1
|
Colli C, Garzitto M, Bonivento C, Delvecchio G, Maggioni E, Fagnani C, Medda E, Mauri M, Nobile M, Brambilla P. Exploring the effects of family and life events on genetic and environmental architecture of schizotypal and hypomanic dimensions: Insights from a twin study. J Affect Disord 2024; 362:375-383. [PMID: 38971195 DOI: 10.1016/j.jad.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 06/12/2024] [Accepted: 07/03/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Strategies of prevention for psychiatric disorders need a deep understanding of the aetiological factors involved in the psychopathological processes. Our twin study aims at disentangling the contributions of genes and environment to schizotypal and hypomanic dimensions, considering the role of stressful life events (LEs) and the quality of family relationships. METHODS The Magical Ideation Scale (MIS) and Perceptual Aberration Scale (PAS) were used to assess positive schizotypy, while Hypomanic Personality Scale (HPS) and its sub-scales were used to investigate proneness to affective disorders. 268 twins (54.5 % female; aged 18.0 ± 6.68) were included. Participants filled out a questionnaire on LEs and their parents provided an evaluation of intra-family relationship (Relationship Quality Index, RQI). Classic univariate twin models for quantitative traits were fitted for scales, and the effects of covariates (LEs and RQI) were assessed. RESULTS For MIS, HPS and its sub-scales, significant common and unique environmental effects were detected, with genetic factors affecting only HPS Social Vitality sub-scale. Unique environment was the only source of variance of PAS score. The number of recent LEs influenced MIS and PAS models, while RQI score affected MIS model. LIMITATIONS The main limitation of the study is the small sample size, which reduces statistical power and may potentially lead to an underestimation of heritability. Additionally, the cross-sectional design limits the possibility to draw causal considerations. CONCLUSIONS Findings provide preliminary evidence for a significant environmental role in modulating states of vulnerability. Moreover, the expression of positive schizotypy resulted influenced by recent stressors and intra-family relationships.
Collapse
Affiliation(s)
- Chiara Colli
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Marco Garzitto
- Department of Medicine (DAME), University of Udine, Udine, Italy
| | | | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora Maggioni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Corrado Fagnani
- Italian Twin Registry, Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Emanuela Medda
- Italian Twin Registry, Centre for Behavioural Sciences and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Maddalena Mauri
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute, IRCCS Eugenio Medea, Bosisio Parini (LC), Italy
| | - Paolo Brambilla
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| |
Collapse
|
2
|
Vardhan A, Vishwanath R, Soman S, Nagaraj AK. A summer of acute and transient psychosis: A case series. Indian J Psychiatry 2024; 66:213-215. [PMID: 38523757 PMCID: PMC10956583 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_323_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/11/2023] [Accepted: 01/17/2024] [Indexed: 03/26/2024] Open
Abstract
The association between the season and the occurrence of acute transient psychotic disorder (ATPD) has been sparsely studied. We would like to report five patients who presented with acute psychotic symptoms during the summer and discuss other risk factors that could be associated with this seasonal predilection.
Collapse
Affiliation(s)
- Arohi Vardhan
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rashmi Vishwanath
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Savitha Soman
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anil Kumar Nagaraj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
3
|
Ho NF, Lin AY, Tng JXJ, Chew QH, Cheung MWL, Javitt DC, Sim K. Abnormalities in visual cognition and associated impaired interactions between visual and attentional networks in schizophrenia and brief psychotic disorder. Psychiatry Res Neuroimaging 2022; 327:111545. [PMID: 36272310 DOI: 10.1016/j.pscychresns.2022.111545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022]
Abstract
The extent and nature of cognitive impairment in brief psychotic disorder remains unclear, being rarely studied unlike schizophrenia. The present study hence sought to directly compare the visual cognitive dysfunction and its associated brain networks in brief psychotic disorder and schizophrenia. Data from picture completion (a complex visual task) and whole-brain functional connectome from resting-state fMRI were acquired from a sample of clinically stable patients with an established psychotic disorder (twenty with brief psychotic disorder, twenty with schizophrenia) and twenty-nine healthy controls. Group differences and the inter-relationships in task performances and brain networks were tested. Picture completion task deficits were found in brief psychotic disorder compared with healthy controls, though the deficits were less than schizophrenia. Task performance also correlated with severity of psychotic symptoms in patients. The task performance was inversely correlated with the functional connectivity between peripheral visual and attentional networks (dorsal attention and salience ventral attention), with increased functional connectivity in brief psychotic disorder compared with healthy controls and in schizophrenia compared with brief psychotic disorder. Present findings showed pronounced visual cognitive impairments in brief psychotic disorder that were worse in schizophrenia, underpinned by abnormal interactions between higher-order attentional and lower-order visual processing networks.
