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Knížková K, Keřková B, Večeřová M, Šustová P, Jonáš J, Siroňová A, Hrubý A, Rodriguez M. Longitudinal course of core cognitive domains in first-episode acute and transient psychotic disorders compared with schizophrenia. Schizophr Res Cogn 2024; 37:100311. [PMID: 38601889 PMCID: PMC11004639 DOI: 10.1016/j.scog.2024.100311] [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: 12/01/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Acute and transient psychotic disorder (ATPD) is characterized by acute onset of psychotic symptoms and early recovery. Contrastingly, schizophrenia (SZ) is a chronic mental disorder characterized by impaired functioning including a deficit in cognition. In SZ, the cognitive deficit is among the core symptoms, but in ATPDs, the existing evidence brings mixed results. Our primary aim was to compare three core cognitive domains (executive functioning/abstraction, speed of processing and working memory) of patients diagnosed with ATPD and SZ over a 12-month period. Moreover, we explored how these diagnostic subgroups differed in their clinical characteristics. We recruited 39 patients with a diagnosis of SZ and 31 with ATPD with schizophrenic symptoms. All patients completed clinical and neuropsychological assessments. At baseline, we used a one-way ANCOVA model with a group as the between-subjects factor. Mixed-model repeated-measures ANOVAs with time as the within-subjects factor and group as the between-subjects factor were run to test the overtime differences. At baseline, we did not find any differences in cognition - with sex, education and age as covariates - between ATPDs and SZ. After one year, all patients showed an improvement in all three domains, however, there were no significant overtime changes between ATPDs and SZ. Regarding clinical profiles, ATPDs demonstrated less severe psychopathology and better functioning compared to SZ both at baseline and after 12 months. The medication dosage differed at retest, but not at baseline between the groups. Our findings suggest clinical differences and a similar trajectory of cognitive performance between these diagnostic subgroups.
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Affiliation(s)
- Karolína Knížková
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Barbora Keřková
- National Institute of Mental Health, Klecany, Czech Republic
| | - Monika Večeřová
- National Institute of Mental Health, Klecany, Czech Republic
| | - Petra Šustová
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University in Prague, Czech Republic
| | - Juraj Jonáš
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University in Prague, Czech Republic
| | - Aneta Siroňová
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Aleš Hrubý
- National Institute of Mental Health, Klecany, Czech Republic
| | - Mabel Rodriguez
- National Institute of Mental Health, Klecany, Czech Republic
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Mishra KK, Patil V, Sathe HS, Reshamvala AM. Clinical features and outcomes in acute psychosis: A retrospective hospital-based study in rural patients of central India. Ind Psychiatry J 2023; 32:297-301. [PMID: 38161475 PMCID: PMC10756627 DOI: 10.4103/ipj.ipj_139_22] [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: 08/04/2022] [Accepted: 02/06/2023] [Indexed: 01/03/2024] Open
Abstract
Background Acute and transient psychotic disorder (ATPD) is a distinct diagnostic category (F23) in ICD-10 which includes non-schizophrenic and non-affective psychoses following a transient course. The clinical features, diagnostic stability, and epidemiology of ATPD have not been adequately explored in the developing countries. The aim was to explore the socio-demographic and clinical characteristics of ATPD as well as examine the diagnostic stability and longitudinal revisions in the diagnosis of ATPD. Material and Methods An observational retrospective study based on 10-year OPD records of ATPD patients was conducted in a tertiary health care center after ethics committee approval. A total of 120 patient records were analyzed for socio-demographic data, clinical symptoms, mental status examination findings, diagnosis on the first visit, and subsequent revisions in the diagnosis. Results The mean age of ATPD patients was 31.8 (±11.73) years. Delusion was the most common psychiatric symptom in ATPD patients followed by abnormal speech, hallucinations, and disorganized behavior. Antecedent psychosocial stressors were found in 44.2% cases. More than half of ATPD patients (51%) followed up after initial symptom remission and were diagnosed with chronic mental illnesses (schizophrenia or bipolar affective disorder). The ATPD patients experiencing a stressor at the onset of illness were less likely to develop chronic mental illness compared to the ones who did not have antecedent stressors. Conclusion Irrespective of the genetic and phenomenological distinctiveness of ATPD, which has led to its inclusion as a separate diagnostic category in ICD-10, ATPD is an unstable diagnosis.
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Affiliation(s)
- Kshirod K. Mishra
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Vrushti Patil
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Harshal S. Sathe
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
| | - Ahmed M. Reshamvala
- Department of Psychiatry, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
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3
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Carden J, Huxley PJ, Poole R, Robinson C, Salmoiraghi A, Foulkes J, Davies S, Williams S, Morris N, Meudell A. Social causes and outcomes of acute transient psychotic disorder: A review of recent evidence. Int J Soc Psychiatry 2023; 69:412-419. [PMID: 36047044 DOI: 10.1177/00207640221106681] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reports of increasing presentations of new cases of acute psychosis both locally, nationally and internationally during the COVID-19 pandemic, warranted further investigation. International case reports almost exclusively reported only clinical outcome (e.g. remission of psychotic symptoms), and fail to report on social precipitants or social outcomes. This is a common omission when investigating new psychosis cases such as acute and transient psychotic disorder (ATPD). In order to assess social impacts and outcomes, we conducted a rapid review of recent evidence. AIMS To conduct a rapid review of the recent evidence of social outcomes on new cases of psychosis emerging during the COVID-19 pandemic. METHOD Four databases (Medline, Embase, Psychinfo and Cochrane COVID-19) were searched for ATPD, psychosis and social outcomes in adults aged 18+. Duplicates were removed. There were no language limitations. Results: There were 24 papers consisting of 18 original data research papers and 6 reviews. Additionally, 33 papers/letters, reporting on 60 individual cases of psychosis emerging during the COVID-19 pandemic. These two sets of papers were reviewed separately. Many original data research papers and reviews were sub optimal in their quality, with 44% online surveys, with the remainder being routinely collected data. CONCLUSION There is a consensus that clinical outcomes of ATPD and other brief psychotic disorders (BPD) are good in the short term. The focus only on symptomatic clinical presentation and outcomes, leaves a gap in our understanding regarding social stressors and longer term social outcomes. ATPD and BPD often may not come to the attention of Early Intervention in Psychosis services, and if they do, are discharged following symptomatic remission. Without an understanding of the social stress factors and social outcomes, opportunities may be missed to prevent increased social disability and future relapse with these presentations.
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Affiliation(s)
- John Carden
- Mental Health Division, Flintshire Community Mental Health Teams, Betsi Cadwaladr University Health Board, Flintshire, UK
| | - Peter John Huxley
- Centre for Mental Health and Society, Wrexham Academic Unit, Bangor University, Wrexham, UK
| | - Robert Poole
- Centre for Mental Health and Society, Wrexham Academic unit, Bangor University, Wrexham, UK
| | | | | | | | - Sioned Davies
- Centre for Mental Health and Society, Wrexham Academic Unit, Bangor University, Wrexham, UK
| | | | - Nia Morris
- Betsi Cadwaladr University Health Board, Wrexham, UK
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Association between Arachidonic Acid and the Risk of Schizophrenia: A Cross-National Study and Mendelian Randomization Analysis. Nutrients 2023; 15:nu15051195. [PMID: 36904193 PMCID: PMC10005211 DOI: 10.3390/nu15051195] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Polyunsaturated fatty acids (PUFAs), especially long-chain PUFAs (LCPUFAs), are crucial for both the structural and functional integrity of cells. PUFAs have been reported to be insufficient in schizophrenia, and the resulting cell membrane impairments have been hypothesized as an etiological mechanism. However, the impact of PUFA deficiencies on the onset of schizophrenia remain uncertain. We investigated the associations between PUFAs consumption and schizophrenia incidence rates through correlational analyses and conducted Mendelian randomization analyses to reveal the causal effects. Using dietary PUFA consumption and national schizophrenia incidence rates in 24 countries, we found that incidence rates of schizophrenia were inversely correlated with arachidonic acid (AA) and ω-6 LCPUFA consumption (rAA = -0.577, p < 0.01; rω-6 LCPUFA = -0.626, p < 0.001). Moreover, Mendelian randomization analyses revealed that genetically predicted AA and gamma-linolenic acid (GLA) were protective factors against schizophrenia (ORAA = 0.986, ORGLA = 0.148). In addition, no significant relationships were observed between schizophrenia and docosahexaenoic acid (DHA) or other ω-3 PUFAs. These findings show that the deficiencies of ω-6 LCPUFAs, especially AA, are associated with schizophrenia risk, which sheds novel insight into the etiology of schizophrenia and a promising diet supplementation for the prevention and treatment of schizophrenia.
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Castagnini A, Foldager L, Caffo E, Berrios GE. The predictive validity and outcome of ICD-10 and DSM-5 short-lived psychotic disorders: a review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2022; 272:1157-1168. [PMID: 34988647 DOI: 10.1007/s00406-021-01356-7] [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: 03/15/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of 'acute and transient psychotic disorders' (ATPDs) encompassing polymorphic, schizophrenic and predominantly delusional subtypes, and the forthcoming ICD-11 revision has restricted it to polymorphic psychotic disorder, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed 'brief psychotic disorder' (BPD). To assess the predictive validity and outcome of ATPDs and BPD, relevant papers in English, French and German were searched in PubMed and Web of Science. Where possible meta-analysis of prognostic validators (diagnostic stability, course, outcome and response to treatment) was conducted. Fifty studies published between January 1993 and July 2019 were found. The clinical and functional outcome of ATPDs proved better than in schizophrenia and related disorders, but mortality risk is high, particularly suicide, and treatment trials provide little evidence. Meta-analysis of 25 studies (13,507 cases) revealed that 55% (95% CI 49-62) do not change diagnosis, 25% (95% CI 20-31) converted into schizophrenia and related disorders, and 12% (95% CI 7-16) into affective disorders on average over 6.3 years. Subgroup meta-analysis estimated prospective consistency of polymorphic psychotic disorder (55%; 95% CI 52-58) significantly greater than that of the ATPD subtypes with schizophrenic (OR 1.7; 95% CI 1.4-2.0) and predominantly delusional (OR 1.3; 95% CI 1.1-1.5) symptoms. Moreover, the diagnostic stability of BPD (13 studies; 294 cases) was 45% (95% CI 32-50) over a mean 4.2 years. Although these findings indicate that short-lived psychotic disorders have little predictive validity, significant differences among the ATPD subtypes support the revised ICD-11 ATPD category.
