The treatment study of patients with Schizophrenia Spectrum Disorders in the first five years of the disease is very important for the development of quality treatment programs and the prevention of recurrence of the disease. Schizophrenic patients often have symptoms of depression and they are forced to take antidepressants besides antipsychotics.
Purpose: to study the antidepressant pharmacotherapy features of patients with Schizophrenia Spectrum Disorders within first five years after onset of disease.
Materials and Methods: Medical records of patients diagnosed with a list of Schizophrenia Spectrum Disorders were analyzed (ICD-10 headings: F20.0-3, F20.5-6, F20.8-9, F21.1-5, F22.02-03, F23.x3-x4, F25.01, F25.11, F25.21-22, F25. 8-9). 1520 patients were used in the analyses: 54,8 % – men, 45,2 % – women (mean age – 33,7±10,1 years).
Results: In 55.2% of cases, besides neuroleptics, patients took other psychotropic drugs. Selective serotonin reuptake inhibitors (58.9% of all antidepressant use cases) prevailed among antidepressants, tricyclic antidepressants were used less frequently (25.9%), selective serotonin and noradrenaline reuptake inhibitors (8.1%) and antidepressants with other chemical structures and mechanisms of action (7.1%) were used even less frequently.
Picture. Frequency of antidepressants using
Conclusion: Symptoms of depression can effect the course of schizophrenia significantly. The obtained data will serve as a basis for the development of treatment programs for patients with Schizophrenia Spectrum Disorders.
The idea of the gender differences effect on the schizophrenia course is ambiguous.
The study of the gender influence on the social functioning of patients with paranoid schizophrenia.
100 patients with paranoid schizophrenia were examined (age 18-50 years, total score on the PANSS <120, duration of mental disorders for at least 5 years). Clinical and socio-demographic characteristics have been analyzed using scales: PANSS, BACS, WHOQOL, PSP, the "Compliance Level" questionnaire, SOMO (Subjective Assessment of Interpersonal Relations) test, "Emotional Intelligence" test and "Dembo-Rubinstein Self-Evaluation Test". Characteristics of patient’s nearest social environment (main caregivers) were assessed by the FACES-3 and LSI scale.
The indicator of social functioning (total PSP score) correlated in men: with passport age (R = -0.356), the duration of the disease (R = -0.384), the number of hospitalizations (R = -0.538), a duration of hospitalization (R = -0.352), negative symptoms (R = -0.661), a quality of life (R = 0.311); in women: with passport age (R = -0.270), negative symptoms (R = -0.463), quality of life (R = 0.440), cognitive indicator (R = 0.313). Logite-regression analysis showed that gender associated with social functioning (B0 = -3.289, R1 = 0.055, χ2 = 20.569, p = 0.00001), but gender didn't associate with a cognitive indicator (B0 = -0.591, R1 = 0.018 , χ2 = 1.522, p = 0.217) and quality of life (B0 = -2.037, R1 = 0.010, χ2 = 2.852, p = 0.091).
Received data indicates the effect of gender differences on the social functioning of patients with paranoid schizophrenia significantly.
Social cognitive dysfunctions contribute to the deficits of psychosocial functioning of people on the Schizophrenia Spectrum. Recently, the focus has turned to the area of affective disorders, with respect to social cognition and alexithymia.
Evaluation of abilities and potential differences in alexithymia and the capacity of facial emotion recognition in individuals suffering with disorders on the schizophrenia or the affective (unipolar depressive) spectrum.
We evaluated two groups of 26 participants each, diagnosed with either a Schizophrenia Spectrum Disorder (SDD) or Recurrent Depressive Disorder (RDD) hospitalized in the Psychiatry Clinic of Timisoara, Romania. The analyzed parameters were: socio-demographic, clinical, alexithymia (Toronto Alexithymia Scale), and the ability to identify emotions (Reading the Mind in the Eye Test).
We established that 57.69% of SSD subjects had alexithymia, while 19.23% had possible-alexithymia and 23.07% were non-alexithymic. Most of the subjects had a low ability to identify emotions (84.61%). In regards to the RDD group, all 26 participants had alexithymia, while almost 74% of them had a lower than normal ability to correctly identify emotions.
The SSD participants showed clear deficits describing and identifying emotions. Overall, the RDD group had similar results, but slightly better abilities of recognizing others’ emotions in the eyes. Our results suggest that difficulties recognising facially expressed emotions and alexithymia could possibly be linked in both spectra. These populations may benefit from tailored social skills training and intervention programs that offer service users more accurate recognition of relapse signs leading to timelier help-seeking.
Tinnitus can be described as a nonspecific symptom without a clear clinical origin or presentation, in our specialty they have been linked to a wide variety of mental disorders.
We intended by the presentation of a clinical case to highlight the importance of nonspecific symptoms as cardinal symptoms of psychotic episodes in order to perform an early intervention in patients at risk of psychosis and to improve their prognosis. A review of the literature on this subject is carried out.
Describing the case of a 67-year-old patient with no previous psychiatric history who presented at the moment he consulted, tinnitus of 5 months of evolution with important repercussion at affective and behavioral level. the patient developped insomnia and behavioural changes. In the psychopathological examination, verbiage, suspiciousness and a delusional idea of harm were observed. Literature referring to psychosis and nonspecific symptoms as tinnitus as a cardinal symptoms is reviewed.
After ruling out an organic cause for the tinnitus, a careful examination of the patient is performed highlighting a certain particularity in relation to these, which with the rest of the symptoms and the clear repercussion at different functional levels led us to consider him within the risk group to suffer a psychosis. He received treatment with low doses of atypical antipsychotic with favorable clinical evolution.
Psychotic episodes with nonspecific symptoms such as tinnitus as cardinal symptoms in patients with or without psychiatric history have been described in literature. In most cases, symptoms improved after treatment with atypical antipsychotic.
Childhood trauma (CT) has been proposed as a risk factor for schizophrenia. Moreover, it has been related to brain abnormalities associated with cognitive functions, including social cognition (SC). Suffering repeated traumatic events could give rise to a threatening interpretation of the environment and affect SC, facilitating psychotic symptoms. Our research draws from the premise that different CT exposure might affect to distinct aspects of SC.
The aims of this study are i) to assess the relations between general and social cognition in schizophrenia patients and ii) to assess the possible relations between childhood adverse experiences and SC deficits.
55 schizophrenia patients and 33 controls (aged 17-67) were included. CT was evaluated using CTQ. GEOPTE scale was used to assess personal perception about SC comparing it to information provided by a relative. General intelligence quotient was taken as a measure of general cognition.
Sample was composed by 66.6% males and 33.3% females. Mean of age was 36.47 years old. CTQ scores were higher for patients in emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse. Patients showed higher GEOPTE scores than controls.Patients who have suffered emotional neglect or emotional abuse obtained higher levels of GEOPTE, and therefore worse social cognition than patients who did not suffer it. An association between emotional intelligence and general intelligence scores was found in patients.
Patients with schizophrenia score worse in social cognition and general cognition than controls. Emotional neglect and emotional abuse could be considered as risk factors for developing worse social cognition in schizophrenia
Ophthalmological disorders in patients with schizophrenia to date have not been sufficiently researched or documented. In most cases these disorders are related to dry eye symptoms and tear film dysfunction.
The objectives of this research was to investigate the subjective indicators regarding tear film dysfunction in schizophrenic patients. The intention was to prove that long-term use of antipsychotics in these patients may cause damage to tear film quality.
The study was conducted on a sample of 160 participants with one group consisting of 80 schizophrenic patients taking antipsychotics and other group including 80 healthy controls. The study gruops did not differ in the parameters considered as risk factors for tear film dysfunction. Both groups were subjected to ophthalmologic examination and filled out the Ocular Surface Disease Index (OSDI) questionnaire related to subjective symptoms of dry eye. The questionnaire consisted of three parts realted to symptoms, visual function and environmental impact.
Obtained results showed statistical significant differences in all subjective measurements and indicators between the two groups. All tested variables showed higher average values in patients with schizophrenia taking antipsychotic therapy compared to healthy controls.
This research shows that long-term use of antipsyhotic drugs in patients with schizophrenia is correlated to tear film dysfunction and may cause subjective ocular symptoms similar to those experienced in patients with dry eye syndrome.
Antipsychotic polypharmacy in schizophrenia is much debated, since it is common and costly with unclear evidence for its efficacy and safe-
ty.(1) Limited data on clinicians’ reasoning suggest various motivations for this strategy, including attempts to increase/speed up efficacy, treat residual positive symptoms, or reduce adverse effects allowing dose reduction of the first antipsychotic(2). Antipsychotic polypharmacy has been reported as a common clinical practice (3).
The aim is to adress the motives clinicians have to use antipsychotic augmentation vs monotherapy.
Is there a reduction of symptoms in patients with antipsychotic augmentation vs monotherapy
Retrospective study in a group of patients in a subacute unit during 2019.
Antipsychotic augmentation was superior to monotherapy regarding total symptom reduction.
Response is greater in the antipsychotic polypharmacy group. This finding suggests that expectation and salience biases, also present inclinical care, may underlie observed improvements and decision making when augmenting one antipsychotic with a second one.
Schizophrenic patients could attemp suicide. Social cognition might be one an importat factor that could improve suicide risk.
Our study aims to compare the neurocognitive profile of two groups of schizophrenia patients that differ in the presence or absence of suicidal risk; find a correlation between the presence of suicidal ideation/attempt and specific neurocognitive deficits.
98 patients with Schizophrenic Disorder (SZ) according to DSM 5-TR were enrolled. Neurocognitive functions were evaluated by means of Measurement Research and Treatment to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Clinical data were assessed through the Brief Psychiatric Rating Scale (BPRS). The existence of suicidal ideation and actual suicide attempts have been investigated through the Columbia-Suicide Severity Rating Scale (C-SSRS). Based on the results on the C-SSRS scale, subjects were dichotomized in suicidal risk patients and non-suicidal risk patients. Suicidal patients had at least 1 on the scale that investigates the severity of the suicidal ideation.
Suicidal patients had a significantly (p=0,006) worse performance on the test that explores the cognitive domain of social cognition (42,43 (mean 46,04)) than patients who did not have a suicidal risk (31,75(mean 40,40)) . The two groups did not differ in other cognitive domains. (Table 2). Instead verbal learning (22,36(mean 5,04)) or speed of processing (42,44(mean 54,13)) were slightly greater in suicidal patients.
Our analysis has shown a significant relationship between social cognitive impairment and suicidal risk in schizophrenia patients. It’s conceivable that social cognitive impairment is an endophenotype of schizophrenia and a risk trait for suicide
Schizophrenia is a chronic psychiatric disorder during whom most of patients experiencing multiple relapses. Relapses prevention is a major concern in patient’s care.
Evaluate the effectiveness of therapeutic strategies set up after a relapse.
A retrospective observational study was conducted. Every patient with schizophrenia hospitalized in 2016 for relapse were included. Patient medical records and prescription software were used to collect different parameters. Effectiveness of the strategies implemented during the hospitalization was assessed via the relapse caused re-hospitalization rate within one year of discharge. Links between the variables collected were studied by ANOVA performed with R software.
A total of 102 patients were included. The cause of relapse was mainly non-adherence to antipsychotic medication(56%). Three types of strategies have been identified: maintenance of treatment (same molecule, dosage and route of administration, n=26); optimization (same molecule, change in dosage or route, n=37); change of molecule (n=39). Thirty-five percent of patients were re-hospitalized for relapse within one year of discharge. No statistically significant association was found between the strategy implemented, the class of antipsychotic, the route of administration and the occurrence of a re-hospitalization during the year. Relapsed patients were those who had the most history of relapses.
Non adherence to treatment is a major problem in schizophrenia. The lack of association between antipsychotic management and relapse occurrence shows significance of non-pharmacological therapies such as therapeutic patient education or psychoeducation. Each treatment has to be individualized started as early as possible, and education practices has to be establish to improve treatment adherence.
Assessment of depression is schizophrenia is clinically important due to high risk for suicidality, distress and impact on functioning. Limited numbers of studies have evaluated depression in patients with schizophrenia in clinical remission.
To assess the prevalence of depression in patients with chronic schizophrenia who are currently in remission.
Two hundred and fifty patients with schizophrenia, who were in clinical remission, were assessed for depression using Calgary depression rating scale for schizophrenia (CDSS) and Global Assessment of Functioning (GAF) Scale. CDSS score of ≥7 was considered cut-off for depression.
The mean age of the sample was 35.14 (SD: 10.01) years and the mean duration of formal education was 10.4 (SD: 4.52) years. Majority of the participants were males (66.4%), married (56.4%), unemployed (53.2%), and hailed from nuclear family (59.6%). The mean age of onset of illness was 27.17 (SD: 9.37) years and duration of untreated illness was 4.40 (SD: 1.79) months, the mean duration of illness was 98.35 (SD: 71.78) months and the mean duration of remission at the time of assessment was 8.4 (SD: 5.45) months and mean GAF score of the sample was 78.44 (SD: 7.59). The prevalence of depression in the study sample was 18.8%.
Present study suggests that one in five patients of schizophrenia, currently in clinical remission has depression.
In recent years, cognitive involvement in first-episode psychosis (FEP) is becoming more important, with multiple publications in this regard, with generally heterogeneous results due to different methodologies. The solider data point to impairment in verbal and working memory, processing speed and executive function,and being them all related with negative symptoms
Preliminary results regarding cognitive function in patients with FEP are presented
A longitudinal and prospective case-control study will be performed during a year.FEP patients with cannabis-use are identified as cases and FEP patients with no cannabis-use as controls.The sample will be constituted by all the patients, diagnosed of first psychotic episode,admitted during a year at the Psychiatry Unit of the HUPHM.Three evaluations will be made.The first of them will be administered on the days before the discharge, the second 6 months after and the third a year a head.Each evaluation will include different scales, cognitive impairment is assessed by SCIP-S
We present preliminary result of cognitive impairment in 32 consecutive FEP admitted to our center. We included 23 cases (71.8%) and 9 controls (28.1%).Result regarding SCIP percentile on the different areas were the following: all of them except verbal fluency were higher among controls (IMAGE-1).Differences regarding processing speed were significant (p<0.1)(IMAGE-2).7 subjects had a second evaluation after 6 months.Regarding total-SCIP percentil,cases suffered greater improvement compared with controls (p=0.05)(IMAGE-3)
First cognitive evaluation in FEP can be substantially altered in cannabis-users,however,we highlight changes occurring during follow-up, being specially this group the one suffering greater total improvement in cognitive functions,compared with non-consumers
The use of antipsychotic combinations in patients diagnosed with schizophrenia is an extended intervention in our daily clinical practice. It is estimated that 10-30% of patients with this diagnosis have used more than one antipsychotic concurrently.
The aim of this study was to evaluate the clinical evidence that support the use of antipsychotic polypharmacy against monotherapy in Treatment-resistant schizophrenia (TRS) in terms of long-term efficacy and efficiency, as well as of safety and tolerability.
A non-systematic review of the literature was conducted by searching in the Pubmed database the keywords: “antipsychotic combinations”, “antipsychotic polypharmacy” and “Schizophrenia”. The authors only selected papers published within the last 5 years.
During the last years, different studies including meta-analyses and systematic reviews have been published, yielding to conflicting results. While in some cases the use of combination of antipsychotics showed higher outcomes in reduction of symptoms and risk of rehospitalization -in particularly for Clozapine and Aripiprazole combination-, others concluded that polytherapy predicts an earlier relapse as well as higher risk of discontinuation followed from a worst side effects profile.
Although several publications of high level of evidence have been carried out, the results obtained are generally contradictory and of low consistency. Nevertheless, some recent long-term studies show encouraging results with some antipsychotic combinations in particular. Further investigations are needed in order to elucidate the efficacy and risks of this therapeutic option.
Theory of mind along with alexithymia, represent two important factors involved in an adecvate social functioning of any patients diagnosed with a psychotic disorder, therefore, also in the schizoaffective disorder.
The purpose of this study is to evaluate the alexithymia and theory of mind in patients diagnosed with schizoaffective disorder, that are in remission and under treatment.
22 subjects diagnosed with schizoaffective disorder (according to ICD10 criteria) have been included in our study. The subjects have been selected using inclusion and exclusion criteria. The analized parameters were: socio-demographical data , alexithymia ( Toronto Alexithymia Scale) and Theory of Mind (“Reading the Mind in the Eyes test”). The data obtained was analyzed statistically.
The socio-demographical data revealed that the median age of onset of the disorder was 28,2 years, the median education level was 11,2 years (highschool), the median evolution of the disorder is 10,8 years and all of them are now retired due to sickness or disability. The analyzed data showed that the ability of reading the mind in the eyes in 82% of the patients, as well as the alexithymia (79% of the patients) were impaired. Also, there is a direct correlation between these two; a lower ability to express emotions correlates to a lower ability to identify emotions (r=-0.524324317).
In the schizoaffective disorder, theory of mind, as well as alexithymia are impaired and there is a direct correlation between them.
Parry fractures,a fracture in the forearm usually consequence of protecting the face against aggressive attacks, are known to be an indicator of interpersonal violence.They are frequently used in bioarcheological studies.Studies on violence and schizophrenia are mainly focused on the violent behaviors of patients while lacking the violence the patients are exposed to.Radiologically shown parry fracture could be a sign to detect victimization in patients with schizophrenia.
To shed light on this issue we present two schizophrenic patients with parry fractures.
Exposure to violence in these patients was assessed by radiological examination.
Case 1: 28-year old male with schizophrenia and inhalant use disorder,was treated in an inpatient clinic because of a psychotic attack.He had surgical scars on his left forearm and elbow.He said that he was attacked by his friends 5 years ago.The left ulna and humerus were broken due to that assault.
Case 2: 40-year old female patient with schizophrenia,was seen in an outpatient clinic and she was in remisson clinically.When questioned whether she has been subjected to physical violence in the past,she said that she was attacked by her ex-husband.Although she was under pain in her forearm,she didn’t apply to hospital back then.Radiological imaging revealed the old fracture.
It is known that autobiographical memory is reduced in patients with schizophrenia.Therefore,physical examination and therapeutic alliance may reveal the victimization of the patients.Furthermore,some specific bone fractures and wounds could be used to detect victimization even after plenty of time passes.
Sialorrhea is one of the most common side effect of neuroleptics treatment. It can be unconfortable and could be a reason for therapeutic non-compliance. Botulinum toxin has been effective in the treatment of hypersalivation in Parkinson disease, infant cerebral palsy and amyotrophic lateral sclerosis.
To illustrate the utility of botulinum-A toxin as a treatment of antipsychotic-induced sialorrhea through a case report.
We report the clinical history of a young male diagnosed as treatment-refractory schizophrenia in treatment with clozapine and paliperidone and a severe pharmachological induced hypersalivation.
After onset treatment with botulinum-A toxin inyections in both parotid glands, sialorrhea decreased.
Botulinum-A toxin may be a good therapeutic option for the treatment of neuroleptic-induced sialorrhea.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that can affect multiple organs.
Neuropsychiatric manifestations occur in two-thirds of patients with SLE, but psychosis is rare.
Corticosteroids are the cornerstone treatment in those cases, but can also induce psychosis themselves.
To describe a case depicting psychotic symptoms in a patient with SLE, highlighting the importance of a correct diagnosis and its implications on the treatment.
Clinical case report and brief review of relevant literature.
M, a 40-year old female, with a background of SLE for 30 years and psychiatric history of depressive episode 2 years earlier, checks in the emergency room with persecutory delusional ideation initiating 3 months prior. M had a SLE-related nephrological relapse 6 months earlier, with a proteinuria peak of 2g/day.
M was found medicated with sertraline 100mg; mirtazapine 15mg; hydroxychloroquine 400mg; enalapril 20mg; losartan 50mg; prednisolone 5mg (on tapering phase) and mycophenolate mofetil 400mg 2id (maintenance dose).
No significant signs or changes were found either at objective examination or on blood analyses. Brain CT revealed brain groove accentuation. Brain MRI showed unspecific signs. Lumbar puncture was refused by the patient.
M was diagnosed with organic delusional disorder secondary to SLE, and started prednisolone 40mg/day and risperidone 2mg 2id.
M was discharged one month after, maintaining residual delusional ideation but with reduced expressed emotion towards it.
The differential diagnosis of psychotic symptoms in a patient with SLE is fundamental, since it will determine the treatment strategy adopted.
Sometimes it is necessary to perform an organic screening before referring a patient to mental health. A basic study can avoid therapeutic problems.
34-year-old woman with no previous history in mental health. No family history in mental health. Married and mother of a daughter.After a car accident of some neighbors in his village, she starts abruptly with fear of damaging herself. This leads him to confine himself at home and limit his social activities, needing continuous supervision by his mother and daughter. Her mother says that in previous days she was tired.
Psychopathological examination: Conscious, oriented, collaborative. Hypotymic mood. Overrated ideas about hurting herself, afraid of going to the act. In the background, delusional ideas of harm. Floating anxiety, feeling of associated asthenia.
Antidepressant and antipsychotic treatment is started. By not giving up the symptomatology, analytics that demonstrate hypothyroidism are requested. A computed axial tomography is also requested, and it doesn’t show significant alterations for the patient’s age. She is derived to endocrinology and by supplementing with thyroid hormone, symptoms improve, achieving psychopathological stability.
When referring to mental health in a case of sudden onset of symptoms, organic pathology must be ruled out previously, since the response to treatment may not be effective and the patient is being damaged.
Creutzfeldt - Jakob disease (CJD) is an extremely rare and devastating disease characterized by rapid neurological deterioration in a healthy individual. The classic clinical presentation of CJD includes rapidly progressive dementia, myoclonus, pyramidal, extrapyramidal and cerebellar signs. Although it is less frequent that the disease begin with non-specific psychiatric signs.
describe the psychiatric symptoms of CJD
retrospective study of a patient diagnosed with CJD
We reported the case of a 66-year-old woman without personal or familial psychiatric history. Initial symptoms included delusions of persecution, depressed mood, memory loss, and a strange sensation
His sons stated that his cognitive problems had worsened significantly in the previous two weeks and associated with visual, auditory and sensory hallucinations. The physical examination was significant for perseverance, agnosia and apraxia associated with depressed mood and loss of vital momentum. His muscle tone was normal at all four extremities. Magnetic resonance imaging (MRI) showed high signal intensity in the bilateral caudate, putamen and left frontotemporal cortex in T2-weighted and diffusion-weighted imaging. Studies on cerebrospinal fluid (CSF) were also performed. The number of cells, glucose and proteins were within normal limits its 14-3-3 protein level was positive.
Our patient was diagnosed with probable CJD, based on internationally-agreed diagnostic criteria. This fatal neurological disease occurs in sporadic, familial and acquired forms. Psychiatric symptoms are considered rare; in early stages of the disease they are found in up to 40% of the cases. However, presentation as a pure psychotic condition over so many months of development is not typical.
Schizophrenia and other psychotic disorders have a great impact on the socio-health framework worldwide. Its onset in the young adult prevails, and these disorders can be detected at both earlier and later ages, requiring an adequate diagnostic-therapeutic approach.
The case of a 19-year-old female patient is presented, with follow-up by a Mental Health Unit from the age of 12 for presenting psychotic symptoms, who was admitted to the Acute Inpatient Psychiatry Unit after going to the Emergency Department due to an exacerbation of her psychotic symptoms along with behavioural disturbances and low mood. Upon admission, the patient verbalized delusional ideas of persecution, as well as overvalued ideas and delusional perceptions, in which she felt persecuted on the street, as well as observed in the bathroom, mostly by men known to the patient, and in occasions by her deceased father. She also referred being suffering olfactory hallucinations (in differential diagnosis with delusional perceptions).
Complete analytics, cranial CT and electroencephalogram revealed no pathological findings.
Differential diagnosis was established among between schizophrenia, delusional disorder, schizoaffective disorder, major depressive disorder with psychotic symptoms and dissociative disorder.
The patient was treated with oral Aripiprazole at a dose of 15mg per day resulting in an adequate therapeutic response, a decrease in psychotic symptoms, as well as mood and behavioural stability.
Adequate anamnesis and psychopathological exploration are necessary to achieve a correct diagnosis of the psychotic symptoms.
Aripiprazole may be an effective therapeutic option in the treatment of psychotic symptoms in young patients.
First-time presence of schizophrenic symptoms in 40-year old persons is rare. The complex symptomatology of shizoaffective disorder makes a misdiagnosis highly likely.
To present a case of schizoaffective disorder.
Medline search and review of the clinical history and the related literature.
We present the case of a 40-year-old man who suffered psychotic symptoms for the first time. According to the psychiatric history, this patient has needed emergency psychiatric examination half year before hospitalization due to deregulated behaviour in relation to persecutory delusions triggered by the regular use of cannabis. Before hospital treatment there was a two years history of persecutory, reference and erotic delusions, auditory hallucinations, sleeping disturbances and during hospital time elevated mood. Laboratory results and brain imaging were unremarkable. He was diagnosed with schizoaffective disorder and cannabis abuse. During the following month he was treated with an atypical antipsychotic and a mood stabiliser and his psychotic and manic symptoms improved. With these drugs and cannabis abstinence, he almost enjoyed normal life and work.
Late onset psychosis is due to a wide range of clinical conditions. The evolution and presentation of psychotic and affective symptoms in this patient made us think of schizoaffective disorder as main diagnosis.
First-time presence of schizophrenic symptoms in 40-year old person is rare. The complex symptomatology of shizoaffective disorder makes a misdiagnosis highly likely.
To present a case of schizoaffective disorder.
Medline search and review of the clinical history and the related literature.
We present the case of a 40-year-old who suffered psychotic symptoms for the first time. According to the psychiatric history, this patient has needed emergency psychiatric examination half year before hospitalization due to deregulated behaviour in relation to persecutory delusions triggered by the regular use of cannabis. Before hospital treatment there was a two year history of persecutory, reference and erotic delusions, auditory hallucinations, sleeping disturbances and during hospital time elevated mood. Laboratory results and brain imaging were unremarkable. He was diagnosed with syhizoaffective disorder and cannabis abuse. During the following month he was treated with atypical antipsychotic and mood stabiliser and his psychotic and manic symptoms improved. With these drugs and cannabis abstinence, he almost enjoyed normal life and work.
Late onset psychosis is due to a wide range of clinical conditions. The evolution and presentation of psychotic and afective symptoms in this patient made us think of schizoaffective disorder as main diagnosis.
Amongst psychotic disorders, late-onset schizophrenia is rare. It debuts after 40 years of age and is associated with forthcoming psychosocial factors, higher relacional, educational and laboral achievement, female and paranoid subtype preponderance, lower rates of substance use, and weaker family history of schizophrenia. Phenomenologically, auditory hallucinations predominate but there is a higher proportion of other modalities.
Succeed in the understanding of the course of late-onset schizophrenia, which could go unnoticed for a long time, resulting in delay in diagnosis and in torpid recovery.
Presentation of a case and review of the scientific literature.
We report the case of a 57-year-old man with two previous referrals to Mental Health due to psychotic sintomatology, which apparently started eleven years prior, never being evaluated. Up until the debut of the disease he had been married and held various jobs, having isolating himself from the family, coming to live in unsanitary conditions and being completely invaded by the experience of being influenced by an otherworldly force, generating insidious changes in his personality and behaviour. Eventually, he filed a complaint against “the power of the dead” and the forensic specialist requested a psychiatric report, so he was evaluated and admitted involuntarily to the psychiatric unit, staying two months. He was diagnosed with paranoid schizophrenia and treated with antipsychotics, currently being monitored.
We illustrate late-onset schizophrenia in men and the relevance of a proper and early diagnosis; highlighting the risks of overlooking these patients, with the potential repercussions in their own means to function in society.
Amongst delusional disorders, delusional parasitosis or Ekbom’s syndrome is relatively infrequent. These patients report an unwavering false belief of skin infestation due to sensoperceptive hallucinations, despite the absence of any medical evidence. There are two forms of delusional parasitosis: in the primary form the delusion of parasitic infection is the only symptom present, whereas in the secondary form it occurs alongside another psychiatric disorder, such as schizophrenia, drug abuse or an organic cause. Antipsychotics are the most usen treatment.
Presentation of a case and discussion of first approach to delusional parasitosis.
Presentation of a case and a small review of the scientific literature available in PubMed.
Caucasian, 49-year-old woman reported a not-confirmed toe nail fungic infection one year prior, progressing with the subjective sensation of spreading to the rest of the body. Consequently, she employed diverse topical and oral remedies without medical supervision. One month prior she got medical assessment in a different medical centre, being evaluated by Dermatology and Psychiatry, getting the diagnosis of delusional parasitosis despite a lack of a battery of tests. She is given treatment, with no adherence. She escalated into more aggresive compulsions of cleasing, resulting in excoriations and scaldings, with increasing difficulties to lead her life.
We illustrate the relevance of close multidisciplinary cooperation and the use of an adequate battery of tests to rule out an organic cause. An early diagnosis is key, as a therapeutic alliance prevents the patients from isolation and the development of depression symptoms, or else, of self-harm.
Identifying people at clinical high-risk (CHR) for psychosis facilitates the development of intervention strategies aimed to prevent the onset of a full-blown psychosis. There is evidence linking attachment adversity and poor mentalization to the risk for developing psychosis.
In this study we aimed at: (1) investigating attachment patterns in a clinical sample of adolescent/young adult help-seekers and comparing the distribution of attachment patterns in CHR vs non-CHR subjects; (2) exploring the association between reflective functioning and subclinical psychotic symptoms; and (3) longitudinally examining the predictivity of attachment patterns, reflective functioning, and the interaction between them, with respect to transition to psychosis.
57 CHR outpatients were compared with 53 other outpatients who did not meet the high-risk criteria. A multi-method diagnostic assessment was implemented, including the Structured Interview for Prodromal Syndromes (SIPS). Adult Attachment Interview was also administered, and the transcripts were further assessed using the Reflective Functioning (RF) Scale. Participants were followed-up over a mean period of 14 months.
