scholarly journals Reappraising insight in psychosis

2000 ◽  
Vol 177 (3) ◽  
pp. 233-240 ◽  
Author(s):  
Manuel J. Cuesta ◽  
Victor Peralta ◽  
Amalia Zarzuela
Keyword(s):  
Affective Disorder ◽  
Schizoaffective Disorder ◽  
Predictive Value ◽  
Acute Episode ◽  
Psychotic Symptoms ◽  
Significant Relationships ◽  
Insight Into ◽  
Over Time

BackgroundMany patients suffering from psychosis are unaware of their disorder and symptoms.AimsTo investigate whether insight changes with time, and how it relates to patients' psychopathology, and to examine the correlations between insight scales in patients with psychoses.MethodSeventy-five consecutively admitted in-patients with schizophrenia, affective disorder with psychotic symptoms, or schizoaffective disorder were examined after remission of an acute episode and at follow-up (>6 months). Three different scales were used to assess insight.ResultsTo some extent, insight into past episodes improved over time in patients with psychosis, regardless of diagnosis. Few significant relationships between insight and psychopathology remained stable at follow-up. The higher the negative and disorganisation dimensions at baseline, the less did attitudes to treatment vary when tested at follow-up. No predictive value for variability of psychopathological dimensions was found for insight dimensions. The insight scales used were highly intercorrelated, suggesting that they measure the same construct.ConclusionsInsight and psychopathology seem to be semi-independent domains.

Course and symptom and functional correlates of passivity symptoms in schizophrenia: an 18-year multi-follow-up longitudinal study

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Ellen S. Herbener ◽  
Martin Harrow
Keyword(s):  
Longitudinal Study ◽  
Schizoaffective Disorder ◽  
Similar Rate ◽  
Psychotic Symptoms ◽  
Work Functioning ◽  
Index Hospitalization ◽  
Persecutory Delusions ◽  
Work Impairment ◽  
Time Information

Abstract Background Change in the experience of oneself may lay the groundwork for the development of additional hallucinations and delusions in individuals with schizophrenia. However, to date, the course and symptom and functioning correlates of passivity symptoms (cf. thought insertion, thought withdrawal) have not been measured consistently over long periods of time. Information on the course and correlates of passivity symptoms is essential for developing models of their contribution to schizophrenic illness. Method Eighty-two individuals diagnosed with schizophrenia or schizoaffective disorder were recruited at an index hospitalization and reassessed at three or more follow-ups over the following 18 years. Results The results indicate that a small group of participants report passivity symptoms at all follow-ups, many reported passivity symptoms at some follow-ups, and the majority of individuals never reported passivity symptoms. The prevalence of passivity symptoms was similar to that for delusions of reference and persecutory delusions. Notably, when individuals did experience passivity symptoms, they also had a greater number of additional psychotic symptoms than individuals without passivity symptoms. Further, the presence of passivity symptoms was associated with work impairment at some assessments. Conclusions Passivity symptoms present episodically, at a similar rate as delusions of reference and persecutory delusions, and when present, they are associated with having a higher number of additional psychotic symptoms, as well as having some impact on work functioning. These results suggest that passivity symptoms may increase vulnerability to additional psychotic symptoms and greater work impairment.

scholarly journals Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion

2016 ◽  
Vol 26 (3) ◽  
pp. 287-298 ◽  
Author(s):  
T. H. Zhang ◽  
H. J. Li ◽  
K. A. Woodberry ◽  
L. H. Xu ◽  
Y. Y. Tang ◽  
...  
Keyword(s):  
High Risk ◽  
Symptom Onset ◽  
Help Seeking ◽  
Cox Regression ◽  
Clinical Population ◽  
Psychotic Symptoms ◽  
Clinical High Risk ◽  
Chinese Sample ◽  
Over Time

