Organic Psychosis Research Articles

S242. BEFORE AND AFTER: PATHWAYS TO CARE AND AFTER DISCHARGE AT A NEWLY ESTABLISHED EARLY PSYCHOSIS INPATIENT UNIT

BackgroundThe duration from onset of psychotic symptoms to appropriate treatment also includes pathways to adequate care centers. Treatment delays within health care services might influence overall outcome of patients experiencing a first episode psychosis (FEP) negatively. In addition, subsequent postdischarge care is an essential part of maintaining treatment and therefore crucial for relapse prevention. This study aimed to examine pathways to specialized early intervention inpatient care and recommendations relating postdischarge care among patients with FEP at a newly established early psychosis inpatient unit within a general psychiatric service in a general hospital.MethodsData of all patients admitted to the early psychosis inpatient unit of the Clinical Division of Social Psychiatry of the Medical University of Vienna from 01.01.2016 to 31.03. 2017 were analysed. The unit was established in 2014. Diagnoses of FEP include first episode of schizophreniform, acute polymorphic, affective, organic or substance-related psychosis according to ICD-10.ResultsIn the given period a total of 127 patients were admitted, whereof 91 (= 71,7%) were diagnosed with a psychotic disorder at time of discharge. Among them 36 (= 39,6%) patients had a first episode psychosis, including 21 (58,3%) with schizophrenia spectrum psychosis, 10 (27,8%) with affective psychosis, 4 (11,1%) with substance-related psychosis and 1 (2,8%) with organic psychosis as main diagnosis at time of discharge. The mean age of FEP patients was 26.7 years (SD 10,4), with no significant differences concerning sex distribution (52,8% male, 47,2% female). For the majority of FEP patients, namely 23 (63,9%) referral was done through the acute psychiatric outpatient clinic. 4 (11,1%) patients were assigned by the specialized early psychosis outpatient clinic of the same department and 3 (8,3%) by mental health professionals in private practice. The other 5 (13,9%) FEP patients were transferred from either non-psychiatric or psychiatric inpatient units. The largest proportion of FEP patients (91,7%, n = 36) were discharged to secondary care, of those 16 (44,4%) to psychosocial outpatient services. 3 (8,3%) patients were assigned to day-care hospital.DiscussionOur results show that shortly after the establishment of an early psychosis inpatient unit within a general psychiatric service most referrals involved the acute psychiatric outpatient clinic. Hence, information on the availability and specialization was communicated adequately within the rest of the psychiatric staff. The comparatively low proportion of referrals from the early psychosis outpatient clinic might be related to the fact that it focusses on clinical high risk states, who might not be in need of inpatient treatment as much as FEP patients. To ensure pathways to specialized early psychosis care without delay raising awareness of early recognition within the psychiatric staff is required. Reported results concerning discharge recommendations imply that in most cases sufficient psychopathological stability for subsequent outpatient care was achieved. Furthermore, the high rate of referrals to secondary care might reflect the mental health service structure with specialized low threshold services in Vienna, Austria.

S41. RANDOMISED CONTROLLED TRIAL OF METACOGNITIVE TRAINING COMPARED WITH PSYCHOEDUCATION IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS: EFFECTS ON INSIGHT

