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Psychological Medicine Jan 2024Psychosis is one of the most disabling psychiatric disorders. Pediatric traumatic brain injury (pTBI) has been cited as a developmental risk factor for psychosis,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Psychosis is one of the most disabling psychiatric disorders. Pediatric traumatic brain injury (pTBI) has been cited as a developmental risk factor for psychosis, however this association has never been assessed meta-analytically.
METHODS
A systematic review and meta-analysis of the association between pTBI and subsequent psychotic disorders/symptoms was performed. The study was pre-registered (CRD42022360772) adopting a random-effects model to estimate meta-analytic odds ratio (OR) and 95% confidence interval (CI) using the Paule-Mandel estimator. Subgroup (study location, study design, psychotic disorder . subthreshold symptoms, assessment type, and adult . adolescent onset) and meta-regression (quality of evidence) analyses were also performed. The robustness of findings was assessed through sensitivity analyses. The meta-analysis is available online as a computational notebook with an open dataset.
RESULTS
We identified 10 relevant studies and eight were included in the meta-analysis. Based on a pooled sample size of 479686, the pooled OR for the association between pTBI and psychosis outcomes was 1.80 (95% CI 1.11-2.95). There were no subgroup effects and no outliers. Both psychotic disorder and subthreshold symptoms were associated with pTBI. The overall association remained robust after removal of low-quality studies, however the OR reduced to 1.43 (95% CI 1.04-1.98). A leave-one-out sensitivity analysis showed the association was robust to removal of all but one study which changed the estimate to marginally non-significant.
CONCLUSIONS
We report cautious meta-analytic evidence for a positive association between pTBI and future psychosis. New evidence will be key in determining long-term reliability of this finding.
Topics: Adult; Adolescent; Humans; Child; Reproducibility of Results; Psychotic Disorders; Risk Factors
PubMed: 37772418
DOI: 10.1017/S0033291723002878 -
General Hospital Psychiatry 2022To ascertain the clinical characteristics of anti-NMDA receptor encephalitis (NMDARE) in older patients. (Review)
Review
OBJECTIVE
To ascertain the clinical characteristics of anti-NMDA receptor encephalitis (NMDARE) in older patients.
METHOD
A systematic literature review using PubMed and Scopus of all published case reports of NMDARE was undertaken, from database inception to June 2020. From this, cases reporting on patients older than 65 years of age and whose diagnosis was confirmed by the presence of anti-NMDAR antibodies in CSF were selected.
RESULTS
23 case reports fulfilling the study's criteria were found. Median age was 70.1 years (range 65-84), fourteen were female (60.9%), and mostly presented with acute behavioral and cognitive changes (95.7%). Atypical psychosis occurred in eleven patients (47.8%) with a sudden onset and fluctuating clinical pattern of delusions (39.1%), hallucinations (30.4%), and motility disturbances (34.8%) including catatonia (17.4%). Nine patients presented with seizures (39.1%). Pleocytosis in CSF (>5 WBC) was described in twelve cases (52.2%). Eleven cases (47.8%) had abnormal brain magnetic resonance imaging (MRI) scans with limbic inflammatory lesions. Thirteen patients had an abnormal EEG (56.5%).
CONCLUSION
NMDARE should be included in the differential diagnosis of older patients who present with new psychiatric episodes, especially when characterized by sudden onset psychotic polymorphic symptomatology, fluctuating course with marked cognitive decline, and with catatonic features.
Topics: Aged; Aged, 80 and over; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Catatonia; Female; Humans; Magnetic Resonance Imaging; Psychotic Disorders; Receptors, N-Methyl-D-Aspartate
PubMed: 34929551
DOI: 10.1016/j.genhosppsych.2021.11.006 -
Rivista Di Psichiatria 2020The therapeutic approaches of the so-called "third wave" of clinical cognitivism have assumed increasing relevance in recent years alongside cognitive-behavioral therapy...
INTRODUCTION
The therapeutic approaches of the so-called "third wave" of clinical cognitivism have assumed increasing relevance in recent years alongside cognitive-behavioral therapy in the treatment of psychosis.
AIMS
To evaluate the efficacy of some of the most relevant third wave cognitive-behavioral approaches (metacognitive interventions and therapies based on mindfulness and acceptance) in the treatment of psychosis.