Collapse
Affiliation(s)
- New Fei Ho
- Institute of Mental Health, Singapore; Duke-National University of Singapore Medical School, Singapore.
| | | | | | | | | | | | - Kang Sim
- Institute of Mental Health, Singapore
| |
Collapse
|
4
|
Vasile CI, Vasile MC, Zlati ML, Herbei EE, Lepădatu L, Munteanu C, Nechifor A, Tatu AL. Post COVID-19 Infection Psychosis: Could SARS-CoV-2 Virus Infection Be a Neuropsychiatric Condition That Triggers Psychotic Disorders? - A Case-Based Short Review. Infect Drug Resist 2022; 15:4697-4705. [PMID: 36034176 PMCID: PMC9416515 DOI: 10.2147/idr.s373578] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022] Open
Abstract
Corona virus (COVID-19) is an epidemy of respiratory disease caused by a novel corona virus and it was declared by the World Health Organization (WHO) to be a global health pandemic emergency. Due to the neuropsychiatric manifestation of Covid-19 that have been associated with psychotic disorders, in this paper we choose to present a case from “Elena Doamna” Psychiatric Hospital from Galati, Romania and to correlate it with other cases from literature in a mini review presentation. In our paper, we present the case of a patient of 44-year-old men, with no past psychiatric history whose behavior included psycho-motor agitation, perception and thinking disorders, disorganized behaviour, attempted suicide by stabbing. The last perspectives from the two years of pandemic together with psychiatric disease linked the virus infections with psychosis to the main concern that Covid-19 could determine psychiatric disorders. There were also presented same literature studies of patients with no personal pathological history in the psychiatric field which developed psychiatric disorders after COVID-19 infection. SARS-CoV-2 has a psychological impact on the mental health status of the worldwide and, especially when it is associated with psychotic symptoms and can affect the quality-of-life. In some cases, the virus affected the brain and as a result, the psychosis symptoms could be an emerging phenomenon associated with the corona virus. Based on the DSM V and ICD-10 criteria, the diagnosis was of acute psychiatric disorders with symptoms of schizophrenia (F23.1). The case report and review reliefs that there is a causal link between the SARS CoV-2 infection and mental disorders, which is currently being investigated.
Collapse
Affiliation(s)
- Claudiu Ionut Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, România.,"Elena Doamna" Clinical Hospital of Psychiatry, Galaţi, România
| | - Mihaela Camelia Vasile
- Clinical Medical Department, Faculty of Medicine and Pharmacy, "Dunărea de Jos" University, Galați, România.,Infectious Diseases Department, Clinical Hospital of Infectious Diseases "Sf. Cuvioasa Parascheva", Galați, România
| | - Monica Laura Zlati
- Business Administration Department, Dunărea de Jos University, Galați, România.,Accounting, Audit and Finance Department, Stefan Cel Mare University, Suceava, România
| | - Elena Emanuela Herbei
- Department of Materials and Environmental Engineering, Centre of Nanostructures and Functional Materials, Faculty of Engineering, University "Dunărea de Jos", Galaţi, România
| | - Lorena Lepădatu
- "Sf Ap Andrei" Emergency County Clinical Hospital, Galați, România
| | | | - Alexandru Nechifor
- Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, Galați, România
| | - Alin Laurențiu Tatu
- Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, Galați, România.,Dermatology Department, "Sf Cuv Parascheva" Clinical Hospital of Infectious Diseases, Galați, România.,Multidisciplinary Integrated Center of Dermatological Interface Research MIC DIR, Dunărea de Jos" University, Galați, România
| |
Collapse
|
5
|
Valdés-Florido MJ, López-Díaz Á, Palermo-Zeballos FJ, Garrido-Torres N, Álvarez-Gil P, Martínez-Molina I, Martín-Gil VE, Ruiz-Ruiz E, Mota-Molina M, Algarín-Moriana MP, Guzmán-del Castillo AH, Ruiz-Arcos Á, Gómez-Coronado R, Galiano-Rus S, Rosa-Ruiz A, Prados-Ojeda JL, Gutierrez-Rojas L, Crespo-Facorro B, Ruiz-Veguilla M. Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study. Eur Arch Psychiatry Clin Neurosci 2022; 272:5-15. [PMID: 33811552 PMCID: PMC8019303 DOI: 10.1007/s00406-021-01256-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
