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Knížková K, Keřková B, Večeřová M, Šustová P, Jonáš J, Siroňová A, Hrubý A, Rodriguez M. Longitudinal course of core cognitive domains in first-episode acute and transient psychotic disorders compared with schizophrenia. Schizophr Res Cogn 2024; 37:100311. [PMID: 38601889 PMCID: PMC11004639 DOI: 10.1016/j.scog.2024.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024]
Abstract
Acute and transient psychotic disorder (ATPD) is characterized by acute onset of psychotic symptoms and early recovery. Contrastingly, schizophrenia (SZ) is a chronic mental disorder characterized by impaired functioning including a deficit in cognition. In SZ, the cognitive deficit is among the core symptoms, but in ATPDs, the existing evidence brings mixed results. Our primary aim was to compare three core cognitive domains (executive functioning/abstraction, speed of processing and working memory) of patients diagnosed with ATPD and SZ over a 12-month period. Moreover, we explored how these diagnostic subgroups differed in their clinical characteristics. We recruited 39 patients with a diagnosis of SZ and 31 with ATPD with schizophrenic symptoms. All patients completed clinical and neuropsychological assessments. At baseline, we used a one-way ANCOVA model with a group as the between-subjects factor. Mixed-model repeated-measures ANOVAs with time as the within-subjects factor and group as the between-subjects factor were run to test the overtime differences. At baseline, we did not find any differences in cognition - with sex, education and age as covariates - between ATPDs and SZ. After one year, all patients showed an improvement in all three domains, however, there were no significant overtime changes between ATPDs and SZ. Regarding clinical profiles, ATPDs demonstrated less severe psychopathology and better functioning compared to SZ both at baseline and after 12 months. The medication dosage differed at retest, but not at baseline between the groups. Our findings suggest clinical differences and a similar trajectory of cognitive performance between these diagnostic subgroups.
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Affiliation(s)
- Karolína Knížková
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Barbora Keřková
- National Institute of Mental Health, Klecany, Czech Republic
| | - Monika Večeřová
- National Institute of Mental Health, Klecany, Czech Republic
| | - Petra Šustová
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University in Prague, Czech Republic
| | - Juraj Jonáš
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Arts, Charles University in Prague, Czech Republic
| | - Aneta Siroňová
- National Institute of Mental Health, Klecany, Czech Republic
- Department of Psychology, Faculty of Social Studies, Masaryk University, Brno, Czech Republic
| | - Aleš Hrubý
- National Institute of Mental Health, Klecany, Czech Republic
| | - Mabel Rodriguez
- National Institute of Mental Health, Klecany, Czech Republic
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Ngamaba KH, Lombo LS, Makopa IK, Webber M, Liuta JM, Madinga JN, Mampunza SMM, Heap C. Mental health outcomes, literacy and service provision in low- and middle-income settings: a systematic review of the Democratic Republic of the Congo. NPJ MENTAL HEALTH RESEARCH 2024; 3:9. [PMID: 38609473 PMCID: PMC10956021 DOI: 10.1038/s44184-023-00051-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 12/20/2023] [Indexed: 04/14/2024]
Abstract
In the Democratic Republic of the Congo (DRC), the prevalence of mental health issues could be greater than in other low-income and middle-income countries because of major risk factors related to armed conflicts and poverty. Given that mental health is an essential component of health, it is surprising that no systematic evaluation of mental health in the DRC has yet been undertaken. This study aims to undertake the first systematic review of mental health literacy and service provision in the DRC, to bridge this gap and inform those who need to develop an evidence base. This could support policymakers in tackling the issues related to limited mental health systems and service provision in DRC. Following Cochrane and PRISMA guidelines, a systematic (Web of Science, Medline, Public Health, PsycINFO, and Google Scholar) search was conducted (January 2000 and August 2023). Combinations of key blocks of terms were used in the search such as DRC, war zone, mental health, post-traumatic stress disorder (PTSD), anxiety, depression, sexual violence, war trauma, resilience, mental health systems and service provision. We followed additional sources from reference lists of included studies. Screening was completed in two stages: title and abstract search, and full-text screening for relevance and quality. Overall, 50 studies were included in the review; the majority of studies (n = 31) were conducted in the Eastern region of the DRC, a