Most Recent Articles Published on Psychoses

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A study of the use of clozapine in old age psychiatry.

Int Clin Psychopharmacol. 2011 Jul;26(4):232-5

Authors: Snowdon J, Halliday G

Abstract
The aim of this study was to review the use of clozapine in a Sydney area old age psychiatry service. Data were extracted from case files of all people who were treated in a health area's old age psychiatry units with clozapine during a 15-year period. Additional details were obtained from clinicians who provided ongoing care after discharge from the hospital. Note was made of psychiatric diagnoses, length of time taking clozapine, dosage, side effects and outcome. Sixteen patients aged over 65 years commenced or continued taking clozapine while inpatients of the service. Of the 13 patients who had a history of schizophrenia or schizoaffective disorder, four patients (all female) developed neutropenia and therefore clozapine was stopped. In one case, neutropenia was first diagnosed 6 years after commencing the medication. Two women died; the nine other women, and one of the deceased, stopped taking clozapine, usually because of side effects. The mean daily dose at cessation was 236 mg. All five men were still taking clozapine (mean 260 mg daily) when followed at a mean age of 72 years, having taken it for an average of 10 years. This case review adds to evidence of the risk of neutropenia when older people are prescribed clozapine.

PMID: 21278575 [PubMed - indexed for MEDLINE]

Mood and nonmood components of perceived stress and exacerbation of Crohn's disease.

Inflamm Bowel Dis. 2011 Nov;17(11):2358-65

Authors: Cámara RJ, Schoepfer AM, Pittet V, Begré S, von Känel R,

Abstract
BACKGROUND: Diverse psychological factors are involved in the pathophysiology of stress. In order to devise effective intervention strategies, it is important to elucidate which factors play the most important role in the association between psychological stress and exacerbation of Crohn's disease (CD). We hypothesized that the association between perceived stress and exacerbation of CD would remain after removal of mood and anxiety components, which are largely involved in stress perception.
METHODS: In all, 468 adults with CD were recruited and followed in different hospitals and private practices of Switzerland for 18 months. At inclusion, patients completed the Perceived Stress Questionnaire and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. During the follow-up, gastroenterologists assessed whether patients presented with a CD exacerbation. By means of binary logistic regression analysis, we estimated the factor by which one standard deviation of perceived stress would increase the odds of exacerbation of CD with and without controlling for anxiety and depression.
RESULTS: The odds of exacerbation of CD increased by 1.85 times (95% confidence interval 1.43-2.40, P < 0.001) for 1 standard deviation of perceived stress. After removing the anxiety and depression components, the residuals of perceived stress were no longer associated with exacerbation of CD.
CONCLUSIONS: The association between perceived stress and exacerbation of CD was fully attributable to the mood components, specifically anxiety and depression. Future interventional studies should evaluate the treatment of anxiety and depression as a strategy for potential prevention of CD exacerbations.

PMID: 21287671 [PubMed - indexed for MEDLINE]

Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study.

Psychol Med. 2011 Nov;41(11):2317-29

Authors: Wigman JT, van Winkel R, Raaijmakers QA, Ormel J, Verhulst FC, Reijneveld SA, van Os J, Vollebergh WA

Abstract
BACKGROUND: Research suggests that subclinical psychotic experiences during adolescence represent the behavioral expression of liability for psychosis. Little is known, however, about the longitudinal trajectory of liability in general population samples.
METHOD: Growth mixture modeling was used to examine longitudinal trajectories of self-reported positive psychotic experiences in the Youth Self Report (YSR), completed three times over a period of 6 years by a general population cohort of adolescents aged 10-11 years at baseline (n=2230).
RESULTS: Four groups with distinct developmental trajectories of low, decreasing, increasing and persistent levels of mild positive psychotic experiences were revealed. The persistent trajectory was associated strongly with cannabis use, childhood trauma, developmental problems and ethnic minority status, and consistently displayed strong associations with factors known to predict transition from subclinical psychotic experience to clinical psychotic disorder (severity of and secondary distress due to psychotic experiences, social and attentional problems and affective dysregulation) and also with high levels of parental-reported psychotic experiences and use of mental health care at the end of the follow-up period. Progressively weaker associations were found for the increasing, decreasing and low trajectories respectively.
CONCLUSIONS: The results suggest that the outcome of early developmental deviation associated with later expression of psychotic experiences is contingent on the degree of later interaction with environmental risks inducing, first, persistence of psychotic experiences and, second, progression to onset of need for care and service use. Insight into the longitudinal dynamics of risk states in representative samples may contribute to the development of targeted early intervention in psychosis.

