Atypical Psychosis Research Articles

The convergence between different definitions of functional psychoses

The purpose of this study was to investigate the mutual concordance between different definitions of functional psychoses, including ICD-10. The operational criteria checklist (OPCRIT) was applied to 168 patients with clinical diagnoses of psychotic and affective disorders. The main sources of OPCRIT ratings were the ninth and tenth versions of present-state examination (68%), and formal psychiatric interview with chart reviews constituted the remaining source (32%). Mutual concordance between different definitions of schizophrenia, mania, depressive disorders (atypical psychosis, schizophreniform, schizo-affective, and other functional psychotic disorders) was calculated. On the average, a modest concordance level was found for schizophrenia and depressive disorders (0.52, 0.50, respectively) and a good concordance level for mania (0.67). Mutual concordance levels between ICD-10, DSM-III, DSM-III-R. and RD definitions for schizophrenia, mania, and depression ranged from good to excellent. Old diagnostic systems tend to have lower concordance levels. Poor concordance levels between different definitions of nonschizophrenic and non-affective psychoses were found. Although the findings of this study indicate that recent definitions of diagnostic systems are comparable, a multidiagnostic approach to assess patients with mental disorders is recommended.

Plasma interleukin-1 beta and sleep architecture in schizophrenia and other nonaffective psychoses.

It has been reported that sleep deprivation may enhance interleukin (IL)-1 beta production of healthy subjects. Furthermore, patients with acute psychoses have been reported to exhibit higher levels of IL-1 beta than healthy controls. The present study examined polysomnographic sleep and morning IL-1 beta plasma values in 20 drug-free patients with acute nonaffective psychoses. Ten patients with DSM-III diagnosis of schizophrenia, five with delusional disorder, and five with atypical psychosis underwent polysomnographic sleep registrations and their morning blood levels of IL-1 beta were measured. IL-1 beta values correlated negatively with the length of the sleep period (p = 0.010) and the relative time of rapid eye movement (REM) sleep (p = 0.038), and positively with REM latency (p = 0.043). It is concluded that reduced sleep, possibly especially reduced REM sleep, may be a reason for increased morning IL-1 beta values in these patients. Additional studies on IL-1 beta in psychiatric patients should consider the possibility of sleep disturbances as a possible explanation for deviations in IL-1 beta levels.

P-15-18 - An association study between atypical psychosis and dopamine D2 receptor gene

P-15-18 - An association study between atypical psychosis and dopamine D2 receptor gene

The concept of 'atypical psychoses': special reference to its development in Japan.

Reviewing the development of concepts of 'atypical' psychoses in European countries and in the United States shows that there are various terminologies which are given to a group of psychoses unclassifiable within Kraepelinian dichotomy. Bouffée délirante (French school), cycloid psychoses (Leonhard, Perris), reactive psychoses (Scandinavian school) and acute schizoaffective psychoses (Kasanin) are the most common terms. These are consistent in terms of acute onset, polymorphic symptomatology and good prognosis, and are considered to be distinct from major psychoses, especially from typical schizophrenia. The concept atypical psychoses in Japan was developed under the influence of Mitsuda's clinico-genetic studies. According to Mitsuda, atypical psychoses are not mere phenotypical variants of typical schizophrenia and manic-depressive psychosis (MDP) but belong to a genetically different category and are probably heterogeneous. The characteristic features in the Japanese concept of atypical psychoses emphasizes the alteration of consciousness in symptomatology and pays attention to the nosological relationship with epilepsy, as well as with schizophrenia and MDP. Thus, in Japan it is generally considered that atypical psychoses are independent of 'typical' major psychoses and are located nosologically in the border area between typical schizophrenia, MDP and epilepsy.

