Current Psychotic Symptoms Research Articles

Premorbid cannabis use is associated with more symptoms and poorer functioning in schizophrenia spectrum disorder.

Cannabis use disorder is associated with an earlier age at onset and a more severe outcome of schizophrenia spectrum disorders. The role of cannabis use before the onset of illness (premorbid cannabis use) has not been fully investigated. We here examined how amount and type of premorbid cannabis use was associated with the later course of illness including current substance use, symptoms and level of functioning in schizophrenia spectrum disorder. We used a naturalistic sample of patients with DSM-IV schizophrenia spectrum disorders with a comprehensive history of illness and substance use. Data on premorbid substance use was obtained from comprehensive self-report. The relationship to outcome was investigated using regression models that included current substance use and premorbid functioning. Pre-schizophrenia cannabis use was significantly associated with more severe psychotic symptoms and impaired functioning. Higher levels of premorbid cannabis use were associated with higher levels of current psychotic symptoms. These associations were independent of current substance use and premorbid functioning. Early use of cannabis (age <17 years) was associated with earlier age at onset of psychosis, independently of potential confounders. Pre-psychosis cannabis use affects illness outcome in schizophrenia spectrum disorders, and is associated with lower age at onset of psychosis. These findings of independent negative effects of premorbid cannabis use in schizophrenia suggest that a limitation of the general use of cannabis may have beneficial health effects.

A brief CBT intervention for depersonalisation/derealisation in psychosis: study protocol for a feasibility randomised controlled trial.

BackgroundDepersonalisation is the experience of being detached or disconnected from one’s experience. Studies suggest that clinically significant levels of depersonalisation are common in individuals who have psychotic symptoms and are associated with increased impairment. However, to date, there have been no studies that have investigated an intervention designed to target clinically significant depersonalisation in such patient groups. This study aims to determine the feasibility and acceptability of a brief intervention targeting clinically significant depersonalisation in those who also have current psychotic symptoms.Methods/designThe feasibility of delivering six sessions of cognitive behavioural therapy for depersonalisation in psychosis patients will be evaluated using a single-blinded randomised controlled trial with a treatment as usual control condition. Participants will be assessed at baseline and then randomised to either the treatment or control arm. Participants randomised to the treatment arm will be offered six sessions of individual cognitive behavioural therapy delivered over a maximum of 10 weeks. Therapy will focus on an individualised shared formulation of depersonalisation experiences and behavioural, cognitive, emotional regulation and thinking process strategies to decrease distress associated with depersonalisation. Participants will be assessed again at a 10-week (post-randomisation) follow-up assessment. The primary outcomes of interest will be those assessing the feasibility and acceptability of the intervention including rates of referral, eligibility and acceptance to participate; attendance at therapy sessions and completion of homework tasks; satisfaction with the intervention; maintenance of blinding; and therapist competence. Secondary outcomes will be data on clinical outcome measures of depersonalisation and positive symptoms of psychosis, anxiety, depression and post-traumatic stress.DiscussionThis study will determine the feasibility of delivering six sessions of cognitive behavioural therapy for individuals with current psychotic symptoms who also experience clinically significant levels of depersonalisation. The results will provide information to inform a larger randomised trial to assess intervention efficacy.Trial registrationClinicalTrials.gov NCT02427542

Stimulant Medication and Psychotic Symptoms in Offspring of Parents With Mental Illness.

