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Psychiatrike = Psychiatriki Sep 2021The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic...
The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the patient's family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a greater extent the individual's whole experience. Their presence is associated with more severe symptoms, higher medication dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms with religious content for the first time. Other important prognostic factors are patients' lack of adherence to treatment, their greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special characteristics of religious delusions, which seem more corrosive to the patients' psyche than other delusions. Religion and spirituality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice. Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both preventing and treating psychotic disorders.
Topics: Delusions; Humans; Psychotic Disorders; Religion; Religion and Psychology; Schizophrenic Psychology
PubMed: 33770751
DOI: 10.22365/jpsych.2021.014 -
Journal of Behavior Therapy and... Sep 2020Several meta-analyses have shown that people with psychosis tend to gather less information (i.e., they make fewer draws to decision, or DTD) on the beads task than... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Several meta-analyses have shown that people with psychosis tend to gather less information (i.e., they make fewer draws to decision, or DTD) on the beads task than healthy controls. A single meta-analysis has also found a small negative association between delusion-proneness and DTD in healthy samples, but with considerable heterogeneity.
METHODS
We used the new and more reliable "distractor sequences" beads task to clarify the nature of the relationship between delusion-proneness and DTD in a healthy sample. Healthy participants (N = 203) completed the distractor sequences beads task and the Peters Delusions Inventory (PDI), which measures delusion-proneness.
RESULTS
PDI and DTD were positively correlated, and those who jumped to conclusions (DTD ≤ 2) had lower PDI than those who did not. Comparing PDI quartiles on DTD provided some evidence the positive association did not extend to the highest PDI quartile. We found that DTD and delusion-proneness were positively related in our non-clinical sample, which was unexpected.
LIMITATIONS
Results need replication with a clinical sample.
CONCLUSIONS
Considering the well-established association between the JTC bias and clinical delusions, the current finding may reflect a relationship that differs between non-clinical and clinically significant delusional groups, or one which reverses sign at some level of delusion-proneness.
Topics: Adolescent; Adult; Aged; Decision Making; Delusions; Female; Humans; Male; Middle Aged; Psychotic Disorders; Young Adult
PubMed: 32105906
DOI: 10.1016/j.jbtep.2020.101562 -
Psychiatria Danubina 2022
Topics: Antipsychotic Agents; Delusions; Humans; Parkinson Disease
PubMed: 35467618
DOI: 10.24869/psyd.2022.94 -
The Lancet. Psychiatry Oct 2022The content of grandiose delusions-inaccurate beliefs that one has special powers, wealth, mission, or identity-is likely to be highly meaningful. The meaning, for...
BACKGROUND
The content of grandiose delusions-inaccurate beliefs that one has special powers, wealth, mission, or identity-is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning.
METHODS
We did a cross-sectional self-report questionnaire study in two cohorts: non-clinical participants aged 18 years and older, with UK or Irish nationality or residence; and patients with affective or non-affective psychosis diagnoses, aged 16 years and older, and accessing secondary care mental health services in 39 National Health Service providers in England and Wales. Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions (Grandiosity Meaning Measure [termed gram]) and one assessing the sources of meaning (Grandiosity Meaning Measure-Sources [termed grams]). The Grandiosity Meaning Measure and Grandiosity Meaning Measure-Sources were developed using exploratory factor analysis and confirmatory factor analysis. Structural equation modelling was used to test the associations of meaning with the severity of grandiosity. The primary outcome measure for grandiosity was the Specific Psychotic Experiences Questionnaire (grandiosity subscale) and associations were tested with the Grandiosity Meaning Measure and the Grandiosity Meaning Measure-Sources.
FINDINGS
From Aug 30, 2019, to Nov 21, 2020, 13 323 non-clinical participants were enrolled. 2821 (21%) were men and 10 134 (76%) were women, 11 974 (90%) were White, and the mean age was 39·5 years (SD 18·6 [range 18-93]). From March 22, 2021, to March 3, 2022, 798 patients with psychosis were enrolled. 475 (60%) were men and 313 (39%) were women, 614 (77%) were White, and the mean age was 43·4 years (SD 13·8 [range 16-81]). The experience of meaning in relation to grandiose delusions had three components: coherence, purpose, and significance. The sources of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self among others, greater good, supporting loved ones, and happiness. The measurement of meaning was invariant across clinical and non-clinical populations. In the clinical population, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion. Meaning in grandiose delusions was strongly associated with severity of grandiosity, explaining 53·5% of variance, and with grandiose delusion conviction explaining 27·4% of variance. Grandiosity was especially associated with sense of purpose, and grandiose delusion conviction with coherence. Similar findings were found for the non-clinical population.
INTERPRETATION
Meaning is inherently tied to grandiose delusions. This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity. The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed.
FUNDING
Health Education England and National Institute for Health and Care Research.
