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PubMed2006

Brief psychotic disorder mimicking the symptoms of cerebrovascular attack evoked by symptoms that symbolized death in a patient with terminal stage stomach cancer: case report and review of the literature.

OBJECTIVE: We report here a terminally ill patient with stomach cancer who developed a brief psychotic disorder mimicking cerebrovascular attack after a short episode of nasal bleeding. Close examination of the patient revealed that nasal bleeding was an event that symbolized deterioration of the general condition leading to death for the patient. METHODS: A 77-year-old male, who was diagnosed as having stomach cancer and was receiving palliative care, presented with tremor and insomnia just after a short episode of nasal bleeding and showed reduced response to stimuli mimicking cerebrovascular attack. Laboratory data were unremarkable. The next day, catatonic behavior developed. He had no history of psychiatric illness or drug or alcohol abuse. After receiving haloperidol, psychiatric symptoms disappeared and he returned to the previous level of functioning within 3 days. The patient explained that he had seen a patient whose general condition deteriorated after nasal bleeding and regarded nasal bleeding as a symptom of deteriorating general condition leading to death and thereafter became afraid of the nasal bleeding. RESULTS AND SIGNIFICANCE OF RESULTS: Although, nasal bleeding is common and usually not severe in medical settings, for the patient, it was an event that symbolized deterioration of the general condition leading to death. Brief psychotic disorder in cancer patients is rare in the literature, although patients receiving terminal care share various kinds of psychological burden. Medical staff in the palliative care unit should be aware of the psychological distress experienced by each patient and consider brief psychotic disorder as part of the differential diagnosis when patients show unexplained neurological-like and/or psychiatric symptoms.

Aged↗
PubMedDate not supplied

Induced psychotic disorder: clinical aspects, theoretical considerations, and some guidelines for treatment.

We describe our experience with a case of folie à famille with role reversal, including the long-term course. In addition, the case reports published since 1974 were reviewed and an overview is given of the psychoanalytic and system theory concepts on the pathogenesis of induced psychotic disorder. The inductor often appears to be suffering from schizophrenia. No further indications could be found in the literature for a hereditary predisposition in the recipient. It is sometimes difficult to distinguish between the inductor and the recipient, owing to the circular character of induced psychotic disorder and the role reversal that sometimes occurs. The DSM-III-R criteria for induced psychotic disorder were found to be lacking in practice because of their disregard for the circular causality and the strict exclusion criteria. In the short term, physical separation of the inductor and recipient leads to better treatment results than nonseparation, particularly in the case of recipient children. Long-term results are seldom mentioned. On the basis of theoretical considerations, interventions that aim at separation in psychological terms are necessary to achieve favorable long-term treatment results.

Adult↗
PubMed1989

Water excretion and plasma vasopressin in psychotic disorders.

To investigate the pathogenesis of water intoxication in psychotic disorders, a standard water load test was given to 23 unmedicated patients with schizophrenic or schizoaffective disorders. Levels of plasma arginine vasopressin were measured concurrently. Compared with 28 healthy volunteers, the psychotic patients had significantly smaller cumulative urine output and higher minimum urine osmolalities. Patients whose current illness had lasted less than 24 weeks exhibited the most severe antidiuretic state and also had the highest plasma arginine vasopressin levels. Water intoxication in acute exacerbations of psychosis may develop as a result of impaired excretory mechanisms.

Adolescent↗
PubMed2003

Costs of schizophrenia and other psychoses in urban Australia: findings from the Low Prevalence (Psychotic) Disorders Study.

OBJECTIVE: To estimate the costs associated with the treatment and care of persons with psychosis in Australia based on data from the Low Prevalence Disorders Study (LPDS), and to identify areas where there is potential for more efficient use of existing health care resources. METHOD: The LPDS was a one-month census-based survey of people with psychotic disorders in contact with mental health services, which was conducted in four metropolitan regions in 1997-1998. Mental health and service utilization data from 980 interviews were used to estimate the economic costs associated with psychotic disorders. A prevalence-based, 'bottom-up' approach was adopted to calculate the government and societal costs associated with psychosis, including treatment and non-treatment related costs. RESULTS: Annual societal costs for the average patient with psychosis are of the order of 46,200 Australian dollars , comprising 27,500 Australian dollars in lost productivity, 13,800 Australian dollars in inpatient mental health care costs and 4900 Australian dollars in other mental health and community services costs. Psychosis costs the Australian government at least 1.45 billion Australian dollars per annum, while societal costs are at least 2.25 billion Australian dollars per annum (including 1.44 billion Australian dollars for schizophrenia). We also report relationships between societal costs and demographic factors, diagnosis, disability and participation in employment. CONCLUSIONS: Current expenditure on psychosis in Australia is probably inefficient. There may be substantial opportunity costs in not delivering effective treatments in sufficient volume to people with psychotic disorders, not intervening early, and not improving access to rehabilitation and supported accommodation.

