Schizophreniforme Psychose bei temporoparietalem Meningeom rechts

Affective reactivity to daily life stress: Relationship to positive psychotic and depressive symptoms in a general population sample

Objectives: Although pharmacotherapy with antipsychotic medication is an effective intervention for early psychosis (EP), drop out from treatment and relapse rates appear still relatively high. In the last decade, there is growing interest in Cognitive-Behavioural Therapy (CBT) as early intervention for EP. Some studies suggest that CBT may be an effective adjuvant to pharmacotherapy to reduce risk of development of chronic psychosis in individuals who experienced first episodes. Symptoms of depression and social anxiety are very common among patients experiencing first episode psychosis, thus impairing quality of life and functioning. This aspect may create a negative vicious cycle, that may reinforce feelings of learned helplessness and hopelessness with regard to psychosis diagnosis, thus increasing vulnerability to relapse in further episodes. However, there is little knowledge on the use of CBT to target both reoccurrence of psychotic episodes and symptoms of depression and social anxiety secondary to first psychotic episodes. The current case report presents the administration of a modular CBT semi-manualized intervention to a young patient to enhance prevention of psychosis and target symptoms of social anxiety and depression following first psychotic episodes. Methods: Treatment consisted in 21 individual weekly sessions, delivered in an outpatient setting, involving two phases. The first one targeted prevention of psychotic episodes. Case formulation was developed according to cognitive behavioural model of psychosis. Psychoeducation on early signs and vulnerability factors of relapse in psychotic episodes was delivered in order to promote patient’s self-monitoring and insight on positive symptoms prodromes. The second treatment phase targeted symptoms of depression and social anxiety. Homework based on behavioural activation were assigned in order to address depressive symptoms, and cognitive restructuring was used to normalize dysfunctional beliefs. A social skills and assertiveness training was used to target social anxiety. CBT treatment was delivered in combination with medication. Clinical interviews were conducted at pre-, immediate post-treatment, and at 5-month-follow-up, to evaluate reoccurrence of psychotic episodes, and changes in depression, social anxiety, and functioning. Results: As observed by clinical interviews, the patient did not experience further relapse in psychotic episodes. In addition, it was observed a reduction in depressive symptoms and social anxiety through the increase of the number of daily activities, social relations, work and academic engagement. Conclusions: Important limitations of the study are discussed. Future research using large randomized controlled trials with longer follow-up assessments should evaluate the effectiveness of CBT to target depressive symptoms and social anxiety for patients with EP.

Noninvasive Staging of Non-small Cell Lung Cancer : A Review of the Current Evidence

A state-independent network of depressive, negative and positive symptoms in male patients with schizophrenia spectrum disorders

Aims: Dissociative Identity Disorder (DID) is a complex psychiatric condition that is often misdiagnosed due to its overlapping symptoms with other disorders such as mood and psychotic disorders. The presence of psychotic features, including auditory and visual hallucinations, disorganized behaviour, and memory gaps, can make the diagnosis of DID particularly challenging. This case study highlights a 27-year-old female whose DID diagnosis was delayed due to misinterpretation of her psychotic symptoms, which were initially attributed to other psychiatric disorders.Methods: A 27-year-old female with a 15-year history of psychiatric care began experiencing symptoms at the age of 13, initially presenting with anxiety and panic attacks. Over time, her symptoms escalated to include episodes of auditory and visual hallucinations, disorganized speech, and erratic behaviour, leading to multiple hospitalizations. During one hospitalization, she displayed regressive behaviours, mutism, aggressive outbursts, hypomania, and dissociative amnesia. Despite extensive workups, including MRI scans and lab tests, no organic causes were found. Her diagnosis fluctuated between psychotic disorders, mood disorders, anxiety disorder, and dissociative disorder. Her mood and psychotic symptoms were initially treated as schizoaffective disorder, but the patient experienced adverse reactions to antipsychotic medications, including galactorrhoea from risperidone and weight gain from amisulpride. These medications were ineffective, prompting a reassessment of her diagnosis. A thorough review of her clinical history, including reports of memory gaps, identity disturbances, and dissociative episodes, led to the reconsideration of DID as the primary diagnosis.Results: The psychotic features in this patient, such as hallucinations and disorganized behaviour, were secondary to her dissociative episodes, occurring during times of identity disturbance. This case underscores that psychotic symptoms in DID can easily be misinterpreted as part of a mood or psychotic disorder, especially when dissociative episodes are not initially recognized. The prolonged misdiagnosis delayed appropriate treatment, but a more comprehensive understanding of her symptoms led to the correct diagnosis and tailored management.Conclusion: This case highlights the diagnostic challenges in identifying DID, particularly when psychotic features overlap with other psychiatric conditions. Early recognition of DID, with a thorough longitudinal assessment of both dissociative and psychotic symptoms, is crucial for accurate diagnosis and improving patient outcomes. A more targeted approach, including trauma-informed care and psychotherapy, would have been beneficial and should be considered in similar cases.

