Chronic Psychosis Research Articles

Frequency specific resting state functional abnormalities in psychosis.

Resting state functional magnetic resonance imaging studies of psychosis have focused primarily on the amplitude of low-frequency fluctuations in the blood oxygen level dependent (BOLD) signal ranging from .01 to 0.1 Hz. Few studies, however, have investigated the amplitude of frequency fluctuations within discrete frequency bands and higher than 0.1 Hz in patients with psychosis at different illness stages. We investigated BOLD signal within three frequency ranges including slow-4 (.027-.073 Hz), slow-3 (.074-0.198 Hz) and slow-2 (0.199-0.25 Hz) in 89 patients with either first-episode or chronic psychosis and 119 healthy volunteers. We investigated the amplitude of frequency fluctuations within three frequency bands using 47 regions-of-interest placed within 14 known resting state networks derived using group independent component analysis. There were significant group x frequency interactions for the visual and motor cortex networks, with the largest significant group differences (patients < healthy volunteers) evident in slow-4 and slow-3, respectively. Also, healthy volunteers had an overall higher amplitude of frequency fluctuations compared to patients across the three frequency ranges in the visual cortex, dorsal attention and motor cortex networks with the opposite effect (patients > healthy volunteers) evident within the salience and frontal gyrus networks. Subsequent analyses indicated that these effects were evident in both first-episode and chronic patients. Our study provides new data regarding the importance of BOLD signal fluctuations within different frequency bands in the neurobiology of psychosis.

La paranoïa : des aliénistes au DSM-5

From ancient Greek, paranoia, made up of para “besides” and noos “thought, mind”, signifies behaviour “against understanding”. The term paranoia has taken on diverse meanings throughout years and places. In France, paranoia has corresponded to the delusion of persecution as described by Lasègue in 1852, himself a descendant of Esquirol's monomaniacal delusional descriptions. Later, the delusional interpretations of Serieux and Capgras in 1909 or of “folie raisonnante” comes closer to the paranoia described by Kraepelin in 1898 as “a lasting delusional system impossible to undermine and which is established with a complete conservation of clarity and thought order”. Classically, paranoia is thus described as a chronic psychosis of progressive installation and of relatively late emergence (after 35 years of age). In traditional French nosography, we distinguish 3 subtypes: interpretation delusions, passionate delusions (erotomanic, of jealousy and of vengeance) and sensitive delusions. Today, paranoia delusions do not appear as such in the DSM-5 but we find it in “delusional disorders” characterised by the presence of delusional ideas lasting more than one month and which do not fill the criteria of a schizophrenic diagnosis, with the absence of marked alterations in functioning or strangeness. The subtypes are erotomanic, megalomaniac, of jealousy, of persecution and somatic. Furthermore, we find paranoia personality disorders, characterized by an overwhelming suspicion and mistrust towards others, whose intentions are interpreted as malicious. The continuum between personality and delusion remains controversial and recent neurocognitive research shines light on cognitive bias associated to strong anxious components.

Ecological association between chronic hepatitis C virus infection and psychosis: An study in Colombia, 2009-2016

Background: Hepatitis C virus (HCV) infection affects approximately 180 million people worldwide. HCV infection is a leading cause of liver disease including hepatitis, cirrhosis and hepatocellular carcinoma, but also of extrahepatic manifestations such as psychiatric conditions including psychosis. Colombia is a country with multiple social, economic, educational and basic health access problems for the population and high prevalence of HCV infection. To date there are no data showing the association between HCV infection and psychosis in Colombia. Methods & Materials: An ecological study using data from health information system RIPS (Individual Record of Provision of Health Services) in Colombia, for chronic HCV infection (B18.2) and acute polymorphic psychotic disorder with and without symptoms of schizophrenia (F23.1 and F23.0, respectively). We used reference populations to calculate incidence rates of (cases/100,000pop.) for the period 2009-2016. Nonlinear regression models were run between chronic HCV infection (independent variable) rates and psychoses rates (dependent variables) (p < 0.05), using licensed Stata IC 14®. Results: Cumulative rate for chronic HCV infection was estimated in 6.49 cases/100,000 pop, increasing from 2009 (0.88) to 2013 (1.77), whilst for psychosis without schizophrenia 12.79, varying from 0.8 (2016) to 2.51 (2012), and with schizophrenia 10.99, varying from 0.78 (2012) to 2.21 (2014). The variation in incidence of those psychotic disorders showed a significant association in the models (r2 > 0.24, p < 0.01), being for the acute polymorphic psychotic disorder without schizophrenia: r2 = 0.2422, p < 0.0001 and for the acute polymorphic psychotic disorder with schizophrenia: r2 = 0.4451, p < 0.0001. Conclusion: In this study, the prevalence of psychosis (specifically acute psychotic episodes) was significantly associated with the prevalence HCV infection in Colombia during the years 2009 to 2016. This results matched with the findings in other countries. Knowing the association between HCV infection and psychosis opens the gate to increase the knowledge about both pathologies, but also it gives us tools to prevent and to treat the comorbidities and consequences of this infection. This study is the starting line to establishing the association of psychosis and HCV infection in our country.

