Substance-induced Psychotic Disorder Research Articles

A systematic review and meta-analysis of synthetic cathinone use and psychosis.

Synthetic cathinones (SC), commonly referred to as "bath salts", are stimulants resembling the natural alkaloid cathinone found in the khat plant. These substances have the potential to induce serious health risks such as hallucinations, delusions, paranoia and agitation which can lead to substance-induced psychotic disorders. Despite growing concerns, there is a limited understanding of the association between SC consumption and the devolvement of such psychopathologies. We conducted a systematic review to investigate the frequency of substance-induced psychotic disorder (SIPD) and associated conditions in humans following synthetic cathinone consumption. We qualitatively and quantitatively analyzed SC exposure cases. A total of 32 studies were included, with a diverse range of demographics, synthetic cathinone types, and consumption patterns. The proportion of individuals developing psychotic symptoms was reported at 0.380 (Random-effects model, 95% CI 0.289 - 0.475). Additionally, the significant heterogeneity in diagnostic approaches limited our ability to provide a precise estimate of prevalence. Synthetic cathinone consumption is associated with the risk of developing psychotic symptoms as indicated by the prevalence of hallucinations and/or delusions. Due to the lack of information on classifying factors, particularly duration of symptoms, we are unable to conclude synthetic cathinone-induced psychosis. Further research is warranted to elucidate the underlying mechanism linking synthetic cathinone consumption and psychosis. This review underscores the urgency of addressing the growing health risks posed by synthetic cathinone use. Additionally, it highlights the necessity of proper quantification of psychotic symptoms through scales and reporting of classification criteria to accurately diagnose SIPD.

3-Methoxy-Phencyclidine Induced Psychotic Disorder: A Literature Review and an 18F-FDG PET/CT Case Report.

New Psychoactive Substances (NPS) are modifying the drug scenario worldwide and have become a public health concern because of their toxicological profiles and their harmful physical/psychological effects. 3-Methoxy-Phencyclidine (3-MeO-PCP), a non-competitive antagonist of glutamate N-methyl-D-aspartate (NMDA) receptors, belongs to the phencyclidine-like subfamily of arylcyclohexylamines and has gained attention for its toxic, sometimes fatal, effects. Despite several cases of intoxication and death reported in the literature, little is known about substance-induced psychotic disorders (SIP) and potential cognitive impairment following 3-MeO-PCP intake. This literature review aimed to summarize available evidence about 3-MeO-PCP mechanisms of action and physical and psychotropic effects and to spread preliminary findings about persistent psychotic symptoms and impaired cognitive functioning. Additionally, the case of an SIP is reported in a 29-year-old man with small oral intakes of 3-MeO-PCP over two weeks until a high dose ingestion. Psychometric and neuropsychological assessment and brain [18F]-fluorodeoxyglucose positron emission tomography integrated with computed tomography were used to support clinical description. Identifying and addressing the characteristic clinical features and neural substrates of NPS-induced psychoses might help clinicians with a more precise differentiation from other psychotic disorders. Although further studies are required, phenotyping the cognitive profile of NPS users might provide targets for tailored therapeutic approaches.

Comparison of cognitive functions in individuals with primary psychosis and substance-induced psychotic disorders

ABSTRACT Background Cognitive dysfunctions are common in patients with primary psychosis disorder (PPD) and substance-induced psychotic disorder (SIPD), and this problem is very important in the course of their treatment and relapse. The present research was done to study the cognitive functions in the patients suffering from PPD compared to the patients with SIPD. Methods In this analytical study, the study population included all patients admitted to Farabi Hospital, Kermanshah, Iran, diagnosed with PPD and SIPD, whose cognitive functions were compared using the Rey Auditory Verbal Learning Test (RAVLT), Symbol Digit Modalities Test (SDMT) and Verbal Fluency Test (VFT). Results Only the mean number of words in the first list that the patient was unable to identify (Miss) distinguished the two groups in terms of the mean RAVLT scores. Due to the number of accurate answers in the SDMT and the speed of visual search, there was no discernible difference between the PPD and SIPD groups. The results showed a significant difference between the two groups due to the total number of correct VFT word in two parts of letters and categories. Conclusion The results of the present study can be used in the treatment and rehabilitation of PPD and SIPD patients.

