Outcome of reactive psychosis: a prospective study from India

In a prospective study, 22 patients diagnosed to have "Reactive Psychosis" were followed-up for 6 months. Clinical and social recovery was seen in 16 cases, three patients had relapsed, and in three patients the diagnosis of "Reactive Psychosis" was changed to either major depressive disorder or schizophrenia. The results of the study suggest that "Reactive Psychosis" has good outcome and stability of diagnosis over a short period of time.     

The Nordic concept of reactive psychosis--a multicenter reliability study.

Reactive psychosis is a common diagnosis in the Nordic countries (Norway, Sweden, Denmark, Finland and Iceland) and in several other parts of the world. In ICD-9 and DSM-III-R, the concept is defined more narrowly than in the Nordic tradition. In this study we examined the interrater reliability of the Nordic concept by the case-summary method between clinicians from 9 university departments in the Nordic countries. The results show that Nordic psychiatrists have a reasonably reliable concept of reactive psychosis, and that this psychosis can be diagnosed as reliably as schizophrenia and affective psychosis.     

Follow-up and family study of postpartum psychoses Part I: Overview

A group of 119 patients suffering from a severe psychiatric postpartum disorder who were admitted for the first time in their life to a psychiatric hospital has been investigated. The onset of illness occurred within 3 months following delivery. The patients represented 92% of the total sample fulfilling the inclusion criteria. A follow-up investigation was performed after a mean of 21 years (range 2–35 years). Of the patients 66% had nonpuerperal psychotic episodes in later life. The diagnosis, taking into account the long-term course, was affective psychosis in 57%, schizoaffective psychosis in 18%, schizophreniform psychosis in 12%, brief reactive psychosis in 4% and schizophrenia in 9%. A bipolar psychosis was found in 31%. The relation of unipolar to bipolar psychoses corresponded to that in a control group of affectively ill women without puerperal onset. The frequency of a manic syndrome in bipolar psychoses at the index episode was the same as in nonpuerperal episodes, which does not suggest a mania-provoking pathoplastic effect of the puerperium. The comparison with female nonpuerperal controls matched for age and diagnosis revealed evidence of a better long-term course in the index patients. The risk of a puerperal relapse for further pregnancies was 35%. The global morbidity risk for functional psychoses in first-degree relatives was 11%, with affective psychoses representing the majority of secondary cases (6.8%). The index patients showed a nonsignificant lower-morbidity risk in relatives than a control group of psychotically ill women without puerperal onset. The major aetiological factor found for postpartum psychoses is the relation of these disorders to functional psychoses. There is strong evidence that the postpartum period tends to provoke affective psychoses and other nonschizophrenic psychoses, but not, or only to a lesser degree, narrowly defined schizophrenias. The liability to puerperal decompensations suggests some common pathophysiological mechanism, the nature of which remains unknown.     

Psychogenic facial movement disorders: Clinical features and associated conditions

The facial phenotype of psychogenic movement disorders has not been fully characterized. Seven tertiary‐referral movement disorders centers using a standardized data collection on a computerized database performed a retrospective chart review of psychogenic movement disorders involving the face. Patients with organic forms of facial dystonia or any medical or neurological disorder known to affect facial muscles were excluded. Sixty‐one patients fulfilled the inclusion criteria for psychogenic facial movement disorders (91.8% females; age: 37.0 ± 11.3 years). Phasic or tonic muscular spasms resembling dystonia were documented in all patients most commonly involving the lips (60.7%), followed by eyelids (50.8%), perinasal region (16.4%), and forehead (9.8%). The most common pattern consisted of tonic, sustained, lateral, and/or downward protrusion of one side of the lower lip with ipsilateral jaw deviation (84.3%). Ipsi‐ or contralateral blepharospasm and excessive platysma contraction occurred in isolation or combined with fixed lip dystonia (60.7%). Spasms were reported as painful in 24.6% of cases. Symptom onset was abrupt in most cases (80.3%), with at least 1 precipitating psychological stress or trauma identified in 57.4%. Associated body regions involved included upper limbs (29.5%), neck (16.4%), lower limbs (16.4%), and trunk (4.9%). There were fluctuations in severity and spontaneous exacerbations and remissions (60%). Prevalent comorbidities included depression (38.0%) and tension headache (26.4%). Fixed jaw and/or lip deviation is a characteristic pattern of psychogenic facial movement disorders, occurring in isolation or in combination with other psychogenic movement disorders or other psychogenic features. © 2012 Movement Disorder Society     

