Delusional Disorder Research Articles

Psychiatric in-patient care in England: as safe as it can be? An examination of in-patient suicide between 2009 and 2020.

Psychiatric in-patients have a greatly elevated risk of suicide. We aimed to examine trends in in-patient suicide rates and determine if characteristics of in-patients who died by suicide have changed over time. We identified all in-patients in England who died by suicide between 2009 and 2020 from the National Confidential Inquiry into Suicide and Safety in Mental Health. Suicide rates were calculated using data from Hospital Episodes Statistics. The rate of in-patient suicide per 100 000 bed days fell by 41.9% between 2009-2011 and 2018-2020. However, since 2016 the rate has remained static with no significant fall. Rates fell in men, those aged 30-59, and those with schizophrenia and other delusional disorders or personality disorder. Rates also fell for suicide by hanging (including hanging on the ward) and jumping. No falls were seen in suicide rates among women, younger and older age groups, and those with affective disorder. There was no indication of a transfer of risk to the post-discharge period or to home treatment/crisis care. More in-patients in the latter part of the study were aged under 25, were on authorised leave, and had psychiatric comorbidity. In-patient suicide has significantly fallen since 2009, suggesting patient safety may have improved. The recent slowdown in the fall in rates, however, highlights that renewed preventative efforts are needed. These should include a greater focus on women, younger and older patients, and those with affective disorder. Careful reviews prior to granting leave are important to ensure a safe transition into the community.

Emergency care for psychogenic paranoids in modern environment

The work presents data on the main modern variants of reactive paranoids. Clinical manifestations, differential diagnostic criteria, features of the dynamics, modern approaches to treatment of this pathology are described. The possibility of distinguishing modern variants of psychogenic paranoids is emphasized, taking into account the existing pathomorphosis of manifestations of this pathology. Currently, the most common forms are paranoids of attitude, persecution, litigious, somatogenic-reactive, induced, deprivation variants of psychogenic delusions. The patterns for the development of delusional psychogenic disorders are presented. The manifestations of attitude and persecution paranoid are described, with emphasis on the reflection of psychotraumatic experiences in patients’ statements and behavior. When considering litigious reactive psychosis, the importance of paranoid personality traits is emphasized, which contribute to the formation of a “struggle for justice” with a psychotic interpretation of real events. Information is given about the emergence of a relatively new variant of somatogenic-reactive paranoid in patients with combat injuries. Psychogenic deprivation hallucinosis with paranoid interpretation of experiences in premorbidly healthy individuals is described. Differential diagnosis of reactive paranoids and similar pathology is carried out. A special place is given to emergency care for psychomotor agitation of patients with the need to comply with the requirements of current legislation in psychiatry. Recommendations are given for further treatment of patients after relief of acute conditions, with the need to add psychocorrective measures to restore mental health.

The exogenous model of psychotic experience induced by novel psychoactive substances: A clinical overview

The previous two decades have been marked by profound societal transformations, including ongoing developments in the illegal drug market and the emergence of numerous novel psychoactive substances. Nevertheless, a comprehensive understanding of the diverse clinical presentations of psychopathological conditions, particularly within the domain of psychotic symptoms, remains deficient. In this clinical overview, our aim is to provide a detailed analysis of the psychotic manifestations induced by various substances. Exogenous psychoses may present with visual hallucinations, delusional perceptions, and paranoid ideation, frequently accompanied by an ego-dystonic experience that deviate from an individual's customary self-identity. Variations in the presentation of symptoms are also influenced by the specific pharmacological pathways with which the substance interacts. Visual hallucinations characterized by vivid colours and associated with positive or negative emotional experiences are most frequently linked to the serotonergic pathway. Paranoid ideation and auditory hallucinations are primarily associated with the dopaminergic pathways. Dissociative responses, often characterized by feelings of derealization and somatopsychic depersonalization, are typically elicited through glutamatergic pathways. Lastly, the endocannabinoid pathways are associated with anxiety-related psychosis-like states, ideas of reference, grandiose delusions, and paranoid delusions.

Weight change following diagnosis with psychosis: a retrospective cohort study in Greater Manchester, UK