Clinical Variables and Peripheral Biomarkers Associated with Substance-Induced Psychotic Disorder: Differences Related to Alcohol, Cannabis, and Psychostimulant Abuse.

Background: The present retrospective observational study aims to identify differences in clinical features and peripheral biomarkers among patients affected by substance-induced psychotic disorder (SIPD) according to the primary substance of abuse. Methods: A sample of 218 patients was divided into three groups according to the type of consumed substance: alcohol, cannabis, and psychostimulants. The three groups were compared using one-way analyses of variance (ANOVAs) for continuous variables and χ2 tests for qualitative variables. After excluding the alcohol-induced psychotic disorder group, the same analyses were repeated. The statistically significant variables from these subsequent analyses were included in a binary logistic regression model to confirm their reliability as predictors of cannabis- or psychostimulant-induced psychotic disorder. Results: Psychotic cannabis abusers were younger (p < 0.01), with illness onset at an earlier age (p < 0.01). Alcohol consumers presented a longer duration of illness (p < 0.01), more frequent previous hospitalizations (p = 0.04) and medical comorbidities (p < 0.01), and higher mean Modified Sad Persons Scale scores (p < 0.01). Finally, psychostimulant abusers had a higher frequency of lifetime history of poly-substance use disorders (p < 0.01). A binary logistic regression analysis revealed that higher mean Brief Psychiatric Rating Scale scores (p < 0.01) and higher sodium (p = 0.012) and hemoglobin (p = 0.040) plasma levels were predictors of cannabis misuse in SIPD patients. Conclusions: Different clinical factors and biochemical parameters con be associated with SIPD according to the main substance of abuse, thus requiring specific management by clinicians.

Substance Use in Patients Admitted to the Psychiatric Emergency Department in Northern Iran

Background: Acute psychiatric problems are increasingly observed following substance abuse in emergency departments. To address this significant societal issue, it is essential to understand its various dimensions in order to develop comprehensive control policies. Objectives: This study aimed to evaluate substance use and its related factors in patients admitted to a psychiatric emergency ward in Sari, Mazandaran, Iran. Methods: In this cross sectional investigation, all patients who were admitted to the emergency department of Zare referral psychiatry hospital during the previous one year were studied. A checklist of demographic and psychiatric factors was completed for each patient based on their medical records. Urine rapid tests were routinely conducted in this department to screen for drug consumption. Descriptive statistics, central and dispersion indices, and the chi-square test were used to analyze the data. Results: A total of 578 cases, comprising 406 males (70.2%) and 172 females (29.8%), were examined. The mean age of patients was 34.7 ± 11.2 years. The most common symptoms reported were aggression (50.5%), insomnia (11.2%), paranoia (10.7%), and self-talk (8.1%), respectively. The most frequent final clinical diagnosis was bipolar disorder in 145 cases (25.1%), followed by schizophrenia in 131 cases (22.7%), and substance-induced psychotic disorder in 63 cases (10.9%). In the substance use screening among patients, the urine test was positive for morphine in 17.6% of the patients. Methamphetamine, methadone, and cannabis tests were positive in 16.1%, 9.5%, and 3.5% of cases, respectively. Among patients with positive urine tests (for methamphetamine, methadone, or morphine), the most common clinical diagnosis was substance-induced psychotic disorder, followed by schizophrenia. Schizophrenia and substance-induced psychotic disorder were the two most common diagnoses in patients with positive cannabis urine tests, respectively. Conclusions: The high rate of substance abuse among psychiatric emergency patients, often co-occurring with other psychiatric disorders, the high prevalence of psychosis, and the behavioral risks associated with these patients emphasize the need for special attention to this biopsychosocial problem.

Duration of the psychosis prodrome and its relationship to duration of untreated psychosis across all 12 DSM-IV psychotic diagnoses: Evidence for a trans-diagnostic process associated with resilience

