Metabolic Abnormalities in Psychosis, Interventions and Transmissions - Term Paper Example

Article Review: Metabolic Abnormalities in Psychosis [Name] [Professor Name] [Course] [Date] Abstract: Early intervention and treatment of patients diagnosed with first-episode psychosis (FEP) increases the response to treatment and chances of improved outcome. This paper examines the evidence of the nature and prevalence of metabolic morbidity in the young people after using antipsychotic medication. It reviews three published reports that examine how persons who suffer from schizophrenia are susceptible to obesity, weakened tolerance to glucose as well as possible occurrences of lipid abnormalities, the impact of early detection of the metabolic complexities following the start of the treatment in patients with the FEP and how they can enable early intervention as well as the success of medication. Further, it also explores studies into the prevalence of psychotic disorders from parents to their offspring and the peculiarity in the inheritance across different subtypes of psychoses. Metabolic Abnormalities in Psychosis, Interventions and Transmissions Introduction Proper and systematic analysis of the underlying causes of a psychotic disorder can prevent recommendation of wrong intervention and treatment to persons with psychiatry illnesses. Given the multi-factorial complexity of the psychotic disorders, it is important that careful and proper diagnosis of the disorders be conducted. This is essential in facilitating the early detection and diagnosis of the diseases as well as in monitoring its treatment. The purpose of this paper is to review three research reports that have examined the prevalence of metabolic morbidity in young people after antipsychotic interventions, the link between overweight or obesity and schizophrenia and the transmission of psychotic disorders from parents to their offspring and the peculiarity in the inheritance across different subtypes of psychoses. The first article by Curtis et al (2011) entails a report on the occurrence of weight gain among children and adolescents resulting from the development of metabolic abnormalities more specifically, among those who receive antipsychotic drugs during the first instances of psychosis disorders. The study investigated the prevalence of such abnormalities. It further examined the techniques of closing the existing gap between practicable guidelines and the available evidence. According to Curtis et al (2011), the severe effects that children experience from the antipsychotic drugs overstate the substantial burden of suffering from a severe mental disorder. It can be commented here that a majority of these young people may face a future that is controlled by stigmatizing psychoses disorders as well as a life that is limited and cut short by ill health, particularly cardiovascular disease or type-2 diabetes. The study used case record audit (retrospective) of some 85 patients aged between 16 and 27 years who were attending early psychosis service, and who exhibited at least a single metabolic measure identified by the blood glucose, lipids, waist circumference and blood pressure. It further explored the evidence of the nature and prevalence of metabolic morbidity in the young people after using antipsychotic medication (Curtis et al 2011). In its findings, about 42 percent of the females and 55 percent of the males became overweight following a median treatment period of eight months. The period of the antipsychotic therapy was linked to the higher BMI (r = 0.28, P < 0.01). Over 40 percent of the sum total of the sample gained higher waist circumference. The study further revealed that of the 64 respondents with entire metabolic date, about 13 percent satisfied complete IDF criteria for metabolic syndrome, while another 33 percent either showed increase in waist circumference with a single metabolic abnormality (Curtis et al 2011). This indicates increasing evidence in the number of the chief antecedents of metabolic syndrome that occur after diagnosis and the onset of antipsychotic treatment accumulating over time. The report illustrated that a third of the child and adolescent patients who undergo their firs-episode psychosis (FEP) either exhibited metabolic abnormalities or had metabolic syndrome (Curtis et al 2011). From this illustration, it can be argued that the detection of the metabolic complexities after the start of the treatment in patients with the FEP will allow for timely intervention with lifestyle or the drug interventions in the persons who are at risk of substantial physical health morbidity. Curtis et al (2011) postulates that policies or guidelines surrounding the monitoring the metabolic syndrome in the young people who suffer from mental illnesses receive antipsychotic treatment are limited. However, an opportunity is found in the alteration of the course towards cardiovascular disorders and type-2 diabetes through early detection and intervention. This enables the reduction of the risk of cardio-metabolic effects instead of waiting until the end-points of the disease is attained later in life. In summary, effectual treatment in the patients diagnosed with first-episode psychosis (FEP) increases the response to treatment and chances of improved outcome. In addition, the review of the article reveals that antipsychotic treatments remain the foundational medications