Brief Psychotic Disorder Research Articles

Hair cannabinoids for distinguishing acute psychosis from chronic psychosis in cannabis users with brief psychotic disorder

To make an early differential diagnosis, in cannabis users with psychotic disorders, between disorders of the schizophrenic field and disorders induced by cannabis. Among young consumers of cannabis, a brief psychotic disorder (BPD) can be either the clinical manifestation of acute cannabis psychosis (ACP) or an announcement of schizophrenia's onset. The clinical presentation is of the same order, and only the evolution of disorders makes it possible to differentiate between these entities. To date, no clinical or even less paraclinical criteria have made it possible to differentiate syndromes whose prognoses and management are different (Hirschtritt M. Perm J 2021;25:20.179). Since 2010, we measured delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in head hair among New Caledonian patients, all cannabis consumers ( n = 256) (Barguil Y. medRxiv 2022.04.13.22273751). We wanted to determine if these patients, cannabis users, suffering from different mental pathologies, present particular phenotypes of capillary cannabinoid concentrations (THC and CBD). At the time of initial psychiatric consultation, a sample of 3 cm proximal length of head hair was prepared for analysis. Capillary THC and CBD were then assayed by GC-MS (LOQ: 0.05 ng/mg) (Kintz P. Forensic Sci Int 1995;70:175–82). At the end of the 6 months medico-psychologic follow-up from the initial evaluation, four groups of cannabis users were identified according to the final psychiatric diagnosis: control, acute cannabis psychosis (ACP), chronic psychosis (CP), and other personality disorders (OPD) groups. Samples for which CBD and/or THC were not detected were considered in this study because these patients are known to be cannabis consumers (urine samples were positive for THC-COOH prior to hair sampling). A threshold value was arbitrarily set at 0.0024 ng/mg for the calculation of ratios. In this study, a “high” level of THC detected (> 0.70 ng/mg) associated with a low CBD/THC ratio (< 0.26) are two parameters that taken together could be good markers of CP development. For OPD and ACP, discriminating between the two types of disease development is more ambiguous. Indeed, values for THC and CBD found in hair overlap and cannot discriminate between these two groups, even though THC seems to be lower and CBD higher in the ACP group than in the OPD group. It is necessary to calculate the CBD/THC ratios for patients to discriminate ACP from OPD. The ratios were higher in the ACP group (> 0.43) than in the OPD group (< 0.32). In this study, the CP group was composed of people who possessed high levels of THC in their hair. This data may be correlated with the fact that patients with CP smoke more joints, or smoke more potent cannabis joints than people from other groups. Moreover, in the CP group, values obtained for CBD and for CBD/THC ratios were lower than in the control and the ACP groups. CBD may play a role in the protection against chronic or periodic mental disease development. This study highlights, once again, the protective role of CBD against the deleterious effects of THC. In association with clinical evaluation, this toxicological approach could be helpful for psychiatric diagnosis and would allow early management of BPD in cannabis consumers. Schizophrenia, for example, is a progressive disease, and a delay in therapeutic management compromises the chances of socio-professional reintegration. Close collaboration between psychiatrists, medical biologists, and analysts allows assistance with the therapeutic approach. It would be possible to make a first diagnosis just after the initial psychiatric evaluation.

COVID- 19 Following Acute Psychosis: Case series report

IntroductionCoronavirus disease (COVID-19) could result in various medical consequences. Clinical manifestations are diverse and range from asymptomatic or mild, fever-like symptoms, to more severe and life-threatening complications. Although the clinical presentation was initially dominated by respiratory symptoms, psychiatric symptoms and sequelae have been reported in COVID- 19 patients and convalescents.ObjectivesTo describe four clinical case reports of patients admitted to the inpatient unit of Psychiatric Hospital Sarajevo (PHS) with acute onset of psychosis in the recovery stage of COVID-19.Methods In this case series we report cases of 4 patients, all female, mean age 53.25 years, hospitalized in PHS during the third wave of the COVID-19 pandemic. All developed psychotic symptoms in the recovery phase of COVID-19. None had a previous history of psychiatric disturbances of any kind. All patients were diagnosed with brief psychotic disorder (BPD), according to DSM 5 criteria for BPD.ResultsCOVID-19 affects various organ systems, including the brain, with variable symptoms based on disease severity. Psychotic features have been observed as well. The pathophysiology and direct biological effects of the disease are not fully understood. COVID-19 patients and convalescents can develop psychotic symptoms as a consequence of multiple concurrent factors. Several proposed mechanisms include direct central nervous system infiltration, cytokine network dysregulation, peripheral immune cell transmigration, and post-infectious autoimmunity [1], treatments used to manage the infection, and psychosocial stress.ConclusionsClinicians need to be aware of possible psychotic manifestations in COVID-19 patients and survivors. Long-term follow-up is warranted to provide efficient patient care.DisclosureNo significant relationships.

