Psychotic Syndromes Research Articles

How Are Psychotic Syndromes Related to Personality Disorders?

How Are Psychotic Syndromes Related to Personality Disorders?

How are psychotic syndromes related to personality disorders?

How are psychotic syndromes related to personality disorders?

Psychotic syndromes in epilepsy.

Claims have been made that epilepsy is associated with both brief psychotic episodes and persistent psychotic states. The existence of brief, nonconfusional psychotic episodes in epilepsy has received some formal support; these may be a function of temporal lobe subictal activity. Persistent psychosis is found in about 7% of patients with epilepsy; independent evidence indicates this to be a significant association. Temporal lobe seizure activity, again probably acting subictally, may be involved in the pathogenesis of these states, perhaps in interaction with other factors. Occurrence of psychotic syndromes in epilepsy may be relevant to kindling, atypical psychoses unrelated to epilepsy, and the psychotropic effect of carbamazepine.

Subtype stability in schizophrenia

The authors examine the long-term stability of the subtypes of schizophrenia defined by four diagnostic systems. When all patients were considered, agreement between subtype assigned at index and follow-up was modest. This agreement increased considerably when only patients diagnosed as paranoid, hebephrenic, or catatonic at both index and follow-up were considered. As for individual subtypes, stability was highest for paranoid schizophrenia, intermediate for hebephrenia, and virtually absent for undifferentiated schizophrenia. The stability of paranoid schizophrenia was greatest when onset occurred after age 30. As length of follow-up increased, a larger proportion of patients were diagnosed as undifferentiated or residual.

Dopaminomimetic action of diphenylhydantoin in rat striatum: effect on homovanillic acid and cyclic AMP levels.

Diphenylhydantoin (DPH) is known to induce reversible paroxysmal dyskinesias and paranoid psychosis in humans, but its interactions with dopamine (DA) metabolism are not clear. Single doses of DPH (60-100 mg kg-1), with serum levels over 10 micrograms ml-1, reduced homovanillic acid (HVA) levels in rat striatum. The DPH-induced HVA decrease was enhanced by supersensitivity of postsynaptic DA receptors following chronic haloperidol (Hal) administration. DPH 60 mg kg-1 given acutely enhanced the HVA decrease induced by apomorphine (Apo) and partially counteracted the HVA increase following acute Hal (0.1-0.5-2 mg kg-1). After chronic DPH treatment, Apo was ineffective in reducing striatal HVA levels. Concomitant chronic treatment with DPH and Hal counteracted the development of supersensitivity of postsynaptic DA receptors to Apo. Single doses of DPH (30-60-100 mg kg-1) increased cyclic AMP striatal content; this effect was blocked by Hal. A dopaminomimetic DPH action and a subsensitivity of postsynaptic DA receptors after chronic DPH seem to be suggested. These effects could be related to the dyskinetic and psychotic syndromes produced by the drug.

The concept of schizophrenia

Since the original description of dementia praecox by Kraepelin, a variety of psychotic syndromes have been described which have features in common with the so-called schizoph enic psychoses. In this paper the development of the concept of schizophrenia and thecurrently available diagnostic- and classification systems are mentioned. It is concluded that a standardized manner of diagnosis and classification may lead to a more reliable understanding of the syndromal features of this kind of psychosis.

High-performance liquid chromatography of haloperidol in serum at the concentrations achieved during chronic therapy

