Polymorphic Psychotic Disorder Research Articles

Prodromal period of psychosis: diagnostic criteria.

Aim: To study the psychopathological mechanisms of the development of the prodromal stage of psychosis in order to identify risk factors for the formation of psychosis. Materials and Methods: In this research 137 patients with newly diagnosed psychosis were examined: 65 patients with a diagnosis of paranoid schizophrenia; 72 patients - with a diagnosis of acute polymorphic psychotic disorder. Results: According to the analysis of symptoms using the PANSS, the absence of signs of an anxious state, conceptual disorganization of thinking, emotional withdrowal are reliable signs of PPP in PS, and unusual thought content, absence of signs of stereotyped thinking, tension, anxiety, and hallucinations are reliable signs of PPP in APPD. According to the analysis of symptoms using the SOPS, unusual thought content/delusional ideas, bizarre thinking, social anhedonia, suspiciousness/persecutory ideas, decrease in expressiveness of emotions are reliable signs of PPP in PS, and bizarre thinking, impaired tolerance to normal stress, sleep disturbance, perceptual abnormalities/hallucinations, trouble with focus and attention are reliable signs of PPP in APPD. Conclusions: In the process of studying the clinical-psychopathological and pathopsychological aspects of the development of the PPP, a number of risk factors for the formation of psychosis were identified. We found that he most important diagnostic signs of PPP in PS patients are: stereotyped thinking, social isolation, disorganizational thinking disorders, passive-apathetic social detachment, suspiciousness. The most informative prodromal symptoms of HP in PS patients are: conceptual disorganization of thinking, bizzare thinking, social isolation, suspiciousness/persecutory ideas, reduced expression of emotions.

COVID-19-associated schizophrenia-like psychosis during the COVID-19 pandemic

IntroductionThe viral theory of the development of psychoses was formulated in the 19th century, but the role of viral agents in the pathogenesis of psychoses remains a matter of debate. In the context of the 2020 pandemic, the results of several papers on the characteristics of psychotic disorders in COVID-19 have been published. Coronaviruses are neuroinvasive, capable of affecting mental and body functions.ObjectivesThe aim of the study was to identify patients with acute psychosis without a history of mental disorders in order to test the hypothesis about the possibility of manifestation of schizophreniform psychosis due to a viral attack.MethodsWithin a year and a half, 50 patients with mental disorders associated with COVID-19 were identified. The reason for hospitalization in a psychiatric hospital is the development of acute schizophreniform psychosis against the background of a new coronavirus infection. The diagnosis was verified according to traditional clinical criteria and modern psychometric tools. Inclusion criteria: no previous visits to a psychiatrist; verified acute polymorphic psychotic disorder and coronavirus infection COVID-19 (ICD-10); manifestation of psychosis against the background of infection with COVID-19; age 18-60 years; consent to participate in the study. Exclusion criteria: signs of organic brain damage; indications of substance abuse; delirium of any etiology; somatic pathology in the stage of decompensation.Results27 women (54%) and 23 men (46%), aged 20 to 57 years (average age 34.5±7.6), of which 18 people (36%) worked, 2 (4%) studied , 29 (58%) people are unemployed. 27 people (54%) are single, 16 (32%) are married, 7 (14%) are divorced; 18 people (36%) were raising children, which indirectly indicated a relatively favorable premorbid functioning. At the time of the examination, the condition was determined by polymorphic psychotic symptoms with a predominance of dissociative-delusional, paraphrenic and oneiric phenomena with plots containing plots of infection and the spread of coronavirus. At the same time, the sum of PANSS is from 53 to 130 (85) points, including PANSS P - from 15 to 37 (27), PANSS N - from 7 to 44 (18), PANSS G - from 23 to 57 (39.9 ); P1 - 5.7; P3 - 5.1. When comparing the obtained data with the world experience, we found some differences. Delusional symptoms were diagnosed twice as rarely, cases with tactile hallucinations were not detected, but catatonic symptoms were observed twice as often, and manic arousal was twice as rare. In general, the studied data are comparable with the results published in the world practice.ConclusionsThe unique experience of the coronavirus pandemic will allow us to assess the influence of environmental factors, namely the role of infections, in the manifestation or predisposition to schizophrenia spectrum disorders. It is planned to evaluate the dynamics of the course of the disorder after the relief of the acute period.Disclosure of InterestNone Declared

