Acute psychotic disorder: Which future?

IntroductionAt present, in absence of reliable clinical and evolutionary data, it is difficult to determine what the consequences of an acute psychotic disorder, specifically if it is a mode of entry into schizophrenia, a mood disorder or a short-lived episode.AimThe objective of this study was to describe the sociodemographic characteristics and evolutionary modalities of a population of patients with a first psychotic episode.MethodsThis is a retrospective descriptive study, which involved patients admitted to psychiatric ward EPS Mahdia for acute psychotic disorder according to DSM-VI-TR criteria. Data collection was conducted from archived observations and through a predetermined sheet.ResultsOne hundred and eleven patients were collected. The average age of the study population was 27 years, a male predominance was noted (59.5%), 52.3% were from urban, 73% of patients were single, 33.3% were from a consanguineous marriage. Among those patients with a first acute psychotic episode, 43 patients (38.7%) progressed to schizophrenia, 15.3% to bipolar disorder, 23, 4% to recovery while 22.5% were lost view.ConclusionThe long-term evolution of an acute psychotic disorder remains unpredictable. In fact, the severity is related primarily to the risk of developing a schizophrenic disorder or a mood disorder. In this context, attention is paid in recent years to recognize and seek the earliest possible factors associated with this development.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Diagnostic Stability in First Psychotic Episode after 5 years follow-up

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2138 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S197-S197

Author(s):

M. Mota-Oliveira ◽

M.J. Peixoto ◽

I. Ferraz ◽

E. Pereira ◽

R. Guedes ◽

...

Keyword(s):

Health Clinic ◽

Admission Diagnosis ◽

Psychotic Episode ◽

Diagnostic Stability ◽

First Psychotic Episode ◽

Not Otherwise Specified ◽

Competing Interest ◽

Drop Outs

IntroductionThe diagnosis of psychosis is based on the presence or absence of characteristic symptoms. The presence of such symptoms varies during the course and treatment, raising the question of diagnostic stability after a first psychotic episode.Aims and objectivesThe aim of this study is to evaluate the diagnostic stability after a first psychotic episode in the long term (five years after the first inpatient admission).MethodologyA retrospective study that included patients with first psychotic episode between 2007 and 2011 admitted to the inpatient unit of the psychiatry and mental health clinic of São João hospital center, Oporto, Portugal and re-evaluation of the diagnosis after five years.ResultsWe included 60 patients with a first psychosis episode, 22 of which were drop-outs after five years. Of the 38 patients evaluated, it was possible to see that after 5 years 68.4% (n = 26) maintained the same diagnosis during follow-up. In particular, the diagnosis of schizophrenia was kept in 83.3% of patients after 5 years (n = 15, 18 patients with the diagnosis of schizophrenia after first admission). Diagnosis of acute and transient psychotic disorder and psychosis not otherwise specified were the least stable diagnosis after 5 years.ConclusionsThe diagnosis after a first psychotic episode has important therapeutic and prognostic implications. The presence of characteristic symptomatology, with periods of partial or total remission between subsequent episodes emphasizes the need for regular monitoring, since this group of patients appears to be more vulnerable to changes in diagnosis over time.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Disturbance of neurotransmitters monoamines and indices of reducing-oxidizing processes in patient with the first episode of schizophrenia (FES)

European Psychiatry ◽

10.1016/s0924-9338(11)73117-0 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1412-1412

Author(s):

V. Kalinina ◽

Y. Gryzunov ◽

N. Smolina ◽

M. Uzbekov ◽

E. Misionzhnik ◽

...

Keyword(s):

Oxidase Activity ◽

Amine Oxidase ◽

Social Activity ◽

First Episode ◽

Psychotic Episode ◽

Metabolic Disturbances ◽

Biophysical Parameters ◽

First Psychotic Episode ◽

Sh Group

IntroductionEffective treatment of FES patients may lead to achievement of long-term remission, decrease the number of relapses and increase the level of social activity and quality of life.AimTo study some pathophysiological mechanisms of FES.MethodsThe group of patients who were investigated clinically and biochemically consists of 26 persons (11 women and 15 men, average age 28.2 ± 9.5 years) with the first psychotic episode (F20.0; F20.3). Some biochemical parameters, representing the monoaminergic systems, and some biophysical parameters, representing reducing-oxidizing processes, were investigated. These parameters in all patients were estimated following the admission and prior to any treatment.ResultsThe severity of the disorder on admission to the clinic according to PANSS score was 75,5 ± 2,2 (i.e., moderately severe). Patients with FES were characterized by a significant increase of platelet momnoamine oxidase activity (by 107%; р < 0,01) and decrease of serum semicarbazide-sensitive amine oxidase activity (by 29%; p < 0,001) in comparison to the controls. Both reactive capability of SH-group (Cys-34 residue) of serum albumin, the main source of thiols of plasma and intersticial fluid, measured in reaction with thiol-specific reagent - dithyonitrobenzoic acide, and kinetic coefficient were decreased in FES patients (by 24%; p = 0,02) in comparison to controls.ConclusionThese results show that FES patients are characterized by pronounced metabolic disturbances.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Outcomes of involuntary hospital admission. Satisfaction with treatment and the effect of involuntary admissions on patients

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.264 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S328-S329 ◽

Cited By ~ 1

Author(s):

T. Reshetukha ◽

N. Alavi ◽

E. Prost ◽

D. Groll ◽

R. Cardy ◽

...

Keyword(s):

Mentally Ill ◽

Psychiatric Ward ◽

Involuntary Admission ◽

Involuntary Hospitalization ◽

Term Outcome ◽

Long Term Outcome ◽

Significant Difference ◽

Satisfaction With Treatment ◽

Competing Interest

IntroductionInvoluntary hospitalization in those presumed to be mentally ill has been a common practice. Although some patients are hospitalized for aggression, two-thirds of the patients are hospitalized because of the threat they pose to themselves. Although these patients require risk assessment and evaluation for possible presence of mental illness, the question is how much these patients will benefit from involuntary admission and what the long-term outcome would be.MethodAll patients admitted involuntary to the psychiatric ward in Kingston, Canada, and psychiatrists involved in their care were interviewed to see whether they think the involuntary admission was helpful. All patients were asked to fill-out MacArthur AES to assess their satisfaction with hospitalization.ResultsAlthough psychiatrists frequently reported that the admission was justified, only 29 out of 81 patients reported being explained to why they had been admitted involuntarily. Also, there was a significant difference in AES scores between those who were and were not given an explanation for admission. In addition, psychiatrists more often reported that the involuntary admission worsened the therapeutic relationship which was significantly associated with involuntary admission that was not explained to patients.DiscussionThe results of our study shows that patients admitted involuntarily often feel disappointed with staff and mental health system. It could lead to feeling of hopelessness, frustration and low self-esteem. If explained, some patients who present with risk to self might accept voluntary admissions, that will improve therapeutic alliance with psychiatrists and increase satisfaction from hospitalization. Result of this study could improve the decision making process for involuntary admissions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text

Acute psychotic disorders: Factors related to schizophrenia evolution

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.2106 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S186-S186

Author(s):

R. Ben Soussia ◽

A. Bouallagui ◽

I. Marrag ◽

S. Khouadja ◽

S. Younes ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Clinical Syndrome ◽

Recurrence Time ◽

Male Predominance ◽

Kaplan Meier ◽

Prolonged Duration ◽

History Of ◽

Competing Interest ◽

Psychiatric Department

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.

Download Full-text