Group Of Psychotic Disorders Research Articles

Course of Cognitive Development From Infancy to Early Adulthood in the Psychosis Spectrum

Most patients with psychotic disorders experience severe cognitive impairment, but the onset and course of this impairment remain unclear. Moreover, the course of cognitive functions in other psychiatric conditions remains largely unexamined. To chart the course of general and specific cognitive functions in individuals with psychotic disorders, psychotic experiences, and depression. The Avon Longitudinal Study of Parents and Children (ALSPAC) is a prospective cohort study comprising all live births between April 1, 1991, and December 31, 1992, in Avon, England. The dates of analysis were September 2015 to July 2016. Participants who underwent cognitive testing at ages 18 months and 4, 8, 15, and 20 years and psychiatric assessment at age 18 years were included. Individuals with psychotic disorder, psychosis with depression, psychotic experiences, and depression were compared with controls. Outcomes were full-scale, verbal, and nonverbal IQ at ages 18 months and 4, 8, 15, and 20 years, as well as measures of processing speed, working memory, language, visuospatial ability, and attention at ages 8 and 20 years. The following numbers of individuals were available for analyses in this longitudinal birth cohort study: 511 (238 male [46.6%]) at age 18 months (mean [SD] age, 1.53 [0.03] years), 483 (229 male [47.4%]) at age 4 years (mean [SD] age, 4.07 [0.03] years), 3930 (1679 male [42.7%]) at age 8 years (mean [SD] age, 8.65 [0.29] years), 3783 (1686 male [44.6%]) at age 15 years (mean [SD] age, 15.45 [0.27] years), and 257 (90 male [35.0%]) at age 20 years (mean [SD] age, 20.06 [0.55] years). Individuals with psychotic disorder showed continually increasing deficits between infancy (18 months) and adulthood (20 years) in full-scale IQ (effect size of change [ESΔ] = -1.09, P = .02) and nonverbal IQ (ESΔ = -0.94, P = .008). The depression group showed a small, increasing deficit in nonverbal IQ (ESΔ = -0.29, P = .04) between infancy and adulthood. Between ages 8 and 20 years, the psychotic disorder group exhibited developmental lags (ie, slower growth) in measures of processing speed (ESΔ = -0.68, P = .001), working memory (ESΔ = -0.59, P = .004), and attention (ESΔ = -0.44, P = .001) and large, static deficits in measures of language (ES = -0.87, P = .005) and visuospatial ability (ES = -0.90, P = .001). There was only weak evidence for cognitive deficits in the psychosis with depression group and the psychotic experiences group. The findings herein suggest that the origins of psychotic disorder involve dynamic developmental processes, affecting both verbal and nonverbal abilities throughout the first 2 decades of life and leading to increasing dysfunction. These developmental processes do not manifest in other psychiatric disorders, such as psychosis with depression and depression.

Prevalence of Thyroid Function Abnormality in Admitted Male Patients with Alcohol Dependence Syndrome

Objective: Alcohol is one of the commonest psychoactive substances consumed globally. There are evidences suggesting its role in causing thyroid abnormality. It has been reported to have multiple effects on the hypothalamopituitary- thyroid axis. This study aimed to look at the thyroid function abnormalities in admitted male patients with alcohol dependence syndrome. Methods: Thyroid function parameters were compared among 30 male in-patients with Alcohol dependence syndrome (ADS) and 30 male in-patients with psychotic disorders as controls. Results: 23.3% of patients in the alcohol dependence group had thyroid stimulating hormone (TSH) abnormality compared to 3.3% among control (psychotic disorders) group. 23.3% in the ADS group and 10% of the control group had free T4 (FT4) abnormality. TSH abnormality was seen more in individuals whose age of onset of alcohol use was 20-30 years which was statically significant (p=0.01). TSH abnormality was noted more in patients who consumed alcohol for more than 15 years and with quantity exceeding>720 ml.

