Nosological Significance Research Articles

Folie à deux: contagious mental illness? Report of a clinical case

IntroductionFolie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system. However, folie à deux is still a matter of study and debate today as it remains a challenge for psychiatrists.ObjectivesThe aim of this article is to report a clinical case of folie à deux, between na inducer son and an induced mother. Review the nosological significance of folie à deux and to explore the disorder among patients with psychosis.MethodsSearch in the PubMed/MedLine and Medscape databases with the following key words: folie à deux; shared psychosis; shared delusion.ResultsWe presente a case of folie à deux between na inducer son 28 years old and the induced, his mother. They were found to be sharing similiar delusional beliefs. The patient has assumed the role of “man of the house” since his father’s death.ConclusionsMany years after it was first described, folie à deux is still an interesting and challenging disorder to psychiatrists. Its recognition and correct referral for a rare diagnosis, such as folie a deux, are extremely important.DisclosureNo significant relationships.

Modern Problems of Medical and Pharmacological Education

The primary task of this article was to identify key problems of medicine and outline ways to solve them optimally. An innovative intellectual approach to making medical diagnostic decisions is proposed. Levels of knowledge and didactic systems, their limitations are described. Methodologies and computerized technologies are defined as tools to overcome obstacles. Results: a series of didactic experiments were conducted to compare traditional and proposed innovative methods of diagnosis and vocational training. Evaluation of experiments demonstrates the significant benefits of innovation. The above problems can be successfully solved with the help of computerized diagnostics based on an algorithmic approach to evidence-based disease recognition and mass vocational training, mainly based on eLearning. The term “diagnosis” has two definitions: 1. Intellectual process of disease recognition; 2. Nosological significance - determining the nature of the case. To distinguish these values, we use two different terms: diagnosis - an intellectual process that leads to diagnosis; diagnosis - the result of diagnosis. Differential diagnostic algorithm (DDA) and DDA algorithmization is the step-by-step determination of operations to diagnose all diseases based on leading syndromes, main symptoms or signs, such as chest pain, fever, jaundice, round shadow on chest X-ray, etс [1]. E-learning, corporate e-learning. The term eLearning is a widely used word today. E-learning has its place in the lexicon of learning and education, but it will be a long time before the practice of eLearning becomes commonplace and widespread.

The Distinctiveness of Grief, Depression, and Posttraumatic Stress: Lessons From Children After 9/11.

The clinical and nosological significance of grief reactions in youth exposed to a shared trauma (9/11, the September 11, 2001 terrorist attacks on the United States) was tested by examining whether the predictors (ie, non-loss-related trauma versus traumatic bereavement), clinical correlates, factorial structure, and phenomenology of grief reactions are distinct from those of major depressive disorder (MDD) and 9/11-related posttraumatic stress disorder (PTSD). In a representative sample of New York City schoolchildren (N= 8,236; grades 4-12; n= 1,696 bereaved), assessed 6 months post-9/11, multivariate regressions examined predictors of grief, PTSD, and MDD, as well as the incremental validity of grief in predicting health problems and functional impairment. Factor analysis and latent class analysis determined, respectively, the factorial and the syndromic distinctiveness of grief, PTSD, and MDD. Four types of evidence supporting the distinctiveness of grief emerged. (1) Bereavement was associated with grief independently of PTSD and MDD, but not with PTSD and MDD after adjusting for grief; conversely, non-loss related trauma was associated primarily with PTSD. (2) Grief contributed uniquely to functional impairment. (3) Grief reactions loaded on a separate factor. (4) Youth with elevated grief reactions fell into two classes characterized by only moderate and negligible probability of co-occurring PTSD and MDD symptoms, respectively. A multifaceted approach provided convergent evidence that grief reactions are independent of other common types of postdisaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress. These findings suggest that grief reactions in traumatically bereaved youth merit separate clinical attention, informing tailored interventions.

