Almost 1 % of the population in the western world will eventually fulfil the criteria of schizophrenia or a related severe mental illness . Core symptoms of many people suffering from psychoticdisorders are hallucinations, delusions, incoherent thoughts, memory problems, loss of initiative, flat affect, poverty of speech and social withdrawal . Moreover, patients frequently experience problems with psychosocial functioning, such as a lack of daytime activities, social contacts, intimate relation- ships and a reduced quality of life [3, 4]. They often have poor physical health and experience medication side effects that contribute to an early onset of cardiovascular diseases. Different studies have shown a reduced life expectancy ranging from 10 up to 28 years [5, 6]. Some patients manage to recover both in terms of their symp- toms, as well as in reaching personal and social goals. However the majority only partially recovers, with recur- rence of symptoms and enduring personal and social problems often for the rest of their life. Especially patients with the most severe symptoms (fulfilling cri- teria for schizophrenia or schizoaffective disorders) often need lifetime medical, psychiatric and social care. Rec- ommended treatment options are described in national treatment guidelines; in the Netherlands the Multidiscip- linary Guideline for Schizophrenia is used (which is largely in line with the NICE guideline) . The Optimal Treatment Project revealed that 2 years of optimal, evidence-based treatment led towards a clear trend in recovery from clinical impairment and social disability of patients with psychoticdisorders . Despite increasing evidence that pharmacological and psychosocial inter- ventions are effective in improving clinical symptoms and patients’ functioning, the availability of treatment interventions and integration in psychiatric care is often suboptimal . Also, many patients with psychotic disor- ders find it difficult to express their needs, show a de- creased awareness of their symptoms and only partially understand the different possible treatment options. Therefore, psychological, medical and social problems often go undetected or untreated . There is a challenge to monitor symptoms and unmet care needs of these patients in order to offer optimal care, espe- cially in realizing their varying needs in different domains for many years.
Introduction: Long‑term benzodiazepine (BZD) treatment in patients with mental disorders is widespread in clinical practice, and this is also the case of patients with schizophrenia, although the evidence is weak and BZD prescription is discouraged by guidelines and medical authorities. Data on BZD prescription are usually derived from national or regional databases whereas information on the use of BZD by patients with schizophrenia and related psychoses in general population‑based samples is limited. Materials and Methods: Information for 77 patients with psychoticdisorders who were regularly attending follow‑up appointments with the multidisciplinary Mobile Mental Health Unit of the prefectures of Ioannina and Thesprotia, Northwest Greece, during 1‑year period (2015) was obtained from our database. Results: From the total of 77 engaged patients, 30 (39%) were regularly prescribed BZDs in the long term, as part of their treatment regimen. Prescribed BZDs were mostly diazepam and lorazepam, in 43.3% of cases each. The mean daily dose of these compounds was 13 mg and 3.77 mg, respectively. Statistical analysis showed a correlation of long‑term BZD use with the history of alcohol/substance abuse. Most patients were receiving BZD continuously for several years, and the mean dose was steady within this interval. Conclusions: A large proportion of patients with psychoticdisorders were regularly prescribed BZD in long term. It appears that when BZDs are prescribed for some period in the course of a psychotic disorder, their use commonly exceeds the recommended interval and then becomes a regular part of the chronic treatment regimen. Future research should address the factors that may be related to the long‑term BZD use by patients with psychoticdisorders. Interventions for the reduction of regular BZD prescription should target the primary care setting and all those who treat first episode patients.
health care institutions in the Netherlands that primarily treat patients with psychotic and other severe mental disorders (often with comorbid substance-use disorder). Patients met the following inclusion criteria: age between 18 and 65 years, having a psychotic disorder, taking antipsychotic depot medication or an indication to start using it, receiving outpatient treatment, and having given written informed consent on participating in a randomized controlled trial. There were two exclusion criteria: inability to participate due to cognitive impairments and inability to participate due to insufficient understanding of the Dutch language. The study was approved by the accredited Dutch Medical Ethical Trial Committee at Erasmus University Medical Center (Trial Registration NTR2350).
