Clinical profile of delusional disorder and its subtypes: a descriptive study from Turkey

The fact that delusional disorder (DD) received minimal research attention indicates the need for descriptive studies that will better delineate the clinical and socio-demographic characteristics of DD. We conducted a chart review descriptive study in a tertiary hospital from Turkey. A total of 99 cases of DD were identified through hospital registry system. 57 were male (57.6%), and mean age at first admission was 49.34±13.49. The most common type of DD was persecutory (36.4%), followed by jealous type (28.3%), mixed type (18.2%), and somatic type (16.2%). Jealous type DD patients were more likely to be married, and mixed type DD patients were more likely to be divorced. The presence of hallucinations was significantly associated with history of hospitalization. About one-tenth of the patients had a family history of psychotic spectrum disorder. Comorbid depressive disorder was present in 42.9% of the patients, whereas only 9.2% had comorbid anxiety disorder. Depressive disorder comorbidity in DD seems to be associated with continued treatment for longer periods of time in psychiatry services. While most of our data were comparable with the literature on DD, our divergent findings like higher rates of male patients and jealous type of the disorder might be attributed to the cultural and geographical factors. This situation points out that future research with larger populations and from different regions would contribute to better understanding of clinical and socio-demographical characteristics of delusional disorder.

The prevalence, incidence, and admission rate of diagnosed schizophrenia spectrum disorders in Korea, 2008-2017: A nationwide population-based study using claims big data analysis

This study estimated the prevalence and incidence rate of schizophrenia, schizotypal, and delusional disorders (SSDD) in Korea from 2008 to 2017 and analyzed the hospital admission rate, re-admission rate, and hospitalization period. It used the Korean nationwide National Health Insurance Service claims database. SSDD patients who had at least one visit to Korea's primary, secondary, or tertiary referral hospitals with a diagnosis of SSDD, according to the International Classification of Diseases, 10th Revision (ICD-10), were identified as SSDD cases if coded as F20-F29. Data were analyzed using frequency statistics. Results showed that the 12-month prevalence rate of SSDD increased steadily from 0.40% in 2008 to 0.45% in 2017. Analysis of the three-year cumulative prevalence rate of SSDD showed an increase from 0.51% in 2011 to 0.54% in 2017. In 2017, the five-year cumulative prevalence rate was 0.61%, and the 10-year cumulative prevalence rate was 0.75%. The hospital admission rate among SSDD patients decreased from 2008 (30.04%) to 2017 (28.53%). The incidence of SSDD was 0.05% and no yearly change was observed. The proportion of SSDD inpatients whose first hospital visit resulted in immediate hospitalization was 22.4% in 2017. Epidemiological indicators such as prevalence, incidence, and hospitalization rate play an important role in planning social and financial resource allocation. Therefore, efforts to produce more accurate epidemiological indicators are very important and this study's findings could have a significant social impact.

The impact of depressive symptoms on the clinical presentation of Persistent Delusional Disorder

BACKGROUND

Our aim was to investigate the influence of depressive symptoms on the clinical presentation of Persistent Delusional Disorder (PDD).

METHODS

We have previously conducted a retrospective review of patients diagnosed with PDD (n = 455). We divided this sample into two groups according to the presence or absence of co-morbid depressive symptoms - a subsample of PDD with depressive co-morbidity (PDD + D; n = 187) and a subsample of PDD without depressive co-morbidity (PDD only; n = 268).

RESULTS

PDD + D group had a significantly younger age at onset of PDD. The PDD + D group received significantly more antidepressants but had similar response and adherence rates.

CONCLUSIONS

The presence of depressive symptoms in 41% of the study population did not appear to influence the clinical presentation or response to treatment.

[Late life psychotic disorders : clinical aspects]

Old age is a vulnerable period of life for either the apparition or the exacerbation of psychiatric disorders. Among others, psychoses are relatively frequent in the elderly. Alas diagnoses of non-organic psychoses are still matters of debate, namely because of the important variability of symptoms and the lack of data in the elderly population. DSM-5 adds only little precision to this nosographic issue. These questions are however important in practice, since they influence prognostic aspects and treatment choices. Thus diagnostic criteria and care remain complex. The present article summarizes these clinical aspects for the most frequent forms of late life psychoses, namely early- and late-onset schizophrenia and delusional disorder.

Posttraumatic Stress Disorder in First-Episode Psychosis: Prevalence and Related Factors

INTRODUCTION

The experience of psychosis or related treatment can be conceptualized as a traumatic event, which might lead to posttraumatic stress disorder (PTSD) or PTSD syndrome (which is defined as the presence of PTSD symptoms irrespective of the DSM-IV criterion A definition of a traumatic event as an actual or threatened harm). Few studies explored the subject so far.

METHODS

This cross-sectional study included 52 clinically stabilized patients who were hospitalized for a first-psychotic episode during the two years preceding the study. Sociodemographic and clinical information were collected including past trauma history and drug and alcohol use. Patients were administered the Clinician-Administered PTSD Scale (CAPS), the Major Depression Inventory (MDI), the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning scale (GAF), and the Brief COPE.

RESULTS

A total of 22 patients (42.3%) met full PTSD criteria and 36 patients (69.2%) met PTSD syndrome criteria. Full PTSD as well as PTSD syndrome were both associated with physical restraint, higher scores on the MDI and its maladaptive coping scales. The most distressing symptoms were paranoid delusions, and the most distressing treatment experiences involved physical restraint and problems with other hospitalized patients.

DISCUSSION/CONCLUSIONS

Our data showed high rates of psychosis-related PTSD. To prevent PTSD, conditions of hospitalization should be optimized and the use of coercive treatments should be limited. Subjects with recent-onset psychosis should be screened for PTSD symptoms. Improving coping abilities with a well-fitted therapy would be useful in these patients.

Social disorganization of neighborhoods and incidence of psychotic disorders: a 7-year first-contact incidence study

BACKGROUND

Environmental factors such as urban birth and ethnic minority position have been related to risk for psychotic disorders. There is some evidence that not only individual, but also neighborhood characteristics influence this risk. The aim of this study was to investigate social disorganization of neighborhoods and incidence of psychotic disorders.

METHOD

The research was a 7-year first-contact incidence study of psychotic disorders in The Hague. Neighborhood characteristics included continuous, dichotomous and cumulative measures of socio-economic level, residential mobility, ethnic diversity, proportion of single person households, voter turnout, population density and crime level. Using multilevel Poisson regression analysis, incidence rate ratios (IRRs) and 95% confidence intervals (CIs) of psychotic disorders were calculated for the indicators of neighborhood social disorganization.

RESULTS

A total of 618 incident cases were identified. Neighborhood socio-economic level and residential mobility had the strongest association with incidence of psychotic disorders [individual-level adjusted Wald χ2 1 = 13.03 (p = 0.0003) and 5.51 (p = 0.02), respectively]. All but one (proportion of single person households) of the dichotomous neighborhood indicators were significantly associated with a higher IRR. The cumulative degree of neighborhood social disorganization was strongly and linearly associated with the incidence of psychotic disorders (trend test, Wald χ2 5 = 25.76, p = 0.0001). The IRR in neighborhoods with the highest degree of social disorganization was 1.95 (95% CI 1.38-2.75) compared with the lowest disorganization category.

