Five year follow-up of non-psychotic adults with frequent auditory verbal hallucinations: are they still healthy?

BackgroundPreviously, we described 103 adults (mean age 41 years) who experienced frequent, auditory verbal hallucinations (AVH), in the absence of a need for mental healthcare. Importantly, these adults were largely past the peak incidence age for psychosis (15–35 years). It is unclear if these older individuals with AVH are still at increased risk for psychosis or other psychopathology. To address this question, we conducted a 5-year follow-up of previously included individuals (103 with AVH, 60 controls).MethodEighty-one adults with AVH (78.6%) and forty-nine controls (81.7%) could be contacted and were willing to participate. Participants were screened for psychosis and a need for mental healthcare at follow-up using the Comprehensive Assessment of Symptoms and History interview (CASH). Need for mental healthcare was defined as a clinical diagnosis as identified using the CASH and/or treatment by a mental healthcare specialist. Phenomenology of AVH was assessed with the PSYRATS Auditory Hallucinations Rating Scale.ResultsFive individuals with AVH (6.2%) had developed psychosis and 32 (39.5%) had developed a need for mental healthcare. Voice-related distress at baseline significantly predicted need for mental healthcare. AVH persisted in most individuals (86.4%), without significant changes in phenomenology. None of the controls had developed psychotic symptoms, and need for mental healthcare (n = 6, 12.2%) was significantly lower in this group.ConclusionsThese findings suggest that frequent AVH in non-psychotic adults past the peak incidence age for psychosis constitute a rather static symptom and that individuals with AVH may be best viewed as situated on a need for care continuum.

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Depressive symptoms in a treated multiple sclerosis cohort

Multiple Sclerosis Journal ◽

10.1191/1352458503ms960oa ◽

2003 ◽

Vol 9 (6) ◽

pp. 616-620 ◽

Cited By ~ 46

Author(s):

Scott B Patten ◽

Shanika Fridhandler ◽

Cynthia A Beck ◽

Luanne M Metz

Keyword(s):

Multiple Sclerosis ◽

Depressive Symptoms ◽

Interferon Beta ◽

Rating Scale ◽

Epidemiological Studies ◽

Treatment Groups ◽

Increased Risk ◽

The University ◽

Depression Ratings

Background: Recent side effect data from clinical trials of interferon beta in multiple sclerosis (MS) have failed to confirm that these medications are associated with an increased risk of depression. However, these studies have used highly selected samples and the results may not be generalizable to real world settings. Methods: C linical data on subjects from southern A lberta who have applied for, or are receiving, public reimbursement for MS treatment are maintained in a database at the University of C algary Multiple Sclerosis C linic. Depression ratings obtained using the C enter for Epidemiological Studies Depression Rating Scale (C ES-D) are included in this database. In the current analysis, these longitudinal data were used to determine whether depressive symptoms were associated with disease-modifying treatments. Results: A t baseline, ratings were available for 163 subjects. Those choosing interferon beta resembled those choosing glatiramer acetate in most respects. During follow-up, no differences were observed in the prevalence or incidence of depression and C ES-D scores were not found to differ between the treatment groups. Conclusions: The failure to identify higher rates of depression both in previous intervention studies and in the current observational study provides confirmation that these drugs are not substantially associated with the occurrence of depression.

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Cognitive–behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication

The British Journal of Psychiatry ◽

10.1192/bjp.186.4.324 ◽

2005 ◽

Vol 186 (4) ◽

pp. 324-330 ◽

Cited By ~ 99

Author(s):

Lucia R. Valmaggia ◽

Mark van der Gaag ◽

Nicholas Tarrier ◽

Marieke Pijnenborg ◽

Cees J. Slooff

Keyword(s):

Cognitive Behavioural Therapy ◽

Rating Scale ◽

Behavioural Therapy ◽

Controlled Study ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

Cognitive Behavioural ◽

Supportive Counselling ◽

Treatment Refractory

BackgroundThere is increasing evidence that cognitive–behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia.AimsTo investigate the effects of cognitive–behavioural therapy on in-patients with treatment-refractory psychotic symptoms.MethodManualised therapy was compared with supportive counselling in a randomised controlled study. Both interventions were delivered by experienced psychologists over 16 sessions of treatment. Therapy fidelity was assessed by two independent raters. Participants underwent masked assessment at baseline, after treatment and at 6 months' follow-up. Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale. The analysis was by intention to treat.ResultsParticipants receiving cognitive–behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment, but these findings were not maintained at follow-up.ConclusionsCognitive–behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia.

