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15th Winter Workshop
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Most Recent Articles Published on Psychoses

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Sexual problems in schizophrenia: prevalence and characteristics. A cross sectional survey.

Soc Psychiatry Psychiatr Epidemiol. 2010 Jul;45(7):759-66

Authors: Harley EW, Boardman J, Craig T

OBJECTIVE: To determine the prevalence and characteristics of psychosexual problems in people with schizophrenia, and to compare the subjects' and researcher's perceptions of the presence of these problems. METHODS: Cross-sectional survey of 137 people with established schizophrenia or schizoaffective disorder, aged 18-65 in one geographical area of southeast England, using a semi-structured interview format. RESULTS: A total of 74% of men and 82% of women reported at least one ICD-10 defined sexual problem. Arousal problems were associated with physical health problems in men. Orgasm problems were more common in people in relationships. The researcher was about three times more likely to record a sexual problem than the respondents were to report one. CONCLUSIONS: People with schizophrenia report sexual dysfunction that is similar in nature but which occurs at a higher rate than is reported in the general population. There are gender differences and differences in the perception of psychosexual problems between those with schizophrenia and the researcher.

PMID: 19701710 [PubMed - indexed for MEDLINE]

Therapist fidelity with an exposure-based treatment of PTSD in adults with schizophrenia or schizoaffective disorder.

J Clin Psychol. 2010 Apr;66(4):383-93

Authors: Long ME, Grubaugh AL, Elhai JD, Cusack KJ, Knapp R, Frueh BC

This study examined therapists' fidelity to a manualized, multicomponent cognitive-behavioral intervention for posttraumatic stress disorder (PTSD), including exposure therapy, among public sector patients with a psychotic disorder. Independent raters assessed therapists' competence and adherence, rating 20% of randomly selected audio taped sessions (n=57 sessions, coded by two raters, with strong interrater agreement). Adherence ratings indicated that therapists complied well with the protocol, and competency ratings typically averaged "very good" or higher (6 on 7-point Likert scale). Findings suggest that therapists can effectively deliver a manualized cognitive-behavioral intervention for PTSD, with exposure therapy, to patients with severe mental illness without compromise to the structure of sessions and/or the therapeutic relationship.

PMID: 20112407 [PubMed - indexed for MEDLINE]

Course and predictors of suicidality over the first two years of treatment in first-episode schizophrenia spectrum psychosis.

Arch Suicide Res. 2010 Apr;14(2):158-70

Authors: Melle I, Johannessen JO, Friis S, Haahr U, Joa I, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, McGlashan T

The objective of this study was to investigate the course of suicidal behavior over the first 2 years of comprehensive, integrated treatment in two groups of patients with DSM-IV first episode schizophrenia spectrum psychosis, where one group was recruited through an early detection program. We have previously shown that the rate of severe suicidal behavior was lower in the earlier detected group than in the other. First episode schizophrenia is a high risk period for suicidality, but we found low rates of completed suicides and suicide attempts in both groups after 2 years in treatment, with no between-groups differences. Severe suicidality (plans and attempts) was predicted by drug abuse, dissatisfaction with life and severe suicidality at start of treatment.

PMID: 20455151 [PubMed - indexed for MEDLINE]

[A randomized controlled study on the impact of pharmacoeducation on a French patient population with schizophrenic and schizoaffective disorders]

Can J Psychiatry. 2010 May;55(5):329-37

Authors: Maurel M, Drai D, Kaladjian A, Pauly V, Azorin JM

OBJECTIVE: To evaluate the impact of a pharmacoeducation module both on hospital stay and on clinical and functional state in a French patient population with schizophrenic and schizoaffective disorders. METHODS: After inclusion, 82 patients were randomly distributed in 2 groups, one group receiving the pharmacoeducation module and the other to be a control group. Data on the number of hospital stays and emergency visits, and the type of medication received, were compiled. Patients were evaluated with the Positive and Negative Syndrome Scale, Clinical Global Impression Scale, Barnes Akathisia Scale, Simpson-Angus Scale, Quality of Life Scale, and Global Assessment of Functioning; data were gathered at baseline, then each year for 2 years. RESULTS: Among the 72 analyzed patients, those receiving pharmacoeducation had significantly lower total hospital stays, forced hospital stays, and emergency visits, compared with the control group patients. They also had more improvement in their symptomatology, autonomy, and quality of life. They presented less akathisia and less medication intake. CONCLUSIONS: Pharmacoeducation can reduce the hospital stays of patients with schizophrenia and schizoaffective disorders, as well as improve their clinical and functional state, likely through better compliance.

