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Psychological Medicine Jun 2021Obsession and delusion are theoretically distinct from each other in terms of reality testing. Despite such phenomenological distinction, no extant studies have examined...
BACKGROUND
Obsession and delusion are theoretically distinct from each other in terms of reality testing. Despite such phenomenological distinction, no extant studies have examined the identification of common and distinct neural correlates of obsession and delusion by employing biologically grounded methods. Here, we investigated dimensional effects of obsession and delusion spanning across the traditional diagnostic boundaries reflected upon the resting-state functional connectivity (RSFC) using connectome-wide association studies (CWAS).
METHODS
Our study sample comprised of 96 patients with obsessive-compulsive disorder, 75 patients with schizophrenia, and 65 healthy controls. A connectome-wide analysis was conducted to examine the relationship between obsession and delusion severity and RFSC using multivariate distance-based matrix regression.
RESULTS
Obsession was associated with the supplementary motor area, precentral gyrus, and superior parietal lobule, while delusion was associated with the precuneus. Follow-up seed-based RSFC and modularity analyses revealed that obsession was related to aberrant inter-network connectivity strength. Additional inter-network analyses demonstrated the association between obsession severity and inter-network connectivity between the frontoparietal control network and the dorsal attention network.
CONCLUSIONS
Our CWAS study based on the Research Domain Criteria (RDoC) provides novel evidence for the circuit-level functional dysconnectivity associated with obsession and delusion severity across diagnostic boundaries. Further refinement and accumulation of biomarkers from studies embedded within the RDoC framework would provide useful information in treating individuals who have some obsession or delusion symptoms but cannot be identified by the category of clinical symptoms alone.
Topics: Humans; Connectome; Delusions; Magnetic Resonance Imaging; Neural Networks, Computer; Obsessive Behavior
PubMed: 31997729
DOI: 10.1017/S0033291720000057 -
The Psychiatric Quarterly Dec 2018Delusions of thought insertion involve subjects claiming that external agents of different nature had placed thoughts into their minds/heads. However, despite being... (Review)
Review
Delusions of thought insertion involve subjects claiming that external agents of different nature had placed thoughts into their minds/heads. However, despite being regarded as one of the most severe and complex symptoms of psychotic disorders, a number of disagreements surround the description of its most fundamental phenomenology. This work has reviewed classic and current research on thought insertion in order to examine and clarify its main experiential features as reported by patients from a first-person perspective. The review shows that such features can be grouped into two categories: (i) experiential changes characterizing the period preceding the adoption of the delusion and, (ii) subjective features of full-blown delusional cases. While the discussion of the latter set of experiential features has received some attention within literature, the examination of the former set has been largely neglected. After this, the review offers a discussion of the most important conceptual disagreements surrounding the phenomenological descriptions of the symptom. Overcoming disagreements regarding the experiential structure of thought insertion is fundamental to elaborate phenomenologically and empirically coherent explanatory theories of the symptom and advance its clinical treatment.
Topics: Delusions; Humans; Psychotic Disorders; Thinking
PubMed: 30090993
DOI: 10.1007/s11126-018-9593-4 -
Fortschritte Der Neurologie-Psychiatrie Mar 2020Distinguishing between melancholic and non-melancholic depression is still of significant importance in the classification and differentiation of depressive disorders.... (Review)
Review
Distinguishing between melancholic and non-melancholic depression is still of significant importance in the classification and differentiation of depressive disorders. Melancholy appears to be a psychopathological and biologically based entity which can be described as a disorder of drive and which finds its extreme culmination in depressive delusion. Its pathogenesis ranges from the melancholic predisposed personality, mostly of the Typus melancholicus, over psychomotor inhibition and depersonalization, to depressive delusion. Delusion arises from the fear that the realization of basic human values, such as one's existence for important others or ideals, health and livelihood has become hopeless. A clear understanding of the nature and pathogenesis of melancholic delusional depression not only facilitates the diagnostic process, and the empathic assistance to the patient, but also has direct consequences for an appropriate treatment of this disorder.
