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PCN Reports : Psychiatry and Clinical... Jun 2023While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected.
BACKGROUND
While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected.
CASE PRESENTATION
A woman aged in her 60s diagnosed with schizophrenia was admitted to our hospital for psychotic symptoms, including delusions of reference, delusions of guilt, auditory hallucinations, cenesthetic hallucinations, agitation, depression, suicidal ideation, and catatonia. During hospitalization, her cenesthetic hallucinations progressed to include nihilistic delusions. She described cenesthetic hallucinations along with various delusional descriptions, including the belief that various objects, such as spoons, irons, nails, rulers, bins, and coins, were inside her body and that her body was being burned or in danger of exploding. She also claimed an altered sense of her own body, that her body was larger than normal or reversed. Moreover, she reported nihilistic delusions that her face and body did not exist, that her heart was not functioning, and that she was going to die soon or was already dead. She occasionally refused to eat because of the feeling of being dead. Notably, during a severe episode, she claimed that a doctor in front of her was dead. Clozapine was effective in improving her symptoms. Ultimately, the patient regained her sense of being alive and acknowledged that the doctor was alive.
CONCLUSION
We report the case of a patient presenting with nihilistic delusions regarding both self and others, along with prior cenesthetic hallucinations. Aberrant interoceptive processing could be a potential link between these two forms of nihilistic delusions.
PubMed: 38868142
DOI: 10.1002/pcn5.93 -
PCN Reports : Psychiatry and Clinical... Jun 2023In the 1960s and 1970s, there was widespread discussion in Japan about the pathological experience of "unpleasant odors emanating from one's body." This symptom is... (Review)
Review
In the 1960s and 1970s, there was widespread discussion in Japan about the pathological experience of "unpleasant odors emanating from one's body." This symptom is called "Jikoshu," and this term was used in combination with various words, such as "Genkaku" (hallucination) and "Moso" (delusion), reflecting its symptomatological ambiguity. The best-known term in the English-language literature is ( phobia). By further abstracting this symptom and viewing it as a delusion-like experience of "something leaking out of me," egorrhea syndrome (Fujinawa) was proposed, which was considered to be partly a pathology of schizophrenia. Similar cases were characteristically observed during adolescence, and a study emerged suggesting that the syndrome was "adolescent paranoia" (Murakami), distinct from schizophrenia. However, the terms "Jikoshu-Taiken" ( experience; Kasahara et al.) and "Jikoshu-Sho" ( syndrome; Miyamoto) were proposed to emphasize the nosological ambiguity. Considered a culture-bound syndrome unique to Japan or East Asia, received little attention in the English-language literature apart from a 1971 study of olfactory reference syndrome (Pryse-Phillips), which presents with similar symptoms. In recent years, research has placed this disorder within the obsessive-compulsive spectrum, and it has been adopted as an ICD-11 disorder under the term "olfactory reference disorder."
PubMed: 38868136
DOI: 10.1002/pcn5.112 -
PCN Reports : Psychiatry and Clinical... Sep 2023The present article spotlights challenging conceptual and epistemological issues regarding delusions. A research history of various approaches to delusions in Europe,... (Review)
Review
The present article spotlights challenging conceptual and epistemological issues regarding delusions. A research history of various approaches to delusions in Europe, the United States, and Japan reveals the difficulty of defining delusions. Facing these difficulties, the standard concept of delusions has become thinner than the traditional ones, making its boundary with minority opinions vaguer. Nevertheless, clinical typology and epistemological approaches are contributing to the continuous conceptual refinement of delusions. Both standpoints validate and promote each other in elaborating the characteristics of delusions and their boundaries with non-delusions. In addition, epistemological inquiries into delusions shed new light on the extraordinarily difficult problems in the relationship among belief, knowledge, certainty, and delusions, contributing to epistemology in general. These approaches to delusions promote the evolution of the concept of delusions and related epistemological inquiries.
PubMed: 38867837
DOI: 10.1002/pcn5.126 -
The International Journal on Drug Policy Jun 2024Methamphetamine frequently causes substance-induced psychosis and related symptoms. There are currently no interventions to prevent or assist in self-management of these...
