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Patients share some common traits, but linked to anxiety or behaviour problems, not psychosis.

VANCOUVER - Personality profiles of patients with a first episode of psychosis aren't specifically linked to psychotic symptoms, according to a collaborative study by researchers from the University of British Columbia and the University of Montreal.

While some personality traits are similar in individuals suffering psychosis, there is no personality "type" that's useful in predicting the likelihood of psychosis vulnerability, study co-author Dr. Tania Lecomte (PhD), an assistant professor of psychiatry at UBC, said in a presentation at the recent 4th International Conference on Early Psychosis here.

When diagnosing psychosis, Dr. Lecomte urged caution, suggesting there are other factors involved.

"Some people will have only one episode of psychosis, and that's it," said Dr. Lecomte. "A lot of people believe that those with schizophrenia are socially withdrawn. But we found that's not the case. They're not withdrawn. They actually want social access. It's just that they are anxious. These are people who don't necessarily have a lot of friends."

Forty-eight patients, ages 18 to 35 years and suffering from a first psychotic episode, were enrolled for the study. Assessments included socioeconomic data, the Brief Psychiatric Rating Scale (BPRS), and the NEO Personality Inventory Revised, which measures such non-pathological personality traits as neuroticism, extroversion/openness, agreeability and conscientiousness. Researchers found few correlations between the five NEO dimensions and BPRS total score and psychosis sub-score.

"When we did our analysis, we found that there wasn't one type of trait," she noted. "In fact, there were more than five different traits that emerged. They did, however, differ from a group matched for age and gender. But none were linked to psychotic symptoms.

"The bottom line is, the personality traits were not linked at all to psychotic symptoms. They were correlated with other symptoms, more like anxiety or behavioural problems. So to say that people with psychosis have specific types of personalities is not supported by this study.

"We're showing that many different profiles of people can actually develop psychosis, and the psychosis doesn't necessarily change personality."

She advises family doctors to look first at whether there have been any major life changes. Social withdrawal, a dramatic drop in school grades, or obsessive-compulsive behaviours should be investigated.

"Sometimes you'll see a person's behaviour change within a matter of weeks. They'll go from having a lot of friends to not wanting to go out anymore. Psychosis is multi-dimensional, with many different risk factors and profiles. You can't say 'this is the track.'"

Males ages 13 to 20 are most atrisk for a psychotic episode. Women are most vulnerable in the years from 20 to 35. Substance-abusers are particularly susceptible.

"People who use drugs such as cannabis are more likely to have a psychotic episode earlier," she said. "There's the drug-induced psychosis that often doesn't resolve by itself. In some people, because of their habits, the first psychotic episode can be at a young age."

Treatment for first-timers includes psycho-education and relapse prevention.

"A lot of the literature suggests the more episodes you have, the less likely you are to respond to medication or recover afterwards," she said. "Early intervention is essential because you want to make sure the patient doesn't have more than one hospitalization. Most psychiatrists will prescribe low-dose anti-psychotics and will monitor them for a year, then possibly take them off medications. I offer cognitive-behaviour therapy to help people understand the link between stress and their vulnerability to these episodes.

"Psychosis can occur over a period of months, but when a young person's behaviour changes significantly, beyond usual teen behaviour, it should be looked at. It doesn't necessarily mean schizophrenia, but it does mean they need help to make sense of what they are going through. There may be a time when medication should be involved."

Lynn Haley. Medical Post. Toronto: Oct 26, 2004.Vol.40, Iss. 40; pg. 34, 1 pgs
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