Understanding reduced activity in psychosis: the roles of stigma and illness appraisals.
Soc Psychiatry Psychiatr Epidemiol. 2012 Feb 25;
Authors: Moriarty A, Jolley S, Callanan MM, Garety P
PURPOSE: Increasing activity and social inclusion for people with psychosis is a primary goal of mental health services. Understanding the psychological mechanisms underlying reduced activity will inform more carefully targeted and effective interventions. Anxiety, depression, positive symptom distress and negative symptoms all make a contribution, but much of the variance in activity remains unaccounted for and is poorly understood. Appraisals of illness impact on adjustment to illness: mood, engagement in treatment and quality of life are all affected. It is plausible that illness appraisals will also influence activity. This study investigated the extent to which three components of illness appraisal accounted for variance in activity. METHOD: 50 people with psychosis completed measures of activity, positive and negative symptoms, anxiety and depression, cognitive functioning, stigma, insight and illness perceptions. RESULTS: Multiple regression revealed that internalised stigma, but not insight or illness perception, was significantly correlated with reduced activity. 42% of the variance in activity was accounted for by stigma, negative symptoms, positive symptom distress and social support. Affect, cognitive functioning and positive symptoms were not associated with activity. CONCLUSION: For people with psychosis, activity levels appear to be compromised particularly by fears of what others think of them and how they will be treated by others. Directly targeting these fears should improve the impact of psychological interventions on functioning. Specific, individualised cognitive behavioural interventions could be a useful adjunct to recovery-focused narrative therapies and complement public information campaigns to reduce discriminatory attitudes and behaviours.
PMID: 22366910 [PubMed - as supplied by publisher]
Aggressive and impulsive behavior in Alzheimer's disease and progression of dementia.
Med Sci Monit. 2012 Feb 20;18(3):CR190-197
Authors: Bidzan L, Bidzan M, P?chalska M
Background: The symptoms of Alzheimer's disease (AD) are numerous, including worsening of mood, psychotic symptoms, aggressive and impulsive behaviours, and many others. It is generally assumed that there exists a relationship between the severity of dementia and aggressive symptoms. The aim of this study was to assess the relationship between aggressive and impulsive behaviours and cognitive function disorders in AD patients.<br /> Material/Methods: Forty-eight AD patients living in a nursing home were included in the research group on the basis of NINCDS/ADRDA criteria. The subjects underwent two years of naturalistic observation. The intensity of agitation and aggressive behaviours was assessed on the basis of the Cohen-Mansfield Agitation Inventory (CMAI). The Alzheimer's Disease Assessment Scale Cog (ADAS-cog) was used to assess cognitive function. Pharmacotherapy administered during the observation period was also taken into account.<br /> Results: Thirty-one patients completed the two year long observation. Individuals with more severe cognitive deficiencies demonstrated a greater intensity of aggressive and impulsive behaviours, as assessed using the CMAI scale. Aggression escalated together with the development of dementia disorders. The intensity of dementia disorders was most significantly connected with physical agitation and verbal aggression. The use of neuroleptics and mood stabilisers decreased the progression of aggressive and impulsive behaviours.<br /> Conclusions: There is a relationship between cognitive functioning disorders and the intensification of aggressive and impulsive behaviours. More severe forms of dementia are connected with greater intensification of aggressive and impulsive behaviours as the disease progresses. Periodical administration of pharmacotherapy may reduce the development of aggressive behaviours.<br />
PMID: 22367129 [PubMed - in process]
Eicosapentaenoic Acid interventions in schizophrenia: meta-analysis of randomized, placebo-controlled studies.
J Clin Psychopharmacol. 2012 Apr;32(2):179-85
Authors: Fusar-Poli P, Berger G
BACKGROUND: Omega-3 fatty acids, in particular, eicosapentaenoic acid (EPA) have been suggested as augmentation strategies in the treatment of schizophrenia and related psychosis. Published results are conflicting, and the antipsychotic efficacy of such augmentation strategies is not well established.
METHODS: Double-blind, randomized, placebo-controlled studies using purified or EPA-enriched oils in established schizophrenia were included in a meta-analysis. The effect size of EPA on psychotic symptoms was measured using Hedges' g. Publication bias was assessed with funnel plots and Egger's intercept. Heterogeneity was assessed with Q statistic and I index. Influence of moderators was assessed with meta-regression analyses in Comprehensive Meta-analysis Software version 2.
RESULTS: The database included 167 schizophrenic subjects under the placebo arm (mean age, 37 [SD, 9.7] years; 37% females) matched with 168 schizophrenic subjects under the EPA arm (mean age, 37 [SD, 7.9] years; 36% females) (t tests P > 0.05). Meta-analysis showed no consistent significant effect for the EPA augmentation on psychotic symptoms (Hedges' g = 0.242; 95% confidence interval, 0.028-0.512, Z = 1.7531, P > 0.05). There were no significant effects for moderator variables such as age, sex, and EPA dose used in the trials. Heterogeneity across studies was small and statistically non significant (Q = 9.06; P = 0.170; I = 33.81).
CONCLUSIONS: Meta-analysis of randomized controlled trials on symptomatic outcome revealed no beneficial effect of EPA augmentation in established schizophrenia. However, no conclusion can be made for medium- to long-term effects of EPA in schizophrenia, in particular on relapse prevention in the early course of psychotic disorders.
PMID: 22367656 [PubMed - in process]
Augmenting Clozapine With Sertindole: A Double-Blind, Randomized, Placebo-Controlled Study.
