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PubMed1983

Ego function assessment of schizo-affective patients as compared to schizophrenic and affective psychotic patients.

A 1-year sample of consecutively admitted patients between 18 and 40 years of age is studied. Psychopathology has been elicited by the Schedule for Affective Disorders and Schizophrenia (SADS), and diagnoses have been set according to Research Diagnostic Criteria (RDC). The sample consists of 57 cases with schizophrenia, 8 cases with schizo-affective psychosis and 23 cases with affective psychoses. Bellak's Ego Function Assessment Test was given to all these patients. The test does not show any significant differences between the schizo-affective and the schizophrenic groups. Some significant differences are found between the schizo-affective group and the group of affective psychosis. The findings do not validate schizo-affective psychosis as a diagnostic category.

Adolescent↗
PubMed1985

Persecutory affective psychoses: a follow-up.

A series of 66 cases with persecutory affective psychoses was followed up between 5 and 44 years. These psychoses can be considered as a subgroup of catamnestically verified paranoid reactive psychoses. They comprise cases with and without clouded consciousness. The long-term prognosis is best for cases with clouded consciousness at the initial stage of the psychosis. The characteristics of premorbid personality, psychological precipitating factors and psychotic symptomatology are illustrated by several tables.

Adult↗
PubMed1995

[Management dialogue within multi-professional teams: contribution of psychoanalysis to integrated therapy of psychotic patients].

By means of case studies and experiences in supervising multiprofessional teams in psychiatric wards it is pointed out that the institutional frame of psychiatry is dynamically connected with the intrapsychic conflicts of the psychotic patients and their interpersonal defence. The understanding of the teammembers' countertransference prevents collusive patterns of relationship. This symbolizing process which is permanently endangered by the psychotic splitting mechanisms of the patients as well as by the institutional defence contributes to develop a "common language" in the multiprofessional teams. Furthermore psychoanalytic supervision enables the multiprofessional staff to understand the intrapsychic and the interactional dimension of the behaviour of the psychotic patient and to maintain their empathy even under difficult conditions.

Affective Disorders, Psychotic↗
PubMed2005

Affective processes in the onset and persistence of psychosis.

OBJECTIVES: Cognitive models suggest that beliefs and appraisal processes are crucially important in the onset and persistence of psychosis. This study investigated whether (i) neuroticism increases the risk for development of psychotic symptoms, and (ii) a delusional interpretation and/or a depressed response to hallucinatory experiences predicts the onset of psychotic disorder. METHOD: A general population sample with no lifetime evidence of any psychotic disorder was interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify onset of psychotic disorder. RESULTS: Baseline level of neuroticism increases the risk for incident psychotic symptoms. Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome was much higher in the group with delusional ideation or depressed mood at year 1 than in those without delusional ideation or depressed mood. CONCLUSION: A cognitive style characterised by a tendency to worry increases the risk for newly developed psychotic symptoms. Individuals who report hallucinatory experiences and react to these with a delusional interpretation and/or negative emotional states have an increased risk for developing clinical psychosis.

Adolescent↗
PubMed1977

Typological prediction of response to amitriptyline: a replication study.

This paper reports a replication study of prediction of outcome by a cluster-analysis derived four-group typoloy of depression. 143 acutely depressed women were treated with amitriptyline for 4 weeks. In replication of the earlier findings, anxious depressives showed the worst response, hostile depressives and young depressive with personality disorder the best, with psychotic depressive intermediate. The findings provide further validating evidence for the typology, and for the view that nonpsychotic depressives are heterogenous.

Adult↗
PubMedDate not supplied

[Interhemispheric asymmetry according to evoked potential parameters in patients with depression].

In depressive patients with different degrees of severity of the disorder hemispheric differences of the occipital and central EP peak amplitude and latency were estimated under the conditions of presentation of a neutral light stimulus, structural stimulus, and mental reproducing the structural stimulus during presentation of the neutral one. Affective responses to the stimuli were also taken into account. In non-psychotic depression hemispheric asymmetry was observed in all responses studied being correlated with the dominant affect. In anxiety most of the EP components were higher in the right hemisphere; in sad affect they were higher in the left hemisphere. In psychotic depression, irrespective of the dominant affect, EP characteristics were higher in the right hemisphere.

Affect↗
PubMed1999

Interactive risk factors for treatment adherence in a chronic psychotic disorders population.

