Delusional Symptoms Research Articles

Étude nationale française du profil des patients hospitalisés en unité pour malades difficiles

The ten French psychiatry high security care units (Unité pour Malades Difficiles : UMD) are the only forensic institutions in the country to provide care for dangerous and/or difficult patients (homicide, acts of barbarity, sexual assault, cannibalism, pyromania…). They benefit from intensive care protocols and high security measures. In this first epidemiological multicentric descriptive study in French history including 418 violent and homicidal patients, medico-judiciary and social characteristics of the standard UMD patient are described. This standard patient is a young single man, with a criminal record and from an underprivileged background, suffering from treatment-resistant schizophrenia with strong delusional symptoms. He has a weak compliance to treatment, low insight, a history of drug abuse and is admitted for severe violence against others and in particular against caretakers or for homicidal act. The study's secondary goal is to revisit the risk factors of high violence described in medical literature and to reveal new ones (cultural uprooting, parental psychopathology, homelessness, perverse sadistic behavior, aggressive behavior a month prior the violent acting out, resistance to antipsychotic drugs, treatment discontinuation), particularly in the homicidal patient cohort. This study should enable clinicians to evaluate dangerousness and to offer better medical care and preventive measures against violence.

The effect of perceived parental attitude score on symptoms of bipolar disorder and schizophrenia

Objectives: We aimed to investigate the effect of perceived parental attitudes on the symptoms of these diseases in patients with schizophrenia and bipolar disorder (BD) and to compare the perceived parental attitudes between these two disorders. Methods: This cross-sectional study was conducted between August 2020 and August 2021 at a university hospital in Turkey. Fifty-two patients with BD and 50 patients with schizophrenia in remission, aged 16-50 years, who met the respective diagnostic criteria defined by the Diagnostic and Statistical Manual of Mental Disorder-5 were included in the study. Results: The mean age of patients with BD was 38.90 ±1 0.95 years, while it was 39.08 ± 11.51 years for those with schizophrenia. Females comprised 65.38% (n = 34) of the BD group and 78.00% (n = 39) of the schizophrenia group. Our results showed that the severity of various negative schizophrenia symptoms increased with higher levels of perceived parental libertarian attitude. In addition, the severity of delusion, which is one of the positive symptoms of schizophrenia, was found to increase with lower perceived parental interest. We did not find a significant relationship between the severity of mania and depression symptoms and perceived parental attitudes. Conclusions: In addition to supporting previously reported relationships of various factors and schizophrenia and BD, our results suggest that the increase in the level of liberality of parents has a negative impact on the negative symptoms of schizophrenia. In addition, the decrease in the level of interest of parents towards their children exacerbates delusion symptoms.

Talking about delusion, what delusion?

When we talk about the clinic of delusional symptoms, we are first and foremost affirming that delusions exist. Professionals working in psychiatry know that delusions can be listened to, that they give meaning to suffering and are part of the history of the subject. Taking the time to reflect on this type of symptom allows us to invest in the clinical field specific to psychiatry, and only makes sense if the clinical approach is based on work referring to the patient's individual history. Maintaining and developing these attitudes to care is essential to the survival of psychiatry as a discipline. Focusing on the clinic of delusion is neither a luxury nor a waste of time.

Return to Work Assessment in A Financial Analyst with Major Depressive Disorder: A Case Report

Background: More than half of the global population are workers, and depression and anxiety result in the loss of 12 billion working days per year, costing the global economy around $1 trillion.1 Depression is a widespread mood disorder that can lead to self-harm and suicide.2,3 Work eligibility assessments are essential to ensure that workers can perform their duties safely and effectively. This case report discusses the fitness-to-work assessment of a financial analyst with major depressive disorder with psychotic features. Objective: To explore factors affecting the fit-to-work status of a patient with major depressive disorder and assess the fit-to-work status of the patient.Case Presentation: A 27-year-old female with a history of depression and trauma worked as a financial analyst. She had a psychiatric evaluation revealing major depressive disorder with psychotic features, moderate stressors, narcissistic personality disorder, and problematic workplace relationships.Discussion: PERDOKI has a seven-step process for evaluating fitness to work and return-to-work programs. These steps involve assessing the patient’s medical condition, disability, job demands, risks, and tolerance to determine the appropriate work status. In this case, the patient is declared fit to work with a note.Conclusion: The role of occupational medicine in workers with major depressive disorder is very important, in-depth interviews regarding workload and other factors that are stressors for workers must be carried out. Support from the inner circle, family and workplace is very important for workers with major depressive disorder. Clinical symptoms of delusions, hallucinations and suicidal tendencies are the main criteria for determining return to work in addition to other influential factors.

