Blood cell count in antipsychotic-naive patients with non-affective psychosis.

BACKGROUND: Schizophrenia is a complex medical entity with a reduced life expectancy, mostly due to an increased prevalence of cardiovascular diseases compared to the general population. An unbalanced immune response and a pro-inflammatory state might underlie this process. In treated patients, abnormal white blood cell (WBC), lymphocyte and neutrophil count suggests atypical immune response related to clinical variables. We aimed to test the hypothesis that newly diagnosed naïve patients with non-affective psychosis would show abnormal blood cell count values after controlling for potential confounding factors compared to matched controls. METHODS: Seventy-five patients were compared with 80 controls matched for age, gender, body mass index and smoking. Analyses were conducted before and after controlling for smoking. RESULTS: Patients and controls displayed similar mean values (×103 /µL [SD]) for WBC count 7.02 [2.2] vs 6.50 [1.7] (P = .159), neutrophil count 4.25 [1.8] vs 3.84 [1.3] (P = .110) and monocyte count 0.43 [0.2] vs 0.40 [0.1] (P = .326). After controlling for smoking, 38 non-smoking patients showed a higher WBC and neutrophil count compared with 49 matched controls. Respective means of 7.01 [2.2] vs 5.97 [1.4] (P = .011) for WBC and 4.24 [1.9] vs 3.51 [1.2] (P = .028) for neutrophil count. Monocyte count showed an increased mean value 0.43 [0.2] vs 0.36 [0.1] with a trend towards signification (P = .063). CONCLUSIONS: These results suggest that abnormal immune response is present before the effects of medication and other confounders had taken place. Increased immune parameters might underlie the high ratio of medical co-morbidities described in schizophrenia.

A double dissociation between two psychotic phenotypes: Periodic catatonia and cataphasia.

Schizophrenia as a single liability model was confronted to the multiple psychotic phenotypes model proposed by the Wernicke-Kleist-Leonhard school, focusing on two: periodic catatonia (PC) and cataphasia (C). Both are stable and heritable psychotic phenotypes with no crossed liability and are coming with the buildup of specific residual symptoms: impairment of psychomotricity for PC and a specific disorganization of thought and language in C. Regional cerebral blood flow (rCBF) was used as a biomarker. We attempted to refute the single phenotype model by looking at relevant and specific rCBF anomalies for PC and C, that would exceed anomalies in common relative to controls (CTR), i.e. looking for a double dissociation. Twenty subjects with PC, 9 subjects with C and 27 matched controls had two MRI QUIPSS-II arterial spin labeling sequences converted in rCBF. One SPM analysis was performed for each rCBF measurement and the results were given as the conjunction of both analysis. There was a clear double dissociation of rCBF correlates between PC and C, both being meaningful relative to their residual symptomatology. In PC: rCBF was increased in the left motor and premotor areas. In C: rCBF was decreased bilaterally in the temporo-parietal junctions. Conversely, in both (schizophrenia): rCBF was increased in the left striatum which is known to be an anti-psychotics' effect. This evidence refuts the single schizophrenia model and suggests better natural foundations for PC and C phenotypes. This pleads for further research on them and further research on naturally founded psychotic phenotypes. CLINICAL TRIAL: Name of the registry: ClinicalTrials.gov Identification: NCT02868879.

Sobre alucinação e realidade: a psicose na CID-10, DSM-IV-TR e DSM-V e o contraponto psicanalítico / À propos de l'hallucination et la réalité: la psychose dans la CID-10, DSM-IV-TR et DSM-V et la et le contrepoint psychanalytique / Acerca de la alucinación y la realidad: la psicosis en la CID-10, DSM-IV-TR y DSM-V y el contrapunto psicoanalítico / Regarding hallucination and reality: the psychosis in ICD-10, DSM-IV-TR, and DSM-V and the psychoanalytic counterpoint

A psicose é um dos poucos termos da psicopatologia clássica e da psicanálise que permanece nos sistemas classificatórios atuais, como o DSM (Manual Diagnóstico Estatístico de Transtornos Mentais) e a CID (Classificação Internacional de Doenças), o que nos dá condições para investigarmos as diversas maneiras de pensar o sofrimento psíquico. Desse modo, analisamos criticamente como o DSM-IV-TR, a sua atual edição (DSM-V) e a CID-10 definem e utilizam o termo 'psicose'. A apropriação desse conceito ampara-se em definição meramente descritiva como estratégia de recusa ao debate etiológico. A alucinação, um dos critérios para a classificação dos transtornos psicóticos, é definida partindo-se de realismo ingênuo em que a realidade é tomada objetivamente como um dado. Assim, apresentamos o contraponto psicanalítico para essa apropriação: a psicanálise aponta para a relevância da estruturação simbólica dos fenômenos perceptivos e para a realidade como construção subjetiva.