A visual evoked potential study of atypical endogenous psychoses

Because of the continued controversies about the nature of atypical endogenous psychoses and their relationship to typical endogenous psychoses such as schizophrenias or affective disorders, a visual evoked potential (VEP) study was performed on 11 patients with atypical endogenous psychosis, 6 schizophrenics (both medicated) and 11 normal controls to observe the characteristics of cerebral responsiveness in atypical endogenous psychoses. VEPs were elicited by flashes. A modification of Kadobayashi's addition task method was employed as the mental task and the changes in P 100 amplitude of the VEPs at the time points of 1, 3, 5, 7, 9 and 11 minutes after the task were estimated from the amplitude ratios before and after the task. A majority of the patients with atypical endogenous psychosis (73%) showed remarkable increases in VEP amplitude after the mental task, and the rest showed decreases regardless of the variety in their clinical features such as confusion, elation or depression, being in part consistent with the findings in bipolar affective disorders previously reported by this author and his colleagues. On the other hand, the schizophrenics all showed remarkable decreases in VEP amplititude after the task with a mean value of amplitude ratios of 65.1 +/- 14.7. In group comparisons between both disorders of the amplitude ratio at each time point within 11 minutes after the task and in their average, the differences reached a statistically significant level at all time points except 11 minutes after the task and in their average. In the normal controls the amplitude changes were slight with a mean value of amplitude ratios of 95.1 +/- 9.9. Between the normal controls and the schizophrenics, significant differences were found at all time points except 5 and 11 minutes after the task and in their average. Patients with atypical endogenous psychosis showed higher incidences of the amplitude ratios deviating from the normal range than the normal controls. The differences were of statistical significance at all time points except 3 and 11 minutes after the task and except in their average. From the viewpoint of the neurophysiological aspect of cerebral evoked potentials the author discussed the similarities of brain excitability in atypical endogenous psychoses and affective disorders.

Integrated Treatment Model for First-Contact Patients with a Schizophrenia-Type Psychosis: The Finnish API Project

This paper presents the background, rationale, set-up and first results of the Finnish API study, whose aim was to investigate the use of a psychotherapeutically oriented and familycentred treatment model for acute psychosis in different treatment settings, and especially the role of neuroleptic drug treatment when working along the principles of the integrated treatment model. Six psychiatric catchment areas from different parts of the country participated by collecting a material of 136 first-contact patients with a schizophrenia-type psychosis. More than half of the patients received a formal diagnosis from the schizophrenia group at the initial examination, and more than one-third a diagnosis of reactive or atypical psychosis. In the treatment plans for the patients, the psychosocial modes of treatment dominated, especially the family therapeutic methods. Neuroleptic drug treatment was recommended for only 40% of the patients, and for one-fourth no psychotropic drugs at all. Acute psychosis, Integrated treatment. Neuroleptic-free treatment, Treatment models. Research Professor Ville Lehtinen, National Research and Development Centre for Welfare and Health (Stakes), Mental Health Unit, Kunnallissairaalantie 20, Building 4, FIN-20700 Turku, Finland; Accepted: 25 March 1996.

Delineation of Acute and Transient Psychotic Disorders in a Developing Country Setting

We examined whether acute transient psychoses can be distinguished from schizophrenia and the affective disorders. We studied 46 cases of nonaffective acute psychosis in the Chandigarh Acute Psychosis Study. With respect to separation from schizophrenia, we examined the distribution of duration of the episode. With respect to separation from affective disorders, we assessed the frequency of affective symptoms. Duration was bimodal, suggesting the presence of two distinct conditions of short and long duration. Affective symptoms were minimal, suggesting that these were not atypical affective syndromes. Acute transient psychoses conform neither with schizophrenia of brief duration nor with atypical affective psychosis, and thus require separate classification as proposed in the ICD-10.

Effects of haloperidol, alone and combined with DRO, on the self-injurious behavior in a woman with profound mental retardation and atypical psychosis

The effects of haloperidol, alone and combined with differential reinforcement of other behavior (DRO) on self-injurious behavior (SIB) of a woman with profound mental retardation and atypical psychosis were evaluated. Haloperidol, alone and combined with DRO, produced large reductions in SIB and injuries resulting from SIB. Response to environmental stimuli improved, meal refusal decreased significantly, her weight increased to an acceptable range, and sleep stabilized. SIB, meal refusal, sleep difficulties, weight loss, and inconsistent response to environmental stimuli appeared to be components of atypical psychosis that was responsive to low-dose haloperidol in combination with DRO. Treatment effects were maintained at a 27-month follow-up.

