Assessment Of Psychotic Symptoms Research Articles

Cognitive impairment in adults under compulsory psychiatric care: association with psychotic symptoms and high-dose antipsychotics

Background There is limited evidence on the association between cognitive function, psychotic symptoms and doses of antipsychotics in adults under compulsory psychiatric care. Aims We assessed (a) the degree of cognitive impairment in adults involuntarily hospitalised for compulsory psychiatric care and (b) correlation of Montreal Cognitive Assessment (MoCA) score with psychotic symptoms, polypharmacy and prescription of high-dose antipsychotics. Method This was a nationwide, cross-sectional study, conducted at the only referral state hospital for compulsory psychiatric care in Cyprus (December 2016–February 2018). Τhe MoCA was applied for the assessment of cognitive functioning. The Positive and Negative Syndrome Scale (PANSS) was applied for the assessment of psychotic symptoms. Results The sample comprised 187 men and 116 women. The mean MoCA score was 22.09 (reported scale range (RSR): 3–30); the mean PANSS general symptoms subscale score was 49.60 (RSR = 41–162). The participants who reported positive psychiatric history (mean 21.71, s.d. 5.37), non-adherence to pharmacotherapy (mean 21.32, s.d. 5.56) and prescription of high-dose antipsychotics (with medication prescribed as needed: mean 21.31, s.d. 5.70; without medication prescribed as needed: mean 20.71, s.d. 5.78) had lower mean MoCA scores compared with those who reported negative psychiatric history (mean 23.42, s.d. 4.51; P = 0.017), adherence to pharmacotherapy (mean 23.10, s.d. 6.61; P = 0.003) and no prescription of high-dose antipsychotics (with medication prescribed as needed: mean 22.56, s.d. 4.90; without medication prescribed as needed: mean 22.60 s.d. 4.94; P = 0.045–0.005), respectively. Mean MoCA score was mildly and inversely associated with total PANSS score (r = −0.15, P = 0.03), PANSS general (r = −0.18, P = 0.002) and PANSS negative (r = −0.16, P = 0.005) symptoms subscales, respectively. Conclusions Our findings support the evaluation of cognitive functioning in adults under compulsory psychiatric care via the MoCA tool, with focus on those prescribed high-dose antipsychotics, with positive mental health history and non-adherence to pharmacotherapy.

Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review.

Virtual reality (VR) has emerged as a safe and non-invasive technology for the assessment of psychotic symptoms, social and cognitive impairments, and psychosocial intervention in improving outcomes in psychosis. This study systematically reviewed the current state of evidence in applying semi- and fully immersive VR for assessing and treating patients with psychosis. A systematic review was conducted adhering to the PRISMA statement and was conducted in Embase, PsycINFO, and PubMed databases for articles published between January 2013 and April 2022, which identified 28 eligible studies, including 12 for assessment and 16 for intervention. In the assessment studies, not all VR tasks could distinguish the differences between patients and healthy controls regarding their physiological responses, paranoid ideation, and certain aspects of cognitive functioning such as memory bias on the object tasks. Comparatively, VR-based interventions are more promising, especially for improving cognitive impairments, social skills, agoraphobic avoidance, negative and positive affective states, auditory verbal hallucination, paranoid ideation and persecutory delusions, and other psychiatric symptoms in patients. We conclude that more rigorous studies are needed to confirm treatment effectiveness and to understand the underlying mechanism of VR-based intervention for psychotic disorders. Future studies should also improve the reliability and validity of VR-based assessments for psychotic disorders.

432 - Ultrabrief Right Unilateral ECT in Older Adults with Catatonia: A Case Series and Literature Review

