DIFFERENCES IN CLINICAL CHARACTERISTICS BETWEEN BIPOLAR PATIENTS WITH CURRENT PSYCHOTIC SYMPTOMS AND THOSE WHO HAVE NEVER BEEN PSYCHOTIC

The hypothesis of a low self-esteem in depressive patients was tested using the Rosenberg Self-Esteem Scale in 24 recovered unipolar and 27 recovered bipolar patients, compared with a normal control group of 26 subjects matched for age and sex. The hypothesis was confirmed only for unipolars; bipolar patients presented a self-esteem score not significantly different from normal scores. Self-esteem was not related to clinical characteristics of the affective disorder, suggesting that low self-esteem may be a basic component of a depression-prone personality. The investigation of the relationship between self-esteem and social adjustment confirmed the presence of social conformism in bipolar patients and rigidly set low self-esteem in unipolar patients. These results should stimulate the evaluation of different psychotherapeutic treatments in the long-term psychosocial management of affectively ill patients.

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Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

European Psychiatry ◽

10.1016/j.eurpsy.2010.11.001 ◽

2011 ◽

Vol 27 (8) ◽

pp. 557-562 ◽

Cited By ~ 8

Author(s):

J.-M. Azorin ◽

A. Kaladjian ◽

M. Adida ◽

E. Fakra ◽

E. Hantouche ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicide Attempts ◽

Correct Diagnosis ◽

Manic Episode ◽

Psychotic Symptoms ◽

First Episode ◽

Prodromal Phase ◽

Multiple Episode ◽

Patients At Risk ◽

Bipolar Patients

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

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Depression with and without a history of psychotic symptoms in the general population: sociodemographic and clinical characteristics

Journal of Affective Disorders ◽

10.1016/j.jad.2020.04.048 ◽

2020 ◽

Vol 273 ◽

pp. 247-251 ◽

Cited By ~ 1

Author(s):

Victoire BENARD ◽

Baptiste PIGNON ◽

Pierre A. GEOFFROY ◽

Imane BENRADIA ◽

Jean-Luc ROELANDT ◽

...

Keyword(s):

General Population ◽

Clinical Characteristics ◽

Psychotic Symptoms ◽

History Of

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Les manifestations psychiatriques dans la démence: perspective phénoménologique

The Canadian Journal of Psychiatry ◽

10.1177/070674379303801009 ◽

1993 ◽

Vol 38 (10) ◽

pp. 671-677 ◽

Cited By ~ 1

Author(s):

Isabelle Paquette

Keyword(s):

Major Depression ◽

Cognitive Deficits ◽

Clinical Characteristics ◽

Depressive Symptomatology ◽

Psychiatric Symptoms ◽

Memory Loss ◽

Psychotic Symptoms ◽

Neuropsychological Evaluations ◽

Operational Criteria ◽

Psychiatric Manifestations

The study of psychiatric manifestations in dementia has long been overshadowed by the more classical manifestations of the disease, such as memory loss and other cognitive deficits. In recent years, however, psychiatric symptoms as part of the demential process have attracted interest and research has become more specific. Clinicians are faced with diagnostic, treatment and management difficulties related to affective or psychotic symptoms, which account for much distress and morbidity. Several studies indicate that the prevalence of psychiatric manifestations in clinical populations of patients suffering from dementia is high: 15% to 30% for hallucinations, 15% to 30% for delusions, ten percent to 20% for major depression and 40% to 50% for depressed mood. These figures tend to confirm the hypothesis that psychiatric features in dementia are neither infrequent nor atypical. Thus, researchers have sought to link psychotic or depressive symptomatology with several clinical characteristics of dementia, namely stage, severity, prognosis or cognitive dysfunction. Some recent studies involving extensive neuropsychological evaluations indicate that subgroups of patients can be defined according to psychiatric criteria, as well as cognitive or neurological criteria. Unfortunately, results are inconsistent. Some of the contradictions in the literature are related to poorly defined terms and symptoms, a lack of reliable operational criteria, absence of validation of instruments and scales and heterogeneity of the populations studied. Ambiguous syndromes, such as pseudodementia, while illustrative of certain clinical situations, have not been helpful in categorizing demented patients. The author suggests that research focused on specific and clearly defined psychiatric symptoms in dementia will better serve our comprehension of mixed syndromes.

