Primary Psychotic Disorders Research Articles

Mental Health Assessment in Patients Admitted to Iran Psychiatric Hospital with a Diagnosis of Psychosis Due to 2 - 5 Years of Methamphetamine Use

Background: Psychotic disorder due to methamphetamine has a high prevalence with an unknown nature and history. Patients with such disorders are faced with the risk of recurrence of abuse and other psychiatric disorders. Methamphetamine-induced psychotic disorders may continue by independent of methamphetamine abuse, such as primary psychotic disorders (such as schizophrenia). Objectives: This study was performed to evaluate the mental health and frequency of methamphetamine-induced psychosis in patients referred to Iran psychiatric hospital (a university hospital in Tehran, Iran). Patients and Methods: The research was done on patients with methamphetamine-induced psychosis after 2 to 5 years using of methamphetamine (150 person in the Iran Psychiatric Hospital) .The diagnostic interview was done based on a semi-structured interview (SCID). The data was analyzed by Binary Logistic Regression Model. Results: From 150 patients that were followed, 6 of them (4.0%) died during the phone interview-follow up. The mean age of alive patients was 34.9 ± 8.7 years and 12 of them were women (8.0%). At the follow-up interview, 38 patients reclassified as the cases of schizophrenia (25.3%), 17 as the cases of major depressive disorder (11.3%), 7 as the cases of bipolar disorder type I (4.7), two as the cases of schizoaffective disorder (1.3%), and two of them as the cases of delusional disorder (1.3%). A total of 84 cases (56.0%) were diagnosed as recovered cases or as methamphetamine-induced psychotic disorders. Prediction of diagnosis change showed the diagnosis of methamphetamine use disorder (adjusted OR = 3.978, 95% CI: 1.265 - 12.512), previous psychiatric admission (adjusted OR = 6.749; 95% CI: 1.639 - 27.779), and short duration of psychotic episode (adjusted OR = 0.171; 95% CI: 0.056 - 0.520. Conclusions: The results of our study show that methamphetamine-induced psychotic disorders are associated, in many cases, with the mood disorders. It seems that comorbid mood disorders, age of first use, history of previous psychiatric hospitalization, the risk of methamphetamine use disorders, and psychotic episodes are associated longer with the diagnosis towards primary psychotic disorders.

Neuroanatomical correlates of perceptual aberrations in psychosis

BackgroundAberrations in body perception are common in psychotic disorders. The insula and temporoparietal junction (TPJ) are involved in body ownership and spatial perception suggesting that abnormal structure of these regions might be related to the expression of perceptual aberrations in psychosis. Methods58 individuals with a primary psychotic disorder and 40 healthy subjects completed the Chapman Perceptual Aberration Scale (PAS) and underwent structural magnetic resonance imaging (MRI). Grey matter volume was extracted from a-priori defined TPJ, whole insula, and insula sub-division regions-of-interest (ROIs) and correlated with PAS scores. Additionally, a voxel-based morphometry (VBM) analysis examining the correlation between voxel-wise grey matter volume and PAS scores was conducted. ResultsPAS scores in psychosis patients correlated with bilateral whole insula (right: r=−0.30, p=0.026; left: r=−0.35, p=0.011) and right TPJ (r=−0.27, p=0.024) volumes. The correlation between grey matter volume and PAS was strongest for the posterior sub-division of the insula (right: r=−0.32, p=0.017; left: r=−0.37, p=0.006). VBM analyses confirmed the ROI results: negative correlations with PAS were identified in clusters within the posterior and dorsal anterior insula, and the right TPJ. An exploratory, whole-brain analysis also revealed two additional regions located in the left middle orbitofrontal gyrus and left inferior temporal gyrus that inversely correlated with PAS scores. ConclusionsPerceptual aberrations in individuals with psychosis are related to lower grey matter volume in the insula and TPJ. This relationship was strongest in the posterior region of the insula and right TPJ; brain areas that have been implicated in interoception and somesthesis.

