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BJPsych Open Apr 2023Both stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has been under-researched. To date,...
BACKGROUND
Both stroke and psychosis are independently associated with high levels of disability. However, psychosis in the context of stroke has been under-researched. To date, there are no general population studies on their joint prevalence and association.
AIMS
To estimate the joint prevalence of stroke and psychosis and their statistical association using nationally representative psychiatric epidemiology studies from two high-income countries (the UK and the USA) and two middle-income countries (Chile and Colombia) and, subsequently, in a combined-countries data-set.
METHOD
Prevalences were calculated with 95% confidence intervals. Statistical associations between stroke and psychosis and between stroke and psychotic symptoms were tested using regression models. Overall estimates were calculated using an individual participant level meta-analysis on the combined-countries data-set. The analysis is available online as a computational notebook.
RESULTS
The overall prevalence of probable psychosis in stroke was 3.81% (95% CI 2.34-5.82) and that of stroke in probable psychosis was 3.15% (95% CI 1.94-4.83). The odds ratio of the adjusted association between stroke and probable psychosis was 3.32 (95% CI 2.05-5.38). On the individual symptom level, paranoia, hallucinated voices and thought passivity delusion were associated with stroke in the unadjusted and adjusted analyses.
CONCLUSIONS
Rates of association between psychosis and stroke suggest there is likely to be a high clinical need group who are under-researched and may be poorly served by existing services.
PubMed: 37066638
DOI: 10.1192/bjo.2023.47 -
Psychiatria Polska Dec 2022The diagnostic criteria for schizophrenia and the diagnostic criteria for personality disorders refer to the same dimensions of mental functioning, except for the... (Review)
Review
The diagnostic criteria for schizophrenia and the diagnostic criteria for personality disorders refer to the same dimensions of mental functioning, except for the presence of typical psychotic symptoms in schizophrenia (hallucinations, delusions and catatonic behaviours). Since schizophrenia is a psychosis with a predominantly chronic course, with exacerbations and steady course periods, a simultaneous diagnosis of personality disorders, which are also "permanent" in nature, and a significant part of which affect the same areas of mental functioning, in the same patient is at least controversial. Although therapeutic interventions in patients with schizophrenia are mainly based on pharmacotherapy, psychotherapy and work with the patient's family are also important. Since pharmacotherapy is virtually ineffective for personality disorders, psychotherapy is the main form of management. This however does not constitute a justification for a simultaneous use of these two diagnoses in the same patient.
Topics: Humans; Schizophrenia; Psychotic Disorders; Hallucinations; Personality Disorders; Comorbidity; Delusions
PubMed: 37098191
DOI: 10.12740/PP/144112 -
Cotard's Delusion and Its Relation With Different Psychiatric Diagnoses in a Tertiary Care Hospital.Cureus May 2023Background Cotard's delusion/Cotard's syndrome is a series of delusions ranging from a false, fixed, unshakeable belief that one has lost their soul, blood, organs, and...
Background Cotard's delusion/Cotard's syndrome is a series of delusions ranging from a false, fixed, unshakeable belief that one has lost their soul, blood, organs, and body parts to the belief that one is dead. The syndrome was initially thought to be associated with only mood disorders but later was found in other psychiatric illnesses as well. Aim The study aimed to find an association between Cotard's delusion and the psychopathology of different psychiatric diagnoses. Method The clinical study comprised seven patients presenting with symptoms of Cotard syndrome with different presentations, diagnoses, and onset and meeting inclusion criteria. The study was carried out in the Department of Psychiatry, Assam Medical College and Hospital. The patients were hospitalized and, after a detailed history, mental status examination, and laboratory investigations, were treated with pharmacological and non-pharmacological methods. A descriptive statistical analysis was done. Results Denial of the existence of body organs was the most similar complaint encountered in the cases. The duration of illness onset ranged from weeks to months. The symptoms were found to be present in different psychiatric illnesses like schizophrenia, delusional disorder, depression, and intellectual disability. The patient had responded well to pharmacological agents with the exception of three patients who were treated with electroconvulsive therapy. Conclusion The study highlights the different subtypes of Cotard's syndrome and its associated symptoms, which provides a better understanding of the condition. The case series presents a finding of a higher proportion of male patients and adolescent cases than in previous reports. The study also provides valuable insights into its heterogeneity in the diagnosis and treatment of Cotard's syndrome, which may help in the early recognition and management of this rare condition.
PubMed: 37362522
DOI: 10.7759/cureus.39477 -
World Psychiatry : Official Journal of... Jun 2024
PubMed: 38727068
DOI: 10.1002/wps.21202 -
Psychiatrike = Psychiatriki Sep 2021The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic...
The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the patient's family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a greater extent the individual's whole experience. Their presence is associated with more severe symptoms, higher medication dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms with religious content for the first time. Other important prognostic factors are patients' lack of adherence to treatment, their greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special characteristics of religious delusions, which seem more corrosive to the patients' psyche than other delusions. Religion and spirituality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice. Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both preventing and treating psychotic disorders.
Topics: Delusions; Humans; Psychotic Disorders; Religion; Religion and Psychology; Schizophrenic Psychology
PubMed: 33770751
DOI: 10.22365/jpsych.2021.014 -
Frontiers in Integrative Neuroscience 2021Delusions are marked, fixed beliefs that are incongruent with reality. Delusions, with comorbid hallucinations, are a hallmark of certain psychotic disorders (e.g.,...
