Clinical compoenets of psychotic disorders: their relationship to treatment.
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Antipsychotic Agents↗
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Biochemical versus psychopathological action profile of neuroleptics: a comparative study of chlorpromazine and oxypertine in acute psychotic disorders.
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Adolescent↗
Egocentrism in children of parents with a history of psychotic disorders.
It is known that children of schizophrenic parents have an increased risk for becoming schizophrenic, but it has been extremely difficult to determine what features may exist in such children before they become manifestly ill that might provide a key for identifying vulnerability to subsequent disorder. This study was carried out to determine whether certain types of egocentric perception exist in the children of psychotic parents that might represent a clue to vulnerability. Sixty parent-child pairs were investigated as part of the University of Rochester (NY) Child and Family Study, using standardized diagnostic assessment procedures in the parents and several methods for evaluating egocentric perception in their offspring. Results showed that severity of psychotic symptoms in a parent related significantly to the degree of persistent age-inappropriate spatial egocentrism in his or her child. All of several diagnostic approaches used for parent classification were about equally valid in this regard, except for hospital diagnosis of schizophrenia, which did not correlate significantly with offspring egocentricity.
Child↗
Biochemical research into psychosis.
A strategy is presented for biological psychosis research with neuroleptics acting as a point of crystallisation like antidepressants do in biological depression research. The neuroleptics chlorpromazine, haloperidol and oxypertine were studied, and it was found that they influence central catecholamine (CA) metabolism in man. An increased central dopamine (DA) turnover was found to occur in psychotic disorders, mostly in the form of motor agitation. As the first of a planned series of studies, chlorpromazine with presumed ability to reduce both DA-ergic and noradrenaline (NA)-ergic transmission and oxypertine as a more selective blocker of NA-ergic transmission were selected for comparison. The overall therapeutic effect of oxypertine was inferior to that of chlorpromazine, whereas oxypertine proved more effective in cases where loss of initiative was predominant. On the other hand, chlorpromazine exerted a more marked influence on extrapyramidal motor functions than oxypertine. In chronic psychotic disorders with inertia, oxypertine thus seems to be a neuroleptic which is strong enough to prevent exacerbation of delusions and hallucinations while at the same time increasing the level of motivation. These findings were in accordance with our predictions. The comparative study is illustrative of the practical significance of the research approach in this study: The biochemical action profile of a neuroleptic seems to be a more reliable indicator of its clinical action than does its chemical structure.
Brain↗
The clinical activity of oxazepam.
Over the years, oxazepam has distinguished itself clinically from other benzodiazepines by virtue of its excellent tolerance. Recent research suggests that this is due to metabolic and pharmacokinetic differences rather than an intrinsically more favourable toxic-to-therapeutic dosage ratio. Because of its excellent tolerance, dosage is very flexible, and it is, therefore, possible to utilize oxazepam in a wide spectrum of anxiety-related disorders including the psychoses. The use of oxazepam in anxiety neurosis, depressive neurosis, psychotic disorders, alcoholism, and insomnia is discussed.
Alcoholism↗
Prevalence of psychosis in South Asia: A systematic review and meta-analysis.
BACKGROUND: Psychotic disorders are a major contributor to global disability, yet prevalence data from South Asia which inhabits a quarter of the world's population, remain limited. Reliable estimates are essential for health service planning, policy, and closing the substantial treatment gap. This review provides the first comprehensive synthesis of psychosis prevalence across South Asia. METHODS: We searched PubMed, Embase, Web of Science, Global Health, and Medline to 18 December 2024 for DSM- or ICD-based prevalence studies in Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Cross-sectional and longitudinal studies in community or clinical populations were included. Study quality was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analyses estimated pooled prevalence using the logit transformation. Heterogeneity was explored with meta-regression of key methodological variables (publication year, diagnostic system, residential setting). FINDINGS: Thirty-one studies from five countries were included. Among community-dwelling adults, pooled point prevalence was 0.85% and lifetime prevalence was 1.40%, with inter-country differences (India 1.18%, Pakistan 2.13%, Nepal 2.90%). Clinical samples showed substantially higher proportions of individuals with psychosis in service settings (11.44%), reflecting concentration of cases in treatment-seeking samples. Data for children and adolescents were limited and summarised narratively. Heterogeneity was high across meta-analyses, and exploratory meta-regression did not identify any significant moderators. INTERPRETATION: Psychosis prevalence estimates in South Asia appear higher than global averages but should be interpreted cautiously due to substantial heterogeneity and methodological variation; nevertheless, they highlight the need for culturally sensitive screening, improved detection, and strengthened mental health services.
