Prognostic significance of psychotic relapse in patients with first-episode acute and transient psychosis: New empirical support for ICD-11

Immunological Biomarkers as Predictors of Treatment Response in Psychotic Disorders

Psychotic disorders, notably schizophrenia, impose a detrimental burden on both an individual and a societal level. The mechanisms leading to psychotic disorders are multifaceted, with genetics and environmental factors playing major roles. Increasing evidence additionally implicates neuro-inflammatory processes within at least a subgroup of patients with psychosis. While numerous studies have investigated anti-inflammatory add-on treatments to current antipsychotics, the exploration of immunological biomarkers as a predictor of treatment response remains limited. This review outlines the current evidence from trials exploring the potential of baseline inflammatory biomarkers as predictors of the treatment effect of anti-inflammatory drugs as add-ons to antipsychotics and of antipsychotics alone. Several of the studies have found correlations between baseline immunological biomarkers and treatment response; however, only a few studies incorporated baseline biomarkers as a primary endpoint, and the findings thus need to be interpreted with caution. Our review emphasizes the need for additional research on the potential of repurposing anti-inflammatory drugs while utilizing baseline inflammatory biomarkers as a predictor of treatment response and to identify subgroups of individuals with psychotic disorders where add-on treatment with immunomodulating agents would be warranted. Future studies investigating the correlation between baseline inflammatory markers and treatment responses can pave the way for personalized medicine approaches in psychiatry centred around biomarkers such as specific baseline inflammatory biomarkers in psychotic disorders.

Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3-year longitudinal study

INTRODUCTION

Brief psychotic disorder (BPD) is a relatively uncommon and underexplored psychotic condition. Even though BPD has been related to a more favorable outcome than other schizophrenia spectrum disorders (SSD), current knowledge of its predictive factors remains scant. This study aimed to examine its prevalence and find early predictors of BPD diagnostic stability.

METHODS

SSD diagnosis following Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria was explored in a large epidemiological cohort (n = 569) of non-affective first-episode psychosis (FEP) patients enrolled in a three-year longitudinal intervention program (PAFIP). Premorbid, sociodemographic, and clinical information was collected to characterize BPD patients and determine factors predictive of diagnostic stability. Multivariate analysis included predictors selected from clinical knowledge and also those that had achieved marginal significance (p ≤ 0.1) in univariate analysis.

RESULTS

A total of 59 patients enrolled in the PAFIP program (10.4% of the whole cohort) met DSM-IV criteria for BPD, of whom 40 completed the three-year follow-up. The temporal stability of BPD in our sample was as high as 40% (n = 16). Transition from BPD to schizophrenia occurred in 37% (n = 15) of patients. Fewer hallucinations at baseline and better insight independently significantly predicted BPD diagnostic stability over time.

CONCLUSION

Our findings confirm that BPD is a clinical condition with moderate-to-low temporal stability and demonstrate that approximately two-thirds of FEP individuals experiencing BPD will develop a long-lasting psychotic disorder during follow-up, mainly schizophrenia.

Acute and Transient Psychotic Disorder induced by fear of coronavirus infection

BACKGROUND

Acute and Transient Psychotic Disorder (ATPD) (ICD-10) is characterized by the sudden onset of psychotic symptoms and can be triggered by psychological stress. In the ICD-10 definition of ATPD, episodes are short-term, lasting from days to three months, followed by complete remission.

OBJECTIVE

This paper reports the case of a 37-year-old woman with stress-induced new-onset psychosis instigated by fear of coronavirus infection.

METHOD

Physical examinations, paraclinical testing, and neuroimaging excluded an organic cause of symptoms. A thorough anamnestic investigation excluded the presence of other concomitant stress factors as the trigger of the patient's psychotic symptoms.

RESULTS

In response to the COVID-19 lockdown, the patient developed excessive concern about coronavirus infection and, consequently, sleeping difficulties. Symptoms intensified, and she was admitted to the psychiatric ward, presenting with hallucinations, delusions, disorganized speech, and disorientation. The clinical picture fulfilled the diagnostic criteria of an Acute and Transient Psychotic Disorder. After one week of antipsychotic treatment, her symptoms had remitted, and the patient was discharged. Albeit, four months after treatment discontinuation, her psychotic symptoms re-emerged, and she was readmitted. The patient recovered from symptoms within 48 hours of treatment initiation with antipsychotics. She later reported to have been stressed and anxious while awaiting her coronavirus test result and, following, had doubted the negative result.

CONCLUSION

The present case supports previous reports describing the COVID-19 pandemic's effect on population mental health; the psychological stress caused by the fear of infection can lead to the debut of psychotic manifestations and ATPD.