Follow-up and family study of postpartum psychoses

Patients suffering from a severe psychiatric postpartum disorder (n=119) were classified according to early onset (EO) of symptoms, i.e. onset within 2 weeks postpartum, versus late onset (LO) in the 3-month period following delivery. The patients were admitted for the first time in their life to a psychiatric hospital. The EO cases more often had a manic syndrome, the symptomatology of cycloid psychoses, signs of confusion and an abrupt onset of illness. They were also younger at the index delivery and at the first episode of illness. No important difference in the distribution of diagnoses considering the long-term course was found in the two groups. The global psychopathological outcome was also similar. There is no definite evidence that different diseases are provoked in the early and later postpartum period.     

Alternating and postictal psychoses: review and a unifying hypothesis

A comparison of the clinical and pathophysiological features of postictal psychosis and brief interictal or alternating psychosis was undertaken to examine if the underlying mechanisms are distinct in these 2 conditions. A selective review of the published literature in English on epilepsy and brief psychosis was carried out. The literature indicates that even though brief postictal and alternating psychoses are considered to be separate syndromes, they have a number of similarities. It can be argued that the underlying pathomechanisms are common, with the brain's inhibitory processes in response to seizures playing a key role in the development of the psychosis. These homeostatic mechanisms manifest as electrophysiological, cerebral blood flow, and neurotransmitter and receptor changes. Both syndromes are likely to be associated with prolonged inhibition in limbic circuits, with further seizures modifying the psychosis depending upon whether it is associated with disinhibition or hypersynchrony involving enhanced inhibition. The neurotransmitter with a key role is GABA, although ionic currents, catecholamines, opiates, adenosine, glutamate, and nitric oxide play a role. Brief postictal and alternating psychoses provide an opportunity to understand the complex relationships between epilepsy and schizophrenia-like brief psychotic episodes, and this understanding can assist in their management.     

Psychogenic parkinsonism: a combination of clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations improves diagnostic accuracy.

We evaluated the concordance between independent clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations as a staged procedure for an accurate diagnosis in 9 patients referred with a diagnosis of suspected psychogenic parkinsonism. Three patients were reclassified as pure psychogenic parkinsonism (PP), 6 with a form of combined psychogenic parkinsonism and Parkinson's disease (PP + PD), and none with pure Parkinson's disease (PD). Electrophysiological recordings showed the characteristics of psychogenic tremor in 5 of 7 patients with tremor. In two of these 5, PD tremor was also recorded. SPECT scan results were abnormal in five of 9 patients. In one case of clinically suspected PP + PD, SPECT scan results were normal. Long-term follow-up supported the final diagnosis of PP (initial clinical misdiagnosis). Electrophysiology contributes to the clinical diagnosis of psychogenic tremor and may help confirm associated organic PD tremor. [(123)I]-FP-CIT SPECT is a robust test to ascertain dopaminergic denervation and increase the confidence of the clinical and electrophysiological diagnosis of associated PD. A combination of clinical, electrophysiological, and [(123)I]-FP-CIT SPECT scan explorations improves diagnostic accuracy in order to distinguish PP from PP + PD.     

First-case postpartum psychoses in Eastern Turkey: a clinical case and follow-up study.

OBJECTIVE: The aim of this study was to investigate the clinicodemographic features and long-term course of postpartum psychosis (PPP). METHOD: A total of 64 in-patients with psychotic postpartum disorder, who were admitted for the first time to a psychiatry clinic, were reexamined retrospectively and then compared with 64 control patients. Follow-up investigation was carried out either by interviewing the patients personally or with the help of general practitioners (GPs). All patients were rediagnosed according to DSM-IV. RESULTS: The majority of PPP patients were young, married, primiparae, had a low educational level and were living in rural areas. The mean onset time of PPP after delivery was 3.62 weeks. More than 75% of the patients with PPP had further psychotic episodes during the follow-up period of 11 years; 42% of the puerperal cases were diagnosed as schizophrenia at the follow-up investigation, and 59.3% of the patients had confuso-oneiroid syndrome. CONCLUSION: These findings, unlike those of the Western studies, demonstrate that PPP is not uniform in different populations.     