METHOD
A systematic research was carried out for systematic reviews and meta-analysis on the efficacy of metacognitive interventions and mindfulness- and acceptance-based therapies in the treatment of psychosis, published from 1 January 2009 to 31 December 2018. The selected studies were evaluated using AMSTAR 2, a valid and reliable tool composed of 16 items to measure the methodological quality of systematic reviews and meta-analysis.
RESULTS
7 meta-analysis were selected: 4 for metacognitive therapies (3 of low quality, 1 of critically low quality) and 3 for mindfulness- and acceptance-based therapies (1 of medium quality, 2 of low quality).
DISCUSSION AND CONCLUSIONS
Among metacognitive therapies, metacognitive training has shown promising results on positive symptoms and in particular on the psychopathology of delusions. Mindfulness- and acceptance-based therapies have shown mild to moderate effects on general and positive symptoms as well as some effects on negative symptoms, depressive symptoms, hospitalization rates and length. However, further research is needed to confirm overall the encouraging results of both metacognitive training and mindfulness- and acceptance-based therapies as the small number of randomized controlled trials and the low methodological quality of most meta-analysis realized up to date does not allow to draw yet sufficiently solid conclusions on their efficacy in the treatment of psychosis.
Topics: Cognitive Behavioral Therapy; Humans; Meta-Analysis as Topic; Metacognition; Mindfulness; Non-Randomized Controlled Trials as Topic; Psychotic Disorders; Randomized Controlled Trials as Topic; Schizophrenia; Systematic Reviews as Topic; Treatment Outcome
PubMed: 32202543
DOI: 10.1708/3333.33020 -
Dementia & Neuropsychologia 2019The association between Capgras syndrome and Alzheimer's disease has been reported in several studies, but its prevalence varies considerably in the literature, making...
UNLABELLED
The association between Capgras syndrome and Alzheimer's disease has been reported in several studies, but its prevalence varies considerably in the literature, making it difficult to measure and manage this condition.
OBJECTIVE
This study aims to estimate the prevalence of Capgras syndrome in patients with Alzheimer's disease through a systematic review, and to review etiological and pathophysiological aspects related to the syndrome.
METHODS
A systematic review was conducted using the Medline, ISI, Cochrane, Scielo, Lilacs, and Embase databases. Two independent researchers carried out study selection, data extraction, and qualitative analysis by strictly following the same methodology. Disagreements were resolved by consensus. The meta-analysis was performed using the random effect model.
RESULTS
40 studies were identified, 8 of which were included in the present review. Overall, a total of 1,977 patients with Alzheimer's disease were analyzed, and the prevalence of Capgras syndrome in this group was 6% (CI: 95% I² 54% 4.0-8.0).
CONCLUSION
The study found a significant prevalence of Capgras syndrome in patients with Alzheimer's disease. These findings point to the need for more studies on the topic to improve the management of these patients.
PubMed: 31844501
DOI: 10.1590/1980-57642018dn13-040014 -
The Cochrane Database of Systematic... Oct 2021Glutamergic system dysfunction has been implicated in the pathophysiology of bipolar depression. This is an update of the 2015 Cochrane Review for the use of glutamate... (Review)
Review
BACKGROUND
Glutamergic system dysfunction has been implicated in the pathophysiology of bipolar depression. This is an update of the 2015 Cochrane Review for the use of glutamate receptor modulators for depression in bipolar disorder.
OBJECTIVES
1. To assess the effects of ketamine and other glutamate receptor modulators in alleviating the acute symptoms of depression in people with bipolar disorder. 2. To review the acceptability of ketamine and other glutamate receptor modulators in people with bipolar disorder who are experiencing depressive symptoms.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Embase and PsycINFO all years to July 2020. We did not apply any restrictions to date, language or publication status.
SELECTION CRITERIA
RCTs comparing ketamine or other glutamate receptor modulators with other active psychotropic drugs or saline placebo in adults with bipolar depression.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. Primary outcomes were response rate and adverse events. Secondary outcomes included remission rate, depression severity change scores, suicidality, cognition, quality of life, and dropout rate. The GRADE framework was used to assess the certainty of the evidence.
