Psychoza – Epidemiologia

Psychoza
Epidemiologia

Psychoza definiowana jest jako utrata kontaktu z rzeczywistością, manifestująca się halucynacjami, urojeniami, zaburzeniami myślenia oraz dezorganizacją mowy i zachowania. Epidemiologicznie, zaburzenia psychotyczne dotyczą około 1,5-3,5% populacji, z zapadalnością na pierwszy epizod psychozy około 50 na 100 000 osób rocznie, a schizofrenii około 15 na 100 000. Wiek szczytowego początku psychozy różni się płciowo: u mężczyzn przypada na okres nastoletni do połowy dwudziestych lat, u kobiet do późnych dwudziestych lat. Czynniki ryzyka obejmują m.in. używanie substancji psychoaktywnych (np. konopi indyjskich, metamfetaminy), ubóstwo, niski kapitał społeczny, a także przynależność do mniejszości etnicznych, co wiąże się z wyższą zapadalnością. Psychozy mogą występować także w przebiegu chorób neurologicznych (np. padaczka, choroba Parkinsona), demencji (szczególnie z ciałami Lewy’ego), po udarze mózgu oraz w okresie poporodowym (1-2 na 1000 porodów). Wczesna interwencja, zwłaszcza u osób z klinicznym wysokim ryzykiem psychozy (CHR-P), jest kluczowa dla poprawy rokowania i zmniejszenia przejścia do pełnoobjawowej psychozy.

Epidemiologia Psychozy – Przegląd Ogólny

Psychoza to stan umysłu definiowany jako utrata kontaktu z rzeczywistością, charakteryzujący się występowaniem objawów takich jak halucynacje, urojenia, zaburzenia myślenia oraz dezorganizacja mowy lub zachowania. Jest częstym objawem wielu zaburzeń psychiatrycznych, neuropsychiatrycznych, neurologicznych, neurorozwojowych i medycznych.¹²

Szacuje się, że około 1,5-3,5% populacji ogólnej spełnia kryteria diagnostyczne zaburzeń psychotycznych, jednak znacznie większa liczba osób doświadczy przynajmniej jednego objawu psychotycznego w ciągu życia. Około 3% populacji ogólnej w Stanach Zjednoczonych doświadcza co najmniej jednego epizodu psychotycznego w ciągu życia, przy czym częstość występowania zaburzeń psychotycznych szacuje się na mniej niż 1% populacji (między 0,25 a 0,64%).³⁴

Zapadalność na pierwszy epizod psychozy wynosi około 50 na 100 000 osób rocznie, podczas gdy zapadalność na schizofrenię to około 15 na 100 000 osób rocznie. W szerszym badaniu międzynarodowym oszacowano, że całkowita zapadalność na zaburzenia psychotyczne wynosi 21,4 na 100 000 osób-lat, z dużą zmiennością geograficzną – od niskiego wskaźnika 6,0 na 100 000 osób-lat na obszarach wiejskich w okolicach Santiago (Hiszpania) do ponad 45 na 100 000 osób-lat w centrach miast Paryża i południowo-wschodniego Londynu.⁵⁶⁷

Metaanaliza obejmująca 73 badania pierwotne wykazała, że mediana punktowej i 12-miesięcznej chorobowości psychoz wynosi odpowiednio 3,89 i 4,03 na 1000 osób, natomiast mediana chorobowości życiowej wynosi 7,49 na 1000 osób. Oznacza to, że około jedna na 150 osób zostanie zdiagnozowana z zaburzeniami psychotycznymi w jakimś momencie swojego życia.⁸⁹

Czynniki Demograficzne w Epidemiologii Psychozy

Wiek i Płeć

Wiek szczytowego początku psychozy dla mężczyzn przypada na okres od nastoletniego do połowy dwudziestych lat życia, podczas gdy u kobiet początek psychozy pojawia się najczęściej w okresie od nastoletniego do późnych dwudziestych lat życia. Psychoza jest niezwykle rzadka u dzieci.¹⁰

Badania wskazują również na zróżnicowanie częstości występowania psychozy w zależności od płci. W przypadku zaburzeń psychotycznych nieafektywnych mężczyźni są bardziej narażeni niż kobiety (wskaźnik zapadalności 1,60 [1,44-1,77]), ale nie dotyczy to psychotycznych zaburzeń afektywnych (0,87 [0,75-1,00]).¹¹

Interesujące jest, że badanie przeprowadzone podczas pandemii COVID-19 wykazało zmianę we wzorcu epidemiologicznym – kobiety stanowiły znacząco wyższy odsetek pacjentów z pierwszym epizodem psychozy w porównaniu z okresem sprzed pandemii (46,3% vs 28%, p=0,005). Ta zależność pozostała istotna w analizie regresji logistycznej (iloraz szans dla kobiet: 2,12 [przedział ufności 1,17-3,82]; p=0,014).¹²¹³

Etniczność i Czynniki Społeczno-Ekonomiczne

Badania z Wielkiej Brytanii sugerują wyższą częstość występowania psychozy wśród populacji czarnoskórej i mniejszości etnicznych w porównaniu z populacją białą. Szacuje się, że nawet 22% wszystkich przypadków psychozy w Anglii (46,9% w badanych obszarach) można by zapobiec, gdyby usunięto czynniki ekspozycji zwiększające zapadalność w populacjach mniejszości etnicznych.¹⁴¹⁵

Istotnym czynnikiem środowiskowym związanym z wyższym wskaźnikiem występowania zaburzeń psychotycznych jest niski odsetek mieszkań własnościowych na danym obszarze. Ponadto występowanie psychozy jest zwiększone w dzielnicach, które są bardziej społecznie sfragmentowane (współczynnik zapadalności (IRR) = 2,40, 95% CI 1,05-5,51, p = 0,04), a także istnieje tendencja do zwiększonej zapadalności w dzielnicach o niższym kapitale społecznym (IRR = 1,43, 95% CI 0,99-2,06, p = 0,05).¹⁶¹⁷

Badania wskazują również na związek między ubóstwem a gorszymi wynikami leczenia psychozy. Analiza przeprowadzona w prowincji Guangdong w Chinach wykazała, że obszary dotknięte ubóstwem, o słabszych warunkach ekonomicznych, często charakteryzują się gorszą skutecznością leczenia i wyższą oceną ryzyka. Z kolei w regionach o rozwiniętej gospodarce i dobrych zasobach medycznych ryzyko było niższe, wskazując na skuteczniejszą kontrolę choroby.¹⁸

Epidemiologia Różnych Typów Psychozy

Około 3% osób uzależnionych od alkoholu doświadcza psychozy podczas ostrego zatrucia lub odstawienia. Około 10% pacjentów uzależnionych od alkoholu, którzy są w stadium odstawienia, doświadcza ciężkich objawów odstawiennych, w tym psychozy. Osoby z pierwszym epizodem psychozy są dwukrotnie bardziej narażone niż populacja ogólna na współwystępowanie nadużywania substancji, przy czym najczęściej zgłaszaną substancją jest konopie indyjskie (51%), a następnie alkohol (43%).¹⁹

Badania wykazały także związek między używaniem kannabis a rozwojem psychozy. U osób, które nie miały wcześniej objawów psychotycznych ani nie używały kannabis, rozpoczęcie używania kannabis w okresie od badania wyjściowego do drugiego pomiaru zwiększało ryzyko późniejszego wystąpienia objawów psychotycznych (skorygowany iloraz szans 1,9, 95% przedział ufności 1,1-3,1; P=0,021). Ponadto kontynuowanie używania kannabis zwiększało ryzyko utrzymywania się objawów psychotycznych (2,2, 1,2-4,2; P=0,016).²⁰²¹

W przypadku psychozy związanej z metamfetaminą, badania wykazały, że częstość występowania psychozy u osób używających metamfetaminę jest znacznie wyższa niż w populacji ogólnej, szczególnie u osób uzależnionych. Czynniki ryzyka obejmują płeć męską, niski poziom wykształcenia, bezrobocie i bycie osobą samotną, a także formę metamfetaminy, intensywność używania (dawka, częstotliwość i czas trwania) oraz używanie wielu narkotyków jednocześnie.²²

Psychoza Poporodowa

Psychozy poporodowe stanowią ciężką formę poporodowych zaburzeń nastroju, dotykając 1-2 na 1000 porodów. Okres poporodowy to czas szczególnie wysokiego ryzyka wystąpienia poważnych zaburzeń psychicznych, co sugeruje rolę porodu w wyzwalaniu tych epizodów. W fundamentalnym badaniu przeprowadzonym na brytyjskiej próbie populacyjnej ryzyko przyjęcia psychiatrycznego z powodu choroby psychotycznej lub zaburzenia nastroju było 22 razy większe w pierwszym miesiącu po porodzie w porównaniu z okresem przed ciążą.²³

Ponad 40% kobiet dotkniętych psychozą poporodową nie ma wcześniejszej historii poważnej choroby psychicznej, jednak pozostałe prezentują nawrót wcześniej istniejącej choroby psychicznej, głównie zaburzenia psychotycznego lub nastroju. Dowody wskazują na silny i specyficzny związek z chorobą afektywną dwubiegunową, sugerując, że w większości przypadków psychoza poporodowa może być manifestacją choroby afektywnej dwubiegunowej u kobiet podatnych na czynnik wyzwalający związany z okresem połogowym.²⁴

Niedawna metaanaliza oszacowała, że nawet jedna na pięć kobiet z chorobą dwubiegunową jest dotknięta epizodem psychotycznym lub maniakalnym w okresie poporodowym, co stanowi częstość znacznie wyższą niż obserwowana w populacji ogólnej (1-2 na 1000 porodów) i innych zaburzeniach psychicznych.²⁵

Obok pogorszenia funkcji poznawczych, 90% pacjentów z demencją doświadcza behawioralnych i psychologicznych objawów, takich jak psychoza, agresja, pobudzenie i depresja. Psychoza związana z demencją (DRP), która obejmuje urojenia i halucynacje, przyczynia się do instytucjonalizacji, pogorszenia funkcji poznawczych i obciążenia opiekunów.²⁶

Psychoza związana z demencją może występować we wszystkich typach demencji. Częstość występowania psychozy wśród osób z demencją jest szacowana jako najwyższa u osób z otępieniem z ciałami Lewy’ego (DLB) i chorobą Parkinsona (PD). Badania wykazały następujące przybliżone ogólne wskaźniki częstości występowania DRP: DLB – 75%, PD – 50%, choroba Alzheimera – 30%, demencja naczyniowa – 15%, demencja czołowo-skroniowa – 10%.²⁷