Identification of a plasma signature of psychotic disorder in children and adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort

The identification of an early biomarker of psychotic disorder is important as early treatment is associated with improved patient outcome. Metabolomic and lipidomic approaches in combination with multivariate statistical analysis were applied to identify plasma alterations in children (age 11) (38 cases vs 67 controls) and adolescents (age 18) (36 cases vs 117 controls) preceeding or coincident with the development of psychotic disorder (PD) at age 18 in the Avon Longitudinal Study of Parents and Children (ALSPAC). Overall, 179 lipids were identified at age 11, with 32 found to be significantly altered between the control and PD groups. Following correction for multiple comparisons, 8 of these lipids remained significant (lysophosphatidlycholines (LPCs) LPC(18:1), LPC(18:2), LPC(20:3); phosphatidlycholines (PCs) PC(32:2; PC(34:2), PC(36:4), PC(0-34-3) and sphingomyelin (SM) SM(d18:1/24:0)), all of which were elevated in the PD group. At age 18, 23 lipids were significantly different between the control and PD groups, although none remained significant following correction for multiple comparisons. In conclusion, the findings indicate that the lipidome is altered in the blood during childhood, long before the development of psychotic disorder. LPCs in particular are elevated in those who develop PD, indicating inflammatory abnormalities and altered phospholipid metabolism. These findings were not found at age 18, suggesting there may be ongoing alterations in the pathophysiological processes from prodrome to onset of PD.

Cognitive changes in alcohol-induced psychotic disorder

AimsThis study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol dependence.MethodsParticipants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital.ResultsThe groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking.ConclusionThis study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.

SU25. Lack of Pupillary Modulation by Antisaccade Performance in Schizophrenia, Schizoaffective Disorder, and Psychotic Bipolar Disorder Suggests Reduced Top-Down Control During Response Preparation on an Executive Control Task

Background: Pupil dilation, a measure of physiological arousal, is associated with increased cognitive demand (Moresi et al, 2008) and response preparation in the antisaccade task. Greater change in pupil size during the preparatory period prior to saccade generation for correctly performed antisaccade trials vs prosaccade errors has been observed among healthy controls, perhaps reflecting inhibitory input from the frontal eye fields (FEF) and superior colliculus (SC) to brainstem regions responsible for saccade generation (Wang et al, 2015). The relationship between pupillary response and antisaccade performance in individuals across the psychosis spectrum is less established. Our objective was to examine differences in the relationship between changes in pupil size during the preparatory period and antisaccade performance in individuals across the psychosis spectrum and healthy controls. Methods: Individuals with schizophrenia (n = 47), schizoaffective disorder (n = 31), psychotic bipolar disorder (n = 67), and controls (n = 68) from the Chicago site of the Bipolar Schizophrenia Network on Intermediate Phenotype (BSNIP) study completed an antisaccade task, in which they were to inhibit the response to look to a target and generate an eye movement in the opposite direction. Percent change in pupil size from baseline during the 700-ms preparatory period prior to target appearance was measured for correct and incorrect antisaccade performance and compared across patient and control groups. Results: As reported previously (Reilly et al, 2015), patient groups had increased antisaccade error rate compared to controls, and this effect was greatest among schizophrenia and schizoaffective groups followed by the psychotic bipolar disorder group. Linear mixed-effects models revealed a greater increase in pupil size over the preparatory period for correct antisaccade trials compared to incorrect trials among healthy controls (P ≤ .001); this modulation of pupillary response and antisaccade performance was not observed among the patient groups (P’s > .9). Changes in pupillary response during the preparatory period were not related to current daily antipsychotic medication dose or current exposure among patient groups. Conclusion: Pupil size was modulated by antisaccade performance in healthy controls, such that greater pupil size in preparation for intact antisaccade performance compared to incorrect performance was observed. This relationship was not maintained in individuals with schizophrenia, schizoaffective disorder, or psychotic bipolar disorder. These findings suggest that reduced top-down control during the response preparation period, perhaps from FEF inputs to the SC, contributes to the deficits in executive control as assessed by the antisaccade task across the psychosis spectrum. Furthermore, these data provide support for pupillometry as a useful index of top-down control in cognitive tasks.

