Non-psychotic Psychiatric Disorders Research Articles

Assessing and managing hallucinations in children and adolescents

SummaryHallucinations (erroneous percepts in the absence of identifiable stimuli) are a key feature of psychotic states, but they have long been known to present in children with non-psychotic psychiatric disorders. Recent epidemiological studies of child populations found surprisingly high rates (about 10%) of hallucinatory experiences. These hallucinatory phenomena are most likely to occur in the absence of psychiatric disorder and are usually simpler, less elaborate and less distressing than those observed in children with psychiatric disorders. This article details the clinical assessment of hallucinations in children and adolescents, taking into account developmental considerations and paediatric organic associations. It describes hallucinations in young people with psychoses (schizophrenia spectrum and mood disorders) and non-psychotic psychiatric disorders (emotional and behavioural disorders), and it addresses therapeutic aspects.

All that glitters is not gold: prevalence and relevance of psychotic‐like experiences in clinical sample of children and adolescents aged 8–17 years old

Recent studies have examined the prevalence of psychotic-like experiences (PLEs) and their relationship with functioning, psychopathology and distress in adult and mixed young adult and adolescent samples. There is, however, a lack of knowledge about the prevalence and clinical weight of PLEs in clinical child and adolescent (CAD) populations. Available research has primarily been conducted on community populations, and even clinical samples mostly used self-reported questionnaires. These studies also recruited participants 12 years old and older, with a consequent lack of information on children from 8 to 11 years old. We examined the prevalence of PLEs and their relationship with psychiatric diagnosis, functioning, intelligence quotient (IQ), anxiety and depressive symptoms in a clinical sample aged 8-17 years old. The study was conducted on a clinical sample of 46 CAD with PLEs compared to a clinical sample of 60 CAD without PLEs. The two groups were compared on global, social and role functioning, IQ, anxiety and depressive symptoms, and number of psychiatric diagnoses. Global, role and social functioning were significantly lower in the CAD clinical sample with PLEs. These significant differences were maintained when the covariate IQ, number of psychiatric diagnoses or level of anxiety or depression was added. No significant age-related differences in the presence of PLEs were found. The findings of this study show that PLEs are common in a clinical sample of CAD, even those under 12 years old. The presence of PLEs should therefore be investigated and considered in planning treatment of non-psychotic psychiatric disorders in CAD.

Future marginalisation and mortality in young Swedish men with non-psychotic psychiatric disorders and the resilience effect of cognitive ability: a prospective, population-based study

ObjectiveLarge-scale studies examining future trajectories of marginalisation and health in adolescents with mental illness are scarce. The aim of this study was to examine if non-psychotic psychiatric disorders (NPDs) were...

Attenuated psychotic and basic symptom characteristics in adolescents with ultra-high risk criteria for psychosis, other non-psychotic psychiatric disorders and early-onset psychosis.

While attenuated psychotic symptoms (APS) and basic symptoms (BS) are the main current predictors of psychosis in adults, studies in adolescents are scarce. Thus, we (1) described the prevalence and severity of positive, negative, disorganization, general, and basic symptoms in adolescent patients at ultra-high risk for psychosis (UHR), with other non-psychotic psychiatric disorders (PC) and with early-onset psychosis (EOP); and (2) investigated BS criteria in relation to UHR criteria. Sixty-nine 12-18-year-old adolescents (15.3±1.7years, female=58.0%, UHR=22, PC=27, EOP=20) were assessed with the structured interview for prodromal syndromes (SIPS) and the schizophrenia proneness instrument-child and youth version (SPI-CY). Despite similar current and past 12-month global functioning, both UHR and EOP had significantly higher SIPS total and subscale scores compared to PC, with moderate-large effect sizes. Expectedly, UHR had significantly lower SIPS positive symptom scores than EOP, but similar SIPS negative, disorganized, and general symptom scores. Compared to PC, both EOP and UHR had more severe basic thought and perception disturbances, and significantly more often met cognitive disturbances criteria (EOP=50.0%, UHR=40.9%, PC=14.8%). Compared to UHR, both EOP and PC significantly less often met cognitive-perceptive BS criteria (EOP=35.0%, UHR=68.2%, PC=25.9%). BS were significantly more prevalent in both EOP and UHR than PC, and UHR were similar to EOP in symptom domains. Given the uncertain outcome of adolescents at clinical high-risk of psychosis, future research is needed to determine whether the combined assessment of early subjective disturbances with observable APS can improve the accuracy of psychosis prediction.

