Thought Disorder Research Articles

Sleep disorders in meningoencephalitis with adjustment disorders

Many patients with medical disorders, such as meningoencephalitis are evaluated by psychiatrists complaining of sleep problems as one of the symptoms. A 65-years old married male patient who was currently unemployed was interviewed by a psychiatrist in an uncomfortable reclining position. The patient had been hospitalized for 8 days prior to the interview with a history of being unconscious. The patient showed disorganized speech, tried to pull the intravenous line, and hit his wife. The patient said that at this time, he was unable to sleep due to the throbbing headaches, nauseous, and frequent urination at night. Thus, the patient felt uncomfortable, tired, and drowsy in the morning. Those symptoms got worse in the last week. The patient never had sleep problems before. The psychiatric status showed an appropriate appearance, uncomfortable looks, adequate verbal and visual contact, clear consciousness, dysphoric mood and affect which was congruent, logical realist coherent thought process, and a preoccupation of headache. There was no hallucination or illusion, but mixed type insomnia was found. The patient was diagnosed with adjustment disorder with predominant symptoms and sleep disturbances (F43.28).

Mental Health of Incarcerated Veterans and Civilians: Latent Class Analysis of the 2016 Survey of Prison Inmates

Using data from the 2016 Survey of Prison Inmates, this study used latent class analysis to examine patterns of mental health comorbidity within a large, nationally-representative sample of incarcerated adults ( N = 24,848), including 7.6% with prior military service. Classes were compared on Veteran status, military service-related variables, and treatment-related variables. Results suggest four latent mental health patterns—“Low Psychopathology” (70% of the total sample), “Internalizing + Thought Disorder” (8%), “Internalizing” (14%), and “High Psychopathology” (8%). The High Psychopathology class had the highest rates of prior psychiatric/psychological treatment. Incarcerated Veterans were more likely to be in the Internalizing class, and rates of combat exposure, military service-related injury, and less-than-honorable military discharge were highest in Internalizing and High Psychopathology classes. Results attest to the importance of person-centered mental health care within correctional settings and suggest a “treatment track” or “step-based” approach may best address the needs of individuals in these settings.

Network analysis of psychiatric symptoms in schizophrenia: Findings from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP).

Schizophrenia is a major mental disorder with a wide range of psychiatric symptoms. This study explored the structure of psychiatric symptoms of schizophrenia using network analysis in a large representative Asian sample based on a survey of clinical features and treatment used in schizophrenia patients across 15 countries/territories in Asia. Data on the demographic characteristics and psychiatric symptoms in schizophrenia patients were extracted from the dataset of the fourth Research on Asia Psychotropic Prescription for Antipsychotics (REAP-AP) project. The presence of the following psychiatric symptoms including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, social/occupational dysfunction, verbal aggression, physical aggression, and affective symptoms were analyzed. A total of 3681 patients were included. The network analysis revealed that verbal aggression, hallucinations, and social/occupational dysfunction were the most central symptoms, while the connections between social/occupational dysfunction and verbal aggression, and between hallucinations and disorganized speech were the two strongest edges. There were significant gender differences in the network structure based on the network structure invariance test (M=0.74, P=0.03) and invariant edge strength test. The positive correlation between verbal aggression and hallucinations was significantly stronger in the female network than that in the male network (P=0.03), while a negative correlation between affective symptoms and negative symptoms was found in the female, but not the male network (P<0.01). Central symptoms including verbal aggression, hallucinations, and socio-occupational dysfunction should be addressed in developing targeted treatment strategy for schizophrenia patients.

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.

