Gustatory Hallucinations Research Articles

Dissociation as a Mediator Between Childhood Abuse and Hallucinations: An Exploratory Investigation Using Dissociative Identity Disorder and Schizophrenia Spectrum Disorders

ABSTRACT Previous research has shown that the relationship between childhood abuse and the presence of auditory hallucinations is mediated by dissociation, specifically depersonalization and absorption. The current study assessed dissociation as a mediator of the relationship between childhood abuse and auditory hallucination frequency, characteristics and associated distress in those with dissociative identity disorder (DID; n = 50) and schizophrenia spectrum disorders (SSD; n = 49). It also tested whether dissociation mediated the relationship between childhood abuse and the presence of non-auditory hallucinations. Participants completed measures of childhood abuse, dissociation, auditory hallucination frequency, characteristics, distress, and non-auditory hallucinations. With distress associated with auditory hallucinations as the outcome, depersonalization was a mediator in the DID group. For non-auditory hallucinations, in the DID group depersonalization and amnesia were mediators between childhood abuse and the presence of visual, tactile and olfactory hallucinations. In the SSD group absorption mediated between childhood abuse and visual, olfactory and gustatory hallucinations. Results suggest that the presence of non-auditory hallucinations in DID and SSD are associated with different dissociative experiences.

Frequency and Determinants of Olfactory Hallucinations in Parkinson's Disease Patients.

Background: Olfactory dysfunctions and hallucinations are considered common nonmotor symptoms in Parkinson’s disease (PD). Visual and auditory hallucinations are well-known; however, olfactory hallucinations (OHs) are not fully investigated. The aim of this study was to evaluate OHs in PD patients, and their correlation to motor impairment, cognitive abilities, visual and auditory hallucinations, and olfactory and gustatory function. Methods: A sample of 273 patients was enrolled: 141 PD patients (mean age ± SD: 70.1 ± 9.5 years) and 132 healthy controls (mean age ± SD: 69.4 ± 9.6 years). In all patients, the following parameters were evaluated: motor symptoms (UPDRS-III), olfactory function, cognitive abilities, and occurrence of OH, gustatory hallucinations (GHs), and visual/auditory hallucinations. Results: OHs were found only in PD patients with a percentage of 11.3%. Among PD patients with OHs, 2.8% also presented GHs. High significant frequencies of females, the presence of visual/auditory hallucinations, and a high mean UPDRS-III score were found in patients with OHs related to patients without them. Binary logistic regression evidenced the presence of visual/auditory hallucinations and sex as main variables predicting the presence of OHs. Conclusions: Our data indicated that OHs occur frequently in PD patients, especially in women, and often concomitant with visual and auditory hallucinations, without any association with olfactory impairment.

Bridging the Gap between Neurology and Psychiatry- Psychiatric Symptoms in the course of Neurodegenerative Disorders

It is increasingly recognized that there is significant heterogeneity in phenotype and clinical trajectories in Alzheimer's disease as well as Lewy Body and Vascular dementia. Relatively common neurodegenerative disorder, Lewy Body Dementia (LBD) presents with psychiatric features. Mood disorders are common and often precede core symptoms of LBD. Patient with LBD especially early in the course of disease are at increased risk for suicide. Psychosis is one of the most debilitating symptoms of LBD as it is an independent risk factor for nursing home placements, increased caregiver distress and mortality. Visual hallucinations are the most common psychotic manifestation in LBD. Auditory, olfactory, tactile and gustatory hallucinations and delusions are less frequently found. Global cognitive deficits including attention, frontal executive dysfunction, visuospatial abnormalities, language and verbal memory were associated with the presence of psychosis in Lewy Body Dementia. Glucocerebrosidase gene (GBA) mutations and polymorphisms found to be associated with LBD. Up to 25% of Alzheimer's disease (AD) cases do not show the typical neuropathology. Subtypes and atypical non-amnestic AD presentations have been formalized in the International Working Group (IWG) clinical diagnosis criteria. Frontal signs and symptoms are often seen in Alzheimer's disease especially in patients with early onset. In those clinical situations differential diagnosis especially distunguising between Clinical diagnosis of atypical AD has significantly been improved by the availability of biomarkers, including cerebrospinal fluid levels of Aβ42, total tau and phosphorylated tau181. MRI volumetric estimation of hippocampal and medial temporal atrophy, and amyloid brain PET imaging. We will review atypical forms of AD from these varied perspectives to help improve diagnostic confidence among clinicians. Cerebral amyloid angiopathy (CAA) is a highly prevalent pathologic finding in the elderly contributing to cognitive loss, neuropsychiatric symptoms and morbidity. It is characterized by predominantly vascular deposition of beta amyloid protein Its prevalence varies across different populations. Initially conceptualized as vascular dementia syndrome CAA was proved to overlap with AD pathology and is thought to affect over 80% of AD patients. Lobar intracerebral hemorrhage and infarction are the well-known striking clinical manifestations, but CAA has multiple other clinical phenotypes: Inflammatory disease in the form of vasculitis known as amyloid beta related angiitis (ABRA) and inflammatory leukoencephalopathy, also known as CAA related inflammation (CAA-RI). Due to multiple clinical phenotypes CAA remains clinically underdiagnosed and underreported especially in elderly with dementia and other psychiatric symptoms. The underlying pathophysiological mechanism for the spectrum of CAA will be discussed.

