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Cureus May 2024The abuse of inhalants like nitrous oxide (NO), readily available worldwide, has remained a prominent public health problem during the last few decades. Literature...
The abuse of inhalants like nitrous oxide (NO), readily available worldwide, has remained a prominent public health problem during the last few decades. Literature reveals increased use during the previous pandemic, particularly regarding recreational use. There is limited evidence-based data available to relate the abuse of NO with psychosis. Therefore, this case report of a 22-year-old adult with no previous psychiatry history, reportedly abusing 75-100 canisters of NO per day during the last pandemic COVID-19 lockdown, highlights the relationship between (NO) abuse and the symptoms evolved including delusions, auditory hallucinations, and disorganized cognition. All the laboratory findings and results from imaging modalities were inconsistent for any organic cause of the symptoms. The case then underwent treatment with antipsychotic medications and a multidisciplinary model, which improved the symptoms gradually. The case, in particular, discusses NO abuse, which is widespread in European Union countries, including the UK and the Republic of Ireland, and its chronic use puts one at a higher risk of developing psychosis, personality changes, affective lability, anxiety, depression, cognitive impairment, and myeloneuropathy. The sale of NO for its psychoactive properties is prohibited in many countries, including the Republic of Ireland, as per legislation. However, NO is not a controlled drug, meaning it is not a crime to possess NO. This case report manifests the psychopathy caused by abuse of NO, which would further attract specialists in the field to conduct epidemiological studies for prevention at the primary level.
PubMed: 38903353
DOI: 10.7759/cureus.60634 -
World Journal of Clinical Cases Jun 2024Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances, hallucinations, delusions, and emotional instability. For some...
BACKGROUND
Schizophrenia is a common and severe mental disorder characterized by severe thought disturbances, hallucinations, delusions, and emotional instability. For some patients, conventional treatment methods may not effectively alleviate symptoms, necessitating the use of alternative therapeutic approaches. Modified electroconvulsive therapy (MECT) is an effective treatment modality for schizophrenia, inducing anti-depressive and antipsychotic effects through the stimulation of brain electrical activity.
AIM
To explore the impact of psychological nursing intervention (PNI) before and after MECT on the efficacy and quality of life of patients with schizophrenia.
METHODS
Eighty patients with schizophrenia who received MECT treatment from 2021 to 2023 were randomly divided into two groups: The intervention group ( = 40) and the control group ( = 40). The intervention group received PNI before and after MECT, while the control group received routine nursing care. The efficacy of MECT was evaluated by the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression Scale (CGI) before and after the treatment. The quality of life was assessed by the Short Form 36 Health Survey (SF-36) after the treatment.
RESUITS
The intervention group had significantly lower scores of PANSS and CGI than the control group after the treatment ( < 0.05). The intervention group also had significantly higher scores of SF-36 than the control group in all domains except physical functioning ( < 0.05).
CONCLUSION
PNI before and after MECT can improve the efficacy and quality of life of patients with schizophrenia. It is suggested that nurses should provide individualized and comprehensive psychological care for patients undergoing MECT to enhance their recovery and well-being.
PubMed: 38899291
DOI: 10.12998/wjcc.v12.i16.2751 -
Journal of Nippon Medical School =... Jun 2024Schizophrenia develops during adolescence. Maternal infections during the fetal period increase the incidence of schizophrenia in children, which suggests that the...
Schizophrenia develops during adolescence. Maternal infections during the fetal period increase the incidence of schizophrenia in children, which suggests that the pathogenesis involves neuroinflammation. Here, we report a case of new-onset schizophrenia in a 16-year-old boy after COVID-19. After developing COVID-19, he entered a catatonic state 4 days later and was hospitalized. Benzodiazepines alleviated his catatonia, but hallucinations and delusions persisted. Encephalitis and epilepsy were excluded by magnetic resonance imaging (MRI), encephalography, and cerebrospinal fluid examination. Psychosis persisted after the virus titer declined and the inflammatory response subsided. Moreover, the patient exhibited delusions of control-a Schneider's first-rank symptom. Schizophrenia was diagnosed, and olanzapine improved his symptoms. He had a brief history of insomnia before COVID-19 but his symptoms did not satisfy the ultra-high-risk criteria. However, COVID-19 may have facilitated development of schizophrenia through neuroinflammation and volume reduction in the gray matter of the right medial temporal lobe. This case demonstrates that infectious diseases in adolescents should be carefully managed, to prevent schizophrenia.
PubMed: 38897947
DOI: 10.1272/jnms.JNMS.2025_92-301 -
Cortex; a Journal Devoted To the Study... May 2024Postpartum psychosis is a rare but serious condition that can affect women after childbirth. We present a case study of an individual with no comorbidities or...
Postpartum psychosis is a rare but serious condition that can affect women after childbirth. We present a case study of an individual with no comorbidities or psychiatric history who developed postpartum psychosis characterised by prominent misidentification delusions whilst admitted to hospital. The woman recovered quickly with medication and showed no evidence of relapse over the following three years. Whilst still symptomatic and after recovery, the patient was able to provide a detailed description of her experiences. Contemporaneous interviews and observations during her hospital admission and a subsequent detailed retrospective account provide a unique, comprehensive window into her experience of these time-limited delusions. Her case reveals important insights including the triggers for her misidentification delusions, the role of social and contextual influences on delusional beliefs, and her recall of active involvement in evaluating and discarding delusional hypotheses. These insights highlight the complexity of delusional beliefs, challenge existing theories of delusions, and help inform broader theories of belief formation.
PubMed: 38875734
DOI: 10.1016/j.cortex.2024.04.018 -
PCN Reports : Psychiatry and Clinical... Dec 2023Delusions are a common symptom in schizophrenia. Some scales have been developed to measure delusional tendencies in healthy people, and nonpathological delusional...
