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PubMed1982

Outcome in schizophrenic and similar paranoid psychoses.

A 5-year followup study of patients with schizophrenic or paranoid psychoses was performed using standardized instruments. Less than half of the patients had a poor global outcome. Several findings from other recent outcome studies were replicated. Besides data on occupational history and psychiatric hospitalization, psychopathological characteristics assessed at discharge by psychiatrists' ratings and patients' self-ratings proved to have predictive value.

Adult↗
PubMed1982

Prognosis as the critical variable in classification of the functional psychoses.

Kraepelin used a disease entity concept to define the two major functional psychoses (i.e., distinctive patterns of onset, symptoms, and course of illness). There have been many subsequent studies using patient outcome or distribution of illness among relatives to test the validity of these nosological classes. Differences between chronic schizophrenia and (predominantly nonchronic) affective disorders are often reported, but it is difficult to discern whether these differences are associated with diagnostic symptomatology rather than premorbid prognostic status. The evidence suggesting a genetic link between good prognosis schizophrenia and affective disorders may be misinterpreted if premorbid prognostic processes are the distinguishing heritable components between chronic schizophrenia and nonchronic illnesses. Which components of severe psychiatric disorders are heritable is not yet clear. The developmental, psychological and neurological processes associated with premorbid and early morbid characteristics of illness appear good candidates. Considering such variables as prognostic (early morbid or premorbid) rather than diagnostic would permit examination of class assignment (e.g., schizophrenia, bipolar affective disorder) and premorbid development. The literature now suggests that chronicity in psychiatric illness breeds true and that symptom constellations breed true. Both of these views may be corrects, and the taxing study design required to simultaneously study these two attributes of disease entities is warranted. This may establish good prognosis schizophrenia as a "third psychosis," or may affirm its standing within traditional nosology.

Bipolar Disorder↗
PubMed1985

The late-onset psychoses. Clinical and diagnostic features.

Psychoses of late onset are poorly understood due to a limited number of inconsistent studies. The authors conducted this study to determine the clinical characteristics of a clearly defined group of patients with onset of psychosis after age 65 years and to test the usefulness of DSM-III criteria in diagnosing the condition of these patients. Late-onset psychosis occurred in 8% of the patients admitted to the geropsychiatry unit during the study period. More than three quarters of these patients suffered from either an organic mental disorder or major affective disorder, the remainder having primary psychotic disorder. The diagnoses of the psychotic patients were much less reliable than those of a comparable group of nonpsychotic patients, with more than 5 times as many patients in the psychosis group changing diagnostic categories between the time of their admission and their discharge. DSM-III diagnostic criteria were not well suited for the categorization of many of these patients. For patients with primary psychotic disorder, the criteria artificially subdivided groups of similar patients. For patients with organic mental disorder, the criteria did not provide sufficient guidance for the diagnosis of psychosis in the presence of dementia. All three groups of patients responded to somatic therapies. A subgroup of patients with affective disorder improved without neuroleptic treatment, and several patients with primary psychotic disorder benefited from antidepressant treatment. These results highlight the difficulty inherent in the treatment of patients with late-onset psychosis. Further research is needed to develop adequate diagnostic criteria and to determine which patients will benefit from neuroleptic and/or antidepressant therapy.

Age Factors↗
PubMed1986

Interhemispheric transfer in major psychoses.

The authors studied 25 schizophrenics and 21 affectively ill, pure right-handed, male patients by using the Tactual Performance Test (TPT), a stereognosis block identification task, and an anomia task to evaluate their interhemispheric information transfer. Although both groups generally had difficulty performing the TPT, the pattern of performance deficit was not different between diagnostic groups and was not consistent with a clear-cut interhemispheric transfer problem. Schizophrenics made more naming errors and TPT preferred-hand errors than did affectively ill patients, whereas affectively ill patients were able to identify more blocks with their preferred hand than could the schizophrenics. Patient index age, illness onset age, handedness, medications received at time of testing, personal and family history of alcoholism, and family history of major mental illness did not relate to cognitive performance. It is concluded that these data are not consistent with an interhemisphere transfer deficit that is specific for schizophrenia, but they are consistent with either a nonspecific interhemisphere transfer deficit in psychoses or with a left or bilateral hemisphere impairment in schizophrenia.