Classification of Mental Disorders Based on Temperament

Context: Different paradoxical theories are available regarding psychiatric disorders. The current study aimed to establish a more comprehensive overall approach. Evidence Acquisition: This basic study examined ancient medical books. “The Canon” by Avicenna and “Comprehensive Textbook of Psychiatry” by Kaplan and Sadock were the most important and frequently consulted books in this study. Results: Four groups of temperaments were identified: high active, high flexible; high active, low flexible; low active, low flexible; and low active, high flexible. When temperament deteriorates personality, non-psychotic, and psychotic psychiatric disorders can develop. Conclusions: Temperaments can provide a basis to classify psychiatric disorders. Psychiatric disorders can be placed in a spectrum based on temperaments.

Cost effectiveness of interpersonal community psychiatric treatment for people with long-term severe non-psychotic mental disorders: protocol of a multi-centre randomized controlled trial.

BackgroundThis study aims for health gain and cost reduction in the care for people with long-term non-psychotic psychiatric disorders. Present care for this population has a limited evidence base, is often open ended, little effective, and expensive. Recent epidemiological data shows that 43.5% of the Dutch are affected by mental illness during their life. About 80% of all patients receiving mental health services (MHS) have one or more non-psychotic disorders. Particularly for this group, long-term treatment and care is poorly developed. Care As Usual (CAU) currently is a form of low-structured treatment/care. Interpersonal Community Psychiatric Treatment (ICPT) is a structured treatment for people with long-term, non-psychotic disorders, developed together with patients, professionals, and experts. ICPT uses a number of evidence-based techniques and was positively evaluated in a controlled pilot study.Methods/DesignMulti-centre cluster-randomized clinical trial: 36 professionals will be randomly allocated to either ICPT or CAU for an intervention period of 12 months, and a follow-up of 6 months. 180 Patients between 18–65 years of age will be included, who have been diagnosed with a non-psychotic psychiatric disorder (depressive, anxiety, personality or substance abuse disorder), have long-term (>2 years) or high care use (>1 outpatient contact per week or >2 crisis contacts per year or >1 inpatient admission per year), and who receive treatment in a specialized mental health care setting. The primary outcome variable is quality of life; secondary outcomes are costs, recovery, general mental health, therapeutic alliance, professional-perceived difficulty of patient, care needs and social contacts.DiscussionNo RCT, nor cost-effectiveness study, has been conducted on ICPT so far. The empirical base for current CAU is weak, if not absent. This study will fill this void, and generate data needed to improve daily mental health care.Trial registrationNetherlands Trial Register (NTR): 3988. Registered 13th of May 2013.

Epilepsy in Elderly Patients and Affective Disorders

Introduction This makes the issues of epilepsy in elderly patients and of emotional and affective disorders more and more topical. Study objectives To study the structure of non-psychotic psychiatric disorders (NPD) in post-stroke elderly patients and in patients with symptomatic post-stroke epilepsy. Materials and methods Two groups of 56 patients were studied. In Group 1 (37 patients: 21 men and 16 women), the stroke was complicated by the development of symptomatic post-stroke localization-related epilepsy. In Group 2 (19 patients: 7 men and 12 women), no paroxysmal states of the epileptic nature were found. The average age of Group 1 patients was 63.00 years, of Group 2 patients, 62.5 years. Results In Group 1, affective d epression-spectrum disorders were found more frequently than in Group 2 (Group 1 – 78.9%; Group 2 – 33.3%), whereas in Group 2, affective anxiety-spectrum disorders were found more frequently than in Group 1 (Group 1 – 21.1%; Group 2 – 66.7%). The average depression score in Group 1 and Group 2 was 34.81±2.73 and 28.57±3.07 on the BDI scale and 21.84 ±1.50 and 13.79±1.36 (p≤0.01) on the HRDS scale, respectively. In Group 1, a considerable correlation dependence between the index of the impact of depression and anxiety on the manifestation of other psychopathological factors (up to .819**) and the General Severity Index (GSI) was found. In Group 2, a weak correlation dependence between anxiety and the GSI (up to .828*) Conclusion The study results have shown a high severity of depression in elderly patients with symptomatic post-stroke epilepsy.

