Presence Of Psychotic Symptoms Research Articles

Cognitive disturbances basic symptoms in help-seeking patients with borderline personality disorder: Characteristics and association with schizotypy.

Although the presence of psychotic symptoms has been widely recognized in Borderline Personality Disorder (BPD), no study previously investigated cognitive Basic Symptoms (BS) and their clinical implications in patients with BPD. This cross-sectional study specifically examined the prevalence of COGDIS (cognitive disturbances) BS criteria in 93 help-seeking outpatients with BPD by using the Schizophrenia Proneness Instrument-Adult Version (SPI-A). We then explored associations of COGDIS with personality traits, functioning and core psychopathological features of BPD. The prevalence rates of COGDIS criterion were 62.4%. BPD patients meeting COGDIS criteria reported higher levels of schizotypal personality traits, dissociative experiences and work/social functional impairment compared to individuals without COGDIS criteria. Furthermore, the number of cognitive BSs showed a positive correlation with severity levels of schizotypy. Cognitive BS are common in BPD. Cognitive disturbances are associated with schizotypal personality traits and specific clinical features. The presence of cognitive BSs may identify a more severe subgroup of patients with BPD, potentially vulnerable to psychotic symptoms and reliably identifiable through assessment of schizotypal traits.

Association of clinical variables and thyroid-stimulating hormone with psychotic symptoms in patients with first-episode and drug-naïve major depressive disorder with elevated fasting blood glucose: preliminary exploratory study with a large sample.

Psychotic symptoms and elevated fasting blood glucose (FBG) are frequently observed in people with major depressive disorder (MDD), but there is a lack of research into this relationship within this cohort. This study aimed to preliminarily explore the prevalence of psychotic symptoms and their predictors among patients with MDD and elevated FBG. This study enrolled 1718 patients with first-episode and drug-naïve (FEDN) MDD. Sociodemographic data and physical and biochemical indicators were collected. Clinical symptoms were assessed with tools such as the Hamilton Rating Scale for Anxiety, Hamilton Rating Scale for Depression (HRSD) and Positive and Negative Syndrome Scale positive subscale. The odds ratio for psychotic symptoms in those with MDD and elevated FBG (18.7%) was 2.33 times higher than those with MDD without elevated FBG. Presence of psychotic symptoms was significantly correlated with HRSD score, suicide attempts, and total cholesterol and thyroid-stimulating hormone levels. The combination of HRSD score, suicide attempts and thyroid-stimulating hormone levels among patients with MDD and elevated FBG effectively distinguished between individuals with and without psychotic symptoms, achieving an area under the curve of 0.87. Psychotic symptoms are frequently observed among FEDN MDD patients with elevated FBG, and depressive symptoms, suicide attempts and thyroid-stimulating hormone levels are related to psychotic symptoms in this cohort.

Perspectives in treatment-resistant depression: esketamine and electroconvulsive therapy.

Modern electroconvulsive therapy (ECT) and the approval of nasal esketamine for clinical use have significantly improved the approach to treatment-resistant depression (TRD), which is defined as non-response to at least two different courses of antidepressants with verified adherence to treatment, adequate dosage, and duration of treatment. The goal of this literature review is to present the newest evidence regarding efficacy and safety. Furthermore, we aim to provide an overview of future perspectives in this field of research, for example, regarding structural and molecular effects. Both treatment methods will be critically evaluated for their individual advantages, disadvantages, and response rates. Firstly, we will discuss the well-established method of ECT and its different treatment modalities. Secondly, we will discuss the properties of ketamine, the discovery of its antidepressive effects and the route to clinical approval of the esketamine nasal spray. We will comment on research settings which have evaluated intravenous ketamine against ECT. The decision-making process between esketamine nasal spray or ECT should include the assessment of contraindications, age, severity of disease, presence of psychotic symptoms, patient preference and treatment accessibility. We conclude that both treatment options are highly effective in TRD. If both are indicated, pragmatically esketamine will be chosen before ECT; however, ECT studies in ketamine non-responders are missing.

Psychotic symptoms in frontotemporal dementia with TDP-43 tend to be associated with type B pathology.

