Delusional Disorder Research Articles

Towards the DSM-6: The Intersection of OCD and Psychosis: Expert Perspectives on Insight in the Diagnosis of OCD

In 1994, the DSM-IV added the specifier “with poor insight” to the diagnostic criteria of obsessive-compulsive disorder (OCD). The DSM-5 went one step further and now allows clinicians to diagnose OCD “with absent insight/delusional beliefs,” thereby blurring the long-standing distinction between OCD and psychosis. The present study surveyed OCD experts as to their opinions on the insight specifier and the future classification of OCD.The final sample comprised 60 experts, with a subgroup of 35 experts with verified identity and at least 6 years of clinical and/or research experience (“verified experts”).While most experts supported the inclusion of the insight specifier for OCD, verified experts were split on the question of whether, in the case of full absence of insight, a diagnosis of OCD should be accompanied by an additional diagnosis (e.g., delusional disorder). A relative majority of the full sample (48.3% yes vs. 36.7% no) and an absolute majority of verified experts (51.4% vs. 34.3%) recommended removing the term “delusional beliefs” as a specifier; most were concerned that including delusional beliefs as a symptom of OCD might foster the prescription of antipsychotics and skepticism about the efficacy of psychotherapy for OCD. An absolute majority (56.7% of full sample, 60.0% of verified experts) agreed that at least some doubt or partial insight into the excessiveness of one's obsessional beliefs should be present for a diagnosis of OCD. In addition, most experts opposed the reclassification of OCD as an anxiety disorder.Looking ahead to the development of the DSM-6, we recommend that (1) the criteria should emphasize that full absence of insight is rare in OCD and (2) the term “delusional beliefs” should be dropped.

Prosopagnosie et syndrome de Capgras : deux syndromes en miroir ?

First described in the 19th century in patients with brain lesions, prosopagnosia was named in 1947 by Joachim Bodamer (1910–1985), a German neuropsychiatrist. The term refers to the inability to recognise a familiar face, a rarely isolated symptom. Prosopagnosia is thought to result from brain lesions, predominantly at the ventral right temporo-occipital junction. There are more common cases of developmental prosopagnosia, where no lesion has been identified. Capgras syndrome (CS), described by Joseph Capgras (1873–1950), a psychiatrist, consists of the persistent belief that a close relative, identified, has been replaced by a look-alike. SC, considered a delusional disorder of identification or familiarity, has been described in chronic psychoses, mainly schizophrenia. It is also reported in the course of neurodegenerative diseases (mainly Alzheimer's disease, Lewy body dementia, Parkinson's dementia). Lesion-based forms have recently been described. Prosopagnosia and SC were initially thought to result from mirror-image lesions involving a single factor, one affecting an overt ventral circuit for face recognition (in the case of prosopagnosia), the other a covert dorsal circuit involved in emotional and vegetative responses (in the case of CS). Lesion network mapping has been used in both lesion-related conditions and suggests a more complex figure. Lesions causing prosopagnosia were correlated with one of the main regions associated with face recognition, the right fusiform face area, and anticorrelated with left frontal regions possibly involved in visual attentional control. In lesional forms of CS or other delusional misidentification syndromes, there was a correlation with left retrosplenial cortex, an area associated with familiarity processing, and a correlation with right frontal regions associated with belief evaluation. This finding supports the intervention of two factors in CS, one generating the impaired familiarity associated with perception and the other the genesis and persistence of a delusional idea. The debate on the mechanisms of CS is not settled, especially as it is limited to its lesional forms, but studies using lesion network mapping already mark a more general paradigm shift, with attention shifting from lesions (clinico-anatomical method) to circuit dysfunction.