BACKGROUND
Methamphetamine frequently causes substance-induced psychosis and related symptoms. There are currently no interventions to prevent or assist in self-management of these symptoms.
METHODS
We evaluated a program providing "Methamphetamine Assist Packs" to patients who were seen in a psychiatric emergency services program for methamphetamine-induced psychosis. Methamphetamine Assist Packs included a small number of tablets of an antipsychotic medication (olanzapine), administration instructions, and referral information. We reviewed medical charts of patients who received Methamphetamine Assist Packs from January 2022 through May 2023 for sociodemographic and emergency visit characteristics. We assessed the changes between the number of psychiatric emergency visits before and after Methamphetamine Assist Pack receipt at two, six, and 12 months using generalized estimating equations.
RESULTS
Ninety-two patients received a Methamphetamine Assist Pack, with a mean age of 40 years; 79 % were male and 49 % Black/African American; 77 % experienced housing instability or homelessness. The most common symptoms were suicidal ideation (54 %), paranoia or delusions (45 %), and hallucinations (40 %); 55 % were on involuntary psychiatric hold, 38 % required medications for agitation, and 18 % required seclusion or physical restraints. The rate of psychiatric emergency visits after Methamphetamine Assist Pack receipt was 0.68 and 0.87 times the rate prior to receipt at two and six months, respectively (p < 0.001). There was no difference at 12 months.
CONCLUSIONS
Methamphetamine Assist Packs were associated with fewer psychiatric emergency visits for six months after receipt, and represent a promising intervention to address acute psychiatric toxicity from methamphetamine in need of further research.
PubMed: 38861841
DOI: 10.1016/j.drugpo.2024.104480 -
Cureus May 2024Delusional parasitosis (DP) with Koro-like syndrome poses a complex clinical challenge, demanding a comprehensive and empathetic approach from healthcare professionals....
Delusional parasitosis (DP) with Koro-like syndrome poses a complex clinical challenge, demanding a comprehensive and empathetic approach from healthcare professionals. This exceptional combination of fixed beliefs about infestation and experiences of genital retraction can profoundly impact patients' well-being and daily functioning. The associated stigma and misconceptions further compound the difficulties faced by individuals struggling with these co-occurring conditions. Given the rarity of encountering both conditions simultaneously, navigating the diagnosis and treatment of delusional parasitosis with Koro-like syndrome requires a thorough understanding of its multifaceted nature. Embracing a holistic strategy encompassing psychoeducation, psychotherapy, and pharmacological interventions is essential for effectively addressing these dual conditions.
PubMed: 38854356
DOI: 10.7759/cureus.59946 -
Acta Anaesthesiologica Scandinavica Jun 2024Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering....
BACKGROUND
Many patients in the Intensive Care Unit (ICU) experience delirium. Understanding the patient perspective of delirium is important to improve care and reduce suffering. The aim of our study was to investigate the subjective patient experience of delirium, delirium-related distress, and delirium management in ICU.
METHODS
Our study had a qualitative multicenter design applying individual interviews and thematic analysis. Participants were critically ill adult patients that were determined delirium positive according to validated delirium screening tools during ICU admission. The interviews were conducted after ICU discharge when patients were delirium-free as assessed by the "Rapid clinical test for delirium" (4AT) and able to participate in an interview.
RESULTS
We interviewed 30 patients choosing the main themes deductively: Delirium experience; Delirium related distress; and Delirium management. Despite variations in recollection detail, ICU survivors consistently reported delirium-related distress during and after their ICU stay, manifesting as temporal confusion, misinterpretations, and a sense of distrust towards ICU staff. Delusions were characterized by a blend of factual and fictional elements. Impaired short-term memory hindered communication and intensified feelings of isolation, neglect, and loss of control.
CONCLUSION
The ICU survivors in our study recalled delirium as an unpleasant and frightening experience, often leading to delirium-related distress during and after their ICU stay, indicating the necessity for enhanced assessment and treatment.