MAIN RESULTS
Ten studies (647 participants) were included in this review (an additional five studies compared to the 2015 review). There were no additional studies added to the comparisons identified in the 2015 Cochrane review on ketamine, memantine and cytidine versus placebo. However, three new comparisons were found: ketamine versus midazolam, N-acetylcysteine versus placebo, and riluzole versus placebo. The glutamate receptor modulators studied were ketamine (three trials), memantine (two), cytidine (one), N-acetylcysteine (three), and riluzole (one). Eight of these studies were placebo-controlled and two-armed. In seven trials the glutamate receptor modulators had been used as add-on drugs to mood stabilisers. Only one trial compared ketamine with an active comparator, midazolam. The treatment period ranged from a single intravenous administration (all ketamine studies), to repeated administration for riluzole, memantine, cytidine, and N-acetylcysteine (with a follow-up of eight weeks, 8 to 12 weeks, 12 weeks, and 16 to 20 weeks, respectively). Six of the studies included sites in the USA, one in Taiwan, one in Denmark, one in Australia, and in one study the location was unclear. All participants had a primary diagnosis of bipolar disorder and were experiencing an acute bipolar depressive episode, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (IV) or fourth edition text revision (IV-TR). Among all glutamate receptor modulators included in this review, only ketamine appeared to be more efficacious than placebo 24 hours after infusion for response rate (odds ratio (OR) 11.61, 95% confidence interval (CI) 1.25 to 107.74; P = 0.03; participants = 33; studies = 2; I² = 0%, low-certainty evidence). Ketamine seemed to be more effective in reducing depression rating scale scores (MD -11.81, 95% CI -20.01 to -3.61; P = 0.005; participants = 32; studies = 2; I = 0%, very low-certainty evidence). There was no evidence of ketamine's efficacy in producing remission over placebo at 24 hours (OR 5.16, 95% CI 0.51 to 52.30; P = 0.72; participants = 33; studies = 2; I = 0%, very low-certainty evidence). Evidence on response, remission or depression rating scale scores between ketamine and midazolam was uncertain at 24 hours due to very low-certainty evidence (OR 3.20, 95% CI 0.23 to 45.19). In the one trial assessing ketamine and midazolam, there were no dropouts due to adverse effects or for any reason (very low-certainty evidence). Placebo may have been more effective than N-acetylcysteine in reducing depression rating scale scores at three months, although this was based on very low-certainty evidence (MD 1.28, 95% CI 0.24 to 2.31; participants = 58; studies = 2). Very uncertain evidence found no difference in response at three months (OR 0.82, 95% CI 0.32 to 2.14; participants = 69; studies = 2; very low-certainty evidence). No data were available for remission or acceptability. Extremely limited data were available for riluzole vs placebo, finding only very-low certainty evidence of no difference in dropout rates (OR 2.00, 95% CI 0.31 to 12.84; P = 0.46; participants = 19; studies = 1; I = 0%).
AUTHORS' CONCLUSIONS
It is difficult to draw reliable conclusions from this review due to the certainty of the evidence being low to very low, and the relatively small amount of data usable for analysis in bipolar disorder, which is considerably less than the information available for unipolar depression. Nevertheless, we found uncertain evidence in favour of a single intravenous dose of ketamine (as add-on therapy to mood stabilisers) over placebo in terms of response rate up to 24 hours, however ketamine did not show any better efficacy for remission in bipolar depression. Even though ketamine has the potential to have a rapid and transient antidepressant effect, the efficacy of a single intravenous dose may be limited. We did not find conclusive evidence on adverse events with ketamine, and there was insufficient evidence to draw meaningful conclusions for the remaining glutamate receptor modulators. However, ketamine's psychotomimetic effects (such as delusions or delirium) may have compromised study blinding in some studies, and so we cannot rule out the potential bias introduced by inadequate blinding procedures. To draw more robust conclusions, further methodologically sound RCTs (with adequate blinding) are needed to explore different modes of administration of ketamine, and to study different methods of sustaining antidepressant response, such as repeated administrations.
Topics: Adult; Bipolar Disorder; Depression; Humans; Ketamine; Quality of Life; Receptors, Glutamate
PubMed: 34623633
DOI: 10.1002/14651858.CD011611.pub3 -
Frontiers in Psychiatry 2021Identifying the characteristics of behavioral and psychological symptoms of dementia (BPSD) associated with different dementia types may be a promising strategy to...