The relationship between theory of mind deficits and neurocognition in first episode-psychosis

Research suggests that theory of mind (ToM) deficits are related to chronic psychosis and to first-episode psychosis (FEP) independently of other neurocognition domains. The aim of this study was to measure the differences in ToM area in a Spanish population of FEP sample (N = 32) and in a healthy control group (N = 32). A further aim was to describe the relationship between different domains of neurocognition, psychotic symptoms and social functioning with ToM in this sample. ToM was assessed with the MASC task. Estimated IQ with a short version of the WAIS III, Rey-Osterrieth Complex figure, Trail Making Test, Stroop test and Wisconsin Carting Sorting test were used to assess neurocognition. Psychotic symptoms were assessed with Community Assessment of Psychic Experiences (CAPE) in both groups and with PANSS scale in FEP group. GAF and Cannon-Spoor scales were used to measure social functioning before and after onset of psychosis. FEP showed important deficits in ToM domain compared to controls. A worse executive functioning was associated with worse scores in ToM task. However, no relation was found between positive or negative psychotic symptoms and ToM or social functioning and ToM. In our sample neurocognition tests were strongly related to ToM domain independently of other variables.

Abstract 5452: Pimozide suppresses the growth of brain tumor by targeting oncogenic pathways

Abstract Brain tumor is considered as one of the most aggressive and incurable form of cancer. Majority of the brain tumors have a median survival rate of only 12%. Even though advanced treatments such as surgical removal, chemotherapy and radiotherapy are available, brain tumor persists to be lethal. Obstacles associated with the current treatment options are: recurrence, development of resistance and inability to cross blood brain barrier (BBB). BBB restricts majority of drugs to reach the brain thus resulting in an ineffective treatment. Pimozide (PMZ) is an antipsychotic drug used for the treatment of schizophrenia and chronic psychosis. In this study, pimozide has shown significant reduction in the viability of U-87MG, U-251MG, DAOY and T98G cell lines with an IC50 ranging from 11µM to 20µM after 24 h of treatment. Pimozide induced apoptosis in these cell lines as evaluated by FITC/Annexin assay and further validated by the cleavage of caspase 3 as well as PARP by western blot analysis. Pimozide treatment resulted in the concentration dependent decrease in the expression of GLI1, OCT4, SOX2 and NANOG in U87MG, U251MG, DAOY and T98G brain cancer cell lines, depicting a reduction in the stem cell like property of these cell lines. In addition, pimozide treatment inhibited the expression of proto-oncogene c-Myc. Inhibition of Gli1 and c-Myc demonstrates that pimozide might also inhibit the growth of cancer cells by targeting SHH signaling. Our results further demonstrated that oral administration of pimozide (25mg/kg) inhibits the brain tumors in intracranial tumor model with no significant difference in average weight of critical organs. It is important to note that pimozide is an FDA approved drug with no considerable toxicity. Overall, this study depicts that pimizode is a potential candidate to target brain tumors. Citation Format: Itishree Kaushik, Alok Ranjan, Blake Schwettmann, Sanjay Srivastava. Pimozide suppresses the growth of brain tumor by targeting oncogenic pathways [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5452.

