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Ugeskrift For Laeger May 2023This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead....
This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead. The condition was interpreted as a presentation of Cotard syndrome as part of early-onset schizophrenia. Treatment with an antidepressant and multiple antipsychotic medications was not effective. The patient was then treated with ECT, resulting in subjective and measurable positive effects.
Topics: Female; Humans; Adolescent; Delusions; Schizophrenia
PubMed: 37264869
DOI: No ID Found -
Cognitive Neuropsychiatry 2015Current theories of confabulation are based primarily on the observation of neurological patients. The present paper evaluates these theories based on evidence from... (Review)
Review
INTRODUCTION
Current theories of confabulation are based primarily on the observation of neurological patients. The present paper evaluates these theories based on evidence from schizophrenia. Schizophrenia is unique in that it presents with a pathophysiology which differs from that of other neuropsychiatric conditions, and yet the candidate's deficits that various theories of confabulation implicate are often simultaneously present in schizophrenia.
METHODS
A selective review of literature on schizophrenic and neurological confabulations was undertaken.
RESULTS
Schizophrenic confabulation differs from neurological confabulation in terms of its characteristic features and association with symptoms, cognition and linguistic functions. Current evidence also suggests that confabulation may be conceptualized as a special class of delusions pertaining to memory phenomena.
CONCLUSIONS
Schizophrenia presents with confabulations that cannot be fully accounted for by the existing theories. It also presents with confabulations with unique features, which have different cognitive correlates and relation to other symptoms of the condition.
Topics: Cognition; Delusions; Humans; Memory; Memory Disorders; Schizophrenic Psychology
PubMed: 25078663
DOI: 10.1080/13546805.2014.940886 -
Psychiatry Research Sep 2023A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are... (Review)
Review
INTRODUCTION
A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are based on a limited number of cases and focus on a few drug classes, so a clear overview of this topic remains difficult. To address this issue, we provide in this article a comprehensive analysis of drug-induced delusion, based on the World Health Organization (WHO) pharmacovigilance database.
METHODS
We performed a disproportionality analysis of this database using the information component (IC). The IC compares observed and expected values to find associations between drugs and delusion, using disproportionate Bayesian reporting. An IC0.25 (lower end of the IC 95% credibility interval) > 0 is considered statistically significant.
RESULTS
Here we present an analysis of 4559 suspected drug-induced delusion reports in the WHO pharmacovigilance database. These results identified 66 molecules statistically associated with delusion and an extensive analysis of confounding factors and coprescriptions was performed, using full database as background with an IC0.25 > 0. The main drug classes involved were antidepressants, antiepileptics, dopaminergic agents, opioids, antiinfective agents, benzodiazepines, anti-dementia drugs and psychostimulants.
CONCLUSION
These results will help clinicians identify potential suspected drugs associated with delusion and decide which drug to discontinue and eventually lead to a re-evaluation of drug labels for some molecules.
Topics: Humans; Pharmacovigilance; Bayes Theorem; Delusions; Antidepressive Agents; Databases, Factual; World Health Organization; Adverse Drug Reaction Reporting Systems; Central Nervous System Stimulants
PubMed: 37517106
DOI: 10.1016/j.psychres.2023.115365 -
Brain and Nerve = Shinkei Kenkyu No... Nov 2018Delusion is a common neuropsychiatric symptom in dementia, especially in Alzheimer disease and dementia with Lewy bodies. Persecutory delusions are the most common, and...
Delusion is a common neuropsychiatric symptom in dementia, especially in Alzheimer disease and dementia with Lewy bodies. Persecutory delusions are the most common, and include delusions of theft, jealousy, and abundant. Patients with persecutory delusions have impairment of the psychological processes mediating the formation and maintenance of normal social beliefs. Several disordered psychological processes such as attentional bias, attributional bias, jumping-to-conclusions reasoning bias, and theory of mild deficit may contribute to the delusion formation. Cognitive processes involving information about self, others, and social interaction are required in social cognition. Damage of the neural circuitry involved in social cognition ("social brain"), such as the medial prefrontal cortex, may be a neuroanatomical basis for persecutory delusions in dementia.
Topics: Alzheimer Disease; Brain; Delusions; Humans; Lewy Body Disease
PubMed: 30416106
DOI: 10.11477/mf.1416201158 -
Behavior Therapy Jan 2023There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change... (Randomized Controlled Trial)
Randomized Controlled Trial
There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes. In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control. In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.
Topics: Humans; Delusions; Schizophrenia; Self Concept
PubMed: 36608970
DOI: 10.1016/j.beth.2022.07.011 -
Cognitive Neuropsychiatry Nov 2022Cotard delusion-the delusional belief "I am dead"-is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that...
INTRODUCTION
Cotard delusion-the delusional belief "I am dead"-is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea "I am dead" comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if "I am dead" were true, there would be no emotional responsivity to the world.
METHODS
We scrutinised the literature on people who expressed the delusional belief "I am dead", looking for data on whether such patients are reported as entirely lacking in emotional responsivity.
RESULTS
In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry.
CONCLUSIONS
We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea "I am dead" comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.
