Psychotic Mood Disorders Research Articles

Decoding Early Psychoses: Unraveling Stable Microstructural Features Associated With Psychopathology Across Independent Cohorts

BackgroundPatients with early psychosis (EP) (within 3 years after psychosis onset) show significant variability, which makes predicting outcomes challenging. Currently, little evidence exists for stable relationships between neural microstructural properties and symptom profiles across EP diagnoses, which limits the development of early interventions. MethodsA data-driven approach, partial least squares correlation, was used across 2 independent datasets to examine multivariate relationships between white matter properties and symptomatology and to identify stable and generalizable signatures in EP. The primary cohort included patients with EP from the Human Connectome Project for Early Psychosis (n = 124). The replication cohort included patients with EP from the Feinstein Institute for Medical Research (n = 78) as part of the MEND (Multimodal Evaluation of Neural Disorders) Project. Both samples included individuals with schizophrenia, schizoaffective disorder, and psychotic mood disorders. ResultsIn both cohorts, a significant latent component corresponded to a symptom profile that combined negative symptoms, primarily diminished expression, with specific somatic symptoms. Both latent components captured comprehensive features of white matter disruption, primarily a combination of subcortical and frontal association fibers. Strikingly, the partial least squares model trained on the primary cohort accurately predicted microstructural features and symptoms in the replication cohort. Findings were not driven by diagnosis, medication, or substance use. ConclusionsThis data-driven transdiagnostic approach revealed a stable and replicable neurobiological signature of microstructural white matter alterations in EP across diagnoses and datasets, showing strong covariance of these alterations with a unique profile of negative and somatic symptoms. These findings suggest the clinical utility of applying data-driven approaches to reveal symptom domains that share neurobiological underpinnings.

Functional network characteristics in adolescent psychotic mood disorder: associations with symptom severity and treatment effects.

Adolescent psychotic mood disorder (MDP) is a specific phenotype that characterized by more severe symptoms and prognosis compared to nonpsychotic mood disorder (MDNP). But the underlying neural mechanisms remain unknown, and graph theory analysis can help to understand possible mechanisms of psychotic symptoms from the perspective of functional networks. A total of 177 adolescent patients with mood disorders were recruited, including 61 MDP and 116 MDNP. Functional networks were constructed, and topological properties were compared between the two groups at baseline and after treatment, and the association between properties changes and symptom improvement was explored. Compared to the MDNP group, the MDP group exhibited higher small-world properties (FDR q = 0.003) and normalized clustering coefficients (FDR q = 0.008) but demonstrated decreased nodal properties in the superior temporal gyrus (STG), Heschl's gyrus, and medial cingulate gyrus (all FDR q < 0.05). These properties were found to be correlated with the severity of psychotic symptoms. Topological properties also changed with improvement of psychotic symptoms after treatment, and changes in degree centrality of STG in the MDP was significantly positive correlated with improvement of psychotic symptoms (r = 0.377, P = 0.031). This study indicated that functional networks are more severely impaired in patients with psychotic symptoms. Topological properties, particularly those associated with the STG, hold promise as emerging metrics for assessing symptoms and treatment efficacy in patients with psychotic symptoms.

Recurrent antimicrobial exposure and acute psychosis.

There is an increased prevalence of recent antimicrobial exposure in patients with acute psychosis. We previously found recurrent urinary tract infections (UTIs) in some patients with psychosis. We evaluated the prevalence of recurrent antimicrobial exposure in acutely ill inpatients with psychosis. We performed a retrospective chart review of 85 patients age 18 to 65 with multiple hospitalizations for acute psychosis. Antimicrobial exposure was defined as occurring within 3 days of each psychiatric hospitalization. Recurrent infections were defined as antimicrobial exposure during ≥2 separate hospitalizations for acute psychosis. The prevalence of recurrent antimicrobial exposure was 26% (22/85), including 25% (13/51) in patients with schizophrenia and 26% (9/34) in patients with psychotic mood disorders. Patients with schizophrenia and recurrent antimicrobial exposure were significantly more likely to have visual hallucinations in admissions with infection vs without (31% vs 14%, respectively, P = .04). We found that a subset of patients with schizophrenia and psychotic mood disorders has recurrent infections at the time of hospitalization for acute psychosis. Findings replicate an association between recurrent UTIs and acute psychosis. Although the mechanism of this association remains unclear, findings provide additional evidence that infections may be relevant to illness relapse in some patients with psychosis.

