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Swets M, Van Dael F, Roza S, Schoevers R, Myin-Germeys I, de Haan L. Evidence for a Shared Etiological Mechanism of Psychotic Symptoms and Obsessive-Compulsive Symptoms in Patients with Psychotic Disorders and Their Siblings. PLoS One 2015; 10:e0125103. [PMID: 26061170 PMCID: PMC4465647 DOI: 10.1371/journal.pone.0125103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/05/2015] [Indexed: 11/18/2022] Open
Abstract
The prevalence of obsessive-compulsive disorder in subjects with psychotic disorder is much higher than in the general population. The higher than chance co-occurrence has also been demonstrated at the level of subclinical expression of both phenotypes. Both extended phenotypes have been shown to cluster in families. However, little is known about the origins of their elevated co-occurrence. In the present study, evidence for a shared etiological mechanism was investigated in 3 samples with decreasing levels of familial psychosis liability: 987 patients, 973 of their unaffected siblings and 566 healthy controls. The association between the obsessive-compulsive phenotype and the psychosis phenotype c.q. psychosis liability was investigated. First, the association was assessed between (subclinical) obsessive-compulsive symptoms and psychosis liability. Second, in a cross-sib cross-trait analysis, it was examined whether (subclinical) obsessive-compulsive symptoms in the patient were associated with (subclinical) psychotic symptoms in the related unaffected sibling. Evidence was found for both associations, which is compatible with a partially shared etiological pathway underlying obsessive-compulsive and psychotic disorder. This is the first study that used a cross-sib cross-trait design in patients and unaffected siblings, thus circumventing confounding by disease-related factors present in clinical samples.
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Affiliation(s)
- Marije Swets
- Arkin Mental Health and Addiction Treatment Centre, Amsterdam, the Netherlands
| | - Frank Van Dael
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - Sabine Roza
- Department of psychiatry, Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | - Robert Schoevers
- Department of psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, the Netherlands
| | - Lieuwe de Haan
- Academic Medical Centre University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
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van der Velde J, Swart M, van Rijn S, van der Meer L, Wunderink L, Wiersma D, Krabbendam L, Bruggeman R, Aleman A. Cognitive alexithymia is associated with the degree of risk for psychosis. PLoS One 2015; 10:e0124803. [PMID: 26030357 PMCID: PMC4451258 DOI: 10.1371/journal.pone.0124803] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 03/18/2015] [Indexed: 01/22/2023] Open
Abstract
Alexithymia is a personality construct denoting emotion processing problems. It has been suggested to encompass two dimensions: a cognitive and affective dimension. The cognitive dimension is characterized by difficulties in identifying, verbalizing and analyzing emotions, while the affective dimension reflects the level of emotional arousal and imagination. Alexithymia has been previously proposed as a risk factor for developing psychosis. More specifically, the two alexithymia dimensions might be differentially related to the vulnerability for psychosis. Therefore, we examined the two dimensions of alexithymia, measured with the BVAQ in 94 siblings of patients with schizophrenia, 52 subjects at ultra-high risk (UHR) for developing psychosis, 38 patients with schizophrenia and 109 healthy controls. The results revealed that siblings and patients had higher levels of cognitive alexithymia compared to controls. In addition, subjects at UHR for psychosis had even higher levels of cognitive alexithymia compared to the siblings. The levels of affective alexithymia in siblings and patients were equal to controls. However, UHR individuals had significantly lower levels of affective alexithymia (i.e. higher levels of emotional arousal and fantasizing) compared to controls. Alexithymia was further related to subclinical levels of negative and depressive symptoms. These findings indicate that alexithymia varies parametrically with the degree of risk for psychosis. More specifically, a type-II alexithymia pattern, with high levels of cognitive alexithymia and normal or low levels of affective alexithymia, might be a vulnerability factor for psychosis.
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Affiliation(s)
- Jorien van der Velde
- Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Academy for sociale studies, Hanze University of Apllied Sciences, Groningen, The Netherlands
- * E-mail:
| | - Marte Swart
- Lentis, Center for Mental Healthcare, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sophie van Rijn
- Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands
| | | | - Lex Wunderink
- Department of Psychosis studies, Mental Health Care Friesland, Leeuwarden, The Netherlands
| | - Durk Wiersma
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lydia Krabbendam
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Educational Neuroscience, Faculty of Psychology and Education, VU University Amsterdam, Amsterdam, The Netherlands
| | - André Aleman
- Neuroimaging Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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253
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Bratlien U, Øie M, Haug E, Møller P, Andreassen OA, Lien L, Melle I. Self-reported symptoms and health service use in adolescence in persons who later develop psychotic disorders: a prospective case-control study. Early Interv Psychiatry 2015; 9:221-7. [PMID: 24224904 DOI: 10.1111/eip.12102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/22/2013] [Indexed: 01/12/2023]
Abstract
AIM To investigate self-reported psychiatric and somatic symptoms and health service use at age 16 in persons who later developed a psychotic disorder compared with a control group from the same geographical areas. METHOD Responses concerning psychiatric or somatic health and health service use from Norwegian youth studies in a cohort of 15- and 16-year-olds in three Norwegian counties (N = 11 101, 90% response rate) were gathered. The questionnaire responses from persons later identified with a lifetime diagnosis of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) psychotic disorders (n = 30) (confirmed psychosis, CP) were compared with responses from the rest of the group (population control, PC) (n = 11 067). Follow-up analyses were made for cases with a confirmed onset of a psychotic disorder after the time of the survey (n = 21). RESULTS The main significant differences between the CP and PC groups were more self-reported anxiety, depression and 'feeling in need of treatment for eating disorders' at age 16 in the CP group. The rate of self-reported eating disorder symptoms alone reached the level of statistical significance in the follow-up analyses. The CP group did not use available health services to a markedly greater extent than the control group. CONCLUSION We found that, in comparison with others, youths who were later identified with a psychotic disorder reported more symptoms at age 16.
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Affiliation(s)
- Unni Bratlien
- Division of Mental Health, Innlandet Hospital Trust, Ottestad, Norway
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254
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Sutliff S, Roy MA, Achim AM. Social anxiety disorder in recent onset schizophrenia spectrum disorders: The relation with symptomatology, anxiety, and social rank. Psychiatry Res 2015; 227:39-45. [PMID: 25818255 DOI: 10.1016/j.psychres.2015.02.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 01/02/2015] [Accepted: 02/19/2015] [Indexed: 01/08/2023]
Abstract
Social anxiety disorder (SAD) represents a common comorbidity in schizophrenia, but questions remain regarding how this comorbidity is related to symptomatology and self-perceptions. Forty-two patients with recent-onset schizophrenia were evaluated for SAD, and assessed with the Positive and Negative Syndrome Scale (PANSS), as well as the Social Comparison Scale (SCS), which assessed how participants perceived themselves in relation with others (i.e., social rank). Eighteen patients met criteria for SAD (SZ+) while 24 patients did not (SZ-). Analysis of symptoms using a five-factor model of the PANSS revealed that the SZ- group had more severe symptoms than SZ+ on the Cognitive/Disorganization factor. Further analyses of individual symptoms demonstrated that the SZ- group was more affected in attention, abstract thinking, and cognitive disorganization (Cognitive/Disorganization symptoms), while the SZ+ group was more severely affected in anxiety, suspiciousness/persecution, and active social avoidance. Interestingly, severity of social anxiety symptom ratings correlated with certain PANSS symptoms only in the SZ- group. Perception of social rank, which was reduced in SZ+, displayed a trend level correlation with the positive symptoms in SZ-. Overall, the results suggest that SZ+ and SZ- may have different clinical profiles that could be important to consider when tailoring treatments for these patients.
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Affiliation(s)
- Stephanie Sutliff
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3
| | - Marc-André Roy
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3
| | - Amélie M Achim
- Département de Psychiatrie et neurosciences, Université Laval, Centre de Recherche de l׳Institut Universitaire en Santé Mentale de Québec, Canada, 2601 Chemin de la Canardière, Québec, QC G1J 2G3.
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255
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de Bont PAJM, van den Berg DPG, van der Vleugel BM, de Roos C, de Jongh A, van der Gaag M, van Minnen A. Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. Br J Psychiatry 2015; 206:408-16. [PMID: 25792693 DOI: 10.1192/bjp.bp.114.148486] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is highly prevalent in patients with a psychotic disorder. Because a PTSD diagnosis is often missed in patients with psychosis in routine care, a valid screening instrument could be helpful. AIMS To determine the validity of the Trauma Screening Questionnaire (TSQ) as a screening tool for PTSD among individuals with psychotic disorders. METHOD Among 2608 patients with a psychotic disorder, the rate of trauma exposure was determined and the TSQ was administered to screen for PTSD. PTSD status was verified in 455 patients using the Clinician-Administered PTSD Scale (trial registration: ISRCTN 79584912). RESULTS Trauma exposure was reported by 78.2% of the 2608 patients. PTSD prevalence was estimated at 16% (95% CI 14.6-17.4%) compared with 0.5% reported in the patients' clinical charts. A TSQ cut-off score of six predicted PTSD with 78.8% sensitivity, 75.6% specificity, 44.5% correct positives and 93.6% correct negatives. CONCLUSIONS The TSQ seems to be a valid screening tool for PTSD in patients with a psychotic disorder.
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Affiliation(s)
- Paul A J M de Bont
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - David P G van den Berg
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Berber M van der Vleugel
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Carlijn de Roos
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Ad de Jongh
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Mark van der Gaag
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Agnes van Minnen
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
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Ankur S, Ankit S, Manish K. Case report of visual hallucinations in anxiety. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:126-9. [PMID: 26120264 PMCID: PMC4466855 DOI: 10.11919/j.issn.1002-0829.215011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/24/2015] [Indexed: 11/27/2022]
Abstract
Hallucinations rarely occur in individuals with anxiety disorders. This case report describes a 36-year-old male with Social Phobia and Agoraphobia with Panic Attacks who had prominent visual hallucinations that were both distressing and incapacitating. Treatment with sertraline 200 mg/d, clonazepam 1 mg/d, and propranolol 20 mg/day for one month completely resolved both his anxiety and the hallucinations, after which he was able to return to his social and occupational life. The report underscores the fact that visual hallucinations are not always indicators of a psychotic disorder, they may be present across a spectrum of mental disorders. In cases where hallucinations occur in nonpsychotic disorders, treatment of the underlying condition usually simultaneously resolves the associated hallucinations without the need to resort to the use of antipsychotic medication. Detailed analyses of such unusual cases can help improve our understanding of the pathogenesis of psychotic-like symptoms.