Topics: Adult; Cohort Studies; Cross-Sectional Studies; Delusions; Female; Humans; Ireland; Male; Population Groups; Psychotic Disorders; State Medicine; United Kingdom
PubMed: 36049491
DOI: 10.1016/S2215-0366(22)00236-X -
Neuroscience Letters Jan 2021Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will... (Review)
Review
Historical epidemiological perspectives from past pandemics and recent neurobiological evidence link infections and psychoses, leading to concerns that COVID-19 will present a significant risk for the development of psychosis. But are these concerns justified, or mere sensationalism? In this article we review the historical associations between viral infection and the immune system more broadly in the development of psychosis, before critically evaluating the current evidence pertaining to SARS-CoV-2 and risk of psychosis as an acute or post-infectious manifestation of COVID-19. We review the 42 cases of psychosis reported in infected patients to date, and discuss the potential implications of in utero infection on subsequent neurodevelopment and psychiatric risk. Finally, in the context of the wider neurological and psychiatric manifestations of COVID-19 and our current understanding of the aetiology of psychotic disorders, we evaluate possible neurobiological and psychosocial mechanisms as well as the numerous challenges in ascribing a causal pathogenic role to the infection.
Topics: Adolescent; Adult; COVID-19; Delusions; Female; Humans; Male; Middle Aged; Psychotic Disorders; Risk Factors; Young Adult
PubMed: 33220366
DOI: 10.1016/j.neulet.2020.135491 -
Journal of Psychiatric Research Mar 2024A clear understanding of the pathophysiology of schizophrenia and related spectrum disorders has been limited by clinical heterogeneity. We investigated whether relative...
A clear understanding of the pathophysiology of schizophrenia and related spectrum disorders has been limited by clinical heterogeneity. We investigated whether relative severity and predominance of one or more delusion subtypes might yield clinically differentiable patient profiles. Patients (N = 286) with schizophrenia spectrum disorders (SSD) completed the 21-item Peters et al. Delusions Inventory (PDI-21). We performed factor analysis followed by k-means clustering to identify delusion factors and patient subtypes. Patients were further assessed via the Brief Psychiatric Rating Scale, Brief Negative Symptom Scale, Digit Symbol and Digit Substitution tasks, use of cannabis and tobacco, and stressful life events. The overall patient sample clustered into subtypes corresponding to Low-Delusion, Grandiose-Predominant, Paranoid-Predominant, and Pan-Delusion patients. Paranoid-Predominant and Pan-Delusion patients showed significantly higher burden of positive symptoms, while Low-Delusion patients showed the highest burden of negative symptoms. The Paranoia delusion factor score showed a positive association with Digit Symbol and Digit Substitution tasks in the overall sample, and the Paranoid-Predominant subtype exhibited the best performance on both tasks. Grandiose-Predominant patients showed significantly higher tobacco smoking severity than other subtypes, while Paranoid-Predominant patients were significantly more likely to have a lifetime diagnosis of Cannabis Use Disorder. We suggest that delusion self-report inventories such as the PDI-21 may be of utility in identifying sub-syndromes in SSD. From the current study, a Paranoid-Predominant form may be most distinctive, with features including less cognitive impairment and a stronger association with cannabis use.
Topics: Humans; Schizophrenia; Delusions; Mood Disorders; Brief Psychiatric Rating Scale
PubMed: 38246028
DOI: 10.1016/j.jpsychires.2023.12.025 -
Schizophrenia Bulletin Sep 2019Psychotic experiences may be understood as altered information processing due to aberrant neural computations. A prominent example of such neural computations is the... (Review)
Review
Psychotic experiences may be understood as altered information processing due to aberrant neural computations. A prominent example of such neural computations is the computation of prediction errors (PEs), which signal the difference between expected and experienced events. Among other areas showing PE coding, hippocampal-prefrontal-striatal neurocircuits play a prominent role in information processing. Dysregulation of dopaminergic signaling, often secondary to psychosocial stress, is thought to interfere with the processing of biologically important events (such as reward prediction errors) and result in the aberrant attribution of salience to irrelevant sensory stimuli and internal representations. Bayesian hierarchical predictive coding offers a promising framework for the identification of dysfunctional neurocomputational processes and the development of a mechanistic understanding of psychotic experience. According to this framework, mismatches between prior beliefs encoded at higher levels of the cortical hierarchy and lower-level (sensory) information can also be thought of as PEs, with important consequences for belief updating. Low levels of precision in the representation of prior beliefs relative to sensory data, as well as dysfunctional interactions between prior beliefs and sensory data in an ever-changing environment, have been suggested as a general mechanism underlying psychotic experiences. Translating the promise of the Bayesian hierarchical predictive coding into patient benefit will come from integrating this framework with existing knowledge of the etiology and pathophysiology of psychosis, especially regarding hippocampal-prefrontal-striatal network function and neural mechanisms of information processing and belief updating.
