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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 -
Nordic Journal of Psychiatry Sep 2018Religion and psychiatry may be both considered to be two different ways of explaining the unknown, of responding to questions about the meaning of life, and of bringing... (Review)
Review
BACKGROUND
Religion and psychiatry may be both considered to be two different ways of explaining the unknown, of responding to questions about the meaning of life, and of bringing healing.
AIMS
To discuss the border between religion and psychiatry.
METHOD
This lecture explores the interface between religion and psychiatry and discusses the border between soul and mind.
RESULTS
Religious beliefs may affect behaviours and may been seen on a psychopathological continuum with overvalued ideas and delusions. There is an overlap between psychiatric and religious categories, in possession states described in research literature and by many cultural groups. Several studies suggest possible factors for differentiating schizophrenia from demonic influence and report on the efficacy of exorcism among possessed/psychotic subjects. Diagnostic criteria have been proposed for dissociative trance disorder or possession disorder.
CONCLUSIONS
Both mental health professionals and religious believers may require criteria to distinguish adaptive and maladaptive expressions of religious experience.
Topics: Delusions; Humans; Religion; Religion and Psychology
PubMed: 30489188
DOI: 10.1080/08039488.2018.1525639 -
Psychiatry Research Sep 2023A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are... (Review)
Review
INTRODUCTION
A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are based on a limited number of cases and focus on a few drug classes, so a clear overview of this topic remains difficult. To address this issue, we provide in this article a comprehensive analysis of drug-induced delusion, based on the World Health Organization (WHO) pharmacovigilance database.
METHODS
We performed a disproportionality analysis of this database using the information component (IC). The IC compares observed and expected values to find associations between drugs and delusion, using disproportionate Bayesian reporting. An IC0.25 (lower end of the IC 95% credibility interval) > 0 is considered statistically significant.
RESULTS
Here we present an analysis of 4559 suspected drug-induced delusion reports in the WHO pharmacovigilance database. These results identified 66 molecules statistically associated with delusion and an extensive analysis of confounding factors and coprescriptions was performed, using full database as background with an IC0.25 > 0. The main drug classes involved were antidepressants, antiepileptics, dopaminergic agents, opioids, antiinfective agents, benzodiazepines, anti-dementia drugs and psychostimulants.
CONCLUSION
These results will help clinicians identify potential suspected drugs associated with delusion and decide which drug to discontinue and eventually lead to a re-evaluation of drug labels for some molecules.
Topics: Humans; Pharmacovigilance; Bayes Theorem; Delusions; Antidepressive Agents; Databases, Factual; World Health Organization; Adverse Drug Reaction Reporting Systems; Central Nervous System Stimulants
PubMed: 37517106
DOI: 10.1016/j.psychres.2023.115365 -
Comprehensive Psychiatry Apr 2021Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act... (Review)
Review
OBJECTIVES
Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act according to their delusions. This study proposes an investigation of how this issue is addressed in psychopathological literature.
METHODS
This article offers a critical review of psychopathological literature which focuses on the influence of delusional ideation on behaviour.
RESULTS
Phenomenological psychiatry has relied on the paradox pointed out by Bleuler and Jaspers to emphasize disorders of self-experience in psychosis whereas analytical philosophy of delusion has focused on the psychological status of delusion, regarded as belief, certainty, or imagination. The empirical studies conducted during the past three decades - which were devoted to acting on delusion - focused on violent and safety-seeking behaviours. These studies have shown that these behavioural disorders are motivated by an emotional outburst (anger and/or fear) rather than by delusional content.
CONCLUSION
Delusional inconsequentiality can be clarified by conceptual research in phenomenological psychiatry and analytical philosophy, even though its role in the psychopathological processes has not yet been clearly identified or conceptualised. Empirical psychopathology on acting on delusion confirms the delusional inconsequentiality, but only implicitly, by highlighting the role of affectivity (rather than beliefs) in delusional actions. Given the major implications of better understanding this phenomenon, in terms of psychopathology and clinical practices, we suggest considering delusional inconsequentiality as a promising concept which could guide further research in contemporary psychopathology.