Objectives:Comparing Ultra-brief (UB) Right Unilateral Electroconvulsive Therapy (RU ECT) to the existing literature, this case series highlights the use of the treatment with geriatric patients.Methods:This is a retrospective chart review of 5 patients with catatonia who were successfully treated with UB RUL ECT. Medical records were reviewed for clinical data and ECT treatment. The existing literature is compared and contrasted with other published cases. Quick Inventory of Depressive Symptomatology (QIDS) was completed both pre-ECT and post-ECT. Clinical Global Impression–Improvement (CGI-I) scale was performed post-ECT. Response was defined as decrease of QIDS by 50% and remission was defined as QIDS ≤5. CGI response was defined as CGI-I ≤2.Results:All patients received UB RUL ECT treatment (mean age 67, 100% female). 20% (n=2) were caucasian. 60% had mood disorders and 40% had psychotic disorders. Number of treatments in the acute treatment course ranged from 5 to 20, charge was dosed at 6-10 times the seizure threshold determined at first treatment. All patients had a significant clinical response to ECT as reflected by clinical data, ECT procedure notes, and rating scales when available. All patients completed post ECT CGI-I. Response rate was 60% (n = 3). We also assessed QIDS scores for patients with comorbid depression. Out of these patients, 40% (n = 2) were unable to complete baseline QIDS secondary to symptoms severity. Mean baseline QIDS for the remaining patients was 9.67 (SD 1.53). Post-treatment QIDS was 3.67 (SD 5.51). Paired-samples t-test comparing these scores at baseline and post-ECT demonstrated a significance P value of 0.14. None of the patients experienced worsening of cognitive function.Conclusions:UB RUL ECT is a safe and effective treatment for Catatonia. Our data demonstrate clinical improvement in patients with Catatonia with UB RUL ECT. In addition, this method may lower the burden of cognitive effects that can significantly benefit the older adult population. The literature is limited regarding the use of Ultra-brief (<0.37 milisec) Right Unilateral (RU) ECT in Catatonia. Additional studies will benefit from the inclusion of objective metrics such as Bush Francis Catatonia Scale, Scale for the Assessment of Psychotic Symptoms (SAPS), and the systematic evaluation of cognitive status and function.

Assessment of Psychotic Symptoms in Individuals Exposed to Very High or Extreme Altitude: A Field Study.

Hüfner, Katharina, Fabio Caramazza, Agnieszka E. Stawinoga, Evelyn R. Pircher Nöckler, Paolo Fusar-Poli, Sanjeeb S. Bhandari, Buddha Basnyat, Monika Brodmann Maeder, Giacomo Strapazzon, Iztok Tomazin, Barbara Sperner-Unterweger, and Hermann Brugger. Assessment of psychotic symptoms in individuals exposed to very high or extreme altitude: A field study. High Alt Med Biol. 22:369–378, 2021.Background: Symptoms of psychosis such as hallucinations can occur at high or extreme altitude and have been linked to accidents on the mountain. No data are available on how to assess such symptoms in the field and what their prevalence or predisposing factors might be.Methods: In this field study at Everest Base Camp (5,365 m) in Nepal, 99 participants of organized expeditions underwent 279 assessments: The High Altitude Psychosis Questionnaire (HAPSY-Q), the Prodromal Questionnaire, 16-items (PQ-16), and the Mini International Neuropsychiatric Interview (M.I.N.I., psychosis section) were collected together with further clinical data. Statistical analysis was done for each phase, that is, altitude range of the climb, and overall data.Results: One of 97 climbers fulfilled the M.I.N.I. diagnostic criteria for psychosis during one acclimatization climb. At least one endorsed item on the HAPSY-Q and the PQ-16, indicating the presence of symptoms of psychosis in the absence of a psychotic disorders, were identified in 10/97 (10.3%) and 18/87 (20.7%) participants respectively. The scores of the HAPSY-Q and the PQ-16 were correlated (r = 0.268, p < 0.001). Odds ratio analysis identified an increased risk for accidents in individuals with endorsed items on the HAPSY-Q.Conclusions: The diagnosis of high altitude psychosis is rare in climbers during organized expeditions. Nevertheless, subdiagnostic symptoms of psychosis occurred in a significant proportion of climbers. Future research is needed to validate these pilot findings.

MHealth-Assisted Detection of Precursors to Relapse in Schizophrenia.

Theoretical views and a growing body of empirical evidence suggest that psychiatric relapses in schizophrenia-spectrum disorders (SSDs) have measurable warning signs. However, because they are time- and resource-intensive, existing assessment approaches are not well-suited to detect these warning signs in a timely, scalable fashion. Mobile technologies deploying frequent measurements—i.e., ecological momentary assessment—could be leveraged to detect increases in symptoms that may precede relapses. The present study examined EMA measurements with growth curve models in the 100 days preceding and following 27 relapses (among n = 20 individuals with SSDs) to identify (1) what symptoms changed in the periods gradually preceding, following, and right as relapses occur, (2) how large were these changes, and (3) on what time scale did they occur. Results demonstrated that, on average, participants reported elevations in negative mood (d = 0.34), anxiety (d =0.49), persecutory ideation (d =0.35), and hallucinations (d =0.34) on relapse days relative to their average during the study. These increases emerged gradually on average from significant and steady increases (d = 0.05 per week) in persecutory ideation and hallucinations over the 100-day period preceding relapse. This suggests that brief (i.e., 1–2 item) assessments of psychotic symptoms may detect meaningful signals that precede psychiatric relapses long before they occur. These assessments could increase opportunities for relapse prevention as remote measurement-based care management platforms develop.

