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PubMed2004

Dimensions of major psychoses: a confirmatory factor analysis of six competing models.

The symptoms of major psychosis aggregate in factors. Models of one to eight dimensions have been reported. In the present study, we tested six competing factor models, based on the psychotic and affective items of the OPCRIT checklist, in a large sample (N = 1294) of patients diagnosed with DSM-IV schizophrenia (n = 460), bipolar disorder (n = 726) and delusional disorder (n = 108). Confirmatory factor analysis was used to test the following models: (1) unique psychotic dimension; (2) positive-manic items, negative-depressive items; (3) model 2 with the addition of a disorganized factor; (4A) positive, negative, depressive and manic dimensions; (4B) model 4A with loss of pleasure (Anhedonia) and loss of energy (Apathy) included among depressive instead of negative symptoms; and (5) same as model 4B except for the addition of a disorganized domain. The four- and five-factor models fit the data much better than simpler ones. Between the two four-factor models, M4B emerged as more appropriate than M4A. The five-factor solution (M5) displayed the best fit. In conclusion, our confirmatory factor analysis in a large sample of psychotic subjects indicated that the symptomatology of major psychoses is composed of the following five factors: mania, positive symptoms, disorganization, depression and negative symptoms.

Adult↗
PubMed2004

Depressive syndrome in major psychoses: a study on 1351 subjects.

The aim of this study was to investigate depressive symptomatology across distinct major psychiatric disorders. A total of 1351 subjects affected by major depressive disorder (MDD = 389), bipolar disorder (BP = 511), delusional disorder (DD = 93) and schizophrenia (SKZ = 358) were included in our study. Subjects were assessed using the Operational Criteria for Psychotic Illness checklist (OPCRIT). The most frequently represented depressive symptoms in MDD were Loss of energy/tiredness, Loss of pleasure, Poor concentration, and Sleep disorders. Compared with MDD, BP had higher occurrences of Agitated activity, Excessive sleep, and Increased appetite and/or Weight gain, as well as lower Loss of pleasure. In our sample, 32.3% and 26.8% of DD and SKZ, respectively, had quite consistent depressive symptomatology, with at least four or more depressive symptoms. The most common depressive symptoms were Sleep disorders, Poor concentration and Loss of energy/Tiredness, followed by Psychomotor symptoms in SKZ only. Excessive self-reproach, Suicidal ideation, and Appetite and/or Weight changes were more specific to mood disorders. Finally, compared with SKZ, DD suffered from more depressive symptoms and had more severe depressive symptomatology. A quite consistent level of depressive symptomatology is therefore present in subpopulations of delusional and schizophrenic subjects other than in affective subjects. We identified some symptoms that are common across all major psychoses and symptoms that are more specific to each group.

Bipolar Disorder↗
PubMed2006

A special role of negative emotion in children and adolescents with schizophrenia and other psychoses.

Emotional impairments are apparent at an early stage in schizophrenia. While emotion processing has been studied intensively in adult patients, investigations focusing on children and adolescents with psychoses are rare. Emotion probes for mood induction and emotion discrimination that have been standardized in healthy subjects and applied to adult schizophrenia patients were evaluated in young patients (11-20 years). Twenty children and adolescents with schizophrenia and other psychotic disorders as well as twenty healthy volunteers matched for age, gender and parental education were examined. Results reveal successful mood induction in both patients and healthy volunteers, but with more negative affect prominent in patients. While a reduced ability to discriminate negative emotional faces emerged in patients than in controls, this difference failed to reach statistical significance. The similarities between test results of children and adolescents compared with those of adults demonstrate that both tests proved to be useful when applied to younger ages. Negative affect seems to be differentially affected, a finding that which may be already evident in the early course of schizophrenia.

Adolescent↗
PubMed2004

The persistence of developmental markers in childhood and adolescence and risk for schizophrenic psychoses in adult life. A 34-year follow-up of the Northern Finland 1966 birth cohort.