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Affiliation(s)
- Sachdeva Ankur
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Park Street, New Delhi, India
| | - Saxena Ankit
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Park Street, New Delhi, India
| | - Kandpal Manish
- Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, Park Street, New Delhi, India
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257
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Simpson HB, Reddy YCJ. Obsessive-compulsive disorder for ICD-11: proposed changes to the diagnostic guidelines and specifiers. BRAZILIAN JOURNAL OF PSYCHIATRY 2015; 36 Suppl 1:3-13. [PMID: 25388607 DOI: 10.1590/1516-4446-2013-1229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Since the approval of the ICD-10 by the World Health Organization (WHO) in 1990, global research on obsessive-compulsive disorder (OCD) has expanded dramatically. This article evaluates what changes may be needed to enhance the scientific validity, clinical utility, and global applicability of OCD diagnostic guidelines in preparation for ICD-11. Existing diagnostic guidelines for OCD were compared. Key issues pertaining to clinical description, differential diagnosis, and specifiers were identified and critically reviewed on the basis of the current literature. Specific modifications to ICD guidelines are recommended, including: clarifying the definition of obsessions (i.e., that obsessions can be thoughts, images, or impulses/urges) and compulsions (i.e., clarifying that these can be behaviors or mental acts and not calling these "stereotyped"); stating that compulsions are often associated with obsessions; and removing the ICD-10 duration requirement of at least 2 weeks. In addition, a diagnosis of OCD should no longer be excluded if comorbid with Tourette syndrome, schizophrenia, or depressive disorders. Moreover, the ICD-10 specifiers (i.e., predominantly obsessional thoughts, compulsive acts, or mixed) should be replaced with a specifier for insight. Based on new research, modifications to the ICD-10 diagnostic guidelines for OCD are recommended for ICD-11.
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Affiliation(s)
- Helen Blair Simpson
- College of Physicians and Surgeons, Columbia University Medical College, New York, NY, USA
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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258
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Kim SW, Jeong BO, Kim JM, Shin IS, Hwang MY, Paul Amminger G, Nelson B, Berk M, McGorry P, Yoon JS. Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness. Psychiatry Res 2015; 226:368-75. [PMID: 25681006 DOI: 10.1016/j.psychres.2015.01.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 11/15/2022]
Abstract
This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score ≥ 10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Bo-Ok Jeong
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea
| | - Michael Y Hwang
- Department of Psychiatry, New York Medical College, F.D.R. VAMC (116A), 2094 Albany Post Road, Montrose, New York 10548, USA
| | - G Paul Amminger
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia
| | - Barnaby Nelson
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia
| | - Michael Berk
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia; Impact Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC 3220, Australia
| | - Patrick McGorry
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne and Melbourne Health, Parkville, VIC 3052, Australia
| | - Jin-Sang Yoon
- Department of Psychiatry, Chonnam National University Medical School, 5 Hak-dong, Dong-gu, Gwang-ju 501-746, Republic of Korea.
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Picado M, Carmona S, Hoekzema E, Pailhez G, Bergé D, Mané A, Fauquet J, Hilferty J, Moreno A, Cortizo R, Vilarroya O, Bulbena A. The neuroanatomical basis of panic disorder and social phobia in schizophrenia: a voxel based morphometric study. PLoS One 2015; 10:e0119847. [PMID: 25774979 PMCID: PMC4361479 DOI: 10.1371/journal.pone.0119847] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 01/20/2015] [Indexed: 11/18/2022] Open
Abstract
Objective It is known that there is a high prevalence of certain anxiety disorders among schizophrenic patients, especially panic disorder and social phobia. However, the neural underpinnings of the comorbidity of such anxiety disorders and schizophrenia remain unclear. Our study aims to determine the neuroanatomical basis of the co-occurrence of schizophrenia with panic disorder and social phobia. Methods Voxel-based morphometry was used in order to examine brain structure and to measure between-group differences, comparing magnetic resonance images of 20 anxious patients, 20 schizophrenic patients, 20 schizophrenic patients with comorbid anxiety, and 20 healthy control subjects. Results Compared to the schizophrenic patients, we observed smaller grey-matter volume (GMV) decreases in the dorsolateral prefrontal cortex and precentral gyrus in the schizophrenic-anxiety group. Additionally, the schizophrenic group showed significantly reduced GMV in the dorsolateral prefrontal cortex, precentral gyrus, orbitofrontal cortex, temporal gyrus and angular/inferior parietal gyrus when compared to the control group. Conclusions Our findings suggest that the comorbidity of schizophrenia with panic disorder and social phobia might be characterized by specific neuroanatomical and clinical alterations that may be related to maladaptive emotion regulation related to anxiety. Even thought our findings need to be replicated, our study suggests that the identification of neural abnormalities involved in anxiety, schizophrenia and schizophrenia-anxiety may lead to an improved diagnosis and management of these conditions.
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Affiliation(s)
- Marisol Picado
- Grup de Recerca en Neuroimatge, Fundació IMIM, Barcelona, Spain
- * E-mail:
| | - Susanna Carmona
- Grup de Recerca en Neuroimatge, Fundació IMIM, Barcelona, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain
| | | | - Guillem Pailhez
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
| | - Daniel Bergé
- Grup de Recerca en Neuroimatge, Fundació IMIM, Barcelona, Spain
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
| | - Anna Mané
- Grup de Recerca en Neuroimatge, Fundació IMIM, Barcelona, Spain
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
| | - Jordi Fauquet
- Grup de Recerca en Neuroimatge, Fundació IMIM, Barcelona, Spain
- Departament de Psicobiologia i Metodologia de Ciències de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Joseph Hilferty
- Departament de Filologia Anglesa i Alemanya, Facultad de Filologia, Universitat de Barcelona, Barcelona, Spain
| | - Ana Moreno
- Fundación para la Investigación y la Docencia Maria Angustias Giménez, Germanes Hospitalàries, Barcelona, Spain
| | - Romina Cortizo
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
| | - Oscar Vilarroya
- Grup de Recerca en Neuroimatge, Fundació IMIM, Barcelona, Spain
| | - Antoni Bulbena
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain
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Schirmbeck F, Mier D, Esslinger C, Rausch F, Englisch S, Eifler S, Meyer-Lindenberg A, Kirsch P, Zink M. Increased orbitofrontal cortex activation associated with "pro-obsessive" antipsychotic treatment in patients with schizophrenia. J Psychiatry Neurosci 2015; 40:89-99. [PMID: 25268790 PMCID: PMC4354822 DOI: 10.1503/jpn.140021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with schizophrenia have an approximately 10-fold higher risk for obsessive-compulsive symptoms (OCS) than the general population. A large subgroup seems to experience OCS as a consequence of second-generation antipsychotic agents (SGA), such as clozapine. So far little is known about underlying neural mechanisms. METHODS To investigate the role of SGA treatment on neural processing related to OCS in patients with schizophrenia, we stratified patients according to their monotherapy into 2 groups (group I: clozapine or olanzapine; group II: amisulpride or aripiprazole). We used an fMRI approach, applying a go/no-go task assessing inhibitory control and an n-back task measuring working memory. RESULTS We enrolled 21 patients in group I and 19 patients in group II. Groups did not differ regarding age, sex, education or severity of psychotic symptoms. Frequency and severity of OCS were significantly higher in group I and were associated with pronounced deficits in specific cognitive abilities. Whereas brain activation patterns did not differ during working memory, group I showed significantly increased activation in the orbitofrontal cortex (OFC) during response inhibition. Alterations in OFC activation were associated with the severity of obsessions and mediated the association between SGA treatment and co-occurring OCS on a trend level. LIMITATIONS The main limitation of this study is its cross-sectional design. CONCLUSION To our knowledge, this is the first imaging study conducted to elucidate SGA effects on neural systems related to OCS. We propose that alterations in brain functioning reflect a pathogenic mechanism in the development of SGA-induced OCS in patients with schizophrenia. Longitudinal studies and randomized interventions are needed to prove the suggested causal interrelations.
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Affiliation(s)
- Frederike Schirmbeck
- Correspondence to: F. Schirmbeck, Academic Medical Centre, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands;
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261
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Schirmbeck F, Boyette LL, van der Valk R, Meijer C, Dingemans P, Van R, de Haan L, Kahn RS, de Haan L, van Os J, Wiersma D, Bruggeman R, Cahn W, Meijer C, Myin-Germeys I. Relevance of Five-Factor Model personality traits for obsessive-compulsive symptoms in patients with psychotic disorders and their un-affected siblings. Psychiatry Res 2015; 225:464-70. [PMID: 25613659 DOI: 10.1016/j.psychres.2014.11.066] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/17/2014] [Accepted: 11/30/2014] [Indexed: 11/29/2022]
Abstract
High rates of obsessive-compulsive symptoms (OCS) in schizophrenia require pathogenic explanations. Personality traits may represent risk and resiliency factors for the development of mental disorders and their comorbidities. The aim of the present study was to explore the associations between Five-Factor Model (FFM) personality traits and the liability for OCS in patients with psychotic disorders and in their un-affected siblings. FFM traits, occurrence and severity of OCS and (subclinical) psychotic symptoms were assessed in 208 patients and in 281 siblings. Differences in FFM traits between participants with vs. without comorbid OCS were examined and the predictive value of FFM traits on group categorization was evaluated. Associations between FFM traits and OCS severity were investigated. Patients and siblings with OCS showed significantly higher Neuroticism compared to their counterparts without OCS. Neuroticism was positively associated with higher OCS severity and significantly predicted group assignment in both patients and in siblings. Patients with comorbid OCS presented with lower scores on Extraversion and Conscientiousness. Higher Neuroticism, and to a lesser degree lower Extraversion and Conscientiousness might add to the vulnerability of patients with a psychotic disorder to also develop OCS. Future prospective studies are needed to elucidate proposed personality-psychopathology interrelations and possible mediating factors.
