Content Of Psychotic Symptoms Research Articles

A thematic analysis of psychotic symptoms in young-onset dementia.

Exploration of the themes and content of psychotic symptoms in young-onset dementia (YOD) is limited to case analysis. The primary objective of this study was to determine the themes of psychotic symptoms in individuals diagnosed with YOD. Comprehensive retrospective file review of discharge summaries. Neuropsychiatry, a specialist mental health service located at the Royal Melbourne Hospital, Australia. Inpatients at Neuropsychiatry admitted between 2018 and 2020 (inclusive). Data extracted included descriptions and prevalence of psychotic symptoms as well as general demographic and clinical data. Data analysis was conducted using a thematic approach. Twenty-three inpatients had a diagnosis of YOD with psychotic symptoms. Themes were identified in the domains of delusions (six themes), auditory hallucinations (five themes), and visual hallucinations (two themes). Strong recurring themes across the modalities of hallucinations and delusions were beliefs and experiences relating to paranoia, suspicion, harm, and abuse. Themes did not clearly intersect across the modalities of hallucinations and delusions. A degree of thematic heterogeneity existed within individuals, and individuals experienced delusions or hallucinations of multiple themes. The themes of the psychotic symptoms did not clearly relate to diagnostic category, nor to time from diagnosis. This study is the first thematic analysis of psychotic symptoms in YOD and provides further understanding of patient phenomenology and experiences of psychosis in YOD.

COVID-19 related Delusional Beliefs: A Case Report

IntroductionA delusion is a fixed false belief based on an inaccurate interpretation of an external reality despite evidence to the contrary. The diagnosis of a delusional disorder is made when a person has one or more non-bizarre (situations that are not real but also not impossible) delusional thoughts for one month or more that cannot be explained by any other condition. In patients with delusional disorder, delusions(s) do not impact the functionality and the patient’s behavior is not overtly bizarre. Although delusional core themes tend to be the same throughout different epochs (i.e., persecution, grandiosity, guilt, religion, hypochondria, love, or jealous), clinicians commonly notice how delusions tend to rapidly incorporate popular hot topical issues. Hence, delusions are dynamic and often represent a combination of psychopathology and external events.ObjectivesThe COVID-19 outbreak has affected millions of people globally and it also has a huge psychological impact. The objective of this case report is to outline the possible effect of the COVID-19 pandemic to delusional disorder in patients with healthy person.MethodsThe 40-year-old gentleman, a drum major (field commander), married, living with his wife and daughter (4,5 years old). He’s current complaints started when he did not want to have the Covid vaccine in April 2021 and therefore was exposed to mobbing at work. It is understood that the patient had irrevocable ideas about vaccine and PCR testing (radioactive lights were coming out from the PCR rod in a video he watched). For this reason, it is understood during the clinical interview that the patient was exposed to social restrictions at work and in his social life (he could not travel by public transport, plane, bus, and enter social facilities because he did not have a vaccination card or did not have a PCR test).He was admitted to our ward for the purpose of arranging his diagnosis and treatment.ResultsOn our ward, the patient showed poor insight with persistence of delusions. The impression was delusinal disorder. He was treated with olanzapine up to 5 mg/day and sertraline up to 100 mg/day, with a progressive resolution of symptoms.ConclusionsThere are other case reports on COVID-19 delusional themes in patients with schizophrenia and patients with no history of mental illness, which means that this phenomenon is not exclusive to affective disorders. In this case, different from the literature, the patient has never had covid. An area of clinical concern is the potential of the pandemic’s psychological context to trigger psychotic disorders and influence their symptomatology. A review of contemporary epidemics and pandemics psychosis research found no evidence of changes in the form and content of psychotic symptoms. Further research should examine those biopsychosocial COVID-related factors that predispose to, precipitate, and perpetuate psychosis.Disclosure of InterestNone Declared

T23 - Polygenic Risk Scores Derived From Largest Schizophrenia Gwas Are Associated With The Presence Of Psychosis And Level Of Mood Incongruent Psychosis In Bipolar Disorder