CONCLUSIONS

The findings suggest that the risk for developing a psychotic disorder is higher for people living in socially disorganized environments. Longitudinal studies are needed to investigate causality.

The prevalence of delusional disorder in prison

Delusional disorder has important implications for forensic psychiatrists, as delusions are not infrequently related to criminal behavior. Thus, we hypothesized that delusional disorder is over-represented in correctional populations. We conducted a retrospective chart review of the electronic medical records from 2000 to 2012 of New Jersey Department of Corrections inmates who remained incarcerated as of March 2012. Potential cases of delusional disorder were initially identified by using a search for current or past diagnoses of such disorders or other diagnoses that could be misdiagnosed cases. After an initial chart review identified an inmate as having probable delusional disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) criteria, the diagnosis was confirmed by at least one concurring independent review. We estimate a point prevalence of 0.24 percent for delusional disorder in our population, which is eight times higher than that expected in the community.

Specific learning difficulties: a retrospective study of their co morbidity and continuity as early indicators of mental disorders

BACKGROUND

Specific Learning difficulties constitute a continuity of complex disorders, which unfold across the lifespan and are associated with a wide range of mental disorders. In order to determine the importance of specific learning difficulties as an underlying factor in various mental disorders, we investigated associations between mental disorders and factors related to learning difficulties, poor family and school environment, and social and psycho-emotional disorders.

METHODS

This retrospective study is based on data from 835 case histories of adults who were treated at the Psychiatric Clinic of the University Hospital in Ioannina, Greece, between 1992 and 2008. The examination of the early (co-)occurrence of specific disorders was based on the ICD-10 classification of mental disorders. LogLinear analysis showed that all models retained 2nd or 3rd order effects with p-values >0.8 for all estimated likelihood ratios.

RESULTS

Patients with specific learning difficulties, who grew up in a socially disturbed environment, and manifested behavioral problems (aggression, alcoholism, and isolation or running away from home) were found to be more frequently diagnosed with schizophrenia than with any other mental disorder. In some cases, the profiles of these patients also included family problems such as parental loss or alcoholism.

CONCLUSIONS

Significant association between learning and other disorders in adult psychiatric patients' developmental profile has been indicated. Furthermore, a specific association between specific learning difficulties, environmental problems, and schizophrenia corroborates the continuity and complexity of these disorders at higher developmental stages. The results from this study can be utilized in the study of mental disorder etiology, raising the possibility that the early treatment of the learning or other disorders could reduce children's likelihood of developing mental disorders in adulthood.

Clinico-Epidemiological Comparison of Delusion-Prominent and Hallucination-Prominent Clinical Subgroups of Paranoid Schizophrenia

BACKGROUND

Though hallucinations and delusions are prominent basic impairments in schizophrenia, reports of the relationship between hallucinatory and delusional symptoms among schizophrenia patients are scant.

AIMS

To examine the epidemiological and clinical differences between mainly hallucinatory and mainly delusional subgroups of paranoid schizophrenia patients.

METHODS

One hundred schizophrenia patients, paranoid type, were recruited. In a cross-sectional study, participants were divided into Mainly Hallucinatory (H) and Mainly Delusional (D) subgroups. Demographic variables were compared and clinical characteristics were evaluated using the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Clinical Global Impression Scale. The Quality-of-Life Enjoyment and Satisfaction Questionnaire-18 was used to assess quality of life.

RESULTS

Clinically, the H group was more heterogeneous as expressed by the broader range of scores that described the clinical picture of patients in that subgroup (in 43 of 78 variables, 55.13%) and similar ranges of scores (31 of 78 variables, 39.74%) for patients in the D group. Duration of hospitalization was significantly longer in group H than in group D (p=0.047). There was no statistically significant difference between the H and D subgroups in demographic characteristics.

CONCLUSIONS

There are distinct epidemiological and clinical differences between the H and D subgroups, with more severe positive and negative symptoms and greater functional impairment in the H group. Paranoid schizophrenia patients with prominent hallucinations have poorer prognosis and need intensive therapeutic rehabilitation beginning with onset-of-illness. Further genetic studies and comparisons of fMRI and/or PET findings are warranted to investigate additional distinctive characteristics of these subgroups.

[Clinical zoanthropy]

BACKGROUND

Clinical zoanthropy is a rare delusion in which a person believes himself or herself to be an animal.

AIM

To assess the clinical and scientific relevance of this classical diagnostic category.

METHOD

A search was conducted in the classical and scientific literature and in PubMed, Embase, and Ovid.

RESULTS

Only 56 cases of clinical zoanthropy could be found in the international scientific literature. Since specific studies have yielded a relatively large numbers of cases in the past, it can be concluded that the disorder is probably more prevalent than is suggested in the literature. These cases may well be not only primary types, based on mental or unclear causes, but also secondary types, mediated by aberrant somatosensory sensations. Treatment of the underlying condition (in most cases a psychotic or mood disorder) has proved to be increasingly successful over time.

CONCLUSION

Because of the possible co-occurrence of zoanthropy and alterations in coenesthesis, i.e. the sensation of physical existence, mental health workers should be on the lookout for cases of clinical zoanthropy in clinical practice and avoid treating them in the same way as they would treat other delusions. All cases that occur should be subjected to extra somatic investigations – including an EEG and neuroimaging – and treatment should be adjusted in accordance with the findings.

Religious content of hallucinations in paranoid schizophrenia

BACKGROUND

Different environmental factors are thought to be responsible for 15-20% of schizophrenia pathogenesis. Religion has long been considered a major force in human life, regardless of economic, social or political affiliation. How the perception of religion has changed over time, especially in the context of mental illness, was the focal point of this long-term comparative study.

SUBJECTS AND METHODS

A random selection of 100 case histories from the years 1932, 1952, 1972 and 1992 was selected. By reviewing the subject history and medical notes, information on the presence of religious hallucinations and/or delusions were collected and grouped.

RESULTS

Religious topics were demonstrated in 46.8% of the test population. Whereas there was a clear diversity of religious-themed delusions, "God", "Christ", "Mary", "Satan/devil" and "hell" all figured prominently across all reviewed years. There is a progressive decrease in the number of religious topics in paranoid schizophrenia. The transfer of holiness from historical saints onto a subject was observed. Evil dominates over good in productive symptoms in paranoid schizophrenia. The phenomenon of apocalyptic subjects in paranoid hallucinations and delusions increased after the Second World War.

CONCLUSION

Religious topics of hallucinations and delusions change over time and relate to objective historical events and reflect changes in religiosity in society.

First presentation psychosis among the elderly in Singapore

INTRODUCTION

In tandem with our ageing population, it is observed there is a growing trend of elderly patients presenting for the first time with psychotic symptoms. Clinical experience suggests differences in the phenomenology of late-onset psychosis in our Asian context compared to studies done in the West. This study aimed to analyse the characteristics and psychopathology of first presentation psychosis in our local elderly and to determine the treatment outcome over a 12-month period.

