Psychotic Group Research Articles

Two-dimensional classification of psychological defense mechanisms

The paper proposes the author’s classification of psychological defense mechanisms, consisting of 20 mechanisms and representing a two-dimensional model. The idea of this model is that these mechanisms have a cross-relationship between 4 levels of the hierarchy (psychotic, infantile, neurotic, and adaptive groups) and 5 types of overcoming frustration which are the basis for the formation and functioning of the defense mechanism. The novelty of the article is the idea that each of the 20 defense mechanisms belongs to one of the 5 types of overcoming frustration — distracting type (mechanisms of regression, action out, compensation, sublimation), «guilty» type (mechanisms of hypochondria, passive-aggressive behavior, reactive formation, altruism), avoiding type (mechanisms of repression, denial, avoidance, suppression), rationalizing type (mechanisms of dissociation, displacement/transfer, rationalization, humor), controlling type (mechanisms of isolation, projection, omnipotence, anticipation). The paper provides description of the defense mechanisms, examples of their manifestation, and possible reasons for their formation. The substantiation of the defense mechanisms’ belonging to the particular groups and types of classification is given. The classification is proposed as a convenient diagnostic tool for counseling psychologists, because it has an optimal number of defense mechanisms, fairly clear criteria for their determination, their location in the structure of psychological defense and the basis for their functioning. The article also provides an overview of current classifications of defense mechanisms and voices problems related to the identification and streamlining of defense mechanisms. These problems are the subtlety of semantic difference and blurring of borders between defense mechanisms, different interpretations in terminology due to difficulties in translation from foreign languages, differences in approaches to hierarchy of defense mechanisms.

Psychosis and Comorbid Opioid Use Disorder: Characteristics and Outcomes in Opioid Substitution Therapy.

Background and ObjectivesSubstance use disorders are highly prevalent among individuals with psychotic disorders and are associated with negative outcomes. This study aims to explore differences in characteristics and treatment outcomes for individuals with psychotic disorders when compared with individuals with other nonpsychotic psychiatric disorders enrolled in treatment for opioid use disorder (OUD).MethodsData were collected from a prospective cohort study of 415 individuals enrolled in outpatient methadone maintenance treatment (MMT). Psychiatric comorbidity was assessed using the Mini-International Neuropsychiatric Interview. Participants were followed for 12 months. Participant characteristics associated with having a psychotic disorder versus another nonpsychotic psychiatric disorder were explored by logistic regression analysis.ResultsAltogether, 37 individuals (9%) with a psychotic disorder were identified. Having a psychotic disorder was associated with less opioid-positive urine drug screens (odds ratio [OR] = 0.97, 95% confidence interval [CI] = 0.95, 0.99, P = .046). Twelve-month retention in treatment was not associated with psychotic disorder group status (OR = 0.73, 95% CI = 0.3, 1.77, P = .485). Participants with psychotic disorders were more likely to be prescribed antidepressants (OR = 2.12, 95% CI = 1.06, 4.22, P = .033), antipsychotics (OR = 3.57, 95% CI = 1.74, 7.32, P = .001), mood stabilizers (OR = 6.61, 95% CI = 1.51, 28.97, P = .012), and benzodiazepines (OR = 2.22, 95% CI = 1.11, 4.43, P = .024).Discussion and ConclusionsThis study contributes to the sparse literature on outcomes of individuals with psychotic disorders and OUD-receiving MMT. Rates of retention in treatment and opioid use are encouraging and contrast to the widely held belief that these individuals do more poorly in treatment. Higher rates of coprescription of sedating and QTc-prolonging medications in this group may pose unique safety concerns.