IntroductionWeight gain in the months/years after diagnosis/treatment of severe enduring mental illness (SMI) is a major predictor of future diabetes, dysmetabolic profile and increased risk of cardiometabolic diseases. There is limited data on the longer-term profile of weight change in people with a history of SMI and how this may differ between individuals. We here report a retrospective study on weight change over the 5 years following an SMI diagnosis in Greater Manchester UK, an ethnically and culturally diverse community, with particular focus on comparing non-affective psychosis (NAP) vs affective psychosis (AP) diagnoses.MethodsWe undertook an anonymised search in the Greater Manchester Care Record (GMCR). We reviewed the health records of anyone who had been diagnosed for the first time with first episode psychosis, schizophrenia, schizoaffective disorder, delusional disorder (non-affective psychosis = NAP) or affective psychosis (AP). We analysed body mass index (BMI) change in the 5-year period following the first prescription of antipsychotic medication. All individuals had taken an antipsychotic agent for at least 3 months. The 5-year follow-up point was anywhere between 2003 and 2023.ResultsWe identified 9125 people with the diagnoses above. NAP (n = 5618; 37.3% female) mean age 49.9 years; AP (n = 4131; 60.5% female) mean age 48.7 years. 27.0% of NAP were of non-White ethnicity vs 17.8% of AP individuals. A higher proportion of people diagnosed with NAP were in the highest quintile of social disadvantage 52.4% vs 39.5% for AP. There were no significant differences in baseline BMI profile. In a subsample with HbA1c data (n = 2103), mean HbA1c was higher in NAP at baseline (40.4 mmol/mol in NAP vs 36.7 mmol/mol for AP). At 5-year follow-up, there was similarity in both the overall % of individuals in the obese ≥ 30 kg/m2 category (39.8% NAP vs 39.7% AP), and % progressing from a normal healthy BMI transitioned to obese/overweight BMI (53.6% of NAP vs 55.6% with AP). 43.7% of those NAP with normal BMI remained at a healthy BMI vs 42.7% with AP. At 5-year follow-up for NAP, 83.1% of those with BMI ≥ 30 kg/m2 stayed in this category vs 81.5% of AP.ConclusionThe results of this real-world longitudinal cohort study suggest that the changes in BMI with treatment of non-affective psychosis vs bipolar disorder are not significantly different, while 43% maintain a healthy weight in the first 5 years following antipsychotic prescription.

Clinical and Psychopathological Features of Late-Onset Schizophrenia and Schizophrenia-Like Psychosis

Background: schizophrenia-like psychosis with very late onset is one of the most common diagnostic group in late age mental disorders exclude dementia and depression with psychotic symptoms [1]. Geriatric psychiatrists discuss its similarity to neurodegenerative diseases and risk of dementia development in the outcome of disease. The aim was to study the clinical and psychopathological features of very late manifesting schizophrenia and schizophrenia-like psychoses and their impact on the course of the disease. Patients and methods: 45 patients were observed, the mean age was 70.6 ± 8.70 years. Patients were diagnosed with schizophrenia, schizoaffective disorder, chronic delusional disorder and schizophrenia-like disorder, with onset after 60 years. Psychopathological and psychometric (PANSS, CDSS, HAMD, MoCA, MMSE) methods were used. Assessment was performed at the 0 day and at the 28th day from the beginning of the treatment. Results: heterogeneity and different short-terms outcomes of acute psychosis were described depending on the clinical characteristics and predominant syndrome complex. In 15 cases (33 %) prevailed severe polymorphic psychotic symptoms of mental disorganization with formation of negative symptoms and cognitive impairment with decreasing social and daily activity. In 22 cases (49 %) dominated paranoid symptoms with old age persecutory delusions with formation of residual positive and negative symptoms. In 8 cases (18 %) prevailed affective and delusional symptoms. This group was characterized with high level of reduction of productive symptoms and restoration of premorbid social and daily activity. Conclusions: features of clinical characteristics, including the nature and severity of cognitive impairment at the onset of disease, are significant for prognosis and outcomes of disease. The data obtained could be served for the development of personalized therapeutic approaches that take into account the syndromic features and course of late-onset psychosis.

Predictors of Discharge from Hospital to Supported Accommodation and Support Needs Once in Supported Accommodation for People with Serious Mental Illness in Scotland: A Linked National Dataset Study

Background. Many individuals with serious mental illness live in supported accommodation. Decisions regarding type of supported accommodation required and level of support to meet individual’s needs are crucial for continuing rehabilitation and recovery following admission to hospital. This study aimed to identify personal and contextual predictive factors for (1) discharge from hospital to different levels of supported accommodation and (2) self‐directed support needs of individuals with serious mental illness once they are in supported accommodation in Scotland. Method. Linked data from the Scottish Morbidity Record‐Scottish Mental Health and Inpatient Day Case Section and the Scottish Government Social Care Survey were analysed using multinomial regression and multivariable logistic regression to identify personal and contextual factors associated with accommodation destination at the time of discharge and four self‐directed support needs: personal care; domestic care; healthcare; and social, educational, and recreational. Results. Personal factors (age and having a diagnosis of schizophrenia, schizotypal, or delusional disorder) were associated with individuals moving to supported accommodation with higher levels of support. One contextual factor, compulsory detention when admitted to hospital, decreased the likelihood of moving to any type of supported accommodation. The personal and contextual factors associated with identified self‐directed support needs varied by need. Support provided by the local authority was associated with all self‐directed support needs, with having a diagnosis of schizophrenia, schizotypal, or delusional disorder associated with identifying domestic care, healthcare, and social, educational, and recreational needs, while living in the most deprived areas was associated with identifying healthcare needs. Advancing age and being compulsorily detained decreased the likelihood of identifying social, educational, and recreational needs. Conclusion. The study highlights that older men with a diagnosis of schizophrenia, schizotypal, or delusional disorder require higher levels of support upon discharge from hospital. When living in supported accommodation, having this diagnosis increases the likelihood of identifying support with looking after the home, looking after their health, and social and recreational activities; however, being older decreases the likelihood of identifying support with social and recreational activities.