METHODS

A total of 64 subjects with first presentation psychosis were consecutively recruited. Those with a non-affective, non-organic psychotic disorder were evaluated using the Positive and Negative Symptoms Scale, the Clinical Global Impression Scale, Mini-Mental State Examination and the Beck's Depression Inventory.

RESULTS

Of the 64 subjects recruited, 55 were enrolled in the study. 59.3% (n = 32) of the subjects were diagnosed to be suffering from very-late-onset schizophrenia-like psychosis, followed by delusional disorder in 31.5% (n = 17). The remaining 11.1% (n = 6) were diagnosed to have late-onset schizophrenia. The sample showed a high preponderance of women, with 88.9% reporting persecutory-type delusions. The majority of them were married and 80% of the subjects were living with relatives. Treatment was effective in ameliorating symptoms, but there was a high loss to follow-up of male subjects (81.8%).

CONCLUSION

This descriptive study found sociodemographic and phenomenological similarities to other studies of late-onset psychosis in the West, except that social isolation and partition delusions were not prominent.

[Retrospective analysis of psychopathological presentation of psychotic episodes in adolescent inpatients]

AIM

Analysis of a clinical presentation and course of psychotic episodes in adolescent inpatients.

METHOD

A retrospective analysis of charts of all (n=104) inpatients diagnosed with one of the schizophrenia-spectrum disorders (schizophrenia, schizotypal disorder and acute and transient psychotic disorders: F20, F21 and F23 according to ICD-10) and assessed with the Positive and Negative Syndrome Scale (PANSS) over a 10-year period (1998-2008) in the Child and Adolescent Psychiatry Department. A psychopathological profile of different disorders and correlation between symptoms and demographic and clinical data were analysed.

RESULTS

Severity of symptoms correlated with length of hospitalisation. In schizophrenia higher PANSS total score and more severe some general symptoms then in schizotypal disorders were observed. Also in schizophrenia more negative symptoms then in acute and transient psychotic disorders were detected. In all three disorders, the psychopathological profile included negative symptoms.

CONCLUSION

In schizophrenia psychopathological symptoms were more severe than in other disorders. Presence of negative symptoms may indicate that all schizophrenia spectrum disorders may have a neurodevelopmental component.

[Profile of population targeted by violent behavior of psychotic patients]

OBJECTIVE

The aim of this study is to examine the population targeted by the violent behavior of psychotic patients and to provide data on the treatment and therapeutic support of psychiatric professionals based on our results.

METHOD

Eighty-one psychotic patients lacking criminal responsibility and under observation or mandatory treatment due to violent crime were compared with a control group of 31 persons with criminal responsibility. The sociodemographic features of the two groups' victims and descriptive data about the crimes and the target populations were examined and analyzed with SPSS 11.

RESULTS

Patient and control groups were compared according to their relationships to their victims. Of psychotic patients' victims, 36.9% percent were family members, while in the non-psychotic group the proportion was 10%, a statistically significant difference (p<0.01). We also found a statistically significant difference between the two groups in the mean ages of their victims and in the proportions who victimized married people, had previously met with their victims or who lived with their victims prior to the homicidal act.

CONCLUSION

This study concludes that violent psychotic patients mostly choose their victims from among their family members. Psychotic patients were three times more likely to choose a relative compared to the control group. Recognizing the risk factors and the population most often targeted by homicidal behavior is essential for protecting patients and the community.

Mental disorders of people with disability pension in Georgia

Correct assessment due to mental diseases is rather important. WHO developed International Classification for Functioning, Disability and Health (ICF) and there are two approaches to its implementation - development of disease specific or generic core sets. In order to know which way to choose up to date information is needed on disorders that most frequently lead to disability in Georgia. The study aimed at identification of the most prevalent mental diseases that led to disability pension in Georgia in 2010. Cross-sectional study of the population of pension beneficiaries was conducted. We have calculated 10% of 607 (diagnosed with disability in 2010) to be included in the survey. They were selected using random sampling method. Patient data were collected from the case histories. Paranoid schizophrenia (F 20.0) was the leading cause of disability both in men and women - 51.6% in men and 50% in women. In men persistent delusional disorder and mild mental retardation with significant impairment of behavior accounted for 9.7% each, while in women persistent delusional disorder led to disability in 15.0% of cases and moderate mental retardation - in 10.0%. All children receiving disability pension are mentally retarded. Paranoid schizophrenia - relatively less common disorder has high associated impairment among adults in Georgia, whereas in children mental retardation is the most frequent disabling condition. However, there are many other diseases that lead to disability. Therefore the best way to move further might be to first develop a generic core set for all psychiatric disability.

Jumping to conclusions in delusional and non-delusional schizophrenic patients

OBJECTIVE

Several studies have provided evidence for the claim that a subgroup of (schizophrenic) patients with current delusions share a jumping to conclusions (JTC) bias. The primary aim of the present study was to investigate whether currently deluded and non-deluded schizophrenic patients perform differently on three tasks tapping probabilistic reasoning.

METHOD

Probabilistic reasoning was assessed in 31 schizophrenic patients, 28 psychiatric controls, and 17 healthy controls. In addition to the traditional draws to decision procedure, we employed two tasks for which participants had to judge, at each stage, the likelihood that beads come from either container (graded estimates procedure). Reaction times were recorded for the graded estimates procedure.

RESULTS

A JTC bias was displayed by 42% of the schizophrenic patients in the draws to decision condition, while 7% of the psychiatric patients and none of the healthy controls reached a decision after only one bead. A similar pattern of results was observed for the graded estimates procedure. This bias was more pronounced in deluded schizophrenic patients, although currently non-deluded patients also showed evidence for earlier decisions. A bias to over-adjust when confronted with potentially disconfirmatory evidence was confined to deluded schizophrenic participants. There was also evidence for an increase in JTC in the deluded group over the course of the tasks. No substantial group differences occurred with respect to reaction time parameters indicating that results are not attributable to impulsivity.

DISCUSSION

The findings provide further evidence for state and trait characteristics of abnormal reasoning in paranoid schizophrenia. Results are discussed in light of several competing explanations for JTC in schizophrenia.

Criminal activities of the elderly in Turkey during the years 2000-2005

The aging of the population is one of the most important demographic events of the 21st century. The aim of this study is to define the basic variables related with criminal behavior among the elderly for cases over 60 years. A retrospective assessment of the criminal data (255 cases) consists of the period between 2000 and 2005 of the Council of Forensic Medicine, Turkish Ministry of Justice. Of the cases whose average age is 68.2±6.9, 25 of the 56 cases were diagnosed as ill. Out of 225 elderly who had committed a criminal act 56 of them had a medical antecedent which is a psychiatric diagnosis. Whether or not they had a medical antecedent the Board made 90 psychiatric diagnosis. This comprised of 25 out of the 56 who also had a medical antecedent and 65 out of the 199 who did not have a medical antecedent. Delusional disorder (43.3%) and schizophrenia (25.6%) are the most frequent diagnoses. Specializing and developing standards for determining the criminal responsibility of the elderly is required.