preferable to these types of patients. Additionally, patients diagnosed with FEP exhibit better response to the medications than those with chronic illnesses. In addition, they are more susceptible to side-effects of obese or weight gain among other abnormalities. The second article by Orešič et al (2011), discusses how persons who suffer from schizophrenia are susceptible to obesity, weakened tolerance to glucose as well as possible occurrences of lipid abnormalities. More importantly, the study presents a comprehensive molecular information on the metabolic abnormalities and how they can offer clues on the changes experienced by persons with schizophrenia. In the population-based study that was conducted in Finland, the researchers used more detailed metabolic in serum samples. The study included all individuals diagnosed with the Diagnostic and Statistical Manual of Mental Disorders DSM-IV primary psychotic disorder. The findings were categorized into three clusters. First, the study found that persons with schizophrenia demonstrated higher metabolite levels in two molecular groups that contained tyrosine, amino acids among other metabolites and secondly, pyruvic , glutamic, lactic and proline acids. Subsequent to the adjustment for metabolic comorbidity and medication, schizophrenia was found to have remained independently linked to higher levels of all the eight groups. Next, the metabolic irregularities were discovered to be less prevalent in persons diagnosed with affective psychosis (Orešič et al 2011). The study sought to establish the serum metabolic profiles connected to the various psychotic disorders classifiable in three major clusters such as affective psychoses, schizophrenia as well as other non-affective psychoses (ONAP). Orešič et al (2011) applied metabolomics approach using extensive analytical coverage to the serum sample from a specific group in population. The researchers afterwards investigated dependencies of the three various diagnostic clusters on particular metabolic profiles with regard to the antipsychotic medication, metabolic comobordity as well as the variables in the lifestyle of the population studied. Indeed, Orešič et al (2011) remarked that metabolomics, which is characteristically vulnerable to both environmental and genetic variation, can become a vital tool essential for effective psychiatric research particularly in examination of disease vulnerability, response to treatment and clinical study. According to Orešič et al (2011), schizophrenia is among the most rigorous and impairing medical diseases with a lifetime prevalence of nearly 1 percent in the overall populations. The researchers postulated that schizophrenia is a developmental disorder that may result from a mixture of varied genetic susceptibilities, cognitive impairment, drug abuse or early environmental affronts with transmissibility of up to 80 percent. The (DSM)-IV groups primary psychotics disorders into nine various diagnoses on the basis of the patterns of the system, the clinical course as well as the outcome, even as it Orešič et al (2011) contends that it remains unapparent whether this can be justified etiologically. On other hand, the study can be described as showing that even as an overlap exists in genetic susceptibility among the various psychotic disorders such as bipolar I disorder or schizophrenia, they do have environmental and non-sharable genetic risk factors. There is however no easy way to distinguish the differences between secondary and primary psychoses based solely on psychopathology. Even so, some symptoms may indicate medical-toxic etiology. In addition, several acute or primary psychiatric presentations may comprise confusion, as a result causing a toxic psychosis. Rather, experts in psychiatry will have to rely on the technicalities such as the onset age, response of treatment and the symptoms. This would help in the early detection and diagnosis of the diseases as well as in monitoring its treatment. From the review of the second article, it can be concluded that the metabolic abnormalities that are related to proline-related or insulin secretion reveal two distinct disease-related pathways. The statement is supported by the fact that a preeminent candidate diagnostic model that separates schizophrenia from other psychotic disorders can be obtained via combination of the metabolites that have been selected from either of the two pathways. The third article by Goldstein, Buka, Seidman and Tsuang (2010) reports an investigation on the spread of psychotic disorders from parents to their offspring and the peculiarity in the inheritance across different subtypes of psychoses. It explores the familial transmission of schizophrenia as well as other psychoses. The study involved a population-based community sampling across different settings including Rhode Island, Boston, Providence and Massachusetts. Some 159 parents and 203 high-risk offspring with psychoses were studied. Those also surveyed included 114 control parents and their 147 offspring. In the study, the main outcome measure included methodologically assessed research DSM-IV psychiatric diagnoses for adult offspring. The study found that those parents with SPS had their offspring significantly at high risk of having SPS disorders (almost 6-fold) and a less significant doubling risk of AP. In addition, offspring of parents diagnosed with AP indicated a 