The Impact of Aging, Psychotic Symptoms, Medication, and Brain-Derived Neurotrophic Factor on Cognitive Impairment in Japanese Chronic Schizophrenia Patients

Background: Cognitive impairment in schizophrenia can result in considerable difficulty in performing functions of daily life or social rehabilitation. Cognitive impairment in schizophrenia is related to various factors, such as the psychotic severity, aging, medication, and brain-derived neurotrophic factor (BDNF). To date, however, no studies investigating the impact of these factors on cognitive functioning in chronic schizophrenia patients have been performed.Objective: The aim of this study is to identify those factors that influence the cognitive functioning in patients with chronic schizophrenia.Methods: Sixty-five of 116 long-term hospitalized chronic schizophrenia patients (63.8 ± 12.1 years old, M/F = 29/36) were enrolled this cross-sectional study. We investigated the relationship among the patients' age, psychotic severity, treatment medication, serum BDNF levels, and cognitive functioning (measured by the Japanese-language version of the Brief Assessment of Cognition in Schizophrenia; BACS-J). Additionally, we performed a multivariable linear regression analysis.Results: According to the partial correlation analysis, certain parameters [i.e., age, chlorpromazine (CP) equivalent, biperiden (BP) equivalent, and serum BDNF] were significantly correlated with cognitive functioning, including working memory (WM), motor function (MF), attention and processing speed (AP), and executive function (EF). For the multivariate analysis, the MF component, which had the highest correlation, was selected as the dependent variable, and the independent variables included age, Manchester Scale for chronic psychosis (ManS) total score, CP equivalent, BP equivalent, serum BDNF, estimated full scale IQ, and years of education. According to the multiple regression analysis of this model, R (multiple regression coefficient) was 0.542, the adjusted R2 (coefficient of determination) was 0.201, and only BP equivalent (β = −0.305, p = 0.030), but not age, ManS score, CP equivalent, or serum BDNF, could significantly explain MF at the 5% significant level.Conclusion: In conclusion, aging, medication (administering more antipsychotics or anticholinergics), and serum BDNF concentration are significantly correlated with cognitive dysfunction in chronic schizophrenia patients but not with the severity of psychotic symptoms. Furthermore, only the anticholinergic dosage had a significant causal relationship with MF. Thus, the use of anticholinergics in chronic schizophrenia patients with deteriorating cognitive functioning must be reconsidered.

Aberrant Cortical Integration in First-Episode Psychosis During Natural Audiovisual Processing

BackgroundFunctional magnetic resonance imaging studies of psychotic disorders have reported both hypoactivity and hyperactivity in numerous brain regions. In line with the dysconnection hypothesis, these regions include cortical integrative hub regions. However, most earlier studies focused on a single cognitive function at a time, assessed by delivering artificial stimuli to patients with chronic psychosis. Thus, it remains unresolved whether these findings are present already in early psychosis and whether they translate to real-life–like conditions that require multisensory processing and integration. MethodsScenes from the movie Alice in Wonderland (2010) were shown to 51 patients with first-episode psychosis (16 women) and 32 community-based control subjects (17 women) during 3T functional magnetic resonance imaging. We compared intersubject correlation, a measure of similarity of brain signal time courses in each voxel, between the groups. We also quantified the hubness as the number of connections each region has. ResultsIntersubject correlation was significantly lower in patients with first-episode psychosis than in control subjects in the medial and lateral prefrontal, cingulate, precuneal, and parietotemporal regions, including the default mode network. Regional magnitude of between-group difference in intersubject correlation was associated with the hubness. ConclusionsOur findings provide novel evidence for the dysconnection hypothesis by showing that during complex real-life–like stimulation, the most prominent functional alterations in psychotic disorders relate to integrative brain functions. Presence of such abnormalities in first-episode psychosis rules out long-term effects of illness or medication. These methods can be used in further studies to map widespread hub alterations in a single functional magnetic resonance imaging session and link them to potential downstream and upstream pathways.

The long-term outcome of patients with heroin use disorder/dual disorder (chronic psychosis) after admission to enhanced methadone maintenance