This study aimed to characterize the clinical profile of patients with brief psychotic disorders (BPD) triggered by the psychosocial distress derived from the COVID-19 crisis. A multicenter study was conducted from March 14 to May 14, 2020 (the peak weeks of the pandemic in Europe). All consecutive patients presenting non-affective psychotic episodes with a duration of untreated psychosis of less than 1 month and whose onset was related to the COVID-19 crisis were recruited, but only those patients meeting Diagnostic Statistical Manual 5th edition (DSM-5) criteria for "BPD with marked stressors" (DSM-5 code: 298.8) during follow-up were finally included. Patients' sociodemographic and clinical characteristics were collected at baseline and summarized with descriptive statistics. During the study period, 57 individuals with short-lived psychotic episodes related to the emotional stress of the COVID-19 pandemic were identified, of whom 33 met DSM-5 criteria for "BPD with marked stressors". The mean age was 42.33 ± 14.04 years, the gender distribution was almost the same, and the majority were rated as having good premorbid adjustment. About a quarter of the patients exhibited suicidal symptoms and almost half presented first-rank schizophrenia symptoms. None of them were COVID-19 positive, but in more than half of the cases, the topic of their psychotic features was COVID-19-related. The coronavirus pandemic is triggering a significant number of BPD cases. Their risk of suicidal behavior, their high relapse rate, and their low temporal stability make it necessary to closely monitor these patients over time.
Collapse
Affiliation(s)
| | - Álvaro López-Díaz
- grid.411375.50000 0004 1768 164XVirgen Macarena University Hospital, Seville, Spain ,grid.414816.e0000 0004 1773 7922Institute of Biomedicine of Seville (IBiS), Seville, Spain ,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain
| | | | | | - Paula Álvarez-Gil
- grid.411380.f0000 0000 8771 3783Virgen de las Nieves University Hospital, Granada, Spain
| | - Iván Martínez-Molina
- grid.411109.c0000 0000 9542 1158Virgen del Rocío University Hospital, Seville, Spain
| | | | - Elena Ruiz-Ruiz
- grid.411349.a0000 0004 1771 4667Reina Sofía University Hospital, Córdoba, Spain
| | | | | | | | | | | | | | | | | | | | - Benedicto Crespo-Facorro
- Institute of Biomedicine of Seville (IBiS), Seville, Spain. .,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain. .,Virgen del Rocío University Hospital, Seville, Spain. .,Department of Psychiatry, University of Seville, Seville, Spain.
| | - Miguel Ruiz-Veguilla
- grid.414816.e0000 0004 1773 7922Institute of Biomedicine of Seville (IBiS), Seville, Spain ,Network Centre for Biomedical Research in Mental Health (CIBERSAM), Seville, Spain ,grid.411109.c0000 0000 9542 1158Virgen del Rocío University Hospital, Seville, Spain ,grid.9224.d0000 0001 2168 1229Department of Psychiatry, University of Seville, Seville, Spain
| |
Collapse
|
6
|
Fusar-Poli P, Salazar de Pablo G, Rajkumar RP, López-Díaz Á, Malhotra S, Heckers S, Lawrie SM, Pillmann F. Diagnosis, prognosis, and treatment of brief psychotic episodes: a review and research agenda. Lancet Psychiatry 2022; 9:72-83. [PMID: 34856200 DOI: 10.1016/s2215-0366(21)00121-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 12/25/2022]
Abstract
Brief psychotic episodes represent an intriguing paradox in clinical psychiatry because they elude the standard knowledge that applies to the persisting psychotic disorders such as schizophrenia. This Review describes key diagnostic considerations such as conceptual foundations, current psychiatric classification versus research-based operationalisations, epidemiology, and sociocultural variations; prognostic aspects including the risk of psychosis recurrence, types of psychotic recurrences, other clinical outcomes, prognostic factors; and therapeutic issues such as treatment guidelines and unmet need of care. The advances and challenges associated with the scientific evidence are used to set a research agenda in this area. We conclude that brief psychotic episodes can be reconceptualised within a clinical staging model to promote innovative translational research and improve our understanding and treatment of psychotic disorders.
