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Psychopathology 2022The aim of the present study is to investigate the relationship between personality, trait affectivity, and severity of delusions in patients with delusional disorder...
The aim of the present study is to investigate the relationship between personality, trait affectivity, and severity of delusions in patients with delusional disorder (DD). Thirty-two outpatients affected by DD were administered the Structured Interview for DSM-IV-TR Personality Disorders (SIDP-IV), the Pathological Narcissism Inventory (PNI), the Positive and Negative Affect Schedule (PANAS), and the Psychotic Symptom Rating Scale (PSYRATS). We analyzed the prevalence of personality disorder in our sample of patients with DD and studied the correlations between the severity of delusions and the different affective variables. Finally, we obtained a multivariate explanatory model of the severity of the delusions. The severity of delusions was directly associated with "grandiose fantasy" item of narcissistic personality and inversely related with the feelings of shame, fear, and guilt. In the multivariate model, the feeling of shame was the only independent variable capable of accounting for the severity of delusions that, in DD patients, would lie on an affective core of shame.
Topics: Delusions; Humans; Narcissism; Personality Disorders; Schizophrenia, Paranoid; Shame
PubMed: 35272292
DOI: 10.1159/000522344 -
Revista de Psiquiatria Y Salud Mental 2016The phenomena of depersonalisation/derealisation have classically been associated with the initial phases of psychosis, and it is assumed that they would precede (even... (Comparative Study)
Comparative Study
INTRODUCTION
The phenomena of depersonalisation/derealisation have classically been associated with the initial phases of psychosis, and it is assumed that they would precede (even by years) the onset of clinical psychosis, being much more common in the prodromal and acute phases of the illness. The aims of the present study are to analyse the differences in depersonalisation/derealisation between patients with initial and multiple episodes and the factors that could influence this.
MATERIAL AND METHODS
A descriptive, controlled and cross-sectional study of 48 patients diagnosed with paranoid schizophrenia (20 with an initial episode and 28 with multiple episodes). These patients were assessed using scales such as the Cambridge Depersonalization Scale, the Positive and Negative Symptom Scale, and the Dissociative Experiences Scale.
RESULTS
Participants with initial episodes score higher on both the Cambridge Depersonalisation Scale, and the subscale of the Dissociative Experiences Scale that evaluates such experiences. There were no associations between these types of experience and the positive symptoms subscale of the Positive and Negative Symptom Scale.
CONCLUSIONS
Depersonalisation/derealisation experiences appear with greater frequency, duration and intensity in patients in the early stages of the illnesses, gradually decreasing as they become chronic.
Topics: Adolescent; Adult; Cross-Sectional Studies; Depersonalization; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Young Adult
PubMed: 26961912
DOI: 10.1016/j.rpsm.2016.01.010 -
PloS One 2016Schizophrenia spectrum disorders result in enormous individual suffering and financial burden on patients and on society. In Germany, there are about 1,000,000...
BACKGROUND
Schizophrenia spectrum disorders result in enormous individual suffering and financial burden on patients and on society. In Germany, there are about 1,000,000 individuals suffering from schizophrenia (SZ) or schizoaffective disorder (SAD), a combination of psychotic and affective symptoms. Given the heterogeneous nature of these syndromes, one may assume that there is a difference in treatment costs among patients with paranoid SZ and SAD. However, the current the national system of cost accounting in psychiatry and psychosomatics in Germany assesses all schizophrenia spectrum disorders within one category.
METHODS
The study comprised a retrospective audit of data from 118 patients diagnosed with paranoid SZ (F20.0) and 71 patients with SAD (F25). We used the mean total costs as well as partial cost, i.e., mean costs for medication products, mean personal costs and mean infrastructure costs from each patient for the statistical analysis. We tested for differences in the four variables between SZ and SAD patients using ANCOVA and confirmed the results with bootstrapping.
RESULTS
SAD patients had a longer duration of stay than patients with SZ (p = .02). Mean total costs were significantly higher for SAD patients (p = .023). Further, we found a significant difference in mean personnel costs (p = .02) between patients with SZ and SAD. However, we found no significant differences in mean pharmaceutical costs (p = .12) but a marginal difference of mean infrastructure costs (p = .05) between SZ and SAD. We found neither a common decrease of costs over time nor a differential decrease in SZ and SAD.