Stimulants, such as methylphenidate, are among the most commonly used medications in children and adolescents. Psychotic symptoms have been reported as rare adverse reactions to stimulants but have not been systematically inquired about in most previous studies. Family history of mental illness may increase the vulnerability to drug-induced psychotic symptoms. We examined the association between stimulant use and psychotic symptoms in sons and daughters of parents with major mood and psychotic disorders. We assessed psychotic symptoms, psychotic-like experiences, and basic symptoms in 141 children and youth (mean ± SD age: 11.8 ± 4.0 years; range: 6-21 years), who had 1 or both parents with major depressive disorder, bipolar disorder, or schizophrenia, and of whom 24 (17.0%) had taken stimulant medication. Psychotic symptoms were present in 62.5% of youth who had taken stimulants compared with 27.4% of participants who had never taken stimulants. The association between stimulant use and psychotic experiences remained significant after adjustment for potential confounders (odds ratio: 4.41; 95% confidence interval: 1.82-10.69; P = .001) and was driven by hallucinations occurring during the use of stimulant medication. A temporal relationship between use of stimulants and psychotic symptoms was supported by an association between current stimulant use and current psychotic symptoms and co-occurrence in cases that were assessed on and off stimulants. Psychotic symptoms should be monitored during the use of stimulants in children and adolescents. Family history of mood and psychotic disorders may need to be taken into account when considering the prescription of stimulants.

Predicting psychosis across diagnostic boundaries: Behavioral and computational modeling evidence for impaired reinforcement learning in schizophrenia and bipolar disorder with a history of psychosis.

There is increasing evidence that schizophrenia (SZ) and bipolar disorder (BD) share a number of cognitive, neurobiological, and genetic markers. Shared features may be most prevalent among SZ and BD with a history of psychosis. This study extended this literature by examining reinforcement learning (RL) performance in individuals with SZ (n = 29), BD with a history of psychosis (BD+; n = 24), BD without a history of psychosis (BD-; n = 23), and healthy controls (HC; n = 24). RL was assessed through a probabilistic stimulus selection task with acquisition and test phases. Computational modeling evaluated competing accounts of the data. Each participant's trial-by-trial decision-making behavior was fit to 3 computational models of RL: (a) a standard actor-critic model simulating pure basal ganglia-dependent learning, (b) a pure Q-learning model simulating action selection as a function of learned expected reward value, and (c) a hybrid model where an actor-critic is "augmented" by a Q-learning component, meant to capture the top-down influence of orbitofrontal cortex value representations on the striatum. The SZ group demonstrated greater reinforcement learning impairments at acquisition and test phases than the BD+, BD-, and HC groups. The BD+ and BD- groups displayed comparable performance at acquisition and test phases. Collapsing across diagnostic categories, greater severity of current psychosis was associated with poorer acquisition of the most rewarding stimuli as well as poor go/no-go learning at test. Model fits revealed that reinforcement learning in SZ was best characterized by a pure actor-critic model where learning is driven by prediction error signaling alone. In contrast, BD-, BD+, and HC were best fit by a hybrid model where prediction errors are influenced by top-down expected value representations that guide decision making. These findings suggest that abnormalities in the reward system are more prominent in SZ than BD; however, current psychotic symptoms may be associated with reinforcement learning deficits regardless of a Diagnostic and Statistical Manual of Mental Disorders (5th Edition; American Psychiatric Association, 2013) diagnosis.

Bipolar I and II versus unipolar depression: Clinical differences and impulsivity/aggression traits

ObjectiveTo investigate distinguishing features between bipolar I, II and unipolar depression, and impulsivity/aggression traits in particular. MethodsSix hundred and eighty-five (n=685) patients in a major depressive episode with lifetime Unipolar (UP) depression (n=455), Bipolar I (BP-I) disorder (n=151), and Bipolar II (BP-II) (n=79) disorder were compared in terms of their socio-demographic and clinical characteristics. ResultsCompared to unipolar patients, BP-I and BP-II depressed patients were significantly younger at onset of their first depressive episode, and were more likely to experience their first depressive episode before/at age of 15. They also had more previous affective episodes, more first- and second-degree relatives with history of mania, more current psychotic and subsyndromal manic symptoms, and received psychopharmacological and psychotherapy treatment at an earlier age. Furthermore, BP-I and BP-II depressed patients had higher lifetime impulsivity, aggression, and hostility scores. With regard to bipolar subtypes, BP-I patients had more trait-impulsivity and lifetime aggression than BP-II patients whereas the latter had more hostility than BP-I patients. As for co-morbid disorders, Cluster A and B Personality Disorders, alcohol and substance abuse/dependence and anxiety disorders were more prevalent in BP-I and BP-II than in unipolar patients. Whereas the three groups did not differ on other socio-demographic variables, BP-I patients were significantly more often unemployed that UP patients. ConclusionOur findings comport with major previous findings on differences between bipolar and unipolar depression. As for trait characteristics, bipolar I and II depressed patients had more life-time impulsivity and aggression/hostility than unipolar patients. In addition, bipolar I and II patients also differed on these trait characteristics.

