Previous History Of Psychosis Research Articles

Psychoses after an antiepileptic drug administration: Frequency, timing, and duration

ObjectivesTo clarify the pathophysiology of psychoses after the new administration of antiepileptic drugs (AED), we analyzed the annual incidence, timing of development, and duration of episodes. MethodsPsychotic outcomes in the first 6-month period after an AED or non-AED administration in patients with focal epilepsy were exhaustively reviewed in eight Japanese neuropsychiatry institutions. In cases with psychotic episodes, the subtype of psychosis, timing of development, previous history of psychosis, and duration of the episode were evaluated. ResultsBetween 1981 and 2015, 5018 new drugs (4402 AED and 616 non-AED) were administered to 2067 patients with focal epilepsy. In the first 6-month period, 105 psychotic episodes occurred (81 interictal psychosis [IIP] and 24 postictal psychosis). Furthermore, 55 cases were first episodes and 50 were recurrent episodes. The frequency of psychoses is significantly higher after AED administration (n = 102) compared with non-AED administration (n = 3). Psychosis occurred most frequently in the initial 1-month period after new-AED administration and tended to decrease with increasing time.The estimated annual incidence of all psychoses after a new AED administration was 3.5% (2.0% for first-episode psychosis and 1.8% for first-episode IIP). Duration of psychoses (mean, 38.5 weeks) was equivalent to overall IIP. Duration of IIP did not shorten with discontinuation of newly administered AED. SignificancePatients with epilepsy exhibit psychosis more frequently after new AED administration than after non-AED administration. This study shows the pathophysiology of psychoses after AED administration with annual incidence, the timing of development, and the duration of PAP, which have rarely been reported.

Psychotic symptoms in COVID-19 patients. A retrospective descriptive study

Psychotic symptoms have been related to other coronavirus infections. We conducted a single-centre retrospective and observational study to describe new-onset psychotic episodes in COVID-19 patients. Ten patients infected by the novel coronavirus with psychotic symptoms and no previous history of psychosis were identified by the emergency and liaison psychiatry departments. Nine of the cases presented with psychotic symptoms at least two weeks after the first somatic manifestations attributed to COVID-19 and receiving pharmacological treatment. Structured delusions mixed with confusional features were the most frequent clinical presentations. Hence, COVID-19 patients can develop psychotic symptoms as a consequence of multiple concurrent factors.

Visual hallucinations in patients with acute stroke: a prospective exploratory study.

The incidence, underlying physiopathology, features and association with lesion topography of visual hallucinations in acute stroke have scarcely been investigated. Patients with a diagnosis of acute stroke (ischaemic or haemorrhagic) in any vascular territory, admitted within 24 h after the onset of symptoms, were consecutively included in the study. Patients with a previous history of psychosis or cognitive impairment were excluded. They and/or their caregivers answered a structured hallucination and sleep questionnaire at admission, within the first 15 days and at the clinical follow-up 3-6 months after discharge. Lesion location (IMAIOS online atlas) and leukoaraiosis (Wahlund scale) were determined by magnetic resonance imaging or computed tomography scan. Subsets of patients also underwent a neuropsychological evaluation (N = 50) and an electroencephalogram (N = 33) before discharge. In all, 77 patients with a mean age of 71 ± 12 years were included of whom 57.1% were men. The incidence of visual hallucinations was 16.7%. These hallucinations were mostly complex, in black and white and self-limited. The appearance of hallucinations was not influenced by age, sex, neuropsychological performance during admission or modified Rankin scale score at discharge. Visual hallucinations were associated with occipital cortex lesions (P = 0.04), and with sleep disturbances during and before admission (P = 0.041 and P = 0.03 respectively). Visual hallucinations are relatively frequent in patients with acute stroke and they are self-limited. Patients with occipital lesions and sleep disturbances are more likely to suffer them.

