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Brain Sciences May 2022Background: This study examines the relationship between delusional severity in cognitively impaired adults with automatically computed volume and texture biomarkers...
Background: This study examines the relationship between delusional severity in cognitively impaired adults with automatically computed volume and texture biomarkers from the Normal Appearing Brain Matter (NABM) in FLAIR MRI. Methods: Patients with mild cognitive impairment (MCI, n = 24) and Alzheimer’s Disease (AD, n = 18) with delusions of varying severities based on Neuropsychiatric Inventory-Questionnaire (NPI-Q) (1—mild, 2—moderate, 3—severe) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) were analyzed for this task. The NABM region, which is gray matter (GM) and white matter (WM) combined, was automatically segmented in FLAIR MRI volumes with intensity standardization and thresholding. Three imaging biomarkers were computed from this region, including NABM volume and two texture markers called “Integrity” and “Damage”. Together, these imaging biomarkers quantify structural changes in brain volume, microstructural integrity and tissue damage. Multivariable regression was used to investigate relationships between imaging biomarkers and delusional severities (1, 2 and 3). Sex, age, education, APOE4 and baseline cerebrospinal fluid (CSF) tau were included as co-variates. Results: Biomarkers were extracted from a total of 42 participants with longitudinal time points representing 164 imaging volumes. Significant associations were found for all three NABM biomarkers between delusion level 3 and level 1. Integrity was also sensitive enough to show differences between delusion level 1 and delusion level 2. A significant specified interaction was noted with severe delusions (level 3) and CSF tau for all imaging biomarkers (p < 0.01). APOE4 homozygotes were also significantly related to the biomarkers. Conclusion: Cognitively impaired older adults with more severe delusions have greater global brain disease burden in the WM and GM combined (NABM) as measured using FLAIR MRI. Relative to patients with mild delusions, tissue degeneration in the NABM was more pronounced in subjects with higher delusional symptoms, with a significant association with CSF tau. Future studies are required to establish potential tau-associated mechanisms of increased delusional severity.
PubMed: 35624987
DOI: 10.3390/brainsci12050600 -
The Primary Care Companion For CNS... Apr 2023
Topics: Female; Pregnancy; Humans; Pseudopregnancy; Transgender Persons; Delusions; Transsexualism
PubMed: 37058715
DOI: 10.4088/PCC.22cr03343 -
Journal of Psychiatric Research Jun 2022The coronavirus (COVID-19) pandemic has caused major disruptions to social and other forms of functioning, which may influence schizotypy expression. The current study...
The coronavirus (COVID-19) pandemic has caused major disruptions to social and other forms of functioning, which may influence schizotypy expression. The current study aimed to explore possible distal and proximal predictors contributing to schizotypy in a sample of the Australian general population during the COVID-19 pandemic. The COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project is an online mental health study aimed at tracking key mental health indicators over the progression of the pandemic. Adults residing in Australia were invited to take part using non-discriminative snowball sampling. Demographic-clinical information was collected for 850 participants in either October 2020 or January 2021. To assess schizotypy facets, the Launay-Slade Hallucinations Scale-Extended (LSHS-E) and Peters Delusions Inventory (PDI-21) were used to measure hallucination and delusion proneness respectively. Generalised linear models (with gamma and negative binomial distributions) were employed. Age, negative emotions and loneliness significantly contributed to both hallucination and delusion proneness; gender, education and religiosity also significantly contributed to delusion proneness, in the final regression models. Our study corroborated the specific contribution of loneliness, amongst other factors, in the prediction of schizotypy facets. Tackling loneliness represents a public health challenge that needs to be urgently addressed, especially in the face of the ongoing COVID-19 pandemic.
Topics: Adult; Australia; COVID-19; Hallucinations; Humans; Pandemics; Schizotypal Personality Disorder
PubMed: 35398666
DOI: 10.1016/j.jpsychires.2022.03.060 -
International Journal of Women's... Oct 2022Delusions of parasitosis (DOP), which is also called Morgellons disease or delusional infestation, can be one of the most challenging clinical encounters in a... (Review)
Review
Delusions of parasitosis (DOP), which is also called Morgellons disease or delusional infestation, can be one of the most challenging clinical encounters in a dermatologist's practice. One reason for this is lack of education during dermatology residency and a paucity of resources for the practicing dermatologist such as specialized psychodermatology clinics for these patients. To help close this knowledge gap, an interview was conducted with 3 experts in the field of psychodermatology and their responses were recorded and edited with goal of improving care for patients suffering from DOP by educating the busy, practicing dermatologist. The experts discussed many topics regarding DOP including the difference between primary and secondary DOP, how to build a good rapport with DOP patients, why the condition is seen mostly in older woman, and which medications are effective for treatment. The interview ends with a few high-yield practical treatment tips.
