Exacerbation Of Psychotic Symptoms Research Articles

TREATMENT OF SCHIZOPHRENIA IN ELDERLY PATIENTS

Introduction: The treatment of schizophrenia in elderly patients presents a significant clinical challenge due to the disease's particularities in this age group. Schizophrenia is a chronic mental disorder characterized by profound disturbances in thought, emotions, and behavior. In elderly patients, the condition may manifest in a more complex manner, with exacerbation of psychotic symptoms and cognitive decline that negatively impacts quality of life. The interplay between aging and schizophrenia requires a therapeutic approach tailored to the specific needs of the elderly, considering comorbidities, polypharmacy, and adverse effects of treatments. Objective: The objective of the systematic review was to evaluate treatment strategies for schizophrenia in elderly patients, examining the effectiveness and safety of available therapeutic interventions, as well as the specific clinical management issues within this population. Methodology: The systematic review was conducted based on the PRISMA checklist, utilizing the databases PubMed, Scielo, and Web of Science. Five main descriptors were used: "schizophrenia," "elderly," "treatment," "antipsychotic therapy," and "effectiveness." Articles published in the last 10 years were included. Inclusion criteria were: studies focused on patients aged 65 and older diagnosed with schizophrenia, articles addressing specific therapeutic interventions, and studies reporting quantifiable clinical outcomes. Exclusion criteria were: articles that did not differentiate the age group of participants, studies without original data or that did not include elderly patients, and publications that did not directly address schizophrenia treatment. Results: The results indicated that treatment for schizophrenia in the elderly frequently involved the use of atypical antipsychotics, which are preferred due to their more favorable side effect profile compared to typical antipsychotics. However, the effectiveness of these medications may be reduced in the elderly due to altered pharmacokinetics and increased risk of adverse effects. The combination of psychosocial therapy and support proved beneficial in improving treatment adherence and quality of life for patients. The need for individualized management and consideration of comorbidities were also highlighted. Conclusion: Treatment of schizophrenia in elderly patients requires a personalized approach that accounts for the complexities associated with aging. Medication choices should be made cautiously, prioritizing those with a lower risk of adverse effects. Additionally, integrating psychosocial strategies can significantly improve clinical outcomes and quality of life for these patients. Ongoing review of practices and guidelines is crucial for optimizing care and addressing the needs of this aging population.

Gradually tapering off antipsychotics: lessons for practice from case studies and neurobiological principles.

There has been an increasing focus on deprescribing in psychiatry recently, particularly of antipsychotic medication, with recognition that not all patients with psychotic disorders require lifelong medication. We summarize some empirical and theoretical papers, and examine case studies to provide instruction on this topic. Recent studies have found that slower tapering (over months or longer) of antipsychotics is associated with a lower relapse rate than quicker tapering (weeks). Case studies presented suggest that the process of reduction is associated with the precipitation or exacerbation of psychotic symptoms and that a slower process of reduction may minimize this effect. This may be because faster reductions cause greater disruption of homeostatic equilibria, provoking psychotic symptoms either as direct withdrawal symptoms or consequences of nonpsychotic withdrawal symptoms (e.g. insomnia) - although not all patients will experience withdrawal symptoms. This suggests that smaller dose reductions, especially at lower doses, made very gradually, may minimize the risk of psychotic symptoms. Slower tapering of antipsychotics may provide time for adaptations made to the presence of the medications to resolve, thus reducing the disruption to homeostatic equilibrium caused by dose reduction, potentially reducing the risk of relapse. Exacerbation of psychotic symptoms on antipsychotic reduction may not represent evidence of the need for a higher dose of antipsychotic on a long-term basis but may indicate the need for more gradual reduction. Gradual reduction of antipsychotics, especially after long-term use in clinical practice is prudent.

Patterns of admission in forensic units during the COVID-19 pandemic: a process analysis.