Romatoid artriti olan kadın hastada hidroksiklorokin kullanımına bağlı gelişen akut psikotik bozukluk: Olgu sunumu

Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report Chloroquine and its derivative hydroxychloroquine (HCQ) have been used for acute and prophilactic treatment of malaria for most of the last century. HCQ has anti-inflammatory, antilipidemic and antithrombotic effects and in recent years has become an important drug for treating rheumatoid arthritis (RA). In the literature, antimalarial-induced psychosis has been reported in a small number of cases; however, we did not find any case related with HCQ-induced psychosis in rheumatoid arthritis. We want to report a 73-year-old female RA patient without a previous history of psychosis who developed psychosis after use of HCQ. HCQ is being increasingly prescribed in autoimmune diseases. Clinicians need to be aware of psychosis as a rare but debilitating side effect.

Suicide Attempts in a General Hospital Emergency Room

Introduction Suicidal attempts and suicidal ideation are both frecuent causes of phychiatric assessments in an emergency hospital based unit. Objectives and Aims The aim was to determine socio-demographic variables and pshychiatric diagnosis associated with suicide attempts in the population admitted to the Emergency Room of a General Hospital in Spain. Methods We studied the prevalence of suicidal behaviour in patients assesed in the Emergency Room of Elche University Hospital (Alicante, Spain) during a period of a year. We studied different characteristics such as age, sex, association with abuse substance, the prevalence of admission to a psychiatric ward and psychiatric diagnosis associated. Results A third of Hospital Psychiatric Emergency assessments were for suicide attempt or suicide ideation. Emergency Psychiatrists assessed 262 patients with suicide attempt, 91 male and 171 female, mean age was 31 years. 7,25% of the parasuicide patients treated in the Emergency Room were hospitalized, 63,15% of them with history of psychotic symptoms. 8,33% consumed alcohol or cocaine before the suicide attempt. Conclusions The parasuicide attempts are more frequent in young women. Suicide attempt is nearly twice more frequent in women than men. The most important variable to decide admission in a psychiatric ward was found to be a previous history of psychosis.

Subcortical morphometry and psychomotor function in euthymic bipolar disorder with a history of psychosis.

Psychomotor disturbances are prominent in bipolar disorder patients with a history of psychosis, but their neural correlates remain largely unexplored. We hypothesized that these psychomotor disturbances are associated with morphometric changes in functionally specific regions of the basal ganglia and thalamus. To test if psychomotor performance is associated with changes in volume and shape in these brain regions, we investigated 20 euthymic bipolar disorder patients with a history of psychosis and 20 healthy controls with structural magnetic resonance imaging and vertex-based morphometry. Within the patient group, the local shape of the basal ganglia was significantly associated with longer duration of illness, increased number of manic episodes, and treatment with antipsychotics. There were neither any statistically significant associations between psychomotor performance and morphometric measures in the patient group, nor any significant morphometric differences between patients and controls. We conclude that euthymic subjects with bipolar disorder and a previous history of psychosis show shape changes in regions of the basal ganglia associated to clinical variables that may predict psychomotor disturbances in bipolar disorder.

Executive deficits: A continuum schizophrenia–bipolar disorder or specific to schizophrenia?

Executive dysfunction is a core deficit in schizophrenia (SCH). However, some controversy exists when examining such deficits in studies of bipolar disorder (BD). The aim of the present research was to investigate whether executive deficits were similar or distinct in both illnesses. 148 patients with BD, 262 patients with stable SCH and 108 healthy controls (CT) were recruited for the study. The BD patients were also differentiated according to the clinical subtype (BD subtype I, BDI, or subtype II, BDII) they exhibited and according to whether there was a previous history of psychosis. All subjects completed a broad neuropsychological battery. The influences of other clinical data were also evaluated. Both the BD and SCH patients showed widespread deficits in all executive tasks, with no differences between these two groups of patients. BDII patients only showed some selective deficits, and their scores on planning and inhibitory tasks fell on the continuum between the CT, the BDI and the SCH patients. Psychotic phenotypes did not influence the BD patients' performance on the battery. Other clinical variables related to illness severity did influence deficits in any subgroup of patients. Our results point to the existence of common executive disturbances in both diagnostic categories. Moreover, the inclusion of subclinical phenotypes in research may be helpful in cognitive assessment studies.

