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PubMed2003

Predictors of quality of life in major psychoses: a naturalistic follow-up study.

BACKGROUND: Improved quality of life (QOL) of patients suffering from major psychoses has become an important treatment goal. We sought to determine predictors of perceived QOL and to explore the changes that occur regarding QOL among individuals with schizophrenia as compared to patients with schizoaffective/mood disorders. METHOD: In a naturalistic longitudinal design, 148 inpatients with schizophrenia and 51 inpatients with schizoaffective/mood disorders (DSM-IV) were tracked for 16 months (SD = 4.6 months). Subjects were assessed at 2 timepoints for psychopathology, stress process-related factors, and perceived QOL, as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire. Predictors of fluctuations in QOL index scores during the follow-up period were identified using multiple regression techniques. RESULTS: We found that poor QOL is not a more severe problem for schizophrenia patients than for schizoaffective/mood disorder patients. Improved QOL of schizophrenia patients is associated with reduced paranoid and distress (obsessiveness, somatization) symptoms and increased self-efficacy and self-esteem ratings. Individual changes in QOL index scores among patients with schizoaffective/mood disorders are associated with changes in depression, sensitivity, expressed emotion, and task-oriented coping scores. CONCLUSION: Predictors of changes in satisfaction with life quality over time among schizophrenia patients are distinct from those associated with schizoaffective/mood disorders. Changes in stress process-related factors, rather than psychopathology, predict change in perceived QOL and should be considered when evaluating QOL outcomes.

Adaptation, Psychological↗
PubMed2003

Do integrated mental healthcare organisations facilitate process quality in the treatment of people with schizophrenia and related psychoses?

OBJECTIVE: The objective of this study is to investigate the influence of mergers of ambulatory and mental healthcare organisations on the process quality of care for persons suffering from schizophrenia or related psychoses. THEORY: On the basis of the theory of Donabedian we assume the relationships between three types of quality in healthcare: structure quality, process quality and outcome quality. This study focuses on the influences of structure quality, i.e. years since merger and catchment area size upon process quality. METHODS: Criteria according to Tugwell for evaluating healthcare were used to describe the process quality of schizophrenia care, resulting in a process quality questionnaire with 6 subscales and 21 items. Leading psychiatrists of 31 Dutch mental healthcare organisations, covering 89% of the country, answered the questionnaire. Both programmes and documents from the responding institutions and schizophrenia projects were analysed. Correlations of two determinants, age of the merged organisation and catchment area size, were made with total scale scores and the sub scores of the questionnaire. RESULTS: The response rate was 97% (31/32). Twenty-two organisations (71%) had a score of more than 50% on the used scale, 8 (29%) scored less. Two evidence-based interventions were implemented in more than 50% of the organisations, three in less than 50%. A low degree of implementation occurs in establishing care for people with schizophrenia from ethnic minorities, standardising diagnostic procedures and continuity of care. No significant relationship between the age of the merged organisation ('age') and the total process quality of schizophrenia care was found, however, the relationships between age and the subscales availability of interventions and integrated treatment were significant. No association was found between the size of the MHO's catchment area and any of the used subscales. CONCLUSIONS: The age of integration of residential and ambulatory mental health institutions correlates significantly with two subscales of process quality of schizophrenia care, i.e. availability of interventions and treatment. Catchment area size is not significantly associated with process quality or any of the subscales. Despite the mentioned positive effects, the overall picture of schizophrenia care is not very positive. Additional forces other than merely integration of ambulatory and residential services are needed for the further implementation of evidence-based interventions, diagnostic standards and continuity of care. The development of a national 'schizophrenia standard' (like in other countries) in relation with implementation plans and strategies to evaluate care on a regional level is recommended as well as further research on patient outcomes in relation to mergers of mental healthcare organisations.

Journal Article↗
PubMed1999

Dopamine receptor D4 gene is not associated with major psychoses.

We previously reported an association between dopamine receptor D4 (DRD4) gene exon 1 variants and delusional disorder. The aim of this investigation was to study the DRD4 gene exon 1 and 3 variants in schizophrenia, delusional, bipolar, and unipolar disorders. We studied 651 inpatients affected by schizophrenia (n = 229), delusional (n = 86), bipolar (n = 210), and unipolar (n = 126) disorders (DSM III-R) and 471 healthy controls; these were typed for DRD4 variants at the first and third exon using polymerase chain reaction techniques. DRD4 variants were not associated with schizophrenic and delusional subjects even when possible confounders like gender and onset were considered. A marginal association between DRD4 exon 3 variants with unipolar (excess of DRD4*2/4, p = 0.004) and bipolar (excess of DRD4*2/4, p = 0.001) disorders was observed, both associations drop to insignificance when corrected for multiple testing. Our results exclude that coding variants of the DRD4 exon 1 and 3 may play a major role in conferring susceptibility to major psychoses; moreover, we could not replicate the association of DRD4 exon 1 variant with delusional disorder.