Reliability and validity of Turkish Version of DSM-5 Psychosis Scale

Objective: In this study we evaluated the reliability and validity of the Turkish version of DSM-5 Psychosis Scale developed in order to evaluate severity of psychosis in adult patients. Methods: This study was carried out with patients who met the diagnostic criteria for any psychotic disorder according to DSM-5 criteria and who are undergoing treatment in the inpatient and outpatient wards of Psychiatry Department of Celal Bayar University Medical School. Except for psychotic disorders patients with any mental or physical disease were excluded. A total of 49 patients (40 patients with schizophrenia, six patients with not otherwise specified psychotic disorder, three patients with schizoaffective disorder) were included in the study. One hundred and one volunteers without any mental or physical disease were included as the healthy control group. Reliability analysis was based on internal consistency and item-total score correlation. Validity analysis was based on exploratory factor analysis, comparison of mean scores of the patient and healthy control groups and ROC analysis. Results: The mean age of the study group was 26.0±10.3 years and 52.7% of the sample group (n=79) were female. Sixty-nine point three percent of the study group were college graduates, 8% primary school graduates, 19.3% is also high school graduates. Mean disease duration was 17.1±9.7 years in the psychotic disorder group. The internal consistency of the Psychosis Scale was 0.91 and, item-total correlation coefficients of the Psychosis Scale were between 0.25 and 0.82. In the factor analysis, for sample adequacy Kaiser- Meier-Olkin (KMO) coefficient was found as 0.81 and Bartlett coef-ficient as 1.03. Single-factor solution was obtained and the eigenvalue is 5.12, representing 64.0% of the total vari-ance. Factor loadings of the items of the scale were between 0.33 and 0.88. The mean of score was 11.00±5.20 in patient group while it was calculated as 0.21±1.21 in control group. The area under the curve was calculated as 0.98 in the ROC analysis. Conclusion: These results indicate that the Turkish version of Psychosis Scale is reliable and valid.

Validity and reliability of the Turkish Version of the Clinician Rated Severity of Autism Spectrum and Social Communication Disorders Scale

Objective: The purpose of the present study was to investigate the validity and reliability of the Turkish form of the Clinician Rated Severity of Autism Spectrum and Social Communication Disorders Scale. The scale was originally developed to measure the severity of autism spectrum and social communication disorders regarding the DSM-5 criteria. Methods: The study was conducted in the Department of Psychiatry at Celal Bayar University Hospital. The participants were in- or out-patients diagnosed with any psychotic disorders according to DSM-5. The exclusion criteria were comorbidity of other psychiatric disorders and/or physical diseases. The study was carried out with a total of 49 patients who were diagnosed with schizophrenia (n=40), schizoaffective disorder (n=3), and not otherwise specified psychotic disorder (n=3). One hundred and one volunteers without any mental or physical disease were also included to represent the healthy control. Reliability analysis was performed to examine the internal consistency of the Turkish version of the scale. Additionally, item-total correlations were reported. In validity analyses, compari-son of the total score of the scale in the patient and control groups was evaluated for the discriminative validity. ROC analysis was also performed. Results: 52.7% of the sample were male (n=79). 69.3% of them were graduated from university (n=104), 19.3% from high school (n=29), and 8% from elementary school (n=12). The mean age of the study group was 26.3±10.3 years. Disease duration of psychotic disorder group was 18,29±6.43 years. The internal consistency of the Autism Spectrum and Social Communication Disorder Scale was 0.81. Furthermore, item-total correlations revealed that all items in the scale contributed to the consistency of scores with item-total correlations approaching 0.70. The mean score of the scale in the patient group on the scale was 1.42 whereas the mean score of the healthy group was 0.0. The t-test analysis indicated that there was a statistically significant difference between the sample group and the healthy group in their scores on the scale. In the ROC analysis, the area under the curve was 0.84. Conclusion: Results demonstrated that the Turkish version of Autism Spectrum and Social Communication Disorder Scale was a valid and reliable instrument which may serve as useful in guiding future research that aims to understand autism spectrum and social communication disorder.

