Sarcoidosis and Corticosteroid Therapy: Dilemma from a Psychiatric Point of View

Introduction and Methods: A man diagnosed with sarcoidosis developed partial retrograde amnesia followed by three months of depressive symptoms with panic attacks, which remitted with an antidepressant and a benzodiazepine. However, three months later hallucinations and overvalued persecutory ideations subsequently emerged, only to show partial response to antipsychotic treatment. Results: Sarcoidosis was treated with corticosteroids but serial thorax imaging shows minimal response. Corticosteroid was onboard throughout treatment, corresponding with non-remission of psychotic symptoms. There are persistent subjective cognitive difficulties but Mini Mental State Exam score is full. He is currently being treated with escitalopram, alprazolam and quetiapine. Conclusion: This case illustrated the dilemma between prolonging the corticosteroid therapy for sarcoidosis treatment and the psychiatric sequalae. While symptomatic antipsychotic treatment is effective, multi-disciplinary approach is imperative in determining the duration of the corticosteroid therapy.

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M138. THE STRUCTURAL AND FUNCTIONAL BRAIN IMPACT OF CLOZAPINE IN SCHIZOPHRENIC PATIENTS: REVIEW OF THE LITERATURE

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.450 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S188-S188

Author(s):

Lucie Metivier ◽

Anais Vandevelde

Keyword(s):

Frontal Cortex ◽

Treatment Response ◽

Mode Of Action ◽

Negative Symptoms ◽

Cerebral Metabolism ◽

Point Of View ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Functional Brain ◽

Pubmed Database

Abstract Background Schizophrenia is a common and severe mental disorder. The actual treatment is neuroleptic. Clozapine (CLZ), the atypical antipsychotic leader, is the best treatment of the resistant schizophrenia. Neuroimaging studies are important to understand better the neurological effects of CLZ. The main goal of this study is to analyze actual data of anatomic imaging studies (MRI, DTI, fMRI, PET and SPECT), evaluate CLZ anatomical and functional brain effect on patients suffering resistant schizophrenia (SZ) in order to characterize the mode of action of CLZ, identify the neural bases of the CLZ treatment response and establish the link between the mode of action and CLZ and the treatment response on patients suffering resistant SZ. Methods We have analyzed literature using PUBMED database with the following keywords: « clozapine », « neuroimaging », »MRI », « DTI », « VBM », « functional magnetic resonnance imaging », « PET », « fMRI », « SPECT ». Results 51 studies were included. 10 on anatomical imagery and 41 on functional imagery. From an anatomic point of view, studies suggest best cerebral integrity on patients with CLZ treatment compared to other antipsychotics, on grey nuclei, prefrontal cortex and on white matter beams belonging to the fronto sub cortical network. LEROUX et col, OCZELIK et col. From the functional point of view, studies show a functional connectivity modulation and an action on the cerebral metabolism MOLINA et col, especially in the frontal cortex of patients that respond to CLZ treatment compared to patients who have received another antipsychotic treatment. The PET and SPECT studies show the CLZ action mechanism especially on the glutamatergic system FUKUYAMA et col. Concerning CLZ-treated patients’ response, many studies have shown a larger perfusion on the frontal cortex and thalamic region on patient responding to CLZ compared non-responders. MOLINA et col, ERTUGUL et col. About clinical evolution, the longitudinal studies show an amelioration of the psychotic symptoms (positive symptoms, negative symptoms, suicidal risk and cognitive alteration) on CLZ-treated patients compared than the ones who have been treated with another antispychotic. ARANGO et col, MOLINA et col. CLZ treatment allows a decrease of craving on patients who suffer cannabis usage disorders compared with patients who are treated with risperidone. MACHIELSEN et col. Discussion These results bring a new light on SZ psychopathological, on CLZ cerebral mechanism and open the debate of actual prescription recommendations. However, we won’t conclude with certainly due heterogeneity of the experimental design, as other studies are necessary to complete knowledge of this subject.

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The Relationship of Psychiatric Symptoms with Performance-Based and Self-Reported Cognitive Function After Ischemic Stroke

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721000187 ◽

2021 ◽

pp. 1-13

Author(s):

Elisabeth Kliem ◽

Elise Gjestad ◽

Truls Ryum ◽

Alexander Olsen ◽

Bente Thommessen ◽

...