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Misdiagnosis, duration of untreated illness (DUI) and outcome in bipolar patients with psychotic symptoms: A naturalistic study

Journal of Affective Disorders ◽

10.1016/j.jad.2015.04.024 ◽

2015 ◽

Vol 182 ◽

pp. 70-75 ◽

Cited By ~ 63

Author(s):

A. Carlo Altamura ◽

Massimiliano Buoli ◽

Alice Caldiroli ◽

Lea Caron ◽

Claudia Cumerlato Melter ◽

...

Keyword(s):

Psychotic Symptoms ◽

Naturalistic Study ◽

Duration Of Untreated Illness ◽

Bipolar Patients

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A Retrospective Study of the Clinical Characteristics Associated with Alcohol and Cannabis use in Early Phase Psychosis

The Canadian Journal of Psychiatry ◽

10.1177/0706743720905201 ◽

2020 ◽

Vol 65 (6) ◽

pp. 426-435 ◽

Cited By ~ 2

Author(s):

Jacob Cookey ◽

Jacob McGavin ◽

Candice E. Crocker ◽

Kara Matheson ◽

Sherry H. Stewart ◽

...

Keyword(s):

Trait Anxiety ◽

Early Phase ◽

Clinical Characteristics ◽

Alcohol Misuse ◽

Treatment Guidelines ◽

Group Differences ◽

Psychotic Symptoms ◽

High Alcohol ◽

Occupational Functioning ◽

Cross Sectional

Objective: Alcohol and cannabis misuse are common in patients with early phase psychosis (EPP); however, research has tended to focus primarily on cannabis misuse and EPP outcomes, with a relative lack of data on alcohol misuse. This retrospective cross-sectional EPP study investigated the relationship between cannabis, alcohol, and cannabis combined with alcohol misuse, on age, gender, psychotic, depressive and anxiety symptom severity, and social/occupational functioning, at entry to service. Methods: Two-hundred and sixty-four EPP patients were divided into 4 groups based on substance use measured by the Alcohol, Smoking and Substance Involvement Screening Test: (1) no to low-level cannabis and alcohol misuse (LU), (2) moderate to high alcohol misuse only (AU), (3) moderate to high cannabis misuse only (CU), and (4) moderate to high alcohol and cannabis misuse (AU + CU). Results: We found significant between group differences in age (with the AU group being the oldest and AU + CU group the youngest) as well as gender (with the CU group having the highest percentage of men). There were also group differences in positive psychotic symptoms (lowest in AU group), trait anxiety (highest in AU + CU group), and social/occupational functioning (highest in AU group). Further regression analyses revealed a particularly strong relationship between AU + CU group and trait anxiety (3-fold increased odds of clinical trait anxiety for combined misuse of alcohol and cannabis compared to non/low users). Conclusions: This study demonstrates the unique demographic and clinical characteristics found in the EPP population at entry to care associated with alcohol and cannabis misuse both separately and in combination. This work highlights the importance of including the assessment of alcohol misuse in addition to cannabis misuse in future treatment guidelines and research.

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The Expanding Role of Antipsychotics

CNS Spectrums ◽

10.1017/s1092852900027140 ◽

2004 ◽

Vol 9 (S1) ◽

pp. 7-12

Author(s):

Philip G. Janicak

Keyword(s):

Bipolar Disorder ◽

Manic Episode ◽

Acute Mania ◽

Psychotic Symptoms ◽

Primary Therapy ◽

Obsessive Compulsive ◽

Stabilizing Agent ◽

Compulsive Disorder ◽

Bipolar Patients

Antipsychotics have been utilized in the treatment of bipolar disorder for many decades and were the mainstay of treatment before lithium was reintroduced in the late 1960s. Today, many bipolar patients who present with psychotic features are misdiagnosed and prescribed an antipsychotic for another disorder. Estimates of psychotic symptoms in bipolar disorder, particularly during a manic episode, are ≥50% by clinical assessment and even higher by individual reports. Thus, antipsychotics are frequently used: as first treatment for psychosis not recognized as bipolar disorder, and as an adjunct to a mood-stabilizing agent in bipolars with psychotic symptoms.Most recently, antipsychotics have been examined for their mood-stabilizing properties as well (Slide 9). One may conceptualize using a selective serotonin reuptake inhibitor (SSRI) antidepressant for disorders such as panic disorder or obsessive-compulsive disorder, and using an antiepileptic as a mood-stabilizing agent; however, it is more difficult to accept that an agent approved for treatment of psychosis can be a primary therapy for bipolar disorder. Data from the monotherapy trials suggest that second-generation antipsychotics (SGAs) are at least as effective as lithium and valproic acid for acute mania. There is a very large database indicating that SGAs can be utilized as monotherapy for acute mania. However, there is limited data on the role of these agents in prevention of relapse and recurrence and in their efficacy for depression in the context of bipolar disorder. More studies will be needed to clarify whether SGAs should be used as monotherapy or whether they would be best used as augmenting agents in severe and psychotically manic or depressed patients.