region devastated by war and sexual violence. Different instruments were used to measure participants' mental health such as the Hopkins Symptoms Checklist (HSCL-25), The Harvard Trauma Questionnaire, Patient Health Questionnaire (PHQ-9); General Anxiety Disorder (GAD-7), and Positive and Negative Symptoms Scale (PANSS). Our study found that wartime sexual violence and extreme poverty are highly traumatic, and cause multiple, long-term mental health difficulties. We found that depression, anxiety, and PTSD were the most common problems in the DRC. Psychosocial interventions such as group therapy, family support, and socio-economic support were effective in reducing anxiety, depression, and PTSD symptoms. This systematic review calls attention to the need to support sexual violence survivors and many other Congolese people affected by traumatic events. This review also highlights the need for validating culturally appropriate measures, and the need for well-designed controlled intervention studies in low-income settings such as the DRC. Better public mental health systems and service provision could help to improve community cohesion, human resilience, and mental wellbeing. There is also an urgent need to address wider social issues such as poverty, stigma, and gender inequality in the DRC.
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Affiliation(s)
- Kayonda Hubert Ngamaba
- International Centre for Mental Health Social Research, Social Policy and Social Work, School for Business and Society, University of York, Heslington, York, YO10 5DD, UK.
| | - Laddy Sedzo Lombo
- Centre Spécialisé dans la Prise en charge Psychosociale en Santé Mentale (CSPEMRDC), Université Chrétienne de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Israël Kenda Makopa
- Neuropsychiatre et Addictologue Centre Spécialisé dans la Prise en charge Psychosociale en Santé Mentale (CSPEMRDC), Université Chrétienne de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Martin Webber
- International Centre for Mental Health Social Research, Social Policy and Social Work, School for Business and Society, University of York, Heslington, York, YO10 5DD, UK
| | - Jack M Liuta
- Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK
| | - Joule Ntwan Madinga
- WHO Country Office DRC & Medical Parasitology and Epidemiology, Faculty of Medicine, University of Kikwit, Kikwit, Democratic Republic of Congo
| | - Samuel Ma Miezi Mampunza
- Faculte de Medicine University of Kinshasa & Université Protestante au Congo (UPC), Kinshasa, Democratic Republic of Congo
| | - Cheyann Heap
- International Centre for Mental Health Social Research, Social Policy and Social Work, School for Business and Society, University of York, Heslington, York, YO10 5DD, UK
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Tschentscher N, Woll CFJ, Tafelmaier JC, Kriesche D, Bucher JC, Engel RR, Karch S. Neurocognitive Deficits in First-Episode and Chronic Psychotic Disorders: A Systematic Review from 2009 to 2022. Brain Sci 2023; 13:brainsci13020299. [PMID: 36831842 PMCID: PMC9954070 DOI: 10.3390/brainsci13020299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/12/2023] Open
Abstract
Cognitive impairment in patients suffering from schizophrenia spectrum disorders has been discussed as a strong predictor for multiple disease outcome variables, such as response to psychotherapy, stable relationships, employment, and longevity. However, the consistency and severity of cognitive deficits across multiple domains in individuals with first-episode and chronic psychotic disorders is still undetermined. We provide a comprehensive overview of primary research from the years 2009 to 2022. Based on a Cochrane risk assessment, a systematic synthesis of 51 out of 3669 original studies was performed. Impairment of cognitive functioning in patients diagnosed with first-episode psychotic disorders compared with healthy controls was predicted to occur in all assessed cognitive domains. Few overall changes were predicted for chronically affected patients relative to those in the first-episode stage, in line with previous longitudinal studies. Our research outcomes support the hypothesis of a global decrease in cognitive functioning in patients diagnosed with psychotic disorders, i.e., the occurrence of cognitive deficits in multiple cognitive domains including executive functioning, memory, working memory, psychomotor speed, and attention. Only mild increases in the frequency of cognitive impairment across studies were observed at the chronically affected stage relative to the first-episode stage. Our results confirm and extend the outcomes from prior reviews and meta-analyses. Recommendations for psychotherapeutic interventions are provided, considering the broad cognitive impairment already observed at the stage of the first episode. Based on the risk of bias assessment, we also make specific suggestions concerning the quality of future original studies.
