"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/

---------------------------------


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

[paranoid_cataclysm]

Huh that's weird, I thought depression and mania were symptoms of mood disorder and not also of psychosis itself, if I read that right.

[compnet]

Just came across this from the Merck site:

"CNS symptoms include psychosis, encephalopathy (characterized by impaired consciousness), and cognitive decline (dementia). Psychosis is characterized by memory impairment, disorientation, confusion, and confabulation; the predominant symptom may be excitement, depression, mania, delirium, or paranoia."


I've also found on google that psychosis can be caused by deficiencies in: Calcium/Magnesium, B12, Niacin, and Vitamin D.

[yarrow]

These are fascinating topics.  Please do post updates.

[ILADVOCATE]

Yes I agree that can be a concern. That's why it should only be taken at the specific amount directed by a psychiatrist and only under psychiatric supervision. However from what my psychopharmocologist informed me he is changing over any patient of his who takes fish oil to Lovaza because it is an FDA approved medication so that it is a known quantity. The other reason besides what you posted is that any product containing concentrates of fish would have a build up of mercury residue because of pollutants in the sea(this I was directly informed).  When I took fish oil or flaxseed oil in the past it was only of benefit as a supplement to known medications. As to whether Lovaza which is an FDA approved medication and can thus be prescribed off label will be beneficial for bipolar as a primary mood stabilizer or just an adjunct will take further controlled studies which are ongoing at this point (those are listed in Clinicaltrials.gov where are all ongoing clinical studies are listed, Pubmed is another good search engine to read for informational purposes). I did experience some extra pyramidal side effects from fish oil which might be clinically rare or it might be what you described. That I would not know. Lovaza may or may not have the same side effect profile but I'll read up on it before I take it and discuss any concerns with my doctor or pharmacist and see what happens. I did read the first post and did note some of the signs of emergent mania so it will be worthwhile to achieve some further stability. I will keep people updated over time.

[yarrow]

There are indeed a number of studies indicating that fish oil can be quite beneficial in bipolar disorder, but one teeny word of warning, buried about 3/4 of the way down this article, in the segment headed "Side effects and warnings:

http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-fishoil.html  

"There are rare reports of mania in patients with bipolar disorder or major depression. Restlessness and formication (the sensation of ants crawling on the skin) have also been reported."

In reading messages on forums in which fish oil is discussed, such as the heart rhythm community, I have seen maybe three or four messages (out of hundreds) from people who had felt their anxiety/agitation became worse on fish oil, and one who noted that crawly feeling on the skin, probably without having read anything at the website I just noted.

The only study I could find which notes this effect of Omega 3s appears in an 8/08 study cited further below, within the paragraph titled "Safety Profile of Omega-3 Polyunsaturated Fatty Acids":

"Since ω-3 polyunsaturated fatty acids may have antidepressant effects, another possible adverse effect is drug-induced mania. Until now, there has only been one formal case report to show ω-3 polyunsaturated fatty acid–induced hypomania.[64] Further research is needed to clarify whether treatment with ω-3 polyunsaturated fatty acids increases the risk for mania or hypomania."
(The Use of Omega-3 Fatty Acids in Treatment of Depression, http://www.psychiatrictimes.com/cme/display/article/10168/1171213)

[compnet]

"I've posted there is a whole new generation of antipsychotics in clinical study, the NMDA receptor modulates that are based on **increasing glutamate transmission** instead of decreasing dopamine transmission."

Very interesting.