PMID: 20482960 [PubMed - indexed for MEDLINE]

Caudate nucleus volume in individuals at ultra-high risk of psychosis: a cross-sectional magnetic resonance imaging study.

Psychiatry Res. 2010 Jun 30;182(3):223-30

Authors: Hannan KL, Wood SJ, Yung AR, Velakoulis D, Phillips LJ, Soulsby B, Berger G, McGorry PD, Pantelis C

The aim of the present study was to investigate whether volumetric abnormalities of the caudate nuclei predate the onset of psychotic illness. Caudate nuclei volume (CNVs), excluding the tail, were measured using region-of-interest (ROI) tracing of magnetic resonance imaging (MRI) scans acquired on a 1.5T scanner. Subjects included 39 individuals deemed at ultra-high risk of psychosis who converted to psychosis (UHR-P) after initial MRI scanning; 39 matched individuals at ultra-high risk who did not convert to psychosis (UHR-NP); and 39 matched healthy controls. All subjects were neuroleptic-naïve. After adjusting CNVs for intracranial volume (ICV), univariate analyses of variance and repeated measures analyses of variance were undertaken to examine the relationship of CNVs to psychosis transition and to family history of psychosis. Pearson's correlations were used to investigate the relationship of psychopathological scores to CNVs. CNVs did not differ significantly between UHR individuals and healthy controls, and there was no significant difference between converters and non-converters to psychosis. In the UHR group, presence of family history of psychosis was not related to CNVs. There was no correlation between CNVs and either positive or negative symptoms of schizophrenia. Significant associations were found between larger CNV and increased errors on a spatial working memory task but better verbal fluency performance. These data suggest that the caudate is macroscopically normal prior to illness onset, while the relationship to tasks of executive function may implicate the caudate together with its connections to prefrontal regions. Future research should examine changes longitudinally together with analysis of shape to assess subregions of the caudate that connect with prefrontal cortex.

PMID: 20488675 [PubMed - indexed for MEDLINE]

Schizoaffective disorder - a possible MEG auditory evoked field biomarker.

Psychiatry Res. 2010 Jun 30;182(3):284-6

Authors: Reite M, Teale P, Collins D, Rojas DC

We recorded magnetoencephalographic auditory steady state responses (SSR) from eight schizoaffective (SAD) subjects and compared the resulting data with previously published findings in persons with schizophrenia (SZ) and controls. SAD subjects exhibited SSR responses similar to controls in the left hemisphere and greater than controls in the right hemisphere, whereas SZ subjects exhibited deficits in both amplitude and phase control in both hemispheres. Our findings suggest preservation of GABAergic inhibitory interneuronal control of layer 3 pyramidal cell activity in primary auditory cortex in SAD.

PMID: 20488676 [PubMed - indexed for MEDLINE]

Not "au revoir" but "merci beaucoup".

J ECT. 2010 Jun;26(2):149

Authors: Rosa MA

PMID: 20502204 [PubMed - indexed for MEDLINE]

Psychopharmacology and adverse effects of antipsychotic long-acting injections: a review.

Br J Psychiatry Suppl. 2009 Nov;52:S13-9

Authors: Taylor D

BACKGROUND: Depot antipsychotics are widely used in clinical practice. Long-acting formulations of second-generation antipsychotics are now being developed and introduced. AIMS: To review the pharmacology, pharmacokinetics and adverse effect profiles of currently available antipsychotic long-acting injections (LAIs). METHOD: The psychopharmacological properties of first- and second-generation antipsychotic LAIs are reviewed using data available up to October 2008. RESULTS: First-generation antipsychotic (FGA) LAIs are associated with a high rate of acute and chronic movement disorders. Risperidone LAI is better tolerated in this respect, but is associated with hyperprolactinaemia and weight gain. Olanzapine LAI causes weight gain and other metabolic effects but appears not to be associated with an important incidence of movement disorders. CONCLUSIONS: Dosing of LAIs is complicated by delayed release of drug, changes in plasma levels without change in dose, and by the lack of data establishing clear dose requirements. All LAIs offer the prospect of assured adherence (although patients may still default on treatment) but their use is complicated by adverse effects, complex pharmacokinetics and confusion over dose-response relationships.

PMID: 19880912 [PubMed - indexed for MEDLINE]

Attitudes of patients and mental health staff to antipsychotic long-acting injections: systematic review.

