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Sato S, Imai K. The efficacy of vortioxetine for the delusional disorder of cenesthopathy. Neuropsychopharmacol Rep 2024; 44:272-274. [PMID: 37794715 PMCID: PMC10932763 DOI: 10.1002/npr2.12384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023] Open
Abstract
Cenesthopathy is a rare syndrome characterized by strange bodily and oral sensations and is classified as a delusional disorder, somatic type, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Cenesthopathy has been considered difficult to treat. However, to improve cenesthopathy, many pharmacotherapeutic options are reported, including antidepressants and antipsychotics. In this case report, vortioxetine significantly alleviated the distress of oral cenesthopathy in a patient with cerebral ischemia and depression without any adverse effects. To the best of our knowledge, this is the first report on the efficacy of vortioxetine in treating cenesthopathy. Though it is unclear why vortioxetine was effective for cenesthopathy in our case, we stated two possibilities for improving his oral cenesthopathy. When treating oral cenesthopathy in elderly patients, clinicians consider to be one of the options to prescribe vortioxetine.
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Affiliation(s)
- Shinji Sato
- Department of Psychiatry, Ibaraki Clinical Educational and Training Center, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Koubun Imai
- Department of Psychiatry, Hitachi Medical Education and Research CenterUniversity of Tsukuba HospitalTsukubaJapan
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2
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Atolagbe A, Metellus P, Nkemjika S. Capgras Syndrome, Multiple Sclerosis, and COVID-19 Infection: A Case Report. Cureus 2024; 16:e53924. [PMID: 38465171 PMCID: PMC10925012 DOI: 10.7759/cureus.53924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/12/2024] Open
Abstract
Capgras syndrome is a psychotic illness characterized by an unshaken false belief in having a close family member replaced by an imposter when there is no evidence of such. The patient described in this case report is a 68-year-old Caucasian female who presented with Capgras syndrome in the context of chronic progressive multiple sclerosis (MS) following an acute COVID-19 illness. She was treated with quetiapine with full resolution of symptoms.
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Affiliation(s)
- Ayodele Atolagbe
- Department of Psychiatry and Behavioral Sciences, Kingsbrook Jewish Medical Center, Brooklyn, USA
| | - Peterson Metellus
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
| | - Stanley Nkemjika
- Department of Psychiatry and Behavioral Sciences, Interfaith Medical Center, Brooklyn, USA
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3
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Devanand DP, Jeste DV, Stroup TS, Goldberg TE. Overview of late-onset psychoses. Int Psychogeriatr 2024; 36:28-42. [PMID: 36866576 DOI: 10.1017/s1041610223000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Several etiologies can underlie the development of late-onset psychosis, defined by first psychotic episode after age 40 years. Late-onset psychosis is distressing to patients and caregivers, often difficult to diagnose and treat effectively, and associated with increased morbidity and mortality. METHODS The literature was reviewed with searches in Pubmed, MEDLINE, and the Cochrane library. Search terms included "psychosis," "delusions," hallucinations," "late onset," "secondary psychoses," "schizophrenia," bipolar disorder," "psychotic depression," "delirium," "dementia," "Alzheimer's," "Lewy body," "Parkinson's, "vascular dementia," and "frontotemporal dementia." This overview covers the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses. RESULTS Late-onset schizophrenia, delusional disorder, and psychotic depression have unique clinical characteristics. The presentation of late-onset psychosis requires investigation for underlying etiologies of "secondary" psychosis, which include neurodegenerative, metabolic, infectious, inflammatory, nutritional, endocrine, and medication toxicity. In delirium, psychosis is common but controlled evidence is lacking to support psychotropic medication use. Delusions and hallucinations are common in Alzheimer's disease, and hallucinations are common in Parkinson's disease and Lewy body dementia. Psychosis in dementia is associated with increased agitation and a poor prognosis. Although commonly used, no medications are currently approved for treating psychosis in dementia patients in the USA and nonpharmacological interventions need consideration. CONCLUSION The plethora of possible causes of late-onset psychosis requires accurate diagnosis, estimation of prognosis, and cautious clinical management because older adults have greater susceptibility to the adverse effects of psychotropic medications, particularly antipsychotics. Research is warranted on developing and testing efficacious and safe treatments for late-onset psychotic disorders.
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Affiliation(s)
- D P Devanand
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Dilip V Jeste
- Departments of Psychiatry, Neurosciences University of California San Diego, La Jolla, USA
| | - T Scott Stroup
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
| | - Terry E Goldberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, USA
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Satake Y, Kanemoto H, Taomoto D, Suehiro T, Koizumi F, Sato S, Wada T, Matsunaga K, Shimosegawa E, Gotoh S, Mori K, Morihara T, Yoshiyama K, Ikeda M. Characteristics of very late-onset schizophrenia-like psychosis classified with the biomarkers for Alzheimer's disease: a retrospective cross-sectional study. Int Psychogeriatr 2024; 36:64-77. [PMID: 36714996 DOI: 10.1017/s1041610222001132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES We aimed to investigate the association between very late-onset schizophrenia-like psychosis (VLOSLP), a schizophrenia spectrum disorder with an onset of ≥60 years, and Alzheimer's disease (AD) using biomarkers. DESIGN Retrospective cross-sectional study. SETTING Neuropsychology clinic of Osaka University Hospital in Japan. PARTICIPANTS Thirty-three participants were classified into three groups: eight AD biomarker-negative VLOSLP (VLOSLP-AD), nine AD biomarker-positive VLOSLP (VLOSLP+AD), and sixteen amnestic mild cognitive impairment due to AD without psychosis (aMCI-P+AD) participants. MEASUREMENTS Phosphorylated tau levels in the cerebrospinal fluid and 18F-Florbetapir positron emission tomography results were used as AD biomarkers. Several scales (e.g. the Mini-Mental State Examination (MMSE), Wechsler Memory Scale-Revised (WMS-R) Logical Memory (LM) I and II, and Neuropsychiatric Inventory (NPI)-plus) were conducted to assess clinical characteristics. RESULTS Those in both VLOSLP-AD and +AD groups scored higher than those in aMCI-P+AD in WMS-R LM I. On the other hand, VLOSLP+AD participants scored in between the other two groups in the WMS-R LM II, with only VLOSLP-AD participants scoring significantly higher than aMCI-P+AD participants. There were no significant differences in sex distribution and MMSE scores among the three groups or in the subtype of psychotic symptoms between VLOSLP-AD and +AD participants. Four VLOSLP-AD and five VLOSLP+AD participants harbored partition delusions. Delusion of theft was shown in two VLOSLP-AD patients and five VLOSLP+AD patients. CONCLUSION Some VLOSLP patients had AD pathology. Clinical characteristics were different between AD biomarker-positive and AD biomarker-negative VLOSLP, which may be helpful for detecting AD pathology in VLOSLP patients.
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Affiliation(s)
- Yuto Satake
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hideki Kanemoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Daiki Taomoto
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Suehiro
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Fuyuki Koizumi
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shunsuke Sato
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tamiki Wada
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Keiko Matsunaga
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shiho Gotoh
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kohji Mori
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Morihara
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Psychiatry, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kenji Yoshiyama
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
| | - Manabu Ikeda
- Department of Psychiatry, Osaka University Graduate School of Medicine, Suita, Japan
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Kakar G, Mehendale AM, Sadh K, Bakshi SS, Bodke H, Krishnani H. A Phenomenal Depiction of Paranoid Schizophrenia With Auditory Hallucinations: A Case Report. Cureus 2023; 15:e46092. [PMID: 37900418 PMCID: PMC10611902 DOI: 10.7759/cureus.46092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
This case report provides a vivid illustration of a schizophrenic case in a 59-year-old man with auditory hallucinations, illuminating the nature of his symptoms. Auditory hallucinations were prominent, and the patient received voices urging him to perform actions that clearly corresponded to his paranoid thoughts. Through comprehensive research and long-term follow-up, this report reveals the complexity of traumatic schizophrenia, highlighting the importance of early recognition and intervention. One must emphasize a multidisciplinary approach, including psychiatric assessment, pharmacotherapy, and psychotherapy. This case report aims to highlight the critical role of comprehensive individual care in improving the patient's condition and emphasizes the importance of compassionate healthcare practices.
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Affiliation(s)
- Gauri Kakar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashok M Mehendale
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Kamaldeep Sadh
- Department of Psychiatry, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sanket S Bakshi
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harsh Bodke
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshil Krishnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Bafarat AY, Labban SA, Alhatmi N, Aly H, Bashah DM, Alshaiki F. Hyponatremia-Induced Seizure in a Patient With Psychogenic Polydipsia: A Case Report. Cureus 2023; 15:e37710. [PMID: 37206512 PMCID: PMC10191386 DOI: 10.7759/cureus.37710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Psychogenic polydipsia is a rare condition characterized by overconsumption of water. It can lead to water intoxication, which is potentially a life-threatening situation. Moreover, it usually occurs in patients with mental disorders, mainly schizophrenia. This report discusses a successful treatment of a 16-year-old male with psychogenic polydipsia and delusional disorder presenting to the emergency room with a hyponatremia-induced seizure. After stabilizing the patient, he was referred to a psychologist, and behavioral therapy was conducted. Post-discharge follow-ups revealed that behavioral therapy and the use of self-monitoring technique were effective in controlling the patient's condition. His water intake was reduced from 15 liters per day to three liters per day. This case highlights the importance of psychological assessment for patients with features suggestive of psychogenic polydipsia. It also highlights the need for immediate admission and prompt treatment for such patients as it is a high-risk condition.