Стресові реакції у хворих з розладами спектру шизофренії та комплексний підхід в їх лікуванні

Abstract The psychotraumatic factors that occurred during the war of 2022-2023 significantly affect on the onset and dynamics of schizophrenia spectrum disorders (SSD). Objective. To study the relationship between the influence of stress factors in patients with SSD with the dynamics of exacerbation of psychopathological symptoms and to create complex of treatment and rehabilitation (CTR) for these patients. Methods and materials. There was psychopathological examination of 68 patients with different types of SSD who experienced severe stress during the war and assessed the clinical features of theire psychotic state, and the content of stress factors. Results. In the research the largest number were patients with schizophrenia (Sch, 42.6% of cases), most often with paranoid form with progressive paroxysmal course, as well as patients with acute and transient psychotic disorders (APD), schizoaffective disorder (SchAD) and schizotypal disorder (StD). There were diagnosed affective and delusional symptoms (54.4% of cases) most often as the leading psychopathological reaction to the psychotraumatic stress effects in patients with SSD. Only patients with Sch had the highest incidence of hallucinatory-paranoid syndrome (71.4% of cases). The onset or relapse of a psychotic episode among patients with SSD developed as a result of a significant impact of stress factors with different content, but related to the war in all cases. The most frequent of these were difficulties during evacuation, which caused increasing in family conflicts, especially in patients with Sch and StD. It was found the stressful media impact caused an exacerbation of psychotic symptoms in one third of patients with Sch and StD. There was essential psychotraumatic impact to patients with SSD as of the repeated bombing; the death of relatives; fears experienced during the occupation; inability to continue treatment; and psychotraumatic circumstances associated with the loss of work or no money to live. The CTR for patients with SSD who have been significantly affected by stress based on the analysis of the relationship between nosology, clinical symptoms and stress factors. The aim of the CTR is effective treatment of a psychotic episode or reactive psychotic state, should be steady and consist of the following stages: diagnostic; emergency, outpatient and/or inpatient care; psycho-rehabilitation, as well as support and psychoprophylaxis. Its structure should combine the use of psychopharmacotherapy with psychotherapy (psychocorrection) and psychoeducation, followed support of the patient at the stage of remission.

The Role of Buspirone in the Treatment of Patients with Paranoid Schizophrenia with Non-Suicidal Auto Aggression Who Have Had a Coronavirus Infection

The relevance of this work is due to the insufficient number of modern studies on the treatment of patients with paranoid schizophrenia with non-suicidal autoaggressive actions or in short: “NSAA”, who have had a coronavirus infection. The aim of the study was to study the role of buspirone in the complex therapy of patients with paranoid schizophrenia with NSAA who had a coronavirus infection. Materials and research methods: 99 patients with paranoid schizophrenia meeting ICD-10 criteria were examined by a continuous, non-randomized clinical method. Fisher’s test was used for statistical evaluation. Results: It was established that the consequence of the coronavirus infection was an increase in the proportion of residual organic changes in the form of manifestations of the dysphoric syndrome, specific changes in the cognitive sphere, and the autonomic nervous system. The manifestations of dysphoria included an increase in the frequency of openly manifested aggression, anxiety, impulsivity, and the implementation of NSAA by the type of affective discharge. The structure of acquired cognitive impairments consisted of changes in thinking by the type of thoroughness, and rigidity of perseveration. Changes in the autonomic nervous system are presented in the form of diencephalic crises. Also, psychotic states not characteristic of the previously examined patients were noted, such as twilight stupefaction, delusional symptoms of Cappgras, Fregoli, and tactile hallucinosis. It has been established that the use of buspirone as part of complex therapy with neuroleptics, compared with monotherapy with neuroleptics, increases the effectiveness of therapy in relation to these clinical manifestations in the studied individuals. Conclusion: The use of buspirone in combination with neuroleptic drugs increases the effectiveness of therapy in relation to the leading psychopathological manifestations in patients with paranoid schizophrenia with NSAA who have undergone coronavirus infection.