J Clin Psychopharmacol. 2012 Apr;32(2):173-178
Authors: Nielsen J, Emborg C, Gydesen S, Dybbro J, Aagaard J, Haderup K, Glyngdal P, Fabricius S, Thode D, Lublin H, Andersen T, Damkier P, Taylor D
ABSTRACT: Clozapine augmentation with antipsychotic drugs is widely used despite sparse evidence supporting this strategy. Sertindole is a nonsedating atypical antipsychotic drug with low affinity for cholinergic receptors, which makes it potentially suitable for augmentation of clozapine. The study design was a 12-week, double-blind, randomized, placebo-controlled study including patients with International Statistical Classification of Diseases, 10th Revision schizophrenia (F20.0-F20.3) and treated with clozapine for at least 6 months who had not achieved sufficient response. Patients were randomized 1:1 to either sertindole 16 mg or placebo, and assessment was done at baseline and after 6 and 12 weeks. Assessment included the Positive and Negative Syndrome Scale, Clinical Global Impression, Udvalg for Kliniske Undersøgelser, World Health Organization Quality of Life Brief, Drug Attitude Inventory, fasting glucose, lipids, and electrocardiogram. Clozapine augmentation with sertindole was not superior to placebo regarding total score or subscale score of the Positive and Negative Syndrome Scale, Clinical Global Impression, World Health Organization Quality of Life Brief, or Drug Attitude Inventory. No increased adverse effects compared with placebo were found. Four patients randomized to sertindole experienced a significant worsening of psychosis, and 2 of them required psychiatric admission. Metabolic parameters were unchanged during the study, but augmentation of clozapine with sertindole was associated with a 12-millisecond (SD, 20-millisecond) QTc prolongation compared with 0 millisecond (SD, 20 milliseconds) in the placebo group (P < 0.03). Augmentation with sertindole showed no benefits compared with placebo. Psychiatrists should be aware that augmentation might not add any benefits for the patients and in some cases worsen psychosis.
PMID: 22367659 [PubMed - as supplied by publisher]
Glutamic Acid decarboxylase autoantibody syndrome presenting as schizophrenia.
Neurologist. 2012 Mar;18(2):88-91
Authors: Najjar S, Pearlman D, Zagzag D, Golfinos J, Devinsky O
INTRODUCTION: : Glutamic acid decarboxylase (GAD) is the rate-limiting enzyme converting glutamate into ?-aminobutyric acid. Impaired GAD function can alter motor, cognitive, and behavioral function. Anti-GAD antibodies (GADAbs) can cause several neurological disorders. However, the association between anti-GADAbs and pure psychosis, without seizures or focal neurological deficits, is not well defined.
CASE REPORT: : A 19-year-old woman with recent-onset psychotic disorder was diagnosed with schizophrenia. Brain magnetic resonance imaging and cerebrospinal fluid analysis were normal. Serum anti-GADAb titers were elevated. Brain biopsy showed subcortical gliosis and microglia-macrophage infiltration. The clinical syndrome improved with immune therapy.
CONCLUSIONS: : Severe psychosis and mild cognitive decline without other neurological features, meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision diagnostic criteria for schizophrenia, can result from brain inflammation associated with elevated serum anti-GADAbs.
PMID: 22367838 [PubMed - in process]
Susceptibility Genes for Schizophrenia: Mutant Models, Endophenotypes and Psychobiology.
Curr Top Behav Neurosci. 2012 Feb 26;
Authors: O'Tuathaigh CM, Desbonnet L, Moran PM, Waddington JL
Schizophrenia is characterised by a multifactorial aetiology that involves genetic liability interacting with epigenetic and environmental factors to increase risk for developing the disorder. A consensus view is that the genetic component involves several common risk alleles of small effect and/or rare but penetrant copy number variations. Furthermore, there is increasing evidence for broader, overlapping genetic-phenotypic relationships in psychosis; for example, the same susceptibility genes also confer risk for bipolar disorder. Phenotypic characterisation of genetic models of candidate risk genes and/or putative pathophysiological processes implicated in schizophrenia, as well as examination of epidemiologically relevant gene × environment interactions in these models, can illuminate molecular and pathobiological mechanisms involved in schizophrenia. The present chapter outlines both the evidence from phenotypic studies in mutant mouse models related to schizophrenia and recently described mutant models addressing such gene × environment interactions. Emphasis is placed on evaluating the extent to which mutant phenotypes recapitulate the totality of the disease phenotype or model selective endophenotypes. We also discuss new developments and trends in relation to the functional genomics of psychosis which might help to inform on the construct validity of mutant models of schizophrenia and highlight methodological challenges in phenotypic evaluation that relate to such models.
PMID: 22367925 [PubMed - as supplied by publisher]
Wellness: The Overlooked Intervention for Individuals with Psychosis in the Kingdom of Bahrain.
Occup Ther Int. 2012 Feb 24;
Authors: Jahrami H, Panchasharam G, Saif Z
PMID: 22368110 [PubMed - as supplied by publisher]
The Treatment of Hallucinations in Schizophrenia Spectrum Disorders.