Network analysis of psychotic manifestations among cocaine users

Psychotic experiences can be described along a continuum ranging from no psychotic experience at all, to clinical psychotic disorder. Any individual in the general population may encounter psychotic experiences under certain circumstances. Transient Cocaine Induced Psychotic Symptoms (TCIPS) are a well described model of such circumstances.Therefore, our aim was to use a network analysis to get a better knowledge on the architecture of previously described risk factors and how they contributed to two different measures of psychosis (psychosis proneness and transient cocaine induced psychotic symptoms)This study is a secondary analysis conducted among 180 cocaine users in addiction care centers in Paris and Paris suburb, who were evaluated with the PDI (Peters Delusion Inventory) and the SAPS-CIP (Scale for the Assessment of Psychotic Symptoms – Cocaine Induced Psychosis). Schizophrenia diagnosis was extracted from medical record. Relevant variables significantly associated with SAPS-CIP total score or PDI at the first step were included in a network analysis to better figurate their respective associations.The network centrality measures showed that the product preferentially used (crack vs cocaine) was related to TCIPS, psychosis proneness and, to a lesser extent, schizophrenia. Secondly, in this model TCIPS is a mediator between intensive cocaine use and psychosis proneness. Thirdly, this study refines the previous knowledge on heavy cannabis use being a risk factor for TCIPS. The observed link is not direct but mediated by psychosis proneness.

Assessing psychotic symptoms in forensic evaluations of criminal responsibility – a pilot study using Positive And Negative Syndrome Scale

ABSTRACT Description of symptoms and signs related to psychotic disorders at the time of the crime is essential in forensic evaluations of legal insanity. Knowledge of the content of forensic reports is important to improve and secure their quality. Here we report the findings of a pilot study using PANSS as an instrument to assess descriptions of psychotic symptoms in forensic psychiatric reports. Three experienced psychiatrists assessed 20 forensic reports focusing on forensic experts’ descriptions of the defendant’s mental state at the time of the observation and at the time of the alleged crime. PANSS was evaluated as a tool for examining relevant psychotic symptoms, and interrater reliability was calculated. Interrater reliability was satisfactory. It varied based on the percentage of symptoms not described in the reports and on the type of symptom. At both times more symptoms were described from the positive scale of PANSS, than from the negative and the general scale. This pilot study shows that PANSS can be used as an instrument for the structured assessment of psychotic symptoms in written forensic reports and indicates that psychotic symptoms at the time of the alleged crime are poorly described.

Prevalence of Non-Affective Psychoses in Individuals with Autism Spectrum Disorders: A Systematic Review.

Autism spectrum disorders (ASD) and non-affective psychoses such as schizophrenia are commonly acknowledged as discrete entities. Previous research has revealed evidence of high comorbidity between these conditions, but their differential diagnosis proves difficult in routine clinical practice due to the similarities between core symptoms of each disorder. The prevalence of comorbid non-affective psychoses in individuals with ASD is uncertain, with studies reporting rates ranging from 0% to 61.5%. We therefore performed a systematic review and pooled analysis of the available studies reporting the prevalence of non-affective psychosis in ASD. Fourteen studies, including a total of 1708 participants, were included, with a weighted pooled prevalence assessed at 9.5% (95% CI 2.6 to 16.0). In view of significant heterogeneity amongst the studies, subgroup analyses were conducted. We observed higher prevalence of non-affective psychoses among ASD inpatients versus outpatients, when operationalised criteria were used, and in studies with smaller sample sizes, whereas the figures were comparable between children and adults with ASD. Our results suggest that future studies involving larger samples should implement both operationalized criteria and specific scales for the assessment of psychotic symptoms in individuals with ASD. A deeper understanding of both differential and comorbid features of ASD and non-affective psychosis will be required for the development of optimized clinical management protocols.