Collapse
Affiliation(s)
- Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Gonzalo Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK; Institute of Psychiatry and Mental Health, Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERSAM, Madrid, Spain
| | - Ravi Philip Rajkumar
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Álvaro López-Díaz
- University Hospital Virgen Macarena, Seville, Spain; Institute of Biomedicine of Seville, Seville, Spain
| | | | - Stephan Heckers
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Frank Pillmann
- WO Center of Psychiatry, Halle, Germany; Martin Luther University, Halle-Wittenberg, Germany
| |
Collapse
|
7
|
Damiani S, Rutigliano G, Fazia T, Merlino S, Berzuini C, Bernardinelli L, Politi P, Fusar-Poli P. Developing and Validating an Individualized Clinical Prediction Model to Forecast Psychotic Recurrence in Acute and Transient Psychotic Disorders: Electronic Health Record Cohort Study. Schizophr Bull 2021; 47:1695-1705. [PMID: 34172999 PMCID: PMC8530399 DOI: 10.1093/schbul/sbab070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acute and transient psychotic disorders (ATPDs) include short-lived psychotic episodes with a high probability of developing psychotic recurrences. Clinical care for ATPD is currently limited by the inability to predict outcomes. Real-world electronic health record (EHR)-based retrospective cohort study STROBE/RECORD compliant included all individuals accessing the South London and Maudsley NHS Trust between 2006 and 2017 and receiving a first diagnosis of ATPD (F23, ICD-10). After imputing missing data, stepwise and LASSO Cox regression methods employing a priori predictors (n = 23) were compared to develop and internally validate an individualized risk prediction model to forecast the risk of psychotic recurrences following TRIPOD guidelines. The primary outcome was prognostic accuracy (area under the curve [AUC]). 3018 ATPD individuals were included (average age = 33.75 years, 52.7% females). Over follow-up (average 1042 ± 1011 days, up to 8 years) there were 1160 psychotic recurrences (events). Stepwise (n = 12 predictors) and LASSO (n = 17 predictors) regression methods yielded comparable prognostic accuracy, with an events per variable ratio >100 for both models. Both models showed an internally validated adequate prognostic accuracy from 4 years follow-up (AUC 0.70 for both models) and good calibration. A refined model was adapted in view of the new ICD-11 criteria on 307 subjects with polymorphic ATPD, showing fair prognostic accuracy at 4 years (AUC: stepwise 0.68; LASSO 0.70). This study presents the first clinically based prediction model internally validated to adequately predict long-term psychotic recurrence in individuals with ATPD. The model can be automatable in EHRs, supporting further external validations and refinements to improve its prognostic accuracy.
Collapse
Affiliation(s)
- Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Grazia Rutigliano
- Department of Pathology, University of Pisa, Pisa, Italy
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
| | - Teresa Fazia
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Sergio Merlino
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Carlo Berzuini
- Center for Biostatistics, The University of Manchester, Manchester, UK
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions & Clinical-detection (EPIC) Lab, Department of Psychosis Studies, King’s College London, London, UK
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
8
|
Canal-Rivero M, Ayesa-Arriola R, Setién-Suero E, Crespo-Facorro B, Arango C, Dutta R, Lopez-Morinigo JD. Understanding the Influence of Personality Traits on Risk of Suicidal Behaviour in Schizophrenia Spectrum Disorders: A Systematic Review. J Clin Med 2021; 10:jcm10194604. [PMID: 34640622 PMCID: PMC8509679 DOI: 10.3390/jcm10194604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Risk of suicidal behaviour (SB) in schizophrenia spectrum disorders (SSD) is a major concern, particularly in early stages of the illness, when suicide accounts for a high number of premature deaths. Although some risk factors for SB in SSD are well understood, the extent to which personality traits may affect this risk remains unclear, which may have implications for prevention. We conducted a systematic review of previous studies indexed in MEDLINE, PsycINFO and Embase examining the relationship between personality traits and SB in samples of patients with SSD. Seven studies fulfilled predetermined selection criteria. Harm avoidance, passive-dependent, schizoid and schizotypal personality traits increased the risk of SB, while self-directedness, cooperativeness, excluding persistence and self-transcendence acted as protective factors. Although only seven studies were retrieved from three major databases after applying predetermined selection criteria, we found some evidence to support that personality issues may contribute to SB in patients with SSD. Personality traits may therefore become part of routine suicide risk assessment and interventions targeting these personality-related factors may contribute to prevention of SB in SSD.
