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The Lancet. Psychiatry Jul 2024
Topics: Humans; Delusions
PubMed: 38705168
DOI: 10.1016/S2215-0366(24)00058-0 -
Cognitive Neurodynamics Apr 2024Schizophrenia (SZ) is a mental disorder that causes lifelong disorders based on delusions, cognitive deficits, and hallucinations. By visual assessment, SZ diagnosis is...
Schizophrenia (SZ) is a mental disorder that causes lifelong disorders based on delusions, cognitive deficits, and hallucinations. By visual assessment, SZ diagnosis is time-consuming and complicated, because brain states are more effectively revealed by electroencephalogram (EEG) signals, which are effectively used in SZ diagnosis. The application of existing deep learning methods in SZ detection is effective in the classification of 2-dimensional images, and these methods require more computational resources. Therefore, dimensionality reduction is necessary for SZ diagnosis using EEG signals. To reduce the dimensionality of the data, an improved CAO (ICAO) dimensionality reduction method is proposed, which integrates horizontal and vertical crossover approaches with AOA. The optimal feature subset is achieved by satisfying the ICAO conditions, and a fitness function is evaluated based on rough sets for improved accuracy in feature selection. Therefore a Crossover-boosted Archimedes optimization algorithm (AOA) with rough sets for Schizophrenia detection (CAORS-SD) was proposed using multichannel EEG signals from both SZ and normal patients. The signals are decomposed using multivariate empirical mode decomposition into multivariate intrinsic mode functions (MIMFs). Entropy metrics such as spectral entropy, permutation entropy, approximate entropy, sample entropy, and SVD entropy are evaluated on the MIMF domain to detect SZ. The processing time of the kernel support vector machine classifier is minimized with fewer features, reducing the risk Fof overfitting. Accuracy, sensitivity, specificity, precision, and F1-score of the CAORS-SD model should be conducted to diagnose SZ. Therefore, the proposed CAORS-SD method achieves the higher performance of accuracy, sensitivity, specificity, precision, and F1-score values of 96.34, 98.95, 96.86, 98.52, and 96.74% respectively. Also, the CAORS-SD method minimizes the error rate and significantly reduces the execution time.
PubMed: 38699607
DOI: 10.1007/s11571-023-10011-x -
ArXiv Apr 2024The mechanisms of psychotic symptoms like hallucinations and delusions are often investigated in fully-formed illness, well after symptoms emerge. These investigations...
The mechanisms of psychotic symptoms like hallucinations and delusions are often investigated in fully-formed illness, well after symptoms emerge. These investigations have yielded key insights, but are not well-positioned to reveal the dynamic forces underlying symptom formation itself. Understanding symptom development over time would allow us to identify steps in the pathophysiological process leading to psychosis, shifting the focus of psychiatric intervention from symptom alleviation to prevention. We propose a model for understanding the emergence of psychotic symptoms within the context of an adaptive, developing neural system. We will make the case for a pathophysiological process that begins with cortical hyperexcitability and bottom-up noise transmission, which engenders inappropriate belief formation via aberrant prediction error signaling. We will argue that this bottom-up noise drives learning about the (im)precision of new incoming sensory information because of diminished signal-to-noise ratio, causing an adaptive relative over-reliance on prior beliefs. This over-reliance on priors predisposes to hallucinations and covaries with hallucination severity. An over-reliance on priors may also lead to increased conviction in the beliefs generated by bottom-up noise and drive movement toward conversion to psychosis. We will identify predictions of our model at each stage, examine evidence to support or refute those predictions, and propose experiments that could falsify or help select between alternative elements of the overall model. Nesting computational abnormalities within longitudinal development allows us to account for hidden dynamics among the mechanisms driving symptom formation and to view established symptomatology as a point of equilibrium among competing biological forces.
PubMed: 38699166
DOI: No ID Found -
Journal of Neural Transmission (Vienna,... Jul 2024Psychotic major depression (PMD) is characterized by major depressive disorder (MDD) accompanied by delusions or hallucinations. While the prevalence of PMD and its...
BACKGROUND
Psychotic major depression (PMD) is characterized by major depressive disorder (MDD) accompanied by delusions or hallucinations. While the prevalence of PMD and its association with anxiety have been studied, gender-specific differences and the role of thyroid hormones in PMD-related anxiety remain less explored.