Background Bipolar disorder (BD) includes a broad range of phenotypic features – most research examining its genetic underpinning focuses on the overall syndrome rather than its subphenotypic components. BD is a highly heritable disorder and while its genetic architecture is not fully elucidated there is increasingly strong support for a very polygenic component with partial polygenic overlap with schizophrenia (SZ). Here we present preliminary results from an analysis examining the association of SZ derived polygenic risk scores (PRS) across different BD subtypes (Bipolar Type 1(BPI), Bipolar Type 2 (BPII) and Schizoaffective disorder (SAD), and subphenotypes defined by the presence of psychosis and its associated level of mood incongruence. Methods We used a UK sample of 3101 BP cases, collected using a consistently administrated interview protocol with OPCRIT confirmed lifetime diagnosis of Research Diagnostic Criteria (RDC - BPI, BPII or SAD). PRS were generated using 1000 genomes (phase3, 2014) imputed genetic data (INFO score>0.8, HWE>1e-6, MAF>0.01) trained on the results from Psychiatric Genetic Consortium (PGC2) SZ GWAS, pruned r2 Results PRS with the SZ association p-value cut-off of 0.5, have shown significant association across the BD subtypes with relative risk ratios RRR = 1.28 (95%CI: 1.18-1.39, p Discussion Preliminary analyses show a genetic - phenotypic association, between polygenic features of schizophrenia and BP characterised by the presence of psychosis, suggesting the phenotypic overlap between SZ and BD may in part be driven by polygenic overlap. This finding is further supported by the association of PRS and level of mood incongruence in the content of psychotic symptoms. These results suggest the PRS effect is not solely mediated though the psychosis subphenotype, at least in the BPI group. Our analyses show promise for the strategy of examining polygenic/phenotypic associations based on fine grained clinical characterisations

DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization?

There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n=776), India (n=504) and Sarawak, Malaysia (n=259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.

Cognitive Therapy of Schizophrenia

Back to table of contents Previous article Next article Book ReviewFull AccessCognitive Therapy of SchizophreniaTimothy B. Sullivan M.D.Timothy B. Sullivan M.D.Search for more papers by this authorPublished Online:1 Feb 2007https://doi.org/10.1176/ps.2007.58.2.277AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail It's hard to say how bad ideas, misinformed or misguided clinical saws, originate. One of the most enduring in psychiatry is the notion that talking to patients with schizophrenia about their symptoms or about their subjective experiences is potentially harmful. It is little wonder that so few medical students or psychiatric residents wish to specialize in work with patients who have seriously mental illness. There have been studies and reviews, most famously the Patient Outcomes Research Team recommendations ( 1 ), which have directed our attention to the lack of efficacy ( 2 ), obvious paucity of controlled observation, and insufficiently documented putative harm associated with "uncovering therapies," by which is meant psychoanalytic therapy and its congeners. Kingdon and Turkington lament the effect these proscriptions have unintentionally had on creative engagement of persons suffering from disorders such as schizophrenia. They note that "many practitioners continue to believe that the content of psychotic symptoms should be ignored and that any psychological work … is liable to lead to increased distress and exacerbation of symptoms, as a result of having opened up disturbing areas." Of course the problem with past, well-intentioned, and compassionate efforts by a legion of gifted therapists is that the therapeutic model, and the theory of mind supporting it, did not accurately reflect the nature of the disorder. It was not the effort to be empathic that was flawed but the various notions about how symptoms were produced or could be ameliorated. If you don't understand what you're treating, you will misdirect, misinform, and inevitably disappoint.Kingdon and Turkington set out to provide clinicians with a treatment model that will make the uncertain knowable and that which is alienating comfortable. They successfully present a cogent, approachable, and flexible model for psychotherapeutic engagement of persons suffering from serious psychotic illness. This is not a "manualized" treatment, and the authors explain why that approach is not appropriate. A careful exposition of the nature of the illness processes, and the theory of cognitive-behavioral therapy and its particular adaptation to this setting, is explicated. There are many clinical examples, guidelines, forms to use, and even patient handouts that can be copied and distributed are included. The succinct review of the psychology of schizophrenia is particularly useful, such as the discussion of "externalizing bias" and the central role of stigmatization in symptom development.The fourth chapter, on therapeutic engagement, and later chapters on work with delusions and hallucinations, are not only brilliantly executed but come as close as one can, in print, to detailed individual case supervision. Even experienced practitioners will find these presentations extremely helpful, because they reflect the careful thought of talented clinicians who have immersed themselves in their subject and achieved valuable insights.I do have one brief quibble. As a heuristic device, Kingdon and Turkington use four clinical subgroups to differentiate "types" of schizophrenia. In the context of the book, these subgroups are useful and unify their presentation. I am not sure I can agree that the subgroups encompass the range of patients I see.Reviewers will often say that the book they are reviewing belongs on everyone's shelf. I urge you to please buy and read this book. Our patients deserve our attention to these issues. Those of you who are talented clinicians but who avoid this population out of confusion or lack of confidence in your ability to help will, I assure you, find this book crucial. You will find yourself able to approach a person with schizophrenia with confidence, and it will change how you think about your work.Dr. Sullivan is chief of services for the seriously mentally ill at Saint Vincent's Catholic Medical Center, Westchester, New York, and assistant professor of psychiatry at New York Medical College, Valhalla.