Social cognition in first-degree relatives of patients with schizophrenia and mania with psychotic symptoms: A comparative study

Background: Non-affective psychosis refers to psychosis unrelated to mood or affect. Affective psychosis is a psychological disorder where people experience a loss of contact with reality and experience mood disturbances working as a primary cause. The focus has been shifted to the first-degree relatives of these populations to prevent the disorder at the earliest. So, the first-degree relatives are known to be a high-risk population with genetic vulnerability. These two disorders (schizophrenia and mania with psychotic symptoms) show various impairments in various field but these impairments are present to define these disorders, unaffected relatives of these two disorders for different areas like social, cognitive, neurocognitive and social functioning. Cognitive dysfunction and social cognition dysfunction as a trait marker nearly established in affective and non- affective populations. Aims and Objectives: Purpose of this study to assess social cognition, neurocognition and social functioning in FDRs of patients with schizophrenia and mania with psychotic symptoms. Methodology: The sample consisted of 30 FDRs of patients with schizophrenia and mania with psychotic symptoms and 15 normal healthy control. After the initial screening by the clinical assessments, based on their amenability for the interview, Social Cognition Rating Tools in Indian Setting (SOCRATIS) was applied to all three groups. Result and Conclusion: The study found that first degree relatives of patients with schizophrenia group found to be lower in externalized attribution bias on a measure of social cognition compared to FDRs of patients with mania with psychotic symptoms group and healthy controls. And the FDRs of patients with schizophrenia and mania with psychotic symptoms groups were found higher in reaction time in trail making on a measure of neurocognition compared to healthy controls.

Basic symptoms in young people at ultra-high risk of psychosis: Association with clinical characteristics and outcomes

There has been limited research into the predictive value of basic symptoms and their relationship with other psychopathology in patients identified using the ‘ultra high risk’ (UHR) for psychosis approach. The current study investigated whether basic symptoms, specifically cognitive disturbances (COGDIS), were associated with a greater risk of transition to psychotic disorder and persistent attenuated psychotic symptoms (APS) at medium term follow-up (mean = 3.4 years) in UHR patients, as well as with general psychopathology at baseline. The sample included 304 UHR participants (mean age = 19.12 years) involved in an international multicenter trial of omega-3 fatty acids. UHR individuals who also met the COGDIS criteria (basic symptoms risk criteria) did not have a greater risk of transition than those who met the UHR criteria alone. However, meeting COGDIS risk criteria was associated with a greater likelihood of meeting the UHR attenuated psychotic symptoms risk group (i.e., having persistent attenuated psychotic symptoms) at 12-month follow-up (odds ratio = 1.85; 95% CI = 1.03, 3.32). Greater severity of cognitive basic symptoms was also independently associated with more severe general psychopathology at study entry. The findings do not support the notion that combined risk identification approaches (UHR and basic symptoms) aid in the identification of individuals at greatest risk of psychosis, although this interpretation is limited by the modest transition to psychosis rate (13%) and the time of follow up. However, the findings indicate that basic symptoms may be a clinically useful marker of more severe general psychopathology in UHR groups and risk for persistent attenuated psychotic symptoms.

Bir Toplum Ruh Sağılığı Merkezinde İzlenen Hastaların Klinik ve Sosyodemografik Özellikleri ile Tedavi yaklaşımlarının incelenmesi

Amaç: Bu çalışmada amaç bir Toplum Ruh Sağlığı Merkezi’nden hizmet alan hastaların klinik ve sosyodemografik özellikleri ile tedavi yaklaşımlarının incelenmesidir.Metod: Toplum ruh sağlığı merkezinde kayıtlı ve çalışmaya katılmayı kabul eden toplam 203 hastayla klinisyen yüz yüze görüşme yaparak DSM-IV tanı kriterlerine göre hastalara tanı konuldu. Kesitsel tipte olan çalışmada tüm hastalara sosyodemografik veri formu, bipolar bozukluk grubu hastalarına ise Hamilton Depresyon Derecelendirme Ölçeği (HDDÖ) ve Young Mani Derecelendirme Ölçeği (YMDÖ), psikotik bozukluk grubu hastalarına ise Pozitif ve Negatif Sendrom Ölçeği (PANSS) uygulandı.Bulgular: Çalışmamızda 52(%25,6) hastada bipolar bozukluk tanısı, 151 (%74,4) hastada psikotik bozukluk tanısı vardı. Hastaların ölçek puan ortalamaları HDDÖ 3,40±1,62, YMDÖ 2,38±0,97 ve PANSS Toplam 58,94±12,16 idi. Hastaların çoğunluğu erkek olup hanedeki ilk ve ikinci çocuklarda ruhsal hastalığın daha fazla oranda görüldüğü belirlenmiştir. 78 (%38,4) hastanın birinci derecede yakınlarında psikiyatrik hastalığın olduğu, bunun yanında 24 (%11,8) hastada adli sorun öyküsünün ve 4 (%2) hastada madde kötüye kullanımı öyküsünün olduğu görülmüştür. Tedaviye bakıldığında hastaların 29 (%14,3) kişisi risperidon uzun etkili enjeksiyon formu, 6 (%3) kişisi paliperidon palmitat uzun etkili enjeksiyon formu ve 9 (%4,4) kişisi aripiprazol uzun etkili enjeksiyon formu kullanmaktaydı.Sonuç: Bildiğimiz kadarıyla çalışmamız Türkiye’de Toplum Ruh Sağlığı Merkezi’nden hizmet alan hastaların klinik ve tedavi özelliklerini inceleyen nadir çalışmalardan biridir. Bu nedenle çalışmamızın literatür açısından önemli olduğu düşünmekteyiz.

