Diagnostic Stability 2 Years After Treatment Initiation in the Early Psychosis Intervention Programme in Singapore

2007 ◽  
Vol 41 (6) ◽  
pp. 495-500 ◽  
Author(s):  
Mythily Subramaniam ◽  
Elaine Pek ◽  
Swapna Verma ◽  
Yiong Huak Chan ◽  
Siow Ann Chong
Keyword(s):  
Psychotic Disorders ◽  
Early Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Intervention Programme ◽  
Affective Psychosis ◽  
Diagnostic Stability ◽  
Schizophrenia Spectrum ◽  
Axis I ◽  
First Contact

Objective: To evaluate the diagnostic stability of psychotic disorders over a 2 year period in patients presenting with first-episode psychosis. Methods: One hundred and fifty-four patients were recruited from an early psychosis intervention programme (EPIP). They were diagnosed by the attending psychiatrist using the Structured Clinical Interview for DSM-IV Axis I at first contact (baseline) and after 24 months. The diagnoses were classified into the following categories: schizophrenia spectrum disorders (schizophrenia, schizophreniform disorder and schizoaffective disorder), affective psychosis (bipolar and major depressive disorders with psychotic symptoms), and other non-affective psychosis (delusional disorder, psychosis not otherwise specified and brief psychotic disorder). Two measueres of stability, the prospective and the retrospective consistency were determined for each diagnosis. Results: The diagnoses with the best prospective consistency were schizophrenia (87.0%) and affective psychosis (54.5%). The shift into schizophrenia spectrum disorder was the most frequent diagnostic change. Duration of untreated psychosis was found to be the only significant predictor of shift. Conclusion: It is difficult to make a definitive diagnosis at first contact. The clinical need to review the diagnosis throughout the period of follow up is emphasized.

scholarly journals S102. DIAGNOSTIC CHALLENGES AT TIME OF INPATIENT ADMISSION: DIAGNOSTIC SHIFTS IN PATIENTS WITH FIRST EPISODE PSYCHOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S73-S73
Author(s):  
Marlene Koch ◽  
Melanie Trimmel ◽  
Josef Baumgartner ◽  
Barbara Hinterbuchinger ◽  
Zsuzsa Litvan ◽  
...  
Keyword(s):  
First Episode Psychosis ◽  
Inpatient Unit ◽  
Early Psychosis ◽  
First Episode ◽  
Organic Psychosis ◽  
Affective Psychosis ◽  
Clinical Phenotypes ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
Time Of Admission

Abstract Background First episode psychoses (FEP) may present with diffuse symptoms and a broad range of clinical phenotypes, leading to difficulties in the early detection of the different pluripotent trajectories and consequently to instability of the diagnoses. The aim of this study was to assess the stability of diagnoses at time of admission compared to discharge in patients with FEP at a newly established early psychosis inpatient unit within a general psychiatric service in a general hospital. Methods Charts of all patients admitted to the early psychosis inpatient unit of the Clinical Division of Social Psychiatry of the Medical University of Vienna between 01.01.2016 and 31.03.2017 were reviewed. FEP was defined as a first presentation of affective, schizophreniform, acute polymorphic, organic or substance-related psychosis according to ICD-10. Results 127 patients were admitted during the said period, among whom 92 (72,4%) were diagnosed with a psychotic disorder at time of admission. 39,1% (n=36) of those had a FEP, whereof 58,3% (n=21) were diagnosed with schizophrenia spectrum psychosis, 27,8% (n=10) with affective psychosis, 11,1% (n=4) with substance-related psychosis and 2,8% (n=1) with organic psychosis as main diagnosis at time of discharge. In 50% (n=18) of FEP patients, diagnosis at time of admission was not maintained. 54,2% (n=13) of FEP patients who were admitted with a schizophrenia spectrum diagnosis had a shift in diagnosis at time of discharge, whereof 46,2% (n=6) were adjusted to another diagnosis of the same spectrum and 53,8% (n=7) to a diagnosis of either affective spectrum, substance-related psychosis or organic psychosis. 100% (n=2) of those with a persistent delusional disorder had a different diagnosis at discharge, as well as 56,3% (n=9=) of those admitted with a diagnosis of acute and transient psychotic disorders. Changes in the admission diagnoses of affective psychosis were necessary in 44,4% (n=4), whereof one half was adjusted to another diagnosis of the same spectrum and the other half to a diagnosis of the schizophrenia spectrum. Discussion The diagnostic instability in this study underlines the concept of the highly dynamic and changeable nature of psychopathology in the early stages and the pluripotent trajectories of psychosis. Furthermore, inadequate information available for specific diagnosis at time of admission as well as diagnostic uncertainty at the onset of psychosis could be implicated in the described diagnostic instability. The broad range of clinical phenotypes of early psychosis and the limitations of current diagnostic risk and identification approaches for the assessment of first episode psychosis indicate psychopathology conformed to a more dimensional rather than categorical model, as well as the need of a more dynamic model of prediction, such as the clinical staging model.