Psychotic symptoms are increasingly recognized as a distinguishing clinical feature in patients with dementia due to frontotemporal lobar degeneration with TDP-43 pathology (FTLD-TDP). Within this group, carriers of the C9orf72 repeat expansion are particularly prone to develop delusions and hallucinations. The present retrospective study sought to provide novel details about the relationship between FTLD-TDP pathology and the presence of psychotic symptoms during life. We found that FTLD-TDP subtype B was more frequent in patients with psychotic symptoms than in those without. This relationship was present even when corrected for the presence of C9orf72 mutation, suggesting that pathophysiological processes leading to the development of subtype B pathology may increase the risk of psychotic symptoms. Within the group of FTLD-TDP cases with subtype B pathology, psychotic symptoms tended to be associated with a greater burden of TDP-43 pathology in the white matter and a lower burden in lower motor neurons. When present, pathological involvement of motor neurons was more likely to be asymptomatic in patients with psychosis. This work suggests that psychotic symptoms in patients with FTLD-TDP tend to be associated with subtype B pathology. This relationship is not completely explained by the effects of the C9orf72 mutation and raises the possibility of a direct link between psychotic symptoms and this particular pattern of TDP-43 pathology.

Rates and associations of relapse over 5 years of 2649 people with bipolar disorder: a retrospective UK cohort study

BackgroundEvidence regarding the rate of relapse in people with bipolar disorder (BD), particularly from the UK, is lacking. This study aimed to evaluate the rate and associations of clinician-defined relapse over 5 years in a large sample of BD patients receiving routine care from a UK mental health service.MethodWe utilised de-identified electronic health records to sample people with BD at baseline. Relapse was defined as either hospitalisation, or a referral to acute mental health crisis services, between June 2014 and June 2019. We calculated the 5-year rate of relapse and examined the sociodemographic and clinical factors that were independently associated with relapse status and the number of relapses, over the 5-year period.ResultsOf 2649 patients diagnosed with BD and receiving care from secondary mental health services, 25.5% (n = 676) experienced at least one relapse over 5 years. Of the 676 people who relapsed, 60.9% experienced one relapse, with the remainder experiencing multiple relapses. 7.2% of the baseline sample had died during the 5-year follow-up. Significant factors associated with experiencing any relapse, after adjustment for relevant covariates, were history of self-harm/suicidality (OR 2.17, CI 1.15–4.10, p = 0.02), comorbidity (OR 2.59, CI 1.35–4.97, p = 0.004) and psychotic symptoms (OR 3.66, CI 1.89–7.08, p < 0.001). Factors associated with the number of relapses over 5 years, after adjustment for covariates, were self-harm/suicidality (β = 0.69, CI 0.21–1.17, p = 0.005), history of trauma (β = 0.51, CI = 0.07–0.95, p = 0.03), psychotic symptoms (β = 1.05, CI 0.55–1.56, p < 0.001), comorbidity (β = 0.52, CI 0.07–1.03, p = 0.047) and ethnicity (β = − 0.44, CI − 0.87 to − 0.003, p = 0.048).ConclusionsAround 1 in 4 people with BD in a large sample of people with BD receiving secondary mental health services in the UK relapsed over a 5-year period. Interventions targeting the impacts of trauma, suicidality, presence of psychotic symptoms and comorbidity could help to prevent relapse in people with BD and should be considered in relapse prevention plans.

The Development of Psychosis in Patients with Substance Use Disorder and Its Association with Cavum Septum Pellucidum and Adhesio Interthalamica.

It is known that there is a relationship between psychotic disorders and the presence of cerebral midline defects, such as the cavum septum pellucidum and the absence of adhesio interthalamica. This study aims to investigate whether these defects in people with alcohol/substance use disorders are associated with the occurrence and persistence of psychotic symptoms. The files of the patients who were hospitalized in an addiction inpatient unit were retrospectively scanned. The presence of cavum septum pellucidum and the absence of adhesio interthalamica were determined by evaluation of the magnetic resonance imaging findings. The presence of psychotic symptoms at admission and the persistence of psychotic symptoms after 2 weeks of detoxification treatment were used as dependent variables in different logistic regression models. The presence of cavum septum pellucidum and the absence of adhesio interthalamica were included in 2 separate models as independent variables. The results of the regression analyses showed no significant relationship with respect to cavum septum pellucidum. However, the analyses revealed that the absence of adhesio interthalamica increases the risk of the persistence of psychotic symptoms. Our findings suggest that the absence of adhesio interthalamica can be considered a structural risk factor for the development of psychosis in people receiving treatment for substance use.

