Hearing impairment and psychosis revisited

The previously reported but still poorly investigated link between deafness or hearing impairment (DHI) and the onset of positive psychotic experiences was investigated prospectively in a general population sample. Of the 109 DHI subjects at baseline, 11 (10.1%) displayed psychotic experiences at T(2) versus 137 (2.9%) of the non-DHI subjects (OR=3.8, 95% CI: 2.0, 7.2). This effect size was only slightly attenuated after adjustment for baseline psychotic experiences (OR=3.2, 95% CI: 1.6, 6.5) and after adjustment for T(0) psychotic experiences and a range of other confounders (OR=3.0, 95% CI: 1.4, 6.2) These results confirm previous findings of an association between hearing impairments and psychosis and show that this association can also be found prospectively in a nonclinical population.     

Neuropsychological impairment and psychosis in mania

Deficits involving executive function, working memory, speed of information processing, and new learning occur in many people with mania. Factors that predict impairment remain poorly understood, but there are indications that psychotic features may correspond with increased risk of neurocognitive dysfunction during manic episodes. The current study examined neuropsychological function in 40 inpatients with bipolar I mania, 24 of whom presented with psychotic features. Compared to a control group, the inpatients showed worse executive function, speed of information processing, new learning, and dexterity. Nonetheless, presence of psychotic features failed to distinguish the inpatients with mania. Thus, psychotic features do not appear to increase neurobehavioral morbidity in people with mania, but presence of mania clearly corresponded with neurobehavioral dysfunction. Implications of these data for clinical practice and our understanding of bipolar disorder are discussed.     

Neuropsychological impairment and its neurological correlates in adult offspring with heightened risk for schizophrenia and affective psychosis

OBJECTIVE: Schizophrenia is generally considered to be a neurodevelopmental disorder reflected in findings of neuropsychological impairments and neurological abnormality in patients and their relatives. The authors investigated whether neuropsychological impairments are related to neurological abnormality and whether such deficits also characterize risk for affective psychosis. METHOD: In a longitudinal study with a 93% rate of effective follow-up, the authors investigated neuropsychological impairment and its relation to neurological abnormality at a mean age of 22.3 years in 74 offspring of mothers with a history of psychotic disorders (38 offspring with heightened risk for schizophrenia and 36 with risk for affective psychosis) and 88 normal-risk offspring born to mothers with no history of psychosis. RESULTS: Offspring with genetically heightened risk for schizophrenia showed significantly impaired verbal memory, selective attention, and grammatical reasoning, compared with normal-risk offspring. Having impaired verbal memory, attention, and grammatical reasoning functions identified a significantly larger subgroup (16%) among offspring with heightened risk for schizophrenia than among offspring with heightened risk for affective psychosis (0%) and among normal-risk offspring (3%). Multiple neuropsychological functions were significantly related to neurological abnormality in offspring with heightened risk for schizophrenia and in normal-risk offspring but not among offspring with heightened risk for affective psychosis. The extension of schizophrenia and affective psychosis risk groups to include additional offspring of mothers with psychosis-spectrum disorders yielded results similar to those for the core risk groups. CONCLUSIONS: The neurocognitive dysfunction attending heightened risk for schizophrenia is likely based on genetically mediated neurodevelopmental factors, with schizophrenia and affective psychosis belonging to different biological spheres.     

