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Journal articles on the topic 'Long term psychotic illness'
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Federico, M. T., S. Priebe, C. Fusco, N. Strapelli, R. Singh, and R. McCabe. "Communication about Psychotic Symptoms in Long-Term Psychiatric Illness." Psychopathology 46, no. 4 (2013): 233–40. http://dx.doi.org/10.1159/000342259.
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Gotfredsen, D. R., R. S. Wils, C. Hjorthøj, S. F. Austin, N. Albert, R. G. Secher, A. A. E. Thorup, O. Mors, and M. Nordentoft. "Stability and development of psychotic symptoms and the use of antipsychotic medication – long-term follow-up." Psychological Medicine 47, no. 12 (April 6, 2017): 2118–29. http://dx.doi.org/10.1017/s0033291717000563.
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BackgroundFew studies have evaluated the development in the use of antipsychotic medication and psychotic symptoms in patients with first-episode psychosis on a long-term basis. Our objective was to investigate how psychotic symptoms and the use of antipsychotic medication changed over a 10-year period in a cohort of patients with first-episode psychosis.MethodThe study is a longitudinal prospective cohort study over 10 years with follow-ups at years 1, 2, 5 and 10. A total of 496 patients with first-episode psychosis were included in a multi-centre study initiated between 1998 and 2000 in Copenhagen and Aarhus, Denmark.ResultsAt all follow-ups, a large proportion (20–30%) of patients had remission of psychotic symptoms without use of antipsychotic medication at the time of the follow-up. Patients who were in this group at the 5-year follow-up had an 87% [95% confidence interval (CI) 77–96%] chance of being in the same group at the 10-year follow-up. This stability was also the case for patients who had psychotic symptoms and were treated with antipsychotic medication at year 5, where there was a 67% (95% CI 56–78%) probability of being in this group at the consecutive follow-up.ConclusionsA large group of patients with psychotic illness were in remission without the use of antipsychotic medication, peaking at year 10. Overall there was a large degree of stability in disease courses over the 10-year period. These results suggest that the long-term outcome of psychotic illness is heterogeneous and further investigation on a more individualized approach to long-term treatment is needed.
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Kingston, T., P. J. Scully, D. J. Browne, P. A. Baldwin, A. Kinsella, V. Russell, E. O'Callaghan, and J. L. Waddington. "Diagnostic trajectory, interplay and convergence/divergence across all 12 DSM-IV psychotic diagnoses: 6-year follow-up of the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS)." Psychological Medicine 43, no. 12 (March 12, 2013): 2523–33. http://dx.doi.org/10.1017/s003329171300041x.
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BackgroundThe boundaries of psychotic illness and the extent to which operational diagnostic categories are distinct in the long term remain poorly understood. Clarification of these issues requires prospective evaluation of diagnostic trajectory, interplay and convergence/divergence across psychotic illness, without a priori diagnostic or other restrictions.MethodThe Cavan-Monaghan First Episode Psychosis Study (CAMFEPS), conducted using methods to attain the closest approximation to epidemiological completeness, incepts all 12 DSM-IV psychotic diagnoses. In this study we applied methodologies to achieve diagnostic reassessments on follow-up, at a mean of 6.4 years after first presentation, for 196 (97%) of the first 202 cases, with quantification of prospective and retrospective consistency.ResultsOver 6 years, the 12 initial psychotic diagnoses were characterized by numerous transitions but only limited convergence towards a smaller number of more stable diagnostic nodes. In particular, for initial brief psychotic disorder (BrP), in 85% of cases this was the harbinger of long-term evolution to serious psychotic illness of diagnostic diversity; for initial major depressive disorder with psychotic features (MDDP), in 18% of cases this was associated with mortality of diverse causality; and for initial psychotic disorder not otherwise specified (PNOS), 31% of cases continued to defy DSM-IV criteria.ConclusionsCAMFEPS methodology revealed, on an individual case basis, a diversity of stabilities in, and transitions between, all 12 DSM-IV psychotic diagnoses over 6 years; thus, psychotic illness showed longitudinal disrespect to current nosology and may be better accommodated by a dimensional model. In particular, a first episode of BrP or MDDP may benefit from more vigorous, sustained interventions.
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Goater, Nicky, Michael King, Eleanor Cole, Gerard Leavey, Eric Johnson-Sabine, Robert Blizard, and Amanda Hoar. "Ethnicity and outcome of psychosis." British Journal of Psychiatry 175, no. 1 (July 1999): 34–42. http://dx.doi.org/10.1192/bjp.175.1.34.
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BackgroundAn excess of psychotic illness in Black people has been found in cross-sectional studies. Little is known about the outcome of psychosis in different ethnic groups in the UK.AimsTo compare the incidence, nature and long-term outcome of psychosis in different ethnic groups.MethodA five-year, prospective study of an epidemiological cohort of people with a first contact for psychosis.ResultsAge-standardised incidence rates for schizophrenia and non-affective psychosis were higher for Black and Asian people than Whites. Stability of diagnosis and course of illness were similar in all ethnic groups. During the fifth year, Black people were more likely than others to be detained, brought to hospital by the police and given emergency injections.ConclusionsThe nature and outcome of psychotic illness is similar in all ethnic groups but Black people experience more adverse contacts with services later in the course of illness.
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Gómez-de-Regil, Lizzette. "Causal Attribution and Illness Perception: A Cross-Sectional Study in Mexican Patients with Psychosis." Scientific World Journal 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/969867.
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Health psychology researchers have begun to focus greater attention on people’s beliefs about health/illness since these beliefs can clearly affect behavior. This cross-sectional study aimed at (1) identifying the most common factors psychotic patients attribute their illness to and (2) assessing the association between causal attribution and illness perception (cognitive, emotional, and comprehensibility dimensions). Sixty-two patients (56.5% females) who had been treated for psychosis at a public psychiatric hospital in Mexico answered the Angermeyer and Klusmann Illness Attribution Scale and the Brief Illness Perception Questionnaire. Results showed that most patients attributed psychosis onset to social factors and that attribution to their personality might have an overwhelmingly negative effect on their lives. Acknowledging psychotic patient attributional beliefs and considering them in clinical practice could improve treatment efficacy and overall recovery success. This is particularly important in psychosis, since symptoms are often severe and/or persistent and require long-term treatment.
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Özyıldırım, İ., S. Çakır, and O. Yazıcı. "Impact of psychotic features on morbidity and course of illness in patients with bipolar disorder." European Psychiatry 25, no. 1 (January 2010): 47–51. http://dx.doi.org/10.1016/j.eurpsy.2009.08.004.
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AbstractObjectiveIn this study, we aimed to compare the clinical features and response patterns to the long-term prophylaxis of bipolar patients with or without psychotic features.MethodThe life charts of patients with bipolar I disorder were evaluated. Two hundred and eighty-one patients who suffer with bipolar disorder for at least 4 years and who had at least three mood episodes were included to the study. The patients whose all episodes are psychotic (psychotic group) and the patients who never experienced psychotic episode (non-psychotic group) were assigned as comparison groups. The clinical features and the response to long-term prophylaxis were compared across the groups.ResultsThe psychotic group consists of 43 patients; non-psychotic group consists of 54 patients. The history of bipolar disorder among the first-degree relatives was remarkably more prevalent in non-psychotic group (p = 0.032). The predominance of manic/hypomanic episodes was significantly higher in psychotic group than non-psychotic group; and the rate of depressive episodes were higher in non-psychotic group than psychotic group (p = 0.013). Episodes were more severe (p < 0.001) and hospitalization rates were higher (p = 0.023) in psychotic group. The response to lithium monotherapy was better in non-psychotic group (p < 0.001).ConclusionThe well identified psychotic subtype of bipolar patients may give important predictions about long term course and prophylaxis of bipolar disorder.
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Searle, Geoffrey. "Optimising neuroleptic treatment for psychotic illness." Psychiatric Bulletin 22, no. 9 (September 1998): 548–51. http://dx.doi.org/10.1192/pb.22.9.548.
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The release of the antipsychotic agents risperidone, sertindole and olanzepine forces difficult choices upon clinicians. The new compounds are better tolerated than neuroleptics, expensive and their long-term side-effects unknown. These choices can be made easier by the dose and side-effect minimisation procedure set out below, which aims to produce the greatest benefit and least harm from conventional neuroleptics.
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Humphreys, Martin, and Alan Ogilvie. "Feigned psychosis revisited –a 20 year follow up of 10 patients." Psychiatric Bulletin 20, no. 11 (November 1996): 666–69. http://dx.doi.org/10.1192/pb.20.11.666.