[Rising incidence rates of schizophrenia among children and adolescents]

INTRODUCTION

The purpose was to expand the understanding of schizophrenia development in children and adolescents. An age- and gender-specific analysis of children and adolescents diagnosed with schizophrenia (F20.xx) was performed. The analysis included calculation of incidence rates of schizophrenia, schizophrenia subtypes, and an account of occurrence of any registered psychiatric diagnoses prior to first schizophrenia diagnosis.

MATERIAL AND METHODS

Patients aged 0-21 years diagnosed with schizophrenia (F20.xx) and registered in the Danish Psychiatric Central Research Register in 1994-2007 were included.

RESULTS

The cohort consisted of 3,065 patients aged 6-21 years. Incidence rates vary with age and gender, and have been increasing in recent years. Boys have earlier onset and higher incidence rates than girls. The most common schizophrenia subtypes were paranoid (F20.0; 44.0%) and unspecified (F20.9; 28.7%). Three in every four patients had contact with the psychiatric hospital system prior to first schizophrenia diagnosis.

CONCLUSION

Schizophreniform symptomatology tends to overlap with other psychiatric disorders, and diagnostic stability is low. The diagnosis schizophrenia should be systematically included in diagnostic deliberations. Qualitative studies describing and analysing early psychopathology in children and adolescents with schizophrenia will improve the present knowledge.

Testing the continuum of delusional beliefs: an experimental study using virtual reality

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose–response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables.

The influence of temperament and character of psychotic individuals on the possibility of committing criminal offences

Cloninger's theoretical biosocial model of personality represents the personality as a hierarchical organisational system consisting of 4 temperament dimensions and 3 character dimensions as 3 aspects of self-concept. It attempts to define behavioural and bio-genetic aspects of temperament, and the neuroanatomical and biochemical brain network responsible for activation, maintenance and inhibition of behaviour. The basic objective of this research is to establish whether temperament and character act as measures of personalities in psychotic persons on the possibility of committing criminal offences. This study is part of wider prospective clinical research on criminogenetic specificities of psychotic patients treated in the Psychiatric Hospital Rab, Croatia, in the period 2005.-2007. It encompasses 122 patients of male gender, up to 60 years of age, treated with the diagnosis paranoid schizophrenia (F20.0; MKB-10), of which half (n = 61; test group) with committed criminal offence and in forensic treatment, while the other (n = 61; control group) without committed criminal offence. The methods encompassed a socio-demographic questionnaire (for processing of general patient data with an emphasis on the characteristics of the committed criminal offence) and Temperament-Character Inventory (TCI) which was filled out once. The Statistical package for social sciences (SPSS) especially the chi2 test, t-test, analysis of variances (ANOVA), matrices for intercorrelation and graded logistical regression analysis for construction of predictor models were used for statistical analysis. According to the results obtained, the tested groups significantly statistically differ with the average results on all scales of the TCI survey (Self-Directedness (SD): F = 34.32; p < 0.05; Cooperativeness (CO): F = 81.54; p < 0.05; Novelty Seeking (NS): F = 42.83; p < 0.05; Harm Avoidance (HA): F = 6.01; p < 0.05; Persistence (PE): F = 4.87; p < 0.05; Reward Dependence (RD): F = 10.91; p < 0.05) except on the scale of Self-Transcendence (self--awareness) (ST), which is not an expected result. Upon further analysis 3 reliable predictor models were established with 1, 2 and 3 independent predictors (cooperativeness, novelty seeking and persistence) which can be identified in about 78-82% of cases in the group of perpetrators of criminal offences or the overall sample. Finally, although this research established some significant distinguishing traits in the observed variables between the respondent groups of perpetrators and non-perpetrators of criminal offences within the framework of diagnostic categories of paranoid schizophrenia, as well as some significant predictive factors in the prediction of psychosis (operationalised in the psychosis scale) that is aggression (operationalised in the spontaneity and reactive aggression scales), we hold that the research results are more probable tendencies rather than staunch facts which should be further researched on a larger sample.

No significant association between the genetic polymorphisms in the GSK-3 beta gene and schizophrenia in the Chinese population

The GSK-3 beta gene encodes a protein kinase which is abundant in the brain, and its product is involved in signal transduction cascades of neuronal cell development, energy metabolism and body pattern formation. Previous studies have suggested that GSK-3 beta might act as a potential candidate locus for schizophrenia susceptibility. We genotyped six SNPs within the gene and conducted a case-control study involving 329 schizophrenic patients and 288 healthy subjects in the Chinese population. We examined allele and genotype frequencies and haplotype distributions in the subtype of paranoid schizophrenic patients as well as schizophrenic subjects in general. Our results fail to replicate the association of the GSK-3 beta gene with susceptibility to schizophrenia in the Chinese population.

Relationship between cardiovagal modulation and psychotic state in patients with paranoid schizophrenia

Disturbed autonomic nervous system (ANS) function in schizophrenia might contribute to increased cardiovascular mortality. We obtained heart rate variability indices from 40 unmedicated schizophrenic patients and 58 matched controls. Mainly we found that patients displaying stronger psychotic symptoms as assessed by the Brief Psychiatric Rating Scale exhibit more severe cardiac ANS disturbances compared with controls.

[Changes in the relationship between cognitive functioning and psychopathological symptoms in patients with paranoid schizophrenia in the periods of psychosis and development of remission]

The aim of our study was to investigate the relationship between cognitive functioning and psychopathological symptoms in patients with paranoid schizophrenia both in acute state and in the period of development of remission. Fourteen patients with paranoid schizophrenia (ICD-10, F20.0) were examined twice during 4,5-5 months, first--at the acute episode and second--at the period of development of remission during the treatment with olanzapine. The PANSS for assessment of psychopathological symptoms and Wechsler Adult Intelligence Scale (WAIS) and Benton Visual Retention Test as measures of cognitive functioning have been used. Though the patient's general cognitive functioning was in a normal range. The results of performance part (vs. verbal part) of the WAIS were significantly lower. The performance subtests idem were more sensible for changing in patient's actual status. The reduction of psychotic symptoms was accompanied by the improvement of almost all cognitive domains studied. The spectrum of interrelations between different aspects of cognition and clinical symptoms was revealed. These interrelations vary greatly in depending of the state of patients (exacerbation of psychosis or remission). During the remission, patient's cognitive functioning negatively correlated with two types of disorders: residual hallucinations and disturbance of verbal communication.

