Disorganized Behavior Research Articles

Resultados preliminares del impacto de la COVID-19 en niños/as y adolescentes expuestos a maltrato intrafamiliar

Preliminary data confirm the psychological impact that the COVID-19 crisis is causing in children and adolescents in the community population. It is unknown how it affects the child population who suffer intrafamilial abuse. The objective of the study was to examine the additional emotional impact of the measure of confinement in minors exposed to intimate partner violence towards women who received psychological attention in the Region of Murcia. One hundred and eighty-five mothers reported, by telephone comunication, how the confinement affected to 269 children between the ages of 0 and 18. Also the 108 minors who were 6 years old or older completed the list on their own emotional state. The incidence increasement of psychological disorders within this population has been low (1.1-4.8%), although among those with increased symptoms, behavioral disorganization and emotional disturbance was predominant. Likewise, it was found that some variables (sex, age, days of confinement, family conflict) contributed to increase the behavioral disorganization and traumatic stress/depression. It is necessary to develop more research in this line due to the derived implications both at diagnosis and treatment levels.

Measuring Psychosocial Reactions to COVID-19: The COVID Reaction Scales (COVID-RS) as a New Assessment Tool.

Knowing and measuring the psychosocial reactions of people to the coronavirus crisis could be useful for predicting citizen responsibility and psychological well-being in the general population. In this research, we present the COVID Reaction Scales (COVID-RS), a new tool that can measure and quantify the psychopathological reactions of the population to the COVID-19 crisis. The sample consisted of 667 subjects. Explorative and confirmative factor analyses were applied to examine the validity and reliability of the COVID-RS. Five dimensions were extracted that predicted 35.08% of the variance of the psychopathological reactions: (1) disorganized behaviors, (2) avoidant behaviors, (3) maladaptive information consumption, (4) herd behaviors and (5) loneliness. The results indicated that social quarantine induces and increases psychopathological reactions. However, emotional loneliness is reduced for each person with whom the respective subject lives during the quarantine. Finally, we can conclude that the COVID-RS has satisfactory validity and reliability. Measuring dysfunctional reactions to COVID-19 can enable the prediction of citizen responsibility.

Subtypes of Clinical High Risk for Psychosis that Predict Antipsychotic Effectiveness in Long-Term Remission.

In a previous report, we used canonical correlation analysis to classify individuals with clinical high risk (CHR) of psychosis into the 3 subtypes: subtype-1, characterized by extensive negative symptoms and cognitive deficits, appeared to have the highest risk for conversion to psychosis; subtype-2, characterized by thought and behavioral disorganization, with moderate cognitive impairment; subtype-3, characterized by the mildest symptoms and cognitive deficits. The present study attempted to identify these subtypes' response to antipsychotic (AP) treatment. A total of 289 individuals with CHR were identified and followed up for 2 years. Individuals with CHR were classified by subtype. Use of APs was examined at 2-month, 1-year, and 2-year follow-up interviews that inquired after the subjects' medication history since the first visit. The main outcome was remission, determined according to global assessment of function (GAF) score (i. e., functional outcome) and SIPS positive symptom score (symptomatic outcome) at the follow-up points. Among the 289 individuals with CHR included in the current analysis, 223 (77.2%) were treated using APs for at least 2 weeks during the follow-up period. Individuals with CHR tended to show significant improvement in both symptoms and function after 2 years, but subtypes exhibited significantly different trajectories. Subtype status can predict AP treatment outcome in terms of remission. The likelihood of remission differed significantly among the subtype groups. The remission rates for individuals with subtypes 1-3 treated using AP were 13.5%, 36.1%, and 67.0%, respectively. These subtypes may be of clinical value in AP treatment decision-making in the CHR population.