Identifying the characteristics of behavioral and psychological symptoms of dementia (BPSD) associated with different dementia types may be a promising strategy to effectively deal with BPSD. We aimed to synthesize the prevalence rates of BPSD characteristics in community-dwelling dementia patients. We searched Medline, EMBASE, and PsycARTICLES databases for original clinical studies published until December 2020 that enrolled at least 300 community-dwelling dementia patients. The methodological qualities of prevalence studies were assessed using the Joanna Briggs Institute's critical appraisal checklist. Thirty studies were included. The prevalence of the BPSD characteristic ranged from 4 (elation and mania) to 32% (apathy) in the pooled samples. The prevalence of delusions, anxiety, apathy, irritability, elation and mania, and aberrant motor behavior in Alzheimer's disease patients was 1.72-2.88 times greater than that in vascular dementia (VD) patients, while the prevalence of disinhibition in VD patients was 1.38 times greater. The prevalence of anxiety, irritability, and agitation and aggression, delusion, hallucinations, apathy, disinhibition, and aberrant motor behavior tended to increase as the severity of dementia increased, while that of depression, eating disorder, sleep disorders, and elation and mania tended to stable. In community-dwelling patients with dementia, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was higher than 20%, while that of disinhibition and elation and mania was lower than 10%. Overall, the pooled prevalence of apathy, depression, anxiety, irritability, agitation and aggression, sleep disorders, and eating disorder was generally high in patients with dementia. Also, the prevalence of some BPSD characteristics differed according to the type and the severity of dementia. The methodological quality of the included studies is not the best, and high heterogeneity may affect the certainty of the findings. However, the results of this review can deepen our understanding of the prevalence of BPSD. https://osf.io/dmj7k, identifier: 10.17605/OSF.IO/DMJ7K.
PubMed: 34744832
DOI: 10.3389/fpsyt.2021.741059 -
Neurological Sciences : Official... Jul 2021Psychosis in Parkinson's disease (PD) is common and consists of hallucinations, illusions, and delusions. Among the latter, delusional jealousy, also named Othello... (Review)
Review
INTRODUCTION
Psychosis in Parkinson's disease (PD) is common and consists of hallucinations, illusions, and delusions. Among the latter, delusional jealousy, also named Othello syndrome (OS), might impair the quality of life of both patients and their partners. We aimed to perform a systematic review and report a series of PD patients presenting with OS.
METHODS
A systematic review research was performed in PubMed database, excluding non-English articles, single case reports, reviews and neuropathology articles, comments, and articles concerning OS associated with deep brain stimulation (DBS) and levodopa-carbidopa intestinal gel infusion. We also described eleven PD patients (9 M and 2 F) with OS, identified in a cohort of consecutive 153 patients, comparing them with eleven matched no OS (nOS) PD subjects taken from the same cohort.
RESULTS
We included eight articles (four case series and four cross-sectional studies). OS resulted more common among males than females. We did not find higher levodopa dose and levodopa equivalent dose for dopamine agonists and for all anti-parkinsonian drugs in our OS group. In our case series, OS patients showed visual hallucinations (p=0.001) and a trend to have depression (p=0.080) more frequently than nOS ones.
CONCLUSIONS
OS is not a rare disorder in PD, probably due not only to abnormal dopaminergic stimulation but also to serotonergic dysfunction in biologically predisposed subjects. Visual hallucinations and other concomitant psychiatric diseases, in particular depression, might represent a risk factor for the OS development.
Topics: Antiparkinson Agents; Cross-Sectional Studies; Delusions; Dopamine Agonists; Female; Humans; Levodopa; Male; Parkinson Disease; Quality of Life
PubMed: 33978871
DOI: 10.1007/s10072-021-05249-4 -
World Psychiatry : Official Journal of... Feb 2021Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge...
