Incidence Of Psychotic Symptoms Research Articles

Psychotic symptoms in Chinese adolescent patients with major depressive disorder: prevalence and related endocrine clinical factors

ObjectiveMajor depressive disorder (MDD) is often accompanied by psychotic symptoms. However, few studies have examined the relationship between psychotic symptoms and endocrine factors in adolescent patients with MDD. Therefore, this study aimed to investigate the prevalence and related endocrine clinical factors of psychotic symptoms in Chinese adolescent patients with MDD.MethodsIn total, 601 patients (aged 12–18) with MDD were recruited. The Patient Health Questionnaire – 9 items (PHQ – 9) was utilized for assessing depressive symptoms. Psychotic symptoms were assessed through clinical interviews. Prolactin (PRL), thyroid-stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (FT3), thyroxine (T4), and free thyroxine (FT4) were also measured.ResultsThe incidence of psychotic symptoms in adolescent patients with MDD was 22.6%. The findings demonstrated that age, self-harming behavior, PHQ-9 score, FT4, and normalized PRL were independently associated with psychotic symptoms in patients with MDD (All p < 0.05).ConclusionsPRL and FT4 levels are more likely to be abnormally elevated in major depressive adolescents with psychotic symptoms. Prolactin and thyroid hormones in patients with MDD should be paid more attention.

The dangers of neuroleptic use in Parkinsonian-spectrum illnesses - management of emergent hypodopaminergic syndromes and catatonia

IntroductionIn Parkinson disease (PD), the incidence of psychotic symptoms has an estimated rate of 25-30%, a cumulative long term prevalence rate of 60%, with visual hallucinations being the most common type of sensory hallucination. The use of high and low potency, antidopaminergic, antipsychotic medications (AP) have the potential to exacerbate motor symptoms of PD and precipitate neuroleptic malignant syndrome (NMS), neuroleptic malignant-like syndrome in PD known as Parkinson hyperpyrexia syndrome (PHS), and catatonia in at risk population. MethodsHere, we present a clinical case and a review of the current treatment modalities available for movement disorder emergencies in parkinsonian-spectrum illnesses (PSI). Patient was assessed by a multidisciplinary team, including neurology and a geriatric consult-liaison psychiatry service. ResultsThis is a case report of a 79-year-old man with no previous psychiatric history, an initial diagnosis of PD due to early emergence of tremors and motor symptoms responsive to levodopa-carbidopa (LC). This was followed by progressive cognitive impairments, delusional jealousy, and formed visual hallucinations, which prompted concern for cortical lewy body involvement. Pimavanserin was initiated for presumed diagnosis of Parkinson disease psychosis and ameliorated the frequency of visual hallucinations. Patient presented to the hospital for agitation and was positive for COVID-19 on admission; prior to this, he had missed doses of LC and was febrile per family. He received intramuscular haloperidol and ziprasidone for behavioral disturbances and subsequently developed delirium, severe VH's, elevated serum CK, diffuse rigidity, and hyperactive non-purposeful activity, raising concern for NMS.Emergent treatment included bromocriptine, lorazepam, and supportive measures; home dose of LC and pimavanserin were resumed after significant reductions in CK levels. Unfortunately, rigidity and delirium persisted leading to a prolonged hospitalization and requirement of a nasogastric tube for malnutrition. Neurology was concerned for PHS due to clinical overlap with NMS. Psychiatry consult-liaison service suspected protracted delirium and catatonia secondary to recent COVID-19 infection and neuroleptic use.Initial Bush Francis Catatonia Rating Score (BFCRS) was 22. Treatment trials of benzodiazepines, amantadine and memantine were unsuccessful due to adverse effects of excessive sedation, myoclonus, and increase aggression, respectively. Ultimately, bilateral, brief wave, electroconvulsive therapy (ECT) was initiated. Patient had improvements in increased alertness, executive speech, verbal comprehension, appetite, with BFCRS 6 by ninth ECT session, and was more attuned to his surroundings. After twelve ECT sessions and successful treatment of catatonia, despite some residual delirium, family felt comfortable caring for patient at their own home with supportive services. ConclusionThis case demonstrates the nebulous presentation of overlapping syndromes of delirium and catatonia - with NMS and PHS also in the differential - in the setting of acute COVID-19 infection and iatrogenic neuroleptic use in a patient with PSI. NMS and catatonia can be precipitated by dopaminergic blockade, while PHS is most encountered during dopaminergic withdrawal and intercurrent infections. Theorized pathophysiology is due to central dopamine hypofunction, leading to clinical features of altered consciousness, fevers, elevated serum CK, and parkinsonian exacerbation – all of which can be indistinguishable from the above-mentioned diagnoses. These syndromic illnesses appear to occur on an NMS-like spectrum, are a neurological emergency and necessitate prompt treatment with supportive measures, intensive care level monitoring, and restoration of the dopaminergic balance with LC, bromocriptine, and dantrolene. ECT has shown to improve both motor and psychotic symptoms in PD, should be first line in NMS, malignant and benzodiazepine-refractory catatonia, and has even demonstrated effectiveness in a case report of PHS. ECT could be the ideal next step in exacerbated movement disorder emergencies following medication trials and supportive measures. However, the evidence is limited and the logistical nuances of conducting a randomized controlled trial in the geriatric population would be ethically challenging.

