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Fortschritte Der Neurologie-Psychiatrie Mar 2020Distinguishing between melancholic and non-melancholic depression is still of significant importance in the classification and differentiation of depressive disorders.... (Review)
Review
Distinguishing between melancholic and non-melancholic depression is still of significant importance in the classification and differentiation of depressive disorders. Melancholy appears to be a psychopathological and biologically based entity which can be described as a disorder of drive and which finds its extreme culmination in depressive delusion. Its pathogenesis ranges from the melancholic predisposed personality, mostly of the Typus melancholicus, over psychomotor inhibition and depersonalization, to depressive delusion. Delusion arises from the fear that the realization of basic human values, such as one's existence for important others or ideals, health and livelihood has become hopeless. A clear understanding of the nature and pathogenesis of melancholic delusional depression not only facilitates the diagnostic process, and the empathic assistance to the patient, but also has direct consequences for an appropriate treatment of this disorder.
Topics: Delusions; Depression; Depressive Disorder; Humans; Personality; Personality Inventory
PubMed: 31378852
DOI: 10.1055/a-0957-3226 -
Academic Psychiatry : the Journal of... Jun 2022
Topics: Delusions; Humans; Psychiatric Status Rating Scales
PubMed: 33890244
DOI: 10.1007/s40596-021-01437-8 -
Sante Mentale Au Quebec 2019Context Psychotic disorders are severe mental disorders that can cause a loss of contact with reality. Along with positive symptoms (delusions and hallucinations), they... (Review)
Review
Context Psychotic disorders are severe mental disorders that can cause a loss of contact with reality. Along with positive symptoms (delusions and hallucinations), they also encompass many other dysfunctions, such as sleep problems, which themselves can cause great distress and impairment in patients. Objective To review current literature on the relationship between sleep disorders and psychosis, on the clinical impact of such a relationship, and the psychological treatment of sleep disorders in the context of psychosis. Method Narrative overview of the literature synthesizing the findings about the relationship between psychosis and sleep disorders, and the psychological treatment of the latter, retrieved from searches of computerized databases, hand searches, and authoritative texts. Results Evidence shows a bidirectional relationship between psychosis and sleep disorders. Despite many hypotheses involving genetics, hormones, or neuronal functions regarding the nature of this association, the exact mechanism remains elusive. However, sleep-related problems are an interesting therapeutic target to improve quality of life and psychotic symptoms and respond well to psychological interventions. Conclusion Patients with psychotic disorders can benefit from CBT for insomnia, given a few adaptations to existing protocols. Additional studies are necessary to determine which patients are most likely to benefit from such interventions and to clarify the relationship between psychosis and sleep disorders, and the clinical implications of them co-existing.
Topics: Delusions; Female; Hallucinations; Humans; Male; Middle Aged; Psychotic Disorders; Quality of Life; Sleep Wake Disorders
PubMed: 33270392
DOI: No ID Found -
Soins. Psychiatrie 2022Recovering from a mental disorder is a process by which the affected person will develop a new life project, based on the optimal use of personal and environmental...
Recovering from a mental disorder is a process by which the affected person will develop a new life project, based on the optimal use of personal and environmental resources. This involves adapting and managing certain symptoms better, in order to be able to rebuild oneself psychologically. This may be the case for delusions, which need to be distanced and accepted in order to develop this new life stage in. In this perspective, the notions of mourning for the self and mourning for delusional beliefs seem to be necessary steps in the reconstruction of a self that is favourable to recovery.
Topics: Delusions; Grief; Humans; Psychotic Disorders
PubMed: 36109135
DOI: 10.1016/j.spsy.2022.04.007 -
Integrative Psychological & Behavioral... Jun 2021In this article I aim to understand meaning construction from a cultural psychological stance and investigate how human beings - both individually and collectively -...
In this article I aim to understand meaning construction from a cultural psychological stance and investigate how human beings - both individually and collectively - create norms and beliefs that become guidelines for how we perceive. The real and the imaginary are closely intertwined- sometimes to the extent that one of them is taken for the other. Considering some specific product of the imagination as if it is real amounts to a delusion - the topic of this paper. A person constructs and attributes meaning and associations to objects and people and these constructions have been made by both personal and socially shared ideas. The dilemma seems to be concerning perspectives on truth and what lies prior to the determination of this. The attempt of this article and the autoethnographic research is to comprehend the extent and diversity of delusions. This will be examined in the attempt to investigate and distinguish delusions from everyday life to what can be considered pathological hence scrutinize the borderline of healthy versus maladaptive. This borderline will furthermore be discussed with the basis of symptom criteria from the ICD- and DSM diagnosis systems. This seems to be of big importance when diagnostically comprehend the pathological elements of the delusions in the sense that the judgement could come to determine life situation. These discussions lead to an understanding of delusions as semiotically made when distinguishing between general versus pathological psychological conditions.
