Friday, March 18, 2016

Associations Between Psychotic Experiences, Mental Disorders Found to Be Bidirectional

While previous studies suggest that psychotic experiences are associated with an elevated risk of subsequent mental disorders, the findings of a study published online today in AJP in Advance also suggest that most mental disorders are associated with an elevated risk of subsequent psychotic experiences.

John McGrath, M.D., Ph.D. (pictured above), a professor of psychiatry at the University of Queensland in Brisbane, Australia, and colleagues drew on data gathered by trained lay interviewers on 31,261 people in 18 countries as part of the World Health Organization’s World Mental Health Surveys. They were looking not just for prevalence of psychotic experiences and mental illnesses but for any temporal associations between the two.

Of the 21 common mental disorders studied, psychotic experiences were significantly associated with subsequent first onset of eight disorders (major depressive disorder, bipolar disorder, generalized anxiety disorder, social phobia, posttraumatic stress disorder, adult separation anxiety disorder, bulimia nervosa, and alcohol abuse). In contrast, 18 of the 21 mental disorders were linked with subsequent first-onset psychotic experiences, with odds ratios ranging from 1.5 to 2.8 depending on the illness.

“These findings call into the question the specificity of the association between psychotic experiences and psychotic disorders,” the researchers wrote. “A better understanding of how psychotic experiences unfold across the lifespan and interact with mental disorders may provide clues to help guide clinical management.”

In a related video, McGrath describes the study in more detail and what the findings might mean for clinicians.

For related information, see the Psychiatric News article “Same Brain Circuits Linked With Psychosis in Two Disorders.”

Help Make ECT Accessible to More Patients

The Food and Drug Administration (FDA) is proposing to reclassify ECT from a Class III (high risk) medical device to Class II (low risk), a change APA supports. APA urges psychiatrists to contribute their comments to the FDA in favor of the reclassification. A template letter has been prepared that provides talking points. The FDA must receive comments by March 28.

“[I]t is so important for psychiatrists to take the lead in expressing their views in regard to the role that ECT plays in clinical practice and in the treatment of major depressive disorder,” wrote APA CEO and Medical Director Saul Levin, M.D., M.P.A., and APA President RenĂ©e Binder, M.D., in a blog post. “For appropriate patients, ECT has been a lifesaver. It has given them an opportunity for a normal, functional life.”

For information about previous efforts to reclassify ECT, see the Psychiatric News article “FDA Advisory Panel Favors ECT in High-Risk Category.”


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