The choroid plexus (ChP) is part of the blood‐cerebrospinal fluid barrier, regulating brain homeostasis and the brain's response to peripheral events. Its upregulation and enlargement are considered essential in psychosis. However, the timing of the ChP enlargement has not been established. This study introduces a novel magnetic resonance imaging‐based segmentation method to examine ChP volumes in two cohorts of individuals with psychosis. The first sample consists of 41 individuals with early course psychosis (mean duration of illness = 1.78 years) and 30 healthy individuals. The second sample consists of 30 individuals with chronic psychosis (mean duration of illness = 7.96 years) and 34 healthy individuals. We utilized manual segmentation to measure ChP volumes. We applied ANCOVAs to compare normalized ChP volumes between groups and partial correlations to investigate the relationship between ChP, LV volumes, and clinical characteristics. Our segmentation demonstrated good reliability (.87). We further showed a significant ChP volume increase in early psychosis (left: p < .00010, right: p < .00010) and a significant positive correlation between higher ChP and higher LV volumes in chronic psychosis (left: r = .54, p = .0030, right: r = .68; p < .0010). Our study suggests that ChP enlargement may be a marker of acute response around disease onset. It might also play a modulatory role in the chronic enlargement of lateral ventricles, often reported in psychosis. Future longitudinal studies should investigate the dynamics of ChP enlargement as a promising marker for novel therapeutic strategies.

No abstract

Long-acting injectable antipsychotics (LAIs) increase drug compliance and offer a reliable treatment option with stable pharmacokinetics. The aim of our study is to examine the rate and predictors of LAIs' prescription at discharge in inpatients with schizophrenia and other psychotic disorders. This retrospective study included 400 inpatients. Sociodemographic and clinical characteristics of the patients, the treatments applied in the past and prescribed at discharge were obtained from the hospitalization files. We compared these characteristics of those who were given LAI treatment at discharge to the patients who were given oral treatments. Thirty-nine percent of the patients were prescribed a LAI at discharge. Duration of illness was longer, and number of previous hospitalizations was higher in the LAI group. Nonadherence to the antipsychotics before the hospitalization, the previous history of LAI use, lack of insight at the admission and no previous antidepressant use were found as independent contributors to LAI prescription as the treatment of discharge in logistic regression analysis. Our study showed that LAIs are used at a high rate in our clinic; however, they are still initiated at a later stage, mostly in chronic patients with a lack of insight and compliance at admission.

Tuberous sclerosis (TSc) is an autosomal dominant multisystemic disorder. Mutant TSC1 and TSC2 are the responsible genes for the disorder that leading to a hyperactivation of the mammalian target of rapamycin (mTOR), a signaling cascade involved in cell growth, proliferation, protein synthesis, and metabolism. Everolimus and sirolimus, the mTOR inhibitors, are recently offered to restore pathologically up-regulated mTOR pathway in TSc. However, the neuropsychiatric side effects of these drugs are yet to be studied. Here we reported a 22-year-old male patient, with diagnoses of tuberous sclerosis, epilepsy, learning disability, and organic personality disorder without any psychotic manifestations, who was admitted to our outpatient clinic because of disorganized behavior, hallucinations, and delusions with a recent history of hostility and aggression. The aforementioned psychotic manifestations initiated soon after he had undergone on a placebo-controlled double-blind study of everolimus 6 mg/daily for TSc for last four months. Clinical examination, laboratory screening, and magnetic resonance imaging (MRI) of the brain have not revealed any other organic causes of psychosis. His symptoms resolved over the next ten or so days with moderate doses of antipsychotics. The current case is presented in order to discuss possible underlying neuronal signaling mechanisms those may lead psychosis following a short-term mTOR inhibition treatment. Although it would be difficult to allege the direct involvement of short-term everolimus exposure in the development of psychotic symptoms, impaired protein synthesis related to the mTOR inhibition leads to impaired neuronal network and plasticity, and may predispose to the development of psychotic symptoms, consequently.

Background Although the growing evidence show the advantages of long acting injectable (LAI)antipsychotics on treatment of psychotic disorders, characteristics of the patients with psychotic disorders using LAI is not studied enough. The aim of this retrospective study is to understand the clinical characteristics of the patients with psychotic disorders to whom any LAI was prescribed at discharge from hospital Methods We screened the files of 400 inpatients with psychosis spectrum disorders who were treated in inpatient units of Istanbul Faculty of Medicine, Department of Psychiatry between 01.01.2014-01.016.2019. We recorded the last admission if the patient had more than one hospitalization. We compared the variables including illness duration, diagnosis, presence of involuntary hospitalization, insight, substance/alcohol abuse, forensic problems between those who were prescribed LAI and others. We also applied logistic regression analysis to detect the independent predictors of LAI prescription. Results Thirty-nine percent of the patients were given LAI at discharge. Patients with schizophrenia and schizoaffective disorders were more common compared to psychotic disorder NOS/schizophreniform disorder in LAI group (p&lt;0.001). Those who prescribed LAI were older and had longer duration of psychotic disorder. Poor insight at admission, past and present noncompliance, involuntary admission (64,5% vs 35,5%, p=0.003) and history of forensi problems (63% vs 37%, p=0.01)were more common in LAI group. Past ECT treatment, antipsychotic polypharmacy and LAI treatment in past were more common in LAI group. Lack of insight at admission, history of LAI treatment before and noncompliance to medications before hospitalization were appeared as predictors of LAI prescription at discharge in logistic regression. We found no relationship between LAI prescription and drug abuse, treatment resistance and psychiatric comorbidity. Discussion Our findings suggest that LAIs were prescribed to chronic and older inpatients with lack of insight, and compliance at admission. The patients who were prescribed LAI also had indirect indicators of poor outcome, like previous ECT and polypharmacy. Contrary to previous reports, we found no difference in alcohol/substance abuse between those who were prescribed LAI and others.

No abstract

No abstract