Psychiatric symptoms’ treatment to patients addicted to alcohol, cocaine and crack

IntroductionExtrapyramidal side-effects (EPS) related to the use of neuroleptics are an limiting factor to patients’ compliance during the treatment with this group of drugs.ObjectiveThe aim of this study was to identify which drugs are mostly prescribed for cocaine, crack and alcohol addicts’ psychotic symptoms.MethodsThis study selected 31 patients with mean age of 33.61 ± 1.90 enrolled with psychotic disorders related to use of illicit drugs in an public mental health service.ResultsPatients under this study were addict to alcohol (61,29%), cocaine or crack, associated (38,71%).The percentage of patients addicted to alcohol treated with typical neuroleptic-(typical-neurol) was 42,11%, with atypical neuroleptic-(atypical-neurol) was 26,32%, with association of typical and atypical neuroleptics-(typical/atypical-neurol) (21,60%), and with benzodiazepines associated with serotonin-reuptake-inhibitors (BZD-SSRI) (10,00)%. The cocaine or crack associated or not with alcohol patients were treated with typical-neurol (41,67%), atypical-neurol (41,67%), typical/atypical-neurolol (8,33%) and BZD-SSRI (8,33%).The EPS related to the use of neuroleptics in patients addicted to alcohol were given biperiden (52,65%), promethazine or anticolvulsant (Prometh/Anticonv) (42,11%) and no-treatment (5,26%). For those patients, addicted to cocaine, crack and alcohol altogether were given biperiden (58,34%), Prometh/Anticonv (25,00%) and no-treatment (16,67%).ConclusionsIn the case of using neuroleptics, the EPS should be reversed with biperiden in an dose combined with the neuroleptic prescribed to each individual, in an effort to minimized hallucination. Also, if sedation was indicated using Prometh/Anticonv to patients that are taking neuroleptics, then the health care professional team in charge must be aware of consciousness level-reduction.

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Perceived Stress and Life Events in Patients Affected by Schizophrenia and Schizoaffective and Bipolar Disorder: Is There a Role for Self-Reported Basic Symptoms?

Psychopathology ◽

10.1159/000514926 ◽

2021 ◽

pp. 1-8

Author(s):

Giovanna Parmigiani ◽

Gabriele Mandarelli ◽

Lorenzo Tarsitani ◽

Valentina Roselli ◽

Ilaria Gaviano ◽

...

Keyword(s):

Bipolar Disorder ◽

Life Events ◽

Perceived Stress ◽

Psychotic Disorders ◽

Psychiatric Symptoms ◽

Study Groups ◽

Psychotic Symptoms ◽

Subjective Perception ◽

University Hospitals ◽

Basic Symptoms

Introduction: The stress-diathesis model of psychotic disorders describes, in vulnerable individuals, the role of psychosocial stress in the onset and exacerbation of psychotic symptoms. Another interesting approach to the study of vulnerability in the development of psychosis is represented by the basic symptoms concept. Objective: The present study aims at proposing an integration between these two models and investigating possible associations between psychotic symptoms, basic symptoms, perceived stress, and life events in a sample of patients affected by schizophrenia (SZ), schizoaffective (SA), and bipolar disorder with and without psychotic symptoms. Methods: 112 patients were recruited in two university hospitals. Severity of psychiatric symptoms (Positive and Negative Syndrome Scale, PANSS), basic symptoms (Frankfurt Complaint Questionnaire, FCQ), perceived stress (Stress-related Vulnerability Scale, SVS), and life events (Paykel’s interview for recent life events) were assessed. Results: Patients affected by bipolar disorder (both with and without psychotic symptoms) showed a higher number of independent life events (p < 0.01) and tended to report more frequently at least 1 life event in the previous 6 months (p < 0.01) than patients affected by SZ or SA disorder. No differences emerged between the study groups in perceived stress nor in measures of basic symptoms. In the whole sample, a logistic regression analysis showed that the SVS total score (p < 0.05) and PANSS total score (p < 0.001) were associated with the presence of psychotic symptoms. Conclusions: In the study sample, life events and basic symptoms did not play a major role in influencing psychotic symptoms, compared to the subjective perception of stress and the severity of psychopathology. Taken together, these results can be informative for rehabilitation therapies aimed at enhancing resilience and coping strategies in this vulnerable group of patients.

