Substance-induced Psychotic Disorder Research Articles

Substance-Induced Psychoses Converting Into Schizophrenia

Despite the clinical importance of substance-induced psychosis (SIP), few studies have examined the course of this condition after its acute manifestation. To investigate the rate of SIP conversion to a schizophrenia spectrum disorder and the length of follow-up needed to catch the majority of these patients whose diagnoses change. In addition to the conversion rate and pattern, we wanted to look for possible related factors. Using the nationwide Finnish Hospital Discharge Register, we followed all patients (N = 18,478) since their first inpatient hospital admission with a diagnosis of SIP (codes 2921 and 2928 in DSM-III-R and codes F10-F19 in ICD-10 with a third digit of 4, 5, or 7) between January 1987 and December 2003 in Finland. Patients (mean age = 43.7 years, standard deviation = 13.5 years) were followed until first occurrence of schizophrenia spectrum disorder, death, or the end of December 2003, whichever took place first. Conversions of discharge diagnoses into schizophrenia spectrum disorders (codes 2951-2959 and 2971 in DSM-III-R and codes F20, F22, and F23 in ICD-10) were recorded at follow-up. Eight-year cumulative risk to receive a schizophrenia spectrum diagnosis was 46% (95% CI, 35%-57%) for persons with a diagnosis of cannabis-induced psychosis and 30% (95% CI, 14%-46%) for those with an amphetamine-induced psychosis. Although alcohol-induced psychosis was the most common type of SIP, 8-year cumulative risk for subsequent schizophrenia spectrum diagnosis was only 5.0% (95% CI, 4.6%-5.5%). No differences were detected with regard to gender, except for amphetamine-induced psychosis, which converted into a schizophrenia spectrum disorder significantly more often in men (P = .04). The majority of conversions to a schizophrenia spectrum diagnosis occurred during the first 3 years following the index treatment period, especially for cannabis-induced psychosis. Substance-induced psychotic disorders predict schizophrenia spectrum disorders to a greater extent than previously thought. The intensity of clinical attention focused on substance-induced psychotic disorders should be increased.

Long-term follow-up of patients treated for psychotic symptoms that persist after stopping illicit drug use.

BackgroundThe long-term outcome of patients diagnosed with drug-induced psychotic disorders in China is unknown.AimAssess the course of illness and severity of psychiatric symptoms in patients previously admitted to a psychiatric hospital for treatment of psychotic symptoms that were induced by the use of illicit drugs.MethodsPatients with psychotic symptoms at the time of their first psychiatric admission who had used illicit drugs in the month prior to admission were followed up 13 to 108 months after admission. Patients and coresident family members were interviewed about post-discharge drug use and psychotic symptoms.ResultsThe 258 identified patients were primarily young, unemployed males whose most common drug of abuse was methamphetamines and who had been abusing drugs for an average of 7 years at the time of admission. Among these patients 189 (73%) were located and reinterviewed; 168 (89%) had restarted illicit drug use and 25 (13%) had required rehospitalization over the follow-up period. In 114 patients (60%) the psychotic symptoms resolved in less than 1 month after stopping the drugs, in 56 (30%) the symptoms persisted for 1 to 6 months, and in 19 (10%) the symptoms persisted for longer than 6 months (in 8 of these the diagnosis had changed to schizophrenia). Compared to the other two groups, patients whose symptoms persisted more than 6 months were more likely to have a family history of mental illness, an earlier age of onset and a longer duration of drug abuse prior to the index admission; they were also more likely to have been re-hospitalized during the follow-up period and to have psychotic symptoms at the time of follow-up.ConclusionMost patients with substance-induced psychotic disorders in our sample had a good long-term prognosis but those who started illegal drug use early, used drugs for prolonged periods, or had a family history of psychiatric illnesses were more likely to develop a chronic psychosis. Further prospective studies are needed to determine the relationship of the neurotoxic effects of illicit drugs and the predisposing characteristics of the individuals in the development of chronic psychosis in persons who use illicit drugs.

Psychiatric comorbidity in cocaine users treated in therapeutic community: Substance-induced versus independent disorders

This is a cross-sectional study of 227 cocaine dependent individuals in six different therapeutic communities (TCs) within a single treatment network in Andalusia (Spain). The primary aim of the study is to examine the prevalence of lifetime psychiatric comorbidity in this sample using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Diagnoses were assessed 15–20 days after admission. The data indicate that more than 65% of the sample experienced a lifetime co-occurring psychiatric comorbidity. Substance-induced mood (21.6%) and psychotic (11.5%) disorders were more prevalent in this population than independent mood (12.3%) and psychotic (7.5%) disorders. These data suggest the need to introduce changes in these centers, both in the diagnostic aspects and in the treatment programs.

