Deliberate self-harm in a patient with hyperthyroidism with acute psychosis

Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China

INTRODUCTION

Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD.

METHODS

A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt.

RESULTS

Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32).

CONCLUSION

Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.

Association between thyroid function and psychotic symptoms in adolescents with major depressive disorder: A large sample sized cross-sectional study in China

Backgrounds

Thyroid function was associated with depression and psychotic symptoms; however, little research has focused on its role in coexisting psychotic symptoms in adolescents with depressive disorder. This study aimed to explore the association between thyroid function and psychotic symptoms among depression adolescents.

Methods

A total of 679 adolescent patients (aged 12-18) diagnosed as depressive disorder were recruited. Their socio-demographic, clinical data and thyroid function parameters were collected. The severity of psychotic symptoms was measured according to the assessment measure in DSM-5. Based on the severity of psychotic symptoms, patients were distributed into psychotic depression (PD) and non-psychotic depression (NPD) subgroups, respectively.

Results

The prevalence rate of PD was 52.7% among adolescents with depressive disorder in this study. PD patients were younger (p < 0.01), with more female (p < 0.001) and non-Han nationality (p < 0.01), and presented serum FT4 level decrease (p < 0.01). PD patients displayed a higher rate of abnormal thyroid relevant parameters (p < 0.05). 35.2% of PD patients presented at least one abnormal parameter among all five parameters tested (TSH, TT3, FT3, TT4, and FT4), compared to 27.4% among NPD patients. Further logistic regression analysis indicated that increased serum FT4 level was a protective effect of PD with an adjusted odds ratio (OR) of 0.615. We did not find a statistically significant difference in the family history of mental disorders, serum TSH, TT3, FT3, and TT4 levels.

Conclusions

Our results suggested a high prevalence of PD among depression adolescents, associated with younger age, female, non-Han nationality, and decreased serum FT4 level. We recommend that adolescents with depressive disorder regularly screen their serum FT4 levels for better clinical outcomes.

Redefining the Cut-Off Ranges for TSH Based on the Clinical Picture, Results of Neuroimaging and Laboratory Tests in Unsupervised Cluster Analysis as Individualized Diagnosis of Early Schizophrenia

Thyroid abnormalities, including mild forms of hypothyroidism and hyperthyroidism, are reported as risk factors for the development of a number of neuropsychiatric disorders, including schizophrenia. The diagnostic process still takes into account the extreme ranges of the accepted reference values for serum TSH since the concentration of free thyroxine in the serum does not change by definition. TSH mU/L cut-off values in psychiatric patients are currently clinically considered in the case of extremely high serum TSH levels (>4.0 mU/L). The results obtained in this study suggest that the clinically significant value has a lower TSH cut-off point with an upper limit of 2–2.5 mU/L. The criteria for the differential diagnosis of patients with schizophrenia, however, mainly take into account statutory reference ranges without a background related to the history of thyroid diseases in the family. The results indicate the need to lower the upper cut-off values for TSH among patients with early psychosis, which is related to the potential clinical significance of the obtained values both in the field of clinical evaluation and neuroimaging and laboratory evaluation parameters. The cut-off points obtained with the prior available knowledge coincided with the values established in the unsupervised clustering method, which further confirms the legitimacy of their use in the individualized diagnosis strategy of schizophrenia.