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Affiliation(s)
- Augusto Castagnini
- School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - Leslie Foldager
- Health Research Unit, Department of Animal Science, Aarhus University, Tjele, Denmark.,Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Ernesto Caffo
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - German E Berrios
- Department of Psychiatry and Robinson College, University of Cambridge, Cambridge, UK
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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.
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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
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Phalen P, Millman Z, Rouhakhtar PR, Andorko N, Reeves G, Schiffman J. Categorical versus dimensional models of early psychosis. Early Interv Psychiatry 2022; 16:42-50. [PMID: 33559329 PMCID: PMC8349380 DOI: 10.1111/eip.13128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 01/03/2023]
Abstract
AIM Early psychosis is typically operationalized as a categorical construct by dividing people into one of three diagnostic statuses: low-risk, clinical high-risk, and first episode psychosis. We empirically assess whether an alternative dimensional approach focused on observed symptom severity may be more desirable for clinical and research purposes. METHODS Participants were 152 help-seeking youths ages 12-22 years old. Structured interview for psychosis risk syndromes interviews were used to obtain dimensional psychosis symptom severity ratings, and to classify participants by categorical psychosis risk status. Twenty-five participants were classified as having a diagnosable psychotic disorder, 52 participants as clinical high-risk, and 75 participants as help-seeking controls. We assessed the relation between categorical and dimensional measurements of psychosis severity, and then compared categorical versus dimensional psychosis severity in their ability to predict social and role functioning. RESULTS On average, dimensional psychosis symptom severity increased along with categorical risk status (help-seeking control < clinical high-risk < diagnosable psychotic disorder). There was, however, considerable overlap between categories, with people at clinical high-risk being particularly hard to distinguish from people with diagnosable psychotic disorders on the basis of symptom severity. Dimensional symptom severity was more predictive of functioning than categorical risk status. CONCLUSIONS Categorical risk status and psychosis symptom severity are related but not interchangeable, and dimensional models of psychosis may be more predictive of functional outcomes. Adopting a dimensional rather than categorical approach to the psychosis risk spectrum may facilitate better predictive models and a richer theoretical understanding of early psychosis.
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Affiliation(s)
- Peter Phalen
- VA Capitol Health Care Network (VISN 5), Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA.,Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Zachary Millman
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA.,Center of Excellence in Psychotic Disorders, McLean Hospital, Belmont, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicole Andorko
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA
| | - Gloria Reeves
- Division of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland, Baltimore, Maryland, USA.,Psychological Science, University of California, Irvine, California, USA
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López-Díaz Á, Ayesa-Arriola R, Ortíz-García de la Foz V, Suárez-Pinilla P, Ramírez-Bonilla ML, Vázquez-Bourgon J, Ruiz-Veguilla M, Crespo-Facorro B. Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3-year longitudinal study. Acta Psychiatr Scand 2021; 144:578-588. [PMID: 34431080 DOI: 10.1111/acps.13364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Álvaro López-Díaz
- UGC Salud Mental, Hospital Universitario Virgen Macarena, Seville, Spain.,Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain
| | - Rosa Ayesa-Arriola
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Víctor Ortíz-García de la Foz
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Paula Suárez-Pinilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - María Luz Ramírez-Bonilla
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Vázquez-Bourgon
- Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain.,Departamento de Psiquiatría, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ruiz-Veguilla
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
| | - Benedicto Crespo-Facorro
- Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,Centro Investigación Biomédica en Red Salud Mental (CIBERSAM), Seville, Spain.,UGC Salud Mental, Hospital Universitario Virgen del Rocío, Seville, Spain.,Departamento de Psiquiatría, Universidad de Sevilla, Seville, Spain
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Provenzani U, Salazar de Pablo G, Arribas M, Pillmann F, Fusar-Poli P. Clinical outcomes in brief psychotic episodes: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2021; 30:e71. [PMID: 35698876 PMCID: PMC8581951 DOI: 10.1017/s2045796021000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with brief psychotic episodes (BPE) have variable and fluctuating clinical outcomes which challenge psychiatric care. Our meta-analysis aims at providing a comprehensive summary of several clinical outcomes in this patient group. METHODS A multistep systematic PRISMA/MOOSE-compliant literature search was performed for articles published from inception until 1st March 2021. Web of Science database was searched, complemented by manual search of original articles reporting relevant outcomes (psychotic recurrence, prospective diagnostic change or stability, remission, quality of life, functional status, mortality and their predictors) for patients diagnosed with acute and transient psychotic disorders (ATPD), brief psychotic disorders (BPD), brief intermittent psychotic symptoms (BIPS) and brief limited intermittent psychotic symptoms (BLIPS). Random-effects methods and Q-statistics were employed, quality assessment with Newcastle-Ottawa Scale, assessment of heterogeneity with I2 index, sensitivity analyses (acute polymorphic psychotic disorders, APPD) and multiple meta-regressions, assessment of publication bias with funnel plot, Egger's test and meta-regression (psychotic recurrence and sample size). RESULTS A total of 91 independent articles (n = 94 samples) encompassed 37 ATPD, 24 BPD, 19 BLIPS and 14 BIPS samples, totalling 15 729 individuals (mean age: 30.89 ± 7.33 years, mean female ratio: 60%, 59% conducted in Europe). Meta-analytical risk of psychotic recurrence for all BPE increased from 15% (95% confidence interval (CI) 12-18) at 6 months, 25% (95% CI 22-30) at 12 months, 30% (95% CI 27-33) at 24 months and 33% (95% CI 30-37) at ⩾36 months follow-up, with no differences between ATPD, BPD, BLIPS and BIPS after 2 years of follow-up. Across all BPE, meta-analytical proportion of prospective diagnostic stability (average follow-up 47 months) was 49% (95% CI 42-56); meta-analytical proportion of diagnostic change (average follow-up 47 months) to schizophrenia spectrum psychoses was 19% (95% CI 16-23), affective spectrum psychoses 5% (95% CI 3-7), other psychotic disorders 7% (95% CI 5-9) and other (non-psychotic) mental disorders 14% (95% CI 11-17). Prospective diagnostic change within APPD without symptoms of schizophrenia was 34% (95% CI 24-46) at a mean follow-up of 51 months: 18% (95% CI 11-30) for schizophrenia spectrum psychoses and 17% (95% CI 10-26) for other (non-psychotic) mental disorders. Meta-analytical proportion of baseline employment was 48% (95% CI 38-58), whereas there were not enough data to explore the other outcomes. Heterogeneity was high; female ratio and study quality were negatively and positively associated with risk of psychotic recurrence, respectively. There were no consistent factor predicting clinical outcomes. CONCLUSIONS Short-lived psychotic episodes are associated with a high risk of psychotic recurrences, in particular schizophrenia spectrum disorders. Other clinical outcomes remain relatively underinvestigated. There are no consistent prognostic/predictive factors.
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Affiliation(s)
- U. Provenzani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - G. Salazar de Pablo
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M. Arribas
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - F. Pillmann
- AWO Center of Psychatry, Halle, Germany
- Martin Luther University Halle-Wittenberg, Halle, Germany
| | - P. Fusar-Poli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, London, UK
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10
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Ajnakina O, Stubbs B, Francis E, Gaughran F, David AS, Murray RM, Lally J. Employment and relationship outcomes in first-episode psychosis: A systematic review and meta-analysis of longitudinal studies. Schizophr Res 2021; 231:122-133. [PMID: 33839370 DOI: 10.1016/j.schres.2021.03.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/20/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
As employment and relationship status are important long-term outcomes in individuals with a diagnosis of first episode psychosis (FEP) disorders, there is a need to elucidate more accurately the extent of these social deficits in people with FEP. This in turn can aid treatment planning and policy development ultimately ensuring more complete and sustainable recoveries. We carried out a systematic review and meta-analysis of longitudinal studies in FEP reporting on employment and relationship status during the illness course. Random effects meta-analyses and meta-regression analyses were employed. Seventy-four studies were included with a sample totalling 15,272 (range = 20-1724) FEP cases with an average follow-up duration of 8.3 years (SD = 7.2). 32.5% (95%CI = 28.5-36.9) of people with a diagnosis of FEP disorders were employed and 21.3% (95%CI = 16.5-27.1) were in a relationship at the end of follow-up. Studies from high-income countries and Europe had a higher proportion of people in employment at the end of follow-up compared to middle-income nations and non-European countries. The inverse was found for relationship status. The proportion of people with a diagnosis of FEP in employment decreased significantly with longer follow-up. Living with family, being in a relationship at first contact and Black and White ethnicities were identified as significant moderators of these outcomes. These findings highlight marked functional recovery deficits for people with FEP, although cultural factors need to be considered. They support the need for interventions to improve employment opportunities, and social functioning, both in early psychosis and during the longitudinal illness course.
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Affiliation(s)
- Olesya Ajnakina
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, University of London, London, United Kingdom; Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom.