Topics: Delusions; Humans; Psychiatry; Psychopathology; Psychotic Disorders; Thinking
PubMed: 33581447
DOI: 10.1016/j.comppsych.2021.152230 -
Journal of Psychosomatic Obstetrics and... Mar 2022Delusions of pregnancy are associated with functional impairment and psychological distress. Previous works have focused on characterizing their etiology and identifying... (Review)
Review
PURPOSE
Delusions of pregnancy are associated with functional impairment and psychological distress. Previous works have focused on characterizing their etiology and identifying contributory social and cultural factors. The purpose of this review is to give an overview of the literature on medical or surgical comorbidities associated with delusions of pregnancy.
METHODS
We searched Google Scholar, PubMed, and PsycInfo using the terms "pregnancy delusion," "delusional pregnancy," "pseudocyesis", and "false/pseudo/phantom/spurious pregnancy" to identify all published cases of delusional pregnancies. We included cases in which medical or surgical factors might have contributed to the delusion. We extracted the following information from selected case reports: patient age, psychiatric diagnoses, medications, medical comorbidities, somatic complaints, treatment, and outcome.
RESULTS
We found that 23 of 140 cases (16.4%) were potentially influenced by concomitant medical or surgical conditions including gallstones, abdominal tumors, hyperprolactinemia, constipation, a tubal cyst, and esophageal achalasia. Medical or surgical treatment was pursued in 15 of these 23 cases, followed by mitigation of the delusion in ten cases.
CONCLUSIONS
We emphasize the importance of a thorough workup including physical and gynecological examinations in patients presenting with a delusion of pregnancy. Clinicians should recognize and overcome potential barriers to undertaking comprehensive assessments in order to prevent delays in management and treatment of underlying medical or surgical conditions.
Topics: Delusions; Female; Humans; Mental Disorders; Pregnancy; Pregnancy Trimester, Third
PubMed: 32597281
DOI: 10.1080/0167482X.2020.1779696 -
International Review of Psychiatry... 2020Capgras and Fregoli syndromes are two psychotic and complex conditions also known as Delusional Misidentification Syndromes (DMSs). Their description dates back to the... (Review)
Review
Capgras and Fregoli syndromes are two psychotic and complex conditions also known as Delusional Misidentification Syndromes (DMSs). Their description dates back to the beginning of XX century, and many explanatory models have been formulated through myths, psychoanalytical and psychological hypotheses, as well as neurobiological proposals. Even if DMSs are not fully considered in the modern diagnostic manuals, they still remain intriguing phenomena to be clinically observed and explained. Also, the employment of psychotropics and physical techniques in the treatment of such conditions is not supported by robust evidences and this may encourage further studies. We conclude that it would be of great interest to brush up the neglected MDSs in order to improve our knowledge on the underlying mechanisms of delusion and brain functioning.
Topics: Capgras Syndrome; Delusions; Humans; Neurobiology
PubMed: 32378427
DOI: 10.1080/09540261.2020.1756625 -
American Journal of Alzheimer's Disease... Jun 2015Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy. (Review)
Review
BACKGROUND
Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy.
OBJECTIVE
To identify the characteristic of a psychotic symptom, the phenomenon of delusion of pregnancy, in the context of dementia.
METHOD
MEDLINE and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2014. Search terms used included delusion of pregnancy, uncommon presentation, behavioral and psychological symptoms, dementia, Alzheimer's disease, and frontotemporal dementia (FTD). Publications found through this indexed search were reviewed for further relevant references. We included case reports that highlight the relationship and overlap between dementia presenting as schizophrenia-like psychosis and schizophrenia.
RESULTS
Literature on delusion of pregnancy in the course of dementia consists mostly of case reports and small samples of patients.