CHR status was negatively associated to secure attachment patterns and positively associated to dismissing attachment patterns (χ2= 6.98, p = 0.03). The RF scores were significantly lower in the CHR sample (t=3.99; p<.001) and significant correlations between RF and SIPS subscales were found. Moreover, we found a significant effect of RF on the probability of transit in psychosis (β=.75, p=.03; OR=.473, 95% CI: .242, .924).
Our results suggest that attachment-informed and mentalization-based psychotherapies may be effective preventive treatments for CHR patients.
Psychotic disorders have been described as a comorbidity in epilepsy. Psychotic syndromes associated with epilepsy are normally defined based on their chronological relation to the seizures ( interictal, posictal). They are more frequent in patients with long-standing history of seizures, family antecedents of psychosis, and invovelment of temporal lobe.
We describe a case case of a patient with a diagnosis of secundary epilepsy, who developed psychotic symthoms in a stability period and suitable control of seizures.
Data are obtained at medical history, physical examination, complete analysis, CT, magnetic resonance and electroencephalogram.
A 54 year old female patient was atended at hospital because of subacute behavioral disturbances, auditory and visual hallucinations, paranoid ideation, spacetime disorientaion.
She has a secundary epilepsy diagnoses since she was 19 years old, neurocysticercosis (parenchymal nodular calcificated involved and subarachnoid alteration) and chronic hydrocephalus stabilized. She was treated with levetiracetam, lacosamide and valproate. Last time that she had suffered one episode of partial complex seizure was 4 months earlier.
When acute organic causes of psychiatric symthoms were discarded, she was hospitalized at psychiatry department of our hospital and neuroleptic treatment was iniciated. During hospitalization we also noticed several symthoms of mild cognitive impairment. She was succesfuly treated and discharged home with low doses of neuroleptics.
The diagnosis of psychotic states associated with epilepsy could be difficoult because of the very different clinical manifestations and. It is important to consider the high prevalence of psychiatric comorbility in patients with epilepsy to administer them a multidisciplinary treatment.
Psychosis is a rare sequela of TBI that occurs in a range between 0.9% to 8.5% of patients. Besides, a maniac episode occurs in approximately 9% of patients in this group.
We describe a case of a 29-year-old woman who presented psychotic and manic symptomatology after a TBI, as well as the diagnostic process and treatment.
In this poster, we report a case of post-TBI severe mental illness.
Our patient hospitalized because of psychotic and maniform symptoms, appeared after a polytrauma involving a TBI. This clinical picture had been progressing for years, consisting of abrupt humour changes, irritability, impulsivity, self-referentiality and verbalization of megalomaniac and persecutory ideas. Occasionally, these delusional symptoms had a greater emotional and behavioural impact in the form of aggressive and uninhibited conduct, which coincided with a reduction of sleep needs, an increase of activity and remarkable dysphoria, this being the situation of the patient when she arrived at the hospital. After several weeks of observation and treatment in our hospitalization unit, the patient was diagnosed with schizoaffective disorder and organic personality disorder.
It is essential for all kind of specialists to think about mental illness as a possible sequela of TBI to reach an early diagnostic.
A program of First Episodes Psychosis has been implemented in Navarra
To describe the baseline sociodemographic and clinical characteristics of patients attending the PEPsNa.
We present the baseline results of the sample
To date, 211 patients have been treated.
Mean age: 29.9 years (SD: 10.5).
Gender: 67.8% male.
Ethnicity: 73% Caucasian, 15.2% Latin American, 5.7% African and 3.8% Arab.
Marital status: 70% were single.
Housing: 49.5% live with their parents or family.
Employment and occupation: 42.7% of patients have a job or carry out standardised studies. 33.5% are long-term unemployed.
DUP: The duration of untreated psychosis is 19.5 months (SD 46.9).
The premorbid GAF score is 71.5 and the GAF score of the episode is 30.35.
Referrals: 56.7% of patients are referred from the acute psychiatric hospitalization unit and a 30% from Mental Health Centres.
Substance abuse: only 20% of patients do not consume any substance. The most consumed drugs are alcohol (75%), cannabis (57.8%) and stimulants (37%).
Baseline diagnosis: brief psychotic disorder (42.9%), unspecified psychotic disorder (20%), schizophrenia (14.6%) and substance-induced psychotic disorder (11.7%).
Psychopathology: CASH (global rating) for psychotic syndrome: 3.7 (SD 1.1); disorganised syndrome: 2.2 (SD 1.5); negative syndrome: 1.2 (SD 1.3).
Treatment: 15.5% of patients received no antipsychotic treatment. The most frequent antipsychotic is risperidone (40.8%).
Basal metabolic syndrome: 4% of patients meet criteria.
We highlight data such as a short dup that may be related early intervention, substance use is very frequent and Metabolic Syndrome is present from the beginning of the disease
Childhood trauma is the main non-hereditary factor that has proved a strong link to schizophrenia development in adulthood. All kinds of interpersonal childhood trauma have been linked to psychosis. Young age and poly-victimisation increase likelihood for trauma-related psychosis onset.
1) Describe childhood traumatic experiences of patients with schizophrenia, 2) Assess relationship between trauma and suicidal history in these patients.
Retrospective study including adult patients diagnosed with schizophrenia spectrum disorders. Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ-SF), which includes 28 items grouped into 5 specific factors (physical, emotional and sexual abuse, physical and emotional neglect).
Forty-five patients (55.5% men, mean age: 41.1 years) were included. 77.8% had experienced childhood trauma, with no significant gender differences (48.9% emotional abuse, 28.9% physical abuse, 40.0% sexual abuse, 55.6% emotional neglect, 46.7% physical neglect). 31.1% reported severe poly-victimisation (≥4 types of trauma). Childhood trauma was significantly related with lifetime suicidal history for patients with any sort of abuse (p=0.001), emotional abuse (p=0.017) and physical neglect (p=0.028). Likelihood of suicidal behaviour was doubled in patients who had been sexually abused during childhood (p=0.063).
More than 3/4 of schizophrenia spectrum patients were abused during childhood and 3 out of 10 patients suffered from more than 3 types of abuse. Childhood trauma is a risk factor for lifetime suicidal behaviour. Systematic inquiry on childhood abuse in these patients is recommended.
The gastrointestinal system is colonized by a large number of bacteria, known as microbioma, that can play a significant role in the interaction between the brain and the gastrointestinal tract. It has been proposed that microbiota may be involved in the pathogenesis of various neurological and psychiatric disorders, involving the immune response, and in the treatment resistance of those disorders.
The aim of this study is to review the possible relationships between microbiota, schizophrenia and treatment resistance.
We review the clinical case of a 45-year-old patient who was admitted to our hospital, diagnosed with schizophrenia, and the treatment difficulties we had, which could be related to the ulcerative colitis he had. We also review some literature about this topic.
Some studies have recognized the importance of interactions between the brain and the gut, mediated by microbiota, in the pathogenesis of psychiatric disorders, such a schizophrenia. In addition, it has been proposed an immune hypothesis of schizophrenia, and a genomic relationship has been suggested between schizophrenia and some autoimmune disorders, such as Crohn’s disease, multiple sclerosis, primary biliary cirrhosis, psoriasis, rheumatoid arthritis, systemic lupus erythematosus, type I diabetes, and ulcerative colitis.
There is a close relationship between microbiota alterations and schizophrenia, including its resistant forms. This may provide the basis for future studies on immune system modulation and microbiota as a target for the treatment for schizophrenia.
Potomania is defined as the desire to drink large amounts of liquid compulsively with a pleasuring feeling. It is not included in the psychiatric classifications with a specific diagnosis and it is remarkable the lack of studies and the little scientific evidence on it.
Presenting the case of a patient diagnosed with potomania, describing its management during admission to Psychiatry
A 35-year-old male admitted to the Psychiatry plant after hyponatremia due to water intake. Psychiatric history of Schizophrenia with multiple decompensation episodes, alcoholism and Cannabis consumption. Admitted 3 months ago to the ICU for severe hyponatremia. In treatment with Quetiapine and Risperidone.
He referred to drinking 8 liters of water a day due to a sensation of dry mouth and to "purify". Three years ago, fluid intake increased progressively until several hyponatremia occurred. A scan impoverished discourse, residual, affective flattening, no
no positive psychotic symptoms. Initially multiple demands and no control over water intake.
Behavioral measures applied at admission: strict surveillance, closed bath, water restriction, chewing gum. Valproic acid treatment started up to 1500mg/d. Progressively improvement over impulse control and decrease the desire to water intake until sodium is in range. After discharge, he moves to mid-stay to continue care.
The most frequent diagnosis for potomanian patients is Schizophrenia. Apart from being a vital danger due to the risk of hyponetremia, it is related to chronicity, deficit symptoms and less response to treatment. It would be necessary to continue with investigations in order to improve the approach of these patients.
Cognitive impairment is a key feature in patients with psychotic disorders. The Montreal Cognitive Assessment (MoCA) is a brief tool that has been shown to be effective in identifying mild cognitive impairment and early dementia.
This study explores the usefulness of this instrument to detect cognitive impairment in long-term psychotic disorders.
One hundred-forty stabilized patients were re-evaluated more than 15 years after a First Episode of Psychosis (FEP). Patients were psychopathologically assessed, and the MoCA test and Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery were administered. Two cut-off scores for cognitive impairment using the MATRICS battery were applied (T score <40 and <30).
Concurrent validation was found between the total scores of the MoCA and MATRICS. We also found significant associations between 5 out of 7 MoCA subtests (visuospatial-executive, attention, language, abstraction and delayed recall) and MATRICS subtests but not for the naming and orientation MoCA subtests. Receiver operating characteristic (ROC) analysis suggested a <25 cut-off for cognitive impairment instead of the original <26.
Our results suggest that the MoCA test is a useful screening instrument for assessing cognitive impairment in psychotic patients and has some advantages over other available instruments, such as its ease-of-use and short administration time.
Cognitive impairments in psychotic disorders have been reported as a continuum in severity, from schizophrenia spectrum disorders (more severe) to affective disorders (less severe) (Hill et al 2013). However, findings to date have been inconsistent (Reichenberg et al 2019).
To establish the cognitive profiles in the MATRICS Consensus Cognitive Battery (MCCB) of a sample of patients with psychotic disorders, according to their diagnosis.
172 outpatients with psychosis were assessed with the MCCB. Patients were grouped considering their diagnosis: Schizophrenia spectrum disorders (SSD, n=69); Affective disorders (AD, n=46), Schizoaffective disorders (SAD, n=39), Other psychoses(OP, n=18), including patients with one or more psychotic episodes in the past which remitted and do not meet diagnostic criteria for a current psychotic disorder.
Patients with SSD showed worse performance on attention, verbal and visual learning, and combined score of the MCCB, with respect to the OP group. They also underperformed AD group in verbal learning and social cognition. AD patients showed worse performance than OP patients in processing speed and visual learning tasks. SAD patient only showed significant differences in attention scores, with respect to OP patients (Table 1, Fig. 1).
SSD patients showed the most severe cognitive impairment with respect to OP patients. These results suggest a similar profile of impairment in SSD, SAD and AD, and significant differences in severity regarding OP patients. OP patients as a group showed average performance in all the cognitive functions explored.
Network analysis represents a promising approach to study the relationships between clinical and cognitive variables in psychiatric disorders. However, only one study to date has studied cognition in patients with psychosis using network analysis (Chang et al 2019).
To examine the relationships between a set of neuropsychological variables using the network analysis in a sample of patients with first episode psychosis (FEP)
266 patients with a FEP were assessed with a set of neuropsychological tests, including measures of premorbid IQ, attention, working memory, verbal memory, processing speed, executive functions and social cognition. Network analysis was applied using the qgraph package of R-Studio software, to obtain the relationships among cognitive scores controlling for the influence of all the other variables in the network.
The interrelations between the nodes in the cognitive network of this sample of patients with FEP showed a strong association between the measures of each neuropsychological test. Cognitive domains established a priori were validated by the network only in those measures that belonged to the same test (verbal memory and social cognition). However, measures corresponding to processing speed and executive function showed different interconnection patterns, according to the tests and not to the cognitive domains.
The network shows strong relationships between the variables of each test. However, the strength of some of the connections do not correspond with ‘a priori’ cognitive domains when different tests are involved. Further research is needed to ascertain whether this structure is replicated.
Negative symptoms are a core feature of schizophrenia. The CAINS (Clinical Assessment Interview for Negative Symptoms) is an empirically-developed “second generation” scale for the assessment of negative symptoms.
We examined the psychometric properties of the CAINS scale and their comparative value regarding the Scale for the Assessment of Negative Symptoms (SANS) for predicting psychosocial outcome
A total of 98 consecutive admissions with schizophrenia spectrum psychosis were administered the SANS at admission and discharge times, and the CAINS at discharge time. The Global Assessment of Functioning (GAF) and World Health Organization Disability Assessment Schedule (WHODAS) were used for the assessment of psychosocial functioning.
The CAINS motivation/pleasure and expression subscales correlated significantly with all of the SANS subscales, both for admission and discharge, with the exception of attention.
The CAINS motivation/pleasure score was significantly associated with other psychopathological dimensions at discharge, such as positive, disorganized and illness unawareness dimensions but inversely with mania dimension. And the CAINS expression subscale was only inversely and significantly associated with mania dimension at admission.
Factor analysis of CAINS items revealed a two-dimensional structure that explained the 81.62% of the variance.
Both CAINS and SANS subscales were strongly associated with WHODAS and GAF psychosocial functioning scores.
These findings suggest that the CAINS Spanish version is a valid tool for measuring negative symptoms in schizophrenia. And despite both high scores on both CAINS and SANS scales showed significant associations with poor functioning, it seems that the associations of CAINS scores were less strong than those of SANS scale.
Gender differences have an impact on the course of schizophrenia. Earlier age of onset, worse premorbid functioning, more severe negative symptoms and cognitive impairment are reported in males and might be associated with poor functioning.
Within the Italian Network for Research on Psychoses, we investigated, in a sample of 280 females (F) and 641 males (M) with chronic schizophrenia, the frequency of negative symptoms and their impact on real-life functioning, controlling for the major causes of secondary negative symptoms and neurocognitive impairment.
BNSS assessed negative symptom domains: anhedonia, asociality, avolition, blunted affect and alogia. Linear regression analyses investigated the predictors of real-life functioning domains (assessed with the SLOF): interpersonal relationships (IR), everyday life activities (AC) and work skills (WS). Depression, parkinsonism, positive and disorganization dimensions, neurocognitive composite score and BNSS domains were used as independent variables.
M showed a greater impairment in functioning and higher frequency of negative symptoms than F. Impairment in IR was predicted by asociality, alogia and disorganization in M; by asociality, positive dimension and anhedonia in F. In M, deficit in AC was predicted by disorganization, alogia, neurocognitive impairment, avolition and positive dimension. In F, disorganization and neurocognitive impairment predicted the deficit in AC. WS deficit was predicted by disorganization, neurocognitive impairment, anhedonia, positive dimension and parkinsonism in M; by disorganization, avolition and neurocognitive impairment in F.
Our results support the higher frequency of negative symptoms in M and demonstrate gender-related differences in factors associated with poor functioning, suggesting the importance of individualized gender-specific rehabilitation programs.
It is widely known that the exposure to stressful life events can trigger psychosis in vulnerable individuals. There are several models proposing the possible mechanisms underlying this relationship. Stress increases the cortisol level in the brain and therefore it could increase the level of dopamine receptors. On the other hand, it has been proposed that social disadvantage could increase the sensitivity to dopamine in the brain. Psychosis may also be explained as an exacerbated defense mechanism (“hyperconsciousness”) in changing environments.
To present a case of a first-psychotic episode during an Erasmus Program and to review the literature about stressful life events and psychosis.
We will present a case report and a literature review.
We report a case of a 21-year-old woman, with no psychiatric nor substance abuse history. Erasmus student, living in a foreign European city for a month and a half. Her symptoms started after 3 weeks living abroad with confusion, thought blocking and persecutory and referential delusions. Physical exam, blood analysis and cerebral CT scan were normal. We started treatment with aripiprazole 20 mg and lorazepam 3 mg daily with clinical improvement in two weeks.
Changing environments can work as stressful life events that can trigger psychosis in vulnerable individuals. There is evidence in favor that stressful events in adult life may be involved in the onset of psychosis and our study supports these findings.
The degree of acceptance of long-term injectable medication is still controversial. Could this trend change as patients know the existence of a quarterly formulation?
The present study attempts to test whether the introduction of injectable PILP injection medication on a quarterly basis implies a change in acceptance and attitudes toward injectable medication.
It is a descriptive study that collects data from patients with an initial negative attitude towards an injectable treatment and who changes when they know the existence of a quarterly formulation.
In our study we used the ICD scale (N = 50), finding a difference mayor of 3 positive points when starting treatment with quarterly PILP suggests a good predisposition and a change of attitude of the patients when knowing the existence of a quarterly injectable formulation
Acceptance of treatment by the patient is of great importance as an integral part of their recovery process.
Limitations:
- Scarce total number of cases and need for validation with more detailed scales
- Need a longer study since it is done in an outpatient setting
Strengths:
- Reflects the "real" attitude of patients with regard to injectable medication
- Allows the patient to make decisions regarding their treatment
In this study, we observed that the treatment with quarterly PILP is a benefit for the patient perceived by the patient, with a more adequate attitude and a better acceptance of an injectable treatment, which leads to a substantial improvement in their quality of life and the prognosis of her illness
Cannabis use, due to its influence on the developmentn and prognosis of the disease, has become a target for the prevention and treatment of FEP patients.
Cannabis use in FEP is correlated with poor adherence treatment, the severity of psychotic symptoms, the risk of relapse and poorer functional outcome at follow-up.
It has been shown that psychoeducation, as an adjuvant to pharmacological treatment, is effective in improving negative symptoms and functionality. However, there is a need to develop effective specific interventions to reduce cannabis use as part of comprehensive treatment programs for patients with psychosis.
The objective of the study was to assess the comparative efficacy of a cognitive-behavioral treatment program for cannabis use cessation (experimental group) in relation to Psychoeducation (standard group) in FEP patients.
Patients were randomly assigned to one of the two treatment groups (experimental/standard group) and were assessed with an assessment protocol for gathering data on clinical, functional and cannabis variables (baseline, post-treatment, 3, 6 and 12 months of follow-up).
The effectiveness of both interventions was compared by models of repeated measures and logistic regression.
Experimental group patients showed a greater reduction in use of cannabis compared to the control group (B=.-3,367; p=,000), less psychotic symptoms (t= -2.808, p= 0.007), and better functionality (t= -2.721, p= 0.008) in the post-treatment. No differences were found in depressive, anxious or manic or symptomatology.
The intervention focused on the management of cannabis use is essential to prevent relapses and to improve the prognosis of FEP patients.
Early psychosocial interventions adjunctive to pharmacotherapy may contribute to symptomatic and functional recovery of first episode psychosis patients (FEP). Therefore, individuals who receive early intervention including guidance on how to improve their adherence to treatment, insight into their illness and self-management, have a better course and, hence, these factors are associated with a better prognosis.
The objective of the study was to assess the efficacy of a psychoeducation programme versus treatment as usual in improving the symptomatology and functionality of patients (pre/post-treatment).
This is a single-blind randomised clinical trial in which FEP patients were randomly assigned to one of two treatment groups: 1) the control group, receiving pharmacotherapy together with regular sessions with a psychiatrist (treatment as usual), and 2) the intervention group receiving integrated treatment, namely treatment as usual plus a psychoeducational intervention. The psychoeducational programme has 14 sessions focused on improving patient insight into their illness, treatment adherence, prodromal identification, early intervention to prevent relapses, healthy lifestyles, techniques for managing anxiety, social skills and problem solving. Patients can also call a telephone helpline between sessions.
The improvemente in adherence (Morisky Green Medication Adherence Scale), psychotic (Positive and Negative Syndrome Scale), and functionality (Functioning Assessment Short Test) was analyzed using bivariate analysis, linear and logistic regression models.
The intervention group presented better functionality (B=11,024; p=0,000) and adherence (B =3,128; p=0,001) and fewer psychotic symptoms (B=-2,002; p=0,0037) than control group in the post-treatment.
Psychoeducation is effective as a complementary therapy to pharmacological treatment, improving the evolution of FEP.
Hyperprolactinemia is a frequent but neglected adverse effect observed in patients treated with antipsychotic-drugs. The prevalence of hyperprolactinemia among psychiatric patients receiving antipsychotic medications was estimated to be between 30% and 70%. An English study showed that 18% of men and 47% of women treated with antipsychotics for severe mental illness had a prolactin level above the normal range (Besnard et al. 2014).
Hyperprolactinemia is in fact more frequent in women than in men. Sometimes it is asymptomatic, but the higher the prolactin level is, the more patients have clinical manifestations.
The sample consisted of 119 consecutively acute admitted women, aged 18 to 45 years with recurrent schizophrenia diagnosed on bases of DSM-5 criteria. Assessment for all the enrolled subjects comprised a psychiatric evaluation and blood draw to determine the prolactin level. Hyperprolactinemia was defined as a level of prolactin above the upper limit of normal (>23.00 µg/L for females).
Hyperprolactinemia was detected in 74.79% patients (n=89), whereas the group without hyperprolactinemia comprised 25.21% of the sample.
The percentage of hyperprolactinemia of 74,79% in this study can be attributed to the fact that the sample consisted of women with recurrent schizophrenia who were receiving antipsychotic medication for a period of time. Our findings may support a possible role of hyperprolactinemia in recurrent episodes of schizophrenia in female patients (taking into account the total number of subjects with elevated prolactin levels), but further research is required to confirm these results.
Facing extreme life experiences can impoverish the ability to narrate experience and self. Descriptive psychiatry's model of psychoeducation focusing insight in psychosis may fail its purpose and threaten the already damaged patient’s identity.
Through the process of accepting illness, a value-bearing individual can end up being considered dysfunctional and worthless and experience guilt, shame, hopelessness, demoralization and helplessness. Elseway, denying illness would be considered proof of anosognosia. Both situations may lead to illness narratives introjection, agency loss, own beliefs and competency mistrust and stagnation.
The aim is to show narrative therapy as an advantageous complement or alternative to objective psychiatry psychoeducation in psychosis clinical practice.
Reintegrate one’s life narratives and retrieve recovery agency is one of the most powerful, adaptative and healing a person can accomplish.
Narrative model encourages the patient to build and tell coherent and desirable stories in which recovery is promoted, from a personal point of view, and validates these.
A non-pathologizing speech, normalization, externalization, empathy, respect and kindness are recomended. It is fostered to embrace different truths and alternative versions of self, promoting dialogue and cooperation between selves to dynamize identity narratives and allow choosing a preferred self in each situation. Exploiting personal resources is encouraged.
The person feels reauthorized in the direction of life and recovery, starts narrating personal life stories and recover the possibility of social interaction.
Through recovery process, the person regain an integrated sense of identity, separated from illness and develop an author-narrator-protagonist role in his own life story and the recovery process.
Narrative therapy in psychotic patients shows recovery as an adaptative process: the personal recovery journey.
Myths have always brought cultural and institutional cohesion and bind all human beings in any era or country. Hero’s Journey is a myth that appeals to any person who faces life challenges. The hero is an example of courage, strength, and resilience who resist setbacks and obstacles and in doing so experiences an identity transformation. The victory of the heroine is the victory of all mankind. When he returns from the journey he shares knowledge with the rest of the inhabitants of the "ordinary world". In Myth, this knowledge transcends intrahistory, and becomes part of popular culture outside the tale.
The aim of this work is to adapt Hero’s Journey scheme to narrative psychotherapy in psychosis.
The person is invited to his own-Hero’s Journey and encouraged to try identities and coping strategies through narrative approach, methaphors and hope speech that normalizes recovery.
The therapist doesn’t show the way but motivates the individual to undertake a journey towards well-being and develop his potential overcoming difficulties along the way.
The journey teaches that challenges can be embraced and profitable. Narrative processing systems steered and blocked by illness are now dynamized, promoting desirable identity narratives and integrating them in one’s self.
Recovery journey is an adaptation, growth and self-rediscovery journey whose goal is individual fulfillment and wellbeing. The “psychotic” person puts himself into a position to start high personal value trips and to become the author-narrator-hero of his life story.
Studies have shown that up to 40% with a diagnose of schizophrenia have hearing hallucinations after optimal pharmacological treatment. Experience shows that patients who hear voices can develop and improve their relationship with the voices and manage his voices in a better way.
We wish to evaluate the Auditory vocal hallucination treatment.
The hearing voices therapy is a supplement to existing treatment and is done with understanding and interpretation of the voices in order to reduce anxiety for the voices as well as to master and interpret the voices so that they become "useful" to the patient. The professional attitude is accommodating, non-confrontational and not requiring the patient to change relationship with his voices.
Purpose of group treatment:
To share the experience of hearing voices.
To gain better acceptance and knowledge of hearing voices.
To achieve better cooperation with their voices in an equal relationship.
Learning to interpret their voices and break isolation.
Measures: Auditory Vocal Hallucination Rating Scale (AVHRS). Sleep (Pittsburgh Sleep Quality Index).
21 patients participated. On average they scored high on AVHRS. The patients had very bad sleep quality. The women had a decrease in AVHRS (2.1; p= 0.03) after 1 years.
The group treatment was acceptable for the patients and the study found positive outcomes for female sex. The study can be followed by a larger RCT.
Nowadays, suicide and attempted suicide set up a major impact on individuals’ life; studies show that every year around 800.000 people die due to suicide. Needless to highlight the importance of identifying correctly the population at risk, even more when we discuss about psychiatric patients. One of the psychiatric disorders that goes hand in hand with high mortality through suicide is schizophrenia.
The following presentation case reveals the situation of a 26 years old subject, Caucasian male, intellectual, without any somatic or psychiatric records, who came to the emergency room after an attempted suicide by defenestration.
As time went on, the patient’s evolution was towards schizophrenia.
Among other risk factors, on long-term, suicide attempts may be consider a significant agent for the development of schizophrenia.
Therefore, a patient with suicide attempt/s must be carefully evaluated, counseled, observed and treated for a long period of time, as this event/s opens the door for various mental illnesses (including schizophrenia).
Patients with serious mental illness (SMI) reduced life expectancy by up to 20 years. Smoking is the main preventable risk factor in relation to reducing mortality. Developing new tools to motivate patients towards cessation of smoking is a priority.
The objective is to evaluate the effectiveness to quit smoking of an intensive antitobacco intervention on lung damage and possibilities of prevention in patients with schizophrenia or bipolar disorder to quit smoking.
It is a 12-month follow-up, multicenter study to evaluate an intensive motivational tool based on the individual risk of pulmonary damage and prevention opportunities. A minimum of 204 smokers will be included, aged over 40 years old, all of whom are patients diagnosed with either schizophrenia or bipolar disorder (BD). Chronic obstructive pulmonary disease (COPD) will be evaluated using spirometry, and the diagnosis will then be validated by a pneumologist and the lung age estimated. Based on this value, a motivational message about prevention will be issued for the intervention group, which will be reinforced by individualized text messages over a period of 3 months.
231 subjets were screening but only 160 signed the consent to participated and completed the intervention. 100 completed the follow-up in the intervention group and 97 in the control group.
In the context of community care, screening and early detection of lung damage could potentially be used, together with mobile technology, in order to produce a prevention message, which may provide patients with SMI with a better chance of quitting smoking.
Patients with schizophrenia or bipolar disorder (BD) continue with tobacco rates similar to the general population were in the 50th. Antitobacco strategies were starting to use in different countries but not always was applied to serious mental illness (SMI). There are two forms to measure the motivation bases in the Prochaska and DiClemente Transtheoretical Model (TTM), the Stage of Change (SOC) or the continuous Readiness to Change (RTC).
Evaluate the predictive capacity of the 2 indices for measuring motivation described in the TTM. SOC and RTC.
75 adult patients were included in a Multicomponent Smoking Cessation Program (9 months follow-up). At the end of the preparation stage, the patients completed the URICA Scale to measure the SOC and the RTC. Regression analyses were carried out to identify the predictors of the efficacy outcomes: reduction of at least 50% of the cigarettes per day or abstinence or reduction of the carbon monoxide.
We find differences in the measurement of motivational levels independently, but this difference disappeared during the follow-up. In a linear mixed-effects model, the reduction of the CO was significatively associated with the reduction of the CO at the end of the active treatment and during the follow-up (b: -1.51; SD: 0.82; p<0.01).
The level of RTC predicts the reduction of CO at the end of the active phase and at the end of the follow-up. So, clinical practice and research in SMI could consider using the continuous form to examine the level of motivation.
Poor adherence has also been associated with an increased risk and rate of relapse, increased number of voluntary and involuntary admissions, greater levels of residual positive symptoms, and poor quality of life, social relations, and activities of daily living. The rate of medication nonadherence varies from 26% to 53% for complete discontinuation at the end of the one year to 33%–63% of inadequate medication adherence.
To determine the prevalence of non-adherence in a cohort of patients with first episode psychosis and the sociodemographic and clinical factors associated with non-adherent behaviour.
The sample included 216 consecutive patients from 2016 to 2018 diagnosed with schizophrenia spectrum disorder or an affective psychosis using ICD-10. Sociodemographic variables, duration of untreated psychosis, insight, severity of psychopathology and clinical diagnoses were collected. Patients were assessed at baseline and 1 year with the PANSS and Global Assessment of Functioning Scale (GAF). Medication adherence was grouped into 3 categories: no-adherence, partial adherence and regular adherence.
In their first year in the program 31% were non-adherent, 17% partial adherent, and 52% adherent. Non-adherent patients demonstrated more positive symptoms, more relapses, more psychoactive substance use disorder, reduced insight, and poorer quality of life. They were younger, had an earlier age of onset and lesser family support in treatment.