A comparison of schizophrenia, schizoaffective disorder, and bipolar disorder: Results from the Second Australian national psychosis survey

IntroductionIt remains uncertain whether schizoaffective disorder (SAD) is a discrete diagnostic entity, is a variant of either a psychotic mood disorder such as bipolar disorder (BDP) or schizophrenia (SCZ), or exists on a spectral continuum between these disorders. The present study examined whether SCZ, SAD, and BDP differed qualitatively on demographic and clinical variables based on a large Australian dataset. MethodsThis study examined data from the Australian Survey of High Impact Psychosis (SHIP), in which 1469 of the 1825 participants in who had an ICD-10 diagnosis of SCZ (n=857), SAD (n=293), and BDP (n=319) were assessed across a broad range of variables. ResultsWhen compared to patients with SCZ, those with SAD reported more current delusional and thought disorder symptoms, a greater number of lifetime depression, mania, and positive symptoms, and fewer negative symptoms. Relative to the BPD group, the SAD group were younger, endorsed more current positive, delusional, and thought disorder symptoms, fewer lifetime mania symptoms, more lifetime psychotic, hallucination, and delusional symptoms, and recorded lower premorbid IQ scores. Compared to patients with BPD, those with SCZ were significantly younger, endorsed more current psychotic and hallucination symptoms, fewer lifetime depression and mania symptoms, more lifetime psychotic, hallucination, and delusional symptoms, reported more negative symptoms and had lower premorbid IQ and psychosocial functioning scores. LimitationsValidated psychometric measures of psychotic or mood symptoms were not used. ConclusionThis pattern of results is consistent with the conceptualisation of a spectrum of disorders, ranging from BDP at one end, to SAD in the middle, and SCZ at the other end.

P.3.d.029 Analyzing the efficacy of second-generation antipsychotic drugs in treatment-resistant schizophrenia: a meta-analysis