Badanie podłużne pacjentów żyjących z chorobą Alzheimera wykazało, że w ciągu 3 lat 23% pacjentów rozwinęło tylko urojenia, 9% rozwinęło tylko halucynacje, a 19% rozwinęło zarówno urojenia, jak i halucynacje. Przegląd 55 badań wykazał, że psychoza występowała u około 40% pacjentów z chorobą Alzheimera, przy czym urojenia występowały częściej (36%) niż halucynacje (18%).²⁸

Psychoza Poudarowa

Psychoza poudarowa (PSP) to rzadkie, ale poważne powikłanie neuropsychiatryczne charakteryzujące się urojeniami i/lub halucynacjami po udarze. Pomimo jej wpływu na rokowanie i jakość życia, PSP pozostaje niedodiagnozowana i niedostatecznie leczona.²⁹

W badaniu przeprowadzonym w Aswanie częstość występowania PSP wynosiła 5,4% (108/2624) pacjentów z udarem, u których rozwinęła się psychoza w ciągu 6 miesięcy po udarze. Czynniki ryzyka istotnie związane z PSP obejmowały starszy wiek, płeć męską, niższy poziom wykształcenia (≤5 lat), hemiplegię, zaburzenia zwieraczy, zmiany korowe, zanik mózgu, chorobę małych naczyń, udar niedokrwienny, otępienie poudarowe i napady drgawkowe.³⁰³¹

Padaczka od dawna jest uważana za czynnik ryzyka psychozy. W systematycznym przeglądzie i metaanalizie zbadano częstość występowania psychozy w padaczce. Łączny iloraz szans dla ryzyka psychozy wśród osób z padaczką w porównaniu z kontrolami wynosił 7,8. Sumaryczna częstość występowania psychozy w padaczce wynosiła 5,6% (95% CI: 4,8-6,4).³²

Częstość występowania psychozy jest wyższa w padaczce skroniowej (7%) w porównaniu do wszystkich rodzajów padaczki (5,6%). Badacze odnotowali również niską częstość występowania psychozy ponapadowej w padaczce – 2%, podczas gdy częstość występowania psychozy międzynapadowej wynosiła 5,2%, co było ponad dwuipółkrotnie więcej niż częstość psychozy ponapadowej, ale podobnie do ogólnej częstości psychozy w padaczce.³³³⁴

Wczesna Interwencja i Monitorowanie Psychozy

Wczesna interwencja jest niezbędna dla dobrych długoterminowych wyników w leczeniu psychozy. U osób z grupy wysokiego ryzyka klinicznego psychozy (CHR-P) wczesna interwencja może zmniejszyć wskaźniki przejścia do psychozy.³⁵³⁶

Lekarze pierwszego kontaktu odgrywają kluczową rolę w identyfikacji pacjentów z grupy ryzyka, ale identyfikacja osób zagrożonych rozwojem psychozy w podstawowej opiece zdrowotnej jest trudna. Niektórzy lekarze nie są zaznajomieni z koncepcją ryzyka rozwoju psychozy i uważają, że mogą nie posiadać odpowiednich umiejętności do identyfikacji tej grupy pacjentów. Inne bariery wiążą się z tym, że pacjenci nie zgłaszają lub nie ujawniają objawów psychotycznych, a także z ograniczeniami nakładanymi przez skąpe zasoby na strukturę i świadczenie usług NHS, takimi jak brak ciągłości opieki i wysokie progi dostępu do wyspecjalizowanych usług.³⁷³⁸

Monitorowanie wczesnych oznak ostrzegawczych (EWS) może pomóc w zapobieganiu nawrotom psychozy. Technologia mobilna oferuje znaczącą możliwość dostarczania monitorowania zmian samopoczucia, które są ekologicznie trafne i kontekstowo wrażliwe. Zespół z UNIGE opracował aplikację, która umożliwia monitorowanie częstości i intensywności objawów u osób zagrożonych psychozą na co dzień, aby móc dostosować ich opiekę medyczną i określić przyczynę pojawienia się objawów.³⁹⁴⁰

Chorobowość Współistniejąca i Psychoza

Współwystępowanie Zaburzeń Psychicznych

Osoby z ryzykiem klinicznym psychozy (CHR-P) często mają złożone i niejednorodne prezentacje kliniczne z częstymi niespecyficznymi współistniejącymi zaburzeniami psychicznymi wykraczającymi poza ich osłabione objawy psychotyczne, takimi jak objawy negatywne i afektywne, zaburzenia nastroju, lękowe, obsesyjno-kompulsywne i osobowości.⁴¹

Niedawna metaanaliza wykazała, że ponad trzy czwarte osób z CHR-P ma współistniejące zaburzenia psychiczne wykraczające poza ich cechy CHR-P. Częstość występowania współistniejących zaburzeń psychicznych ma tendencję do zmniejszania się w czasie, pozostając jednak wysoka, z wyjątkiem wszelkich zaburzeń związanych z używaniem substancji, które zwiększały się w okresie obserwacji.⁴²⁴³

Osoby z CHR-P miały wyższą bazową częstość występowania wszelkich lęków, paniki, zaburzeń lękowych bliżej nieokreślonych, schizotypowego zaburzenia osobowości i zaburzeń związanych z używaniem alkoholu w porównaniu z kontrolami nieposychicznymi.⁴⁴

Zaburzenia Snu

Zaburzenia snu są wysoce rozpowszechnione u pacjentów z zaburzeniami psychotycznymi. Ta współchorobowość ma znaczący wpływ na przebieg kliniczny choroby, w tym pogarszające się objawy psychotyczne i upośledzenie funkcji poznawczych, a także gorszą funkcjonowanie i zmniejszoną jakość życia. Istnieją dowody na wysoką częstość występowania złej jakości snu i bezsenności u pacjentów z pierwszym epizodem psychozy (FEP). Zaburzenia snu stanowią potencjalny cel terapeutyczny w psychozie, aby poprawić psychopatologię i funkcjonowanie.⁴⁵

Choroby Medyczne

Stany medyczne związane z psychozą obejmują zaburzenia autoimmunologiczne, endokrynologiczne, neurologiczne i żywieniowe. Podejrzewane choroby endokrynologiczne obejmują dysfunkcję tarczycy i przytarczyc. Charakterystyczne stany neurologiczne obejmują padaczkę skroniową, chorobę Parkinsona i chorobę Lewy’ego.⁴⁶

Podostry początek psychozy powinien wzbudzić podejrzenie przyczyny onkologicznej, takiej jak guz wydzielający steroidy, zajmująca miejsce zmiana w mózgu lub etiologia paraneoplastyczna. Należy wziąć pod uwagę choroby genetyczne lub dziedziczne; na przykład, choroba Huntingtona może początkowo prezentować się epizodem psychotycznym.⁴⁷

Warto również pamiętać o kiłze jako potencjalnej przyczynie objawów psychotycznych. Badania wskazują, że około 30,8% pacjentów z neurosyfilis wykazuje objawy psychiatryczne. Biorąc pod uwagę rosnącą częstość występowania kiły i neurosyfilisu, istotne jest, aby pozostać czujnym i rozważyć neurosyfilis jako diagnozę różnicową łagodnych zaburzeń poznawczych.⁴⁸

Konsekwencje Zdrowotne i Społeczne Psychozy

W porównaniu do swoich rówieśników, osoby z schizofrenią są znacznie bardziej narażone na bezrobocie, uwięzienie, bezdomność, izolację społeczną i przedwczesną śmiertelność. Badania przeprowadzone przez personel SPIRIT wykazały, że weterani ze schizofrenią mają zwiększone ryzyko śmiertelności w porównaniu do weteranów bez zaburzeń psychicznych. W badaniu krajowej próby ponad 500 000 weteranów, posiadanie diagnozy schizofrenii wiązało się z 1,5-krotnie wyższym ryzykiem śmiertelności z wszystkich przyczyn w okresie 9 lat.⁴⁹

Osoby ze schizofrenią mają również wyższe ryzyko demencji. W badaniu populacyjnym obejmującym ponad 2,8 miliona osób w wieku 50 lat lub starszych z 6 krajowych rejestrów w Danii, które były obserwowane przez 18 lat, osoby ze schizofrenią – zwłaszcza te poniżej 65 roku życia – miały znacznie zwiększone względne ryzyko demencji, którego nie można było wytłumaczyć ustalonymi czynnikami ryzyka demencji.⁵⁰

Używanie tytoniu jest związane ze złymi wynikami w leczeniu pierwszego epizodu psychozy. W badaniu wykorzystującym dane z badania klinicznego RAISE stwierdzono, że 50% z 400 młodzieży i młodych dorosłych, którzy uczestniczyli w tym badaniu, zgłosiło niedawne używanie tytoniu – palacze tytoniu mieli znacznie cięższe objawy psychiatryczne i niższą jakość życia podczas leczenia w porównaniu do osób niepalących.⁵¹

Posiadanie schizofrenii zwiększa ryzyko ponownej hospitalizacji medycznej wśród osób z cukrzycą. W badaniu ponad 80 000 dorosłych w stanie Waszyngton, którzy mieli hospitalizację medyczną z powodu cukrzycy w latach 2010-2011, osoby, które miały również schizofrenię, miały o 24% większe prawdopodobieństwo ponownej hospitalizacji w ciągu 30 dni.⁵²

Dysproporcje Rasowe w Leczeniu Psychozy

W dodatkowych analizach danych z badania RAISE, badacze SPIRIT wykazali, że czarnoskórzy pacjenci mieli mniejsze prawdopodobieństwo otrzymania ważnych usług (w porównaniu z pacjentami rasy białej niehiszpańskiej), zarówno wśród tych otrzymujących zwykłą opiekę społeczną, jak i leczenie NAVIGATE obejmujące skoordynowaną opiekę specjalistyczną.⁵³

Inne badania wykazały, że efekty grupowe etniczne na ryzyko psychozy są zakłócone przez doświadczenie dyskryminacji. Szacuje się, że nawet 22% wszystkich psychoz w Anglii (46,9% w badanych obszarach) można by zapobiec, gdyby usunięto ekspozycje związane ze zwiększoną zapadalnością w populacjach mniejszości etnicznych; stanowi to równowartość 66,9% w samych grupach mniejszości etnicznych.⁵⁴⁵⁵

Globalne Wzorce i Zróżnicowanie Geograficzne

Częstość występowania psychozy może być blisko ośmiokrotnie wyższa w niektórych regionach w porównaniu z innymi. Międzynarodowe badanie porównawcze zapadalności na zaburzenia psychotyczne oszacowało zapadalność na 17 obszarach w sześciu krajach – Wielkiej Brytanii, Francji, Włoszech, Holandii, Hiszpanii i Brazylii – przy użyciu porównywalnej metodologii. Badacze odkryli duże różnice między różnymi obszarami, od niskiego wskaźnika 6,0 na 100 000 osób-lat na obszarach wiejskich wokół Santiago (Hiszpania), do wysokiego wskaźnika ponad 45 w centrach miast Paryża i południowo-wschodniego Londynu.⁵⁶