Predictors of Outcomes in Adolescents With Clinical High Risk for Psychosis, Other Psychiatric Symptoms, and Psychosis: A Longitudinal Protocol Study.

In children and adolescents, schizophrenia is one of the ten main causes of disability-adjusted life years. The identification of people at Clinical High Risk of developing Psychosis (CHR-P) is one of the most promising strategies to improve outcomes. However, in children and adolescents research on the CHR-P state is still in its infancy and the clinical validity of at-risk criteria appears understudied in this population. Furthermore, only few studies have evaluated the psychopathological, neuropsychological, neuroimaging characteristics and, especially, long-term outcomes of adolescents at high risk. We present here the protocol of an innovative longitudinal cohort study of adolescents aged 12-17. The sample will consist of patients admitted to a third level neuropsychiatric unit, belonging to one of the following three subgroups: 1) adolescents with established Diagnostic and Statistical Manual of Mental Disorder–Fifth Edition psychosis, 2) adolescents with CHR-P, and 3) adolescents with psychiatric symptoms other than established psychosis or CHR-P. The primary aim of our study is to evaluate the 2-year prognosis across the three groups. We will measure transition to psychosis (or the stability of the diagnosis of psychosis in the psychotic group), the risk of development of other psychiatric disorders, as well as socio-occupational functioning at outcome. The secondary aim will be to explore the effect of specific predictors (clinical, neuropsychological and neuroimaging factors) on the prognosis. At baseline, 1-year and 2-year follow-up participants will be assessed using standardized semi-structured interviews and instruments. Psychopathological and functioning variables, as well as neuropsychological domains will be compared across the three subgroups. Moreover, at baseline and 2-year follow-up all recruited patients will undergo a 3-Tesla magnetic resonance imaging examination and diffusion tensor imaging parameters will be analyzed. We believe that this study will advance our ability to predict outcomes in underage CHR-P samples. In particular, our data will enable a better understanding of the clinical significance of CHR-P in adolescents, and shed new light on prognostic factors that can be used to refine the prediction of clinical outcomes and the implementation of preventive interventions.

Schizophrenia polygenic risk score and 20-year course of illness in psychotic disorders

Understanding whether and how the schizophrenia polygenic risk score (SZ PRS) predicts course of illness could improve diagnosis and prognostication in psychotic disorders. We tested whether the SZ PRS predicts symptoms, cognition, illness severity, and diagnostic changes over the 20 years following first admission. The Suffolk County Mental Health Project is an inception cohort study of first-admission patients with psychosis. Patients were assessed six times over 20 years, and 249 provided DNA. Geographically- and demographically-matched never psychotic adults were recruited at year 20, and 205 provided DNA. Symptoms were rated using the Schedule for the Assessment of Positive Symptoms and Schedule for the Assessment of Negative Symptoms. Cognition was evaluated with a comprehensive neuropsychological battery. Illness severity and diagnosis were determined by consensus of study psychiatrists. SZ PRS was significantly higher in first-admission than never psychotic groups. Within the psychosis cohort, the SZ PRS predicted more severe negative symptoms (β = 0.21), greater illness severity (β = 0.28), and worse cognition (β = −0.35), across the follow-up. The SZ PRS was the strongest predictor of diagnostic shifts from affective to non-affective psychosis over the 20 years (AUC = 0.62). The SZ PRS predicts persistent differences in cognition and negative symptoms. The SZ PRS also predicts who among those who appear to have a mood disorder with psychosis at first admission will ultimately be diagnosed with a schizophrenia spectrum disorder. These findings show potential for the SZ PRS to become a tool for diagnosis and treatment planning.

