Delusional Thinking Research Articles

Neuropsychiatric symptoms and diagnosis of grey matter heterotopia: A case-based reflection.

Neuropsychiatric symptoms can be related to less common underlying neuropsychiatric conditions – in this case report, the condition discussed is that of grey matter heterotopia (GMH). The patient presented with a history of prominent aggression, impulsivity and manipulative and attention-seeking behaviour. Episodes of depression and incidents of deliberate self-harm and suicide attempts had been reported. Neuropsychiatric symptoms included anxiety, a labile mood, delusional thinking and auditory hallucinations. Testing revealed some cognitive difficulties and severe impairment of frontal lobe functions. A magnetic resonance imaging (MRI) scan of his brain revealed the presence of GMH, which had previously been misdiagnosed as tuberous sclerosis. An MRI scan of the brain is the special investigation of choice for the correct diagnosis of GMH. The pathognomonic finding is that of heterotopic grey matter abnormally located within areas of white matter. Defective foetal neuronal migration between the third and fifth month of pregnancy can lead to GMH, which can present later on in childhood or adolescence with epilepsy, intellectual impairment or reading difficulties. During the late teenage years or early adulthood, a wide variety of neuropsychiatric symptoms may be present, which can lead to diagnostic difficulties.

Unusual psychotic presentation after discontinuation of treatment in a patient with Wilson's disease: a case report.

Psychiatric manifestations are common in patients with Wilson's Disease(WD), and they are usually correlated with neurological symptoms. However, psychotic presentation without neurological symptoms has rarely been reported. We present a case of WD involving a 34-year-old gentleman who was diagnosed at the age of 22, but due to lack of medication for approximately 5 months was admitted in a psychiatric ward with delusional thoughts of grandeur and persecution, echopraxia and echolalia. No neurological impairment, ophthalmic manifestations or liver abnormalities were identified. Through this report, we aim to discuss the pathophysiology and the treatment of psychosis in WD, and its association with neurological, liver and ophthalmic manifestations.

Everyday suspicion: our life is delusional

Suspicious thinking in given situations can be useful and helps the adaptation as events occurring in the world also corroborate this. Factors participating in the development of paranoia can be listed as psychodynamic (projection), salience attributional, neurobiological (dopamine), impaired perceptual (hearing loss), sociocultural (minority, pseudocommunity), self-esteem (worrying, depression, mania), and cognitive (jump-to-conclusion) mechanisms. Along the spectrum of thinking, from the mild to the severe, enhanced worrying, salience attribution, overvalued concepts, suspicion/mistrust, paranoid ideations, and crystallized delusions may occur with different contents. In recent years intensive research has been started to reveal the presence of subclinical paranoid thoughts in the general population. Applying various screening methods developed for this purpose (delusions inventories, psychometric tests, virtual reality laboratory) it has been found that suspicious/mistrustful ideations are fairly common in nonclinical samples and some of these are comparable to that seen in patient population. From the larger occurrence of milder forms to the smaller frequency of more severe delusional thoughts the whole hierarchical phenomenon can be described as a 'paranoia pyramid'. Based on this everyday paranoid thinking style lurking in people, it may well be that 'our life is delusional'. Orv. Hetil., 2016, 157(50), 1979-1988.

Effects of ketamine on brain function during smooth pursuit eye movements.

The uncompetitive NMDA receptor antagonist ketamine has been proposed to model symptoms of psychosis. Smooth pursuit eye movements (SPEM) are an established biomarker of schizophrenia. SPEM performance has been shown to be impaired in the schizophrenia spectrum and during ketamine administration in healthy volunteers. However, the neural mechanisms mediating SPEM impairments during ketamine administration are unknown. In a counter-balanced, placebo-controlled, double-blind, within-subjects design, 27 healthy participants received intravenous racemic ketamine (100 ng/mL target plasma concentration) on one of two assessment days and placebo (intravenous saline) on the other. Participants performed a block-design SPEM task during functional magnetic resonance imaging (fMRI) at 3 Tesla field strength. Self-ratings of psychosis-like experiences were obtained using the Psychotomimetic States Inventory (PSI). Ketamine administration induced psychosis-like symptoms, during ketamine infusion, participants showed increased ratings on the PSI dimensions cognitive disorganization, delusional thinking, perceptual distortion and mania. Ketamine led to robust deficits in SPEM performance, which were accompanied by reduced blood oxygen level dependent (BOLD) signal in the SPEM network including primary visual cortex, area V5 and the right frontal eye field (FEF), compared to placebo. A measure of connectivity with V5 and FEF as seed regions, however, was not significantly affected by ketamine. These results are similar to the deviations found in schizophrenia patients. Our findings support the role of glutamate dysfunction in impaired smooth pursuit performance and the use of ketamine as a pharmacological model of psychosis, especially when combined with oculomotor biomarkers. Hum Brain Mapp 37:4047-4060, 2016. © 2016 Wiley Periodicals, Inc.