Według międzynarodowego badania epidemiologicznego, częstość występowania nieafektywnych ostrych psychoz remitujących, w przeciwieństwie do schizofrenii, była 10-krotnie wyższa w krajach rozwijających się niż w krajach uprzemysłowionych. To samo badanie wykazało, że częstość występowania krótkotrwałych zaburzeń psychotycznych jest 2-krotnie wyższa u kobiet niż u mężczyzn.⁵⁷

Światowa Organizacja Zdrowia zwraca uwagę, że ponad dwie trzecie osób z psychozą na świecie nie otrzymuje specjalistycznej opieki zdrowia psychicznego. Tylko 31,3% osób z psychozą otrzymuje specjalistyczną opiekę zdrowia psychicznego. WHO korzysta z programu Mental Health Gap Action Programme (mhGAP), który wykorzystuje oparte na dowodach wytyczne techniczne, narzędzia i pakiety szkoleniowe, aby rozszerzyć usługi w krajach, zwłaszcza w warunkach ubogich w zasoby.⁵⁸

Przyszłe Trendy i Wyzwania

Rozwój narzędzi prognostycznych opartych na danych epidemiologicznych może pomóc w planowaniu usług zdrowia psychicznego poprzez identyfikację regionów o zwiększonej zapadalności na psychozę. Narzędzie prognostyczne dla częstości występowania zaburzeń psychotycznych w Anglii i Walii, dostępne bezpłatnie online (http://www.psymaptic.org), dostarcza komisarzom opieki zdrowotnej dokładnych prognoz dotyczących pierwszego epizodu psychozy na podstawie solidnej epidemiologii i przewidywanych lokalnych potrzeb populacyjnych.⁵⁹⁶⁰

Rosnące zainteresowanie skierowane jest na zrozumienie wpływu społeczeństwa nadzoru i rzeczywistości medialnej na rozwój objawów psychotycznych. Psychiatrzy w USA i Wielkiej Brytanii zgłaszają rosnącą liczbę pacjentów psychotycznych, którzy są paranoiczni, że kamery obserwują każdy ich ruch. Inni obawiają się, że sieć światowa monitoruje ich życie lub jest wykorzystywana do przekazywania zdjęć lub informacji osobistych.⁶¹

Naukowcy sugerują, że możliwym sposobem patrzenia na urojenia i halucynacje osób psychicznie chorych jest to, że reprezentują one skrajne przypadki tego, o co martwi się populacja ogólna lub osoby jedynie neurotyczne. Schizofrenia i inni pacjenci paranoiczni mogą brać powszechne obawy – takie jak kradzież tożsamości z powodu informacji przesyłanych przez Internet lub utrata prywatności z powodu powszechności kamer bezpieczeństwa do walki z przestępczością – i je powiększać.⁶²

Wreszcie, istotne jest zrozumienie niepełnosprawności psychospołecznej związanej z psychozą, która często zaczyna się na lata przed formalnym początkiem zaburzenia. Psychoza jest najczęstszą przyczyną niepełnosprawności psychospołecznej na świecie. Interwencje, które koncentrują się na funkcjonowaniu psychospołecznym we wczesnych stadiach psychozy, oferują perspektywę zapobiegania długoterminowej niepełnosprawności psychospołecznej.⁶³

Jednak obecne wczesne podejścia interwencyjne skoncentrowane na objawach nie wydają się wpływać na niepełnosprawność psychospołeczną i dlatego wymagają przemyślenia. Dostarczanie interwencji na poziomie uniwersalnym dla grup ryzyka, takich jak młodzi ludzie, którzy nie przechodzą ze szkoły do zatrudnienia lub szkolenia, może zapobiec długoterminowemu niekorzystnemu położeniu ekonomicznemu i marginalizacji społecznej, potencjalnie wzmacniając odporność na rozwój poważnych problemów zdrowia psychicznego, takich jak psychoza.⁶⁴