Immunomodulatory effect of Celecoxib on HMGB1/TLR4 pathway in a recurrent seizures model in immature rats

Epileptic seizures constitute an important problem in pediatric neurology during the developmental period. The frequency and nosological significance of seizures, as well as their association with epileptogenesis, may be related to underlying mechanisms such as neuroinflammation. Those mechanisms of response activate inflammatory molecules induced in the neurons, activated glial cells and endothelial cells via the key HMGB1/TLR4 pathway. In this study, the drug celecoxib (CCX) was used as a blocker of the cyclooxygenase 2 (COX-2) and HMGB1/TLR-4 pathways. The experimental model was implemented in 10-day-old neonatal Sprague Dawley rats to induce recurrent seizures with kainic acid (KA, 1.4 mg/kg). Data were evaluated at early (14 PND) and late (30 PND) time points. The results showed that the CCX and CCX + pentobarbital (PB) groups exhibited a protective effect by significantly increasing the time latency of seizures compared to the KA group at both early (p < 0.01) and late (p < 0.001) times. When the CCX group was compared to the KA group, there was also a significant decrease in the number of HMGB1 and TLR-4 transcripts (p < 0.05) and in COX-2 protein expression (p < 0.05) in the most important areas for seizure generation (the hippocampus and cortex) at both the early and late time points. These results demonstrated that CCX treatment after epileptic seizures has a neuroprotective effect due to the inhibition of proinflammatory proteins and associated signaling pathways and reduces seizure susceptibility. Additionally, the timely intervention of inflammatory pathways will reduce the risk of developing epilepsy in adulthood.

A Contagious Disorder: Folie à Deux and Dementia.

Folie à deux is a clinical condition that was first described in 19th century. It is a psychotic disorder in which two closely associated individuals share a similar delusional system. The aim of this article is to review the nosological significance of folie à deux and to explore the disorder among patients with dementia. Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2017. Search terms used included dementia, folie à deux, induced delusional disorder, neurocognitive disorders, shared psychotic disorder. Publications found through this indexed search were reviewed for further relevant references. Cases of Folie à deux involving patients with dementia are reported quite infrequently. Most of the studies on the topic consist in case reports. Clinicians are obliged to treat the disorder. They should be alert to the potential high risk inherent this psychotic syndrome.

The Science of The Psychiatric Genomics Consortium (Part 2)

Overall Abstract On the advice of the Jerusalem organizers, the Psychiatric Genomics Consortium (PGC) is submitting two symposia which are meant to occur on the same afternoon. The PGC, now in its ninth year, is one of the most innovative experiments in the history of psychiatry. We have unified much of the field to enable rapid progress in elucidating the genetic basis of psychiatric disorders. We have 900+ investigators from 40+ countries and >400K subjects. The PGC has published 17 main papers plus 31 secondary analysis/methods development papers. Due to our open-source approach, there are 75+ papers that use PGC results, and numerous groups are using our findings to direct basic and applied research (including therapeutic development). Large amounts of new data will be available to the PGC in the next five years. We have developed a rigorous set of approaches that are yielding discoveries for all of the initial five disorders (which led to adding four new disorders). We thus have the unique opportunity to rapidly and efficiently increase our knowledge of common and rare variation in order to understand the causes and comorbidities of major psychiatric disorders. Our overarching goal is to identify “actionable” variation via the empirical evaluation of the etiological, clinical, nosological, therapeutic, and biological significance of our genomic findings. In Part 2, we provide more informationn about the current status and future plans for additional key PGC groups: OCD and TS (Knowles), PTSD (Liberzon), schizophrenia (O'Donovan), substance use disorders (Gelertner), pathway analysis (Breen), and cross-disorder findings (Smoller).