Adolescent↗
PubMed2000

Pharmacokinetics, tolerability, and clinical effectiveness of quetiapine fumarate: an open-label trial in adolescents with psychotic disorders.

BACKGROUND: This is the first investigation of the pharmacokinetics, tolerability, and efficacy of quetiapine fumarate in adolescents with chronic or intermittent psychotic disorders. METHOD: Ten patients with DSM-IV chronic or intermittent psychotic disorders (ages 12.3 through 15.9 years) participated in an open-label, rising-dose trial and received oral doses of quetiapine twice daily (b.i.d.), starting at 25 mg b.i.d. and reaching 400 mg b.i.d. by day 20. The trial ended on day 23. Key assessments were pharmacokinetic analysis of plasma quetiapine concentrations and neurologic, safety, and efficacy evaluations. RESULTS: No statistically significant differences were observed between 100-mg b.i.d. and 400-mg b.i.d. quetiapine regimens for total body clearance, dose-normalized area under the plasma concentration-time curve, or dose-normalized premorning- or postmorning-dose trough plasma values obtained under steady-state conditions after multiple-dose regimens. No unexpected side effects occurred with quetiapine therapy, and no statistically significant changes from baseline were observed for the UKU Side Effect Rating Scale items that were rated. No serious adverse events or clinically important changes in hematology or clinical chemistry variables were reported. The most common adverse events were postural tachycardia and insomnia. Extrapyramidal side effects improved, as evidenced by significant (p < .05) decreases from baseline to endpoint in the mean Simpson-Angus Scale total scores and Barnes Akathisia Scale scores. Quetiapine improved positive and negative symptoms, as shown by significant (p < .05) decreases from baseline to endpoint in the mean Brief Psychiatric Rating Scale total score, the Clinical Global Impressions-Severity of Illness scale, and the Modified Scale for the Assessment of Negative Symptoms summary score. CONCLUSION: Quetiapine pharmacokinetics were dose proportional in adolescents and were similar to those previously reported for adults. Quetiapine was well tolerated and effective in the small number of adolescents studied.

Adolescent↗
PubMedDate not supplied

[Possibility of predicting and preventing psychotic disorders during ketamine anesthesia].

The results of ketamine anesthesia are analyzed in 327 patients after stomach resection and cholecystectomy. Preoperative determination of nervous system type, using MMPI test, has revealed maximum incidence of psychotic disorders after ketamine anesthesia in anosognosia syndrome and paranoia. Administration of a neurometabolic stimulator nootropil (pyracetam) prior to extubation in 143 patients decreased the incidence of psychotic disorders from 23.3% to 3.5%, which was confirmed by the results of psychophysiological tests. It is concluded that ketamine anesthesia is inadvisable in patients with anosognosia syndrome and paranoia. To prevent psychotic disorders it is recommended to administer nootropil that recovers intra- and inter-hemisphere connections in the brain.

Adult↗
PubMed2006

Effect of religion on suicide attempts in outpatients with schizophrenia or schizo-affective disorders compared with inpatients with non-psychotic disorders.

Little is known of the relations between psychosis, religion and suicide. One hundred and fifteen outpatients with schizophrenia or schizo-affective disorder and 30 inpatients without psychotic symptoms were studied using a semi-structured interview assessing religiousness/spirituality. Their past suicide attempts were examined. Additionally, they were asked about the role (protective or incentive) of religion in their decision to commit suicide. Forty-three percent of the patients with psychosis had previously attempted suicide. Religiousness was not associated with the rate of patients who attempted suicide. Twenty-five percent of all subjects acknowledged a protective role of religion, mostly through ethical condemnation of suicide and religious coping. One out of ten patients reported an incentive role of religion, not only due to negatively connotated issues but also to the hope for something better after death. There were no differences between groups (i.e. psychotic vs. non-psychotic patients). Religion may play a specific role in the decisions patients make about suicide, both in psychotic and non-psychotic patients. This role may be protective, a finding particularly important for patients with psychosis who are known to be at high risk of severe suicide attempts. Interventions aiming to lower the number of suicide attempts in patients with schizophrenia should take these data into account.