Psychogenic amnesia and self‐identity: a multimodal functional investigation

Background: Patients with psychogenic amnesia generally suffer from episodic memory deficits associated with an impairment of self‐identity. While the first is generally attributed to limbic dysfunction, the latter might be related to posterior parietal cortex. Methods and Results: In a patient with acute repetitive psychogenic amnesia, three different functional investigations (fMRI, electrical‐neuroimaging, PET) during both resting‐state and a behavioural paradigm testing ‘time‐travel’ showed left posterior parietal activation, unlike in 12 control subjects. Conclusion: Impairment of self‐identity and episodic memory in psychogenic amnesia may be associated with functional alterations of left posterior parietal cortex.     

The Reactivity of Psychosis Rating Form (RPRF): background,development and psychometrics

The ICD-10 and DSM-IV classifications have both given low priority to “reactivity” to acute stress as a classificatory principle for functional psychoses. In Scandinavia, reactivity is still considered an important factor in the development of such psychoses. Reactivity is a complex concept, and its various components are historically examined. The Reactivity of Psychosis Rating Form (RPRF) was developed in order to operationalize reactivity. Seven of the 10 elements of RPRF can be rated reliably. Factor analysis of the RPRF yields three factors: stressor, onset and change, that also show high interrater reliability. Our results indicate that RPRF has both construct and discriminant validity. Further studies with the RPRF may elucidate the true status of reactivity in functional psychoses.     

A follow-up study of postpartum psychoses: prognosis and risk factors for readmission.

OBJECTIVE: The aim of this study was to describe the prognosis and risk factors for the first readmission after postpartum psychosis. METHOD: Linking the Danish Medical Birth Register and the Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1173 women diagnosed with a psychosis within 91 days of delivery. The relative risk (RR) of readmission was estimated using Cox proportional hazard regression models. RESULTS: An increased risk of readmission was found for women with a diagnosis of schizophrenia (RR = 2.4, 95% CI = 1.9-3.1) and for women with a history of previous psychiatric admission (RR = 1.8, 95% CI = 1.5-2.1) compared to first-admitted women with other functional psychoses. Unmarried women also showed an increased risk of readmission, and only preterm delivery was associated with a reduced risk of readmission. CONCLUSION: Preterm delivery predicts the best prognosis after postpartum psychosis. The majority of readmissions were related to the psychopathology of the patient and to lack of social support.     

Psychogenic movement disorders in children: A report of 15 cases and a review of the literature

Data on psychogenic movement disorders (PMD) in children are scarce, with most existing literature relating to adults only. We report 15 cases with the aim of highlighting the clinical characteristics, risk factors, comorbidity, treatment, outcome, and prognosis of PMD in children. Only 13% of cases had onset before age 10, with the mean age at onset being 12.3 years. Females were predominantly affected (F:M = 4:1). The most common types of movement disorders seen were dystonia (47%), tremor (40%), and gait disorders (13%). Multiple hyperkinetic phenomenologies were observed in many cases. Abrupt onset and precipitation by minor injuries, and stressful life events were commonly reported. Clinical clues on examination suggesting a psychogenic origin were similar to those identified in adults. A distinct feature of PMD in children was the predominant involvement of the dominant limb. The underlying psychiatric diagnosis was conversion disorder in the majority of cases. Time from symptom onset until diagnosis of a PMD varied broadly (between 2 weeks and 5 years). Treatment with cognitive and behavioral therapy and rehabilitation by a multidisciplinary team led to improvement in most cases. However, treatment was much more effective in children with a short time from symptom onset to diagnosis and treatment. © 2008 Movement Disorder Society     

A prospective study of postpartum psychoses in a high-risk group. 2. Relationships to demographic and psychiatric history characteristics

