Acute psychotic disorders: Factors related to schizophrenia evolution

IntroductionAcute psychotic disorders are described as a clinical syndrome characterized by Acuteness of the installation, the intensity and the polymorphism of delirium.AimDescribe the demographic characteristics of a population of patients with an acute psychotic disorder and identify factors correlated with evolution to schizophrenia.MethodsThis is a retrospective, descriptive and analytic study conducted on hospitalized patients in psychiatric department EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. A study of the recurrence time was performed by Kaplan–Meier and Cox test was used to identify factors correlated with evolution to schizophrenia.ResultsOne hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 39.6% of patients had family history of psychiatric disorders, including schizophrenic disorders and bipolar disorder were the most common with rates of 63.6 and 18.4% of cases. For our patients, 38.7% progressed to schizophrenia. Four risk factors were significantly predictive of progression to schizophrenia: male gender (P = 0.026), subacute or progressive onset disorders (P = 0.003), partial remission of the disorder (P = 0.023) and the prolonged duration of untreated psychosis (P = 0.027).ConclusionThe evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related to the risk of developing schizophrenia or mood disorder. Attention is paid in recent years to recognize and seek most precociously as possible factors associated with this evolution.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cannabis-induced Psychotic Disorders and THC use Among Patients with Psychotic Symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2156 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S203-S203

Author(s):

A. Fernandez-Quintana ◽

C. Quiroga-Fernandez ◽

A. Novo-Ponte ◽

M.D.C. Garcia-Mahia

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Cannabis Use ◽

Personal History ◽

Psychotic Symptoms ◽

Psychotic Episode ◽

Time Interval ◽

Old Patients ◽

History Of ◽

Competing Interest

IntroductionCausality between THC and psychotic symptoms has been outlined in several studies and a potential role for THC in the development of Schizophrenia remains to be assessed.MethodsRetrospective study undertaken in a sample of 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms. Medical records were reviewed to obtain clinical and sociodemographic variables.Objectives(1) To analyse the prevalence of THC consumption among psychotic patients in ED; (2) to establish the prevalence of cannabis-induced psychotic disorder; (3) to underpin the socio-demographic and clinical variables associated with cannabis-induced psychosis.ResultsPersonal history of cannabis use 31.5% (6.5% as a single drug.) Accumulated time interval of cannabis use prior to the first psychotic episode: 0 – 5 years 15% (3.9% developed psychosis during the first year of cannabis use), 5 – 10 years 9.2%, more than 10 years 20.8%. Cannabis-induced psychotic disorder (F12.5) was diagnosed in 3.3% of the sample. The prevalence of this diagnosis was the same among male and female patients. The highest prevalence of cannabis-induced psychosis was found among 36–50 years old patients (50%). All patients with a diagnosis of Cannabis-induced psychotic disorder had a personal history of THC use and urine tests had been positive for THC in 75% of the cases. Habitat: 75% urban, 25% rural. Marital status: 50% single, 50% married.ConclusionsCannabis use is highly prevalent among patients who present with psychotic symptoms in ED and THC is correlated with psychotic episodes. The prevalence of cannabis-induced psychosis has also increased. Further studies comprising larger samples are warranted.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Atypical psychosis – historical and current perspective

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1298 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S362-S362

Author(s):