68969: Comparative Study Of Neuropsychology、MRI and 18F‐FDG PET in Patients with Alzheimer’s Disease and Semantic Dementia

AbstractBackgroundConfusion between Alzheimer’s disease (AD) and semantic dementia (SD) in early diagnosis is common, and most previous studies have been based on clinical diagnoses without a pathological diagnosis by biomarkers.Method15 patients 18F‐AV 45 PET (+) with AD and 9 patients 18F‐AV 45 PET (‐) with SD enrolled. All patients underwent the following examinations: (1) Neuropsychological tests, including Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Activities of Daily Living (ADL), Boston Nomenclature Test (BNT), and Neuropsychiatric Scale table (NPI). (2) 3.0 head MRI examination, the imaging results were evaluated by MTA‐Scale, Koedam scale, and Kipps scale. (3) 18F‐FDG PET examination, PET images were quantitatively analyzed by Neuro Q software.ResultADL score increased in both groups, and the ADL score in the AD group was higher than that in the SD group (P = 0.035). BNT score decreased in both groups, but the BNT score in the SD group was lower than that in the AD group (P = 0.013). There were differences between the two groups in several psycho‐behavioral symptoms; delusions symptoms in the AD group were more prominent than those in the SD group (P = 0.009), and euphoria and disinhibition symptoms in the SD group were more pronounced than AD group (P = 0.015 and 0.015, respectively). The MRI atrophy rating scale showed that the left hippocampus, left frontal lobe, left anterior, and posterior temporal lobe atrophy in the SD group was more severe than that of the AD group (P = 0.018, 0.018, 0.022, and 0.044, respectively). Compared with the two groups of patients, the brain regions with significantly decreased metabolism in the AD group included the right inferior parietal lobule, right posterior cingulate gyrus, and left posterior cingulate gyrus (P = 0.037, 0.014, and 0.037, respectively); the brain regions with significantly decreased metabolism were left inferior frontal gyrus, left medial anterior temporal lobe, right medial anterior temporal lobe, left inferior lateral temporal lobe and left caudate nucleus (P = 0.017, 0.003, 0.037, 0.003, and 0.017, respectively).ConclusionNeuropsychology, brain structure, and brain metabolism aid in AD and SD differential diagnosis.

Clinical and Immunological Aspects of Delusional Disorders in Paranoid Schizophrenia

Background: insufficient study of heterogeneous delusional disorders in schizophrenia and the role of inflammation in the development of the disease served as the basis for this study. The aim: to establish the role of immune mechanisms in the processes of the interaction of different forms of delusional symptom complexes in schizophrenia. Patients: 60 patients (mean age 38.4 ± 1.11 years) with the diagnosis “paranoid schizophrenia, continuous progressive course” (F20.00, ICD-10) were included in the study. The state of patients was defined by persistent delusional/hallucinatory delusional disorders. Based on the clinical assessment, patients were divided into three groups: 27 patients (group 1) with interpretative delusion, 22 patients (group 2) with delusion of influence based on the phenomena of mental automatism, and 11 examinees (group 3) with mixed forms of delusions (interpretative and delusions of influence with mental automatism). The control group consisted of 17 mentally and somatically healthy people, comparable with the patients by sex and age. Methods: inflammatory and autoimmune markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity, leukocyte inhibitor index (LII) and antibody (aAb) level to S100B and MBP were determined in the blood. Results: in all groups of patients, an increase in the activity of LE and α1-PI was revealed compared with the control (p < 0.05). In group 2, an increase in aAb level to S100B was also detected (p < 0.05). Intra-group differences in LE activity served as the basis for dividing patients into three clusters. Cluster 1 was characterized by moderate activation of the immune system and was represented mainly by patients with interpretative delusions (54.5% of patients in the corresponding clinical group). Clusters 2 and 3 were distinguished by a higher level of immune system activation. A distinctive feature of cluster 3 was low LE activity against the background of high α1-PI activity and elevated level of aAb to S100B. Clusters 2 and 3 were represented mainly by patients with delusion of influence (74.1%). Сonclusion: the study confirmed the involvement of inflammation in the pathophysiology of delusional disorders in paranoid schizophrenia and allowed us to identify the relationship between the psychopathological structure of these disorders and the features of the spectrum of immune markers. The highest level of activation of the immune system, as well as immunological features presumably indicating impaired permeability of the blood-brain barrier, were associated mainly with delusions of influence with the phenomena of mental automatism.