Results for this group are similar to those reported in the literature. Correlates are often the consequence of non-adherence. Non-compliance has to be anticipated and relationships maintained with patients and families to intervene as soon as possible to minimize the consequence of non-compliance.
150 women, patients with paranoid schizophrenia and their families were examined in a comprehensive manner. The examined patients were divided into 4 groups depending on the model of family interaction.
1. Analyze the peculiarities of the clinical psychopathological symptoms of schizophrenia of women in different models of family interaction.
Research methods: clinical, clinical psychopathological, clinical anamnestic, psychodiagnostic, socio-demographic and statistical.
Group psychoeducational and behavioral impacts first (general orientation), then taking into account the necessity of the restoration skills of family roles' performance, defined by a model family interaction, backed up by the further %tage of the elements of family psychotherapy
.Use of these approaches to medical and psych rehabilitation work with PSH female patients and members of their families, proved their effectiveness compared with specified measures of the standard care given to patients according to their quality of life, social functioning and patients' compliance with supportive therapy.
Recent works have highlighted the role of the glutamatergic model in the pathophysiology of schizophrenia.
This narative revue aims at reviewing current knowledge of alterations in glutamatergic neurotransmission in schizophrenia.
We used the following keywords « schizophrenia » AND « glutamate » OR « ketamine » OR « NMDA » in PubMed. From the 5600 results, we have selected only those published from 2010 to 2019. Articles were selected according to their relevance.
The 16 selected articles bring large evidence concerning the glutamatergic model in schizophrenia. This model explains negative and cognitive symptoms by an excess of inhibition of the mesocortical pathway by GABA interneurons, directly stimulated by glutamatergic pathways. NMDA antagonists induce schizophrenia-like symptoms in disease-free subjects. Evidences were brought by brain imaging, genetic, post-mortem, and Mismatch Negativity studies. Antipsychotics currently used have only a limited effect on glutamatergic neurotransmission. Clozapine seems to have the largest effect on glutamatergic pathways. NMDA co-agonists, like sarcosine and D-serine, might be interesting in treatment of negative symptoms. Molecules targeting other glutamatergic pathways might also be interesting in schizophrenia treatment.
Those studies support the link between schizophrenia and hypofunction of NMDA receptors. This model brings new perspectives in treatment development. The potential of molecules targeting glutamatergic pathways as treatment needs to be investigated at larger scale.
Schizophrenia affects people’s well-being and participation in everyday activities through, among others, a mechanism of cognitive impairments. Cognitive remediation (CR) has promising evidence for its effectiveness among people with schizophrenia. However, its feasibility and effectiveness in inpatient settings are evasive. Virtual Reality (VR) technology provides a platform for CR in ecological environments and tasks having a potential to overcome previously reported limitations.
Test the effectiveness of VR-based CR for improvement of cognition, functional capacity and participation in daily-life activities among inpatients with schizophrenia.
Twenty-four inpatients (male: N=19, 79.2%; Age: M=33.8, SD=8.7) were enrolled into the pre-post designed study using convenience sampling. The participants completed 10 sessions of 20 minutes using the Functional Brain Trainer (Intendu©), a body-controlled, interactive adaptive tool for training of inhibition, response planning, working and reverse memory, shifting, self-initiation, persistence, and attention in functional tasks and environments. Evaluation procedure includes assessments of cognition, functional capacity, schizophrenia symptoms and dimensions of participation using standard tools.
Improvement was found in visual-motor skills, processing speed and shifting (-2.44<Z<-2.89, p<.05), schizophrenia symptoms (positive, negative and general: -3.9<Z<-3.2 p<.001), functional capacity (Z=-3, p<.01) and participation diversity (t(22)= -2.9, p<.05).
This preliminary study provides initial evidence for effectiveness and ecological validity of the short VR-based cognitive training in inpatient acute settings suggesting its contribution to daily-life reintegration after discharge and well-being of individuals with schizophrenia. Larger, controlled studies are needed to provide a clearer evidence of the effectiveness of this tool in these population.
Negative symptoms in schizophrenia can persist despite remission of positive symptoms, and even during periods of clinical stability. It is known they can have great impact on normal functions. Currently approved atypical antipsychotics treatment have efficacy on positive symptoms, but they have still limited improvement on primary negative symptoms.
The aim of the current paper is to provide an updated comprehensive perspective on the treatment of negative symptoms in psychosis.
Literature review related to the topic
Negative symptoms such as blunted affect, anhedonia, alogia or asociality can be categorized as primary negative symptoms, related to the onset of psychosis. We might consider that they can also be described in relation with others psychiatric symptoms, such as depression, and secondary to positive symptoms or side-effects of antipsychotic treatments and long term antipsychotic treatment side effects. Primary negative psychotic symptoms have been related to poor social and occupational functioning. They also commonly have great impact on patient´s daily life and decreases global recovery. There are some recent studies focus on new antipsychotic treatments, as well as some specific psychological interventions.
Specific treatments for primary negative symptoms in psychosis are still limited. Early intervention and integral approach of primary negative symptoms could provide a significant improvement in patient recovery. Combined treatment, including antipsychotics drugs and psychological and psychosocial intervention might also be considered, although further studies would be necessary.
Even though antipsychotic treatment is usually effective in suppressing psychotic symptoms there are about a 20% of cases which doesn’t respond to an otherwise adequate treatment even after prescribing clozapine, that is why it’s necessary to redefine some terms and reach a consensus about how to deal with these cases.
The aim of this study is to analyze the different therapeutic alternatives and combinations available for the treatment of ultra-resistant schizophrenia
We proceed to review the recent bibliography on this subject, with regard to the case of a 41 year old female diagnosed of Paranoid Schizophrenia since its first episode in 1998, followed by 8 more episodes that required hospitalization. While she has experimented clear improvement after each stance in the psychiatric ward the affection has evolved worse than expected even though she has had a correct compliance and adherence to every prescribed treatment. Psychopathologically the patient experimented intense psychotic symptoms including auditory hallucinations that had a strong impact on her and her physical state leading to a huge loss of weight after she stopped eating properly due to the voices contents, these symptoms kept evolving even after increasing the daily dose of clozapine.
After maintaining the treatment with clozapine at higher doses and not seeing improvement, we finally achieved improvement by adding aripiprazole.
Even though clozapine has proved to be an effective treatment there are some cases when it’s not enough and we need to rely on polytheraphy , being one of those aripiprazole.
In Pamplona, Spain, there is an Early Intervention Program that has been providing assistance for First Psychotic Patients for the last two years.
To analyze the longitudinal effects of the different interventions in clinical variables applied to 211 patients during two years of follow-up: CASH dimensions, substance abuse, antipsychotic type and dosage, remission rates, re-hospitalization rates and all-cause-of-treatment-dropout and DSM 5 diagnoses
We apply a standarized evaluation protocol to every patient at different times: premorbid, initial time, and every three months during follow up.
The CASH positive dimension (delusions and hallucinations) had a mean score at baseline of 3.77, showing an evident decline during the follow-up. The same happened with the disorganized dimension. We found no significant differences in the negative, motor and affective dimensions.
Regarding remission rates from the 6 to the 24 months we found a decline in the rates, accordingly to the increase in re-hospitalization rates. Some of these cases were due to treatment dropout. The doses of antipsychotic treatment are lower at the end of follow-up
Substance abuse rates are lower within the first six months, but after this time the percentage of non-consumers declines.
The most frequent DSM 5 basal diagnosis is Brief Psychotic Episode, but during follow-up the diagnosis of Schizophrenia increase from 14.6% at baseline up to 46.2% at month 24.
The Early Intervention Services improve, psychopathological dimensions and decrease re-hospitalization rates.
Erotomania is defined as a condition in which the patient believes that some celebrity or person of higher status is in love with her, and interprets his words and actions as unequivocal signs of love. The father of this concept, Clerambault, described erotomania as a clinical syndrome, with a chronic or transitory course, sometimes a premonitory syndrome or as an independent entity.
Describe a case of a female patient with erotomanic delusions with no remission under therapy and to review the links between erotomania and other psychiatric disorders.
Literature review and a case report. The databases Pubmed and Medline have been consulted and the most appropriate articles were examined.
We report the case of a 70-year-old white woman diagnosed with having schizoaffective disorder for the previous 56 years. She had multiple hospitalizations, most of them with maniac symptoms associated with mystical, megalomaniac and erotomanic delusions. Clinical remissions were minimal, despite various treatment modalities, the patient remain entrapped by their erotomaniac delusions.
Erotomania is described as a rare entity, usually listed under other syndromes and neglected in the recent literature. There are a few studies with schizoaffective and schizophrenic patients that conclude, like our case-report, that erotomanic delusions have a chronic course and are relatively refractory to treatment. However, there is still lack of systematic description, assessment and diagnosis and there is a need for further enhanced epidemiological study.
Schizophrenia is a frequent and severe group of mental disorders without pathognomonic signs.
Symptoms may include disfunctional perception, cognition, behavior. Individuals seek public health system referring their thoughts, feelings, acts are felt/ shared/ influenced by external forces. Humor accompany inertia, negativism, lethargy.
Studies have shown symptoms occur firstly in patients younger than 25 years old.
To assess the impact of schizophrenia with gender and ages most affected in public health system of Brazil.
Assess patients by age and gender in Brazilian public system of health and expenses created due to schizophrenia. Data were collected and analyzed from SIH/SUS including all public health institutions in Brazilian states.
Hospitalizations- Age/Gender | ||||||||||||||
Gender/Age | > 1 | 1- 4 | 5 - 9 | 10 - 14 | 15 - 19 | 20 - 29 | 30 - 39 | 40 - 49 | 50 - 59 | 60 - 69 | 70 - 79 | 80 + | Total | |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
TOTAL | 184 | 56 | 289 | 4.147 | 36.939 | 178.219 | 218.193 | 198.671 | 136.241 | 49.431 | 12.218 | 3.469 | 838.057 | |
Male | 98 | 26 | 200 | 2.275 | 26.089 | 127.980 | 139.393 | 112.863 | 72.994 | 24.981 | 5.556 | 1.455 | 513.910 | |
Female | 86 | 30 | 89 | 1.872 | 10.850 | 50.239 | 78.800 | 85.808 | 63.247 | 24.450 | 6.662 | 2.014 | 324.147 |
According to records in SIH/SUS database in 10 years, ages most affected by schizophrenia and correlations are 20-29 and 30-39. Total expenses were BRL2.104.780.862,51, approximately USD5.045.159,7.
Results found agree with previous studies that most common age of onset was around 25 years. Schizophrenia and correlations are a concern for public health, because underdiagnosis increase the burden and create further expenses, along with discomfort for patients and families.
Noonan síndrome (NS) is a relatively common genetic syndrome caused by mutations affecting a cellular signaling pathway known as the Ras-map kinase (RAS-MAPK) pathway, which is essential for the typical growth and development of multiple systems. NS is estimated to occur in approximately 1:100 to 1:2500 births. Clinically, NS is associated with cardiovascular abnormalities, growth and endocrine disorders, hematologic symptoms, as well as neuropsychological features including cognition, language, memory, attention, adaptive behaviour, social skills and anxiety. Most of these symtoms are associated with psycosis.
To expose the importance of the higher incidence of psychosis in NS.
This is a systematic review in UpToDate.
Intellectual disabilities in children with NS are increased to the general population. Lower inteligence has shown to be a risk factor for attention difficulties. Also, it has shown that NS patients has slowed processing speed, which is linked to developmental and behavioral disorders. There have been found some differences in frontal lobe-subcortical circuitry, which is critical for working memory, response inhibitiom and cognitive flexibility. Anxiety and depression were present in almost three times greater tan de community.
All these features added to the physical limitations, make it reasonable to expect higher rates of psychosis in these individuals, although studies that determine the extent to which they are increased are lacking.
The review of the physical and neuropsychological features suggest that in NS there is an increased risk for anxiety, social cognition and adaptative behabiour, which could increase the risk of psychotic symptoms.
The rates of mortality among people with psychotic disorders are a major public health concern. Little is known about clinical and social factors that can predict these differences in mortality rates with respect to general population and to those patients who don’t have anticipated death (Reininghaus et al., 2015).
To study mortality in a cohort of patients with a first episode of psychosis (FEP) and to examine clinical and social variables which are associated with an increase in early death in psychotic disorders.
This is a retrospective observational study of a cohort of 523 patients, who were hospitalized in the Psychiatric Department of the Complejo Hospitalario de Navarra between 1990 and 2009 with a FEP, and a mean follow-up of 18 years. Mortality rate of this cohort is reported, and clinical and demographic variables are examined.
The mortality in this cohort was of 83 patients (15.87%). First cause of death was natural death (36.14%) followed by suicide (18.07%) and cancer (16.87%) (Fig. 1)
When comparing demographic, clinical and functionality variables, we found that both groups only showed significant differences in age at illness onset and education (Table 1)
A late illness onset and low educational attainments resulted in two differential factors in our sample of FEP patients who were followed up after a mean of 18 years. Although the first cause of death was natural death, a deeper analysis of the high rates of suicide is needed.
The inaugural stages of psychotic conditions are a critical period, during which patient involvement and adherence to treatment are essential, as delaying the institution of psychosis treatment is associated with long-term negative consequences. About two thirds of patients have a suboptimal response to antipsychotics, and these results are further aggravated when substance use disorders are present. Studies have shown that there has been a somewhat limited impact of psychosocial therapy, suggesting little or no benefit from using psychotherapeutic interventions in these individuals.
Evaluate the use of Cannabidiol as an adjunctive treatment for inaugural (or already established) psychosis in order to improve adherence to antipsychotic therapy in patients with cannabis abuse.
Narrative literature review by performing a search on MedLine for English-written articles. The query used was “(CBD OR Cannabidiol) AND (Schizophrenia OR Psychosis) AND (Psychiatric OR Psychiatry)”.
Increasing attention has recently emerged towards the endocannabinoid system as a potential therapeutic target for these disorders. CBD, unlike THC, is devoid of adverse psychoactive effects and its clinical interest in psyhchiatry derives from its antipsychotic, anxiolytic, anti-inflammatory and neuroprotective properties. CBD appears to counteract psychotic symptoms and cognitive impairment associated with cannabis use and may lower the risk for developing psychosis that is related to cannabis use.
Cannabidiol is nowadays an emerging therapeutic agent that has shown potential efficacy in the treatment of psychotic disorders, substance use disorders, and coexistence of these disorders. Cannabidiol may thus represent a more easily acceptable and tolerable therapeutic agent for this particularly vulnerable population.
Schizophrenia is a severe mental disorder leading to patients’ functional deterioration, compromising their daily life.
Investigate the potential impact that a long-acting injectable such as aripiprazole once-monthly (AOM) has in the course of schizophrenia by evaluating patients’ functionality and overall clinical outcome, in the psychiatric clinic of a general hospital in Greece.
Five patients are included in the current report, two males and three females, 25 to 45 years old. CGI-S (Clinical Global Impression- Severity) and GAF (Global Assessment of Functioning) scales were evaluated at hospital admission, upon discharge and once monthly for a period of at least 6 months. Functional improvement was set as a treatment goal for these patients for the first time after diagnosis.
CGI-S score at baseline was >5 and GAF score was ≥40. All five patients, previously stabilized with aripiprazole per os, responded to AOM 400 mg treatment and experienced improvement in daily functioning. Clinical improvement was observed in 6-8 months’ time with a reduction in the CGI-S score >1 point and functionality improvement was evident by almost doubling the GAF score, possibly increasing the expectations for better disease progression. More specifically, in 6 months’ time patients experienced “no more than slight impairment in social, occupational or school functioning”, a description based on the GAF score.
Treatment with an atypical long-acting injectable antipsychotic such as AOM 400mg, improved the aforementioned patients’ functionality and overall treatment outcome in a real-life clinical setting.
Synthetic catinones are
We present a case report of psychotic symptoms resulting from mephedrone use.
A 32-year-old male consults at the emergency department for psychotic symptoms present three days after consuming mephedrone.
There is no prior psychiatric history. He refers occasional use of drugs for recreational purposes: cocaine, amphetamines, GHB, mephedrone. Although he has never consulted, he admits previous psychotic experiences, in the context of drug use, specifically by mephedrone.
At the moment he reports threats and noises coming from his neighbours’ home for the last three days, describing fear for his safety. He also presents insomnia and hyporexia. He confirms mephedrone use, in the context of chemsex.
Drug-induced psychotic disorder is diagnosed. Aripiprazole 5mg is indicated and the patient is referred for follow-up.
Chemsex is a psychosocial phenomenon growing in Spain, involving the use of psychoactive substances to seek pleasant sensations and facilitate certain sexual practices. Mephedrone is one of the drugs used, and can lead to psychotic symptomatology.
Anti–N-methyl-D-aspartate receptor encephalitis is an autoimmune syndrome that presents with complex neurologic symptoms, like memory deficits, alterations in level of consciousness, seizures, abnormal movements, as well as psychiatric manifestations. Patients can develop psychotic symptoms, anxiety, agitation or bizarre behavior. Occasionally, psychiatric manifestations are the most prominent symptoms, and clinicians may initially suspect psychiatric illness, resulting in an inaccurate diagnostic approach and delay in correct treatment.
We here present a case of a young woman admitted in the Psychiatry ward for acute onset psychotic symptoms, suspecting a psychotic or dissociative disorder.
A 28 year-old-woman is brought to the Emergency department presenting with agitation, hallucinations, disorganized speech, delusions and insomnia.
She has a history of a mixed anxiety disorder that had been treated with SSRIs and benzodiazepines. At the moment she was not taking any psychiatric medications.
Initially, she was treated with antipsychotic drugs and benzodiazepines, resulting in rapid remission of the psychotic symptoms. She presented excessive drowsiness, this believed secondary to treatment. Moreover, cognitive alterations displayed: short-term memory deficits, errors in nomination and repetition, semantic paraphasias, echolalia and bradypsychia.
Brain MRI found no remarkable alterations. Electroencephalogram was normal. Analisys of cerebrospinal fluid finds anti–N-methyl-D-aspartate antibodies in 1:16 proportion.
Anti-NMDAR Encephalitis is diagnosed. Patient is transferred to the Neurology ward and starts immunotherapy. Further studies are carried out for the detection of teratoma.
For patients presenting psychotic or other psychiatric symptoms associating cognitive or memory alterations, anti–N-methyl-D-aspartate receptor encephalitis should be considered in the differential diagnosis.
First episode psychosis is one of the most challenging subjects in Psychiatry because the symptoms can be complex, they are not specific, the prodrome varies and the consequences can be devastating if the patients don’t receive the right treatment as fast as possible.
The main goal was to evaluate the relationship between the symptomatology and the way of addressability at mental health services of a group of patients diagnosed with First Episode Psychosis.
We observed 22 patients hospitalised in our Clinic of Psychiatry during September-December 2018 who were at the first contact with any Psychiatric Service and had the diagnosis of Acute and transient psychotic disorders( F23 on ICD 10). The following parameters were analyzed by us: gender, age, urban/rural, education, profession, marital status, way of addressability and clinic symptomatology. We divided the subjects in two groups: A – patients brought by their families and B – patients brought by ambulance and police.
The majority of subjects( 68,18%) were brought at the Hospital by ambulance and police but still at the initiative of their families. Subjects from group A showed: paranoid delusions(100%), hallucinations( 71,43%), delusion of control(71,43%) and expansive delusions(85,81%). Subjects from group B showed: paranoid delusions(93.33%), hallucinations(80%), delusion of control(73,33%) and expansive delusions(73,33%). Statistically there are no major differences between the two groups regarding the symptomatology.
The majority of subjects with First Episode Psychosis reach the Psychiatric Facilities brought by ambulance and police and less brought by their families. The dominant symptoms are paranoid delusions, hallucinations and expansive delusions.
There are few studies comparing samples of schizophrenic and delusional patients hospitalized for first time in their life.
- Determine the prevalence of both diseases in a sample of first-time hospitalized patients.
- Determine the differences between the two groups comparing multiple variables collected during their first hospitalization.
We selected all patients who were first-time hospitalized in our psychiatric unit between 1996 and 2018 and diagnosed according to DSM-IV with Schizophrenia or Delusional Disorder.
Through the SPSS program we compared different clinical and sociodemographic variables collected during basal hospitalization between diagnostic groups.
117 patients were diagnosed with Schizophrenia and 107 with Delusional Disorder, representing 4.9% and 4.5% of the total number (2370) of first-time hospitalized patients. The variables that significantly differentiated delusional patients were: female gender (53% vs. 22% , P<0.000), higher age (average of 56 vs. 38, P<0.00), more involuntary admissions (26% vs 11% , P<0.005), more organic comorbidity (49% vs 24%, P<0.000), shorter duration of illness (10% more 20 years vs 27%, P<0.004), less antecedents of previous cannabis use (15% vs. 35% P<0.002). After a logistic regression analysis, higher age, more percentage of involuntary admission and shorter duration of illness remained significantly associated with Delusional Disorder.
- Schizophrenics and delusional patients represent 4.9% and 4.5% respectively of all first-time hospitalized patients.
- Delusional patients are significantly older, have a significantly shorter duration of illness and are involuntarily hospitalized in a larger percentage than schizophrenics.
Impairment in different social cognition domains has been found across different phases of schizophrenia spectrum disorders. There is growing evidence showing that they are linked with worse functional outcomes, which raises the question whether they remain stable over time. To date, few studies have tried to establish a comparison between social cognition performance in early and chronic psychosis and mixed findings have arised
The aim of the current study is to compare social cognition performance between samples of early and chronic psychosis.
Data from 81 patients: 53 chronic (>5y) psychotic patients and 28 early psychosis (<5y) was collected. Patients were assessed on different Social Cognition tasks: Reading the mind in the eyes test (RMET), Ambiguous Intentions Hostility Questionnaire (AIHQ) and Hinting Task Test (HT).
Compared with chronic SSD patients, Early Psychosis group had better performance on some social cognition tasks: HT, Mean Difference (MD): -1,593 CI 95% -2,551 to -0,634 p:0.02; and RMET MD: -3,142 CI95% -5.490 to -0,794 p:0.01. Although no differences were found on global AIHQ performance, Early Psychosis patients tended to display more aggression attributions (AIHQ-AB MD: -,24080 CI95% -,474 to -,007 p: 0,044), and Chronic SSD patients more hostility attributions (AIHQ-HB MD: 0,303 CI95% 0,002 to 0,603)
Social Cognition decline in psychotic population is a largely unexplored field, although it can be an important factor explaining functional decline in patients not attending psychosocial treatments focusing on this field. Clinical significance of the results and limitations of the study are discussed.
Introduction: Non-adherence to antipsychotic therapy is an important problem in the management of schizophrenia. Long-acting injectable (LAI) antipsychotics favor treatment compliance, improving disease prognosis and reducing associated health care costs. Recent reviews seem to suggest that the optimal time to start LAI therapy would be just before hospital discharge once patients are stabilized after an acute episode.
Objectives: To evaluate and describe the treatment persistence-related factors in patients initiated in aripiprazole once-monthly (AOM) during the first 6 months after an acute schizophrenia relapse.
Methods: Observational, retrospective, non-interventional study not interfering with normal clinical practice (retrospective inclusion).
Results: 140 patients enrolled in 12 Spanish sites, 91 included in the Full Analysis Set (FAS) population. Demographics for persistent and non-persistent patients (table 1) and clinical results (table 2):
Table 1. Patient demographics
Persistent | Non-persistent | |
Persistent (%) | 71.4% | 28.6% |
Time since diagnosis (years) | 10.5 | 17.3 ** |
≤1 comorbidity at AOM initiation | 26.2% | 53.9% |
Inpatient care setting visits after AOM initiation (%) | 1.2% | 42.6% |
** p<0.001
Table 2. Clinical results
Variable | AOM initiation | 6 months follow-up |
CGI-S score | 5.0 | 4.0** |
BPRS total Score | 50.1 | 36.3*** |
BPRS positive symptoms score | 14.1 | 8.4* |
BPRS negative symptoms score | 10.2 | 8.6*** |
* p<0.003, ** p<0.001, ***p<0.0001
Mean persistence (days) in the first 6 months for persistent vs non-persistent was of 182.0 vs 48.5 (Fig. 1).
There were no serious AE/ADRs.
Conclusions: Fewer years since schizophrenia diagnosis (p=0.003) and fewer concomitant medication (p=0.02) at initiation are associated with a decrease of risk of AOM discontinuation (Multivariate Cox regression model).
Quality of life (QoL) and functionality are some of the most important outcomes for patients with chronic, debilitating diseases such as schizophrenia.
The aim of our study was to evaluate the effects of depression on functionality and QoL in schizophrenia patients.
This was a prospective non-interventional study assessing QoL in chronic stable schizophrenia patients. We evaluated schizophrenia patients admitted for re-evaluation between October 2010-October 2012 in the “Obregia” Psychiatric Hospital, Bucharest. We assessed depression using the Positive and Negative Symptoms Scale (PANSS) G6 item, QoL - measured through the World Health Association – Quality of Life (WHO-QOL) and functionality (evaluated with the Global Assessment of Functioning Scale - GAFS). We analyzed (linear regression) the influence of depressive symptoms on QoL and functionality while controlling for positive and negative symptoms (evaluated with PANSS).
We included 110 patients, 45 (40.9%) of which were males. The mean age was 40.2 (±10.37). The mean PANSS G6 score was 3, meaning most patients presented with mild to moderate depression. More depression symptoms are associated with lower QoL, especially in the physical (F(1,108)=10.559, p=.002, R2=.089), social relationships (F(1,108)=4.911, p=.029, R2=.043) and psychological domains (F(1,108)=8.553, p=.004, R2=.073) of the WHO-QOL. From a clinician point of view (measured through GAF), depression had no impact on the functionality of these patients (mean GAF score 75.13, ±9.17, p=.259).
Patients with schizophrenia experience depressive symptoms which lower their QoL. It is important to diagnose and treat these symptoms in order to provide prompt interventions which may improve QoL in schizophrenia patients.
Psychiatrists must always keep in mind the variety of organic mental disorders. Alterations in thyroid hormones are a common cause of psychiatric symptoms, most of them related to mood disorder. However, psychosis is not as well defined as a part of this disorders.
The aim of this review is to bring closer to professionals this kind of manifestations, with a clinical example with a wide range of symptoms.
We conducted a review of the scientific literature on Pubmed, following a clinical case registered in our center. The search was focused on symptoms, its relation with blood levels of thyroid hormones and treatment.
Thyroid disfunction are common and affect almost 5% of the general population, with a female predominance. After Asher (1949) created the concept of “myxedema madness”, number of cases in literature has increased. Etiopathogenesis is still unknown, although several theories are defended. There is no correlation between the degree of thyroid dysfunction and the severity of the psychiatric symptoms manifested.
- Organic diseases can cause classic psychotic symptoms: hypothyroidism is one of them.
- Etiopathogenesis of psychotic symptoms in hypothyroidism is still unknown.
- Correlation was not found between the degree of thyroid dysfunction and the severity of the psychiatric symptoms.
- Treatment consist on hormone replacement therapy, although some symptoms can remain in some cases.
- Further investigations, as well as systematized reviews, are required to get a better knowledge of cases and get an earlier diagnosis.
Creutzfeldt - Jakob disease (CJD) is an extremely rare and devastating disease characterized by rapid neurological deterioration in a healthy individual. The classic clinical presentation of CJD includes rapidly progressive dementia, myoclonus, pyramidal, extrapyramidal and cerebellar signs. Although it is less, frequent that the disease begin with non-specific psychiatric signs.
Describe the different psychiatric aspects of CJD
retrospective study of a single case diagnosed CJD
We reported the case of a 66-year-old woman without personal or familial psychiatric history. Initial symptoms included delusions of persecution, depressed mood, memory loss, and a strange sensation.
His sons stated that his cognitive problems had worsened significantly in the previous two weeks and associated with visual, auditory and sensory hallucinations. The physical examination was significant for perseverance, agnosia and apraxia associated with depressed mood and loss of vital momentum. His muscle tone was normal at all four extremities. Magnetic resonance imaging (MRI) showed high signal intensity in the bilateral caudate, putamen and left frontotemporal cortex in T2-weighted and diffusion-weighted imaging. Studies on cerebrospinal fluid (CSF) were also performed. The number of cells, glucose and proteins were within normal limits its 14-3-3 protein level was positive.
Our patient was diagnosed with probable CJD, based on internationally-agreed diagnostic criteria. This fatal neurological disease occurs in sporadic, familial and acquired forms. Psychiatric symptoms are considered rare; in early stages of the disease they are found in up to 40% of the cases. However, presentation as a pure psychotic condition over so many months of development is not typical
Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by facial capillary malformations and / or ipsilateral cerebral and ocular vascular malformations, which give rise to varying degrees of ocular and neurological abnormalities.
Prevalence at birth in Europe is estimated at around 1 / 20,000 and 1 / 50,000.
Cerebral vascular malformations are also present. Babies usually have leptomeningeal angiomatosis in the first year of life, responsible for the existence of complex focal or partial epileptic seizures, early manual laterality and preferences in the direction of the gaze. With the progression of the disease, and depending on the severity of the seizures, patients may develop hemiparesis, hemiplegia and varying degrees of intellectual disability.
The objective of this communication is to present an unusual and unusual case of Sturge Weber Sindrme with psychotic symptoms with behavioral disorders.
Description and analysis of the clinical case and review of the state of the art.
A 45-year-old patient diagnosed with Sturge-Weber syndrome (encephalotrigeminal angiomatosis). In 2019, it begins with a delusional idea of damage by livestock farm employees, generating multiple conflicts with them. He disappears from his city and the police place him in France, he suffers an epileptic crisis after leaving the treatment and the family locates him in the immediate vicinity of the hospital, after which he is transferred to Spain to enter his reference hospital in the area of psychiatry
The patient is treated with amisulpride and antiepileptic drugs, improving behavior and the delusional idea of harm.