BackgroundInsight in schizophrenia spectrum disorders (SSD) has been linked with positive outcomes. However, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight in SSD has led to speculation that metacognitive training (MCT) may improve insight and clinical outcomes in SSD.MethodsDesign: Single-center, assessor-blind, parallel-group, randomised controlled trial (RCT).Sample: Participants are recruited from the outpatient clinic of Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain) over June-December 2019. Inclusion criteria: i) age: 18–64 years, both inclusive, at the study inception; ii) diagnosis: SSD based on the Mini International Neuropsychiatric Interview (Sheehan et al., 1998) and iii) IQ>70 according to the Wechsler Adults Intelligence Scale-IV (Wechsler, 1981). Those with organic and drugs-induced psychosis, poor level of Spanish and/or lack of cooperativeness are excluded.Intervention: Participants are randomised to receive eight weekly group sessions of MCT or group psychoeducation (PSE) and they will be assessed at: T0) at baseline; T1) after treatment and T2) at 1-year follow-up, although follow-up data are not available yet.Co-primary outcome measures: clinical and cognitive insight dimensions, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) (Kemp & David, 1997), and the Beck Cognitive Insight Scale (BCIS) (Beck et al., 2004), respectively.Secondary outcome measures: i)Symptom severity-Positive and Negative Syndrome Scale (Kay et al., 1987); ii)Functioning-General Assessment of Functioning (Endicott et al., 1976), World Health Organization Disability Scale (WHO, 2012) and Satisfaction Life Domains Scale (Carlson et al., 2009), and only at follow-up (T2) iii)Suicidal Behaviour and iv) Hospitalizations.Power calculations: To reach a power of β=80% and detect a between-group difference of two points on the SAI-E total scores, which is considered to be clinically meaningful -effect size of 0.33-, the estimated sample size at the end of the study is n=126.Statistics: Student’s T-test and Mann-Whitney U tests were used as appropriate to compare between-group differences before- and after-treatment, i.e., the changes from baseline to post-treatment scores.The protocol of the study is registered at ClinicalTrials.gov (NCT04104347).Resultsn=49 subjects have been assessed at baseline so far (26 males, age: 47.0±10.2 years, diagnosis of schizophrenia -F20-ICD10-, n=36, 73.5%).Fifteen individuals (MCT: n=8; controls: n=7) have completed the treatment and the post-treatment assessment (T1).‘After-treatment-T1 - baseline-T0’ scores difference means/medians between-group differences (MCT vs. PSE) were: SAI-E total insight 1.00 vs. -2.00, p=0.050; SAI-E illness awareness 0.62±2.20 vs. -0.43±1.62, p=0.316; SAI-E symptom relabelling 0.37±3.38 vs. -1.86±2.34, p=0.167; SAI-E treatment compliance 0.00 vs. 0.00, p>0.05,ns; BCIS self-reflectiveness 0.50±3.78 vs. -1.43±2.22, p=0.259, BCIS self-certainty 1.62±2.97 vs. 0.00±2.44, p=0.298 and BCIS Composite Index -1.13±5.62 vs. -2.17±3.49, p=0.698.DiscussionThis is the first RCT testing the effect of group MCT on insight (as primary outcome) in a sample of unselected patients with SSD in comparison with psychoeducation. Two main findings emerged from the results. First, MCT appears to improve clinical and cognitive insight in SSD. Second, MCT was shown to be superior to PSE in changing insight.Whether the above MCT-related insight improvement is maintained at longer-term and whether this has an impact on clinical and social outcomes are yet to be established, which will be properly looked at in this trial.

Organic Psychosis Causing Secondary Schizophrenia in One-Fourth of a Cohort of 200 Patients Previously Diagnosed With Primary Schizophrenia.

To identify the prevalence of secondary schizophrenia (organic psychosis causing a schizophrenia-like syndrome) in patients with a prior diagnosis of schizophrenia presenting to Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal. Two hundred files were retrospectively assessed through paper and electronic records of patients admitted to the hospital with an International Classification of Diseases, Ninth Edition diagnosis of schizophrenia (eg, code 295.x) in a 1-year time span (September 1, 2015-September 1, 2016). One-fourth of patients (n = 50, 25%) received a new organic psychosis (secondary schizophrenia) diagnosis: epilepsy-related schizophrenia-like psychosis (9.5%), dementia-related schizophrenia-like psychosis (9.5%), brain mass (3.5%), stroke-related schizophrenia-like psychosis (2.0%), and encephalitis-related schizophrenia-like psychosis (0.5%). Among patients with organic psychosis (secondary schizophrenia), the mean delay until correct diagnosis was 12 years. The most striking feature of this study was the high prevalence of incorrect diagnosis of schizophrenia, with patients not receiving the minimum correct assessment before that diagnosis, resulting in negative consequences. Caution is recommended when diagnosing severely psychotic patients independent of their acute or chronic condition.