Having paid work 1 year after disability claim in different types of mental and behavioural disorders

Abstract Background The majority of claimants diagnosed with a mental and/or behavioral disorder have residual work capacity, however, the chance of actual (return to) work after a disability claim assessment may differ within this diagnosis group depending on the specific type of disease. The aim of this study is to examine the associations of different mental and behavioural diseases with having paid employment one year after the claim assessment. Methods This longitudinal register based cohort study included all work disability applicants with mental and behavioural disorders assessed with residual work capacity in the Netherlands in 2016. Data were derived from the Dutch Social Security Institute (UWV) and were linked to register data on paid employment. ICD codes were used to categorize 11 disease groups (mental retardation, autism spectrum disorders, ADHD, somatoform disorders, adjustment disorders, PTSS, anxiety, personality disorders, mood affective disorders, addictions and delusional disorders. Multivariable logistic regression analyses were conducted separately for applicants who work and not work at time of the claim assessment. Results A total of 8544 claimants (mean age 45, 56% female; n = 1915 work at baseline) were included. In the working group being diagnosed with ADHD (OR 3.05, CI 1.08-8.61) or PTSS (OR 1.45, CI 1.04-2.02) was associated with paid work, and adjustment disorder was negatively associated (OR 0.74, CI 0.56-0.97). In the not-working group, autism spectrum disorder (OR 1.51, CI 1.02-2.22), personality disorder (OR 1.36, CI 1.02-1.81) and addiction (OR 1.94, CI 1.32-2.86) was associated with return to work, and somatoform (OR 0.51, CI 0.31-0.84) disorders and mood affective disorders (OR 0.83, CI 0.70-0.99) were negatively associated. Conclusions The findings of this study show different associations between type of mental and behavioural disease groups and paid employment one year after the claim assessment. Key messages • The association of either remaining at work or return to work is different among mental and behavioural diagnosis groups, therefore a different approach is indicated. • Active interventions to facilitate return to or remain at work might be indicated in specific diagnosis groups.

Substance use and lifestyle risk factors for somatic disorders among psychiatric patients in Greenland

ABSTRACT Patients with psychotic disorders exhibit elevated mortality and morbidity rates compared to the general population primarily due to comorbid somatic diseases. This study aims to describe the prevalence of selected risk factors and somatic disorders among psychiatric patients with a diagnosis of psychotic disorder. Material and methods: Data were retrieved from Greenland’s nationwide electronic medical record. The study population consists of 104 patients diagnosed with a psychotic disorder, encompassing schizophrenia or schizotypal and delusional disorders, residing in Nuuk. The study population comprised 104 patients (68 males and 36 females) with a mean age of 40 years. More than 80% were daily smokers, and 68% had harmful use of cannabis. More than half had dyslipidemia (any imbalance in lipids), while over a quarter were classified as obese with body mass index of 30 kg/m2 or higher. Eighteen percent had hypertension, and six percent suffered from diabetes. This study revealed a notable prevalence of risk factors for somatic diseases, particularly smoking and cannabis use among patients with schizophrenia in Nuuk, indicating that a high prevalence of somatic diseases might be expected as the population gets older and the risk of developing somatic diseases becomes greater. Increased focus on monitoring and preventing those as part of the health care is recommended.

Prevalence of schizophrenia spectrum disorders in the Lazio region, Italy: use of an algorithm based on health administrative databases

BackgroundMental healthcare provision is undergoing substantial reconfiguration in many regions of the world. Such changes require a broad, evidence-based approach incorporating epidemiological data and information on local needs. The objective of this study was to estimate the prevalence of schizophrenia spectrum disorders (SSD) in the Lazio region and its geographical distribution using regional administrative healthcare databases.MethodsCases of SSD (15–64 years old) were identified using an algorithm based on data from the hospital discharge registry (ICD IX CM: 295, 297, 298 [excl. 298.0], 299) and the ticket exemption database [code 044], between 2006 and 2019. We calculated crude, age- and gender-specific prevalence estimates on December 31, 2019. We also calculated age- and gender-adjusted prevalence to compare prevalence in different regional areas.ResultsWe identified 18,371 cases. The overall prevalence was 5.03 per 1000 population (95% CI 4.96–5.10). Age-adjusted prevalence estimates were 4.18 (95% CI 4.09–4.27) per 1000 for women and 5.92 (95% CI 5.81–6.04) per 1000 for men. The prevalence was higher among older age groups, in both genders. There were differences in prevalence within the region, ranging from 4.25/1000 in the province of Viterbo to 5.42/1000 in Rome and 6.02/1000 in the province of Frosinone. When we analysed the subcategories of SSD, the three most frequent conditions were schizophrenia, schizoaffective disorder, and psychosis NOS. In general, the prevalence was higher in men for all the conditions but delusional disorders and brief psychosis.ConclusionsOur results show that the overall prevalence of SSD among adults in the Lazio region is similar to those published in previous reviews, but an uneven regional distribution was observed. While possible underestimation must be considered, administrative databases represent a valuable source of information for epidemiological surveillance and healthcare planning.