Schizophr Bull. 2012 Feb 24;
Authors: Sommer IE, Slotema CW, Daskalakis ZJ, Derks EM, Blom JD, van der Gaag M
This article reviews the treatment of hallucinations in schizophrenia. The first treatment option for hallucinations in schizophrenia is antipsychotic medication, which can induce a rapid decrease in severity. Only 8% of first-episode patients still experience mild to moderate hallucinations after continuing medication for 1 year. Olanzapine, amisulpride, ziprasidone, and quetiapine are equally effective against hallucinations, but haloperidol may be slightly inferior. If the drug of first choice provides inadequate improvement, it is probably best to switch medication after 2-4 weeks of treatment. Clozapine is the drug of choice for patients who are resistant to 2 antipsychotic agents. Blood levels should be above 350-450 ?g/ml for maximal effect. For relapse prevention, medication should be continued in the same dose. Depot medication should be considered for all patients because nonadherence is high. Cognitive-behavioral therapy (CBT) can be applied as an augmentation to antipsychotic medication. The success of CBT depends on the reduction of catastrophic appraisals, thereby reducing the concurrent anxiety and distress. CBT aims at reducing the emotional distress associated with auditory hallucinations and develops new coping strategies. Transcranial magnetic stimulation (TMS) is capable of reducing the frequency and severity of auditory hallucinations. Several meta-analyses found significantly better symptom reduction for low-frequency repetitive TMS as compared with placebo. Consequently, TMS currently has the status of a potentially useful treatment method for auditory hallucinations, but only in combination with state of the art antipsychotic treatment. Electroconvulsive therapy (ECT) is considered a last resort for treatment-resistant psychosis. Although several studies showed clinical improvement, a specific reduction in hallucination severity has never been demonstrated.
PMID: 22368234 [PubMed - as supplied by publisher]
Shape Alteration in the Caudate Nucleus in Individuals With Bipolar Affective Disorder Disorder.
Aust N Z J Psychiatry. 2012 Feb 24;
Authors: Ong D, Walterfang MA, Malhi G, Styner M, Velakoulis D, Pantelis C
Objective: The caudate nucleus (CN) is a crucial component of the ventral striatum, which is part of a prefrontal-striatal-thalamic circuit that is modulated by limbic structures to subserve emotional processing. Bipolar disorder is thought to be underpinned by dysfunctional anterior limbic networks, although MRI studies examining the CN have shown equivocal results. As gross volumetric analyses may not detect subtle regional change, we aimed to clarify the role of the CN in bipolar disorder by undertaking shape analysis to detect regional reductions.Methods: The CN was manually traced on MRI scans from 27 patients with bipolar-I disorder and 24 matched controls. A non-parametric spherical harmonic shape analysis was undertaken using the SPHARM toolkit.Results: Whilst the left CN volume was consistently larger in the sample, there was no effect of group or gender or significant interactions between these variables. Volume did not correlate with illness duration or lithium dosage, but was larger in those with a history of psychosis at trend level. However, left caudate shape differed significantly between groups, with deflation in an area along the ventromedial surface (connecting to dorsolateral prefrontal regions) in bipolar patients. Psychotic patients showed increases in the dorsal head and body at trend level overall, in regions connecting to medial and orbitofrontal regions.Conclusions: These findings suggest that subtle rather than gross structural changes occur in the CN, which may not be detectable by volumetric analysis alone, and reflect alterations in specific frontostriatal circuitry in the disorder.
PMID: 22368240 [PubMed - as supplied by publisher]
Does giving up substance use work for patients with psychosis? A systematic meta-analysis.
Aust N Z J Psychiatry. 2012 Feb 24;
Authors: Mullin K, Gupta P, Compton MT, Nielssen O, Harris A, Large M
Objective: To assess the extent to which ceasing the use of cannabis or other substances reduces the symptoms and social disability associated with psychotic illness.Methods: The electronic databases CINAHL, EMBASE, MEDLINE and PsycINFO were searched for peer-reviewed publications in English that report data about the characteristics of current and former substance-using patients diagnosed with psychotic illnesses. The searches yielded 328 articles, of which 23 studies met the inclusion criteria. Four key outcome variables; positive symptoms, negative symptoms, ratings of depression and global function, and five other measures of outcome that were reported in five or more studies were examined using meta-analysis.Results: Current substance-using patients were significantly younger than former substance-using patients (standardised mean difference (SMD) = -0.38), but did not differ in age at onset of psychosis, sex, level of education or marital status. Current substance users had higher scores on rating scales of positive symptoms (SMD = 0.29) and depression (SMD = 0.36), and lower scores on global function (SMD = -0.26) when compared with former substance users. There was a significant improvement in the ratings of positive symptoms, mood and global function among patients who stopped using substances during the first episode of psychosis, while improvements in the symptoms of patients with a more established psychotic illness did not reach statistical significance.Conclusion: The results suggest that substance use contributes to both the symptoms and the burden of disability experienced by patients with psychosis. Patients in the early stages of psychotic illness should be informed about the benefits of giving up substances earlier, rather than later in the illness. Psychiatric services should regard the treatment of substance use as an integral part of the treatment of psychotic disorders.
PMID: 22368242 [PubMed - as supplied by publisher]
Facial affect recognition and schizotypal personality characteristics.
Early Interv Psychiatry. 2012 Feb 28;
Authors: Abbott GR, Green MJ
Aim: Deficits in facial affect recognition are well established in schizophrenia, yet relatively little research has examined facial affect recognition in hypothetically psychosis-prone or 'schizotypal' individuals. Those studies that have examined social cognition in psychosis-prone individuals have paid little attention to the association between facial emotion recognition and particular schizotypal personality features. The present study therefore sought to investigate relationships between facial emotion recognition and the different aspects of schizotypy. Methods: Facial affect recognition accuracy was examined in 50 psychiatrically healthy individuals assessed for level of schizotypy using the Schizotypal Personality Questionnaire. This instrument provides a multidimensional measure of schizophrenia proneness, encompassing 'cognitive-perceptual', 'interpersonal' and 'disorganized' features of schizotypy. It was hypothesized that the cognitive-perceptual and interpersonal aspects of schizotypy would be associated with difficulties identifying facial expressions of emotion during a forced-choice recognition task using a standardized series of colour photographs. Results: As predicted, interpersonal aspects of schizotypy (particularly social anxiety) were associated with reduced accuracy on the facial affect recognition task, but there was no association between affect recognition accuracy and cognitive-perceptual features of schizotypy. Conclusions: These results suggest that subtle deficits in facial affect recognition in otherwise psychiatrically healthy individuals may be related to the vulnerability for interpersonal communication difficulties, as seen in schizophrenia.