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Affiliation(s)
| | - Suhail A Labban
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Nada Alhatmi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Jeddah, SAU
| | - Hanan Aly
- Psychiatry and Behavioral Sciences, King Abdulaziz Hospital, Jeddah, SAU
- Psychiatry and Behavioral Sciences, Sohag University, Sohag, EGY
| | | | - Fatma Alshaiki
- Internal Medicine, Saudi Ministry of Health, Jeddah, SAU
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Özaydın Y, Dalkopan A, Metin H, Sair A, Sair YB, Sevincok L. Association of dementia-related delusional disorder and psychosis intermittent hyponatraemia and polydipsia (PIP) syndrome: a case report. Psychogeriatrics 2023; 23:550-552. [PMID: 36932668 DOI: 10.1111/psyg.12955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/22/2023] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Affiliation(s)
- Yiğit Özaydın
- Department of Child and Adolescence Psychiatry, Aydin Adnan Menderes University, Aydin, Turkey
| | - Atakan Dalkopan
- Department of Psychiatry, Aydin Adnan Menderes University, Aydin, Turkey
| | - Hülya Metin
- Department of Psychiatry, Aydin Adnan Menderes University, Aydin, Turkey
| | - Ahmet Sair
- Department of Neurology, Aydin Adnan Menderes University, Aydın, Turkey
| | - Yasan Bilge Sair
- Department of Psychiatry, Aydin Adnan Menderes University, Aydin, Turkey
| | - Levent Sevincok
- Department of Psychiatry, Aydin Adnan Menderes University, Aydin, Turkey
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Barbieri C, Rocca G, Bosco C, Tattoli L, Grattagliano I, Di Vella G. The Doppelgänger phenomenon and death: a peculiar case of homicide by a subject with first-episode psychosis. Forensic Sci Res 2023; 7:798-802. [PMID: 36817250 PMCID: PMC9930753 DOI: 10.1080/20961790.2022.2055827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
The Doppelgänger phenomenon refers to the experience of a direct encounter with one's self, characteriswed by: (i) the perception of a figure with one's own identical physical features; or (ii) the apprehension that the perceived figure shares the same personality and identity. The Doppelgänger does not only look like the same person, it is his/her double. The perceptual element is usually a hallucination, although occasionally a false perception of an actual figure may be involved. This phenomenon has been described in individuals suffering from overwhelming fear, severe anxiety or intoxication, epilepsy, as well as in the sleep-wakefulness transition. It has also been reported in major psychoses. The fear of imminent death often precedes the Doppelgänger experience. This report presents the case of a 30-year-old man, Mr. Y, who was stabbed to death by Mr. X, his "double". The aggressor and his victim, although not related, were truly doubles; remarkably, they shared the same name and surname, age, professional activity and place of work. Moreover, they attended the same sports center but barely knew each other. The forensic psychiatric evaluations in Mr. X, subsequent to the crime committed, were suggestive of a psychotic condition. This case is unique in the scientific literature. In the most serious psychotic forms, the issue of the "double" calls into question not only the dissociative processes involved in the etiopathogenesis of the disorder, but also bio-psycho-social elements, as well as personal data in this case, which made the victim and the aggressor "identical". In the context of psychopathological functioning, the delusional mood (Wahnstimmung) that precedes the development of delirium is a sort of gateway to an impending psychotic illness, involving delusional awareness or mood (atmosphere). In psychosis, splitting is the main issue and this influence is seen as an evil, foreign, apocalyptic and unknown side no longer recognised as belonging to the self even in a physical sense. In such a situation, it is felt that the only way to survive is by suppressing one's double as a defense against disorganisation of the self.
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Affiliation(s)
- Cristiano Barbieri
- Section of Forensic Medicine and Forensic Sciences, University of Pavia, Pavia, Italy
| | - Gabriele Rocca
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Caterina Bosco
- Department of Public Health and Pediatric Sciences, Legal Medicine Unit, University of Turin, Turin, Italy,CONTACT Caterina Bosco
| | - Lucia Tattoli
- S.C. Medicina Legale U, A.O.U. Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ignazio Grattagliano
- Department of Education, Psychology, Communication University Aldo Moro of Bari, Bari, Italy
| | - Giancarlo Di Vella
- Department of Public Health and Pediatric Sciences, Legal Medicine Unit, University of Turin, Turin, Italy
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González-Rodríguez A, Seeman MV, Román E, Natividad M, Pagés C, Ghigliazza C, Ros L, Monreal JA. Critical Issues in the Management of Agitation, Aggression, and End-of-Life in Delusional Disorder: A Mini-Review. Healthcare (Basel) 2023; 11. [PMID: 36832992 DOI: 10.3390/healthcare11040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/15/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023] Open
Abstract
Background: Compared to other psychotic disorders, there is little information about staging care in delusional disorder (DD). Unlike schizophrenia, this is a disorder that begins in middle age, a time at which chronic medical comorbidities have already begun to impact global functioning. With age, the combination of psychological and somatic conditions leads to new behaviours, e.g., agitation, aggression, and behaviours that require specific preventive and interventive measures. With further age, knowledgeable end-of-life care becomes necessary for this population. Aim: The aim of this article was to review existing evidence on the management of these successive phases. Methods: We conducted a narrative review using PubMed and ClinicalTrials.gov and searched for the following terms: (agitation OR aggressivity OR aggression OR palliative OR "end-of-life") AND ("delusional disorder"). Results: We found that the literature was sparse. Existing evidence suggests that medical causes are frequently at the root of agitation and aggression. With respect to management, de-escalation strategies are generally preferred over pharmacotherapy. Specific delusional syndromes, e.g., de Clérambault, Othello, Capgras, Fregoli, as well as folie à deux, are associated with aggression. The somatic subtype of DD is the one most often requiring palliative care at the end of life. Conclusions: We conclude that insufficient attention has been given to the care needs of the accelerated aging process in DD.
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Smulevich AB, Klyushnik TP, Romanov DV, Lobanova VM, Voronova EI, Zozulya SA, Dorozhenok IY, Ilina EV, Magomedagaev MM, Boubaker R. [Bimodal model of delusional psychoses (on the problem of the correlation of paranoid dimensions in the psychopathological space of schizophrenia)]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:44-51. [PMID: 37382977 DOI: 10.17116/jnevro202312306144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
OBJECTIVE To establish clinico-pathogenetic ratios of delusional psychoses constituting the psychopathological space of paranoid schizophrenia and to determine clinical and pathogenetic validity of concepts of a single delusional psychosis (a model of chronic delusion with a staged course) and two endogenous delusional psychoses. MATERIAL AND METHODS A sample consisted of 56 patients (19 women, 37 men; the average age 39.7±9.3 years; average duration of the disease 10.6±9.1 years) with a diagnosis of paranoid schizophrenia, continuous type of course (F20.00), developed at the age above 18 years. At the time of examination, the condition of the patients was determined by persistent delusional or hallucinatory delusional disorders. Clinical, pathopsychological, psychometric (SANS, SAPS, PANSS), immunological and statistical methods were used. RESULTS The study substantiates a bimodal model of a single delusional psychosis with a polar arrangement of interpretive delusions and delusions of influence based on the phenomena of mental automatism, both in terms of the vector of development (toward the poles of negative/positive disorders) and in terms of the rate of progression. Psychopathological manifestations of interpretive delusions correlate with the slow evolving development of psychosis, the dimensional structure of the paranoid is limited to the limits of the delusional register; functional activity is represented by affiliation to negative changes, integration with personality anomalies ends with the transformation of positive disorders into pathocharacterological ones, corresponding to the post-processual development of the personality. Manifestation of delusional impact (syndrome of mental automatism) is manifested by the complication and maximum expansion of the spectrum of positive disorders; the dimensional structure is represented by a wide range of psychopathological disorders and is formed with the participation of processes of mental dissociation, reaching the level of delusional depersonalization; functional activity is high, which creates conditions for the formation of a «new» subpsychotic structure, a «psychotic character», which is an attenuated duplicate of delusional psychosis. In both groups of patients, a significant increase in the activity of inflammatory markers of leukocyte elastase (249.2 ((231.1-270.0); 272.2 (236.0-292.6) nmol/min∙ml) and alpha - 1 proteinase inhibitor (48.8 (46.0-55.0); 50.4 (42.1-54.8) IU/ml) was shown compared with controls (205.0 (199.8-217.3) nmol/min∙mL and 33.0 (31.0-36.0) IU/mL, p<0.01, respectively). In the group of patients with delusions of influence, an increased level of antibodies to S-100B was also observed (0.88 (0.67-1.0) opt.density units) compared with the control values (0.7 (0.65-0.77) opt.density units, p<0.05). CONCLUSION The concept of the model is supported by the results of the immunological study, according to which interpretive delusions and delusion based on the mental automatism, indicates the different level of immunity tension, and a qualitative changes in immune reactivity (also due to different genetic burden).