While duration of the psychosis prodrome (DPP) attracts attention in relation to the developmental trajectory of psychotic illness and service models, fundamental issues endure in the context of dimensional-spectrum models of psychosis. Among 205 epidemiologically representative subjects in the Cavan-Monaghan First Episode Psychosis Study, DPP was systematically quantified and compared, for the first time, across all 12 DSM-IV psychotic diagnoses. DPP was also compared with duration of untreated psychosis (DUP) and each was then analysed in relation to premorbid features across three age ranges: <12, 12–15 and 16–18 years. For each diagnosis, medians for both DPP and DUP were shorter than means, indicating common right-skewed distributions. Rank orders for both DPP and DUP were longest for schizophrenia, intermediate for other schizophrenia-spectrum psychoses, psychotic depression and psychotic disorder not otherwise specified, and shortest for brief psychotic disorder, bipolar disorder and substance-induced psychotic disorder, though with overlapping right-skewed distributions. DPP was longer than DUP for all diagnoses except substance-induced psychotic disorder. Across functional psychotic diagnoses, longer DPP was predicted by higher premorbid intelligence and better premorbid adjustment during age 16–18 years. These findings indicate that, trans-diagnostically, DPP and DUP share right-skewed continuities, in accordance with a dimensional-spectrum model of psychotic illness, and may reflect a unitary process that has been dichotomized at a subjective threshold along its trajectory. Better premorbid functioning during age 16–18 years appears to confer resilience by delaying progression to overt psychotic symptoms and may constitute a particular target period for psychosocial interventions.

Impact of non-medical cannabis legalization with market restrictions on health service use and incident cases of psychotic disorder in Ontario, Canada

BackgroundCannabis is a risk factor in the onset and persistence of psychotic disorders. There is concern that non-medical cannabis legalization in Canada may have population-level impacts on psychotic disorders. We sought to examine changes in health service use and incident cases of psychotic disorder following cannabis legalization, during a period of tight restrictions on retail stores and product types. MethodsWe conducted a cross-sectional interrupted time-series analysis using linked population-based health administrative data from Ontario (Canada) from January 2014 to March 2020. We identified psychosis-related outpatient visits, emergency department visits, hospitalizations, and inpatient length of stay, as well as incident cases of psychotic disorders, among people aged 14 to 60 years. ResultsWe did not find evidence of increases in health service use or incident cases of psychotic disorders over the short-term (17 month) period following cannabis legalization. However, we found clear increasing trends in health service use and incident cases of substance-induced psychotic disorders over the entire observation window (2014–2020). ConclusionOur findings suggest that the initial period of tight market restriction following legalization of non-medical cannabis was not associated with an increase in health service use or frequency of psychotic disorders. A longer post-legalization observation period, which includes expansion of the commercial cannabis market, is needed to fully understand the population-level impacts of non-medical cannabis legalization; thus, it would be premature to conclude that the legalization of non-medical cannabis did not lead to increases in health service use and incident cases of psychotic disorder.

Prevalence of Comorbidities of Psychotic Disorders in Patients with Substance Use Disorders in Iran Psychiatric Hospital in Tehran, Iran

Background: Substance use disorders are highly prevalent among psychotic patients and are associated with poorer clinical outcomes. Objective: This study aimed to investigate the prevalence of psychotic disorders in substance users and the epidemiological features of this population. Material&amp;Methods: In a cross-sectional study, we investigated 455 outpatient and inpatient participants with SUD referred to the Iran psychiatric hospital from April, 2020, to March, 2021. All participants were substance users, referred to Iran psychiatric center to follow up on their comorbidities and psychiatric disorders. The Structured Clinical Interview for DSM-5 (SCID) was used for psychotic disorders and substance use disorder diagnoses. Finally, gathered data were analyzed by SPSS-25. Results: A total of 455 patients were involved in the study. The mean age was 34.66 years, of which 89.7% were men. The most common main substances include methamphetamine (39.1%) and heroin (27%). The prevalence of psychotic disorder was 36.7%, and the most common type was substance-induced psychotic disorder (26.4%) and schizophrenia (8.4%). There was a significant association between methamphetamine and opium use and the presence of substance-induced psychotic disorder and schizophrenia, respectively (p˂ 0.001). Conclusion: The most common type of substance use was methamphetamine, and the most common type of psychotic disorder was substance-induced psychotic disorder. There was a significant association between methamphetamine and opium use and the presence of substance- induced psychotic disorder and schizophrenia, respectively. It should be noted that this was a sample of individuals hospitalized for substance abuse. It was not a general population sample and was very biased toward substance use.

