Is the abuse of psychoactive drugs in psychotic patients linked to social adjustment?
Fifty-five psychotic men from a detention centre or a psychiatric hospital were assessed with the Social Adjustment Scale (SAS-II) and a French version of the Phillips Rating Scale of Premorbid Adjustment in Schizophrenia.
In psychotic patients, the abuse of psychoactive drugs is linked to some indicators of social adjustment and premorbid sexual adaptation.
Differences were found in some aspects of social functioning, but it is difficult to establish an overall assessment of social adjustment.
A study sample of 51 patients with acute and transient psychotic disorder (ATPD) (ICD-10) is presented. The findings suggest that, in hospital settings, ATPD is a non-frequent condition with onset in early adult life and most often associated with female sex, good premorbid social functioning and no or minor/moderate psychosocial stressors. The DSM-IV criteria distribute the patients into three diagnostic categories: schizophreniform disorder (41%), brief psychotic disorder (33%) and psychotic disorder not otherwise classified (25%). A high prevalence (63%) of personality disorders (PD) is revealed after recovery from the psychotic episode. The ATPD is not related to any specific PD, and in a substantial minority (37%) of cases no PD is found. The unspecified category is by far the most frequent PD in patients with ATPD. The sample will be followed up and reassessed.
We investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data.
Our sample included 715 adolescents aged 15-18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use.
Stronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity.
In a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.
OBJECTIVES: Affective psychosis has its peak incidence during the childbearing years, but little is known about the effects of the illness on pregnancy. We investigated risks of preterm delivery (PTD), low birthweight (LBW), births of infants small for their gestational age (SGA), stillbirth and infant death in births to mothers with affective psychosis using a nested case-control design within a cohort of 1,558,071 singleton births in Sweden during 1983-1997. METHODS: Using prospectively collected data from population registers, we compared the pregnancy outcomes of 5,618 births to women with affective psychosis with the outcomes of 46,246 births to unaffected mothers. RESULTS: Mothers with affective psychosis had elevated risk for giving birth to preterm, small or growth-retarded babies. The risk for stillbirth and infant death during the first year of life was not significantly higher. The risks were greatest in mothers receiving hospital treatment for affective disorder during pregnancy: (i) preterm delivery: odds ratio (OR) = 2.67, 95% confidence interval (CI) = 1.71-4.17; (ii) SGA: OR = 2.36; 95% CI = 1.34-4.16; (iii) low birthweight: OR = 2.22; 95% CI = 1.31-3.76; and (iv) stillbirth: OR = 2.19; 95% CI = 0.55-8.76. After adjustment for covariates, particularly smoking, the risks were attenuated but remained significant. CONCLUSIONS: Clinicians should be aware of the increased risk of adverse pregnancy outcomes in women with affective psychosis, some of which may be preventable.
To examine the prevalence of homelessness and its relationship to mental disorder, criminal behaviour, and health care.
Interview and file data were collected for 790 male admissions to a large, pretrial jail facility over a 12-month period.
A significant relationship was found between homelessness and severe mental disorder as well as between homelessness and prior psychiatric history. There were no significant differences found between the homeless and the nonhomeless on the types of crimes for which they were incarcerated or on contact with health care services within the past year.
The findings indicate the need for a link between the jail and community services for homeless individuals.
Obesity is a serious health problem, especially in patients with long-term mental disorders. We explored the socio-demographic, psychiatric, and clinical factors that increase the risk of changing from under- or normal weight in adolescence to overweight/obese in adulthood. We found a 3.6-fold risk of weight gain in females with psychotic disorder. Other significant correlates of weight gain in males were physical inactivity, unhealthy diet, high alcohol consumption, and being single; and in females, chronic diseases, physical inactivity, high alcohol consumption, and having at least three children. These findings emphasize the importance of regular weight monitoring in clinical practice, especially in females with psychotic disorders.
This study was undertaken to determine whether the incidence of schizophrenia is equivalent for males and females.
An attempt was made to identify every first-episode case of psychosis in a large Canadian city over a period of 2 1/2 years. A comprehensive referral network was established that included hospital and community settings where psychotic persons might appear. More than 300 potential subjects were identified, 175 of whom underwent a structured psychiatric interview and were assigned diagnoses according to five different diagnostic systems.
The incidence of schizophrenia was two to three times higher among males than among females. Even though the use of different diagnostic systems yielded slightly different risk rates, the elevated risk for males remained consistent. There were no differences between the sexes in the incidence of affective psychosis. In comparison with schizophrenia, the incidence rates for mood disorders with psychotic features were sometimes lower and sometimes higher, depending on the diagnostic system used.
