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Brown, Kayla, Laura Corlin, Maureen Dubreuil, Tien Tran, Hannah Brown, and Christina Borba. "M87. PREVALENCE OF AUTOIMMUNE DISEASES IN INDIVIDUALS WITH PRIMARY PSYCHOTIC DISORDERS AT BOSTON MEDICAL CENTER." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S167—S168. http://dx.doi.org/10.1093/schbul/sbaa030.399.
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Abstract Background The prevalence of autoimmune diseases is higher among individuals with psychiatric illnesses than in the general population. It is unknown if the prevalence of autoimmune diseases differs among people with different primary psychotic disorders. Our objective was to assess whether the prevalence of autoimmune diseases differs among people with schizophrenia/schizoaffective disorder, affective (bipolar/depression) psychosis, and other psychotic disorders (delusional, brief psychotic, schizophreniform, or unspecified psychosis). Methods For our cross-sectional study, we used International Classification of Diseases (ICD) codes to identify individuals with primary psychotic disorders/unspecified psychoses who received treatment at Boston Medical Center between October 2003 and May 2019. Individuals with other/unspecified psychosis with an organic cause and individuals with unspecified psychosis, brief psychotic disorder with coinciding drug withdrawal, post-partum psychosis, or drug-induced mental illness, confusion, or seizure were excluded. Autoimmune diseases were categorized as systemic or as one of seven organ-specific subgroups (dermatological, endocrinological, gastroenterological, hematological, non-systemic connective tissue, and neurological). Multivariable logistic regression was used to compare differences in prevalence of autoimmune diseases among individuals with different psychoses adjusting for age, sex, and race. We also considered sex and race-stratified analyses. Results Of the 13,938 individuals (mean age = 43 years; 58% male) diagnosed with psychosis, 55% had schizophrenia, 17% had affective psychosis, and 29% had other/unspecified psychosis. Overall, nearly 9% of individuals with psychosis had at least one autoimmune disease (8% with schizophrenia, 11% with affective psychosis, and 8% with other/unspecified psychosis). The most prevalent autoimmune disease subgroups were systemic (39%), dermatological (26%), and endocrinological (23%). Compared to individuals with schizophrenia, individuals with affective psychosis had increased odds of having any autoimmune disease (OR: 1.38; 95% CI: 1.17, 1.63), dermatological autoimmune diseases (OR: 1.55; 95% CI: 1.15, 2.07), or endocrinological autoimmune diseases (OR: 1.56; 95% CI: 1.14, 2.12). Compared to individuals with schizoaffective as the only psychosis diagnosis, individuals with affective psychosis had increased odds of having any autoimmune disease (OR: 1.31; 95% CI: 1.03, 1.66) and individuals with schizophrenia had decreased odds of having neurological autoimmune diseases (OR: 0.46; 95% CI: 0.23, 0.96). Among individuals with any psychotic disorder, females were 95% more likely to have any autoimmune disease (OR: 1.95; 95% CI: 1.72, 2.20). No racial differences were observed overall; however, compared to individuals who identified as white, individuals who identified as Black, Hispanic, and Asian had decreased odds of having gastroenterological autoimmune diseases (OR: 0.52; 95% CI: 0.35, 0.76), neurological autoimmune diseases (OR: 0.32; 95% CI: 0.10, 0.83), and systemic autoimmune diseases (OR: 0.25; 95% CI: 0.04, 0.80), respectively, while Black individuals had increased odds of having systemic autoimmune diseases (OR: 1.45; 95% CI: 1.17, 1.81). Discussion The prevalence of autoimmune diseases varied among people with different primary psychotic disorders, and certain associations were modified by sex and race. Clinicians may consider additional screening for autoimmune diseases among individuals with psychosis.
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Feinstein, Anthony, George Du Boulay, and Maria A. Ron. "Psychotic Illness in Multiple Sclerosis." British Journal of Psychiatry 161, no. 5 (November 1992): 680–85. http://dx.doi.org/10.1192/bjp.161.5.680.
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Ten patients with multiple sclerosis (MS) and psychosis were assessed using the Present State Examination, and matched retrospectively with respect to age, disability, duration of symptoms, and disease type with 10 MS patients without psychosis. Both groups underwent MRI of the brain. There was a trend for the psychotic group to have a higher total lesion score, particularly around the periventricular areas. This reached statistical significance in the areas around the temporal horn. In all cases, neurological symptoms preceded the onset of psychosis. The psychotic group also had a later age of onset of psychosis than psychotic patients without brain disease. These results point to an aetiological association between the pathological process of MS and psychosis.
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Connors, Michael H., Armando Teixeira-Pinto, and Clement T. Loy. "Psychosis and longitudinal outcomes in Huntington disease: the COHORT Study." Journal of Neurology, Neurosurgery & Psychiatry 91, no. 1 (October 13, 2019): 15–20. http://dx.doi.org/10.1136/jnnp-2019-320646.
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ObjectiveHuntington disease (HD) is an autosomal dominant neurodegenerative disease involving motor disturbances, cognitive decline and psychiatric symptoms. Psychotic symptoms occur in a significant proportion of patients. We sought to characterise the clinical outcomes of this group of patients.MethodsData were drawn from the Cooperative Huntington Observational Research Trial, a prospective, multi-centre observational study. 1082 patients with HD were recruited. Measures of cognition, function, behavioural disturbance and motor function were completed annually over 5 years.ResultsOverall, 190 patients (17.6%) displayed psychotic symptoms. These patients demonstrated worse cognition, function and behavioural disturbances than patients without psychosis over time. Patients with psychosis also demonstrated lower levels of chorea than patients without psychosis, despite adjusting for concurrent antipsychotic and tetrabenazine use.ConclusionsPsychosis in HD is associated with poorer outcomes in cognition, function and behavioural symptoms. Patients with psychotic symptoms may also have less chorea. Altogether, the findings suggest patients with psychosis have a distinct clinical course.
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Feinstein, Anthony, and Maria A. Ron. "Psychosis associated with demonstrable brain disease." Psychological Medicine 20, no. 4 (November 1990): 793–803. http://dx.doi.org/10.1017/s0033291700036485.
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SynopsisSixty-five psychotic patients with unequivocal evidence of brain pathology and a variety of neurological disorders were assessed with respect to phenomenology and outcome. No relationship was found between site of brain pathology and type of psychotic disorder. A majority of patients had a syndrome indistinguishable from schizophrenia without coarse brain involvement and shared similar variables predicting outcome of psychosis, thus raising important issues concerning their nosological status.
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Fontaine, A., and G. Radu. "New Insights in the Pharmacotherapy of Psychosis: The Example of Parkinson's Disease Psychosis." European Psychiatry 41, S1 (April 2017): S650. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1083.
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IntroductionWith 10 million of patients across the world, Parkinson's disease is the second most common form of neurodegeneration, after Alzheimer's. Among half of patients develop psychotic symptoms, such as visual hallucinations and delusions, which are correlated with higher rate of placement in nursing home, are difficult to treat and severely affect quality of life, making Parkinson's disease psychosis (PDP) a major public health issue.ObjectivesThe aim of this study is to identify treatment options that could be used to treat PDP and clarify underlying pathophysiology.MethodWe conducted a literature review on Pubmed, Goggle scholar and Cochrane library, using a combination of the following: “Parkinson's disease Psychosis” “visual hallucinations” “Pimavanserin” “Clozapine” “atypical anti-psychotics” 120 articles were screened.ResultsConsidering that hallucinations arise from overactivation of dopaminergic receptors, treatment options include reducing the dopaminergic drugs used to control motor symptoms; using atypical anti-psychotics such as Risperidone, Olanzapine, Quetiapine, which often results in the worsening of extra-pyramidal symptoms. Another option is the use of low doses of Clozapine, which has been proven efficient with no worsening of non-motor symptoms, suggesting the implication of other pathways, such as serotonin. Finally, Pimavanserin, a 5-HT2A receptor inverse agonist, without any dopaminergic activity, has been demonstrated to be effective in the treatment of PDP, well tolerated and easy to use.ConclusionSerotonin inverse agonists represent a major breakthrough in the pharmacotherapy of PDP, and may lead the way to changes in the treatment of schizophrenia and other psychotic disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Hernández Sánchez, J. M., M. Á. Canseco Navarro, M. Machado Vera, C. Garay Bravo, and D. Peña Serrano. "Late Onset Psychosis. Review." European Psychiatry 33, S1 (March 2016): S530. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1962.
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IntroductionSeveral risk factors make older adults more prone to psychosis. The persistent growth in the elderly population makes important the necessity of accurate diagnosis of psychosis, since this population has special features especially regarding to the pharmacotherapy and side effects.ObjectivesTo review the medical literature related to late-life psychosis.MethodsMedline search and ulterior review of the related literature.ResultsReinhard et al. [1] highlight the fact that up to 60% of patients with late onset psychosis have a secondary psychosis, including: metabolic (electrolite abnormalities, vitamines defficiency…); infections (meningitides, encephalitides…); neurological (dementia, epilepsy…); endocrine (hypoglycemia…); and intoxication. Colijn et al. [2] describe the epidemiological and clinical features of the following disorders: schizophrenia (0.3% lifetime prevalence > 65 years); delusional disorder (0.18% lifetime prevalence); psychotic depression (0.35% lifetime prevalence); schizoaffective disorder (0.32% lifetime prevalence); Alzheimer disease (41.1% prevalence of psychotic symptoms); Parkinson's disease (43% prevalence of psychotic symptoms); Parkinson's disease dementia (89% prevalence of visual hallucinations); Lewy body dementia (up to 78% prevalence of hallucinations) and vascular dementia (variable estimates of psychotic symptoms). Recommendations for treatment include risperidone, olanzapine, quetiapine, aripiprazole, clozapine, donepezil and rivastigmine.ConclusionsDifferential diagnosis is tremendously important in elderly people, as late-life psychosis can be a manifestation of organic disturbances. Mental disorders such as schizophrenia or psychotic depression may have different manifestations in comparison with early onset psychosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Friedman, Joseph H. "Atypical Antipsychotic Drugs in the Treatment of Parkinson’s Disease." Journal of Pharmacy Practice 24, no. 6 (November 17, 2011): 534–40. http://dx.doi.org/10.1177/0897190011426556.
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Parkinson’s disease (PD) patients often develop psychotic symptoms that severely affect quality of life and limit the use of medications to ameliorate motor symptoms. Psychotic symptoms are a major cause for nursing home placement. While these symptoms do not always require treatment, they often do but antipsychotic drugs all share the common pharmacological mechanism of blocking dopamine D2 receptors which may worsen motor problems in this very vulnerable population. Double blind, placebo controlled trials (DBPCT) have shown that clozapine is effective at controlling the psychotic symptoms at doses far below those used in schizophrenia, without worsening motor function, even improving tremor. DBPCT have demonstrated that olanzapine worsens motor function without improving psychosis. Quetiapine has been shown in DBPCT to be free of motor side effects in PD patients but not effective, whereas many open label studies have indicated that quetiapine is effective. The other atypical have been the subjects of conflicting open label reports. The effects of the atypicals in PD psychosis is reviewed.
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Mellers, John D. C., Niall P. Quinn, and Maria A. Ron. "Psychotic and Depressive Symptoms in Parkinson's Disease a Study of the Growth Hormone Response to Apomorphine." British Journal of Psychiatry 167, no. 4 (October 1995): 522–26. http://dx.doi.org/10.1192/bjp.167.4.522.
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BackgroundThe growth hormone (GH) response to apomorphine, thought to reflect central dopaminergic receptor sensitivity, has been reported as enhanced in acute schizophrenia. We investigated this response in relation to the psychotic episodes associated with Parkinson's disease (PD).MethodThe GH response to apomorphine was measured in three groups of patients with Parkinson's disease: those currently psychotic (n = 9), those with a past history of psychosis (n = 7) and those who had never been psychotic (n = 8).ResultsApomorphine-induced GH response was not related to psychosis but was unexpectedly associated with measures of depression.ConclusionsVisual hallucinations were a prominent feature in the psychotic patients and the atypical nature of these psychoses might explain why we found no evidence of dopaminergic sensitivity. Serotonergic dysfunction would be in keeping with this. Dopaminergic mechanisms may contribute to the minor depressive symptomatology seen in PD.
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Ferreira, M. D. C., S. Varanda, G. Carneiro, B. Santos, and Á. Machado. "Parkinson disease psychosis – A case report." European Psychiatry 33, S1 (March 2016): S147. http://dx.doi.org/10.1016/j.eurpsy.2016.01.258.
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IntroductionPsychosis is one of the most prevalent non-motor complications in Parkinson's disease (PD). Risk factors for PD psychosis are advancing age, longer disease duration, severe motor symptoms, presence of dementia, sleep disorders, depression and autonomic dysfunction. Treatment is challenging in this setting because antipsychotic medications are known to worse motor symptoms.ObjectivesTo highlight the therapeutic difficulties in PD-related psychosis.MethodsCase description and literature review.ResultsWe report a case of a 74-year-old woman with a 9-year history of PD, who presented a complex psychotic disorder consisting in auditory, olfactory and visual (gulliverian and lilliputian) hallucinations, persecutory and sexual delusions. Additionally, the patient presented euthymic mood, without evidence of cognitive impairment or impulse-control disorder. These symptoms began after dopamine agonist therapy (ropinirole 4 mg/day). Other medical conditions that could justify these symptoms were excluded. Initially, ropinirole was removed, but without psychotic remission. Then, she was treated with antipsychotic medication (clozapine 25 mg/day) with full psychotic remission and without significant worsening of motor symptoms.ConclusionsClozapine treatment is frequently delayed, mainly for fear of its side effects, particularly agranulocytosis. However, this antipsychotic drug presents many benefits regarding the management of PD-related psychosis, namely few motor effects and even improvement of motor fluctuations.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Barrett, Matthew J., Jamie C. Blair, Scott A. Sperling, Mark E. Smolkin, and T. Jason Druzgal. "Baseline symptoms and basal forebrain volume predict future psychosis in early Parkinson disease." Neurology 90, no. 18 (April 4, 2018): e1618-e1626. http://dx.doi.org/10.1212/wnl.0000000000005421.
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ObjectiveDetermining baseline predictors of future psychosis in Parkinson disease (PD) may identify those at risk for more rapidly progressive disease, i.e., a more malignant PD subtype.MethodsThis cohort study evaluated 423 patients with newly diagnosed PD collected as part of the Parkinson's Progression Markers Initiative. Psychotic symptoms were assessed with the Movement Disorders Society–Unified Parkinson Disease Rating Scale item 1.2, which assesses hallucinations and psychosis over the past week. At baseline, participants completed the Scales for Outcomes in Parkinson's Disease–Autonomic, the REM Sleep Behavior Disorder (RBD) Screening Questionnaire, and the Epworth Sleepiness Scale. Cholinergic nucleus 4 (Ch4) density was calculated for 228 participants with PD and 101 healthy controls.ResultsMultivariate logistic regression adjusted for age and sex found that greater autonomic symptoms (p = 0.002), RBD (p = 0.021), and excessive daytime sleepiness (EDS) (p = 0.003) at baseline were associated with increased risk of reporting psychotic symptoms on ≥2 occasions. Having 2 or 3 of these baseline symptoms was associated with lower Ch4 density (p = 0.007). In a logistic regression model adjusted for age and sex, higher Ch4 gray matter density was associated with lower risk of reporting psychotic symptoms on ≥2 occasions (odds ratio 0.96 [for an increase in density of 1 unit], p = 0.03).ConclusionsThis study confirms that RBD, EDS, and greater autonomic symptom burden are associated with greater risk of future psychotic symptoms in PD. Reduced Ch4 density at baseline is associated with future psychotic symptoms and a greater burden of RBD, EDS, and autonomic symptoms.
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Petrykiv, S., L. de Jonge, and M. Arts. "Parkinson Psychosis: A Complex Interaction of Disease and Medication Related Factors." European Psychiatry 41, S1 (April 2017): S662. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1119.
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IntroductionPsychotic symptoms are the most important non-motoric symptoms of the Parkinson disease (PD). The quality of life of those patients can be significantly improved with an appropriate therapy. In this article we provide evidence about the etiology, differential diagnosis and therapeutic possibilities with a work-up for the clinics.Objectives & aimsTo provide a case report of patient with PD who developed a paranoid psychosis after administration of levodopa/carbidopa, followed by a literature review on psychotic symptoms evoked by psychotropic medication by patients with PD.MethodsAn English-language literature search was conducted using Pubmed, EMBASE searching for case reports and observational studies reporting iatrogenic psychotic symptoms by patients with PD.ResultsMs. C. was a 65-year old woman with PD who was observed in a polyclinic setting and who used a levodopa/carbidopa combination. She developed paranoid psychosis with a following admission to the psychiatric ward. We have gradually lowered the dose of anti-Parkinson medication. Subsequently, treatment with clozapine was initiated and the psychotic symptoms resolved within five months.ConclusionParkinson psychosis is due to a complex interaction of neurodegenerative changes and pharmacological therapy. Therefore, the role of iatrogenic factors must be always carefully assessed. Psychosis inducting agents should be lowered or stopped before the treatment with antipsychotic medication.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Devenney, Emma M., Rebekah M. Ahmed, Jashelle Caga, Elizabeth Highton-Williamson, Eleanor Ramsey, Margaret Zoing, John Hodges, and Matthew Kiernan. "015 Unravelling psychosis in motor neurone disease – a study of clinical features, cognition, and survival." Journal of Neurology, Neurosurgery & Psychiatry 90, e7 (July 2019): A6.1—A6. http://dx.doi.org/10.1136/jnnp-2019-anzan.15.
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IntroductionPsychotic symptoms are now recognised to occur in patients with MND, often in association with FTD, and particularly in C9orf72 expansion carriers. As yet the impact of these symptoms on the clinical disease state is unknown and the relationship between severity and nature of these symptoms is not well understood. This study aimed to comprehensively explore the relationship between psychotic symptoms, clinical features, cognitive status and survival.MethodsIn total 148 participants; MND (n=100) and MND-FTD (n=48), were enrolled in the study. A detailed clinical interview in addition to a neurological, neuropsychological and behavioural assessment, genetic testing and brain MRI was undertaken in each participantResultsPsychotic symptoms were present in 25% of the cohort. The majority of participants in the psychosis cohort were male (83%) and were negative for the C9orf72 expansion (70%). Psychotic symptoms in younger patients were more likely to be florid, require medication and delay diagnosis. Within the MND subgroup, patients with psychotic symptoms were more impaired in the cognitive subdomains of attention, memory and executive functioning and exhibited more disinhibition, apathy and stereotypy, than patients without psychotic symptoms (all p<0.01), but no differences were identified for the MND-FTD subgroup (all p>0.2). Symptoms of depression were more common in those without psychotic symptoms (p>0.1). Survival was prolonged for patients with psychotic symptoms (HR=4.7, 95% CI: 2.1–10, p<0.001)ConclusionMND with psychosis represents a distinct clinical, cognitive and behavioural phenotype that has a positive impact on survival and may represent an overlap with psychiatric disorders.
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McDonnell, Tara Muire, Michael Lockhart, Carmel Kennedy, Leanne Cussen, Graham Roberts, Diarmuid Smith, Mohsen Javadpour, and Amar Agha. "Cushing’s Disease Presenting With Severe Weight Loss, Anorexia and Refractory Psychotic Depression." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A580. http://dx.doi.org/10.1210/jendso/bvab048.1183.
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Abstract Introduction: In this paper we report an unusual case of Cushing’s disease presenting with psychotic depression, paranoia, anorexia leading to severe weight loss culminating in 18% of her body weight. Case: A 22 year old female admitted with first episode psychosis to her local hospital displaying psychotic depressive symptoms, low mood, severe anorexia and mood congruent delusions regarding food contamination. Clinical manifestations of Cushing’s were recognised: cushingoid facies, facial plethora, hirsutism with striae and proximal myopathy. The degree of weight loss (70kg to 57kg) and paranoid ideation surrounding food necessitated caloric supplementation parenterally. Laboratory indices notable for hypokalaemia of 2.7nmol/l, male range testosterone level of 10.7nmol/l, DHEAS>27.1umol and suppressed gonadotrophins. Urine Free Cortisol was >25 times normal. Late night salivary cortisol was 13.4nmol/L(<2.6nmol/L). ACTH was raised at 74.0pg/ml in keeping ACTH dependent Cushing’s. MRI pituitary showed a bulky pituitary. CRF testing and Inferior Petrosal Sinus Sampling both indicated pituitary dependent Cushing’s disease. Following Metyrapone therapy and nutritional treatment the patient condition improved. She proceeded to transphenoidal pituitary exploration. Intraoperatively a very soft central lesion was excised and neuropathology confirmed a corticotroph adenoma. Post-operative morning cortisol at day 3 was 31nmol/l indicating early remission. 3 months post-operative there was remarkable improvement in mood, weight, cessation of anti-psychotics with normal diet and return of menses. She remained severely hypocortisolaemic 6 months post-op Conclusion: Cushing’s disease may present with severe psychiatric manifestation and significant weight loss. Clinicians need to be vigilant of psychosis as the primary presentation of Cushing’s disease.
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Chen, Jack J. "Treatment of psychotic symptoms in patients with Parkinson disease." Mental Health Clinician 7, no. 6 (November 1, 2017): 262–70. http://dx.doi.org/10.9740/mhc.2017.11.262.
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Abstract Persistent psychotic symptoms will develop in up to 60% of patients with Parkinson disease (PD). The initial approach to the management of PD psychosis (PDP) begins with addressing concurrent systemic conditions associated with psychotic behavior, such as delirium, medical conditions (eg, infections), psychiatric disorders (eg, major depression with psychotic symptoms, mania, schizophrenia), and substance misuse or withdrawal. A review of current medications is recommended, and medications that may trigger psychotic symptoms should be eliminated. If possible, antiparkinson medications should be reduced to the minimum therapeutic dose or discontinued in a sequential manner. Generally, dose reduction or discontinuation of anticholinergics is attempted first, followed by that of monoamine oxidase B inhibitors, amantadine, dopamine agonists, catechol-O-methyltransferase inhibitors, and lastly carbidopa/levodopa. The aim of antiparkinson medication dose reduction is to achieve a balance between improving drug-related psychotic symptoms and not significantly worsening the motor symptoms of PD. If additional measures are needed for chronic PDP treatment, the use of second-generation antipsychotics, such as clozapine, pimavanserin, or quetiapine, must be considered. The first-generation antipsychotics (eg, fluphenazine, haloperidol) are not recommended. In the patient with comorbid dementia, the addition of a cholinesterase inhibitor might also be beneficial for PDP. The choice of agent is based on patient-specific parameters, potential benefit, and side effects.
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Irwin, Rosie, Pete M. Ellis, and John Delahunt. "Psychosis following Acute Alteration of Thyroid Status." Australian & New Zealand Journal of Psychiatry 31, no. 5 (October 1997): 762–64. http://dx.doi.org/10.3109/00048679709062692.
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Objective: Mania with psychotic features presenting following abrupt normalisation of thyroid function from severe Graves's disease is reported. Clinical picture: A 33-year-old man with severe, untreated Graves's disease was treated aggressively, with rapid restoration of normal serum thyroid hormone levels. Symptoms of mania and psychosis then developed. Treatment: Time limited anti psychotic medication and continuing medical treatment. Outcome: There was resolution of psychiatric symptoms. Conclusions: The association of mania and psychosis with thyroid disease is rare, but aggressive medical treatment and rapid restoration of normal serum thyroid levels may increase the risk of the emergence of such symptoms.
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Lenka, Abhishek, Javier Pagonabarraga, Pramod Kumar Pal, Helena Bejr-Kasem, and Jaime Kulisvesky. "Minor hallucinations in Parkinson disease." Neurology 93, no. 6 (July 9, 2019): 259–66. http://dx.doi.org/10.1212/wnl.0000000000007913.
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ObjectivePsychosis is one of the most debilitating complications of Parkinson disease (PD). Although research on PD psychosis has been focused on the study of well-structured visual hallucinations (VH), currently accepted National Institute of Neurological Disorders and Stroke–National Institute of Mental Health diagnostic criteria emphasize minor hallucinations (MH) as the most common psychotic phenomena in PD. The objective of this review is to comprehensively describe the clinical and research advances on the understanding of MH and to provide future directions for obtaining further insights into their potential major implications for PD management and prognosis.MethodsA PubMed search was done in November 2018 to identify articles on minor psychotic phenomena in PD.ResultsMH often precede the onset of well-structured VH and are associated with other nonmotor symptoms such as REM sleep behavior disorder and depression. The pattern of functional brain connectivity changes associated with MH involve visual-processing areas and attention control networks, which overlap with abnormalities described in patients with well-structured VH. The dysfunction of cortical networks in patients with MH may be an early indicator of a more widespread form of the disease.ConclusionAlthough called “minor,” MH may have major clinical and prognostic implications. Further research is needed to establish whether MH are associated with a higher risk of disabling psychotic complications, cognitive deterioration, or a more accelerated disease progression. Understanding the early neurobiological underpinnings of MH may provide the background for future studies to identify the progressive dysfunction of neural circuits leading to more severe forms of psychosis in PD.
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Andrade, F., A. S. Machado, A. Vieira, and A. Silva. "Bipolar mania with psychosis vs without psychosis: A clinical characterization with indirect measures of severity." European Psychiatry 64, S1 (April 2021): S82—S83. http://dx.doi.org/10.1192/j.eurpsy.2021.247.
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IntroductionThe presence of psychotic symptoms is highest during acute episodes of bipolar mania. There is no evidence base regarding the implications of psychosis in the prognosis of bipolar disorder, despite common assumption that their occurrence reflects greater disease severity.ObjectivesWe aim to compare sociodemographic and clinical characteristics of inpatients admitted for bipolar mania with and without psychotic features.MethodsRetrospective observational study of inpatients admitted between January 1st 2017 and 31 October 2020 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.ResultsBetween 2017 and October 2020 there were 103 admissions due to mania bipolar I disorder, 53.4% (n=55) with psychotic symptoms. When compared with mania without psychosis, psychotic mania was associated to male gender (71.1% to 39.7%; c2(1, N = 103) = 10,06; p = 0.02) and younger age (t(103) = -2.43; p = 0.017). The proportion of compulsory admissions and average length of stay were similar between mania with psychosis and mania without psychosis. Also, having a manic bipolar episode with psychotic symptoms was not associated to being prescribed a long-acting injectable antipsychotic.ConclusionsThe presence of psychotic symptoms in bipolar manic episodes were associated to male gender and younger age but not to indirect measures of illness severity.DisclosureNo significant relationships.
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Chendo, Ines, Carlos Silva, Gonçalo S. Duarte, Luisa Prada, Valerie Voon, and Joaquim J. Ferreira. "Frequency and Characteristics of Psychosis in Parkinson’s Disease: A Systematic Review and Meta-Analysis." Journal of Parkinson's Disease 12, no. 1 (January 21, 2022): 85–94. http://dx.doi.org/10.3233/jpd-212930.
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Background: Psychotic symptoms are highly frequent in Parkinson’s disease (PD) patients and are associated with poor prognosis. They include hallucinations, delusions, and minor psychotic phenomena, including sense of presence, passage hallucinations, and illusions. Objective: To evaluate the frequency of psychosis in PD patients. Methods: A systematic review and meta-analysis of clinical trials, prospective and retrospective cohort studies, case-control studies, and cross-sectional studies reporting the frequency of psychosis, hallucinations, and delusions in PD. Results: Electronic database search wielded 3536 articles, an additional 91 were identified through citation chaining. Of these, 163 were fully inspected, 57 removed, and 106 included as relevant for neuropsychiatric events frequency, with 32 meeting our inclusion criteria (psychosis and/or specific psychotic phenomena). The pooled frequency of psychosis was 20.7% (95% CI 14.5 to 28.6; I2 = 94%, 15 studies; combined n = 2919). None of the pre-defined meta-regressions or subgroup analyses were statistically significant or helped explain the statistical heterogeneity. The pooled frequency of any form of hallucination was 21.6% (95% CI 14.7 to 30.6; I2 = 95%; 18 studies; combined n = 3161). Duration of PD at baseline and mean baseline Hoehn & Yahr stage helped explain the statistical heterogeneity in the meta-analysis of hallucinations. Conclusion: Based on the available evidence, around a fifth of PD patients experience psychosis or hallucinations. The risk of developing hallucinations is likely moderated by the disease duration, Hoehn & Yahr stage, and the cognitive status.
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Wilkosz, Patricia A., Howard J. Seltman, Bernie Devlin, Elise A. Weamer, Oscar L. Lopez, Steven T. DeKosky, and Robert A. Sweet. "Trajectories of cognitive decline in Alzheimer's disease." International Psychogeriatrics 22, no. 2 (September 28, 2009): 281–90. http://dx.doi.org/10.1017/s1041610209991001.
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ABSTRACTBackground: Late-onset Alzheimer disease (LOAD) is a clinically heterogeneous complex disease defined by progressively disabling cognitive impairment. Psychotic symptoms which affect approximately one-half of LOAD subjects have been associated with more rapid cognitive decline. However, the variety of cognitive trajectories in LOAD, and their correlates, have not been well defined. We therefore used latent class modeling to characterize trajectories of cognitive and behavioral decline in a cohort of AD subjects.Methods: 201 Caucasian subjects with possible or probable Alzheimer's disease (AD) were evaluated for cognitive and psychotic symptoms at regular intervals for up to 13.5 years. Cognitive symptoms were evaluated serially with the Mini-mental State Examination (MMSE), and psychotic symptoms were rated using the CERAD behavioral rating scale (CBRS). Analyses undertaken were latent class mixture models of quadratic trajectories including a random intercept with initial MMSE score, age, gender, education, and APOE ϵ4 count modeled as concomitant variables. In a secondary analysis, psychosis status was also included.Results: AD subjects showed six trajectories with significantly different courses and rates of cognitive decline. The concomitant variables included in the best latent class trajectory model were initial MMSE and age. Greater burden of psychotic symptoms increased the probability of following a trajectory of more rapid cognitive decline in all age and initial MMSE groups. APOE ϵ4 was not associated with any trajectory.Conclusion: Trajectory modeling of longitudinal cognitive and behavioral data may provide enhanced resolution of phenotypic variation in AD.
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Knolle, Franziska, Sara Garofalo, Roberto Viviani, Anna Ermakova, and Graham Murray. "M145. ALTERED SUBCORTICAL EMOTIONAL SALIENCE PROCESSING AND A ‘JUMPING TO CONCLUSIONS’ BIAS IN PARKINSON’S PATIENTS WITH PSYCHOTIC SYMPTOMS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S190—S191. http://dx.doi.org/10.1093/schbul/sbaa030.457.
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Abstract Background Current research does not provide a clear explanation for why some patients with Parkinson’s Disease (PD) develop psychotic symptoms. In schizophrenia research the ‘aberrant salience hypothesis’ of psychosis has been influential in explaining the development of psychotic symptoms. The theory proposes that dopaminergic dysregulation leads to inappropriate attribution of salience to otherwise irrelevant or non-informative stimuli, facilitating the formation of hallucinations and delusions, by providing irrational explanations. However, this theory has received very limited attention in the context of PD-psychosis. Methods In the study, we investigated salience processing in 14 PD-patients with psychotic symptoms, 23 PD-patients without psychotic symptoms and 19 healthy controls. All patients received dopaminergic medication. There was no difference in the medication dose between the two patient groups. We examined emotional salience using a visual oddball fMRI paradigm that has been used to investigate early stages of schizophrenia spectrum psychosis, controlling for resting cerebral blood flow (arterial spin labelling fMRI). Furthermore, a subgroup of the two patient groups complete a behavioural ‘jumping to conclusions’ task. Results We found significant differences in brain responses to emotional salience between the two patient groups. PD-patients with psychotic symptoms revealed enhanced brain responses in the striatum, the hippocampus and the amygdala compared to patients without psychotic symptoms. PD-patients with psychotic symptoms showed significant correlations between the levels of dopaminergic drugs they were taking and BOLD signalling, as well as psychotic symptom scores. Furthermore, our data provide first indications for dysfunctional top-down processes, measured in a ‘jumping to conclusions’ bias. Discussion Our study suggests that enhanced signalling in the striatum, hippocampus and amygdala together with deficient top-down cognitive regulations is associated with the development of psychotic symptoms in PD, similarly to that proposed in the ‘aberrant salience hypothesis’ of psychosis in schizophrenia.
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Baker, Justin T., Daniel G. Dillon, Lauren M. Patrick, Joshua L. Roffman, Roscoe O. Brady, Diego A. Pizzagalli, Dost Öngür, and Avram J. Holmes. "Functional connectomics of affective and psychotic pathology." Proceedings of the National Academy of Sciences 116, no. 18 (April 15, 2019): 9050–59. http://dx.doi.org/10.1073/pnas.1820780116.
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Converging evidence indicates that groups of patients with nominally distinct psychiatric diagnoses are not separated by sharp or discontinuous neurobiological boundaries. In healthy populations, individual differences in behavior are reflected in variability across the collective set of functional brain connections (functional connectome). These data suggest that the spectra of transdiagnostic symptom profiles observed in psychiatric patients may map onto detectable patterns of network function. To examine the manner through which neurobiological variation might underlie clinical presentation, we obtained fMRI data from over 1,000 individuals, including 210 diagnosed with a primary psychotic disorder or affective psychosis (bipolar disorder with psychosis and schizophrenia or schizoaffective disorder), 192 presenting with a primary affective disorder without psychosis (unipolar depression, bipolar disorder without psychosis), and 608 demographically matched healthy comparison participants recruited through a large-scale study of brain imaging and genetics. Here, we examine variation in functional connectomes across psychiatric diagnoses, finding striking evidence for disease connectomic “fingerprints” that are commonly disrupted across distinct forms of pathology and appear to scale as a function of illness severity. The presence of affective and psychotic illnesses was associated with graded disruptions in frontoparietal network connectivity (encompassing aspects of dorsolateral prefrontal, dorsomedial prefrontal, lateral parietal, and posterior temporal cortices). Conversely, other properties of network connectivity, including default network integrity, were preferentially disrupted in patients with psychotic illness, but not patients without psychotic symptoms. This work allows us to establish key biological and clinical features of the functional connectomes of severe mental disease.
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PAULSEN, JANE S., REBECCA E. READY, JULIE C. STOUT, DAVID P. SALMON, LEON J. THAL, IGOR GRANT, and DILIP V. JESTE. "Neurobehaviors and psychotic symptoms in Alzheimer's disease." Journal of the International Neuropsychological Society 6, no. 7 (November 2000): 815–20. http://dx.doi.org/10.1017/s1355617700677081.
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Psychotic symptoms are common in Alzheimer's disease (AD) and clinicoanatomical and neuropsychological evidence indicate an association between these symptoms and frontal lobe dysfunction. Neurobehaviors associated with frontal dysfunction were assessed in Alzheimer's disease (AD) patients with (n = 20) and without psychotic symptoms (n = 21) matched for mean age, education, gender, and dementia severity. The Frontal Lobe Personality Scale (FLOPs) was completed by patient caregivers to measure behaviors typically associated with frontal dysfunction. Findings indicated that AD patients with psychotic symptoms exhibited significantly greater neurobehavioral dysfunction (FLOPs M = 130.69, SD = 24.70) than AD patients without psychotic symptoms (FLOPs M = 111.10, SD = 25.83). Subscale analyses indicated that psychotic AD patients were more disinhibited (M = 28.28, SD = 7.54) than patients without psychotic symptoms (M = 20.92, SD = 4.9). Findings are consistent with and contribute to previous neuropsychological and clinicoanatomical research suggesting increased frontal dysfunction in AD with psychotic symptoms and lend additional empirical support to subtyping AD based on the presence of psychotic symptoms. Furthermore, findings provide preliminary evidence indicating which specific type of neurobehavioral abnormalities are related to the presence of distressing psychotic symptoms. (JINS, 2000, 6, 815–820.)
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Divac, Nevena, Radan Stojanović, Katarina Savić Vujović, Branislava Medić, Aleksandar Damjanović, and Milica Prostran. "The Efficacy and Safety of Antipsychotic Medications in the Treatment of Psychosis in Patients with Parkinson’s Disease." Behavioural Neurology 2016 (2016): 1–6. http://dx.doi.org/10.1155/2016/4938154.
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Psychotic symptoms are present in up to 50% of patients with Parkinson’s disease. These symptoms have detrimental effects on patients’ and caregivers’ quality of life and may predict mortality. The pathogenesis of psychotic symptoms in Parkinson’s disease is complex, but the use of dopaminergic medications is one of the risk factors. The treatment of psychotic symptoms in Parkinson’s disease is complicated due to the ability of antipsychotic medications to worsen motor symptoms. The efficacy of clozapine in the treatment of psychosis in patients with Parkinson’s disease has been confirmed in several clinical trials; however, the adverse effects and the necessity of blood count monitoring are the reasons why the use of this drug is challenging. The studies on safety and efficacy of other antipsychotics conflicting results. The use of antipsychotics in these patients is also associated with increased mortality. Psychotic symptoms in Parkinson’s diseaseper seare also proven predictors of mortality. Thus it is necessary to treat psychotic symptoms but the choice of an antipsychotic should be based on careful risk/benefit assessment. Pimavanserin as a novel therapeutic option with more favorable adverse effects profile is now available for this indication, but careful postmarketing monitoring is necessary to establish the true picture of this drug’s long-term safety and efficacy.
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Pahwa, Rajesh, and Kelly E. Lyons. "A New Perspective in the Treatment of Parkinson’s Disease Psychosis." US Neurology 12, no. 02 (2016): 93. http://dx.doi.org/10.17925/usn.2016.12.02.93.
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Neuropsychiatric symptoms, such as psychosis, are well described in Parkinson’s disease (PD); most appear to be due to disease pathology with exacerbation caused by dopaminergic treatment. More than 50% of patients with PD develop psychosis at some point throughout their disease course. Clinicians need to routinely assess patients with PD for psychotic symptoms, particularly hallucinations. Treatment of psychotic symptoms in PD is an unmet need as there are currently no US Food and Drug Administration (FDA) approved medications specifically for PD psychosis (PDP). Current treatments for PDP have been adapted from dopamine antagonists used to treat psychosis in other conditions, such as schizophrenia. Typical antipsychotics, as well as some atypical antipsychotics, worsen PD motor symptoms due to blockade of dopamine D2 receptors. Quetiapine and clozapine have been studied in PDP and are the most commonly used treatments for PDP. Clozapine has been shown to be effective; however, regular bloodwork is required, while data for quetiapine are inconsistent. Pimavanserin, a highly selective serotonin (5HT2A subtype) receptor inverse agonist, is not associated with motor worsening in PDP patients due to the absence of dopamine blockade. In a double-blind, placebo-controlled study, pimavanserin showed significant improvement in moderate to severe psychosis compared to placebo, with good tolerability and without worsening of PD motor symptoms. These data suggest that pimavanserin is a safe and efficacious treatment for PDP psychosis and could be a potential new treatment option for PDP.
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Vilella Martín, C., P. García Vázquez, Y. Barrera García, P. Fernández Perea, M. Á. Heredero Sanz, A. Serrano García, R. Gómez Martínez, and C. Franch Pato. "Psychosis as alzheimer disease debut: a case report." European Psychiatry 65, S1 (June 2022): S883. http://dx.doi.org/10.1192/j.eurpsy.2022.2293.
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Introduction Psychosis in Alzheimer’s disease has an incidence of ˜ 10% per year. Recent work has focused on the presence of psychosis in people with mild cognitive impairment, as a risk factor for the development of Alzheimer’s disease. Objectives To Study a case of Alzheimer’s disease presenting psychotic symptoms Methods Retrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology. Results A 40-year-old goes to the emergency room due to hetero-aggression at home. He says that his father steals his money and prostitues have been hired in his house. The patient is oriented, partially collaborative and approachable. Psychomotor restlessness is observed. He has self-referral delusions, auditory hallucinations and insomnia. Provisional diagnosis of acute psychotic episode made and low dose risperidone was prescribed. During his stay on the hospital Ward, sedation, recent memory alterations, spatio-temporal disorientation lack of initiative and disorganized behaviors appear. Risperidone is withdrawn and complementary test are performed. Imaging tests show temporal and frontal atrophy. Increased TAU protein and low levels of amyloid in CSF are found. Brain biopsy is +. His mother died of Alzheimer’s disease with 36 years-old and another affected brother with 42 yeras-old. The definitive diagnosis is Alzheimer’s disease and genetic studies are currently being carried out. Conclusions Alzheimer’s disease can debut with psychosis. It is important to investigate family history of patients who begin with memory loss in the context of psychosis Disclosure No significant relationships.
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Miruna, Milin, Lăzărescu M, Racolţa Anca, Silvoșeanu C, and Bredicean Cristina. "A Comparative Study of Affective Bipolar Disorder with Schizoaffective Disorder from a Longitudinal Perspective." Acta Medica Marisiensis 59, no. 4 (August 1, 2013): 219–22. http://dx.doi.org/10.2478/amma-2013-0051.
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Abstract Introduction: In the last years there is a great interest for the theory of the “psychotic continuum”, which accepts that there is a transition between schizophrenia and affective pathology, including bipolar disorder with psychotic interferences and the recently introduced diagnosis of schizoaffective disorder. There are few studies that analyze bipolar disorder with mood-incongruent psychosis. The purpose of this study was to observe the way in which the interference of mood-incongruent psychotic symptoms can influence the long term evolution of patients diagnosed with bipolar disorder and the similarities that exists between this type of pathology and schizoaffective disorder. Material and methods: Sixty subjects were selected, who are now diagnosed with schizoaffective disorder and bipolar disorder, with and without psychotic features. All cases have at least 15 years of evolution since the first episode of psychosis and were analyzed in term of their age of onset and longitudinal evolution. Results: The results showed that bipolar patients who had mood incongruent psychotic symptoms had an earlier age of onset and a higher rate of hospitalizations in their long term evolution compared to bipolar patients without psychotic features, which brings them closer to patients with schizoaffective disorder in term of their pattern of evolution. Conclusions: This study has demonstrated that the interference of mood-incongruent psychosis with bipolar disorder determines a worse prognosis of this disease, very similar with the evolution of patients with schizoaffective disorder
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Gordillo Montaño, M. J., S. Ramos Perdigues, C. Merino del Villar, C. Caballero Roy, S. Latorre, M. Guisado Rico, A. Bravo Romero, S. V. Boned Torres, and M. de Amuedo Rincon. "Confusion between symptom and disease. Parkinson vs meningioma." European Psychiatry 41, S1 (April 2017): s493. http://dx.doi.org/10.1016/j.eurpsy.2017.01.605.
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IntroductionParkinson's disease is caused by decreased dopaminergic neurons of the substantia nigra. Psychosis occurs between 20 and 40% of patients with Parkinson's disease. Dopaminergic drugs act as aggravating or precipitating factor. Before the introduction of levodopa patients had described visual hallucinations but the frequency was below 5%.ObjectiveIllustrated importance of treatment, reassessment after its introduction and refractoriness to answer; as well as the importance of a differential diagnosis at the onset of psychotic symptoms later in life.MethodClinical case: female patient 75 years tracking Neurology by parkinsonism in relation to possible early Parkinson disease. She was prescribed rasagiline treatment. Begins to present visual and auditory hallucinations, delusional self-referential and injury. She had no previous psychiatric history. She went on several occasions to the emergency room, where the anti-Parkinson treatment is decreased to the withdrawal point and scheduled antipsychotics did not answer. Doses of antipsychotics are increased despite which symptoms persist and even increase psychotic symptoms. In this situation it is agreed to extend the study. Subsequently an NMR of the skull where the image is suggestive of a right occipital meningioma appears.Results/conclusionsWith the emergence of psychotic symptoms later in life it will be important to ask a broad differential diagnosis, since in a large number of cases will be secondary to somatic or to drug therapies.Parkinsonism can be a symptom of occipital meningioma, presenting in the psychotic clinic. Refractoriness, on one hand to the suspension of treatment for Parkinson's disease, such as poor response to antipsychotics, did extend the study, which ultimately gave us the diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Almeida, Osvaldo P., Andrew H. Ford, Graeme J. Hankey, Bu B. Yeap, Jonathan Golledge, and Leon Flicker. "Risk of dementia associated with psychotic disorders in later life: the health in men study (HIMS)." Psychological Medicine 49, no. 2 (March 22, 2018): 232–42. http://dx.doi.org/10.1017/s003329171800065x.
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AbstractBackgroundRecent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life.MethodsProspective cohort study of a community-representative sample of 37 770 men aged 65–85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk.ResultsA total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30–3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available.ConclusionOlder men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.
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Campos Mangas, M. C., and M. A. Ruiz Feliu. "Early intervention program for psychosis: Experience and results in a mental health center." European Psychiatry 26, S2 (March 2011): 1163. http://dx.doi.org/10.1016/s0924-9338(11)72868-1.
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IntroductionThis program aims to assist young people aged 16 to 35 years at risk for or who have a severe mental disorder, a psychosis both affected and unaffected, according to the principles of early intervention and assertive community treatment.ObjectivesAssisting young people with psychosis in order to achieve symptomatic and functional recovery, return to provide standardized environment and prevent deterioration.MethodsInitial assessment is made and individualized plan of work.Inclusion criteria1.Diagnosis: substance-induced psychotic disorder, schizophrenia and other psychotic disorders, bipolar disorder and mood disorders with psychotic symptoms2.age: 16–35 years3.Informed consentEvaluation ToolsPANSS, SCIP, CDS, CGI-S, PAS, CAN, EU, SFS, GAF, WHOQUOL-BREF, IEQ-EU, UKU, HoNOS, CGI-IP, CGI-ICResultsThe sample consisted of 22 patients. 45.5% men and 54.5% women. Mean age 24 (SD = 4.74). Diagnosis: schizophrenia 54.5%, 27.3% acute psychotic disorder, 4.5% and 13.6% schizoaffective disorder manic episode with psychotic symptoms. Clinical stage at the beginning of the program: 45.5% stage 2, 4.5% stage 3a; 22.7% stage 3b, 3c stage 22.7% and 4.5% stage 4.ConclusionsIt is necessary to implement such programs to establish the treatment as soon as possible to the onset of the disease and improve prognosis.
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Manea, M., V. Rusanu, B. E. Patrichi, R. M. Stoean, M. M. Cristina, S. M. Bectas, and A. A. Frunza. "Psychotic disorder after radioactive iodine treatment in a 42-year-old woman thyroidectomized for papillary thyroid carcinoma: case report." European Psychiatry 26, S2 (March 2011): 1733. http://dx.doi.org/10.1016/s0924-9338(11)73437-x.
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IntroductionReports in the medical literature describe several cases of acute onset psychosis as a result of hypothyroidism, and a small number related to radioactive iodine treatment (RAIT). The effectiveness of RAIT in the therapy of differentiated thyroid cancer depends on a sufficient TSH level elevation obtained by discontinuing thyroid hormone replacement therapy.ObjectivesDescribing a case of new-onset psychotic disorder in a 42-year-old woman following a RAIT session, one year after total thyroidectomy for papillary thyroid carcinoma developed on multinodular goiter.AimsIdentifying a relation between the psychosis onset and the therapeutic protocol the patient underwent for the thyroid disease treatment.MethodsWe present the case of a patient with a medical history of thyroid disease, secondary posttraumatic epilepsy and minor thalassemia; the clinical and paraclinical evaluations; the psychiatric presentation, treatment and evolution.ResultsThe overt psychotic symptomatology developed in this case a few days after RAIT and led to an emergency psychiatric hospitalization, the laboratory findings showed a TSH value of 75 microunits/ml. The psychotic episode remitted after a month of antypsichotic medication and levothyroxinum replacement therapy. The patient has been receiving psychotropic medication for a year, during which she was readmitted for a depressive episode (6 months after first discharge).ConclusionsThe patient's psychotic disorder developed after a period of thyroid hormone replacement therapy discontinuation and consecutive to the RAIT session, which indicates that in susceptible individuals there is a risk for psychosis with this therapeutical strategy.
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Brandão, D., and J. Massano. "Frontotemporal dementia and psychosis: Literature review." European Psychiatry 33, S1 (March 2016): S367. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1315.
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IntroductionFrontotemporal dementia (FTD) is a progressive neurodegenerative disease especially sporadic. About 30–40% have positive family history, with an identifiable genetic mutation in a percentage of cases increasing. Although the FTD psychosis has been recognized for many years, it is not included in the clinical criteria.ObjectivesTo assess the prevalence and characteristics of psychotic symptoms in FTD, compare the presence of psychosis in FTD C9+ versus C9− and analyze the occurrence of wrong diagnoses in FTD with psychosis.MethodsLiterature review, using computerized databases (Pubmed®). Articles were selected based on the content of their abstract and their relevance.ResultsIt is frequently the presence of psychotic symptoms in FTD associated with C9+ versus C9−. These may arise as initial symptom often leading to a psychiatric diagnosis years before obtaining diagnosis of FTD. There is no conclusive evidence about the anatomical correlation of psychotic features in the FTD, although there is the possible association with the right brain degeneration.ConclusionsThe existence of psychotic symptoms do not argues against the diagnosis of FTD verifying a high frequency of psychosis in FTD – C9+. As can be the first symptom in FTD is critical to differentiate psychiatric disorders. Further studies are needed in order to obtain a better characterization of psychotic symptoms in FTD – C9+.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Sweet, Robert A., Ronald L. Hamilton, Oscar L. Lopez, William E. Klunk, Stephen R. Wisniewski, Daniel I. Kaufer, Matthew T. Healy, and Steven T. DeKosky. "Psychotic Symptoms in Alzheimer's Disease Are Not Associated With More Severe Neuropathologic Features." International Psychogeriatrics 12, no. 4 (December 2000): 547–58. http://dx.doi.org/10.1017/s1041610200006657.
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Psychotic symptoms in Alzheimer's disease (AD) have been associated with increased rates of cognitive impairment and functional decline. Prior studies have been conflicting with regard to whether AD patients with psychosis (AD+P) have evidence of more severe neuropathologic findings at postmortem exam. We examined the severity of neuritic plaques and neurofibrillary tangles in six brain regions—middle frontal cortex, hippocampus, inferior parietal cortex, superior temporal cortex, occipital cortex, and transentorhinal cortex—in 24 AD+P subjects and 25 matched AD subjects without psychosis (AD-P). All analyses controlled for the presence of cortical Lewy bodies, and corrected for multiple comparisons. We found no significant associations between neuritic plaque and neurofibrillary tangle severity and AD+P, and no significant associations with any individual psychotic symptom. The association of AD+P with a more rapidly progressive course of AD appears to be mediated by a neuropathologic process other than increased severity of plaque and tangle formation.
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Mota, P. "“I have no disease and weed just relaxes me!”: The therapeutic challenge in young patients with psychosis and cannabis abuse." European Psychiatry 64, S1 (April 2021): S172. http://dx.doi.org/10.1192/j.eurpsy.2021.456.
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IntroductionSubstance use disorders (SUDs) are estimated to affect around 30 million people worldwide, and are characterized by repeated use of a substance that leads to clinically significant impairment or suffering, making it a serious health problem, with high associated costs.ObjectivesUnderstand and evaluate the impact of cannabis use on adherence to treatment in young patients with psychosis.MethodsNarrative literature review by performing a search on MedLine for English-written articles. The query used was “(Cannabis) AND (Schizophrenia OR Psychosis) AND (Adherence)”.ResultsAbout 70 to 80% of young people with SUDs have at least one concomitant psychiatric disorder and cannabis is involved in approximately 50% of psychosis or schizophrenia of those cases, so there is a growing concern about the deleterious medical and psychiatric consequences of the increase and early initiation of consumption of this substance. It is estimated that about 26% of patients with psychotic conditions do not adhere to the treatment plan established by the psychiatrist; however, especially during the inaugural phases of psychotic disorders, rates of non-adherence to therapy are high (above 50%), and are said to be higher in younger patients.ConclusionsThe risk of relapse after a first psychotic episode is high. As the use of cannabis is a potentially preventable risk factor, interventions aimed at improving therapeutic adherence in psychotic conditions must specifically target the use of this substance, since reducing its consumption can lead to a more favorable course of the disease and at less expensive costs in addressing these pathologies.DisclosureNo significant relationships.
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Maia, L., I. Carvalho, D. Silva, and L. Carneiro. "The Onset of Psychotic Disorders and the Immigration Status – A Look Into A Growing Reality." European Psychiatry 33, S1 (March 2016): S491. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1805.
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IntroductionRecent studies point for an increased incidence of psychotic disorders among immigrants when compared to nom-immigrant population, with a substantial risk variation being observed among different ethnic minority groups and diverse host countries/societies.ObjectiveThis communication explores the relation between immigration and the onset of psychosis disease, namely the individual and socio-environmental factors implicated in this association.AimsAccessing the implications of immigration in the establishment of psychotic disorders.MethodsThe authors conducted a literary search on Medline and PsychInfo databases regarding the subject immigration and psychotic disorders, elaborating a bibliographic review of the topic.ResultsA greater incidence of psychotic disorders in immigrants (in comparison to nom-immigrant population) has been established. In actuality a range of studies carried out in different socio demographic contexts and with different ethnic groups (of immigrants) identify ethnicity, neighbourhood characteristics (namely level ethnic density), discrimination and refugee status, as some of the probable factors that modulate the rate of psychotic disorder and influence its incidence in immigrants.ConclusionsWith regard to the relationship between immigration and the development of psychosis, much is still to be understood. Future studies with focuses on different individual, social, cultural and demographic aspects need to be developed in order to better understand and addressed this phenomenon.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Lemey, L., J. Godderis, and H. van den Ameele. "Psychiatric complications of drug treatment of Parkinson's disease." Acta Neuropsychiatrica 13, no. 1 (March 2001): 29–36. http://dx.doi.org/10.1017/s092427080003533x.
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SUMMARYDrug-induced psychiatric conditions are a common and severe problem in the treatment of patients with Parkinson's disease. Psychotic symptoms are the most frequent reason for nursing home placement of patients with Parkinson's disease. The psychotic symptoms seem to present themselves in a continuum where alterations in dreaming patterns often precede visual hallucinations, which often progress into delusional syndromes and, finally, into confusional organic syndromes. When evaluating a patient on dopaminergic treatment, it is important to inquire systematically about abnormal sleep related phenomena, for these are important clues in the early detection of psychotic symptoms. The pathogenesis of the psychotic symptoms is not yet fully understood but complex adaptations of various neurotransmitter systems seem to be involved. In the treatment of these drug-induced psychotic symptoms, the atypical antipsychotic drug clozapine plays an important role. Drug-induced mania, hypersexuality and anxiety, although less frequent than the psychotic symptoms, also occur as a complication of dopaminergic treatment. Depressive symptoms, although common in Parkinson's disease, are less likely to occur as a side effect of the drug treatment.
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Jethwa, Ketan Dipak, and Oluwademilade A. Onalaja. "Antipsychotics for the management of psychosis in Parkinson's disease: systematic review and meta-analysis." BJPsych Open 1, no. 1 (June 2015): 27–33. http://dx.doi.org/10.1192/bjpo.bp.115.000927.
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BackgroundAntipsychotics can exacerbate motor symptoms in Parkinson's disease psychosis.AimsTo systematically review the literature on the efficacy and acceptability of antipsychotics for Parkinson's disease psychosis.MethodRandomised controlled trials comparing an antipsychotic with placebo were systematically reviewed.ResultsThe final selection list included nine studies using quetiapine (3), clozapine (2), olanzapine (3) and pimavanserin (1). A narrative synthesis and meta-analyses (where appropriate) were presented for each antipsychotic. Clozapine demonstrated superiority over placebo in reducing psychotic symptoms. Quetiapine and olanzapine did not significantly improve psychotic symptoms. All three antipsychotics may exacerbate motor symptoms. Quetiapine studies were associated with high drop-out rates due to adverse events. Pimavanserin is a novel treatment that warrants further investigation.ConclusionsFurther research is needed. Clozapine and pimavanserin appear to be a promising treatment for Parkinson's disease psychosis.
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Bidaki, R., SM Yassini, MT Maymand, M. Mashayekhi, and S. Yassini. "Acute psychosis due to brucellosis in a rural Iran: a report of two cases." International Journal of Infection and Microbiology 2, no. 1 (April 30, 2013): 29–31. http://dx.doi.org/10.3126/ijim.v2i1.8007.
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Introduction: Brucellosis is a zoonotic disease that causes multi systemic involvement. Neurobrucellosis occurs in less than 5% of patients. Psychosis as a presentation of neuro-brucellosis is a rare condition. Case Report: We report a woman that was referred because of psychotic depression following brucellosis. Also we present a 66-year-old man that was admitted because of acute psychotic symptoms. He had behavioral disorders, visual and auditory hallucination, restlessness, impulsivity, incoherency and episodic crying. Neurobrucellosis was confirmed. Conclusion: In patients with atypical psychosis in endemic areas, physicians should consider the portability of brucellosis. DOI: http://doi.dx.org/10.3126/ijim.v2i1.8007 Int J Infect Microbiol 2013;2(1):29-31
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Friedman, Joseph H., Christopher C. Goetz, and Glenn T. Stebbins. "PSYCHOTIC SYMPTOMS IN PARKINSON'S DISEASE." Journal of the American Geriatrics Society 45, no. 2 (February 1997): 252. http://dx.doi.org/10.1111/j.1532-5415.1997.tb04522.x.
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Mures, R. A. Baena, L. Niell Galmes, I. Mesián Pérez, M. D. Saiz González, and Y. Lázaro Pascual. "Psychotic episode and Crohn’s disease." European Neuropsychopharmacology 26 (October 2016): S496—S497. http://dx.doi.org/10.1016/s0924-977x(16)31511-5.
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Papapetropoulos, Spiridon, and D. C. Mash. "Psychotic symptoms in Parkinson’s disease." Journal of Neurology 252, no. 7 (July 2005): 753–64. http://dx.doi.org/10.1007/s00415-005-0918-5.
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Ballard, Clive. "Psychotic Episodes in Alzheimer’s Disease." European Neurological Review 12, no. 02 (2017): 60. http://dx.doi.org/10.17925/enr.2017.12.02.60.
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Lindsey, Pamela L., and Kathleen C. Buckwalter. "Psychotic Events in Alzheimer’s Disease." Journal of Gerontological Nursing 35, no. 8 (August 1, 2009): 20–27. http://dx.doi.org/10.3928/00989134-20090706-05.
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Cooper, James K., Dan Mungas, Maxine Verma, and Philip G. Weiler. "Psychotic symptoms in Alzheimer's disease." International Journal of Geriatric Psychiatry 6, no. 10 (October 1991): 721–26. http://dx.doi.org/10.1002/gps.930061006.
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Jabeen, Sabiha, Ian G. McKeith, Andrew F. Fairbairn, Robert H. Perry, and I. Nicol Ferrier. "Psychotic symptoms in Alzheimer's disease." International Journal of Geriatric Psychiatry 7, no. 5 (May 1992): 341–45. http://dx.doi.org/10.1002/gps.930070506.
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Knezevic, Jelena, Vladimir Knezevic, Svetlana Simic, Lorand Sakalas, and Svetlana Ivanovic-Kovacevic. "Psychotic symptoms in Parkinson’s disease: Etiology, prevalence and treatment." Medical review 72, no. 1-2 (2019): 30–33. http://dx.doi.org/10.2298/mpns1902030k.
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Introduction. Parkinson?s disease is the second most common neurodegenerative disease with as many as 50-70% of patients experiencing psychotic symptoms during the course of the illness. Our aim was to provide an evidence-based review on the etiology, prevalence and management of psychotic symptoms in Parkinson?s disease. Material and Methods. We used references from the ?Medline? database published from 1999 to 2019. Results. The most common psychotic symptoms in Parkinson?s disease are visual hallucinations, which occur in 25-30% of patients, acoustic hallucinations in about 20%, and delusions in around 5% of these patients. The etiology of psychotic symptoms is not fully clarified, but researchers suggest a complex interrelationship of factors associated with the disease itself and the factors associated with antiparkinsonian medications. After exclusion of other etiologic causes of psychotic symptoms, it is necessary to revise the type and dose of antiparkinsonian drugs. Although pimavanserin has recently been approved by the United States Food and Drug Administration, the current treatment of choice for psychotic symptoms in Parkinson?s disease is still quetiapine. Only patients who do not tolerate or do not respond to quetiapine are treated with clozapine, which has been proven more effective, but with significant side effects. Conclusion. Timely diagnosis and adequate treatment of psychotic symptoms in Parkinson?s disease are essential, because they dramatically affect the quality of life of patients and their families. Therefore, it is necessary to establish more effective tools for screening and treatment of psychotic symptoms in Parkinson?s disease.
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Kaleda, V., U. Popovich, and N. Romanenko. "Religious delusions in adolescence and young adults: Features of psychopathology and clinic." European Psychiatry 64, S1 (April 2021): S804. http://dx.doi.org/10.1192/j.eurpsy.2021.2126.
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IntroductionReligious delusions is a complex psychopathological phenomenon. The delusional disorders with religious content in young age, the need for an additional detailed study of the conditions of their formation, patterns of the course and outcome of the disease determine the relevance of this study.ObjectivesTo identify the psychopathological features, the conditions of formation, the characteristics of the course of psychosis with religious delusions in young age.Methods95 patients (62 male and 33 female) with religious delusions (delusion of sin - 33,7%, delusion of demonic possession (40,0%), messianic and antagonistic delusion - 18,9%, oneiroid with religious content – 7,4 %) in psychotic episode (F20, F25 according to the ICD-10) at a young age (16-25 years) were included in the study and examined with clinical-psychopathological, clinical-follow-up and psychometric (PSP, SANS) methods. The average duration of follow-up was 7.4 ± 2.3 years.ResultsIn a post-psychotic period it is possible to preserve or form religiosity, as well as a complete reduction of the religious worldview in patients who had been indifferent to religious issues before the first episode of the disease. Though, the formation of residual psychotic symptoms with religious content were noted with greater frequency. The delusions of demon obsession in a psychosis episode is unfavorable prognostic factor.ConclusionsGeneral psychopathological features of psychotic states with religious delusions, according to the specificity of young age, were identified. A role of the previous religiosity, including overvalued religious ideas, was clarified.DisclosureNo significant relationships.
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Hegde, Raviprasd, and Suhas Kumar Shetty. "A CRITICAL ANALYSIS OF ATATVABHINIVESHA AS MAHAGADA, AND ITS MODERN INTERPRETATION." International Ayurvedic Medical Journal 9, no. 5 (May 15, 2021): 1050–53. http://dx.doi.org/10.46607/iamj1709052021.
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Atatvabhinivesha is a disease explained only in Charaka Samhita and considered it as a difficult to treat mental disorder (Mahagada). Budhi Vibhramsha (loss of intellect) is the predominant symptom of Atatvabhinivesha. Be- cause of complete derangement of intellectual capacity person loses his insight towards disease, and self. Modern interpretation for Atatvabhinivesha can be done to the symptoms of Psychosis, where person loses insight and develops psychotic symptoms predominantly delusions and hallucinations. Keywords: Atatvabhinivesha, Mahagada, Psychosis
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Poletti, Michele. "The dark side of dopaminergic therapies in Parkinson’s disease: shedding light on aberrant salience." CNS Spectrums 23, no. 6 (March 7, 2017): 347–51. http://dx.doi.org/10.1017/s1092852917000219.
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Psychotic subjects and patients with Parkinson’s disease (PD) “on” dopaminergic drugs, especially on dopamine agonists, present a hyperdopaminergic state that interferes with learning processing. These clinical populations present with distinct alterations of learning that share an increased potential motivational significance of stimuli: psychotic subjects may attribute salience to neutral stimuli, while medicated PD patients may overvalue rewards. Herein is discussed the speculative hypothesis that the hyperdopaminergic state induced by dopaminergic treatments, especially with dopamine agonists, may also facilitate the attribution of salience to neutral stimuli in PD patients, altering the physiological attribution of salience. Preliminary empirical evidence is in agreement with this speculative hypothesis, which needs further empirical investigation. The clinical implications of this hypothesis are discussed in relation to behavioral addictions, psychosis proneness, and enhanced creativity in medicated PD patients.
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Morant, Amparo. "Psychosis and Silent Celiac Disease in a Down Syndrome Adolescent: A Case Report." Case Reports in Pediatrics 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/970143.
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Celiac disease is an autoimmune systemic disorder. It presents gastrointestinal and nongastrointestinal manifestations as well as associated conditions. We report a 16-year-old Down syndrome girl who presented psychosis symptomatology, and she was diagnosed as having silent celiac disease. Olanzapine treatment and gluten-free diet were satisfactory. It is necessary to consider celiac disease in Down syndrome patients with psychiatric symptoms, mainly psychotic symptomatology.
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Martín, C. Vilella, M. Á. Heredero Sanz, P. García Vázquez, I. Gonzalez Rodríguez, S. Nuñez Sevillano, and A. Serrano García. "Psychosis in a 40-year-old man as debut of Alzheimer’s disease." European Psychiatry 64, S1 (April 2021): S809. http://dx.doi.org/10.1192/j.eurpsy.2021.2139.
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IntroductionPsychosis in Alzheimer’s disease has an incidence of ~ 10% per year. Recent work has focused on the presence of psychosis in people with mild cognitive impairment, as a risk factor for the development of Alzheimer’s disease.ObjectivesTo study a case of Alzheimer’s disease presenting psychotic symptomsMethodsRetrospective review of clinical records and complementary test, including psychiatry, electrophysiology and neurology.ResultsA 40-year-old goes to the emergency room due to hetero-aggression at home. He says that his father steals his money and prostitues have been hired in his house. The patient is oriented, partially collaborative and approachable. Psychomotor restlessness is observed. He has self-referral delusions, auditory hallucinations and insomnia. Provisional diagnosis of acute psychotic episode made and low dose risperidone was prescribed. During his stay on the hospital Ward, sedation, recent memory alterations, spatio-temporal disorientation lack of initiative and disorganized behaviors appear. Risperidone is withdrawn and complementary test are performed. Imaging tests show temporal and frontal atrophy. Increased TAU protein and low levels of amyloid in CSF are found. Brain biopsy is +. His mother died of Alzheimer’s disease with 36 years-old and another affected brother with 42 yeras-old. The definitive diagnosis is Alzheimer’s disease and genetic studies are currently being carried out.ConclusionsPsychiatric symptoms may be present in Alzheimer’s desease. It is mandatory to carry out an adequate organic screening before a late first psychotic episode.DisclosureNo significant relationships.