Predictors of diagnostic stability in brief psychotic disorders: Findings from a 3-year longitudinal study.

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. 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. 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. 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.

Clinical characterization of brief psychotic disorders triggered by the COVID-19 pandemic: a multicenter observational study.

This study aimed to characterize the clinical profile of patients with brief psychotic disorders (BPD) triggered by the psychosocial distress derived from the COVID-19 crisis. A multicenter study was conducted from March 14 to May 14, 2020 (the peak weeks of the pandemic in Europe). All consecutive patients presenting non-affective psychotic episodes with a duration of untreated psychosis of less than 1 month and whose onset was related to the COVID-19 crisis were recruited, but only those patients meeting Diagnostic Statistical Manual 5th edition (DSM-5) criteria for “BPD with marked stressors” (DSM-5 code: 298.8) during follow-up were finally included. Patients' sociodemographic and clinical characteristics were collected at baseline and summarized with descriptive statistics. During the study period, 57 individuals with short-lived psychotic episodes related to the emotional stress of the COVID-19 pandemic were identified, of whom 33 met DSM-5 criteria for “BPD with marked stressors”. The mean age was 42.33 ± 14.04 years, the gender distribution was almost the same, and the majority were rated as having good premorbid adjustment. About a quarter of the patients exhibited suicidal symptoms and almost half presented first-rank schizophrenia symptoms. None of them were COVID-19 positive, but in more than half of the cases, the topic of their psychotic features was COVID-19-related. The coronavirus pandemic is triggering a significant number of BPD cases. Their risk of suicidal behavior, their high relapse rate, and their low temporal stability make it necessary to closely monitor these patients over time.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00406-021-01256-w.

Post-surgical acute psychotic episode – case report

Brief psychotic disorders (BPD) are amid the most severe and burdening diagnostics, despite their low incidence. Among them, secondary somatic-associated BPD are real clinical challenges. Post-surgical and post-anesthetic psychotic episodes usually occur in a delirium context. A.A., a 70-years old patient without prior psychiatric history, diagnosed with laryngeal cancer three years ago, undergoes a major curative surgical procedure (total laryngectomy). Afterwards, the patient starts developing psychotic symptoms. His family requests a psychiatric evaluation, and the patient is urgently admitted to our ward. During hospitalization, in order to make a differential diagnosis, several clinical and paraclinical investigations are performed. After gathering all the data, we reach the BPD in post-surgical context diagnosis. Psychopharmacological treatment is initiated (Risperidone, Sertraline, Valproic acid) with favorable evolution. Diagnostic challenges associated with post-surgical or post-anesthetic BPD, especially in elderly patients, demand to investigate multifactorial etiology related to the initial disease, surgery, anesthesia, and possible onset of a neuropsychiatric disorder triggered by this context. In this situation, a multidisciplinary approach is necessary to offer adequate medical care and increase patients’ quality of life.

Clinical outcomes in brief psychotic episodes: a systematic review and meta-analysis.

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. 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). 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. 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.

Regional brain volumes in brief psychotic disorder

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.

Psychosis following chloroquine ingestion: a 10-year comparative study from a malaria-hyperendemic district of India

ObjectivesSerious adverse effects such as acute psychoses have been reported following treatment with chloroquine. Chloroquine can cause cell death, including neurons. We aimed to identify the most frequent type of psychiatric manifestation and symptomatological characteristics of psychosis following chloroquine ingestion (PFC). MethodOut of a total of 4471 randomly selected recent-onset psychosis patients, 3610 consecutive patients who had responded to standard treatment were screened for entry in the study. We compared background clinicodemographic profile information and psychopathology of 51 PFC patients, who were either drug free or drug naive, to 51 brief psychotic disorder (BPD) patients who were matched in terms of age, sex and education. Only those patients who remitted within 8weeks (PFC patients) or 4weeks (BPD patients) were included. Cranial computed tomography, electroencephalography and lumbar puncture of the entire experimental group were normal, and none had Mini Mental Status Examination score <22. Group difference and correlational statistics (parametric and nonparametric) have been used to test the hypotheses and explain the results. ResultsThe most common (76.2%) type of psychiatric disturbance in PCF group was mood disorder (mixed episode) accompanied by predominant irritability with little blunting of affect. PFC patients characteristically had prominent positive symptoms with visual hallucination and derealization experiences. They were more restless, agitated and anxious and had more disturbed thought content and orientation, but better preserved insight. There was no linear relationship between the amount of chloroquine consumed and the severity of psychosis. ConclusionConsidering the large number of patients still receiving chloroquine especially in developing countries, this study has been presented to draw attention of the psychiatrists and other health professionals to the hazardous effect of chloroquine on mental health.