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Affiliation(s)
- A B Smulevich
- Mental Health Research Center, Moscow, Russia
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
| | | | - D V Romanov
- Mental Health Research Center, Moscow, Russia
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
| | | | - E I Voronova
- Mental Health Research Center, Moscow, Russia
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
| | - S A Zozulya
- Mental Health Research Center, Moscow, Russia
| | - I Yu Dorozhenok
- Mental Health Research Center, Moscow, Russia
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
| | - E V Ilina
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
| | - M M Magomedagaev
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
| | - R Boubaker
- Sechenov First Moscow State Medical Universit (Sechenov University), Moscow, Russia
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11
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Muacevic A, Adler JR, Mota M, Salgado H. Revisiting Paraphrenia: A Case Report. Cureus 2023; 15:e34391. [PMID: 36726768 PMCID: PMC9886067 DOI: 10.7759/cureus.34391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a disorder associated with paranoid dementia and paranoia, but with less personality deterioration than schizophrenia and without fulfilling the clinical features of a delusional disorder. This classic diagnostic entity is not currently listed in main diagnostic systems, rendering delusional disorders difficult to classify in cases that resemble the concept of paraphrenia. We revisit the concept of paraphrenia through a critical review based on a clinical vignette of a patient followed at the psychiatry department of the University Hospital Center of São João.
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Abstract
OBJECTIVES The primary aim was to systematically review the literature regarding the effectiveness of clozapine in reducing symptoms of primary psychotic and bipolar disorders in older adults. The secondary aim was to describe other reported patient and caregiver outcomes of clozapine treatment in older adults. DESIGN MEDLINE, Embase, PsychINFO, ProQuest, and PubMed databases were searched according to PRISMA guidelines for original empirical research examining the effectiveness of clozapine in adults aged 65 years or more with primary psychotic and bipolar disorders. Identified studies were assessed for methodological quality using the QualSyst tool. RESULTS 1121 records were screened, of which 7 studies met the inclusion criteria. In total, 128 subjects participated in the included studies (111 of whom were from a single study), with an age range of 65-86 years, and diagnoses including schizophrenia, schizoaffective disorder, bipolar disorder, and delusional disorder. Indications for clozapine use included treatment resistance and inability to tolerate other treatments. While six out of seven studies reported some improvement on the primary measure of psychopathology after treatment with clozapine, the group effects were modest and based on low-level evidence. Additional reported outcomes included discharge destination, death, and relapse. Most of the included studies were only of adequate methodological quality, with significant risks of bias identified. CONCLUSIONS Clozapine may have positive effects for primary psychotic and bipolar illnesses in some older adults, but the group effects reported were modest and based on low-level evidence studies with methodological limitations. Based on these findings, clinical decision-making about whether or not to trial clozapine should involve an individualized analysis of potential benefits and risks in collaboration with patients and their families and caregivers.
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13
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Ray M, Kumar S, Sinha A, Pisharody RR. Delusion of pregnancy: Conception in brain. Ind Psychiatry J 2022; 31:341-345. [PMID: 36419711 PMCID: PMC9678162 DOI: 10.4103/ipj.ipj_166_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/19/2021] [Accepted: 09/19/2021] [Indexed: 11/06/2022] Open
Abstract
Delusional disorders are common psychiatric disorders, but a delusion of pregnancy is a rare condition. Four cases that presented at a single tertiary care psychiatry center with delusion of pregnancy as a part of different psychological disorders are illustrated here. These cases were seen over a period of 6 months and had varied presentations and associated psychopathologies. Three of the four patients showed rapid recovery to treatment, but one patient was lost to follow-up. The heterogeneity in the presentation, sociodemographic profile of the patients and even in the symptom profile and response to treatment in this condition is highlighted and discussed in this case series.
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Affiliation(s)
- Madhubrata Ray
- Department of Psychiatry, Command Hospital (WC), Panchkula, Haryana, India
| | - Sanjay Kumar
- Department of Psychiatry, Command Hospital (WC), Panchkula, Haryana, India
| | - Alok Sinha
- Department of Psychiatry, Command Hospital Air Force, Bengaluru, Karnataka, India
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Bajouco M, Mota D. Cariprazine on Psychosis: Beyond Schizophrenia - A Case Series. Neuropsychiatr Dis Treat 2022; 18:1351-1362. [PMID: 35818373 PMCID: PMC9270979 DOI: 10.2147/ndt.s355941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Cariprazine is an atypical antipsychotic that has D2 and D3 partial agonism properties in addition to the usual 5-HT2A receptor antagonist action of second-generation antipsychotics. It has a distinctly higher affinity for D3 receptors, which is 10-fold higher than for D2 receptors. Cariprazine is also a 5-HT1A partial agonist, with a potential antidepressant effect. Cariprazine has been approved for treatment of both positive and negative symptoms of schizophrenia and for treatment of bipolar disorder. It could potentially be used in depression as an add-on treatment. There are few data reporting effectiveness of cariprazine in the broader spectrum of psychosis. In this paper, the authors report three cases where cariprazine was used in the treatment of psychotic conditions other than schizophrenia, namely a first episode psychosis, a case of delusional disorder, and a case of a patient with borderline personality disorder and psychotic symptoms. The authors suggest that cariprazine may be effective in the treatment of psychosis in a broader sense and should be considered a first-line treatment option.
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Affiliation(s)
- Miguel Bajouco
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - David Mota
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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15
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Ben Ammar H, Bouguira E, Brahmi L, Hamdi G, Bouallagui A, Khelifa E, Mnif L. Simultaneous occurrence of a Takotsubo syndrome and paranoia delirium, related to Covid-19 pandemic: A case report. Clin Case Rep 2021; 9:e05026. [PMID: 34765206 PMCID: PMC8572332 DOI: 10.1002/ccr3.5026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 11/07/2022] Open
Abstract
Some psychosomatic diseases, like Tako-tsubo cardiomyopathy, may occur because of exposure to a stressful event like COVID-19. The simultaneous development of psychosis and Tako-tsubo cardiomyopathy suggests a field of vulnerability. Specific measures need to be taken to help vulnerable people to manage these stressful events.
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Affiliation(s)
- Hanen Ben Ammar
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Emna Bouguira
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Lina Brahmi
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Ghada Hamdi
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Azza Bouallagui
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Emira Khelifa
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
| | - Leila Mnif
- Faculty of Medicine of TunisEl Manar UniversityTunisTunisia
- RaziHospitalManoubaTunisia
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16
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Gümüş T, Cesur E, Keyvan A, Türkcan A. Comparison of the sociodemographic, clinical and offense-related data of delusional disorder patients with and without a criminal history. Psychiatr Psychol Law 2021; 29:631-643. [PMID: 35903497 PMCID: PMC9318258 DOI: 10.1080/13218719.2021.1956386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This study investigates the relationship of delusional disorder and its subtypes to criminal and violent behavior by comparing the sociodemographic and clinical characteristics of patients with and without a criminal history and identifying predictors of crime. The records of 346 patients with a delusional disorder diagnosis were retrospectively evaluated using a sociodemographic data form, a crime violence rating scale and the Overt Aggression Scale (OAS). The results show that homicide and attempted homicide were committed more frequently by patients with jealous delusions, whereas verbal assault and crimes against the public were committed more frequently by patients with persecutory and other delusions. Patients with a criminal history had more hospital admissions and longer stays. Marital status, persecutory delusions, a high OAS score and older age were found to be associated with higher risk of crime. Clinical subtypes and sociodemographic characteristics seem to discriminate delusional disorder patients' risk of crime.
