scholarly journals T196. THERAPEUTIC MANAGEMENT IN MULTIPLE SCLEROSIS AND SCHIZOPHRENIA SPECTRUM DISORDERS DUAL DIAGNOSIS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S306-S306
Author(s):  
Octavian Vasiliu
Keyword(s):  
Multiple Sclerosis ◽  
Dual Diagnosis ◽  
Atypical Antipsychotics ◽  
Psychotic Disorders ◽  
Complement Factor ◽  
Schizophrenia Spectrum Disorders ◽  
Positive Effects ◽  
Schizophrenia Spectrum ◽  
Baseline Values ◽  
Spectrum Disorders

Abstract Background Multiple sclerosis has been suggested as a potential vulnerability factor for schizophrenia and other psychotic disorders, and there is a hypothesis about a common etiology in a subgroup of schizophrenia and multiple sclerosis [1]. Immune-related single-nucleotide polymorphisms have been associated with schizophrenia and genetic pleiotropy between schizophrenia and multiple sclerosis has been reported, but not between bipolar disorder and multiple sclerosis (at the level of major histocompatibility complex) [2]. As new data about the involvement of genetically-determined immune factors in the susceptibility to schizophrenia appear (e.g., variants of complement factor 4 possibly linked to synaptic pruning during brain development) [3] the interest for finding therapeutic targets within the immune system for psychotic disorders is also increasing. Methods Three patients diagnosed with both schizophrenia spectrum disorders (schizophrenia n=2, or schizoaffective disorder, depressive type n=1), female, mean age 43.7, with a history of psychotic disorder for at least one year, were monitored during 6 months using Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Clinical Global Impressions – Severity (CGI-S), Columbia-Suicide Scale for Schizophrenia (CSSRS), Calgary Depression Scale (CDS), Multiple Sclerosis Severity Scale (MSSS), and the Extrapyramidal Symptom Rating Scale (ESRS). None of these patients presented other organic or psychiatric co-morbidity, and they were on active treatment for their multiple sclerosis throughout the 6-month duration of psychiatric evaluation. All patients were initiated on a new antipsychotic, because of the lack of efficacy of the previous agents, or due to their lack of therapeutic adherence. A patient was initiated on olanzapine 15 mg/day, while the other two received risperidone 4 mg/day. The antipsychotic doses were flexible during the 6 months of the treatment, with olanzapine between 10 and 20 mg daily, and risperidone between 3–6 mg daily. The initial PANSS mean score was 92.2, with a GAF of 35.3 and a CGI-S of 5.1. Results All patients reached the week 24 visit of their evaluation, and the overall tolerablity of the antipsychotic treatment was good. All patients had lower PANSS scores at week 24 (the mean decrease was -25.6 points compared to baseline), higher GAF scores (+27.7 points), and lower CGI-S (-2.5 points). CSSRS did not change significantly during the 6 months, the score remained at minimum value, and the CDS scores also remained constantly under 3. ESRS recorded transient increments, but at week 12 they were not significantly increased reported at the baseline values, and no corrective medication was recommended throughout the 6 months for extrapyramidal symptoms. MSSS mean score did not change significantly at week 12 compared to its baseline values. Discussion Atypical antipsychotics are efficient and well tolerated in patients with schizophrenia and multiple sclerosis dual diagnosis. The positive effects of atypical antipsychotics maintained during the 6 months of monitoring and they had no significant impact over the multiple sclerosis symptoms. References

scholarly journals How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations

2017 ◽  
Vol 4 (1) ◽  
pp. e1 ◽  
Author(s):  
Murielle Villani ◽  
Viviane Kovess-Masfety
Keyword(s):  
Mental Health ◽  
Literature Review ◽  
Health Information ◽  
Psychotic Disorders ◽  
The Internet ◽  
Schizophrenia Spectrum Disorders ◽  
Internet Users ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders ◽  
Source Of Information