The impact of COVID-19 pandemic on forensic service practice remains matter of debate. Increased rates of anxiety, depression, and exacerbation of psychotic symptoms were reported in the early phases of the pandemic among detained persons. However, longitudinal analyses in medium-security hospitals taking into account the whole pandemic period led to mitigated results. This report examines the evolution of the type (voluntary versus involuntary) and reason of admissions, length of stay, history of outpatient care, short-term seclusion hours for aggressive behaviors, and clinical diagnoses for detainees needing acute psychiatric care during the COVID-19 pandemic in the sole secure ward located in the central prison of Geneva, Switzerland. To determine the general trend of the processes over time we applied a combination of process analysis with run chart plotting, and fractional polynomial regression. Run tests showed that the proportion of cases with personality disorders, substance use disorders (SUD), and previous outpatient care tended to increase during the COVID pandemic with subsequent decrease to reach the pre-COVID values. This was also the case for depressive symptoms as reason for admission. The proportion of involuntary admission showed a steady increase both during the COVID and post-COVID time periods. In contrast, short-term seclusion hours decreased during the COVID pandemic followed by a return to their pre-COVID values. Regression models revealed that the COVID pandemic was associated with a significant increase in the rates of inmates with personality disorders and SUD admitted for forensic care explaining 36 and 41% of their variance. These data support the idea that, in terms of acute care needs, the COVID-19 pandemic was associated with increased needs for acute forensic care that concerned detainees with personality disorders characterized by increased levels of impulsiveness, decreased tolerance to frustrations, loss of control, increased extraversion and frequent SUD comorbidity.

Cariprazine augmentation of clozapine in schizophrenia-a retrospective chart review.

The aim of our study was to evaluate the efficacy of cariprazine augmentation of clozapine in treatment-resistant schizophrenia in a retrospective chart review. Among 916 medical records of schizophrenia patients, we identified 12 individuals treated with a combination of those drugs for a duration of 3-60weeks [median 32 (10-40)]. Clinical Global Impression-Improvement (CGI-I) scores were used to measure the treatment response between the introduction of cariprazine augmentation of clozapine and the last point of observation. The majority of the patients presented treatment response (9/12 patients, 75%) after 4-16weeks of therapy [median 6 (4-12)]. Treatment was associated with the decrease in positive, negative, affective, and anxiety symptom severity, as well as improvement of patient global functioning. One patient discontinued the treatment due to side effects (akathisia), and two patients halted the therapy due to the exacerbation of psychotic symptoms. Our study presents a thorough clinical description of the largest number of treatment-resistant schizophrenia patients medicated using cariprazine augmentation of clozapine in a "real-world" setting. Our results suggest that the use of this combination may lead to the improvement in a broad range of symptoms of patients with this condition.

The relationship between sleep and suicidality in schizophrenia spectrum and other psychotic disorders: A systematic review.

Individuals with Schizophrenia Spectrum Disorders (SSDs) have significantly higher rates of suicidal thoughts, attempts, and death by suicide in comparison to the general population. Sleep disturbances (reduced duration, timing and quality of sleep) are risk factors for suicidality in the general population, with research indicating the relationship is both immediate and accumulative. Sleep disturbances are also considered to be implicated in the onset and exacerbation of psychotic symptoms in SSDs. Reducing the risk of suicidality in SSDs remains an important public health priority, thus exploration of contributing risk factors is warranted. Sleep monitoring may also offer an adjunct risk monitoring method to suicidality assessments in SSDs, and a potential treatment target for psychotic symptoms. This review aimed to explore proximal and longitudinal relationships between self-reported and objectively measured sleep and suicidality in SSDs and other psychotic disorders. A comprehensive search of four databases was conducted. Eleven studies met the inclusion criteria (10 cross sectional and 1 longitudinal). Narrative synthesis indicated that self-reported sleep disturbances and sleep disorders (e.g. insomnia) were associated with increased risk of suicidal ideation and attempt. However, one study employing polysomnography did not find sleep to be associated with suicidality. Methodological limitations of the evidence base include: i) little experimental or longitudinal evidence, (ii) self-report and/or single item assessment of sleep disturbance, (iii) limited use of validated measures of suicidality, (iv) considerable research in long-term schizophrenia but sparse evidence in early psychosis. Future research should explore (i) cross-sectional and longitudinal relationships between specific aspects of suicidality and objective sleep parameters, (ii) use qualitative or mixed-methods designs to disentangle the nuances and bidirectionality in the sleep-suicide relationship, (iii) explore the psychological processes underpinning or mediating the sleep-suicide relationship in SSDs.