Effects of the COVID-19 Pandemic on Social Determinants of Mental Health and Psychiatric Decompensation

IntroductionThe impact of the COVID-19 pandemic has propelled changes in healthcare delivery, incorporating new technologies and resulting in interruptions of care and access to treatment.ObjectivesTo understand the ways that the COVID-19 pandemic has affected mental health, particularly in those with psychotic disorders. The unique nature and scale of the COVID-19 pandemic today presents an opportunity to learn more about the challenges faced by our patients and improvements that can be made in the delivery of mental healthcare.MethodsWe report five cases of patients with preexisting psychotic disorders seen on an inpatient psychiatry unit who decompensated for reasons relating to the COVID-19 pandemic. We conducted a review of the literature by searching the PubMed database for the keywords “mental health,” “psychosis,” “COVID-19,” “epidemic,” “pandemic,” and “coronavirus.ResultsThe prevalence of psychotic disorders in the US is estimated to be between 0.25% and 0.64%. In the context of an epidemic or pandemic, the incidence of psychotic symptoms in those infected with a virus is estimated to be between 0.9% and 4%, demonstrating increased risk to this group. The effects of the COVID-19 pandemic have contributed to psychiatric decompensation.ConclusionsThe COVID-19 pandemic is an opportunity to identify ways in which our patients are at risk and how we can attempt to alleviate those risks to provide improved care going forward. By appreciating the multifaceted ways in which the current situation has affected our patient population, we can extrapolate lessons that will allow us to better serve our patients even when this pandemic passes.DisclosureNo significant relationships.

Psychotic disorders amid the COVID-19 pandemic: a consideration of risks and impacts.

The COVID-19 pandemic has had a severe and widespread global impact but particularly for those with psychosis. This review summarizes recent evidence on the relationship between the COVID-19 pandemic and psychotic disorders, highlighting the risks faced by these individuals including the negative impacts on treatment services, complications from contracting COVID-19, and the acceptability of digital interventions. Mortality, morbidity, and infection outcomes are among the worst for individuals with psychotic disorders. Presentation rates for psychotic disorders are elevated at emergency departments compared with before the COVID-19 pandemic; demand for inpatient services has increased, and there have been complications in access because of pandemic restrictions. COVID-19 related stressors have led to the exacerbation and incidence of psychotic symptoms among individuals with and without preexisting psychotic diagnoses. Digital interventions may be an acceptable method for maintaining patient contact and treatment during extended isolation. More data is needed on the longitudinal trajectory for psychotic symptoms post-COVID-19 infection and pandemic restrictions to better support individuals with psychotic disorders. Development of a long-term pandemic management plan is needed to monitor and support psychiatric health across the population.

Effects of the COVID-19 Pandemic on Patients with Psychotic Disorders: Review of the Literature and Case Series