The coexistence of obsessive compulsive symptoms (OCS) and psychotic symptoms has been reported since the 19th century, with low prevalence rates (1-3.5 %). However, more contemporary studies have shown a much higher prevalence of OCS (25%) and OCD (12%) in schizophrenia. Schizo-obsessive disorder has been proposed to clasify these patients.
Here we present a case report of a patient who has presented a wide range of OCS, both in the acute and in the chronic phase. We describe the main characteristics of the schizo-obsessive spectrum, the patient´s disease progression and his treatment.
Description of a clinical case and literature review.
A 28 year-old-male, previously diagnosed with schizophrenia and OCD, was admitted to the psychiatric rehabilitation unit. He had a long history of hospital admissions and had received a multitude of psychopharmacological treatments. Since the first psychotic episode, the content of the obsessions and compulsions wasn´t interrelated with the content of delusions. Althought OCS worsened after the introduction of certains antipsychotics, mainly clozapine, these symptoms were present before receiving any type of drug. Also, his clinical presentation changed over time, from the predominance of paranoid delusions and contamination obsessions, to becoming particularly disorganized and with extravagant time-consuming compulsive rituals.
There is enough evidence in the literature showing the clinical importance of the schizo-obsessive spectrum disorders. However, little is known about the treatment strategies and there is a great dificulty in categorizing these disorders, because, sometimes, in clinical practice, the borders between obsessive and delusional thoughts are diffuse and arbitrary.
Carboplatin-liposomal doxorubicin is a widely used chemotherapy combination against ovarian cancer. Very few cases of new-onset psychosis have been reported during treatment with platinum-containing antineoplastic drugs. Anxiety, depression and insomnia have been reported with doxorubicin; but there are no reports of acute psychosis so far.
The aim is to expose a clinical case in order to provide further evidence on this topic.
We present a 67-year-old woman without previous psychiatric history, diagnosed with ovarian high-grade serous carcinoma stage IIIB. She received three cycles of carboplatin-paclitaxel, which was later changed to carboplatin-liposomal doxorubicin due to peripheral neurotoxicity associated to paclitaxel. Behavioural disturbances, persecutory delusions, insomnia and aggressiveness appeared two weeks after receiving the second cycle of the new antineoplastic combination. She was hospitalized and assessed for organic etiologies, although no evidence of metastasis in Central Nervous System was found.
She was diagnosed with brief psychotic disorder and started on paliperidone up to 12 mg per day and quetiapine 50 mg per day. The following days she recovered to her basal mental state and one week after she was discharged. No psychotic relapse occurred after two more cycles of chemotherapy.
This case reports the possible association between chemotherapy and the development of a psychotic episode. The timing of symptomatology onset suggests doxorubicin was responsible for the psychiatric complication. Behavioural disturbances in patients receiving chemotherapy should lead to psychiatric evaluation, as long as organic pathology has been discarded.
Psychotic disorders in childhood and early adolescence often progress to more serious illness, but in many instances, there are underlying diagnosable medical causes. Careful clinical examinations are warranted to detect any signs of a possibly treatable disease.
To report a case of a 14-year-old male with behavioural changes.
Case report based on clinical records. Brief literature review.
A 14-year-old male was first evaluated in an outpatient clinic. 5 months earlier, he began presenting slight behavioural changes, mainly disinhibition, with increasing severity, alongside parasomnias (agitation, repetitive incoherent speech and subsequent amnesia). By the time he was evaluated, psychomotor restlessness and disinhibition was marked. He also presented pressured speech with loose associations and some speech perseverance. No delusional content was detected. There was a significant impact in the familial and school domains. A diagnosis of probable hypomanic episode was prompted and the patient derived to a specialized program. Blood workup, serum and cerebrospinal fluid autoimmunity study, MRI and electroencephalogram wielded no relevant results. He showed limited response to olanzapine. Aripiprazole wielded better behavioural response and valproate add-on led to added benefit, although incomplete. Later, a polysomnography revealed right temporal dysfunction with very frequent epileptiform activity and occasional left temporal activity. Eslicarbazepine was added with remission of parasomnia episodes and behavioural improvement.
This case highlights the importance of thorough diagnostic workup when dealing with manic/psychotic symptoms in very young patients. Considering a possible underlying structural substratum is paramount as it may affect the treatment and the prognosis.
Based on the work carried out with more than a hundred and fifty patients who have participated in the Art Therapy activity at the Puerta de Hierro Majadahonda Psychiatric Day Hospital since 2002, and the analysis of its expressive and communicative processes, a paradigmatic case has been selected.
To identify which characteristics of verbal language hinder its expressive and communicative function in schizophrenic patients, and determine what the differential contribution of artistic language could be.
Analysis of the art therapy process of a 55-year old male, diagnosed with schizophrenia since the age of 24, with persecutory delusions and sensoperception alterations, whose most dysfunctional symptomatology was a disorganized, prolix, circumstantial verbal language that did not allow him to communicate. This frustrated him as well as the rest of the patients and therapists.
The differences between the way of constructing the verbal and de artistic language are analyzed.
The written logical verbal language recorded over a year of treatment in the HDP does not present relevant changes in terms of its expressive and/or communicative functionality.
The discourse developed from the plastic language is perceived by the patient as egosyntonic, endowed with meaning and effective in terms of social connectivity.
Opposed to the continued dysfunctionality of written verbal logical language as and expressive and communicative route, plastic language can facilitate the construction of a structured narrative that is meaningful to the patient and comprehensible to his or her environment.
Corticosteroids are commonly used to treat collagen tissue diseases.However,they are associated with various neuropsychiatric disorders including depression,hypomania and mania,frank psychosis,delirium and etc.In the literature,there are many case reports about corticosteroid-induced psychosis when high doses have been used.
Our aim is to present a case of psychotic exacerbation occurring at a low dose of corticosteroids with delusional disorder,in contrast with the literature.
History:Mr.O.A. is a 64 year-old patient diagnosed with delusional disorder, who was admitted to our inpatient service in 2019 due to a three month history of delusions of reference,persecutory delusions and delusions of passivity and delusional misinterpretation.His history revealed that he was diagnosed with delusional disorder in 2013,was presented with delusion of jealousy and agitation.During this period, he also experienced a worsening of his psoriatic arthropathy and the immunologist therefore increased his prednisolone dose from 5mg to 10mg daily.The delusions of reference,persecutory delusions and delusions of passivity then resurfaced after this medication increase.
Discussion:To date, many studies have discussed the link between corticosteroids and neuropsychiatric disorders.There is no agreed cut-off dose for corticosteroid treatment for patients with psychiatric diagnoses, nor any information about the effect of delusion’s types.In our case,symptoms added after increasing corticosteroid dose to 10mg totally disappered after decreasing prednisolone dose to 5mg again.
Corticosteroid is an important and effective treatment for collagen tissue diseases.However,corticosteroids cause many psychiatric disorders or symptoms.There is no recognised cut-off limit for corticosteroid therapy when is administered to a patient with a psychiatric disorder.Further research and attention in this area are required.
The phenomenon of infantilism and puerelism are considered as parallel in the framework of «age identity disorders» (AID). However, the comparative clinical pathway of infantilism and puerilism in schizophrenia remains poorly understood.
The aim of study - psychopathological, psychometric analysis of AID on the model of schizophrenia.
Research summarize the results of the study in a sample of 45 patients with schizophrenia, following with the detectable signs of AID in clinical course of the disease (23 - infantilism; 22 – puerilism).
Psychometric evaluation was carried out using SANS, DES and “Methods for diagnostics of personal maturity” (MDPM). Statistical processing was carried out using Mann-Whitney test and Spearman correlation analysis.
The differentiation between infantilism and puerilism in schizophrenia is not limited by differences in the indicators of age-related immaturity (Tab.1):
Scale | Infantilism | Puerilism | p |
SANS | |||
Avolition | 2.9±0.4 | 3.2±0.4 | <0.05 |
Asociality | 1.7±0.3 | 2.4±0.3 | <0.05 |
DES | 0.3±0.2 | 0.8±0.1 | <0.01 |
MDPM | 46.3±5.7 | 82.4±6.2 | <0.01 |
Tab.1. Psychometric scores by groups
1) Infantilism forms in childhood and shows an affinity to the dimensional structures of the negative symptoms - avolition disorders (Tab.2).
2) Puerilism forms in adulthood, manifests in the framework of dissociative psychosis and, conversely, shows the affinity to the positive symptoms - dissociative psychopathological formations.
MDPM | R | ||
SANS | DES | ||
avolition | asociality | ||
Infantilism | -0.876 (!) | -0.325 | -0.325 |
Puerilism | -0.325 | -0.267 | -0.987 (!) |
Tab 2. Correlation between MDPM and SANS/DES scores by groups
Infantilism and puerilism are associated with polar dimensional structures (positive-negative symptoms) and can be regarded as psychopathologically heterogeneous formations.
Meningioma is a slow-growing benign tumor arising from meninges, usually asymptomatic. Meningiomas may be primarily present with mood disorders, psychosis, memory disturbances, personality changes, anxiety or anorexia nervosa, but frequently it presented with neurologic signs due to mass effect.
Prevalence rates for meningiomas are variable and range from 50.4/100,000 to 70.7/100,000. Female incidence is about three-fold the male incidence, with the largest difference observed between 30 and 59 years.
Although there may be an association between some tumor locations and psychiatric symptoms, it is difficult to predict the symptoms based on the location or vice versa.
Show the importance of complementary test due to discard organic anomalies that could justify symptomatology.
A 53 years old single woman with no history of psychiatric disorder or drug abuse. The patient came to urgencies with his family due to behavior disorder, anxiety and insomnia in the last month. In the examination presents disorganized behavior with rituals, and thoughts abnormalities, including though blocking and irrational laughers inconsistent with the mood. Strange speech behaving suspiciously and hyperalert. Hyporexia and weight loss of 10kg
Blood tests, serologies, drug screening shows no abnormalities
Craneal MRI: pineal/ tentorial border meningioma
BDI: 9
IPDE: correlation to histrionic behavior
We decide an involuntary hospitalization due to lack of diagnosis and patient unconsciousness of her mental condition. We initiate treatment with paliperidone 6mg/24h , lorazepam 1mg/8h and lormetazepam 2mg/24h.
The posibility of cerebral tumours as the cause of developing first psychotic episode and the importance of cerebral scaner in middle ages.
The term chemsex refers to sex intentionally had under the influence of psychoactive drugs, mostly among men who have sex with other men. When drugs are administered by intravenously, it is know as slamming or slamsex. Mephedrone is the most commonly used drug to this practice, in combination with other as amphetamines. This practice has been associated with some psychiatric and organic complications.
Describe a case about drug-induced psychosis, one of chemsex complications. Moreover, show the multiple medical complications associated with its consumption.
Patient’s data is obtained from medical history, psychiatric interviews carried out during his hospitalizations and his psychological follow-up in center for comprehensive drug addiction care.
45 year-old man patient was admitted into psychiatric unit due to delusional ideation, behavioral disturbances and heteroaggressiveness after mephedrone, amphetamines and other drugs intoxication in the context of slamsex practice. He has a history of two previous autolytic attempts but no psychotic episodes, and a consumption of intravenous mephedrone since two years ago with great emotional impact. After one week of hospitalization and antipsychotic treatment psychotic symptoms disappear. Concerning his medical history, he was infected for HIV, syphilis, hepatitis A and visceral Leishmania.
It is necessary to be aware of the increased in chemsex and slamsex rates and therefore of the comorbidities that have associated. Rapid detection is important in order to reduce and control the severe addiction they entail (especially intravenous consumption).
Sensibility to other people’s opinion about oneself varies from apathetic to hypersensitive states. As first described by Kretschmer, when the sensitive disposition is exaggerated occurring simultaneously with some endogenous and exogenous pathogenic factors, it may lead to sensitive delusions of reference. The sensitive character is defined as shy, hyper-emotive and sensitive individuals, with a tendency to self-criticism.
Presentation of a scientific poster discussing a case of sensitive delusion of reference in a 40 years old male.
Case report is presented. Bibliographic research conducted using the search engine Pubmed®.
A 40 year old male with premorbid obsessive traits, seeks psychiatric help due to feelings of prejudice and people looking at him “strangely, specifically staring at his pubic region”. He also refers having the perception “people talking about him behind his back”. Characterwise, its an individual with anancastic personality traits, highly demanding with himself and very competitive. Diagnosis was initially complex, however later he revealed that symptoms started since he once used a penis enlargement device and felt that someone must have noticed it.
The symptomatology of sensitive delusions of reference is the exaggerated effect of the sensitive character traits. This often starts after a traumatic event that reveals the subject own failure and/or humiliates him/her. Their ideas of reference, hypochondriacal fears and self accusations all lead to one central experience. The course of all sensitive delusions of reference is comparative benign although severer forms may take a course of several years.
With the growing of global aging population, psychosis arising for the first time in older people is becoming more common. Presently, the diagnostic boxes on the subject of late onset psychosis remain controverse. As Bleuler once described “the science of late onset psychosis is the most obscure field of psychiatry”. The observation of psychotic symptoms in individuals over 60 years old with no psychiatric premorbility has suggested that late paraphrenia (LP) is nosologically different from schizophrenia. Recently, LP has been classified as very late-onset schizophrenia-like psychosis.
Our goal is to present a scientific poster discussing a case of late onset psychosis in a 68 years old male and its diagnostic challenges.
Case report. Bibliographic research was conducted using the search engine Pubmed® and the keywords: “Late onset psychosis”.
A 68 years old male presented himself at the emergency service with persecutory delusions and hallucinations in the visual and auditory modalities. He had been hospitalized in the previous year for similar symptoms. However, the diagnosis became challenging as hospitalization progressed.
This condition can be a form of presentation of late onset schizophrenia, or it may constitute a distinct condition. Late paraphrenia does share some similarities with schizophrenia, such as delusional beliefs and possible hallucinations (mostly auditory), but is distinguished by the well preserved personality and affect. It has been suggested that the older the patient the greater the similarities between LP and late onset schizophrenia in respect of neuropathology, treatment and prognosis.
Cannabis is the most commonly used recreational drug in the world, and its use has been associated with increased risk of psychosis. Nonetheless, despite the hypothesis that cannabis use is a contributory cause of schizophrenia, other possibilities have been formulated to explain the replicated association between cannabis use and psychosis: (a) persons with schizophrenia may use cannabis as a form of self-medication; (b) cannabis use is a confounder of use of other psychotogenic drug use or (c) there is a common genetic vulnerability between cannabis use and psychosis.
Analyse difference in reason to use cannabis between cases and controls
Using data from the multicentric EUGEI case-control study of First-Episode Psychosis, we examined differences in reasons to start use of cannabis, using the Cannabis Experiences Questionnaire. Descriptive comparisons between groups were made with Chi2 and associations were explored using multinomial logistic regression models.
Around 85% of controls started using cannabis because either friends or family were using it, 68% of cases attributing starting due to this reason. Significantly higher percentage of cases started using cannabis to feel better (18% of cases vs 5% of controls). Regression models showed that being a case was positively associated with starting use in order to feel better (RRR 4.67, z=7.58, p>0.001), remaining significant when adjusted.
A higher proportion of patients with psychosis than controls start using cannabis as a way to make them feel better; this raises the possibility that in a minority of cases, self-medication may be relevant.
The negative symtoms and metabolic syndrom are a very frecuent phemomena with hard treatment.
Find the differences in the improving of negative symtoms and the metabolic rates in patients with change of neuroleptic (oral to paliperidone palmitate injection).
Observational longitudinal study during 18 months. We incluided all the patients with the diagnosis of schizophrenia, in which we done a change from oral neurolepic to Palmitate of Paliperidone and age of 18 years o more.
We used SANSS and CGI-Scale for negative symtoms and metabolic rates (weight, IMC, Glucose, Colestherol, TG and prolactin) and abdominal perimeter.
40 patients was incluided. 60% are male. Average age 42.48 years. 22% has metabolic disease, 32% with axis IV disease and 28% with toxic sustances Average dosis of palmate of paliperidone 105 mg/28 days.
The reason of change to injection was: No response 38% to oral neuroleptic treatment and side effects 28%. Rest patients wish.
Metabolic rates improved: Less in weight, IMC, Glucose, Colestherol, TG and prolactin and abdominal perimeter.
The SANSS scale improved, All of them were statadistical significative (p<0,05) and CGI scale results improved.
The change from oral neuroleptic to palmitate of paliperidone improved metabolic rates and abdominal perimeter . Also improved SANSS and CGI Scale.
The palmitate of paliperidone is useful in schizophrenic patients and with less incidence of metabolic side efects and improved of negative symptoms.
Risperidone long-acting injection and Paliperidone Palmitate one month are value in the treatment of Schizophrenia.
The assess the long term efficacy of Risperidone vs Paliperidone to preveting relapse. Risperidone long-acting injection and Paliperidone Palmitate are a valuable strategy for the treatment of the schizophrenia. More studies are necessary to assess the efectiveness to preventing relapse.
30 patients with diagnosis of schizophrenia was treated with Risperidone and 30 patients with diagnosis of schizophrenia with Palmitate of paliperidone. We Follow 30 months PANSS, PSMQ are performed at the begin and de end of study, We defined Relapse: Rehospitalization or 25% base lane PANSS.
The 56,6 % patients with Risperidone long-acting injection no relapse and 83,3% with Paliperidone Palmitate. The 63,3 % patients with Risperidone long-acting injection are satisfied or very satisfied while 86,6% oatients with Paliperidone Palmitate are satisfied or very satisfied . Also his famly member. The improved of de CGI scale global patients with Risperidone long-acting injection was 2,8 points, and patients with Paliperidone Palmitate was 3,9.
We observed higher percentage of relapse free in patients treated with Paliperidone Palmitate than treated with Risperidone long-acting injection. Patients treated with Paliperidone Palmitate apperars to have greter acceptance and in her family than patients treated with Risperidone long-acting injection.
People who experience a trauma may react differently, such as depression, anxiety, agitation.
In this case, patient was dismissed on charges of terrorism and reacted with childish behaviors.
CASE:
42 years old male, married with three children; suspended on charges of terrorism. For this reason, he is introverted, rarely going out. He returned to work 5 months later, but he was restless, unhappy and felt excluded from the business environment. Two months after starting work, patient had high fever and 2-hour loss of consciousness following diarrhea without any organic pathology. His mental state examination revealed visual and auditory hallucinations and persecutory delusions. Preliminary diagnosis was hysterical psychosis. He started to walk and talk childishly; his age gets smaller and smaller. Sertraline (50 mg/daily), alprazolam (2*0.5 mg) was started. In the event of advancing regression like starting to crawling and fear of falling when walking; the dose of Sertraline doubled (100 mg/daily), per day.
Four months after his discharge the idea that he was being followed lasts. He was still talking lispingly. Quetiapine(100 mg/daily), was added to the treatment. After 6 months his nightmares continue. Dissociative episodes are reduced but still last. The dose of Quetiapine is increased to 250 mg/daily. After 9 months, lispingly speech improved and functionality almost returned to normal.
Psychoanalytic explanation: the desire to escape the pressures and responsibilities of adult life. In this case, it is interesting that the regression progresses to crawling. The diagnosis of adult baby syndrome is becoming increasingly worthy of discussion.
Both childhood adversity (CA) (i.e., household discord (HD), bullying and abuse) and cannabis use increase the risk of developing psychosis, nevertheless little is known about the mechanisms underlying their association.
Using data from the EU-GEI case-control study of First-Episode Psychosis (FEP), we examined whether cannabis use mediated the relationship between CA and psychosis.
853 FEP patients and 1,174 controls were recruited as part of the EUGEI study. The Cannabis Experience Questionnaire was used to collect detailed history of cannabis use. The Childhood Experience of Care and Abuse was used to assess exposure to HD, sexual, physical, emotional abuse and bullying Early (when exposure occurred in childhood: between birth and age 12), and Late (in adolescence: between ages 12 and age 17). We performed mediation analyses to test whether the relationship between CA, Early and Late, was mediated by (1) lifetime cannabis use, (2) cannabis potency, and (3) frequency of use in adolescence.
Results (see Table 1) indicated that the relationship between HD and psychosis was mediated by lifetime cannabis use, cannabis potency, and frequency of use. When the analyses were restricted to Early HD, both lifetime cannabis use, and cannabis potency mediated the association with psychosis. In addition, both sexual abuse, and late bullying relationships with psychosis were mediated by lifetime cannabis use.
The mediational role of cannabis use was particularly robust for experiences of HD relative to other types of trauma. For that reason, children and adolescents exposed can benefit from psychosocial interventions aiming at preventing cannabis misuse.
Cognitive impairment has been found to be a more significant predictor of noncompliance than the severity of positive symptoms or attitude to treatment. Patients with the first episode of schizophrenia are characterized by high probability of exacerbations after the first attack, which is .associated with the ack of drug compliance.
The purpose of this study was to explore the relationship betweens cognitive functioning and compliance characteristics in patients with the first episode of schizophrenia.
50 patients with the first episode of schizophrenia (F20.0 "Paranoid schizophrenia") in stable remission were . assessed by PANSS, BACS, DAI. Statistical analysis was performed in the R programming environment, version 3.6.1.
The data obtained indicate that compliant patients have better indicators of auditory speech memory. In addition, patients with a satisfactory compliance, unlike non-compliant patients, have a higher level of motor skills, as well as higher speed of information processing and better planning. Executive functioning (Tower of London) had a statistically significant positive correlation with the degree of adherence to therapy (r=0,32, p=0,022).
88% of patients had neurocognitive impairment, 38% of which were characterized by low adherence to therapy. The severity of neurocognitive deficiency in certain areas, particularly planning, of cognitive functioning may be predictive in terms of the risk of violation of the treatment regimen and relapse of the disease.
Among various neurobiological models of schizophrenia,much attention is paid to structure and microstructure disturbances in brain white matter. The aim of this study is to research the most important pyramid pathway of the brain responsible for impulse transduction during motion regulation - corticospinal tract (CST) - using method of diffusion tensor imaging (DTI).
The study was done in accordance to the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans. All participants signed an informed consent.
13 young (17 -27) male patients with schizophrenia (F20, ICD-10) and 15 mentally healthy age- and sex-matched subjects were analyzed.
MRI data were obtained on Achieva 3.0T scanner (Philips) with DualQuasar gradient system and 8-channel radio-frequency receiver coil for the head. DT-images were acquired in the axial plane using echoplanar impulse sequence. Diffusion gradient were applied in 32 non-collinear directions.
Functional anisotropy (FA) and diffusion coefficient (DC) were measured in the following parts of CST in left and right hemispheres: motor area, radiate crown, posterior limb of internal capsule, cerebral peduncle, pyramids of the medulla oblongata.
A decrease in the coefficient of fractional anisotropy in the posterior limb of the internal capsule and an increase in diffusion coefficient in the radiate crown and motor cortex were observed.
The results reflect different mechanisms of changes in water diffusion in various areas of the corticospinal tract: changes in nerve fiber microstructure in internal capsule (left hemisphere) and density decrease in motor cortex and radiate crown.
Metabolic features of neuronal systems controlling movement are poorly studied in schizophrenia despite revealed motor disorders.
Aim of this study was to analyze dynamics of motor cortex metabolism in norm and in early stage of schizophrenia in period of BOLD response to event related single stimulus.
Patient group comprised 9 males aged from 16 to 28 years who met the criteria of schizophrenia (F20, ICD-10). Study was performed on Phillips Achieva 3.0 T MRI scanner. VOI in motor cortex was localized on the base of fMRI study (EPI FFE, TR = 3000 ms, TE = 30 ms).
BOLD signal in both groups demonstrated maximum at the 6th s after target stimulus, however its value was reliably lover in schizophrenia in comparison with the control group.The only [NAA] in normal motor cortex was changed after the stimulation. In schizophrenia [NAA], [Cr] and [Cho] were constant. [NAA] in normal cortex statistically significantly decreased at the 12th s after stimulus presentation and returned to initial value at the 15th s.
The reversible decrease of NAA observed for the norm in the study could provide a short-term activation of neuronal Krebs cycle through a synthesis of AcCoA using acetate obtained in ASPA reaction. Different behavior of [NAA] in the norm and schizophrenia might be related with a difference in location (or activity) of ASPA. Decreased expression of glutamate transporters in schizophrenia could also reduce consumption of NAA as a source of acetate in synthesis of AcCoA which is used for restoration of ATP.
Antipsychotics have been recognized as weight-inducing agents. Weight gain seems to result from increased food intake and reduced energy expenditure. Schizophrenia(SZ) patients are more likely to stay indoors and have reduced exposure to sunlight. Vitamin D(VitD) deficiency has been linked with SZ. It is unclear the effect of VitD supplementation on psychiatric and nutritional status in patients with chronic SZ who present obesity and being at risk of inadequacy VitD levels.
Presenting a case-report, and reviewing the association between VitD and schizophrenia.
A research was conducted using Pubmed® and the key-words: schizophrenia, vitamin D, nutritional status, selecting an English literature.
Female, 38 years old, single, referred to the nutrition consultation due to obesity, with a BMI ≥ 30.0 kg/m2(42.3kg/m2) using the cut-offs of the WHO criteria. Psychiatric evaluation was characterized by positive and negative symptoms of SZ (according to ICD-10 diagnostic criteria), received antipsychotics (risperidone 2mg, cyamemazine 100mg) medication. Medical history, obesity-related complications, medication use and blood samples were obtained. Inadequate levels of VitD(17.0 ng/mL), using the IOM cut-off points was observed. Oral supplement of 2668 U.I./day VitD was started. A tailored diet was also performed. After twelve months of follow-up improvements in the BMI(39.7kg/m2) and on psychiatric symptoms were found reducing the antipsychotic (risperidone 2mg, cyamemazine 25mg SOS) medication. Current investigations show that there is a direct association between VitD levels and the symptoms of schizophrenia, suggesting that treatment should include assessment of patients` VitD levels.
Vitamin D status should be evaluated in patients`with schizophrenia.
Treatment effects in patients with severe mental disorders are often limited by poor treatment adherence. A large body of evidence concerning non-compliance with antipsychotic medication revealed average dropout rates of about 42% within 6 months of treatment. A significantly lower number of studies examined dropout rates of psychosocial treatments (e.g. cognitive behavioral therapy, cognitive remediation) and their predicting factors. Reported dropout rates range up to 50% with a mean of 13% depending on characteristics of the study (e. quality), the therapy (e.g. duration) as well as the patient. While male gender, higher age and a longer duration of illness were often found to be associated with premature dropout from treatment, other factors like severity of negative symptoms, poor functioning and poor working memory only inconsistently impacted treatment adherence.
We aimed at investigating patient related characteristics associated with dropping out from 6 months cognitive remediation programs.
Predictive value of age, gender, education, occupational status, migration, duration of illness and psychosocial functioning on dropout status are analysed in 2x90 patients with schizophrenia. Patients participate in an ongoing RCT comparing social cognitive vs. neurocognitive remediation (ISST-study).
Interim analysis in n=110 patients completing (74%) or noncompleting (26%) the treatment period so far did not reveal significant association between investigated predictors and dropout status.
The results show that 6 months outpatient cognitive remediation is feasible, in general well received, and suitable for all patients with schizophrenia without special groups at increased risk for non-adherence.
Cognitive remediation (CR) aims to improve social- or neuro-cognitive processes with the ultimate goal of enhancing functioning and recovery. However, sufficient intensity and consistency over a period of time is required to produce cognitive gains (Wykes & Spaulding 2011), while nonadherence is likely to minimize the effectiveness of CR (Dillon et al. 2016). Though integration of CR in rehabilitative settings is preferable and benefitious (Wykes et al. 2011), the outpatient setting and longer duration of treatment usually associated with this requirement is also prone for more non-adherence in schizophrenia patients.
We aimed at investigating the feasibility of 6 months outpatient cognitive remediation in schizophrenia patient with respect to adherence and safety parameters.
Attendance in treatment and assessment sessions, reasons for discontinuation, and safety parameters (suicidal crisis, rehospitalisation) are analysed in 2x90 patients with schizophrenia. Patients participate in ongoing RCT comparing social cognitive vs. neurocognitive remediation (ISST-study). Both CR-conditions comprise 18 sessions each within a treatment period of 6 months.
Interim analysis in n=81 patients completing and n=29 patients discontinuing the treatment period so far revealed very high rates of attendance in treatment sessions in completers (94%) as well as in the entire sample including discontinuing patients (74%). Safety events were transient and occurred in total in only about 15% of patients during the treatment period.
The results show that 6 months outpatient cognitive remediation is feasible, in general well received, and save for patients with schizophrenia.
The findings of the previous study clearly indicated higher levels of subjective well-being among older age groups than younger ones, and females than males in Japanese adults (Shimai et al). However, little is known about these factors for people living with mental illness.
This study aims to describe factors associated with subjective well-being in patients with endogenous psychosis in the psychiatric hospital and community, and especially the effect of age and gender.
A comparative cross-sectional study was conducted with clinically stable persons diagnosed with endogenous psychosis. A convenience sample of 29 participants(15 participants: fifty years old and above, 14: under 50 years old) was drawn from the inpatients、the psychiatric day care and the sheltered workshop settings. They were evaluated by the Subjective Well-Being under Neuroleptic drug treatment Short form -Japanese Version (SWNS-J) as a specific well-being measure. The Japanese version of the Brief Psychiatric Rating Scale (BPRS) was used to assess symptom severity. Man-Whitney U test was used to analysis the differences between two groups.
The SWNS-J score in participants of 50 years old and above was significantly higher, compared with that in participants under 50 years old (P<0.02). The largest correlations were obtained between the SWNS-J score and age, particularly in males (P<0.05).
