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1.01 - Approaches to Positive Psychotic Symptoms

from Part I - Treatment Strategies

Published online by Cambridge University Press:  19 October 2021

Michael Cummings
Affiliation:
University of California, Los Angeles
Stephen Stahl
Affiliation:
University of California, San Diego
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Summary

In community settings, the most common barriers to independent living, employment, and stable interpersonal relationships for patients suffering from schizophrenia-spectrum disorders or other psychotic disorders are negative symptoms and cognitive deficits [1]. In contrast, severely mentally ill individuals, often incarcerated or chronically institutionalized, more frequently experience substantial barriers related to positive psychotic symptoms leading to problematic behaviors such as aggression or violence [2]. This is not to say that among the chronically institutionalized severely mentally ill population that positive psychotic symptoms are the only, or even majority, source of problematic behaviors. A survey conducted within the California Department of State Hospitals, a circa 7000-bed system dedicated to the treatment of conserved and forensically committed patients, reviewed 839 episodes of aggression or violence by 88 persistently aggressive inpatients and found that 54% of such episodes were impulsive, 39% were predatory or instrumental, and 17% were psychotically driven [3]. Nevertheless, amelioration or control of positive psychotic symptoms commonly forms the initial treatment focus among the severely mentally ill [4].

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Publisher: Cambridge University Press
Print publication year: 2021

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References

Kaneko, K. (2018). Negative symptoms and cognitive impairments in schizophrenia: two key symptoms negatively influencing social functioning. Yonago Acta Med, 61, 91102.Google Scholar
Dack, C., Ross, J., Papadopoulos, C., et al. (2013). A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatr Scand, 127, 255268.CrossRefGoogle ScholarPubMed
Quanbeck, C. D., McDermott, B. E., Lam, J., et al. (2007). Categorization of aggressive acts committed by chronically assaultive state hospital patients. Psychiatr Serv, 58, 521528.CrossRefGoogle ScholarPubMed
Stahl, S. M., Morrissette, D. A., Cummings, M., et al. (2014). California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines. CNS Spectr, 19, 449465.CrossRefGoogle ScholarPubMed
Merritt, K., McGuire, P., Egerton, A. (2013). Relationship between glutamate dysfunction and symptoms and cognitive function in psychosis. Front Psychiatry, 4, 151.Google Scholar
Howes, O. D., McCutcheon, R., Agid, O., et al. (2017). Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology. Am J Psychiatry, 174, 216229.CrossRefGoogle Scholar
Maust, D. T., Kim, H. M., Seyfried, L. S., et al. (2015). Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry, 72, 438445.Google Scholar
Galling, B., Roldan, A., Hagi, K., et al. (2017). Antipsychotic augmentation vs. monotherapy in schizophrenia: systematic review, meta-analysis and meta-regression analysis. World Psychiatry, 16, 7789.CrossRefGoogle ScholarPubMed
Nucifora, F. C. Jr., Woznica, E., Lee, B. J., et al. (2018). Treatment resistant schizophrenia: clinical, biological, and therapeutic perspectives. Neurobiol Dis, 131, 104257.Google ScholarPubMed
Kane, J., Honigfeld, G., Singer, J., et al. (1988). Clozapine for the treatment-resistant schizophrenic. a double-blind comparison with chlorpromazine. Arch Gen Psychiatry, 45, 789796.Google Scholar
Stroup, T. S., Gerhard, T., Crystal, S., et al. (2016). Comparative effectiveness of clozapine and standard antipsychotic treatment in adults with schizophrenia. Am J Psychiatry, 173, 166173.CrossRefGoogle ScholarPubMed
Yoshimura, B., Yada, Y., So, R., et al. (2017). The critical treatment window of clozapine in treatment-resistant schizophrenia: secondary analysis of an observational study. Psychiatry Res, 250, 6570.Google Scholar
Ogloff, J. R., Daffern, M. (2006). The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients. Behav Sci Law, 24, 799813.CrossRefGoogle ScholarPubMed
Hankin, C. S., Bronstone, A., Koran, L. M. (2011). Agitation in the inpatient psychiatric setting: a review of clinical presentation, burden, and treatment. J Psychiatr Pract, 17, 170185.CrossRefGoogle ScholarPubMed
Vaaler, A. E., Iversen, V. C., Morken, G., et al. (2011). Short-term prediction of threatening and violent behaviour in an Acute Psychiatric Intensive Care Unit based on patient and environment characteristics. BMC Psychiatry, 11, 44.CrossRefGoogle Scholar
Volavka, J., Citrome, L. (2011). Pathways to aggression in schizophrenia affect results of treatment. Schizophr Bull, 37, 921929.Google Scholar
Joshi, A., Krishnamurthy, V. B., Purichia, H., et al. (2012). “What’s in a name?” Delirium by any other name would be as deadly. A review of the nature of delirium consultations. J Psychiatr Pract, 18, 413418.CrossRefGoogle Scholar
Ruberg, S. J., Chen, L., Stauffer, V., et al. (2011). Identification of early changes in specific symptoms that predict longer-term response to atypical antipsychotics in the treatment of patients with schizophrenia. BMC Psychiatry, 11, 23.Google Scholar
Lopez, L. V., Kane, J. M. (2013). Plasma levels of second-generation antipsychotics and clinical response in acute psychosis: a review of the literature. Schizophr Res, 147, 368374.CrossRefGoogle ScholarPubMed
Meyer, J. M., Cummings, M. A., Proctor, G., et al. (2016). Psychopharmacology of persistent violence and aggression. Psychiatr Clin North Am, 39, 541556.CrossRefGoogle ScholarPubMed
Siskind, D., Siskind, V., Kisely, S. (2017). Clozapine response rates among people with treatment-resistant schizophrenia: data from a systematic review and meta-analysis. Can J Psychiatry, 62, 772777.CrossRefGoogle ScholarPubMed
Lally, J., Tully, J., Robertson, D., et al. (2016). Augmentation of clozapine with electroconvulsive therapy in treatment resistant schizophrenia: a systematic review and meta-analysis. Schizophr Res, 171, 215224.Google Scholar
Stein-Parbury, J., Reid, K., Smith, N., et al. (2008). Use of pro re nata medications in acute inpatient care. Aust N Z J Psychiatry, 42, 283292.Google Scholar

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