Schizophrenia and Other Psychotic Disorders

2014 ◽  
Author(s):  
Matthew D. Erlich ◽  
Thomas E. Smith ◽  
Ewald Horwath ◽  
Francine Cournos
Keyword(s):  
Psychotic Disorders ◽  
Psychiatric Rehabilitation ◽  
Psychosocial Interventions ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
Residual Symptoms ◽  
Illness Onset ◽  
Affective Expression ◽  
Degree Of Disability

Patients with schizophrenia experience three categories of symptoms: positive (delusions and hallucinations); negative (blunting of affective expression, loss of volition, and apathy); and disorganized (as reflected by a formal thought disorder). A diagnosis of schizophrenia requires that continuous signs of illness, which may include prodromal and residual symptoms, be present for at least 6 months. Research indicates that schizophrenia is likely a neurodevelopmental illness with clear heritable risk factors. Patients with schizophrenia tend to have an illness onset by young adulthood and a generally debilitating and long-term course, but the degree of disability and functional impairment is widely variable. Other illnesses characterized by prominent psychotic symptoms include schizoaffective disorder and delusional disorder. Treatment for psychotic illnesses includes antipsychotic medication and recovery-oriented psychosocial interventions aimed at “psychiatric rehabilitation” wherein patients can learn or relearn skills necessary to live independently and work competitively.

What Diagnoses Are Associated with Psychosis?

2021 ◽  
pp. 35-48
Author(s):  
Beth Broussard ◽  
Michael T. Compton
Keyword(s):  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Healthcare Provider ◽  
Psychotic Disorders ◽  
Definitive Diagnosis ◽  
Psychotic Symptoms ◽  
Specific Diagnosis ◽  
Substance Related Disorders

In this chapter we discuss the different diagnoses associated with psychosis. Schizophrenia is one of several primary psychotic disorders, a group of psychiatric disorders that primarily cause psychosis. Other disorders can cause psychotic symptoms—or symptoms similar to these—but are not considered psychotic disorders. A few examples of such disorders are major depressive disorder, bipolar disorder, and some substance-related disorders. It is often difficult to make a specific diagnosis when long-term information is not available at first. In instances in which a definitive diagnosis is uncertain, a working diagnosis allows the healthcare provider to begin effective treatments for psychosis even before a more certain diagnosis is made.

Symptoms of Psychoses

1995 ◽  
Vol 166 (2) ◽  
pp. 236-240 ◽  
Author(s):  
Toshinori Kitamura ◽  
Yuji Okazaki ◽  
Akira Fujinawa ◽  
Masahiro Yoshino ◽  
Yomishi Kasahara
Keyword(s):  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Current Knowledge ◽  
Psychiatric Patients ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
Affective Symptoms ◽  
Five Factors ◽  
Thought Disorders ◽  
Positive And Negative Symptoms

BackgroundThe literature on the statistical analysis of symptoms of psychoses was limited to positive and negative symptoms in schizophrenia. The present study explored the relationship between positive and negative symptoms as well as affective symptoms in a wider category of psychotic disorders.MethodThe symptoms of 584 psychiatric patients, consecutively admitted to any of the 95 mental hospitals in Japan, were studied. They manifested at least one of the following: (a) delusions, (b) hallucinations, (c) formal thought disorder, (d) catatonic symptoms, or (e) negative (defect) symptoms.ResultsFactor analysis yielded five factors interpretable as (a) manic symptoms, (b) depressive symptoms, (c) negative (defect) symptoms and formal thought disorders, (d) positive (psychotic) symptoms, and (e) catatonic symptoms.ConclusionThese results suggest that although major symptoms seen among psychotic patients can be categorised into positive, negative, manic, and depressive groups, corresponding to current knowledge of phenomenology, catatonic symptoms constitute a discrete syndrome, while formal thought disorders merge into the negative syndrome.