COVID-19-associated schizophrenia-like psychosis during the COVID-19 pandemic

IntroductionThe viral theory of the development of psychoses was formulated in the 19th century, but the role of viral agents in the pathogenesis of psychoses remains a matter of debate. In the context of the 2020 pandemic, the results of several papers on the characteristics of psychotic disorders in COVID-19 have been published. Coronaviruses are neuroinvasive, capable of affecting mental and body functions.ObjectivesThe aim of the study was to identify patients with acute psychosis without a history of mental disorders in order to test the hypothesis about the possibility of manifestation of schizophreniform psychosis due to a viral attack.MethodsWithin a year and a half, 50 patients with mental disorders associated with COVID-19 were identified. The reason for hospitalization in a psychiatric hospital is the development of acute schizophreniform psychosis against the background of a new coronavirus infection. The diagnosis was verified according to traditional clinical criteria and modern psychometric tools. Inclusion criteria: no previous visits to a psychiatrist; verified acute polymorphic psychotic disorder and coronavirus infection COVID-19 (ICD-10); manifestation of psychosis against the background of infection with COVID-19; age 18-60 years; consent to participate in the study. Exclusion criteria: signs of organic brain damage; indications of substance abuse; delirium of any etiology; somatic pathology in the stage of decompensation.Results27 women (54%) and 23 men (46%), aged 20 to 57 years (average age 34.5±7.6), of which 18 people (36%) worked, 2 (4%) studied , 29 (58%) people are unemployed. 27 people (54%) are single, 16 (32%) are married, 7 (14%) are divorced; 18 people (36%) were raising children, which indirectly indicated a relatively favorable premorbid functioning. At the time of the examination, the condition was determined by polymorphic psychotic symptoms with a predominance of dissociative-delusional, paraphrenic and oneiric phenomena with plots containing plots of infection and the spread of coronavirus. At the same time, the sum of PANSS is from 53 to 130 (85) points, including PANSS P - from 15 to 37 (27), PANSS N - from 7 to 44 (18), PANSS G - from 23 to 57 (39.9 ); P1 - 5.7; P3 - 5.1. When comparing the obtained data with the world experience, we found some differences. Delusional symptoms were diagnosed twice as rarely, cases with tactile hallucinations were not detected, but catatonic symptoms were observed twice as often, and manic arousal was twice as rare. In general, the studied data are comparable with the results published in the world practice.ConclusionsThe unique experience of the coronavirus pandemic will allow us to assess the influence of environmental factors, namely the role of infections, in the manifestation or predisposition to schizophrenia spectrum disorders. It is planned to evaluate the dynamics of the course of the disorder after the relief of the acute period.Disclosure of InterestNone Declared

Clinical management of psychotic pregnancy denial: what do we know? Case report and narrative review.