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Quality of life and associated factors among chronic mental illness patients in Kaohsiung

European Psychiatry ◽

10.1016/s0924-9338(11)72229-5 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 522-522

Author(s):

F.H.-C. Chou ◽

R.-R. Huang ◽

C.-Y. Su

Keyword(s):

Quality Of Life ◽

Mental Illness ◽

Social Factors ◽

Associated Factors ◽

Family Factors ◽

Psychotic Symptoms ◽

Chronic Mental Illness ◽

Personal Factors ◽

Bipolar Patients

ObjectiveThe purpose of this study was to predict quality of life (QoL) and associated factors in patients with chronic mental illness (CMI) in Kaohsiung, Taiwan.MethodsPatients (N = 2,023; 52.9% male, 47.1% female) were recruited using cross-sectional and convenience sampling. Structured questionnaires, including a living conditions questionnaire, a psychotic symptom assessment scale, the Caregiver Burden Scale, the 5-item Brief Symptom Rating Scale (BSRS-5), and the Medical Outcomes Study Short Form-12 (MOS SF-12) were used to collect data.ResultsSingle-factor analyses showed that those who were single, employed, and younger had better QoL. Additionally, patients who had fewer psychological problems and lower levels of psychological distress reported better QoL. Current psychotic symptoms, especially positive symptoms, were negatively correlated with QoL. For disease factors, schizophrenic patients and hospitalized patients reported better QoL than both bipolar patients and community patients. For family factors, caregiver's attitude and caregiver's burden were negatively correlated with QoL. For social factors, unstable housing and community social dysfunction were negatively correlated with QoL. The results showed that all four dimensions (social, family, disease and personal factors) were significant predictors of the mental component summary (MCS) and physical component summary (PCS) dimensions of QoL.ConclusionsPersonal factors and disease factors were the most important predictors of QoL in CMI patients of this sample. Family factors were more important than social factors in the MCS dimension, but social factors were more important than family factors in the PCS dimension.

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Clinical features associated with costs in early AD

Neurology ◽

10.1212/01.wnl.0000204189.18698.c7 ◽

2006 ◽

Vol 66 (7) ◽

pp. 1021-1028 ◽

Cited By ~ 51

Author(s):

C. W. Zhu ◽

N. Scarmeas ◽

R. Torgan ◽

M. Albert ◽

J. Brandt ◽

...

Keyword(s):

Depressive Symptoms ◽

Medical Care ◽

Clinical Characteristics ◽

Medical Costs ◽

Psychotic Symptoms ◽

Direct Medical Costs ◽

Medical Care Costs ◽

Extrapyramidal Signs ◽

Disease Costs ◽

Care Costs

Background: Few studies on cost of caring for patients with Alzheimer disease (AD) have simultaneously considered multiple dimensions of disease costs and detailed clinical characteristics.Objective: To estimate empirically the incremental effects of patients' clinical characteristics on disease costs.Methods: Data are derived from the baseline visit of 180 patients in the Predictors Study, a large, multicenter cohort of patients with probable AD followed from early stages of the disease. All patients initially lived at home, in retirement homes, or in assisted living facilities. Costs of direct medical care included hospitalizations, outpatient treatment and procedures, assistive devices, and medications. Costs of direct nonmedical care included home health aides, respite care, and adult day care. Indirect costs were measured by caregiving time. Patients' clinical characteristics included cognitive status, functional capacity, psychotic symptoms, behavioral problems, depressive symptoms, extrapyramidal signs, comorbidities, and duration of illness.Results: A 1-point increase in the Blessed Dementia Rating Scale score was associated with a $1,411 increase in direct medical costs and a $2,718 increase in unpaid caregiving costs. Direct medical costs also were $3,777 higher among subjects with depressive symptoms than among those who were not depressed.Conclusions: Medical care costs and unpaid caregiving costs relate differently to patients' clinical characteristics. Poorer functional status is associated with higher medical care costs and unpaid caregiving costs. Interventions may be particularly useful if targeted in the areas of basic and instrumental activities of daily living.

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