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Schizophrenia Bulletin Jun 2018
Topics: Adult; Female; Humans; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 29878273
DOI: 10.1093/schbul/sbx046 -
Actas Espanolas de Psiquiatria Nov 2018After defining that fundamental element of psychic life which is intentionality, based on original descriptions by Franz Brentano and Edmund Husserl, the authors try to...
After defining that fundamental element of psychic life which is intentionality, based on original descriptions by Franz Brentano and Edmund Husserl, the authors try to show the way in which this phenomenon is respectively altered in schizophrenia and in depression. For understanding what occurs with respect to this in schizophrenia it is first necessary to focus on what Husserl calls “the consciousness of the interior or immanent time”. The current of consciousness is not a mere succession of “nows”, but of a process of dynamic self-organization, which begins to be developed as, for example, a lecture or a melody is heard. The persistence of the past in me is what Husserl called retentio, while he called protentio this permanent anticipation of the future. The intentional arc would be what connects the beginning and the end of a phrase or of a melody. This intentional arc will keep tenser, the bigger is the potency of the aim of my speech and my capacity to exclude inadequate associations. Thomas Fuchs has compared this protentio function with a cone, whose starting point is the “now”. The more ordered is the thought and/or talk, the thinner will be the surface of the cone. In schizophrenia this cone expands and then there appears what Bleuler called “lax associations”, Cameron “overinclusion” and Peters “disturbance of the field of the word”. In previous works one of the authors (O. D. Z.) has developed the idea that the common denominator to all thought and/or language disturbances of schizophrenia would be the loss of the dialogic character, since context finally means co-text, text in common, agreement. Thomas Fuchs thinks that not only the alteration of thought is a consequence of the disturbance of the intentionality, but also the rest of the symptoms of schizophrenia. And thus, in delusional mood there would be a “retraction” of the intentional arc and in the paranoid ideas, an inversion of the intentionality and then the patient, instead of being actively thinking, perceiving and acting, is transformed in victim of the perceptions and actions of the others. Finally, this weakening of the intentionality also comes to explain the obstruction of the “life path”, the ability of constructing one’s own life. In the case of melancholia, the disturbance of the intentionality would be presented in the first place in the “not-being-able-to” or inhibition (one of the fundamental symptoms of this illness) and which von Gebsattel, with his concept of Werdenshemmung (inhibition of becoming), considered as the root of all the depressive manifestations. The disturbance of the intentionality is also showed to us in another phenomenon which has to do with temporality, which is the incapacity to anticipate. But the other fundamental phenomena of this illness can also be seen as a disturbance of the intentionality. Thus, in what we have called “becoming a thing” or “chrematization” (1980) and Fuchs “corporealization” (2005), when the body loses its transparence, the subject cannot project himself toward the action and toward the future. Finally, the third fundamental phenomenon of melancholy, which is the alteration, inversion or suspension of the biologic rhythms, is temporal by definition and insofar they constitute the base of anticipation, there is not other possibility than its compromise be expressed in a severe disturbance of intentionality.
Topics: Depressive Disorder; Humans; Intention; Schizophrenic Psychology
PubMed: 30552813
DOI: No ID Found -
Cureus Jan 2021This paper presents the case of a 20-year-old patient with a suspected diagnosis of paranoid schizophrenia. He was prescribed oral olanzapine at a dose of 10 mg per day,...
This paper presents the case of a 20-year-old patient with a suspected diagnosis of paranoid schizophrenia. He was prescribed oral olanzapine at a dose of 10 mg per day, and the treatment was associated with rhabdomyolysis (serum creatine kinase = 9,725 U/L on day four of the therapy). On suspicion of its contribution to rhabdomyolysis, olanzapine was immediately withdrawn. Pharmacogenetic testing demonstrated that the patient's genotype was . Based on these results, the patient was switched to trifluoperazine, a medication that is not metabolized by the CYP2D6 isoenzyme. Subsequently, the patient recovered well and was discharged without any nephrological sequelae. The presented case demonstrates that pharmacogenetic-guided personalization of treatment may allow selecting the best medication and determining the right dosage, resulting in the reduced risk of adverse drug reactions and pharmacoresistance.
PubMed: 33564555
DOI: 10.7759/cureus.12568 -
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 -
Schizophrenia Bulletin Mar 2024
Topics: Humans; Delusions; Paranoid Disorders; Schizophrenia, Paranoid
PubMed: 38309718
DOI: 10.1093/schbul/sbae012 -
Clinical Ophthalmology (Auckland, N.Z.) 2015This case report documents a 58-year-old male who presented to the clinic with a 12-month history of a burrowing sensation in his eyelids that he attributed to a...