BackgroundOver-standard methadone doses are generally needed in the treatment of heroin use disorder (HUD) patients that display concomitant high-severity psychopathological symptomatology. A flexible dosing regimen may lead to higher retention rates in dual disorder (DD), as we demonstrated in bipolar 1 HUD patients, leading to outcomes that are as satisfactory as those of HUD patients without high-severity psychopathological symptomatology.ObjectiveThis study aimed to compare the long-term outcomes of treatment-resistant chronic psychosis HUD patients (PSY-HUD) with those of peers without dual disorder (HUD).Methods85 HUD patients who also met the criteria for treatment resistance—25 of them affected by chronic psychosis and 60 without DD—were monitored prospectively for up to 8 years while continuing to receive enhanced methadone maintenance treatment.ResultsThe rates of endurance in the treatment of PSY-HUD patients were 36%, compared with 34% for HUD patients (p = 0.872). After 3 years of treatment, these rates tended to become progressively more stable. PSY-HUD patients showed better outcome results than HUD patients regarding CGI severity (p < 0.001) and DSM-IV-GAF (p < 0.001). No differences were found regarding good toxicological outcomes or the methadone dosages used to achieve stabilization. The time required to stabilize PSY-HUD patients was shorter (p = 0.034).ConclusionsAn enhanced methadone maintenance treatment seems to be equally effective in patients with PSY-HUD and those with HUD.

17. CANNABIDIOL AS A TREATMENT IN DIFFERENT STAGES OF PSYCHOSIS- EFFICACY AND MECHANISMS

Overall : While drugs that target the dopaminergic and glutamatergic neurotransmitter systems have been extensively investigated as treatments for psychosis, there has been increasing attention in recent years on the endocannabinoid system as a therapeutic target. The CB1 receptor, the main central cannabinoid receptor is ubiquitous and modulates the function of several neurotransmitters, including dopamine and glutamate. A growing body of evidence suggests that psychosis is associated with alterations in the endocannabinoid system, independent of exposure to cannabis.The CB1 receptor is the main molecular target for delta-9-tetrahydrocannabinol (THC), the major psychoactive ingredient in cannabis. THC is responsible for the psychotogenic effects of cannabis, and is a partial agonist at the CB1 receptor. On the other hand, Cannabidiol (CBD), the second major constituent of cannabis is a non-psychoactive compound that may have an inverse agonist/antagonist effect at CB1 receptors, in addition to a range of other possible mechanisms of action. Interest in the therapeutic potential of CBD stemmed from evidence that it has broadly opposite effects to that of THC, at both the neural and the behavioural level in healthy individuals. Consistent with these results independent evidence that CBD has antipsychotic and anxiolytic properties in patients with mental health disorders has been accumulating. The absence of significant adverse effects associated with CBD, is a critical advantage in relation to the treatment of patients in the various stages of psychosis. Given its tolerability profile, CBD is a treatment of particular interest not just in those with chronic psychosis as in schizophrenia, but also in those in the earlier stages of psychosis. However, published evidence regarding the therapeutic efficacy of CBD as a treatment in psychosis has been limited except a small randomized clinical trial (RCT) some years ago (Leweke et al 2012). Furthermore, the mechanisms that may underlie the beneficial effects of CBD are unclear.This symposium will bring together state of the art evidence regarding the efficacy of CBD in the different stages of psychosis – from those at clinical high-risk (CHR), through early psychosis to chronic schizophrenia. Furthermore, data from animal and human studies will be presented to give an understanding of the potential mechanisms that may underlie the therapeutic effects of CBD.The first speaker (Prof Crippa) will set the scene by presenting evidence regarding the different potential mechanisms of action that may underlie the antipsychotic effect of CBD.The second speaker (Prof McGuire) will present the results of a 6-week placebo-controlled RCT demonstrating the efficacy of CBD as an add-on to existing antipsychotic treatment in schizophrenia.The third speaker (Dr. Ranganathan) will present the results from an ongoing, placebo-controlled RCT using an within-subject, crossover design to show the effects of 4-week CBD treatment on psychotic symptoms, cognition and electrophysiological markers in patients with established psychosis.Finally, the fourth speaker (Dr. Bhattacharyya) will present the results from a recently completed proof-of-concept study demonstrating the efficacy of short-term CBD treatment on symptoms and distress in CHR patients as well as on neurocognitive substrates implicated in the CHR state.Evidence presented here will be discussed by Prof D’Souza, who is an internationally recognized expert in cannabinoid pharmacology and experimental therapeutics development.

S24. IS IT FEASIBLE TO PREDICT LONG-TERM METABOLIC OUTCOMES IN PSYCHOSIS USING BIOLOGICAL PROFILING AT BASELINE?