Neurocognitive criteria for predicting recovery in a primary psychotic episode

Were examined 160 patients with primary psychotic episode (49 patients diagnosed with schizophrenia (F20), 59 with a diagnosis of acute polymorphic psychotic disorder (F23) and 52 with a diagnosis of schizoaffective disorder (F25)), who were under observation for 1 year. Were analyzed and described neurocognitive features of patients, which cause complete and incomplete exit from psychosis. It has been found that complete recovery in primary psychotic episode causes the preservation of cognitive functioning, in particular memory and verbal speed, as well as greater variability in methods of cognitive regulation of emotions and the presence of an outfit with mal- adaptive methods of adaptive regulation options, in particular positive focusing and acceptance

Proteomic profile of serum from patients with schizophrenia spectrum disorders.

This article describes the most likely classes of proteins and molecular processes that specifically characterize schizophrenic spectrum disorders such as simple and paranoid schizophrenia, schizotypal disorder, and acute polymorphic psychotic disorder (APPD). The identification of patients’ serum proteins was carried out using mass spectrometry. For patients with paranoid schizophrenia, the proteins responsible for translation and transcription are characteristic. A significant part of the proteins of patients with simple schizophrenia regulate the cell’s main metabolic and transport processes. These are proteins of the receptor system, vesicular transport, and extracellular matrix, which mainly carry out catabolic processes. The proteins of patients with schizotypal disorder mostly coincided with the classes of other patients, apart from chaperone proteins, which were not found in other studied groups. These proteins are mainly involved in anabolic processes. The main classes of proteins found in patients with APPD are responsible for the metabolism of nucleic acids. Active apoptosis processes were also revealed in these patients. These results from our basic knowledge about the molecular mechanisms of the pathogenesis of these disorders.

Pharmacogenetic markers to predict safety of antipsychotics in adolescents experiencing acute psychotic episodes

Introduction There are relatively fewer pharmacogenetic studies of antipsychotics in adolescents than in adult patients. The development of personalized pharmacotherapy is promising.ObjectivesIdentify the most significant pharmacogenetic predictors of antipsychotic safety in adolescents experiencing acute psychotic episodesMethods The study included 101 adolescents diagnosed with acute polymorphic psychotic disorder at the time of admission (F23.0-9 according to ICD-10). All patients were taking an antipsychotic as their main treatment for 14 days. Children’s Global Assessment Scale (CGAS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I), UKU Side Effects Rating Scale (UKU SERS), Sympson-Angus Scale (SAS), Barnes Akathisia rating scale (BARS) were used. All study participants underwent pharmacogenetic testing of pharmacokinetic and pharmacodynamic factors.Results CYP2D6 “intermediate” metabolism increased the risk of developing an adverse reaction by a trend of significance (OR=2.616 (95% CI 0.950-7.203); p=0.063). Carriage of HTR2A rs6313 was associated with a lower score on the UKU SERS “Other Symptoms” subscale (Beta=(-0.289); p=0.003) and an objective score on the BARS akathisia severity scale (Beta=(-0.217); p=0.029). DRD3 rs324026 carriers had a lower BARS akathisia scale score (Beta=(-0.349); p=0.004); DRD3 rs6280 carriers had a lower SAS extrapyramidal symptom severity scale score (Beta=(-0.351); p=0.003). Carriers of ANKS1B rs7968606 were associated with a higher SAS scale score (Beta=0.237; p=0.017).ConclusionsWe proposed that genotyping of CYP2D6*4, *10, DRD3 rs324026 (C allele), DRD3 rs6280 (C allele), HTR2A rs6313 (TT genotype) and ANKS1B rs7968606 (T allele) will predict the high risk of intolerance to antipsychotics in adolescents with acute psychotic episodes.DisclosureNo significant relationships.