Substance-induced psychotic disorders: 13-Year data from a de-addiction centre and their clinical implications

The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

Differentiating first episode substance induced and primary psychotic disorders with concurrent substance use in young people

ObjectiveSubstance use is common in first-episode psychosis, and complicates the accurate diagnosis and treatment of the disorder. The differentiation of substance-induced psychotic disorders (SIPD) from primary psychotic disorders (PPD) is particularly challenging. This cross-sectional study compares the clinical, substance use and functional characteristics of substance using first episode psychosis patients diagnosed with a SIPD and PPD. MethodParticipants were 61 young people (15–24years) admitted to a psychiatric inpatient service with first episode psychosis, reporting substance use in the past month. Diagnosis was determined using the Psychiatric Research Interview for DSM-IV Substance and Mental disorders (PRISM-IV). Measures of clinical (severity of psychotic symptoms, level of insight, history of trauma), substance use (frequency/quantity, severity) and social and occupational functioning were also administered. ResultsThe PRISM-IV differentially diagnosed 56% of first episode patients with a SIPD and 44% with a PPD. Those with a SIPD had higher rates of substance use and disorders, higher levels of insight, were more likely to have a forensic and trauma history and had more severe hostility and anxious symptoms than those with a PPD. Logistic regression analysis indicated a family history of psychosis, trauma history and current cannabis dependence were the strongest predictors of a SIPD. Almost 80% of diagnostic predictions of a SIPD were accurate using this model. ConclusionsThis clinical profile of SIPD could help to facilitate the accurate diagnosis and treatment of SIPD versus PPD in young people with first episode psychosis admitted to an inpatient psychiatric service.

Substance-Induced Psychoses: A Critical Review of the Literature

Substances with psychotomimetic properties such as cocaine, amphetamines, hallucinogens and cannabis are widespread, and their use or abuse can provoke psychotic reactions resembling a primary psychotic disease. The recent escalating use of methamphetamine throughout the world and its association with psychotic symptoms in regular users has fuelled concerns. The use of cannabis and cocaine by young people has considerably increased over recent years, and age at first use has dramatically decreased. There is some evidence that cannabis is now on the market in a more potent form than in previous decades. Furthermore, a large number of studies have reported a link between adolescent cannabis use and the development of stable psychosis in early adulthood. The situation is further complicated by the high rates of concomitant substance use by subjects with a psychotic illness which, especially in young users with an early-phase psychotic disorder, can make diagnosis difficult. This paper reviews the literature concerning the properties of psychotogenic substances and the psychotic symptoms they can give rise to, and discusses the association between substance abuse and psychosis with particular emphasis on the differential diagnosis of a primary and substance-induced psychotic disorder. The findings of this review indicate that psychosis due to substance abuse is commonly observed in clinical practice. The propensity to develop psychosis seems to be a function of the severity of use and dependence. From a phenomenological point of view, it is possible to identify some elements that may help clinicians involved in differential diagnoses between primary and substance-induced psychoses. There remains a striking paucity of information on the outcomes, treatments, and best practices of substance-induced psychotic episodes.

