Psychotic Mental Disorders Research Articles

Psychological mechanisms of the formation of non-psychotic mental disorders in patients with hyperthyroidism

The application of a comprehensive, integrative, systemic approach to the examination of patients with abnormal thyroid gland has to lie in the basis of planning strategies and tactics of medical programs such patients. On this point of view we consider that non- psychotic mental disorders are developing on the basis of both organic and adaptation levels. Population researches showed that the majority of patients with endocrinological pathology suffer from one of the three DCPR syndromes: irritant mood, demoralization thrown in (desperation), persistant somatization. The task of our work was to investigate mechanisms of psychological defense in patients with hyperthyroidism with non-psychotic mental disorders. One hundred and twenty-five patients were examined. Non-psychotic mental disorders with different syndromologic structure were found in 76% of patients (study group), among which anxious-asthenic (38.95%), anxiety and depression (23.16%) were dominant. The method of Robert Plutchik for assessment of the mechanisms of defense was used. In asthenic syndrome we found excessive functioning of negation and regression, inadequate functioning of intellectualization. In patients with astheno-anxious syndrome inadequate functioning of negation, intellectualization, compensation, and excessive repression contributed to the formation of the sensations of anxiety. Excessive compensation, projection, reactive formation generally affected the structure of the asteno-depressive syndrome. The lack of displacing of reactive formation, repression and excessive intellectualization in a complex influenced to the structuring of anxious-depressive syndrome. In hypochondrical syndrome projection, regression and negation were the basis of the formation of clinical picture. Thus, meaningful relationships between intrapsychic level of functioning and syndromological structure of non-psychotic disorders were installed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychotic experiences as precursors in schizophrenia? Findings from a population-based sample in Germany (DEGS1-MH)

There are only a few studies that have studied the prevalence of psychotic experiences (PEs) in a representative population-based sample and a broad range of age. The association and predictive role of PEs in the context of psychotic and other mental disorders remains a subject of discussion. The Mental Health Module of the German Health Interview and Examination Survey for Adults is the first wave of a German health monitoring survey describing:– the distribution and frequency, the severity and the impairments of a wide range of mental disorders;– risk factors as well as patterns of help-seeking and health care utilization;– associations between mental and somatic disorders.A total of 4483 participants participated in the mental health section of the survey. The Composite International Diagnostic Interview, the Launay-Slade Hallucination Scale and the Peter's Delusion Inventory were used to assess PEs by clinically experienced interviewers. We can confirm and extend previous findings for younger age groups that PEs are very frequent psychopathological expressions in the general population across genders and all age groups. PEs rates were elevated among those with other mental disorders, particularly among possible psychotic disorders, PTSD and affective disorders. This points to the relevant role of PEs as a marker for psychopathology and mental disorders. Future prospective studies will have to focus on specific properties of psychotic experiences such as their appraisal or underlying social influences to determine their significance for the prediction of psychotic and other mental disorders.Disclosure of interestThe author has not supplied his declaration of competing interest.

Yokukansan and its ingredients as possible treatment options for schizophrenia.

Schizophrenia is a debilitating psychotic mental disorder that affects almost the entire range of human mental function. The devastating effect of the illness is usually long-lasting and requires lifelong treatment. Despite an evolved psychopharmacological understanding, the overall therapeutic effect of antipsychotics is still not satisfactory. The choice of proper medication presents a clinical dilemma between efficacy and safety. As a result, searching for comparable treatment options with safer profiles is very important. Yokukansan (TJ-54), also called yi-gan san in Chinese, is a traditional herbal medicine with evident therapeutic effect for neuropsychiatric disorders. There are several open-label clinical studies upholding the possibility of using yokukansan to treat schizophrenia or schizophrenia-like psychosis. Evidence from animal studies and neurobiology also sheds light on the antipsychotic implications of yokukansan and its ingredients. Nevertheless, correlations between the experimental environment and clinical settings may be complicated by a number of confounders. Clinical trials with more sophisticated designs are required to fill the gap between the experimental environment and clinical settings.