Topics: Delusions; Humans; Imagination
PubMed: 33907965
DOI: 10.1007/s12124-021-09614-y -
The Journal of Clinical Psychiatry Jul 2023Delusions and hallucinations are common in Alzheimer disease (AD) and Parkinson disease (PD), especially in the later stages of illness. Antipsychotic drugs are... (Meta-Analysis)
Meta-Analysis
Delusions and hallucinations are common in Alzheimer disease (AD) and Parkinson disease (PD), especially in the later stages of illness. Antipsychotic drugs are effective in treating these psychotic symptoms but are associated with an increased risk of serious adverse events, including mortality. There is therefore a need to explore other treatment approaches. In this context, a recent individual patient data meta-analysis of 17 randomized controlled trials (RCTs) conducted in AD (12 RCTs) and PD (5 RCTs) found that the cholinesterase inhibitor (ChEI) drugs donepezil, rivastigmine, and galantamine attenuated the severity of both delusions and hallucinations in both AD and PD. Most of these trials were 24 weeks in duration. The effect sizes, expressed as standardized mean differences (SMDs), were, however, small, lying in the -0.08 to -0.14 range. These values are so small as to be perhaps clinically insignificant. When analyses were restricted to data from patients who actually had delusions and hallucinations at baseline, all effect sizes became larger, lying in the -0.13 to -0.39 range; however, after correcting for multiple hypothesis testing, only the finding for delusions in PD remained statistically significant. The meta-analysis did not provide information on what the best doses were, how long it took for improvement to become evident, and what proportion of patients showed remission from psychotic symptoms. Whereas the signal identified in this meta-analysis merits examination in appropriately designed RCTs, the findings of the meta-analysis may not much change current treatment strategies because patients with dementia would probably anyway receive a ChEI. Therefore, if psychotic symptoms persist for 24 weeks despite optimally dosed ChEI treatment, and if behavioral and psychosocial interventions do not help, clinicians may need to consider the potential benefits vs risks of other drugs, such as atypical antipsychotics and pimavanserin, in a shared decision-making process.
Topics: Humans; Cholinesterase Inhibitors; Alzheimer Disease; Delusions; Parkinson Disease; Antipsychotic Agents; Hallucinations
PubMed: 37530610
DOI: 10.4088/JCP.23f15009 -
Geriatrie Et Psychologie... Sep 2019This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia. (Review)
Review
UNLABELLED
This article aims to review evidence on pharmacologic treatments for the management of delusional symptoms in elderly patients with dementia.
METHODS
We searched PubMed using the words 'delusion', 'dementia' and 'treatment' from January 2007 till November 2017.
RESULTS
Non-pharmacologic interventions are first-line treatment. Acetyl-cholinesterase inhibitors have shown conflicting results in the treatment of delusions in dementia patients. However, donepezil may be particularly useful in the treatment of psychotic symptoms in Lewy body dementia (LBD). Antipsychotics are reserved for the treatment of severe symptoms. The highest level of evidence exists for risperidone, followed by olanzapine and quetiapine. Clozapine and pimavenserine are therapeutic options for Parkinson disease dementia and LBD. The duration of antipsychotic treatment should not exceed 6 weeks as per the French recommendations (Agence nationale pour la sécurité du médicament) and 4 months as per the American psychiatric association recommendations. In the event of failure to respond to the aforementioned treatments or as an alternative, antidepressants, in particularly citalopram can be considered. There is not enough evidence to recommend melatonine for the treatment of delusions in dementia patients, although it has been shown to improve behavioral symptoms of dementia in general.
CONCLUSIONS
The choice of medication for the treatment of delusions in dementia patients should be tailored to each patient. The severity of the symptom and its related danger should be considered along with the patient's co-morbidities and the medication's potential adverse effect.