Adult↗
PubMed1975

[Childhood psychoses and the family].

This paper reviews 328 child psychiatric case histories over a period of 3 years; 19 were classified as psychoses. Five cases presented frank clinical symptomatology and 14 were detected by psychological testing. Individual and family therapy were used. The most important findings were the following: 1. Immature parents, with a dominant mother figure and a weak father figure. 2. Lack of a good father-child relationship. 3. Poor communication among family members. 4. Parents' rejection of their responsability in managing the psychotic child.

Child↗
PubMed1999

[Acute postpartum psychoses].

The post-partum is a high risk period for the development of acute psychotic disorders. The frequence of post-partum psychoses is evaluated at 1 to 2 per 1,000 births. Post-partum psychosis include major affective disorders which is the most frequent diagnosis. The clinical pictures have specific characteristics: rapid change of symptomatology, liability of mood, and frequent confusional signs. The short-term prognosis is generally good but the risk of recurrence of the mental disorder, in or outside puerperal context, is high. At clinical, evolutive and genetic levels, the studies do not provide arguments for nosological autonomy of post-partum psychosis. At therapeutic level, the ECT is particularly efficient in this indication.

Acute Disease↗
PubMed2000

[Peculiarities of polymorphism in gene of serotonin transporter in men from different ethnic groups with acute alcoholic psychoses].

Analysis of polymorphism in locus of the gene of serotonin transporter (hSERT) was performed in men of Russian and Tatar nationalities with acute alcoholic psychoses by polymerase chain reaction. An absence of the differences in the distribution of the frequences of genotypes and alleles of hSERT gene was observed between populations examined, that corresponded to such values in Caucasians. An association was found between the allelic variations with 9 units of the repetitions of hSERT gene and an early onset of chronic alcoholization and development of acute alcoholic psychosis. Among the men, who developed acute alcoholic psychosis at the age over 35 there were significant differences in distribution of frequences of genotype of hSERT-gene between the populations. Genetic heterogeneity of such pathology in Russians and Tatars and impact of hSERT in the development of the disease in Tatars, are suggested.

Adult↗
PubMed2000

[Manic-depressive disorders in adolescence. Mood disorders and psychoses in adolescence].

DISEASE ONSET: In adolescents, the different aspects of mood disorders and psychoses are closely related. The first episode of what will become schizophrenia is often suggestive of a mood disorder. The inverse is also true. Frequently, a psychotic state is the inaugural manifestation of a mood disorder. SIGNS AND SYMPTOMS: The depressive manifestations observed in adolescents are very similar to negative psychotic symptoms. More so than in adults, the thymic disorder is expressed as severe episodes of psychosis. It would appear that in this case, the psychotic elements are related to the intensity of the thymic disorder. DIAGNOSTIC ERRORS: Misdiagnosis is probably related to the fact that mood is not sufficiently taken into account in acute psychotic states. The risk inherent in "over"-diagnosis of schizophrenic disorders is related to the therapeutic implications: prescriptions of neuroleptics can hinder the psychic work involved in the structuralization process going on in the adolescent.

Adolescent↗
PubMed1975

[Hypothetical concept: the physiopathological entity of monoaminergic psychoses].

