Rozprawy doktorskie: „Psychotic symptoms”

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Sandt, Arthur Ralph. "Hedonic Functioning and Subthreshold Psychotic Symptoms". Diss., Temple University Libraries, 2013. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/164124.

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Psychology
Ph.D.
Schizophrenia is a debilitating disorder with an array of affective, cognitive, and behavioral consequences. In addition to these impairments, research suggests that there is a distinct pattern of hedonic functioning in schizophrenia that may contribute to some of the most intractable symptoms of the disorder, the negative symptoms. Specifically, individuals with schizophrenia appear to experience deficient levels of pleasure during anticipation of a pleasurable stimulus, while experiencing typical levels of pleasure while directly engaged with a pleasurable stimulus. Despite these findings, it is unclear whether hedonic functioning deficits occur in individuals with subthreshold levels of psychotic symptoms and/or in individuals at clinical high risk for the disorder. The purpose of this study was to examine hedonic functioning in relation to the continuum of psychotic symptoms in a college undergraduate student sample, and in those at clinical risk for schizophrenia. Participants were 679 students who completed self-report measures of current psychotic-like experiences, and trait-like components of hedonic functioning (i.e., anticipatory and consummatory pleasure). Consistent with study hypotheses, deficits in anticipatory pleasure, but not in consummatory pleasure, were significantly associated with increased clinical risk for schizophrenia. However, this relation was found exclusively among women in the sample, whereas men did not show a significant relation between anticipatory pleasure deficits and clinical high-risk. Furthermore, anticipatory pleasure deficits were not significantly associated with increases in the number of positive psychotic symptoms endorsed. Moreover, consummatory pleasure was not associated with increases in the number of subthreshold positive psychotic symptoms, nor was there a relation with the number of distressing positive psychotic symptoms or clinical risk status. The present study provides the first examination of the relation between hedonic functioning and subthreshold psychotic symptoms, as well as the relation with clinical high-risk for psychosis. These findings suggest that anticipatory pleasure deficits may be more closely related to increased clinical risk for psychosis among women rather than increases in psychotic symptoms in the general population. Anticipatory pleasure deficits may be a useful target for intervention and prevention techniques among those at clinical risk for psychosis, especially in female at risk populations. Additional longitudinal studies will be essential for testing whether anticipatory pleasure deficits predict the occurrence of future psychotic disorders among those at high risk for the disorder in order to improve early identification and early intervention efforts in this population.
Temple University--Theses

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Spauwen, Janneke, Lydia Krabbendam, Roselind Lieb, Hans-Ulrich Wittchen i Os Jim van. "Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-108608.

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Background. The reported link between psychological trauma and onset of psychosis remains controversial. Aims. To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness). Method. At baseline, 2524 adolescents aged 14-24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms. Results. Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR1.89,95% CI1.16-3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032). Conclusions. Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.

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Spauwen, Janneke, Lydia Krabbendam, Roselind Lieb, Hans-Ulrich Wittchen i Os Jim van. "Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness". Technische Universität Dresden, 2006. https://tud.qucosa.de/id/qucosa%3A26761.

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Background. The reported link between psychological trauma and onset of psychosis remains controversial. Aims. To examine associations between self-reported psychological trauma and psychotic symptoms as a function of prior evidence of vulnerability to psychosis (psychosis proneness). Method. At baseline, 2524 adolescents aged 14-24 years provided self-reports on psychological trauma and psychosis proneness, and at follow-up (on average 42 months later) participants were interviewed for presence of psychotic symptoms. Results. Self-reported trauma was associated with psychotic symptoms, in particular at more severe levels (adjusted OR1.89,95% CI1.16-3.08) and following trauma associated with intense fear, helplessness or horror. The risk difference between those with and without self-reported trauma at baseline was 7% in the group with baseline psychosis proneness, but only 1.8% in those without (adjusted test for difference between these two effect sizes: χ2=4.6, P=0.032). Conclusions. Exposure to psychological trauma may increase the risk of psychotic symptoms in people vulnerable to psychosis.

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Ballard, C. G. "Depression and psychotic symptoms in dementia sufferers". Thesis, University of Leicester, 1995. http://hdl.handle.net/2381/34340.

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One hundred and twenty five patients with mild or moderate dementia according to the CAMDEX criteria, who were in contact with either a memory clinic or psychiatric services were assessed. Dementia was diagnosed according to the NINCDS ADRDA criteria, the Hachinski scale, DSMIIIR criteria, HAS AGECAT and the McKeith criteria for Senile Dementia of Lewy Body Type. Depression was diagnosed according to the DSMIIIR and RDC criteria and psychotic symptoms were assessed using the Bums Symptom Checklist. Cognitive impairment was evaluated using the CAMCOG schedule. Informants were interviewed at monthly intervals for one year concerning the symptoms of depression and psychotic symptoms experienced by the dementia sufferers. A repeat CAMCOG was undertaken one year after the initial assessment. The one month prevalence rates of delusions, visual hallucinations and delusional misidentification were 48.4%, 35.5% and 29.0% respectively. Each had a distinct pattern of associations, an impression supported by a principal components analysis which generated four psychotic factors, the three categories already discussed and comfort phenomena. Only sixteen patients had any insight into their psychotic symptoms and 61% were distressed by them. The annual incidence rate of psychotic symptoms was 46.7% and 53% of patients experienced symptom resolution. The number of months during which psychotic symptoms were experienced was significantly associated with the magnitude of cognitive deterioration. The one month prevalence rate of RDC major depression was 27.4%. An additional 27.4% of patients fulfilled the criteria for RDC minor depression. Having Alzheimer's disease was significantly inversely associated with both RDC major depression and DSMIIIR major depression. There were six patients with RDC depression in the context of vascular dementia, all of whom experienced depression for at least three months compared to only 33.3% of the patients with Alzheimer's disease. The annual incidence rate of RDC major depression was 10.6%.

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Spengler, Peter A., i Hans-Ulrich Wittchen. "Procedural validity of standardized symptom questions for the assessment of psychotic symptoms". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-103807.

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The study examines to what degree well-documented present and life-time psychotic symptoms in a group of former psychiatric inpatients are ascertained when using the Diagnostic Interview Schedule (DIS). The Inpatient Multidimensional Psychiatric Scale (IMPS) and the Manual for the Assessment and Documentation of Psychopathology/Diagnostische Sichtlochkartei (AMDP/DiaSika) Interview-Checklist approach were used for the “clinical” evaluations of symptoms. The results indicate fair concordance between the two clinical approaches and the DIS with regard to the presence of any delusional or hallucination symptoms. Low to poor agreement was found in the assessment of many of the rather specific hallucinations and delusions. Generally, the concordance found was higher when compared to the more clinical AMDP/DiaSiKa approach than to the IMPS. More detailed comparisons with diagnostic subgroups of schizophrenic and schizoaffective patients substantiated the findings in the overall sample. Overall it was reconfirmed that the DIS approach is limited to those patients who are cooperative and at least partly remitted.

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6

Preston, Neil Joseph. "The causal predominance of psychotic experience". Thesis, Curtin University, 2003. http://hdl.handle.net/20.500.11937/2307.

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The present study investigated the causal predominance of cognition on anxiety, depression, paranoia, phobia and somatic concern over three time waves of self reported data measured every six months over one year, of 145 cases experiencing their first episodes of psychosis. In turn the symptoms of anxiety, depression, paranoia, phobia and somatic concern were examined for their cross-influential effects on cognition. Cognition was examined under a causal predominance hypothesis as the lead symptom because of its influence recognised in the literature under the neurodevelopmental hypothesis. These longitudinal effects were examined using structural equation modelling. Prior to this investigation, the research was able to demonstrate a stable 6-factor measurement model with these symptoms between two independent samples of early psychosis cases that met guidelines of treatment under the Australian national early psychosis treatment guidelines. This measurement model demonstrated good internal reliability and construct validity. Most symptoms over each time wave had a "domino effect" where the symptom prior to the next wave of assessment had an influence. This is known as a mediation effect. Somatic concern and depression demonstrated a "snow ball" or direct effect where the extent of the condition at time one influenced directly the condition at time three. Structural models, which examined the cross-influential effect between cognition and the other symptoms, demonstrated an effect between paranoia and cognition. This effect demonstrated that paranoia at Time 2 (i.e., 6 months after stabilisation of symptoms), had a crossinfluential effect on cognition at Time 3 (ie, 12 months after stabilisation of symptoms).It was argued that poor thinking styles that lead to distortion in feelings of mistrust evident in the paranoia symptom, in turn led to deterioration in cognition. Other symptoms did not demonstrate a cross influential effect. Previous research suggesting that symptoms act independently of each other over time supports the results of independence of the other symptoms. Further research was suggested by linking different levels of psychosis research of the aetiological factors (e.g. genetic factors), neuropathology (e.g., reduced synapse density) and phenomenology (e.g., positive and negative symptoms) into an integrative framework. It was suggested that structural equation modelling as exemplified in the thesis could be used as a technique to examine how these differing levels could be investigated under a unified theory of psychosis based upon the neurodevelopmental hypothesis.

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Preston, Neil Joseph. "The causal predominance of psychotic experience". Curtin University of Technology, School of Psychology, 2003. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=14961.

