scholarly journals Neurocognition and functional outcome in patients with psychotic, non-psychotic bipolar I disorder, and schizophrenia. A five-year follow-up

2018 ◽  
Vol 56 (1) ◽  
pp. 60-68 ◽  
Author(s):  
Estela Jiménez-López ◽  
Eva María Sánchez-Morla ◽  
Ana López-Villarreal ◽  
Ana Isabel Aparicio ◽  
Vicente Martínez-Vizcaíno ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Psychotic Symptoms ◽  
Functional Impairments ◽  
Neurocognitive Performance ◽  
Psychosocial Impairment ◽  
Functional Deficits ◽  
History Of ◽  
Functional Deterioration ◽  
Progressive Course

AbstractBackground:Bipolar disorder (BD) and schizophrenia (SZ) are characterized by neurocognitive and functional deficits with marked heterogeneity. It has been suggested that BD with a history of psychotic symptoms (BD-P) could constitute a phenotypically homogeneous subtype characterized by greater neurocognitive and functional impairments, or by a distinct trajectory of such deficits. The aim of this study was to compare the neurocognitive and functional course of euthymic BD-P, euthymic BD patients without a history of psychosis (BD-NP), stabilized patients with schizophrenia and healthy subjects, during a five-year follow-up.Methods:Neurocognitive and psychosocial function was examined in 100 euthymic patients with BD (50 BD-P, 50 BD-NP), 50 stabilized patients with schizophrenia (SZ), and 51 healthy controls (HC) at baseline (T1), and after a 5-year follow-up (T2).Results:The course of both neurocognitive performance and functional outcome of patients with SZ and BD (BD-P and BD-NP) is stable. The profile of neurocognitive impairment of patients with SZ or BD (BD-P and BD-NP), is similar, with only quantitative differences circumscribed to certain domains, such as working memory. The subgroup of patients with BD-NP does not show functional deterioration.Conclusions:We have not found evidence of progression in the neurocognitive or psychosocial impairment in any of the three groups of patients, although it cannot be dismissed the possibility of a subset of patients with a progressive course. Other longitudinal studies with larger samples and longer duration are necessary to confirm these findings.

scholarly journals Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients

2015 ◽  
Vol 45 (13) ◽  
pp. 2727-2736 ◽  
Author(s):  
L. Alameda ◽  
C. Ferrari ◽  
P. S. Baumann ◽  
M. Gholam-Rezaee ◽  
K. Q. Do ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Social Functioning ◽  
Physical Abuse ◽  
Early Psychosis ◽  
Global Assessment Of Functioning ◽  
Functional Impairments ◽  
Functional Level ◽  
History Of ◽  
The Impact

BackgroundEvidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients.MethodTwo hundred and twenty-five patients aged 18–35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up.ResultsThere were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p= 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p= 0.025) and lower SOFAS (p= 0.048) scores, Late SPA patients did not.ConclusionOur results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.

scholarly journals Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study

2021 ◽  
pp. 1-9
Author(s):  
Zeev Meiner ◽  
Anat Marmor ◽  
Murad Jalagel ◽  
Hagai Levine ◽  
Shimon Shiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Functional Status ◽  
Accelerated Aging ◽  
Late Effect ◽  
Paralytic Poliomyelitis ◽  
Cross Sectional ◽  
History Of ◽  
Initial Severity ◽  
Functional Deterioration

BACKGROUND: More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. OBJECTIVE: To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. METHODS: A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. RESULTS: Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. CONCLUSIONS: Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.

A Role for EMDR in the Treatment of Trauma in Patients Suffering From a Psychosis: Four Vignettes

2014 ◽  
Vol 8 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Richard Laugharne ◽  
Deborah Marshall ◽  
Jon Laugharne ◽  
Alan Hassard
Keyword(s):  
Hospital Admissions ◽  
Anxiety And Depression ◽  
Psychotic Symptoms ◽  
Ptsd Symptoms ◽  
Treatment Needs ◽  
Psychotic Illness ◽  
Functional Psychosis ◽  
History Of

Many patients with a functional psychosis are likely to have a history of trauma and symptoms of posttraumatic stress disorder (PTSD); some may be traumatized by their psychotic symptoms. We present a series of vignettes to describe eye movement desensitization and reprocessing (EMDR) treatment of 4 patients suffering from a functional psychotic illness who had a significant history of trauma. After receiving EMDR, each patient showed an improvement in their PTSD symptoms and reported an improvement in the quality of their lives. Follow-up at 3–6 years indicated that the treatment effects were maintained, with changes evident in elimination of trauma-related delusions, reduction in anxiety and depression, fewer hospital admissions, and overall improved quality of life. Because a history of trauma and PTSD symptoms are more frequent in patients with a psychosis, and trauma may be an etiological component of psychosis, EMDR treatment needs to be researched and explored as a treatment opportunity.

scholarly journals Post-stroke psychosis: how long should we treat?