Keyword(s):

Ischemic Stroke ◽

Executive Function ◽

Depressive Symptoms ◽

Cognitive Function ◽

Psychiatric Symptoms ◽

Post Stroke ◽

Cognitive Difficulties ◽

Memory And Attention ◽

Relationship Of ◽

The Relationship

Abstract Objective: Findings on the relationship of psychiatric symptoms with performance-based and self-reported cognitive function post-stroke are inconclusive. We aimed to (1) study the relation of depression and anxiety to performance-based cognitive function and (2) explore a broader spectrum of psychiatric symptoms and their association with performance-based versus self-reported cognitive function. Method: Individuals with supratentorial ischemic stroke performed neuropsychological examination 3 months after stroke. For primary analyses, composite scores for memory and attention/executive function were calculated based on selected neuropsychological tests, and the Hospital Anxiety and Depression Scale (HADS) was used. Psychiatric symptoms and self-reported cognitive function for secondary aims were assessed using the Symptom-Checklist-90 – Revised (SCL-90-R). Results: In a sample of 86 patients [mean (M) age: 64.6 ± 9.2; Mini-Mental State Examination (MMSE), 3–7 days post-stroke: M = 28.4 ± 1.7; National Institutes of Health Stroke Scale (NIHSS) after 3 months: M = 0.7 ± 1.6] depressive symptoms (HADS) were associated with poorer memory performance after controlling for age, sex, and education (p ≤ .01). In a subsample (n = 41; Age: M = 65.7 ± 8.1; MMSE: M = 28.4 ± 1.8; NIHSS: M = 1.0 ± 1.9), symptoms of phobic anxiety (SCL-90-R) were associated with poorer performance-based memory and attention/executive function, and symptoms of anxiety (SCL-90-R) with lower attention/executive function. Higher levels of self-reported cognitive difficulties were associated with higher scores in all psychiatric domains (p ≤ .05). Conclusion: Even in relatively well-functioning stroke patients, depressive symptoms are associated with poorer memory. The results also suggest that various psychiatric symptoms are more related to self-reported rather than to performance-based cognitive function. Screening for self-reported cognitive difficulties may not only help to identify patients with cognitive impairment, but also those who need psychological treatment.

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Effect of Marriage on Pre-existing Psychoses: A Convenient or Futile Solution for Severe Mental Disorders?

Journal of Psychosexual Health ◽

10.1177/2631831820971738 ◽

2020 ◽

Vol 2 (3-4) ◽

pp. 273-276

Author(s):

Prakash B. Behere ◽

Aniruddh P. Behere ◽

Debolina Chowdhury ◽

Amit B. Nagdive ◽

Richa Yadav

Keyword(s):

Mental Disorders ◽

Age Of Onset ◽

Social Stigma ◽

Positive Family History ◽

Mental Illnesses ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Contractual Relationship ◽

History Of ◽

Paranoid Type

Marriage can be defined as the state of being united as spouses in a consensual and contractual relationship recognized by law. The general population generally believes marriage to be a solution to mental illnesses. It can be agreed that mental disorders and marital issues have some relation. Parents of patients with psychoses expect that marriage is the solution to the illness and often approach doctors and seek validation about the success of the marriage of their mentally ill child, which is a guarantee no doctor can give in even normal circumstances. Evidence on sexual functioning in patients of psychosis is limited and needs further understanding. Studies show about 60%–70% women of the schizophrenia spectrum and illness to experience sexual difficulties. Based on available information, sexual dysfunction in population with psychosis can be attributed to a variety of psychosocial factors, ranging from the psychotic symptoms in itself to social stigma and institutionalization and also due to the antipsychotic treatment. Despite the decline in sexual activity and quality of life in general, it is very rarely addressed by both the treating doctor and by the patient themselves hence creating a lacuna in the patient’s care and availability of information regarding the illness’ pathophysiology. Patients become noncompliant with medications due to this undesirable effect and hence it requires to be given more attention during treatment. It was also found that paranoid type of schizophrenia patient had lower chances of separation than patients with other types of schizophrenia. The risk of relapse in cases with later age of onset of the disease, lower education, a positive family history of psychosis or a lower income increased more than other populations.

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

Psychological Medicine ◽

10.1017/s0033291713003188 ◽

2014 ◽

Vol 44 (11) ◽

pp. 2419-2430 ◽

Cited By ~ 17

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.