457 - VERY LATE-ONSET SCHIZOPHRENIA-LIKE PSYCHOSIS… A DIAGNOSTIC DILEMMA…

Background:The nosology and etiological underpinnings of very late -onset schizophrenia-like psychosis (VLOSLP) have remained controversial. This case report highlights its diagnostic complexity.Case report:A 64-year-old woman, with a previous history of hypertension, diabetes, mild cognitive decline, right grade-4 hemiparesis as sequelae of an ischemic-stroke (three years before), started persecutory and partition delusions. After six months, the delusions were accompanied by complex visual hallucinations (scenic, lilliputian and holocampine), elementary auditory, tactile, olfactory, and gustatory hallucinations, causing a profound daily life impact, consequently she was hospitalized. Neither negative symptoms nor formal thought disorders were present. Electroencephalography and laboratorial evaluations were unremarkable (including thyroid function, folic acid, cyanocobalamin, infectious serologies and anti-gliadin/transglutaminase antibodies). Neuroimaging displayed subcortical microvascular lesions in the left centrum semiovale, bilateral thalamic and basal ganglia lacunes. Neuropsychological examination revealed mild/moderate impairment in working-memory, sustained-attention, executive functions, abstract thinking, and visuospatial abilities. Mini-mental state examination (MMSE) scored 20/30. Clozapine was started. As psychotic symptoms ameliorated cognitive deficits also improved (MMSE score: 25/30). She was discharged with residual symptoms.Discussion:Late-life psychosis implies a thorough investigation, bringing about challenges in diagnosis. Several medical causes, including neuroinflammatory/immunologic, were ruled out. This two-stage progression, with partition delusions and multimodal hallucinations, in the absence of formal thought disorder and negative symptoms is typical of VLOSP. It is arguable to ascribe our patient’s psychosis to a previous vascular dementia or to VLOSLP. Almost half of VLOSLP patients may develop dementia. It is still debatable whether this propensity is a true characteristic of VLOPSL or reflects an initial misdiagnosis. Some neuropathological studies suggest a restricted limbic tauopathy underlying VLOSP. Notwithstanding, cognitive impairment is common in VLOSLP, including in those patients who do not develop dementia. Neuroimaging studies evidence that lacunar infarction in the basal ganglia alongside chronic white matter small vessels ischemic disease, may underlie the pathophysiology of psychosis via a disruption in the frontal-subcortical pathways. Nevertheless, cases of post-stroke psychosis usually resolve in few months. In conclusion, the neurobiological underpinnings of VLOSLP are complex and multifaceted. More systematized studies using biomarkers and neuroimaging are needed so clinicians can perform a more accurate diagnosis of VLOSLP.