Affective Disorders, Psychotic↗
PubMed2006

Incidence of schizophrenia or other psychoses in first- and second-generation immigrants: a national cohort study.

The main aims of this study were to investigate whether the increased risk of psychotic disorders among certain immigrant groups is present in the next generation and whether having one parent born in Sweden has a protective effect on the risk of psychotic disorders among second-generation immigrants. In total, 2,243,546 individuals were followed from January 1, 1992, until December 31, 1999, for first hospital admission for schizophrenia or other psychoses. Cox regression was used to estimate hazard ratios. The highest risks of psychotic disorders were found among first-generation and second-generation Finns, after adjustment for socioeconomic status. Having one parent born in Sweden had no protective effect on the risk of being hospitalized for psychotic disorders among second-generation immigrants. The disabling symptoms of psychotic disorders call for increased awareness among clinicians and public health planners involved in the treatment and prevention of psychotic disorders, especially among certain immigrant groups.

Adult↗
PubMed1987

Computer-assisted linguistic analysis of an autistic adolescent's language: implications for the diagnosis of Aspberger's syndrome and atypical psychoses.

This study illustrates the use of a computer-assisted linguistic analysis technique to compare the spoken language of an adolescent, diagnosed in childhood as autistic, with that of normal and schizophrenic individuals. A distinctive profile, in keeping with accounts in the literature of autistic speech, was noted to be radically different from that found in linguistic analysis of schizophrenic speech. This distinctive profile was mirrored by her written linguistic analysis. Changes indicative of some improvement in language function were seen on re-recording after 5 years. Implications of this technique for differential diagnosis of Aspberger's syndrome and atypical psychoses are mentioned.

Adolescent↗
PubMed2004

Schizophrenia-spectrum psychoses in people with and without intellectual disability.

BACKGROUND: Although there is an increased risk of schizophrenia-spectrum psychoses (SSP) in people with intellectual disability (ID), there is a paucity of research evidence into clinical presentation of the disorder in comparison with research into SSP in people without ID. AIMS: The aims of the study were to compare clinical, functional, and social factors in patients with mild ID (ICD-10: F70) and SSP (ICD-10: F20-9) attending a specialist mental health service for people with ID, with a control group of patients without ID but with SSP attending a generic adult mental health (GAMH) outpatient clinic. METHOD: A total of 106 patients with SSP (53 with ID and 53 from GAMH) were assessed on psychopathological symptoms, functioning scales and quality of life. They were compared using chi-squared and regression analysis where appropriate. RESULTS: People with ID and SSP appear to be more debilitated by the co-occurring disorder than those with the same disorder but without ID. Increases in observable psychopathology and "negative" schizophrenic symptoms, and decreased functional abilities were observed in the group with ID when compared to the GAMH group. The clinical implications of these findings are discussed.

Adult↗
PubMed1981

Psychoses in twins - a longitudinal study. Introductory clinical report.

A sample of psychotic and prepsychotic twins is presented, based on 9000 patients born during 1930--1946 and admitted to psychiatric departments in Scania, Sweden, during the 1960's. All twins of the same sex (76 pairs) were registered and their records examined. Twenty-three complete pairs, where one or both twins showed psychotic or prepsychotic symptoms, were carefully examined with regard to different clinical, genetic, biochemical, and psychophysiological parameters. A fairly young sample was chosen in order to include a sufficient number of discordant pairs to be followed prospectively and thus making it possible to study a group of individuals exposed to a very high risk of developing psychoses. Of the 23 pairs, eight pairs were monozygotic, which is somewhat less than expected and may be due to the very careful diagnoses of zygosity which also included analysis of HL-A antigens. An account is given of material and methods, principles of sampling, and clinical data of all twin pairs. No less than 17 complete pairs were judged to be discordant for serious mental disturbance at the time of the examination. Brief histories of the monozygotic twin pairs are included.

Diseases in Twins↗
PubMed1997

Dreamy states and psychoses in temporal lobe epilepsy: mediating role of affect.