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Feigned psychosis, although rare, presents considerable diagnostic problems in clinical psychiatric practice. Long-term follow up data are lacking. A retrospective case note study was undertaken of 10 patients described in a previous paper, published in 1970, on the simulation of psychosis. The computerised diagnostic instrument OPCRIT was applied to both index episode and lifetime occurrence of symptoms. All 10 patients were found to have had a major psychotic illness based on lifetime symptoms at 20 year follow-up by DSM–III–R criteria. Eight had met such criteria at the time of the initial episode. Diagnosis in patients thought to be feigning psychotic symptoms changes over time and major mental illness is likely to emerge which may be schizophrenic or affective. The term feigned psychosis should be abandoned and more attention given to why symptoms are accepted as genuine in some cases but not others.
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Lee, Alan S., and Robin M. Murray. "The Long-Term Outcome of Maudsley Depressives." British Journal of Psychiatry 153, no. 6 (December 1988): 741–51. http://dx.doi.org/10.1192/bjp.153.6.741.
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Eighty-nine consecutive admissions with primary depressive illness were prospectively ascertained and diagnosed in 1965–66 by R. E. Kendell, who also allocated each a position on a neurotic-psychotic continuum on the basis of previous discriminant function analysis. In 1983–84, 94% of the survivors were personally interviewed by a psychiatrist blind to index admission data. Operational outcome criteria were employed and longitudinal data were established for 98% of the series. Mortality risk was doubled overall, and increased sevenfold for women under 40 years at index admission. Less than one-fifth of the survivors had remained well, and over one-third of the series suffered unnatural death or severe chronic distress and handicap. Patients whose index episode marked their first psychiatric contact had a 50% chance of readmission within their lifetime, but those with previous admissions had a 50% chance of readmission within three years. Readmissions occurred even after 12 years of being symptom-free, and conversely patients recovered after as long as 15 years of illness. There was a high incidence of other disorders (schizoaffective disorder, alcoholism, schizophrenia), and only four patients showed pure recurrent unipolar histories. Patients at the psychotic end of the continuum were more likely to be readmitted and to have very poor outcomes.
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Koekkoek, B., and W. van Tilburg. "Ineffective chronic illness behaviour in a patient with long-term non-psychotic psychiatric illness." Case Reports 2010, no. 26 1 (November 29, 2010): bcr0220102739. http://dx.doi.org/10.1136/bcr.02.2010.2739.
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Knytl, P., V. Vorackova, and P. Mohr. "Quality of Lfe in Healthy Siblings of Patients with First Episode of Psychotic Illness and its Predictors." European Psychiatry 41, S1 (April 2017): S269—S270. http://dx.doi.org/10.1016/j.eurpsy.2017.02.094.
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Families of patients with first episode of psychotic illness are exposed to numerous distress factors related to the care of their relative. It has been shown that these families experience higher levels of anxiety, depression, economic strain, and helplessness. According to the prior studies, long-term psychotic illness can also have negative impact on quality of life (QoL) in healthy siblings [1]. The aim of our study was to assess QoL in siblings of patients with first episode of psychosis and to examine effects of sibling-related and illness-related variables on QoL. Study sample consisted of first-episode psychosis patients (n = 20) and their healthy siblings (n = 20). All subjects were administered World Health Organisation Quality of Life Questionnaire Scale Brief (WHOQOL-Brief). Duration of untreated psychosis, medication adherence (Hayward scale) and severity of positive psychotic symptomatology (evaluated by Positive and Negative Symptom Scale) were used as illness-related variables, birth order served as a sibling–related variable. QoL has been accepted as a valuable outcome measure in many psychiatric conditions; thus, identification of contributing factors may help to improve overall outcome. Moreover, close monitoring of adverse effects of illness on QoL in healthy siblings may become a part of larger prevention strategies.Supported by the grant projects MH CR AZV 15-28998A, MEYS NPU4NUDZ: LO1611.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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ROBLING, S. A., E. S. PAYKEL, V. J. DUNN, R. ABBOTT, and C. KATONA. "Long-term outcome of severe puerperal psychiatric illness: a 23 year follow-up study." Psychological Medicine 30, no. 6 (November 2000): 1263–71. http://dx.doi.org/10.1017/s0033291799003025.
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Background. Although there have been many follow-up studies of severe puerperal psychiatric illness, few have been very long-term.Methods. Sixty-four subjects from 85 (75·3%) in an unselected sample of women admitted to a psychiatric hospital within 6 months of childbirth were successfully followed up a mean of 23 years (range 17–28) later. Most subjects were interviewed in detail, with further information obtained from general practice and hospital records. Data included subsequent illnesses and diagnoses, subsequent childbirth, longitudinal social function, current symptoms and social function.Results. Seventy-five per cent of subjects had further psychiatric illnesses, most of them unrelated to childbirth, and 37% had at least three subsequent episodes. The risk of puerperal psychiatric illness was 29% in subsequent pregnancies. At outcome interview the majority of subjects were well, with satisfactory social adjustment. Diagnoses in subsequent psychiatric illnesses showed considerable consistency with index diagnoses, with some shift to bipolar disorder. Further illnesses were less likely to occur where the index illness occurred with first child, onset was within 1 month of delivery, and where the index diagnosis was unipolar depression.Conclusions. There is a high risk of subsequent non-puerperal recurrences following severe puerperal psychotic illness, showing considerable diagnostic consistency with the index episode, but with good functional outcome. Puerperal illnesses showed strong continuities with non-puerperal illnesses in these women.
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Susser, Ezra, Vijoy K. Varma, S. K. Mattoo, Molly Finnerty, Ramin Mojtabai, B. M. Tripathi, Arun K. Misra, and N. N. Wig. "Long-term course of acute brief psychosis in a developing country setting." British Journal of Psychiatry 173, no. 3 (September 1998): 226–30. http://dx.doi.org/10.1192/bjp.173.3.226.
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BackgroundThis study in North India compared acute brief psychosis – defined by acute onset, brief duration and no early relapse – with other remitting psychoses, over a 12-year course and outcome.MethodIn a cohort of incident psychoses, we identified 20 cases of acute brief psychosis and a comparison group of 43 other remitting psychoses based on two-year follow-up. Seventeen people (85%) in the acute brief psychosis group and 36 (84%) in the comparison group were reassessed at five, seven and 12 years after onset, and were rediagnosed using ICD–10 criteria.ResultsAt 12-year follow-up, the proportion with remaining signs of illness was 6% (n=1) for acute brief psychosis versus 50% (n=18) for the comparison group (P=0.002). Using ICD–10 criteria, the majority in both groups were diagnosed as having schizophrenia.ConclusionsAcute brief psychosis has a distinctive and benign long-term course when compared with other remitting psychoses. This finding supports the ICD– 10 concept of a separable group of acute and transient psychotic disorders. To effectively separate this group, however, the ICD–10 criteria need modification.
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Birchwood, M., R. Mason, F. MacMillan, and J. Healy. "Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis." Psychological Medicine 23, no. 2 (May 1993): 387–95. http://dx.doi.org/10.1017/s0033291700028488.
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SynopsisThis paper explores the hypothesis that depression in chronic schizophrenia is in part a psychological response to an apparently uncontrollable life-event, namely the illness and its long-term disabilities. It is suggested that depression is linked to patients' perception of controllability of their illness and absorption of cultural stereotypes of mental illness. Clinically and operationally diagnosed schizophrenic and manic-depressive patients receiving long-term maintenance treatment were studied. The cross-sectional prevalence of depression in schizophrenics was 29% and 11% for patients with bipolar affective illness. The hypothesis was supported. Multivariate analyses revealed that patients' perception of controllability of their illness powerfully discriminated depressed from non-depressed psychotic patients. Although those patients who accepted their diagnosis reported a lower perceived control over illness and an external locus of control, label acceptance was not associated with lowered depression, self-esteem or unemployment. The cross-sectional nature of the study makes the direction of causality and the role of intrinsic illness variables difficult to ascertain; however, the results set the scene for prospective and intervention studies and the various possibilities are discussed.
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Pomeroy, John C., and Bruce Ricketts. "Long-Term Attendance in the Psychiatric Outpatient Department for Non-Psychotic Illness." British Journal of Psychiatry 147, no. 5 (November 1985): 508–16. http://dx.doi.org/10.1192/bjp.147.5.508.