[The clinical peculiarities of psychogenically-induced exacerbations of paranoid schizophrenia]

One hundred and twenty-eight patients diagnosed with paranoid schizophrenia were studied. A main group comprised 84 patients with psychogenically-induced paranoid psychoses. A control group consisted of 44 patients with spontaneous exacerbations of the disease. Psychogenically-induced exacerbations of paranoid schizophrenia differed by the clinical polymorphism, heterogeneity and atypism. Three types of psychogenically-induced relapses of paranoid schizophrenia were singled out: endoreactive, delusional with affective symptoms and delusional. Higher frequencies of suicidal tendencies (32.1%), absolute therapy resistance (25.0%), hospitalism (21.4%), non-compliance (46.4%) were observed in the main group of patients. These features predicted the poor outcome comparing to paranoid psychoses developed spontaneously. In conclusion, treatment of patients with paranoid schizophrenia with psychogenically-induced exacerbations demands the obligatory administration of psychotherapy. A combination of traditional neuroleptics with symptomatic pharmacotherapy of psychopathological presentations is the most efficient.

Delusional disorder: Study from North India

The aim of the present study was to study sociodemographic profile, clinical parameters including comorbidity, usefulness of antipsychotics especially atypicals, family history, and follow-up rates for delusional disorder. The records of all subjects who were seen in the Department of Psychiatry during a period of 10 years (i.e. 1994-2003) were reviewed. Eighty-eight subjects fulfilling the inclusion criteria were enrolled. The sample consisted predominantly of female subjects (55.7%), most of the total subjects were married and had favorable social functioning. The most common delusion was persecutory (54.5%), followed by delusion of reference (46.6%). The majority of the subjects had a comorbid psychiatric disorder. Education was negatively correlated with age at onset and positively correlated with the number of delusions. Age at onset was negatively correlated with total number of delusions. The sociodemographic profile of delusional disorder is consistent across various cultures, has high comorbidity and, when treated appropriately, responds to various antipsychotic agents.

Case report: clozapine given in the context of chemotherapy for lung cancer

BACKGROUND

Despite the frequent use of the antipsychotic medication, clozapine, in chronic treatments of psychiatric patients, there is limited clinical evidence available to guide clinicians in the problematic situation of a chemotherapy-induced blood dyscrasia.

OBJECTIVE

To perform a literature review and add a case report to the available clinical evidence.

METHOD

We gathered evidence through literature searches on Medline and with the assistance of a medical information specialist from Novartis who searched their internal database. We also report the case of a patient maintained on clozapine treatment despite full-dose chemotherapy (cisplatin and etoposide) for an extensive lung cancer.

RESULT

The searches returned seven clinically relevant references. These references do not establish a synergistic effect of clozapine and chemotherapy on blood counts. However, it has been shown that clozapine exposure activates common apoptotic pathways shared with anticancer drugs.

CONCLUSION

Although the meagre clinical evidence precludes drawing any general conclusion as to the safety of maintaining clozapine administration during chemotherapy, it does not point to an obvious worsening of the haematological outcomes.

Attention bias for paranoia-relevant visual stimuli in schizophrenia

INTRODUCTION

A number of studies indicate that patients with schizophrenia share a bias for paranoia-relevant material. The presence of an attentional bias for such stimuli would be of utter importance for our pathogenetic understanding of the disorder in view of ample evidence that patients with schizophrenia gather little information before arriving at strong conclusions: A both scarce and affectively biased data selection of available information may heavily distort its inner representation and thus prompt the formation of false beliefs. To date, the profile of this putative attentional bias in schizophrenia (e.g., automatic vs. controlled; hypervigilance towards vs. problems to disengage from such stimuli) is not fully uncovered.

METHODS

To shed light on this aspect of information processing in schizophrenia, we administered a novel task based on the inhibition of return paradigm (IOR). Twenty-four schizophrenia patients and thirty-four healthy controls were presented neutral (e.g., cup), anxiety-relevant (e.g., shark), and paranoia-relevant cue pictures (e.g., gun) at either of two possible locations. Subsequent to either a short or long interval, a target appeared at the same or opposite location. Participants were requested to press a spatially corresponding button.

RESULTS

Both currently paranoid and nonparanoid schizophrenia patients responded faster to all kinds of targets following paranoia-relevant pictures, that is, such stimuli speeded reaction times irrespective of the cue-target interval and spatial correspondence.

CONCLUSIONS

This indicates that paranoia-relevant information generally alerts patients more than other stimuli and facilitates processing of subsequent information. Possible implications of this finding for our understanding of delusion formation and maintenance are outlined.

Cognitive impairment in schizophrenia: clinical ratings are not a suitable alternative to neuropsychological testing

Despite the fact that cognitive impairment rated with clinical rating scales has been shown to be a poor proxy for cognitive functioning measured with a performance-based assessment battery, studies are still using this approach to predict aspects of outcome in schizophrenia. In the current study 106 outpatients with chronic schizophrenia who had been stable both from a symptomatic and a medication perspective for a period of 6 months before study inclusion were investigated to assess the relationship between a clinical rating of cognitive impairment and the actual performance on neuropsychological tests. The cognitive component of the PANSS was compared to results from a neuropsychological test battery which was selected to cover domains known to be impaired in patients with schizophrenia. Correlations of the cognitive component of the PANSS with the individual neuropsychological tests were low. They ranged between 0.19 and 0.35. None of them was sufficiently high to indicate that the cognitive component of the PANSS adequately covers the cognitive dimension measured by the respective neuropsychological test. These data clearly show that clinical assessment of cognitive deficits by the PANSS is not a viable alternative to neuropsychological testing to obtain information about cognitive functioning in schizophrenia.

Avoidant personality disorder is a separable schizophrenia-spectrum personality disorder even when controlling for the presence of paranoid and schizotypal personality disorders The UCLA family study

It is unresolved whether avoidant personality disorder (APD) is an independent schizophrenia (Sz)-spectrum personality disorder (PD). Some studies find APD and social anxiety symptoms (Sxs) to be separable dimensions of psychopathology in relatives (Rels) of schizophrenics while other studies find avoidant Sxs to be correlated with schizotypal and paranoid Sxs. Rates of APD among first-degree Rels of Sz probands, attention-deficit/hyperactivity disorder (ADHD) probands, and community control (CC) probands were examined. Further analyses examined rates when controlling for the presence of schizotypal (SPD) and paranoid (PPD) personality disorders, differences in APD Sxs between relative groups, and whether APD in Rels of Szs reflects a near miss for another Sz-spectrum PD. Three hundred sixty-two first-degree Rels of Sz probands, 201 relatives of ADHD probands, and 245 Rels of CC probands were interviewed for the presence of DSM-III-R Axis I and II disorders. Diagnoses, integrating family history, interview information, and medical records, were determined. APD occurred more frequently in Rels of Sz probands compared to CC probands (p<0.001) and also when controlling for SPD and PPD (p<0.005). Two Sxs of APD were most characteristic of the Rels of Sz probands: "avoids social or occupational activities..." and "exaggerates the potential difficulties..." 65% of the Rels of Sz probands who had diagnoses of APD were more than one criterion short of a DSM-III-R diagnosis of either SPD or PPD. This indicates that APD is a separate Sz-spectrum disorder, and not merely a sub-clinical form of SPD or PPD.