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emma Francis
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anthony S David
- Institute of Mental Health, University College London, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Italy
| | - John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Psychiatry, St Vincent's Hospital Fairview, Dublin, Ireland
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11
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Kalling S, Brus O, Landén M, Lundberg J, Nordanskog P, Nordenskjöld A. Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder. Nord J Psychiatry 2021; 75:201-206. [PMID: 33095086 DOI: 10.1080/08039488.2020.1834617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Acute polymorphic psychotic disorder (APPD) without symptoms of schizophrenia is a serious psychiatric condition. APPD can be effectively treated with electroconvulsive therapy (ECT), but little is known about relapse prevention after ECT for APPD. MATERIALS AND METHODS This was a retrospective register-based study conducted with 97 patients with APPD (ICD-10 diagnosis F23.0). We estimated the rates of readmission and suicide, and the prognostic factors of these outcomes after ECT. We combined data from several national Swedish registers and used Cox's regression analysis to identify demographic factors, disease characteristics, and relapse preventive treatments that predicted time to readmission or suicide (relapse). Data registered between 2011 and 2016 were used in the study. RESULTS Twenty percent of cases relapsed within a year. Thereafter, relapse rate was low. Two cases died during follow-up, whereof one by suicide. Anxiolytic treatment, lamotrigine treatment, and having more than four previous psychiatric hospital admissions were associated with shorter time to relapse. The most robust of these associations was between anxiolytics and relapse risk. CONCLUSIONS The first year after discharge from APPD is the period associated with the highest risk of relapse. Having many previous admissions was associated to relapse risk after ECT for APPD. The associations between anxiolytics, lamotrigine, and relapse are uncertain and might be influenced by indication bias.
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Affiliation(s)
- Styrbjörn Kalling
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Ole Brus
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health Örebro University, Örebro, Sweden
| | - Mikael Landén
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lundberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet and Region Stockholm, Stockholm, Sweden
| | - Pia Nordanskog
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience, Faculty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Psychiatry, Region Östergötland, Linköping, Sweden
| | - Axel Nordenskjöld
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
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12
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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 2021; 47:15-22. [PMID: 32761196 PMCID: PMC7454891 DOI: 10.1093/schbul/sbaa112] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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.
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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
| | - 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
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13
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Salvatore P, Khalsa HK, Tohen M, Baldessarini RJ. Long-term morbidity in major affective and schizoaffective disorders following hospitalization in first psychotic episodes. Acta Psychiatr Scand 2021; 143:50-60. [PMID: 33043430 DOI: 10.1111/acps.13243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/14/2020] [Accepted: 10/04/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate morbidity during long-term follow-up with clinical treatment of affective and schizoaffective disorder subjects followed from hospitalization for first major psychotic episodes. METHODS We followed adult subjects systematically at regular intervals from hospitalization for first-lifetime episodes of major affective and schizoaffective disorders with initial psychotic features. We compiled % of days with morbidity types from detailed records and life charts, reviewed earliest antecedent morbidities, compared both with final diagnoses and initial presenting illness types, and evaluated morbidity risk factors with regression modeling. FINDINGS With final diagnoses of bipolar-I (BD-I, n = 216), schizoaffective (SzAffD, 71), and major depressive (MDD, 42) disorders, 329 subjects were followed for 4.47 [CI: 4.20-4.47] years. Initial episodes were mania (41.6%), mixed states (24.3%), depression (19.5%), or apparent nonaffective psychosis (14.6%). Antecedent morbidity presented 12.7 years before first episodes (ages: SzAffD ≤ BD-I < MDD). Long-term % of days ill ranked SzAffD (83.0%), MDD (57.8%), BD-I (45.0%). Morbidity differed by diagnosis and first-episode types, and was predicted by first episodes and suggested by antecedent illnesses. Long-term wellness was greater with BD-I diagnosis, first episode not mixed or psychotic nonaffective, rapid onset, and being older at first antecedents, but not follow-up duration. CONCLUSIONS Initially, psychotic BD-I, SzAffD, or MDD subjects followed for 4.47 years from first hospitalization experienced much illness, especially depressive or dysthymic, despite ongoing clinical treatment. Antecedent symptoms arose years before index first episodes; antecedents and first episode types predicted types and amounts of long-term morbidity, which ranked: SzAffD > MDD > BD-I.
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Affiliation(s)
- Paola Salvatore
- International Consortium for Mood & Psychotic Disorders, Mailman Research Center, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Section of Psychiatry, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Harimandir K Khalsa
- International Consortium for Mood & Psychotic Disorders, Mailman Research Center, McLean Hospital, Belmont, MA, USA.,Behavioral Health Center, John Muir Hospital, San Francisco, CA, USA
| | - Mauricio Tohen
- International Consortium for Mood & Psychotic Disorders, Mailman Research Center, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Ross J Baldessarini
- International Consortium for Mood & Psychotic Disorders, Mailman Research Center, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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14
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Kalla O, Wahlström J, Aaltonen J, Lehtinen V, González de chávez M. 12‐month follow‐up of first‐episode psychosis in Finland and Spain—differential significance of social adjustment‐related variables. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2011.00002.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Outi Kalla
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jarl Wahlström
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Jukka Aaltonen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | - Ville Lehtinen
- National Research and Development Centre for Welfare and Health, Helsinki, Finland, and
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15
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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.
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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.
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16
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Murrie B, Lappin J, Large M, Sara G. Transition of Substance-Induced, Brief, and Atypical Psychoses to Schizophrenia: A Systematic Review and Meta-analysis. Schizophr Bull 2020; 46:505-516. [PMID: 31618428 PMCID: PMC7147575 DOI: 10.1093/schbul/sbz102] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Some people who experience substance-induced psychosis later develop an enduring psychotic disorder such as schizophrenia. This study examines the proportion of people with substance-induced psychoses who transition to schizophrenia, compares this to other brief and atypical psychoses, and examines moderators of this risk. A search of MEDLINE, PsychINFO, and Embase identified 50 eligible studies, providing 79 estimates of transition to schizophrenia among 40 783 people, including 25 studies providing 43 substance-specific estimates in 34 244 people. The pooled proportion of transition from substance-induced psychosis to schizophrenia was 25% (95% CI 18%-35%), compared with 36% (95% CI 30%-43%) for brief, atypical and not otherwise specified psychoses. Type of substance was the primary predictor of transition from drug-induced psychosis to schizophrenia, with highest rates associated with cannabis (6 studies, 34%, CI 25%-46%), hallucinogens (3 studies, 26%, CI 14%-43%) and amphetamines (5 studies, 22%, CI 14%-34%). Lower rates were reported for opioid (12%), alcohol (10%) and sedative (9%) induced psychoses. Transition rates were slightly lower in older cohorts but were not affected by sex, country of the study, hospital or community location, urban or rural setting, diagnostic methods, or duration of follow-up. Substance-induced psychoses associated with cannabis, hallucinogens, and amphetamines have a substantial risk of transition to schizophrenia and should be a focus for assertive psychiatric intervention.
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Affiliation(s)
- Benjamin Murrie
- St George Hospital and Sutherland Hospital, South Eastern Sydney Local Health District, Kogarah, Australia
| | - Julia Lappin
- School of Psychiatry, University of NSW, Sydney, Australia,National Drug and Alcohol Research Centre, University of NSW, Sydney, Australia
| | - Matthew Large
- School of Psychiatry, University of NSW, Sydney, Australia
| | - Grant Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, Australia,Northern Clinical School, Sydney Medical School, University of Sydney, St Leonards, Australia,To whom correspondence should be addressed; PO Box 169, North Ryde NSW 1670, Australia; tel: 61-2-88775132, fax: 61-2-98875722, e-mail:
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17
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Lee BJ, Kim SW, Kim JJ, Yu JC, Lee KY, Won SH, Lee SH, Kim SH, Kang SH, Kim E, Kim K, Piao YH, Chung YC. Defining Treatment Response, Remission, Relapse, and Recovery in First-Episode Psychosis: A Survey among Korean Experts. Psychiatry Investig 2020; 17:163-174. [PMID: 32093460 PMCID: PMC7046996 DOI: 10.30773/pi.2019.0240] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE For the proper treatment of first-episode psychosis, assessment of treatment response, remission, relapse, and recovery is important. Therefore, the present study aimed to develop operational definitions of clinical outcomes in first-episode psychosis. METHODS A questionnaire was developed by a panel of experts and underwent three revisions. The final survey was presented to 150 psychiatrists who were members of the Korean Society for Schizophrenia Research. Respondents selected factors that they believed were important to consider while defining treatment response, remission, relapse, and recovery using a 6-point Likert scale. Selected factors that constituted each definition were statistically extracted, and operational definitions were developed. RESULTS A total of 91 experts responded to the survey. The extent of reduction in psychopathology, socio-occupational functioning, and duration of each state were the core factors of each definition. Outcomes obtained from discussions and consultations by experts have been summarized and proposed. CONCLUSION The criteria developed in this survey tended to be somewhat stricter than those used by other studies. The fundamental reason for this is that this survey focused on first-episode psychosis. A better understanding of each definition in first-episode psychosis is necessary to improve effective treatment outcomes.
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Affiliation(s)
- Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jung Jin Kim
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary’s Hospital, Seoul, Republic of Korea
| | - Je-Chun Yu
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kyu Young Lee
- Department of Psychiatry, Eulji University School of Medicine, Eulji General Hospital, Seoul, Republic of Korea
| | - Seung-Hee Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
| | - Shi Hyun Kang
- Department of Psychiatry, Seoul National Hospital, Seoul, Republic of Korea
| | - Euitae Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kunhyung Kim
- Department of Occupational and Environmental Medicine, Institute of Environmental and Occupational Medicine, Busan Paik Hospital, Inje University, Busan, Republic of Korea
| | - Yang Hong Piao
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea
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18
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Li H, Kéri S. Regional brain volumes in brief psychotic disorder. J Neural Transm (Vienna) 2020; 127:371-378. [PMID: 31955300 PMCID: PMC7096370 DOI: 10.1007/s00702-020-02140-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/08/2020] [Indexed: 12/03/2022]
Abstract
Brief psychotic disorder (BPD) is a relatively rare representative of psychotic disorders. Structural brain abnormalities in BPD are not known. We compared 30 patients with BPD and 30 matched healthy controls using high-resolution structural T1-weighted magnetic resonance imaging (MRI). We performed cortical/subcortical reconstruction and volumetric segmentation using FreeSurfer v6.0. Results revealed that the caudal/rostral middle frontal cortex, superior frontal cortex, and the frontal pole were significantly smaller in patients with BPD compared to controls. The number of lifetime psychotic episodes negatively correlated with caudal middle frontal and frontal pole volumes. These results indicate structural abnormalities of the frontal cortex in BPD, which are associated with the number of psychotic relapses.