La psychose est l'un des rares termes de psychopathologie et de la psychanalyse classique qui restent dans les systèmes de classification actuels, tels que le Manuel diagnostique et statistique des troubles mentaux (DSM) et la Classification internationale des maladies (CID), qui nous donne les conditions pour enquêter sur les différents façons de penser la détresse psychologique. Ainsi, nous verrons comment le DSM-IV-TR, son numéro actuel (DSM-V) et la CID-10 définissent et utilisent le terme psychose. L'appropriation de ce concept se prend comme une définition purement descriptive de refus de stratégie de débat étiologique. L'hallucination, l'un des critères pour la classification des ' roubles psychotiques' est définie à partir d'un réalisme naïf où la réalité est prise comme une donnée objective. Ainsi, nous présentons le contrepoint psychanalytique de cette appropriation: les points psychanalyse à la pertinence de la structuration symbolique des phénomènes de perception et la réalité comme une construction subjective.

La psicosis es uno de los pocos términos de la psicopatología clásica y el psicoanálisis que permanecen en los sistemas de clasificación actuales, tales como el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM) y la Clasificación Internacional de Enfermedades (CID), que nos da las condiciones para investigar las distintas formas de pensar sobre la angustia psicológica. Por lo tanto, se discute cómo el DSM-IV-TR, su edición actual (DSM-V) y el CID-10 definen y utilizan el término psicosis. La apropiación de este concepto mantiene a sí misma como una definición puramente descriptiva de la negativa a la estrategia de debate etiológico. La alucinación, uno de los criterios para la clasificación de los trastornos psicóticos se define empezando con un realismo ingenuo donde la realidad se toma como un hecho objetivamente. Por lo tanto, presentamos el contrapunto psicoanalítica a esa apropiación: puntos psicoanálisis a la relevancia de la estructuración simbólica de los fenómenos de percepción y la realidad como una construcción subjetiva.

Abstract Psychosis is one of the few terms in classical psychopathology and psychoanalysis that remain in the current classification systems, such as the DSM (Diagnostic and Statistical Manual of Mental Disorders) and the ICD (International Classification of Diseases), which allows to investigate the various ways of thinking about psychological distress. We discuss how the DSM-IV-TR, its current edition (DSM-V), and the ICD-10 define and use the term psychosis. The appropriation of this concept is based on a merely descriptive definition, as a refusal strategy towards etiological discussion. Hallucination, one of the criteria for the classification of psychotic disorders is defined with a naive realism in which reality is taken as an objective construction. We present the psychoanalytic counterpoint to such appropriation: psychoanalysis points to the relevance of the symbolic structuring of perceptual phenomena and reality as a subjective construction.

Psicose e esquizofrenia: efeitos das mudanças nas classificações psiquiátricas sobre a abordagem clínica e teórica das doenças mentais / Psychosis and schizophrenia: effects of changes in psychiatric classifications on clinical and theoretical approaches to mental illness

Resumo Abordam-se as mudanças nos sistemas de classificação diagnóstica das doenças mentais, em especial o enfraquecimento conceitual da categoria “psicose” e a dominância da esquizofrenia como psicose única. As classificações atuais priorizam uma abordagem fisicalista da patologia mental. Ocorrem, então, a medicalização das condições antes associadas à neurose e à subjetividade; a localização de quadros antes reconhecidos como psicóticos na rubrica dos transtornos de personalidade; e a redução da psicose à esquizofrenia, abordada como deficit das funções psíquicas. Aponta-se a validade clínica e operatória da noção de “psicose” como categoria nosográfica que permite abordagem mais complexa da “esquizofrenia”, última noção, na psiquiatria, com o peso simbólico da loucura.