Recovery Versus Remission in Schizophrenia and Related Persistent Psychotic Disorders: no Contrasting but Complementary Models

2011 ◽  
Vol 26 (S2) ◽  
pp. 1386-1386
Author(s):  
V. Fricchione Parise ◽  
G. Balletta ◽  
M.R. Landolfi ◽  
G. Manna
Keyword(s):  
Psychotic Disorders ◽  
Psychiatric Rehabilitation ◽  
Psychotic Symptoms ◽  
Psychotic Episode ◽  
Recovery Model ◽  
Level Of Functioning ◽  
Persistent Symptoms ◽  
Recovery Movement ◽  
Relative Neglect ◽  
Remission Criteria

At present there is no consensus on defining “Recovery” in schizophrenia,while there is an accepted definition of “Remission”. Remission model considers “stability” the treatment primary goal and, once achieved, focus is on mainteining stability and preventing relapse. This model reflects a condition where are absent prominent symptoms but may be present some mild symptoms of schizophrenia, retaining not realistic absence of any symptoms. It would require treating an acute psychotic episode,then there still may be a range of no detectable or persistent and disabling symptoms:remission and level of functioning are related but not the same. Some patients could have good level of functioning despite persistent symptoms and others could meet remission criteria despite considerable impairments. Remission is an obteinable outcome for many psychotic outpatients:the point of departure between manteinance and recovery-oriented model happens only after “stability” is achieved;no one could recover in face of repeated crisis,hospitalisation or unrelenting psychotic symptoms. Unfortunately two causes have resulted in a relative neglect of the concept of recovery from psychotic illness:the divide between mainstream biologically oriented psychiatry and the psychiatric rehabilitation movement;the misunderstanding fact that term “recovery movement” is sometimes construed as anti-medication or anti-psychiatry orientation. Irrefuteble point is that recovery model not rejects the importance of remission:stability and relapse prevention. The recovery model besides asserts that achieving remission is the beginning and not the end of treatment plan:then there will be continued efforts to work with patient,family,caregiver,to continue to achieve further improvements in life goals. The “Recovery” patient-centred model have to be embraced as prymary goal by mainstream organizations and services in Mental Health.

Duration of untreated psychosis: a critical examination of the concept and its importance

2001 ◽  
Vol 31 (3) ◽  
pp. 381-400 ◽  
Author(s):  
ROSS M. G. NORMAN ◽  
ASHOK K. MALLA
Keyword(s):  
Treatment Outcome ◽  
Negative Symptoms ◽  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Critical Examination ◽  
Duration Of Untreated Psychosis ◽  
Relationship Of ◽  
The Relationship

Background. The concept of duration of untreated psychosis (DUP) has recently attracted much interest because of its possible relationship to treatment outcome and implications for preventive efforts with reference to psychotic disorders, especially schizophrenia. In this paper we review critically the literature concerning the concept and its importance.Methods. Articles concerned with measuring DUP and those that have been suggested to provide indirect or direct evidence of the effect of DUP on treatment outcome are reviewed.Results. Evidence thus far suggests that DUP may be related to ease of reducing psychotic symptoms once treatment begins for first episode patients, but there is no evidence of a relationship to likelihood of relapse. There has been little investigation of the relationship of DUP to other long-term outcomes such as negative symptoms and cognitive functioning neither have the possible confounds of DUP been widely investigated or controlled.Conclusions. It is important that there should be more thorough investigations of DUP, its correlates, and the extent to which it does mediate any advantages of earlier intervention.

Need-Adapted and Open-Dialogue Treatments: Empirically Supported Psychosocial Interventions for Schizophrenia and Other Psychotic Disorders

2012 ◽  
Vol 14 (3) ◽  
pp. 162-177 ◽  
Author(s):  
Jill Gromer
Keyword(s):  
United States ◽  
Psychotic Disorders ◽  
Psychosocial Interventions ◽  
The United States ◽  
Psychotic Symptoms ◽  
Empirically Supported ◽  
Mental Health Service System ◽  
Alternative Approaches ◽  
Open Dialogue ◽  
Health Service System

Purpose: People experiencing acute or severe psychosis in the United States do not typically have access to alternatives to standard practice. To provide people with psychotic symptoms meaningful choices in treatment, alternative approaches should be evaluated for potential integration into the mental health service system. The need-adapted and open-dialogue approaches are psychotherapeutically focused interventions for psychosis that were developed in Finland. If these treatments are found to be effective, they could potentially be used in the United States. Method: This narrative review uses systematic and transparent methods to locate and synthesize findings from treatment, quasi-treatment, and pretreatment outcome studies of the need-adapted and open-dialogue approaches. Results: One hundred twelve potentially relevant studies were identified for this review using electronic searches and reference harvesting. Of those, 7 met the review’s inclusion criteria. These studies revealed that the open-dialogue and need-adapted treatments had outcomes that were equivalent or superior to those of standard care. Discussion: More research is needed on these promising modalities before they are routinely incorporated into U.S. practice.