METHODS
A total of 1718 first-episode and drug-naïve MDD patients was assessed for the presence of PMD and severe anxiety. Clinical assessments, including Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impressions-Severity (CGI-S) scale, were conducted to assess depression, anxiety, psychotic symptoms, and clinical severity, respectively. Blood samples were collected to measure thyroid function parameters.
RESULTS
The prevalence of severe anxiety was higher in PMD patients compared to non-psychotic MDD patients (71.3% vs. 5.3%). No significant gender differences were observed in the prevalence of severe anxiety among PMD patients. However, elevated thyroid-stimulating hormone (TSH) levels and increased depression severity (HAMD scores) were identified as independent risk factors for severe anxiety in female PMD patients. In contrast, no significant risk factors were found in male PMD patients. The area under the receiver operating characteristic (AUCROC) analysis revealed that the HAMD score and TSH level showed acceptable discriminatory capacity for distinguishing between female PMD patients with and without severe anxiety.
CONCLUSION
This study highlights the heightened prevalence of severe anxiety in PMD patients, with TSH levels and depression severity emerging as gender-specific risk factors for anxiety in females. These findings suggest the importance of thyroid hormone assessment and tailored interventions for managing anxiety in female PMD patients.
Topics: Humans; Female; Male; Adult; Depressive Disorder, Major; Middle Aged; Sex Factors; Anxiety; Thyroid Hormones; Severity of Illness Index; Psychotic Disorders; Young Adult; Sex Characteristics; Thyrotropin
PubMed: 38693463
DOI: 10.1007/s00702-024-02781-3 -
Epileptic Disorders : International... Jun 2024Psychosis of epileptic origin can present a wide range of cognitive and affective symptoms and is often underrecognized. Usually occurring in the inter- and postictal...
Psychosis of epileptic origin can present a wide range of cognitive and affective symptoms and is often underrecognized. Usually occurring in the inter- and postictal phase, epileptic psychosis is mostly related to temporal lobe epilepsy. Here, we describe the clinical presentation and diagnostic workup including routine EEG recording and brain MRI of a 63-year-old woman expressing isolated nihilistic delusions comprising belief of being dead and denial of self-existence. EEG showed an ictal pattern fulfilling the Salzburg criteria of nonconvulsive status epilepticus and brain MRI revealed extensive peri-ictal hyperperfusion. Delusional symptoms and EEG abnormalities subsided after acute antiseizure treatment. Our case illustrates how nihilistic delusions can occur as a direct clinical correlate of seizure activity, thereby expanding the spectrum of ictal neuropsychiatric phenomena in temporal lobe epilepsy and highlighting the need to consider an epileptic origin in patients presenting with psychotic symptoms.
Topics: Humans; Status Epilepticus; Female; Delusions; Middle Aged; Electroencephalography; Magnetic Resonance Imaging; Psychotic Disorders; Anticonvulsants
PubMed: 38686977
DOI: 10.1002/epd2.20221 -
Zhonghua Yi Xue Yi Chuan Xue Za Zhi =... May 2024To explore the genetic etiology for a patient with Alström syndrome (ALMS) presenting as dilated cardiomyopathy.
OBJECTIVE
To explore the genetic etiology for a patient with Alström syndrome (ALMS) presenting as dilated cardiomyopathy.
METHODS
A 41-year-old male patient who had presented at the Sixth Medical Center of PLA General Hospital on October 20, 2021 was selected as the study subject. Clinical and laboratory examinations were carried out. Whole exome sequencing (WES) was employed for genetic testing, and candidate variants were validated by Sanger sequencing and pathogenicity analysis.
RESULTS
The patient had a 14-year medical history characterized by dilated cardiomyopathy, complete atrioventricular block, visual impairment, sensorineural hearing loss, truncal obesity, insulin resistance, type 2 diabetes, hypertension, renal dysfunction, and paranoid delusions. Genetic testing revealed that he has harbored compound heterozygous variants of the ALMS1 gene, namely c.6823C>T (p.Arg2275Ter) and c.9442_9445dup (p.Ser3149LysfsTer2). Sanger sequencing confirmed that they were inherited from his father and mother, respectively. Based on the guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were predicted to be pathogenic (PVS1_VeryStrong+PM2_Supporting+PM3+PP3, PVS1_VeryStrong+PM2_Supporting+PM3). Literature review indicated that the complete atrioventricular block in the patient was a phenotype unreported previously.