Advanced Administration and Interpretation of Multiple Validity Tests

Professional organizations recommend inclusion of multiple performance (PVTs) and symptom validity tests (SVTs) (Bush et al., Archives of Clinical Neuropsychology, 20, 419–426, 2005; Heilbronner et al., The Clinical Neuropsychologist, 23(7), 1093–1129, 2009). However, to date, empirically driven recommendations for interpretation of multiple validity indicators are largely absent, and the generalizability of available psychometric data is questionable in clinical practice. The current aim is to provide base rate data and recommendations for interpretation of multiple validity indicators, assuming varying correlations between each PVT at a range of specificity and sensitivity rates. As an initial step, Monte Carlo methodology was validated across 24 embedded and stand-alone validity indicators in seven extant noncompensation-seeking clinical samples. Samples were comprised of patients with psychotic and nonpsychotic psychiatric disorders, as well as different neurological conditions. Strategies are outlined for clinical integration of base rate data for advanced administration and interpretation of multiple validity indicators. In light of the current findings, recommendations are provided to reduce false-positive rates associated with making determinations regarding noncredible test performance.

Substance use in people at clinical high-risk for psychosis.

BackgroundSome high-risk (HR) mental states for psychosis may lack diagnostic specificity and predictive value. Furthermore, psychotic-like experiences found in young populations may act not only as markers for psychosis but also for other non-psychotic psychiatric disorders. A neglected consideration in these populations is the effect of substance misuse and its role in the development of such mental states or its influence in the evolution toward full psychotic presentations. Therefore, the main aim of this study was to thoroughly describe past and current substance use profiles of HR individuals by comparing a consecutive cohort of young people at high risk referred to a population-based early intervention clinical service with a random sample of healthy volunteers (HV) recruited from the same geographical area.MethodsWe compared alcohol and substance use profiles of sixty help-seeking HR individuals and 60 healthy volunteers (HV). In addition to identification of abuse/dependence and influence on psychotic-like experiences, differences between HR individuals and HV were assessed for gender, ethnicity, occupational status, age of lifetime first substance use, prevalence and frequency of substance use.ResultsThere were no cases of substance use disorder or dependence in either groups. HR individuals were significantly younger than HV when they first started to use substances (p = 0.014). The prevalence of overall HR substance use was similar to that of HV. Although HR individuals reported less cannabinoid use than HV currently (15% vs. 27%), and more in the past (40% vs. 30%), the differences were not statistically significant (p = 0.177 & 0.339 respectively). Current frequency of use was significantly higher for HR individuals than HV for alcohol (p = 0.001) and cannabinoids (p = 0.03). In this sample, only 5% of HR individuals converted to psychosis over a two-year follow-up.ConclusionsCertain profiles of substance use could potentially play a significant part in the evolution of HR presentations. Therefore, substance use may well represent a clinical domain that requires further emphasis and more detailed consideration in future studies.

Health and psychosocial service use among suicides without psychiatric illness.

Although mental illness is a major suicide risk factor, some cases of suicide list no symptoms of mental disorder at the time of death. Studying suicides without psychiatric illness has important implications for social work because this group's service needs seem to have been overlooked. The authors of this article conducted a psychological autopsy study of 150 people who committed suicide and 150 age- and gender-matched living controls. Suicides without psychiatric illness showed similar detectable psychopathology as the suicide and living control groups with nonpsychotic psychiatric disorders. Though suicides without psychiatric disorders showed fewer warning signs that could be noticed by their informants, they experienced more negative life events than living controls. The suicide cases without psychiatric illness also seemed to be less protected by enabling factors (such as social support and employment) than living controls with and without psychiatric disorders. Furthermore, they had lower use of services than the control and deceased-with-diagnosis groups. With fewer at-risk signs and poorer enabling resources, they were undetected or unengaged by the existing physical, psychiatric, and psychosocial services. This group should be of concern to social workers, who may develop community-based health education programs and preventive services to meet this vulnerable population's psychosocial needs.

