History Of Psychotic Disorder Research Articles

Familial history of psychotic disorders in patients with bipolar I and II disorder

Familial history of psychotic disorders in patients with bipolar I and II disorder

Self-Esteem and Delusion Proneness

The present study was an examination of global self-esteem and various types of unusual beliefs in a nonclinical population. Individuals with no history of psychotic disorder (N = 121) completed a measure of delusion-proneness and also a measure of self-esteem. Results indicated high delusion prone individuals had lower self-esteem than low delusion prone individuals (p = 0.044). In addition, higher levels of paranoid ideation and suspiciousness were associated with lower self-esteem (p < 0.001). Significant, yet smaller relationships also emerged between low self-esteem and higher levels of beliefs related to thought disturbances, catastrophic ideation/thought broadcasting, and ideation of reference/influence. The significance of these findings as they relate to theories of delusion formation is discussed.

Transient Complex Visual Hallucinations With Venlafaxine Treatment

Sir: Antidepressants have been noted to cause hallucinations, often with drug overdose, but also in rare instances as a side effect at therapeutic dose.1 Bupropion, tricyclics, and selective serotonin reuptake inhibitors (SSRIs) have most often been cited as the causative agents.1 We present a case of transient complex visual hallucinations following the initiation of venlafaxine for major depressive disorder. Case report. Mr. A was a 44-year-old man recovering from alcohol dependence in an outpatient partial hospitalization program. He had been recently hospitalized for delirium tremens and was discharged 3 days before admission to our outpatient program in December 2007. He began venlafaxine treatment, 75 mg daily, for depression 2 weeks after his last drink. Before initiation of treatment, he had had no auditory or visual hallucinations for 10 days and no history of psychotic disorders or manic symptoms. He was diagnosed according to DSM-IV-TR with alcohol dependence and recurrent major depressive disorder without psychosis. Mr. A had been 3 weeks' sober when, after 1 week of venlafaxine treatment, he reported having visual hallucinations during daytime group sessions: seeing an acetylene torch in his hand and trying to strike it against his desk to light it as well as nodding his head to drop a welding shield over his face, as he did when he worked as a welder. He had insight that these were hallucinations. He had no delusions or hallucinations in other modalities, no manic symptoms, and no altered mental status. The only other side effect noted was increased vividness to his dreams. The only other medication changes were the addition of lactulose for mildly elevated ammonia, 41 μmol/L at the onset of hallucinations. After 1 week, his hallucinations resolved, and he had no repeat episodes. The venlafaxine dose was maintained throughout his treatment. He completed the outpatient program and was discharged without further incidents 3 weeks later, and at 2 monthly follow-up appointments he reported no additional hallucinations. Antidepressants have been cited as inducing hallucinations in rare cases. There have been 2 reports of venlafaxine-induced hallucinations, in an adolescent patient and an adult patient.2,3 Given that Mr. A's dose was low (75 mg daily), the assumed mechanism of action for hallucinosis is serotonergic, not norepinephrinergic. Some studies have suggested that SSRIs may induce psychotic symptoms by 5-HT2– and 5-HT3–mediated dopamine release in the ventral striatum.4 Venlafaxine may have produced visual hallucinations via dopamine release in the mesolimbic pathway by stimulation of 5-HT2 and 5-HT3 receptors. A possible interaction could have been reactivation of alcoholic hallucinosis with venlafaxine, which was reported with sertraline in 1 case by Hermann et al.5 However, the causative mechanism in that case was felt to be due to increased dopamine availability. Sertraline shows the greatest amount of dopamine reuptake inhibition of all SSRIs, while venlafaxine shows no inhibition of the dopamine reuptake transporter. Lastly, our patient's ammonia was mildly elevated, and treatment could have exacerbated a subclinical hepatic encephalopathy, although no altered mental status or other signs of delirium were observed during his partial hospitalization. Adam C. Tripp, M.D., Ph.D. Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center Scott A. Golden, M.D. Behavioral Health Division, Veterans Hospital at Highland Drive, Pittsburgh, Pennsylvania

Plasma homovanillic acid and family history of psychotic disorders in bipolar I patients

It has been suggested that the family history of psychotic disorders is useful in defining homogeneous groups of bipolar patients. The plasma homovanillic acid (pHVA) concentrations have been related to the effect of antipsychotic treatment in psychotic patients. We have studied the influence of a positive family history of psychotic disorders both on the variation of pHVA levels and on the relation between pHVA concentrations and the clinical response to treatment. Clinical status and pHVA levels were assessed in 58 medication free patients before and after 4 weeks of treatment with olanzapine and lithium. Clinical improvement correlated positively with pHVA levels on the 28th day of treatment only in the patients having first degree relatives with psychotic disorders. The pHVA levels did not decrease after 28 days of treatment. Our results reinforce the idea that a positive family history of psychosis in psychotic bipolar disorders may constitute a good basis for sub-grouping these patients.