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Affiliation(s)
- Nadja Tschentscher
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
- Correspondence:
| | - Christian F. J. Woll
- Section of Clinical Psychology of Children and Adolescents, Department of Psychology and Educational Sciences, Ludwig Maximilian University of Munich, Leopoldstr. 13, 80802 Munich, Germany
| | - Julia C. Tafelmaier
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Dominik Kriesche
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Julia C. Bucher
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Rolf R. Engel
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Susanne Karch
- Section of Clinical Psychology and Psychophysiology, Department of Psychiatry and Psychotherapy, LMU Hospital Munich, Nußbaumstr. 7, 80336 Munich, Germany
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Ho NF, Lin AY, Tng JXJ, Chew QH, Cheung MWL, Javitt DC, Sim K. Abnormalities in visual cognition and associated impaired interactions between visual and attentional networks in schizophrenia and brief psychotic disorder. Psychiatry Res Neuroimaging 2022; 327:111545. [PMID: 36272310 DOI: 10.1016/j.pscychresns.2022.111545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/08/2022] [Accepted: 09/23/2022] [Indexed: 12/04/2022]
Abstract
The extent and nature of cognitive impairment in brief psychotic disorder remains unclear, being rarely studied unlike schizophrenia. The present study hence sought to directly compare the visual cognitive dysfunction and its associated brain networks in brief psychotic disorder and schizophrenia. Data from picture completion (a complex visual task) and whole-brain functional connectome from resting-state fMRI were acquired from a sample of clinically stable patients with an established psychotic disorder (twenty with brief psychotic disorder, twenty with schizophrenia) and twenty-nine healthy controls. Group differences and the inter-relationships in task performances and brain networks were tested. Picture completion task deficits were found in brief psychotic disorder compared with healthy controls, though the deficits were less than schizophrenia. Task performance also correlated with severity of psychotic symptoms in patients. The task performance was inversely correlated with the functional connectivity between peripheral visual and attentional networks (dorsal attention and salience ventral attention), with increased functional connectivity in brief psychotic disorder compared with healthy controls and in schizophrenia compared with brief psychotic disorder. Present findings showed pronounced visual cognitive impairments in brief psychotic disorder that were worse in schizophrenia, underpinned by abnormal interactions between higher-order attentional and lower-order visual processing networks.
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Affiliation(s)
- New Fei Ho
- Institute of Mental Health, Singapore; Duke-National University of Singapore Medical School, Singapore.
| | | | | | | | | | | | - Kang Sim
- Institute of Mental Health, Singapore
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Mwesiga EK, Akena D, Koen N, Senono R, Obuku EA, Gumikiriza JL, Robbins RN, Nakasujja N, Stein DJ. A systematic review of research on neuropsychological measures in psychotic disorders from low and middle-income countries: The question of clinical utility. Schizophr Res Cogn 2020; 22:100187. [PMID: 32874938 PMCID: PMC7451606 DOI: 10.1016/j.scog.2020.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/02/2020] [Accepted: 08/17/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Several studies of neuropsychological measures have been undertaken in patients with psychotic disorders from low- and middle-income countries (LMICs). It is, however, unclear if the measures used in these studies are appropriate for cognitive screening in clinical settings. We undertook a systematic review to determine if measures investigated in research on psychotic disorders in LMICs meet the clinical utility criteria proposed by The Working Group on Screening and Assessment. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses were employed. We determined if tests had been validated against a comprehensive test battery, the duration and scope of the tests, the personnel administering the tests, and the means of administration. RESULTS A total of 31 articles were included in the review, of which 11 were from Africa. The studies included 3254 participants with psychosis and 1331 controls. 3 studies reported on the validation of the test against a comprehensive cognitive battery. Assessments took 1 h or less to administer in 6/31 studies. The average number of cognitive domains assessed was four. Nonspecialized staff were used in only 3/31 studies, and most studies used pen and paper tests (17/31). CONCLUSION Neuropsychological measures used in research on psychotic disorders in LMICs typically do not meet the Working Group on Screening and Assessment clinical utility criteria for cognitive screening. Measures that have been validated in high-income countries but not in LMICs that do meet these criteria, such as the Brief Assessment of Cognition in Schizophrenia, therefore deserve further study in LMIC settings.