Clinical Correlates of Childhood Trauma and Dissociative Phenomena in Patients with Severe Psychiatric Disorders

In this present study, we aim to investigate the possibility of a link between psychotic disorders and traumatic experiences in a group of female patients diagnosed with psychotic disorders by comparing childhood trauma exposure with a group of non-psychotic psychiatric disorder attending the same pschiatric clinic. Secondary purpose of this study is to examine the clinical correlates of trauma exposure, dissociative phenomena and psychiatric symptomatology between these two group of patients. Two psychiatric sample groups, those with psychotic disorders-mostly schizophrenic-(n = 54), and those with a non-psychotic severe psychiatric disorders (n = 24), were recruited. Data were collected for demographic, psychiatric and trauma histories and psychiatric symptomatology for all patients. In this study, high prevalance rates of childhood traumatic experiences and dissociative phenomena were found in both groups. Total scores of childhood trauma questionnaire in favor of the non-psychotic group were found to be close to significance (p = 0.052). DES scores of non-psychotic group were also higher although not statistically significant. 54.2 % of nonpsychotic cases had DES scores >20 on the other hand, that percentage of psychotic cases were found to be as 38.9 %. Furthermore, psychiatric patients who have suffered childhood traumatic experiences are far more likely to try to kill themselves than psychiatric patients who have not experienced such abuse. The high rates of childhood traumatic events in our present samples of both schizophrenia-spectrum patients and nonpsychotic patients confirm the need for clinicans to take trauma histories routinely.

Psychotic symptoms, functioning and coping in adolescents with mental illness.

BackgroundPsychotic symptoms in the context of psychiatric disorders are associated with poor functional outcomes. Environmental stressors are important in the development of psychosis; however, distress may only be pathogenic when it exceeds an individual’s ability to cope with it. Therefore, one interesting factor regarding poor functional outcomes in patients with psychotic symptoms may be poor coping. This paper aimed to address the question whether 1) psychotic symptoms are associated with poorer functioning and 2) whether poor coping moderated the association.MethodsIn a clinical case-clinical control study of 106 newly-referred adolescent patients with non-psychotic psychiatric disorders, coping was investigated using the Adolescents Coping Scale. Severity of impairment in socio-occupational functioning was assessed with the Children’s Global Assessment Scale.ResultsPatients with non-psychotic psychiatric disorders and additional psychotic symptoms (N = 50) had poorer functioning and were more likely to use avoidance-oriented coping compared to patients with non-psychotic psychiatric disorders without psychotic symptoms (N = 56). No differences were found with respect to approach-oriented coping. When stratifying for poor/good coping, only those adolescent patients with psychotic symptoms who applied poor coping (i.e. less use of approach-oriented coping styles [OR 0.24, p < 0.015] and more use of avoidance-oriented coping [OR 0.23, p < 0.034]) had poorer functioning. However, these interactions were not significant.ConclusionsNon-adaptive coping and poorer functioning were more often present in adolescents with non-psychotic psychiatric disorders and additional psychotic symptoms. Due to small subgroups, our analyses could not give definitive conclusions about the question whether coping moderated the association between psychotic symptoms and functioning. Improvement of coping skills may form an important target for intervention that may contribute to better clinical and functional outcomes in patients with psychotic symptoms.

Facial self-mutilation: an analysis of published cases

ObjectivesFacial self-mutilation is rare. It is usually discussed from the psychiatric or psychoanalytic perspectives but has little prominence in general medical literature. Our objective was to describe facial self-mutilation in...

Psychiatric morbidity, functioning and quality of life in young people at clinical high risk for psychosis

