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Schizophrenia Bulletin Mar 2014In his textbook from 1838, Esquirol made the first comprehensive psychopathological description of paranoia, which he labeled partial psychosis. This was a condition... (Review)
Review
In his textbook from 1838, Esquirol made the first comprehensive psychopathological description of paranoia, which he labeled partial psychosis. This was a condition with encapsulated, well organized, and persistent delusions. These are defended with a great deal of emotions and sharp argument. The individual appears quite convincing, especially because he or she otherwise behaves rationally. The intellectual capacity is used to achieve defined goals according to the delusional content. This condition is difficult to uncover because of dissimulation and adaptation. The frequency in the population is unknown, but the condition is rare in psychiatric treatment facilities, and usually only when the persons become litigious or criminal. In Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the condition is covered by the concept of delusional disorder, but that concept also comprises benign acute/subacute conditions as well as cases that turn out to have the diagnosis changed to schizophrenia.
Topics: Diagnostic and Statistical Manual of Mental Disorders; Humans; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 24421383
DOI: 10.1093/schbul/sbt203 -
Frontiers in Psychiatry 2023Wherever psychopathology operates with the concept of (disorders of) the self and personality, it can address the role of the intuitive access we have toward ourselves,... (Review)
Review
Wherever psychopathology operates with the concept of (disorders of) the self and personality, it can address the role of the intuitive access we have toward ourselves, others, and the world. This study discusses the concept of . It examines its role in explaining paranoia as a change in self-and-world relatedness. In the first , symptomatic features of paranoid personality disorder are sketched, with a focus on the explanatory role of attentional and interpretative biases, which correlate with significant changes in intuitive processing. In the second , the prototypical phenomenality of feelings of unfamiliarity and mistrust are discussed against the backdrop of changes of oikeiôsis in paranoid personality disorder. In the , the main therapeutic challenge in treating paranoid personality disorder-building a trustful relationship-is explored. It is concluded that the notion of oikeiôsis resonates particularly with introspection-based therapeutic approaches.
PubMed: 38268566
DOI: 10.3389/fpsyt.2023.1307629 -
Journal of Psychiatric Research Jun 2021Paranoia significantly contributes to social impairments across clinical diagnoses, and amygdala dysfunction has been identified as a neurobiological marker of paranoia...
BACKGROUND
Paranoia significantly contributes to social impairments across clinical diagnoses, and amygdala dysfunction has been identified as a neurobiological marker of paranoia among individuals with schizophrenia. Therefore, we aimed to investigate amygdala functional connectivity (FC) in paranoia across diagnoses.
METHODS
Forty-five patients with recent history of clinically significant paranoid ideation and a current DSM-5 diagnosis of any disorder underwent resting-state functional magnetic resonance imaging either in a paranoid (N = 23) or non-paranoid (N = 22) state. Amygdala FC were compared between paranoid and non-paranoid patients. Supplemental correlation analyses between amygdala FC and paranoia score were performed separately in patients and a non-equivalent healthy control (HC; N = 60) group.
RESULTS
Increased FC was found between right amygdala and the prefrontal cortex (PFC) [bilateral medial superior frontal gyrus, anterior cingulate, medial frontal gyrus, the triangular part and the opercular part of the inferior frontal gyrus (IFG); right orbital part of IFG], the frontal cortex (bilateral median cingulate, left precentral gyrus), and subcortical areas (right insula) in the paranoid group compared with the non-paranoid group. No significant between-group differences were observed in left amygdala FC. FC between right amygdala and PFC and frontal cortex was positively correlated with paranoia in patient and HC groups.
CONCLUSION
Paranoia is associated with right amygdala hyperconnectivity with PFC, frontal cortex, and insula. This hyperconnectivity was evident regardless of diagnosis and therefore identify a likely transdiagnostic neural mechanism, which may help to identify treatment targets that could potentially improve the social functioning of individuals with clinical diagnoses.
