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Frontiers in Psychiatry 2024Applying cognitive defusion techniques to enduring psychotic symptoms, such as delusions, presents both a challenge and a promising opportunity for psychiatric nurses to...
Effect of applying nursing-based cognitive defusion techniques on mindful awareness, cognitive fusion, and believability of delusions among clients with schizophrenia: a randomized control trial.
BACKGROUND
Applying cognitive defusion techniques to enduring psychotic symptoms, such as delusions, presents both a challenge and a promising opportunity for psychiatric nurses to manage delusions among schizophrenia clients.
OBJECTIVE
This study aimed to examine the impact of cognitive defusion techniques on psychological flexibility, mindful awareness, cognitive fusion, and the believability of delusions in schizophrenia clients.
METHODOLOGY
This study used a single-blind, parallel-arm Randomized Controlled Trial design. Over five weeks, 70 clients with schizophrenia were randomized to either the cognitive defusion intervention group (n = 35) or the control group (n = 35).
FINDINGS
The participants showed significant reductions in the believability of delusions, cognitive fusion, and psychological inflexibility immediately after the intervention and at follow-up. Notable enhancements were observed in cognitive defusion and mindfulness awareness abilities.
CONCLUSION
Cognitive defusion techniques positively affect schizophrenia clients who struggle with persistent delusional beliefs. This underscores the importance of further investigating this approach to decrease the intensity of delusions as part of a comprehensive therapeutic intervention. Psychiatric nurses must receive training in "cognitive defusion skills" to aid schizophrenia clients in becoming more aware of their emotions and modifying their coping strategies for delusional beliefs. On August 3, 2023, the research was retrospectively registered under the reference number NCT05759091 as a randomized clinical trial.
CLINICAL TRIAL REGISTRATION
https://classic.clinicaltrials.gov/ct2/show/NCT05759091, identifier NCT05759091.
PubMed: 38736628
DOI: 10.3389/fpsyt.2024.1369160 -
International Journal of Law and... 2024The number of women involved with forensic mental health systems internationally is rising, however, limited research has explored the characteristics of those assessed...
The number of women involved with forensic mental health systems internationally is rising, however, limited research has explored the characteristics of those assessed for criminal responsibility. We investigated the demographic, psychiatric, and criminological characteristics of women recommended as eligible or ineligible for the defence of Not Criminally Responsible (NCR) on account of mental disorder following a criminal responsibility assessment in Central Canada. Data were collected through retrospective chart reviews of court-ordered criminal responsibility assessments for 109 women referred for evaluations between 2003 and 2019. Accused were an average age of 34.55 years, predominately identified as Indigenous (37.7%) or Caucasian (20.8%), and had often been charged with assault (47.7%). Women identified in the reports as NCR-eligible were significantly more likely to be employed, experience delusions during the index offence, and have expert reports linking their mental health symptoms to NCR legal criteria. They were also significantly less likely to have a personality disorder, substance-related diagnosis, or have used substances during the index offence. Delusions during the index offence significantly predicted assessment recommendations when controlling for age at assessment order, current substance-related diagnosis, and whether the expert report linked mental health symptoms to NCR legal criteria. Findings indicate the key factors considered by forensic mental health professionals when conducting criminal responsibility assessments with women. Meaningful differences exist between women identified as NCR-eligible and ineligible, with findings illustrating who may be more likely to receive services within the Canadian forensic mental health system.
Topics: Humans; Female; Adult; Canada; Retrospective Studies; Mental Disorders; Middle Aged; Forensic Psychiatry; Mental Competency; Criminals; Young Adult; Insanity Defense
PubMed: 38735266
DOI: 10.1016/j.ijlp.2024.101988 -
Guiding Ethical Decisions in Cochlear Implantation for the Hearing Impaired with Comorbid Psychosis.The Journal of Clinical Ethics 2024AbstractCochlear implants can restore hearing in people with severe hearing loss and have a significant impact on communication, social integration, self-esteem, and...
AbstractCochlear implants can restore hearing in people with severe hearing loss and have a significant impact on communication, social integration, self-esteem, and quality of life. However, whether and how much clinical benefit is derived from cochlear implants varies significantly by patient and is influenced by the etiology and extent of hearing loss, medical comorbidities, and preexisting behavioral and psychosocial issues. In patients with underlying psychosis, concerns have been raised that the introduction of auditory stimuli could trigger hallucinations, worsen existing delusions, or exacerbate erratic behavior. This concern has made psychosis a relative contraindication to cochlear implant surgery. This is problematic because there is a lack of data describing this phenomenon and because the psychosocial benefits derived from improvement in auditory function may be a critical intervention for treating psychosis in some patients. The objective of this report is to provide an ethical framework for guiding clinical decision-making on cochlear implant surgery in the hearing impaired with psychosis.
Topics: Humans; Cochlear Implantation; Psychotic Disorders; Hearing Loss; Cochlear Implants; Quality of Life; Comorbidity; Decision Making; Clinical Decision-Making; Ethics, Medical
PubMed: 38728696
DOI: 10.1086/729415 -
The Journal of Craniofacial Surgery Jun 2024Cortical bone thickness is essential for the mechanical function of bone. Some factors including aging, sex, body size, hormone levels, behavior, and genetics lead to...
