ABSTRACT
AIM: Retrospective studies indicate that patients with psychotic disorders and schizophrenia often suffer from depressive symptoms before the onset of psychosis. In a historical-prospective design, we studied the association between dysthymia in adolescence and later hospitalization for psychotic disorders and schizophrenia. METHODS: The Israeli Draft Board screens the entire, unselected population of 16-17 years old male adolescents for psychiatric disorders. These adolescents were followed for hospitalization for psychotic disorders and schizophrenia using the Israeli National Psychiatric Hospitalization Case Registry. Of 275,705 male adolescents screened, 1267 (0.5%) were hospitalized for psychotic disorders (International Classification of Diseases [ICD]-10 20.0-29.9), and 757 (0.3%) were hospitalized for schizophrenia (ICD-10 20.0-20.9) over the next 1-10 years. RESULTS: Of 275,705 male adolescents screened, 513 (0.2%) were diagnosed as suffering from dysthymia by the Draft Board. Of these adolescents, 10/513 (2.0%) were later hospitalized for psychotic disorders (including schizophrenia, HR=3.967, 95%CI (confidence intervals): 2.129-7.390), and 4/513 (0.8%) were later hospitalized for schizophrenia (HR=2.664, 95%CI: 0.997-7.116). CONCLUSIONS: In this population-based cohort of male adolescents, dysthymia was associated with increased risk for future psychotic disorders. Dysthymia in some adolescents might be a prodromal symptom, while in others it might be a risk factor for later psychosis. Clinicians assessing dysthymic adolescents should be aware that these symptoms might be part of the prodrome.
Subject(s)
Dysthymic Disorder/psychology , Psychotic Disorders/etiology , Adolescent , Cohort Studies , Confidence Intervals , Dysthymic Disorder/diagnosis , Dysthymic Disorder/epidemiology , Dysthymic Disorder/therapy , Hospitalization/statistics & numerical data , Humans , Israel/epidemiology , Male , Proportional Hazards Models , Psychotic Disorders/epidemiology , Psychotic Disorders/prevention & control , Risk Factors , Schizophrenia/epidemiology , Schizophrenia/etiology , Schizophrenia/prevention & control , Time FactorsABSTRACT
Eight patients (6 men and 2 women) with chronic post-traumatic stress disorder (PTSD) were treated with naltrexone 100-200 mg/day. Seven patients completed 2 weeks of treatment. A subtle and clinically insignificant improvement was noted in intrusive and hyperarousal symptoms (p < 0.05 for both), but not in avoidance symptoms. All patients demonstrated side effects which limited the targeted dose. It is suggested that the subtle positive effect of naltrexone and the hypersensitivity of these patients to its side effects do not encourage the use of naltrexone in the treatment of PTSD patients.