Psychotic Experiences Are Not Always a Sign of Mental Illness

Hearing Voices UMB-O Dollarphotoclub_73109512According to a July 2015 article by Anna Medaris Miller for U.S. News and World Report, there are “lots of potential reasons someone might hear voices, including anxiety, stress, depression and a history of trauma.”

Of course, all of these are “good reasons to seek mental health help.” But don’t conclude that a mental illness diagnosis is the only outcome.

In the article, Miller quotes Lisa Forestell, the director of community support at Western Massachusetts Recovery Learning Community who has heard voices her entire life. “They’re playful and silly and they try to cheer me up when I’m sad.” She also quotes Dr. John McGrath, a professor of psychiatry at The University of Queensland in Australia and researcher at the Queensland Brain Institute whose research team found that 2.5% of the population has heard voices and 3.8% has seen something others didn’t see. Psychotic experiences, he says, “are more common than we had been taught. What we really have to do is go back and revise how these symptoms fit into the profile of mental illness.”

This isn’t to say that hallucinations are never a symptom of mental illness. The point really is that hallucinations are a symptom with a variety of possible causes, including mental illness, but possibly also stress or trauma. Dr. Joseph Pierre, co-chief of the Schizophrenia Treatment Unit at VA West Los Angeles Healthcare Center, and also discussed in the article, conducted a study that compared 118 people who hear voices at least once a month and have a psychotic diagnosis to 111 people who hear voices at least once a month but don’t have mental illness. He found differences, including the tendency for people with psychosis to hear voices more often, to hear them express negative emotions. The diagnosed psychotic subjects also had little control over their voices. In his study, Pierre compared hearing voices to coughs — “common experiences that are often, but not always, symptoms of pathology associated with a larger illness.”

To read the article see Living With the Voices in Your Head.

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The Difference Between Bipolar Disorder and Schizophrenia

There are numerous mental illnesses that the medical field recognizes today, ranging from anxiety issues to depression and beyond. Two of the most serious problems are schizophrenia and bipolar disorder. They’re also two of the most confusing issues, largely due to the fact that they share a number of similar symptoms. Because of this, it’s often difficult for even professional psychiatrists to make an accurate diagnosis between the two. 

However, there are a few things that can help. First, it’s worth understanding the differences and similarities. For starters, schizophrenia is classified as a psychotic disorder that leads to delusions, hallucinations, and more. Bipolar disorder is a mood disorder, though it may manifest in ways that often seem similar to schizophrenia. 

The source of most confusion comes from the overlapping symptoms. For example, things like mania, depression, suicidal thoughts, social issues, and more are all common in both types of mental illness. The biggest difference lies in hallucinations. While those with bipolar disorder can experience hallucinations, they’re far more common among schizophrenics. And even when they do occur in those with a bipolar disorder, the patient will usually be far more alert and expressive when explaining those hallucinations. 

Many who begin to experience mental illness likely won’t even realize that they are suffering from the symptoms of one of these diseases – at the very least, they won’t be able to identify the specific issue they’re dealing with. Today, most psychiatrists will rely on counseling and on scans of brain activity in order to understand the exact problem. Since schizophrenic patients will show a loss of gray matter in their brain and those with bipolar disorder won’t show that loss, this is the primary method of distinguishing between the two when no other methods are working. 

No matter the problem, there are solutions. Modern medicine has led to numerous treatments that can help patients overcome bipolar disorder and schizophrenia. But the first step is simply figuring out which of the two one is suffering from. To find out more, contact us today.

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Study Suggests Cognitive Deficits Precede First Episode of Schizophrenia

From Psychiatric News Alert: A new study provides further evidence that cognitive deficits appear in individuals at risk for psychosis well before the first episode of acute psychosis–i.e., the “first break”–appears. The study is published online in Schizophrenia Research by the Department of Psychiatry at the Istanbul Faculty of Medicine in Turkey. The study compared cognitive functions of four groups of people:

  • Patients at ultra high risk for psychosis–UHR
  • Patients who had a first episode of psychosis (FES), their 30 healthy siblings (who were considered to be at familial high risk, FHR), and 35 healthy controls with no familial risk.

The researchers found that the FES group had worse neuropsychological performance than did controls on all of the cognitive domains measured, and the UHR group had worse performance on three of them—verbal learning, attention, and working memory—than did controls. They also found that individuals with familial risk had worse performance on executive functions and measures of attention than did the control group. In addition, the FES group had lower global composite scores than did the UHR group and scored worse on a measure of sustained attention than did their siblings in the FHR group.

The researchers concluded that their findings “suggest that cognitive deficits in schizophrenia may start before the first episode, since cognitive functions were similar among FHR, UHR, and FES groups. Our aim as a next step is to detect cognitive predictors of transition to psychosis in both groups in a study with a longitudinal design and with larger sample size.”

For research on improving cognitive function in patients with schizophrenia, see thePsychiatric News article, “Optimism Grows About Potential to Aid Schizophrenia Cognition.” For a review of assessment and treatment issues in schizophrenia, see American Psychiatric Publishing’s Clinical Manual for Treatment of Schizophrenia. And for a recent study on this topic, see the American Journal of Psychiatry report“Anatomical and Functional Brain Abnormalities in Drug-Naïve First-Episode Schizophrenia.”

The Importance of Developing Tools to Make Early Psychosis Intervention a Reality

Raquel Gur, M.D.

From Psychiatric News Alert: Early identification of schizophrenia and other psychoses should not just be a priority for clinicians—it should be a national priority, says psychiatrist Raquel Gur, M.D., a leading schizophrenia researcher. Speaking at the APA Institute on Psychiatric Services, Gur pointed out that despite the illness’s complexity, early psychosis identification is becoming more likely thanks to a growing research base linking genetic, neurodevelopmental, and behavioral findings about how psychosis progresses over time. Such early identification must follow the pattern that made it routine for diabetes, cardiovascular disease, and other disorders.

