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Continuum (Minneapolis, Minn.) Jun 2015Psychosis is a common and functionally disruptive symptom of many psychiatric, neurodevelopmental, neurologic, and medical conditions and an important target of... (Review)
Review
PURPOSE OF REVIEW
Psychosis is a common and functionally disruptive symptom of many psychiatric, neurodevelopmental, neurologic, and medical conditions and an important target of evaluation and treatment in neurologic and psychiatric practice. The purpose of this review is to define psychosis, communicate recent changes to the classification of and criteria for primary psychotic disorders described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and summarize current evidence-based approaches to the evaluation and management of primary and secondary psychoses.
RECENT FINDINGS
The DSM-5 classification of and criteria for primary psychotic disorders emphasize that these conditions occur along a spectrum, with schizoid (personality) disorder and schizophrenia defining its mild and severe ends, respectively. Psychosis is also identified as only one of several dimensions of neuropsychiatric disturbance in these disorders, with others encompassing abnormal psychomotor behaviors, negative symptoms, cognitive impairments, and emotional disturbances. This dimensional approach regards hallucinations and delusions as arising from neural systems subserving perception and information processing, thereby aligning the neurobiological framework used to describe and study such symptoms in primary psychotic disorders with those used to study psychosis associated with other neurologic conditions.
SUMMARY
This article provides practicing neurologists with updates on current approaches to the diagnosis, evaluation, and treatment of primary and secondary psychoses.
Topics: Adult; Antipsychotic Agents; Delusions; Hallucinations; Humans; Male; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia
PubMed: 26039850
DOI: 10.1212/01.CON.0000466662.89908.e7 -
Journal of Child Psychology and... Jul 2023Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context... (Review)
Review
Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context of other psychiatric and medical conditions. Many children and adolescents describe psychotic-like experiences, which can be associated with other types of psychopathology and past experiences (e.g., trauma, substance use, and suicidality). However, most youth reporting such experiences do not have, nor will ever develop, schizophrenia or another psychotic disorder. Accurate assessment is critical because these different presentations have different diagnostic and treatment implications. For this review, we focus primarily on the diagnosis and treatment of early onset schizophrenia. In addition, we review the development of community-based first-episode psychosis programming, and the importance of early intervention and coordinated care.
Topics: Adolescent; Child; Humans; Psychotic Disorders; Schizophrenia; Hallucinations; Suicidal Ideation; Psychopathology; Delusions
PubMed: 36878476
DOI: 10.1111/jcpp.13777 -
Psychiatria Danubina Jun 2019This article reviews cognitive models of positive and negative symptoms of schizophrenia, as well as basic principles of cognitive behavioural therapy (CBT) for... (Review)
Review
This article reviews cognitive models of positive and negative symptoms of schizophrenia, as well as basic principles of cognitive behavioural therapy (CBT) for hallucinations, delusions and negative symptoms. Cognitive models of schizophrenia posit that individuals' view of the self is influenced by a combination of genetic vulnerability, early childhood experience and environmental stressors later in the life, and that these factors determine how internal and external experiences are interpreted. Cognitive behavioural therapy for schizophrenia is based on the basic principles of CBT and establishes connection between thoughts, emotions and behaviour. Treatment focuses on the meaning the individual attributes to psychotic experience, his or her understanding of it and ways of coping with symptoms, and is intended to reduce the distress caused by psychotic experience and correct thoughts and assumptions that are incompatible with objective evidence. The latest contradictory data on the efficacy of CBT for schizophrenia point to the need to use protocols that are tailored to specific symptoms and subgroups of patients based on the stage of illness, level of neurocognitive impairment and severity of the disorder, and manual-based in order to ensure fidelity of implementation.