DESIGN AND EVALUATION OF AN ECOLOGICAL MOMENTARY ASSESSMENT TOOL FOR ASSESSING DEPRESSION IN DEMENTIA

Background. Assessing depression in people with dementia is challenging due to limitations of retrospectivity. Mobile Ecological Momentary Assessment (EMA) provides a novel approach in assessing depressive symptoms by collecting informant measures in intervals throughout the day, decreasing recall bias and increasing representativeness. Objective. The objective of this study is to design an EMA application for assessing depression in individuals with dementia. Methods. A literature review was conducted to determine commonly used and validated assessments for depression in dementia. Assessments were analyzed for common items, where items less commonly used (<50% of assessments sharing the item) or not relevant to be collected using EMA were excluded. Wording of items were also analyzed to develop the specific structure of questions for the EMA assessment. Results: Six assessments were found and demonstrated adequate performance outcomes. Items fell into either mood-related, dementia-related, vegetative, psychotic or positive mood symptom groups. The mood-related group was analyzed separately for prominent items, which were sadness, anxiety, pessimism, loss of interest and irritability. Wording of items were modified to be consistent with being collected throughout the day, rather than retrospectively. These items were incorporated as core observational domains in the application to be tested. Sadness and anxiety were additionally included as self-report items as studies have shown these to be most discordant between individuals with dementia and informants. Conclusions: This research is a first step towards an innovative approach to assessing depression in dementia. Next steps involve evaluation of the application’s feasibility and reliability for assessing depression in dementia.

Physical Functional Limitations in a First-Admission Cohort at Midlife: Findings From the Suffolk County Mental Health Project.

Psychosis is a risk factor for aging-related conditions and early mortality. Little is known about the age-specific risk of objectively measured physical functional limitations among individuals with serious mental illness. The Suffolk County Mental Health Project is a prospective study of individuals hospitalized for the first time for psychosis. To assess physical functioning at midlife and to identify emerging risk factors for older-age changes, 101 participants with schizophrenia (mean age = 47.2, SD = 8.0 years; 41.6% female) and 112 participants with other psychoses (mean age = 48.2, SD = 9.5 years; 45.5% female) were assessed for chair-rise and balance limitations 20 years after diagnosis. A never-psychotic comparison group of 237 age/sex/geographically matched community controls was similarly assessed (mean age = 50.3, SD = 8.8 years; 44.7% female). Logistic regression was used to examine group differences in prevalence of poor performance and demographic, medical, and treatment correlates. Chair-rise limitations (45.5% [35.8-55.3]) and balance limitations (17.2% [9.8-24.5]) were common in individuals with schizophrenia. Prevalence of chair-rise limitations was higher in schizophrenia (46.3%) than in other psychotic disorders (31.9%) and never-psychotic group (22.1%), whereas risk of balance limitations was higher in schizophrenia (17.2%) compared with never-psychotic controls (8.1%). Schizophrenia was a significant risk factor for chair-rise (adjusted odds ratio = 3.01 [1.79-5.08], p < .001) and balance limitations (adjusted odds ratio = 2.63, [1.25-5.51], p = .010). Multivariable analysis of symptom severity found avolition was associated with chair-rise limitations, but not balance, independent of diagnosis. Physical limitations are crucial because they identify existing problems with mobility and portend an increased risk of disability and death. Because participants with schizophrenia were at increased risk of physical limitations, assessments of chair-rise and balance limitations may be critical to monitoring individuals with psychosis.