Atypical psychosis in a person living with HIV: A case report

Introduction: An organic disorder is defined as psychiatric syndromes, the fundamental manifestations of which are the direct consequence of a known anatomophysiological alteration of the brain. HIV is a neurotropic virus, which infects the central nervous system early. Despite the widely known high prevalence of HIV-related brain atrophy, the presence of psychotic symptoms is rare. Case report: This is a 28-year-old patient with a recent diagnosis of HIV with Western Blot in 2017, his diagnosis was made in a mental health center due to psychotic symptoms, an imaging study with simple tomography of the brain was performed with the result of frontal atrophy and occipital, in a young adult patient with no history of head trauma, hemorrhagic or ischemic events, as well as; Central nervous system infections are ruled out. Conclusions: This is a disorder with chronic psychotic symptoms in a patient with cortical atrophy secondary to HIV infection.

Migration, perceived discrimination and the development of psychosis

IntroductionMigration is a rapidly growing phenomenon in European countries and its association with psychotic disorders is a public health concern. Psychosis is more prevalent among migrants, which suggests that adverse social experiences play an important role in its pathogenesis. Throughout the migration process, migrants are exposed to several social disadvantages, including in the post-immigration context, where perceived discrimination appears to be an important stressor. In fact, the highest incidence rates of psychosis occur in the most discriminated populations, namely migrants with darker skin complexion, particularly when living in low-ethnic-density neighborhoods, where both discrimination and social isolation are more prominent.ObjectivesTo conduct an updated review about the association between migration, perceived discrimination and psychosis, aiming to better understand the mechanisms involved.MethodsNarrative literature review using the keywords “migration”; “psychosis”; “discrimination”; “racism” on PubMed database, in conjunction with presentation of a clinical case concerning a patient from Guinea-Bissau, admitted to our hospital in the context of first-episode psychosis (FEP), with onset months after completing the Mediterranean migration route to Europe.ResultsLiterature suggests that experiences of racism and social exclusion contribute to feelings of imminent danger, fear and general anxiety, which may develop into paranoid ideas of ubiquitous persecution. Furthermore, intense social defeat experiences, common in migrants, are associated with more distressing forms of delusional content, with delusions of psychological persecution being more common. However, there is also evidence that migrants with FEP have better occupational and social functioning profiles compared to natives, suggesting that, in these patients, there is a higher burden of social-environmental risk factors, with the onset of psychosis occurring only when this burden overcomes a higher threshold. Our patient fits this description. After completing his migratory route and while living in an Italian refugee camp, he described suffering experiences of severe discrimination. Real or not, these experiences escalated to become delusional ideas of persecution involving European governments, thought to seek for his humiliation. Despite the presence of psychotic symptoms, this patient was able to maintain a reasonable level of functioning during years, up to his psychiatric admission.ConclusionsGiven the notorious effect of perceived discrimination and racism on the increased risk of psychosis in immigrants, it is urgent to adopt policies that promote the social protection of these vulnerable groups, namely through enhancing their integration in the host countries.Disclosure of InterestNone Declared

Clinical and neuroendocrine correlates of childhood maltreatment history in adults with bipolar disorder

IntroductionChildhood maltreatment (CM) has been associated to an increased risk of developing bipolar disorder (BD). A role of the hypothalamus-pituitary-adrenal (HPA) axis in mediating trauma-related risk for adult psychopathology has been suggested but scarcely investigated in BD.ObjectivesThe aim of this study is to explore the impact of childhood maltreatment on clinical features of BD and on the activity of the HPA axis.MethodsOne hundred and six patients participated in the study. On the basis of their history of childhood trauma, as assessed by the Childhood Trauma Questionnaire (CTQ), they were divided into a group with a history of childhood maltreatment (CM+) and a group without (CM−). Twenty-nine participants (16 with a history of childhood trauma and 13 without) underwent the cortisol awakening response (CAR) test. Saliva cortisol concentrations were determined by an enzyme immunoassay method, using a commercially available ELISA kit.ResultsAccording to CTQ, 62 had a history of childhood maltreatment and 44 had not. CM was significantly more frequent in females than males. CM+ patients showed significant higher body mass index (p = .01), number of suicide attempts (p = .03), and more severe mania symptoms (p = .01) than CM− ones. Significant associations between lifetime suicide attempts and any type of childhood maltreatment (OR = 2.79; CI = 1.01-7.73) and between emotional abuse and the presence of psychotic symptoms (OR = 2.74, CI = 1.11-6.74) or mixed mood episodes were found (OR = 2.62, CI = 1.07-6.43). Moreover, CM+ individuals with BD exhibited a significantly reduced CAR with respect to CM− ones.ConclusionsOur results add to literature findings showing a worse clinical course in BD patients with a history of childhood maltreatment and show for the first time that childhood trauma exposure is associated to impaired CAR in adults with BD.Disclosure of InterestNone Declared

Are there any differences in clinical and biochemical variables between bipolar patients with or without lifetime psychotic symptoms?

