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Case Reports in Psychiatry 2023This paper reports the case of a 27-year-old man with paranoid schizophrenia who was finally stabilized on clozapine medication. After vaccination against severe acute...
This paper reports the case of a 27-year-old man with paranoid schizophrenia who was finally stabilized on clozapine medication. After vaccination against severe acute respiratory syndrome coronavirus 2, serum levels of clozapine increased. It is well established that immune responses can trigger cytokine cascades affecting drug metabolism, which, in the case of clozapine treatment, can lead to severe intoxication.
PubMed: 38058314
DOI: 10.1155/2023/9914879 -
Postepy Psychiatrii Neurologii Sep 2023Lurasidon is a relatively new, second-generation antipsychotic drug with an interesting receptor profile. It is considered to be safe and has a low risk of side effects....
PURPOSE
Lurasidon is a relatively new, second-generation antipsychotic drug with an interesting receptor profile. It is considered to be safe and has a low risk of side effects. It is a substance with a multi-receptor mechanism of action: it mainly blocks dopaminergic D2 and serotonergic 5-HT2A receptors. According to the Summary of Product Characteristics, the adverse reaction of neutropenia was too rare to enable the estimation of its frequency.
CASE DESCRIPTION
A case of 39-year-old patient is presented in the article, diagnosed with paranoid schizophrenia, who developed neutropenia as a result of treatment with lurasidone. After the discontinuation of lurasidone and recommended supplementation, the blood test results gradually improved and finally reached the normal range.
COMMENT
This case report shows the need for regular monitoring of blood cell parameters in patients treated with second-generation antipsychotics, as there is a risk of neutrocytopenia or even agranulocitosis.
PubMed: 38034503
DOI: 10.5114/ppn.2023.132474 -
BMJ Mental Health Nov 2023Paranoia-incorrectly thinking that others are deliberating trying to harm you-causes distress, undermines social interactions and leads to withdrawal. It presents across...
BACKGROUND
Paranoia-incorrectly thinking that others are deliberating trying to harm you-causes distress, undermines social interactions and leads to withdrawal. It presents across multiple psychiatric diagnoses.
OBJECTIVE
The primary aim was to determine the extent that cognitive and social processes may explain paranoia. The secondary aim was to identify explanatory factors that distinguished paranoia and social anxiety.
METHODS
10 382 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, participated in a non-probability survey. All participants completed a paranoia measure and assessments of cognitive and social processes. Structural equation modelling was conducted.
FINDINGS
2586 (24.9%) participants described being mistrustful of other people. 1756 (16.9%) participants wanted help to trust more. 66.7% of variance in paranoia was explained by a model comprising (in descending order of importance): within-situation defence behaviours, negative images, negative self-beliefs, discrimination, dissociation, aberrant salience, anxiety sensitivity, agoraphobic distress, worry, less social support, agoraphobic avoidance, less analytical reasoning and alcohol use. All explanatory factors were associated with paranoia and social anxiety. Ten factors were more closely associated with paranoia than social anxiety, including discrimination, hallucinations, negative images, aberrant salience and alcohol use. Nine factors were more closely associated with social anxiety, including less positive self-belief, an external locus of control, worry and less analytical reasoning.
CONCLUSIONS
Multiple causes are likely to be involved in paranoia. Cognitive and social processes may explain a high degree of paranoia.
CLINICAL IMPLICATIONS
Multiple clear targets for intervention to reduce paranoia are identified.
Topics: Adult; Humans; Paranoid Disorders; Anxiety; Anxiety Disorders; Fear; Cognition
PubMed: 37945313
DOI: 10.1136/bmjment-2023-300880 -
Philosophy, Ethics, and Humanities in... Nov 2023Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing... (Review)
Review
Schizophrenia stands as one of the most studied and storied disorders in the history of clinical psychology; however, it remains a nexus of conflicting and competing conceptualizations. Patients endure great stigma, poor treatment outcomes, and condemnatory prognosis. Current conceptualizations suffer from unstable categorical borders, heterogeneity in presentation, outcome and etiology, and holes in etiological models. Taken in aggregate, research and clinical experience indicate that the class of psychopathologies oriented toward schizophrenia are best understood as spectra of phenomenological, cognitive, and behavioral modalities. These apparently taxonomic expressions are rooted in normal human personality traits as described in both psychodynamic and Five Factor personality models, and more accurately represent explicable distress reactions to biopsychosocial stress and trauma. Current categorical approaches are internally hampered by axiomatic bias and systemic inertia rooted in the foundational history of psychological inquiry; however, when such axioms are schematically decentralized, convergent cross-disciplinary evidence outlines a more robust explanatory construct. By reconceptualizing these disorders under a dimensional and cybernetic model, the aforementioned issues of instability and inaccuracy may be resolved, while simultaneously opening avenues for both early detection and intervention, as well as for more targeted and effective treatment approaches.
Topics: Humans; Schizotypal Personality Disorder; Schizophrenia, Paranoid; Schizoid Personality Disorder; Personality; Paranoid Personality Disorder
PubMed: 37936219
DOI: 10.1186/s13010-023-00142-8 -
Cureus Sep 2023This case report provides a vivid illustration of a schizophrenic case in a 59-year-old man with auditory hallucinations, illuminating the nature of his symptoms....
