength of a stimulus in space is reduced when the stimulus is surrounded by other stimuli. For motion perception, two studies so far have suggested that spatial suppression and sensitivity to motion perception is also reduced in patients with schizophrenia. Studies to date have been conducted in patients with chronic schizophrenia, however, whether these abnormalities are present at the onset of the disorder or whether they emerge during the course of the illness has not been examined, and no study has assessed whether these abnormalities are specific to schizophrenia or whether they are present in other psychotic disorders. Furthermore, if reduced spatial suppression and sensitivity for motion in schizophrenia are related to a glutamatergic hypofunction, as suggested by a recent study (Schallmo et al., 2019), these reductions may be more accentuated in patients who fail to respond to first-line antipsychotic treatment. Methods Sample: 33 patients with a first psychotic episode (16 females, age=16.4±0.6) and 17 healthy controls (9 females, age=17.2±0.61). Exclusion criteria for both groups were: intellectual disability according to DSM-V criteria. For healthy controls, exclusion criteria also included having a first degree relative with a history of psychotic disorder, current or past diagnosis of psychiatrics disorders. Instruments: The perceptual test was performed on a tablet, and consisted of a briefly presented grating (small or large) drifted sideways (the direction was chosen at random with equal probability), in which the participant was instructed to report the perceived direction. Clinical assessment at illness onset and 12 week follow-up: Positive and Negative Symptom Scales (PANSS), Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version and Structured Clinical Interview for DSM-IV. Non-response to treatment was defined as lack of 50% reduction in PANSS positive or negative scores at 12 weeks, any change in antipsychotics or need for combinations due to lack of clinical response. Psychophysical analysis: Motion sensitivity was estimated independently of lapses of attention, which were assessed by including trials in which the motion stimulus was easily discriminated. Results Patients and healthy controls were homogeneous in age (t=-.720, p=,537) and sex (X2=0.38, p=0.542). In patients, mean treatment response rates was 56.5%. Patients had similar scores of positive and negative symptomatology (positive symptoms= 21±7,13; negative symptoms= 18,4±8,18; general symptoms= 40,7±13,07). At 12 weeks 43,8% had a diagnosis of affective psychosis (bipolar disorder, depressive disorder with psychotic symptoms). Patients with a first psychotic episode, regardless of diagnosis or response to treatment, had less motion sensitivity than healthy controls (f=6.397, p=0.0148). No significant differences were found between groups in surround suppression and no significant correlations were observed between spatial suppression and clinical symptoms. Discussion To our knowledge, this is the first study to find abnormal motion sensitivity in patients with a first episode of psychosis. Our measure of sensitivity, given that it was not contaminated by lapses, indicates that patients had a genuine motion perception deficit rather than an inability to focus on the task. Our results also suggest that motion sensitivity may not be specific to patients with schizophrenia but may also characterize affective psychoses. Larger studies may be needed to clarify whether there is a relationship between motion sensitivity and severity of symptoms and response to treatment.

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From ADHD to psychosis… executive functions and time

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1252 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S353-S353

Author(s):

C.D.M. Isabel

Keyword(s):

