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

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.

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

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.

The relevance of Paraphrenia: Case report

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.

What Antipsychotic is More Effective? Pafip Three Years Longitudinal Study Comparing Haloperidol, Risperidone, Olanzapine, Quetiapine, Ziprasidone and Aripiprazole

2017 ◽  
Vol 41 (S1) ◽  
pp. S81-S81
Author(s):  
M. Gomez Revuelta ◽  
P. Alonso Alvarez ◽  
J.L. Garcia Egea ◽  
M. Juncal Ruiz ◽  
O. Porta Olivares ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Functional Decline ◽  
Drop Out ◽  
Psychotic Episode ◽  
Assistance Program ◽  
First Psychotic Episode ◽  
Competing Interest ◽  
Early Intervention In Psychosis ◽  
Prevention Of Relapse

IntroductionEarly stages after a first psychotic episode (FEP) are crucial for the prognosis of the disease. Those patients who drop out of treatment after a FEP show a significant increase in their vulnerability to relapse. Relapses associated a greater risk of neurotoxicity, chronicity, hospitalization, decrease of response to the treatment, increase of burden and functional decline.ObjectivesTo determine what antipsychotic is more effective in the prevention of relapse after a first psychotic episode.Material and methodsPAFIP is an assistance program focused on early intervention in psychosis. Between January 2001 and January 2011, 255 patients were recruited and randomly assigned to treatment with haloperidol (n = 48), olanzapine (n = 41), risperidone (n = 44), quetiapine (n = 34), ziprasidone (n = 38) and aripiprazole (n = 50). We compared the rates of relapse and remission reached by haloperidol, olanzapine, risperidone, aripiprazole, ziprasidone and quetiapine during a 3-year follow-up. All of the patients were antipsychotic naives at the beginning of the treatment.ResultsThere were no statistically significant differences in regard to the rate of clinical remission. Patients assigned to the groups of aripiprazole, olanzapine and risperidone presented a solid trend to a significantly inferior rate of discontinuation for any reason since the beginning of the treatment.ConclusionsThese data point to a greater protection against relapse and a likely better prognosis related to the use of aripiprazole, Olanzapine and risperidone.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Acute psychotic disorder: Which future?

2017 ◽  
Vol 41 (S1) ◽  
pp. S186-S186
Author(s):  
R. Ben Soussia ◽  
A. Bouallagui ◽  
S. Younes ◽  
I. Marrag ◽  
M. Nasr
Keyword(s):  
Mood Disorder ◽  
Psychotic Disorder ◽  
Psychotic Episode ◽  
Psychiatric Ward ◽  
Male Predominance ◽  
Mode Of Entry ◽  
First Psychotic Episode ◽  
Study Population ◽  
Competing Interest

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.

Kleine–Levin syndrome. A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. s856-s856
Author(s):  
S. Sanz Llorente ◽  
Z. González Vega ◽  
P. Bernal Romaguera ◽  
A.I. Ojeda Martinez ◽  
T. Ventura Faci ◽  
...  
Keyword(s):  
Case Report ◽  
Sleep Disorder ◽  
Memory Loss ◽  
Poor Performance ◽  
Behavioral Disorder ◽  
Psychotic Episode ◽  
Stressful Situation ◽  
Not Otherwise Specified ◽  
Competing Interest ◽  
Similar Episode

IntroductionNowadays, 30% of the Spanish population suffers from some form of sleep disorder, occupying much of the visits to a psychiatrist. Sleep disorders are not a serious condition by itself, but have serious implications in daily life: physical exhaustion, poor performance, daytime sleepiness. Insomnia is a most common sleep disorder, however, hypersomnia must also be considered due to the limitations that it causes.ObjectiveBy the description of case report, we will carry out a review of the syndrome Kleine Levine.MethodsCase report.ResultsA case of Kleine–Levin syndrome in a 23-year-old male is described. The episodic disorder was characterized by excessive sleep, voracious appetite, hyper-sexuality, irritability and memory loss. Among its history, he included a psychotic episode in childhood and an episode of behavioral disorder caused by a stressful situation. His partner refers a similar episode of hypersomnia last year that was self-limiting in 15 days and he did not go to the doctor. Patients often act normal between episodes. Remission was spontaneous. Prospects, for organic aetiology, differential diagnosis. However, arises additional tests (analytical, brain CT, EEG…) resulted no pathological. Patient fulfilled the criteria for KLS, but due to the rarity of the disorder he was previously diagnosed as psychosis not otherwise specified.ConclusionsThis case report aim to highlight that KLS though considered a rare disorder but not uncommon and lack of enough available research data is likely to be responsible for missed or erroneous diagnosis; thus we require more systematic studies regarding etiologies and treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

First Psychotic Episode and Predictors of Bipolar Disorder Progression

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.