Clinical Management of Psychotic Disorders

Psychotic disorders constitute a spectrum of mental illnesses that include symptoms of hallucinations, delusions, and/or disorganized thinking and behavior. Although some psychoses are short-term and reversible conditions, schizophrenia is the prototypical illness, which often develops in young adulthood and is typically chronic in its course. A complete medical and psychiatric evaluation is necessary to evaluate patients presenting with psychotic symptoms and to differentiate primary from secondary causes. Treatment of psychosis includes treatment of identifiable causal conditions, acute management of potentially harmful behaviors, prescribing antipsychotic medication, and psychotherapeutic and psychosocial interventions. A variety of antipsychotic medications are available for treatment, which must be individualized to maximize symptom reduction and to minimize short-term and long-term side effects. Long-acting injectable medications are available to improve medication adherence. In some cases, medications to counteract side effects may need to be prescribed. In more severe cases, electroconvulsive therapy may be indicated. Psychotherapy such as cognitive-behavioral therapy can reduce the severity of hallucinations and delusions. Integrated care that also includes family psychoeducation, skills training, and/or assertive community treatment is an essential part of a comprehensive multidisciplinary treatment program for the management of patients with psychotic disorders. This review contains 5 Figures, 10 tables, and 33 references. Key words: antipsychotic, dopamine, psychosis, psychosocial treatment, schizophrenia serotonin

Antipsychotic Behavioral Phenotypes in the Mouse Collaborative Cross Recombinant Inbred Inter-Crosses (RIX).

Schizophrenia is an idiopathic disorder that affects approximately 1% of the human population, and presents with persistent delusions, hallucinations, and disorganized behaviors. Antipsychotics are the standard pharmacological treatment for schizophrenia, but are frequently discontinued by patients due to inefficacy and/or side effects. Chronic treatment with the typical antipsychotic haloperidol causes tardive dyskinesia (TD), which manifests as involuntary and often irreversible orofacial movements in around 30% of patients. Mice treated with haloperidol develop many of the features of TD, including jaw tremors, tongue protrusions, and vacuous chewing movements (VCMs). In this study, we used genetically diverse Collaborative Cross (CC) recombinant inbred inter-cross (RIX) mice to elucidate the genetic basis of antipsychotic-induced adverse drug reactions (ADRs). We performed a battery of behavioral tests in 840 mice from 73 RIX lines (derived from 62 CC strains) treated with haloperidol or placebo in order to monitor the development of ADRs. We used linear mixed models to test for strain and treatment effects. We observed highly significant strain effects for almost all behavioral measurements investigated (P < 0.001). Further, we observed strong strain-by-treatment interactions for most phenotypes, particularly for changes in distance traveled, vertical activity, and extrapyramidal symptoms (EPS). Estimates of overall heritability ranged from 0.21 (change in body weight) to 0.4 (VCMs and change in distance traveled) while the portion attributable to the interactions of treatment and strain ranged from 0.01 (for change in body weight) to 0.15 (for change in EPS). Interestingly, close to 30% of RIX mice exhibited VCMs, a sensitivity to haloperidol exposure, approximately similar to the rate of TD in humans chronically exposed to haloperidol. Understanding the genetic basis for the susceptibility to antipsychotic ADRs may be possible in mouse, and extrapolation to humans could lead to safer therapeutic approaches for schizophrenia.

Impact of polycystic ovary syndrome on eating behavior, depression and health related quality of life: A cross-sectional study in Riyadh.

Background & objectivesPolycystic ovary syndrome (PCOS) is the most common endocrinal disorder, and the greatest cause of infertility in women. Despite availability of individual data on impact of multiple endocrinal, reproductive and even metabolic factors in PCOS individuals, the data on the co-existence of BED and depression in PCOS patients with its relationship on the quality of life in Saudi Arabian females is not found. Hence this study is aimed to elucidate the implication of PCOS on eating behaviour, induction of depression and general health quality in Saudi Arabian population of Riyadh.Materials and methodsThis is a cross-sectional study carried out in multiple health facilities of Riyadh from January to March 2019. The study samples (494) were recruited by convenience sampling and administered validated questionnaire by trained research participants. The data obtained was analysed by binary logistic regression using SPSS-IBM 25.ResultsOf the total 494 women participated in the study, 23.48% (116) were PCOS individuals. The odds of developing abnormal health related quality of (HRQ) in patients with PCOS was significantly (P = 0.000, OR = 3.472) high when compared to non-PCOS participants. The odds of showing high binge eating disorder (BED, P = 0.007, OR = 2.856) and depression (P = 0.000, OR = 2.497) scores in PCOS participants were significantly more than patients who were not having PCOS. Out of the three parameters studied, abnormal health related quality of life possessed a higher influence of PCOS compared to depression and abnormal eating behavior.Interpretation & conclusionIn conclusion, the present study shows that women with PCOS are at a significant risk for depressive disorders, disorganized eating behavior and impaired quality of life. Therefore, necessary care and screening is required to minimize the impact of PCOS on already burdened individuals.