Underlying cerebrovascular pathology causing secondary psychosis

Case Background Psychosis can be classified as primary if it is caused by a psychiatric disorder or secondary if it is due to a specific medical condition. Despite there being multiple identified causes of secondary psychosis, making such a diagnosis can prove challenging. Case Details This case report presents a 57-year-old male who was brought by ambulance to the emergency department following an intentional jump from a first story window due to visual and auditory hallucinations and persecutory paranoid delusions. MRI findings on admission were consistent with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The patient’s background included an ischaemic stroke with haemorrhagic transformation five years previously. He experienced psychotic symptoms during the immediate recovery period. Prior to this he had no psychiatric history. Discussion Post-stroke psychosis and the condition of CADASIL are both entities that are relatively rarely described in the literature. However, this may be due to missed diagnosis and therefore not reflective of true prevalence. Conclusion Identifying a cause-effect relationship and establishing a diagnosis of secondary psychosis can be confounded by many factors. Nevertheless, this patient’s case demonstrates the importance of considering an underlying cause, particularly when the presentation is atypical and there is a temporal relationship between the proposed medical condition and the symptoms of psychosis. Patient Consent Obtained: Yes

A combined tropical medicine and psychiatry approach to patients with possible delusional infestation.

Delusional infestation (DI) is a well-recognized delusional disorder presenting as the persisting belief of being infested. Combined clinics have been run by dermatology and psychiatry in a small number of centres. In this article we focus on our Liverpool University Hospitals NHS Foundation Trust clinic hosted at the Liverpool School of Tropical Medicine, UK, where we run a specialist clinic for DI. We describe the specific set-up and approach of our clinic as a guide for clinicians working in specialties likely to see patients with DI (including tropical medicine, infectious diseases and dermatology) who may either want to set up similar clinics or be better equipped to manage DI patients promptly within existing practice. We describe the details of the clinic's approach. Between 2018 and 2023, the service saw 208 patients, of which 82.7% could be assessed and 55.7% had DI. The female:male ratio was 2:1. Interdisciplinary combined clinics with medical and psychiatry consultants working together offer an approach to managing this rare, challenging and high-consequence condition.

Interictal psychosis of epilepsy: What is the role of the neurologist?

Psychotic disorders are more frequent in people with epilepsy than the general population. They constitute one of the most serious psychiatric comorbidities which require an immediate psychopharmacologic intervention. Yet, access to psychiatrists is often limited or not available and the neurologists taking care of these patients are called-upon to start treatment with antipsychotic medication. The purpose of this manuscript is to provide clinicians with pragmatic psychopharmacologic strategies to treat interictal psychotic disorders in patients with epilepsy. We review the case of a 45 years-old man with a 35-year history of treatment-resistant focal epilepsy of bitemporal origin who developed a de-novo psychotic episode that began with insomnia, mood lability and agitation and evolved into paranoid delusions, auditory hallucinations and a thought disorder. The patient was diagnosed with an interictal psychotic episode and was treated with aripiprazole which resulted in significant improvement after reaching a 20 mg /day dose and allowed for the patient to be discharged home. In summary, interictal psychotic episodes of epilepsy are relatively frequent in patients with epilepsy and require of an early psychopharmacologic treatment to facilitate their remission or stabilization until mental health professionals can take over their long-term care. Compared to primary psychotic disorders, interictal psychotic episodes respond better and at lower doses of antipsychotic drugs.