PMID: 22369486 [PubMed - as supplied by publisher]
[Ethical consequences of the diagnosis of psychosis.]
Ugeskr Laeger. 2012 Feb 27;174(9):563-565
Authors: Lindhardt A
Psychosis is defined by the loss of reality testing. Apart from that, it is rather broadly and vaguely defined. Ethics is the art of defining what is right and what is wrong. Medical ethics apply a diversity of ethical principles to a complex clinical reality after discussion and consideration. In forensic psychiatry the diagnosis of psychosis has vast ethical implications. In the Danish law on psychiatry conditions for coercion and involuntary treatment are stated, and in the law on penalty the principle of treatment instead of penalty is stated. Thus, implications for diagnoses and treatment go far beyond other medical diagnoses.
PMID: 22369904 [PubMed - as supplied by publisher]
Facial emotion recognition in adolescents with psychotic-like experiences: a school-based sample from the general population.
Psychol Med. 2012 Feb 28;:1-10
Authors: Roddy S, Tiedt L, Kelleher I, Clarke MC, Murphy J, Rawdon C, Roche RA, Calkins ME, Richard JA, Kohler CG, Cannon M
BACKGROUND: Psychotic symptoms, also termed psychotic-like experiences (PLEs) in the absence of psychotic disorder, are common in adolescents and are associated with increased risk of schizophrenia-spectrum illness in adulthood. At the same time, schizophrenia is associated with deficits in social cognition, with deficits particularly documented in facial emotion recognition (FER). However, little is known about the relationship between PLEs and FER abilities, with only one previous prospective study examining the association between these abilities in childhood and reported PLEs in adolescence. The current study was a cross-sectional investigation of the association between PLEs and FER in a sample of Irish adolescents.MethodThe Adolescent Psychotic-Like Symptom Screener (APSS), a self-report measure of PLEs, and the Penn Emotion Recognition-40 Test (Penn ER-40), a measure of facial emotion recognition, were completed by 793 children aged 10-13 years. RESULTS: Children who reported PLEs performed significantly more poorly on FER (?=-0.03, p=0.035). Recognition of sad faces was the major driver of effects, with children performing particularly poorly when identifying this expression (?=-0.08, p=0.032). CONCLUSIONS: The current findings show that PLEs are associated with poorer FER. Further work is needed to elucidate causal relationships with implications for the design of future interventions for those at risk of developing psychosis.
PMID: 22370095 [PubMed - as supplied by publisher]
Neuroanatomy of auditory verbal hallucinations in schizophrenia: A quantitative meta-analysis of voxel-based morphometry studies.
Cortex. 2012 Feb 1;
Authors: Modinos G, Costafreda SG, van Tol MJ, McGuire PK, Aleman A, Allen P
INTRODUCTION: Voxel-based morphometry (VBM) studies demonstrate grey matter volume (GMV) deficits in schizophrenia. This method is also applied for detecting associations between specific psychotic symptoms and brain structure, such as auditory verbal hallucinations (AVHs). However, due to differing methodological approaches, the available findings are inconsistent and difficult to integrate. METHODS: We used a novel voxel-based meta-analytical method to provide a robust quantitative review of neuroanatomical abnormalities specifically associated with the hallucinatory phenomenon in the schizophrenic brain. We reviewed all VBM studies of AVHs in schizophrenia published until July 2011 (n = 9). A total of 438 patients with a diagnosis of schizophrenia were included (307 with AVHs). Using a random-effects parametric voxel-based meta-analysis, coordinates of 83 foci reported as significant in the source studies were extracted and computed to estimate the brain locations most consistently associated with AVHs. RESULTS: Severity of AVHs was significantly associated with GMV reductions in the left (p = .022) and marginally with the right (p = .062) superior temporal gyri (STGs, including Heschl's gyri) across studies examining correlations with AVHs severity in patients (n = 8). Analysis of studies categorically comparing patients with and without AVHs did not reveal any significant findings, possibly due to the small number of studies using this approach (n = 3). CONCLUSIONS: This meta-analysis implicates bilateral STG (including Heschl's gyri) as key areas of structural pathology in AVHs in schizophrenia. These findings support a model postulating that aberrations within neural systems involved at different levels of language processing are critical to AVHs in schizophrenia.
PMID: 22370252 [PubMed - as supplied by publisher]
Bath salts: an emerging danger.
Del Med J. 2011 Nov;83(11):357-9; quiz 360
Authors: Gallucci G, Malik M, Kahn S, Afzal N, Trimzi I
We report a case of psychosis in an individual who has ingested a new compound known as "bath salts." Bath salts represent an emerging public health threat due to serious neuropsychiatric and behavioral symptoms associated with their use.
PMID: 22372121 [PubMed - in process]
Dementia for hospital physicians.
Clin Med. 2012 Feb;12(1):35-9
Authors: Harwood RH
Many people with dementia are admitted to general hospitals, yet doctors feel ill-prepared to manage them. Problems are often multiple and complex. In many cases, dementia is complicated by delirium. Medical assessment must be meticulous and requires collateral history taking, mental state examination and cognitive function testing. Hospital environments can be provocative, and the way staff interact with people with dementia can increase distress. Difficult behaviours usually represent unmet needs. The right approach by (all) staff can reduce this, including special efforts to establish reassuring, comforting relationships with patients. Try to see situations from the perspective of the person with dementia. Skilled communication is vital and family carers should be kept informed and involved. People with dementia are prone to side effects of prescribed drugs. Antipsychotic drugs are rarely the answer to difficult behaviours, but may be used in cases of psychosis or severe distress.