Executive Functions ◽

Psychotic Disorders ◽

Stressful Life Event ◽

Auditory Hallucination ◽

First Episode ◽

Psychotic Episode ◽

Positive Symptoms ◽

Memory Work ◽

First Psychotic Episode ◽

Competing Interest

IntroductionCognitive impairment is present from the early stages of psychotic disorders. Alterations are found mainly in areas of attention, memory work and executive functions. During adolescence, ADHD patients often suffer from secondary disorders to lack of efficient procurement processes information by the poor development of executive functions.ObjectiveEvaluation of a patient whose diagnosis of ADD evolve to acute psychotic episode.MethodReview by clinical and psychometric tests developments in executive functions disorders.ResultsTwelve years old patient who comes to the hospital since 2012, was initially diagnosed with literacy difficulties and low academic performance, after MFF-20 speaks of Learning Disabilities. It presents lack of motivation, apathy, difficulty in scheduling and organization and adherence to schedules, so they diagnosed ADD. It is given treatment with methylphenidate and atomoxetine, presenting erratic path.After a year without treatment and the presence of a major stressful life event, at 17, has a first episode, consisting in mutiste attitude, phenomena of self-referenciality, experiences of control, enforcement and dissemination of ideas and auditory hallucination imperative type.ConclusionsThe presence of emocional dysregulation and alterations in the executive functions atribuyen to ADD, in this case, were premorbid symtomatology of a first psychotic episode. The presence of positive symptoms allows to clarify the diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment Adherence in Psychosis: A 2 Years Follow-Up of First-Psychotic Episode Patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.100 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S271-S272

Author(s):

S. Malta Vacas ◽

R. Carvalho ◽

M.J. Heitor

Keyword(s):

Great Majority ◽

First Episode ◽

Psychotic Episode ◽

Term Care ◽

First Psychotic Episode ◽

Effective Interventions ◽

Episode Psychosis ◽

Competing Interest

IntroductionMuch research on psychosis has focused on early detection and the development of effective interventions. However, the effectiveness of any intervention depends on the willingness of the patient to engage with an intervention in a sustained manner. Disengagement from treatment by patients with serious mental illness is a major concern of mental health services.ObjectivesThis study aims to examine the prevalence of disengagement in a longitudinal cohort of first episode psychosis (FEP) patients.MethodsRetrospective naturalistic 2 years follow-up study of FEP patients aged 18 to 35 admitted into the department of psychiatry of the Beatriz Angelo's hospital from 2012 to 2014. Data on socio-demographics, clinical characteristics, appointments and medication adherence and readmissions were collected.ResultsBetween 2012 and 2014 were admitted 56 patients with a FEP into the department of psychiatry of the Beatriz Angelo's hospital. The great majority of the patients (67.9%) disengaged from the treatment, both appointments and medication. Of those, 13.2% did not attend any appointment, 26.3% attended between one and three appointments and 60.5% attended at least 3 appointments before disengaged. About 23% were readmitted between the 2 years follow up period, 15.4% were readmitted more than once.ConclusionsThe evidence reviewed indicates that approximately 30% of individuals with FEP disengage from services. Continuity of care is of particular importance with FEP, given evidence suggesting that long-term care can improve symptoms and functioning and reduces relapse risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Treatment efficacy with paliperidone palmitate in patients after the first psychotic episode

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1995 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S539-S540

Author(s):

S. Galiano Rus ◽

A. Soler Iborte ◽

S. García Marín

Keyword(s):

Evolutionary Process ◽

Monitoring And Evaluation ◽

Paliperidone Palmitate ◽

Average Score ◽

Psychotic Episode ◽

Hospital Unit ◽

First Psychotic Episode ◽

Competing Interest ◽

Clinically Significant ◽

Mental Health Hospital

ObjectivesTo evaluate factors of therapeutic efficacy of paliperidone palmitate, such as the speed of action and its maintenance in patients who experienced a first psychotic episode that led to a hospital admission in the acute unit.Materials and methodsTwo-year observational and descriptive study. Patients admitted to the Mental Health Hospital Unit (MHHU) from January 2013 to July 2014, with a first psychotic episode and under paliperidone palmitate treatment. Monitoring and evaluation six months after hospital discharge. They were evaluated using the PANSS and BPRS scales at four different time points of the evolutionary process.ResultsAverage scores of the BPRS scale: 39 on admission day, 27 on day of discharge, 23 on the third month and 20 on the sixth month. Average score of PANSS scale: PANSS-PG: 64 on admission day, 48 on day of discharge, 25 on the 3rd month, and 20 on the 6th month. PANSS-P: 41 on admission day, 21 on day of discharge, 12 on the 3rd month, and 10 on the 6th month. PANSS-N: 21 on admission, 11 at discharge, 8 on 3rd month and 7 on 6th month. No clinically significant side effects were observed that would lead to the modification of the doses or the abandonment of the treatment in this period.ConclusionThe results of this observational study show that the start of the treatment with PAP is associated with an observable clinical response on the 4th day. The evaluation scales at the 3rd and 6th months also suggest the maintenance of efficacy of the treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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The relevance of Paraphrenia: Case report