The intervention in this study aims at a broad group of patients in terms of psychiatric diagnosis (non-psychoticdisorders in several combinations) and in terms of demo- graphic characteristics (although women, and persons with a lower socio-economic status are overrepresented), but a specific group in terms of care use (long-term and intensive). The severity of the disorder may account for the long duration of care, yet in psychiatric care people may also become accustomed to using services. Some studies highlight such iatrogenic dependency , and show very high service use of non-psychotic patients across health and social services . We specifically aim at this group of patients, who have serious mental illnesses, but who may also have become accustomed to long term or high care use. These patients may be per- ceived as ‘difficult’  and difficult-to-place, and be passed around by services . They may get lost in the system, since they neither fit in long-term care pro- grams (mostly aimed at patients with psychotic disor- ders), nor in short-term therapy (mostly aimed at patients with singular non-psychoticdisorders, who respond well to medication and/or psychotherapy). In- stead of keeping on ‘pampering and dithering’ we offer this group a generic program that aims at improving quality of life while decreasing costs.
Data collection began on March 6 th and ended on April 30 th 2014 (total duration 8 weeks). During this 8-week period, all participating practitioners prospectively re- ported the patients they had seen and who met the fol- lowing inclusion criteria: 18 years old and over, meeting a diagnosis of psychotic disorder according DSM-IV-TR (i.e. codes 295.xx, 297.x, 298.x)  and receiving an antipsychotic treatment prescribed during the consult- ation. The last criterion (prescription of an antipsychotic during the consultation) was added for two reasons. Firstly, to avoid including subjects currently in remission. Sec- ondly, to avoid counting the same subject more than once, given that subjects were in contact with several physicians during this study period (e.g. a psychiatrist prescribing the psychopharmacological treatment, another psychiatrist supervising psychotherapy at the day-care centre and their GP managing care for medical/somatic problems).
Abstract: Background: Neuroleptic-induced movement disorders constitute a worldwide problem in the treatment of schizophrenia because of the limited affordability of atypical antipsychotic drugs. The observable features of acute Parkinsonism; such as limb stiffness and slowness of movement are a social and functional handicap. The same is true for the restless movements and agitation associated with acute akathisia. Tardive dyskinesia, on the other hand is a permanent condition that affects quality of life. However, very few studies have been conducted to estimate the prevalence of Neuroleptic- induced movement disorders and their associated factors among psychotic patients in Ethiopia. Thus the aim of this study was to determine the prevalence of conventional antipsychotic induced movement disorders and associated factors among psychotic patients treated at Amanuel mental specialized Hospital. Method: Hospital based cross-sectional study was conducted by using established clinical rating scales to identify cases of conventional antipsychotic-induced movement disorders in Amanuel mental specialized Hospital on a sample of 377 psychotic outpatients. Systematic random sampling method was employed to select subjects. Logistic regression was used for comparison of the subjects with and without Neuroleptic-induced movement disorders. Results: the prevalence of Neuroleptic-induced movement disorders, namely; neuroleptic-induced Parkinsonism, neuroleptic-induced Akathisia and neuroleptic-induced tardive dyskinesia were found to be 46.4%, 28.6% and 11.9% respectively. Khat (Catha Edulis) use, AOR=1.93, 95%CI: 1.01-3.66, was factors remained to be associated with the presence of NIA. Alcohol use, AOR = 3.25, 95%CI: 1.04-10.16, was associated with TD. Being on chlorpromazine equivalent dose range of >=400mg/day, AOR =4.32, 95%CI: 2.25-8.30, AOR = 3.677, 95%CI: 1.807-7.482, AOR=4.157, 95%CI: 1.165-14.834 were associated with Parkinsonism, Akathisia and TD respectively. Conclusions and Recommendation: Considerable number of patients with psychoticdisorders suffered from a conventional antipsychotic - induced movement disorder. Khat, alcohol and high dose of drugs were found to be associated with conventional antipsychotic Induced movement disorders. Designing treatment guideline, increasing availability of drugs with minimal side effects and psycho-education for patients and their family is essential to reduce these devastating side effects.