Increased risk of psychosis to ivermectin treatment

IntroductionAdolescence: a state of mental fragility, where psychiatric disorders may debut, where have been reported several cases of toxidermy, encephalopathy and neuropsychiatric disorder related to ivermectin treatment (excluding organicity, substance abuse or medication) (1). It has effect on the dopaminergic system with an alteration on glycoprotein P leading to high levels of ivermectin causing neurotoxicity (2). In this poster, we discuss the case of a 14 y/o´s psychosis to ivermectinObjectivesPresentation of a clinical reportMethods14 years old woman. Background: father with schizophrenia. Comorbility: None. Initially, presented to ER with 2 week of treatment to ivermectin 6mg for pediculosis; presenting first psychotic episode. She presented first clinical outbreak of psychosis characterized by mystical-religious, erotomaniac, harm and reference delusions, auditory and visual hallucinations adding isolation, abulia, apathy, dialogued soliloquies, and spontaneous crying. No prior psychiatric treatment.ResultsIn hospitalization: elevated indirect and direct bilirubins and hiponatremia; neuroimaging studies are reported normal. Haloperidol 7.5 mg/day is indicated and parkinsonism is presented. Treatment is changed to olanzapine 15mg/day with notorious improvement. Diagnostic impression: Acute polymorphic psychotic disorder with symptoms of schizophreniaConclusionsPossible causes were analyzed, finding a relationship with ivermectin treatment. This case makes evident the importance of conducting in-depht evaluations and finding risks factors for psychosis.DisclosureNo significant relationships.

The predictive validity and outcome of ICD-10 and DSM-5 short-lived psychotic disorders: a review and meta-analysis.

The ICD-10 Classification of Mental and Behavioural Disorders introduced the category of 'acute and transient psychotic disorders' (ATPDs) encompassing polymorphic, schizophrenic and predominantly delusional subtypes, and the forthcoming ICD-11 revision has restricted it to polymorphic psychotic disorder, while the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) listed 'brief psychotic disorder' (BPD). To assess the predictive validity and outcome of ATPDs and BPD, relevant papers in English, French and German were searched in PubMed and Web of Science. Where possible meta-analysis of prognostic validators (diagnostic stability, course, outcome and response to treatment) was conducted. Fifty studies published between January 1993 and July 2019 were found. The clinical and functional outcome of ATPDs proved better than in schizophrenia and related disorders, but mortality risk is high, particularly suicide, and treatment trials provide little evidence. Meta-analysis of 25 studies (13,507 cases) revealed that 55% (95% CI 49-62) do not change diagnosis, 25% (95% CI 20-31) converted into schizophrenia and related disorders, and 12% (95% CI 7-16) into affective disorders on average over 6.3years. Subgroup meta-analysis estimated prospective consistency of polymorphic psychotic disorder (55%; 95% CI 52-58) significantly greater than that of the ATPD subtypes with schizophrenic (OR1.7; 95% CI 1.4-2.0) and predominantly delusional (OR 1.3; 95% CI 1.1-1.5) symptoms. Moreover, the diagnostic stability of BPD (13 studies; 294 cases) was 45% (95% CI 32-50) over a mean 4.2years. Although these findings indicate that short-lived psychotic disorders have little predictive validity, significant differences among the ATPD subtypes support the revised ICD-11 ATPD category.