Experiencing psychological trauma during childhood and/or adolescence is associated with an increased risk of psychosis in adulthood. However, we lack a clear knowledge of how developmental trauma induces vulnerability to psychotic symptoms. Understanding the psychological processes involved in this association is crucial to the development of preventive interventions and improved treatments. We sought to systematically review the literature and combine findings using meta-analytic techniques to establish the potential roles of psychological processes in the associations between developmental trauma and specific psychotic experiences (i.e., hallucinations, delusions and paranoia). Twenty-two studies met our inclusion criteria. We found mediating roles of dissociation, emotional dysregulation and post-traumatic stress disorder (PTSD) symptoms (avoidance, numbing and hyperarousal) between developmental trauma and hallucinations. There was also evidence of a mediating role of negative schemata, i.e. mental constructs of meanings, between developmental trauma and delusions as well as paranoia. Many studies to date have been of poor quality, and the field is limited by mostly cross-sectional research. Our findings suggest that there may be distinct psy-chological pathways from developmental trauma to psychotic phenomena in adulthood. Clinicians should carefully ask people with psychosis about their history of developmental trauma, and screen patients with such a history for dissociation, emotional dysregulation and PTSD symptoms. Well conducted research with prospective designs, including neurocognitive assessment, is required in order to fully understand the biopsychosocial mechanisms underlying the association between developmental trauma and psychosis.
PubMed: 33432756
DOI: 10.1002/wps.20841 -
Psychological Medicine Apr 2024The network theory of psychological disorders posits that systems of symptoms cause, or are associated with, the expression of other symptoms. Substantial literature on... (Review)
Review
The network theory of psychological disorders posits that systems of symptoms cause, or are associated with, the expression of other symptoms. Substantial literature on symptom networks has been published to date, although no systematic review has been conducted exclusively on symptom networks of schizophrenia, schizoaffective disorder, and schizophreniform (people diagnosed with schizophrenia; PDS). This study aims to compare statistics of the symptom network publications on PDS in the last 21 years and identify congruences and discrepancies in the literature. More specifically, we will focus on centrality statistics. Thirty-two studies met the inclusion criteria. The results suggest that cognition, and social, and occupational functioning are central to the network of symptoms. Positive symptoms, particularly delusions were central among participants in many studies that did not include cognitive assessment. Nodes representing cognition were most central in those studies that did. Nodes representing negative symptoms were not as central as items measuring positive symptoms. Some studies that included measures of mood and affect found items or subscales measuring depression were central nodes in the networks. Cognition, and social, and occupational functioning appear to be core symptoms of schizophrenia as they are more central in the networks, compared to variables assessing positive symptoms. This seems consistent despite heterogeneity in the design of the studies.
Topics: Humans; Schizophrenia; Psychotic Disorders; Cognition; Schizophrenic Psychology; Psychiatric Status Rating Scales
PubMed: 38174555
DOI: 10.1017/S003329172300363X -
Human Brain Mapping Apr 2024Schizophrenia is a chronic psychiatric disorder with characteristic symptoms of delusions, hallucinations, lack of motivation, and paucity of thought. Recent evidence... (Review)
Review
Schizophrenia is a chronic psychiatric disorder with characteristic symptoms of delusions, hallucinations, lack of motivation, and paucity of thought. Recent evidence suggests that the symptoms of schizophrenia, negative symptoms in particular, vary widely between the sexes and that symptom onset is earlier in males. A better understanding of sex-based differences in functional magnetic resonance imaging (fMRI) studies of schizophrenia may provide a key to understanding sex-based symptom differences. This study aimed to summarize sex-based functional magnetic resonance imaging (fMRI) differences in brain activity of patients with schizophrenia. We searched PubMed and Scopus to find fMRI studies that assessed sex-based differences in the brain activity of patients with schizophrenia. We excluded studies that did not evaluate brain activity using fMRI, did not evaluate sex differences, and were nonhuman or in vitro studies. We found 12 studies that met the inclusion criteria for the current systematic review. Compared to females with schizophrenia, males with schizophrenia showed more blood oxygen level-dependent (BOLD) activation in the cerebellum, the temporal gyrus, and the right precuneus cortex. Male patients also had greater occurrence of low-frequency fluctuations in cerebral blood flow in frontal and parietal lobes and the insular cortex, while female patients had greater occurrence of low-frequency fluctuations in the hippocampus, parahippocampus, and lentiform nucleus. The current study summarizes fMRI studies that evaluated sex-based fMRI brain differences in schizophrenia that may help to shed light on the underlying pathophysiology and further understanding of sex-based differences in the clinical presentation and course of the disorder.
Topics: Humans; Male; Female; Magnetic Resonance Imaging; Sex Characteristics; Brain; Schizophrenia; Brain Mapping
PubMed: 38520370
DOI: 10.1002/hbm.26664