Among 104 patients with temporal lobe epilepsy treated in our clinic between 1992-1995, thirteen patients with repeated dreamy states were evaluated for affective manifestations of dreamy states and their relationship with psychotic states. The types of dreamy states were classified as déjà vu, jamais vu and reminiscence. The affective experiences during dreamy states were evaluated as positive, negative or neutral. As a result, seven patients had déjà vu and/or reminiscence: seizure manifestations in four of these patients were affectively evaluated as positive (familiar and/or pleasurable), and three as neutral. Six cases had experience of jamais vu: five of them were affectively evaluated as negative (mostly fear), and one as neutral. Psychiatrically, only four patients with jamias vu accompanied by feelings of fear had mental disorders: a chronic paranoid-hallucinatory state in two cases, a chronic paranoid state in one case, and obsessive-compulsive symptoms in one case. Other patients who had positive or neutral affect did not demonstrate psychiatric disturbances. Thus, most patients with jamais vu were accompanied by negative affect of fear, and those patients with jamais vu tended to show more psychotic symptoms than those with reminiscence or déjà vu, which were associated with positive or neutral affects. Based on these results, we discuss the possibility that repeated negative feelings associated with jamais vu are one of the causes for developing epileptic psychoses.

Adult↗
PubMed1985

Chromosome abnormalities in infantile autism and other childhood psychoses: a population study of 66 cases.

Sixty-six psychotic children aged between two and 20 years, examined by the same child psychiatrist and diagnosed according to strict criteria as suffering from infantile autism, other psychoses and Asperger's syndrome, were examined with chromosomal cultures in folic-acid deficient medium. 47 per cent of the children showed major or minor chromosomal aberrations. The infantile autistic group comprised a total population of autistic children. The fra(X)(q27) marker was seen in 25 per cent of autistic boys. A subgroup of children with the fra(X)(q27) abnormality, infantile autism, psychomotor epilepsy and brainstem dysfunction was identified. Other chromosome markers and abnormalities occurring in several cases included long Y chromosomes, fra(X)(p22), fra(16)(q23) and fra(6)(q26). The results are discussed and correlated with certain clinical characteristics.

Adolescent↗
PubMed1994

Postoperative psychoses in epileptic patients after temporal lobectomy.

INTRODUCTION: Psychosis is the most severe psychiatric complication after epilepsy surgery. PATIENTS AND METHODS: We evaluated postoperatively at 1 year the psychoses of a series of 57 adult patients with intractable epilepsy who underwent temporal lobe surgery. RESULTS: Five patients (8.8%) developed postoperative psychosis. Two (3.5%) of these 5 revealed postictal psychotic episodes in connection with persisting seizures, both of them had had similar episodes even preoperatively. Two patients (3.5%) exhibited a definite and one patient (1.8%) a probable de novo schizophrenia. CONCLUSION: Our findings clearly emphasize the need for careful postoperative psychiatric follow-up for patients with temporal lobectomy.

Adult↗
PubMed1975

Attempted suicide and suicide in functional psychoses.

A total of 2,243 first admissions to Gaustad Hospital between 1938 and 1961 diagnosed as functional psychotics were either followed up to the time of their death within 5 years, or observed over a period of 5 years, and then reexamined. Of these patients, 325 had attempted suicide prior to their admission. The frequency of attempted suicide was equal in both sexes. Men appeared to use more dangerous methods, and to have more serious intentions. The psychosis appears to have been of importance when considering whether, but not how the suicide should be attempted. The greatest risk of attempted suicide was to be found amongst patients with psychoses of a depressive nature. Twenty-eight of the 2,243 patients in this study committed suicide within 5 years following their discharge, and a further 20 took their own lives prior to the reexamination. A certain connection can be seen between attempted suicide and psychotic symptoms.

Adult↗
PubMed1979

Comparison of sulpiride and chlorpromazine in psychoses. A double-blind multicentre study.

In a material of 71 patients admitted because of acute or chronic psychoses, 32 were treated with sulpiride (up to 1,800 mg per day) and 39 with chlorpromazine (up to 675 mg). Duration of treatment was from 4 to 8 weeks. The effect of the two preparations was very similar as were the type and frequency of side effects, except that sulpiride did not cause sunrash.

Adult↗
PubMed1982

Genetic factors in puerperal affective psychoses.