scholarly journals Dissociation as a causal pathway from sexual abuse to positive symptoms in the spectrum of psychotic disorders

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohsen Khosravi ◽  
Nour-Mohammad Bakhshani ◽  
Niloofar Kamangar
Keyword(s):  
Sexual Abuse ◽  
Childhood Maltreatment ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Mediating Role ◽  
Dissociative Experiences ◽  
Gender And Education ◽  
Schizophrenia Spectrum

Abstract Background Although numerous studies have supported the role of childhood maltreatment in the etiology of psychosis, underlying mechanisms have not been well understood yet. The present study aimed to investigate the mediating role of particular forms of dissociation in the relationship between five major types of childhood abuse and psychotic symptoms among patients with schizophrenia spectrum and other psychotic disorders. Methods In this cross-sectional correlation study, 70 first-episode psychotic patients and 70 chronic psychotic patients were selected by systematic random sampling (with the sampling interval of 3) from among inpatients and outpatients referring to Baharan Psychiatric hospital, Zahedan, Iran, and were matched based on age, gender, and education level. Moreover, 70 age-, gender-, and education level-matched community controls were recruited from hospital staff and their relatives and friends. All of the participants completed a research interview and questionnaires. Data on experiences of childhood maltreatment, psychosis, dissociation, and demographics were collected and analyzed by SPSS V25 software. Results The obtained results revealed that the mean scores of sexual abuse, emotional abuse, and physical abuse were higher in psychotic patients than community controls (without any significant difference between first-episode psychotic patients and chronic psychotic patients). Furthermore, the highest mean scores of dissociative experiences belonged to chronic psychotic patients. Multiple-mediation also indicated that absorption and dissociative amnesia played a mediating role in the relationship between sexual abuse and positive symptoms. Moreover, this study demonstrated the role of physical abuse in predicting psychotic symptoms even in the absence of sexual abuse. Conclusions This study illustrated specific associations among childhood maltreatment, dissociative experiences, and psychotic symptoms in the clinical population. Thus, to provide appropriate interventions, patients with schizophrenia spectrum and other psychotic disorders were asked about a wide range of possible adverse childhood experiences and dissociative experiences. Nevertheless, further studies using prospective or longitudinal designs need to be carried out to realize the differential contribution of various forms of childhood maltreatment and their potential interactions, more precisely.

scholarly journals Dissociation as a Causal Pathway from Sexual Abuse to Positive Symptoms in the Spectrum of Psychotic Disorders

2021 ◽  
Author(s):  
Mohsen Khosravi ◽  
Nour-Mohammad Bakhshani ◽  
Rashya Kasaeiyan
Keyword(s):  
Sexual Abuse ◽  
Childhood Maltreatment ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Mediating Role ◽  
Dissociative Experiences ◽  
Schizophrenia Spectrum ◽  
The Relationship