Replication of the abnormal niacin response in first episode psychosis measured using laser Doppler flowmeter.

Impaired sensitivity of the skin flush response to niacin is found in approximately 30% of patients with schizophrenia. Although the niacin response abnormality (NRA) may serve as a useful endophenotype for schizophrenia, few studies have directly replicated NRA in patients with first-episode psychosis (FEP). In total, 204 patients with FEP, 16 with psychotic mood disorder (PMD), and 68 healthy controls (HC) were included. The log10 (EC50 ) values represent the concentration of methyl nicotinate required to elicit a half-maximal blood flow (MBF) response, and the MBF value was calculated. The NRA was defined as having log10 (EC50 ) molar value above the 90% and an MBF value below the 60% of those in the HC group. In total, 13.7% of the FEP, 12.5% of the PMD, and 7.4% of the HC group met the definition of NRA. Significant differences were found in the log10 (EC50 ) values between the FEP and HC groups (p=.014) and in the MBF between the FEP and PMD groups (p=.011). Patients with FEP and NRA had more severe negative symptoms than those with a normal niacin response. These data represent the NRA in patients with FEP, defining a small subgroup of patients with early-phase psychosis possessing a clinically significant phospholipid-signaling defect.

Resting state functional connectivity and structural abnormalities of the brain in acute retarded catatonia: an exploratory MRI study.

In this first cross-sectional MRI study in acute catatonia, we compared the resting state whole-brain, within-network and seed (left precentral gyrus)-to-voxel connectivity, as well as cortical surface complexity between a sample of patients in acute retarded catatonic state (n = 15) diagnosed as per DSM-5 criteria and a demographically matched healthy control sample (n = 15). The patients had comorbid Axis-I psychiatric disorders including schizophrenia spectrum disorders and psychotic mood disorders, but did not have diagnosable neurological disorders. Acute retarded catatonia was characterized by reduced resting state functional connectivity, most robustly within the sensorimotor network; diffuse region of interest (ROI)-ROI hyperconnectivity; and seed-to-voxel hyperconnectivity in the frontoparietal and cerebellar regions. The seed (left precentral gyrus)-to-voxel connectivity was positively correlated to the catatonia motor ratings. The ROI-ROI as well as seed-to-voxel functional hyperconnectivity were noted to be higher in lorazepam responders (n = 9) in comparison to the non-responders (n = 6). The overall Hedges' g effect sizes for these analyses ranged between 0.82 and 3.53, indicating robustness of these results, while the average Dice coefficients from jackknife reliability analyses ranged between 0.6 and 1, indicating fair (inter-regional ROI-ROI connectivity) to perfect (within-sensorimotor network connectivity) reliability of the results. The catatonia sample showed reduced vertex-wise cortical complexity in the right insular cortex and contiguous areas. Thus, we have identified neuroimaging markers of the acute retarded catatonic state that may show an association with treatment response to benzodiazepines. We discuss how these novel findings have important translational implications for understanding the pathophysiology of catatonia as well as for the mechanistic understanding and prediction of treatment response to benzodiazepines.

Clinical features and predictors of non-response in severe catatonic patients treated with electroconvulsive therapy

