Early Diagnosis and Counseling in Adolescents With Subclinical Psychotic Symptoms

Psychosis is a condition characterized on current diagnostic tests by impairment and may include severe disturbances of cognition, thinking, behaviour, and emotion. The need for early diagnosis and prevention of psychotic episodes in adolescents challenges traditional models of counselling, diagnosis, and treatment. The aim of the present study is to derive the main themes and psychological manifestations in the first psychotic episode in adolescents and to deepen knowledge and raise questions around the specific experiences of psychotic adolescents in order to help the clinical psychologist and psychotherapist in diagnostic and therapeutic counselling. This thus goes beyond the visible behaviour and the medical model that pays little attention to the causal relationships in psychosis and its unconscious components. Thirty-six adolescents (27 girls) with subclinical and clinical psychotic symptoms and 30 adolescents (16 girls) with neurotic symptoms were interviewed. A clinical approach was used – clinical psychological interview followed by psychotherapeutic work. Findings and statements can be found showing that early psychotic signs may change into a more severe adolescent crisis, as well as indications of the nature of anger towards parents, unstable mood and aggressivity. Leading themes in interviews and psychotherapeutic sessions may relate to feelings of insignificance in the world around them, unclear sexual identification, too close a relationship with their mothers, and anxiety about real or symbolic absence such as their mothers’ working away from home for long periods of time. In 79% of the interviews with adolescents with psychotic symptoms, we see a lack of real symbolic play in childhood. suitable for non-psychotic adolescents, in this case to change in the first psychotic episode.****What does this last sentence mean? The importance of early diagnosis is recognized and the known psychotherapeutic techniques must be used. Keywords: early psychosis, adolescent, positive psychotherapy, counselling

Acceptance and Commitment Therapy for Patients with a First Psychotic Episode

ABSTRACT The search for the most effective methods of therapy for mental disorders is a priority for modern psychiatry. An approach to the early diagnostics and rehabilitation of patients experiencing a psychotic episode for the first time is proposed in the present article. The proposed approach is based on the combination of drug therapy and, acceptance and commitmenttherapy (ACT) characterized by the development of the patient's psychological flexibility, rather than controlling the disease symptoms. The article describes the main processes of the ACT model: acceptance, cognitive defusion, contact with the present moment, understanding of the inner world, awareness of significant values and the regulation of purposeful behaviour for the implementation of these values. Recommendations for different stages of treatment were also developed by specialists of the First Psychotic Episode Clinic at the Mental-health clinic No.1 named after N.A. Alexeev. The psychological rehabilitation of patients with the use of ACT in the case of psychotic disorders with both negative and productive symptoms was elaborated. The application of acceptance and commitment therapy in the early diagnostics and treatment of patients with a first psychotic episode results in fewer readmissions and improved psychosocial functioning in both inpatient and outpatient care.

Ceramides: Shared Lipid Biomarkers of Cardiovascular Disease and Schizophrenia

INTRODUCTION: Schizophrenia, although a debilitating mental illness, greatly affects individuals physical health as well. One of the leading somatic comorbidities associated with schizophrenia is cardiovascular disease, which has been estimated to be one of the leading causes of excess mortality in patients diagnosed with schizophrenia. Although the shared susceptibility to schizophrenia and cardiovascular disease is well established, the mechanisms linking these two disorders are not well understood. Genetic studies have hinted toward shared lipid metabolism abnormalities co-occurring in the two disorders, while lipid compounds have emerged as prognostic markers for cardiovascular disease. In particular, three ceramide species in the blood plasma, Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1), have been robustly linked to the latter disorder. AIM: We aimed to assess the differences in abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in the blood plasma of schizophrenia patients compared to healthy controls. METHODS: We measured the abundances of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) in a cohort of 82 patients with schizophrenia and 138 controls without a psychiatric diagnosis and validated the results using an independent cohort of 26 patients with schizophrenia, 55 control individuals, and 19 patients experiencing a first psychotic episode. RESULTS: We found significant alterations for all three ceramide species Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) and a particularly strong difference in concentrations between psychiatric patients and controls for the ceramide species Cer(d18:1/18:0). CONCLUSIONS: The alteration of Cer(d18:1/16:0), Cer(d18:1/18:0), and Cer(d18:1/24:1) levels in the blood plasma might be a manifestation of metabolic abnormalities common to both schizophrenia and cardiovascular disease.