Assessing suicide risk with the Clinical Interview for Psychotic Disorders (CIPD): Preliminary reliability and validity of the Suicide Risk Scale for Psychosis (SRS-P)

2017 ◽  
Vol 41 (S1) ◽  
pp. S188-S189
Author(s):  
M.J. Martins ◽  
P. Castilho ◽  
C. Carvalho ◽  
T. Pereira ◽  
J. Gonçalves ◽  
...  
Keyword(s):  
Convergent Validity ◽  
Suicide Risk ◽  
Psychotic Disorders ◽  
Therapeutic Process ◽  
Reliability And Validity ◽  
Important Variable ◽  
Psychotic Symptoms ◽  
Good Reliability ◽  
Illness Onset ◽  
Self Compassion

BackgroundSuicide risk is an important variable to consider both in assessment and throughout the therapeutic process in psychotic disorders. The SRS-P is an 18-item scale computed from the patient and clinician-rated scores obtained in the CIPD. The scale comprises lifetime assessment of depressed mood, anhedonia and its current interference and severity, current and past feelings of hopelessness, suicidal ideation, ‘voices’ about suicide, and suicide-related behaviors.AimsTo assess reliability and convergent validity of the SRS-P in a sample of participants with psychosis.MethodsThe sample comprised 22 participants (68.2% male), single (72.7%), between 19 and 47 years old (M = 31.05; SD = 7.088), with 4–17 years of education (M = 11.77; SD = 3.176), employed (50%). The most prevalent diagnosis was schizophrenia (68.2%) and the participants had a mean of 1.90 hospitalizations (SD = 2.548). The mean age of illness onset was 23.57 years (SD = 5.555). The participants were assessed with the CIPD, Depression, Anxiety and Stress Scales-21, Forms of Self-Criticism and Reassurance Scale, Self-Compassion Scale, Other as Shamer Scale and the Empowerment with Psychotic Symptoms Scales.ResultsThe SRS-P has shown good reliability (α = .87) and validity in relation to depressive symptoms (r = .67; P = .001), anxiety (r = .74; P < .001), stress (r = .59; P = .004), inadequate self (r = .43; P = .046), hated self (r = .54; P = .009), reassured self (r = –.65; P = .001), self-compassion (r = –.63; P = .002), shame (r = .46; P = .033) and empowerment regarding positive symptoms (r = –.54; P = .015).ConclusionsThe SRS-P presented adequate reliability and convergent-divergent validity. Further studies are planned in order to test the factorial structure of the scale and confirm the presented results in a larger sample.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals When the going gets tougher: the importance of long-term supportive psychotherapy in psychosis

2008 ◽  
Vol 14 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Alan Meaden ◽  
Susie Van Marle
Keyword(s):  
Clinical Practice ◽  
Psychosocial Interventions ◽  
Individual Case ◽  
Routine Care ◽  
Routine Clinical Practice ◽  
Psychotic Symptoms ◽  
Treatment Team ◽  
Supportive Psychotherapy ◽  
The Individual

There has been considerable progress in recent years in developing psychosocial interventions for people who experience persistent psychotic symptoms. However, it is sometimes difficult to generalise these findings into routine clinical practice. Long-term, psychodynamically informed, supportive psychotherapy is a valuable approach for working with individuals for whom current psychosocial interventions are ineffective or where unhelpful team reactions are obstacles to care. Its principles are used to inform a multiaxial formulation, which is shared with the treatment team and guides treatment, promoting good-quality comprehensive routine care. The benefits of this approach can best be seen at the individual case level using a subsequent multiaxial reformulation.