Abstract Background: Although numerous studies have supported the role of childhood maltreatment in the etiology of psychosis, underlying mechanisms have not been well understood yet. The present study aimed to investigate the mediating role of particular forms of dissociation in the relationship between five major types of childhood abuse and psychotic symptoms among patients with schizophrenia spectrum and other psychotic disorders.Methods: In this cross-sectional correlation study, a total of 210 participants, including 140 patients with schizophrenia spectrum and other psychotic disorders (70 first-episode psychotic patients and 70 chronic psychotic patients) and 70 community controls, were selected by systematic random sampling (with the sampling interval of 3) and one-to-one matching, respectively, from among inpatients and outpatients referring to Baharan Psychiatric hospital, Zahedan, Iran, and people living in this region. In this study, the evaluation criteria included Dissociative Experiences Scale, Childhood Trauma Questionnaire-Short Form, and Positive and Negative Syndrome Scale.Results: The obtained results revealed that the mean scores of sexual abuse, emotional abuse, and physical abuse were higher in psychotic patients than community controls (without any significant difference among first-episode psychotic patients and chronic psychotic patients). Furthermore, the highest mean scores of dissociative experiences belonged to chronic psychotic patients. Regarding the three study groups, there was no significant gender-based difference between mean scores of dissociative experiences and various types of childhood maltreatment. Multiple-mediation also indicated that absorption and dissociative amnesia played a mediating role in the relationship between sexual abuse and positive symptoms. Moreover, this study implied the role of physical abuse in predicting psychotic symptoms even in the absence of sexual abuse. Conclusions: This study illustrated specific associations among childhood maltreatment, dissociative experiences, and psychotic symptoms in the clinical population. Thus, to provide appropriate interventions, patients with schizophrenia spectrum and other psychotic disorders needed to be asked about a wide range of possible adverse childhood experiences and dissociative experiences. Nevertheless, further studies using prospective or longitudinal designs need to be carried out to realize the differential contribution of various forms of childhood maltreatment and their potential interactions, more precisely.

scholarly journals The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study

2014 ◽  
Vol 44 (11) ◽  
pp. 2419-2430 ◽  
Author(s):  
F. J. Oher ◽  
A. Demjaha ◽  
D. Jackson ◽  
C. Morgan ◽  
P. Dazzan ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Population Density ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Urban Environments ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Multilevel Regression ◽  
Symptom Dimensions ◽  
Reality Distortion

BackgroundThe extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments.MethodWe collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10–F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation.ResultsReality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06–0.24] and depressive symptoms (EES 0.21, 95% CI 0.07–0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES –0.06, 95% CI –0.10 to –0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83–1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12–1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09–1.61).ConclusionsIn people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

Pathways to care of first-admitted subjects with psychosis in South-Western France

2004 ◽  
Vol 34 (2) ◽  
pp. 267-276 ◽  
Author(s):  
A. COUGNARD ◽  
E. KALMI ◽  
A. DESAGE ◽  
D. MISDRAHI ◽  
F. ABALAN ◽  
...  
Keyword(s):  
Access To Care ◽  
Risk Behaviour ◽  
Psychotic Symptoms ◽  
Pathways To Care ◽  
First Episode ◽  
Sources Of Information ◽  
Multiple Sources ◽  
Episode Psychosis ◽  
First Contact ◽  
First Admission

Background. A limited number of studies have assessed the pathways to care of patients with first-episode psychosis. The aim of the study was to describe the pathways to care of subjects with psychosis between onset of psychosis and first admission, and to examine the demographic and clinical factors influencing access to care.Method. Number and type of helping contacts since onset of first psychotic symptoms were assessed using multiple sources of information in 86 subjects with psychosis first-admitted in two hospitals of South-Western France. Characteristics independently associated with long delays between onset of symptoms and first helping contact, first treatment and first admission were explored using logistic regressions.Results. Twelve per cent of subjects were first admitted without any previous helping contact. The patients were seen by a median of two helpers (maximum 7). For most patients (70%), the first helping contact was a health care professional, and the same proportion of patients had a first contact with a GP or a psychiatrist. The type of first contact was not predicted by demographic or clinical characteristics. Subjects with poor pre-morbid functioning or at-risk behaviour were more likely to have a delayed access to care.Conclusions. The delay in access to care may not be totally attributed to inadequate management by health professionals, but may be a characteristic of the disease itself, at least in part independent of the organization of the health system.

scholarly journals M176. INTESTINAL PERMEABILITY AND LOW-GRADE CHRONIC INFLAMMATION IN SCHIZOPHRENIA: DO THEY INFLUENCE COGNITION AND COGNITIVE RESERVE?