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Affiliation(s)
- Hua Li
- National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Szabolcs Kéri
- National Institute of Psychiatry and Addictions, Budapest, Hungary. .,Department of Cognitive Science, Budapest University of Technology and Economics, Egry J. str. 1, 1111, Budapest, Hungary. .,Department of Physiology, University of Szeged, Szeged, Hungary.
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19
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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.
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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
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20
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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.
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21
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Rosengard RJ, Malla A, Mustafa S, Iyer SN, Joober R, Bodnar M, Lepage M, Shah JL. Association of Pre-onset Subthreshold Psychotic Symptoms With Longitudinal Outcomes During Treatment of a First Episode of Psychosis. JAMA Psychiatry 2019; 76:61-70. [PMID: 30304442 PMCID: PMC6583454 DOI: 10.1001/jamapsychiatry.2018.2552] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The clinical high-risk state in psychosis is most often characterized by subthreshold psychotic symptoms (STPS) and represents a target for psychosis prevention. However, evidence suggests that between 30% and 50% of patients with a first episode of psychosis (FEP) report no prior history of STPS, indicating that not all patients with FEP experience a previous clinical high-risk phase. As with other early characteristics of illness onset, this diversity in the early course of symptoms may offer prognostic value for subsequent clinical trajectories. OBJECTIVE To determine whether a history of pre-onset STPS is associated with differential 1-year treatment outcomes in an early intervention service for FEP. DESIGN, SETTING, AND PARTICIPANTS Data on 195 patients 15 to 35 years of age who were recruited between January 17, 2003, and October 17, 2013, were collected from a catchment-based specialized early intervention service for FEP. Patients who reported experiencing at least 1 STPS prior to the onset of FEP were identified as STPS present (STPSp; n = 135); those who reported no such history were identified as STPS absent (STPSa; n = 60). Statistical analysis was conducted from December 15, 2016, to February 15, 2018. MAIN OUTCOMES AND MEASURES Summary scores on the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms, Calgary Depression Scale for Schizophrenia, Hamilton Anxiety Rating Scale, Global Assessment of Functioning scores, and Social and Occupational Functioning Assessment Scale scores at baseline and after 1 year of treatment were analyzed to evaluate 1-year outcomes. RESULTS Individuals in the STPSp group (39 female and 96 male participants; mean [SD] age, 23.4 [4.2] years) and the STPSa group (20 female and 40 male participants; mean [SD] age, 23.9 [5.1] years) did not differ in symptom severity or functioning at baseline. Although both groups improved by 1 year of treatment, mixed analyses of covariance (controlling for duration of untreated psychosis) revealed group-by-time interactions for scores on the Scale for the Assessment of Negative Symptoms (F1,192 = 6.17; P = .01), the Global Assessment of Functioning (F1,188 = 7.54; P = .006), and the Social and Occupational Functioning Assessment Scale (F1,192 = 3.79; P = .05). Mixed analyses of covariance also revealed a group effect for scores on the Scale for the Assessment of Positive Symptoms (F1,192 = 5.31; P = .02). After controlling for multiple comparisons, all significant results indicate poorer 1-year outcomes for patients with STPSp compared with patients with STPSa. CONCLUSIONS AND RELEVANCE A history of pre-onset STPS consistent with a prior clinical high-risk state is associated with poorer outcomes in psychotic symptoms and global functioning for patients after 1 year of treatment for FEP. The presence or absence of pre-onset STPS therefore has prognostic value for treatment outcomes, even during a later stage of psychotic illness.
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Affiliation(s)
- Rachel J. Rosengard
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada
| | - Ashok Malla
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Sally Mustafa
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Srividya N. Iyer
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Michael Bodnar
- Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Martin Lepage
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
| | - Jai L. Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Québec, Canada,Integrated Program in Neuroscience, McGill University, Montreal, Québec, Canada,Department of Psychiatry, McGill University, Montreal, Québec, Canada
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22
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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.
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Singh K, Ghazi F, White R, Sarfo-Adu B, Carter P. Improving access to Early Intervention in Psychosis (EIP): the 2-week wait for cancer comes to psychosis. BMJ Open Qual 2018; 7:e000190. [PMID: 30167471 PMCID: PMC6109946 DOI: 10.1136/bmjoq-2017-000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 06/19/2018] [Accepted: 07/19/2018] [Indexed: 11/21/2022] Open
Abstract
Early Intervention in Psychosis (EIP) services aim to rapidly initiate specialist packages of care for those people newly experiencing symptoms. The intention of such rapid engagement is to mitigate the negative effects of a prolonged duration of untreated psychosis. Aiming to achieve a ‘parity of esteem’ between mental and physical health, a new target was introduced by the National Health Service (NHS) England, where 50% of new referrals were expected to receive a concordant package of care within 2 weeks from the National Institute for Health and Care Excellence. A baseline assessment in late 2014 found that just 21% of all referrals received and accepted met this target within the EIP Team for the North-East London NHS Foundation Trust. This project sought to improve the team’s performance, seeking input from all team members and using an iterative process with the primary aim of meeting the target ahead of its roll-out. It was determined that the relatively high number of inappropriate referrals (34% at baseline) is a key causative agent in delaying staff from processing eligible cases in a timely fashion. These are defined as referrals which do not meet basic eligibility criteria such as no previous treatment for psychosis. Interventions were therefore designed targeting three domains of improving staff awareness of the new target, improving efficiency by changing the case allocation process and improving the referral pathway for external sources. The impact of these changes was re-evaluated over two cycles beyond baseline. By the final cycle, 62% of new referrals were seen within 2 weeks, while inappropriate referrals declined to just 3%. The multi-interventional nature of this project limits its generalisability and further work should be carried out to identify those changes that were most impactful. Nevertheless, focused targeting of the referral pathway may prove to be of benefit to other EIP services struggling with lengthy wait times.
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Affiliation(s)
| | - Fatima Ghazi
- General Practice, Freezywater Primary Care Centre, London, UK
| | - Rebecca White
- General Practice, Early Intervention in Psychosis Service, North-East London NHS Foundation Trust, London, UK
| | | | - Peter Carter
- Early Intervention in Psychosis Service, North-East London NHS Foundation Trust, London, UK
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24
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Abstract
SummaryThis article examines the clinical, epidemiological and nosological aspects of short-lived psychotic disorders as currently classified under ‘acute and transient psychotic disorders' in ICD-10 and ‘brief psychotic disorder’ in DSM-5. After describing earlier diagnostic concepts such as bouffée délirante, cycloid psychosis, reactive psychosis and schizophreniform psychosis, we present an overview of the literature and discuss implications for classification, diagnosis and treatment of these conditions, pointing out differences from longer-lasting psychotic disorders.
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25
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Taraskina AE, Nasyrova RF, Zabotina AM, Sosin DN, Sosina КА, Ershov EE, Grunina MN, Krupitsky EM. Potential diagnostic markers of olanzapine efficiency for acute psychosis: a focus on peripheral biogenic amines. BMC Psychiatry 2017; 17:394. [PMID: 29221470 PMCID: PMC5723030 DOI: 10.1186/s12888-017-1562-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 11/30/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Biomarkers are now widely used in many fields of medicine, and the identification of biomarkers that predict antipsychotic efficacy and adverse reactions is a growing area of psychiatric research. Monoamine molecules of the peripheral bloodstream are possible prospective biomarkers based on a growing body of evidence indicating that they may reflect specific changes in neurotransmitters in the brain. The aim of this study was to detect peripheral biogenic amine indicators of patients with acute psychosis and to test the correlations between the biological measures studied and the psychopathological status of the patients. METHODS This research included 60 patients with acute psychosis treated with olanzapine (n = 30) or haloperidol (n = 30). Here, we measured biogenic amine indicators, including mRNA levels of dopamine receptor D4 (DRD4) and the serotonin 2A receptor (5HTR2A), in peripheral blood mononuclear cells (PBMCs) using quantitative real-time polymerase chain reaction and serum dopamine concentrations by enzyme linked immunosorbent assay (ELISA). Psychopathological status was evaluated using psychometric scales. The assessments were conducted prior to and after 14 and 28 days of treatment. RESULTS The administration of haloperidol, but not olanzapine, up-regulated 5HTR2A mRNA in a linear manner, albeit without statistical significance (p = 0.052). Both drugs had non-significant effects on DRD4 mRNA levels. Nevertheless, a positive correlation was found between DRD4 and 5HTR2A mRNA levels over a longitudinal trajectory, suggesting co-expression of the two genes. A significant positive correlation was observed between 5HTR2A mRNA levels and total Positive and Negative Syndrome Scale (PANSS) scores in both groups of patients before treatment. A significant correlation between baseline 5HTR2A mRNA levels and PANSS scores on days 14 and 28 of treatment remained for patients treated with olanzapine only. Moreover, a significant positive correlation was observed between blood serum dopamine levels and scores on extrapyramidal symptom scales in the olanzapine group. CONCLUSIONS The DRD4 and 5HTR2A genes are co-expressed in PBMCs during antipsychotic administration. Despite a correlation between the studied biogenic amine indicators and the psychopathological status of patients, reliable biomarkers of treatment response could not be determined.