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A comparison was made of initial assessment, treatment, and pattern of care of two groups of non-psychotic patients, referred to a Central London psychiatric outpatient department. The patients, none of whom had been in recent psychiatric treatment, were differentiated into those receiving short-term care (less than one year) and those having long-term care (greater than one year). Chronic psychiatric disorders predominated in both groups. It was also common to have physical illness and contact with other hospital departments. Short-term care consisted of very brief contact for 70% of patients, and psychiatrists seemed unable to engage these referrals in treatment. Long-term attendance was associated with acutely ill young, or chronically ill older patients, more active initial intervention, and referral within the same hospital group. Follow-up revealed that long-term patients reported little symptomatic improvement, experienced considerable disruption in course of care, made increased demands on all aspects of psychiatric service, and often proved to have personality disturbance and social problems that were not perceived on initial contact. Types of intervention and their effects on other hospital departments were examined.
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Mirabile, Charles S., and Martin H. Teicher. "Hand Preference and Diagnosis in Major Mental Illness." Perceptual and Motor Skills 95, no. 3 (December 2002): 875–76. http://dx.doi.org/10.2466/pms.2002.95.3.875.
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A sample of 1,671 patients in a long-term psychiatric inpatient hospital were polled for hand preference in writing. Nonright-handers ( n = 420) were more often diagnosed schizophrenic than Right-handers ( n 1,251), but the overall proportion of psychotic illness was the same in both handedness groups, suggesting the possibility that nonright-handedness may be associated with a change in the expression of psychotic illness so it is somewhat more likely to be manifest as thought disorder than mood disorder.
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Duggan, Conor, Pak Sham, Carine Minne, Alan Lee, and Robin Murray. "Family history as a predictor of poor long-term outcome in depression." British Journal of Psychiatry 173, no. 6 (December 1998): 527–30. http://dx.doi.org/10.1192/bjp.173.6.527.
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BackgroundWe investigated whether family history had prognostic significance in depression in a study which addressed some of the methodological shortcomings of previous studies.MethodWe collected family history data on a consecutive series of 89 patients admitted with RDC major depression, blind to the outcome of the proband. This comprised 116, 283 and 120 first-degree relatives examined with the SADS–L, FH–RDC and case note data, respectively. The outcome of 74 of these probands (83%), previously categorised into four operationally defined groups, was then examined.ResultsA positive family history of severe psychiatric illness (i.e. a relative with a history of either a psychosis, hospitalised depression or suicide) was associated with poor outcome in the proband. This association persisted after controlling for variable family size, age structure and gender. As family history was correlated with neither Kendell's neurotic/psychotic index nor the probands neuroticism score, an individual with high scores an all three would have a greatly increased chance of having a poor outcome.ConclusionsA family history of severe psychiatric illness in a first-degree relative may be useful as one of the vulnerability factors for predicting poor long-term outcome in depression.
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Blinc, M., B. Novak, B. Avgustin, and M. Agius. "Treating Prodromal Psychosis in Slovenia." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71342-2.
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This presentation describes an ongoing program in Ljubljana.The program originated with one psychiatrist [MB] who began to offer treatment with antipsychotics- typicals with the earliest patients, and later atypicals, in particular olanzapine, in very low doses [e.g.2.5 mg olanzapine], often combined with group psychotherapy, in patients considered to be at the initial [prodromal or ‘at risk mental state’] phase of developing a psychotic illness. Often, where indicated, antidepressants and occasionally anxiolytics were also added to the treatment. Thus this program differed substantially from other well known studies of treatment in the prodrome [e.g. Melbourne and Yale], and developed independently of them.It has been shown by repeated clinical evaluation of the patients that these patients were indeed originally in the prodromal phase of psychotic illness.Many patients have now been followed over several years as they developed into full first episodes of psychosis and for some years later.The presentation will describe the process of how the patients were treated, and how their illness developed.The presentation will describe results, of a study comparing outcomes of treatment in the prodrome by this method, with treatment of patients who presented with psychotic illness in the usual way, with long DUP. This shows long term advantages in terms of severity of symptoms, reduced relapse and readmission rates, better employment results, and improved relationships among the patients treated in the prodrome.
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Waddington, J. L., H. A. Youssef, and A. Kinsella. "Sequential cross-sectional and 10-year prospective study of severe negative symptoms in relation to duration of initially untreated psychosis in chronic schizophrenia." Psychological Medicine 25, no. 4 (July 1995): 849–57. http://dx.doi.org/10.1017/s0033291700035108.
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SYNOPSISCurrent clinical correlates of duration of initially untreated psychotic symptoms were investigated in a cross-sectional analysis followed by a 10-year prospective study among 88 inpatients with a long-standing schizophrenic illness, many of whom had experienced prolonged periods of untreated psychosis due to illness onset and hospital admission in the pre-neuroleptic era. After controlling for the effects of age, and duration and continuity of subsequent neuroleptic treatment, the primary clinical correlate of duration of initially untreated psychosis was muteness. Over the subsequent 10-year-period, no new cases of muteness emerged and some existing cases of muteness partially resolved, though the speech that emerged remained very sparse and revealed generally gross cognitive debility. The pathophysiology underlying active, unchecked psychosis may also constitute an active morbid process that is associated with the further progression of severe negative symptoms and cognitive dysfunction in the long-term.
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Vuckovich, Paula K. "Compliance versus adherence in serious and persistent mental illness." Nursing Ethics 17, no. 1 (January 2010): 77–85. http://dx.doi.org/10.1177/0969733009352047.
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Failure to follow prescribed treatment has devastating consequences for those who are seriously and persistently mentally ill. Nurses, therefore, try to get clients to take psychotropic medication on a long-term basis. The goal is either compliance or adherence. Although current nursing literature has abandoned the term compliance because of its implications of coercion, in psychiatric nursing practice with patients suffering from serious long-term mental illness compliance and adherence are in fact different goals. The ideal goal is adherence, which requires the patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence.
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Harrison, G., K. Hopper, T. Craig, E. Laska, C. Siegel, J. Wanderling, K. C. Dube, et al. "Recovery from psychotic illness: A 15- and 25-year international follow-up study." British Journal of Psychiatry 178, no. 6 (June 2001): 506–17. http://dx.doi.org/10.1192/bjp.178.6.506.
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BackgroundPoorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia.AimsTo describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables.MethodHistoric prospective study. Standardised assessments of course and outcome.ResultsAbout 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery.ConclusionsA significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains.
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Bainbridge, E., F. Byrne, B. Hallahan, and C. McDonald. "Clinical stability in the community associated with long-term approved leave under the Mental Health Act 2001." Irish Journal of Psychological Medicine 31, no. 2 (May 19, 2014): 143–48. http://dx.doi.org/10.1017/ipm.2014.19.
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IntroductionWe present the case of a 27-year-old man with a background diagnosis of treatment resistant schizophrenia and absent insight who for the last 3 years has been residing in a high support residential setting on approved leave under the Mental Health Act (MHA) 2001. The case demonstrates how this man achieved clinical stability in the community with the assistance of long-term involuntary admission under the MHA 2001, in contrast to the previous years of his illness in which he had suffered multiple relapses of his psychotic illness with ssociated distress, poor self-care and repeated in-patient re-admissions. We discuss the equivalent use of community treatment orders in other jurisdictions and how the judicious use of approved leave under the MHA 2001 may be used as an alternative in Ireland where community treatment orders are not currently available.MethodCase Report.ConclusionThe case report highlights how the use of long-term approved leave under the MHA2001 may be used as alternative in Ireland to mimic CTOs for certain difficult to treat patients with psychotic illness who would benefit from ongoing treatment, but lack capacity to engage in such treatment due to persistent symptoms and lack of insight.
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Mathai, P. John, and P. S. Gopinath. "Deficits of Chronic Schizophrenia in Relation to Long-Term Hospitalisation." British Journal of Psychiatry 148, no. 5 (May 1986): 509–16. http://dx.doi.org/10.1192/bjp.148.5.509.
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Eighty chronic schizophrenic and 16 manic-depressive psychotic patients conforming to Research Diagnostic Criteria were examined in terms of their mental state, cognitive functioning, current behaviour, and neurological status. They comprised out-patients, day-care patients, and long-stay in-patients belonging to two mental hospitals with different social conditions. Assessed deficits were not significantly related to record variables such as age, duration of Illness, duration of hospitalisation, or treatment received. Analysis of the different groups of patients reveals that long-term hospital care has had little effect on the deficits of chronic schizophrenia, and suggests that these are integral features of the disease process.
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Campbell, Linda E., Mary-Claire Hanlon, Cherrie A. Galletly, Carol Harvey, Helen Stain, Martin Cohen, Don van Ravenzwaaij, and Scott Brown. "Severity of illness and adaptive functioning predict quality of care of children among parents with psychosis: A confirmatory factor analysis." Australian & New Zealand Journal of Psychiatry 52, no. 5 (November 4, 2017): 435–45. http://dx.doi.org/10.1177/0004867417731526.