Abstract This article discusses changes in the diagnostic classification systems for mental illness, especially the conceptual weakening of the “psychosis” category while schizophrenia became the only psychosis. Current pathological classifications prioritize a physicalist approach. Consequently, conditions that previously were associated with neurosis and subjectivity are being medicalized, conditions previously recognized as psychotic are relocated under the heading of personality disorders, and psychosis has been reduced to schizophrenia and considered a deficit of psychic functions. This article indicates the clinical and operational validity of the notion of “psychosis” as a nosographic category permitting a more complex approach to “schizophrenia”, which in psychiatry is the last concept that bears the symbolic weight of madness.

Severe methylenetetrahydrofolate reductase deficiency: clinical clues to a potentially treatable cause of adult-onset hereditary spastic paraplegia.

IMPORTANCE: Hereditary spastic paraplegia is a highly heterogeneous group of neurogenetic disorders with pure and complicated clinical phenotypes. No treatment is available for these disorders. We identified 2 unrelated families, each with 2 siblings with severe methylenetetrahydrofolate reductase (MTHFR) deficiency manifesting a complicated form of adult-onset hereditary spastic paraparesis partially responsive to betaine therapy. OBSERVATIONS: Both pairs of siblings presented with a similar combination of progressive spastic paraparesis and polyneuropathy, variably associated with behavioral changes, cognitive impairment, psychosis, seizures, and leukoencephalopathy, beginning between the ages of 29 and 50 years. By the time of diagnosis a decade later, 3 patients were ambulatory and 1 was bedridden. Investigations have revealed severe hyperhomocysteinemia and hypomethioninemia, reduced fibroblast MTHFR enzymatic activity (18%-52% of control participants), and 3 novel pathogenic MTHFR mutations, 2 as compound heterozygotes in one family and 1 as a homozygous mutation in the other family. Treatment with betaine produced a rapid decline of homocysteine by 50% to 70% in all 4 patients and, over 9 to 15 years, improved the conditions of the 3 ambulatory patients. CONCLUSIONS AND RELEVANCE: Although severe MTHFR deficiency is a rare cause of complicated spastic paraparesis in adults, it should be considered in select patients because of the potential therapeutic benefit of betaine supplementation.

[The schizophrenia spectrum and other psychotic disorders in the DSM-5]. / Schizofreniespectrum en andere psychotische stoornissen in de DSM-5.

BACKGROUND: This article discusses changes made in the diagnostic criteria for psychotic disorders in the transition from DSM-IV to DSM-5. AIM: To review and evaluate the changes incorporated in the DSM-5 criteria for psychotic disorders. METHOD: Relevant documents and proceedings were reviewed on the basis of personal experience in the APA working group on psychotic disorders. RESULTS: The chapter on the 'schizophrenia spectrum and other psychotic disorders' in DSM-5 introduces a conceptual psychosis continuum, in which the level, number and duration of psychotic signs and symptoms are used to differentiate between various forms of psychotic disorders. The chapter includes only a few marginal adjustments, aimed at simplifying usage and measurement-based treatment. The DSM-5 Committee also aspired for harmonization with the ICD. The Committee was in favor of a new name for schizophrenia, but referred the matter to the WHO. The empirical basis for 'attentuated psychosis syndrome' was found to be insufficient for the syndrome to be included as a diagnosis. The most important changes in the criteria for schizophrenia are the elimination of the classic subtypes, the clarification of cross-sectional and longitudinal course specifiers, the elimination of special status of Schneiderian first-rank symptoms, and the clarification and better delineation of schizophrenia in terms of: a) the relationship between schizophrenia and schizoaffective disorders and b) the relationship between schizophrenia and catatonia. In schizoaffective disorder, the perspective shifts from an episode diagnosis in DSM-IV to a life course for the illness in DSM-5. Although the committee gave serious consideration to the inclusion of trans-diagnostic dimensions, these have not been included; a factor that precludes more personalised diagnoses, at least for the time being. CONCLUSION: The limitations of the classic system of categorical diagnosis are widely acknowledged and serious consideration has been given to the abolition of this type of diagnosis or at least to the possibility of enriching it with a transdiagnostic focus on dimensions of psychopathology. These steps have not been taken in DSM-5 - for the consensus committees this is evidently still a bridge too far.

Evolución histórica y conceptual de los trastornos psicóticos no esquizofrénicos en los DSM / [Historical and conceptual evolution of non-schizophrenic psychotic disorders in DSM].