Cabergoline-Induced Psychosis in a Patient With Undiagnosed Depression

Back to table of contents Previous article Next article LettersFull AccessCabergoline-Induced Psychosis in a Patient With Undiagnosed DepressionLouai Bilal, M.D., M.Sc., and Christopher Ching, Pharm.D.Louai BilalKaiser Permanente Behavioral Health CenterSearch for more papers by this author, M.D., M.Sc., and Christopher ChingKaiser Permanente Behavioral Health CenterSearch for more papers by this author, Pharm.D.Published Online:1 Oct 2012https://doi.org/10.1176/appi.neuropsych.11110348AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Dopamine agonists bromocriptine and cabergoline are used in the medical treatment of prolactinomas.1 Emergence of psychotic symptoms is a more established association with bromocriptine treatment.2 With cabergoline it is reported once, and only in patients with known paranoid schizophrenia.3 Like other pro-dopaminergic agents, its potential to cause psychosis in patients with no history of psychosis is theoretically there, but not reported. The following is a case of cabergoline-induced psychosis in a woman with no prior psychiatric history of psychosis, who was being treated for a prolactinoma.A 44-year-old woman became convinced she was in an episode of the TV show “Hoarders.” She thought she saw a film crew from her apartment window and somehow inferred they wanted to harm her. She called 911 when she thought they infiltrated her apartment. When the police came, they took her to the psychiatric emergency room, not having found any evidence of people inside her apartment. Delusions and visual hallucinations had developed 1 week before admission. In the psychiatric unit, a detailed history uncovered that she had been being treated for a prolactinoma with cabergoline for 3 months. Before cabergoline, the patient was treated with bromocriptine, but this was changed because of complaints of lethargy.Cabergoline was stopped, and, without need to give an antipsychotic, all symptoms revolved within 48 hours of observation in the hospital. Review of psychiatric symptoms after resolution of psychosis uncovered some sadness, poor energy, passive suicidal thoughts, free-floating anxiety, excessive alcohol use, and a history of compulsive hoarding, with some frequent hand-washing, but no noted obsessions or other compulsions. Stressors included unemployment, social isolation, and breaking up with boyfriend of many years. She remembered feeling depressed for many years and not seeking any psychiatric treatment. She has a family history of attempted suicide in her father and completed suicide in an uncle. She accepted a referral to an intensive outpatient program and deferred starting any further treatment to that setting. The patient’s progress was monitored over 1 month after hospital discharge, and no symptoms of psychosis were noted.To our knowledge, this is the first reported case of cabergoline-induced psychosis in a patient with no previous history of psychosis. Our patient reported a history of long-standing untreated depression, compulsive hoarding, self-medicating with alcohol, and many psychosocial stressors. We wondered if patients with severe depression, in particular, constituted a clinical population who warrant careful monitoring when they are prescribed caberogoline because of fear of inducing psychosis. This, we feel, is a potentially important clinical situation that deserves further study.Kaiser Permanente Behavioral Health CenterNone of the authors have any relevant conflicts of interests to disclose.References1 Ali S, Miller KK, Freudenreich O: Management of psychosis associated with a prolactinoma: case report and review of the literature. Psychosomatics 2010; 51:370–376Crossref, Medline, Google Scholar2 Boyd A: Bromocriptine and psychosis: a literature review. Psychiatr Q 1995; 66:87–95Crossref, Medline, Google Scholar3 Chang SC, Chen CH, Lu ML: Cabergoline-induced psychotic exacerbation in schizophrenic patients. Gen Hosp Psychiatry 2008; 30:378–380Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByTreatments of psychiatric disorders, hyperprolactinemia and dopamine agonistsBest Practice & Research Clinical Endocrinology & Metabolism, Vol. 379Treatment of Prolactinoma13 August 2022 | Medicina, Vol. 58, No. 8Start low, go slowly – mental abnormalities in young prolactinoma patients under cabergoline therapyJournal of Pediatric Endocrinology and Metabolism, Vol. 32, No. 9Asian Journal of Psychiatry, Vol. 31Archives of Endocrinology and Metabolism, Vol. 62, No. 2Clozapine Treatment for Cabergoline-Induced Psychosis in a Patient With a Giant ProlactinomaRodrigo Pérez-Esparza, M.D., M.Sc., Carlos Alberto Rojas-Guerrero, M.D., Gerson Geovany Andino-Rios, M.D., Patricia Arias-Garro, M.D., Jesús Ramírez-Bermúdez, M.D., Ph.D., Lesly Portocarrero-Ortiz, M.D., M.Sc.27 February 2017 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 29, No. 3Australian and New Zealand Journal of Obstetrics and Gynaecology, Vol. 56, No. 4Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, Vol. 26, No. 2Gynecological Endocrinology, Vol. 31, No. 10Cabergoline2 March 2013 | Reactions Weekly, Vol. 1441, No. 1 Volume 24Issue 4 Fall 2012Pages E54-E54 Metrics None of the authors have any relevant conflicts of interests to disclose.PDF download History Published online 1 October 2012 Published in print 1 October 2012