BRIDGING THE GAP BETWEEN NEUROLOGY AND PSYCHIATRY- PSYCHIATRIC SYMPTOMS IN THE COURSE OF NEURODEGENERATIVE DISORDERS

It is increasingly recognized that there is significant heterogeneity in phenotype and clinical trajectories in Alzheimer's disease as well as Lewy Body and Vascular dementia. Relatively common neurodegenerative disorder, Lewy Body Dementia (LBD) presents with psychiatric features. Mood disorders are common and often precede core symptoms of LBD. Patient with LBD especially early in the course of disease are at increased risk for suicide. Psychosis is one of the most debilitating symptoms of LBD as it is an independent risk factor for nursing home placements, increased caregiver distress and mortality. Visual hallucinations are the most common psychotic manifestation in LBD. Auditory, olfactory, tactile and gustatory hallucinations and delusions are less frequently found. Global cognitive deficits including attention, frontal executive dysfunction, visuospatial abnormalities, language and verbal memory were associated with the presence of psychosis in Lewy Body Dementia. Glucocerebrosidase gene (GBA) mutations and polymorphisms found to be associated with LBD. Up to 25% of Alzheimer's disease (AD) cases do not show the typical neuropathology. Subtypes and atypical non-amnestic AD presentations have been formalized in the International Working Group (IWG) clinical diagnosis criteria. Frontal signs and symptoms are often seen in Alzheimer's disease especially in patients with early onset. In those clinical situations differential diagnosis especially distunguising between Clinical diagnosis of atypical AD has significantly been improved by the availability of biomarkers, including cerebrospinal fluid levels of Aβ42, total tau and phosphorylated tau181. MRI volumetric estimation of hippocampal and medial temporal atrophy, and amyloid brain PET imaging. We will review atypical forms of AD from these varied perspectives to help improve diagnostic confidence among clinicians. Cerebral amyloid angiopathy (CAA) is a highly prevalent pathologic finding in the elderly contributing to cognitive loss, neuropsychiatric symptoms and morbidity. It is characterized by predominantly vascular deposition of beta amyloid protein Its prevalence varies across different populations. Initially conceptualized as vascular dementia syndrome CAA was proved to overlap with AD pathology and is thought to affect over 80% of AD patients. Lobar intracerebral hemorrhage and infarction are the well-known striking clinical manifestations, but CAA has multiple other clinical phenotypes: Inflammatory disease in the form of vasculitis known as amyloid beta related angiitis (ABRA) and inflammatory leukoencephalopathy, also known as CAA related inflammation (CAA-RI). Due to multiple clinical phenotypes CAA remains clinically underdiagnosed and underreported especially in elderly with dementia and other psychiatric symptoms. The underlying pathophysiological mechanism for the spectrum of CAA will be discussed

Features of schizophrenia following premorbid eating disorders

ObjectiveEating disorders (ED) and schizophrenia are frequently comorbid and schizophrenia shares genetic susceptibility with anorexia. Many factors associated with schizophrenia can disrupt eating, but ED can present years before schizophrenia. If premorbid ED distinguishes a particular subtype of schizophrenia, then phenotypic features may differ between schizophrenia cases with and without premorbid ED. MethodThis secondary analysis used data from an inpatient schizophrenia research study that comprehensively assessed life course psychiatric disorders (DIGS interview), intelligence (WAIS), global assessments of function (GAF) and assessed symptoms during medication-free and fixed dose neuroleptic phases (PANSS). ResultsPremorbid ED was identified in 27 of the 288 schizophrenia cases (9.4%). This group had more females than the group without premorbid ED (74.1% vs. 30%); premorbid ED was 5-fold more common in female than male cases (χ2 (17.9, P < .0001). Only the premorbid ED group had gustatory hallucinations. They also demonstrated significantly more severe psychotic and disorganization symptoms during medication-free and fixed dose treatment phases, despite similar negative symptoms and GAF scores, as other cases. The premorbid ED group had significantly better cognition overall, but relatively lower nonverbal than verbal intelligence. DiscussionPremorbid ED may define a specific subtype of schizophrenia that is common in females. Their more severe psychotic symptoms and better IQ, despite similarly impaired function and negative symptoms as other cases, suggests a distinct pathophysiology. Premorbid ED should be considered in evaluating risk states for schizophrenia, and as a relevant phenotype for treatment resistant schizophrenia.

F155. Negative Content and Distress Across Hallucination Sensory Modalities

Evidence suggests that auditory hallucinations (AH) in clinical samples are predominantly negative in content. Whether this extends to visual (VH), tactile (TH), olfactory (OH), and gustatory (GH) hallucinations is unknown. Consistently negative content across modalities may indicate a common mechanism. To address this, we compared the degree of negative content and distress between hallucinations across sensory modalities.