Br J Psychiatry Suppl. 2009 Nov;52:S43-50

Authors: Waddell L, Taylor M

BACKGROUND: The attitudes of staff and patients have been demonstrated to influence the acceptance of long-acting injections (LAIs) or depot antipsychotics. AIMS: To examine the attitudes of patients and staff to LAIs. METHOD: A systematic review was carried out. Studies included contained quantitative data for attitudes of patients or staff to LAIs. RESULTS: Twelve studies published subsequent to the systematic review reported in 2001 were identified. Five studies conveyed an overall positive attitude. The most positive attitudes among patients were seen in those already prescribed an LAI. Positive attitudes of staff correlated closely with the extent of their knowledge of LAIs. CONCLUSIONS: Long-acting injections continue to have an image problem, arguably perpetuated by manufacturers of oral second-generation antipsychotic drugs, and exacerbated by the predominant use of these medications as a ;last resort' often for the most stigmatized individuals. The introduction of better-tolerated LAIs and better education of both staff and patients may encourage individuals to re-examine their attitudes.

PMID: 19880916 [PubMed - indexed for MEDLINE]

Knowledge about antipsychotic long-acting injections: bridging that gap.

Br J Psychiatry Suppl. 2009 Nov;52:S5-6

Authors: Burns T

Antipsychotics in depot (or ;long-acting injection', LAI) form are shown in this supplement to be a significant component of clinical practice. They are comparatively underresearched, which may reflect their frequent use witih poorly adherent patients. This supplement clearly demonstrates the need for that research, highlighting the variations in dosing and the absence of established, specific guidelines in their use. Traditional evidence-based approaches to systematic reviews are of limited utility in this area so this supplement's blending of experimental trials with observational research is particularly appropriate and effective. After a brief decline in their use with the introduction of oral atypical antipsychotics, LAIs are regaining a central position in the care of long-term psychosis. This comprehensive review of current knowledge makes a timely contribution.

PMID: 19880917 [PubMed - indexed for MEDLINE]

Antipsychotic long-acting injections in clinical practice: medication management and patient choice.

Br J Psychiatry Suppl. 2009 Nov;52:S51-6

Authors: Gray R, Spilling R, Burgess D, Newey T

BACKGROUND: A patient-centred approach to care, focusing on recovery, demands a reconsideration of how choices are made about treatment, how this affects medication adherence, and the role of long-acting antipsychotics (LAIs) in this process. AIMS: To explore the role of the mental health professional (particularly nurses) in helping patients manage their medication, with a specific focus of the use and administration of LAIs. METHOD: A pragmatic review of the literature. RESULTS: Patients (by experience) and mental health professionals (by training and clinical practice) are experts in the care and treatment of psychosis. When patients and clinicians make a joint decision both are more likely to adhere to the treatment plan. In this paper we consider good practice in the administration of LAIs that focuses on where and when they should be given and administration techniques. Skills for talking with patients about their medication that include exchanging information, monitoring the effects of medication and making advance choices about treatment in the event of a crisis are also discussed. CONCLUSIONS: Mental health professionals require a range of competences to help patients manage their medication effectively.

PMID: 19880918 [PubMed - indexed for MEDLINE]

Clinical guideline recommendations for antipsychotic long-acting injections.

Br J Psychiatry Suppl. 2009 Nov;52:S63-7

Authors: Kane JM, Garcia-Ribera C

BACKGROUND: Long-acting injections (LAIs) of antipsychotic drugs were developed over 40 years ago in an attempt to improve the long-term treatment of schizophrenia. AIMS: To review existing guidelines concerning antipsychotic use generally, and LAIs in particular, and how patients might be identified as potential candidates for LAI treatment. METHOD: Literature review. RESULTS: Currently several first-generation and one second-generation antipsychotic LAIs are available, with others under development. Although the use of LAIs is widespread around the world, patterns of use vary widely. Important considerations regarding the use of LAIs include the indications for long-term pharmacotherapy in schizophrenia in general, the indications for LAIs, the risks associated with LAIs, the need to update guidelines and the issue of cost. CONCLUSIONS: The use of these injections in first-episode psychosis and treatment-refractory schizophrenia is not currently a focus of recommendations, but should be considered. Long-acting injections remain an underutilised option in many countries despite frequent non-adherence with oral medication and subsequent relapse.

PMID: 19880920 [PubMed - indexed for MEDLINE]

Social behaviour vs. psychiatric features of frontotemporal dementia - Clinical report of two cases.

