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[The lithium test, test of endogenous criteria].

The lithium-test (Li-T) requests hospitalisation of the patient, administration of Li to obtain a plasma/level of at the lust 0, 8 mEq/l, since the third to the eight day. It improve depressions, acute delusions, pseudo-dementias: the field of the lithiodépendent endogenic diseases as to be enlarged. The Li-T may distinguish between this lithiodependence of the other, non-lithiodépendent, in dysthymic psychotic disorders.

Adult↗
PubMed1996

Predictors of functional outcome among adolescents and young adults with psychotic disorders.

Adolescents and young adults who experience the onset of a psychotic disorder often demonstrate major disruptions in occupational and social functioning. Yet, certain persons appear to be at a greater risk for impaired functioning after an episode of psychosis than others. This review of the psychiatric research literature on outcomes in psychotic disorders identifies several variables predictive of occupational and social functioning among young persons with both affective and nonaffective psychoses. Variables predictive of functional outcomes include diagnosis, symptom severity, duration of onset of symptoms, age of onset of symptoms, gender, stressful life events, premorbid functioning, and social supports. A model for conceptualizing the relationships of these variables to functioning is presented, and the implications for occupational therapy practice and research are discussed.

Adolescent↗
PubMed1977

[Communicating hydrocephalus. Clinical aspects, diagnosis, pathogenesis].

A description of the clinical symptoms of the communicating hydrocephalus (normal-pressure hydrocephalus = NPH) is given: progressive psycho-organic alterations, ataxia, tetraspastic signs, urinary incontinence, without increased intracranial pressure. Diagnosis can be confirmed by use of pneumencephalography, isotope-cisternography and tomography of the brain by use of a water-solubile contrast fluid. Skull radiographs. EEG, testing of liquor and psychological examinations are of less diagnostic value. The illness is the result of a disturbance of liquor resorption and circulation. In this context there is to differentiate between cases of known (Hydrocephalus communicans obstructivus = HCO) and unknown etiology (Hydrocephalus communicans non obstructivus = HCNO). The group of cases with unknown etiology represents the central part of cases of normal-pressure hydrocephalus (NPH). The prognosis after a ventricular shunt-procedure is here worse than in the group of cases with known etiology. For differential diagnosis presenil dementia, cerebrovascular insufficiency, intracranial tumors and reactive and psychotic depressions are to be considered.

Affective Disorders, Psychotic↗
PubMed1991

Unipolar delusional depression. Outcome in reactive versus endogenous types.

A sample of 83 first-admitted patients with delusional depression were diagnosed according to DSM-III, ICD-9 and reactive and endogenous types. They were followed up twice after a mean of 10 and 18.5 years. As to background, course and outcome variables DSM-III schizoaffective patients were closely related to affective patients. A small difference between reactive and endogenous type was accounted for by the endogenous subgroup of DSM-III schizoaffective patients. The study provides evidence for dismissing the reactive-endogenous distinction in terms of psychotic depressive disorder, but in terms of schizodepressive disorder the issue is less clarified based on course and outcome.

Adult↗
PubMed2002

Prevalence of depressive episodes with psychotic features in the general population.

OBJECTIVE: The study evaluated the prevalence of major depressive episodes with psychotic features in the general population and sought to determine which depressive symptoms are most frequently associated with psychotic features. METHOD: The sample was composed of 18,980 subjects aged 15-100 years who were representative of the general populations of the United Kingdom, Germany, Italy, Portugal, and Spain. The participants were interviewed by telephone by using the Sleep-EVAL system. The questionnaire included a series of questions about depressive disorders, delusions, and hallucinations. RESULTS: Overall, 16.5% of the sample reported at least one depressive symptom at the time of the interview. Among these subjects, 12.5% had either delusions or hallucinations. More than 10% of the subjects who reported feelings of worthlessness or guilt and suicidal thoughts also had delusions. Feelings of worthlessness or guilt were also associated with high rates of hallucinations (9.7%) and combinations of hallucinations and delusions (4.5%). The current prevalence of major depressive episode with psychotic features was 0.4% (95% CI=0.35%-0.54%), and the prevalence of a current major depressive episode without psychotic features was 2.0% (95% CI=1.9%-2.1%), with higher rates in women than in men. In all, 18.5% of the subjects who fulfilled the criteria for a major depressive episode had psychotic features. Past consultations for treatment of depression were more common in depressed subjects with psychotic features than in depressed subjects with no psychotic features. CONCLUSIONS: Major depressive episodes with psychotic features are relatively frequent in the general population, affecting four of 1,000 individuals. Feelings of worthlessness or guilt can be a good indicator of the presence of psychotic features.

Adolescent↗
PubMed1986

Mental disorders and ecological structure in Nottingham.