2017 ◽  
Vol 39 (2) ◽  
pp. 144-146 ◽  
Author(s):  
Maria do Céu Ferreira ◽  
Célia Machado ◽  
Beatriz Santos ◽  
Álvaro Machado
Keyword(s):  
Low Dose ◽  
Rare Complication ◽  
Acute Onset ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Antipsychotic Therapy ◽  
Post Stroke ◽  
History Of ◽  
One Year

Abstract Objective: To describe a rare case of a patient who developed psychotic symptoms after a right stroke that disappeared with antipsychotic treatment, but appears to need low-dose maintenance antipsychotic therapy. Case description: A 65-year-old man presented at the psychiatric emergency service with a history of persistent delusional jealousy, visual illusions and agitation with onset about 1 month after a right posterior cerebral artery ischemic stroke. These symptoms only disappeared with therapeutic dosages of an antipsychotic drug (3 mg/day of risperidone). At 2-year follow-up, he no longer had delusional activity and the antipsychotic treatment was gradually discontinued over the following year. However, 1 week after full cessation, the patient once more became agitated and suspicious and was put back on risperidone at 0.25 mg/day, resulting in rapid clinical remission. One year after the return to low-dose risperidone, the patient's psychopathology is still under control and he is free from psychotic symptoms. Comments: Psychosis is a relatively rare complication after stroke. To our knowledge, no cases of post-stroke psychosis that apparently require continuous low-dose antipsychotic treatment have been reported to date. Our case suggests that low-dose maintenance antipsychotic therapy may be needed for certain patients with post-stroke psychosis, especially for those with risk factors and non-acute onset.

Depression and functional outcome in patients with brain tumors: a population-based 1-year follow-up study

2005 ◽  
Vol 103 (5) ◽  
pp. 841-847 ◽  
Author(s):  
Arja Mainio ◽  
Helinä Hakko ◽  
Asko Niemelä ◽  
John Koivukangas ◽  
Pirkko Räsänen
Keyword(s):  
Brain Tumors ◽  
Functional Outcome ◽  
Population Based ◽  
Primary Brain Tumor ◽  
Karnofsky Performance Scale ◽  
Entire Study ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The authors analyzed changes in depression and contemporary functional states by using valid tools in a population-based study sample during a 1-year follow-up period. Methods. The study population consisted of 77 patients with a solitary primary brain tumor treated surgically at the Oulu Clinic for Neurosurgery. Each patient's depressive status, according to the Beck Depression Inventory (BDI), and functional outcome, based on the Karnofsky Performance Scale (KPS), were evaluated before the tumor was surgically treated as well as 3 months and 1 year after surgery. Before surgery 27 patients (35%) had BDI scores indicating the presence of depression. These scores were significantly higher in patients with a history of depression (p = 0.017) and in those with a lower functional outcome (p = 0.015). In the entire study sample the severity of depression decreased statistically significantly (p = 0.031) at 3 months postsurgery. A lower functional status (KPS score ≤ 70) in patients was significantly associated with high depression scores at the 3-month (p = 0.000) and 1-year (p = 0.005) assessments. The decrease in the level of depression was significant in patients with an anterior tumor (p = 0.049) and those with a pituitary adenoma (p = 0.019). Conclusions. Affective disorders among patients with brain tumors must be considered immediately after surgery, especially in persons with a depression history and in those with a coincident physical disability.

Transition to Psychosis: 6-Month follow-up of a Chinese High-Risk Group in Hong Kong

2006 ◽  
Vol 40 (5) ◽  
pp. 414-420 ◽  
Author(s):  
May M.L. Lam ◽  
Se-Fong Hung ◽  
Eric Y.H. Chen
Keyword(s):  
At Risk ◽  
High Risk ◽  
Mental State ◽  
Functional Decline ◽  
High Risk Group ◽  
Psychotic Symptoms ◽  
Syndrome Scale ◽  
History Of ◽  
At Risk Mental State