EVIDENCE FOR AN INTERACTION BETWEEN FAMILIAL LIABILITY AND PRENATAL EXPOSURE TO INFECTION IN THE CAUSATION OF SCHIZOPHRENIA

Objective: The authors sought to determine whether prenatal exposure to infection and a positive family history of psychotic disorders interact synergistically to increase the risk of later developing schizophrenia. Method: The authors linked two national registers, the Medical Birth Register and the Finnish Population Register, to identify all women in Helsinki who received hospital treatment during pregnancy for an upper urinary tract infection (N=9,596) between 1947 and 1990. The Finnish Hospital Discharge Register was used to ascertain psychiatric outcomes in adulthood of offspring exposed to infection prenatally. Family history of psychotic disorders was determined by linking the Hospital Discharge Register and the Population Register. The authors used an additive statistical interaction model to calculate the amount of biological synergism between positive family history and prenatal exposure to infection. Results: Prenatal exposure to infection did not significantly increase the risk of schizophrenia. However, the effect of prenatal exposure to pyelonephritis was five times greater in those who had a family history of psychosis compared to those who did not. The synergy analysis suggested that an estimated 38%-46% of the offspring who developed schizophrenia and had both prenatal exposure to infection and a positive family history of psychotic disorders did so as a result of the synergistic action of both risk factors. Conclusions: These findings support a mechanism of gene-environment interaction in the causation of schizophrenia.

Cross-Cultural Evaluation of Maternal Competence in a Culturally Diverse Society

“Ms. A” is a 27-year-old recent immigrant from China who was hospitalized twice in her early twenties because of psychotic symptoms. She was treated and maintained on antipsychotic medication at low dosages. Ms. A subsequently had a short-lived relationship with a man who disappeared from her life when he learned that she was pregnant. She decided to carry the pregnancy to term and to keep the child, not an easy decision because she had virtually no family support and few friends. However, she was intelligent and resourceful, lived in a relatively comfortable apartment in Toronto, and was able to support herself and her child on a disability pension. She had a good relationship with her psychiatrist and her social worker. Ms. A’s mother and several siblings lived in the same city, but Ms. A did not perceive them as supportive.

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Neuropsychological Impairment and Its Neurological Correlates in Adult Offspring With Heightened Risk for Schizophrenia and Affective Psychosis

Schizophrenia is generally considered to be a neurodevelopmental disorder reflected in findings of neuropsychological impairments and neurological abnormality in patients and their relatives. The authors investigated whether neuropsychological impairments are related to neurological abnormality and whether such deficits also characterize risk for affective psychosis. In a longitudinal study with a 93% rate of effective follow-up, the authors investigated neuropsychological impairment and its relation to neurological abnormality at a mean age of 22.3 years in 74 offspring of mothers with a history of psychotic disorders (38 offspring with heightened risk for schizophrenia and 36 with risk for affective psychosis) and 88 normal-risk offspring born to mothers with no history of psychosis. Offspring with genetically heightened risk for schizophrenia showed significantly impaired verbal memory, selective attention, and grammatical reasoning, compared with normal-risk offspring. Having impaired verbal memory, attention, and grammatical reasoning functions identified a significantly larger subgroup (16%) among offspring with heightened risk for schizophrenia than among offspring with heightened risk for affective psychosis (0%) and among normal-risk offspring (3%). Multiple neuropsychological functions were significantly related to neurological abnormality in offspring with heightened risk for schizophrenia and in normal-risk offspring but not among offspring with heightened risk for affective psychosis. The extension of schizophrenia and affective psychosis risk groups to include additional offspring of mothers with psychosis-spectrum disorders yielded results similar to those for the core risk groups. The neurocognitive dysfunction attending heightened risk for schizophrenia is likely based on genetically mediated neurodevelopmental factors, with schizophrenia and affective psychosis belonging to different biological spheres.

The psychosocial outcome of pregnancy in women with psychotic disorders

Objective: To investigate the psychosocial outcome of pregnancies in women with a history of psychotic disorder in an epidemiologically representative sample and to determine the predictors of having a baby looked after by social services in the first year of life. Method: Historical matched controlled cohort study and nested case control study using the General Practice Research Database (GPRD), an anonymised primary care database, in women with a history of psychotic disorders who gave birth in 1996–1998 (199 cases and 787 controls). Results: Twenty-seven percent of cases had a psychotic episode and a further 38% had nonpsychotic depression in the first year after birth. Women with nonaffective psychoses were at a significantly higher risk of postnatal depression compared with controls (adjusted rate ratio 2.07, 95% CI 1.45–2.96, p<0.001). Cases were well supported with 72% in a cohabiting relationship and only 38% on benefits. The only significant predictor of parenting difficulties was recent contact with psychiatric services. Conclusions: Women with a history of psychotic disorder are at high risk of psychiatric illness postpartum, particularly a twofold risk of postnatal depression, even if they have not been in contact with psychiatric services during pregnancy. However, this epidemiologically representative sample has better parenting outcomes than has been previously reported for specialist treated cases. Liaison between all professionals involved in the care of mothers with psychotic disorders during and after pregnancy is essential to optimise care for them and their families.

