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Psychiatry Research. Neuroimaging Sep 2023Neurobiological foundations of delusional disorder (DD) have been studied less with neuroimaging techniques when compared to other psychotic disorders. The present study...
Neurobiological foundations of delusional disorder (DD) have been studied less with neuroimaging techniques when compared to other psychotic disorders. The present study aimed to delineate the neural substrates of DD by investigating neuroanatomical characteristics of the corpus callosum (CC) with statistical shape analysis (SSA) conducted on magnetic resonance images (MRI). Twenty (female:male=1:1) DSM-5 DD patients and 20 age- and gender-matched healthy individuals were included. High-resolution 3D T1 Turbo Field Echo MRI images were scanned with a 1.5 T MR device. The landmarks that were selected to determine the shape differences in CC were identified based on previous studies. Furthermore, constructed landmarks were determined and employed to better assess regional shape differences. There was no significant difference in the CC area in the mid-sagittal images between the DD patients and controls. However, DD patients exhibited a pattern of structural CC changes in various regions. The study findings emphasizes the variable subregional nature of CC in DD patients. Future SSA studies with larger samples could shed further light on DD etiology, diagnosis, classification and treatment options.
Topics: Humans; Male; Female; Corpus Callosum; Schizophrenia, Paranoid; Magnetic Resonance Imaging; Neuroimaging; Image Processing, Computer-Assisted
PubMed: 37567087
DOI: 10.1016/j.pscychresns.2023.111695 -
L'Encephale Apr 2019Currently, all of the studies that focus on the relationship between paranoia and criminal offenses exclusively concern subjects suffering from a delusional paranoid...
BACKGROUND
Currently, all of the studies that focus on the relationship between paranoia and criminal offenses exclusively concern subjects suffering from a delusional paranoid disorder. However, subjects with single paranoid personality disorder, without any associated delusional disorder, are not uncommon in forensic practice.
OBJECTIVES
This study aims to describe the offenses committed by subjects suffering from a single paranoid personality disorder and to compare them with the offenses committed by the subjects affected by a paranoid delusional disorder associated with paranoid personality disorder. Our initial hypothesis is that both populations have a comparable criminological profile.
METHODS
Based on a 17 year-long experience carried out in the framework of a forensic assessment, we have selected all subjects presenting a paranoid personality disorder, whether single or associated with paranoid delusional disorder. The selected individuals were divided into two groups according to whether they presented paranoid delusional disorder or not. The offenses were grouped into criminal categories. The alpha risk was fixed at 1%. Data analysis is done by SAS software version 9.4.
RESULTS
In a sample of 106 subjects presenting a paranoid personality disorder, including 4 women and 102 men, we found 79 subjects with a single paranoid personality and 27 with an associated paranoid delusional disorder. The average age at the time of the offense was 41 for those with single personality disorders and 49 for those with paranoid delusional disorders. Both groups had forensic antecedents (41%, 11/27 of paranoid delusional disorder and 51%, 40/79 of single paranoid personality disorder). Psychiatric history was more frequent in the paranoid delusional disorder group (59%, 16/27) than in the single paranoid personality disorder group (13%, 10/79). History of addiction was comparable in terms of alcohol abuse (26% in both groups) and other substances (7.5%, 2/27 of paranoid delusional disorder and 9%, 7/79 of single paranoid personality disorder). Comparison of the two groups highlighted significant differences in the type of criminal offenses committed (Fisher's exact test: P=0.0003, alpha risk <0.0001). The offenses committed by delusional authors essentially came down to verbal or physical violence, including homicide (44%, 12/27), and were usually focused on a designated persecutor. Sexual violence was rare. On the other hand, paranoid personality disorder was associated with a wider variety of offenses. Sexual offenses (including 28 rapes, 35%, 28/79) were thus almost as frequent as murder, and attempted murder (38%, 30/79). This diversity of committed offenses was found in their forensic antecedents. In these subjects, the logic of omnipotence may had over ruled the logic of revenge.
CONCLUSION
We conducted a retrospective study on 106 subjects with paranoid personality disorder, including 27 subjects with associated paranoid delusional disorder. The comparison of the two groups demonstrated significant differences in offenses. Verbal and physical but non-sexual violence, committed in a delusional logic, was found among delusional subjects, while the forms of violence were more multiform in the single paranoid personality disorder group, frequently including sexual violence. This is, as far as we know, the first study describing the medico-legal acting-out of paranoid personalities. These results, which will need to be confirmed by future studies, point out the importance of the criminological risk that may be associated with paranoid personality disorder, without any associated delusional disorder.
