Reactive psychosis and mortality

Reactive psychosis is generally thought of as a nosological term of favourable course and outcome. Studies of mortality risk following this psychosis are sparse and inconclusive. This study shows that using mortality as an index of outcome, first-admitted patients with reactive psychosis have as poor an outcome as patients with the endogenous psychoses schizophrenia and manic-depressive psychosis, and thus an excess mortality risk compared with that of the population in general. Reactive depressed patients have even a higher relative mortality risk than endogenous depressed patients. Certain precautions are attached to the use of diagnostic classification of first admissions and especially for reactive psychosis. But as this is a commonly used diagnostic term in Scandinavian psychiatry, the high relative mortality risk is notable. In the search for methods of prevention, the cause of death will be examined in future studies.     

62例旅途性精神病司法鉴定分析

目的探讨旅途性精神病犯罪行为的特点及原因。方法对62例旅途性精神病的卷宗及临床资料进行回顾性分析。结果被鉴定人均系边远地区的务工者,犯罪行为性质以暴力凶杀为主,作案特点多为突然发生,动机不明,无预谋,被害人多为同车旅客或一般路人,与被鉴定人素不相识。作案工具大多为随身携带的劳动工具或即景物件。被鉴定人作案当时均有不同程度的意识障碍、关系妄想、被害妄想和错幻觉。结论旅途性精神病多为暴力犯罪行为,这与其精神病理症状的特点有关,也与该群体所处社会地位有一定关联。     

Cognitive functioning in elderly depressed patients with and without psychosis

Cognitive deficits occurring with major depression in the elderly are well recognized. However, cognitive differences in depressed patients with and without psychotic features have received little attention. Of 14 consecutively referred elderly patients with major depression, the eight patients with psychotic features had significantly more cognitive deficits on neuropsychological tests than the six patients with major depression without psychotic features. The differences in performance IQ were most remarkable, but the differences extended to verbal IQ subtests, word fluency and memory.     

Cause of death in reactive psychosis.

Patients admitted for the first time with reactive psychosis have a greater mortality risk than the general population. This is caused by an increased risk of almost every cause of death, even cancer. However, the suicidal risk is increased considerably and suicide is the most frequent cause of death among men and women. Postpsychotic treatment that includes careful examination for somatic illness is recommended, and it is questioned whether the time has come to resolve reactive psychosis as a diagnostic term.     

A possible association between paternal longevity and major depression among elderly men

Abstract  Ancestral longevity is sometimes thought to contribute to psychosocial well-being in late life. The resent paper aims to examine if parental longevity is associated with mental health among the elderly. The age at death of the parents was compared between 68 patients with major depression who were aged 65 or over and 40 subjects of the same age range without any history of psychiatric disorder. Cox regression revealed that the fathers of the elderly men with unipolar depression died at a significantly younger age than those of the control group. Several hypotheses are advanced to explain this unexpected and intriguing association.     

Multivariate prediction of falls in elderly inpatients

One hundred and forty falls sustained by 65 psychogeriatric inpatients of average age 77.1 were studied in an attempt to identify risk factors. Multivariate analysis revealed increased age, a diagnosis of dementia and use of tricyclic antidepressants to be positively associated with falls when comparison was made to a control group of patients treated on the same unit who did not fall. Use of high-potency neuroleptics was negatively associated with falls in the same analysis. A second analysis failed to reveal any variables, including routine daily measurements of orthostatic change in blood pressure, to be associated with rate of falling within the group of fallers.     

An attempt to operationalize reactive delusional psychosis

Reactive psychosis is a diagnostic concept widely used in Scandinavia but it is still a subject of discussion and controversy internationally. Inside Scandinavia the diagnosis is used according to varying criteria, which is one of the reasons for high diagnostic instability and a threat to the validity and reliability of the concept. This article presents an attempt to operationalize reactive delusional psychosis, to test its clinical utility in a pilot study, and to test the reliability of the individual items. More clinical studies based on operationalization, demarcation of the concept, and interrater reliability are needed to convince psychiatrists outside Scandinavia of the existence of reactive psychosis as a useful nosological concept in patients with good prognosis and who mainly need psychotherapy.     

Psychiatric presentation of intracranial tumour in the elderly

Fourteen patients aged 66–87 years are described, in whom major psychiatric problems dominated the presentation of intracranial tumour. Six had initially been referred to psychogeriatricians and eight to geriatricians. All showed intellectual failure, developing over a few weeks or months, with failure of self-care, and a variety of disturbances of behaviour. Four had undoubted and two possible seizures. Their mental state was described as facile, or slow, with relatively unimpaired memory when it could be tested. Four were inaccessible or mute. Abnormal neurological signs were absent in two, but included unilateral or bilateral hypertonia and hyperreflexia in most; the plantar responses were flexor in seven, equivocal in three, and extensor on one or both sides in four. Computed tomographic (CT) scans shows frontal or bifrontal tumours in 13, and one occipital lobe tumour. The corpus callosum was involved in eight. Ten tumours were considered to be high-grade astrocytomas (proven by biopsy in three and autopsy in one); one patient had bifrontal metastatic tumours, and three had meningiomas, all of them successfully resected. Clinical diagnosis was difficult, but a CT scan is indicated in all patients with a short history of intellectual failure.     

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.     