IntroductionDenial of pregnancy is the lack of awareness of being pregnant. It associates with increased morbidity and mortality of mother and child and can be classified as non-psychotic or psychotic. There is few literature regarding the latter, making it difficult to recognize, let alone to treat, since we do not have robust data on the incidence nor approved interventions.ObjectivesTo get a better understanding on the standard of care for patients with psychotic denial of pregnancy.MethodsWe present a case report alongside a narrative literature review on the topic.ResultsWe report the case of a 39-year-old caucasian woman, foreign, undomiciled, who was admitted to a Psychiatry unit due to psychotic symptoms. Her birthplace and prior medical records were unknown. She did not recognize being pregnant and showed great irritability when asked; her responses ranged from delusional attributions of symptoms related to the pregnancy to partially acknowledging her state but refusing to answer questions. Obstetric ultrasound revealed a low risk 35 weeks pregnancy. Treatment included quetiapine up to 700mg daily and psychological approach. A multidisciplinary team managed the case and arranged a plan for delivery. Eventually, delusional symptoms remitted and she accepted the gestation. She showed full collaboration during delivery, giving birth to a healthy female and presented transient recovery. After being separated from her daughter, her clinical situation worsened.Psychotic denial of pregnancy is rather uncommon. It is usually seen in patients with prior history of major mental illness, most frequently schizophrenia, and important psychosocial vulnerability. It associates with several negative outcomes for mother and baby, including neonaticide. Most studies agree on the need of a multidisciplinary intervention including obstetrics, psychiatry, and others (social agents, ethical consultants…) to generate a plan for mother and baby. Biopsychosocial aspects should always be considered and each case individually formulated. Pregnant women must be given clear and concise information about the process. For some, seeing obstetric ultrasound might help them accept the pregnancy. Some authors propose labour induction prior to 39 weeks and performing a C-section, especially in cases of uncontrolled psychosis or risk of noncompliance. Most studies also recommend antipsychotic treatment. In cases of persistent denial or acute crisis, especially during the third trimester, patients should be admitted to a psychiatry unit with easy access to obstetric care. Supportive psychotherapy and psychosocial intervention should try to identify precipitating stressors for denial, such as prior or anticipated custody loss, which has been linked to psychotic denial.ConclusionsPsychotic denial is a serious illness which requires a multidisciplinary treatment including biopsychosocial and obstetrical aspects.Disclosure of InterestNone Declared

Late diagnosis of attention deficit hyperactivity disorder and cocaine abuse

IntroductionAdult ADHD diagnosis sometimes represents a challenge for the clinician, due to the comorbid psychiatric diseases that are often associated and which complicate de recognition of the primary symptoms of ADHD. The prevalence of ADHD in adult populations is 2’5% and it is a relevant cause of functional impairment.ObjectivesPresentation of a clinical case of a male cocaine user diagnosed with adult ADHD.MethodsLiterature review on adult ADHD and comorbid substance abuse.ResultsA 43-year-old male who consulted in the Emergency Department due to auditory hallucinosis in the context of an increase in his daily cocaine use. There were not delusional symptoms associated and judgment of reality was preserved. Treatment with olanzapine was started and the patient was referred for consultation. In psychiatry consultations, he did not refer sensory-perceptual alterations anymore, nor appeared any signals to suspect so, and he was willing to abandon cocaine use after a few appointments. He expressed some work concerns, highlighting that in recent months, in the context of a greater workload, he had been given several traffic tickets for “distractions.” His wife explained that he had always been a inattentive person (he forgets important dates or appointments) and impulsive, sometimes interrupting conversations. In the Barkley Adult ADHD Rating Scale he scored 32 points.He was diagnosed with adult ADHD and treatment with extended-release methylphenidate was started with good tolerance and evolution, with improvement in adaptation to his job and social environment. Since then, the patient has moderately reduced the consumption of drugs, although he continues to use cocaine very sporadically.ConclusionsEarly detection of ADHD and its comorbidities has the potential to change the course of the disorder and the morbidity that will occur later in adults. Comorbidity in adult ADHD is rather the norm than the exception, and it renders diagnosis more difficult. The most frequent comorbidities are usually mood disorders, substance use disorders, and personality disorders. Treatment of adult ADHD consists mainly of pharmacotherapy supported by behavioral interventions. When ADHD coexists with another disorder, the one that most compromises functionality will be treated first and they can be treated simultaneously. The individual characteristics of each patient must be taken into account to choose the optimal treatment.Disclosure of InterestNone Declared

Interpretations of Innovation: The Role of Technology in Explanation Seeking Related to Psychosis

Background. The prominence of technology in modern life cannot be understated. However, for some people, these innovations or their related plausible advancements can be associated with perceptual misinterpretation and/or incorporation into delusional concepts. Objective. This paper aims to explore the intersection of technological advancement and experiencing psychosis. We present a discussion about the explanation seeking that incorporates the concept, that for some people, of technological innovation becoming intertwined with delusional symptoms over the past 100 years. Methods. A longitudinal review of the literature was conducted to synthesize and draw these concepts together, mapping them to a timeline that aligns computing science and healthcare expertise and presents the significant technological changes of the modern era charted against mental health milestones and reports of technology-related delusions. Results. It is possible for technology to be incorporated into the content of delusions with evidence supporting a link between the rate of technological change, the content of delusions, and the use of technology as a way of seeking an explanation. Moreover, analysis suggests a need to better understand how innovations may impact the mental health of people at risk of psychosis and other mental health conditions. Conclusions. Clinical experts and lived experience experts need to be informed about and collaborate with future research and development of technology, specifically artificial intelligence and machine learning, early in the development cycle. This concurs with other artificial intelligence research recommendations calling for design attention to the development and implementation of technological innovation applied in a mental health context.

