Substance-induced Psychotic Disorders in an Emergency Department

IntroductionSubstance abuse has been correlated with psychotic disorders albeit more accurate details on causality remain to be assessed. Furthermore, the prevalence and prognosis of substance-induced psychotic disorders have not been clearly established.MethodRetrospective study performed in 124 patients assessed in an Emergency Department (ED) due to psychotic symptoms over a 6-month period. Medical records were reviewed to obtain clinical and socio-demographic variables.Objectives(1) To analyse substance abuse patterns among ED psychotic patients; (2) to estimate the prevalence of substance-induced psychotic disorders in ED; (3) to underpin the socio-demographic and clinical variables associated.ResultsPersonal history of substance abuse: THC 31.5%, alcohol 29%, cocaine 18.5%, benzodiazepines 18.5%, opiates 6.5%, MDMA 4%, amphetamines 3.2%, hallucinogens 2.4%. Accumulated time interval of substance abuse prior to psychotic onset: 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%. Urine testing for drug misuse undertaken in 80.6% of cases: positives 53%, negatives 47%. Among positive urine test results: THC 16.5%, benzodiazepines 16.5%, cocaine 6.1%, opiates 5.1%, alcohol 0.9%, amphetamines 0.8%, hallucinogens 0.8%. Substance-induced psychotic disorder (F19.15) was diagnosed among 20.4% of patients. This diagnosis was 1.5 times more prevalent among males. Forty-eight percent of patients were single, 36% married, 12% divorced, 4% widowers. Habitat: 68% urban, 34% rural. Highest prevalence group 36 – 50 year olds.ConclusionsBoth substance abuse and substance-induced psychotic disorders are highly prevalent in our sample. Their socio-demographic and clinical profile is similar to that found in schizophrenia. Further refinements of these findings are warranted.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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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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Experiences of substance-using suicidal males who present frequently to the emergency department

CJEM ◽

10.1017/s1481803500010344 ◽

2008 ◽

Vol 10 (04) ◽

pp. 339-346 ◽

Cited By ~ 3

Author(s):

Julia M. Spence ◽

Yvonne Bergmans ◽

Carol Strike ◽

Paul S. Links ◽

Jeffrey S. Ball ◽

...

Keyword(s):

Emergency Department ◽

Substance Abuse ◽

Suicidal Behaviour ◽

Group Identification ◽

High Risk Group ◽

Staff Members ◽

Care Workers ◽

History Of ◽

Seeking Help ◽

Iterative Coding

ABSTRACTObjective:This qualitative study investigated the repeated use of the emergency department (ED) by men with a history of suicidal behaviour and substance abuse to understand the needs and barriers to care for this high-risk group. Identification of common themes from interviews with patients and health care workers can serve as a basis for improved ED-based interventions.Methods:Using semistructured interviews, patients, ED staff and family physicians were asked about needs of the aformentioned group. Twenty-five patients were interviewed and completed questionnaires regarding their substance use, aggression, parasuicidal behaviour, alexithymia and childhood trauma. In addition, 27 staff members were interviewed. Interviews were tape-recorded, transcribed and qualitatively analyzed using an iterative coding process.Results:Of the 25 patients, 23 (96%) had a mood or anxiety disorder and 18 (75%) had borderline personality disorder. One-half of the patients scored high and another quarter scored moderate on alexithymia testing. The ED was viewed as a last resort despite seeking help. Frustration was felt by both patients and staff regarding difficult communication, especially during an acute crisis.Conclusion:The ED plays an important role in the provision of care for men with recurrent suicidal behaviour and substance abuse. Some of the diagnoses and problems faced by these patients are beyond the purview of the ED; however, staff can identify mutual goals for crisis interventions, allow for frequent communication and seek to de-escalate situations through the validation of the stress patients are experiencing.

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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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The Role of Acetyl Cysteine in Cocaethylene (Non-Acetaminophen) Acute Liver Failure

Case Reports in Emergency Medicine ◽

10.1155/2018/4393064 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Getaw Worku Hassen ◽

Amaninder Dhaliwal ◽

Catherine Ann Jenninigs ◽

Hossein Kalantari

Keyword(s):

Emergency Department ◽

Substance Abuse ◽

Liver Failure ◽

Liver Transplant ◽

Acute Liver Failure ◽

Active Substance ◽

Vital Signs ◽

Normal Limits ◽

History Of ◽

Acetyl Cysteine

Background.Acute liver failure can result from acetaminophen overdose, viral infection, toxins, and other disease conditions. Liver transplant is available in limited fashion and the criteria are strict as to who should get an available liver. N- Acetyl Cysteine (NAC) has been used in non-acetaminophen induced liver failure with success. Here we report a case of acute liver failure from cocaethylene that was reversed with NAC along with other medical therapy.Case Presentation.A 50-year-old female patient presented to the Emergency Department (ED) with a two-day history of coffee ground vomiting and hematemesis. She reported occasional substance abuse and heavy alcoholism. She reported shortness of breath and chest pain from the recurrent forceful vomiting. The rest of the review of systems was unremarkable except a fall from intoxication. Physical examination revealed anicteric conjunctiva and nontender abdomen and her vital signs were within normal limits. Initial blood work revealed acute liver and renal failure. The patient was started with general medical management and liver transplant service rejected the case due to active substance abuse. She underwent brief hemodialysis and was started on NAC. Over the course of her hospital stay her liver function and kidney function improved significantly and patient was discharged to home.Conclusion.In cases where liver transplant is not an option for various reasons including active substance abuse, a trial of N-Acetyl Cysteine may be beneficial and should be considered in the Emergency Department.