Associations of CYP2D6, ABCB1 2677G>T/A and 3435C>T with effectiveness and safety of pharmacotherapy for acute psychotic episodes in adolescents over 28 days

Introduction. Pharmacokinetic genetic factors are prognostically relevant when prescribing antipsychotics to adult patients. Currently, there is a dearth of research on adolescents with an acute psychotic episode. Aim. To identify possible associations of CYP2D6, CYP3A4/5 and ABCB1 gene polymorphic variants with the efficacy and safety of pharmacotherapy in adolescents with an acute psychotic episode within 28 days. Materials and methods. The study included 68 adolescents with an established diagnosis of acute polymorphic psychotic disorder at the time of admission (F23.0-9 according to ICD- 10). All patients received an antipsychotic as their main therapy. Patients were monitored for 28 days. The effectiveness of antipsychotics was assessed using the Children’s Global Assessment Scale (CGAS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I). The safety of pharmacotherapy was assessed using the UKU Side Effects Rating Scale (UKU SERS), Sympson-Angus Scale (SAS), Barnes Akathisia rating scale (BARS). From each patient we obtained a buccal scraped epithelium, extracted DNA from it by sorbent method and detected carriage of genetic polymorphisms CYP3A4*22 (rs2740574), CYP3A5*3 (6986A>G, rs776746), CYP2D6*4, *9, *10 (rs3892097, rs4986774, rs1065852), ABCB1 1236C>T (rs1128503), 2677G>T/A (rs2032582), 3435C>T (rs1045642) by real-time PCR. Results. Carriers of ABCB1 2677G>T/A significantly less frequently demonstrated response to pharmacotherapy according to PANSS scale on day 14 compared to GG homozygotes (64.6 % vs. 94.7 %; p=0.014). Carriers of the ABCB1 3435C>T differed by a higher total UKU SERS score on day 14 compared to CC genotype carriers (9.21±5.95 vs. 5.1±4.48; p=0.037). Patients with «intermediate» CYP2D6 metabolism were more likely to have reduced sleep duration (13.6 % vs. 0 %; p=0.031). ABCB1 2677G>T/A (51 % vs. 15.8 %; p=0.012) and 3435C>T (46.6 % vs. 10 %; p=0.039) were more frequently associated with dry mouth. ABCB1 3435C>T carriers were also more likely to have orthostatic vertigo (34.5 % vs. 0 %; p=0.028). Conclusion. Carriage of the ABCB1 3435C>T was associated with greater efficacy of pharmacotherapy for acute psychotic episode in adolescents after 28 days, but also increases the risk of adverse reactions in the first 2 weeks of treatment. The ABCB1 2677G>T/A was associated with an increased risk of adverse reactions as well as less reduction of psychotic symptoms on day 14 of pharmacotherapy.

Analysis of associations between pharmacodynamic genetic factors and antipsychotics’ effectiveness and safety in adolescents with acute psychotic episodes taking antipsychotics during a 28-day follow-up