SLC20A2-related primary familial brain calcification with purely acute psychiatric symptoms: a case report

BackgroundPrimary familial brain calcification (PFBC) is a rare inherited neurological disorder characterized by bilateral basal ganglia calcification with a series of motor and nonmotor symptoms. Mutations in the SLC20A2 gene, encoding the PiT2 protein, are the major cause of the disease. Here, we report a Chinese PFBC family carrying a SLC20A2 gene mutation, and the proband presented with purely acute psychiatric symptoms, which has been rarely reported in this disease.Case presentationA 38-year-old woman was hospitalized due to disorganized speech; disordered thought contents; disorganized behaviour; emotional instability and lability; and grandiose words, actions and facial expressions. Brain computerized tomography (CT) revealed calcification in the basal ganglia; cerebellar dentate nuclei; and subcortical, periventricular, and deep white matter regions in she and her family members. Through mutation analysis, a heterozygous truncating mutation, c.1723G > T, p.(Glu575*), was identified in the SLC20A2 gene in this family. Thus, this patient was diagnosed with genetically confirmed PFBC, and she responded well to a low dose of antipsychotic drugs. The penetrance of the disease in this family was only 33%, which was significantly lower than that in most families carrying SLC20A2 gene mutations.ConclusionsPatients with SLC20A2-related PFBC might present with psychiatric symptoms alone, and the penetrance of the disease may be quite low, which adds to the clinical heterogeneity of the disease.

Cognitive behavioural therapy (group) for schizophrenia.

Cognitive behavioural therapy (group) for schizophrenia.

Aberrant salience correlates with psychotic dimensions in outpatients with schizophrenia spectrum disorders

BackgroundAberrant salience is a well-known construct associated with the development and maintenance of psychotic symptoms in schizophrenia. However, only a few studies have investigated aberrance salience as a trait, with no study investigating the association between the five aberrant salience domains and psychotic symptoms. We aimed to explore the role of aberrant salience and its domains on psychotic dimensions in both clinically remitted and non-remitted patients.MethodsA sample of 102 patients diagnosed with schizophrenia spectrum disorders was divided according to the Positive and Negative Syndrome Scale (PANSS) remission criteria into two groups: remitted and non-remitted. Differences regarding psychotic symptomatology assessed by the PANSS and aberrant salience measured by the Aberrant Salience Inventory (ASI) were explored. Finally, a correlation analysis between the PANSS and the ASI was run.ResultsSignificantly higher ASI scores were evident among non-remitted patients. Positive symptoms (i.e. delusions, conceptual disorganization, and hallucinatory behaviour) and general psychopathology (i.e. postural mannerisms, unusual thought content) were correlated to the aberrant salience subscales ‘sharpening of senses’, ‘heightened emotionality’ and ‘heightened cognition’ and with the ASI total score. Significant correlations emerged between negative symptoms (blunted affect and social withdrawal) and ‘heightened cognition'. Finally, lack of spontaneity of conversation was related to the subscales ‘heightened emotionality’ and ‘heightened cognition’, as well as to the ASI total score.ConclusionsThese preliminary results support the hypothesis of an association between aberrant salience and psychotic symptoms in schizophrenia. Further research is needed, especially into the mechanisms underlying salience processing, in addition to social and environmental factors and cognitive variables.

The joint hierarchical structure of psychopathology and dysfunctional personality domain indicators among community-dwelling adults.

To examine the hierarchical structure of psychopathology and dysfunctional personality domains, 2416 Italian community-dwelling adult volunteers were administered a set of psychometrically sound psychopathology measures and the Personality Inventory for DSM-5 Brief Form+ (PID-5-BF+). Parallel analysis, minimum average partial, and very simple structure results suggested that 1-6 principal components (PCs) should be retained. Goldberg's bass-ackwards model of the joint psychopathology measure and PID-5-BF+ ipsatized domain scale correlation matrix evidenced a hierarchical structure that was consistent with the working model proposed by the Hierarchical Taxonomy of Psychopathology (HiTOP) consortium. Hierarchical agglomerative cluster analysis around latent variables of the psychopathology indicators and PID-5-BF+ domain scales recovered four latent dimensions, which were akin to the corresponding bass-ackwards components and nicely reproduced the HiTOP Internalizing, Externalizing, Thought Disorder, and Eating Pathology dimensions.