Assessing evidence supporting cannabis harm reduction practices for adolescents at clinical high-risk for psychosis: a review and clinical implementation tool.

Cannabis use is consistently associated with both increased incidence of frank psychotic disorders and acute exacerbations of psychotic symptoms in healthy individuals and people with psychosis spectrum disorders. Although there is uncertainty around causality, cannabis use may be one of a few modifiable risk factors for conversion to psychotic disorders in individuals with Clinical High Risk for Psychosis (CHR-P) syndromes, characterized by functionally impairing and distressing subthreshold psychotic symptoms. To date, few recommendations beyond abstinence to reduce adverse psychiatric events associated with cannabis use have been made. This narrative review synthesizes existing scientific literature on cannabis' acute psychotomimetic effects and epidemiological associations with psychotic disorders in both CHR-P and healthy individuals to bridge the gap between scientific knowledge and practical mental health intervention. There is compelling evidence for cannabis acutely exacerbating psychotic symptoms in CHR-P, but its impact on conversion to psychotic disorder is unclear. Current evidence supports a harm reduction approach in reducing frequency of acute psychotic-like experiences, though whether such interventions decrease CHR-P individuals' risk of conversion to psychotic disorder remains unknown. Specific recommendations include reducing frequency of use, lowering delta-9-tetrahydrocannabinol content in favor of cannabidiol-only products, avoiding products with inconsistent potency like edibles, enhancing patient-provider communication about cannabis use and psychotic-like experiences, and utilizing a collaborative and individualized therapeutic approach. Despite uncertainty surrounding cannabis' causal association with psychotic disorders, cautious attempts to reduce acute psychosis risk may benefit CHR-P individuals uninterested in abstinence. Further research is needed to clarify practices associated with minimization of cannabis-related psychosis risk.

Central nervous system-related safety and tolerability of add-on ketamine to standard of care treatment in treatment-resistant psychotic depression in patients with major depressive disorder and bipolar disorder.

Psychotic treatment-resistant depression represents a complex and challenging form of mood disorder in clinical practice. Despite its severity, psychotic depression is frequently underdiagnosed and inadequately treated. Ketamine has demonstrated rapid and potent antidepressant effects in clinical studies, while exhibiting a favorable safety and tolerability profile. Although there is limited literature available on the use of ketamine in psychotic TRD, reports on its efficacy, safety, and tolerability profile are of great interest to clinicians. The aim of this study is to investigate the relationship between dissociative symptomatology and psychomimetic effects in inpatients with treatment-resistant major psychotic depression and treatment-resistant bipolar psychotic depression, who receive intravenous ketamine treatment alongside psychotropic medication, both during and after treatment. A total of 36 patients diagnosed with treatment-resistant unipolar (17 patients) or bipolar (18 patients) depression with psychotic features were treated with eight intravenous infusions of 0.5 mg/kg ketamine twice a week over 4 weeks. Ketamine was given in addition to their standard of care treatment. The severity of depressive symptoms was evaluated using the MADRS, while dissociative and psychomimetic symptoms were assessed using the CADSS and BPRS, respectively. There were no statistically significant changes observed in MADRS, CADSS, and BPRS scores within the study group during ketamine infusions. However, significant improvements in MADRS, CADSS, and BPRS scores were observed during ketamine infusions in both the unipolar and bipolar depression groups. This study provides support for the lack of exacerbation of psychotic symptoms in both unipolar and bipolar depression.

Стресові реакції у хворих з розладами спектру шизофренії та комплексний підхід в їх лікуванні