This study identified the unique and primary contributions of several concurrent risk factors for poor adherence to treatment recommendations in a clinic population of individuals with chronic psychotic disorders, i.e. 48% had DSM-IV diagnoses of schizoaffective disorder, 38% had schizophrenia, paranoid type, 12% had schizophrenia, undifferentiated type, and 2% had affective disorder with psychotic features. The target cohort consisted of 87 consecutive admissions to a continuing day treatment program. As part of a services-oriented quality assurance program, clinical staff completed rating scales for all patients. These included the BASIS-32 rating scale, which consisted of the following five subscales: psychosis; depression/anxiety; impulsive/addictive behavior; relation to self and others; and daily living and role functioning, and the Working Alliance Inventory-short form (therapist version), which consisted of the following three subscales: goal; task; and bond. These data were used to identify risk factors that weaken a patient's adherence to medication and non-medication treatment during the first 2 weeks of treatment in the clinic. Medication treatment consisted of both typical and atypical neuroleptic medications, with most patients being on multiple medications. Correlational analyses suggested that many of the risk factor variables were significantly associated with poor treatment adherence. Regression analyses suggested that the degree of psychoticism was most strongly associated with poor adherence to medication treatment and that difficulties relating to self and others were the strongest predictor of poor adherence to non-medication treatment. A large-sample services research design such as this can begin to determine patterns of associations between previous identified risk factors and poor treatment adherence in individuals with chronic psychotic disorders.

Adult↗
PubMed1977

A family history study of schizo-affective disorder.

All patients with a discharged diagnosis of schizo-affective disorder (53 cases) admitted to the University of Iowa Department of Psychiatry during 1971-73, were selected for the present study. Schizophrenia (chronic psychotic disorders) and affective disorders (episodic remitting disorders with affective symptoms) were diagnosed among parents and sibs on the basis of chart material. The frequency of schizophrenia was 0.9%; the frequency of affective disorders, 11.8%. These results were compared to data for the relatives of cases of schizophrenia and affective disorders. There were no significant differences for the rates of schizophrenia among the relatives. The rate of affective disorder among the relatives of the schizo-affectives was significantly higher than for the relatives of schizophrenics (3.2%), and not significantly different from the relatives of affective disorder cases (8.3%). An analysis of outcome, precipitants, and age of admission also support the view that schizo-affective disorder should not be routinely classified as schizophrenia for research purposes.

Adolescent↗
PubMed1980

Psychotherapy of the affective psychoses.

Too few research studies that identify effective therapeutic methods for treatment of psychotic depressions are available. A few studies indicate that cognitive therapy reduces symptoms and may provide prophylaxis in outpatients with moderately severe depressions. Cognitive theory provides a conceptual framework for developing techniques to treat more severely depressed patients. Specific obstacles in the psychotherapy of this group include negatively biased recall of current and past events; difficulties in forming a therapeutic alliance; memory and concentration deficits; hallucinations; delusions; and somatic complaints. This paper presents preliminary attempts to develop and apply cognitive change techniques to some of these difficulties. The role of medication in combination with psychotherapy, the identification of depressions requiring psychotheeapy, and the development of methods specific to psychotherapy with psychotic depressions and promising areas in need of further investigation.

Adolescent↗
PubMed1990

Enlargement of cerebral third ventricle in psychotic patients with delayed response to neuroleptics.

Enlargement of the cerebral third ventricle appears to be a replicable finding in groups of patients with psychotic illnesses, and there is evidence for an association of third ventricle enlargement with poorer response to treatment. Third ventricle area and width were measured from computed tomography (CT) scans in 24 mood-incongruent psychotic patients and 14 controls age and gender matched to schizophrenic patients. Patients were treated with a fixed dose of haloperidol and classified as rapid responders (55% symptom reduction on New Haven Schizophrenic Index (NHSI) within 4.5 +/- 1.3 days) or delayed responders (55% symptom reduction on NHSI within 18.6 +/- 10.5 days). The significant enlargement of third ventricle area was isolated among the 12 delayed neuroleptic responders (19.3 +/- 9.0 mm2) compared with the 14 controls (11.7 +/- 4.8 mm2, p = 0.01), and 12 other mood-incongruent psychotics. Third ventricle width also showed a trend towards larger width in the delayed responders. There was a clear positive correlation between ventricular size and patient's age exclusively in the delayed responders (r = 0.78); a comparable relationship between ventricular size and age was not present in controls, or in the other psychotics. This finding is consistent with an age-related progressive degenerative process in the central nervous system (CNS) isolated to the neuroleptic-delayed responsive psychotics.

Adult↗
PubMed2003

[Depression and schizophrenia].

Affective disorders in schizophrenia overlap with positive symptoms and are co-morbid with negative changes. At schizophrenia onset, depression may emerge in the form of psychogenic disorders (posttraumatic stress disorder, juvenile asthenic failure, etc.). Depression, developing during the disease, determines clinical picture of attacks provoked psychogenically (hysterical depression, anxious depression)--reactive schizophrenia. In post-attack stages of schizophrenia, two types may be singled out--post-psychotic depression and post-schizophrenic one. The post-psychotic depressions us includes neuroleptic depression with features of anesthetic melancholia, persevering depression, akinetic depression, neuroleptic dysphoria. Its induced by antipsychotics and combine with extrapyramidal disorders.