Brain function during stages of working memory in schizophrenia and psychotic bipolar disorder

Working memory (WM) is impaired in psychotic disorders and linked to functional outcome. Most neurobiological models emphasize prefrontal cortex (PFC) dysfunction in the etiology of WM impairment. However, WM is composed of multiple processes, including encoding and maintenance, and the delineation of the neurobiology of these sub-processes has not been well characterized in schizophrenia and psychotic bipolar disorder. Functional MRI was obtained during an event-related spatial delayed match-to-sample task from 58 healthy individuals, 72 individuals with schizophrenia and 41 people with bipolar I disorder with psychotic features in order to: 1) characterize neural responses during encoding, maintenance and retrieval stages of WM using complementary region-of-interest and whole brain approaches; 2) determine whether schizophrenia and psychotic bipolar disorder exhibit similar abnormalities in WM-related brain function; and 3) elucidate the associations between WM-related brain function, task performance, and neuropsychological functioning. Both schizophrenia and psychotic bipolar disorder groups showed encoding- and maintenance-related impairments in the posterior parietal cortex (PPC) and frontal eye fields (FEF). BOLD response in the PPC and FEF, during encoding and maintenance respectively, was associated with task performance independent of group. Additionally, encoding-related activation in the PPC correlated with general neuropsychological functioning independent of group. Only encoding-related activation in the right ventral striatum differed between schizophrenia and psychotic bipolar disorder; individuals with schizophrenia showed significantly lower activation than both psychotic bipolar disorder and healthy groups. Our results are consistent with emerging evidence implicating PPC dysfunction in WM impairment and suggest interventions targeting neural activation in PPC may improve WM and neuropsychological functioning across psychotic disorders.

Clinical Characteristics of Obstructive Sleep Apnea in Psychiatric Disease.

Patients with serious psychiatric diseases (major depressive disorder (MDD), bipolar disorder (BD), and schizophrenia and psychotic disorder) often complain about sleepiness during the day, fatigue, low energy, concentration problems, and insomnia; unfortunately, many of these symptoms are also frequent in patients with Obstructive Sleep Apnea (OSA). However, existing data about the clinical appearance of OSA in Psychiatric Disease are generally missing. The aim of our study was a detailed and focused evaluation of OSA in Psychiatric Disease, in terms of symptoms, comorbidities, clinical characteristics, daytime respiratory function, and overnight polysomnography data. We examined 110 patients (56 males and 54 females) with stable Psychiatric Disease (Group A: 66 with MDD, Group B: 34 with BD, and Group C: 10 with schizophrenia). At baseline, each patient answered the STOP–Bang Questionnaire, Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), and Hospital Anxiety and Depression Scale (HADS) and underwent clinical examination, oximetry, spirometry, and overnight polysomnography. Body Mass Index (BMI), neck, waist, and hip circumferences, and arterial blood pressure values were also measured. The mean age of the whole population was 55.1 ± 10.6 years. The three groups had no statistically significant difference in age, BMI, hip circumference, and systolic and diastolic arterial blood pressure. Class II and III obesity with BMI > 35 kg/m2 was observed in 36 subjects (32.14%). A moderate main effect of psychiatric disease was observed in neck (p = 0.044, η2 = 0.064) and waist circumference (p = 0.021, η2 = 0.078), with the depression group showing the lowest values, and in pulmonary function (Forced Vital Capacity (FVC, %), p = 0.013, η2 = 0.084), with the psychotic group showing the lowest values. Intermediate to high risk of OSA was present in 87.37% of participants, according to the STOP–Bang Questionnaire (≥3 positive answers), and 70.87% responded positively for feeling tired or sleepy during the day. An Apnea–Hypopnea Index (AHI) ≥ 15 events per hour of sleep was recorded in 72.48% of our patients. AHI was associated positively with male sex, schizophrenia, neck, and waist circumferences, STOP–Bang and ESS scores, and negatively with respiratory function. A large main effect of psychiatric medications was observed in waist circumference (p = 0.046, η2 = 0.151), FVC (%) (p = 0.027, η2 = 0.165), and in time spend with SaO2 < 90% (p = 0.006, η2 = 0.211). Our study yielded that patients with Psychiatric Disease are at risk of OSA, especially men suffering from schizophrenia and psychotic disorders that complain about sleepiness and have central obesity and disturbed respiratory function. Screening for OSA is mandatory in this medical population, as psychiatric patients have significantly poorer physical health than the general population and the coexistence of the two diseases can further negatively impact several health outcomes.