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Affiliation(s)
- Emmanuel K. Mwesiga
- Department of Psychiatry, Makerere University, Uganda
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Uganda
| | - Dickens Akena
- Department of Psychiatry, Makerere University, Uganda
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Uganda
| | - Nastassja Koen
- SA MRC Research Unit on Risk & Resilience in Mental Disorders, South Africa
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
| | - Richard Senono
- Infectious Disease Institute, Makerere University, Uganda
| | - Ekwaro A. Obuku
- Africa Centre for Systematic Reviews and Knowledge Translation, College of Health Sciences, Makerere University, Uganda
| | | | - Reuben N. Robbins
- New York State Psychiatric Institute, Columbia University Irving Medical Center, United States of America
| | | | - Dan J. Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa
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Kilciksiz CM, Keefe R, Benoit J, Öngür D, Torous J. Verbal memory measurement towards digital perspectives in first-episode psychosis: A review. Schizophr Res Cogn 2020; 21:100177. [PMID: 32322540 PMCID: PMC7163058 DOI: 10.1016/j.scog.2020.100177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 03/20/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Even in the early phases of psychotic spectrum illnesses such as schizophrenia, patients can experience cognitive decline or deficits prior to the onset of psychotic symptoms such as delusions and hallucinations. In this systematic review, we assessed which verbal memory assessments are most widely used in first-episode psychosis and may be applied via digital technologies (smartphone applications, etc.) for use in early detection. METHODS In November 2019, we searched for studies measuring verbal memory in first episode psychosis or schizophrenia over the past 10 years on PubMed and PsycINFO. We screened abstracts of these studies and excluded review studies. Full-texts of included studies were used to identify the verbal memory measurement tests, follow-up frequencies, and sample sizes. RESULTS We screened 233 reports and found that 120 original research studies measured verbal memory in first episode psychosis over the past 10 years. Four of these studies specified using a computer, 24 (20%) used a paper-pen format, 1(1%) used both, and 91 (76%) studies did not specify their administration tools or suggest there were offered in digital formats. Thirty-five (30%) studies had follow-up measurements of verbal memory, while 85 (70%) had only a single verbal memory measurement. DISCUSSION While many scales are commonly used to measure verbal memory in first episode psychosis, they are not often administered via digital technology. There is an emerging opportunity to administer these and other tests via digital technologies for expanding access to early detection of cognitive decline in clinical high risk and first-episode psychosis.