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S203-S204
Author(s):  
Gerard Anmella ◽  
Silvia Amoretti ◽  
Miqueu Alfonso ◽  
Oriol Cuñat ◽  
Gemma Safont ◽  
...  
Keyword(s):  
Chronic Inflammation ◽  
Mediterranean Diet ◽  
Intestinal Permeability ◽  
Cognitive Reserve ◽  
Psychotic Disorders ◽  
Verbal Learning ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Low Grade ◽  
Cross Sectional

Abstract Background Higher intestinal-permeability is known to cause low-grade chronic inflammation, which seems to participate in the development and worsening of psychotic disorders both in first-episode psychosis (FEP) and schizophrenia (SCZ) patients. Moreover, in psychotic disorders, inflammation has been linked to cognition and cognitive reserve (CR). The aim of this study is to assess the relation between intestinal-permeability, low-grade chronic inflammation, cognition and cognitive reserve in psychotic disorders. Methods Observational, cross-sectional and multisite study including four centers in Spain (Grant from Fondo de Investigación Sanitaria, PI17/00246). A total of 500 adult patients with DSM-5 SCZ-spectrum disorder at any stage of the disease were recruited. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). Disease severity was assessed using the Clinical Global Impression (CGI) scale and functioning was assessed using the Global Assessment of Functioning (GAF) scale. The intestinal-permeability was estimated with the “Permeable-Intestine-syndrome questionnaire”. The diet was assessed with the “Mediterranean-diet-adherence questionnaire”. Exercise was measured with the “International Physical Activity Questionnaire (IPAQ)”. Cognition was measured with the SCIP-S scale. CR was assessed with the Cognitive Reserve Assessment Scale in Health (CRASH), which is a scale developed to measure CR specifically for patients with severe mental illness. Correlations between CRASH scores and the remainder variables were performed. Results For the present study we included only the subjects who had CRASH score, a total of 112 patients, 42.7% female, aged 40.61±12.4 (mean±SD). Substance use was present in 44.3%. The CRASH score was 33.30±15.72 (mean±SD) and was associated with negative (but not positive) psychotic symptoms assessed by PANSS (PANSS negative; rp=-3.98; p=0.001, PANSS general; rp=-2.13; p=0.038, GAF; rp=0.410; p<0.0001, CGI; rp=-0.30; p=0.002, IPAQ; rs=0.224; p=0.025 and the permeability-scale; rs=-0.266; p=0.008. All cognitive domains (assessed by SCIP-S) were associated to CRASH: verbal learning immediate (rp=0.584; p<0.0001) and differed (rp=0.515; p<0.0001), working memory (rp=0.539; p<0.0001), verbal fluency (rs=0.485; p<0.0001) and processing speed (rp=0.584; p<0.0001). No significant associations were found with Mediterranean-diet scale (rs=0.195; p=0.056), IMC (rs=-0.192; p=0.063), C-reactive protein (rs=-0.104; p=0.278) and the IPAQ-resting scale and permeability-scale (rs=0.119; p=0.244). Discussion

Impulsivity in early psychosis: A complex link with violent behaviour and a target for intervention

2018 ◽  
Vol 49 ◽  
pp. 30-36 ◽  
Author(s):  
V. Moulin ◽  
P. Golay ◽  
J. Palix ◽  
P.S. Baumann ◽  
M-M. Gholamrezaeec ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Early Intervention ◽  
Psychotic Disorders ◽  
Interaction Analysis ◽  
Early Psychosis ◽  
First Episode ◽  
Positive Symptoms ◽  
Violent Behaviour ◽  
Increased Risk ◽  
Early Intervention In Psychosis