M.A. Aleixo ◽

C.A. Moreira ◽

G. Sobreira ◽

J. Oliveira ◽

L. Carvalhão Gil

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Case Identification ◽

Current Perspective ◽

Pubmed Database ◽

Brief Psychotic Disorder ◽

Icd 10 ◽

History Of ◽

Competing Interest ◽

Definition Of

IntroductionClinical concepts regarding atypical psychosis such as the French bouffeé délirante, the German cycloid psychosis, and the Scandinavian reactive and schizophreniform psychoses are now under the category of F23 ‘Acute and transient psychotic disorders’ (ATPD) of the tenth revision of the International Classification of Mental and Behavioural Disorders (ICD-10).AimsThe authors’ aim is to highlight the clinical and scientific relevance of atypical psychosis from the historical concepts to the current perspective.MethodsA Pubmed database search using as keywords “atypical psychosis”, “acute and transient psychotic disorders”, and “brief psychotic disorder” and retrieved papers were selected according to their relevance.ResultsDifferent psychiatric schools, often of a regional or national character, have provided concepts for transient psychotic states. The acute and transient psychotic disorders of ICD-10 and the brief psychotic disorder of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reflect the diversity of the history of such concepts. The available evidence suggests that case identification and follow-up is difficult in ATPD due to the heterogeneous and infrequent nature of this clinical phenomenon. Furthermore ATPD has a low diagnostic stability and there are few studies focused on brief psychotic disorders.ConclusionsThe present definition of acute and transient psychotic disorders and brief psychotic disorder, while taking into account the history of the concepts involved, leave many questions open to further studies.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

Psychological Medicine ◽

10.1017/s0033291720004444 ◽

2021 ◽

pp. 1-11

Author(s):

Andrea A. Jones ◽

Kristina M. Gicas ◽

Sara Mostafavi ◽

Melissa L. Woodward ◽

Olga Leonova ◽

...

Keyword(s):

Risk Factors ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Community Sample ◽

Dynamic Networks ◽

Premature Mortality ◽

Psychotic Symptoms ◽

Network Measures ◽

History Of ◽

Precarious Housing

Abstract Background People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. Method The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. Results Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. Conclusions Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

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Clinical manifestations in patients with acute and transient psychosis

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1303 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S363-S364

Author(s):

Á. López Díaz ◽

A. Soler Iborte ◽

S. Galiano Rus ◽

J.L. Fernández González ◽

J.I. Aznarte López

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Clinical Manifestations ◽

Retrospective Chart Review ◽

International Classification Of Diseases ◽

Exact Test ◽

Chi Squared ◽

Classification Of Diseases ◽

Icd 10 ◽

Competing Interest

IntroductionThe term, acute and transient psychosis, is comprehended as a heterogeneous group of disorders, which share, as a common feature, the abrupt and brief deployment of typical psychotic behaviour, either polymorph, delusional, or schizophreniform. This diversity of symptoms may also be present in other psychotic disorders, for which, some authors question its reliability.ObjetiveTo analyse the clinical manifestations present in acute and transient psychotic disorders (ATPD), and determine the differences between its different subcategories.MethodRetrospective chart review study of adult patients admitted in our psychiatric unit between 2011 and 2015, with a mean diagnosis of ATPD at hospital discharge. Diagnostic criteria was according to the International Classification of Diseases (ICD-10). Symptoms were divided under operative procedures, as set out in psychopatologic descriptions. For methodological reasons, statistical analysis was conducted between polymorphic features group (PM) and nonpolymorphic group (NPM). Chi-squared test and Fisher's exact test (as appropriate) were performed, using MedCalc software.ResultsThirty-nine patients met the inclusion criteria. Acute polymorphic psychotic disorder with and without symptoms of schizophrenia (39%), acute schizophrenia-like psychotic disorder (20%), acute predominantly delusional psychotic disorder (23%), other and NOS (18%). There were statistically significant differences between PM and NPM groups in emotional turmoil (>PM, P = 0.0006), grossly disorganized or abnormal motor behaviour (>PM, P = 0.0038), and type of onset (sudden >PM, P = 0.0145).ConclusionCurrently, the same concept encompasses two categories (PM and NPM) to be differentiated. The ATPD construct is under review, due its long-term instability.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Cycloid Psychosis: A Case Report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1969 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S532-S532

Author(s):

G. Martinez-Ales ◽

I. Louzao ◽

A. Irimia ◽

M.F. Bravo ◽

J. Marin

Keyword(s):

