Chronic Psychotic Disorders Research Articles

Epidemiological, Clinical and Therapeutic Aspects of Schizoaffective Disorder at the CHU-Campus of Lomé (Togo)

Introduction: Schizoaffective disorder is a chronic psychotic disorder. It is characterized by the simultaneous presence of symptoms of a characterized mood disorder and symptoms of schizophrenia. Data on this disorder are almost non-existent in West Africa. The objective was to describe the epidemiological, clinical and therapeutic aspects of schizoaffective disorder at the Campus University Hospital Centre (CHU-Campus) of Lomé in Togo. Framework and Method: This was a retrospective study with a descriptive aim on patients hospitalized at the Clinic of Psychiatry and Medical Psychology (CPPM) of CHU-Campus from January 1st, 2013 to December 31, 2018. Results: A total of 46 patients were included in this study. Their mean age was 39.5 years with extremes ranging from 14 to 65 years. Females had predominated at 52.18% or a sex ratio of 0.91. Married people represented 47.83%. Primary education represented 34.80%. The unemployed were in the majority at 32.92%. Sixty-five point twenty two percent (65.22%) of the patients had a personal psychiatric history. All patients had presented with delusions plus other psychotic and mood symptoms. Almost all patients (97.82%) had received a thymoregulator associated with a first generation antipsychotic (95.65%). Conclusion: More studies should be done in our countries to describe the cultural aspects of this disease.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Health Care Costs of Individuals With Chronic Psychotic Disorders Who Experience Incarceration in Ontario.

Little is known about the health care costs of individuals with chronic psychotic disorders who experience incarceration. This study sought to address this knowledge gap. The authors analyzed linked 2007-2010 correctional and administrative health care data on sex- and age-matched individuals with chronic psychotic disorders with and without known incarceration in prison for up to 2 years in the Ontario correctional system. Mean 1-year health care costs (overall and by sex) in the year before incarceration (when release occurred in 2010) were estimated from third-party payer data and compared between the two groups. Costs were calculated in 2018 Canadian dollars. Individuals who experienced incarceration (N=3,197) had mean 1-year costs of $15,728 in the year before incarceration, whereas those who did not (N=6,393) had 1-year costs of $11,588. This difference was mostly due to costs arising from psychiatric hospitalizations, emergency department visits, and physician services. The main factors associated with the difference were incarceration in the following year (increase of $4,827, p<0.001), being age 18-29 years compared with ages 30-39 or 40-49 (increase of $4,448 and $4,218, respectively, p<0.001), and chronic psychotic disorder duration of 1-2 years compared with ≤1 year duration (increase of $6,812, p=0.004). Women who experienced incarceration had higher costs than incarcerated men ($20,648 vs. $14,763). Individuals with chronic psychotic disorders who experienced incarceration had higher health care costs than comparable individuals who did not. These higher health care costs may signal the need for interventions and policies that help individuals with psychotic disorders avoid criminal justice system involvement.

Antipsychotic induced hyponatremia: Clinical case report

Akvilė Gaupšaitė1 1Vilnius University, Faculty of Medicine Abstract Introduction. Antipsychotics are one of the most commonly used medications in a psychiatric practice treating acute or chronic psychotic disorders. They often cause various adverse drug reactions (ADR), such as extrapyramidal symptoms, parkinsonism or metabolic syndrome. However, there is an increasing number of clinical cases of antipsychotic-induced hyponatremia, requiring hospitalization. Clinical case: we report the clinical case of a 52 year old patient with paranoid schizophrenia who has been taking antipsychotic medication for more than 5 years. He was admitted to the emergency department after a first tonic-clonic seizure due to severe hyponatremia. The patient was diagnosed with impaired antidiuretic hormone secretion syndrome, possibly caused by antipsychotic medications. Literature review: hyponatremia is one of the most common electrolyte disorders that afflict hospitalized patients. There are an increasing number of clinical cases where antipsychotics cause this electrolyte imbalance. One of the possible mechanisms for the development of hyponatremia is the syndrome of impaired antidiuretic hormone secretion, although further research on this topic remains needed. Conclusion: this case, like many others, highlights the gap in the outpatient treatment of psychiatric illnesses and the need to periodically monitor patients’ blood electrolytes or change treatment in a timely manner when prescribing antipsychotics. Keywords: antipsychotics, hyponatremia, syndrome of inappropriate antidiuretic hormone secretion.