Adaptation, Psychological↗
PubMed2000

Psychotic disorders in urban areas: an overview of the Study on Low Prevalence Disorders.

OBJECTIVE: This paper reports on a study designed within the framework of the National Survey of Mental Health and Wellbeing to: estimate the prevalence of psychoses in urban areas of Australia; identify profiles of symptomatology, impairments and disabilities; collect information on services received and needed; and explore quality of life issues in a broadly representative sample of people with psychotic illnesses. METHOD: The study was conducted over four areas in the Australian Capital Territory, Queensland, Victoria and Western Australia, as a two-phase survey: (i) a census and screening for psychosis of all individuals who made contacts with mental health services during a period of 1 month in 1997; and (ii) interviews with a stratified random sample (n=980) of the screen-positive individuals (n=3800) using a standardised instrument. RESULTS: The point prevalence (1 month) of psychotic disorders in the urban population aged 18-64 is in the range of 4-7 per 1000 with a weighted mean of 4.7 per 1000. People with psychotic disorders experience high rates of functional impairments and disability, decreased quality of life, persistent symptoms, substance-use comorbidity and frequent side effects of medication. Although the utilisation of hospital-based and community mental health services, as well as of public and non-governmental helping agencies, is high, the majority live in extreme social isolation and adverse socioeconomic circumstances. Among the many unmet needs, the limited availability of community-based rehabilitation, supported accommodation and employment opportunities is particularly prominent. CONCLUSIONS: The so-called 'low-prevalence' psychotic disorders represent a major and complex public health problem, associated with heavy personal and social costs. There is a need for a broad programmatic approach, involving various sectors of the community, to tackle the multiple dimensions of clinical disorder, personal functioning and socioeconomic environment that influence the course and outcome of psychosis and ultimately determine the effectiveness of service-based intervention.

Activities of Daily Living↗
PubMed2005

Developing therapeutics for schizophrenia and other psychotic disorders.

Although the second-generation or atypical antipsychotic drugs have been breakthrough medicines for the treatment of schizophrenia and other psychotic conditions, cognitive dysfunction and to some extent negative symptoms of the disease continue to be the main cause of poor vocational status of the patients. Thus, the majority of investigational drug development efforts today target these unmet medical needs. This review postulates that the field of schizophrenia research has advanced sufficiently to develop biochemical hypotheses of the etiopathology of the disease and target the same for revolutionary disease modifying therapy. This postulate is based on recent studies that have begun to provide a testable etiopathology model that integrates interactions between genetic vulnerability factors, neurodevelopmental anomalies, and neurotransmitter systems. This review begins with a brief overview of the nosology and etiopathology of schizophrenia and related psychotic disorders to establish a context for subsequent detailed discussions on drug discovery and development for psychotic disorders. Particular emphasis is placed on recent advances in genetic association studies of schizophrenia and how this can be integrated with evidence supporting neurodevelopmental abnormalities associated with the disease to generate a testable model of the disease etiopathology. An in-depth review of the plethora of new targets and approaches targeting the unmet medical need in the treatment of schizophrenia exemplify the challenges and opportunities in this area. We end the review by offering an approach based on emerging genetic, clinical, and neurobiological studies to discover and validate novel drug targets that could be classified as disease modifying approaches.

Animals↗
PubMed1999

Family study of acute and transient psychotic disorders: comparison with schizophrenia.

BACKGROUND: Acute non-organic psychoses, as often described in European and Indian literature, and categorized as 'Acute and transient psychotic disorders' in ICD-10, lack a clear nosological distinction from schizophrenia. METHODS: A family study of psychiatric disorders in first-degree relatives (FDRs) of 40 ICD-10-diagnosed probands of acute and transient psychotic disorders (ATP) was carried out using a semi-structured interview schedule. The results were compared with those of 40 schizophrenic probands. RESULTS: FDRs of ATP probands had a higher prevalence of ATP than those of schizophrenic probands. FDRs of schizophrenic probands had significantly higher prevalence of schizophrenia than those of ATP probands. ATP subtypes with schizophrenic symptomatology (ICD-10 codes F 23.1 and F 23.2) had more family history of schizophrenia than the rest of the ATP subtypes. CONCLUSION: ATP as a group has a differential pattern of risk of illness compared to schizophrenia. Further, the subtypes subsumed under ICD-10 ATP may be genetically heterogeneous, those with schizophrenia-like symptomatology being possibly more akin to schizophrenia itself or forming an interface between ATP and schizophrenia.

