Vulnerability to psychosis in patients attending primary and psychiatric care. Results of the RADEP study

We studied occurrence of psychotic symptoms and their associations with occurrence of depressive and manic symptoms; 563 patients attending primary care (PrC) and 163 patients attending psychiatric outpatient care (PsC) completed a questionnaire including lists of psychotic, manic and depressive symptoms, and patients with depressive symptoms were interviewed using the same questionnaire 6 months after baseline examination. Of PrC patients, 8.5% and of PsC patients, 36.2% reported at least seven lifetime psychotic symptoms. During the 6-month follow-up, the corresponding figures were 0.22% for PrC and 2.84% for PsC patients. Among PrC patients, men, young, never-married, students and unemployed reported more psychotic symptoms than others. In multivariate analyses, occurrence of psychotic symptoms was associated with young age, never being married, poor functioning and former psychiatric treatment, as well as with occurrence of manic and depressive symptoms. Psychotic symptoms are rather prevalent in primary care and very common in psychiatric care. In primary care, vulnerability to psychosis is associated with the patient's background more strongly than in psychiatric care. Concurrent occurrence of psychotic symptoms with manic and depressive symptoms is common.     

Vulnerability to psychosis in patients attending primary and psychiatric care. Results of the RADEP study

We studied occurrence of psychotic symptoms and their associations with occurrence of depressive and manic symptoms; 563 patients attending primary care (PrC) and 163 patients attending psychiatric outpatient care (PsC) completed a questionnaire including lists of psychotic, manic and depressive symptoms, and patients with depressive symptoms were interviewed using the same questionnaire 6 months after baseline examination. Of PrC patients, 8.5% and of PsC patients, 36.2% reported at least seven lifetime psychotic symptoms. During the 6-month follow-up, the corresponding figures were 0.22% for PrC and 2.84% for PsC patients. Among PrC patients, men, young, never-married, students and unemployed reported more psychotic symptoms than others. In multivariate analyses, occurrence of psychotic symptoms was associated with young age, never being married, poor functioning and former psychiatric treatment, as well as with occurrence of manic and depressive symptoms. Psychotic symptoms are rather prevalent in primary care and very common in psychiatric care. In primary care, vulnerability to psychosis is associated with the patient's background more strongly than in psychiatric care. Concurrent occurrence of psychotic symptoms with manic and depressive symptoms is common.     

Vulnerability factors to depression

The objective of this study is to reveal in their complexity the biological and cognitive vulnerability factors, as well as the environmental and socialisation predisposing factors playing a role in the development of depression in non-clinical sample of subjects (college students). Biological vulnerability was examined through temperament and character features, cognitive vulnerability was examined through dysfunctional attitudes, attributional style and coping strategies, and environmental, socialization predisposing factors were observed through certain family socialisation effects (type of family atmosphere, educational objectives, educational and rearing attitudes and style) and parental rearing behaviour. 681 college students were involved in this study (465 females, 216 males). Students were assigned to the study group if they fell in the fourth quartile of the sample based on the results obtained by the Beck's Depression Inventory: 170 persons (128 females, 42 males). Students who fell in the first quartile of the sample on the basis of their results obtained by the mentioned Inventory formed the control group: 204 persons (118 females, 86 males). The results of our study have demonstrated that in a sub-clinical sample the lack of parental care was observed to be a socialization predisposing factor in the development of depression, while certain dysfunctional attitudes and pessimistic interpretation styles were detected to be cognitive vulnerability factors, and harm avoidance proved to be a biological vulnerability factor. We also managed to reveal the effects of certain background factors, which produce their influence indirectly through mediating factors.     

Vulnerability to psychosis associated with hallucinogen use

Ninety-five patients hospitalized for acute psychosis were reviewed with respect to hallucinogen use and family history of mental illness. Sixty-three percent of admissions had used hallucinogens to some degree within 3 years of the index admission. Drug users were predominantly male, although no age or diagnostic differences with the nondrug group were found. The incidence of hospitalized first degree relatives was approximately 30% and equal for both drug and nondrug groups. Male drug users and female nondrug users were more likely to have had first degree relatives hospitalized. For male psychotics only, lower degrees of drug use were associated with a greater number of hospitalized first degree relatives. For female psychotics only, drug use was positively associated with full scale IQ. The findings suggest sex differences in vulnerability to psychoses associated with hallucinogen use.     

Vulnerability factors to normal depression

Brown and colleagues have defined and delineated several vulnerability factors as psychosocial variables that increase the likelihood of a life event producing depression. In the present study the influences of several possible vulnerability factors were examined in a large non-clinical group. Parental characteristics did not emerge clearly as vulnerability factors. Extraversion and external locus of control appeared irrelevant as vulnerability factors. Neuroticism, low self-esteem and female sex emerged as significant predictors of reported depressive experience in response to a number of precipitants suggesting their relevance as vulnerability factors.     

