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PubMed2000

Use of community support services by middle-aged and older patients with psychotic disorders.

OBJECTIVE: The study sought to determine the degree to which use of community services is related to predisposing, enabling, and need factors among older patients with psychotic disorders who live in the community and to assess whether high use of community services is associated with improving or declining psychopathology. METHODS: The sample consisted of 89 middle-aged and elderly community-dwelling patients with schizophrenia or other psychotic disorders. Assessments at baseline and two follow-ups at six-month intervals included measures of psychopathology, well-being, and social adjustment, in addition to the frequency of use of 17 formal community services in three categories-psychological, social, and daily living services. RESULTS: Ninety-two percent of patients reported use of community support services. The mean number of annual service contacts per patient was 36.6 for psychological services, 81 for social services, and 39.7 for daily living services. High users of psychological services were younger and experienced more severe positive psychotic symptoms and depressive symptoms. High users of social services were of higher socioeconomic status, more likely to be female, and had a longer history of psychosis, more cognitive deficits, and more severe negative psychotic and depressive symptoms. Patients who used daily living services were older, had poorer functional health status and more cognitive deficits, and had more severe negative psychotic and depressive symptoms. A trend was noted for high users of social services to experience relief from depressive symptoms over time. CONCLUSIONS: Use of community services is common among older outpatients with psychotic disorders, but its frequency varies as a function of patient characteristics.

Aged↗
PubMed2002

The assessment of disability in patients with psychotic disorders: an application of the ICIDH-2.

OBJECTIVES: To describe the application of the International Classification of Functioning and Disability (ICIDH-2) in the assessment of disability in patients with psychotic disorders. METHOD: The study was conducted at the inpatient unit of St Vincent's Mental Health Service, Melbourne. Twenty inpatients with psychotic disorders were concurrently assessed by two raters. An evaluation of the feasibility of the instrument was made during this process. Inter-rater agreement was determined using raw agreement percentages and weighted kappas. RESULTS: The ICIDH-2 provides a comprehensive framework for the description and measurement of disability, including the dimensions of impairments in body structures and functions, activity limitations, participation restrictions and environmental factors. Certain codes are difficult for clinicians to rate because of the subjective manner in which they are defined. Our inter-rater reliability assessment varied across the dimensions from poor to almost perfect agreement. CONCLUSIONS: The ICIDH-2 is potentially useful in the clinical assessment of disability in patients with psychotic disorders although modifications are needed. These could include the use of anchor points defined for each dimension or code to assist the rating process and an alternative rating scale in which categories for rating are more broadly defined. Formal training may also be necessary to enable standardization of the rating process. There is also a need to augment measurements by clinicians with the assessment of the subjective experience of patients using self-rated disability and assessment of quality of life.

Activities of Daily Living↗
PubMed2006

Predictors of psychosis remission in psychotic disorders that co-occur with substance use.

OBJECTIVE: To examine rates and predictors of psychosis remission at 1-year follow-up for emergency admissions diagnosed with primary psychotic disorders and substance-induced psychoses. METHOD: A total of 319 patients with comorbid psychosis and substance use, representing 83% of the original referred sample, were rediagnosed at 1 year postintake employing a research diagnostic assessment. Remission of psychosis was defined as the absence of positive and negative symptoms for at least 6 months. Likelihood ratio chi-square tests and multivariate logistic regression were the main means of analysis. RESULTS: Of those with a baseline diagnosis of primary psychotic disorder, 50% were in remission at 1 year postintake, while of those with a baseline diagnosis of substance-induced psychosis, 77% were in remission at this time point. Lower Positive and Negative Syndrome Scale (PANSS) symptom levels at baseline, better premorbid functioning, greater insight into psychosis, and a shorter duration of untreated psychosis predicted remission at 1 year in both diagnostic groups. No interaction effects of baseline predictors and diagnosis type were observed. A stepwise multivariate logistic regression holding baseline diagnosis constant revealed the duration of untreated psychosis (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.95, 0.997), total PANSS score (OR = 0.98; 95% CI = 0.97, 0.987), Premorbid Adjustment Scale score (OR = 0.13; 95% CI = 0.02, 0.88), and Scale to Assess Unawareness of Mental Disorders unawareness score (OR = 0.84; 95% CI = 0.71, 0.993) as key predictors of psychosis remission. CONCLUSIONS: The association of better premorbid adjustment, a shorter duration of untreated psychosis, better insight into psychotic symptoms, and lower severity of psychotic symptoms with improved clinical outcome, reported previously in studies of schizophrenia, generalizes to psychosis remission in psychotic disorders that are substance induced.