Topics: Adult; Alcoholism; Crime; Criminals; Female; France; Homicide; Humans; Male; Middle Aged; Paranoid Personality Disorder; Personality Disorders; Retrospective Studies; Schizophrenia, Paranoid; Sex Offenses; Violence
PubMed: 30309614
DOI: 10.1016/j.encep.2018.07.005 -
Neuropsychobiology 2020Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are...
INTRODUCTION
Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are unclear. Recent research suggests that specific delusional content may be associated with distinct neural substrates.
OBJECTIVE
Here, we used structural magnetic resonance imaging to investigate multiple parameters of brain morphology in patients presenting with paranoid type delusional disorder (pt-DD, n = 14) compared to those of healthy controls (HC, n = 25).
METHODS
Voxel- and surface-based morphometry for structural data was used to investigate gray matter volume (GMV), cortical thickness (CT) and gyrification.
RESULTS
Compared to HC, patients with pt-DD showed reduced GMV in bilateral amygdala and right inferior frontal gyrus. Higher GMV in patients was found in bilateral orbitofrontal and in left superior frontal cortices. Patients also had lower CT in frontal and temporal regions. Abnormal gyrification in patients was evident in frontal and temporal areas, as well as in bilateral insula.
CONCLUSIONS
The data suggest the presence of aberrant GMV in a right prefrontal region associated with belief evaluation, as well as distinct structural abnormalities in areas that essentially subserve processing of fear, anxiety and threat in patients with pt-DD. It is possible that cortical features of distinct evolutionary and genetic origin, i.e. CT and gyrification, contribute differently to the pathogenesis of pt-DD.
Topics: Adult; Aged; Amygdala; Cerebral Cortex; Female; Gray Matter; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prefrontal Cortex; Schizophrenia, Paranoid; Temporal Lobe
PubMed: 32160619
DOI: 10.1159/000505601 -
Schizophrenia Research Feb 2019Previous evidence suggests that delusional disorder has a later onset and better functional outcomes compared to schizophrenia. However, studies have not examined...
BACKGROUND
Previous evidence suggests that delusional disorder has a later onset and better functional outcomes compared to schizophrenia. However, studies have not examined longitudinal outcomes in a first episode population, where confounding factors may be adjusted for.
METHODS
A nested case control study was designed within the National EDEN study; a cohort of 1027 first episode psychosis patients. Patients with a baseline diagnosis of delusional disorder (n = 48) were compared with schizophrenia (n = 262) at 6 and 12 months with respect to symptomatic and functional outcomes. Regression analysis was used to adjust for possible confounders.
RESULTS
Delusional disorder patients had a shorter duration of untreated psychosis compared to schizophrenia but were similar in other baseline characteristics. At baseline, delusional disorder patients had lower symptom scores but higher function scores compared to those with schizophrenia. At 12 months the differences persisted for symptoms scores but not overall function scores. After adjusting for baseline score, age and duration of untreated psychosis, differences between the groups remained significant only for Positive and Negative Syndrome Scale (PANNS) negative, general and total scores and recovery rates. There were no differences in changes in outcomes scores.
CONCLUSIONS
Delusional disorder in a first episode psychosis population presents with less severe symptoms, higher recovery rates and better functioning than schizophrenia, but at 12 months differences are ameliorated when adjusting for baseline differences.
Topics: Adolescent; Adult; Case-Control Studies; Early Medical Intervention; Female; Humans; Longitudinal Studies; Male; Outcome Assessment, Health Care; Psychotic Disorders; Schizophrenia; Schizophrenia, Paranoid; Young Adult
PubMed: 30195583
DOI: 10.1016/j.schres.2018.08.036 -
Schizophrenia Bulletin Jun 2018
Topics: Adult; Female; Humans; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 29878273
DOI: 10.1093/schbul/sbx046 -
Schizophrenia Bulletin Jan 2024
Topics: Humans; Schizophrenia, Paranoid; Paranoid Disorders
PubMed: 37439602
DOI: 10.1093/schbul/sbad108 -
Psychological Medicine Oct 2015Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in... (Comparative Study)
Comparative Study
BACKGROUND
Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in ascertaining a representative sample size. Existing knowledge has been mostly generated from inpatient cohorts, which may be biased towards a more severe sample.