Introduction. Antipsychotics are the main drugs for treatment of schizophrenia spectrum disorders. Pharmacodynamic genetic factors are being actively studied to improve the accuracy of antipsychotic selection based on pharmacogenetic testing.Purpose of this study: to establish associations of genetic polymorphisms of the DRD2, DRD3, DRD4, HTR2A, COMT, ZNF804A, and ANKS1B genes with the efficacy and safety of antipsychotics in adolescents with an acute psychotic episode during a 28-day follow-up.Materials and methods. The study included 68 adolescents with an established diagnosis of acute polymorphic psychotic disorder at the time of admission (F23.0-9 according to ICD-10). All patients received an antipsychotic as their main therapy. Patients were monitored for 28 days. The effectiveness of antipsychotics was assessed using the Children’s Global Assessment Scale (CGAS), Positive and Negative Symptoms Scale (PANSS), Clinical Global Impression Severity (CGI-S) and Improvement (CGI-I). The safety of pharmacotherapy was assessed using the UKU Side Effects Rating Scale (UKU SERS), Sympson-Angus Scale (SAS), Barnes Akathisia rating scale (BARS). From each patient we obtained a buccal scraped epithelium, extracted DNA from it by sorbent method and detected carriage of genetic polymorphisms DRD2 rs1800497 (C>T), DRD3 rs6280 (C>T), DRD3 rs324026 (C>T), DRD4 rs1800955 (C>T), HTR2A rs6313 (T>C), COMT rs4680 (Val158Met, G>A), ZNF804A rs1344706 (A>C), ANKS1B rs7968606 (C>T) by real-time PCR.Results. DRD2 rs1800497 T allele carriers had a stronger reduction in the PANSS subscore «Productive Symptomatics» on day 14 (Me=-7.0 [-9.0;-5.0] vs Me=-7.0 [-8.0;-2.0]; p=0.018) and day 28 of follow-up (Me=-11.0 [-9.0;-5.5] vs Me=-8.0 [-8.0;-2.0]; p=0.019). Also, greater improvement on the CGAS scale on day 14 of follow-up was seen in TC+CC HTR2A rs6313 carriers (Me=2.0 [1.0;3.0] vs. Me=2.0 [1.0;2.0]; p=0.029). DRD3 rs324026 homozygous carriers (TT) had a significantly lower SAS score (Me=0.5 [0.0; 1.0] vs. Me=1.0 [0.0; 5.0]; p=0.016) and UKU subscore «Neurological Disorders» on 28 days of antipsychotic therapy (Me=0.0 [0.0; 0.0] vs. Me=1.0 [0.0; 3.8]; p=0.005). DRD3 rs324026 TT carriers also had lower severity of akathisia according to the BARS scale. Carriers of the T DRD4 rs1800955 allele had a higher SAS scale score on day 28 of therapy compared with CC homozygotes (Me=1.0 [0.0;4.0] vs Me=0.0 [0.0;1.0]; p=0.036).Conclusion. The DRD2 rs1800497 was a predictor of better reduction of productive symptoms; HTR2A rs6313 demonstrated a similar association. The DRD2 rs1800497 polymorphic variant was a predictor of better reduction of productive symptomatology; HTR2A rs6313 demonstrated a similar association. DRD3 rs324026 and HTR2A rs6313 were associated with a lower frequency of neurological adverse reactions and akathisia. In contrast, carriers of the DRD4 rs1800955 were more prone to adverse reactions on pharmacotherapy.

Полиморфные варианты генов рецепторов дофамина DRD2, DRD3 и DRD4 ассоциированы с ранней эффективностью и безопасностью антипсихотиков у подростков с острым психотическим эпизодом

The prospective observational study included 101 adolescents diagnosed with acute polymorphic psychotic disorder at the time of admission. Patients were followed up for 14 days. All patients received an antipsychotic as their main therapy. The following scales were used to assess the efficacy and safety of therapy on day 14: CGAS, PANSS, CGI-S, CGI-I, UKU SERS, SAS, BARS. The determination of polymorphic variants of DRD2 (rs1800497, C>T), DRD3 (rs6280, C>T), DRD3 (rs324026, C>T), and DRD4 (rs1800955, C>T) genes was performed by real-time polymerase chain reaction (PCR).

Acute polymorphic psychosis: An interesting case report

Introduction Acute Polymorphic Psychotic Disorder is a psychotic disorder with an acute onset, presenting thought and perception disorders variable into hours. Often, an emotional fluctuation is present and it may have a sudden onset and a rapid remission.ObjectivesThe review’s objective is to manifest acute polymorhic psychotic disorders and possible effective medical interventions.MethodsThe current case concerns a 52-year old mother of 4 children with the manifestation of acute polymorphic psychotic disorder with a background of a stressful factor. The patient was involuntarily hospitalized in the Psychiatric Hospital of Thessaloniki from 04/01/ 2019 -21/ 01/2019 due to disorganization and acute confusing condition within the last 9 days. Delusional ideas of religious content were first observed, which alternated with ideas of greatness and then persecution, association and self-denial. She also presented auditory hallucinations while there was a fluctuation of emotion from excessive euphoria to depression. The patient had no previous hospitalization in a psychiatric clinic, however, 7 months ago she experienced another acute psychotic epeisode, while at the age of 17 and under the influence of intense stress, she described mood disorders.ResultsThe current symptoms subsided after one week from the day of admission. During her hospitalization, a brain CT was performed without presence of pathological findings. Initially, her medication included i.m. haloperidol 15mg / ml daily, followed by a change to per os paliperidone 9mg daily.ConclusionsHer mental status was improved, with no disturbances of consciousness noted and she was discharged on paliperidone as home medication.DisclosureNo significant relationships.