Prevalence of active tuberculosis and associated factors among people with chronic psychotic disorders at St. Amanuel Mental Specialized Hospital and Gergesenon Mental Rehabilitation center, Addis Ababa, Ethiopia

BackgroundTuberculosis (TB) is an airborne chronic infectious disease mainly caused by Mycobacterium tuberculosis complex bacteria. Currently, about 1.7 billion (26%) of the world’s population are considered to be infected with M. tuberculosis. The risk of acquiring tuberculosis is higher on some segments of societies including people with severe mental illness. As a result, World health organization (WHO) strongly recommends screening for tuberculosis in such risk groups and setting.MethodsA cross-sectional study was conducted to assess the prevalence of active tuberculosis and associated factors among patients with chronic psychotic disorders admitted at St. Amanuel Mental Specialized Hospital and Gergesenon Mental rehabilitation center from February to June, 2020. All admitted patients were screened for any sign of TB as recommended by WHO. Presumptive TB cases were identified. Sputum samples were collected and tested by Xpert MTB/RIF assay. Data analysis was performed using SPSS version 25.0 statistical software and Chi square analysis was used to test the statistical association.ResultsFrom a total 3600 pschotic patients screened for TB, 250 (6.94%) presumptive tuberculosis cases were detected. From these, 27 (10.8%) were positive by Xpert MTB/RIF assay. Most of the patients were males (68.4%). The mean ± SD age of the participant was 36.5 ± 9.7 years. The overall prevalence of tuberculosis was found to be 750 per 100,000 population. The number of patients per room (p = 0.039) was associated with Xpert MTB/RIF positive active tuberculosis.ConclusionThe prevalence of active tuberculosis among chronic psychotic patients was high. Number of admitted patients per room was identified as risk factors for Xpert MTB/RIF positive active tuberculosis. Therefore, to control TB transmission in chronic mental health treatment facilities, efforts should be directed to periodic screening for early case detection and improving the number of patients per room.

Dumbness revealing Fahr syndrome

Fahr’s syndrome is an anatomoclinical entity, defined by Theodor Fahr in 1930. It is determined by the presence of intracerebral, bilateral and symmetrical calcifications, non-arteriosclerotic, located in the basal ganglia. One of its main aetiologies is Pseudohypoparathyroidism (PHP), which shows resistance to the action of Parathyroid hormone (PTH), with mainly hypocalcemia and normal to high levels of PTH. The clinical manifestations of the disease do not correspond to any specific picture, but they can be dominated by various neuropsychiatric symptoms. We report the case of a 28-year-old young man who had a first psychotic attack a year ago, treated but without therapeutic observance, and who presented for mutism revealing Fahr syndrome. The evolution was marked by an improvement under conventional neuroleptics. Keywords: Fahr syndrome; chronic psychotic disorder; neuroleptic.

Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly

Recommendations for the Diagnosis and Therapy of Psychotic Disorders in the Elderly Abstract. Psychotic disorders in the elderly cover a wide range of causes and manifestations. They often occur as part of a depression, dementia, substance abuse or delirium. While psychosis can occur with a first manifestation in advanced age, many patients with chronic psychotic disorders reach a high age. Many elderly individuals are also affected by cognitive impairment and somatic conditions, making a third-party history most relevant. The associated changes in life and the complexity of the individual situation needs to be integrated into the diagnosis and treatment. The presented recommendations have been developed under the lead of the Swiss Society of Old Age Psychiatry (SGAP) in collaboration with the Swiss Association of Nurses (SBK) and the subcommittees for gerontological and psychiatric nursing of the association of nursing science (VFP) as well as further professional societies. We aim to make current knowledge concerning diagnosis and treatment available to the interprofessional teams working in in- and outpatients' settings.