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Affiliation(s)
- Frederike Schirmbeck
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands.
| | - Lindy-Lou Boyette
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | | | - Carin Meijer
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Peter Dingemans
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Rien Van
- Arkin Mental Health Department, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | | | - René S Kahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht The Netherlands
| | - Lieuwe de Haan
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Jim van Os
- Maastricht University Medical Center, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
| | - Durk Wiersma
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, The Netherlands
| | - Richard Bruggeman
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, The Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht The Netherlands
| | - Carin Meijer
- Academic Medical Center University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
| | - Inez Myin-Germeys
- Maastricht University Medical Center, South Limburg Mental Health Research and Teaching Network, Maastricht, The Netherlands
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262
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Bajor LA, Gunzler D, Einstadter D, Thomas C, McCormick R, Perzynski AT, Kanuch SW, Cassidy KA, Dawson NV, Sajatovic M. Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes. Int J Psychiatry Med 2015; 49:309-20. [PMID: 26060262 PMCID: PMC4698974 DOI: 10.1177/0091217415589307] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. METHODS Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. RESULTS Anxiety disorders were seen in 33.1% (N=52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. CONCLUSION One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II.
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Affiliation(s)
- Laura A. Bajor
- VA Boston Healthcare Center, Boston, MA and Instructor of Psychiatry, Harvard Medical School
| | - Douglas Gunzler
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Douglas Einstadter
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Charles Thomas
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Richard McCormick
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Stephanie W Kanuch
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Kristin A Cassidy
- School of Medicine, Case Western Reserve University, University Hospitals Case Medical Center, USA
| | - Neal V Dawson
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA
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263
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Devi S, Rao NP, Badamath S, Chandrashekhar CR, Janardhan Reddy YC. Prevalence and clinical correlates of obsessive-compulsive disorder in schizophrenia. Compr Psychiatry 2015; 56:141-8. [PMID: 25308405 DOI: 10.1016/j.comppsych.2014.09.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Obsessive compulsive symptoms frequently occur in a substantial proportion of patients with schizophrenia. The term schizoobsessive has been proposed to delineate this subgroup of schizophrenia patients who present with obsessive-compulsive symptoms/disorder. However, whether this co-occurrence is more than just co-morbidity and represents a distinct subgroup remains controversial. A striking variation is noted across studies examining prevalence of obsessive-compulsive symptoms/disorder in schizophrenia patients and their impact on clinical profile of schizophrenia. Hence, in this study, we examined the prevalence of obsessive-compulsive symptoms/disorder in a large sample of consecutively hospitalized schizophrenia patients and compared the clinical and functional characteristics of schizophrenia patients with and without obsessive-compulsive symptoms/disorder. We evaluated 200 consecutive subjects with the DSM-IV diagnosis of schizophrenia using the Structured Clinical Interview for DSM-IV Axis I disorders, Positive and Negative Syndrome Scale, Yale-Brown Obsessive-Compulsive Scale, Brown Assessment of Beliefs Scale, Clinical Global Impression-Severity scale, Global Assessment of Functioning Scale, Family Interview for Genetic Studies and World Health Organization Quality of Life scale. The prevalence of obsessive-compulsive symptoms in patients with schizophrenia was 24% (n=48); 37 of them had obsessive-compulsive disorder (OCD) and 11 had obsessive-compulsive symptoms not amounting to a clinical diagnosis of OCD (OCS). Schizophrenia patients with OCS/OCD had an earlier age at onset of schizophrenia symptoms, lower positive symptoms score, higher co-morbidity with Axis II disorders, higher occurrence of OCD in family and better quality of life. Findings of the study indicate a higher prevalence of OCS/OCD in schizophrenia. Schizophrenia patients with and without OCS/OCD have comparable clinical profile with few exceptions. High rates of OCD in first degree relatives suggest possible genetic contributions and differences in neurobiology. Finally, evidence to consider schizoobsessive as a distinct diagnostic entity is inconclusive and warrants further studies.
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Affiliation(s)
- Sugnyani Devi
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Centre for Neuroscience, Indian Institute of Science, Bangalore, India
| | - Suresh Badamath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - C R Chandrashekhar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India.
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264
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Alterations in spatial memory and anxiety in the MAM E17 rat model of hippocampal pathology in schizophrenia. Psychopharmacology (Berl) 2015; 232:4099-112. [PMID: 25633092 PMCID: PMC4970796 DOI: 10.1007/s00213-014-3862-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/29/2014] [Indexed: 12/26/2022]
Abstract
Adult rats exposed to methylazoxymethanol acetate (MAM) at embryonic day 17 (E17) display robust pathological alterations in the hippocampus. However, discrepancies exist in the literature regarding the behavioural effects of this pre-natal manipulation. Therefore, a systematic assessment of MAM E17-induced behavioural alterations was conducted using a battery of dorsal and ventral hippocampus-dependent tests. Compared to saline controls, MAM E17-treated rats displayed deficits in spatial reference memory in both the aversive hidden platform watermaze task and an appetitive Y-maze task. Deficits in the spatial reference memory watermaze task were replicated across three different cohorts and two laboratories. In contrast, there was little, or no, effect on the non-spatial, visible platform watermaze task or an appetitive, non-spatial, visual discrimination task, respectively. MAM rats were also impaired in the spatial novelty preference task which assesses short-term memory, and displayed reduced anxiety levels in the elevated plus maze task. Thus, MAM E17 administration resulted in abnormal spatial information processing and reduced anxiety in a number of hippocampus-dependent behavioural tests, paralleling the effects of dorsal and ventral hippocampal lesions, respectively. These findings corroborate recent pathological and physiological studies, further highlighting the usefulness of MAM E17 as a model of hippocampal dysfunction in at least some aspects of schizophrenia.
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265
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van Minnen A, Zoellner LA, Harned MS, Mills K. Changes in comorbid conditions after prolonged exposure for PTSD: a literature review. Curr Psychiatry Rep 2015; 17:549. [PMID: 25736701 PMCID: PMC4348535 DOI: 10.1007/s11920-015-0549-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Prolonged exposure (PE) is an effective psychological treatment for patients who suffer from PTSD. The majority of PTSD patients have comorbid psychiatric disorders, and some clinicians are hesitant to use PE with comorbid patients because they believe that comorbid conditions may worsen during PE. In this article, we reviewed the evidence for this question: what are the effects of PE on comorbid symptoms and associated symptomatic features? We reviewed findings from 18 randomized controlled trials of PE that assessed the most common comorbid conditions (major depression, anxiety disorders, substance use disorders, personality disorders, and psychotic disorders) and additional symptomatic features (suicidality, dissociation, negative cognitions, negative emotions, and general health and work/social functioning). Although systematic research is not available for all comorbid populations, the existing research indicates that comorbid disorders and additional symptomatic features either decline along with the PTSD symptoms or do not change as a result of PE. Therefore, among the populations that have been studied to date, there is no empirical basis for excluding PTSD patients from PE due to fear of increases in comorbid conditions or additional symptomatic features. Limitations of the existing research and recommendations for future research are also discussed.
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Affiliation(s)
- Agnes van Minnen
- Behavioural Science Institute, Radboud University Nijmegen, NijCare, Pro Persona, Tarweweg 2, 6524 AM, Nijmegen, The Netherlands,
| | - Lori A. Zoellner
- Department of Psychology, University of Washington, Seattle, WA USA
| | | | - Katherine Mills
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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266
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Emotional perception and theory of mind in first episode psychosis: the role of obsessive-compulsive symptomatology. Psychiatry Res 2014; 220:112-7. [PMID: 25130778 DOI: 10.1016/j.psychres.2014.07.058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 07/12/2014] [Accepted: 07/24/2014] [Indexed: 11/23/2022]
Abstract
The aim of the present study was to investigate the effects of comorbid obsessive-compulsive symptoms on emotional perception and theory of mind (ToM) in patients with first-episode psychosis. Participants were 65 patients with non-affective first episode psychosis (FEP) and 47 healthy controls. The patient group was divided into two subgroups, those with (FEP+; n=38) and those without obsessive-compulsive symptomatology (FEP-; n=27). Emotion perception and ToM were assessed with the Perception of Social Inference Test. Severity of psychotic and obsessive-compulsive symptoms was assessed with the Positive and Negative Syndrome Scale (PANSS) and the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), respectively. Deficits in emotion recognition and theory of mind were confirmed in patients with non-affective first-episode psychosis compared to healthy controls. In patients, comorbidity with obsessive-compulsive symptoms was associated with worse performance on certain aspects of social cognition (ToM 2nd order) compared to FEP- patients. Our findings of impaired emotion perception and ToM in patients with first-episode psychosis support the hypothesis that deficits are already present at illness onset. Presence of OCS appears to have further deleterious effects on social cognition, suggesting that these patients may belong to a schizo-obsessive subtype of schizophrenia characterized by more extensive neurobiological impairment.
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267
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Matheson SL, Shepherd AM, Carr VJ. How much do we know about schizophrenia and how well do we know it? Evidence from the Schizophrenia Library. Psychol Med 2014; 44:3387-3405. [PMID: 25065407 DOI: 10.1017/s0033291714000166] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND True findings about schizophrenia remain elusive; many findings are not replicated and conflicting results are common. Well-conducted systematic reviews have the ability to make robust, generalizable conclusions, with good meta-analyses potentially providing the closest estimate of the true effect size. In this paper, we undertake a systematic approach to synthesising the available evidence from well-conducted systematic reviews on schizophrenia. METHOD Reviews were identified by searching Medline, EMBASE, CINAHL, Current Contents and PsycINFO. The decision to include or exclude reviews, data extraction and quality assessments were conducted in duplicate. Evidence was graded as high quality if reviews contained large samples and robust results; and as moderate quality if reviews contained imprecision, inconsistency, smaller samples or study designs that may be prone to bias. RESULTS High- and moderate-quality evidence shows that numerous psychosocial and biomedical treatments are effective. Patients have relatively poor cognitive functioning, and subtle, but diverse, structural brain alterations, altered electrophysiological functioning and sleep patterns, minor physical anomalies, neurological soft signs, and sensory alterations. There are markers of infection, inflammation or altered immunological parameters; and there is increased mortality from a range of causes. Risk for schizophrenia is increased with cannabis use, pregnancy and birth complications, prenatal exposure to Toxoplasma gondii, childhood central nervous system viral infections, childhood adversities, urbanicity and immigration (first and second generation), particularly in certain ethnic groups. Developmental motor delays and lower intelligence quotient in childhood and adolescence are apparent. CONCLUSIONS We conclude that while our knowledge of schizophrenia is very substantial, our understanding of it remains limited.