Cases where pituitary tumor is presented first with psychiatric signs are very rare

Mutations identified in SCN1A , the gene encoding the neuronal sodium channel α1 subunit, have been linked with a disorder called generalized epilepsy with febrile seizures plus (GEFS+).1 GEFS+ can also be linked to mutations in SCN2A, SCN1B, and GABRG2 genes.2 Inherited mutations, commonly missense, account for 5% to 15% of GEFS+.1 Sporadic missense mutations have been reported.2 ### Case report. A 12-year-old-female patient was the third child of healthy and unrelated parents. Psychomotor development and language acquisition were normal. At age 2.8 years, she had an episode during sleep with retching, vomiting, pallor, generalized hypotonia, and loss of consciousness, lasting 6 to 7 hours. CT scan, MRI, and CSF examination results were normal. A similar episode occurred 1 year later. On that occasion, a cardiorespiratory arrest also occurred, with admission of the patient to an intensive care unit. The episode lasted approximately 8 hours. EKGs and cardiac ultrasonography were normal. At age 4.2 years, sleeping episodes with retching, vomiting, pallor, excessive sweating, loss of consciousness, and head deviation toward the left right lasting …

Prevalence of co-occurring severe depression and psychotic symptoms in college students and its relationship with childhood maltreatment

Antipsychotic therapy is given frequently to the patient with depressive symptoms. Antipsychotics are used to enhance the effects of antidepressants in the depressive patients. The aim of this study was to evaluate the length of stay of antipsychotic therapy selection in the depressive patient without/with psychosis symptoms. This study was conducted by quantitative method, multicenter, non-experimental approach, and cohort design study. Data were collected from medical records of 187 patients diagnosed with depression without/with psychosis symptoms from the various mental-illness hospital in Central Java Province. There was a significant difference (p <0.05) in the length of stay with the selection of antidepressants in depressive patients without psychotic symptoms, and there was no significant difference (p> 0.05) in the length of stay with the selection of antipsychotic agents in depressive patients without/with psychotic symptoms. Keywords— Length of stay, depression, without/with psychosis symptoms, antipsychotic

Urban and rural populations have different rates of psychotic illness. If psychosis exists as a continuous phenotype in nature, urban-rural population differences in the rate of psychotic disorder should be accompanied by similar differences in the rate of abnormal mental states characterized by psychotic or psychosislike symptoms. A random sample of 7076 individuals aged 18 to 64 years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview. Approximately half of those with evidence of psychosis according to the Composite International Diagnostic Interview were additionally interviewed by clinicians. We investigated associations between a 5-level urbanicity rating and (1) any DSM-III-R diagnosis of psychotic disorder (sample prevalence, 1.5%), (2) any rating of hallucinations and/or delusions (sample prevalence, 4.2%), and (3) any rating of psychotic or psychosislike symptoms (sample prevalence, 17.5%). Level of urbanicity was associated not only with DSM-III-R psychotic disorder (adjusted odds ratio [OR] over 5 levels, 1.47; 95% confidence interval [CI], 1.25-1.72), but also, independently, with any rating of delusion and/or hallucination (adjusted OR, 1.28; 95% CI, 1.17-1.40; clinician-assessed psychotic symptoms only: OR, 1.30; 95% CI, 1.03-1.64) and any rating of psychosislike symptom (adjusted OR, 1.18; 95% CI, 1.13-1.24). Psychotic symptoms were strongly and independently associated with psychotic disorder, regardless of the level of urbanization. Community level of psychotic and psychosislike symptoms may be inextricably linked to the prevalence of psychotic disorder. The prevalence of abnormal mental states that facilitate development to overt psychotic illness increases progressively with level of urbanization.

Longitudinal data from 4,331 homeless mentally ill clients at 18 sites participating in the Access to Community Care and Effective Services and Supports program were used to assess participants' quality of life over a one-year period. At baseline higher quality of life was associated with less severe depressive and psychotic symptoms, less use of alcohol and drugs, and more social support. At 12 months improved quality of life was associated with decreased psychotic and depressive symptoms, reduced substance abuse, fewer days of homelessness, and increased social support, income, employment, and service use.

Cannabis use is associated with psychotic disorder onset and exacerbation. This study examines how continued cannabis use affects depressive symptoms, psychotic symptoms, and suicidal behaviors following cannabis-induced first-episode psychosis (FEP). Sixty-five participants (aged 16-50 years) with FEP were recruited from psychiatric inpatient facilities in northern Italy. Participants were categorized into two groups: non-cannabis users (NCU) and cannabis users (CU), based on substance use during the 9-month follow-up. Twenty-one participants (32.3%) were lost to follow-up, with a final sample of 44 subjects (NCU = 22, CU = 22). Assessments were conducted at baseline, 3 months, and 9 months using PANSS, CDSS, SSI, and GAF scales). CU exhibited persistently higher depression (CDSS) and suicidality (SSI) scores than NCU throughout follow-up, with significant differences at both 3 months (CDSS: p = .000006; SSI: p < .001) and 9 months (CDSS: p = .0000001; SSI: p < .001). Positive psychotic symptoms improved in both groups, though CU showed slower recovery and higher relapse rates (59.9% vs. 18.8%). PANSS positive subscale scores remained significantly higher in CU at 3 months (p = .001) and 9 months (p < .0002). GAF scores improved significantly only in NCU (p = .024 at 9 months). Continued cannabis use adversely affects depressive and psychotic symptoms and suicidality in FEP patients, while cannabis cessation is associated with improved clinical outcomes. This study tracks depressive symptoms, suicidality, and psychotic manifestations in cannabis-induced FEP, demonstrating that continued use is associated with treatment-resistant depressive symptoms even when psychotic symptoms improve, highlighting the need for integrated clinical approaches.