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Affiliation(s)
- Tuğba Gümüş
- Istanbul Training and Research Hospital, Psychiatry Unit, Istanbul, Turkey
| | - Ender Cesur
- Council of Forensic Medicine, Psychiatry Unit, Istanbul, Turkey
| | - Ali Keyvan
- Council of Forensic Medicine, Psychiatry Unit, Istanbul, Turkey
| | - Ahmet Türkcan
- Neurology and Neurosurgery, Bakirkoy Research & Training Hospital for Psychiatry, Forensic Psychiatry Unit, Istanbul, Turkey
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17
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Guàrdia A, González-Rodríguez A, Seeman MV, Álvarez A, Estrada F, Acebillo S, Labad J, Monreal JA. Dopamine, Serotonin, and Structure/Function Brain Defects as Biological Bases for Treatment Response in Delusional Disorder: A Systematic Review of Cases and Cohort Studies. Behav Sci (Basel) 2021; 11:141. [PMID: 34677234 DOI: 10.3390/bs11100141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 01/05/2023] Open
Abstract
Although blockade of dopamine receptors D2 and D3 appears to be the main mechanism of antipsychotic action, treatment response variability calls for an examination of other biological systems. Our aim is to systematically review reports of treatment response in delusional disorder (DD) in order to help determine its biological bases. Computerized searches of ClinicalTrials.gov, PubMed, and Scopus databases (from 1999 to September 2021) were systematically reviewed, in keeping with PRISMA directives. We used the search terms: (treat * OR therap * AND (delusional disorder)). We included all studies that explored the biological mechanisms of treatment response in DD, as diagnosed by ICD or DSM criteria. A total of 4344 records were initially retrieved, from which 14 papers were included: case reports, case series, and cohort studies. Findings point to (1) dopaminergic dysfunction (based on biochemical and genetic studies), (2) serotonergic dysfunction (based on partial agonism/antagonism of drugs), and (3) brain structure/function impairment, especially in the temporal and parietal lobes, as crucial factors in treatment response. Further studies with higher levels of evidence are needed to help clinicians determine treatment.
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18
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Abstract
OBJECTIVE Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, i.e., the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition. METHOD To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD. RESULTS Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy. CONCLUSIONS Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
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Affiliation(s)
- Rosa A S Couto
- School of Medicine, University of Minho, Braga, Portugal.,REQUIMTE, LAQV, Laboratory of Applied Chemistry, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Luís Moreira Gonçalves
- Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo (USP), São Paulo, Brazil
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19
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Nagdive AB, Bhainsora RS, Fernandes R, Behere PB, Sethi S. Pseudocyesis Leading to Folie-à-Deux. J Neurosci Rural Pract 2021; 12:419-423. [PMID: 33927534 PMCID: PMC8064852 DOI: 10.1055/s-0041-1726615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pseudocyesis or false belief of pregnancy is the emergence of classical manifestations of pregnancy—nausea, breast enlargement and pigmentation, abdominal distention, amenorrhea, and labor pains—in a nonpregnant woman. It is a multifactorial disease and its development is influenced by many different elements such as neuroendocrine, social, psychodynamic, and cultural issues. “Folie-à-deux,” is shared psychotic disorder, describes a syndrome in which delusion is transferred to another person who is more susceptible. Both individuals are closely related or know each other for a long time and typically live together in relative social isolation. In its commonest form, the individual who first develops the delusion (the primary case) is often chronically ill and typically is the dominant member in a close relationship with a more suggestible person (the secondary case) who also develops the delusion. Treatment options should also be kept in mind as antipsychotics themselves can increase prolactin levels and can lead to amenorrhoea and galactorrhea and can further strengthen patient’s belief about her pregnancy. This case highlights that the most important therapeutic step in the treatment of folie-à-deux is separation of the inducer and the induced. Here we describe a case of folie-à-deux of a married couple in which the female had delusional pregnancy while the husband shared and supported her delusion against substantial medical evidence.
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Affiliation(s)
- Amit B Nagdive
- Department of Psychiatry, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Ravi Singh Bhainsora
- Department of Psychiatry, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Rouchelle Fernandes
- Department of Psychiatry, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Prakash B Behere
- Department of Psychiatry, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | - Siddharth Sethi
- Department of Psychiatry, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
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20
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Karakuş İH, Bulut NS. Oral cenesthopathy superimposed on burning mouth syndrome treated with aripiprazole: A case report with a phenomenological overview. Gerodontology 2021; 38:113-116. [PMID: 33586237 DOI: 10.1111/ger.12516] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/26/2020] [Accepted: 11/08/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Burning mouth syndrome (BMS) is an idiopathic condition that presents with chronic pain and/or burning sensations in the oral structures. The syndrome mostly affects elderly women with hormonal changes and/or with a diagnosis of comorbid psychiatric disorder. In some rare conditions, the clinical appearance of BMS may also overlap with oral cenestopathy (OC), which is defined in the literature as a special form of delusional disorder of somatic type. Patients with OC may complain about abnormal experiences such as melting, feeling of stickiness, as well as extremely strange feelings of wires, metal coils, etc being present in their mouths. CASE PRESENTATION We present an elderly woman whose ongoing symptoms of BMS (burning in the mouth and tongue, taste alterations etc) were, over time, superimposed by cenesthopatic delusions that her gums had melted, and her palate had totally dissolved. We believe that the case is clinically striking and demonstrative for the understanding of complex nosology of BMS and OC, given that (a) the patient exhibited a relatively rare example of overlapping BMS and OS symptoms, which both are not sufficiently recognised by clinicians, (b) OC symptoms have disappeared with low-dose aripiprazole and psychoeducation-based cognitive therapy, which resulted in significant improvement in the patient's quality of life. CONCLUSION Clinicians are required to be aware of BMS and OC, two syndromes with multifactorial aetiology and highly heterogeneous presentation, in order to determine the most appropriate treatment options from a multidisciplinary perspective, as well as to avoid unnecessary medical interventions.
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Affiliation(s)
- İbrahim Hakkı Karakuş
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
| | - Necati Serkut Bulut
- Department of Psychiatry, Marmara University Pendik Training and Research Hospital, İstanbul, Turkey
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21
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Fabrazzo M, Giannelli L, Riolo S, Fuschillo A, Perris F, Catapano F. A hypothesis on Cotard's syndrome as an evolution of obsessive-compulsive disorder. Int Rev Psychiatry 2021; 33:23-28. [PMID: 33016787 DOI: 10.1080/09540261.2020.1810425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cotard's syndrome usually presents as combined symptoms occurring in a broad series of neurological, psychiatric, and medical disorders, being severe depression the most frequent. The syndrome is not classified as a distinct clinical entity in the nosological systems but appears solely as a clinical condition in case reports. Thus, the diagnosis of Cotard's syndrome mainly centres on the psychiatric interview and the ability of the clinician to recognise specific symptoms due to the absence of both clinical instruments and diagnostic criteria. Cotard's syndrome has never been described to date in patients with a history of obsessive-compulsive disorder (OCD). We report a case of a 49-year-old woman presenting obsessive symptoms and related compulsions for more than 30 years. Cotard's syndrome appeared after 3 years from a tragic event that had caused a psychological trauma. Such an occurrence may have contributed to worsening OCD and leading to a second major depressive episode followed by a suicidal attempt. Since then, the subject of our patient's obsessive thoughts changed, and the belief of being dead appeared. The repetitive and stereotyped thoughts caused severe distress, and accompanied the compulsive nature of reassurance seeking, temporarily beneficial to the anxiety arousing. The transition from obsession to delusion occurred when resistance was abandoned, and insight was lost. Once Cotard's syndrome had stabilised, OCD was no longer present. Additional distinctive features were the absence of psychiatric family history and the persistent nature of the affective psychosis. We concluded that Cotard's syndrome represented the evolution of the initial obsessive-compulsive disorder. Furthermore, we differentiated the clinical condition of our patient from other psychiatric diseases with similar clinical features. Larger-scale research is needed to consider topics other than comorbidity and also to explore significant elements of the patient's clinical history to discover what may influence the evolution and/or the persistence of the diseases.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Lisa Giannelli
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Serena Riolo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonietta Fuschillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Perris
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Catapano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
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22
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Torales J, García O, Barrios I, O'Higgins M, Castaldelli-Maia JM, Ventriglio A, Jafferany M. Delusional infestation: Clinical presentations, diagnosis, and management. J Cosmet Dermatol 2020; 19:3183-3188. [PMID: 33098221 DOI: 10.1111/jocd.13786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Delusional infestation is a primary psychiatric disorder characterized by a somatic-type delusional disorder (primary delusional infestation) that may lead to self-induced cutaneous lesions which are often difficult to recognize and treat properly. It may be also secondary to other psychiatric disorders, medical diseases, or substance abuse. AIMS This review will describe prevalence, common clinical features, different clinical presentations, differential diagnoses, and treatment recommendation. Special focus has been put on psychological aspects. METHODS We conducted a literature search on PubMed from January 2001 to June 2020 with the search terms of delusional parasitosis, delusional infestation, psychological, Reference lists of identified articles were examined for further relevant studies. The search was limited to English language articles. No specified quality criteria were used for study inclusion. RESULTS The clinical manifestations of delusional infestation are very important in the differential diagnosis and its psychological implications and management perspectives. CONCLUSION This article presents an update regarding the clinical aspects and treatment options of delusional infestation in order to provide an up-to-date review for dermatologists and general practitioners.
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Affiliation(s)
- Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Oscar García
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Iván Barrios
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - Marcelo O'Higgins
- Department of Psychiatry, School of Medical Sciences, National University of Asunción, San Lorenzo, Paraguay
| | - João Mauricio Castaldelli-Maia
- Department of Neuroscience, Medical School, Fundação do ABC, Santo André, Brazil.,Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Mohammad Jafferany
- Department of Psychiatry, Central Michigan University, Mount Pleasant, MI, USA
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González-Rodríguez A, Labad J, Seeman MV. Sleep Disturbances in Patients with Persistent Delusions: Prevalence, Clinical Associations, and Therapeutic Strategies. Clocks Sleep 2020; 2:399-415. [PMID: 33118525 DOI: 10.3390/clockssleep2040030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/12/2020] [Accepted: 10/12/2020] [Indexed: 11/17/2022] Open
Abstract
Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review’s findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen. As one symptom can aggravate another, comorbidities in patients with serious mental illness all need to be treated, a task that requires close liaison among medical specialties.