Association of Primary Care Consultation Patterns With Early Signs and Symptoms of Psychosis

Primary care is an important part of the care pathway for patients with psychosis; therefore, primary care physicians need to be able to accurately identify those at clinical high risk of psychosis. The difficulty of this task is increased because clinical high-risk symptoms are frequently nonspecific to psychosis. To determine whether the consultation patterns for a prespecified set of symptoms can be used to identify primary care patients who later developed a psychotic illness. This nested case-control study used primary care consultation data collected from 530 primary care practices in 13 UK regions from January 1, 2000, through September 30, 2009. Participants included 11 690 adults with a diagnosis of psychosis and 81 793 control participants who did not have a diagnosis of psychosis individually matched by age group, sex, and primary care practice. Data were analyzed from July 1, 2015, through June 2, 2017. Prespecified symptoms selected from literature included attention-deficit/hyperactivity disorder-like symptoms, bizarre behavior, blunted affect, problems associated with cannabis, depressive symptoms, role functioning problems, social isolation, symptoms of mania, obsessive-compulsive disorder-like symptoms, disordered personal hygiene, sleep disturbance, problems associated with cigarette smoking, and suicidal behavior (including self-harm). Case (diagnosis of psychosis) or control (no diagnosis of psychosis) status. Conditional logistic regression was used to investigate the association between symptoms and case-control status in the 5 years before diagnosis. Positive predictive values (PPVs) were calculated using the Bayes theorem for symptoms stratified by age group and sex. Repeated-measures Poisson regression was used to investigate symptom consultation rate. Of the total sample of 93 483 participants, 57.4% were female and 40.0% were older than 60 years (mean [SD] age, 51.34 [21.75] years). Twelve symptoms were associated with a later psychotic diagnosis (all prespecified symptoms except disordered personal hygiene). The strongest association was with suicidal behavior (odds ratio [OR], 19.06; 95% CI, 16.55-21.95). Positive predictive values were heterogeneous across age and sex. The highest PPVs were for suicidal behavior (33.0% in men 24 years or younger [95% CI, 24.2%-43.2%] and 19.6% in women aged 25-34 years [95% CI, 13.7%-27.2%]). Pairs of symptoms were associated with an increase in PPV. Consultation rates were higher in cases and increased 3 months before diagnosis. Most of the preselected nonspecific symptoms were associated with a later psychotic diagnosis, particularly among young men consulting for suicidal behavior, especially if consulting with increasing frequency. These symptoms should alert physicians to patients who may benefit from a further assessment of psychotic symptoms.

Dilemmas in the treatment of early-onset first-episode psychosis.

Early-onset first-episode psychosis (EOP) is a severe mental disorder that can pose a number of challenges to clinicians, young people and their families. Its assessment and differentiation from other neurodevelopmental and mental health conditions may at times be difficult, its treatment may not always lead to optimal outcomes and can be associated with significant side effects, and its long-term course and prognosis seem to be less favourable compared with the adult-onset disorder. In this paper, we discuss some dilemmas associated with the evaluation and management of EOP and propose approaches that can be used in the clinical decision-making process. A detailed and well-informed assessment of psychotic symptoms and comorbidities, a systematic approach to treatment with minimum possible medication doses and close monitoring of its effectiveness and adverse effects, and multidimensional interventions taking into consideration risks and expectations associated with EOP, are paramount in the achievement of the most favourable outcomes for affected children and young people.

Psychosis Risk Syndrome: What Now?

Schizophrenia is a chronic psychiatric disorder that generally begins in late adolescence or early adulthood. This early onset is often linked with a devastating lifelong impact on both the social network and work capacities of the affected subjects. Beginning in the mid-1990s, several sets of diagnostic criteria aiming to identify "high-risk" patients were developed and applied in clinical studies. Short-term rates of onset of psychosis in this subgroup of subjects ranged from 20% to 40%. However, 20 years later, the proposal to introduce "psychosis risk syndrome" as a coded diagnostic category in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders remained controversial and was finally rejected. Instead, "attenuated psychosis syndrome" was included in section III of the newly published manual as a condition for further studies. The goal of this article is to review the extant literature concerning the advantages and risks of early assessment of psychotic symptoms ("prodrome" and "psychosis-risk syndrome") and concerning available therapeutic options, both psychosocial and pharmacological. "Attenuated psychosis syndrome" is a clinically useful concept. It identifies help-seeking individuals with mental health problems who need an intervention and who, if no treatment strategy is proposed, present a higher likelihood of developing a psychosis spectrum disorder in the years following their first contact with a mental health facility. In parallel with the clinical utility of this concept, additional research focused on this group of patients is warranted to further understand the emerging phase of psychotic disorders and to develop effective and efficient evidence-based prevention strategies.

