Persistent Delusional Disorder Research Articles

Case Report: Experience with Cariprazine in Organic Delusional Disorder in an Elderly with Concomitant Somatic Pathology, Brief Report

Background: Organic disorder remains one of the most pressing issues in practical psychiatry, especially a disorder dominated by persistent or recurrent delusions. The difficulty for practitioners is often due to the older age of patients and the burden of concomitant therapeutic diseases. Modern and potentially promising pharmacological drugs developed in recent years include partial agonists of D2 and D3 receptors. Currently, there are insufficient publications of studies on Cariprazine use in various disorders that are not associated with endogenous pathology. Case Presentation: The author presented the results of the patient’s clinical examination with a complex of psychodiagnostic techniques, instrumental research methods, observation data in the department, and an analysis of the patient’s medical history. The paper describes the experience of treating a patient with the latest generation antipsychotic drug Cariprazine. Results: The author presents a case report on Cariprazine therapy in a 71-year-old female patient with a persistent organic delusional disorder with concomitant severe somatic illness. Conclusion: Cariprazine showed good efficacy in this case. Delusional symptoms were significantly reduced, and the author noted a reduction in negative symptoms. Mild side effects of the drug quickly resolved in the course of treatment. The key point is that the description of this case may be relevant to justify the need for further clinical studies on Cariprazine. Further clinical studies of the drug in the treatment of various mental pathologies may be in demand by specialists around the world.

Application of the MMPI-2 inventory in the differential diagnosis of psychotic disorders – based on profile analysis of a patient diagnosed with persistent delusional disorder and personality disorder

Aim: Paranoid states or traits can be present in various mental disorders; hence, their clarification is valuable for establishing a reliable nosological diagnosis. Clinical practice and literature on the subject highlight a range of defence mechanisms specific to the discussed nosological group. These mechanisms can impede the process of psychiatric and psychotherapeutic diagnosis and treatment. In contemporary evidence-based medical practice, the prevalent clinical approach is based on qualitative methods (e.g. free interviews and observations) complemented by standardised diagnostic tools. This approach assists the clinician in supplementing, organising, and objectifying clinical data related to the patient’s mental state. It is particularly beneficial for handling data that may be uncertain or unavailable in an observational study for various reasons. The article presents insightful and pragmatic theoretical, empirical, and case-related information on the potential application of the Minnesota Multiphasic Personality Inventory (MMPI-2) in the psychological diagnosis of patients with persistent delusional disorders. Methods: The paper explores theoretical issues and analyses a case study involving a female patient with a suspected diagnosis of delusional disorder and co-occurring personality disorder. In the case study, the authors employed qualitative methods, including observation and free psychological interview, and supplemented clinical data with insights gained through the use of a standardised psychometric method: the MMPI-2. Reflections and practical recommendations are divided into two groups. One group comprises the potential applications of the MMPI-2 in clinical psychological diagnosis. The other focuses on the importance of the diagnostic alliance and its roles in the process of planning the psychological diagnosis in patients with delusional disorders.

Gender differences in the young-onset persistent delusional disorder.

We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N=236) with onset of illness before the age of 30 years. Gender differences in marital and employment status were significant (p-0.001). Delusion of infidelity and erotomania were more common in females, while males had more body dysmorphic and persecutory delusions (X2-20.45, p-0.009). Males had more substance dependence (X2-21.31, p<0.001), as well as a family history of substance abuse and PDD (X2-18.5, p<0.01). To conclude, gender differences in PDD comprised some psychopathology, co-morbidity, and family history among those with young onset PDD.

Persistent delusional disorder: psychopathological remission associated with clozapine-induced epileptic seizures

IntroductionPersistent delusional disorder has some features similar to schizophrenia, although the functionality of patients with this diagnosis is usually higher and is diagnosed at an older age. Although the pharmacological treatment of schizophrenia has been studied extensively, there is not much data on the treatment of persistent delusional disorder. Regarding the use of clozapines specifically in persistent delusional disorders, there are some case reports with encouraging results. Electroconvulsive therapy is not generally used as a treatment for persistent delusional disorder.ObjectivesTo reflect on the relevance of using electronvulsive therapy in the treatment of persistent delusional disorder.MethodsThrough the description of a clinical case in which there was evidence of remission of resistant psychotic symptoms after clozapine-induced epileptic seizures, the authors hypothesize the existence of a direct relationship between the crisis and the resolution of a persistent delusional disorder.ResultsA.F., 78 years old, male. No personal history of psychiatric or medical-surgical illness. Admitted for psychotic decompensation framed in persistent delusional disorder. The patient underwent pharmacological treatment with resistance to three lines of antipsychotics. With the introduction of clozapine 100mg/day, the patient had two epileptic seizures, followed by complete remission of psychotic symptoms.ConclusionsThe clinical case described refers to a patient diagnosed with resistant persistent delusional disorder, with almost immediate resolution of the condition after epileptic seizures induced by clozapine. Taking into account the clinical response in our patient to two spontaneous epileptic seizures, we hypothesize that electroconvulsive therapy may be effective in the treatment of persistent delusional disorder.Disclosure of InterestNone Declared