METHOD
We compared the demographic, clinical and cognitive differences between 71 patients with first-episode DD and 71 age-matched patients with first-episode SZ. Participants were consecutively recruited from a population-based territory-wide study of early psychosis in Hong Kong targeting first-episode psychosis. Basic demographic information, premorbid functioning, duration of untreated psychosis, pathways to care, symptomatology, social, occupational, and cognitive functioning were comprehensively assessed using standardized measurements.
RESULTS
Patients with DD had less premorbid schizoid and schizotypal traits compared to patients with SZ. More patients with DD were married compared to patients with SZ. However, at first episode, there were no significant differences between the two groups in regards to the duration of untreated psychosis, pathways to care, symptom severity, neurocognitive performance, treatment, and functioning.
CONCLUSIONS
Our findings challenge previous thinking that patients with DD had better functioning than patients with SZ. This study not only provides an updated perspective into conceptualizing the clinical differences between DD and SZ, but also expands the descriptive account of the two disorders to include the neurocognitive dimension.
Topics: Adult; Cognition; Cross-Sectional Studies; Delusions; Female; Help-Seeking Behavior; Humans; Jealousy; Male; Middle Aged; Neuropsychological Tests; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenia, Paranoid
PubMed: 26036591
DOI: 10.1017/S0033291715001051 -
International Clinical... Jul 2015The association between caffeine consumption and various psychiatric manifestations has long been observed. We present two cases that show the ability of caffeine to... (Review)
Review
The association between caffeine consumption and various psychiatric manifestations has long been observed. We present two cases that show the ability of caffeine to induce psychotic and manic symptoms, and we also review the extant literature on caffeine-induced psychiatric manifestations. On the basis of our own and others' findings, we suggest that caffeine may be related to not only de-novo psychotic or mood symptoms but also to aggravation of pre-existing psychotic or mood disorders. We therefore suggest that caffeine consumption among patients with mood or psychotic symptoms should be assessed carefully in clinical practice as part of routine psychiatric evaluations.
Topics: Administration, Oral; Adult; Affect; Antipsychotic Agents; Bipolar Disorder; Caffeine; Central Nervous System Stimulants; Coffee; Diet; Energy Drinks; Humans; Male; Psychoses, Substance-Induced; Risk Factors; Schizophrenia, Paranoid; Schizophrenic Psychology; Treatment Outcome
PubMed: 25856116
DOI: 10.1097/YIC.0000000000000076 -
Revista de Psiquiatria Y Salud Mental 2017
Topics: Antidepressive Agents; Antipsychotic Agents; Cognitive Behavioral Therapy; Combined Modality Therapy; Comprehensive Health Care; Diagnosis, Differential; Humans; Schizophrenia, Paranoid
PubMed: 28476504
DOI: 10.1016/j.rpsm.2017.03.003 -
Psychiatry Research Nov 2021Clozapine is a second-generation antipsychotic often used for treatment-refractory schizophrenia and has many adverse effects. Cardiac adverse events potentiated by...
Clozapine is a second-generation antipsychotic often used for treatment-refractory schizophrenia and has many adverse effects. Cardiac adverse events potentiated by clozapine include myocarditis which is a black box warning. Even more rarely, there are multiple cases of pericarditis reported in the literature. This is a case report of a 32-year old male with paranoid schizophrenia who developed pericarditis after initiation and titration of clozapine in the inpatient psychiatry unit. Patient presented with chest pain, persistent tachycardia, and orthostatic hypotension two weeks after titration of clozapine. The diagnosis of pericarditis was supported by the repeat electrocardiogram which revealed PR depressions, the audible friction rub, and the pleuritic/episodic nature of the chest pain. All other possible causes of pericarditis were ruled out and clozapine was suspected as the most likely explanation. The pericarditis resolved with treatment of colchine and ibuprofen on evidence from a repeat echocardiogram. This case report demonstrates and supports few cases of clozapine induced pericarditis in the literature. Cardiac events of clozapine can be life-threatening; therefore, greater baseline and subsequent cardiac monitoring may be implicated in the future.
Topics: Adult; Antipsychotic Agents; Clozapine; Humans; Male; Myocarditis; Pericarditis; Schizophrenia, Paranoid
PubMed: 34749222
DOI: 10.1016/j.psychres.2021.114250