BackgroundAntipsychotic medications are widely prescribed for the treatment of psychotic disorders but carry a variable propensity to increase weight. Thus metabolic dysfunction is the primary cause of premature death in psychosis patients. A system-based approach to understanding the molecular mechanisms behind metabolic dysfunction can potentially provide scope for tailored interventions and alternative treatment pathways that avert such risks on an individual basis. The aim of this study is to identify transcriptomic predictors of high Body Mass Index (BMI) and blood glucose in first episode and chronic psychosis patients.Methods100 first-episode and 100 chronic cases of psychosis meeting ICD-10 criteria (F20-29 and F30-33) were recruited as part of 2 independent studies from 3 NHS Trusts: South London and Maudsley (SLAM), Oxleas and Sussex. Cases were ethnically mixed and aged between 18–65. All participants gave informed consent for biological sampling and a range of physical health assessments. Blood glucose was measure using HbA1c while height and weight data were also taken and used to calculate BMI. For FEP subjects biological measures were taken at baseline, 3 months and 12 months post recruitment. RNA samples were collected at the baseline timepoint via PAXgene blood tubes and interrogates, using the Illumina HumanHT-12.v4 beadchip array. Samples were run at the National Institute for Health Research’s (NIHR) Biomedical Research Centre for Mental Health (BRC-MH) at the Institute of Psychiatry, Psychology and Neuroscience. A total of 4756 probes passed a stringent quality control across the 200 samples.ResultsQuantitative data on BMI and hba1c levels were used to assess the predictive efficacy of variables grouped by source (ie. clinical, demographic, technical and transcriptomic features) in first episode psychosis patients. All the predictor categories were included in the initial model, although individual categories were then dropped one at a time. This leave-one-out strategy allowed the direction, impact and relative contribution of the different feature classes to be assessed. Gene-expression and clinical features were consistently associated with the lowest Mean Squared Error after 100 iterations of K-fold cross-validation and after 11 different values of the alpha parameter across 500 imputed datasets. Hba1c or BMI was used as the clinical predictor, depending on whether Hba1c or BMI was used as the target variable. Unattributed surrogate variables derived from surrogate variable analysis (n=6) were analysed within the technical feature set. Having established that gene expression has inherent value as a predictor of metabolic status the same analytical steps were repeated for the discretised versions of these traits (ie. diabetes and obesity). Top-ranking gene transcripts were compared between the quantitative and discretised models. Rank lists of transcripts were subsetted to allow the power distribution across ordered transcripts to be profiled.DiscussionThe top performing transcripts identified are undergoing validation analysis in the chronic sample. Results will be conveyed in terms of sensitivity and false positive rates (ie. the area under the Receiver Operating Characteristic curve). We will undertake further validation through trajectory analysis of gene-expression profiles in followed-up patients.

Antipsychotic-Induced Pisa Syndrome: A 2-Year Follow-up Study.

Pisa syndrome is characterized by lateral trunk flexion. It is an uncommon adverse drug reaction in patients on antipsychotic medication. Although Pisa syndrome has been reported in patients on antipsychotic treatment, previous studies have not discussed the prognosis of patients with Pisa syndrome. We studied psychiatric patients with Pisa syndrome following antipsychotic treatment for a 2-year period. From January 2012 to December 2014, 13 inpatients with Pisa syndrome following antipsychotic treatment were identified at our institution, from a prospectively collected database. These patients were studied for a 2-year period. The prevalence rate of Pisa syndrome during neuroleptic treatment was 0.45% in men and 0.37% in women, with a collective prevalence rate of 0.42%. The mean age of patients with Pisa syndrome was 47 years. Eight (61.5%) of the cases had a position with a tilt toward the right side. In 5 (38.5%) of the cases, a tilt toward the left side was observed. The average Cobb angle of the trunk was 17.3 (SD, 4.0) degrees. On presentation with Pisa syndrome within 3 months of medication modification, the pattern of trunk dystonia had a significantly shorter duration (P = .024) compared with that seen in the tardive-onset group. Pisa syndrome is an uncommon adverse event that can also be chronic or recurrent, especially in those with tardive onset. We should be aware of the risks in patients with the following predisposing factors: old age, chronic psychosis, long-term antipsychotic use, advanced drug-induced parkinsonism, and combined pharmacologic treatment.