The cannabis profile: A high-risk subtype

2017 ◽  
Vol 41 (S1) ◽  
pp. S310-S311
Author(s):  
R. Landera Rodríguez ◽  
M. Gómez Revuelta ◽  
J.L. García Egea ◽  
O. Porta Olivares ◽  
M. Juncal Ruíz ◽  
...  
Keyword(s):  
Early Intervention ◽  
High Risk ◽  
Intervention Program ◽  
Age Of Onset ◽  
Psychotic Episode ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cannabis Consumption ◽  
Competing Interest

IntroductionThe first phase following the diagnosis of a first psychotic episode (FEP), is crucial to determine clinical and functional long-term outcome. Cannabis exerts a mediating action on the debut of the disease and determines a poor prognosis.ObjectivesThe description of a specific population profile of increased vulnerability to maintain cannabis use after a FEP could help to identify this high risk subtype of patients and speed up the implementation of specific interventions.Materials and methodsOne hundred and seventy-eight patients were recruited from PAFIP (early intervention program on FEP), obtaining detailed socio-demographic assessment. They were followed-up for a year during which cannabis consumption was assessed by Drake scale every three months. We divided the sample into two groups:– those patients who neither smoked cannabis before the FEP nor during follow-up period (nn);– consumers group: cannabis users before the FEP who kept on smoking during the follow-up period (ss) and those who smoked before the FEP and gave up consumption during follow-up (sn).ResultsStatistically significant differences between groups were observed. The consumers group (ss + sn) had an earlier age of onset, most were male, unemployed, single, prone to loneliness and they were concomitant users of alcohol and tobacco.ConclusionsThe use of cannabis has a detrimental effect on the outcome of schizophrenia. A specific and early intervention could contribute to prognostic improvements. Identifying cannabis consumption subtypes could be useful for this purpose.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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

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.

scholarly journals Acceptance and Commitment Therapy for Patients with a First Psychotic Episode

10.17816/cp97 ◽  
2021 ◽  
Author(s):  
Maria Dmitrievna Polyakova ◽  
Marta Vladimirovna Sozinova ◽  
Nikita Vladimirovich Chernov ◽  
Tatiana Valentinovna Moiseeva ◽  
Maria Alexandrovna Belyakova
Keyword(s):  
Acceptance And Commitment Therapy ◽  
Psychosocial Functioning ◽  
Psychotic Disorders ◽  
Health Clinic ◽  
Psychotic Episode ◽  
Present Moment ◽  
Early Diagnostics ◽  
First Psychotic Episode ◽  
Commitment Therapy ◽  
Acceptance And Commitment

ABSTRACT The search for the most effective methods of therapy for mental disorders is a priority for modern psychiatry. An approach to the early diagnostics and rehabilitation of patients experiencing a psychotic episode for the first time is proposed in the present article. The proposed approach is based on the combination of drug therapy and, acceptance and commitmenttherapy (ACT) characterized by the development of the patient's psychological flexibility, rather than controlling the disease symptoms. The article describes the main processes of the ACT model: acceptance, cognitive defusion, contact with the present moment, understanding of the inner world, awareness of significant values and the regulation of purposeful behaviour for the implementation of these values. Recommendations for different stages of treatment were also developed by specialists of the First Psychotic Episode Clinic at the Mental-health clinic No.1 named after N.A. Alexeev. The psychological rehabilitation of patients with the use of ACT in the case of psychotic disorders with both negative and productive symptoms was elaborated. The application of acceptance and commitment therapy in the early diagnostics and treatment of patients with a first psychotic episode results in fewer readmissions and improved psychosocial functioning in both inpatient and outpatient care.

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