Evidence for the effectiveness of treatments in early-onset psychosis is sparse. Current guidance for the treatment of early-onset psychosis is mostly extrapolated from trials in adult populations. The UK National Institute for Health and Care Excellence has recommended evaluation of the clinical effectiveness and cost-effectiveness of antipsychotic drugs versus psychological intervention (cognitive behavioural therapy [CBT] and family intervention) versus the combination of these treatments for early-onset psychosis. The aim of this study was to establish the feasibility of a randomised controlled trial of antipsychotic monotherapy, psychological intervention monotherapy, and antipsychotics plus psychological intervention in adolescents with first-episode psychosis.We did a multicentre pilot and feasibility trial according to a randomised, single-blind, three-arm, controlled design. We recruited participants from seven UK National Health Service Trust sites. Participants were aged 14–18 years; help-seeking; had presented with first-episode psychosis in the past year; were under the care of a psychiatrist; were showing current psychotic symptoms; and met ICD-10 criteria for schizophrenia, schizoaffective disorder, or delusional disorder, or met the entry criteria for an early intervention for psychosis service. Participants were assigned (1:1:1) to antipsychotics, psychological intervention (CBT with optional family intervention), or antipsychotics plus psychological intervention. Randomisation was via a web-based randomisation system, with permuted blocks of random size, stratified by centre and family contact. CBT incorporated up to 26 sessions over 6 months plus up to four booster sessions, and family intervention incorporated up to six sessions over 6 months. Choice and dose of antipsychotic were at the discretion of the treating consultant psychiatrist. Participants were followed up for a maximum of 12 months. The primary outcome was feasibility (ie, data on trial referral and recruitment, session attendance or medication adherence, retention, and treatment acceptability) and the proposed primary efficacy outcome was total score on the Positive and Negative Syndrome Scale (PANSS) at 6 months. Primary outcomes were analysed by intention to treat. Safety outcomes were reported according to as-treated status, for all patients who had received at least one session of CBT or family intervention, or at least one dose of antipsychotics. The study was prospectively registered with ISRCTN, ISRCTN80567433.Of 101 patients referred to the study, 61 patients (mean age 16·3 years [SD 1·3]) were recruited from April 10, 2017, to Oct 31, 2018, 18 of whom were randomly assigned to psychological intervention, 22 to antipsychotics, and 21 to antipsychotics plus psychological intervention. The trial recruitment rate was 68% of our target sample size of 90 participants. The study had a low referral to recruitment ratio (around 2:1), a high rate of retention (51 [84%] participants retained at the 6-month primary endpoint), a high rate of adherence to psychological intervention (defined as six or more sessions of CBT; in 32 [82%] of 39 participants in the monotherapy and combined groups), and a moderate rate of adherence to antipsychotic medication (defined as at least 6 consecutive weeks of exposure to antipsychotics; in 28 [65%] of 43 participants in the monotherapy and combined groups). Mean scores for PANSS total at the 6-month primary endpoint were 68·6 (SD 17·3) for antipsychotic monotherapy (6·2 points lower than at randomisation), 59·8 (13·7) for psychological intervention (13·1 points lower than at randomisation), and 62·0 (15·9) for antipsychotics plus psychological intervention (13·9 points lower than at randomisation). A good clinical response at 6 months (defined as ≥50% improvement in PANSS total score) was achieved in four (22%) of 18 patients receiving antipsychotic monotherapy, five (31%) of 16 receiving psychological intervention, and five (29%) of 17 receiving antipsychotics plus psychological intervention. In as-treated groups, serious adverse events occurred in eight [35%] of 23 patients in the combined group, two [13%] of 15 in the antipsychotics group, four [24%] of 17 in the psychological intervention group, and four [80%] of five who did not receive any treatment. No serious adverse events were considered to be related to participation in the trial.This trial is the first to show that a head-to-head clinical trial comparing psychological intervention, antipsychotics, and their combination is safe in young people with first-episode psychosis. However, the feasibility of a larger trial is unclear because of site-specific recruitment challenges, and amendments to trial design would be needed for an adequately powered clinical and cost-effectiveness trial that provides robust evidence.National Institute for Health Research.

The risk and associated factors of methamphetamine psychosis in methamphetamine-dependent patients in Malaysia

ObjectiveThe objective of this study was to determine the risk of lifetime and current methamphetamine-induced psychosis in patients with methamphetamine dependence. The association between psychiatric co-morbidity and methamphetamine-induced psychosis was also studied. MethodsThis was a cross-sectional study conducted concurrently at a teaching hospital and a drug rehabilitation center in Malaysia. Patients with the diagnosis of methamphetamine based on DSM-IV were interviewed using the Mini International Neuropsychiatric Interview (M.I.N.I.) for methamphetamine-induced psychosis and other Axis I psychiatric disorders. The information on sociodemographic background and drug use history was obtained from interview or medical records. ResultsOf 292 subjects, 47.9% of the subjects had a past history of psychotic symptoms and 13.0% of the patients were having current psychotic symptoms. Co-morbid major depressive disorder (OR=7.18, 95 CI=2.612–19.708), bipolar disorder (OR=13.807, 95 CI=5.194–36.706), antisocial personality disorder (OR=12.619, 95 CI=6.702–23.759) and heavy methamphetamine uses were significantly associated with lifetime methamphetamine-induced psychosis after adjusted for other factors. Major depressive disorder (OR=2.870, CI=1.154–7.142) and antisocial personality disorder (OR=3.299, 95 CI=1.375–7.914) were the only factors associated with current psychosis. ConclusionThere was a high risk of psychosis in patients with methamphetamine dependence. It was associated with co-morbid affective disorder, antisocial personality, and heavy methamphetamine use. It is recommended that all cases of methamphetamine dependence should be screened for psychotic symptoms.

