Delusional Symptoms Research Articles

A Case Report of Vitamin B12 Deficiency with Symptoms of Depression, Hallucination and Delusion

A Case Report of Vitamin B12 Deficiency with Symptoms of Depression, Hallucination and Delusion

Interaction of multiple gene variants and their effects on schizophrenia phenotypes

BackgroundSchizophrenia is a clinically heterogeneous disorder and may be explained by its complex genetic architecture. Many schizophrenia susceptibility genes were identified but the picture remains unclear due to inconsistent or contradictory genetic association studies. This confusion may, in part, be because symptoms result from the combined interaction of many genes and these interacting genes are associated with specific sub-phenotypes of schizophrenia rather than schizophrenia as a whole. This study investigates the relationship between schizophrenia susceptibility genes and schizophrenia sub-phenotypes by identifying multiple gene variant interactions. Materials and methodsFifty SNPs from 21 genes were genotyped in 235 Australian participants with schizophrenia screened for various phenotypes. Schizophrenia participants were grouped into relevant phenotype clusters using cluster analysis and normalized phenotype cluster scores were calculated for each patient. The relationship between genotypes and normalized phenotype cluster scores were analyzed by linear regression analysis. ResultsThree phenotype clusters were identified. There was some overlap in symptoms between phenotype clusters, particularly for depression. However, cluster 1 appears to be characterized by speech disorder and affective behavior symptoms, cluster 2 has predominantly hallucination symptoms and cluster 3 has mainly delusion symptoms. Interaction of five SNPs was found to have an effect on cluster 1 symptoms; ten SNPs on cluster 2 symptoms; and eight SNPs on cluster 3 symptoms. ConclusionThe interaction of specific susceptibility genes is likely to lead to specific clinical sub-phenotypes of schizophrenia. Larger patient cohorts with more extensive clinical data will improve the detection of gene interactions and the resultant schizophrenia clinical phenotypes.

Symptoms of Depression, Positive Symptoms of Psychosis, and Suicidal Ideation Among Adults Diagnosed With Schizophrenia Within the Clinical Antipsychotic Trials of Intervention Effectiveness

Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.

Psychological health and menopause-specific quality of life of Malaysian women with type 2 diabetes.

Anxiety and depression are more common among females and those experiencing diabetes and menopause. Menopausal symptoms experienced by women can vary tremendously from population to population; therefore, there is a need to investigate these symptoms and associated risk factors in different communities. This study investigated the differences in psychological health and menopause-specific quality of life (MENQOL) between women with and without diabetes type 2 (T2DM) in Malaysia. Women with T2DM (n=320) were matched by age range to controls without T2DM (n=320). Data were collected from March 2012 to January 2013. Delusions Symptoms States Inventory (DSSI) instrument was used to identify symptoms of depression and anxiety. Women with diabetes had higher depressive (11.8% versus 8.4%) and anxiety (8.4% versus 6.6%) symptoms compared to women without diabetes. In both groups, the most common menopausal symptom was aches (muscles and joints). Women without diabetes had significantly higher scores for the sexual domain compared to women with diabetes (4.20 versus 3.21, p=0.001). The odds that a postmenopausal woman with diabetes was depressed or anxious on the DSSI scale increased significantly when the MENQOL score on the physical, vasomotor, and psychosocial domains increased by one unit. Both diabetes and psychological problems have negative impact on MENQOL. Our findings support the view of screening postmenopausal women with diabetes for depressive and anxiety, to improve overall quality of life.

Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients: A Systematic Review.

Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients.

Causal narratives and psychotic phenomena.

Causal narratives and psychotic phenomena.

Clinical diagnosis and drug therapy of elderly patients with schizophrenia : A restrospective analysis of data in a department of old age psychiatry