Team case formulation for challenging behaviour on acute psychiatric wards

Due to the high prevalence of challenging behaviours on acute psychiatric wards, there is a need for more therapeutic interventions that utilize psychological theory to support staff and patients. This study assessed feasibility, effectiveness and mechanisms of multidisciplinary team case formulation to reduce challenging behaviours of patients. This was a cohort study with a pre‐ and post‐formulation analysis of patients from five acute wards. Structured team case formulation sessions were held using an integrative psychological model incorporating cognitive behavioural principles and the Newcastle model. Staff attendance and fidelity to formulation components were recorded. Frequency of staff-rated challenging behaviours and the frequency of incidents of violence and self‐harm pre‐ and one‐week post‐formulation were assessed. To test mechanisms, changes in staff perceptions of the overall frequency of challenging behaviours and the number of incidents of violence and self‐harm were compared to the number of strategies identified, the number of strategies implemented, and the number of staff present. Participants (N = 50) had a range of serious mental health conditions, including 50% with F20???F29 schizophrenia, schizotypal and delusional disorder. Fidelity to formulation model components was found to be high. There was a significant decrease in staff perception of the frequency of patients’ challenging behaviours, with large effect sizes. There was strong evidence of a reduction in the number of violent incidents and self‐harm post‐case formulation. None of the mechanism tests were significant. Case formulation sessions appear to be a feasible and effective intervention to reduce challenging behaviours within acute inpatient care.

An Exploratory Study of Cognitive Distortions and Psychosis among Meth-Amphetamine Users

This research aims at studying the cognitive distortions and psychosis among the meth-amphetamine users. This study was exploratory in nature and qualitative research design was used. The sample size of this study was N = 19 meth-amphetamine users who were residing in different rehabilitation centers of Islamabad/Rawalpindi and convenient sampling technique was used. Semi-structured interviews were conducted and then the thematic analysis was used to analyze the data. The results of the analysis indicates that there is a strong association between cognitive distortions and psychotic symptoms. The results also highlighted that the most common type of cognitive distortions includes all or nothing thinking, mental filtering, and catastrophizing. This study has shown that hallucinations and paranoid delusions can cause significant harm to their day-to-day functioning as well as to their quality of life. The research highlight the critical role that social and emotional support plays in mitigating the impact of cognitive distortions on mental illness. The results of this study highlights the need of comprehensive intervention techniques which will target both the cognitive and psychosocial levels in the treatment of addiction to prevent the relapse rate.

Relations between changes in safety behavior, paranoid ideations, cognitive biases, and clinical characteristics of patients with a psychotic disorder over time

BackgroundSafety behaviors, both positive (maladaptive coping behavior) and negative (avoidance behavior), are used by people with paranoid delusions to avoid perceived threats. Safety behaviors contribute to the persistence of paranoid delusions by preventing disconfirmation of threat beliefs and may influence other psychiatric symptoms. This study investigated how changes in safety behaviors are related to changes in paranoid ideation, social anxiety, depression, cognitive biases and self-esteem over time. MethodsThis study included 116 patients diagnosed with a psychotic disorder (DSM-IV) and at least moderate levels of paranoid ideations (GTPS >40).The data were collected as part of a multi-center randomized controlled trial where patients were randomized to VR-CBT (n = 58) or treatment as usual (TAU; n = 58). Assessments were completed at baseline (T0), after three months (T3) and after six months (T6). For all variables, change scores between T0 and T3 and T3 and T6 were calculated and Pearson correlations between change scores were computed. ResultsA decrease in total safety behavior was related to diminished paranoid ideation, social anxiety, and depression. No significant temporal associations were found between changes in safety behavior and changes in cognitive biases and self-esteem. Similar but less robust results were found for respectively negative safety behavior and positive safety behavior. ConclusionDropping safety behavior can be specifically targeted in behavioral interventions. Whereas there appears to be a relation with reduction in anxiety, paranoia, and depressive symptoms, changes in safety behavior do not seem to align with changes in cognitive thinking processes.