Visual hallucinations associated with multimodal hallucinations, suicide attempts and morbidity of illness in psychotic disorders

BackgroundVisual hallucinations (VH) are a common, but understudied symptom of psychosis, experienced by individuals across diagnostic categories of psychotic and neuropsychiatric conditions. There are limited data on VH and associated clinical phenotypes in adult idiopathic psychotic disorders, which are needed to elucidate their relevance to psychotic illness paradigms. MethodIn this cross-sectional study, we examined clinical risk factors for VH in a well-characterized sample of 766 patients with adult psychotic disorders across diagnostic categories of schizophrenia (n = 227), schizoaffective disorder (n = 210), and bipolar I disorder (n = 329). The Structured Clinical Interview for DSM-IV-TR was used for diagnosis and symptom measurements. ResultsThe prevalence of VH was 26.1% (200/766). Multivariate logistic regression showed that VH were independently associated with the presence of hallucinations in other modalities, including auditory, tactile, olfactory, and gustatory hallucinations. History of a suicide attempt and catatonic behavior were also associated with VH. In addition, specific delusions were associated with VH, in particular, delusions of control, and religious, erotomanic and jealousy delusions. Diagnosis, negative symptoms, and family history of psychosis were not independent predictors of VH. ConclusionsResults showed the clinical and disease relevance of VH as they were associated with severe morbidity of illness, including suicide attempts and catatonic behavior. Findings also suggest a phenotype associated with hallucinations in other modalities and specific types of delusions. Based on our findings, VH may be a significant factor in assessing for suicidality and illness severity, warranting clinical attention and further study of underlying mechanisms.

BRIDGING THE GAP BETWEEN NEUROLOGY AND PSYCHIATRY-ATYPICAL PRESENTATION OF COMMON NEURODEGENERATIVE DISORDERS: Session 418

It is increasingly recognized that there is significant heterogeneity in phenotype and clinical trajectories both in Alzheimer's as well as in Parkinson's disease. Up to 25% of Alzheimer's disease (AD) cases do not show the typical neuropathology. Recently subtypes and atypical non-amnestic AD presentations have been formalized in the International Working Group (IWG) clinical diagnosis criteria. Clinical diagnosis of atypical AD has significantly been improved by the availability of biomarkers, including cerebrospinal fluid levels of Aβ42, total tau (t-tau) and phosphorylated tau181 (p-tau), MRI volumetric estimation of hippocampal and medial temporal atrophy, and amyloid brain PET imaging. We will review the typical and atypical forms of AD from these varied perspectives to help improve diagnostic confidence among clinicians. Special attention will be given to language variant of Alzheimer's disease. A predominant deficit in the language domain is a key feature of primary progressive aphasia but language impairment is commonly present in Alzheimer's disease. International diagnostic criteria for PPA and its three variants (agrammatic, logopenic, semantic) were published relatively recently in 2011. Since then, studies have investigated the validity of these criteria in classifying patients which includes clinical symptoms, neurocognitive presentations, distinct MRI signatures, and neuropathological differences. In this session, we will review the subtypes of PPA using the above parameters to assist clinicians in diagnosis of these conditions. Special attention will be given of logopenic PPA a syndrome frequently seen in atypical Alzheimer's disease. Another common neurodegenerative disorder, Parkinson's disease (PD) conceptualized as predominantly movement disorder presents with myriad of atypical features predominantly psychiatric in nature. Psychosis is one of the most debilitating symptoms of PD, as it is an independent risk factor for nursing home placements, increased caregiver distress and mortality. Visual hallucinations are the most common psychotic manifestation in PD. Auditory, olfactory, tactile and gustatory hallucinations are infrequently found and usually coexist with visual ones. Delusions occur in about 5% of Parkinson's disease patients. Cognitive correlates of hallucinations and delusions appear to be different in PD. They may have distinct pathogenic mechanisms and possibly anatomical substrates. Global cognitive deficits including attention, frontal executive dysfunction, visuospatial abnormalities, language and verbal memory were associated with the presence of hallucinations in Parkinson's disease, but did not correlate with the presence of delusions. APOE and glucocerebrosidase gene (GBA) mutations and polymorphisms found to be associated with a distinct cognitive profile of changes characterized by greater impairment in working memory/executive function and visuospatial abilities in PD patients. During this session new findings on pathognomonic, cognitive and genetic correlates of psychosis in PD will be presented.

