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Neuropsychopharmacologia Hungarica : a... Oct 2008INTRODUCTION, AIMS: The authors present the Cotard's syndrome, a rare psychiatric condition, pointing out the latest results in terms of etiology and psychoneurology.... (Review)
Review
UNLABELLED
INTRODUCTION, AIMS: The authors present the Cotard's syndrome, a rare psychiatric condition, pointing out the latest results in terms of etiology and psychoneurology. The central feature of the syndrome is a nihilistic delusion, in which the patient denies his or her own existence and that of the external world.
METHOD
We searched electronic databases using the appropriate search terms, relevant articles were carefully reviewed. We present three cases from our clinical practice.
RESULTS
After the overview of the latest biological and neuropsychological findings, the historical aspects of the condition, the terminology, the nosology, the classification, the differential diagnostics and the etiology are discussed. The psychopathology and the phenomenology of Cotard's syndrome are also presented, shedding light on existential aspects as well. To sum up with useful information for the clinical practice, the possible treatment strategies, the course and the prognosis of the disease are also discussed.
CONCLUSIONS
The presented theoretical and practical aspects give a lead on deeper understanding, easier recognition and more adequate therapy of the Cotard's syndrome.
Topics: Aged; Body Image; Colonic Neoplasms; Delusions; Depression; Depressive Disorder, Major; Diagnosis, Differential; Female; France; Grief; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Male; Middle Aged; Neuropsychological Tests; Prognosis; Reality Testing; Respiration; Respiratory Insufficiency; Stroke; Syndrome; Terminology as Topic
PubMed: 19213200
DOI: No ID Found -
Psychology and Psychotherapy Mar 2021Grandiose delusions are arguably the most neglected psychotic experience in research.
BACKGROUND
Grandiose delusions are arguably the most neglected psychotic experience in research.
OBJECTIVES
We aimed to discover from patients: whether grandiose delusions have harmful consequences; the psychological mechanisms that maintain them; and what help patients may want from clinical services.
DESIGN
A qualitative interview design was used to explore patients' experiences of grandiose delusions.
METHOD
Fifteen patients with past or present experiences of grandiose delusions who were attending psychiatric services were interviewed. Thematic analysis and grounded theory were used to analyse the data.
RESULTS
Participants reported physical, sexual, social, occupational, and emotional harms from grandiose delusions. All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self-identity, or it made sense of unusual or difficult events. The meaning from the belief was not synonymous with extreme superiority or arrogance. The meaning obtained appeared to be a key driver of the persistence of the beliefs. Other maintenance factors were subjectively anomalous experiences (e.g., voices), symptoms of mania, fantasy elaboration, reasoning biases, and immersive behaviours. Participants described insufficient opportunities to talk about their grandiose beliefs and related experiences and were generally positive about the possibility of a psychological therapy.
CONCLUSIONS
We conclude that grandiosity is a psychologically rich experience, with a number of maintenance factors that may be amenable to a targeted psychological intervention. Importantly, the term 'grandiose delusion' is an imprecise description of the experience; we suggest 'delusions of exceptionality' may be a credible alternative.
PRACTITIONER POINTS
Harm from grandiose delusions can occur across multiple domains (including physical, sexual, social, occupational, and emotional) and practitioners should assess accordingly. However, grandiose delusions are experienced by patients as highly meaningful: they provide a sense of purpose, belonging, or self-identity, or make sense of unusual or difficult events. Possible psychological maintenance mechanisms that could be a target for intervention include the meaning of the belief, anomalous experiences, mania, fantasy elaboration, reasoning biases, and immersive behaviours. Patients are keen to have the opportunity to access talking therapies for this experience. Taking extra time to talk at times of distress, 'going the extra mile', and listening carefully can help to facilitate trust.
Topics: Delusions; Emotions; Humans; Mood Disorders; Qualitative Research
PubMed: 31785077
DOI: 10.1111/papt.12260 -
Tijdschrift Voor Psychiatrie 2015The delusion of world catastrophe was conceptualised by classic authors such as Jaspers and Conrad as a specific expression of acute psychosis that deserved special... (Review)
Review
BACKGROUND
The delusion of world catastrophe was conceptualised by classic authors such as Jaspers and Conrad as a specific expression of acute psychosis that deserved special attention in psychiatric diagnosis. We need to find out whether this approach is still relevant today.
