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Actas Espanolas de Psiquiatria Jun 2024The neurobiological basis of delusional disorder is less explored through neuroimaging techniques than in other psychotic disorders. This study aims to provide...
BACKGROUND
The neurobiological basis of delusional disorder is less explored through neuroimaging techniques than in other psychotic disorders. This study aims to provide information about the neural origins of delusional disorder (DD) by examining the neuroanatomical features of some basal nuclei with magnetic resonance imaging (MRI) texture analysis.
MATERIALS AND METHODS
Twenty DD patients and 20 healthy individuals were included in the study. Globus pallidus, putamen, and caudate nuclei were selected individually with a region of interest (ROI) on the axial MRI images. The entire texture analysis algorithm applied to all selected ROIs was done with an in-house software. Nuclei on both sides were taken as separate samples.
RESULTS
There were no significant differences between groups in terms of age and gender. The average "mean, median and maximum" values of all three nuclei were decreased in DD patients. The small putamen area and the differences detected in different tissue parameters for all three nuclei in delusional disorder patients indicate that they differ in delusional disorder from normal controls (p < 0.05).
CONCLUSION
The differences detected in the texture parameters for all three nuclei indicate that there is something different in the DD from in the normal controls. Neuroimaging studies with larger samples and different techniques in the future may shed light on the etiology of delusional disorder.
Topics: Humans; Female; Putamen; Male; Globus Pallidus; Magnetic Resonance Imaging; Caudate Nucleus; Middle Aged; Schizophrenia, Paranoid; Adult; Case-Control Studies; Neuroimaging
PubMed: 38863052
DOI: 10.62641/aep.v52i3.1604 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2021To define psychopathological and phenomenological characteristics of the apocalyptic variant of end-world delusion with religious content (EWDRC) in schizophrenia, to...
OBJECTIVE
To define psychopathological and phenomenological characteristics of the apocalyptic variant of end-world delusion with religious content (EWDRC) in schizophrenia, to identify features of clinical dynamics of delusional disorders and their interaction with delusional behavior of patients.
MATERIAL AND METHODS
A total of 28 patients with schizophrenia (F20.01, F20.02 according to ICD-10) and EWDRC were examined. Clinical-psychopathological and follow-up methods were used.
RESULTS
The development of the end-world delusional ideas occurred in unstructured affective-delusional disorder with acute sensual delusion. Two types of EWDRC were differentiated: with predominance of perception delusion or picturesque delusion. These types differed by acuity and massiveness of psychotic symptomatology, the mono- or polythematic character of delusional disorders, affect type, as well as by the duration and intensity of the development of delusional stages, and in their phenomenological specifics.
CONCLUSION
Delusional ideas of the end of the world in schizophrenic patients develop in the structure of the syndrome of acute sensory delusions with a predominance of delusions of perception (type I) or visual-figurative delusions of the imagination (type II), which have different duration, degree of dominance and depth of psychopathological disorders.
Topics: Delusions; Humans; International Classification of Diseases; Psychopathology; Psychotic Disorders; Schizophrenia
PubMed: 34693683
DOI: 10.17116/jnevro20211210917 -
Psychopharmacology Jul 2022How striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has...
Striatal dopamine synthesis capacity and its association with negative symptoms upon resolution of positive symptoms in first-episode schizophrenia and delusional disorder.
RATIONALE
How striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has seldom been explored. As negative symptoms during active psychotic episodes can be complicated by secondary influences, such as positive symptoms, longitudinal investigations may help to clarify the relationship between striatal DSC and negative symptoms and differentiate between primary and secondary negative symptoms.
OBJECTIVE
A longitudinal study was conducted to examine whether baseline striatal DSC would be related to negative symptoms at 3 months in first-episode SZ and DD patients.
METHODS
Twenty-three first-episode age- and gender-matched patients (11 DD and 12 SZ) were consecutively recruited through an early intervention service for psychosis in Hong Kong. Among them, 19 (82.6%) patients (9 DD and 10 SZ) were followed up at 3 months. All patients received an F-DOPA PET/MR scan at baseline.