Emerging sensor-based m-health interventions in the assessment of psychotic symptoms

This speech aims to overview ongoing research trends on the integration of mobile health and sensors based behavioral analysis in therapeutics programs for subjects with mental health symptoms or disorders. The variety of easily acquirable personal data by smartphones and wearables in a transparent and unobtrusive way, offers the opportunity to describe the person in terms of his/her lifestyle and behavior at physical, cognitive and environmental level. An appropriate management of these data may initiate a new line in healthcare management characterized by tailored and timely interventions. However, despite the huge amount of data that could be acquired, an effective contribution of such information to the improvement of the quality of care in mental-health is still not sufficiently explored. The sensors and data which have been used in studies on mental status include accelerometer, gyroscope, GPS, microphone, calls, messages, screen, apps usage, environmental light, heart rate, skin conductance, and temperature. The primary outcomes build on correlations between sensor data and mental health status/severity of symptoms. These data are provided from studies on bipolar disorders and depression, using validated clinical scales (Patient Health Questionnaire-9; Hamilton Rating Scale for Depression; Young Mania Rating Scale; Center for Epidemiologic Studies Depression Scale; etc.).m-RESIST consortium is fully aware of the importance to describe behavioral patterns of patients with schizophrenia that could be used to setup remotely based therapeutic tool. m-RESIST is setting up a framework for the creation of a Clinical Decision Support System based on a mobile therapeutic intervention for treatment-resistant schizophrenia.Disclosure of interestThe author has not supplied his declaration of competing interest.

Assessment of psychotic symptoms in bipolar disorder

IntroductionBipolar disorder is a disabling condition characterized by the presence of manic, depressive, hypomanic or mixed episodes, affective symptoms that may coexist with several types of psychotic features.ObjectivesThe purpose is to evaluate the frequency of psychotic symptoms among bipolar disorder.MethodThe study included 55 bipolar patients admitted in the Psychiatry Clinical Hospital from January 2012 until May 2013. Inclusion criteria were represented by diagnosis of bipolar disorder, manic or depressive episode, according to DSM-IV-TR and ICD 10 criteria. Clinical instruments used to assess the severity of the current affective episode were Young Mania Rating Scale (YMRS) for manic patients and Hamilton Depression Rating Scale-17 items – (HDRS) for the depressive ones. Psychotic symptoms were evaluated with the Brief Psychiatric Rating Scale-18 items – (BPRS).ResultsOut of the 55 patients, 32 had psychotic symptoms upon admission to the hospital. BPRS results showed delusions of guilt, inutility, hypochondriac and nihilistic delusions for the depressed patients. Delusions of grandiosity and megalomania accounted for most of psychotic symptoms in manic patients. A smaller number of patients showed delusions of invention and reform. Perception disturbances such as auditory hallucinations were present in both diagnosis categories but in a higher percentage in depressive bipolar patients.ConclusionsEven if less frequently than in schizophrenia or schizoaffective disorder, psychotic symptoms are present in bipolar disorder. They influence the general functioning and the outcome of patients diagnosed with this illness.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comparison of psychopathology of schizophrenia ill patients with hyponatremia or normonatremia on hospital admission

