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Asian Journal of Psychiatry Aug 2023We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N = 236) with onset of...
We conducted a retrospective chart review to examine the gender differences in young onset Persistent Delusional Disorder (PDD) subjects (N = 236) with onset of illness before the age of 30 years. Gender differences in marital and employment status were significant (p-0.001). Delusion of infidelity and erotomania were more common in females, while males had more body dysmorphic and persecutory delusions (X-20.45, p-0.009). Males had more substance dependence (X-21.31, p < 0.001), as well as a family history of substance abuse and PDD (X-18.5, p < 0.01). To conclude, gender differences in PDD comprised some psychopathology, co-morbidity, and family history among those with young onset PDD.
Topics: Male; Female; Humans; Adult; Delusions; Schizophrenia, Paranoid; Sex Factors; Retrospective Studies; Comorbidity; Substance-Related Disorders
PubMed: 37270876
DOI: 10.1016/j.ajp.2023.103653 -
Cureus Jul 2021Caffeine is one of the most frequently used stimulants worldwide. It is, therefore, subject to frequent intentional and unintentional misuse. However, severe erosive...
Caffeine is one of the most frequently used stimulants worldwide. It is, therefore, subject to frequent intentional and unintentional misuse. However, severe erosive esophagitis due to acute caffeine overdose is extremely rare. We report the case of a 43-year-old male with a past medical history of paranoid schizophrenia admitted to our hospital with esophageal symptoms (throat pain, retrosternal chest pain, dysphagia/odynophagia, nausea, and vomiting) two days after ingesting a bottle of caffeine pills containing about 30 g of caffeine in a suicide attempt. He was found to have rhabdomyolysis and acute renal failure warranting hemodialysis. Esophagogastroduodenoscopy done due to persistent retrosternal chest pain, dysphagia, odynophagia, and nausea despite being on oral famotidine 20 mg daily revealed severe erosive esophagitis. This case highlights the risk of concurrent renal and gastrointestinal injuries after acute ingestion of an excessive amount of caffeine tablets. Our experience suggests that in patients of caffeine overdose with persistent esophageal symptoms such as odynophagia, dysphagia, and retrosternal chest pain, endoscopic evaluation is advisable to rule out drug-induced esophagitis.
PubMed: 34373814
DOI: 10.7759/cureus.16253 -
Criminal Behaviour and Mental Health :... Aug 2019Suicide with accompanying homicide is frightening and ill understood.
BACKGROUND
Suicide with accompanying homicide is frightening and ill understood.
AIMS
To raise professional awareness of its complexities and difficulties and identify areas for developing research.
METHOD
A Crime in Mind seminar was held in London in December 2018, with four expert presentations and discussion. This paper draws on that seminar and supplementary literature.
FINDINGS
Homicide/suicide is very difficult to predict and thus prevent. Victims and perpetrators may have a dependency relationship. Better training, especially of general practitioners, may increase the likelihood of detecting signs of despair and delusional ideas. Psychiatrists should be more alert to fixed delusions and homicidal thoughts. Individual assessment and management alone is unlikely to be sufficient. Public health strategies are likely to be important too. Weapons control is vital. Employers of people with great personal responsibility and special access to potentially lethal tools, such as airline pilots, and perhaps clinicians, should have regular, compulsory, mental health checks.
CONCLUSIONS
Six points of clinical importance emerged, including lowering the threshold for diagnosing delusional disorder and the establishment of anti-violence clinics.
Topics: Adult; Crime Victims; Delusions; Female; Homicide; Humans; London; Male; Mental Disorders; Suicide; Violence; Weapons
PubMed: 31483084
DOI: 10.1002/cbm.2125 -
Clinical Case Reports Jun 2022Serial criminality, although rare, has always aroused the interest of researchers in criminology, psychiatry, psychology, and sociology. We report the case of a patient,...
Serial criminality, although rare, has always aroused the interest of researchers in criminology, psychiatry, psychology, and sociology. We report the case of a patient, suffering from a chronic psychotic disorder, having committed several murders over a period of 9 years, underpinned by a delirium of misidentification of Frigoli syndrome.
PubMed: 35662775
DOI: 10.1002/ccr3.5922 -
Immunobiology Mar 2023The abnormal neurodevelopment secondary to in utero adversities, such as hypoxia, malnutrition and maternal infections, underlies schizophrenia (SZ) etiology. As the...
