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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 -
Postepy Dermatologii I Alergologii Feb 2021Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have...
INTRODUCTION
Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have a fixed false belief of being infested with certain organisms or objects.
AIM
To analyse clinical features of subjects with DI who were admitted to the tertiary dermatology ward.
MATERIAL AND METHODS
A retrospective analysis concerning DI patients hospitalized between 1997 and 2019 was carried out. The emphasis was put on the duration of symptoms, psychiatric symptomatology (including the "specimen sign"), comorbidities as well as therapy.
RESULTS
We gathered data regarding 21 consecutive patients with DI. The mean age of subjects was 65.2 ±13.3 years, the majority were females (76.2%). The mean time span between the disease onset and diagnosis was 1.9 ±1.7 years. Previous psychiatric consultations were attended by 57.0% of patients. The specimen sign was present in 47.6% of cases, whereas the most common suspected causative factors were described as worms (52.4%), unspecified parasites (42.9%), "something" (33.3%) and flies (19.0%). Primary delusional disorder was diagnosed in 76.2%, followed by shared delusional disorder and secondary delusional disorder of organic origin (9.5% each). Risperidone monotherapy was initiated in 61.9% of patients. In total, only 33.3% of patients attended the follow-up visit.
CONCLUSIONS
DI features a wide spectrum of clinical signs and symptoms. Risperidone remains the drug of choice in the majority of cases. Successful management of each DI case requires collaboration between dermatologists and psychiatrists and still remains a major challenge.
PubMed: 34408581
DOI: 10.5114/ada.2019.88464 -
International Psychogeriatrics Apr 2020There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic...
OBJECTIVES
There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic use and treatment outcomes in patients with DD aged 65 years and older. Secondarily, we sought to examine associated clinical features and socio-demographic variables.
DESIGN AND SETTING
This descriptive study reviewed all consecutive cases of DD referred to an Australian old age psychiatry service over a 12-year period. Fifty-five patients were assessed in the inpatient and/or community setting, with data verified from a review of all individual medical records.
MEASUREMENTS
Data were collected with respect to antipsychotic use, outcomes, and clinical features. Socio-demographic variables of DD cases were compared to a non-matched comparison group (n=278) and an age and gender matched comparison group with a 1:1 ratio (n=55).
RESULTS
The predominant type of DD was persecutory (87%). Non-prominent hallucinations were experienced by 18%, and depressive symptoms occurred in 22%. There was a statistically significant association between having DD and social isolation (χ2= 11.04 (DF=1) p<0.001; McNemar's test p<0.001). Atypical antipsychotic medication was prescribed in 32 cases, with follow-up permitted in 51 of the 55 cases (mean duration 36.6 months). Sustained recovery occurred in 20%, and improvement in an additional 35% of the study sample. Four patients subsequently developed dementia, and two developed mild cognitive impairment.
CONCLUSIONS
Clinical improvement, including sustained recovery, occurred in more than half of those with late life DD. The majority of those who improved (96%) received atypical antipsychotics.
Topics: Aged; Aged, 80 and over; Aging; Antipsychotic Agents; Australia; Dementia; Female; Humans; Male; Schizophrenia, Paranoid; Treatment Outcome
PubMed: 31354123
DOI: 10.1017/S1041610219000966 -
Journal of Forensic Sciences Jan 2020Homicide is the most serious and costly criminal offense and better forensic and criminological understanding of homicidal ideation as a potential psychobehavioral...
Homicide is the most serious and costly criminal offense and better forensic and criminological understanding of homicidal ideation as a potential psychobehavioral precursor to homicidal conduct is critical. Using data from the 2016 Nationwide Emergency Department Sample (NEDS) from the Healthcare Cost and Utilization Project (HCUP) distributed by the Agency for Healthcare Research and Quality (AHRQ), we found 64,910 cases of homicidal ideation among a sample of 25.6 + million-a prevalence of 0.25%. Numerous conditions conferred increased substantially the likelihood of homicidal ideation including antisocial personality disorder (2406%), schizoaffective disorder (1821%), borderline personality disorder (1557%), paranoid personality disorder (1,504%), schizophrenia (1,143%), obsessive-compulsive personality disorder (921%), brief psychotic disorder (771%), unspecified psychosis (737%), avoidant personality disorder (596%), and schizoid personality disorder (571%), delusional disorder (546%), and other psychotic disorder (504%). Homicidal ideation is comorbid with serious psychiatric and behavioral problems and has important implications for offender typologies and homicidality.
Topics: Adolescent; Adult; Age Distribution; Databases, Factual; Emergency Service, Hospital; Female; Forensic Psychiatry; Homicide; Humans; Male; Medicaid; Mental Disorders; Middle Aged; Sex Distribution; United States; Urban Population; Young Adult
PubMed: 31404481
DOI: 10.1111/1556-4029.14156 -
Wiadomosci Lekarskie (Warsaw, Poland :... 2024Aim: To study the psychopathological mechanisms of the development of the prodromal stage of psychosis in order to identify risk factors for the formation of psychosis.