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The present study investigated the causal predominance of cognition on anxiety, depression, paranoia, phobia and somatic concern over three time waves of self reported data measured every six months over one year, of 145 cases experiencing their first episodes of psychosis. In turn the symptoms of anxiety, depression, paranoia, phobia and somatic concern were examined for their cross-influential effects on cognition. Cognition was examined under a causal predominance hypothesis as the lead symptom because of its influence recognised in the literature under the neurodevelopmental hypothesis. These longitudinal effects were examined using structural equation modelling. Prior to this investigation, the research was able to demonstrate a stable 6-factor measurement model with these symptoms between two independent samples of early psychosis cases that met guidelines of treatment under the Australian national early psychosis treatment guidelines. This measurement model demonstrated good internal reliability and construct validity. Most symptoms over each time wave had a "domino effect" where the symptom prior to the next wave of assessment had an influence. This is known as a mediation effect. Somatic concern and depression demonstrated a "snow ball" or direct effect where the extent of the condition at time one influenced directly the condition at time three. Structural models, which examined the cross-influential effect between cognition and the other symptoms, demonstrated an effect between paranoia and cognition. This effect demonstrated that paranoia at Time 2 (i.e., 6 months after stabilisation of symptoms), had a crossinfluential effect on cognition at Time 3 (ie, 12 months after stabilisation of symptoms).
It was argued that poor thinking styles that lead to distortion in feelings of mistrust evident in the paranoia symptom, in turn led to deterioration in cognition. Other symptoms did not demonstrate a cross influential effect. Previous research suggesting that symptoms act independently of each other over time supports the results of independence of the other symptoms. Further research was suggested by linking different levels of psychosis research of the aetiological factors (e.g. genetic factors), neuropathology (e.g., reduced synapse density) and phenomenology (e.g., positive and negative symptoms) into an integrative framework. It was suggested that structural equation modelling as exemplified in the thesis could be used as a technique to examine how these differing levels could be investigated under a unified theory of psychosis based upon the neurodevelopmental hypothesis.

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Hides, Leanne, i n/a. "An Examination of the Influence of Cannabis Use on Psychotic Symptom Exacerbation and Relapse in Early Psychosis". Griffith University. School of Applied Psychology, 2003. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20030922.130049.

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There has been concern about the impact of cannabis use on the onset, course and relapse of psychosis. Evidence from retrospective and a small number of prospective studies has suggested that cannabis use may precipitate a latent psychosis, exacerbate psychotic symptoms and increase the likelihood of psychotic relapse. The purpose of the current study was to examine the influence of cannabis use on psychotic symptom exacerbation and relapse within the stress vulnerability-coping model of psychosis. Two studies were conducted. The influence of cannabis use on the onset and course of psychosis was retrospectively examined in the first study. The second study prospectively examined the influence of cannabis use on psychotic symptom exacerbation and relapse over a 6-month period. The influence of the severity of psychotic symptoms on a relapse in cannabis use was also explored. Eighty-four participants were assessed at admission, 81 of whom were followed up for a 6-month period. Measures consisted of structured diagnostic interviews and self-report measures of stress, medication compliance, family functioning, premorbid adjustment, quality of life, substance use and psychotic symptoms. The onset of cannabis use clearly preceded the onset of psychosis. Cannabis use was predictive of the severity of psychotic and general psychopathology symptoms at admission. Both the frequency and quantity of cannabis use was predictive of time to psychotic relapse over the 6-month follow up period. Psychotic symptom severity was predictive of a substantial increase in the quantity but not the frequency of cannabis use. Cannabis use was related to the onset, course and relapse of psychosis.

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Hides, Leanne. "An Examination of the Influence of Cannabis Use on Psychotic Symptom Exacerbation and Relapse in Early Psychosis". Thesis, Griffith University, 2003. http://hdl.handle.net/10072/366456.

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There has been concern about the impact of cannabis use on the onset, course and relapse of psychosis. Evidence from retrospective and a small number of prospective studies has suggested that cannabis use may precipitate a latent psychosis, exacerbate psychotic symptoms and increase the likelihood of psychotic relapse. The purpose of the current study was to examine the influence of cannabis use on psychotic symptom exacerbation and relapse within the stress vulnerability-coping model of psychosis. Two studies were conducted. The influence of cannabis use on the onset and course of psychosis was retrospectively examined in the first study. The second study prospectively examined the influence of cannabis use on psychotic symptom exacerbation and relapse over a 6-month period. The influence of the severity of psychotic symptoms on a relapse in cannabis use was also explored. Eighty-four participants were assessed at admission, 81 of whom were followed up for a 6-month period. Measures consisted of structured diagnostic interviews and self-report measures of stress, medication compliance, family functioning, premorbid adjustment, quality of life, substance use and psychotic symptoms. The onset of cannabis use clearly preceded the onset of psychosis. Cannabis use was predictive of the severity of psychotic and general psychopathology symptoms at admission. Both the frequency and quantity of cannabis use was predictive of time to psychotic relapse over the 6-month follow up period. Psychotic symptom severity was predictive of a substantial increase in the quantity but not the frequency of cannabis use. Cannabis use was related to the onset, course and relapse of psychosis.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology
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10

Henquet, Cécile, Lydia Krabbendam, Janneke Spauwen, Charles Kaplan, Roselind Lieb, Hans-Ulrich Wittchen i Os Jim van. "Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120761.

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Objective: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence. Design: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later. Participants: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis. Main outcome measure: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline. Results: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the “predisposition” group was significantly greater than the risk difference in the “no predisposition” group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31). Conclusion: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.

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Henquet, Cécile, Lydia Krabbendam, Janneke Spauwen, Charles Kaplan, Roselind Lieb, Hans-Ulrich Wittchen i Os Jim van. "Prospective cohort study of cannabis use, predisposition for psychosis, and psychotic symptoms in young people". Technische Universität Dresden, 2004. https://tud.qucosa.de/id/qucosa%3A27119.

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Objective: To investigate the relation between cannabis use and psychotic symptoms in individuals with above average predisposition for psychosis who first used cannabis during adolescence. Design: Analysis of prospective data from a population based sample. Assessment of substance use, predisposition for psychosis, and psychotic symptoms was based on standardised personal interviews at baseline and at follow up four years later. Participants: 2437 young people (aged 14 to 24 years) with and without predisposition for psychosis. Main outcome measure: Psychotic symptoms at follow up as a function of cannabis use and predisposition for psychosis at baseline. Results: After adjustment for age, sex, socioeconomic status, urbanicity, childhood trauma, predisposition for psychosis at baseline, and use of other drugs, tobacco, and alcohol, cannabis use at baseline increased the cumulative incidence of psychotic symptoms at follow up four years later (adjusted odds ratio 1.67, 95% confidence interval 1.13 to 2.46). The effect of cannabis use was much stronger in those with any predisposition for psychosis at baseline (23.8% adjusted difference in risk, 95% confidence interval 7.9 to 39.7, P = 0.003) than in those without (5.6%, 0.4 to 10.8, P = 0.033). The risk difference in the “predisposition” group was significantly greater than the risk difference in the “no predisposition” group (test for interaction 18.2%, 1.6 to 34.8, P = 0.032). There was a dose-response relation with increasing frequency of cannabis use. Predisposition for psychosis at baseline did not significantly predict cannabis use four years later (adjusted odds ratio 1.42, 95% confidence interval 0.88 to 2.31). Conclusion: Cannabis use moderately increases the risk of psychotic symptoms in young people but has a much stronger effect in those with evidence of predisposition for psychosis.

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12

Reeves, Lauren Elizabeth. "Cannabis use and attenuated positive psychotic symptoms: A multiple mediation model". Diss., Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/465547.

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Psychology
Ph.D.
Cannabis use has been associated with various psychosis outcomes, including psychotic disorders, the clinical high risk period of psychosis, and subthreshold measures of psychotic symptoms in non-clinical samples, such as attenuated positive psychotic symptoms (APPS). The present study examined whether individual- and contextual-level factors account for the relationship between cannabis use and psychosis. Specifically, we hypothesized that the relationship between cannabis and psychosis would be mediated by social functioning; negative, depression, anxiety, and aggression symptoms; context of cannabis use; and motivations for cannabis use. Nine hundred and forty-five young adults ages 18-35 years (M = 20.1 years, 24.4% male) completed self-report questionnaires: the Prodromal Questionnaire, Marijuana Use Form, Social Functioning Scale, Center for Epidemiologic Studies Depression Scale, State-Trait Anxiety Inventory-Trait Form-Anxiety Subscale, Social Phobia Scale, Life History of Aggression Scale, Reasons for Use scale, and Drug Use Frequency questionnaire. Psychosis outcomes included a dimensional measure of APPS and a dichotomous measure indicating potential higher/lower risk for psychosis, based on number of distressing symptoms endorsed (i.e., D-APPS status). A multiple mediation framework was used, and significance of mediators was evaluated through estimating the significance of indirect effects using bootstrapped confidence intervals. Increases in negative and aggression symptoms mediated the relationship between higher cannabis use and increases in APPS. Negative and aggression symptoms, context of cannabis use, and using cannabis to cope with unpleasant affect mediated the relationship between cannabis use and high-D-APPS status. Results indicate that individual and contextual-level characteristics may contribute to the relationship between cannabis use and psychosis.
Temple University--Theses

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Bo, Borghild. "The development and preliminary evaluation of a self-administered screening instrument for first rank symptoms and basic symptoms in psychotic and non psychotic disorders". Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 1999. https://ro.ecu.edu.au/theses/1243.

