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International Review of Psychiatry... 2020Injustice, breach of trust, and humiliation are social stressors which can result in embitterment, known to everybody and which has been described in the Bible (Cain and... (Review)
Review
Injustice, breach of trust, and humiliation are social stressors which can result in embitterment, known to everybody and which has been described in the Bible (Cain and Abel) or by Aristotle in the Nicomachean Ethics. It has been discussed by several authors since the early days of psychiatric classification. In the textbook 'Psychiatry' by E. Kraepelin a full chapter is devoted to 'querulant delusion', named a reactive psychosis, which can be discriminated from endogenous psychosis or personality disorders. Core symptoms are embitterment, negativism, helplessness, self blame, unspecific somatic symptoms, phobic avoidance of persons or situations related to the event, intrusions, phantasies of revenge and aggression. Another name is 'Posttraumatic Embitterment Disorder' according to the leading emotion. This severe mental disorder has by and large been ignored over the years by health professionals. In ICD-11 the term embitterment is mentioned for the first time in the category '6B43 adjustment disorder'. Embitterment can be measured with the 'Bern Embitterment Inventory (BVI)' and the 'Post-Traumatic Embitterment Self-rating Scale (PTED scale)'. Treatment must take into account the special features of embitterment including often aggressive rejection of help. A promising treatment approach is, to refer to wisdom psychology and transfer this in 'wisdom psychotherapy'.
Topics: Adjustment Disorders; Delusions; Emotions; Humans; Personality Disorders
PubMed: 32427007
DOI: 10.1080/09540261.2020.1747410 -
Ugeskrift For Laeger May 2023This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead....
This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead. The condition was interpreted as a presentation of Cotard syndrome as part of early-onset schizophrenia. Treatment with an antidepressant and multiple antipsychotic medications was not effective. The patient was then treated with ECT, resulting in subjective and measurable positive effects.
Topics: Female; Humans; Adolescent; Delusions; Schizophrenia
PubMed: 37264869
DOI: No ID Found -
Wiley Interdisciplinary Reviews.... Sep 2019Delusions are symptoms of psychiatric disorders such as schizophrenia and dementia. By and large, delusions are characterized by their behavioral manifestations and... (Review)
Review
Delusions are symptoms of psychiatric disorders such as schizophrenia and dementia. By and large, delusions are characterized by their behavioral manifestations and defined as irrational beliefs that compromise good functioning. In this overview paper, we ask whether delusions can be adaptive notwithstanding their negative features. Can they be a response to a crisis rather than the source of the crisis? Can they be the beginning of a solution rather than the problem? Some of the psychological, psychiatric, and philosophical literature has recently suggested that they can. We consider different types of delusions and different ways in which they can be considered as adaptive: psychologically (e.g., by increasing wellbeing, purpose in life, intrapsychic coherence, or good functioning) and biologically (e.g., by enhancing genetic fitness). Although further research is needed to map the costs and benefits of adopting and maintaining delusional beliefs, a more nuanced picture of the role of delusions in people's lives has started to emerge. This article is categorized under: Philosophy > Representation Philosophy > Knowledge and Belief Neuroscience > Cognition.
Topics: Adaptation, Psychological; Delusions; Humans
PubMed: 31056862
DOI: 10.1002/wcs.1502 -
Psychiatry Research Sep 2023A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are... (Review)
Review
INTRODUCTION
A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are based on a limited number of cases and focus on a few drug classes, so a clear overview of this topic remains difficult. To address this issue, we provide in this article a comprehensive analysis of drug-induced delusion, based on the World Health Organization (WHO) pharmacovigilance database.
METHODS
We performed a disproportionality analysis of this database using the information component (IC). The IC compares observed and expected values to find associations between drugs and delusion, using disproportionate Bayesian reporting. An IC0.25 (lower end of the IC 95% credibility interval) > 0 is considered statistically significant.
RESULTS
Here we present an analysis of 4559 suspected drug-induced delusion reports in the WHO pharmacovigilance database. These results identified 66 molecules statistically associated with delusion and an extensive analysis of confounding factors and coprescriptions was performed, using full database as background with an IC0.25 > 0. The main drug classes involved were antidepressants, antiepileptics, dopaminergic agents, opioids, antiinfective agents, benzodiazepines, anti-dementia drugs and psychostimulants.
CONCLUSION
These results will help clinicians identify potential suspected drugs associated with delusion and decide which drug to discontinue and eventually lead to a re-evaluation of drug labels for some molecules.