Influence of clozapine on platelet serotonin, monoamine oxidase and plasma serotonin levels

The purpose of this study was to investigate the influence of clozapine on plasma serotonin, platelet serotonin and monoamine oxidase (MAO) levels in schizophrenic patients and to compare their results with those of unmedicated healthy controls. Groups of 20 outpatients with schizophrenia and 20 healthy controls matched for age, sex and smoking status were recruited for the study. Psychopathology, neurocognitive functioning, plasma serotonin, platelet serotonin and MAO levels were assessed after 1-week drug free interval, and 8 weeks after initiation of clozapine treatment in an open design. The mean clozapine dose at week 8 was 382.5+/-96.4 (range: 250-600) mg/day. In the patient group, at baseline, plasma serotonin and platelet MAO levels were significantly lower, and platelet serotonin levels were significantly higher than in controls. After 8 weeks of clozapine treatment, plasma serotonin and platelet MAO levels increased significantly, while a significant decrease in platelet serotonin levels was detected compared with baseline values. Baseline platelet MAO levels explained 22% of the variance in Clinical Global Impression - Improvement (CGI-I) and improvement in attention, while baseline platelet serotonin predicted 23% of the variance in the improvement in positive symptoms during clozapine treatment. Our data indicate that clozapine may be reversing or compensating for a pre-existing alteration in serotonergic neurotransmission in schizophrenic patients. The prediction of response to clozapine through peripheral biochemical markers may have important clinical implications if repeated in larger samples.

[The problem of remission in schizophrenia: clinical and epidemiological study]

Remission has been considered as a stage in the development of endogenous process taking into account a type of disease course (continuous, episodic-progressive, slow-progressive, number of psychotic episodes) and as an independent clinical presentation differentiated by syndrome structure and stability level. Remissions have been assessed by predominance of positive (symptom remissions) or negative (syndrome remissions) disorders. Two hundreds and thirty-eight patients with schizophrenia, aged 42,4+/-11,2 years, from an out-patient clinic have been studied at the stage of remission. The high frequency of paranoid, thymopathic and apathic remission was observed. The most frequent variants of remission featured the low level of adaptation (77,31% of patients) that was correlated with the high percentage of patients unemployed due to health problems (69,75%). A group with symptomatic remissions is the first that needs pharmacologic correction. Atypical antipsychotics, including depo forms, are drugs of first choice in the therapy of remissions.

Disturbances of visual information processing in early states of psychosis and experimental delta-9-tetrahydrocannabinol altered states of consciousness

Recent data on alterations of the endogenous cannabinoid system in schizophrenia have raised the question of its functional role in this disease. The psychoactive compound of Cannabis sativa, delta-9-tetrahydrocannabinol (Delta9-THC), has been shown to induce psychotic symptoms, but it is unknown to what extend prodromal states of psychoses are reflected by these experimental approaches. This study compares four groups of subjects: antipsychotic-naïve patients suffering from acute paranoid schizophrenic or schizophreniform psychosis (SZ), patients in the prodromal state (IPS), healthy controls without any pharmacological intervention (HC) and a second group of healthy volunteers who were orally administered synthetic Delta9-THC (Dronabinol) (HC-THC). Neither SZ and IPS nor HC received the experimental drug. All subjects were assessed using the Brief Psychiatric Rating Scale (BPRS) and the Binocular Depth Inversion Illusion Test (BDII). The latter represents a sensitive measure of impaired visual information processing that manifests in various experimental and naturally occurring psychotic states. BDII values were well comparable in SZ, IPS and HC-THC, and all groups differed significantly to HC. The BPRS revealed no significant difference between HC-THC and IPS while both were significantly different from SZ and HC, respectively. Our results suggest that Delta9-THC-induced altered states of consciousness may serve as a useful tool for modeling psychotic disorders, particularly their prodromal states. Furthermore, they provide insight into the perceptual and psychopathological alterations induced by Delta9-THC, which is essential for the understanding of the pro-psychotic effects of herbal cannabis preparations with highly enriched Delta9-THC content.

Delusions related to infant and their association with mother-infant interactions in postpartum psychotic disorders

The relationship between mother infant interactions and psychopathology in postpartum psychotic disorders has been recognised as being clinically important, however data in the field is sparse. The current study had two aims--firstly, to study the prevalence and nature of delusions towards the infant among mothers with postpartum onset severe mental illness and secondly, to study the association between delusional symptoms towards the infant and mother infant interactions. 108 consecutive women with onset of severe mental illness in the postpartum, who were admitted to an inpatient psychiatric unit in South India over a two-year period, were systematically assessed for presence of delusions related to the infant, using the Kannada version of the Birmingham Interview for Maternal Mental Health. Fifty-three percent of subjects reported delusions related to the infant, with 34% reporting more than one delusion. Mothers with infant related persecutory delusions were more likely to show affectionate behaviour and had normal competence and caring for baby's basic needs; however, they were more likely to get disturbed and agitated if separated from the baby. Mothers who had delusions that the baby was a devil or ill fated or someone else's baby, were more likely to have significant abusive incidents towards the baby. Overall, the mothers who had delusions related to the infant were seen to have more significant abusive incidents and were more likely to be considered unsafe in looking after the baby alone. The study emphasises the need for systematic clinical assessment of psychopathology in mothers with postpartum psychosis.

Psychiatric aspects of homicide in Singapore: a five-year review (1997 - 2001)

INTRODUCTION

The association between mental illness and violent offenders is an important issue not just for psychiatrists but for the public as well. Several studies have linked an increased prevalence of psychiatric illness among offenders of violent crimes. This study seeks to update the psychiatric community in Singapore on individuals charged with murder from 1997 to 2001, all of whom received a psychiatric assessment.

METHODS

110 individuals were charged with murder from 1997 to 2001. Socio-demographical data, psychiatric diagnoses, offence and victim profiles and court outcomes were obtained from prison records and psychiatric files.

RESULTS

There were 110 individuals charged with murder between January 1, 1997 to December 31, 2001, with a total of 113 victims. In 70 of the cases, one offender killed one victim. Offenders were mostly unmarried males in the 20-39 year age group who received a secondary school level of education or less. 57 of the remandees were found not to suffer from any mental illness. Alcohol abuse and dependence disorders accounted for the largest diagnostic group. Depressive disorders accounted for 9.1 percent of the accused persons and schizophrenia, 6.4 percent. Victim profiles and court outcomes are also described. A comparison is drawn between this study and the last large report on homicides in Singapore, published in 1985. No difference is detected when the rates of schizophrenia and depression are compared between the two eras.

CONCLUSION

Perpetrators of murder have been shown to have an increased incidence of psychiatric disorders. Reduction of the rate of homicide in the country may be achievable via the reduction of controllable factors found to be linked to the aetiology of murder. Alcohol and other illicit substance use are frequently found to be associated with homicide. The authorities are encouraged to enhance campaigns to dissuade alcohol abuse.

Sildenafil in the treatment of antipsychotic-induced erectile dysfunction: a randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover trial

OBJECTIVE

Antipsychotic-induced erectile dysfunction is a significant clinical problem and is a common reason for poor medication compliance. This report studied the efficacy and tolerability of sildenafil citrate in patients with antipsychotic-induced erectile dysfunction.