The abnormal neurodevelopment secondary to in utero adversities, such as hypoxia, malnutrition and maternal infections, underlies schizophrenia (SZ) etiology. As the genes of MBL-associated serine proteases (MASP) of the complement lectin pathway, MASP1 and MASP2, are expressed in the developing cortex and are functionally important for neuronal migration, we hypothesize that the malfunction ofl-ficolin-MASP arm may also be involved in schizophrenia pathophysiology as it was shown for MBL-MASP complexes. We investigated serum l-ficolin and plasma MASP-2 levels, the activity of l-ficolin-bound MASP-2, as well as an array of the complement-related variables in chronic schizophrenic patients in the acute phase of the disease and controls without physical or mental diagnoses. The median concentration of l-ficolin in Armenian controls was 3.66 μg/ml and similar to those reported for other Caucasian populations. SZ-cases had ∼40 % increase in serum l-ficolin (median 5.08 μg/ml; P < 0.0024). In the pooled sample, l-ficolin level was higher in males than in females (P < 0.0031), but this gender dichotomy was not affecting the variable association with schizophrenia (P < 0.016). Remarkably, MASP-2 plasma concentration showed gender-dependent significant variability in the group of patients but not in controls. When adjusted for gender and gender*diagnosis interaction, a significantly high MASP-2 level in female patients versus female controls was observed (median: 362 ng/ml versus 260 ng/ml, respectively; P < 0.0020). A significant increase in l-ficolin-bound MASP-2 activity was also observed in schizophrenia (on the median, cases vs controls: 7.60 vs 6.50 RU; P < 0.021). Correlation analyses of the levels of l-ficolin and MASP-2, l-ficolin-(MASP-2) activity and the demographic data did not show any significant association with the age of individuals, family history, age at onset and duration of the illness, and smoking. Noteworthy, the levels of l-ficolin and MASP-2 in circulation were significantly associated with the type of schizophrenia (paranoid SZ-cases had much higher l-ficolin (P < 0.0035) and lower MASP-2 levels than the other types combined (P < 0.049)). Correlations were also found between: (i) the classical pathway functional activity and l-ficolin level (rs = 0.19, P < 0.010); (ii) the alternative pathway functional activity and MASP-2 level (rs = 0.26, P < 0.00035); (iii) the activity of l-ficolin-bound MASP2 and the downstream C2 component haemolytic activity (rs = -0.19, P < 0.017); and (iv) l-ficolin and the upstream C-reactive protein (CRP) serum concentrations (r = 0.28, P < 0.018). Overall, the results showed l-ficolin-related lectin pathway alterations in schizophrenia pathophysiology. It is likely that in addition to the MBL-MASP component over-activity reported previously, the alterations of the lectin pathway in schizophrenia also involve variations of l-ficolin-(MASP-2) on protein concentration and activity levels.
Topics: Male; Humans; Female; Mannose-Binding Protein-Associated Serine Proteases; Schizophrenia; Lectins; Complement Pathway, Mannose-Binding Lectin; Complement System Proteins; Mannose-Binding Lectin; Ficolins
PubMed: 36805857
DOI: 10.1016/j.imbio.2023.152349 -
Clocks & Sleep Oct 2020Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to... (Review)
Review
Sleep disturbances accompany almost all mental illnesses, either because sound sleep and mental well-being share similar requisites, or because mental problems lead to sleep problems, or vice versa. The aim of this narrative review was to examine sleep in patients with delusions, particularly in those diagnosed with delusional disorder. We did this in sequence, first for psychiatric illness in general, then for psychotic illnesses where delusions are prevalent symptoms, and then for delusional disorder. The review also looked at the effect on sleep parameters of individual symptoms commonly seen in delusional disorder (paranoia, cognitive distortions, suicidal thoughts) and searched the evidence base for indications of antipsychotic drug effects on sleep. It subsequently evaluated the influence of sleep therapies on psychotic symptoms, particularly delusions. The review's findings are clinically important. Delusional symptoms and sleep quality influence one another reciprocally. Effective treatment of sleep problems is of potential benefit to patients with persistent delusions, but may be difficult to implement in the absence of an established therapeutic relationship and an appropriate pharmacologic regimen. As one symptom can aggravate another, comorbidities in patients with serious mental illness all need to be treated, a task that requires close liaison among medical specialties.
PubMed: 33118525
DOI: 10.3390/clockssleep2040030 -
Neuropsychobiology 2020Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are...
INTRODUCTION
Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are unclear. Recent research suggests that specific delusional content may be associated with distinct neural substrates.
OBJECTIVE
Here, we used structural magnetic resonance imaging to investigate multiple parameters of brain morphology in patients presenting with paranoid type delusional disorder (pt-DD, n = 14) compared to those of healthy controls (HC, n = 25).
METHODS
Voxel- and surface-based morphometry for structural data was used to investigate gray matter volume (GMV), cortical thickness (CT) and gyrification.
