Functional and clinical outcomes of delusional disorder and schizophrenia patients after first episode psychosis: a 4-year follow-up study.

BACKGROUND: Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years. METHODS: 71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years. RESULTS: At four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients. CONCLUSIONS: Results indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.

An Umbrella Systematic Review of Seasonality in Mood Disorders and Suicide Risk: The Impact on Demand for Primary Behavioral Health Care and Acute Psychiatric Services.

Objective: To review the current literature focusing on the most recent systematic reviews relating to mood, suicide, and psychiatric service utilization.Study Selection and Data Extraction: A systematic literature search of PubMed, CINAHL, and PsycINFO databases using the search terms "Systematic review" AND "season*" AND mood OR depression OR bipolar OR psychosis OR suicid* OR psychiatr* initially yielded 209 results. After screening by title and abstract for relevance, 6 records remained, while a further 3 were identified after screening of reference lists. A qualitative synthesis of these results was then performed due to data heterogeneity between studies.Results: We found evidence of winter peaks for depressive symptoms and suggestions of summer peaks for suicidal activity, emergency department (ED) self-harm presentations, and manic-related hospital admissions. Suicide is 11%-23% more frequent in spring and summer. ED suicide attempts are also 1.2-1.7 times higher in spring and summer compared to winter. Admissions for mania are 7.4%-16% higher in spring and summer, while there are 1.5 times more admissions for bipolar depression in winter months.Conclusions: There is a summer peak for many aspects of mental health activity, particularly in terms of acute hospital utilization and suicidality. This is contrary to the winter-related peak of depressive symptoms. Further research is needed to affirm these findings.