Delusions are marked, fixed beliefs that are incongruent with reality. Delusions, with comorbid hallucinations, are a hallmark of certain psychotic disorders (e.g., schizophrenia). Delusions can present transdiagnostically, in neurodegenerative (e.g., Alzheimer's disease and fronto-temporal dementia), nervous system disorders (e.g., Parkinson's disease) and across other psychiatric disorders (e.g., bipolar disorder). The burden of delusions is severe and understanding the heterogeneity of delusions may delineate a more valid nosology of not only psychiatric disorders but also neurodegenerative and nervous system disorders. We systematically reviewed structural neuroimaging studies reporting on delusions in four disorder types [schizophrenia (SZ), bipolar disorder (BP), Alzheimer's disease (AD), and Parkinson's disease (PD)] to provide a comprehensive overview of neural changes and clinical presentations associated with delusions. Twenty-eight eligible studies were identified. This review found delusions were most associated with gray matter reductions in the dorsolateral prefrontal cortex (SZ, BP, and AD), left claustrum (SZ and AD), hippocampus (SZ and AD), insula (SZ, BP, and AD), amygdala (SZ and BP), thalamus (SZ and AD), superior temporal gyrus (SZ, BP, and AD), and middle frontal gyrus (SZ, BP, AD, and PD). However, there was a great deal of variability in the findings of each disorder. There is some support for the current dopaminergic hypothesis of psychosis, but we also propose new hypotheses related to the belief formation network and cognitive biases. We also propose a standardization of assessments to aid future transdiagnostic study approaches. Future studies should explore the neural and biological underpinnings of delusions to hopefully, inform future treatment.
PubMed: 35140591
DOI: 10.3389/fnint.2021.726321 -
Biological Psychiatry. Cognitive... Nov 2022Persecutory delusions are among the most common delusions in schizophrenia and represent the extreme end of the paranoia continuum. Paranoia is accompanied by...
BACKGROUND
Persecutory delusions are among the most common delusions in schizophrenia and represent the extreme end of the paranoia continuum. Paranoia is accompanied by significant worry and distress. Identifying cognitive mechanisms underlying paranoia is critical for advancing treatment. We hypothesized that aberrant belief updating, which is related to paranoia in human and animal models, would also contribute to persecutory beliefs in individuals with schizophrenia.
METHODS
Belief updating was assessed in 42 participants with schizophrenia and 44 healthy control participants using a 3-option probabilistic reversal learning task. Hierarchical Gaussian Filter was used to estimate computational parameters of belief updating. Paranoia was measured using the Positive and Negative Syndrome Scale and the revised Green et al. Paranoid Thoughts Scale. Unusual thought content was measured with the Psychosis Symptom Rating Scale and the Peters et al. Delusions Inventory. Worry was measured using the Dunn Worry Questionnaire.
RESULTS
Paranoia was significantly associated with elevated win-switch rate and prior beliefs about volatility both in schizophrenia and across the whole sample. These relationships were specific to paranoia and did not extend to unusual thought content or measures of anxiety. We observed a significant indirect effect of paranoia on the relationship between prior beliefs about volatility and worry.
CONCLUSIONS
This work provides evidence that relationships between belief updating parameters and paranoia extend to schizophrenia, may be specific to persecutory beliefs, and contribute to theoretical models implicating worry in the maintenance of persecutory delusions.
Topics: Humans; Paranoid Disorders; Schizophrenia; Delusions; Anxiety; Surveys and Questionnaires
PubMed: 35430406
DOI: 10.1016/j.bpsc.2022.03.013 -
Psychiatria Danubina 2022
Topics: Antipsychotic Agents; Delusions; Humans; Parkinson Disease
PubMed: 35467618
DOI: 10.24869/psyd.2022.94 -
Frontiers in Behavioral Neuroscience 2022
PubMed: 35923897
DOI: 10.3389/fnbeh.2022.926742 -
Postepy Psychiatrii Neurologii Jun 2022This review discusses the assessment of psychotic disorders in prelingually deaf patients and the related challenges. (Review)
Review
PURPOSE
This review discusses the assessment of psychotic disorders in prelingually deaf patients and the related challenges.
VIEWS
Although prelingually deaf patients are often diagnosed with psychotic disorders, the clinical presentation of this group is complex and no clear guidelines regarding the assessment process can be formulated due to the lack of valid, reliable research. Sign language dynamics or language dysfluency may be falsely recognized as disorganized thinking. Some of the symptoms indicating disorganized thinking in the case of spoken languages may fulfill specific functions when used in sign language (for example object chaining). Furthermore, deaf individuals experience multiple stressors that may be considered as risk factors for developing delusions, especially for those growing up in hearing, non-signing families. Nevertheless, it is important to acknowledge that some seemingly delusional beliefs shared by prelingually deaf people may be associated with the lack of assisted learning, gullibility, low level of confidence in healthcare or deaf communities' social norms. The question concerning the sensory modality of hallucinations experienced by deaf individuals remains unresolved. Patients' accounts suggest that hallucinations described as auditory may be perceived as lip-reading without identifying the speaker's face, among others. However, for those who provide help it is far more important to recognize the function of hallucinations and to differentiate them from normative experience.
CONCLUSIONS
It is essential to expand our knowledge regarding the clinical presentation of psychotic disorders in deaf individuals in order to develop assessment guidelines and tools and, above all, increase the well-being of those suffering from psychotic disorders, as well as of those whose diagnosis remains unclear.
PubMed: 37082090
DOI: 10.5114/ppn.2022.118131