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Schizophrenia Research May 2024The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the... (Review)
Review
The purpose of the present article is to consider schizophrenia-the very idea-from the perspective of phenomenological psychopathology, with special attention to the problematic nature of the diagnostic concept as well as to the prospect and challenges inherent in focusing on subjective experience. First, we address historical and philosophical topics relevant to the legitimacy of diagnostic categorization-in general and regarding "schizophrenia" in particular. William James's pragmatist approach to categorization is discussed. Then we offer a version of the well-known basic-self or ipseity-disturbance model (IDM) of schizophrenia, but in a significantly revised form (IDMrevised). The revised model better acknowledges the diverse and even seemingly contradictory nature of schizophrenic symptoms while, at the same time, interpreting these in a more unitary fashion via the key concept of hyperreflexivity-a form of exaggerated self-awareness that tends to undermine normal world-directedness and the stability of self-experience. Particular attention is paid to forms of exaggerated "self-presence" that are sometimes neglected yet imbue classically schizophrenic experiences involving subjectivism or quasi-solipsism and/or all-inclusive or ontological forms of paranoia. We focus on the distinctively paradoxical nature of schizophrenic symptomatology. In concluding we consider precursors in the work of Klaus Conrad, Kimura Bin and Henri Grivois. Finally we defend the concept of schizophrenia by considering its distinctive way of altering certain core aspects of the human condition itself.
Topics: Humans; Ego; Schizophrenia; Schizophrenic Psychology; Self Concept
PubMed: 38693032
DOI: 10.1016/j.schres.2024.03.022 -
Archives of Iranian Medicine Mar 2024This study aimed to compare the level of mental disorders among families of ISIS captives residing in Sulaymaniyah with the native population in 2023. (Comparative Study)
Comparative Study
BACKGROUND
This study aimed to compare the level of mental disorders among families of ISIS captives residing in Sulaymaniyah with the native population in 2023.
METHODS
In the present descriptive-analytical cross-sectional study, a total of 383 ISIS captives by census aged 18-60 years were selected, along with an equal number of matched native individuals from Sulaymaniyah in terms of demographic characteristics. The data collection tool was the SCL-90 questionnaire. The 90-R-SCL interview and test were used to assess the level of symptoms related to mental disorders.
RESULTS
The results showed statistically significant differences between ISIS captives and the native population in terms of the total psychological disorder mean score (2.54±0.30 vs. 1.52±0.16; <0.001), Global Severity Index (GSI) (253.40±32.82 vs. 137.03±14.74; <0.001) and the mean scores of the dimensions of psychological disorder including: physical complaint (2.52±0.45 vs. 1.67±0.54; <0.001), obsessive compulsive disorder (2.51±0.43 vs. 1.50±0.44; <0.001), disorder in interpersonal relationships (2.55±0.44 vs. 19.10±0.29; <0.001), depressive disorder (2.60±0.41 vs. 1.60±0.55; <0.001), anxiety disorder (2.50±0.41 vs. 12.10±0.29; <0.001), aggression disorder (2.55±0.49 vs. 19.10±0.40; <0.001), morbid fear disorder (2.55±0.45 vs. 1.48±0.45; <0.001), paranoid ideation disorder (2.49±0.55 vs. 1.39±0.40; <0.001), and psychotic disorder (2.47±0.43 vs. 1.52±0.57; <0.001).
CONCLUSION
The findings of this study suggest that ISIS captives suffer from multiple psychological disorders, and the presence of more severe mental disorders among this population necessitates comprehensive psychiatric and psychological services for them.
Topics: Humans; Cross-Sectional Studies; Adult; Female; Male; Middle Aged; Young Adult; Mental Disorders; Adolescent; Iran; Surveys and Questionnaires; Severity of Illness Index; Family
PubMed: 38685838
DOI: 10.34172/aim.2024.21 -
Journal of Alzheimer's Disease : JAD 2024Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer's disease (AD) and other neurodegenerative... (Comparative Study)
Comparative Study
BACKGROUND
Psychosis, characterized by delusions and/or hallucinations, is frequently observed during the progression of Alzheimer's disease (AD) and other neurodegenerative dementias (ND) (i.e., dementia with Lewy bodies (DLB), and frontotemporal dementia (FTD)) and cause diagnostic and management difficulties.
