scholarly journals Substance-related exogenous psychosis: a postmodern syndrome

CNS Spectrums ◽  
2020 ◽  
pp. 1-8 ◽  
Author(s):  
Giovanni Martinotti ◽  
Luisa De Risio ◽  
Chiara Vannini ◽  
Fabrizio Schifano ◽  
Mauro Pettorruso ◽  
...  
Keyword(s):  
Substance Use ◽  
Negative Symptoms ◽  
Diagnostic Category ◽  
Social Contexts ◽  
First Episode ◽  
Comorbid Conditions ◽  
Present Contribution ◽  
Clinical Criteria ◽  
Separate Clinical Entity ◽  
Choice Of Treatment

Abstract There is growing recognition that substance use is associated with the emergence of psychosis.Elements of post-modernity dominate contemporary social contexts and operate as existential background factors that contribute to the emergence of substance-related psychotic phenomena, particularly use of potent and highly rewarding novel psychoactive substances (NPS). About 25% of first-episode psychoses are substance-induced (SIP). DSM-5 SIP diagnosis is based on the assumption that symptoms are transient and disappear after sustained abstinence. This narrowed definition does not consider the issue of persistent SIP. There is a clear need for a new diagnostic framework that provides reliable, unambiguous clinical criteria to differentiate between comorbid conditions (i.e., schizophrenia patients with a substance use disorder) and substance-related psychoses. In the present contribution, we aim to outline a novel and separate clinical entity: substancerelated exogenous psychosis (SREP). Within this diagnostic category, we refer to both transientand persistent psychoses associated with substance use. SREP is conceived as a distinct psychoticdisorder with psychopathological specificities that clearly differentiate it from schizophrenia. We address differences in terms of clinical presentation, epidemiology, etiological models and treatment response. SREP is characterized by altered states of consciousness, persecutory delusions, visual and cenesthetic hallucinations, impulsivity and psychomotor agitation, affectiveand negative symptoms, a pervasive feeling of unreality and intact insight. Delusions are typically secondary to abnormal perception resulting from a characteristic “sensorialization” of the world. Longitudinal studies are warranted to substantiate our hypothesis of a novel diagnostic categoryand support the clinical validity of SREP. This may have important implications in terms of early differential diagnosis and staging (i.e., between comorbid conditions, persistent and transientsubstance-related psychotic states) as well as choice of treatment interventions.

Effect of substance misuse in early psychosis

1998 ◽  
Vol 172 (S33) ◽  
pp. 134-136 ◽  
Author(s):  
Jean Addington ◽  
Donald Addington
Keyword(s):  
Quality Of Life ◽  
Substance Use ◽  
Negative Symptoms ◽  
Substance Misuse ◽  
Age Of Onset ◽  
Past History ◽  
Psychotic Symptoms ◽  
First Episode ◽  
History Of

Background Studies examining the temporal relationship between substance use and the onset of psychotic symptoms in schizophrenia are inconclusive.Method Three groups of out-patients with schizophrenia were compared on onset of illness, symptoms and quality of life. Fifty-one subjects had no past or present history of substance misuse, 29 subjects had a history of past substance misuse occurring around the onset of their illness, and 33 subjects were currently misusing substances.Results Current substance misusers had poorer quality of life scores and less negative symptoms than the non-users. Those who had a past history of substance misuse had a significantly earlier age of onset than those with no substance use.Conclusions Attention should be paid to substance misuse present at the first episode. Treatment for schizophrenia should begin even though a diagnosis of drug-induced psychosis cannot be ruled out.

scholarly journals Naturalistic follow-up of co-morbid substance use in schizophrenia: the West London first-episode study

2007 ◽  
Vol 38 (1) ◽  
pp. 79-88 ◽  
Author(s):  
I. Harrison ◽  
E. M. Joyce ◽  
S. H. Mutsatsa ◽  
S. B. Hutton ◽  
V. Huddy ◽  
...  
Keyword(s):  
Substance Use ◽  
Depressive Symptoms ◽  
Negative Symptoms ◽  
Spatial Working Memory ◽  
Problem Drinking ◽  
Specific Treatment ◽  
First Episode ◽  
First Episode Schizophrenia ◽  
The Impact

BackgroundThe impact of co-morbid substance use in first-episode schizophrenia has not been fully explored.MethodThis naturalistic follow-up of a cohort of 152 people with first-episode schizophrenia examined substance use and clinical outcome in terms of symptoms and social and neuropsychological function.ResultsData were collected on 85 (56%) of the patient cohort after a median period of 14 months. Over the follow-up period, the proportion of smokers rose from 60% at baseline to 64%. While 30% reported lifetime problem drinking of alcohol at baseline, only 15% had problem drinking at follow-up. Furthermore, while at baseline 63% reported lifetime cannabis use and 32% were currently using the drug, by the follow-up assessment the latter figure had fallen to 18.5%. At follow-up, persistent substance users had significantly more severe positive and depressive symptoms and greater overall severity of illness. A report of no lifetime substance use at baseline was associated with greater improvement in spatial working memory (SWM) at follow-up.ConclusionsPast substance use may impede recovery of SWM performance in people with schizophrenia in the year or so following first presentation to psychiatric services. The prevalence of substance use other than tobacco tends to diminish over this period, in the absence of specific interventions. Persistent substance use in first-episode schizophrenia is associated with more severe positive and depressive symptoms but not negative symptoms, and should be a target for specific treatment intervention.

