Going back to basics prior to mentioning the use of antipsychotics in patients with pain, the International Association for the Study of Pain (IASP) definition of pain can be summarized as an unpleasant experience, composed of sensory experience caused by actual tissue damage and/or emotional experience caused by potential tissue damage. Less used than antidepressants, antipsychotics have also been used for treating this unpleasant experience as adjuvant analgesics without sufficient evidence from research. Because recently developed atypical antipsychotics reduce the adverse reactions of extrapyramidal symptoms, such as acute dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia caused by typical antipsychotics, they are expected to be used more frequently in various painful conditions, while increasing the risk of metabolic syndromes (weight gain, diabetes, and dyslipidemia). Various antipsychotics have different neurotransmitter receptor affinities for dopamine (D), 5-hydroxytryptamine (5-HT), adrenergic (α), histamine (H), and muscarinic (M) receptors. Atypical antipsychotics antagonize transient, weak D₂ receptor bindings with strong binding to the 5-HT(2A) receptor, while typical antipsychotics block long-lasting, tight D₂ receptor binding. On the contrary, antidepressants in the field of pain management also block the reuptake of similar receptors, mainly on the 5-HT and, next, on the norepinephrine, but rarely on the D receptors. Antipsychotics have been used for treating positive symptoms, such as delusion, hallucination, disorganized thought and behavior, perception disturbance, and inappropriate emotion, rather than the negative, cognitive, and affective symptoms of psychosis. Therefore, an antipsychotic may be prescribed in pain patients with positive symptoms of psychosis during or after controlling all sensory components.
Affective Symptoms ; Analgesics ; Antidepressive Agents ; Antipsychotic Agents ; Delusions ; Dopamine ; Drug-Related Side Effects and Adverse Reactions ; Dystonia ; Hallucinations ; Histamine ; Humans ; Movement Disorders ; Norepinephrine ; Pain Management ; Prolactin ; Psychomotor Agitation ; Psychotic Disorders ; Receptor, Serotonin, 5-HT2A ; Receptors, Neurotransmitter ; Serotonin ; Weight Gain

Wolfram syndrome is a relatively unexplored entity in clinical psychiatry. Historically, the discovery of a specific WFS1 gene had generated huge fanfare regarding specific genetic causations of psychiatric disorders. While the initial enthusiasm has faded now, association of Wolfram syndrome with psychiatric illnesses like schizophrenia, psychosis and suicidal behavior still remain important for understanding biological underpinnings of such disorders. We report a case of Wolfram syndrome presenting with multiple manic episodes, discuss possible genetic underpinnings for the affective symptoms and then discuss certain issues regarding management.
Affective Symptoms ; Bipolar Disorder* ; Comorbidity ; Psychotic Disorders ; Schizophrenia ; Wolfram Syndrome

Therapeutic misconception (TM) denotes the phenomenon in which research subjects conflate research purpose, protocols and procedures with clinical treatment. We examined the prevalence, contributory factors, clinical associations, impact, and collated solutions on TM within psychiatric research, and made suggestions going ahead. Literature search for relevant empirical research papers was conducted until February 2015. Eighty-eight reports were extracted, of which 31 were selected, summarised into different headings for discussion of implications and collated solutions of TM. We found variable and high rates of TM (ranging from 12.5% to 86%) in some psychiatry research populations. Contributory factors to TM included perceived medical roles of researchers, media, research setting and subject factors. Greater TM in affective, neurodevelopmental and psychotic spectrum conditions were associated with demographic variables (such as lower education, increased age), clinical factors (such as poor insight, cognitive deficits, increased symptoms, poorer self-rated quality of health), and social functioning (such as decreased independence). Inattention to TM may lead to frustration, negative impression and abandonment of participation in psychiatry research. Strategies such as the employment of a neutral educator during the informed consent process and education modules may be effective in addressing TM. Further research is warranted to examine the different TM facets, specific clinical correlates and more effective management strategies.
Affective Disorders, Psychotic ; Education ; Empirical Research ; Employment ; Frustration ; Head ; Humans ; Informed Consent ; Prevalence ; Research Subjects ; Therapeutic Misconception*

Occurrence of carbon monoxide intoxication has decreased due to decline in use of coal briquettes (anthracite) in Korea. However, suicide attempt by use of a coal fire lighter (beon-gae-tan) has shown a rapid increase over the past five years with relevance to imitated suicide. Acute carbon monoxide intoxication is a dangerous problem affecting the brain, kidney, lung, and other major organs. Sometimes, delayed encephalopathy after carbon monoxide intoxication makes clinical psychiatric diagnosis and treatment puzzling because neuropsychiatric sequelae are ambiguous with premorbid psychiatric problems, such as mood disorder, psychotic disorder, or other substance dependence. We report on a case of delayed encephalopathy of carbon monoxide intoxication and discuss its diagnosis and management.
Affective Disorders, Psychotic ; Brain ; Carbon Monoxide* ; Carbon* ; Coal ; Diagnosis ; Fires ; Kidney ; Korea ; Lung ; Mental Disorders ; Substance-Related Disorders ; Suicide