EFFECTIVE THERAPEUTIC INTERVENTIONS TO PROMOTE RECOVERY FROM FIRST PSYCHOTIC EPISODE AND MINIMIZE ITS RELAPSE: A QUALITATIVE STUDY FROM PAKISTAN

Objective: To explore effective therapeutic strategies to promote recovery from first episode of psychosis and minimize its relapse. Study Design: Qualitative study. Place and Duration of Study: Karwan-e-Hayat Psychiatric Care and Rehabilitation Center, Karachi, from Mar to Jun 2019. Methodology: Seventeen participants were recruited through purposive sampling and data was collected through in-depth interviews. Qualitative thematic content analysis was done through generation of a coding scheme. Results: Almost half i.e., 8 (47%) had experience of 10 years, while 7 (41%) had 15 years’ experience, and 2 (12%) had 30 years’ experience as psychiatrists. Analysis of the interview transcripts revealed three main themes related to psychiatrists’ views on interventions for first episode of psychosis to prevent relapse: (1) duration of first episode of psychosis (2) compliance and rate of recovery after first episode (3) effective interventions for first episode psychosis. Conclusion: The effective interventions to promote recovery from first psychosis episode and minimize its relapse included multiple combinations of integrated stage-specific approaches necessitating antipsychotics (pharmacological) and psychosocial support (non-pharmacological).

Psychofarmaca: pleidooi voor een voorzichtig beleid bij vroege psychose

Psychopharmaceuticals: a plea for cautious management in early psychosis. From the holistic approach in VRINT (Early psychosis intervention team), a psychotic episode is regarded as an existential crisis in which both biological and psychosocial factors play a role and interact with each other. Non-pharmacological treatments are indispensable and preferred. However, antipsychotics can have an important role and be even lifesaving in certain circumstances. Therefore, in this article 3 questions are explored: How long before prescribing antipsychotics? How long should they be prescribed and is medication tapering possible? Are antipsychotics neuroprotective or rather harmful? Based on the scientific literature regarding antipsychotics as well as their own experience, the authors conclude that they do have their place in treating early psychosis, but they should be prescribed with the necessary caution, since antipsychotics are not harmless products. Treatment with antipsychotics should always consist of administering the lowest possible dose with a minimum of side effects. The decision to start treatment with antipsychotics and the correct adjustment of dosage should always be done in consultation with the person in crisis and his or her family. After a first psychotic episode, medication tapering can be considered, but the tapering off must be properly supervised over a sufficiently long period of time. After all, a full long-term recovery is pursued, whereby the person with psychosis can take control of his or her own life.

First psychotic episode, related to COVID-19 pandemic, in a patient with tuberous sclerosis complex

The psychological impact of COVID-19 pandemic in patients with genetic diseases such as Tuberous sclerosis complex remains to be misunderstood. We report a case of a patient with Tuberous sclerosis who presented with hallucinations, delusions, and disorganized behavior. He developed psychotic symptoms directly triggered by stress derived from COVID-19 pandemic.

Brief psychotic disorder associated with quarantine and mild COVID-19

A 30-year-old man with no significant previous or family psychiatric history became severely anxious about his health after a positive COVID-19 test. Physical symptoms of COVID-19 were mild, with no evidence of hypoxia or pneumonia, throughout his illness. He was admitted to a quarantine facility. He remained highly anxious, and 1 week later, he developed paranoid delusions and auditory hallucinations (his first psychotic episode). He was treated with lorazepam 1 mg four times a day, mirtazapine 30 mg nocte and risperidone 1 mg two times a day. His psychotic symptoms lasted 1 week. He stopped psychiatric medication after 4 weeks and had remained well when reviewed 3 months later. A Diagnostic and Statistical Manual of Mental Disorders fifth edition diagnosis of brief psychotic disorder with marked stressor (brief reactive psychosis) was made. Anxiety about his health and social isolation appeared the main aetiological factors but an inflammatory component cannot be excluded. The case highlights that first episode psychosis can be associated with mild COVID-19.