The hypothesis that puerperal affective psychosis (PAP) is genetically related to manic-depressive disorder was tested by comparing the morbidity risks for puerperal and non-puerperal affective disorders in the relatives of 17 PAP subjects and 20 parous manic-depressives (PMD) with no history of puerperal illness. The risk for affective disorder (mania, depression or suicide) and puerperal affective disorder was the same in the two groups of relatives and the test hypothesis was accepted, although the sample size was small. The frequencies of HLA-A, B and C locus antigens, nine blood group antigens and 10 red blood cell isoenzymes were not significantly different in the PAP and PMD subjects, showing that in this series genetic markers do not distinguish puerperal from non-puerperal affective psychoses.

Adult↗
PubMed1988

Admission pattern and diagnostic stability of patients with functional psychoses in Denmark during a two-year observation period.

This register-based study shows that the incidence of first-admitted patients to psychiatric hospital who were diagnosed as having functional psychoses was 55 per 100,000 inhabitants in Denmark in 1984. During a two-year observation period, half of the patients were readmitted and two-fifths had their diagnosis changed. Young and schizophrenic patients were especially liable to readmission. Reactive psychosis and paranoia were the most unstable diagnostic concepts, as half of the patients were classified differently at the latest readmission compared to the first admission. Schizophrenic patients are still to a great extent treated as inpatients. Comparisons between two catchment areas are made. It is necessary to be very careful when one is using patients' first diagnosis from the present nosologic classification for prediction of clinical and diagnostic course. Studies based on phenomenology and on diagnoses made using operational criteria are badly needed.

Adolescent↗
PubMed1989

Long-term course and outcome in unipolar affective and schizoaffective psychoses.

Of 301 first-time admitted patients with delusional psychoses, 50 met DSM-III criteria for major depressive disorder (MDD), 33 schizoaffective disorder, depressive type (SADD), and 94 schizophrenia. At personal follow-up after 3-39 (mean 22) years, the SADD group was recorded in between on course and outcome variables, but closer to MDD. The findings in MDD and SADD were respectively: remission 66% vs. 42%, personality disorders 14% vs. 12%, anxiety disorder or alcohol abuse 2% vs. 6%, psychosis 18% vs. 36% (with bipolar development in 2% vs. 6%, paranoid disorder 2% vs. 3%, schizophrenia 4% vs. 3%). Chronic psychosis was recorded in 10% vs. 27%. No significant outcome difference was found between early onset MDD and SADD cases and those who fell ill at a higher age. The assumption that antidepressants may induce mania could not be confirmed. Normal premorbid personality seemed to predict a favourable course.

Adult↗
PubMed1990

Anticonvulsants as adjuncts for the neuroleptic treatment of schizophrenic psychoses: a clinical study with beclamide.

A recent study showed an adjuvant effect of carbamazepine in the neuroleptic treatment of acute schizophrenic psychoses. Since beclamide (beta-chlorpropionamide) was reported to reduce the neuroleptic doses required, the combination haloperidol-beclamide was tested using a double-blind, placebo-controlled study in 23 inpatients with an acute schizophrenic psychosis. In both groups patients received haloperidol and either beclamide or placebo. Every 7 d the treating psychiatrist could increase the haloperidol dose by 3 mg per day if clinically necessary. Chlorprothixene and biperiden were on hand as additional medication. After 28 d beclamide or placebo were discontinued under a constant dose of haloperidol and a final rating with the Inpatient Multidimensional Rating Scale, Brief Psychiatric Rating Scale, and Extrapyramidal Symptom Scale was carried out. Without reaching statistical significance, the beclamide group needed a lower dose of neuroleptic medication, showed fewer side effects and a more pronounced psychopathological improvement.

Anticonvulsants↗
PubMed1998

Criticism and hostility in relatives of patients with schizophrenia or related psychoses: demographic and clinical predictors.

Relatives' criticism and hostility are important risk factors for relapse in schizophrenia. In order to explain these attitudes, we examined a Norwegian sample of 47 recently hospitalized patients (with schizophrenia or related psychoses) and 72 relatives. Relatives' expressed emotion was assessed by means of the Camberwell Family Interview. Demographic and clinical data were used as predictor variables in confirmatory regression analyses. The most robust predictors of high levels of criticism were, on the part of the patient, lack of paid employment, more than 3 previous hospital admissions, more troublesome behaviours reported by relatives, especially anxiety/depression, and better cognitive functioning at admission. Robust predictors of hostility were lack of employment and more than 3 previous hospitalizations. Interventions to reduce criticism should include employing patients and working with relatives' unrealistic expectations.

Adolescent↗