Synthetic Cannabinoid Use in a Transitional Housing Shelter: A Survey to Characterize Awareness of Risks and Reasons for Use

Synthetic Cannabinoid Use in a Transitional Housing Shelter: A Survey to Characterize Awareness of Risks and Reasons for Use

P.5.f.002 - Misdiagnosis of epilepsy psychosis and treatment issues

The recognition and treatment of psychosis in persons with epilepsy (PWE) is recommended with the apparent dilemma between treating psychosis and opening the possibility of exacerbating seizures. The pooled prevalence estimate of psychosis in PWE is 5.6%. It has been proposed that a ‘two hit’ model, requiring both aberrant limbic activity and impaired frontal control, may account for the wide range of clinical phenotypes. The role of antiepileptic drugs in psychosis in PWE remains unclear. Alternating psychosis, the clinical phenomenon of a reciprocal relationship between psychosis and seizures, is unlikely to be an exclusively antiepileptic drug-specific phenomenon but rather, linked to the neurobiological mechanisms underlying seizure control. Reevaluation of antiepileptic treatment, including the agent/s being used and degree of epileptic seizure control is recommended. The authors found very few controlled studies to inform evidence-based treatment of psychosis in PWE. However, antipsychotics and benzodiazepines are recommended as the symptomatic clinical treatments of choice for postictal and brief interictal psychoses. The general principle of early symptomatic treatment of psychotic symptoms applies in epilepsy-related psychoses, as for primary psychotic disorders. In the authors' experience, low doses of antipsychotic medications do not significantly increase clinical risk of seizures in PWE being concurrently treated with an efficacious antiepileptic regimen.

Psychotic disorders in DSM-5 and ICD-11.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was published by the American Psychiatric Association (APA) in 2013, and the Work Group on the Classification of Psychotic disorders (WGPD), installed by the World Health Organization (WHO), is expected to publish the new chapter about schizophrenia and other primary psychotic disorders in 2017. We reviewed the available literature to summarize the major changes, innovations, and developments of both manuals. If available and possible, we outline the theoretical background behind these changes. Due to the fact that the development of ICD-11 has not yet been completed, the details about ICD-11 are still proposals under ongoing revision. In this ongoing process, they may be revised and therefore have to be seen as proposals. DSM-5 has eliminated schizophrenia subtypes and replaced them with a dimensional approach based on symptom assessments. ICD-11 will most likely go in a similar direction, as both manuals are planned to be more harmonized, although some differences will remain in details and the conceptual orientation. Next to these modifications, ICD-11 will provide a transsectional diagnostic criterion for schizoaffective disorders and a reorganization of acute and transient psychotic and delusional disorders. In this manuscript, we will compare the 2 classification systems.

Psychosis of epilepsy: a multifaceted neuropsychiatric disorder.

Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy. The prevalence of POE is more than 7 times higher than the frequency of primary schizophreniform disorders in the general population. While POE has been associated with focal epilepsy of temporal and frontal lobe origin, its etiology and pathophysiology of POE have yet to be established.The treatment of all forms of POE, with the exception of ictal psychotic episodes, requires the use of antipsychotic drugs, preferably the atypical antipsychotic agents with a very low or negligible potential to lower the seizure threshold (eg, risperidone, apiprazole), starting at a low dose with stepwise increments.

Symptom Profile of Substance-induced Psychosis Versus Primary Psychosis in a Sample of Egyptian Patients: A Preliminary Study