OBJECTIVE
Aim: To study the psychopathological mechanisms of the development of the prodromal stage of psychosis in order to identify risk factors for the formation of psychosis.
PATIENTS AND METHODS
Materials and Methods: In this research 137 patients with newly diagnosed psychosis were examined: 65 patients with a diagnosis of paranoid schizophrenia; 72 patients - with a diagnosis of acute polymorphic psychotic disorder.
RESULTS
Results: According to the analysis of symptoms using the PANSS, the absence of signs of an anxious state, conceptual disorganization of thinking, emotional withdrowal are reliable signs of PPP in PS, and unusual thought content, absence of signs of stereotyped thinking, tension, anxiety, and hallucinations are reliable signs of PPP in APPD. According to the analysis of symptoms using the SOPS, unusual thought content/delusional ideas, bizarre thinking, social anhedonia, suspiciousness/persecutory ideas, decrease in expressiveness of emotions are reliable signs of PPP in PS, and bizarre thinking, impaired tolerance to normal stress, sleep disturbance, perceptual abnormalities/hallucinations, trouble with focus and attention are reliable signs of PPP in APPD.
CONCLUSION
Conclusions: In the process of studying the clinical-psychopathological and pathopsychological aspects of the development of the PPP, a number of risk factors for the formation of psychosis were identified. We found that he most important diagnostic signs of PPP in PS patients are: stereotyped thinking, social isolation, disorganizational thinking disorders, passive-apathetic social detachment, suspiciousness. The most informative prodromal symptoms of HP in PS patients are: conceptual disorganization of thinking, bizzare thinking, social isolation, suspiciousness/persecutory ideas, reduced expression of emotions.
Topics: Male; Humans; Prodromal Symptoms; Psychotic Disorders; Anxiety; Risk Factors; Hallucinations
PubMed: 38431807
DOI: 10.36740/WLek202401107 -
Schizophrenia Bulletin Mar 2024
Topics: Humans; Delusions; Paranoid Disorders; Schizophrenia, Paranoid
PubMed: 38309718
DOI: 10.1093/schbul/sbae012 -
International Journal of Law and... 2015Psychiatric diagnosis is not considered a risk factor for offending following discharge. However, treatment interventions and aftercare are strongly influenced by...
Psychiatric diagnosis is not considered a risk factor for offending following discharge. However, treatment interventions and aftercare are strongly influenced by clinical primary diagnosis. We compared differential risks of reoffending of patients falling into six primary diagnostic categories following discharge from Medium Secure Units in the UK: schizophrenia/schizoaffective disorder; delusional disorder; mania/hypomania; depressive disorder; organic brain syndrome; personality disorder. We followed up 1344 patients, on average 6.2 years (SD=2.1) at risk, discharged from 7 of 14 Regional Medium Secure services in England and Wales. Outcomes were period prevalence, incidence, and cumulative probability of criminal conviction. Established demographic and criminal history predictors of reoffending were observed across different diagnostic categories. Risks of all offending were increased for personality disorder, violence/acquisitive offending for delusional disorder, sexual offending for mania/hypomania and violence/acquisitive offending for organic brain syndrome. Patterns of risk over time differed markedly between categories of mental disorder. Most patients with personality disorder who offended violently did so within 4 years of discharge. A subgroup with delusional disorder demonstrated increased risk of violent offending 5 years after discharge. Differential risks of reoffending are observed between different diagnostic groups. Clinical diagnosis should be included together with established risk measures in risk management following discharge. Close supervision of patients with personality disorder should begin immediately after discharge when risks of reoffending are greatest. For delusional disorder further investigation is needed into the marked increase in risk of violence after 5 years.
Topics: Adult; Bipolar Disorder; Crime; Depressive Disorder; Female; Humans; Male; Mental Disorders; Patient Discharge; Personality Disorders; Risk Factors; Schizophrenia; Schizophrenia, Paranoid; Sex Offenses; United Kingdom; Violence
PubMed: 25660350
DOI: 10.1016/j.ijlp.2015.01.009 -
Acta Dermato-venereologica Feb 2022
Topics: Diagnosis, Differential; Humans; Munchausen Syndrome; Schizophrenia, Paranoid; Skin Ulcer; Ulcer
PubMed: 35146526
DOI: 10.2340/actadv.v102.677 -
Social Psychiatry and Psychiatric... Aug 2014Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an... (Review)
Review
PURPOSE
Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions.
METHODS
A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia.
RESULTS
Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments.
CONCLUSIONS
There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.
Topics: Adult; Aged; Anxiety; Cognitive Behavioral Therapy; Culture; Delusions; Female; Humans; Internal-External Control; Male; Middle Aged; Paranoid Disorders; Psychotic Disorders; Risk Factors; Schizophrenia, Paranoid; Severity of Illness Index; Thinking
PubMed: 25005465
DOI: 10.1007/s00127-014-0928-7