Mumurshiyam of Bhela Indriya Sthana: An Explorative Study

Similar to “Agnivesha tantra” (popularly known as “Charaka samhita”), “Maharshi Bhela” has composed an Ayurvedic treatise known as “Bhela samhita.” Bhela samhita consists of 8 sections (sthana) and 120 chapters (adhyaya). “Indriya sthana” is one of the eight sections of “Bhela samhita” and it comprises 12 chapters. “Bhela Indriya sthana” deals with estimating life span and various prognostic aspects. “Mumurshurindriyam” is the third chapter of “Bhela indriya sthana.” The word “mumurshu” denotes a dying person and the chapter “mumurshurindriyam” contains the description of various signs and symptoms seen in the patients with terminal illness or end-of-life stages. Although previous works have explored “Charaka indriya sthana,” studies on “Bhela indriya sthana” are lacking. The present work is aimed to explore the contents of “Mumurshurindriyam” (third chapter) of “Bhela indriya sthana.” “Murmushurindriyam” chapter contains the description of conditions which are commonly seen during end-of-life stages. Various concepts/conditions such as end-of-life dreams and visions, deathbed communications, near death experiences, out-of-body experiences, visual hallucinations, delusions, dementia, delirium, organic psychosis, central auditory perception disorder, age-related hearing loss, late life psychosis, lower gastrointestinal bleeding, colon cancer, inflammatory bowel disease, end-stage renal disease, chronic kidney disease, diabetic ketoacidosis, central diabetes insipidus, spontaneous rupture of urinary bladder, myiasis, and medical etiquette are documented in this chapter by “Maharshi Bhela.” “Maharshi Bhela” has provided a list of signs and symptoms or clinical features in this chapter based on which questionnaire or screening methods can be developed, which can be used in prognostic research. Further research is required to substantiate the claims made in this chapter. The present study paves the path for future research directions.

Vataja Unmada: Schizophrenia or Dementia or Mood Disorder with Psychosis?

Unmada (a broad term which includes different psychiatric conditions under one umbrella) is characterized by the derangement of manas (mind), buddhi (cognitive functions), samgna gnana (orientation), smriti (memory), bhakti (interests), sheela (character/personality), cheshtha (psychomotor activity/behavior), and achara (conduct). Unmada is classified into five (vataja, pittaja, kaphaja, sannipataja and agantuja) types, and “Vataja Unmada” (VU) is one among them. The description of VU is available in all major Ayurvedic classical texts, and it comes under “Doshaja” (psychiatric disorder which occurs due to the aggravation of doshas) category. Studies or scientific literature on VU has been lacking, and the present work is focused on to explore this condition. The etiopathology of VU denotes deficiency of various nutritional factors such as vitamins, minerals, omega-3-fatty acids, amino acids, and antioxidants. Lacking or deficiency of these nutritional factors leads to structural and/or functional damage and degeneration of the brain (neurodegenerative or demyelinating pathology) which ultimately leads to the manifestation of different degenerative psychiatric disorders. The clinical picture of VU resembles various psychiatric or neuropsychiatric conditions such as “disorganized schizophrenia” or “hebephrenia” or “catatonia” or “dementia” or “bipolar disorder with psychotic features” or “mania with psychotic features,” or “organic or secondary psychoses.” VU is a treatable condition, and it can be managed successfully by “Panchakarma” procedures along with internal medicines.

Trials and Tribulations of Diagnosing and Managing Psychosis Secondary to Non-Convulsive Epilepsy

Background: It is well known that psychotic symptoms can occur as a result of seizure activity in the brain. This can easily be diagnosed in those with recognizable seizures by taking a careful history. However, in the absence of a typical seizure presentation, it is far more challenging to differentiate between an organic and primary psychosis. Case Presentation: We present the case of a 51-year-old female who had a 28-year history of treatment-resistant schizophrenia. She did not report or display any seizure activity, and an extensive investigation was unremarkable. The unusual nature of her psychopathology, which was predominantly visual hallucinations and somatic delusions, and the difficult to treat nature of her symptoms, prompted investigation with Electroencephalograph which demonstrated bilateral temporal lobe epileptic activity. Conclusion: Treatment with divalproex sodium and discontinuation of antipsychotic medication achieved an excellent response, where her visual hallucinations and somatic delusions were both remarkably ameliorated.

