Psychotic Grandiosity

Treatment early in the course of psychosis can improve prognostic outcomes, facilitate adaptive functioning, and reduce familial and societal burden. However, little is known about the pathway of first episode psychosis (FEP) from the perspective of highly adherent adolescents and young adults. This study sought to understand the pathways in youth self-determination and self-management of treatment by investigating youth and parents' changing perceptions of illness in the early course of psychosis. Twenty-eight (n = 28) interviews were conducted using a semistructured interview guide on 12 adolescents following their FEP hospitalization and 16 parents. Standardized self-report forms and hospital inpatient records were used to collect and confirm demographic and clinical data. On average, three years had passed from initial hospitalization (age 16.2 years, SD = 1.2) to time of interview (age 19.3 years, SD = 2.3), thus allowing for a range of experiences across the early period of illness. Highly adherent adolescents experienced identifiable temporal phases of early psychosis, comprised of emergent and specific themes. Parents described a parallel pathway toward supporting their child's self-determination and self-management of treatments, with some distinct experiential differences. Five dominant themes that emerged across time were symptom recognition, awareness of change, negative appraisals, positive appraisals, and treatment self-management. Examining how these themes evolve over the early course of psychosis can help guide interventions that are compatible with the parent and adolescent's perceptions of illness at that point in time, and can therefore work in concert with the family's existing efforts to understand and manage their emerging condition and progress toward recovery.     

Psychotic depression

This paper will bring a brief overview of the clinical aspects of psychotic depression, with emphasis in the differentiation between mood-congruent and mood-incongruent delusions. Biological aspects of this disorder will be reviewed. Changes have been found in serotonergic and dopaminergic neurotransmission and also a characteristic shortening of REM latency. Alterations of hypothalamic-pituitary-adrenal (HPA) axis are especially prominent and may have specific features in this disorder. Attention will be given to structural brain alterations, cognitive impairments and the relationships of both with the HPA alterations previously described. Finally, a treatment update will be provided. Combination of antidepressants and antipsychotics is still the preferred psychopharmacologic treatment. There is recent research in selective serotonin reuptake inhibitors as monotherapy, atypical antipsychotics and antiglucocorticoid strategies but more investigations are needed.     

Psychotic consciousness

ABSTRACT Congruent with recent demands for greater attention to be given to patients' actual experiences at a fine-grained level in the understanding of psychosis (e.g. Thomas 1997) the present paper first describes one day in an actual psychotic episode suffered by the author in 1979 and then subjects this narrative to analytic and normalisation interpretations. It is suggested that acute psychotic thinking of paranoid form is critically mediated by real social events and by intrapsychic deficits in attentional capacity; metacognition; thought regulation and signal discriminative ability. Cognitive processes in delusion however, are suggested to be influenced by the presence of a threatening external locus of control. This reflects the strong social and political quality to delusional suffering. The effects therefore of victimisation on cognitive processes is suggested to be an important issue in social cognitive psychology and psychiatry.     

Psychotic onset of multiple sclerosis

A case is reported of a woman in whom acute manic attacks were followed later in life by neurological signs of multiple sclerosis, thus suggesting a possible correlation between the two clinical entities.     

Psychotic onset of multiple sclerosis

A case is reported of a woman in whom acute manic attacks were followed later in life by neurological signs of multiple sclerosis, thus suggesting a possible correlation between the two clinical entities.

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Sommario è descritto il caso di una donna in cui la sclerosi multipla fu preceduta da attacchi acuti di tipo psicotico (maniacale).

     

Psychotic disorders in DSM-III-R

The authors review the important changes in the three sections of DSM-III-R that include only psychotic disorders (schizophrenia, delusional disorder, and psychotic disorders not elsewhere classified), outline the rationale for these changes, and, where available, review their empirical basis. In addition, they review two proposed changes that were not incorporated into DSM-III-R. They conclude by calling for an increasingly rigorous and data-based process of nosologic revision.     

Psychotic syndromes in epilepsy

Claims have been made that epilepsy is associated with both brief psychotic episodes and persistent psychotic states. The existence of brief, nonconfusional psychotic episodes in epilepsy has received some formal support; these may be a function of temporal lobe subictal activity. Persistent psychosis is found in about 7% of patients with epilepsy; independent evidence indicates this to be a significant association. Temporal lobe seizure activity, again probably acting subictally, may be involved in the pathogenesis of these states, perhaps in interaction with other factors. Occurrence of psychotic syndromes in epilepsy may be relevant to kindling, atypical psychoses unrelated to epilepsy, and the psychotropic effect of carbamazepine.     