PMID: 22372218 [PubMed - in process]
Comparison of Long-Term (At Least 24 Weeks) Weight Gain and Metabolic Changes Between Adolescents and Adults Treated with Olanzapine.
J Child Adolesc Psychopharmacol. 2012 Feb 28;
Authors: Kryzhanovskaya LA, Xu W, Millen BA, Acharya N, Jen KY, Osuntokun O
Abstract Objective: The purpose of these analyses was to compare the weight and other metabolic changes between adolescents and adults during long-term (at least 24 weeks) olanzapine treatment. Method: The adult database included 86 studies with 12,425 patients with schizophrenia, schizoaffective disorder, depression, borderline personality disorder, or bipolar I disorder; the adolescent database comprised six studies with 489 patients with schizophrenia, schizoaffective disorder, borderline personality disorder, bipolar I disorder, or prodromal psychosis. Patients who had at least 24 weeks of olanzapine exposure (N=4,280 from adult database and N=179 from adolescent database) were analyzed in this study. Weight data were collected for all patients, fasting glucose and lipids data were collected in some patients. For weight gain, data in 34.5% adults (4,280/12,425) and 36.6% adolescents (179/489) were analyzed while for glucose and lipids, data in 8.4% (1,038/12,425) adults and 24.9% adolescents (122/489) were analyzed. Adult patients were treated with oral (5-20?mg/day) or depot formulations (doses equivalent to oral doses of 5-20?mg/day) of olanzapine and adolescent patients were treated with oral olanzapine (2.5-20?mg/day). The incidences of potentially clinically significant categorical changes in weight and metabolic parameters were calculated with a 95% confidence interval (CI). Nonoverlapping 95% CIs were considered as indicating a statistically significant difference. Weight, lipid, and glucose change comparisons are summarized. Results: The mean age for adolescents and adults was 15.8 and 38.8, respectively. The percentage of the male population was similar for both adults (58.5%) and adolescents (62.8%). The median duration of the follow-up period was 201 days for adolescent database and 280 days for adult database. The mean weight gain from baseline to endpoint in adolescents was 11.24 kg when compared with 4.81 kg in adults. The 95% CI for adolescents (10.1, 12.4) and adults (4.57, 5.04) are not overlapping, which indicates that the difference between adolescents and adults is statistically significant. The percentage of olanzapine-treated adolescents with ?7% mean weight gain was 89.4% compared with 55.4% in adults (Number need to harm [NNH]=3). Mean changes from baseline to endpoint were also greater for adolescents than for adults in fasting total cholesterol (5.49?mg/dL vs. 2.06?mg/dL), LDL (5.41?mg/dL vs. 0.49?mg/dL), and triglycerides (20.49?mg/dL vs. 16.72?mg/dL), but overlapping 95% CIs were observed for all lipid parameters. Mean changes from baseline to endpoint in fasting glucose values were similar between adolescents and adults (3.13?mg/dL vs. 3.95?mg/dL). However, the incidence of treatment-emergent significant glucose changes was greater in adults. Among olanzapine-treated adults and adolescents, 8.9% and 0.9% experienced a shift from normal to high and 12.5% and 3.3% experienced a shift from normal/impaired glucose tolerance (IGT) to high fasting glucose, respectively. The incidence of IGT to high elevations in glucose was greater in adolescents, but overlapping 95% CI was observed. Conclusions: The types of metabolic changes during the long-term olanzapine treatment in adolescents were similar to those observed in adults. However, the magnitude of changes in weight and lipid parameters was greater in adolescents. Patients should receive regular monitoring of weight, fasting blood glucose, and lipid profile at the beginning of, and periodically during, treatment with olanzapine.
PMID: 22372514 [PubMed - as supplied by publisher]
Self-enucleation: forget Freud and Oedipus, it's all about untreated psychosis.
Br J Ophthalmol. 2012 Feb 28;
Authors: Large MM, Nielssen OB
Self-enucleation is a rare but serious ophthalmological and psychiatric emergency. It has traditionally been considered to be the result of psycho-sexual conflicts, including those arising from Freud's Oedipal complex and Christian religious teaching. However, an analysis of published case reports suggests that self-enucleation is a result of psychotic illnesses such as schizophrenia. Early treatment with antipsychotic medication in the case of unilateral or threatened self-enucleation might prevent some cases of blindness.
PMID: 22373824 [PubMed - as supplied by publisher]
Neuropsychological effects associated with recreational cocaine use.
Psychopharmacology (Berl). 2012 Feb 29;
Authors: Soar K, Mason C, Potton A, Dawkins L
RATIONALE: Recent evidence suggests that recreational cocaine use is on the increase, with the UK reporting one of the highest levels of use in the EU (EMCDDA 2010). Nevertheless, very few studies have addressed the neuropsychological effects associated with non-dependent recreational cocaine use. OBJECTIVES: The current study aimed to assess whether recreational cocaine users show neuropsychological deficits on a battery of tests, previously shown to be sensitive to cocaine-dependent and psychosis-prone individuals. Schizotypal traits were also measured. METHODS: Recreational cocaine users (n?=?17) were compared with controls (n?=?24) on drug use patterns, the General Health Questionnaire, the Brief Schizotypal Personality Questionnaire (SPQ-B) and four neuropsychological tasks: spatial working memory, intra/extra-dimensional set shifting, the Stocking of Cambridge and the rapid visual processing. RESULTS: Relative to controls, recreational cocaine users produced significantly more errors on the intra/extra-dimensional set shift task and completed fewer stages, made significantly more six box stage errors on the spatial working memory task, and made significantly more errors and fewer hits, with overall poorer detection rates on the rapid visual processing task. Recreational cocaine users reported significantly higher scores on the cognitive perceptual and disorganised thinking SPQ-B subscales and total SPQ-B scores compared to controls. CONCLUSIONS: Recreational cocaine users displayed impairments on tasks tapping sustained attention, attentional shifting and spatial memory and reported higher schizotypal trait expression. These findings are consistent with the emerging literature suggesting subtle cognitive deficits, putatively reflecting underlying dopaminergic dysfunction, in non-dependent, recreational cocaine users.