As we have summarized, a confluence of pathophysiological and epidemiological studies establish that both acute and chronic forms of psychosocial stress contribute to the pathogenesis of atherosclerosis. Clinical consequences of acute stress include the development of myocardial ischemia, cardiac arrhythmias, and fostering of more vulnerable coronary plaques and hemostatic changes. Chronic stress and affective disorders, such as depression, appear to promote atherosclerosis via hypothalamic-pituitary-adrenal (HPA) axis overstimulation. Chronic stress can contribute to the occurrence of cardiovascular disease (CVD) by direct and indirect pathways. These results establish that, in addition to traditional CVD risk factors, psychosocial factors contribute to CVD. Physicians should never neglect to assess psychosocial risk factors, for example depression, hostility, social isolation, and chronic life stress and job stress, by clinical interview or standardized questionnaires. Management approaches include directly treating patients with mild forms of psychological distress by applying multifactorial lifestyle interventions and treating patients with clinical depression and anxiety. However, patients with severe psychological distress should be referred to specialists. Additional attention and research related to stress and CVD will be needed in the future.
Affective Disorders, Psychotic ; Anxiety ; Arrhythmias, Cardiac ; Atherosclerosis ; Axis, Cervical Vertebra ; Cardiovascular Diseases ; Depression ; Foster Home Care ; Hostility ; Humans ; Life Style ; Mood Disorders ; Myocardial Ischemia ; Surveys and Questionnaires ; Risk Factors ; Social Isolation ; Specialization ; Stress, Psychological

Schizoaffective disorders are a controversially discussed but existing nosological category describing an episodic condition meeting the criteria of both schizophrenia and mood disorders and lying on a continuum between these two prototypes. Both DSM-IV and ICD-10 classify them within the group of "schizophrenia, schizotypal and delusional disorders" with ICD-10 not requiring the absence of mood symptoms for a certain time. Cross-sectionally, schizoaffective disorder can be subdivided into schizodepressive, schizomanic and mixed types. In a longitudinal way, unipolar and bipolar types are distinguished. The division into schizo-dominated and mood dominated types is based on the severity and dominance of the schizophreniform symptomatology and implies significant consequences for treatment and prognosis. In addition, concurrent types should be differentiated from sequential types. Schizoaffective disorder is not rare; lifetime prevalence is estimated at 0.3%. About one third of all psychotic patients suffer from schizoaffective disorder. About two thirds of the patients do not only have schizoaffective episodes but also pure schizophreniform or mood episodes or episodes of acute and transient psychotic disorder. In more than 50% of the patients, symptoms remit more or less completely. The others suffer from light, moderate or severe residual states, which might affect their social adaptation. The suicide rate in schizoaffective disorder is about 12%. The treatment of schizoaffective disorder primarily is a combination of antipsychotics and mood stabilizers or antidepressants. Long-term prophylactic treatment mainly consists of antipsychotics and mood stabilizers. Differential diagnosis of schizoaffective disorder is not at all easy. It must be distinguished from psychotic mood disorder, where the psychotic symptoms are mood-congruent. Although DSM-IV allows even mood-incongruent psychotic symptoms in psychotic mood disorder, these cases should better be allocated to schizoaffective disorder. Schizoaffective disorder must also be distinguished from schizophrenia with mood symptoms. In the latter, the mood symptoms are not complete and not so prominent to meet the criteria of a mood episode, or they occur after the schizophreniform have remitted. Sometimes, schizoaffective disorder is mixed up with acute and transient psychotic disorder, although these two conditions do not have very much in common.
Affective Disorders, Psychotic ; Antidepressive Agents ; Antipsychotic Agents ; Deception ; Delusions ; Diagnosis, Differential ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; International Classification of Diseases ; Light ; Mood Disorders ; Prevalence ; Prognosis ; Psychotic Disorders ; Schizophrenia ; Suicide