Aripiprazole

Delirium is a palliative care emergency where patients experience changes in perception, awareness, and behavior. Common features include changes in the sleep-wake cycle, emotional lability, delusional thinking, and language and thought disorders. Delirium results from neurotransmitter imbalances involving several neurotransmitters such as dopamine, glutamate, norepinephrine, acetylcholine, gamma-aminobutyric acid, and serotonin. Untreated delirium causes significant morbidity and mortality. Nonpharmacologic and pharmacologic approaches treat delirium. Current pharmacologic management of delirium involves using agents such as haloperidol or second-generation antipsychotics. Third-generation atypical antipsychotic drugs have emerged as a potential choice for delirium management. Aripiprazole is a third-generation antipsychotic with a dopamine receptor-binding profile distinct from other second-generation antipsychotics. Aripiprazole acts as partial agonist at dopamine D2 and 5-hydroxytryptamine (5-HT)1A receptors, stabilizing the dopamine receptor leading to improvement in symptoms. The article reviews the pharmacology, pharmacodynamics, metabolism, and evidence of clinical efficacy for this new antipsychotic agent. This article explores possible roles in palliative care.

A REVIEW OF KETAMINE ABUSE AND DIVERSION.

Ketamine was discovered in the 1960s and released for public use in 1970. Originally developed as a safer alternative to phencyclidine, ketamine is primarily used in clinical settings for analgesia and sedation. In recent years, other uses have been developed, including pain management and treatment of asthma and depression. Clinical use of ketamine causes dissociation and emergence delirium. These effects have led to recreational abuse. Although death from direct pharmacologic effects appears rare, the disinhibition and altered sensory perceptions caused by ketamine puts users at risk of environmental harm. Ketamine has also been implicated in nonconsensual sexual intercourse. Data continue to build that chronic ketamine use may lead to morbidity. Impairment of memory and persistent dissociative, depressive, and delusional thinking has also been reported with long-term use. Lower urinary tract symptoms, including cystitis have been described. Gastric and hepatic pathology have also been noted, including abnormal liver function tests, choledochal cysts and dilations of the common bile duct. S-ketamine, an enantiomer in racemic ketamine, has been shown to be hepatotoxic in vitro. Abstinence from ketamine may reduce the adverse effects of chronic use and is considered the mainstay of treatment. Specialized urine drug testing may be required to detect use, as not all point of care urine drug screens include ketamine.

Restricted attention to social cues in schizophrenia patients.

Deficits of psychosocial functioning are a robust finding in schizophrenia. Research on social cognition may open a new avenue for the development of effective interventions. As a correlate of social perceptive information processing deficits, schizophrenia patients (SZP) show deviant gaze behavior (GB) while viewing emotional faces. As understanding of a social environment requires gathering complex social information, our study aimed at investigating the gaze behavior of SZP related to social interactions and its impact on the level of social and role functioning. GB of 32 SZP and 37 healthy control individuals (HCI) was investigated with a high-resolution eye tracker during an unguided viewing of 12 complex pictures of social interaction scenes. Regarding whole pictures, SZP showed a shorter scanpath length, fewer fixations and a shorter mean distance between fixations. Furthermore, SZP exhibited fewer and shorter fixations on faces, but not on the socially informative bodies nor on the background, suggesting a cue-specific abnormality. Logistic regression with bootstrapping yielded a model including two GB parameters; a subsequent ROC curve analysis indicated an excellent ability of group discrimination (AUC .85). Face-related GB aberrations correlated with lower social and role functioning and with delusional thinking, but not with negative symptoms. Training of spontaneous integration of face-related social information seems promising to enable a holistic perception of social information, which may in turn improve social and role functioning. The observed ability to discriminate SZP from HCI warrants further research on the predictive validity of GB in psychosis risk prediction.