Coprescription of mood stabilizers in schizophrenia, dosing, and clinical correlates: An international study.

Studies examining coprescription and dosages of mood stabilizers (MSs) with antipsychotics for psychotic disorders are infrequent. Based on sparse extant data and clinical experience, we hypothesized that adjunctive MS use would be associated with certain demographic (e.g., younger age), clinical factors (e.g., longer illness duration), and characteristics of antipsychotic treatment (e.g., multiple or high antipsychotic doses). Within an Asian research consortium focusing on pharmaco-epidemiological factors in schizophrenia, we evaluated rates of MS coprescription, including high doses (>1000 mg/day lithium-equivalents) and clinical correlates. Among 3557 subjects diagnosed with schizophrenia in 14 Asian countries, MSs were coprescribed with antipsychotics in 13.6% (n = 485) of the sample, with 10.9% (n = 53) on a high dose. Adjunctive MS treatment was associated (all p < 0.005) with demographic (female sex and younger age), setting (country and hospitalization), illness (longer duration, more hospitalizations, non-remission of illness, behavioral disorganization, aggression, affective symptoms, and social-occupational dysfunction), and treatment-related factors (higher antipsychotic dose, multiple antipsychotics, higher body mass index, and greater sedation). Patients given high doses of MSs had a less favorable illness course, more behavioral disorganization, poorer functioning, and higher antipsychotic doses. Schizophrenia patients receiving adjunctive MS treatment in Asian psychiatric centers are more severely ill and less responsive to simpler treatment regimens.

Psychiatric Implication of Eyelid Tattooing

A tattoo is a permanent design created by injecting exogenous pigments into the dermis. Eyelid is an exotic place for tattooing. We present a 34-year-old man with eyelid tattooing as disorganized behavior.

Postpartum psychosis: can it be prevented? A high-risk case report with a favorable outcome

Introduction: postpartum psychosis is a rare psychiatric emergency that poses serious risks to both mother and child. Suicide and infanticide are the worst outcomes. Perinatal clinical and psychiatric examination is crucial in order to determine which patients are at high risk. Case Report: A puerperal patient whose 23-day-old son was a wanted child from a planned pregnancy presented with behavioral changes that began seventeen days after the birth, including introversion, incoherent speech, soliloquy, and auditory hallucinations. She was into one of psychomotor agitation, irritability, and disorganized and hazardous behavior. At the diagnosis, she was suffering delusions of guilt and unfaithfulness. She was paranoid and negligent with her newborn. Previous psychiatric events appeared to be a manic episode. Pharmacological treatment resulted in full remission, and she was discharged from hospital. Discussion: This condition is frequently overlooked due to its low incidence. This case report are suggestive of the need for greater observance during the perinatal period. Red flags include history of post-partum psychosis or bipolar disorder, clinical prodromal signs such as delirium, psychomotor agitation, and mental confusion, especially when social stress factors are present. Conclusion: A thorough medical evaluation is recommended in order to prevent risks and implement preventative treatment, such as Lithium Carbonate.

Patterns of long acting injectable antipsychotic use and associated clinical factors in schizophrenia among 15 Asian countries and region.