The atypical neuroleptic clozapine (Leponex)--current knowledge and recent clinical aspects

The dibenzoepine derivative clozapine is seen as a prototype of an atypical neuroleptic, because clozapine has good antipsychotic efficacy but only minimal dopamine antagonistic properties in common animal paradigms. The latter is reflected by the observation that extrapyramidal symptoms during clozapine are a rare phenomenon. Furthermore, recent studies in the USA demonstrated a superior efficacy of clozapine in schizophrenic patients who are nonresponsive to classic neuroleptics. Therefore, the introduction of clozapine in the USA was performed in 1990 despite the well-known risk of agranulocytosis (1-2% during the first year of treatment); however, under restricted conditions regarding the mandatory weekly control of the white blood cell count. For the use of clozapine in Europe, it should be underlined that in 1992 the indication was restricted to "acute and chronic forms of schizophrenia" whereas formerly it was permitted to treat several other neuroleptic resistant syndromes with clozapine, e.g. severe psychotic excitement, aggressive behavior or manic or atypical psychosis. The usage of clozapine in these indications is now only permitted under the restricted legal conditions of a "therapeutic trial" in selected patients. However, several indications for which clozapine has been used successfully in Europe are currently re-investigated in the USA, hopefully leading to a redefinition and extension of the indication spectrum. On the other hand, the American multicenter trials lead to the conclusion that the treatment with clozapine is not furthermore the treatment of last choice but a serious therapeutic alternative which should be available for all schizophrenic patient in case of neuroleptic resistance or of severe side effects of standard neuroleptics. Clozapine treatment leads to an improvement of the quality of life in one third of these schizophrenics and, moreover, results in a marked reduction of costs mainly by reducing the rehospitalisation rates. On the other hand, the list of well-known side effects of clozapine (e.g. agranulocytosis, increased risk of seizures, initial sedation) has to be extended (e.g. transient leucocytosis or eosinophilia, rare but severe complications like cardiorespiratory arrest and "sudden death" during combination with benzodiazepines, case reports of pericarditis, pancreatitis or polyserositis). On the background of possible cardiorespiratory complications we recommend to start the first treatment with clozapine in high risk patients (e.g. those in older age or in case of organic brain impairment) only in restricted indications and only in centers with sufficient clozapine experience.

The Ullevål acute-ward follow-up study: Reflections on the treatment of psychotic patients who committed suicide

Of all patients with functional psychosis from one catchment area treated in an acute ward in Oslo, eight patients (9%) committed suicide during the following 8 years, six men and two women, with an age range of 18–70 years. Four had affective psychoses, three schizophrenia, and one atypical psychosis. Five problematic issues in the treatment of these patients have been identified: 1) poor therapeutic alliance, 2) countertransference problems, 3) problems with drug compliance, 4) discrepancy between treatment ideology and patient needs, and 5) disputes between treatment units over treatment responsibility. The clinical problems are illustrated by three case stories. These patients need continuity of care, but the establishment of long-term aftercare is complicated by psychopathology, lack of therapist capacity, and controversies between units about treatment responsibility. Countertransference problems are common, and wards should develop clinical milieus that offer openness for personal reactions and ava...

Single Photon Emission Computed Tomography (SPECT) Findings Using N‐Isopropyl‐p‐[123I]iodoamphetamine (123I‐IMP) in Schizophrenia and Atypical Psychosis

Abstract: As a basis for possible classification of schizophrenic psychoses into schizophrenia and atypical psychosis, we studied the brain functional differences among 16 schizophrenic patients, 16 atypical psychosis patients and 16 healthy volunteers by single photon emission computed tomography (SPECT) using N‐isopropyl‐p‐[123I]iodoamphetamine. As a result, schizophrenics showed hypofrontality. On the other hand, atypical psychotics had no such hypofrontality but showed a reduced uptake rate in the right thalamic region. No influence of sex, duration of illness and medication was confirmed by the findings. The results suggest that schizophrenics might have some lesions in the frontal regions, whereas atypical psychotics might have no such lesions, but dysfunction in the right thalamic region. Consequently, the SPECT findings at least indicate possibly different etiologies for schizophrenia and atypical psychosis.