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Affiliation(s)
- S L Matheson
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
| | - A M Shepherd
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
| | - V J Carr
- Schizophrenia Research Institute, Darlinghurst, Sydney, NSW,Australia
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268
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Garay RP, Samalin L, Hameg A, Llorca PM. Investigational drugs for anxiety in patients with schizophrenia. Expert Opin Investig Drugs 2014; 24:507-17. [DOI: 10.1517/13543784.2014.987339] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Ricardo P Garay
- 1Université Paris-Sud et Hôpital Marie Lannelongue, INSERM U999, Le Plessis-Robinson, France
- 2Craven, Villemoisson-sur-Orge, France ;
| | - Ludovic Samalin
- 3Clermont-Ferrand University, CHU Clermont-Ferrand, EA 7280, Clermont-Ferrand, France
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269
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Williams MT, Capozzoli MC, Buckner EV, Yusko D. Cognitive-Behavioral Treatment of Social Anxiety Disorder and Comorbid Paranoid Schizophrenia. Clin Case Stud 2014. [DOI: 10.1177/1534650114559717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report on the cognitive-behavioral treatment (CBT) of a patient with comorbid social anxiety disorder (SAD), schizophrenia, and major depressive disorder, complicated by alcohol abuse. Symptoms included auditory hallucinations that commented on the patient’s behavior and paranoid thoughts. The paranoid symptoms affected his social interactions as this included the fear that his thoughts may be heard and judged by others. Therapeutic activities raised awareness as to how avoidance interferes with and perpetuates the cycle of depression and psychosis while maintaining symptoms of SAD. Psychoeducation was provided about factors that maintain social anxiety and increase social isolation. New skills were obtained by helping the patient discover alternative ways to view social situations, experimentation, and real-world application to disprove notions about others’ predicted behavior. Treatment led to a great reduction in social anxiety, depression, and suspicious thinking. This case study demonstrates that SAD symptoms in a patient experiencing psychosis can be effectively treated using CBT.
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Affiliation(s)
- Monnica T. Williams
- University of Pennsylvania, Philadelphia, USA
- University of Louisville, KY, USA
| | | | | | - David Yusko
- University of Pennsylvania, Philadelphia, USA
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270
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Fonseka TM, Richter MA, Müller DJ. Second generation antipsychotic-induced obsessive-compulsive symptoms in schizophrenia: a review of the experimental literature. Curr Psychiatry Rep 2014; 16:510. [PMID: 25256097 DOI: 10.1007/s11920-014-0510-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Second generation antipsychotics (SGAs) have been implicated in the de novo emergence and exacerbation of obsessive-compulsive symptoms (OCS) in patients with schizophrenia. Among SGAs, clozapine, olanzapine, and risperidone are the most prominent agents associated with these sequelae, according to case reports. Comorbid OCS can impede recovery by compromising treatment benefits, medication compliance, and clinical prognoses. Previous reviews of SGA-induced OCS have predominantly focused on descriptive case reports, with limited attention paid toward experimental findings. To address this paucity of data, we sought to review the effects of SGAs on OCS in schizophrenia in the experimental literature, while addressing the role of different treatment (duration, dose, serum levels) and pharmacogenetic factors. Our findings suggest that clozapine confers the greatest risk of OCS in schizophrenia, with 20 to 28% of clozapine-treated patients experiencing de novo OCS, in addition to 10 to 18% incurring an exacerbation of pre-existing OCS. Clozapine can also yield full threshold obsessive-compulsive disorder (OCD), in some cases. Olanzapine is another high risk drug for secondary OCS which occurs in 11 to 20% of schizophrenic patients receiving olanzapine therapy. At this time, there is insufficient experimental evidence to characterize the effects of other SGAs on OCS. Despite some experimental support for the involvement of longer treatment duration and genetic factors in mediating drug-induced OCS, more research is needed to clearly elucidate these associations. Based on these results, schizophrenic patients should be routinely monitored for OCS throughout the course of SGA treatment, particularly when clozapine or olanzapine is administered.
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Affiliation(s)
- Trehani M Fonseka
- Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada
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271
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Zink M, Schirmbeck F, Rausch F, Eifler S, Elkin H, Solojenkina X, Englisch S, Wagner M, Maier W, Lautenschlager M, Heinz A, Gudlowski Y, Janssen B, Gaebel W, Michel TM, Schneider F, Lambert M, Naber D, Juckel G, Krueger-Oezguerdal S, Wobrock T, Hasan A, Riedel M, Müller H, Klosterkötter J, Bechdolf A. Obsessive-compulsive symptoms in at-risk mental states for psychosis: associations with clinical impairment and cognitive function. Acta Psychiatr Scand 2014; 130:214-26. [PMID: 24571191 DOI: 10.1111/acps.12258] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Obsessive-compulsive symptoms (OCS) constitute a major comorbidity in schizophrenia. Prevalence estimations of OCS for patients with at-risk mental states (ARMS) for psychosis vary largely. It is unclear how ARMS patients with or without comorbid OCS differ regarding general psychosocial functioning, psychotic and affective symptoms and neurocognitive abilities. METHOD At-risk mental states patients (n = 233) from the interventional trial PREVENT (Secondary Prevention of Schizophrenia) were stratified according to the presence or absence of comorbid OCS and compared on several clinical variables. RESULTS Patients, who fulfilled the criteria for obsessive-compulsive disorder (OCD) or presented with subclinical OCS (ARMSposOCS sample), did not significantly differ from patients without OCS (ARMSnegOCS) with regard to gender, age, premorbid verbal intelligence and levels of education. Furthermore, similar severity of depressive syndromes, basic cognitive, attenuated psychotic and brief limited intermittent psychotic symptoms were found. However, ARMSposOCS patients showed more impairment of psychosocial functioning and higher general psychopathology. In contrast, they scored higher in cognitive tasks measuring working memory and immediate verbal memory. CONCLUSION Findings extend upon previous results due to the multidimensional assessment. Subsequent longitudinal studies might elucidate how comorbid OCS influence differential treatment response, especially to cognitive behavioural interventions and the transition rates to psychosis.
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Affiliation(s)
- M Zink
- Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Hypochondriasis and obsessive-compulsive disorder in schizophrenic patients treated with clozapine vs other atypical antipsychotics. CNS Spectr 2014; 19:340-6. [PMID: 24176043 DOI: 10.1017/s1092852913000795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the prevalence rates of obsessive-compulsive disorder (OCD) and hypochondriasis in schizophrenic patients treated with atypical antipsychotics (AAPs) and to investigate the different comorbidity rates of OCD and hypochondriasis between clozapine-treated patients and patients treated with other AAPs. METHODS We therefore recruited 60 schizophrenic patients treated with clozapine or other AAPs. We assessed the prevalence rates of OCD or OC symptoms and hypochondriasis or hypochondriac symptoms in the whole group of patients and in clozapine-treated patients versus patients treated with other AAPs. RESULTS Schizophrenic patients had a higher comorbidity rate of OCD (26.6% vs 1-3%) and hypochondriasis (20% vs 1%) than the general population. These comorbidities were more frequent in schizophrenic patients treated with clozapine versus patients treated with other AAPs (36.7% vs 16.7% and 33.3% vs 6.7%). Clozapine-treated patients showed a higher mean Y-BOCS and HY-BOCS score when compared to patients treated with other AAPs (10.90 vs 5.90, p = .099; 15.40 vs 8.93, p = .166). A statistical significant correlation was found between the Y-BOCS and HY-BOCS scores of the whole group (r = .378, p = 0.03). Furthermore, we found an inverse correlation between the global level of functioning and the diagnosis of hypochondriasis (p = .048) and the severity of hypochondriac symptoms (p = .047). CONCLUSIONS Hypochondriasis could represent an important clinical feature of schizophrenic patients treated with atypical antipsychotics, and further research is needed in this field.
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Premkumar P, Onwumere J, Wilson D, Sumich A, Castro A, Kumari V, Kuipers E. Greater positive schizotypy relates to reduced N100 activity during rejection scenes. Neuropsychologia 2014; 61:280-90. [PMID: 25010933 DOI: 10.1016/j.neuropsychologia.2014.06.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/06/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
Social anxiety due to rejection sensitivity (RS) exacerbates psychosis-like experiences in the general population. While reduced dorsal anterior cingulate cortex (dACC) activity during social rejection in high schizotypy has suggested self-distancing from rejection, earlier stages of mental processing such as feature encoding could also contribute to psychosis-like experiences. This study aimed to determine the stage of mental processing of social rejection that relates to positive schizotypy. Forty-one healthy participants were assessed for schizotypy and RS. Event-related potential amplitudes (ERPs) were measured at frontal, temporal and parieto-occipital sites and their cortical sources (dACC, temporal pole and lingual gyrus) at early (N100) and late (P300 and late slow wave, LSW) timeframes during rejection, acceptance and neutral scenes. ERPs were compared between social interaction types. Correlations were performed between positive schizotypy (defined as the presence of perceptual aberrations, hallucinatory experiences and magical thinking), RS and ERPs during rejection. Amplitude was greater during rejection than acceptance or neutral conditions at the dACC-P300, parieto-occipital-P300, dACC-LSW and frontal-LSW. RS correlated positively with positive schizotypy. Reduced dACC N100 activity during rejection correlated with greater positive schizotypy and RS. Reduced dACC N100 activity and greater RS independently predicted positive schizotypy. An N100 deficit that indicates reduced feature encoding of rejection scenes increases with greater positive schizotypy and RS. Higher RS shows that a greater tendency to misattribute ambiguous social situations as rejecting also increases with positive schizotypy. These two processes, namely primary bottom-up sensory processing and secondary misattribution of rejection, combine to increase psychosis-like experiences.