Objective To explore the demographic and clinical features of severe catatonic patients, comparing responders and non-responders to ECT in order to detect possible predictors of non-response. Methods This naturalistic study included 59 catatonic inpatients with a diagnosis of mood disorder according to DSM-IV-TR criteria. All patients were treated with bilateral ECT and evaluated before and after ECT course. The response to ECT was defined as a Clinical Global Impression (Improvement subscale) rating 1 ‘very much improved’ or 2 ‘much improved’. Clinical variables were compared between responders and non-responders; logistic regression was used to predict the probability of non-response, with regard to the symptoms presented by the patients. Results The response rate was 83.1%. Non-responders (n = 10) to ECT showed neurological comorbidities, treatments with dopamine agonists and anticholinergic drugs, waxy flexibility, and echophenomena more frequently than respondents (n = 49). Echophenomena resulted a significant predictor of non-response in the multivariate analysis. Conclusion In line with previous reports, ECT resulted effective in the vast majority of severe catatonic patients. The association between ECT resistant catatonia and neurological comorbidity, use of dopamine-agonist and anticholinergic medications is consistent with the hypothesis that ECT is more effective in ‘top-down’ than in ‘bottom-up’ variant of catatonia. Key points Catatonic symptoms are frequently associated with severe and psychotic mood disorders. Electroconvulsive therapy is effective in treating most forms of severe catatonia. Neurological comorbidity and the presence of ‘echopraxia/echolalia’ could represent predictors of non-response to ECT.

S160. ALTERATIONS IN SHORT-RANGE STRUCTURAL CONNECTIVITY ACROSS THE PSYCHOSIS SPECTRUM: FINDINGS FROM THE B-SNIP STUDY

BackgroundSchizophrenia (SZ) and bipolar disorder (BD) have been increasingly viewed as psychotic mood disorders along a shared spectrum. Long-range and short-range structural connectivity have been implicated in both disorders, conceptualising them as “disconnection syndromes”. There has been a rise in neuroimaging tools to understand the overlap and boundaries between the two disorders, which has shifted our focus towards appreciating traits in addition to diagnosis. Our recent pilot study examining short-range U-fibers found in superficial white matter (SWM) found shared and distinct traits among people with SZ and BD and we aimed to investigate SWM further using data from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) consortium.MethodsUsing diffusion weighted imaging (DWI), we performed whole brain tractography in 113 people with SZ, 69 people with SA disorder, 49 people with psychotic BD and 77 healthy controls using BrainVISA and Connectomist 2.0. Segmentation and labelling of SWM tracts were performed using a comprehensive U-fiber atlas. ComBat was applied to remove site effects and principle components analysis was performed to identity networks of bundles used for comparative analyses.ResultsPrinciple component analysis revealed a network comprised of 8 short tracts in frontal, parietal, and temporal regions that had decreased anatomical connectivity in patients, regardless of diagnosis, relative to healthy controls. This network overlaps, in part, regions that differed between patients (SZ and BD) and healthy controls in our recent pilot study. However, we were unable to detect differences between people with SZ, SA disorder and psychotic BD.DiscussionWe demonstrate that short U-fibers are likely vulnerable to pathological processes in psychotic illnesses, encouraging further understanding of their anatomy and function. Our lack of findings between patient groups may reflect a more homogeneous population (three subgroups of psychosis) and may suggest that abnormalities in SWM are less likely due to mood disturbances.

Cues for different diagnostic patterns of interpersonal violence in a psychiatric sample: an observational study

BackgroundInterpersonal violence has increased as a health concern, especially in psychiatry practice, over the last decades. Nevertheless, most patients with stable mental disorders do not present an increased risk of violence, and mental disorder is not a necessary or sufficient cause of violent behaviours. People with mental disorders endorse more often a number of risk factors for violence that could confound this association, such as young age and male gender. The aim of this study was to investigate the effect of age, gender, and diagnosis on reported levels of interpersonal violence in a sample of people with severe mental illness.MethodsThe sample was composed of 160 inpatients: 73 with a psychosis within the schizophrenia spectrum, 53 with a mood disorder and 34 with a personality disorder. All patients enrolled in the study were assessed for experiences of victimization and perpetration of interpersonal violence using the Karolinska Interpersonal Violence Scale interview. Demographic variables were also collected.ResultsBoth violence perpetration and victimization negatively correlated with age. Compared to males, females were exposed to higher degree of victimization in childhood and adulthood, whereas males were more involved in the perpetration of violence in childhood. Personality disorders were associated with higher levels of interpersonal violence, both perpetration and victimization; an interaction effect of gender and diagnosis was also observed for violence perpetration in adulthood. Distinct patterns of interpersonal violence did emerge for the diagnostic groups with mood disorder showing a victimization pattern, personality disorders a perpetration pattern and psychoses less defined patterns.ConclusionsThe main finding is that psychotic disorders, mood disorders and personality disorders have different patterns of violent experiences interacting with age and gender. This study offers a better understanding of how gender and age could affect violent behaviours. Moreover, study findings may increase the comprehension of the reason why some mental disorders, compared to others, are more associated with the risk of victimization or perpetration of violence. These patterns could have pathophysiological or pathoplastic meaning addressing clinical and diagnostic trajectories and they could interact with other intervening risk factors.