Collapse
Affiliation(s)
- Manuel Canal-Rivero
- Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (M.C.-R.); (B.C.-F.)
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain; (R.A.-A.); (C.A.)
- Grupo de Psiquiatría Traslacional, Instituto de Biomedicina de Sevilla (IBIS), 41013 Sevilla, Spain
| | - Rosa Ayesa-Arriola
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain; (R.A.-A.); (C.A.)
- Department of Psychiatry, Marqués de Valdecilla University Hospital, IDIVAL, School of Medicine, University of Cantabria, 39008 Santander, Spain
| | - Esther Setién-Suero
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, 48007 Bilbao, Spain;
| | - Benedicto Crespo-Facorro
- Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (M.C.-R.); (B.C.-F.)
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain; (R.A.-A.); (C.A.)
- Grupo de Psiquiatría Traslacional, Instituto de Biomedicina de Sevilla (IBIS), 41013 Sevilla, Spain
| | - Celso Arango
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain; (R.A.-A.); (C.A.)
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28029 Madrid, Spain
| | - Rina Dutta
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK;
- South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Javier-David Lopez-Morinigo
- Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), 28029 Madrid, Spain; (R.A.-A.); (C.A.)
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, 28029 Madrid, Spain
- Departament of Psychiatry, School of Medicine, Universidad Autónoma de Madrid, 28029 Madrid, Spain
- Department of Psychiatry, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-627-277-126
| |
Collapse
|
9
|
Esposito CM, Fiorentini A, Callari A, Galeazzi GM, Brambilla P. Transition Between Sensitive Delusion of Reference and Mood Disorder: A Case Report. Front Psychiatry 2021; 12:712552. [PMID: 34552517 PMCID: PMC8450362 DOI: 10.3389/fpsyt.2021.712552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
The Sensitive Delusion of Reference is a clinical entity described by Ernst Kretschmer and never integrated into mainstream nosographic systems. It represents the possibility of developing psychosis starting from a personality characterized by sensitivity, scrupulousness, and fear of judgment of others. The presentation of the following clinical case highlights how the overlap between this clinical entity and mood disorders leads to characteristic psychopathology, which has not been sufficiently detailed. In particular, the delusions, which always starts from the idea of reference and the shame in the face of the judgment of others, takes on characteristics of guilt during the depressive phases and persecutory themes during the activation phases. This clinical observation, which obviously needs to be confirmed on a larger scale, encourages a renewed interest in the concept of Kretschmer's Sensitive Delusion of Reference and creates the possibility of intersecting multiple psychopathological levels, for a more complete perspective on the individual case.
Collapse
Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Fiorentini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonio Callari
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento di Salute Mentale e Dipendenze Patologiche, USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| |
Collapse
|
10
|
Parra A, Juanes A, Losada CP, Álvarez-Sesmero S, Santana VD, Martí I, Urricelqui J, Rentero D. Psychotic symptoms in COVID-19 patients. A retrospective descriptive study. Psychiatry Res 2020; 291:113254. [PMID: 32603930 PMCID: PMC7311337 DOI: 10.1016/j.psychres.2020.113254] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023]
Abstract
Psychotic symptoms have been related to other coronavirus infections. We conducted a single-centre retrospective and observational study to describe new-onset psychotic episodes in COVID-19 patients. Ten patients infected by the novel coronavirus with psychotic symptoms and no previous history of psychosis were identified by the emergency and liaison psychiatry departments. Nine of the cases presented with psychotic symptoms at least two weeks after the first somatic manifestations attributed to COVID-19 and receiving pharmacological treatment. Structured delusions mixed with confusional features were the most frequent clinical presentations. Hence, COVID-19 patients can develop psychotic symptoms as a consequence of multiple concurrent factors.