IntroductionBipolar Disorder (BD) is a frequent psychiatric disorder, which can be associated with high disability. Psychotic symptoms occur in more than half of bipolar patients and are associated with an unfavorable course of the disorder (Chakrabarti et al. World J Psychiatry 2022; 12(9) 1204-1232).ObjectivesThe aim of this study is therefore to identify clinical and biological markers able to discriminate between BD patients with (BD-PS) and without lifetime psychotic symptoms (BD-NPS) to facilitate early diagnosis and to implement a target clinical management of these patients.MethodsWe recruited 665 patients consecutively hospitalized for BD at Fondazione IRCCS Policlinico (Milan) and at San Gerardo Hospital (Monza). Data were obtained through a screening of the clinical charts and blood analyses conducted during the hospitalization. Patients were assessed by psychometric scales. The two groups (BD-PS and BD-NPS) were compared by t tests for quantitative variables and χ2 tests for qualitative ones. Variables that resulted to be significant in univariate analyses were inserted in binary logistic models with the presence of psychotic symptoms as dependent variable.ResultsAmong the total sample, 64.5% of patients were affected by BD-PS while 35.5% by BD-NPS. The final binary logistic regression model showed that, compared to patients with BD-NPS, those with BD-PS had a longer duration of hospitalization (p=0.007) and were more frequently hospitalized for a manic episode (p=0.001). In addition, subjects with BD-PS had a lower score on the current Global Assessment of Functioning (GAF) (t = 3.157; p = 0.002) and were more frequently males (χ² = 4.061; p = 0.044; OR = 1.399). With regard to biological variables, patients with BD-PS, compared to the counterpart, had a higher Neutrophile to Lymphocyte Ratio (NLR) (t = 2.776; p = 0.006), lower levels of Gamma-Glutamyl Transferase (γGT) (t = 2.249; p = 0.026), higher total bilirubin (t = 2.348; p = 0.019) and creatine phosphokinase (CPK) (t=2.807; p = 0.005), lower total cholesterol (t = 2.369; p = 0.018) and triglycerides (t = 2.554; p = 0.013).ConclusionsOur data appear to be in line with the literature, especially with respect to the occurrence of psychotic symptoms mainly in manic episodes and their association with greater clinical severity, longer hospitalization and worse outcome (Altamura et al. Aust N Z J Psychiatry 2019; 53(8) 772-781). From a biological point of view, it seems important to emphasize that patients with lifetime psychotic symptoms presented a higher NLR, revealing more prominent low-grade inflammation in these patients than the counterpart. These data confirm the possibility of using NLR as biomarker of severity in bipolar patients, as proposed previously by other authors (Kulacaoglu et al. Nord J Psychiatry 2022). Future multi-center study have to confirm the results of the present study.Disclosure of InterestNone Declared

Psychotic symptoms in eating disorders: a case report

IntroductionPsychotic symptoms and eating disorders can occur in the same person, sometimes at the same time. This comorbidity is not well studied despite the difficulties of management at both clinical and pharmacological levels that it may entail. We present the case of a 35-year.old female patient with anorexia nervosa with years of evolution, currently admitted to a center specializing in Eating Disorders, who comes to the emergency department with psychotic symptoms.ObjectivesTo know the prevalence of comorbidity of psychotic symptoms in people with eating disorders, as well as possible risk factors, severity and management of them.MethodsPresentation of a case and review of the available literature on the presence of symptoms of the psychotic sphere in persons diagnosed with eating disorders.ResultsThe literature reflects data of a prevalence of 10-15% of patients with eating disorders presenting psychotic symptoms. The presence of psychotic symptoms is not directly related to a greater severity of the eating disorder. Some genetic associations have been found, as well as alterations at the physiological, cognitive and brain structure level that coincide in both pathologies. In some cases, an improvement in eating behavior has been observed when the psychotic symptomatology is resolved. In the case of patients with bulimia nervosa, a higher number of psychotic symptomatology has been observed, such as paranoid ideations, which some studies relate to a greater emotional capacity and histrionic expressiveness of this patient profile.ConclusionsThe comorbidity of psychotic symptoms and eating disorders is relatively frequent and makes us face challenges in the diagnosis, as well as in the management of these patients. This comorbidity is especially important in patients with bulimia nervosa. Future research is necessary to know a more exact management of these pathologies.Disclosure of InterestNone Declared