Patterns of clinical use of long-acting injectable (LAI) antipsychotic drugs in many countries, especially in Asia, for treatment of patients diagnosed with chronic psychotic disorders including schizophrenia are not well established. Within an extensive research consortium, we evaluated prescription rates for first- (FGA) and second-generation antipsychotic (SGA) LAI drugs and their clinical correlates among 3557 subjects diagnosed with schizophrenia across 15 Asian countries and region. Overall, an average of 17.9% (638/3557; range: 0.0%-44.9%) of treated subjects were prescribed LAI antipsychotics. Those given LAI vs orally administered agents were significantly older, had multiple hospitalizations, received multiple antipsychotics more often, at 32.4% higher doses, were more likely to manifest disorganized behavior or aggression, had somewhat superior psychosocial functioning and less negative symptoms, but were more likely to be hospitalized, with higher BMI, and more tremor. Being prescribed an FGA vs SGA LAI agent was associated with male sex, aggression, disorganization, hospitalization, multiple antipsychotics, higher doses, with similar risks of adverse neurological or metabolic effects. Rates of use of LAI antipsychotic drugs to treat patients diagnosed with schizophrenia varied by more than 40-fold among Asian countries and given to an average of 17.9% of treated schizophrenia patients. We identified the differences in the clinical profiles and treatment characteristics of patients who were receiving FGA-LAI and SGA-LAI medications. These findings behoove clinicians to be mindful when evaluating patients' need to be on LAI antipsychotics amidst multifaceted considerations, especially downstream adverse events such as metabolic and extrapyramidal side effects.

Aspects of Parent-Child Interaction from Infancy to Late Adolescence Are Associated with Severity of Childhood Maltreatment through Age 18.

Childhood maltreatment (CM) is a pervasive public health problem worldwide, with negative health consequences across the lifespan. Despite these adverse outcomes, identifying children who are being maltreated remains a challenge. Thus, there is a need to identify reliably observable features of parent–child interaction that indicate risk for CM and that can instigate strategically targeted family supports. The aim of this longitudinal study was to assess multiple aspects of observed mother–child interaction from infancy to late adolescence as risk indicators of the overall severity of CM by age 18. Mother–child dyads were assessed in infancy (N = 56), at age 7 years (N = 56), and at age 19 years (N = 56/110). Severity of CM through age 18 was indexed by combined prospective and retrospective assessments. Interactions associated with severity of CM by age 18 included maternal hostility in infancy, maternal withdrawal in infancy and middle childhood, child disorganized attachment behavior in middle childhood and late adolescence, as well as hostile and role-confused interactions in late adolescence. This study identifies new indices of maternal and child behavior as important risk indicators for the severity of CM. These indices could be used to improve early identification and tailor preventive interventions for families at risk for CM.

M97. PREDICTORS OF TRANSITION TO SCHIZOPHRENIA IN BRIEF PSYCHOTIC DISORDER: FINDINGS FROM A 3-YEAR LONGITUDINAL STUDY IN THE PAFIP COHORT