Privacy-Preserving Social Ambiance Measure From Free-Living Speech Associates With Chronic Depressive and Psychotic Disorders.

A social interaction consists of contributions by the individual, the environment and the interaction between the two. Ideally, to enable effective assessment and interventions for social isolation, an issue inherent to depressive and psychotic illnesses, the isolation must be identified in real-time and at an individual level. However, research addressing sociability deficits is largely focused on determining loneliness, rather than isolation, and lacks focus on the richness of the social environment the individual revolves in. In this paper, We describe the development of an automated, objective and privacy-preserving Social Ambiance Measure (SAM) that converts unconstrained audio recordings collected from wrist-worn audio-bands into four levels, ranging from none to active. The ambiance levels are based on the number of simultaneous speakers, which is a proxy for overall social activity in the environment. Results show that social ambiance patterns and time spent at each ambiance level differed between participants with depressive or psychotic disorders and healthy controls. Individuals with depression/psychosis spent less time in diverse environments and less time in moderate/active ambiance levels. Moreover, social ambiance patterns are found associated with the severity of self-reported depression, anxiety symptoms and personality traits. The results in this paper suggest that objectively measured social ambiance can be used as a marker of sociability, and holds potential to be leveraged to better understand social isolation and develop effective interventions for sociability challenges, thus improving mental health outcomes.

Complicated Grief, Depression, Health and Attachment Style in First Degree Relatives of Individuals with a Chronic Psychotic Disorders.

Complicated grief (CG) is a form of unrelenting grief after the death of a loved one. However, family members of individuals who suffer from Schizophrenia, Schizoaffective disorders and Bipolar disorder may experience symptoms of CG even though their loved one is still alive. The present study assessed CG and risk factors for CG in first degree relatives of individuals with severe chronic mental illness. The incidence of CG was examined in 78 parents, siblings, adult children and spouses recruited through organizations and social media that provide support services for individuals suffering from mental illness and their families. High rates of CG (39.7%) were found in this group. CG was associated with a higher prevalence of posttraumatic and depression symptoms and poorer physical health. These findings may contribute to heightening therapists' awareness of the importance of assessing, acknowledging and resolving CG in the family members of patients with chronic psychotic disorders.

Research on psychotic disorders in rural areas: Recent advances and ongoing challenges.

Research on patients with chronic psychotic disorders in rural areas is scarce. Those patients may not receive adequate mental health care. Mental health disparities among rural and urban areas have been recognized. This review aims to present the most recent research on psychotic disorders in rural areas. We conducted a search in the PubMed and Scopus databases. The search involved articles published over the last decade (2011-2020). All types of research design were included, if studies had used a controlled group of urban patients and reported on the differences among rural/urban residents with psychotic disorders. The focus of the review was on outcome and treatment. A total of 12 studies were included in this review. Most have been conducted in China or India. Reports from Western countries are rare. Outcome studies showed that employment rates are significantly higher in rural patients, as well as rates of marriage in women. It is not clear what is the impact of those outcomes on patients' lives. The finding of lower cost of psychotic disorders in some rural areas, should be viewed with scepticism. Studies on treatment aspects suggested that rural patients were less likely to receive antipsychotics, antipsychotic combination or clozapine. Those results were attributed to limited access to specialized treatment. When rural patients receive specialized community care they seem to have better outcomes than urban patients. There is an ongoing, but still scarce research on patients with chronic psychotic disorders in rural areas. Researchers pointed out the impact of socioeconomic inequalities on outcome and treatment, and stressed the importance of minimizing mental health disparities. These findings may have potential implications for future research; for the introduction of accessible, locally based mental health services in rural areas; and for political initiatives that would address poverty and social inequalities.