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Panic Attacks in Chronic Schizophrenia

The British Journal of Psychiatry ◽

10.1192/bjp.157.3.430 ◽

1990 ◽

Vol 157 (3) ◽

pp. 430-433 ◽

Cited By ~ 45

Author(s):

Nicholas Argyle

Keyword(s):

Maintenance Therapy ◽

Social Phobia ◽

Negative Symptoms ◽

Chronic Schizophrenia ◽

Panic Attacks ◽

Psychotic Symptoms ◽

Relationship Of ◽

The Relationship

Of 20 patients attending a clinic for maintenance therapy of schizophrenia, seven had regular panic attacks, and these were often associated with agoraphobia and social phobia. Similar fears and avoidance in other cases were associated with paranoid ideas and negative symptoms. The relationship of panic to psychotic symptoms varied greatly. In two patients neuroleptics were associated with an increase in panic attacks.

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Quality of life in individuals with attenuated psychotic symptoms: Possible role of anxiety, depressive symptoms, and socio-cognitive impairments

Psychiatry Research ◽

10.1016/j.psychres.2017.08.024 ◽

2017 ◽

Vol 257 ◽

pp. 431-437 ◽

Cited By ~ 12

Author(s):

Tsutomu Takahashi ◽

Yuko Higuchi ◽

Yuko Komori ◽

Shimako Nishiyama ◽

Mihoko Nakamura ◽

...

Keyword(s):

Quality Of Life ◽

Depressive Symptoms ◽

Cognitive Impairments ◽

Psychotic Symptoms

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Psychotic symptoms in the general population – an evolutionary perspective

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.076018 ◽

2010 ◽

Vol 197 (3) ◽

pp. 167-169 ◽

Cited By ~ 47

Author(s):

Ian Kelleher ◽

Jack A. Jenner ◽

Mary Cannon

Keyword(s):

General Population ◽

Clinical Research ◽

Clinical Phenotype ◽

Population Based ◽

Point Of View ◽

Self Report ◽

Psychotic Symptoms ◽

Evolutionary Perspective ◽

Evolutionary Context ◽

Research Population

SummaryOur ideas about the intrinsically pathological nature of hallucinations and delusions are being challenged by findings from epidemiology, neuroimaging and clinical research. Population-based studies using both self-report and interview surveys show that the prevalence of psychotic symptoms is far greater than had been previously considered, prompting us to re-evaluate these psychotic symptoms and their meaning in an evolutionary context. This non-clinical phenotype may hold the key to understanding the persistence of psychosis in the population. From a neuroscientific point of view, detailed investigation of the non-clinical psychosis phenotype should provide novel leads for research into the aetiology, nosology and treatment of psychosis.

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Dopamine D1 receptor availability is not associated with delusional ideation measures of psychosis proneness

10.1101/321646 ◽

2018 ◽

Cited By ~ 1

Author(s):

Granville James Matheson ◽

Pontus Plavén-Sigray ◽

Anaïs Louzolo ◽

Jacqueline Borg ◽

Lars Farde ◽

...

Keyword(s):

Clinical Studies ◽

Dopamine D1 Receptor ◽

D1 Receptor ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Exact Nature ◽

Healthy Controls ◽

Psychosis Proneness ◽

Delusional Ideation ◽

Increased Risk

AbstractThe dopamine D1 receptor (D1R) is thought to play a role in psychosis and schizophrenia, however the exact nature of this involvement is not clear. Positron emission tomography studies comparing D1R between patients and control subjects have produced inconsistent results. An important confounding factor in most clinical studies is previous exposure to antipsychotic treatment, which is thought to influence the density of D1R. To circumvent some of the limitations of clinical studies, an alternative approach for studying the relationship between D1R and psychosis is to examine individuals at increased risk for psychotic disorders, or variation in subclinical psychotic symptoms such as delusional ideation within the general population, referred to as psychosis proneness traits. In this study, we investigated whether D1R availability is associated with delusional ideation in healthy controls using data from 76 individuals measured with PET using [11C]SCH23390 and 217 individuals who completed delusional ideation questionnaires, belonging to three different study cohorts. We first performed exploratory, hypothesis-generating, analyses by creating and evaluating a new measure of delusional ideation (n=132 and n=27), which was then found to show a negative association with D1R availability (n=24). Next, we performed confirmatory analyses using Bayesian statistical modelling, in which we first attempted to replicate this result (n=20), and then evaluated the association of Peters Delusion Inventory scores with D1R availability in two independent cohorts (n=41 and 20). Collectively, we found strong evidence that there is little to no linear association between delusional ideation and D1R availability in healthy controls. If differences in D1R can be confirmed in drug-naive schizophrenia patients compared to controls, further studies are needed to ascertain whether these changes occur at the onset of psychotic symptoms or if they are associated with specific behavioural or genetic aspects of psychosis proneness other than delusional ideation.