Research based treatment through neuroleptics (antipsychotics) in Pakistan: Can it be trusted?

Madam, Schizophrenia is a mental illness where patients observe and interpret reality in an alternate fashion or perspective. The word is derived from Greek 'schizo' (splitting) and 'phren' (mind), with the term initially proposed by Eugen Bleuler (1908)1. The debilitating illness usually has symptoms of hallucinations, delusions, and overall distorted versions of reality. Patients may also exhibit social withdrawal, disordered speech, disorderly movement and behavioral change. Schizophrenia affects less than one per cent of the global population, and not all Pakistani clinics are equipped to manage patients mentioned above. Schizophrenia is a psychiatric illness commonly treated with antipsychotics to alessen the patients symptoms. More often than not, second generation antipsychotics (clozapine, asenapine, risperidone etc.) are used to provide a better result and adequately decrease the systematic side effects of these neuroleptics. However, what is a moment of caution for clinicians globally as well as in Pakistan, is that these second-generation antipsychotics may be causing problems bigger than just side effects like weight gain, diabetes, or hypertension. Research conducted by Mitchell et al. confirmed the high probability of second-generation antipsychotics causing metabolic syndrome in patients2 by presenting with abnormal findings that put them at cardiovascular risk. These findings include visceral adiposity, insulin tolerance, elevated triglyceride levels, and decreased high-density lipoprotein (HDL) cholesterol levels. These drugs are not only affecting first- world countries but are bringing about more significant influence in third- world countries. Pakistan lacks available treatments for schizophrenia, at around 96%, which is comparable to an approximately median of 32.2% globally and 69% in low-income and middle-income countries (LMICs)3. From 2010 to 2015, there was a progressive rise in the use of antipsychotics in Pakistan, most commonly risperidone and olanzapine4. The onus ultimately falls on inadequate evidence and treatment protocol in first and third- world countries. However, a feasible suggestion could be knowing the minimum effective dosage of second-generation antipsychotics. Research conducted by Leucht et al. mentioned the exact dosages, to minimize lethal side effects of these drugs (aripiprazole 10 mg/1.33, clozapine 300 mg/40, risperidone 2 mg/0.27)5. To date, these drugs are still being prescribed in most countries without proper control on dosages. It is imperative for healthcare workers in Pakistan to implement an accurate administration plan for dosages considering the favourable outcomes in patients with schizophrenia.

Augmentation therapy of resistant schizophrenia with rhythmic transcranial magnetic stimulation

To identify the clinical efficacy of rhythmic transcranial magnetic stimulation (rTMS) in resistant schizophrenia. The study included 44 male patients with resistant schizophrenia, divided into 4 groups: with depressive (group 1; n=11, 25.0%), with hallucinatory (group 2; n=12, 27.3%), with negative (group 3; n=11, 25.0%) and with delusional symptoms (group 4; n=10, 22.7%). Patients received rTMS, the parameters of which were determined depending on the typological variety, for 3 weeks (15 sessions). Psychometric assessment was carried with PANSS, CGI-S, CGI-I, SANS, CDSS, AHRS when included in the study (0 day), after stimulation (21 days) and by the end of the study (42 day) that allowed evaluation of both the severity of the therapeutic effect and its duration. By the end of the course of stimulation, patients of the first three groups developed a distinct positive effect corresponding to a significant reduction in the total PANSS score: group 1 - 24.4% (p=0.002), group 2 - 8.3% (p=0.02), group 3 - 11.7% (p=0.001), which remained stable by day 42 in patients of the first (p=0.001) and second (p=0.005) groups. In patients with delusional symptoms (group 4), a subpsychotic state developed with a corresponding increase in the total PANSS score by 9.7% (p=0.007) requiring a course of relief therapy, which showed effectiveness by the end of the observation (day 42), indicating that resistance was overcome. The study demonstrated the validity of rTMS as an adjuvant method of treatment in the resistant schizophrenia. To implement the potential of rTMS, it is necessary first of all to take into account the structural features of the condition, as well as to continue improving the stimulation technique itself (increasing the duration of the course, developing supportive courses).