Rates and Correlates of HIV and STI Infection Among Homeless Women

We studied the prevalence of biologically confirmed HIV, Chlamydia, and gonorrhea in a randomly selected sample of sheltered homeless women in New York City, and explored their association with demographic, homeless history, and clinical risk factors. 329 women were randomly selected from 28 family and single adult shelters. The estimated prevalence of HIV in the study sample is 0.6% (±0.3%); for Chlamydia it is 6.7% (±2.2%); for gonorrhea it is 0.9% (±0.04%). A history of childhood sexual abuse, arrest history, current psychotic symptoms, and substance use disorder placed women at greater risk of infection. We consider contextual factors that may yield underestimates of HIV prevalence in our sample and discuss how a more comprehensive prevalence estimate might be constructed. Findings underscore the importance of offering HIV/STI testing, counseling, and HIV risk prevention interventions to homeless women and suggest that interventions should be tailored to the needs of specific subgroups of homeless women.

Prevalence of Psychotic Symptoms in a Community-Based Parkinson Disease Sample

: To determine the prevalence of psychotic phenomena, including minor symptoms, in a Parkinson disease (PD) sample and compare the clinical correlates associated with the various psychotic phenomena. To evaluate the extent to which cases met National Institute of Neurological Diseases and Stroke (NINDS)/National Institute of Mental Health (NIMH)-proposed criteria for PD-associated psychosis. : A total of 250 patients with idiopathic PD and Mini Mental State Exam scores greater than 23 from three community-based movement disorder clinics underwent comprehensive research diagnostic evaluations by a geriatric psychiatrist as part of a study on mood disorders in PD. Psychotic symptoms were categorized using a checklist, which included a breakdown of hallucinations, delusions, and minor symptoms. Clinical characteristics of groups with minor and other psychotic symptoms were compared. The NINDS/NIMH criteria for PD-psychosis were retrospectively applied. : Of the total sample, 26% of patients were found to have any current psychotic symptoms, with 47.7% of those having isolated minor symptoms, and 52.3% having hallucinations and/or delusions. Compared to those with no current psychiatric symptoms, minor symptoms were associated with more depressive symptoms and worse quality of life, and 90.8% of those with psychotic symptoms fulfilled the NINDS/NIMH proposed criteria. : Psychotic symptoms are common in PD patients, with minor psychotic phenomena present in nearly half of affected patients in a community-based sample. Psychotic symptoms, including minor phenomena, were clinically significant. The NINDS/NIMH PD-psychosis criteria captured the clinical characteristics of psychosis as it relates to PD. Longitudinal studies are needed to determine whether minor psychotic symptoms represent a precursor to hallucinations and delusions, and to further validate diagnostic criteria.

Increased Risk of Diabetes Mellitus Among Persons With Psychotic Symptoms

To analyze with a symptom-based approach the relationship between psychosis and diabetes mellitus in the general population. Nationally representative samples from the World Health Organization (WHO) World Health Survey, totaling 224,743 randomly selected adults 18 years and older from 52 countries worldwide, were interviewed to establish the presence of psychotic symptoms and diabetes mellitus. Presence of psychotic symptoms was established using questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Presence of diabetes was established with a response of "yes" to the question, "Have you ever been diagnosed with diabetes (high blood sugar)?" The World Health Survey was conducted between 2002 and 2004. An increasing number of psychotic symptoms was related to increasing likelihood of diabetes mellitus (OR = 1.27; 95% CI, 1.24-1.30). As compared to no symptoms, at least 1 psychotic symptom substantially elevated the risk (OR = 1.71; 95% CI, 1.61-1.81). In people with a lifetime diagnosis of schizophrenia or psychosis, the prevalence of diabetes was higher in those with current psychotic symptoms (7.3% vs 5.2%; OR = 1.65; 95% CI, 1.21-2.26), suggesting that the persistence of symptoms over time could play a central role. After controlling for different potential confounders, there was a clear increase in the probability of having diabetes as the number of psychotic symptoms increased. The relationship between psychotic symptoms and diabetes was tested with multiple mediation models and path analyses for categorical outcomes. Only body mass index appeared as a relevant mediator in a model with a good fit (ie, χ21 = 3.2, P = .0742; comparative fit index = 0.999). Psychotic symptoms are related to increased rates of diabetes mellitus in nonclinical samples, independent of several potential confounders-including a clinical diagnosis of psychosis or schizophrenia, previous antipsychotic treatment, depression, lifestyle, and individual or country socioeconomic status. The findings highlight the worldwide relevance of the problem and the importance of identifying the specific paths of this association.