Collapse
Affiliation(s)
- A Parra
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Juanes
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - C P Losada
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain; MRcPsych. Royal College of Psychiatrist, London, United Kingdom
| | - S Álvarez-Sesmero
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V D Santana
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - I Martí
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Urricelqui
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Rentero
- Servicio de Psiquiatría, Hospital Universitario 12 de Octubre, Madrid, Spain; Instituto de Investigación Sanitaria Hospital Universitario 12 de Octubre (i+12), Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| |
Collapse
|
11
|
D′Agostino A, D’Angelo S, Giordano B, Cigognini AC, Chirico ML, Redaelli C, Gambini O. Brief Psychotic Disorder During the National Lockdown in Italy: An Emerging Clinical Phenomenon of the COVID-19 Pandemic. Schizophr Bull 2020; 47:15-22. [PMID: 32761196 PMCID: PMC7454891 DOI: 10.1093/schbul/sbaa112] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The impact of the COVID-19 pandemic on psychosis remains to be established. Here we report 6 cases (3 male and 3 female) of first-episode psychosis (FEP) admitted to our hospital in the second month of national lockdown. All patients underwent routine laboratory tests and a standardized assessment of psychopathology. Hospitalization was required due to the severity of behavioral abnormalities in the context of a full-blown psychosis (the Brief Psychiatric Rating Scale [BPRS] = 75.8 ± 14.6). Blood tests, toxicological urine screening, and brain imaging were unremarkable, with the exception of a mild cortical atrophy in the eldest patient (male, 73 years). All patients were negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) throughout their stay, but 3 presented the somatic delusion of being infected. Of note, all 6 cases had religious/spiritual delusions and hallucinatory contents. Despite a generally advanced age (53.3 ± 15.6), all patients had a negative psychiatric history. Rapid discharge (length of stay = 13.8 ± 6.9) with remission of symptoms (BPRS = 27.5 ± 3.1) and satisfactory insight were possible after relatively low-dose antipsychotic treatment (Olanzapine-equivalents = 10.1 ± 5.1 mg). Brief psychotic disorder/acute and transient psychotic disorder diagnoses were confirmed during follow-up visits in all 6 cases. The youngest patient (female, 23 years) also satisfied the available criteria for brief limited intermittent psychotic symptoms. Although research on larger populations is necessary, our preliminary observation suggests that intense psychosocial stress associated with a novel, potentially fatal disease and national lockdown restrictions might be a trigger for FEP.
Collapse
Affiliation(s)
- Armando D′Agostino
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy,To whom correspondence should be addressed; Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, via Antonio di Rudinì 8, 20142, Milan, Italy; tel: +39-02-81844516, fax: +39-02-81844026, e-mail:
| | - Simone D’Angelo
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | - Barbara Giordano
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy
| | | | | | - Cristiana Redaelli
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy
| | - Orsola Gambini
- Department of Mental Health, San Paolo Hospital, ASST Santi Paolo e Carlo, Milan, Italy,Department of Health Sciences, Università degli Studi di Milano, Milan, Italy,CRC “Aldo Ravelli” for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| |
Collapse
|
12
|
López-Díaz Á, Fernández-González JL, Lara I, Ruiz-Veguilla M. Predictors of diagnostic stability in acute and transient psychotic disorders: validation of previous findings and implications for ICD-11. Eur Arch Psychiatry Clin Neurosci 2020; 270:291-299. [PMID: 31062078 DOI: 10.1007/s00406-019-01014-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 04/16/2019] [Indexed: 01/03/2023]
Abstract
Acute and transient psychotic disorders (ATPD) have moderate prospective diagnostic stability. Female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features have been found to be predictive factors of diagnostic stability in ATPDs. Nevertheless, most of these findings need to be replicated. The purpose of this study was to evaluate the diagnostic stability of patients with ATPD, and to determine whether previously accepted predictors of diagnostic stability for ATPD could be externally validated in our cohort. To that end, a prospective 2-year observational study was conducted on patients with first-episode ATPD. Multivariate analysis was performed to determine factors associated with ATPD diagnostic stability at the end of the follow-up period. The following prior knowledge variables were analyzed: female gender, older age at onset, good premorbid adjustment, abrupt onset, shifting polymorphic symptomatology and absence of schizophrenic features. Sixty-eight patients with first-episode ATPD completed the follow-up, of whom 55.9% (n = 38) retained their diagnosis of ATPD at the end of the study. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the presence of shifting polymorphic symptomatology (OR = 7.42, 95% CI 1.65-33.30; p = 0.009) and the absence of schizophrenic features (OR = 6.37, 95% CI 1.47-27.54; p = 0.013) at the onset of the psychotic disorder. Our findings provide empirical support for the ICD-11 proposal restricting the new ATPD category to the acute polymorphic disorder without schizophrenia symptoms.