Background Studies show that the Internet has become an influential source of information for people experiencing serious psychiatric conditions such as schizophrenia spectrum disorders or other psychotic disorders, among which the rate of Internet users is growing, with rates ranging from 33.3% to 79.5% given the country. Between 20.5% and 56.4% of these Internet users seek mental health information. Objective Focusing on this population’s Web searches about their mental health, this paper examines what type of content they look for and what could be the benefits and disadvantages of this navigation. Methods We conducted a literature review through medical and psychological databases between 2000 and 2015 using the keywords “Internet,” “Web,” “virtual,” “health information,” “schizophrenia,” “psychosis,” “e-mental health,” “e-support,” and “telepsychiatry.” Results People experiencing schizophrenia spectrum disorders or other psychotic disorders wish to find on the Internet trustful, nonstigmatizing information about their disease, flexibility, security standards, and positive peer-to-peer exchanges. E-mental health also appears to be desired by a substantial proportion of them. In this field, the current developments towards intervention and early prevention in the areas of depression and bipolar and anxiety disorders become more and more operational for schizophrenia spectrum disorders and other psychotic disorders as well. The many benefits of the Internet as a source of information and support, such as empowerment, enhancement of self-esteem, relief from peer information, better social interactions, and more available care, seem to outbalance the difficulties. Conclusions In this paper, after discussing the challenges related to the various aspects of the emergence of the Internet into the life of people experiencing schizophrenia spectrum disorders or other psychotic disorders, we will suggest areas of future research and practical recommendations for this major transition.

Diagnosis and Epidemiology of Psychotic Disorders

2017 ◽  
Author(s):  
Emma Meyer ◽  
Julie Walsh-Messinger ◽  
Dolores Malaspina
Keyword(s):  
Psychotic Disorders ◽  
Schizophrenia Spectrum Disorders ◽  
Emil Kraepelin ◽  
Course Of Illness ◽  
Dsm 5 ◽  
Clinical Reality ◽  
Manic Depressive ◽  
Schizophrenia Spectrum ◽  
History Of ◽  
Spectrum Disorders

Schizophrenia spectrum disorders and affective psychoses are jointly considered in this chapter in light of the ongoing controversy concerning the diagnostic boundary between these conditions. Emil Kraepelin first separated schizophrenia (which he named dementia praecox) from manic-depressive insanity based on the deteriorating course of illness in schizophrenia, and the convention is still upheld in the DSM-5. A wealth of evidence suggests that this dichotomy does not mirror clinical reality. This chapter reviews the history of the diagnostic concepts underlying the grouping and separation of “the psychoses,” focusing on schizophrenia, schizoaffective disorder, and bipolar disorder.

scholarly journals Diagnosing Organic Causes of Schizophrenia Spectrum Disorders: Findings from a One-Year Cohort of the Freiburg Diagnostic Protocol in Psychosis (FDPP)

Diagnostics ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 691
Author(s):  
Dominique Endres ◽  
Miriam Matysik ◽  
Bernd Feige ◽  
Nils Venhoff ◽  
Tina Schweizer ◽  
...  
Keyword(s):  
Diagnostic Procedure ◽  
University Hospital ◽  
Complement Factor ◽  
Schizophrenia Spectrum Disorders ◽  
Barrier Dysfunction ◽  
Metabolic Markers ◽  
Diagnostic Protocol ◽  
Csf Analysis ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders

Introduction: Secondary schizophrenia spectrum disorders (SSDs) have clearly identifiable causes. The Department for Psychiatry and Psychotherapy at the University Hospital Freiburg has continued to expand its screening practices to clarify the organic causes of SSDs. This retrospective analysis was carried out to analyze whether a comprehensive organic diagnostic procedure could be informative in patients with SSDs. Methods and Participants: The “Freiburg Diagnostic Protocol in Psychosis” (FDPP) included basic laboratory analyses (e.g., thyroid hormones), metabolic markers, pathogens, vitamin status, different serological autoantibodies, rheumatic/immunological markers (e.g., complement factors), cerebrospinal fluid (CSF) basic and antineuronal antibody analyses, as well as cranial magnetic resonance imaging (cMRI) and electroencephalography (EEG). The findings of 76 consecutive patients with SSDs (55 with paranoid–hallucinatory; 14 with schizoaffective; 4 with hebephrenic; and 1 each with catatonic, acute polymorphic psychotic, and substance-induced psychotic syndromes) were analyzed. Results: Overall, vitamin and trace element deficiency was identified in 92%. Complement factor analyses detected reduced C3 levels in 11%. Immunological laboratory alterations were detected in 76%. CSF analysis revealed general alterations in 54% of the patients, mostly with signs of blood–brain barrier dysfunction. cMRI analyses showed chronic inflammatory lesions in 4%. Combination of EEG, cMRI, and CSF revealed alterations in 76% of the patients. In three patients, autoimmune psychosis was suspected (4%). Discussion: On the basis of these findings, we conclude that a comprehensive diagnostic procedure according to the FDPP in patients with SSD is worthwhile, considering the detection of secondary, organic forms of SSDs, as well as alterations in “modulating factors” of the disease course, such as vitamin deficiency. Larger studies using comprehensive diagnostic protocols are warranted to further validate this approach.

