Ideas Of Reference Research Articles

Ziprasidone Associated Sexual Hyperarousal: a Case Report

Background Sexual dysfunction is a common condition in patients taking antipsychotic medication, with a reported prevalence of 45-80% in males, and 30-80% in females (1). Ziprasidone induced spontaneous orgasm (2) and priapism (3) were reported in the literature. Here, we report a case of increased sexual arousal after ziprasidone treatment. Case A twenty-three-year old, single, female patient was admitted to our clinic with reference and persecutory delusions, auditory and visual hallucinations. Her complaints had been persisting for about one month. Her mental status examination revealed the following: attention and concentration were diminished, speech was slow, delusions of reference and other Schneiderian first-rank symptoms, and hallucinations were present, reality testing was impaired, judgment and abstract thinking skills partially preserved. The patient was not able to tolerate her treatment due to side effects. Therefore, it was changed to ziprasidone 40 mg/day and the dosage was increased gradually. After increasing the ziprasidone dose to 60 mg/day, she complained about increased sexual arousal. No other symptoms suggestive of a manic episode were present, and no other medical causes were detected. The patient also said that she never had a similar period in her life previously. Ziprasidone was tapered slowly, and quetiapine 300 mg/day was started. She indicated that increased sexual arousal disappeared after the cessation of ziprasidone. Discussion Ziprasidone has been reported to cause sexual dysfunction at a much lower rate than other antipsychotics. To the best of our knowledge, this is the first case report of increased sexual arousal with ziprasidone.

Cutaneous Reactions Carbamazepine-related, Dose and Time Independent, in Chronic Psychotic Patients

Anecdotal evidence suggests carbamazepine as treatment of impulsiveness in chronic psychotic patients. Several carbamazepine-related side effects have been reported in the literature and, among them, serious cutaneous reactions are the most frequent. Erythematous lesions onset, during the first carbamazepine introduction, suggest an idiosyncrasic nature of this reaction. We report here two clinical cases of two men, respectively 30 and 53 years old, affected by chronic psychosis, showing persecutory and reference delusions, auditory hallucinations and aggressive behaviour. Both were treated with carbamazepine (at a dose of 200 mg/day in the first patient, and of 400 mg/day in the second one), antipsychotics and benzodiazepines. After two weeks of carbamazepine treatment, a cutaneous reaction was shown in both cases: it was a papular and erythematous lesion, mainly spread on hands, feet and shoulders. Therefore, patients complained about pricking, fatigue and headache. Medical and allergological tests (Prick test, Patch test) were performed, but serum IgE levels were not reasonably related to an allergopathy; furthermore cutaneous tests were all negative. Carbamazepine treatment was discontinued and a steroidal i.m. therapy was performed for four days, with a gradual resolution of the symptoms. These two clinical cases suggest that cutaneous reactions carbamazepine-related could represent a serious side effect of this treatment. These reactions, dose and time independent are related to genic abnormalities involving alleles HLA-A31:01 e HLA-B15:02 (Genin et al., 2014). Pharmacogenetic studies to identify predictive factors of individual susceptibility to carbamazepine response are needed.

Leukocytosis in Clozapine-treated Patients: a Sign of Loss of Response to the Antipsychotic

Anecdotal evidence tends to suggest clozapine as a cause of leukocytosis in schizophrenic patients, however no conclusive evidence is available on this topic so far. Moreover, transient and persistent clozapine-related leukocytosis has received little attention in the literature. We report two clinical cases of two men, respectively 23 and 34 years old, affected by schizophrenia, showing persecutory and reference delusions, auditory hallucinations and aggressive behaviour. Both had been treated for several years with first and second generation antipsychotics, all at therapeutic doses, reporting only occasional ameliorations. In both patients the previous treatment was gradually tapered down and then discontinued, and clozapine was gradually introduced, at a dose of 200 mg/die in the first patient, and of 400 mg/die in the second one. After ten years of clinical compensation and without any abnormality of blood cell count, leukocytosis appeared in both cases. WBC and ANC counts ranged between 12.56x10 3 and 22.26x10 x10 3 /mm 3 and between 8.57x10 3 and 17.67x10 3 /mm 3 , respectively. When leukocytosis appeared, there was loss of response to clozapine and, consequently, psychopatological decompensation in both patients. Therefore a daily clozapine dose of 350 mg in the first patient and of 650 mg in the second one was reached within two weeks. No clinical amelioration was observed, but an increase in the previous WBC count was shown. Medical and hematological consultations found no evidence of systemic or myeloproliferative illness. These two clinical cases suggest that the onset of leukocytosis in clozapine-treated patients could be associated to loss of response to the antipsychotic.