High incidence of hepatocellular carcinoma and cirrhotic complications in patients with psychiatric illness: a territory-wide cohort study

BackgroundBecause of high-risk behaviours, sedentary lifestyle and side effects of medications, psychiatric patients are at risk of viral hepatitis, alcohol-related liver disease and non-alcoholic fatty liver disease. We aimed to study the incidence of hepatocellular carcinoma (HCC) and cirrhotic complications in psychiatric patients.MethodsWe identified consecutive adult patients in all public hospitals and clinics in Hong Kong with psychiatric diagnoses between year 2003 and 2007 using the Clinical Data Analysis and Reporting System, which represents in-patient and out-patient data of approximately 80% of the 7.4-million local population. The patients were followed for liver-related events (HCC and cirrhotic complications) and deaths until December 2017. Age- and sex-standardized incidence ratio (SIR) of HCC in psychiatric patients to the general population was estimated by Poisson model.ResultsWe included 105,763 psychiatric patients without prior liver-related events in the final analysis. During a median (interquartile range) follow-up of 12.4 (11.0–13.7) years, 1461 (1.4%) patients developed liver-related events; 472 (0.4%) patients developed HCC. Compared with the general population, psychiatric patients had increased incidence of HCC (SIR 1.42, 95% confidence interval [CI] 1.28–1.57, P < 0.001). The SIR was highest in patients with drug-induced (SIR 3.18, 95% CI 2.41–4.11, P < 0.001) and alcohol-induced mental disorders (SIR 2.98, 95% CI 2.30–3.81, P < 0.001), but was also increased in patients with psychotic disorders (SIR 1.39, 95% CI 1.16–1.65, P < 0.001) and mood disorders (SIR 1.16, 95% CI 1.00–1.34, P = 0.047). Liver disease was the fifth most common cause of death in this population, accounting for 595 of 10,614 (5.6%) deaths. Importantly, 569 (38.9%) patients were not known to have liver diseases at the time of liver-related events. The median age at HCC diagnosis (61 [range 26–83] years) was older and the median overall survival (8.0 [95% CI 5.0–10.9] months) after HCC diagnosis was shorter in this cohort of psychiatric patients than other reports from Hong Kong.ConclusionsHCC, cirrhotic complications, and liver-related deaths are common in psychiatric patients, but liver diseases are often undiagnosed. More efforts are needed to identify liver diseases in the psychiatric population so that treatments and screening for HCC and varices can be provided to patients in need.

Impact of Mood Disorders, Psychotic Disorders, and Histories of Abuse on Adaptive Functioning Deficits in Adolescents with Intellectual Impairment

ABSTRACTBackground: There is no study to date that has examined the association between history of abuse and adaptive functioning deficits in youth with co-occurring and psychotic disorders or mood disorders.Method: This study used a retrospective chart review of 98 youth under the age of 18 (Mean age = 16.06 years) with co-occurring intellectual impairment (Mean IQ = 63.9) and psychotic disorders, mood disorders, or other psychiatric disorders. Using multi-mediation models in the path analytic framework, this study examined the relationships between psychiatric diagnosis (based on DSM-IV criteria), cognitive functioning (Full Scale IQ Scores), adaptive functioning (Socialization, Communication, Motor Skills, Daily Living Skills), and the presence of the history of physical, sexual, and/or emotional abuse/neglect.Results: A very high incidence of all three forms of abuse was present in the study sample, with more than three-quarters of the youth having experienced at least one form of abuse and more than half having experienced two or the three forms of abuse. A history of sexual abuse was significantly and directly associated with an increased incidence of mood disorders. Mood disorders were the strongest predictors of adaptive functioning deficits. Youth with schizophrenia spectrum disorder scored significantly lower in communication skills than those with bipolar disorder.Conclusion: Results are discussed in terms of the need for treatment studies and further investigations of the relationship between childhood maltreatment and adaptive functioning in youth with intellectual impairment and psychiatric disorders.