Prevalence of Psychoactive Substance use among Adults Ages of 20 to 40 Years at the Georgetown Public Hospital Corporation

Background: Guyana is a developing nation with a population of under one million. Yet, 15 to 20 percent of the population suffer from some form of mental health condition. Oftentimes persons turn to psychoactive substances to deal with their mental health condition. This study aimed to investigate the prevalence of psychoactive substance use, as well as, to identify psychoactive substances and risk factors among adults attending the psychiatric outpatient clinic at the Georgetown Public Hospital (GPHC). Methodology: A review of outpatient clinic charts belonging to patients ages 20 to 40 years, who were enrolled from January 1st to December 31st, 2019 at the psychiatric clinic (GPHC) regardless of their presenting complaint or diagnosis was carried out. Those that had records of psychoactive substance use were collected for analysis in this study. Sociodemographic characteristic and type of psychoactive substances were assessed using descriptive analysis. Results: Of 200 patient charts reviewed, 150 (75%) had records of psychoactive substance use. The majority of psychoactive substance users were Afro-Guyanese (42.7%), Christians (71.3%) and male (76.7%) with an average age of 28 years. Additionally, most patients had only primary education (59.3%) and were not in a relationship (80.7%). Moreover, the majority patients experienced a major traumatic life event (60%) and were from dysfunctional families (13.3%). The findings also showed that 47.3% of persons with a previous psychiatric history used psychoactive substances, while 36% developed a substance-induced psychotic disorder. Cannabis (78%) was identified as the most frequently used drug, followed by alcohol (50.7%) and tobacco (45.3%). Conclusion: There was a high prevalence of psychoactive substance use among patients enrolled in the psychiatric clinic, GPHC. With the majority of patients having known risk factors for psychoactive substance use. Also, results highlighted that some patients developed psychotic disorders post substance use. This emphasizes the need for more mental health awareness strategies targeted at adults and the need for effective drug rehabilitation programs, which can help reduce the use of psychoactive substances among adults in Guyana. Keywords: Young Adults, Psychoactive Substance, Mental Health, Guyana

Quasi-Experimental Study On Tachyphylaxis In Psychiatric Patients

The objective of the present ex-post facto study is to the prevalence of tachyphylaxis in patients using psychotropic drugs. Method: As a quasi-experimental style of study, 100 participants were purposively selected who were admitted to the rehabilitation centre for the treatment of substance-induced disorders, Psychotic disorders, Bipolar disorder and other psychiatric disorders and being treated with medication. The age range was 18 to 60 years. An Urdu-translated version of the Rothschild Scale for Antidepressant Tachyphylaxis (RSAT) was used to find out the prevalence of tachyphylaxis in patients. Results: A significant number of patients were found with tachyphylaxis after treatment of 6 or more than six months as they were being treated with antipsychotics, antidepressants, anxiolytics, tranquillizers and narcotics.

Who gets diverted into treatment? a study of defendants with psychosis

The current study aimed to advance our understanding of the factors that influence mental health diversion in Local Courts in New South Wales, Australia. Logistic regression was used to systematically identify the factors that are correlated with diversion in a cohort of individuals (N = 7283) diagnosed with psychosis. Those with a substance-induced psychotic disorder were less likely to be diverted than those with an affective psychosis or schizophrenia, after adjusting for age, gender, Indigenous status, offence seriousness, violence and criminal history. Unexpectedly, those with psychotic disorders committing violent or serious offences were more likely to be diverted than those committing non-violent, less serious offences. Legal representation should be provided to all individuals with serious mental illnesses facing criminal charges. The State-wide Community and Court Liaison Service should be expanded to more Local Courts. Further research is required into why Aboriginal defendants with a psychotic illness are less likely to be diverted.

Substance-Induced Psychotic Disorder

A clinical dilemma is how to clearly differentiate a substance-induced psychotic disorder (SIPD) from a primary psychotic illness or a psychotic illness with comorbid substance use. Symptoms of SIPD include but are not limited to paranoia and hallucinations, negative symptoms, disinhibition or dreaminess, and/or sensations of heightened awareness. In cocaine use, there also exist paranoid delusions and hallucinations. While there is no definitive standard of treatment to address SIPD, management of such disorders tends to vary depending on substances used, clinical symptomatology, dosage, frequency, and chronicity, among other variables. Given that the relationship between SIPD and the development of several mental illnesses is well established, a long-term follow-up period is needed to identify, prevent, and effectively treat further relapses. [ Psychiatr Ann . 2023;53(4):166–170.]