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Is staged bilateral thalamic radiosurgery an option for otherwise surgically ineligible patients with medically refractory bilateral tremor?

Journal of Neurosurgery ◽

10.3171/2016.11.jns162044 ◽

2018 ◽

Vol 128 (2) ◽

pp. 617-626 ◽

Cited By ~ 8

Author(s):

Ajay Niranjan ◽

Sudesh S. Raju ◽

Edward A. Monaco ◽

John C. Flickinger ◽

L. Dade Lunsford

Keyword(s):

Median Time ◽

Rating Scale ◽

Maximum Dose ◽

Karnofsky Performance Status ◽

Dominant Hand ◽

Complete Restoration ◽

Increased Risk ◽

Before And After ◽

Median Maximum

OBJECTIVEUnilateral Gamma Knife thalamotomy (GKT) is a well-established treatment for patients with medically refractory tremor who are not eligible for invasive procedures due to increased risk of compications. The purpose of this study was to evaluate whether staged bilateral GKT provides benefit with acceptable risk to patients suffering from disabling medically refractory bilateral tremor.METHODSEleven patients underwent staged bilateral GKT during a 17-year period (1999–2016). Eight patients had essential tremor (ET), 2 had Parkinson's disease (PD)–related tremor, and 1 had multiple-sclerosis (MS)–related tremor. For the first GKT, a median maximum dose of 140 Gy was delivered to the posterior-inferior region of the nucleus ventralis intermedius (VIM) through a single isocenter with 4-mm collimators. Patients who benefitted from unilateral GKT were eligible for a contralateral GKT 1–2 years later (median 22 months). For the second GKT, a median maximum dose of 130 Gy was delivered to the opposite VIM nucleus to a single 4-mm isocenter. The Fahn-Tolosa-Marin (FTM) clinical tremor rating scale was used to score tremor, drawing, and drinking before and after each GKT. The FTM writing score was assessed only for the dominant hand before and after the first GKT. The Karnofsky Performance Status (KPS) was used to assess quality of life and activities of daily living before and after the first and second GKT.RESULTSThe median time to last follow-up after the first GKT was 35 months (range 11–70 months). All patients had improvement in at least 1 FTM score after the first GKT. Three patients (27.3%) had tremor arrest and complete restoration of function (noted via FTM tremor, writing, drawing, and drinking scores equaling zero). No patient had tremor recurrence or diminished tremor relief after the first GKT. One patient experienced new temporary neurological deficit (contralateral lower-extremity hemiparesis) from the first GKT. The median time to last follow-up after the second GKT was 12 months (range 2–70 months). Nine patients had improvement in at least 1 FTM score after the second GKT. Two patients had tremor arrest and complete restoration of function. No patient experienced tremor recurrence or diminished tremor relief after the second GKT. No patient experienced new neurological or radiological adverse effect from the second GKT. Statistically significant improvements were noted in the KPS score following the first and second GKT.CONCLUSIONSStaged bilateral GKT provided effective relief for medically refractory, disabling, bilateral tremor without increased risk of neurological complications. It is an appropriate strategy for carefully selected patients with medically refractory bilateral tremor who are not eligible for deep brain stimulation.

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Neurodevelopmental Outcomes after Neonatal Mechanical Ventilation

QJM ◽

10.1093/qjmed/hcab113.030 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Eman Ahmed Zaky ◽

Hebatallah AM Shaaban ◽

Mohamed OA Dawoud ◽

Kareem SEF Madbouly ◽

Shaymaa M Deifalla

Keyword(s):

Mechanical Ventilation ◽

Rating Scale ◽

Neurodevelopmental Outcomes ◽

Neurodevelopmental Delay ◽

Increased Risk ◽

Study Results ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Significant Difference

Abstract Background A majority of extremely preterm infants are treated with mechanical ventilation, which is associated with an increased risk for future development of chronic lung disease, neonatal brain damage, and neurodevelopmental impairments. Objectives The aim of the current study was to evaluate the current and follow up neurodevelopmental status of an Egyptian sample of newly and previously discharged mechanically ventilated infants following them up for a period of 6 months for the earlier group and a year for the latter. Patients and Methods The current study was designed to be a descriptive study with retrospective (50 infants) and prospective (50 infants) domains. It was carried out on 100 neonates who were recruited from the Pediatric Neonatology Clinic, Children's Hospital and Neonatal Intensive Care Unit, Ain Shams University using clinical evaluation, Bayley Scales of Infant Development, and Childhood Autism Rating Scale (CARS).. Results There was statistically significant negative correlation between CARS score and Bayley Scale by using Composite Score (Cognitive, Language and Motor) on first assessment and follow up in the Prospective group while no correlation was found in the retrospective group. The study results showed that there was no statistical significant difference between two groups as regards gestational age, gender, residency, consanguinity, maternal disease, maturity, mode of delivery, respiratory distress, duration of stay in NICU, duration on mechanical ventilation, weight on admission, audiometry and fundus examination (P > 0.05). Conclusion Using a mechanical ventilator in the neonatal period for a prolonged duration increased the risk for ASD and neurodevelopmental delay. Future studies on large samples are recommended from multicenters to confirm the validity of such findings, Bayley scale is a predicative for neurodevelopmental delay in neonates with long duration stay at NICU especially preterms with low birth weight.