My Analyst Has Dementia, I Might Need a Donut

ABSTRACT This paper explores a ten-year analytic relationship through the lens of analyst as patient dealing with love and loss. The patient is witness to her analyst’s mind succumbing to dementia. The vault of encrypted memory, containing the years of work, is under attack. Juxtaposing moments of dementia madness are shared space connected to significant expansion of mind and emotional experience. This experience challenges all framework of psychoanalytic work, and yet it doesn’t. Psychoanalysis espouses giving patients: meaning, vitality, sturdiness, and an expansive emotional range of experiences. This analytic work accomplished these features and more. But, what does it mean to be held in mind when the analyst mind has been highjacked by a paranoid delusion momentarily? Moreover, delusions of persecution reflect profound fear and anxiety with the loss of the ability to tell what’s real and what’s not. Delusions are a common feature of dementia. Delusions are often triggered by memory loss connected to simple things like losing one’s keys. My lived story of personal transformation lives among the mind field of sporadic delusions sometimes expressed by my analyst’s mind. What happens to psychoanalytic work when the vault of the analyst mind is compromised by dementia?

Dangerous Intersection of Alcoholism and Othello Syndrome: A Comprehensive Review of Delusional Jealousy and Treatment Strategies.

The modern pace of life, increased susceptibility to stressors, and easy access to psychoactive substances have contributed to the increase in the number of people addicted to alcohol. Alcoholism has serious and life-threatening consequences, one of which is brain damage causing morbid jealousy, otherwise known as Othello syndrome. The disease, currently classified as a subtype of delusional disorder, manifests itself in groundless and dangerous judgments about a partner's sexual infidelity. People with Othello syndrome constantly believe in their partner's infidelity despite inadequate evidence of it. Patients become aggressive toward their partners as well as themselves, which is why in a fit of anger they can commit murder or suicide. Othello syndrome can occur as a symptom of an underlying mental illness, but it is most often associated with brain damage caused by chronic alcohol use. Antipsychotic drugs and serotonin reuptake inhibitors are used in pharmacotherapy. Targeted treatment using the neuropeptide oxytocin, which modulates the transmitter systems responsible for disease symptoms, is also being considered. The use of oxytocin seems groundbreaking, but it remains at the research stage. The treatment of addictions and primary diseases, as well as long-term cognitive-analytic psychotherapy, also have a huge impact. Othello syndrome is a life-threatening disease with an insidious course and serious consequences. This article aims to review the manifestations of morbid jealousy, including delusional disorder, and the association with alcoholism.

Cognitive Function in Patients with Psychotic and Affective Disorders: Effects of Combining Pharmacotherapy with Cognitive Remediation.

Background: Cognitive impairment is a relevant problem in psychiatry and can be well assessed with a cross-diagnostic test such as the Screen for Cognitive Impairment in Psychiatry (SCIP). The aim of our pilot study is to assess cognitive impairment in acute psychiatric inpatients diagnosed with psychotic disorders, bipolar disorder and depression using the German version of the SCIP (SCIP-G). We also investigate whether cognitive dysfunction improves over the course of the inpatient treatment, where patients are offered a combination of pharmacological treatment and cognitive remediation. Methods: A total of 143 adult inpatients were included in the study. Cognitive testing was performed using two different forms of the SCIP-G. All patients received state-of-the-art pharmacotherapy and cognitive remediation using the COGPACK® software package version 6.06. Results: Based on the ICD-10 Criteria for Research, 54 patients were given an F2 diagnosis (schizophrenia and schizotypal and delusional disorders). Thirty-nine patients met the criteria for bipolar disorder (F30 and F31) and fifty for depression (F32 and F33). At baseline, a significant difference was observed between the SCIP total scores of the F2 and F32/33 patients (p < 0.001) and between the F2 and F30/31 groups (p = 0.022). At the second measurement time point, the SCIP total score showed significant improvement in all three groups (p < 0.001), and there was no statistically significant interaction between SCIP total score and diagnostic groups (p = 0.860). Conclusions: Cognitive dysfunction is present in psychiatric disorders and can be easily assessed during an inpatient hospital stay. In our sample, patients with a psychotic disorder were more cognitively impaired at baseline than patients with an affective disorder. Inpatient treatment, consisting of pharmacotherapy and cognitive remediation, improved cognitive deficits. Patients with psychotic disorders, bipolar disorder and depression showed similar improvements in cognitive performance.

