scholarly journals Predicting engagement with services for psychosis: insight, symptoms and recovery style

2003 ◽  
Vol 182 (2) ◽  
pp. 123-128 ◽  
Author(s):  
Lynda Tait ◽  
Max Birchwood ◽  
Peter Trower
Keyword(s):  
Psychological Adjustment ◽  
Treatment Engagement ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Short Term ◽  
Service Engagement ◽  
Clear Shift ◽  
Engagement With Services

BackgroundTreatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.AimsWe examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.MethodFifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.ResultsSealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.ConclusionsRecovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.

Neuropsychiatric Symptoms and Antipsychotic Therapy in the Elderly Patients with Dementia

Psychiatry ◽  
2020 ◽  
Vol 18 (4) ◽  
pp. 6-15
Author(s):  
I. V. Kolykhalov
Keyword(s):  
Neuropsychiatric Symptoms ◽  
The Elderly ◽  
Psychotic Symptoms ◽  
Mixed Dementia ◽  
Short Term ◽  
Antipsychotic Therapy ◽  
Dementia Patients ◽  
Frequency Of Use ◽  
Number Of Patients ◽  
High Incidence

The objective of the study was to investigate syndromal-nosological specificities of neuropsychiatric symptoms (NPS) and the frequency of use of antipsychotics in patients with various types of dementias, institutionalized to geriatric units of mental hospitals.Patients and methods: a total of 106 in-patients of three psychogeriatric units were examined. The median age of patients is 75 years [69; 80].The diagnostic distribution of patients at the time of the examination was as follows: in 33 subjects (31.1%) Alzheimer’s disease (AD) was diagnosed, in 25 (23.6%) - mixed dementia (MD), in 32 (30.2%) - vascular dementia (VD) and in 16 (15.1%) patients had dementia of complex origin (DCO).Results: a high incidence (54.7%) of NPS was found in patients with dementia of various origins. The greatest number of patients with behavioral and psychotic symptoms was found in AD and MD. The proportion of dementia patients with such disorders in each of these types of dementia is about 70%, while in CGD and VD, the proportion of patients with NPS is noticeably smaller (30% and 40%, respectively). For the treatment of NPS, antipsychotics were most often prescribed, but their use caused adverse events (AEs) in 1/3 of cases. Patients with VD are most susceptible to the development of AE, and AD patients are the least susceptible.Conclusion: the study showed that NPS are one of the important components of dementia, regardless of the nosology and stage of the disease. The treatment of NPS in dementia is particularly challenging because, although the symptoms cause significant distress, there are currently no effective alternative therapies. The risk of AE can be minimized by carefully considering the indications for prescribing antipsychotics and their short-term use, regular monitoring of the patient’s condition, and educating caregivers.

scholarly journals An Unusual Case of COVID-19 Presenting as Acute Psychosis

2020 ◽  
pp. 089719002097772
Author(s):  
Cameron G. Lanier ◽  
Stacey A. Lewis ◽  
Paras D. Patel ◽  
Ahmed Mohamed Ahmed ◽  
Paul O. Lewis
Keyword(s):  
Antiviral Treatment ◽  
Gastrointestinal Symptoms ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Shortness Of Breath ◽  
Neurological Manifestations ◽  
Psychiatric Facility ◽  
Disorder Patient ◽  
Artery Disease ◽  
Alcohol Liver Disease

Purpose To report a case of COVID-19 presenting with acute psychosis, without the hallmark respiratory symptoms of fever, cough, and shortness of breath associated with the novel virus. Case Summary A 58 year-old male presented with acute psychosis and no symptoms associated with COVID-19. He denied fever, chills, chest pain, shortness of breath, or gastrointestinal symptoms. The patient had a medical history of coronary artery disease, chronic hepatitis C, polysubstance abuse (including cocaine and alcohol), liver disease, anxiety, and panic disorder. Patient was confused, disruptive, unable to communicate, and admitted to hallucinations. Prior to transfer to a psychiatric facility, the patient developed a cough, triggering COVID-19 testing and a positive result. He was initially treated with hydroxychloroquine before this was discontinued. The patient was treated with haloperidol and lorazepam before returning to baseline. He was discharged home with continued isolation. Conclusion Acute psychosis, with or without other symptoms, appears to be a potential presentation of COVID-19 and should be considered by clinicians as a possible presenting manifestation. Other coronaviruses appear to have also been linked to neurological manifestations, including psychosis. Neurological manifestations of the virus vary widely, but have been reported multiple times. Treatment, as shown in this case report, appears to be supportive and symptom based for the associated psychotic symptoms. Optimal antiviral treatment is still yet to be clearly defined, as research continues on how to best treat the virus itself.