CONCLUSION
We found evidence for a difference of case related costs of inpatient treatments for paranoid SZ and SAD. The differences in mean total costs seem to be primarily related to the mean personnel costs in patients with paranoid SZ and SAD rather than mean pharmaceutical costs, possibly due to higher personnel effort and infrastructure.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Cohort Studies; Electronic Health Records; Female; Germany; Health Care Costs; Humans; Male; Mental Health Services; Middle Aged; Psychiatry; Psychophysiologic Disorders; Psychotic Disorders; Retrospective Studies; Schizophrenia, Paranoid; Young Adult
PubMed: 27391238
DOI: 10.1371/journal.pone.0157635 -
Schizophrenia Research Sep 2018Clozapine has been shown to be the most efficacious therapy for treatment resistant schizophrenia, estimated at one third of all schizophrenia cases. There is... (Review)
Review
Clozapine has been shown to be the most efficacious therapy for treatment resistant schizophrenia, estimated at one third of all schizophrenia cases. There is significant morbidity and mortality associated with clozapine including risk of agranulocytosis, aspiration pneumonia, bowel ischemia, myocarditis, seizures, and weight gain. Here we present a case of a 62-year-old man with chronic paranoid schizophrenia refractory to numerous antipsychotics who was started on clozapine therapy during an acute inpatient psychiatric admission. Within three weeks of starting clozapine, the patient developed flu-like symptoms, pleuritic chest pain, and was sent to a medical hospital for evaluation. After transfer, the patient had a rapidly deteriorating course with newly developed congestive heart failure, acute respiratory failure requiring intubation, and cardiovascular collapse requiring vasopressors. The patient expired within two days of transfer and four days after initial symptoms developed. The underlying etiology in this case is likely clozapine induced myocarditis leading to rapid cardiovascular collapse and death. Mortality with clozapine induced myocarditis has been estimated up to 24%. Given that 90% of clozapine cardiotoxic sequelae are seen in the first month post-initiation, more rigorous post-initiation surveillance is recommended for the first four weeks of clozapine with weekly cardiac enzymes (troponins, creatinine kinase-MB), EKG, and acute inflammatory markers (C-reactive protein, and erythrocyte sedimentation rate).
Topics: Antipsychotic Agents; Clozapine; Fatal Outcome; Humans; Male; Middle Aged; Myocarditis; Schizophrenia, Paranoid
PubMed: 29503232
DOI: 10.1016/j.schres.2018.02.058 -
Psychiatrike = Psychiatriki 2018The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are...
The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally fused functions of perception and recognition. The classical sub-types are: the syndromes of Capgras, Fregoli,Intermetamorphosis (mentioned in 3) and Subjective doubles. These syndromes occur in a clear sensorium and shouldbe differentiated from the banal transient misidentifications occurring in confusional states and in mania and from thenon-delusional misidentifications (e.g. prosopagnosia). Joseph Capgras, who described the best-known sub-type, was indecisive on its pathogenesis. In his original report he defined the syndrome as "agnosia of identification" produced by a conflict between affective accompaniments ofsensory and mnemonic images. In his subsequent two publications, he considered the syndrome as a restitution delusionand as a psychopathological mechanism to hide incestuous desires. For more details see the chapter by J.P. Luaute in avolume on DMS. Psychodynamic approaches are, essentially, variants of the formulation that DMSs result from ambivalent feelings resolvedby directing hate feelings onto an imagined double in order to retain the original intact (and thus avoid guilt).These views have been voiced by David Enoch [relevant chapter in (3)] and with variations by many other investigatorsreviewed by Oyebode. Regression to archaic modes of thought (like thinking in terms of doubles and dualisms) due to personality disintegrationproduced by psychotic illness is a fascinating hypothesis by John Todd [mentioned in (1)]. However, if this was thecase, DMS should be much more frequent. Mayer-Gross and Ackner (mentioned in 9) had observed that when there is a delusional development, depersonalization-derealization experiences tend to be included within the delusional system. Such experiences usually precede orcoincide with the onset of DMS. In view of this, Christodoulou suggested that DMSs may represent delusional evolutions of depersonalization-derealization experiences. Similar mechanisms were proposed for false memories of familiarity,reduplicative paramnesia and autoscopy. Cerebral "dysrhythmia" has also been noted in patients with DMS. In view of clinical and prognostic similarities