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The assessment of psychopathology is fundamental to clinical psychiatry. Schneider's (1959) First Rank Symptoms (FRS) are an integral part of numerous diagnostic criteria and Huber's Basic Symptoms (BS) are thought to form the basis of the FRS (Huber & Gross, 1989). The aim of the current study was to develop and evaluate a self-administered screening instrument to detect FRS and BS in clinical populations. A three stage design was used to achieve this. Stage one included the development of items and stage two was concerned with item analysis. Stage three comprised a pilot study in which a number of hypotheses were tested in the process of evaluating the instrument's performance. The sample comprised two groups of 51 psychiatric patients (probands) and 50 healthy controls. The probands were diagnosed through the administration of the Diagnostic Interview for Psychosis (DIP; Commonwealth Department of Health and Family Services, in press) and grouped by the Operational Criteria for Psychosis (OPCRIT; McGuffin, Farmer & Harvey, 1991) algorithm into categories of "schizophrenia", "other psychotic" and "non-psychotic" disorders in accordance with the International Classification of Diseases, 10th Revision (ICD-1 0; World Health Organisation, l992a). The results showed that while healthy controls occasionally experience and report the First Rank and Basic Symptoms phenomena, the probands reported significantly more FRS and BS than the healthy controls (p < .001). FRS were reported significantly more frequently by patients diagnosed with schizophrenia than by patients diagnosed with "other psychotic" or "non-psychotic" disorders (Q = .004). BS were reported more frequently by patients with schizophrenia compared with the other two groups, however, the difference was not statistically significant. By using Kendall's tau correlation, the FRS and BS categories were found to be associated. This preliminary study presents data supporting the reliability, validity and the sensitivity of the screening instrument for detecting psychotic symptomatology in clinical populations. The results show that psychiatric patients can self-report their psychopathological experiences. With further development, this instrument may be a useful tool in a variety of clinical and research settings.

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Creese, Byron. "Genetic epidemiology of psychotic symptoms and their treatment in dementia". Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/genetic-epidemiology-of-psychotic-symptoms-and-their-treatment-in-dementia(65565986-7989-4e9d-9905-4f73117ad08b).html.

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There is an urgent need to develop safe and effective treatments for psychotic symptoms in dementia and make better use of current treatments. This will be aided by a better understanding of the mechanisms underlying both the symptoms and treatments. Thus, two lines of research were followed: 1) analysis of the prevalence and course of psychotic symptoms in Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB)/Parkinson’s disease dementia (PDD), and, 2) analysis of the response to treatments in AD. To address the former, the COMT val158met and 5HTTLPR polymorphisms were assessed with respect to the presence of persistent symptoms and the MAPT haplotype with respect to the course of symptoms. The 5HTTLPR LL genotype was associated with a significantly increased risk of persistent delusions in DLB/PDD and the MAPT haplotype with a significantly increased risk of worsening delusions in AD. Finally, the COMT val158met polymorphism was found to predict more rapid cognitive decline in mild AD patients. The examination of point 2) above chiefly concerned histamine H1 receptor antagonism and antipsychotic mortality. Patients taking high affinity H1 antipsychotics had a significantly greater mortality risk compared with those taking no antipsychotics with evidence also suggesting effect modification by the HNMT gene polymorphism. Collectively, in what are among the best characterised cohorts to date, these findings bring greater clarity to the current understanding of the role of 5HTTLPR and COMT val158met in contributing to psychotic symptoms in dementia, supporting the prioritisation of serotonin-acting treatments in DLB/PDD and suggesting that dopamine levels may indirectly influence the presentation of psychosis via more rapid cognitive decline in AD. New evidence was also found to support the hypotheses that tau pathology is associated with psychosis and histamine antagonism is a key harmful property of antipsychotics, with important implications for treatment strategies.

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Gaudiano, Brandon A. Herbert James D. "Acceptance and commitment therapy for psychiatric inpatients with psychotic symptoms /". Philadelphia, Pa. : Drexel University, 2004. http://dspace.library.drexel.edu/handle/1860/295.

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Cooper, Shanna. "EXPERIENTIAL NEGATIVE SYMPTOMS IN YOUNG ADULTS ENDORSING PSYCHOTIC-LIKE EXPERIENCES". Diss., Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/517180.

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Psychology
Ph.D.
While many studies of risk factors for psychosis focus on positive symptoms, such as subthreshold levels of hallucinations and delusions, fewer studies have examined negative symptoms in the early course of the schizophrenia or other psychotic disorders. This relative lack of focus on the role of negative symptoms is problematic, given findings that negative symptoms, such as a loss of motivation and pleasure (MAP), are associated with a more persistent and impairing course of psychosis, and tend to appear earlier in the development of psychotic symptoms. Psychotic disorders, which afflict approximately 3-5% of the population, tend to emerge in late adolescence/early adulthood and are among the most debilitating and costly of mental disorders. The current project explored three areas of negative symptoms in young adults who demonstrated a range of psychotic-like experiences (PLEs). First, a review of the literature pertaining to negative symptoms across the span of psychosis was conducted. Second, we tested whether experiential negative symptoms – specifically MAP deficits – were associated with increases in PLEs, including those that are experienced as distressing (PLEDs). Third, we examined the potential influence of episodic memory performance factors on the relationship between MAP symptoms and PLEs/PLEDs. Collectively, this project highlights the importance of including negative symptoms (i.e., MAP deficits) and/or cognitive performance (i.e., associative/relational learning/memory) outcomes when evaluating people with PLEs/PLEDs to identify those who may be at greater risk for developing a psychotic disorder.
Temple University--Theses

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Law, Hing-kiu Irene. "Help-seeking pathways of parents whose adolescent children manifest psychotic symptoms /". View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36785878.

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Law, Hing-kiu Irene, i 羅慶翹. "Help-seeking pathways of parents whose adolescent children manifest psychotic symptoms". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B45014528.

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Gonterman, Andrea R. "The relationships between insight, psychopathological symptoms, and neurocognitive function in psychotic disorders". Thesis, University of North Texas, 2001. https://digital.library.unt.edu/ark:/67531/metadc3054/.

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Many psychotic patients fail to admit they are mentally ill. The current study evaluated the associations between insight, specific symptoms, and neurocognitive impairments. Thirty-three acute inpatients with a schizophrenia, schizoaffective disorder, or psychotic disorder NOS diagnosis were rated on the SAIE, Birchwood's IS, and the BPRS. Neurocognitive assessments of attention and frontal lobe functioning were also conducted. Stepwise multiple regression analyses found composites representing delusions, disorganization, and anxiety/depression, as well as CPT-IP shapes hit rate, served as significant predictors of total insight or the specific insight dimensions. At least for acute patients, symptoms tended to have stronger relationships with and were more regularly predictive of insight than neurocognitive measures, though the attentional task associated with right hemisphere functioning, contributed significantly.

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Casstevens, Willa Jeanne. "Evaluation of a mentored self-help intervention for the management of psychotic symptoms". FIU Digital Commons, 2006. http://digitalcommons.fiu.edu/etd/2070.

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Cognitive behavioral therapy has been shown to be promising for the treatment of individuals experiencing psychotic symptoms, who are often diagnosed with schizophrenia. Using a non-random non-equivalent comparison group design (n = 26), this study explores whether an individually mentored self-help and self-paced intervention based upon cognitive behavioral approaches to auditory hallucinations or "hearing voices" makes a significant positive difference for individuals with major mental disorder diagnoses and psychotic symptoms who are residing in the community and receiving community mental health services. The mentored self-help intervention uses a workbook (Coleman & Smith, 1997) that stemmed from the British psychiatric survivor and "voice hearers"' movements and from cognitive behavioral approaches to treating psychotic symptoms. Thirty individuals entered the study. Pre- and post-intervention assessments of 15 participants in the intervention group and 11 participants in the comparison group were carried out using standardized instruments, including the Rosenberg Self-Esteem Scale, the Brief Psychiatric Rating Scale, and the Hoosier Assurance Plan Inventory - Adult. Four specific research questions address whether levels of self-esteem, overall psychotic symptoms, depression-anxiety, and disruption in life improved in the intervention group, relative to the comparison group. Pre- and post-assessment scores were analyzed using repeated measures analysis of variance. Results showed no significant difference on any measure, with the exception of the Brief Psychiatric Rating subscale for Anxious Depression, which showed a statistically significant pre-post difference with a strong effect size. A conservative interpretation of this single positive result is that it is due to chance. An alternative interpretation is that the mentored self-help intervention made an actual improvement in the level of depression-anxiety experienced by participants. If so, this is particularly important given high levels of depression and suicide among individuals diagnosed with schizophrenia. This alternative interpretation supports further research on the intervention utilized in this study.

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Thewissen, Viviane Hubertine Marie. "Understanding the psychology of positive psychotic symptoms an epidemiological and momentary assessment approach /". [Maastricht] : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=9198.

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Homer, Hanne Margareta. "The waxing and waning of psychotic symptoms and co-fluctuating source memory impairment". Thesis, University of East Anglia, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.251895.

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Venneri, Annalena. "A study of psychotic symptoms in Alzheimer's disease : a cognitive and neuroimaging approach". Thesis, University of Aberdeen, 1999. http://digitool.abdn.ac.uk/R?func=search-advanced-go&find_code1=WSN&request1=AAIU116371.