Abnormalities in one-carbon metabolism in young patients with psychosis.

Folates, the main actors in one-carbon (C1) metabolism, are involved in synthesising monoamines and maintaining genomic stability. Previous studies support the association between C1 metabolism and schizophrenia. The main purpose of this study was to assess the prevalence of plasma folate, and/or vitamin B12 deficiencies and hyperhomocysteinemia in young patients with psychotic disorders. We included young inpatients (15-30 years old) with psychosis between 2014 and 2017 from Sainte-Anne Hospital in Paris. Plasma folate, vitamin B12 deficiency and homocysteinemia dosages were done at admission. Clinical data were extracted retrospectively, and patients diagnosed with a first-episode psychosis (FEP), schizophrenia, schizoaffective disorder, or persistent delusional disorder were retained for the analysis. Among the 334 inpatients, 188 (56%) had C1 dosages available (135 males; 53 females). From the 188 patients, 32% had a C1 abnormality. This abnormality reached 38% of FEP patients. The most frequent abnormality was folate deficiency: 21% of all patients and 27% of FEP. Lower levels of folates were found in males compared to females (p = 0.02) and were correlated with more severe disorder, as assessed by Clinical Global Impression - Severity (CGI-S; p = 0.009). Antipsychotic dosage was positively associated with B12 levels (p = 0.013) and negatively with homocysteinemia (p = 0.034). One-carbon metabolism anomalies in young patients with psychotic disorders are highly prevalent, reaching almost half of the patients with FEP. Potential protective effects from females and antipsychotics have emerged. These results spotlight the need for new therapeutic prospects, such as folate supplementation, to achieve personalised medical approaches to the early stages of psychotic disorders.

Mapping diagnostic trajectories from the first hospital diagnosis of a psychiatric disorder: a Danish nationwide cohort study using sequence analysis

A key clinical problem in psychiatry is predicting the diagnostic future of patients presenting with psychopathology for the first time. The objective of this study was to establish a comprehensive map of subsequent diagnoses after a first psychiatric hospital diagnosis. Through the Danish National Patient Registry, we identified patients aged 18 years or older with an inpatient or outpatient psychiatric hospital contact and who had received one of the 20 most common first-time psychiatric diagnoses (defined at the ICD-10 two-cipher level, F00-F99) between Jan 1, 1995, and Dec 31, 2008. For each first-time diagnosis, the 20 most frequent subsequent psychiatric diagnoses (F00-F99), and death, occurring during 10 years of follow-up were identified as outcomes. To assess diagnostic stability, we used social sequence analyses, assigning a subsequent diagnosis to each state with a length of 6 months following each first-time diagnosis. The subsequent diagnosis was defined as the last diagnosis given within each 6-month period. We calculated the normalised entropy of each sequence to show the uncertainty of predicting the states in a given sequence. Cox proportional hazards models were used to assess the risk of receiving a subsequent diagnosis (at the one-cipher level, F0-F9) after each first-time diagnosis. The cohort consisted of 184 949 adult patients (77 129 [41·7%] men and 107 820 [58·3%] women, mean age 42·5 years [SD 18·5; range 18 to >100). Ethnicity data were not recorded. Over 10 years of follow-up, 86 804 (46·9%) patients had at least one subsequent diagnosis that differed from their first-time diagnosis. Measured by mean normalised entropy values, persistent delusional disorders (ICD-10 code F22), mental and behavioural disorders due to multiple drug use and use of other psychoactive substances (F19), and acute and transient psychotic disorders (F23) had the highest diagnostic variability, whereas eating disorders (F50) and non-organic sexual dysfunction (F52) had the lowest. The risk of receiving a subsequent diagnosis with a psychiatric disorder from an ICD-10 group different from that of the first-time diagnosis varied substantially among first-time diagnoses. These data provide detailed information on possible diagnostic outcomes after a first-time presentation in a psychiatric hospital. This information could help clinicians to plan relevant follow-up and inform patients and families on the degree of diagnostic uncertainty associated with receiving a first psychiatric hospital diagnosis, as well as likely and unlikely trajectories of diagnostic progression. Mental Health Services, Capital region of Denmark. For the Danish translation of the abstract see Supplementary Materials section.