After firmly established the "kraepelinean dichotomy" (dementia praecox - manic-depressive insanity), classical psychiatry began to describe a group of psychotic disorders which did not fit in any of these main diagnoses. Many of these clinical pictures where incorporated to the DSM and underwent several changes throughout the successive editions of the American manual. This article aims to make a historical and conceptual overview of this group of non-schizophrenic psychotic disorders accompanying schizophrenia in the "Schizophrenia spectrum and other psychotic disorders" chapter of DSM-5.

[Epilepsy-related psychoses]. / Epilepsirelaterte psykoser.

BACKGROUND: Epilepsy-related psychoses lie in the border zone between neurology and psychiatry. The aim of this article is to give a brief overview of current knowledge of these psychoses, and to offer recommendations for their treatment. METHOD: The article is based on a discretionary selection of articles found through a search in PubMed, as well as the authors' own experience with this patient group. RESULTS: Epilepsy-related psychoses may occur during, after or between seizures. In addition, psychoses may occur as a side-effect of antiepileptic drugs, and as so-called alternative psychosis. The latter may arise in patients who, with the aid of treatment (medication or surgery), have become completely seizure-free. Ictal psychoses and the majority of postictal psychoses are often of such short duration that treatment with antipsychotics is not appropriate. In these cases, optimizing antiepileptic treatment is the best prophylaxis. Treatment with antipsychotics may, however, be indicated for interictal psychoses and for some patients with especially long-lasting or recurrent postictal psychoses. INTERPRETATION: Different types of epilepsy-related psychosis require different types of treatment, and some are treated with antipychotics. In those circumstances, we recommend the use of medication that is less likely to lower the seizure threshold, for example risperidone.

Psychotic disorders in DSM-5: summary of changes.

Key issues related to the diagnosis of schizophrenia and other psychotic disorders addressed in DSM-5 were more precisely defining diagnostic boundaries between different psychotic disorders, reducing spurious comorbidity, improving coherence across the diagnostic manual, and enhancing validity without loss of reliability. New information about the nature of these disorders generated since DSM-IV was incorporated into their definition. Resulting changes in DSM-5 include elimination of the classic subtypes of schizophrenia, elimination of special treatment of Schneiderian 'first-rank symptoms', more precise delineation of schizoaffective disorder from schizophrenia and psychotic mood disorders, and clarification of the nosologic status of catatonia and its consistent treatment across the manual. Changes in section 3 of the manual include addition of a new category of "attenuated psychosis syndrome" as a condition for further study and addition of unique psychopathological dimensions (that represent treatment targets across disorders). The specific nature of these revisions in the DSM-5 criteria for schizophrenia and other psychotic disorders along with their rationale are summarized in this article.

Schizophrenia and other psychotic disorders in DSM-5.

Whereas improving validity and reliability of psychiatric diagnoses were key objectives in the development of DSM-5, enhancing clinical utility was the primary goal. With reference to psychotic disorders, changes addressed limitations in DSM-IV while incorporating new information about the nature of these disorders generated over the past twenty years. With regard to schizophrenia, variation in distinct psychopathological dimensions has been found to better account for the heterogeneity of schizophrenia than traditional subtypes. Resulting changes in DSM-5 will likely include elimination of the classic subtypes of schizophrenia and addition of unique psychopathological dimensions, along with elimination of the special treatment of Schneiderian "first-rank symptoms." In view of the poor reliability and limited validity of DSM-IV schizoaffective disorder, a clearer definition is provided in DSM-5. Considering the discrepant treatment of catatonia in DSM-IV, it is treated consistently across the DSM-5 manual. Minor changes are made in the definition of delusional disorder to reduce spurious comorbidity and unnecessary complexity. A new category of "attenuated psychosis syndrome" is included in the appendix as a condition for further study. In this article, major likely revisions in the DSM-5 (due to be published in May 2013) criteria for schizophrenia spectrum and other psychotic disorders are summarized and their implications for clinical practice are discussed.

[Psychiatric disorders in patients with Cushing's disease before and after neurosurgery]. / Cushing Hastalarinda Nörocerrahi Öncesi ve Sonrasinda Görülen Psikiyatrik Bozukluklar.