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Affiliation(s)
- Preethi Premkumar
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK.
| | - Juliana Onwumere
- King׳s College London, Department of Psychology, Institute of Psychiatry, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Wilson
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Alexander Sumich
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK
| | - Antonio Castro
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham NG1 4BU, UK
| | - Veena Kumari
- King׳s College London, Department of Psychology, Institute of Psychiatry, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Elizabeth Kuipers
- King׳s College London, Department of Psychology, Institute of Psychiatry, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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274
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Katzman MA, Bleau P, Blier P, Chokka P, Kjernisted K, Van Ameringen M. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 2014; 14 Suppl 1:S1. [PMID: 25081580 PMCID: PMC4120194 DOI: 10.1186/1471-244x-14-s1-s1] [Citation(s) in RCA: 457] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. METHODS These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980-2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines. RESULTS These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions. CONCLUSIONS Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.
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Affiliation(s)
- Martin A Katzman
- Department of Psychiatry, University of Toronto, Toronto, ON, M5S 1A1, Canada
| | - Pierre Bleau
- Department of Psychiatry, McGill University, Montreal, QC, H3A 1A1, Canada
| | - Pierre Blier
- Department of Psychiatry and Cellular/Molecular Medicines, University of Ottawa, Ottawa, ON, K1Z 7K4, Canada
| | - Pratap Chokka
- Department of Psychiatry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Kevin Kjernisted
- Department of Psychiatry, University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, L8N 3K7, Canada
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The effects of a brief CBT intervention, delivered by frontline mental health staff, to promote recovery in people with psychosis and comorbid anxiety or depression (the GOALS study): study protocol for a randomized controlled trial. Trials 2014; 15:255. [PMID: 24973026 PMCID: PMC4100041 DOI: 10.1186/1745-6215-15-255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND NICE guidance states that cognitive behavioural therapy (CBT) should be offered to all patients with psychosis. However, there is a need to improve access to therapeutic interventions. We aim to train frontline mental health staff to deliver brief, structured CBT-based therapies. We have developed and piloted a manualized intervention to support people with psychosis and anxious avoidance or depression to work towards a personal recovery goal. METHODS/DESIGN The 'GOALS Study' is a pilot randomized controlled trial comparing usual care plus an 8-week intervention with usual care alone. The key objective is to assess clinical feasibility (recruitment and randomization; compliance with the treatment manual; acceptability and satisfaction; progress towards goals). A secondary objective is a preliminary evaluation of efficacy. Sixty-six participants with a diagnosis of psychosis, plus symptoms of depression or anxiety will be recruited from adult mental health services. Those currently refusing medication, in receipt of CBT, or with a primary diagnosis of an organic mental health problem or substance dependency will be excluded. Following informed consent, randomization will be independent of the trial team, at a 50:50 ratio, at the level of the individual and stratified by main problem focus. Following randomization, participants allocated to the intervention group will begin the 8-week intervention with a local, trained member of staff, supervised by the study coordinator. Outcomes will be assessed blind to treatment condition at 0, 12 and 18 weeks post-randomization. The primary outcome measure for the efficacy analysis will be activity levels at 12 weeks. Secondary outcome measures include mood, psychotic symptoms, quality of life and clinical distress. A health economic analysis comparing service use in each condition will also be performed. Recruitment began in March, 2013 and is ongoing until December, 2014. DISCUSSION This is the first trial of the GOALS intervention. The approach is brief and staff can be readily trained in its delivery: there is therefore potential to develop a cost-effective intervention that could be widely disseminated. If the trial proves clinically feasible and demonstrates preliminary evidence of efficacy, a large multi-site trial will be warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN 73188383. http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=13538.
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276
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Tully LM, Niendam TA. Beyond “Cold” Cognition: Exploring Cognitive Control of Emotion as a Risk Factor for Psychosis. Curr Behav Neurosci Rep 2014. [DOI: 10.1007/s40473-014-0016-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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277
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Zink M. Comorbid Obsessive-Compulsive Symptoms in Schizophrenia: Insight into Pathomechanisms Facilitates Treatment. Adv Med 2014; 2014:317980. [PMID: 26556409 PMCID: PMC4590963 DOI: 10.1155/2014/317980] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 05/19/2014] [Indexed: 12/17/2022] Open
Abstract
Insight into the biological pathomechanism of a clinical syndrome facilitates the development of effective interventions. This paper applies this perspective to the important clinical problem of obsessive-compulsive symptoms (OCS) occurring during the lifetime diagnosis of schizophrenia. Up to 25% of schizophrenia patients suffer from OCS and about 12% fulfil the diagnostic criteria of obsessive-compulsive disorder (OCD). This is accompanied by marked subjective burden of disease, high levels of anxiety, depression and suicidality, increased neurocognitive impairment, less favourable levels of social and vocational functioning, and greater service utilization. Comorbid patients can be assigned to heterogeneous subgroups. It is assumed that second generation antipsychotics (SGAs), most importantly clozapine, might aggravate or even induce second-onset OCS. Several epidemiological and pharmacological arguments support this assumption. Specific genetic risk factors seem to dispose patients with schizophrenia to develop OCS and risk-conferring polymorphisms has been defined in SLC1A1, BDNF, DLGAP3, and GRIN2B and in interactions between these individual genes. Further research is needed with detailed characterization of large samples. In particular interactions between genetic risk constellations, pharmacological and psychosocial factors should be analysed. Results will further define homogeneous subgroups, which are in need for differential causative interventions. In clinical practise, schizophrenia patients should be carefully monitored for OCS, starting with at-risk mental states of psychosis and longitudinal follow-ups, hopefully leading to the development of multimodal therapeutic interventions.
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Affiliation(s)
- Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, P.O. Box 12 21 20, 68072 Mannheim, Germany
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278
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Rajkumar RP. Childhood attachment and schizophrenia: the "attachment-developmental-cognitive" (ADC) hypothesis. Med Hypotheses 2014; 83:276-81. [PMID: 24957505 DOI: 10.1016/j.mehy.2014.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 05/05/2014] [Accepted: 05/24/2014] [Indexed: 10/25/2022]
Abstract
Schizophrenia is a complex psychiatric syndrome whose exact causes remain unclear. However, current scientific consensus has highlighted the importance of neurodevelopmental and neurocognitive processes in the development of schizophrenic symptoms. Research over the past three decades, motivated by the findings of the World Health Organization's large-scale studies, has highlighted the importance of psychosocial adversities - including childhood abuse and neglect - in this disorder. In this paper, I propose a hypothesis based on John Bowlby's framework of attachment theory, which I have termed the attachment-developmental-cognitive (ADC) hypothesis. The ADC hypothesis integrates recent developments related to (1) existing models of schizophrenia, (2) studies examining the effect of attachment on brain biology and cognitive development, and (3) various known facts about the course and outcome of this disorder. In doing so, it explains how disturbed childhood attachment leads to core psychological and neurochemical abnormalities which are implicated in the genesis of schizophrenia and also affect its outcome. The ADC hypothesis compasses and expands on earlier formulations, such as the "social defeat" and "traumagenic" models, and has important implications regarding the prevention and treatment of schizophrenia. Ways of testing and refining this hypothesis are outlined as avenues for future research. Though provisional, the ADC hypothesis is entirely consistent with both biological and psychosocial research into the origins of schizophrenia.
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Affiliation(s)
- Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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279
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Naidu K, van Staden W(CW, van der Linde M. Severity of psychotic episodes in predicting concurrent depressive and anxiety features in acute phase schizophrenia. BMC Psychiatry 2014; 14:166. [PMID: 24903304 PMCID: PMC4068766 DOI: 10.1186/1471-244x-14-166] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 05/28/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Considering that depressive and anxiety symptoms are common in schizophrenia, this study investigated whether the severity of a psychotic episode in an acute phase schizophrenia cohort is predictive of concurrent depressive and anxiety features. METHOD Fifty one recently hospitalised patients suffering from acute phase schizophrenia participated prospectively in a cross-sectional study. The severity of the psychotic episode, the depressive features and the anxiety features were measured by the Structured Clinical Interview for Positive and Negative Syndrome Scale (SCI-PANSS), the Calgary Depression Scale for Schizophrenia (CDSS), the Hamilton Anxiety Rating Scale (HAM-A) and the Staden Schizophrenia Anxiety Rating Scale (S-SARS). The total SCI-PANSS-scores were adjusted to exclude appropriately the depression or anxiety items contained therein. To examine akathisia as potential confounder, the Barnes Akathisia Scale was also applied. The relationships were examined using linear regressions and paired t-tests were performed between lower and higher scores on the SCI-PANSS. RESULTS A higher adjusted total SCI-PANSS-score predicted statistically significantly higher scores for depressive features on the CDSS (p < 0.0001) and for anxiety features on the HAM-A (p = 0.05) and the S-SARS (p < 0.0001). The group that scored more or equal to the median (=99) of the adjusted total SCI-PANSS, scored significantly higher (p < 0.0001) on the CDSS, the HAM-A and the S-SARS than the group scoring below it. Akathisia measured distinctly different (p < 0.0001) from both the anxiety measures. CONCLUSION The study suggests that the severity of a psychotic episode in acute phase schizophrenia predicts the severity of concurrent depressive and anxiety features respectively.
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Affiliation(s)
- Kalai Naidu
- Department of Psychiatry, University of Pretoria, Private Bag X323, Arcadia, Pretoria 0007, South Africa
| | - Werdie (CW) van Staden
- Department of Psychiatry, University of Pretoria, Private Bag X323, Arcadia, Pretoria 0007, South Africa
| | - Mike van der Linde
- Department of Statistics, University of Pretoria, Pretoria, South Africa
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280
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Granö N, Karjalainen M, Edlund V, Saari E, Itkonen A, Anto J, Roine M. Anxiety symptoms in adolescents at risk for psychosis: a comparison among help seekers. Child Adolesc Ment Health 2014; 19:97-101. [PMID: 32878386 DOI: 10.1111/camh.12012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several studies have reported on how anxiety disorders and anxiety symptoms are already present before the onset of psychosis. However, anxiety disorders are typically studied in these studies at diagnosis-level. The aim of present study was to investigate the profile of anxiety symptoms in subjects at risk of developing psychosis and to compare the anxiety profile with those who are not at risk. METHOD Data were collected at Helsinki University Central Hospital (HUCH) by an early detection and intervention team. Of 185 help-seeking respondents, between 12 and 18 years of age, 59 adolescents were classified as being at risk of psychosis and 126 as not being at risk via an interview conducted by a validated at-risk assessment tool (PROD). Anxiety was measured using the Beck Anxiety Inventory (BAI). RESULTS The anxiety total sum score was higher in the at-risk group for psychosis (mean 8.33 vs. 13.34, p = .000). Both subfactors of the anxiety scale, cognitive anxiety (p = .000) and somatic anxiety (p = .000), differed significantly by risk status. After using the Bonferroni correction for multiple analysis, items of relax (p = .000), nervous (p = .002), losing control (p = .000) and faint (p = .002) had statistically significant higher mean scores in the group at risk of psychosis. In logistic regression analysis, being female (p = .015) and the subfactor relating to cognitive anxiety (p = .044) significantly explained the at-risk status for psychosis. CONCLUSIONS Adolescents at risk for psychosis have a higher level of anxiety compared with other help-seeking adolescents. These results should be considered in clinical practice.