Topics: Delusions; Depression; Depressive Disorder; Humans; Personality; Personality Inventory
PubMed: 31378852
DOI: 10.1055/a-0957-3226 -
CNS Neuroscience & Therapeutics Jul 2018Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare... (Review)
Review
Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare phenomenon, but its study has significantly contributed to the understanding of delusion formation. The evidence from case studies of patients with focal strokes shows that delusions develop following unilateral damage of the right hemisphere. The majority of patients with right hemisphere stroke do not develop delusions however, and advanced neuroimaging analysis has elucidated why this symptom develops in only a small proportion. Lesions of the right lateral prefrontal cortex or lesions with connectivity to this area correlate with delusional beliefs in this subgroup. Studies of patients with primary psychosis, for example schizophrenia, or under the influence of the psychotogenic drug ketamine, also show abnormal function of this area in relation to the severity of their abnormal beliefs. The conclusion of these studies is that the right lateral prefrontal cortex is 1 hub in a neural network which includes the basal ganglia and limbic system and receives inputs from midbrain dopamine neurones. In patients with schizophrenia, or at risk of psychosis, dopamine is dysregulated and evidence suggests that faulty dopamine signaling is the precursor of delusion formation. It is therefore likely that the mechanism of delusion formation is the same in both primary and secondary psychosis. This is consistent with the mainstay of treatment of both conditions being antipsychotic medication. However, antipsychotic medication in people with cerebrovascular disease should be avoided if at all possible. This is because epidemiological studies have found that antipsychotic use is associated with an increased risk of stroke and will thus compound the possibility of a further cerebrovascular accident.
Topics: Animals; Biology; Delusions; Humans; Pathology
PubMed: 29766653
DOI: 10.1111/cns.12973 -
Academic Psychiatry : the Journal of... Jun 2022
Topics: Delusions; Humans; Psychiatric Status Rating Scales
PubMed: 33890244
DOI: 10.1007/s40596-021-01437-8 -
Soins. Psychiatrie 2022Recovering from a mental disorder is a process by which the affected person will develop a new life project, based on the optimal use of personal and environmental...
Recovering from a mental disorder is a process by which the affected person will develop a new life project, based on the optimal use of personal and environmental resources. This involves adapting and managing certain symptoms better, in order to be able to rebuild oneself psychologically. This may be the case for delusions, which need to be distanced and accepted in order to develop this new life stage in. In this perspective, the notions of mourning for the self and mourning for delusional beliefs seem to be necessary steps in the reconstruction of a self that is favourable to recovery.
Topics: Delusions; Grief; Humans; Psychotic Disorders
PubMed: 36109135
DOI: 10.1016/j.spsy.2022.04.007 -
Integrative Psychological & Behavioral... Jun 2021In this article I aim to understand meaning construction from a cultural psychological stance and investigate how human beings - both individually and collectively -...
In this article I aim to understand meaning construction from a cultural psychological stance and investigate how human beings - both individually and collectively - create norms and beliefs that become guidelines for how we perceive. The real and the imaginary are closely intertwined- sometimes to the extent that one of them is taken for the other. Considering some specific product of the imagination as if it is real amounts to a delusion - the topic of this paper. A person constructs and attributes meaning and associations to objects and people and these constructions have been made by both personal and socially shared ideas. The dilemma seems to be concerning perspectives on truth and what lies prior to the determination of this. The attempt of this article and the autoethnographic research is to comprehend the extent and diversity of delusions. This will be examined in the attempt to investigate and distinguish delusions from everyday life to what can be considered pathological hence scrutinize the borderline of healthy versus maladaptive. This borderline will furthermore be discussed with the basis of symptom criteria from the ICD- and DSM diagnosis systems. This seems to be of big importance when diagnostically comprehend the pathological elements of the delusions in the sense that the judgement could come to determine life situation. These discussions lead to an understanding of delusions as semiotically made when distinguishing between general versus pathological psychological conditions.
Topics: Delusions; Humans; Imagination
PubMed: 33907965
DOI: 10.1007/s12124-021-09614-y -
Geriatrie Et Psychologie... Sep 2019This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia. (Review)
Review
UNLABELLED
This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia.
METHODS
We searched PubMed using the words 'delusion', 'dementia' and 'treatment' from January 2007 till November 2017.