We conclude that these data of our report provide the valuable information for future research in mental health area, especially in the area of interventions to promote subjective well-being of people living with mental illness.
30 — 60% of patients have treatment-resistant schizophrenia (TRS). The most frequently used overcoming methods are high therapeutic doses of clozapine or augmentation strategy. Although these methods are widely adopted, their effectiveness is often insufficient, the number of patients not responding to clozapine is estimated between 40 – 70%. Alternatively, electroconvulsive therapy (ECT) can be used, with no positive response only in 10%. Despite this, the ECT is highly stigmatized, and its safety needs an objective verification.
Objective verification of safety of ECT by analysis of biological markers and rating scales of patients with TRS.
The study included 98 patients with TRS divided into 2 groups: receiving only psychopharmacotherapy (PPT) and psychopharmacotherapy in combination with ECT (ECT+PPT). The condition of patients and venous blood were tested and evaluated before the experiment and after 4 weeks of therapy. The following biomarkers were used: BDNF, NSE, S100B, CK-MB, as well as the PANSS and UKU scales.
Patients receiving ECT and PPT after 4 weeks of therapy showed significantly lower level of positive, negative and general psychopathology symptoms on the PANSS scale, (p<0.001). Patients receiving ECT with pharmacotherapy did not have an increase in the severity of side effects on the UKU scale, some of them reduced (especially neurological and mental), (p<0.001). There was no statistically significant increase in NSE, S100B, CK-MB and slight increase in BDNF levels in patients receiving ECT and PPT.
ECT is an effective and safe therapy method of treatment-resistant schizophrenia that doesn't cause structural damage to the brain.
Mounting evidence suggests strong relationship between emotion recognition impairments and limited social functioning (SF) in both Schizophrenia (SZ) and Alzheimer´s Disease (AD) patients. However, the specific profile of deficits may differ in both and are likely to have a relationship with the deficits observed in emotional recognition processes in both patient populations.
This study aimed to investigate SF of these disorders and its influence on facial emotion recognition.
Four groups were recruited: SZ (n = 57, 71.93% men; m = 30.72 years, sd = 6.34), AD (n = 46, 56.52% men; m = 68.83 years, sd = 7.05) and two age-matched control groups (CG1: n = 31, 58.06% men; m = 28.55 years, sd = 7.18; CG2: n = 28, 53.57% men; m = 67.07 years, sd = 7.03). Participants completed some scales on SF, loneliness and depression symptoms. Facial emotion recognition was assessed by the Facial Emotion Recognition Task (FERT), and general cognition by the Digit Symbol Substitution Test (DSST).
As a result, SZ participants showed higher levels of loneliness and lower levels of social engagement (p < .01); than those from CG1. FERT performance was predicted by general cognition (all outcomes). Poor social engagement and interpersonal behaviour was related with worse accuracy to detect negative emotions. Finally, higher levels of loneliness were associated with lower misclassification of negative emotions. These results were independent of study group.
Higher levels of social deficit insight in SZ patients and a systematic bias in negative facial emotion decoding could explained these results.
The presence of negative symptoms in early psychosis is variable. However, its persistence has been associated with a worsening prognosis and impaired functionality.
To determine the influence of negative symptoms on functional outcomes, in the early stages of psychosis.
An observational study was designed on a sample of 41 outpatients, aged between 18 and 45 years, who had presented a first episode of psychosis, without a substance use disorder, during the last three years. A semi-structured interview collected the main sociodemographic characteristics and negative symptoms were explored using the Positive and Negative Syndromes Scale (PANSS). The Functioning Assessment Short Test (FAST) was applied, focusing on six areas (autonomy, occupational and cognitive functioning, financial issues, leisure) to quantify the functionality. Statistical analysis was performed using SPSS v21.0 (statistical significance p <0.05).
The patient profile was a male (55%), with a mean age of 30.5 years (SD = 7.2), single (87.5%), student (47.5%), living in urban areas (82,5%) with the family (60%). The average age of psychotic debut stood at 25.8 years (SD = 6.9). Standardized PANSS-Negative scores were positively correlated significantly with the standardized results of FAST-Total (r= 0.385; p= 0.015) and FAST-Cognitive (r= 0.478; p= 0.002), respectively. Negative symptoms explained 12% of the variance of total functioning (R2= 0.115) and 20% of the variance of cognitive functioning (R2= 0.196; p= 0.005).
The presence of negative symptoms in early stages of psychosis appears to increase the impairment of psychosocial functioning and cognition.
Dysmorfofobia is a pathological discontent with one's own appearance, which is most common at a young age. It can occur in relatively mild mental illness-depression, hypochondria, personality disorders, and schizophrenic spectrum disorders. At the same time, the nosological specificity of dysmorphophobia is noted.
To study the clinical manifestations, dynamics and outcomes of dysmorphophobia syndrome in patients with schizophrenia.
115 patients (70 men and 45 women of young age) with the established diagnosis "pseudoneurotic schizophrenia" were examined. The pathological dissatisfaction with the appearance (syndrome of dysmorphophobia) was revealed in the clinical findings of the abovementioned patients. The Research Methods: clinical-and-psychopathological, catamnestic, psychometric, and statistical methods.
The following features of dysmorphophobia in patients with schizophrenia were revealed: mostly delusional pathological dissatisfaction with appearance, dysmorphophobic ideas related to several parts of the body; actual physical disabilities of patients were ignored; delusions of reference and the relentless pursuit for the correction of physical disability and were expressed.
Schizophrenia with dysmorphophobia syndrome occurs predominantly in low - and average progredience, accompanied by severe social exclusion, isolation, and loss of the ability to work. Dysmorphophobia in patients with schizophrenia is very difficult to treat.
Substance abuse is the most prevalent comorbid psychiatric condition associated with schizophrenia, and contributes to an unfavourable disease course. Cannabis is the illicit drug most often abused.
The aim of the study was to determinate whether schizophrenia patients with a history of cannabis use have a different prognosis, compared with those without a history of cannabis use.
This retrospective cohort study included schizophrenics admitted to the psychiatric ward of Mahdia University Hospital over the period from 2015 to 2018. We divided our sample into two groups: a first group consisting of patients with a tetra-hydro-cannabinol positive toxicology dosage and a second group with a negative toxicological dosage.
58 case of schizophrenia were included in this study, of which 40 had a positive tetrahydro-cannabinol dosage. Among schizophrenia patients with a history of cannabis use, the mean age of the first hospitalization was earlier (27.27 vs 33.58, p = 0.04), the number of hospital days was higher (29.33 vs 24.67, p = 0.02). Also, they required a higher-dose antipsychotic in chlorpromazine equivalent (732 vs 603, p = 0.04). No statistically significant difference was found for the psychometric scales between the two groups.
Our results indicate that the course and prognosis of schizophrenic with cannabis use may be more severe than schizophrenia cases in general. These findings bring attention on the importance of preventing and treating addictive behavior among these patients.
Schizophrenia is a chronic mental disorder that requires long-term treatment. Non-adherence to antipsychotics is common and associated with poor outcomes.
Our study is aimed to describe the therapeutic adherence and to identify the factors associated with poor adherence among schizophrenic patients.
This was a cross-sectional study conducted at psychiatry consultation of the university medical center of Mahdia, Tunisia. Data collection occurred between the months of January and March 2018, including patients suffering from schizophrenia. The evaluation of adherence was performed using the MARS scale (Medication Adherence Rating Scale).
In our sample of 131 schizophrenic patients, there is a male predominance (76%), as well as unmarried status (58.7%), unemployed (72%). The rate of non compliance treatment was 73%. Low levels of education, poor insight and polytherapy were associated to poor adherence. Although patients aged more than 40 years, who were married and diagnosed with undifferentiated schizophrenia were good compliant to treatment (p<0.05).
We suggest a proper treatment strategy for each patient based on the identification of non adherence risk factors.
In assessing a first psychotic episode it is necessary to discard possibilities of other underlying medical pathologies that may cause the psychiatric symptoms.
To illustrate the warning signs that must be considered in the assessment of a first psychotic episode.
We present the case of a 24-year-old male, without psychiatric history, treated in the emergency department for behavioral disturbances evolving over the course of 5 days. Auditory and visual hallucinations, echolalia, episodes of self-aggression and psychomotor agitation are described. Fever had been described for 3 days before the consultation.
No analytical alterations are observed, nor in the imaging tests (Rx thorax, cranial CT). Lumbar puncture is normal. Serologies and drug test are negative. Empirical treatment is initiated with Aciclovir and Haloperidol. Subsequently, EEG and NMR are performed that are within normality. With this data it seems very unlikely to be infectious encephalitis, therefore treatment is suspended after 10 days. The patient evolves favorably without presenting any neurological deficit, being finally diagnosed with neurological functional disorder possibly reactive to systemic infection.
The data that guide our patient towards secondary psychosis are: fever of unknown origin, fluctuations in symptomatology and state of consciousness, visual hallucinations and absence of personal or family psychiatric history.
It is essential to conduct a regulated study of the patient prior to the first psychotic episode, by means of a complete history, a careful clinical examination, and regulated complementary tests.
Antipsychotic-induced sexual dysfunctions are common and can be an important source of impaired quality of life of patients.
The aim of the study is to estimate the types and degrees of sexual dysfunction of psychotic patients and to study the factors related to it.
We conducted a cross-sectional study of a serie of 53 patients treated at the external psychiatric consultation of Hedi Chaker Hospital in Sfax and treated with antipsychotics for at least for six months. "Arizona Sexual Experience Scale" (ASEX) and "Psychotropic Linked Sexual Dysfunction Questionnaire" (PRSexDQ-SALSEX) were used to assess the prevalence and degree of sexual dysfunctions.
Our patients have an average age of 42 years. 48 patients (77,4%) were male. Patients were without a partner in 60.4% of cases and inactive in 52.8% of cases. First-generation antipsychotics were prescribed in 67.9% and second-generation antipsychotics in 18.9% of patients. The prevalence of sexual dysfunction was 62.3%, and a change in sexual activity after antipsychotic treatment was observed by 58.5% of patients. Sexual dysfunction weas associated with female sex (p = 0.01), occupational inactivity (p = 0.02), childhood sexual abuse (p = 0.03), number antipsychotic molecules prescribed (p = 0.004) and use of first-generation antipsychotics (p=0,01), risperidone and amisulpride (p <0.001).
Specialized training in sexology is necessary to optimize the care of patients so they can enjoy their sexuality and improve their quality of life.
This is a 45 year old male with a diagnosis of delusional disorder with low adherence and poor response to treatments (last pimozide in infratherapeutic doses due to side effects) that is admitted due to high dysfunctionality during his daily day. No apparent deterioration since the beginning of follow-up.
The aim of this case is to demonstrate the efficacy of prolonged-release paliperidone as a treatment of long-term poisoning delusion.
case report and literature review
The patient presents the idea of being poisoned through “pills” by neighbors and relatives. He perceives drug particles through wall moldings, dust motes, in toothpaste and in different foods being for a week without eating because of this reason. He presents bodily sensations such as headache and intense itching. Due to the characteristics of the ideas, he was diagnosed with delusional ideation, but in the last admission, he verbalized that the pills generate "cerebral changes, noting that his frontal lobe softens so that more medication can get through”.
After starting paliperidone injection, a progressive distancing of ideas is achieved, an improvement in anxiety, allowing him to interact with others without hyper-alert status. Diagnosis in the last admission: Paranoid schizophrenia
Pimozide is an effective drug to treat tactile delusional ideas, although research lines are lacking. In this case, the "bizarre" of the ideas presented and their functional impairment led to the diagnosis of paranoid schizophrenia. Paliperidone injection is effective against this symptomatology, reducing side effects compared to oral, improving adherence.
It is increasingly clear that cognitive deficits are an intrinsic part of both schizophrenia and epilepsy.
To study and compare the main characteristics of the cognitive deficit that appears both in patients with schizophrenia and in those with epilepsy.
We made a bibliographic review of the most relevant literature on this subject published over the last 5 years.
Epilepsy:
- Cognitive deficits can be seen in several domains, including learning, memory, attention and executive functioning. The most common one is memory impairment.
- The etiology of seizures is the main factor in cognitive outcome.
- Seizures in early life, regardless of etiology, can lead to cognitive impairment.
Schizophrenia:
- The most deficient cognitive functions are: attention, working memory, reasoning and problem solving, visual learning and social cognition.
- The key areas that predict evolution are: memory, attention and executive function.
- Executive function and memory are probably the most significant areas and are associated with the ability to function effectively in society.
Cognitive deficits can be observed in all phases of both diseases, even before the onset of psychosis or epilepsy, and are relatively stable over time.
Memory, attention and executive function are the areas of cognitive impairment in which schizophrenia and epilepsy seem to have more in common.
The profile of cognitive impairment in schizophrenia like-psychosis (chronic interictal psychosis that is difficult to differentiate from schizophrenia) within epilepsy seems to be similar to that observed in schizophrenia, but less pronounced, suggesting that there is no nosological independence between them.
Sensitive delusion of reference is a favourable evolution subgroup within delusional disorders that is most frequently observed in neurotic personalities that may develop psychotic symptoms (delusional ideation / interpretations) in the context of stressful situations.
To present a theoretical and practical review about sensitive delusion of reference.
We carry out a literature review about sensitive delusion of reference, accompanied by the clinical description of one patient with this diagnosis.
35 years old male referred to our outpatient mental health service with depressive symptoms (sadness, irritability, apathy, social withdrawal, psychomotor slowdown, cognitive failures) of several months evolution, occasionally accompanied by distrust, referential symptoms and delusional ideation. Anancastic and avoidant personality traits were appreciated. As previous personal psychiatric history it should be noted a psychogenic psychosis episode two years before. We initially established diagnosis of depressive episode and initiated treatment with duloxetine and aripiprazol. The symptoms described improved and antipsychotic treatment was gradually withdrawn with a recurrence of distrust, referential clinic and delusional interpretations, but without worsening of the depressive symptoms. Then we consider a primary psychotic disorder, not only the presence of psychotic symptoms in context of an affective disorder; due to symptomatology and personality traits observed we propose the diagnosis of sensitive delusion of reference. Months later antidepressant treatment is withdrawn, without worsening of the described clinic.
We must propose sensitive delusion of reference in the differential diagnosis of psychotic disorders with predominance of delusion and referential symptoms in patients with neurotic traits.
This study aimed at describing the socio-demographic, clinical and therapeutic characteristics of a sample of Tunisian patients diagnosed with schizophrenia.
This study aimed at describing the socio-demographic, clinical and therapeutic characteristics of a sample of Tunisian patients diagnosed with schizophrenia.
It was a retrospective descriptive study including 30 inward Tunisian patients diagnosed with schizophrenia according to DSM- criteria.
The mean age at the time of the study was 39±9.11 years.
All patients are male. Fifty per cent of the patients had low socioeconomic level and 50 % had average socioeconomic level. Celibacy was the most frequently observed civil status as it was found in 93% of the patients.
Seventy per cent of the patients received support from family members.
Seventy percent of the patients had nicotine use disorder, 23 % had alcohol use disorder and 17% had cannabis use disorder.
The mean duration of untreated psychosis was 4.8±4,65 years.
The mean age of the onset of schizophrenia was 23.36±5.9.
The mean number of hospitalisations in psychiatric ward per year was 0.6±1,26.
The mean duration of hospitalisations was 7,47± 21 days.
Good adherence to treatment was found in 57% of the cases.
Socio-professional reinsertion was only found in 20%of the patients.
Schizophrenia is characteriezed by a long period of untreated illness, with a chronic course and a functional impairement that hinders socio-professional reinsertion. Thus, primary care settings must me initiated to detect schizophrenia symptoms at an early stage.
“Ultra-high risk for psychosis” (UHR) refers to subjects experiencing sub-threshold psychotic symptoms that can be regarded as a risk factor for developing schizophrenia. Although there is strong evidence regarding behavioral problems UHR subjects, studies of impulsivity in this population are scarce. Serious behavioral problems may be associated with impulsivity. Therefore, early intervention before psychosis develops is critical for relieving these adverse manifestations.
The aim of this literature review was to update the mechanisms linking impulsivity and UHR, the clinical and course features of these concomitant disorders, assessment of impulsivity and current therapeutic indications.
We conducted this literature review through the pubmed website, using these keywords: impulsivity, UHR, early psychosis.
Several models have been cited to explain the link between impulsivity and psychosis or prepsychotic states: impaired executive functions, neurobiological mechanisms, emotional dysregulation, genetic and environmental mechanisms.
Some evidence suggests that high levels of impulsivity in UHR subjects are associated with a higher risk of psychotic transition.
Impulsivity is a dynamic risk factor for some serious behavioral disorders (such as violence, substance use, and suicide) that may be targeted by specific therapeutic measures.
Some cognitive, pharmacological, neuromodulatory and neurofeedback therapeutic approaches seem promising in the management of impulsivity in the early phases of psychosis.
Impulsivity rates appear to be significantly higher among UHR subjects and to influence the course of these disorders, including the psychosis transition. The detection and early management of high impulsivity in UHR subjects is of great importance in reducing negative consequences on functioning, as well as serious behavioral consequences.
Myocarditis is caused by multiple factors, including drugs. Antipsychotics are one of them that can cause it. We present the case of a patient who presents with myocarditis with clozapine treatment.
The objective is to make a brief review of this side effect.
22 year old male with a previous diagnosis of schizophrenia. He presents a decompensation of his basic psychopathology with delusions and hallucinations. After trying three different types of antipsychotics, it is decided to start treatment with clozapine, reaching a maximum dose of 100 mg.
On the third day of treatment, the patient presents an alteration in the EKG, as well as elevation of the troponin to 0.23 µg / L. He was diagnosed of myocarditis. For that reason, it is decided to withdraw the drug.
Myocarditis caused by clozapine is around 0.7-3%. The mechanism of production is either by type 1 hypersensitivity reaction (mediated by IgE) or by direct damage, through muscle infiltration. It usually appears in the first six months of treatment, being more frequent in the first weeks of treatment. It is not clear whether it is a dose-dependent effect; however, it has been observed that the faster the dose increase the more risk there is of developing it. The treatment that can be fatal (about 33%) is the withdrawal of the cause.
The endocannabinoid system has been linked to the etiopathogenesis of dual disorders in patients with schizophrenia
The objective is to make a brief review in relation to a case of a patient with dual pathology.
A 45-year-old female patient who, as a background of interest, had a psychotic episode in relation to cannabis use. The patient, from the age of 14, consumed, without any withdrawal period, up to 12 U day of cannabis.
Progressively, for about two weeks, the patient began with delusional ideation of harm and auditory hallucinations centered on her neighbors. This symptomatology, after receiving antipsychotic treatment, yields after two weeks of admission. After this episode, the patient presents great affectation in the previous functionality, with affective flattening and alteration of the executive functions. Despite this, it maintains active cannabis use.
The endocannabinoid system consists of two ligands and two receptors (CB1 and CB2). One of those ligands is the AEA that is a CB1 agonist and a CB2 partial agonist. Above all, it is located at the level of the prefrontal cortex, basal ganglia and hippocampus. It acts on the reward system, modulating the response to stress and memory.
Dual pathology, is in close relationship with this system. On the one hand, in the schizophrenia the same regions where the endocannabinoid system is altered, there is an increase at peripheral level and in CSF of AEA and also the density of the CB1 and CB2 receptors are altered.
Carpenter et al. (1985) proposed a subtype of schizophrenia, characterized by the presence of persistent negative symptoms, which was called deficit schizophrenia. This subgroup could have different pathophysiological mechanisms.
The aim was to evaluate the neurocognitive and psychosocial functioning of patients with a diagnosis of schizophrenia (SZ), classified as patients with deficit (D-SZ) or nondeficit (ND-SZ) schizophrenia, throughout a five-year follow-up.
One hundred and fifty-two patients with SZ, stabilized, and 40 healthy controls (HC) were assessed at baseline (T1), and after a 5-year follow-up (T2). A neurocognitive evaluation was realized, using a comprehensive neurocognitive battery (six neurocognitive domains). For the functional evaluation, the Quality of Life Scale and the Global Assessment Functioning Scale were utilized. The statistical analysis was carried out with repeated measures ANOVA.
1)Forty-seven patients (30.9%) were classified as D-SZ, and 117 patients as ND-SZ (69.1%).
2)HC had a better performance than the two groups of patients at baseline, both for the neurocognitive composite index (NCI) and for the different subdomains.
3)ND-SZ performed better than D-SZ in all neurocognitive measures.
4)The repeated measures ANOVA, did not show a group x time interaction, either for the NCI or for any neurocognitive domain, except for sustained attention.
5)No differences were found in the neurocognitive trajectories of the two groups of patients.
The neurocognitive impairment in both deficit and nondeficit forms of schizophrenia, is stable. However, the sustained attention domain has a progressive course.
It has been suggested that patients with a higher level of neurocognitive functioning have a greater chance of reaching the clinical and functional remission (Helldin et al., 2006)
The objective was to examine the neurocognitive functioning of patients with a diagnosis of schizophrenia (SZ) in remission / non-remission, in relation to a group of patients with bipolar disorder (BD), and a group of healthy controls (HC).
Three hundred and one stabilized patients with SZ, 119 euthymic BD, and 255 HCs were evaluated. Assessments were carried out with a comprehensive neurocognitive battery (11 neurocognitive tests, which provided 17 measures, grouped in 6 domains). SZ were classified as in remission (R-SZ) or non-remission (NR-SZ), according to the criteria of Andreasen et al. (2005).
1) Ninety-two patients were classified as R-SZ (30.5%). 2) The three groups of patients performed worse than the HC in all neurocognitive measures except for sustained attention, where there were differences only between HC and NR-SZ. 3) If we consider the neurocognitive composite index (NCI), the R-SZ had higher scores than NR-SZ. No differences were found between BD and R-SZ. 4) R-SZ had a better performance than NR-SZ in all neurocognitive domains. 5) There were no differences between TB and R-SZ in any neurocognitive domain, except for executive function. Surprisingly, R-SZ had a better performance BD in this domain.
The patients with schizophrenia who reach the clinical remission have better neurocognitive functioning, comparable to that found in euthymic patients with bipolar disorder.
Patients with schizophrenia (SZ) and bipolar disorder (BD) show deficits in their neurocognition and their social cognition, although the differences found between these groups are a subject of discussion (Aparicio et al., 2017; Van-Rheenen et al., 2017).
We aimed to compare the profile of the cognitive function of patients with SZ, patients with BD, and a control group.
Seventy euthymic bipolar I patients, 140 stabilized patients with a diagnosis of SZ, and 60 healthy controls were included. All subjects were cognitively examined with the MATRICS Consensus Cognitive Battery (MCCB); additionally, emotion processing was assessed with the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT).
1)The ANOVA showed differences between the groups in years of education and age. Furthermore, the gender distribution was not homogeneous. 2)Neurocognition: After controlling for sex, age, and education, the MANOVA showed a main effect of group for all cognitive domains. Healthy controls obtained better results than both groups of patients in every neurocognitive domain. Patients with BD had better performance than SZ in some neurocognitive domains, such as speed of processing, attention, verbal memory, and visual memory. 3)Social cognition; healthy controls had better scores than the two groups of patients. However, there were no differences between patients with BD and patients with SZ in any measure of social cognition.
Patients with bipolar disorder and schizophrenia share a similar profile of social and non-social impairment. In any case, the differences found are quantitative and circumscribed to some cognitive domains.
Corticosteroids have seen their prescription expand in different medical disciplines. However, their therapeutic effects in multiple pathologies are obtained at the cost of equally varied side effects
Psychiatric side effects secondary to corticoide have been described for a long time.
To describe the cortico-induced psychiatric manifestations.
A patient case is presented with associated literature review.
Ms M.K aged 35 years old, without medical history, admitted to the gastroenterology department since 5 days to manage a first episode of hemorrhagic rectocolitis. M.K was treated with hydrocortisone hemisuccinate in high doses. At the 3rd day of treatment, M.K presented irritability, anxiety and insomnia, then auditory and visual hallucinations and delusions of persecution. The diagnosis of acute psychotic episode was retained. Thus, the patient was put on resperidone with a progressive degression of corticosteroids then a switch to 5 ASA. The treatment was well tolerated and allowed a rapid amendment of psychiatric symptomatology after one week. The antipsychotic was maintained in outpatient follow-up for six months.
Informing health care teams, patients and their families about the possibility of psychiatric side effects related to corticosteroids would allow early detection and management and avoid the occurrence of serious disorders.
Social factors of motivation include traditional, submissive, pseudo-cultural. Personal factors include hedonistic , ataractic ( desire to neutralize negative emotional experiences, anxiety, fear), hyperactivation of behavior ( desire to achieve a stimulating, disinhibiting effect , desire to avoid boredom, psychological emptiness). Pathological factors are abstinence, addictive , self-harm . Abuse in order to correct their mental condition can be considered as ineffective coping strategy.
Definition of the motives of stimulants abuse of the patients with schizophrenic spectrum disorders
35 patients with schizophrenic spectrum disorders ( 21 with schizophrenia and 14 with schyzotypal disorder) also stimulants(synthetic cathinones) abusers and 33 stimulants addicts were examined by clinical and psychological methods.
The use of stimulants by schizophrenic patients was not an addiction. It was associated with psychopathology and independent of social factors. The motivation for using stimulants was an ineffective coping strategy with a desire to cope with such endogenous spectrum disorders as a decrease in energy potential with asthenic symptoms , depressions with the loss of a sense of joy and interest in life, social isolation with communication difficulties, increasing autism, cognitive disorders with difficult the focus of attention and concentration, anxiety. Sometimes the use of stimulants was associated with a specific world view and pseudophilosophical concepts , when substance use was considered as a way of knowing the world, obtaining specific information, a “spiritual” practice to understand themselves
These features of motivation were characteristic of patients with sluggish forms of schizophrenia (schizotypal disorder) and initial stage of the disease.
Adherence to pharmacological treatment is essential for alleviation of psychotic symptoms in schizophrenia. Medication nonadherence is associated with an increased risk for relapse of psychosis, persistent symptoms, and suicide attempts.
To understand how patients with schizophrenia adjust management of therapeutic regime to their daily lives and to identify the factors affecting medication compliance.
A generic qualitative methodological approach was used. A total of twenty patients with schizophrenia were recruited from an acute psychiatric unit at a general hospital in Portugal. We conducted interviews based on a structured interview guide. Interviews were recorded, transcribed, codes generated and thematic analysis undertaken aided by NVivo.
The mean age of the sample was 38.7 years (SD = 5.3 years; range 22–62). The sample distribution included 8 women and a roughly even distribution of individuals residing independently vs in board and care homes. Four categories of dimensions were identified: (a) individual factors, defined conceptually by dealing with stigma and self-management strategies, which include interruption of treatment, selective medication-taking and forgetting, (b) related to treatment, regarding side effects of medication, (c) social factors, conceptually defined by social and family support, (d) health system-related factors, including the nature of relationship between healthcare professionals and patients.
Management of therapeutic regime is a complex and multidimensional process, determined by the intersection of several interrelated factors that together can improve or worse it. Regarding the patients, psycho-education can improve their knowledge, learn how to adapt with symptoms and develop behaviors that help them move toward recovery.
Delusional parasitosis, delusional infestation or Ekbom syndrome, is an uncommon psychotic disorder characterized by a false belief that there is a parasitic infestation of the skin - the delusion that insects are crawling underneath the skin
The aim of this work is to summarize and evaluate the current available evidence regarding Delusional parasitosis.
The authors have conducted an online research in PubMed with the words “Delusional parasitosis” “delusional infestation”, “Ekbom syndrome” from 2011 until 2019, from the outcome, the articles considered to be relevant were collected and analyzed.
Delusional parasitosis can be classified into primary delusional parasitosis without other psychiatric or organic disorders present, secondary – functional (secondary to several mental disorders such as schizophrenia, depression, dementia, anxiety, and phobia), and organic forms (associated with hypothyroidism, anemia, vitamin B12 deficiency, hepatitis, diabetes, infections (e.g., HIV, syphilis), and cocaine abuse.
In 5–15% of cases, another individual may share this delusion known as delusional parasitosis with folie à deux. It is most commonly seen in middle-aged (an average 57 ± 14 years) women. The patients became frequently socially isolated, prone to the development of depression symptoms.
This syndrome often presents a high level of psychosocial morbidity. (2) Patients often seek dermatologists help at first place, although there is no medical evidence. Psychiatrists play a major role in diagnosis and treatment of these patients. Psychopharmacological therapy is quite challenge, because patient’s belief that they have a parasitic infestation and not a psychiatric condition.
Description of the clinical case. A 27-year-old woman with schizophrenia who has been requesting a long-term injectable treatment regimen for 6 months to improve compliance with treatment in which the relationship of attachment with her child is evaluated and the difficulties in parenting are monitored.
First psychotic episode at age 19, since then in mental health with oral paliperidone treatment. Subsequently he has presented two psychotic episodes and the need for hospitalization. Diagnosis of schizophrenia. Good family support and stable partner. 6 months ago, he changed from oral treatment to long-term injectable with good tolerance.
Psychopathology Exploration: Stability of the psychotic clinic, although it refers to episodes of anxiety and difficulty in handling emotions in response to your child's demands. No current major psychotic or affective clinic.
Complementary explorations. Detection of difficulties in the upbringing and evaluation of attachment ties is carried out.
Schizophrenia. DSM5: 295.90; ICD10: F20.9
Evolution. It is detected at 2 months postpartum autorefferentiality, she refered to frequent forgetfulness of oral antipsychotic, so the Paliperidone Palmitate regimen is assessed. Over the next 6 months, clinical stabilization is achieved, mother-child attachment links improve, and it is included in the psychoeducation program.