Surprising Accord Found in Psychiatric Testimony

Back to table of contents Previous article Next article Legal NewsFull AccessSurprising Accord Found in Psychiatric TestimonyJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:4 Feb 2011https://doi.org/10.1176/pn.46.3.psychnews_46_3_010AbstractDo expert witnesses' adversarial roles in criminal cases influence their conclusions about a defendant's psychiatric diagnosis?Matthew Large, M.D., a conjoint senior lecturer at the University of New South Wales in Australia, and colleagues thought the answer would be yes. Their hypothesis, however, turned out to be wrong.They examined 270 reports provided to courts by expert witnesses concerning 110 criminal cases concluded from 2005 to 2007. In each of these cases, at least one report from an expert engaged by the prosecution and at least one from an expert engaged by the defense were available. The reports were provided by the Office of the Director of Public Prosecutions in New South Wales, Australia. All of the cases involved serious offenses, such as fraud, kidnapping, arson, physical assault, sexual assault, and murder.In each of these reports, a DSM-IV psychiatric disorder was recorded or a statement that no mental disorder was present was recorded. Large and his colleagues looked to see whether expert witnesses representing the two sides in each case tended to agree or disagree on a psychiatric diagnosis. In most cases they agreed.Thus “concern about bias in expert psychiatric opinion in criminal cases appears to have been overstated,” the researchers wrote in the winter 2010 issue of the Journal of the American Academy of Psychiatry and the Law. “There was little evidence to suggest that experts' adversarial roles influenced their opinions on psychiatric diagnosis.”The researchers also examined the 270 reports provided by expert witnesses to see whether psychiatric diagnoses provided by psychiatrists tended to agree with those provided by psychologists, or vice versa. (Out of the 270 reports, 226 had been written by 30 psychiatrists, and 44 by 15 psychologists.) The researchers expected experts from the same profession to agree more often on diagnoses than experts from different professions. But once again, they were surprised: Report pairs written by a psychiatrist and a psychologist were as likely to agree on a diagnosis as report pairs written by two psychiatrists.Regarding the diagnosis of various types of mental disorders, however, expert agreement varied considerably. Whereas there was good or very good inter-rater agreement on the diagnoses of acquired brain injury, schizophrenia-spectrum psychosis, and substance-induced psychotic disorder, and moderate agreement on depressive disorders and personality disorders, concurrence on anxiety disorders—especially on posttraumatic stress disorder (PTSD)—was poor.The reason why agreement on PTSD was particularly lacking, the researchers speculated, was either because PTSD “was not relevant to criminal proceedings, or because it is difficult, with the current diagnostic criteria, to make the diagnosis in a reliable way in legal settings.”If a study similar to the Australian one were conducted in the United States, the findings would probably be similar, Large told Psychiatric News, since forensic experts in Australia are trained and employed in a manner similar to those in the United States. “But since our study appears to be the only one of its kind, we can't be absolutely sure.”In a previous study, published in the winter 2008 Journal of the American Academy of Psychiatry and the Law, Large and his colleagues had examined levels of agreement among expert witnesses in civil cases (motor vehicle accidents). They found that experts' diagnoses generally favored the side that engaged them and that experts engaged by the same side were significantly more likely to agree on a psychiatric disorder than experts engaged by the opposite side.One possible explanation for the discrepancy between these findings and those from their criminal case study, Large and colleagues suggested, is that the experts tapped in their criminal case study tended to be forensic psychiatrists in clinical practice who had provided testimony for both the prosecution and the defense, whereas the experts tapped in their civil case study were often retired forensic psychiatrists who had become full-time witnesses for an insurance company or a firm specializing in personal injury.Another possible explanation for the discrepancy, the researchers noted, is that many of the defendants in the criminal cases they studied had severe, disabling schizophrenia, which is fairly easy to diagnose and thus not likely to be a point of contention among expert witnesses. In contrast, many of the defendants in the civil cases they studied had PTSD or other anxiety disorders, which are harder to diagnose than schizophrenia and thus more likely to be a point of dispute among expert witnesses.The study had no outside funding.“The Reliability of Evidence About Psychiatric Diagnosis After Serious Crime: Part I. Agreement Between Experts” is posted at <www.jaapl.org/cgi/reprint/38/4/516>. ISSUES NewArchived

Epidemiology of suicide attempts among persons with psychotic disorder in the general population

Objective To establish the epidemiology of suicide attempts in persons with psychotic disorder identified from the general population and to investigate the associations of suicidal behavior with other clinical characteristics and with physical violence against other people. Method A random sample of 9922 Finnish persons aged 18 years or over was screened for psychotic disorder using multiple sources of information. All screen positives and random sample of screen negatives were invited to an SCID interview. Diagnostic assessment, lifetime history of suicide attempts and violence against others were based on all available systematically evaluated information from the questionnaire, interview and/or case records. Results Of persons with a lifetime history of any primary or substance-induced psychotic disorder ( n = 264), 34.5% (women: 34.1%, men: 34.9%) had a history of at least one suicide attempt. There were no suicide attempts among persons with delusional disorder, while the rate of suicide attempts was higher among persons with substance-induced psychotic disorders (48.8%) than in persons with other psychotic disorders 41.8%) ( χ 2 = 4.4, d.f. = 1, P = 0.036). Suicide attempts were associated with younger age, comorbid substance use disorders, depressive symptoms, and physical violence against other people. Conclusion Suicide attempts are common in all psychotic disorders except for delusional disorder. They are particularly common in substance-induced psychotic disorder and in persons with comorbid substance use disorders. They are associated with severe depressive symptoms but not with the severity of psychotic symptoms. Suicidal behavior correlates with physical violence against other people.