RESULTS
Compared to HC, patients with pt-DD showed reduced GMV in bilateral amygdala and right inferior frontal gyrus. Higher GMV in patients was found in bilateral orbitofrontal and in left superior frontal cortices. Patients also had lower CT in frontal and temporal regions. Abnormal gyrification in patients was evident in frontal and temporal areas, as well as in bilateral insula.
CONCLUSIONS
The data suggest the presence of aberrant GMV in a right prefrontal region associated with belief evaluation, as well as distinct structural abnormalities in areas that essentially subserve processing of fear, anxiety and threat in patients with pt-DD. It is possible that cortical features of distinct evolutionary and genetic origin, i.e. CT and gyrification, contribute differently to the pathogenesis of pt-DD.
Topics: Adult; Aged; Amygdala; Cerebral Cortex; Female; Gray Matter; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Prefrontal Cortex; Schizophrenia, Paranoid; Temporal Lobe
PubMed: 32160619
DOI: 10.1159/000505601 -
Expert Opinion on Pharmacotherapy Apr 2022
Topics: Antipsychotic Agents; Aripiprazole; Humans; Morgellons Disease
PubMed: 35076344
DOI: 10.1080/14656566.2022.2029407 -
International Psychogeriatrics Apr 2020There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic...
OBJECTIVES
There is a paucity of available research to guide clinical practice in delusional disorder (DD), particularly in late life. This study aimed to evaluate antipsychotic use and treatment outcomes in patients with DD aged 65 years and older. Secondarily, we sought to examine associated clinical features and socio-demographic variables.
DESIGN AND SETTING
This descriptive study reviewed all consecutive cases of DD referred to an Australian old age psychiatry service over a 12-year period. Fifty-five patients were assessed in the inpatient and/or community setting, with data verified from a review of all individual medical records.
MEASUREMENTS
Data were collected with respect to antipsychotic use, outcomes, and clinical features. Socio-demographic variables of DD cases were compared to a non-matched comparison group (n=278) and an age and gender matched comparison group with a 1:1 ratio (n=55).
RESULTS
The predominant type of DD was persecutory (87%). Non-prominent hallucinations were experienced by 18%, and depressive symptoms occurred in 22%. There was a statistically significant association between having DD and social isolation (χ2= 11.04 (DF=1) p<0.001; McNemar's test p<0.001). Atypical antipsychotic medication was prescribed in 32 cases, with follow-up permitted in 51 of the 55 cases (mean duration 36.6 months). Sustained recovery occurred in 20%, and improvement in an additional 35% of the study sample. Four patients subsequently developed dementia, and two developed mild cognitive impairment.
CONCLUSIONS
Clinical improvement, including sustained recovery, occurred in more than half of those with late life DD. The majority of those who improved (96%) received atypical antipsychotics.
Topics: Aged; Aged, 80 and over; Aging; Antipsychotic Agents; Australia; Dementia; Female; Humans; Male; Schizophrenia, Paranoid; Treatment Outcome
PubMed: 31354123
DOI: 10.1017/S1041610219000966 -
Neuroscience and Biobehavioral Reviews Dec 2022We studied the prevalence of suicide attempts and cumulative incidence of completed suicide in schizophrenia (SZ), schizoaffective disorder (SZAF), delusional disorder... (Meta-Analysis)
Meta-Analysis Review
We studied the prevalence of suicide attempts and cumulative incidence of completed suicide in schizophrenia (SZ), schizoaffective disorder (SZAF), delusional disorder (DD) and first-episode psychosis (FEP). A systematic review was performed using Scopus and PubMed databases (1990- July 2020). A random effects meta-analysis was conducted. Stratified analyses were conducted by diagnosis, clinical setting and geographical region. The prevalence of attempted suicide was 20.3% for SZ, 46.8% for SZAF, 11.1% for DD and 12.5% for FEP. Suicide attempts rates were higher for outpatient samples than for inpatient samples in SZ, SZAF and DD (but not FEP) studies. Analyses by geographical region in SZ showed greater prevalence of suicide attempts in North America and Northern Europe. The cumulative incidence of completed suicide was 2.0% for SZ, 2.4% for SZAF; 2.2% for DD and 1.9% for FEP. In schizophrenia and FEP studies, Northern European studies reported higher rates of completed suicide when compared to Western European countries. In conclusion, suicidal behaviour rates in psychoses differ by diagnoses, clinical setting and geographical region.
Topics: Humans; Suicidal Ideation; Suicide; Psychotic Disorders; Suicide, Attempted; Schizophrenia; Risk Factors
PubMed: 36403792
DOI: 10.1016/j.neubiorev.2022.104964