PMID: 21477418 [PubMed - indexed for MEDLINE]

Cannabis use and psychosis: re-visiting the role of childhood trauma.

Psychol Med. 2011 Nov;41(11):2339-48

Authors: Houston JE, Murphy J, Shevlin M, Adamson G

Abstract
BACKGROUND: Cannabis consumption continues to be identified as a causal agent in the onset and development of psychosis. However, recent findings have shown that the effect of cannabis on psychosis may be moderated by childhood traumatic experiences.
METHOD: Using hierarchical multivariate logistic analyses the current study examined both the independent effect of cannabis consumption on psychosis diagnosis and the combined effect of cannabis consumption and childhood sexual abuse on psychosis diagnosis using data from the Adult Psychiatric Morbidity Survey 2007 (n=7403).
RESULTS: Findings suggested that cannabis consumption was predictive of psychosis diagnosis in a bivariate model; however, when estimated within a multivariate model that included childhood sexual abuse, the effect of cannabis use was attenuated and was not statistically significant. The multivariate analysis revealed that those who had experienced non-consensual sex in childhood were over six times [odds ratio (OR) 6.10] more likely to have had a diagnosis of psychosis compared with those who had not experienced this trauma. There was also a significant interaction. Individuals with a history of non-consensual sexual experience and cannabis consumption were over seven times more likely (OR 7.84) to have been diagnosed with psychosis compared with those without these experiences; however, this finding must be interpreted with caution as it emerged within an overall analytical step which was non-significant.
CONCLUSIONS: Future studies examining the effect of cannabis consumption on psychosis should adjust analyses for childhood trauma. Childhood trauma may advance existing gene-environment conceptualisations of the cannabis-psychosis link.

PMID: 21557896 [PubMed - indexed for MEDLINE]

An update expert opinion on management and research strategies in Parkinson's disease psychosis.

Expert Opin Pharmacother. 2011 Sep;12(13):2009-24

Authors: Goldman JG, Vaughan CL, Goetz CG

Abstract
INTRODUCTION: Psychosis, a frequent complication in Parkinson's disease (PD), contributes significantly to morbidity, mortality, nursing-home placement and quality of life. Medication side effects, issues of trial design and negative outcomes have limited clinical advances of new treatments for PD psychosis. Evidence-based medicine maintains clozapine as the most effective antipsychotic in PD without motor worsening, despite risk of agranulocytosis. Safe, effective treatments that improve psychosis without exacerbating parkinsonism are urgently needed. AREAS COVERED: This article reviews the: i) phenomenology of PD psychosis, ii) pharmacological rationale for antipsychotics in PD; iii) clinical trials of antipsychotics in PD; iv) novel research strategies such as neuroimaging, genetics and animal models; and v) associated challenges in studying and treating PD psychosis. Preparation of this review included an extensive literature search using PubMed. EXPERT OPINION: Management of PD psychosis is complex. Challenges pertaining to study design, rating scales, subject recruitment and completion have limited PD psychosis treatment trials. Novel research strategies focus on nondopaminergic systems and incorporate neuroimaging, genetic associations and animal models. These strategies also have challenges but have the potential to enhance our understanding of PD psychosis and advance the development of agents that can ultimately be tested in well-designed, randomized, controlled trials.

PMID: 21635198 [PubMed - indexed for MEDLINE]

Assessment of a disease screener by hierarchical all-subset selection using area under the receiver operating characteristic curves.

