Secondary Psychotic Symptoms Research Articles

Associations of neural processing of reward with posttraumatic stress disorder and secondary psychotic symptoms in trauma-affected refugees

ABSTRACT Background: Psychological traumatic experiences can lead to posttraumatic stress disorder (PTSD). Secondary psychotic symptoms are not common but may occur. Objectives: Since psychotic symptoms of schizophrenia have been related to aberrant reward processing in the striatum, using the same paradigm we investigate whether the same finding extends to psychotic and anhedonic symptoms in PTSD. Methods: A total of 70 male refugees: 18 PTSD patients with no secondary psychotic symptoms (PTSD-NSP), 21 PTSD patients with secondary psychotic symptoms (PTSD-SP), and 31 healthy controls (RHC) were interviewed and scanned with functional magnetic resonance imaging (fMRI) during a monetary incentive delay task. Using region of interest analysis of the prefrontal cortex and ventral striatum, we investigated reward-related activity. Results: Compared to RHC, participants with PTSD had decreased neural activity during monetary reward. Also, participants with PTSD-SP exhibited decreased activity in the associative striatum relative to participants with PTSD-NSP during processing of motivational reward anticipation which correlated with severity of psychotic symptoms. However, the difference between the two PTSD groups disappeared when PTSD severity and trauma exposure were accounted for. Conclusions: Anhedonia and secondary psychotic symptoms in PTSD are characterized by dysfunctional reward consumption and anticipation processing, respectively. The latter may reflect a mechanism by which abnormal reward signals in the basal ganglia facilitates psychotic symptoms across psychiatric conditions.

PTSD with secondary psychotic features among trauma-affected refugees: The role of torture and depression

This cross-sectional study examined the prevalence of PTSD with secondary psychotic symptoms (PTSD-SP), its comorbidities, and its association with torture and depression in treatment-seeking refugees. Data were pooled from the Danish Database on Refugees with Trauma (DART). The sample represents approximately 90% of trauma-affected refugee-patients (N = 627) attending a Danish psychiatric outpatient clinic from 2008 to 2013. PTSD, secondary psychotic symptoms, and comorbidities were assessed with structured and routine clinical interviews. The association of PTSD-SP with torture and depression was investigated using hierarchical logistic regression. The prevalence of PTSD-SP in treatment-seeking refugees with PTSD was 30%. Among these, 44% fulfilled the criteria for Enduring Personality Change After Catastrophic Experience (EPCACE). Psychotic symptoms comprised hallucinations and persecutory delusions, often reflecting trauma-related themes. Comorbidity with depression was high (79%). Neither torture, nor other war-trauma (ex-combatant, imprisonment, civilian war trauma) predicted PTSD-SP, but comorbid depression did. Depression only explained a small amount of the total PTSD-SP variance. Results indicate that PTSD-SP is common in treatment-seeking refugees. However, its etiology is poorly understood. This highlights the need for further research to improve diagnosis and treatment for this patient group.

Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: a retrospective cohort study

BackgroundA substantial amount of refugees (10–30%) suffer from Post-Traumatic Stress Disorder (PTSD). In Denmark there are different facilities specialised in psychiatric treatment of trauma-affected refugees. A previously published case report from such a facility in Denmark shows that some patients suffer from secondary psychotic symptoms alongside their PTSD.The aim of this study was to illustrate the characteristics and estimate the prevalence of psychotic features in a clinical population of trauma-affected refugees with PTSD.MethodsPsychiatric records from 220 consecutive patients at Competence Centre for Transcultural Psychiatry (CTP) were examined, and all the PTSD patients were divided into two groups; one group with secondary psychotic features (PTSD-SP group) and one without (PTSD group). A categorisation and description of the secondary psychotic features was undertaken.ResultsOne hundred eighty-one patients were diagnosed with PTSD among which psychotic symptoms were identified in 74 (40.9, 95% CI 33.7–48.1%). The majority of symptoms identified were auditory hallucinations (66.2%) and persecutory delusions (50.0%). There were significantly more patients diagnosed with enduring personality change after catastrophic experience in the PTSD-SP group than in the PTSD group (P = 0.009). Furthermore the PTSD-SP group included significantly more patients exposed to torture (P = 0.001) and imprisonment (P = 0.005).ConclusionThis study provides an estimation of PTSD-SP prevalence in a clinical refugee population with PTSD. The study points to the difficulties distinguishing psychotic features from flashbacks and the authors call for attention to psychotic features in PTSD patients in order to improve documentation and understanding of the disorder.