Cortical bone thickness is essential for the mechanical function of bone. Some factors including aging, sex, body size, hormone levels, behavior, and genetics lead to changes in cranial cortical robusticity. Moreover, the skull is one of the hardest and most durable structures in the human body. Schizophrenia is defined as a psychiatric disease characterized by delusions and hallucinations, and these patients have reduced brain volume; however, there is no study including cortical bone structure. For this reason, the aim of this study was to determine whether there is a difference in the skull cortical thickness of patients with schizophrenia and, compare it with healthy subjects. The cranial length, cranial width, anterior cortical thickness, right and left anterior cortical thickness, right and left lateral cortical thickness, right and left posterior lateral thickness, and posterior cortical thickness were measured with axial computed tomography images of 30 patients with schizophrenia and 132 healthy individuals aged between 18 and 69years. A statistically significant difference was found between the two groups in the measurements of right and left posterior lateral thickness, and posterior cortical thickness ( P = 0.006, P = 0.001, and P = 0.047, respectively). The sexes were compared, and it was found that the cranial width, anterior thickness, left anterior thickness, and right and left posterior thickness measurements of patients with schizophrenia showed a statistically significant difference compared with the control group ( P < 0.001, P = 0.003, P = 0.001, P < 0.001 and P < 0.001, respectively). The authors observed that skull cortical thickness may be different in schizophrenia. The results obtained from this study may be beneficial for evaluating these structures for clinical and pathological processes. Furthermore, knowledge about the skull cortical thickness in planning surgical procedures will increase the reliability and effectiveness of the surgical method, and this will minimize the risk of complications.
Topics: Humans; Male; Female; Schizophrenia; Adult; Middle Aged; Skull; Tomography, X-Ray Computed; Adolescent; Aged; Young Adult; Cortical Bone; Case-Control Studies
PubMed: 38727232
DOI: 10.1097/SCS.0000000000010261 -
World Psychiatry : Official Journal of... Jun 2024
PubMed: 38727068
DOI: 10.1002/wps.21202 -
Schizophrenia Research Jul 2024Schizophrenia is a complex neuropsychiatric disorder characterized by positive symptoms, negative symptoms, cognitive deficits, and co-occurring mood symptoms. Network...
BACKGROUND
Schizophrenia is a complex neuropsychiatric disorder characterized by positive symptoms, negative symptoms, cognitive deficits, and co-occurring mood symptoms. Network analysis offers a novel approach to investigate the intricate relationships between these symptom dimensions, potentially informing personalized treatment strategies.
METHODS
A cross-sectional study was conducted from November 2019 to October 2021, involving 1285 inpatients with schizophrenia in Liaoning Province, China. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA-14), and Montreal Cognitive Assessment (MoCA). Network analysis was conducted to investigate the network structure, central symptoms, and bridge symptoms.
RESULTS
The network analysis uncovered profound interconnectivity between core symptoms and the anxiety-depression community. Central symptoms, such as psychic anxiety, poor rapport, delusions, and attention, were identified as potential therapeutic targets. Bridge symptoms, including insomnia, depressed mood, anxiety-somatic, conceptual disorganization, and stereotyped thinking, emerged as key nodes facilitating interactions between symptom communities. The stability and reliability of the networks were confirmed through bootstrapping procedures.
DISCUSSION
The findings highlight the complex interplay between schizophrenia symptoms, emphasizing the importance of targeting affective symptoms and cognitive impairment in treatment. The identification of central and bridge symptoms suggests potential pathways for personalized interventions aimed at disrupting self-reinforcing symptom cycles. The study underscores the need for a transdiagnostic, personalized approach to schizophrenia treatment.
Topics: Humans; Schizophrenia; Adult; Male; Female; Cross-Sectional Studies; Middle Aged; Cognitive Dysfunction; China; Depression; Anxiety; Affective Symptoms; Young Adult
PubMed: 38723518
DOI: 10.1016/j.schres.2024.04.016 -
Iranian Journal of Nursing and... 2024The impact of the coronavirus disease 2019 (COVID-19) pandemic on health systems worldwide has been associated with less attention to maternal support in breastfeeding....
BACKGROUND
The impact of the coronavirus disease 2019 (COVID-19) pandemic on health systems worldwide has been associated with less attention to maternal support in breastfeeding. The objective of this study was to explore the experiences of breastfeeding mothers, during the COVID-19 pandemic, and the impact of the pandemic on breastfeeding initiation and maintenance.
MATERIALS AND METHODS
A qualitative, descriptive study was conducted by means of in-depth semi-structured interviews. The study participants included 28 mothers who had children aged 0 to 12 months, lived in Guilan Province, Iran, and had breastfed their children at least once after March 2021. Conventional content analysis was performed simultaneously with data collection.