From organic psychosis to mixed dementia

From organic psychosis to mixed dementia

Autoantibody-associated schizophreniform psychoses: pathophysiology, diagnostics, and treatment

In the context of secondary, possibly organic schizophreniform psychoses, autoantibody(AB)-associated autoimmune encephalitis (AE) plays an increasingly important role. If this is suspected, clinical investigations, including laboratory, magnetic resonance imaging, electroencephalography and cerebrospinal fluid (CSF) analyses are recommended. The AB screening should include the most frequent ABs against neuronal cell surface antigens (NMDA receptor [R], CASPR2, LGI1, AMPA-R, GABAB-R), intracellular antigens (Hu, Ri, Yo, CV2/CRMP5, Ma2[Ta], amphiphysin, GAD65), thyroid tissue (TG, TPO, TRAK), and antinuclear antigens (ANAs). The ABs against cell surface antigens and GAD65 should be examined directly in serum and CSF. Less frequent ABs can be looked for in a second step. Furthermore, immunofluorescence tests on brain slices of rodents may identify previously unknown ABs. The detection of ABs in combination with further findings can lead to the diagnosis of AE which implies new therapeutic opportunities with immunomodulators.

Discrepancies between clinical and autopsy diagnosis of cause of death among psychiatric patients who died due to natural causes. A retrospective autopsy study

Background/Aim. Autopsy studies rarely investigate the causes of natural death in psychiatric population. The aim of this study was to examine the causes of death among the subjects with various psychiatric disorders in whom a clinical (pathoanatomical) autopsy was requested. Methods. The study group included 118 patients (65% men, 35% women, mean age 58.2 ? 13.6 years) with a psychiatric diagnosis, in whom a clinical autopsy was performed. We compared the distribution of causes of natural death among psychiatric patients and other patients, representatives of the general population who died of natural causes. We also analyzed the difference between clinical diagnoses of cause of death and the autopsy findings in psychiatric patients. Results. Psychiatric patients died earlier than the control group (58 vs. 69 years), usually due to the respiratory (46%) and cardiovascular diseases (37%). The most common diagnoses in psychiatric patients were organic psychoses and dementias (F00-F09) and schizophrenia and schizoaffective disorders (F20-F29). Majority of the patients (55%) died in general hospitals vs. specialized psychiatric hospitals (45%) due to somatic diseases. There was a significant difference in the distribution of causes of death compared to the control group in which the cardiovascular diseases dominated. Even in 64% of psychiatric patients there was a discrepancy between the clinical diagnosis of the cause of death and definite autopsy findings. Conclusion. The assessment of somatic diseases in psychiatric patients is insufficient, especially in specialized psychiatric hospitals. That leads to a significant discrepancy between clinical diagnosis of the cause of death and autopsy findings. Therefore, it is necessary to pay additional attention in diagnostics and treatment of somatic diseases in these patients to improve their health care.

Self-harm as a rare sequelae in a case of post dengue encephalitis: A rare case report

Dengue is the most common human arbovirus infection. The psychiatric symptoms may accompany the acute phase of dengue or can be a late manifestation. Encephalopathy is an atypical manifestation of dengue disease and may present with depressed sensitivity, seizures, nuchal rigidity, pyramidal signs, headache, papilledema, myoclonus, and behavioral disorders. Post - infectious sequelae are mainly memory disturbance, dementia, mania, Reye’s syndrome, and meningo‑encephalitis. In this report we present a case where self-harm is reported as a rare sequelae in Post dengue encephalitis but not part of organic psychosis.

The impact of the 2008 economic crisis on the increasing number of young psychiatric inpatients