Background.Chinese psychiatrists have gradually started to focus on those who are deemed to be at ‘clinical high-risk (CHR)’ for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China.Method.The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan–Meier) methods along with Log-rank tests were performed to illustrate the relationship of baseline data to either conversion or non-conversion over time. Cox regression was performed to identify baseline predictors of conversion by the 2-year follow-up.Results.In total 25 (29.1%) of 86 completers transitioned to a psychotic disorder over the course of follow-up. Among the CHR sample, the mean time between attenuated symptom onset and professional help-seeking was about 4 months on average, and converters developed fully psychotic symptoms about 12 months after symptom onset. Compared with those CHR participants whose risk syndromes remitted over the course of the study, converters had significantly longer delays (p = 0.029) for their first visit to a professional in search of help. At baseline assessment, the conversion subgroup was younger, had poorer functioning, higher total SIPS positive symptom scores, longer duration of untreated prodromal symptoms, and were more often given psychosis-related diagnoses and subsequently prescribed antipsychotics in the clinic.Conclusions.Chinese CHR identified primarily by a novel clinical screening approach had a 2-year transition rate comparable with those of specialised help-seeking samples world-wide. Early clinical intervention with this functionally deteriorating clinical population who are suffering from attenuated psychotic symptoms, is a next step in applying the CHR construct in China.

Misattributing speech and jumping to conclusions: A longitudinal study in people at high risk of psychosis

2015 ◽  
Vol 30 (1) ◽  
pp. 32-37 ◽  
Author(s):  
T.T. Winton-Brown ◽  
M.R. Broome ◽  
P. Allen ◽  
I. Valli ◽  
O. Howes ◽  
...  
Keyword(s):  
Psychotic Disorder ◽  
Symptom Severity ◽  
Cognitive Biases ◽  
Psychotic Symptoms ◽  
Self Monitoring ◽  
Level Of Functioning ◽  
Jumping To Conclusions ◽  
Over Time ◽  
At Risk Mental State

AbstractBiases in cognition such as Jumping to Conclusions (JTC) and Verbal Self-Monitoring (VSM) are thought to underlie the formation of psychotic symptoms. This prospective study in people with an At Risk Mental State (ARMS) for psychosis examined how these cognitive biases changed over time, and predicted clinical and functional outcomes. Twenty-three participants were assessed at clinical presentation and a mean of 31 months later. Performance on a JTC and VSM tasks were measured at both time points. Relationships to symptom severity, level of function and the incidence of psychotic disorder were then examined. The levels of symptoms, function and VSM all improved over time, while JTC was stable. Five participants (22%) developed a psychotic disorder during the follow-up period, but the risk of transition was not related to performance on either task at baseline, or to longitudinal changes in task performance. JTC performance correlated with symptom severity at baseline and follow-up. Similarly, performance on the two tasks was not related to the level of functioning at follow-up. Thus, while the ARMS is associated with both VSM and JTC biases, neither predict the onset of psychosis or the overall functional outcome.

scholarly journals Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

2019 ◽  
Vol 50 (6) ◽  
pp. 991-1001 ◽  
Author(s):  
Olesya Ajnakina ◽  
Brendon Stubbs ◽  
Emma Francis ◽  
Fiona Gaughran ◽  
Anthony S. David ◽  
...  
Keyword(s):  
Systematic Review ◽  
Longitudinal Studies ◽  
Meta Analysis ◽  
First Episode Psychosis ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Hospitalised Patients ◽  
Episode Psychosis ◽  
Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

scholarly journals Monitoring Communication Development Between Teachers and Their Students With Congenital Deafblindness: An Application of the Layered Communication Model

2020 ◽  
Vol 5 ◽  
Author(s):  
Kirsten Wolthuis ◽  
Gerard W. Bol ◽  
Alexander Minnaert ◽  
Marleen J. Janssen
Keyword(s):  
Communication Model ◽  
Baseline Phase ◽  
Communicative Behaviors ◽  
Communication Development ◽  
Primary Layer ◽  
Communication Layer ◽  
Insight Into ◽  
Partial Interval ◽  
Over Time