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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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A broken heart

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.386 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S422-S423

Author(s):

M.J. Gordillo Montaño ◽

S. Ramos Perdigues ◽

S. Latorre ◽

M. de Amuedo Rincon ◽

P. Torres Llorens ◽

...

Keyword(s):

Heart Function ◽

Mood Stabilizer ◽

Psychotic Symptoms ◽

Emotional States ◽

Cardiac Syndrome ◽

History Of ◽

Competing Interest ◽

High Doses ◽

Depressive Episodes ◽

The Impact

IntroductionWithin the various cultures and throughout the centuries has observed the relationship between emotional states and heart function, colloquially calling him “heartbroken”. Also in the medical literature are references to cardiac alterations induced by stress.ObjectiveTakotsubo is a rare cardiac syndrome that occurs most frequently in postmenopausal women after an acute episode of severe physical or emotional stress. In the text that concerns us, we describe a case related to an exacerbation of psychiatric illness, an episode maniform.MethodWoman 71 years old with a history of bipolar I disorder diagnosed at age 20. Throughout her life, she suffered several depressive episodes as both manic episodes with psychotic symptoms. Carbamazepine treatment performed and venlafaxine. He previously performed treatment with lithium, which had to be suspended due to the impact on thyroid hormones and renal function, and is currently in pre-dialysis situation.She requires significant adjustment treatment, not only removal of antidepressants, but introduction of high doses of antipsychotic and mood stabilizer change of partial responders. In the transcurso income, abrupt change in the physical condition of the patient suffers loss of consciousness, respiratory distress, drop in blood pressure, confusion, making involving several specialists. EEG was performed with abnormal activity, cranial CT, where no changes were observed, and after finally being Echocardiography and coronary angiography performed when diagnosed Takotsubo.Results/conclusionsIn this case and with the available literature, we can conclude that the state of acute mania should be added to the list of psychosocial/stressors that can trigger this condition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Auditory Hallucinations In A Deaf Patient? – A Clinical Report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1952 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S527-S527

Author(s):

M.A. Aleixo ◽

C.A. Moreira ◽

G. Sobreira ◽

J. Oliveira ◽

L. Carvalhão Gil

Keyword(s):

Psychotic Disorders ◽

Outpatient Setting ◽

Auditory Hallucinations ◽

Current Evidence ◽

Psychotic Symptoms ◽

Clinical Report ◽

Pubmed Database ◽

Paradoxical Finding ◽

Competing Interest ◽

Prelingually Deaf

IntroductionAccording to some studies, deaf psychiatric inpatients have prevalence rates of psychotic disorders ranging from 20 to 54%. There are descriptions of the paradoxical finding that prelingually deaf patients with psychosis may hear voices.ObjectivesTo present a case report and conduct a database review in order to understand if deaf patients with psychosis can have auditory hallucinations.AimsThe authors’ aim is to describe a case, highlight the clinical and scientific relevance of auditory hallucinations in deaf patients and the difficulties and limitations of this process.MethodsA Pubmed database search using as keywords “auditory hallucinations”, “deaf” and “deafness” and retrieved papers were selected according to their relevance.ResultsThe authors report a case of a 47-year-old female patient apparently suffering from congenital deafness. The patient had no previous psychiatric history until 4 months prior to her admission at our institution, when she started having psychotic symptoms. The patient was admitted into a Neurology ward but because no neurological sign was found psychiatric liaison consultation was requested. Four months later, she had the same symptoms, describing a voice that said to “shut up” and was admitted to a psychiatric hospital. After medication, the symptoms relapsed and now she is followed in an outpatient setting.The presence and nature of auditory hallucinations in deaf patients is not fully elucidated and there are methodological problems in the investigation of this subject.ConclusionsCurrent evidence is still inconclusive and the fact that prelingually deaf patient hear voices needs further research.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Gestchwind syndrome and epileptic psychosis, beyond the schizophrenia frontier

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2405 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S639-S639

Author(s):

V. Rodriguez ◽

C. Gómez ◽

C. Gomis ◽

L. González ◽

E. Tercelán ◽

...

Keyword(s):

Correct Diagnosis ◽

Personal History ◽

Psychotic Symptoms ◽

Delusional Ideation ◽

Religious Feeling ◽

Cognitive Disturbances ◽

History Of ◽

False Diagnosis ◽

Competing Interest ◽

Clonic Convulsions

During late 19th and early 20th century neuropsychiatrists began to identify common behavioral and cognitive disturbances in epilepsy, but it is not until 1973 that Norman Gestchwind described the basics of what we know as Gestchwind syndrome. This syndrome includes the triada of hyper-religiosity, hypergraphia and hypo/hypersexuality and it was mainly associated with temporal lobe epilepsy. Moreover, it is well known the association between epilepsy and psychotic symptoms, the so-called schizophrenia-like syndrome, which can lead us to a false diagnosis of schizophrenia. We report a 44-year-old man who was brought to the hospital with delusional ideation of prosecution and reference in his work environment with important behavioral disruption, as well as delusional ideation of religious content. He had a diagnosis of schizophrenia since he was 18-years-old and personal history of generalized tonic-clonic convulsions in his twenties. During the admission, he recovered ad integrum very rapidly with low doses of risperidone, but referred recurrence of déjà vu episodes. After reviewing his patobiography and past medical history, we identified the presence of hypergraphia, hypersexuality and a profound religious feeling, fulfilling the criteria for Gestchwind syndrome, in the context of which was later diagnosed as chronic epileptic psychosis. It is very important a careful approach to the patobiography and personal history. Also, we should include classic differential diagnosis such as Gestchwind syndrome, as they can lead us finally to the correct diagnosis, which in this case meant not only a different treatment but also a better prognosis.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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