OBJECTIVE: Cushing's disease which is a consequence of ACTH-secreting pituitary adenoma leads to hypercortisolism. Cushing's disease is associated with several psychiatric disturbances. The aim of the present study was to identify which psychiatric disorders were present in patients with Cushing's disease over a 2-year period and to monitor their general psychiatric condition. Additionally, the study aimed to examine the relationship between the duration of Cushing's disease, and the severity of psychiatric conditions based on psychiatric rating scales. METHOD: The study included 39 patients with Cushing's disease that underwent neurosurgery for ACTH-secreting pituitary adenomas. The transsphenoidal approach (the standard microsurgery technique) was performed in all patients. ACTH-secreting pituitary adenomas were confirmed based on immunohistochemistry in all patients. Psychiatric conditions in the patients were identified using the Clinical Global Impression Scale (CGI) and ICD 10 diagnostic criteria at 3 time points: prior to surgery, and 6 and 48 months post surgery. RESULTS: The Cushing's disease patients exhibited statistically significant improvement in their psychiatric condition, according to the CGI, 6 and 48 months post surgery. There wasn't any significant correlation between the duration of Cushing's disease and psychiatric status, as measured by the CGI prior to surgery, 6 months post surgery, or 48 months post surgery. CONCLUSION: Patients with Cushing's disease had a significant level psychiatric disturbance that remitted after surgery. There wasn't a significant correlation between the duration of Cushing's disease and psychiatric status.

Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders.

Most mental illnesses emerge during adolescence and early adulthood, with considerable associated distress and functional decline appearing during this critical developmental phase. Our current diagnostic system lacks therapeutic validity, particularly for the early stages of mental disorders when symptoms are still emerging and intensifying and have not yet stabilized sufficiently to fit the existing syndromal criteria. While this is, in part, due to the difficulty of distinguishing transient developmental or normative changes from the early symptoms of persistent and disabling mental illness, these factors have contributed to a growing movement for the reform of our current diagnostic system to more adequately inform the choice of therapeutic strategy, particularly in the early stages of a mental illness. The clinical staging model, which defines not only the extent of progression of a disorder at a particular point in time but also where a person lies currently along the continuum of the course of an illness, is particularly useful as it differentiates early, milder clinical phenomena from those that accompany illness progression and chronicity. This will not only enable clinicians to select treatments relevant to earlier stages of an illness, where such interventions are likely to be more effective and less harmful than treatments delivered later in the course of illness, but also allow a more efficient integration of our rapidly expanding knowledge of the biological, social, and psychological vulnerability factors involved in the development of mental illness into a useful diagnostic framework.

The catatonia conundrum: evidence of psychomotor phenomena as a symptom dimension in psychotic disorders.

To provide a rational basis for reconceptualizing catatonia in Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), we briefly review historical sources, the psychopathology of catatonia, and the relevance of catatonic schizophrenia in contemporary practice and research. In contrast to Kahlbaum, Kraepelin and others (Jaspers, Kleist, and Schneider) recognized the prevalence of motor symptoms in diverse psychiatric disorders but concluded that the unique pattern and persistence of certain psychomotor phenomena defined a "catatonic" subtype of schizophrenia, based on intensive long-term studies. The enduring controversy and confusion that ensued underscores the fact that the main problem with catatonia is not just its place in Diagnostic and Statistical Manual of Mental Disorders but rather its lack of conceptual clarity. There still are no accepted principles on what makes a symptom catatonic and no consensus on which signs and symptoms constitute a catatonic syndrome. The resulting heterogeneity is reflected in treatment studies that show that stuporous catatonia in any acute disorder responds to benzodiazepines or electroconvulsive therapy, whereas catatonia in the context of chronic schizophrenia is phenomenologically different and less responsive to either modality. Although psychomotor phenomena are an intrinsic feature of acute and especially chronic schizophrenia, they are insufficiently recognized in practice and research but may have significant implications for treatment outcome and neurobiological studies. While devising a separate category of catatonia as a nonspecific syndrome has heuristic value, it may be equally if not more important to re-examine the psychopathological basis for defining psychomotor symptoms as catatonic and to re-establish psychomotor phenomena as a fundamental symptom dimension or criterion for both psychotic and mood disorders.

Neurophysiological characteristics of cognitive functions in patients with first episodes of endogenous psychosis.