RESULTS
Data analysis led to the extraction of three main categories and nine subcategories: in the shadow of peace (receiving correct information from reliable sources, observing health and quarantine principles, and enjoying the awareness of not having COVID-19 [both the mother and the infant]), under the stress (information poverty, invalid and stressful information, and stressful association of underlying diseases), and in the delusion of exposure (refusal to breastfeed, and non-compliance with recommendations).
CONCLUSIONS
Mothers' breastfeeding experiences during the COVID-19 pandemic indicate factors such as receiving or not receiving breastfeeding support, quarantine and the resulting stress, and exposure to conflicting information. Mothers felt that their experience with breastfeeding during the pandemic encouraged them to continue breastfeeding, but it is important to support breastfeeding mothers. Monitoring and supporting vulnerable groups such as breastfeeding mothers, for mental health problems during the COVID-19 pandemic, should be considered during the planning phase.
PubMed: 38721231
DOI: 10.4103/ijnmr.ijnmr_20_23 -
Neurology. Clinical Practice Jun 2024Dementia presents not only differing neuropsychiatric symptoms (NPS) across Alzheimer disease (AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB) but...
BACKGROUND AND OBJECTIVES
Dementia presents not only differing neuropsychiatric symptoms (NPS) across Alzheimer disease (AD), frontotemporal dementia (FTD), dementia with Lewy bodies (DLB) but also subjective cognitive decline (SCD). This study examined sex-based variations in NPS severity and progression across these conditions.
METHODS
We performed a longitudinal cohort study including 1,068 participants. Hierarchical generalized linear mixed models were used to model NPS as a function of disease severity and biological sex at birth.
RESULTS
Female participants with AD exhibited NPS more frequently than male participants. In FTD, female participants had more frequent delusions, hallucinations, and depression/dysphoria, while male participants had higher instances of agitation/aggression, apathy, disinhibition, and irritability/lability. In DLB, male participants showed higher instances of depression, and female participants more frequently experienced anxiety. In SCD, female participants showed higher nighttime behaviors. The trajectory of NPS significantly differed between sexes.
DISCUSSION
These findings highlight sex-specific NPS impact in different neurodegenerative conditions.
PubMed: 38720954
DOI: 10.1212/CPJ.0000000000200299 -
General Hospital Psychiatry 2024To improve understanding of Capgras syndrome (CS) in the pediatric population, this study investigates its clinical features and discerns similarities and differences...
OBJECTIVES
To improve understanding of Capgras syndrome (CS) in the pediatric population, this study investigates its clinical features and discerns similarities and differences compared to CS in adults.
METHODS
We conducted a descriptive systematic review of case reports following PRISMA guidelines, including cases of pediatric patients with CS. Patient demographics, medical and psychiatric history, imposter identity, underlying diagnosis, clinical manifestation, treatments, and outcomes were extracted and analyzed.
RESULTS
We included 37 articles comprising 38 cases. The median age of patients was 15, with 23 (60.5%) being male. The most prevalent underlying diagnoses were schizophrenia spectrum and other psychotic disorders (47.3%). Imposter identity involved parents in 32 cases (84.2%). Associated symptoms included persecutory delusions (63.1%), auditory hallucinations (42.1%), aggression (31.5%), and depression (21.0%).
CONCLUSION
There is a significant gap in our understanding of CS, particularly in pediatric patients. This is the first systematic review of CS in pediatric patients, encompassing all cases found in English literature since 1923.
Topics: Humans; Capgras Syndrome; Child; Adolescent; Male; Female
PubMed: 38718719
DOI: 10.1016/j.genhosppsych.2024.05.003 -
International Journal of Offender... May 2024The relationship between schizophrenia spectrum disorders (SSD) and violent offending has long been the subject of research. The present study attempts to identify the...
The relationship between schizophrenia spectrum disorders (SSD) and violent offending has long been the subject of research. The present study attempts to identify the content of delusions, an understudied factor in this regard, that differentiates between violent and non-violent offenses. Limitations, clinical relevance, and future directions are discussed. Employing a retrospective study design, machine learning algorithms and a comprehensive set of variables were applied to a sample of 366 offenders with a schizophrenia spectrum disorder in a Swiss forensic psychiatry department. Taking into account the different contents and affects associated with delusions, eight variables were identified as having an impact on discriminating between violent and non-violent offenses with an AUC of 0.68, a sensitivity of 30.8%, and a specificity of 91.9%, suggesting that the variables found are useful for discriminating between violent and non-violent offenses. Delusions of grandiosity, delusional police and/or army pursuit, delusional perceived physical and/or mental injury, and delusions of control or passivity were more predictive of non-violent offenses, while delusions with aggressive content or delusions associated with the emotions of anger, distress, or agitation were more frequently associated with violent offenses. Our findings extend and confirm current research on the content of delusions in patients with SSD. In particular, we found that the symptoms of threat/control override (TCO) do not directly lead to violent behavior but are mediated by other variables such as anger. Notably, delusions traditionally seen as symptoms of TCO, appear to have a protective value against violent behavior. These findings will hopefully help to reduce the stigma commonly and erroneously associated with mental illness, while supporting the development of effective therapeutic approaches.
PubMed: 38708899
DOI: 10.1177/0306624X241248356