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessTeens’ Psychotic Symptoms Strongly Associated With Suicidal BehaviorMark MoranMark MoranSearch for more papers by this authorPublished Online:4 Jan 2013https://doi.org/10.1176/appi.pn.2013.1a17AbstractAdolescents with symptoms of psychosis were 10 times more likely to report suicidal behavior than were nonpsychotic peers.Psychotic symptoms are strongly associated with increased risk for suicidal behavior in the general adolescent population and in adolescents with nonpsychotic psychiatric disorders, according to a report of two independently conducted case-control clinical interview studies from Ireland.In both studies, an absolute majority of adolescents with more severe suicidal behavior (including ideation, suicidal plans and acts) reported psychotic symptoms when directly questioned about this as part of a psychiatric interview.The report was published in the December 2012 Archives of General Psychiatry.“The immediate clinical relevance of these findings is that all patients presenting at risk for suicidal behavior should receive a thorough assessment of psychotic symptoms and not just a screening to rule out psychotic disorder,” write Ian Kelleher, Ph.D., and colleagues at the Royal College of Surgeons in Ireland. “Research has shown that the largest increase in suicide risk in the general population occurs after there has already been contact with mental health services and that approximately half of patients who complete suicide have contact with primary care providers in the month preceding their death.”The two independently conducted case-control clinical interview studies included one with 212 adolescents aged 11 to 13 and a second with 211 adolescents aged 13 to 15. Participants were recruited from schools, and suicidal behavior and psychotic symptoms were assessed by semi-structured diagnostic clinical interview.The researchers found that psychotic symptoms were associated with a 10-fold increased odds of any suicidal behavior (including ideation, plans, or acts) in both the early- and middle-adolescence studies.Adolescents with depressive disorders who also experienced psychotic symptoms were at a nearly 14-fold increased odds of more severe suicidal behavior (suicide plans and suicide acts) compared with adolescents with depressive disorders who did not experience psychotic symptoms. Among all adolescents with suicidal ideation, those who also reported psychotic symptoms had a nearly 20-fold increased odds of suicide plans and suicide acts compared with adolescents with suicidal ideation who did not report psychotic symptoms.The researchers suggest several possible explanations as to the mechanisms underlying the strong relationship between psychotic symptoms and suicidal behavior. “The most obvious is that hallucinations may direct the individual to harm or kill themselves,” they wrote. “In fact, a post hoc analysis of the type of psychotic symptoms reported by adolescents with suicidal behavior demonstrated that all included auditory hallucinations. However, only one of the participants in either of the studies reported command hallucinations to harm or kill themselves. It is possible, however, that psychotic symptoms may impact suicidal behavior via indirect cognitive mechanisms. Changes in the subjective sense of self, for example, are among the earliest recognizable symptoms of psychosis, and a sense of disintegration and fragmentation of the self resulting from intrusive voices or thoughts has been linked to suicidal thinking.” ■ ISSUES NewArchived

The negative symptoms of psychosis and depressive symptomatology share several features, e.g. low motivation, apathy and reduced activity. Understanding the associations between these two sets of symptoms will support improved assessment and the development of interventions targeting these difficulties in people with psychosis. This is the first large systematic review and meta-analysis to quantify the relationship between these two categories of symptoms, as measured in studies to date. PsycInfo, Embase and Medline were systematically searched to identify eligible studies. Inclusion criteria ensured the studies measured both depression and negative symptoms using validated measures in a sample of over 8000 participants with non-affective psychosis diagnoses. The search led to 2020 records being screened and 56 included in the meta-analysis and review. Both meta-analyses and meta-regressions were conducted to explore the main effect and potential moderating variables. A clear pattern emerges showing that higher ratings of negative symptoms are associated with higher levels of depressive symptoms, with a small effect [standardised effect size = 0.19, p < 0.05). This did not vary greatly with the measures used (SES = 0.19-0.26) and was not moderated by demographic variables or quality ratings. Interestingly, higher depressive symptoms predict a significant relationship with co-occurring negative symptoms. However, higher negative symptoms predict that it is less likely there will be a relationship with co-occurring depressive symptoms. Heterogeneity was high across these analyses. The findings support the adoption of a symptom-specific approach to understanding the interplay between negative and depressive symptoms in psychosis, to improve assessment and intervention.

The 22q11.2 Deletion in Children: High Rate of Autistic Disorders and Early Onset of Psychotic Symptoms