Abstract The psychotraumatic factors that occurred during the war of 2022-2023 significantly affect on the onset and dynamics of schizophrenia spectrum disorders (SSD). Objective. To study the relationship between the influence of stress factors in patients with SSD with the dynamics of exacerbation of psychopathological symptoms and to create complex of treatment and rehabilitation (CTR) for these patients. Methods and materials. There was psychopathological examination of 68 patients with different types of SSD who experienced severe stress during the war and assessed the clinical features of theire psychotic state, and the content of stress factors. Results. In the research the largest number were patients with schizophrenia (Sch, 42.6% of cases), most often with paranoid form with progressive paroxysmal course, as well as patients with acute and transient psychotic disorders (APD), schizoaffective disorder (SchAD) and schizotypal disorder (StD). There were diagnosed affective and delusional symptoms (54.4% of cases) most often as the leading psychopathological reaction to the psychotraumatic stress effects in patients with SSD. Only patients with Sch had the highest incidence of hallucinatory-paranoid syndrome (71.4% of cases). The onset or relapse of a psychotic episode among patients with SSD developed as a result of a significant impact of stress factors with different content, but related to the war in all cases. The most frequent of these were difficulties during evacuation, which caused increasing in family conflicts, especially in patients with Sch and StD. It was found the stressful media impact caused an exacerbation of psychotic symptoms in one third of patients with Sch and StD. There was essential psychotraumatic impact to patients with SSD as of the repeated bombing; the death of relatives; fears experienced during the occupation; inability to continue treatment; and psychotraumatic circumstances associated with the loss of work or no money to live. The CTR for patients with SSD who have been significantly affected by stress based on the analysis of the relationship between nosology, clinical symptoms and stress factors. The aim of the CTR is effective treatment of a psychotic episode or reactive psychotic state, should be steady and consist of the following stages: diagnostic; emergency, outpatient and/or inpatient care; psycho-rehabilitation, as well as support and psychoprophylaxis. Its structure should combine the use of psychopharmacotherapy with psychotherapy (psychocorrection) and psychoeducation, followed support of the patient at the stage of remission.

Ketamine as Add-On Treatment in Psychotic Treatment-Resistant Depression.

Psychotic treatment-resistant depression is a complex and challenging manifestation of mood disorders in the clinical setting. Psychotic depression is a subtype of major depressive disorder characterized by mood-consistent hallucinations and/or delusions. Psychotic depression is often underdiagnosed and undertreated. Ketamine appears to have rapid and potent antidepressant effects in clinical studies, and the Federal Drug Agency approved the use of ketamine enantiomer esketamine-nasal spray for treatment-resistant depression pharmacotherapy in 2019. This study aimed to assess the usage of ketamine for major depressive disorder with psychotic features as an add-on treatment to the standard of care. Here we present four inpatients suffering from treatment-resistant depression with psychotic features, including one with severe suicidal crisis, all treated with 0.5 mg/kg intravenous infusion of ketamine. Subsequent monitoring revealed no exacerbation of psychotic symptoms in short and long-term observation, while stable remission was observed in all cases with imminent antisuicidal effect. Results suggest ketamine may benefit individuals with treatment-resistant depression with psychotic features.

CLINICAL DIFFERENCES IN MANIFESTATIONS OF SELF-DESTRUCTIVE BEHAVIOR IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM PSYCHOTIC DISORDERS

Manifestations of self-destructive behavior (SDB) differ in patients with schizophrenia spectrum psychotic disorders and our study aims to identify these differences through the demonstration of clinical cases. The purpose of the study is to explore clinical differences in manifestations of self-destructive behavior in patients with schizophrenia spectrum psychotic disorders. The study involved 95 patients diagnosed with schizophrenia spectrum disorders. The patients were divided into two groups. The first group (Gr1 PermSDB) included 40 patients (42% of the total number of subjects) with psychiatric disorders, who expressed a constant presence of manifestations of self-destructive behavior throughout the whole disease period or during more than half of this period (both according to the patients and to the medical records). The second group (Gr2 ImpSDB) included 55 patients (58% of the total number of subjects), where the manifestations of self-destructive behavior appeared only at the height of exacerbation of psychopathological symptoms, and this caused the acts of impulsive self-harm. Looking at the examples, we see a difference in motivational statements in different groups of patients: in Gr2, the main factor that motivated patients to harm themselves was the exacerbation of psychotic symptoms. At the same time, the main factors influencing the self-harm in Gr1 were personal experiences related to psychological problems Keywords: self-destructive behavior, schizophrenia, schizophrenia spectrum psychotic disorders, clinical cases

Esketamine for Unipolar Major Depression With Psychotic Features: A Retrospective Chart Review and Comparison With Nonpsychotic Depression.