This case report provides a vivid illustration of a schizophrenic case in a 59-year-old man with auditory hallucinations, illuminating the nature of his symptoms. Auditory hallucinations were prominent, and the patient received voices urging him to perform actions that clearly corresponded to his paranoid thoughts. Through comprehensive research and long-term follow-up, this report reveals the complexity of traumatic schizophrenia, highlighting the importance of early recognition and intervention. One must emphasize a multidisciplinary approach, including psychiatric assessment, pharmacotherapy, and psychotherapy. This case report aims to highlight the critical role of comprehensive individual care in improving the patient's condition and emphasizes the importance of compassionate healthcare practices.
PubMed: 37900418
DOI: 10.7759/cureus.46092 -
Cureus Sep 2023Myxedema coma is a rare and potentially life-threatening condition that occurs when severe hypothyroidism is untreated or inadequately managed. It is characterized by a...
Myxedema coma is a rare and potentially life-threatening condition that occurs when severe hypothyroidism is untreated or inadequately managed. It is characterized by a rapid drop in mental status, hypothermia, respiratory failure, hypotension, and other symptoms of severe metabolic dysfunction. The condition primarily affects older women with a history of thyroid dysfunction but can occur in any age or gender group. A common trigger for this condition is seen with a drop in atmospheric temperatures or during the cold winter months. However, a rare, poorly documented trigger is recent antipsychotic use in severe hypothyroid states. The diagnosis of myxedema coma requires prompt recognition and treatment, as delays can result in significant morbidity and mortality which is the objective of this case report.
PubMed: 37842468
DOI: 10.7759/cureus.45190 -
BMC Psychiatry Oct 2023There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to...
BACKGROUND
There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation.
METHODS
A survey was administered to a self-selecting sample in-person (n = 157) or online (n = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context.
RESULTS
Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership. Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support. Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime. Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood.
CONCLUSIONS
Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.
Topics: Humans; Mental Health; Psychotic Disorders; Smartphone; Surveys and Questionnaires; Cell Phone
PubMed: 37803367
DOI: 10.1186/s12888-023-05114-y -
Neuropsychopharmacology Reports Mar 2024Cenesthopathy is a rare syndrome characterized by strange bodily and oral sensations and is classified as a delusional disorder, somatic type, according to the fifth...
Cenesthopathy is a rare syndrome characterized by strange bodily and oral sensations and is classified as a delusional disorder, somatic type, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. Cenesthopathy has been considered difficult to treat. However, to improve cenesthopathy, many pharmacotherapeutic options are reported, including antidepressants and antipsychotics. In this case report, vortioxetine significantly alleviated the distress of oral cenesthopathy in a patient with cerebral ischemia and depression without any adverse effects. To the best of our knowledge, this is the first report on the efficacy of vortioxetine in treating cenesthopathy. Though it is unclear why vortioxetine was effective for cenesthopathy in our case, we stated two possibilities for improving his oral cenesthopathy. When treating oral cenesthopathy in elderly patients, clinicians consider to be one of the options to prescribe vortioxetine.
Topics: Humans; Aged; Vortioxetine; Schizophrenia, Paranoid; Antidepressive Agents; Antipsychotic Agents
PubMed: 37794715
DOI: 10.1002/npr2.12384 -
BMC Psychiatry Sep 2023Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the...
BACKGROUND
Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years.
METHODS
71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years.
RESULTS
At four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients.
CONCLUSIONS
Results indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.
Topics: Humans; Child, Preschool; Follow-Up Studies; Quality of Life; Schizophrenia, Paranoid; Psychotic Disorders; Age Factors
PubMed: 37723482
DOI: 10.1186/s12888-023-05175-z -
BMJ Open Sep 2023Cognitive behavioural therapy for psychosis (CBTp) has demonstrated effectiveness in reducing positive symptoms, improving depression, enhancing coping skills and...
INTRODUCTION
Cognitive behavioural therapy for psychosis (CBTp) has demonstrated effectiveness in reducing positive symptoms, improving depression, enhancing coping skills and increasing awareness of illness. However, compared with cognitive behavioural therapy for depression and anxiety, the spread of CBTp in clinical practice is minimal. The present study designed a randomised controlled trial (RCT) research protocol to evaluate whether real-time remote video-conference CBTp (vCBTp) could facilitate access to psychosocial interventions and effectively improve symptoms compared with usual care (UC) for patients with schizophrenia.
METHODS AND ANALYSIS
This exploratory RCT will consist of two parallel groups (vCBTp+UC and UC alone) of 12 participants (n=24) diagnosed with schizophrenia, schizoaffective disorder or paranoid disorder, who remain symptomatic following pharmacotherapy. Seven 50-min weekly vCBTp interventions will be administered to test efficacy. The primary outcome will be the positive and negative syndrome scale score at week 8. The secondary outcome will be the Beck Cognitive Insight Scale to assess insight, the Patient Health Questionnaire-9 to assess depression, the Generalised Anxiety Disorder-7 to assess anxiety, the 5-level EuroQol 5-dimensional questionnaire to assess quality of life and the Impact of Event Scale-Revised to assess subjective distress about a specific stressful life event. We will take all measurements at 0 weeks (baseline) and at 8 weeks (post-intervention), and apply intention-to-treat analysis.
ETHICS AND DISSEMINATION
We will conduct this study in the outpatient department of Cognitive Behavioral Therapy Center at Chiba University Hospital. Further, all participants will be informed of the study and will be asked to sign consent forms. We will report according to the Consolidated Standards of Reporting Trials.
TRIAL REGISTRATION NUMBER
UMIN000043396.
Topics: Humans; Schizophrenia; Outpatients; Psychotic Disorders; Anxiety; Cognitive Behavioral Therapy; Randomized Controlled Trials as Topic
PubMed: 37696635
DOI: 10.1136/bmjopen-2022-069734