OBJECTIVE
This review aims at presenting a concise and up-to-date overview of psychotic symptoms that occur in patients with ND with a comparative approach.
METHODS
A systematic review was conducted following the PRISMA guidelines. 98 original studies investigating psychosis phenotypes in neurodegenerative dementias were identified (40 cohort studies, 57 case reports).
RESULTS
Psychosis is a frequently observed phenomenon during the course of ND, with reported prevalence ranging from 22.5% to 54.1% in AD, 55.9% to 73.9% in DLB, and 18% to 42% in FTD. Throughout all stages of these diseases, noticeable patterns emerge depending on their underlying causes. Misidentification delusions (16.6-78.3%) and visual hallucinations (50-69.6%) are frequently observed in DLB, while paranoid ideas and somatic preoccupations seem to be particularly common in AD and FTD, (respectively 9.1-60.3% and 3.10-41.5%). Limited data were found regarding psychosis in the early stages of these disorders.
CONCLUSIONS
Literature data suggest that different ND are associated with noticeable variations in psychotic phenotypes, reflecting disease-specific tendencies. Further studies focusing on the early stages of these disorders are necessary to enhance our understanding of early psychotic manifestations associated with ND and help in differential diagnosis issues.
Topics: Humans; Psychotic Disorders; Neurodegenerative Diseases; Lewy Body Disease; Frontotemporal Dementia; Alzheimer Disease; Delusions; Dementia
PubMed: 38669539
DOI: 10.3233/JAD-231363 -
BMJ Case Reports Apr 2024We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history...
We present a case involving a male patient in his 30s who was admitted to hospital due to recurrent episodes of hypokalaemia over the past 5 years. His medical history revealed hypertension, attention deficit hyperactivity disorder (ADHD), autism, and paranoia. He was taking citalopram, ramipril, amlodipine, and pramipexole. Tests indicated normal levels of aldosterone/renin ratio and plasma metanephrines. On reviewing his dietary history, it was noted that he consumed 3 to 3.5 L of cola-flavoured drinks on a daily basis. Normal potassium levels were achieved after a significant reduction in cola-flavoured drinks intake and potassium replacement. Subsequent outpatient clinic follow-up revealed that normal potassium levels were maintained even after the patient ceased taking potassium replacement tablets. Given the rarity of hypokalaemia associated with fizzy drinks, the underlying mechanism for this association remains unclear. In this case report, we attempt to provide a possible explanation for the involved mechanisms.
Topics: Humans; Male; Hypokalemia; Adult; Carbonated Beverages; Attention Deficit Disorder with Hyperactivity; Hypertension
PubMed: 38649244
DOI: 10.1136/bcr-2023-258873 -
Cureus Mar 2024Late-onset psychosis refers to the development of psychotic symptoms after the age of 40 and can encompass various conditions like schizophrenia, mood disorders with...
Late-onset psychosis refers to the development of psychotic symptoms after the age of 40 and can encompass various conditions like schizophrenia, mood disorders with psychotic features, and delusional disorder. Non-pharmacological interventions are critically important in older adults with psychosis, especially considering the lack of evidence for the efficacy of antipsychotics and the high risk of side effects. Social isolation is recognized as one of the risks of late-onset psychosis, and interventions to eliminate this risk are becoming increasingly important in Japan, where social isolation among older people is widespread as society ages. We present a case of late-onset delusional disorder in which multidimensional interventions for social isolation and loneliness, which have significant impacts on symptoms, were effective in achieving persistent remission. The case involved a woman in her mid-70s who began to complain of paranoia that taking a painkiller recommended by her husband caused persistent pain. Her husband's hospitalization and the deterioration of her relationship with her children resulted in her becoming socially isolated, which intensified her delusions and led to aggressive behavior and depression. Although antipsychotic medications had a limited effect, remission was achieved through supportive psychotherapy, cognitive therapy, family education, participation in group occupational therapy, and the introduction of daycare services, which were implemented to reduce loneliness and social isolation. Specifically, supportive psychotherapy and family education for her loneliness, awareness of another possible cause of pain that she developed through Socratic questioning, and environmental adjustments played important roles in preparing her to accept cognitive therapy, achieve delusional remission, and maintain her state of remission, respectively. The interventions implemented in this case provide insights for addressing social isolation and loneliness in late-onset psychosis.