“It is no different for psychosis. When someone presents with a risk, we cannot send them away until they meet DSM criteria for schizophrenia.”

Pursuing the path of other illnesses, however, will not be simple, she added, in large part because of the stubborn stigma that attaches to mental illness and the complexity of the brain. But:

“the train toward psychosis leaves the station early, and we are trying to capture it before it derails.”

She cited several examples of research that is advancing the knowledge needed for early psychosis identification, including the Philadelphia Neurodevelopmental Cohort, which is seeking to describe how genetics impact trajectories of brain development and cognitive functioning in adolescence and understand how abnormal trajectories of development are associated with psychiatric symptoms. In this study, nearly 10,000 youth presenting at Children’s Hospital of Philadelphia for nonpsychiatric reasons have received a comprehensive genetic, psychiatric, and cognitive assessment, with a subsample of these participants receiving multimodal neuroimaging.

Read more about this and other studies laying the groundwork for early psychosis intervention in the Psychiatric News article “Expert Says Early Identification of Psychosis Should Be Priority.”

Lack of Psychiatric Treatment for Former Prisoners with Schizophrenia Increases Chance of Later Violent Offenses

A study that tracked released prisoners convicted of violent crimes found that mental health treatment affected rates of subsequent violence among those with schizophrenia. Most of the 967 prisoners in the study had no psychosis at about nine months after their release. However, 94 were diagnosed with schizophrenia, 29 with a delusional disorder, and 102 with drug-induced psychosis.

After adjusting for demographic factors, psychiatric comorbidities, and substance use, former prisoners whose schizophrenia was untreated during or after imprisonment were found to be three times more likely to be violent after their release than were prisoners who received psychosis treatment or those without psychosis, wrote Robert Keers, Ph.D., of Queen Mary University of London, and colleagues, online today in AJP in AdvanceThe presence of persecutory delusions appeared to explain at least part of that association, they said.

“Our findings are consistent with those in studies of treatment compliance in psychosis that report that nonadherence to medication is associated with increased risk of violence. They are also in line with findings from studies of first-episode patients that suggest that the risk of violence is higher at first presentation than following treatment.”

The fact that a prisoner was untreated for psychosis should be considered a risk factor for violent recidivism, they concluded. To read more about early detection and treatment of schizophrenia, see the Psychiatric News column “Early Detection of Schizophrenia: The Time Is Now.” Also see the book Essentials of Schizophrenia from American Psychiatric Publishing.

Psychotic Symptoms Linked to Adolescent Suicide Risk

From Psychiatric News Alert (8/12/13): According to a recent study, psychotic symptoms alone (as distinguished from diagnosed psychotic disorders) are a striking marker of suicide danger in adolescents, especially in those adolescents who demonstrate other types of psychiatric pathology.

“This is a very interesting study,” said child and adolescent psychiatrist Kayla Pope, M.D., of Boys Town National Research Hospital in Nebraska. “We need better markers for assessing suicide risk, and the finding in this study is an important step in that direction.”

The finding, from a team of European researchers in JAMA Psychiatry, came as a surprise to the lead researcher, Ian Kelleher, M.D., Ph.D.

“While we knew that people with psychotic disorders are at high risk of suicidal behavior, we did not know that there was such a strong relationship between psychotic experiences (which are much more common than psychotic disorders) and suicidal behavior in the population.”

More information about suicide risks can be found in Psychiatric News herehere, andhere. Information about suicide is also available in The American Psychiatric Publishing Textbook of Suicide Assessment and Management, Second Edition.

Psychotic Symptoms, Rather than Antipsychotic Meds, Linked to Alzheimer Patient Death & Institutionalization

It is the presence of psychiatric symptoms, including psychosis and agitation, not the use of antipsychotic medications that appears to raise the risk for institutionalization or death among patients with Alzheimer’s disease (AD), according to a new study published in AJP in Advance.

Researchers at several institutions, led by Oscar Lopez, M.D., of the University of Pittsburgh, examined time to nursing home admission and time to death in nearly 1,000 patients with a diagnosis of probable AD, taking into account a range of variables, including dementia severity, physical illnesses, extrapyramidal signs, depression, psychosis, aggression, agitation, and dementia medication use. A total of 241 patients (25 percent) were exposed to antipsychotics at some time during follow-up. A higher proportion of patients exposed to antipsychotic medications, especially conventional antipsychotics, were admitted to a nursing home or died compared with those who never took these medications, but the association was no longer significant after adjustment for psychiatric symptoms. Psychosis was strongly associated with nursing home admission and time to death, but neither conventional nor atypical antipsychotics were associated with time to death.

“This observational study does not support the association between mortality and antipsychotic use that has been reported in institutionalized elderly patients,” the researchers stated.

Geriatric psychiatrist and immediate past APA President Dilip Jeste, M.D., who reviewed the study, called it “an important contribution to the literature on mortality related to psychosis and antipsychotics in persons with Alzheimer’s disease.”

“The results from various published studies have often been at variance with one another. The present study’s finding that psychosis itself is associated with increased mortality is consistent with several other reports, suggesting the need to treat these symptoms. Although there are no FDA-approved safe and effective treatments for psychosis in dementia, a number of pharmacological and psychosocial approaches are available. The treating clinician needs to take into account the risk-benefit ratios for various treatments as well as no specific treatment.”

For more information about AD, see American Psychiatric Publishing’s Clinical Manual of Alzheimer Disease and Other Dementias here and Psychiatric News here.