Psychotic Affective Disorders Research Articles

Negative symptoms of familial schizophrenia breed true in unstable (vs. stable) cerebral-ventricle pedigrees

A pattern of negative symptoms associated with a high rate of ongoing brain and ventricular instability has been described in a cohort of schizophrenia spectrum probands (patients with schizophrenia, schizoaffective disorder depressed and bipolar, and psychosis NOS) (Garver, D.L., Nair, T.R., Christensen, J.D., Holcomb, J., Ramberg, J., Kingsbury, S., 1999. Differential patterns of premorbid functioning, symptoms and neuroleptic response in stable and unstable ventricular-volume schizophrenia. Neuropsychopharmacology 20, in press). The present study contrasts the prevalence of negative symptoms in first- and second-degree relatives of probands with unstable ventricle volume (UnsVV) and stable ventricle volume (SVV). One hundred and sixteen first- and second-degree relatives of 10 probands were interviewed using the SANS, the ‘Characterization of Course: “Pattern of Symptoms” ’ [from Comprehensive Assessment of Symptoms and History (CASH)], SCID and SCID-II by interviewers blind to the status of the proband. Thirty-five of the 116 family members met DSM-IV criteria for schizophrenia, SA depressed, ‘Cluster A’ of the SCID-II (paranoid, schizotypal, schizoid personality disorder), psychosis NOS, or psychotic affective disorder. These 35 family members were defined as falling within a ‘schizophrenia spectrum’ as described by Farmer, A.E., McGuffin, P., Gottesman, I.I., 1987. Arch. Gen. Psychiatry 44, 634–641, but with the addition of DSM-IV affective psychosis. On that basis, the 35 members were considered ‘affected family members’ (AFMs). The remaining 81 family members were considered unaffected. The ‘predominant symptoms of illness‘ (during the past 2–3 years) for 25 of the 35 AFMs could be characterized according to the ‘Patterns of Symptoms‘ derived from the CASH. Twenty-five of the 35 AFMs were found to maintain a predominant symptom pattern during the course of illness, which could be characterized according to the ‘Pattern of Symptoms‘ as ‘predominantly positive‘ or ‘predominantly negative‘. Three of the probands had UnsVV; seven had SVV. Of the 35 AFMs, 11 were related to the UnsVV probands, and 24 were relatives of the SVV probands. The nine rated AFMs of the UnsVV probands showed a trend toward higher SANS scores (7.3±5.1) (mean±s.d.) than the 20 rated AFMs of SVV probands (4.3±5.1) ( p=0.08) at the time of the interview. Eighty-three per cent (eight of 10) of rated affected pedigree members of the pedigrees delineated by probands with UnsVV probands had a predominantly negative symptom course of illness, and 96% (23 of 24) of rated affected pedigree members of the pedigrees with SVV probands had a predominantly positive symptom course of illness during the preceding 2–3 years ( p=0.002). None of the 12 rated affected pedigree members within pedigrees having UnsVV probands were married at the time of the interview; 45% (14 of 31) of affected pedigree members having SVV probands were married ( p=0.004). A psychiatric disorder, characterized by unstable cerebral ventricles and predominant negative symptoms (including avoidance/failure of marital relationships) appears symptomatically to breed true in pedigrees containing schizophrenia-like illnesses.

The New York High-Risk Project. Prevalence and comorbidity of axis I disorders in offspring of schizophrenic parents at 25-year follow-up.

The New York High-Risk Project is a study of offspring of patients with schizophrenia (HRSz group) or affective illness (HRAff group) and psychiatrically normal parents (NC group) observed prospectively from childhood to adulthood. We herein present lifetime prevalence and comorbidity rates of Axis I disorders in subjects and their siblings from sample A of the project. Schedule for Affective Disorders and Schizophrenia-Lifetime Version interviews conducted with the offspring in adulthood were used to obtain diagnoses of Axis I disorders. Schizophrenia and unspecified psychoses occurred only in the HRSz group. However, schizoaffective and psychotic affective disorders occurred equally in the HRSz and HRAff groups. Total rates of psychosis in these groups were significantly higher than in the NC group. All groups had similar rates of nonpsychotic affective and substance abuse disorders. The HRAff group, however, had significantly more total affective illness than the NC group and tended to have more anxiety disorders than the other groups. Comorbidity rates in the HRSz and HRAff groups were nearly twice those of the NC group. The familial liabilities to schizophrenia and affective disorders show specificities and commonalities, differing markedly from each other in their expression of some disorders and sharing others. Patterns of comorbidity are generally, although not entirely, similar to these liabilities.