Prognostic significance of psychotic relapse in patients with first-episode acute and transient psychosis: New empirical support for ICD-11

This study examined the impact of psychotic relapse on the diagnostic stability of acute and transient psychotic disorders (ATPD), and how this potential risk factor could differentiate ‘acute polymorphic psychotic disorder without symptoms of schizophrenia’ (APPD; ICD-10 code F23.0) from the remaining non-APPD subtypes (F23.1–9). A two-year cohort study was performed on 68 patients with first-episode ATPD. At the end of follow-up, the diagnostic stability of ATPD was 55.9% and the overall rate of psychotic relapse was 61.8%. Statistical analysis showed that recurrence was an independent risk factor for diagnostic shift in ATPDs (relative risk [RR] = 1.67, 95% confidence interval [CI] = 1.17–2.39; p = 0.005) and that this risk differed among their subtypes insofar as its appearance significantly increased the likelihood of diagnostic change in patients with non-APPD subtypes (RR = 2.52, 95% CI = 1.56–4.07; p < 0.001), but not in those with APPD (RR = 0.95, 95% CI = 0.57–1.57; p = 0.844). Our findings confirm the negative implications of recurrence in patients with ATPD, encourage long-term intervention targeting relapse prevention in this population, and provide new empirical evidence in support of narrowing the ATPD category to APPD in the upcoming ICD-11.

Social, demographic and clinical characteristics of female patients with schizophrenia and HIV

To evaluate social, demographic and clinical characteristics of women with schizophrenia and HIV. Medical histories of patients who were in inpatient treatment during 2017 were retrospectively studied. A total of 174 medical histories were analyzed, but the final analysis included 40 HIV-infected patients (main groups) and 48 patients without HIV infection (comparison group). These groups included patients with a diagnosis of schizophrenia or acute polymorphic psychotic disorder. All patients with HIV infection were examined by a specialist and an immunological analysis was performed. Correlation analysis was performed between quantitative clinical indicators (duration of illness, number of hospitalizations, the number and duration of remissions, etc.) and immunological parameters. Patients with schizophrenia and HIV infection are more often hospitalized and stay in the hospital longer than patients with schizophrenia without HIV infection, which may in part be determined by the social problems of this cohort of patients. There is a relationship between individual indicators of the immune status of the patients, the duration and some features of the course of mental illness. Regular treatment of HIV infection correlates with a lower frequency of hospitalizations in a psychiatric hospital due to an exacerbation of the mental state.

Relapse risk after in-ward electroconvulsive therapy for acute polymorphic psychotic disorder

Purpose Acute polymorphic psychotic disorder (APPD) without symptoms of schizophrenia is a serious psychiatric condition. APPD can be effectively treated with electroconvulsive therapy (ECT), but little is known about relapse prevention after ECT for APPD. Materials and methods This was a retrospective register-based study conducted with 97 patients with APPD (ICD-10 diagnosis F23.0). We estimated the rates of readmission and suicide, and the prognostic factors of these outcomes after ECT. We combined data from several national Swedish registers and used Cox’s regression analysis to identify demographic factors, disease characteristics, and relapse preventive treatments that predicted time to readmission or suicide (relapse). Data registered between 2011 and 2016 were used in the study. Results Twenty percent of cases relapsed within a year. Thereafter, relapse rate was low. Two cases died during follow-up, whereof one by suicide. Anxiolytic treatment, lamotrigine treatment, and having more than four previous psychiatric hospital admissions were associated with shorter time to relapse. The most robust of these associations was between anxiolytics and relapse risk. Conclusions The first year after discharge from APPD is the period associated with the highest risk of relapse. Having many previous admissions was associated to relapse risk after ECT for APPD. The associations between anxiolytics, lamotrigine, and relapse are uncertain and might be influenced by indication bias.