The objective of this study was to survey the consistency of the clinical diagnostics and the psychopharmacological treatment of schizophrenia and delusional disorders suffered by older persons. Afurther aspect was to record significant clinical differences and also similarities between the patient groups in care, matching with the criteria of ICD10 for schizophrenia (F20), persistent delusional disorders (F22) and schizoaffective disorder (F25). Retrospective analysis with reference to the manually and electronically recorded patient medical records of an acute case care ward for geriatric psychiatry and psychotherapy. During the assessment period 210 patients over the age of 65years were included consecutively in the study (F20 - 64patients, F22 - 78patients, F25 - 64patients, 4patients died). Ignoring the fact that many of the patients were admitted without adiagnosis, the diagnostic classification of the referring doctor, above all those made by general practitioners, proved to be very consistent for the groups F20 and F25. In the group F22 diagnoses, however, up to almost one half of the referred patients were incorrectly admitted with an F20 diagnosis. The patients included in group F22 formed aheterogeneous group, or amelting pot for various sub-groups, with the common shared characteristic of being comprised of persons suffering from adelusional disorder. These differed from the other two groups in the following attributes: the patients were either older or very old persons, they were mostly receiving inpatient treatment for the first time and subsequently had fewer re-admissions. They also suffered more frequently from both psychiatric and somatic comorbidities; furthermore they included elderly people who had suffered from learning deficiencies or borderline intellectual deficiencies throughout their earlier lives. The patients in groups F20 and F25 differed primarily only in terms of their psychiatric medication, with significantly more mood stabilizer prescribed in the F25 group. Patients in all three groups frequently received tranquilisers during the day and sedatives in the evening, atypical antipsychotics were prescribed in the great majority of cases. The referral diagnoses of patients suffering from many years of schizophrenic type illnesses were largely in compliance with the diagnostic criteria, amuch more difficult issue for the referring doctors was the allocation of patients with afirst occurrence of delusional symptoms. Those patients who were allocated to the diagnostic group schizophrenia differed significantly from patients from the group with delusional disorders.

Are persistent delusions in schizophrenia associated with aberrant salience?

ObjectiveIt has been suggested that positive psychotic symptoms reflect ‘aberrant salience’. Previously we provided support for this hypothesis in first-episode schizophrenia patients, demonstrating that delusional symptoms were associated with aberrant reward processing, indexed by the Salience Attribution Test (SAT). Here we tested whether salience processing is abnormal in schizophrenia patients with long-standing treatment-refractory persistent delusions (TRS). MethodEighteen medicated TRS patients and 31 healthy volunteers completed the SAT, on which participants made a speeded response to earn money in the presence of cues. Each cue comprised two visual dimensions, colour and form. Reinforcement probability varied over one of these dimensions (task-relevant), but not the other (task-irrelevant). ResultsParticipants responded significantly faster on high-probability relative to low-probability trials, representing implicit adaptive salience; this effect was intact in TRS patients. By contrast, TRS patients were impaired on the explicit adaptive salience measure, rating high-probability stimuli less likely to be associated with reward than controls. There was little evidence for elevated aberrant salience in the TRS group. ConclusionThese findings do not support the hypothesis that persistent delusions are related to aberrant motivational salience processing in TRS patients. However, they do support the view that patients with schizophrenia have impaired reward learning.

Determinants of per diem Hospital Costs in Mental Health.

IntroductionAn understanding of differences in hospital costs between patient groups is relevant for the efficient organisation of inpatient care. The main aim of this study was to confirm the hypothesis that eight a priori identified cost drivers influence per diem hospital costs. A second aim was to explore further variables that might influence hospital costs.MethodsThe study included 667 inpatient episodes consecutively discharged in 2014 at the psychiatric hospital of the Medical Centre- University of Freiburg. Fifty-one patient characteristics were analysed. Per diem costs were calculated from the hospital perspective based on a detailed documentation of resource use. Mixed-effects maximum likelihood regression and an ensemble of conditional inference trees were used to analyse data.ResultsThe study confirmed the a priori hypothesis that not being of middle age (33–64 years), danger to self, involuntary admission, problems in the activities of daily living, the presence of delusional symptoms, the presence of affective symptoms, short length of stay and the discharging ward affect per diem hospital costs. A patient classification system for prospective per diem payment was suggested with the highest per diem hospital costs in episodes having both delusional symptoms and involuntary admissions and the lowest hospital costs in episodes having neither delusional symptoms nor somatic comorbidities.ConclusionAlthough reliable cost drivers were identified, idiosyncrasies of mental health care complicated the identification of clear and consistent differences in hospital costs between patient groups. Further research could greatly inform current discussions about inpatient mental health reimbursement, in particular with multicentre studies that might find algorithms to split patients in more resource-homogeneous groups.