Frontal and temporal cortical volume, white matter tract integrity, and hemispheric asymmetry in schizotypal personality disorder

Abnormalities in temporal and frontal cortical volume, white matter tract integrity, and hemispheric asymmetry have been implicated in schizophrenia-spectrum disorders. Schizotypal personality disorder can provide insight into vulnerability and protective factors in these disorders without the confounds associated with chronic psychosis. However, multimodal imaging and asymmetry studies in SPD are sparse. Thirty-seven individuals with SPD and 29 healthy controls (HC) received clinical interviews and 3T magnetic resonance T1-weighted and diffusion tensor imaging scans. Mixed ANOVAs were performed on gray matter volumes of the lateral temporal regions involved in auditory and language processing and dorsolateral prefrontal cortex involved in executive functioning, as well as fractional anisotropy (FA) of prominent white matter tracts that connect frontal and temporal lobes. In the temporal lobe regions, there were no group differences in volume, but SPD had reduced right>left middle temporal gyrus volume asymmetry compared to HC and lacked the right>left asymmetry in the inferior temporal gyrus volume seen in HC. In the frontal regions, there were no differences between groups on volume or asymmetry. In the white matter tracts, SPD had reduced FA in the left sagittal stratum and superior longitudinal fasciculus, and increased right>left asymmetry in sagittal stratum FA compared to HC. In the SPD group, lower left superior longitudinal fasciculus FA was associated with greater severity of disorganization symptoms. Findings suggest that abnormities in structure and asymmetry of temporal regions and frontotemporal white matter tract integrity are implicated in SPD pathology.

Regionally specific volume deficits along the hippocampal long axis in early and chronic psychosis.

Previous studies in psychosis patients have shown hippocampal volume deficits across anterior and posterior regions or across subfields, but subfield specific changes in volume along the hippocampal long axis have not been examined. Here, we tested the hypothesis that volume changes exist across the hippocampus in chronic psychosis but only the anterior CA region is affected in early psychosis patients. We analyzed structural MRI data from 179 patients with a non-affective psychotic disorder (94 chronic psychosis; 85 early psychosis) and 167 heathy individuals demographically matched to the chronic and early psychosis samples respectively (82 matched to chronic patients; 85 matched to early patients). We measured hippocampal volumes using Freesurfer 6-derived automated segmentation of both anterior and posterior regions and the CA, dentate gyrus, and subiculum subfields. We found a hippocampal volume deficit in both anterior and posterior regions in chronic psychosis, but this deficit was limited to the anterior hippocampus in early psychosis patients. This volume change was more pronounced in the anterior CA subfield of early psychosis patients than in the dentate gyrus or subiculum. Our findings support existing models of psychosis implicating initial CA dysfunction with later progression to other hippocampal regions and suggest that the anterior hippocampus may be an important target for early interventions.

Teška pneumonija izazvana antipsihotičnim lekovima - šta ne odgovara, pacijent ili lek?

Introduction: Antipsychotic drugs are generally categorized as typical antipsychotics (sometimes referred to as first-generation or conventional antipsychotics, or neuroleptics) and atypical antipsychotics; both are approved for the treatment of acute and chronic psychoses (i.e, schizophrenia), mania, agitation, and other psychiatric disorders. In 2005 the US Food and Drug Administration issued a warning about the increased risk of all-cause mortality associated with atypical antipsychotic use in elderly patients with dementia. Community acquired pneumonia (CAP) was one of the most frequently reported causes of death. The same warning was extended to typical antipsychotics in 2008 with extension to people with or without dementia. Case report: We present a 65-year-old Caucasian woman who was admitted to hospital due to massive pneumonia. She was suffered forschisophrenia 15-years and at moment of admission she was in remission. She had continuously high fever up to 40 degrees. All collected cultures (blood, sputum, urine, smear of aspirating catheter) were negative. She was treated with various antibiotics without improvement. After changing antipsychotic drugs, she showed slow improvement until total recovery after 3 months. Discussion and conclusion: Antipsychotic-associated CAP seems to be a clinically relevant issue in frail elderly patients, as consistently documented in several epidemiologic investigations. No clear evidence exists for an increased risk of pneumonia in younger patients treated with antipsychotics. In elderly populations, the increase in risk is dose-dependent, and is more pronounced in the early phases of treatment. Future studies should better define the mechanism underlying antipsychotic-induced pneumonia and identify subgroups of antipsychotic users at higher risk of developing pneumonia.