P01-463 - Prevalence of psychotic symptoms: comparation of immigrants and native- born primary care service users

IntroductionEpidemiological studies reveal higher rates of psychotic disorders among immigrants of ethnic minorities. However, the variation in prevalence of psychosis differs, and the proposed explanations and risk factors vary across the literature.Objectives1) to examine the prevalence of psychotic symptoms in a sample of immigrants and native-born in a primary care setting context2) to explore the effect that certain socio-demographic characteristics have in the difference in prevalence.AimsIt is expected that the presence of psychotic symptoms will be greater for the immigrant population than for the native-born population. Low educational level, a low socio-economic status and the presence of a physical illness will partly explain these differences.Methods3000 patients (1500 immigrants and 1500 native-born outpatients paired in age and gender) were interviewed in a primary care setting. They completed the Mini International Neuropsychiatric Interview, including the psychotic disorders sections, and a questionnaire that probed demographic characteristics and physical health status.ResultsImmigrants showed significantly higher rates of psychotic symptoms than native-born patients in both sections of diagnosis: life-span psychotic symptoms only (9.8% in immigrants and 5.3% in native-born) and life span with current psychotic symptoms (7% of the immigrants and 4.8% of the native-born). Immigrants also showed a lower education level, and a lower socio-economic status. When controlling for these factors, a relationship between these factors and the symptoms was found.ConclusionsFindings are discussed in the context of culture and etiology of psychotic symptoms, and suggestions with regard to future research are made.

P01-518 - Quality of life and associated factors among chronic mental illness patients in Kaohsiung

ObjectiveThe purpose of this study was to predict quality of life (QoL) and associated factors in patients with chronic mental illness (CMI) in Kaohsiung, Taiwan.MethodsPatients (N = 2,023; 52.9% male, 47.1% female) were recruited using cross-sectional and convenience sampling. Structured questionnaires, including a living conditions questionnaire, a psychotic symptom assessment scale, the Caregiver Burden Scale, the 5-item Brief Symptom Rating Scale (BSRS-5), and the Medical Outcomes Study Short Form-12 (MOS SF-12) were used to collect data.ResultsSingle-factor analyses showed that those who were single, employed, and younger had better QoL. Additionally, patients who had fewer psychological problems and lower levels of psychological distress reported better QoL. Current psychotic symptoms, especially positive symptoms, were negatively correlated with QoL. For disease factors, schizophrenic patients and hospitalized patients reported better QoL than both bipolar patients and community patients. For family factors, caregiver's attitude and caregiver's burden were negatively correlated with QoL. For social factors, unstable housing and community social dysfunction were negatively correlated with QoL. The results showed that all four dimensions (social, family, disease and personal factors) were significant predictors of the mental component summary (MCS) and physical component summary (PCS) dimensions of QoL.ConclusionsPersonal factors and disease factors were the most important predictors of QoL in CMI patients of this sample. Family factors were more important than social factors in the MCS dimension, but social factors were more important than family factors in the PCS dimension.