Collapse
Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | - Ignacio Lara
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Miguel Ruiz-Veguilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Seville, Spain. .,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain. .,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot sn. 41013, Seville, Spain.
| |
Collapse
|
13
|
Valdés-Florido MJ, López-Díaz Á, Palermo-Zeballos FJ, Martínez-Molina I, Martín-Gil VE, Crespo-Facorro B, Ruiz-Veguilla M. Reactive psychoses in the context of the COVID-19 pandemic: Clinical perspectives from a case series. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2020; 13:90-94. [PMID: 38620329 PMCID: PMC7183984 DOI: 10.1016/j.rpsm.2020.04.009] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/27/2023]
Abstract
Introduction The world is currently undergoing an extremely stressful scenario due to the COVID-19 pandemic. This unexpected and dramatic situation could increase the incidence of mental health problems, among them, psychotic disorders. The aim of this paper was to describe a case series of brief reactive psychosis due to the psychological distress from the current coronavirus pandemic. Materials and methods We report on a case series including all the patients with reactive psychoses in the context of the COVID-19 crisis who were admitted to the Virgen del Rocío and Virgen Macarena University Hospitals (Seville, Spain) during the first two weeks of compulsory nationwide quarantine. Results In that short period, four patients met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for a brief reactive psychotic disorder. All of the episodes were directly triggered by stress derived from the COVID-19 pandemic and half of the patients presented severe suicidal behavior at admission. Conclusions We may now be witnessing an increasing number of brief reactive psychotic disorders as a result of the COVID-19 pandemic. This type of psychosis has a high risk of suicidal behavior and, although short-lived, has a high rate of psychotic recurrence and low diagnostic stability over time. Therefore, we advocate close monitoring in both the acute phase and long-term follow-up of these patients.
Collapse
Affiliation(s)
| | - Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | | | | | | | - Benedicto Crespo-Facorro
- UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Spain
- Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| | - Miguel Ruiz-Veguilla
- UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Spain
- Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| |
Collapse
|
14
|
López-Díaz Á, Fernández-González JL, Lara I, Crespo-Facorro B, Ruiz-Veguilla M. The prognostic role of catatonia, hallucinations, and symptoms of schizophrenia in acute and transient psychosis. Acta Psychiatr Scand 2019; 140:574-585. [PMID: 31436311 DOI: 10.1111/acps.13092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To examine the prospective temporal stability of acute and transient psychotic disorders (ATPDs) and analyze whether there are clinical, psychopathological, or sociodemographic characteristics that predict ATPD diagnostic stability. METHOD We conducted a prospective, 2-year, observational study of patients presenting a first-episode ATPD. A multivariate logistic regression model was developed to identify independent variables associated with ATPD diagnostic stability. Well-established predictive factors of diagnostic stability, as well as all the psychopathological features included in the ICD-10 Diagnostic Criteria for Research (DCR) descriptions of ATPD, were analyzed. RESULTS Sixty-eight patients with a first episode of ATPD completed the study with a diagnostic stability rate as high as 55.9% (n = 38) at the end of the follow-up period. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the baseline presence of motility disturbances (OR = 6.86, 95% CI = 1.10-42.62; P = 0.039), the absence of hallucinations (OR = 5.75, 95% CI = 1.51-21.98; P = 0.010), and the absence of schizophrenic features (OR = 7.13, 95% CI = 1.38-36.90; P = 0.019). CONCLUSION A symptom checklist assessing these psychopathological features would enable early identification of those subjects whose initial ATPD diagnosis will remain stable over time.