Glutamate Level’s in Blood Serum of Patients with Schisophrenic Spectrum and Bipolar Affective Disorder

The objective: the involvement of glutamatergic neurotransmitter systems in the pathogenesis of schizophrenic spectrum disorders and BD has been repeatedly proven. But today, there are no methods available to evaluate the glutamate metabolism in patients with mental disorders. The paper presents differences in the level of glutamate in the blood serum of patients with a schizophrenic spectrum disorder, bipolar disorder, and healthy individuals.Patients and methods: the study included 224 people. 179 patients were presented with paranoid schizophrenia, simple schizophrenia, schizotypal disorder, acute polymorphic disorder, schizoaffective disorder and BD.Results: in this work shows that the level of glutamate in patients in all studied groups is statistically significantly higher than in healthy individuals, except for acute polymorphic psychotic disorder. Serum glutamate concentration in patients with schizotypal disorder is 1.6 times higher than in healthy individuals. The significant differences in glutamate levels were detected in patients with schizotypal disorder and OCD (p = 0.045), and patients with paranoid schizophrenia (p = 0.012). The concentration of glutamate is also increased in patients with simple schizophrenia compared to patients with paranoid schizophrenia (p = 0.039). In addition, it was observed a glutamate increase in healthy individuals compared in patients with a continuous course of schizophrenia (p = 0.001), in patients with an episodic course with progressive deficit (p = 0.0211) and in patients with a schizophrenia duration of more than 12 years.Conclusions: thus, the concentrations of glutamate in the blood serum of patients are depending on the severity of the course of schizophrenia and maybe an additional paraclinical criterion for the diagnosis of schizotypal disorder.

Мотивація саморуйнівної поведінки у пацієнтів з психотичними розладами шизофренічного спектру

The present study assesses the difference in motivation of SDB and SI was found in different groups. In Gr1 PermSDB the main motivation was psychological problems associated with mental illness, social and interpersonal problems, while in Gr2 ImpSI the exclusive reason of SI was «command» to do it under influence of imperative pseudo-hallucinations. They were 95 patients with schizophrenia, schizoaffective disorder and acute polymorphic psychotic disorder examined in this issue and divided into 2 groups according to the pathways types of SDB: the first group – patients with permanent features of SDB as comorbid disturbance (Gr1 PermSDB), the second group – patients with impulsive SDB manifestations as secondary behavior disturbance on background acute psychotic episode with imperative pseudo-hallucinations (Gr2 ImpSI). There was a weighty predominance of patients with schizophrenia and hallucinatory-paranoid syndrome in both groups. Patients with schizophrenia more frequently realized impulsive SI exactly with imperative pseudo-hallucinations as the cause of them. Results confirmed that fundamentally diverse pathways for SDB manifestation and dynamic of it, also SI motivation exist in patients with SSPsD. It should be taken in the treatment tactic and rehabilitation course for such different patients.

Self-destructive behavior in patients with psychotic disorders of the schizophrenia spectrum