ObjectiveRecent studies suggest that psychotic-like experiences may also act as markers for non-psychotic psychiatric disorders, which may indicate that the focus of research in individuals at high risk (HR) for psychosis needs updating. In this study we thoroughly examined the clinical and functional characteristics of a consecutive cohort of young people at HR for psychosis and compared them to a matched sample of healthy volunteers. MethodBetween February 2010 and September 2012 60 help-seeking HR individuals, aged 16–35, were recruited from CAMEO Early Intervention in Psychosis Service, Cambridgeshire, UK. Forty-five age- and gender-matched healthy volunteers were randomly recruited from the same geographical area. Sociodemographic, psychiatric morbidity, functioning and quality of life measures were compared between both groups. ResultsHR individuals suffered a wide range of DSM-IV psychiatric disorders, mainly within the affective and anxiety diagnostic spectra. In comparison to healthy volunteers, young people at HR reported more suicidal ideation/intention, depressive and anxiety symptoms and presented with remarkably poor functioning and quality of life. ConclusionThe presence of co-morbid moderate or severe depressive and anxiety symptoms was common in our sample of young people at enhanced risk for psychosis. A HR mental state may be associated not only with an increased risk for psychosis, but also other psychiatric disorders. Our findings may have implications for the future implementation of therapeutic interventions that this population could benefit from.

Pragmatic use of language by children who develop schizophrenia in adult life

At eleven years of age all children in a UK national birth cohort wrote short stories about the life they expected to be leading at age 25.Using a data linkage exercise, we identified those who later developed schizophrenia, affective psychosis, or other non-psychotic psychiatric disorders in later life based on the PSE CATEGO diagnostic system. The majority of these had completed the written essays. Controls from the reference population were selected, matched for gender, IQ and social and economic status.The essays were scored using well established methods for assessing pragmatic use of language, namely narrative coherence and linguistic cohesion.We hypothesised that children pre-morbid for schizophrenia (Pre-Scz) would obtain low scores on all these measures. However this general hypothesis was largely disproved by the data, although some unpredicted gender effects were found.It is concluded that thought is organised in an unexceptional way in adolescents before they develop schizophrenia, once the data are corrected for any lowering of general cognitive ability in the Pre-Scz cases.

Base rates, blindness, and schizophrenia

GENERAL COMMENTARY article Front. Psychol., 03 April 2013Sec. Psychopathology Volume 4 - 2013 | https://doi.org/10.3389/fpsyg.2013.00157

Psychotic Symptoms in Adolescence Index Risk for Suicidal Behavior

CONTEXT Recent evidence from both clinical and population research has pointed to psychotic symptoms as potentially important markers of risk for suicidal behavior. However, to our knowledge, there have been no epidemiological studies to date that have reported data on psychotic symptoms and suicidality in individuals who have been clinically assessed for suicidal behavior. OBJECTIVES To explore associations between psychotic symptoms in nonpsychotic adolescents and risk for suicidal behavior in (1) the general population, (2) adolescents with psychiatric disorder, and (3) adolescents with suicidal ideation. DESIGN Two independently conducted case-control clinical interview studies. SETTING Population-based studies in Ireland. PARTICIPANTS Study 1 included 212 adolescents aged 11 to 13 years. Study 2 included 211 adolescents aged 13 to 15 years. Participants were recruited from schools. MAIN OUTCOME MEASURES Suicidal behavior and psychotic symptoms, assessed by semi-structured diagnostic clinical interview. RESULTS Psychotic symptoms were associated with a 10-fold increased odds of any suicidal behavior (ideation, plans, or acts) in both the early and middle adolescence studies (odds ratio [OR], 10.23; 95% CI, 3.25-32.26; P&lt;.001 and OR, 10.5; 95% CI, 3.14-35.17; P&lt;.001, respectively). Adolescents with depressive disorders who also experienced psychotic symptoms were at a nearly 14-fold increased odds of more severe suicidal behavior (suicide plans and suicide acts) compared with adolescents with depressive disorders who did not experience psychotic symptoms (OR, 13.7; 95% CI, 2.1-89.6). Among all adolescents with suicidal ideation, those who also reported psychotic symptoms had a nearly 20-fold increased odds of suicide plans and suicide acts compared with adolescents with suicidal ideation who did not report psychotic symptoms (OR, 19.6; 95% CI, 1.8-216.1). CONCLUSIONS Psychotic symptoms are strongly associated with increased risk for suicidal behavior in the general adolescent population and in adolescents with (nonpsychotic) psychiatric disorder. In both studies, an absolute majority of adolescents with more severe suicidal behavior (suicidal plans and acts) reported psychotic symptoms when directly questioned about this as part of a psychiatric interview. Assessment of psychotic symptoms should form a key part of suicide risk assessment.