Public Stigma Associated With Psychosis Risk Syndrome in a College Population: Implications for Peer Intervention

This study compared stigma associated with the psychosis risk label and diagnostic labels for nonpsychotic and psychotic mental disorders among young adult peers. Urban college respondents (N=153) read an experimental vignette describing a young adult experiencing prodromal symptoms who was randomly assigned a diagnostic label (major depression, generalized anxiety disorder, schizophrenia, or psychosis risk with and without accurate information about the psychosis risk label) and answered questions about stigma toward the individual in the vignette. Compared with labels for nonpsychotic disorders, schizophrenia elicited more negative stereotyping and the at-risk label invoked greater social distance and less willingness to help. Any increased social distance appeared to be reduced by accurate information about the at-risk state. No differences in stigma were found for the psychosis risk and schizophrenia labels. The psychosis risk label alone appeared to evoke greater status loss and discrimination. Accurate information may minimize some stigmatizing attitudes among college peers.

1415 – Psychological mechanisms in formation of non-psychotic mental disorders in patients with primary hypothyroidism

On the point of view of systemic approach we consider that non- psychotic mental disorders are developing on the basis of both organic and adaptation levels. According today investigations psychiatrists distinguish both psychological and intrapsychic levels of adaptation. The task of our work was to investigate mechanisms of psychological defense in patients with primary hypothyroidism with non-psychotic mental disorders. Totally 132 patients with primary hypothyroidism patients were ranged. 108 patients accounted for 81,12% of the total number of monitored, was to provide various forms of non-psychotic mental disorders: astheno-depressive (32,41), asthenic (27,78%) and astheno-anxious (18,52%). In 23 patients (12,04%) anxiousdepressive syndrome, and 10 (9.25%) developed hypochondrical syndrome. In the study the adopted method of assessment typology of psychological defense was used. In asthenic syndrome we found excessive functioning of negation and regression, inadequate functioning of intellectualization. In patients with astheno-anxious syndrome inadequate functioning of negation, intellectualization, compensation, and excessive repression contributed to the formation of the sensations of anxiety. Excessive compensation, projection, reactive formation generally affected the structure of the asteno-depressive syndrome. The lack of displacing of reactive formation, repression and excessive intellectualization in a complex influenced to the structuring of anxious-depressive syndrome. In hypochondrical syndrome projection, regression and negation were the basis of the formation of clinical picture. Thus, meaningful relationships between intrapsychic level of functioning and syndromological structure of non-psychotic disorders were installed and highlighted the basic mechanisms of protection, that affect the formation of a clinical picture.

902 – A combined fMRI and VBM study to show motor deficits in schizophrenic versus control subjects during a simple motor task

Schizophrenia is one of the psychotic mental disorders, characterized by social problems and disorders of thought, behaviour, motor and cognitive functions such as long-term memory, verbal memory, executive functioning and vigilance etc. However, the relation between structural and functional alterations in schizophrenia remains unclear. Therefore, the present study sought to investigate whether functional alterations in schizophrenia are also associated with structural brain aberrations directly in related brain regions or in anatomically closely connected areas. The current study was conducted to investigate the possible relationship between functional and structural changes for a simple motor task in schizophrenics. 16 controls and 16 schizophrenic patients were chosen for the study. The structural and functional MRI scans were acquired using 3 Tesla whole-body MRI system with a 16 channel head array coil. For fMRI, a block paradigm with alternating blocks of motor task (right finger tapping; 120 taps/min) and rest was carried out. Pre-processing and post-processing of MRI scans were performed using SPM8 software. The fMRI study showed relatively less activation in the left precentral and postcentral gyrus and right cerebellum in schizophrenic patients as compared to controls during finger tapping task. Voxel-based morphometry (VBM) revealed grey matter decreases in the left precentral and postcentral gyrus and left middle frontal gyrus while white matter decreases in the right cerebellum and right inferior temporal gyrus of schizophrenics as compared to controls. The present study provides strong evidence for an association between motor functional deficits and structural alterations in schizophrenic patients as compared to controls.