One of the advantages of using data based on the whole population is the possibility of performing ana- lyses by sex and age. Thus we have been able to show differences in the trends of psychoticdisorders rates ac- cording to age in men and women. First, there is a delay of 10 to 15 years between the highest rates in males and females for both psychoticdisorders and schizophrenia, highest rates in men being in the 35–49 age group and at age 50 in women. Whether this gap is due to a later onset of the disorder in women or a greater delay in the diagnosis or in the treatment is not clear and has yet to be explored. An earlier onset in males compared to fe- males by 3 to 5 years is usually reported and can be partly attributed to a higher proportion of men with psychoticdisorders who have a history of illicit sub- stance abuse . We also found that the prevalence rates for psychoticdisorders in men decreased after age 50 while in females a plateau was maintained with ad- vancing age. This differential trend according to sex and age was not found in patients with the specific diagnosis of schizophrenia: the prevalence rates decreased with ad- vancing age in males and females. Several reasons can account for the decrease in the prevalence rates with ad- vancing age, either a decrease in the number of patients in the healthcare system or a decrease in the absolute number of patients due to complete recovery but most probably due to a higher mortality and a lower mean age of death of individuals with psychosis and schizophrenia compared to the general population . In addition, our algorithm may perhaps be less appropriate for in- cluding aged patients with psychoticdisorders, hence underestimating this population. However, this decrease with advancing age was not found in women with psych- otic disorders. In the elderly women, we found a stability in the rates of attribution of full health insurance cover- age (ALD) and of antipsychotic treatment which coun- terbalanced the decrease in the rates of psychiatric hospitalization and ambulatory care. This result suggests that most probably, late onset of psychotic-like symp- toms and delusions in ageing women manageable in
factors associated with coagulation (fibrinogen, plasminogen activator inhibitor and antithrom- bin III) and inflammation-related factors (CRP and leptin) in schizophrenic patients chronically treated with typical and atypical (clozapine and olanzapine) antipsychotics and their first-degree relatives. They found that patients treated with typical antipsychotics showed the highest CRP level in spite of having the lowest BMI. More- over, schizophrenic patients as a single group had higher CRP levels than relatives. Authors ar- gued that elevated CRP levels associated to anti- psychotictreatment might be an additional factor in the metabolic dysfunction often observed in schizophrenia; interestingly, they further suggest- ed that the observed high CRP levels in the pa- tients treated with typical antipsychotics in spite of their low BMI may be related to the low socio- economic status of these subjects which may pro- mote subclinical inflammation related to smok- ing, substance abuse, poor dietary and hygiene habits. These results are in line with those of a previous study that showed an increase in CRP levels after 8 weeks of treatment with olanzap- ine among sixty patients (26 women and 34 men) with severe schizophrenia undergoing chronic hospitalization and whose conventional antipsy- chotic treatment were switched to olanzapine 70 .