Childhood precursors of schizophrenia include multiple abnormalities of development. Continuities between early and subsequent deviance are poorly characterised. We studied associations among premorbid developmental deviance using data at ages 1 year (learning to stand, walk, and speak, attainment of bladder and bowel control) and 16 years (success at school). Generalised linear modelling was used to examine differential linear associations and trends across adult psychiatric diagnoses. In babies who, as adults, suffered schizophrenia or any psychosis, those who learned to stand latest were also more likely to perform poorly at school in both motor and theoretical domains at age 16 when compared with earlier learners. The effect was independent of genetic and perinatal factors. We conclude that the early developmental deviation in the first year of life is associated with lower school performance at age 16. Developmental continuity among children who develop psychoses was stronger than among normal controls and those hospitalized for nonpsychotic psychiatric disorder. These findings are in line with the hypothesis that a neural diathesis is present during postnatal brain development before schizophrenia. This supports the longitudinal dimension and life span models of schizophrenia.

Adolescent↗
PubMed2006

Diagnostic specificity and predictors of neurological soft signs in schizophrenia, bipolar disorder and other psychoses over the first 4 years of illness.

BACKGROUND: Neurological soft signs (NSS) are well described among patients with schizophrenia, the neurology of other psychoses is relatively unexplored and few comparative studies have prospectively examined these signs in first-episode patients. METHODS: We assessed neurological functioning in 242 patients presenting with a first episode of psychosis (in accordance with DSM-IV diagnosis) using the Condensed Neurological Examination (CNE). We sought to determine whether NSS were specific to patients with schizophrenia, bipolar affective disorder and other forms of psychosis. We also examined the factors associated with and predictive of neurodysfunction at first presentation and at 4 year follow-up. RESULTS: NSS were not specific to any diagnostic group. Neurological functioning was closely associated with psychopathology and mixed-handedness at first presentation. At follow-up there was a statistically significant improvement in neurological functioning. Persistent neurodysfunction at this stage was related to enduring negative symptoms and associated with poorer outcome. DISCUSSION: Schizophrenia and bipolar disorder are indistinguishable in terms of neurodysfunction at presentation. At presentation and 4 years NSS closely parallel psychopathology and mixed-handedness indicating that NSS may be a function of these factors or possibly an independent factor operates equally upon both symptoms and neurological function.

Adolescent↗
PubMed1997

N400 abnormalities in late life schizophrenia and related psychoses.

The N400, an event-related brain potential (ERP) sensitive to semantic congruity, has been reported to have increased latency and/or reduced amplitude in young adults with schizophrenia. Little is known, however, regarding the N400 in older schizophrenia patients, especially those with late onset. We studied 18 middle-aged and elderly patients with schizophrenia and related psychoses (nine with early-onset psychosis (EOP) and nine with late-onset psychosis (LOP)), and nine normal comparison (NC) subjects. Subjects read words which were semantically incongruent (50%) or congruent (50%) with a preceding spoken phrase which defined either an antonymic or categorical relationship. The LOP group had a significantly later peak latency of the N400 congruity effect compared to the NC group. Seven of 18 psychosis patients, but none (0/9) of the normal subjects, had an abnormal latency or amplitude (p = 0.04), measured at T6 (right temporal). Smaller amplitudes were associated with more severe negative symptoms (rp = 0.58; p = 0.01). N400 abnormalities in older schizophrenia patients likely reflect abnormal processing of semantic information.

Adult↗
PubMedDate not supplied

Somatic morbidity among patients diagnosed with affective psychoses and paranoid disorders. A case-control study.