Sex-specifics of ECT outcome

ObjectiveElectroconvulsive therapy (ECT) is the most effective treatment for patients with severe major depressive disorder (MDD). Given the known sex differences in MDD, improved knowledge may provide more sex-specific recommendations in clinical guidelines and improve outcome. In the present study we examine sex differences in ECT outcome and its predictors. MethodsClinical data from 20 independent sites participating in the Global ECT-MRI Research Collaboration (GEMRIC) were obtained for analysis, totaling 500 patients with MDD (58.6 % women) with a mean age of 54.8 years. Severity of depression before and after ECT was assessed with validated depression scales. Remission was defined as a HAM-D score of 7 points or below after ECT. Variables associated with remission were selected based on literature (i.e. depression severity at baseline, age, duration of index episode, and presence of psychotic symptoms). ResultsRemission rates of ECT were independent of sex, 48.0 % in women and 45.7 % in men (X2(1) = 0.2, p = 0.70). In the logistic regression analyses, a shorter index duration was identified as a sex-specific predictor for ECT outcome in women (X2(1) = 7.05, p = 0.01). The corresponding predictive margins did show overlapping confidence intervals for men and women. ConclusionThe evidence provided by our study suggests that ECT as a biological treatment for MDD is equally effective in women and men. A shorter duration of index episode was an additional sex- specific predictor for remission in women. Future research should establish whether the confidence intervals for the corresponding predictive margins are overlapping, as we find, or not.

Rendimiento cognitivo en individuos con un primer episodio psicótico de acuerdo a la edad de inicio de los síntomas psicóticos y el cociente intelectual premórbido

Introduction: There is great variability in the cognitive performance profile, clinical presentation, course of symptoms, and subsequent functioning in individuals with a first episode of psychosis (FEP). Premorbid IQ (pIQ) and age of onset are two important prognostic factors relevant to clinical practice and broadly explored in psychosis research (1,2) that could help to explain heterogeneity in cognitive performance after FEP. Methods: The present prospective longitudinal (two-year) observational study examines the neurocognitive performance profiles of 255 individuals with FEP and 326 controls. Using ANOVA, we compared four FEP subgroups according to the following criteria: age of onset before or after 18 years old, and pIQ below or above 85. We examined cognitive changes in the subgroups with pair-wise comparisons, two-way mixed ANOVA, and repeated measures ANOVA. General objective: to characterize the neuropsychological profiles of the four subsets of individuals with a FEP defined by age of onset of psychosis (&lt;18 or ≥ 18) and p-IQ (low or average) and to compare these subgroups’ neuropsychological performance, at baseline and at two-year follow-up. Results: The subgroups with early-onset and adult-onset low pIQ showed cognitive deficits more than 1 SD below the control mean and significantly different from early- and adult-onset average pIQ subsets at both the baseline evaluation and the two-year follow-up. These deficits were in attention and processing speed (p &lt;0.001), working memory (p &lt;0.001), verbal learning and memory (p &lt;0.001), executive function (p &lt;0.001), and global cognition (p &lt;0.001). Cognitive performance in the early-onset average pIQ subgroup did not differ from that of the adults with average pIQ, and the former subgroup showed improved scores over time. Discussion: Our results suggest that the presentation of psychotic symptoms in patients with a lower than average pIQ is associated with a globally impaired profile. Estimating pIQ in the early stages of the disorder can help identify individuals who require early personalized neurocognitive intervention.