Intellectual impairment in adolescent psychosis. A controlled psychometric study

The relationship of cognitive impairment to the course of schizophrenia remains uncertain. By studying psychotic adolescents, 90% of whom were hospitalized for the first time, we hoped to reduce the influence of such confounding variables as lengthy disease process, neuroleptic treatment, and institutionalization. 39 psychotic adolescent subjects who fulfilled DSM-III criteria for schizophrenia, schizophreniform psychosis, paranoid schizophrenia, or atypical psychosis were compared to 41 non-psychotic adolescent psychiatric controls. Subjects were administered the Wechsler Intelligence Scale for Children-Revised, Peabody Individual Achievement tests of reading, reading comprehension, and mathematics, Bender-Gestalt, and Purdue Pegboard test within 3 weeks of admission to a psychiatric hospital. Performance IQ was significantly lower in the psychotic group (72 versus 93, P = 0.03). Thus, the IQ pattern in adolescent psychotic patients at an early stage in their illness was similar to the pattern displayed by chronic adult schizophrenic patients. Results were not consistent with theories of left hemisphere involvement in schizophrenia. Academic achievement was similar in both groups despite marked differences in performance IQ. Psychotropic medication had no significant impact on the results. In summary, deficits in processing novel material seem at the very least to be present at the onset of the psychotic disorder, though they may be non-progressive thereafter.     

Paranoid psychosis and cognitive impairment associated with hepatitis C antiviral therapy

Objective

To report a case of paranoid psychosis and cognitive impairment associated with Hepatitis C virus (HCV) antiviral therapy.

Methods

Case report.

Results

A 55-year-old male presented with paranoid psychosis and cognitive impairment, 4 months after initiating interferon-based HCV antiviral therapy. His psychosis resolved with discontinuation of therapy and initiation of risperidone, but his cognitive impairment persisted. His psychosis also re-emerged months later when attempting to titrate down his risperidone. Brain MRI demonstrated bilateral asymmetric subcortical and deep white matter changes, which were non-specific but may have rendered him susceptible to neuropsychiatric sequelae of antiviral therapy.

Conclusion

This case emphasizes the importance of neuropsychiatric screening and monitoring of patients being treated with interferon-based therapy for HCV, particularly if there is evidence of previous neurologic disease.     

Korsakoff's psychosis: noradrenergic systems and cognitive impairment

Recent studies of patients with Korsakoff's amnesia suggest that central noradrenergic (NE) activity is diminished by the brainstem and diencephalic lesions associated with this disease. Similarly, there is a body of evidence that experimental manipulations of central NE activity affect the ability of animals to learn and remember some conditioned behaviors. The relationship between brain NE activity and human amnesia is underscored by evidence of comparable behavioral deficits in animals with NE depleting lesions and in humans with Korsakoff's psychosis. We argue that diminished NE activity impairs cognitive activation and that this limits processes related to attention and to the information processing capacity of patients with Korsakoff's psychosis.     

The relationship of excess cognitive impairment in MCI and early Alzheimer's disease to the subsequent emergence of psychosis

BACKGROUND: Psychotic symptoms in Alzheimer disease (AD + P) identify a heritable phenotype associated with greater cognitive impairment. Knowing when the cognitive course of AD + P subjects diverges from that of subjects without psychosis would enhance understanding of how genetic variation results in AD + P and its associated cognitive burden. This study seeks to determine whether the degree of cognitive impairment and cognitive decline in early AD predicts subsequent AD + P onset. METHODS: 361 subjects with possible or probable AD or mild cognitive impairment (MCI) without psychosis were evaluated every 6 months until psychosis onset. RESULTS: Severity of cognitive dysfunction was a strong predictor of AD + P up to two years prior to psychosis onset. Cognition did not decline more rapidly prior to onset of AD + P. CONCLUSIONS: Individuals who will develop AD + P already demonstrate excess cognitive impairment during the mild stages of disease. Genetic variation and brain pathophysiology may lead to a cognitive risk phenotype which is present prior to dementia onset.     

Amphetamine psychosis and schizophrenia: A dual model

Several of the behavioral consequences of acute and chronic amphetamine treatment were evaluated and related to the underlying neurochemical correlates of drug treatment. It was suggested that decreased noradrenergic activity after long-term amphetamine treatment influences stimulus sampling, whereas enhanced dopaminergic activity is responsible for the progressive augmentation of stereotypy and self-stimulation behavior observed after long-term exposure to amphetamine. It was hypothesized that amphetamine-induced psychosis and the symptomatology associated with schizophrenia are related to alterations in both norepinephrine and dopamine activity.     