Predictors of violent victimization amongst those with psychosis

OBJECTIVE: The aim of this study was to establish the prevalence and predictors of violent victimization amongst a community-dwelling sample of individuals with psychosis. METHOD: The 2-year prevalence of self-reported violent victimization was estimated for a sample of 708 individuals with chronic psychosis living in the community in four urban UK centres. Baseline socio-demographic and clinical factors were examined as possible risk factors for victimization over the 2-year follow-up period. RESULTS: The 2-year prevalence of violent victimization in the sample was 23%. Four factors were found to be independently predictive of victimization - history of victimization, less than daily family contact, young age at illness onset and the presence of co-morbid Cluster B personality disorder. CONCLUSION: Those with psychotic illnesses are at elevated risk of being assaulted. Given the likely adverse health implications, clinicians should routinely enquire about victimization in their assessments of those with psychotic disorders particularly amongst those who are socially isolated, with a younger age of illness onset and in those with co-morbid personality disorder.     

Reactive psychosis – A PROSPECTIVE STUDY

A prospective study was carried out on 30 patients suffering from a psychotic episode following a stressful life event. They were found to have an Emotional, Timid, Sensitive, Tense and Insecure personality. Sleep disturbance, Affective symptoms, Histrionic behaviour and Excitement were the common clinical features. Sixty-six per cent were found to be clinically and socially remitted during a 6 months’follow-up. For 20% the diagnosis was revised to Affective Psychosis and for 10% to Schizophrenia.     

A survey of the views of geriatric psychiatrists in the United Kingdom on the use of electroconvulsive therapy to treat physically ill people

BACKGROUND: One of the main concerns about ECT is its use for people with concurrent medical illnesses. Geriatric psychiatrists are more often likely to encounter this situation in working with older age groups. Drawing on the collective experience of all UK geriatric psychiatrists may allow a better understanding of the use of ECT for people with major medical illness. METHODS: A postal questionnaire was used to seek the views of all consultant geriatric psychiatrists in the UK on the use of ECT in the presence of major illness. The questionnaire was developed from previous literature on the subject, a previous pilot study, published guidelines and clinical experience of the authors. RESULTS: Geriatric psychiatrists most often favour bilateral ECT. They are likely to carry out physical examination, chest X-ray, ECG, haemoglobin estimation, urea and electrolytes, thyroid and liver function tests in medically ill people before considering ECT. They are more likely to change their ECT assessment procedures when dealing with medical illness, rather than any other aspect of treatment, and are unlikely to change any aspect of ECT treatment in someone of advanced age. CONCLUSIONS: Geriatric psychiatrists see their roles in relation to ECT as primarily that of assessment, and rely on others to advise on anaesthetic drug use, treatment technique, concurrent drug treatment and post-ECT management. It is important that the ECT consultant and ECT anaesthetist are aware of their role and prepared to offer appropriate advice. The role of the ECT consultant in relation to the responsible medical officer requires clarification.     

Liaison referrals to a department of psychiatry for the elderly 1984–5

Patients referred for liaison consultation to a Department of Psychiatry for the Elderly were studied over 12 months. One hundred and twelve patients were referred by hospital doctors and most of these were seen on consultations within the hospital. These patients had more physical problems than those referred from the community over that period. The absence of a formal psychiatric diagnosis does not mean that psychiatric skills cannot be useful in managing a patient. Many elderly physically ill people present complex problems and the old age psychiatry service can play a valuable role in providing liaison consultations to other departments within the general hospital.     

Paranoid psychosis in the elderly. A follow-up study

Hospital records comprising 106 first admissions of patients aged 60 years or more diagnosed paranoid disorder were studied. Affective psychosis and dementia were excluded. The female/male ratio was 2:1. Symptomatology, treatment and diagnostic classification are presented. Seventy-five per cent revealed persecutory delusions, and nearly half were hallucinated. Almost all patients received neuroleptics. The majority were diagnosed paranoid psychosis or reactive psychosis. After 5-15 years of observation a full remission was seen in 27% according to the judgement of general practitioners as well as hospital records. Delusions such as megalomania and delusions with ideas of sex and jealousy showed a significantly poor outcome. The diagnosis reactive psychosis predicts a course of illness characterized by few relapses.     

Psychometric properties and factor structure of the Neuropsychiatric Inventory Nursing Home version in an elderly neuropsychiatric population

BACKGROUND: The Neuropsychiatric Inventory (NPI) is an interview-based instrument designed to elicit information from an informal caregiver to evaluate behavioral disturbances in persons with dementia. Minor modifications of this instrument have produced the Neuropsychiatric Inventory-Nursing Home version (NPI-NH), a version specifically designed for interviewing professional care facility staff. The purpose of this investigation is to further understand the psychometric properties of the NPI-NH by examining its reliability, validity, and factor structure in an elderly neuropsychiatric population. METHOD: Participants were 204 elderly inpatients from a large provincial neuropsychiatric hospital in British Columbia, Canada. Data were collected as part of a patient needs assessment project. RESULTS: The internal consistency reliability of the NPI-NH was alpha=0.67. An exploratory principal axis analysis with varimax rotation revealed five factors that accounted for 63.2% of the variance. These factors reflect aspects of psychiatric disturbance associated with: (a) Agitation; (b) Mood; (c) Psychosis; (d) Sleep/Motor Activity; and (e) Elevated Behavior. Convergent and discriminant validity of the five factors by correlating them with other behavioral measures was considered satisfactory. CONCLUSIONS: These results provide support for the clinical use of the NPI-NH as a screen for neuropsychiatric symptoms in an elderly neuropsychiatric population. However, additional research is encouraged to further evaluate the clinical utility of the NPI-NH in nursing home and inpatient geriatric settings.