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Schizophrenia Bulletin Dec 2020
Topics: Adult; Antipsychotic Agents; Delusions; Hallucinations; Humans; Male; Olanzapine; Psychotic Disorders
PubMed: 31355406
DOI: 10.1093/schbul/sbz083 -
JAMA Neurology Aug 2023Psychotic symptoms greatly increase the burden of disease for people with neurodegenerative disorders and their caregivers. Cholinesterase inhibitors (ChEIs) may be... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Psychotic symptoms greatly increase the burden of disease for people with neurodegenerative disorders and their caregivers. Cholinesterase inhibitors (ChEIs) may be effective treatment for psychotic symptoms in these disorders. Previous trials only evaluated neuropsychiatric symptoms as a secondary and an overall outcome, potentially blurring the outcomes noted with ChEI use specifically for psychotic symptoms.
OBJECTIVE
To quantitatively assess the use of ChEIs for treatment of individual neuropsychiatric symptoms, specifically hallucinations and delusions, in patients with Alzheimer disease (AD), Parkinson disease (PD), and dementia with Lewy bodies (DLB).
DATA SOURCES
A systematic search was performed in PubMed (MEDLINE), Embase, and PsychInfo, without year restrictions. Additional eligible studies were retrieved from reference lists. The final search cutoff date was April 21, 2022.
STUDY SELECTION
Studies were selected if they presented the results of placebo-controlled randomized clinical trials, including at least 1 donepezil, rivastigmine, or galantamine treatment arm in patients with AD, PD, or DLB; if they applied at least 1 neuropsychiatric measure including hallucinations and/or delusions; and if a full-text version of the study was available in the English language. Study selection was performed and checked by multiple reviewers.
DATA EXTRACTION AND SYNTHESIS
Original research data were requested on eligible studies. A 2-stage meta-analysis was then performed, using random-effects models. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed for extracting data and assessing the data quality and validity. Data extraction was checked by a second reviewer.
MAIN OUTCOMES AND MEASURES
Primary outcomes were hallucinations and delusions; secondary outcomes included all other individual neuropsychiatric subdomains as well as the total neuropsychiatric score.
RESULTS
In total, 34 eligible randomized clinical trials were selected. Individual participant data on 6649 individuals (3830 [62.6%] women; mean [SD] age, 75.0 [8.2] years) were obtained from 17 trials (AD: n = 12; PD: n = 5; individual participant data were not available for DLB). An association with ChEI treatment was shown in the AD subgroup for delusions (-0.08; 95% CI, -0.14 to -0.03; P = .006) and hallucinations (-0.09; 95% CI, -0.14 to -0.04; P = .003) and in the PD subgroup for delusions (-0.14; 95% CI, -0.26 to -0.01; P = .04) and hallucinations (-0.08, 95% CI -0.13 to -0.03; P = .01).
CONCLUSIONS AND RELEVANCE
The results of this individual participant data meta-analysis suggest that ChEI treatment improves psychotic symptoms in patients with AD and PD with small effect sizes.
Topics: Humans; Female; Aged; Male; Cholinesterase Inhibitors; Alzheimer Disease; Parkinson Disease; Rivastigmine; Hallucinations; Randomized Controlled Trials as Topic
PubMed: 37358841
DOI: 10.1001/jamaneurol.2023.1835 -
Schizophrenia Bulletin Nov 2023The neurocomputational framework of predictive processing (PP) provides a promising approach to explaining delusions, a key symptom of psychotic disorders. According to... (Review)
Review
BACKGROUND AND HYPOTHESIS
The neurocomputational framework of predictive processing (PP) provides a promising approach to explaining delusions, a key symptom of psychotic disorders. According to PP, the brain makes inferences about the world by weighing prior beliefs against the available sensory data. Mismatches between prior beliefs and sensory data result in prediction errors that may update the brain's model of the world. Psychosis has been associated with reduced weighting of priors relative to the sensory data. However, delusional beliefs are highly resistant to change, suggesting increased rather than decreased weighting of priors. We propose that this "delusion paradox" can be resolved within a hierarchical PP model: Reduced weighting of prior beliefs at low hierarchical levels may be compensated by an increased influence of higher-order beliefs represented at high hierarchical levels, including delusional beliefs. This may sculpt perceptual processing into conformity with delusions and foster their resistance to contradictory evidence.
STUDY DESIGN
We review several lines of experimental evidence on low- and high-level processes, and their neurocognitive underpinnings in delusion-related phenotypes and link them to predicted processing.