Discussion. The approach to schizophrenia at different stages of the life cycle is very important. In our case, the introduction of long-lasting injectable antipsychotic has facilitated the completion of treatment, allowing to jointly address comprehensive care towards the promotion of parenting and specific needs at this stage of the life cycle.
Schizophrenia and schizoaffective disorder are two prevalent pathologies. It is necessary to make a proper differential diagnosis to make possible a good management and treatment of the patient.
To make a differential diagnosis between schizophrenia and schizoaffective disorder through the clinical case of a patient with a diagnosis of schizophrenia and schizoaffective disorder later, who is admitted for psychotic decompensation.
A review of the patient's history is carried out in order to determine the evolution of the disease and to make a differential diagnosis between the two pathologies. The patient was treated with paliperidone palmitate 150 mg daily and oral paliperidone 6 mg daily. During the patient's admission, the oral paliperidone dose was increased to 18 mg daily and after objecting to a good tolerance it was decided to modify the treatment by administering a monthly dose of paliperidone palmitate depot of 300 mg. Then, oral paliperidone was decreased until its withdrawal. It was decided to withdraw valproic acid, at a dose of 1200 mg daily,because the diagnosis of schizophrenia was the most likely. After this changes of treatment, improvement of symptoms was assessed through the PANNS scale.
The patient's productive psychotic symptoms ceased and he remained no affective symptoms was observed after valproic acid withdrawal.
It is necessary to make an adequate differential diagnosis between the affective symptoms of schizophrenia and a schizophrenic disorder. Paliperidone palmitate may be a useful treatment in patients with schizophrenia that present affective symptoms.
The effects of long-term antipsychotic therapy on patients with schizophrenia should be assessed. Aripiprazole is an effective drug for the positive and negative symptoms of schizophrenia; it is well tolerated and has a low sedative potential.
To assess the effectiveness, functionality and tolerability of Aripiprazole long-acting injectable (ALAI) in patients with stable schizophrenia
The study sample involved 18 patients with stable schizophrenia (DSM 5 criteria) who started treatment with ALAI between January-December 2016.
On a tri-monthly basis, the following evaluations were performed during a follow-up period of 33 months: Brief Psychiatric rating Scale (BPRS): Global Clinical Impression Scale (ICG-SI); Personal and social Performance (PSP) And Side effects reported
The study was performed in accordance with the Declaration of Helsinki and all the participants provided written consent for participation.
Student's t-test and Chi-square test were used to assess differences between baseline evaluation and subsequent visits. Statistical analysis was performed with SPSS 22.0
Mean variations from baseline scores at 33 months were: (-3,65 ±3.14) on the BPRS, (-1.07± 0.82) on the ICG-SI and (10.21±5.67) on the PSP scale.
The most frequent side effect with an incidence of 22% was transient mild insomnia.
The rate of adherence to treatment with Aripiprazole long-acting injectable after 33 months was 55.6%.
The percentage of patients on monotherapy increased from 39.6% baseline to 66.6% at the end of the study
Aripiprazole long-acting injectable can be effective therapy for the treatment of patients with schizophrenia improves psychopathological symptoms, functionality and is well tolerated, In clinical practice conditions
Paliperidone Palmitate 3-month formulation (PP3M) is a new formulation of the Palmitate salt ester of Paliperidone which provides an extended sustained release of Paliperidone.
The principal aim of this study was to evaluate the effectiveness, safety and tolerability of the PP3M in patients with non-acute schizophrenia on an outpatient basis
30 outpatients with diagnosis of schizophrenia (DSM 5) that started treatment with PP3M were recruited.
On a tri-monthly basis, the following evaluations were performed during a follow-up period of 36 months:
Positive and Negative Syndrome Scale (PANSS), Personal and Social Performance Scale (PSP), Global Clinical Impression Scale (ICG),UKU Side Effect Scale and Patient Satisfaction with Medication Questionnaire (PSMQ).
Efficacy values: Percentage of patients who remained relapse free at the end of the 36 months (as defined by Csernansky)
Percentage of patients who remained relapse free at the end of the 36 months was 90 %.
Mean variations from baseline scores at 36 months were: (-2.8 ±3.6) on the PANSS, (-0.27 ±0-32) on the ICG scale and (3.89 ±2.67) on the PSP scale.
A not significant increase was found in the number of patients reporting to be "extremely satisfied" or "very satisfied" with their medication (PSQM) (80% at baseline vs. 86.66% at 36 months)
The rate of adherence to treatment with PP3M after 36 months was 86,7%. Tolerance to PP3M was high and only of the patients discontinued their treatment due to adverse effects (sexual dysfunction)
We found that long-term treatment with PP3M is effective, safe and well tolerated in clinical practice conditions
We present a woman with schizophrenia with a disease duration of more than 15 years, a duration of untreated psychosis of 5 years and multiple hospital admissions. After acute stabilization, she is admitted in long stay psychosis unit for rehabilitation and psychotherapeutic approach.
The objective of the clinical case is to evaluate the efficacy of cognitive remediation interventions as well as cognitive behavioral and metacognitive therapy over patient functionality.
She was evaluated with the global assessment functioning scale (GAF) before and after the therapeutic intervention (individual 1 / week and group 3 / week for 9 months). In addition, she received cognitive remediation through the NeuronUp program once a week.
Antipsychotic treatment was not modified during this process due to attenuated psychotic symptoms. The patient is maintained with a dose of 450 mg of clozapine daily in association with injectable second-generation antipsychotics. Changes were made with respect to the latter (from injectable paliperidone 75mg monthly to aripiprazole 400mg monthly im) due to extrapyramidalisms and weight gain.
She improved on the global assessment functioning scale (GAF) from 35 points upon admission to 95 at discharge. The patient initially had severe problems in resolving conflicts with roommates at home as well as making risky economic decisions. Gradually strategies such as ABC, interventions focused on not jumping to conclusions allowed a good level of interpersonal functioning and a normalized employment.
CBT and metacognition are interventions of proven rehabilitative efficacy in schizophrenia by improving understanding of psychotic experiences and management of residual psychotic symptoms.
Interpersonal communication as an ambiguous situation may instigate anxiety and specific vulnerabilities in patients with mental disorders. Machiavellianism in such cases can play a role of psychological defense against intolerable encounter with subjectivity of the Other.
The goal of the study was to reveal what clinical traits and values-related attitudes are related to manipulative conduct in inpatients with schizophrenia spectrum disorders.
40 inpatients with paranoid schizophrenia and 40 inpatients with schizotypal disorder took part in the study. Machiavellianism was measured with a modified MACH-IV scale (Znakov, 2000). Clinical traits were assessed with the Russian version of SPQ-74 questionnaire (Efremov, Enikolopov, 2011). Personal values were determined by “Fairness-Care” questionnaire (Molchanov 2005).
Correlation analysis in schizotypal patients group reveals a link between Machiavellianism and Suspiciousness (r=0,362, p<0,05). They show high levels of mistrust, the higher the more manipulative they are. In paranoid schizophrenia group the Suspiciousness was also high, but wasn’t significantly related to Machiavellianism.
In inpatients with paranoid schizophrenia high levels of Machiavellianism are related to low Account for individual rights and freedom (r=-0,406, p<0,01). In both groups Machiavellianism is positively related to negligence of Law and Order (p<0.01). Machiavellians with schizophrenia spectrum are oriented towards own intentions even if those contradict the conventional norms.
Machiavellian schizophrenia spectrum inpatient with a developed cynical image of deceitful, hypocritical world relies on his own interests and orients towards situational values and self-comfort. He tends to attribute similar attitudes to other people and in turn reacts with suspiciousness, vigilance and fear.
Oculomotor dysfunction is one of the most replicated findings in schizophrenia.
We have tested smooth pursuit eye movements (SPEM) in different schizophrenia dimensions, according to the three-syndrome model of schizophrenia.
The study included 187 patients who met the ICD-10 criteria for schizophrenia (mean age 36.8 years; standard deviation [SD] =11.6) and 60 healthy volunteers ((mean age 36,4 SD =11.4).The schizophrenia patients were divided into three groups based on the sum of the global SAPS and SANS scores: patients with predominantly negative symptoms (NS, n=111); positive symptoms (PS, n=54) and disorganization symptoms (DS, n=22). Horizontal eye movements were recorded using videonystagmograph. Visual stimulus was presented on the portable light bar and moved with different speed (0,2 Hz - 0,7Hz).
We found that SPEM performances (measured by smoothness coefficient G) in all groups of schizophrenia patients were lower than in controls at stimulus speed being 0.2 Hz. The smoothness (G) decline was the highest in the DS group compared to controls (Cohen’s d=1.25). The higher speed of the stimulus, the more difference between controls and schizophrenia group grew, reaching its maximum at the speed of 0,7 Hz. Starting with the speed of 0,4 Hz the DS group showed sharp decline in smoothness compared both to controls (Cohen’s d=2.05), and other comparison groups (Cohen’s d PS-DS=0,93, d NS-DS =0.79). The performances of PS and NS were close to each other on all stimulus speeds.
The DS group showed the worst SPEM performance among all groups of schizophrenia patients.
Simple schizophrenia is a rare subtype of schizophrenia, which is characterized by the insidious development of negative symptoms, with the absence of hallucinations or well-formed delusions. Despite its significant impact on a functional and social level, it remains a controversial diagnosis.
Reflecting on the case of a 31-year-old male diagnosed with schizophrenia with a clear predominance of negative symptoms.
We present the case of a 31-year-old male diagnosed with schizophrenia, who was admitted in psychiatry unit due to behavioural alterations. The patient manifested a clear predominance of negative symptoms. No auditory or other hallucinations (except occasional olfactory hallucinations of very mild intensity) were observed at any time during hospitalization. Taking into account his previous psychiatric history, as well as the symptoms observed in the current hospitalization, the patient would meet the ICD-10 and Black and Boffeli's criteria for simple schizophrenia. Literature referring to simple schizophrenia is reviewed.
Clozapine was prescribed at a dose of 400 mg, with a progressive dose increase, being well tolerated. A clear improvement was observed in the patient (organization of speech, thought and behaviour, as well as a decrease in affective flattening).
The concept of simple schizophrenia is still relevant today, as new approaches advocate rethinking negative symptoms as a central feature of schizophrenia. Epidemiological studies are needed that contribute to knowledge about simple schizophrenia. More studies are needed that can support clozapine treatment in these patients.
Patients diagnosed with schizophrenia (PDS) have a decreased life expectancy, which has been linked to a higher prevalence of medical comorbidity. Inflammatory, neuroendocrine and immune alterations have been reported in PDS. Current research suggests an intrinsic vulnerability to some physical illnesses in this population.
70% of the risk of developing schizophrenia is genetically determined. Neuroendocrine and immune alterations have been described in relatives of PDS. Therefore, PDS relatives may also have a higher prevalence of physical illnesses. Some studies have reported a high prevalence of diabetes mellitus and autoimmune diseases in this population. However, the literature on this subject is still scarce.
We intend to study the prevalence of physical illness in relatives of PDS. This research may contribute to expanding knowledge about the etiopathogenesis of schizophrenia.
Cross-sectional observational study. A pilot sample of 30 PDS admitted to the psychiatric hospitalization unit of the Hospital Central de la Defensa Gómez Ulla will be selected. Subjects will be interviewed for a personal and familiar history of psychiatric and medical illness. The data will be contrasted with the information in the patient's medical records. Whenever possible, the data will be confirmed by interviewing the parents or siblings of the patients.
The data will be displayed numerically and graphically using a quantitative statistical methodology.
Results will be discussed and compared with previous literature on this subject. A larger sample may be needed so that the conclusions can be considered final.
Multiple sclerosis (MS) is a chronic neurological disease that affects the central nervous system.
The symptoms of MS will depend on the damaged area. Some of the usual symptoms are: blurred vision, muscle weakness, paraesthesia and muscle spasms, psychiatric symptoms such as depression.
The objective is to present a clinical case with differential diagnosis in neurological diseases in patients with schizophrenia who perform antipsychotic treatment.
A 35-year-old patient has had difficulty walking accompanied by oral-lingual movements for 1 year. This clinic was attributed to side effects of neuroleptic medication that he took when suffering from paranoid schizophrenia. The patient has a fluctuating clinical difficulty in walking due to impaired balance and less force in the LLL. The clinic worsened, making it impossible to walk and affecting sphincter control. Negativist. Delusional ideas of ruin. Depressed mood Pseudo-auditory hallucinations. Neurological examination: Left predominance paraparesis: LLL 3-/5. Hyperreflexia of left predominance. Inability to stand up. Cranial and spinal NMR: 4 hyperintense lesions in T2 and flair at the periventricular level, extensive involvement of signal increase affecting the cervical and dorsal region at level C2-C3, D6-D7, D9-D10, suggestive of lesions demyelinating. Evoked potentials: Left optic neuropathy.
The diagnosis of multiple sclerosis is confirmed. An extrapyramidal effect of treatment is ruled out, such as oral-lingual dyskinesias that can occur in treatments with first-generation antipsychotics more frequently.
The differential diagnosis of extrapyramidal symptoms in psychotic patients is important since they can be associated with side effects and mask as in this case a multiple sclerosis.
Long acting injectable atypical antipsychotics are useful therapeutic instruments in clinical settings, but differences between them are not well-documented in terms of efficacy and tolerability. No clear-cut recommendations are included in the guidelines that could favor one long acting injectable atypical antipsychotic over another.
To compare the evidence for long acting atypical antipsychotics efficacy and tolerability.
We search through the available electronic databases for differences between the existing long acting injectable atypical antipsychotics, at pharmacodynamic and pharmacokinetic level, in order to verify if specific recommendations could be formulated for each drug.
Pharmacological properties of risperidone microspheres, paliperidone palmitate 1-month and paliperidone palmitate 3-month administered formulations, olanzapine pamoate, aripiprazole monohydrate and aripiprazole lauroxil were analysed and specific properties were underlined. There are a number of pharmacological properties of these drugs that should be taken into consideration when specific variables are considred, like special populations (e.g. renal or hepatic failure), comorbidities (e.g. obesity, metabolic syndrome), individual sensibility to extrapyramidal adverse events, life-style impact (sedation, weight gain, sexual dysfunctions etc). Of course, therapeutic adherence is the main argument for these formulations, but no study has yet demonstrated that longer action (e.g. 12 weeks or 6 weeks interval between doses compared to only 2 to 4 weeks) of some of the above mentioned formulations are associated with higher adherence.
A relatively wide range of long acting injectable atypical antipsychotics is available, therefore choosing between them in clinical practice should be based on a careful analysis of drugs’ specific farmacological properties.
La atención a los primeros episodios psicóticos es cada vez más prioritaria en el abordaje de la patología mental. En las últimas dos décadas se han llevado a cabo numerosos estudios que enfatizan en la importancia de estas intervenciones.
Nuestro objetivo se basa en informar sobre los distintos abordajes en el tratamiento de la patología mental juvenil en cuatro países, así como los desafíos planteados en base al recorrido histórico de los mismos
Revisión bibliográfica de las estrategias llevadas a cabo por los sistemas sanitarios de cuatro países: Australia, Irlanda, Reino Unido y Canadá, así como las líneas de investigación que actualmente están desarrollando
Se presentan los diferentes retos a conseguir en los distintos países estudiados. Australia ha diseñado una intervención de primera línea en su sistema sanitario; en Irlanda ha surgido una red de ayuda a jóvenes con enfermedades mentales; en el Reino Unido se ha reestructurado el sistema sanitario recientemente para mejorar la atención de esta población y en Canadá está realizándose un estudio financiado con la expectativa de aplicar sus resultados al sistema nacional de salud.
A través de dicha investigación y actuación de los distintos países, podemos inferir la importancia creciente en el abordaje integral de la patología mental en este segmento de la población, así como los problemas emergentes que aún están por resolver.
Data on the use of clozapine and injectable antipsychotics in patients with schizophrenia has been a study source in several articles in recent years, demonstrating heterogeneity and a big variability in the prescriptions.
Our goal is to compare these data with those obtained in Calatayud’s Region, assess whether there are differences to initiate future strategies to be proposed.
We access and review data on clozapine consumption and use of depot treatment in patients diagnosed with schizophrenia and under follow-up by the Calatayud Mental Health Unit.
Patients diagnosed with schizophrenia in this territory compromise around 0.21% of their total population (64.3% men and 35.7% women). The mean age of the user is 49.85 years, the median and the mode 50 years. Patients diagnosed with schizophrenia on treatment with Clozapine are 13.1% of patients under treatment, 41.7% use Depot injections and 2.38% of patients use both.
Global prescribing data for Clozapine and Depot injections in patients diagnosed with schizophrenia in the area we studied (Calatayud) are similiar to data collected in other national studies.
It is the treatment applied to relieve the disability or inability of a person to do business. Rehabilitation is integrated with acquaintance, introduction, recognition and study.
To ensure regular and continuous treatment and follow-up
Reasoning, thinking, remembering, making decisions, cognitive rehabilitation and development of skills such as problem solving
Improving daily living activities such as money management, transportation, shopping, food preparation
Provide time management and activity planning training
Education of individual's family, caregivers or other persons
Encourage the exploration of relevant areas and the development of free time activities
Developing and encouraging self-concept through creative activities
Improving community participation and vocational rehabilitation
Studies in Rehabilitation Practice:
Home visit, Occupational training,RUTBE training (Mental social skills training),Outpatient Service,Art therapy,Family education and interviews
Meetings to adapt to daily life, Individual interview, individual therapy,Institution visits,Social and cultural activities
Institutions and organizations that can be cooperated for rehabilitation practice:
Provincial Health Directorate and Mental Health Branch,
Municipalities, mukhtars and social welfare organizations, Associations, chambers, universities,İŞKUR, MEB, Halk Egitim Private education centers and organizations
The first consultant in Case-1 showed successful work in all the workshops, very good dexterity, negative findings disappeared, and he is running the treatment himself.
The second consultant in Case-2 was provided with self-confidence, improved manual skills, communicated with the environment, and gained the ability to maintain treatment and follow-up.
The first counselor trained the second counselor. In rehab, counselors trained each other. A consultant who is continuing and receiving training at TRSM has supported a newly joined client in the role of educator.
The disruption of Pragmatics has been observed in over 75% of patients with schizophrenia. Poor pragmatics has a relevant impact on daily functioning, by contributing to social isolation and lower quality of life. Only few pragmatic treatments have been developed and tested in schizophrenia, focusing only on specific pragmatic features and without using a Randomized Controlled Trial (RCT) design.
Investigating the efficacy of PragmaCom Training (PT), a novel intervention specifically developed to enhance pragmatics in schizophrenia.
30 patients with schizophrenia were randomly assigned to PT to an active control group (ACG). All patients were assessed for global pragmatics (APACS), metaphor comprehension (PMM), executive functions (BACS Tower of London), abstract thinking (PANSS N5 score), and daily functioning (QLS).
Patients treated with PT showed small to medium-large effect-sizes in global pragmatics, metaphors comprehension, functioning, and abstract thinking. Several ANCOVAs, entering post-training measures as dependent variables, measures at baseline and executive functions as covariates, and treatment (PT vs ACG) as grouping variables, showed a significant effect of PT in enhancing global pragmatic abilities (F=5.4,p=.03), metaphor comprehension (F=8.94,p=.007) and abstract thinking (F=8.1,p=.01). No effect was found for functioning.
This RCT study confirms the efficacy of PT in improving multiple domains, encompassing global pragmatics, the comprehension of figurative language, and abstract thinking in schizophrenia. Impact on functioning is also expected. However, in line with literature, it is likely to occur at later time points, since it requires the chance to apply the enhanced abilities in ecological contexts.
The term “dual diagnosis” indicates the comorbidity between a severe mental disorder and a substance use disorder (SUD), a condition characterized by a pathological use of the substance that leads to an impairment or clinically significant discomfort. In subjects with schizophrenia, double diagnosis has a high prevalence (19-47%) and is generally associated with negative longitudinal indicators.
The aim of the present study was to explore the impact of concomitant SUD on psychopathology, cognitive functions, real-life functioning and personal resources in a large sample of subjects with schizophrenia.
Nine hundred twenty-one subjects with schizophrenia, 239 of which with SUD, were recruited within the Italian Network for Research on Psychosis.
Patients with concomitant SUD, compared with patients without SUD, showed a greater severity of positive and depressive symptoms, lower severity of negative symptomatology, better premorbid functioning in the social area and worse premorbid functioning in the academic area, worse real-life functioning in the domains of social acceptability and work skills, less involvement in mental health services, as well as lower family cohesion. No statistically significant differences were found between the two groups of patients regarding neurocognitive and social cognition indices.
Our data showed that subjects with schizophrenia with SUD differed from those without such comorbidity in specific psychopathological domains and in specific aspects of real-life functioning, premorbid adaptation and personal resources, with possible implications for rehabilitative and pharmacological treatments.
It has been hypothesized that longer duration of untreated psychosis (DUP) is associated with poorer outcome of treatments, resulting in longer inpatient care and poorer quality of life. This issue is under-researched in Middle Eastern population.
address the duration of untreated psychosis among adolescents with first-episode psychosis admitted at the Sultan Qaboos University Hospital in Oman.
This is a retrospective cross-sectional analytical study conducted at the Department of Behavioural Medicine at Sultan Qaboos University Hospital (SQUH), Muscat, Oman from January 2010 to December 2018.
A total of 121 adolescents fulfilled the inclusion criteria. The overall mean DUP in this sample is 4 months (SD 4.5) with the range from a minimum of 1 month to a maximum of 24 months. The median duration for the same is 3 months (IQR 3 months). Females, patients from lower SES, and older adolescents aged 15 to 19 had longer DUP, but the association was not statistically significant. Whereas the association was significant between longer DUP and patients from rural areas and those who visited traditional healers before accessing mental health services, in patients with a positive family of psychosis, and those who presented with both positive and negative symptoms.
This study has embarked on exploring the socio-demographic and clinical characteristics linked to DUP among adolescents with FEP in Oman. The DUP is deemed one of the detrimental outcome predictors for psychotic patients. Identifying factors linked to DUP can play a major role in improving outcomes in psychosis.
Butyrylcholinesterase (BChE) is an enzyme that has been investigated for its putative role in neurodegenerative and neuropsychiatric disorders.
The aim of our work was to study BChE activity variations in schizophrenic patients and to investigate the involvement of this enzyme in schizophrenia’s physiopathology.
This was a cross-sectional case-control study conducted between June 2016 and July 2018 on antipsychotic-free schizophrenic patients compared to healthy controls. Patients were hospitalized at the psychiatric C department in Hedi Chaker University Hospital (UH) in Sfax. The diagnosis of schizophrenia was established according to DSM-5 criteria. The symptoms’ severity was evaluated by the positive and negative syndrome scale (PANSS). Cognitive functions were evaluated according to the Montreal Cognitive Assessment (MoCA) scale.The analysis of BChE levels was performed in the laboratory of Biochemistry in Habib Bourguiba UH in Sfax using a colorimetric method by Cobas 6000 Analyser (Roche®).
The sample consisted of 145 individuals: 45 with schizophrenia and 100 with no psychiatric disorder.
BChE levels in the schizophrenic group were significantly increased compared to controls (8655 ± 1342 UI/L vs7648 ± 1304 UI/L; p<0,001).
There was no correlation between BChE levels and PANSS different scores. However, BChE levels were significantly and negatively correlated with MoCA cognitive scale (r=-0,566 ; p=0,001)
Schizophrenic patients expressed higher levels of BChE which could be related to the pathophysiology of schizophrenia.
The combination of antipsychotics can be seen in up to 70% due to the presence of resistance to treatment, aggression and self destructive behavior in schizophrenia spectrum disorders in clinical practice which can lead to increased drug side effects.
The aim of this study is retrospectively investigate the differences between sociodemographic and clinical characteristics of monotherapy and combination therapy with antipsychotics in male patients with inpatient psychotic disorder.
The files of 754 cases admitted to the hospital from the first day of January 2013 to the last day of December 2016 were reached. According to DSM-5 , patients who were diagnosed under the category of " Schizophrenia Spectrum and Other Psychotic Disorders”were included.
Patients seperated into two different groups (monotherapy- combined therapy). Sociodemographic and disease charecteristics of these two groups were included the analysis.
Pearson chi-square test and student t test were used in data analysis
Age was significantly lower in patients treated with combined antipsychotics (t = 2,264, p = 0.026) The age at onset of the disease was significantly lower in patients receiving combined antipsychotics (t = 2,771, p = 0.007). Education level was lower (t = 2,333, p = 0.02) and duration of hospital stay was longer in this group (t = 3,069, p = 0.002).
Similar to the literature, antipsychotic treatment combinations are preferred more frequently in patients requiring hospitalization in the closed ward. Age, age onset of psychosis, education level and duration of hospital stay were have statisticly different in these two treatment groups
Schizophrenia is a chronic mental disorder with high social impact and mortality. Suicide is the leading cause of death in schizophrenic patients. Despite great efforts in preventing, suicide rates remained alarming, highlighting the need for better understanding of the phenomenon.
to determine the prevalence of suicide in schizophrenic patients, identify the main risk factors and the characteristics of suicide.
A retrospective study on medical records of 87 patients (65 men / 22 women) who were admitted to the Arrazi Hospital in Salé for a suicide attempt, from June 2016 to June 2018, using an operating file that includes (socio-demographic criteria, personal and family history, characteristics of the suicide attempt, treatment).
statistical analysis : SPSS 20.0
socio-demographic characteristics are shown in Table 1.
Characteristics of the suicide attempt are shown in Graphic 1.
At the time of the suicide attempt, 66% of our patients were alone, 89% took action during the day and 46% performed the act impulsively (Table 2).
After TS, two-thirds of our patients required medical management (60 % in ambulatory and 10 % in hospital). 5% of the cases had required a surgical intervention or a stay in resuscitation. 37% of patients were treated with conventional neuroleptics and 63% with second-generation antipsychotics.
The prevention of suicide in these patients remains fundamental, as is the reduction of positive or negative symptoms, the improvement of the quality of life, the reduction of disability caused by this disease and the fight against the stigmatization of patients.
The Cognitive Assessment Interview (CAI) was developed to investigate the subjective assessment of cognitive impairment and its impact on functioning in subjects with schizophrenia (SCZs). The Food and Drug Administration indicated that the evaluation of changes induced by pharmacological treatments on cognitive deficits should be carried out by integrating "primary" measures (assessed by means of neuropsychological tests) with co-primary measures which include interview-based evaluations as well as the assessment of functional capacity.
The aim of the present study was to investigate the psychometric properties and the functional correlates of the Italian version of CAI in 599 SCZs and their caregivers.
In the context of the Italian Network for Research on Psychoses, we administered CAI to 599 SCZs and their caregivers. We assessed neurocognition by means of the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB), social cognition, functional capacity and real-life functioning.
The Italian version of the CAI revealed excellent internal consistency. The global CAI composite score was correlated with the MCCB score and with the indices of social cognition, functional capacity and real-life functioning.
Our results demonstrated a good convergent validity and an excellent internal consistency of the Italian version of the CAI. Furthermore, this study showed an association between the subjective assessment of cognitive impairment and the objective measures of cognitive functions, social cognition, functional capacity and functional outcome.
Schizophrenia is a severe mental disorder with a relatively high toll on the quality of life of the patient and caregiver
Clinically, we come across number of persons with schizophrenia with deficits in vocational functioning.
We often see the onset of difficulties during student life.
With the primary focus being on symptom control, other complaints of residual cognitive impairment, difficulty in accessing educational resources, are marginalized.
To enlist and evaluate factors hindering educational outcome in students with schizophrenia
1. Research Design
Semi-structured qualitative interviewing about factors hindering educational outcome in students with schizophrenia/schizoaffective disorder (with both caregivers and patients)
2.Sampling:
Purposive sampling was done. We recruited in total 21 participants (11 patients and 10 caregivers)
3.Inclusion criteria:
a) Subjects meeting ICD-10 criteria for Schizophrenia and schizoaffective disorder according to MINI (Sheehan et al., 1998)
b) Age group: 16 yrs-30 yrs
c) Occupation-Student/Can be employed
d) 1 week remission
TABLE 1
As illustrated in Table 1, 17 (85%) patients scored illness symptoms as as having significant influence on their educational outcome. For other factors, the number of patients scoring it as atleast some influence is:
Temperamental traits-1(5%)
Poor extrinsic/intrinsic motivation-1(5%)
High extrinsic motivation (5%)
Side effects of medications-10 (50%)
Delay in treatment -1(5%),
This studywas possibly one of the first to evaluate factors hindering educational outcome in patients with schizophrenia in India.
Clinical remission might not translate to optimal educational and we need to acknowledge that psychosocial factors need to be considered when making a rehabiliation plan for our client.
Psychosis is the primary manifestation of schizophrenia spectrum disorders, and is characterized by significant impairment in reality testing.
We aimed to identify biomarkers that are associated with disease pathophysiology and treatment response.
We performed global untargeted metabolomics analysis of cerebrospinal fluid and serum of patients presenting with first-episode psychosis prior to and following 18 months of antipsychotic treatment, utilizing ultra-pressure liquid chromatography coupled with time-of-flight mass spectroscopy.
We identified a catalog of 142 metabolites that significantly differ between psychotic patients and healthy controls. 55 of these metabolites significantly differed only at baseline, while 54 differed at both baseline and follow-up, and 33 differed only at follow-up. Similarly, we compared the metabolomics profile of psychotic patients at baseline and follow-up to identify 184 metabolites that were significantly altered within only the cerebrospinal fluid, 12 metabolites altered only within the serum, and 20 metabolites that underwent the same directional change within both the cerebrospinal fluid and serum. Finally, 16 metabolites were found to exhibit the same directional change based upon the change in difference between healthy controls and psychotic patients as was identified based upon the effect of treatment for psychotic patients.
Our findings identify unique inventories of metabolites that may be associated with schizophrenia spectrum disorders or antipsychotic treatment, and may provide important insights into the pathophysiology of psychosis and/or the mechanisms underlying antipsychotic treatment efficacy.