PubMed: 38646378
DOI: 10.7759/cureus.56697 -
Cureus Mar 2024Posterior reversible encephalopathy syndrome (PRES), which was first described in 1996, is a neurologic condition characterized by a combination of clinical and...
Posterior reversible encephalopathy syndrome (PRES), which was first described in 1996, is a neurologic condition characterized by a combination of clinical and neuroimaging findings. PRES may arise in the context of preeclampsia, eclampsia, renal failure, and sepsis, among other conditions. Neuropsychiatric symptoms of PRES include altered mental status, agitation, and in some cases psychosis. PRES occurring in the postpartum period is understudied, especially with regard to its psychiatric manifestations. We aim to add to the literature a case of PRES associated with psychosis and agitation in a postpartum woman, highlighting clinical implications and offering suggestions for practice. A female in her late 20s, with no significant psychiatric or medical history, presented to the hospital at 29 weeks and one day of gestation following a witnessed seizure. She was found to be hypertensive and hyponatremic, was diagnosed with eclampsia, and underwent an emergent cesarean section due to fetal malpresentation. The next day, the patient developed paranoia with acute agitation, and the psychiatry team diagnosed her with delirium with psychosis/agitation secondary to her underlying medical condition. She required intramuscular medications for agitation, was placed in restraints, and was transferred to the ICU for sedation. Subsequently, CT and MRI scans of her head both indicated that she had developed PRES. The patient's delirium and psychotic behavior resolved after appropriate treatment of her eclampsia. To our knowledge, this case report is the second documented case in the literature, of a patient who presented with PRES characterized by agitation and psychotic features in the postpartum period. Due to the significant overlap in symptoms between delirium and postpartum psychosis, this case highlights the crucial importance of interdisciplinary collaboration for accurate diagnosis and prompt treatment of PRES in the postpartum period. The case also speaks to the importance of differentiating postpartum psychosis associated with a primary psychiatric disorder from delirium arising in postpartum patients with or without a previous psychiatric history.
PubMed: 38646354
DOI: 10.7759/cureus.56731 -
Brain : a Journal of Neurology Apr 2024The prediction error account of delusions has had success. However, its explanation of delusions with different contents has been lacking. Persecutory delusions and...
The prediction error account of delusions has had success. However, its explanation of delusions with different contents has been lacking. Persecutory delusions and paranoia are the common unfounded beliefs that others have harmful intentions towards us. Other delusions include believing that one's thoughts or actions are under external control, or that events in the world have specific personal meaning. We compare learning on two different cognitive tasks, probabilistic reversal learning (PRL) and Kamin blocking, that have relationships to paranoid and non-paranoid delusion-like beliefs, respectively. We find that Clinical High-Risk status alone does not result in different behavioral results on the PRL task but that an individual's level of paranoia is associated with excessive switching behavior. During the Kamin blocking task, paranoid individuals learned inappropriately about the blocked cue. However, they also had decreased learning about the control cue, suggesting more general learning impairments. Non-paranoid delusion-like belief conviction (but not paranoia) was associated with aberrant learning about the blocked cue but intact learning about the control cue, suggesting specific impairments in learning related to cue combination. We fit task-specific computational models separately to behavioral data to explore how latent parameters vary within individuals between tasks, and how they can explain symptom-specific effects. We find that paranoia is associated with low learning rates on the PRL task as well as the blocking task. Non-paranoid delusion-like belief conviction was instead related to parameters controlling the degree and direction of similarity between cue updating during simultaneous cue presentation. These results suggest that paranoia and other delusion-like beliefs involve dissociable deficits in learning and belief updating, which - given the transdiagnostic status of paranoia - may have differential utility in predicting psychosis.
PubMed: 38637303
DOI: 10.1093/brain/awae122 -
Schizophrenia Research May 2024Predictive models of psychotic symptoms could improve ecological momentary interventions by dynamically providing help when it is needed. Wearable sensors measuring...
INTRODUCTION
Predictive models of psychotic symptoms could improve ecological momentary interventions by dynamically providing help when it is needed. Wearable sensors measuring autonomic arousal constitute a feasible base for predictive models since they passively collect physiological data linked to the onset of psychotic experiences. To explore this potential, we investigated whether changes in autonomic arousal predict the onset of hallucination spectrum experiences (HSE) and paranoia in individuals with an increased likelihood of experiencing psychotic symptoms.
