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Ugeskrift For Laeger Nov 2020Obsessive-compulsive-like symptomatology may be present in various psychiatric disorders including schizophrenia. This has been described since Kraepelin and Bleuler. In... (Review)
Review
Obsessive-compulsive-like symptomatology may be present in various psychiatric disorders including schizophrenia. This has been described since Kraepelin and Bleuler. In this review, we draw attention to the often ignored notion of pseudo-obsession. The concept can add to the distinction between true obsession in OCD and related psychopathological phenomena in the schizophrenia spectrum disorders and improve diagnostic practice. The recent changes in the diagnostic manuals have made this distinction more difficult by allowing a lack of insight and delusional beliefs in the diagnostic criteria for OCD.
Topics: Diagnosis, Differential; Humans; Obsessive-Compulsive Disorder; Schizophrenia
PubMed: 33269684
DOI: No ID Found -
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 -
Cureus Jan 2023Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a...
Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a disorder associated with paranoid dementia and paranoia, but with less personality deterioration than schizophrenia and without fulfilling the clinical features of a delusional disorder. This classic diagnostic entity is not currently listed in main diagnostic systems, rendering delusional disorders difficult to classify in cases that resemble the concept of paraphrenia. We revisit the concept of paraphrenia through a critical review based on a clinical vignette of a patient followed at the psychiatry department of the University Hospital Center of São João.
PubMed: 36726768
DOI: 10.7759/cureus.34391 -
Frontiers in Psychiatry 2021Culture can affect psychiatric disorders. Clinical Lycanthropy is a rare syndrome, described since Antiquity, within which the patient has the delusional belief of...
Culture can affect psychiatric disorders. Clinical Lycanthropy is a rare syndrome, described since Antiquity, within which the patient has the delusional belief of turning into a wolf. Little is known on its clinical or therapeutic correlates. We conducted a systematic review (PRISMA) on PubMed and Google Scholar, until January 2021. Case reports, data on neurobiological hypotheses, and cultural aspects were included. Language was not restricted to English. Forty-three cases of clinical lycanthropy and kynanthropy (delusion of dog transformation) were identified. Associated diagnoses were: schizophrenia, psychotic depression, bipolar disorder, and other psychotic disorders. Antipsychotic medication may be an efficient treatment for this rare transnosographic syndrome. In case of depression or mania, the treatment included antidepressants or mood regulators. The neuroscientific hypotheses include the conception of clinical lycanthropy as a cenesthopathy, as a delusional misidentification of the self-syndrome, as impairments of sensory integration, as impairments of the belief evaluation system, and right hemisphere anomalies. Interestingly, there is a clinical overlap between clinical lycanthropy and other delusional misidentification syndromes. Clinical lycanthropy may be a culture-bound syndrome that happens in the context of Western cultures, myths, and stories on werewolves, and today's exposure to these narratives on cultural media such as the internet and the series. We suggest the necessity of a cultural approach for these patients' clinical assessment, and a narrative and patient-centered care. Psychiatric transtheoretical reflections are needed for complementaristic neurobiological and cultural approaches of complex delusional syndromes such as clinical lycanthropy. Future research should include integrative frameworks.
PubMed: 34707519
DOI: 10.3389/fpsyt.2021.718101 -
Focus (American Psychiatric Publishing) Oct 2021Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly...
Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly poor quality of life and high rates of suicidality. Onset of BDD is usually in childhood or adolescence and, unless appropriately treated, tends to be chronic. The first-line pharmacologic approach for both delusional and non-delusional BDD is serotonin reuptake inhibitors (SRIs), often at high doses. SRI augmentation and switching strategies can be effective. The first-line psychotherapy is cognitive-behavioral therapy (CBT) tailored to BDD's unique clinical features. Cosmetic treatment (such as surgery or dermatologic treatment), although received by a majority of patients with BDD, is not recommended. BDD has many similarities to obsessive-compulsive disorder (OCD) and appears closely related to OCD but also has some important differences. This article, which updates a 2015 article on BDD that we published in this journal, provides a clinically focused overview of BDD and its relationship to OCD.
PubMed: 35747292
DOI: 10.1176/appi.focus.20210012 -
Frontiers in Psychiatry 2021Global communities are currently confronted with a number of complex problems and threats, the reality of which is amplified by the media. These environmental and...
Global communities are currently confronted with a number of complex problems and threats, the reality of which is amplified by the media. These environmental and socio-political stressors have been accompanied by the spread of problematic psychological and behavioural tendencies, such as the growing polarisation of opinions and values, online radicalisation and extremism, deepening xenophobia and nationalism, the proliferation of irrational beliefs and conspiracy theories, and resistance to rational public policy measures. Here we argue that although they fall outside the scope of psychopathology, they nevertheless currently constitute a major challenge for psychiatry as a research domain and a clinical practise. To substantiate this claim, we outline the mechanisms by which media-transmitted stressors impact mental well-being and possibly psychopathology. The common denominator of these global problems and the media's construction of reality is the increase in uncertainty, unpredictability, and uncontrollability, which prompts defensive responding and, in predisposed individuals, functions as a potent source of chronic stress. These contribute to cognitive inflexibility, a strong predisposing factor for the development of rigid beliefs and attitudes, which to varying degrees underlie the adverse psychological and behavioural tendencies mentioned above. We suggest that the tightening of beliefs and ideas that is the result of cognitive rigidity may correspond to the clinical characteristics of induced delusional disorder. This can be seen as a (ultimately maladaptive) defensive strategy for coping with a high degree of uncertainty and unpredictability. We conclude by briefly outlining the possible ways in which psychiatry can face this challenge.