Haloperidol, 4-[4-( p-chlorophenyl)-4-hydroxypiperidino]-4′-fluorobutyrophenone, is a widely prescribed neuroleptic which is used in both adults and children for the treatment of acute and chronic psychotic syndromes and abnormal movements. Therapeutic monitoring of haloperidol is indicated for the following reasons; (1) there is no direct relationship between daily doses and serum levels at steady state; (2) saturation kinetics may apply at higher doses; (3) commonly associated drugs or disease states may alter the drugs pharmacokinetic parameters; (4) drug disposition is faster in children than adults; (5) optimum serum concentrations vary between pathological syndromes and age groups, and (6) side effects and adverse reactions are clearly related to haloperidol serum concentrations [1]. To date all the accepted methods for monitoring haloperidol have used gas chromatography (GC) and large volumes of serum [2]. A recent electron-capture GC method required only 1 ml of plasma or serum, but the selectivity of the assay was not reported [3]. The present method overcomes the use of such high sample volumes, is simpler to perform and is of equal or higher sensitivity. It has been used to monitor haloperidol serum concentrations in various psychiatric patients and the results of these determinations in 28 patients are presented.

The psychopathology of 'late schizophrenia'.

We investigated the clinical features of schizophrenic syndromes first manifested after the age of 50. By comparison with the schizophrenic syndromes first manifested before the 50th year of life we found: late schizophrenia is characterized by rich psychotic productive syndromes (delusions and hallucinations); disturbances of thought are rare; depression, euphoria and anxiety show no difference between the two groups; females are much more represented than males; social isolation is not more common in late schizophrenia than in non-late schizophrenia.

CANNABIS-ASSOCIATED PSYCHOSIS WITH HYPOMANIC FEATURES

The mental state of 20 psychotic men with high urinary cannabinoid levels on admission to a psychiatric hospital was compared with that of 20 matched cannabis-free controls. All patients underwent toxicological analysis to exclude the presence of alcohol and other exogenous agents. Cannabis levels were measured by a semiquantitative enzyme immunological technique and mental state was assessed by the use of the Present State Examination (PSE), once shortly after admission and again 7 days later. The cannabis group showed significantly more hypomania and agitation and significantly less affective flattening, auditory hallucinations, incoherence of speech, and hysteria than did the controls. Clouding of consciousness was absent in most cannabis patients. After 1 week the cannabis group showed marked improvement (particularly in the psychotic syndromes), whereas the controls remained virtually unchanged. There was no significant difference in amount of medication received between the two groups. Our data suggest that a high intake of cannabis may be related to a rapidly resolving psychosis manifesting with marked hypomanic features, though often presenting as a schizophrenia-like illness.

Haloperidol plasma level monitoring in neuropsychiatric patients.

The available data on haloperidol pharmacokinetics and haloperidol plasma level monitoring in neuropsychiatric patients are reviewed and compared with authors' personal observations. It appears that although haloperidol disposition can be described by linear kinetics in volunteers, this is not the case in patients in whom a 7--10-fold variability in plasma levels is observed for the same dosage together with the possibility of saturation kinetics and/or first pass effect. Anticholinergics may interfere with haloperidol absorption, and significant differences in disposition rate and binding have been observed in children and cirrhotic patients. A clear correlation appears to exist between plasma concentrations and side effects or adverse reactions with threshold levels for extrapyramidal syndromes of 6--9 ng/ml. Threshold levels for therapeutic effects vary with syndromes and age. In Gilles de la Tourette syndrome, active levels are of the order of 1--3 ng/ml, whereas in psychotic syndromes levels of 10--15 ng/ml are requested. In mania, a good therapeutic effect has been observed with plasma levels of 2.5--4.5 ng/ml. In general, children require lower plasma levels for the same therapeutic effects. In chronic unresponsive schizophrenic patients, poor drug bioavailability is not the major factor for the lack of response, and the possibility that these patients constitute a nosological subgroup is suggested. Therapeutic drug monitoring of haloperidol appears justified because (a) no direct relationship exists between daily doses and haloperidol steady-state plasma levels; (b) there is a possibility of saturation kinetics at higher doses; (c) commonly associated drugs or diseases may alter the kinetic profile of the drug; (d) drug disposition is faster in children than in adults; (e) optimal plasma concentration appears to differ in various pathological syndromes and age groups; and (f) side-effects and adverse reactions are clearly related to haloperidol plasma levels.