Incidence of Psychotic Disorders in the 50 Year Follow Up of the Lundby Population

The aim of the present study was to analyse first incidence of psychotic disorders in the Lundby population during a 50 year period by comparing male and female age at onset, overall incidence rates and age-specific incidence rates. The Lundby Study is a prospective study of the mental health of a complete community population (n = 3563), which was followed from 1947 to 1997. Data from interviews, registers, case files and key informants were accumulated via four waves of field work (1947 1957, 1972 and 1997). Mean and median age at onset, and overall and age-specific incidence rates, for the first episodes of major groups of psychotic disorders according to the DSM-IV were calculated (the major groups were: any psychotic disorder, psychotic disorder due to a general medical condition, substance-induced psychotic disorder, non-affective psychotic disorder, schizophrenia, other non-affective psychotic disorder and affective psychotic disorder). Male-female differences in mean ages at onset and overall incidence rates were tested. Male-female differences in incidence by age patterns were described. The overall 50 year incidence rate in male subjects was higher than in female subjects for substance-induced psychotic disorder, but for the other disorders the overall rates did not differ significantly between the sexes. The male mean age at onset was lower than that for female subjects for any psychotic disorder, psychotic disorder due to a general medical condition, non-affective psychotic disorder and schizophrenia. Male and female subjects had different incidences by age patterns for any psychotic disorder, non-affective psychotic disorder, schizophrenia and other non-affective psychotic disorder, with a male preponderance among early-onset cases, and a female preponderance among late-onset cases. The differences in incidence between the sexes in this 50 year follow up may indicate psychotic disorder-delaying mechanisms in female subjects, or different aetiologies of psychosis in male and female subjects.

Pharmacogenetics of antipsychotics using an animal model

One major problem of the therapy with neuroleptics is the lack of efficacy in many of the patients and the occurrence of extrapyramidal side effects that can both limit the therapy and the compliance. Thus, the availability of a predictive tool for the response to psychopharmacologic agents in the therapy of psychiatric disorders is desirable. To search for genes associated with e.g. response to neuroleptics or extrapyramidal symptoms (EPS) a hypothesis free approach was used including animal models, neuronal cell cultures, and differenzial gene expression analyses. Immunohistochemical analyses were performed in rats that received an agent mimicking aspects of psychosis (MK-801), or haloperidol, or a combination of these agents, or saline. Genes differenzially expressed between the different groups had been genotyped in our clinical sample on pharmacogenetics including 104 patients with acute psychosis (schizophrenia, schizoaffective, brief psychotic, and substance-induced psychotic disorder) treated with haloperidol for up to 28 days. Diagnosis was established by applying the SCID I and II interview. Patients were assessed at baseline and on days 3, 7, 14, 21and 28. Improvement and response were measured by using the Positive and Negative Syndrome Scale. We will present novel data on this ongoing large-scale association study on response to haloperidol.

How common are psychotic and bipolar disorders? A 50-year follow-up of the Lundby population

Background: The purpose was to present the prevalence of all psychotic and bipolar (BP) disorders in a total general population (n=3563), which has been followed from 1947 to 1997. Materials and Methods: Best-estimate consensus DSM-IV diagnoses, supported by data from interviews, case notes, registers and key-informants, were assessed. The period prevalence from 1947 to 1997 and the lifetime prevalence (LTP) in 1997, respectively, was calculated. Results: The period prevalence per 100 was: 4.24 for any psychotic or BP disorder, 2.25 for non-affective psychotic (NAP) disorder, 0.76 for psychotic disorder related to a general medical condition (GMC), 0.62 for affective psychotic (AP) disorder and 0.59 for substance-induced psychotic (SIP) disorder. The LTP per 100 was: 2.82 for any psychotic or BP disorder, 1.38 for NAP disorder, 0.54 for psychotic disorder related to a GMC, 0.48 for SIP disorder and 0.42 for AP disorder. The specific diagnosis with the highest period prevalence 1.43 per 100 and LTP 0.84 per 100, respectively, was schizophrenia. The LTP of psychotic disorder related to a GMC, SIP disorder, schizophrenia and delusional disorder, respectively, was higher than in most recent community studies while the LTP of brief psychotic disorder, schizophreniform disorder and AP disorder, respectively, was lower. However, the findings were in approximate accord with the estimates in the Psychoses in Finland (PIF) Study . Conclusions: The findings suggest that psychotic disorders are common in the community, and should be considered a major public health concern.