Reappraisal of the nosological significance of ALS-PDC mixed cases on Guam

Reappraisal of the nosological significance of ALS-PDC mixed cases on Guam

Mild cognitive impairment in adult: A neuropsychological review

Mild cognitive impairment (MCI) is associated with an increased risk of developing dementia. This is clinically relevant overt dementia can be prevented if treatment strategies are devised for MCI. Neuropsychological deficits in this condition are very common and are important clinically for treatment and outcomes. We aimed to review various neuropsychological deficits in MCI. Further, we have presented the current evidence for nosological status, neuroanatomical basis, and clinical outcome of this heterogeneous construct. All published papers on the topic of neuropsychological deficits in MCI on Medline and other databases were reviewed. A wide range of memory and executive function deficits are common in MCI patients. However, several studies are limited by either improper designs or inadequate sample sizes. Several neuropsychological impairments like memory function and executive functions can be diagnosed in MCI. The evidence base for the exact neuroanatomical basis of MCI is not robust yet. However, given the wide range of outcomes, controversies and debates exist regarding the nosological significance of the deficits. Hence, more studies are needed to specifically locate the impairments and further delineate the construct of MCI.

On the nosologic significance and competence of use of the term «Endometrioid disease»

The problem of endometriosis terminology is discussed in the paper; the nosologic significance, expediency, and competence of use of the term «endometrioid disease» is shown. Clinicopathologic parallels are drawn by the example of the most frequent organ localizations of that pathology — adenomyosis, ovarian endometriosis, and extragenital endometriosis; the community of some components of pathogenesis, determining the process progress, clinical presentations, morphological structure of heterotopias, and directions of morphogenesis are shown. Introduction of the term «endometrioid disease» into practice determines the possibility to optimize the clinical and morphological diagnostics of endometriosis taking into account the organ localization, stage of the process, morphofunctional form, and directions of morphogenesis, which is necessary to select the adequate method of treatment and personal prognosis

Different neural pathways to negative affect in youth with pediatric bipolar disorder and severe mood dysregulation

Questions persist regarding the presentation of bipolar disorder (BD) in youth and the nosological significance of irritability. Of particular interest is whether severe mood dysregulation (SMD), characterized by severe non-episodic irritability, hyper-arousal, and hyper-reactivity to negative emotional stimuli, is a developmental presentation of pediatric BD and, therefore, whether the two conditions are pathophysiologically similar. We administered the affective Posner paradigm, an attentional task with a condition involving blocked goal attainment via rigged feedback. The sample included 60 youth (20 BD, 20 SMD, and 20 controls) ages 8–17. Magnetoencephalography (MEG) examined neuronal activity (4–50 Hz) following negative versus positive feedback. We also examined reaction time (RT), response accuracy, and self-reported affect. Both BD and SMD youth reported being less happy than controls during the rigged condition. Also, SMD youth reported greater arousal following negative feedback than both BD and controls, and they responded to negative feedback with significantly greater activation of the anterior cingulate cortex (ACC) and medial frontal gyrus (MFG) than controls. Compared to SMD and controls, BD youth displayed greater superior frontal gyrus (SFG) activation and decreased insula activation following negative feedback. Data suggest a greater negative affective response to blocked goal attainment in SMD versus BD and control youth. This occurs in tandem with hyperactivation of medial frontal regions in SMD youth, while BD youth show dysfunction in the SFG and insula. Data add to a growing empirical base that differentiates pediatric BD and SMD and begin to elucidate potential neural mechanisms of irritability.