Aberrant functional connectivity within the salience network is related to cognitive deficits and disorganization in psychosis

In schizophrenia and schizoaffective disorder cognitive deficits are a reliable characteristic predicting a poor functional outcome. It has been theorized that both the default mode network (DMN) and the salience network (SN) play a crucial role in cognitive processes and aberrant functional connectivity within these networks in psychotic patients has been reported. The goal of this study was to reveal potential links between aberrant functional connectivity within these networks and impaired cognitive performance in psychosis.We chose two approaches for cognitive assessment, first the MATRICS Consensus Cognitive Battery (MCCB) combined into a global score and second the disorganization factor derived from a five-factor model of the Positive and Negative Syndrome Scale (PANSS) known to be relevant for cognitive performance. DMN and SN were identified using independent component analysis on resting-state functional magnetic resonance imaging data.We found significantly decreased connectivity within the right supplementary motor area (SMA) and bilateral putamen in patients with psychosis (n = 70; 27F/43M) compared to healthy controls (n = 72; 28F/44M). Within patients, linear regression analysis revealed that aberrant SMA connectivity was associated with impaired global cognition, while dysfunctional bilateral putamen connectivity predicted disorganization. There were no significant changes in connectivity within the DMN.Results support the hypothesis that SN dysfunctional connectivity is important in the pathobiology of cognitive deficits in psychosis. For the first time we were able to show the involvement of dysfunctional SMA connectivity in this context. We interpret the decreased SN connectivity as evidence of reduced functionality in recruiting brain areas necessary for cognitive processing.

Feasibility and Effectiveness of a Psychosis-Specific Intensive Outpatient Program.

ObjectiveIntensive outpatient programs (IOPs) are rarely designed specifically to treat psychosis. In 2016 UCLA established the Thought Disorders Intensive Outpatient Program (TD IOP), combining a time‐limited, group‐based intervention called cognitive behavioral social skills training (CBSST) and medication management to treat individuals with psychosis. The purpose of this study is to assess the feasibility of developing an IOP for individuals with psychosis and the effectiveness of the program in improving psychotic symptom severity.MethodsAdults were referred to the TD IOP from inpatient and outpatient settings. Programming included 3 hours of CBSST and 6 hours of additional groups weekly as well as individual psychiatry and social work services. Primary outcomes were symptom changes as measured at intake and discharge by the Clinician‐Rated Dimensions of Psychosis Symptom Severity scale. Program feedback was solicited from a small subset of patients.ResultsOf the 92 enrolled subjects, 71 completed the program (77.2%). Average length of stay was 52 ± 30 days across all enrolled. Participants showed significant (p < 0.05) improvement with small‐moderate effect sizes across five of eight psychosis symptom domains (hallucinations, delusions, disorganized speech, depression, and mania). Patient‐reported program satisfaction was high (86.6 ± 12.7 score, range 0–100).ConclusionsThe current study indicates that targeted treatment for psychosis is successful within an IOP framework, with minimal additional training required for Master's level clinicians. Participants demonstrated significant symptomatic relief from group‐based, time‐limited treatment. Further work is needed to determine the full range of program benefits on patient well‐being and illness morbidity.

Vitamin D and cardiometabolic outcomes in first episode psychosis (FEP): A prospective cohort study

In schizophrenia and schizoaffective disorder cognitive deficits are a reliable characteristic predicting a poor functional outcome. It has been theorized that both the default mode network (DMN) and the salience network (SN) play a crucial role in cognitive processes and aberrant functional connectivity within these networks in psychotic patients has been reported. The goal of this study was to reveal potential links between aberrant functional connectivity within these networks and impaired cognitive performance in psychosis.We chose two approaches for cognitive assessment, first the MATRICS Consensus Cognitive Battery (MCCB) combined into a global score and second the disorganization factor derived from a five-factor model of the Positive and Negative Syndrome Scale (PANSS) known to be relevant for cognitive performance. DMN and SN were identified using independent component analysis on resting-state functional magnetic resonance imaging data.We found significantly decreased connectivity within the right supplementary motor area (SMA) and bilateral putamen in patients with psychosis (n = 70; 27F/43M) compared to healthy controls (n = 72; 28F/44M). Within patients, linear regression analysis revealed that aberrant SMA connectivity was associated with impaired global cognition, while dysfunctional bilateral putamen connectivity predicted disorganization. There were no significant changes in connectivity within the DMN.Results support the hypothesis that SN dysfunctional connectivity is important in the pathobiology of cognitive deficits in psychosis. For the first time we were able to show the involvement of dysfunctional SMA connectivity in this context. We interpret the decreased SN connectivity as evidence of reduced functionality in recruiting brain areas necessary for cognitive processing.