Objectives: The identification of individuals at high risk of becoming psychotic within the near future creates opportunities for early intervention before the onset of psychosis. This study sets out to identify a group of symptomatic young people in a Chinese population with the high likelihood of transition to psychosis within a follow-up period of 6 months, and to determine the rate of transition to psychosis in this group. Method: Symptomatic individuals with a family history of psychotic disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were identified using the operationalized criteria of an ‘At Risk Mental State’. The individuals were prospectively assessed monthly on a measure of psychopathology for 6 months. Results: Eighteen out of 62 individuals (29%) made the transition to frank psychosis within a 6 month follow-up period, with the majority occurring within 3 months. In addition, significant differences were found in the intake Positive and Negative Syndrome Scale, Comprehensive Assessment of ‘At Risk Mental State’ and Global Assessment of Functioning scores between the group that ultimately became psychotic and the group that did not. Conclusion: The period of the highest risk of transition to psychosis was within the 3 months after the study began. Thus, distressed youths in our outpatient clinic, who meet the high-risk criteria should be monitored most closely in the initial 3 months, particularly those individuals with high levels of psychopathology and functional decline.

Childhood maltreatment and transition to psychotic disorder independently predict long-term functioning in young people at ultra-high risk for psychosis

2015 ◽  
Vol 45 (16) ◽  
pp. 3453-3465 ◽  
Author(s):  
A. R. Yung ◽  
J. Cotter ◽  
S. J. Wood ◽  
P. McGorry ◽  
A. D. Thompson ◽  
...  
Keyword(s):  
At Risk ◽  
High Risk ◽  
Functional Outcome ◽  
Psychotic Disorder ◽  
Childhood Maltreatment ◽  
History Of Childhood ◽  
Ultra High Risk ◽  
History Of

Background.Individuals identified as at ultra-high risk (UHR) for psychosis are at risk of poor functional outcome regardless of development of psychotic disorder. Studies examining longitudinal predictors of poor functioning have tended to be small and report only medium-term follow-up data. We sought to examine clinical predictors of functional outcome in a long-term longitudinal study.Method.Participants were 268 (152 females, 116 males) individuals identified as UHR 2–14 years previously. A range of clinical and sociodemographic variables were assessed at baseline. Functioning at follow-up was assessed using the Social and Occupational Functioning Assessment Scale (SOFAS).Results.Baseline negative symptoms, impaired emotional functioning, disorders of thought content, low functioning, past substance use disorder and history of childhood maltreatment predicted poor functioning at follow-up in univariate analyses. Only childhood maltreatment remained significant in the multivariate analysis (p < 0.001). Transition to psychosis was also significantly associated with poor functioning at long-term follow-up [mean SOFAS score 59.12 (s.d. = 18.54) in the transitioned group compared to 70.89 (s.d. = 14.00) in the non-transitioned group, p < 0.001]. Childhood maltreatment was a significant predictor of poor functioning in both the transitioned and non-transitioned groups.Conclusions.Childhood maltreatment and transition to psychotic disorder independently predicted poor long-term functioning. This suggests that it is important to assess history of childhood maltreatment in clinical management of UHR individuals. The finding that transition to psychosis predicts poor long-term functioning strengthens the evidence that the UHR criteria detect a subgroup at risk for schizophrenia.

scholarly journals M27. FUNCTIONAL OUTCOME OF CHILDREN AND ADOLESCENTS WITH ATTENUATED PSYCHOTIC SYMPTOMS: RESULTS FROM A LONGITUDINAL STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Silvia Molteni ◽  
Eleonora Filosi ◽  
Martina Maria Mensi ◽  
Giulia Spada ◽  
Elena Ballante ◽  
...  
Keyword(s):  
At Risk ◽  
Children And Adolescents ◽  
Functional Outcome ◽  
Treatment Plan ◽  
Psychotic Symptoms ◽  
Average Score ◽  
Occupational Functioning ◽  
Significant Impairment ◽  
Over Time

