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3 results

  • Childhood trauma, antipsychotic medication, and symptom remission in first-episode psychosis

  • Akiah Ottesen, W. T. V. Hegelstad, Inge Joa, Stein E. Opjordsmoen, Bjørn Rishovd Rund, Jan Ivar Røssberg, Erik Simonsen, Jan Olav Johannessen, Tor K. Larsen, Ulrik Helt Haahr, Thomas H. McGlashan, Svein Friis, Ingrid Melle
  • Journal:
    Psychological Medicine / Volume 53 / Issue 6 / April 2023
    Published online by Cambridge University Press:
    15 November 2021, pp. 2399-2408
    • Article
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  • Background

    To what extent psychotic symptoms in first-episode psychosis (FEP) with a history of childhood interpersonal trauma (CIT) are less responsive to antipsychotic medication is not known. In this longitudinal study, we compare symptom trajectories and remission over the first 2 years of treatment in FEP with and without CIT and examine if differences are linked to the use of antipsychotics.

    Methods

    FEP (N = 191) were recruited from in- and outpatient services 1997–2000, and assessed at baseline, 3 months, 1 and 2 years. Inclusion criteria were 15–65 years, actively psychotic with a DSM-IV diagnosis of psychotic disorder and no previous adequate treatment for psychosis. Antipsychotic medication is reported as defined daily dosage (DDD). CIT (<18) was assessed with the Brief Betrayal Trauma Survey, and symptomatic remission based on scores from the Positive and Negative Syndrome Scale.

    Results

    CIT (n = 63, 33%) was not associated with symptomatic remission at 2 years follow-up (71% in remission, 14% in relapse), or time to first remission (CIT 12/ no-CIT 9 weeks, p = 0.51). Those with CIT had significantly more severe positive, depressive, and excited symptoms. FEP with physical (N = 39, 20%) or emotional abuse (N = 22, 14, 7%) had higher DDD at 1 year (p < 0.05). Mean DDD did not excerpt a significant between-group effect on symptom trajectories of positive symptoms.

    Conclusion

    Results indicate that antipsychotic medication is equally beneficial in the achievement of symptomatic remission in FEP after 2 years independent of CIT. Still, FEP patients with CIT had more severe positive, depressive, and excited symptoms throughout.

  • 4 - Neuroreceptor imaging of schizophrenia

  • from Section I - Schizophrenia
    • By Dean F. Wong, The Russel H. Morgan Department of Radiology and Radiological Science The Johns Hopkins University School of Medicine Baltimore, MD, USA, James Robert Brašić, The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins University School of Medicine Baltimore, MD, USA, Nicola Cascella, Department of Psychiatry and Behavioral Sciences The Johns Hopkins University School of Medicine Baltimore, MD, USA
  • Edited by Martha E. Shenton, Bruce I. Turetsky, University of Pennsylvania
  • Book:
    Understanding Neuropsychiatric Disorders
    Published online:
    10 January 2011
    Print publication:
    09 December 2010, pp 78-87

  • Summary

    Neuroreceptor imaging has a major role in aiding how to administer a clinically effective drug dose that minimizes dose-dependent side effects. Considerable lines of evidence converge to confirm that alterations in the density, distribution, and function of dopamine D2/D3 receptors in the brain play a role in the pathophysiology of schizophrenia. Positron emission tomography (PET)/single-photon emission computed tomography (SPECT) receptor occupancy allows determination of the likely optimal dose of dopamine D2 receptor blocking drugs to produce a therapeutic effect with minimal adverse effects. Pharmacological challenges are one of the most promising areas in in-vivo neuronal receptor imaging to alter neurotransmitters levels. Serotonin is the second major neurotransmitter system studied in schizophrenia. Glutamate, the excitatory neurotransmitter, likely has multiple roles in the pathogenesis and pathology of schizophrenia. A novel approach to the treatment of schizophrenia is the use of anti-psychotic medication.

  • 10 - Bipolar affective disorder: Special issues for women

    • By Shaila Misri, Department of Psychiatry and OB/GYN, University of British Columbia, Columbia, SC, USA; Reproductive Mental Health Program, St. Paul's Hospital and BC Women's Hospital, Vancouver BC, Canada, Diana Carter, Reproductive Mental Health Program, St. Paul's Hospital and BC Women's Hospital, Vancouver BC, Canada, Ruth M. Little, Reproductive Mental Health Program, St. Paul's Hospital and BC Women's Hospital, Vancouver BC, Canada
  • Edited by David Castle, University of Melbourne, Jayashri Kulkarni, Monash University, Victoria, Kathryn M. Abel
  • Foreword by Jill Goldstein
  • Book:
    Mood and Anxiety Disorders in Women
    Published online:
    13 August 2009
    Print publication:
    23 February 2006, pp 185-211

  • Summary

    This chapter describes the gender differences relevant to bipolar disorder (BD), reproductive health issues for women with BD, risk factors for relapse or new onset BD during childbearing, the impact of untreated BD in pregnancy and the postpartum, and the management issues and strategies during preconception and the prenatal, perinatal and post-natal periods. There are differences in the expression of BD in males and females, with women more commonly experiencing rapid cycling, depressive episodes and possibly mixed mania. Experts recommend classifying all pregnant women with BD as "high-risk" pregnancies. The principles of drug administration during pregnancy include using the lowest possible therapeutic dose, monotherapy and using agents with the lowest potential for adverse foetal effects. Pharmacotherapy is the mainstay of treatment for BD. The acute treatment of postpartum psychosis typically involves hospital admission and anti-psychotic medication. During the childbearing era, women with BD face specific risks, particularly illness exacerbation.