Case Report ◽

Psychotic Disorders ◽

Clinical History ◽

Diagnostic Systems ◽

Cycloid Psychosis ◽

History Of ◽

Competing Interest ◽

High Index Of Suspicion ◽

Clinical Pictures ◽

Restitutio Ad Integrum

IntroductionEpisodes of time-limited acute psychosis, with full recovery in between, are categorized as acute polymorphic psychotic or brief psychotic disorders. Leonhard described the three forms of cycloid psychosis (CP). Perry considers it a separate entity.Case reportWe report the case of a 54-year-old male, with a 9-year history of brief psychotic disorders. He was admitted to an inpatient unit after a 4-day episode of persecutory delusion, leading to high emotional repercussions and isolation at home. Euthymia was present. Previous admissions, 9 and 5 years before, presented similar clinical pictures. Treatment with low dose paliperidone during 6-month periods had led to the complete resolution of the episodes (restitutio ad integrum: no psychotic manifestations and the ability to run his business). In this episode, 8 days after the reintroduction of 12 mg of paliperidone per day, cessation of the symptoms took place. Careful reconstruction of the clinical history showed no stressors or drug consumption. And immediately previous 5-day phase of insomnia, hyperactivity and expenditure was described by the patient's wife.DiscussionThree inpatient admissions, a careful clinical history and a thorough review of the evidence regarding Perris criteria led to a diagnosis of CP.ConclusionCP, a classical nosological approach, is helpful in a clinical setting, as it might imply different prognosis and treatment. Recognition of CP, not included as an entity by the major diagnostic systems, requires a high index of suspicion.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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M92. THE OVERLAP BETWEEN PSYCHOTIC SYMPTOMS, SUBSTANCE USE, AND ADVERSITY HISTORY: A SYSTEMATIC REVIEW

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.404 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S169-S170

Author(s):

Victoria Patterson ◽

Alissa Pencer ◽

Philip Tibbo

Keyword(s):

Systematic Review ◽

Substance Use ◽

Adverse Event ◽

Adverse Events ◽

Psychotic Disorder ◽

Substance Misuse ◽

Psychotic Disorders ◽

Treatment Options ◽

Psychotic Symptoms ◽

History Of

Abstract Background Research has found that adversity and substance use individually influence the onset of psychosis and its clinical outcomes, though there has been little examination of a potential three-way interaction. An estimated 30–75% of individuals with psychosis have experienced at least one adverse event that predates their psychotic symptoms, and substance misuse is estimated to exceed 55% in individuals with psychosis. The current systematic review is the first attempt to review the temporal ordering of adversity, psychosis, and substance misuse, as well as examining the effect of type (e.g., type of adversity, type of substance) on the association between these variables. Methods Following PRISMA guidelines, a comprehensive search strategy and review of studies against strict inclusion and exclusion criteria was completed. Studies published between 2000 and 2020 were included from PsycINFO, PubMed, CINAHL, EMBASE, Scopus, Web of Science, and the grey literature. Inclusion criteria, all of which must be met within a single study, included a diagnosed psychotic disorder, experiencing at least one adverse event, and current or past problematic substance use (i.e., substance misuse). High-risk and prodromal studies were excluded. We used search term combinations such as (schizophrenia OR schizoaffective) AND (adversity or trauma OR abuse) AND (“substance abuse” OR cannabis OR cocaine). Results Our initial search found 7,183 papers examining psychotic disorders, substance misuse, and adversity. Preliminary results for included studies indicate that 13 studies met criteria for inclusion. Across studies, the prevalence of experiencing at least one adverse event ranged from 24.8 to 100%, with significant variation in rates among studies due to variance in definitions of adversity, instruments used, and types of adverse events assessed. It is noteworthy that people with a psychotic disorder and a substance use disorder experienced more adverse events compared to people with a psychotic disorder and no substance use disorder. Moreover, individuals with a psychotic disorder, substance misuse, and a history of adversity are more likely to experience reduced functional outcomes, lower rates of remission of psychotic symptoms, and increased post-traumatic stress symptoms and diagnoses. Across studies, adversity appeared to precede substance misuse, which preceded psychotic disorder onset. Discussion Our results suggest that individuals affected by psychotic disorders, substance misuse, and a history of adversity fare worse than those without a history of adversity, even once enrolled in a treatment program for psychosis. Moreover, adversity appeared to precede both substance misuse and psychotic disorders, however, the role of additional adverse events within this relationship was not well-studied and should be examined in the future. Findings suggest that assessing for substance use and a history of adversity within psychosis treatment programs is a critical first step in the recovery for people affected by these psychiatric comorbidities and specific treatment options addressing these factors would be critical for recovery. Moreover, treatment options should be capable of targeting maintenance mechanisms (e.g., avoidance, hopelessness) shared by all three constructs to provide an integrated treatment approach.