Assessing clinical implications of spiritual experiences

Since spiritual experiences (SE) very often resemble dissociative and psychotic symptoms, there is a risk of misdiagnosis in both directions: labeling a healthy SE as a mental disorder or taking a mental disorder as an SE. There is a scarcity of well-controlled studies on this subject. The paper provides a brief overview of studies on dissociative and psychotic experiences in the non-clinical population, especially those occurring in spiritual populations. At the end, some guidelines are proposed to help clinical reasoning when making the differential diagnosis between healthy SE with psychotic and dissociative experiences and mental disorders that may resemble SE.

P-1049 - Toxic psychoses - comparison to schizophrenia

Introduction Toxic psychoses are growing problem in every-day clinical psychiatric practice. Well-known is fact that use of psychoactive substances, particularly stimulants and cannabis, is associated with psychotic mental disorders. Objectives Differences between psychopathology of schizophrenia and toxic psychotic states are not clear. Aims To compare psychopathology of patients treated with schizophrenia and toxic psychosis. Methods Patients with schizophrenia who only temporally used psychoactive substances and patients with non-alcoholic toxic psychoses treated at Psychiatric Clinic of FMUC and UHB in interval of years 2006–2010 were enrolled in present study. Retrospective analysis of demographic and clinical characteristic, especially psychopathological symptoms was conducted. Results The authors collected data from medical records of 93 patients treated with non-alcoholic toxic psychoses (TP; 86,0% males, 14,0% females) and 80 patients treated with schizophrenia who only temporally used psychoactive substances (SCH; 93,7% males, 6,3% females) (Tab. 1). Toxic psychotic state was induced mostly by more substances, stimulants and cannabis. Diagnosis acc. ICD-10 n % F 20.0 58 72,4 F 20.3 13 16,3 F 20.5 5 6,3 F 20.6 4 5,0 [Diagnostic spectrum in patients with schizophrenia] Conclusions The most frequently observed clinical picture in toxic psychoses was paranoid-hallucinatory syndrome. In schizophrenia group was most prominent paranoid form. The authors found and discussed differences between psychopathology in both groups. It seems to that a more specific description and classification of toxic psychoses could be possible.

P-457 - Dementia in elderly long term inpatients with serious mental illness

Introduction Cognitive impairment and loss of functionality are key characteristics of dementia and also highly prevalent among patients with serious mental illness. Our study reports on the prevalence of dementia and the relationship between cognitive decline, behavioral and social functioning disturbances, lifestyle/ physical health parameters and the pharmaceutical approaches, in an elderly population of the psychiatric hospital of Attica. Methods 103 patients, aged 55 years or more, with diagnosis of Schizophrenia/other psychotic disorders, Mood disorders, and mental disorders due to a general medical condition (DSM-IV-TR) participated. Dementia was also defined according to DSM-IV-TR. Data collection was through their medical records and scales (Mini Mental State Examination, Clock Drawing Test, Global Deterioration Scale, Katz Index of Independence in Activities of Daily Living, Neuropsychiatric Inventory). All variables were statistically analyzed using the SPSS. Results Of the sample of 103 participants, 35.9% men, 64.1% women (mean age of 71), 60.2% had Schizophrenia, 7.8% Mood disorder, 32% Mental disorders due to a general medical condition. Dementia was diagnosed in 42 patients. 43,7% had severe daily skills dysfunction. Only 12,6% had no concomitant physical illness. Although they all had cognitive impairment, only 1/3 were treated with cognitive enhancers. Conclusions Long term mental disorder and long term hospitalization lead to severe deterioration of both cognitive function and daily skills abilities. Along with early screening for dementia, psychogeriatric patients need specific therapeutic approaches, promotion of favourable physical profile and amelioration of the consequences of the long term medication in their fragile health.