Saúde mental e aplicação penal: destino de presos considerados inimputáveis

Objetivo: Verificar o destino dos sujeitos classificados como inimputáveis no Instituto Médico Legal do Centro de Perícias Científicas “Renato Chaves”, analisando os fatores determinantes dos desfechos possíveis. Métodos: Trata-se de estudo transversal realizado com 76 periciandos considerados inimputáveis, nos anos de 2012 a 2013, em centro forense no estado do Pará. Os dados foram obtidos através de protocolo de pesquisa revisando o exame de responsabilidade penal, e analisados pelos testes de Qui-quadrado de Aderência e o Teste Exato de Fisher. Resultados: Na casuística destacou-se: o gênero masculino (89,5%), nível escolar: ensino fundamental (55,3%), e crimes hediondos (51,3%). As análises que tiveram relevância estatística foram: preponderância de crimes hediondos cometidos pelos periciandos submetidos à medida de segurança detentiva (44,7%), e internações como medida de segurança com frequência relevante para aqueles com transtornos psicóticos (39,5%) abuso de substâncias psicoativas e retardo mental (13,2%). Conclusão: A medida de segurança detentiva foi a mais frequente, justificadas pelos transtornos psicóticos. Apenas o tipo de crime e o grupo dos transtornos psicóticos foram determinantes sobre a escolha do tipo de medida de segurança. O acompanhamento desses pacientes desde a atenção básica pode minimizar o risco de desfechos negativos tanto para si quanto para a sociedade.

Comparison of the treatment motivations of patients undergoing inpatient treatment with substance use disorder according to the types of application for treatment

Objective: It was aimed to investigate addiction treatment motivation among groups who applied to treatment volun-tarily, involuntarily applied with environment force, and reluctantly hospitalized with substance-induced psychotic disorder. Methods: Data of 85 patients treated in AMATEM clinic with substance use disorder were retrospectively reviewed. Two-way variance analysis was applied for comparison. Results: There was statistically significant differ-ence between groups in total Treatment Motivation Questionnaire and Internal Motivation scores (p=0.016, p=0.02). This difference was between volunteer and psychotic groups (p=0.004, p=0.003), no difference was found between volunteer and involuntary groups (p>0.05). The difference between Help Seeking Behavior scores was between volunteer-involuntary and volunteer-psychotic groups (p=0.020, p=0.018). There was no significant difference between groups’ external motivation and confidence in treatment scores (p>0.05). Discussion: Treatment motiva-tion similarity of volunteer group with involuntary group in many areas and with the group taken to addiction treat-ment with substance-induced psychotic disorder in certain areas indicating that these groups could benefit from addiction treatment similarly.

Analysis of elderly patients treated with electroconvulsive therapy and complication rates: a single center experience

Objective: Electroconvulsive therapy (ECT) is an effective treatment method used in many psychiatric disorders, primarily in mood and psychotic disorders. ECT is also effective and safe for geriatric depression. This study aimed to analyze elderly patients treated with ECT in bipolar disorder, major depressive disorder and psychotic disorder diagnostic groups. Methods: In this study, we retrospectively reviewed 58 geriatric patients over 60 years old who were treated with ECT between January 2014 and December 2017. Patients’ sociodemographic data, preliminary American Society of Anesthesiologists physical status assessments (ASA) scores and Clinical Global Impression (CGI), Hamilton Depression Rating Scale (HAMD), Young Mania Rating Scale (YMRS), Positive and Negative Symptom (PANSS) Scales before and after ECT were analyzed. Results: CGI, HAMD, YMRS and PANSS scores have significantly decreased after ECT. According to preoperative anesthesia consultations of the patients, 62.1% (n=36) were assessed to be in ASA 2 risk group and 34.5% (n=20) in ASA 3 risk group. One patient in the ASA 2 risk group and four patients in ASA 3 group had to discontinue treatment due to cardiovascular instability. These patients were administered medical treatment. There were no other mortalities or severe complications. Conclusion: This data shows that there were no mortalities or severe complications in elderly patients and supports the effectiveness and safety of ECT in elderly patients with bipolar disorder, major depressive disorder and psychotic disorder.

Aberrant Resting-State Functional Connectivity in the Default Mode Network in Pediatric Bipolar Disorder Patients with and without Psychotic Symptoms.

