prodromal psychosis
Post on 09-Apr-2018
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Dr Ayedh Talha
PRODROMALPSYCHOSIS
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Prodrome Prodrome refers to the early symptoms of an illness which precede
the
manifestation of the fully developed disorder
Most research on the prodrome in psychosis has been conducted in
individuals with schizophrenia
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Symptoms Yung & Mcgorry study:
A prodromal phase was detected in all cases
Duration from 3 days to 6 years
Sleep disturbance 100%
Anxiety 86%
Irritability 86%
Deterioration in role functioning 76%
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Con. Symptoms depressed mood (76%)
social withdrawal (71%),
Poor concentration 71%
suspiciousness (71%),
loss of motivation (68%),
perceptual disturbances (62%),
motor changes (62%)
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weight loss (57%).
A sense of confusion, perplexity and
bewilderment 50%
Obsessive-compulsive symptoms 19%
Suicidal thoughts 24%
Self harm 15%.
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Defining Prodromal State The boundary between different but not psychotic (pre -psychotic) and frankly psychotic
is often
Blurred
transient
psychotic symptoms, attenuated (subclinical) psychotic symptomsor family
history plus functional decline
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PANSS definition
was defined byTransient psychosissymptoms that scored 4 or more for
hallucinations,4 or more for delusions, or 5 or more forconceptual disorganizations, lasted
less than one week and resolved
without antipsychotic
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were defined byAttenuated symptoms
the presence of symptoms that scored3 for delusions, 2-3 for hallucinations, 3-
4 for suspiciousness or 3-4 for on
conceptual disorganisation
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Definition of At-Risk-Mental-State State and trait risk factors
1. First degree relative with any history of psychotic disorder or
bipolar disorder or schizotypal personality disorder.
2. Reduction on GAF* scale of 30% or more points from premorbid
level
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Attenuated psychotic symptoms
1. At least one of ideas of reference, odd beliefs or magical
thinking,perceptual disturbance, digressive speech or thought,odd behaviour or appearance.
2. The symptom occurs at least several times per week.
3. The change in mental state has been present for at least one
week
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Transient psychotic symptoms At least one of: Perceptual disturbance or hallucinations, ideas of
reference, magical thinking or delusions, digressive speech, orformal thought disorder, odd behaviour or appearance.
Duration of each is less than one week and resolves
spontaneously
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DSM 5 PROPOSED DEF Attenuated Psychotic Symptoms Syndrome
All six of the following: a) Characteristic symptoms: at least one of the following in attenuated f
with intact reality testing, but of sufficient severity and/or frequency that it isnot discounted or ignored;
(i) delusions
(ii) hallucinations
(iii) disorganized speech
b) Frequency/Currency: symptoms meeting criterion A must be present inthe past month and occur at an average frequency of at least once per week inpast month
c) Progression: symptoms meeting criterion A must have begun in orsignificantly worsened in the past year;
d) Distress/Disability/Treatment Seeking: symptoms meeting criterion A sufficiently distressing and disabling to the patient and/or parent/guardian tolead them to seek help
e) Symtpoms meeting criterion A are not better explained by any DSM-5diagnosis, including substance-related disorder.
f) Clinical criteria for any DSM-V psychotic disorder have never been m
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Predictors for Psychosis in Individuals with Prodromal
Symptoms
long duration of prodromal symptoms (>900 days),
poor functioning (GAF score 15;
BPRS psychotic subscale score >2)
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depression (HRSD score >18)
disorganization (SANS attention score >1)
Cannabis dependence
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Intervention in the Prodromal Phase broad variety of non-specific symptoms
risk of false positives
Lack of standard treatment
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Recommended approaches Early recognition, easy access to care and close follow-up
treatment for syndromes such as depression, anxiety or substanceuse
Family education and support
antipsychotic medication can affect the natural course of psychoticdisorders
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The first intervention study conducted in PACE examined theefficacy of atypical neuroleptics plus CBT compared to standardtreatment (such as antidepressants, anxiolytics and moodstabilisers) in 33 individuals
35.7% of those receiving standard care developed psychosis
only 9.7% of those who received atypical neuroleptics and CBT
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In 2 years after ceasing treatment, only 2 more individuals fromthe specific treatment group developed psychosis
The mean dose of risperidone in the PACE intervention studywas 1.3 mg (range 0.5-2.0 mg).
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When to use antipsychotics rapid deterioration is occurring, the risk of suicide is very high and treatment of any depression
had proved ineffective
when aggression or hostility is increasing and poses a risk toothers.
low doses of atypical medications are
preferred and should be regarded as a therapeutic trial for alimited period
the medication may be continued with the patients consent for
a further 6 months to 2years
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Thank youThank you
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