Delirium and stereotypy from anticholinergic antiparkinson drugs

1. This report describes two cases of psychotic syndrome from benztropine (Cogentin), which was used to treat haloperidol-induced extrapyramidal side effects. The patients' symptomatology meets DSM III criteria for delirium. Both patients displayed repetitive motor automatisms (stereotypy). 2. Symptomatology appeared one-to-two days after the start of benztropine 2 mg b.i.d. and subsided one-to-several days after benztropine was stopped. Treatment consisted of administration of sedative hypnotic drugs. 3. The literature on anticholinergic-induced psychotic syndromes is surveyed. Particular attention is drawn to the occurrence of stereotypy. 4. It is proposed, on the basis of a review of animal and clinical data, that stereotypies in delirious patients are related to muscarinic blockade in the central nervous system. This model is used to explain repetitive motor automatisms which are seen in Alzheimer's disease. 5. The paper concludes with brief guidelines for the management of anticholinergic delirium.

Diagnosing early infantile autism

Forty years after Kanner’s seminal article, experts continue to disagree about the definition, reliability and usefulness of the Early Infantile Autism (EIA) syndrome. The ongoing controversy is fuelled by misconceptions about the purpose of diagnosis, by the use of various diagnostic criteria and a failure to consider whether the EIA diagnosis is useful in a practical sense. In the present article, the EIA syndrome is examined from three perspectives. The first addresses the general question of whether identifying childhood psychotic syndromes is a worthwhile enterprise. Next, evidence for the reliability of the EIA syndrome is reviewed. Finally, the usefulness of considering EIA a discrete syndrome is examined. It is concluded that: (a) identifying syndromes of childhood psychosis is not only worthwhile but crucial for progress in research and treatment; (b) EIA can be reliably diagnosed and, (c) there is evidence supporting the usefulness of the EIA syndrome.

SCHIZOPHRENIA-LIKE PSYCHOSIS CAUSED BY A METABOLIC DISORDER

Four patients with an intermittent psychosis closely resembling hallucinogenic drug-induced states were suspected of having a porphyric disease and were investigated for a possible relation between the metabolic dysfunctions of porphyria and the psychotic syndrome. Theoretically the link could be in a disturbance of serine and glycine metabolism. This theory was supported by disturbances in serine and glycine excretion found in all patients during psychotic episodes. In addition, loading with one low oral dose of serine produced psychotic symptoms 5 h later which lasted 3-6 h. One patient reacted to glycine in the same way. These findings suggest that disturbed serine-glycine metabolism may have a key role in certain schizophreniform psychotic syndromes.

GENETIC AND OTHER FACTORS IN SCHIZOPHRENIC, MANIC-DEPRESSIVE, AND SCHIZO-AFFECTIVE PSYCHOSES

The major psychoses have been investigated for genetic and environmental etiological factors for over two centuries. Recent emphasis has been placed on a genetic (diathesis) environmental stress model. For schizophrenia, manic-depressive, and schizo-affective psychoses, research evidence from psycho-biological studies, family, pedigree, twin, and adoptee studies has provided sufficient data from diagnostic and follow-up studies and new psychopharmacological research that for these three major psychoses a strong necessary but not sufficient basis for genetic causation exists. This review attempts to summarize existing data into a hypothesis that suggests that two separate gene pools of polygenic nature relate to the development of schizophrenia and manic-depressive illness and that schizo-affective illness may result from genetic transmission from each of these separate gene pools. The hypothetical model for each psychosis proposes that polygenetic inheritance affects different central nervous system neuroanatomical sites in the human which are in homeostasis as to catecholamine neurotransmitter regulation of the psyche. With sufficient environmental stress, an "imbalance" occurs in the neural integrative systems which produces phenotypically the three separate psychotic behavioral syndromes of schizophrenia, manic-depressive psychosis, and schizo-affective psychosis.