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Objective: Parenthood is central to the personal and social identity of many people. For individuals with psychotic disorders, parenthood is often associated with formidable challenges. We aimed to identify predictors of adequate parenting among parents with psychotic disorders. Methods: Data pertaining to 234 parents with psychotic disorders living with dependent children were extracted from a population-based prevalence study, the 2010 second Australian national survey of psychosis, and analysed using confirmatory factor analysis. Parenting outcome was defined as quality of care of children, based on participant report and interviewer enquiry/exploration, and included level of participation, interest and competence in childcare during the last 12 months. Results: Five hypothesis-driven latent variables were constructed and labelled psychosocial support, illness severity, substance abuse/dependence, adaptive functioning and parenting role. Importantly, 75% of participants were not identified to have any dysfunction in the quality of care provided to their child(ren). Severity of illness and adaptive functioning were reliably associated with quality of childcare. Psychosocial support, substance abuse/dependence and parenting role had an indirect relationship to the outcome variable via their association with either severity of illness and/or adaptive functioning. Conclusion: The majority of parents in the current sample provided adequate parenting. However, greater symptom severity and poorer adaptive functioning ultimately leave parents with significant difficulties and in need of assistance to manage their parenting obligations. As symptoms and functioning can change episodically for people with psychotic illness, provision of targeted and flexible support that can deliver temporary assistance during times of need is necessary. This would maximise the quality of care provided to vulnerable children, with potential long-term benefits.
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Wannan, C. M. J., C. F. Bartholomeusz, V. L. Cropley, T. E. Van Rheenen, A. Panayiotou, W. J. Brewer, T. M. Proffitt, et al. "Deterioration of visuospatial associative memory following a first psychotic episode: a long-term follow-up study." Psychological Medicine 48, no. 1 (June 19, 2017): 132–41. http://dx.doi.org/10.1017/s003329171700157x.
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BackgroundCognitive deficits are a core feature of schizophrenia, and impairments in most domains are thought to be stable over the course of the illness. However, cross-sectional evidence indicates that some areas of cognition, such as visuospatial associative memory, may be preserved in the early stages of psychosis, but become impaired in later established illness stages. This longitudinal study investigated change in visuospatial and verbal associative memory following psychosis onset.MethodsIn total 95 first-episode psychosis (FEP) patients and 63 healthy controls (HC) were assessed on neuropsychological tests at baseline, with 38 FEP and 22 HCs returning for follow-up assessment at 5–11 years. Visuospatial associative memory was assessed using the Cambridge Neuropsychological Test Automated Battery Visuospatial Paired-Associate Learning task, and verbal associative memory was assessed using Verbal Paired Associates subtest of the Wechsler Memory Scale - Revised.ResultsVisuospatial and verbal associative memory at baseline did not differ significantly between FEP patients and HCs. However, over follow-up, visuospatial associative memory deteriorated significantly for the FEP group, relative to healthy individuals. Conversely, verbal associative memory improved to a similar degree observed in HCs. In the FEP cohort, visuospatial (but not verbal) associative memory ability at baseline was associated with functional outcome at follow-up.ConclusionsAreas of cognition that develop prior to psychosis onset, such as visuospatial and verbal associative memory, may be preserved early in the illness. Later deterioration in visuospatial memory ability may relate to progressive structural and functional brain abnormalities that occurs following psychosis onset.
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Gibbons, Pat, Grace Hogan, and Sheila McGauran. "An assessment of the psychoeducational needs of long-term psychiatric patients." Irish Journal of Psychological Medicine 16, no. 3 (September 1999): 104–8. http://dx.doi.org/10.1017/s0790966700005395.
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AbstractObjectives: We aimed to identify which illness related topics were of most interest to chronic psychiatric patients in our catchment area service, and to obtain a baseline measure of the amount of knowledge which patients with schizophrenia had about their illness.Method: Patients attending for a minimum of one year were recruited from the outpatient clinic and day centre. Participants completed three instruments: a brief questionnaire which asked about the details of their diagnosis and drug treatment regimen, the ‘Educational Needs Questionnaire’ (ENQ), and a modified form of the ‘Understanding Schizophrenia Scale’ (USS).Results: Forty-seven patients with a chronic psychotic illness participated in the study. Despite having attended the service for an average of 14 years, the majority of patients were unable to correctly identify their diagnosis. Most patients were able to name the drugs which they had been prescribed; but were not able to describe the dosage of these drugs. According to the ENQ results, patients expressed most interest in learning about general aspects of their illness, such as ‘how to cope with stress’, and less in how to manage specific illness related symptoms. Similarly, schizophrenia patients were found to know more about general aspects of their illness, such as rehabilitation and non-medical aspects of treatment, than about medication.Conclusion: Chronic psychiatric patients, especially those with schizophrenia, have very limited knowledge of their illness and its treatment. The focus of psychoeducation should be extended from insight and compliance to include broader ‘quality of life’ issues which appear to be of more concern to patients themselves. Patient participation in psychoeducation can thus be improved by including topics identified by such instruments as the ENQ. It is encouraging that cognitive deficits and negative symptomatology do not seem to prevent long-term psychiatric patients from benefiting from such inputs.
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Warner, James P., Michael King, Robert Blizard, Zara McClenahan, and Sylvia Tang. "Patient-held shared care records for individuals with mental illness." British Journal of Psychiatry 177, no. 4 (October 2000): 319–24. http://dx.doi.org/10.1192/bjp.177.4.319.
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BackgroundFew formalised shared care schemes exist within psychiatry and the evidence base for sharing psychiatric care is weak.AimsTo evaluate the utility of patient-held shared care records for individuals with long-term mental illness.MethodCluster-randomised controlled parallel-group 12-month trial involving 90 patients with long-term mental illness drawn from 28 general practices.ResultsCarrying a shared care record had no significant effect on mental state or satisfaction with psychiatric services. Compared with controls, patients in the shared care group were no more likely to be admitted (relative risk 1.2, 95% CI 0.86–1.67) and attend clinic (relative risk 0.96, 95% CI 0.67–1.36) over the study period. Uptake of the shared care scheme was low by patients and professionals alike. Subjects with psychotic illness were significantly less likely to use their records (relative risk 0.51, 95% CI 0.27–0.99).ConclusionsPatient-held records may not be helpful for patients with long-term mental illness.
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Beckman, K., E. Mittendorfer-Rutz, P. Lichtenstein, H. Larsson, C. Almqvist, B. Runeson, and M. Dahlin. "Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort." Psychological Medicine 46, no. 16 (September 20, 2016): 3397–405. http://dx.doi.org/10.1017/s0033291716002282.
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BackgroundSelf-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.MethodWe conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.ResultsSelf-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9–20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8–6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7–3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.ConclusionWe found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.
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Nordentoft, M., N. Albert, C. Hjorthoj, H. Jensen, and M. Melau. "Assertive Interventions for First Episode Psychoses: The Danish Experience." European Psychiatry 41, S1 (April 2017): S4. http://dx.doi.org/10.1016/j.eurpsy.2017.01.021.
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Early Intervention services with team-based intensive case management and family involvement are superior to standard treatment in reducing psychotic and negative symptoms and comorbid substance abuse and improving social functioning and user satisfaction. The results of the OPUS-trial will be presented together with meta-analyses based on similar trials. The implementation of OPUS all over Denmark will be presented together with the Danish OPUS-fidelity study. Specialized elements are being are being developed such as inclusion of new methods in CBT for psychotic and negative symptoms, neurocognitive and social cognitive training programs, interventions for supported employment and focus on physical health. Results of long term follow-up studies indicate that the prognosis of first episode psychosis is very diverse with the extremes represented by one group being well functioning and able to quit medication without relapse; and another group having a long term chronic course of illness with a need for support to maintain daily activities. The Danish TAILOR-trial–testing dose reduction versus maintenance therapy will be presented. It will be of immense value to be able to intervene in risk groups identified in the premorbid phase, and there are few examples of ongoing trial for children of parent with schizophrenia and bipolar disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hobbs, Coletta, Christopher Tennant, Alan Rosen, Lesley Newton, Helen M. Lapsley, Kate Tribe, and Judith E. Brown. "Deinstitutionalisation for Long-Term Mental Illness: A 2-Year Clinical Evaluation." Australian & New Zealand Journal of Psychiatry 34, no. 3 (June 2000): 476–83. http://dx.doi.org/10.1080/j.1440-1614.2000.00734.x.