A Case of Brief Psychotic Disorder: An Unintended Consequence of COVID-19 Virus

Brief psychotic disorder is a sudden onset of psychosis in a patient for a duration of more than a day and less than a month. The DSM-5 defines brief psychotic disorder as a psychotic condition involving the sudden onset of at least one psychotic symptoms such as delusions, hallucinations, disorganized thought processes, disorganized speech and/or behaviors. This condition can also be associated with impaired memory of recent events, screaming, mutism, outlandish dressing, or behaviors. Acute psychotic symptoms can be associated with emotional lability often triggered by substance abuse or severe and acute stress such as the loss of a loved one. Patients ultimately receive the diagnosis of schizophrenia if the symptoms persist for a duration longer than six months. Brief psychotic disorder is often diagnosed in teenage patients, but it is less commonly seen in the females. Although the exact pathophysiology of brief psychotic disorder has not been determined, historically and similarly to schizophrenia it has been strongly linked to familial history. In some cases, it has been preceded by a traumatic and stressful event. Brief psychotic disorder has also been theorized to be the cause of maladaptive defense mechanism to escape a stressor. In this case report, we present a fifteen-year-old female patient who abruptly lost her mother to COVID-19, her adaptation few months following the loss and her eventual reactive psychosis as well as management challenges.

A Case of Adult Attention Deficit Hyperactivity Disorder with Non-Organic Psychosis Comorbidity

IntroductionAlthough ADHD is the most frequently diagnosed psychiatric disorder in childhood, the majority of adults with ADHD are not diagnosed and 90% of the cases remain untreated. One of the main reasons that may lead to the missed diagnosis of ADHD in adults may be the high rate of comorbid psychiatric conditions masking the main symptoms.ObjectivesIn this study, it was aimed to present a case who was followed up with the diagnosis of ADHD since childhood and developed psychosis after a recent traumatic life event.MethodsA 19-year-old male patient was consulted because of his complaints of persecution delusions, and disorganized speech that started 2 years ago. IIt was learned that the first psychiatry application of the patient was 10 years ago with complaints of impulsivity, aggression, increased psychomotor movements, and methylphenidate treatment was started during this period. The patient, whose current clinical picture was evaluated as psychosis, was discharged after the symptoms subsided with paliperidone depot 100mg/month treatment after hospitalization. It is understood that his psychotic complaints completely regressed in the follow-ups.ResultsIt is stated that approximately 80% of adult ADHD cases have at least one accompanying psychiatric disorder. However, there are limited studies in the literature on the relationship between psychotic disorders and ADHD.ConclusionsRecent studies indicate that beyond the fact that ADHD is a feature of the schizophrenia prodrome, ADHD diagnosis may be associated with an increased risk of psychosis in the future. Therefore, this association can be better clarified in further studies on comorbidities.DisclosureNo significant relationships.

Lennox-Gastaut and Schizophrenia: Comorbidity or complication?