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24
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Hurşıtoğlu O, Tuman TC. Fahr's Syndrome Misdiagnosed As Delusional Disorder: A Case Report. ACTA ACUST UNITED AC 2020; 57:254-256. [PMID: 32952430 DOI: 10.29399/npa.24888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/16/2020] [Indexed: 11/07/2022]
Abstract
Fahr's disease is a rare neurological disorder that is characterized by bilateral basal ganglia calcification. In the present study, a 49-year-old male patient presented with delusional beliefs. He had normal neurologic examination. Follow-up mental status examination and clinical findings revealed delusional disorder. After three weeks, the patient presented to the clinic with postural tremor in the hands, and gait difficulties. A cranial CT scan showed that he had bilateral basal ganglia, thalamus, and centrum semiovale calcifications. The case illustrates the importance of considering organic etiologies before diagnosing a patient, particularly one who has late-onset presentation of psychosis.
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Affiliation(s)
- Onur Hurşıtoğlu
- Necip Fazıl City Hospital, Department of Psychiatry, Kahramanmaraş, Turkey
| | - Taha Can Tuman
- Birecik State Hospital, Department of Psychiatry, Birecik, Şanlıurfa, Turkey
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25
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Abstract
Capgras and Fregoli syndromes are two psychotic and complex conditions also known as Delusional Misidentification Syndromes (DMSs). Their description dates back to the beginning of XX century, and many explanatory models have been formulated through myths, psychoanalytical and psychological hypotheses, as well as neurobiological proposals. Even if DMSs are not fully considered in the modern diagnostic manuals, they still remain intriguing phenomena to be clinically observed and explained. Also, the employment of psychotropics and physical techniques in the treatment of such conditions is not supported by robust evidences and this may encourage further studies. We conclude that it would be of great interest to brush up the neglected MDSs in order to improve our knowledge on the underlying mechanisms of delusion and brain functioning.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Dinesh Bhugra
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Domenico De Berardis
- Department of Mental Health, ASL Teramo, Teramo, Italy.,Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti, Chieti, Italy
| | - Julio Torales
- Department of Psychiatry, School of Medical Science, National University of Asuncion, Asuncion, Paraguay
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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26
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Goodwin TA, Lowry TJ, Meurk C, Neillie D. Treating the untreatable? The biopsychosocial treatment of delusional disorder: a case study. Australas Psychiatry 2020; 28:433-437. [PMID: 32019353 DOI: 10.1177/1039856220901463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Delusional disorder (DD) is well recognised, but its treatment is controversial. This article presents a case study that highlights the therapeutic benefits associated with assertive biopsychosocial treatment of DD. METHOD The literature on pharmacological and psychological treatments for DD is briefly reviewed, and a case example from the Queensland Fixated Threat Assessment Centre is given to illustrate a comprehensive biopsychosocial treatment framework. RESULTS Combined pharmacological and psychosocial intervention resulted in stabilisation and improvement in mental state for the case described. CONCLUSIONS There is an emergent evidence base for an assertive biopsychosocial approach to treating DD. The case study demonstrates that a range of therapeutic goals is achievable.
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Affiliation(s)
| | - Tim J Lowry
- Queensland Fixated Threat Assessment Centre (QFTAC), Australia.,The University of Queensland, Australia
| | - Carla Meurk
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Australia.,The University of Queensland, Australia
| | - Darren Neillie
- Queensland Fixated Threat Assessment Centre (QFTAC), Australia
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27
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Abstract
The de Clérambault syndrome, commonly known as erotomania, is a delusional disorder in which the patient is convinced that another person has fallen in love with him or her. The syndrome is more frequent in female patients, who usually believe that their lover is a man belonging to a higher social and economic class, or is married, unknown, or even imaginary or deceased person. The course of the syndrome is usually chronic, with serious problematic behavioural consequences, including stalking behaviours, such as repetitive calling, unexpected visits or continuous attempts to send gifts or letters. According to the DSM-5, this syndrome is included in the erotomanic type of the delusional disorder, however, it is usually neglected in psychiatric practice and almost forgotten by modern psychiatrists.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesca Zinno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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28
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Reznik AM, Syunyakov TS, Shcherbakov DV, Martynyuk YL. [Psychotic disorders in the veterans of local wars]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:31-36. [PMID: 32729688 DOI: 10.17116/jnevro202012006231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the frequency of the key psychopathological syndromes, the dynamics and comorbidity of schizophrenia and other psychoses in Russian veterans of local wars receiving hospital treatment. MATERIAL AND METHODS The study included 685 patients of a psychiatric department of a military hospital, including 264 veterans of the local wars (the main group), 296 people (career military servicemen and retirees), who do not take part in combat actions (the first comparison group) and 125 people matched for the middle age and the age distribution curve with the main group (the second comparison group). RESULTS AND CONCLUSION The frequency of psychoses appeared to be slightly less in veterans (7.2%) compared to patients of comparison groups (14.5% and 8.8%, respectively). In all groups, most patients were diagnosed with schizophrenia (ICD-10 F20): 3.8% in the main group, 4.4% in the first comparison group and 4.0% in the second comparison group. Other acute and chronic psychotic disorders (F22-F23) were diagnosed in 0.8, 5.4 and 3.2% patients, respectively. Organic delusion disorders were diagnosed in 1.5% patients of the main group, 3.7% patients of the first comparison group and were not detected in the second comparison group. Comorbidity of posttraumatic stress disorder (PTSD) and psychosis was about 2% in the main group in whole and 26.3% in those with schizophrenia and other delusional disorders. The degree of incidence of symptoms of PTSD in veterans diagnosed with psychosis was significantly less than their frequency among all veterans (20% and 46.9%, respectively). Military stress factors do not influence the development of hallucinations and delusions in the main group. In the majority of veterans, psychotic symptoms manifested for the first time after stopping combat stress, the subsequent development and recurrence of psychotic symptoms happened regardless of the influence of combat stress factors.
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Affiliation(s)
- A M Reznik
- Moscow State University of Food Production, Moscow, Russia
| | - T S Syunyakov
- Alekseev Psychiatric Clinical Hospital No. 1, Moscow, Russia.,Zakusov Research Institute of Pharmacology, Moscow, Russia
| | - D V Shcherbakov
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
| | - Y L Martynyuk
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
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Scott R. The immolation of an Indian bus driver in Brisbane, Australia: delusional disorder, not a 'hate crime' In the matter of Anthony O'Donohue [2018] QMHC 8, Dalton J. Psychiatr Psychol Law 2020; 27:715-749. [PMID: 33833608 PMCID: PMC8009115 DOI: 10.1080/13218719.2020.1742244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In October 2016, a burning liquid was thrown over a bus driver in Brisbane, Australia. It was reported across the world that the 29-year-old bus driver was a Punjabi Indian and that his killing may have been a hate crime. A subsequent independent inquiry found that 50-year-old Anthony O'Donohue, who was charged with murder and other offences, had a long history of mental illness and had been discharged from treatment from a community mental health service four-and-a-half months earlier. In August 2018, the Queensland Mental Health Court found that, at the time of the alleged offences, Mr O'Donohue was of unsound mind and acquitted him of all charges. The case provides an opportunity to consider the decision making of a mental health service in the prelude to a major critical incident. The case also highlights the tension between the principles of patient autonomy and the 'recovery model' of mental illness on the one hand and the need to assertively manage persons who have no insight into their serious mental illness and are at risk of harming themselves or others.
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Affiliation(s)
- Russ Scott
- Prison Mental Health Service, the Park – Centre for Mental Health, Treatment and Research, Brisbane, Australia
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30
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Dua D, Grover S. Delusion of pregnancy for 21 years in an elderly woman: A case report and review of literature. Ind Psychiatry J 2020; 29:342-344. [PMID: 34158724 PMCID: PMC8188909 DOI: 10.4103/ipj.ipj_62_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/10/2020] [Accepted: 01/15/2021] [Indexed: 11/22/2022] Open
Abstract
Delusion of pregnancy (DOP) is a rare phenomenon especially in the elderly, with only 22 cases being reported. In this report, we present a case of a 74-year-old female with DOP and depressive disorder. In this case, a diagnosis of persistent delusional disorder was considered as the DOP persisted even after resolution of depressive symptoms with the use of antidepressants, antipsychotics, and electroconvulsive therapy.