scholarly journals Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases

2005 ◽  
Vol 187 (6) ◽  
pp. 510-515 ◽  
Author(s):  
Mikkel Arendt ◽  
Raben Rosenberg ◽  
Leslie Foldager ◽  
Gurli Perto ◽  
Povl Munk-Jørgensen
Keyword(s):  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Separate Analysis ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Central Register ◽  
Increased Risk ◽  
History Of ◽  
Spectrum Disorders ◽  
Incident Cases

BackgroundFew studies have examined samples of people with cannabis-induced psychotic symptoms.AimsTo establish whether cannabis-induced psychotic disorders are followed by development of persistent psychotic conditions, and the timing of their onset.MethodData on patients treated for cannabis-induced psychotic symptoms between 1994 and 1999 were extracted from the Danish Psychiatric Central Register. Those previously treated for any psychotic symptoms were excluded. The remaining 535 patients were followed for at least 3 years. In a separate analysis, the sample was compared with people referred for schizophrenia-spectrum disorders for the first time, but who had no history of cannabis-induced psychosis.ResultsSchizophrenia-spectrum disorders were diagnosed in 44.5% of the sample. New psychotic episodes of any type were diagnosed in 77.2%. Male gender and young age were associated with increased risk. Development of schizophrenia-spectrum disorders was often delayed, and 47.1% of patients received a diagnosis more than a year after seeking treatment for a cannabis-induced psychosis. The patients developed schizophrenia at an earlier age than people in the comparison group (males, 24.6 v. 30.7 years, females, 28.9 v. 33.1 years).ConclusionsCannabis-induced psychotic disorders are of great clinical and prognostic importance.

scholarly journals Cerebrospinal fluid abnormalities in first- and multi-episode schizophrenia-spectrum disorders: impact of clinical and demographical variables

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Tatiana Oviedo-Salcedo ◽  
Elias Wagner ◽  
Mattia Campana ◽  
Anna Gagsteiger ◽  
Wolfgang Strube ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Psychotic Disorders ◽  
Retrospective Chart Review ◽  
First Episode ◽  
Schizophrenia Spectrum Disorders ◽  
Response Predictors ◽  
Schizophrenia Spectrum ◽  
Episode Psychosis ◽  
The Mean ◽  
Spectrum Disorders

AbstractMultiple lines of evidence indicate that immunological and inflammatory alterations contribute at least in a subgroup to the pathophysiology of schizophrenia. In this retrospective chart review, we investigated whether clinical factors contribute to altered cerebrospinal fluid (CSF) findings in schizophrenia-spectrum disorders. Clinical data from electronic medical records of patients with psychotic disorders (ICD-10: F20-F29) who received routine CSF diagnostics at the Department of Psychiatry and Psychotherapy, LMU Munich, Germany, were included. Chi² tests for dichotomous outcomes and independent t tests for continuous outcomes were used to compare differences between groups. A total of 331 patients were included in the analyses (43.2% female and 56.8% male). The mean age was 37.67 years (±15.58). The mean duration of illness was 71.96 months (±102.59). In all, 40% (128/320) were first-episode psychosis (FEP) patients and 60% (192/320) were multi-episode psychosis (MEP) patients. Elevated CSF protein levels were found in 19.8% and elevated CSF/serum albumin ratios (QAlb) in 29.4% of the cases. Pleocytosis was found in 6.1% of patients. MEP patients showed significantly higher mean QAlb compared with FEP patients (t(304.57) = −2.75, p = 0.006), which did not remain significant after correcting for age. QAlb elevation occurred more frequently in men (X2(1) = 14.76, p = <0.001). For treatment resistance, family history, and cMRI alterations, no significant differences in CSF-related outcomes were detected. Our work extends other retrospective cohorts confirming a relevant degree of CSF alterations in schizophrenia-spectrum disorders and shows the difficulty to relate these alterations to clinical and disease course trajectories. More research is needed to develop treatment response predictors from CSF analyses.

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