Topics: Aged; Aged, 80 and over; Antidepressive Agents; Antipsychotic Agents; Cholinesterase Inhibitors; Delusions; Dementia; Humans; Psychotropic Drugs
PubMed: 31449050
DOI: 10.1684/pnv.2019.0813 -
The Lancet. Psychiatry Apr 2021
Topics: Delusions; Humans; Schizophrenia
PubMed: 33743872
DOI: 10.1016/S2215-0366(21)00027-4 -
Journal of Psychopathology and Clinical... Aug 2023There is widespread agreement that delusions in clinical populations and delusion-like beliefs in the general population are, in part, caused by cognitive biases. Much...
There is widespread agreement that delusions in clinical populations and delusion-like beliefs in the general population are, in part, caused by cognitive biases. Much of the evidence comes from two influential tasks: the Beads Task and the Bias Against Disconfirmatory Evidence Task. However, research using these tasks has been hampered by conceptual and empirical inconsistencies. In an online study, we examined relationships between delusion-like beliefs in the general population and cognitive biases associated with these tasks. Our study had four key strengths: A new animated Beads Task designed to reduce task miscomprehension, several data-quality checks to identify careless responders, a large sample ( = 1,002), and a preregistered analysis plan. When analyzing the full sample, our results replicated classic relationships between cognitive biases and delusion-like beliefs. However, when we removed 82 careless participants from the analyses (8.2% of the sample) we found that many of these relationships were severely diminished and, in some cases, eliminated outright. These results suggest that some (but not all) seemingly well-established relationships between cognitive biases and delusion-like beliefs might be artifacts of careless responding. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Topics: Humans; Delusions; Artifacts; Bias; Data Accuracy; Cognition
PubMed: 37326560
DOI: 10.1037/abn0000844 -
Psychiatrike = Psychiatriki Dec 2023We read with interest the recent report on the definition, diagnosis, and clinical implications of religious delusions (RD).1 In our sample of 929 delusional...
We read with interest the recent report on the definition, diagnosis, and clinical implications of religious delusions (RD).1 In our sample of 929 delusional schizophrenia patients who had been admitted to two psychiatric hospitals in Germany between 2010 and 2014, 138 patients (15%) reported RD. In 569 cases, information on religious affiliation was available. Patients with religious affiliation did not differ from patients without religious affiliation in the frequency of RD [χ2(1,569)= 0.02, p= 0.885]. Furthermore, patients with RD did not differ from patients with other types of delusion (OD) in the duration of hospitalisation [t(924)= -0.39, p= 0.695], or the number of hospitalisations [t(927)= -0.92, p= 0.358]. Additionally, in 185 cases, information on Clinical Global Impressions (CGI) and Global Assessment of Functioning (GAF) was available at the beginning and end of the hospital stay. By CGI-scores, no difference was seen in morbidity of subjects with RD relative to subjects with OD on admission [t(183)= -0.78, p= 0.437] and discharge t(183)= -1.10, p= .273 . Likewise, GAF-scores on admission did not differ in these groups [t(183)= 1.50, p= 0.135]. However, a trend was noted for lower GAF-scores on discharge in subjects with RD [t(183)= 1.91, p= .057, d= 0.39, CI 95% (-0.12-0.78)]. While RD have often been associated with a poorer prognosis in schizophrenia,2,3 we argue that this need not apply to all domains. Mohr et al4 reported that patients with RD were less likely to maintain psychiatric treatment, but did not have a more severe clinical status than patients with OD. Iyassu et al5 found higher levels of positive, but also lower levels of negative symptoms in patients with RD compared to patients with OD. Groups did not differ in terms of length of illness or level of medication. Siddle et al6 reported higher symptom scores in patients with RD at their first presentation, but a similar response to treatment when compared to patients with OD after 4 weeks of treatment. Furthermore, Ellersgaard et al7 iindicated that first-episode psychosis patients with RD at baseline were more likely to be non-delusional at follow-ups conducted after years 1, 2 and 5 when compared to patients with OD at baseline. We conclude that RD may thus interfere with short-term clinical outcome. With regard to long-term effects more favourable observations exist8 and the interplay of psychotic delusions with non-psychotic beliefs still warrants further research.
Topics: Humans; Delusions; Psychotic Disorders; Schizophrenia; Hospitalization
PubMed: 37212804
DOI: 10.22365/jpsych.2023.012