Reduction of Psychosis Proneness in a Daycare Hospital Program for Patients with Severe Alcohol Use Disorder

Objectives Anxiety and depressive symptoms, as well as cognitive dysfunctions, improve with abstinence in individuals with alcohol use disorders (AUD), but less is known about psychotic features. The objective of this study was to evaluate the psychosis proneness in a sample of individuals with severe AUD and potential changes after alcohol withdrawal. Method An observational study was conducted, assessing prospectively Peter’s Delusional Inventory scale (PDI); anxiety and depression symptoms by MADRS and cognitive functioning by the MoCA at entry in daycare hospital (D0) and after 30 days (D30). Individuals with schizophrenia, chronic delusional disorder and bipolar disorder were excluded. Wilcoxon tests were used to evaluate the evolution between D0 and D30, and linear regressions were conducted to test the association between delta PDI and the variables that could be potential confounders. Results Forty individuals (72% males) with a mean age of 50 ± 9 years old and AUD evolved for 15 ± 11 years were included. After one month, PDI score decreased significantly (p = .001), and several biological and clinical parameters improved significantly with abstinence or consumption reduction: GGT (p = .003), MoCA (p < .001), MADRS (p = .047). Conclusion We observed a decrease in delusional thinking along abstinence and/or consumption reduction. To our knowledge, this is the first research to study psychosis proneness evolution in patients with severe AUD. Replications are required in independent samples with larger sample size.

Mood Disorders in Schizotypal Disorder with Leading Syndrome of Eating Disorders

Background: сoverage of the problem of mood disorders in patients with schizotypal disorder with leading eating disorders (EDs), in childhood and adolescence is relevant. However, concomitant disorders in eating disorder in childhood and adolescence and their dynamics have not been sufficiently studied. The aim: to study the clinical and psychopathological structure of mood disorders in patients with schizotypal disorder and eating disorders leading in the clinical picture. Patients and methods: the study included 50 patients (9 boys, 41 girls), aged 7 to 16 years. Inclusion criteria: 1) schizotypal disorder; 2) eating disorders; 3) mood disorders. Research methods: clinical-psychopathological, psychometric (HDRS, PANSS), follow-up, somatic observation. Results: in patients with schizotypal and mood disorders, the following variants of eating disorder were observed: anorexia nervosa (AN — first type), anorexia nervosa with dominance of bulimia (ANB — second type), anorexia nervosa with dominance of bulimia and vomitomania (ANB + B — third type). Mood disorders in the first type of eating disorder were characterized by a pronounced depressive triad, suicidal thoughts and stupor at the cachectic stage of the disease. Mood disorders in the second type of eating disorder were characterized by a mixed affective state: short unproductive mania, ideas of dysmorphophobia, ideas of attitude, followed by a prolonged depressive state with senesto-hypochondriacal disorders, asthenia, and an increase in cognitive impairment. Mood disorders in the third type of eating disorder were characterized by the presence, of pronounced delusional and dysmorphophobic disorders and ideas of attitude, psychopathic behavior, depersonalization-derealization disorders, asthenia and cognitive impairment. Affective pathology in schizotypal disorder with eating disorder, as well as body dysmorphic syndrome, persisted for a long time. The most severe course was observed in the third group of patients (NANB + B), which was due to a significant proportion of psychotic disorders in the structure of the syndrome and somatic complications due to vomiting behavior. Conclusions: patients with schizotypal disorder with leading symptoms of eating disorder and mood disorders require an integrated approach to therapy, including somatic and psychopharmacological treatment.