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Affiliation(s)
- A. E. Taraskina
- Department of Addictions, Department of personalized psychiatry and neurology, V.M. Bekhterev National Medical Research Center Psychiatry and Neurology, ul. Bekhterev, d. 3, Saint-Petersburg, 192019 Russia
- Laboratory of Molecular Biology, First Saint Petersburg Pavlov State Medical University, L’va Tolstogo str. 6/8, Saint-Petersburg, 197022 Russia
- Laboratory of Molecular Human Genetics, National Research Centre “Kurchatov Institute”, Petersburg Nuclear Physics Institute named after B.P. Konstantinov, Leningrad district, Orlova Roscha, Leningrad district, Gatchina, 188300 Russia
| | - R. F. Nasyrova
- Department of Addictions, Department of personalized psychiatry and neurology, V.M. Bekhterev National Medical Research Center Psychiatry and Neurology, ul. Bekhterev, d. 3, Saint-Petersburg, 192019 Russia
| | - A. M. Zabotina
- Laboratory of Molecular Biology, First Saint Petersburg Pavlov State Medical University, L’va Tolstogo str. 6/8, Saint-Petersburg, 197022 Russia
- Laboratory of Molecular Human Genetics, National Research Centre “Kurchatov Institute”, Petersburg Nuclear Physics Institute named after B.P. Konstantinov, Leningrad district, Orlova Roscha, Leningrad district, Gatchina, 188300 Russia
| | - D. N. Sosin
- Department of Addictions, Department of personalized psychiatry and neurology, V.M. Bekhterev National Medical Research Center Psychiatry and Neurology, ul. Bekhterev, d. 3, Saint-Petersburg, 192019 Russia
| | - К. А. Sosina
- Department of Addictions, Department of personalized psychiatry and neurology, V.M. Bekhterev National Medical Research Center Psychiatry and Neurology, ul. Bekhterev, d. 3, Saint-Petersburg, 192019 Russia
| | - E. E. Ershov
- Saint Petersburg Psychiatric Hospital no. 1 named after P.P. Kashchenko, Leningrad region, district, s. Nikolskoye, ul. Menkovskaya, d. 10, Gatchina, Russia
| | - M. N. Grunina
- Laboratory of Molecular Human Genetics, National Research Centre “Kurchatov Institute”, Petersburg Nuclear Physics Institute named after B.P. Konstantinov, Leningrad district, Orlova Roscha, Leningrad district, Gatchina, 188300 Russia
| | - E. M. Krupitsky
- Department of Addictions, Department of personalized psychiatry and neurology, V.M. Bekhterev National Medical Research Center Psychiatry and Neurology, ul. Bekhterev, d. 3, Saint-Petersburg, 192019 Russia
- Laboratory of Molecular Biology, First Saint Petersburg Pavlov State Medical University, L’va Tolstogo str. 6/8, Saint-Petersburg, 197022 Russia
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Holm J, Brus O, Båve U, Landen M, Lundberg J, Nordanskog P, von Knorring L, Nordenskjöld A. Improvement of cycloid psychosis following electroconvulsive therapy. Nord J Psychiatry 2017; 71:405-410. [PMID: 28367711 DOI: 10.1080/08039488.2017.1306579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness. AIMS The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome. METHODS Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n = 42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test. RESULTS The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p < 0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p = 0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p = 0.31). None of the other investigated potential predictors was statistically significantly associated with outcome. CONCLUSIONS ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies. CLINICAL IMPLICATIONS The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.
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Affiliation(s)
- Jonas Holm
- a School of Medical Sciences , Örebro University , Örebro , Sweden
| | - Ole Brus
- b Clinical Epidemiology and Biostatistics, School of Medical Sciences , Örebro University , Örebro , Sweden
| | - Ullvi Båve
- c Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Mikael Landen
- d Department of Medical Epidemiology and Biostatistics , Karolinska Institutet , Stockholm , Sweden.,e Institute of Neuroscience and Physiology , The Sahlgrenska Academy at Gothenburg University , Gothenburg , Sweden
| | - Johan Lundberg
- f Centre for Psychiatry Research, Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Pia Nordanskog
- g Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences , Linköping University , Linköping , Sweden.,h Department of Psychiatry , Region Östergötland , Linköping , Sweden
| | - Lars von Knorring
- i Department of Neuroscience, Psychiatry , Uppsala University , Uppsala , Sweden
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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.
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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
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Community based mental health care as an example of good outcomes for young persons with episode of acute and transient psychotic disorders – Case study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionThe prevalence of acute and transient psychotic disorder (ATPD) varies from 3.9–9.6 per 100,000 population [1]. Even it has clinical course with psychosis, there is no evidence that ATPD is similar with schizophrenia [2].ObjectivesSince in Bosnia and Herzegovina (BH) are not established specialized services for early interventions (EI), community mental health centers (CMHC) are basic services for fast and most efficient interventions in the cases of ATPD among other psychiatric disorders. The mental health reform has planned to establish EI services in the future [3].Aims and methodTo show CMHC as efficient service in the treatment of ATPD without using hospitalisation of young woman with two years follow up (case study)ResultsFull recovery of young female with ATPD using team approach and model of case management. After follow up of two years was any indications that psychotic disorders will develop.ConclusionsEven we have not EI specialized services in our country, CMHC have capacities to manage ATDP in community settings avoiding hospitalisation of young people.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Enderami A, Monesi FS, Zarghami M. One-Year Follow-Up of Patients with a Diagnosis of First Episode Psychosis. Mater Sociomed 2017; 29:21-25. [PMID: 28484349 PMCID: PMC5402367 DOI: 10.5455/msm.2017.29.21-25] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 02/18/2017] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Early diagnosis of symptoms related to psychotic disorders causes hyper responsiveness, recurrence reduction and quality of life improvement. The aim of this study was one-year follow-up of the clinical course and outcomes of hospitalized patients with first episode psychotic disorders and detection of factors affecting consequences. METHODS This longitudinal descriptive study was conducted during 2012 to 2013 on hospitalized patients at Zare Hospital in Sari, Iran, with any psychotic symptoms and with diagnosis of first episode psychosis. The severity of psychotic symptoms was assessed via PANSS scale (Positive and Negative Syndrome Scale) and the global functioning through Global Assessment of Functioning (GAF) scale on admission, discharge day, 6 and 12 months later. Data were analyzed using ANOVA and t-test in SPSS 20 software. RESULTS Thirty two patients had complete follow-up (25 men and 7 women) (mean age of 29.37 ± 8.02). Discharge diagnosis was as 8 (25%) bipolar disorder with psychotic features, 8 (25%) not otherwise specified (NOS), 7 (22%) schizophrenia forum disorder, 7 (22%) psychotic disorder caused by abuse materials, 2 (6%) major depressive disorder with psychotic features. There was drug abuse in half of the patients. The drug abuse in the patients had a positive relationship with the recurrence of psychotic symptoms (p=0.04). CONCLUSION A significant percentage of patients with first episode psychosis (50%) within 12 months after the primary hospitalization experienced recurrence of psychotic symptoms. Likewise, global functioning had no major improvement in the patients. It seems essential the necessity of comprehensive services after discharge, especially in patients with drug abuse, and further support of social service centers.
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Affiliation(s)
- Atena Enderami
- Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
| | - Fatemeh Sheikh Monesi
- Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
| | - Mehran Zarghami
- Department of Psychiatry, School of Medicine, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Mazandaran, Sari, Iran
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Poon JYK, Leung CM. Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study. Nord J Psychiatry 2017; 71:139-144. [PMID: 27834101 DOI: 10.1080/08039488.2016.1252426] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND 'Acute and transient psychotic disorder' (ATPD) is a category in ICD-10 marked by psychosis with acute onset and early remission. It remains relatively under-researched, despite controversies over its nosological status in the current classification system. AIMS (1) To assess the changes in diagnosis over time in patients initially diagnosed as ATPD. (2) To identify factors predicting changes in diagnosis, and compare the long-term outcomes of various patterns of diagnostic shift. (3) To make recommendations on the classification and treatment of ATPD based on the findings of the study. METHODS This was a retrospective longitudinal study based on review of medical records of patients first admitted to a regional hospital in Hong Kong for ATPD during the period from 1990-2000. RESULTS Of the 87 subjects initially diagnosed as ATPD, 64.4% had their diagnoses revised over an average of 20 years, mostly to bipolar disorder and schizophrenia. Among those with diagnosis of ATPD unchanged, 54.8% had one single episode, while the remaining 45.2% had recurrence. Subjects with diagnostic shift had significantly younger age of onset, more first-degree relatives with a history of mental illness, and more subsequent psychiatric admissions. CONCLUSIONS ATPD is likely a composite category consisting of clinically distinct outcome groups, for which further research is warranted to identify diagnostic features that distinguish them at initial presentation and revise the current nosological status of ATPD. Long-term follow-up, judicial use of antipsychotics, and education on prognosis are of paramount importance in managing patients diagnosed with ATPD.
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Affiliation(s)
| | - Chi Ming Leung
- a Department of Psychiatry , Shatin Hospital , Hong Kong SAR , PR China
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Outcome of acute and transient psychotic disorder in an index episode: A study from a tertiary care centre in North India. Asian J Psychiatr 2017; 25:101-105. [PMID: 28262127 DOI: 10.1016/j.ajp.2016.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 08/18/2016] [Accepted: 10/23/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Acute and Transient Psychotic Disorder (ATPD) is a psychotic disorder of brief duration with acute onset and uncertain diagnostic stability. AIM To study the diagnostic stability of ATPD during the index episode. METHOD 140 patients diagnosed with ATPD as per ICD-10, attending a tertiary care hospital in North India were evaluated at follow ups. RESULTS Other acute and transient psychotic disorder (ICD10: F23.8) was the most common (69.3%) subtype of ATPD. In 14.28% patients, there was a past episode of ATPD. In our study, 66.3% patient's episodes resolved as ATPD, 32.7% patients converted into either a mood disorder or schizophrenia spectrum disorders. CONCLUSION The diagnostic stability of ATPD during the index episode was 66.3% during three months follow up period. Nearly two third of patients with ATPD evolve to either, schizophrenia or mood disorders during the index episode.