Acute family marital psychosis

IntroductionAcute marital psychosis is an acute psychotic episode occurring in a particular context which is marriage. In fact, marriage represents an event with a very important emotional load especially in the Arab-Muslim culture. This event can, in some people, induce a relapse of certain psychiatric disorders, particularly psychotic ones. We propose in this work to report two clinical observations concerning two brothers who both presented, a few years apart, an acute nuptial psychosis with two different evolutions.ObjectivesStuding the characteristics of nuptial psychotic episode in a one family and the different evolution of each one.MethodsReporting two clinical cases of two brothers who represented both acute psychotic episode in a nuptial context with different evolution.ResultsThe two patients are brothers with common psychiatric background which is their mother treated for chronic psychotic disorder. They were hospitalized in our psychiatric service for acute psychotic episode occuring in a nuptial context with chronic evolution for the first one and a partial recovery for the second one.ConclusionsMarriage represents an event with a very important emotional load especially in the Arab-Muslim culture. In thiscontext, acute psychotic episode can occur with different evolution for patients predisposed. Studing socio-cultral circumstances related to psychotic episode can help mental health professional to improve the quality of health care service.

Alcohol use in Tanzanians with chronic psychotic disorders and poor medication adherence

BackgroundThe burden of chronic psychotic disorders (CPDs) in sub-Saharan Africa (SSA) is significant. Poorly medically adherent patients are more likely to have worse outcomes and require more resources. However, factors impacting effective treatment of CPD in this population are unclear.AimExamine the relationship between alcohol use and disease management and compare alcohol risk stratification between the Alcohol Use Disorders Identification Test (AUDIT) and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in poorly medication adherent Tanzanians with CPD.SettingMuhimbili National Hospital and ambulatory clinics in Dar es Salaam, Tanzania.Methods100 Tanzanians with CPDs and suboptimal medication adherence were dichotomized into low and moderate-to-high risk alcohol use based on AUDIT scores and compared regarding medication attitudes, adherence and psychiatric symptoms. Patients completed the ASSIST for comparison to AUDIT risk stratification.ResultsModerate-to-high risk alcohol users had worse medication attitudes (p < 0.01), medication adherence (previous week, p = 0.01; previous month, p < 0.001), and psychiatric symptoms (p = 0.03). They were younger, predominately male and more likely to have a family history of alcohol abuse. A logistic regression analysis found age, gender and family history of abuse as significant predictors of hazardous alcohol use (p = 0.02, 0.02, < 0.01, respectively). Risk stratification between AUDIT and ASSIST aligned in 85% of participants.ConclusionAlcohol use is an important consideration in treating poorly adherent Tanzanians with CPD. The ASSIST was comparable to the AUDIT in stratifying risky alcohol use with the additional benefit of screening for other substances.

Minding metabolism: targeted interventions to improve cardio-metabolic monitoring across early and chronic psychosis.

BackgroundAntipsychotics (APs) increase weight, metabolic syndrome, diabetes and cardiovascular disease. Guidelines recommend cardio-metabolic monitoring at initial assessment, at 3 months and then annually in people prescribed APs.AimTo determine the rates of cardio-metabolic monitoring in AP treated early and chronic psychosis and to assess the impact of targeted improvement strategies.MethodsMedical records were reviewed in two cohorts of first-episode psychosis (FEP) patients before and after the implementation of a physical health parameter checklist and electronic laboratory order set. In a separate group of patients with chronic psychotic disorders, adherence to annual monitoring was assessed before and 3 months after an awareness-raising educational intervention.ResultsIn FEP, fasting glucose (39% vs 67%, p=0.05), HbA1c (0% vs 24%, p=0.005) and prolactin (18% vs 67%, p=0.001) monitoring improved. There were no significant differences in weight (67% vs 67%, p=1.0), BMI (3% vs 10%, p=0.54), waist circumference (3% vs 0%, p=1.0), fasting lipids (61% vs 76% p=0.22) or ECG monitoring (67% vs 67%, p=1.0). Blood pressure (BP) (88% vs 57%, p=0.04) and heart rate (91% vs 65%, p=0.03) monitoring dis-improved. Diet (0%) and exercise (<15%) assessment was poor. In chronic psychotic disorders, BP monitoring improved (20% vs 41.4%, p=0.05), whereas weight (17.0% vs 34.1%, p=0.12), BMI (9.7% vs 12.1%, p=1.0), fasting glucose (17% vs 24.3%, p=0.58) and fasting lipids remained unchanged (17% vs 24.3%, p=0.58).ConclusionsTargeted improvement strategies resulted in a significant improvement in a limited number of parameters in early and chronic psychotic disorders. Overall, monitoring remained suboptimal.

Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure

Tardive Dyskinesia: Assessing and Treating a Debilitating Side Effect of Prolonged Antipsychotic Exposure

Community Rehabilitation and Hospitalizations Among People With Chronic Psychotic Disorder: Is There a Differential Association by Co-occurring Substance Use Disorder?

Objective: Co-occurrence of chronic psychotic disorders and substance use disorder (SUD) is clinically challenging and increasingly prevalent. In 2000, legislation was passed in Israel to foster rehabilitation and integration in the community of persons with mental health disorders. In 2010, the need to allocate resources for patients with these co-occurring disorders (COD) was officially recognized. Yet, most rehabilitation services were not specifically designed for COD. This study examines the relationship between duration of community rehabilitation and number of psychiatric hospitalization days among persons with/without COD in Israel.Methods: Data from the National Psychiatric Case Register on 18,684 adults with schizophrenia/schizoaffective disorders hospitalized in 1963–2016, was merged with data from the Israel Mental Rehabilitation Register. Associations and interactions between COD-status (COD/non-COD), time-period (Period1: 2001–2009, Period2: 2010–2016), duration of housing or vocational rehabilitation on hospitalization days per year were analyzed using repeated-measures ANOVA.Results: The proportion of non-COD chronic psychotic patients who received rehabilitation services increased from 56% in Period1 to 63% in Period2, as it did among COD patients—from 30 to 35%. The proportion of non-COD patients who received longer-duration vocational rehabilitation (≥1 year) was significantly higher (43%) than among COD patients (28%) in both time periods. For housing rehabilitation, these proportions were 79 and 68%, respectively. Persons with COD experienced more hospitalization days annually than non-COD patients. Duration of rehabilitation (less/more than a year) was inversely associated with annual number of hospitalization days (p < 0.0001). This pattern was noted in both COD and non-COD groups and remained significant after controlling for age, sex, COD group, percent of hospitalizations with SUD, and age at first hospitalization.Conclusions: COD patients with prolonged rehabilitation seemingly achieve long-term clinical improvement similar to non-COD patients, despite most rehabilitation settings in Israel not being designed for COD patients. Yet, COD patients receive overall less rehabilitation services and for shorter periods than non-COD patients. Long-term rehabilitation services should be provided to COD patients, who may need more time to commit to treatment. To achieve better long-term mental health improvements, a continued expansion of community-based integrative treatment and rehabilitation services for COD patients is needed in Israel.