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Delusions in AD have been poorly investigated and research focusing on identifying the neurobiological substrates of delusions in degenerative dementia has shown lack of consistent findings among studies. By using a cognitive and neuroimaging approach, we studied content specific delusions in AD with the aim to identify their neurological and cognitive correlates. Our data indicate that delusions in AD may be associated with areas of hypoperfusion in the right anterior hemisphere. Further, by selecting AD patients presenting delusions of similar content we have demonstrated that the locus of the brain dysfunction is crucial in determining the content of the delusion. Different delusions result from discrete foci of dysfunction within the right hemisphere. A substantial part of this project focused on a detailed study of a new form of delusion that we have termed autobiographical delusions. Findings showed that this form of delusion results from discrete dysfunction in the right frontal lobe. The patients with autobiographical delusions appear to share also a similar neuropsychological profile. When compared with patients not showing delusions, a difference in performance was detected in episodic memory and executive function tests.

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Weinberg, Laura. "Living a valued life with psychosis : the relationship between psychotic symptoms, illness beliefs, experiential avoidance and success at valued living". Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/29419.

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The aim of this study is to investigate factors associated with success at valued living in a sample of individuals who have experienced psychosis. The association between psychotic symptoms, illness beliefs, experiential avoidance and success at valued living is explored. Method: Eighty-four individuals with experiences of psychosis completed standardised self-report measures of beliefs about illness, experiential avoidance and valued living. The researcher rated an individual’s psychotic symptoms with an interview-based measure. Data were analysed using correlations and path analysis, an extension of multiple regression. Results: Results indicated that success at valued living was best predicted by experiential avoidance. Neither psychotic symptoms nor illness beliefs were found to be directly associated with success at valued living. The clinical and theoretical implications of these findings are discussed.

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Sanderson, Victoria. "Post-Secondary Students with Symptoms of Psychosis: A Mixed-Methods Systematic Review". Thesis, Université d'Ottawa / University of Ottawa, 2019. http://hdl.handle.net/10393/39788.

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The purpose of this thesis was to synthesize evidence on symptoms of psychosis in post-secondary students, including participant characteristics, prevalence, risk factors, interventions, and reported experiences. The design was a mixed-methods systematic review, modeled on the Joanna Briggs Institute and PRISMA guidelines, with all standard systematic review procedures followed. A search in nine databases yielded 26 (published between 2006 and 2018) articles for inclusion. Data were analyzed according to objectives and reported using synthesis tables and narrative summaries. Average age of participants was 21 years and most identified as female and Caucasian. Prevalence of psychosis across the included studies was inconclusive. Risk factors associated with symptoms of psychosis included substance use, depression, and younger age. There were five interventions with mixed results and three studies about experiences. While five promising interventions exist, inadequate testing and replication limits confidence in their effectiveness. There is a notable deficit in qualitative evidence exploring the experiences of students with symptoms of psychosis.

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Kuzenko, Nina, Jitender Sareen, Katja Beesdo-Baum, Axel Perkonigg, Michael Höfler, James Simm, Roselind Lieb i Hans-Ulrich Wittchen. "Associations Between Cocaine, Amphetamine or Psychedelic Use and Psychotic Symptoms in a Community Sample". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-118271.

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Objective: To investigate whether there is an association between use of cocaine, amphetamines, or psychedelics and psychotic symptoms. Method: Cumulated data from a prospective, longitudinal community study of 2588 adolescents and young adults in Munich, Germany were used. Substance use was assessed at baseline, 4-year and 10-year follow-up using the Munich Composite International Diagnostic Interview; psychotic symptoms were assessed at 4-year and 10-year follow-up. Multinomial logistic regression analyses, adjusted for sociodemographic factors, common mental disorders, other substance use, and childhood adversity (adjusted odds ratios, AOR), revealed associations between cocaine, amphetamine or psychedelic use and psychotic symptoms. Results: Lifetime experience of psychotic symptoms was associated with lifetime use of cocaine (AOR 1.94; 95%CI 1.10-3.45), amphetamines (AOR 1.69; 95%CI 0.98-2.93), psychedelics (AOR 2.37; 95%CI 1.20-4.66) and all three substances (AOR 1.95; 95%CI 1.19-3.18). Conclusion: Associations between psychotic symptoms and use of cocaine, amphetamines, and/or psychedelics in adolescents and young adults call for further studies to elucidate risk factors and developmental pathways.

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Kuzenko, Nina, Jitender Sareen, Katja Beesdo-Baum, Axel Perkonigg, Michael Höfler, James Simm, Roselind Lieb i Hans-Ulrich Wittchen. "Associations Between Cocaine, Amphetamine or Psychedelic Use and Psychotic Symptoms in a Community Sample". Technische Universität Dresden, 2011. https://tud.qucosa.de/id/qucosa%3A27049.

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Objective: To investigate whether there is an association between use of cocaine, amphetamines, or psychedelics and psychotic symptoms. Method: Cumulated data from a prospective, longitudinal community study of 2588 adolescents and young adults in Munich, Germany were used. Substance use was assessed at baseline, 4-year and 10-year follow-up using the Munich Composite International Diagnostic Interview; psychotic symptoms were assessed at 4-year and 10-year follow-up. Multinomial logistic regression analyses, adjusted for sociodemographic factors, common mental disorders, other substance use, and childhood adversity (adjusted odds ratios, AOR), revealed associations between cocaine, amphetamine or psychedelic use and psychotic symptoms. Results: Lifetime experience of psychotic symptoms was associated with lifetime use of cocaine (AOR 1.94; 95%CI 1.10-3.45), amphetamines (AOR 1.69; 95%CI 0.98-2.93), psychedelics (AOR 2.37; 95%CI 1.20-4.66) and all three substances (AOR 1.95; 95%CI 1.19-3.18). Conclusion: Associations between psychotic symptoms and use of cocaine, amphetamines, and/or psychedelics in adolescents and young adults call for further studies to elucidate risk factors and developmental pathways.

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Spengler, Peter A., i Hans-Ulrich Wittchen. "Procedural validity of standardized symptom questions for the assessment of psychotic symptoms: A comparison of the DIS with two clinical methods". Technische Universität Dresden, 1988. https://tud.qucosa.de/id/qucosa%3A26471.

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The study examines to what degree well-documented present and life-time psychotic symptoms in a group of former psychiatric inpatients are ascertained when using the Diagnostic Interview Schedule (DIS). The Inpatient Multidimensional Psychiatric Scale (IMPS) and the Manual for the Assessment and Documentation of Psychopathology/Diagnostische Sichtlochkartei (AMDP/DiaSika) Interview-Checklist approach were used for the “clinical” evaluations of symptoms. The results indicate fair concordance between the two clinical approaches and the DIS with regard to the presence of any delusional or hallucination symptoms. Low to poor agreement was found in the assessment of many of the rather specific hallucinations and delusions. Generally, the concordance found was higher when compared to the more clinical AMDP/DiaSiKa approach than to the IMPS. More detailed comparisons with diagnostic subgroups of schizophrenic and schizoaffective patients substantiated the findings in the overall sample. Overall it was reconfirmed that the DIS approach is limited to those patients who are cooperative and at least partly remitted.

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丁錫全 i Sik-chuen Dick Ting. "Relationship of psychotic symptoms to sex offending: a retrospective study of sex offenders with mentaldisorders". Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2008. http://hub.hku.hk/bib/B39558162.

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Mapplebeck, Clare. "The experience of change and psychological growth in people with psychotic symptoms : a phenomenological approach". Thesis, University of Nottingham, 2010. http://eprints.nottingham.ac.uk/11654/.

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Objective. The present study explored people‘s subjective experiences of positive change to understand if experiences of growth are evident in people who have experienced trauma and psychosis. Design. Purposive sampling was used to recruit seven participants from local mental health support groups. All participants reported a diagnosis on the schizophrenia spectrum of disorders and were interviewed using a semi-structured interview schedule designed for the purpose of this study. Methods. Interviews were transcribed and analysed using interpretative phenomenological analysis. Results. Participants described the processes involved in moving towards positive change, with the overarching theme describing a journey towards recovery. Two superordinate themes were identified in the study and included: 'barriers to change' and 'the adapting self'. A number of subordinate themes were discussed within these. Conclusion. Participants described key changes in facilitating psychological growth and recovery, including: self-acceptance, adapting to their experiences and self-integration and identity re-formation. Social support, finding meaning and purpose and regaining control over their lives were also integral in facilitating the process towards psychological growth. The study discussed clinical implications in relation to the changes needed in the provision of psychological therapies to aid and promote psychological growth in this population. Methodological considerations of the research are discussed and future research ideas are suggested.

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Ting, Sik-chuen Dick. "Relationship of psychotic symptoms to sex offending a retrospective study of sex offenders with mental disorders /". Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/HKUTO/record/B39558162.

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Norman, Catherine. "Thinking about thinking : an exploration of metacognitive factors in the development and maintenance of positive psychotic symptoms". Thesis, University of Southampton, 2013. https://eprints.soton.ac.uk/359249/.

