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Clinical Microbiology Reviews Oct 2009This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by... (Review)
Review
This papers aims at familiarizing psychiatric and nonpsychiatric readers with delusional infestation (DI), also known as delusional parasitosis. It is characterized by the fixed belief of being infested with pathogens against all medical evidence. DI is no single disorder but can occur as a delusional disorder of the somatic type (primary DI) or secondary to numerous other conditions. A set of minimal diagnostic criteria and a classification are provided. Patients with DI pose a truly interdisciplinary problem to the medical system. They avoid psychiatrists and consult dermatologists, microbiologists, or general practitioners but often lose faith in professional medicine. Epidemiology and history suggest that the imaginary pathogens change constantly, while the delusional theme "infestation" is stable and ubiquitous. Patients with self-diagnosed "Morgellons disease" can be seen as a variation of this delusional theme. For clinicians, clinical pathways for efficient diagnostics and etiology-specific treatment are provided. Specialized outpatient clinics in dermatology with a liaison psychiatrist are theoretically best placed to provide care. The most intricate problem is to engage patients in psychiatric therapy. In primary DI, antipsychotics are the treatment of choice, according to limited but sufficient evidence. Pimozide is no longer the treatment of choice for reasons of drug safety. Future research should focus on pathophysiology and the neural basis of DI, as well as on conclusive clinical trials, which are widely lacking. Innovative approaches will be needed, since otherwise patients are unlikely to adhere to any study protocol.
Topics: Ectoparasitic Infestations; Humans; Schizophrenia, Paranoid
PubMed: 19822895
DOI: 10.1128/CMR.00018-09 -
Neuropsychiatric Disease and Treatment 2021Schizophrenia is a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan, and it...
Schizophrenia is a chronic relapsing and remitting disorder associated with significant impairments in social and vocational functioning and a shortened lifespan, and it is a disabling psychiatric brain syndrome whose phenotype is characterized by three core symptom domains: positive symptoms, such as delusions and hallucinations, negative symptoms, which include lack of motivation and social withdrawal, and cognitive impairment. Moreover, patients with schizophrenia have severe problems with personal and social relations which affect their quality of life. Antipsychotic medications in conjunction with psychosocial interventions can help patients achieve recovery. Here are described three clinical cases of schizophrenic patients treated with cariprazine for inadequate response to a previous treatment. The purpose of this clinical series is to give useful information for the use of cariprazine in clinical practice.
PubMed: 34285492
DOI: 10.2147/NDT.S315653 -
Biomedical and Environmental Sciences :... Dec 2012To study the contribution of executive function to abnormal recognition of facial expressions of emotion in schizophrenia patients.
OBJECTIVE
To study the contribution of executive function to abnormal recognition of facial expressions of emotion in schizophrenia patients.
METHODS
Abnormal recognition of facial expressions of emotion was assayed according to Japanese and Caucasian facial expressions of emotion (JACFEE), Wisconsin card sorting test (WCST), positive and negative symptom scale, and Hamilton anxiety and depression scale, respectively, in 88 paranoid schizophrenia patients and 75 healthy volunteers.
RESULTS
Patients scored higher on the Positive and Negative Symptom Scale and the Hamilton Anxiety and Depression Scales, displayed lower JACFEE recognition accuracies and poorer WCST performances. The JACFEE recognition accuracy of contempt and disgust was negatively correlated with the negative symptom scale score while the recognition accuracy of fear was positively with the positive symptom scale score and the recognition accuracy of surprise was negatively with the general psychopathology score in patients. Moreover, the WCST could predict the JACFEE recognition accuracy of contempt, disgust, and sadness in patients, and the perseverative errors negatively predicted the recognition accuracy of sadness in healthy volunteers. The JACFEE recognition accuracy of sadness could predict the WCST categories in paranoid schizophrenia patients.