帕金森病伴发认知功能障碍患者的临床特点及其与睡眠障碍的关系

目的 探讨帕金森病（PD）伴发认知功能障碍（CI）患者的临床特点及睡眠情况。方法 连 续纳入2014 年5 月—2017 年5 月就诊于北京天坛医院的394 例PD患者，按照CI程度将患者分为PD不 伴认知功能障碍（PD-NCI）组（94 例，23.86%）、PD 伴发轻度认知功能障碍（PD-MCI）组（177 例，44.92%） 及PD 伴发痴呆（PDD）组（123 例，31.22%）。收集患者的人口学资料，采用蒙特利尔认知评估（MoCA）量 表评价患者的认知功能，比较3 组患者总体认知功能及各认知领域情况；采用视频多导睡眠图（v-PSG） 评估患者的睡眠状况，并对PD 伴发CI 患者的MoCA 量表总分及各认知领域评分与v-PSG 结果进行相 关性分析。结果 3 组患者性别、起病年龄、受教育水平及病程差异均无统计学意义（P ＞ 0.05）。PDNCI 组、PD-MCI 组和PDD 组MoCA 量表总分依次明显降低，分别为（22.20±4.99）分、（17.17±4.36）分和 （10.73±4.85）分（F=143.146，P＜ 0.01），且MoCA 量表各认知领域评分依次明显降低（P ＜ 0.01）。与PDNCI 组比较，PD-MCI 组总睡眠时间减少，睡眠效率降低，觉醒次数增加（均P＜ 0.05）；与PD-MCI 组比较， PDD 组总睡眠时间减少，睡眠效率降低，觉醒次数增加（均P＜ 0.05）。PD 伴发CI 的患者的睡眠效率与 MoCA 量表总分及视空间功能、执行功能、延迟回忆和注意力评分均呈正相关（P＜ 0.05），觉醒次数与 MoCA 量表总分及延迟回忆和注意力评分均呈负相关（P ＜ 0.05）。结论 PD患者CI发生率较高，伴发 CI 的PD 患者总体认知功能及各认知领域均明显受损，总体睡眠时间减少，睡眠效率降低，觉醒次数增 加，并与总体认知功能及部分认知领域受损有关。     

Amphetamine psychosis and schizophrenia: A dual model

Several of the behavioral consequences of acute and chronic amphetamine treatment were evaluated and related to the underlying neurochemical correlates of drug treatment. It was suggested that decreased noradrenergic activity after long-term amphetamine treatment influences stimulus sampling, whereas enhanced dopaminergic activity is responsible for the progressive augmentation of stereotypy and self-stimulation behavior observed after long-term exposure to amphetamine. It was hypothesized that amphetamine-induced psychosis and the symptomatology associated with schizophrenia are related to alterations in both norepinephrine and dopamine activity.     

Increased risk of psychosis in patients with hearing impairment: Review and meta-analyses

Several studies suggest hearing impairment as a risk factor for psychosis. Hearing impairment is highly prevalent and potentially reversible, as it can be easily diagnosed and sometimes improved. Insight in the association between hearing impairment and psychosis can therefore contribute to prevention of psychosis. This paper provides meta-analyses of all epidemiologic evidence on the association between hearing impairment and psychosis and summarizes mechanisms that potentially underlie this relationship.Meta-analyses showed an increased risk of hearing impairment on all psychosis outcomes, such as hallucinations (OR 1.40(95%CI 1.18–1.65; n = 227,005)), delusions (OR 1.55(95%CI 1.36–1.78; n = 250,470)), psychotic symptoms (OR 2.23(95%CI 1.83–2.72; n = 229,647) and delirium (OR 2.67(95%CI 2.05–3.48; n = 12,432). Early exposure to hearing impairment elevated the risk of later development of schizophrenia (OR 3.15(95%CI 1.25–7.95; n = 50,490)).Potential mechanisms underlying this association include loneliness, diminished theory of mind, disturbances of source monitoring and top-down processing and deafferentiation. Early assessment and treatment of hearing impairment in patients with (high risk of) psychosis may be essential in psychosis treatment and prevention.     