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The literature review discusses the role of metacognition, defined as the cognitive processes involved in ‘thinking about thinking’, in the development and maintenance of persecutory delusions and auditory hallucinations. Much of the literature points to a strong role for metacognitive beliefs in the experience of both clinical and non-clinical levels of these symptoms and evidence is emerging too for the importance of metacognitive strategies, for example thought control, in the maintenance of persecutory delusions. Research to date however, has relied predominantly on non-causal correlational methodology to investigate the relationship between metacognition and psychosis. In addition, there is some difficulty in discerning the contribution of metacognition to persecutory delusions and auditory hallucinations specifically, owing to combined analysis or inclusion of delusions that are not persecutory or hallucinations that are not auditory. Overall, the findings of this review support the application of the Self- Regulatory Executive Model (S-REF) to the positive symptoms of psychosis and research strongly demonstrates the key role of affective processes in the development and maintenance of clinical and non-clinical persecutory delusions and auditory hallucinations. The study aimed to explore the role of metacognitive strategies and metacognitive awareness in the maintenance of distress in non-clinical paranoia. A 2x2 between-subject experimental design (paranoia x condition) was employed. Seventy-three non-clinical staff and students participated in the study and were randomised to an experimental condition including an anxiety-inducing task or control condition. All participants completed measures of paranoia, anxiety, self- focus, metacognitive strategies and metacognitive awareness. Results demonstrated that participants with non-clinical paranoia experienced more paranoid cognitions, state and trait anxiety and used significantly more metacognitive strategies, including thought suppression. In addition, there was some evidence for lower metacognitive awareness in participants with high paranoia. These findings were not associated with condition. Future research and clinical implications in relation to the results are discussed.

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Eblin, Joshua J. "Examination of the Validity of the Thought and Perception Assessment System: A Behavioral Measure of Psychotic Symptoms". University of Toledo / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1419279941.

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Eriksson, Linda Kristina. "Do psychosocial interventions for psychotic disorders improve quality of life in adults with psychotic disorders in forensic settings? : a systematic review and narrative synthesis ; and, Modified metacognitive training for negative symptoms in psychosis : a feasibility study". Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31197.

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This thesis focuses on psychosocial interventions for psychosis. It consists of two parts: a systematic review on quality of life in forensic settings and an empirical study on negative symptoms. The systematic review follows the publication guidelines of the journal International Journal of Forensic Mental Health whilst the empirical study follows the publication guidelines of the journal Clinical Psychology and Psychotherapy. Reasonable adjustments have been made to the formatting of this thesis to enhance readability. Purpose: The systematic literature review aimed to summarise and critically appraise studies that have evaluated the effects of psychosocial interventions for psychotic disorders in forensic settings on quality of life. The empirical study aimed to evaluate the feasibility of Metacognitive Training (MCT) for negative symptoms and to identify mechanisms of change. Methods: The literature was systematically searched (using four databases) for research that included any quantitative measure of quality of life (i.e. self-esteem, quality of life, life satisfaction, and/or self-efficacy in relation to life-goals). In the empirical study, a new intervention was developed by modifying MCT for negative symptoms and four aspects of feasibility were evaluated: acceptability, practicality, demand and limited efficacy. The quantitative approach was supplemented with qualitative interviews on participants' views of the intervention. In addition, potential mechanisms of change were evaluated using a promising new method for analysing data from case-series: multilevel modeling. Results: In total, 10 papers met the inclusion criteria in the systematic review. Significant improvements in quality of life were found in five studies. The modified version of MCT showed good feasibility as demonstrated by the attendance rate, the positive oral feedback from participants and the multidisciplinary team, and the improvements on negative symptoms that were found following the intervention. Multilevel modeling proved useful in explaining the variance attributable to three different predictors: depression, internalised stigma, and reflective functioning. Conclusions: It was found that quality of life can be improved in forensic settings using psychosocial interventions. The pilot study indicated that MCT for negative symptoms has high feasibility and that changes in negative symptoms can partially be explained by depression, stigma, and reflective functioning.

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Rogers, Andrew. "Attributional style, theory of mind ability and episodic memory functioning : an integrated cognitive neuropsychological account of psychotic symptoms". Thesis, University of Surrey, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.244780.

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Schuller, Stefan. "Helping to make sense : an evaluation of team-based cognitive-behavioural formulation workshops for recent onset psychotic symptoms". Thesis, Open University, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.441154.

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Kuepper, Rebecca, Os Jim van, Roselind Lieb, Hans-Ulrich Wittchen, Michael Höfler i Cécile Henquet. "Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-120779.

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Objective: To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis). Design: Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study). Setting: Population based cohort study in Germany. Participants: 1923 individuals from the general population, aged 14-24 at baseline. Main outcome measure: Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI). Results: In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively. Conclusion: Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

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Kuepper, Rebecca, Os Jim van, Roselind Lieb, Hans-Ulrich Wittchen, Michael Höfler i Cécile Henquet. "Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study". Technische Universität Dresden, 2011. https://tud.qucosa.de/id/qucosa%3A27121.

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Objective: To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis). Design: Analysis of data from a prospective population based cohort study in Germany (early developmental stages of psychopathology study). Setting: Population based cohort study in Germany. Participants: 1923 individuals from the general population, aged 14-24 at baseline. Main outcome measure: Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI). Results: In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016). The incidence rate of psychotic symptoms over the period from baseline to T2 was 31% (152) in exposed individuals versus 20% (284) in non-exposed individuals; over the period from T2 to T3 these rates were 14% (108) and 8% (49), respectively. Conclusion: Cannabis use is a risk factor for the development of incident psychotic symptoms. Continued cannabis use might increase the risk for psychotic disorder by impacting on the persistence of symptoms.

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Clark-Papasavas, Chloe Melissa. "Characterising the neuropsychological profile of psychotic symptoms in Alzheimer's disease and imaging D2/3 receptor occupancy during treatment". Thesis, King's College London (University of London), 2014. https://kclpure.kcl.ac.uk/portal/en/theses/characterising-the-neuropsychological-profile-of-psychotic-symptoms-in-alzheimers-disease-and-imaging-d23-receptor-occupancy-during-treatment(e96bd2b4-7a12-4f4a-923a-637d857bbc2d).html.

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Background: Psychotic symptoms occur in approximately 40% of patients with Alzheimer's disease (AD) and have been linked with striatal dopamine (D2/3) receptor function. The first component of the thesis aims to investigate the neuropsychological profile accompanying psychotic symptoms in AD, and establish whether cognitive and motor tasks which have a documented association with dopaminergic function might be markers of psychotic symptoms and delusional subtypes in AD. Dopamine D2/3 receptor occupancy studies have been instrumental in guiding antipsychotic prescribing in schizophrenia. The second part of the thesis aims to adapt [18F]fallypride imaging for use in healthy older people and in dopamine (D2/3) receptor occupancy studies in AD. Methods: Neuropsychology: 70 AD subjects aged between 65 and 95 years were categorised into psychotic (n=34) and non-psychotic (n=36) groups, based on carer-rated scales, and then compared using a hypothesis-driven test battery. Imaging: Eight healthy older (>65 years) adults were scanned twice, 4-6 weeks apart. [18F]fallypride binding potential (BPND) was determined and test-retest variability and intraclass correlation coefficient (ICC) values were calculated. A further six subjects with AD were recruited prior to commencing amisulpride treatment. [18F]fallypride BPND pre/post 2-8 weeks of amisulpride treatment and D2/3 occupancy was measured. Results: Neuropsychology: Subjects with psychotic symptoms, in particular misidentification phenomena, had significantly poorer sustained attentional and visuoperceptual function. Imaging: The adapted [18F]fallypride scanning protocol showed high reproducibility and reliability in all but the prefrontal regions and was generally well tolerated in AD subjects. Conclusion: Neuropsychology: Sustained attention deficits may act as a marker of psychotic symptoms in AD due to associations with dopaminergic function in the associative striatum. Visuoperceptual deficits may indicate additional pathology in the ventral visual stream, which could characterize the misidentification subgroup. Imaging: The feasibility of an adapted scanning protocol was demonstrated in AD subjects and represents the first step towards defining a 'therapeutic window' of D2/3 occupancy to guide antipsychotic prescribing in AD.

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Lapworth, Kely Narelle. "An Investigation of Aggression in Methamphetamine Users". Thesis, Griffith University, 2011. http://hdl.handle.net/10072/366564.

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Methamphetamine (MA) use is associated with increased aggression, though the specific mechanisms through which this association operates remain unclear. Research has demonstrated an association between MA, heightened impulsivity and reduced behavioural control. Similarly, there is strong evidence of a link between MA use and psychotic symptoms. Despite research efforts examining these independent associations, there is a paucity of studies examining how these factors interact to influence the relationship between MA use and aggression. Study 1 was conducted to examine the independent and combined roles of impulsivity and positive psychotic symptoms on the relationship between MA and aggression. In this study, 237 injecting MA users completed a range of self-report measures of hostility, impulsivity, and dependence. Higher levels of MA dependence were associated with increased hostility, higher levels of impulsivity and greater positive psychotic symptoms. Furthermore, the relationship between MA use and aggression was mediated by both impulsivity and positive symptoms of psychosis. Synergistic effects of impulsivity and positive psychotic symptoms on hostility were also observed, with substantially higher levels of hostility being associated with the presence of positive symptoms in conjunction with heightened impulsivity. The results of Study 1 are important in increasing our current understanding of the relationship between MA dependence and aggression, but the reliance on self-report measures does present a problem because of the susceptibility of such measures to report biases. Study 2 was therefore designed to extend previous research by exploring the relationship between MA and aggression using a behavioural measure of aggression, as well as self-report measures. Behavioural and self-report measures of impulsivity were also included. Results revealed that MA users, compared with non-MA users, not only reported higher levels of aggression, but they actually behaved more aggressively when competing with a (fictitious) opponent. Furthermore, some evidence of a dose-response relationship between MA and aggression was apparent. Unexpectedly, no group differences were evident on either the behavioural or self-report measures of impulsivity. Taken together, the present research attests to the robustness of the relationship between MA use and aggression, and points to the need for increased understanding of the complex and multifaceted nature of factors such as impulsivity and positive psychotic symptoms that contribute to this relationship.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Psychology
Griffith Health
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Valton, Vincent. "Impaired reinforcement learning and Bayesian inference in psychiatric disorders : from maladaptive decision making to psychosis in schizophrenia". Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/21097.