Differences between substance-induced psychotic disorders and non-substance-induced psychotic disorders and diagnostic stability.

Several hypotheses have been proposed to explain the comorbidity between psychotic disorders and substance use, one of them being the capacity of some to induce psychotic symptoms, although the transition from psychotic episodes induced by substances to schizophrenia has been less studied. In this study, differential variables between patients with induced and non-induced psychosis are determined, and the evolution and change of diagnosis of those induced to schizophrenia in the follow-up is analyzed. This is an observational case-control study with 238 patients admitted to the acute care unit for psychotic episodes between December 2003 and September 2011. The group of non-substance-induced psychotic disorders (NSIPD) included 127 patients, with 111 in the substance-induced (SIPD) group, according to the International Classification of Diseases. Sociodemographic and clinical characteristics, personal and family history, substance use, diagnostic stability and progression were compared. The NSIPD group showed higher scores in severity and in negative symptoms and more family history of psychosis. The SIPD group presented more personal history of personality disorder and family history of addictions and more positive symptoms At 6 years of follow-up, 40.9% of ISDP changed to a diagnosis of schizophrenia, presenting more family history of psychotic disorders and worse progression with more visits to the emergency department and readmissions, than subjects who maintained diagnostic stability. Therefore, special attention should be paid to this group of patients because of the potential severity and the increased risk of developing a chronic psychotic disorder.

Clinical and biochemical parameters associated with substance-induced psychotic disorder: which differences between alcohol, cannabis and psychostimulants

IntroductionAccording to DSM V, substance-induced psychotic disorder is a mental health condition in which the onset of psychotic symptoms can be traced to the use of a psychotropic substance. The pathogenesis of this disease is still poorly understood; current literature traces its causes back to genetic predisposition and early traumatic events (i.e. child abuse).ObjectivesThe present study aims to identify specific clinical features and biochemical markers which could be addressed as predictors for the long-term prognosis of this disease. Moreover, we aim to identify specific correlations between the clinical phenotype and the underlying substance abuse, in order to allow the early start of a tailored treatment.MethodsBetween 2020 and 2022 we recruited 218 patients referring to the Policlinico Hospital in Milan and the San Gerardo Hospital in Monza, Italy. All the patients were diagnosed with substance induced psychotic disorder: 31 reported alcohol abuse (14,2%), 71 psichostimulants (32,6%), 116 cannabis, (53,2%). For each patients, we collected demographic data, medical records and a comprehensive psychometric assessment (GAF, PANSS, BPRS, Modified Sad Person Scale-MOAS). Furthermore, we collected a blood sample for dosing Na+, K+, Na+/K+, hemogram with formula and platelets, glucose , urea, creatinine, uric acid, transaminases, γGT, bilirubin, plasma proteins, albumin, LDH, CPK, PCHE, cholesterol, HDL, LDL, Tg, TSH.ResultsChi squared test (χ²) has been used to compare qualitative variables between the 3 subgrous (alcohol-, psychostimulants- and cannabis-induced psychotic syndromes) (fig.1). One way ANOVA test has been used to compare quantitative variables between the same 3 subgroups (fig.2). After removing one of the subgropus (alcohol-induced psychotic symptoms), the same analysis have been repeated. Significant variables have been included in a binary logistic regression model in order to confirm their validity as predictors for cannabis- and psychostimulants-induced psychotic disorders (fig 3). Finally we performed Omnibus test and Hosmer-Lemeshow test in order to verify the validity of these regression models.Image:Image 2:Image 3:ConclusionsFor each considered subgroups, we indentified the following features. Alcohol induced psychotic syndrome: higher age of onset and age of hospital admission, higher cholesterol and hurea levels, , high comorbidity with medical conditions anxiety/depression, low social functioning, higher suicidal risk;, higher hospitalization rate. Cannabis induced psychotic syndrome: higher hemoglobin and albumin levels, more severe psychiatric symtoms (BPRS), higher smoking rates. Psychostimulants induced psychotic syndrome: higher multi-drug abuse risk. We could assume that according to this consideration the treatment protocols for each of these subgroups should be tailored according to their specific features.Disclosure of InterestNone Declared