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Materiały źródłowe

#1 Psychosis in adults: Epidemiology, clinical manifestations, and diagnostic evaluation – UpToDate
https://www.uptodate.com/contents/psychosis-in-adults-epidemiology-clinical-manifestations-and-diagnostic-evaluation/print
Psychosis is a condition of the mind broadly defined as a loss of contact with reality. Psychotic symptoms can increase patients’ risk for harming themselves or others or being unable to meet their basic needs. […] This topic will characterize different aspects of psychosis including epidemiology, pathogenesis, clinical manifestations, comorbid conditions, and initial diagnostic evaluation of psychosis in adults.
#2 Recognition and Differential Diagnosis of Psychosis in Primary Care | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html
Psychosis is a symptom complex that may include hallucinations, delusions, disorders of thought, and disorganized speech or behavior. Acute psychosis is primary if it is symptomatic of a psychiatric disorder, or secondary if caused by a specific medical condition. Patients with primary psychiatric disorders are likely to have auditory hallucinations, prominent cognitive disorders, and complicated delusions. If psychosis is caused by a medical condition, the patient may exhibit cognitive changes and abnormal vital signs, and may have visual hallucinations. Illicit drug use is the most common medical cause of acute psychosis. […] In the general population, there is an approximate 3% lifetime prevalence of psychotic disorders, with 0.21% accounting for psychosis due to a general medical condition. A recent review found a prevalence of 0.5% to 4.3% for bipolar disorder in primary care populations, and approximately 9% for bipolar spectrum illnesses. In one urban primary care population, the prevalence of psychotic symptoms was most commonly associated with depressive, anxiety, and panic disorders (42.4%, 38.6%, and 24.8%, respectively), followed by substance use disorders (13.8%).
#3 Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK546579/
Psychosis is a common feature of many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions. […] It is thought that although around 1.5 to 3.5 percent of people will meet diagnostic criteria for a psychotic disorder, a significantly larger variable number will experience at least one psychotic symptom in their lifetime. […] The incidence of a first-time episode of psychosis is approximately 50 in 100000 people, while the incidence of schizophrenia is about 15 in 100000 people. […] The peak age of onset for males is teens to mid-20s, while for females, the onset tends to be teens to late-20s. […] Psychosis is extremely uncommon in children. […] The prodromal phase of schizophrenia commonly presents with negative symptoms. […] Early intervention is essential for good long-term outcomes.
#4 Psychosis & Psychotic Disorder: Causes, Risks and Treatment
https://www.therecoveryvillage.com/mental-health/psychosis/psychosis-statistics/
Psychosis affects the mind by causing hallucinations and delusions. Statistics show that approximately 3% of people in the U.S. will experience psychosis. […] Statistics show that psychotic episodes are not as rare as you may think: Around 3% of the people of the United States experience at least one psychotic episode during their lives. […] Psychotic disorder statistics estimate that between 0.25 and 0.64% of the people in the U.S. suffer from a psychotic disorder. […] Psychosis statistics in the United States show that approximately 3 out of 100 people living in the U.S. have or will experience a psychotic episode in their lives. This does not necessarily mean that they will suffer from a psychotic disorder, since the prevalence of psychotic disorders is lower. In fact, less than 1% of the U.S. population lives with a psychotic disorder.
#5 Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK546579/
Psychosis is a common feature of many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions. […] It is thought that although around 1.5 to 3.5 percent of people will meet diagnostic criteria for a psychotic disorder, a significantly larger variable number will experience at least one psychotic symptom in their lifetime. […] The incidence of a first-time episode of psychosis is approximately 50 in 100000 people, while the incidence of schizophrenia is about 15 in 100000 people. […] The peak age of onset for males is teens to mid-20s, while for females, the onset tends to be teens to late-20s. […] Psychosis is extremely uncommon in children. […] The prodromal phase of schizophrenia commonly presents with negative symptoms. […] Early intervention is essential for good long-term outcomes.
#6 Psychosis incidence highly variable internationally | ScienceDaily
https://www.sciencedaily.com/releases/2017/12/171206122540.htm
Rates of psychosis can be close to eight times higher in some regions compared to others, finds a new study led by researchers at UCL, King’s College London and the University of Cambridge. […] The study, published today in JAMA Psychiatry, was the biggest international comparison of incidence of psychotic disorders, and the first major study of its kind in more than 25 years. […] The authors estimated the incidence of psychotic disorders across 17 areas in six countries — the UK, France, Italy, the Netherlands, Spain and Brazil — using comparable methodology. […] They found the overall incidence of psychotic disorders to be 21.4 per 100,000 person-years, but discovered wide variations between different areas, from a low of 6.0 per 100,000 person-years in the rural area around Santiago (Spain), to a high of over 45 in inner-city Paris and Southeast London.
#7 Psychosis incidence highly variable internationally | UCL News – UCL â University College London
https://www.ucl.ac.uk/news/2017/dec/psychosis-incidence-highly-variable-internationally
Rates of psychosis can be close to eight times higher in some regions compared to others, finds a new study led by researchers at UCL, King’s College London and the University of Cambridge. […] The study, published today in JAMA Psychiatry, was the biggest international comparison of incidence of psychotic disorders, and the first major study of its kind in more than 25 years. […] The authors estimated the incidence of psychotic disorders across 17 areas in six countries – the UK, France, Italy, the Netherlands, Spain and Brazil – using comparable methodology. […] They found the overall incidence of psychotic disorders to be 21.4 per 100,000 person-years, but discovered wide variations between different areas, from a low of 6.0 per 100,000 person-years in the rural area around Santiago (Spain), to a high of over 45 in inner-city Paris and Southeast London.
#8 Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195687
The purpose of this study is to provide an updated systematic review to identify studies describing the prevalence of psychosis in order to explore methodological factors that could account for the variation in prevalence estimates. […] Seventy-three primary studies were included, providing a total of 101 estimates of prevalence rates of psychosis. Across these studies, the pooled median point and 12-month prevalence for persons was 3.89 and 4.03 per 1000 respectively; and the median lifetime prevalence was 7.49 per 1000. […] This systematic review provides a comprehensive comparison of methodologies used in studies of the prevalence of psychosis, which can provide insightful information for future epidemiological studies in adopting the most relevant methodological approach. […] The descriptive results of the pooled median global prevalence of psychotic disorders was 4.6 per 1000 persons, while the median point and 12-month prevalence was 3.89 and 4.03 per 1000 persons respectively and the median lifetime prevalence was 7.49 per 1000 persons.
#9 Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195687
Meta-regression analysis showed the methodological aspects of the studies that influenced the variability of the prevalence estimates. Concerning prevalence type, lifetime prevalence was higher than 12-month prevalence (p0.0001). Studies developed in the general population presented higher prevalence estimates that those developed in a population attended in health and/or social services (p = 0.0059), the diagnosis categories of probable psychotic diagnoses (p = 0.022) and non-affective psychosis (p = 0.0091) both present higher estimate rates than the diagnosis of schizophrenia only. Finally, a higher study quality is associated with lower estimates of prevalence of psychotic disorders (p = 0.0002). […] Despite the wide variation in the methodological components of the studies reviewed, these data indicate that approximately one in 150 individuals will be diagnosed with psychosis disorders at some point during their lifetime. Prevalence estimates across studies varied when looking at different periods of assessment, study design setting, diagnosis categories and quality scores. Thus, a well-designed epidemiological study with homogeneous methodology will help to improve our understanding of the global prevalence of this disease.
#10 Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK546579/
Psychosis is a common feature of many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions. […] It is thought that although around 1.5 to 3.5 percent of people will meet diagnostic criteria for a psychotic disorder, a significantly larger variable number will experience at least one psychotic symptom in their lifetime. […] The incidence of a first-time episode of psychosis is approximately 50 in 100000 people, while the incidence of schizophrenia is about 15 in 100000 people. […] The peak age of onset for males is teens to mid-20s, while for females, the onset tends to be teens to late-20s. […] Psychosis is extremely uncommon in children. […] The prodromal phase of schizophrenia commonly presents with negative symptoms. […] Early intervention is essential for good long-term outcomes.
#11 Psychosis: Diagnosis and Management | Doctor
https://patient.info/doctor/psychosis-diagnosis-and-management
About 0.5% of people aged 16 years or older in England receive a diagnosis of a psychotic disorder (schizophrenia, schizoaffective disorder, or affective psychosis) in the preceding year. […] An international study found the pooled incidence of all psychotic disorders was 266 per 100,000 person-years (95% CI 220-317). Heterogeneity was high (I2 985%). Men were at higher risk of all psychotic disorders (incidence rate ratio 144 [127-162]) and non-affective disorders (160 [144-177]) than women, but not affective psychotic disorders (087 [075-100]). […] UK studies suggest a higher prevalence of psychosis in the black and minority ethnic (BAME) rather than white population.
#12 Incidence rate and distinctive characteristics of first episode psychosis during the COVID-19 pandemic: a multicenter observational study | Scientific Reports
https://www.nature.com/articles/s41598-022-26297-6
The COVID-19 pandemic has affected the mental health of people around the world. However, its impact on first-episode psychosis (FEP) remains unclear. The aim of this study was to determine the incidence rate (IR) and the clinical and sociodemographic characteristics of patients who developed FEP during the nine-month period following the COVID-19 outbreak in Spain and to compare these data to the corresponding period in the previous year. The IR was 0.42/100,000 person-years during the pandemic vs. 0.54/100,000 in the prior year (p=0.057). Compared to prior year, women accounted for a significantly higher proportion of FEP patients (46.3% vs. 28%; p=0.005) during the COVID-19 period. This association was significant on the logistic regression analysis (odds ratio, female: 2.12 [confidence interval 1.173.82]; p=0.014). These data reveal a non-significant trend towards a lower incidence of FEP during the pandemic period. Female sex was associated with a greater risk of developing FEP during the pandemic period, perhaps due to differences between males and females in the susceptibility and expression of psychosis.
#13 Incidence rate and distinctive characteristics of first episode psychosis during the COVID-19 pandemic: a multicenter observational study | Scientific Reports
https://www.nature.com/articles/s41598-022-26297-6
When we compared the sociodemographic characteristics of patients in the two study periods, we found a higher percentage of women and a trend towards fewer cannabis users in the pandemic period. After controlling for other factors, female sex was the only variable significantly associated with an increased risk of FEP during the pandemic. […] In conclusion, our data show a trend towards a lower incidence of FEP during the pandemic when compared to the same time period in the prior year. The only variable associated with a greater risk of developing FEP during the pandemic versus the non-pandemic period was female sex.
#14 Psychosis: Diagnosis and Management | Doctor
https://patient.info/doctor/psychosis-diagnosis-and-management
About 0.5% of people aged 16 years or older in England receive a diagnosis of a psychotic disorder (schizophrenia, schizoaffective disorder, or affective psychosis) in the preceding year. […] An international study found the pooled incidence of all psychotic disorders was 266 per 100,000 person-years (95% CI 220-317). Heterogeneity was high (I2 985%). Men were at higher risk of all psychotic disorders (incidence rate ratio 144 [127-162]) and non-affective disorders (160 [144-177]) than women, but not affective psychotic disorders (087 [075-100]). […] UK studies suggest a higher prevalence of psychosis in the black and minority ethnic (BAME) rather than white population.
#15
https://www.emerald.com/insight/content/doi/10.5042/jpmh.2010.0324/full/html
Genetic and environmental factors are associated with psychosis risk, but the latter present more tangible markers for prevention. […] Up to 22% of all psychoses in England (46.9% within our study areas) could be prevented if exposures associated with increased incidence in ethnic minority populations could be removed; this is equivalent to 66.9% within ethnic minority groups themselves. […] Effect sizes for common socioenvironmental risk indicators for psychosis are large; inequalities were marked. This analysis demonstrates potential importance in another light: we need to move beyond current epidemiological approaches to elucidate exact socioenvironmental factors that underpin urbanicity and ethnic minority status as markers of increased risk by incorporating gene-environment interactions that adopt a multi disciplinary perspective.
#16 Psychosis incidence highly variable internationally | ScienceDaily
https://www.sciencedaily.com/releases/2017/12/171206122540.htm