Race bias, social class bias, and gender bias in clinical judgment.

Studies on race bias, social class bias, and gender bias are reviewed. Topics include psychodiagnosis and rating level of adjustment, the description of personality traits and psychiatric symptoms, the prediction of behavior, and treatment planning. Replicated findings include race bias in the differential diagnosis of schizophrenia and psychotic affective disorders, gender bias in the differential diagnosis of histrionic and antisocial personality disorders, race bias and gender bias in the prediction of violence, and social class bias in the referral of clients to psychotherapy. Recommendations for decreasing bias include (a) being aware of when biases are likely to occur, (b) adhering to diagnostic criteria, and (c) using statistical prediction rules to predict behavior.

Does familiality predispose to both emergence and persistence of psychosis? A follow-up study.

It as been suggested that in schizophrenia an association exists between family history of schizophrenia and poor outcome on the one hand, and family history of affective disorders and good outcome on the other. We tested for associations between four-year outcome and familial loading for psychotic disorders in a mixed sample of 150 consecutively admitted patients with functional psychosis (schizophrenia, psychotic affective disorders, other psychotic disorders) of recent onset. For each proband, a familial loading score for (i) broadly defined psychotic disorder, (ii) schizophrenia, and (iii) affective disorder was calculated using information on relatives obtained through the Family History Research Diagnostic Criteria method and direct interviews of relatives with the Schedule for Affective Disorders and Schizophrenia. In our sample of psychotic patients, familial loading for psychotic disorder predicted persistent negative symptoms over the follow-up period (OR 1.5; 95% CI 1-2.2), especially in schizophrenia, and was also associated with more time hospitalised (P < 0.05) [corrected], and more social disability at follow-up (P < 0.05). Greater familial loading for schizophrenia predicted a greater likelihood of non-recovery (OR 2.2; 95% CI 1.1-4.4) and a greater likelihood to have had persistent negative symptoms over the follow-up period (OR 1.7; 95% CI 0.9-3.1). No association was found between outcome and familial loading for affective disorder. We conclude that familial loading may be a continuous risk factor for some dimensions of clinical outcome in the functional psychoses. This suggests that there is a continuum of genetic liability not only to the emergence of psychotic illness, but also the subsequent chronicity of the disorder.

Further association study on dopamine D2 receptor variant S311C in schizophrenia and affective disorders

The dopamine D2 receptor gene is a candidate gene for schizophrenia because the potency of certain neuroleptics correlates with their affinity for this receptor. Case-control studies in 291 schizophrenics, 78 patients with affective disorders, and 579 controls on an association of a molecular variant of S311C of the dopamine D2 receptor with psychiatric disorders were conducted. The frequency of individuals with S311C was significantly higher in schizophrenics with the absence of negative symptoms (17.1%, P < 0.00001), but similar in schizophrenics with the presence of negative symptoms (5.7%, P = 0.46) when compared with the controls (4.1%). The frequency of S311C was significantly higher in familial schizophrenics from one local area but not in those from other areas. It was significant that S311C was frequently present in patients with mood-incongruent psychotic affective disorders (33.3%, P < 0.0001), but not in those with other affective disorders. These data suggest that S311C might be one of the genetic factors for symptomatic dimensions of delusions and hallucinations and might be involved in underlying clinical heterogeneity in schizophrenia and affective disorders. © 1996 Wiley-Liss, Inc.