Schizoaffective disorders are a controversially discussed but existing nosological category describing an episodic condition meeting the criteria of both schizophrenia and mood disorders and lying on a continuum between these two prototypes. Both DSM-IV and ICD-10 classify them within the group of "schizophrenia, schizotypal and delusional disorders" with ICD-10 not requiring the absence of mood symptoms for a certain time. Cross-sectionally, schizoaffective disorder can be subdivided into schizodepressive, schizomanic and mixed types. In a longitudinal way, unipolar and bipolar types are distinguished. The division into schizo-dominated and mood dominated types is based on the severity and dominance of the schizophreniform symptomatology and implies significant consequences for treatment and prognosis. In addition, concurrent types should be differentiated from sequential types. Schizoaffective disorder is not rare; lifetime prevalence is estimated at 0.3%. About one third of all psychotic patients suffer from schizoaffective disorder. About two thirds of the patients do not only have schizoaffective episodes but also pure schizophreniform or mood episodes or episodes of acute and transient psychotic disorder. In more than 50% of the patients, symptoms remit more or less completely. The others suffer from light, moderate or severe residual states, which might affect their social adaptation. The suicide rate in schizoaffective disorder is about 12%. The treatment of schizoaffective disorder primarily is a combination of antipsychotics and mood stabilizers or antidepressants. Long-term prophylactic treatment mainly consists of antipsychotics and mood stabilizers. Differential diagnosis of schizoaffective disorder is not at all easy. It must be distinguished from psychotic mood disorder, where the psychotic symptoms are mood-congruent. Although DSM-IV allows even mood-incongruent psychotic symptoms in psychotic mood disorder, these cases should better be allocated to schizoaffective disorder. Schizoaffective disorder must also be distinguished from schizophrenia with mood symptoms. In the latter, the mood symptoms are not complete and not so prominent to meet the criteria of a mood episode, or they occur after the schizophreniform have remitted. Sometimes, schizoaffective disorder is mixed up with acute and transient psychotic disorder, although these two conditions do not have very much in common.
Affective Disorders, Psychotic ; Antidepressive Agents ; Antipsychotic Agents ; Deception ; Delusions ; Diagnosis, Differential ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; International Classification of Diseases ; Light ; Mood Disorders ; Prevalence ; Prognosis ; Psychotic Disorders ; Schizophrenia ; Suicide

OBJECTIVE: Little is known about the characteristic differences in alexithymic construct in various psychiatric disorders because of a paucity of direct comparisons between psychiatric disorders. Therefore, this study explored disorder-related differences in alexithymic characteristics among Korean patients diagnosed with four major psychiatric disorders (n=388). METHODS: Alexithymic tendencies, as measured by the Korean version of the 20-item Toronto Alexithymia Scale (TAS-20K), of patients classified into four groups according to major psychiatric diagnosis were compared. The groups consisted of patients with depressive disorders (DP; n=125), somatoform disorders (SM; n=78), anxiety disorders (AX; n=117), and psychotic disorders (PS; n=68). RESULTS: We found that substantial portions of patients in all groups were classified as having alexithymia and no statistical intergroup differences emerged (42.4%, 35.9%, 35.3%, and 33.3% for DP, SM, PS, and AX). However, patients with DP obtained higher scores in factor 2 (difficulties describing feelings) than those with SM or AX, after adjusting for demographic variables. CONCLUSION: These findings suggest that alexithymia might be associated with a higher vulnerability to depressive disorders and factor 2 of TAS-20K could be a discriminating feature of depressive disorders.
Affective Symptoms ; Anxiety ; Anxiety Disorders ; Depressive Disorder ; Humans ; Mental Disorders ; Psychotic Disorders ; Somatoform Disorders

OBJECTIVE: The aim of this study was to investigate the relationship between emotional traits and schizotypal symptoms and to establish a hypothetical model for the causal relationship between them. METHODS: Schizotypal symptoms were assessed using the Schizotypal Personality Questionnaire (SPQ), and a total of seven emotional traits considered to be potential risk factors for schizotypy were categorized as emotional disturbances, emotional attenuators or emotional amplifiers. A total of 502 undergraduate students completed the SPQ and other scales. RESULTS: The result of the present study suggested that the high levels of emotional disturbance in individuals who are prone to schizotypy or psychosis are amplified by their intensity and fluctuation. However, if their emotion attenuating abilities function well, these disturbances can be controlled and the schizotypal symptoms and progression to psychosis can be contained. Discriminant analysis showed that 69.0% of the subjects with many schizotypal symptoms and 80.7% of the subjects with few schizotypal symptoms were correctly classified. CONCLUSION: The present study suggests the possibility of using emotional traits to identify the risk factors for psychosis.
Affective Symptoms ; Humans ; Psychotic Disorders ; Surveys and Questionnaires ; Risk Factors ; Weights and Measures

OBJECTIVE: To explore criminal characteristics of patients with affective disorder. METHODS: Analysis was conducted in 72 cases of affective disorder diagnosed in Ankang Hospital, Public Security Bureau of Hangzhou, from 2000 to 2004. RESULTS: There was a correlation between outbreak of the affective disordered and frequency of committing crime. There was a significant difference between the mania and the depression (P<0.01) with respect to harmful behavior. The criminal behavior characteristics of patients with affective disorder were different from that of the schizophrenia, with more realistic and less pathologic intention. CONCLUSION Recurrent attacks are warning signs for affective disorder patients committing crime. The criminal behavior characteristics of the affective disorder are different from that of the schizophrenia, probably because of the differences in etiological factor, development, symptom, and severity of the disorders.
Adolescent ; Adult ; Affective Disorders, Psychotic/diagnosis* ; Criminals ; Female ; Forensic Psychiatry ; Humans ; Male ; Middle Aged ; Young Adult