CONCLUSION
Recognition accuracy of social-/moral emotions, such as contempt, disgust and sadness is related to the executive function in paranoid schizophrenia patients, especially when regarding sadness.
Topics: Adolescent; Adult; Asian People; Executive Function; Facial Expression; Female; Humans; Male; Middle Aged; Schizophrenia, Paranoid; White People; Young Adult
PubMed: 23228840
DOI: 10.3967/0895-3988.2012.06.012 -
Medical Principles and Practice :... 2008The neural basis of psychosis is yet to be fully elucidated. In this review the contribution of schizophrenia-like psychosis of epilepsy, delusional misidentification... (Review)
Review
The neural basis of psychosis is yet to be fully elucidated. In this review the contribution of schizophrenia-like psychosis of epilepsy, delusional misidentification syndromes and psychotic phenomena, such as auditory and visual hallucinations, to our understanding of the neural basis of psychosis is examined. Schizophrenia-like psychosis of epilepsy is associated with seizures originating from the limbic structures. Reduced seizure frequency, left-sided electrical foci, and neurodevelopmental lesions manifesting as cortical dysgenesis are known to influence the likelihood of developing schizophrenia-like psychosis of epilepsy. The delusional misidentification syndromes are a group of rare psychiatric symptoms in which impairments of face recognition memory are present. These conditions appear also to be associated with organic lesions affecting limbic structures and also involving both the frontal and parietal lobes. There is evidence that right-sided lesions predominate in the aetiology of delusional misidentification syndromes. Thus, the common link between schizophrenia, schizophrenia-like psychosis of epilepsy and delusional misidentification syndromes appears to be involvement of limbic structures in their pathophysiology. Discrete psychotic phenomena such as visual and auditory hallucinations appear to arise from functional changes in the same cortical areas subserving the normal physiological functions of vision and audition but also involving limbic structures. In conclusion, the limbic structures appear to be central to the psychopathology of psychosis but with involvement of frontal and parietal structures. These inquiries are revealing as much about psychosis as they are about the nature of normal brain function.
Topics: Epilepsy; Humans; Psychotic Disorders; Risk Factors; Schizophrenia; Schizophrenia, Paranoid
PubMed: 18523391
DOI: 10.1159/000129603 -
Frontiers in Psychiatry 2022Cognitive impairment is among the core dimensions in schizophrenia and is a significant predictor of everyday functioning in people with schizophrenia. Given the...
BACKGROUND
Cognitive impairment is among the core dimensions in schizophrenia and is a significant predictor of everyday functioning in people with schizophrenia. Given the enormous burden of schizophrenia, the search for its clinically relevant biomarkers is essential. Researchers have been trying to elucidate factors of cognitive impairment as well as personal performance, but the search is still ongoing. The aim of the study was to search for associations between BDNF, CRP, IL-6 and clinical symptoms, cognitive and personal performance in patients with paranoid schizophrenia.
METHODS
A total of 86 patients (53.5% women, mean age 31.1 ± 6.5) with paranoid schizophrenia (F20.0; ICD-10) in remission were examined. Clinical and neuropsychological examination included the Positive and Negative Syndrome Scale, Personal and Social Performance Scale, Calgary Depression Scale for Schizophrenia and the Brief Assessment of Cognitive Function in Schizophrenia. IL-6, BDNF, CRP levels were determined in the patients' blood serum.
RESULTS
Cognitive impairment was revealed in 79.1% of patients and was more profound in patients with higher number of hospitalizations ( = 0.006). The average BDNF levels were 13.38 ± 15.84 ng/ml, CRP concentration was 2.09 ± 2.54 mg/l, and IL-6 levels were 12.14 ± 5.88 pg/ml. There were no differences in biomarker levels or BACS results in patients that had different antipsychotic therapy or differed in the presence of anticholinergic therapy. CRP levels were higher in patients with longer disease duration, lower age of onset, more impaired personal social performance and processing speed. IL-6 was higher in individuals with lower working memory scores. PANSS negative subscale score negatively correlated and PSP score positively correlated with most cognitive domains. A linear regression established that the first episode vs. multiple episodes of schizophrenia could statistically significantly predict personal and social performance and cognition, including speech fluency and planning, as well as CRP levels.