AbstractBackgroundViolent behaviour (VB) occurs in first episode of schizophrenia and can have devastating impact both on victims and patients themselves. A better knowledge of the underlying mechanisms of VB may pave the way to preventive treatments.Objectives1) To explore the nature of the link between impulsivity and VB in early psychosis (EP) patients; 2) To explore the interactions between impulsivity and substance abuse, insight, and positive symptoms, the main dynamic risk factors of VB described to date.Design and methodsPost hoc analysis of data acquired in the frame of a 36-months EP cohort study. A total of 265 EP patients, aged 18 to 35, treated at TIPP (Treatment and early Intervention in Psychosis Program), at the Department of Psychiatry in Lausanne, Switzerland, were included in the study. Logistic regression analyzes were performed as well as mediation analysis and interaction analysisResultsOur data suggest that impulsivity is a predictor of VB when analyzed independently and as part of a multi-factorial model. Impulsivity continues to differentiate violent patients from non-violent ones at the end of the program. In addition, the relationship between impulsivity and VB is not mediated by substance abuse. Finally, the effect of impulsivity on the probability of VB is potentiated by the interaction of different levels of insight and positive symptoms.ConclusionsEarly intervention strategies in psychotic disorders should include evaluation of impulsivity considering it is linked to increased risk of VB and may respond to treatment.

scholarly journals Uncharted Waters: Treating Trauma Symptoms in the Context of Early Psychosis

2019 ◽  
Vol 8 (9) ◽  
pp. 1456 ◽  
Author(s):  
Folk ◽  
Tully ◽  
Blacker ◽  
Liles ◽  
Bolden ◽  
...  
Keyword(s):  
Traumatic Stress ◽  
Psychotic Disorders ◽  
Behavioral Therapy ◽  
Specialty Care ◽  
Early Psychosis ◽  
Psychotic Symptoms ◽  
Trauma Symptoms ◽  
Post Traumatic Stress ◽  
Stress Symptoms ◽  
Post Traumatic

Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework, and childhood trauma is one environmental factor that can lead to psychotic symptoms and the development of psychotic disorders. Higher rates of trauma are associated with higher psychosis risk and greater symptom frequency and severity, resulting in increased hospitalization rates and demand on outpatient primary care and mental health services. Despite an estimated 70% of individuals in the early stages of psychosis reporting a history of experiencing traumatic events, trauma effects (post-traumatic anxiety or depressive symptoms) are often overlooked in psychosis treatment and current interventions typically do not target commonly comorbid post-traumatic stress symptoms. We presented a protocol for Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-CBTp), an approach to treating post-traumatic stress symptoms in the context of early psychosis care. We provided a brief summary of TI-CBTp as implemented in the context of Coordinated Specialty Care and presented preliminary data supporting the use of TI-CBTp in early psychosis care. The preliminary results suggest that individuals with comorbid psychosis and post-traumatic stress symptoms can be appropriately and safely treated using TI-CBTp within Coordinated Specialty Care.

A pilot early psychosis intervention programme in Bolivia

2016 ◽  
Vol 33 (S1) ◽  
pp. S585-S585
Author(s):  
G. Rivera Arroyo
Keyword(s):  
Intervention Program ◽  
Multidisciplinary Treatment ◽  
Time Frame ◽  
Early Psychosis ◽  
First Episode ◽  
Treatment Team ◽  
Santa Cruz ◽  
Long Term Outcomes ◽  
Intervention Programme

The problemLess than half of the more than 250 adolescents and young adults who are estimated to experience a first episode of psychosis in the city of Santa Cruz each year are ever diagnosed and receive treatment.Of those patients who are eventually diagnosed, the average duration of their symptoms of psychosis prior to receiving treatment is estimated to be over 2 years.The opportunityMultiple psychosocial variables, such as the reaction of patients and their families to symptoms of psychosis, which play a vital role in determining long-term outcomes, demonstrate their highest degree of flexibility during the period of early psychosis. Psychological, social and evidence-based pharmacological interventions undertaken during this time frame can have a profound impact on the life-course of an individual with psychosis.Our solutionWe propose to establish a pilot early psychosis intervention program that will provide age appropriate biopsychosocial treatment and support for 15–25 years old with first episode psychosis and their families in Santa Cruz. This will improve short and long-term outcomes for those with psychosis, increase speed of recovery, decrease the need for hospitalization, reduce family disruption and decrease rates of relapse.By utilizing a mobile, multidisciplinary treatment team that emphasizes the roles of trained case managers focused on providing intensive individual and family support in the home, this program will provide culturally appropriate care that will leverage contributions from a limited supply of psychiatrists and shift dependence away from a fragmented medical system.Disclosure of interestThe author has not supplied his declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document