P-1026 - Metabolic syndrome and risk for coronary heart disease in elderly inpatients with serious mental illness

Introduction People with severe mental disorders have worse physical health compared with the general population. Metabolic aspects such as obesity, diabetes, hypertension, dyslipidaemia, smoking and antipsychotic medication increase the risk of metabolic syndrome (MetS) and cardiovascular disease. Epidemiological studies have consistently shown excess CVD mortality in patients with schizophrenia, bipolar disorder and depression. Methods The participants (103 patients) age 55 years or more, had diagnosis of Schizophrenia and other psychotic disorders, Mood disorders and Mental disorders due to a general medical condition(DSM IV-TR criteria). Metabolic syndrome was estimated using the ATP III definition. Framingham risk score was calculated using algorithms developed by Wilson for subjects aged 30 years and older. Results Overall prevalence of MetS was 34%. (37.1% men, 62,9% women). Among patients with MetS 74.3% had schizophrenia, 8.6.% Mood disorder and 17.1% Mental disorders due to a general medical condition. In our sample 18.8% of patients with MetS were receiving FGAs, 78.1% SGAs and 3.1% combination of FGAs and SGAs but this difference wasn’t statistically significant. Low risk (FRS 15) had 32% of participants (66.7% men, 33.3% women). Conclusions The results indicate that patients with schizophrenia have higher probability of having MetS, therefore, clinicians should appropriately monitor the risk factors and intervene as required.

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.

Cognitive behavioural therapy and the psychopathology of schizophrenia: Systematic review and meta‐analysis

To examine whether cognitive behaviour therapy (CBT) reduces psychopathology in patients with schizophrenia more effectively than the use of non-cognitive psychotherapies. Systematic review and meta-analysis of the literature was performed. All Randomized Controlled Trials meeting the inclusion criteria were analysed using RevMan software. This design was used to maximize power and study efficacy. Medline, PsycINFO, and Embase were searched using free-text keywords to identify potential papers. Nine were included in the final meta-analysis. Change in psychopathology at the end of therapy was the end point investigated. A random effects model was used to assess the standard mean difference between the CBT and supportive control groups. Meta-analysis of CBT versus supportive therapy did not find significant differences between the therapy groups at the end of treatment in respect of psychopathology. There was no evidence of publication bias. Post hoc power analysis using the Z test ruled out type one error. Theoretically based CBT therapies, although proving effective, may not out perform more accessible and simpler forms of therapy for patients with schizophrenia in reducing psychopathology. Consideration of supportive therapy should be made for patients with psychotic mental disorder.

Psychopathic disorders and criminal responsibility in the USA

The insanity defense in the United States is available to provide a legal excuse for those whose criminal acts were due to serious mental illness. To an underappreciated extent, the evolution of the insanity defense is integrally related to the evolution of conceptions of psychopathic disorders and their relevance, or determined lack thereof, to the insanity defense. As legal and mental health professionals discuss the ideal insanity defense and whether psychopathic disorders should be qualifying or disqualifying conditions, any practical outcome of such discussions must take into account the politics of the insanity defense. When this is done, it becomes apparent that the insanity defense itself, even for serious, psychotic mental disorders, is withering under relentless attack and must be advanced and defended without diluting its salient importance by including psychopathic disorders.

P01-297 - The peculiarities of organization consultative liaision psychiatry/psychotherapy in multiprofile general hospital (12-years experience)

On base 12-years experiense of activity of Department Psychotherapy (2 psychiatrists, 2 psychotherapeutists and 1 medical psychologist) in Moscow City Clinical Hospital (CCH) №36 revealed the peculiarities of organization psychiatric and psychotherapeutic care of somatic patients with comorbid mental disorders. Since 1997 we worked out “Statute of Department Psychotherapy in CCH” and functional duties of every of specialists; more-over owing to select of specialists created of team of adherents on principle “team work”; in the same way cary out educational seminars for internidts on increasing their knowled-ge in “border-line” psychiatry, somaform and psyhosomatic disordres. We selected the optimal of organization consultative liaison psychiatry/psychotherapy in condition in gene-ral hospital - model “liaison-attachment”. Durind 12 years carry out consultative liaison psychiatric treatment 22638 somatic patients with comorbid mental disorders (5,8% from all treated patients in the hospital for 12 years - 390310). On psychiatric diagnosis comor- bid mental disorders distributed on 2 groups: at 13402 patients(59,2%) revealed comorbid non-psychotic mental disorders (neurosis, neurosis-like, somaform, psychosomatic, per- sonality disorders); at 9236 patients(40,8%) with psychotic mental disorders(acute soma- genic psychosis, alcohol delirium and/or mental retardation). Distribution on age: 18-19 years-1,6%,20-39 -20,2%, 40-59 - 32,8%, 60 years and more - 45,4% patients.In result: 12-years experience showed that the functioning of specialists of Department Psychothe-rapy in CCH 36 distincly assisted of improving psychosomatic disorders in 5,8% somatic inpatients (betwen them turned out 45,4% elderly persons - 60 years and more). Treatment in CCH conducted without any stigmatization and discrimination.