<strong>Background:</strong> COVID-19 has impacted healthcare delivery across every setting and patient population since it began ravaging our communities in the early part of 2020. The impact of the pandemic has propelled changes in healthcare delivery incorporating new technologies and resulting at times to interruptions in care and impacting access to treatment. The aim of this study is to understand the various ways in which the COVID-19 pandemic has affected mental health overall and particularly in those with psychotic disorders who are particularly vulnerable to disruptions in their access to care and to their usual routines. There is evidence that mental health is negatively affected during epidemics and public health crises. The unique nature and scale of the COVID-19 pandemic in modern times presents an opportunity to learn more about the challenges faced by our patients and improvements that can be made in the delivery of mental health care. <strong>Methods:</strong> We report five cases of patients with preexisting psychotic disorders seen on the inpatient psychiatry unit of an inner city community hospital who decompensated for various reasons relating to the COVID-19 pandemic. In addition, we conducted a review of the existing literature on the effects of epidemics and pandemics on mental health by searching the PubMed database for the keywords “mental health,” “psychosis,” “COVID-19,” “epidemic,” “pandemic,” and “coronavirus.” <strong>Results:</strong> The ramifications of public health crises on mental health are broad and well documented. The prevalence of psychotic disorders in the US is estimated to be between 0.25% and 0.64%. In the context of an epidemic or pandemic, the incidence of psychotic symptoms in those infected with a virus is estimated to be between 0.9% and 4%. While the effects of the COVID-19 pandemic have led to psychiatric decompensation in predictable ways, such as making it difficult for patients to have access to medication, there have also been less predictable outcomes. For example, a change from in person visits with a psychiatrist to telehealth visits conducted solely on the phone was seen to cause an acute decompensation in one patient. In another case, a patient’s paranoia was exacerbated due to worries about traveling for work during the height of the pandemic, ultimately leading to decompensation. <strong>Conclusions:</strong> The COVID-19 pandemic presents us with an opportunity to identify ways in which our patients are at risk and how we can attempt to better serve them going forward. Many patients with psychotic disorders are at risk for disruptions in their access to regular care even outside the context of a pandemic. For example, while the relative risks and benefits of telehealth must be weighed on a case by case basis, it is often not a perfect replacement for regular in person care. By appreciating the multifaceted ways in which the current situation has affected our patient population, we can extrapolate lessons that will allow us to better serve our patients even when this pandemic passes.

Immunotherapy and psychosis: It there a risk?

IntroductionOver the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%).Objectives To review the effects of monoclonal antibodies on psychosis.MethodsReview of literature using PubMed database. A total of 16 studies were included.ResultsThe targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy.ConclusionsThe available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.

The factors associated with the presence of psychotic symptoms in the HELIAD Greek community study of older adults

Background The prevalence and associated factors related to psychotic symptoms in older adults are understudied. The objectives were to assess the prevalence, incidence and factors associated with psychotic symptoms in a representative Greek sample of community living older adults. Methods The sample includes n = 1,904 residents of the cities of Larissa and Maroussi in Greece participating in the Hellenic Longitudinal Investigation of Aging and Diet study with available data at baseline and n = 947 individuals at the 3-year follow-up. Past-month presence of delusions and hallucinations was assessed on the grounds of the 17 symptoms of the Columbia University Scale for Psychopathology in Alzheimer's Disease and 14 symptoms of the Neuropsychiatric Inventory Questionnaire. A comprehensive neuropsychological assessment for probable diagnosis of dementia and physical comorbidity was carried out by neurologists. Penalized logistic regression analyses were used to assess the socio-economic and clinical factors associated with psychotic symptoms. Results Past-month prevalence of psychotic symptoms was 1.9% and 1.0% when excluding cases of dementia. The prevalence of any delusion and hallucination was 0.8% and 0.3% when excluding dementia. The incidence of psychotic symptoms without dementia was 1.3%. Recent widows and farmers/breeders/craftsmen, versus public servants/teachers/executives, had both six times the odds of experiencing psychotic symptoms without dementia. Hearing impairment and the number of health conditions also increased the odds while increased age was protective. Conclusion Psychotic symptoms unrelated to dementia constitute a considerable mental health problem in old age. Paranoid delusions were the most prevalent. Socio-economic and health status factors are significant predictors of psychotic symptoms.

First Presentation With Psychotic Symptoms in a Population-Based Sample.

Increasing evidence supports the effectiveness of comprehensive early intervention at first onset of psychotic symptoms. Implementation of early intervention programs will require population-based data on overall incidence of psychotic symptoms and on care settings of first presentation. In five large health care systems, electronic health records data were used to identify all first occurrences of psychosis diagnoses among persons ages 15-59 between January 1, 2007, and December 31, 2013 (N=37,843). For a random sample of these putative cases (N=1,337), review of full-text medical records confirmed clinician documentation of psychotic symptoms and excluded those with documented prior diagnosis of or treatment for psychosis. Initial incidence rates (based on putative cases) and confirmation rates (from record reviews) were used to estimate true incidence according to age and setting of initial presentation. Annual incidence estimates based on putative cases were 126 per 100,000 among those ages 15-29 and 107 per 100,000 among those ages 30-59. Rates of chart review confirmation ranged from 84% among those ages 15-29 diagnosed in emergency department or inpatient mental health settings to 19% among those ages 30-59 diagnosed in general medical outpatient settings. Estimated true incidence rates were 86 per 100,000 per year among those ages 15-29 and 46 per 100,000 among those ages 30-59. When all care settings were included, incidence of first-onset psychotic symptoms was higher than previous estimates based on surveys or inpatient data. Early intervention programs must accommodate frequent presentation after age 30 and presentation in outpatient settings, including primary care.