Stat Med. 2011 Jun 30;30(14):1751-60

Authors: Wang Y, Chen H, Schwartz T, Duan N, Parcesepe A, Lewis-Fernández R

Abstract
In many clinical settings, a commonly encountered problem is to assess the accuracy of a screening test for early detection of a disease. In this article, we develop hierarchical all-subset variable selection methods to assess and improve a psychosis screening test designed to detect psychotic patients in primary care clinics. We select items from an existing screener to achieve best prediction accuracy based on a gold standard psychosis status diagnosis. The existing screener has a hierarchical structure: the questions fall into five domains, and there is a root question followed by several stem questions in each domain. The statistical question lies in how to implement the hierarchical structure in the screening items when performing variable selection such that when a stem question is selected in the screener, its root question should also be selected. We develop an all-subset variable selection procedure that takes into account the hierarchical structure in a questionnaire. By enforcing a hierarchical rule, we reduce the dimensionality of the search space, thereby allowing for fast all-subset selection, which is usually computationally prohibitive. To focus on prediction performance of a selected model, we use area under the ROC curve as the criterion to rank all admissible models. We compare the procedure to a logistic regression-based approach and a stepwise regression that ignores the hierarchical structure. We use the procedure to construct a psychosis screening test to be used at a primary care clinic that will optimally screen low-income, Latino psychotic patients for further specialty referral.

PMID: 21638301 [PubMed - indexed for MEDLINE]

[Acute hallucinatory psychosis secondary to oral glucocorticoid treatment in a patient diagnosed with Sheehan's syndrome].

Endocrinol Nutr. 2011 Oct;58(8):445-6

Authors: López MM, Arráez Monllor M, López Fernández M, Hervas Abad E, Hernández Alonso E

PMID: 21641884 [PubMed - indexed for MEDLINE]

Poor childhood mental health may explain linkages between trauma, cannabis use and later psychotic experiences.

Psychol Med. 2011 Sep;41(9):2012-4

Authors: Daly M

PMID: 21676284 [PubMed - indexed for MEDLINE]

Daily cortisol, stress reactivity and psychotic experiences in individuals at above average genetic risk for psychosis.

Psychol Med. 2011 Nov;41(11):2305-15

Authors: Collip D, Nicolson NA, Lardinois M, Lataster T, van Os J, Myin-Germeys I,

Abstract
BACKGROUND: Hypothalamic-pituitary-adrenocortical (HPA) axis abnormalities have been found in patients with a psychotic disorder and first-degree relatives of patients with a psychotic disorder react with subtle increases in non-clinical psychotic experiences and negative emotions in the face of everyday stress. The current study investigated whether HPA axis functioning is altered in individuals at above average genetic risk for psychotic disorder, examining diurnal cortisol profiles, cortisol reactivity to daily stressors and the association between HPA axis activity and subclinical psychotic experiences.
METHOD: Participants included siblings of patients with a psychotic disorder (n=60) and a healthy comparison group (n=63). The Experience Sampling Method (a structured diary technique) was employed to assess stress, psychotic experiences, negative affect and salivary cortisol repeatedly in the flow of daily life.
RESULTS: Multi-level analyses revealed higher diurnal cortisol levels and heightened cortisol reactivity to negative daily events in siblings compared with controls. Diurnal cortisol slope did not differ between the two groups, but momentary increases in psychotic experiences and negative affect were associated with increased cortisol in the sibling group.
CONCLUSIONS: Findings support altered HPA axis activity in individuals at above average genetic risk for psychotic disorder, as evidenced by higher diurnal cortisol levels and increased cortisol reactivity to daily stress. Results also suggest a dynamic association between cortisol secretion and the intensity of psychotic-like experiences and negative emotions in daily life, although the direction of this association remains to be elucidated.

PMID: 21733219 [PubMed - indexed for MEDLINE]

Adiposity as a possible mediator of low testosterone salivary levels in adolescent boys in prodromal stages of psychosis.

Psychol Med. 2011 Sep;41(9):2010-1; author reply 2011-2

Authors: Brietzke E, Bressan RA

PMID: 21733220 [PubMed - indexed for MEDLINE]

Psychosis associated to Parkinson's disease in the early stages: relevance of cognitive decline and depression.

