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JAAD Case Reports Mar 2024
PubMed: 38406621
DOI: 10.1016/j.jdcr.2024.01.010 -
Cureus Jan 2024Ertapenem is a carbapenem antibiotic that is typically prescribed in cases of moderate-to-severe infections, especially ones involving abscess formation. We describe the...
Ertapenem is a carbapenem antibiotic that is typically prescribed in cases of moderate-to-severe infections, especially ones involving abscess formation. We describe the case of an 82-year-old gentleman who presented with osteomyelitis and abscess formation who developed delirium after 15 days of ertapenem treatment. The patient experienced delusions, insomnia, agitation, and disorientation. The patient's mental status improved and returned to his baseline within 48 hours of halting ertapenem treatment. A high index of suspicion is required to identify and treat ertapenem-induced delirium. Withdrawal of ertapenem treatment in such cases usually results in a complete resolution of symptoms.
PubMed: 38384616
DOI: 10.7759/cureus.52732 -
Frontiers in Psychology 2024This theoretical perspective examines the proposition of shared complex trauma between a parent and child, arising from blurred relational boundaries and societal...
This theoretical perspective examines the proposition of shared complex trauma between a parent and child, arising from blurred relational boundaries and societal oppression, leading to inequality both at home and within the larger paternalistic system of society. Specifically, the focus is on living within a paternalistic, authoritarian system where rules are unjust, demanding obedience and compliance without questioning the behaviors of the authority. Individuals growing up in these circumstances are subject to adverse and emotionally overwhelming experiences, which lead to the creation of emotional memory images (EMIs). The delusion in which the child is caught up becomes a reality for the child as time passes. This phenomenon is recognized in psychiatry as "Folie à deux" (the madness of two or more) at the micro level, and "Folie et Société" (the madness of society) on the macro level. Complex trauma, derived from a child's exposure to multiple adverse events, can erode the mind-body relationship, impacting both mental and physical health. These traumatic experiences in early childhood can manifest as body-focused disorders in adolescents, prevailing throughout adulthood if left unattended. This article provides a theoretical perspective on dealing with the dissociation and chronic stress related to oppressive and authoritarian family systems. The broader implications of this article include highlighting the psychophysiological underpinnings of complex trauma, the relationship of a highly oppressive paternalistic authoritarian system imposed on children and adolescents, and the role of Split-Second Unlearning as a therapeutic intervention to clear EMIs and improve overall health outcomes.
PubMed: 38375111
DOI: 10.3389/fpsyg.2024.1324303 -
BMC Psychiatry Feb 2024Electroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered...
BACKGROUND
Electroconvulsive therapy (ECT) is a safe treatment for treatment-resistant schizophrenia. However, it has some side effects, and Takotsubo cardiomyopathy is considered one of the minor complications. Several cases of patients developing Takotsubo cardiomyopathy during a course of ECT have been reported, but none have died. We present a case of post-ECT Takotsubo cardiomyopathy that became fatal.
CASE PRESENTATION
We experienced a case of a 67-year-old woman who had delusions and catatonic symptoms due to schizophrenia but was resistant to several medications. Her symptoms improved by conducting ECT, but she had difficulty maintaining her improvement, which caused her to receive multiple courses of ECT. 3 weeks after her 6th course of ECT, the patient was diagnosed with Takotsubo cardiomyopathy and had a fatal outcome.
CONCLUSION
Our patient had numerous cases of aspiration pneumonia and malnutrition before ECT was performed, which might have made this case fatal. In conclusion, appropriate supplementation of nutrition and reduction of physical stressors are important to avoid death from Takotsubo cardiomyopathy caused by ECT. Prescribing clozapine was a solution in the present case, but there are some difficulties, such as the restriction against prescribing this drug in Japan.
Topics: Humans; Female; Aged; Electroconvulsive Therapy; Schizophrenia; Takotsubo Cardiomyopathy; Catatonia; Japan; Treatment Outcome
PubMed: 38373994
DOI: 10.1186/s12888-024-05593-7 -
Behavioural and Cognitive Psychotherapy May 2024Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas...
BACKGROUND
Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas in mind, elaborate the details, and increase the degree of conviction in the delusion. Pleasant daydreams more generally could contribute to elevated mood, which may influence the delusion content.
AIMS
We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess daydreaming and test potential associations with grandiosity.
METHOD
798 patients with psychosis (375 with grandiose delusions) and 4518 non-clinical adults (1788 with high grandiosity) were recruited. Participants completed a daydreaming item pool and measures of grandiosity, time spent thinking about the grandiose belief, and grandiose belief conviction. Factor analysis was used to derive the Qualities of Daydreaming Scale (QuOD) and associations were tested using pairwise correlations and structural equation modelling.
RESULTS
The questionnaire had three factors: realism, pleasantness, and frequency of daydreams. The measure was invariant across clinical and non-clinical groups. Internal consistency was good (alpha-ordinals: realism=0.86, pleasantness=0.93, frequency=0.82) as was test-retest reliability (intra-class coefficient=0.75). Daydreaming scores were higher in patients with grandiose delusions than in patients without grandiose delusions or in the non-clinical group. Daydreaming was significantly associated with grandiosity, time spent thinking about the grandiose delusion, and grandiose delusion conviction, explaining 19.1, 7.7 and 5.2% of the variance in the clinical group data, respectively. Similar associations were found in the non-clinical group.
CONCLUSIONS
The process of daydreaming may be one target in psychological interventions for grandiose delusions.