The aims of the study were to assess subanesthetic esketamine as an antidepressant for major depressive disorder with psychotic features (PMDD) and to compare posttreatment symptoms among those with PMDD to a sample of nonpsychotic depression (major depressive disorder [MDD]). This study is a retrospective chart review of patients with major depression and current psychotic symptoms, treated with a single parenteral 0.5-mg/kg dose of esketamine. Depression symptoms were assessed at baseline and 24-hour posttreatment with the Montgomery-Åsberg Depression Rating Scale. Individuals with PMDD were matched in a 1:2 ratio to nonpsychotic MDD patients from a randomized, noninferiority clinical trial of esketamine. A total of 15 individuals with PMDD were included, which had higher baseline depression scores (PMDD = 40.9, MDD = 33.6, P = 0.004). A statistically significant change in depressive symptoms was found for the PMDD sample (β = -16.20 [95% confidence interval, -23.30 to -9.10], P < 0.001), and no difference between PMDD and MDD groups was observed in the matched-sample analysis (β = -2.2 [95% confidence interval, -9.32 to 4.58], P = 0.537). Treatment-induced dissociative symptoms were present for both groups, self-contained to within 2 hours after treatment, and no exacerbation of psychotic symptoms was found in clinical assessments. Results suggest a single 0.5-mg/kg dose of esketamine may benefit individuals with PMDD, and the symptom reduction may be comparable with esketamine's effects for MDD. Furthermore, esketamine may induce an antidepressant response in those with PMDD without complication of psychotic symptoms. Future research with controlled designs is warranted.

Management of psychiatric disorders in patients with cancer.

Management of psychiatric disorders in patients with cancer.

Acute and Lifetime Stress and Psychotic Illness: The Roles of Reward and Salience Networks.

Affective reactions to acute stressors often evoke exacerbations of psychotic symptoms and sometimes de novo psychotic symptoms and initial psychotic episodes. Across the lifespan, affective reactions to acute stressors are enhanced by successive adverse childhood experiences (ACEs), in a process called "behavioral sensitization". The net effects of behavioral sensitization of acute stress responses are to alter responsivity to positive and negative feedback and to unexpected events, regardless of valence, leading to the maladaptive assignment of salience to stimuli and events. The assignment of "aberrant" salience to stimuli and events has profound consequences for learning and decision-making, which can influence both the positive and negative symptoms of psychosis. In this review, we discuss some of the psychological and neural mechanisms by which affective reactivity to acute stress, and its sensitization through the experience of stress and trauma across the lifespan, impact both the positive and negative symptoms of psychosis. We recount how the reward and salience networks of the brain, together with inputs from the dopamine and serotonin neurotransmitter systems, are implicated in both affective reactivity to stress and the symptoms of psychosis, likely mediate the effects of stress and trauma on the symptoms of psychosis and could serve as targets for interventions.

Modafinil in the treatment of selected mental disorders

Modafinil belongs to a class of wakefulness promoting agents. It is widely used in the treatment of sleep disorders. Although narcolepsy is the main indication for its use, hypersomnia from obstructive sleep apnoea and shift work sleep disorder are also indications in some countries. Due to its efficacy in the treatment of hypersomnia, the drug has also been clinically assessed in patients with mental disorders to reduce the severity of symptoms such as fatigue, hypersomnolence and cognitive impairment. The aim of this paper is to present the potential clinical applications of modafinil in the treatment of selected mental disorders. The use of modafinil in depressive disorders to enhance the treatment applied may improve mood, anhedonia and apathy, fatigue, hypersomnolence and executive cognitive impairment. In severe episodes of bipolar depression, modafinil may improve depressive symptoms, fatigue, and hypersomnia. Despite the potential risk of manic symptoms during modafinil treatment, recent studies show no increased risk of switching from depressive to manic phase. In schizophrenia, there is no evidence for the beneficial effect of modafinil on the negative symptoms, but improvement in selected cognitive functions accompanied by exacerbation of psychotic symptoms was observed in some patients. Furthermore, modafinil is used as an alternative to standard therapy in attention-deficit/hyperactivity disorder. Despite lacking evidence for the efficacy of modafinil in cocaine addiction, an analysis of selected studies indicates a potential benefit in the form of maintained abstinence. Modafinil is well tolerated and safe in most cases. The risk of dependence is lower than with other psychostimulants.