J Neurol Neurosurg Psychiatry. 2012 Jan;83(1):76-82

Authors: Morgante L, Colosimo C, Antonini A, Marconi R, Meco G, Pederzoli M, Pontieri FE, Cicarelli G, Abbruzzese G, Zappulla S, Ramat S, Manfredi M, Bottacchi E, Abrignani M, Berardelli A, Cozzolino A, Paradiso C, De Gaspari D, Morgante F, Barone P,

Abstract
OBJECTIVE: To evaluate the prevalence of psychosis associated with Parkinson's disease (PSY-PD) in its early stages, its incidence over a 24 month follow-up period and the association with motor and non-motor clinical features.
METHODS: PRIAMO is a 2 year longitudinal observational study that has enrolled patients with parkinsonism in 55 Italian centres. A cohort of 495 patients with early disease stage PD (baseline Hoehn and Yahr score ? 2, disease's duration (median) 3.4 years) were followed for 2 years. PSY-PD was evaluated by means of a clinician rated questionnaire and defined as the presence of at least one of the following symptoms occurring for at least 1 month: illusions, hallucinations, jealousy ideas and persecutory ideas. Patients with and without PSY-PD were compared on several clinical variables, encompassing motor and non-motor features.
RESULTS: The prevalence of PSY-PD at baseline was 3%; the incidences at 12 and 24 months were 5.2% and 7.7%, respectively. Longer disease duration and prescription of dopamine agonists at baseline were associated with the development of PSY-PD over the 24 month period. At this follow-up time, worse disease severity, decline in cognitive performances, presence of depressive symptoms and anxiety were more frequently observed in PSY-PD.
CONCLUSIONS: Psychotic type symptoms may occur in the early stages of PD although less frequently than in later stages. Beyond dopaminergic treatment, there are disease related factors, such as disease severity and the occurrence of cognitive and depressive symptoms, which may underlie the onset of psychotic type symptoms from the earliest stages.

PMID: 21836035 [PubMed - indexed for MEDLINE]

Characteristics of suicide attempts in young people undergoing treatment for first episode psychosis.

Aust N Z J Psychiatry. 2011 Oct;45(10):838-45

Authors: Fedyszyn IE, Harris MG, Robinson J, Edwards J, Paxton SJ

Abstract
OBJECTIVES: Understanding the characteristics of suicide attempts in people undergoing treatment for first episode psychosis (FEP) may have implications for risk management at a service level and local suicide prevention strategies. Although studies have focused on identifying individual-level risk factors for suicide attempts in this patient group, none have yet conducted an in-depth profile of suicide attempts. The aim of the present study was to examine the characteristics of suicide attempts in young people during the initial 18 months of treatment for FEP.
METHOD: A retrospective medical record audit study of a cohort of patients accepted for treatment at a specialist FEP service between 1/12/2002 and 30/11/2005.
RESULTS: Of 607 patients, 73 (12%) attempted suicide during treatment. Of these 73, most (72.6%) attempted suicide on one occasion. The majority of attempts (85.3%) occurred when patients were treated as outpatients and were in regular contact with the service. Suicide attempts tended to be impulsive (77.6%), triggered by interpersonal conflict or distress due to psychotic symptoms. Two thirds involved self-poisoning, usually by overdose of prescribed medications. All inpatient suicide attempts were by hanging or strangulation. Individuals infrequently sought help immediately before or after the attempt; if help-seeking occurred, informal sources of support were contacted.
CONCLUSIONS: To reduce the number of suicide attempts among individuals treated for FEP, psychiatric services could consider: restricting the amount of medication prescribed per purchase; individualised suicide risk management plans for all newly admitted patients, including those who do not appear to be at risk; stringent reviews of inpatient psychiatric units for potential ligature points; providing information and psycho-education for significant others in recognition and response to suicide risk; fostering patients' problem solving and conflict resolution skills; and regular risk assessment and close monitoring of patients, particularly during the high risk period of 3 months after a suicide attempt.

PMID: 21861593 [PubMed - indexed for MEDLINE]

Motivation of primary care physicians for participating in early intervention for psychosis in Japan.

