-
Computational Psychiatry (Cambridge,... 2024Paranoid delusions or unfounded beliefs that others intend to deliberately cause harm are a frequent and burdensome symptom in early psychosis, but their emergence and...
Paranoid delusions or unfounded beliefs that others intend to deliberately cause harm are a frequent and burdensome symptom in early psychosis, but their emergence and consolidation still remains opaque. Recent theories suggest that overly precise prediction errors lead to an unstable model of the world providing a breeding ground for delusions. Here, we employ a Bayesian approach to test for such an unstable model of the world and investigate the computational mechanisms underlying emerging paranoia. We modelled behaviour of 18 first-episode psychosis patients (FEP), 19 individuals at clinical high risk for psychosis (CHR-P), and 19 healthy controls (HC) during an advice-taking task designed to probe learning about others' changing intentions. We formulated competing hypotheses comparing the standard Hierarchical Gaussian Filter (HGF), a Bayesian belief updating scheme, with a mean-reverting HGF to model an altered perception of volatility. There was a significant group-by-volatility interaction on advice-taking suggesting that CHR-P and FEP displayed reduced adaptability to environmental volatility. Model comparison favored the standard HGF in HC, but the mean-reverting HGF in CHR-P and FEP in line with perceiving increased volatility, although model attributions in CHR-P were heterogeneous. We observed correlations between perceiving increased volatility and positive symptoms generally as well as with frequency of paranoid delusions specifically. Our results suggest that FEP are characterised by a different computational mechanism - perceiving the environment as increasingly volatile - in line with Bayesian accounts of psychosis. This approach may prove useful to investigate heterogeneity in CHR-P and identify vulnerability for transition to psychosis.
PubMed: 38774429
DOI: 10.5334/cpsy.95 -
Frontiers in Psychiatry 2024Studies have consistently demonstrated increased stress sensitivity in individuals with psychosis. Since stress sensitivity may play a role in the onset and maintenance...
INTRODUCTION
Studies have consistently demonstrated increased stress sensitivity in individuals with psychosis. Since stress sensitivity may play a role in the onset and maintenance of psychosis, this could potentially be a promising target for treatment. The current study was the first to investigate whether reactivity to and recovery from daily-life stressors in psychosis change in response to treatment, namely virtual-reality-based cognitive behavioral therapy (VR-CBT).
METHODS
116 patients were randomized to either VR-CBT or the waiting list control group (WL). Pre-treatment and post-treatment participants completed a diary ten times a day during six to ten days. Multilevel analyses were used to model the time-lagged effects of daily stressful events on negative affect (NA) and paranoia symptoms to examine reactivity and recovery.
RESULTS
There was a significant difference in NA reactivity. VR-CBT showed higher NA at post-treatment compared to pre-treatment than WL (b=0.14; b=0.19 vs b=0.18; b=0.14). There was a significant difference in NA recovery and paranoia recovery between the groups at lag 1: VR-CBT showed relatively lower negative affect (b=0.07; b=-0.06) and paranoia (b= 0.08; b=-0.10) at post-treatment compared to pre-treatment than WL (b=0.08; b=0.08; b=0.04; b=0.03).
CONCLUSION
Negative affect and paranoia recovery improved in response to treatment. Increased NA reactivity may be explained by a decrease in safety behavior in the VR-CBT group. The discrepancy between reactivity and recovery findings may be explained by the inhibitory learning theory that suggests that an original threat reaction may not erase but can be inhibited as a consequence of exposure therapy.
PubMed: 38745779
DOI: 10.3389/fpsyt.2024.1360165 -
Spanish Journal of Psychiatry and... 2024Population studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian...
INTRODUCTION
Population studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian general population sample.
MATERIAL AND METHODS
We used a random representative sample previously identified via standard stratification procedures. Thus, a final sample of 4507 participants were included (response rate 83.7%). Interviewees were thoroughly assessed on sociodemographic, clinical and psychosocial factors, including: exposures to threatening life events (TLEs), childhood abuse, personality disorder and traits (neuroticism, impulsivity, paranoia), global functioning, physical health and toxics consumption. SAD diagnosis was ascertained using the Mini International Neuropsychiatric Interview. Both, pooled prevalences (with 95% confidence intervals) and risk correlates for SAD were estimated using binary logistic regression.
RESULTS
Estimated prevalence for SAD was 1.1% (95% CI=0.8-1.4). Having a SAD diagnosis was independently and significantly associated with younger age, poorer global functioning, higher neuroticism and paranoia personality traits, having suffered childhood abuse and exposure to previous TLEs. Furthermore, SAD was significantly associated with comorbid personality disorder, major depression, panic disorder and alcohol abuse.
CONCLUSIONS
Among this large Andalusian population sample, the prevalence of SAD and its associated factors are relatively similar to previously reported international studies, although no population study had previously reported such a strong association with paranoia.
Topics: Humans; Phobia, Social; Female; Male; Adult; Middle Aged; Spain; Prevalence; Young Adult; Adolescent; Comorbidity; Aged; Personality Disorders
PubMed: 38720187
DOI: 10.1016/j.rpsm.2021.09.006 -
Clinical Practice and Epidemiology in... 2024Wegener's disease is an autoimmune condition affecting the respiratory tract and kidneys. Mental health assessment is crucial due to the impact of psychological...
BACKGROUND
Wegener's disease is an autoimmune condition affecting the respiratory tract and kidneys. Mental health assessment is crucial due to the impact of psychological disorders on the immune system. Despite this, there is limited community-based research on psychiatric disorders and personality traits among patients with Wegener's disease.