Reliability and validity of the Turkish Version of DSM-5 Level 2 Anger Scale

Objective: The purpose of the present study was to investigate the reliability and validity of the Turkish Form of Level 2 Anger Scale. The scale was originally developed to measure the severity of anger regarding the DSM-5 criteria. Methods: This study was conducted in the Department of Psychiatry in Celal Bayar University Hospital. The participants were in- or out-patients diagnosed with any psychotic disorders according to the DSM-5. The exclusion criteria were comorbidity of other psychiatric disorders and/or physical diseases. The participants were 49 patients who were diagnosed with schizophrenia (n=40), schizoaffective disorder (n=3), and not otherwise specified psychotic disorder (n=6). One hundred and one volunteers without any mental or physical disease were also included to represent the healthy control. In the assesment beside Level 2 Anger Scale, 18-item Brief Psychi-atric Rating Scale was used. In reliability analysis internal consistency coefficient and item-total correlation analysis were performed; for validity analysis exploratory factor analysis was performed. In concurrent validity correlation analyses between Level 2 Anger Scale and BPRS tension, hostility, uncooperativeness, and elated mood subscales were computed. In order to discriminate between the psychosis and the control group, group means of Anger Scale were compared with t-test. Results: The mean age of the study group was 26.0±10.3 and 52.7% of the sample group were female (n=79). 69.3% of them were graduated from university (n=104), 19.3% from high school (n=29), and 8% from elementary school. Disease duration of psychotic disorder group was 17.1±9.7 years. The internal consistency of the Level 2 Anger Scale was 0.91 and, item-total correlation coefficients were between 0.74-0.83. For the exploratory factor analysis of sample adequacy of Level 2 Anger Scale Kaiser-Meðer-Olkin (KMO) coef-ficients 0.81 and Bartlett coefficient 1.03 was found. Single-factor solution was obtained and the eigenvalue is 3.79, representing 75.80 % of the total variance. Factor loadings of the items of the scale were between 0.83-0.90.The mean of score was 5.09±0.72 in the psychosis group while it was calculated as 3.65±0.36 in the control group. There was a statistically significant difference between the groups. There were moderate to high correlations be-tween Level 2 Anger Scale and BPRS tension, hostility, uncooperativeness, and elated mood. Conclusion: Results demonstrated that the Turkish version of Level 2 Anger Scale is a valid and reliable.

Prevalence of dual diagnosis among clinic attending patients in a de-addiction centre of a tertiary care hospital

Indian research on dual diagnosis is mostly on prevalence of co-morbidity in a particular type of substance use disorder or psychiatric disorder. They were not on overall prevalence of dual diagnosis in a clinical sample. The study aims to assess prevalence of dual diagnosis among first time visitors to a tertiary care deaddiction centre. The study participants were recruited using computer-generated random number table from 10th Apr 2013 to 28 June 2013 from a deaddiction centre in North India. Psychiatric diagnosis was done by qualified psychiatrist and confirmed by Mini International Neuropsychiatric Interview (M.I.N.I.). One seventy nine participants were recruited during the study period. The prevalence of dual diagnosis was 58 (32.4%). Affective disorder group 22 (12.3%) is the most common group followed by anxiety disorders group 20 (11.2%) and psychotic disorder group 9 (5.0%). Duration of use and dependence (in months) of alcohol, opioids, and nicotine was shorter and of cannabis and benzodiazepines was longer in dual diagnosis group compared to non dual diagnosis group. This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The study reported that nearly one third of substance use disorder patients are cases of dual diagnosis. The prevalence reported in our study is lower than reported in some western hospital based and community based studies.

Psychotic disorders induced by antiepileptic drugs in people with epilepsy.