Factors associated with violence among Japanese patients with schizophrenia prior to psychiatric emergency hospitalization: A case-controlled study

BackgroundNumerous studies have examined a wide range of risk factors associated with violence among patients with schizophrenia. However, risk factors linked to different socio-cultural backgrounds remain unclear. ObjectiveThe objectives were to investigate factors associated with violence among Japanese patients with schizophrenia prior to emergency hospitalizations and to compare them with factors found in studies on other populations. MethodsWe recruited 420 Japanese patients with schizophrenia who had committed violent acts immediately prior to emergency admission to a psychiatric hospital in Tokyo, during the period 1986 to 2005. Cases were compared with controls (non violent hospitalized patients with schizophrenia) matched for gender, age and admission year. All medical records were reviewed retrospectively. Inter-rater reliability tests of assessment were performed. Conditional logistic regression analysis was used to identify factors associated with violence. ResultsThe symptoms of gross excitement, prior violence, auditory hallucinations, systematization of delusions, incoherence of speech, delusions of reference, TCO symptoms, living with others and long duration of illness were found to be associated with violence. In contrast, antisocial traits such as substance abuse and antisocial episodes were not recognized as significant violence-associated factors. ConclusionViolence among Japanese patients with schizophrenia was strongly associated with elements of schizophrenia itself, rather than antisocial traits. This study highlighted associated factors for violence among Japanese patients with schizophrenia which differ distinctly from associated factors in other countries. This result demonstrates that future studies assessing the risk of violence among patients with schizophrenia need to consider cultural and racial differences in cohorts.

Insular cortex: structural and functional neuroanatomy.

Insular cortex: structural and functional neuroanatomy.

Resolution of positive symptoms of schizophrenia after traumatic brain injury.

Resolution of positive symptoms of schizophrenia after traumatic brain injury.

Factitious disorder in adolescence.

Factitious disorder in adolescence.

Cingulum bundle diffusivity and delusions of reference in first episode and chronic schizophrenia

The goal of this study was to assess integrity of the cingulum bundle in patients diagnosed with first episode schizophrenia, chronic schizophrenia, and matched controls as well as to determine the relationship between diffusion measures of cingulum bundle integrity and severity of patients׳ delusions of reference. Participants, who comprised 18 first episode patients, 20 chronic patients, and two groups of matched controls (20 subjects in each), underwent 3 T MRI diffusion tensor imaging. Patients diagnosed with schizophrenia (chronic+first episode) showed decreased fractional anisotropy in the right cingulum bundle compared with controls. First episode patients exhibited higher trace bilaterally, compared with matched controls, and on the left compared with chronic patients. Axial diffusivity was increased in first episode patients, bilaterally, compared with matched controls and chronic patients. Radial diffusivity was also higher, bilaterally, in first episode patients compared with matched controls, and on the right compared with chronic patients. Trace diffusity and radial diffusivity in first episode patients were significantly correlated with increased severity of delusions of reference. Given that the abnormalities were present only in first episode patients and were not observed in chronic cases, it appears that they normalize over time. These abnormalities in first episode patients involved diffusivity measures in all directions (trace, radial and axial), suggesting a likely acute, partially reversible process in which there is an increase in brain water content, i.e., swelling, edema, or inflammation, that may reflect an early neuroinflammatory response in first episode patients.

Comorbidity of narcolepsy and schizophrenia in an adolescent patient

A 13-year-old boy suffered from hypersomnia, fragmented nighttime sleep, and cataplexy since age 10 years, and then developed prominent psychotic symptoms (i.e., auditory and visual hallucination, hallucinatory behavior, delusions of reference, and misidentification) that occurred persistently during the wakeful and consciously clear period when he was aged 12 years. The child underwent additional medical evaluation and testing, and comorbidity of narcolepsy and schizophrenia was diagnosed. The child's psychotic symptoms and narcolepsy improved significantly upon treatment with methylphenidate 30 mg, olanzapine 25 mg, and haloperidol 10 mg. In this case, the child's symptomology of narcolepsy and schizophrenia and the dilemma of the use of antipsychotics and psychostimulants are representative examples of the diagnostic and therapeutic challenges in adolescent psychiatry.