Differenzialdiagnose psychotischer Symptome

Many patients with psychiatric and organic disorders may present primary or secondary psychotic symptoms. Based on the ICD 10 classification, this article describes the possible underlying diseases and their subdivision. The main focus will be differential-diagnostic evaluations of psychotic syndromes. In the clinical setting, the differential diagnosis of the paranoid schizophrenia and other psychotic disorders into three main disease groups is important: 1. other psychiatric diseases, 2. primary and secondary organic diseases and 3. autoimmune diseases. The first group contains, for example, drug-induced psychoses, affective disorders, personality disorders. The second group includes forms of dementia, forms of deliria or metabolic diseases. Recently, another focus is set on autoimmune diseases, especially encephalitides. A detailed medical history, a physical examination and organic diagnostic can lead to the correct diagnosis and therapy. The differential-diagnostic classification and the detection of organic causes is an important part of psychiatric care, but often a good cooperation with organic specialties is needed.

Acute psychosis in an adolescent with cerebral palsy

IntroductionCerebral Palsy is a movement, posture or muscle toning disorder caused by an insult to the immature, developing brain, most often before birth. It is a leading cause for serious disabilities in childhood and a risk factor for the development of psychiatric disorders, particularly in adolescents. Moreover, according to DSM-5, a Brief psychotic disorder is a short-term illness with psychotic symptoms, which arise suddenly, but last for less than one month, after which the person recovers completely.Objectives/AimsThe authors aim to present a case of an adolescent with cerebral palsy who has developed secondary psychotic symptoms, a rare and sparsely understood phenomenon.MethodsA non-systematic review of English scientific literature was conducted through research in the PubMed search engine, using the keywords “Cerebral Palsy” and “Brief Psychotic Disorder”.ResultsA 16-year-old female adolescent with history of Cerebral Palsy (due to neonatal anoxia) was admitted in the paediatric ward due to behaviour disorder characterized by incoherent speech, full insomnia, agitation and auto/alo-aggression. A complete clinical investigation was performed, in which trauma, organic brain injury, degenerative and inflammatory diseases, infection or toxic ingestion were all excluded. The hypothesis of an acute psychotic disorder was considered and after antipsychotic treatment, a total remission of the symptoms was obtained.ConclusionsAlthough rare, the association between cerebral palsy and psychotic disorders should be considered in the diagnostic investigation of behavioural changes. Early identification allows a proper therapeutic intervention and a better quality of life.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Secondary psychosis 3 months prior to the overt symptoms of multiple myeloma: a case report.

To the Editor: We report a case in which secondary psychotic symptoms presented 3 months prior to the overt signs and subsequent diagnosis of multiple myeloma. Our case report is unique because previous reports of psychiatric symptoms secondary to multiple myeloma are rare and such symptoms typically present after the development of hypercalcemia and uremia.

P-89 - Posttraumatic psychosis and drug abuse. Case study

Introduction It is difficult to distinguish between posttraumatic and idiopathic psychotic disorders. After a traumatic brain injury, the incidence of psychotic symptoms is between 5–20%, with an average duration of 4 years. Delusions and auditory hallucinations are more frequent than negative and catathoniform symptoms. Despite the lack of strong scientific evidence, antipsychotic treatment seems the best choice, although there is a bigger risk of adverse effects. The prognosis does not seem to be related to the severity of the injury. Objectives and aims We intend to illustrate the daily clinical practice, in which we find patients with important comorbidities, difficult differential diagnosis and therapeutic challenges. Methods Using a case-report format, we describe a 26 year old patient with the following diagnostics: traumatic brain injury with secondary psychotic symptoms versus schizophrenia; alcohol abuse; cannabis dependence; pathologic gambling. We summarize complementary explorations, therapeutic management and evolution. Results Along three years of follow up there is a preponderance of negative symptoms. Positive symptom exacerbations also occur, in coincidence with an increase of cannabis consumption. Due to lack of compliance, long acting antipsychotics are prescribed. Motivational Interview is used for the drug use disorders and the treatment compliance, achieving the goal of reducing cannabis consumption. Conclusions Daily clinical practice brings us highly complex cases in which a multidisciplinary approach is very important. This particular case shows the differential diagnose difficulties between posttraumatic and idiopathic psychosis, and the troubles of clinical and therapeutical management in the dual pathology field.

