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PubMed2004

Neuropsychological correlates of psychotic features in major depressive disorders: a review and meta-analysis.

Neuropsychological functioning has been a focus of study in psychotic disorders for many decades. These studies have focused primarily on schizophrenia, and less so on the affective psychoses, including psychotic major depression PMD. Several studies have provided evidence of cognitive dysfunction in PMD. However, these studies have utilized different assessment methods and instruments. Consequently, a clear picture of the nature and severity of cognitive impairment in PMD has yet to emerge in the literature. The current review seeks to provide a summary of the literature by composing a quantitative and qualitative review of the research to date on the cognitive impairment in psychotic major depression, specifically as it contrasts to those deficits observed in nonpsychotic depression. This review also provides a summary model of the pathophysiology of PMD to provide the necessary context to understanding the biological mechanisms of these impairments.

Affective Disorders, Psychotic↗
PubMed1996

Contrasts in neuropsychological test profile between patients with first-episode schizophrenia and first-episode affective disorders.

Patients with first-episode (FE) schizophrenia (n = 27), unipolar depression (n = 10) and bipolar disorder (n = 17) and age- and gender-matched healthy control subjects (n = 27) were administered a battery of neuropsychological (NP) tests. FE schizophrenics performed significantly less well than patients with affective disorders in the area of visual motor processing and attention. Affective disorder patients without psychotic features did not perform significantly differently to controls. However, affective disorder patients with psychotic features performed as poorly as schizophrenics, with the most pronounced impairment in the area of visual motor processing and attention. Our data tentatively suggest the existence of a dichotomy in neuropsychological impairment, with psychotic patients showing similar neuropsychological deficits, while non-psychotic affective patients perform comparably to controls.

Adult↗
PubMed1993

A consensus conference on psychotic depression.

We report a consensus conference on psychotic depression that addressed historic, classification, phenomenologic, epidemiologic, aetiologic, management and outcome issues. We were able to detail the impact of the information offered by having audience members complete questionnaires before and after the conference. The respondents indicated that the status of psychotic depression (as a separate type or as a more severe expression of depression) remains unclear; that delusions, hallucinations and severe psychomotor disturbance have high cross-sectional diagnostic weighting (while longitudinal information is of importance); that determinants include both genetic and organic factors; that most patients with this condition require admission to hospital; and that bilateral ECT is the most effective treatment. The answers to the questionnaires established areas where the audience did not modify their responses because they were already well-informed, others where their views were considerably changed (e.g. "psychotic" episodes in those with a borderline personality disorder) and others where they modified their clinical reasoning (e.g. "if a "psychotic" feature is mood-congruent then the condition must be an affective disorder" became "if the patient has an affective disorder, the psychotic feature must be mood-congruent"). Finally, we make some recommendations for future consensus conferences.

Australia↗
PubMed1988

Effect of psychosis on suicide risk in 1,593 patients with unipolar and bipolar affective disorders.

The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.

Affective Disorders, Psychotic↗
PubMed2005

Neuropsychological impairment and its neurological correlates in adult offspring with heightened risk for schizophrenia and affective psychosis.

OBJECTIVE: Schizophrenia is generally considered to be a neurodevelopmental disorder reflected in findings of neuropsychological impairments and neurological abnormality in patients and their relatives. The authors investigated whether neuropsychological impairments are related to neurological abnormality and whether such deficits also characterize risk for affective psychosis. METHOD: In a longitudinal study with a 93% rate of effective follow-up, the authors investigated neuropsychological impairment and its relation to neurological abnormality at a mean age of 22.3 years in 74 offspring of mothers with a history of psychotic disorders (38 offspring with heightened risk for schizophrenia and 36 with risk for affective psychosis) and 88 normal-risk offspring born to mothers with no history of psychosis. RESULTS: Offspring with genetically heightened risk for schizophrenia showed significantly impaired verbal memory, selective attention, and grammatical reasoning, compared with normal-risk offspring. Having impaired verbal memory, attention, and grammatical reasoning functions identified a significantly larger subgroup (16%) among offspring with heightened risk for schizophrenia than among offspring with heightened risk for affective psychosis (0%) and among normal-risk offspring (3%). Multiple neuropsychological functions were significantly related to neurological abnormality in offspring with heightened risk for schizophrenia and in normal-risk offspring but not among offspring with heightened risk for affective psychosis. The extension of schizophrenia and affective psychosis risk groups to include additional offspring of mothers with psychosis-spectrum disorders yielded results similar to those for the core risk groups. CONCLUSIONS: The neurocognitive dysfunction attending heightened risk for schizophrenia is likely based on genetically mediated neurodevelopmental factors, with schizophrenia and affective psychosis belonging to different biological spheres.