BackgroundThe category ‘brief psychotic disorder’ (BPD) is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) as a short-lived psychotic condition in which delusions, hallucinations, disorganised speech or grossly disorganised or catatonic behaviour are present for at least 1 day but less than 1 month. BPD is a relatively uncommon disease accounting for 2–7% of first-episode psychoses (FEP) and it has been poorly investigated in comparison with other psychotic disorders, probably due to its low prevalence and associated good prognosis. However, FEP patients with BPD have low diagnostic stability at follow-up and a high transition rate (around 55%) to long-lasting psychotic disorders, mainly to schizophrenia. This study explored the proportion of diagnostic transition to schizophrenia after 3 years in a cohort of FEP patients with BPD, to determine whether there were early predictive factors for such transition in this BPD population.MethodsA 36-month prospective observational study of patients with first-episode BPD was conducted. The sample included subjects aged 18–60 from the intervention programme of first-episode psychosis non-affective psychosis (PAFIP) of the University Hospital Marques de Valdecilla (Spain). BPD diagnoses were confirmed using the Structured Clinical Interview for DSM-IV (SCID-I) at 6 months following admission into the PAFIP programme. Sociodemographic, premorbid and baseline clinical variables were collected and patients were followed over 3 years while they received treatment in the PAFIP programme. A DSM-IV diagnostic reassessment was performed on those patients who completed the follow-up and subjects were classified according to whether or not they had developed schizophrenia after 3 years. Univariate screening was performed to determine variables eligible for the predictive model, and factors that reached statistical or marginal significance (p ≤ 0.1) were selected for multivariate logistic regression analysis. Significant statistical level was set at 0.05. All statistical evaluation was performed using MedCalc Statistical Software (version 19.0.7).ResultsOf the 569 patients enrolled in the PAFIP programme between 2001 and 2018, 59 met the criteria for BPD. Of those, 40 (67.8%) completed the 36-month follow-up and 16 (40%) maintained their initial BPD diagnosis. Among the patients who developed other mental disorders by the end of the study period (60%; n = 24), the proportion of transition to schizophrenia was 62.5% (n = 15). Being younger at psychosis onset, living alone, a poor premorbid adjustment, acute onset of psychotic symptomatology, and higher severity of hallucinatory behaviour were variables that showed univariate associations with subsequent development of schizophrenia. A multivariate logistic regression model revealed that transition to schizophrenia was independently significantly associated with younger age at psychosis onset (OR = 0.83, 95% CI 0.69–0.99; p = 0.048), living alone (OR = 14.3, 95% CI 1.09–186.77; p = 0.042) and greater hallucinatory activity (OR = 1.81, 95% CI 1.07–3.07; p = 0.028).DiscussionOur main findings were that 37.5% of patients who presented an initial BPD diagnosis developed schizophrenia in the following 36 months. Being younger at psychosis onset, living alone and experiencing greater hallucinatory activity at baseline were independent predictors of diagnostic transition to schizophrenia in this BPD population. Individuals with BPD presenting these risk factors should therefore be targeted for intensive interventions similar to those performed on patients with first-episode schizophrenia.

GRADUAL DOSE REDUCTION (GDR) CONCERNS IN GERIATRIC PATIENT WITH MENTAL HEALTH DISORDERS, LIVING IN LONG TERM CARE FACILITIES

Introduction Omnibus Budget Reconciliation Act (OBRA) of 1987 limited the use of psychotropic medications in residents of long-term care facilities. Update of OBRA guidelines have even farther increased some dosing restrictions, however documentation of necessity and periodic trials of medication withdrawal (GDR) are still emphasized. Almost 20% of American age 55 and older are suffering from some type of mental health disorders which include but not limited to mood disorders (Unipolar/Bipolar), psychosis, anxiety as well as symptomatic management of agitated patients due to other medical condition. Mental health disorders are implicated as a factor for suicide. Men aged 85?years or older have a suicide rate of 45.23 per 100,000, compared to an overall rate of 11.01 per 100,000 for all ages. While other treatment modalities (psychotherapy etc.) are implemented most of the time one or more psychotropic medication are used for management of these patient's population. In 2006 Center for Medicare and Medicaid Services (CMS) published guidelines about antipsychotic drug therapy only for specific condition, prescribed at the lowest possible dose, used for the shortest period, and continually undergo gradual dose reduction (GDR). There is significant literatures on guidelines and recommendation of GDR in geriatric patients. However, there is limited research and publications on prohibiting or avoiding GDR in some circumstances. We are presenting a case of a patient suffering from mental health disorder comorbid with other medical condition whose GDR might have been the cause of her symptom relapse and the need for acute inpatient management. Methods Ms. GM is 70?years old female with psychiatric diagnosis of schizoaffective disorder bipolar type has been admitted to VA Community Living Center (CLC), after she is medically diagnosed with stage III endometrial cancer and CVA for palliative chemotherapy. She was managed initially with Risperidone 5mg in the morning and 3mg at night, Haloperidol 2mg in the morning and 1mg at night, Gabapentin 200mg twice daily, under the GDR protocol her medication was decreased to Risperidone 2mg twice daily and stop the Haldol all together. Her response were monitored and documented on Computerized Patient Record System (CPRS). While she was initially stable with GDR, gradually she developed hypomanic sxs of paranoid ideation, irritability with hypersexuality as well as expansive thought, disorganized behavior. Ms. GM was not responding to initial behavioral intervention which rendered to an acute inpatient admission for management of her symptom. Once stabilized in the acute inpatient setting, Ms. GM was re-admitted to CLC for continuation of her palliative care of her endometrial cancer, CVA and schizoaffective disorder. Her current psychotropic medication is Risperidone 2mg in the morning and 3mg at night, Gabapentin 300mg QHS, she is responding to the current psychiatric intervention with minimal residual depressive symptoms still remaining. In the last visit her affect improved and she is no longer on one-one observation of irregular behavior. Results Consideration for the exceptions can be as part of GDR for some patient with mental health problem. With proper documentation of patient's response to GDR, utilizing clinical expertise and medication side effects will help prevent relapse of symptoms. Conclusions The goal of recommending psychotropic medication in patients 50 and older is to address mental health disorder and provide quality of life to patients suffering from mental health disorders with or without other medical comorbidities. With respect to their side effects and to avoid polypharmacy, CMS recommended guideline of GDR is an optimal consideration to most of psychiatric patients. However, applying these guidelines are challenging and complex, which requires knowledge of existing clinical evidence, standard of practice on using psychotropic medication with appropriate professional rational on attempting to reduce its dosage. This research was funded by: Zero funding