Late onset schizophrenia. A case report

IntroductionThe presence of elderly people is more and more common in developed countries. Unlike other medical conditions, late onset psychosis includes organic and mental precipitants in its differential diagnosis.ObjectivesTo present a case of late onset schizophrenia.MethodsMedline search and review of the clinical history and the related literature.ResultsWe present the case of a 71-year-old woman with organic medical history of rectum adenocarcinoma in 2008 that underwent radiotherapy, chemotherapy and surgical resection with successful results. According to the psychiatric history, this patient has needed two admissions to the psychiatry ward, the first of them in 2012, (when the delusional symptoms started), due to deregulated behaviour in relation to persecutory delusions and auditory pseudo-hallucinations. In 2012, she was diagnosed with late onset schizophrenia. Blood tests (hemograme, biochemistry) and brain image were normal. Despite treatment with oral amisulpride and oral paliperidone and due to low compliance, delusional symptoms have remained. We started treatment with long-acting injectable papliperidone 75 mg/28 days having reached clinical stability.ConclusionsLate onset psychosis is due to a wide range of clinical conditions. In this case, our patient had no organic precipitants. The evolution and presentation of delusional symptoms in this patient made us think of late onset schizophrenia as main diagnosis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Discontinuation of antipsychotic therapy in severe mania: A six months follow-up study

IntroductionIndependently of the drug choice, antimaniac treatment has to be continued at least until full remission. Most guidelines recommend continuation therapy for 6–12 months but controlled studies are lacking.ObjectivesA six months follow-up study on a sample of 57 inpatients affected by mania at Mood Disorder Unit.AimsTo evaluate a timeframe for the discontinuation of the antipsychotic therapy.MethodsFifty-seven bipolar inpatients affected by a manic episode according to DSM-5 criteria. Patients treated according to our pharmacological protocol with a mood stabilizer (lithium or valproate) and an antipsychotic (haloperidol or risperidone). Course of illness assessed with Young Mania Rating Scale (YMRS) scored at week 0, 1, 2, 4, 8, 24. Remission defined as YMRS < 12.ResultsTwenty men (35.09%) and 37 women (64.91%); mean age 43.18 ± 12.71 years. Mean YMRS basal score 38.55 ± 8.08. At 4th week, remission rate was 54.39% (31 patients); at 8th week was 80.70% (46 patients). At 8th week, 39/57 patients (68.42%) discontinued the antipsychotic. Relapse rate after 6 months was 26.32% (12 depressed, 3 manic). Multiple regression, t-test and Chi2 analysis were performed: older patients (P = 0.01) and with higher number of episodes (P = 0.04) tend to relapse earlier. Neither severity of the episode (P = 0.3), nor delusional symptoms (P = 0.6) nor discontinuation of the antipsychotic (P = 0.3) correlate with relapse time.ConclusionsOur experience suggests that an early discontinuation of antipsychotics, usually 4–8 weeks after remission, does not worsen the short-term course of illness. This approach could minimize the risk of side effects. Evidence is lacking about the duration of this therapy, long-term studies are still necessary.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Haloperidol, risperidone and quetiapine in the treatment of acute severe manic episode in bipolar disorder: The experience at the mood disorder unit in Milan

IntroductionPatients affected by severe manic episode, often with delusional symptoms, are commonly treated with a combination of mood stabilizers, antipsychotics and other sedatives. The choice of a specific drug, dose and term is still debated.ObjectivesA naturalistic study on a sample of 84 inpatients affected by acute severe mania treated with a combination therapy.AimsTo compare efficacy and tolerability of haloperidol/risperidone/quetiapine in association with lithium and/or valproate.MethodsEighty-four bipolar inpatients affected by a manic episode according to DSM-5 criteria. Drugs administered according to our best practice. Clinical course weekly monitored with Young Mania Rating Scale (YMRS) for 4weeks. Extrapiramidal side effects (EPSE) monitored with Saint Hans Rating Scale (SHRS).ResultsTwenty-five men (29.76%) and 59 women (70.24%); mean age 43.37 ± 13.58 years. Mean YMRS score T0 40.27 ± 9.04. Forty-one patients (48.81%) treated with haloperidol (3.4 mg/die); 16 (19.05%) with risperidone (4.3 mg/die); 27 (32.14%) with quetiapine (438 mg/die). The 3 groups showed no difference regarding clinical characteristics and YMRS basal scores. Chi2 analysis confirmed an higher response rate (50% of reduction of YMRS final score compared to T0) with haloperidol (χ2 = 14.88; P = 0.00). The repeated-measures model analysis showed a significant decrease (P < 0.05) in YMRS scores in haloperidol vs. risperidone vs. quetiapine patients for all time points from second week. No statistical difference for EPSE was found.ConslusionsWe suggest that haloperidol could be advisable in the treatment of severe mania, with rapid efficacy, even with low doses. Occurrence of EPSE was not considerable during the acute treatment. Studies with a larger sample size, randomization, fixed doses, double blind design are needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Delusional symptoms with alcohol