Among 88 reproductions to women with a history of nonorganic psychosis, 25 postpartum episodes (PPPs) occurring during the total 6-month period following the current delivery were not systematically related to the woman's demographic characteristics, to her psychiatric history characteristics surrounding onset of the previous disorder or to a history of PPPs following previous reproductions. PPPs were highly significantly related to greater length of previous psychiatric hospitalization and to active mental disturbance just prior to this pregnancy, and this was true both for PPPs developing within 3 weeks of delivery and for those developing later. Considerable differences were found in the demographic characteristics that were related to development of PPPs within these Early vs. Later Onset cases, suggesting these to represent different disorders not only diagnostically but also demographically. In several diagnostic categories, selected demographic or psychiatric history characteristics identified subgroups with PPP rates as high as 75%.     

A prospective study of postpartum psychoses in a high-risk group. 1. Clinical characteristics of the current postpartum episodes

Postpartum psychotic episodes (PPPs) occurring during the first 6 months after delivery were prospectively studied in 88 pregnant index women with a history of nonorganic psychosis and 104 pregnant controls with no such history. While no control developed a PPP, PPPs were found following 28% of the index deliveries, almost all of these 25 cases being psychiatrically hospitalized. PPPs were especially frequent among cases with total illness diagnoses of Cycloid Psychosis and Affective Illness. More than half of the 25 cases had symptom onset within 3 weeks of delivery, and these early onset cases represented predominantly affective disorders, many of whom were manic in this episode. Cases with onset after 3 weeks were predominantly schizophrenic. Confusion was part of the current episode symptomatology in about one third of the cases and was well distributed across the different diagnostic groups.     

A prospective study of postpartum psychoses in a high-risk group. 4. Relationship to life situation and experience of pregnancy

Within a sample of 88 pregnant women with a history of nonorganic psychosis, the woman's life situation and experience of pregnancy, assessed through interviews during pregnancy, were studied in relationship to the development of 25 postpartum psychotic episodes (PPPs) occurring during the first 6 months postpartum. Neither Early nor Later Onset PPPs were associated with more current material situational problems, interpersonal difficulties, lack of relatives' support for the pregnancy, the woman's negative attitude toward the pregnancy or her experience of somatic health complaints. Contrary to expectation, PPP cases reported several more positive situational, attitudinal and experiential characteristics than did risk cases not developing PPPs. A number of different possible explanations for this finding are discussed.     

Distinct neurophysiological mechanisms for manic and cycloid psychoses: evidence from a P300 study on manic patients

Pathologically asymmetrical P300 fields with right lateralized peaks were described in core schizophrenia as an expression of left-temporal functional deficits, while higher than normal amplitudes were found in cycloid psychosis. This latter finding appeared to be specific for cycloid psychosis and was explained by a generalized cerebral hyperarousal. Based on some psychopathological analogies with cycloid psychosis, and on the comparable pharmacological treatment of the acute episodes, a group of 19 manic patients was investigated immediately after remission and clinical stabilization of an episode. Patients with psychotic features were excluded to avoid overlaps with cycloid psychosis. Patients showed normal P300 amplitudes and no pathological asymmetries of the field, but more posterior positive areas compared to age- and sex-matched controls. This indicates that the neurophysiological changes underlying mania are different from both core schizophrenia and cycloid psychosis. Based on previous three-dimensional source location studies, this finding indicates that disinhibition due to reduced frontal lobe activity, and not hyperarousal, is the basic functional mechanism of manic disorders.     

自编住院精神病人《社会功能评定量表》:信度、效度的初步检验

目的 编制一套适合于研究精神科住院病人的《社会功能评定量表(SSFPI)》。方法 根据住院精神病人的实际生活状况及康复活动特点，拟定出含12个条目的量表，并将条目性质类同者归纳为三个因子。同时在住院病人中进行初测及信度、效度检验。结果 总分及各条目重测相关在0．72～0．89之间；分半信度相关为0．943；总分及各因子间内部一致性相关在0．46～0．89之间；与SDSS进行效度检验相关r值为-0．863，社会功能缺陷阳性区分率达98．3％。结论 SSFPI信度和效度符合要求，与中、基层医院的住院精神病人的生活特点吻合，具有一定的研究及应用价值。