Substance use disorders among psychotic patients admitted to inpatient psychiatric care

Previous epidemiological and clinical studies have shown high rates of substance use disorders in patients with psychotic disorders. There are few studies from the Scandinavian countries. The aim of this study was to investigate the rate of substance use disorders in a group of Norwegian psychotic inpatients from a specific catchment area. Sixty patients, aged 18–40 years, were interviewed through standardized methods: the Addiction Severity Index (EuropASI) and the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I). Urine toxicology screens confirmed patients’ self-report of recent substance use. The lifetime rate of substance use disorders was 70% when all psychotic disorders were included and 62.5% when substance-induced psychotic disorders were excluded. Fifty percent of all the patients studied had current substance use disorders. The majority of substance use disorders were dependence disorders. Alcohol, amphetamine and cannabis were the dominant substances. The level of comorbidity found in this study is comparable with that found in American studies, despite lower prevalence of substance use in the Norwegian population. The high rate of substance use disorders in psychotic inpatients has implications for the treatment and the organization of psychiatric care for these patients.

Corticosteroid Induced Psychosis in the Pain Management Setting

Background: Synthetic corticosteroids are commonly utilized in interventional pain management procedures. These substances have potential side-effects including psychological adverse events. Objective: We describe a case of substance-induced psychotic disorder resulting from corticosteroids administration. Design: Case Report Methods: We describe a 67-year-old male that, six months prior to being consulted at our center, received a cervical epidural, 4 level medial branch blocks, 4 trigger point injections and a tendon injection in the shoulder all including corticosteroids all in one treatment session. Results: Approximately 7 days following the multiple injections, the patient developed psychotic episodes including racing thoughts, anger, agitation, pressured hyperverbal speech and paranoia. The symptoms spontaneously resolved in approximately 7-10 days. Discussion: Although well known as a potential complication, corticosteroid induced psychosis secondary to interventional pain procedures have never been reported. We further discuss this potential side effect of utilizing corticosteroids and emphasize the need for guidelines regarding steroid utilization. Key words: Steroid, corticosteroid, psychosis, psychotic disorder

Medical Emergency Department Utilization Patterns Among Uninsured Patients With Psychiatric Disorders

This study examined medical emergency department utilization for patterns among uninsured patients with psychiatric disorders. Billing records of 15,672 uninsured adult patients treated in the emergency department of an academic medical center in southeast Texas over a 12-month period were analyzed for information on demographic characteristics, diagnosis, number of emergency department visits, and hospitalization. Overall, 11.8% of the population was diagnosed as having at least one psychiatric disorder during an emergency department visit. Patients with psychiatric disorders had an increased risk of having multiple emergency department visits and hospitalization compared with patients without psychiatric disorders. The risk of multiple emergency department visits was particularly high for patients with either bipolar disorder or psychotic disorders. Uninsured patients with psychiatric disorders appear to be heavy users of medical emergency department services. These findings may be helpful in developing more efficient strategies to serve the mental health needs of the uninsured.

Substance-Induced Psychosis

To critically examine the DSM-IV-TR criteria for substance-induced psychotic disorder (SIPD). Leading electronic databases (such as MEDLINE, PubMed) were searched for the years 1992 through 2007, using combinations of the following key search terms: substance abuse/dependence, alcohol, marijuana, cannabis, methamphetamine, crack, cocaine, amphetamine, ecstasy, ketamine, phencyclidine, LSD, mental health, drug-induced psychosis, substance-induced psychosis, psychosis, and schizophrenia. References identified from bibliographies of pertinent articles and books in the field were also collected and reviewed. Only research studies or case reports/series that presented data on populations diagnosed with SIPD by using clinical or structured diagnostic interviews and that were published in English were used to assess the validity of the current SIPD criteria. We identified 49 articles that presented clinical data on SIPD. Almost half of these publications were case reports, with 18 articles specifically focusing on delineating the clinical characteristics or outcomes of individuals diagnosed with SIPD. While several large studies have recently been conducted to assess the stability of SIPD, there is a dearth of research that rigorously examines the validity of DSM-IV diagnostic criteria across substances. There remains a striking paucity of information on the outcome, treatment, and best practice for substance-associated psychotic episodes. Further work is clearly required before the advent of DSM-V. We propose an alternative, broader classification that better reflects the current evidence base, inferring association rather than causation.