CONCLUSION
The c.6823C>T (p.Arg2275Ter) and c.9442_9445dup (p.Ser3149LysfsTer2) compound heterozygous variants of the ALMS1 gene probably underlay the pathogenesis in this patient. Above findings have expanded the phenotypic spectrum of ALMS and provided insights for clinicians dealing with similar cases.
Topics: Humans; Male; Alstrom Syndrome; Adult; Cell Cycle Proteins; Genetic Testing; Exome Sequencing; Mutation; Asian People; East Asian People
PubMed: 38684308
DOI: 10.3760/cma.j.cn511374-20230401-00184 -
Neuropsychobiology Apr 202418q deletion syndrome is a rare genetic disorder characterized by various neurodevelopmental anomalies and medical issues. Although the occurrence of psychosis has been...
INTRODUCTION
18q deletion syndrome is a rare genetic disorder characterized by various neurodevelopmental anomalies and medical issues. Although the occurrence of psychosis has been reported in a small number of cases, details regarding the nature of such symptoms and their response to treatment have not been described.
CASE PRESENTATION
We describe a 31-year-old male with a history of speech delays, autistic features, a tethered spinal cord, bilateral vertical talus, subaortic stenosis and aortic regurgitation, recurrent otitis media, mild hearing loss, and hypospadias, who experienced a first episode of psychosis in his late 20s. His psychotic symptoms included auditory hallucinations, various delusions, and disorganization of thought. Although his presentation is atypical in certain ways (e.g., exhibiting highly fluctuant symptoms), he nonetheless meets criteria for schizophrenia. Given his overall clinical picture, chromosomal microarray analysis was completed, which revealed a 19.78 Mb deletion at 18q21.32 from nucleotide 58,226,713 to 78,015,180 (GRCh37). Despite exhibiting a somewhat idiosyncratic response to numerous antipsychotic medications, he eventually achieved partial remission of symptoms with improved insight on relatively low dose oral aripiprazole therapy.
CONCLUSION
This is the first in-depth description of 18q deletion syndrome-associated schizophrenia. While our patient's atypical presentation and idiosyncratic response to treatment may be mediated by his comorbid diagnosis of autism, his unusual psychiatric phenotype may alternatively be directly related to his underlying genetic disorder. The description of additional cases in the future will hopefully help clarify matters further.
PubMed: 38684151
DOI: 10.1159/000538693 -
Advances in Clinical and Experimental... Apr 2024Psychotic-like experiences (PLEs) refer to sub-threshold hallucinations and delusions observed in both clinical samples and the general population. Psychotic-like... (Review)
Review
Psychotic-like experiences (PLEs) refer to sub-threshold hallucinations and delusions observed in both clinical samples and the general population. Psychotic-like experiences have far-reaching implications for an individual's coping strategies and daily functioning. They are associated with both psychotic and non-psychotic disorders. This article presents a comprehensive review of the current literature on PLEs, incorporating a detailed exploration of the definition, prevalence, risk factors, functional impairments, and comorbid psychiatric disorders. Medline/PubMed and Embase were searched to establish and identify the literature. A total of 108 studies met our inclusion criteria. The genetic and biochemical backgrounds of PLEs are discussed, focusing on gene polymorphisms, changes in brain gyrification and hypothalamic-pituitary-adrenal (HPA) axis dysfunction. Psychological factors, such as trauma exposure, emotion regulation difficulties, cognitive biases, and attachment issues, were thoroughly examined, especially in terms of their impact on the emergence of PLEs. Here, we show how important the clinical aspects of developmental PLEs are, underlining the significance of an increased risk of self-harm and suicidal behaviors in those individuals and the comorbidity of psychiatric disorders in enabling clinicians to discern specific areas to observe. Although there is limited evidence on effective protocols for PLE management, various treatment approaches are explained. Despite increased research on PLEs in recent years, further investigation is needed to fully understand the nature of PLEs and to optimize therapeutic strategies. This article consolidates the current knowledge by synthesizing information on PLEs, including risk factors, comorbidities, treatments, and their impact on individual's lives.