PubMed: 35822193
DOI: 10.1097/JW9.0000000000000035 -
Scientific Reports Jun 2023Multiple measures of decision-making under uncertainty (e.g. jumping to conclusions (JTC), bias against disconfirmatory evidence (BADE), win-switch behavior, random...
Multiple measures of decision-making under uncertainty (e.g. jumping to conclusions (JTC), bias against disconfirmatory evidence (BADE), win-switch behavior, random exploration) have been associated with delusional thinking in independent studies. Yet, it is unknown whether these variables explain shared or unique variance in delusional thinking, and whether these relationships are specific to paranoia or delusional ideation more broadly. Additionally, the underlying computational mechanisms require further investigation. To investigate these questions, task and self-report data were collected in 88 individuals (46 healthy controls, 42 schizophrenia-spectrum) and included measures of cognitive biases and behavior on probabilistic reversal learning and explore/exploit tasks. Of those, only win-switch rate significantly differed between groups. In regression, reversal learning performance, random exploration, and poor evidence integration during BADE showed significant, independent associations with paranoia. Only self-reported JTC was associated with delusional ideation, controlling for paranoia. Computational parameters increased the proportion of variance explained in paranoia. Overall, decision-making influenced by strong volatility and variability is specifically associated with paranoia, whereas self-reported hasty decision-making is specifically associated with other themes of delusional ideation. These aspects of decision-making under uncertainty may therefore represent distinct cognitive processes that, together, have the potential to worsen delusional thinking across the psychosis spectrum.
Topics: Humans; Delusions; Thinking; Psychotic Disorders; Decision Making; Bias; Cognition
PubMed: 37301915
DOI: 10.1038/s41598-023-36526-1 -
Current Psychiatry Reports Aug 2019Neuropsychiatric syndromes (NPS) are common in neurodegenerative disorders (NDD). This review describes the role of NPS in the diagnosis of NDD, criteria for the... (Review)
Review
PURPOSE OF REVIEW
Neuropsychiatric syndromes (NPS) are common in neurodegenerative disorders (NDD). This review describes the role of NPS in the diagnosis of NDD, criteria for the diagnosis of NPS, management of NPS, and agents in clinical trials for NPS.
RECENT FINDINGS
NPS play an increasingly important role in the diagnosis of NDD. Consensus diagnostic criteria have evolved for psychosis, depression, agitation, and apathy in NDD. With one exception-pimavanserin is approved for the treatment of hallucinations and delusions in Parkinson's disease-there are no drugs approved by the FDA for treatment of NPS in NDD. Trials show that atypical antipsychotics reduce psychosis in AD and in Parkinson's disease, although side effect concerns have constrained their use. Antidepressants show benefit in treatment of Parkinson's disease with depression. Several agents are in clinical trials for treatment of NPS in NDD. Neuropsychiatric syndromes play a major role in NDD diagnosis. Clinical criteria allow recognition of NPS in NDD. Psychotropic medications are often useful in the treatment of NPS in NDD; efficacious, safe, and approved agents are needed.
Topics: Delusions; Hallucinations; Humans; Neurodegenerative Diseases; Psychotic Disorders; Syndrome
PubMed: 31392434
DOI: 10.1007/s11920-019-1058-4 -
Frontiers in Neurology 2022In addition to cognitive decline, one of the most important problems for caregivers of patients with Alzheimer's is neuropsychiatric symptoms (NPS). This study aimed to...
INTRODUCTION/OBJECTIVES
In addition to cognitive decline, one of the most important problems for caregivers of patients with Alzheimer's is neuropsychiatric symptoms (NPS). This study aimed to evaluate the NPS in patients with Alzheimer's disease (AD) and investigate its relationship with caregiver burden (CB).
METHODS
In a cross-sectional study of 85 patients with AD referred to Shafa Hospital in Rasht and their caregivers in 2020, information was collected using a demographic questionnaire, Neuropsychiatric Inventory Questionnaire (NPI-Q), and the Caregiver Burden Inventory (CBI). Data were analyzed by Spearman correlation, -test, and linear regression, with SPSS version 22.