The role of dopamine replacement on the behavioural phenotype of Parkinson's disease.

Objectives: The pharmacotherapy of Parkinson’s disease (PD) is often challenging as clinicians have to find a favourable balance between the efficacy on motor symptoms and side effect profiles of different dopaminergic medications. We aimed to assess the available evidence on the role of dopamine agonist monotherapy as an alternative to Levodopa in the treatment of motor symptoms of PD, along with the role of dopamine antagonists in the treatment of PD-related psychosis. Methods: We performed a systematic literature review using the databases MEDLINE, EMBASE, PsycINFO and the Cochrane Library Central register of controlled trials. Two searches were performed, ‘Search 1’ extracting trials on dopamine agonists, and ‘Search 2’ on atypical antipsychotics. Eligible studies were Double-blind Randomised Controlled Trials (RCTs) using the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Brief Psychiatric Rating Scale (BPRS) as outcome measures for Search 1 and 2, respectively. Results: 16 relevant RCTs were extracted from the search results. Overall, dopamine agonists were shown to significantly improve UPDRS scores, with a mean percentage improvement of 14.4% compared to −1.9% in the control arm (P value < 0.05)However, their side effect profile illustrated they were associated with twice the incidence of psychotic symptoms in comparison to the controls. The results on the efficacy of atypical antipsychotics for the treatment of PD-related psychosis were not significant. Conclusions: This evidence-based review confirmed that dopamine agonists can be an effective and safe treatment as monotherapy in PD, however psychotic symptoms remain a significant side effect. Atypical antipsychotics may not be relied upon for the correction of these symptoms due to inconsistent results about their efficacy.

K06 Psychosis in HD: a data mining study from REGISTRY

BackgroundThere is little consensus in the literature surrounding the prevalence and incidence of psychotic symptoms in Huntington's Disease (HD) with prevalence rates varying from 5% to 64%. The differences may...

P-89 - Posttraumatic psychosis and drug abuse. Case study

Introduction It is difficult to distinguish between posttraumatic and idiopathic psychotic disorders. After a traumatic brain injury, the incidence of psychotic symptoms is between 5–20%, with an average duration of 4 years. Delusions and auditory hallucinations are more frequent than negative and catathoniform symptoms. Despite the lack of strong scientific evidence, antipsychotic treatment seems the best choice, although there is a bigger risk of adverse effects. The prognosis does not seem to be related to the severity of the injury. Objectives and aims We intend to illustrate the daily clinical practice, in which we find patients with important comorbidities, difficult differential diagnosis and therapeutic challenges. Methods Using a case-report format, we describe a 26 year old patient with the following diagnostics: traumatic brain injury with secondary psychotic symptoms versus schizophrenia; alcohol abuse; cannabis dependence; pathologic gambling. We summarize complementary explorations, therapeutic management and evolution. Results Along three years of follow up there is a preponderance of negative symptoms. Positive symptom exacerbations also occur, in coincidence with an increase of cannabis consumption. Due to lack of compliance, long acting antipsychotics are prescribed. Motivational Interview is used for the drug use disorders and the treatment compliance, achieving the goal of reducing cannabis consumption. Conclusions Daily clinical practice brings us highly complex cases in which a multidisciplinary approach is very important. This particular case shows the differential diagnose difficulties between posttraumatic and idiopathic psychosis, and the troubles of clinical and therapeutical management in the dual pathology field.

The incidence of first‐onset psychotic symptoms and paranoid ideation in a representative population sample followed from age 70–90 years. Relation to mortality and later development of dementia

Limited data are available on the incidence of psychotic symptoms in the elderly. To elucidate the incidence of first-onset psychotic symptoms in the elderly and their relation to mortality and later development of dementia. A population-sample (n = 392) born 1901-1902 was assessed from age 70-90 with psychiatric examinations, medical record reviews and from age 85, also with key-informant interviews. Individuals developing dementia were excluded. The cumulative incidence of first-onset psychotic symptoms was 4.8% (8.0% including key-informant reports in the total sample) and 19.8 % in those who survived to age 85. Sixty-four percent of those with first-onset hallucinations later developed dementia, compared to 30% of those with delusions and 25% of those without psychotic symptoms. One fifth of non-demented elderly who survives up to age 85 develops first-onset psychotic symptoms. Hallucinations predict dementia, but most elderly individuals with first-onset psychotic symptoms do not develop dementia.