Persistent Negative Symptoms (PNS) criteria include the presence of prominent negative symptoms (NS), functional impairment, presence of NS during stability periods and its persistence for at least six months. PNS seems to be associated with male gender, long duration of untreated psychosis (DUP), neurocognitive impairments and presence of traumatic life events.
Study the prevalence of PNS in first-episode psychosis patients (FEP). Describe the association between PNS and gender, age-at-onset in FEP, DUP, functional level, positive symptoms, depressive symptoms, antipsychotic drugs doses and childhood traumatic experiences.
Longitudinal study. Drug-naive FEP patients with NS at the moment of inclusion and maintained at six-month follow-up from Parc Sanitari Sant Joan de Déu were included. Sociodemographic variables, the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDS), the Personal and Social Performance scale (PSP) and Childhood Trauma Questionnaire subscales (CTQ) were administered at six-month follow-up.
A total of 42 patients (64,3% men and 35,7% women) were included. 47,6% met criteria for PNS. Male gender (p=0,01) and worse PSP score (p=0,02) were associated with PNS. Same variables were found to be associated using the regression analysis. Sexual abuse subscale of CTQ was inversly associated with PNS (p=0,03).
As it is found in other publications, worse functional results and male gender seem to be associated with PNS. Controversial results for CTQ are found, maybe due to limited N in our sample, which is the main limitation of the study. Therefore, further studies are needed to improve the conceptualization of SNP.
Previous cross-sectional studies have found clozapine to N-desmethylclozapine (CLZ:NDMC) ratio to be negatively correlated with cognition in clozapine-treated patients with schizophrenia. However, no work examined the effects of the intraindividual ratio changes on cognition.
To examine the longitudinal effects of CLZ:NDMC ratio changes on cognition.
Using an ethically approved database (NRES13/EE/0121, Cambridgeshire, UK), we included patients with two or more standardized cognitive assessments and CLZ:NDMC ratio measurements within 12 weeks of those assessments, without medication change.
Assessment included the age and sex-adjusted composite score of the Brief Assessment of Cognition for Schizophrenia (BACS-C) and the Clinical Global Impression for Schizophrenia – psychosis score (CGI-P). Bivariate and partial correlations were performed.
17 patients were included (mean age=45.41, SD=8.06). The mean time between cognitive assessments was 1060.12 days (SD=369.76). At baseline: clozapine mean dose=382.35mg (SD=144.63, range=200-700), CLZ:NDMC mean ratio=1.28 (SD=0.30, range=0.90-2.20), CGI-P=2.35 (SD=1.77). At follow-up, dose=385.29mg (SD=170.72, range=150-700), ratio=1.47 (SD=0.50, range=0.78-2.94), CGI-P=2.12 (SD=1.36).
We found a negative correlation between variations in the CLZ:NDMC ratio and BACS-C score (r=-0.711, p=0.001, Fig.1). Partial correlation showed similar results when controlling for changes in dose (r=-734, p=0.001), psychosis severity (r=-0.686, p=0.003) or both (r=-0.710, p=0.003). No significant correlations were observed between changes in BACS-C and clozapine dose (r=-0.200, p=0.442) or CGI-P (r=0.321, p=0.210).
This is the first longitudinal analysis of the influence of CLZ:NDMC ratio on cognition. Our results support previous findings, suggesting that a lower CLZ:NDMC ratio might favourably affect cognition, and may indicate a promising therapeutic target to ameliorate cognitive impairment in clozapine-treated patients.
Negative symptoms (SN) may appear at the beginning of a first-episode psychosis (FEP) and seem to be associated with worse functional results, male gender, long duration of untreated psychosis (DUP), early age-at-oncet in FEP, neurocognitive disorders and traumatic life events.
Study the prevalence of NS in patients with drug-naive FEP. Describe the association between NS and gender, age-at-onset in FEP, DUP, premorbid functional level, positive and general psychopathology symptoms, depressive symptoms and childhood traumatic experiences.
Cross-sectional study. Drug-naive FEP patients from Parc Sanitari Sant Joan de Déu were included. Sociodemographic variables, the Positive and Negative Syndrome Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDS), the Personal and Social Performance scale (PSP) and Childhood Trauma Questionnaire (CTQ) were administered. Following the Marder model we used the equation: Marder Negative = 5.8548 + (1.0209 * SANS score), to split the sample into NS group (Marder ≥ 9) and non-NS group (Marder < 9).
A total of 155 patients (65,2% men and 34,8% women) were included. 58,6% of the patients met criteria for NS. PANSS Positive subscale was inversely associated with negative symptoms (p=0,04). Only gender, PANSS positive and general psychopathology subscales were found to be associated with negative symptoms using the regression analysis.
The high prevalence of NS in our sample can be due to the low specificity of the used scales. We found an association between NS and PANSS positive subscale, PANSS general psychopathology subscale and gender. Further studies are needed to improve the conceptualization and evaluation of NS.
INTRODUCTION
Since the firstdescriptionsofschizophrenia, cognitivedysfunctionshavebeenconsideredtoplayafundamentalroleinthedisorder. Existing data about cognitiveendophenotypesemphasize theroleofageneticcomponentinthepathology
and peculiarity of personality undeservedly not considered in the proper way.
OBJECTIVE: The study was designed to assess correlation between cognitive impairment and psychotypes in patients with schizophrenia.
METHOD: Personality types were identified by Minnesota Multiphasic Personality Inventory (MMPI). The severity of cognitive symptoms were evaluated by Clinician Rated Dimensions of Psychosis Symptom Severity(CRDPSS).
RESULTS: We categorized 80 patients (43 men,37 women) with schizophrenia (diagnosed by the DSM-5) on the basis of two leading scales of MMPI profiles. We got 28 psychotypes. In every group of the psychotipes there were subjects with cognitive dysfunctions. The most high index of cognitive dysfunctions (4 scores) had only 6 subjects. In 17 groups of the psychotypes we could not find subjects with cognitive impairments. The most frequent cognitive dysfunctions were in Sc-Pa (leading scales in personality profile – Schizophrenia and Paranoia) group, 14 subjects (53%).
CONCLUSIONS: The most frequently cognitive disfunctions are met in schizophrenic patients who belongs to “schizophreno-paranoid” psychotype, in whom schizoid and paranoiac personality characteristics dominate.
INTRODUCTION: Trauma is a recognized risk factor for Schizophrenia by interfering with normal neurodevelopment and establishing a biological vulnerability.
OBJECTIVES: It was interesting to know the latest research related to traumatic experiences in patients with a First Episode of Psychosis
METHODS: Bibliographic review in Pubmed bases of the last 10 years using the keywords: “First Episode Psychosis, Traumatic experiences, Childhood Trauma”
RESULTS:
Haahr UH et al. (2018) in 191 patients with FEP observed that half of the patients had experienced interpersonal trauma and one third had close interpersonal trauma before the age of 18. Women reported more sexual abuse, physical attacks and physical and emotional abuse than men. There were significant associations between early interpersonal trauma and premorbid adjustment and the duration of untreated psychosis.
In addition to severe traumatic experiences, milder, more common childhood adversities reflecting psychosocial burden may also be common in people with FEP. (Lindgren M et al., 2017).
The history of childhood trauma, especially sexual abuse is associated with a greater number of verbal auditory hallucinations in women but not in men, with more hallucinations in the third person and with abusive / accusatory / persecutory voices) (Misiak B et al., 2016) and with the volumes of the hippocampus and the amygdala in population with FEP (Hoy K et al, 2012)
CONCLUSIONS
Severe and common interpersonal traumas are highly prevalent in patients with FEP
Close interpersonal trauma before age 18 is associated with a poorer premorbid adjustment and a longer duration of untreated psychosis.
Pregabalin is a new generation antiepileptic that effects by reducing the release of neurotransmitters such as glutamate , noradrenaline and substance P via voltage-dependent calcium channels in the central nervous system . Although there has been increasing numbers of reports the potential for abuse of pregabalin in recent years , it is seen that this agent has a wide side effect profile.
In this case report, we aimed to present an acute psychotic condition developed after high dose pregabalin intake in a patient with pregabalin abuse.
We observed the patient in our male ward.
Case: A 20-year-old male patient with no history of psychiatric disease, who had been using pregabalin (600-900 mg / day) twice or three times a week for about 10 months. At last, he took 8-9 pregabalin 300 mg tablets 9 days ago. After 3 days of high dose pregabalin intake, the patient admitted to the psychiatric emergency department of our hospital with complaints of meaningless speechs, ailmess movements, talking to himself and self-mutilation.
Altough pregabalin has major side effects such as dizziness, diplopia, euphoria etc. , there isn’t enough data in the literature on psychogenic side effects. And there are limited cases in the literature about pregabalin induced psychotic disorder. As clinical usage and abuse of pregabalin is increasing, it should be considered that high doses of pregabalin may cause psychotic symptoms.
In traditional French psychiatry, the concept of “pathological journey” has existed since the twentieth century. It is defined as a sudden and unexpected trip, made by an individual under the influence of a psychiatric disorder. Several syndromes of cities or countries (Jerusalem, Paris, Florence, India, New York and more) have been described.
Describe the characteristics of pathological travelers arriving in Geneva and analyze the reasons for this trip.
After a narrative review of the literature, we conducted a retrospective study on the psychiatric service of the Geneva University Hospital from 2008 to 2018. The keywords “pathological travel” were found in 851 files. Swiss patients, migrants, and duplication of medical records were excluded.
In the past ten years, 239 patients were retained for this diagnosis in the admission units of our clinic. The typical patient is a man (61%), who is single (57%), childless (71%), and European (73%). Most patients traveled alone (96%), arrived to the emergency division accompanied by the police (47%) and were previously receiving psychiatric care (92%). Many hospitalizations were involuntary (49%) mainly due to paranoid delusions (72%). Pathological travelers came to Geneva in search of security (26%), or because of specific claims toward international organizations (13%).
Geneva syndrome is a singular pathological syndrome that essentially concerns patients suffering from psychosis. These patients are attracted to Geneva’s international aura for humans’ rights, wealth and Switzerland's reputation of being one of the world's safest country.
Hallucinations in visually deprived old age patients can be due to various conditions and presents an interesting and challenging case. The modality of hallucination also point towards various differential diagnosis. The predominant hallucinations are usually auditory and visual, and hallucinations in other modalities are comparatively rare. Here we present a case report of visually deprived old age man with multimodal hallucination.
The objective of the case report is to elucidate various differential diagnosis and to present rather rare presentation.
History was obtained from Patients relatives, Mental status examination was conducted, and necessary investigations were done.
A 70 year old male presented with complaints from the patient of seeing number of people, who are torturing him physically, talking ill about him, releasing various poisonous gases on him since one year and complaints of altered behavior from the spouse. MSE revealed hallucinations in all sensory modalities, delusions of persecution. MRI revealed diffuse cerebral atrophy with small vessel ischaemic changes. Patient was started on Olanzapine and Aripiprazole, and the hallucinations reduced, with visual hallucinations still persisting.
The above case presents a diagnostic and therapeutic challenge because of the atypical presentation and age respectively. The differentials considered were late onset schizophrenia, dementia with psychosis, and Charless bonet syndrome.
The present research aims to determine if there are stressful life events in common in the clinical population with a diagnosis of the first psychotic episode. The measurement of stressful life events was made by applying the Social Readiness scale of Holmes and Rahe .
Identify stressful life events in the first episode of psychosis
One nonrandom, for convenience of a minimum of 30 patients was obtained who are found as users of the clinic for early intervention in psychosis.
Inclusion criteria
Adult patients , older than 18 years and younger than 36 .
Patients who are enrolled in the service of the clinic of early intervention in psychosis of the seventh floor of the Fray Bernardino Álvarez Psychiatric Hospital between the months of July to September 2017
Informed consent signed by the patient and his responsible family member if necessary .
For the logistic regression analysis six explanatory models were created, and in them the variables that establish the prediction are: Marriage, separation, divorce, injury or illness and death of a close relative ( p <.004 ), while labor problems they had a p <.058 .
There are stressful life factors in common in the population of CITEP users with a diagnosis of first psychotic episode and that the most significant life events were marked by 70% of the respondents were marriage, separation, divorce, injury or illness and death of a close relative which are related to the family, which answers our research question.
Insight in schizophrenia spectrum disorders (SSD) is associated with clinical outcomes. Although insight has been linked with metacognition, the association of specific metacognitive domains with insight remains unclear, which may have implications on treatment -metacognitive therapies-.
To investigate the association of specific metacognitive domains and insight dimensions in a sample of schizophrenia patients.
Outpatients with SSD, age 18-64, with an IQ≥70, from Hospital Universitario Fundación Jiménez Díaz (Madrid, Spain) will be recruited over 01/06/2019-31/12/2020 as part of a larger project.
Outcome measure: the Schedule for Assessment of Insight.
Independent variables: i) jumping to conclusions: Beads Task; ii) cognitive insight: Beck Cognitive Insight Scale; iii) Theory of Mind (ToM): Hinting Task and Emotions Recognition Test Faces.
Statistics: Regression analyses.
N=48 subjects were assessed at baseline (n=25 males, age:46.9±10.2years, schizophrenia-F22.0-ICD10-, n=36).
TOTAL INSIGHT | ILLNESS RECOGNITION | SYMPTOMS RELABELING | TREATMENT COMPLIANCE | |||||||||||||
B | SE | p | R2 | B | SE | p | R2 | B | SE | p | R2 | B | SE | p | R2 | |
Jumping to Conclusions | 1.969 | 5.491 | 0.136 | 0.138 | 2.909 | 2.670 | 0.470 | 0.191 | 0.750 | 2.727 | 0.529 | 0.057 | 0.733 | 1.580 | 0.539 | 0.056 |
Cognitive Insight | 7.656 | 4.709 | 0.002 | 0.262 | 3.629 | 2.499 | 0.037 | 0.139 | 9.318 | 2.265 | 0.001 | 0.328 | 1.295 | 1.568 | 0.287 | 0.065 |
Theory of Mind | 0.534 | 4.761 | 0.470 | 0.021 | 0.245 | 2.554 | 0.784 | 0.010 | 0.454 | 2.301 | 0.639 | 0.016 | 0.873 | 1.574 | 0.427 | 0.044 |
0.421 | 0.340 | 0.401 |
Cognitive insight emerged as the main metacognitive domain underlying insight in SSD. Metacognitive therapies targeting cognitive insight may therefore improve insight, although future randomised controlled trials are needed to demonstrate this.
Aging is complex, ubiquitous procedure with biological, social and psychological impact on a wide range of areas of human functioning. Cognitive functioning is one of the most important areas influenced by aging, especially considering the effects of cognitive decline, in regards with the constant increase in life expectancy.
Research in schizophrenia spectrum disorders reveals a significant effect in cognitive function, in relation with the severity of other psychotic symptoms. The importance of the additive effect of aging is one of the emerging targets of research in schizophrenia.
Thus, DSM-V proposed an 8-item measure, CRDPSS (Clinician-Rated_Dimensions_of_Psychosis_Symptom_Severity), which assesses the severity of eight important symptoms in psychotic disorders, on a 5-point (0-4) scale, including impaired cognition. MoCA cognitive screening test (Montreal_Cognitive_Assessment), validated in Greek, was used for the classification of cognitive impairment, in comparison with age.
The objective of this research is to evaluate the influence of aging on cognitive functioning of patients diagnosed with schizophrenia spectrum disorders.
71 Patients diagnosed with schizophrenia spectrum disorders, attended in the Outpatient Department of Psychotic Disorders of University of Thessaly, Greece and its affiliated psychiatric clinics, were evaluated the last 24 months, using the CRDPSS measure and the validated greek version of the MoCA test.
Cognitive status is negatively affected by aging in patients diagnosed with schizophrenia spectrum disorders. This effect is higher as age (>50 years old) increase.
Future research should further highlight the additive effects of aging and psychosis in cognitive function, allowing the implementation of evidence-based strategies of addressing this complex phenomenon.
Cognitive and social impairment are well defined in schizophrenia and schizoaffective disorders, yet we do not have a clear explanation whether they develop through illness process or environmental.
The purpose of the study is to evaluate the cognitive empathy skills of patients diagnosed with schizophrenia and schizoaffective disorder and their first degree relatives by using “Reading the mind in the eyes test (rmet)”.
The “Reading the mind in the eyes test (RMET)” performances of the patients who were being treated in NPIstanbul Brain Hospital and are diagnosed with schizophrenia and schizoaffective disorders according to DSM V diagnostic criteria first degree relatives of these patients and the control group that doesn’t have any psychiatric diagnoses were compared, through January-April of 2019. We analyzed the correct scores (recognized emotion) and the incorrect scores (unrecognized emotion) received from RMET.
Based on incorrect answer scores acquired from RMET, statistically significant differentiation was detected between the patients diagnosed with schizophrenia and schizoaffective disorders and their first degree relatives and the control group (H(2)=57,691, p<0,001 and H(2)=57,067, p<0,001). Patients’ scores acquired from incorrect answers(unrecognized emotion), differed significantly high in comparison with the patients’ first degree relatives and the control group (p<0,05).
According to the findings of our research, there is a significant differentiation between patients diagnosed with schizophrenia and schizoaffective disorder and their first degree relatives’ incorrect scores in RMET. The results could be tested further to determine the role of genetic and environmental factors in cognitive and social deficencies in schizophrenia and schizoaffective disorders.
The importance of improving access to clozapine in first episode psychosis (FEP) has been recognised internationally across Early Intervention in Psychosis Services (EIPS) following established evidence of improved efficacy in treatment resistant (TR) populations. TR may occur from first onset of psychotic illness, and appears characterized by negative symptoms and younger age of onset. Clozapine remains under prescribed.
This mixed method cross sectional analysis of antipsychotic prescribing in a UK EIPS, aimed to explore clozapine eligibility (CE) and prioritisation of antipsychotic prescribing based on choice, selectivity and appropriateness.
We screened 150 service users. 79% (n=119) were retained after excluding those in assessment phase, at risk mental state, already on clozapine or not meeting FEP criteria. We explored CE in all service users who had had trials of at least 2 antipsychotic medications (n=78).
Following multidisciplinary clinical discussions, 23 service users were CE; 8 had been offered and declined clozapine. When compared to non-CE service users, significant factors associated with CE were history of 2 or more hospital admissions (Mann-Whitney U=269, p=0.008), more than 2 trials of 2 different antipsychotics (Mann-Whitney U=517, p=<0.01), and younger age at FEP (independent-samples t-test, p=0.047). 47.5% of all service users had been started on olanzapine as their first antipsychotic in FEP, despite a high associated risk of cardiometabolic syndrome.
We propose that EIP services adopt a proactive approach in screening for TR, taking into account negative symptoms and young age at onset, prioritising service users with 2 or more hospital admissions and antipsychotic trials.
Negative symptoms are present approximately in 60% of patients with schizophrenia1. Studies have suggested that they have a greater impact on the real world functioning2 affecting the patient's ability to live independently, to be socially active and to work or study2, 3. Up to our knowledge, few studies analyse the differences of the impact of negative symptoms on functioning according to gender.
To investigate the differences between women and men in the relationship of negative symptoms with functioning.
Secondary analysis of a cross-sectional, naturalistic study. 294 patients with Schizophrenia (F20), aged 18-65 under maintenance treatment. Assessments: PANSS, CDS, CGI-S, CAINS; functioning: PSP. Statistical analysis: student-t test, partial correlation.
Mean age: 38.5; men: 60.3%. Women had a statistically significant better functioning in work performance (p=0.002), self-care (p=0.001) and global functioning (p=0.001). Negative symptoms [Motivation and Pleasure (M&P), Expression (E), and Global Negative Symptoms (GNS)] negatively impact on real-world functioning. However, when controlling for scores on CDS, CGI-S and PANSS-P, in women only significant correlations with M&P (-0.452; p= 0.002), and GNS (-0.502; p=0.001) were obtained. In men, all negative symptom scores negatively affected functioning [M&P -0.290; p=0.01; E -0.346; p=0.003; and GNS-0.384; p=0.001].
The effect of negative symptoms on real-world functioning differs between genders; expressive signs play the greatest role in men while they don`t have a significant effect on women, in which only motivation and pleasure have a moderate effect.
One of the diagnostic criteria for schizophrenia is Social Dysfunction (SD). Actually, its definition does not allow a clear differentiation between SD as a specific dimension of schizophrenia from SD that characterizes other mental illness, or SD that merely emerges during adversities. Recently, SD in schizophrenia begins to be better characterized by the introduction of the concept of dis-sociality.
The aim of this study was to explore internal consistency, convergent and divergent validity as well as specificity of a structured interview - the Autism Rating Scale (ARS) – which evaluates dis-sociality in subjects with schizophrenia.
Fifty-one outpatients affected by schizophrenia and 28 affected by bipolar disorder (BD) type 1 were included in the study. Convergent validity was evaluated by examining correlation with positive symptoms and disorganization (assessed by Positive and Negative Syndrome Scale), negative symptoms (assessed by Brief Negative Symptoms Scale) and coenesthopathies (assessed by Schizophrenia Proneness Instrument – Adult Version). Divergent validity was assessed by performing correlation with autism spectrum disorders symptoms (assessed by PANSS Autism Severity Score). Specificity was evaluated by analyzing potential differences in SD among subjects with schizophrenia and patients with bipolar disorder.
The ARS showed strong convergent and divergent validity and good specificity both for frequency and intensity of symptoms.
Our results demonstrated that ARS could contribute to define a more specific characterization of SD in schizophrenia, and it could allow to define more precise phenomenal boundaries between schizophrenia and bipolar disorder.
People with schizophrenia show experiential anomalies in their body perceptions, in particular in feelings and cognitions arising in the domain of their lived body. These abnormal bodily phenomena (ABP) are not part of diagnostic criteria for schizophrenia. One of the main reasons is the difficulty to assess them due to the lack of specific tools.
The aim of the present study was the validation of the Abnormal Bodily Phenomena questionnaire (ABPq), a structured interview carried out to detect and measure those ABP that are specific of schizophrenia.
Fifty-one outpatients with schizophrenia (SCZ) and 28 with bipolar disorder (BD) were recruited. Convergent validity was evaluated by examining correlation with positive symptoms and disorganization (assessed by Positive and Negative Syndrome Scale), negative symptoms (assessed by Brief Negative Symptoms Scale) and coenesthopathies (assessed by Schizophrenia Proneness Instrument – Adult Version). Specificity was evaluated by examining potential differences in ABPq among SCZ and BD subjects.
ABPq showed a strong convergent validity. The analysis of specificity showed a statistically significant difference in frequency of all ABPq dimensions and in severity of all ABPq dimensions except for “Vitality”.
Our results demonstrated that ABPq could contribute to detect more precisely ABP in patients with schizophrenia and to establish more precise phenomenal boundaries between schizophrenia and bipolar disorder. It could also lead to a better definition of the borders between non-psychotic and psychotic forms of ABP and between ABP, negative and disorganized symptoms.
New technologies have developed considerably and have the potential to improve access to psychological treatments for patients with psychosis. Previous studies show an improvement in the access to treatment who use different technological devices in their everyday life.
The aim of this study is review the scientific literature about the use of online intervention for patients with psychosis to show the current state of online intervention and asset the effectiveness of these treatments.
We have identified articles from Pubmed, and Medline databases. We included all randomized controlled trials designed to test the efficacy of the online intervention or web-based intervention to patients with psychosis. We excluded observational trials, non-randomised trial and protocol study. Studies with RCT design and the participants must not have more than 5 to 10 years of evolution since the diagnosis, and the papers have been published between 2010 and 2019, in English language. The researchers independently assessed the articles and the discrepancies were resolved by consensus.
We presented data about all randomized controlled trials of online interventions/ e-Health interventions/ App-mobile based and/or computer based intervention programs than were specifically designed for people with first episode psychosis or psychotic symptoms that had measured changes in functioning, quality of life or positive/negative symptoms. As unique treatment or as a complementary treatment with other psychological or psychopharmacology intervention.
The strengths and limitations of our systematic review will be discussed.
Arachnoid cysts are congenital benign tumors of the central nervous system with manifestations associated with size and location. The most common symptoms are neurological.
Report the association of delusions with arachnoid cyst.
Review of medical records and literature.
A 39-year-old woman was taken to the emergency room after a suicide attempt. This was motivated by delusions that got worse in the last month. Onset of symptoms 9 years ago after a real stressor with her neighbor when she started feeling persecuted. Four years ago, patient suffered the death of her daughter. During the period she had no diagnostic criteria for depression, with worsening of delusions. Despite the symptoms, the patient remained working and in good relationship with her family. Laboratory tests were normal. Head computed tomography revealed left temporal pole arachnoid cyst and diffuse cerebral volume reduction. Due to surgical risks, neurosurgery team opted for conservative conduct. Initiated haloperidol treatment, with unsatisfactory clinical response. Switched to risperidone, maintaining symptoms.
There is no definitive association between the imaging finding and the delusions presented by the patient. However, the patient has no family history of psychiatric illness, has low antipsychotic response and the cyst localization has been associated with psychotic manifestations. Although neurosurgery team didn’t opt for surgical removal of the lesion, evidence suggests that the excision of arachnoid cysts may remedy the symptoms.
Further studies are needed to understand the relationship between psychiatric manifestations and neurological tumors and to point out the best therapy.
Although data regarding the efficacy, tolerability and safety of cariprazine from clinical trials are readily available, real-world data when transitioning from previous antipsychotics is currently missing.
This open-label, 16-week, observational study assessed the efficacy and safety of cariprazine in schizophrenia patients in Latvia.
Adult, outpatients with schizophrenia who previously received a non-effective antipsychotic treatment, experienced side effects, and/or wanted to switch drugs were included and received cariprazine treatment over 16 weeks. Symptom changes were assessed by rating hallucinations, delusions, alogia, affective blunting, avolition, apathy, asociality from 0 to 6 (not observed, minimal, mild, moderate, moderate severe, severe, extreme) and the CGI Improvement (CGI-I) scale. Safety measures included extrapyramidal symptoms (EPS), weight gain and spontaneously reported adverse events.
A total of 116 patients, with an average illness duration of 8 years, coming from 9 different types of antipsychotics received cariprazine treatment for 16 weeks; 82.8% completed the study. Change from baseline to end in symptom control was statistically significant (change from baseline:-7.06, p<.0001), with the most significant improvement in negative symptoms, especially avolition (change from baseline:-1.46, p<.0001). Improvement on CGI-I was also observed; with “Very much improved” and “Much improved” in 42.2% of patients. Pre-existing EPS and prolactin-related side effects gradually deceased, and no weight changes were observed during treatment. Over 70% of doctors were satisfied with both the efficacy and tolerability profile of cariprazine.
Transition from previous treatment to cariprazine was successful in terms of tolerability and efficacy, especially concerning negative symptoms.
Even though epidemiological evidence suggests that early detection of the symptomatology related to non-affective psychosis could improve the outcome of this mental condition, as well as improve the quality of life of the patients, in Bolivia there is a dearth of information as to the relation between duration of untreated psychosis, quality of life and expressed emotions.
Objective of this study is to identify the nature of the relation between quality of life, expressed emotions and untreated non affective psychosis.
Methods and instruments: correlational and cross sectional research, sample n= 50 (25 patients and 25 caregivers), from Hospital Japonés in Santa Cruz de la Sierra, year 2016. Semi structured interview (NOS) with dichotomous scale was administered to the caretakers, in order to reconstruct the duration of the untreated period along with the related emotions; whereas the questionnaire SQoL 18 was given to the patients, with the aim of assessing their quality of life.
Positive and moderate correlation (r= .66, p<0.01) was found to be correlated with the duration of untreated condition.
It is advisable to use a larger and more homogeneous sample. Of particular interest, it would be the study of variables such as sex, age, income. There is a need for treatments aimed at reducing the high levels of emotions expressed by the caregivers and ue recommend the analysis of the influence of EE onto the different symptoms of schizophrenia to highlight individual differences.
Mutism is a symptom which can be found as a part of different psychiatric disorders: selective mutism, schizophrenia and other psychotic disorders, hysteria, stupor, major depressive disorder, etc. In this work we present the case of a woman 50 years old who arrives to the hospital because see suffers from an atypical thoracic pain. Moreover, she is more focused on her religious devotion than usual, and verbalizes delusional ideas of prejudice. When the doctors suggest she should be evaluated by Psychiatry, she stops talking and doesn’t respond to verbal or pain stimulation.
To describe a peculiar case of mutism, and to discuss the differential diagnosis which lead to an appropriate management of this case, with a rapid resolution.
The clinical history of the patient was collected guaranteeing her anonymity, and a comprehensive literature research was conducted via Pubmed, Web of Science, and Up to Date, using key words such as “mutism”, “persistent delusional disorder”, and “psychotic symptoms”.
Complementary exams were run to exclude organic pathology. The patient received treatment with two intramuscular injections of Zuclopenthixol acetate 50 mg/ml in a few days. Shortly after that, she started talking normally again, and the behaviour disorder associated to the delusional ideas improved.
According to the symptoms and vital history of the patient, the diagnosis was a persistent delusional disorder. However, we must not forget the importance of the organic evaluation, and the fact that a systematic anamnesis and differential diagnosis lead to a good outcome.
The concept of the quality of remission in schizophrenia is based on the concept of personal-social recovery - “recovery”, in terms of improving cognitive, social functioning, without focusing on the full resolution of the symptoms of the disease.
A comparative research of the social functions of patients with schizophrenia was carried out, where treatment therapy was long acting antipsychotics of the first and second generation.
The investigation was conducted for 35 patients with paranoid schizophrenia in remission (F20.01 according to ICD-10). The first group (20 patients) receive paliperidone palmitate. In the second group -15 patients, haloperidol-decanoate. The assessment was carried out before the start of therapy and after 12 months of therapy. Used scales: PANSS, PSP, CGI-S.
