AIM To review available evidence on the use of cognitive behavioural therapy(CBT) for treating obsessive compulsive disorder co-occurring with psychosis.METHODS In this paper we present a detailed and comprehensive re...AIM To review available evidence on the use of cognitive behavioural therapy(CBT) for treating obsessive compulsive disorder co-occurring with psychosis.METHODS In this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder(OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubM ed search using as search string("obsessive compulsive disorders" or "obsessive compulsive symptoms") and("schizophrenia" or "schizoaffective disorder" or "psychosis") and("cognitive behavioural therapy"). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.RESULTS The reviewed evidence indicates that CBT is:(1) safe, i.e., does not worsen psychotic symptoms;(2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity;(3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD cooccurring with psychosis; and(4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by secondgeneration antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.CONCLUSION Our results support the use of CBT for OCD in patients with psychosis.展开更多
Introduction: Schizoaffective disorder is a chronic psychotic disorder. It is characterized by the simultaneous presence of symptoms of a characterized mood disorder and symptoms of schizophrenia. Data on this disorde...Introduction: Schizoaffective disorder is a chronic psychotic disorder. It is characterized by the simultaneous presence of symptoms of a characterized mood disorder and symptoms of schizophrenia. Data on this disorder are almost non-existent in West Africa. The objective was to describe the epidemiological, clinical and therapeutic aspects of schizoaffective disorder at the Campus University Hospital Centre (CHU-Campus) of Lomé in Togo. Framework and Method: This was a retrospective study with a descriptive aim on patients hospitalized at the Clinic of Psychiatry and Medical Psychology (CPPM) of CHU-Campus from January 1st, 2013 to December 31, 2018. Results: A total of 46 patients were included in this study. Their mean age was 39.5 years with extremes ranging from 14 to 65 years. Females had predominated at 52.18% or a sex ratio of 0.91. Married people represented 47.83%. Primary education represented 34.80%. The unemployed were in the majority at 32.92%. Sixty-five point twenty two percent (65.22%) of the patients had a personal psychiatric history. All patients had presented with delusions plus other psychotic and mood symptoms. Almost all patients (97.82%) had received a thymoregulator associated with a first generation antipsychotic (95.65%). Conclusion: More studies should be done in our countries to describe the cultural aspects of this disease.展开更多
Hyperpeptiduria and opioid excess have been reported in schizophrenia. According to Prof. Dr. L. Lindstrom, Sweden opioids may explain the patho-physiology of this syndrome. Therefore it is critical to elucidate the p...Hyperpeptiduria and opioid excess have been reported in schizophrenia. According to Prof. Dr. L. Lindstrom, Sweden opioids may explain the patho-physiology of this syndrome. Therefore it is critical to elucidate the presence and nature of opioids in schizophrenia and diagnostic sub groups. First morning urine from untreated schizoaffective patients (ICD-10: F 25.1) was separated on HPLC and peaks that elute where different opioid standards appear, freeze dried, re-dissolved in methanol/water (50/50) and 10mM formic acid. Mass spectrometry and MS/MS or fragmentation mass spectrometry was performed. We found fragmentation pattern of beta-casomorphin 1-3 and 1-4 (bovine) identical to synthetic standards from Bachem. The aggregation tendency of peptides was much in evidence. The reported exorphins were found in the urine from 8 of 12 untreated schizoaffective patients.展开更多
Background: Schizoaffective Disorder (SAD), similarly to schizophrenia, is a potentially chronic mental disorder that negatively affects the functioning of a patient. Various issues in everyday clinical practice often...Background: Schizoaffective Disorder (SAD), similarly to schizophrenia, is a potentially chronic mental disorder that negatively affects the functioning of a patient. Various issues in everyday clinical practice often arise from its diagnostic and therapeutic uncertainty. To date, there is a lack of a well-defined therapeutic algorithm used to treat the simultaneously manifesting schizophrenic and affective components. The aim of this study was to compare the therapeutic approaches in schizophrenia and schizoaffective disorders to identify the need of different treatment strategy for these diseases. Methods: In a retrospective study, we evaluated the therapeutic algorithms used in all patients with SAD (n = 99) hospitalized at the Department of Psychiatry, Comenius University in Bratislava, Faculty of Medicine and University Hospital Bratislava throughout the year 2010 and compared them with the therapeutic procedures used in all schizophrenia patients hospitalized in the same year (n = 120). Results: We