Double-Blind Study with Two Butyrophenone Derivatives: Bromperidol vs. Haloperidol

The present report deals with a double-blind study comparing the new butyrophenone derivative, bromperidol, with haloperidol as the reference substance. Both substances were found to be highly effective in the treatment of psychotic syndromes belonging predominantly to the schizophrenia group. Certain clues, including the onset of action, seem to be indicative of the superiority of bromperidol. No differences between the two substances were observed with respect to side effects and general tolerability.

THE COURSE OF CHILDHOOD PSYCHOTIC SYNDROMES DURING 10 YEARS

Acta Psychiatrica ScandinavicaVolume 49, Issue s243 p. 63-64 THE COURSE OF CHILDHOOD PSYCHOTIC SYNDROMES DURING 10 YEARS BIRTE HÖEG BRASK, Search for more papers by this author BIRTE HÖEG BRASK, Search for more papers by this author First published: August 1973 https://doi.org/10.1111/j.1600-0447.1973.tb10491.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume49, Issues243August 1973Pages 63-64 RelatedInformation

Psychiatric diagnosis and the in-patient multidimensional psychiatric scale (I.M.P.S.).

An interview with the patient is the main method of examination in the functional psychoses, following which the diagnosis is made. This diagnosis is fundamental in communicating about the patient, in clinical discussions between psychiatrists or in comparing research results. It is essential that the diagnosis should be reliable and valid. Kreitman (1961) has defined reliability as the amount of agreement between psychiatrists examining the same patient, or a comparable series of patients. He also argues that the frame of reference of the examiner should be that of general clinical psychiatry. It should also avoid personality traits in psychiatrists which are associated with different kinds of orientation (Kreitman, 1961). Another problem, that of nomenclature, may turn out to be an argument about the choice of labels. These problems are of great concern to the clinical psychiatrist and are made worse by weaknesses in interview techniques. It is important to look for improvements, and the present study examines the reliability and validity of the In-patient Multidimensional Psychiatric Scale (I.M.P.S.). This is a scale for rating psychotic syndromes following an interview with the patient. These syndromes have been established by repeated factor analyses (Lorr and Klett, 1967). The initial work was based on psychotic American patients, but similar factor syndromes appear from studies of psychotics in other countries (Lorr and Klett, 1968, 1969a, 1969b).

Serum creatine phosphokinase activity in newly admitted psychiatric patients. II.

Serum creatine phosphokinase (CPK) activity was determined in 726 patients and correlated with psychiatric diagnosis. Eighty-three of 209 acutely psychotic patients (39.7%) had increased serum CPK activity. The incidence of increased CPK levels in those patients with symptoms of less than two weeks' duration (65.1%) was significantly higher than in those whose symptoms were dated to more than two weeks prior to hospitalization (10.3%). The median increase was four to five times the upper limit of normal. Increases were present in patients with the whole range of acute psychotic syndromes not previously attributed to physical conditions. Few nonpsychotic and chronically psychotic patients had elevated serum CPK levels. Some patients with alcoholic psychoses or cerebral arteriosclerosis had elevated serum CPK activity. The determination of serum CPK activity may be of some use for diagnostic purposes.

Cross-cultural comparison of psychotic syndromes.

Cross-cultural comparison of psychotic syndromes.

Three cases of frontal meningiomas presenting psychiatrically.

The clinical presentation of three patients with meningiomas at different frontal sites is described. They had been ill for 3, 25, and 43 years before the tumour was demonstrated radiologically. Apathy, incontinence, dementia, and fits were seen in association with middle and superior frontal lesions, and may be mistaken for symptoms of involutional depression or presenile cerebral atrophy. In contrast, excitement and hallucinosis were seen in association with a basal frontal lesion, and may mimic psychotic syndromes like hypomania and schizophrenia, particularly if the tumour encroaches on the third ventricle and adjacent structures. Irreversible loss of myelin and axons in the frontal areas of brain surrounding the tumour may have contributed to the clinical picture of the syndrome shown by these patients.