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Objective: The closure of a long-stay psychiatric hospital in Sydney caused the transfer of an initial 40 very long-term patients to four community residences, each with 10 beds, for a continuing process of deinstitutionalisation. Community psychiatric service support and 24-h supervision were provided. This paper describes the residents' clinical progress which was assessed over a 2-year period. Method: This study employed a quasi-experimental longitudinal design. Evaluation commenced prior to discharge and continued for 2 years following community relocation using the Brief Psychiatric Rating Scale, Life Skills Profile, Social Behaviour Scale, Montgomery Asberg Depression Rating Scale and Quality Of Life measures. Readmission, demographic, case history and medication data were also collected. Results: Of the 40 patients initially transferred to the community, seven required long-term readmission to hospital (either prior to or after amalgamation) and one patient died of medical causes. Additional patients transferred from the hospital to the community following the readmissions. Three of these additional patients had achieved a 2-year community tenure during the study period and were included in the clinical evaluation. The 35 residents in total who remained in the community for 2 years, demonstrated a significant improvement in psychotic symptoms, without significant change in the level of neuroleptic medication. Importantly, the 2 years of community living resulted in a significant increase in the residents' life satisfaction. There were no statistically significant changes in residents' living skills, depressive symptoms or social behaviour problems over the 2 years, indicative of the need for supervision and community service support following deinstitutionalisation. Over the 2-year period, some 37% of the residents required temporary readmission. Conclusion: This study demonstrates the clinical effectiveness of deinstitutionalisation, when planned within a mental health system with adequate community resources.
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Salvatore, Paola, Mauricio Tohen, Hari-Mandir Kaur Khalsa, Christopher Baethge, Leonardo Tondo, and Ross J. Baldessarini. "Longitudinal research on bipolar disorders." Epidemiologia e Psichiatria Sociale 16, no. 2 (June 2007): 109–17. http://dx.doi.org/10.1017/s1121189x00004711.
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AbstractLongitudinal assessment of the course of major psychiatric disorders has been advanced by studies from onset, but only rarely have large numbers of patients with a range of psychotic and major affective disorders been studied simultaneously and systematically from illness-onset. The decade-long McLean-Harvard First Episode Project & International Consortium for Bipolar Disorder Research has systematically followed-up large numbers of patients with DSM-IV bipolar or psychotic disorders from first hospitalization. Major findings among patients with bipolar I disorder include: [a] full functional recovery from initial episodes was uncommon, and full symptomatic recovery, much slower than early syndromal recovery; [b] risks of relapse, recurrence, and switching were very high in the first two years; [c] most early morbidity was depressive-dysphoric, as reported in mid-course; [d] initial depression or mixed-states predicted more later depressive and overall morbidity, whereas initial mania or psychosis predicted later mania and a better prognosis; [e] based on within-subject modeling, most patients did not show progressive cycling over time, and illness-course was rather chaotic within and among patients; [f] treatment-latency or episode-counts were unassociated with responsiveness to long-term mood-stabilizing treatment; [g] very high rates of suicidal behavior and accidents occurred early; [h] early substance-use comorbidity associated with anxiety; [i] factor-analysis of prodromal symptoms predicted bipolar disorder much better than non-affective psychotic disorders. Project findings indicate that the course of bipolar I disorder is much less favorable than had been believed formerly, despite clinical treatment with modern mood-stabilizing and other treatments.
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Onwuameze, Obiora E., Susan K. Schultz, and Sergio Paradiso. "An Initial Study of Modifiable and Non-Modifiable Factors for Late-Life Psychosis." International Journal of Psychiatry in Medicine 42, no. 4 (November 2011): 437–51. http://dx.doi.org/10.2190/pm.42.4.g.
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Objective: To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. Method: A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein's Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. Results: There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR=9.12; 95% CI: 1.58–52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR=13.17; 95% CI: 2.10–85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower ( n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). Conclusions: Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.
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Abe, Kazuhiko, and Mikio Ohta. "Recurrent Brief Episodes with Psychotic Features in Adolescence: Periodic Psychosis of Puberty Revisited." British Journal of Psychiatry 167, no. 4 (October 1995): 507–13. http://dx.doi.org/10.1192/bjp.167.4.507.
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BackgroundThere are many reports of adolescents with periodic episodes each followed by complete remission within 2 weeks, but the nosology and long-term prognosis of such cases have not been elucidated.MethodA prospective follow-up study on 11 cases (nine girls and two boys) meeting predetermined criteria is reported.ResultsThe first several episodes were found to meet ICD–10 symptomatic criteria for recurrent depressive disorder in all cases, and, except for two cases, showed psychotic features. The episodes were linked to one phase of the menstrual cycle in only two of six girls with regular menses. There were no recurrences while on lithium in eight of nine cases. Of eight patients followed up 5–14 years after the first onset, three had been well, three had become bipolar and two were still suffering from brief depressive episodes.ConclusionsRecurrent brief episodes in adolescence tend to show a near-monthly rhythm and psychotic features. Most of them appear to be manifestations of affective illness and may be treated and prevented as such.
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Anderson, Karen E., David Stamler, Mat D. Davis, Robert A. Hauser, L. Fredrik Jarskog, Joohi Jimenez-Shahed, Rajeev Kumar, Stanislaw Ochudlo, Joseph McEvoy, and Hubert H. Fernandez. "34 Long-Term Deutetrabenazine Treatment Response in Tardive Dyskinesia by Concomitant Dopamine-Receptor Antagonists and Baseline Comorbidities." CNS Spectrums 24, no. 1 (February 2019): 193. http://dx.doi.org/10.1017/s1092852919000282.
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AbstractBackgroundTardive dyskinesia (TD) results from exposure to dopamine-receptor antagonists (DRAs), such as typical and atypical antipsychotics. Clinicians commonly manage TD by reducing the dose of or stopping the causative agent; however, this may cause psychiatric relapse and worsen quality of life. In the 12-week ARM-TD and AIM-TD trials, deutetrabenazine demonstrated statistically significant improvements in Abnormal Involuntary Movement Scale (AIMS) scores versus placebo and was generally well tolerated, regardless of baseline DRA use or comorbidities.Study ObjectiveTo evaluate the impact of underlying disease and current DRA use on efficacy and safety of long-term therapy of deutetrabenazine in patients with TD.MethodPatients with TD who completed ARM-TD or AIM-TD were eligible to enter this open-label, single-arm, long-term extension after completing the 1-week washout period and final evaluation in the blinded portion of the trial. Change in AIMS scores from baseline to Week 54 and patients “Much Improved” or “Very Much Improved” (treatment success) on the Clinical Global Impression of Change (CGIC) and Patient Global Impression of Change (PGIC) at Week 54 were analyzed by baseline psychiatric illness type, including mood disorders (bipolar disorder/depression/other) or psychotic disorders (schizophrenia/schizoaffective disorder), and presence or absence of current DRA use.ResultsAt Week 54, meaningful improvements from baseline in mean (standard error) AIMS scores were observed for patients with baseline mood disorders (–5.2[0.93]) and psychotic disorders (–5.0[0.63]), and in patients currently using DRAs (–4.6[0.54]) or not using DRAs (–6.4[1.27]). Most patients with mood disorders (73%) and psychotic disorders (71%) were “Much Improved” or “Very Much Improved” on CGIC at Week 54, similar to patients currently using (71%) or not using (74%) DRAs. The majority of patients with mood disorders (62%) and psychotic disorders (57%), as well as patients currently using (58%) or not using (63%) DRAs, were also “Much Improved” or “Very Much Improved” on PGIC at Week 54. Prior treatment in ARM-TD and AIM-TD did not impact the long-term treatment response. Underlying psychiatric disorder and concomitant DRA use did not impact the occurrence of adverse events (AEs). The frequencies of dose reductions, dose suspensions, and withdrawals due to AEs were low, regardless of baseline psychiatric comorbidities and DRAuse.ConclusionsLong-term deutetrabenazine treatment demonstrated meaningful improvements in abnormal movements in TD patients, which were recognized by clinicians and patients, regardless of underlying psychiatric illness or DRAuse.Presented at: American Psychiatric Association Annual Meeting; May 5–9, 2018, New York, New York, USAFunding Acknowledgements: This study was supported by Teva Pharmaceuticals, Petach Tikva, Israel.
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O’Keeffe, Donal, Ailish Hannigan, Roisin Doyle, Anthony Kinsella, Ann Sheridan, Aine Kelly, Kevin Madigan, Elizabeth Lawlor, and Mary Clarke. "The iHOPE-20 study: Relationships between and prospective predictors of remission, clinical recovery, personal recovery and resilience 20 years on from a first episode psychosis." Australian & New Zealand Journal of Psychiatry 53, no. 11 (February 6, 2019): 1080–92. http://dx.doi.org/10.1177/0004867419827648.