Behavioral Response to Catecholamine Depletion in Individuals With Schizophrenia and Healthy Volunteers.

Dysfunction of the dopamine system is the leading neurobiological hypothesis of schizophrenia. In this study, we tested this hypothesis in the context of aberrance salience theory of delusions using catecholamine depletion. We hypothesized that acute dopamine depletion improves both positive symptoms and salience attribution in individuals with schizophrenia. Catecholamine depletion was achieved by oral administration of alpha-methyl-para-tyrosine (AMPT) in 15 individuals with schizophrenia and 15 healthy volunteers. The study design consisted of a randomized, double-blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were the Scale for the Assessment of Positive Symptoms and the Salience Attribution Test. Catecholamine depletion transiently reduced specific psychotic symptoms in symptomatic individuals with schizophrenia, namely delusions and positive formal thought disorder (interaction treatment-by-timepoint, P = .013 and P = .010, respectively). We also found trends for catecholamine depletion to increase relevant bias and adaptive salience in participants with schizophrenia while decreasing them in healthy controls (interaction group-by-treatment, P = .060 and P = .089, respectively). Exploratory analyses revealed that in participants with schizophrenia, higher relevant bias at 3 hours after the end of AMPT treatment corresponded to lower delusional symptoms (Spearman's rho = -0.761, P = .001). This study suggests that the relationship between dopamine hyperactivity and delusional symptoms in schizophrenia is mediated by impaired attribution of salience to reward-predicting stimuli.

A clinical case of multiple sclerosis with an episode of schizophrenia-like syndrome

The article presents a clinical observation of a schizophrenia-like disorder in a patient with multiple sclerosis (MS). The patient had highly active MS with a relapsing course, the diagnosis was made based on the McDonald 2017 criteria. During the course of a demyelinating disease of the nervous system, the patient developed an episode of psychotic disorders with symptoms of mutism, hallucinations, delusions and impaired thinking, which was quickly stopped in stationary conditions. This case is of particular interest to neurologists and psychiatrists, since psychotic disorders occur in MS patients and cause difficulties in diagnosis and treatment.

Differential diagnosis of delusional symptoms in schizophrenia: Brain tractography data

Delusion is an extreme distortion of cognitive processes evaluating reward and prediction, where the damage in structural connectivity between several brain regions responsible for actualization of acquired socioemotional experience and adequate analysis of what is happening serve as a pathomorphological substrate. Referring to the assumption on various neurophysiological developmental mechanisms of two types of delusion, i.e. persecutory and fantastic, we hypothesized that the neural pathways or white matter tracts significantly differ between patients with one of the two types of delusions. Materials and methods40 patients suffering from schizophrenia were examined, 25 of them diagnosed with fantastic/paraphrenic delusions and 15 of them having persecutory/interpretative delusions. The control group comprised 42 healthy age- and sex-matched volunteers. Diffusion MR tractography of the brain was performed using 3 T MRI Magnetom Verio, Siemens. Resultsstatistical decrease in white matter fibers connecting right frontal regions with left motor cortex and certain cerebellar zones was identified in patients with interpretative delusions compared to healthy individuals. Elevated number of white matter fibers was found between the occipital regions and calcarine sulcus of the left hemisphere, and between medial occipitotemporal sulcus of the right hemisphere and right fusiform gyrus when comparing the tracts of patients with fantastic delusions and healthy controls. Conclusionsinterpretative delusions are associated with impaired connectivity in the brain regions responsible for adequate monitoring of current reality, whereas fantastic delusions are accompanied by altered connectivity of regions controlling multimodal sensory integration of signals from various analyzers based on long-term memory attributions.