METHOD

The study design was a randomized, double-blind, placebo-controlled, flexible-dose, two-way crossover trial carried out at a tertiary referral center. Thirty-two married male outpatients with schizophrenia or delusional disorder and antipsychotic-induced erectile dysfunction were recruited for the trial. Sexual function was assessed from patient logs of sexual activity.

RESULTS

Thirty-two subjects and their spouses, who agreed to take part in the study, were included in the crossover trial. Thirty-one (96.9%) completed the trial. There was no significant period effect or treatment-period interaction. Patients reported significant improvement while taking sildenafil in the number of adequate erections, satisfaction with sexual intercourse, and the duration of erections over 2 weeks. The odds ratios for adequate erections and for satisfactory sexual intercourse with sildenafil were 4.07 and 3.77, respectively. The effect of sildenafil remained significant even after adjustment for period and week effects and treatment-period interaction with Poisson regression analysis. There were no major side effects or adverse drug interactions.

CONCLUSIONS

Sildenafil citrate is safe and effective in the treatment of antipsychotic-induced erectile dysfunction. It is also well tolerated.

Recent advances in the treatment of delusional disorder

OBJECTIVE

Often considered difficult to treat in the past, even treatment-resistant, delusional disorder is now regarded as a treatable condition that responds to medication in many instances. Munro and Mok previously reviewed the published record of its treatment to 1994. This review aims to update and extend their observations and to examine the impact of new second-generation antipsychotic agents on the treatment of this condition.

METHOD

We attempted to gather all published reports of delusional disorder from 1994 to 2004, using various database strategies. We then assessed the reports for clarity and completeness, treatment, and outcome descriptions, thereby selecting a patient sample for analysis.

RESULTS

Of 224 cases identified as delusional disorder, only 134 case descriptions provided sufficient treatment and outcome data to inform this review. The demographics of this sample were similar to those of the earlier review. Depression as a comorbid condition was more frequent than before. Adherence to medication regimens was seldom explicitly addressed. Most cases showed improvement regardless of which antipsychotic medication the patients received. Pimozide and other conventional antipsychotics, as well as second-generation antipsychotics, and even clozapine, were used in many of the case reports. Family history of delusional disorder was seldom recorded.

CONCLUSIONS

A positive response to medication treatment occurred in nearly 50% of the cases in our review, which is consistent with the earlier review.

[Investigation of the life situation of schizophrenic and paranoid patients at the Mental Health Care Institution in the City of Debrecen]

Even today we have to reckon with the serious personal and social consequences of schizophrenic diseases. In spite of medical treatment and nursing, psychiatric nursing homes have not been able to obtain real improvement in those serious consequences.

AIM

To survey whether an improvement can be detected as compared to the situation 25 years ago: how the disease affects the fate and progress of our patients in certain areas (marital status, employment, disability, guardianship).

METHOD

Doctors' notes and information obtained by nurses during visits about patients belonging to categories F20.029.9 of ICD, compared to a group of patients not suffering from schizophrenia (F40.0-F60.9).

RESULTS

The data of 2,397 patients in total have been processed. Of these, 893 belonged to categories F20-29. Compared to the 1,504 patients not suffering from schizophrenia, only a 1/3 of them were employed and 12 times as many were on disability pension. Among those of 35-54 years of age, there were four times as many singles, fewer were married, and five times fewer had an employment, three times as many received disability pension. Less than 10% of those in category F20 were employed, compared to 49% in the other group. The need for long-time treatment and nursing is shown by the fact that while the majority of those belonging to categories F40-69, no longer need nursing at about the age of 50, approximately 40% of those in F20 have to be nursed in their old age as well.

CONCLUSION

There is a lot to be done to improve the quality of life of the patients and their rehabilitation. In these important tasks, both psychiatric nursing taking place in the residential area (community psychiatry) and social care will play an indispensable role.

[Schizophrenia and cannabis consumption: epidemiology and clinical symptoms]

More and more young people consume cannabis in sometimes high dosage at an age when their brain is not yet fully developed and reacts particularly sensitive to toxic influences. Cannabis can induce and exacerbate psychotic symptoms and it can deteriorate the disease process in schizophrenic patients. First-episode schizophrenic patients with long-term cannabis consumption were significantly younger at disease-onset, mostly male and suffered more often from paranoid schizophrenia (with a better prognosis) than those without cannabis consumption in our investigation. The significance of higher serum neurotrophin levels in cannabis consuming schizophrenics as compared to those without cannabis consumption remains equivocal so far. The cognitive functions of this patient group are at least not worse than in those with schizophrenia alone. Taken together, the effect of cannabis on the brain vulnerable to schizophrenia is not yet completely understood; besides the undoubtedly deleterious effects, there may also be some neuroprotective effects.

Delusional misidentification

The Capgras syndrome and other forms of delusional misidentification may be encountered frequently in neuropsychiatric settings. DMS can occur in the presence of idiopathic psychiatric illness, in diffuse brain illness such as dementia, and in focal neurologic disease. In patients who have focal lesions, there is evidence that right hemisphere damage is necessary for the production of DMS. Although DMS is associated with a pattern of neuropsychologic impairments in the domains of memory, perception, and executive function, these impairments alone do not account for the selectivity and delusional nature of DMS. Therefore, other factors such as premorbid psychopathology, motivation, and loss of ego functions may be important in determining which vulnerable patients develop DMS and which do not.

Cochlear implantation in severe traumatic brain-injury and paranoid schizophrenia: two case studies

In view of the demanding instruction and training requirements associated with cochlear implantation;,patients with cognitive impairments have typically been considered to be poor candidates for this procedure. This presumption persists in part because experience and research in this area are limited. We describe our experience with implanting cochlear devices in 2 patients who had significant psychological impairments; 1 patient had experienced a severe brain injury, and the other had paranoid schizophrenia. Nevertheless, both patients were able to follow the implant training program, and they experienced different degrees of improvement in their hearing. We discuss our preoperative evaluations of these patients and the key factors that led to our decision to proceed with surgery.

[Aggressive behaviour and substance abuse among schizophrenic adolescents compared to antisocial adolescents--a follow-up study]

OBJECTIVES

The objective of this study was to analyze aggressive behaviour towards others by schizophrenic as opposed to antisocial adolescents, and the influence of substance abuse before, during and after their hospitalization.

METHODS

We analyzed 21 schizophrenic adolescents and compared their aggressive behaviour and their substance abuse to that of 21 antisocial juveniles before and during their hospitalization and again at the time of a follow-up interview. The two samples were matched for age, sex and intelligence. In a first step, data were gathered from the hospital records, in a second step, for follow-up data we conducted standardized telephone interview with the patient and his or her parent or caregiver. Within the analysis we focused on aggressive behaviour towards other people and objects, as well as on criminal acts and regular substance abuse.

RESULTS

We found less aggressive behaviour among psychotic patients during and post-hospitalization than among their antisocial counterparts. As inpatients, the acutely psychotic juveniles were at higher risk for aggressive acts, but adequate treatment subdued their offensive behaviour. In the long term, there were fewer criminal arrests among psychotic patients. Only in connection with their substance abuse, their aggressive misconduct towards others increased.