Mood disorders/psychosis have been associated with dysfunctions in the default mode network (DMN). However, the relative contributions of DMN regions to state and trait disturbances in pediatric bipolar disorder (PBD) remain unclear. The aim of this study was to investigate the possible mechanisms of PBD through brain imaging and explore the influence of psychotic symptoms on functional alterations in PBD patients. Twenty-nine psychotic and 26 non-psychotic PBD patients, as well as 19 age- and sex-matched healthy controls underwent a resting-state functional MRI scan and the data were analyzed by independent component analysis. The DMN component from the fMRI data was extracted for each participant. Spearman's rank correlation analysis was performed between aberrant connectivity and clinical measurements. The results demonstrated that psychotic PBD was characterized by aberrant DMN connectivity in the anterior cingulate cortex/medial prefrontal cortex, bilateral caudate nucleus, bilateral angular gyri, and left middle temporal gyrus, while non-psychotic PBD was not, suggesting further impairment with the development of psychosis. In summary, we demonstrated unique impairment in DMN functional connectivity in the psychotic PBD group. These specific neuroanatomical abnormalities may shed light on the underlying pathophysiology and presentation of PBD.

Olfactory bulbus volume and olfactory sulcus depth in psychotic patients and patients with anxiety disorder/depression.

In the present study, we investigated olfactory bulb (OB) volume and olfactory sulcus (OS) depth of the psychotic patients (predominantly schizophrenia) and patients with anxiety disorder/depression. This study was conducted retrospectively. Group 1 consisted of 30 psychotic patients (predominantly schizophrenia) (19 males and 11 females). Group 2 consisted of 37 patients with anxiety disorder/depression (10 males, 27 females). Group 3 consisted of 30 non-psychotic and non-anxiety disorder/depression subjects (9 males and 21 females). OB volume and OS depth measurements were performed on Cranial MRI. OB volume (right and left) of the psychotic; and anxiety disorder/depression groups were significantly lower than those of the control group (padjusted < 0.0175). OS depth (Left) value of anxiety disorder/depression group was significantly lower than those of the control group (padjusted < 0.0175). In psychotic and anxiety disorder/depression groups, left OS depth values were significantly lower than those of the right side (p < 0.05). In each of the males and females of the anxiety disorder/depression group, left OS depth values were significantly lower than those of the right side (p < 0.05). In psychotic group, OS depth (left) values get lower in older patients (p < 0.05). Decreased OB volume in the psychotic patients and decreased OB volume and OS depth in anxiety disorder/depression patients were detected. Lower OB volume and OS depth are related to the olfactory loss/or olfactory impairment. Physicians should be aware of the olfactory deficits in psychotic patients (mainly schizophrenia) and patients with anxiety disorder/depression. When reduced OB volume is detected on MRI, psychosis, schizophrenia or depression should also be kept in mind and the patients should be evaluated in detail for these diseases.

Clinical correlates of subsyndromal depression in African American individuals with psychosis: The relationship with positive symptoms and comorbid substance dependence

Patients with psychosis exhibit subsyndromal depressive symptoms during the course of illness and yet the clinical correlates of these symptoms remain under-investigated. We aimed to investigate the clinical correlates of subsyndromal depression in psychosis including the extent to which they mediate commonly observed comorbid substance dependence. We developed a model of depression in a non-clinical sample recruited via Amazon's Mechanical Turk (N = 266), and confirmed that model in a locally recruited African-American clinical sample comprising psychotic and non-psychotic individuals (N = 256). Using scores from this model we tested: the strength of relationships between depressive symptomatology and positive, negative and disorganized symptoms in a range of psychotic disorders; whether depressive symptoms were higher in individuals with affective psychoses versus schizophrenia; and if depressive symptomatology mediated the relationship between psychosis and substance dependence. Subsyndromal depressive symptomatology was significantly higher in individuals with psychosis than without psychosis, but did not significantly differ between affective and non-affective psychotic groups. Depressive symptomatology was significantly related to positive (but not negative or disorganized) psychotic symptoms, and mediated the relationship between psychosis and substance dependence. The present study underlines the importance of assessing subsyndromal depression in patients with psychosis, and generates a number of testable predictions for future work. In particular, the examination of the relationships between comorbid psychopathology, namely depression and substance abuse, may improve insight into the neurobiology of psychosis.