of DMSpatients with patients suffering from psychotic states occurring in an epileptic setting, many of these patients have beenconsidered as suffering from broadly speaking "epileptic" psychoses. Joseph [mentioned in (6)] suggested that organiccauses produce disconnection between right and left cortical areas that decode afferent sensory information. This resultsin the creation of a separate image in each hemisphere leading to an awareness of two, physically identical images. Ellis and Young [mentioned in (1) and (6)] have maintained that DMS may result from defects at different stages of aninformation processing chain. More specifically, the Capgras Syndrome appears when the route for unconscious recognitionis damaged. Similar mechanisms have been proposed for the rest of the subtypes. Margariti and Kontaxakis8 have considered that in DMS there is disruption of the ability to recognize identities ratherthan superficial appearance. Others have maintained that DMSs are multimodal neuropathologies and cannot be linkedto a single cognitive defect. Lastly, in view of the marked organic abnormalities detected in all DMS subtypes, DMSs have been linked with a greatnumber of organic conditions [reviewed in detail by Oyebode (5)]. According to Greek mythology, Procrustes was a bandit who stretched or amputated the limbs of his guests to fit hisiron bed. The DMSs do not deserve such treatment. Submitting them to the procrustean bed of uniformity should be avoided. People develop DMS for a variety of reasons. Most subjects have right hemisphere dysfunction but not exclusively.Their condition is associated not with one but with diverse phenomena (depersonalization - derealization, prosopagnosia,false memories of familiarity, autoscopy, reduplicative paramnesia etc.) similarities with psychotic phenomena associatedwith epilepsy have been suggested but this refers to some patients only. Additionally, the charged emotionalrelationship of the patient with the misidentified person(s) is neither necessary nor sufficient. Diagnostically speaking, many roads lead to DMS, ranging from the monosymptomatic and monothematic one (consideredas par excellence DMS) to that associated with disorders mainly of the schizophrenic or organic spectrum. DMScan also be reached by a more "superficial" road, the one of depression, in which the delusion is secondary and often dependenton the self-depreciation ideation. Speculating on these syndromes is a fascinating journey in psychopathologybut, although in most cases an organic contributor is present, yet the great diversity of conditions in the setting of whichDMSs occur renders the possibility of a unifying hypothesis unlikely.
Topics: Cognition Disorders; Delusions; Humans; Neuropsychological Tests; Psychotherapy, Psychodynamic; Schizophrenia, Paranoid
PubMed: 29754115
DOI: 10.22365/jpsych.2018.291.15 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2020To study the antioxidant profile of blood plasma in patients with paranoid schizophrenia and Alzheimer disease (AD).
OBJECTIVE
To study the antioxidant profile of blood plasma in patients with paranoid schizophrenia and Alzheimer disease (AD).
MATERIAL AND METHODS
Thirty-three patients with paranoid schizophrenia and 18 patients with AD were included in the study. Patients with schizophrenia were stratified into two subgroups by response to therapy. The indicators of the antioxidant profile were determined using methods based on chemiluminometry and spectrofluorimetry.
RESULTS
Systemic oxidative stress due to insufficiency of low molecular weight plasma antioxidants is not determined neither in AD nor in treatment resistant schizophrenia. At the same time, a «thiol» oxidative stress, which indirectly indicates a deficiency of the glutathione system, is present in both groups. In patients with paranoid schizophrenia responsive to treatment, systemic oxidative stress is more pronounced and «thiol» oxidative stress is less significant. Among the antipsychotics studied, haloperidol, zuclopenthixol, risperidone and ziprasidone do not exhibit antioxidant properties, but periciazine, clozapine and especially chlorpromazine exhibit strong antioxidant properties, but they unlikely affect the antioxidant potential of blood plasma.
CONCLUSIONS
The glutathione part of the antioxidant system is mostly affected, but systemic oxidative stress is not significant in patients with treatment resistant paranoid schizophrenia and AD. Oxidative disorders are more pronounced in treatment responsive paranoid schizophrenia.
Topics: Alzheimer Disease; Antioxidants; Antipsychotic Agents; Clozapine; Humans; Risperidone; Schizophrenia, Paranoid
PubMed: 32678552
DOI: 10.17116/jnevro202012006182 -
Psychiatry Research Dec 2014Unlike the cognitive dimensions, alterations of the affective components of empathy in schizophrenia are less well understood. This study explored cognitive and...