PubMed: 38850120
DOI: 10.1111/aas.14463 -
Molecular Psychiatry Jun 2024According to classical phenomenology, phenomenal experience is composed of perceptions (related to environmental stimuli) and imagery/ideas (unrelated to environmental... (Review)
Review
According to classical phenomenology, phenomenal experience is composed of perceptions (related to environmental stimuli) and imagery/ideas (unrelated to environmental stimuli). Intensity/vividness is supposed to represent the key phenomenal difference between perceptions and ideas, higher in perceptions than ideas, and thus the core subjective criterion to distinguish reality from imagination. At a neural level, phenomenal experience is related to brain activity in the sensory areas, driven by receptor stimulation (underlying perception) or associative areas (underlying imagery/ideas). An alteration of the phenomenal experience that leads to a loss of contact with reality characterizes psychosis, which mainly consists of hallucinations (false perceptions) and delusions (fixed ideas). According to the current data on their neural correlates across subclinical conditions and different neuropsychiatric disorders (such as schizophrenia), hallucinations are mainly associated with: transient (modality-specific) activations of sensory cortices (primarily superior temporal gyrus, occipito-temporal cortex, postcentral gyrus, and insula) during the hallucinatory experience; increased intrinsic activity/connectivity of associative/default-mode network (DMN) areas (primarily temporoparietal junction, posterior cingulate cortex, and medial prefrontal cortex); and deficits in the sensory systems. Analogously, delusions are mainly associated with increased intrinsic activity/connectivity of associative/DMN areas (primarily medial prefrontal cortex). Integrating these data into our three-dimensional model of neural activity and phenomenal-behavioral patterns, we propose the following model of psychosis. A functional/structural deficit in the sensory systems complemented by a functional reconfiguration of intrinsic brain activity favoring hyperactivity of associative/DMN areas may drive neuronal activations in the sensory (auditory/visual/somatosensory) areas and insular (interoceptive) areas with spatiotemporal configurations maximally independent from environmental stimuli and predominantly related to associative processing. This manifests in perception deficit and imagery/ideas composed of exteroceptive-like and interoceptive/affective-like elements that show a phenomenal intensity indistinguishable from perceptions, impairing the reality monitoring, along with minimal changeability by environmental stimuli, ultimately resulting in dissociation of the phenomenal experience from the environment, i.e., psychosis.
PubMed: 38844531
DOI: 10.1038/s41380-024-02607-4 -
Cognitive Impairments in Drug-Naive Patients With First-Episode Negative Symptom-Dominant Psychosis.JAMA Network Open Jun 2024Available antipsychotic medications are predominantly used to treat positive symptoms, such as hallucinations and delusions, in patients with first-episode psychosis...
IMPORTANCE
Available antipsychotic medications are predominantly used to treat positive symptoms, such as hallucinations and delusions, in patients with first-episode psychosis (FEP). However, treating negative and cognitive symptoms, which are closely related to functional outcomes, remains a challenge.
OBJECTIVE
To explore the cognitive characteristics of patients with negative symptom-dominant (NSD) psychosis.
DESIGN, SETTING, AND PARTICIPANTS
This large-scale cross-sectional study of patients with FEP was led by the Shanghai Mental Health Center in China from 2016 to 2021, with participants recruited from 10 psychiatric tertiary hospitals. A comprehensive cognitive assessment was performed among 788 patients with FEP who were drug-naive. Symptom profiles were determined using the Positive and Negative Symptoms Scale (PANSS), and NSD was defined as a PANSS score for negative symptoms higher than that for positive and general symptoms. Positive symptom-dominant (PSD) and general symptom-dominant (GSD) psychosis were defined similarly. Data were analyzed in 2023.
EXPOSURE
Psychotic symptoms were categorized into 3 groups: NSD, PSD, and GSD.
MAIN OUTCOMES AND MEASURES
Neurocognitive performance, assessed using the Chinese version of the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery.
RESULTS
This study included 788 individuals with FEP (median age, 22 [IQR, 17-28] years; 399 men [50.6%]). Patients with NSD exhibited more-pronounced cognitive impairment than did those with PSD or GSD. Specifically, cognitive differences between the NSD and PSD group, as well as between the NSD and GSD group, were most notable in the processing speed and attention domains (Trail Making [F = 4.410; P = .01], Symbol Coding [F = 4.957; P = .007], Verbal Learning [F = 3.198; P = .04], and Continuous Performance [F = 3.057; P = .05]). Patients with PSD and GSD showed no significant cognitive differences. Cognitive impairment was positively associated with the severity of negative symptoms. Most of the cognitive function tests used were able to differentiate patients with NSD from those with PSD and GSD, with significant differences observed across a range of tests, from Brief Visuospatial Memory Test-Revised (χ2 = 3.968; P = .05) to Brief Assessment of Cognition in Schizophrenia symbol coding (χ2 = 9.765; P = .002).