Long-term Outcomes of People With DSM Psychotic Disorder NOS

AbstractIntroductionThe Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV diagnostic category “Psychotic disorder not otherwise specified” (PNOS) is seldom investigated, and we lack knowledge about long-term outcomes. We examined long-term symptom severity, global functioning, remission/recovery rates, and diagnostic stability after the first treatment for PNOS.MethodsParticipants with first-treatment PNOS (n = 32) were reassessed with structured interviews after 7 to 10 years. The sample also included narrow schizophrenia spectrum disorders (SSD, n = 94) and psychotic bipolar disorders (PBD, n = 54). Symptomatic remission was defined based on the Remission in Schizophrenia Working Group criteria. Clinical recovery was defined as meeting the criteria for symptomatic remission and having adequate functioning for the last 12 months.ResultsParticipants with baseline PNOS or PBD had lower symptom severity and better global functioning at follow-up than those with SSD. More participants with PNOS and PBD were in symptomatic remission and clinical recovery compared to participants with SSD. Seventeen (53%) PNOS participants retained the diagnosis, while 15 participants were diagnosed with either SSD (22%), affective disorders (19%), or substance-induced psychotic disorders (6%). Those rediagnosed with SSD did not differ from the other PNOS participants regarding baseline clinical characteristics.ConclusionsLong-term outcomes are more favorable in PNOS and PBD than in SSD. Our findings confirm diagnostic instability but also stability for a subgroup of participants with PNOS. However, it is challenging to predict diagnostic outcomes of PNOS based on clinical characteristics at first treatment.

Clinical features and peripheral biomarkers associated with substance-induced psychotic disorder: differences between alcohol, cannabis and psychostimulants

Clinical features and peripheral biomarkers associated with substance-induced psychotic disorder: differences between alcohol, cannabis and psychostimulants

The Investigation of Cognitive Functions and Clinical High Risk Status for Psychosis in First-Degree Relatives of Patients with Substance Induced Psychotic Disorder

IntroductionThe etiology of substance-induced psychotic disorder (SIPD) is an important research area to study.ObjectivesIt is aimed to investigate clinical risk status for psychosis, schizotypal features and neurocognitive functions in siblings of the patients who have been diagnosed as SIPD and who have no family history of psychotic spectrum disorder.MethodsThis study included 41 healthy siblings of patients who have been diagnosed as SIPD according to DSM-V and 41 healthy controls without family history of psychiatric disorders (matched on age, gender, and years of education). The data collected with sociodemographic and clinical data form, Digid Span Test, Trail Making Test A, Trail Making Test B, Verbal Fluency Test and Stroop Test, Comprehensive Assesment of At-Risk Mental States (CAARMS) and Structured Interview for Schizotypy-Revised.ResultsIt is determined that %41.5 of siblings and %7.3 of healthy controls are in one of the clinical high risk groups for psychosis according to CAARMS. There is significant difference in Trail Making Test A error and Trail Making Test B error and correction, verbal fluency test- lexical fluency-perseveration mean scores between siblings of patients and healthy controls.ConclusionsSiblings of patients with SIPD have more schizotypal features than healthy control group and they take part more frequent in one of high risk group for psychosis. Schizotypal features are known as trait factor and show genetic predisposition. Siblings who are in high risk groups have more schizotypal features and it may point that predisposition to psychosis is more related to underlying genetic predisposition than environmental factors and social stressors.DisclosureNo significant relationships.

Survey of substance use among adolescent drug offenders referred from juvenile courts in Taiwan: Clinical epidemiology of single versus multiple illicit substance use

Substance use during adolescence might cause substantial health burden. Little is known regarding profiles of multiple illicit substance users compared to single illicit substance users in adolescent population in Taiwan. We enrolled 106 adolescent illicit drug users who received addiction treatment referred by juvenile courts in Taiwan between September, 2016 and September, 2021. We divided them into two groups: single versus multiple illicit drug users, and further compared their socio-demographic characteristics, psychiatric and substance comorbidities. The independent t test or Mann-Whitney U test was used for continuous variables and Pearson's chi-square test for nominal variables. Multivariate logistic regression was used to examine the suicide and violence risk among adolescents. 71.7% of participants were multiple illicit drug users while 28.3% of them were single drug users. Multiple illicit substance users were more likely to use methamphetamine (p=0.005), ketamine (p<0.001), new psychoactive substance (NPS) (p<0.001), MDMA (p=0.003), and nitrous oxide (p<0.001) compared to single illicit substance users. In addition, multiple illicit drug users were more likely to have ADHD (p=0.030), major depressive disorder (p=0.050), and lifetime suicidal attempts (p=0.048) compared to single illicit drug users. In further analysis (NPS vs. traditional drugs), we found NPS users tended to use larger numbers of illicit drugs (p<0.001) and were more likely to have substance-induced psychotic disorder (p=0.008), ADHD (p=0.011), suicidal attempts (p=0.020). Our findings highlight the distinct profiles of multiple illicit drug users compared to single illicit drug users among adolescent population. High suicidality and high psychiatric comorbidities in multiple illicit drug users call for special need for suicide screening and a more integrated care incorporating psychiatric and substance treatment.