OBJECTIVE
This study aimed to investigate the prevalence of psychiatric disorders and examine the predictive role of personality traits among patients with Wegener's disease.
METHODS
A total of 100 patients met the inclusion and exclusion criteria, and all of them were selected to participate in the study. Out of them, 75 individuals completed the questionnaires. The instruments included the SCL-90 questionnaire and the NEO Big Five personality traits. The data were analysed using Stata software, and the prevalence of psychiatric disorders in different patient groups was determined using the chi-square method. The predictive role of personality traits in mental disorders was examined using multivariate regression.
RESULTS
The results revealed that paranoia (53.3%) and depression (44%) had the highest prevalence in terms of psychiatric disorders, while psychosis (17.3%) and hostility (25.33%) had the lowest prevalence. Additionally, the findings demonstrated a positive correlation between most psychiatric disorders and the neuroticism personality trait.
CONCLUSION
Given the influence of mental disorders on the immune system in Wegener's disease, it is essential to provide psychological care for these patients.
PubMed: 38715951
DOI: 10.2174/0117450179276345240117043037 -
Frontiers in Psychiatry 2024Impaired function of brain morphogenic genes is considered one of the predisposing factors for the manifestation of psychiatric and cognitive disorders, such as paranoid...
INTRODUCTION
Impaired function of brain morphogenic genes is considered one of the predisposing factors for the manifestation of psychiatric and cognitive disorders, such as paranoid schizophrenia (SCZ) and major depressive disorder (MDD). Identification of such genes (genes of neurotrophic factors and guidance molecules among them) and their deleterious genetic variants serves as a key to diagnosis, prevention, and possibly treatment of such disorders. In this study, we have examined the prevalence of genomic variants in brain morphogenic genes in individuals with SCZ and MDD within a Russian population.
METHODS
We have performed whole-exome sequencing of 21 DNA samples: 11 from individuals with SCZ and 10 with MDD, followed by ARMS (Amplification-Refractory Mutation System) based screening of detected single nucleotide variants (SNVs) in larger groups: 102 for individuals with SCZ, 79 for those with MDD and 103 for healthy donors.
RESULTS
Whole-exome sequencing has revealed 226 missense mutations in 79 genes (out of 140 studied), some of which occur in patients with psychiatric disorders significantly more frequently than in healthy donors. We have identified previously undescribed genomic variants in brain morphogenic genes: (rs1944294-T and rs17445840-T), (rs11935573-G and rs12500437-G/T) and (rs1227051-G/A), significantly associated with the incidence of SCZ and MDD in the Russian population. For some SNVs (rs6265-T, rs1944294-T, rs11935573-G, rs4760-G) sex-biased differences in their prevalence between SCZ/MDD patients and healthy donors was detected.
DISCUSSION
However, the functional significance of the SNVs identified has still to be confirmed in cellular and animal models. Once it is fulfilled, these SNVs have the potential to complement the diagnostic toolbox for assessing susceptibility to mental disorders. The data obtained indirectly confirm the importance of adequate brain structure formation for its correct functioning and preservation of mental health.
PubMed: 38699454
DOI: 10.3389/fpsyt.2024.1338168 -
MedRxiv : the Preprint Server For... Apr 2024Adolescent self-reported psychotic experiences are associated with mental illness and could help guide prevention strategies. The Community Assessment of Psychic...
BACKGROUND
Adolescent self-reported psychotic experiences are associated with mental illness and could help guide prevention strategies. The Community Assessment of Psychic Experiences (CAPE) was developed over 20 years ago. In a rapidly changing society, where new generations of adolescents are growing up in an increasingly digital world, it is crucial to ensure high reliability and validity of the questionnaire.
METHODS
In this observational validation study, we used unique transgenerational questionnaire and health registry data from the Norwegian Mother, Father, and Child Cohort, a population-based pregnancy cohort. Adolescents, aged ~14 years, responded to the CAPE-16 ( = 18,835) and fathers to the CAPE-9 questionnaire ( = 28,793). We investigated the psychometric properties of CAPE-16 through factor analyses, measurement invariance testing across biological sex, response before/ during the COVID-19 pandemic, and generations (comparison with fathers), and examined associations with later psychiatric diagnoses.
OUTCOMES
One third (33·4%) of adolescents reported lifetime psychotic experiences. We confirmed a three-factor structure (paranoia, bizarre thoughts, and hallucinations) of CAPE-16, and observed good scale reliability of the distress and frequency subscales (ω = ·86 and ·90). CAPE-16 measured psychotic experiences were invariant to biological sex and pandemic status. CAPE-9 was non-invariant across generations, with items related to understanding of the digital world () prone to bias. CAPE-16 sum scores were associated with a subsequent psychiatric diagnosis, particularly psychotic disorders ( OR = 2·06; 97·5% CI = 1·70-2·46; OR = 1·93; 97·5% CI = 1·63-2·26).
INTERPRETATION
CAPE-16 showed robust psychometric properties across sex and pandemic status, and sum scores were associated with subsequent psychiatric diagnoses, particularly psychotic disorders. These findings suggest that with certain adjustments, CAPE-16 could have value as a screening tool for adolescents in the modern, digital world.
FUNDING
European Union's Horizon 2020 Programme, Research Council of Norway, South-Eastern Norway Regional Health Authority, NIMH, and the KG Jebsen Stiftelsen.
PubMed: 38699352
DOI: 10.1101/2024.04.18.24306017 -
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 -
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