CONCLUSIONS AND RELEVANCE
The findings of this cross-sectional study of patients with FEP suggest the presence of a clinical subtype characterized by a predominance of negative symptoms and cognitive impairment.
Topics: Humans; Male; Female; Cross-Sectional Studies; Cognitive Dysfunction; Psychotic Disorders; Adult; China; Young Adult; Psychiatric Status Rating Scales; Schizophrenia; Adolescent; Neuropsychological Tests
PubMed: 38842809
DOI: 10.1001/jamanetworkopen.2024.15110 -
BMC Psychiatry Jun 2024Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical...
Non-linear relationship between TSH and psychotic symptoms on first episode and drug naïve major depressive disorder patients: a large sample sized cross-sectional study in China.
INTRODUCTION
Psychotic depression (PD) is characterized by the co-occurrence of emotional dysfunction and psychotic symptoms such as delusions and hallucinations with poor clinical outcomes. TSH may involve in the development of PD. This study aims to explore relationship between TSH and PD.
METHODS
A total of 1718 outpatients diagnosed as FEDN MDD were recruited in this study. The relationship between PD and TSH was evaluated using multivariable binary logistic regression analysis. To assess the presence of non-linear associations, a two-piecewise linear regression model was employed. Furthermore, interaction and stratified analyses were conducted with respect to sex, education, marital status, comorbid anxiety, and suicide attempt.
RESULTS
Multivariable logistic regression analysis revealed that TSH was positively associated with the risk of PD after adjusting for confounders (OR = 1.26, 95% CI: 1.11 to 1.43; p < 0.05). Smoothing plots showed a nonlinear relationship between TSH and PD, with the inflection point of TSH being 4.94 mIU/L. On the right of the inflection point, for each unit increase in serum TSH level on the right side of the inflection point, the probability of PD increased substantially by 47% (OR = 1.47, 95% CI: 1.25 to 1.73, p < 0.001), while no significant association was observed on the left side of the inflection point (OR = 0.87, 95% CI: 0.67 to 1.14, p = 0.32).
CONCLUSION
Our investigation showed a nonlinear TSH-PD relationship in FEDN MDD patients, thus contributing to effective intervention strategies for psychotic symptoms in depression patients.
Topics: Humans; Male; Female; Cross-Sectional Studies; Adult; Thyrotropin; China; Depressive Disorder, Major; Psychotic Disorders; Middle Aged; Young Adult
PubMed: 38834989
DOI: 10.1186/s12888-024-05860-7 -
Current Psychiatry Reports Jul 2024The assessment of the risk of triggering psychosis upon exposure to grief is a challenge in clinical practice. Adequate diagnosis and early prevention are essential and... (Review)
Review
PURPOSE OF REVIEW
The assessment of the risk of triggering psychosis upon exposure to grief is a challenge in clinical practice. Adequate diagnosis and early prevention are essential and may be helpful in the evolution of normal grief. We aimed to identify studies exploring grief as a risk factor for developing psychosis.
RECENT FINDINGS
A systematic review of 3 databases (PubMed, EMBASE, and Cochrane Library) was conducted.
RESULTS
In the first approach 618 studies were identified. After the selection process, 15 studies were included in the review. The association between grief and the risk of developing psychosis occurred at younger ages (before 18 years of age) in a first-degree relative and as a consequence of suicide or accidental death. We found that risk factors such as comorbidity, mental problems, unemployment, economic difficulties, and close ties with the deceased have a negative impact on health causing greater vulnerability to psychosis with a risk of developing complicated grief, with statistically significant results regarding the associations between early parental death and the probability of developing psychosis in adulthood.
Topics: Humans; Psychotic Disorders; Grief; Risk Factors
PubMed: 38833148
DOI: 10.1007/s11920-024-01512-5