The moderating effects of perceived intentionality: exploring the relationships between ideas of reference, paranoia and social anxiety in schizotypy

Introduction. Ideas of reference (IOR), paranoia and social anxiety are features of schizophrenia-spectrum disorders, which appear to be conceptually related; however, the precise nature of these relationships is unclear. These relationships may be partially explained by perceived intentionality (PI), a social-cognitive bias for perceiving other people's actions during unpleasant situations as being directed at oneself in an intentionally malicious manner. Our primary aim was to examine the moderating role of PI on the relationships between IOR and paranoia, and between IOR and social anxiety amongst individuals with psychometrically defined schizotypy.Methods. We assessed IOR, paranoia and social anxiety amongst individuals with psychometrically defined schizotypy (n = 44) and controls (n = 36) and examined the moderating effects of PI within each group.Results. As hypothesised, PI moderated the relationship between IOR and paranoia such that higher PI predicted higher levels of paranoia as IOR increased. Additionally, we found that PI moderated the relationship between IOR and social anxiety such that higher PI predicted lower levels of social anxiety as IOR increased.Conclusion. Theoretical and practical implications are discussed including the potential for assessing PI as a proxy for paranoia when clinicians suspect a client is underreporting paranoia due to positive impression management.

An exploration of how psychotic-like symptoms are experienced, endorsed, and understood from the National Latino and Asian American Study and National Survey of American Life

Objective. To examine racial-ethnic differences in the endorsement and attribution of psychotic-like symptoms in a nationally representative sample of African-Americans, Asians, Caribbean Blacks, and Latinos living in the USA.Design. Data were drawn from a total of 979 respondents who endorsed psychotic-like symptoms as part of the National Latino and Asian American Study (NLAAS) and the National Survey of American Life (NSAL). We use a mixed qualitative and quantitative analytical approach to examine sociodemographic and ethnic variations in the prevalence and attributions of hallucinations and other psychotic-like symptoms in the NLAAS and NSAL. The lifetime presence of psychotic-like symptoms was assessed using the World Health Organization Composite International Diagnostic Interview (WMH-CIDI) psychotic symptom screener. We used logistic regression models to examine the probability of endorsing the four most frequently occurring thematic categories for psychotic-like experiences by race/ethnicity (n > 100). We used qualitative methods to explore common themes from participant responses to open ended questions on their attributions for psychotic-like symptoms.Results. African-Americans were significantly less likely to endorse visual hallucinations compared to Caribbean Blacks (73.7% and 89.3%, p < .001), but they endorsed auditory hallucinations symptoms more than Caribbean Blacks (43.1% and 25.7, p < .05). Endorsing delusions of reference and thought insertion/withdrawal were more prevalent for Latinos than for African-Americans (11% and 4.7%, p < .05; 6.3% and 2.7%, p < .05, respectively). Attribution themes included: supernatural, ghosts/unidentified beings, death and dying, spirituality or religiosity, premonitions, familial and other. Respondents differed by race/ethnicity in the attributions given to psychotic like symptoms.Conclusion. Findings suggest that variations exist by race/ethnicity in both psychotic-like symptom endorsement and in self-reported attributions/understandings for these symptoms on a psychosis screening instrument. Ethnic/racial differences could result from culturally sanctioned beliefs and idioms of distress that deserve more attention in conducting culturally informed and responsive screening, assessment and treatment.

The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study.

The extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments. We collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10-F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation. Reality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06-0.24] and depressive symptoms (EES 0.21, 95% CI 0.07-0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES -0.06, 95% CI -0.10 to -0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83-1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12-1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09-1.61). In people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

EPA-0130 - Analysis of the behaviour and psychopathology in patients with mania

Introduction Mania is a syndrome characterized by elevation of mood, increased activity and self important ideas. Inflated self-esteem may develop into grandiose delusions and suspiciousness into delusions of persecution. Grandiose delusions can be classified into three types. They are delusions of grandiose ability, grandiose identity and religious delusions. Studies on the content of the grandiose delusions and other psychopathology in patients with mania in Sri Lanka is scarce. Aims To analyze the behavior and psychopathology in patients with mania Methods Descriptive cross sectional study. All patients admitted to University Psychiatry Unit, National Hospital of Sri Lanka (NHSL) who met ICD 10 criteria of first episode mania and Bipolar Affective Disorder, current episode manic, within a period of three months were selected. Interviewer administered questionnaire and clinical records were used. Results Sample was 36. Twenty two (61.1%) had manic episode with psychotic symptoms. Thirteen (36.1%) had destructive behaviour. Thirty three (91.6%) did not show sexual disinhibition. Eighteen (50%) had grandiose delusions. Of the grandiose delusions 10 (55.5%) were of grandiose ability, 6 (33.3%) were of grandiose identity and 2 (11.1%) were of the religious subtype. Five (50%) who had delusion of grandiose ability believed they had healing power. Eleven (30.5%) had persecutory delusions and seven (19.4%) had delusions of reference. Five (13.8%) had auditory hallucinations. Conclusions Grandiose delusions were the commonest type of delusion but almost one third had persecutory delusions. Most common subtype of grandiose delusion was grandiose ability. Most common content of grandiose ability was healing power.