Video telemetry and behavioral analysis discriminate between compulsive cleaning and compulsive checking in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) patients exhibit compulsive acts that share key characteristics that discriminate them from normal behaviors. In OCD, factor analysis of symptomatology has identified separate clusters ( contamination/cleaning; harming/checking; symmetry/ordering; hoarding). Here we used video analysis of the motor characteristics of OCD compulsions derived from two separate clusters, checking and cleaning, in order to determine whether behavioral differences exist in the way these two compulsions are performed. We compared 22 behavioral components (acts) of 12 OC-cleaning rituals and 25 OC-checking rituals. A normal activity with the identical theme was matched for each OC ritual as a control. For each ritual and control, we measured 22 parameters (such as the duration and frequency of act performance), and the levels of functionality, by evaluating the degree to which the act appears to contribute toward achieving its goal. We found that both OC-cleaning and OC-checking rituals differed from their respective control activity, and that they also differ between themselves in seven out of the 22 parameters. OC-cleaning involved increased repetition of functional activity whereas OC-checking involved a relatively increased non-functional activity. These results suggest that OCD cleaning and checking rituals are sufficiently different to justify their division into different subtypes and presumably are sub-served by different mechanisms. A better understanding of the relationship between those behavioral parameters derived from video-telemetry, and the parameters assessed by means of clinical and neurobiological tools, would improve our understanding of the nosological significance of compulsive symptoms and contribute to advancing endophenotypic exploration of the heterogeneity of OCD.

P01-397 - Clinical relevance of self-disorders (Ich-Störungen) in schizophrenia: a review of studies on diagnosis, factor structure and outcome

ObjectiveThe notion of “Ich-Störungen” (self-disorders) depicts a major aspect of Kurt Schneider's concept of first rank symptoms of schizophrenia. Terms such as “passivity phenomena”, “delusions of alien control” and “ego pathology” have been used to characterise these phenomena once postulated to be pathognomonic for schizophrenia. The present review focuses on clinical studies examining the symptoms’ diagnostic and nosological implications.MethodsWe conducted a semi-structured literature review. 374 references were obtained using the key words “ego disorder/(psycho)pathology”, “thought insertion”, “alien control”, “passivity symptoms/phenomena/experiences”, “first rank symptoms”, “schneiderian” and “self disorders”. We distinguished two major fields of research:(1)neurobiological and neuropsychological studies based on phenomenological or neurocognitive paradigms;(2)studies on diagnosis and nosology (including assessment instruments and factor analyses), outcome and prognostic value.Of the studies on the second field, 83 have clinical relevance and are reviewed here.ResultsSeveral specific instruments with sound foundations in psychopathology have been developed for the assessment of self-disorders; however, they have rarely been included in research. Factor analyses have consistently shown a highly loaded factor consisting of self-disorders, in some studies distinct from other first-rank symptoms. There is contradictory data on outcome and prognosis.ConclusionsSelf-disorders remain ill-defined and inconsistently included into diagnostic criteria, and therefore lack nosological significance. Their clinical relevance has been insufficiently studied, although they have been consistently shown to form a highly specific factor within the schizophrenia symptom spectrum. The present review stresses the need for a global definition of self-disorders on the basis of phenomenology.

Structural Differences within Negative and Depressive Syndrome Dimensions in Schizophrenia, Organic Brain Disease, and Major Depression: A Confirmatory Factor Analysis of the Positive and Negative Syndrome Scale

Objective: The emerging dimensional approach to classification and treatment of psychiatric disorders calls for better understanding of diagnosis-related variations in psychiatric syndromes and for proper validation of psychometric scales used for the evaluation of those syndromes. This study tested the hypothesis that negative and depressive syndromes as measured by the Positive and Negative Syndrome Scale (PANSS) are consistent across different diagnoses. Method: We administered the PANSS to subjects with schizophrenia (n = 305), organic brain disease (OBD, n = 66) and major depressive disorder (MDD, n = 75). Confirmatory factor analysis (CFA) was used to establish if the PANSS items for negative symptoms and for depression fit the hypothesized factor structure and if the item factor loadings were similar among the diagnostic groups. Results: The negative and depressive symptom subscales fit well according to a variety of fit indexes for all groups individually after some modest model modification. However, multisample modeling procedures indicated that the pattern of factor loadings was significantly different among the groups in most cases. Conclusion: The results of this study indicate diagnosis-related variations in the negative and depressive syndrome dimensions in schizophrenia, OBD and MDD. These results also validate limited use of the PANSS for evaluation of negative and depressive syndromes in disorders other than schizophrenia. Larger studies are warranted to further evaluate clinical and nosologic significance of diagnostic categories, dimensions and structures of psychiatric syndromes.