Adult↗
PubMedDate not supplied

[Psychotic syndromes in patients with organic brain damage in the light of clinical analysis].

In the Department of Psychiatry, Medical Academy in Gdańsk, 2797 psychotic patients were hospitalized in the years from 1976 to 1986. In addition to the diagnosis of psychosis in 207 cases (7.4%) the organic brain damage was diagnosed: 114 women and 93 men. 157 patients (75.8%) were aged 50-60 years. Following factors underwent the analysis: psychopathology, diagnostic categories of organic brain damage, dependency between psychosis and organic damage, the causes of damage, and the diagnostic procedures leading to the diagnosis. Depression was diagnosed in 57.6% of patients. Psychoses with qualitative disturbances of consciousness were second frequent diagnostic category. Schizophrenia, schizophreniform syndromes and mania were less frequently diagnosed. The diagnostic categories of organic brain damage were: organic background, organic brain damage, dementia, encephalopathy, character disorders , oligophrenia, frontal lobe syndrome, organic defect. The organic brain syndrome was diagnosed primarily on the basis of psychopathology. The analysis do not allow the univocal interpretation of the importance of organic brain changes in psychotic patients.

Adult↗
PubMed2005

Aripiprazole: initial clinical experience with 142 hospitalized psychiatric patients.

BACKGROUND: Aripiprazole is the first dopamine D2 receptor partial-agonist approved for treatment of schizophrenia. Its apparently benign adverse-effect profile encourages broader use in other disorders, especially to limit weight gain associated with other antipsychotic or antimanic agents. We considered the first 6 months of experience with aripiprazole in psychiatric inpatients with a range of disorders. METHODS: We analyzed data obtained from medical records of patients treated with aripiprazole who were hospitalized at McLean Hospital (for 19 +/- 18 days) between December 2002 and June 2003 to evaluate dosing, tolerability, and clinical effects of this new agent in patients diagnosed with DSM-IV psychotic, major affective, or other disorders. RESULTS: Out of a sample of 2766 adult inpatients (65.5% women), 142 were given aripiprazole (mean final daily dose, 16.1 +/- 6.2 mg, 0.20 +/- 0.09 mg/kg body weight) for major affective disorders (52%), primary psychotic disorders (40%), and dementia (8%). CGI ratings improved by 20% on average. Adverse effects were infrequent (15.5%), were three times more likely among women, and most often involved moderate behavioral activation or nausea, with no new episodes of mania. Of the patients who were given aripiprazole, 83% continued it at discharge. Many patients were obese when they were admitted, and obesity was associated with relatively low mg/kg doses of aripiprazole. CONCLUSIONS: Aripiprazole was used in a range of disorders and was generally well tolerated. Adverse effects may reflect its unique dopamine partial-agonist activity. Since aripiprazole is likely to be considered for obese patients, body weight should be considered in establishing adequate doses. Controlled trials of this antipsychotic agent in disorders other than schizophrenia are needed.

Adult↗
PubMed1986

Psychosis and suicide.

The prevalence and characteristics of psychosis were observed in a population of 134 subjects who committed suicide in St. Louis in a 1-year period. Psychosis was diagnosed if a subject had, in the period just prior (1 month or less) to his suicide, experienced any of the following: delusions; hallucinations; bizarre behavior; disorientation, confusion, or memory loss; or formal thought disorder. Using these criteria, 25 (19%) of the 134 subjects were found to be psychotic at the time of suicide.

Adult↗
PubMed1988

Electroencephalographic sleep in mania.

Electroencephalographic (EEG) sleep patterns were examined in nine unmedicated patients meeting DSM-III-R criteria for a current manic episode (four men and five women) for two to four consecutive nights. Compared with age- and sex-matched normal control subjects, manic patients exhibited significantly decreased total recording period, decreased time spent asleep, increased time awake in the last two hours of recording, shortened rapid eye movement (REM) latency, increased REM activity, and increased REM density. These results suggest that mania is associated with marked disturbances of sleep continuity and REM measures. Sleep continuity and REM sleep abnormalities of a similar nature and degree have been reported in major depression and psychotic depression. Thus, it is possible that various forms of affective disorders and psychotic disorders have pathophysiologic mechanisms in common.