A case of Turner syndrome with schizophrenia: Genetic relationship between Turner syndrome and psychosis

Abstract An 82-year-old woman with Turner syndrome and schizophrenia, and her 46-year-old daughter with schizophrenia are described. 45X/46XX chromosomal mosaicism was identified in the peripheral leukocytes of the mother, who showed several Turner dysmorphisms and cavum septi pellucidum in the brain. She had a normal reproductive life-span. The daughter resembled the mother in terms of schizophrenic symptoms, but she did not show any signs of Turner dysmorphism or chromosomal abnormality. The phenotype-karyotype relationship of Turner syndrome and the genetic relationship with psychosis are discussed.     

Smoking status and its relationship to demographic and clinical characteristics in first episode psychosis

Elevated rates of cigarette smoking are observed prior to the onset of psychosis and remain stable early in the illness. Cannabis use frequently co-occurs with cigarette smoking and is independently associated with distinct clinical outcomes. However, past research has not controlled for cannabis use in cigarette smokers with first episode psychosis (FEP), limiting conclusions on the unique relationship of cigarette smoking to the demographic and clinical profiles of these patients. The present study therefore aimed to: (1) Determine the prevalence and patterns of cigarette smoking and its co-use with cannabis in FEP, and (2) Examine the demographic, clinical, cognitive, and functional characteristics associated with cigarette smoking status, after adjusting for frequency of cannabis use. Patients entering specialized treatment for FEP (N = 140) were divided into groups according to their current smoking status: 66 non-smokers (0 cigarettes/day), 47 light/moderate smokers (1–19 cigarettes/day; M = 9.81, SD = 3.93), and 27 heavy smokers (≥20 cigarettes/day; M = 26.39, SD = 6.31). The prevalence of cigarette smoking was 53% and smoking status was highly associated with frequency of cannabis use. After adjusting for cannabis use, significant between-group differences emerged. Heavy smokers were older at program entry and had a later age of onset of psychosis than light/moderate and non-smokers. Non-smokers had more education, better neurocognitive performance, and higher levels of functioning than light/moderate and heavy smokers. Prospective, longitudinal studies are needed to better understand the clinical significance of tobacco use and factors that contribute to the initiation and continuation of smoking behaviours in FEP.     

The relationship between family resiliency factors and caregiver-perceived duration of untreated psychosis in persons with first-episode psychosis

Although the family has an important role in the early detection and intervention of first-episode psychosis (FEP), there are few findings reporting associations between family strengths and early treatment-seeking experiences. This study aimed to investigate, within the framework of the resiliency model of family stress, adjustment, and adaptation, the association between family coping strategies, resource management factors and duration of untreated psychosis (DUP) in Iranian families with one adult child with FEP. Hundred and seven individuals referred to three medical centers in Tehran and diagnosed with FEP participated in this study. Caregiver-perceived DUP was measured via semi-structured interviews administered to primary caregivers. They also completed two questionnaires regarding family resources of stress management and family coping strategies. Data analysis indicated that the Family Inventory of Resources of Management (FIRM) total scale score did not significantly explain the variance of caregiver-perceived DUP, but one of the FIRM subscales, the Extended Family Social Support, and the Family Crisis-Oriented Personal Evaluation scale (F-COPES) total score and one its subscales, the Acquiring Social Support, explained a significant amount of the variance of caregiver-perceived DUP. The results suggest that higher family resiliency, especially social support, facilitates the family?s appropriate adaptive reaction (i.e., treatment-seeking), with the consequent decrease of DUP.     

分裂样精神病的遗传方式探讨

目的　探讨分裂样精神病的遗传方式。方法　采用分离分析方法和多基因阈值理论对 87例分裂样精神病家系进行遗传方式的探讨。结果　分裂样精神病的遗传方式分别符合常染色体隐性遗传或多基因遗传。结论　提示分裂样精神病可能存在着不同的遗传基础。