Humans↗
Neuroleptics, catecholamines, and psychoses: a study of their interrelations.
The authors examined central catecholamine metabolism in various symptomatological psychotic disorders and the relationship between the biochemical and therapeutic action profiles of neuroleptics. Haloperidol and (to a lesser entent) chlorpromaziner icrease the dopamine (DA) turnover in the central nervous system, but the authors influenced; oxypertine has the reverse effect. The authors question whether disorders of DA-metabolism underlie or result from disorders of motor activity, postulating that the hyperdopaminergic activity observable in psychoses is dependent on motor hyperactivity rather than on "true" or psychotic symptoms such as delusions and hallucinations.
Adolescent↗
Mediterranean and standard American diet consumption in psychosis and non-psychosis affective disorders groups: Symptoms and cognition.
UNLABELLED: Research supports an association between diet and health, and emerging evidence suggests that diet is associated with neuropsychiatric symptoms. However, no human study has examined an anti-inflammatory diet across rigorously defined psychiatric diagnoses and its associations with symptom severity and cognition. As inflammation is implicated in mental illness, we investigated adherence to the Mediterranean diet (MD), an anti-inflammatory diet, and the standard American diet (SAD), and examined cross-sectional relationships with psychiatric symptoms and cognition. METHOD: Participants included 54 individuals with psychotic disorders, 30 with non-psychosis affective disorders and 40 healthy controls. Participants underwent diagnostic interviews, PANSS symptom ratings, and MATRICS cognitive assessments. The self-report GBAQ was used to assess adherence to the MD versus SAD. RESULTS: The psychosis group was significantly more likely to consume the SAD than healthy controls (p = 0.007), with MD adherence predicting better working memory (r = 0.461, p < 0.001). In the non-psychosis affective disorders group, MD adherence predicted slower processing speed (r = -0.376, p = 0.049). In the non-psychosis affective disorders group, MD predicted reduced PANSS General Psychopathology scale (r = -0.449, p = 0.013), as well as the Activation (r = -0.362, p = 0.049), and Dysphoric Mood factors (r = -0.403, p = 0.027). DISCUSSION: This first-of-its kind study identified poor dietary choices in persons with psychosis, showing significantly lower symptoms and better cognition in association with the MD in transdiagnostic analyses. It supports the study of dietary interventions for prevention and treatment of psychiatric conditions.
Humans↗
PH-dependent behavior of erythrocyte membrane elevations. II Occurrence in moderate acidemic and alkalemic conditions.
Changes of the number of red cell membrane elevations revealed by freeze-etch electron microscopy are pH-dependent in vitro and in vivo. In healthy volunteers a decrease of the number of red cell surfaces with elevations was observed under moderate acidemic and alkalemic conditions. These changes were different in patients with Huntington's chorea and affective psychotic disorders. Elevations of the red cell membrane with the same diameter can be demonstrated in ultrathin sections, if sodium azide is added during the fixation procedure.
Erythrocyte Membrane↗
Plasma concentrations of perphenazine and its sulphoxide metabolite during continuous oral treatment.
Plasma concentrations of perphenazine (PPZ) (Trilafon) and perphenazinesulphoxide (PPZSO) were estimated during a 2-week period in 16 patients receiving peroral PPZ treatment for various psychotic disorders. The results demonstrated that the average concentration of three plasma samples was a reasonably good expression of the steady-state plasma level despite a great fluctuation in the concentration from sample to sample. Increased doses in three of the patients resulted in disproportionate increases in the plasma levels. Neurological side effects were recorded and their relation to plasma concentrations are discussed.