Auditory brainstem response (ABR) profiling in schizoaffective disorder.

The aim of the study was to assess whether the auditory brainstem response (ABR) profiling test for schizophrenia (SZ) would recognise schizoaffective disorder (SZA) patients as SZ or not. Male and female SZA patients (n = 16) from the psychosis unit at Uppsala University Hospital were investigated. Coded sets of randomised ABR recordings intermingled with patients with SZ, adult attention-deficit hyperactivity disorder (ADHD) and healthy controls were analysed by an independent party blinded to clinical diagnoses. The ABR profiling test for SZ was positive in 5/16 patients (31%) and negative in 11/16 patients (69%) with SZA. A surprising finding was that 4/16 (25%) SZA patients were positive for the ABR profiling test for ADHD. With the ABR profiling test, a minority of patients with SZA tested positive for SZ. In contrast, a majority (85%) of patients with SZ in a previous study tested positive. These preliminary results leave us ignorant whether SZA should be regarded as a SZ-like disorder or a psychotic mood disorder and add to the questions regarding the validity of this diagnostic entity. However, the ABR profiling method is still in its infancy and its exploration in a range of psychiatric disorders is warranted.

Effect of Valproate and Antidepressant Drugs on Clozapine Metabolism in Patients With Psychotic Mood Disorders.

The aim of the present study was to appraise retrospectively the influence of valproate (VPA) and antidepressants (ADs) on the steady-state plasma concentrations of clozapine (CLZ), the prototype of various second-generation antipsychotics, norclozapine (NCLZ, its main metabolite), and their ratio (NCLZ:CLZ). Sixty-seven psychotic patients with a prevalent diagnosis of bipolar disorder were studied. We then analyzed data altogether and subdivided them into 4 groups, according to pharmacological treatments: #1 CLZ (n = 21), #2 CLZ plus ADs (n = 13), #3 CLZ plus VPA (n = 16), and #4 CLZ plus ADs plus VPA (n = 17). First, significant positive between CLZ and NCLZ plasma levels (in nanograms/milliliter) and the drug daily dosages (in milligrams/kilogram of body weight) (n = 67) were observed (Spearman: rCLZ = 0.49; rNCLZ = 0.61; P < 0.001). We then normalized by given doses CLZ and NCLZ plasma levels, natural log transformed them, and performed analysis of variance factor analyses followed by pairwise comparisons, performed on the 4 groups and the 3 CLZ parameters. We identified significant drug effects on (1) CLZ plasma levels, significantly higher in group #2 versus group #1, and (2) NCLZ:CLZ ratio, lower in group #2 versus groups #1 and #3. Significant drug × gender interactions were observed in group #3, showing higher NCLZ levels and NCLZ:CLZ ratios in men compared with women. Despite its inherent limitations, this observational study confirms the significant increase in plasma CLZ concentrations and reduction in NCLZ:CLZ ratio when this drug was coadministered with ADs (group #2), an effect apparently counteracted by VPA (group #4). The drug × gender interactions in patients taking both CLZ and VPA (group #3) warrant further prospective study.

Mood Symptoms in Stabilized Patients with Schizophrenia: A Bipolar Type with Predominant Psychotic Features?

Schizophrenia (SZ) and bipolar disorder (BD) are traditionally distinguished on the basis of progressive deterioration and long-term outcome, but a more dimensional approach is warranted. There are limited data on the occurrence of manic symptoms in patients with schizophrenia. The aim of the current study was to search for patterns in the clinical symptomatology, which may suggest the presence of one or several mood disorders under the label of schizophrenia. Hundred-seventy-five patients diagnosed with schizophrenia according to DSM-5 were included in the study. The psychometric assessment included the Positive and Negative Syndrome Scale, Young Mania Rating Scale, The Montgomery-Åsberg Depression Rating Scale and the Calgary Depression Scale. The statistical analysis included MANOVA, Pearson Correlation coefficient and principal components analysis. Significant subthreshold manic symptoms were present in 25.14% of patients. Mood symptoms correlated with positive symptoms. The PCA revealed a complex structure with 15 factors (one positive, negative, somatic, anxiety, neurocognitive, disorganization and manic, five depressive and three psychomotor/excitement/hostility/violence). Psychotic mood disorders are often phenotypically indistinguishable from schizophrenia, so it is likely that psychotic affective patients have been misdiagnosed with schizophrenia. The current study suggests that there seem to be patients with mania misdiagnosed as 'schizophrenics' because of the presence of psychotic features, a condition better described as 'schizophreniform bipolar disorder'.