Affective Disorders, Psychotic↗
PubMed2005

Differential response to combined treatment in patients with psychotic versus nonpsychotic major depression.

Research has demonstrated that depressed patients with psychotic features show poorer outcomes when treated with pharmacotherapy alone compared with those without psychotic features. However, research has not investigated whether this differential response also applies to combined treatment that includes pharmacotherapy and psychotherapy. In the current study, data were pooled from two clinical trials in which patients diagnosed with major depressive disorder with or without psychotic features were treated with combined treatment. Although similar in severity at pretreatment, results indicated that patients with psychotic depression showed a poorer response in terms of depression severity at postoutpatient treatment and at 6-month follow-up compared with those with nonpsychotic depression. Following treatment, patients with psychotic depression were over four times as likely to exhibit high levels of depression and suicidal ideation. Current state-of-the-art combined treatments have poorer efficacy in depressed patients with psychotic symptoms, and adapted treatment approaches are needed.

Adult↗
PubMedDate not supplied

Chronology of comorbid and principal syndromes in first-episode psychosis.

Psychiatric comorbidity is common in psychotic disorders, but the chronology of comorbid and principal diagnoses has not been closely examined. Understanding chronology may be important for identifying risk factors, or alternatively, prodromal syndromes, for some patients with psychosis. To address this issue, we examined the rates of antecedent comorbid syndromes in patients with first-episode psychoses. Patients aged > or = 12 years presenting with psychosis were recruited from inpatient and outpatient treatment sites. Patients were excluded if they had been previously hospitalized or if symptoms resulted entirely from substance abuse or medical illness. All diagnoses were made using the Structural Clinical Interview for DSM-III-R-Patient Version (SCID-P). Comorbidity was defined as antecedent if the age of onset of the comorbidity predated the age of the onset of the psychotic disorder by more than 1 year. Seventy-one patients were recruited during a 1-year period and included 39 with bipolar disorder, 18 with schizophrenia spectrum disorders, and 14 with psychotic depression. Comorbidity was present in 69% of patients. This comorbidity was antecedent in over 80% of the patients with concurrent syndromes. Patients with psychotic depression had the highest rates of comorbidity, in particular alcohol abuse and antecedent posttraumatic stress disorder (PTSD). Comorbidity is common in first-episode psychosis and is often antecedent to the psychotic disorder. These antecedent comorbidities may represent risk factors or prodromal syndromes for the psychotic disorder.

Adolescent↗
PubMed2004

An overview of the genetics of psychotic mood disorders.

This article presents a conceptual review of the genetic underpinnings of psychotic mood disorders. Both unipolar and bipolar forms of mood disorder sometimes feature psychotic symptoms. Some evidence from epidemiological research suggests that psychotic forms of mood disorder specifically might be heritable. Linkage studies of mood disorders in general have also provided some support for that notion, as have associated studies involving serotonin and dopamine genes and psychotic mood disorder. Some research suggests there might be a genetic connection between schizophrenia and bipolar disorder, undermining the Kraepelinian dichotomous classification of the psychoses. Future research should continue to examine psychotic forms of mood disorder using both epidemiological and molecular approaches.

Affective Disorders, Psychotic↗
PubMed1994

Mood congruent and incongruent psychotic depressions: are they the same?

DSM-III and DSM-III-R instruct the clinician, if possible, to classify major depression with psychotic features into either the mood congruent (MC) or mood incongruent (MI) subtype. Patients hospitalized on a psychiatric unit for major depression with psychotic features were classified as predominantly MC or MI. The MC and MI groups did not differ significantly on a number of demographic or symptom severity variables. Thirteen (50%) MI patients experienced at least one MC symptom and 10 (71%) MC patients experienced at least one MI symptom. Overall, 25 (58%) of these patients experienced both MC and MI symptoms. This study demonstrates that subtyping psychotic depression into MC and MI subtypes is seldom an 'either-or' decision. Indeed, these results combined with findings from previous research suggests that there is no compelling scientific evidence for subclassifying psychotic depression into subtypes.

Adult↗
PubMed1983

Response to dexamethasone in psychotic depression.

The utility of the dexamethasone suppression test (DST) in the diagnosis of psychotic depression was examined by comparing the responses of 11 psychotic and 18 nonpsychotic depressed inpatients. Nine of 11 psychotic patients (81.8%) and 10 of 18 nonpsychotic patients (55.6%) showed nonsuppression (nonsignificant). Using the 0800h cortisol level alone, we found that significantly more psychotic patients (7 of 11; 63.6%) than nonpsychotic patients (3 of 18; 16.7%) showed nonsuppression. Nonsuppression at 0800h postdexamethasone may be a useful biologic marker for patients with psychotic depression. Implications of these data for the nosologic status of psychotic depression are discussed.

Adult↗