Sibling pairs with schizophrenia or schizoaffective disorder: associations of subtypes, symptoms and demographic variables

1998 ◽  
Vol 28 (4) ◽  
pp. 815-823 ◽  
Author(s):  
A. G. CARDNO ◽  
L. A. JONES ◽  
K. C. MURPHY ◽  
R. D. SANDERS ◽  
P. ASHERSON ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Statistical Tests ◽  
Demographic Variables ◽  
Psychotic Symptoms ◽  
Formal Thought Disorder ◽  
Illness Onset ◽  
Sibling Pairs ◽  
Affected Sibling ◽  
Dsm Iv ◽  
Definition Of

Background. Affected sibling pairs provide a valuable means of investigating the familial basis of clinical heterogeneity in schizophrenia.Methods. Associations of schizophrenia subtypes, psychotic symptoms (defined by SAPS/SANS and OPCRIT), affective episodes and demographic variables were studied in 109 sibling pairs with DSM-IV schizophrenia or schizoaffective disorder.Results. None of the subtypes or affective episodes were significantly associated within pairs. A broad definition of positive formal thought disorder, grandiose delusions and delusions of influence (all from OPCRIT) were modestly associated. There was no excess of same-sex pairs. There were modest associations for age of illness onset, pre-morbid adjustment and illness severity. Caution is required in interpreting the results because many statistical tests were carried out.Conclusions. None of the variables appears to be closely associated with specific genetic or shared environmental factors that contribute liability to schizophrenia. They are at best only weakly associated with such factors, and/or are associated with factors unrelated to the aetiology of schizophrenia.

Functional psychoses

2017 ◽  
pp. 1057-1064
Author(s):  
Luis Agüera-Ortiz
Keyword(s):  
Adverse Effects ◽  
Older People ◽  
Atypical Antipsychotics ◽  
Psychotic Disorders ◽  
Late Onset ◽  
Psychotic Symptoms ◽  
Younger Adults ◽  
Psychological Management ◽  
Concomitant Medications

Psychotic symptoms are more common in older people than in any other age. The most frequent psychotic disorders in older people are juvenile-onset schizophrenia in ageing patients, psychosis in Alzheimer’s disease, and the late- and very late-onset schizophrenia-like psychosis. Drug treatment of all types of psychosis is essential and often achieves similar levels of efficacy than in younger adults. The treatment of choice for any psychotic condition is atypical antipsychotics. Rather than being based on specific diagnosis, the choice of drug must be highly personalized, depending on the efficacy for the particular patient, drug’s profile of adverse effects, medical comorbidities, and concomitant medications. Attention should be paid to the emergence of adverse effects that are in general more frequently found with conventional than with atypical antipsychotics. Clinical and psychological management includes the need to establish a therapeutic alliance with the patient and ensure adherence to treatment in the long term.

The impact of childhood adversity on the persistence of psychotic symptoms: a systematic review and meta-analysis

2015 ◽  
Vol 45 (12) ◽  
pp. 2481-2498 ◽  
Author(s):  
A. Trotta ◽  
R. M. Murray ◽  
H. L. Fisher
Keyword(s):  
Systematic Review ◽  
General Population ◽  
Psychotic Disorders ◽  
Meta Analysis ◽  
Childhood Adversity ◽  
Psychotic Symptoms ◽  
Early Adversity ◽  
Ultra High Risk ◽  
The Impact

BackgroundEvidence suggests that childhood adversity is associated with the development of psychotic experiences (PE), psychotic symptoms and disorders. However, less is known regarding the impact of early adversity on the persistence of PE and clinically relevant psychosis. Thus we conducted a systematic review of the association between childhood adversity and the course of PE and symptoms over time.MethodA systematic search of Medline, EMBASE and PsychINFO databases was undertaken to identify articles published between January 1956 and November 2014. We included studies conducted on general population samples, individuals at ultra-high risk (UHR) of psychosis, and patients with full-blown psychotic disorders. A meta-analysis was performed on a subgroup.ResultsA total of 20 studies were included. Of these, 17 reported positive associations between exposure to overall or specific subtypes of childhood adversity and persistence of PE or clinically relevant psychotic symptoms. A meta-analysis of nine studies yielded a weighted odds ratio of 1.76 [95% confidence interval (CI) 1.19–2.32,p< 0.001] for general population studies and 1.55 (95% CI 0.32–2.77,p= 0.007) for studies conducted using clinical populations.ConclusionsThe available evidence is limited but tentatively suggests that reported exposure to adverse events in childhood is associated with persistence of PE and clinically relevant psychotic symptoms. This partially strengthens the case for addressing the consequences of early adversity in individuals presenting with psychotic phenomena to improve long-term outcomes. However, the heterogeneity of studies was high which urges caution in interpreting the results and highlights the need for more methodologically robust studies.

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