STUDY RESULTS
The reviewed evidence supports the notion of decreased weighting of low-level priors and increased weighting of high-level priors, in both delusional and delusion-prone individuals. Moreover, we highlight the role of prefrontal cortex as a neural basis for the increased weighting of high-level prior beliefs and discuss possible clinical implications of the proposed hierarchical predictive-processing model.
CONCLUSIONS
Our review suggests the delusion paradox can be resolved within a hierarchical PP model.
Topics: Humans; Delusions; Psychotic Disorders; Brain; Prefrontal Cortex
PubMed: 37478890
DOI: 10.1093/schbul/sbad084 -
Cureus Jan 2022Hypocalcemia can manifest as a variety of presentations, ranging from neuromuscular irritability to seizures, and psychiatric manifestations such as emotional...
Hypocalcemia can manifest as a variety of presentations, ranging from neuromuscular irritability to seizures, and psychiatric manifestations such as emotional instability, anxiety, and depression. Here, we present a unique case of hypocalcemia-induced acute psychosis. A 24-year-old woman presented to the emergency department (ED) with confusion and agitation for four to five days. The patient was noted by the family to have decreased oral intake and sleep. Auditory and visual hallucinations prompted the family to bring the patient to the ED. The patient was mildly tachycardic. Initially, the patient was agitated, impulsive, and aggressive, exhibiting psychotic features including visual hallucinations, paranoid delusions, thought broadcasting, tangential and perseverative thought processes, and erotomanic delusions. She had mild leukocytosis and elevated procalcitonin on admission. A thorough workup ruled out infectious/inflammatory processes. Cerebrospinal fluid was negative for acute meningitis/encephalitis, autoimmune encephalitis antibodies, and paraneoplastic etiology. Thyroid-stimulating hormone was normal and thyroid antibodies were negative. The CT brain and MRI brain were unremarkable. The patient was severely hypocalcemic (6.7) with low parathyroid hormone (<6) on admission. To note, the patient has multiple endocrine neoplasia, type 2B (MEN2B). She underwent total thyroidectomy five months prior for metastatic medullary thyroid carcinoma complicated by postsurgical hypoparathyroidism. The patient had been non-compliant with calcium and calcitriol supplementation postoperatively. The patient was started on IV calcium gluconate and transitioned to calcitriol with calcium level improvement over the next three days. She experienced marked improvement, with the resolution of her psychosis. The patient's subacute onset psychosis with no personal or family psychiatric history and a rapid response to calcium correction supports hypocalcemia etiology. This case illustrates new-onset acute psychosis in a patient with calcium regulation imbalance. The development of hypocalcemia secondary to thyroidectomy with postsurgical hypoparathyroidism and calcium supplement non-compliance precipitated psychosis. A few similar cases have been reported, and here, we note that treatment of hypocalcemia promptly resolves symptoms. As per our review, this will be the first case of neuropsychiatric symptoms without associated cortical calcifications seen on imaging. It is important to recognize hypocalcemia as a rare cause of psychosis so as to not mistakenly categorize such presentations as primary psychotic disorders and miss a medically treatable illness.
PubMed: 35145781
DOI: 10.7759/cureus.20874 -
Ugeskrift For Laeger Feb 2023Patients with late-onset schizophrenia form a subgroup of schizophrenia that to some extent differs from the typical Gestalt of schizophrenia. Therefore, some of these... (Review)
Review
Patients with late-onset schizophrenia form a subgroup of schizophrenia that to some extent differs from the typical Gestalt of schizophrenia. Therefore, some of these patients may be overlooked in the clinic. This review describes the characteristics of the late-onset subgroup: Overweight of women, higher education, has been or is still married, and with more children than patients with early onset schizophrenia. The symptomatology of the subgroup is characterised by persecutory delusions and auditory hallucination. Knowledge of this subgroup of patients may lead to attention in the clinic and hopefully have therapeutic value in the recovery process for the patients.
Topics: Child; Humans; Female; Schizophrenia; Delusions; Hallucinations; Schizophrenic Psychology; Ambulatory Care Facilities
PubMed: 36892229
DOI: No ID Found -
Ugeskrift For Laeger May 2023This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead....
This is a case report about a 13-year-old girl who presented with depression, severely reduced daily functioning, and eventually nihilistic delusions about being dead. The condition was interpreted as a presentation of Cotard syndrome as part of early-onset schizophrenia. Treatment with an antidepressant and multiple antipsychotic medications was not effective. The patient was then treated with ECT, resulting in subjective and measurable positive effects.
Topics: Female; Humans; Adolescent; Delusions; Schizophrenia
PubMed: 37264869
DOI: No ID Found