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Affiliation(s)
- Can Mişel Kilciksiz
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Richard Keefe
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States of America
| | - James Benoit
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States of America
| | - John Torous
- Digital Psychiatry Division, Psychosis Research Program, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Abstract
PURPOSE OF REVIEW We review the ongoing research in the area of acute and transient psychotic disorders (ATPDs) with regard to their nosology, epidemiology, clinical description, genetics, and neurobiology, examining evidence for distinctiveness or otherwise of ATPDs. We further highlight the lacuna in research in ATPDs. RECENT FINDINGS Studies on ATPDs as defined in the ICD 10 have been reported from different parts of the world, more so from the developing countries. There is consistent evidence that there exist a group of ATPDs that occur more commonly among females, are often precipitated by stressful life events or exposure to physiological stresses like fever, child birth, are associated with well-adjusted premorbid personality, and show complete recovery in a short period. Although in some cases of ATPDs, there is symptomatic overlap with schizophrenic symptoms in the acute phase, they follow a completely different course and outcome, exhibit genetic distinctiveness, and do not share genetic relationship with schizophrenias or bipolar affective disorder (BPAD). Comparative studies on neurophysiology and neuroimaging in ATPDs and schizophrenias have demonstrated evidence of hyper arousal and hyper metabolism in ATPDs vs hypo arousal and hypo metabolism as noted in the P300 response and on FDG PET studies, respectively. Immune markers such as IL-6, TNF-alpha, and TGF-beta show higher levels in ATPDs as compared to healthy controls. Findings on the neurobiological mechanisms underlying ATPDs, so far, point towards significant differences from those in schizophrenia or BPAD. Although the studies are few and far between, nevertheless, these point towards the possibility of ATPDs as a distinct entity and underscore the need for pursuing alternate hypothesis such as neuro inflammatory or metabolic. Research on ATPDs is limited due to many reasons including lack of harmony between the ICD and DSM diagnostic systems and clinician biases. Available research data supports the validity of ATPDs as a distinct clinical entity. There is also evidence that ATPDs are different from schizophrenias or BPAD on genetic, neuroimaging, neurophysiological, and immunological markers and require further studies.
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Husain MO, Chaudhry IB, Thomasson R, Kiran T, Bassett P, Husain MI, Naeem F, Husain N. Cognitive function in early psychosis patients from a lower middle-income country. Int J Psychiatry Clin Pract 2018. [PMID: 28645229 DOI: 10.1080/13651501.2017.1341987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To establish evidence of cognitive changes in early psychosis (EP) patients compared to healthy controls (HC) in Pakistan. METHODS Fifty-one participants with EP were recruited from psychiatric units in Karachi and Rawalpindi, Pakistan and matched with 51 HC. Neurocognitive domains were assessed using standardised neuropsychological tests [the Stroop test, block design, Matrix Reasoning, picture completion, object assembly, oral fluency, memory for design, Coughlan learning task (verbal and visual)]. RESULTS EP patients had higher scores than controls for both Stroop tests (T1: EP = 122 HC = 65, p <.001; T2: EP = 190 HC = 153, p = .007) and memory for design test (EP = 10 HC = 3, p = .005). EP group had lower values for block design (EP = 4, HC = 11, p = .01), category fluency (EP = 18.9, HC = 26.1, p < .001), Coughlan verbal tasks (EP = 36.4 NC = 51.5, p < .001), matrix reasoning (EP = 4 NC = 10, p < .001), picture completion (EP = 4 NC = 6, p = .003) and object assembly (EP = 10.7, HC = 15.5, p = .002). There were limited significant associations between cognitive performance and PANSS scores. CONCLUSIONS Reduced cognitive performance was found across multiple domains in Pakistani EP patients, which suggests that impaired cognitive performance is homogenous in patients with schizophrenia, regardless of ethnicity.