Emotional avoidance process in patients with schizophrenia and bipolar disorder. New module: Emotional body's sensations and meta-cognitive work on the interpretation of delusional thinking

IntroductionPsychological processes play a mediating role in the development of psycho-pathological disorders depending on the Kinderman's model. Excessive use of emotional avoidance becomes, following the model of Barlow and Allen, the booster of emotional distress at long term. Dysfunctional meta-cognitive processes in turn influence the inadequate interpretations of life experiences.ObjectiveTo improve identification, expression and emotional management in patients with schizophrenia (PWS) and patients with bipolar disorder (PWBD).AimsIntroduction of exposition for the emotional body's sensations. This work on emotional awareness by images and sounds prepare to role-playing and to exposure in real life.MethodsGroups of psychotherapy for adults PWS and PWBD was implemented. The techniques used are those of cognitive behavioral therapy CBT (Beck) and emotional therapies (Barlow): columns Beck tailored, role-playing, psycho-emotional and breathing. Four groups of four patients participated in six therapy sessions.ResultsAn increase in emotional flexibility is observed two weeks after the group work (Wilcoxon P = 0.025). Work on emotional identification facilitates the relaxation of the avoidance process while promoting social skills. The new format includes nine sessions three additional sessions on the emotional body sensations. Meta-cognitive work on the interpretation of the delusional thinking has been inserted.ConclusionThe experience of this pilot study provides encouraging results. The transdiagnostic approach referring to the alterations of this common psychological process finds use with PWS and PWBD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosis-related polydipsia and chronic hyponatremia – A case report

IntroductionPsychogenic polydipsia has an estimated prevalence of 6–20% in psychiatric population. Although first described in the 1930s, there are few studies addressing this problem and its management. The high water intake can lead to severe hyponatremia with a mortality rate high enough to merit clinical concern.AimsReport a case of a schizophrenic patient with psychogenic polydipsia and hyponatremia.MethodsRetrospective review of the clinical file and literature research on this topic.ResultsA 41-year-old man with a long-term schizophrenia presented to the emergency room (ER) with exacerbation of psychotic symptoms. In the prior 24 months, he had stopped medication and began excessive water intake (5 to 10 L/day). He presented with auditory hallucinations, passivity phenomena and persecutory and other delusional thoughts that justified this behavior – “The water will end; I have to stock it, like camels do”. Presently he had an asymptomatic hyponatremia (128 mg/dL), but 6 months before he had been admitted in the ER with vomiting, altered state of consciousness and convulsions secondary to severe hyponatremia (108 mg/dL). During the present hospitalization, organic causes of hyponatremia were excluded and he was started on behavioral measures and antipsychotics. The psychotic symptoms improved and there was no need for water restriction after the first week, with restored natremia values on discharge.ConclusionsWith this case report we intended to raise awareness on this potentially fatal condition that despite its prevalence has no defined diagnostic criteria, nor established controlled trials concerning the effectiveness of treatments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Commentary: Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis.

In their meta-analysis, Mehl et al. (2015) examine whether CBT for psychosis is an effective intervention for reducing delusions. The authors reported a small but significant effect size for CBT in comparison to TAU at end-of-therapy (k = 13; d = 0.27) and at follow-up (k = 12; d = 0.25). By contrast, no significant benefit emerged for CBT when compared to active control conditions either at end-of-therapy (k = 8; d = 0.16) or at follow-up (k = 5; d = −0.04). The meta-analysis, however, contains errors and omissions that when rectified, cast doubt on the reliability of the reported significant effects comparing CBT to Treatment as Usual (TAU) at end-of treatment and at follow-up.

Commentary: Musical hallucinations: review of treatment effects.

Commentary: Musical hallucinations: review of treatment effects.

Bayesian accounts and black swans: Questioning the erotetic theory of delusional thinking

Parrott and Koralus argue that a particular cognitive factor – “impaired endogenous question raising” – offers a parsimonious account of three delusion-related phenomena: (1) the development of the Capgras delusion; (2) evidence that patients with schizophrenia outperform healthy control participants on a conditional reasoning task; and (3) evidence that deluded individuals “jump to conclusions”. In this response, I assess these claims, and raise my own questions about the “erotetic” theory of delusional thinking.