Adolescent↗
PubMed2000

Risks factors for homelessness among people with psychotic disorders.

BACKGROUND: Although it is widely accepted that rates of severe mental illness amongst single homeless people are high, little is known about the reasons these individuals become homeless. This study aimed to identify risk factors for homelessness among people with psychotic disorders. METHODS: A matched case-control study of homeless and never homeless people with psychotic disorders was carried out, with respondents recruited from mental health services (N = 39 pairs). Data were collected by semi-structured interviews and from medical records. RESULTS: A number of social and behavioural risk factors were identified; key factors being loss of contact with childhood carers, and substance use. Clinical and service use factors appeared less important as predictors of homelessness. CONCLUSIONS: Mental health services have a limited role in circumventing homelessness among people with psychotic disorders. An integrated approach involving other key agencies is required.

Adolescent↗
PubMed2004

Validity of symptom assessment in psychotic disorders: information variance across different sources of history.

BACKGROUND: Factors such as poor insight, amotivation, suspiciousness, disorganized speech and attentional problems may interfere with the ability of acutely ill individuals with psychotic disorders to provide a valid account of their symptoms. This study was designed to determine the degree to which history provided by such subjects is consistent with that obtained from other sources. METHOD: Fifty-five subjects presenting with psychotic disorders were multiply evaluated with a semi structured interview, the Comprehensive Assessment of Symptoms and History (CASH), which includes the Scales for the Assessment of Negative and Positive symptoms (SANS and SAPS). One interviewer assessed the severity of the patient's symptoms in the previous month based solely on information provided by the patient. A second rater made symptom ratings based on information obtained from a "best informant". Following this, a consensus rating was established based on an extensive evaluation and review of all sources of information. An item-by-item comparison of the three sets of symptom ratings was then quantified by paired t-tests, simple and multiple correlations. RESULTS: Positive and negative symptoms ratings based on the subjects' report were significantly lower than the corresponding consensus ratings. However, those based on the informants' report did not differ from consensus ratings for negative symptoms. Information obtained from subjects and from informants together accounted for a majority of the variance of the consensus ratings. CONCLUSIONS: These findings demonstrate that assessment limited to patients' own reports are likely to underestimate psychopathology in acutely ill patients with psychotic disorders. Obtaining corroborative history from a family member may substantially improve the validity of the assessment of negative symptoms.

Adult↗
PubMed2005

Guideline adherence in medication management of psychotic disorders: an observational multisite hospital study.

OBJECTIVE: To evaluate guideline adherence in in-patient medication care of psychotic disorders. METHOD: A total of 508 persons with psychotic disorders were included in a naturalistic multisite hospital study. Subjects were assessed weekly on mental state, social functioning, socioeconomic factors and medication prescriptions. RESULTS: In total, 17% of individuals were prescribed antipsychotic dosages above the recommended value. Among those with persistent psychotic symptoms, 73% received insufficient antipsychotic drug management. About 58% of patients with depressive symptoms were not treated according to guidelines, and 53% of patients did not receive adequate management of side-effects from antipsychotic medications. Subjects with more than six previous psychiatric hospitalizations (OR 1.80, CI: 1.05-3.08) and those with a prominent thought disorder (OR 2.28, CI: 1.23-4.23) had a higher likelihood of not being treated according to guidelines. CONCLUSION: Individuals with chronic and thought-disordered psychosis may be at a higher risk of receiving medication care not supported by guidelines.

Adult↗
PubMed2004

The assessment of patients with long-term psychotic disorders: application of the WHO Disability Assessment Schedule II.