Acute Disease↗
PubMed2004

Predictors of parenting outcome in women with psychotic disorders discharged from mother and baby units.

OBJECTIVE: To compare the social and clinical characteristics of mothers with psychotic disorders with parenting difficulties, with mothers with no significant parenting problems. METHOD: Descriptive and case-control study. RESULTS: Over half of the women with psychotic disorders admitted to psychiatric mother and baby units had a good outcome at the time of discharge--70% did not need social services supervision, and had no significant parenting problem as judged by clinical staff. Diagnosis was independently associated with all measures of poor parenting; compared with a diagnosis of psychotic depression, a diagnosis of schizophrenia was highly significantly associated with social services supervision [adjusted odds ratio (OR) 25.7; 95% CI 5.97, 111.05], and staff rated problems with emotional responsiveness (adjusted OR 3.39;95% CI 1.42, 8.08), practical baby care (adjusted OR 6.07; 95% CI 2.12, 17.39), and perceived risk of harm to baby (adjusted OR 7.81; 95% CI. 2, 30.53). Low social class and psychiatric illness in the partner were also significantly associated with poor parenting outcomes, including social services supervision (adjusted OR 3.88; 95% CI 2.07, 7.25 and 4.23; 95% CI 2.1, 8.55, respectively). CONCLUSIONS: Although these associations do not demonstrate causality, these findings suggest preventative interventions targeting socio-economic difficulties, early treatment of psychosis, and detection and treatment of psychiatric problems in the partner may be helpful in improving parenting outcomes in these vulnerable families.

Adult↗
PubMed1990

Diagnosis and screening for psychotic disorders in a study of the homeless.

In a survey of homeless men, the authors found that screening scales for psychotic symptoms (Psychiatric Epidemiology Research Instrument) and signs (6-item scale of observational ratings) predicted a rating of psychosis (possible, probable, or definite) on a diagnostic interview (Structured Clinical Interview for DSM-III-R: Psychotic Disorders) reasonably well, in a sample where psychosis was common. Although the two scales performed well when used in conjunction, neither scale showed adequate predictive power when used alone. The authors conclude that screening for psychotic disorders in community studies is feasible for some purposes. They suggest approaches to the use of diagnostic interviews and screening scales in future community studies that might enhance the interpretability as results as well as the efficacy of screening.

Adult↗
PubMed1996

Chronic substance-induced psychotic disorders: state of the literature.

Whether or not drug use can cause a chronic psychotic disorder that is clinically similar to schizophrenia and related disorders is an important question. In this review, the authors attempt to determine whether there is enough evidence in the literature to support the notion that illicit drug use can cause chronic psychotic disorders. They conclude the literature strongly suggests that a number of drugs of abuse in different classes (psychostimulants, hallucinogens, marijuana, and possibly industrial inhalants) can cause or increase the susceptibility for a state of chronic psychosis. It is also likely that the abuse of combinations of these drugs is capable of inducing similar syndromes.

Central Nervous System Stimulants↗
PubMed2006

Psychotic disorder induced by oxybutynin: Presentation of two cases.

Anticholinergic agents are muscarinic receptor antagonists that suppress the activity of the acetylcholine system in the brain. Some of these agents also increase the concentration of dopamine in the synaptic cleft, which may result in psychotic symptoms. Oxybutynin is an antimuscarinic drug that may have adverse effects on the CNS, including memory impairment, confusion, delirium and hallucinations in elderly patients. To date, several case reports have been published about the association between oxybutynin and psychotic symptoms in elderly subjects, but we were unable to find any case reports describing oxybutynin-induced psychotic disorders in young people. Here we report on two patients, a 7-year-old boy and a 21-year-old man, who developed a brief psychotic disorder that may have been caused by oxybutynin. The first patient was kept under observation with vital functions supported but no medication. All his psychotic symptoms regressed and his general condition improved. The second patient was treated with olanzapine 10 mg/day. His psychotic symptoms resolved within 3 weeks. Our two case reports provide evidence that oxybutynin may induce psychotic disorders, and in younger patients.

Adult↗
PubMed1998

Brief report: association of sex chromosome anomalies with childhood-onset psychotic disorders.