RESULTS
Non-pharmacologic interventions are first-line treatment. Acetyl-cholinesterase inhibitors have shown conflicting results in the treatment of delusions in dementia patients. However, donepezil may be particularly useful in the treatment of psychotic symptoms in Lewy body dementia (LBD). Antipsychotics are reserved for the treatment of severe symptoms. The highest level of evidence exists for risperidone, followed by olanzapine and quetiapine. Clozapine and pimavenserine are therapeutic options for Parkinson disease dementia and LBD. The duration of antipsychotic treatment should not exceed 6 weeks as per the French recommendations (Agence nationale pour la sécurité du médicament) and 4 months as per the American psychiatric association recommendations. In the event of failure to respond to the aforementioned treatments or as an alternative, antidepressants, in particularly citalopram can be considered. There is not enough evidence to recommend melatonine for the treatment of delusions in dementia patients, although it has been shown to improve behavioral symptoms of dementia in general.
CONCLUSIONS
The choice of medication for the treatment of delusions in dementia patients should be tailored to each patient. The severity of the symptom and its related danger should be considered along with the patient's co-morbidities and the medication's potential adverse effect.
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Antipsychotic Agents; Cholinesterase Inhibitors; Delusions; Dementia; Humans; Psychotropic Drugs
PubMed: 31449050
DOI: 10.1684/pnv.2019.0813 -
Journal of Psychopathology and Clinical... Aug 2023There is widespread agreement that delusions in clinical populations and delusion-like beliefs in the general population are, in part, caused by cognitive biases. Much...
There is widespread agreement that delusions in clinical populations and delusion-like beliefs in the general population are, in part, caused by cognitive biases. Much of the evidence comes from two influential tasks: the Beads Task and the Bias Against Disconfirmatory Evidence Task. However, research using these tasks has been hampered by conceptual and empirical inconsistencies. In an online study, we examined relationships between delusion-like beliefs in the general population and cognitive biases associated with these tasks. Our study had four key strengths: A new animated Beads Task designed to reduce task miscomprehension, several data-quality checks to identify careless responders, a large sample ( = 1,002), and a preregistered analysis plan. When analyzing the full sample, our results replicated classic relationships between cognitive biases and delusion-like beliefs. However, when we removed 82 careless participants from the analyses (8.2% of the sample) we found that many of these relationships were severely diminished and, in some cases, eliminated outright. These results suggest that some (but not all) seemingly well-established relationships between cognitive biases and delusion-like beliefs might be artifacts of careless responding. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Delusions; Artifacts; Bias; Data Accuracy; Cognition
PubMed: 37326560
DOI: 10.1037/abn0000844 -
Journal of Psychopharmacology (Oxford,... Nov 2016In 2007, we proposed an explanation of delusion formation as aberrant prediction error-driven associative learning. Further, we argued that the NMDA receptor antagonist... (Review)
Review
In 2007, we proposed an explanation of delusion formation as aberrant prediction error-driven associative learning. Further, we argued that the NMDA receptor antagonist ketamine provided a good model for this process. Subsequently, we validated the model in patients with psychosis, relating aberrant prediction error signals to delusion severity. During the ensuing period, we have developed these ideas, drawing on the simple principle that brains build a model of the world and refine it by minimising prediction errors, as well as using it to guide perceptual inferences. While previously we focused on the prediction error signal per se, an updated view takes into account its precision, as well as the precision of prior expectations. With this expanded perspective, we see several possible routes to psychotic symptoms - which may explain the heterogeneity of psychotic illness, as well as the fact that other drugs, with different pharmacological actions, can produce psychotomimetic effects. In this article, we review the basic principles of this model and highlight specific ways in which prediction errors can be perturbed, in particular considering the reliability and uncertainty of predictions. The expanded model explains hallucinations as perturbations of the uncertainty mediated balance between expectation and prediction error. Here, expectations dominate and create perceptions by suppressing or ignoring actual inputs. Negative symptoms may arise due to poor reliability of predictions in service of action. By mapping from biology to belief and perception, the account proffers new explanations of psychosis. However, challenges remain. We attempt to address some of these concerns and suggest future directions, incorporating other symptoms into the model, building towards better understanding of psychosis.
Topics: Animals; Association Learning; Brain; Delusions; Hallucinations; Humans; Ketamine; Psychoses, Substance-Induced; Receptors, N-Methyl-D-Aspartate; Reproducibility of Results
PubMed: 27226342
DOI: 10.1177/0269881116650087