Antipsychotic use in a large community sample of patients with delusional disorder

BackgroundTo examine clinical and sociodemographic differences between patients with delusional disorder; with and without diagnoses of an additional severe mental disorder (SMD) or cognitive impairment. MethodsPopulation-based study including all individuals diagnosed with DD between 2005 and 2021 from a large catchment area in Madrid, Spain. Sociodemographic and clinical characteristics and the antipsychotic prescription patterns of the study population was described. Patients were divided into (i) patients with DD and no additional diagnosis of SMD or cognitive impairment (DD group), (ii) patients with DD and a diagnosis of an additional SMD (DD-SMD group), and (iii) patients with DD and cognitive impairment (DD-CI group). ResultsOf 1109 patients with a DD diagnosis (62.5 % female), 131 (11.8 %) patients were diagnosed with an additional SMD, and 69 (6.2 %) were diagnosed with cognitive impairment. DD-SMD patients were on average 10 years younger and had longer time between first mental healthcare contact and DD disorder than DD patients. DD-CI patients were on average 10 years older and had a higher proportion of females. Paliperidone (21.9 %) and aripiprazole (20.6 %) were the modal antipsychotic drugs chosen overall. DD-SMD patients were more likely to receive paliperidone and to be prescribed long-acting injectable medication; DD-CI were more likely to receive risperidone or quetiapine; and DD patients were more likely to receive olanzapine. ConclusionsSociodemographic and clinical characteristics and choice of antipsychotic drug and delivery method for individuals with DD vary based on its comorbidity.

Prevalence and determinants of post-stroke psychosis in Aswan: a prospective study

BackgroundPost-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. This nested case–control study included 2,624 acute stroke patients from a university hospital between May 2017 and April 2022. Patients who developed PSP within 6 months post-stroke were identified as cases (n = 108), and 119 patients without PSP were randomly selected as controls. Comprehensive assessments included clinical, laboratory, and imaging evaluations at baseline. After 6 months, follow-up evaluations were conducted, including neurological examinations, psychiatric assessments, and stroke severity assessments using the Barthel index (BI). The psychiatric assessments included the Hamilton Depression Rating Scale for depression and the Mini-Mental State Examination for cognitive status.ResultsThe prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (≤ 5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. Non-specified psychosis and delusional disorder were the most common psychosis subtypes. There was a significantly higher percentage of excellent patients in the non-PSP group compared to those who had PSP regarding the observed improvement in the patient's condition. Also, there is a higher percentage of deteriorated patients in the PSP group (46.6%) compared to another group (18.9%) regarding BI.ConclusionPSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors.

Homoeopathy for the Management of Delusional Disorder: A Case Report

Abstract Introduction Delusions, a core symptom of psychosis, are false beliefs that are rigidly held with strong conviction despite contradictory evidence. Persistent delusions if held for more than 1 month lead to the diagnosis of delusional disorder (DD) as per the Diagnostic and Statistical Manual of Mental Disorders-5. Very sparse literature is available evaluating the utility of individualised homoeopathic medicine in this condition. Materials and Methods A 60-year-old man presenting with symptoms of DD was treated during the period of February 2020 to February 2021. Individualised homoeopathic medicine was prescribed. Outcomes were assessed using Psychotic Symptom Rating Scales. Modified Naranjo Criteria was used to assess whether the changes were likely to be associated with the homoeopathic intervention. Results A beneficial result was obtained from Individualised homoeopathic treatment. Conclusion Even though this is a single case report, the recovery of the patient from the suspiciousness is remarkable and there is no relapse of the symptoms. The patient's family life is peaceful now and he was able to rejoin his job.

Frequency of Methamphetamine Use in Patients Admitted to an Addiction Center and Clinical Factors Associated With Methamphetamine Use

We aimed to determine the frequency of methamphetamine (METH) use and the clinical factors associated with METH use. Face-to-face interviews were conducted with 788 patients who applied to an addiction treatment center in Turkey. Patients diagnosed with primary psychotic disorder and/or bipolar disorder were excluded from the study. It was found that 48.9% of patients ( n = 385) used METH, and 24.4% of them ( n = 94) used it every day. Visual hallucinations were present in 34.3% of METH users, auditory hallucinations in 38.2%, paranoid delusions in 55.6%, and agitation in 39.7%. Additionally, 40.8% of patients had spontaneous skin wounds unrelated to scratching after METH use. Oral mucosa and dental lesions (METH mouth) were detected in 37.1% of patients. The incidence of these conditions increased with the frequency of METH use ( p &lt; .001 for all). Regression analysis revealed that the use of pregabalin and poly-substance use independently predicted METH use.