The most vulnerable travelers: patients with mental disorders

Severe mental illness occurring abroad is a difficult situation for patients, their families, and the local medical community. Patients with mental problems are stigmatized due to both their mental illness and the fact that they are foreigners in an unfamiliar country 1. The appropriate treatment is often delayed, while patients are often dealt with in a manner that violates their human rights. Repatriation, which is associated with a better outcome of the mental disorder 2, is often delayed due to the lack of international protocols for the transportation and treatment of mentally ill travelers. Acute travel-induced psychotic attacks are a well-known phenomenon in travelers without a previous history of psychosis. Young adults may experience their first psychiatric episode abroad 3. Elderly people are also susceptible to these attacks 4. Patients with a pre-existing mental illness almost never seek for pre-travel advice, so the prevention of any acute exacerbation is difficult. Specialists in travel medicine usually have little experience with these issues as they usually focus on infectious diseases. There is research evidence that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than two months of therapy at home 5,6. The acute psychotic attacks represent about one fifth of travel-related psychiatric problems. Psycho-organic problems during leisure activities are as high as 5% 7. In a French sample, 15–20% of repatriations were due to psychiatric illness. These problems were predominant in long-term travelers, migrants or expatriates. According to international standards, public transportation should not be used for acute psychotic patients, unless stabilized on medication and accompanied by a knowledgeable companion 8. Most travel insurance policies exclude treatment and repatriation costs incurred due to acute mental illness. Modifying the approach to this issue by police, airport security, and insurance companies represents a challenge for psychiatrists. We believe that a clear set of guidelines, similar to those recently published by the WPA on other mental health issues 1,9,10,11, could help in detecting and managing the traveler with mental disorders abroad. An appropriate preparation of people with mental disorders who have to travel and the application of a protocol for repatriation when needed should decrease the reluctance of insurance companies to cover these patients. The issue, however, is more complex than it may appear. In fact, while it is probably true that many clinicians have difficulties to memorize, recall and correctly apply operational diagnostic criteria, it should not be taken for granted that they will not have problems to memorize, recall and correctly apply prototypes proposed by a diagnostic system. Many clinicians are reluctant to change the templates of mental disorders they have built up in their mind along the years. Being influenced by those templates, they may selectively catch or recall the various features of a prototype, or may read in a prototype description elements which are not actually there. Moreover, the expectation that a given patient will present the various components of a prototype may lead the clinician to infer the presence of clinical aspects which do not actually appear in that patient. Finally, a clinician may conclude that a patient matches a given prototype because several elements of the prototype description are present, while another clinician may conclude that the same patient does not match that prototype because some other aspects are absent. These are indeed the biases that the operational approach aimed to correct, and the risk of a return to the diagnostic chaos preceding the publication of the DSM-III should not be overlooked.