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Acute psychosis induced by short-term treatment with methylprednisolone – a case report

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2349 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S626-S626 ◽

Cited By ~ 1

Author(s):

I.A. Andrei ◽

A.M. Cristache ◽

M.E. Parfene-Banu ◽

A.A. Frunză ◽

M.C. Boer ◽

...

Keyword(s):

Glucocorticoid Receptors ◽

Psychotic Disorders ◽

Psychiatric Symptoms ◽

Early Recognition ◽

Corticosteroid Treatment ◽

Hippocampal Volume ◽

Term Treatment ◽

Psychotic Symptoms ◽

Short Term Treatment ◽

Disc Protrusion

Steroid treatment has been widely used for immunologic and inflammatory disorders. Psychiatric symptoms are not uncommon complications of the corticosteroid treatment. Correlations between the hypothalamic-pituitary-adrenal (HPA) axis and various psychoses have been already established in the specialty literature (modified HPA activity by drugs or not, glucocorticoid receptors downregulation, reduced hippocampal volume). The prevalence of corticosteroid-induced psychotic disorders varies around 5–6%. Most corticosteroid-induced symptoms start during the first few weeks after treatment initiation, but their onset can also be in the first 3–4 days. We would like to report the case of a 30-year-old woman who was taken to the psychiatry emergency room for psychomotor agitation, auditory and visual hallucinations, and bizarre delusions, disorganized thinking and modified behavior. The patient had no personal or family history of psychiatric illness. One month earlier, she was admitted in a neurosurgery ward and underwent lumbar surgery for L4–L5 disc protrusion; at discharge, eight days later, she began treatment with methylprednisolone 80 mg/day for three days. One week later, psychotic symptoms emerged that resulted in her hospitalization in our ward for apparent steroid-induced psychosis. Treatment with risperidone (up to 6 mg/day) and diazepam (10 mg/day, rapidly discontinued) was initiated. The endocrinology examination revealed modified plasmatic cortisol. The psychosis resolved several weeks later and the patient was discharged. Psychiatric complications induced by steroids underline the role of physicians that have to educate the patients and their families about these side effects and their early recognition.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Schizoaffective and schizotypal disorders/acute and transient psychotic disorders

New Oxford Textbook of Psychiatry ◽

10.1093/med/9780198713005.003.0061 ◽

2020 ◽

pp. 609-618

Author(s):

William S. Stone ◽

Stephen V. Faraone ◽

Ming T. Tsuang

Keyword(s):

Personality Disorder ◽

Psychotic Disorders ◽

Psychiatric Symptoms ◽

Schizotypal Personality Disorder ◽

Differential Diagnoses ◽

Psychotic Symptoms ◽

Management Options ◽

Schizotypal Personality ◽

Treatment Management ◽

Dsm 5

This chapter focuses on three disorders that demonstrate similarities to schizophrenia, including schizoaffective disorder, schizotypal personality disorder and acute and transient psychotic disorders (also known as brief psychotic disorders). These conditions typically include positive psychiatric symptoms such as psychotic or attenuated psychotic symptoms in at least some stages of the disorder, though they vary considerably in the extent to which they persist. Similarly, these disorders differ in other dimensions such as their clinical outcomes, relationships to each other, and heterogeneity of their presentations, among others. This chapter reviews the current clinical classifications of these three disorders by emphasizing their (DSM-5) diagnoses, differential diagnoses, clinical features, courses, epidemiology, and treatment/management options.

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Public mental health service use by people with intellectual disability in New South Wales and its costs

The Medical Journal of Australia ◽

10.5694/mja2.51166 ◽

2021 ◽

Author(s):

Preeyaporn Srasuebkul ◽

Rachael Cvejic ◽

Theresa Heintze ◽

Simone Reppermund ◽

Julian N Trollor

Keyword(s):

Mental Health ◽

Intellectual Disability ◽

Mental Health Service ◽

Service Use ◽

New South ◽

Public Mental Health ◽

Mental Health Service Use ◽

Health Service Use ◽

Public Mental Health Service ◽

South Wales

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Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk?