ОСОБЕННОСТИ АУТОАГРЕССИВНОГО ПОВЕДЕНИЯ ПРИ РАССТРОЙСТВАХ АУТИСТИЧЕСКОГО И ШИЗОФРЕНИЧЕСКОГО СПЕКТРОВ В ДЕТСКОМ ВОЗРАСТЕ

Relevance. Auto-aggressive harming behavior (ASB) among children and adolescents who suffer from mental disorders of various nosologies is an urgent problem and requires a special approach from the diagnosis and rehabilitation of such patients. Purpose: To identify clinical, pathopsychological and neurophysiological characteristics of ASP in children and adolescents with different etiopathogenesis depending on the manifestation within the framework of ASD and nosologies of the schizophrenic range with affective disorders. Materials and methods. The study included patients being treated in the Department of Child Psychiatry Study of the Federal State Budgetary Institution National Center for Mental Health. Two samples of patients were formed: the first sample included 30 patients (23 boys and 7 girls), the average age was 6.9 ± 2.5 years, with diagnoses according to ICD-10 ‘Childhood autism’ (DA, F84.02), ‘Atypical autism with mental retardation’ (AA with mental retardation, F84.11), ‘Atypical autism without mental retardation’ (AA without mental retardation, F84.12) with the presence of psychotic symptoms during an attack. The second sample consisted of patients with signs of nonsuicidal ASP (with traces of bodily self-harm) with moderate and severe severity within the nosologies of the schizophrenic circle. 25 female children and adolescents were examined, the average age was 14.15±0.95 years, with diagnoses according to ICD-10 of ‘Schizoaffective disorder, depressive type’ (F25.18), ‘Pseudopsychopathic schizophrenia’ (F21.4), ‘Undifferentiated schizophrenia, observation period less than a yea’ (F20.3). Research methods included clinical-psychopathological, pathopsychological, and neurophysiological studies (EEG with spectral analysis and topographic mapping), survey data with psychometric scales. Results. In patients of the 1st sample with ASD, the leading syndrome in the structure of psychosis was catatonic. Self-harm varied in clinical presentation and severity. In 16 (53%) people, self-harm was represented by palm strikes to the head and face, 11 (37%) – hitting the head against various surfaces, 6 (20%) – hitting parts of the body with the palms, and 6 (20%) – biting fingers and hands. The severity of clinical manifestations of ASP in children with ASD corresponded to the data of a psychometric examination: the severity of autism on the CARS scale was 54.3 ± 3.1, according to the general catatonia scale (BFCRS, Bush-Francis Catatonia Rating Scale, 1996) was 32.7 ± 2.5, which corresponds to a ‘severe’ degree of catatonic disorders. A pathopsychological examination of children with ASP within the framework of ASD revealed a delay in psycho-speech development with signs of the formation of a cognitive defect against the background of distorted dysontogenesis with dissociation of cognitive activity, autism, stereotypic behavior, heteroaggression and ASP, emotional flatness and pronounce dnegativism. These children howed diffuse changes in the form of an increase in the level of slow-wave θ activity, which can be considered as an EEG correlate of immaturity, acuity, and regression of mentalfunctions. Behavioral disorders in the second group of patients with nonsuicidal ASP manifest themselves within the nosologies of the schizophrenic circle (F25.18, F21.4, F20.3), occurring with hallucinatory-delusional, psychopathic-like, and negative symptoms of varying severity, against the background of moderate or severe episode with antivital manifestations, without suicidal actions. Often (in 64% of the patients), the course of the underlying disease was accompanied by cognitive deficits with impaired thinking and memory. The total score on the PANSS scale was 102.5 points, on the CGI scale 6-7 points, which corresponds to a pronounced and severe degree of psychopathological symptoms. Pathopsychological analysis in these patients revealed a dissociated type of mental development, a diversity of thinking, disturbances in the form of slips, associations with secondary symptoms, deficits of will and emotions, and disturbances in social functioning. The decrease and disorganization of the α-rhythm and the increased β-rhythm revealed on the EEG were considered assigns of suppression of the activity of the functions of the cerebral cortex and the severity of psychopathological disorders; the dominance of slow θ- and δ-rhythm sindicates the dysontogenesis of mental development with dissociation of cognitive activity and the formation of cognitive deficit.

Aggressive behavior and its associated factors among persons with mental illness: An observational study.

Aggressive behavior of psychiatric inpatients causes severe complications during treatment; nursing staff needs to understand the factors associated with aggression in inpatient units to prevent aggression. This study aimed to examine the level of aggression and its associated factors. A descriptive observational design was conducted among aggressive patients. An aggressive behavior event was observed during the aggression episode. Data were collected from 55 patients with aggressive behavior using the Staff Observation Aggression Scale-Revised (SOAS-R) and Brief Psychiatric Rating Scale (BPRS). Patient-, staff-, and ward-related factors were assessed using a structured questionnaire. About 69% of patients had a severe level of aggressive behavior. There was a significant association between gender, the severity of symptoms, staff-to-patient ratio, ward milieu, and the number of caregivers with levels of aggression. The majority of the persons with mental illness exhibited severe aggression in a psychiatric setting. Being male, the presence of psychotic symptoms, ward milieu, staff-to-patient ratio, and availability of caregivers were significantly associated with aggression. This study adds to the existing literature by focusing on managing ward-related factors (avoiding noise and overcrowding) to prevent aggressive behavior among mentally ill patients.