AIM
Delusions are a common symptom in schizophrenia. Some scales have been developed to measure delusional tendencies in healthy people, and nonpathological delusional thinking can occur even among these individuals. The existing scales measure the presence and frequency of delusional thoughts, distress levels, and confidence levels. However, these scales are limited because they do not consider the context of the delusions (i.e., where, with whom, and when). In this study, we developed a new scale that presents detailed scenes using illustrations and sentences and measures the tendency toward delusional interpretations.
METHODS
Factor analysis was conducted to confirm the factor structure of the new scale. To examine the validity of the scale, we analyzed the correlations between delusional tendencies and related variables and verified the consistency between the current scale and previously developed tools.
RESULTS
Factor analysis confirmed that the new scale has a two-factor structure, including "internal attribution and paranoid tendency" and "external attribution tendency." The new scale was found to have acceptable reliability and validity. The internal attribution and paranoid tendency factor was negatively correlated with self-esteem and decentering. Furthermore, the internal attribution and paranoid tendency factor showed a moderate positive correlation with depressive state and anxiety tendency and a very weak positive correlation with experiences of bullying or harassment.
CONCLUSION
The correlations between the new scale and related variables confirmed the construct validity and replicated the results reported in previous studies. This new scale enables the measurement of delusional tendencies in healthy subjects based on the social context.
PubMed: 38868731
DOI: 10.1002/pcn5.156 -
PCN Reports : Psychiatry and Clinical... Mar 2024To date, only a few reports of anti-LGI1 encephalitis with isolated psychiatric symptoms in the initial phase have been reported. We present a relatively rare case of...
BACKGROUND
To date, only a few reports of anti-LGI1 encephalitis with isolated psychiatric symptoms in the initial phase have been reported. We present a relatively rare case of antileucine-rich glioma-inactivated 1 (LGI1) encephalitis that developed only psychiatric symptoms at the onset.
CASE PRESENTATION
The patient was a male in his 40s who developed anxiety and panic symptoms and was started on antidepressants after being diagnosed with panic disorder by a psychiatrist. He visited our hospital 2 months later presenting with hallucinations, delusions, mild cognitive decline, and faciobrachial dystonic seizures in the left upper extremity and face. Fluid-attenuated inversion recovery magnetic resonance imaging revealed swelling and hyperintensities in the right caudate nucleus and putamen. Cerebrospinal fluid analysis did not show increased protein levels or cell counts and revealed positive oligoclonal bands. Subsequently, positive results for anti-LGI1 antibodies were observed in the cerebrospinal fluid. Therefore, the patient was diagnosed with anti-LGI1 encephalitis.
CONCLUSION
This case highlights the need to consider anti-LGI1 encephalitis therapy in patients with acute-onset psychiatric symptoms.
PubMed: 38868479
DOI: 10.1002/pcn5.181 -
PCN Reports : Psychiatry and Clinical... Mar 2024Progressive supranuclear palsy (PSP) is a rapidly progressive neurodegenerative disorder characterized by Parkinsonism, supranuclear ophthalmoplegia, postural...
AIM
Progressive supranuclear palsy (PSP) is a rapidly progressive neurodegenerative disorder characterized by Parkinsonism, supranuclear ophthalmoplegia, postural instability, and cognitive impairment.
PATIENTS
This case series describes three patients initially diagnosed with late-life mood disorders (depression and bipolar disorder) who were later diagnosed with PSP because of the development of typical neurological symptoms.
RESULT
The diagnostic challenge of PSP is highlighted in this case report, particularly in the early stages, when characteristic symptoms may not be present. The importance of considering PSP in the differential diagnosis of late-life mood disorders, especially in the absence of response to standard antidepressant therapy, is also emphasized. The heterogeneity of PSP is described, with various subtypes and atypical variants presenting with different clinical features. The psychiatric symptoms of PSP include apathy, disinhibition, depression, and anxiety, whereas hallucinations and delusions are less frequent. Tau positron emission tomography imaging is discussed as a potential biomarker for atypical PSP.
CONCLUSION
Early diagnosis and intervention are crucial for improved outcomes in PSP, necessitating further research to enhance the diagnostic and treatment strategies for PSP and other neurodegenerative diseases.
PubMed: 38868471
DOI: 10.1002/pcn5.178 -
PCN Reports : Psychiatry and Clinical... Mar 2024Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is...
BACKGROUND
Olfactory reference disorder (ORD) is a mental illness in which individuals overestimate their sense of smell and worry about the negative impact of odors. Little is known about its successful treatment. A new cognitive behavioral model was developed based on cognitive behavioral therapy (CBT) for obsessive-compulsive disorder. Using this model, this study reports a successful treatment process of a 53-year-old female with ORD.
CASE PRESENTATION
The patient's initial diagnosis was schizophrenia, and improvements were observed, such as the disappearance of persecutory delusions, through medication therapy. During this treatment process, it became clear that the patient's preoccupation with her own offensive body odor was not a hallucination or delusion caused by schizophrenia but rather a symptom of ORD. Within a limited 4-week hospitalization period, high-intensity CBT was provided by a clinical psychologist and a psychiatrist. Multiple CBT techniques were employed, including case formulation to identify her beliefs, reviewing safety-seeking behaviors, attention shift training, behavioral experiments, public opinion polls, mindfulness meditation, and exposure and response prevention.
CONCLUSION
Following a seven-sessions intensive intervention over 3 weeks, her symptoms of ORD, anxiety, and depression reduced. High-frequency CBT practices could be beneficial in treatment of patients with severe ORD, addressing severe ORD cases, facilitating rapid improvement in both ORD symptoms and functioning.
PubMed: 38868464
DOI: 10.1002/pcn5.179 -
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