Tohoku J Exp Med. 2011;225(1):43-9

Authors: Takamura M, Hagi N, Yokoyama K

Abstract
People with psychosis as represented by schizophrenia experience lengthy delays between the onset and the start of treatment. This duration is called Duration of Untreated Psychosis (DUP). Since it has been indicated that shorter DUP leads to their better prognosis, early intervention has been a hot topic for decades in clinical psychiatry. In Japan, as any patient can visit either specialists or primary care physicians using medical insurance, a considerable portion of psychosis patients are supposed to visit the latter first. Thus, a role of primary care physicians seems keys of success in implementation of early intervention system in the Japanese society. In this study, to clarify the motivation of physicians to participate in early intervention, we sent postal questionnaires to 4030 private clinics throughout Japan, inquiring physicians' situations around psychiatric disorders. Seven hundred and fourteen questionnaires were used for analysis (17.7%). Among these 714 respondents, 364 (51.0%) reported that they have willingness to participate in early intervention. Similarly, 494 (69.2%) were interested in psychiatric disorders, whereas only 168 (23.5%) were confident in identifying schizophrenia. The interest in psychiatric disorders was most strongly associated with their willingness to participate (Odds ratio = 3.54 by logistic regression analysis). These results, therefore, suggest that the interest in psychiatric disorders motivates them to participate in early intervention for psychosis; this has considerable implications for future approach to build up early intervention system in Japan.

PMID: 21869590 [PubMed - indexed for MEDLINE]

Psychosis risk syndrome--far too risky.

Aust N Z J Psychiatry. 2011 Oct;45(10):803-4

Authors: Frances A

PMID: 21910651 [PubMed - indexed for MEDLINE]

His-story or her-story: deconstruction of the concepts of somatization towards a new approach in advanced nursing practice care.

Perspect Psychiatr Care. 2011 Oct;47(4):183-93

Authors: Soltis-Jarrett VM

Abstract
PURPOSE: This article will endeavor to present an alternative view of somatoform disorders, assist in understanding the possible underlying comorbid psychiatric symptoms, and identify psychopharmacological options for treatment.
CONCLUSIONS: Recognizing symptom clusters is a useful strategy when considering psychotropic options for treatment and management.
PRACTICE IMPLICATIONS: The alternative strategies presented and discussed in this article can contribute to a useful and positive experience for both the clinician and the individual suffering from medically unexplained physical symptoms as they promote the care, health, and well-being of the individual rather than a cure, illness, and/or disease state that needs rendering, mending, and/or surgery.

PMID: 21950365 [PubMed - indexed for MEDLINE]

Biological perspectives: update on newer antipsychotic drugs: are they evidence based?

Perspect Psychiatr Care. 2011 Oct;47(4):220-6

Authors: Keltner NL, Moore RL, Grant JS

PMID: 21950369 [PubMed - indexed for MEDLINE]

Internet-related psychosis?a sign of the times.

Isr J Psychiatry Relat Sci. 2011;48(3):207-11

Authors: Nitzan U, Shoshan E, Lev-Ran S, Fennig S

Abstract
BACKGROUND: The psychopathological implications of the Internet are slowly being revealed as its use becomes increasingly common. This papers aim is to call attention to computer mediated communication (CMC), such as Facebook or chats, and alert to its possible relation to psychosis.
DATA: We describe three individuals, with no prior major psychiatric disorder, who presented for psychiatric treatment, due to psychotic symptoms which appeared de novo while they were immersed in CMC. All three patients pointed to the contribution of specific CMC features to the gradual emergence of their psychotic symptoms. They described a 'hyperpersonal' relationship with a stranger, mistrust of the aims and identity of the other party, blurred self boundaries, misinterpretation of information, and undesirable personal exposure in cyberspace. The patients had little prior experience with computers or the Internet, and their vulnerability was intensified due to difficulties in deciphering the meaning of various elements of CMC and in managing its technical aspects.
CONCLUSIONS: The cases we present support the assumption that unique features of CMC might contribute to the formation of psychotic experiences. The use of the Internet is vast, and, as such, we propose that medical staff members might consider routinely questioning patients about their use of it, especially CMC.

PMID: 22141146 [PubMed - indexed for MEDLINE]

[Creativity and psychiatric disorders: recent neuroscientific insights].