10-year outcome study of an early intervention program for psychosis compared with standard care service

2014 ◽  
Vol 45 (6) ◽  
pp. 1181-1193 ◽  
Author(s):  
S. K. W. Chan ◽  
H. C. So ◽  
C. L. M. Hui ◽  
W. C. Chang ◽  
E. H. M. Lee ◽  
...  
Keyword(s):  
Early Intervention ◽  
Standard Care ◽  
Intervention Program ◽  
Suicide Attempts ◽  
Care Service ◽  
Structured Interview ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Short Term ◽  
Long Term Outcome

Background.Despite evidence on the short-term benefits of early intervention (EI) service for psychosis, long-term outcome studies are limited by inconsistent results. This study examined the 10-year outcomes of patients with first-episode psychosis who received 2-year territory-wide EI service compared to those who received standard care (SC) in Hong Kong using an historical control design.Method.Consecutive patients who received the EI service between 1 July 2001 and 30 June 2002, and with diagnosis of schizophrenia-spectrum disorders, were identified and matched with patients who received SC first presented to the public psychiatric service from 1 July 2000 to 30 June 2001. In total, 148 matched pairs of patients were identified. Cross-sectional information on symptomatology and functioning was obtained through semi-structured interview; longitudinal information on hospitalization, functioning, suicide attempts, mortality and relapse over 10 years was obtained from clinical database. There were 70.3% (N = 104) of SC and 74.3% (N = 110) of EI patients interviewed.Results.Results suggested that EI patients had reduced suicide rate (χ2(1) = 4.35, p = 0.037), fewer number [odds ratio (OR) 1.56, χ2 = 15.64, p < 0.0001] and shorter duration of hospitalization (OR 1.29, χ2 = 4.06, p = 0.04), longer employment periods (OR −0.28, χ2 = 14.64, p < 0.0001) and fewer suicide attempts (χ2 = 11.47, df = 1, p = 0.001) over 10 years. At 10 years, no difference was found in psychotic symptoms, symptomatic remission and functional recovery.Conclusions.The short-term benefits of the EI service on number of hospitalizations and employment was sustained after service termination, but the differences narrowed down. This suggests the need to evaluate the optimal duration of the EI service.

scholarly journals MON-252 Pituitary Tumor Apoplexy Presenting with Acute Psychosis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Maria Mercedes Pineyro ◽  
Patrica Agüero ◽  
Florencia Irazusta ◽  
Claudia Brun ◽  
Paula Duarte ◽  
...  
Keyword(s):  
Psychiatric Disorders ◽  
Pituitary Tumor ◽  
Psychiatric Treatment ◽  
Psychiatric Symptoms ◽  
Mental Illnesses ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Sellar Mass ◽  
History Of ◽  
Pituitary Tumor Apoplexy

Abstract Background: Pituitary tumors (PT) can present with neuropsychiatric symptoms. It has been associated with hormonal changes, as well as extension of the tumor to the diencephalon. Psychopathology has been reported in up to 83% in Cushing Disease (CD) and 35% in acromegaly (ACR). Psychiatric disorders (depression, anxiety and psychosis) have been reported up to 77% in CD and 63% in ACR. We present a rare case of a patient presenting with acute psychosis and a PT apoplexy. Case: A 27 year-old Caucasian female with a PMH of primary hypothyroidism presented with a 15-day history of delusions. She had delusional ideas on the subject of harm and prejudice, persecutory and mystical-religious. The mechanism was mainly intuitive and interpretive with false acknowledgments. She also had sleep disturbance, death ideation and subacute alteration of consciousness. There was no history of substance abuse or psychiatric disorders. She did not report headaches, visual disturbances, symptoms of hormone hypersecretion or hypopituitarism. She had regular menses on BCP. She had no family history of mental illnesses. Physical exam revealed reluctance, latency in responses and bradypsychia. She did not have acromegalic or cushingoid features. She was diagnosed with acute psychosis with atypical features so a brain CT was performed, which showed a sellar mass. Pituitary MRI revealed a sellar mass measuring 15x12x13 mm, with suprasellar extension, optic chiasm compression, hyperintense on T1- and hypointense on T2-weighted imaging compatible with subacute hemorrhage. She was treated with neuroleptics and benzodiazepines. Lab work revealed high prolactin (PRL) (114ng/dl), and normal 8 AM cortisol, FT4, LH, FSH and IGF-1 levels. Repeated PRL was 31,6 ng/dl after changing psychiatric treatment to aripiprazole. Her psychiatric symptoms improved. We postulate a diagnosis of PT apoplexy that presented with acute psychosis. In relation to the nature of the PT we postulate a non functioning pituitary adenoma (NFA) or a partial resolution of a prolactinoma after apoplexy. A follow up MRI is pending. Discussion: Infrequently, psychiatric symptoms may be the primary manifestation of brain tumors. Patients with PT have been reported to have altered quality of life, reduced coping strategies, increased prevalence of psychopathological alterations and maladaptive personality disorders. In addition, they can present with psychotic symptoms, mostly reported with hormone excess (GH and cortisol). Psychiatric symptoms such as anxiety and neurosis have been reported in NFA and prolactinomas. However, it is not clear a higher prevalence of psychiatric illnesses in these tumors. To our knowledge this is the first case of a pituitary tumor apoplexy presenting with acute psychosis. Conclusion: Psychiatric symptoms can be the first manifestation of PT, so atypical presentations should warrant further workup with brain imaging.