scholarly journals T127. GENDER DIFFERENCES IN CLINICAL PRESENTATION AND ILLICIT SUBSTANCE USE DURING FIRST EPISODE PSYCHOSIS: AN ELECTRONIC CASE REGISTER NATURAL LANGUAGE PROCESSING ANALYSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S278-S279
Author(s):  
Jessica Irving ◽  
Craig Colling ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Use ◽  
Language Processing ◽  
Negative Symptoms ◽  
Clinical Presentation ◽  
Psychiatric Symptoms ◽  
First Episode ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Male Patients

Abstract Background Gender differences in the clinical presentation of first episode psychosis (FEP) and its relationship to illicit substance use are inconclusive and underexplored. We conducted an electronic health record (EHR) study applying natural language processing (NLP) techniques to investigate gender differences in psychiatric symptoms when controlling for age, ethnicity, and illicit substance use. Methods Data were extracted from EHRs of 3,340 people presenting to the South London and Maudsley (SLaM) NHS Trust between April 2007 and March 2017 with FEP. Logistic regression was used to examine gender differences in presentation of 42 psychiatric symptoms, grouped into positive, negative, depressive, mania and disorganisation symptoms. We controlled for age of onset, ethnicity and illicit substance use (cocaine, amphetamine, MDMA or cannabis) and adjusted p-values for multiple comparisons. Results Patients were predominantly male (62%). Eight symptoms were more prevalent in males (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation), and thirteen in females (tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation), before adjustment for age, ethnicity and substance use. Male patients were significantly more likely to experience negative symptoms than females (e.g. poverty of thought, OR 1.85, 95% CI 1.33 to 2.62); female patients showed increased likelihood of depressive and manic symptoms (e.g. tearfulness, 0.30, 0.26 to 0.35). Male patients were significantly more likely to misuse amphetamines, cannabis and cocaine (e.g. cannabis, OR 3.18, 2.75 to 3.70). All significant differences survived controls for age and ethnicity. After adjustment for illicit substance use gender differences in aggression, agitation, paranoia and grandiosity became insignificant (p > 0.05). However, adjustment for illicit substance use resulted in increased strength of gender associations with negative, manic and depression symptoms. Discussion There are clear gender differences in the clinical presentation of FEP which are modified by exposure to illicit substances. These findings highlight a need to better understand the impact of gender on clinical presentation and treatment outcomes in psychosis, and to ensure that clinicians are aware of how gender differences in presentation could be modified by illicit substance use.

scholarly journals Gender differences in clinical presentation and illicit substance use during first episode psychosis: a natural language processing, electronic case register study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e042949
Author(s):  
Jessica Irving ◽  
Craig Colling ◽  
Hitesh Shetty ◽  
Megan Pritchard ◽  
Robert Stewart ◽  
...  
Keyword(s):  
Gender Differences ◽  
Substance Use ◽  
Language Processing ◽  
Negative Symptoms ◽  
Clinical Presentation ◽  
First Episode Psychosis ◽  
First Episode ◽  
Illicit Substance ◽  
Illicit Substance Use ◽  
Episode Psychosis

ObjectiveTo determine whether gender differences in symptom presentation at first episode psychosis (FEP) remain even when controlling for substance use, age and ethnicity, using natural language processing applied to electronic health records (EHRs).Design, setting and participantsData were extracted from EHRs of 3350 people (62% male patients) who had presented to the South London and Maudsley NHS Trust with a FEP between 1 April 2007 and 31 March 2017. Logistic regression was used to examine gender differences in the presentation of positive, negative, depressive, mania and disorganisation symptoms.Exposure(s) (for observational studies)Gender (male vs female).Main outcome(s) and measure(s)Presence of positive, negative, depressive, mania and disorganisation symptoms at initial clinical presentation.ResultsEight symptoms were significantly more prevalent in men (poverty of thought, negative symptoms, social withdrawal, poverty of speech, aggression, grandiosity, paranoia and agitation). Conversely, tearfulness, low energy, reduced appetite, low mood, pressured speech, mood instability, flight of ideas, guilt, mutism, insomnia, poor concentration, tangentiality and elation were more prevalent in women than men. Negative symptoms were more common among men (OR 1.85, 95% CI 1.33 to 2.62) and depressive and manic symptoms more common among women (OR 0.30, 95% CI 0.26 to 0.35). After adjustment for illicit substance use, the strength of associations between gender and negative, manic and depression symptoms increased, whereas gender differences in aggression, agitation, paranoia and grandiosity became insignificant.ConclusionsThere are clear gender differences in the clinical presentation of FEP. Our findings suggest that gender can have a substantial influence on the nature of clinical presentation in people with psychosis, and that this is only partly explained by exposure to illicit substance use.

