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Neuropsychopharmacology Reports Apr 2024Risk factors for alcohol withdrawal delirium include heavy drinking, prior alcohol withdrawal delirium or convulsions, nondrug sedative use, and a history of...
BACKGROUND
Risk factors for alcohol withdrawal delirium include heavy drinking, prior alcohol withdrawal delirium or convulsions, nondrug sedative use, and a history of tachycardia, withdrawal, and infections.
CASE PRESENTATION
A 76-year-old man with a history of heavy drinking and type 2 diabetes was hospitalized for hypothermia, rhabdomyolysis, and acute renal failure after a typhoon. He developed alcohol withdrawal symptoms 24 h after his last drink, leading to severe withdrawal delirium characterized by restlessness, delusions, and altered consciousness. Treatment included lorazepam, in addition to comprehensive care for his physical condition. His condition fluctuated, especially at night, with his psychiatric symptoms exacerbated by his physical illnesses, suggesting delirium due to the coexistence of severe and multiple physical illnesses. After 44 days, following substantial improvements in both mental and physical health with perospirone, the patient was discharged.
CONCLUSION
This case emphasizes the need for multidisciplinary collaboration in the treatment of such patients, especially during disasters, and the importance of long-term monitoring for elderly patients with alcohol dependence syndrome after a disaster.
PubMed: 38660963
DOI: 10.1002/npr2.12446 -
Frontiers in Psychology 2024Aspects of hypnosis and its application in psychotherapy, psychosomatics and medicine are examined and contextualized in the 250-year history of hypnosis. Imagination as... (Review)
Review
Aspects of hypnosis and its application in psychotherapy, psychosomatics and medicine are examined and contextualized in the 250-year history of hypnosis. Imagination as an essential element of hypnotic treatments appeared as early as 1784 as an argument rejecting the theory of animal magnetism of Franz Anton Mesmer. In somnambulism of German romanticism, another proto-form of hypnosis after 1800, concepts of the mind-body problem were dealt with, which still characterize the understanding of unconscious mental processes today. Hypnosis was at the beginning of psychoanalysis, but was not pursued further by Sigmund Freud from 1900 onwards. Nevertheless, there were some hypnoanalytical approaches in the 20th century, as well as attempts to integrate hypnosis into behavior therapy. Techniques of imagination and relaxation combine both; in particular findings from cognitive psychology explain processes of both hypnosis and cognitive behavioral therapy. The influence of social psychology brought a new perspective to the debate about the nature of hypnosis, which continues to this day: is hypnosis to be understood as a special state of consciousness or is it a completely normal, mundane interaction? The experiments that were carried out to support one side or the other were also dependent on the hypnotizability of the subjects involved, as the more difficult hypnotic phenomena such as paralysis, hallucinations or identity delusions can only be demonstrated by highly hypnotizable subjects. The fact that these are not mere compliance reactions has now been proven by many studies using imaging techniques. But even those who are moderately hypnotizable benefit from hypnosis rituals. Variables postulated by socio-cognitive hypnosis researchers, such as motivation and expectation, are relevant, as is a good "hypnotic rapport." Practical application of hypnotherapy today is characterized by the innovative techniques and strategies developed by Milton H. Erickson. Research into the effectiveness of hypnosis in the field of psychotherapy and psychosomatics still leaves much to be done. The situation is different in the field of medical hypnosis, where there are considerably more studies with a satisfactory design and verifiable effects. However, the impact in practical application in everyday medical practice is still low. Newer developments such as virtual reality and artificial intelligence are being looked at with critical interest.
PubMed: 38659672
DOI: 10.3389/fpsyg.2024.1377900 -
Psychiatria Polska Feb 2024To determine the clinical picture of bipolar affective disorders (BD) in children and adolescents hospitalized at the Clinical Ward of Developmental Age Psychiatry and...
OBJECTIVES
To determine the clinical picture of bipolar affective disorders (BD) in children and adolescents hospitalized at the Clinical Ward of Developmental Age Psychiatry and Psychotherapy (DAPP) in Sosnowiec, Poland.
METHODS
Documentation analysis of 288 BD patients below 18 years of age. Detailed clinical and demographic data were collected and symptoms present during hospitalization were assessed.
RESULTS
The mean age of illness onset was 13.6 ± 1.7 years. A total of 86.5% of the studied individuals received a first diagnosis different from BD/mania, and the average time until the proper diagnosis was 16.9 months. In 45.5% the first episode was depression with varied severity, in 29.2% a mixed episode and in 25.3% mania/hypomania. In 48.6% comorbid disorders were present. The most frequent reason for hospitalization was a mixed episode (47.6%). Among the symptoms, irritability was observed in over 80% of patients with mania or mixed episodes, but also in 60% of patients with depression. Suicidal thoughts were experienced by almost all the depression patients, 84.7% in the mixed episode and also 52.6% in mania/hypomania episode. Anxiety was mostly present in depression (40.7%) and mixed episode (22.6%), while moodcongruent delusions in depression and mania (around 20% of cases). Aggressive behaviours were manifested in around half of patients with mania and a mixed episode.