M131. Washington State New Journeys Program for Young Adults Experiencing First Episode Psychosis: Pilot Results

Abstract Background: Many states are implementing multidisciplinary models to treat young people experiencing first episode psychosis (FEP). Washington State’s New Journeys early intervention for psychosis program includes components from Oregon’s Early Assessment & Support Alliance, as well as the NAVIGATE model of care. We present descriptive results from Year 1 of New Journeys implementation at the first pilot site, a community mental health center in rural Washington State. Methods: Inclusion criteria included: (1) 15–25 years old; (2) diagnosis of a psychotic disorder or mood disorder with psychotic features (in Year 2, diagnostic criteria will be limited to nonaffective psychosis); and (3) duration of psychotic symptoms less than 2 years. The New Journeys model included family psychoeducation, Individual Resiliency Training, Individual Placement and Support/Supported Employment and Education, medication management, and case management. Clients participated in monthly and weekly assessments using an online database (EBP toolkit). The evaluation team provided training and ongoing supervision for New Journeys clinicians using the Toolkit. Descriptive statistics were used to analyze characteristics of the sample at baseline and psychiatric and service utilization variables over the first 5 months of the program. Results: During the first year, 25 participants were enrolled in New Journeys. Presently, 52% of participants are still in the program. Seventy-two percent of referrals were from mental health providers and participants had a mean duration of untreated psychosis of about 1 year. Participants were 84% male, 64% Hispanic or Latino, and had an average age of 19. At the start of the program, 52% of participants reported being enrolled in school, and 24% were working. Twenty-nine percent of participants reported using alcohol and 24% reported using marijuana in the 30 days prior to intake, and 48% smoked cigarettes. At intake, 39% of participants scored at least moderate levels of depression and 81% reporting at least moderate levels of anxiety. After 5 months in the program, reductions in anxiety and depression were observed. Psychotic symptoms varied throughout the first 5 month with no overall reduction at 5 months. Attendance to all services offered was over 75%. Conclusion: Reductions in anxiety and depression during the New Journeys program are encouraging. However, due to attrition in the sample, more data is needed to evaluate changes in psychotic symptoms. Alcohol, drug, and tobacco use are potential areas to target as around a quarter of the sample used alcohol and/or marijuana, and nearly half smoked cigarettes. Attendance to scheduled services was high, but strategies must be implemented to retain participants after the first 5 months in the program.

Key indicators for mental disorders in officers of the Armed Forces of Russia (2003–2015)