The Layered Communication Model (LCM) consists of three layers of intersubjective development divided into different communicative behaviors per layer. Earlier research showed that the LCM can be used to describe the communication level between teachers and their students with congenital deafblindness (CDB). This study analyzed whether the LCM can also be used to monitor the development of LCM behaviors over time. Videos of eight student-teacher dyads recorded at the start of this study (baseline phase) and 5 months later (follow-up phase) were coded using 10-s partial interval coding. The presence of the communicative behaviors at the three layers of the LCM during baseline and follow-up were calculated and compared between dyads and phases. The results on the presence of LCM behaviors were in line with earlier research. The presence of primary layer behaviors was comparable between dyads, confirming that this is a basic communication layer. The differences found between dyads in the presence of secondary and tertiary layer behaviors shows that these can be used to determine a dyad's communicative level. Results also showed that the LCM can be used to monitor communication development. Small increases were found in the presence of LCM behaviors between baseline and follow-up for the primary layer behaviors, but larger increases were found for secondary and tertiary layer behaviors, showing that development can be monitored. In conclusion, this study again showed that the LCM can be used to describe a dyad's communicative level. We also found increases in the presence of certain behaviors between baseline and follow-up for all dyads, which shows that the LCM can also be used to monitor communication over time. More insight into the period between the analyzed phases is suggested to analyze what might have caused the increase in presence of behaviors. This would reveal more about the use of the LCM as a tool to improve communication development.

scholarly journals Optimum timing to assess ablation lesions with Late Gadolinium Enhancement MRl

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
TF Althoff ◽  
P Garre ◽  
G Caixal ◽  
S Prat ◽  
J Perea ◽  
...  
Keyword(s):  
Late Gadolinium Enhancement ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Individual Development ◽  
Atrial Fibrosis ◽  
Gadolinium Enhancement ◽  
Time Points ◽  
Fibrotic Tissue ◽  
Over Time

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III, Spanish Government, Madrid, Spain [FIS_PI16/00435 Background Late gadolinium enhancement MRI (LGE-MRI) is increasingly used to detect native as well as ablation-induced atrial fibrosis in the context of atrial fibrillation (AF). However, cardiac fibrotic tissue including ablation lesions is subject to sustained remodeling, and neither the development of ablation-induced fibrosis over time nor the capability of LGE-MRI to detect it at different stages of scar formation have been defined. We sought to define the long-term development of ablation-induced atrial fibrosis and to validate LGE-MRI for the assessment of ablation lesions at different time points. Methods Patients with first-time AF ablation and an early follow-up LGE-MRI (3 months post ablation) and a late follow-up LGE-MRI (>12 months post ablation) were included. LGE-MRI data were postprocessed for quantification of fibrotic tissue using the ADAS 3D software. In the majority of patients high-density electroanatomical mapping (EAM), performed in a repeat procedure served as a reference. Results 22 consecutive patients fulfilling the inclusion criteria were analysed retrospectively. In the LGE-MRI 3 months post ablation an average of 91.7 ± 7.0% of the ablation lines" circumference displayed late gadolinium enhancement (LGE) reflecting ablation-induced fibrosis, whereas in the late follow-up LGE-MRI, at a median of 28 months post ablation, only 62.8 ± 25.0% of the ablation lines" circumference was covered by LGE (p < 0.0001) (see figure for representative examples and individual development of LGE coverage over time). This decrease of LGE coverage of the ablation lines was also reflected by an increase in the median number of LGE-MRI-predicted gaps per circumferential ablation line from 4 (3 months) to 10 (28 months). These data may suggest a decrease of ablation-induced fibrosis over time. However, EAM subsequent to the late follow-up LGE-MRI, which was performed in 18 of the 22 patients, indicates that it was not ablation-induced fibrosis that decreased over time, but rather the capability of LGE-MRI to detect it. In 95% of the pulmonary vein segments in which the late follow-up LGE-MRI (28 months) indicated a disappearance of local ablation-induced fibrosis, EAM demonstrated durable lesions consistent with the 3-months LGE-MRI. In line with this observation, the overall agreement of EAM at the repeat procedures with the 3-months LGE-MRI regarding the prediction of ablation-induced fibrosis and functional gaps was good (K  0.74;  p< 0.0001,  positive  predictive  value 93%), whereas the agreement with the LGE-MRI at 28-months was only weak (K 0.29; p < 0.0001, positive predictive value 63%). Conclusions Our results indicate that while ablation-induced atrial fibrosis appears to remain rather constant over time, LGE-MRI loses some of its capability to detect it. Thus, LGE-MRI 3 months post ablation may be more accurate in the detection of durable ablation lesions than LGE-MRI at later time points more than 12 months after ablation. Abstract Figure

scholarly journals Alternating Gender: Individuals Who Frequently Switch Between Feeling Male and Female