AIM
To provide an overview of the literature about the delusion of world catastrophe.
METHOD
The literature was searched and historical literature was also consulted.
RESULTS
A patient's delusion of world catastrophe often begins with a phase known as the 'Wahnstimmung' which may be accompanied by subtle positive disorders of perception. This is followed by frank psychosis, with hallucinations, formal thought disorders, and, in exceptional cases, can lead to suicidality and/or homicidality. Prevalence rates derived from populations of patients diagnosed with a schizophrenia spectrum disorder vary from 1% to 8%, with a single outlier of 63.5%. Wetzel was the first to conceptualise the delusion of world catastrophe as an attempt of the brain to make sense of a world on which it had lost its grip due to the psychotic process. The link Wetzel established between subtle disorders of perception and possible organic causes is still relevant today.
CONCLUSION
Patients who are beginning to have delusions of world catastrophe deserve not only to get an early diagnosis of the neurobiological correlates of their perceptual disorders, but also to receive adequate treatment for their psychosis.
Topics: Catastrophization; Delusions; Hallucinations; Humans; Psychotic Disorders
PubMed: 26479253
DOI: No ID Found -
The Ceylon Medical Journal Sep 2003
Topics: Adult; Aged; Animals; Antipsychotic Agents; Delusions; Female; Humans; Male; Parasitic Diseases; Prognosis; Risk Assessment; Sampling Studies; Sri Lanka; Treatment Outcome
PubMed: 14735812
DOI: 10.4038/cmj.v48i3.3359 -
The American Journal of Geriatric... Oct 2019
Topics: Alzheimer Disease; Delusions; Humans; Neuropsychological Tests
PubMed: 31350161
DOI: 10.1016/j.jagp.2019.06.016 -
Cognitive Neuropsychiatry May 2019Two-factor theory suggests delusions require two neuropsychological impairments, one in perception (which furnishes content), and a second in belief evaluation (that... (Review)
Review
INTRODUCTION
Two-factor theory suggests delusions require two neuropsychological impairments, one in perception (which furnishes content), and a second in belief evaluation (that augers formation and maintenance). Capgras delusion; the belief that one's loved one has been replaced by an imposter, then entails two independent processes; first a lack of skin conductance response to familiar faces so the loved one feels different. This has been demonstrated in four patients with damage to the ventromedial prefrontal cortex (vmPFC) but who do not have delusions. Thus two-factor theorists demand a second factor: a change in belief evaluation, which is associated with damage to the right dorsolateral prefrontal cortex (rDLPFC).
METHODS
Literature review of foundational and related papers on the cognitive neuropsychology of delusions, perception and belief.
RESULTS
The four vmPFC patients appear together in another publication, uncited by two-factor theorists, in which the full extent of their damage is documented. These four cases not only lack skin responses to familiar faces, but lack responses to salient psychological stimuli more generally, which challenges factor one. They also have damage outside vmPFC, including damage to rDLPFC, which challenges factor two.
CONCLUSION
Two-factor theory is found lacking and should be reappraised.
Topics: Delusions; Emotions; Humans; Prefrontal Cortex; Recognition, Psychology
PubMed: 31010382
DOI: 10.1080/13546805.2019.1606706 -
Behavioural and Cognitive Psychotherapy Jan 2020Cognitive behavioural treatments are recommended for people with psychosis. Core beliefs regarding the self and others are a key part of the models underpinning...
BACKGROUND
Cognitive behavioural treatments are recommended for people with psychosis. Core beliefs regarding the self and others are a key part of the models underpinning cognitive behavioural therapy but detailed understanding of these putative beliefs in people with psychosis are limited. A greater understanding of these mechanisms is necessary to improve and refine treatments.
AIMS
This study utilized a qualitative approach to explore core schematic beliefs in psychosis (strongly held positive and negative beliefs about the self and others) and their relation to hallucinations and delusions.
METHOD
Twenty individuals with psychosis participated in individual semi-structured interviews. Inductive thematic analysis was used to analyse the interviews.