This case report documents a 58-year-old male who presented to the clinic with a 12-month history of a burrowing sensation in his eyelids that he attributed to a parasitic infestation. After being extensively investigated and reviewed by relevant specialties, no evidence of parasitic infestation was found. He was diagnosed with and treated for blepharitis. Psychiatric referral for presumed delusional infestation (DI) was recommended. Despite this, he remained insistent in his belief of infestation, and was inevitably lost to follow-up. DI, previously known as delusional parasitosis, is a rare delusional disorder where affected individuals have a fixed, false belief that they have a parasitic infestation. Diagnosis can be challenging. Practitioners need to evaluate between primary and secondary DI carefully, as management differs depending on the etiology. Despite this, patients diagnosed with primary DI tend to be resistant to psychiatric referral. This report aims to optimize management by giving the reader a guideline for appropriate investigations and advice on patient approach. It is important to recognize hallmark features of DI to minimize self-inflicted trauma and associated psychosocial consequences. Effective treatment for DI is available, and devastating consequences, including blindness, can be avoided.
PubMed: 26082608
DOI: 10.2147/OPTH.S76420 -
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 -
Medical Care Apr 2021Earlier and more severe onset of chronic health conditions contributes to the increased risk of premature death among adults experiencing homelessness. Trimorbidity, a...
BACKGROUND
Earlier and more severe onset of chronic health conditions contributes to the increased risk of premature death among adults experiencing homelessness. Trimorbidity, a subset of multimorbidity representing overlap of physical health, mental health, and substance use conditions, disproportionately impacts adults experiencing homelessness. We know of no longitudinal data comparing trimorbidity trends among adults experiencing homelessness.
OBJECTIVE
To characterize 19-year trimorbidity trends among adults experiencing homelessness.
RESEARCH DESIGN
Repeated longitudinal, statewide survey administered every 3 years.
SUBJECTS
Adults living throughout Minnesota experiencing homelessness.
MEASURES
Reported diagnoses of chronic health conditions within 3 categories: physical health conditions (hypertension, heart disease, asthma, diabetes); mental health conditions (depression, posttraumatic stress disorder, bipolar disorder, schizophrenia/other paranoid, and delusional disorders); and substance use conditions (alcohol and illicit substances).
RESULTS
A total of 25,552 surveys were completed by adults at 3-year intervals in a total of 7 waves. Participants reported increasing frequency and duration of homelessness, and more nights slept outside/in a car. 77.3% of adults experiencing homelessness in 2018 had one or more chronic health condition in any domain. From 2000 to 2018, bimorbidity and trimorbidity surpassed morbidity within a single domain. This was driven by increases in mental health conditions. In 2018, 31.7% of participants reported bimorbidity and 16.3% of adults reported trimorbidity.
CONCLUSIONS
Adults experiencing homelessness bear a substantial and growing burden of bimorbidity and trimorbidity. Ensuring accessible, high quality care that includes robust services that can address all 3 categories of health is critical. Such care is best delivered in combination with affordable supportive housing.
Topics: Adult; Chronic Disease; Comorbidity; Female; Ill-Housed Persons; Humans; Longitudinal Studies; Male; Mental Disorders; Mental Health; Middle Aged; Minnesota; Substance-Related Disorders; Surveys and Questionnaires
PubMed: 33710099
DOI: 10.1097/MLR.0000000000001435 -
Early Intervention in Psychiatry Aug 2021There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in...
AIM
There is a growing appreciation that subthreshold but clinically elevated levels of autistic traits are clinically relevant. This study examined autistic traits in Singaporean patients with first-episode psychosis and their association with 1-year psychosis recovery.
METHODS
The relationship between baseline patient characteristics, autistic traits (measured with autism screening questionnaires) and psychosis recovery outcomes at 1-year were examined in 180 adults in the Early Intervention Psychosis Programme in Singapore.
RESULTS
Out of 180 participants, 50 (27.8%) had clinically elevated above screening-cut off levels of autistic traits on the self-reported 10-item Autism Spectrum Quotient and 8 (4.4%) on the staff-rated Autism Spectrum Disorder in Adults Screening Questionnaire. At baseline, those with more autistic traits were more likely to be unemployed, economically inactive (ie, students or homemakers); and to have diagnoses of mood disorder with psychotic features, brief psychotic disorder or psychotic disorder not otherwise specified as compared to schizophrenia spectrum and delusional disorder diagnoses. Although most participants showed improvements in their clinical outcomes at 1-year, those with higher autistic traits improved less in the Positive and Negative Syndrome Scale general psychopathology scale and in Global Assessment of Functioning symptomatology.
CONCLUSIONS
Autistic traits are common in those with first-episode psychosis and may be associated with poorer clinical outcomes. Validated screening tools should be developed in this population to support earlier reporting.
Topics: Adult; Autism Spectrum Disorder; Autistic Disorder; Humans; Mood Disorders; Psychotic Disorders; Schizophrenia
PubMed: 32710521
DOI: 10.1111/eip.13021