A study on pharmacogenetics of haloperidol treatment

Haloperidol is highly efficient in the treatment of acute psychosis, especially when severe symptoms predominate. One major drawback is the occurrence of extrapyramidal side effects which can limit therapy and compliance. Thus, the availability of a predictive tool for the occurrence of extrapyramidal side effects is desirable. The aim of this study was to evaluate the predictive value of genetic polymorphisms with regard to haloperidol-induced extrapyramidal side effects. We studied one hundred four patients with acute psychosis (schizophrenia, schizoaffective, brief psychotic, and substance-induced psychotic disorder) which were treated with haloperidol for up to 28 days. Complementary, microaray-based experiments were used to search for novel candidate genes in animals treated with haloperidol. These gene expression experiments revealed that several genes were differentially expressed following haloperidol treatment. SNPs subsequently tested in the patients were found to be associated with Akathisia and Parkinsonism.

Psychotic epizode of multiple drug user after acute anticholinergic intoxication - a case report

Background:In recent years there is the rising trend of anticholinergics use among high school students especially it is common to mix alcohol with anticholinergics. The characteristic features of anticholinergic intoxication are the rapid onset of alterations in mood, cognition and perception in the presence of a clear sensorium and following the ingestion of the drug in a commonly distributable form. But if psychotic symptoms are present in the absence of retained reality testing a diagnosis of substance-induced psychotic disorder may be warranted. Therefore, in same cases clinical picture presents a differential diagnostic dilemma.Method:The authors present the case report of twenty-one year old male with dependence of multiple drug use (according the criteria of ICD-X), who was observed in department of alcoholism. In early adolescence period he used different psychoactive substances (opioids and non-opioid psychoactive substances). At last two years he episodically consumed anticholinergics. Upon the mixed use of alcohol with anticholinergics he experienced auditory hallucinations, rapid and incoherent speech and paranoid ideation. He acted out his imperative hallucinations aggressively with violent behavior.During hospital treatment he was treated with antipsychotic medications, benzodiazepines and supportive and educational therapies.Results:On this regiment psychotic symptoms resolved completely after two weeks.Conclusion:Results of complete psychiatric-psychological examination did not indicate psychotic disorder.

Lifetime Prevalence of Psychotic and Bipolar I Disorders in a General Population

Recent general population surveys of psychotic disorders have found low lifetime prevalences. However, this may be owing to methodological problems. Few studies have reported the prevalences of all specific psychotic disorders. To provide reliable estimates of the lifetime prevalences of specific psychotic disorders. General population survey. A nationally representative sample of 8028 persons 30 years or older was screened for psychotic and bipolar I disorders using the Composite International Diagnostic Interview, self-reported diagnoses, medical examination, and national registers. Those selected by the screens were then re-interviewed with the Structured Clinical Interview for DSM-IV. Best-estimate DSM-IV diagnoses were formed by combining the interview and case note data. Register diagnoses were used to estimate the effect of the nonresponders. Diagnosis of any psychotic or bipolar I disorder according to the DSM-IV criteria. The lifetime prevalence of all psychotic disorders was 3.06% and rose to 3.48% when register diagnoses of the nonresponder group were included. Lifetime prevalences were as follows: 0.87% for schizophrenia, 0.32% for schizoaffective disorder, 0.07% for schizophreniform disorder, 0.18% for delusional disorder, 0.24% for bipolar I disorder, 0.35% for major depressive disorder with psychotic features, 0.42% for substance-induced psychotic disorders, and 0.21% for psychotic disorders due to a general medical condition. The National Hospital Discharge Register was the most reliable of the screens (kappa = 0.80). Case notes supplementing the interviews were essential for specific diagnoses of psychotic disorders. Multiple sources of information are essential for accurate estimation of lifetime prevalences of psychotic disorders. The use of comprehensive methods reveals that their lifetime prevalence exceeds 3%.

Special Section: A Memorial Tribute: Exacerbation of Psychiatric Symptoms During Substance Use Disorder Treatment

Special Section: A Memorial Tribute: Exacerbation of Psychiatric Symptoms During Substance Use Disorder Treatment

ED Physicians Often Misdiagnose Psychosis

ED Physicians Often Misdiagnose Psychosis