Topics: Bayes Theorem; Brain; Cognition; Cognitive Neuroscience; Corpus Striatum; Delusions; Dopamine; Hippocampus; Humans; Learning; Limbic Lobe; Models, Neurological; Models, Psychological; Neural Pathways; Neurophysiology; Prefrontal Cortex; Psychotic Disorders; Reinforcement, Psychology; Reward; Schizophrenia; Schizophrenic Psychology; Synaptic Transmission; Temporal Lobe
PubMed: 30388260
DOI: 10.1093/schbul/sby154 -
Schizophrenia Research Jul 2022Despite the ubiquity of delusional information processing in psychopathology and everyday life, formal characterizations of such inferences are lacking. In this article,...
Despite the ubiquity of delusional information processing in psychopathology and everyday life, formal characterizations of such inferences are lacking. In this article, we propose a generative framework that entails a computational mechanism which, when implemented in a virtual agent and given new information, generates belief updates (i.e., inferences about the hidden causes of the information) that resemble those seen in individuals with delusions. We introduce a particular form of Dirichlet process mixture model with a sampling-based Bayesian inference algorithm. This procedure, depending on the setting of a single parameter, preferentially generates highly precise (i.e. over-fitting) explanations, which are compartmentalized and thus can co-exist despite being inconsistent with each other. Especially in ambiguous situations, this can provide the seed for delusional ideation. Further, we show by simulation how the excessive generation of such over-precise explanations leads to new information being integrated in a way that does not lead to a revision of established beliefs. In all configurations, whether delusional or not, the inference generated by our algorithm corresponds to Bayesian inference. Furthermore, the algorithm is fully compatible with hierarchical predictive coding. By virtue of these properties, the proposed model provides a basis for the empirical study and a step toward the characterization of the aberrant inferential processes underlying delusions.
Topics: Bayes Theorem; Cognition; Delusions; Humans
PubMed: 33648810
DOI: 10.1016/j.schres.2020.11.048 -
World Journal of Urology Feb 2024The present paper takes a different and more critical look at the role of alpha-blockers, sometimes nicknamed as "magical pills", in particular for stone disease and... (Review)
Review
PURPOSE
The present paper takes a different and more critical look at the role of alpha-blockers, sometimes nicknamed as "magical pills", in particular for stone disease and medical expulsive therapy (MET).
METHODS
A non-systematic narrative review was performed, synthesizing pertinent information from selected articles, and critically evaluating their conclusions. Sometimes different views on alpha-blockers were laid bare, including curiosities or other entertaining nuances suitable to the present topic, but always maintaining sharp objectivity and the foremost scientific rigor.
RESULTS AND CONCLUSIONS
Alpha-blockers seem to be a panacea, being used to treat a wide variety of non-urological diseases and conditions. Urological applications include erectile dysfunction to benign prostatic hyperplasia, from incontinence to urinary retention, or even to facilitate urinary stone passage along the urinary tract. Due to its versatility, alpha-blockers appear to be the Swiss army knife of urological medications. However, the efficacy of alpha-blockers for MET, pain management, or facilitating upper tract access is very disappointing, bringing no, or in some instances, only marginal benefits. Their treatment results are far from being significant or impressive let alone magical. Regular sexual intercourse is an effective alternative to alpha-blockers, providing faster ureteral stone expulsion rates and reducing the need for pain medication. Most of the research supporting alpha-blockers has been based on single-center, underpowered, low-quality studies. These low-quality studies biased several subsequent meta-analyses, contaminating them with their low-quality data, enhancing and prolonging this delusion. These results emphasize the need for large, multi-centric, unbiased, randomized, double-blinded, placebo-controlled trials to prevent future year-long delusions that may afflict any medical field.
Topics: Male; Humans; Delusions; Adrenergic alpha-Antagonists; Data Accuracy; Erectile Dysfunction; Ethnicity
PubMed: 38421483
DOI: 10.1007/s00345-024-04785-w -
Brain, Behavior and Evolution 2020The retinal image is insufficient for determining what is "out there," because many different real-world geometries could produce any given retinal image. Thus, the... (Review)
Review
The retinal image is insufficient for determining what is "out there," because many different real-world geometries could produce any given retinal image. Thus, the visual system must infer which external cause is most likely, given both the sensory data and prior knowledge that is either innate or learned via interactions with the environment. We will describe a general framework of "hierarchical Bayesian inference" that we and others have used to explore the role of cortico-cortical feedback in the visual system, and we will further argue that this approach to "seeing" makes our visual systems prone to perceptual errors in a variety of different ways. In this deliberately provocative and biased perspective, we argue that the neuromodulator, dopamine, may be a crucial link between neural circuits performing Bayesian inference and the perceptual idiosyncrasies of people with schizophrenia.
Topics: Animals; Bayes Theorem; Brain; Delusions; Humans; Illusions; Schizophrenia
PubMed: 33784667
DOI: 10.1159/000514859