ABSTRACT: With headlines such as “Ex-mental patient kills family” and “Accused tried to hijack plane ‘to get rid of devil”, the media and some authors alike have painted an image that people with schizophrenia are prone to violence. Schizophrenia is also often described as a deliberating disease, that it deteriorates progressively. Are these really so? With the award-winning movie, “A Beautiful Mind” acted by Russell Crowe and showcased in recent years, some attention has been given to the disorder which could hardly be pronounced by people at one time. In developing countries such as Malaysia, psychiatric disorders are increasingly becoming important diseases as these countries undergo rapid urbanisation. A currently ongoing IRPA research project, that seeks to study the socioeconomic impact on three major psychiatric disorders (including schizophrenia), states that the government has made the improvement of psychiatric services and mental health programmes a priority in the overall health sector reform (Syed Mohamed Aljunid, 2004). Therefore it is high time a paper on Schizophrenia such as this should be presented. In this paper, the psychotic disorder, schizophrenia is described in some details while attempting to paint a better picture of the disorder. The details include a brief history, the symptoms, the sub-types of schizophrenia, how it is assessed, some statistical facts about schizophrenia, the causes (as explained by the Stress- Vulnerability model) and hence the current treatment and some suggestions on prevention. Can this be any clue to perhaps how the situation for schizophrenia patients in Malaysia is like: the Malaysian Psychiatric Association and Mental Health Foundation have organized a testimony-writing competition for “schizophrenia patients who are moving forward”. With sponsorship from the international pharmaceutical company, Lilly, it is awarding 8 winners in Malaysia with a total scholarship award of RM27,000. Would you say there are many schizophrenia patients who are functioning normally out there or would you still hold to the perception that schizophrenia is a deliberating disease?
Always in psychiatry, when giving information about the diagnosis, course of illness, and treatment, the therapist should not ignore the risk of suicide . Also, there is a high proportion of young people with first-episode psychosis who attempted suicide before their first contact with mental health services. This finding suggests that the mortality rates associated with psychoticdisorders may be underreported because of suicide deaths taking place before first treatment contact . It should constantly be considered that in the psychiatric hospital setting the inpatient at risk for suicide has previously exhibited suicidal behavior, suffers from schizophrenia, was admitted involuntarily, and lives alone . It is interesting that among persons hospitalized, the risk of suicide was greater in 1985-1991 than in 1995-2001 for post discharge period, particularly for patients with schizophrenia and patients with affective disorders. Thus, not only the restructuring and downsizing of mental health services was not associated with any increase in suicides, the risk of suicides decreased significantly between the two time periods among several diagnostic categories. But, while in terms of post-discharge suicides, the downsizing of psychiatric hospitals has been a success, there is still a substantial need for better recognition of suicidal risk among psychiatric patients . According to a survey, there are 2 sharp peaks of risk for suicide around psychiatric hospitalization, one in the first week after admission and another in the first week after discharge; suicide risk is significantly higher in patients who received less than the median duration of hospital treatment; affective disorders have the strongest impact on suicide risk in terms of its effect size and population attributable risk; and suicide risk associated with affective and schizophrenia spectrum disorders declines quickly after treatment and recovery, while the risk associated with substance abuse disorders declines relatively slower . The accessibility to one or more means of suicide is a recognized factor in psychiatric institutions. The same is true for the conditions of care: inadequate supervision, the underestimation of the risk of suicide by teams, poor communication within the teams and the lack of intensive care unit promote suicide risk . But according to another study in FEP, the majority of attempts occurred when patients were treated as outpatients and were in regular contact with the service . As suicide is a relatively rare event in psychoticdisorders, general population-based prevention strategies may have more impact in this vulnerable group as well as the wider population [28, 29].
A large body of evidence demonstrated the presence of cognitive deficits in schizophrenia and schizophrenia-spectrum disorders. Such dysfunctions are also reported in mood disor- ders, although the results are conflicting as to the severity of the impairment and the involved cognitive domains. Only a few studies compared the profile and severity of cognitive deficits in psychotic and mood disorders, especially during phases of clinical stability. In subjects with schizophrenia, as compared to those with other syndromes, cognitive deficits are more frequent, severe and stable over time; furthermore, they present a lower association with symptoms, clinical phase and drug treatment. Several studies reported that cognitive deficits have a greater impact on real-life functioning than symptoms. Furthermore, there are evi- dences that cognitive impairment interferes with the outcome of psychosocial rehabilitation programs. Therefore, cognitive deficits are considered an important target for the develop- ment of new pharmacological treatments and for rehabilitation programs for patients with schizophrenia and other severe psychiatric conditions. This paper provides a review of the most recent research on cognitive impairment in schizophrenia and schizophrenia-spectrum disorders, and on its association with functional outcome.
