Psychosis Is Mutable over Time: A Longitudinal Psychopathology Study

Abstract

Background: A neurobiologically informed, system-specific psychopathological approach has been suggested for use in schizophrenia. However, to our knowledge, such an approach has not been used to prospectively describe the course of schizophrenia. Sampling and Methods: We assessed psychopathology in a well-described sample of 100 patients with schizophrenia or schizoaffective disorder with the Bern Psychopathology Scale (BPS) at 6-month intervals for up to 18 months. The BPS groups symptoms into the 3 domains language, affectivity and motor behaviour; each domain is rated as being normal, inhibited or disinhibited. In addition, we collected qualitative psychopathological data in the form of case reports. Results: Forty-eight patients completed at least 2 assessments over the course of at least 1 year. Of these, 16 patients (33.3%) showed a bipolar course pattern (i.e., a switch from inhibited to disinhibited or vice versa) in 1 domain and 6 patients (12.5%) in more than 1 domain. Shifts from 1 dominant domain to another were seen frequently (n = 20, 41.7%), but shifts between 1 dominant domain and a combination of dominant domains were more common (n = 33, 68.8%). Conclusions: The course of schizophrenia is heterogeneous and shows frequent changes in psychopathology. This should be taken into account in the communication with patients and in the research on underlying illness mechanisms and treatment. A major limitation of this study is the small sample size.

Nutritional psychiatry in the treatment of psychotic disorders: Current hypotheses and research challenges

“…There are efforts to distinguish psychosis subgroups based on symptomatology ( Kay and Opler, 1987 ; Strik et al., 2010 ) and on underlying pathology and endophenotypes ( Barron et al., 2017 ; Garcia-Rizo et al., 2012 ). A complicating factor is that phenotypes of schizophrenia-spectrum disorders are also mutable over time ( Wigand et al., 2018 ) and depend on treatment status ( Radhakrishnan et al., 2017 ). Also, the Mild Encephalitis hypothesis applies only to a subgroup of patients with psychosis and neuroinflammation and even only in certain stages of the disease ( Bechter, 2013 ).…”

Feasibility and Acceptability of Photographic Food Record, Food Diary and Weighed Food Record in People with Serious Mental Illness

“…A further consideration is that the features of schizophrenia spectrum disorders and affective disorders change over time [ 33 ], and correspondingly, the medication and the functional impairment are likely to change as well [ 34 ]. Any changes in the occurrence of, for example, medication-related food craving [ 35 , 36 ], food insecurity [ 37 ] and motivation: loss of drive to shop and cook [ 38 ], also influence dietary behavior.…”