Several studies have shown an increased mortality rate among psychiatric patients. Morbidity, however, has been studied less often. In this study, the authors examined the number of hospitalizations with somatic diagnoses in 722 patients with affective psychoses and 472 with a paranoid disorder. Every patient had an age- and sex-matched control subject who did not have a psychiatric illness. Both groups of patients exhibited an increased number of somatic diagnoses compared with their control subjects, and this was true for the majority of the 14 different groups classified according to the International Classification of Diseases the authors studied. The pattern of somatic diagnoses was similar to that presented in one of the authors' prior studies of schizophrenic patients.

Affective Disorders, Psychotic↗
PubMed1977

Increased brain dopamine and reduced glutamic acid decarboxylase and choline acetyl transferase activity in schizophrenia and related psychoses.

Dopamine, glutamic acid decarboxylase (G.A.D.) and choline acetyltransferase (C.A.T.) were measured in four regions of post-mortem brains. 41 patients with the hospital diagnosis of schizophrenia (psychotic group) were compared with a control grout normal in the putamen. G.A.D. activity was significantly reduced in the psychotic group, by about 50% in the nucleus accumbens, amygdala and hippocampus, and by about 30% in the putamen. C.A.T. activity was significantly lower in nucleus accumbens from the psychotic group, but normal in other brain regions. From an assessment of case notes, "schizophrenia" was distinguished from "schizophrenia-like psychosis". The biochemical findings for these subgroups were essentially similar, although C.A.T. activity in nucleus accumbens and hippocampus from the schizophrenic group was significantly lower than in controls. It is of brain are associated with schizophrenia and schizophrenia-like psychoses, although whether such neurochemical abnormalities are related to the illness or are a consequence of prolonged treatment with neuroleptic drugs remains unclear.

Adult↗
PubMed2002

REM sleep and prolactin in patients with non-affective psychoses.

Reduced REM latency is a common polysomnographic finding in patients with schizophrenia. This has been attributed to cholinergic hyperactivity secondary to increased dopaminergic tone. We studied polysomnographic sleep recordings, and morning serum prolactin levels as a measure of dopaminergic tone in 17 drug-free patients suffering from non-affective psychoses, hypothesizing that REM-latency and prolactin would correlate. A clear-cut positive correlation between prolactin and REM latency was found, as well as a negative correlation between prolactin and REM sleep. The findings may be explained by dopaminergic and secondary hypercholinergic and/or serotonergic mechanisms responsible for the regulation of REM sleep and the secretion of prolactin.

Circadian Rhythm↗
PubMed1997

Etiologic heterogeneity of the psychoses: is there a dopamine psychosis?

The distribution of drug-free plasma homovanillic acid (pHVA) concentrations was studied in a sample of psychotic patients, some of whom were selected for good prognostic features. Baseline pHVA was bimodally distributed, suggesting two different patient populations. The high-pHVA patients showed periods of better functioning and/or fewer symptoms 5 years before admission (p < .05) and had a more rapid (p < .05) and complete (p < .001) subacute neuroleptic response than lower-pHVA psychotics. High-pHVA psychotics did not differ in other aspects of demographics or clinical presentation from lower-pHVA psychotics. Compared to the general population, there were more psychotics in the families of high-pHVA patients (p < .005). Rapid antipsychotic response by high-pHVA psychotics is consistent with blockade of the effects of excess synaptic dopamine at D2 receptors for these patients. Results are discussed in the context of the syndromic heterogeneity of the psychoses.

Adolescent↗
PubMed2002

Frequency and age-related variables in interictal psychoses in localization-related epilepsies.