Recorded atypical hallucinations in psychotic and affective disorders and associations with non-benzodiazepine hypnotic use: the South London and Maudsley Case Register

ObjectivesHallucinations are present in many conditions, notably psychosis. Although under-researched, atypical hallucinations, such as tactile, olfactory and gustatory (TOGHs), may arise secondary to hypnotic drug use, particularly non-benzodiazepine hypnotics (‘Z drugs’). This retrospective case-control study investigated the frequency of TOGHs and their associations with prior Z drug use in a large mental healthcare database.MethodsTOGHs were ascertained in 2014 using a bespoke natural language processing algorithm and were analysed against covariates (including use of Z drugs, demographic factors, diagnosis, disorder severity and other psychotropic medications) ascertained prior to 2014.ResultsIn 43 339 patients with International Classification of Diseases, Tenth Edition schizophreniform or affective disorder diagnoses, 324 (0.75%) had any TOGH recorded (0.54% tactile, 0.24% olfactory, 0.06% gustatory hallucinations). TOGHs were associated with male gender, black ethnicity, schizophreniform diagnosis and higher disorder severity on Health of the National Outcome Scales. In fully adjusted models, tactile and olfactory hallucinations remained independently associated with prior mention of Z drugs (ORs 1.86 and 1.60, respectively).ConclusionsWe successfully developed a natural language processing algorithm to identify instances of TOGHs in the clinical record. TOGHs overall, tactile and olfactory hallucinations were shown to be associated with prior mention of Z drugs. This may have implications for the diagnosis and treatment of patients with comorbid sleep and psychiatric conditions.

Comprehensive identification of delusions and olfactory, tactile, gustatory, and minor hallucinations in Parkinson's disease psychosis

IntroductionPsychotic symptoms are underdiagnosed in Parkinson's disease (PD), and there is a need for a comprehensive PD psychosis rating scale. MethodsCross-sectional analysis of 199 consecutive PD outpatients. After a routine clinical visit that included the Unified Parkinson's Disease Rating Scale (UPDRS) and Non-Motor Symptoms Questionnaire (NMS-Quest), subjects completed the enhanced Scale for the Assessment of Positive Symptoms in PD (eSAPS-PD), a structured clinical interview that included the standard SAPS-PD with additional prompts for delusions and olfactory, gustatory, and minor hallucinations. Based on the combined results of these assessments, subjects were categorized as having major psychotic symptoms (hallucinations or delusions; PDP-major), isolated minor psychotic symptoms (passage hallucinations, presence hallucinations, or illusions; PDP-minor), or no psychotic symptoms (PD-controls). ResultsWe identified 58 subjects (29%) with psychotic symptoms, including 28 (14%) with major psychotic symptoms and 30 (15%) with isolated minor psychotic symptoms. Hallucinations were present in 56 subjects (28%); most commonly visual (24%, of which 21% were minor only), followed by olfactory (6%), tactile (4%), auditory (2%), and gustatory (1%). The eSAPS-PD detected psychotic symptoms in more subjects (n = 55, 28%) than all other assessments combined (clinical visit, UPDRS part 1, and NMS-Quest) (n = 22, 11%). Compared with PD-controls, PDP-minor subjects had a higher burden of other non-motor symptoms on the Non-Motor Symptoms Scale (37 [27–51] vs. 18 [9–36], p < 0.001) and lower quality of life scores on the PD Quality of Life Questionnaire (138 [125–151] vs. 149 [137–165], p = 0.01). ConclusionThe eSAPS-PD can markedly improve detection of psychotic symptoms in PD.