Psychotic depression and mortality

OBJECTIVE: Major depressive disorder is associated with elevated mortality rates that increase with the severity of depression. The authors hypothesized that patients with psychotic depression would have higher mortality rates than patients with nonpsychotic depression. METHOD: Survival analytic techniques were used to compare the vital status of 61 patients with psychotic major depression with that of 59 patients with nonpsychotic major depression up to 15 years after hospital admission. Medical status was assessed with the Cumulative Illness Rating Scale. Dexamethasone suppression test (DST) data were available for 101 patients. RESULTS: The mortality rate for subjects with psychotic depression was significantly greater than that for those with nonpsychotic depression, with 41% versus 20%, respectively, dying within 15 years after hospital admission. A proportional hazards model with age and medical status entered as covariates confirmed a significantly higher mortality rate in patients with psychotic depression (hazards ratio=2.31). A positive DST result was associated with psychotic depression but was not related to vital status. CONCLUSIONS: Patients with psychotic depression have a two-fold greater risk of death than do patients with severe, nonpsychotic major depression.     

Psychotic depression and hallucinations.

The clinical syndromes of depression have been systematically studied at a number of different levels of conceptualization: genetic,¹ biochemical and physiological,² psychoanalytic,^3,4 epidemiologic,^5–7 and phenomenologic.^8,9 Hallucinations have also been intensively investigated at a number of different levels of organization: neurophysiologically,¹⁰ pharmacologically,¹¹ in sensory deprivation,¹² hypnotically,¹³ and phenomenologically.¹⁴ The reports in the literature about the incidence of hallucinations in depression vary from Beck's finding¹⁵ of 13% to Goodwin's report¹⁶ of 82%. The work of other investigators^17,18 shows incidences falling between those of Beck and Goodwin.A significant problem in investigating the depressive disorders has been the difficulty in categorizing different depressive states. Affective disorders have the lowest overall rate of diagnostic consistency.¹⁹ Because of the difficulty with the specific nosologic categories of depression, as well as the fact that previous studies of the incidence of hallucinations have primarily dealt with manic-depressive psychoses, this study will focus on the incidence of hallucinations in individuals who specifically meet the diagnostic criteria, outlined in DSM I,²⁰ of Psychotic Depressive Reaction.¹ Furthermore, the group will be described in terms of sex, age, history of psychiatric care, clinical picture, and follow-up for a 9-year period.     

Psychotic episode secondary to gonadotrophins

Objective

To report a case of a substance-induced psychotic disorder secondary to ovulation induction therapy with gonadotrophins.

Method

Case report.

Results

We report a case of a psychotic episode secondary to gonadotrophins therapy. The acute episode was treated with antipsychotic (Aripiprazole). After 2 years the patient remains free of psychotic symptoms.

Conclusion

There have been several reports correlating low levels of estrogen with psychotic symptoms, leading to studies evaluating the possible effect of this hormone as an antipsychotic. In this case, we report psychotic symptoms with high levels of estradiol, which is contrary to that theory.     

Psychotic features and combat-associated PTSD

Psychotic symptoms and psychotic disorder diagnoses have occasionally been reported in association with chronic posttraumatic stress disorder (PTSD). Although psychotic features may be related to core PTSD symptoms, i.e., part of the reexperiencing phenomena, it is possible that they are secondary to certain comorbid disorders which are also prevalent in this patient population, e.g., major depression or substance abuse. In a prospective study, combat associated PTSD patients (n = 25) were administered clinical ratings, including the Structured Clinical Interview for DSM-III-R with psychotic screen (SCID-P), Clinician Administered PTSD Scale (CAPS) and the Impact of Events Scale (IES). Thirty-six percent (n = 9) endorsed psychotic symptoms with associated comorbidity including: major depressive episode, bipolar disorder, alcohol or polysubstance abuse panic disorder, and phobias. All but one of the patients with psychotic features also met criteria for major depressive episode. None had a primary psychotic disorder diagnosis. There were no significant differences in total CAPS scores between patients with or without psychotic features (82.6 ± 17.6 versus 75.3 ± 22.4, p ns), nor for the different symptom cluster subscales. There were also no differences in the IES scores between groups (34.8 ± 10 versus 32.6 ± 10 p ns). This suggests that these psychotic features may not necessarily reflect severity of PTSD symptoms. PTSD may share a common diathesis with mood disorders including psychotic depression. Further study is needed of these phenomena. Depression and Anxiety 5:34–38, 1997. © 1997 Wiley-Liss, Inc.