The influence of temporal lobectomy on the mental state of patients with psychomotor epilepsy. T. Alajouanine, J. Nehlil, R. Houdart. Revue Neurol 1958;98(3):165–171

It is known that in the course of temporal lobe epilepsy, psychic disorders independent of the actual seizures have considerable importance. However, opinions vary on the influence of lobectomy on psychic behavior. Pond and Hill stated, “We also performed operations on a small group of patients. These patients had their seizures under control, but they presented a psychotic mental disorder… Up to the present, we have only operated on a few cases and, frankly, we are not very satisfied with the results as far as an improvement in the mental state is concerned. Apparently, the operation might play a role in preventing a deterioration of the personality. Therefore, the reasons for operating epileptic foci in the temporal lobe region rather than those in other regions of the brain are that the seizures in this region are difficult to control and there is considerable risk for marked psychosis. At this stage of our limited experience, we consider this a rational method of treatment for the most common form of epilepsy with onset in the adult”.

Interaction between interleukin 3 and dystrobrevin-binding protein 1 in schizophrenia

Schizophrenia is a common psychotic mental disorder that is believed to result from the effects of multiple genetic and environmental factors. In this study, we explored gene–gene interactions and main effects in both case–control (657 cases and 411 controls) and family-based (273 families, 1350 subjects) datasets of English or Irish ancestry. Fifty three markers in 8 genes were genotyped in the family sample and 44 markers in 7 genes were genotyped in the case–control sample. The Multifactor Dimensionality Reduction Pedigree Disequilibrium Test (MDR-PDT) was used to examine epistasis in the family dataset and a 3-locus model was identified (permuted p = 0.003). The 3-locus model involved the IL3 (rs2069803), RGS4 (rs2661319), and DTNBP1 (rs2619539) genes. We used MDR to analyze the case–control dataset containing the same markers typed in the RGS4, IL3 and DTNBP1 genes and found evidence of a joint effect between IL3 (rs31400) and DTNBP1 (rs760761) (cross-validation consistency 4/5, balanced prediction accuracy = 56.84%, p = 0.019). While this is not a direct replication, the results obtained from both the family and case–control samples collectively suggest that IL3 and DTNBP1 are likely to interact and jointly contribute to increase risk for schizophrenia. We also observed a significant main effect in DTNBP1, which survived correction for multiple comparisons, and numerous nominally significant effects in several genes.

Hyperprolactinemia and possibly related development of prolactinoma during amisulpride treatment; three cases

Schizophrenia is a chronic and debilitating psychotic mental disorder that affects about 1% of the world's population. Antipsychotic drugs are the mainstay of treatment in schizophrenia. Hyperprolactinemia, which is a common side effect of typical antipsychotics, is also associated with the use of some of the newer atypical agents. Antipsychotics may enhance prolactinoma growth as manifested by an increase in serum prolactin concentration. Prolactin-secreting pituitary adenomas possibly related with antipsychotics have been described in the literature. To our knowledge, this is the first series of cases showing a possible relation between pituitary adenomas and amisulpride treatment in patients with schizophrenia.

Psychosis following head injury: a critical review

Schizophrenia is the most common form of psychotic mental disorder, with a point prevalence generally estimated to lie between 0.6–1.0%. Genetically informative studies have indicated a multifactorial aetiology, with an...

‘What is (mental) disease?’: an open letter to Christopher Boorse

This “open letter” to Christopher Boorse is a response to his influential naturalist (value-excluding) analysis of disease from the perspective of linguistic-analytic value theory. The key linguistic-analytic point against Boorse...