PMID: 22374254 [PubMed - as supplied by publisher]
[Clinical correlates of social anxiety disorder comorbidity in schizophrenia].
Turk Psikiyatri Derg. 2012;23(1):1-8
Authors: Güçlü O, Erk?ran M, Aksu EE, Aksu H
OBJECTIVE: The aim of this study is to investigate the social anxiety disorder comorbidity and clinical features in schizophrenia.
METHOD: 102 (23 women and 79 men) outpatients who had been followed in the Psychotic Disorders Unit in Bak?rköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery were diagnosed with schizophrenia according to DSM-IV criteria were included in the study. Schizophrenia and Social anxiety disorder were assessed by a structured clinical interview for DSM-IV. Patients were evaluated with a questionnaire which included demographics, clinical characteristics, Liebowitz social anxiety scale, Positive and Negative Syndrome Scale (PANSS), Calgary depression scale for schizophrenia (CDSS),The Scale of Unawareness of Mental Disorders (SUMD), Short form-36 health survey questionnaire and state-trait anxiety ?nventory.
RESULTS: In remission, 22 patients (21.6%) had co-morbid social anxiety disorder. Patients with social anxiety disorder comorbidity, had higher levels of awareness. Their depression scores were higher and functional impairments were lower. These patients had been treated with typical and atypical antipsychotics and antidepressants.
CONCLUSION: Social anxiety disorder comorbidity in schizophrenia adversely affects the quality of life and is not rare. Future studies should be planned with the assesment of social anxiety disorder treatment as well as schizophrenia treatment.
PMID: 22374625 [PubMed - in process]
[Psychotic disorders among immigrants from Turkey in Western Europe: An overview of incidences, prevalence estimates, and admission rates].
Turk Psikiyatri Derg. 2012;23(1):53-62
Authors: Binbay T, Ula? H, Alptekin K, Elbi H
OBJECTIVE: To provide an overview of incidence and prevalence estimates, admission rates, and related features of psychotic disorders among immigrants from Turkey in Western Europe.
METHOD: Articles published in all languages between 1990 and 2010 were included. In order to detect relevant studies, a string ([schizo* OR psych*] AND [Turk*] AND [migra* OR immigra*]) was used in MEDLINE and PsychINFO. Turkish indexes and abstracts books of national congresses were also screened to locate additional papers.
RESULTS: We included 21 studies which yielded 25 rates on psychotic disorders among immigrants from Turkey. Fifteen papers reported rates for the immigrants from Turkey in The Netherlands, four for Germany, one for Denmark and one for Switzerland. The incidence estimates of non-affective and affective psychosis among immigrants from Turkey were between 38.5 and 44.9 per 100,000 while incidence estimates of schizophrenia were between 12.4 and 63.8 per 100,000. The prevalence estimates of schizophrenia and other psychotic disorders were between 1.1 and 6.2 per 1,000. Rates and relative risks of psychotic disorders in immigrants from Turkey tended to be higher than the natives and lower than other immigrant groups with similar sociocultural background. In addition to other risk factors, social contextual factors including discrimination and neighbourhood characteristics were the key environmental factors that modulate rates of psychotic disorders among immigrants from Turkey. Males were under a higher risk of incidence, prevalence estimates, and admission rates.
CONCLUSION: Variations in rates and relative risks indicate a possible etiological role of social experiences in immigrants. Studies with a focus on comparing the rates and the social factors of psychotic disorders between immigrants from Turkey in Western Europe and their family members residing in Turkey may provide additional insight into the epidemiology of psychotic disorders.
PMID: 22374632 [PubMed - in process]
Colloidal silver ingestion with copper and caeruloplasmin deficiency.
Ann Clin Biochem. 2012 Feb 28;
Authors: Stepien KM, Taylor A
The copper concentration in serum can be affected by the presence of other trace elements such as silver. Low serum copper may result in decreased caeruloplasmin synthesis. We report the case of a 59-year-old woman, who was admitted to hospital with acute psychosis and who had been ingesting chronically, colloidal silver.
PMID: 22375039 [PubMed - as supplied by publisher]
Has electroconvulsive therapy use remained stable over time? A decade of electroconvulsive therapy service provision in Victoria, Australia.