Psychotic Disorders in the Veterans of Local Wars

Objectives. To determine the frequency of leading psychopathological syndromes, dynamics, and comorbidities of schizophrenia and other endogenous psychoses in Russian veterans of local wars receiving hospital treatment. Materials and methods. A total of 685 patients receiving treatment in the psychiatric departments of a military hospital were studied: 264 veterans of local wars (the study group), 296 servicemen (personnel and reserves) who had not taken part in military engagements (reference group 1), whose mean age differed from that of the study group, and 125 servicemen (personnel and reserves) who had not taken part in military engagements and had the same mean age and age distribution as patients of the study group (reference group 2). Results and conclusions. Among veterans (patients of the study group), the frequency of delusional (schizotypic) psychoses was somewhat lower (7.2%) than among patients who had not taken part in military engagements (14.5% and 8.8%, respectively). Patients of all three groups were mainly diagnosed with schizophrenia (ICD-10 F20): 3.8% in the study group, 4.4% in reference group 1, and 4.0% in reference group 2. Other acute and chronic psychotic disorders (F22–F23) were rarer and were seen in 0.8%, 5.4%, and 3.2% of patients, respectively. Organic delusional disorders were diagnosed in 1.5% of veterans and 3.7% of patients in reference group 1 but were not seen in patients of reference group 2. Comorbidity with post-traumatic stress disorder (PTSD) and psychotic symptoms in veterans was less than 2% but was seen in 26.3% of patients with diagnoses of schizophrenia and other disorders. The incidence of PTSD symptoms in veterans with diagnosed schizophrenia and other delusional disorders was significantly lower than the incidence among all veterans (20% and 46.9%, respectively). No link was found between hallucinatory and delusional experiences and the actions of military stress factors in the study group. In most patients of the study group, psychotic symptomatology became manifest after combat stress ended, and the subsequent development and relapse of psychotic symptomatology occurred independently of the effects of wartime factors.

Pattern of usage of psychotropic agents in geriatric patients in a teritiary care hospital

Psychotropic medications are used in the treatment of chronic psychotic disorders like anxiety, depression, insomnia, bipolar disorders, cognitive impairment, seizure, loss of consciousness, altered sensorium, delirium etc. The objective of this study is to describe the pattern of use of psychotropic medications in patients presenting to geriatrics department, to compare the pattern of usage of psychotropic medication at the time of admission versus at the time of discharge and to find out the dose optimization pattern in elderly patients. Observational retrospective study, conducted in the department of geriatrics. The sample size calculated for the study was 35. The study was carried out through AHIS and by reviewing case files. The data were collected on specially designed data collection forms. Consumption of the psychotropic drugs was the highest within 71-80 years of age group, of which 49.15% of patients fall in this age group. All of the patients prescribed with psychotropic medications had insomnia (26.70%), followed by anxiety (20.30%), seizure (20.30%) and depression (16.90%). Among the 2nd generation anti psychotropics, quetiapine was the most frequently prescribed drug (54.24%). Benzodiazepines were the preferred antidepressants (36%) followed by SSRIs. Sixty two percent of the patients continued the same dose prescribed from the outside hospital and a dose increment was done for 37.5% of the patients. The incidence of usage of psychotropic medications were found to be more with females. Atypical antipsychotic drugs were the most commonly used ones. Current evidence shows no superiority for atypical antipsychotics over haloperidol.

Correlates of poor medication adherence in chronic psychotic disorders

Background Chronic psychotic disorders (CPDs) occur worldwide and cause significant burden. Poor medication adherence is pervasive, but has not been well studied in sub-Saharan Africa. Aims This cross-sectional survey of 100 poorly adherent Tanzanian patients with CPD characterised clinical features associated with poor adherence. Method Descriptive statistics characterised demographic and clinical variables, including barriers to adherence, adherence behaviours and attitudes, and psychiatric symptoms. Measures included the Tablets Routine Questionnaire, Drug Attitudes Inventory, the Brief Psychiatric Rating Scale, the Clinical Global Impressions scale, the Alcohol Use Disorders Identification Test and Alcohol, Smoking and Substance Involvement Screening Test. The relationship between adherence and other clinical variables was evaluated. Results Mean age was 35.7 years (s.d. 8.8), 61% were male and 80% had schizophrenia, with a mean age at onset of 22.4 (s.d. 7.6) years. Mean proportion of missed CPD medication was 64%. One in ten had alcohol dependence. Most individuals had multiple adherence barriers. Most clinical variables were not significantly associated with the Tablets Routine Questionnaire; however, in-patients with CPD were more likely to have worse adherence (P ≤ 0.01), as were individuals with worse medication attitudes (Drug Attitudes Inventory, P &lt; 0.01), higher CPD symptom severity levels (Brief Psychiatric Rating Scale, P &lt; 0.001) and higher-risk use of alcohol (Alcohol Use Disorders Identification Test, P &lt; 0.001). Conclusions Poorly adherent patients had multiple barriers to adherence, including poor attitudes toward medication and treatment, high illness acuity and substance use comorbidity. Treatments need to address adherence barriers, and consider family supports and challenges from an intergenerational perspective.