Further association study on dopamine D2 receptor variant S311C in schizophrenia and affective disorders

The dopamine D2 receptor gene is a candidate gene for schizophrenia because the potency of certain neuroleptics correlates with their affinity for this receptor. Case-control studies in 291 schizophrenics, 78 patients with affective disorders, and 579 controls on an association of a molecular variant of S311C of the dopamine D2 receptor with psychiatric disorders were conducted. The frequency of individuals with S311C was significantly higher in schizophrenics with the absence of negative symptoms (17.1%, P < 0.00001), but similar in schizophrenics with the presence of negative symptoms (5.7%, P = 0.46) when compared with the controls (4.1%). The frequency of S311C was significantly higher in familial schizophrenics from one local area but not in those from other areas. It was significant that S311C was frequently present in patients with mood-incongruent psychotic affective disorders (33.3%, P < 0.0001), but not in those with other affective disorders. These data suggest that S311C might be one of the genetic factors for symptomatic dimensions of delusions and hallucinations and might be involved in underlying clinical heterogeneity in schizophrenia and affective disorders.

The New York High-Risk Project. Psychoses and cluster A personality disorders in offspring of schizophrenic parents at 23 years of follow-up.

We herein present lifetime prevalence rates of psychoses and DSM-III-R cluster A personality disorders in sample A of the New York High-Risk Project, a prospective study following offspring of parents with schizophrenia (HRSz subjects) and affective illness (HRAff subjects) and of psychiatrically normal parents (NC subjects) from midchildhood to adulthood. We interviewed the offspring in adulthood with the Schedule for Affective Disorders and Schizophrenia, Lifetime Version, for Axis I disorders and the Personality Disorder Examination for Axis II disorders. Lifetime prevalence rates (+/- SE) of schizophrenia and unspecified psychosis were 11.1% +/- 4.3% and 5.6% +/- 3.1%, respectively, in the HRSz group and 0% in the HRAff and NC groups. Rates of schizoaffective disorder subclassified as mainly schizophrenic, however, were highest in the HRAff group. Rates of psychotic affective disorders did not differ between the HRSz and other groups. Age-corrected morbidity risks were similar to lifetime prevalence rates. Rates of the three cluster A personality disorders did not differ among the groups, but the combined rate was greater in the HRSz and HRAff groups than in the NC group. Our data strongly support a specific familial liability to narrowly defined schizophrenia that is not shared by families of probands with affective disorder. Schizoaffective disorder and cluster A personality disorders, however, occur in families of both schizophrenic probands and probands with affective disorder. Psychotic affective disorders, which are not increased in HRSz subjects, do not appear to be an expression of the liability to schizophrenia.