scholarly journals Exploring psychotic symptoms: a comparison of motor related neuronal activation during and after acute psychosis

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Luke Sheridan Rains ◽  
Gregory Fallica ◽  
Owen O’Daly ◽  
James Gilleen ◽  
Vincent Giampetro ◽  
...  
Keyword(s):  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Neuronal Activation

scholarly journals Myxedema Psychosis after Levothyroxine Withdrawal in Radioactive Iodine Treatment of Differentiated Thyroid Cancer: A Case Report

2021 ◽  
pp. 1596-1600
Author(s):  
Nutnicha Pattaravimonporn ◽  
Thanat Chaikijurajai ◽  
Wichana Chamroonrat ◽  
Chutintorn Sriphrapradang
Keyword(s):  
Radioactive Iodine ◽  
Auditory Hallucination ◽  
Neuropsychiatric Symptoms ◽  
Hormone Replacement ◽  
Signs And Symptoms ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Paranoid Delusion ◽  
Thyroid Hormone Replacement Therapy ◽  
Iodine Treatment

Neuropsychiatric symptoms, especially acute psychosis (often referred to as myxedema madness or psychosis), are rare but possible clinical presentations of patients with hypothyroidism. A 42-year-old woman with papillary thyroid carcinoma and recent total thyroidectomy had developed flat affect, paranoid delusion, and visual and auditory hallucination during inpatient admission for elective radioactive iodine treatment. On admission, her history and physical exam did not reveal symptoms and signs of significant hypothyroidism. Other medical causes of acute psychosis were excluded, and the patient was immediately treated with thyroid hormone replacement therapy. Subsequently, her thyroid function normalized, and her psychotic symptoms gradually improved. Although there is a lack of classic signs and symptoms of hypothyroidism, myxedema madness should be recognized as one of the potentially treatable causes of acute psychosis.

LGI1 antibody encephalitis and psychosis

2018 ◽  
Vol 26 (6) ◽  
pp. 612-614 ◽  
Author(s):  
Dahai Wang ◽  
Qinjian Hao ◽  
Lan He ◽  
Qiang Wang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Short Term Memory ◽  
Background Activity ◽  
Early Recognition ◽  
Memory Loss ◽  
Psychotic Symptoms ◽  
Resonance Imaging ◽  
Short Term ◽  
Term Memory ◽  
Hippocampal Lesions

Objective: To describe a case of leucine-rich, glioma inactivated 1 antibody-encephalitis presenting with psychosis. Methods: Case report. Results: A young man with leucine-rich, glioma inactivated 1-antibody encephalitis initially presented with acute psychotic symptoms, short-term memory loss and faciobrachial dystonic seizures. Magnetic resonance imaging revealed hippocampal lesions. Electroencephalography revealed frontotemporal slowing of background activity. Conclusion: Increased awareness of leucine-rich, glioma inactivated 1-antibody encephalitis may promote early recognition and treatment.

scholarly journals Massive pulmonary embolism presenting initially as acute psychosis

2019 ◽  
Vol 12 (4) ◽  
pp. e222018
Author(s):  
Michael Lawrenz Ferreras Co ◽  
Arianne Clare Agdamag ◽  
Marcus Juan Esteban ◽  
Roselyn Mateo
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Life Support ◽  
Massive Pulmonary Embolism ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Systemic Thrombolysis ◽  
The Third ◽  
Ventricular Response ◽  
New Onset

This is a case of a 68-year-old man with Parkinson’s disease who was admitted in the psychiatry floor for new-onset aggressive behaviour and hallucinations. On the third day of hospitalisation, he suddenly developed dyspnoea followed by an ECG showing atrial fibrillation with rapid ventricular response. A few seconds later, he went into cardiac arrest; he was resuscitated after multiple rounds of Advanced Cardiovascular Life Support. A transthoracic echo showed hypokinetic and enlarged right ventricle. A CT Chest showed a saddle embolus. Patient was provided with systemic thrombolysis, which led to an improvement in his haemodynamic status. Interestingly, his psychotic symptoms also improved. In this paper, we present and review how pulmonary embolism can be associated with acute psychosis.

scholarly journals Acute psychotic disorders induced by topiramate: report of two cases

2002 ◽  
Vol 60 (2A) ◽  
pp. 285-287 ◽  
Author(s):  
Florindo Stella ◽  
Dorgival Caetano ◽  
Fernando Cendes ◽  
Carlos A.M. Guerreiro
Keyword(s):  
Antipsychotic Drugs ◽  
Psychotic Disorders ◽  
The Other ◽  
Psychotic Symptoms ◽  
Acute Psychosis ◽  
Visual Hallucinations ◽  
Psychomotor Agitation ◽  
Full Remission ◽  
Epileptic Patients ◽  
Severe Anxiety

We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.

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