Among the contributing factors under consideration, they found that the strongest area-level predictor of high rates of psychotic disorders was a low rate of owner-occupied housing. […] In line with previous research, higher incidence of psychosis was also associated with younger age (although the authors also identified a secondary peak in middle age among women), males, and ethnic minorities. […] The researchers say their findings can be used to help plan mental health services, by identifying which regions could expect greater incidence of psychosis. […] The findings add weight to previous evidence that environmental factors could play a larger role in causing psychotic disorders than previously believed. […] The researchers say that more research is needed to identify causal mechanisms, investigate other risk factors, and study psychosis incidence in other environments such as lower-income countries.
#17 Neighbourhood characteristics and the incidence of first-episode psychosis and duration of untreated psychosis | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/neighbourhood-characteristics-and-the-incidence-of-firstepisode-psychosis-and-duration-of-untreated-psychosis/C28E11FF43B948E33FAD63DCC1744D1D
The incidence of psychotic disorders varies between geographical areas and it has been hypothesized that neighbourhood-level factors may influence this variation. […] The aims of this study were to determine whether the incidence of first-episode psychosis (FEP) and the DUP are associated with the level of social deprivation, fragmentation, social capital and population density. […] The incidence of FEP was also increased in neighbourhoods that were more socially fragmented [incidence rate ratio (IRR) = 2.40, 95% CI 1.055.51, p = 0.04] and there was a trend for the incidence to be increased in neighbourhoods with lower social capital (IRR = 1.43, 95% CI 0.992.06, p = 0.05). […] The incidence of psychotic disorders is related to neighbourhood factors and it may be useful to consider neighbourhood factors when allocating resources for early intervention services.
#18 The psychosis analysis in real-world on a cohort of large-scale patients with schizophrenia | BMC Medical Informatics and Decision Making | Full Text
https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/s12911-020-1125-0
Through the above analysis of the distribution characteristics of schizophrenia in various regions of Guangdong province, it could be found that the efficacy and risk were correlated. Poverty areas with backward economic conditions such as northern Guangdong were often accompanied by poor curative effect and high-risk assessment. On the contrary, in areas with developed economy and good medical resources, such as Guangzhou, Foshan, Shenzhen, the risk assessment was lower, indicating that the disease was effectively controlled. […] The evidence of variation in therapeutic effect and risk assessment in different regions, associated with local economic levels and medical resources was analyzed. Several demographic factors affecting the effectiveness and risk of psychiatric care were identified, which might benefit the evaluation and optimization of the disease treatment.
#19 Alcohol-Related Psychosis: Background, Pathophysiology, Epidemiology
https://emedicine.medscape.com/article/289848-overview
Roughly 3% of persons with alcoholism experience psychosis during acute intoxication or withdrawal. Approximately 10% of patients who are dependent on alcohol and are in withdrawal experience severe withdrawal symptomatology, including psychosis. […] Those with first-episode psychosis are twice more likely than the general population to present with comorbid substance abuse and are more commonly males than females. The most commonly reported substance is cannabis (51%) followed by alcohol (43%). […] Studies of the Soviet Slavic Republic of Belarus from 1970-2005 suggest a correlation between cultural and social context of alcohol consumption and alcohol-related suicides and alcohol-induced psychosis. Furthermore, there appears to be a close correlation between alcohol psychosis and higher mortality rates compared with alcohol consumption and no psychosis.
#20 Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study | The BMJ
https://www.bmj.com/content/342/bmj.d738
Objective To determine whether use of cannabis in adolescence increases the risk for psychotic outcomes by affecting the incidence and persistence of subclinical expression of psychosis in the general population (that is, expression of psychosis below the level required for a clinical diagnosis). […] Main outcome measure Incidence and persistence of subthreshold psychotic symptoms after use of cannabis in adolescence. Cannabis use and psychotic symptoms were assessed at three time points (baseline, T2 (3.5 years), T3 (8.4 years)) over a 10 year follow-up period with the Munich version of the composite international diagnostic interview (M-CIDI). […] Results In individuals who had no reported lifetime psychotic symptoms and no reported lifetime cannabis use at baseline, incident cannabis use over the period from baseline to T2 increased the risk of later incident psychotic symptoms over the period from T2 to T3 (adjusted odds ratio 1.9, 95% confidence interval 1.1 to 3.1; P=0.021). Furthermore, continued use of cannabis increased the risk of persistent psychotic symptoms over the period from T2 to T3 (2.2, 1.2 to 4.2; P=0.016).
#21 Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10 year follow-up cohort study | The BMJ
https://www.bmj.com/content/342/bmj.d738
In a population based 10 year follow-up cohort study of adolescents and young adults, we investigated the association between incident cannabis use and true incidence of psychotic experiences (that is, after exclusion of individuals with lifetime pre-existing psychotic experiences) and risk of persistence of psychotic experiences. […] The finding that longer exposure to cannabis was associated with greater risk for persistence of psychotic experiences is in line with an earlier study showing that continued cannabis use over time increases the risk for psychosis in a dose-response fashion. […] Our study confirmed cannabis as an environmental risk factor, impacting on risk of psychosis by increasing the risk of incident psychotic experiences, and, if use continues over time, increasing the risk of persistent psychotic experiences.
#22 MethamphetamineâRelated Psychosis: Symptoms, Epidemiology, Risk Factors and Intervention | Frontiers Research Topic
https://www.frontiersin.org/research-topics/7349/methamphetamine-related-psychosis-symptoms-epidemiology-risk-factors-and-intervention/articles
Over the past decades, a lot of research has been done on MA-related psychosis, and the results showed that the prevalence of psychosis in MA users is much higher than that in the general population, particularly in dependent MA users. Violent behaviors were highly frequent in MA-related psychosis patients. Moreover, persecutory delusion and auditory hallucination were the most frequent persistent psychotic symptoms in these patients. Many factors are related to the development of MA-related psychosis. Studies showed that the risk of MA-related psychosis was significantly different among people with different characteristics. Male gender, low level of education, unemployment, and being single are risk factors of MA-related psychosis. Besides, form of MA, intensity of MA use including dose, frequency, and duration of use, and polydrug use are significantly correlated with the risk of MA-related psychosis. Other important factors contributing to MA-related psychosis include a history of mental disorders and adverse childhood events such as (ADHD). Additionally, research also suggests that there may be a correlation between genetic variation and MA-related psychosis. Some specific genes such as adenosine receptor [ADORA2A] gene, metabotropic glutamate receptor 2 [GRM2] gene, and 5-HTTLPR gene may be related to the susceptibility of MA-related psychosis. However, more studies are needed to replicate these findings and to figure out the interaction between genetic and environmental factors that contribute to the onset of MA-related psychosis.
#23 Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review
https://www.mdpi.com/2076-3425/11/1/47
Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1â2 in every 1000 deliveries. […] The postpartum period has been demonstrated as a time of particularly high risk of severe psychiatric disorders, implicating childbirth in the triggering of these episodes. […] In a seminal study conducted in a UK population sample, the risk of psychiatric admission for a psychotic or mood illness was 22 times greater in the first month following delivery compared to before pregnancy. […] While more than 40% of women affected by postpartum psychosis have no history of severe psychiatric illness, the remainder present with a recurrence of a pre-existing psychiatric illness, predominantly of a psychotic or mood disorder. […] Evidence robustly indicates a strong and specific relationship with bipolar disorder, suggesting that in most cases, postpartum psychosis may be a manifestation of bipolar disorder in women vulnerable to the puerperal trigger.
#24 Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review
https://www.mdpi.com/2076-3425/11/1/47
Postpartum psychoses are a severe form of postnatal mood disorders, affecting 1â2 in every 1000 deliveries. […] The postpartum period has been demonstrated as a time of particularly high risk of severe psychiatric disorders, implicating childbirth in the triggering of these episodes. […] In a seminal study conducted in a UK population sample, the risk of psychiatric admission for a psychotic or mood illness was 22 times greater in the first month following delivery compared to before pregnancy. […] While more than 40% of women affected by postpartum psychosis have no history of severe psychiatric illness, the remainder present with a recurrence of a pre-existing psychiatric illness, predominantly of a psychotic or mood disorder. […] Evidence robustly indicates a strong and specific relationship with bipolar disorder, suggesting that in most cases, postpartum psychosis may be a manifestation of bipolar disorder in women vulnerable to the puerperal trigger.
#25 Phenomenology, Epidemiology and Aetiology of Postpartum Psychosis: A Review
https://www.mdpi.com/2076-3425/11/1/47
A recent meta-analysis estimated that as many as one in five women with bipolar disorder are affected postnatally by a psychotic or manic episode, a rate considerably higher than that observed in the general population (1â2 in every 1000 deliveries) and other psychiatric disorders. […] In contrast, the risk of psychiatric admission for a recurrence of bipolar disorder in the postpartum period is especially high, being 37 times more likely than in women who had never given birth. […] This finding has since been replicated in a more recent study, showing psychiatric admissions within the first 6 weeks of childbirth to most commonly be for a severe recurrence of bipolar disorder (14.4%), while other psychiatric disorders accounted for a considerably lower proportion of all admissions (ranging from 1.4 to 7.2%).
#26 Epidemiology and Pathophysiology of Dementia-Related Psychosis
https://www.psychiatrist.com/jcp/dementia-related-psychosis-epidemiology-and-pathophysiology/
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and depression. Dementia-related psychosis (DRP), which includes delusions and hallucinations, contributes to institutionalization, cognitive decline, and caregiver burden. […] This report will examine the epidemiology and pathophysiology of DRP and communication about psychotic symptoms with patients with dementia (if possible) and their care partners. […] DRP can occur in all dementia types. The prevalence of psychosis among people with dementia is estimated to be greatest in those with DLB and PD; studies have reported the following approximate overall prevalence rates of DRP: DLB, 75%; PD, 50%; AD, 30%; VD, 15%; FTD, 10%. […] A longitudinal study of patients living with AD reported that, over 3 years, 23% of patients developed only delusions, 9% developed only hallucinations, and 19% developed both delusions and hallucinations. A review of 55 studies showed that psychosis occurred in about 40% of patients with AD, and delusions occurred more frequently (36%) than hallucinations (18%).
#27 Epidemiology and Pathophysiology of Dementia-Related Psychosis
https://www.psychiatrist.com/jcp/dementia-related-psychosis-epidemiology-and-pathophysiology/
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and depression. Dementia-related psychosis (DRP), which includes delusions and hallucinations, contributes to institutionalization, cognitive decline, and caregiver burden. […] This report will examine the epidemiology and pathophysiology of DRP and communication about psychotic symptoms with patients with dementia (if possible) and their care partners. […] DRP can occur in all dementia types. The prevalence of psychosis among people with dementia is estimated to be greatest in those with DLB and PD; studies have reported the following approximate overall prevalence rates of DRP: DLB, 75%; PD, 50%; AD, 30%; VD, 15%; FTD, 10%. […] A longitudinal study of patients living with AD reported that, over 3 years, 23% of patients developed only delusions, 9% developed only hallucinations, and 19% developed both delusions and hallucinations. A review of 55 studies showed that psychosis occurred in about 40% of patients with AD, and delusions occurred more frequently (36%) than hallucinations (18%).
#28 Epidemiology and Pathophysiology of Dementia-Related Psychosis
https://www.psychiatrist.com/jcp/dementia-related-psychosis-epidemiology-and-pathophysiology/
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and depression. Dementia-related psychosis (DRP), which includes delusions and hallucinations, contributes to institutionalization, cognitive decline, and caregiver burden. […] This report will examine the epidemiology and pathophysiology of DRP and communication about psychotic symptoms with patients with dementia (if possible) and their care partners. […] DRP can occur in all dementia types. The prevalence of psychosis among people with dementia is estimated to be greatest in those with DLB and PD; studies have reported the following approximate overall prevalence rates of DRP: DLB, 75%; PD, 50%; AD, 30%; VD, 15%; FTD, 10%. […] A longitudinal study of patients living with AD reported that, over 3 years, 23% of patients developed only delusions, 9% developed only hallucinations, and 19% developed both delusions and hallucinations. A review of 55 studies showed that psychosis occurred in about 40% of patients with AD, and delusions occurred more frequently (36%) than hallucinations (18%).
#29 Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-024-00852-6
Post-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. […] The prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. […] PSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors.
#30 Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-024-00852-6