Relevance. There have been made some reorganizations in the Armed Forces of Russia lately (changes in the staff structure, enhancing the image of the officers, increasing officer’s salaries and military pension), which could affected the mental health of military personnel. Intention. The aim of our study was to determine the medical-statistical characteristics of mental health in officers of the Armed Forces of Russia as the most combat-capable unit. Methods. The research presents the stastical analysis of mental disorders in officers of the Armed Forces of Russia during the last 13 years (2003–2015). Results and Discussion. The annual average general morbidity (negotiability) of officers with mental disorders was (8.21 ± 0.86) ‰, the primary morbidity rate – (2.73 ± 0.13) ‰, the dynamic level of dispensary observation – (1.29 ± 0.14) ‰, the hospitalization rate – (2.37 ± 0.12) ‰, the inactivity rate measured in days – (51 ± 3) ‰, the dismissal rate – (0.55 ± 0.06) ‰, the mortality ratio – (0.4 ± 0.2) deaths per 100,000 officers in a year. The polynomial trends at low coefficients of determination of almost all indicators predicted their decrease. With a small contribution of mental disorders (1–6 %) to the structure of general morbidity, hospitalization and inactivity, the dismissal rate of officers with mental disorders remained at a high level and ranks 6th among all diseases. In 97.3 % of cases the structure of the generated complex indicator of the mental health status in officers was determined by 6 groups of disorders from Chapter V of ICD-10: mental disorders due to known physiological conditions (F00–F09), mental and behavioral disorders due to psychoactive substance use (F10–F19), schizophrenia, schizotypal, delusional and other non-mood psychotic disorders (F20–F29), mood (affective) disorders (F30– F39), anxiety, dissociative, stress-related and somatoform disorders (F40–F48). The major contribution to the structure of mental pathology is made by the neurotic, stress-related and somatoform disorders, as well as addiction disorders. In addition it is the chemical forms of addiction and neurotic disorders that often lead to the dismissal of officers from the Armed Forces of Russia. It is shown, that some isolated socio-economic factors have influence on the mental health of officers. It is determined, that the «unpopular» reforms carried out until 2011 had negative influence, on the other hand, there is the reduction of the prevalence rate of mental disorders among the officers since the reforms of 2012. Conclusions. It is assumed, that the system of the psychoprophylactic measures existing at present needs to be further improved and primarily focused on the early diagnosis of the addiction and neurotic disorders.

The 20-Year Longitudinal Trajectories of Social Functioning in Individuals With Psychotic Disorders.

Social impairment is a long-recognized core feature of schizophrenia and is common in other psychotic disorders. Still, to date the long-term trajectories of social impairment in psychotic disorders have rarely been studied systematically. Data came from the Suffolk County Mental Health Project, a 20-year prospective study of first-admission patients with psychotic disorders. A never-psychotic comparison group was also assessed. Latent class growth analysis was applied to longitudinal data on social functioning from 485 respondents with schizophrenia spectrum disorders and psychotic mood disorders, and associations of the empirically derived trajectories with premorbid social adjustment, diagnosis, and 20-year outcomes were examined. Four mostly stable trajectories of preserved (N=82; 59th percentile of comparison group sample distribution), moderately impaired (N=148; 17th percentile), severely impaired (N=181; 3rd percentile), and profoundly impaired (N=74; 1st percentile) functioning best described the 20-year course of social functioning across diagnoses. The outcome in the group with preserved functioning did not differ from that of never-psychotic individuals at 20 years, but the other groups functioned significantly worse. Differences among trajectories were already evident in childhood. The two most impaired trajectories started to diverge in early adolescence. Poorer social functioning trajectories were strongly associated with other real-world outcomes at 20 years. Multiple trajectories were represented within each disorder. However, more participants with schizophrenia spectrum disorders had impaired trajectories, and more with mood disorders had better functioning trajectories. The results highlight substantial variability of social outcomes within diagnoses-albeit overall worse social outcomes in schizophrenia spectrum disorders-and show remarkably stable long-term impairments in social functioning after illness onset across all diagnoses.

Treatment of severe perinatal mood disorders on a specialized perinatal psychiatry inpatient unit.

Perinatal patients with bipolar and psychotic mood disorder exacerbations are challenging to treat and often receive suboptimal care. We sought to examine the treatment patterns and outcomes on one of the only US-based Perinatal Psychiatry Inpatient Units (PPIU). Perinatal patients admitted to the PPIU completed self-report measures at admission and before discharge. Retrospective chart reviews extracted history, diagnoses (current and past), and medication treatment. Patients who had discharge diagnoses of bipolar disorder, major depression with psychotic features, or postpartum psychosis were included. Forty-seven met the diagnostic inclusion criteria. Over an average length of stay (ALOS) of 9.96days, there was significant improvement in depressive and anxiety symptoms and daily functioning (Work and Social Adjustment Scale). Psychiatric comorbidity was common. Polypharmacy was utilized in 87%. The most common medications prescribed at discharge were antipsychotics, alone or in combination with mood stabilizers or antidepressants. ECT was performed in 10% of cases. The complexity of patients with severe mood disorders or psychosis admitted to the PPIU supports individualized treatment plans that address both primary diagnosis and psychiatric comorbidities. Our results provide important information that can be disseminated to others to improve clinical outcomes for severe perinatal mood disorders.