Topics: Amygdala; Cerebral Cortex; Gyrus Cinguli; Humans; Magnetic Resonance Imaging; Paranoid Disorders
PubMed: 33848967
DOI: 10.1016/j.jpsychires.2021.03.049 -
Behavioural Neurology Jan 2013Psychotic symptoms are common in drug treated patients with Parkinson's disease (PD). Visual hallucinations occur in about 30% and delusions, typically paranoid in... (Review)
Review
Psychotic symptoms are common in drug treated patients with Parkinson's disease (PD). Visual hallucinations occur in about 30% and delusions, typically paranoid in nature, occur in about 5%. These problems, particularly the delusions, cause great distress for patient and caregivers, and are among the most important precipitants for nursing home placement. Psychotic symptoms carry a poor prognosis. They often herald dementia, and are associated with increased mortality. These symptoms often abate with medication reductions, but this may not be tolerated due to worsened motor function. Only clozapine has level A evidence to support its use in PD patients with psychosis (PDP), whether demented or not. While quetiapine has been recommended by the American Academy of Neurology for "consideration," double blind placebo controlled trials have demonstrated safety but not efficacy. Other antipsychotic drugs have been reported to worsen motor function and data on the effectiveness of cholinesterase inhibitors is limited. PDP remains a serious problem with limited treatment options.
Topics: Antipsychotic Agents; Humans; Parkinson Disease; Psychotic Disorders
PubMed: 23242358
DOI: 10.3233/BEN-129016 -
Schizophrenia Bulletin Mar 2017Delusion is central to the conceptualization, definition, and identification of schizophrenia. However, in current classifications, the presence of delusions is neither... (Review)
Review
Delusion is central to the conceptualization, definition, and identification of schizophrenia. However, in current classifications, the presence of delusions is neither necessary nor sufficient for the diagnosis of schizophrenia, nor is it sufficient to exclude the diagnosis of some other psychiatric conditions. Partly as a consequence of these classification rules, it is possible for delusions to exist transdiagnostically. In this article, we evaluate the extent to which this happens, and in what ways the characteristics of delusions vary according to diagnostic context. We were able to examine their presence and form in delusional disorder, affective disorder, obsessive-compulsive disorder, borderline personality disorder, and dementia, in all of which they have an appreciable presence. There is some evidence that the mechanisms of delusion formation are, at least to an extent, shared across these disorders. This transdiagnostic extension of delusions is an argument for targeting them therapeutically in their own right. However there is a dearth of research to enable the rational transdiagnostic deployment of either pharmacological or psychological treatments.
Topics: Affective Disorders, Psychotic; Borderline Personality Disorder; Comorbidity; Delusions; Dementia; Humans; Obsessive-Compulsive Disorder; Schizophrenia; Schizophrenia, Paranoid
PubMed: 28399309
DOI: 10.1093/schbul/sbw191 -
Social Psychiatry and Psychiatric... Aug 2014Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an... (Review)
Review
PURPOSE
Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions.
METHODS
A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia.
RESULTS
Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments.
CONCLUSIONS
There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.
Topics: Adult; Aged; Anxiety; Cognitive Behavioral Therapy; Culture; Delusions; Female; Humans; Internal-External Control; Male; Middle Aged; Paranoid Disorders; Psychotic Disorders; Risk Factors; Schizophrenia, Paranoid; Severity of Illness Index; Thinking
PubMed: 25005465
DOI: 10.1007/s00127-014-0928-7 -
Schizophrenia Bulletin Jul 2023Game theory paradigms, such as the Prisoner's Dilemma Game (PDG), have been used to study nonclinical paranoia, though research using clinical populations has been...
BACKGROUND AND HYPOTHESIS
Game theory paradigms, such as the Prisoner's Dilemma Game (PDG), have been used to study nonclinical paranoia, though research using clinical populations has been scarce. We test our novel theoretical model that schizophrenia leads to competitiveness in interpersonal interactions, and that this link is serially mediated by trait paranoia, state paranoia, and distrust.
STUDY DESIGN
In this quasi-experimental study, individuals with schizophrenia spectrum diagnoses with current persecutory delusions (n = 46) and a nonclinical control group (n = 43) played the PDG, and completed measures of trait paranoia, state paranoia, and distrust.
STUDY RESULTS
Individuals with schizophrenia competed more in the PDG than the control group. Supporting our theoretical model, all direct effects were significant: schizophrenia was associated with higher trait paranoia (H1); trait paranoia predicted state paranoia in the PDG (H2); state paranoia in the PDG predicted distrust of the opponent in the PDG (H3); and distrust predicted competition in the PDG (H4). The hypothesized indirect effect of schizophrenia on competition in the PDG via trait paranoia, state paranoia, and distrust was supported in a serial mediation model (H5).