Medical outcome of pregnancy in women with psychotic disorders and their infants in the first year after birth.

There has been little research into the health of infants of women with psychotic disorders. To investigate the antenatal care of mothers with a history of psychotic disorders, obstetric outcomes and the subsequent health of their babies. A matched, controlled cohort study was carried out using the General Practice Research Database. Women with a history of a psychotic disorder, who gave birth in 1996-1998, were compared with women matched for age and general practice (199 cases and 787 controls) and their infants. Cases had a higher proportion of stillbirths (OR=4.03, 95% CI 1.14-4.25, P=0.03) and neonatal deaths (P<0.001). There was no difference in gestational age at antenatal booking. Mothers with psychotic disorders were less likely than controls to attend for infant immunisations 90-270 days after birth (RR=0.94, 95% CI 0.88-0.99, P=0.03). There was no significant difference in the rates of accidents and hospital contacts for infants. There is an increased risk of stillbirth and neonatal death in women with a history of psychotic disorder, and it is therefore important for health care professionals to focus on optimal obstetric care. The physical health of babies who live with mothers with psychotic disorders is not significantly different from that of matched baby controls.

Empirical clusters of DSM-III personality disorders in violent offenders.

Violent male offenders in a maximum security hospital and special units in prisons (N = 164) were interviewed with the Structured Clinical Interview for DSM-III Axis II disorders (SCID-II). Cluster analysis of the personality disorder criteria sets identified six diagnostic patterns: (1) antisocial-narcissistic; (2) paranoid-antisocial; (3) borderline-antisocial-passive-aggressive; (4) borderline; (5) compulsive-borderline; and (6) schizoid. Offenders in the first three groups had more extensive criminal careers, and most were identified as psychopaths by the Psychopathy Checklist-Revised (PCL-R). These Groups also had more frequent lifetime histories of substance abuse. A history of affective and anxiety disorders was more common in Groups 3 and 5, and almost two thirds of Group 2 had a history of psychotic disorder. The results emphasize that dangerous offenders are heterogeneous in personality pathology. They also suggest that personality disorder among violent offenders is more commonly represented by recurring patterns of covarying traits than by single categorical entities proposed in the DSM classification.

A controlled family study in panic disorder

There are only a few family studies in panic disorder. Although there is some evidence that panic disorder is familial, the exact figures of the familial risk for this disorder are at variance across different studies; the impact of comorbidity and of the gender of relatives is also unclear. Family studies in panic disorder controlling for the comorbidity in probands are therefore indicated. This study presents the morbid risks in families of 40 “pure” panic disorder probands (DSM-III-R) without a history of psychotic disorders, major depression or alcoholism compared with families of 80 controls recruited in the general population. The relative frequency of panic disorder (DSM-III-R) in the first-degree relatives of panic disorder probands was 5.7% (the age corrected morbid risk is 7.9%) compared to 1.8% in relatives of healthy controls (age corrected morbid risk 2.3%). Agoraphobia segregated predominantly among female relatives of agoraphobic probands. An increased familial risk of major depression and of alcoholism was also observed. Comorbidity with alcoholism and major affective disorders was excluded in panic disorder probands by definition; therefore, these findings indicate that the etiological factors underlying panic disorder may overlap with those of alcoholism and those of unipolar major depression.

Egocentrism in Children of Parents With a History of Psychotic Disorders

It is known that children of schizophrenic parents have an increased risk for becoming schizophrenic, but it has been extremely difficult to determine what features may exist in such children before they become manifestly ill that might provide a key for identifying vulnerability to subsequent disorder. This study was carried out to determine whether certain types of egocentric perception exist in the children of psychotic parents that might represent a clue to vulnerability. Sixty parent-child pairs were investigated as part of the University of Rochester (NY) Child and Family Study, using standardized diagnostic assessment procedures in the parents and several methods for evaluating egocentric perception in their offspring. Results showed that severity of psychotic symptoms in a parent related significantly to the degree of persistent age-inappropriate spatial egocentrism in his or her child. All of several diagnostic approaches used for parent classification were about equally valid in this regard, except for hospital diagnosis of schizophrenia, which did not correlate significantly with offspring egocentricity.