Механізми формування та система психотерапевтичної корекції станів дезадаптації у студентів медичного закладу вищої освіти

Проведено комплексне обстеження 412 студентів ІІ–V курсів Харківського національного медичного університету обох статей, віком 17–22 років. Усіх обстежуваних було розділено на три групи: I група – 215 студентів, мешканців Східної України; II група – 87 студентів, мешканців Луганської та Донецької областей, які вступили на навчання до ХНМУ до початку АТО; III група – 110 студентів, переселенців з зони АТО. Як показали результати дослідження, студенти-переселенці виявляють більш високий рівень розладів адаптації, порівняно зі студентами І та ІІ груп. Встановлено, що структура розладів адаптації представлена депресивним, неврастенічним, тривожним та дисоціативним синдромокомплексами. Патогенетичну значущість у формуванні дезадаптивних станів у студентів-медиків мають: зміна життєвого стереотипу, важкий навчальний матеріал, недосконалість механізмів психологічного захисту, відсутність навичок саморегуляції, неконструктивні копінг-стратегії, ситуації тривалої психічної напруги. Для студентів-переселенців стресогенним чинником є необхідність адаптації у новому та статус вимушеного переселенця. Прогностично значущими у формуванні розладів адаптації є збудливість і неврівноваженість, конфліктність у відносинах, тривожна помисливість, дезорганізація поведінки, неспроможність до саморегуляції, нездатність успішно долати стресові ситуації, діяти в умовах невизначеності, ригідність, фіксованість на травматичних і негативних переживаннях. Базисом розвитку станів дезадаптації студентів є високі рівні соматизації, депресії та тривоги за шкалою SCL-90-R; переважання важкого депресивного та тривожного епізодів за шкалою Гамільтона; клінічні прояви за лікарняною шкалою тривоги і депресії, переважання інтенсивної та екстенсивної нервово-психічної напруги. Базуючись на отриманих даних, нами розроблено систему медико-психологічної підтримки студента-медика в період навчання, що передбачає застосування комплексного психотерапевтичного, психоосвітнього та психопрофілактичного впливів та доведено її ефективність.

Unmet medical needs and other challenges in the treatment of patients with schizophrenia.