Diagnostic differences in verbal learning strategies and verbal memory in patients with mood disorders and psychotic disorders

A better understanding of verbal learning strategies can offer insight to the difference in verbal memory performance and learning between patients with schizophrenia and schizoaffective disorders, non-psychotic major depression, and psychotic major depression. To date, a comparison of the use of verbal learning strategies and verbal memory performance amongst these specific diagnostic groups has not been investigated. This study examined differences in verbal learning and memory between psychotic major depression (n = 31), nonpsychotic major depression (n = 30), and schizophrenia spectrum disorders (n = 17) disorders. Verbal learning and memory were assessed through the use of the California Verbal Learning Test-II (CVLT-II). Correlations and multiple regression analyses were conducted to analyze differences in verbal learning and memory amongst these groups. There were no significant differences in the use of Semantic Clustering. Diagnostic differences were observed in the use of Serial and Subjective Clustering. The psychotic major depression group utilized Serial Clustering strategy significantly less than the nonpsychotic major depression group. Learning strategies significantly predicted learning and recall. These findings lend support to the hypothesis that learning strategies predict verbal memory performance across diagnostic groups. The present study contains useful information on diagnostic differences in verbal learning and memory, and a framework by which treatment could be tailored to enhance learning specific to these diagnostic groups.

Differences in clinical characteristics between bipolar patients with current psychotic symptoms and those who have never been psychotic.

Psychotic symptoms are common in bipolar disorder (BD). Data suggest that BD patients with or without psychotic symptoms may differ from each other with regards to some clinical features of BD (e.g., age at onset, suicidality, psychiatric comorbidity, number of hospitalizations). However, the literature in this area is relatively scarce and not always conclusive. Therefore, the objective of the current study was to investigate whether the presence of psychotic symptoms is associated with clinical characteristics of patients with BD. We enrolled 365 hospitalized patients who were diagnosed with BD according to the ICD-10 criteria. After we excluded 196 patients without current psychotic symptoms but psychotic mood episodes in their medical history, our final sample consisted of 169 patients (i.e., 89 BD patients presenting with current psychotic symptoms and 80 BD patients who were hospitalized in the same period, but who did not have psychotic symptoms either currently or during their previous hospitalizations). Clinically available data were collected, systematized and statistically processed according to the aims of the study. Early age of onset, bipolar-I diagnosis, comorbid personality disorder, number of hospitalizations and suicidality were significantly more common in the psychotic group compared to the never-psychotic group. On the contrary, sedative/hypnotics dependence was more frequent in the never-psychotic group. Our results support the notion that the presence of psychotic symptoms in the context of BD may be associated with various other clinical features of this disease.

Normative and Maladaptive Personality Trait Models of Mood, Psychotic, and Substance Use Disorders

The Personality Inventory for DSM-5 (PID-5) is a questionnaire developed to assess the five domains represented in the alternative model for personality disorders proposed in Section III of the DSM-5. This study examined the ability of the PID-5 to distinguish between different mental disorders compared to a questionnaire measure of the five-factor model (FFM) of normative personality. The study included the administration of the PID-5 and Revised NEO Personality Inventory (NEO PI-R), a measure of the FFM, to treatment-seeking individuals with Depressive, Bipolar, Psychotic, and Alcohol Use Disorders (AUD). Diagnostic groups were compared at the domain level of PID-5 and NEO PI-R, with sex and age as covariates. The main findings on the PID-5 included higher Detachment scores for Bipolar and Depressive Disorders than Psychotic and AUDs, lower Psychoticism/higher Disinhibition scores for the AUD group compared to all other groups, and lower Negative Affect for the Psychotic Disorders versus AUD group. On the NEO PI-R, the AUD diagnostic group was associated with lower Conscientiousness and Agreeableness scores compared to all other groups, and lower Neuroticism scores than the Bipolar and Depressive groups. Group pairwise comparisons did not appear to show many differences between the PID-5 and NEO PI-R. The results suggest that the alternative DSM-5 model for personality disorders may have clinical utility in distinguishing personality profiles between diagnostic groups. These findings emphasize the importance of additional research on the capacity of maladaptive personality to contribute to the assessment of differential diagnoses.