Intractable depression or psychosis.

OBJECTIVE: Some patients with treatment resistant depression may have a difficult to recognize and therefore untreated thought disorder. Even a subtle disorder may significantly impact patients' lives. This case illustrates a mechanism for identifying and treating this subgroup of patients. METHOD: The treatment of a 67-year-old female with intractable depression is described. RESULTS: The Rorschach Exner Comprehensive System identified the presence of a thought disorder with four out of five conditions positive on the Schizophrenia Index and five out of seven conditions positive on the Depression Index. Low-dose risperidone was added to the patient's medications with excellent results. Post-testing indicated that the Schizophrenia and Depression Indices were no longer positive. CONCLUSION: A subgroup of patients with intractable depression may have an underlying thought disorder that can be identified with the Rorschach and successfully treated with low-dose antipsychotic medication.     

What is the mechanism whereby cannabis use increases risk of psychosis?

Cannabis use has increased greatly over the last three decades. The various types of cannabis differ in their concentration of the main psychoactive component, Δ⁹-tetrahydrocannabinol (THC), and the other major ingredient, cannabidiol (CBD). Plant engineering has maximized levels of THC, thus increasing the potency of street cannabis. It is well known that cannabis intoxication can cause brief psychotic symptoms like paranoia, whilst recent evidence demonstrates that heavy use of cannabis increases the risk of chronic psychoses like schizophrenia; genetic vulnerability seems to predispose some people to a higher risk. This paper starts to consider the neurochemical mechanisms whereby cannabis use increases the risk of psychosis.     

Psychotism and its dimensions in primary care. Associations with patient's background and manic and depressive symptoms. Results of the RADEP study

Dimensions of psychotism have mainly been studied in clinical samples. We studied psychotism, its dimensions and their associations, in a primary care sample. In all, 1199 primary care patients over 18 years of age filled in a questionnaire including lists of psychotic (the Composite International Diagnostic Interview, CIDI), depressive (the Depression Scale, DEPS) and manic (the Mood Disorder Questionnaire, MDQ) symptoms. Psychotic symptoms were factored, and variance in factor scores was explained by patients' background and by depressive and manic symptoms. In the principal component solution, the first factor explained 22% of the total variance in psychotic (CIDI) symptoms and was named global psychotism. Varimax rotation produced seven interpretable dimensions: Schneiderian (9.7% of variance), passivity (8.9%), hallucinatory (8.5%), paranoid (7.7%), infidelity (7.6%), somatic (7.6%) and reference experiences (5.9%). Together they explained 52% of the total variance of CIDI symptoms. Global psychotism (P=0.000), as well as hallucinatory (P=0.003), paranoid (P=0.000) and infidelity (P=0.000) experiences associated inversely with age. Otherwise, patients' background associated differently with global psychotism and with factor dimensions in CIDI symptoms. Manic symptoms associated with global psychotism and with all CIDI dimensions, whereas depressive symptoms associated with global psychotism, passivity, paranoid and infidelity experiences. Psychotism is composed of a global factor and of independent dimensions, and is more prevalent in young people. Independently of patients' background, manic widely and depressive symptoms less widely associate with occurrence of psychotism.     

精神病风险综合征与分裂样精神病临床对照研究

目的 探讨精神病风险综合征(PRS)与分裂样精神病(SFP)临床症状学结构的异同.方法 依据国际疾病分类第10版(ICD-10)及精神病风险综合征定式访谈(SIPS),从病历资料完整的住院患者中筛选出PRS患者71例及SFP患者39例,采用精神病高危症状量表(SOPS)和简明精神病评定量表(BPRS)评估两组疾病症状严重性.结果 两组患者起病形式存在显著性差异(x2=9.24,P=0.010),PRS组以亚急性发病常见(76％),SFP组以急性为主(61％);相关分析显示,SOPS总分与BPRS缺乏活力、思维障碍、敌对猜疑因子分及总分呈正相关(P＜0.01);SFP组SOPS阳性症状因子评分及总分均显著高于PRS组,BPRS总分及思维障碍、激活性因子评分均显著高于PRS组(P ＜0.05,P＜0.01).结论 精神病风险综合征与分裂样精神病是同源类疾病的不同状态,分裂样精神病阳性症状严重于精神病风险综合征.     