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Computational modelling has been gaining an increasing amount of support from the neuroscience community as a tool to assay cognition and computational processes in the brain. Lately, scientists have started to apply computational methods from neuroscience to the study of psychiatry to gain further insight into the mechanisms leading to mental disorders. In fact, only recently has psychiatry started to move away from categorising illnesses using behavioural symptoms in an attempt for a more biologically driven diagnosis. To date, several neurobiological anomalies have been found in schizophrenia and led to a multitude of conceptual framework attempting to link the biology to the patients’ symptoms. Computational modelling can be applied to formalise these conceptual frameworks in an effort to test the validity or likelihood of each hypothesis. Recently, a novel conceptual model has been proposed to describe how positive symptoms (delusions, hallucinations and thought disorder) and cognitive symptoms (poor decision-making, i.e. “executive functioning”) might arise in schizophrenia. This framework however, has not been tested experimentally or against computational models. The focus of this thesis was to use a combination of behavioural experiments and computational models to independently assess the validity of each component that make up this framework. The first study of this thesis focused on the computational analysis of a disrupted prediction-error signalling and its implications for decision-making performances in complex tasks. Briefly, we used a reinforcement-learning model of a gambling task in rodents and disrupted the prediction-error signal known to be critical for learning. We found that this disruption can account for poor performances in decision-making due to an incorrect acquisition of the model of the world. This study illustrates how disruptions in prediction-error signalling (known to be present in schizophrenia) can lead to the acquisition of an incorrect world model which can lead to poor executive functioning or false beliefs (delusions) as seen in patients. The second study presented in this thesis addressed spatial working memory performances in chronic schizophrenia, bipolar disorder, first episode psychosis and family relatives of DISC1 translocation carriers. We build a probabilistic inference model to solve the working memory task optimally and then implemented various alterations of this model to test commonly debated hypotheses of cognitive deficiency in schizophrenia. Our goal was to find which of these hypotheses accounts best for the poor performance observed in patients. We found that while the performance at the task was significantly different for most patients groups in comparison to controls, this effect disappeared after controlling for IQ in one group. The models were nonetheless fitted to the experimental data and suggest that working memory maintenance is most likely to account for the poor performances observed in patients. We propose that the maintenance of information in working memory might have indirect implications for measures of general cognitive performance, as these rely on a correct filtering of information against distractions and cortical noise. Finally the third study presented in this thesis assessed the performance of medicated chronic schizophrenia patients in a statistical learning task of visual stimuli and measured how the acquired statistics influenced their perception. We find that patient with chronic schizophrenia appear to be unimpaired at statistical learning of visual stimuli. The acquired statistics however appear to induce less expectation-driven ‘hallucinations’ of the stimuli in the patients group than in controls. We find that this is in line with previous literature showing that patients are less susceptible to expectation-driven illusions than controls. This study highlights however the idea that perceptual processes during sensory integration diverge from this of healthy controls. In conclusion, this thesis suggests that impairments in reinforcement learning and Bayesian inference appear to be able to account for the positive and cognitive symptoms observed in schizophrenia, but that further work is required to merge these findings. Specifically, while our studies addressed individual components such as associative learning, working memory, implicit learning & perceptual inference, we cannot conclude that deficits of reinforcement learning and Bayesian inference can collectively account for symptoms in schizophrenia. We argue however that the studies presented in this thesis provided evidence that impairments of reinforcement learning and Bayesian inference are compatible with the emergence of positive and cognitive symptoms in schizophrenia.

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Haggarty, David. "Exploring the delivery of family interventions to people facing recent-onset psychotic symptoms : the experience of navigating the family system". Thesis, University of Leicester, 2016. http://hdl.handle.net/2381/38223.

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The experience of an episode of psychosis can be distressing and confusing. Families can encounter issues of grief and loss and may have difficulties navigating complicated healthcare structures. Family interventions (FIs) have been under-researched and have been difficult to implement in general clinical practice. Healthcare systems usually concentrate resources on acute and inpatient services. The delivery of evidence-based psychosocial treatments which support families are often overlooked. Part 1: A systematic review of the quantitative research literature on the effects of FIs on relapse and rehospitalisation in people with recent-onset psychosis was conducted. Searches of four bibliographic databases were completed and ten studies met the criteria for inclusion. FIs were either delivered as a discrete intervention or as part of a multi-element intervention. Findings highlighted that multi-element interventions were effective in reducing time spent in hospital. These treatment gains were robust and conferred long-term advantages. FIs delivered as a discrete intervention had mixed success in reducing the likelihood of readmission. However, there was some evidence that they reduced time in supported living environments as a whole. FIs have some success in reducing relapse and readmission for people with recent-onset psychosis. There have been difficulties in implementing FIs in routine clinical services. Existing research has focused on exploring family workers’ experiences with questionnaires. Further in-depth research is required to capture their experiences in rich detail. Part 2: The research study used Interpretative Phenomenological Analysis (IPA) to investigate the experience of delivering FIs to people with recent-onset psychosis and their families. Five care coordinators from early intervention psychosis (EIP) services were interviewed. Five superordinate themes were identified: A) External supports to delivering family work, B) Balancing the care coordinator and family worker roles, C) Barriers to engaging families, D) The internal world of the family worker and E) Family communication and relationships. The themes were considered in relation to the current understanding of FIs and the wider psychological literature. The findings highlight the need for establishing supportive and enabling conditions for FIs to thrive. Family workers face many clinical dilemmas and conflicts in the course of the work. It is important that high-quality clinical supervision is appropriately provisioned in order to help navigate these. Part 3: The researcher’s reflective account of the research journey. This incorporates the logistical processes, strengths and weaknesses of the study and personal learning as a critical appraisal.

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Heuvelman, Hein Hendrik Pieter. "Ethnicity and psychosis : an investigation of the validity of psychosis screening instruments in the context of cross-cultural population-based survey research". Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/ethnicity-and-psychosis--an-investigation-of-the-validity-of-psychosis-screening-instruments-in-the-context-of-crosscultural-populationbased-survey-research(1019c614-3576-4e4b-8487-41a3470c8371).html.

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Population-based evidence suggests that the prevalence of psychotic symptoms varies with ethnicity. However, the validity of these self-reported experiences, both as measures of psychotic symptoms per se and as measures of ethnic variation in risk for reporting these symptoms, is questionable. Cultural background and social position may affect the experience and expression of symptoms, which may in turn affect their measurement in survey research. This thesis explores these issues by assessing the psychometric properties of psychosis screening instruments as measures of ethnic differences in psychosis risk in two contexts, Great Britain and the United States. Following this, differences in risk for reporting psychotic symptoms were examined in the context of the varying social and economic conditions to which different ethnic groups and migrant generations are exposed. This was accomplished in the following way: Firstly, the prevalence of self-reported psychotic symptoms was examined across ethnic and generational groups in two large samples of British and American populations; Secondly, the construct validity of the instruments was assessed by means of exploratory and confirmatory factor analyses of response to their symptom indicators. The concurrent validity of the symptoms with measures of self-perceived cognitive and social dysfunction was then examined in a structural equation modeling framework; Thirdly, the cross-ethnic and cross-generational validity of response to these screening instruments was assessed in a multiple-group confirmatory factor analysis framework in which in which the psychometric characteristics of the instruments were compared; And finally, ethnic and generational differences in risk for reporting psychotic symptoms were examined in the context of differential exposure to racial discrimination. Both instruments had construct validity in their measurement of psychotic symptoms, with the exception of one item in the British instrument, as well as concurrent validity with measures of self-perceived cognitive or social dysfunction. The British instrument performed adequately in the measurement of psychotic symptoms across ethnic groups, but did not across migrant generations. The American instrument performed adequately in the measurement of psychotic symptoms across generations, but not across ethnic groups. The effect of measurement noninvariance on the estimation of risk across groups was, however, modest in size. Finally, there was evidence for risk of reporting psychotic symptoms being raised among those who were exposed to racial discrimination. These findings suggest that these self-reported psychotic symptoms constitute clinically relevant phenomena which appear phenotypically similar to the clinical symptoms in diagnosed psychotic disorder. Risk is distributed unevenly over ethnic groups in Britain and the US, is higher among minorities who were exposed to social adversity, and higher among the second generation (in most cases). These patterns are, therefore, highly suggestive of social causation in the aetiology of these self-reported symptoms.