A Case Report on Myxedema Madness: Curable Psychosis

Myxedema madness is a very rare but established entity. A psychotic patient having hypothyroid features should always be evaluated regarding same. A 30-year-old female without known significant past medical history had, for the past one and half year, continuous persecutory and referential delusions; second and third person auditory hallucinations, facial puffiness and Brief Psychiatric Rating Scale (BPRS) score of 41 on admission. Her thyroid profile was: Thyroid stimulating hormone - 63.71 mIU/L, Free tri iodo threonine (FT3) - 2.1 pg/ml, free tetra iodo thyronine (FT4) - 0.6 ng/ml with normal ultrasound-thyroid. Patient was started on thyroxin 100 μg with a low dose risperidone 2 mg. Risperidone was withdrawn over a week and the patient was discharged on thyroxin alone with BPRS score of 8 and absence of delusions and hallucinations.

Synthetic cannabinoid receptor agonist- associated psychotic disorder: A case report

Synthetic cannabinoid receptor agonists (SCRA) has become one of the most abused substances, recently. JWH-018 street name known as Bonzai is one of the most abused substances in Turkish Republic of Northern Cyprus. The most common symptoms in cases reported with synthetic cannabis use are agitation, angry, paranoia and reference delusions, disorientation, seizure and nausea. Although the effects are very similar to cannabis, stimulant effects are more likely in SCRA use. In preparations containing SCRA do not contain cannabinidol agent which is reported to reduce the psychotic effects of the cannabis. This may explain the relationship between SCRA and psychotic disorders. We aimed to discuss a brief psychotic disorder associated with SCRA use and treatment which is less reported in the literature in this case report.

Buprenorphine-Induced Psychotic Symptoms:

Buprenorphine-Induced Psychotic Symptoms:

Management of clozapine-induced fever: a case of continued therapy throughout fever

A 22-year-old, white, nonsmoking man was admitted to the psychiatric ward with symptoms of psychosis. In the previous year he had been experiencing auditory hallucinations. At the time of admission, he endorsed tactile hallucinations, somatic delusions and delusions of reference. He had been using

Vitamin B12 Deficiency Masquerading as Clozapine-Resistant Psychotic Symptoms in Schizophrenia

Vitamin B₁₂ Deficiency Masquerading as Clozapine-Resistant Psychotic Symptoms in Schizophrenia

On the Distinction between Monothematic and Polythematic Delusions

Some delusional patients exhibit only a single delusional belief (or several delusional beliefs concerning a single theme): this is monothematic delusion. It contrasts with polythematic delusion, where the patient exhibits a variety of delusions concerning a variety of different themes. The neuropsychological bases of various monothematic delusions are rather well understood, and there is a well‐worked‐out general neuropsychological theory of monothematic delusion, the two‐factor theory. Whether polythematic delusion might be explained in a similar way is an open question: I sketch some possible ways in which a comparable two‐factor account might be developed for polythematic (‘psychiatric’) delusional conditions such as delusions of reference.

Characteristics of Social Perception and their Changes after Treatment in Patients with Schizophrenia Using the Idea of Reference Provoking Task

하는 능력으로 다른 사람을 이해하고 원만한 관계를 유지하 Received: May 21, 2013 / Revised: June 4, 2013 Accepted: June 7, 2013 Address for correspondence: Jae-Jin Kim, Department of Psychiatry, Yonsei University Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-gu, Seoul 135-720, Korea Tel: 02-2019-3341, Fax: 02-3462-4304 E-mail: jaejkim@yonsei.ac.kr 본 연구는 보건복지부 보건의료개발사업의 지원에 의하여 이루어진 것임 (A090537). 관계사고 유발과제로 평가한 조현병 환자의 사회적 지각 특성 및 치료 후 변화