CONCLUSION
Psychotic phenomena such as delusion of pregnancy may be a feature in some cases of dementia. If this bizarre features of dementia appears as early presentation of FTD whose usual onset is in the presenium, it may be mistaken for schizophrenia.
Topics: Delusions; Dementia; Humans
PubMed: 25193999
DOI: 10.1177/1533317514549412 -
Der Nervenarzt Nov 1998The present article endeavours an outline of depressive delusions, their symptomatology and their various topics. Their relations to depressive feelings of guilt and... (Review)
Review
The present article endeavours an outline of depressive delusions, their symptomatology and their various topics. Their relations to depressive feelings of guilt and anxiety are discussed and differentiated. Delusions of guilt, poverty or disease including their preliminary states are by no means rare but regularly occurring symptoms which substantiate the diagnosis of major depressive disorder/endogenous depression/melancholia. Preliminary states like hypochondriatic fears of guilt and poverty are likewise characteristic clinical signs which may be differentiated with high validity from the kind of anxiety associated to neurotic depression/dysthmia. Delusional depression did not prove to be a nosological entity but as a concept may bear considerable heuristic value concerning therapeutic considerations. This particularly serious form of depression requires specific therapeutic procedures.
Topics: Delusions; Depressive Disorder; Diagnosis, Differential; Humans
PubMed: 9859116
DOI: 10.1007/s001150050369 -
The International Journal of... Oct 2015The delusional experience is the result of a grave disjunction in the psyche whose outcome is not readily predictable. Examination of the specific mode of disjunction... (Review)
Review
The delusional experience is the result of a grave disjunction in the psyche whose outcome is not readily predictable. Examination of the specific mode of disjunction may help us understand the nature and radical character of delusion. I will present the therapy of a psychotic patient who after many years of analysis and progresses in his life continues to show delusional episodes although limited and contained. In his case, the two visions, one delusional and the other real, remain distinct and differentiated from each other because they both possess the same perceptual character, that of reality. He has a bi-ocular vision of reality and not a binocular one because his vision lacks integration, as would necessarily be the case if the two visions could be compared with each other. The principle of non-contradiction ceases to apply in delusion. A corollary of the failure of the principle of non-contradiction is that, if a statement and its negation are both true, then any statement is true. Logicians call this consequence the principle of explosion. For this reason, the distinction between truth, reality, improbability, probability, possibility and impossibility is lost in the delusional system, thus triggering an omnipotent, explosive mechanism with a potentially infinite progression. The paper presents some thoughts for a possible analytic transformation of the delusional experience.
Topics: Adult; Delusions; Humans; Male; Psychoanalytic Therapy; Psychotic Disorders; Vision, Binocular
PubMed: 26298703
DOI: 10.1111/1745-8315.12317 -
Geriatrics & Gerontology International Jan 2014Alzheimer's disease and other dementia are associated with cognitive and functional impairment, as well as neuropsychiatric sequelae, including psychotic features.... (Review)
Review
Alzheimer's disease and other dementia are associated with cognitive and functional impairment, as well as neuropsychiatric sequelae, including psychotic features. Research has largely concentrated on the study of cognitive decline, but the associated behavioral and neuropsychiatric symptoms are of equal importance in the clinical profile of the disease. Delusions are common, disabling and persistent in the course of dementia. The purpose of the present review was to examine the phenomenon of delusion in people with dementia. We searched the electronic databases for original research and review articles using the search terms "delusion, dementia, Alzheimer's disease, frontotemporal dementia, vascular dementia and Lewy body disease". Various types of explanations have been proposed regarding the etiology of delusional belief in dementia, and cerebral correlates are considered. Pharmacological and non-pharmacological treatments are analyzed.
Topics: Aged; Cognition; Delusions; Dementia; Geriatric Assessment; Humans; Neuropsychological Tests
PubMed: 23879399
DOI: 10.1111/ggi.12105