Collapse
Affiliation(s)
- Á López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - I Lara
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - B Crespo-Facorro
- UGC Salud Mental, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Barcelona, Spain
| | - M Ruiz-Veguilla
- UGC Salud Mental, Hospital Universitario Virgen del Rocío, Sevilla, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Sevilla, Spain.,Centro de Investigación Biomédica en Red Salud Mental (CIBERSAM), Barcelona, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Grupo Psicosis y Neurodesarrollo, Sevilla, Spain
| |
Collapse
|
15
|
Abstract
PURPOSE OF REVIEW We review the ongoing research in the area of acute and transient psychotic disorders (ATPDs) with regard to their nosology, epidemiology, clinical description, genetics, and neurobiology, examining evidence for distinctiveness or otherwise of ATPDs. We further highlight the lacuna in research in ATPDs. RECENT FINDINGS Studies on ATPDs as defined in the ICD 10 have been reported from different parts of the world, more so from the developing countries. There is consistent evidence that there exist a group of ATPDs that occur more commonly among females, are often precipitated by stressful life events or exposure to physiological stresses like fever, child birth, are associated with well-adjusted premorbid personality, and show complete recovery in a short period. Although in some cases of ATPDs, there is symptomatic overlap with schizophrenic symptoms in the acute phase, they follow a completely different course and outcome, exhibit genetic distinctiveness, and do not share genetic relationship with schizophrenias or bipolar affective disorder (BPAD). Comparative studies on neurophysiology and neuroimaging in ATPDs and schizophrenias have demonstrated evidence of hyper arousal and hyper metabolism in ATPDs vs hypo arousal and hypo metabolism as noted in the P300 response and on FDG PET studies, respectively. Immune markers such as IL-6, TNF-alpha, and TGF-beta show higher levels in ATPDs as compared to healthy controls. Findings on the neurobiological mechanisms underlying ATPDs, so far, point towards significant differences from those in schizophrenia or BPAD. Although the studies are few and far between, nevertheless, these point towards the possibility of ATPDs as a distinct entity and underscore the need for pursuing alternate hypothesis such as neuro inflammatory or metabolic. Research on ATPDs is limited due to many reasons including lack of harmony between the ICD and DSM diagnostic systems and clinician biases. Available research data supports the validity of ATPDs as a distinct clinical entity. There is also evidence that ATPDs are different from schizophrenias or BPAD on genetic, neuroimaging, neurophysiological, and immunological markers and require further studies.
Collapse
|
16
|
Abstract
The ICD-11 International Classification of Diseases and Related Health Problems will move toward a narrower concept of "acute and transient psychotic disorders" (ATPD) characterized by the remnant "polymorphic psychotic disorder" (APPD) of the current ICD-10 category, also including schizophrenic and predominantly delusional subtypes. To assess the validity of APPD, relevant articles published between January 1993 and September 2017 were found through searches in PubMed and Web of Science. APPD is a rare mental disorder and affects significantly more women than men in early-middle adulthood. Its diagnostic reliability is relatively low, and its consistency reaches just 53.8% on average over 8.8 years, but is significantly greater than either of ATPD subtypes, which are more likely to progress to schizophrenia and related disorders. Although APPD has distinctive features and higher predictive power, its rarity and the fleeting and polymorphic nature of its symptoms could reduce its usefulness in clinical practice and discourage research.
Collapse
|
17
|
Castagnini AC, Fusar-Poli P. Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder. Eur Psychiatry 2017; 45:104-113. [PMID: 28756108 DOI: 10.1016/j.eurpsy.2017.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Short-lived psychotic disorders are currently classified under "acute and transient psychotic disorders" (ATPDs) in ICD-10, and "brief psychotic disorder" (BPD) in DSM-5. This study's aim is to review the literature and address the validity of ATPDs and BPD. METHOD Papers published between January 1993 and December 2016 were identified through searches in Web of Science. Reference lists in the located papers provided further sources. RESULTS A total of 295 articles were found and 100 were included in the review. There were only a few studies about the epidemiology, vulnerability factors, neurobiological correlates and treatment of these disorders, particularly little interest seems to exist in BPD. The available evidence suggests that short-lived psychotic disorders are rare conditions and more often affect women in early to middle adulthood. They also are neither associated with premorbid dysfunctions nor characteristic family predisposition, while there seems to be greater evidence of environmental factors particularly in developing countries and migrant populations. Follow-up studies report a favourable clinical and functional outcome, but case identification has proved difficult owing to high rates of transition mainly either to schizophrenia and related disorders or, to a lesser extent, affective disorders over the short- and longer-terms. CONCLUSIONS Although the lack of neurobiological findings and little predictive power argue against the validity of the above diagnostic categories, it is important that they are kept apart from longer-lasting psychotic disorders both for clinical practice and research. Close overlap between ATPDs and BPD could enhance the understanding of these conditions.
Collapse
Affiliation(s)
- A C Castagnini
- School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - P Fusar-Poli
- King's College London, Institute of Psychiatry, and OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|