Is there an association between inflammatory/anti-oxidant markers and the presence of psychotic symptoms or severity of illness in mood and psychotic disorders? A multi-centric study on a drug-free sample

The immune and antioxidant systems are intimately connected and their role in the etiology of major psychiatric disorders is currently under study. The aim of this study was to evaluate the potential associations between inflammatory/antioxidant peripheral markers and presence of psychotic symptoms or severity of illness in patients affected by major psychiatric disorders.One hundred and twenty-six drug-free patients were included. A blood sample was collected to measure total/B/T lymphocytes and plasma levels of albumin, total bilirubin, uric acid, C-reactive protein, and vitamins A and E. Severity of illness was assessed using psychometric scales. Groups of patients divided according to diagnosis were compared in terms of measured markers using multivariate analyses of variance (MANOVAs). Linear and logistic regression analyses were performed to investigate the potential association between markers and severity of illness or presence/absence of psychotic symptoms.Albumin plasma levels were higher in patients with substance-induced psychotic disorder (SIPD) than subjects affected by schizophrenia (F ​= ​4.923; p ​= ​0.003). Lower vitamin E (OR ​= ​0.81; p ​= ​0.014) and T lymphocyte (OR ​= ​0.99; p ​= ​0.048) plasma levels were predictive of lifetime psychotic symptoms. Lower vitamin A levels were associated with higher Montgomery-Åsberg Depression Rating Scale scores (β ​= ​-24.26; p ​= ​0.029), independent of diagnosis.Patients with SIPD may be less vulnerable to oxidative stress. The severity of depressive symptoms, inversely associated with vitamin A plasma levels, is likely to be modulated by the degree of inflammation. Patients presenting with lifetime psychotic symptoms may be more vulnerable to oxidative stress and may have a higher activation of humoral immunity.

A prospective descriptive study on prevalence of catatonia and correlates in an acute mental health unit in Nelson Mandela Bay, South Africa.

Catatonia is a psychomotor abnormality caused by neurological, medical or severe psychiatric disorders and substances. Its prevalence ranges from less than 10% to just above 60%. Diagnosis may be influenced by the screening tools used. Screening of new admissions to a mental health unit for catatonia was undertaken using three instruments to determine prevalence of catatonia. Participants ranged from age 16 years and over. Recruitment took place from September 2020 to August 2021. The setting was a mental health unit within a general hospital in Nelson Mandela Metro, South Africa. Five assessors were trained by the principal investigator to apply the Bush Francis Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual 5 (DSM-5), to assess participants. Clinical and demographic data were collected using a specially designed datasheet. Data analysis was performed to identify significant associations between presence or absence of catatonia and clinical and demographic data. Up to 241 participants were screened and 44 (18.3%) had catatonia. All 44 cases were identified through the BFCSI while the DSM-5 identified only 16 (6.6%%) of the 44 cases even though the remaining 28 (63.6%) participants still required treatment for catatonic symptoms. The DSM-5 diagnostic criteria excluded staring, which was the commonest sign of catatonia identified through the BFCSI [n = 33 (75%)]. Close to half (21; 47.7%) of those with catatonia on the BFCSI had schizophrenia. The rest had bipolar disorder (12; 27.3%), substance-induced psychotic disorder (7; 15.9%) and no specified diagnosis in one (1; 2.6%). The BFCSI was very effective at identifying catatonia while the DSM-5 was inadequate, missing close to 64% (28 of 44) of cases. Predictors of catatonia in this sample were a younger age and being male. A prevalence of 18.3%, indicates that assessment for catatonia should be routinely conducted in this and similar settings.