BackgroundLittle is published about the impact of the 2008 economic crisis on mental health services in Spain. MethodAn interrupted time series analysis was conducted to investigate a potential short-term association between the 2008 economic crisis and the number of psychiatric hospital admissions. The timing of the intervention (April 2008) was based on observed changes in Gross Domestic Product (GDP). Data on 1,152,880 psychiatric inpatients from the national Hospital Morbidity Survey, 69 months before and after the onset of the economic crisis (April 2008), were analyzed. ResultsAge-adjusted psychiatric (ICD9 290–319) hospital discharge rates significantly increased from April 2008, matching the onset of the crisis, especially for inpatients aged 15–24 years old and to a less extend for inpatients aged 25–34 years old. Other age groups were not affected. There was a significant increase in diagnoses for disturbance of conduct and emotions, depression, neurotic and personality disorders and alcohol and drug disorders; however, diagnoses for mental retardation and organic psychosis for 15–34 years old inpatients were unaffected. ConclusionsPsychiatric hospital admissions abruptly increased in April 2008, coinciding with the onset of the economic crisis. We identified age groups and diagnoses affected. Increased hospitalizations were found only at the age-ranges most affected by the rise in unemployment. The diagnoses affected were those most sensitive to environmental changes.

Ernst Trömner: beyond the reflex hammer

Ernst Trömner (1868-1930) was a German neurologist and psychiatrist at the St. Georg Hospital in Hamburg. As clinician and researcher, he contributed to our understanding of various fields within neurology including language and speech disorders, hypnosis and suggestion, sleep physiology and diseases, leukemia with nervous system involvement, gait disorders, metabolic myelopathy, Parkinson's disease, organic psychosis, and schizophrenia. However, his main interest was muscle reflexes. De facto, Trömner described a variant of the Achilles tendon reflex, a modification of the Oppenheim's and Babinski's reflexes, "rediscovered" the corneomandibular reflex and describedthe joint reflexes of the lower extremities as well asa muscle stretch reflex of the diaphragm. Moreover, Trömner has developed the first sedimentation chamber to assess the cerebrospinal fluid as well as the muscle plessimeter and, probably most considerable, the reflex hammer which is widely used by neurologists around the globe todate and is commonly referred to as the "Trömner hammer." His name has also become inextricably linked with the finger flexor reflex, which is commonly known as the "Trömner reflex." This article briefly summarizes Professor Ernst Trömner's life and his contributions to clinical neurology and psychiatry beyond his most famous eponyms, the hammer and the finger flexor reflex.

Severe hair loss associated with psychotropic drugs in psychiatric inpatients—Data from an observational pharmacovigilance program in German-speaking countries

BackgroundThe study aimed to investigate severe hair loss related to psychotropic drugs (PDs) by using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie (AMSP). MethodsData on PD utilization and reports of severe PD-related hair loss were collected in 83 psychiatric hospitals in Austria, Germany and Switzerland during the period 1993–2013. ResultsOut of 432,215 patients under surveillance, 404,009 patients were treated with PDs for the main indications of depression, schizophrenic disorder, neurosis, mania, and organic psychosis. Severe hair loss related to PD treatment was reported in 43 cases (0.01%). The rates of hair loss under antipsychotic drugs were slightly lower than the mean rates of all PDs and antidepressant drugs. Valproic acid was related to the highest risk. In 6 of the 43 cases, hair loss was imputed to multiple drugs, with 4 cases imputed to double drug combinations and 2 cases to triple combinations. Rates of severe hair loss under valproic acid (VPA) and lithium salts were distinctly lower as compared with the overall rates reported in literature. Severe hair loss under PD treatment was reported significantly more often in female patients than in male patients (p < 0.01). ConclusionThe rate of severe PD-related hair loss was very low in the present survey. The large number of patients included in this multicentre study allows for assessment and comparison of hair loss rates related to different PDs and groups of PDs and provides new and supplementary information on PD-related hair loss.

Is Schizophrenia Disappearing? The Rise and Fall of the Diagnosis of Functional Psychoses: an Essay