Mouth and teeth infections in psychiatric setting at Hôpital du Point-G : Observations on 130 cases.

Objective The objective of this study is to analyze the influence of mental illness on the oral health status of psychiatric patients.Materials And MethodsWe performed a prospective, transverse and descriptive study based on the observation of the oral lesions in the patients received in psychiatric consultation. It took place in the department of Psychiatry of the Center Hospitalo Universitaire of Point G for one month (from June to July 2014). The target population was known psychiatric patients followed and / or hospitalized during the study period. The data were collected from the medical files and a questionnaire and entered and analyzed with the software Epi info fr 6.0. In 54.40% of patients, brushing of teeth was performed once daily and twice daily in 26.10% of cases.ResultsDuring the study period, 130 patients were selected according to our inclusion criteria, of which 70.0% were male with a sex ratio of 2.3. The age group 25-34 was the most represented, 31.50%. The majority of our patients had dental abrasion, or 90.80% of the cases. The CAD / D index of our population was 5.22. Halitosis and oral dryness were common in patients with chronic psychosis, respectively 63.5% and 56.90% of cases. Gingivorrhage was observed in 61.10% of patients with chronic psychosis.ConclusionThis study shows the high frequency of oral infection in a psychiatric setting, hence the interest of a partnership between mental health professionals and those in the oral cavity.Keywords : Oral infections ; psychiatry ; buccal dryness, CAD index ; Point G Hospital

Evaluation of outcomes for psychosis and epilepsy treatment delivered by primary health care workers in Nepal: a cohort study

BackgroundMost evaluations of task-shifting have focused on common mental disorders. Much less work has been done on severe mental neurological and substance use (MNS) disorders, such as chronic psychosis and epilepsy. Given the high burden associated with severe MNS and the lack of mental health professionals in low and middle income countries, evaluations on the impact of task-shifting for these disorders are important.MethodsIn a rural district of Nepal, a community mental health program, based on World Health Organization’s Mental Health Gap Action Programme guidelines, was evaluated using a cohort study design. People with epilepsy and psychotic disorders were interviewed at treatment initiation and at 12-month follow-up. We also compared a group that was offered a comprehensive package of care (medication combined with psychosocial interventions, such as counselling and peer support groups) to a group that received medication only.ResultsOne-hundred nineteen persons were enrolled in the epilepsy cohort (EC) and 85 in the psychosis cohort (PC). The patients were enrolled in either the comprehensive package (n = 157) or medication only (n = 47). There was significant improvement (P < 0.0001) in psychosis symptoms (PC: Z = 6.78, r = 0.80) and depressive symptoms (EC: Z = 7.43, r = 0.73; PC: Z = 6.02, r = 0.70), seizures (EC: Z = 6.78), functional disability (EC: Z = 6.38, r = 0.67; PC: Z = 4.60, r = 0.57), family and caregiver burden (EC: Z = 8.09, r = 0.85; PC: Z = 6.81, r = 0.84), and social behaviour (PC: Z = 5.94, r = 0.84). There was greater risk reduction for recent seizures among people with epilepsy in the comprehensive treatment package vs. medication only (risk ratio = 0.52, 95% CI 0.29–0.95; P = 0.03); no other significant differences were observed between treatment arms.ConclusionsA community mental health program in Nepal, implemented by non-specialists, resulted in moderate to large effects among people with epilepsy or psychosis. A comprehensive package of care, including counselling and patient support groups, appears to offer added clinical benefits for patients with epilepsy. For people with psychosis, the basic package of care (i.e., psychotropic medications) performed similar to the comprehensive package, suggesting a less resource-intensive package may offer comparable results.

The repercussions of mental disease in the family. A study of the family members of psychotic patients

Caregiving and related concepts such as family or caregiver burden have been widely discussed in recent literature. A descriptive, cross-sectional study was conducted in a sample (n = 80) of primary caregivers to severe mental patients (diagnosed schizophrenia, chronic psychosis or affective disorder). To describe the caregivers' and corresponding patients' sample, as well as the nature of existing relationships. Levels of caregiver burden and psychological distress were evaluated and a preliminary analysis conducted on objective and subjective burden correlation. Involvement Evaluation Questionnaire (IEQ), General Health Questionnaire (GHQ) and a semi-structured interview designed for this purpose. The extent of burden was found significant in this sample, being unevenly distributed in its components (e.g. tension, worrying or financial burden). Forty-one percent of caregivers experienced minor psychiatric morbidity. Measures of objective and subjective burden were moderately correlated. The same applied to magnitude of associations between each of them and distress parameters. Higher levels of burden were found in groups of caregivers to more severely ill or disabled patients, while diagnosis was not important for this purpose. Most relatives remain highly involved. These results suggest the need to implement specific interventions addressing psychotic patients as well as their families.