RESULTS
Four emergent themes were identified: (i) the solidity and permanency of core beliefs, (ii) the causes and development of core beliefs, (iii) a synergistic relationship between core beliefs and symptoms, and (iv) core beliefs associated with images and their influence on psychotic symptoms.
CONCLUSIONS
This study provides new insights into the range and character of core beliefs in psychosis and provides important data to guide ongoing and future development of treatment approaches for psychosis.
Topics: Adolescent; Adult; Cognitive Behavioral Therapy; Culture; Delusions; Female; Hallucinations; Humans; Imagination; Interview, Psychological; Male; Middle Aged; Psychotic Disorders; Qualitative Research; Schizophrenia; Schizophrenic Psychology; Young Adult
PubMed: 30957739
DOI: 10.1017/S1352465819000274 -
Psychological Medicine Jul 2023Persecutory fears build on feelings of vulnerability that arise from negative views of the self. Body image concerns have the potential to be a powerful driver of...
BACKGROUND
Persecutory fears build on feelings of vulnerability that arise from negative views of the self. Body image concerns have the potential to be a powerful driver of feelings of vulnerability. Body image concerns are likely raised in patients with psychosis given the frequent weight gain. We examined for the first-time body esteem - the self-evaluation of appearance - in relation to symptom and psychological correlates in patients with current persecutory delusions.
METHODS
One-hundred and fifteen patients with persecutory delusions in the context of non-affective psychosis completed assessments of body image, self-esteem, body mass index (BMI), psychiatric symptoms and well-being. Body esteem was also assessed in 200 individuals from the general population.
RESULTS
Levels of body esteem were much lower in patients with psychosis than non-clinical controls ( = 1.2, < 0.001). In patients, body esteem was lower in women than men, and in the overweight or obese BMI categories than the normal weight range. Body image concerns were associated with higher levels of depression ( = 0.55, < 0.001), negative self-beliefs ( -0.52, < 0.001), paranoia ( -0.25, = 0.006) and hallucinations ( -0.21, = 0.025). Body image concerns were associated with lower levels of psychological wellbeing ( 0.41, < 0.001), positive self-beliefs ( 0.40, < 0.001), quality of life ( 0.23, = 0.015) and overall health ( 0.31, = 0.001).
CONCLUSIONS
Patients with current persecutory delusions have low body esteem. Body image concerns are associated with poorer physical and mental health, including more severe psychotic experiences. Improving body image for patients with psychosis is a plausible target of intervention, with the potential to result in a wide range of benefits.
Topics: Male; Humans; Female; Delusions; Body Image; Quality of Life; Psychotic Disorders; Paranoid Disorders
PubMed: 35387699
DOI: 10.1017/S0033291722000800 -
Schizophrenia Bulletin Feb 2018Schizophrenia is characterized by social interaction deficits contributing to poor functional outcome. Hand gesture use is particularly impaired, linked to frontal lobe...
Schizophrenia is characterized by social interaction deficits contributing to poor functional outcome. Hand gesture use is particularly impaired, linked to frontal lobe dysfunction and frontal grey matter deficits. The functional neural correlates of impaired gesturing are currently unclear. We therefore investigated aberrant brain activity during impaired gesturing in schizophrenia. We included 22 patients with schizophrenia and 25 healthy control participants matched for age, gender, and education level. We obtained functional magnetic resonance imaging data using an event-related paradigm to assess brain activation during gesture planning and execution. Group differences in whole brain effects were calculated using factorial designs. Gesture ratings were performed by a single rater, blind to diagnoses and clinical presentation. During gesture planning and execution both groups activated brain areas of the praxis network. However, patients had reduced dorsolateral prefrontal cortex (DLPFC) and increased inferior parietal lobe (IPL) activity. Performance accuracy was associated with IPL activity in patients. Furthermore, patients activated temporal poles, amygdala and hippocampus during gesture planning, which was associated with delusion severity. Finally, patients demonstrated increased dorsomedial prefrontal cortex activity during planning of novel gestures. We demonstrate less prefrontal, but more IPL and limbic activity during gesturing in schizophrenia. IPL activity was associated with performance accuracy, whereas limbic activity was linked to delusion severity. These findings may reflect impaired social action planning and a limbic interference with gestures in schizophrenia contributing to poor gesture performance and consequently poor social functioning in schizophrenia.