14-fold elevated risk of having AP in comparison to offspring of control. The researcher concluded that parents diagnosed with psychosis to a great extent increased the risk of transmitting the disorder to their offspring. In addition, they showed specificity for transmitting SPS disorders and APs in their families (Buka, Seidman and Tsuang, 2010). To this end, Buka, Seidman and Tsuang (2010) specify that an established method of examining etiology of schizophrenia is the familial high risk study as it comprised enhanced samples of subjects at greater risk for schizophrenia. Indeed, the available potential development data on the high risk of parent-offspring transmissions has enabled the detection of pre-illness characteristics as well as eliminated the prospects of reporting bias that may occur in retrospective studies of the psychosis disorders among the family members. Analysis of a number of these studies has surveyed groups of offspring into adulthood. Nevertheless, fewer have studied offspring through the long period of the onset of the disease. The researchers observe that the onset of schizophrenia is prevalent between the ages of 18 ad 30 years, and may persist although with a decelerating rate into individuals between the ages of 30 and 40 years. Therefore, follow-on into the early adulthood ages allows a better estimation of the rates. In fact, higher risks of the psychoses have been noted among offspring whose parents have psychosis than among those of unaffected controls. Buka, Seidman and Tsuang (2010) used data from their high-risk study to investigate the transmission of psychotic disorders from the parents to their children. The study characterized few of the epidemiologically representative cohorts examined that have studied offspring from conception to adulthood (approximately 40 years). According to the study, even though psychosis can happen in any patient, the risk is elevated in persons with causal genetic disposition. In addition, it may affect those with damaged brain structures as a result of exposure to detrimental chemicals, drug abuse or through trauma. In some instances, the causes of the disorder may be an anticholonergic delirium given the abuse of medications and may be prevalent to patients with concurrent chronic schizophrenia. This means it is vital to consider the wide variety of possible etiologies. In brief, the primary psychotic disorders are varied and may include bipolar disorder, schizophrenia, brief psychotic disorder, shared psychotic disorder, schizophreniform disorder, delusional disorder and Depression with psychotic features. The study shows that these conditions are identified based on the presence of key negative or positive symptoms, the presence or absence of emotional disturbances and the period of the symptoms. In conclusion, this paper presented review of three reports. The first article presented a report on the study of some 85 patients aged between 16 and 27 years who were attending early psychosis service, and who exhibited at least a single metabolic measure identified by the blood glucose, lipids, waist circumference and blood pressure. In addition, the paper examined the evidence of the nature and prevalence of metabolic morbidity in the young people after using antipsychotic medication. Using the analysis presented in the report, this paper concluded that the early detection of the metabolic complexities following the start of the treatment in patients with the FEP can enable timely intervention as well as the success of medication. The second article discussed how persons who suffer from schizophrenia are susceptible to obesity, weakened tolerance to glucose as well as possible occurrences of lipid abnormalities. This paper reviewed the article to establish how the serum metabolic profiles are connected to the various psychotic disorders that can be classified into in three major clusters such as affective psychoses, schizophrenia as well as other non-affective psychoses (ONAP). The review revealed that metabolomics, which is characteristically susceptible to both environmental and genetic variation, can become a vital tool in psychiatric research, particularly in examination of disease vulnerability, response to treatment and clinical study. The last article was a report of an investigation into the spread of psychotic disorders from parents to their offspring and the peculiarity in the inheritance across different subtypes of psychoses. It looked at the familial transmission of schizophrenia as well as other psychoses and concluded that the onset of schizophrenia is prevalent between the ages of 18 ad 30 years, and that higher risks of the psychoses have been noted among offspring whose parents have psychosis than among those of unaffected controls. References Curtis, et al, 2011, on Metabolic abnormalities in an early psychosis service: a retrospective, naturalistic cross-sectional study, Early Intervention in Psychiatry, 5 (2) 108–114 Goldstein JM, Buka SL, Seidman LJ & Tsuang MT 2010, Specificity of familial transmission of schizophrenia psychosis spectrum and affective psychoses in the New England family study's high-risk design, Arch Gen Psychiatry, 67:458-467 Orešič, M et al. 2011, Metabolome in schizophrenia and other psychotic disorders: a general population-based study, Genome Medicine, 3 (3) Available from: http://genomemedicine.com/content/3/3/19/ [4 April 2013] Read More