Comprehensive Identification of Delusions and Olfactory, Tactile, Gustatory, and Minor Hallucinations in Parkinson’s Disease Psychosis (P5.001)

Comprehensive Identification of Delusions and Olfactory, Tactile, Gustatory, and Minor Hallucinations in Parkinson’s Disease Psychosis (P5.001)

Associations between nonauditory hallucinations, dissociation, and childhood adversity in first-episode psychosis

ABSTRACTAlthough repeated associations have been found between adversity exposure (particularly exposure to childhood sexual abuse), dissociation, and auditory hallucinations in the context of psychosis, there is little comparable research examining hallucinations in other modalities. This study aimed to determine whether cumulative adversity exposure influences the likelihood of experiencing visual, tactile, olfactory, and gustatory hallucinations among psychosis patients and whether measures of dissociation are significantly associated with nonauditory hallucinations when exposure to childhood adversity and psychological distress are adjusted for. Self-report measures and a retrospective case-control design were applied to assess nonauditory hallucinations, dissociation, psychological distress, and childhood adversity exposure in a sample of first-episode psychosis patients reporting nonauditory hallucinations (n = 36) and controls from the same clinical population without nonauditory hallucinations (n = 31). Case participants reported higher levels of dissociation, psychological distress, and exposure to childhood rape than the control group. Dissociation remained significantly associated with nonauditory hallucinations when we adjusted for childhood sexual abuse, other types of childhood adversity, and a combined measure of emotional distress. Indication of a dose–response relationship was detected, in that total number of adversities was significantly associated with reporting more than one modality of nonauditory hallucination. Observed associations between auditory hallucinations and dissociation in psychosis may extend to other hallucination modalities. It is suggested that more research attention be paid to the etiology and impact of nonauditory hallucinations in psychosis samples.

Sympathomimetic syndrome, choreoathetosis, and acute kidney injury following “bath salts” injection

"Bath salts" is a well known street drug which can cause several cardiovascular and neuropsychiatric symptoms. However, only one case of acute kidney injury has been reported in the literature. We present a case with sympathomimetic syndrome, choreoathetosis, gustatory and olfactory hallucinations, and acute kidney injury following the use of bath salts. A 37-year-old man with past medical history of hypertension and depression was brought to the emergency center with body shaking. Three days before admission he injected 3 doses of bath salts intravenously and felt eye pain with blurry vision followed by a metallic taste, strange smells, profuse sweating, and body shaking. At presentation he had a sympathomimetic syndrome including high blood pressure, tachycardia, tachypnea, and hyperhydrosis with choreoathetotic movements. Laboratory testing revealed leukocytosis and acute kidney injury with a BUN of 95 mg/ dL and a creatinine of 15.2 mg/dL. Creatine kinase was 4,457 IU/dL. Urine drug screen is negative for amphetamine, cannabinoids, and cocaine; blood alcohol level was zero. During his ICU stay he became disoriented and agitated. Supportive treatment with 7.2 liters of intravenous fluid over 3 days, haloperidol, and lorazepam gradually improved his symptoms and his renal failure. Bath salts contain 3,4-methylenedioxypyrovalerone, a psychoactive norepinephrine and dopamine reuptake inhibitor. Choreoathetosis in this patient could be explained through dopaminergic effect of bath salts or uremic encephalopathy. The mechanism for acute kidney injury from bath salts may involve direct drug effects though norepinephrine and dopamine-induced vasoconstriction (renal ischemia), rhabdomyolysis, hyperthermia, and/or volume contraction.

Is there anything distinctive about epileptic déjà vu?

BackgroundDéjà vu can occur as an aura of temporal lobe epilepsy and in some psychiatric conditions but is also common in the general population. It is unclear whether any clinical...

P11 Unusual case of transient epileptic amnesia

Introduction This case report of Transient Epileptic Amnesia (TEA) is presented due to the prolonged nature of the amnestic episodes, the significant delay to the correct diagnosis and the various diagnoses given to the patient in the meantime. Method Patient case presentation: Over a 34-month period a 62-year-old woman was seen in three different health settings before a correct diagnosis was provided. She experienced a total of nine episodes of transient amnesia (frequency: every 3–4 months; duration: 10 days; precipitant: stress and fatigue; occurrence: on waking from a “deep sleep”; precedent: gustatory hallucination; memory disturbance: partial anterograde amnesia, and retrograde amnesia for past events). Over the 3 years, she was given the following diagnoses by different clinicians of Transient Global Amnesia (TGA), Psychogenic Amnesia and then TEA. Following this, she received treatment with anti-epileptic drugs, which terminated any further episodes. Discussion Attacks usually last between 20 min to 60 min. However, in this case it was 10 days, which may be due to ongoing seizure activity or persistent post-ictal dysfunction of memory related brain structures. It took up to three times longer than the median time to diagnosis of 12 months for the correct diagnosis to be made. This may be due to the investigations being carried out inter-ictally, and the standard neuropsychological tests lacking sufficient sensitive to identify subtle memory disturbances. Conclusion The importance of correctly diagnosing the condition are: (1) Effective treatment. (2) Under-diagnosed. (3) Patients are always distressed by them, fearing the onset of dementia.