Short-term air pollution exposure and exacerbation of psychosis: A case-crossover study in the capital city of South Korea

There is a growing concern that air pollution exacerbates mental disorders. However, studies assessing the relationship between short-term exposure to ambient air pollution and acute exacerbation of psychotic symptoms in psychiatric disorders are limited. This study aims to examine the association between short-term air pollution exposure and acute exacerbation of psychosis in diverse psychiatric disorders. We analyzed 15,917 patients with psychosis (schizophrenia and related disorders and mood disorders with psychotic features) who visited Emergency Departments (EDs) in Seoul, South Korea, between 2008 and 2016. We estimated short-term exposures to particles <2.5 μm (PM2.5), particles <10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO). We employed a conditional logistic regression with a time-stratified case-crossover design to compare the levels of ambient air pollution on ED visit days with those on control days. Results show that the risk of ED visits for psychosis was significantly associated with interquartile range increases in PM2.5 (Odds Ratio [OR] = 1.028; 95% Confidence Interval [CI]: 1.006, 1.049), PM10 (OR = 1.022; 95% CI: 1.003, 1.040), NO2 (OR = 1.037; 95% CI: 1.007, 1.068), and SO2 (OR = 1.030; 95% CI: 1.003, 1.058) in the best-fitting lags. Exposure to the highest quartile of air pollutants generally showed a higher risk for psychosis. The associations were higher among male patients, those with schizophrenia and related disorders, and in the cold season. This study provides new evidence that short-term exposure to elevated levels of air pollutants may increase the risk of acute exacerbation of psychosis. These findings could contribute to the development of policies for reducing air pollution levels and the presentation of psychoses. Further studies are warranted to elucidate our findings and explore the underlying mechanisms.

Perceived Stress and Life Events in Patients Affected by Schizophrenia and Schizoaffective and Bipolar Disorder: Is There a Role for Self-Reported Basic Symptoms?

Introduction: The stress-diathesis model of psychotic disorders describes, in vulnerable individuals, the role of psychosocial stress in the onset and exacerbation of psychotic symptoms. Another interesting approach to the study of vulnerability in the development of psychosis is represented by the basic symptoms concept. Objective: The present study aims at proposing an integration between these two models and investigating possible associations between psychotic symptoms, basic symptoms, perceived stress, and life events in a sample of patients affected by schizophrenia (SZ), schizoaffective (SA), and bipolar disorder with and without psychotic symptoms. Methods: 112 patients were recruited in two university hospitals. Severity of psychiatric symptoms (Positive and Negative Syndrome Scale, PANSS), basic symptoms (Frankfurt Complaint Questionnaire, FCQ), perceived stress (Stress-related Vulnerability Scale, SVS), and life events (Paykel’s interview for recent life events) were assessed. Results: Patients affected by bipolar disorder (both with and without psychotic symptoms) showed a higher number of independent life events (p < 0.01) and tended to report more frequently at least 1 life event in the previous 6 months (p < 0.01) than patients affected by SZ or SA disorder. No differences emerged between the study groups in perceived stress nor in measures of basic symptoms. In the whole sample, a logistic regression analysis showed that the SVS total score (p < 0.05) and PANSS total score (p < 0.001) were associated with the presence of psychotic symptoms. Conclusions: In the study sample, life events and basic symptoms did not play a major role in influencing psychotic symptoms, compared to the subjective perception of stress and the severity of psychopathology. Taken together, these results can be informative for rehabilitation therapies aimed at enhancing resilience and coping strategies in this vulnerable group of patients.

Estrogens in schizophrenia: What do we know?

IntroductionSchizophrenia is a chronic disease that significantly impacts cognitive functioning. Sex differences in incidence, onset and course of schizophrenia suggest estrogens have a protective role.ObjectivesOur aim is to review the state of the art on this matter.MethodsThrough a selection of the most relevant articles found on PubMed and ClinicalKey searching the keywords: “estrogens” and “schizophrenia”.Results Accumulating evidence has led to the hypothesis that estrogens act as a protective factor in women regarding the onset of schizophrenia as their increase in puberty may help delay the onset of symptoms. Also, the estrogens abrupt decline in menopause may account for a second peak of onset and greater severity of the symptoms. During the menstrual cycle, when serum estrogens are at their lowest, there is an increase in the number of psychotic episodes and an exacerbation of psychotic symptoms. Pregnancy leads to an improvement of psychotic symptoms, which then worsen in postpartum. Clinical trials testing the efficacy of estrogens have been promising, which suggest they might be a useful adjuvant treatment. Despite the evidence of clinical efficacy, health risks for women using estrogen therapy should be considered, as they decrease its acceptability as a viable treatment option. The use of selective estrogen receptor modulators (SERMs), as raloxifene, could be a favorable and safer alternative.ConclusionsIn conclusion, estrogens are proving to be a promising option as a complementary therapy for schizophrenia; however, further studies are needed to investigate whether they might be overall beneficial.DisclosureNo significant relationships.