Adolescent↗
PubMed1979

[Psychotic depression. 1. Classification, etio-pathophysiology, epidemiology, sympatomatology, diagnosis].

The term "depression" is used to describe a normal mood, a medical symptom, and a collection of psychiatric symptoms. As a normal mood, depression is a common human reaction to a significant loss; as a medical term, it is also used to describe the sadness seen in patients who have other severe medical and psychiatric disorders. Most often, however, "depression" refers to a group of psychiatric syndromes or illnesses with well defined symptoms only one of which is sadness. Depression syndromes are probably universal. There are accounts of depressive illness throughout history from almost every human society. The universality of depressive illness is also reflected in the frequency of depression as a theme of the world's great literature. Studies of the biochemical correlates of psychotic depression have focused on two major hypotheses. The first proposes that affective disorders result from functional changes in the central noradrenergic systems. The second postulates that the primary abnormality is in central serotonergic pathways. These two hypotheses are supported by the pharmacological effects of antidepressant drugs.

Affective Disorders, Psychotic↗
PubMed2004

Persons with psychosis as active agents interacting with their disorder.

The current study focuses on the various strategies employed by individuals coping with psychiatric disorders. Data was gathered as part of the Yale Longitudinal Study; participants were 43 males and females--men and women with psychotic symptoms who were diagnosed with either schizophrenia, schizoaffective disorder, or major affective disorder with psychotic features. Participants were first assessed during hospitalization and completed bi-monthly follow-up interviews over the course of a year. Using qualitative research methods, each participant was interviewed using a semistructured interview that assessed the course of the disorder and change processes, focusing on each person's experiences of coping with a mental illness. In employing qualitative research methods the data obtained was distinctive in that it was suggested by the participants themselves, rather than being limited to predetermined categories. Results revealed a number of common coping strategies employed by individuals with a mental illness. These included: regulating activity, involvement and external stimuli; controlling symptoms; determination and hope; and the instigation of a change in attitude. The implications of these results are discussed for further research and for developing more effective treatment interventions for people with psychiatric disorders.

Adaptation, Psychological↗
PubMed2002

Psychotic illness in people with Prader Willi syndrome due to chromosome 15 maternal uniparental disomy.

In a population-based study of Prader Willi syndrome (PWS), we investigated the relation between genetic subtypes of the syndrome and psychiatric morbidity. Of 25 patients aged 18 years or older, seven (28%) had severe affective disorder with psychotic features, with a mean age of onset of 26 years (SD 5.9). The seven people affected, all aged 28 years or older, included all five with disomies of chromosome 15, one with a deletion in this chromosome, and one with an imprinting centre mutation in the same chromosome. We postulate that in PWS, an abnormal pattern of expression of a sex-specific imprinted gene on chromosome 15 is associated with psychotic illness in early adult life.

Adult↗
PubMed1999

Psychotic subtyping of major depressive disorder and posttraumatic stress disorder.

BACKGROUND: Many studies have established that a large percentage of patients with posttraumatic stress disorder (PTSD) have comorbid major depressive disorder. Other studies have found that patients with PTSD or a history of childhood trauma have an increased rate of psychotic symptoms. In the present report from the Rhode Island Methods to Improve Diagnosis and Services project, we examine whether an association exists between psychotic subtyping of major depressive disorder and PTSD. METHOD: Five hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV. RESULTS: Almost half of the 500 patients had nonbipolar major depressive disorder (N = 235, 47.0%), 45 (19.1%) of whom had PTSD. Nineteen patients had psychotic depression, 216 had nonpsychotic depression. Compared with patients with nonpsychotic depression, the patients with psychotic depression were nearly 4 times more likely to have PTSD (57.9% vs. 15.7%, Fisher exact test, p = .0001). CONCLUSION: The results of the present study suggest that the presence of psychosis in psychiatric outpatients with major depressive disorder is associated with concurrent PTSD. It is hypothesized that the poorer longitudinal course of psychotic versus nonpsychotic depression may be due to the underrecognition of PTSD in psychotically depressed patients.

Adult↗