Schizoaffective and Mood-Incongruent Psychotic Affective Disorders

Back to table of contents Previous article Next article ArticleNo AccessSchizoaffective and Mood-Incongruent Psychotic Affective DisordersMARIO MAJMARIO MAJSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.151.3.455AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Schizoaffective and Mood-Incongruent Psychotic Affective Disorders." American Journal of Psychiatry, 151(3), p. 455 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing Psy[email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byBipolar IllnessNordic Journal of Psychiatry, Vol. 69, No. 6Issues in Estimating the Course of Rapid-Cycling Bipolar DisorderRANJAN BHATTACHARYYA, M.D.MALAY KR GHOSHAL, M.D.DEBASISH SANYAL, M.D.PRATHAMA GUHA, M.D., D.N.B.SUDDHENDU CHAKRABORTYD.P.M.,1 March 2009 | American Journal of Psychiatry, Vol. 166, No. 3Dr. Schneck RepliesCHRISTOPHER D. SCHNECKM.D.,1 March 2009 | American Journal of Psychiatry, Vol. 166, No. 3European Archives of Psychiatry and Clinical Neuroscience, Vol. 259, No. 3Cognitive Behavioral Therapy for Rapid-Cycling Bipolar Disorder: A Pilot StudyJournal of Psychiatric Practice, Vol. 13, No. 5Update and long-term clinical management of rapid cyclingInternational Clinical Psychopharmacology, Vol. 22, No. Supplement 1A 20-Month, Double-Blind, Maintenance Trial of Lithium Versus Divalproex in Rapid-Cycling Bipolar DisorderJoseph R. Calabrese, M.D., Melvin D. Shelton, M.D., Ph.D., Daniel J. Rapport, M.D., Eric A. Youngstrom, Ph.D., Kelly Jackson, L.P.C.C., M.A., Sarah Bilali, M.A., Stephen J. Ganocy, Ph.D., and Robert L. Findling, M.D.1 November 2005 | American Journal of Psychiatry, Vol. 162, No. 11Familial Variation in Episode Frequency in Bipolar Affective DisorderMaria E. Fisfalen, M.D., Thomas G. Schulze, M.D., J. Raymond DePauloJr., M.D., Leslie J. DeGroot, M.D., Judith A. Badner, M.D., and Francis J. McMahon, M.D.1 July 2005 | American Journal of Psychiatry, Vol. 162, No. 7Comparison of Rapid-Cycling and Non-Rapid-Cycling Bipolar Disorder Based on Prospective Mood Ratings in 539 OutpatientsRalph W. Kupka, M.D., Ph.D., David A. Luckenbaugh, M.A., Robert M. Post, M.D., Trisha Suppes, M.D., Ph.D., Lori L. Altshuler, M.D., Paul E. KeckJr., M.D., Mark A. Frye, M.D., Kirk D. Denicoff, M.D., Heinz Grunze, M.D., Gabriele S. Leverich, M.S.W., Susan L. McElroy, M.D., Jörg Walden, M.D., Ph.D., and Willem A. Nolen, M.D., Ph.D.1 July 2005 | American Journal of Psychiatry, Vol. 162, No. 7Phenomenology of Rapid-Cycling Bipolar Disorder: Data From the First 500 Participants in the Systematic Treatment Enhancement ProgramChristopher D. Schneck, M.D., David J. Miklowitz, Ph.D., Joseph R. Calabrese, M.D., Michael H. Allen, M.D., Marshall R. Thomas, M.D., Stephen R. Wisniewski, Ph.D., Sachiko Miyahara, M.S., Melvin D. Shelton, M.D., Ph.D., Terence A. Ketter, M.D., Joseph F. Goldberg, M.D., Charles L. Bowden, M.D., and Gary S. Sachs, M.D.22 December 2014 | American Journal of Psychiatry, Vol. 161, No. 10Critical Care, Vol. 8, No. 6Current Opinion in Psychiatry, Vol. 16The Prognostic Significance of “Switching” in Patients With Bipolar Disorder: A 10-Year Prospective Follow-Up StudyMario Maj, M.D., Ph.D., Raffaele Pirozzi, M.D., Lorenza Magliano, M.D., Ph.D., and Luca Bartoli, M.D.1 October 2002 | American Journal of Psychiatry, Vol. 159, No. 10Adjunctive Lamotrigine Treatment for Major DepressionTHOMAS M. MALTESE, M.D., 1 November 1999 | American Journal of Psychiatry, Vol. 156, No. 11Sublingually Administered Fluoxetine for Major Depression in Medically Compromised PatientsMURAT PAKYUREK, M.D., and ELIAS PASOL, M.D., 1 November 1999 | American Journal of Psychiatry, Vol. 156, No. 11Reliability and Validity of Four Alternative Definitions of Rapid-Cycling Bipolar DisorderMario Maj, M.D., Ph.D., Raffaele Pirozzi, M.D., Anna Maria Rosa Formicola, M.D., and Alfonso Tortorella, M.D.1 September 1999 | American Journal of Psychiatry, Vol. 156, No. 9Rapid Cycling in Women and Men With Bipolar Manic-Depressive DisordersLeonardo Tondo, M.D., and Ross J. Baldessarini, M.D.1 October 1998 | American Journal of Psychiatry, Vol. 155, No. 10Long-Term Outcome of Lithium Prophylaxis in Bipolar Disorder: A 5-Year Prospective Study of 402 Patients at a Lithium ClinicMario Maj, M.D., Ph.D., Raffaele Pirozzi, M.D., Lorenza Magliano, M.D., and Luca Bartoli, M.D.1 January 1998 | American Journal of Psychiatry, Vol. 155, No. 1International Journal of Psychiatry in Clinical Practice, Vol. 1, No. sup1Journal of Clinical Psychopharmacology, Vol. 16, No. 1Depression, Vol. 3, No. 4 Volume 151Issue 3 March 1994Pages 455-455 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1994

Schizoaffective and mood-incongruent psychotic affective disorders

Schizoaffective and mood-incongruent psychotic affective disorders

An 8-year follow-up of patients with DSM-III-R psychotic depression, schizoaffective disorder, and schizophrenia.