Trait-Related Impulsivity, Affective Temperaments and Mood Disorders: Results from a Real-World Multicentric Study.

Trait-related impulsiveness is highly prevalent in patients with mood disorders, being associated with negative outcomes. The predictive role of affective temperaments on trait-related impulsivity is still understudied. The aim of the present study is to investigate the relationship between impulsivity and affective temperaments in a sample of euthymic patients with mood disorders. This is a real-world multicentric observational study, carried out at the outpatient units of seven university sites in Italy. All patients filled in the short version of Munster Temperament Evaluation of the Memphis, Pisa, Paris and San Diego and the Barratt Impulsiveness Scale. The study sample included 653 participants, mainly female (58.2%), with a mean age of 46.9 (±14.1). Regression analyses showed that higher levels of trait-related impulsivity were associated to suicide attempts (p &lt; 0.000), the presence of psychotic symptoms during acute phases (p &lt; 0.05), a seasonal pattern (p &lt; 0.05), a lower age at onset of the disorder (p &lt; 0.05), cyclothymic (p &lt; 0.01) and irritable temperaments (p &lt; 0.01). The results of our study highlight the importance to screen patients with mood disorders for impulsivity and affective temperaments in order to identify patients who are more likely to present a worse outcome and to develop personalized and integrated early pharmacological and psychosocial treatment plans. Novelties of the present paper include the recruitment of patients in a stable phase, which reduced possible bias in patients' self-reports, and the multicentric nature of the study, resulting in the recruitment of a large sample of patients with mood disorders, geographically distributed across Italy, thus improving the generalizability of study results.

A comparison of efficacy, mechanism, and side effects of clozapine and risperidone in patients with schizophrenia

Schizophrenia is a chronic psychotic disorder characterized by the presence of psychotic symptoms (hallucinations, delusions), negative symptoms (decreased expressiveness), and cognitive symptoms (lack of executive function). The exact etiology of schizophrenia is unknown, although it is thought to be linked to increased dopaminergic activity in the mesolimbic neuronal pathway and decreased dopaminergic activity in the prefrontal cortical pathway. Treatment of schizophrenia includes both pharmacological and psychosocial intervention. Nonpharmacological treatments are effective in treating the negative and cognitive symptoms of schizophrenia and increasing patient adherence to medications. The first-generation “conventional” antipsychotic drugs are high-affinity antagonists of dopamine D2 receptors that are most effective against psychotic symptoms and atypical agents differ pharmacologically from previous antipsychotic agents in their lower affinity for dopamine D2 receptors Clozapine and risperidone both are atypical antipsychotics. Clozapine has weak D2 blocking action. It mainly acts by blocking 5-HT2, alpha-adrenergic, and D4 receptors. Risperidone acts by blocking 5-HT, alpha-adrenergic and D2 receptors. It is a more potent D2 blocker than clozapine and can cause extrapyramidal symptoms at a high dose. Aggravation of seizures more with olanzapine and fewer chances with risperidone. Clozapine is a high potential atypical antipsychotic to cause metabolic side effects, while risperidone is a low potential antipsychotic to cause metabolic side effects. Clozapine is used in the treatment of resistant schizophrenia and risperidone is the most potent atypical antipsychotic agent available in long-acting injectable form.

Is there an association between inflammatory/anti-oxidant markers and the presence of psychotic symptoms or severity of illness in mood and psychotic disorders? A multi-centric study on a drug-free sample