CONCLUSIONS
This study continues the search for biomarkers of schizophrenia and cognitive impairment in schizophrenia to improve the reliability of diagnosing the disorder and find new treatment approaches. The role of the number of psychoses experienced (first episode vs. multiple episodes of schizophrenia) in cognition, personal and social performance and inflammation is shown.
PubMed: 35873262
DOI: 10.3389/fpsyt.2022.943869 -
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 -
European Psychiatry : the Journal of... Jan 2019Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional...
BACKGROUND
Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD.
METHODS
Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan's Disability Inventory.
RESULTS
In the final linear regression models, higher scores in the Paranoid (β= 0.471, p < .001, r = 0.273) and Cognitive (β = 0.325, p < .001, r = 0.180) symptomatic dimensions and lower scores in verbal memory (β = -0.273, p < .05, r = 0.075) were significantly associated with poorer psychosocial functioning in patients with DD. Lower scores in verbal memory (β= -0.337, p < .01, r = 0.158) and executive functions (β= -0.323, p < .01, r = 0.094) were significantly associated with higher self-perceived disability.
CONCLUSIONS
Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD.
Topics: Adult; Attention; Cognition; Cognitive Behavioral Therapy; Disability Evaluation; Executive Function; Female; Humans; Male; Memory; Middle Aged; Neuropsychological Tests; Paranoid Disorders; Psychotic Disorders; Schizophrenia, Paranoid; Self-Assessment; Social Skills
PubMed: 30388425
DOI: 10.1016/j.eurpsy.2018.09.010 -
The Primary Care Companion For CNS... Nov 2020
Topics: Delusions; Humans; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 33185988
DOI: 10.4088/PCC.20l02741 -
The Primary Care Companion For CNS... Apr 2018
Topics: Adult; Anemia, Aplastic; Antipsychotic Agents; Cyclosporine; Drug Interactions; Humans; Immunosuppressive Agents; Male; Myelodysplastic Syndromes; Olanzapine; Schizophrenia, Paranoid; Young Adult
PubMed: 29701931
DOI: 10.4088/PCC.17l02124 -
BMC Psychiatry Sep 2023Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the...
BACKGROUND
Literature has typically associated delusional disorder with a poorer prognosis relative to schizophrenia, without considering the confounding effect of age despite the differential age of onset. This study therefore aims to investigate the diagnostic stability, clinical, functional, and neurocognitive differences of Chinese first-episode psychosis age-matched patients with delusional disorder and schizophrenia at four years.
METHODS
71 delusional disorder and 71 age-matched schizophrenia patients were followed up for four years after their initial episode. Their symptoms, insight in psychosis, side effects of medication, medication compliance, functioning, and neurocognitive performance were assessed at four years.
RESULTS
At four years, 65% of DD patients maintained the same diagnosis, while the rest shifted to SZ. Only those without a diagnostic shift were included in the analysis. Delusional disorder patients (n = 46) experienced greater general psychopathology and poorer insight, but better attitude towards medication than schizophrenia patients (n = 71). Social and occupational functioning, quality of life, and cognitive functioning, however, were similar in delusional disorder and schizophrenia patients.
CONCLUSIONS
Results indicate that delusional disorder is less diagnostically stable than schizophrenia. Their outcomes in a Chinese population were largely similar at four years after removing the confounding age factor, implying that delusional disorder and schizophrenia may not be as distinct as previously thought.
Topics: Humans; Child, Preschool; Follow-Up Studies; Quality of Life; Schizophrenia, Paranoid; Psychotic Disorders; Age Factors
PubMed: 37723482
DOI: 10.1186/s12888-023-05175-z