Antiepileptic drug treatment can induce psychosis in some patients. However, there are no agreed definitions or diagnostic criteria for antiepileptic drug-induced psychotic disorder in the classification systems of either epileptology or psychiatry. In this study we investigated the clinical spectrum of antiepileptic drug-induced psychotic disorder in patients with epilepsy. The medical records of all patients with epilepsy who were diagnosed by a neuropsychiatrist as having a psychotic disorder at the Royal Melbourne Hospital from January 1993 to June 2015 were reviewed. Data were extracted regarding epilepsy and its treatment, psychotic symptoms profile and outcome. The diagnosis of epilepsy was established in accordance to the classification system of the International League Against Epilepsy while that of psychotic disorder was made according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposal on neuropsychiatric disorders in epilepsy. Patients with antiepileptic drug-induced psychotic disorder were compared to those with psychotic disorders unrelated to antiepileptic drugs assessed over the same period (non-antiepileptic drug induced psychotic disorder group). Univariate comparisons were performed and variables with a value of P < 0.1 were selected for the multivariate logistic regression analysis. The records of 2630 in-patients and outpatients with epilepsy were screened, from which 98 (3.7%) with psychotic disorders were identified. Among these, 14 (14.3%) were diagnosed to have antiepileptic drug-induced psychotic disorder. Excluding one patient who developed psychosis after valproate withdrawal, 76.9% in the antiepileptic drug induced psychotic disorder group were female and the percentage of temporal lobe involvement was higher in the antiepileptic drug induced psychotic disorder group (69.2% versus 38.1%, P < 0.05). Current use of levetiracetam was higher in antiepileptic drug-induced psychotic disorder group (84.6% versus 20.2%, P < 0.01) while use of carbamazepine was higher in the comparator group (15.4% versus 44.0%, P < 0.05). Multivariate logistic regression confirmed four factors associated with antiepileptic drug-induced psychotic disorder: female gender, temporal lobe involvement and use of levetiracetam, and a negative association with carbamazepine. Disorganized behaviours and thinking were more common in the antiepileptic drug-induced psychotic disorder group (100% versus 72.6% and 76.9% versus 38.1%, respectively; P < 0.05). The percentage of continuous treatment with antipsychotic drugs was lower in the antiepileptic drug-induced psychotic disorder group (15.4% versus 66.7%, P < 0.01). No patients experienced a chronic course in antiepileptic drug-induced psychotic disorder group whereas 40.5% did in non-antiepileptic drug induced psychotic disorder (P < 0.05). Our findings indicated that one in seven patients with epilepsy who developed psychosis had antiepileptic drug-induced psychotic disorder. In these patients, female gender, temporal lobe involvement and current use of levetiracetam were significantly associated with antiepileptic drug induced psychotic disorder compared to other types of psychosis, while carbamazepine had a negative association. Disorganized behaviours and thinking were predominant in antiepileptic drug-induced psychotic disorder. Patients with antiepileptic drug-induced psychotic disorder differed from non-antiepileptic drug-induced psychotic disorders in having better outcome.

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.

Effectiveness of Occupational Therapy on Symptoms of Schizophrenia

Schizophrenia is a group of psychotic disorders that interfere with thinking and mental or emotional responsiveness that last longer than 6 months. It affects about 24 million persons worldwide. Due to this, a study was undertaken in selected hospitals of Mangalore with an objective to assess the effectiveness of occupational therapy on symptoms of schizophrenia. Using purposive sampling technique 30 subjects were undertaken for the study. Scale for assessment of negative symptoms (SANS) was used to assess the symptoms of schizophrenia in schizophrenic clients. Statistical analysis revealed that more than half of subjects (5 3.4%) were within the age group of 21–40 years. Both males and females constitute 50%. About 46.6% of the subjects were married and with lower socio economic status.43.4% were Hindus.36,8% of the subjects completed primary school education. About 40% of the subjects resides in urban area. Majority of the subjects 60% were diagnosed with paranoid schizophrenia. Nearly half of the subjects 63.3% were not on regular medication. Highest percentage of subjects 70%were hospitalized before. Finding reveals that occupational therapy was not effective for negative symptoms of schizophrenia. The calculated t valve (0.942) was lower than the table value (2.05) at 0.05 level of significance

Comparative Study between the Quality Management Indicators, Marker of Major Psychiatric Disorders in Evolution.