OBJECTIVES: To evaluate the use of the World Health Organization Disability Assessment Schedule II (WHODAS II), a patient questionnaire measuring disability, in patients treated for long-term psychotic disorders. METHOD: The study was conducted at St. Vincent's Mental Health Service, Melbourne, Australia. Twenty patients with long-term psychotic disorders under the care of either the residential Community Care Unit or the outpatient Mobile Support and Treatment Service were selected. For all 20 patients a clinician assessment of disability and functional status was recorded using the International Classification of Impairments, Disabilities and Handicaps-2 (ICIDH-2), Life Skills Profile (LSP) and Health of the Nation Outcome Scale (HoNOS). The WHODAS II survey was then administered to each patient. The WHODAS II was re-administered by a second rater within 5 days of the initial assessment for the purpose of test-retest reliability analysis. Each patient also completed the WHO Quality of Life instrument (brief version) (WHQOL-BREF), a self-report questionnaire on quality of life. RESULTS: The WHODAS II was experienced as relatively complex and at times difficult to administer with full co-operation in this clinical context. Overall, test-retest reliability was fair. The information it yielded gave valuable insights into patients' experiences. Most of the participants reported fewer impairments in mental functions and fewer activity limitations than reported by clinicians. However, patients reported significant restrictions in participation in social activities and limitations due to environmental barriers. The WHOQOL-BREF highlighted difficulties experienced by patients in their participation in society, through exploring difficulties and satisfaction with various aspects of life experience and this instrument was well accepted. CONCLUSIONS: The self-reported experience of patients is needed alongside clinician-rated measures to assess outcomes in people with long-term psychotic disorders. The WHODAS II records and measures patients' own experiences of disability. It may be used together with the WHOQOL-BREF, a distinct and complementary self-report assessment of quality of life.

Adult↗
PubMed2002

Ecstasy-induced psychotic disorder: six-month follow-up study.

OBJECTIVE: To describe the psychiatric symptoms manifested by persons diagnosed for the first time as having ecstasy-induced psychotic disorder and to explore the evolution of their symptoms over a 6-month period. DESIGN: Observational study with a 6-month follow-up. METHOD: The subjects studied were 32 ecstasy consumers who were treated at two drug-dependency outpatient centers for hallucinatory-delusive manifestations and who were diagnosed as having ecstasy-induced psychotic disorder according to DSM-IV criteria. For the assessment of the intensity of the syndrome and its follow-up, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression (CGI) were used at the outset and after 1, 3 and 6 months. All subjects received treatment with olanzapine. RESULTS: The treatment program was completed by 96.9% of the patients. At the baseline assessment, a high incidence of symptoms of a severe psychiatric disorder was observed. From the first month the psychotic symptoms (BPRS) were considerably reduced with treatment, with the most severe positive symptoms remitting in the first 3 months. The three assessment indicators (BPRS, HDRS and CGI) showed a statistically significant clinical reduction over the 6 months of the assessment period. Furthermore, no relevant side effects were noted. CONCLUSIONS: In its initial manifestations, a drug-induced psychotic syndrome includes marked symptoms meeting the criteria of a severe psychotic disorder, with the presence of considerable positive and negative symptoms. Olanzapine has been shown to be very effective in these situations and its use is suggested as first-choice therapy.

Adolescent↗
PubMed1996

Use of risperidone in psychotic disorder following ischemic brain damage.

Risperidone, a novel atypical neuroleptic agent, was used to treat a psychotic disorder secondary to ischemic brain damage in a 19-year-old adolescent, who had been treatment-refractory to two conventional antipsychotic agents and valproate. Clinically significant reductions in behavioral agitation and psychotic thinking initially appeared within the first 4 days of treatment with risperidone 3 mg twice daily. Risperidone was well tolerated despite this adolescent's severe cardiac and pulmonary illnesses. There was no evidence of increased neurotoxic symptoms in the presence of the ischemic brain damage. With its favorable side effect profile, risperidone may hold promise in the treatment of patients with psychotic disorders due to general medical conditions.

Adult↗
PubMed2003

Brief psychotic disorder associated with bereavement in a patient with terminal-stage uterine cervical cancer: a case report and review of the literature.