CONCLUSIONS

Our results suggest that drug treatment during adolescence might help to lessen the risk of aggressive behaviour towards others.

Behavioral and psychological symptoms of dementia in developing countries

BACKGROUND

Little is known about the prevalence of, or associations with behavioral and psychological symptoms of dementia (BPSD) in developing countries.

METHODS

Individuals diagnosed as having dementia according to DSM-IV criteria (mild and moderate cases as defined by the Clinical Dementia Rating scale only), together with their main caregiver, were recruited from 21 centers in 17 developing countries. People with dementia were directly assessed with the Community Screening Interview for Dementia and the Geriatric Mental State Schedule (GMS); GMS data were processed by the AGECAT computer program to yield diagnostic information on 8 psychiatric syndromes. Caregivers answered direct questions about behavioral symptoms of dementia (BSD) and completed the Zarit Burden Inventory.

RESULTS

At least one BSD was reported in 70.9% of the 555 participants. At least one case-level AGECAT psychiatric syndrome (not including the organic syndrome) was exhibited by 49.5% of people with dementia. Depression syndromes (43.8%) were most common followed by anxiety neurosis (14.2%) and schizophreniform/paranoid psychosis (10.9%). Caregivers were more likely to report BSD in people with dementia who were married, younger and better educated. More advanced dementia, poorer functioning and the presence of depression or anxiety were each associated with BSD. BSD, and psychiatric syndromes (anxiety neurosis and schizophreniform/paranoid psychosis) predicted caregiver strain after controlling for cognitive impairment. BPSD are poorly understood, leading to shame and blame.

CONCLUSIONS

BPSD are common among people with dementia in developing countries, though we found marked regional variations. Representative population studies are needed to clarify prevalence and impact, but our research suggests considerable unmet need, with much scope for intervention. Raising awareness of the problem should be the first step.

Treatment of perinatal delusional disorder: a case report

This article is a report on a complicated case of delusional disorder in pregnancy and lactation, and effective multidisciplinary treatment. Few reports in the literature concern delusional disorder in pregnancy, or regard olanzapine's safety in pregnancy and lactation. A gravid woman in her third trimester merited twin diagnoses of delusional disorder and borderline personality disorder, and was successfully treated with olanzapine and psychotherapy during pregnancy and lactation. Her infant was large for gestational age (LGA) and had Erb's palsy, which resolved, and remained healthy at six months, with continued breastfeeding. Her delusional beliefs did not recur, nor did she have postpartum depression or psychosis.

Patterns of personality disorders in women with chronic eating disorders

The aim of this study was to describe patterns of personality disorders (PDs) in women with chronic eating disorders (EDs). An index group of nineteen women who have had EDs for an average of 8.5 years was compared with a control group of same-aged women from the general population. At the time of the study the index group received treatment at a tertiary treatment center in Stockholm. The PDs were assessed using the DSM-IV part of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). In the index group, eighteen of nineteen fulfilled the criteria for one or more PD. The number of PD diagnoses for each women ranged from zero (n = 1) to eight (n = 2) with a median of three. Among the controls, only one woman fulfilled the criteria for one or more PD. The most prevalent disorders in the index group were Borderline, Avoidant, and Obsessive-Compulsive. The index group had significantly higher DIP-Q dimensional scores than the controls in the Paranoid, Schizoid, Schizotypal, Borderline, Histrionic, Avoidant, and Dependent scales. Although the assessment of PD symptoms was limited to self-reports, the high prevalence of PD diagnoses and PD symptoms most probably reflects the severe psychiatric impairments in patients suffering from chronic ED.

[Core factors of schizophrenia structure based on PANSS and SAPS/SANS results. Discerning and head-to-head comparisson of PANSS and SASPS/SANS validity]

AIM

A lot of inconsistencies across dimensional studies of schizophrenia(s) are being unveiled. These problems are strongly related to the methodological aspects of collecting data and specific statistical analyses. Psychiatrists have developed lots of psychopathological models derived from analytic studies based on SAPS/SANS (the Scale for the Assessment of Positive Symptoms/the Scale for the Assessment of Negative Symptoms) and PANSS (The Positive and Negative Syndrome Scale). The unique validation of parallel two independent factor models was performed--ascribed to the same illness and based on different diagnostic scales--to investigate indirect methodological causes of clinical discrepancies.

METHOD

100 newly admitted patients (mean age--33.5, 18-45, males--64, females--36, hospitalised on average 5.15 times) with paranoid schizophrenia (according to ICD-10) were scored and analysed using PANSS and SAPS/SANS during psychotic exacerbation. All patients were treated with neuroleptics of various kinds with 410mg equivalents of chlorpromazine (atypicals:typicals --> 41:59). Factor analyses were applied to basic results (with principal component analysis, normalised varimax rotation). Investing the cross-model validity, canonical analysis was applied.

RESULTS

Models of schizophrenia varied from 3 to 5 factors. PANSS model included: positive, negative, disorganisation, cognitive and depressive components and SAPS/SANS model was dominated by positive, negative and disorganisation factors. The SAPS/SANS accounted for merely 48% of the PANSS common variances. The SAPS/SANS combined measurement preferentially (67% of canonical variance) targeted positive-negative dichotomy. Respectively, PANSS shared positive-negative phenomenology in 35% of its own variance. The general concept of five-dimensionality in paranoid schizophrenia looks clinically more heuristic and statistically more stabilised.

The mood spectrum in unipolar and bipolar disorder: arguments for a unitary approach

OBJECTIVE

This study examined the extent to which individuals with a lifetime diagnosis of recurrent unipolar disorder endorse experiencing manic/hypomanic symptoms over their lifetimes and compared their reports with those of patients with bipolar I disorder.

METHOD

The study group included 117 patients with remitted recurrent unipolar depression and 106 with bipolar I. Subjects had their clinical diagnosis confirmed by the Mini International Neuropsychiatric Interview and were administered the Structured Clinical Interview for the Mood Spectrum, which assesses lifetime symptoms, traits, and lifestyles that characterize threshold and subthreshold mood episodes as well as "temperamental" features related to mood dysregulation.

RESULTS

The patients with recurrent unipolar depression endorsed experiencing a substantial number of manic/hypomanic symptoms over their lifetimes. In both patients with recurrent unipolar depression and patients with bipolar I disorder, the number of manic/hypomanic items endorsed was related to the number of depressive items endorsed. In the group with recurrent unipolar depression, the number of manic/hypomanic items was related to an increased likelihood of endorsing paranoid and delusional thoughts and suicidal ideation. In the bipolar I group, the number of lifetime manic/hypomanic items was related to suicidal ideation and just one indicator of psychosis.

CONCLUSIONS

The presence of a significant number of manic/hypomanic items in patients with recurrent unipolar depression seems to challenge the traditional unipolar-bipolar dichotomy and bridge the gap between these two categories of mood disorders. The authors argue that their mood spectrum approach is useful in making a more accurate diagnostic evaluation in patients with mood disorders.