Les troubles psychotiques post-traumatiques : un modèle physiopathologique de la schizophrénie

Traumatic Brain Injury (TBI) and later serious psychopathology have long been associated in the literature. Psychotic disorder following traumatic head injury is reported to occur in 0.7 to 9% of patients who sustain a head injury. This paper summarizes the recent literature about psychotic symptoms following TBI and try to articulate these psychotic disorders to a pathophysiological model of primary schizophrenia. Psychotic disorder due to a general medical condition (TBI) indicates that the hallucinations or delusions are the direct physical consequences of the medical condition. A contrario, schizophrenia-like psychosis is a secondary schizophreniform syndrom that must be differentiated from posttraumatic schizophrenia where the head trauma is an external factor furthering the onset of a primary psychosis. A dimensional approach could although take place for understanding pathophysiology. Head injury has been reported to increase the likelihood of the development of psychosis disorder due to TBI, schizophrenia-like psychosis and posttraumatic schizophrenia. While TBI is a major public health issue, schizophrenia following TBI is relatively rare and poorly studied. The onset of schizophrenia occurs most commonly from late adolescence to mid-adulthood, in an age group where head injury is more frequent. Even if early illness features of schizophrenia might increase exposure to TBI, posttraumatic schizophrenia could be the result of a gene-environment interaction. The pathophysiology research in psychotic disorders following TBI does not distinguish schizophrenia from other psychotic syndromes but have to consider a dimensional approach of these psychotic phenomena. Family history of schizophrenia and frontal or parietal lobe deficits was more common in patients with posttraumatic psychotic symptoms. Susceptibility to schizophrenia is believed to be due to multiple genetic and interacting factors and mild childhood head injury may play a role in the development and onset of schizophrenia in families with a strong genetic predisposition. The authors suggest hypotheses aimed at furthering the understanding of the physiologic mechanisms relating traumatic brain injuries to psychotic symptoms. Psychotic disorder following TBI, schizophrenia-like psychosis and posttraumatic schizophrenia are a potential interest to clinicians and neuroscientists, as it may provide clues to understanding primary psychotic disorders such as schizophrenia. Schizophrenia is a psychotic disorder commonly attributed to the interaction of genetic vulnerability and environmental events which implies that environmental factors modulate the effects of the genotype. Schizophrenia related to TBI could also be the result of a gene-environment interaction. Schizophrenia genes may increase exposure to head trauma (through agitation or cognitive impairment), with head trauma further increasing the risk for schizophrenia. Further studies are needed to articulate the links between secondary psychotic symptoms and primary schizophrenia in a structure/function paradigm. The new imaging techniques of magnetic resonance imaging, position emission tomography and single-photon emission computed tomography could aid in this sense.

Corticotropin-releasing factor in posttraumatic stress disorder (PTSD) with secondary psychotic symptoms, nonpsychotic PTSD, and healthy control subjects

BackgroundRecent studies have reported a high comorbidity between posttraumatic stress disorder (PTSD) and psychotic symptoms, and it has been hypothesized that PTSD with comorbid psychosis is a severe form of PTSD. Few studies have examined the neurobiology of PTSD with comorbid psychosis. If PTSD with secondary psychotic symptoms (PTSD-SP) is a severe form of PTSD, then it might be expected to show more extreme perturbations in the neuroendocrine patterns that characterize PTSD. MethodsPatients with PTSD with secondary psychotic symptoms (PTSD-SP), PTSD without psychosis, and healthy comparison subjects were compared for differences in cerebrospinal fluid concentrations of corticotropin-releasing factor (CRF) and somatotropin-release-inhibiting hormone (SRIF). ResultsThe PTSD-SP subjects had significantly higher mean levels of CRF than either the PTSD or control subjects (p < .01). The three groups showed similar SRIF levels. ConclusionsThese data implicate abnormalities in the secretion of CRF with the production of secondary psychotic symptoms in PTSD. This finding supports the validity of PTSD-SP as a PTSD subtype and as a severe form of PTSD.

Differences in smooth pursuit eye movement between posttraumatic stress disorder with secondary psychotic symptoms and schizophrenia

Studies show high comorbidity between post-traumatic stress disorder and psychotic symptoms. Despite this fact, there has been only one published study of the neurobiology of this enigmatic disorder. This preliminary study examines the relationship between psychotic symptoms in post-traumatic stress disorder (PTSD) and schizophrenia by measuring smooth pursuit eye movement (SPEM) in subjects with PTSD and secondary psychotic symptoms, schizophrenia, and healthy controls. The results show that PTSD with secondary psychotic symptoms is associated with a SPEM deficit that is different from the SPEM deficit associated with schizophrenia.

Secondary psychotic symptoms in a patient with biphasic meningo-encephalitis

SummaryWe report on the case of a patient who developed an acute meningitis and, after a period of about two weeks, without any neuropsychiatric problems, an acute paranoid-hallucinatory and catatonic syndrome. The symptomatology is discussed, in relation with the diagnostic difficulties of differentiating between a biphasic meningo-encephalitis with an organic psychosis or a first manifestation of an endogenous psychosis.