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Objective: Knowledge of outcome in psychotic illness is limited by the paucity of very long-term epidemiologically representative studies of incidence first episode psychosis (FEP) cohorts that measure and compare outcomes reflecting modern clinical practice, mental health policy and research agendas. Our study aimed to address this gap. Method: iHOPE-20 is a prospective 20-year follow-up study of a FEP incidence cohort ( N = 171) conducted between 2014 and 2017 in Ireland. Data from previous studies and medical records were used to recruit cohort members. We assessed remission, clinical recovery, personal recovery and resilience at 20 years; explored the relationships between these outcomes and examined the predictive value of baseline characteristics in determining them. Results: At follow-up, 20 out of 171 cohort members (11.70%) were deceased. We assessed 80 out of 151 alive cohort members (53% recruitment rate); 65% were in remission; 35.2% were in Full Functional Recovery and 53.7% confirmed they were fully recovered according to their personal definition of recovery. A complex array of relationships between outcomes was found. Outcomes were better for people who had a short duration of untreated psychosis, displayed higher premorbid social adjustment (between the ages of 5–11) and at baseline, were older, not living alone, in full-time employment, given a non-affective diagnosis, and had lower Global Assessment of Functioning scores. Conclusion: Among participants, full remission of psychotic symptoms and personally defined recovery was not just possible but likely in the very long term. However, attaining positive functional outcomes and building resilience in FEP remain key challenges for mental health services.
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Gauillard, J. "Treating chronically psychotic patients in nursing homes." European Psychiatry 33, S1 (March 2016): S37. http://dx.doi.org/10.1016/j.eurpsy.2016.01.875.
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The increase of aging patients with schizophrenia becomes a public health issue. The exponential demography of the elderly, the improvement of cares associated with better physical follow-up directly impact the number of old patients with chronic psychiatric disease. Deinstitutionalization associated with a dramatic enhancement of ambulatory and community cares has led to a reduction of beds in psychiatric hospitals. When dependency occurs, due to physical comorbid illness or a worsening of the negative symptoms, psychiatric teams should find appropriate housing and no longer the psychiatric hospital. Nursing home and sheltered housing for the elderly dependent persons become a solution, but geriatric staffs are not always prepared to receive resident with schizophrenia and other psychotic disorders. They often are at a loss when faced with the expression of psychiatric symptoms or with the specificity of caring for often-younger patients whose behavior is different from older people with neurodegenerative disorders.How psychiatric teams could long-term assist the sheltered housing and nursing home and bring a psychiatric know-how within staffs often reluctant to deal with psychotic patients who could burden caregivers. How could they be trained to cope with complex cognitive functions impairments of schizophrenia, far from cognitive impairments of Alzheimer dementia? How to change the representation of psychiatric illness, which often leads to a double stigmatization (old age and madness)? Improving the quality of life of aging patients with severe chronic mental illness in homes for seniors is a great challenge for psychiatric teams in collaboration with geriatric caregivers.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Dazzan, Paola, Julia M. Lappin, Margaret Heslin, Kim Donoghue, Ben Lomas, Uli Reininghaus, Adanna Onyejiaka, et al. "Symptom remission at 12-weeks strongly predicts long-term recovery from the first episode of psychosis." Psychological Medicine 50, no. 9 (July 25, 2019): 1452–62. http://dx.doi.org/10.1017/s0033291719001399.
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AbstractBackgroundTo determine the baseline individual characteristics that predicted symptom recovery and functional recovery at 10-years following the first episode of psychosis.MethodsAESOP-10 is a 10-year follow up of an epidemiological, naturalistic population-based cohort of individuals recruited at the time of their first episode of psychosis in two areas in the UK (South East London and Nottingham). Detailed information on demographic, clinical, and social factors was examined to identify which factors predicted symptom and functional remission and recovery over 10-year follow-up. The study included 557 individuals with a first episode psychosis. The main study outcomes were symptom recovery and functional recovery at 10-year follow-up.ResultsAt 10 years, 46.2% (n = 140 of 303) of patients achieved symptom recovery and 40.9% (n = 117) achieved functional recovery. The strongest predictor of symptom recovery at 10 years was symptom remission at 12 weeks (adj OR 4.47; CI 2.60–7.67); followed by a diagnosis of depression with psychotic symptoms (adj OR 2.68; CI 1.02–7.05). Symptom remission at 12 weeks was also a strong predictor of functional recovery at 10 years (adj OR 2.75; CI 1.23–6.11), together with being from Nottingham study centre (adj OR 3.23; CI 1.25–8.30) and having a diagnosis of mania (adj OR 8.17; CI 1.61–41.42).ConclusionsSymptom remission at 12 weeks is an important predictor of both symptom and functional recovery at 10 years, with implications for illness management. The concepts of clinical and functional recovery overlap but should be considered separately.
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Serra, G., A. Koukopoulos, L. De Chiara, A. E. Koukopoulos, G. Sani, L. Tondo, P. Girardi, D. Reginaldi, and R. J. Baldessarini. "Early clinical predictors and correlates of long-term morbidity in bipolar disorder." European Psychiatry 43 (June 2017): 35–43. http://dx.doi.org/10.1016/j.eurpsy.2017.02.480.
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AbstractObjectives:Identifying factors predictive of long-term morbidity should improve clinical planning limiting disability and mortality associated with bipolar disorder (BD).Methods:We analyzed factors associated with total, depressive and mania-related long-term morbidity and their ratio D/M, as %-time ill between a first-lifetime major affective episode and last follow-up of 207 BD subjects. Bivariate comparisons were followed by multivariable linear regression modeling.Results:Total % of months ill during follow-up was greater in 96 BD-II (40.2%) than 111 BD-I subjects (28.4%; P = 0.001). Time in depression averaged 26.1% in BD-II and 14.3% in BD-I, whereas mania-related morbidity was similar in both, averaging 13.9%. Their ratio D/M was 3.7-fold greater in BD-II than BD-I (5.74 vs. 1.96; P < 0.0001). Predictive factors independently associated with total %-time ill were: [a] BD-II diagnosis, [b] longer prodrome from antecedents to first affective episode, and [c] any psychiatric comorbidity. Associated with %-time depressed were: [a] BD-II diagnosis, [b] any antecedent psychiatric syndrome, [c] psychiatric comorbidity, and [d] agitated/psychotic depressive first affective episode. Associated with %-time in mania-like illness were: [a] fewer years ill and [b] (hypo)manic first affective episode. The long-term D/M morbidity ratio was associated with: [a] anxious temperament, [b] depressive first episode, and [c] BD-II diagnosis.Conclusions:Long-term depressive greatly exceeded mania-like morbidity in BD patients. BD-II subjects spent 42% more time ill overall, with a 3.7-times greater D/M morbidity ratio, than BD-I. More time depressed was predicted by agitated/psychotic initial depressive episodes, psychiatric comorbidity, and BD-II diagnosis. Longer prodrome and any antecedent psychiatric syndrome were respectively associated with total and depressive morbidity.
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Porto, Linda, Paul C. Bermanzohn, Simcha Pollack, Richard Morrissey, and Samuel G. Siris. "A Profile of Obsessive-Compulsive Symptoms In Schizophrenia." CNS Spectrums 2, no. 3 (March 1997): 21–25. http://dx.doi.org/10.1017/s1092852900004570.
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AbstractObsessive-compulsive (OC) symptoms and schizophrenia may present, as intertwined phenomena whose relationship remains poorly understood. The purpose of this paper is to provide a detailed phenomenological description of OC symptoms in schizophrenia.Fifty long-term patients with chronic schizophrenia or schizoaffective disorder from a continuing day-treatment program were assessed using the Structured Clinical Interview for DSM-IV and the Yale-Brown Obsessive-Compulsive Scale symptom checklist. Forty-six percent (n=23) reported clinically significant OC symptoms. Twenty-six percent (n=13) met criteria for OCD, from which three subgroups emerged: (1) patients whose OCD was unrelated to their psychotic symptoms, (2) patients whose OCD was related to, but not restricted to, their psychotic symptoms, and (3) patients whose OC symptoms existed on a continuum with their psychosis. The last group tended to incorporate their OC symptoms into delusional beliefs during the active phase of illness and shift to OCD during full or partial remissions. Eight percent met all inclusion criteria for OCD, but their OC symptoms were better accounted for by their psychosis.We conclude that these findings support previous clinical constructs that OCD and schizophrenia are not always dichotomous disorders, but may be interconnected.