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M209. TO WHOM WE PRESCRIBE LONG ACTING ANTPSYCHOTICS AT DISCHARGE FROM HOSPITAL?

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.521 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S216-S216

Author(s):

Alp Ucok ◽

Olcay Şenay ◽

Zhala Mursalova ◽

Shahriyar Gadimov

Keyword(s):

Logistic Regression ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

Treatment Resistance ◽

Involuntary Hospitalization ◽

Older Inpatients ◽

History Of ◽

Long Acting ◽

Abuse Treatment ◽

Discharge From Hospital

Abstract Background Although the growing evidence show the advantages of long acting injectable (LAI)antipsychotics on treatment of psychotic disorders, characteristics of the patients with psychotic disorders using LAI is not studied enough. The aim of this retrospective study is to understand the clinical characteristics of the patients with psychotic disorders to whom any LAI was prescribed at discharge from hospital Methods We screened the files of 400 inpatients with psychosis spectrum disorders who were treated in inpatient units of Istanbul Faculty of Medicine, Department of Psychiatry between 01.01.2014-01.016.2019. We recorded the last admission if the patient had more than one hospitalization. We compared the variables including illness duration, diagnosis, presence of involuntary hospitalization, insight, substance/alcohol abuse, forensic problems between those who were prescribed LAI and others. We also applied logistic regression analysis to detect the independent predictors of LAI prescription. Results Thirty-nine percent of the patients were given LAI at discharge. Patients with schizophrenia and schizoaffective disorders were more common compared to psychotic disorder NOS/schizophreniform disorder in LAI group (p<0.001). Those who prescribed LAI were older and had longer duration of psychotic disorder. Poor insight at admission, past and present noncompliance, involuntary admission (64,5% vs 35,5%, p=0.003) and history of forensi problems (63% vs 37%, p=0.01)were more common in LAI group. Past ECT treatment, antipsychotic polypharmacy and LAI treatment in past were more common in LAI group. Lack of insight at admission, history of LAI treatment before and noncompliance to medications before hospitalization were appeared as predictors of LAI prescription at discharge in logistic regression. We found no relationship between LAI prescription and drug abuse, treatment resistance and psychiatric comorbidity. Discussion Our findings suggest that LAIs were prescribed to chronic and older inpatients with lack of insight, and compliance at admission. The patients who were prescribed LAI also had indirect indicators of poor outcome, like previous ECT and polypharmacy. Contrary to previous reports, we found no difference in alcohol/substance abuse between those who were prescribed LAI and others.

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Treatment with intramuscular paliperidone palmitate in schizoaffective disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2156 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S581-S581

Author(s):

L. Maroto Martin ◽

P. Hervías Higueras

Keyword(s):