Childhood trauma and distress experiences associate with psychotic symptoms in patients attending primary and psychiatric outpatient care. Results of the RADEP study

GoalWe studied the prevalence of and association between psychotic symptoms and childhood trauma experiences in primary care patients compared with psychiatric care patients.Patients and methodsWe note 911 primary care and psychiatric care patients over 16 years of age filled in a questionnaire including a list of lifetime psychotic symptoms of the Composite International Diagnostic Interview (CIDI) and the childhood Trauma and Distress Scale (TADS). Prevalence of and correlations between psychotic symptoms and childhood trauma and stressful experiences were calculated. Association between the sum of CIDI symptoms and the TADS sum score was analysed by Anova.ResultsIn primary care, more than half of the patients had had at least one psychotic symptom during their lifetime, and nearly 70% of patients had experienced a childhood trauma at some time or more often. In psychiatric care patients, CIDI symptoms were more prevalent and TADS scores were higher than in primary care patients. In the whole sample, CIDI symptoms correlated with TADS scores. The association remained even when the effects of age, service, and patient's functioning were taken into account. There was a dose-response between TADS scores and CIDI symptoms.ConclusionChildhood trauma experiences associate with psychotic symptoms. In clinical work, it is important to acknowledge that psychotic symptoms and childhood trauma experiences are common not only in psychiatric care but also in primary care patients, and thus require adequate attention.     

Pituitary volume predicts future transition to psychosis in individuals at ultra-high risk of developing psychosis.

BACKGROUND: We examined pituitary volume before the onset of psychosis in subjects who were at ultra-high risk (UHR) for developing psychosis. METHODS: Pituitary volume was measured on 1.5-mm, coronal, 1.5-T magnetic resonance images in 94 UHR subjects recruited from admissions to the Personal Assessment and Crisis Evaluation Clinic in Melbourne, Australia and in 49 healthy control subjects. The UHR subjects were scanned at baseline and were followed clinically for a minimum of 1 year to detect transition to psychosis. RESULTS: Within the UHR group, a larger baseline pituitary volume was a significant predictor of future transition to psychosis. The UHR subjects who later went on to develop psychosis (UHR-P, n = 31) had a significantly larger (+12%; p = .001) baseline pituitary volume compared with UHR subjects who did not go on to develop psychosis (UHR-NP, n = 63). The survival analysis conducted by Cox regression showed that the risk of developing psychosis during the follow-up increased by 20% for every 10% increase in baseline pituitary volume (p = .002). Baseline pituitary volume of the UHR-NP subjects was smaller not only compared with UHR-P (as described above) but also compared with control subjects (-6%; p = .032). CONCLUSIONS: The phase before the onset of psychosis is associated with a larger pituitary volume, suggesting activation of the HPA axis.     

Candidate neuroanatomic substrates of psychosis in old-aged depression.

1. The authors investigated the candidate neuroanatomic substrates underlying delusional thought disorder in old-aged depressed patients by using magnetic resonance imaging (MRI), and examined the relationship between volumes for individual brain structures and clinical correlates of particular relevance to depression: executive cognitive impairment and global severity of depression. 2. MR morphometry was performed on nineteen deluded depressed patients and 26 non-deluded depressed patients, all older than 55 years of age. Subjects were administered a neuropsychological test battery and measures of depression. 3. The absolute volume of prefrontal cortex (PFC) was smaller in the deluded depressed group than in non-deluded depressed group (131.79 +/- 37.26 ml vs. 152.65 +/- 26.13 ml, p = 0.03); a difference that was statistically significant even after adjusting for the effect of whole brain volume (p = 0.01). No group differences were observed in the volumes of the basal ganglia, the temporal lobes, the superior temporal gyri, the amygdala-hippocampal complex, the lateral ventricles, or whole brain. The relative volume of PFC correlated inversely and significantly with the index of Wisconsin Card Sorting Test (WCST) performance (r = -0.76, p < 0.01) in depressed patients. 4. PFC may be one of the candidate neuroanatomic substrates underlying delusional thought disorder in old-aged depression.     

Vulnerability to depression: from brain neuroplasticity to identification of biomarkers

A stressful event increases the risk of developing depression later in life, but the possible predisposing factors remain unknown. Our study aims to characterize latent vulnerability traits underlying the development of depressive disorders in adult animals. Four weeks after a priming stressful event, serum corticosterone concentration returned to control values in all animals, whereas the other biological parameters returned to basal level in only 58% of animals (called nonvulnerable). In contrast, 42% of animals displayed persistent decreased serum and hippocampus BDNF concentrations, reduced hippocampal volume and neurogenesis, CA3 dendritic retraction and decrease in spine density, as well as amygdala neuron hypertrophy, constituting latent vulnerability traits to depression. In this group, called vulnerable, a subsequent mild stress evoked a rise of serum corticosterone levels and a "depressive" phenotype, in contrast to nonvulnerable animals. Intracerebroventricular administration of 7,8-dihydroxyflavone, a selective TrkB receptor agonist, dampened the development of the "depressive" phenotype. Our results thus characterize the presence of latent vulnerability traits that underlie the emergence of depression and identify the association of low BDNF with normal corticosterone serum concentrations as a predictive biomarker of vulnerability to depression.