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The Journal of Clinical Psychiatry Sep 2020 Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and... (Review)
Review
Along with cognitive decline, 90% of patients with dementia experience behavioral and psychological symptoms, such as psychosis, aggression, agitation, and depression. Dementia-related psychosis (DRP), which includes delusions and hallucinations, contributes to institutionalization, cognitive decline, and caregiver burden. Delusions and hallucinations tend to increase with the duration and severity of the disease, but there are also individual fluctuations. While a variety of symptoms can occur in all types of dementia, visual hallucinations are particularly common in the Lewy body dementias (dementia with Lewy bodies and Parkinson disease dementia). Mechanisms behind DRP are multifactorial, including different neurobiological factors as well as environmental, social, and psychological factors. This report examines the frequency, symptoms, and pathophysiology of DRP and communication about psychotic symptoms with patients with dementia (if possible) and their care partners.
Topics: Aged; Caregivers; Dementia; Humans; Psychotic Disorders
PubMed: 32936544
DOI: 10.4088/JCP.AD19038BR1C -
Acta Psychiatrica Scandinavica Jul 2021Narcolepsy is a rare sleep disorder in which psychotic-like symptoms can present diagnostic and therapeutic challenges. We aimed to review the association between, and... (Review)
Review
OBJECTIVE
Narcolepsy is a rare sleep disorder in which psychotic-like symptoms can present diagnostic and therapeutic challenges. We aimed to review the association between, and medical management of, narcolepsy and psychosis in children and adults.
METHODS
We reviewed the full text of 100 papers from 187 identified by a PubMed search on narcolepsy plus any of these keywords: psychosis, schizophrenia, delusion, side effects, safety, and bipolar disorder.
RESULTS
Three relevant groups are described. (i) In typical narcolepsy, psychotic-like symptoms include predominantly visual hallucinations at the sleep-wake transition (experienced as "not real") and dissociation because of intrusion of rapid eye movement (REM) sleep phenomena into wakefulness. (ii) Atypical patients ("the psychotic form of narcolepsy") experience more severe and vivid, apparently REM-related hallucinations or dream/reality confusions, which patients may rationalize in a delusion-like way. (iii) Some patients have a comorbid schizophrenia spectrum disorder with psychotic symptoms unrelated to sleep. Psychostimulants used to treat narcolepsy may trigger psychotic symptoms in all three groups. We analyzed 58 published cases from groups 2 and 3 (n = 17 and 41). Features that were reported significantly more frequently in atypical patients include visual and multimodal hallucinations, sexual and mystical delusions, and false memories. Dual diagnosis patients had more disorganized symptoms and earlier onset of narcolepsy.
CONCLUSION
Epidemiological studies tentatively suggest a possible association between narcolepsy and schizophrenia only for very early-onset cases, which could be related to the partially overlapping neurodevelopmental changes observed in these disorders. We propose a clinical algorithm for the management of cases with psychotic-like or psychotic features.
Topics: Adult; Child; Hallucinations; Humans; Narcolepsy; Psychotic Disorders; Schizophrenia; Sleep, REM
PubMed: 33779983
DOI: 10.1111/acps.13300 -
Journal of Child Psychology and... Jul 2023Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context... (Review)
Review
Psychotic symptoms, including hallucinations, delusions, and disorganized thinking and behaviors, are the hallmarks of schizophrenia; but may also present in the context of other psychiatric and medical conditions. Many children and adolescents describe psychotic-like experiences, which can be associated with other types of psychopathology and past experiences (e.g., trauma, substance use, and suicidality). However, most youth reporting such experiences do not have, nor will ever develop, schizophrenia or another psychotic disorder. Accurate assessment is critical because these different presentations have different diagnostic and treatment implications. For this review, we focus primarily on the diagnosis and treatment of early onset schizophrenia. In addition, we review the development of community-based first-episode psychosis programming, and the importance of early intervention and coordinated care.
Topics: Adolescent; Child; Humans; Psychotic Disorders; Schizophrenia; Hallucinations; Suicidal Ideation; Psychopathology; Delusions
PubMed: 36878476
DOI: 10.1111/jcpp.13777 -
Psychopathology 2022Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology,... (Review)
Review
Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for schizophrenia. Since delusional perception has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness. In this article, we explore the clinical roots of delusional perception, elucidate the psychopathological phenomenon, and discuss its two predominant conceptualizations, i.e., Schneider's well-known two-link model and Matussek's lesser known one-link model. The two-link model posits that delusional perception amounts to an abnormal interpretation of an intact perception, whereas the one-link model posits that the delusional meaning is contained within a changed perception. Despite their differences, both models stress that delusional perception is a primary delusion that takes place within an altered experiential framework that is characteristic of the psychopathological Gestalt of schizophrenia. We discuss the role of delusional perception in future psychopathological and diagnostic assessment and argue that such assessments must be conducted in comprehensive manner, eliciting the psychopathological context within which symptoms and signs are embedded. Finally, we discuss the compatibility of the two models of delusional perception with contemporary cognitive models on delusion and cognitive psychotherapeutic approaches.
Topics: Humans; Delusions; Schizophrenia; Psychopathology; International Classification of Diseases; Perception
PubMed: 35588694
DOI: 10.1159/000524642 -
Clinical Psychological Science : a... Jan 2021Because of the traditional conceptualization of delusion as "irrational belief," cognitive models of delusions largely focus on impairments to domain-general reasoning.... (Review)
Review
Because of the traditional conceptualization of delusion as "irrational belief," cognitive models of delusions largely focus on impairments to domain-general reasoning. Nevertheless, current rationality-impairment models do not account for the fact that (a) equivalently irrational beliefs can be induced through adaptive social cognitive processes, reflecting social integration rather than impairment; (b) delusions are overwhelmingly socially themed; and (c) delusions show a reduced sensitivity to social context both in terms of how they are shaped and how they are communicated. Consequently, we argue that models of delusions need to include alteration to coalitional cognition-processes involved in affiliation, group perception, and the strategic management of relationships. This approach has the advantage of better accounting for both content (social themes) and form (fixity) of delusion. It is also supported by the established role of mesolimbic dopamine in both delusions and social organization and the ongoing reconceptualization of belief as serving a social organizational function.
PubMed: 33552704
DOI: 10.1177/2167702620951553 -
Industrial Psychiatry Journal 2023Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic was declared, cases of psychosis, delusions, hallucinations, and disorganized behavior... (Review)
Review
Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic was declared, cases of psychosis, delusions, hallucinations, and disorganized behavior have been reported worldwide, both during the acute phase of COVID-19 and after recovery. Given the recent emergence of COVID-19, data are still accumulating, and it is premature to correlate COVID-19 with psychotic disorders causally. However, SARS-CoV-2 has been shown to have the ability to cross the blood-brain barrier and penetrate neurons. This finding and the amount of published work on COVID-19 and psychotic disorders compel special attention to elucidate the link between SARS-CoV-2 and the occurrence of psychotic symptoms. In this article, several reviews and case reports that have analyzed the link between COVID-19 and psychotic disorders are reviewed. In light of the data that have emerged at the present time, study criteria were proposed to identify COVID-19-related psychosis.
PubMed: 38161482
DOI: 10.4103/ipj.ipj_27_23 -
Brain : a Journal of Neurology Apr 2021Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies,...
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
Topics: Aged; Delusions; Female; Hallucinations; Humans; Male; Middle Aged; Neurodegenerative Diseases; Prevalence; Psychotic Disorders
PubMed: 33501939
DOI: 10.1093/brain/awaa413