Persistent delusional disorder with delusions of poverty - a case study.

We present a case study of a patient who was hospitalized with the initial diagnosis of psychotic depression with predominant delusions of poverty. During his hospital stay despite antidepressant and antipsychotic treatment with 150 mg of sertraline and 20 mg of olanzapine per day, no symptomatic improvement was achieved. Besides, the psychotic features have risen to the fore along with inadequately vaguely expressed affective component. What drew attention was the coherence and permanence of delusional judgements, which, albeit variable in expression, always concerned one theme - the belief of an inevitable bankruptcy. The whole clinical picture, both with the objectifying interview defining the order of emerging symptoms, was suggestive and the verification of diagnosis was made. Persistent delusional disorder with delusions of poverty with subsequent mood disorder was diagnosed. The treatment with 275 mg of clozapine per day was started and we observed a slow gradual withdrawal of psychosis as well as a total normalization of the affective range. The case illustrates the importance of differential diagnosis of mental states in which psychotic features coexist with affective symptoms. It is helpful to determine the sequence of the symptoms development. It should be noted that although the ICD-10 classification distinguishes exclusively 7 subtypes of persistent delusional disorder, in the clinical practice we can encounter other thematic areas of psychosis. It brings substantial therapeutic and prognostic implications.

Self-perceived functional impairment or disability in Delusional Disorder – Case Reports

IntroductionDelusional disorder (DD) is a psychotic disorder with an estimated prevalence of less than one percent,traditionally characterized by systematized delusional ideas with no cognitive deterioration.However, some studies have been reporting impairment of neurocognitive system (social cognition,learning and memory, expressive language,complex attention, executive function) that might have an impact functionality both in social and work domains..ObjectivesThis work aims to review clinical evidence on self-perceived functional impairment or disability in DD and to present two clinical cases evaluated at a psychiatric unit.MethodsWe report two clinical cases based on patients’ history and clinical data, and reviewed clinical records using PubMed® database with search terms of “Delusional Disorder”,“Cognition Impairment in Persistent DD”.ResultsWe present two clinical cases of patients who were admitted to psychiatric unit after developing psychotic symptoms namely persecutory delusions about neighbors.A persistent delusional disorder was established and antipsychotic treatment was initiated.The 74-years-old men presented deficits in executive and memory processes; ended up institutionalized after two months of being discharged.The 47-years-old woman, despite remaining as a lawyer, noticed a decrease in work capacity and so she ended up being responsible for less demanding cases.Cases of delusional disorder showed a poor performance in most cognitive tests and some of the cognitive deficits seem to affect functionality namely memory, expressive language and attention.ConclusionsAlthough classical literature has not systematized an association between DD and personality deterioration,there are some evidences of loss of functionality and cognitive commitment in this disorder.This suggests the importance of cognitive interventions to improve functional prognosis in this clinical population.DisclosureNo significant relationships.

Abstract- Poster

Background:Delusional Infestation is characterized by patients' fixed belief that their skin and body is infested by small,vivid(or less frequently inanimate)pathogens,although there is no medical or microbiological evidence for this. It is a type of Somatic Delusion.Case Report:63year old female,referred by dermatologist with complaints of being infested with both animate and inanimate particles and itching all over the body from 6months. She was preoccupied with multiple somatic sensations all over her body. She reported that these particles were being emitted from her orifices like ears,eyes,nose,and skin pores. These particles penetrated her bones and were crushing them in to powder. The animate ones flowed through her skin and would be found on the place where she sits. These would get collected in clusters under her skin and she could feel them as nodules. Patient also had symptoms of mild depressive disorder secondary to these symptoms. There was a positive Specimen(Match box)sign observed.Results:Diagnosis of Persistent delusional disorder- infestation type with mild depressive disorder was made and was treated with antipsychotics.20% improvement in the symptoms was reported a week later.Conclusion:This patient has been experiencing primary delusional infestation. She has continued to present to many different specialists with her complaints and is adamant about the presence of these particles. Due to the very low prevalence of this disorder,it is valuable to document it in order to understand and treat this phenomenon.