COVID-19-induced psychosis: two case reports and narrative literature review

Abstract Introduction: SARS-CoV-2 infection might be presented in many various specific and non-specific manifest and symptoms from different systems. Also, the psychotic symptoms are documented but the explanation for their pathophysiology remains debatable and a complex matter. The main objective of this paper is to present cases of patients without a history of psychiatric disorders who developed the first episode of psychosis during the SARS-CoV-2 infection. Material and methods: Two cases of not-related patients with no previous psychiatric history developed psychotic episodes during COVID-19 infection. In both cases chronologically first they experienced symptoms of infection, secondly, delusions and psychomotor agitation that required psychiatric hospitalization. Full remission was observed after antipsychotic treatment in both cases. Results: Even though the pathophysiology of the post-COVID-19 psychiatric symptoms remains unclear, some reports that indicate associations between the infection and the onset of such symptoms. The infection itself, by the induction of cytokine storm followed by the excessive release of pro-inflammatory cytokines, is considered to stimulate the potential onset of the psychosis, however, other factors such as medications used during treatment (with a particular emphasis on glucocorticosteroids) or psychological factors should be considered as well. Conclusions: Patients infected with SARS-CoV-2 might develop serious psychotic episodes even without a prior psychiatric history. Besides, psychiatric symptoms might be the first the even the only manifestations associated with the active SARSCoV-2 infection which seems to be very challenging especially in cases of rapid psychotic episodes without any clear respiratory symptoms.

A Fictional Glimpse of Challenges to Belonging: Excerpts from “Sidekick”

“Sidekick,” an original short fiction work, explores the concept of belonging through its two main characters, Birch and Aggie, who struggle to find social acceptance. The challenge for Birch is that he has paranoid schizophrenia. While he exhibits symptoms of delusions and experiences auditory complex perceptions, as do many with paranoid schizophrenia, unlike most, he also sees visual hallucinations. The general population might confuse his disability with dissociative identity disorder, or existing in multiple personality states. Instead, Birch seems cut off from reality, and while highly intelligent and educated, has been unable, especially in recent years, to maintain a successful life. The narrator, Aggie, is a retiree whose career was spent as an expatriate working with farming communities for a non-governmental organization (NGO) in Cambodia. She has recently returned to her home in Virginia. Her perceptions and experience are partially based on research and my observations while visiting Cambodia and my conversations with NGO employees there. The greater portion, however, is informed by my observations and experiences over the last eighteen years as a member of the expatriate community in Doha, Qatar, one of the Gulf states. Usually, expatriates are motivated by imagining a better life abroad in status, salary, and/or in opportunities to make a meaningful contribution. Aggie’s desires fit within the third category, but as is common in the lives of expats, her dreams met with obstacles, which require adjustment if the expat is to remain abroad. Aggie was unable to find a way to adjust. However, upon her return, she has realized that her home is no longer familiar to her, and while she has never quite fit into the fashionable society of Richmond’s West End, her outsider status has become even more pronounced. Her first-person account relays her chance encounter at a café with the much younger Birch and the tentative attempts these two lonely people make in pursuing a possible platonic friendship.

Feasibility and Benefit of Cognitive Behavioural Therapy for Psychosis via Teleconsultation in Indonesia: A Case Study of a 40-Year-Old Schizoaffective Disorder Patient

AbstractWhilst Cognitive Behavioural Therapy for Psychosis (CBTp) has been found to reduce psychotic symptoms, most evidence supporting its implementation originates from studies in Western and high-income countries. Furthermore, questions remain regarding the efficacy of CBTp conducted via teleconsultation. Herein we report an ongoing case in Indonesia involving an individual with schizoaffective disorder, who received 60 sessions of CBTp over seven months. Sessions were delivered via a combination of voice and video calls. The patient, a 40-year-old male, was diagnosed with schizoaffective disorder at the age of 26. He exhibited symptoms of paranoid and religious delusions, hallucinations (auditory, visual, and somatic) and disorganised speech during our intake interview. Negative symptoms were not apparent. In the 14 years prior to our initial consultation, the patient was prescribed antipsychotics and demonstrated good adherence. He had no history of psychotherapy independent of our clinic. Treatment involved CBTp techniques, including psychoeducation, a symptom diary, relaxation, and behavioural experiments. Study outcome was assessed with Psychotic Symptom Rating Scales. Both hallucination and delusion subscale scores improved 53% from 53 at intake to 25 during an assessment administered 6 months later. Results from this study demonstrate that the CBTp is both feasible, and beneficial, when conducted via teleconsultation in Indonesia.