The temporal dynamics of sleep disturbance and psychopathology in psychosis: a digital sampling study.

Sleep disruption is a common precursor to deterioration and relapse in people living with psychotic disorders. Understanding the temporal relationship between sleep and psychopathology is important for identifying and developing interventions which target key variables that contribute to relapse. We used a purpose-built digital platform to sample self-reported sleep and psychopathology variables over 1 year, in 36 individuals with schizophrenia. Once-daily measures of sleep duration and sleep quality, and fluctuations in psychopathology (positive and negative affect, cognition and psychotic symptoms) were captured. We examined the temporal relationship between these variables using the Differential Time-Varying Effect (DTVEM) hybrid exploratory-confirmatory model. Poorer sleep quality and shorter sleep duration maximally predicted deterioration in psychosis symptoms over the subsequent 1-8 and 1-12 days, respectively. These relationships were also mediated by negative affect and cognitive symptoms. Psychopathology variables also predicted sleep quality, but not sleep duration, and the effect sizes were smaller and of shorter lag duration. Reduced sleep duration and poorer sleep quality anticipate the exacerbation of psychotic symptoms by approximately 1-2 weeks, and negative affect and cognitive symptoms mediate this relationship. We also observed a reciprocal relationship that was of shorter duration and smaller magnitude. Sleep disturbance may play a causal role in symptom exacerbation and relapse, and represents an important and tractable target for intervention. It warrants greater attention as an early warning sign of deterioration, and low-burden, user-friendly digital tools may play a role in its early detection.

An effect of cholinesterase blockade on negative symptoms in schizophrenia

To assess the possibilities of influencing the severity of negative disorders in schizophrenic patients with cholinesterase blockade. The study included stable 26 patients (13 of them women), average age 40.4 (SD 11.7) with paranoid schizophrenia, episodic form according to ICD-10). All patients received antipsychotic therapy, which was not changed at least for 2 months. We used psychometric scales (Positive and Negative Syndrome Assessment Scale (PANSS), Global Functioning Scale (GAF), neurocognitive techniques (Brief Assessment of Cognition in Schizophrenia-BACS), projective psychological techniques (Rorschach test). The results of the study showed that augmentation of maintenance antipsychotic therapy with a cholinesterase blocker (ipidacrine at a dose of 20 mg per day) had positive impact on negative symptoms, decreasing the severity of emotional deficiency. The positive changes of cognitive impairment, measured with BACS, occurred regardless of changes in the severity of negative disorders, measured with PANSS. The Rorschach test showed an improvement in the conventional orientation of the patients' thinking. No exacerbation of psychotic symptoms was registered.

A pregnant patient with schizophrenia - dilemmas of treatment and care. A problem still not only for psychiatrists.

Pregnancy is a special period in any women's life. A pregnant woman who suffers from schizophrenia is a special patient and a huge challenge both for the psychiatrist and gynecologist. Such pregnancy is associated not only with the higher level of risk because of inappropriate diet, insufficient prenatal care and smoking but also because of the risk of possible mental degradation of a pregnant woman - occurrence or exacerbation of psychotic symptoms. Moreover, pharmaceutical treatment during pregnancy and its influence on fetus rises doubts and controversy. The aim of the study is to show three stories of pregnant patients treated for schizophrenia in a context of up to date knowledge on anti-psychotic treatment and to pay attention to the need of interdisciplinary approach to this special group of patients. Every pregnant woman suffering from schizophrenia requires individual approach in terms of treatment and care. The problem, which is still ignored, is the need of effective and constant cooperation between the doctors: a psychiatrist and a gynecologist since the very beginning of pregnancy, in order to assess the risk factors associated with pregnancy and periparturient period.