Clinical Schizophrenia and Related Psychoses最新文献

Missed appointments are a problem in all types of outpatient clinics including those providing mental healthcare. A review of literature was conducted to explore the problem of missed appointments in mental health and identify methods that have been used to improve attendance. Study results demonstrate that patients miss appointments for many reasons. Common reasons for missed appointments in the articles reviewed were the interval between scheduling and appointment day, forgetting, being discharged against medical advice, and problems with substance abuse. Effective in reducing no-shows was contact via phone, mail, or text messaging. No articles were found related to the use of positive reinforcement in reducing no-shows, which is an area to consider for further research. Clinicians may identify techniques from this review applicable to their particular clinical setting to improve clinic attendance.

The goal of this 21-year naturalistic study of clozapine-treated patients was to examine the cardiovascular risk factors following clozapine initiation and resultant mortality estimates from cardiovascular disease. Data were collected from January 1992 to February 2012 medical records from clozapine-treated patients with schizophrenia or schizoaffective disorder. Demographics, clozapine dosage and laboratory results were extracted at 12-month intervals. At clozapine initiation, the mean age of the 96 patients was 36.4 years±7.6 years; n=27 (28%) were women. The mean duration of clozapine use was 13 years. The Kaplan-Meier estimate for 21-year cardiovascular events was 29%, while the Kaplan-Meier estimate for 21-year mortality from cardiovascular disease was 10%. The mean cardiovascular risk increased during the first ten years (p<.01), while a slight decrease occurred beyond ten years (p<.01). Patients involved in cardiometabolic research showed a greater decrease in cardiovascular risk factors over 21 years (p=.05). The Kaplan-Meier estimate for 21-year all-cause mortality was 22%. Forty-one patients were diagnosed with diabetes (42.7%), compared to a nationwide prevalence of 13.7% in a similar age group. These results support the hypothesis that clozapine-treated patients are at risk for cardiovascular events and death secondary to an increased risk of medical disorders. Interventions that target weight loss, smoking cessation, and lipid profile improvement may alleviate the increased risk of cardiovascular mortality.

Approximately 60% of individuals with schizophrenia do not take their antipsychotic medications as prescribed, and nonadherence is associated with exacerbation of psychotic symptoms, increased hospital and emergency room use, and increased healthcare costs. Behavioral-tailoring strategies that incorporate medication taking into the daily routine and use environmental supports have shown promise as adherence-enhancing interventions. Informed by the Information-Motivation-Behavioral (IMB) Skills Model and using the iterative process of user-centered design, we collaborated with individuals with schizophrenia and psychiatrists to develop an interactive smartphone application and web-based clinician interface, MedActive, for improving adherence to oral antipsychotic treatment. MedActive facilitates the active involvement of individuals with schizophrenia in managing their antipsychotic medication regimen by providing automated reminders for medication administration and tailored motivational feedback to encourage adherence, and by displaying user-friendly results of daily ecological momentary assessments (EMAs) of medication adherence, positive psychotic symptoms, and medication side effects for individuals and their psychiatrists. In a 2-week open trial completed by 7 individuals with schizophrenia and their psychiatrists, MedActive was determined to be both feasible and acceptable, with patient participants responding to 80% of all scheduled EMAs and providing positive evaluations of their use of the application. Psychiatrist participants were interested in viewing the information provided on the MedActive clinician interface, but cited practical barriers to regularly accessing it and integrating into their daily practice.

Background: The involvement of Cryptococcus as an etiological agent in behavioral disorders, such as psychosis, is rare finding.

Methods: We report the case of 20-year-old man showed apparent functioning behavior premorbid, immunocompetent, with had a first psychotic episode one day after a clinical condition by mild fever, polyarthralgia, headache, fatigue and insomnia and detected cryptococcal antigen latex and India ink positive for Cryptococus neoformans in lumbar puncture. The psychotic episode responded to antifungal and antipsychotic treatment.

Conclusions: We emphasize the importance of paying attention to subtle systemic and neurological signs and investigating the general medical condition cause in the case of a first psychotic episode.

Objective: clinical staging and profiling of schizophrenia spectrum disorders has been proposed to describe and define the heterogenous course of disease. We examined the construct validity of clinical staging in schizophrenia spectrum disorders by measuring differences in distribution and severity of relevant clinical profilers and therapeutic improvement (HoNOS) across clinical stages.