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Affiliation(s)
- Devakshi Dua
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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31
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González-Rodríguez A, Seeman MV. Addressing Delusions in Women and Men with Delusional Disorder: Key Points for Clinical Management. Int J Environ Res Public Health 2020; 17:E4583. [PMID: 32630566 DOI: 10.3390/ijerph17124583] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Delusional disorders (DD) are difficult conditions for health professionals to treat successfully. They are also difficult for family members to bear. The aim of this narrative review is to select from the clinical literature the psychosocial interventions that appear to work best for these conditions and to see whether similar strategies can be modeled or taught to family members so that tensions at home are reduced. Because the content of men's and women's delusions sometimes differ, it has been suggested that optimal interventions for the two sexes may also differ. This review explores three areas: (a) specific treatments for men and women; (b) recommended psychological approaches by health professionals, especially in early encounters with patients with DD; and (c) recommended psychoeducation for families. Findings are that there is no evidence for differentiated psychosocial treatment for men and women with delusional disorder. What is recommended in the literature is to empathically elicit the details of the content of delusions, to address the accompanying emotions rather than the logic of the presented argument, to teach self-soothing techniques, and to monitor behavior with respect to its safety. These recommendations have only been validated in individual patients and families. More rigorous clinical trials need to be conducted.
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32
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Gillespie CS, McMahon CJ. Iatrogenic cerebral abscess leading to resolution of severe delusional disorder. BMJ Case Rep 2019; 12:12/12/e232394. [PMID: 31796437 PMCID: PMC7001695 DOI: 10.1136/bcr-2019-232394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
A cerebral abscess (focal infection of brain parenchyma) carries a high mortality and morbidity. Iatrogenic cerebral abscesses are less common and make up 10% of all cases. The presence of a cerebral abscess can rarely improve a patient's prognosis and quality of life, however this case illustrates an abscess and its treatment following a prolonged course of antibiotics leading to resolution of a severe psychotic disorder. This is a case report of a 32-year-old female inpatient at a psychiatric hospital with a long-standing history of congenital hydrocephalus, cerebral palsy and organic delusional disorder who developed an iatrogenic cerebral abscess after insertion of an implantable intracranial pressure monitoring device. After receiving treatment of 6 weeks of intravenous meropenem the patient's mental condition rapidly improved, she became stable and euthymic and was discharged home. The patient has since had no delusions or hallucinations and is living independently at home.
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Affiliation(s)
- Conor Sn Gillespie
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK .,School of Medicine, University of Liverpool, Liverpool, UK
| | - Catherine J McMahon
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool, UK
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33
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Gurok MG, Keles DD, Korkmaz S, Yildirim H, Kilic MÇ, Atmaca M. Smaller Pituitary Volumes in Patients with Delusional Disorder. Med Arch 2019; 73:253-256. [PMID: 31762560 PMCID: PMC6853737 DOI: 10.5455/medarh.2019.73.253-256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: Delusional disorder shares some clinical characteristics of OCD and hypochondriasis. Delusions compared to obsessions in the OCD and compared to bodily preoccupations in the hypochondriasis are more established beliefs. Aim: To measure pituitary volumes in patients with delusional disorder and hypothesized that volumes would be reduced in those patients by a mechanism that we could not account for before for patients with OCD and hypochondriasis. Methods: Eighteen patients with delusional disorder and healthy controls were included into the study. Pituitary gland volumes were measured. Results: When using independent t test, the mean total pituitary volume was 777.22±241.28 mm3 in healthy controls, while it was 532.11±125.65 mm3 in patients with delusional disorder. The differences in regard to pituitary gland volumes between patients with delusional disorder and healthy control subjects were statistically meaningful (p<0.01), as supported by ANCOVA, with the covariates of age, gender and total brain volumes as covariates. Conclusion: We determined that patients with delusional disorder had smaller pituitary volumes compared to those of healthy control subjects.
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Affiliation(s)
- Mehmet Gurkan Gurok
- Department of Psychiatry, Firat University School of Medicine, Elazig,Turkey
| | | | - Sevda Korkmaz
- Department of Psychiatry, Firat University School of Medicine, Elazig,Turkey
| | - Hanefi Yildirim
- Department of Radiology, Firat University School of Medicine, Elazig,Turkey
| | | | - Murad Atmaca
- Department of Psychiatry, Firat University School of Medicine, Elazig,Turkey
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34
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Almeida OP, Ford AH, Hankey GJ, Yeap BB, Golledge J, Flicker L. Hearing loss and incident psychosis in later life: The Health in Men Study (HIMS). Int J Geriatr Psychiatry 2019; 34:408-414. [PMID: 30430657 DOI: 10.1002/gps.5028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/03/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if hearing loss is associated with increased risk of incident psychosis in later life. METHODS Longitudinal cohort study of a community-representative sample of 38 173 men aged 65 to 85 years at the start of the follow-up period of 18 years. We used the Western Australian Data Linkage System to ascertain the presence of hearing loss and of psychotic disorders according to the International Classification of Diseases (ICD) (versions 8, 9, and 10). We also collected information on concurrent morbidities: cancer and diseases of the cardiovascular, respiratory, digestive, and renal systems. RESULTS One thousand four hundred forty-two (3.8%) and 464 (1.2%) men had a recorded diagnosis of hearing loss and psychosis at the start of follow-up. After excluding the 464 participants with prevalent psychosis, 37 709 men were available for the longitudinal study, and of these, 252 (0.7%) developed a psychotic disorder. Competing risk regression showed that hearing loss was associated incident psychosis (subhazard ratio = 2.03, 95% CI, 1.24-3.32; after statistical adjustment for age and concurrent morbidities). CONCLUSIONS Hearing loss is associated with double the risk of incident psychosis in older men. Available evidence suggests that this link could be causal, although conclusive evidence is still missing from randomized controlled trials designed to test the effect of correction of hearing loss on the prevalence and incidence of psychosis.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Faculty of Health and Medical Sciences, University of Western Australia.,Department of Psychiatry, Royal Perth Hospital and Bentley Hospital, Perth, Australia
| | - Andrew H Ford
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Faculty of Health and Medical Sciences, University of Western Australia.,Department of Psychiatry, Royal Perth Hospital and Bentley Hospital, Perth, Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health & Ageing, Faculty of Health and Medical Sciences, University of Western Australia.,Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia
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Abstract
BACKGROUND Recent research has identified several potentially modifiable risk factors for dementia, including mental disorders. Psychotic disorders, such as schizophrenia and delusional disorder, have also been associated with increased risk of cognitive impairment and dementia, but currently available data difficult to generalise because of bias and confounding. We designed the present study to investigate if the presence of a psychotic disorder increased the risk of incident dementia in later life. METHODS Prospective cohort study of a community-representative sample of 37 770 men aged 65-85 years who were free of dementia at study entry. They were followed for up to 17.7 years using electronic health records. Clinical diagnoses followed the International Classification of Diseases guidelines. As psychotic disorders increase mortality, we considered death a competing risk. RESULTS A total of 8068 (21.4%) men developed dementia and 23 999 (63.5%) died during follow up. The sub-hazard ratio of dementia associated with a psychotic disorder was 2.67 (95% CI 2.30-3.09), after statistical adjustments for age and prevalent cardiovascular, respiratory, gastrointestinal and renal diseases, cancer, as well as hearing loss, depressive and bipolar disorders, and alcohol use disorder. The association between psychotic disorder and dementia risk varied slightly according to the duration of the psychotic disorder (highest for those with the shortest illness duration), but not the age of onset. No information about the use of antipsychotics was available. CONCLUSION Older men with a psychotic disorder have nearly three times greater risk of developing dementia than those without psychosis. The pathways linking psychotic disorders to dementia remain unclear but may involve mechanisms other than those associated with Alzheimer's disease and other common dementia syndromes.
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Affiliation(s)
| | - Andrew H Ford
- Medical School, University of Western Australia,Perth,Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia,Perth,Australia
| | - Bu B Yeap
- Medical School, University of Western Australia,Perth,Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University,Townsville,Australia
| | - Leon Flicker
- Medical School, University of Western Australia,Perth,Australia
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36
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Abstract
Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, USA
| | - Juan Young
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rakin Hoq
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
| | - Kyle Resnick
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
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37
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Noort A, Beekman ATF, van Gool AR, Braam AW. Religious delusions in older adults: Diagnoses, combinations, and delusional characteristics. Int J Geriatr Psychiatry 2018; 33:1680-1687. [PMID: 30251269 DOI: 10.1002/gps.4973] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 08/06/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Religious delusions (RDs) tend to occur relatively often in patients with affective or non-affective psychosis. Few studies exist about RDs in later life. The current study explores (1) the distribution of RDs across diagnosis, (2) how RDs relate to other types of delusions, and (3) how RDs relate to several dimensions or characteristics of delusions. METHODS Inpatients and outpatients in a Geriatric Psychiatry Department in the Netherlands (N = 155; mean age 76.5 years), and who were diagnosed with an affective or non-affective psychotic disorder, participated in semi structured diagnostic interviews, using the Schedules for Clinical Assessement in Neuropsychiatry 2.1. RESULTS Religious delusions were most common among patients with psychotic depression (47%) and schizophrenia (32%). The RDs frequently co-occurred with other types of delusions. When combined with delusions of grandeur, RDs were more often classified as bizarre and were accompanied by higher levels of positive psychotic symptoms. When combined with delusions of guilt, RDs were associated with higher levels of distress and a shorter disease duration. The delusional characteristics bizarreness, frequency of psychotic symptoms, and degree of distress were more prevalent for RDs than for any other type of delusion. CONCLUSIONS The current study suggests that the prevalence of RDs in older adults is particularly high in late life psychotic depression. Also, in later life, RDs can be perceived of as independent marker of complex psychotic states, and as a denominator of severe arousal with respect to existential concerns.