Cognitive Therapy of Schizophreniaby David G. Kingdon and Douglas Turkington; New York, Guilford Press, 2004, 219 pages, $37

Back to table of contents Previous article Next article Book ReviewFull AccessCognitive Therapy of SchizophreniaTimothy B. Sullivan M.D.Timothy B. Sullivan M.D.Search for more papers by this authorPublished Online:1 Feb 2007https://doi.org/10.1176/ps.2007.58.2.277AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail It's hard to say how bad ideas, misinformed or misguided clinical saws, originate. One of the most enduring in psychiatry is the notion that talking to patients with schizophrenia about their symptoms or about their subjective experiences is potentially harmful. It is little wonder that so few medical students or psychiatric residents wish to specialize in work with patients who have seriously mental illness. There have been studies and reviews, most famously the Patient Outcomes Research Team recommendations ( 1 ), which have directed our attention to the lack of efficacy ( 2 ), obvious paucity of controlled observation, and insufficiently documented putative harm associated with "uncovering therapies," by which is meant psychoanalytic therapy and its congeners. Kingdon and Turkington lament the effect these proscriptions have unintentionally had on creative engagement of persons suffering from disorders such as schizophrenia. They note that "many practitioners continue to believe that the content of psychotic symptoms should be ignored and that any psychological work … is liable to lead to increased distress and exacerbation of symptoms, as a result of having opened up disturbing areas." Of course the problem with past, well-intentioned, and compassionate efforts by a legion of gifted therapists is that the therapeutic model, and the theory of mind supporting it, did not accurately reflect the nature of the disorder. It was not the effort to be empathic that was flawed but the various notions about how symptoms were produced or could be ameliorated. If you don't understand what you're treating, you will misdirect, misinform, and inevitably disappoint.Kingdon and Turkington set out to provide clinicians with a treatment model that will make the uncertain knowable and that which is alienating comfortable. They successfully present a cogent, approachable, and flexible model for psychotherapeutic engagement of persons suffering from serious psychotic illness. This is not a "manualized" treatment, and the authors explain why that approach is not appropriate. A careful exposition of the nature of the illness processes, and the theory of cognitive-behavioral therapy and its particular adaptation to this setting, is explicated. There are many clinical examples, guidelines, forms to use, and even patient handouts that can be copied and distributed are included. The succinct review of the psychology of schizophrenia is particularly useful, such as the discussion of "externalizing bias" and the central role of stigmatization in symptom development.The fourth chapter, on therapeutic engagement, and later chapters on work with delusions and hallucinations, are not only brilliantly executed but come as close as one can, in print, to detailed individual case supervision. Even experienced practitioners will find these presentations extremely helpful, because they reflect the careful thought of talented clinicians who have immersed themselves in their subject and achieved valuable insights.I do have one brief quibble. As a heuristic device, Kingdon and Turkington use four clinical subgroups to differentiate "types" of schizophrenia. In the context of the book, these subgroups are useful and unify their presentation. I am not sure I can agree that the subgroups encompass the range of patients I see.Reviewers will often say that the book they are reviewing belongs on everyone's shelf. I urge you to please buy and read this book. Our patients deserve our attention to these issues. Those of you who are talented clinicians but who avoid this population out of confusion or lack of confidence in your ability to help will, I assure you, find this book crucial. You will find yourself able to approach a person with schizophrenia with confidence, and it will change how you think about your work.Dr. Sullivan is chief of services for the seriously mentally ill at Saint Vincent's Catholic Medical Center, Westchester, New York, and assistant professor of psychiatry at New York Medical College, Valhalla.

Trauma and psychosis: theoretical and clinical implications

Trauma and psychosis: theoretical and clinical implications