Prepubertal Psychosis: A Case Control Study

Psychotic symptoms, hallucinations, delusions, or a thought disorder, are very rarely observed in children. This holds true not only for the community at large, but even in high risk groups such as the offspring of schizophrenic mothers. This study was undertaken to describe the frequency, syndromes, demographics, and neurodevelopmental and medical correlates of prepubertal psychosis. A chart review was conducted at nine child psychiatry inpatient units in the New York metropolitan area of all children admitted over a two year period who received a discharge diagnosis of a DSM III-R axis I “nonorganic” psychotic disorder. The next age and sex matched admission was used as a control subject. One hundred prepubertal psychotic children were identified, of which 55 were given a diagnosis of psychotic disorder NOS (atypical psychosis). Psychotic children were overwhelmingly male and from the lower social classes. In both cases and matched controls, disorders of higher cognitive functioning were frequent, while neurologic and medical disorders were rarely diagnosed. Psychotic symptoms occur prior to the onset of puberty, but the syndromal presentation and demographics differ from adult onset psychotic disorders. These results support the hypothesis of a neurodevelopmental influence upon psychotic symptomatology and suggest an alternative explanation of the schizophrenic progress.

MDMA (“ecstasy”) abuse: Psychopathological features and craving for chocolate: A case series

}89): Introduction dose was 200 mg (about 2.8 mg/kg BW), at intervals ranging from mor1-14 days. He reported sporadic use of other drugs (alcohol, ben153. The amphetamine analog 3,4-methylenedioxymethamphetamine zodiazepines, cannabis, cocaine). His family psychiatric history ' and (MDMA. ecstasy) is a drug of abuse which combines the effects was negative. He had not complained of any psychological distur176of amphetamines and lysergic acid diethylamide (LSD). MDMA bances until starting to use MDMA, but in the last 3 years he had has become increasingly popular in northern Italy, but its use has suffered from paranoid delusions (he was convinced he was being litter been associated with lasting adverse neuropsychiatric sequelae in stared at and ridiculed by people when he went out of doors). He dishumans who have taken repeated doses (and in one case even after also suffered from high levels of anxiety; delusions of bodily a single dose; McCann and Ricaurte 1992). These adverse effects change the believed his brain had been stolen, his eyes were not his 1 the include anxiety, panic attacks, insomnia, flashbacks, chronic psyown); changes of mood (which never met DSM-III-R diagnostic 'ogia choses (McGuire and Fahy 1991), recurrent acute paranoid psycriteria for an affective disorder); inverted sleeping-waking patchosis, cognitive abnormalities, and depression with suicidal beterns; aggressive outbursts; and loss of appetite accompanied by _n B havior (Benazzi and Mazzoli 1991; Creighton et al 1991; McCann striking weight loss ( 10 kg) despite no dieting (his original weight ts of and Ricaurte 1991; Pallanti and Mazzi 1992: Krystal and Price was 70 kg). Over the last 2 years, for the first time in his life, hehad 1992). It has been suggested (Henry 1992) that it will take many been having intermittent episodes of craving for foods containin_ : and yearstounderstand fullytherealcontribution ofMDMAabuseto chocolate: the frequent, usually twice-weekly, chocolate bingethe onset of psychiatric disturbances. In the last 24 months. 50 eating episodes were associated with loss of appetite ['or other line. consecutive MDMA abusers presented to the Addiction Treatment foods. During such episodes, he would ingest an estimated 1500 Unit in Padova and one or more of the above-described psychokcal. The patient was unable to explain why this happened: he had and pathological features were found in 16 of them (data not shown no history of bulimic episodes, and there was no clear temporal ,eirnhere; Schifano 1994). The present report focuses on seven patients relationship between his MDMA intake and binge-eating epi(one has been the subject of another communication; Schit'ano sodes. Routine blood tests and computed tomography (CT) of the ative 1991) whose psychopathological disturbances included a craving brain were normal. A chronic, atypical psychosis was diagnosed for chocolate (a symptom which, to the best of our knowledge, had according to DSM-III-R criteria. Neuroleptic therapy (haloperidol not been observed previously in MDMA abusers), and promazine) was only partially beneficial.

