First Author : Georgiana Neme Coauthor : Alexandra Kovacs Coordinators : Lecturer Livia ăran, Dr. Gabriela Buicu International Scientific Congress for Students, Young Physicians and Pharmacists Marisiensis 2015 The evolution of the first psychotic episode outlined by the prodromal symptoms

Psychosis Psychotic disorders are heterogeneous, and the severity of symptoms can predict important aspects of the illness, such as the degree of cognitive or neurobiological deficits. It may appear in adolescence or early adulthood, and onset can occur across the lifespan, with the average age at onset being the mid 30s. The period of subclinical signs and symptoms that precedes the onset of psychosis is referred to as the prodrome. It can last from weeks to several years and is characterized as a process of changes or deterioration in heterogeneous subjective and behavioral symptoms that precede the onset of clinical psychotic symptoms. DELUSIONS HALLUCINATIONS DISORGANISED SPEECH DISORGANISED BEHAVIOR Presence of one (or more) of the following symptoms:

Psychosis Progression of psychosis: premorbid phase - asymptomatic, characterised by changes in emotional, cognitive and behavior, without altering the function of the patient prodromal phase - with prepsychotic symptoms and changes in social function psychotic phase - diagnosed with positive, negative symptoms, disorganised in patient’s behavior remission phase/ postpsychotic - with a variable course. Unspecific symptoms from the prodromal phase could lead to : SCHIZOPHRENIA BIPOLAR DISORDER SCHIZOAFFECTIVE DISORDER MAJOR DEPRESSION

Schizophrenia Schizophrenia is a severe mental disorder which has heterogeneous presentations, with positive and negative symptoms at different levels of prominence across time and across individuals. While positive symptoms occur periodically during psychoticexacerbations, negative and cognitive symptoms often emerge before the first psychotic episode and persist with low functional outcome and poor prognosis. + - Believing that what other people are saying is not true (delusions) Hearing, seeing, tasting, feeling, or smelling things that others do not experience (hallucinations) Lack of pleasure in everyday life Lack of ability to begin and sustain planned activities Speaking little, even when forced to interact.

Depression It is characterized by discrete episodes of at least 2 weeks' duration (although most episodes last considerably longer) involving clear-cut changes in affect, cognition, and neurovegetative functions and inter-episode remissions. Most of the day, nearly every day: 1. Depressed mood. 2. Diminished interest or pleasure in all / almost all. 3. Significant weight loss when not dieting or weight gain. 4. Insomnia or hypersomnia. 6. Loss of energy. 7. Feelings of worthlessness / excessive / inappropriate guilt (which may be delusional) 8. Diminished ability to think or concentrate / indecisiveness 9. Recurrent thoughts of death recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Objective The aim of our study was to highlight specific symptoms regarding schizophrenia precisely from the prodromal phase which will lead to a better outcome of the patient. Since the scientific researchers were not able to find an eligible biomarker blood test / objective test, the doctors have to use subjective tests in order to put a diagnose.

Material & Methods Data was collected from the Psychiatric Ambulatory and reviewed between 1 feb – 31 march The source was : firstly, patients and their family members and secondly, the doctor. This is a retrospective study which includes the evaluation of 2 lots of patients who are in the first 5 years since the onset of the disorder. The first lot : 20 patients who were diagnosed with schizophrenia and acute psychotic episode,as the DSM IV TR and PANSS tests concluded. The second lot : 20 patients who were diagnosed with major depressive episode and major depressive affective disorder, as the HAMD and BDI test concluded. The interview with the patient and the family focused on identifying the prodrome type and risk factors,as well as personality traits,psycho traumas,resilience etc, which could suggest a certain type of future evolution.

Results

Results Patients’ symptoms

Results Patients’ history:

Results Statistical analysis of data was performed using the computer program GraphPad InStat 3. The estimation of results was performed according to the decision criteria of the statistical tests:

Results Even though some symptoms are not significat for a psychotic episode, patients’ experience them but in a lower intensity and frequency.

Results Patients’ HistoryP value95 % CIORSignificant Psychiatric family history< to no Alcohol abuse< to no Drug usage (canabis)< to no Dysfunctional family< to no Work Dysfunctions< to yes Psyhotraumas (decease, divorce, loss of work place) < to no Personality disorders< to no

Conclusions Prodromal symptoms which matched the psychotic onset Social withdrawal Personality changes Thinking disorder Bizarre behavior Appetite changes Lack of motivation Decreased affection Aggression Paranoia Apathy Tearfulness Depressed mood Anxiety Insomnia ! Could be a major symptom for both diseases

Conclusions Detecting the prodrome facilitates an early intervention in the treatment of the disorder. A delayed treatment is associated with a lower chance of remission and a less favorable long term prognosis. Adolescents and young adults who appear to be prodromal or at ultra high risk should be monitored and provided with symptom-targeted treatments (e.g., antidepressants, psychosocial treatments). Antipsychotics should be used as soon as frank psychosis emerges.

References 1. Stoica I. (2008) – Prodromul in primul episod psihotic 2. American Psychiatric Association (2013) – Diagnostic and Statistical manual of mental disorders, fifth edition 3. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders; Expert Rev Neurother Aug; 10(8): Biomarkers in Schizophrenia: A Brief Conceptual Consideration - Dis Markers. (2013) 5.What is schizophrenia? 6. PET scan pictures from

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