Indicators of quality management are represented by: accounting hospitalization days (duration of stay); mortality rate; the rate of nosocomial infections; patients readmitted in 30 days; the percentage patients transferred; inconsistent diagnoses. The hospitalization period is a marker of evolution. The present study reflects comparative data between duration and the number of hospitalisations in patients with major psychiatric disorders. Introduction. Medical Psychiatry as a discipline has developed a specialized approach in the treatment of mental diseases, a phenomenon linked to the progress of knowledge ofpsychopathology and the increasing complexity of methods of diagnosis and treatment. The history of psychiatric patients reflects not only changes in scientific understanding of mental disorder, but also the beliefs of political, social and economic interests of that period [1,2]. Objectives. We analised the duration and number of hospitalisation in patients with schizophrenia, psychotic disorders compared to those with bipolar disorder and major depressive disorder in Psychiatric clinic from Craiova between 2006-2010. Method. Retrospective study during 2006-2010 took into account 8234 patients aged between 20-65 years from the Psychiatric Clinic Craiova constituting four groups: group N1=989 patients belonging to the schizophrenia group; group N2=1222 patients with psychotic disorders, group N3=918 patients with bipolar disorder and group N4=5101 with major depressive disorder.For data processing we used Microsoft Excel (Microsoft Corp., Redmond, WA, USA), together with the suite for MS Excel XLSTAT (Addinsoft SARL, Paris, France) and IBM SPSS Statistics programme 20.0 (IBM Corporation, Armonk, NY, USA). Results. Schizophrenia being defined as a chronic disease was noted that 85.4 % of the patients from the first group received at least two admissions during the trial. Females have better prognosis, having a lower share in the group with multiple hospital admissions. The duration of the stay was longer than two weeks for 61,7% in the N1 group. Group N2 patients, bipolar disorder, have received at least two admissions, the share between the sexes is similar, the duration of hospitalisation not exceeding 7 days for 54,2% of patients with bipolar disorder. Women with more than 14 hospitalisation days had a share of 21.6%. Duration of hospitalization with the N3 group was of maximum two weeks at 71,4%, the group of major depressive disorders N4 had a number of short admissions of 44,4%. Conclusion. Statistically significantly high differences (p =0,000233<0.001) in favor of the schizophrenia and psychotic disorders group compared with the group of disorders of affectivity, in terms of the number and the duration of hospitalizations, marker of the evolution on the long term.

Increased serum interleukin-6 levels in early stages of psychosis: Associations with at-risk mental states and the severity of psychotic symptoms

Schizophrenia patients experience activated inflammatory responses, but little is known about the presence of such inflammatory processes at or prior to disease onset. We measured interleukin-6 (IL-6) and C-reactive protein (CRP) serum levels and plasma fibrinogen in 17 at-risk mental state (ARMS) subjects, 77 patients with psychotic disorder (PD) and 25 healthy control subjects (HC). ARMS subjects were followed-up, and transition to psychosis was registered. IL6 rs1800795 SNP was genotyped, as IL-6 levels may be influenced by this genetic variant. We did not observe significant differences in the IL6 rs1800795 SNP genotype frequencies between the groups. ARMS subjects exhibited significantly higher IL-6 levels than did controls (p=0.019). In subjects not taking cannabis, we found that patients diagnosed with ARMS or PD exhibited increased IL-6 levels when compared with HC (p=0.004). In both ARMS and PD subjects, IL-6 levels were positively associated with negative symptoms. However, with respect to positive psychotic symptoms, a different relationship was observed in the ARMS and PD groups (positive relationship in ARMS; negative relationship in PD). These findings could not be attributed to confounding variables, including gender, body mass index (BMI), tobacco consumption or the rs1800795 genotype. Six of 17 ARMS subjects (35%) exhibited a transition to psychosis during the follow-up period of 26 months. ARMS subjects who developed psychosis exhibited increased median IL-6 levels compared with those who did not transition (0.61 vs. 0.35pg/mL). However, this difference was not statistically significant, which could be explained by a lack of statistical power due to the small sample size. Our results suggest that IL-6 may be a biomarker for early psychotic symptoms; however, further studies in larger samples are needed to confirm this result.