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Abstract 158: Progression of Microvascular Brain Disease and Stroke Incidence in the Atherosclerosis Risk in Communities Study

Stroke ◽

10.1161/str.51.suppl_1.158 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Silvia Koton ◽

Andrea L Schneider ◽

B. Gwen Windham ◽

Thomas H Mosley ◽

Rebecca F Gottesman ◽

...

Keyword(s):

Rating Scale ◽

Brain Mri ◽

Brain Disease ◽

Cardiovascular Health Study ◽

Stroke Incidence ◽

Atherosclerosis Risk In Communities ◽

Increased Risk ◽

Atherosclerosis Risk ◽

Unit Increase

Background and Purpose: Data on the significance of combined white matter hyperintensities (WMH)/lacunar brain infarcts measures progression for the incidence of clinical stroke are scarce. We aimed to study associations between the progression in measures of microvascular brain disease over time and risk of stroke in the Atherosclerosis Risk in Communities (ARIC) Study. Methods: We analyzed data on 907 ARIC participants who underwent a brain MRI in 1993-95, a second brain MRI in 2004-6, and were subsequently followed for incident stroke through December 31 st , 2017 (median [IQR] follow-up of 12.6 [8.9-13.4] years from the second brain MRI in 2004-6). At each MRI, WMH was categorized according to the Cardiovascular Health Study 0-9 rating scale and scans were centrally reviewed for lacunar infarcts. A combined measure of microvascular brain disease was defined, and progression from the first to the second brain MRI, manifesting as new WMHs and lacunes at the second brain MRI, was categorized as: no progression; increase of ≥1 unit in WMH grade or incident lacune; increase of ≥1 unit in WMH grade and incident lacune. All fatal and non-fatal strokes occurring in the participants during the study period, and adjudicated as definite/probable ischemic or hemorrhagic incident stroke, were included in this analysis. Associations between progression of microvascular brain disease and incidence of stroke were studied with Cox proportional hazard models, adjusting for age, gender, race, education level, BMI, smoking, hypertension, diabetes and coronary heart disease. Results: At the second brain MRI (mean age 72y), no progression in the combined measure of microvascular disease was found in 38% of participants, while 57% showed ≥1 unit increase in WMH grade or new lacune, and 5% showed increased WMH grade and new lacune. Sixty-four incident strokes occurred during follow-up. Compared to no change in the combined measure, progression of microvascular brain disease expressed as ≥1 unit increase in WMH grade and incident lacune was significantly associated with higher risk of stroke (adjusted HR 3.01, 95% CI 1.30-6.95). Conclusion: Progression of combined measures of microvascular brain disease over a decade is associated with a significant increased risk of stroke.

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Infection-related morbidity and mortality among older patients with DLBCL treated with full- or attenuated-dose R-CHOP

Blood Advances ◽

10.1182/bloodadvances.2021004286 ◽

2021 ◽

Vol 5 (8) ◽

pp. 2229-2236

Author(s):

Toby A. Eyre ◽

William Wilson ◽

Amy A. Kirkwood ◽

Julia Wolf ◽

Catherine Hildyard ◽

...