Schizophrenia is a chronic mental health disorder hallmarked by a variety of symptoms impacting mental state, emotions, and behaviors, including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, and cognitive impairment. Schizophrenia leaves patients with the inability to function appropriately in their daily lives, including at work, in relationships, and even with self-care. The exact cause of this disorder has yet to be elucidated; however, multiple factors, including genetic susceptibility and environmental influences, have been implicated in its development. Patients with schizophrenia frequently demonstrate medication nonadherence and have multiple concurrent comorbidities that lead to increased morbidity and mortality. Schizophrenia is estimated to affect more than 21 million individuals globally, and while many therapies have become available for management, the disorder still presents unique challenges to providers, caregivers, and the healthcare system. Unmet medical needs remain for this complex disease state, and research is ongoing to address these needs and improve the overall health and outcomes of patients living withschizophrenia.

Child Schizophrenia: Theory and Practice

Child schizophrenia is a mental disorder that affects brain structures, emotional and cognitive functions. The disorder is characterized by psychotic symptoms: disorder of thinking, inadequate emotional reactions, disorganized behavior, deterioration of social functioning and loss of will. Schizophrenia in children is one of the most common mental illnesses affecting up to 1% of all children. For a long time, the term "child schizophrenia" was used to refer to various disorders that had similarities with each other. Children were referred to schizophrenics if they had borderline symptoms. Child schizophrenia develops gradually; sudden onset it is not common. Schizophrenic child requires help from multidisciplinary team members including child and adolescent psychiatrist and all possible levels of psychotherapy and psychological interventions. This article discusses classification, clinical presentation, all possible treatment and rehabilitation of children with schizophrenia.

Comorbid of Obsessive Compulsive Disorder and Schizophrenia: A Case Report

Abstract&#x0D; Introduction&#x0D; Schizophrenia was a chronic mental disorder that marked by abnormal social and impairment in reality testing ability. A person diagnosed with schizophrenia may experience amount of symptoms including hallucinations, delusions, and disorganized thinking, bizzare speech and behaviour. Obsessive compulsive disorder are well known as a comorbid of schizophrenia. Comorbid OCD will affect treatment of schizophrenia and others mental disorder.&#x0D; Case Presentation&#x0D; A 14-year-old student Muslim boy from a rural household in Central Java, Indonesia who had 8 years of formal education and live with his parent was brought to emergency department of mental hospital by his parents who reported a one year history of excessive washing of his body, soaking his body for hours in bathtub and sleep in bathroom. The patient first fell in January 2019; over a six-month period he became progressively deteriorated, lost interest in his hobby, stopped going to school and reduced his food intake. After one week treatment of venlafaxine and risperidone, He became more cooperative and interactive to the examiner. At that time, the patient reported delusional beliefs about contamination, paranoid delusion and there were several indications of formal thought disorder, including derailment, neologisms, concrete thinking, circumstantiality, and illogicality. An intelligence test revealed average intelligence (IQ=100). The total score of the Brief Psychiatric Rating Scale (BPRS) 3 dropped from 42 to 24, the score on the Yates-Brown Obsessive Compulsive Symptoms (YBOCS)4 scale dropped from 24 to 18, and the score on the Global Assessment of Functioning scale (GAF)5 increased from 25 to 55. After discharge the patient adhered to his medication regimen and at three months after discharge his clinical improvement persisted; he was able to maintain is his personal hygiene and take care of his daily needs, but he remained socially isolated and was unable to return to school.&#x0D; &#x0D; Conclusion&#x0D; Obsessive compulsive disorder and schizophrenia could happen together in one individual. The treatment should consider underlying condition and cognitive function, especially if patient in productive age.

Psychosis in a Young Patient with a Left Temporal Arachnoid Cyst: A Case Report

Background: Psychiatric disorders can be caused by organic conditions. Arachnoid cysts are suggested to be related to psychiatric disorders since many case reports have be published presenting coexistence of arachnoid cyst and psychosis. Case report: An 18-year-old single male was admitted to the psychiatry hospital with severe fearfulness, disorganized behavior, decreased sleep, and refusal of oral intake. He had delusions of guilt, persecution and misidentification. He also showed periods of incoherent and very poor speech, perplexity, disorientation, and some catatonic features. There was no history of substance use or significant medical problem. Physical, including neurological, examination and laboratory investigations were normal. A brain CT revealed the presence of an arachnoid cyst in the left temporal lobe. He was treated pharmacologically with partial and slow response. Conclusion: Causal relationship between arachnoid cyst and psychosis is difficult to be concluded in this case, but the possibility should not be ignored. This case is reported from Arab region where there is lack of such publications. More in-depth research is needed.