Australasian Psychiatry ◽

10.1177/1039856220984032 ◽

2021 ◽

pp. 103985622098403

Author(s):

Marianne Wyder ◽

Manaan Kar Ray ◽

Samara Russell ◽

Kieran Kinsella ◽

David Crompton ◽

...

Keyword(s):

Mental Health ◽

Risk Factors ◽

Risk Assessment ◽

High Risk ◽

Suicide Risk ◽

Public Mental Health ◽

Assessment Tools ◽

Suicide Risk Assessment ◽

Public Mental Health Service ◽

Risk Assessment Tools

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

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Cannabinoids, reward processing, and psychosis

Psychopharmacology ◽

10.1007/s00213-021-05801-2 ◽

2021 ◽

Author(s):

Brandon Gunasekera ◽

Kelly Diederen ◽

Sagnik Bhattacharyya

Keyword(s):

Psychotic Disorders ◽

Neural Substrates ◽

Brain Regions ◽

Reward Processing ◽

Anterior Cingulate ◽

Psychotic Symptoms ◽

Dopamine Synthesis ◽

Future Research ◽

Drug Challenge ◽

Psychotomimetic Effects

Abstract Background Evidence suggests that an overlap exists between the neurobiology of psychotic disorders and the effects of cannabinoids on neurocognitive and neurochemical substrates involved in reward processing. Aims We investigate whether the psychotomimetic effects of delta-9-tetrahydrocannabinol (THC) and the antipsychotic potential of cannabidiol (CBD) are underpinned by their effects on the reward system and dopamine. Methods This narrative review focuses on the overlap between altered dopamine signalling and reward processing induced by cannabinoids, pre-clinically and in humans. A systematic search was conducted of acute cannabinoid drug-challenge studies using neuroimaging in healthy subjects and those with psychosis Results There is evidence of increased striatal presynaptic dopamine synthesis and release in psychosis, as well as abnormal engagement of the striatum during reward processing. Although, acute THC challenges have elicited a modest effect on striatal dopamine, cannabis users generally indicate impaired presynaptic dopaminergic function. Functional MRI studies have identified that a single dose of THC may modulate regions involved in reward and salience processing such as the striatum, midbrain, insular, and anterior cingulate, with some effects correlating with the severity of THC-induced psychotic symptoms. CBD may modulate brain regions involved in reward/salience processing in an opposite direction to that of THC. Conclusions There is evidence to suggest modulation of reward processing and its neural substrates by THC and CBD. Whether such effects underlie the psychotomimetic/antipsychotic effects of these cannabinoids remains unclear. Future research should address these unanswered questions to understand the relationship between endocannabinoid dysfunction, reward processing abnormalities, and psychosis.

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Relationship Pattern of Personality Disorder Traits in Major Psychiatric Disorders: A Cross-Sectional Study

Indian Journal of Psychological Medicine ◽

10.1177/0253717621999537 ◽

2021 ◽

pp. 025371762199953

Author(s):

Bhavneesh Saini ◽

Pir Dutt Bansal ◽

Mamta Bahetra ◽

Arvind Sharma ◽

Priyanka Bansal ◽

...

Keyword(s):