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Sahoo S, Malhotra S, Basu D, Modi M. Auditory P300 event related potentials in acute and transient psychosis-Comparison with schizophrenia. Asian J Psychiatr 2016; 23:8-16. [PMID: 27969085 DOI: 10.1016/j.ajp.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/06/2016] [Accepted: 07/06/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Limited biological research data are available on acute and transient psychotic disorder (ATPD) vis-à-vis schizophrenia. P300 event related potentials (ERP) have been extensively studied as an important neurophysiological parameter in schizophrenia. However, no P300 ERP studies comparing the two disorders are available. We compared auditory P300 ERP in patients remitted from ATPD with schizophrenia in remission and biologically unrelated healthy controls. METHODS In this case-control study design, 25 subjects remitted from ATPD were age-/gender-matched with healthy controls and patients with schizophrenia in remission. Clinical assessment and auditory P300 ERP (amplitude and latencies at central and parietal sites, reaction time) were recorded. The ERP parameters were compared across the three groups. RESULTS All three groups showed significant differences in P300 amplitudes and latencies at central and parietal sites. Schizophrenia group differed significantly (p<0.001) from the ATPD group in all the P300 parameters. The ATPD group was found to have lower Pz latency (p<0.05) and lower mean reaction time (p<0.001) as compared to healthy controls. CONCLUSION The results suggest that P300 could easily distinguish between ATPD and schizophrenia in remission, thus neurophysiologically differentiating the two disorders. Lower P300 latency and reaction time, which indicate hyper-arousability, distinguished ATPD from normal controls, with implications for a better understanding of ATPD.
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Affiliation(s)
- Swapnajeet Sahoo
- Department of Psychiatry, Post graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Savita Malhotra
- Department of Psychiatry, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Debasish Basu
- Department of Psychiatry, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manish Modi
- Department of Psychiatry, Post graduate Institute of Medical Education and Research, Chandigarh, India
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33
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Castagnini AC, Munk-Jørgensen P, Bertelsen A. Short-term course and outcome of acute and transient psychotic disorders: Differences from other types of psychosis with acute onset. Int J Soc Psychiatry 2016; 62:51-6. [PMID: 26087685 DOI: 10.1177/0020764015590493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The category of 'acute and transient psychotic disorders' (ATPDs) appeared in the ICD-10 Classification of Mental and Behavioural Disorders (ICD-10), but its distinctive features remain uncertain. AIM To examine the course and outcome of ATPDs, pointing out differences from other types of psychosis. METHODS A one-year follow-up investigation of patients enrolled at the former World Health Organization (WHO) Centre for Research and Training in Mental Health in Aarhus (Denmark) for the WHO collaborative study on acute psychoses. RESULTS Of 91 patients aged 15-60 years presenting with acute psychosis, 47 (51.6%) were diagnosed with ATPD, and it occurred more commonly in females; yet, the other acute psychoses featured mainly mood disorders and affected equally both genders. After 1 year, the ATPD diagnosis did not change in 28 cases (59.6%); the remaining developed either affective psychoses (27.7%), or schizophrenia and schizoaffective disorder (12.8%). Nearly, all patients with unchanged diagnosis of ATPD enjoyed full recovery, while those with other types of acute psychosis had significantly higher rates of recurrence or incomplete remission. Duration of illness within 4 weeks and stressful events in the 3 months before symptom onset predicted 1-year favourable clinical outcome for acute psychoses. CONCLUSION Although ATPDs fared better over the short-term than other acute psychoses, their diagnostic stability is relatively low.
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Affiliation(s)
| | - Povl Munk-Jørgensen
- Department of Organic Psychiatric Disorders and Emergency Ward, Aarhus University Hospital, Risskov, Denmark
| | - Aksel Bertelsen
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus University Hospital, Risskov, Denmark
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Farooq S, Rehman M, Naeem F. Pharmacological interventions for acute and transient psychotic disorder (ATPD). Hippokratia 2015. [DOI: 10.1002/14651858.cd011974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Saeed Farooq
- Staffordshire University & Black Country Social Partnership NHS Foundation Trust; Centre for Ageing and Mental Health; Dunstall Road Wolverhampton UK WV6 0NZ
| | | | - Farooq Naeem
- Queen's University; Department of Psychiatry; Kingston ON Canada
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Cui Y, Prabhu V, Nguyen TB, Yadav BK, Chung YC. The mRNA Expression Status of Dopamine Receptor D2, Dopamine Receptor D3 and DARPP-32 in T Lymphocytes of Patients with Early Psychosis. Int J Mol Sci 2015; 16:26677-86. [PMID: 26561806 PMCID: PMC4661842 DOI: 10.3390/ijms161125983] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 01/22/2023] Open
Abstract
Peripheral blood lymphocytes are an attractive tool because there is accumulating evidence indicating that lymphocytes may be utilized as a biomarker in the field of psychiatric study as they could reveal the condition of cells distributed in the brain. Here, we measured the mRNA expression status of dopamine receptor D2 (DRD2), DRD3, and dopamine and cyclic adenosine 3',5'-monophosphate regulated phosphoprotein-32 (DARPP-32) in T lymphocytes of patients with early psychosis by quantitative real-time polymerase chain reaction (q-PCR) and explored the relationships between their mRNA levels and the psychopathological status of patients. The present study demonstrated that the mRNA expression levels of DRD3 in T lymphocytes were significantly different among controls, and in patients with psychotic disorder not otherwise specified (NOS) and schizophrenia/schizophreniform disorder. However, no significant differences in mRNA expression levels of DRD2 and DARPP-32 were found among the three groups. We found a significant positive correlation between the DRD2 mRNA level and the score of the excited factor of the Positive and Negative Syndrome Scale (PANSS) in patients with schizophrenia/schizophreniform disorder. These findings suggest that DRD3 mRNA levels may serve as a potential diagnostic biomarker differentiating patients with early psychosis from controls.
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Affiliation(s)
- Yin Cui
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju 561-756, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561-756, Korea.
| | - Vishwanath Prabhu
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju 561-756, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561-756, Korea.
| | - Thong Ba Nguyen
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju 561-756, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561-756, Korea.
| | - Binod Kumar Yadav
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju 561-756, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561-756, Korea.
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju 561-756, Korea.
- Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju 561-756, Korea.
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Queirazza F, Semple DM, Lawrie SM. Transition to schizophrenia in acute and transient psychotic disorders. Br J Psychiatry 2015; 204:299-305. [PMID: 24357576 DOI: 10.1192/bjp.bp.113.127340] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The diagnostic category of acute and transient psychotic disorders (ATPD) was introduced in ICD-10. Subsequent studies have called into question its validity and reliability. AIMS To determine the pattern of diagnostic revision to schizophrenia in first-ever diagnosed ATPD. METHOD Using data drawn from the Scottish Morbidity Record, we estimated incidence and diagnostic change in first-ever diagnosed ATPD in Scottish hospitals between January 1997 and December 2010 (n = 2923). RESULTS The average incidence of ATPD was 4.1 per 100 000 population per year. Diagnostic stability was estimated at 53.9% over an average of approximately 4 years of observation. The most common diagnostic shift was to schizophrenia (12.6%), over an average of 1.7 years. Estimates of the transition risks for schizophrenia were 80% at 2.8 years and 90% at 4.6 years. Longer first admission to hospital, younger age at onset and male gender were associated with increased risk and earlier development of schizophrenia. CONCLUSIONS Routinely collected data suggest that approximately one in eight individuals with first-ever diagnosed ATPD will develop schizophrenia within 3-5 years. Those at high risk of transition may benefit from monitoring for possible diagnostic change.
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Affiliation(s)
- Filippo Queirazza
- Filippo Queirazza, MD, MRCPsych, Hairmyres Hospital, East Kilbride, Glasgow; David M. Semple, MB ChB, MRCPsych, Division of Psychiatry, University of Edinburgh, Edinburgh, and Hairmyres Hospital, East Kilbride, Glasgow; Stephen M. Lawrie, MD, FRCPsych, Division of Psychiatry, University of Edinburgh, UK
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Mehta S. Diagnostic Stability of Acute and Transient Psychotic Disorders in Developing Country Settings: An Overview. Ment Illn 2015; 7:5640. [PMID: 26266021 PMCID: PMC4508627 DOI: 10.4081/mi.2015.5640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/10/2015] [Accepted: 02/03/2015] [Indexed: 11/23/2022] Open
Abstract
Acute and transient psychotic disorders (ATPD), introduced in the International Classification of Diseases (ICD-10) diagnostic system in 1992, are not receiving much attention in developing countries. Therefore, the main objective of this article is to review the literature related to the diagnostic stability of ATPD in developing countries. A PubMed search was conducted to review the studies concerned with this issue in the context of developing countries, as diagnostic stability is more of a direct test of validity of psychiatric diagnoses. Four publications were found. According to the literature search, the stability percentage of the ICD-10 ATPD diagnosis is 63-100%. The diagnostic shift is more commonly either towards bipolar disorder or schizophrenia, if any. Shorter duration of illness (<1 month) and abrupt onset (<48 hours) predict a stable diagnosis of ATPD. Based on available evidence, the diagnosis of ATPD appears to be relatively stable in developing countries. However, it is difficult to make a definitive conclusion, as there is a substantial lack of literature in developing country settings.
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Affiliation(s)
- Shubham Mehta
- Department of Psychiatry, Maharaja Agrasen Medical College , Agroha (Hisar), Haryana, India
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Recurrent acute and transient psychotic disorder: A pilot study. Asian J Psychiatr 2015; 14:61-4. [PMID: 25801801 DOI: 10.1016/j.ajp.2015.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/10/2015] [Accepted: 02/28/2015] [Indexed: 11/22/2022]
Abstract
Acute and transient psychotic disorder (ATPD) is associated with recurrent episodes of illness in 35-45% of cases. However, the course of such relapses and the factors associated with them are unclear. 20 patients with an ICD-10 diagnosis of ATPD (F23.x) who had experienced at least two episodes of illness, and who had been followed up for at least one year, were interviewed and their case records were reviewed. Information pertaining to relapses, their frequency, and the factors associated with them were collected and analyzed. The mean episode frequency was 0.7 episodes per year. Relapse within two years of the first episode (p=0.001) and a later age at onset (p=0.016) were significantly associated with a higher frequency of episodes. Relapse rates were 30% after a second episode and 50% after a third; mean inter-episode intervals decreased with the number of episodes, but not significantly. Patients with a stress-related onset of ATPD tended to have further stress-related relapses. Diagnostic subtypes of ATPD tended to remain stable over time. Though acute and transient psychotic disorder is a recurrent condition, recurrences do not increase significantly over time, and there is no clear evidence for a shortening of the inter-episode period. A later onset of ATPD may be associated with greater illness severity. These results are preliminary and require replication in larger prospective samples.