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Barragán, Farfán Janis Marcela. "Psychotic-like experiences and psychometric schizotypy: their relationships with depressive symptoms and theory of mind in adolescents from the general population". Doctoral thesis, Universitat Autònoma de Barcelona, 2013. http://hdl.handle.net/10803/129120.

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Las personas que experimentan síntomas seudopsicóticos (SSP) presentan un riesgo elevado de sufrir trastornos psicóticos. Sin embargo, asociaciones encontradas entre SSP y trastornos no psicóticos sugieren que la relevancia clínica de los SSP no se limita a la psicosis y por lo tanto, investigar el rol de síntomas adicionales tales como la depresión, puede mejorar la capacidad de predecir el riesgo de desarrollar trastornos psicóticos. Asimismo, estudiar las habilidades en teoría de la mente (ToM), área cognitiva que sufre alteraciones en pacientes con esquizofrenia, en adolescentes de la población general, puede contribuir a clarificar si las personas consideradas en riesgo presentan déficits en ToM. La evidencia sugiere que los déficits en ToM no son exclusivos de los pacientes sintomáticos y que una mayor comprensión de la naturaleza de estas alteraciones se puede lograr a través su estudio antes del inicio del trastorno. Objetivos: (1) examinar la presencia de SSP positivos y negativos y su asociación con síntomas depresivos en una muestra de adolescentes de la población general; (2) analizar la presencia de subtipos de SSP positivos y negativos, y (3) examinar el funcionamiento de ToM, su asociación con esquizotipia psicométrica, SSP y síntomas depresivos. Método: los participantes en este estudio transversal fueron adolescentes con edades entre los 13 y 17 años, estudiantes de secundaria en escuelas de Barcelona, España. Para establecer la presencia de subtipos de SSP positivos y negativos se llevaron a cabo análisis factoriales de las subescalas que evaluaban estos síntomas. La asociación entre los subtipos de síntomas positivos y negativos y los síntomas depresivos se examinó mediante el análisis de regresión múltiple. Resultados: Se identificaron dimensiones de SSP y esquizotipia en esta muestra de adolescentes de la población general. Cuatro factores de síntomas positivos (ideación persecutoria, ideación de grandiosidad, experiencias alucinatorias/de primer rango y pensamiento auto-referencial) y tres factores de síntomas negativos (retraimiento social, aplanamiento afectivo y abulia) fueron identificados. Se encontraron relaciones entre los subtipos de síntomas positivos y negativos y síntomas depresivos, así: la ideación persecutoria y las experiencias alucinatorias y de primer rango se asociaron a puntuaciones más altas en síntomas depresivos, mientras que la ideación de grandiosidad se asoció a puntuaciones más bajas en depresión. No se encontró asociación entre depresión y pensamiento autorreferencial. Se encontraron también asociaciones entre subtipos de síntomas negativos y depresión: retraimiento social y abulia se asociaron positivamente al auto-informe de síntomas depresivos, mientras que el aplanamiento afectivo no se asoció a depresión. No se observaron diferencias en las habilidades de ToM entre los adolescentes con puntuaciones totales más altas en SSP o esquizotipia comparados con los adolescentes con puntuaciones totales más bajas. Las puntuaciones altas en la escala de experiencias inusuales que evalúa esquizotipia positiva, al igual que la subescala de experiencias de primer rango, se asociaron con déficits en ToM, mientras que la ideación persecutoria se asoció a un mejor desempeño en ToM. El desempeño en ToM no se asoció a pensamiento mágico ni a experiencias alucinatorias. Los síntomas negativos y la esquizotipia negativa no se relacionaron con el desempeño en ToM. Un mejor desempeño en ToM se asoció a mayor no-conformidad impulsiva. Conclusiones: los hallazgos presentados en esta tesis confirman que no todos los tipos de SSP positivos y negativos se asocian con depresión y por lo tanto, podrían conferir diferente vulnerabilidad a sufrir trastornos psicóticos. Las alteraciones en ToM no se limitan a la fase aguda de un trastorno psicótico, y podrían asociarse a la esquizotipia positiva y a experiencias de primer rango. Estos hallazgos sugieren que es posible identificar alteraciones en ToM durante la adolescencia antes del inicio de cualquier trastorno.
Individuals who report psychotic-like experiences (PLEs) are at significantly increased risk for clinical psychotic disorders. However, associations between PLEs and non-psychotic disorders indicate that the clinical relevance of PLEs is not limited to psychosis and thus, investigating the role of additional symptoms, such as depression, may improve the capacity to predict risk of developing psychotic disorders. Additionally, studying theory of mind (ToM) abilities, one of the cognitive areas impaired in schizophrenic patients, in adolescents from the general population may contribute to clarify whether ToM deficits are present in at-risk individuals before the onset of the illness and derived impairments. Evidence suggests that ToM impairments are not exclusive of symptomatic patients, and that further understanding of the nature of ToM dysfunction in schizophrenia might be achieved through examination of ToM impairments from the early phases and even before the onset of the illness. Objectives: this thesis was aimed at (1) examining the presence of both positive and negative PLEs and their association with depressive symptoms in a community sample of adolescents; (2) analysing the presence of subtypes of positive and negative PLEs dimensions in adolescents of the community, and (3) exploring ToM functioning, its association with psychometric schizotypy, PLEs, and depressive symptoms, in a sample of adolescents from the general population. Method: participants in this cross-sectional study were adolescents aged between 13 and 17 years, attending compulsory secondary education in schools from Barcelona, Spain. To establish the presence of subtypes of positive and negative PLEs, separate principal component factor analyses of the CAPE positive and negative subscales were performed. Multiple linear regression analysis was conducted to examine the association between specific CAPE positive and negative PLE subtypes and depressive symptoms. Results: PLEs and psychometric schizotypy dimensions were present in this community sample of adolescents. Four factors of positive symptoms (persecutory ideation, grandiose thinking, first-rank-hallucinatory, and self-referential thinking) and three factors of negative symptoms (social withdrawal, affective flattening, and avolition) emerged from the analysis. Different relationships between subtypes of positive PLEs and depressive symptoms were found: persecutory ideation and first-rank/hallucinatory experiences related to higher scores on the depressive symptoms scale whilst grandiose thinking related to lower scores on depression. No association with self-referential thinking was found. Associations between subtypes of the negative dimension and depression were also found: social withdrawal and avolition were positively associated with the self-report of depressive symptoms, while affective flattening did not relate to depression. No differences were found in ToM abilities in adolescents with higher global scores on schizotypy or PLEs relative to those with lower global scores. Higher scores on the unusual experiences subscale assessing positive schizotypy and on first-rank experiences were associated with poorer ToM ability, whereas persecutory beliefs were related to better ToM performance. No association was found between ToM and magical thinking or hallucinatory experiences. Negative PLEs or negative schizotypy were not related to ToM abilities. In addition, an association between better mentalising abilities and higher impulsive nonconformity was found. Conclusions: these findings support the view that not all types of positive and negative PLEs in adolescence are associated with depression and, therefore, may not confer the same vulnerability for psychotic disorders. ToM impairments are not restricted to the acute phase of a psychotic disorder, and may be associated to positive schizotypy and first-rank experiences. These findings constitute evidence indicating that ToM impairments can be identified during adolescence before the onset of any psychotic disease.

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Jaya, Edo Sebastian Verfasser], i Tania [Akademischer Betreuer] [Lincoln. "The interplay between social factors and psychotic symptoms : Cognitive vulnerability and affective pathway in focus / Edo Sebastian Jaya ; Betreuer: Tania Lincoln". Hamburg : Staats- und Universitätsbibliothek Hamburg, 2017. http://d-nb.info/1136719903/34.

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Schlier, Björn [Verfasser], i Tania [Akademischer Betreuer] Lincoln. "Psychotic symptoms in ambulatory assessment and longitudinal studies : Development of state measures and evaluation of stress-related predictors / Björn Schlier ; Betreuer: Tania Lincoln". Hamburg : Staats- und Universitätsbibliothek Hamburg, 2019. http://d-nb.info/1187444820/34.

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Wigman, Johanna T. W., Nierop Martine van, Wilma A. M. Vollebergh, Roselind Lieb, Katja Beesdo-Baum, Hans-Ulrich Wittchen i Os Jim van. "Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity – Implications for Diagnosis and Ultra-High Risk Research". Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-129460.

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Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n=3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.

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Wigman, Johanna T. W., Nierop Martine van, Wilma A. M. Vollebergh, Roselind Lieb, Katja Beesdo-Baum, Hans-Ulrich Wittchen i Os Jim van. "Evidence That Psychotic Symptoms Are Prevalent in Disorders of Anxiety and Depression, Impacting on Illness Onset, Risk, and Severity – Implications for Diagnosis and Ultra-High Risk Research". Technische Universität Dresden, 2012. https://tud.qucosa.de/id/qucosa%3A27328.