Post-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. […] The prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. […] PSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors.
#31 Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study | The Egyptian Journal of Neurology, Psychiatry and Neurosurgery | Full Text
https://ejnpn.springeropen.com/articles/10.1186/s41983-024-00852-6
Post-stroke psychosis (PSP) is a significant neuropsychiatric complication that can profoundly impact the prognosis and quality of life of stroke survivors. Despite its importance, PSP is often underdiagnosed and undertreated, and there is a paucity of global data on its prevalence and risk factors. […] In this study, 5.4% (108/2624) of stroke patients initially screened developed PSP within 6 months post-stroke. These prevalence estimates closely align with the findings from a prior systematic review in 2018 (4.86%) […] Multivariate logistic regression identified older age, male sex, lower education level (5 years), hemiplegia, sphincter affection, cortical lesions, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures as independent predictors of PSP development.
#32 The prevalence of psychosis in epilepsy; a systematic review and meta-analysis | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-75
Epilepsy has long been considered to be a risk factor for psychosis. However there is a lack of consistency in findings across studies on the effect size of this risk which reflects methodological differences in studies and changing diagnostic classifications within neurology and psychiatry. The aim of this study was to assess the prevalence of psychosis in epilepsy and to estimate the risk of psychosis among individuals with epilepsy compared with controls. […] The pooled odds ratio for risk of psychosis among people with epilepsy compared with controls was 7.8. The pooled estimate of prevalence of psychosis in epilepsy was found to be 5.6% (95% CI: 4.8-6.4). […] Our systematic review found that up to 6% of individuals with epilepsy have a co-morbid psychotic illness and that patients have an almost eight fold increased risk of psychosis. The prevalence rate of psychosis is higher in temporal lobe epilepsy (7%).
#33 The prevalence of psychosis in epilepsy; a systematic review and meta-analysis | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-75
In one of the most epidemiologically complete studies involving direct patient interviews of all individuals with epilepsy in Iceland, Gudmundson (1966) reported a rate of psychosis of 7.2%. […] The majority of studies have found a higher prevalence of psychosis in patients with epilepsy compared with the general population, but this finding is not consistent and reported rates varying from 0.48% to 35.7%. […] Our finding of 5.6% pooled prevalence of psychosis in epilepsy is lower than estimates of approximately 7% estimates from previous narrative reviews, although our finding of 7% for the rate of psychosis in temporal lobe epilepsy is similar. […] Based on results from population based studies with control samples, we found that the rate of psychosis among people with epilepsy is 7.8 times higher than in people without epilepsy.
#34 The prevalence of psychosis in epilepsy; a systematic review and meta-analysis | BMC Psychiatry | Full Text
https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-14-75
We found a low prevalence of postictal psychosis in epilepsy-2%. […] The rate of interictal psychosis at 5.2% was over two and a half times the rate of postictal psychosis, but similar to the rate for overall psychosis in epilepsy. […] Our results found a slighter higher rate of psychosis in TLE as compared to all epilepsies (7% v 5.6%). […] Most of the studies included in this review were cross sectional in design (77.6%) and based on samples from tertiary referral centres (71%) and these factors may limit the interpretation of the results with respect to the general population. Only 10% of the studies were population-based.
#35 Psychosis – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK546579/
Psychosis is a common feature of many psychiatric, neuropsychiatric, neurologic, neurodevelopmental, and medical conditions. […] It is thought that although around 1.5 to 3.5 percent of people will meet diagnostic criteria for a psychotic disorder, a significantly larger variable number will experience at least one psychotic symptom in their lifetime. […] The incidence of a first-time episode of psychosis is approximately 50 in 100000 people, while the incidence of schizophrenia is about 15 in 100000 people. […] The peak age of onset for males is teens to mid-20s, while for females, the onset tends to be teens to late-20s. […] Psychosis is extremely uncommon in children. […] The prodromal phase of schizophrenia commonly presents with negative symptoms. […] Early intervention is essential for good long-term outcomes.
#36 Identifying patients at risk of psychosis: a qualitative study of GP views in South West England | British Journal of General Practice
https://bjgp.org/content/71/703/e113
Early intervention in people with an at-risk mental state for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of this patient group but very few studies have explored GPs awareness of patients who are at risk of psychosis. […] Some GPs were not familiar with the concept of being at risk of developing psychosis, and perceived that they may not have the right skills to identify this patient group. Other barriers related to patients not presenting or disclosing psychotic symptoms, and limitations imposed by scarce resources on the structure and provision of NHS services, such as lack of continuity of care and high thresholds for accessing specialised services. […] Identifying people at risk of psychosis in primary care is difficult. Provision of GP training, development of policies that support continuity of care, and improved access to specialised services could help improve the identification of this patient group.
#37 Identifying patients at risk of psychosis: a qualitative study of GP views in South West England | British Journal of General Practice
https://bjgp.org/content/71/703/e113
Early intervention in people with an at-risk mental state for psychosis can decrease the rates of transition to psychosis. GPs play a key role in the identification of this patient group but very few studies have explored GPs awareness of patients who are at risk of psychosis. […] Some GPs were not familiar with the concept of being at risk of developing psychosis, and perceived that they may not have the right skills to identify this patient group. Other barriers related to patients not presenting or disclosing psychotic symptoms, and limitations imposed by scarce resources on the structure and provision of NHS services, such as lack of continuity of care and high thresholds for accessing specialised services. […] Identifying people at risk of psychosis in primary care is difficult. Provision of GP training, development of policies that support continuity of care, and improved access to specialised services could help improve the identification of this patient group.
#38 Identifying patients at risk of psychosis: a qualitative study of GP views in South West England | British Journal of General Practice
https://bjgp.org/content/71/703/e113
Very few studies have explored GPs awareness of the at-risk mental state for psychosis, and to the authors knowledge, no study has explored GPs views of these patients in detail, or the difficulties GPs face in identifying this patient group. […] GPs are usually the first point of contact with health services for people with early signs of psychosis, and play a key role in referring patients to specialised services. However, identification of people with an at-risk mental state for psychosis is not straightforward given the non-specific nature of its presentation, and the high comorbidity with common mental health problems. […] GPs may not be familiar with the concept of being at risk of developing psychosis. Some GPs mentioned that they may not be asking the right questions and would benefit from more training on the early symptoms of psychosis. GPs also reported that mild or short-lived psychotic symptoms often occurred in the context of other mental health disorders, which made the identification of these patients difficult. However, there were GPs who recognised this patient group, but reported that potential patients with an at-risk mental state for psychosis rarely consulted in primary care. […] The challenges of working within a healthcare system where resource limitations impose restrictions on appointment availability and length of consultations, as well as a lack of continuity of care were mentioned as having a negative impact on identifying these patients.
#39 JMIR Research Protocols – Early Signs Monitoring to Prevent Relapse in Psychosis and Promote Well-Being, Engagement, and Recovery: Protocol for a Feasibility Cluster Randomized Controlled Trial Harnessing Mobile Phone Technology Blended With Peer Support
https://www.researchprotocols.org/2020/1/e15058/
A Cochrane review focused on the effectiveness of interventions targeting recognition and management of EWSs of relapse in schizophrenia. […] Mobile phone technology offers a significant opportunity to deliver EMA-based monitoring of changes in well-being that are ecologically valid and contextually sensitive. […] Digital technology has the potential to offer a step change that can influence early signs monitoring both for people receiving and providing mental health services. […] The EMPOWER intervention aims to enhance the recognition of EWSs by people using services and their carers and to provide a stepped-care pathway that is either self-activated or in liaison with a carer and/or community health care professional, which then triggers a relapse prevention strategy that can be stepped up to a whole team response to reduce the likelihood of a psychotic relapse.
#40 Azthena logo with the word Azthena
https://www.news-medical.net/news/20211028/New-application-makes-it-possible-to-monitor-the-symptoms-of-people-at-risk-for-psychosis.aspx
A team from the UNIGE has developed an application that makes it possible to monitor the frequency and intensity of the symptoms of people at risk for psychosis on a daily basis, in order to be able to adapt their medical follow-up and determine the cause of the appearance of symptoms. […] In order to adapt the medical follow-up and to avoid a worsening of the disorder, it is essential to closely monitor the evolution of psychotic symptoms, both in terms of frequency and intensity. […] This remote monitoring would make it possible to space out face-to-face sessions and make them necessary only when the person is going through a crisis phase or an exacerbation of symptoms. […] To study the development of psychosis, scientists are following patients suffering from a microdeletion of chromosome 22q11.2, a genetic condition associated with an increased risk of psychosis such as schizophrenia.
#41 Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment | Molecular Psychiatry
https://www.nature.com/articles/s41380-023-02029-8
Comorbid mental disorders in subjects at clinical high risk for psychosis (CHR-P) may impact preventive care. […] A recent meta-analysis estimated that the epidemiological prevalence of CHR-P status is around 1.7% in the general population, and 19.2% in clinical samples. […] Subjects with CHR-P have complex and heterogeneous clinical presentations with frequent non-psychotic comorbid mental disorders beyond their attenuated psychotic symptoms, such as negative, and affective symptoms, mood, anxiety, obsessive compulsive and personality disorders. […] The clinical impact of comorbid disorders on the level of functioning in CHR-P individuals is not fully understood. […] Overall, CHR-P individuals have a risk of transitioning to a first episode of psychosis of 20% by two years and 35% by 10 years, which only plateaus after year 4.
#42 Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment | Molecular Psychiatry
https://www.nature.com/articles/s41380-023-02029-8
There is also contrasting evidence that baseline comorbid mental disorders impact risk of transition to psychosis in CHR-P individuals, with some studies showing that depression increases the risk, or that anxiety decreases it, and other studies showing no significant association. […] Most of those who will not develop psychosis at follow-up will present persistent comorbid mental disorders. […] The primary outcome was the baseline prevalence of comorbid mental disorders in CHR-P individuals. […] The core finding of this meta-analysis is that over three-quarters of CHR-P subjects present with baseline comorbid mental disorders beyond their CHR-P features. […] This finding aligns with ancient phenomenological accounts and more recent epidemiological evidence indicating that psychosis onset can originate from various non-psychotic precursors and therefore it is essentially transdiagnostic in nature.
#43 Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment | Molecular Psychiatry
https://www.nature.com/articles/s41380-023-02029-8
We also found that the prevalence of comorbid mental disorders tended to decrease over time, yet remaining high, with the exception of any substance use disorders, which increased over follow-up. […] The observed increased prevalence may be partially explained by the fact that cannabis use disorders (which is part of any substance use disorders) is an independent risk factor for developing psychosis. […] Overall, our findings on increased rates of substance use disorders after CHR-P status should be interpreted with caution as they are based on five studies at best across multiple follow-up time points. […] We further found that CHR-P individuals had higher baseline prevalence of any anxiety, panic, anxiety disorders not otherwise specified, schizotypal personality disorder, and alcohol use disorders compared to non-psychotic controls.
#44 Meta-analytic prevalence of comorbid mental disorders in individuals at clinical high risk of psychosis: the case for transdiagnostic assessment | Molecular Psychiatry
https://www.nature.com/articles/s41380-023-02029-8
We also found that the prevalence of comorbid mental disorders tended to decrease over time, yet remaining high, with the exception of any substance use disorders, which increased over follow-up. […] The observed increased prevalence may be partially explained by the fact that cannabis use disorders (which is part of any substance use disorders) is an independent risk factor for developing psychosis. […] Overall, our findings on increased rates of substance use disorders after CHR-P status should be interpreted with caution as they are based on five studies at best across multiple follow-up time points. […] We further found that CHR-P individuals had higher baseline prevalence of any anxiety, panic, anxiety disorders not otherwise specified, schizotypal personality disorder, and alcohol use disorders compared to non-psychotic controls.