Topiramate-Induced Psychosis

Back to table of contents Previous article Next article Letter to the EditorFull AccessTopiramate-Induced PsychosisDANA KOBER, M.D., and GLEN O. GABBARD, M.D., DANA KOBERSearch for more papers by this author, M.D., and GLEN O. GABBARDSearch for more papers by this author, M.D., Houston, Tex.Published Online:1 Aug 2005https://doi.org/10.1176/appi.ajp.162.8.1542AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: With the use of topiramate as a strategy for treatment-resistant bipolar disorder (1)—not to mention other off-label uses for conditions such as borderline personality disorder (2) and eating disorders (3)—clinicians need to be aware of the possibility of topiramate-induced psychosis in patients who have not previously had a psychotic episode. Although there is a small amount of literature in neurology journals regarding psychiatric adverse events in seizure patients (4), the psychiatric literature is largely silent on the subject (5). We report on a patient without a previous history of psychosis who developed psychosis after an increase in his dose of topiramate.Mr. A was a 32-year-old man with obsessive-compulsive disorder who was initially administered 25 mg/day of topiramate for mood stabilization and weight loss. Eight months later, his dose was increased from 150 mg b.i.d. to 200 mg b.i.d. Within 1 week of the increase, he became paranoid, believed he was “the messiah,” and intended to sacrifice himself as directed by God. He also developed disorganized and illogical thought processes and a flattened affect. He appeared to be responding to internal stimuli. Mr. A was transferred to our care 2 months later, after having no improvement with a reduction in his dose of topiramate and the use of risperidone, 6 mg b.i.d. After discontinuation of topiramate, he became less paranoid and more organized, and his affect brightened. He improved continuously throughout the day, and within 24 hours, his psychosis had resolved.The anticonvulsant topiramate is known to cause cognitive adverse events. Psychiatric adverse events reported in the neurology literature include paranoid delusions, visual and auditory hallucinations, depression, aggressive behavior, and irritability (4). In some case reports of patients with seizure disorder, a decrease in the dose of topiramate resulted in resolution of the psychosis (6). Although no controlled trials have shown topiramate to be adequate for mood stabilization, clinicians need be aware of adverse psychiatric events in patients taking topiramate and consider decreasing the dose or discontinuing the medication altogether.

Psychiatric symptoms after therapy with new antiepileptic drugs: Psychopathological and seizure related variables

The purpose of this paper is to understand the association between antiepileptic drugs (AEDs), patient characteristics, changes in seizure pattern and emergent psychiatric disorder, i.e. psychosis or affective disorder. To this end we carried out a retrospective casenote study on 89 patients who developed psychiatric symptoms during treatment with topiramate, vigabatrin or tiagabine. The psychiatric problem was either an affective or a psychotic disorder (not including affective psychoses). It was discovered that 99% of the patients suffered from complex partial seizures with or without secondary generalization. More than half were on polytherapy with two or more other AEDs. Nearly two-thirds had a previous psychiatric history. There was a strong association between the type of previous psychiatric illness and the type of emerging psychiatric problem, both for psychoses and for affective disorders. Patients on vigabatrin had an earlier onset of epilepsy and more neurological abnormalities than those on topiramate. Those patients on lower doses had a shorter interval between the start of the AED therapy and the onset of the psychiatric problem. A seizure-free period was observed in more than half of the patients before they developed the psychiatric symptoms, and of these more were likely to develop a psychosis rather than an affective disorder. There seemed to be an association of suppression of right-sided seizures and the onset of the psychiatric problem. The conclusions drawn were that patients with a previous history of psychosis or affective disorder tended to develop the same psychiatric problem with new AEDs. Those with a seizure-free period before the onset of the psychiatric problem were more likely to develop a psychosis than an affective disorder.

Psychotic disorders in urban areas: Results from the Australian National Survey 1997–1998

As part of the National Survey of Mental Health and Wellbeing, the study on psychotic disorders in four urban areas (Brisbane, Canberra, Melbourne and Perth) included onemonth census and screening of all contacts with treatment and social agencies for individuals meeting criteria for psychosis. Of 3800 screen-positive persons (age 18-64), 980 (including public service users, patients of private practitioners, and homeless people) were sampled and assessed with a structured diagnostic interview. Further 146 interviewees were individuals with previous history of psychosis but no contacts for 1 to 3 years prior to census.