179 A delayed diagnosis of mistaken mitosis

Mitotic errors during early embryonal cell cleavage result in somatic cells having different genotypes. Such somatic mosaicism, in the presence of a chromosomal or genetic disorder, generally results in a...

Clinical and Cognitive Correlates of Psychiatric Comorbidity in Delusional Disorder Outpatients

The aims of this study were to investigate the prevalence, as well as the clinical, cognitive, and functional correlates of psychiatric comorbidity in patients with delusional disorder (DD). Eighty-six outpatients with DSM-IV DD were evaluated for psychiatric comorbidity on Axis I disorders using the Mini International Neuropsychiatry Interview (MINI). The following instruments were administered: the Standardized Assessment of Personality (SAP), the Positive and Negative Symptom Scale (PANSS), the Montgomery-Asberg Depression Rating Scale (MADRS), a neuropsychological battery (consisting of measures for attention, verbal and working memory, and executive functions), the Sheehan Disability Inventory (SDI), and the Global Assessment of Functioning (GAF) scale. A socio-demographic and clinical questionnaire was also completed. Forty-six percent of the subjects had at least one additional lifetime psychiatric diagnosis, the most common being depressive disorders (N = 16, 32.6%), followed by anxiety disorders (N = 8, 14%). DD with comorbid Axis I disorders (N = 40, 46.5%) was associated with a specific syndromic constellation (more common cluster C personality psychopathology, somatic delusions, olfactory and gustatory hallucinations, and suicide risk), and greater severity of the psychopathology, particularly as regards emotional dysregulation (total and general PANSS scales, MADRS, and perceived stress SDI scoring). In contrast, DD without psychiatric comorbidity - "pure" DD - (N = 46, 53.5%) was associated with worse overall neurocognitive performance, mainly in working memory. There were no differences in functionality between the two groups (as per the GAF and SDI total, work, social and family life disability scores). Our findings reveal one type of DD with associated psychiatric comorbidity with greater emotion-related psychopathology and another "pure" DD, without psychiatric comorbidity, related to worse global cognitive functioning. Treatment for DD should address both types of processes.

Olfactory and Gustatory Hallucinations Presenting as Partial Status Epilepticus Because of Glioblastoma Multiforme

Olfactory and gustatory hallucinations are not often encountered in the acute care setting but may represent the subtle presenting features of a significant underlying disease process. We describe a patient whose most striking presenting symptoms were of olfactory and gustatory hallucinations and in whom the diagnosis and treatment of a new brain tumor and partial status epilepticus occurred entirely in the emergency department. The lesion was subsequently identified as glioblastoma multiforme involving the hippocampus and amygdala.

Tactile, Olfactory, and Gustatory Hallucinations in Psychotic Disorders: A Descriptive Study

Hallucinations are a common feature of psychotic illness and occur across diagnoses. While auditory and visual hallucinations are known to represent common features of psychosis, tactile, olfactory, and gustatory hallucinations (TOGHs) are often believed to be rare in primary psychotic illness. The present study examined hallucinations across sensory modalities in patients with primary psychotic disorders by diagnosis and in association with mood and psychotic symptoms. In this descriptive study we examined diagnostic and symptom data from a large cohort of patients with schizophrenia (n = 133), schizoaffective disorder (n = 101), or bipolar I disorder (n = 186). TOGHs were common (20% of the total sample), and occurred across all diagnostic categories, although at different rates by diagnosis. TOGHs were correlated with each other and with other hallucinations, and were associated with specific clinical features such as somatic delusions, delusions of control, thought broadcasting, earlier age at onset, and a lifetime history of depressive episodes. In the present sample, hallucinations in all modalities occurred in patients across diagnoses suggesting that no one type of hallucinatory experience is pathognomonic to any given diagnosis. Additionally, TOGHs were present in patients across diagnostic groups are were associated with specific symptoms and earlier age of onset. Implications for clinical practice and clinical and neurobiological research are discussed.