Aust N Z J Psychiatry. 2012 Feb 28;
Authors: Plakiotis C, George K, O'Connor DW
Objective: Despite the long history of electroconvulsive therapy (ECT) as a psychiatric treatment modality in Australia, existing literature regarding ECT use and practices in Australia is limited. In this unique study, we report ECT provision in Victoria to adults aged 25 years and over from 1998 to 2007, based on complete data from all public and private treatment settings within the State; compare our results to previous literature in the field; and offer possible explanations for these findings as a basis for future research.Method: Analysis of statutory ECT service provision data collected by the Office of the Chief Psychiatrist of Victoria.Results: ECT use declined overall from 2001 onward, followed by a small increase in use in 2007. Eighty per cent of patients received ECT for depression and 14% for psychosis. Sixty-two per cent of ECT recipients were women. Although patients aged 65 years and over were small in number, age adjustment of data was indicative of a higher utilisation rate in this group. With increasing age, the percentage of ECT recipients treated for depression increased, whereas the percentage treated for psychosis decreased. Sixty per cent of patients were treated in the public sector. Public-private sector ECT use did not differ greatly for depression, but more patients were treated in the public sector for psychosis. The majority of patients with depression received treatment voluntarily, but the converse was true for patients with psychosis. Unilateral electrode placement predominated.Conclusions: While utilisation rates gradually declined over the decade studied, patients continued receiving ECT in significant numbers, suggesting its role in treating severe mental illness is far from superseded. The present, population-level research cannot explain the causative factors underlying the patterns observed, but raises interesting questions for further investigation. Ongoing collection of statutory ECT data in a manner making it amenable to research applications is recommended.
PMID: 22375067 [PubMed - as supplied by publisher]
The visinin-like proteins VILIP-1 and VILIP-3 in Alzheimer's disease-old wine in new bottles.
Front Mol Neurosci. 2012 Jan 19;5:20
Authors: Braunewell KH
The neuronal Ca(2+)-sensor (NCS) proteins VILIP-1 and VILIP-3 have been implicated in the etiology of Alzheimer's disease (AD). Genome-wide association studies (GWAS) show association of genetic variants of VILIP-1 (VSNL1) and VILIP-3 (HPCAL1) with AD+P (+psychosis) and late onset AD (LOAD), respectively. In AD brains the expression of VILIP-1 and VILIP-3 protein and mRNA is down-regulated in cortical and limbic areas. In the hippocampus, for instance, reduced VILIP-1 mRNA levels correlate with the content of neurofibrillary tangles (NFT) and amyloid plaques, the pathological characteristics of AD, and with the mini mental state exam (MMSE), a test for cognitive impairment. More recently, VILIP-1 was evaluated as a cerebrospinal fluid (CSF) biomarker and a prognostic marker for cognitive decline in AD. In CSF increased VILIP-1 levels correlate with levels of A?, tau, ApoE4, and reduced MMSE scores. These findings tie in with previous results showing that VILIP-1 is involved in pathological mechanisms of altered Ca(2+)-homeostasis leading to neuronal loss. In PC12 cells, depending on co-expression with the neuroprotective Ca(2+)-buffer calbindin D28K, VILIP-1 enhanced tau phosphorylation and cell death. On the other hand, VILIP-1 affects processes, such as cyclic nucleotide signaling and dendritic growth, as well as nicotinergic modulation of neuronal network activity, both of which regulate synaptic plasticity and cognition. Similar to VILIP-1, its interaction partner ?4?2 nicotinic acetylcholine receptor (nAChR) is severely reduced in AD, causing severe cognitive deficits. Comparatively little is known about VILIP-3, but its interaction with cytochrome b5, which is part of an antioxidative system impaired in AD, hint toward a role in neuroprotection. A current hypothesis is that the reduced expression of visinin-like protein (VSNLs) in AD is caused by selective vulnerability of subpopulations of neurons, leading to the death of these VILIP-1-expressing neurons, explaining its increased CSF levels. While the Ca(2+)-sensor appears to be a good biomarker for the detrimental effects of A? in AD, its early, possibly A?-induced, down-regulation of expression may additionally attenuate neuronal signal pathways regulating the functions of dendrites and neuroplasticity, and as a consequence, this may contribute to cognitive decline in early AD.
PMID: 22375104 [PubMed - in process]
How do auditory verbal hallucinations in patients differ from those in non-patients?
Front Hum Neurosci. 2012;6:25
Authors: Larøi F
Auditory verbal hallucinations (AVHs) are experienced by individuals with various clinical diagnoses, such as psychosis, but also a significant minority of healthy individuals from the general population may experience them. Although much research has been carried out the past few decades, the mechanisms and factors underlying the emergence of AVHs is still poorly understood. One way of clarifying this issue involves comparing AVHs in patient and non-patient populations. In particular, differences between these groups will provide important information concerning the emergence of AVHs. After a general presentation and discussion of the notion of a continuum hypothesis, studies comparing patients with non-patients experiencing AVHs will be reviewed. This will comprise studies examining the phenomenological characteristics of AVHs in addition to neuroimaging and cognitive studies. Although we are beginning to elucidate important differences on a phenomenological level between these two types of AVHs, far too few studies have directly compared patient and non-patient AVHs in terms of underlying cerebral correlates and cognitive mechanisms. Nevertheless, and based on recent research on phenomenological differences, two issues stand out that need to be addressed, namely, the highly negative emotional content of AVHs in patients and the early onset of AVHs in non-patients populations. Suggestions for future research will be discussed.
PMID: 22375112 [PubMed - in process]
Women and psychosis.
Womens Health (Lond Engl). 2012 Mar;8(2):215-24
Authors: Seeman MV
Background: There are subtle differences in the presentation of psychosis that depend on the biological sex of the person exhibiting the symptoms. Because much of the early research in the field was conducted on male animals and on men, several issues of importance to women have been relatively neglected until recently. Current research into psychotic illness is beginning to analyze results for men and women separately and greater emphasis on qualitative methods has allowed the experiences of women patients to be documented. Methods: The last decade of research into the many facets of psychosis in women were reviewed for this paper by introducing the relevant search terms into PubMed, PsycINFO and SOCINDEX. Results: Subtle differences are reported in several areas, with important ramifications for treatment. Conclusions: It is important for service providers to devise treatment programs that address the different needs of the two sexes. Effective treatment of women with psychosis is especially important in that these women are often mothers, whose well being impacts on the health of the next generation.