Abstract- Poster

Background:Delusion of pregnancy is a false and fixed belief of being pregnant despite factual evidence to the contrary. Both biological and psychological factors have been implicated in its causation. As prolactin directs metabolic and behavioural adaptations to the pregnant state, hyperprolactinemia is one of the leading causes.Case Description:A 27yrs old female, married, medical professional, belonging to Hindu joint family of upper socio-economic status presented to us claiming she was 8.5 months pregnant, along with irritable mood, nausea, excessive weight gain, increased appetite and craving for food which she attributed to her pregnancy, while last menstrual period was a month ago. With history of psychotic illness in patient›s maternal aunt,disturbed emotional environment during formative years and induced abortion at 3months of gestation in first pregnancy. On physical examination, central obesity and stretch marks were noted. No other objective signs of pregnancy were present. On mental status examination, delusion of pregnancy was elicited. Diagnosis of somatic type persistent delusional disorder was considered. During the course of hospital stay of 1 month, obstetric opinion was taken in view of amenorrhea since admission, following investigations were done. Serum prolactin was 220ng/mL and non-contrast MRI brain revealed Pituitary Microadenoma for which cabergoline 0.25mg bi weekly was started by endocrinologist, on which menstrual cycles resumed. She was discharged on oral Risperidone 10mg. On subsequent follow-up, delusions resolved and Risperidone was cross tapered with Aripiprazole.Conclusion:Present case highlights a rare case of delusional disorder, with delusion of pregnancy with possible trigger as hyperprolactinemia secondary to pituitary microadenoma.

Phenomenological description of PTSD through a case

Post-traumatic stress disorder (PTSD) is a severe mental disorder described only by operational criteria, without a proper dialectic essential analysis. In this study, we present a typical PTSD case with psychotic features, describing his living world through the domains of Heideggerian ontological-existential constituents –spatiality, temporality, corporeity and interpersonality (being-with-others). A phenomenological reduction and diagnostic elaboration was then performed. An essence of pervasive fear, that locks all intentionality and taints the entire being-in-the-world is described as the main characteristic of PTSD. The differential diagnosis is then discussed through a temporal perspective, showing essential differences among Bipolar Disorder, Schizophrenia and Persistent Delusional Disorder. We stand for a return to phenomenology, and its use to diagnosis and disorder description as a way to improve diagnostic validity and reliability.

Vexatious litigant vs paranoia querulans: A systematic review

IntroductionParanoia querulans is a type of persistent delusional disorder of the persecutory subtype, recognized under ICD-10 and DSM-IV. Being a classically described entity, evidence is lacking from its conceptualization as a nosological entity to diagnosis and treatment. Furthermore, controversy still exists regarding its interplay between the judicial and mental health systems.ObjectivesTo summarize current evidence and knowledge regarding Paranoia querulans on its conceptualization, ethiopathological explanations, therapeutical management and interface between psychiatry and the law.MethodsA systematic review was undertaken between June and October 2020 in the PubMed, Web of Science and Scopus databases according to PRISMA directive. Key-terms: ((querul* OR vexatious) AND (paranoia OR delusio* OR neuros* OR behavi* OR complai*) OR litig*) AND psychiatry. No language or time restrictions were established.ResultsA total of 1648 studies were initially identified (PubMed: 679; WOS: 945; Scopus: 24; other: 0); after duplicates were removed, n=1381 studies remained. After screening title and abstract, 56 studies were included. Their main content was categorized into: 1. Conceptualization (n=26): Neurosis (n=5), psychosis (n=9), behavioral disorder (n=5); no psychiatric diagnosis (n=7). 2. Descriptive psychopathology (n=8) 3. Etiopathogenesis (n=9): Social or personality basis (n=3), culture (n=4), trauma (n=1), cognitive decline (n=1) 4. Management (n=1) 5. Psychiatry and Law: same object, different objectives (n=12)ConclusionsThere is controversy regarding the nosological entity of querulousness, from psychosis to neurosis or behavioral disorders. Some authors consider this behavior to not be a psychiatric diagnosis. Furthermore, most papers dealt with a social or nurture-based origin. There is a dearth of information regarding treatment.Conflict of interestJPE has received CME-related fees from Lundbeck.