Administration, Oral↗
Clinical Characteristics associated with functional seizures in individuals with psychosis.
BACKGROUND AND HYPOTHESIS: Functional seizures (FS) are episodes characterized by seizure-like events that are not caused by hypersynchronous neuronal activity. Prior studies have suggested an increased prevalence of psychotic disorders among patients with FS, but results have been inconsistent. We hypothesize that FS are associated with psychosis and that among patients with psychosis, the presence of FS may influence patient clinical characteristics, mortality, and medical resource utilization. STUDY DESIGN: The association between FS and psychosis was assessed using electronic health records data from a total of 761,848 individuals receiving care at Vanderbilt University Medical Center between 1989 and 2023. Analyses of the association between FS and psychiatric outcomes, sexual trauma, healthcare utilization, and other clinical comorbidities were conducted in a subset of 5219 patients with psychosis. STUDY RESULTS: Odds of FS were elevated among patients with psychosis compared to controls (OR = 10.09, 95 % CI = 8.40-12.13). Among patients with psychosis, those with FS exhibited higher rates of suicidality (OR = 2.18 95 % CI = 1.50-3.17), catatonia (OR = 2.15, 95 % CI = 1.33-3.45), sexual trauma history (OR = 2.93, 95 % CI = 2.00-4.29) and had a greater number of antipsychotic trials (4.63 versus 3.37, beta = 1.23, SE = 0.18, adjusted p < 0.001) than those without FS. Furthermore, patients with comorbid FS had more hospital presentations at one, three, five, and ten years after receiving a psychosis diagnosis (adjusted p < 0.001). CONCLUSIONS: FS are more common among patients with psychosis and are associated with increased healthcare utilization as well as an increased prevalence of suicidality, catatonia, and certain psychiatric and medical comorbidities.
Humans↗
Integrating biological pathway polygenic scores and trauma in psychosis: findings from the EU-GEI study.
Psychotic disorders are complex, multifactorial conditions influenced by both genetic liability and early environmental adversity. Polygenic risk scores (PRSs) derived from genome-wide association studies have shown utility in capturing genetic predisposition, but their biological interpretability remains limited. In this study, we evaluated whether biologically informed pathway-specific polygenic scores (pPGSs) for psychosis, restricted to neurotransmitter-related pathways, could help clarify gene-environment interplay. Using data from 1 192 individuals in the EU-GEI multi-site case-control study, we constructed pPGSs for dopamine, glutamate, GABA, and serotonin systems. We investigated associations between pPGSs and childhood trauma (rGE), their interactions on psychosis risk (GxE), and the influence of the genome-wide psychosis PRS on these relationships. Serotonin, dopamine, and glutamate pPGSs were positively associated with a composite trauma exposure (i.e., abuse and neglect), suggesting shared genetic factors contributing to both psychosis liability and early adversity. Significant negative GxE effects were observed for both dopamine and serotonin pPGSs, indicating that higher trauma exposure diminished the relative influence of genetic liability on psychosis risk. Adjustment for the genome-wide psychosis PRS attenuated most effects, but serotonergic and dopaminergic associations remained robust, supporting pathway-specific contributions beyond general polygenic risk. These findings provide proof-of-concept for the utility of pPGSs in psychiatric research, suggesting both genetic contributions to trauma exposure and GxE effects on psychosis risk. Further research incorporating epigenetic data and longitudinal designs may enhance mechanistic insight and translational potential.
Adult↗
Immune dysregulation in depression and psychosis: summary of current evidence and future perspectives.
Despite compelling epidemiological, genetic and cellular evidence linking immune dysregulation to depression and schizophrenia (and other psychotic disorders), causality remains contested and no immune biomarker has yet demonstrated robust clinical utility. Emerging methodological approaches - from target trial emulation on observational data to functional genomics - offer a potential path towards precision immunopsychiatry and stratified immunomodulatory treatment.