Folie à Deux and shared psychotic disorder

Folie à deux (FAD) was first described in 19th century France. Since then, the concept has been elaborated, and several subtypes of FAD have been successively reported in France. In contrast, studies in German-speaking psychiatry mainly focused on the conceptual boundary between reactive/endogenous psychosis and etiological hypothesis (ie, psychogenesis vs genetic predisposition). In North America, Gralnick wrote a seminal review and redefined four subtypes of FAD by adopting the European classical concepts. More recently, "shared psychotic disorder" in DSM or "induced delusional disorder" in ICD-10 was branched off from FAD. However, several classical subcategories of FAD were not included in these recent definitions, the nosological significance of which should not be underestimated. We examined demographic data of FAD case reports published from the 19th to the 21st century and found that some of the earlier hypotheses, such as females being more susceptible, older and more intelligent individuals being more likely to be inducers, and sister-sister pairs being the most common relationship, were not supported. The controversial issue of the etiology of FAD-association of subjects or genetically driven psychosis-was re-examined in light of recent studies.

The nosological significance of Folie à Deux: a review of the literature

BackgroundFolie à Deux is a rare syndrome that has attracted much clinical attention. There is increasing doubt over the essence of the condition and the validity of the original description, such that it remains an elusive entity difficult to define.MethodWe conducted a systematic review of the literature of all cases reporting the phenomenon of Folie à Deux, from the years 1993–2005.Results64 cases were identified of which 42 met the inclusion criteria. The diagnoses in the primary and secondary were more heterogeneous than current diagnostic criteria suggest. There exists a high degree of similarity between the primary and secondary in terms of susceptibility to psychiatric illness, family and past psychiatric history, than previously thought.ConclusionFolie à Deux can occur in many situations outside the confines of the current classification systems and is not as rare as believed, and should alert the clinician to unrecognized psychiatric problems in the secondary.

Behavioral and Molecular Genetic Contributions to a Dimensional Classification of Personality Disorder

This article examines the possible contribution of behavioral and molecular genetic research to the development of a dimensional classification of personality disorder. It is argued that the results of molecular studies are too preliminary to have immediate nosological significance. However, behavioral genetic methods could play a useful role in constructing a classification that reflects the genetic architecture of personality disorder. It is also argued that the best approach to constructing a valid classification would be to integrate behavioral genetic methods with the construct validation framework used in test construction. An integrative approach is proposed that seeks to combine constructs from alternative dimensional models. It is suggested that strong evidence of a four-dimensional structure to personality disorder provides a way to organize a preliminary model. An initial set of primary traits to define these secondary domains would then be compiled from existing models and refined using a combination of traditional psychometric analyses and behavioral genetic methods. It is concluded that an etiologically based classification is feasible for the DSM-V.