Early signs and symptoms of psychosis among Palauan adolescents

This study was designed to identify early symptoms associated with the occurrence of psychosis during adolescence. Participants were recruited in the Republic of Palau, an isolated island nation in Micronesia with a prevalence rate for schizophrenia of 1.99%. Diagnostic interviews were used to obtain reports of early and current symptoms from 112 genetically high-risk (GHR) and 208 genetically low-risk (GLR) adolescents (ages 16-23). Based on current psychotic symptoms, participants were sorted into three groups: non-clinical, at-risk/symptomatic risk and clinically symptomatic. Multivariate analysis of variance revealed several between-group differences on rates of early symptoms. Most notably, youth who were in the GHR-clinically symptomatic group reported significantly higher rates of early marijuana use than GLR-clinically symptomatic youth, who were significantly more likely to report early symptoms of depression and behaviour disorders. In addition, several gender based differences in the link between early symptoms and adolescent onset psychosis were noted. Findings are generally consistent with previous research on early indicators, though several unexpected findings suggest that results from this study may not be fully generalizable beyond this relatively isolated and culturally distinct Micronesian nation.

Psychosocial functioning among bipolar youth

Background Evidence indicates that children and adolescents with bipolar disorder (BP) experience significant functional impairment. However, little is known about the association between psychosocial functioning and episodes of illness, demographic, and clinical variables in this population. Methods Subjects included 446 patients aged 7 to 17 diagnosed with DSM-IV bipolar disorder via the K-SADS for the Course and Outcome of Bipolar Youth (COBY) study. The Psychosocial Functioning Schedule of the Adolescent Longitudinal Interval Follow-Up Assessment (A-LIFE) was administered at study intake. Results Mild to moderate levels of psychosocial impairment were evident in work (includes academics), interpersonal, and overall domains of functioning among BP youth. Multivariate analyses indicated that the strongest predictors of psychosocial impairment were adolescence (regardless of age of onset), current mood episode, current affective symptom severity, current psychotic symptoms, and current comorbid conduct disorder. Bipolar youth in-episode were significantly more impaired than those in partial remission/recovery in every functional domain examined and were less satisfied with their functioning. Yet, BP youth in partial remission/recovery reported significant psychosocial impairment. Limitations Limitations include the reliance on patient and parent retrospective report of psychosocial functioning. Additionally, we did not account for the impact of psychosocial and pharmacological interventions on functioning. Conclusions Findings suggest pediatric BP is associated with significant impairment in psychosocial functioning during and between episodes, with greater impairment during mood episodes than during partial remission/recovery. Additionally, functional impairment in BP appears to increase during adolescence regardless of age of onset. Clinicians should carefully assess and address psychosocial impairment during and between mood episodes, with particular attention to the functioning of BP adolescents.

Neurocognitive Impairment in Bipolar Patients With and Without History of Psychosis

Little is known regarding the impact of psychotic symptoms on the cognitive functioning of bipolar patients. Findings from previous reports are controversial and mainly focused on current psychotic symptoms. The main aim of this study was to ascertain whether the history of psychotic symptoms was associated with greater cognitive impairment in euthymic bipolar patients. Sixty-five euthymic bipolar disorder patients (DSM-IV criteria; 35 with a history of psychotic symptoms and 30 without such a history) were assessed through a neuropsychological battery targeting attention, psychomotor speed, verbal memory, and executive functions. Thirty-five healthy controls were also included in the study in order to compare the neuropsychological performance among groups. Multivariate analysis of covariance was performed controlling for the effect of residual depressive symptoms as a covariate. The study was conducted from June 2005 to June 2006. Bipolar patients with a history of psychotic symptoms showed a higher number of manic episodes and more hospitalizations than patients without such a history (both p < .001). Regarding neuropsychological performance, patients with a history of psychotic symptoms performed more poorly than those without such a history or controls in all verbal memory measures (p < .005). Furthermore, patients with a history of psychotic symptoms were more impaired on tasks related to executive functions compared to healthy controls (p < .05). History of psychotic symptoms was found to be a predictor of verbal memory impairment. Our findings suggest that the history of psychotic symptoms may partly account for the cognitive dysfunctions seen in euthymic bipolar patients, especially with regard to persistent verbal memory dysfunction, as well as with some executive dysfunctions.