The purpose of this study was to investigate the long-term outcome of patients with functional psychoses. The functional status of patients with mood-congruent and mood-incongruent psychotic depression, schizoaffective disorder, and schizophrenia was examined. Ninety-two inpatients with nonmanic and nonorganic functional psychoses who had been discharged from the hospital were identified through inpatient records. A blind rater used DSM-III-R criteria to assign research diagnoses to the patients on the basis of the data gathered at admission. Seventy-one patients were located 8 years later, and personal interviews were conducted with them. Baseline diagnosis was a powerful predictor of long-term outcome, even after controlling for age at onset and duration of episode at admission. Patients with psychotic depression had much better outcomes than patients with schizoaffective disorder or schizophrenia. Fourteen (43.8%) of 32 patients with psychotic depression were free from psychosis at follow-up, in marked contrast to those who had schizoaffective disorder or schizophrenia, none of whom had recovered. Patients with schizoaffective disorder could not be distinguished from patients with schizophrenia. The prognosis of patients with major depression with mood-incongruent features most closely resembles that of depressed patients with mood-congruent features, while patients with DSM-III-R schizoaffective disorder have a prognosis resembling that of schizophrenic patients. Patients with psychotic affective disorders have a much higher likelihood of recovering from psychosis than do schizophrenic patients.

The association between lithium carbonate and smooth pursuit eye tracking among first-episode patients with psychotic affective disorders.

The association between treatment with lithium carbonate and smooth pursuit eye tracking performance was investigated in first-episode patients with psychotic affective disorders. The horizontal pursuit performance of patients with major depression and bipolar disorder who were receiving lithium carbonate was contrasted with that of patients not receiving lithium carbonate. In addition, the accuracy and quality of pursuit eye tracking was examined in bipolar patients whose lithium status changed from the time of initial testing to the time of retest 10 months later. For the combined group of depressed and bipolar patients, treatment with lithium carbonate was not associated with worse pursuit performance. Bipolar disordered patients on lithium did not differ in tracking proficiency from those not on lithium; bipolar patients whose lithium status changed from intake to retest also did not display a significant change in pursuit performance.

Psychiatric morbidity in the relatives of patients with DSM-III schizophreniform disorder: Comparisons with the relatives of schizophrenic and bipolar disorder patients

Risks for psychiatric disorders (RDC) among first degree relatives of DSM-III schizophreniform, bipolar, and schizophrenic probands obtained from an epidemiologic sample using family history methods were examined. The relatives of the schizophreniform probands differed from the relatives of the schizophrenic and bipolar probands. The relatives of schizophreniform probands had significantly higher rates of affective illnesses (with the exception of bipolar illness) than the relatives of schizophrenic probands, and they had a significantly higher rate of psychotic affective disorders than the relatives of the bipolar probands.

Voluntary Motor Performance in Psychotic Disorders: A Replication Study

Voluntary motor performance was used to investigate the hypothesis of a continuum of psychosis from depression through schizophrenia. 43 schizophrenic, 36 schizoaffective, 50 major depressive, 20 manic, and 25 nonpsychotic patient controls were tested for tapping speed, finger dexterity, hand grip strength, and neuropsychological motor performance. Sex was included as an independent variable, and the effects of psychotropic drugs were evaluated. A continuum of motor dysfunction from depression through schizophrenia was not obtained. A measure of current psychotic symptoms was not associated with motor or neuropsychological performance. Motor performance was significantly worse in schizophrenic, schizoaffective, and psychotic affective disorders, when compared to nonpsychotic affective disorders. In this final analysis, psychoticism was defined by history. The results are discussed in terms of the hypothesis that psychoticism is a trait that is independent of diagnosis.