Substance Use Patterns and Schizophrenia Spectrum Disorders: A Retrospective Study of Inpatients at a Community Teaching Hospital.

BackgroundSchizophrenia is one of the chronic mental illnesses, characterized by delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and cognitive decline. It frequently leads to a lifetime of impairment and disability that span the entire lifespan of the patients. Several epidemiologic studies have shown that schizophrenia spectrum disorders (SSDs) contribute significantly to years lived with disability. Additionally, substance use disorders have been reported to co-occur commonly among patients with SSD (a comorbidity also known as dual diagnosis), attracting notable attention over the past few decades. This dual diagnosis often requires treatment modifications to ensure for best patient outcomes.MethodsThis study was a retrospective review of the electronic medical charts. The patients included in the study were discharged from the psychiatric unit of our hospital between July 1, 2017 and October 31, 2017. Patients were included in the study using three inclusion criteria: 1) age ≥18 years; 2) had a diagnosis of SSD at discharge; and 3) had urine drug screen performed. Sociodemographic and clinical variables were abstracted. Univariate analysis and summary statistics were performed. Bivariate and multivariate analyses were done via logistic regression models to determine the odds ratios (ORs) and corresponding P values (P).ResultsA total of 365 (52.2%) patients had a diagnosis of SSD at discharge. Of these, 349 met the inclusion criteria. The age ranged from 19 to 79 years, with a mean age of 42.2 years, and 76.8% of the patients used substances. Out of the 269 patients who used substances, 199 (74%) used two or more substances. Tobacco use was most prevalent (62.3%), followed by cannabis use (41.5%), alcohol use (40.2%), and cocaine use (27.4%). Patients who reported using tobacco, were more likely to have comorbid alcohol use (OR = 7.24; P = 0.000), cannabis use (OR = 2.80; P = 0.000), cocaine use (OR = 5.00; P = 0.000), and synthetic cannabis (K2) use (OR = 4.62; P = 0.048). Results of the multivariate analyses supported the other findings.ConclusionsOur study found a high association between schizophrenia spectrum disorders and substance use, with three out of four patients with SSD using a substance. This prevalence is higher than previously reported by other studies. Among those who use substances, about three in four use multiple substances. These point to some interaction between the substances and appear to be heavily influenced by significant social determinants of mental health that continue to plague the community. It is important to establish if a patient with schizophrenia has a comorbid substance use disorder, because addressing both generally leads to better patient outcomes.

Anti-Inflammatory Diets and Schizophrenia.

Schizophrenia is a mental illness characterized by symptoms such as hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, and negative symptoms (emotional flatness, apathy, and lack of speech). It causes social and economic burdens to patients and their family. Although etiology of schizophrenia is still uncertain, dopamine dysregulation is traditionally considered as a main etiological factor of schizophrenia, which has been utilized to develop drugs for treating schizophrenia. Recently, inflammation has presented being a risk factor for schizophrenia in that neuroinflammation contributes to the pathophysiology of schizophrenia and the exacerbation of symptom severity. Various factors including diet can regulate inflammatory state. Specific foods or dietary patterns have anti- or pro-inflammatory potentials. Increased levels of pro-inflammatory cytokines and microglia activation have been reported in schizophrenia populations and were related to the pathogenesis of schizophrenia. Omega-3 fatty acids were often recommended to schizophrenia patients because of their anti-inflammatory activities. In this review, we investigate the inflammation-related pathogenesis of schizophrenia and summarize potential nutritional approaches to inhibit the manifestation of symptoms and to alleviate symptom severity using anti-inflammatory nutrients or functional components.