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Abstract
BACKGROUND Acute and transient psychotic disorders (ATPDs) are relatively under-researched. There is therefore a dearth of information on the disorders especially in developing countries, where they have been shown to be relatively common. AIM To describe the socio-demographic and clinical characteristics of patients with ATPD, as well as to examine the factors that are associated with early recovery in patients with ATPD in a developing country. METHODS A review of 124 cases of untreated first episode of ATPD that presented at the University College Hospital, Ibadan, Nigeria over a five-year period. RESULTS Of the new cases that presented at the psychiatry department of the hospital, 10.1% were ATPDs. There was no significant difference between the proportions of males and females presenting at the hospital (50.8% vs 49.2%). Mean age at presentation was 29.5 (SD = 9.6) years, while the mean duration of illness before presentation was 7.3 (SD = 6.1) days. Female gender was significantly associated with earlier recovery (p = .047). CONCLUSION ATPDs are common in developing countries. The epidemiology in developing countries is probably different from that of the developed countries.
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Affiliation(s)
- Oluyomi Esan
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, Nigeria
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, University of Ibadan, University College Hospital, Ibadan, Nigeria
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Remberk B, Bażyńska AK, Krempa-Kowalewska A, Rybakowski F. Adolescent insanity revisited: course and outcome in early-onset schizophrenia spectrum psychoses in an 8-year follow-up study. Compr Psychiatry 2014; 55:1174-81. [PMID: 24794640 DOI: 10.1016/j.comppsych.2014.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/22/2014] [Accepted: 03/25/2014] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES Despite inclusion of adolescent insanity-a concept proposed by Thomas Clouston in late XIX century-into the broader nosological entity of dementia praecox, the uniqueness of early psychosis is still discussed. The aim of the current study is the assessment of course and outcome in the large sample of early-onset psychosis subjects. METHOD Of 299 patients hospitalized in the period 1998-2008 in an adolescent psychiatry ward with schizophrenia spectrum diagnosis 158 completed a follow-up interview. Data concerning current diagnosis, further admissions, current treatment status and occupational and relationship outcome were analyzed after a mean of 8 years of follow-up. RESULTS Mean age at the index admission and the follow-up was 16.6 ± 1.2 and 24.5 ± 3.0 years respectively. After the subsequent discharge almost all subjects (97%) at least briefly continued psychiatric treatment and 75% of patients had been readmitted. Overall diagnostic stability was 42%. For schizophrenia spectrum disorders and schizophrenia diagnostic stability was 72% and 78%, respectively. At the follow-up assessment 119 (77.3%) of the traced subjects declared current psychiatric treatment and 110 (73.3%) were receiving pharmacotherapy. Almost half of the subjects (48%) were employed or studying and more than a third (35.8%) remained in a stable relationship. Different distributions of baseline diagnoses were observed in males and females, and the latter showed a better outcome. CONCLUSION Early-onset psychoses were characterized by limited diagnostic stability, a necessity for further treatment and hospitalizations and significant percentage of unfavorable functional outcomes. Baseline diagnosis of acute and transient psychotic disorders and female gender were associated with an overall better outcome.
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Affiliation(s)
- Barbara Remberk
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland.
| | - Anna Katarzyna Bażyńska
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland.
| | | | - Filip Rybakowski
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, ul. Sobieskiego 9, 02-957 Warsaw, Poland; University of Social Sciences and Humanities, ul. Kutrzeby 10, Poznan, Poland.
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Rusaka M, Rancāns E. A prospective follow-up study of first-episode acute transient psychotic disorder in Latvia. Ann Gen Psychiatry 2014; 13:4. [PMID: 24502369 PMCID: PMC3922543 DOI: 10.1186/1744-859x-13-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute and transient psychotic disorder (ATPD) has been described as an acute psychosis with brief onset and polymorphous symptomatology (WHO, 1993). The study of ATPD is growing increasingly relevant as scientists start an active discussion of the possibility of changing the ATPD classification in the next International Classification of Diseases (ICD-11). The aims of this study were to describe the clinical features of the index episode of ATPD in patients in Latvia, to analyse the stability and longitudinal changes of the diagnosis, to explore potential correlations between the sociodemographic and disease characteristics and to describe stressful life events before the first ATPD episode. METHODS A prospective follow-up study of all first-time admitted patients from the Riga Centre of Psychiatry and Addiction Disorders who fulfilled the ICD-10 criteria for ATPD (WHO, 1993) during the 15-month period from 9 January 2010 to 30 March 2011 and followed up until 31 October 2012. Stressful life events, demographics and clinical features during the index episode were assessed. RESULTS One hundred two patients were admitted with first-episode ATPD. The majority were females (60.7%). Over an average 26.5-month follow-up period, 59.8% of the patients were not readmitted. The overall stability rate of ATPD diagnosis in our sample was 67.4% (p = 0.0001). In the subgroup of patients who were readmitted, 70.7% had their diagnosis converted to schizophrenia in subsequent visits. Stressful life events before the first episode were found in 49.0% of first-episode ATPD patients. Thought disorder was found to be the strongest statistically significant predictor of ATPD diagnosis conversation to schizophrenia (odds ratio 4.3), with high Wald's criterion (9.435) in binary logistic regression. CONCLUSIONS ATPD is prevalent in Latvia, with rather high overall stability rate. Combining these data from first-episode ATPD patients in Latvia with data from other countries may help predict the development of the disease and provide a basis for potential changes to ICD-11.
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Affiliation(s)
- Marija Rusaka
- Riga Centre of Psychiatry and Addiction Disorders, Tvaika str, 2, Riga LV 1005, Latvia.
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Rusaka M, Rancāns E. First-episode acute and transient psychotic disorder in Latvia: a 6-year follow-up study. Nord J Psychiatry 2014; 68:24-9. [PMID: 23383651 DOI: 10.3109/08039488.2012.761726] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute and transient psychotic disorder (ATPD; F23, ICD-10) is an acute, short-lived psychosis, which has variable prevalence worldwide and has not been extensively studied. AIMS To explore the first episode of ATPD in patients in Latvia by describing the clinical features, analyzing the longitudinal changes of diagnosis and associated socio-demographic characteristics. MATERIAL AND METHODS Retrospective chart review of all first-time hospitalized patients fulfilling the ICD-10 criteria for ATPD treated at the Riga Centre of Psychiatry and Addiction Disorders, Latvia, during a 3-year period. Patients were followed-up and assessed using standardized instruments. RESULTS During a 3-year period, 294 patients were first-time hospitalized with a ATPD diagnosis; 54% were women. The average age at first psychotic episode was 35.7 ± 12.3 years for women, and 30.0 ± 10.8 years for men (P < 0.0001). Over an average of 5.6 years follow-up period, 51% of patients were not re-hospitalized. Later diagnosis was changed to schizophrenia in 73% of the re-hospitalized patients, mostly within the first 2 years of illness. The overall stability rate of ATPD diagnosis reached 58%. Typical polymorphic symptomatology, abrupt onset (i.e. within 48 h), less frequent anxiety, but more frequent hallucinations were observed in ATPD patients that later developed schizophrenia (P < 0.05). Stressful life events in the 6 months prior to the first episode were found in 44% of patients. CONCLUSIONS Combining these assessments from first-episode ATPD patients in Latvia, with data from other countries may help to predict the development of disease and provide the possible basis for potential changes to ICD-11.
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Affiliation(s)
- Marija Rusaka
- Riga Centre of Psychiatry and Addiction Disorders , Riga , Latvia
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Castagnini A, Foldager L. Epidemiology, course and outcome of acute polymorphic psychotic disorder: implications for ICD-11. Psychopathology 2014; 47:202-6. [PMID: 24481421 DOI: 10.1159/000357784] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/04/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The proposed revision of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), subsuming polymorphic, schizophrenic or predominantly delusional syndromes, would restrict their classification to acute polymorphic psychotic disorder, reminiscent of the clinical concepts of bouffée délirante and cycloid psychosis. SAMPLING AND METHODS We selected all subjects aged 15-64 years (n = 5,426) who were listed in the Danish Psychiatric Central Register with a first-admission diagnosis of ATPDs in 1995-2008 and estimated incidence rates, course and outcome up to 2010. RESULTS Although about half of ATPD patients tended to experience transition to another category over a mean follow-up period of 9.3 years, acute polymorphic psychotic disorder fared better in terms of cases with a single episode of psychosis and temporal stability than the subtypes featuring schizophrenic or predominantly delusional symptoms. Acute polymorphic psychotic disorder was more common in females, while cases with acute schizophrenic features predominated in younger males and evolved more often into schizophrenia and related disorders. CONCLUSIONS These findings suggest that acute polymorphic psychotic disorder exhibits distinctive features and challenge the current approach to the classification of ATPDs.