Psychiatr Danub. 2010 Jun;22(2):179-82

Authors: Liscić RM, Kogoj A

Behavioural disturbances are prominent in frontotemporal dementia (FTD), a focal, non-Alzheimer type of dementia. Although most patients with FTD present with socially inappropriate behaviour, compulsive-like acts, poor insight and disinhibition, the presence of psychiatric features including delusions, hallucinations, and paranoia can lead to a misclassification of FTD as psychiatric disorder. In the absence of cognitive deficits non-experts fail to recognize these social changes as dementia symptoms. We report two individuals who met current clinical criteria for behavioural or frontal variant FTD (bv-FTD), with the aim of distinguishing between psychotic symptoms and the often bizarre personality and behaviour change found in FTD. Also we review the literature on the noncognitive neuropsyhiatric manifestation of this disorder. Clinical findings presented, and a literature review, indicate that psychotic symptoms are rare in FTD. Better awareness of behavioural symptoms in clinical practice is necessary in order to avoid misdiagnosis of FTD as psychiatric disorder.

PMID: 20562743 [PubMed - indexed for MEDLINE]

The Croatian version of diagnostic interview for genetic studies.

Psychiatr Danub. 2010 Jun;22(2):193-7

Authors: Glucina D, Britvić D, Lasić D, Dedić M, Jakelić M, Brajević-Gizdić I, Kralj Z, Bucan M

Diagnostic Interview for Genetic Studies (DIGS) is a modern structured interview schedule that has been in use since 1994. Main purpose of the DIGS is to record information regarding to a subject's functioning and psychopathology and it was specifically designed for psychiatric genetic studies. The DIGS is also suitable for making diagnosis, evaluation of comorbidity and other researches. It contents items and sections and has a semi-structured design that gives interviewers the freedom needed to extract the best in formation possible. The validity of a Croatian version of the DIGS was investigated. The original English version was initially translated into Croatian. The Croatian version was then back-translated and compared with the original. In this paper we will describe each item that DIGS contents as well as the use of this diagnostic instrument.

PMID: 20562746 [PubMed - indexed for MEDLINE]

Issues regarding the delivery of early intervention psychiatric services to the South Asian population in England.

Psychiatr Danub. 2010 Jun;22(2):266-9

Authors: Agius M, Talwar A, Murphy S, Zaman R

INTRODUCTION: Little research has been done to ascertain how patients and families of South Asian origin access and use early intervention mental health services today. The aim of this retrospective study is to gain a better understanding of how well South Asian patients engage with standard psycho-social interventions. SUBJECTS AND METHODS: In June 2003 an audit was conducted amongst 75 patients from different ethnic groups in Luton. Measures of engagement with mental health services included; number of missed outpatient appointments over one year and compliance with medication regimes. RESULTS: The results of this audit showed that South Asian patients are more likely to miss appointments and refuse to take medication in comparison to their Caucasian or Afro- Caribbean counter-parts. Further analysis revealed that the Bangladeshi subgroup had missed more appointments and had a greater proportion of medication refusal in comparison to the other Asian subgroups. CONCLUSIONS: These results support the pioneering work by Dr Robin Pinto in the 1970s he observed that Asian patients perceive and utilise mental health services in a different way compared to the Caucasian population. The observations from our study depict the difficulties in engaging ethnic minority patients into existing services. Hence we argue that future interventions should be adapted and tailored to overcome cultural and language barriers with patients and their families.

PMID: 20562759 [PubMed - indexed for MEDLINE]

Catechol-O-methyl transferase and schizophrenia.

Psychiatr Danub. 2010 Jun;22(2):270-4

Authors: Sagud M, Mück-Seler D, Mihaljević-Peles A, Vuksan-Cusa B, Zivković M, Jakovljević M, Pivac N

Catechol-O-methyl transferase (COMT) is an enzyme involved in the degradation of dopamine. The most commonly examined polymorphism within the COMT gene is Val108/158Met polymorphism, which results in three to fourfold difference in COMT enzyme activity. It is particularely important in prefrontal cortex, since COMT activity is the most important regulator of the prefrontal dopamine function. Given the association between schizophrenia and decreased dopamine activity in the prefrontal cortex, it is not surprising that Val108/158Met polymorphism is among the most extensively investigated polymorphisms in schizophrenia. According to different studies, Val allele may be a small risk factor for schizophrenia. There is also some evidence that Val108/158Met polymorphism influences the age of onset of schizophrenia, cognitive function, severity of psychotic symptoms, as well as efficacy and adverse events of antipsychotics. Heterogenity of patient population has undoubtedly influenced the results of these studies. Interaction of Val108/158Met polymorphism with other genes and environmental factors is an important avenue for future research.