Introduction: There is an extensive literature on the link between psychosis and substance use. The nature of this association has been a matter of controversy for the last 2 decades, especially the possible cause effect relationship that may be involved in this association. The differential diagnosis of substance-induced psychotic disorder and primary psychotic disorder is particularly challenging during an acute admission when psychotic symptoms are the most severe and the identification of possible markers of these disorders could simplify their recognition and treatment. Objectives: The main objective of the current study was to compare the clinical picture between a sample of patients with substance-induced psychosis (SIP) and patients with primary psychosis, as regards the phenomenological aspects and to study the different correlates affecting their clinical picture. Materials and Methods: A comparative cross-sectional study including 22 patients with first-episode psychotic disorder recruited from the inpatient wards of the Institute of Psychiatry Ain-Shams University. All patients were interviewed between 1 week and 1 month of onset of symptoms using Structured Clinical Interview for DSM-IV (SCID-I) and Positive and Negative Syndrome Scale (PANSS). Patients were labeled into 2 groups according to diagnosis, group I: patients fulfilling criteria of brief psychotic episode. Group II: patients fulfilling criteria of substance-induced psychotic disorder. Results: No statistical difference between the 2 studied groups as regard PANSS score positive, negative, and general psychopathology, as well as the severity of symptoms. However, further analysis of the PANSS score components showed SIP group to have significantly higher P4 (excitement) score (P=0.02), G10 (disorientation) score (P=0.03), and G11 (poor attention) score (P=0.004). Conclusions: This study adds to a growing body of literature highlighting the differences between SIP and primary psychosis. It provides set of variables that distinguish the substance-induced and primary psychosis groups from one another, which should be an area for further studies.

Psychiatric correlates in deficit of immunoglobulins

Introduction Many neurological, oncological and autoimmune diseases may have psychiatric symptoms; these diseases sometimes start with these symptoms, so the diagnosis may be confused and the treatment is delayed. Objective Review the relationship between the secondary immune deficiency and increased predisposition to infectious processes and the psychopathological conditions which manifest themselves in some cases in these situations. Methods A 17-year-old male patient, who began psychiatry consultations when he was 3 years old due to psychomotor delay and behavior disorders. He was diagnosed with ADHD and mild mental retardation. Medical history: Viral encephalitis; Perthes disease; recurrent urinary tract infections; intestinal giardiasis; Alport syndrome. He's being treated with aripiprazole 5mg (1/2-0-0). The patient presents an episode of perplexity, psychotic anguish, auditory hallucinations and paranoid delusion. The patient presented an infectious process with general malaise, diarrhea and vomiting during previous days. Results The patient was assessed by the Departments of internal medicine, neurology and psychiatry. A cerebral TAC, lumbar puncture, EEG and urine porphyrins were requested. The secondary immune deficiency makes the patient more vulnerable in an infectious process. Discussion The diagnosis of psychotic disorder due to medical condition may be transient or recurrent. Treating of the medical condition often gets resolution of psychosis, although the symptoms can persist in some cases. There is often a prodomo of viral syndrome weeks before the rest of symptoms appear. The differential diagnosis should be made with primary psychotic disorders, affective disorders, confusional syndromes, impulse control disorder or sleep disorders, neuroleptic malignant syndrome, serotonin syndrome and substance-induced psychotic disorders.

The importance of descriptive psychopathology in differential diagnosis of dissociative disorders: A case report

IntroductionSome kinds of hallucinations are misdiagnosed due to primary psychotic disorders. Hallucinations can be classified into 3 categories: true hallucinations, pseudo-hallucinations and hallucinosis. True hallucinations are different from the others due to incapacity of insight of the unreal and pathologic character of the phenomenon.ObjectivesThis study reports a case initially diagnosed as psychotic depression that after a rigorous psychopathologic investigation revealed to be an unspecified dissociative disorder.Case presentationTwenty-four-year-old female, with a past of psychiatric treatment since 18-years-old, reports brief dysphoric episodes associated with visions of bleeding clowns and skulls that were always connected to a psychosocial stressor. At the interview she asserts that she understands those symptoms as pathological and caused by her mind, and associate them with external stressors. These episodes were brief and remitted spontaneously. The mental state examination did not show any psychopathological disturbance. The reduction and suspension of antipsychotics did not result in worsening of these symptoms.ResultsThe psychopathological disturbances reported by the patient did not represent a true hallucination. The presence of insight, the evolution and duration of the symptoms, and the association with psychosocial stressors has shown that the phenomena and symptoms are associated to a dissociative disorder. Therefore, the prescription of antipsychotics involves unnecessary pharmacological and clinical risks for this patient at the moment.ConclusionDespite the use of psychopathology is considered by some as outdated, it is still an important semiological instrument for an accurate diagnosis and planning therapeutic conduct.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Correlates of transient versus persistent psychotic symptoms among dependent methamphetamine users