The categories of functional psychoses build on views of influential professionals. There have long been four main categories – affective, schizophrenic, schizoaffective/cycloid/reactive/polymorphic, and delusional/paranoid psychoses. The last three are included in “psychotic disorders”. However, this dichotomy and the distinctions between categories may have been over-estimated and contributed to lack of progress. 1. The categories of functional psychoses have varied with time, place and professionals’ views, with moving boundaries, especially between schizophrenia and affective psychoses. 2. Catatonia is most often related to affective and organic psychoses, and paranoia is related to grandiosity and guilt, calling in question catatonic and paranoid schizophrenia. Arguments exist for schizophrenia being a “misdiagnosis”. 3. In some countries schizophrenia has been renamed, with positive consequences. 4. The doctrine of “unitary psychosis”, which included abnormal affect, was left in the second half of the 1800s. 5. This was followed by a dichotomy between schizophrenia and affective psychoses and broadening of the schizophrenia concept, whereas affective symptoms were strongly downgraded. 6. Many homogeneous psychoses with mixtures of schizophrenic and affective symptoms were described and related to “psychotic disorders”, although they might as well be affective disorders. 7. Critique of the extensive schizophrenia concept led to, in DSM-III and ICD-10, affective symptoms being exclusion criteria for schizophrenia and acceptance of mood-incongruent psychotic symptoms in affective psychoses. 8. However, affective symptoms are often difficult to acknowledge, diagnosis is often done on the basis of tradition and previous education, and patients’ affect characterized accordingly. 9. DSM-5 is up-dated with separate chapters for catatonia and psychotic symptoms, and removal of the subtypes of schizophrenia. However, time may be running out for categorical psychosis diagnoses, which may be replaced by continuum, spectrum, dimensional and research domain criteria, in line with new biological data 10. This is supported by treatment responses across categories. The time-consuming works on diagnosis of psychoses may have hampered progress. Chronic mood disorders may appear as schizophrenic or paranoid psychosis, end-stages like heart failure in heart diseases. This underscores the importance of early and optimal treatment of mood disorders.

Organic psychosis: The pathobiology and treatment of delusions.

Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare phenomenon, but its study has significantly contributed to the understanding of delusion formation. The evidence from case studies of patients with focal strokes shows that delusions develop following unilateral damage of the right hemisphere. The majority of patients with right hemisphere stroke do not develop delusions however, and advanced neuroimaging analysis has elucidated why this symptom develops in only a small proportion. Lesions of the right lateral prefrontal cortex or lesions with connectivity to this area correlate with delusional beliefs in this subgroup. Studies of patients with primary psychosis, for example schizophrenia, or under the influence of the psychotogenic drug ketamine, also show abnormal function of this area in relation to the severity of their abnormal beliefs. The conclusion of these studies is that the right lateral prefrontal cortex is 1 hub in a neural network which includes the basal ganglia and limbic system and receives inputs from midbrain dopamine neurones. In patients with schizophrenia, or at risk of psychosis, dopamine is dysregulated and evidence suggests that faulty dopamine signaling is the precursor of delusion formation. It is therefore likely that the mechanism of delusion formation is the same in both primary and secondary psychosis. This is consistent with the mainstay of treatment of both conditions being antipsychotic medication. However, antipsychotic medication in people with cerebrovascular disease should be avoided if at all possible. This is because epidemiological studies have found that antipsychotic use is associated with an increased risk of stroke and will thus compound the possibility of a further cerebrovascular accident.

Antibodies in the Diagnosis, Prognosis, and Prediction of Psychotic Disorders.

Blood-based biomarker discovery for psychotic disorders has yet to impact upon routine clinical practice. In physical disorders antibodies have established roles as diagnostic, prognostic and predictive (theranostic) biomarkers, particularly in disorders thought to have a substantial autoimmune or infective aetiology. Two approaches to antibody biomarker identification are distinguished: a “top-down” approach, in which antibodies to specific antigens are sought based on the known function of the antigen and its putative role in the disorder, and emerging “bottom-up” or “omics” approaches that are agnostic as to the significance of any one antigen, using high-throughput arrays to identify distinctive components of the antibody repertoire. Here we review the evidence for antibodies (to self-antigens as well as infectious organism and dietary antigens) as biomarkers of diagnosis, prognosis, and treatment response in psychotic disorders. Neuronal autoantibodies have current, and increasing, clinical utility in the diagnosis of organic or atypical psychosis syndromes. Antibodies to selected infectious agents show some promise in predicting cognitive impairment and possibly other symptom domains (eg, suicidality) within psychotic disorders. Finally, infectious antibodies and neuronal and other autoantibodies have recently emerged as potential biomarkers of response to anti-infective therapies, immunotherapies, or other novel therapeutic strategies in psychotic disorders, and have a clear role in stratifying patients for future clinical trials. As in nonpsychiatric disorders, combining biomarkers and large-scale use of “bottom-up” approaches to biomarker identification are likely to maximize the eventual clinical utility of antibody biomarkers in psychotic disorders.