Correlates of psychotic symptoms among elderly outpatients

Psychotic symptoms presenting in late life can offer a diagnostic challenge to the clinician. In this study, 140 geriatric outpatients were prospectively examined for psychotic symptoms and assessed on a number of demographic and clinical variables. Cognition was assessed using the Mini-Mental State Exam. Psychiatric diagnoses were made by DSM-III-R criteria. Twenty-seven per cent (N = 38) had psychotic symptoms, delusions being the most common type. Patients with psychosis were significantly more likely to have a previous history of psychosis, to have a lower MMSE and to live in a nursing home. Four diagnoses accounted for 79.5% of all psychotic patients. In order of frequency, these were dementia, major depression, delirium and organic psychosis (organic hallucinosis, organic delusional disorder). Psychotic patients were significantly more likely to have a diagnosis of dementia, delirium or organic psychosis than non-psychotics, but depression was significantly more likely to occur in patients without psychosis. Although psychotic symptoms occur in a variety of illnesses, elderly patients with psychosis should be carefully evaluated for these disorders.

Termination of pregnancy and psychiatric morbidity.

We investigated whether reported psychiatric morbidity was increased after termination of pregnancy compared with other outcomes of an unplanned pregnancy. This was a prospective cohort study of 13,261 women with an unplanned pregnancy. Psychiatric morbidity reported by GPs after the conclusion of the pregnancy was compared in four groups: women who had a termination of pregnancy (6410), women who did not request a termination (6151), women who were refused a termination (379), and women who changed their minds before the termination was performed (321). Rates of total reported psychiatric disorder were no higher after termination of pregnancy than after childbirth. Women with a previous history of psychiatric illness were most at risk of disorder after the end of their pregnancy, whatever its outcome. Women without a previous history of psychosis had an apparently lower risk of psychosis after termination than postpartum (relative risk RR = 0.4, 95% confidence interval CI = 0.3-0.7), but rates of psychosis leading to hospital admission were similar. In women with no previous history of psychiatric illness, deliberate self-harm (DSH) was more common in those who had a termination (RR 1.7, 95% CI 1.1-2.6), or who were refused a termination (RR 2.9, 95% CI 1.3-6.3). The findings on DSH are probably explicable by confounding variables, such as adverse social factors, associated both with the request for termination and with subsequent self-harm. No overall increase in reported psychiatric morbidity was found.

Life Stress and Post-Partum Psychosis: a Preliminary Report

This is a preliminary report from a prospective study of the influence of psychosocial stressors on post-natal relapse in women at high risk of psychiatric disorder after childbirth. Forty-three index subjects with a previous history of psychosis or severe depression were compared with 45 pregnant control subjects without any previous psychiatric disorder. After delivery 51% of index subjects relapsed (RDC diagnoses): 28% were categorised as psychotic and 23% non-psychotic. All psychotic relapses were in women with a previous history of bipolar or schizoaffective disorder (46% of this subgroup). Only the non-psychotic post-partum relapses (mostly depressions) were associated with an increased likelihood of a severe life event in the 12 months preceding illness onset.

Capgras Delusion and Seizures in Association With Therapeutic Dosages of Disulfiram

We have described a patient in whom EEG abnormalities, a seizure disorder, and Capgras syndrome developed two weeks after she started taking disulfiram. That disulfiram has been shown to inhibit dopamine beta-hydroxylase in vitro suggests an etiologic role for dopaminergic pathways in at least some cases of Capgras syndrome. Our experience with this patient suggests that convulsions and psychosis may occur as a side effect of standard dosages of disulfiram in patients with no previous history of psychosis or brain disease. Furthermore, the symptoms may resolve spontaneously without the long-term use of antipsychotic or anticonvulsant medication.

The performance of manic patients on the "grid test for schizophrenic thought disorder'.

It can be difficult to make a confident diagnosis and one that will stand the test of time when a person without a family history or previous history of psychosis presents as psychotic with overactivity, pressure of talk, loose association of ideas and perhaps some paranoid ideation. He may be schizophrenic or manic. The nature of the disturbance of speech, and by inference thought, may assist in making the clinical diagnosis, but standard textbooks (Slater and Roth, 1969; Freedman and Kaplan, 1967) state that pressure of speech, flight of ideas, clang associations, distractibility and inability to adhere to a line of thought are common to both conditions.