Schizoaffective Disorder ◽

Complex Disease ◽

Psychotic Disorders ◽

Paliperidone Palmitate ◽

Valuable Treatment ◽

History Of ◽

Competing Interest ◽

One Year ◽

Long Acting ◽

Monthly Dose

IntroductionInjectable formulations of long acting antipsychotic are a valuable treatment option for patients with psychotic disorders. Schizoaffective Disorder (SAD) is a complex disease; the optimal treatment is not well established yet.ObjectiveAnswer the question about the effectiveness offered by intramuscular Paliperidone Palmitate in SAD versus other injectable antipsychotics. Keywords: schizoaffective disorder; paliperidone palmitate injection.MethodsA case report of a 35-year-old male diagnosed with Schizoaffective Disorder six years ago and with personal history of multiple manic decompensation after treatment discontinuation. Throughout his life he has been treated with intramuscular Risperidone 87.5 mg (50 + 37.5) every 14 days, Olanzapine flas 20 mg/day, Risperidone flas 3 mg, Amisulpride 600 mg/day, Valproic acid 1500 mg/day Clonazepam 2 mg/day and Lormetazepam 1 mg. In the last admission one year ago, he started treatment with intramuscular paliperidone palmitate up to 200 mg a month. Currently he receives a monthly dose of 100 mg and concomitant lithium 800 mg/day.DiscussionThe use of intramuscular paliperidone palmitate in SAD and its effectiveness against other injectable antipsychotic is discussed.ConclusionsThe use of intramuscular paliperidone palmitate appears to constitute an employment opportunity in the treatment of intramuscular maintenance in SAD. It could be effective in stabilizing episodes of acute exacerbation and remissions of psychotic, manic and depressive symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth

The British Journal of Psychiatry ◽

10.1192/bjp.182.1.63 ◽

2003 ◽

Vol 182 (1) ◽

pp. 63-67 ◽

Cited By ~ 57

Author(s):

Louise M. Howard ◽

Claudia Goss ◽

Morven Leese ◽

Graham Thornicroft

Keyword(s):

General Practice ◽

Psychotic Disorder ◽

Psychotic Disorders ◽

General Practice Research Database ◽

Practice Research ◽

Obstetric Outcomes ◽

Research Database ◽

Increased Risk ◽

Significant Difference ◽

History Of

BackgroundThere has been little research into the health of infants of women with psychotic disorders.AimsTo investigate the antenatal care of mothers with a history of psychotic disorders, obstetric outcomes and the subsequent health of their babies.MethodA matched, controlled cohort study was carried out using the General Practice Research Database. Women with a history of a psychotic disorder, who gave birth in 1996–1998, were compared with women matched for age and general practice (199 cases and 787 controls) and their infants.ResultsCases had a higher proportion of stillbirths (OR=4.03, 95% CI 1.14–4.25, P=0.03) and neonatal deaths (P<0.001). There was no difference in gestational age at antenatal booking. Mothers with psychotic disorders were less likely than controls to attend for infant immunisations 90–270 days after birth (RR=0.94, 95% CI 0.88–0.99, P=0.03). There was no significant difference in the rates of accidents and hospital contacts for infants.ConclusionsThere is an increased risk of stillbirth and neonatal death in women with a history of psychotic disorder, and it is therefore important for health care professionals to focus on optimal obstetric care. The physical health of babies who live with mothers with psychotic disorders is not significantly different from that of matched baby controls.

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Electroconvulsive therapy (ECT) treatments in late-onset schizophrenia: Report of a case

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2053 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S556-S556

Author(s):

M. Valverde Barea ◽

F. Cartas Moreno ◽

M.E. Ortigosa Luque

Keyword(s):

Behavioral Disorders ◽

Electroconvulsive Therapy ◽

Psychotic Disorders ◽

Late Onset ◽

Personal History ◽

Psychotic Symptoms ◽

Sexual Content ◽

History Of ◽

Competing Interest ◽

Effective Result

Female patient, 66 years old, who goes to the doctor because of behavioral disorders and delusional injury 8 months of evolution. She showed no personal history of psychiatric disorders. In the psychopathological examination some relevant symptoms are seen delusions of prejudice with their immediate surroundings, self-referential regarding neighbors and walls. Delusional interpretations of sexual content. Punitive pseudo hallucinations hearing which are identifies with her daughters and sex with her son-in-law. Behavioral disorders consisting of going out naked into the street overnight and rebuking pedestrians; furthermore, she showed heteroaggressivity towards objects. Logical psychotropic treatment is initiated as indicated by the guidelines having no effect. Electroconvulsive therapy being tested an effective result. The late-onset schizophrenia symptoms should be taken into account in people with psychotic symptoms start at an advanced age, but is most prevalent at younger ages. Electroconvulsive therapy (ECT) may be used as an adjunct to drug therapy or as second-line treatment in patients with affective or psychotic disorders resistant to treatment with psychotropic drugs. It is essential a differential diagnosis with dementia symptoms previously established, given that part of the late-onset schizophrenia evolves to dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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