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Affiliation(s)
- Annemarie Noort
- Centre for Old Age Psychiatry, Hei- en Boeicopseweg 64a, 4126 RK Hei- en Boeicop, The Netherlands
| | | | - Arthur R van Gool
- Yulius Academy, Dennenhout 1, 2994 GC Barendrecht, Yulius voor geestelijke gezondheidszorg, The Netherlands
| | - Arjan W Braam
- Department of Emergency Psychiatry and Department of Residency Training, Altrecht Mental Health Care, The Netherlands
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38
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Karila L, Polomeni P, Benyamina A. [Persistent delusional disorder]. Rev Prat 2018; 68:e411-e414. [PMID: 30869239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Laurent Karila
- Service de psychiatrie et d'addictologie, hôpital universitaire Paul-Brousse, AP-HP, université Paris-Sud-11, Inserm U1000, France
| | - Pierre Polomeni
- Service d'addictologie, hôpital René-Muret, AP-HP, Muret, Bondy, université Paris-13, France
| | - Amine Benyamina
- Service de psychiatrie et d'addictologie, hôpital universitaire Paul-Brousse, AP-HP, université Paris Sud-11, France
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39
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Karayiannis KC. Bellingham, the Assassin of Spencer Perceval: A Case of Delusional Disorder and a Missed Opportunity for Legal Reform. Psychiatr Psychol Law 2018; 26:335-342. [PMID: 31984080 PMCID: PMC6762154 DOI: 10.1080/13218719.2018.1485524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 06/04/2018] [Indexed: 06/10/2023]
Abstract
In May 1812, Spencer Perceval became the only British Prime Minister to be assassinated. His murderer, John Bellingham, was executed after a rushed trial and a failed insanity defence. In this article, the writer examins the case, concludes that Bellingham was subject to a mental disorder and speculates whether the case would have preceded the landmark M'Naghten decision by some 30 years had it not been for political imperatives.
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Affiliation(s)
- Kyros C. Karayiannis
- Forensic psychiatrist, Regional Forensic Psychiatric Service, Auckland, New Zealand
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40
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Menakuru S, Ali MI, Karasala K. Genitalia self-mutilation commanded by hallucinations: a psychointensive case of Klingsor syndrome. BMJ Case Rep 2018; 2018:bcr-2018-226838. [PMID: 30232077 PMCID: PMC6150190 DOI: 10.1136/bcr-2018-226838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sasmith Menakuru
- Department of Internal Medicine, Narayana Medical College and Hospital, Nellore, India
- Mount Sinai Health System, New York, USA
| | - Mir Inzamam Ali
- RAK College Of Medical Sciences, Ras-al-Khaimah Medical and Health Sciences University, UAE
| | - Kashyap Karasala
- Department of Surgery, Narayana Medical College and Hospital, Nellore, India
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41
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Virani SA, Sobotka J, Brainch N, Bazzi L. Violence Associated with Somatic Delusions. Cureus 2018; 10:e3186. [PMID: 30364849 PMCID: PMC6199142 DOI: 10.7759/cureus.3186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) characterizes delusional disorder (DD) by the presence of delusions for longer than one month, without bizarre behavior or functional impairment. According to Kaplan and Saddock, the lifetime prevalence of DD (all subtypes) is about 0.2%. The persecutory subtype of delusional disorder (DD-PS) is the most common and the somatic subtype (DD-SS) is exceedingly rare. We aim to describe two cases of patients with somatic delusions, both presenting as imminently dangerous and threatening. We also discuss one case that resulted from our extensive literature review where somatic delusions were implicated in elevating a mass shooter's violence risk. Both patients whose cases are presented were involuntarily hospitalized after their doctors called 911 to report that they were being threatened by a weapon. These patients had no established psychiatric diagnoses and were evaluated thoroughly and diagnosed with DD-SS. Both perceived that their physicians were indifferent to their needs and cited their frustration as the trigger for planning attacks on the doctors. Unlike PS, SS is not traditionally described as increasing danger or risk of violence, and thorough risk assessments are not usually performed in DD-SS. We demonstrate that formal psychiatric violence risk assessments remain a useful tool to methodically stratify and effectively address risk, even in patients we do not typically expect to demonstrate premeditated violence.
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Affiliation(s)
| | - John Sobotka
- Psychiatry, Maimonides Medical Center, Brooklyn, USA
| | | | - Lama Bazzi
- Psychiatry, Maimonides Medical Center, New York, USA
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42
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Michel C, Schimmelmann BG, Schultze-Lutter F. Demographic and clinical characteristics of diagnosed and non-diagnosed psychotic disorders in the community. Early Interv Psychiatry 2018; 12:87-90. [PMID: 27556574 DOI: 10.1111/eip.12360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 03/21/2016] [Accepted: 06/12/2016] [Indexed: 11/30/2022]
Abstract
AIM Retrospective studies of first-episode psychosis patients have reported that psychosis often remains untreated for some time. Yet, from clinical samples, the characteristics and number of non-diagnosed untreated psychosis patients in a community can only be estimated. Thus, this short report compares socio-demographic and clinical features of diagnosed and non-diagnosed psychotic individuals assessed in the community. METHODS Using telephone interviews, we clinically assessed 2682 community participants (aged 16-40 years) in the Canton of Bern, Switzerland, to examine the characteristics of non-diagnosed psychosis. RESULTS Of the 41 detected psychosis patients (1.5% of the sample), 21 (54%) had already been diagnosed and treated. Non-diagnosed individuals experienced a delusional disorder (DD) (n = 10) more frequently than diagnosed individuals (n = 1), but did not differ in other socio-demographic characteristics. CONCLUSION Further study of DD should be emphasized, along with increased awareness of the condition in primary healthcare services, as individuals with DD might present themselves for other complaints.
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Affiliation(s)
- Chantal Michel
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Research Department, University of Bern, Bern, Switzerland
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Research Department, University of Bern, Bern, Switzerland
| | - Frauke Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Research Department, University of Bern, Bern, Switzerland
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43
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Masiran R, Hussin NS. Morbid jealousy reactivated by mood episodes. BMJ Case Rep 2018; 2018:bcr-2017-223430. [PMID: 29348292 PMCID: PMC5778221 DOI: 10.1136/bcr-2017-223430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 11/04/2022] Open
Abstract
A middle-aged man who has been enduring financial constraint experienced a period of irritability, increased goal-directed activities and insomnia occurring along with extreme jealousy with his current wife. The episode was followed by depressed mood and non-prominent auditory hallucination. His previous history revealed a forensic psychiatry case of a murder he committed 20 years ago.
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Affiliation(s)
- Ruziana Masiran
- Department of Psychiatry, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nik Shaliza Hussin
- Department of Psychiatry, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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44
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Muñoz-Negro JE, Ibáñez-Casas I, de Portugal E, Lozano-Gutiérrez V, Martínez-Leal R, Cervilla JA. A Psychopathological Comparison between Delusional Disorder and Schizophrenia. Can J Psychiatry 2018; 63:12-19. [PMID: 28595494 PMCID: PMC5788118 DOI: 10.1177/0706743717706347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To contribute to a better differential clinical categorisation of delusional disorder (DD) versus schizophrenia (SZ) and to add and complete evidence from previous clinical studies of DD compared to schizophrenia. METHODS A cross-sectional study using a clinical sample of 275 patients (132 patients with DD) was studied. Patients were consecutively attending public clinics located in urban and rural areas in both Andalusia and Catalonia (Spain). All participants met DSM-IV diagnostic criteria for either DD or SZ. Data were gathered on sociodemographics, illness duration, Barona-Index estimation of intelligence quotient (IQ), and global functioning, along with a thorough psychopathological assessment using the Positive and Negative Syndrome Scale (PANSS). Comparisons between both groups were calculated using χ2, Student t, and multivariate analysis of covariance tests. RESULTS Patients with DD were older (mean [SD], 50.3 [14.6] years vs. 36.6 [11.1] years; t = 8.597; P ≤ 0.0001), were more frequently married (45.4% vs. 10.8%; χ2 = 38.569; P ≤ 0.0001), and had a higher mean estimated premorbid IQ (111.4 vs. 105.4; t = 2.609; P ≤ 0.01). On the other hand, SZ patients were predominantly male (71.4% vs. 48.9%; χ2 = 14.433; P ≤ 0.0001) and had greater work-related disability than DD patients (20.5% vs. 50.3%; χ2 = 19.564; P ≤ 0.001). Overall, the DD group showed a less severe PANSS psychopathology than SZ group. Thus, total mean (SD) PANSS scores for schizophrenia and delusional disorder, respectively, were 76.2 (22.4) versus 54.1 (18.4) ( t = -8.762; P ≤ 0.0001). Moreover, patients with DD showed a better global functioning than those with SZ (62.7 [13.2] vs. 51.9 [16.9]; F = 44.114; P ≤ 0.0001). CONCLUSIONS DD is a milder and distinct disorder compared to SZ in terms of psychopathology and global functionality.