A patient is twenty-eight years old who comes to the emergency services because he has visual hallucinations related to alcohol consumption. He only consumes alcohol sporadically in leisure time. Since he began drinking at 18 years he has presented these symptoms in only four occasions. He does not relate with a more quantity of alcohol or another stressors. After a few minutes, these symptoms disappear and so he criticizes.It is about of study through a clinical case the alcoholic hallucinosis, their characteristics and to see the differences in the patient. The patient in the acute phase presents a view of reality altered that later he recovers. There is no loss of consciousness or behavioral disorders. There are similarities with a pathological intoxication but there is not a regular relationship between consumption and symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

When Ockham razor's principle is not applicable: Differential diagnosis of a rare case of child and adolescent psychosis

IntroductionThe diagnosis of schizophrenia in children is rare. Less than 4% of schizophrenic patients begin before age 15 being much less stable than in adults as an entity in time. It is estimated that only 50% of diagnoses of schizophrenia in patients under 15 years are maintained over time. The most frequent differential diagnoses are bipolar disorder, post-traumatic stress disorder and dissociative disorder.Objective and methodsA case of a patient of 18 years old admitted in our service with diagnosis of paranoid schizophrenia due to the presence of delusional symptoms at age of 14 and due his evolution with impaired overall performance is presented. Upon arrival he presented delusions, self-referentiality and a strange phenotype with a pitched voice. Clinical history included presence of sexual abuse prior to debut of psychotic symptoms and rare medical comorbidity (diagnosed at age 15 of hypertension and paroxysmal sinus tachycardia). A kariotipe was done in a previous admission with normal results.ResultsDuring hospitalization symptomatic remission was achieved in just two days by decreasing antipsychotic potency of the treatment, he also presented elevated metanephrines and also elevated plasma aldosterone and renin in blood tests.ConclusionsWe discuss the differential diagnosis including schizophrenia, post-traumatic stress disorder with dissociative symptoms and endocrine pathology (pheochromocytoma and hyperaldosteronism).L. Galindo is a Rio Hortega fellowship (ISC III; CM14/00111).Disclosure of interestThe authors have not supplied their declaration of competing interest.

Elevated Serum Levels of High-SensitivityC-Reactive Proteins Are Associated With Severe Delusional Symptoms in a Subgroup of Patients With Schizophrenia

Elevated Serum Levels of High-SensitivityC-Reactive Proteins Are Associated With Severe Delusional Symptoms in a Subgroup of Patients With Schizophrenia

Overconfidence in psychosis: The foundation of delusional conviction?

AbstractA number of recent studies have identified an “overconfidence effect” in psychosis, whereby people with schizophrenia are overconfident in errors while simultaneously slightly underconfident when accurate. This effect may have implications for why delusions, which are based on inaccurate inferences, perceptions and judgements, are typically held with high conviction. Given the importance the overconfidence effect may have in accounting for delusional conviction, the current narrative review aims to summarise and critique the recent evidence for the effect within schizophrenia. People with schizophrenia were consistently found to be overconfident in errors and slightly underconfident in correct appraisals, and this effect appears not to be an artefact of poor task performance. While the overconfidence effect has been linked to delusion-proneness in the general population, there was less direct evidence linking overconfidence to delusional symptoms in clinical populations. Future studies need to ado...

Trajectories of maternal depression: a 27-year population-based prospective study

To identify distinct trajectories of depression experienced by a population-based sample of women over a 27-year period and to assess the validity of the derived trajectories. The Mater University of Queensland Study of Pregnancy is a birth cohort study which commenced in 1981. Women (N = 6753) were interviewed at their first clinic visit, at 6 months, then 5, 14, 21 and 27 years after the birth of their child, using the Delusions Symptoms - States Inventory. Some 3561 (52.7%) women were followed up at 27 years, with 3337 (49.4%) of the sample completing the Composite International Diagnostic Interview (CIDI). Depression trajectories over a 27-year period were identified using Latent Class Growth Modelling (LCGM). LCGM was used to identify respondents with similar patterns of depression over a 27-year period. At the 27-year follow-up women who completed the CIDI, were stratified according to their trajectory group membership. Three trajectory groups, each with different life-course patterns of depression were identified. The low/no symptoms of depression trajectory group comprised 48.4% of women. The mid-depression group (41.7%) had a consistent pattern of occasional symptoms of depression. The high/escalating trajectory group comprised 9.9% of the women in the study. We then examined each trajectory group based on their completion of the CIDI at the 27-year follow-up. Using the CIDI, 27.0% of women in the study had met the DSM-IV criteria for lifetime ever depression by their mean age of 46.5 years. The responses to the CIDI differed greatly for each of the trajectory groups, suggesting that the trajectories validly reflect different life histories of depression. The high/escalating trajectory group had an earlier age of first onset, more frequent episodes, longer duration of each episode of depression and experienced higher levels of impairment for their episodes of depression. For the high symptoms trajectory group, clinically significant depression is estimated to be experienced by women almost one in every 6 days of their life. While symptoms of depression are commonly experienced in a large community-based sample of women, a minority of women experience many episodes of depression in their lifetime. It is this group of women who are most impaired and should be of most concern, and who should be the main target of prevention and treatment initiatives.