However, an individual with neurocognitive impair- ments (albeit possibly subtle) leading to difficulties in information processing and social interactions might actually, early in development, elicit hostile, critical or neglectful reactions from others. Others, with lesser or minimal degrees of biological vulnerability, may of course in reality experience a harsh or depriving upbringing that may in turn contribute to the likelihood of later developing a psychotic disorder. From a CAT perspective, all such experiences would be seen to be internalized as increasingly maladaptive RRPs (charac- terized for example by a ‘criticised’ relative to ‘criticis- ing or rejecting’ voice, a ‘neglected’ relative to ‘feeling one “ought” to manage alone’ voice, or a role of ‘abused’ relative to ‘potentially abusing of either self or others’). These would collectively constitute an increase in psychological vulnerability and also consequently, in a dialectical process, contribute to further stressful inter- personal difficulties, thereby further increasing vulner- ability. Cognitive analytic therapy would see such stress as being experienced as and mediated through not only difficult, ‘real’, social and interpersonal experience but also increasingly as internally generated, ‘self-stressful’ experience through the internal enactment of RRPs (in self–self enactments or dialogue). The up-shot of these internal enactments we have described as ‘internal expressed emotion’ (see case vignette). This represents a major focus for therapy in this model for psychoticdisorders, both schizophrenic and bipolar affective, although the underlying neurobiology of the latter appears to differ considerably [6,20]. Given that the process of neurological development is not complete until late adolescence and may be adversely effected by stress and chronic trauma both in childhood [21,22] and also in utero [23,24], possibly through the toxic effects of stress hormones , it can be seen that such mecha- nisms could account for increased vulnerability at a
Lack of sympathy, social constraints, dual emotions, depression and mental exhaustion, fear and concern, coping strategies, and life problems were categories derived from the experiences of the participants who lived with psychotic patients. In line with this result, Möller-Leimkühler et al showed that psychoticdisorders led to disruption in the individual, social, family, and occupational performance. They also indicated that given the fact that these patients experience agitation and confusion of emotions and perceptions, their spouses need to deal with psychological problems in addition to tolerating financial problems and medical expenses (14). Also, studies have shown that the experiences of individuals diagnosed with schizophrenia, bipolar disorder, and depression affect the mental health of their spouses (15). According to the results of the present study, negative mental experiences of women living with a spouse who is diagnosed with mental disorders threaten their mental and even physical health. Therefore, diagnosis of mental problems in one of the spouses affects all family members, especially one’s spouse, laying the foundation for the possibility of depression in them .
Abstract: The relapse rate for many psychiatric disorders is staggeringly high, indicating that treatment methods combining psychotherapy with neuropharmacological interventions are not entirely effective. Therefore, in psychiatry, there is a current push to develop alternatives to psychotherapy and medication-based approaches. Cognitive deficits have gained consider- able importance in the field as critical features of mental illness, and it is now believed that they might represent valid therapeutic targets. Indeed, an increase in cognitive skills has been shown to have a long-lasting, positive impact on the patients’ quality of life and their clinical symptoms. We hereby present four principal arguments supporting the use of event-related potentials (ERP) that are derived from electroencephalography, which allow the identification of specific neurocognitive deficiencies in patients. These arguments could assist psychiatrists in the development of individualized, targeted therapy, as well as a follow-up and rehabilitation plan specific to each patient’s deficit. Furthermore, they can be used as a tool to assess the possible benefits of combination therapy, consisting of medication, psychotherapy, and “ERP-oriented cognitive rehabilitation”. Using this strategy, specific cognitive interventions could be planned based on each patient’s needs, for an “individualized” or “personalized” therapy, which may have the potential to reduce relapse rates for many psychiatric disorders. The implementation of such a combined approach would require intense collaboration between psychiatry departments, clinical neurophysiology laboratories, and neuropsychological rehabilitation centers.
