Shortened duration of untreated first episode of psychosis: changes in patient characteristics at treatment.

OBJECTIVE: This study examined whether duration of untreated psychosis can be shortened in patients with first episodes of DSM-IV schizophrenia spectrum disorders and whether shorted duration alters patient appearance at treatment. METHOD: Two study groups were ascertained in the same Norwegian health care sector: one from 1993-1994 with usual detection methods and one from 1997-1998 with early detection strategies that included education about psychosis. RESULTS: Patients with early detection had a shorter median duration of untreated psychosis by 21.5 weeks than patients with usual detection. The number with psychosis was greater in the early detection group; the number with schizophrenia was less. Early detection patients had more substance abuse and were younger, better adjusted premorbidly, and less ill. CONCLUSIONS: Early detection can shorten duration of untreated psychosis and help more patients when they are less severely ill. Given the devastation of psychosis, this is a significant treatment advance.

The Reactivity of Psychosis Rating Form (RPRF): background, development and psychometrics.

The ICD-10 and DSM-IV classifications have both given low priority to "reactivity" to acute stress as a classificatory principle for functional psychoses. In Scandinavia, reactivity is still considered an important factor in the development of such psychoses. Reactivity is a complex concept, and its various components are historically examined. The Reactivity of Psychosis Rating Form (RPRF) was developed in order to operationalize reactivity. Seven of the 10 elements of RPRF can be rated reliably. Factor analysis of the RPRF yields three factors: stressor, onset and change, that also show high interrater reliability. Our results indicate that RPRF has both construct and discriminant validity. Further studies with the RPRF may elucidate the true status of reactivity in functional psychoses.

[Violent behavior of patients--is it predictable?]. / Voldelig atferd hos pasienter--kan den forutsies?

In previous research on prediction of violent behaviour in patients some of the most important limitations have been lack of precision in defining violent behaviour, unsystematic registration of violence, and the fact that the prediction has been made valid for contexts other than that in which the original assessment was made. Of the neurobiological factors associated with violence, scientists have recently focused upon the serotonergic system in the central nervous system as being important. The authors review the literature on individual predictors of violent behaviour. Strong predictors seem to be previous violent behaviour, a high degree of hostility, suspiciousness and grandiosity, and current alcohol or drug abuse. The article includes suggestions for future research, and concludes with a presentation of guidelines for clinical assessment of risk of violence, with emphasis on recent events and observed behaviour.

Were Langfeldt's schizophreniform psychoses really affective?

Langfeldt's cases of schizophreniform psychoses were reclassified according to the ICD-9 and DSM-III-R diagnostic systems. The main purpose was to reexamine the validity of his concept of 'schizophreniform psychoses' to see whether it supported the existence of a 'third psychosis', and whether his material could be helpful in identifying good prognostic features in schizophrenia. Most of the schizophreniform psychoses turned out to be affective disorders with psychotic features. The number of other psychotic disorders was too small to facilitate a more thorough examination.

Langfeldt's schizophreniform psychoses fifty years later.

As a result of follow-up studies published in 1937 and 1939, Langfeldt divided schizophrenia into two groups; 'typical schizophrenia' which had a poor outcome, and the 'schizophreniform psychoses' which had a less typical clinical picture of schizophrenia and a good outcome. Langfeldt's cases of schizophreniform psychoses were reclassified according to the ICD-9 and DSM-III-R diagnostic systems. Most of the schizophreniform psychoses did not appear 'schizophrenia-like' at all, but turned out to be mainly affective disorders. Those included in Langfeldt's diagnosis of 'schizophreniform psychoses' were found to be too heterogenous to validate the existence of this syndrome.

Predictive value of the four good prognostic features in DSM-III-R schizophreniform disorder.

DSM-III-R divides schizophreniform disorder into 2 subtypes with and without good prognostic features. The 4 prognostic features have been selected based on the literature, and the presence of at least 2 should indicate a good prognosis. The predictive value of the good prognostic features was tested in a sample of 16 untreated patients with DSM-III-R schizophreniform disorder with known long-term outcome based on personal follow-up examination. No correlation between the presence of 2 or more features and favorable outcome was observed. Confusion, disorientation or perplexity at the height of the psychotic episode was the only feature consistently associated with a favorable outcome in this sample. The introduction of good prognostic features of schizophreniform disorder by DSM-III-R has been done without due consideration of the methodological problems of prediction research.

Comparing the performance of two gamma cameras under high counting rates: principles and practice.

The performance of two large Anger cameras at high counting rates was compared, and the principles for measuring the relevant parameters, especially deadtime loss and coincidence artifacts, are discussed. The results demonstrate the importance of the following factors: modern pulse-shaping circuitry with short paralyzable deadtime, and anti-pileup circuit, and uniform energy information within the field of view, which requires separate summing matrices for energy and position. Elaborate testing of the specifications should be carried out before purchase of a gamma camera.

Anger camera imaging of perfused and nonperfused brain tissue with intra-arterial 133Xenon technique.

The regional cerebral blood flow, the regional blood flow distribution, and the regional distribution of perfused (= vital) brain tissue been imaged with a digitalized conventional Anger camer. An analog scaler was placed behind the PM-tubes to reduce dead-time loss. The input pulse rate was doubled to counteract the effect of scaling on counting statistics, and the gamma emission was filtered through 1 mm of brass to increase the fraction of the integral count rate within the 40% window. In this way the 31 keV peak disappears, and Compton scatter and disturbing coincidences are markedly reduced. This improves spatial resolution. The flow parameters are imaged regionally in 3 X 3 mm2 matrix elements after flat field correction and smoothing. The matrix is 64 X 64 interpolated to 128 X 128. Patient studies emphasized the importance of imaging the distribution of perfused and nonperfused tissue in cases of infarctions, dilacerations, etc., where angiography and conventional brain scanning may often be negative.