First Author : Georgiana NemeFirst Author : Georgiana NemeșCoauthor : Alexandra KovacsCoauthor : Alexandra KovacsCoordinators : Lecturer Livia Coordinators : Lecturer Livia ȚăȚăran, ran, DDr. r. Gabriela BuicuGabriela Buicu

International Scientific Congress for Students, Young Physicians and International Scientific Congress for Students, Young Physicians and PharmacistsPharmacists

Marisiensis 2015Marisiensis 2015

The evolution of the first The evolution of the first psychotic episode outlined psychotic episode outlined

by the prodromal symptomsby the prodromal symptoms

PsychosisPsychosis

Psychotic disorders are heterogeneous, and the severity of symptoms can predict important aspects of the illness, such as the degree of cognitive or neurobiological deficits.

It may appear in adolescence or early adulthood, and onset can occur across the lifespan, with the average age at onset being the mid 30s.

The period of subclinical signs and symptoms that precedes the onset of psychosis is referred to as the prodrome. It can last from weeks to several years and is characterized as a process of changes or deterioration in heterogeneous subjective and behavioral symptoms that precede the onset of clinical psychotic symptoms.

DELUSIONSDELUSIONS

HALLUCINATIONS

HALLUCINATIONS

DISORGANISED SPEECH

DISORGANISED SPEECH

DISORGANISED BEHAVIOR

DISORGANISED BEHAVIOR

Presence of one (or more) of the following symptoms:

PsychosisPsychosisProgression of psychosis:• premorbid phase - asymptomatic, characterised by changes in emotional, cognitive

and behavior, without altering the function of the patient• prodromal phase - with prepsychotic symptoms and changes in social function• psychotic phase - diagnosed with positive, negative symptoms, disorganised in

patient’s behavior • remission phase/ postpsychotic - with a variable course .

Unspecific symptoms from the prodromal phase could lead to : Unspecific symptoms from the

prodromal phase could lead to :

SCHIZOPHRENIASCHIZOPHRENIA BIPOLAR DISORDERBIPOLAR DISORDER

SCHIZOAFFECTIVE DISORDERSCHIZOAFFECTIVE DISORDER MAJOR DEPRESSIONMAJOR DEPRESSION

SchizophreniaSchizophreniaSchizophrenia is a severe mental disorder which has heterogeneous presentations, with

positive and negative symptoms at different levels of prominence across time and across individuals. While positive symptoms occur periodically

during psychoticexacerbations, negative and cognitive symptoms often emerge before the first psychotic episode and persist with low functional outcome and poor

prognosis.

++ --Believing that what other people are saying is not true (delusions)

Hearing, seeing, tasting, feeling, or smelling things that others do not experience (hallucinations)

Lack of pleasure in everyday life

Lack of ability to begin and sustain planned activities

Speaking little, even when forced to interact.

DepressionDepression It is characterized by discrete episodes of at least 2 weeks' duration (although most episodes last considerably longer) involving clear-cut changes in affect, cognition, and

neurovegetative functions and inter-episode remissions.

Most of the day, nearly every day:

1. Depressed mood.2. Diminished interest or pleasure in all / almost all.3. Significant weight loss when not dieting or weight

gain.4. Insomnia or hypersomnia.6. Loss of energy.7. Feelings of worthlessness / excessive /

inappropriate guilt (which may be delusional)8. Diminished ability to think or concentrate /

indecisiveness9. Recurrent thoughts of death recurrent suicidal

ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

ObjectiveObjective

The aim of our study was to highlight specific symptoms regarding schizophrenia precisely from the prodromal phase which will lead to a better outcome of the

patient.

Since the scientific researchers were not able to find an eligible biomarker blood test / objective test, the doctors have to use subjective tests in order to put a diagnose.

Material & MethodsMaterial & MethodsData was collected from the Psychiatric Ambulatory and reviewed between 1 feb – 31

march 2015. The source was : firstly, patients and their family members and secondly, the doctor.

This is a retrospective study which includes the evaluation of 2 lots of patients who are in the first 5 years since the onset of the disorder.

The first lot : 20 patients who were diagnosed with schizophrenia and acute psychotic episode,as the DSM IV TR and PANSS tests concluded.

The second lot : 20 patients who were diagnosed with major depressive episode and major depressive affective disorder, as the HAMD and BDI test concluded.

The interview with the patient and the family focused on identifying the

prodrome type and risk factors,as well as personality traits,psycho traumas,resilience etc, which could suggest a certain type of

future evolution.

ResultsResults

ResultsResults Patients’ symptoms

ResultsResults Patients’ history:

ResultsResultsStatistical analysis of data was performed using the computer program GraphPad

InStat 3. The estimation of results was performed according to the decision criteria of the statistical tests:

ResultsResultsEven though some symptoms are not significat for a psychotic episode, patients’

experience them but in a lower intensity and frequency.

ResultsResults

Patients’ History P value 95 % CI OR Significant

Psychiatric family history <0.1274 0.8624 to 27.233 4.846 no

Alcohol abuse <1.0000 0.2321 to 2.861 0.8148 no

Drug usage (canabis) <0.6050 0.3177 to 35.385 3.353 no

Dysfunctional family <0.5145 0.1427 to 1.923 0.5238 no

Work Dysfunctions < 0.0001 4.564 to 159.73 27.000 yes

Psyhotraumas (decease, divorce, loss of work place)

<0.5006 0.1295 to 1.931 0.5000 no

Personality disorders <0.2733 0.07071 to 1.519 0.3277 no

ConclusionsConclusions

Prodromal symptoms which matched the psychotic onsetProdromal symptoms which matched the psychotic onset

Social withdrawalPersonality changesThinking disorderBizarre behaviorAppetite changesLack of motivationDecreased affectionAggression Paranoia

ApathyTearfulnessDepressed moodAnxiety

Insomnia!

Could be a major symptom for both

diseases

ConclusionsConclusions

Detecting the prodrome facilitates an early intervention in the treatment of the disorder. A delayed treatment is associated with a lower chance of remission and a less favorable

long term prognosis.

Adolescents and young adults who appear to be prodromal or at ultra high risk should be monitored and provided with symptom-targeted treatments (e.g., antidepressants, psychosocial treatments). Antipsychotics should be used as soon as frank psychosis

emerges.

ReferencesReferences

1. Stoica I. (2008) – Prodromul in primul episod psihotic2. American Psychiatric Association (2013) – Diagnostic and Statistical manual of mental

disorders, fifth edition3. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and

related psychotic disorders; Expert Rev Neurother. 2010 Aug; 10(8): 1347-13594. Biomarkers in Schizophrenia: A Brief Conceptual Consideration - Dis Markers. (2013) 5.What is schizophrenia?

www.nimh.nih.gov/health/publications/schizophrenia/index.shtml6. PET scan pictures from www.webmed.com

Thank you!Thank you!

THE WAY WE CHOOSE TO SEE THE WAY WE CHOOSE TO SEE THE WORLD CREATES THE THE WORLD CREATES THE

WORLD WE SEE.WORLD WE SEE.-Barry Neil Kaufman--Barry Neil Kaufman-