We report here a terminally ill patient with uterine cervical cancer who developed a brief psychotic disorder after bereavement following the loss of three close friends also suffering from gynecological cancer. A 49-year-old housewife, who was diagnosed as having uterine cervical cancer and was receiving palliative care was referred for psychiatric consultation because of an abrupt onset of delusions, bizarre behavior, disorganized speech, and catatonic behavior. On psychiatric examination, she showed delusional thought and catatonic behavior. Laboratory data were unremarkable, as was brain MRI. She had no history of psychiatric illness or drug or alcohol abuse. After receiving haloperidol, psychiatric symptoms disappeared, and she returned to the previous level of functioning after 3 days. The patient explained that the death of three of her friend due to gynecological cancer was shocking event for her. She focused her attention on her own fears of dying from the same disease. Brief psychotic disorder in cancer patients is rare in the literature. However, our report of brief psychotic disorder associated with bereavement may highlight possible precipitating factors, which have not been adequately emphasized in the literature to date. From a clinical perspective, it would be informative for liaison psychiatrists to inquire about the patient's experience of loss of significant others with the same disease. This may provide useful information helpful to understanding the patient's conception of the disease process. Cancer patients' bereaving friends who had cancer is not rare in clinical settings. Therefore, medical staff should be mindful of interpersonal relationships between patients and bereavement arising from these relationships.

Bereavement↗
PubMed2000

Long-Term use of quetiapine in elderly patients with psychotic disorders.

BACKGROUND: Quetiapine is an atypical antipsychotic agent that does not appear to increase patient risk for treatment-emergent extrapyramidal symptoms (EPS) or anticholinergic symptoms. Previous studies of quetiapine use in elderly patients with schizophrenia and other psychoses examined short-term administration (< or = 12 weeks). Given the growing elderly population, the commensurate increase in elderly patients with psychoses, and the expected increase in disease treatment-years, the effect of long-term quetiapine administration in older patients is of considerable interest. OBJECTIVE: This study assesses the long-term tolerability, safety, and clinical benefit of quetiapine in elderly patients with psychosis. METHODS: Elderly patients (> or = 65 years of age) with psychotic disorders, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, participated in this 52-week, open-label, multicenter trial. Investigators increased (and later adjusted) daily doses of quetiapine on the basis of clinical response and tolerability, and assessed safety and efficacy. Efficacy assessments were made using the 18-item Brief Psychiatric Rating Scale (BPRS), Clinical Global Impressions (CGI), Simpson-Angus Scale, and the Abnormal Involuntary Movement Scale (AIMS). For patients who withdrew before week 52, analyses were performed using observed data and the last observation carried forward. RESULTS: One hundred eighty-four patients with psychotic disorders (98 women and 86 men) with a mean age of 76.1 years entered the trial. Seventy-two percent had psychotic disorders due to general medical conditions such as Alzheimer's disease, and 28% had other psychotic disorders, most commonly schizophrenia. Overall, 89 (48%) patients completed treatment through 52 weeks. Median total daily dose was 137.5 mg. Reasons, for withdrawal included lack of efficacy (19%), adverse events or intercurrent illness (15%), failure to return for follow-up (13%), protocol noncompliance (3%), and diminished need for treatment (2%). Somnolence (31%), dizziness (17%), and postural hypotension (15%) were common adverse events, but they rarely resulted in withdrawal from therapy. EPS-related adverse events occurred in 13% of patients. At end point (week 52), mean total score on the Simpson-Angus Scale had decreased from baseline by 1.8 points, whereas changes in AIMS scores were negligible. No clinically important effects were reported relative to mean changes in hematologic, thyroid function, or hepatic function variables. Quetiapine treatment appeared to have no associated cardiovascular adverse outcomes despite cardiovascular comorbidities and unrestricted use of concomitant cardiovascular medications. Significant decreases in BPRS total score (n = 170, P < 0.001) and CGI Severity of Illness item score (n = 177, P < 0.002) were seen at end point (observed data and last observation carried forward). Decreases of > or = 20% in mean BPRS total score were observed in 83 (49%) patients. CONCLUSIONS: These results provide preliminary information to clinicians regarding tolerability, safety, and clinical improvement with quetiapine in elderly patients with psychotic symptoms, and support controlled studies of quetiapine in this patient population.

Aged↗
PubMed1998

A 3 year case study of alcohol related psychotic disorders at Hospital Seremban.

This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.

Adult↗
PubMedDate not supplied

Antihypertensive medication adherence and blood pressure control in patients with psychotic disorders compared to persons without psychiatric illness.