Clinicopathological significance of psychotic experiences in non-psychotic young people: evidence from four population-based studies

Epidemiological research has shown that hallucinations and delusions, the classic symptoms of psychosis, are far more prevalent in the population than actual psychotic disorder. These symptoms are especially prevalent in childhood and adolescence. Longitudinal research has demonstrated that psychotic symptoms in adolescence increase the risk of psychotic disorder in adulthood. There has been a lack of research, however, on the immediate clinicopathological significance of psychotic symptoms in adolescence. To investigate the relationship between psychotic symptoms and non-psychotic psychopathology in community samples of adolescents in terms of prevalence, co-occurring disorders, comorbid (multiple) psychopathology and variation across early v. middle adolescence. Data from four population studies were used: two early adolescence studies (ages 11-13 years) and two mid-adolescence studies (ages 13-16 years). Studies 1 and 2 involved school-based surveys of 2243 children aged 11-16 years for psychotic symptoms and for emotional and behavioural symptoms of psychopathology. Studies 3 and 4 involved in-depth diagnostic interview assessments of psychotic symptoms and lifetime psychiatric disorders in community samples of 423 children aged 11-15 years. Younger adolescents had a higher prevalence (21-23%) of psychotic symptoms than older adolescents (7%). In both age groups the majority of adolescents who reported psychotic symptoms had at least one diagnosable non-psychotic psychiatric disorder, although associations with psychopathology increased with age: nearly 80% of the mid-adolescence sample who reported psychotic symptoms had at least one diagnosis, compared with 57% of the early adolescence sample. Adolescents who reported psychotic symptoms were at particularly high risk of having multiple co-occurring diagnoses. Psychotic symptoms are important risk markers for a wide range of non-psychotic psychopathological disorders, in particular for severe psychopathology characterised by multiple co-occurring diagnoses. These symptoms should be carefully assessed in all patients.

P-235 - Evaluation of psychiatric illness in iranian stoma patients

The objective of this study was to assess the nonpsychotic psychiatric disorders of stoma patients in Iran. In this cross-sectional study, patients referred to the Iranian Ostomy Association from 2005 to 2006 filled the 28-item General Health Questionnaire (GHQ) in Farsi as a screening instrument to identify cases of nonpsychotic psychiatric morbidity. A total of 155 patients participated in the study, of whom 79 (51%) were female and 76 (49%) were male. Fifty-five percent of the patients (n = 86) had psychiatric problems. The females' mean GHQ score was significantly higher than that of males (P = .001). Psychiatric disorder was significantly more frequent among patients with the following specifications: educational level of high school or lower (P = .001), mucosal hemorrhage of the ostomy (P = .03), stomal stenosis (P = .012), and history of psychiatric drug consumption (P = .000). GHQ score decreased as stoma age increased (P = .032; r = -.177). Similar to other complications, psychiatric problems are prevalent in Iranian stoma patients. Our findings highlight the need for special support.

Identification and Characterization of Prodromal Risk Syndromes in Young Adolescents in the Community: A Population-Based Clinical Interview Study

While a great deal of research has been conducted on prodromal risk syndromes in relation to help-seeking individuals who present to the clinic, there is a lack of research on prodromal risk syndromes in the general population. The current study aimed first to establish whether prodromal risk syndromes could be detected in non-help-seeking community-based adolescents and secondly to characterize this group in terms of Axis-1 psychopathology and general functioning. We conducted in-depth clinical interviews with a population sample of 212 school-going adolescents in order to assess for prodromal risk syndromes, Axis-1 psychopathology, and global (social/occupational) functioning. Between 0.9% and 8% of the community sample met criteria for a risk syndrome, depending on varying disability criteria. The risk syndrome group had a higher prevalence of co-occurring nonpsychotic Axis-1 psychiatric disorders (OR = 4.77, 95% CI = 1.81-12.52; P < .01) and poorer global functioning (F = 24.5, df = 1, P < .0001) compared with controls. Individuals in the community who fulfill criteria for prodromal risk syndromes demonstrate strong similarities with clinically presenting risk syndrome patients not just in terms of psychotic symptom criteria but also in terms of co-occurring psychopathology and global functioning.