Neuroimmunology↗
The treatment of psychotic major depressive disorder with drugs and electroconvulsive therapy.
A retrospective chart review of 54 patients demonstrating depression with psychotic symptoms was accomplished with the use of Research Diagnostic Criteria (RDC) for diagnosis of psychotic major affective disorder. Patients received adequate trials of either tricyclic antidepressants alone, antipsychotics, the two in combination, or electroconvulsive therapy (ECT). Antidepressants alone were found to be ineffective or only partially effective in treating psychotic depression unless somatic or depressive declusions were the only psychotic symptoms. Antipsychotics alone were usually effective in providing at least a partial response, particularly with psychotic symptoms. Excellent responses of the depressive and psychotic elements were provided with ECT, ECT with antipsychotic medication, and the combination of antidepressant and antipsychotic medications. These latter treatments may be the most appropriate for depression with psychotic features.
Adult↗
Mental disturbed violent offenders in Sweden.
Among perpetrators of crimes of violence against persons submitted to psychiatric examination, 16 men with severe mental disorder have been examined by standardized psychologic tests and clinical interviews. Objective anamnestic data have been used to assess social background, individual development and onset of mental disorder. Psychotic as well as nonpsychotic men reacted with violence against threat to the offender's physical existence of his self image. In most instances ego weakness or depleted mental energy exaggerated the feeling of threat or stymied the ability to choose alternative solutions. Abuse of alcohol and narcotics and acute inebriation often weakened self-control and triggered of the act of violence.
Adolescent↗
Familial psychosis and diverse neurologic abnormalities in adult-onset Gaucher's disease.
A family is described in which adult-onset Gaucher's disease developed, followed years later by atypical psychotic disorders with neurologic and electroencephalographic abnormalities. A biochemical investigation of primary and secondary enzyme alterations in the index case was performed in an attempt to identify a pattern that might be specific to this clinical profile. The literature pertaining to CNS involvement in adult patients with Gaucher's disease is also reviewed. An etiologic link may exist between the inherited metabolic disorder and associated neuropsychiatric impairment. The biochemical basis of this hypothesized association remains unclear, however, and further enzymatic and pathologic investigations are warranted.
Acid Phosphatase↗
The hysterical personality. An attempt at validation with the MMPI.
We attempted to validate the DSM-II diagnosis of hysterical personality and the depression often experienced by such patients by comparing mean Minnesota Multiphasic Personality inventory (MMP) scores of hysterical personality patients with those of paranoid schizophrenic patients and a group with mixed psychiatric diagnoses. Index patients had significantly higher scores than either control group and could be distinguished on individual scales from the paranoid schizophrenics. However, the mean MMPl profile of hysterical personalities was similar to that of depressed controls. Therefore, the MMPl alone could not differentiate these two groups nor could it confirm or refute the validity of the diagnostic concept of hysterical personality, but it did support the clinical observation that depression is a major risk for individuals given this diagnosis and that the experience of depression by these patients is genuine.
Adolescent↗
Methylation hypothesis.
L-Methionine had no behavioral effects in normal humans and failed to increase concentrations of S-adenosylmethionine (methyl donor) in human or rat blood, while increasing rat liver levels more than fivefold. Methionine or S-adenosylmethionine in very high doses had almost no effect on methylation of tritiated levodopa in rodent tissues; various "methyl acceptor" molecules, including nicotinamide, guanidineacetic acid, and estradiol similarly had little effect. In rabbit lung, methionine and S-adenosylmethionine not only failed to increase production of dimethyltryptamine, but actually decreased it, possibly due to end-product inhibition by S-adenosylhomocysteine, which also strongly inhibited methylation of dopa in rat. These results fail to support several predictions of the "methylation hypothesis" concerning the pathophysiology and potential treatment of idiopathic psychotic disorders and leave the consistent clinical worsening effects of methionine in schizophrenia unexplained.
Adult↗