[Development of a water intoxication syndrome during a manic-depressive psychosis].
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Manic depressive psychosis
Water intoxication
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The authors report suicide risk among 1,593 patients with major depression or bipolar disorder, 443 (27.8%) of whom were psychotic (260 bipolar and 183 unipolar). The subjects were followed for 0-14 years, and their suicide experience was compared with that of the state population. Eight (19.5%) of the 41 suicide victims were from the psychotic group. The psychotic and nonpsychotic subjects in each diagnostic group had similar risks for suicide. A higher risk for suicide was not found in the bipolar subjects. The authors conclude that among patients with major affective disorder psychosis per se does not predispose to suicide.
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Manic depressive psychosis
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Diagnostic shifts have been prospectively examined in the short term, but the long-term stability of diagnoses has rarely been evaluated. The authors examined diagnostic shifts over a 10-year follow-up period.A cohort of 470 first-admission patients with psychotic disorders was systematically assessed at baseline and at 6-month, 2-year, and 10-year follow-ups. Longitudinal best-estimate consensus diagnoses were formulated after each assessment.At baseline, the diagnostic distribution was 29.6% schizophrenia spectrum disorders, 21.1% bipolar disorder with psychotic features, 17.0% major depression with psychotic features, 2.4% substance-induced psychosis, and 27.9% other psychoses. At year 10, the distribution changed to 49.8%, 24.0%, 11.1%, 7.0%, and 8.1%, respectively. Overall, diagnoses were changed for 50.7% of study participants at some point during the study. Most participants who were initially diagnosed with schizophrenia or bipolar disorder retained the diagnosis at year 10 (89.2% and 77.8%, respectively). However, 32.0% of participants (N=98) originally given a non-schizophrenia diagnosis had gradually shifted to a schizophrenia diagnosis by year 10. The second largest shift was to bipolar disorder (10.7% of those not given this diagnosis at baseline). Changes in the clinical picture explained many diagnostic shifts. In particular, poorer functioning and greater negative and psychotic symptom ratings predicted a subsequent shift to schizophrenia. Better functioning and lower negative and depressive symptom ratings predicted the shift to bipolar disorder.First-admission patients with psychotic disorders run the risk of being misclassified at early stages in the illness course, including more than 2 years after first hospitalization. Diagnosis should be reassessed at all follow-up points.
Diagnosis of schizophrenia
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It is not out of conceptual fetishism that the term “manic-depressive psychosis” is preferable to “bipolar disorder.” Firstly, the bipolar mode is the normal structural state and is not an illness in itself. Secondly, the term “bipolar” does not distinguish between neurosis and psychosis, and as a consequence, many patients with mood swings may be prescribed antipsychotic medications. In addition, the term “bipolar” ignores the subjectivity that governs changes in mood. This discussion is useful to psychoanalysts since it can demonstrate that melancholy can indeed be a kind of psychosis.
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Manic depressive psychosis
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Major depressive episode
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Hurd in 1888 described cases of mania, melancholia, folie circulaire and attempted suicide in mental defectives. Ireland in 1898 described three ‘imbecile lunatics’ who were ‘clear cases of melancholia’, and quoted an earlier physician, Wells, who in 1845 had seen ‘attacks of mania in cretins, as well as a peculiar suicidal form of this affliction, which prompts the wretched maniac to attempt self-destruction by throwing himself into the fire’. Clouston (1883) considered that ‘congenital imbeciles may have attacks of maniacal excitement or of melancholic depression—in fact are subject to them’. Kraepelin (1896, 1902) took the view that ‘imbecility may form the basis for the development of other psychoses such as manic-depressive insanity, the psychoses of involution and dementia praecox’. Gordon (1918) stated that mental defectives suffering from depression rarely express ideas of guilt or thoughts of suicide; manics lacked ‘quickness of comprehension of wit or humour or sarcasm’. He noted that depression was more common than mania and that recurrences tended to run true to type. Prideaux (1921) accepted that manic-depressive psychosis could occur in high-grade mental defectives, and drew attention to the increased incidence of conversion hysteria in patients of low intelligence. Medow (1925) observed that mental defectives could manifest all the types of mental illness seen in people of normal intelligence but in the defective mental illness had a silly, fantastic, nonsensical colouring. Neustadt (1928) put forward the view that the typical psychoses of the mental defective were acute episodic states of excitement.
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Introduction The presence of psychotic symptoms is highest during acute episodes of bipolar mania. There is no evidence base regarding the implications of psychosis in the prognosis of bipolar disorder, despite common assumption that their occurrence reflects greater disease severity. Objectives We aim to compare sociodemographic and clinical characteristics of inpatients admitted for bipolar mania with and without psychotic features. Methods Retrospective observational study of inpatients admitted between January 1 st 2017 and 31 October 2020 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0. Results Between 2017 and October 2020 there were 103 admissions due to mania bipolar I disorder, 53.4% (n=55) with psychotic symptoms. When compared with mania without psychosis, psychotic mania was associated to male gender (71.1% to 39.7%; c 2 (1, N = 103) = 10,06; p = 0.02) and younger age (t(103) = -2.43; p = 0.017). The proportion of compulsory admissions and average length of stay were similar between mania with psychosis and mania without psychosis. Also, having a manic bipolar episode with psychotic symptoms was not associated to being prescribed a long-acting injectable antipsychotic. Conclusions The presence of psychotic symptoms in bipolar manic episodes were associated to male gender and younger age but not to indirect measures of illness severity. Disclosure No significant relationships.
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