PMID: 20562760 [PubMed - indexed for MEDLINE]

Cannabis and psychiatric disorders.

Psychiatr Danub. 2010 Jun;22(2):296-7

Authors: Loga S, Loga-Zec S, Spremo M

There are connection between use of cannabis and many psychiatric disturbances in adolescents, especially "cannabis psychosis", depression, panic attacks and suicide. Negative effects could occur either as a result of a specific pharmacological effect of cannabis, or as the result of stressful experiences during the intoxication of cannabis in young people. Potentially is very dangerous high frequency suicidal ideation among cannabis users.

PMID: 20562767 [PubMed - indexed for MEDLINE]

Gender, psychosis and psychotropic drugs: differences and similarities.

Psychiatr Danub. 2010 Jun;22(2):338-42

Authors: Groleger U, Novak-Grubic V

Acute psychosis is diagnosed by clearly defined operational criteria embedded into international classification systems. Many studies have tried to determine the role of gender in psychosis but mainly in terms of epidemiology and course of illness, most often schizophrenia. There are however also important gender-specific differences in clinical symptoms of acute psychosis. No guidelines or treatment recommendations suggest gender as an important factor in the choice of antipsychotic treatment, which is true for all treatment modalities (antipsychotic, dose, duration). We will review shortly available literature and present some of our own research data on gender differences in clinical presentations of acute psychosis. When the diagnosis of an illness depends almost entirely on symptoms and their presentations as in the case of acute psychosis, important gender specific differences might challenge the diagnostic process as well as treatment choice and course of psychosis. Our as well as other data confirm that acute psychosis manifest itself differently in males and females. To define further the impact of observed differences we need further research into gender specific clinical and not just epidemiological variables.

PMID: 20562777 [PubMed - indexed for MEDLINE]

Integrative approach to treatment of a patient with psychotic depression.

Psychiatr Danub. 2010 Jun;22(2):370-2

Authors: Ruzić K, Knez R, Grahovac T, Dadić-Hero E, Graovac M

Integrative approach to treatment of psychiatric patients incorporates a variety of therapeutic procedures that overlap and are not mutually exclusive. Their objective is unique: to heal and to restore patients' proper functioning in their family, work and social environments alike. Treatment often requires integration of various therapeutic approaches. In this paper we report the efficacy of an integrative model in the case of a female patient who developed a clinical picture of psychotic depression after giving birth. Taking an individual approach alongside the continuous use of psycho pharmacotherapy enabled us to look for an appropriate model of hospital and ambulatory treatment, namely psychotherapeutic setting. This example proved individual psychotherapy to be a complementary method to psycho pharmacotherapy. This was due to a strong feeling of shame that prevented the patient from opening up and dealing with her inner conflict in the previous group treatment. Integrative and personalised treatment has resulted in a relatively quick recovery and return to her everyday duties.

PMID: 20562786 [PubMed - indexed for MEDLINE]

Hypokalemic thyrotoxic periodic paralysis with thyrotoxic psychosis and hypercapnic respiratory failure.

Am J Med Sci. 2010 Aug;340(2):147-53

Authors: Abbasi B, Sharif Z, Sprabery LR

Thyrotoxic periodic paralysis is a rare and potentially lethal neuromuscular disease that manifests as recurrent episodic muscle weakness associated with hypokalemia and thyrotoxicosis. Paralysis can rarely involve respiratory muscles leading to acute respiratory failure. The disease primarily affects people of Asian descent, but it is being increasingly reported in other ethnic groups. We review the literature and report a case of hypokalemic thyrotoxic periodic paralysis manifesting as thyroid storm with episodic acute respiratory failure requiring recurrent intubation and eventually requiring thyroidectomy for resolution of symptoms.

PMID: 20581656 [PubMed - indexed for MEDLINE]

The 16th Biennial Winter Workshop in Psychoses

A clinical and research conference focusing on Schizophrenia, Bipolar Disorders and Other Psychoses

30 Jan - 2 Feb 2011, Innsbruck

Co-Chairs: Profs. Bernd Gallhofer (D) & Marion Leboyer (F)

Most Recent Articles Published on Psychoses