"Pre-psychotic Signals"

[compnet]

Hello,

I came across this in the Journal of Nervous And Mental Disease.  I hadn't heard of their being early warning signs of psychosis coming on.  I hope people find this helpful.



"The discovery of a mechanism of early identification of prepsychotic signals was replicated in additional studies (Dittmann and Schuttler, 1990), and its importance was described in a first-person account by Leete (1989). A woman in her 50s diagnosed with schizoaffective disorder who was interviewed for our study described how she calls a Crisis Hotline when she perceives that a relapse might be impending.

“I depend on [calling the Crisis Hotline]. I’m trying to keep from going in [the acute hospital unit]. I don’t want to go back there . . . usually when I call crisis and reach out for help and tell them how I am feeling they will either tell me to come to the emergency room or to get my medicine, take my medicine as prescribed, take me a cup of tea or drink a glass of milk and lie down for a while. If that doesn’t work, get up and see if you can go around, be around somebody.”

The principles of monitoring warning signs have been used to develop relapse prevention programs (Herz et al., 2000; Lam et al., 2000; Perry et al., 1999; Scott et al., 2001) that teach a form of anticipatory coping skills in that they focus on helping people prepare for the possible but not yet occurring threat of relapse, and take steps directed to minimizing its negative effect. These programs usually include identifying events and situations that had triggered episodes in the past and making a conscious effort to build a routine that would help the person avoid such events and situations in the future. In addition, one can choose a support person whom they would like to help him or her in case he or she felt that things were not going well, as well as generate a crisis plan to implement in case early warning signs are detected.

The relationship between anticipatory coping and a reduced likelihood of relapse has not been well-studied; however, positive findings for the impact of relapse prevention treatment suggest that learning to use anticipatory coping can reduce the likelihood of having a psychiatric hospitalization and associated consequences (Herz et al., 2000).

Preventive coping refers to the process by which a person builds up resources and resistance “just in case” possible stressors occur in the distant future (Schwarzer, 2001). Unlike reactive coping where the stressor has occurred, and anticipatory coping where there are more specific stressors within a shorter timeline which one is preparing for coping with, preventive coping reflects more general preparatory activities to cope with more unknown possible stressors within a more fluid timeline. Others (Aspinwall and Taylor, 1997) have referred to these types of strategies as proactive coping, but Schwarzer has drawn a distinction between preventive and proactive coping, which we follow in our adaptation of his model.

One example of preventive coping is developing “wellness management skills” (Copeland, 1997; Mueser et al., 2002). These are coping strategies that are used on a regular basis whether or not one is experiencing symptoms. The value and purpose of developing such strategies is that they can help reduce one’s vulnerability to future stress and improve resources for dealing more effectively with stressors that might occur. Typical wellness management strategies reported by people with SMI include routinely accessing social support, following a routine for taking medication, exercising, reducing substance use, and adopting a healthy and balanced lifestyle (Yanos, 2001). The man in his 40s diagnosed with schizophrenia who was interviewed for our study described his use of several preventive coping strategies as follows."


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1790964/

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Early Warning Signs

Early warning signs of a psychosis can be defined as subjective
experiences, thoughts, and behaviours of the patient that occur in the phase
preceding a psychotic relapse (Heinrichs & Carpenter 1985; Herz & Melville
1980). The question is now which experiences, thoughts, and behaviours are
characteristic for this phase.

Heinrichs and Carpenter (1985) conducted a prospective study of the
early warning signs of a psychosis in 47 ambulatory patients with
schizophrenia (n=38) or a schizoaffective disorder (n=9). During weekly
appointments with the client, clinicians noted whether or not warning signs
were present that indicated an impending psychotic relapse. On the basis of
this, 32 early warning signs were identified. The ten most common are:
hallucinations (53%),
suspiciousness (43%),
change in sleep (43%),
anxiety (38%),
cognitive inefficiency (26%),
anger/hostility (23%),
somatic symptoms or delusions (21%),
thought disorder (17%)
disruptive inappropriate behaviour (17%),
and depression (17%).

Source:
Recognition of early warning signs in patients with schizophrenia:
A review of the literature

B. van Meijel
M. van der Gaag
R.S. Kahn
M.H.F. Grypdonck

[compnet]

Another interesting note:

Antipsychotics work on dopamine and glutamate

Folate and/or B12 has to do with glutamate, and monoamine neurotransmitters.