This report presents studies of the neurophysiological correlates of the characteristics of cognitive disorders in patients with first psychotic episodes of endogenous psychosis at juvenile age. Three groups of patients were studied: those with a predominance of catatonic symptomatology (22 patients), those with a predominance of hallucinatory-delusional symptomatology (22 patients), and those with a predominance of affective-delusional symptomatology (24 patients), along with a group of psychologically healthy subjects (15 subjects). Parameters of auditory evoked potentials were analyzed using the oddball paradigm. The group with a predominance of catatonic disorders showed the greatest differences in the latent periods (LP) of the N200 and P300 components as compared with the other groups; patients with a predominance of hallucinatory-delusional symptomatology showed the most localized anomalies in the latent period of the P300 component; the group of patients dominated by affective-delusional symptomatology showed almost no increase in the latent period of the N200 component, though the extents of anomalies in the N100 component in responses to non-target signals and deviations in the P300 component were more marked than in the other groups. These characteristics of the neurophysiological correlates of cognitive functions in each group of patients supported the significance of evaluating the psychopathological structure of manifest psychotic episodes for determining the clinical typology.

The distribution of positive psychosis-like symptoms in the population: a latent class analysis of the National Comorbidity Survey.

OBJECTIVE: Previous research has suggested that psychosis is better described as a continuum rather than a dichotomous entity. This study aimed to describe the distribution of positive psychosis-like symptoms in the general population by means of latent class analysis. METHOD: Latent class analysis was used to identify homogeneous sub-types of psychosis-like experiences. Multinomial logistic regression models were used to interpret the nature of the latent classes, or groups, by estimating the associations with demographic factors, clinical variables, and experiences of traumatic events. RESULTS: The best fitting latent class model was a four-class solution: a psychosis class, a hallucinatory class, an intermediate class, and a normative class. The associations between the latent classes and the demographic risk factors, clinical variables, and experiences of traumatic events showed significantly higher risks for the psychosis class, the hallucinatory class, and the intermediate class compared to the normative class. Furthermore there appeared to be a grading in the magnitude of the odds ratios: the odds ratios for the psychosis group were generally higher than those for the hallucinatory class, and the odds ratios for the hallucinatory class were generally higher than those for the intermediate class. CONCLUSIONS: The latent class analysis showed that psychosis-like symptoms at the population level could be best explained by four groups that appeared to represent an underlying continuum.

Atendimento a pacientes dependentes de drogas: atuação conjunta do psicólogo e do psiquiatra / Attendance of drug-dependent patients: psychologists and psychiatrists in team-work

Muito se tem discutido acerca da interrelação entre psicólogos e psiquiatras quanto ao tratamento multidisciplinar de seus pacientes, e este aspecto constituiu-se no objetivo principal desta investigação. O material utilizado constou de um roteiro de entrevista com perguntas abertas, analisado segundo o método de Lefèvre e Lefèvre, tendo como amostra três psicólogos e três psiquiatras em um ambulatório de uma instituição pública de saúde do Estado de São Paulo. As conclusões resultantes desta pesquisa revelam ainda existirem pontos de divergência entre as especialidades, mas sugerem perspectivas de entrosamento no que se refere ao entendimento e expectativas entre elas.

The interrelationship amongst psychologists and psychiatrists has been an issue in terms of multidisciplinary team related to the treatment of their patients, and this aspect constituted the focus of this investigation. Three psychologists and three psychiatrists from a State Public Health Institution in Sao Paulo were interviewed and their responses to open questions were analyzed by means of the qualitative method proposed by Lefèvre and Lefèvre. The main conclusions reveal that there still are divergences amongst these specialties, but also that perspectives of mutual understanding of their professional roles can be seen.

A evolução de longo prazo pode diferenciar dois subtipos de psicose de início tardio / Long term follow-up can differenciate two subtypes of late-life psychosis

A esquizofrenia de início tardio ainda é pouco estudada. Os trabalhos atuais apontam para uma patologia heterogênea, com perfil cognitivo semelhante ao encontrado na esquizofrenia com início no adulto jovem e dois tipos de evolução: um grupo com estabilização dos déficits neuropsicológicos e outro grupo com piora destes déficits ao longo do tempo. Apresentam-se dois casos clínicos avaliados por testes neuropsicológicos CAMCOG e Miniexame do Estado Mental (MEEM), Escore Isquêmico de Hachinski, Questionário de Atividades Funcionais de Pfeffer, PANSS e Inventário Neuropsiquiátrico. O desempenho cognitivo e das atividades de vida diária destes casos foram distintos, o que aponta para a necessidade de estudos prospectivos com enfoque neuropsicológico, para entendimento dos diferentes tipos de evolução das psicoses de início tardio.