A family study of self-reported personality traits and DSM-III-R personality disorders

Personality traits and DSM-III-R personality disorders of first-degree relatives of patients with psychoses were studied using the NEO Five-Factor Inventory (NEO-FFI) and the Personality Diagnostic Questionnaire-Revised (PDQ-R), two self-report instruments. The relatives were compared on their scores for the five personality factors in the NEO-FFI, the prevalence of individual DSM-III-R personality disorders, and their scores for each personality disorder scale in the PDQ-R. The results suggest that there is no difference in personality traits and prevalence of personality disorders, including schizophrenia spectrum disorders, when relatives of patients with schizophrenia, bipolar disorder, and major depression are compared to each other. Relatives of patients with “atypical psychosis,” psychotic disorders that do not meet DSM-III-R criteria for any specific nonorganic psychotic disorder, may be a distinctive group.

The Roscommon Family Study. II. The risk of nonschizophrenic nonaffective psychoses in relatives.

We sought to clarify the familial relationship between the nonschizophrenic, nonaffective psychoses (schizoaffective disorder [SAD], schizophreniform disorder, delusional disorder, and atypical psychosis) and schizophrenia and affective illness (AI). A case-controlled epidemiologic family study using DSM-III-R criteria. Compared with relatives of unscreened controls, the risk of nonschizophrenic, nonaffective psychoses was significantly elevated in relatives of probands with schizophrenia, SAD, schizotypal personality disorder, and psychotic AI. No significant elevation in risk to these disorders was seen in relatives of probands with nonpsychotic AI. The risk for SAD alone was significantly increased in relatives of probands with psychotic or bipolar AI. The nonschizophrenic, nonaffective psychoses have a significant familial relationship with both schizophrenia and schizotypical personality disorder. Schizoaffective disorder, as defined by DSM-III-R, shares familial etiologic factors with at least some forms of AI.

Clinical electroencephalography in a psychiatric service.

An audit of the use of clinical electroencephalography in a psychiatric service was carried out by examining the referrals for an EEG from the service over one year (11% of all referrals), comparing them with matched patient controls, rating the EEGs blindly and estimating the clinical value of the investigation for each patient; 37% were abnormal, 19% anomalous and 44% normal. The following two clusters of symptoms and signs were associated with EEG referral--the patients with "organic" mental state phenomena and/or CNS signs; EEG usually abnormal and the patients with behavioural changes that raise the suspicion of an organic process but, taken alone, are not compelling evidence of such (for example, impulsive behaviour, acute and atypical psychoses, perceptual or behavioural phenomena of the type associated with temporal lobe epilepsy in the absence of frank complex partial seizures); EEG usually normal or anomalous. Ninety-two percent of EEGs were judged to be of clinical value; 53% positive and 39% negative. Eight percent of referrals made no contribution to the clinical evaluation.

Phospholipase A2 activity in serum of neuroleptic-naive psychiatric inpatients.

The activity of phospholipase A2 (PLA2), an enzyme that, besides a number of other functions, is involved in prostaglandin synthesis, regulation of membrane stability, and presynaptic neurotransmitter release, has been reported to be greater in the serum and plasma of schizophrenic patients than in that of other psychiatric patients and normal controls. Furthermore, it is said to be significantly reduced by haloperidol treatment. We decided to replicate these findings in an independent sample of patients by using a highly sensitive assay for determining PLA2 activity.-- Of 167 consecutive male admissions giving informed consent 35 were found never to have received neuroleptics previously. Ten had DSM-III diagnoses of schizophrenia, schizophreniform disorder, or atypical psychosis, eight of other psychiatric disorders and 17 of alcohol or drug dependence (Table 1). Blood samples were drawn before medication was initiated. For patients still in hospital (Table 3), this was repeated after 21 days of treatment (n = 10). Samples from 10 healthy subjects were also obtained. PLA2 activity was determined according to Märki and Franson (1986), using a radiochemical assay.-- On day 0, there were no statistically significant intergroup differences in PLA2 serum activity. After 21 days, it was not possible to detect any significant decrease in PLA2 activity (Table 4). The PLA2 activity of the patient groups did not differ from that of the group of healthy subjects (Table 5).-- It was not possible to replicate the finding of increased PLA2 activity in schizophrenic patients in our sample of patients never treated with neuroleptics before.(ABSTRACT TRUNCATED AT 250 WORDS)

A neuropsychological perspective on dual diagnosis.