The erotetic theory of delusional thinking

Introduction. In this paper, we argue for a novel account of one cognitive factor implicated in delusional cognition. According to the erotetic theory of delusion we present, the central cognitive factor in delusion is impaired endogenous question raising.Method. After presenting the erotetic theory, we draw on it to model three distinct patterns of reasoning exhibited by delusional and schizophrenic patients, and contrast our explanations with Bayesian alternatives.Results. We argue that the erotetic theory has considerable advantages over Bayesian models. Specifically, we show that it offers a superior explanation of three phenomena: the onset and persistence of the Capgras delusion; recent data indicating that schizophrenic subjects manifest superior reasoning with conditionals in certain contexts; and evidence that schizophrenic and delusional subjects have a tendency to “jump to conclusions.” Moreover, since the cognitive mechanisms we appeal to are independently motivated, we avoid having to posit distinct epistemic states that are intrinsically irrational in order to fit our model to the variety of data.Conclusion. In contrast to Bayesian models, the erotetic theory offers a simple, unified explanation of a range of empirical data. We therefore conclude that it offers a more plausible framework for explaining delusional cognition.

Corollary Discharge Failure in an Oculomotor Task Is Related to Delusional Ideation in Healthy Individuals.

Predicting the sensory consequences of saccadic eye movements likely plays a crucial role in planning sequences of saccades and in maintaining visual stability despite saccade-caused retinal displacements. Deficits in predictive activity, such as that afforded by a corollary discharge signal, have been reported in patients with schizophrenia, and may lead to the emergence of positive symptoms, in particular delusions of control and auditory hallucinations. We examined whether a measure of delusional thinking in the general, non-clinical population correlated with measures of predictive activity in two oculomotor tasks. The double-step task measured predictive activity in motor control, and the in-flight displacement task measured predictive activity in trans-saccadic visual perception. Forty-one healthy adults performed both tasks and completed a questionnaire to assess delusional thinking. The quantitative measure of predictive activity we obtained correlated with the tendency towards delusional ideation, but only for the motor task, and not the perceptual task: Individuals with higher levels of delusional thinking showed less self-movement information use in the motor task. Variation of the degree of self-generated movement knowledge as a function of the prevalence of delusional ideation in the normal population strongly supports the idea that corollary discharge deficits measured in schizophrenic patients in previous researches are not due to neuroleptic medication. We also propose that this difference in results between the perceptual and the motor tasks may point to a dissociation between corollary discharge for perception and corollary discharge for action.

Perceptual distortions and delusional thinking following ketamine administration are related to increased pharmacological MRI signal changes in the parietal lobe.

Ketamine produces effects in healthy humans that resemble the positive, negative and cognitive symptoms of schizophrenia. We investigated the effect of ketamine administration on brain activity as indexed by blood-oxygen-level-dependent (BOLD) signal change response, and its relationship to ketamine-induced subjective changes, including perceptual distortion. Thirteen healthy participants volunteered for the study. All underwent a 15-min functional MRI acquisition with a ketamine infusion commencing after 5 min (approx 0.26 mg/kg over 20s followed by an infusion of approx. 0.42 mg/kg/h). Following the scan, participants self-rated ketamine-induced effects using the Psychotomimetic States Inventory. Ketamine led to widespread cortical and subcortical increases in BOLD response (FWE-corrected p < 0.01). Self-rated perceptual distortions and delusional thoughts correlated with increased BOLD response in the paracentral lobule (FWE-corrected p < 0.01). The findings suggest that BOLD increases in parietal cortices reflect ketamine effects on circuits that contribute to its capacity to produce perceptual alterations and delusional interpretations.

The effectiveness of early psychosis programming for young women: a systematic review protocol

The effectiveness of early psychosis programming for young women: a systematic review protocol

The Measure of Madness: Philosophy of Mind, Cognitive Neuroscience, and Delusional Thoughtby Philip Gerrans. Cambridge, Mass., MIT Press, 2014, 304 pp., $40.00 (hardcover).

The Measure of Madness: Philosophy of Mind, Cognitive Neuroscience, and Delusional Thoughtby Philip Gerrans. Cambridge, Mass., MIT Press, 2014, 304 pp., $40.00 (hardcover).

Is delusional ideation a critical link in the nexus between personality disorder and violent offending?