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Affiliation(s)
- Muhammed Omair Husain
- a Faculty of Medical and Human Sciences , University of Manchester , Manchester , UK
| | - Imran B Chaudhry
- a Faculty of Medical and Human Sciences , University of Manchester , Manchester , UK
| | - Rachel Thomasson
- b Department of Psychiatry , Greater Manchester West NHS Foundation Trust , Manchester , UK
| | - Tayyeba Kiran
- c Global Health, Pakistan Institute of Learning and Living , Karachi , Pakistan
| | | | - Muhammad I Husain
- e Complex Depression, Anxiety and Trauma, Camden and Islington NHS Foundation Trust , London , UK
| | - Farooq Naeem
- f Department of Psychiatry , Queens' University , Kingston , Ontario , Canada
| | - Nusrat Husain
- g Division of Psychology and Mental Health , University of Manchester , Manchester , UK
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Castagnini AC, Fusar-Poli P. Diagnostic validity of ICD-10 acute and transient psychotic disorders and DSM-5 brief psychotic disorder. Eur Psychiatry 2017; 45:104-113. [PMID: 28756108 DOI: 10.1016/j.eurpsy.2017.05.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/17/2017] [Accepted: 05/22/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Short-lived psychotic disorders are currently classified under "acute and transient psychotic disorders" (ATPDs) in ICD-10, and "brief psychotic disorder" (BPD) in DSM-5. This study's aim is to review the literature and address the validity of ATPDs and BPD. METHOD Papers published between January 1993 and December 2016 were identified through searches in Web of Science. Reference lists in the located papers provided further sources. RESULTS A total of 295 articles were found and 100 were included in the review. There were only a few studies about the epidemiology, vulnerability factors, neurobiological correlates and treatment of these disorders, particularly little interest seems to exist in BPD. The available evidence suggests that short-lived psychotic disorders are rare conditions and more often affect women in early to middle adulthood. They also are neither associated with premorbid dysfunctions nor characteristic family predisposition, while there seems to be greater evidence of environmental factors particularly in developing countries and migrant populations. Follow-up studies report a favourable clinical and functional outcome, but case identification has proved difficult owing to high rates of transition mainly either to schizophrenia and related disorders or, to a lesser extent, affective disorders over the short- and longer-terms. CONCLUSIONS Although the lack of neurobiological findings and little predictive power argue against the validity of the above diagnostic categories, it is important that they are kept apart from longer-lasting psychotic disorders both for clinical practice and research. Close overlap between ATPDs and BPD could enhance the understanding of these conditions.
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Affiliation(s)
- A C Castagnini
- School of Child Neuropsychiatry, University of Modena and Reggio Emilia, Modena, Italy.
| | - P Fusar-Poli
- King's College London, Institute of Psychiatry, and OASIS Service, South London and the Maudsley NHS Foundation Trust, London, UK
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10
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Aas M, Dazzan P, Mondelli V, Melle I, Murray RM, Pariante CM. A systematic review of cognitive function in first-episode psychosis, including a discussion on childhood trauma, stress, and inflammation. Front Psychiatry 2014; 4:182. [PMID: 24409157 PMCID: PMC3884147 DOI: 10.3389/fpsyt.2013.00182] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 12/13/2013] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To carry out a systematic review of the literature addressing cognitive functions in first-episode psychosis (FEP), divided into domains. Although this is not a full "cognitive-genetics-in-schizophrenia review," we will also include putative ideas of mechanism(s) behind these impairments, focusing on how early stress, and genetic vulnerability may moderate cognitive function in psychosis. METHOD Relevant studies were identified via computer literature searches for research published up to and including January 2013, only case-control studies were included for the neurocognitive meta-analysis. RESULTS Patients with FEP present global cognitive impairment compared to healthy controls. The largest effect size was observed for verbal memory (Cohen's d effect size = 2.10), followed by executive function (effect size = 1.86), and general IQ (effect size = 1.71). However, effect sizes varied between studies. CONCLUSION Cognitive impairment across domains, up to severe level based on Cohen's effect size, is present already in FEP studies. However, differences in levels of impairment are observed between studies, as well as within domains, indicating that further consolidation of cognitive impairment over the course of illness may be present. Cognitive abnormalities may be linked to a neurodevelopmental model including increased sensitivity to the negative effect of stress, as well as genetic vulnerability. More research on this field is needed.