play a role in the genetic etiology of the nonsyndromic versions of the psychiatric disorders included in this study. This finding would be concordant with re- sults of our own study showing that mice with heterozygous loss of Tbx1 do not show the same sensorimotor gating deficits observed in mice carrying large deletions affecting Tbx1 and 26 other genes (63). The lack of association would also be supported by data published by Hiroi et al who found that although the behavioral anomalies of mice transgenic for a segment containing four genes in- cluding TBX1 could be ameliorated by antipsychotic drugs, this effect was not observed in mice heterozygous for TBX1 loss (70). However, our findings contrast with those of a study by Paylor et al (55), who showed that prepulse inhibition (PPI) defects seen in a mouse model of
Treatment teams were approached by the PI and clinicians working in these teams received oral and written informa- tion about the study and were asked for informed consent. Subsequently, clinicians were asked to provide their case- load to the PI, who randomly selected ten eligible patients for participation (or if fewer than ten eligible patients were available, all the eligible patients were selected). Clinicians explained to the selected patients the contents and procedure of the study and asked for participation. To enhance the likelihood of participation, patients were given an incentive of € 15 for participating. If a patient consented to participate, an appointment was made with the PI, sometimes accom- panied by the clinician for the patient’s comfort and/or the investigator’s safety. The patient received oral and written information about the contents and procedures of the study once more before signing informed consent. Subsequently, patients and clinicians completed the baseline assessments. Independent research assistants accompanied patients during the assessment, such that they could help if necessary. This could, for example, include reading items aloud to accom- modate patients with concentration problems and/or explain- ing items that were not readily understood. This procedure took about 2 hours for most patients and about 20 minutes for clinicians.
This study has a number of limitations. First, it was cross-sectional in nature, so the direction of causality between sexual dysfunction and the sociodemographic and clinical variables could not be inferred from the findings. Second, there is a limitation regarding the gen- eralizability of the result to other patients on conven- tional antipsychotics in Nigeria, as the study was conducted in just one centre. Third, the absence of a control group is also an important limitation to the generalizability of our results. However, to the best of our knowledge, it is the first to examine sexual dysfunc- tion among specific group of psychiatric outpatients on conventional antipsychotics in Nigeria. It is also one of the few available studies on sexual dysfunction in a de- veloping country setting where conventional antipsychotic medications are commonly prescribed for the treatment of psychotic illnesses .
The differences in vocational activity between the intervention group and the comparison group at the end of the intervention period probably rely on a series of both external and internal factors. When the JUMP study was launched, adults with severe mental illness were most often not offered vocational rehabilitation, but instead got a disability pension shortly after the diag- nosis was established,- We lack precise information on how many of the TAU participants were included in some kind of vocational rehabilitation program, but the number was probably very small, reflecting that work for people with severe mental illness has until recently not been a central issue neither in clinical psychiatry nor in the social services in Norway. Originally, the design of the JUMP study included a control group receiving or- dinary vocational rehabilitation. We struggled to recruit this group for almost two years, but very few eligible persons were identified. Thus we had to abandon this control group, and concluded that active vocational re- habilitation was normally not offered to patients with schizophrenia spectrum disorders in Norway. This may be considered a finding in the present study.
percent of the population had adverse childhood expe- riences (ACEs) . ACEs comprise exposure to chronic environmental stressors such as domestic violence, child- hood maltreatment (e.g., emotional, physical or sexual abuse, etc.) and interpersonal loss (e.g., parental men- tal illness, parental divorce, or parental death) as a child (17 years and below) [4–7]. Children exposed to severe maltreatment and trauma during their early childhood are at a higher risk of early onset of mental disorders , increased health-harming behaviors [9, 10], poorer social adjustment, functioning, educational and employ- ment outcomes as adolescents and adults [6, 11–15]. Further analyses by Kessler, McLaughlin  suggested that 29.8% of incidences of mental disorder in patients