Reliability and validity of the Chinese version of the schedule for assessment of insight

Objective To investigate reliability and validity of the Chinese version of the schedule for assessment of insight (SAI). Methods The original version of SAI was translated into Chinese and then back-translated into English to develop the Chinese version of SAI which reliability and validity were tested. 220 subjects who met the diagnosis of Schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder or brief psychotic disorder were assessed. Results The Cronbach's α was 0.890; the test-retest reliability was 0.742; the inter-rater reliability was 0.986. Three main factors were obtained from the factor load matrix as awareness of illness, ability to relabel psychotic experience, compliance with treatment. The loading coefficient were 0.883-0.944. The correlation of the SAI total score and three subscales with insight of PANSS were -0.635, -0.305, -0.631and -0.512 respectively(P<0.01). Conclusion The SAI has good reliability and validity. The scale is useful to measure insight in psychosis. Key words: Insight; Reliability; Validity; Psychometrics; Psychosis

Cycloid psychoses: Leonhard´s descriptions revisited

Background and Objectives: Cycloid psychoses are characterized by polymorphic symptomatology with intraphasic bipolarity, a remitting and recurrent course and favourable prognosis. Perris and Brockington (P&B) described the first set of operational criteria that were partly incorporated in ICD-10. The present study investigates psychopathological profiles according to the P&B criteria and the original descriptions by Leonhard, both against the background of the criteria from the prevailing international classification systems. Methods: Eighty patients with psychotic disorders were recruited and assessed with various psychometric instruments at baseline and after six weeks of antipsychotic treatment in order to investigate the presence of cycloid psychoses according to Leonhard (LCP) and the effect of treatment with antipsychotics. The overlap between LCP and DSM-IV Brief Psychotic Disorder (BPD), ICD Acute Polymorphic Psychotic Disorder (APP) and P&B criteria was calculated Results: Using P&B criteria and a symptom checklist adapted from the original descriptions by Leonhard, 14 and 12 cases of cycloid psychosis were identified respectively reflecting a prevalence of 15-18%. Small though significant concordance rates were found between LCP and both DSM-BPD and ICD-APP. Concordance between LCP and P&B criteria was also significant, but modest. Conclusions: This study demonstrates that LCP can be identified in a substantial number of patients with psychotic disorders. Cycloid psychoses are not adequately covered in current classification systems and criteria. Since they are demonstrated to have a specific psychopathological profile, relapsing course and favourable prognosis, it is advocated to include these psychoses in daily differential diagnostic procedures.

P-1064 - Cycloid psychoses: Leonhard's descriptions revisited

Cycloid psychoses (CP) as described by Leonhard comprise the subtypes anxiety-happiness, confusion and motility psychoses. CP presents with an acute onset and have a favourable prognosis. The operational criteria by Perris and Brockington (P&B, 1981) are partly incorporated in ICD-10 as acute polymorphic psychosis (APP). The DSM-IV category Brief Psychotic Disorder (BPD) includes all psychoses with short duration. Establishing concordance of Leonhard's CP with DSM-IV and ICD-10 categories. This study was aimed to investigate the clinical characteristics of CP and to determine the prevalence of CP in patients with psychotic disorders. 80 patients with psychotic disorders were assessed by means of CASH, PANSS and CGI at baseline and after six weeks of treatment. CP's were identified according to Leonhard's descriptions. Furthermore, patients were classified using DSM-IV, ICD-10 and P&B criteria. A diagnosis of Leonhard's CP was present in 12 patients. Overlap between Leonhard's and P&B-CP was modest. ICD-10 and DSM-IV classification showed considerable heterogeneity. Diagnoses of ICD-APP and DSM-BPD were mostly assigned to CP patients. Concordance between Leonhard's CP and these categorical diagnoses was small. Leonhard CP patients showed, compared to non-CP patients, more atypical symptoms like perplexity, pananxiety and psychomotor disturbances. The estimated prevalence of CP in patients with psychotic disorders is 15 percent. Although identification of CP is of heuristic value, this is not warranted by current classification systems or operational criteria. Thorough clinical evaluation of psychotic disorders is required, especially in patients presenting with perplexity, psychomotor disturbances or severe anxieties.