RESULTS
Baseline striatal DSC (K) was inversely associated with negative symptoms at 3 months in first-episode SZ patients (r = - 0.80, p = 0.010). This association remained in SZ patients even when controlling for baseline negative, positive, and depressive symptoms, as well as cumulative antipsychotic dosage (β = - 0.69, p = 0.012). Such associations were not observed in first-episode DD patients. Meanwhile, the severity of negative symptoms at 3 months was associated with more positive symptoms in DD patients (r = 0.74, p = 0.010) and not in SZ patients.
CONCLUSIONS
These findings highlight the role of striatal DSC in negative symptoms upon resolution of active psychotic episodes among first-episode SZ patients. Baseline striatal dopamine activity may inform future symptom expression with important treatment implications.
Topics: Corpus Striatum; Dopamine; Humans; Longitudinal Studies; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 35211769
DOI: 10.1007/s00213-022-06088-7 -
International Journal of Psychiatry in... Sep 2021Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, , the patient holds nihilistic delusions concerning his/her own existence.... (Review)
Review
OBJECTIVE
Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, , the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition.
METHOD
To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD.
RESULTS
Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy.
CONCLUSIONS
Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
Topics: Algorithms; Delusions; Diagnosis, Differential; Humans
PubMed: 32935595
DOI: 10.1080/13651501.2020.1819335 -
Case Reports in Dermatological Medicine 2020Isotretinoin, an active form of vitamin A, is the drug of last resort for the treatment of severe acne. Depression, suicidal ideation, and psychosis are among the most...
Isotretinoin, an active form of vitamin A, is the drug of last resort for the treatment of severe acne. Depression, suicidal ideation, and psychosis are among the most well-documented psychiatric side effects. Here, we report a case of isotretinoin-induced psychosis, which was diagnosed as delusional disorder somatic subtype, in a young male in the absence of any prodromal symptoms, previous psychiatric history, or family history of mental illness. The onset of psychosis was in the context of a dosage increase from 40 mg/day to 80 mg/day. Isotretinoin was discontinued, and the patient showed improvement on low-dose quetiapine.
PubMed: 32774942
DOI: 10.1155/2020/8853167 -
Frontiers in Psychiatry 2023Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no...
Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.
PubMed: 38161722
DOI: 10.3389/fpsyt.2023.1298497 -
Tijdschrift Voor Psychiatrie 2023Clozapine is the most effective treatment for people with treatment-resistant schizophrenia. However, it is prescribed less often than guidelines indicate. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Clozapine is the most effective treatment for people with treatment-resistant schizophrenia. However, it is prescribed less often than guidelines indicate.
AIM
To personalize clozapine treatment, we investigated the efficacy of clozapine as first- or second-line treatment and investigated whether there are factors that were associated with efficacy and side effects.
METHOD
We collected a unique cohort of over 800 clozapine users diagnosed with a schizophrenia spectrum disorder. We meta-analyzed factors that were associated with response during clozapine treatment. Additionally, we conducted genetic association analyses to investigate the relations between side effects and symptom severity during clozapinetreatment.
RESULTS
From our meta-analyses, we found that clozapine was more effective when used as a first- or second-line treatment. Furthermore, we found that younger age, less negative symptoms and the paranoid subtype of schizophreniawere associated with a better clozapine response. Several specific locations on genes (loci) were associated with clozapine-induced agranulocytosis and neutropenia, while polygenic risk scores were associated with symptom severity.
CONCLUSION
We found that clozapine could be effective earlier in treatment and identified factors that could aid the prediction of< response to clozapine treatment in the future. These finding could contribute to the start of a personalized clozapine treatment.
Topics: Humans; Antipsychotic Agents; Clozapine; Neutropenia; Precision Medicine; Schizophrenia
PubMed: 36912056
DOI: No ID Found -
Current Pharmaceutical Design 2022Adherence to medication regimens is of great importance in psychiatry because drugs sometimes need to be taken for long durations in order to maintain health and... (Review)
Review
BACKGROUND
Adherence to medication regimens is of great importance in psychiatry because drugs sometimes need to be taken for long durations in order to maintain health and function.
OBJECTIVE
This study aimed to review influences on adherence to antipsychotic medications, the treatment of choice for the delusional disorder (DD), and to focus on adherence in women with DD.
METHODS
This is a non-systematic narrative review of papers published since 2000 using PubMed and Google Scholar, focusing on women with DD and medication adherence.