Cognitive insight and acute psychosis in schizophrenia

Cognitive insight is a new concept. There are very few data regarding the relationship between cognitive insight and positive symptoms. The goal of the present study was to investigate the impact of acute psychosis (delusions and hallucinations) on overconfidence in judgments and self-reflectiveness of patients with schizophrenia. The Beck Cognitive Insight Scale was used to compare the cognitive insight of schizophrenia patients with (n = 93) and without (n = 45) current psychotic symptoms. Clinical symptoms and clinical insight of the patients were also assessed. The present findings suggest that both overconfidence in judgments and impaired self-reflectiveness are associated with acute psychosis. Only diminished self-reflectiveness seem to be improved following hospitalization. Although overconfidence of schizophrenia patients in their judgments was more severe in schizophrenia patients with psychotic symptoms, self-certainty of schizophrenia patients may be a relatively persistent characteristic that is also present after recovery of psychosis. Studies with larger samples involving follow up for longer periods will be valuable to understand the nature of the relationship between cognitive insight and clinical symptoms of schizophrenia.

Psychopathology and social functioning among offspring of depressed women

Offspring of depressive parents have two times more risk of developing a depression, other psychiatric diseases or a poor social functioning. To assess psychopathology and social functioning among offspring of currently depressed mothers. We enrolled 290 depressed mother-child pairs in five primary-care clinics in Santiago. A two-stage screening process to identify female primary-care patients with current major depressive illness with children aged 6-16 years, was used. AH eligible and consenting patients were asked to complete the general health questionnaire (GHQ-12). Those scoring 5 or more were invited to participate in a baseline assessment. The final sample consisted of 290 mother-child pairs. Patients with a current DSM-IV diagnosis of major depression were eligible unless they had current psychotic symptoms, imminent suicide risk, history of mania, or current alcohol abuse. Child psychopathology was assessed with the Child Behavior Checklist (CBCL), a highly reliable and widely used parent-rated checklist to assess competencies and behavioural and emotional problems in children 4 to 18 years of age. Fifty percent (95% confidence interval (CI): 43.9-55.7) of children had overall CBCL psychopathology scores in clinical range. Internalizing symptoms were more prevalent than externalizing symptoms (62.2% [9596CI: 56.3-67.8] and 35.7% [9596CI: 30.2-41.5]. A large proportion of children of depressed poor mothers attending primary care clinics in Chile, had psychopathological symptom scores in the clinical range, with a predominance of internalizing symptoms. These results are similar to those previously reported in the United States of America.

¿Cómo es la salud mental de los hijos de madres deprimidas consultantes a servicios de atención primaria?

Offspring of depressive parents have two times more risk of developing a depression, other psychiatric diseases or a poor social functioning.To assess psychopathology and social functioning among offspring of currently depressed mothers.We enrolled 290 depressed mother-child pairs in five primary-care clinics in Santiago. A two-stage screening process to identify female primary-care patients with current major depressive illness with children aged 6-16 years, was used. AH eligible and consenting patients were asked to complete the general health questionnaire (GHQ-12). Those scoring 5 or more were invited to participate in a baseline assessment. The final sample consisted of 290 mother-child pairs. Patients with a current DSM-IV diagnosis of major depression were eligible unless they had current psychotic symptoms, imminent suicide risk, history of mania, or current alcohol abuse. Child psychopathology was assessed with the Child Behavior Checklist (CBCL), a highly reliable and widely used parent-rated checklist to assess competencies and behavioural and emotional problems in children 4 to 18 years of age.Fifty percent (95% confidence interval (CI): 43.9-55.7) of children had overall CBCL psychopathology scores in clinical range. Internalizing symptoms were more prevalent than externalizing symptoms (62.2% [9596CI: 56.3-67.8] and 35.7% [9596CI: 30.2-41.5].A large proportion of children of depressed poor mothers attending primary care clinics in Chile, had psychopathological symptom scores in the clinical range, with a predominance of internalizing symptoms. These results are similar to those previously reported in the United States of America.

Trauma and psychosis: theoretical and clinical implications

Trauma and psychosis: theoretical and clinical implications