The present study assesses the peculiarities and the pathways of self-destructive behavior (SDB) and self-injury acts (SI) in a group of inpatients who have schizophrenia spectrum psychotic disorders (SSPsD). They were 77 patients with schizophrenia, schizoaffective disorder and acute polymorphic psychotic disorder examined in this issue and divided into 2 groups according to the pathways types of SDB: the first group — patients with permanent peculiarities of SDB as comorbid disturbance (Gr1 PermSDB), the second group — patients with impulsive SDB manifestations as secondary behavior disturbance on background acute psychotic episode with imperative pseudo-hallucinations (Gr2 ImpSI) There was a weighty predominance of patients with schizophrenia and hallucinatory-paranoid syndrome in both groups. Patients with schizophrenia more frequently realized impulsive SI exactly with imperative pseudo-hallucinations as the cause of them. Significant difference in motivation of SDB and SI was found in different groups. In Gr1 PermSDB the main motivation was psychological problems associated with mental illness, social and interpersonal problems, while in Gr2 ImpSI the exclusive reason of SI was «command» to do it under influence of imperative pseudo-hallucinations. The psychometric results (the Plutchik’s impulsivity scale) revealed a much higher level of impulsivity in Gr1 PermSDB. Results confirmed that fundamentally diverse pathways for SDB manifestation and dynamic of it, also SI motivation exist in patients with SSPsD. It should be taken in the treatment tactic and rehabilitation course for such different patients. Key words: self-destructive behaviour, self-injury, psychotic disorders of the schizophrenia spectrum

Respuesta ultrarrápida a la terapia electroconvulsiva en un caso de trastorno psicótico agudo polimorfo.

Existe la errónea percepción de que la Terapia Electroconvulsiva (TEC) debe usarse como último recurso de manejo psiquiátrico y únicamente en casos crónicos y/o refractarios. Esto, entre otras causas, ha llevado a la lamentable disminución de su empleo a lo largo de los últimos tiempos en nuestro medio y en otras latitudes. Sin embargo, las psicosis agudas con síntomas motores de tipo catatoniforme presentan tasas de respuesta de hasta 100% y la TEC debiera, por ende, hallarse en la primera línea de los recursos de tratamiento para estos cuadros, evitando o previniendo, de ese modo, connsecuencias ominosas de la catatonía. A propósito de un cuadro de trastorno psicótico agudo polimorfo sin síntomas de esquizofrenia (F23.0, CIE-10) que presentó remisión completa de síntomas catatónicos y psicóticos luego de una sola sesión de TEC (lo que es, de hecho, un resultado infrecuente), se realiza una revisión de la literatura pertinente. Se concluye que la TEC debiera retomar su relevancia en casos psicóticos agudos de buen pronóstico, en los que su postergación acarreará consecuencias innecesariamente negativas.

The rehabilitation of patients with acute polymorphic psychotic disorder

To assess the effectiveness of a rehabilitation program in patients with acute polymorphic psychotic disorder. The study included 128 patients in remission. The rehabilitation program was administered to 75 patients with acute polymorphic psychotic disorder. The patients were randomized into groups depending on the type of compensatory-adaptive protection. The effectiveness of the program was estimated using the Personal and Social Performance (PSP) scale. Comparison of the results of rehabilitation in the study and control groups showed a significant improvement in the level of social functioning. Based on the findings, the authors developed varied rehabilitative programs, including psychopharmacological, psychotherapeutic and socio-therapeutic procedures, for patients with acute polymorphic psychotic disorder with account for their adaptation types. The rehabilitation program based on the type of compensatory-adaptive protection can be implemented in practice of psychiatric services as an effective form of psychological and social support of patients.

Acute Polymorphic Psychotic Disorder: Concepts, Empirical Findings, and Challenges for ICD-11.

The ICD-11 International Classification of Diseases and Related Health Problems will move toward a narrower concept of "acute and transient psychotic disorders" (ATPD) characterized by the remnant "polymorphic psychotic disorder" (APPD) of the current ICD-10 category, also including schizophrenic and predominantly delusional subtypes. To assess the validity of APPD, relevant articles published between January 1993 and September 2017 were found through searches in PubMed and Web of Science. APPD is a rare mental disorder and affects significantly more women than men in early-middle adulthood. Its diagnostic reliability is relatively low, and its consistency reaches just 53.8% on average over 8.8 years, but is significantly greater than either of ATPD subtypes, which are more likely to progress to schizophrenia and related disorders. Although APPD has distinctive features and higher predictive power, its rarity and the fleeting and polymorphic nature of its symptoms could reduce its usefulness in clinical practice and discourage research.