The Psychoses of Menstruation and Childbearingby Ian Brockington, M.D., F.R.C.P. Cambridge, England, Cambridge University Press, 2017, 391 pp., $140.00 (hardcover).

The Psychoses of Menstruation and Childbearingby Ian Brockington, M.D., F.R.C.P. Cambridge, England, Cambridge University Press, 2017, 391 pp., $140.00 (hardcover).

TRATAMENTO MEDICAMENTOSO DOS TRANSTORNOS PARAFÍLICOS

O objetivo deste artigo foi apresentar as medicações utilizadas para o tratamento de Transtornos Parafílicos (TP), seus mecanismos de ação, efeitos colaterais e a importância das comorbidades presentes para a escolha da melhor droga para cada caso. Foi realizada revisão de literatura no Pubmed e Medline. Muitas medicações podem ser úteis: antidepressivos que agem no receptor serotoninérgico5HT2a, especialmente em casos de depressão e doenças ansiosas;antipsicóticos, que são antidopaminérgicos, em psicoses; estabilizadores de humor em transtorno bipolar e impulsividade; naltrexona no alcoolismo; antiandrógenos de ação periférica ou central como os agonistas parciais do hormônio liberador de gonadotrofina hipotalâmico (agonistasLHRH), em casos mais severos. O melhor tratamento para cada indivíduo depende dos diagnósticos (sexual, psiquiátrico e médico geral). Tratar um indivíduo com doença de Wilson, psicose orgânica e transtorno exibicionista é diferente de trat ar um indivíduo com o mesmo TP, hipotireoidismo e depressão. É também importante tentar preservar a função sexual da maneira mais saudável possível. Por outro lado, é fundamental proteger a sociedade dos agressores sexuais. Questões éticas como a possibilidade de toxicidade das medicações devem ser amplamente discutidas e documentadas. Destaca-se o fato de que o uso de antiandrógenos para castração química não é liberado no Brasil.

Cannabis induced psychosis - an overview

Psychosis is a condition where there is a loss of contact with reality with symptoms like delusions, hallucinations, paranoia, disorganized thinking & speech, loss of motivation, depression, anxiety & poor sleep. It can be associated with Schizophreniform disorder, Bipolar disorder, Schizoaffective disorder, Depression with psychotic features, Drug-induced psychosis, Organic psychosis or Post-traumatic stress disorder. Psychosis is so common that about 3 out of every 100 people will have a psychotic episode in their lifetime. The phases of psychosis include an initial Prodromal Phase where there is subtle changes in thinking, perception and behavior. During acute Phase full blown symptoms occur which may affect the individual's daily living. Later Recovery Phase starts.

Use and safety of antiepileptic drugs in psychiatric inpatients-data from the AMSP study.

The psychiatric utilization patterns and risks of antiepileptic drugs (AEDs) were assessed by using data from the drug safety programme Arzneimittelsicherheit in der Psychiatrie over the time period 1993-2013. In a total of 432,215 patients, the main indications for AED use were acute mania, schizoaffective disorder, and schizophrenic and organic psychoses. Valproic acid (VPA) was the most common substance across all of those groups, reaching administration rates of up to 50% since 2005, at which time carbamazepine (CBZ) administration consistently dropped below a rate of 10%. Lamotrigine (LTG) and pregabalin (PGB) increased in relevance after 2005 and 2010, respectively (with administration rates of up to 9%), whereas oxcarbazepine (OXC) was least prevalent (<3%). The mean rates of severe adverse drug reactions (ADRs) ranged from 6 cases per 1000 patients treated (VPA) to 19/1000 (OXC) and were significantly lower with treatment with VPA compared to OXC and CBZ. Hyponatremia was the leading ADR during treatment with OXC; severe allergic skin reactions were most often observed during treatment with CBZ and LTG, and severe oedema was most common during treatment with PGB. Severe hyponatremia induced by OXC was observed significantly more often in female patients than in male patients.