Topics: Adult; Humans; Delusions; Fantasy; Reproducibility of Results; Psychotic Disorders; Mood Disorders
PubMed: 38372129
DOI: 10.1017/S1352465824000018 -
JAAD International Jun 2024
PubMed: 38371665
DOI: 10.1016/j.jdin.2024.01.001 -
Industrial Psychiatry Journal Nov 2023Internet addiction has recently been suggested as a possible diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and incorporated in...
Internet addiction has recently been suggested as a possible diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and incorporated in the International Classification of Diseases 11 Revision (ICD-11) as a gaming disorder, predominantly, online or offline. Mostly, psychotic phenomena have been described by either alcohol or opioid withdrawal, but there is a paucity of literature on Internet-related psychosis. We report two cases from Northern India of sudden onset of psychosis due to Internet addiction. The contents of hallucinations and delusions reflected themes of Internet gaming. Psychosis as a specifier for Internet gaming disorder (IGD) is not defined in DSM-5, whereas it should be considered as one of the presentations of Internet addiction.
PubMed: 38370923
DOI: 10.4103/ipj.ipj_242_23 -
MedRxiv : the Preprint Server For... Feb 2024Schizophrenia is associated with an increased risk of aggressive behaviour, which may partly be explained by illness-related changes in brain structure. However,...
BACKGROUND
Schizophrenia is associated with an increased risk of aggressive behaviour, which may partly be explained by illness-related changes in brain structure. However, previous studies have been limited by group-level analyses, small and selective samples of inpatients and long time lags between exposure and outcome.
METHODS
This cross-sectional study pooled data from 20 sites participating in the international ENIGMA-Schizophrenia Working Group. Sites acquired T-weighted and diffusion-weighted magnetic resonance imaging scans in a total of 2095 patients with schizophrenia and 2861 healthy controls. Measures of grey matter volume and white matter microstructural integrity were extracted from the scans using harmonised protocols. For each measure, normative modelling was used to calculate how much patients deviated (in -scores) from healthy controls at the individual level. Ordinal regression models were used to estimate the associations of these deviations with concurrent aggressive behaviour (as odds ratios [ORs] with 99% confidence intervals [CIs]). Mediation analyses were performed for positive symptoms (i.e., delusions, hallucinations and disorganised thinking), impulse control and illness insight. Aggression and potential mediators were assessed with the Positive and Negative Syndrome Scale, Scale for the Assessment of Positive Symptoms or Brief Psychiatric Rating Scale.
RESULTS
Aggressive behaviour was significantly associated with reductions in total cortical volume (OR [99% CI] = 0.88 [0.78, 0.98], = .003) and global white matter integrity (OR [99% CI] = 0.72 [0.59, 0.88], = 3.50 × 10) and additional reductions in dorsolateral prefrontal cortex volume (OR [99% CI] = 0.85 [0.74, 0.97], =.002), inferior parietal lobule volume (OR [99% CI] = 0.76 [0.66, 0.87], = 2.20 × 10) and internal capsule integrity (OR [99% CI] = 0.76 [0.63, 0.92], = 2.90 × 10). Except for inferior parietal lobule volume, these associations were largely mediated by increased severity of positive symptoms and reduced impulse control.
CONCLUSIONS
This study provides evidence that the co-occurrence of positive symptoms, poor impulse control and aggressive behaviour in schizophrenia has a neurobiological basis, which may inform the development of therapeutic interventions.
PubMed: 38370846
DOI: 10.1101/2024.02.04.24302268 -
Frontiers in Psychiatry 2024There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic... (Review)
Review
BACKGROUND
There is a paucity of literature regarding ethical strategies for treating pregnant people with psychosis. While not uncommon, psychotic pregnancy denial is a psychotic illness in which patients have the delusion that they are not pregnant. The authors provide a literature review regarding psychotic pregnancy denial, present an unpublished case and its questions and dilemmas, and offer recommendations for resolving the ethical challenges these cases raise.
CASE
A 26-year-old, single, unemployed woman of no fixed residence was admitted for suicidal ideation. She had a history of psychosis, had multiple ER visits and at least one previous hospitalization, had minimal contact with psychiatric outpatient clinics, and had been poorly compliant with treatment recommendations. She was discovered to be about 31 weeks pregnant in the emergency room. Ultrasound exams revealed no fetal anomalies. This was the patient's second pregnancy; her previous pregnancy resulted in an abortion. Her sole psychotic symptom was the delusional belief that she was not pregnant. On the rare occasions when the patient acknowledged being pregnant, she requested termination of pregnancy. Despite intensive pharmacological treatment of her psychosis, the patient continued believing that she was not pregnant and repeatedly said she would not participate in the labor and delivery process. She disagreed with the induction of labor or a cesarean section if needed. The patient developed gestational hypertension, an obstetric indication for delivery. Induction of labor was offered to avoid potentially disastrous outcomes for the pregnant woman and the fetus.
CONCLUSION
Psychotic pregnancy denial is potentially life-threatening. Delivery of the fetus requires carefully weighing risks and benefits and thoroughly considering the ethical framework.
TEACHING POINTS
Treatment of birthing people with psychotic denial of pregnancy is complex; it requires special clinical and ethical skills to determine the patient's level of decision-making impairment and to find a middle ground between the pregnant person's right to autonomy and the physicians' beneficence-based duties. Using a well-coordinated, interdisciplinary approach and a solid ethical framework, the decision to deliver the fetus while engaging the pregnant person, to the extent possible, in the decision-making process is essential.
PubMed: 38370555
DOI: 10.3389/fpsyt.2024.1337988