Delusional infestation: Two case reports

IntroductionDelusional infestation (DI), also known as delusional parasitosis or Ekbom syndrome, is a rare disorder, characterised by fixed belief that the skin, body or immediate environment is infested by small pathogens, despite the lack of any medical evidence for it.ObjectivesTo describe and discuss two clinical cases of DI, in order to show two different ways of presenting in this entity.MethodsTwo case report and non-systematic review.ResultsWe present the case of a 76-year-old woman, without psychiatric history, with an DI with 5 years of evolution, referred to a psychiatric consultation by a dermatologist. The second case, is a 41-year-old woman with a history of multiple substance use disorder, with an DI with a month of evolution, who resorted to the emergency department. DI is not a single diagnostic entity. The classic form, as represented in the first case,is a primary form, which develops without any known cause or underlying disease, corresponding to a persistent delusional disorder. However, about 60% of patients have secondary forms of DI, in the context of substance misuse, some medications or in the course of physical or psychiatric diseases (e.g. stroke, delirium, dementia, depression, schizophrenia).ConclusionsDI can occur as a primary delusional disorder or secondary to several other medical conditions. An in-depth clinical history is essential in order to make the correct diagnosis. A multidisciplinary approach is also important, to exclude any possible organic etiology, not forgetting that many patients may turn to other medical specialities first.DisclosureNo significant relationships.

La Passion comme modalité de suppléance au Traumatisme Psychique ? Étude clinique

IntroductionThe term passionate decompensation is used less and less in psychiatry. In classical French nosology, it designates delusions occurring in sectors on very specific themes (of claim, jealousy, erotomania, sensitive) of prevailing intuitive and interpretative mechanisms. In international literature, we speak rather of persistent delusional disorders and/or psychotic disorders congruent or not to the mood in the event of thymic disorders. In patients with post-traumatic stress disorder, it is not uncommon to observe a change in character associated with a stiffening of social relationships and themes of claim that may suggest delusional decompensation. The objective of this work is to propose a psychopathological reflection based on different clinical cases allowing to identify psychotherapeutic issues. Clinical studyIn this chapter, we present three clinical cases. One asking the question of the decompensation of a delusion of claim, a second that of a hypochondriac complaint and a third that of the emergence of a passion in the sense of investing in a new activity in a patient in phase of stabilisation of his affection. These different clinical cases allow us to discuss the relationship between the symptoms of the passion register and the premorbid personality, the impact of psychological trauma as a triggering factor, but also the psychopathological and psychotherapeutic issues underlying these symptomatic manifestations. Indeed, the question of recognition and reparation is often associated with the work of working through the mourning of the previous state, restoring the self-image and recovering a new balance. In some cases, the need for reparation is such that it turns into an emotional quest that can lead to conflicts with those around them. Finally, the lack of control related to the circumstances of the trauma can lead as a reaction to an excessive desire for control and mastery of the environment. ConclusionVery often in the development of psychologically injured patients, there is a transitional phase of claiming and/or of excessive rigidification of relationships with others, which in fact testifies to a work of mourning and narcissistic restoration. If these phenomena become chronic, it is advisable to question their relationship with the pre-morbid personality and/or to look for signs in favour of psychotic decompensation. In some cases, however, the newfound ability to commit to a cause, to bear witness to one's experience, to invest in a life project makes it possible to restore meaning to an existence shattered by trauma.

An unusual case of delusional disorder.

An unusual case of delusional disorder.

Antipsychotic Drug Induced Tardive Dyskinesia

A typical antipsychotics are at a lower risk of developing extra-pyramidal symptoms (EPS). But now, atypical antipsychotics are increasingly being associated with neurological side effects such as tardive dyskinesia, tardive dystonia, akinesia, parkinsonism, akathisia, bradykinesia, tremor etc. in which one of the major cases reported is Olanzapine induced tardive dyskinesia (TD). Schooler and Kane criteria is used for diagnosing tardive dyskinesia. Many cases have been published on this particular drug-induced side effect. In many instances tardive dyskinesia is misdiagnosed as tardive dystonia. Here we report the case of tardive dyskinesia associated with the use of antipsychotic drugs in a 50-year-old adult male suffering from persistent delusional disorder in a tertiary health care centre in India. The patient was on Olanzapine therapy for more than 2 years. Upon recurrent episodes of somatic delusions, Olanzapine dose was increased. When the patient developed symptoms of TD, the dose of Olanzapine was de-escalated. Even though the drug dose was reduced, the symptoms persisted which lead to the diagnosis of olanzapine induced TD. Based on this, Olanzapine was stopped and Clozapine treatment was initiated. On follow up, the patient was found to be relieved of the symptoms and complete recovery was achieved after 2 months of clozapine treatment.