CONCLUSIONS
In the studied population of children and adolescents, BD usually started with a depression episode accompanied by a high rate of comorbid disorders and in most cases there was an original misdiagnosis. Study results also point to a significant frequency of some pathological symptoms in this population.
PubMed: 38654505
DOI: 10.12740/PP/OnlineFirst/175719 -
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 -
PloS One 2024The claustrum is an irregular and fine sheet of grey matter in the basolateral telencephalon present in almost all mammals. The claustrum has been the object of several...
The claustrum is an irregular and fine sheet of grey matter in the basolateral telencephalon present in almost all mammals. The claustrum has been the object of several studies using animal models and, more recently, in human beings using neuroimaging. One of the most extended cognitive processes attributed to the claustrum is the salience process, which is also related to the insular cortex. In the same way, studies with human subjects and functional magnetic resonance imaging have reported the coactivation of the claustrum/insular cortex in the integration of sensory signals. This coactivation has been reported in the left claustrum/insular cortex or in the right claustrum/insular cortex. The asymmetry has been reported in task studies and literature related to neurological disorders such as Alzheimer's disease and schizophrenia, relating the severity of delusions with the reduction in left claustral volume. We present a functional connectivity study of the claustrum. Resting-state functional and anatomical MRI data from 100 healthy subjects were analyzed; taken from the Human Connectome Project (HCP, NIH Blueprint: The Human Connectome Project), with 2x2x2 mm3 voxel resolution. We hypothesize that 1) the claustrum is a node involved in different brain networks, 2) the functional connectivity pattern of the claustrum is different from the insular cortex's pattern, and 3) the asymmetry is present in the claustrum's functional connectivity. Our findings include at least three brain networks related to the claustrum. We found functional connectivity between the claustrum, frontoparietal network, and the default mode network as a distinctive attribute. The functional connectivity between the right claustrum with the frontoparietal network and the dorsal attention network supports the hypothesis of claustral asymmetry. These findings provide functional evidence, suggesting that the claustrum is coupled with the frontoparietal network serving together to instantiate new task states by flexibly modulating and interacting with other control and processing networks.
Topics: Animals; Humans; Claustrum; Connectome; Brain; Gray Matter; Cerebral Cortex; Magnetic Resonance Imaging; Mammals
PubMed: 38635579
DOI: 10.1371/journal.pone.0298349 -
Case Reports in Psychiatry 2024Cotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or...
Cotard syndrome is a rare presentation where patients present with nihilistic thoughts of dying or already being dead. These delusions manifest from either a medical or psychiatric etiology and can be difficult to treat. Recently Couto and Gonçalves purposed that treatment should include an atypical antipsychotic alone or in combination with either a mood stabilizer or antidepressant. Here the authors advocate for a more specific but well-known psychotropic regimen, namely the combination of olanzapine and fluoxetine. We conducted a literature review and of 246 papers identified, only three reported using a combination of fluoxetine and olanzapine with many of them having limited or confounding information that make it difficult for us to comment on the historically efficacy of this medication combination. Therefore, the authors provide two case examples of patients being treated successfully with olanzapine and fluoxetine. One, a 66-year-old male veteran and another 76-year-old male veteran. Both of these cases hold significance as the patient's psychotic depression was so severe as to warrant ECT as a possible treatment. In both cases, this medication combination was able to avoid the procedure. Overall, with the addition of our cases and the sparse information available in the literature, we propose the combination of fluoxetine and olanzapine as an effective Cotard syndrome treatment.
PubMed: 38633733
DOI: 10.1155/2024/7630713 -
BMC Psychiatry Apr 2024Narcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from... (Observational Study)
Observational Study
BACKGROUND
Narcissism has been implied as a putative risk factor for substance use disorders (SUDs). However, previous research did not disentangle the degree of substance use from substance-related problems, the symptoms of SUDs. This preregistered study addressed the open question whether grandiose and vulnerable narcissism and their constituent traits convey specific SUD risk, that is, explain substance-related problems beyond the degree of use. Furthermore, we tested whether impulsivity or substance use motives linked to narcissistic self-regulation mediate this association.
METHODS
Narcissism, impulsivity, substance use motives, past-year substance use, and substance-related problems were assessed in 139 (poly-)substance users, 121 of whom completed a one-year follow-up. For significant longitudinal associations between narcissism factors and substance-related problems controlled for the degree of use, we tested impulsivity and substance use motives as mediators.
RESULTS
Grandiose narcissism (r =.24, p =.007) and its constituent factors antagonistic (r =.27, p =.003) and agentic narcissism (r =.18, p =.050), but not vulnerable narcissism, prospectively predicted substance-related problems beyond the degree of substance use. Associations of grandiose narcissism and antagonistic narcissism with substance-related problems were fully mediated by impulsivity, but not substance use motives. Impulsivity explained roughly one third of the association of both grandiose (P̂ = 0.30) and antagonistic narcissism (P̂ = 0.26) with substance-related problems.