PMID: 22375723 [PubMed - in process]
Support Needs of Mothers Who Experience Postpartum Psychosis and Their Partners.
J Obstet Gynecol Neonatal Nurs. 2012 Feb 29;
Authors: Doucet S, Letourneau N, Blackmore ER
OBJECTIVES: To explore the perceived support needs and preferences of women with postpartum psychosis and their partners. DESIGN: A multisite, exploratory, qualitative descriptive design was used. SETTING AND PARTICIPANTS: A purposive sample of nine mothers (Canada, n = 7, United States, n = 2) and eight fathers (Canada, n = 7, United States, n = 1) was obtained. METHODS: Data were collected through one-on-one, in-depth, semistructured interviews. Inductive thematic analysis was used to explore the qualitative transcripts. RESULTS: Couples who experienced postpartum psychosis looked to health professionals to provide reassurance and information on the illness, its management, and prognosis. The quality of support and interactions with staff varied, and participants reported difficulty identifying and obtaining professional support upon discharge. All participants felt that support groups for postpartum illnesses would help to normalize the experience and dissipate feelings of isolation. Participants reported that informal support networks provided practical help but were limited or hindered recovery and management due to lack of knowledge of the illness. Despite feeling overwhelmed and isolated, fathers were reluctant to identify their own support needs and struggled to ask for help from professionals and their informal support network. CONCLUSION: These findings suggest that clinical interventions are needed to address the support needs and aid in the recovery of families affected by postpartum psychosis.
PMID: 22375839 [PubMed - as supplied by publisher]
Presentation and Treatment of Acute Psychosis in an Adolescent Girl with Cerebral Palsy.
J Child Adolesc Psychopharmacol. 2012 Feb 29;
Authors: Grody MB, Coffey BJ
PMID: 22375855 [PubMed - as supplied by publisher]
MTR abnormalities in subjects at ultra-high risk for schizophrenia and first-episode schizophrenic patients compared to healthy controls.
Schizophr Res. 2012 Feb 27;
Authors: Bohner G, Milakara D, Witthaus H, Gallinat J, Scheel M, Juckel G, Klingebiel R
BACKGROUND: Neuroimaging studies have suggested gray (GM) and white matter (WM) abnormalities in early stages of schizophrenia. We aimed at evaluating subtle parenchymal alterations in individuals at ultra-high risk (UHR) for transition into psychosis and first-episode schizophrenic (FES) patients by measuring the magnetization transfer ratio (MTR). Methods and material In a cross-sectional study magnetization transfer images and high-resolution volumetric T1-weighted images were acquired in 70 age- and gender-matched subjects (25 UHR subjects, 16 FES patients and 29 controls) in a 1.5Tesla scanner. Following normalization of MTR-maps the intensity histograms were analyzed by performing a Kruskal-Wallis-test. RESULTS: Gray matter MTR decreases were depicted in UHR subjects solely, involving the cingulate gyrus and precentral cortex. WM MTR alterations were more pronounced in FES than in UHR patients and exclusively affected the frontal lobe bilaterally. In addition, UHR subjects showed bilateral MTR decreases at the stria terminalis though statistically significant only on the left side (p=0.018.) CONCLUSION: Our results indicate GM affection earlier on during disease progression as well as cumulative WM affection within frontal lobes during transition from UHR to FES. MTR reductions at the stria terminalis of UHR patients points to the involvement of the extended amygdala in the prodromal disease stage.
PMID: 22377101 [PubMed - as supplied by publisher]
Cognitive changes following antidepressant or antipsychotic treatment in adolescents at clinical risk for psychosis.
Schizophr Res. 2012 Feb 27;
Authors: Bowie CR, McLaughlin D, Carrión RE, Auther AM, Cornblatt BA
BACKGROUND: Improving neurocognitive abilities is a treatment priority in schizophrenia, however, pharmacological efforts to enhance deficits after illness onset have resulted in quite modest results that are of questionable clinical meaningfulness. Individuals at clinical risk for psychosis demonstrate neurocognitive impairments intermediate to the level of deficits observed in schizophrenia and normative performance, suggesting that a similar magnitude of improvement might result in more clinically meaningful change. In this study, we examined neurocognitive changes after six months of treatment in adolescents with clinical signs of risk for psychosis. METHODS: Adolescents who were referred to the Recognition and Prevention program, which is focused on treatment and research for individuals at a clinical high risk for psychosis, were followed in a naturalistic treatment design. At study entry and approximately six months after starting treatment, we examined neuropsychological functioning and clinical symptoms for patients who remained off medications (OFF; N=27), started selective serotonin reuptake inhibitor antidepressant medication (AD; N=15), or started a second-generation antipsychotic medication (AP; N=11) within three months of study entry. We also included a locally recruited healthy comparison group (HC; N=17). RESULTS: The clinical groups were not significantly different on baseline demographic, neurocognitive, or clinical symptom measures. Linear mixed models were used to examine cognitive changes, with time between assessments, depressive symptom severity, and attenuated positive symptom severity as random effects. Group by time effects were observed in sustained attention and verbal learning, with the AD group showing a more favorable response than the AP group. The AD group's improvements were not significantly different from the HC or OFF group. CONCLUSION: Early intervention for those at clinical high risk for psychosis may result in neurocognitive improvements. These improvements were observed for those prescribed antidepressant, but not antipsychotic medications even though the groups did not differ in clinical symptom severity or treatment response.
PMID: 22377102 [PubMed - as supplied by publisher]