PubMed: 38683046
DOI: 10.17219/acem/186815 -
Cureus Mar 2024Schizophrenia affects 1% of the population, causing chronic debilitating symptoms with largely unknown causes. Structural brain changes and neurochemical alterations are...
Schizophrenia affects 1% of the population, causing chronic debilitating symptoms with largely unknown causes. Structural brain changes and neurochemical alterations are believed to contribute to its etiology. Delayed treatment initiation is a major concern. This case involves a male patient with a decade-long history of psychosis, experiencing isolation, agoraphobia, and paranoid delusions. His situation deteriorated to the point where he lived in a self-imposed physically constraining environment for a year, leading to muscle atrophy and deteriorating health. Delayed help-seeking was driven by insurance concerns, despite prior academic success. Following extensive evaluation, he received the diagnosis of schizophrenia (first episode, severe), requiring multidisciplinary treatment, including medication adjustments and therapy. This case serves as a poignant illustration of a missed opportunity for early intervention, with treatment initiated only after symptoms became severe. Research indicates that early intervention in schizophrenia is crucial, typically leading to improved outcomes, emphasizing its critical importance.
PubMed: 38681378
DOI: 10.7759/cureus.57191 -
Progress in Neuro-psychopharmacology &... Jul 2024As a major mental health disorder, symptoms of schizophrenia (SCZ) include delusions, reduced motivation, hallucinations, reduced motivation and a variety of cognitive... (Meta-Analysis)
Meta-Analysis
As a major mental health disorder, symptoms of schizophrenia (SCZ) include delusions, reduced motivation, hallucinations, reduced motivation and a variety of cognitive disabilities. Many of these symptoms are now known to be associated with abnormal regulation of the immune system. Low blood levels of cytokines and chemokines have been suggested to be one of the underlying causes of SCZ. However, their biological roles at different stages of SCZ remain unclear. Our objective was to investigate expression patterns of cytokines and chemokines at different stages of onset and relapse in SCZ patients and to conduct an analysis of their relationship to disease progression. We also aimed to identify immune features associated with different disease trajectories in patients with SCZ. Gene set enrichment analysis (GSEA) was used to interrogate the GSE27383 dataset and identify key genes associated with inflammation. These results led us to recruit 36 healthy controls, 40 patients with first-episode psychosis (FEP), and 39 patients with SCZ relapse. Meso Scale Discovery technology was used to independently validate serum levels of 35 cytokines and chemokines. This was followed by a meta-analysis to gain a more comprehensive understanding of the role of interleukin-8 (IL-8/CXCL8) in SCZ. Analysis of the GSE27383 database revealed 3596 genes with distinct expression patterns. A significant portion of these genes were identified as inflammation-related and showed remarkable enrichment in three key pathways: IL-17, cytokine-cytokine receptor, and AGE-RAGE signaling in diabetic complications. We observed co-expression of CXCL8 and IL-16 within these three pathways. In a subsequent analysis of independently validated samples, a notable discrepancy was detected in the inflammatory status between individuals experiencing FEP and those in relapse. In particular, expression of CXCL8 demonstrated superior predictive capability in FEP and relapsed patients. Notably, results of the meta-analysis confirmed that Chinese and European populations were consistent with the overall results (Z = 4.60, P < 0.001; Z = 3.70, P < 0.001). However, in the American subgroup, there was no significant difference in CXCL8 levels between patients with SCZ compared to healthy controls (Z = 1.09, P = 0.277). Our findings suggest that the inflammatory response in patients with SCZ differs across the different stages, with CXCL8 emerging as a potential predictive factor. Collectively, our data suggest that CXCL8 has the potential to serve as a significant immunological signature of SCZ subtypes. Trial registration: The clinical registration number for this trial is ChiCTR2100045240 (Registration Date: 2021/04/09).
Topics: Humans; Schizophrenia; Interleukin-8; Adult; Female; Recurrence; Male; Young Adult; Cytokines
PubMed: 38670447
DOI: 10.1016/j.pnpbp.2024.111018