Unlike the cognitive dimensions, alterations of the affective components of empathy in schizophrenia are less well understood. This study explored cognitive and affective dimensions of empathy in the context of the subjective experience of aspects of emotion processing, including emotion regulation, emotional contagion, and interpersonal distress, in individuals with schizophrenia and healthy controls. In addition, the predictive value of these parameters on psychosocial function was investigated. Fifty-five patients with paranoid schizophrenia and 55 healthy controls were investigated using the Multifaceted Empathy Test and Interpersonal Reactivity Index, as well as the Subjective Experience of Emotions and Emotional Contagion Scales. Individuals with schizophrenia showed impairments of cognitive empathy, but maintained emotional empathy. They reported significantly more negative emotional contagion, overwhelming emotions, lack of emotions, and symbolization of emotions by imagination, but less self-control of emotional expression than healthy persons. Besides cognitive empathy, the experience of a higher extent of overwhelming emotions and of less interpersonal distress predicted psychosocial function in patients. People with schizophrenia and healthy controls showed diverging patterns of how cognitive and emotional empathy related to the subjective aspects of emotion processing. It can be assumed that variables of emotion processing are important moderators of empathic abilities in schizophrenia.
Topics: Adult; Emotions; Empathy; Female; Humans; Male; Middle Aged; Neuropsychological Tests; Photic Stimulation; Schizophrenia, Paranoid; Self Concept
PubMed: 25288043
DOI: 10.1016/j.psychres.2014.09.009 -
Shanghai Archives of Psychiatry Jun 2015The human brain is a complex network of regions that are structurally interconnected by white matter (WM) tracts. Schizophrenia (SZ) can be conceptualized as a...
BACKGROUND
The human brain is a complex network of regions that are structurally interconnected by white matter (WM) tracts. Schizophrenia (SZ) can be conceptualized as a disconnection syndrome characterized by widespread disconnections in WM pathways.
AIMS
To assess whether or not anatomical disconnections are associated with disruption of the topological properties of inter- and intra-hemispheric networks in SZ.
METHODS
We acquired the diffusion tensor imaging data from 24 male patients with paranoid SZ during an acute phase of their illness and from 24 healthy age-matched male controls. The brain FA-weighted (fractional anisotropy-weighted) structural networks were constructed and the inter- and intra-hemispheric integration was assessed by estimating the average characteristic path lengths (CPLs) between and within the left and right hemisphere networks.
RESULTS
The mean CPLs for all 18 inter-and intra-hemispheric CPLs assessed were longer in the SZ patient group than in the control group, but only some of these differences were significantly different: the CPLs for the overall inter-hemispheric and the left and right intra-hemispheric networks; the CPLs for the interhemisphere subnetworks of the frontal lobes, temporal lobes, and subcortical structures; and the CPL for the intra- frontal subnetwork in the right hemisphere. Among the 24 patients, the CPL of the inter-frontal subnetwork was positively associated with negative symptom severity, but this was the only significant result among 72 assessed correlations, so it may be a statistical artifact.
CONCLUSIONS
Our findings suggest that the integrity of intra- and inter-hemispheric WM tracts is disrupted in males with paranoid SZ, supporting the brain network disconnection model (i.e., the (')connectivity hypothesis(')) of schizophrenia. Larger studies with less narrowly defined samples of individuals with schizophrenia are needed to confirm these results.
PubMed: 26300598
DOI: 10.11919/j.issn.1002-0829.215036 -
The Cochrane Database of Systematic... Dec 2019Primary delusional infestation (DI) is a primary psychiatric disorder characterised by delusions and abnormal tactile sensations. The pathophysiology is undecided and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Primary delusional infestation (DI) is a primary psychiatric disorder characterised by delusions and abnormal tactile sensations. The pathophysiology is undecided and treatment includes both pharmacological and non-pharmacological options. There is currently no Cochrane Review of the treatments used. Primary DI is a diagnosis often encountered by both dermatologists and psychiatrists, with a large associated disease burden.
OBJECTIVES
To evaluate the effectiveness of different treatments in primary delusional infestation (DI).
SEARCH METHODS
On 24 December 2014 and 19 March 2019, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including registries of clinical trials.
SELECTION CRITERIA
Randomised controlled trials involving the treatment of adults with primary DI.
DATA COLLECTION AND ANALYSIS
Two review authors independently screened and assessed studies for inclusion using pre-specified inclusion criteria.
MAIN RESULTS
We did not identify any studies for inclusion.
AUTHORS' CONCLUSIONS
Currently there is no evidence from RCTs available to compare treatment of primary DI with placebo. We cannot, therefore, make any conclusions regarding the effects of treatments (pharmacological or non-pharmacological) for primary DI. This lack of evidence for treatment of primary DI has implications for research and practice. Robust randomised trials are indicated.
Topics: Antipsychotic Agents; Humans; Psychotherapy; Randomized Controlled Trials as Topic; Schizophrenia, Paranoid; Self Concept
PubMed: 31821546
DOI: 10.1002/14651858.CD011326.pub2 -
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