446 - Persistent Delusional Disorder (Late Paraphrenia) - An innovative and cost effective clinical model in the community by older adult‘s mental health crisis and home treatment team

AimsTo review the various available clinical models of care delivery for patients with persistent delusional disorder (PDD) in community and economically evaluate the REACT model of safe care delivery- REACT’s Assertive and Prudent- Model of Safe Care (RAP–MoSC).MethodsREACT (Response Enhanced Assessment Crisis and Home Treatment Team) is the only bespoke crisis and home treatment team for older adults with mental health problems in the whole of Wales available only for the residents of Cardiff and Vale of Glamorgan through Cardiff and Vale University Health Board..It was set up on 28 February 2012. The cases of PDD in REACT service since its inception to 31 Dec 2016 were studied in relation to the assertive and prudent health care model. The economic evaluation of this service model for PDD patients was studied in detail.Results of the studyThe RAP-MoSC model is economically effective in avoiding patients getting admitted to hospital under Mental Health Act by managing them safely in the community.During the period between 28 February 2012 and 31 December 2016 there were 44 patients with a diagnosis of PDD in REACT’s case load. Only 3 patients got admitted to mental health assessment ward with the average length of stay period of 120 days. 41 patients were safely managed in the community with REACT with an average length of stay period of 21 days in REACT. A PDD patient will cost NHS £21,000 if admitted to a mental health bed. If the patient is managed in the community with RAP-MoSC model of care the cost will be £1533. REACT saved £793,548 by avoiding 41 PDD patients being admitted into hospital during an episode of delusional intensification in the period February 2012 to December 2016. PDD patients need under the RAP-MoSC model a bespoke MDT approach with better communication between secondary mental health and primary care services. Assertive and Prudent Clinical leadership is needed to sustain the RAP-MoSC in the community. Clinical reflections of this model of care will be presented in the conference.ConclusionsOn reflection REACT found that the key points in working with PDD are; Using a ‘foot in the door approach’Mental health professionals introducing themselves as Health professionalsRemote prescribing

Persistent delusional disorder versus OCD – how can we differentiate between delusions and obsessions without insight. A literature review

Both obsessive-compulsive disorders and psychotic disorders are very common among inpatients and outpatients. Though at first these 2 seem to not have much in common there is an aspect that requires more attention from the clinician: differentiating between delusions and obsessions without insight. This could be facilitated by a careful comparative examination of the phenomenological features of typical obsessions (with or without compulsions) and delusions (with or without repetitive delusional behaviors). In this article we examined key clinical features of obsessions and delusions in order to help differentiate between them and several of these features, if properly and empathically investigated, can help discriminate obsessions and compulsive rituals from delusions and delusional repetitive behaviors. We also touch on the topic of beliefs as they are associated with most obsessions and compulsions in obsessive–compulsive disorder and as their characteristics can vary considerably, some of them have been regarded as delusions.

M124. ASSOCIATION OF CHRONIC PHYSICAL MULTIMORBIDITY WITH THE EFFICACY OF TREATMENT IN DIFFERENT SCHIZOPHRENIA SPECTRUM DISORDERS