found similarities between the groups of patients with schizophrenia and SAD in the number, type and length of hospitalizations and general patient management. Differences were identified in terms of the spectrum of used pharmacotherapy. For the treatment of both mental disorders, atypical antipsychotics were used the most. In the treatment of schizophrenia, we found the most frequent use of combined antipsychotic therapy, meaning oral and long-acting injectable forms. Patients with SAD mostly received antipsychotic monotherapy, but its complex effects were supplemented with other psychotropic drugs, mostly mood-stabilizers and anxiolytics. Conclusion: The results of our study show similarities between schizophrenia and SAD in terms of health care utilization, despite the fact that SAD is generally considered to be a “milder” disorder. On the other hand, this study indicates differences in the spectrum of pharmacotherapy used.展开更多
Background: Much research in psychiatry has been a search for diagnostic biomarkers of mental illness but practically useful markers have remained elusive. The problem may be unrealistic expectations and the aim in th...Background: Much research in psychiatry has been a search for diagnostic biomarkers of mental illness but practically useful markers have remained elusive. The problem may be unrealistic expectations and the aim in this paper is to show that the relationship between circadian heart rate and psychiatric status can contribute to useful understanding in this regard. Aim: To discuss the biomarker implications of changes in circadian heart rate (CHR) in psychiatric disorders. Methods: Comparisons of CHR were made between and within individuals receiving treatment for different psychiatric disorders diagnosed according to criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: Broadly different DSM-5 disorders are associated with distinctly different changes in CHR. Some disorders are more consistently associated with distinctive changes but CHR does not predict symptoms or specific clinical diagnoses reliably. Changes in CHR, particularly during sleep, are state-dependent. Clinical improvement is associated with normalisation of CHR. Conclusion: Changes in CHR are a part of the physiological changes in mental illness. Distinctly different changes in CHR suggest distinctly different physiological changes that may constitute diagnostic discrimination at a physiological level. An analysis of CHR can add objective adjunct information to clinical assessment and the evaluation of treatment but does not predict symptoms or clinical diagnoses reliably. Much the same is likely to apply to all candidate biomarkers of mental illness.展开更多
基金Supported by "Fondazione dell’Istituto di Psicopatologia Onlus",Rome,Italy
文摘AIM To review available evidence on the use of cognitive behavioural therapy(CBT) for treating obsessive compulsive disorder co-occurring with psychosis.METHODS In this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder(OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubM ed search using as search string("obsessive compulsive disorders" or "obsessive compulsive symptoms") and("schizophrenia" or "schizoaffective disorder" or "psychosis") and("cognitive behavioural therapy"). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.RESULTS The reviewed evidence indicates that CBT is:(1) safe, i.e., does not worsen psychotic symptoms;(2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity;(3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD cooccurring with psychosis; and(4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by secondgeneration antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.CONCLUSION Our results support the use of CBT for OCD in patients with psychosis.
文摘Introduction: Schizoaffective disorder is a chronic psychotic disorder. It is characterized by the simultaneous presence of symptoms of a characterized mood disorder and symptoms of schizophrenia. Data on this disorder are almost non-existent in West Africa. The objective was to describe the epidemiological, clinical and therapeutic aspects of schizoaffective disorder at the Campus University Hospital Centre (CHU-Campus) of Lomé in Togo. Framework and Method: This was a retrospective study with a descriptive aim on patients hospitalized at the Clinic of Psychiatry and Medical Psychology (CPPM) of CHU-Campus from January 1st, 2013 to December 31, 2018. Results: A total of 46 patients were included in this study. Their mean age was 39.5 years with extremes ranging from 14 to 65 years. Females had predominated at 52.18% or a sex ratio of 0.91. Married people represented 47.83%. Primary education represented 34.80%. The unemployed were in the majority at 32.92%. Sixty-five point twenty two percent (65.22%) of the patients had a personal psychiatric history. All patients had presented with delusions plus other psychotic and mood symptoms. Almost all patients (97.82%) had received a thymoregulator associated with a first generation antipsychotic (95.65%). Conclusion: More studies should be done in our countries to describe the cultural aspects of this disease.