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Affiliation(s)
- Niklas Granö
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
| | - Marjaana Karjalainen
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
| | - Virve Edlund
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
| | - Erkki Saari
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
| | - Arja Itkonen
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
| | - Jukka Anto
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
| | - Mikko Roine
- Helsinki University Central Hospital, Jorvi Hospital, Department of Psychiatry, Turuntie 150, 02740, Espoo, Finland
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281
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Michalopoulou PG, Konstantakopoulos G, Typaldou M, Papageorgiou C, Christodoulou GN, Lykouras L, Oulis P. Can cognitive deficits differentiate between schizophrenia with and without obsessive-compulsive symptoms? Compr Psychiatry 2014; 55:1015-21. [PMID: 24411931 DOI: 10.1016/j.comppsych.2013.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The frequent occurrence of obsessive-compulsive symptoms (OCS) in the course of schizophrenia and their impact on the functional outcome of the illness underlie the suggestion that the presence of OCS represents a separate subtype of schizophrenia, with a distinct clinical presentation and prognosis and specific neurobiological characteristics. This study investigated whether the presence of OCS in schizophrenia is associated with worse cognitive functioning in the domains of processing speed, executive functions and visuospatial memory. We also explored whether the degree of impairment in any of these cognitive domains could predict group membership (i.e. Schizophrenia with OCS [Sch-OCS] and Schizophrenia without OCS) and if there was a relationship between cognitive functioning and severity of OCS within the Sch-OCS group. METHODS Forty patients with schizophrenia, 20 with and 20 without OCS, individually matched for age, gender, years of education and severity of psychotic symptoms and 20 healthy controls underwent a comprehensive neuropsychological assessment. RESULTS Only lower performance in processing speed discriminated patients with OCS from patients without OCS. Processing speed impairment not only classified patients in OCS or non-OCS group but was also independent of the severity of OCS symptoms. CONCLUSIONS The notion of additive effects of both schizophrenia and OCD on the structural and functional integrity of the brain circuits that support cognitive functions warrants further investigation in longitudinal neuropsychological and neuroimaging studies with larger samples and sufficient variation in the severity of OCS.
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Affiliation(s)
- Panayiota G Michalopoulou
- Section of Schizophrenia, Imaging and Therapeutics, Department of Psychosis studies, Institute of Psychiatry, King's College London, UK; Second Department of Psychiatry, Athens University Medical School, Greece.
| | - George Konstantakopoulos
- First Department of Psychiatry, Athens University Medical School, Greece; Section of Cognitive Neuropsychiatry, Department of Psychosis studies, Institute of Psychiatry, King's College London, UK
| | - Maria Typaldou
- First Department of Psychiatry, Athens University Medical School, Greece
| | | | | | - Lefteris Lykouras
- Second Department of Psychiatry, Athens University Medical School, Greece
| | - Panagiotis Oulis
- First Department of Psychiatry, Athens University Medical School, Greece
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282
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Modeling combined schizophrenia-related behavioral and metabolic phenotypes in rodents. Behav Brain Res 2014; 276:130-42. [PMID: 24747658 DOI: 10.1016/j.bbr.2014.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/08/2014] [Accepted: 04/09/2014] [Indexed: 12/11/2022]
Abstract
Schizophrenia is a chronic, debilitating disorder with a complex behavioral and cognitive phenotype underlined by a similarly complex etiology involving an interaction between susceptibility genes and environmental factors during early development. Limited progress has been made in developing novel pharmacotherapy, partly due to a lack of valid animal models. The recent recognition of the potentially causal role of central and peripheral energy metabolism in the pathophysiology of schizophrenia raises the need of research on animal models that combine both behavioral and metabolic phenotypic domains, similar to what have been identified in humans. In this review we focus on selected genetic (DBA/2J mice, leptin receptor mutants, and PSD-93 knockout mice), early neurodevelopmental (maternal protein deprivation) and pharmacological (acute phencyclidine) animal models that capture the combined behavioral and metabolic abnormalities shown by schizophrenic patients. In reviewing behavioral phenotypes relevant to schizophrenia we apply the principles established by the Research Domain Criteria (RDoC) for better translation. We demonstrate that etiologically diverse manipulations such as specific breeding, deletion of genes that are primarily involved in metabolic regulation and in synaptic plasticity, as well as early metabolic deprivation and adult pharmacological challenge of the glutamate system can lead to schizophrenia-related behavioral and metabolic phenotypes, which suggest that these pathways might be interlinked. We propose that using animal models that combine different domains of schizophrenia can be used as a translationally valid approach to capture the system-level complex interplay between peripheral and central processes in the development of psychopathology.
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283
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Fusar-Poli P, Carpenter W, Woods S, McGlashan T. Attenuated Psychosis Syndrome: Ready for DSM-5.1? Annu Rev Clin Psychol 2014; 10:155-92. [DOI: 10.1146/annurev-clinpsy-032813-153645] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- P. Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London SE5 8AF, United Kingdom;
- OASIS Prodromal Team, South London and the Maudsley (SLaM) NHS Foundation Trust, London SE5 8AF, United Kingdom
| | - W.T. Carpenter
- Maryland Psychiatric Research Center, University of Maryland School of Medicine, Baltimore, Maryland 21228
- US Department of Veterans Affairs, VISN 5 Mental Illness Research and Clinical Center, Baltimore, Maryland 21201
| | - S.W. Woods
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut 06519
| | - T.H. McGlashan
- Department of Psychiatry, Yale University School of Medicine, Connecticut Mental Health Center, New Haven, Connecticut 06519
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284
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Janssen G, De Mey H, Hendriks A, Koppers A, Kaarsemaker M, Witteman C, Egger J. Assessing Deictic Relational Responding in Individuals With Social Anxiety Disorder: Evidence of Perspective-Taking Difficulties. PSYCHOLOGICAL RECORD 2014. [DOI: 10.1007/s40732-014-0013-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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285
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Llorca PM, Lancon C, Blanc O, de Chazeron I, Samalin L, Caci H, Lesturgeon JA, Bayle FJ. A composite scale applied to evaluate anxiety in schizophrenic patients (SAES). Eur Arch Psychiatry Clin Neurosci 2014; 264:171-8. [PMID: 23771406 DOI: 10.1007/s00406-013-0416-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/31/2013] [Indexed: 01/24/2023]
Abstract
Anxiety in schizophrenia possesses specific features and is difficult to assess because no specific evaluating tool is currently available. The aim of this study was to develop and validate a hetero-assessment-based scale to specifically measure anxiety in schizophrenia. A literature review and a survey among psychiatrists allowed the selection of 29 items from 4 previous scales evaluating anxiety. Factor analysis allowed building up a final 22-item composite scale of anxiety evaluation in schizophrenia (SAES), which was then validated in 147 schizophrenic patients. One hundred and forty-seven (147) schizophrenic patients (70.8 % male, mean age = 36.9 years) were included in the study. Principal component analysis of the SAES revealed three factors, namely "expressed and perceived anxiety," "somatic anxiety," and "anxiety and environment". All total and factor scores of the SAES were significantly correlated (p < .001) with total and factor scores of the original scales. Finally, the SAES showed good inter-rater reliability [intra-class correlation coefficient (ICC) = .82]. In conclusion, a specific tool for evaluating anxiety in schizophrenia (SAES) was developed and validated in a sample of schizophrenic patients. The SAES can be useful to investigate clinical, psychopathological, and therapeutic aspects of anxiety in schizophrenia.
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Affiliation(s)
- Pierre-Michel Llorca
- CHU of Clermont-Ferrand, Psychiatry Service, Place Henri Dunant, 63000, Clermont-Ferrand, France
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286
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The obsessive compulsive spectrum in schizophrenia, a meta-analysis and meta-regression exploring prevalence rates. Schizophr Res 2014; 152:458-68. [PMID: 24361303 DOI: 10.1016/j.schres.2013.10.033] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 10/16/2013] [Accepted: 10/25/2013] [Indexed: 01/26/2023]
Abstract
AIMS The aims of this study were to conduct a meta-analysis and meta-regression to estimate the prevalence rates for obsessive compulsive symptoms (OCS) and obsessive compulsive disorder (OCD) in schizophrenia, and to investigate what influences these prevalence rates. METHOD Studies were identified via an online OVID database search, including PsychInfo, Embase and Medline until December 2009. RESULTS Forty-three studies summarizing outcomes for 3978 subjects met inclusion criteria. The mean OCD prevalence is 12.3%, slightly increasing to 13.6% after adjustment in meta-regression. The prevalence rate of OCS, defined as any obsession or compulsion is 30.7% (30.3% adjusted). Higher severity of OCS, DIGS assessment, and Sub-Saharan African origin of study are associated with a lower OCS/OCD prevalence rate, use of DSM-IV edition, Y-BOCS assessment and longer schizophrenia history are associated with a higher prevalence rate. CONCLUSION The prevalence of OCS and OCD in schizophrenia is substantial, specifically in more chronic patient populations and is influenced by the method of assessment.