[compnet]

Hello,

I was talking on an Addison's forum and they got me talking about some other bloodwork.


What might these mean?

And interestingly, just five months AFTER the bloodwork (below), I ended up in the hospital with my first psychosis episode; and I've read that iron anemia, and folate/B12 deficiencies can cause psychosis. My doctor didn't say a word about the above issues, only my estradiol and physical complaints I had, as well as low mood and anxiety, all associated with life issues.



____________________________________
I'm soon to be 28, and my Ferritin in 2008 was 15.3 [ref 6.2-137.0 ng/mL]


Also:



RBC COUNT 3.49 LOW [REF 4.2-5.4]


Hemoglobin 11.8 LOW [REF 12.0-16.0]


HEMATOCRIT 34.7 LOW [REF 37-47%]


MCV 99.3 HIGH [REF 81-99]


MCH 33.9 HIGH [REF 27-31]
____________________________________



I'm wondering if I've got an iron, B12 and/or Folate deficiency. Years of fatigue and poor attention/concentration/retention/memory here.



Is it possible for that kind of anemia to go back to normal?





Preceding all of that, I had been on lots of meat/poultry/fish eating, along with lots of vegetables, seaweed, supplements, sea salt, olive oil, etc. and cutting back on carbs and sugars, all to see if it would help my energy and concentration. Also, there was a very stressful, dysfunctional environment; friend moving out of state; beloved pets dying painfully, etc.


Thank you.

[ILADVOCATE]

Well adrenaline and other neurotransmitters when increased artificially (such as by steroids as described in the article) can clearly worsen psychosis in a person with a pre-existing psychiatric disability or cause psychosis of their own. It should also be noted that another cause of psychosis which is substance induced is PCP induced psychosis has lead to promising research to treat it and understand the nature of psychosis from schizophrenia and other related psychiatric disabilities. That was how the NMDA receptor modulates were discovered (google "A New Class of Antipsychotics"). In treating PCP induced psychosis, they were then used to see if they were of efficacy in treating schizophrenia which was found to be the case. As well Thyroxine is in clinical study for use on bipolar depression:
http://www.psycheducation.org/thyroid/introduction.htm

[compnet]

FEP = First Episode Psychosis

RESULTS: At baseline, no differences were observed in cortisol, DHEAS or the cortisol/DHEAS ratio between patients and controls. . . .

Within FEP patients, decreases in cortisol and the cortisol/DHEAS ratio over time were directly related to the improvement in depression . . . negative . . . and psychotic symptoms . . . .

Perceived stress significantly correlated with DHEAS . . . and the cortisol/DHEAS ratio . . . in controls, but not patients, possibly reflecting an impaired hormonal response to stress in FEP patients.

http://www.ncbi.nlm.nih.gov/pubmed/20619421
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What does that last paragraph mean?  "Impaired hormonal response?"  No correlation with cortisol/DHEA?  Why?

Any thoughts?

[compnet]

Also interesting, adrenal issues can cause psychosis, paranoia, hallucinations...

http://psy.psychiatryonline.org/cgi/content/full/47/2/175

There are many results on google with "adrenal + psychosis."

[ILADVOCATE]

They can be related. The psychosis caused by direct structural damage to the brain can appear similar to that from a psychiatric disability but a full clinical tests can rule out those causes as they are clinically separate. In schizoaffective disorder and bipolar with psychotic features mania and psychosis can overlap and a person needs both a working mood stabilizer and an antipsychotic and the effects overlap so that if an antipsychotic is not working properly a person can become manic and the reverse. The full spectrum from bipolar to bipolar with psychotic features and schizoaffective is not fully understood. Neither is the relation between dementia and bipolar and schizophrenia although dementia can be a part of advanced schizophrenia especially if it is left untreated. As per myself, the Lovaza has worked on standard symptoms of mood stabilization and in augmenting an antipsychotic agent helped on symptoms of psychosis as well. Because it also provided marked help with tardive dyskinesia (which is not a known effect, although fish oil has been used for that purpose) I will be seeing my neurologist to gauge that specific effect and of course my psychiatrist to follow up as well. The beneficial effect of fatty acids on the brain is still being clinically understood through specific research as well.