CONCLUSIONS
The findings make clear theoretical and methodological contributions. We provide the first evidence for a theoretical process model by which schizophrenia leads to competitiveness in interpersonal interactions via trait paranoia, state paranoia, and distrust. Game theory paradigms, and the PDG in particular, are important for advancing theory and research on paranoia as it occurs in both clinical and nonclinical populations.
Topics: Humans; Schizophrenia; Paranoid Disorders; Delusions; Interpersonal Relations
PubMed: 36912015
DOI: 10.1093/schbul/sbad021 -
Cureus Jan 2023Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a...
Paraphrenia is a chronic psychotic disorder characterized by a strong delusional component with preservation of thought and personality. It was first introduced as a disorder associated with paranoid dementia and paranoia, but with less personality deterioration than schizophrenia and without fulfilling the clinical features of a delusional disorder. This classic diagnostic entity is not currently listed in main diagnostic systems, rendering delusional disorders difficult to classify in cases that resemble the concept of paraphrenia. We revisit the concept of paraphrenia through a critical review based on a clinical vignette of a patient followed at the psychiatry department of the University Hospital Center of São João.
PubMed: 36726768
DOI: 10.7759/cureus.34391 -
Schizophrenia Bulletin Apr 2018Humans possess a basic need to belong and will join groups even when they provide no practical benefit. Paranoid symptoms imply a disruption of the processes involved in...
Humans possess a basic need to belong and will join groups even when they provide no practical benefit. Paranoid symptoms imply a disruption of the processes involved in belonging and social trust. Past research suggests that joining social groups and incorporating those groups into one's identity (social identification) promotes positive self-views and better physical and mental health. However, no research has investigated whether social identity is associated with paranoia, nor the mechanisms by which this effect may emerge. Here, we examined the relationship between social identity and mental health (paranoia, auditory verbal hallucinations [AVHs], and depression), and tested the mediating role of self-esteem. In study 1, we analyzed data collected from 4319 UK residents as part of the NIHR CLAHRC NWC Household Health Survey. Study 2 comprised data collected from 1167 students attending a large UK university. The studies provided convergent evidence that social identification reduces symptoms of paranoia and depression by furnishing people with self-esteem. There was no consistent effect of social identification on AVHs. People developing mental health assessments, treatments, and policies are encouraged to consider the notion that joining and identifying with social groups may reduce people's risk of paranoia and depression.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Depressive Disorder; Female; Hallucinations; Humans; Male; Middle Aged; Paranoid Disorders; Psychotic Disorders; Self Concept; Social Identification; United Kingdom; Young Adult
PubMed: 28981888
DOI: 10.1093/schbul/sbx110 -
Schizophrenia Bulletin Mar 2017This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms... (Review)
Review
This review traces, through psychiatric textbooks, the history of the Kraepelinian concept of paranoia in the 20th century and then relates the common reported symptoms and signs to the diagnostic criteria for paranoia/delusional disorder in DSM-III through DSM-5. Clinical descriptions of paranoia appearing in 10 textbooks, published 1899 to 1970, revealed 11 prominent symptoms and signs reported by 5 or more authors. Three symptoms (systematized delusions, minimal hallucinations, and prominent ideas of reference) and 2 signs (chronic course and minimal affective deterioration) were reported by 8 or 9 of the authors. Four textbook authors rejected the Kraepelinian concept of paranoia. A weak relationship was seen between the frequency with which the clinical features were reported and the likelihood of their inclusion in modern DSM manuals. Indeed, the diagnostic criteria for paranoia/delusional disorder shifted substantially from DSM-III to DSM-5. The modern operationalized criteria for paranoia/delusional disorder do not well reflect the symptoms and signs frequently reported by historical experts. In contrast to results of similar reviews for depression, schizophrenia and mania, the clinical construct of paranoia/delusional disorder has been somewhat unstable in Western Psychiatry since the turn of the 20th century as reflected in both textbooks and the DSM editions.
Topics: Diagnostic and Statistical Manual of Mental Disorders; History, 20th Century; Humans; Paranoid Disorders; Schizophrenia, Paranoid
PubMed: 28003468
DOI: 10.1093/schbul/sbw161