The importance of amino acid transport across the blood-brain barrier as the limiting factor in the metabolism of monoamines has been emphasized by many recent publications. Particularly critical is the transport of tryptophan, since tryptophan hydroxylase is not saturated. This transport is regulated by complex mechanisms, both at the periphery (total and free plasmatic levels and levels of the other essential amino acids) and centraly (by feedback mechanism initiated at the pre- and post-synaptic levels). The hydroxylated derivatives of tryptophan and tyrosine, i.e. 5-HTP and L-DOPA, most probably share the same transport mechanism as these amino acids themselves. In manic-depressive patients, the uptake of L-5-HTP is increased during the depressive phase, while the uptake of L-DOPA, is increased during the manic phase. We suggest that an increase in the uptake of tryptophan may set off oscillations in all the monoaminergic systems, thus providing a biochemical model of manic-depressive psychosis. In terms of this model, melancholy would be due to a hyperserotoninergic syndrome together with a relative hypocatecholaminergic syndrome. Mania would be due to a homogeneous hypercatecholaminergic syndrome together with a relative hyposerotoninergic syndrome. Such a model is compatible with present knowledge of the physiology of monoamines, of the semeiology and biological disturbances of manic-depressive psychosis, and of the treatment of this disease. It reconciles the monoaminergic and ionic theories of the disease better than other existing hypotheses. A reduced transport of tryptophan with a secondary increase in the transport ot tyrosine provides a conceivable model for schizophrenia. Indeed, a serotoninergic hypoactivity coupled with a dopaminergic hyperactivity, with or without a noradrenergic deficiency, would account for the semeiology quite adequately. This model too would be compatible with present knowledge of monoamine physiology, of the biochemical disturbances underlying schizophrenia and of the mode of action of anti-psychotic drugs. This unitarian heuristic concept of the monoaminergic psychoses would be in better agreement with the classic clinical data concerning this disease (typology intermediate syndromes and crossed heredity).

5-Hydroxytryptophan↗
PubMed1975

[Pathogenetic model-theories of endogenous psychoses (author's transl)].

The multiplicity of frequently conflicting views in the psychiatry of today inspires the wish for a uniform way thinking about the thorough knowledge and the many hypotheses that have become almost boundlessly vast. Such ideas of models as have played a part for quite some time in the mathematical and natural sciences, and of late in the sociology, are also to be found in the field of psychiatry, without however always being called so expressis verbis. Guided by the historical development an attempt has been made to expose model-like ideas about the etiology and pathogenesis of endogenic psychoses, first of all of schizophrenia, as they have become decisive for modern psychiatry. It appears that in the abbreviation of the "model" the basis for a discussion already overdue is to be found.

Anthropology↗
PubMed2001

[Serotonin type 2a (5-HTR2A) receptor gene polymorphism and personality traits in patients with endogenous psychoses].

Genetic polymorphism of the serotonin receptor (5-HTR2A) gene has been reported to be associated with the expression of clinical signs characteristic of major psychoses, including schizophrenia and affective disorders. In this study, personality traits of patients with these diseases and the associations of these traits with 5-HTR2A allelic polymorphisms were studied. It was demonstrated that schizophrenic and affective patients with the 2/2 genotype of serotonin receptor had lower scores on the anxiety scale and on the anxiety-related hypochondriasis and neuroticism scales than subjects with the 1/1 and 1/2 genotypes.

Adolescent↗
PubMed2001

[Dopamine receptor gene (DRD2) polymorphism in patients with endogenous psychoses with regard to their clinical heterogeneity].

Recently an association between genetic dopamine receptor gene (DRD2) polymorphism and schizophrenia was observed in several studies. In the current investigation we attempted to undertake further study of such association using an extended sample which comprised patients with schizophrenia (n = 184), schizoaffective psychosis (n = 63), affective disorders (n = 121)); healthy control subjects (n = 117) and first-degree relatives of the patients with psychoses who show no signs of mental diseases (n = 111). The genotypes A1A1, A1A2 and A2A2 and the relationship between Taq1DRD2 variants and some clinical symptoms and pathogenetic features of the patients with schizophrenia were studied. The results did not confirm the association between DRD2 genotype and any of disorders studied. But the A2A2 genotype frequency in the schizophrenic patient's group, with illness duration above 20 years and highly expressed positive, negative and psychopathological symptoms, increased significantly as compared to control group (73.7% vs 52.9%) and patients with less illness duration (73.7% vs 42.5%). In the latter case odds ratio was calculated as 4.12. In the light of this finding, A2A2 DRD2 genotype appears to be related to chronicity of schizophrenia.

Adult↗
PubMedDate not supplied

[Psychosocial factors associated with hospital readmission of patients with organic psychoses].