IntroductionLennox-Gastaut syndrome (LGS) belongs to the group of severe childhood epileptic encephalopathies and represents 1 to 2% of all childhood epilepsies.It is characterized by the occurrence of generalized epileptic seizures, characterized by a particular pattern of the electroencephalogram; slowed mental development and personality disorders.This syndrome appears between the ages of 2 and 7 years, and its management remains difficult, as it is generally refractory to conventional treatment.The long-term prognosis of this syndrome is poor, marked by the presence of periods of regression of cognitive functions, the appearance of frontal or even psychotic signs and extrapyramidal and cerebellar signs.ObjectivesWe will try trow a clinical case, to discuss the evolution of Lennox Gastaut syndrome towards schizophrenia, which remains an infrequent complication, and to determine what would be the adequate management of these patients?MethodsWe report the case of a 16-year-old patient,followed for Lennox Gastaut syndrome since the age of 03, who presented to the psychiatric emergency room for psychomotor agitation, geophagia and altered general condition. The admission interview showed a patient with motor instability, disorganized speech, delusional persecution syndrome, auditory and intrapsychic hallucinations, suicidal ideations in the context of mental automatism, impaired judgment and insight, and insomnia.The blood tests and the brain CT scan came back without any particularities.ResultsThe patient was put on Risperidone, Valproate sodium, Lamotrigine and Clobazam, with good clinical evolution.ConclusionsThe cognitive consequences are catastrophic, 85 to 92% of the patients have a progressive cognitive deterioration, in spite of the reduction of the frequency of the seizures and the improvement of the paroxysmal EEG anomalies.DisclosureNo significant relationships.

Evolution of Delusional Disorder across the DSM editions

IntroductionStates compatible with “Delusional disorder” have been described since the XIX century. Esquirol mentioned “irrational ideas and actions that would develop via logical and plausible arguments”; Kraepelin referred to the condition as “paranoia” and considered that hallucinations could not be present– unlike Bleuler, who considered them to be a possible feature. The criteria for delusional disorder have suffered several changes in the last centuries.ObjectivesWe aim to review the evolution of the criteria for delusional disorder across the editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).MethodsReview of DSM editions.ResultsCriteria for the diagnosis of “paranoia” (DSM III) or “delusional disorder” (DSM III-IV.V) underwent several changes. In the first editions hallucinations could not be prominent (DSM-III-IIIR) and in the DSM IV, only tactile or olfactory hallucinations related to delusions could be present. In DSM-V hallucinations of other modalities related to the delusional theme can be present. Regarding delusional themes, the first edition of the DSM III regarded persecutory delusions only – which was changed in the DSM-III-R, with the inclusion of grandiose, jealous, erotomaniac, and somatic. Only in the DSM-V did the occurrence of bizarre delusions become possible in delusional disorder. Across the editions, there is a consensus about the absence of negative symptoms, absence of disorganized speech, and that the behavior is not odd aside from delusional content.ConclusionsThe most debatable symptoms across centuries in the classification of delusional disorders were: presence of hallucinations, the nature of the delusional content, and inclusion of bizarre delusions.DisclosureNo significant relationships.

Social Disorganization, Community Engagement, and Public High School Performance

This study examines whether community-level social disorganization and community engagement initiatives are associated with public high school performance. Analyzing data from the National Center for Education Statistics (NCES) School Attendance Boundary Survey (SABS), a latent variable measuring community-level social disorganization is examined within a structural equation model for 302 traditional public high schools in Florida. The study finds a statistically significant and large negative association between community-level social disorganization and a latent variable representing Florida Department of Education performance metrics. Correspondingly, the recognition of receiving the Florida Five Star School award for satisfying recommended community engagement criteria is positively associated with high school performance with social disorganization factors simultaneously considered. This research hopes to further provide an emphasis for recognizing and engaging community within the context of addressing disparities in public education performance.

Structural brain imaging abnormalities correlate with positive symptom in schizophrenia