This paper presents the findings of a specifically geographical investigation of the incidence, distribution and social/environmental correlates of mental disorder in Nottingham. Three diagnostic groups were examined, namely schizophrenia and paranoia, the effective psychoses (or manic depression) and the non-psychotic mental disorders. Analysis of two distinct cohorts of first contact patients for both the schizophrenia and affective psychoses diagnoses yielded markedly dissimilar incidence rates. It is therefore suggested that observed variations in the incidence of specific mental disorders between cities probably reflect such nosocomial (i.e. service related) factors as diagnostic accuracy and the levels of local psychiatric services. It is therefore dangerous to ascribe the variations solely to the contrasting social/environmental milieux found in these cities. The spatial distributions of the selected mental disorders within Nottingham were analysed in the context of a set of 12 distinct ecological areas. These areas were derived from a matrix comprising 105 sub-areas and 40 variables via principal components analysis and a non-hierarchical clustering algorithm. Marked spatial variation in the incidence of all the mental disorders was demonstrated via both traditional mapping and probability mapping techniques. Pearson product-moment analysis revealed that the distributions of the two diagnostically distinct schizophrenia and affective psychoses cohorts were virtually identical. The relationships between the inception rates for the mental disorders and social/environmental attributes were analysed. Stepwise multiple regression models for both the principal components and the individual census variables revealed strong and systematic relationships with all the mental disorders. Although such ecological analysis has limited explanatory power it nevertheless provides useful insights into mental disorder-environmental relationships. It is argued that these can be subsequently best examined at a disaggregated (i.e. behavioural) level.

Affective Disorders, Psychotic↗
PubMed1991

Reduced neuronal size in posterior hippocampus of schizophrenic patients.

The hippocampus, an integral component of the corticolimbic circuitry of the brain, has been recently implicated in the pathophysiology of schizophrenia. This article has employed quantitative morphometric techniques to determine whether abnormalities of posterior hippocampal cross-sectional area, as well as the number, size, and degree of disarray of pyramidal neurons were present in 9 control and 14 schizophrenic subjects. Seven schizophrenic patients showed evidence of superimposed mood disturbance (schizoaffective type), while the remaining seven were a mixture of paranoid, undifferentiated, and catatonic types. All morphometric measurements were conducted under strictly blind conditions; stepwise multiple regression and analyses of covariance were used to evaluate the effects of various confounding variables. There were no differences in the cross-sectional size of the hippocampus or degree of neuronal disarray between the two groups. Similarly, the number of pyramidal neurons was also the same in sectors Cornu Ammonis (CA) 2, CA 3, and CA 4 for the controls and schizophrenic subjects. In CA 1, the schizophrenic subjects without mood disturbances showed a significant reduction (36%) of pyramidal neuron numbers when compared with those of both controls and patients with mood disturbance. Pyramidal neurons were smaller in all sectors of the schizophrenic specimens, CA 1 (p less than or equal to 0.01), CA 2 (p less than or equal to 0.01), CA 3 (p less than or equal to 0.01), and CA 4 (p less than or equal to 0.005), but there were no differences with respect to the presence of mood disturbances. Corrections for the effects of age, postmortem interval, fixation interval, hypoxia, and neuroleptic exposure did not alter the pattern in the data. The significance of a smaller size of hippocampal pyramidal neurons in this group of schizophrenic specimens is unclear, but it is consistent with the suggestions of other laboratories that there may be altered function of this brain region in chronically psychotic individuals.

Affective Disorders, Psychotic↗
PubMed1980

The march of symptoms in a psychotic decompensation. Case report and theoretical implications.

The onset and evolution of symptoms were studied in a female patient with a history of recurrent depressive psychoses. In each episode, her psychotic decompensations were characterized by an orderly and progressive sequence including similar psychological or somatic precipitants, mounting anxiety, nystagmoid eye movements associated with panic, unfolding delusions, and olfactory hallucinations, culminating in a complete psychotic regression. The evolving sequence repeated during each episode in the present case is compared with that of a similarly stereotyped progression of symptoms in temporal lobe and Jacksonian seizures. Kindling is suggested as a model relevant to the understanding of both epilepsy and the functional psychoses. Detailed observation of the evolution of symptoms during psychotic episodes may provide important clues to the underlying pathological anatomy and physiology of psychotic illness.

Adolescent↗
PubMed1990

The influence of gender on the classification of psychotic disorders--a multidiagnostic approach.

A multidiagnostic approach was used prospectively to classify a sample of 176 psychotic patients. An excess of males was found with only one out of 11 systems of schizophrenia, the World Health Organization "flexible" system of schizophrenia, with an excess of females noted in 2 of 5 systems of schizoaffective disorder, the Kasanin schizoaffective system and the Feighner schizoaffective depressed category. Correlation matrices of the diagnostic categories were generated for men and women and multidimensional scaling was used to plot the distribution of diagnostic categories. In the male sample, patients appeared to cluster according to affective symptoms and the mood-congruence of psychotic symptoms. Four clusters were apparent, but were less evident in the female sample. This gender difference was given partial support by quantitative measures of concordance. It is suggested that women manifested a greater admixture of symptoms, especially mixed affective and psychotic symptoms, than men.

Acute Disease↗
PubMed1982

Thought pathology in manic and schizophrenic patients. Its occurrence at hospital admission and seven weeks later.

To evaluate the extent and persistence of thought pathology in manic patients, 113 manic, schizophrenic, and nonpsychotic patients were assessed at the acute phase, and a subsample was reevaluated seven weeks later. Another subsample of 55 patients was assessed medication free at the acute phase. Three major indices of thought disorder were used. The data indicate that (1) most hospitalized manics are severely thought disordered; (2) hospitalized manics are as thought disordered as schizophrenics; (3) unmedicated manics are as severely thought disordered as unmedicated schizophrenics; (4) both manics' and schizophrenics' thought disorders improve after the acute phase; (5) even after the acute phase, some manics show severe thought pathology. The results support formulations that thought disorder is not unique to schizophrenia. Some factors involved in manic and schizophrenic thought pathology are similar. There may be a general psychosis factor that cuts across psychotic diagnoses.

Adolescent↗