BackgroundPatients with schizophrenia spectrum disorders (SSD) have higher prevalence of chronic physical illness (CPI) and a substantially reduced life expectancy compared with the general population. Despite the increasing amount of research in this area, the effect on psychiatric treatment outcome is still not clear. Some research reported significant associations between several CPIs and different SSD treatment outcomes, whereas the remaining study did not. The objective of the current study is to assess differences in the association of the number of CPI with the overall number of psychiatric rehospitalization in specific SSD diagnosis.MethodsWe conducted a cross-sectional study of 354 patients diagnosed with SSD (ICD10): 135 schizophrenia, 71 acute and transient psychotic disorder, 57 schizoaffective disorder, 68 unspecified unorganic psychosis, 23 other (persistent delusional disorder, schizotypal disorder). The primary outcome was the association of the number of CPI with the number of psychiatric rehospitalization since the diagnosis, as the surrogate outcome for the treatment success, adjusted for the time from diagnosis, age, and gender of participants.ResultsMean number of CPI adjusted for the time from diagnosis, age, and gender was not significantly nor clinically relevantly different between particular SSD diagnosis (F(5,345)=0.70; p=0.620). It was 1.7 in schizophrenia, 1.5 in acute and transient psychotic disorder, 1.4 in schizoaffective disorder, 1.8 in unspecified unorganic psychosis, 1.0 in persistent delusional disorder and 1.9 in schizotypal disorder. The mean number of CPI adjusted for the same three potential confounders was significantly different between particular SSD diagnosis (F(5,345)=2.78; p=0.018). It was 6.7 in schizophrenia, 3.8 in acute and transient psychotic disorder, 7.3 in schizoaffective disorder, 4.8 in unspecified unorganic psychosis. However, the association of the number of CPI with the psychiatric rehospitalizations, adjusted for the previously stated three confounders, was significant and clinically relevant only in participants diagnosed with schizophrenia. In these participants, an increase of one CPI was associated with the 2.3 (95% CI 1.2 to 3.5) more psychiatric rehospitalizations (p<0.001). In participants diagnosed with other specific SSD the association of the number of CPI was not significantly associated with the number of psychiatric rehospitalizations. Moreover, on this particular sample level, it was negative, meaning that more CPI was associated with the lower number of psychiatric rehospitalization in all other SSD except in the case of unspecified nonorganic psychosis.DiscussionIn this cross-sectional study, we observed that the hypothesis of the effect of the number of CPI on the SSD treatment outcomes is valid only in the case of schizophrenia. Further research is needed to clarify whether additional psychological distress is related to the additional burden of multimorbidity.

S102. DIAGNOSTIC CHALLENGES AT TIME OF INPATIENT ADMISSION: DIAGNOSTIC SHIFTS IN PATIENTS WITH FIRST EPISODE PSYCHOSIS

BackgroundFirst episode psychoses (FEP) may present with diffuse symptoms and a broad range of clinical phenotypes, leading to difficulties in the early detection of the different pluripotent trajectories and consequently to instability of the diagnoses. The aim of this study was to assess the stability of diagnoses at time of admission compared to discharge in patients with FEP at a newly established early psychosis inpatient unit within a general psychiatric service in a general hospital.MethodsCharts of all patients admitted to the early psychosis inpatient unit of the Clinical Division of Social Psychiatry of the Medical University of Vienna between 01.01.2016 and 31.03.2017 were reviewed. FEP was defined as a first presentation of affective, schizophreniform, acute polymorphic, organic or substance-related psychosis according to ICD-10.Results127 patients were admitted during the said period, among whom 92 (72,4%) were diagnosed with a psychotic disorder at time of admission. 39,1% (n=36) of those had a FEP, whereof 58,3% (n=21) were diagnosed with schizophrenia spectrum psychosis, 27,8% (n=10) with affective psychosis, 11,1% (n=4) with substance-related psychosis and 2,8% (n=1) with organic psychosis as main diagnosis at time of discharge. In 50% (n=18) of FEP patients, diagnosis at time of admission was not maintained. 54,2% (n=13) of FEP patients who were admitted with a schizophrenia spectrum diagnosis had a shift in diagnosis at time of discharge, whereof 46,2% (n=6) were adjusted to another diagnosis of the same spectrum and 53,8% (n=7) to a diagnosis of either affective spectrum, substance-related psychosis or organic psychosis. 100% (n=2) of those with a persistent delusional disorder had a different diagnosis at discharge, as well as 56,3% (n=9=) of those admitted with a diagnosis of acute and transient psychotic disorders. Changes in the admission diagnoses of affective psychosis were necessary in 44,4% (n=4), whereof one half was adjusted to another diagnosis of the same spectrum and the other half to a diagnosis of the schizophrenia spectrum.DiscussionThe diagnostic instability in this study underlines the concept of the highly dynamic and changeable nature of psychopathology in the early stages and the pluripotent trajectories of psychosis. Furthermore, inadequate information available for specific diagnosis at time of admission as well as diagnostic uncertainty at the onset of psychosis could be implicated in the described diagnostic instability. The broad range of clinical phenotypes of early psychosis and the limitations of current diagnostic risk and identification approaches for the assessment of first episode psychosis indicate psychopathology conformed to a more dimensional rather than categorical model, as well as the need of a more dynamic model of prediction, such as the clinical staging model.