Abstract Background Assessing longitudinal functional outcomes, besides the risk of transition, seems important in underage population given the concerns about the use of at-risk criteria in this age range. Indeed, it has been highlighted that attenuated psychotic symptoms appear to be more common and transient than in adults and could, more often, represent normative experiences (Bartels-Velthuis et al. 2016; Schimmelmann et al. 2013). Thus, in this longitudinal cohort study, we aimed to evaluate socio-occupational functioning at follow-ups in children and adolescents with attenuated psychotic symptoms (APS) and to investigate potential clinical predictors of the functional outcome. Methods Help-seeking adolescents (aged 12–18 years) consecutively admitted to Child and Adolescent Neuropsychiatric inpatient and outpatient units of the IRCCS Mondino Foundation (Pavia, Italy) were recruited. The Comprehensive Assessment of At-Risk Mental State (CAARMS) was used in order to evaluate the presence of attenuated psychotic symptoms. The final sample consisted of 31adolescents suffering from early onset psychosis (EOP), 110 APS and 102 adolescents with psychiatric disorders other than APS and EOP (non-APS). At baseline patients underwent an extensive clinical and, in a subset, also neuropsychological assessment using standardized semi-structured interviews and instruments. All APS patients recruited until March 2019 were followed up for a median period of 33 months (range 4–81 months) and baseline measures were repeated (every 12 months). The level of functioning was defined through the Social and Occupational Functioning Assessment Scale (SOFAS). Results At 12 months and last visit follow-ups APS patients overall continued to display a significant impairment in socio-occupational functioning that persisted over time (baseline SOFAS average score 47.3±9.6, average 12-months follow-up 51.7±13.7, average last-visit follow-up SOFAS 51.6±11.5). Also APS adolescents that did not develop psychosis continued to display a significant impairment in socio-occupational functioning that persisted over time. Besides conversion status (p=0.04), a higher SOFAS (p=0.0026) and better social functioning (p=0.016) and total IQ (p=0.02) at baseline and not having a baseline diagnosis of anxiety disorders (generalized anxiety disorder, p=0.005 and panic disorder, p=0.003) significantly predicted socio-occupational functioning at follow-up. Discussion In line with previous literature in adults, besides the risk of transitioning, at follow-ups APS adolescents overall continued to display a significant impairment in socio-occupational functioning that persisted over time. These data further show that APS adolescents are truly in need of care and underscore the need, also and especially in adolescents, not to focus only on transition risk, as APS adolescents appear to be both at risk of conversion to psychosis but also of functional disability persistent over time. Thus, preventive interventions should not only target emerging psychosis, but also improving APS social and global functional impairment that already at baseline seems to be linked with such a disabling outcome. In APS children and adolescents a multidimensional treatment plan including careful monitoring not only for a potential progression but also psychological interventions aiming at improving functioning is strongly recommended

scholarly journals A Case of Psychosis in Disulfiram Treatment for Alcoholism

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Raquel Calvão de Melo ◽  
Rui Lopes ◽  
José Carlos Alves
Keyword(s):  
Psychiatric Illness ◽  
Past History ◽  
Rare Complication ◽  
Chronic Alcoholism ◽  
Physical Symptoms ◽  
Psychotic Symptoms ◽  
Alcohol Dependency ◽  
Mesolimbic System ◽  
History Of

Background. Disulfiram, a drug used in the treatment of alcohol dependence, is an inhibitor of dopamine-β-hydroxylase causing an increase in the concentration of dopamine in the mesolimbic system. In addition to the physical symptoms associated with concomitant use of alcohol, disulfiram may lead to adverse events, when used alone, including psychosis.Aims. To report a case of a rare complication when using disulfiram for alcoholism treatment in a patient in alcoholic abstinence.Case Report. We describe the case of a 42-year-old male patient, who developed psychotic symptoms 3 weeks after initiating treatment with disulfiram for alcohol dependency. The patient had a history of chronic alcoholism for 12 years and was under disulfiram treatment (250 mg/day) for 1 month, with no other past history of psychiatric illness. The symptoms worsened after he initiated alcohol consumption, while taking disulfiram. The patient was hospitalized and disulfiram was suspended. After 4 days he was asymptomatic and at 6-week follow-up remained asymptomatic.Conclusion. Treatment with disulfiram can lead to the appearance of psychosis in patients with increased vulnerability. In clinical practice, psychosis in the context of alcoholism with disulfiram therapy is often neglected and should be taken into account.

scholarly journals Serious delinquency and later schizophrenia: A nationwide register-based follow-up study of Finnish pretrial 15- to 19-year-old offenders sent for a forensic psychiatric examination

2017 ◽  
Vol 44 ◽  
pp. 173-178 ◽  
Author(s):  
N. Lindberg ◽  
J. Miettunen ◽  
A. Heiskala ◽  
R. Kaltiala-Heino
Keyword(s):  
Psychotic Symptoms ◽  
Future Research ◽  
Psychiatric Examination ◽  
Correctional Services ◽  
Follow Up Study ◽  
Potential Link ◽  
History Of ◽  
Forensic Psychiatric ◽  
Made In

AbstractBackground:Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989–2010.Methods:The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care.Results:Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53–32.39, P < 0.001). Almost half of the pretrial adolescents with later schizophrenia were diagnosed within 5 years of the forensic psychiatric examination, but latency was longer among the other half of the sample, reaching up to 20.5 years.Conclusions:The study supports the previous research indicating a potential link between serious delinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia.

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