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Molecular Neurobiology May 2024Schizophrenia (SCZ) is a complex, severe psychotic disorder that is highly persistent. Patients often cannot control their emotions and have delusions of victimization,...
Schizophrenia (SCZ) is a complex, severe psychotic disorder that is highly persistent. Patients often cannot control their emotions and have delusions of victimization, world-weariness, and even suicide. Therefore, safer and more effective drugs are urgently needed. Rannasangpei (RNSP) from "the four medicine tantras" was used as a neuroprotective agent. The objective of this study was to investigate the effect and mechanism of RNSP on MK-801-induced SCZ in mice. Fifty C57BL/6J mice were randomly divided into a normal group, a model group, an RNSP group, a crocin (CRO) group, and an olanzapine (OLA) group, except for the normal group. The remaining mice were used to establish the MK-801-induced SCZ model. Changes in positive symptoms and cognitive impairment in mice before and after drug intervention were assessed by using the prepulse inhibition (PPI) test, Y-maze test (YMT), and open-field test (OFT). Intragastric administration of RNSP alleviated the symptoms of SCZ in SCZ mice, as demonstrated by the PPI, YMT, and OFT results. Compared with the model group, the first-line antipsychotic olanzapine reversed the anxiety-like phenotypes, hypermotility, and PPI deficits in the SCZ model mice. Further analysis revealed that RNSP reduced oxidative stress in SCZ model mice, as evidenced by increased superoxide dismutase (SOD) levels and decreased malondialdehyde (MDA) levels in the hippocampus, cortex, and blood of SCZ model mice. In our study, RNSP treatment restored the expression of brain-derived neurotrophic factor (BDNF), dopamine D2 receptor, p-Trkb, Akt/p-Akt, and doublecortin and inhibited the expression of IBA1 and Bax in the hippocampus of SCZ model mice. The polymerase chain reaction data indicated that RNSP treatment increased the expression of Bcl-2 and TGF-β and decreased the expression of Bax, IL-1β, and TNF-α in the brains of the model mice. Our results are the first to show that RNSP reverses SCZ-like behaviors in rodents (both positive symptoms and cognitive deficits) by reducing oxidative stress and activating the BDNF-TrkB/Akt pathway, suggesting that RNSP is a novel approach for treating SCZ.
PubMed: 38753130
DOI: 10.1007/s12035-024-04213-5 -
Cureus Apr 2024Cotard's syndrome is a rare clinical condition characterized by the presence of nihilistic delusions, delusions of immortality, depressive mood, and anxiety....
Longitudinal Changes of Regional Cerebral Blood Flow on a Single-Photon Emission Computed Tomography (SPECT) Scan in a Patient With Schizophrenia Having Cotard's Syndrome.
Cotard's syndrome is a rare clinical condition characterized by the presence of nihilistic delusions, delusions of immortality, depressive mood, and anxiety. Longitudinal changes in regional cerebral blood flow (rCBF) obtained under different conditions with and without Cotard's syndrome have rarely been reported in the literature. We report a case of a patient with Cotard's syndrome in whom longitudinal rCBF was assessed using single-photon emission computed tomography (SPECT). The patient was a 52-year-old man suffering from schizophrenia and mild mental retardation. He was transported to our hospital because of lumbar fractures caused by a suicidal attempt. In the second week after admission, he displayed Cotard's syndrome, i.e., nihilistic delusions, suicidal thoughts, and depressive mood. SPECT with 99mTc-ethyl cysteinate dimer was performed, and the rCBF increased in the bilateral prefrontal cortex but decreased in the occipital and parietal lobes. He was treated with pharmacotherapy mainly using lurasidone, and his Cotard's symptoms disappeared. SPECT was performed again. The increased rCBF in the bilateral prefrontal cortex and the decreased rCBF in the right occipital and parietal lobes were improved. The present case suggests that increased rCBF in the prefrontal cortex and decreased rCBF in the right occipital and parietal lobes are associated with the development of Cotard's syndrome.
PubMed: 38752030
DOI: 10.7759/cureus.58263 -
Cureus Apr 2024Current literature shows very few case reports about manic symptoms arising in patients with arteriovenous malformations and no other predisposing factors, where these...
Current literature shows very few case reports about manic symptoms arising in patients with arteriovenous malformations and no other predisposing factors, where these cases presented with mania before the initiation of treatment. We report a rare case of a 46-year-old male patient, with a history of a left arteriovenous malformation (AVM) status post radiation treatment with associated seizures, who presented to the emergency department of a local hospital with acute mania and other behavioral changes. The patient had manic symptoms, including mood lability, impulsivity, insomnia, decreased appetite, jealous delusions, pressured speech, and suicidal ideations. The patient's escitalopram dose for depression was reduced from 20 mg to 10 mg, and valproate was started during admission. After a three-day hospital admission, his psychiatric symptoms gradually improved. He was subsequently discharged home with additional instructions to follow up with his neurologist. In this case report, we show that organic manic disorder should be considered in any manic patient who presents outside the usual age of onset for idiopathic manic-depressive disease, lacks a family or personal history of affective disturbance, or exhibits concomitant neurologic deficits. In addition, we emphasize that distinguishing between primary psychiatric conditions and those secondary to medical causes for patients who present with acute mania can significantly impact the care a patient receives and can make a difference in their psychiatric and medical prognosis.
PubMed: 38752023
DOI: 10.7759/cureus.58297 -
Clinical Neurology and Neurosurgery Jul 2024Psychosis, especially in delusions, greatly impairs the quality of life of patients with Parkinson's disease (PD) and their caregivers. Few objective risk indicators of...
OBJECTIVES
Psychosis, especially in delusions, greatly impairs the quality of life of patients with Parkinson's disease (PD) and their caregivers. Few objective risk indicators of the association between psychosis and clinical features has been reported. It is unclear whether the reduction in DAT binding represents the underlying mechanism of delusion or its association. There are no long-term data on the objective prognostic value of DAT binding for delusions. We investigated whether DAT binding at baseline can be a prognostic risk factor for future development of PD delusions.
MATERIALS AND METHODS
We reviewed the detailed clinical chart of patients with PD without a history of psychosis who underwent [I]FP-CIT SPECT during the disease. The endpoint was defined as when the delusions occurred during the 5 years after the examination of [I]FP-CIT SPECT. Specific binding ratio (SBR) values were calculated.
RESULTS
Sixty-one patients with PD were included in the analysis, and 11 patients had delusions within 5 years of [I] FP-CIT SPECT. The average (p = 0.004), minimum (p = 0.004), maximum (p = 0.001), right-sided (p = 0.002), and left-sided (p = 0.003) SBRs in the striatum were significantly smaller in patients with delusions than in patients without delusions. Each difference of each SBR was significantly smaller than those without delusions after adjusting after controlling for age, gender, disease severity, timing of [I]FP-CIT SPECT, anti-parkinsonian medications, hospitalization, administering more or newly anti-parkinsonian drugs, and receiving DBS or LCIG.
CONCLUSIONS
PD delusions is still problematic, and lowering DAT binding may be helpful for predicting future delusions, regardless of the timing of [I]FP-CIT SPECT.
Topics: Humans; Male; Female; Delusions; Dopamine Plasma Membrane Transport Proteins; Tomography, Emission-Computed, Single-Photon; Aged; Middle Aged; Parkinson Disease; Tropanes; Retrospective Studies; Aged, 80 and over
PubMed: 38749355
DOI: 10.1016/j.clineuro.2024.108321 -
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