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287
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Vodušek VV, Parnas J, Tomori M, Škodlar B. The phenomenology of emotion experience in first-episode psychosis. Psychopathology 2014; 47:252-60. [PMID: 24481376 DOI: 10.1159/000357759] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although it has been suggested that disturbances in emotion experience and regulation play a central role in the aetiology and psychopathology of schizophrenia spectrum disorders, the phenomenology of emotion experience in schizophrenia remains under-researched. SAMPLING AND METHODS In-depth interviews were conducted twice with each of the 20 participants (firstly at admission and secondly 6 months later). Data collection and analysis were guided by the principles of phenomenological study of lived experience. RESULTS The emotion experiences described by our participants vary greatly in both quality and intensity, but appear to have a common phenomenology. Anxiety is reported as the basic emotion which buffers, transforms and sometimes supplants all others. Emotions in general are experienced as foreign, unstable and perturbing, thereby contributing greatly to feelings of ambivalence, perplexity and an unstable sense of self in general. CONCLUSIONS The findings of this study have important therapeutic and theoretical implications because they suggest that emotion experiences in schizophrenia spectrum disorders may underlie a wide range of psychopathological phenomena in both the cognitive and social functioning domains. Due to the relatively small sample size and its selection from psychotherapeutic units, the results may not be generalizable to all schizophrenia patients.
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Affiliation(s)
- V V Vodušek
- University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
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288
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Rial D, Lara DR, Cunha RA. The Adenosine Neuromodulation System in Schizophrenia. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2014; 119:395-449. [DOI: 10.1016/b978-0-12-801022-8.00016-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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289
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Andersen SM, Randers A, Jensen CM, Bisgaard C, Steinhausen HC. Preceding diagnoses to young adult bipolar disorder and schizophrenia in a nationwide study. BMC Psychiatry 2013; 13:343. [PMID: 24359146 PMCID: PMC3898215 DOI: 10.1186/1471-244x-13-343] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 12/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this comparative study was to investigate the type and frequency of diagnoses preceding adult bipolar disorder (BD) and schizophrenia (SZ). METHODS A follow-back study of all preceding diagnoses in all patients aged 21-34 years with a primary, first time diagnosis of BD (N = 784) or SZ (N = 1667) in 2008 to 2010. Data were taken from the Danish Psychiatric Central Research Register (DPCRR) including ICD-10 and ICD-8 diagnoses. RESULTS The numbers of patients with any preceding diagnoses amounted to 69.3% in BD and 76.6% in SZ with affective disorders (excluding BD) being the most frequent preceding diagnosis (46.6 vs. 28.0%), followed by psychoses (PSY) other than SZ (14.2 vs. 41.5%, p < .001), and substance use disorders (SUD) (16.1 vs. 26.9%, p < .001). Reactions to severe stress were equally frequent in both samples (26.3 vs. 26.6%) as were personality disorders (21.8 vs. 22.4%) and ADHD (4.2 vs. 3.5%), whereas rates of conduct disorders (1.7 vs. 3.1%) were rather low in both samples. Very few of the preceding diagnoses had their onset in childhood and adolescence. Overall patients with SZ had a minor but statistically significant earlier onset of any psychiatric disorder compared to BD (mean age: 23.3 vs. 22.5, p < .001). Regression analyses indicated that BD was associated with an increased risk of having experienced preceding affective disorders and ADHD, while SZ was associated with an increased risk of preceding substance use disorders, psychosis, anxiety disorders, and personality disorders. CONCLUSIONS Specific developmental trajectories of preceding disorders were delineated for BD and SZ with affective disorders being more specific for BD and both SUD and PSY more specific to SZ. There are different patterns of vulnerability in terms of preceding diagnosis in young adults with BD and SZ.
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Affiliation(s)
- Søren Martin Andersen
- Department of Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, DK 9000 Aalborg, Denmark.
| | - Anne Randers
- Department of Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Mølleparkvej 10, DK 9000 Aalborg, Denmark
| | - Christina Mohr Jensen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Charlotte Bisgaard
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark
| | - Hans-Christoph Steinhausen
- Research Unit for Child and Adolescent Psychiatry, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark,Clinical Psychology and Epidemiology, Institute of Psychology, University of Basel, Basel, Switzerland,Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
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290
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de Bont PAJM, van Minnen A, de Jongh A. Treating PTSD in patients with psychosis: a within-group controlled feasibility study examining the efficacy and safety of evidence-based PE and EMDR protocols. Behav Ther 2013; 44:717-30. [PMID: 24094795 DOI: 10.1016/j.beth.2013.07.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 06/23/2013] [Accepted: 07/11/2013] [Indexed: 11/29/2022]
Abstract
The present study uses a within-group controlled design to examine the efficacy and safety of two psychological approaches to posttraumatic stress disorder (PTSD) in 10 patients with a concurrent psychotic disorder. Patients were randomly assigned either to prolonged exposure (PE; N=5) or eye movement desensitization and reprocessing (EMDR; N=5). Before, during, and after treatment, a total of 20 weekly assessments of PTSD symptoms, hallucinations, and delusions were carried out. Twelve weekly assessments of adverse events took place during the treatment phase. PTSD diagnosis, level of social functioning, psychosis-prone thinking, and general psychopathology were assessed pretreatment, posttreatment, and at three-month follow-up. Throughout the treatment, adverse events were monitored at each session. An intention-to-treat analysis of the 10 patients starting treatment showed that the PTSD treatment protocols of PE and EMDR significantly reduced PTSD symptom severity; PE and EMDR were equally effective and safe. Eight of the 10 patients completed the full intervention period. Seven of the 10 patients (70%) no longer met the diagnostic criteria for PTSD at follow-up. No serious adverse events occurred, nor did patients show any worsening of hallucinations, delusions, psychosis proneness, general psychopathology, or social functioning. The results of this feasibility trial suggest that PTSD patients with comorbid psychotic disorders benefit from trauma-focused treatment approaches such as PE and EMDR.
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291
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Tsai J, Rosenheck RA. Psychiatric comorbidity among adults with schizophrenia: a latent class analysis. Psychiatry Res 2013; 210:16-20. [PMID: 23726869 PMCID: PMC3800495 DOI: 10.1016/j.psychres.2013.05.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 05/04/2013] [Accepted: 05/07/2013] [Indexed: 12/31/2022]
Abstract
Schizophrenia is a severe mental illness that often co-occurs with and can be exacerbated by other psychiatric conditions. There have not been adequate efforts to examine schizophrenia and psychiatric comorbidity beyond pairwise examination using clusters of diagnoses. This study used latent class analysis to characterize patterns of 5-year psychiatric comorbidity among a national sample of adults with schizophrenia. Baseline data from 1446 adults with schizophrenia across 57 sites in the United States were analyzed. Three latent classes were identified labeled Solely Schizophrenia, Comorbid Anxiety and Depressive Disorders with Schizophrenia, and Comorbid Addiction and Schizophrenia. Adults in the Solely Schizophrenia class had significantly better mental health than those in the two comorbid classes, but poorer illness and treatment insight than those with comorbid anxiety and depressive disorders. These results suggest that addiction and schizophrenia may represent a separate latent profile from depression, anxiety, and schizophrenia. More research is needed on how treatment can take advantage of the greater insight possessed by those with schizophrenia and comorbid anxiety and depression.
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Affiliation(s)
- Jack Tsai
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Robert A. Rosenheck
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, CT, USA,Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA,Yale School of Public Health, New Haven, CT, USA
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292
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Cunill R, Huerta-Ramos E, Castells X. The effect of obsessive-compulsive symptomatology on executive functions in schizophrenia: a systematic review and meta-analysis. Psychiatry Res 2013; 210:21-8. [PMID: 23810510 DOI: 10.1016/j.psychres.2013.05.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 04/29/2013] [Accepted: 05/23/2013] [Indexed: 11/28/2022]
Abstract
The presence of obsessive-compulsive symptoms (OCS) and obsessive-compulsive disorder (OCD) is frequent in patients with schizophrenia and has been associated with greater functional impairment. The impact of these features on cognitive function is unclear. In this article, we performed a systematic review and meta-analysis to assess the effect of OCS/OCD on executive functions in schizophrenia patients. Results indicate that schizophrenia patients with OCS/OCD were more impaired in abstract thinking than schizophrenia patients without OCS/OCD. This finding provides support to the double jeopardy hypothesis and may partially explain the greater functional impairment shown in schizo-obsessive patients compared to those with schizophrenia. Inconsistent results were found for set-shifting, cognitive flexibility, cognitive inhibition and verbal fluency, as indicated by the high statistical heterogeneity found. Potential sources of heterogeneity such as definition of OCS/OCD, age of onset, severity of negative symptoms and premorbid intelligence were planned to be explored but there was an insufficient number of studies to perform these analyses. Our findings highlight the complexity of the relationship between OCS/OCD and schizophrenia and warrant further investigation of the cognitive function of schizo-obsessive patients.
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Affiliation(s)
- Ruth Cunill
- Unitat d'Hospitalització Psiquiàtrica Penitenciària de Catalunya, Parc Sanitari Sant Joan de Déu, Carretera Martorell-Capellades km 23, 08735, Sant Esteve Sesrovires, Barcelona, Catalonia, Spain.
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293
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Braga RJ, Reynolds GP, Siris SG. Anxiety comorbidity in schizophrenia. Psychiatry Res 2013; 210:1-7. [PMID: 23932838 DOI: 10.1016/j.psychres.2013.07.030] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/06/2013] [Accepted: 07/19/2013] [Indexed: 10/26/2022]
Abstract
Diagnostic and treatment hierarchical reductionisms have led to an oversight of anxiety syndromes in schizophrenia. Nevertheless, recent data have indicated that anxiety can be a significant source of morbidity in this patient group. This paper reviews current knowledge concerning anxiety comorbidity in schizophrenia, its epidemiology, course, and treatment. A computerized search of the literature published from 1966 to July 2012 was conducted on Medline. Comorbid anxiety disorders are present in 38.3% of subjects with schizophrenia spectrum disorders. The most common anxiety disorder is social phobia followed by post-traumatic stress disorder and obsessive compulsive disorder. The presence and severity of symptoms of anxiety are associated with more severe clinical features and poorer outcomes. Available literature on the treatment consists primarily of case reports and open trials. Fragments of data support the notion of treating these anxiety states and syndromes as co-occurring clinical conditions with adjunctive medications and psychosocial interventions. However, additional work remains to be done on this issue before firm conclusions can be drawn.