Tijdschr Psychiatr. 2011;53(12):905-15

Authors: Thys E, Sabbe B, de Hert M

Abstract
BACKGROUND: Creativity is an important human characteristic on which many of mankind's achievements are based. For centuries practitioners of various disciplines have deliberated over the possible connection between creativity and psychopathology. Even today the issue is still being investigated, mainly by groups working more or less independently; these range from art experts to psychiatrists and neuroscientists.
AIM: In this article we bring together the foremost recent neuroscientific findings on the subject.
METHOD: We searched for relevant articles via electronic databases using a broad-band search strategy and concentrating mainly on neuroscientific publications.
RESULTS: Our study of relevant articles showed that both the definition and the measurability of creativity are still problematic. Psychometric and psychodiagnostic research supports a link between creativity and the psychopathology of bipolar, schizophrenic and especially schizotypal disorders; the results of imaging techniques are less consistent and genetic research reveals a link between creativity and proneness to psychosis.
CONCLUSION: There seems to be a connection between creativity and psychopathology in the bipolar-schizophrenic continuum. This connection is even more evident within the individual components of creativity and symptom groups of these pathologies. There is a need for accurate definitions, measuring instruments and multidisciplinary collaboration.

PMID: 22161792 [PubMed - indexed for MEDLINE]

Sociodemographic and clinical characteristics of Roma and non-Roma psychiatric outpatients in Greece.

Ethn Health. 2012 Jan 31;

Authors: Vorvolakos T, Samakouri M, Tripsianis G, Tsatalmpasidou E, Arvaniti A, Terzoudi A, Livaditis M

Abstract
Objective. Differences in psychiatric symptoms are often reported between minority and majority groups. The aim of this study was to compare Roma psychiatric outpatients who are Greek citizens living in Thrace (Greece) with outpatients belonging to the 'majority Greek group' with respect to socio-demographic characteristics, psychopathological symptoms and psychiatric diagnoses. Design. A sample of 122 Roma and 132 majority Greek patients visiting the Outpatient Psychiatric Clinic at the University General Hospital of Alexandroupolis, Greece, were examined with the Structured Clinical Interview for DSM III-R (SCID-I), the International Personality Disorder Examination (IPDE) and the Derogatis Psychiatric Rating Scale (DPRS). Only those with a psychiatric diagnosis were retained in the analyses. The two groups of patients were compared in relation to their socio-demographic characteristics, their diagnoses and their scores on the DPRS symptom dimensions. Results. In comparison to the majority group, Roma patients were younger, more often women, less educated, married, parents of more children, without social security coverage; The Roma group had higher scores on many DPRS symptom dimensions such as somatisation, hostility, sleep disturbance, phobic anxiety, psychoticism, psychomotor retardation, hysterical behaviour and abjection-disinterest. In addition, Roma women presented psychotic and bipolar disorders less often than the majority group women. Symptoms did not differ by ethnic group for those seeking medical certification. Conclusion. Roma patients face serious social problems and show greater levels of symptoms than the majority group. The limitations of this include that the sample was not representative of the general psychiatric patient population and language, as well as other cultural and educational barriers, might have obscured important aspects of the Roma people's psychopathology.

PMID: 22292797 [PubMed - as supplied by publisher]

The Selective Metabotropic Glutamate 2/3 Receptor Agonist MGS0028 Reverses Isolation Rearing-Induced Abnormal Behaviors in Mice.

J Pharmacol Sci. 2012 Jan 27;

Authors: Ago Y, Araki R, Yano K, Kawasaki T, Chaki S, Nakazato A, Onoe H, Hashimoto H, Baba A, Takuma K, Matsuda T

Abstract
Isolation-induced abnormal behaviors are useful animal models for assessing potential anti-psychotic drugs. This study examined the effect of MGS0028, a selective metabotropic glutamate 2/3 receptor agonist, on abnormal behaviors such as hyperactivity, aggression, and deficits of prepulse inhibition in isolation-reared mice. MGS0028 attenuated hyperactivity and aggressive behaviors in isolation-reared mice. The agonist also reversed isolation rearing-induced deficits of prepulse inhibition. On the other hand, MGS0028 did not affect locomotor activity and prepulse inhibition in group-reared mice. These results suggest that the metabotropic glutamate 2/3 receptor agonist, MGS0028, is a potential compound for the treatment of psychiatric disorders.

PMID: 22293290 [PubMed - as supplied by publisher]