文摘Hyperpeptiduria and opioid excess have been reported in schizophrenia. According to Prof. Dr. L. Lindstrom, Sweden opioids may explain the patho-physiology of this syndrome. Therefore it is critical to elucidate the presence and nature of opioids in schizophrenia and diagnostic sub groups. First morning urine from untreated schizoaffective patients (ICD-10: F 25.1) was separated on HPLC and peaks that elute where different opioid standards appear, freeze dried, re-dissolved in methanol/water (50/50) and 10mM formic acid. Mass spectrometry and MS/MS or fragmentation mass spectrometry was performed. We found fragmentation pattern of beta-casomorphin 1-3 and 1-4 (bovine) identical to synthetic standards from Bachem. The aggregation tendency of peptides was much in evidence. The reported exorphins were found in the urine from 8 of 12 untreated schizoaffective patients.
文摘Background: Schizoaffective Disorder (SAD), similarly to schizophrenia, is a potentially chronic mental disorder that negatively affects the functioning of a patient. Various issues in everyday clinical practice often arise from its diagnostic and therapeutic uncertainty. To date, there is a lack of a well-defined therapeutic algorithm used to treat the simultaneously manifesting schizophrenic and affective components. The aim of this study was to compare the therapeutic approaches in schizophrenia and schizoaffective disorders to identify the need of different treatment strategy for these diseases. Methods: In a retrospective study, we evaluated the therapeutic algorithms used in all patients with SAD (n = 99) hospitalized at the Department of Psychiatry, Comenius University in Bratislava, Faculty of Medicine and University Hospital Bratislava throughout the year 2010 and compared them with the therapeutic procedures used in all schizophrenia patients hospitalized in the same year (n = 120). Results: We found similarities between the groups of patients with schizophrenia and SAD in the number, type and length of hospitalizations and general patient management. Differences were identified in terms of the spectrum of used pharmacotherapy. For the treatment of both mental disorders, atypical antipsychotics were used the most. In the treatment of schizophrenia, we found the most frequent use of combined antipsychotic therapy, meaning oral and long-acting injectable forms. Patients with SAD mostly received antipsychotic monotherapy, but its complex effects were supplemented with other psychotropic drugs, mostly mood-stabilizers and anxiolytics. Conclusion: The results of our study show similarities between schizophrenia and SAD in terms of health care utilization, despite the fact that SAD is generally considered to be a “milder” disorder. On the other hand, this study indicates differences in the spectrum of pharmacotherapy used.
文摘Background: Much research in psychiatry has been a search for diagnostic biomarkers of mental illness but practically useful markers have remained elusive. The problem may be unrealistic expectations and the aim in this paper is to show that the relationship between circadian heart rate and psychiatric status can contribute to useful understanding in this regard. Aim: To discuss the biomarker implications of changes in circadian heart rate (CHR) in psychiatric disorders. Methods: Comparisons of CHR were made between and within individuals receiving treatment for different psychiatric disorders diagnosed according to criteria defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Results: Broadly different DSM-5 disorders are associated with distinctly different changes in CHR. Some disorders are more consistently associated with distinctive changes but CHR does not predict symptoms or specific clinical diagnoses reliably. Changes in CHR, particularly during sleep, are state-dependent. Clinical improvement is associated with normalisation of CHR. Conclusion: Changes in CHR are a part of the physiological changes in mental illness. Distinctly different changes in CHR suggest distinctly different physiological changes that may constitute diagnostic discrimination at a physiological level. An analysis of CHR can add objective adjunct information to clinical assessment and the evaluation of treatment but does not predict symptoms or clinical diagnoses reliably. Much the same is likely to apply to all candidate biomarkers of mental illness.