Attempted Suicide in the Armed Forces: a Retrospective Study of Norwegian Conscripts

In the easily surveyable and rather homogeneous military population of the Norwegian Armed Forces, a group of 112 male suicide-attempting conscripts was studied retrospectively. Compared to a normal conscript population, suicide attempters more often had troublesome backgrounds, had experienced psychiatric problems and abuse, and had previously more often attempted suicide. Diagnostically adjustment disorders, alcohol and drug abuse, and personality disorders predominated, whereas major affective disorders and psychotic disorders were rare. Methods of self-destruction employed were mostly drug ingestion and laceration. Personality disordered subjects tended to have lower suicidal intent than others.

Treatment of psychotic affective disorders

Treatment of psychotic affective disorders

Recent advances in the assessment and treatment of psychotic affective disorders

Recent advances in the assessment and treatment of psychotic affective disorders

Twin Studies and Genetic Models of Schizophrenia-Reply

—We are grateful for the opportunity to reply to Dr Levinson's comments on our article, and we welcome his interest. However, we disagree with his comment that there is a reasonable possibility of a misdiagnosed affective psychosis in the schizophrenic twin. The Maudsley twin subjects used in our study are quite elderly and are therefore certainly not young patients with psychotic affective disorder who might be assigned a misdiagnosis of schizophrenia. Although the original diagnosis was made before the advent of operational definitions, a panel of six diagnosticians from different theoretical orientations made the consensus diagnosis of schizophrenia.1More recently,2we have applied operational definitions to the same series, and, if there was doubt about the schizophrenia diagnosis, these patients were excluded (for instance, the MZ probands numbered 10A and 12A). Thus, all the remaining probands fulfilled at least one set of modern operational criteria for schizophrenia

A DSM-III family study of the nonschizophrenic psychotic disorders.

The authors conducted a blind DSM-III family study based on probands diagnosed from long-term follow-up information as having schizophreniform disorder, schizoaffective disorder, or psychotic affective illness. The pattern of psychopathology in relatives of schizophreniform probands closely resembled that found previously in relatives of schizophrenic probands. Relatives of schizoaffective probands had an excess risk for schizophrenia, other psychoses, and bipolar illness. The pattern of illness found in relatives of the probands meeting Research Diagnostic Criteria for mainly schizophrenic schizoaffective disorder appeared indistinguishable from that of relatives of schizophrenic probands. Relatives of probands with psychotic affective disorder had an excess risk for schizophrenia and for unipolar and bipolar affective disorder.

The dexamethasone suppression test for diagnosis and prognosis in psychiatry. Commentary and review.

A modified dexamethasone suppression test (DST) has had unprecedented evaluation among biologic tests proposed for clinical use in psychiatry. It has not proved to reflect pathophysiologic changes at the level of the central nervous system or pituitary, and tissue availability of dexamethasone itself may contribute to test outcome. The sensitivity of the DST in major depression is limited (about 44% in over 5,000 cases) but is higher in psychotic affective disorders and mixed manic-depressive states (67% to 78%). The high specificity of the DST vs control subjects (over 90%) is not maintained vs other psychiatric disorders (77% specificity overall), and acute "distress" may contribute to nonsuppression of cortisol. The test may have power in differentiating severe melancholic depression, mania, or acute psychosis from chronic psychosis (87% specificity) or dysthymia (77% specificity). The DST status adds about 11% to the prediction of short-term antidepressant response. Suggestions that failure to maintain normal suppression of cortisol predicts poor outcome are not secure. Uncritical enthusiasm or excessive skepticism regarding the DST are unwarranted.

Diagnosing Psychotic Disorders and Affective Disorders With Psychotic Features

This month we are focusing on the diagnosis of psychotic disorders, with questions about the DSM-III diagnoses of scbizopbrenia, scbizopbren: form and schizo-affective disorders, and affective disorders with psychotic features. Readers are urged to submit questions about any aspect of DSM-III for future columns to Dr. Williams at the New York State Psychiatric institute, 722 West 168th Street, New York, New York 10032.