Acute psychosis owing to recurrence of craniopharyngioma in an elderly woman

A 63-year-old woman, after 5 years of resection of craniopharyngioma, developed recurrence of tumor with acute onset of psychotic symptoms. After 4 years of resection of craniopharyngioma, the patient presented with psychotic symptoms of varied delusion of reference, persecution, black magic and occasional auditory hallucinations. On physical examination, she showed no neurological deficit. Her blood investigations were at normal levels. Her recent magnetic resonance imaging brain scan showed large cystic lesion supposed to be a recurrent mass in sellar and suprasellar regions. After 2 months of antipsychotic treatment, her delusions and hallucinations were much decreased to extent that now she can do some household work. Her psychosis was controlled while she awaits neurosurgical intervention for recurrent craniopharyngioma. Acute psychosis is rarely found in elderly people and after few years of craniotomy for craniopharyngioma resection. So, the psychosis can be associated with the recurrence of craniopharyngioma. Such psychosis needs surgical intervention for primary cause.

Social Adversity in the Etiology of Psychosis: A Review of the Evidence.

Despite increasing evidence for the role of psychosocial factors in the onset and continuance of psychosis, the experiences involved are still largely considered the result of a biogenetic anomaly for which medication is the first-line treatment response. This review summarizes the extensive literature demonstrating that adverse events involving trauma, loss, stress, and disempowerment have a central etiological role in psychosis. Evidence is further presented to show that many neurological changes traditionally considered indicative of a disease process can in fact be accounted for as secondary effects to the physiology of stress or the residual of long-term neuroleptic prescription. Particular emphasis is given to the traumagenic neurodevelopmental model of psychosis, which illustrates how many of the structural and functional cerebral anomalies observed in adult patients with psychosis (including dopamine dysregulation, atrophy, hippocampal damage, and overactivity of the hypothalamic-adrenal-pituitary axis) closely correspond to those in the brains of abused children. Finally, research is discussed that demonstrates how trauma may manifest in characteristic symptoms of psychosis, particularly hallucinations and delusions. It is suggested that if social adversities are of central importance in psychosis, then psychotherapy that addresses the long term sequelae of those adversities should be considered an essential aspect of treatment.

Anxiety symptoms and the risk of diabetes mellitus in Australian women: evidence from 21-year follow-up

ObjectivesThis study aimed to explore the association between transitions in anxiety symptoms and the risk of diabetes in women, using longitudinal data. Study designThis longitudinal study measured diabetes, and transitions in anxiety symptoms, using validated instruments. MethodsData obtained by the Mater-University of Queensland Study of Pregnancy were analysed. Anxiety was measured using the Delusion Symptoms States Inventory (DSSI). To examine possible transitions over different time periods, anxiety was grouped into four categories and assessed at different phases over a 21-year period. ResultsThree hundred and one women reported diabetes 21 years after the index pregnancy. Almost half of the women who reported anxiety symptoms continued to report these at a subsequent follow-up (FU) phase. About 1 in 10 women who had not reported anxiety symptoms at 5-year FU did so at the subsequent 14-year FU. In prospective analyses, we did not find significant association of diabetes with negative transition (no anxiety to anxiety at subsequent phase) or with positive history of anxiety symptom, but an increasing risk was evident. Women with persistent symptoms had a 1.85-fold greater risk of diabetes (95% CI: 1.18–2.90). The cross-sectional analysis did not produce significant results. ConclusionsDespite some limitations, this study provides insight into the long-term association between events of anxiety and the risk of diabetes across the reproductive life of women. However, the evidence is not strong enough to support a direct effect of anxiety in causing diabetes.