The findings, coupled with reports in the past 10 years from other investigators, challenge the conventional belief that the incidence of schizophrenia is the same for the two sexes.
Comment In: Am J Psychiatry. 1993 Sep;150(9):1431-28352365
BACKGROUND: The prevalence in Norwegian prisons of psychiatric disorders in relation to the treatment potential in the prison health system has not been properly examined. MATERIAL AND METHOD: The prevalence of psychiatric disorders, drug problems and personality disorders was examined in a prison population in the western health region in Norway. Additionally, treatments of these disorders were surveyed. The methods used were structured clinical interviews, self reports and reviews of medical case notes. RESULTS: Psychiatric disorders in need of treatment were found in 18 out of 40 interviewed inmates. Of these 18, 13 actually received treatment with psychoactive medication. Criteria for alcohol and drug addiction or misuse were fulfilled by over 90%. Personality disorders were found in 80% and antisocial personality disorder in more than 60%. INTERPRETATION: The prevalence of psychiatric disorders including personality disorders and drug addiction is high among inmates. Compared to international studies, more of the inmates with psychiatric disorders that we interviewed receive psychoactive medication.
Comment In: Tidsskr Nor Laegeforen. 2004 Aug 26;124(16):207915334117
OBJECTIVE: To examine the association between first hospital admissions due to postpartum psychosis and the explanatory variables age, educational level, marital status and year of delivery. METHOD: All Swedish first-time mothers (n = 502,767) were included during a 12-year period and followed for first hospital admissions due to postpartum psychosis. Cox regression was used to estimate hazard ratios, adjusted for the explanatory variables. RESULTS: Older age and being a single mother implied an increased risk of first hospital admissions due to postpartum psychosis among first-time mothers. Educational level was not associated with first hospital admissions due to postpartum psychosis. During the 1990s, when a reduction in psychiatric beds occurred, first hospital admissions due to postpartum psychosis decreased significantly. CONCLUSION: Certain sociodemographic factors are associated with first hospital admissions due to postpartum psychosis. Untreated postpartum psychosis due to fewer psychiatric beds could have hazardous effects on mothers and their children.
Associations between HIV and schizophrenia in people with and without substance use disorders and the effect on timeliness of HIV diagnosis, antiretroviral therapy (ART), and treatment outcomes are poorly understood. We aimed to assess the association between HIV and schizophrenia and the effect on HIV treatment outcomes in people with and without substance use disorders.
We did a population-based cohort study with data from nationwide registries in Denmark to investigate the risk of schizophrenia after a diagnosis of HIV and the risk of HIV after a diagnosis of schizophrenia, accounting for substance misuse, timeliness of HIV diagnosis, and treatment success in relation to schizophrenia. We selected the cohort from people born in Denmark between Jan 1, 1955, and Dec 31, 1995, who we followed up from their 16th birthday or Jan 1, 1995 (whichever occurred last) until their death, emigration from Denmark, onset of schizophrenia, or Dec 31, 2011 (whichever came first). We estimated incidence rate ratios (IRRs) with Poisson and Cox regression, with adjustment for calendar period, and age and its interaction with sex.
We identified 2,786,286 individuals, of whom we included 2,646,154 people in analyses of risk of schizophrenia diagnosis and 2,658,662 people in analyses of risk of HIV diagnosis. In 35,353,633 person-years of follow up, HIV was associated with an increased risk of schizophrenia (IRR 4·09, 95% CI 2·73-5·83) and acute psychosis (7·15, 4·45-10·8); the IRR was highest within the first year of HIV diagnosis for both disorders (8·24, 2·95-17·7 and 12·7, 3·15-32·9, respectively). Schizophrenia was not associated with an increased risk of HIV in individuals without substance misuse disorders (IRR 1·42, 95% CI 0·81-2·27). The risk of schizophrenia in individuals with HIV decreased after ART (IRR 0·53, 0·32-0·87). The risk of acute psychosis did not differ between HIV-infected individuals receiving antiretroviral regimens with and without efavirenz (IRR 0·70, 95% CI 0·32-1·54). We recorded no differences in CD4 cell counts, time to ART, or viral suppression between individuals with schizophrenia with HIV and those without schizophrenia when substance use was taken into account. Between 1999 and 2011, the mortality rate ratio comparing HIV-infected individuals with schizophrenia with HIV-negative individuals without schizophrenia was 25·8 (95% CI 18·8-34·3).
Our findings emphasise the need for interventions to prevent HIV in people with schizophrenia, especially for those with substance use disorders, and for accessible mental health services for individuals with HIV.
Stanley Medical Research Institute, Lundbeck Foundation, Preben and Anna Simonsen Fund, Novo Nordisk Foundation, The Danish AIDS Foundation, and the Augustinus Foundation.