Differential Effects of Acute Treatment With Antipsychotic Drugs on Peripheral Catecholamines

Antipsychotic drugs represent the most effective treatment for chronic psychotic disorders. The newer second generation drugs offer the advantage of fewer neurological side-effects compared to prior drugs, but many cause serious metabolic side-effects. The underlying physiology of these side-effects is not well-understood, but evidence exists to indicate that the sympathetic nervous system may play an important role. In order to examine this possibility further, we treated separate groups of adult female rats acutely with either the first generation antipsychotic drug haloperidol (0.1 or 1 mg/kg) or the second generation drugs risperidone (0.25 or 2.5 mg/kg), clozapine (2 or 20 mg/kg), olanzapine (3 or 15 mg/kg) or vehicle by intraperitoneal injection. Blood samples were collected prior to drug and then 30, 60, 120, and 180 mins after treatment. Plasma samples were assayed by HPLC-ED for levels of norepinephrine, epinephrine, and dopamine. Results confirmed that all antipsychotics increased peripheral catecholamines, although this was drug and dose dependent. For norepinephrine, haloperidol caused the smallest maximum increase (+158%], followed by risperidone (+793%), olanzapine (+952%) and clozapine (+1,684%). A similar pattern was observed for increases in epinephrine levels by haloperidol (+143%], olanzapine (+529%), risperidone (+617%) then clozapine (+806%). Dopamine levels increased moderately with olanzapine [+174%], risperidone [+271%], and clozapine [+430%]. Interestingly, levels of the catecholamines did not correlate strongly with each other prior to treatment at baseline, but were increasingly correlated after treatment as time proceeded. The results demonstrate antipsychotics can potently regulate peripheral catecholamines, in a manner consistent with their metabolic liability.

Differential Effect of Community Rehabilitation Reform on Hospitalizations of Patients with Chronic Psychotic Disorders With and Without Substance Use Disorder, Israel, 1991-2016.

The co-occurrence of schizophrenia and substance use disorder (SUD) is clinically challenging and increasingly prevalent. This study compares trends in hospitalization characteristics of chronic psychotic patients with and without SUD in Israel, before and after introduction of the Community Rehabilitation of Persons with Mental Disability Law in 2000. The National Psychiatric Case Registry provided data on 18,684 adults with schizophrenia/schizoaffective disorders, hospitalized in 1991-2016 (at least once in 2010-2015). Repeated-measures ANOVA was used to measure the effect (and interactions) of group (patients with and without co-occurring disorders (COD)), time-period (Period1: 1991-2000, Period2: 2001-2009, Period3: 2010-2016) and age, on hospitalization measures-average length of stay (LOS), annual number of hospitalizations and hospitalization days. Among non-COD patients hospitalized in all three periods, LOS declined by half from 133.3days in Period1 to 63.2 in Period3, and the annual number of hospitalizations increased slightly from 0.45 to 0.56. Among COD patients, LOS declined moderately from 82.7days to 58.3days, while annual hospitalizations increased dramatically from 0.56 to 0.82. The annual average number of hospitalization days/capita declined from 49.7 in Period1 to 26.3 in Period3 among non-COD patients, yet remained virtually unchanged among COD patients-39.6 and 37.4 in the two periods, respectively. Since introduction of the law, a significant improvement in hospitalization characteristics of chronic psychotic non-COD patients has been noted, whereas the situation worsened somewhat for COD patients. Community rehabilitation services for COD patients in Israel have yet to develop as a suitable alternative to hospitalization, and additional rehabilitation services are urgently needed.