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Affiliation(s)
- Monica Aas
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, K.G. Jebsen Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London, London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
| | - Ingrid Melle
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- NORMENT, K.G. Jebsen Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London, London, UK
| | - Carmine M. Pariante
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, London, UK
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Schaefer J, Giangrande E, Weinberger DR, Dickinson D. The global cognitive impairment in schizophrenia: consistent over decades and around the world. Schizophr Res 2013; 150:42-50. [PMID: 23911259 PMCID: PMC4196267 DOI: 10.1016/j.schres.2013.07.009] [Citation(s) in RCA: 370] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 07/02/2013] [Accepted: 07/03/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Schizophrenia results in cognitive impairments as well as positive, negative, and disorganized symptomatology. The present study examines the extent to which these cognitive deficits are generalized across domains, potential moderator variables, and whether the pattern of cognitive findings reported in schizophrenia has remained consistent over time and across cultural and geographic variation. METHOD Relevant publications from 2006 to 2011 were identified through keyword searches in PubMed and an examination of reference lists. Studies were included if they (1) compared the cognitive performance of adult schizophrenia patients and healthy controls, (2) based schizophrenia diagnoses on contemporary diagnostic criteria, (3) reported information sufficient to permit effect size calculation, (4) were reported in English, and (5) reported data for neuropsychological tests falling into at least 3 distinct cognitive domains. A set of 100 non-overlapping studies was identified, and effect sizes (Hedge's g) were calculated for each cognitive variable. RESULTS Consistent with earlier analyses, patients with schizophrenia scored significantly lower than controls across all cognitive tests and domains (grand mean effect size, g=-1.03). Patients showed somewhat larger impairments in the domains of processing speed (g=-1.25) and episodic memory (g=-1.23). Our results also showed few inconsistencies when grouped by geographic region. CONCLUSIONS The present study extends findings from 1980 to 2006 of a substantial, generalized cognitive impairment in schizophrenia, demonstrating that this finding has remained robust over time despite changes in assessment instruments and alterations in diagnostic criteria, and that it manifests similarly in different regions of the world despite linguistic and cultural differences.
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Affiliation(s)
- Jonathan Schaefer
- Genes, Cognition and Psychosis Program and Clinical Brain Disorders Branch, IRP, NIMH, NIH, 10 Center Drive, MSC 1379, Bethesda, Maryland 20892 USA
| | - Evan Giangrande
- Genes, Cognition and Psychosis Program and Clinical Brain Disorders Branch, IRP, NIMH, NIH, 10 Center Drive, MSC 1379, Bethesda, Maryland 20892 USA
| | - Daniel R. Weinberger
- Genes, Cognition and Psychosis Program and Clinical Brain Disorders Branch, IRP, NIMH, NIH, 10 Center Drive, MSC 1379, Bethesda, Maryland 20892 USA,Lieber institute for Brain Development, Johns Hopkins University Medical Center 855 North Wolfe Street, Baltimore, Maryland 21205 USA
| | - Dwight Dickinson
- Genes, Cognition and Psychosis Program and Clinical Brain Disorders Branch, IRP, NIMH, NIH, 10 Center Drive, MSC 1379, Bethesda, Maryland 20892 USA
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Nugent KL, Paksarian D, Mojtabai R. Nonaffective acute psychoses: uncertainties on the way to DSM-V and ICD-11. Curr Psychiatry Rep 2011; 13:203-10. [PMID: 21344285 PMCID: PMC3662493 DOI: 10.1007/s11920-011-0190-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since the early 20th century, a group of nonaffective psychoses with acute onset and brief duration have been described in different countries under various names, including cycloid psychosis, bouffée délirante, and reactive psychosis. These psychoses share several characteristics, including benign course, greater prevalence in women than men and in developing countries than in industrialized countries, and high prevalence of premorbid psychological and physiologic stressors. However, the variations in names and minute details of symptomatology have overshadowed the basic similarities across these various descriptions. Confusion in classification persists in the two contemporary diagnostic systems, the DSM-IV and the ICD-10. We believe that most cases of these psychoses could be captured under a broad, unified category of nonaffective psychosis with acute onset and brief duration, and urge the authors of the upcoming revisions of the DSM and ICD to create such a category. A unified diagnostic category for these disorders would reduce unnecessary fragmentation in the diagnostic systems and assist in the progress of research on these rare conditions.
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Affiliation(s)
- Katie L. Nugent
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Diana Paksarian
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
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