2019 ◽  
Author(s):  
Laura Case ◽  
Tracy Alderman ◽  
Radhika Gosavi ◽  
Vilayanur S Ramachandran
Keyword(s):  
Gender Identity ◽  
Cognitive Neuroscience ◽  
Psychological Assessment ◽  
Online Survey ◽  
Self Report ◽  
Male And Female ◽  
Psychological Correlates ◽  
Insight Into ◽  
Over Time

We characterize a small minority of individuals who self-report frequent, involuntary alternation in their gender identity (Alternating Gender; AG) in an attempt to glean insight into gender identity from a cognitive neuroscience perspective. We conducted an online survey of 73 AG individuals (44 male natal sex), with follow-up phone interviews and psychological assessment of 20 participants. Our results suggest that AG may be a previously uncharacterized gender phenomenon not explained by existing psychological diagnoses or commonly recognized gender identities. Further research on AG may yield novel insight into the neural and psychological correlates of gender identity by allowing the study of gender variation within individuals over time.

scholarly journals Feigned psychosis revisited –a 20 year follow up of 10 patients

1996 ◽  
Vol 20 (11) ◽  
pp. 666-669 ◽  
Author(s):  
Martin Humphreys ◽  
Alan Ogilvie
Keyword(s):  
Case Note ◽  
Psychotic Symptoms ◽  
Psychotic Illness ◽  
Retrospective Case ◽  
Long Term Follow Up ◽  
Initial Episode ◽  
Changes Over Time ◽  
Over Time

Feigned psychosis, although rare, presents considerable diagnostic problems in clinical psychiatric practice. Long-term follow up data are lacking. A retrospective case note study was undertaken of 10 patients described in a previous paper, published in 1970, on the simulation of psychosis. The computerised diagnostic instrument OPCRIT was applied to both index episode and lifetime occurrence of symptoms. All 10 patients were found to have had a major psychotic illness based on lifetime symptoms at 20 year follow-up by DSM–III–R criteria. Eight had met such criteria at the time of the initial episode. Diagnosis in patients thought to be feigning psychotic symptoms changes over time and major mental illness is likely to emerge which may be schizophrenic or affective. The term feigned psychosis should be abandoned and more attention given to why symptoms are accepted as genuine in some cases but not others.

scholarly journals M27. FUNCTIONAL OUTCOME OF CHILDREN AND ADOLESCENTS WITH ATTENUATED PSYCHOTIC SYMPTOMS: RESULTS FROM A LONGITUDINAL STUDY

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Silvia Molteni ◽  
Eleonora Filosi ◽  
Martina Maria Mensi ◽  
Giulia Spada ◽  
Elena Ballante ◽  
...  
Keyword(s):  
At Risk ◽  
Children And Adolescents ◽  
Functional Outcome ◽  
Treatment Plan ◽  
Psychotic Symptoms ◽  
Average Score ◽  
Occupational Functioning ◽  
Significant Impairment ◽  
Over Time