Effectiveness of a low support, remotely accessible, cognitive remediation training programme for chronic psychosis: cognitive, functional and cortical outcomes from a single blind randomised controlled trial.

Cognitive remediation (CR) training has emerged as a promising approach to improving cognitive deficits in schizophrenia and related psychosis. The limited availability of psychological services for psychosis is a major barrier to accessing this intervention however. This study investigated the effectiveness of a low support, remotely accessible, computerised working memory (WM) training programme in patients with psychosis. Ninety patients were enrolled into a single blind randomised controlled trial of CR. Effectiveness of the intervention was assessed in terms of neuropsychological performance, social and occupational function, and functional MRI 2 weeks post-intervention, with neuropsychological and social function again assessed 3-6 months post-treatment. Patients who completed the intervention showed significant gains in both neuropsychological function (measured using both untrained WM and episodic task performance, and a measure of performance IQ), and social function at both 2-week follow-up and 3-6-month follow-up timepoints. Furthermore, patients who completed MRI scanning showed improved resting state functional connectivity relative to patients in the placebo condition. CR training has already been shown to improve cognitive and social function in patient with psychosis. This study demonstrates that, at least for some chronic but stable outpatients, a low support treatment was associated with gains that were comparable with those reported for CR delivered entirely on a 1:1 basis. We conclude that CR has potential to be delivered even in services in which psychological supports for patients with psychosis are limited.

Childhood adversities and clinical symptomatology in first-episode psychosis

In addition to severe traumatic experiences, milder, more common childhood adversities reflecting psychosocial burden may also be common in people with psychotic disorders and have an effect on symptomatology and functioning. We explored eleven negative childhood experiences and their influence on clinical symptoms among young adults with first-episode psychosis (FEP, n = 75) and matched population controls (n = 51). Individuals with FEP reported more adversities than controls. Specifically serious conflicts within the family, bullying at school, maternal mental health problems, and one's own and parents’ serious illness during childhood were experienced by the patients more often than by controls. In the FEP group, the severity of adversity was associated with increased anxiety, manic, and obsessive-compulsive symptoms, but not with the severity of positive psychotic symptoms. Adversity produced a more pronounced effect on symptoms in male patients than in female patients. To conclude, in line with earlier studies of more chronic psychosis, a majority of the participants with FEP reported exposure to childhood adversities, with the FEP group reporting more adversities than controls. High levels of mood and anxiety symptoms in patients with FEP may be related to cumulative exposure to childhood adversities. This should be taken into account in the treatment for FEP.

The evidence base for Multiple Family Therapy in psychiatric disorders: a review (part 1)

AbstractThis article provides an updated and comprehensive overview of the empirical literature regarding Multiple Family Therapy (MFT)'s applications to major psychiatric disorders. It shows that MFT's strongest evidence base is for schizophrenia and chronic psychoses, making its psychoeducational model one of the best available practices for these disorders. There is also a growing body of evidence regarding the usefulness of MFT for mood disorders (particularly in children), eating disorders and alcohol‐substance abuse, but more controlled research is needed for these conditions. Other disorders such as anxiety disorders, autism and attention deficit hyperactivity disorder have been studied in a more anecdotal fashion and require more rigorous investigations. Future research efforts should focus on: (1) the specific advantage of MFT over other active treatment modalities, (2) the comparative efficacy of various MFT models for a given population, and (3) MFT's change processes.Practitioner points McFarlane's psychoeducational MFT model is considered best practice for schizophrenia and other psychoses (and possibly mood disorders), facilitated by its manual‐based approach The Maudsley model is a valuable treatment for adolescent anorexia nervosa. Family therapists who are less ED‐focused in their interventions can also use more generic MFT models MFT practitioners should attempt to operationalize their MFT model and include an evaluation component in their therapeutic implementation