PURPOSE: Several studies have described that patients with temporal lobe epilepsy (TLE) develop psychoses more frequently than patients with extra-temporal localization-related epilepsy (LRE). However, few controlled studies have demonstrated an increased susceptibility to psychosis in TLE patients. As one of a series of multi-center studies on psychosis in epilepsy, we investigated whether the frequency of interictal psychosis differs between types of LRE. METHODS: We reviewed some biological characteristics of 197 PE patients with interictal psychosis and of 456 LRE patients with no history of psychosis. Type of PE was determined as TLE, frontal lobe epilepsy, parietal lobe epilepsy, occipital lobe epilepsy, and multi-lobar epilepsy/undifferentiated lobar epilepsy by clinical symptoms, EEG findings, and neuroimaging. The frequency of psychosis for each type of LRE was compared. Ages at onset of epilepsy and psychosis and the time interval between onset of each were also analyzed. RESULTS: There was no significant correlation between psychosis and epilepsy type (P=0.211). Age-related variables also failed to show any significant differences between LRE types (age at onset of epilepsy, P=0.369; age at onset of psychosis, P=0.852; the time interval, P=0.893). CONCLUSIONS: Patients with LREs as well as with TLE are susceptible to interictal psychosis. The mean ages at onset of symptoms and the interval between onset of epilepsy and onset of psychosis that we observed suggest that patients with LREs, regardless of focus, may share similar processes in the development of psychiatric symptoms.

Adolescent↗
PubMed2004

A polydiagnostic and dimensional comparison of epileptic psychoses and schizophrenia spectrum disorders.

After establishing the validity of the Japanese version of the Operational Criteria Checklist for Psychotic Illness (OPCRIT), we applied it to 58 consecutive patients with epileptic psychoses (index group) and to age- and sex-matched controls with schizophrenia spectrum disorders (control group). Compared with the control group, the index group had a low family history of schizophrenia, high premorbid personality disorder and unemployment, abrupt or acute onset of psychosis, good recovery with single or multiple episodes, and low deterioration from a premorbid level of function. From 9% to 52% of the index group and 38% to 84% of the control group were diagnosed with schizophrenia according to the operational criteria used. The percentages of patients diagnosed with schizophrenia based on various diagnostic criteria in the two groups were similar. In the index group, a diagnosis of schizophrenia was more commonly made among patients with inter-ictal psychosis than among those with post-ictal psychosis. An exploratory factor analysis identified five factor solutions of manic, negative, depressive, vegetative, and positive symptoms. Although positive and negative factor values were lower in the index group than in the control group, the two groups shared a similar factor profile. These results indicate that the difference in symptomatology between the two groups was quantitative rather than qualitative.

Adult↗
PubMed2004

Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences.

Patients with schizophrenia and related psychoses frequently use, abuse and become dependent on psychoactive substances. Local surveys indicate differences in both types and patterns of substances used. A cross-sectional survey was conducted to document abuse in 207 successive outpatients presenting to a psychiatric continuing care facility in a large Canadian city. Nicotine, alcohol and cannabis were the most frequently abused substances in the cohort. Excluding nicotine, 44.9% met criteria for lifetime and 14.0% for current abuse/dependence. Cocaine, heroin, hallucinogen, amphetamine, and inhalant use were rarely reported. Patients with current substance abuse/dependence and a psychotic disorder (dual diagnosis, DD) had significantly higher Positive and Negative Symptom Scale (PANSS) positive scores than lifetime-DD or those with a single diagnosis (SD). Significantly more current-DD (69.0%) patients were depressed (HAM-D score > or =12) compared to SD (45.6%). Furthermore, current-DD (27.6%) patients were more likely than SD (4.5%) to be medication non-compliant. Patients with current-DD were more likely to smoke cigarettes (88.9%) compared to those with SD (49.6%) and they had significantly longer histories of cigarette smoking (19.1 for DD vs. 11.5 years for SD). The smoking behavior of the DD population is discussed in terms of enhanced risk for alcohol abuse, as well as effects on antipsychotic blood levels and metabolism.

Adolescent↗
PubMed2000

Inverse correlation between hallucinations and serum prolactin in patients with non-affective psychoses.

Serum prolactin (PRL) was correlated with clinical symptomatology in 17 drug-free patients suffering from non-affective psychoses. A clear-cut negative correlation was found between the Comprehensive Psychiatric Rating Scale (CPRS) items assessing hallucinations and serum PRL levels (r=-6.14, P=0.009). No correlation was observed between clinical measures (total CPRS score, schizophrenia subscale score or depression and anxiety subscale score) and serum PRL.