Low dose olanzapine induced torticollis and treatment: A case report

Olanzapine is a second generation antipsychotic agent that is used for the treatment of the psychotic disorders and mood disorders. Olanzapine is also known to have greater affinity for mezolimbic dopaminergic pathway than for nigrostriyatal dopamine pathway. As a result olanzapine is associated with significantly fewer extrapyramidal symptoms. Tardive dystonia is a rare side effect of antipsychotic treatment frequently causing twisting painful muscle contractions. Effective treatment choice for tardive dystonia is limited. The clinicians must consider acute dystonia neurological disorders and family history for differential diagnosis. Here we present a rare case of torticollis after 5 mg/day olanzapine treatment in a young female patient with psychotic disorder.

Familiality of Psychotic Disorders: A Polynosologic Study in Multiplex Families.

Phenotype definition of psychotic disorders has a strong impact on the degree of familial aggregation. Nevertheless, the extent to which distinct classification systems affect familial aggregation (ie, familiality) remains an open question. This study was aimed at examining the familiality associated with 4 nosologic systems of psychotic disorders (DSM-IV, ICD-10, Leonhard's classification and a data-driven approach) and their constituting diagnoses in a sample of multiplex families with psychotic disorders. Participants were probands with a psychotic disorder, their parents and at least one first-degree relative with a psychotic disorder. The sample was made of 441 families comprising 2703 individuals, of whom 1094 were affected and 1709 unaffected. The Leonhard classification system had the highest familiality (h (2) = 0.64), followed by the empirical (h (2) = 0.55), DSM-IV (h (2) = 0.50), and ICD-10 (h (2) = 0.48). Familiality estimates for individual diagnoses varied considerably (h (2) = 0.25-0.79). Regarding schizophrenia diagnoses, Leonhard's systematic schizophrenia (h (2) = 0.78) had the highest familiality, followed by latent class core schizophrenia (h (2) = 0.74), DSM-IV schizophrenia (h (2) = 0.48), and ICD-10 schizophrenia (h (2) = 0.41). Psychotic mood disorders showed substantial familiality across nosologic systems (h (2) = 0.60-0.77). Domains of psychopathology other than reality-distortion symptoms showed moderate familiality irrespective of diagnosis (h (2) = 0.22-0.52) with the deficit syndrome of schizophrenia showing the highest familiality (h (2) = 0.66). While affective psychoses showed relatively high familiality estimates across classification schemes, those of nonaffective psychoses varied markedly as a function of the diagnostic scheme with a narrow schizophrenia phenotype maximizing its familial aggregation. Leonhard's classification of psychotic disorders may be better suited for molecular genetic studies than the official diagnostic systems.

Metabolic Syndrome Among Psychotic Patients: Comparative Study in Schizophrenia, Mood Disorder with Psychotic Features and Healthy Control

Background and Aim Metabolic syndrome affect around 20% of general population, authors have incriminated antipsychotics as serious risk factor that may provoke such derangement. The aim of our study is to assess metabolic syndrome in patients presenting psychotic features (delusions and hallucinations) whether schizophrenia or mood disorder and compare results in terms of drug naif, on medication and healthy control. Subjects and Methods The study recruited 40 schizophrenic patients, half of them drug naif and the other half on antipsychotics, 40 patients with mood disorder with psychotic features, half of them drug naif and the other half on medication, 20 healthy control. Exclusion criteria were put in order to exclude patients having already endocrine or metabolic disorders that my interfere with results obtain to minimize confusion bias. Metabolic syndrome assessed by measuring parameters including weight, body mass index, waist circumference, triglyceride level, HDL, fasting glucose, fasting insulin and insulin resistance Results No difference was found when comparing drug naif to those on medication in both schizophrenic and psychotic mood disorder arms, schizophrenic patients in general tend to show higher fasting glucose while patients with psychotic mood disorder tend to show higher fasting insulin level Conclusion This study suggest that presence of psychotic features themselves regardless being on medication or not carries a risk for insulin resistance and metabolic syndrome.