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Petersen, Lone, Merete Nordentoft, Pia Jeppesen, Johan ⊘hlenschlæger, Anne Thorup, Torben Østergaard Christensen, Gertrud Krarup, Jytte Dahlstr⊘m, Bodil Haastrup, and Per J⊘rgensen. "Improving 1-year outcome in first-episode psychosis." British Journal of Psychiatry 187, S48 (August 2005): s98—s103. http://dx.doi.org/10.1192/bjp.187.48.s98.
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BackgroundBecause early illness course and outcome may affect the long-term outcome of schizophrenia-spectrum disorders, it is especially important to address poor outcome in this early critical period.AimsTo evaluate whether integrated treatment compared with standard treatment reduced the proportion of patients with poor clinical and social outcome after 1 year.MethodA total of 547 patients with first-episode psychosis were included in the study, 275 randomly assigned to integrated treatment and 272 to standard treatment. Measures assessed psychotic symptoms and social functioning.ResultsThere was a significant beneficial effect of integrated treatment v. standard treatment on ‘any poor outcome’. Integrated treatment had a significantly better effect on ‘any poor outcome’ in patients with schizophrenia compared with patients in standard treatment.ConclusionsThe integrated treatment significantly reduced the proportion of patients with poor clinical and social outcome compared with standard treatment.
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Larson, F. V., J. Whittington, T. Webb, and A. J. Holland. "A longitudinal follow-up study of people with Prader–Willi syndrome with psychosis and those at increased risk of developing psychosis due to genetic subtype." Psychological Medicine 44, no. 11 (December 13, 2013): 2431–35. http://dx.doi.org/10.1017/s0033291713002961.
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BackgroundPeople with Prader–Willi syndrome (PWS), a genetically defined developmental disorder, are at increased risk of developing psychotic illness. This is particularly the case for those with a genetic subtype of PWS called maternal uniparental disomy (mUPD), where rates of psychosis are more than 60% by early adult life. Little is known about the long-term course of their disorder.MethodIndividuals who had had episodes of psychosis or were at increased risk of developing psychosis due to their genetic subtype and had taken part in a previous study were contacted. Ten people were untraceable or deceased, leaving a total of 38 potential participants. Of these, 28 agreed to take part in a follow-up interview or complete a questionnaire about their mental health and medication. This represented 20/35 (57.1%) people from the original study who had had psychosis and 8/13 (61.5%) people who were at risk due to their genetic subtype. They were thought to be representative of those groups as a whole based on IQ and number of episodes of psychosis.ResultsTwo individuals had had recurrent episodes of psychosis while all others remained well. There were no new-onset cases of psychosis in those at risk. Individuals with PWS remained on high levels of psychiatric medication throughout the follow-up period.ConclusionsRecurrent episodes of psychosis may be rare in people with PWS once stability has been achieved in the management of their illness. We speculate that this may be due to the protective influence of medication.
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Crisan, C. A., S. Pintea, I. Miclutia, and R. Macrea. "The predictive role of insight for the evolution of the disease in Romanian patients diagnosed with schizophrenia." European Psychiatry 41, S1 (April 2017): s809. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1565.
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IntroductionSchizophrenia is a serious disorder that influences all life aspects of the patients. The most important goals in schizophrenia are remission, recovery, improving psychosocial functioning and quality of life, which can be influenced by different factors, especially insight.ObjectivesTo evaluate the awareness of illness in Romanian patients diagnosed with schizophrenia and to determine the predictive role of insight.AimsThis study wants to highlight the importance of the evaluation of insight in psychotic patients, taking into account that awareness leads to compliance with treatment, decreased rate of relapses and rehospitalization and a better prognosis.Material and methodsOverall, 80 patients (44 males and 36 females) recruited from first and second psychiatric clinic Cluj-Napoca, diagnosed according to ICD-10 and DSM-V criteria with schizophrenia and acute psychotic disorder participated in this study. A semi-structured interview collected demographical data. Psychotic symptoms were evaluated using PANSS, severity of the disease using CGI and insight using SUMD.ResultsOur results showed that the most important predictive factors for the evolution were: level of insight (r = −0.41 P < 0.01), presence of family history (r = 0.24 P < 0.05) and belonging to urban areas (r = 0.23 P < 0.05). The level of insight explained 16% of variance of improving psychotic symptoms during hospitalization.ConclusionsThe awareness of illness is one of the predictive factors for long-term schizophrenia and the best predictive model of disease progression is composed of variables SUMD total and PANSS total on admission.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Carter, J. W., J. Parnas, A. Urfer-Parnas, J. Watson, and S. A. Mednick. "Intellectual functioning and the long-term course of schizophrenia-spectrum illness." Psychological Medicine 41, no. 6 (September 22, 2010): 1223–37. http://dx.doi.org/10.1017/s0033291710001820.
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BackgroundRecent neurodevelopmental models of schizophrenia, together with substantial evidence of neurocognitive dysfunction among people with schizophrenia, have led to a widespread view that general cognitive deficits are a central aspect of schizophrenic pathology. However, the temporal relationships between intellectual functioning and schizophrenia-spectrum illness remain unclear.MethodLongitudinal data from the Copenhagen High-Risk Project (CHRP) were used to evaluate the importance of intellectual functioning in the prediction of diagnostic and functional outcomes associated with the schizophrenia spectrum. The effect of spectrum illness on intellectual and educational performance was also evaluated. The sample consisted of 311 Danish participants: 99 at low risk, 155 at high risk, and 57 at super-high risk for schizophrenia. Participants were given intellectual [Weschler's Intelligence Scale for Children (WISC)/Weschler's Adult Intelligence Scale (WAIS)] assessments at mean ages of 15 and 24 years, and diagnostic and functional assessments at mean ages 24 and 42 years.ResultsIntellectual functioning was found to have no predictive relationship to later psychosis or spectrum personality, and minimal to no direct relationship to later measures of work/independent living, psychiatric treatment, and overall severity. No decline in intellectual functioning was associated with either psychosis or spectrum personality.ConclusionsThese largely negative findings are discussed in the light of strong predictive relationships existing between genetic risk, diagnosis and functional outcomes. The pattern of predictive relationships suggests that overall cognitive functioning may play less of a role in schizophrenia-spectrum pathology than is widely believed, at least among populations with an evident family history of schizophrenia.
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Chopra, Sidhant, Alex Fornito, Shona M. Francey, Brian O’Donoghue, Vanessa Cropley, Barnaby Nelson, Jessica Graham, et al. "Differentiating the effect of antipsychotic medication and illness on brain volume reductions in first-episode psychosis: A Longitudinal, Randomised, Triple-blind, Placebo-controlled MRI Study." Neuropsychopharmacology 46, no. 8 (February 26, 2021): 1494–501. http://dx.doi.org/10.1038/s41386-021-00980-0.
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AbstractChanges in brain volume are a common finding in Magnetic Resonance Imaging (MRI) studies of people with psychosis and numerous longitudinal studies suggest that volume deficits progress with illness duration. However, a major unresolved question concerns whether these changes are driven by the underlying illness or represent iatrogenic effects of antipsychotic medication. In this study, 62 antipsychotic-naïve patients with first-episode psychosis (FEP) received either a second-generation antipsychotic (risperidone or paliperidone) or a placebo pill over a treatment period of 6 months. Both FEP groups received intensive psychosocial therapy. A healthy control group (n = 27) was also recruited. Structural MRI scans were obtained at baseline, 3 months and 12 months. Our primary aim was to differentiate illness-related brain volume changes from medication-related changes within the first 3 months of treatment. We secondarily investigated long-term effects at the 12-month timepoint. From baseline to 3 months, we observed a significant group x time interaction in the pallidum (p < 0.05 FWE-corrected), such that patients receiving antipsychotic medication showed increased volume, patients on placebo showed decreased volume, and healthy controls showed no change. Across the entire patient sample, a greater increase in pallidal grey matter volume over 3 months was associated with a greater reduction in symptom severity. Our findings indicate that psychotic illness and antipsychotic exposure exert distinct and spatially distributed effects on brain volume. Our results align with prior work in suggesting that the therapeutic efficacy of antipsychotic medications may be primarily mediated through their effects on the basal ganglia.
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Panserga, Ester G., Patricia Wulandari, and Rachmat Hidayat. "Psychotic Symptoms Related Anti NMDA Receptor in Ovarian Teratoma." Scientia Psychiatrica 1, no. 2 (April 13, 2020): 1–8. http://dx.doi.org/10.37275/scipsy.v1i2.6.