Topics: Anxiety Disorders; Delusions; Depersonalization; Emotions; Humans; Psychiatry
PubMed: 36112925
DOI: 10.1080/13546805.2022.2119839 -
The Psychiatric Quarterly Dec 2018The elderly with dementing illness often present with psychotic symptoms such as delusions, but the thematic content of delusions in the elderly differs from that of... (Review)
Review
The elderly with dementing illness often present with psychotic symptoms such as delusions, but the thematic content of delusions in the elderly differs from that of delusions expressed by younger individuals, and can be pathognomonic of early dementia. The aim of this paper is to review the recent literature on the delusion of theft, the most prevalent delusion in the elderly, in order to arrive at a deeper understanding of its sources and to identify successful therapeutic approaches. The literature from 2000 to the present was searched on the Google Scholar database using relevant search terms. Several older classical papers were also referenced. Understanding the origins of the delusion of theft - multiple losses, attempts at attributing such losses to an outside source, attempts at reliving a happier past - helps in devising responses that are comforting to the patient. The distress that often accompanies the delusion of having been robbed can be decreased by nursing home improvements in the handling of personal possessions, by the correction of sensory deficits, and by the provision of activities that distract from loneliness. Attention to stimuli that trigger the delusion helps to limit its occurrence. Medications may help, but can sometimes make matters worse. Understanding that delusional thinking can arise from sensory and cognitive deficits is critical to empathic caregiving and also to the lessening of caregiver burden.
Topics: Aged; Aging; Delusions; Dementia; Humans; Memory Disorders; Sensation Disorders; Theft
PubMed: 29956101
DOI: 10.1007/s11126-018-9588-1 -
Cognitive Neuropsychiatry Jan 2022Capgras delusion is sometimes defined as believing that close relatives have been replaced by strangers. But such replacement beliefs also occur in response to...
INTRODUCTION
Capgras delusion is sometimes defined as believing that close relatives have been replaced by strangers. But such replacement beliefs also occur in response to encountering an acquaintance, or the voice of a familiar person, or a pet, or some personal possession. All five scenarios involve believing something familiar has been replaced by something unfamiliar.
METHODS
We evaluate the proposal that these five kinds of delusional belief should count as subtypes of the same delusion.
RESULTS
Personally familiar stimuli activate the sympathetic nervous system (SNS) much more strongly than unfamiliar stimuli. In Capgras delusion, this difference is absent, prompting the delusional idea that a familiar person is actually a stranger. We suggest this absence of an effect of familiarity on SNS response will occur in all five scenarios and will prompt the idea that the familiar has been replaced by the unfamiliar.
CONCLUSIONS
We propose that: (a) all five scenarios be referred to as subtypes of Capgras delusion; (b) in all five, ideas about replacement are prompted by weakness of SNS responses to familiar stimuli; (c) this is insufficient to generate delusion. For a delusional idea to become a belief, a second factor (impaired hypothesis evaluation) must also be present.
Topics: Capgras Syndrome; Delusions; Humans; Recognition, Psychology
PubMed: 34890309
DOI: 10.1080/13546805.2021.2011185 -
Revista de Neurologia Apr 2019Hubris syndrome (HS) is an acquired psychiatric disorder that affects people who exercise power in any of its forms. It has been reported in many fields, from politics... (Review)
Review
INTRODUCTION
Hubris syndrome (HS) is an acquired psychiatric disorder that affects people who exercise power in any of its forms. It has been reported in many fields, from politics to finance. The physician-patient relationship is also one of power. A lack of humbleness and empathy in this situation can lead to qualities such as self-confidence and self-assurance becoming pride, arrogance and high-handedness, which characterise a doctor suffering from HS.
AIMS
To identify the symptoms of HS in the medical setting that make it easier to diagnose and to help healthcare organisations anticipate and mitigate its consequences.
DEVELOPMENT
The diagnostic criteria for HS initially reported in political leaders with government responsibilities are analysed and transferred to the medical field of neurosurgery. Two forms of medical HS are described and ten diagnostic criteria are proposed that are valid for any physician-patient relationship.
CONCLUSIONS
HS is an acquired psychiatric disorder that is triggered by power and enhanced by success, and can easily be observed on a daily basis in physicians working in settings that are very close to us. Early identification of these medical behaviours is necessary to be able to mitigate their consequences.
Topics: Administrative Personnel; Attitude of Health Personnel; Authoritarianism; Bullying; Cerebral Cortex; Delusions; Empathy; Humans; Interprofessional Relations; Leadership; Narcissism; Neurosurgeons; Neurosurgery; Neurotransmitter Agents; Physician-Patient Relations; Power, Psychological; Self Concept; Syndrome
PubMed: 30963532
DOI: 10.33588/rn.6808.2018355 -
Cortex; a Journal Devoted To the Study... Feb 2017Confabulation is sometimes defined - by Berlyne, for example - as a symptom that is seen only in one neuropsychological condition, amnesia. In this paper I argue for a...
Confabulation is sometimes defined - by Berlyne, for example - as a symptom that is seen only in one neuropsychological condition, amnesia. In this paper I argue for a somewhat more liberal - and, I contend, more productive - conception of confabulation, according to which it is seen not only in amnesia but also in other neuropsychological conditions such as delusion - and, indeed, even in healthy people. I also argue that it follows from this that in neuropsychological conditions where confabulations are seen, these are responses to abnormal experiences brought about by brain damage, but the occurrence of confabulation itself need not be seen as due to any impairment of cognitive processes due to the brain damage. It is instead a consequence of a general property of human cognition that is often referred to as "the drive for causal understanding".
Topics: Amnesia; Cognition; Delusions; Humans; Memory; Memory Disorders; Neuropsychological Tests
PubMed: 27613333
DOI: 10.1016/j.cortex.2016.08.002