Personality Disorder ◽

Psychiatric Disorders ◽

Psychotic Disorders ◽

Age Of Onset ◽

Psychiatric Patients ◽

Cross Sectional Study ◽

Psychotic Symptoms ◽

Sectional Study ◽

Cross Sectional ◽

Neurotic Disorders

Background: Normal personality development, gone awry due to genetic or environmental factors, results in personality disorders (PD). These often coexist with other psychiatric disorders, affecting their outcome adversely. Considering the heterogeneity of data, more research is warranted. Methods: This was a cross-sectional study on personality traits in psychiatric patients of a tertiary hospital, over 1 year. Five hundred and twenty-five subjects, aged 18–45 years, with substance, psychotic, mood, or neurotic disorders were selected by convenience sampling. They were evaluated for illness-related variables using psychiatric pro forma; diagnostic confirmation and severity assessment were done using ICD-10 criteria and suitable scales. Personality assessment was done using the International Personality Disorder Examination after achieving remission. Results: Prevalence of PD traits and PDs was 56.3% and 4.2%, respectively. While mood disorders were the diagnostic group with the highest prevalence of PD traits, it was neurotic disorders for PDs. Patients with PD traits had a past psychiatric history and upper middle socioeconomic status (SES); patients with PDs were urban and unmarried. Both had a lower age of onset of psychiatric illness. Psychotic patients with PD traits had higher and lower PANSS positive and negative scores, respectively. The severity of personality pathology was highest for mixed cluster and among neurotic patients. Clusterwise prevalence was cluster C > B > mixed > A (47.1%, 25.2%, 16.7%, and 11.4%). Among subtypes, anankastic (18.1%) and mixed (16.7%) had the highest prevalence. Those in the cluster A group were the least educated and with lower SES than others. Conclusions: PD traits were present among 56.3% of the patients, and they had many significant sociodemographic and illness-related differences from those without PD traits. Cluster C had the highest prevalence. Among patients with psychotic disorders, those with PD traits had higher severity of psychotic symptoms.

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Emotion regulation across the psychosis continuum

Development and Psychopathology ◽

10.1017/s0954579418001682 ◽

2019 ◽

Vol 32 (1) ◽

pp. 219-227 ◽

Cited By ~ 2

Author(s):

Hannah C. Chapman ◽

Katherine F. Visser ◽

Vijay A. Mittal ◽

Brandon E. Gibb ◽

Meredith E. Coles ◽

...

Keyword(s):

Emotion Regulation ◽

Psychotic Disorders ◽

Psychiatric Symptoms ◽

Healthy Controls ◽

Community Members ◽

Targeted Treatments ◽

Regulation Strategies ◽

Dose Dependent Decrease ◽

Study Participants ◽

Prodromal Syndrome

AbstractEmotion regulation dysfunction is characteristic of psychotic disorders, but little is known about how the use of specific types of emotion regulation strategies differs across phases of psychotic illness. This information is vital for understanding factors contributing to psychosis vulnerability states and developing targeted treatments. Three studies were conducted to examine emotion regulation across phases of psychosis, which included (a) adolescent community members with psychotic-like experiences (PLEs; n = 262) and adolescents without PLEs (n = 1,226); (b) adolescents who met clinical high-risk criteria for a prodromal syndrome (n = 29) and healthy controls (n = 29); and (c) outpatients diagnosed with schizophrenia or schizoaffective disorder (SZ; n = 61) and healthy controls (n = 67). In each study, participants completed the Emotion Regulation Questionnaire and measures of psychiatric symptoms and functional outcome. The three psychosis groups did not differ from each other in reported use of suppression; however, there was evidence for a vulnerability-related, dose-dependent decrease in reappraisal. Across each sample, a lower use of reappraisal was associated with poorer clinical outcomes. Findings indicate that emotion regulation abnormalities occur across a continuum of psychosis vulnerability and represent important targets for intervention.

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Comment: ‘Devining’ The Role of the Consultant Psychiatrist in a Public Mental Health Service

Australian & New Zealand Journal of Psychiatry ◽

10.3109/00048679809113111 ◽

1998 ◽

Vol 32 (5) ◽

pp. 612-615 ◽

Cited By ~ 3

Author(s):

Alan Rosen

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Health Service ◽

Public Mental Health ◽

Consultant Psychiatrist ◽

Persistent Mental Illness ◽

Public Mental Health Service ◽

Key Players ◽

Recovery Program

We admitted to ourselves, …and to our colleagues that we cannot treat people with severe and persistent mental illness as independent practitioners, and asked to be key players on the multidisciplinary team (Extract from A 12-Step Recovery Program for Psychiatrists [1]).

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