Reduced gray matter volume in psychotic disorder patients with a history of childhood sexual abuse

Childhood trauma is associated with smaller gray matter volume, similar to the pattern seen in psychotic disorders. We explored the relationship between childhood abuse, psychosis, and brain volume in a group of 60 individuals with a psychotic disorder and 26 healthy control subjects. We used voxel-based morphometry (VBM) to quantify gray and white matter volume and the Childhood Trauma Questionnaire (CTQ) to measure childhood abuse. Within the psychotic disorder group, total gray matter volume was inversely correlated with the severity of childhood sexual abuse (r=−.34, p=.008), but not the other types of abuse. When the 24 patients with sexual abuse were compared with demographically matched samples of 23 patients without sexual abuse and 26 control subjects, only patients with a history of sexual abuse had reduced total gray matter volume (t(48)=2.3, p=.03; Cohen's d=.63). Voxel-based analysis revealed a cluster in the prefrontal cortex where volume was negatively correlated with sexual abuse severity. Voxel based comparison of the three matched groups revealed a similar pattern of results, with widespread reductions in psychosis patients with sexual abuse relative to controls that were not found in psychosis patients without sexual abuse. These findings indicate that some of the variance of gray matter volume in psychotic disorders can be explained by a history of sexual abuse.

Age and Remission of Personality Pathology in the Psychotic Disorders Compared to Mood and/or Anxiety Disorders

In order to explore age-related differences in personality pathology between psychotic disorder (PSD) and mood and/or anxiety disorder (MAD) among psychiatric outpatients, 2,354 subjects were sampled randomly from outpatients in Shanghai and divided into two groups: PSD (N = 951) and MAD (N = 1403). Dimensional scores for personality disorder (PD) traits were assessed by using a self-reported personality diagnostic questionnaire (PDQ4+). Significant age differences were observed in most of the PD traits in MAD patients. Cluster B and C PD traits displayed an apparent decrease with age in MAD group, but such decline trend was not evident in PSD group. In both groups, the decline of self-reported Cluster A PD traits were less visible than the other clusters. Age-related mellowing of some PD traits such as "dramatic, erratic, anxious" occurred primarily in MAD patients; however the same traits in PSD patients appear to be less resistant to aging. Besides, "old eccentric" PD traits in both MAD and PSD patients seem to be maintained and less modified by aging.

Schizophrenia: A syndrome approach

Schizophrenia represents a group of chronic psychotic mental disorders with multi-factorial causes, whose fundamental characteristics are a distortion of reality and the appearance of many symptoms related to psychological function and behavior. The multi-factorial etiopathology of this illness is related to the organic, psychodynamic and social moment of the start of the illness, but we cannot be certain what, initiates it. In past decades and up to the present day, scientific research has been focused on the etiopathogenesis of different categories, which are related to genetic liability, an association with neuro-transmitted disorders, neuro-development, neuro-degeneration and other presumed etiopathological factors. The conglomerate symptoms of schizophrenia are symptoms, which we cannot separate from the Syndrome approach; therefore this illness cannot be discussed as a unique clinical entity.