The authors compared antihypertensive medication adherence and blood pressure control among middle-aged and older outpatients with schizophrenia and related those with psychotic disorders versus persons without any psychiatric illness. A total of 178 subjects were included in the investigation (89 patients with a psychotic disorder and 89 randomly selected, age-matched comparison subjects). Although the two groups had similar antihypertensive medication adherence, the patients with a psychotic disorder were significantly less likely to have had controlled blood pressure during the 1-year study period. The results highlight the need for clinicians to monitor closely the management of medical comorbidity in patients with schizophrenia and related disorders.

Aged↗
PubMed1999

Early-onset psychotic disorders: course and outcome over a 2-year period.

OBJECTIVE: To examine the course and outcome of early-onset psychotic disorders. METHOD: These are data from a longitudinal, prospective study of youths with psychotic disorders. Standardized diagnostic and symptom rating measures were used. RESULTS: Fifty-five subjects with the following disorders have been recruited: schizophrenia (n = 18), bipolar disorder (n = 15), psychosis not otherwise specified (n = 15), schizoaffective disorder (n = 6), and organic psychosis (n = 1). Follow-up assessments were obtained on 42 subjects at year 1 and 31 subjects at year 2. Youths with schizophrenia had more chronic global dysfunction, whereas subjects with bipolar disorder overall had better functioning, with a cyclical course of illness. However, according to results of a regression model, premorbid functioning and ratings of negative symptoms, but not diagnosis, significantly predicted the highest level of functioning over years 1 and 2. CONCLUSIONS: Course and level of functioning differentiated bipolar disorder from schizophrenia. However, premorbid functioning and ratings of negative symptoms were the best predictors of functioning over the follow-up period. These findings are consistent with the adult literature, and they further support that psychotic illnesses in young people are continuous with the adult-onset forms.

Adolescent↗
PubMed1990

Relationship between expressed emotion and family burden in psychotic disorders: an exploratory study.

This study explored the relationship between level of expressed emotion (EE) and level of family burden in 20 families of individuals with psychotic disorder. Results indicated that a relationship between EE and family burden did exist, but it appeared to be strongly influenced by demographic and illness-related variables. The usefulness of the 5-min speech sample method of assessing EE was limited by the aversion of some family members to being videotaped and by denial of patient symptoms by some relatives. Other methodological weaknesses are discussed. The relationship between demographic and illness-related variables and level of EE needs further exploration.

Affective Disorders, Psychotic↗
PubMed1993

[Clinical study of pregnant women with psychotic disorders during last 14 years in Osaka Medical College].

The clinical features and outcomes of 51 pregnancies (47 patients) complicated by psychotic disorders were studied. These patients were diagnosed as having the following psychotic disorders: 7 schizophrenias, 8 atypical psychoses, 6 mood disorders, 25 epilepsies, 4 anxiety disorders, and 1 personality disorder. The mean delivery age of women suffering from schizophrenia, atypical psychosis, and anxiety disorder was over 30 with deliveries 7-10 years after the onset of their psychoses. The predominant obstetrical complications for schizophrenias, atypical psychoses, and mood disorders were gestational toxicosis, threatened premature birth, and premature birth, respectively. Six out of eight (75.0%) patients with atypical psychosis, 4 out of 6 (66.7%) patients with mood disorder, and 2 of 4 patients with anxiety disorder became worse during pregnancy and/or postpartum. The rate of deterioration of the patients with schizophrenia was 14.3% (1/7) during pregnancy. An increasing rate of epileptic attack during pregnancy and/or postpartum were observed in 40.0% (10/25) of patients. Nine cases underwent cesarean section not due to their mental disorders but for obstetrical reasons. The present study suggests that the cooperation between obstetrician and psychiatrist, and the existence of a key person who knows the patient very well is required for a desirable outcome of the treatment.

Adult↗
PubMed1994

Challenges in conceptualizing psychotic mood disorders.

Psychotic mood disorders represent a complex group of syndromes in which depression and/or mania are accompanied by delusions, hallucinations, or both. The presence of psychotic features has a profound influence on the course and treatment response of mood disorders, and psychotic disorders in turn are influenced by coexisting dysregulation of mood. Psychosis and mood, along with other features such as severity, a high rate of recurrence, psychomotor changes, dissociation, and mental states reflecting a history of trauma, appear to interact to alter each other's expression. The treatment of psychotic mood disorders, regardless of coexisting conditions, requires pharmacotherapy--usually a combination of an antipsychotic drug and a medication for mood--or electroconvulsive therapy. The results of treatment are usually positive.

Affect↗