The purpose of this study was to investigate whether patients experiencing both a major psychiatric disorder and a concurrent substance abuse problem (dual diagnosis) manifest greater neuropsychological dysfunctions than patients experiencing a major psychiatric disorder alone. Differences in diagnostic variability and fluidity between dual diagnosis and non-dual diagnosis patients and the occurrence of polysubstance abuse among the dual diagnosis patients were also investigated. The hypotheses were tested by retrospectively reviewing the psychiatric records of 50 dual diagnosis patients and comparing them to 36 chronically hospitalized non-dual diagnosis psychiatric patients. Results revealed that dual diagnosis patients manifested significantly greater neuropsychological impairments than non-dual diagnosis patients and that dual diagnosis patients showed a greater range of diagnoses and diagnostic fluidity than non-dual diagnosis patients. Results also revealed that over one-half of the dual diagnosis patients abused a variety of different substances. An etiological role of neuropsychological dysfunction in the development of the dual diagnosis syndrome in at least a subgroup of dual diagnosis patients is suggested. More specifically, it is suggested that the neuropsychological dysfunctional pattern that is described may represent an organic substrate of a nonspecific vulnerability to developing both (atypical) psychoses and (poly) substance abuse.

Multivariate analyses of CT findings in typical schizophrenia and atypical psychosis.

In order to investigate the brain morphological differences between typical schizophrenia and atypical psychosis, the brain CTs of 41 patients with typical schizophrenia, 27 patients with atypical psychosis (ATP), and 20 controls were examined. The schizophrenics had larger values for 9 CT indices, i.e., interhemispheric fissure (IHF) index, VBR, 2 lateral ventricles (L-V) and 3rd ventricle (III-V) indices, and 4 sylvian fissure (SF) indices, while the values of ATP patients for 3 SF indices were greater than for the controls. Moreover, the schizophrenics had greater III-V and L-V indices than the ATP patients. The correlation matrix of CT indices indicates that the III-V index correlated well with the other CT indices, whereas the VBR, IHF and right SF indices did not. Therefore, it was speculated that there might be 3 subgroups, each of which has a main focus of alteration in the above-mentioned regions. Therefore, all the cases were divided by means of a cluster analysis into 5 groups. Group I, which contained mainly normal controls, and Group II, which consisted mainly of atypical psychosis patients, had no abnormal CT findings. Group III, which comprised mainly ATP patients and paranoid type schizophrenics, had right SF enlargement. Group IV, which showed significant IHF enlargement, and the residue group, which had larger VBR and significant left SF enlargement, consisted mostly of schizophrenics. Thus, our results suggest that the classification by CT data corresponds on the whole to our clinical diagnosis, according to which schizophrenic psychosis is divided into typical schizophrenia and atypical psychosis, and that each of the two psychosis groups may be further classified into distinct subgroups.

Treatment of dual diagnosis patients: A relapse prevention group approach

The authors describe the successful use of an adjunctive group psychotherapy for substance-abusing patients with major psychiatric disorders (bipolar, schizophrenia, schizoaffective, psychotic depression, and atypical psychosis). The group utilizes a psychoeducational approach that focuses on substance abuse causes and consequences, principles of recovery, and relapse prevention strategies. Eight patients with prolonged histories of abuse of cocaine, alcohol, marijuana, or other drugs were enrolled in this weekly group treatment at a community mental health center drug treatment program, while continuing in treatment with their current case manager or primary therapist. Six of the eight patients achieved periods of stable abstinence, documented by self-report, urine toxicology screens, continued group attendance, and improved social functioning. Case examples are utilized to illustrate the group process.