Topical Review: The Neuronal Ceroid-Lipofuscinoses

The neuronal ceroid-lipofuscinoses, a group of progressive neurodegenerative diseases in children and in adults, have now been recognized for some 90 years, and the childhood forms represent one of the largest groups of progressive neurodegenerative diseases in children. Apart from a core group of major clinical forms-the infantile, the late-infantile, the juvenile, and the adult forms--numerous atypical patients afflicted with neuronal ceroid-lipofuscinosis have now been identified, constituting 10% to 20% of all patients with neuronal ceroid-lipofuscinosis. These "atypical" patients have, over the past 10 years, prompted the suggestion of 15 atypical variants or minor syndromes, many of them displaying the lipopigments of classic curvilinear and fingerprint ultrastructure, but others displaying granular osmiophilic deposits. The former lipopigments contain the subunit C of the mitochondrial adenosine triphosphate synthase, but lipopigments of the granular osmiophilic deposits including the classic infantile type Santavuori-Haltia, apparently do not, the latter type exhibiting sphingolipid activator proteins. The nosologic significance of both the subunit C of the adenosine triphosphate synthase and the sphingolipid activator proteins, although they make up a considerable amount of the crude auto-fluorescent lipopigments in neuronal ceroid-lipofuscinosis, is still unclear. In spite of numerous pathogenetic principles invoked, such as a defect in lipid peroxidation, abnormalities of dolichols and dolichol phosphates, and defects in protease inhibitors, precise pathogenesis and etiology of the neuronal ceroid-lipofuscinoses remain elusive. Recent promising molecular genetic studies have, however, revealed the gene for infantile neuronal ceroid-lipofuscinosis, CLN1, on chromosome 1p32; the gene for juvenile neuronal ceroid-lipofuscinosis, CLN3, on chromosome 16p12.1-11.2; and the gene for a Finnish variant of late-infantile neuronal ceroid-lipofuscinosis, CLN5, on chromosome 13q31-32. The genes for classic late-infantile neuronal ceroid-lipofuscinosis, CLN2, and for adult neuronal ceroid-lipofuscinosis, CLN4, have not been located, the former having been excluded from chromosomes 1 and 16. However, the gene products of the normal allelic forms have not yet been identified. A considerable number of sporadic animal models is now available, largely equivalent to the juvenile and infantile forms of neuronal ceroid-lipofuscinosis, with those of the English setter and the South Hampshire sheep evaluated best. Recently, several mouse models have been added to this list of autosomal-recessive models, again the one most thoroughly studied being the motor-neuron disease mouse. Progress has also been made in the prenatal diagnosis of neuronal ceroid-lipofuscinosis: now the infantile, late-infantile, and juvenile forms can be recognized prenatally by a combined genetic and electron microscopic approach.

Sleep disorders in the elderly: Depression and post-traumatic stress disorder

We report on two studies of sleep in the elderly. (1) One hundred and ninety-eight Spanish outpatients aged over 65 who met ICD-10 criteria for either a depressive episode, a recurrent, or a persistent mood disorder were compared with a matched population of depressives aged under 55. Factorial analysis and multiple regression showed that sleep complaints in the older group correlated less with severity of depression and had a less stable response to pharmacological treatment. (2) Post-traumatic stress disorder (PTSD) symptoms and sleep complaints were studied in 817 World War II veterans from Alsace-Lorraine who had been forcibly drafted into the Wehrmacht and subsequently detained as prisoners of war in Russia. The diagnosis of PTSD was associated with more severe wartime stressors and long internment. Eighty percent of respondants still report recurrent distressing dreams of wartime or captivity events after over 45 years. We analyzed sleep complaints in two elderly populations. Part one describes a Spanish study which compared the nosological significance and treatment response of sleep complaints in depressives aged over 65 or under 55. In part two, we study sleep complaints in former Alsatian prisoners of war (POWs) and analyze the influence of previous stressors and the aging process.

Nosological significance of retinopathies in neurodegenerative disorders with emphasis on Batten disease.

Nosological significance of retinopathies in neurodegenerative disorders with emphasis on Batten disease.

Fear of flying in agoraphobia and simple phobia: Distinguishing features

We conducted structured interviews with 17 agoraphobics and 17 simple phobics, all of whom were seeking behavioral treatment for fear of flying. Although all subjects had a flying phobia, the groups differed in their motivation for flight avoidance. In general, agoraphobics avoided flying because they feared having panic attacks while in flight, whereas simple phobics avoided flying because they feared crashing. Conversely, agoraphobics worried little about plane crashes, and simple phobics worried little about panic per se. These data support the retention of apprehension about panic as a diagnostic criterion for panic disorder in DSM-IV, and underscore the nosological significance of the fear of anxiety concept.