RESULTS
Several factors have been identified as exerting influence on adherence in women with persistent delusional symptoms who are treated with antipsychotics. Personality features, intensity of delusion, perception of adverse effects, and cognitive impairment are patient factors. Clinical time spent with the patient, clarity of communication, and regular drug monitoring are responsibilities of the health provider. Factors that neither patient nor clinician can control are the social determinants of health, such as poverty, easy access to healthcare, and cultural variables.
CONCLUSION
There has been little investigation of factors that influence adherence in the target population, e.g., women with DD. Preliminary results of this literature search indicate that solutions from outside the field of DD may apply to this population. Overall, a solid therapeutic alliance appears to be the best hedge against nonadherence.
Topics: Antipsychotic Agents; Female; Humans; Medication Adherence; Schizophrenia, Paranoid
PubMed: 35272589
DOI: 10.2174/1381612828666220310151625 -
Postepy Dermatologii I Alergologii Feb 2021Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have...
INTRODUCTION
Patients presenting with cutaneous symptomatology may in fact suffer from underlying psychiatric conditions. Individuals diagnosed with delusional infestation (DI) have a fixed false belief of being infested with certain organisms or objects.
AIM
To analyse clinical features of subjects with DI who were admitted to the tertiary dermatology ward.
MATERIAL AND METHODS
A retrospective analysis concerning DI patients hospitalized between 1997 and 2019 was carried out. The emphasis was put on the duration of symptoms, psychiatric symptomatology (including the "specimen sign"), comorbidities as well as therapy.
RESULTS
We gathered data regarding 21 consecutive patients with DI. The mean age of subjects was 65.2 ±13.3 years, the majority were females (76.2%). The mean time span between the disease onset and diagnosis was 1.9 ±1.7 years. Previous psychiatric consultations were attended by 57.0% of patients. The specimen sign was present in 47.6% of cases, whereas the most common suspected causative factors were described as worms (52.4%), unspecified parasites (42.9%), "something" (33.3%) and flies (19.0%). Primary delusional disorder was diagnosed in 76.2%, followed by shared delusional disorder and secondary delusional disorder of organic origin (9.5% each). Risperidone monotherapy was initiated in 61.9% of patients. In total, only 33.3% of patients attended the follow-up visit.
CONCLUSIONS
DI features a wide spectrum of clinical signs and symptoms. Risperidone remains the drug of choice in the majority of cases. Successful management of each DI case requires collaboration between dermatologists and psychiatrists and still remains a major challenge.
PubMed: 34408581
DOI: 10.5114/ada.2019.88464 -
Journal of Forensic Sciences Sep 2021Fifteen cases of Fetal Abduction by Maternal Evisceration (FAMAE) reported to the National Center for Missing and Exploited Children during 1987-2011 outline the...
Fifteen cases of Fetal Abduction by Maternal Evisceration (FAMAE) reported to the National Center for Missing and Exploited Children during 1987-2011 outline the findings from a review of the forensic psychiatric considerations and legal course of each of the cases. Most offenders confessed to law enforcement within a short time of being placed under arrest in statements reflecting a continued effort to manage impressions and minimize culpability. Psychiatric assessment is invariably central to the legal disposition of FAMAE cases, as the defendant's goal is to diminish the perception of culpability/criminal responsibility and mitigate sentencing. Of those sentenced in the United States, nine defendants received life without parole, two received the death penalty (one executed), and one received a minimum of 30 years. Two abductors committed suicide and were not sentenced. Proffered diagnoses at trial included psychogenic amnesia, pseudocyesis, dissociative disorder, and delusional disorder; however, these rarely stood up to court scrutiny. Psychiatric experts showed the greatest variance in diagnosis over what to call the feigned pregnancy. In addition to delusional disorder and dissociative disorder, pseudocyesis, factitious disorder/pregnancy, pseudopregnancy, schizophrenia, and PTSD were among the various diagnoses proposed. A differential diagnosis for many FAMAE offenders may also include borderline personality disorder. Future research accounting for those women claiming false pregnancy who do not become homicidal will clarify whether FAMAE is the extreme endpoint of a fertility identity disorder.
Topics: Adolescent; Adult; Crime; Female; Fetus; Forensic Psychiatry; Forensic Psychology; Humans; Mental Disorders; Pregnancy; Pregnant Women; Young Adult
PubMed: 34156091
DOI: 10.1111/1556-4029.14788