Affective symptoms can help diagnose early psychotic disorders

Symptoms such as verborrhea or hyperactivity could throw light on the type of disorder suffered

Functional psychosis can be diagnosed from the first indications of the patient, thanks to affective symptomatology. Depressive moods, hyperactivity and lack of concentration are affective symptoms that can present themselves during the first psychotic episodes, and the presence or absence of any of them may contribute to differentiating, at an early stage, between the different variations of the mental disease. Thus concludes researcher Ms Marta Arrasate, who also pointed to the symptoms belonging to the activation dimension (verborrhea, lack of concentration, hyperactivity, etc.) as the best indicators. Her thesis, defended at the UPV/EHU, was entitled Valor predictivo de la sintomatolog-a afectiva en primeros episodios psic-ticos (Predictive value of affective symptomatology during the first psychotic episodes).

This is the first European PhD undertaken at the -lava/Araba Unit of the Faculty of Medicine of the UPV/EHU, and was codirected by Ana Gonz-lez-Pinto, 2010 National Award winner of the Spanish Society for Biological Psychiatry. According to Ms Gonz-lez-Pinto, the relevance of the research lies in that "affective symptoms can help not only in telling future prognosis but also in contributing to diagnosis - something difficult in psychiatry because diagnostic tests equivalent to a radiograph, an analysis or a scanner do not exist. This is why, if a test were found, however simple, or rudimentary, it would be of great use".

Evaluation in three stages

Ms Arrasate undertook the study based on a sample of 112 hospitalised patients with a first psychotic episode, and analysed the predictive value of the affective symptoms that present themselves in three concrete moments: initial hospital admission, the third year and the fifth year. In order to evaluate the results, the different affective symptoms were grouped according to dimensions (these classifications being based on a previous study of patients with bipolar disorders), and associated with variables such as the number of relapses, hospital or health centre admissions, suicide attempts, etc.

The results show that the activation dimension (involving symptoms of hyperactivity, lack of concentration and verborrhea, amongst others) can be an especially useful tool for early distinguishing between the various types of psychotic symptoms. This is what has been deduced from the data obtained from a study of one of the principal diseases in this field: bipolar disorder. According to Ms Arrasate's research, the activation and manic dimensions are those which best characterise bipolar disorder. Nevertheless, the manic dimension is absent in the first episodes; moreover, that which is present during these first episodes is the depressive dimension, thus possibly giving rise to confusion and inability in making an early and correct diagnosis. Thus, the results point to the activation dimension as the reliable path to follow: it is a useful predictive factor in the early diagnosis of bipolar disorder with psychotic symptoms.

These results open a new line of research as they prove that affective symptoms are able to discriminate between different psychoses, and contribute to an early diagnosis during its course. In fact, the evaluating panel for Ms Arrasate's thesis have made a point of informing those experts responsible for reviewing diagnostic criteria of mental diseases worldwide of these findings.