Topics: Humans; Pharmacovigilance; Bayes Theorem; Delusions; Antidepressive Agents; Databases, Factual; World Health Organization; Adverse Drug Reaction Reporting Systems; Central Nervous System Stimulants
PubMed: 37517106
DOI: 10.1016/j.psychres.2023.115365 -
Neurology Jun 2020
Topics: Accidents, Traffic; Amnesia, Retrograde; Craniocerebral Trauma; Delusions; Frontal Lobe; Hematoma, Subdural; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuroimaging; Neurologic Examination; Space Flight
PubMed: 32513751
DOI: 10.1212/WNL.0000000000009587 -
Behavior Therapy Jan 2023There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change... (Randomized Controlled Trial)
Randomized Controlled Trial
There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes. In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control. In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.
Topics: Humans; Delusions; Schizophrenia; Self Concept
PubMed: 36608970
DOI: 10.1016/j.beth.2022.07.011 -
Cognitive Neuropsychiatry Nov 2022Cotard delusion-the delusional belief "I am dead"-is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that...
INTRODUCTION
Cotard delusion-the delusional belief "I am dead"-is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea "I am dead" comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if "I am dead" were true, there would be no emotional responsivity to the world.
METHODS
We scrutinised the literature on people who expressed the delusional belief "I am dead", looking for data on whether such patients are reported as entirely lacking in emotional responsivity.
RESULTS
In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry.
CONCLUSIONS
We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea "I am dead" comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.
Topics: Anxiety Disorders; Delusions; Depersonalization; Emotions; Humans; Psychiatry
PubMed: 36112925
DOI: 10.1080/13546805.2022.2119839 -
Cognitive Neuropsychiatry Jan 2022Capgras delusion is sometimes defined as believing that close relatives have been replaced by strangers. But such replacement beliefs also occur in response to...
INTRODUCTION
Capgras delusion is sometimes defined as believing that close relatives have been replaced by strangers. But such replacement beliefs also occur in response to encountering an acquaintance, or the voice of a familiar person, or a pet, or some personal possession. All five scenarios involve believing something familiar has been replaced by something unfamiliar.
METHODS
We evaluate the proposal that these five kinds of delusional belief should count as subtypes of the same delusion.
RESULTS
Personally familiar stimuli activate the sympathetic nervous system (SNS) much more strongly than unfamiliar stimuli. In Capgras delusion, this difference is absent, prompting the delusional idea that a familiar person is actually a stranger. We suggest this absence of an effect of familiarity on SNS response will occur in all five scenarios and will prompt the idea that the familiar has been replaced by the unfamiliar.
CONCLUSIONS
We propose that: (a) all five scenarios be referred to as subtypes of Capgras delusion; (b) in all five, ideas about replacement are prompted by weakness of SNS responses to familiar stimuli; (c) this is insufficient to generate delusion. For a delusional idea to become a belief, a second factor (impaired hypothesis evaluation) must also be present.
Topics: Capgras Syndrome; Delusions; Humans; Recognition, Psychology
PubMed: 34890309
DOI: 10.1080/13546805.2021.2011185 -
Geriatrie Et Psychologie... Sep 2019
Topics: Aged; Aged, 80 and over; Alzheimer Disease; Delusions; Dementia; Geriatrics; Humans
PubMed: 31449047
DOI: 10.1684/pnv.2019.0818 -
Clinical Psychology Review Aug 2019Many reasoning biases that may contribute to delusion formation and/or maintenance are common in healthy individuals. Research indicating that reasoning in the general... (Review)
Review
Many reasoning biases that may contribute to delusion formation and/or maintenance are common in healthy individuals. Research indicating that reasoning in the general population proceeds via analytic processes (which depend upon working memory and support hypothetical thought) and intuitive processes (which are autonomous and independent of working memory) may therefore help uncover the source of these biases. Consistent with this possibility, recent studies imply that impaired conflict processing might reduce engagement in analytic reasoning, thereby producing reasoning biases and promoting delusions in individuals with schizophrenia. Progress toward understanding this potential pathway to delusions is currently impeded by ambiguity about whether any of these deficits or biases is necessary or sufficient for the formation and maintenance of delusions. Resolving this ambiguity requires consideration of whether particular cognitive deficits or biases in this putative pathway have causal primacy over other processes that may also participate in the causation of delusions. Accordingly, the present manuscript critically evaluates whether impaired conflict processing is the primary initiating deficit in the generation of reasoning biases that may promote the development and/or maintenance of delusions. Suggestions for future research that may elucidate mechanistic pathways by which reasoning deficits might engender and maintain delusions are subsequently offered.
Topics: Conflict, Psychological; Delusions; Humans; Thinking
PubMed: 31226640
DOI: 10.1016/j.cpr.2019.101748