Accumulating evidence indicates neuroanatomical mechanisms underlying positive symptoms in schizophrenia; however, the exact structural determinants of positive symptoms remain unclear. This study aimed to investigate associations between positive symptoms and structural brain changes, including alterations in grey matter (GM) volume and cortical thickness, in patients with first-episode schizophrenia (FES). This study included 44 patients with FES and 48 healthy controls (HCs). Clinical symptoms of patients were evaluated and individual-level GM volume and cortical thickness were assessed. Patients with FES showed reduced GM volume in the right superior temporal gyrus (STG) and increased cortical thickness in the left inferior segment of the circular sulcus of the insula (S_circular_insula_inf) compared with HCs. Increased thickness of the left S_circular_insula_inf correlated positively with positive symptoms in patients with FES. Exploratory correlation analysis found that increased thickness of the left S_circular_insula_inf correlated positively with conceptual disorganization and excitement symptoms, and the right STG GM volume correlated negatively with hallucinations. This study suggests that GM abnormalities in the STG and altered cortical thickness of the S_circular_insula_inf, which were detected at the early stage of schizophrenia, may underlie positive symptoms in patients with FES.

The Latent Structure of Child and Adolescent Psychopathology and its Association with Different Forms of Trauma and Suicidality and Self-Harm

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a multidimensional and hierarchical model of the latent structure of psychopathology. While HiTOP has received much support in child/adolescent community samples, fewer studies have assessed this model in clinical samples of children/adolescents. Here, we modelled the latent structure of 45 symptoms of psychopathology from a clinical sample of children/adolescents and assessed how dimensions of psychopathology were related to specific forms of trauma and suicidality/self-harm. Clinician-derived assessments were obtained from 507 people aged 7–18 years. Confirmatory factor analysis was used to determine the optimal fitting model, and structural equation modelling was used to estimate associations with trauma exposure and suicidality/self-harm. The best fitting model(s) included five first-order factors reflecting Fear, Distress, Externalizing, Thought Disorder, and Traumatic Stress, with a higher-order general factor (p) accounting for the covariation between these factors. Unique associations were identified between specific forms of trauma and each dimension of psychopathology. p was strongly associated with suicidality/self-harm, and of the first-order factors, Distress was most strongly associated with suicidality/self-harm. Findings support the predictions of HiTOP that the latent structure of child/adolescent psychopathology can be effectively described by a multidimensional and hierarchal model. Moreover, we found tentative evidence for a unique dimension of Traumatic Stress psychopathology. Our findings also highlight the unique associations between specific forms of early life trauma and specific dimensions of psychopathology, and the importance of Distress related psychopathology for suicidality/self-harm in children and adolescents.

Overview Of Schizophrenia: A Review Article

Schizophrenia is a chronic brain condition that affects roughly 1% of the world's population and causes delusions, hallucinations, disorganized speech, mental difficulties, and a lack of motivation while it is active. Despite the fact that treatment, especially drug therapy, has been widely used for nearly a century, there is no evidence that it has improved the majority of people with schizophrenia. Current adverse effects may be better if we view schizophrenia as a developmental disorder with psychosis as a stage of delayed illness. This ‘rethinking’ of schizophrenia as a neurodevelopment disorder, very different from the way we thought about illness in the last century, has great potential for prevention and treatment over the next two decades. Conclusion: Most people with schizophrenia benefit from a combination of antimicrobials and non-pharmacologic treatments designed for their specific needs. The provision of low-dose antipsychotic drugs, monitoring and resolving side effects, and providing clozapine if patients continue to have psychiatric symptoms are the norm for medical treatment. Several promising ways to improve outcomes in schizophrenia are being investigated, including glutamate-N-methyld-aspartate (NMDA) cascade drugs, which can help patients with chronic disease reduce persistent psychiatric symptoms, symptoms, and dementia.

The Form in Formal Thought Disorder: A Model of Dyssyntax in Semantic Networking

Formal thought disorder (FTD) is a clinical mental condition that is typically diagnosable by the speech productions of patients. However, this has been a vexing condition for the clinical community, as it is not at all easy to determine what “formal” means in the plethora of symptoms exhibited. We present a logic-based model for the syntax–semantics interface in semantic networking that can not only explain, but also diagnose, FTD. Our model is based on description logic (DL), which is well known for its adequacy to model terminological knowledge. More specifically, we show how faulty logical form as defined in DL-based Conception Language (CL) impacts the semantic content of linguistic productions that are characteristic of FTD. We accordingly call this the dyssyntax model.