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Affiliation(s)
- Augusto Castagnini
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Castagnini A, Foldager L. Variations in incidence and age of onset of acute and transient psychotic disorders. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1917-22. [PMID: 23783414 DOI: 10.1007/s00127-013-0726-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 05/29/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine incidence and age of onset of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs) characterised by subtypes with polymorphic, schizophrenic and predominantly delusional symptoms, pointing out differences from schizophrenia (SZ) and bipolar affective disorder (BD). METHODS We identified all subjects aged 15-64 years who were listed for the first time in the Danish Psychiatric Register with a diagnosis of ATPDs (n = 3,350), SZ (n = 4,576) and BD (n = 3,200) in 1995-2008. Incidence rates and rate ratios (IRR; 95 % confidence interval) by gender and age were calculated. RESULTS The incidence of ATPDs was 6.7 per 100,000 person-years, similarly high for both genders (IRR 1.0; 0.9-1.1). Among the ATPD subtypes, polymorphic psychotic disorder was more common in females (IRR 1.4; 1.2-1.6) as opposed to those featuring schizophrenic symptoms, which tended to occur in younger males (IRR 1.4; 1.2-1.7). No significant gender difference was found for acute predominantly delusional disorder (IRR 1.0; 0.9-1.2), which had a later onset than any ATPD subtypes. SZ had an incidence twice as high in males (IRR 2.0; 1.9-2.2), and an earlier age of onset than ATPDs. A different pattern was observed for BD in terms of a slightly greater incidence in females (IRR 1.1; 1.0-1.1), and a later age of onset than both ATPDs and SZ. CONCLUSION These findings are likely to reflect the heterogeneity of the clinical features encompassed by ATPDs, and contribute to building a case for their revision in ICD-11.
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Affiliation(s)
- Augusto Castagnini
- Translational Neuropsychiatry Unit, Department of Clinical Medicine, Aarhus University, Skovagervej 2, 8240, Risskov, Denmark,
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Castagnini AC, Laursen TM, Mortensen PB, Bertelsen A. Family psychiatric morbidity of acute and transient psychotic disorders and their relationship to schizophrenia and bipolar disorder. Psychol Med 2013; 43:2369-2375. [PMID: 23343536 DOI: 10.1017/s0033291713000044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although transient psychotic disorders are currently classified as a category separate from schizophrenia (SZ) and affective disorders, their distinctive features remain uncertain. This study examines the family psychiatric morbidity of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), pointing out differences from SZ and bipolar disorder (BD). METHOD From a cohort of 2.5 million persons, we identified all patients enrolled in the Danish Psychiatric Register who were ever admitted with ATPDs (n=2537), SZ (n = 10639) and BD disorder (n=5292) between 1996 and 2008. The relative risk (RR) of ATPDs, SZ and BD associated with psychiatric morbidity in first-degree relatives (FDRs) was calculated as the incidence rate ratio using Poisson regression. RESULTS The RR of ATPDs [1.93, 95% confidence interval (CI) 1.76-2.11] was higher if patients with ATPDs had at least one FDR admitted with any mental disorder than patients without family psychiatric antecedents. An additional risk arose if they had FDRs admitted not only with ATPDs (RR 1.60, 95% CI 1.33-1.92) but also with SZ (RR 2.06, 95% CI 1.70-2.50) and/or BD (RR 1.55, 95% CI 1.23-1.96). Despite some overlap, the risk of SZ (RR 2.80, 95% CI 2.58-3.04) and BD (RR 3.68, 95% CI 3.29-4.12) was markedly higher if patients with SZ and BD had FDRs admitted with the same condition. CONCLUSIONS These findings suggest that family psychiatric predisposition has a relatively modest impact on ATPDs and argue against a sharp differentiation of ATPDs from SZ and BD.
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Affiliation(s)
- A C Castagnini
- Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
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Castagnini A, Foldager L, Bertelsen A. Excess mortality of acute and transient psychotic disorders: comparison with bipolar affective disorder and schizophrenia. Acta Psychiatr Scand 2013; 128:370-5. [PMID: 23331302 DOI: 10.1111/acps.12077] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate mortality and causes of death of short-lived psychotic disorders, by carrying out a comparison with bipolar disorder and schizophrenia. METHOD Record linkage study to the official register of causes of death of all cases aged 15-64 years who were listed for the first time in the Danish Psychiatric Register between 1995 and 2008 with an ICD-10 diagnosis of 'acute and transient psychotic disorders' (ATPDs; n = 4157), bipolar disorder (n = 3200) and schizophrenia (n = 4576). RESULTS A total of 232 patients (5.6%) with ATPDs, 172 (5.4%) with bipolar disorder and 233 (5.1%) with schizophrenia had died over a mean follow-up period of 6.6 years. The standardized mortality ratio for all causes, natural causes and unnatural causes was significantly high for the three conditions. Mortality of ATPDs was greater in men, with about two-thirds of all deaths resulting from natural causes mainly cardiovascular, digestive, neoplastic and respiratory diseases. Suicide was the major cause of premature death in patients with ATPDs. CONCLUSION These findings suggest that ATPDs are associated with an increased mortality from both natural causes and suicide.
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Affiliation(s)
- A Castagnini
- Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark
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Castagnini A, Foldager L, Bertelsen A. Long-term stability of acute and transient psychotic disorders. Aust N Z J Psychiatry 2013; 47:59-64. [PMID: 23028179 DOI: 10.1177/0004867412461692] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the temporal stability of the category 'acute and transient psychotic disorders' (ATPDs), ICD-10 Classification of Mental and Behavioural Disorders, including subtypes characterised by polymorphic, schizophrenic and predominantly delusional features. METHOD We checked the readmission patterns of all patients aged 15-64 years (n = 5426), whether admitted to hospital or treated as outpatients, who were enrolled for the first time in the Danish Psychiatric Register with a diagnosis of ATPDs between 1995 and 2008. RESULTS An increasing number of cases with ATPDs changed diagnosis in subsequent admissions after 1, 2 and 5 years, mainly either to schizophrenia and related disorders or affective disorders. In their last admission, on average after 7.3 years, there were 2429 patients listed with ATPDs, accounting for an overall stability of 44.8%. Females were less likely than males to develop another diagnosis. Among the ATPD subtypes, polymorphic psychotic disorder without schizophrenic symptoms had a higher stability than those featuring schizophrenic or predominantly delusional features. CONCLUSIONS The low diagnostic stability of ATPDs reflects the lack of clearly defining features and argues against their validity as a distinct category.
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Affiliation(s)
- Augusto Castagnini
- Centre for Psychiatric Research, Aarhus Psychiatric University Hospital, Risskov, Denmark.
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Esan OB, Ojagbemi A, Gureje O. Epidemiology of schizophrenia--an update with a focus on developing countries. Int Rev Psychiatry 2012; 24:387-92. [PMID: 23057975 DOI: 10.3109/09540261.2012.725219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Developments over the past few decades in analytical epidemiological research in schizophrenia have challenged some long-held views about the disorder. For example, the conventional view that schizophrenia may have a favourable outcome in developing countries is currently being challenged by emerging empirical data. However, quality research from developing countries is still relatively scarce. In this article we review some major epidemiological findings of schizophrenia with a focus on data from the developing world and within the context of the methodological issues and challenges associated with such studies.
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Affiliation(s)
- Oluyomi B Esan
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, Nigeria.
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Udomratn P, Burns J, Farooq S. Acute and transient psychotic disorders: an overview of studies in Asia. Int Rev Psychiatry 2012; 24:463-6. [PMID: 23057982 DOI: 10.3109/09540261.2012.715579] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute and transient psychotic disorders (ATPD), introduced in the International Classification of Diseases (ICD-10) diagnostic system, have not received much attention in Asia. As the World Health Organization (WHO) is in the process of revising the ICD-10 and ICD-11 is expected to be published in the near future, it seems appropriate to review the status of ATPD in this region. A PubMed search using appropriate keywords was conducted to identify literature describing samples from Asian countries with the diagnosis of ATPD for evidence of ATPD as a distinct diagnostic group. A total of 103 papers were found, but only nine publications were specifically related to ATPD and the ICD-10 criteria. The total number of patients receiving a diagnosis of ATPD in these studies was 390. Immigrants appear prone to ATPD, especially foreign domestic workers. When compared to schizophrenia, ATPD as a group had a different family history, course and outcome. However, ATPD was diagnostically unstable over time. A range of 35.5% to 73.3% in Asian patients with baseline ATPD retained their diagnoses over 3-12 years. Most individuals with polymorphic subtypes of ATPD in India and Hong Kong were rediagnosed with bipolar disorder after 3-5 years. In Japan, 31.2% of polymorphic cases were diagnosed as schizophrenia after 12 years of follow-up. This review supports the ICD-10 concept of separating ATPD into its own group; however, polymorphic subtypes may need revision in ICD-11. Before firm suggestions are submitted to the WHO, further research and data review from other regions is necessary.
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Affiliation(s)
- Pichet Udomratn
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
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Narayanaswamy JC, Shanmugam VH, Raveendranathan D, Viswanath B, Muralidharan K. Short-term diagnostic stability of acute psychosis: data from a tertiary care psychiatric center in South India. Indian J Psychol Med 2012; 34:176-8. [PMID: 23162196 PMCID: PMC3498783 DOI: 10.4103/0253-7176.101797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
CONTEXT Studies on acute psychosis in patients from India report good outcome. A small proportion of these patients may suffer relapses or other develop major psychiatric disorders later. AIM The aim of this study was to examine the diagnostic stability of acute psychosis in patients from India. MATERIALS AND METHODS The records of patients who presented with the first episode of acute and transient psychotic disorder (n=57) over 1 year (2004) were analyzed, and the follow-up data at the end of 1 and 2 years were recorded. RESULTS The mean age of the sample was 30.72 years. The mean duration of illness episode was 18.15±17.10 days. The follow-up data were available for 77.2% (n=44) and 75.4% (n=43) of the sample at the end of first and second years. Relapse was recorded in 47.4 and 54.4% at the end of first and second years, respectively. CONCLUSION The diagnosis changed into other disorders such as bipolar disorder, schizophrenia, and unspecified psychosis, while a majority retained the initial diagnosis of acute psychosis. The findings suggest that acute psychosis is a relatively stable condition. A small percentage of these patients may go on to develop schizophrenia or bipolar disorder.
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Affiliation(s)
- Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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