A comparison of DSM-IV brief psychotic disorder with “positive” schizophrenia and healthy controls

To determine the psychosocial features, course, and outcome of DSM-IV brief psychotic disorder (BPD) in a comparative study, we recruited a cohort of 26 consecutive inpatients fulfilling DSM-IV criteria of BPD as well as a control group with "positive" schizophrenia (PS) and psychiatrically healthy controls matched for age and sex. Demographic and clinical features were systematically evaluated and follow-up investigations were performed at an average of 2.1 years after the index episode or 7.8 years after onset of the disorder using standardized instruments. The index group of 26 cases represented 2.5% of 1,036 patients treated as inpatients for psychotic disorders or major affective episode during the 5-year inclusion period. Eighty-one percent of the BPD patients were female. Indicators of premorbid functioning slightly favored BPD patients. Age at first episode and episode frequency did not differentiate between BPD and PS patients. Relapse was frequent in both groups. At follow-up BPD patients had a significantly more favorable outcome than patients with PS as evidenced by employment, independent living, social role functioning, psychological impairment, and global functioning. As a group, in many respects BPD patients approached the status of psychiatrically healthy controls. DSM-IV BPD is a psychotic disorder of favorable prognosis despite frequent relapse.

DSM-III-R Brief Reactive Psychosis and Personality Disorders

DSM-III and DSM-III-R defined the diagnostic criteria of brief reactive psychosis (BRP) identifying some personality disorders (PDs) as predisposing factors: up to now no experimental data support this hypothesis. In this research, the authors studied the link between BRP and PDs, assessing axis II diagnosis (SIDP-R), after recovery of BRP in a group of 23 patients. Eighty-seven percent of the patients (n = 19) received at least one diagnosis of PDs. The widespread presence of PDs and, particularly, the high prevalence of cluster C (n = 11, 47.8%), are only partially in accordance with the hypothesis of DSM-III. A possible alternative model of interaction is suggested.

Follow-up and family study of postpartum psychoses. Part IV: Schizophreniform psychoses and brief reactive psychoses: lack of nosological relation to schizophrenia.

Among 30 women suffering from a postpartum psychosis without affective syndrome, and for whom this episode of illness was the first leading to psychiatric hospitalisation, 19 fulfilled in the long-term course the DSM-III-R criteria for schizophreniform psychosis (SCHF) or brief reactive psychosis (BRP), and 11 fulfilled the criteria for schizophrenia (SCH). The two groups were compared in order to investigate their nosological relation. Patients with SCHF or BRP more often had the symptomatology of cycloid psychoses and signs of confusion, the onset of illness was more frequently abrupt and the age at the index delivery tended to be lower (p < 0.07) than in patients with SCH. No case of SCHF or BRP was observed at the index episode that later developed into SCH. These findings, together with the different liability to puerperal decompensations, suggest that SCHF and BRP beginning in the postpartum period are nosologically distinct from SCH.

From hysterical psychosis to reactive dissociative psychosis

AbstractIn this paper Reactive Dissociative Psychosis (RDP) is seen as a post‐traumatic stress response and as a subcategory of Brief Reactive Psychosis (BRP). A review of the literature and the evolution of RDP from Hysteria and Hysterical Psychosis are given. Issue is taken with defining the duration of BRP as “Brief.” The authors argue that long‐standing psychotic symptoms may be traumatically induced. The dissociative aspects of RDP as its key feature and the concomitant implications for accurate diagnosis are proposed. The usefulness of applying hypnosis in RDP treatment is summarized in a case study from Janet and detailed in a case from the authors' practice.

From hysterical psychosis to Reactive Dissociative Psychosis

In this paper Reactive Dissociative Psychosis (RDP) is seen as a post-traumatic stress response and as a subcategory of Brief Reactive Psychosis (BRP). A review of the literature and the evolution of RDP from Hysteria and Hysterical Psychosis are given. Issue is taken with defining the duration of BRP as “Brief.” The authors argue that long-standing psychotic symptoms may be traumatically induced. The dissociative aspects of RDP as its key feature and the concomitant implications for accurate diagnosis are proposed. The usefulness of applying hypnosis in RDP treatment is summarized in a case study from Janet and detailed in a case from the authors' practice.