RESULTS
The mean age of the patients and their caregivers were 74.95 ± 8.87 years and 43.98 ± 11.38 years, respectively. The mean total score of NPS in patients with AD was 44.25 (0-144) and the mean CB score was 36.27 (0-96), which was a moderate level. According to the results, 91% of patients had apathy, while happiness/euphoria was reported as the most uncommon symptom. In addition, there was a significant relationship between the score of NPS and CB ( = 0.542, < 0.0001), as well as all its sub-components, time-dependence burden with more correlation ( = 0.509, < 0.0001), and social burden with less correlation ( = 0.352, < 0.001). NPS, hallucination, aberrant motor behavior (AMB), delusion, and depression were most correlated with CB. Also, the mean score of CB was significantly higher in women than in men ( = 0.045). Living in a rural area had a significant relationship with NPS score ( = 0.026). Also, linear regression showed that with increasing 1 year of patients' age, the mean score of patient's NPS decreased by 0.374 ( = 0.048).
CONCLUSION
Neuropsychiatric symptoms, especially hallucination, aberrant motor behavior (AMB), delusion, and depression were associated with caregiver burden. Apathy was the most common symptom in patients with AD.
PubMed: 35968317
DOI: 10.3389/fneur.2022.877143 -
Dementia & Neuropsychologia 2023The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies.
UNLABELLED
The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies.
OBJECTIVES
This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies.
METHODS
A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology).
RESULTS
A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD.
CONCLUSIONS
We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.
PubMed: 37223834
DOI: 10.1590/1980-5764-DN-2022-0044 -
Iranian Journal of Psychiatry Apr 2022Charles Bonnet Syndrome (CBS) consists of visual hallucinations occurring in patients with visual impairment. CBS is commonly overlooked by medical professionals and...
Charles Bonnet Syndrome (CBS) consists of visual hallucinations occurring in patients with visual impairment. CBS is commonly overlooked by medical professionals and underreported by patients due to the underlying stigma attached to the presence of hallucinations. Lack of awareness regarding CBS among medical professionals may lead to failures in providing forewarning and education to patients with visual impairment. In patients who are not familiar with CBS, this might lead to a higher risk of distress, misattribution to cultural belief or mental illness, and the potential of developing psychosis, especially in elderly patients with other modalities of sensory deprivation. This case report aims to increase awareness and knowledge about CBS among clinicians for the proper management of patients. This case illustrated a patient with worsening visual impairment who presented with typical CBS and later progressed to visual hallucination and persecutory delusion Providing information on CBS and antipsychotics resulted in less distress and improved the patient's visual hallucination and delusion Education and reassurance play a role in the management of CBS It is important for medical professionals to be aware of CBS and provide clear information for patients who are at risk to lower their distress.
PubMed: 36262761
DOI: 10.18502/ijps.v17i2.8914 -
The Journal of Clinical Psychiatry Mar 2022Most people with dementia will experience neuropsychiatric symptoms, including psychosis characterized by hallucinations and delusions. Across dementia subtypes,...
Most people with dementia will experience neuropsychiatric symptoms, including psychosis characterized by hallucinations and delusions. Across dementia subtypes, hallucinations and delusions are common, though their prevalence and presentation may vary. These symptoms have been associated with worse outcomes compared with dementia alone, including accelerated functional decline and mortality. Many people with dementia reside in long-term care facilities, and identification and management of hallucinations and delusions in this setting are critical. For residents in long-term care facilities, the following factors can hinder management of hallucinations and delusions related to dementia: (1) delayed recognition of symptoms; (2) reluctance of staff and family members to acknowledge psychiatric issues; (3) lack of approved pharmacotherapies to treat hallucinations and delusions associated with dementia-related psychosis; and (4) regulatory and institutional guidelines, including the long-term care regulatory guidelines established by the Centers for Medicare and Medicaid Services and the 5-star rating system. Barriers to the treatment of hallucinations and delusions in patients with dementia in the long-term care setting are myriad and complex. Early diagnosis of dementia-related psychosis and new treatment options for managing hallucinations and delusions are needed to improve care of this patient population.
Topics: Aged; Delusions; Dementia; Hallucinations; Humans; Long-Term Care; Medicare; Psychotic Disorders; United States
PubMed: 35275456
DOI: 10.4088/JCP.21m14050