#45 Prevalence and Correlates of Sleep Disorders in First-Episode Psychosis
https://www.psychiatrictimes.com/view/prevalence-and-correlates-of-sleep-disorders-in-first-episode-psychosis
Sleep disorders are highly prevalent in patients with psychotic disorders. This comorbidity has a significant impact on the clinical course of illness, including worsening psychotic symptoms and cognitive impairment, as well as poorer functioning and decreased quality of life. […] The authors concluded that there was a high prevalence of poor sleep quality and insomnia in patients with FEP. […] Findings provide evidence that sleep problems are common at the onset of psychotic illness. Sleep disorders represent a potential therapeutic target in psychosis to improve psychopathology and functioning.
#46 Recognition and Differential Diagnosis of Psychosis in Primary Care | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html
Medical conditions associated with psychosis include autoimmune, endocrine, neurologic, and nutritional disorders. Suspected endocrine conditions include thyroid and parathyroid dysfunction. Hallmark neurologic conditions include temporal lobe epilepsy, Parkinson disease, and Lewy body disease. A subacute onset of psychosis should raise suspicion for an oncologic cause, such as a steroid-producing tumor, space-occupying brain lesion, or paraneoplastic etiology. Genetic or heritable diseases should be considered; for example, Huntington disease may first present with a psychotic episode.
#47 Recognition and Differential Diagnosis of Psychosis in Primary Care | AAFP
https://www.aafp.org/pubs/afp/issues/2015/0615/p856.html
Medical conditions associated with psychosis include autoimmune, endocrine, neurologic, and nutritional disorders. Suspected endocrine conditions include thyroid and parathyroid dysfunction. Hallmark neurologic conditions include temporal lobe epilepsy, Parkinson disease, and Lewy body disease. A subacute onset of psychosis should raise suspicion for an oncologic cause, such as a steroid-producing tumor, space-occupying brain lesion, or paraneoplastic etiology. Genetic or heritable diseases should be considered; for example, Huntington disease may first present with a psychotic episode.
#48
https://journals.lww.com/joms/fulltext/2025/01000/psychiatric_manifestations_in_a_patient_with.7.aspx
The incidence of syphilis has been steadily increasing over the past decade in both the United States and Taiwan. […] These trends underscore the importance of continued vigilance and awareness of syphilis, particularly in the context of its varied and often subtle presentations. […] Previous research indicates that approximately 30.8% of patients with neurosyphilis exhibit psychiatric manifestations. […] Given the increasing incidence of syphilis and neurosyphilis, it is essential to remain vigilant and consider these treatment protocols to manage and prevent the resurgence of this infection effectively. […] This case underscores the importance of recognizing and treating neurosyphilis, even in the era of widespread antibiotic use. […] It is important for a psychiatrist to be more watchful when evaluating syphilis screening tests and take neurosyphilis into consideration as a differential diagnosis of mild cognitive impairment so as to enhance the therapeutic strategy for elderly patients and prevent the potentially irreversible complications it can cause.
#49 Epidemiology & Impact of Psychosis | SPIRIT Center at the University of Washington
https://uwspiritcenter.org/epidemiology-impact-of-psychosis/
Epidemiology & Impact of Psychosis […] Compared to their peers, people with schizophrenia are at substantially increased risk of unemployment, incarceration, homelessness, social isolation, and premature mortality. Research conducted by SPIRIT faculty has investigated the epidemiology and impact of psychosis and factors that drive quality of care and outcomes and has identified critical health and healthcare disparities. […] National Study of Mental Health (NSMH). This Substance Abuse and Mental Health Services (SAMHSA)-funded National Study of Mental Health (NSMH) will provide precise national estimates of mental health disorders among U.S adults ages 18 to 65. […] SPIRIT investigators are partners on this large nationwide study which will involve clinical interviews of national samples of households and incarcerated individuals in federal/state prisons; and local samples of individuals in homeless shelters, jails and state psychiatric hospitals in New York City, NY; Seattle, WA and Durham, NC. […] Veterans with schizophrenia have increased risk of mortality compared to veterans who do not have a mental disorder. […] In a study of a national sample of more than 500,000 veterans, having a diagnosis of schizophrenia was associated with 1.5 times the risk of all-cause mortality over a 9-year period. […] People with schizophrenia have a higher risk of dementia. […] In a population-based study of more than 2.8 million persons aged 50 years or older from 6 nationwide registers in Denmark followed for 18 years, individuals with schizophreniaâespecially those younger than 65 yearsâhad a markedly increased relative risk of dementia that could not be explained by established dementia risk factors. […] Tobacco use is associated with poor outcomes in First Episode Psychosis treatment. […] In another study that used data from the RAISE clinical trial, we found that 50% of the 400 youth and young adults who participated in this research study reported recent tobacco useâthat tobacco smokers had significantly more severe psychiatric symptoms and lower quality of life during treatment relative to non-smokers. […] Racial Disparities in First Episode Psychosis Treatment. […] In additional analyses of RAISE study data, SPIRIT investigators demonstrated that Black patients were less likely to receive important services (compared with non-Hispanic white patients), both among those receiving either usual community care or the NAVIGATE treatment of coordinated specialty care. […] Having schizophrenia increases the risk of medical re-hospitalization among people with diabetes. […] In a study of more than 80,000 adults in Washington state who had a medical hospitalization for diabetes between 2010-2011, those who also had schizophrenia were 24% more likely to be re-hospitalized within 30 days.
#50 Epidemiology & Impact of Psychosis | SPIRIT Center at the University of Washington
https://uwspiritcenter.org/epidemiology-impact-of-psychosis/
Epidemiology & Impact of Psychosis […] Compared to their peers, people with schizophrenia are at substantially increased risk of unemployment, incarceration, homelessness, social isolation, and premature mortality. Research conducted by SPIRIT faculty has investigated the epidemiology and impact of psychosis and factors that drive quality of care and outcomes and has identified critical health and healthcare disparities. […] National Study of Mental Health (NSMH). This Substance Abuse and Mental Health Services (SAMHSA)-funded National Study of Mental Health (NSMH) will provide precise national estimates of mental health disorders among U.S adults ages 18 to 65. […] SPIRIT investigators are partners on this large nationwide study which will involve clinical interviews of national samples of households and incarcerated individuals in federal/state prisons; and local samples of individuals in homeless shelters, jails and state psychiatric hospitals in New York City, NY; Seattle, WA and Durham, NC. […] Veterans with schizophrenia have increased risk of mortality compared to veterans who do not have a mental disorder. […] In a study of a national sample of more than 500,000 veterans, having a diagnosis of schizophrenia was associated with 1.5 times the risk of all-cause mortality over a 9-year period. […] People with schizophrenia have a higher risk of dementia. […] In a population-based study of more than 2.8 million persons aged 50 years or older from 6 nationwide registers in Denmark followed for 18 years, individuals with schizophreniaâespecially those younger than 65 yearsâhad a markedly increased relative risk of dementia that could not be explained by established dementia risk factors. […] Tobacco use is associated with poor outcomes in First Episode Psychosis treatment. […] In another study that used data from the RAISE clinical trial, we found that 50% of the 400 youth and young adults who participated in this research study reported recent tobacco useâthat tobacco smokers had significantly more severe psychiatric symptoms and lower quality of life during treatment relative to non-smokers. […] Racial Disparities in First Episode Psychosis Treatment. […] In additional analyses of RAISE study data, SPIRIT investigators demonstrated that Black patients were less likely to receive important services (compared with non-Hispanic white patients), both among those receiving either usual community care or the NAVIGATE treatment of coordinated specialty care. […] Having schizophrenia increases the risk of medical re-hospitalization among people with diabetes. […] In a study of more than 80,000 adults in Washington state who had a medical hospitalization for diabetes between 2010-2011, those who also had schizophrenia were 24% more likely to be re-hospitalized within 30 days.
#51 Epidemiology & Impact of Psychosis | SPIRIT Center at the University of Washington
https://uwspiritcenter.org/epidemiology-impact-of-psychosis/
Epidemiology & Impact of Psychosis […] Compared to their peers, people with schizophrenia are at substantially increased risk of unemployment, incarceration, homelessness, social isolation, and premature mortality. Research conducted by SPIRIT faculty has investigated the epidemiology and impact of psychosis and factors that drive quality of care and outcomes and has identified critical health and healthcare disparities. […] National Study of Mental Health (NSMH). This Substance Abuse and Mental Health Services (SAMHSA)-funded National Study of Mental Health (NSMH) will provide precise national estimates of mental health disorders among U.S adults ages 18 to 65. […] SPIRIT investigators are partners on this large nationwide study which will involve clinical interviews of national samples of households and incarcerated individuals in federal/state prisons; and local samples of individuals in homeless shelters, jails and state psychiatric hospitals in New York City, NY; Seattle, WA and Durham, NC. […] Veterans with schizophrenia have increased risk of mortality compared to veterans who do not have a mental disorder. […] In a study of a national sample of more than 500,000 veterans, having a diagnosis of schizophrenia was associated with 1.5 times the risk of all-cause mortality over a 9-year period. […] People with schizophrenia have a higher risk of dementia. […] In a population-based study of more than 2.8 million persons aged 50 years or older from 6 nationwide registers in Denmark followed for 18 years, individuals with schizophreniaâespecially those younger than 65 yearsâhad a markedly increased relative risk of dementia that could not be explained by established dementia risk factors. […] Tobacco use is associated with poor outcomes in First Episode Psychosis treatment. […] In another study that used data from the RAISE clinical trial, we found that 50% of the 400 youth and young adults who participated in this research study reported recent tobacco useâthat tobacco smokers had significantly more severe psychiatric symptoms and lower quality of life during treatment relative to non-smokers. […] Racial Disparities in First Episode Psychosis Treatment. […] In additional analyses of RAISE study data, SPIRIT investigators demonstrated that Black patients were less likely to receive important services (compared with non-Hispanic white patients), both among those receiving either usual community care or the NAVIGATE treatment of coordinated specialty care. […] Having schizophrenia increases the risk of medical re-hospitalization among people with diabetes. […] In a study of more than 80,000 adults in Washington state who had a medical hospitalization for diabetes between 2010-2011, those who also had schizophrenia were 24% more likely to be re-hospitalized within 30 days.
#52 Epidemiology & Impact of Psychosis | SPIRIT Center at the University of Washington
https://uwspiritcenter.org/epidemiology-impact-of-psychosis/
Epidemiology & Impact of Psychosis […] Compared to their peers, people with schizophrenia are at substantially increased risk of unemployment, incarceration, homelessness, social isolation, and premature mortality. Research conducted by SPIRIT faculty has investigated the epidemiology and impact of psychosis and factors that drive quality of care and outcomes and has identified critical health and healthcare disparities. […] National Study of Mental Health (NSMH). This Substance Abuse and Mental Health Services (SAMHSA)-funded National Study of Mental Health (NSMH) will provide precise national estimates of mental health disorders among U.S adults ages 18 to 65. […] SPIRIT investigators are partners on this large nationwide study which will involve clinical interviews of national samples of households and incarcerated individuals in federal/state prisons; and local samples of individuals in homeless shelters, jails and state psychiatric hospitals in New York City, NY; Seattle, WA and Durham, NC. […] Veterans with schizophrenia have increased risk of mortality compared to veterans who do not have a mental disorder. […] In a study of a national sample of more than 500,000 veterans, having a diagnosis of schizophrenia was associated with 1.5 times the risk of all-cause mortality over a 9-year period. […] People with schizophrenia have a higher risk of dementia. […] In a population-based study of more than 2.8 million persons aged 50 years or older from 6 nationwide registers in Denmark followed for 18 years, individuals with schizophreniaâespecially those younger than 65 yearsâhad a markedly increased relative risk of dementia that could not be explained by established dementia risk factors. […] Tobacco use is associated with poor outcomes in First Episode Psychosis treatment. […] In another study that used data from the RAISE clinical trial, we found that 50% of the 400 youth and young adults who participated in this research study reported recent tobacco useâthat tobacco smokers had significantly more severe psychiatric symptoms and lower quality of life during treatment relative to non-smokers. […] Racial Disparities in First Episode Psychosis Treatment. […] In additional analyses of RAISE study data, SPIRIT investigators demonstrated that Black patients were less likely to receive important services (compared with non-Hispanic white patients), both among those receiving either usual community care or the NAVIGATE treatment of coordinated specialty care. […] Having schizophrenia increases the risk of medical re-hospitalization among people with diabetes. […] In a study of more than 80,000 adults in Washington state who had a medical hospitalization for diabetes between 2010-2011, those who also had schizophrenia were 24% more likely to be re-hospitalized within 30 days.