Substance abuse in first episode psychosis: Baseline characteristics and clinical outcome

2016 ◽  
Vol 33 (S1) ◽  
pp. S587-S587 ◽  
Author(s):  
A. Toll ◽  
A. Mané ◽  
D. Bergé ◽  
V. Pérez-Solà
Keyword(s):  
Substance Use ◽  
Negative Symptoms ◽  
First Episode Psychosis ◽  
First Episode ◽  
Younger Age ◽  
Episode Psychosis ◽  
Baseline Characteristics ◽  
Competing Interest ◽  
Gaf Scores

IntroductionThere are high rates of substance use disorders (SUD) amongst first episode psychosis (FEP). SUD have been linked to better premorbid adjustment, more severe positive and negative symptoms at presentation and poorer symptomatic and functional outcome [1]. Moreover, shorter duration of untreated psychosis (DUP) has been described as an important predictor of outcome in FEP [2].AimsWith this study, we want to know which baseline characteristics and clinical outcomes differ between FEP patients with and without substance use.MethodsOne hundred and seventy-five FEP were consecutively admitted to Hospital del Mar since January 2008 to September 2014 and entered the FEP programme of the institution. The included evaluation was socio-demographic and clinical data at baseline and 1 year follow-up. We studied differences in age, gender, DUP, GAF scores at baseline and 1 year follow-up and PANSS subscale scores at base and 1 year follow-up between substance users and non-users.ResultsCannabis: we found that users were significative younger (P < 0.01), had a higher proportion of males (P < 0.01) and a significative shorter DUP in users (P = 0.008).Alcohol: we found that users were significative younger (P < 0.009), had a higher proportion of males (P < 0.003) and a significative lower PANNS negative scores at baseline (P = 0.01) and 1 year follow-up (P = 0.03).ConclusionsIn our sample of first episode psychosis, cannabis and alcohol use is linked with a younger age and a high proportion of males. Moreover, it seems that cannabis use could be associated with a shorter DUP.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Conceptual disorganization and redistribution of resting state cortical hubs in untreated first episode psychosis: A 7T MRI study

2020 ◽  
Author(s):  
Avyarthana Dey ◽  
Kara Dempster ◽  
Michael Mackinley ◽  
Peter Jeon ◽  
Tushar Das ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Superior Temporal Gyrus ◽  
Brain Regions ◽  
First Episode Psychosis ◽  
Cortical Reorganization ◽  
First Episode ◽  
Formal Thought Disorder ◽  
Whole Brain ◽  
Episode Psychosis ◽  
Positive And Negative Symptoms

Background:Network level dysconnectivity has been studied in positive and negative symptoms of schizophrenia. Conceptual disorganization (CD) is a symptom subtype which predicts impaired real-world functioning in psychosis. Systematic reviews have reported aberrant connectivity in formal thought disorder, a construct related to CD. However, no studies have investigated whole-brain functional correlates of CD in psychosis. We sought to investigate brain regions explaining the severity of CD in patients with first-episode psychosis (FEPs) compared with healthy controls (HCs).Methods:We computed whole-brain binarized degree centrality maps of 31 FEPs, 25 HCs and characterized the patterns of network connectivity in the two groups. In FEPs, we related these findings to the severity of CD. We also studied the effect of positive and negative symptoms on altered network connectivity.Results:Compared to HCs, reduced hubness of a right superior temporal gyrus (rSTG) cluster was observed in the FEPs. In patients exhibiting high CD, increased hubness of a medial superior parietal (mSPL) cluster was observed, compared to patients exhibiting low CD. These two regions were strongly correlated with CD scores but not with other symptom scores.Discussion:Our observations are congruent with previous findings of reduced but not increased hubness. We observed increased hubness of mSPL suggesting that cortical reorganization occurs to provide alternate routes for information transfer.Conclusion:These findings provide insight into the underlying neural processes mediating the presentation of symptoms in untreated FEP. A longitudinal tracking of the symptom course will be useful to assess the mechanisms underlying these compensatory changes.

scholarly journals Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan–Monaghan early intervention service

2021 ◽  
pp. 1-14
Author(s):  
S. Fayyaz ◽  
N. Nkire ◽  
B. Nwosu ◽  
N. Amjad ◽  
A. Kinsella ◽  
...  
Keyword(s):  
Early Intervention ◽  
Negative Symptoms ◽  
Education Programme ◽  
First Episode ◽  
Antipsychotic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Research Findings ◽  
Prospective Research ◽  
Operational Activities

Objectives: As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan–Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. Methods: COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. Results: During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. Conclusions: COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.

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