Evidence suggests that consideration of personality disorder (PD) severity, incorporating both externalising and internalising features of PD, might help to clarify the PD – violence relationship; moreover, that separate developmental pathways might link externalising and internalising personality pathology with criminal violence. This study of 96 forensic patients with confirmed PD and a history of violent offending addressed the question of whether delusional ideation, measured by the Peters Delusions Inventory, might play a significant role in the link between severe PD and criminal violence. Severe PD, defined by summing scores across DSM-IV PD criteria, was significantly associated with delusional thinking, with violence, and with high levels of both externalising and internalising personality features. Delusional thinking was associated with violence via internalising but not externalising PD features, suggesting that the link between severe PD and violence may be partly mediated by delusional thinking.

Conspiracy theory and cognitive style: a worldview.

This paper assessed whether belief in conspiracy theories was associated with a particularly cognitive style (worldview). The sample comprised 223 volunteers recruited via convenience sampling and included undergraduates, postgraduates, university employees, and alumni. Respondents completed measures assessing a range of cognitive-perceptual factors (schizotypy, delusional ideation, and hallucination proneness) and conspiratorial beliefs (general attitudes toward conspiracist thinking and endorsement of individual conspiracies). Positive symptoms of schizotypy, particularly the cognitive-perceptual factor, correlated positively with conspiracist beliefs. The best predictor of belief in conspiracies was delusional ideation. Consistent with the notion of a coherent conspiratorial mindset, scores across conspiracy measures correlated strongly. Whilst findings supported the view that belief in conspiracies, within the sub-clinical population, was associated with a delusional thinking style, cognitive-perceptual factors in combination accounted for only 32% of the variance.

Schizophrenia in identical twins.

Byline: Choudhary. Narayan, Deep. Shikha, Shivendra. Shekhar Sir, Genetic factors are believed to play an important role in the causation of schizophrenia. While the lifetime risk in the general population is just below 1%, it is 6.5% infirst-degree relatives of patients [sup][1] and it rises to more than 40% in monozygotic twins of affected people.[sup][2] Analyzing classic studies of the genetics of schizophrenia done as early as in 1930s, Fischer concludes that a concordance rate for psychosis of about 50% in monozygotic twins seems to be a realistic estimate, which is significantly higher than that in dizygotic twins of about 10–19%.[sup][3] A case of schizophrenia occurring in identical twin is reported here. Mr. A, 30-year-old unmarried male from middle socioeconomic urban background was brought with the complaints of irrelevant talks, sleeplessness, restlessness, lack of self-care, loss of weight, poor appetite, etc., for 8–9 months. He had developed firm belief that he had been afflicted with some cancerous disease and had such serious illness that his intestines and other abdominal contents had started rotting. He was also extremely suspicious about his family members and kept on refusing medications even for pulmonary tuberculosis from which he was suffering. He appeared to be a bit retarded and socially withdrawn, talking very little, and mostly in short sentences. Rapport was established with great difficulty. He was preoccupied with the delusional thoughts as described above and reported hearing occasional voices. On physical examination and after perusal of his investigation reports including X-ray chest, it was found that he was also suffering from pulmonary tuberculosis. A clinical diagnosis of schizophrenia, paranoid type, (ICD 10, F20.0) was made in addition to pulmonary tuberculosis. He was placed on risperidone with the dose gradually increased to 8 mg/day and olanzapine 5 mg at bed time along with medications for pulmonary tuberculosis as advised by his treating physician. After a series of counseling and reassurance measures, he was somehow or other impressed upon to accept the treatment. After 1-month of treatment, he improved greatly both physically and mentally. After about 2 months of treatment, he was able to resume his duties in the postal department, where he was employed as a clerk. At the follow-up after 6 months, he improved greatly and was continuing the medications. Risperidone dose was maintained on 2 mg twice a day. Mr. B, 30-year-old unmarried male was the identical twin of Mr. A with strikingly similar facial and other physical features. He was brought by his family members about 1-year later with the complaints of extreme social withdrawal, suspiciousness, unexplained fears, impairment of day to day and social activities and persistent belief that he has been afflicted by some cancerous disease due to which some foul smells are constantly coming out of his body. He had firm belief of foul smell coming out of his entire body and had also developed hypochondriac delusions of being afflicted some cancerous disorder. He took special meaning of other's activities and was extremely suspicious of activities of his family members leading to noncooperation with any type of treatment. He was a thin built man with evidence of neglect of personal care and hygiene. He showed extreme social withdrawal, uncooperativeness, and psychomotor retardation. …