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1235 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S699-S699

Author(s):

M. Peixoto ◽

M.M. Oliveira ◽

M. Bragança

Keyword(s):

Case Report ◽

Psychotic Episode ◽

Psychiatric Ward ◽

Cognitive Deterioration ◽

Medical Work ◽

First Psychotic Episode ◽

Not Otherwise Specified ◽

Personality Changes ◽

Competing Interest ◽

Disorganized Speech

IntroductionParaphrenia is a chronic psychotic disorder with a better-preserved affect and minimal disturbances of emotion and volition and a much less cognitive deterioration and personality changes.Objectives/aimsTo report a case with probable Paraphrenia and to highlight the importance of the differential diagnosis in a first psychotic episode.MethodsCase report and systematic review of the literature.ResultsWe report a case of a 41-year-old man without a past psychiatry history that was led to the psychiatry emergency department (PED), by officers, because of strange behaviour and aggressiveness towards his family. In the PED the patient said that his real father was his father-in-law and that his ex-wife was his sister. His mental exam revealed disinhibition, disorganized speech with slightly mood elation, persecutory, mystic and influential delusions with various delusional interpretations. After being admitted to the psychiatric ward, in compulsatory care, he began treatment and a medical work up was completed. According to the family the patient had begun this strange behaviour four years prior. During the hospitalization it became clear that the patient was experiencing imaginative-confabulatoric multi-thematic delusions, sometimes interviewer guided, without showing cognitive deterioration and retaining his personality.ConclusionsThe diagnosis of atypical psychosis or psychosis not otherwise specified is not satisfactory since it agglutinates different conditions together. Paraphrenia is a well-established concept and should be used in order to define a group of psychotic patients who exhibited characteristic symptoms of schizophrenia, minus personality impairment and slower cognitive decline.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Low IQ scores in schizophrenia: primary or secondary deficit?

Acta Neuropsychiatrica ◽

10.1034/j.1601-5215.2002.140302.x ◽

2002 ◽

Vol 14 (3) ◽

pp. 106-110 ◽

Cited By ~ 3

Author(s):

M. van Beilen ◽

F. Withaar ◽

A. H. van Zomeren ◽

R. van den Bosch

Keyword(s):

Cognitive Functioning ◽

Psychotic Disorders ◽

Psychotic Episode ◽

Prodromal Phase ◽

Speed Of Information Processing ◽

First Psychotic Episode ◽

Iq Test ◽

School Career ◽

Iq Scores ◽

Low Iq

Background:Schizophrenia is consistently associated with lower IQ compared to the IQ of control groups, or estimated premorbid IQ. It is not likely that the IQ scores deteriorate during the prodromal phase or first psychotic episode; they are already present before the onset of the prodromal phase and have been detected in childhood.Methods:We investigated cognitive functioning and IQ levels in a group of 36 patients with schizophrenia or other psychotic disorders.Results:The IQ scores in our sample were lower than average. The IQ showed a relation with attention, memory, speed of information processing and some aspects of executive functioning. However, when IQ scores were corrected for processing speed, they were no longer below average.Conclusions:These findings are important in considering the value of intelligence levels in schizophrenia. IQ scores should be judged in combination with cognitive functioning and school career to assess a patients capabilities in society. Cognitive functions and other variables might have a considerable influence on IQ scores. This rises the question of whether the low IQ scores are a primary or secondary deficit. Schizophrenia patients may have normal IQs, but could be less capable of making an IQ-test.

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