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An Exploratory Retrospective Evaluation of Ropinirole-Associated Psychotic Symptoms in an Outpatient Population Treated for Restless Legs Syndrome or Parkinson's Disease

Annals of Pharmacotherapy ◽

10.1345/aph.1m183 ◽

2009 ◽

Vol 43 (9) ◽

pp. 1426-1432 ◽

Cited By ~ 10

Author(s):

Steven C Stoner ◽

Megan M Dahmen ◽

Mignon Makos ◽

Jessica W Lea ◽

Lora J Carver ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dopamine Receptors ◽

Restless Legs Syndrome ◽

Dopamine Agonists ◽

Dual Therapy ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Restless Legs ◽

Psychotic Features

Background: Traditional treatment approaches for the management of restless legs syndrome (RLS) and Parkinson's disease (PD) include the use of medications that either directly or indirectly increase dopamine levels. In turn, a potential adverse event that could be expected is the development or exacerbation of psychiatric-related symptoms. Objective: To evaluate and describe the incidence of psychosis and associated behavioral features in patients taking ropinirole for RLS or PD. Methods: Patients were identified from a computerized database search of outpatients being treated with ropinirole for 1 of 2 medical conditions: PD or RLS. Data were collected in a retrospective manner from 95 patients who were tracked over the course of their therapy to determine whether psychosis or associated behavioral symptoms developed as a result and whether an intervention was needed to adjust ropinirole dosing or if additional medications had to be added to control features associated with psychosis. Results: A total of 284 patients being treated for RLS or PD were identified; of this group, 95 patients were identified as being treated for PD or RLS with ropinirole. Of the 95 patients being treated with ropinirole, 13 developed psychotic features that required therapeutic intervention with either the use of an antipsychotic or dose adjustment of ropinirole. PD patients included in this study were numerically more likely to develop psychotic features compared with RLS patients; however, the difference was not statistically significant (p = 0.122). The results do suggest that this risk is increased when ropinirole is used as part of a dual therapy approach with dopamine agonists in the treatment of either PD or RLS (p = 0.003). Discussion: Dopamine agonists have long been used as preferred treatment in the management of PD and RLS. When treating either PD or RLS in the psychiatric population, the concern arises that increased activity at dopamine receptors may induce or exacerbate psychiatric features. A potential clinical concern with the use of ropinirole is the potential for patients to develop psychiatric features, although there are few data available to demonstrate whether stimulation of targeted individual dopamine receptors is linked to the development or exacerbation of psychotic features. It is also undetermined whether concurrent antipsychotic treatment provides any protective benefit against psychosis, especially in patients already being treated for psychotic symptoms. Conclusions: Our findings suggest that ropinirole may play a role in inducing or exacerbating psychosis and its associated features, although a number of confounding variables prevent the determination of a clear association and suggest that further investigation is warranted in controlled clinical trials.

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Panic Disorder Induced by the Coronavirus Disease Pandemic in a Patient with Organic Mood Disorder Successfully Treated with Vortioxetine

Case Reports in Psychiatry ◽

10.1155/2020/8870014 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3

Author(s):

Reiji Yoshimura ◽

Naomichi Okamoto ◽

Yuki Konishi ◽

Atsuko Ikenouchi

Keyword(s):

Traumatic Brain Injury ◽

Depressive Symptoms ◽

Brain Injury ◽

Panic Disorder ◽

Mood Disorder ◽

Traffic Accident ◽

Panic Attacks ◽

Depressive State ◽

Multiple Episodes

We present a case of panic disorder induced by the coronavirus disease (COVID-19) pandemic in a patient with an organic mood disorder. The patient was a 62-year-old woman with mild mood swings and reduced motivation and volition caused by a traumatic brain injury after a traffic accident. She was maintained on carbamazepine (600 mg/day). When the COVID-19 outbreak occurred in Japan, she developed concerns regarding the illness and complained of multiple episodes of panic attacks. Further, her depressive symptoms worsened. Thus, vortioxetine was added to the ongoing CBZ treatment. Four weeks after initiating vortioxetine treatment, the symptoms of panic disorder and depressive state were ameliorated. The present case suggests that vortioxetine augmentation can improve symptoms of depressive state and panic disorder induced by the COVID-19 pandemic.

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