Keyword(s):

Older Patients ◽

Rating Scale ◽

International Prognostic Index ◽

Prognostic Index ◽

Dose Intensity ◽

B Cell Lymphoma ◽

Morbidity And Mortality ◽

Risk Of Infection ◽

Increased Risk

Abstract Infection-related morbidity and mortality are increased in older patients with diffuse large B-cell lymphoma (DLBCL) compared with population-matched controls. Key predictive factors for infection-related hospitalization during treatment with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) and deaths as a result of infection in older patients during and after treatment with R-CHOP remain incompletely understood. For this study, 690 consecutively treated patients age 70 years or older who received full-dose or attenuated-dose R-CHOP treatment were analyzed for risk of infection-related hospitalization and infection-related death. Median age was 77 years, and 34.4% were 80 years old or older. Median follow-up was 2.8 years (range, 0.4-8.9 years). Patient and baseline disease characteristics were assessed in addition to intended dose intensity (IDI). Of all patients, 72% were not hospitalized with infection. In 331 patients receiving an IDI ≥80%, 33% were hospitalized with ≥1 infections compared with 23.3% of 355 patients receiving an IDI of <80% (odds ratio, 1.61; 95% confidence interval, 1.15-2.25; P = .006). An increased risk of infection-related admission was independently associated with IDI >80% across the whole cohort. Primary quinolone prophylaxis independently reduced infection-related admission. A total of 51 patients died as a result of infection. The 6-month, 12-month, 2-year, and 5-year cumulative incidences of infection-related death were 3.3%, 5.0%, 7.2%, and 11.1%, respectively. Key independent factors associated with infection-related death were an International Prognostic Index (IPI) score of 3 to 5, Cumulative Illness Rating Scale for Geriatrics (CIRS-G) score ≥6, and low albumin, which enabled us to generate a predictive risk score. We defined a smaller group (15%) of patients (IPI score of 0-2, albumin >36 g/L, CIRS-G score <6) in which no cases of infection-related deaths occurred at 5 years of follow-up. Whether patients at higher risk of infection-related death could be targeted with enhanced antimicrobial prophylaxis remains unknown and will require a randomized trial.

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Substance use and the course of early psychosis: a 2-year follow-up of first-admitted subjects

European Psychiatry ◽

10.1016/s0924-9338(03)00027-0 ◽

2003 ◽

Vol 18 (3) ◽

pp. 133-136 ◽

Cited By ~ 64

Author(s):

F. Sorbara ◽

F. Liraud ◽

F. Assens ◽

F. Abalan ◽

H. Verdoux

Keyword(s):

Substance Use ◽

Substance Misuse ◽

Alcohol Misuse ◽

Psychotic Symptoms ◽

Sources Of Information ◽

Social Outcome ◽

Course Of Illness ◽

Increased Risk ◽

The Impact

AbstractObjectiveTo examine the impact of alcohol and substance use on the early course of psychosis.Methods: First-admitted subjects with psychosis (n = 58) were assessed at 6-month intervals over a 2-year follow-up. Information on substance and alcohol misuse and clinical and social outcome was collected using multiple sources of information.ResultsAfter adjustment for potential confounding factors, subjects with persistent substance misuse over the follow-up were at increased risk of readmission (OR = 3.1; 95%CI = 1.0-9.4; P = 0.05), of presenting with psychotic symptoms (OR = 4.3; 95%CI = 1.0-18.1; P = 0.04), and with a non-continuous course of illness (OR = 11; 95%CI = 1-122; P = 0.05). No significant association was found between substance misuse and social outcome, or between alcohol misuse and clinical and social outcome.ConclusionsPersistent substance misuse after a first admission for psychosis has a deleterious impact on clinical outcome. Early identification and treatment of substance use is essential in the care of subjects with incipient psychosis.

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Cognitive biases and auditory verbal hallucinations in healthy and clinical individuals

Psychological Medicine ◽

10.1017/s0033291713000275 ◽

2013 ◽

Vol 43 (11) ◽

pp. 2339-2347 ◽

Cited By ~ 18

Author(s):

K. Daalman ◽

I. E. C. Sommer ◽

E. M. Derks ◽

E. R. Peters

Keyword(s):