METHOD
For 24 h of ambulatory assessment, 62 participants wore electrodermal activity and heart rate sensors and were provided with an Android smartphone to answer questions about their HSE-, and paranoia-levels every 20 min. We calculated random forests to detect the onset of HSEs and paranoia. The generalizability of our models was tested using leave-one-assessment-out and leave-one-person-out cross-validation.
RESULTS
Leave-one-assessment-out models that relied on physiological data and participant ID yielded balanced accuracy scores of 80 % for HSE and 66 % for paranoia. Adding baseline information about lifetime experiences of psychotic symptoms increased balanced accuracy to 82 % (HSE) and 70 % (paranoia). Leave-one-person-out models yielded lower balanced accuracy scores (51 % to 58 %).
DISCUSSION
Using passively collectible variables to predict the onset of psychotic experiences is possible and prediction models improve with additional information about lifetime experiences of psychotic symptoms. Generalizing to new individuals showed poor performance, so including personal data from a recipient may be necessary for symptom prediction. Completely individualized prediction models built solely with the data of the person to be predicted might increase accuracy further.
Topics: Humans; Male; Female; Adult; Psychotic Disorders; Proof of Concept Study; Wearable Electronic Devices; Hallucinations; Galvanic Skin Response; Young Adult; Paranoid Disorders; Ecological Momentary Assessment; Heart Rate; Smartphone; Monitoring, Ambulatory; Middle Aged
PubMed: 38615563
DOI: 10.1016/j.schres.2024.03.049 -
BMC Oral Health Apr 2024The Coronavirus 2019 disease (COVID-19) caused drastic changes in people's lifestyle that affected TMD characteristics through its physical and psychological influences....
BACKGROUND
The Coronavirus 2019 disease (COVID-19) caused drastic changes in people's lifestyle that affected TMD characteristics through its physical and psychological influences. The aim of this study was to define the clinical and psychological characteristics of a large group of well-defined TMD patients and seek their differences between before and during the COVID-19 pandemic to establish points of care to be emphasized in the post-pandemic era.
METHODS
TMD patients diagnosed by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) aged ≥ 18 were analyzed. Samples between September, 2017 to July, 2019 (n = 455) and March, 2021 to June, 2022 (n = 338) were collected to represent before and during COVID-19, respectively. The Graded Chronic Pain Scale (GCPS) and Symptom Checklist-90-Revision (SCL-90-R) were used to evaluate disability levels and psychological status. Clinical indices were compared between COVID periods and factors related to higher pain levels were investigated according to pandemic period.
RESULTS
More patients reported pain on palpation of the masticatory muscles during the pandemic (p = 0.021) while the number decreased for neck muscles (p = 0.001) and TMJ (p < 0.001) areas. Patients reporting nocturnal bruxism (23.3-29.6%) and clenching (45.1-54.7%) significantly increased during the pandemic. TMD patients with pain without disability were more common during the pandemic regardless of pain intensity (p < 0.001). The number of patients expressing interference in daily activities decreased drastically during COVID-19 regardless of disability level (p < 0.001). Factors associated with higher than moderate pain intensity (CPI ≥ 50) were insomnia (odds ratio [OR] = 1.603, p = 0.047) and somatization (OR = 1.082, p < 0.001) before the pandemic. During the pandemic, age (OR = 1.024, p = 0.007), somatization (OR = 1.070, p = 0.006), and paranoid ideation (OR = 1.117, p = 0.003) were significantly associated with higher pain intensity.
CONCLUSIONS
The results of our study underline the importance of evaluating psychological profiles of TMD patients, especially somatization, paranoid ideation and psychoticism, in exceptional situations that may cause a change in individual mental status. This will lead to a better understanding of the individual TMD patient and help in planning personalized treatment strategies that will assist the patient in adjusting to changes occurring in special environments such as the COVID-19 pandemic.
Topics: Humans; COVID-19; Pandemics; Temporomandibular Joint Disorders; Chronic Pain; Life Style
PubMed: 38609928
DOI: 10.1186/s12903-024-04168-y