Abstract Purpose A comparison of differences in the psychopathological profile in aggravated schizophrenia patients with hyponatremia or normonatremia on hospital admission or at hospital discharge. Method The mental state in 11 patients with schizophrenia and hyponatremia on hospital admission was compared to mental state in 22 patients with schizophrenia and normonatremia on hospital admission being a control group. The comparison included all patients from hyponatremia and normonatremia groups, and then 11 pairs chosen from among them and matched for age and sex. The mental state of patients was assessed twice, at the beginning and at the end of hospitalisation using the following scales: clinical global impression (CGI) scale, detailed Mental State Assessment (Przegląd Stanu Psychicznego; PSP) scale – a Polish modification of the German AMDP system, as well as three scales profiled to measure positive and negative syndromes of psychosis (PANSS), depressive symptoms in schizophrenia (CDSS) and mania symptoms (BRMAS). Results The clinical global impression (CGI) only at the hospital discharge and only in the case of comparison in pairs indicated greater severity of disorders in patients with hyponatremia. The total score of the assessment according to PSP/AMDP did not favour patients with hyponatremia, while the detailed assessment – both when comparing groups and pairs – indicated greater severity of consciousness and orientation disorders observed at the beginning of hospitalisation and remaining at the end of hospitalisation. In the group without hyponatremia, the PSP/AMDP assessment revealed greater severity of delusions as well as affective and anxiety symptoms, but only at the beginning of hospitalisation. The results of the assessment of psychotic symptoms according to PANSS, depressive symptoms according to CDSS and mania symptoms according to BRMAS did not show any significant differences depending on the presence of hyponatremia. Conclusions The results suggest that consciousness and orientation disorders may be the only hyponatremia-related feature distinguishing schizophrenia patients with hyponatremia diagnosed on the hospital admission, which retains its influence throughout hospitalisation. The clinical impression also suggests worse results as far as treatment of these patients is concerned.

Psychotic spectrum symptoms across the lifespan are related to lifetime suicidality among 147 patients with bipolar I or major depressive disorder

BackgroundConflicting evidence exists about the relationship between psychotic symptoms and suicidality in mood disorders. We aimed to investigate the lifetime suicidality and its relationship with dimensions of the psychotic spectrum over the lifespan among subjects with bipolar I (BD I) or major depressive disorder (MDD).Methods147 Consecutive out- and inpatients with BD I or MDD presenting for treatment at 11 Italian Departments of Psychiatry were administered the Structured Clinical Interview for DSM-IV Axis I Disorders, the Structured Clinical Interview for the Psychotic Spectrum (SCI-PSY, lifetime version) and the Mood Spectrum Self-Report (MOODS-SR, lifetime version).ResultsSubjects with psychotic features did not differ from those without for MOODS-SR suicidality score. Controlling for age, gender and diagnosis (MDD/BD I), the SCI-PSY total score (p = .007) and Paranoid (p = .042), Schizoid (p = .007) and Interpersonal Sensitivity (p < .001) domain scores independently predicted lifetime MOODS-SR suicidality score in the overall sample.ConclusionsPsychotic features, as evaluated upon the presence of delusions or hallucinations, are not associated with suicidality among subjects with BD I or MDD. However, more subtle dimensions of the psychotic spectrum, such as Interpersonal Sensitivity, Paranoid and Schizoid symptoms, show a significant relationship with lifetime suicidality. Our findings highlight the potential usefulness of a spectrum approach in the assessment of psychotic symptoms and suicide risk among subjects with BD I or MDD.

The impact of psychotic symptoms on the persons with dementia experiencing them

To portray the emotional and behavioral reactions of persons with dementia to the delusions and hallucinations they experience, according to the reports of their family caregivers. The article also explores the relationship between those reactions and background variables. Study participants were family caregivers of 74 older persons with a diagnosis of dementia (aged ≥ 65) residing in the community recruited from adult day centers and support groups for caregivers of persons with dementia and by advertising online. Assessments included the Behavioral Pathology in Alzheimer's Disease, the Neuropsychiatric Inventory, the Etiological Assessment of Psychotic Symptoms in Dementia, Activities of Daily Living questionnaire, and the Mini-Mental State Examination. Findings concerning emotional reactions reveal that close to half of the delusions resulted in discomfort, whereas around 40% did not. We found significant differences in the discomfort associated with different types of delusions, with delusions of abandonment, danger, and infidelity associated with more discomfort than other delusions. Around half of the delusions were associated with a behavioral manifestation. The findings highlight the need to examine the emotional impact of delusions and hallucinations as part of their assessment and as a consideration in treatment decisions.

Influence of NRGN rs12807809 polymorphism on symptom severity in individuals with schizophrenia in the Han population but not the Zhuang population of south China.