OBJECTIVE: To assess the relationship between psychosocial factors, frequent relapses and hospital readmissions in patients with organic psychoses. MATERIAL AND METHODS: A cross-sectional descriptive study was conducted among 33 patients diagnosed with organic psychosis, seen at Hospital Psiquiatrico Guillermo Dávila, of Instituto Mexicano del Seguro Social in Mexico City. Patients had been readmitted more than two occasions during 1993-1994. Data collection instruments consisted of recorded interviews, five-minute dialogues of expressed emotions (EE), and combined questionnaires to assess perception of illness and the physician-patient relationship. The Kappa statistic and Cronbach's alpha were used to establish the validity and reliability of the measurements; descriptive and inferential methods were used for statistical data analysis. RESULTS: A high percentage (60.9%) of patient's relatives showed high level of EE, as measured by their expression of criticism, hostility, or emotional over-involvement; 64.3% of study subjects lived for more than 35 hours per week with relatives having high EE levels. CONCLUSIONS: High EE levels were associated with frequent readmissions to the psychiatric ward. Greater perception of illness characteristics was observed among relatives than in patients. Even though a satisfactory physician-patient relationship was found, it was not conducive to improving the perception of illness nor compliance with therapy.

Adolescent↗
PubMed1975

[Studies on protein genetic factors in multiple sclerosis and psychoses].

In more than 200 cases of multiple sclerosis, psychosis and cyclothymia, the Hp types are studied with the help of polyacrylamide gel electrophoresis (Schreyer and Schaible, 1967) and the Gc types wtih agar gel electrophoresis (Schlesinger, Vogt and Prokop, 1963). All Hp and Gc types were found in these diseases, but there was no frequent occurence of any particular type in multiple acleroses of psychoses. According to our results, there is no interdependence between these diseases and the Hp and Gc types.

Haptoglobins↗
PubMed2002

[Antipsychotic agents and pharmacotherapy of psychoses].

Antipsychotic drugs have been used clinically for approximately 50 years. Reserpine and chlorpromazine were first drugs found be useful in schizophrenia. The term "antipsychotic" is used to describe a group of drugs that has been used mainly for treating of schizophrenia, but also is effective in some other psychoses and agitated states. The dopamine hypothesis is the most fully developed of several hypothesis and is the basis for rational drug therapy. However, the dopamine hypothesis is far from complete. Typical antipsychotic drugs have a wide spectrum of central nervous system, autonomic and endocrine effects. The most recently introduced antipsychotics are at least as potent in inhibiting 5-HT receptors as they are in inhibiting D receptors. A rational choice of antipsychotic drugs may be based on differences between chemical structures and pharmacological differences. No basis exists for choosing drugs for the use against selected target symptoms, as there is no evidence of specificity in their effects.

Acute Disease↗
PubMed1976

[Dynamics of the clinico-pathophysiologic characteristics of psychoses in old age under the influence of azafen].

A study of singular doses and subsequent maintenance therapy by azafen on the higher nervous activity of mental patients in presenile age (67 cases) revealed that its action depends upon the dosage of the preparation and the nosological syndrome. A depressive involutional psychoses can be controlled by azafen in doses up to 75 mg daily. By dosages of 25 mg azafen reduces or cessates completely the syndrome of changed consciousness due to disorders of brain circulation. An arrest of a depressive syndrome in manic-depressive psychosis in old age can be attained by an introduction of 150-200 mg of azafen daily.

Aged↗
PubMed1992

[Individual prognosis in endogenous affective and schizoaffective psychoses: clinical predictors].

The purpose of the work was to search for predictors for early individual prognosis of the clinical characteristics of affective and schizoaffective psychoses and forecasting treatment responses to the tricyclic antidepressants and prevention with lithium salts. 285 patients (190 with affective and 95 with schizoaffective pathology) were examined. The mean disease standing was about 15 years, the mean duration of the follow-up amounted to over 4 years. More than 40 clinical and therapeutic signs were taken into account on the whole. The data were processed by EC-1036 computer. A number of coefficients indicating the intensity of interrelations between the study signs were computed. Based on the magnitudes of the above coefficients, the lists of the clinical predictor signs and protector signs were compiled to be used in psychiatric practice.

Adult↗
PubMed1992

[Individual prognosis in endogenous affective and schizoaffective psychoses: biological predictors].

A study was made of the distribution of a complex of biological markers: HLA antigens, loci A and B, ABO blood groups, haptoglobin phenotypes, acetylator status, indicators of anthropometry and dermatoglyphics, and marital radius of the parents in 285 patients with affective and schizoaffective psychoses--representatives of the Byelorussian population. The mean time of the clinical follow-up was over 4 years. The magnitudes of relative risk (RR) were computed with regard to the indicated biological signs to estimate their relation to the disease and to some characteristics thereof: polarity of affective disorders, the type of the course, age of manifestation, the presence of homonomous hereditary aggravation, late outcome as well as the efficacy of tricyclic antidepressants and lithium prevention. The data obtained are discussed from the standpoint of their practical use.

ABO Blood-Group System↗