Topics: Adult; Amygdala; Cerebral Cortex; Delusions; Executive Function; Female; Gestures; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Motor Activity; Schizophrenia; Severity of Illness Index; Social Behavior; Young Adult
PubMed: 28575506
DOI: 10.1093/schbul/sbx059 -
L'Encephale Sep 2010SOURCE MONITORING FRAMEWORK: Source monitoring refers to the ability to remember the origin of information. Three source monitoring processes can be distinguished:... (Review)
Review
UNLABELLED
SOURCE MONITORING FRAMEWORK: Source monitoring refers to the ability to remember the origin of information. Three source monitoring processes can be distinguished: external source monitoring, internal or self-monitoring and reality monitoring (i.e. discrimination between internal and external sources of information). Source monitoring decisions are based on memory characteristics recorded such as perceptions, contextual information or emotional reactions and heuristic or more controlled judgement processes.
BRAIN STRUCTURES
Several studies suggested that specific structures in the prefrontal and the mediotemporal lobes are the main areas implicated in source monitoring.
ASSESSMENT
A typical source monitoring paradigm includes an items generation stage and a second stage of recognition of items (old versus new) and identification of their sources: external (usually the examiner) or internal (the subject). Several indices can be calculated based on the raw data such as the number of false alarms, attribution biases or discrimination indexes. To date, there is no standardized source monitoring task and differences in the type of items used (words, pictures), in the cognitive or emotional effort involved or in the delay between the two test stages, contribute to the heterogeneity of results.
FACTORS INFLUENCING SOURCE MONITORING
Factors such as age (either very young or very old) and emotions influence source monitoring performances. Influence of gender was not properly explored, whereas the role of IQ and selective attention is still debated.
SOURCE MONITORING DEFICITS IN NEUROLOGICAL DISORDERS
Source monitoring deficits are observed mainly in disorders affecting frontotemporal areas, such as frontal trauma, Alzheimer's disease or frontotemporal dementia.
SOURCE MONITORING AND SCHIZOPHRENIA
Source monitoring errors (e.g. external misattribution of self-generated information) are observed in schizophrenia and seem to correlate with positive symptomatology, in particular auditory hallucinations, thought intrusion and alien control symptoms. These results are of particular interest in clinical research because source monitoring is one of the rare cognitive tests showing a correlation with the positive dimension. Source monitoring deficits have been proposed as a potential explanation for the positive symptoms and some, but not all studies lent support to this hypothesis. Heterogeneity of studied samples, in particular different criteria to define hallucinating subjects (e.g. currently versus anytime during their lives), could explain the discordant results.
SOURCE MONITORING IN PSYCHIATRIC DISORDERS WITHIN THE SCHIZOPHRENIC SPECTRUM
Source monitoring impairments were observed in pharmacological models of psychosis, in first degree relatives of schizophrenic patients, and also in the general population associated with schizotypal dimensions. These results support a relationship between source monitoring deficits and some of the symptomatic dimensions of the schizophrenic spectrum but still await replication.
SOURCE MONITORING AND OTHER PSYCHIATRIC DISORDERS
Some studies found source monitoring deficits in other psychiatric conditions such as mania or obsessive-compulsive disorder. Thus, those studies suggest that source monitoring deficits may be not specific to schizophrenia.
CONCLUSION
Source monitoring competencies are critical for good (i.e. adapted) everyday functioning. Source monitoring deficits have been suggested as a potential explanation for some (or all) positive psychotic symptoms. However, to date, methodological inconsistencies (especially with regard to test design and choice of subjects' samples) have precluded firm, definite conclusions.
Topics: Attention; Brain Mapping; Delusions; Discrimination, Psychological; Dominance, Cerebral; Hallucinations; Humans; Imagination; Internal-External Control; Judgment; Mental Recall; Neuropsychological Tests; Prefrontal Cortex; Reality Testing; Recognition, Psychology; Schizophrenia; Schizophrenic Psychology; Social Perception; Temporal Lobe
PubMed: 20850604
DOI: 10.1016/j.encep.2009.12.010