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Abstract
Psychotic symptoms related ovarian teratoma are uncommon but has been well known in previous medical literature. Psychotic problems experienced by patients are often mistaken for psychological causes without organic causes, because commonly patients do not show symptoms associated with teratomas. Diagnosis of teratoma-related psychotic illnesses is often delayed due to the nature of the symptoms, that is leading to delayed treatment and worsen long-term neurological outcomes. Neuropsychiatric symptoms in teratoma can occur if it contains brain tissue inside and antibody anti-NMDA (N-methyl-D-Aspartate) receptor. The occurrence of psychotic symptoms in ovarian teratomas is based on cellular mechanisms. Antibodies bind to the NMDA receptor, which leads to the internalization of the cell surface and the relative state of the NMDA receptor hypofunction. While the impact of specific regions and circuit circuits of anti-NMDA receptor antibodies remains to be explored, the mechanism of anti-NMDA receptor encephalitis strengthens the hypothesis that NMDA receptor hypofunction may have a role in schizophrenia and psychosis.
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VILLENEUVE, DAVID B., and VERNON L. QUINSEY. "Predictors of General and Violent Recidivism among Mentally Disordered Inmates." Criminal Justice and Behavior 22, no. 4 (December 1995): 397–410. http://dx.doi.org/10.1177/0093854895022004004.
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One hundred and twenty male inmates who had been released from a maximum-security inpatient psychiatric unit of a federal penitentiary were followed for an average of 92 months. Seventy-eight percent of the sample were arrested for any offense, and 50% were arrested for a violent offense. An actuarial instrument developed using Nuffield's (1982) method correlated .43 with violent recidivism, resulting in 32% relative improvement over chance. The predictors of violent recidivism in this instrument were the following: juvenile delinquency, younger age at release, drugs involved in offenses, violent convictions, separation from parents before age 16, alcohol involved in offenses, criminal versatility, short periods of employment, and no psychotic illness. These results support those of earlier follow-up studies, in particular, the negative association between psychosis and violent recidivism in high-risk samples and the use of actuarial instruments for appraising the long-term risk of violent recidivism.
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JAMES, W., N. J. PRESTON, G. KOH, C. SPENCER, S. R. KISELY, and D. J. CASTLE. "A group intervention which assists patients with dual diagnosis reduce their drug use: a randomized controlled trial." Psychological Medicine 34, no. 6 (August 2004): 983–90. http://dx.doi.org/10.1017/s0033291703001648.
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Background. There is a well-recognized association between substance use and psychotic disorders, sometimes described as ‘dual diagnosis’. The use of substances by people with psychosis has a negative impact in terms of symptoms, longitudinal course of illness and psychosocial adjustment. There are few validated treatments for such individuals, and those that do exist are usually impracticable in routine clinical settings. The present study employs a randomized controlled experimental design to examine the effectiveness of a manualized group-based intervention in helping patients with dual diagnosis reduce their substance use.Method. The active intervention consisted of weekly 90-min sessions over 6 weeks. The manualized intervention was tailored to participants' stage of change and motivations for drug use. The control condition was a single educational session.Results. Sixty-three subjects participated, of whom 58 (92%) completed a 3-month follow-up assessment of psychopathology, medication and substance use. Significant reductions in favour of the treatment condition were observed for psychopathology, chlorpromazine equivalent dose of antipsychotics, alcohol and illicit substance use, severity of dependence and hospitalization.Conclusions. It is possible to reduce substance use in individuals with psychotic disorders, using a targeted group-based approach. This has important implications for clinicians who wish to improve the long-term outcome of their patients.
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Peritogiannis, Vaios, and Panagiota Nikolaou. "Functioning in community-dwelling patients with schizophrenia spectrum disorders in rural Greece." International Journal of Social Psychiatry 66, no. 2 (November 6, 2019): 111–17. http://dx.doi.org/10.1177/0020764019882709.
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Background: There is a dearth of studies on functioning in patients with psychotic disorders in rural areas. Aim: The objective of this study was to assess functioning in a population-based sample of patients with psychotic disorders who live in rural, remote and deprived areas in Greece, and to explore the differences in functioning across ages. Methods: The sample consisted of 61 patients with psychotic disorders that were engaged to treatment with a community mental health service. The mean age of patients was 54.2 years, and the mean illness duration was 26.5 years. Results: A total of 23 patients (37.7%) had score in the Global Assessment of Functioning scale >60, and were rated as adequately functioning, and 18 patients (29.5%) had score in Clinical Global Impression scale-Schizophrenia ⩽3 and could be rated as mildly or minimally ill. Functioning was found to be inversely related to the patients’ symptomatology. No correlation with age was found. Conclusion: This study suggests that a large proportion of patients with psychotic disorders in rural Greece may achieve a satisfactory level of functioning in the long-term, across the whole age range despite the not completely remitted symptomatology. More research is needed to clarify the factors associated with rural residency that may account for patients’ functioning.
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Koponen, H. "Antipsychotic medication and outcomes in schizophrenia from a lifespan perspective." European Psychiatry 33, S1 (March 2016): S34. http://dx.doi.org/10.1016/j.eurpsy.2016.01.867.
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IntroductionAntipsychotic medications play an important role in schizophrenia, and their efficacy in the relapse prevention and treatment of acute psychotic symptoms is clear-cut.ObjectivesData on the long-term use of antipsychotics and impact on prognostic issues is limited, although some previous studies noted a high risk of relapse during the first two years after the first acute psychosis.AimsOur aim was to study the characteristics and clinical course of medicated and unmedicated schizophrenia patients.MethodsThe study population consisted of schizophrenia patients from the Northern Finland 1966 Birth Cohort (n = 70). Use of antipsychotics was examined in the follow-up interview by asking about the subjects’ medication history during the previous three months. The sample was divided into a non-medicated group (n = 24) and a medicated group (n = 46).ResultsRelapses during the follow-up were equally frequent between non-medicated and medicated subjects (47% vs. 53%). Not having been hospitalised during previous five years, but not previous two years, before the interview predicted long-term successful antipsychotic withdrawal without relapse. Fifteen of the subjects in the non-medicated group (63%) and 9 in the medicated group (20%) were in remission.ConclusionsThe present results imply that there are some individuals with schizophrenic psychoses not using antipsychotic medication whose psychotic illness and clinical course are so favourable that they do not necessarily need medication permanently. Changes in the antipsychotic dosing should not be made too fast and the patient and relatives should be able to contact without delay if exacerbation of psychotic symptoms is suspected.Disclosure of interestThe author has not supplied his declaration of competing interest.
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Pelayo-Terán, José María, Virginia Gajardo-Galán, Marcos Gómez-Revuelta, Victor Ortiz-García de la Foz, Rosa Ayesa-Arriola, Rafael Tabarés-Seisdedos, and Benedicto Crespo-Facorro. "Duration of active psychosis and functional outcomes in first-episode non-affective psychosis." European Psychiatry 52 (August 2018): 29–37. http://dx.doi.org/10.1016/j.eurpsy.2018.03.003.
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AbstractBackground:The duration of untreated psychosis (DUP) has been associated with negative outcomes in psychosis; however, few studies have focused on the duration of active psychotic symptoms after commencing treatment (DAT). In this study, we aimed to evaluate the effect of DUP and DAT on functional long-term outcomes (3 years) in patients with early psychosis.Methods:We evaluated the Scale for the Assessment of Positive Symptoms (SAPS) at frequent intervals for 3 years after presentation to determine the DAT for 307 individuals with first-episode psychosis together with DUP and clinical variables. The functional outcomes were assessed using the Disability Assessment Scale (DAS) at three years, and functional recovery was defined as minimal impairment and return to activity. Associated variables, DAT and DUP were included in logistic regression models to predict functional outcomes. Receiver operating characteristic curves and Youden’s index were applied to assess the best cut-off values.Results:DAT, (Wald: 13.974; ExpB: 1.097; p < 0.001), premorbid adjustment, initial BPRS score, gender, age of onset and schizophrenia diagnosis were significant predictors of social functioning, whereas only premorbid adjustment (Wald: 11.383; ExpB:1.009), DAT (Wald: 4.850; ExpB: 1.058; p = 0.028) and education were significant predictors of recovery. The optimal cut-off of DAT for predicting social functioning was 3.17 months for DAT (sensitivity: 0.68; specificity: 0.64; Youden’s index: 0.314).Conclusions:DAT is strongly related to functional outcomes independent of the DUP period or other variables. As a modifiable variable, the reduction of the DAT should be considered a main focus of intervention from the onset of the illness to improve long-term outcomes.