OBJECTIVE: An apparent excess of sex chromosome aneuploidies (XXY, XXX, and possibly XYY) has been reported in patients with adult-onset schizophrenia and with unspecified psychoses. This study describes the results of cytogenetic screening carried out for pediatric patients meeting DMS-III-R criteria for childhood-onset schizophrenia (COS) and a subgroup of patients with childhood-onset psychotic disorder not otherwise specified, provisionally labeled by the authors as multidimensionally impaired (MDI). METHOD: From August 1990 to July 1997, karyotypes were determined for 66 neuroleptic-nonresponsive pediatric patients (28 MDI, 38 COS), referred to the National Institute of Mental Health for an inpatient treatment trial of clozapine. RESULTS: Four (6.1%) of 66 patients (3 MDI, 1 COS) were found to have sex chromosome anomalies (mosaic 47,XXY; 47,XXY; 47,XYY; mosaic 45,XO, respectively), which is higher than the expected rate of 1 per 426 children or 2.34 per 1,000 in the general population (4/66 versus 1/426, chi 2 = 19.2, df = 1, p = .00001). All cases had been previously undiagnosed. CONCLUSIONS: These findings lend support to a hypothesis that a loss of balance of gene products on the sex chromosomes may predispose affected individuals to susceptibility to additional genetic and environmental insults that result in childhood-onset psychotic disorders. Karyotyping of children with psychotic disorders should be routine.

Adolescent↗
PubMed2003

[General practitioners' attitudes towards psychotic disorders and their treatment in the primary health care system].

OBJECTIVE: To assess general practitioners' attitudes and behavior towards psychotic disorders, antipsychotic drug prescriptions, and patients with psychosis in primary health care settings. METHOD: 262 general practitioners (GPs) practicing in primary care settings in Kocaeli province were included in the study. The 20-item questionnaire, which was prepared by the researchers, was sent to all GPs via the Kocaeli branch of the Health Ministry. 195 (74.4%) questionnaires were returned. The GPs' responses and the relations between different variables were examined. RESULTS: The participation rate among GPs in any education about psychosis and antipsychotic treatment after graduation was 27.2%. The rate seeking structured and advanced education about psychosis was 41.0%. The mean daily number of patients with psychosis examined by GPs in primary care settings during the previous six months was 1.4. They first prescribed any antipsychotic drug by themselves at a rate of 12.8% in the previous six-month. The most frequent reason for antipsychotic prescription was re-prescription (80.0%). The most frequent problem in the pharmacological treatment of psychotic disorders was the drop-out rate of patients (75.9%). The predictors of starting patients with psychosis on medication were the belief that the patients were treatable in primary care and the suspicion of GPs about psychosis. CONCLUSION: GPs practicing in primary care settings rarely encounter patients with psychosis. GPs mostly avoid undertaking the responsibility of treating them. However, some are eager to participate in structured education about psychosis in order to have more confidence when diagnosing and treating it.

Adult↗
PubMed2005

Psychotic disorders in MS: population-based evidence of an association.

Administrative data from a Canadian province were accessed to assess the association of psychotic disorders with multiple sclerosis (MS). Physician-assigned ICD-9-CM codes were used to classify MS and psychotic disorder status. A significant association was observed. Additional research is needed to determine the clinical importance and treatment needs of this population.

Adolescent↗
PubMedDate not supplied

Subjective experiences in psychotic disorders: diagnostic value and clinical correlates.

This study evaluated the prevalence and clinical correlates of abnormal subjective experiences across functional psychotic disorders. Patients were recruited from consecutive admissions with the following diagnoses; schizophrenia (n = 40), schizophreniform disorder (n = 40), schizoaffective disorder (n = 21), mood disorder (n = 18), brief reactive psychosis (n = 15), and atypical psychosis (n = 16). Subjective experiences were assessed using the Frankfurt Complaint Questionnaire (FCQ), and the clinical status was assessed with the Scales for the Assessment of Positive and Negative Symptoms (SAPS and SANS) and the Manual for the Assessment and Documentation of Psychopathology (AMDP). Neither the FCQ total score nor individual subjective experiences displayed significant differences across diagnoses. When the clinical predictors of subjective experiences were studied by multiple regression analyses, a different pattern resulted for individual psychotic disorders. In schizophrenic patients, subjective experiences were predicted by female gender, euphoria, lack of insight, greater illness severity, and more positive symptoms. The only predictors of subjective experiences in the schizophreniform disorder group were the negative symptoms. Within the affective disorders group, subjective experiences had no clinical predictors.

Adult↗