Persistent Auditory Hallucinations That Are Unresponsive to Antipsychotic Drugs

Persistent Auditory Hallucinations That Are Unresponsive to Antipsychotic Drugs

Cannabis use and expression of mania in the general population

Background Cannabis use is common in patients with bipolar disorder, however little is known about cannabis as a risk factor for mania. In order to investigate the association between exposure to cannabis and subsequent development of manic symptoms whilst controlling for psychotic symptoms, a longitudinal population-based study was carried out. Methods 4815 individuals aged 18 to 64 years were interviewed using the Composite International Diagnostic Interview at baseline, 1 year follow up and 3 year follow up, including assessment of substance use, manic symptoms and psychotic symptoms. Results Use of cannabis at baseline increased the risk for manic symptoms during follow-up (adjusted OR 2.70, 95% CI: 1.54, 4.75), adjusted for age, sex, educational level, ethnicity, single marital status, neuroticism, use of other drugs, use of alcohol, depressive symptoms and manic symptoms at baseline. The association between cannabis use and mania was independent of the prevalence and the incidence of psychotic symptoms. There was no evidence for reverse causality, as manic symptoms at baseline did not predict the onset of cannabis use during follow-up (OR = 0.35, 95% CI: 0.03, 3.49). Limitations As 3 years is a relative short period of follow-up, long-term effects of cannabis use on mania outcomes could not be detected. Conclusion The results suggest that cannabis use may affect population expression of manic symptoms (and subsequent risk to develop bipolar disorder [Regeer, E.J., Krabbendam, L., R, DE Graaf, Ten Have, M., Nolen, W.A., Van Os, J., 2006. A prospective study of the transition rates of subthreshold (hypo)mania and depression in the general population. Psychol Med, 1-9.]). These findings may not be due to the emergence of psychotic symptoms or the effects of self-medication.

455. Sensory gating in older healthy adults

Sensory gating is an essential protective function of the brain. Failure of sensory gating is one of the mechanisms underlying the development of psychotic symptoms. There is evidence that the incidence of psychotic symptoms may increase with aging. As a possible contributing mechanism examination of sensory gating in healthy elderly subjects may help with understanding the mechanisms of psychosis in this group.

QUETIAPINE IMPROVES PSYCHOTIC SYMPTOMS ASSOCIATED WITH PARKISON's DISEASE

The incidence of psychotic symptoms in patients with advanced Parkinson's disease (PD) is ≤ 40%. These symptoms are frequently precipitated by treatment with anticholinergic and dopaminergic agents, but withdrawal of these agents or treatment with conventional antipsychotics can lead to intolerable motor disability. Quetiapine fumarate (quetiapine), a recently approved antipsychotic, is effective in treating the positive and negative symptoms of psychosis, is well tolerated, and does not differ from placebo in the incidence of extrapyramidal symptoms or elevations of plasma prolactin.

An audit of topiramate use in a general neurology clinic

The purpose of this study was to look at the efficacy and side effect profile of topiramate in a neurology unit. Using case notes, 94 patients who had been treated with topiramate were identified: 48 patients had taken part in clinical trials of topiramate, 46 received topiramate once licensed. Of these patients 24% had a greater than 50% decrease in seizure frequency. Patients with primary generalized epilepsy (n = 12) had a greater reduction in seizures compared with those with partial epilepsies (n = 70) P > 0.03. There was a high incidence (41%) of side effects, particularly psychiatric problems, leading to withdrawal of therpay in 41% of patients. Seven patients were admitted to hospital as a result of psychotic symptoms or depression. The incidence of psychotic symptoms (12%) was significantly higher for patients receiving topiramate compared with 191 patients attending the department on gabapentin (0.5%) and 270 patients attending the department on lamotrigine (0.7%) P < 0.001. 'Abnormal thinking', consisting of mental slowing and word-finding difficulties, occurred in 31%. The incidence could be significantly reduced by using 25 mg dose increments fortnightly as opposed to 100 mg weekly (P > 0.03). Although topiramate is an effective antiepileptic drug, its use is accompanied by a high incidence of particularly psychiatric side effects.

Baclofen (para-chlorphenyl-GABA) in Schizophrenia*

21 schizophrenic patients were treated in a single blind study with para-chlorphenyl-GABA (baclofen) for 20 days after a placebo period of at least 1 week. Global clinical impression identified five patients as behaviorally unchanged, seven as improved and nine as worsened during the active drug administration. Four patients had to be withdrawn from the trial because of serious and unmanageable psychotic exacerbations. Overall incidence of psychotic symptoms in the group of the schizophrenic patients did not change substantially neither did the remission coefficient as calculated from the AMP documentation system. No differential effect was detected either on selected Schneiderian first rank symptoms or on symptoms more characteristic for chronic defectuous schizophrenia. It is concluded that baclofen is not a useful drug in the therapy of schizophrenia.