The immune and antioxidant systems are intimately connected and their role in the etiology of major psychiatric disorders is currently under study. The aim of this study was to evaluate the potential associations between inflammatory/antioxidant peripheral markers and presence of psychotic symptoms or severity of illness in patients affected by major psychiatric disorders.One hundred and twenty-six drug-free patients were included. A blood sample was collected to measure total/B/T lymphocytes and plasma levels of albumin, total bilirubin, uric acid, C-reactive protein, and vitamins A and E. Severity of illness was assessed using psychometric scales. Groups of patients divided according to diagnosis were compared in terms of measured markers using multivariate analyses of variance (MANOVAs). Linear and logistic regression analyses were performed to investigate the potential association between markers and severity of illness or presence/absence of psychotic symptoms.Albumin plasma levels were higher in patients with substance-induced psychotic disorder (SIPD) than subjects affected by schizophrenia (F ​= ​4.923; p ​= ​0.003). Lower vitamin E (OR ​= ​0.81; p ​= ​0.014) and T lymphocyte (OR ​= ​0.99; p ​= ​0.048) plasma levels were predictive of lifetime psychotic symptoms. Lower vitamin A levels were associated with higher Montgomery-Åsberg Depression Rating Scale scores (β ​= ​-24.26; p ​= ​0.029), independent of diagnosis.Patients with SIPD may be less vulnerable to oxidative stress. The severity of depressive symptoms, inversely associated with vitamin A plasma levels, is likely to be modulated by the degree of inflammation. Patients presenting with lifetime psychotic symptoms may be more vulnerable to oxidative stress and may have a higher activation of humoral immunity.

Determining whether Sex and Zygosity modulates the association between ApoE4 and Psychosis in Neurodegenerative Disease Cohorts using the ONDRI platform

<h3>Introduction</h3> The Apolipoprotein E (APOE) gene has been implicated in Alzheimer's disease (AD), as individuals with the APOE ε4 allele show an increased risk of developing AD compared to individuals with the more common APOE ε3 allele. Previous work by our group using a large dataset has suggested that having two copies of the APOE ε4 allele increases the likelihood of psychosis in female, but not male, carriers while one allele had no effect. It is not clear whether or not this effect extends to psychotic patients with Parkinson's disease (PD). The objective of this study was to determine the effect of the APOE ε4 allele dose on the presence of psychotic symptoms (delusions and/or hallucinations) and potential sex-specific effects in a combined AD and PD patient cohort. <h3>Methods</h3> Data on AD and PD patients in the Ontario Neurodegenerative Disease Research Institute (ONDRI) was compiled (N=266). Patients with missing data and/or an NPI total severity score of 0 were excluded, and the final sample size was N=187. APOE genotype and NPI data was gathered. Patients were classified as E4(-), E4, or E44 based on the number of APOE ε4 alleles they carry (0, 1, 2 alleles, respectively). Fisher's Exact Test was performed to determine the association between the presence of psychotic symptoms and the number of APOE ε4 alleles. <h3>Results</h3> Results from Fisher's Exact Test revealed a sex-specific effect, as there was a positive association between having 2 APOE ε4 alleles and the presence of delusions in females (p= .027). There was no effect of one allele and no effect in males, suggesting this effect is limited to females homozygous for APOE ε4. There was no significant association between hallucinations and the number of APOE ε4 alleles in males or females. <h3>Conclusions</h3> The findings of this study demonstrate that females homozygous for APOE ε4 showed a significant association with presence of delusions, not hallucinations, while the same was not discovered in males or individuals with one allele. Our findings suggest that sex and zygosity moderate the effect of APOE ε4 on delusions in a combined AD/PD cohort. Further studies are required to identify underlying mechanisms. <h3>This research was funded by</h3> This research was conducted with the support of the Ontario Brain Institute, an independent non-profit corporation, funded partially by the Ontario government. The opinions, results and conclusions are those of the authors and no endorsement by the Ontario Brain Institute is intended or should be inferred. Chart: https://apps.aagponline.org/abstracts/uploads/2022/82jltxa5mwe4xun.pdf

Prevalence of psychotic symptoms and their impact on course and outcome of patients with bipolar disorder: Findings from the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study)

AimMost of the available data on the prevalence and impact of psychotic symptoms on the course of bipolar disorder (BD) is from Western countries. We aimed to study the prevalence of at least one psychotic episode in the lifetime in patients with BD and its association with the long-term course and outcome. Methodology773 patients recruited as part of the Bipolar Disorder Course and Outcome study from India (BiD-CoIN study) were divided into 2 groups, based on the presence or absence of at least one psychotic episode in the lifetime. Results326 (42.2%) patients had at least one psychotic episode in their lifetime. At least one psychotic episode in the lifetime was associated with overall more severe illness in terms of lower age of onset, a higher number of episodes in the first 5 years of illness; higher rates of BD-II, a higher rate of lifetime history of at least 1 suicide attempt, lifetime history of hospitalization, history of receiving Electroconvulsive Therapy, and a higher prescription rates of antipsychotics. However, presence of psychotics symptoms was associated with better cognitive functioning. ConclusionsOur findings suggest that the presence of psychotic symptoms during episodes in patients with BD is associated with poorer course of BD.