DISCUSSION
We demonstrate that grandiose narcissism- particularly antagonistic but also agentic narcissism- is specifically linked to substance-related problems beyond the degree of substance use. The mediating effect of impulsivity but not substance use motives suggests that impulsivity may be a more important mechanism than narcissistic self-regulation in promoting SUD in narcissism. However, future studies may use more targeted measures than substance use motives to further probe the role of self-regulation. Similar result patterns for alcohol compared to all substances together indicate that mechanisms may be alike across substances. In conclusion, narcissistic individuals may not use substances more but have a higher SUD risk, informing prevention and treatment.
Topics: Humans; Narcissism; Impulsive Behavior; Motivation; Delusions; Substance-Related Disorders
PubMed: 38622531
DOI: 10.1186/s12888-024-05718-y -
Cureus Mar 2024Weight loss is not uncommon in the field of psychiatry; however, when severe cases arise, it necessitates attention and thorough evaluation for accurate diagnosis and...
Weight loss is not uncommon in the field of psychiatry; however, when severe cases arise, it necessitates attention and thorough evaluation for accurate diagnosis and appropriate treatment. This report highlights the case of a 32-year-old man referred to psychiatry due to significant weight loss. The patient mentioned consuming small food portions, attributing it to an undetected stomach illness despite repeated investigations by previous treating doctors. His current weight stood at 31 kg, with a body mass index (BMI) of 10.2 kg/m². Physical examinations and laboratory investigations were otherwise within normal parameters. A somatic delusion was confirmed, and the patient has been diagnosed with a delusional disorder after excluding other possibilities. This report highlights the importance of considering delusional disorder (somatic type) as a potential diagnosis for substantial weight loss, and it records an unexpected degree of physical well-being despite a notably low BMI.
PubMed: 38618312
DOI: 10.7759/cureus.56217 -
Scientific Reports Apr 2024Hallucinations and delusions can be symptoms of psychiatric illness, but more often—though less commonly known—are actually part of a healthy range of experiences...
Hallucinations and delusions can be symptoms of psychiatric illness, but more often—though less commonly known—are actually part of a healthy range of experiences found throughout the general population. The studies in this Special Collection paint a picture of the wide range of hallucinatory and delusional experiences across diverse populations, as well as comparative perspectives between clinical and non-clinical samples. In this editorial, I make three related points that are exemplified in the articles published here. First, that hallucinations and delusions are part of a normal distribution of human diversity; their mere presence does not indicate psychosis or psychiatric illness. Second, that the ubiquity of hallucinatory and delusional experiences across clinical and non-clinical populations suggests common cognitive and neural mechanisms. Finally, despite these commonalities, it is important to understand the difference between psychiatric symptoms and healthy experience. In summary, I conclude that it is important to investigate both common mechanisms and distinguishing factors to comprehensively elucidate these oft-misunderstood experiences. This Special Collection provides a showcase of the cutting-edge research that encompasses these objectives.
Topics: Humans; Delusions; Hallucinations; Psychotic Disorders; Forecasting
PubMed: 38600126
DOI: 10.1038/s41598-024-57472-6 -
Scientific Reports Apr 2024The persecutory delusion is the most common symptom of psychosis, yet its underlying neurobiological mechanisms are poorly understood. Prior studies have suggested that...
The persecutory delusion is the most common symptom of psychosis, yet its underlying neurobiological mechanisms are poorly understood. Prior studies have suggested that abnormalities in medial temporal lobe-dependent associative learning may contribute to this symptom. In the current study, this hypothesis was tested in a non-clinical sample of young adults without histories of psychiatric treatment (n = 64), who underwent classical Pavlovian fear conditioning while fMRI data were collected. During the fear conditioning procedure, participants viewed images of faces which were paired (the CS+) or not paired (the CS-) with an aversive stimulus (a mild electrical shock). Fear conditioning-related neural responses were measured in two medial temporal lobe regions, the amygdala and hippocampus, and in other closely connected brain regions of the salience and default networks. The participants without persecutory beliefs (n = 43) showed greater responses to the CS- compared to the CS+ in the right amygdala and hippocampus, while the participants with persecutory beliefs (n = 21) failed to exhibit this response. These between-group differences were not accounted for by symptoms of depression, anxiety or a psychosis risk syndrome. However, the severity of subclinical psychotic symptoms overall was correlated with the level of this aberrant response in the amygdala (p = .013) and hippocampus (p = .033). Thus, these findings provide evidence for a disruption of medial temporal lobe-dependent associative learning in young people with subclinical psychotic symptoms, specifically persecutory thinking.
Topics: Young Adult; Humans; Adolescent; Fear; Amygdala; Conditioning, Classical; Brain; Hippocampus; Magnetic Resonance Imaging
PubMed: 38589562
DOI: 10.1038/s41598-024-57746-z