This study examined correlates of transient versus persistent psychotic symptoms among people dependent on methamphetamine. A longitudinal prospective cohort study of dependent methamphetamine users who did not meet DSM-IV criteria for lifetime schizophrenia or mania. Four non-contiguous one-month observation periods were used to identify participants who had a) no psychotic symptoms, (n=110); (b) psychotic symptoms only when using methamphetamine (transient psychotic symptoms, n=85); and, (c) psychotic symptoms both when using methamphetamine and when abstaining from methamphetamine (persistent psychotic symptoms, n=37). Psychotic symptoms were defined as a score of 4 or greater on any of the Brief Psychiatric Rating Scale items of suspiciousness, hallucinations or unusual thought content. Relative no psychotic symptoms, both transient and persistent psychotic symptoms were associated with childhood conduct disorder and comorbid anxiety disorders. Earlier onset methamphetamine use and being male were more specifically related to transient psychotic symptoms, while a family history of a primary psychotic disorder and comorbid major depression were specifically related to persistent psychotic symptoms. We conclude that there are overlapping but also distinct clinical correlates of transient versus persistent psychotic symptoms, suggesting potentially heterogeneous etiological pathways underpinning the psychotic phenomena seen amongst people who use methamphetamine.

The profile of psychiatric symptoms exacerbated by methamphetamine use

BackgroundMethamphetamine use can produce symptoms almost indistinguishable from schizophrenia. Distinguishing between the two conditions has been hampered by the lack of a validated symptom profile for methamphetamine-induced psychiatric symptoms. We use data from a longitudinal cohort study to examine the profile of psychiatric symptoms that are acutely exacerbated by methamphetamine use. Methods164 methamphetamine users, who did not meet DSM-IV criteria for a lifetime primary psychotic disorder, were followed monthly for one year to assess the relationship between days of methamphetamine use and symptom severity on the 24-item Brief Psychiatric Rating Scale. Exacerbation of psychiatric symptoms with methamphetamine use was quantified using random coefficient models. The dimensions of symptom exacerbation were examined using principal axis factoring and a latent profile analysis. ResultsSymptoms exacerbated by methamphetamine loaded on three factors: positive psychotic symptoms (suspiciousness, unusual thought content, hallucinations, bizarre behavior); affective symptoms (depression, suicidality, guilt, hostility, somatic concern, self-neglect); and psychomotor symptoms (tension, excitement, distractibility, motor hyperactivity). Methamphetamine use did not significantly increase negative symptoms. Vulnerability to positive psychotic and affective symptom exacerbation was shared by 28% of participants, and this vulnerability aligned with a past year DSM-IV diagnosis of substance-induced psychosis (38% vs. 22%, χ2(df1)=3.66, p=0.056). ConclusionMethamphetamine use produced a symptom profile comprised of positive psychotic and affective symptoms, which aligned with a diagnosis of substance-induced psychosis, with no evidence of a negative syndrome.

A 20 Year Practice Review of Electroconvulsive Therapy for Adolescents.