NRGN is one of the most promising candidate genes for schizophrenia based on function and position. Therefore, this study aimed to examine the genetic association of this polymorphism with schizophrenia in the Zhuang and Han populations of south China. Subjects and methods A total of 282 patients (188 Han and 94 Zhuang) and 282 healthy subjects (188 Han and 94 Zhuang) were recruited. Of these, 246 schizophrenia patients underwent an assessment of psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS). A TaqMan genotyping assay method was used to determine the genotypes. We did not find a significant association of rs12807809 polymorphism with schizophrenia in the total pooled samples, or in the separate ethnic groups. However, in Han schizophrenia patients, quantitative data analyses showed that the CC genotype of the rs12807809 polymorphism was associated with PANSS aggression subscale score and activation subscale score. Furthermore, carriers of the C allele of rs12807809 polymorphism among Han schizophrenia patients had higher scores of general, activation, depression, aggression, and global symptoms than the T allele carriers. In conclusion rs12807809 polymorphism may not contribute to the risk of schizophrenia but influence the clinical symptoms of schizophrenia in the Han population.

Is it possible to combine different psychotic symptom scales in bipolar disorder?

It has been suggested that data on positive and negative psychotic symptoms in patients with schizophrenia as assessed using different scales may be combined. For the first time, we assessed correlations between the positive syndrome subscale of the Positive and Negative Syndrome Scale (PANSS-P) and the Scale for the Assessment of Positive Symptoms (SAPS), and between the negative syndrome subscale of the Positive and Negative Syndrome Scale (PANSS-N) and the Scale for the Assessment of Negative Symptoms (SANS) in patients with bipolar disorder. We also aimed to confirm these correlations in patients with schizophrenia. This cross-sectional study was conducted with a group of 94 patients (40 diagnosed with bipolar disorder, 54 with schizophrenia). Assessments were carried out using the PANSS, SAPS and SANS. Large significant correlations were found between the PANSS-P and SAPS, and between the PANSS-N and SANS, in both the bipolar disorder group and the schizophrenia group. These results confirm previous findings regarding correlations between these scales in schizophrenia, and support the hypothesis that similar correlations exist in bipolar disorder. Therefore, our data support the potential usefulness in collaborative research of combining results from different scales for the assessment of psychotic symptoms in patients with bipolar disorder.

Effects of Multidimensional Treatment Foster Care on Psychotic Symptoms in Girls

Neurodevelopmental theories of psychosis highlight the potential benefits of early intervention, prevention, and/or preemption. How early intervention should take place has not been established, nor whether interventions based on social learning principles can have preemptive effects. The objective was to test whether a comprehensive psychosocial intervention can significantly alter psychotic symptom trajectories during adolescence-a period of heightened risk for a wide range of psychopathology. This study was a randomized controlled trial (RCT) of Multidimensional Treatment Foster Care (MTFC) for delinquent adolescent girls. Assessment of psychotic symptoms took place at baseline and then 6, 12, 18, and 24 months post-baseline using a standardized self-report instrument (Brief Symptom Inventory). A second source of information about psychotic symptoms was obtained at baseline or 12 months, and again at 24 months using a structured diagnostic interview (the Diagnostic Interview Schedule for Children [DISC]). Significant benefits for MTFC over treatment as usual for psychosis symptoms were observed over a 24-month period. Findings were replicated across both measures. Effects were independent of substance use and initial symptom severity and persisted beyond the initial intervention period. Ameliorating nonclinical psychotic symptoms trajectories beginning in mid-adolescence via a multifaceted psychosocial intervention is possible. Developmental research on nonclinical psychotic symptoms and their prognostic value should be complemented by more psychosocial intervention research aimed at modifying these symptom trajectories early in their natural history. Clinical trial registration information-Juvenile Justice Girls Randomized Control Trial: Young Adult Follow-up; http://clinicaltrials.gov; NCT01341626.

Reactions and Interventions for Delusions in Nursing Home Residents with Dementia.

This is a qualitative and quantitative study examining institutional staff members' reactions to delusions experienced by nursing home residents. Participants were 38 nursing home residents aged 65 and older, diagnosed with dementia. Data were collected from 8 nursing homes in Israel between June 2007 and January 2009. Assessments included Behavioral Pathology in Alzheimer's Disease Rating Scale, Neuropsychiatric Inventory: Nursing Home version, Etiological Assessment of Psychotic Symptoms In Dementia, Activities of Daily Living, and Mini-Mental State Examination. A wide variety of interventions with dementia-related symptoms was found to be effective to varying degrees. This included general approaches for a variety of symptoms as well as symptom-specific interventions. Caregivers do not always seem to be aware that multiple approaches are available to them when dealing with dementia. The most effective approaches may be those tailored to the individual. Combining interventions may increase overall effectiveness. Caregiver's experience and the institutional culture may affect the choice of intervention used, either positively or negatively.