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Affiliation(s)
- Raphael J Braga
- The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Department of Psychiatry Research, Glen Oaks, NY, USA; Department of Psychiatry, Hofstra North Shore-LIJ School of Medicine at Hofstra University, Hempstead, NY, USA.
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294
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Schirmbeck F, Rausch F, Englisch S, Eifler S, Esslinger C, Meyer-Lindenberg A, Zink M. Stable cognitive deficits in schizophrenia patients with comorbid obsessive-compulsive symptoms: a 12-month longitudinal study. Schizophr Bull 2013; 39:1261-71. [PMID: 23104864 PMCID: PMC3796074 DOI: 10.1093/schbul/sbs123] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Amongst schizophrenia patients, a large subgroup of up to 25% also suffers from comorbid obsessive-compulsive symptoms (OCSs). The association between comorbid OCSs in these patients and neuropsychological impairment remains unclear and somewhat contradictory. Longitudinal approaches investigating the stability of OCS-associated cognitive deficits are missing. METHODS Thirty-seven patients with schizophrenia and comorbid OCSs and 43 schizophrenia patients without OCS were assessed with a comprehensive cognitive test battery and compared at baseline and, again, 12 months later. RESULTS Schizophrenia patients with comorbid OCSs showed significant pronounced deficits, with increasing effect sizes over the 12-month assessment period in specific cognitive areas such as visuospatial perception and visual memory (WAIS-R block design, Rey-Osterrieth Complex Figure Test), executive functioning (perseveration in the Wisconsin Card Sorting test), and cognitive flexibility (Trail Making test B). These cognitive domains are correlated with OCS severity and are known to be candidate cognitive domains in obsessive-compulsive disorder (OCD). CONCLUSIONS OCSs in schizophrenia is associated with specific and longitudinally stable cognitive deficits, strongly arguing for at least partially overlapping neurobiological mechanisms with OCD. Prospective studies involving patients with at-risk mental states for psychosis are necessary to decipher the interaction of cognitive impairment and the clinical manifestations of schizophrenia and OCSs. This might facilitate the definition of patients at high risk for OCSs, an early detection of subclinical levels, therapeutic interventions, and clinical monitoring.
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Affiliation(s)
- Frederike Schirmbeck
- To whom correspondence should be addressed; Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, University of Heidelberg, PO Box 12 21 20, D-68072 Mannheim, Germany; tel: 0049-621-1703-2523, fax: 0049-621-1703-1205, e-mail:
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295
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Attachment and self-consciousness: A dynamic connection between schizophrenia and panic. Med Hypotheses 2013; 81:792-6. [DOI: 10.1016/j.mehy.2013.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 08/14/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
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296
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Training Frontline Mental Health Staff to Deliver “Low Intensity” Psychological Therapy for Psychosis: A Qualitative Analysis of Therapist and Service User Views on the Therapy and its Future Implementation. Behav Cogn Psychother 2013; 43:298-313. [DOI: 10.1017/s1352465813000908] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Increasing access to evidence-based talking therapies for people with psychosis is a national health priority. We have piloted a new, “low intensity” (LI) CBT intervention specifically designed to be delivered by frontline mental health staff, following brief training, and with ongoing supervision and support. A pilot feasibility study has demonstrated significant improvement in service user outcomes. This study is a qualitative analysis of the experiences of the staff and service users taking part in the evaluation. Aims: To evaluate the acceptability of the training protocol and the therapy, and to examine the factors promoting and restraining implementation. Method: All trained staff and service users completed a semi-structured interview that was transcribed and subjected to thematic analysis. Results: Service users spoke about learning new skills and achieving their goals. Staff spoke about being able to use a brief, structured intervention to achieve positive outcomes for their clients. Both groups felt that longer, more sophisticated interventions were required to address more complex problems. The positive clinical outcomes motivated therapists to continue using the approach, despite organizational barriers. Conclusions: For both trained staff and service users, taking part in the study was a positive experience. Staff members’ perceived skill development and positive reaction to seeing their clients improve should help to promote implementation. Work is needed to clarify whether and how more complex difficulties should be addressed by frontline staff.
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297
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Kim SW, Lindenmayer JP, Hwang MY. Schizophrenia with Obsessive-Compulsive Symptoms: Clinical and Conceptual Issues. Psychiatr Ann 2013. [DOI: 10.3928/00485713-20131003-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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298
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Oulis P, Konstantakopoulos G, Lykouras L, Michalopoulou PG. Differential diagnosis of obsessive-compulsive symptoms from delusions in schizophrenia: A phenomenological approach. World J Psychiatry 2013; 3:50-56. [PMID: 24255875 PMCID: PMC3832861 DOI: 10.5498/wjp.v3.i3.50] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 05/31/2013] [Accepted: 06/10/2013] [Indexed: 02/05/2023] Open
Abstract
Several studies suggest increased prevalence-rates of obsessive-compulsive symptoms (OCS) and even of obsessive-compulsive disorder (OCD) in patients with schizophrenic disorders. Moreover, it has been recently proposed the existence of a distinct diagnostic sub-group of schizo-obsessive disorder. However, the further investigation of the OCS or OCD-schizophrenia diagnostic comorbidity presupposes the accurate clinical differential diagnosis of obsessions and compulsions from delusions and repetitive delusional behaviours, respectively. In turn, this could be facilitated by a careful comparative examination of the phenomenological features of typical obsessions/compulsions and delusions/repetitive delusional behaviours, respectively. This was precisely the primary aim of the present investigation. Our examination included seven features of obsessions/delusions (source of origin and sense of ownership of the thought, conviction, consistency with one’s belief-system, awareness of its inaccuracy, awareness of its symptomatic nature, resistance, and emotional impact) and five features of repetitive behaviours (aim of repetitive behaviours, awareness of their inappropriateness, awareness of their symptomatic nature, and their immediate effect on underlying thought, and their emotional impact). Several of these clinical features, if properly and empathically investigated, can help discriminate obsessions and compulsive rituals from delusions and delusional repetitive behaviours, respectively, in patients with schizophrenic disorders. We comment on the results of our examination as well as on those of another recent similar investigation. Moreover, we also address several still controversial issues, such as the nature of insight, the diagnostic status of poor insight in OCD, the conceptualization and differential diagnosis of compulsions from other categories of repetitive behaviours, as well as the diagnostic weight assigned to compulsions in contemporary psychiatric diagnostic systems. We stress the importance of the feature of mental reflexivity for understanding the nature of insight and the ambiguous diagnostic status of poor insight in OCD which may be either a marker of the chronicity of obsessions, or a marker of their delusionality. Furthermore, we criticize two major shortcomings of contemporary psychiatric diagnostic systems (DSM-IV, DSM-V, ICD-10) in their criteria or guidelines for the diagnosis of OCD or OCS: first, the diagnostic parity between obsessions and compulsions and, second, the inadequate conceptualization of compulsions. We argue that these shortcomings might artificially inflate the clinical prevalence of OC symptoms in the course of schizophrenic disorders. Still, contrary to a recent proposal, we do not exclude on purely a priori grounds the possibility of a concurrence of genuine obsessions along with delusions in patients with schizophrenia.
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299
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Bosanac P, Mancuso S, Castle D. Anxiety symptoms in psychotic disorders. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2013:1-22. [PMID: 24047760 DOI: 10.3371/csrp.boma.091313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BackgroundThe prevalence of anxiety symptoms among Australians with psychotic disorders was examined as part of the Survey of High Impact Psychosis (SHIP).MethodsA two-phase design was used. Of 7,955 people who were screen positive for psychosis and eligible, 1825 participants (18-34 years and 35-64 years) were interviewed. Data were collected on symptomatology, substance use, cognitive ability, functioning, disability, physical health, mental health service utilisation, medication use, education, employment and housing. Anxiety symptomatology was divided into generalized anxiety, panic, phobic, social anxiety and obsessive-compulsive symptoms.ResultsThe most common ICD-10 diagnoses were schizophrenia or schizoaffective disorder (63.0%) and bipolar (mania) disorder (17.5%). Overall, 59.8% (n = 1092) of participants reported experiencing anxiety symptoms in the previous 12 months. Female gender was highly associated with all domains of anxiety. Smoking was significantly associated with all domains of anxiety, except generalized anxiety. The presence of any depressive symptoms in the previous 12 months was significantly associated with all anxiety symptoms. Medication side-effects were associated with phobic and obsessive-compulsive symptoms. Social dysfunction was associated with social anxiety, and less so for obsessive-compulsive symptoms.ConclusionsAnxiety symptoms are common in people with psychotic disorders. Appropriate screening and treatment should be a clinical priority.
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Affiliation(s)
- P Bosanac
- St Vincent's Mental Health, University of Melbourne, PO Box 2900, Fitzroy 3065, Melbourne Australia
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300
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Dekker N, Swets M, Cahn W, Linszen DH, de Haan L, van Os J, Krabbendam L, Myin-Germeys I, Wiersma D, Bruggeman R. Substance use in a large sample of patients with schizophrenia or related disorders and co-morbid obsessive-compulsive symptoms. Aust N Z J Psychiatry 2013; 47:868-74. [PMID: 23723291 DOI: 10.1177/0004867413491156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to examine the relationship between obsessive-compulsive symptoms (OCS) and substance use in patients with a non-affective psychotic disorder. METHOD The data were derived from the Genetic Risk and Outcome of Psychosis study. Using the Yale-Brown Obsessive Compulsive Scale, three groups of in- and outpatients with non-affective psychotic disorder (76.6% male, mean age 27.7 years, mean duration of illness 4.5 years) were distinguished: patients without OCS (N = 777), patients with mild OCS (N = 143) and patients with more severe OCS (N = 85). These three groups were compared using various substance use variables, including quantitative substance use variables and severity of substance use [Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) misuse disorders]. RESULTS We found no statistically significant differences in smoking and other substance use variables between the three patients groups according to the severity of OCS. CONCLUSIONS Our large study sample and detailed comparison of substance use rates strongly adds to the evidence that schizophrenia patients with OCS do not differ in prevalence of substance use compared to patients without OCS. This suggests that in clinical practice, enquiring into (problematic) substance use is relevant in both schizophrenia patients with co-morbid OCS and patients without OCS.
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Affiliation(s)
- Nienke Dekker
- Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands
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