Abstract Background Assessing longitudinal functional outcomes, besides the risk of transition, seems important in underage population given the concerns about the use of at-risk criteria in this age range. Indeed, it has been highlighted that attenuated psychotic symptoms appear to be more common and transient than in adults and could, more often, represent normative experiences (Bartels-Velthuis et al. 2016; Schimmelmann et al. 2013). Thus, in this longitudinal cohort study, we aimed to evaluate socio-occupational functioning at follow-ups in children and adolescents with attenuated psychotic symptoms (APS) and to investigate potential clinical predictors of the functional outcome. Methods Help-seeking adolescents (aged 12–18 years) consecutively admitted to Child and Adolescent Neuropsychiatric inpatient and outpatient units of the IRCCS Mondino Foundation (Pavia, Italy) were recruited. The Comprehensive Assessment of At-Risk Mental State (CAARMS) was used in order to evaluate the presence of attenuated psychotic symptoms. The final sample consisted of 31adolescents suffering from early onset psychosis (EOP), 110 APS and 102 adolescents with psychiatric disorders other than APS and EOP (non-APS). At baseline patients underwent an extensive clinical and, in a subset, also neuropsychological assessment using standardized semi-structured interviews and instruments. All APS patients recruited until March 2019 were followed up for a median period of 33 months (range 4–81 months) and baseline measures were repeated (every 12 months). The level of functioning was defined through the Social and Occupational Functioning Assessment Scale (SOFAS). Results At 12 months and last visit follow-ups APS patients overall continued to display a significant impairment in socio-occupational functioning that persisted over time (baseline SOFAS average score 47.3±9.6, average 12-months follow-up 51.7±13.7, average last-visit follow-up SOFAS 51.6±11.5). Also APS adolescents that did not develop psychosis continued to display a significant impairment in socio-occupational functioning that persisted over time. Besides conversion status (p=0.04), a higher SOFAS (p=0.0026) and better social functioning (p=0.016) and total IQ (p=0.02) at baseline and not having a baseline diagnosis of anxiety disorders (generalized anxiety disorder, p=0.005 and panic disorder, p=0.003) significantly predicted socio-occupational functioning at follow-up. Discussion In line with previous literature in adults, besides the risk of transitioning, at follow-ups APS adolescents overall continued to display a significant impairment in socio-occupational functioning that persisted over time. These data further show that APS adolescents are truly in need of care and underscore the need, also and especially in adolescents, not to focus only on transition risk, as APS adolescents appear to be both at risk of conversion to psychosis but also of functional disability persistent over time. Thus, preventive interventions should not only target emerging psychosis, but also improving APS social and global functional impairment that already at baseline seems to be linked with such a disabling outcome. In APS children and adolescents a multidimensional treatment plan including careful monitoring not only for a potential progression but also psychological interventions aiming at improving functioning is strongly recommended

Revised European Scleroderma Trials and Research Group Activity Index is the best predictor of short-term severity accrual

2019 ◽  
Vol 78 (12) ◽  
pp. 1681-1685 ◽  
Author(s):  
Serena Fasano ◽  
Antonella Riccardi ◽  
Valentina Messiniti ◽  
Paola Caramaschi ◽  
Edoardo Rosato ◽  
...  
Keyword(s):  
Disease Progression ◽  
Research Group ◽  
Predictive Value ◽  
Activity Index ◽  
Group Activity ◽  
Short Term ◽  
Adjusted Means ◽  
Over Time ◽  
Better Than

BackgroundThe European Scleroderma Trials and Research Group (EUSTAR) recently developed a preliminarily revised activity index (AI) that performed better than the European Scleroderma Study Group Activity Index (EScSG-AI) in systemic sclerosis (SSc).ObjectiveTo assess the predictive value for short-term disease severity accrual of the EUSTAR-AI, as compared with those of the EScSG-AI and of known adverse prognostic factors.MethodsPatients with SSc from the EUSTAR database with a disease duration from the onset of the first non-Raynaud sign/symptom ≤5 years and a baseline visit between 2003 and 2014 were first extracted. To capture the disease activity variations over time, EUSTAR-AI and EScSG-AI adjusted means were calculated. The primary outcome was disease progression defined as a Δ≥1 in the Medsger’s severity score and in distinct items at the 2-year follow-up visit. Logistic regression analysis was carried out to identify predictive factors.Results549 patients were enrolled. At multivariate analysis, the EUSTAR-AI adjusted mean was the only predictor of any severity accrual and of that of lung and heart, skin and peripheral vascular disease over 2 years.ConclusionThe adjusted mean EUSTAR-AI has the best predictive value for disease progression and development of severe organ involvement over time in SSc.

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