ICD-10 Casebook: The Many Faces of Mental Disorders—Adult Case Histories According to ICD-10

Back to table of contents Previous article Next article Book Forum: ASSESSMENT AND DIAGNOSISFull AccessICD-10 Casebook: The Many Faces of Mental Disorders—Adult Case Histories According to ICD-10MARY V. SEEMAN, M.D., MARY V. SEEMANSearch for more papers by this author, M.D., Toronto, Ont., CanadaPublished Online:1 Oct 1999https://doi.org/10.1176/ajp.156.10.1656AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail “Names,” says an old maxim, “are things. They certainly are influences. Impressions are left and opinions are shaped by them.…The mean and selfish talk of their prudence and economy; the vain and proud prate about self-respect; obstinacy is called firmness, and dissipation the enjoyment of life; seriousness is ridiculed as cant, and strict morality and integrity, as needless scrupulosity; and so men deceive themselves.” Tryon Edwards (1809–1894) published this maxim in his first book of quotations in 1852 under the title Jewels for the Household. He certainly was not thinking about psychiatric diagnoses, but his words apply rather well to the self-deception that underlies the notion that to name something is to know it.Psychiatry is good at naming. The case histories in this little book were selected from those used in ICD-10 training courses around the world and in the clinical field trials that resulted in the current international classification system. The field trials apparently yielded some 400 case summaries. This book presents more than 100, each illustrating one of the categories of the adult diagnoses coded F0 to F6 in ICD-10. Because the psychiatric categories are very similar to those in DSM-IV, the cases may well be useful for training and discussion. And questioning.The personal stories are culled from around the world, and each contains the presenting problem, the history, the findings, and the course of illness. Each is followed by a discussion section that illustrates the application of ICD-10 guidelines in the making of a specific diagnosis. Each example is colorfully titled, so the story (and the salient diagnostic issues) remains firmly planted in the minds of students, e.g., “The Royal Visit,” “The Smell of Revenge,” “Pulling Up the Flax.”The editors direct interested students to two companion books, the “blue” book (ICD-10 chapter 5, “Clinical Descriptions and Diagnostic Guidelines”) for clinicians and the “green” book (ICD-10 chapter 5, “Diagnostic Criteria for Research”) for researchers. This one is the “red” book, meant as an easy introduction to the art of diagnosis based on predominantly cross-sectional information about presenting symptoms and physicians’ findings.Students may find it helpful to make the crosswalk between the international system and the American system. ICD-10 continues to use the term “organic mental disorders” (F0 and F1), F1 encompassing psychoactive substance abuse disorders. DSM-IV has stopped using the word “organic” (presumably all disease has biological correlates) and, instead, uses descriptive categories: deliriums, dementias, amnesic disorders, mental disorder due to a general medical condition, and substance-related disorders. ICD-10 F2 and F3 are grouped as psychotic mental disorders (schizophrenia and mood disorders), although many of the examples are without psychotic features. Why is something a psychotic disorder if only some of the cases, some of the time, exhibit psychosis? Incidentally, what is psychosis? The ICD-10 F4, F5, and F6 categories cover “neurotic, stress, and personality disorders.” DSM-IV calls these anxiety, somatoform, factitious, dissociative, sexual and gender identity, eating, impulse control, and personality disorders, having dispensed with the meaningless word “neurotic.” Perhaps, soon, the equally meaningless word “personality” will yield to more understandable descriptors.Despite the somewhat different names, the syndromes are clearly similar in the two systems, and, around the world, as in the United States, the available treatments continue to be limited in number and efficacy no matter what the disorder is called.There is certainly magic in names. “Some to the fascination of a name surrender judgement, hoodwinked” (William Cowper, 1731–1800).By T.B. Üstün, A. Bertelsen, J. van Drimmelen, C. Pull, A. Okasha, N. Sartorius, and other ICD-10 Reference and Training Center Directors. Washington, D.C., American Psychiatric Press, 1996, 237 pp., $35.00. FiguresReferencesCited byDetailsCited byNone Volume 156Issue 10 October 1999Pages 1656-1656 Metrics History Published online 1 October 1999 Published in print 1 October 1999