Methods: we performed a prospective cross-sectional study with 258 inpatiënts who met DSM-IV criteria for schizophrenia spectrum disorders, recruited in an acute ward of a psychiatric hospital from 1-1-2015 until 31-12-2016. All patients (N=258) were assigned to a clinical stage, according to the criteria described by McGorry and clinical profilers were determined. Therapeutic improvement was assessed by measuring change in differences in HoNOS score during admission.

Results: significant higher severity scores of clinical profilers were found in more advanced stages compared to earlier stages. This pattern was apparent in the clinical profilers negative symptoms (F=4.56, P<0.01), number of psychotic episodes last year (F=13.65, P<0.01), compliance (F=2.76, P<0.05), work and daily activities (F=9.85, P<0.001), living situation (F=3.71, P<0.05), support of close relatives (F=9.38, P<0.001) and pre-morbid functioning (F=7.33, P<0.001). Judicial background was less prevalent in earlier stages compared to more advanced disease stages. No differences in therapeutic improvement (HoNOS) were found between clinical stages.

Conclusion: this study demonstrates that clinical staging in schizophrenia spectrum disorders has an acceptable construct validity between earlier and more chronic stages of disease. Several clinical profilers increase in more advanced stages compared to earlier clinical stages, which supports construct validity.

Previous research on theory of mind suggests that people with schizophrenia have difficulties with complex mentalization tasks that involve the integration of cognition and affective mental states. One of the tools most commonly used to assess theory of mind is the Faux-Pas Test. However, it presents two main methodological problems: 1) the lack of a standard scoring system; 2) the different versions are not comparable due to a lack of information on the stories used. These methodological problems make it difficult to draw conclusions about performance on this test by people with schizophrenia. The aim of this study was to develop a reduced version of the Faux-Pas test with adequate psychometric properties. The test was administered to control and clinical groups. Interrater and test-retest reliability were analyzed for each story in order to select the set of 10 stories included in the final reduced version. The shortened version showed good psychometric properties for controls and patients: test-retest reliability of 0.97 and 0.78, inter-rater reliability of 0.95 and 0.87 and Cronbach's alpha of 0.82 and 0.72.

Hypokalemia is the most frequent electrolyte abnormality seen in clinical practice. Hypokalemia is defined as serum potassium below 3.5 mEq/L and is usually asymptomatic and only identified in routine laboratory analysis. However, in some cases, symptoms include hypertension, palpitations, muscle weakness, easy fatigability, cramping and myalgias, memory impairment, disorientation and confusion, depressed or anxious mood, and irritability. Although rare, hypokalemia has been associated with psychosis. In particular, hypokalemia has been associated with psychotic exacerbations in patients with chronic psychotic disorder. We present a case report of a young female who developed a first presentation of acute psychosis and in which complementary investigations revealed hypokalemia. The psychosis resolved in few hours after replacement therapy with potassium chloride. The patient returned her usual functioning after discharge and there were no signs of psychosis at six-month follow-up.

Premenstrual psychosis is a rare phenomenon initiating during or preceding menses, often lasting one to two weeks after the onset of menses. Previous literature shows links between the estrogen decline of the menstrual cycle's late luteal phase and the worsening of preexisting symptomatology in psychosis. There is thought to be a similar etiology in premenstrual psychosis. Current literature describes mostly clinical cases showing successful treatment using oral contraceptives and/or atypical antipsychotics. We present an adolescent who suffered from a new episode of psychosis beginning just before the onset of menses. Her symptoms abated after the completion of menses and with the initiation of combined oral contraceptives and olanzapine.

Clozapine-induced neutropenia occurs in 3-5% of individuals treated with clozapine. Current US guidelines require interruption of clozapine when the absolute neutrophil count (ANC) drops below 1000 cells/mm ³ . There is minimal available guidance for what dosing schedule to use when restarting clozapine after an episode of neutropenia. Here, we present a case of a 50-year-old Caucasian female with a history of schizoaffective disorder who was successfully rechallenged on clozapine one month after developing clozapine-induced neutropenia (ANC 600 cells/mm ³ ). To understand published re-titration rates of clozapine after neutropenia, we conducted a literature review using a using the PubMed database and found only seven case reports that unambiguously reported a clozapine dosing schedule during re-challenge. All were successful except one, a case of clozapine rechallenge after agranulocytosis. Including this case presentation, six out of eight cases restarted clozapine more cautiously than recommended by the US guidelines for a new clozapine initiation. We cannot comment what role a slower or more rapid titration plays in a successful rechallenge after neutropenia with the available evidence. We encourage researchers to publish their dosing schedule in detail after an episode of neutropenia or agranulocytosis.