Clinical reviews of practice outcomes of adolescent patients who have received electroconvulsive therapy (ECT) remain relatively rare. This study reports the clinic practice and outcome of adolescents receiving ECT at a tertiary medical center. From April 1991 through November 2013, 51 adolescents (30 female; mean [SD] age, 16.8 [1.6] years) received ECT. The electronic medical record at the time of the first ECT session was reviewed for the clinical diagnosis, ECT lead placement and general administration, seizure duration, adverse effects, concurrent medications, and clinical outcome. ECT was recommended for primary mood and psychotic disorders or catatonia. Patients received a mean (SD) of 9.3 (3.5) treatments, with initial bitemporal lead placement in 36 patients (71%). Thirty-nine patients (77%) were much or very much improved based on Clinical Global Impressions-Improvement scale at the end of the acute treatment. Prolonged seizure duration (>120 seconds) was relatively common (63%) but appeared to decrease in older patients. This report describes the largest group of adolescents receiving ECT since 1947, and supports ECT as a safe and effective modality for most treatment-recalcitrant psychiatric illness in youth.

Cannabis-induced psychosis or Cannabis-associated psychosis: Diagnostically no clear winner

Cannabis is the most commonly used illicit drug worldwide including India. The role of Cannabis in the causation of psychiatric disorders, especially psychosis remains debatable. Cannabis use has been reported to present with symptoms similar to those of schizophrenia and bipolar affective disorder. The distinction between Cannabis-induced psychoses and primary psychotic disorder is important from management perspective as it would determine the need and duration of antipsychotic medications, as well as relative focus on the management of substance use. At times, however, such a distinction may be difficult to make. We present a case where we were faced with difficulty labeling the origin of psychotic symptoms in a patient who was otherwise a heavy user of Cannabis. Management options considered in the presence of insoluble diagnostic problem have also been discussed.

McLean OnTrack: a transdiagnostic program for early intervention in first-episode psychosis.

Most programs specializing in the treatment of first-episode psychosis in the United States focus on schizophrenia. However, many early psychosis patients do not fit into this diagnostic category. Here we describe McLean OnTrack, an intensive outpatient treatment program that accepts all comers with first-episode psychosis. We assessed baseline characteristics of patients in the 2.5 years since program initiation. We examined how initial referral diagnoses compare with current diagnoses, calculating the proportion of diagnostic changes. At 2.5 years, patients in McLean OnTrack consist of 30 (33.0%) individuals with primary psychotic disorder, 40 (44.0%) with affective psychosis, 19 (20.9%) with psychotic disorder not otherwise specified (NOS) who do not meet full criteria for either category and two (2.2%) individuals with no psychosis. Although patients with affective psychosis had higher pre-morbid functioning, all three categories of psychosis had similar rates of prior hospitalizations and substance use. The retention rate in the psychotic disorder NOS group was lower than that in affective and primary psychotic disorders. Finally, diagnoses changed over the course of treatment in 50.5% of patients. Diagnostic heterogeneity appears to be the norm among patients with first-episode psychosis, and diagnoses commonly evolve over the illness course. Baseline indices of illness severity were similar across categories and suggest the need for early intervention, irrespective of specific diagnosis. We discuss the benefits and challenges of a transdiagnostic approach to early intervention in first-episode psychosis, treating patients who share many but not all characteristics.

Schizophrenia in 2020: Trends in diagnosis and therapy.

Schizophrenia research is providing an increasing number of studies and important insights into the condition's etiopathogenesis based on genetic, neuropsychological and cranial neuroimaging studies. However, research progress has not yet led to the incorporation of such findings into the revised classification criteria of mental disorders or everyday clinical practice. By 2020, schizophrenia will most likely still be a clinically defined primary psychotic disorder. While there is some hope that treatment will be improved with new antipsychotic drugs, drugs addressing negative symptoms, more refined psychotherapy approaches and the introduction of new treatment modalities like transcranial magnetic stimulation, an additional hope is to improve early detection and prevention. As the results of new research into the etiopathogenesis of schizophrenia are promising to improve diagnosis, classification and therapy in the future, a picture of complex brain dysfunction is currently emerging requiring sophisticated mathematical methods of analysis. The imminent clinical challenge will be to develop comprehensive diagnostic and treatment modules individually tailored to the time-variable needs of patients and their families.