AS13-04 - Classification of psychotic disorders in ICD-11

The current revision of ICD-10 also involves the group of schizophrenia and other non-organic psychotic disorders. To describe the current status of the development of the revised diagnostic criteria by the working group on psychotic disorders for ICD-11. This presentation will describe the development of the work group on psychotic disorders and its current activities. Report of the current activities of the WHO ICD-11 working group on psychotic disorders. The workgroup was formed in 2010 and had its first in person meeting in January 2010. Several conceptual issues were evident and are currently being reviewed, including the use of dimensional assessments, the role of functional outcome assessments, the definition of course and severity specifiers, and the reorganisation of the psychotic disorders in the chapter. Also, the group has started to review the specific diagnostic criteria for schizophrenia, acute and transient psychotic disorders, schizoaffective disorder, delusional and brief psychotic disorders, and schizotypal disorders. While the revision proposals should be mainly evidence-based, initial review results indicate that in many cases expert consensus decisions will be necessary due to a lack of studies. The workgroup on the classification of psychotic disorders is currenly reviewing the scientific evidence for specific diagnostic criteria and more general issues pertaining to the classification of psychotic disorders. Both expert consensus and evidence-guided criteriology will be necessary and the lack of suitable studies in some areas of psychosis research may prompt research suggestions for the upcoming ICD-11 field trials.

Adherence to Antihyperlipidemic Medication and Lipid Control in Diabetic Veterans Affairs Patients with Psychotic Disorders

Medication adherence for chronic medical illnesses has been studied extensively, but there is limited data evaluating medication adherence for comorbid medical illnesses in a psychiatric population. Furthermore, only one study has evaluated both medication adherence and clinical outcomes between the two populations. Examining medication adherence rates and clinical outcomes are important as chronic medical illnesses occur commonly in psychiatric patients, can be drug-induced, and have negative long-term consequences. To compare antihyperlipidemic medication adherence and lipid control between individuals with psychotic disorders and those without a psychiatric illness. This was a retrospective medical record review of 124 subjects with hyperlipidemia and diabetes (62 subjects with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched individuals without a psychiatric illness) receiving medical and psychiatric care through the Veterans Affairs Medical Center during 2008. Cumulative mean gap ratio (CMGR) was used to determine adherence. Lipid values were utilized to compare lipid control between groups. A significant difference in CMGR was detected. Subjects with psychotic disorders were without antihyperlipidemic therapy for 44 days compared with 62 days for the nonpsychiatric comparison group (P = 0.034). Antipsychotic adherent subjects (≥80% adherent) were more likely to adhere to their antihyperlipidemic medication (P = 0.0007). There were no significant differences between the groups for lipid control. Antihyperlipidemic medication adherence differed with the psychotic disorder group having fewer days without drug therapy. However, there was no significant difference in lipid control between subjects with a psychotic disorder and those without a psychiatric illness.

Medication adherence and glycemic control in patients with psychotic disorders in The Veterans Affairs healthcare system

To compare antihyperglycemic medication adherence and glycemic control between individuals with schizophrenia and related psychotic disorders and a nonpsychiatric comparison group. This was a retrospective medical record review. A total of 124 subjects with diabetes (62 patients with schizophrenia or a related psychotic disorder and 62 randomly selected, age-matched patients without a psychiatric illness) receiving their medical and psychiatric care exclusively through the Kansas City Veterans Affairs healthcare system during 2008 were included in the study. Adherence to antihyperglycemic and antipsychotic medication was determined by refill records obtained through the computerized patient record system to calculate the cumulative mean gap ratio. Hemoglobin A1C values were utilized to compare glycemic control between groups and compared to glycemic goals established by diabetes treatment guidelines. Antihyperglycemic medication adherence was poor for both groups as approximately 60% of the psychotic disorder group and 75% of the nonpsychiatric comparison group were without antihyperglycemic medication for greater than 30 days during the 12-month period but adherence did not differ between the groups (p=0.182). Antipsychotic adherent subjects (≥80% adherent) were more likely to be adherent to their antihyperglycemic medication (p=0.0003). There were no significant differences between groups in glycemic control. Antihyperglycemic medication adherence and glycemic control was less than optimal for both groups. There were no significant differences in antihyperglycemic medication adherence and glycemic control between patients with a psychotic disorder and those without a psychiatric illness.