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Background: It is commonly assumed that there are clear lines of demarcation between anxiety and depressive disorders on the one hand and psychosis on the other. Recent evidence, however, suggests that this principle may be in need of updating. Methods: Depressive and/or anxiety disorders, with no previous history of psychotic disorder, were examined for the presence of psychotic symptoms in a representative community sample of adolescents and young adults (Early Developmental Stages of Psychopathology study; n=3021). Associations and consequences of psychotic symptomatology in the course of these disorders were examined in terms of demographic distribution, illness severity, onset of service use, and risk factors. Results: Around 27% of those with disorders of anxiety and depression displayed one or more psychotic symptoms, vs 14% in those without these disorders (OR 2.23, 95% CI 1.89–2.66, P < .001). Presence as compared with nonpresence of psychotic symptomatology was associated with younger age (P < .0001), male sex (P < .0058), and poorer illness course (P < .0002). In addition, there was greater persistence of schizotypal (P < .0001) and negative symptoms (P < .0170), more observable illness behavior (P < .0001), greater likelihood of service use (P < .0069), as well as more evidence of familial liability for mental illness (P < .0100), exposure to trauma (P < .0150), recent and more distant life events (P < .0006–.0244), cannabis use (P < .0009), and any drug use (P < .0008). Conclusion: Copresence of psychotic symptomatology in disorders of anxiety and depression is common and a functionally and etiologically highly relevant feature, reinforcing the view that psychopathology is represented by a network or overlapping and reciprocally impacting dimensional liabilities.

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Soares, Walter Barbalho. "Sintomas psicóticos em uma amostra comunitária de idosos sem demência da cidade de São Paulo: incidência e fatores de risco". Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5142/tde-11092017-083150/.

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Pouco se sabe sobre a presença de sintomas psicóticos em idosos sem diagnóstico de demência, levando a dificuldades no esclarecimento da etiologia, na ausência de informações quanto a possíveis diagnósticos e no manejo clínico. Os estudos sobre a incidência de sintomas psicóticos nessa população são ainda mais escassos e limitados. Os dados disponíveis na literatura são todos provenientes de estudos em populações de países desenvolvidos. A prevalência de sintomas psicóticos em idosos sem diagnóstico de demência varia de 0,9 a 10,5%, já a incidência na literatura varia entre 4,8 e 8,0%. É possível especular sobre alguns fatores de risco para o desenvolvimento de sintomas psicóticos em indivíduos sem demência: idade avançada, gênero feminino, comprometimento sensorial, pior desempenho cognitivo, isolamento social, pior funcionalidade. Dados recentes sugerem os sintomas psicóticos como uma expressão prodrômica da demência, devido a sintomas como alucinações, delírios e ideação paranoide estarem associados ao aumento da incidência de demência no acompanhamento, à maior presença deles à medida que a faixa etária sobe e à menor média no escore do Miniexame do Estado Mental (MEEM) em indivíduos com tais sintomas. Objetivamos determinar a incidência de sintomas psicóticos, correlacioná-los com características clínicas e estabelecer uma taxa de conversão em idosos sem comprometimento cognitivo. Este estudo foi realizado em uma amostra de idosos de comunidade de São Paulo, sendo a amostra inicial composta por 1.125 indivíduos acima de 60 anos. Destes, 547 foram reavaliados em 2011 e submetidos ao mesmo protocolo inicial. Não tinham sintomas psicóticos na primeira fase 199 e 64 já possuíam em 2006. A incidência de ao menos um sintoma psicótico em 7 anos foi 8,0% (alucinações visuais/táteis: 4,5%; ideias persecutórias: 3,0%; alucinações auditivas: 2,5%). A incidência esteve relacionada à epilepsia (OR: 7,75 e 15,83), baixa pontuação no MEEM (OR: 0,72) e depressão referida (OR: 6,48). 57,8% dos indivíduos com sintomas psicóticos, mas sem demência na fase I, desenvolveram comprometimento cognitivo em 7 anos (alucinações visuais/táteis foram preditivas - OR: 5,66), o que estava relacionado a baixo MEEM e comprometimento funcional. A incidência de sintomas psicóticos e a taxa de conversão em comprometimento cognitivo estão no limite superior dos dados da literatura. Alucinações visuais/táteis foram os sintomas mais incidentes e os únicos preditivos para a evolução para comprometimento cognitivo em 5 anos. Encontramos importantes relações entre sintomas psicóticos e MEEM, crises convulsivas, depressão referida, diabetes e sífilis
Background: Studies of the incidence of psychotic symptoms in elderly people at risk of dementia are scarce. This is a seven year follow up study aiming to determine the incidence of psychotic symptoms and their correlation with other clinical aspects as well as conversion rates to cognitive impairment. Objectives: To determine the incidence of psychotic symptoms, correlate these symptoms with clinical characteristics and establish the conversion rate to cognitively impaired individuals. Design: Cross-sectional study of a community-based sample of elderly subjects. Setting: City of Sao Paulo, State of Sao Paulo, Brazil. Participants: The original sample was composed of 1,125 individuals aged 60 years and older from a community. Among this sample, 547 subjects were re-evaluated in 2011 and submitted to the same protocol. Of these, 199 did not have psychotic symptoms at phase I and 64 already had psychotic symptoms in 2006. Results: The incidence of at least one psychotic symptom in 7 years was 8.0% (Visual/tactile hallucinations: 4.5%; Persecutory delusions: 3.0%; Auditory hallucinations: 2.5%). Psychotic symptom incidence was associated with epilepsy (OR: 7.75 and 15.83), lower MMSE (OR: 0.72) and reported depression (OR: 6.48). A total of 57.8% of individuals with psychotic symptoms but without dementia at phase I developed cognitive impairment after 7 years (visual/tactile hallucinations were the only psychotic symptom predictive of this impairment - OR: 5.66), which was related to lower MMSE and increased functional impairment. Conclusions: The incidence of psychotic symptoms and the conversion rate to cognitive impairment was in the upper range of previous literature reports. Visual/tactile hallucinations were the most incident symptoms and the only predictive psychotic symptoms for cognitive impairment in 5 years. Important relationships were found between psychotic symptoms incidence and MMSE, epilepsy, reported depression, diabetes and syphilis

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Vorspan, Florence. "Mise au point de mesures de variables intermédiaires pour les essais cliniques dans la dépendance à la cocaïne : craving et symptômes psychotiques". Phd thesis, Université René Descartes - Paris V, 2012. http://tel.archives-ouvertes.fr/tel-00744102.

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La dépendance à la cocaïne est un problème de santé publique d'importance croissante. Il n'existe pas actuellement de traitement pharmacologique validé dans la dépendance à la cocaïne. Les essais thérapeutiques nécessitent une méthodologie qui permette d'évaluer l'efficacité des médicaments employés. Il n'existait pas à ce jour de mesure d'efficacité des traitements pharmacologiques dans la dépendance à la cocaïne validée en français. Nous avons mis au point et validé des questionnaires pouvant servir de mesures intermédiaires d'efficacité pour les essais pharmacologiques dans la dépendance à la cocaïne. Nous avons choisi de nous intéresser à deux types de variables intermédiaires : le craving et les symptômes psychotiques. Le craving est le besoin impérieux de reconsommer une drogue. Ce concept psychologique est un marqueur de dépendance. Nous avons conçu un questionnaire de craving en langue française : l'OCCS (Obsessive Compulsive Cocaïne Scale), en nous basant sur les travaux de plusieurs équipes travaillant dans le domaine de la dépendance à l'alcool. Nous avons validé ce questionnaire sur une population de 119 sujets cocaïnomanes suivis en centre de soins (Vorspan et al 2012). Nous avons notamment montré que les scores à ce questionnaire étaient corrélés à une mesure de craving par échelle visuelle analogique, étaient supérieurs chez les sujets dépendants par rapport aux sujets abuseurs de cocaïne, et étaient sensible au changement. Nous avons déjà utilisé le questionnaire de craving OCCS dans un essai thérapeutique en ouvert d'aripiprazole chez 10 patients dépendants du crack non schizophrènes (Vorspan et al 2008). Nous proposons également de l'utiliser pour évaluer l'efficacité d'interventions non pharmacologiques dans la dépendance à la cocaïne, comme la stimulation cérébrale profonde (Vorspan et al 2011), ou des interventions psychothérapeutiques. Les symptômes psychotiques se composent de différentes manifestations (hallucinations, idées délirantes et modifications comportementales). Nous avons choisi d'adapter en français un questionnaire évaluant les symptômes psychotiques transitoires survenant dans les quelques minutes à quelques heures suivant une consommation de cocaïne : le SAPS-CIP (Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis). Nous avons montré que ces symptômes sont fréquents mais d'intensité variable dans une population de patients cocaïnomanes suivis en centre de soins (Vorspan et al, soumis), et qu'ils étaient sensibles au changement (Vorspan et al 2011). Il existe des hypothèses de vulnérabilité génétique à la survenue des symptômes psychotiques lors de l'usage de cocaïne. La vulnérabilité à cette complication pourrait être un facteur de protection vis-à-vis de l'acquisition d'une dépendance à la cocaïne (Brousse et al 2010). La mesure des symptômes psychotiques survenant lors de l'usage de drogue permet de modéliser une vulnérabilité pharmacogénétique vis-à-vis des addictions. Nous proposons d'utiliser ces deux mesures (OCCS pour le craving et SAPS-CIP pour les symptômes psychotiques) dans les essais thérapeutiques dans la dépendance à la cocaïne. En effet, il paraît pertinent, au regard des particularités cliniques de la dépendance à la cocaïne, de viser une réduction ou une disparition de ces deux ordres de symptômes. Une diminution du craving pourrait constituer une variable intermédiaire de l'objectif final d'obtenir une abstinence de la drogue. Une diminution des symptômes psychotiques pourrait constituer un moyen de réduction de la morbi-mortalité liée à l'usage de cocaïne.

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