Cognitive Biases ◽

Emotional Valence ◽

Cognitive Models ◽

Physical Characteristics ◽

Psychotic Symptoms ◽

Clinical Group ◽

Healthy Controls ◽

Need For Care ◽

Auditory Verbal Hallucinations ◽

Emotional Reasoning

BackgroundSeveral cognitive biases are related to psychotic symptoms, including auditory verbal hallucinations (AVH). It remains unclear whether these biases differ in voice-hearers with and without a ‘need-for-care’.MethodA total of 72 healthy controls, 72 healthy voice-hearers and 72 clinical voice-hearers were compared on the Cognitive Biases Questionnaire for psychosis (CBQp), which assesses ‘intentionalizing’, ‘jumping to conclusions’, ‘catastrophizing’, ‘dichotomous thinking’ and ‘emotional reasoning’ in vignettes characterized by two themes, ‘threatening events’ and ‘anomalous perceptions’.ResultsHealthy voice-hearers scored intermediately on total CBQp between the control and clinical groups, differing significantly from both. However, on four out of five biases the scores of the healthy voice-hearers were comparable with those of the healthy controls. The only exception was ‘emotional reasoning’, on which their scores were comparable with the clinical group. Healthy voice-hearers demonstrated fewer biases than the psychotic patients on the ‘threatening events’, but not the ‘anomalous perceptions’, vignettes. CBQp scores were related to both cognitive and emotional, but not physical, characteristics of voices.ConclusionsMost cognitive biases prevalent in clinical voice-hearers, particularly with threatening events themes, are absent in healthy voice-hearers, apart from emotional reasoning which may be specifically related to the vulnerability to develop AVH. The association between biases and both beliefs about voices and distress/emotional valence is consistent with the close links between emotions and psychotic phenomena identified by cognitive models of psychosis. The absence of reasoning biases might prevent the formation of threatening appraisals about anomalous experiences, thereby reducing the likelihood of distress and ‘need for care’.

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γ' Fibrinogen as a Predictor of Survival in Amyotrophic Lateral Sclerosis

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.715842 ◽

2021 ◽

Vol 8 ◽

Author(s):

Ana Catarina Pronto-Laborinho ◽

Catarina S. Lopes ◽

Vasco A. Conceição ◽

Marta Gromicho ◽

Nuno C. Santos ◽

...

Keyword(s):

Amyotrophic Lateral Sclerosis ◽

Rating Scale ◽

Neurodegenerative Disorder ◽

Positive Impact ◽

Enzyme Linked Immunosorbent Assay ◽

Fibrinogen Concentration ◽

Respiratory Impairment ◽

Increased Risk ◽

Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is an aggressive neurodegenerative disorder related to neuroinflammation that is associated with increased risk of thrombosis. We aimed to evaluate γ' fibrinogen plasma level (an in vivo variant of fibrinogen) as a biomarker in ALS, and to test its role as a predictor of disease progression and survival. Sixty-seven consecutive patients with ALS were followed and the results were compared with those from 82 healthy blood donors. Patients were clinically evaluated at the time of blood sampling and on follow-up (every 3 months for the beginning of the follow-up until death) by applying the revised ALS Functional Rating Scale. Human plasma γ' fibrinogen concentration was quantified using a specific two-site sandwich kit enzyme-linked immunosorbent assay. We found, for the first time, a positive association between γ' fibrinogen concentration and survival in ALS patients: patients with higher γ' fibrinogen plasma levels survived longer, and this finding was not influenced by confounders such as age, gender, respiratory impairment, or functionality (ALSFRS-R score). Since increased levels have a positive impact on outcome, this novel biomarker should be further investigated in ALS.

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Explaining Transitions Over the Hypothesized Psychosis Continuum

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2005.01541.x ◽

2005 ◽

Vol 39 (3) ◽

pp. 180-186 ◽

Cited By ~ 44

Author(s):

Lydia Krabbendam ◽

Inez Myin-Germeys ◽

Maarten Bak ◽

Jim Van Os

Keyword(s):

Coping Strategies ◽

Psychotic Disorder ◽

Population Sample ◽

Psychotic Symptoms ◽

Emotional States ◽

Need For Care ◽

Psychotic Experience ◽

Delusional Ideation ◽

Psychosis Continuum ◽

Increased Risk

Objectives: It is crucial to understand the psychological mechanisms that mediate transition from having one or two psychotic symptoms to becoming a patient with a psychotic disorder. This study investigated whether: (i) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the later onset of clinical psychotic disorder; and (ii) the presence of need for care in relation to psychotic disorder was associated with the use of particular coping strategies. Method: A general population sample of 4672 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder with need for care. Coping, subjective distress with and perceived control over the psychotic experience were assessed using the Maastricht Assessment of Coping Strategies (MACS). Results: Given the presence of hallucinatory experiences at baseline, the increase in risk on the additive scale of having the psychosis outcome at T2 was higher in the group with delusional ideation at T1 than in those without delusional ideation at T1. Similarly, presence of depressed mood at T1 increased the risk of having the psychosis outcome at T2, but this effect overlapped partly with the risk-increasing effect of delusional ideation. Individuals with a need for care were much more likely to display symptomatic coping, whereas the presence of the other coping types was not different across the groups with and without need for care. Conclusion: Transitions over the psychosis continuum are, at least in part, driven by the emotional, cognitive and behavioural responses to the initial psychotic or psychosis-like experiences. Individuals who react with a delusional interpretation, negative emotional states and/or a symptomatic coping style have an increased risk for developing clinical psychosis.

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