Topics: Cognition; Cognitive Behavioral Therapy; Delusions; Female; Hallucinations; Humans; Schizophrenia; Schizophrenic Psychology
PubMed: 31158119
DOI: No ID Found -
Psychopathology 2022Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology,... (Review)
Review
Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for schizophrenia. Since delusional perception has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness. In this article, we explore the clinical roots of delusional perception, elucidate the psychopathological phenomenon, and discuss its two predominant conceptualizations, i.e., Schneider's well-known two-link model and Matussek's lesser known one-link model. The two-link model posits that delusional perception amounts to an abnormal interpretation of an intact perception, whereas the one-link model posits that the delusional meaning is contained within a changed perception. Despite their differences, both models stress that delusional perception is a primary delusion that takes place within an altered experiential framework that is characteristic of the psychopathological Gestalt of schizophrenia. We discuss the role of delusional perception in future psychopathological and diagnostic assessment and argue that such assessments must be conducted in comprehensive manner, eliciting the psychopathological context within which symptoms and signs are embedded. Finally, we discuss the compatibility of the two models of delusional perception with contemporary cognitive models on delusion and cognitive psychotherapeutic approaches.
Topics: Humans; Delusions; Schizophrenia; Psychopathology; International Classification of Diseases; Perception
PubMed: 35588694
DOI: 10.1159/000524642 -
Clinical Psychological Science : a... Jan 2021Because of the traditional conceptualization of delusion as "irrational belief," cognitive models of delusions largely focus on impairments to domain-general reasoning.... (Review)
Review
Because of the traditional conceptualization of delusion as "irrational belief," cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition-processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.
PubMed: 33552704
DOI: 10.1177/2167702620951553 -
Brain : a Journal of Neurology Apr 2021Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies,...
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
Topics: Aged; Delusions; Female; Hallucinations; Humans; Male; Middle Aged; Neurodegenerative Diseases; Prevalence; Psychotic Disorders
PubMed: 33501939
DOI: 10.1093/brain/awaa413 -
Schizophrenia Bulletin Dec 2020
Topics: Adult; Antipsychotic Agents; Delusions; Hallucinations; Humans; Male; Olanzapine; Psychotic Disorders
PubMed: 31355406
DOI: 10.1093/schbul/sbz083 -
Psychopathology 2015Ketamine, the NMDA glutamate receptor antagonist drug, is increasingly employed as an experimental model of psychosis in healthy volunteers. At subanesthetic doses, it...
BACKGROUND
Ketamine, the NMDA glutamate receptor antagonist drug, is increasingly employed as an experimental model of psychosis in healthy volunteers. At subanesthetic doses, it safely and reversibly causes delusion-like ideas, amotivation and perceptual disruptions reminiscent of the aberrant salience experiences that characterize first-episode psychosis. However, auditory verbal hallucinations, a hallmark symptom of schizophrenia, have not been reported consistently in healthy volunteers even at high doses of ketamine.
SAMPLING AND METHODS
Here we present data from a set of healthy participants who received moderately dosed, placebo-controlled ketamine infusions in the reduced stimulation environment of the magnetic resonance imaging (MRI) scanner. We highlight the phenomenological experiences of 3 participants who experienced particularly vivid hallucinations.
RESULTS
Participants in this series reported auditory verbal and musical hallucinations at a ketamine dose that does not induce auditory hallucination outside of the scanner.
CONCLUSIONS
We interpret the observation of ketamine-induced auditory verbal hallucinations in the context of the reduced perceptual environment of the MRI scanner and offer an explanation grounded in predictive coding models of perception and psychosis - the brain fills in expected perceptual inputs, and it does so more in situations of altered perceptual input. The altered perceptual input of the MRI scanner creates a mismatch between top-down perceptual expectations and the heightened bottom-up signals induced by ketamine. Such circumstances induce aberrant percepts, including musical and auditory verbal hallucinations. We suggest that these circumstances might represent a useful experimental model of auditory verbal hallucinations and highlight the impact of ambient sensory stimuli on psychopathology.
Topics: Adult; Delusions; Dose-Response Relationship, Drug; Female; Frontal Lobe; Hallucinations; Humans; Ketamine; Magnetic Resonance Imaging; Male; Perception; Psychotic Disorders; Young Adult
PubMed: 26361209
DOI: 10.1159/000438675