#53 Epidemiology & Impact of Psychosis | SPIRIT Center at the University of Washington
https://uwspiritcenter.org/epidemiology-impact-of-psychosis/
Epidemiology & Impact of Psychosis […] Compared to their peers, people with schizophrenia are at substantially increased risk of unemployment, incarceration, homelessness, social isolation, and premature mortality. Research conducted by SPIRIT faculty has investigated the epidemiology and impact of psychosis and factors that drive quality of care and outcomes and has identified critical health and healthcare disparities. […] National Study of Mental Health (NSMH). This Substance Abuse and Mental Health Services (SAMHSA)-funded National Study of Mental Health (NSMH) will provide precise national estimates of mental health disorders among U.S adults ages 18 to 65. […] SPIRIT investigators are partners on this large nationwide study which will involve clinical interviews of national samples of households and incarcerated individuals in federal/state prisons; and local samples of individuals in homeless shelters, jails and state psychiatric hospitals in New York City, NY; Seattle, WA and Durham, NC. […] Veterans with schizophrenia have increased risk of mortality compared to veterans who do not have a mental disorder. […] In a study of a national sample of more than 500,000 veterans, having a diagnosis of schizophrenia was associated with 1.5 times the risk of all-cause mortality over a 9-year period. […] People with schizophrenia have a higher risk of dementia. […] In a population-based study of more than 2.8 million persons aged 50 years or older from 6 nationwide registers in Denmark followed for 18 years, individuals with schizophreniaâespecially those younger than 65 yearsâhad a markedly increased relative risk of dementia that could not be explained by established dementia risk factors. […] Tobacco use is associated with poor outcomes in First Episode Psychosis treatment. […] In another study that used data from the RAISE clinical trial, we found that 50% of the 400 youth and young adults who participated in this research study reported recent tobacco useâthat tobacco smokers had significantly more severe psychiatric symptoms and lower quality of life during treatment relative to non-smokers. […] Racial Disparities in First Episode Psychosis Treatment. […] In additional analyses of RAISE study data, SPIRIT investigators demonstrated that Black patients were less likely to receive important services (compared with non-Hispanic white patients), both among those receiving either usual community care or the NAVIGATE treatment of coordinated specialty care. […] Having schizophrenia increases the risk of medical re-hospitalization among people with diabetes. […] In a study of more than 80,000 adults in Washington state who had a medical hospitalization for diabetes between 2010-2011, those who also had schizophrenia were 24% more likely to be re-hospitalized within 30 days.
#54 Cognitive epidemiology: psychological and social risk mechanisms for psychosis | SpringerLink
https://link.springer.com/chapter/10.1007/978-3-642-57516-7_4
The hypothesis that psychosis exists in nature as a distribution of symptoms is not so bold as it may seem. […] Given the substantial degree of overlap in terms of psychopathology, outcome, risk factors and treatment between depression and psychosis, it is unlikely that psychosis, contrary to depression, would have a completely non-continuous, dichotomous distribution. […] This hypothesis, however, has attracted relatively little research effort, especially from the psychiatric profession. […] Risk factors for onset and persistence of psychosis. […] Self-reported psychosis-like symptoms and the continuum of psychosis. […] Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison. […] Psychosis as a continuum of variation in dimensions of psychopathology. […] Evidence that ethnic group effects on psychosis risk are confounded by experience of discrimination.
#55
https://www.emerald.com/insight/content/doi/10.5042/jpmh.2010.0324/full/html
Genetic and environmental factors are associated with psychosis risk, but the latter present more tangible markers for prevention. […] Up to 22% of all psychoses in England (46.9% within our study areas) could be prevented if exposures associated with increased incidence in ethnic minority populations could be removed; this is equivalent to 66.9% within ethnic minority groups themselves. […] Effect sizes for common socioenvironmental risk indicators for psychosis are large; inequalities were marked. This analysis demonstrates potential importance in another light: we need to move beyond current epidemiological approaches to elucidate exact socioenvironmental factors that underpin urbanicity and ethnic minority status as markers of increased risk by incorporating gene-environment interactions that adopt a multi disciplinary perspective.
#56 Psychosis incidence highly variable internationally | UCL News – UCL â University College London
https://www.ucl.ac.uk/news/2017/dec/psychosis-incidence-highly-variable-internationally
Rates of psychosis can be close to eight times higher in some regions compared to others, finds a new study led by researchers at UCL, King’s College London and the University of Cambridge. […] The study, published today in JAMA Psychiatry, was the biggest international comparison of incidence of psychotic disorders, and the first major study of its kind in more than 25 years. […] The authors estimated the incidence of psychotic disorders across 17 areas in six countries – the UK, France, Italy, the Netherlands, Spain and Brazil – using comparable methodology. […] They found the overall incidence of psychotic disorders to be 21.4 per 100,000 person-years, but discovered wide variations between different areas, from a low of 6.0 per 100,000 person-years in the rural area around Santiago (Spain), to a high of over 45 in inner-city Paris and Southeast London.
#57 Brief Psychotic Disorder: Practice Essentials, Background, Pathophysiology and Etiology
https://emedicine.medscape.com/article/294416-overview
Brief psychotic disorder is not common. In a follow-up study of 221 first-admission patients with affective and nonaffective psychoses, only 20 (9%) of the 221 experienced brief psychoses, and only 7 (3%) experienced acute brief psychoses. […] According to an international epidemiologic study, the incidence of nonaffective acute remitting psychoses in contrast to that of schizophrenia, was 10-fold higher in developing countries than in industrialized countries. […] An international epidemiologic study found the incidence of the disorder to 2-fold higher in women than in men.
#58
https://www.who.int/news-room/fact-sheets/detail/schizophrenia
Schizophrenia causes psychosis and is associated with considerable disability and may affect all areas of life including personal, family, social, educational, and occupational functioning. […] More than two out of three people with psychosis in the world do not receive specialist mental health care. […] Only 31.3% of people with psychosis receive specialist mental health care. […] There is clear evidence that mental hospitals are not effective in providing the care that people with mental health conditions need and, regularly, violate the basic human rights of persons with schizophrenia. […] WHO’s Mental Health Gap Action Programme (mhGAP) uses evidence-based technical guidance, tools and training packages to expand service in countries, especially in resource-poor settings. It focuses on a prioritized set of conditions, including psychosis, directing capacity building towards non-specialized health-care providers in an integrated approach that promotes mental health at all levels of care.
#59 Psychosis incidence highly variable internationally | UCL News – UCL â University College London
https://www.ucl.ac.uk/news/2017/dec/psychosis-incidence-highly-variable-internationally
The researchers say their findings can be used to help plan mental health services, by identifying which regions could expect greater incidence of psychosis. […] The findings add weight to previous evidence that environmental factors could play a larger role in causing psychotic disorders than previously believed. […] The researchers say that more research is needed to identify causal mechanisms, investigate other risk factors, and study psychosis incidence in other environments such as lower-income countries.
#60 A population-level prediction tool for the incidence of first-episode psychosis: translational epidemiology based on cross-sectional data | BMJ Open
https://bmjopen.bmj.com/content/3/2/e001998
A population-level prediction tool for the incidence of first-episode psychosis: translational epidemiology based on cross-sectional data […] Specialist early intervention services (EIS) for people aged 14-35 years with first episodes of psychosis (FEP) have been commissioned throughout England since 2001. […] We sought to develop a realistically complex, population-based prediction tool for FEP, based on precise estimates of epidemiological risk. […] We have developed a prediction tool for the incidence of psychotic disorders in England and Wales, made freely available online (http://www.psymaptic.org), to provide healthcare commissioners with accurate forecasts of FEP based on robust epidemiology and anticipated local population need. […] Using rich epidemiological data on variation in the incidence of FEP according to major sociodemographic risk factors, we describe the development and validation of a population-level prediction tool capable of accurately estimating the expected incidence of psychiatric disorder, based on the sociodemographic structure of the population in a given region.
#61 Surveillance Society Sparks Psychosis | WIRED
https://www.wired.com/2008/08/surveillance-so/
If you think someone is watching you, you’re probably right. But this doesn’t mean you’re not also crazy, according to psychiatrists who say that our surveillance and reality TV society is spawning a new kind of psychosis. They’re calling it the Truman Show delusion. […] Psychiatrists in the U.S. and Britain say they’re seeing a growing number of psychotic patients who are paranoid that cameras are watching their every move. […] Others fear the World Wide Web is monitoring their lives or being used to transmit photographs or personal information. […] The psychiatrists say such patients are often mirroring — albeit, to an extreme — what is occurring in the environment around them. […] One way of looking at the delusions and hallucinations of the mentally ill is that they represent extreme cases of what the general population, or the merely neurotic, are worried about. Schizophrenics and other paranoid patients can take common fears – like identity theft because of information transmitted on the Internet, or the loss of privacy because of the prevalence of security cameras to fight crime – and magnify them, psychiatrists say. […] Which would seem to suggest that these patients might not be so delusional after all.
#62 Surveillance Society Sparks Psychosis | WIRED
https://www.wired.com/2008/08/surveillance-so/
If you think someone is watching you, you’re probably right. But this doesn’t mean you’re not also crazy, according to psychiatrists who say that our surveillance and reality TV society is spawning a new kind of psychosis. They’re calling it the Truman Show delusion. […] Psychiatrists in the U.S. and Britain say they’re seeing a growing number of psychotic patients who are paranoid that cameras are watching their every move. […] Others fear the World Wide Web is monitoring their lives or being used to transmit photographs or personal information. […] The psychiatrists say such patients are often mirroring — albeit, to an extreme — what is occurring in the environment around them. […] One way of looking at the delusions and hallucinations of the mentally ill is that they represent extreme cases of what the general population, or the merely neurotic, are worried about. Schizophrenics and other paranoid patients can take common fears – like identity theft because of information transmitted on the Internet, or the loss of privacy because of the prevalence of security cameras to fight crime – and magnify them, psychiatrists say. […] Which would seem to suggest that these patients might not be so delusional after all.
#63 Vulnerability to psychosocial disability in psychosis | Epidemiology and Psychiatric Sciences | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/vulnerability-to-psychosocial-disability-in-psychosis/EC069770E50140F77697917E81622E1D
Psychosocial disability affects a number of individuals with psychosis and often begins years before the formal onset of disorder. […] Psychosis is the most common cause of psychosocial disability world-wide. […] Psychosocial disability, or poor functioning, emerges long before the formal onset of psychosis, but peaks at illness onset and plateaus thereafter, suggesting that disability is a longstanding trait rather than direct sequela of the symptoms used to classify the disorder hallucinations, delusions and thought disorder. […] The logic of this is that interventions which target psychosocial functioning in the initial stages of psychosis hold out the prospect of preventing long-term psychosocial disability. […] Early Intervention Services (EIS), which provide specialist assertive outreach-style care during the critical period, are considered the gold standard treatment for young people with early psychosis.
#64 Vulnerability to psychosocial disability in psychosis | Epidemiology and Psychiatric Sciences | Cambridge Core
https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/vulnerability-to-psychosocial-disability-in-psychosis/EC069770E50140F77697917E81622E1D
Widespread impairments in premorbid functioning defined as functioning prior to the onset of illness is typical of individuals who later develop psychosis. […] This underlines that for many young people, functional deficits are already in place before psychosis formally manifests, and psychosocial disability apparent at the formal onset of psychosis is simply a continuation of earlier trajectories; these individuals are likely at risk of enduring illness and disability. […] Intervention in this premorbid phase may be most effective to prevent long-term disability. […] Current symptom-focused early intervention approaches do not seem to affect psychosocial disability and therefore need re-thinking. […] Delivering interventions at a universal level to at-risk groups, such as young people who fail to make the transition from school to employment or training, may prevent long-term economic disadvantage and social marginalisation, potentially bolstering resilience against the development of severe mental health problems such as psychosis.