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Affiliation(s)
- José Eduardo Muñoz-Negro
- 1 Mental Health Unit, Granada University Hospital, Granada, Spain.,2 Department of Psychiatry, Faculty of Medicine, Granada University Hospital Complex, University of Granada, Granada, Spain
| | - Inmaculada Ibáñez-Casas
- 2 Department of Psychiatry, Faculty of Medicine, Granada University Hospital Complex, University of Granada, Granada, Spain.,3 Department of Psychology, University of North Carolina, Wilmington, NC, USA
| | | | - Vanessa Lozano-Gutiérrez
- 2 Department of Psychiatry, Faculty of Medicine, Granada University Hospital Complex, University of Granada, Granada, Spain
| | - Rafael Martínez-Leal
- 5 UNIVIDD, Fundación Villablanca, Grupo de Neurociencias Clínicas Aplicadas, IISPV, URV, CIBERSAM, Tarragona, Spain
| | - Jorge A Cervilla
- 1 Mental Health Unit, Granada University Hospital, Granada, Spain.,2 Department of Psychiatry, Faculty of Medicine, Granada University Hospital Complex, University of Granada, Granada, Spain
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45
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Ingram DH. Psychodynamic Psychiatrists' Experiences of Being Stalked. Psychodyn Psychiatry 2018; 46:201-219. [PMID: 29809116 DOI: 10.1521/pdps.2018.46.2.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the estimated 15% likelihood that a psychiatrist will become the victim of stalking, there is little formal recognition of its prevalence or its impact on well-being. Through narrative accounts, ten psychiatrists with psychodynamic orientations speak of their experiences including how each managed the anxieties consequent to stalking. These include a variety of adaptive psychic operations as well as concrete actions to curtail stalking.
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Affiliation(s)
- Douglas H Ingram
- Clinical Professor of Psychiatry and Behavioral Sciences, New York Medical College
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46
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Abstract
A 50-year-old man with known multidrug resistant coexistent focal and generalised epilepsy was commenced on ethosuximide, with normalisation of his electroencephalogram and cessation of absence seizures. Within 3 weeks, he developed a rapidly worsening paranoid psychosis with visual and olfactory hallucinations. A month after the cessation of ethosuximide and concurrent treatment with olanzapine, his psychosis resolved and permitted reinitiation of ethosuximide at a lower dose without recurrence of psychotic symptoms.
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Affiliation(s)
- Sean Apap Mangion
- Department of Telemetry, University College London, Institute of Neurology, London, UK
| | - Fergus Rugg-Gunn
- Deparment of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
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47
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Jacobs D, Willekens D, de Die-Smulders C, Frijns JP, Steyaert J. Delusional and psychotic disorders in juvenile myotonic dystrophy type-1. Am J Med Genet B Neuropsychiatr Genet 2017; 174:359-366. [PMID: 28449271 DOI: 10.1002/ajmg.b.32524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 12/16/2016] [Indexed: 11/08/2022]
Abstract
We investigated the clinically derived hypothesis of a relatively high incidence of delusional and psychotic disorders in adolescents with juvenile Myotonic Dystrophy type-1 (DM1). Twenty-seven subjects of age 16-25 with juvenile DM1 and their parents were invited to have a clinical psychiatric interview, and to complete an ASEBA behavior checklist (YSR, ASR, CBCL, and ABCL). We diagnosed a Delusional Disorder in 19% of our patients and a Psychotic Disorder not otherwise specified in another 19%. These two groups of patients had a significantly worse level of clinically defined general functioning. It is clinically relevant to investigate in patients with juvenile DM the symptom of delusions and the presence of a delusional and psychotic disorder, and to consider the presence of juvenile DM in youngsters presenting with such a thought disorder. These disorders compromise the general functioning of the subjects and are often to some extent treatable. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Delphine Jacobs
- Centre for Human Genetics, University of Leuven, Leuven, Belgium
| | - Diane Willekens
- Centre for Human Genetics, University of Leuven, Leuven, Belgium
| | | | | | - Jean Steyaert
- Centre for Human Genetics, University of Leuven, Leuven, Belgium
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McLean BF, Mattiske JK, Balzan RP. Association of the Jumping to Conclusions and Evidence Integration Biases With Delusions in Psychosis: A Detailed Meta-analysis. Schizophr Bull 2017; 43:344-354. [PMID: 27169465 PMCID: PMC5605251 DOI: 10.1093/schbul/sbw056] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We completed a meta-analysis to investigate the relationship between delusions in psychosis and 4 cognitive biases: "jumping to conclusions" (JTC), the "bias against disconfirmatory evidence" (BADE), the "bias against confirmatory evidence" (BACE), and "liberal acceptance" (LA). Building on recent meta-analyses we compared more narrowly defined groups. We identified 35 JTC, 8 BADE, 7 BACE, and 6 LA studies for inclusion. Groups with schizophrenia who were currently experiencing delusions demonstrated greater JTC, BADE, BACE, and LA than groups with schizophrenia who were not currently experiencing delusions, who in turn demonstrated no more JTC than healthy control groups. Hence JTC, BADE, BACE, and LA co-vary with delusions in cross-sectional samples of people with schizophrenia. Groups who were experiencing delusions due to other psychiatric illnesses also demonstrated greater JTC than healthy controls, and equivalent JTC to groups with schizophrenia currently experiencing delusions. Hence JTC is associated with delusions across a range of diagnoses. Groups with other, non-delusional psychiatric illnesses demonstrated less JTC, BADE, BACE, and LA than groups with schizophrenia currently experiencing delusions, less JTC than groups experiencing delusions due to other diagnoses, and no more JTC, BADE, BACE, or LA than healthy control groups. Hence JTC, BADE, BACE, and LA were not associated with psychiatric illnesses in general. Our results indicate all 4 biases are associated with delusions specifically rather than merely with a diagnosis of schizophrenia or with being psychiatrically ill, consistent with the possibility that they contribute to delusional severity.
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Affiliation(s)
- Benjamin F. McLean
- School of Psychology, Flinders University, Adelaide, Australia;,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | | | - Ryan P. Balzan
- School of Psychology, Flinders University, Adelaide, Australia;,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
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49
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Abstract
This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA;,Department of Psychiatry, Virginia Commonwealth University, Richmond VA;,Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA
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Holubova M, Prasko J, Latalova K, Ociskova M, Grambal A, Kamaradova D, Vrbova K, Hruby R. Are self-stigma, quality of life, and clinical data interrelated in schizophrenia spectrum patients? A cross-sectional outpatient study. Patient Prefer Adherence 2016; 10:265-74. [PMID: 27019596 PMCID: PMC4786060 DOI: 10.2147/ppa.s96201] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current research attention has been moving toward the needs of patients and their consequences for the quality of life (QoL). Self-stigma is a maladaptive psychosocial phenomenon disturbing the QoL in a substantial number of psychiatric patients. In our study, we examined the relationship between demographic data, the severity of symptoms, self-stigma, and QoL in patients with schizophrenia spectrum disorder. METHODS Probands who met International Classification of Diseases-10 criteria for schizophrenia spectrum disorder (schizophrenia, schizoaffective disorder, or delusional disorder) were recruited in the study. We studied the correlations between the QoL measured by the QoL Satisfaction and Enjoyment Questionnaire, self-stigma assessed by the Internalized Stigma of Mental Illness, and severity of the disorder measured by the objective and subjective Clinical Global Impression severity scales in this cross-sectional study. RESULTS A total of 109 psychotic patients and 91 healthy controls participated in the study. Compared with the control group, there was a lower QoL and a higher score of self-stigmatization in psychotic patients. We found the correlation between an overall rating of self-stigmatization, duration of disorder, and QoL. The level of self-stigmatization correlated positively with total symptom severity score and negatively with the QoL. Multiple regression analysis revealed that the overall rating of objective symptom severity and the score of self-stigma were significantly associated with the QoL. CONCLUSION Our study suggests a negative impact of self-stigma level on the QoL in patients suffering from schizophrenia spectrum disorders.
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Affiliation(s)
- Michaela Holubova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
- Correspondence: Michaela Holubova, Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, IP Pavlova 6, 77520 Olomouc, Czech Republic, Email
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Aleš Grambal
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Dana Kamaradova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Kristyna Vrbova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
| | - Radovan Hruby
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University Olomouc, University Hospital Olomouc, Olomouc, Czech Republic
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