Psychotic Disorders in ICD-11

SummaryFor the development of ICD-11, the World Health Organization (WHO) has inaugurated a Working Group on the Classification of Psychotic Disorders (WGPD). A range of changes of the classification of primary psychotic disorders was developed by this group. While DSM-5 was published in 2013, the ICD-11 proposals are currently undergoing internet-based and clinical field trials and the final version is due in 2017. Among the major changes suggested by the WGPD for ICD-11 are the chapter titles, the replacement of the current schizophrenia subtypes by a number of symptom specifiers, a new set of course specifiers harmonized with DSM-5, transsectional diagnostic criteria for schizoaffective disorder, and a reorganization of the acute and transient psychotic disorders and delusional disorders.

Hospital-based Clinical Forensic Program in Violence Risk Assessment: Utilization and Management Considerations

Introduction Risk assessment of future disruptive and violent acts is of great importance to public protection and care in the medical setting. The VA Puget Sound created a Disruptive Behavior Evaluation Clinic, which utilizes clinical forensic risk evaluations in its assessments of veterans with disruptive Patient Record Flags or at elevated risk for violent behavior. Objectives This poster will review the results of a utilization study of the Disruptive Behavior Evaluation Clinic after its first two years in operation. Aim To better understand the utilization of the clnic for future targeted interventions and allocation of resources to reduce risk of violent or disruptive behavior at the facility. Methods Medical charts of all evaluees assessed in the Disruptive Behavior Evaluation Clinic were reviewed to assess the evaluee characteristics, mental health and substance abuse histories, recommendations from the forensic evaluator, whether recommendations were followed, and disposition of persons evaluated in the facility's Disruptive Behavior Evaluation Clinic. Results Results indicate that the most common diagnoses for persons evaluated in the clinic to date were alcohol or substance use disorders, personality disorder, and primary psychotic disorders. Demographics, referral source, and disposition outcomes were tabulated. As a result of the forensic risk assessment reports generated by the clnic several evaluees subsequently qualified for housing services. Conclusion The information on utilization is helpful to better assess the characteristics of veterans most prone to violence at one VA facility. It helps the facility allocate risk reduction resources to targeted clinics or programs.

The clinical and psychosocial profile of inmates in psychiatric hospitals in the State of Ceará, Brazil

One of the most vexing problems in the context of psychiatric reform are the inmates of psychiatric hospitals institutionalized for one year or more. The long periods of hospitalization indicate that these inmates have been abandoned, which can aggravate their psychiatric disorders. This article seeks to trace a socio-demographic and clinical profile of the inmates of psychiatric hospitals in the State of Ceará, Brazil. It is a cross-sectional study, based on reviews of medical registers, interviews and application of two scales: the Katz Index and the PANSS. Most of the 39 participants were men, single and of an economically active age. Information on education (69.2%) and religion (66.7%) were not known and for 12.8%, their marital status was unknown. Nearly 75% received no visits from friends or relatives. Two thirds maintained total independence to perform ADLs (Activities of Daily Living). The majority were admitted for primary psychotic disorder (76.8%). These manifested a marked negative syndrome in 96.7% of cases. The study highlights the situation of abandonment and loss of citizenship experienced by chronically institutionalized patients. It is questionable to what extent hospitals are prepared to offer the assistance that this population needs.

Delusion of Snake Infestation Following Sexual Intercourse: Report of Two Cases

Delusional infestation, a condition wherein a person believes his or her body to be infested with living organisms, has been observed in patients with primary psychotic disorders, as well as those with psychotic episodes secondary to mood disorders. Here we describe two similar cases of delusional snake infestation following sexual intercourse in female patients, one with schizophrenia and the other with new diagnosis of bipolar disorder. During the course of hospitalization, both patients misinterpreted abdominal pain/abnormal sensation following sexual intercourse as snakes infesting various parts of the abdomen and genital tract. In both cases, symptoms rapidly resolved after antipsychotic and appropriate medical treatment

Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis.

Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD (n = 19) and 95% were diagnosed with SUDs without SIPD (n = 360). More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the “schizophrenia nuclear symptoms” dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances.