Academic literature on the topic 'Psychotic symptoms (PsyS)'

Abstract Background Family environment plays a key role in the development of psychotic symptoms (Pitschel-Walz et al., 2001; Tienari et al., 2004) and negative family environmental factors are linked to poor prognosis in psychosis (Geller et al., 2000). By contrast, a positive family environment is associated with greater improvements in negative and disorganized symptoms among individuals at imminent risk of becoming psychotic (O’Brien et al., 2006). Nonetheless, little is known about the implication of family environment on longitudinal functioning in patients that presented a first psychotic episode. Methods This study is part of the “Phenotype-genotype and environmental interaction. Application of a predictive model in first psychotic episodes” (PEPS) study, a multicentric, longitudinal, naturalistic follow-up study (Bernardo et al., 2013). The Functional Assessment Short Test (FAST) was used to assess functional outcome. The Family Environment Scale (FES) evaluated family emotional climate in different categories: COHESION (C) for mutual reliance; EXPRESSIVITY (EX), the extent to which family members express their feelings directly; CONFLICTS (CON) for open expression of anger, aggressiveness and conflict; INDEPENDENCE (IND), the extent to which family members are independent in their decisions; ACHIEVEMENT ORIENTATION (AO) for an achievement-orientated environment; INTELLECTUAL–CULTURAL ORIENTATION (ICO) for political, intellectual, cultural interests; ACTIVE–RECREATIONAL ORIENTATION (ARO) for participation in social activities; MORAL–RELIGIOUS EMPHASIS (MRE) for the importance given to ethical and religious practices and values; ORGANIZATION (ORG) for the organization in activities and responsibilities; and CONTROL (CTL), the extent to which the family considers rules and established procedures. Patients with a first psychotic episode (FEPs) and healthy controls (HCs) have been evaluated baseline and after two years of follow-up. Diagnoses at 2 years have been established according to the Structured Clinical Interview for DSM-IV. Linear regression models have been conducted in order to assess the effect that different family environments exert on functioning at baseline but also at 2 years of follow-up, when the group of FEPs has been divided in patients diagnosed with psychotic disorders (PSYC) versus bipolar disorder (BD). All data were analyzed with the Statistic Package for Social Sciences (SPSS v.23 for Windows). All the analyses were two-tailed with alpha set at p < 0.05. Results At baseline, the total sample included 335 FEPs (mean FAST=27.8±16.1) and 253 HCs (mean FAST 3.5±8.1). At baseline the linear model was not significant neither for FEPs nor for HCs and no family environment was associated with functioning. At 2 years (mean FAST BD=13.8±15.1, mean FAST PSYC =20.98±15.4), in the BD group (F(10,14)=2.6, p=.05) worse functioning was associated with CON (β=.741, p=.004) whilst in the PSYC group (F(10,108)=3.509, p=<.001) it was negatively associated with ARO (β=- .305, p=.006) and AO (β=- .204, p=.039) and positively associated with MRE (β=.268, p=.003). Discussion At baseline, no specific family environment was associated with functioning. At 2 years, in BD worse functioning was associated with higher rates of open expression of conflict in the family whilst in PSYC it was associated with lower rates of participation in social activities and achievement-orientated family environment as well as with higher rates of religious practices and values. Family environment exerts an important role in the functioning of FEPs mainly in the long-term, with important implications for early interventions for both patients and caregivers.

Background: Reductions in the volume of brain white matter are a common feature in schizophrenia and bipolar disorder while the association between white matter and polygenic schizophrenia-related risk is unclear. To look at the intermediate state between health and the full-blown disorder, we investigated this aspect in groups of patients before and after the onset of psychosis. Methods: On a 3 Tesla scanner, total and regional white matter volumes were investigated by structural magnetic resonance imaging (MRI) in the following groups: 37 at-risk mental state patients (ARMS), including 30 with no transition to psychosis (ARMS-NT) and 7 with a transition to psychosis (ARMS-T) pooled with 25 first episode psychosis (FEP) patients. These T1-weighted images were automatically processed with the FreeSurfer software and compared with an odds-ratio-weighted polygenic schizophrenia-related risk score (PSRS) based on the publicly available top white matter single-nucleotide polymorphisms. Results: We found no association, only a trend, between PSRS and white matter volume over all groups (β = 0.24, p = 0.07, 95% confidence interval = [-0.02 – 0.49]). However, a higher PSRS was significantly associated with a higher probability of being assigned to the ARMS-T + FEP group rather than to the ARMS-NT group (β = 0.70, p = 0.02, 95% confidence interval = [0.14 – 1.33]); there was no such association with white matter volume. Additionally, a positive association was found between PSRS and the Brief Psychiatric Rating Scale (BPRS) total score for the pooled ARMS-NT/ARMS-T+FEP sample and for the ARMS-T + FEP group also, but none for the ARMS-NT group only. Conclusion: These findings suggest that at-risk mental state patients with a transition and first-episode psychosis patients have a higher genetic risk for schizophrenia than at-risk mental state patients with no transition to psychosis; this risk was associated with psychopathological symptoms. Further analyses may allow polygenic schizophrenia-related risk scores to be used as biomarkers to predict psychosis.

Objective.(1) To describe the clinical course and response to treatment; and (2) to evaluate and compare damage accrual of distinct phenotypic subgroups of patients with clinically important psychiatric illness of pediatric systemic lupus erythematosus (pSLE).Methods.A single-center cohort study of patients with pSLE followed at a pediatric lupus clinic from 1985 to July 2009. Clinical course and response to treatment were studied. Remission was defined by absence of psychiatric/cognitive symptoms while receiving minimal doses of prednisone. Disease activity and damage were measured using SLE Disease Activity Index and SLE Damage Index.Results.Fifty-three children were included: 40 with psychosis and cognitive dysfunction (PSYC group) and 13 with isolated cognitive dysfunction (COG group). All received immunosuppressive treatment. Eighteen of 32 treated with azathioprine required a change to cyclophosphamide for poor response but none on cyclophosphamide required a change. The median times to remission were 72 weeks (PSYC) and 70 weeks (COG). Eight patients (7 PSYC, 1 COG) experienced flare following response/remission. New damage was noted in 50% of children at a median of 11 months: 57% of PSYC group, 31% of COG group. Persistent cognitive dysfunction was seen in 16% of PSYC patients and 15% of COG patients.Conclusion.Most patients responded to immunosuppressive treatment, although median time to remission was > 1 year. Roughly half the patients acquired a new damage item, most of which did not interfere with functional abilities. Fewer than 20% of patients developed neuropsychiatric damage. Both phenotypes of psychiatric pSLE responded equally well to current treatment.

AbstractBackgroundChromosome 22q11.2 deletion syndrome (22q11DS) is associated with high rates of psychiatric disorders, including schizophrenia in up to 30% of individuals with the syndrome. Despite this, we know relatively little about trajectories and predictors of persistence of psychiatric disorders from middle childhood to early adulthood. Accordingly, we followed youth over four timepoints, every 3 years, to assess long-term trajectories of attention-deficit hyperactivity disorder (ADHD), anxiety, mood, and psychosis-spectrum disorders (PSDs), as well as medication usage.MethodsEighty-seven youth with 22q11DS and 65 controls between the ages of 9 and 15 years at the first timepoint (T1; mean age 11.88 ± 2.1) were followed for 9 years (mean age of 21.22 ± 2.01 years at T4). Baseline cognitive, clinical, and familial predictors of persistence were identified for each class of psychiatric disorders.ResultsBaseline age and parent-rated hyperactivity scores predicted ADHD persistence [area under curve (AUC) = 0.81]. The presence of family conflict predicted persistence of anxiety disorders (ADs) whereas parent ratings of child internalizing symptoms predicted persistence of both anxiety and mood disorders (MDs) (AUC = 0.84 and 0.83, respectively). Baseline prodromal symptoms predicted persistent and emergent PSDs (AUC = 0.83). Parent-reported use of anti-depressants/anxiolytics increased significantly from T1 to T4.ConclusionsPsychiatric, behavioral, and cognitive functioning during late childhood and early adolescence successfully predicted children with 22q11DS who were at highest risk for persistent psychiatric illness in young adulthood. These findings emphasize the critical importance of early assessments and interventions in youth with 22q11DS.

Given the heterogeneity of symptoms allowed in the diagnosis of psychotic disorders, as well as other challenges of categorical diagnosis (e.g., First et al., 2002; Krueger, 1999), the increased specificity brought by dimensional ratings of underlying features is often important. Models using the factorial structure of psychotic symptoms perform as good as or better than traditional categorical models (Allardyce, Suppes, & Van Os, 2007). DSM-5 has provided such a system of ratings to aid clinicians, the Clinician Rated Dimensions of Psychosis Symptom Severity Scale (PSS; APA, 2013). In this approach, the clinician rates symptom severity in eight domains which emphasize traditional psychotic symptomatology, cognition, and mood. Given its accessibility and the support of the DSM-5, it is possible that the measure could achieve wide use. However, little is known about the measure and the challenges of applying it in clinical settings. This study is a conceptual analysis of the conceptual foundation of the PSS, including its psychometric properties, applications, and demonstrated validity. It is also compared to the widely used Brief Psychiatric Rating Scale – Revised (BPRS-R). The PSS is more concise that other measures, and five of the PSS domains parallel the DSM-5's "Key Features That Define the Psychotic Disorders" (p. 87-88) (although the brief instructions of the PSS differ at times from DSM-5 definitions, and little in the way of definition is offered in the PSS itself). In contrast, no rationale is given for adding the remaining three domains. The dimensional model of the PSS has similarities to the factor structure typically found for symptomatology in psychotic disorder, but a number of important differences are noted. The data required for making ratings is never defined, although the only mention of data that might be helpful for rating one of the domains depends upon extensive testing. Although anchors for the ratings might, at first glance, appear to be given in the PSS, in fact, they offer almost nothing beyond the adjectives of "equivocal," "mild," "moderate," and "severe." Finally, we found that very little research exists on the PSS, no field trial was done, psychometric properties are largely unknown, and normative data is unavailable. The PSS is brief and provides a quick way to rate the severity of the five key features of psychosis required by DSM-5 diagnoses. Thus, it can work as a quick quantification of these features. Beyond this its utility is unknown, and it appears to lack the specificity of other rating scales, such as the BPRS-R.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular measure of psychosocial functioning and psychopathology in the assessment of individuals in a variety of settings. However, the method of construction employed with the MMPI more than 60 years ago with psychiatric patients challenges the applicability of the scales for determining the psychosocial functioning of individuals from different settings. The restandardisation conducted in 1987 made no effort to eradicate the item overlap that was a result of the criterion keying method with contrasted groups. Although restandardized and updated with more contemporary language and content, the original psychiatric constructs were retained in order to maintain continuity with its predecessor. The aims of this investigation were to develop a new structure for the MMPI-2 constructed at the item-level, empirically derived and which specifically represents the dimensions that are relevant and appropriate in evaluating the psychosocial functioning of personal injury claimants. This task included comparisons with a comparable scale-level analysis and developing optimal scoring strategies where items in components and facets are allocated weightings based upon their strength of association. Study 1 was conducted using a sample of 2989 personal injury claimants assessed in Australia and the United States of America. The final sample of 3230, included 241 normal individuals, was utilized to develop a scale-level structure from 79 standard MMPI-2 scales and subscales. A nine-component solution consisting of General Maladjustment /Emotional Distress, Asocial Beliefs, Social Vulnerability, Somatic Complaints, Psychological Disturbance, Impulsive Expression, Antisocial Practices, Stereotypic Fears and Family Difficulties was derived using principal component analysis. However, intercorrelation between components in the structure signaled the need to develop a structure that would eradicate problems that were perpetuated by item overlap. The second study was conducted with a set of best practice procedures with the same clinical sample of 2989 personal injury claimants as Study 1. Forty-one components were derived through principal component analysis. Through the application of a set of criteria, a 35-component solution was retained. The pattern coefficients from the allocation of items to components determined the weightings to be applied to each item. Further analysis of the 35 components derived a substructure of 37 facets. The 35 components included only 442 of the 567 items, with the reliability coefficients of the first 25 components that ranged between .5 and .97, and the remaining 10 components that ranged from .29 to .49. The latter unreliable components were not included in the final Structural Summary, leaving 25 components (400 items) and their 33 facets for interpretation. Hence, in demonstrating the utility of the newly-derived structure, only 25 components and their 33 facets were interpreted. The 25 components were grouped conceptually into six domains. In the emotional domain were Psychological Distress (PsyDist), Anger, Fears, Psychotic Symptoms (PsyS), Paranoia (Par), Irritability (Irrit), Elation (Elat), Fear of the Dark (FD), and Financial Worry (FinWo). Somatic Complaints (SomC), Sexual Concerns (SexCon), and Gastrointestinal Problems (GasP) made up the measures in the physiological domain. In the behavioural domain were Cognitive Difficulties (CogDiff), Stimulus-Seeking (StimuS), Discipline (Dis), and Delinquency (Del) whilst the interpersonal domain was formed by Social Withdrawal (SoW), Negative Interpersonal Attitude (NIA), Timidity (Tim), Lie, Dissatisfaction with Self (DWS) and Family Relationship Difficulties (FReD). Alcoholism (Alco) was the only measure in the substance abuse domain, and the gender domain was comprised of Masculinity (Mas) and Femininity (Fem). The third study established preliminary normative means and standard deviations using a small opportunistic Australian university student sample (N = 219). No substantial gender differences were found but gender norms were maintained to facilitate comparisons with the traditional MMPI-2 approach. Comparisons of frequency of 'true' item response between the Australian university student sample and the U.S. restandardisation sample found relatively little differences and permitted evaluation of between sample differences on components and facets. The utility of the structure was demonstrated with the illustration of two clinical case examples, and a comparison was made with the standard MMPI-2 scales and subscales. The Structural Summary for the MMPI-2 demonstrated discriminative measures of psychosocial functioning that were a result of no item overlap, and the ability to attend to the different levels of intensity of self-report items because of differential weightings.