The initial indicators of the first group are 54 + - 7.9 points according to PANSS and 2.45 + - 0.5 points according to CGI, PSP-71 + - 5.6 points.
In the second group, PANSS showed 75 + - 13.8 points, CGI - 2.8 + - 0.4 points, PSP - 62 + - 10.3. After 12 months, a reassessment was carried out: PANSS 52 + 13.7 (first group) and 71 + 13.2 (second group). PSP receiving paliperidone palmitate represents a significant improvement of 80.3 + 9.7 points for PSP, patients receiving haloperidol decanoate reached 67.1 + 11.7 points, which reflected a slight improvement in social functioning.
Thus, the indicator of social functioning by PSP during paliperidone palmitate therapy increased by 11%, while in patients receiving haloperidol decanoate, by 6% (p <0.05).
Schizophrenia is a highly heterogeneous disorder and approximately 30% of patients of schizophrenia show poor response to first-line antipsychotics, denoted as treatment-resistant schizophrenia (TRS). Clozapine is the most effective antipsychotic for TRS, although is not effective in 40% of resistant patients (ultra-treatment-resistant - UTR). TRs do not respond to first-line treatment since disease onset and show worse basal cognitive functions, thus suggesting a distinct and more disrupted neurobiological substrate. However, despite the central role of cognition in schizophrenia, to date no study has investigated longitudinal cognitive outcome among TRs.
To anayse longitudinal cognitive trajectories in a sample of clinically stabilized patients with schizophrenia, stratified according to antipsychotic response.
We enrolled 93 patients with schizophrenia (DSM-V), stratified as follows: 32 first-line responders (FLR), 42 TRS and 19 UTR. Cognition was longitudinally assessed at baseline and at least after 6 years of follow-up (9.3±2.8 years) using BACS. General linear Models (GLM) were performed with overall cognitive index effect size as dependent variable, treatment (FLR/TRS/UTR) as categorical variable and age/sex/education as covariates.
The first GLM (FLR/TR) showed a significant main effect of treatment (F=7.34, p=0.01), with worse cognitive outcome between TR patients. Consistently, the second GLM (FLR/TRS/UTR) resulted significant (F=17.90, p<0.001), with UTR group showing worse cognitive trajectory (p<0.001).
This is the first study to longitudinally evaluate cognitive trajectories in schizophrenia according to pharmacoresistance. We showed that TR is associated with a more severe cognitive decline, with worse outcome among UTRs, consistently with the hypothesis of a distinct and more disrupted neurobiological substrate.
The average length of a stay for a patient in a Japanese psychiatric hospital is 267.7 days. Trying to identify the means to shorten the hospitalization period is crucial. There is a large need for a better support for psychiatric patients who live in the community, as well as their families. This guideline was created in hopes to develop a better support system for severe psychiatric outpatient visits, improve the quality of life (QOL) of patients and families in the community, and to promote recovery.
In this study, we aimed to formulate guidelines for severe psychiatric outpatients who live in their community and their families, and present primary results from the evaluation.
We created a draft of the guideline by examining the contents of pre-existing guidelines and evaluation methods. We selected eight areas, 18 categories, and 96 items to evaluate for "The Care" content. The delphi method was used to evaluate the guidelines. The assessment was conducted as an anonymous survey on the web, measuring the importance, difficulty, and frequency of the care.
50 professionals participated in our study. 92 items out of 96 of the importance section scored 8.1 points or over, with interquartile range (IQR) of 76.0 – 92.0%.
The major difficult areas of care included; family care, specific care to promote strengths, specific care such as suicide and self-harm prevention, and coordination with other sectors. We aim to further revise the guidelines to be used in the severe psychiatric outpatient setting.
The pharmacotherpy of major psychotropic drugs has never been investigated before in Bahrtain.
We examined the outpatient prescription pattern of psychotropic drugs used for the treatment of five major psychiatric diseases in Bahrain.
This was a retrospective, cross-sectional study in which we targeted randomly selected prescriptions (n= 992, 56.1% males, 43.9% females) from 1st of January until 31st of December, 2017. Main outcome measure the types of outpatient psychotropic drugs prescribed by the physicians
The pharmacotherapy of schizophrenia consisted of atypical anti-psychotics (92.8%), or typical anti-psychotics (17.8%). The anti-depressants used were: Selective-serotonin reuptake inhibiters (SSRIs) (41.6%), Serotonin-norepinephrine reuptake inhibiters (SNRIs) (34.5%), tricyclic anti-depressants (TCAs) (12.8%), and atypical anti-depressants (10.6%). Combination anti-depressants was employed in (12.4%) of cases. The pharmacotherapy for anxiety disorders was composed of benzodiazepines (59.5%), atypical anti-psychotics (45.2%), SSRIs (40.5%), SNRIs (28.6%), TCAs (14.3%), and anti-convulsants (16.7%) and atypical anti-psychotics (7.1). The medications prescribed for bipolar disorder were atypical anti-psychotics (78.6%), anti-convulsants (66.5%), benzodiazepines (27.7%), typical anti-psychotics (8.9%) and lithium (6.7%). Schizoaffective disorder patients received atypical anti-psychotics (97.3%), anti-convulsants (47.8%), benzodiazepines (27.4%), SNRIs (25.7%), SSRIs (15%), typical anti-psychotics (10.6%), atypical anti-depressants (10.6%) and TCAs (6.2%). A combination of antipsychotics and anti-depressants was employed in 33.6% and 4.7% of all subjects regardless of the diagnosis, respectively.
With a few exceptions, the pharmacotherapy of psychiatric diseases in Bahrain was in line with the latest recommendations. However, psychotropic polypharmacy was observed and calls for immediate attention
Schizophrenia is probably the psychiatric disorder with the greatest impact on people's quality of life. Pharmacological treatment includes antipsychotics that are often effective for treating positive symptoms and have little impact on negative and cognitive ones. Oral side effects of antipsychotic medication, including alteration of the secretion of saliva, bruxism or oromandibular dyskinesia could compromise the oral health of these patients.
To study the oral and dental health of people with schizophrenia attended in the Bizkaia Mental Health Network treated with antipsychotic medication.
A prospective multicentre descriptive study was carried out, including patients with a diagnosis of schizophrenia treated with antipsychotics (n=69) and a control group (n=40). An oral health status evaluation was performed, including DMF-T (decayed, missing, filled tooth) and CPITN (community periodontal index of treatment needs) indices, salivary flow measurement and yeast culture and identification. The diagnosis of the lesions detected in the oral mucosa was also established.
Psychiatric patients had higher scores than control group in decayed and missing teeth (9.62 vs. 6.5), a higher need of periodontal treatment (CPITN index 2 vs. 1), and exhibited greater xerostomia scores (23 vs. 6 cases). Among the oral mucosa lesions, hyperkeratosis was described in 9% of psychiatric patients. No candidiasis was detected in any group.
The patients with schizophrenia in this study showed reduced oral health, which could be related to several factor such as limited access to dental care, higher use of alcohol, sugary drinks, tobacco but also to pharmacological treatment itself.
A growing body of evidence suggests that urban living in high income countries contributes to the development of psychosis.
After resuming the state of the art on the matter, we will present the results of a Swiss-based original study with use of mixed methods ( video-recorded go alongs, semi-structured interviews and a survey ) and outline future prospects for research and therapeutical strategies.
Litterature survey, qualitative and quantitative analysis (original study) and scoping for novel research and therapeutic strategies.
Despite accumulated data, the majority of studies conducted so far failed to explain how specific factors of urban environment combine in daily life to create protective and disruptive milieus. This undermines the translation of a vast epidemiological knowledge into effective urbanistic and therapeutic developments calling for more interdisciplinary and experience based approaches. In our original study we found that development of psychosis influences the way early psychosis patients perceive the city and their capacity to benefit from its assets.
New studies on urbanicity shall bridge knowledge from different disciplines (psychiatry, epidemiology, human geography, urbanism, etc.) in order to enrich research methods and ensure the development of effective treatment and preventive strategies. A set of macrolevel strategies ranging from urban planning to mental health policies can be implemented to mitigate urbanicity effect. Considering the high level of social withdrawal and its detrimential impact on the recovery process, we strongly believe that investing city avoidance and city anhedonia as main targets for individual therapies can help to bounce back after a psychotic outbreak.
Patients with co-morbid Major depressive disorder (MDD) in schizophrenia (SZ) may represent a specia diagnostic category requiring specific treatments. A recognition and diagnosis of MDD among patients with schizophrenia is especially important in order to select appropriate therapies
The aim of this study was to explore the co-morbidity Major depressive disorder (MDD) among schizophrenia (SZ) patients and explore clinical characteristics of these patients
A cohort-study was carried out on 396 patients . We employed the WHO Composite International Diagnostic Interview (WHO-CIDI), and Structured clinical interview for DSM-5 (SCID-5) for diagnoses, the Yale-Brown Obsessive- Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in SZ patients with and without co-morbid MDD .
A total of 396 subjects were interviewed. MDD with SZ (146, 36.8%) were 42.69±14.33 years old whereas MDD patients without SZ were 41.59±13.59 years old. . Statistically significant differences between MDD with SZ patients and MDD without SZ were: in BMI (body mass index) (p=0.025), family income (p=0.004), cigarette smoking (p<0.001), and prevalence of consanguinity (p=0.023). Statistically significant differences were found inGeneral Health Score (p=0.017), Clinical Global Impression-BD Score (p=0.042), duration of illnesses (p=0.003), and Global Assessment of Functioning (p=0.012). Anxiety dimensions (general anxiety, agoraphobia, , somatisation, any anxiety disorder) mood dimensions (major depression, mania, oppositional defiant behaviour, Bipolar disorder), ADHD, psychotic and personality dimensions were higher among MDD with SZ patients than MDD without SZ.
This study confirms that MDD-SZD is a common co-morbidity, largely under-recognized in clinical practice, which may significantly change SZ presentation and outcome.
Wilson`s Disease (WD) is a rare disorder affecting copper metabolism with a recessive inheritance. In spite of cardiac, neurological, hepatic and renal manifestations are well defined, approximately 30% of patients debut with neuropsychiatric symptoms. Theese psychiatric alterations are poorer known and less specific and result from the accumulation of this heavy metal in the basal ganglia.
Reviewing neuropsychiatric symptoms about a case
A review of psychiatric symptoms in WD is made and a description of a case of a 37-year-old woman diagnosed with WD who presented neuropsychiatric symptoms and a consequent delay in diagnosis and causal treatment.
Patients who develop WD starting with a predominance of neuropsychiatric symptoms tend to manifest symptoms later, have a longer time delay of diagnosis and a poorer outcome than patients with hepatic symptoms. When they occur not associated with hepatic or neurological symptoms there is a high risk of misdiagnosis.
Sometimes, treatment with cupper chelates is enough to resolve psychiatric symptoms.
Psychiatric manifestations are common in WD and can be present at any point in the course of the illness. Diagnosis and appropriate treatment can solve psychiatric symptoms in a very short period of time. An early diagnosis of WD can avoid irreversible neurological damage.
People with a schizophrenia experience higher levels of stigma.
Our aim was to explore the relationship between internalized stigma, depression and quality of life (QoL) in these patients.
This is a cross-sectional and analytical study including 37 stabilized patients with schizophrenia or schizoaffective disorder followed up in the outpatient psychiatry department at Hedi Chaker hospital university of Sfax, between August and October 2019. The Internalized Stigma of Mental Illness scale (ISMI-29) was used to assess internalized stigma and its five dimensions. We used the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) to assess QoL and the Calgary Depression Scale (CDS) to evaluate depression.
73% of these patients were followed for schizophrenia and 27% for schizoaffective disorder.
The global mean score of ISMI was 71.95. The mean scores of alienation, stereotype endorsement, perceived discrimination, social withdrawal and stigma resistance were 15.16, 16.54, 12.95, 15.65 and 11.38, respectively. The Q-LES-Q-SF mean score was 65.51. According to CDS, 18.9% of patients had depression with a mean score of 2.27.
Internalized stigma scores (global and the five dimensions scores) were significantly and negatively associated with QoL enjoyment satisfaction score (respective p: p<0.001;p<0.001; p=0.004; p<0.001; p<0.001; p<0,001; p<0.001).
Global ISMI score and the four first dimensions scores were positively associated with depressive patients (respective p: p=0.002, p<0.001, p=0.025, p=0.001 and p=0.003) while stigma resistance was negatively correlated with depression (p<0.001).
Our results confirmed that internalized stigma is associated with impaired QoL and depression in stabilized patients with schizophrenia-spectrum diagnosis.
The coming out of depressive disorders seems to be associated with severity of schizophrenia’s disease and with poor quality of life (QoL).
The aim of our study was to assess the relationship between depression and QoL in patients with schizophrenia.
This is a cross-sectional and analytical study including stabilized patients with schizophrenia or schizoaffective disorder followed up in the outpatient psychiatry department at Hedi Chaker hospital university of Sfax (Tunisia), between August and October 2019. We used the Calgary Depression Scale (CDS) to evaluate depression and the Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q-SF) to assess QoL.
We recruited 37 patients with a mean age of 49.14 years and a sex ratio of 4.66. Seventy-three (73%) of patients were followed for schizophrenia and 27% for schizoaffective disorder. They were married in 43.2% and 35.1% of patients had a regular work.
According to CDS, 18.9% of patients had depression with a mean score of 2.27 (SD 2). QLESQSF mean score was 65.51%.
Depression was negatively correlated with Quality of Life Enjoyment and Satisfaction (r=-0.59, p<0.001).
We did not find a significant difference in depression according to the socio-demographic characteristics of the respondents or the clinical features of the disease.
It is clear that depression in patients with schizophrenia is associated with significant functional disability. Strategies to overcome the burden of depression may instil hope for functional recovery.
The schizoaffective disorder is multifactoriel. Several factors almost unquestioned, even indisputable, participate in the episodes decompensation and affect various fields: biological, pharmacological or neurobiochemical.
Draw up the sociodemographic and clinical profile of patients treated for schizoaffective disorder and determine the role of life events in the onset of the disorder.
This is a retrospective study of 52 patients hospitalized in the psychiatric department of Monastir diagnosed with schizoaffective disorder according to DSM-V during the period from january 2016 to june 2016. The information was collected using a preset sheet with 35 items.
A total of 52 record was gathered. The average age was 38 years. The sample was predominantly male of rural origin I 61.5% of cases. The level of education was low in 59.6% of cases. More than half were without profession and single in 46.2% of cases. The mean age of onset of the disorder was noted in 22 patients, that to say, 42.3% of the sample. Family and emotional events were most frequently encountered with respective rates of 48.2% and 24.7%, followed by the professional events (20%) and social ones (6%).
Life events are due to chance but also to the environment. The complexity of the “event” concept was again underlined in a new perspective, breaking social rhythms.
Antipsychotic plasma levels have been extensively used for the assessment of poor treatment response, lack of adherence and adverse events in schizophrenia. However, evidence for delusional disorder is sparse.
Our main goal was to investigate the relationship between risperidone (R) and 9-hydroxyrisperidone (9-OH-R) plasma concentrations and clinical outcomes in delusional disorder. We also reviewed literature focusing on the use of risperidone plasma levels.
Case series: Risperidone and 9-OH-risperidone (active metabolite) plasma levels were determined by high-performance liquid chromatography (HPLC). Clinical variables were qualitatively correlated with two plasma ratios: R:9-OH-R concentration ratio (indicating CYP2D6 activity) and the total concentration-to-dose (C:D) ratio (indicating risperidone elimination). Review: A systematic electronic search was performed (PubMed) from inception until September 2019 according to the PRISMA statement. Search terms: "risperidone" OR "9-OH-risperidone" OR "paliperidone" OR "plasma levels" OR "therapeutic drug monitoring" AND "delusional disorder".
Case series: 12 patients (n=8 inpatients; n=4 outpatients) were included. Dose range: 0.5-6mg/day. One in 4 outpatients presented risperidone levels under the detection limit (<2.8 ng/mL) (lack of adherence). All other patients showed R: 9-OH-R <1 (CYP2D6 activity). Four (33%) patients presented a C:D ratio >14 (diminished risperidone elimination) which was associated with poor clinical response (n=2) and antipsychotic-adverse events (n=2).
Review: A total of 42 articles were retrieved (n=38 Pubmed, n=4 other sources). Two of them reported determinations of risperidone plasma levels: n=1, poor clinical response; n=1, adverse-events).
Antipsychotic plasma levels may be useful to estimate metabolic drug clearance, and by implication, for the assessment of clinical response and adverse-events.
Delusional disorder (DD) is considered to be rare. It does not seem to be properly diagnosed at the beginning and this may lead to dramatic consequences.
To make an epidemiological approach to delusional disorder and to describe its evolution.
We lead a retrospective descriptive study, involving 30 male patients suffering from DD (according to DSM 5) who were hospitalized in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2009 and December 2018. Data were collected from medical records.
DD constituted 1.3% of all admission. The mean age was 45.6 years. Patients were unemployed in 43.3% of cases. Nineteen patients (63.3%) were university educated. Family history of schizophrenia and DD were found in respectively 16.7% and 13.3% of cases.
The mean age of onset of the DD was 36 years. The main initial diagnoses were schizophrenia (54.5%) and depressive disorder (36.4%). The average delay to establish the correct diagnosis was about seven years after the first psychiatric examination. The main delusion themes were: mixed (43.3%), persecution (40%) and jealousy (6.7%). A comorbid paranoiac personality was diagnosed among 75% of our cases. Antipsychotics had been prescribed for all patients and they were long-acting neuroleptic for 23.3% of cases. Evolution has been characterized by erratic follow-up (73.3%), major depressive episodes (44.8%) and commission of criminal offenses (40%).
Our study highlighted the diagnostic difficulties of DD which may remain unrecognized and untreated for many years.
Schizencephaly is a rare congenital neurodevelopmental disorder resulting in the formation of abnormal clefts in the cerebral hemispheres. The major symptoms may include developmental delay, seizures and cognitive impairment.
To present a case report of a Tunisian patient who presented a first-episode psychosis associated with schizencephaly and to compare it with the six other cases found in the literature.
A literature search was conducted using PUBMED searching for case reports studies reporting cases of schizencephaly associated with psychosis.
A 23-year-old lyceum-educated Tunisian male patient who was referred to the F psychiatric ward of Razi Hospital by a general practitioner after his parents expressed concerns regarding his mental state. The patient had previously presented a specific learning disorder and had focal epileptic seizures at an early age. His physical examination revealed nystagmus, and his mental state examination revealed irritability, inflated self-esteem, racing thoughts, loosening of associations, interpretive and imaginative delirium.
There was no family history of mental illness.
Abnormal EEG findings (slow theta waves predominating in the right parietal temporal regions, accentuated at the hyperpnea) called for magnetic resonance imaging, which revealed unilateral parietal closed-lip schizencephaly. The patient has responded partially to the association of Olanzapine and Sodium Valproate.
Although schizencephaly seems to be rare, this clinical case highlights the importance of anamnesis, a detailed clinical examination and additional examinations when psychiatric symptoms appear.
Schizophrenia is a significantly disabling psychotic disorder. While in recent years, several studies have been conducted to assess the consequences of a long “duration of untreated psychosis” (DUP), which appears to be associated with poorer early course and long term outcomes, only a few have focused on the search for predictive factors of a long DUP.
This study aims to explore the clinical and social determinants of DUP in a sample of Tunisian patients with a diagnosis of schizophrenia spectrum disorder.
100 patients with a diagnosis of schizophrenia spectrum disorder were identified from patients hospitalized from March 2018 to March 2019 in “F” psychiatric ward of Razi hospital. We obtained data relating to socio-demographic and clinical variables and to DUP from medical files. A DUP of more than 12 months has been defined as long. SPSS and Khi-2 tests were used to analyze data.
The mean age of illness onset was 24.28 years. The mean duration of untreated psychosis was 28 months (range 6-240 months).
An onset of psychiatric disorders involving delusional speech (p=0,053) or psychomotor arousal (p=0.047) was significantly associated with a short DUP. However, the onset of disorders made of bizarre behavior was correlated with a longer DUP (p=0,047).
There was no significant association between DUP and age of patients, age of onset, sex, educational attainment, family history of psychiatric disorder, personal history of substance abuse.
The study highlights the importance of implementing awareness and information mental health campaigns to the general public and the need for early therapeutic intervention.
Dementia is often associated with neuropsychiatric symptoms, such as psychosis. Still, the implication of psychotic symptoms in advanced age, as very late-onset schizophrenia-like psychosis or as prodromal to dementia, and their treatment, remain a debated subject.
We aimed to review the literature and discuss psychotic symptoms in late life, focussing the diagnostic challenges and existing treatment recommendations.
A non-systematic literature review was conducted by searching the terms “psychotic disorders”, “dementia”, “dementia with psychosis” and “very late-onset schizophrenia-like psychosis” using Pubmed/MEDLINE Database. The research was limited to articles published in the last 5 years.
Psychotic symptoms seem to be common in older adults, resulting from several risk factors such as sensory deficits, social isolation and cognitive decline. Some studies understand the emergence of psychotic symptoms as prodromal to dementia, carrying a negative impact on its clinical course in terms of mortality and conversion to dementia. Psychotic symptoms are also frequently associated with established dementia, which seems to be related to greater cortical synaptic impairments. Psychosis in dementia is associated with a more rapid cognitive decline and overall worse outcomes. In terms of treatment, there is strongest evidence for the use of non-pharmacologic approaches, given the mortality risks associated with antipsychotics. Yet, growing evidence favors the use atypical antipsychotics or medications outside the antipsychotic class.
There is a need to better understand the diagnosis of psychosis in late life. Although psychotic disorders are common in older adults, there is low availability of evidence-based treatments.
Attention in the early stages of psychosis has become more important in recent years. It is estimated that there are about 6-20 new cases of psychosis per 100,000 inhabitants. Psychosis spends not only about 8 billion euros a year to our health system but also an incalculable emotional cost.
To develop an early intervention in psychosis program
Our Early Intervention Program in psychosis is dependent on the University Hospital La Paz, but focused on community care of patients with early stages of psychosis (people with a first psychotic episode between 16 and 40 years old) and their families. The program is included in the serious mental disorder case management program.
The program focuses on the community's attention to the individual with psychosis experience and his family, coordinated by a social worker, and with the figure of the extra-hospital psychiatrist as a responsible reference for the patient. Thus, a path of several evaluations and interventions has been designed, individualizing the attention according to the needs of each subject. A series of transversal resources of individual, group and family interventions has been established. The program also addresses the different comorbidities (such as addictions) and psychosocial and occupational rehabilitation. Objectives were also set regarding health education, case detection and clinical research.
Early intervention in psychosis is becoming increasingly important in our environment, and should be offered in each mental health unit, given the improvement in the quality of life of people served. Moreover, this kind of programs will help to conduct further research.
It is well known that besides cognitive impairments, individuals with psychotic disorders experience deficits in their functional capacity. Indeed, the recovery of the functional capacity is one of the most important aims in the treatment of patients with First-Episode Schizophrenia (FESz). As far as we know, this is the first study in Spain assessing the relationship between Neurocognition and Social Cognition using the MATRICS Consensus Cognitive Battery (MCCB) and Functional Capacity using The Brief International Functional Capacity Assessment (BIFCA), a novel instrument developed by the MATRICS Assessment Initiative, in patients with FESz.
To study the relationship between Neurocognition, Social Cognition and Functional Capacity in patients with FESz.
Twenty-eight patients with FESz (Mean age = 25.2, SD = 5.3 years old; Male = 78.6%) were recruited from an ongoing First Episode Psychotic Program at the Department of Psychiatry, Hospital 12 de Octubre, Madrid. The Neurocognition and Social Cognition were assessed with the MCCB and the Functional Capacity was assessed with the BIFCA battery.
Preliminary results showed a positive correlation between the MCCB´s Overall Composite score and the BIFCA´s Functional Capacity score (r = .432, p = .031), only explained by the Neurocognitive score (r = .529, p = .004) but not by the Social Cognition score (r = .110, p = .600) in patients with FESz.
Cognition and Functional Capacity seem to be directly related in patients with FESz, with regard to Neurocognition but not to Social Cognition.
Insight or awareness of illness is one of the most important predictors of future outcomes in patients with First-Episode Schizophrenia (FESz). The relationship between cognition and insight has been well established. However, the potential associations of social cognition and neurocognition with insight have been less characterized and reported, especially in patients with FESz.
To study the relationship between social cognition, neurocognition and insight in a sample of patients with FESz.
Twenty-four patients with FESz (Mean age = 25.9, SD = 5.6 years old, Males = 75%) recruited from an ongoing First-Episode Psychotic Program at the Department of Psychiatry, Hospital 12 de Octubre Madrid, participated in this study. The Social Cognition and Neurocognition were assessed using the MATRICS Consensus Cognitive Battery (MCCB). The Insight was measured using The Scale to Assess Unawareness of Mental Disorder (SUMD).
Preliminary results showed correlations between the MCCB Overall Composite score and Insight scores (SUMD1: r = -.505, p = .020; SUMD2: r = -.447, p = .042; SUMD3: r = -.494, p = .023) based only on the Social Cognition scores (SUMD1: r = -.415, p = .061; SUMD2: r = -.492, p = .023; SUMD3: r = -.557, p = .009), but not on the Neurocognition scores.
There is a relationship between cognitive function and insight in patients with FESz, in which insight is related to social cognition, but not to neurocognition.
Clozapine is the last line of medication for treatment resistant schizophrenia (TRS) as sole or main pharmacological option. Complications include life threatening events (seizures, epilepsy, QT prolongation, arrhythmias and ileus) and cardiovascular events of varying severity (tachycardia). Early recognition and management, as result of a detailed preventions schedule, is of paramount importance for patient safety and treatment continuation.
The highly successful early recognition and management of a rare series of serious complications (tachycardia, epilepsy and ileus) during treatment WITH clozapine as main treatment, is presented.
A young patient developed TRS with persistent negative symptoms. Treatment with haloperidol and amisulpride, produced minimal results. Haloperidol was discontinued and clozapine was initiated. Efficient algorithms including simple graphs for heart rate trend monitoring, programmed and symptom-related ECGs, estimation of clinical, EEG and laboratory findings (CPK) for seizure recognition and a detailed scheme of interventions for gastrenteric function regulation were applied.
Sinus tachycardia was recorded, estimated and controlled after a 20% beat per minute (bpm) increase (from 100 to 120 bpm - Graph 1). Epileptic seizures were recorded early during routine ECG examination and relapse was suspected from abnormal CPK findings after a 48-hour period, finally confirmed with EEG (Image 1). Ileus was detected after every day monitoring for intestinal function abnormalities and confirmed using repeated abdominal x-rays (X-ray 1). All complications were successfully treated without treatment discontinuation.
Statistical rarity of clozapine related complications combinations cannot exclude the possibility of their appearance. Management can be successful, if careful monitoring is applied from day-1 of treatment.
The role of family members as caregivers in Tunisia, where rehabilitation services are almost nonexistent, is important. Families experience a lot of physical, emotional and financial distress due to a patient’s abnormal behavior, and social dysfunction.
Assessing the burden of family caregivers of patients with schizophrenia.
Identify the associated risk factors
A cross-sectional, descriptive and analytical study was conducted in the outpatient psychiatry department of the University Hospital in Sfax (Tunisia), among 30 family caregivers of patients with schizophrenia. Caregivers were evaluated with Zarit Burden Interview.
Mean ages of caregivers and patients were 56.43 years and 43.5 years respectively. The sex ratio (M/F) was 0.66 in caregivers and 4 in patients.About 43.3% of caregivers were employed. Low income was found in 36.7% and financial difficulty in 56.7% of caregivers.
Caregivers were victim of aggression by the patient in 36.7% of cases.
Age of onset of the disorder was 25.4 years. Average number of hospitalizations was 2.17.Patients were unemployed in 80% of cases.
The total burden score of caregivers in our study was 34.47.
The level of burden experienced by family caregivers was moderate to severe in 43.4%.
A higher level of burden has been correlated with lower income (p=0.011) and financial difficulty (p= 0.018) of caregivers.
Our survey shows that schizophrenia is a source of great burden and psychological distress on caregivers. Caring for the psychotic patient need to change from a patient focused approach to a combined patient and caregiver approach.
Case management has been shown to be successful in reduction of hospitalizations and people leaving treatment.
To know the treatment adherence and the psychiatric hospitalizations of patients with severe schizophrenia (GCI-S ≥5) before (standard treatment) and during treatment in a community based, case managed program. And also the role of oral or long-acting injectable antipsychotic medication.
Observational study, mirror image, of ten years of follow-up and ten retrospectives, of patients with severe schizophrenia in a community based program, with integrated pharmacological and psychosocial treatment and intensive case management (N=344). Reasons for the Program discharge and psychiatric hospital admissions were recorded ten years before and during treatment. And also the antipsychotic medication prescribed.
After 10 years 12.2% of the patients were voluntary discharges (In previous standard treatment: 84.3%). CGI-S at baseline was 5.9(0.7). After ten years 51.7% of patients continued under treatment (CGI-S= 3.9(0.9); p<0.01); 19.3% were medical discharged (CGI-S=3.4(1.5); p<0.001); and 12.2 were voluntary discharges. Forty patients died during follow-up, five of them by suicide.The percentage of patients with hospital admissions and the number of admissions due to relapses decreased after beggining in the Program (p <0.0001), and as well the involuntary ones (p <0.001). To be on long-acting injectable antipsychotic treatment was related to these results (p <0.0001).
Treatment of patients with severe schizophrenia in a integrated, case-managed community-based program achieved higher retention, and was effective in reducing psychiatric hospitalizations, compared to the previous standard treatment. To be treated with long-acting injectable antipsychotics was clearly linked to these outcomes.