Adolescent↗
PubMed2000

The antecedents of psychoses: a case-control study of selected risk factors.

Winter birth, urban birth and/or childhood residence, and perinatal complications have each been identified as environmental risk factors for the later development of schizophrenia, schizoaffective disorder, and bipolar disorder. A preliminary case-control study also identified cat exposure in childhood as a possible risk factor. To assess selected environmental events, including childhood exposure to pets, as possible risk factors for these diseases, a case-control telephone survey was carried out by the University of Maryland Survey Research Center for 264 mothers of cases and 528 mothers of matched controls. The cases were randomly selected mothers who were members of the National Alliance for the Mentally Ill, and whose children had been diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. The controls were mothers randomly selected from the same telephone exchanges. For five of the 19 major variables, there were statistically significant differences between cases and controls: fever during pregnancy, complications during delivery, city or suburban residence at birth, cat ownership between birth and age 13, and breast-feeding. In a multivariate logistic regression including these five variables, each variable made a significant contribution. The finding of perinatal complications, urban/suburban residence at birth, and cat ownership in childhood as risk factors for the later development of psychoses confirmed previous studies. Previous research on breast-feeding as a risk factor has yielded contradictory results. Additional research is needed to ascertain how such environmental risk factors interact with genetic risk factors. Understanding these could lead to better treatments and possible prevention strategies.

Adolescent↗
PubMed2002

5HTR2A gene polymorphism and personality traits in patients with major psychoses.

Serotonin receptor (5HTR2A) gene polymorphism has been reported to be associated with clinical phenotypes in schizophrenia. The current study attempted to investigate a relationship between 5HTR2A 102T/C polymorphism and personality traits as well as clinical symptoms in patients with ICD-10 diagnoses of schizophrenia and affective disorders. 5HTR2A genotyping, clinical and psychological assessment were administered to 375 patients, 104 first-degree healthy relatives of the patients and 157 controls. In the patients an association was observed between the 2/2 5HTR2A genotype and scores on the Hypochondriasis scale (MMPI) (ANOVA, F = 4.56; P = 0.011) and trait anxiety (F = 4.21; P = 0.002). A significant difference between 1/1 and 2/2 genotypes has been also found for Neuroticism scores (EPI) (t = 2.18; P = 0.0031). No significant differences by 5HTR2A genotype were observed in either the control or first-degree relatives group for all scales studied. Positive, negative and psychopathological symptoms emerged higher in the 2/2 genotype patients compared to other genotype carriers. Therefore, the 2/2 genotype may contribute to produce the phenotype, with specific clinical and pathological features in common, regardless of nosologic heterogeneity of psychoses.

Adult↗
PubMed1988

Drug response patterns as a basis of nosology for the mood-incongruent psychoses (the schizophrenias).

Interaction of therapeutic drugs with a series of different biopathological substrates of psychosis might be expected to generate a series of different response patterns. Herein the authors suggest that multi-modal response patterns following lithium and neuroleptic treatment of psychotic patients may aid in resolving the heterogeneity of psychotic disorders and lead to a new nosology of the psychoses.

Haloperidol↗
PubMed1990

The ventricular-brain ratio (VBR) in functional psychoses: the relationship of lateral ventricular and total intracranial area.

CT scans were performed on 72 consecutive patients with a functional psychosis, and compared with 50 community controls. There was a specific difference in lateral ventricular area between these two groups but it accounted for only 11% of the variance in this measure. In contrast, racial and sexual differences in the ventricular-brain ratio (VBR) related to differences in intracranial area. It is argued that analysis of variance, using lateral ventricular area and intra-cranial area, is more informative than VBR in examining these structural changes in functional psychoses.

Adolescent↗