PubMed: 35082704
DOI: 10.3389/fpsyt.2021.809239 -
Journal of Psychiatric Research Dec 2020Firmly held beliefs that have a delusional quality are commonly experienced in those with schizophrenia spectrum disorders (SSD) and have been reported in those with...
Firmly held beliefs that have a delusional quality are commonly experienced in those with schizophrenia spectrum disorders (SSD) and have been reported in those with dissociative identity disorder (DID). However, no study to date has compared delusional belief content and characteristics between these diagnostic groups. This study examined delusional content, and the degree of conviction, preoccupation and distress associated with them in 50 participants with DID and 50 with an SSD exploring also dissociation and childhood trauma as predictors of delusional beliefs. Multivariate analysis of variance and linear regressions were conducted to explore differences between beliefs and characteristics and to examine their association with dissociation and childhood trauma. The SSD sample presented more self-referential delusional beliefs and characteristics compared to the DID group. Yet, the DID group had more mistrust delusional beliefs and characteristics in comparison to SSD participants. Mistrust beliefs were predicted by depersonalization/derealization in the DID sample, but did not predict any delusional belief in the SSD sample. The content of fixed beliefs differs between DID and SSD samples and in this study depersonalization/derealization experiences were related to mistrust beliefs but not to other delusional forms, and only in the DID sample.
Topics: Delusions; Dissociative Disorders; Dissociative Identity Disorder; Humans; Psychotic Disorders; Schizophrenia
PubMed: 33038656
DOI: 10.1016/j.jpsychires.2020.09.015 -
Ideggyogyaszati Szemle May 2023
Although rumination and schizotypal traits can be considered transdiagnostic phenomena and can occur within non-clinical population as well, a relatively small...
BACKGROUND AND PURPOSE
Although rumination and schizotypal traits can be considered transdiagnostic phenomena and can occur within non-clinical population as well, a relatively small number of research has been carried out on the topic involving both patient and non clinical participants. The aim of this study is to examine the relationship between schizotypal traits and rumination using a transdiagnostic approach, involving participants living with psychotic disorders and sine morbo individuals.
.METHODS
We recruited participants living with psychotic disorders (paranoid schizophrenia, hebephrenia, schizoaffective disorder, etc.) (n = 30) and controls who had not been diagnosed with any mental illnesses (n = 67). The connection between rumination and schizotypal traits was examined by self-report questionnaire method in a cross-sectional arrangement. The Oxford-Liverpool Inventory was used to measure schizotypal traits, and the Ruminative Thought Style Questionnaire was used to determine the level of rumination.
.RESULTS
Schizotypal symptoms (β = 0.575; p < 0.001), especially cognitive disorganization (β = 0.459; p < 0.001) and unusual experiences (β = 0.221; p = 0.029) significantly explained the degree of rumination.
.CONCLUSION
Our results support the hypothesis that the association between rumination and schizotypic traits is due to decreased cognitive inhibitory functions.
.Topics: Humans; Schizotypal Personality Disorder; Cross-Sectional Studies; Psychotic Disorders; Surveys and Questionnaires; Personality
PubMed: 37294028
DOI: 10.18071/isz.76.0149 -
The Diagnostic Workup, Screening, and Treatment Approaches for Patients with Delusional Infestation.Dermatology and Therapy Dec 2023Delusional infestation (DI) is a psychiatric disorder defined by the fixed, false belief that one has been infested by an organism without evidence to support this.... (Review)
Review
Delusional infestation (DI) is a psychiatric disorder defined by the fixed, false belief that one has been infested by an organism without evidence to support this. Patients may present with skin lesions and report abnormal cutaneous sensations. The diagnostic workup for patients presenting with delusional infestation is essential to ensuring accurate diagnosis in ruling out other explanations for symptoms and investigating potential secondary causes of DI. In addition to a comprehensive history and physical examination, laboratory workup should be considered depending on the clinical picture. Antipsychotic medications are the most common drugs used in management of adults with DI and tailor the choice of treatment according to patient characteristics. This article serves as a guide for dermatologists, psychiatrists, and other clinicians as it reviews the workup and screening that should be considered when managing a patient with delusional infestation and subsequent treatment protocols once the diagnosis has been made.
PubMed: 37872445
DOI: 10.1007/s13555-023-01053-4 -
Anxiety, Stress, and Coping May 2023Anxiety is a dominant emotion in schizophrenia. It is most often diagnosed by questionnaire-based methods. In this study, it was decided to analyse the utterances of...
BACKGROUND AND OBJECTIVES
Anxiety is a dominant emotion in schizophrenia. It is most often diagnosed by questionnaire-based methods. In this study, it was decided to analyse the utterances of patients with schizophrenia for the occurrence of lexical indicators of anxiety, which are a good predictor of experienced anxiety and lie beyond the subject's control.
DESIGN
The indicators most frequently described in the literature and considered to be of the most significant diagnostic value were selected: first-person pronouns and verbs; causal expressions and conjunctions; affirmative and negative particles; and dogmatic expressions. It was assumed that more of these would appear in the utterances of people with schizophrenia than in the utterances of healthy subjects.
METHODS
The study was conducted on 130 patients with paranoid schizophrenia and 130 healthy subjects. They were asked to describe five pictures.
RESULTS
In all verbal indicators of anxiety (except for negative particles) patients with positive schizophrenia attained the highest values, differing significantly from the results for the control groups.
CONCLUSION
This result is consistent with the subject literature, which emphasizes the high level of anxiety in schizophrenia, especially in its first phase, when the generative symptoms of the illness predominate.
Topics: Humans; Schizophrenia, Paranoid; Anxiety; Anxiety Disorders; Emotions; Surveys and Questionnaires
PubMed: 35561064
DOI: 10.1080/10615806.2022.2076081