Female body-corporeal as both the aetiological site and the site of resistance: Conceptualizing manic depression in Jerry Pinto's Em and the BigHoom

The hegemonic discourse of normalcy perpetuates unfavourable portrayals of mental illness; it distorts our understanding of the sufferer's existential and affective experiences. However, mental illness is a multifaceted phenomenon; it necessitates a holistic understanding of how an individual's identity and personhood are emplaced at the intersection of the diverse sociocultural conditions. The article conceptualizes manic depression as a complex interplay of the corporeal, cognitive, and cultural factors in Jerry Pinto's critically acclaimed contemporary novel Em and the Big Hoom (2012). Jerry Pinto is a Mumbai-based Goanese Indian author who embarks on exploring the intricacies of psychological vulnerabilities and draws heavily from his personal experiences to write poignant, humane and empathetic stories. Em and the Big Hoom documents the narrator's reminiscences of his late mother, Em or Imelda's experiences of mood swings, paranoid delusions, freakish breakdowns, and psychiatric treatments. It scrutinizes extracts of Em's diary notes, letters, and past conversations to exhibit how a woman succumbs to abjection due to socio-cultural expectations of sex, pregnancy, and childbirth and eventually resorts to self-harm. The article projects the female body-corporeal as both the aetiological site and the site of resistance; while phallocentric cartography of the female body engenders abjection, manifestations of abjection at the corporeal level formulate tropes of resistance. The article challenges the phallocentric tendency to pathologize deviant body-behaviour motifs in women, contributing to the expanding corpus of phenomenological knowledge on pathologized female subjectivities.

Paranoid psychosis after a single parenteral dose of indomethacin administered for headache diagnosis: A case and review of the literature

Background: Indomethacin is a non-steroidal anti-inflammatory used to diagnose and treat hemicrania continua and paroxysmal hemicrania. Treatment can be complicated by gastrointestinal adverse effects; less commonly reported are idiosyncratic neuropsychiatric adverse effects with indomethacin. Methods: A 50-year-old male with lateralized brief attacks of headache associated with cranial autonomic symptoms was administered a single 200 mg dose of intramuscular indomethacin. Within an hour, he developed acute psychosis, with paranoid delusions and verbal and physical aggression lasting 5 h, followed by recovery to baseline. We used search terms “indomethacin psychosis,” “indomethacin psychiatric,” “indomethacin side effects,” “non-steroidal anti-inflammatory psychosis,” and “non-steroidal anti-inflammatory psychiatric” within PubMed to identify previous reports and literature in this area. Results: Neuropsychiatric adverse effects of indomethacin have been reported since 1965 in a dose-dependent manner, usually with oral courses. They may be more common in the elderly, postpartum women and postoperative patients. Conclusion: Neuropsychiatric adverse effects should be considered in headache medicine, particularly in at-risk groups when indomethacin is administered. Patients, particularly those at highest risk, should be counseled about the risk of neuropsychiatric side effects on indomethacin which may be dose-dependent and are generally reversible on stopping the drug.

Short and Long-term Effects of Cognitive Behavioral Therapy on Sleep Problems and Psychotic Symptoms in Patients with Psychotic Disorders: A Meta-Analysis Study.

Sleep problems are common in patients with psychotic disorders, especially schizophrenia. Although pharmacological methods are at the forefront of treatment, this method has some drawbacks. Cognitive behavioral therapy for insomnia (CBT-I) is an option for the treatment of individuals with insomnia. In recent years, there has been an increasing interest in its use in patients with psychotic disorders. This meta-analysis aims to evaluate the effectiveness of CBT-I on sleep problems in patients with psychotic disorders. A systematic search was conducted using PubMed, Scopus, and EBSCO (MEDLINE) databases to identify relevant studies. The study included RCTs and uncontrolled studies that focused on participants diagnosed with schizophrenia, schizoaffective disorder, delusional disorder, psychotic disorders not otherwise specified, bipolar disorders, or unipolar depression with psychotic features, who had sleep problems for at least one month, and who were receiving treatment. The initial search yielded 246 studies, and eight studies were selected for the meta-analysis after screening and applying inclusion and exclusion criteria.The statistical analysis was conducted using the R software. CBT-I significantly ameliorates insomnia and sleep quality in patients with psychotic disorders during short and long-term periods. In addition to this, CBT-I leads to a significant improvement in psychotic symptoms in the short-term period and contributes significantly to the improvement in mental well-being in both short and long-term periods. CBT-I is an effective and valuable method for sleep problems in patients with psychotic disorders and its use is recommended to be widespread.

Clinical systematics of chronic delusional psychoses in schizophrenia and schizophrenia-spectrum pathology

To develop a systematics of chronic delusional psychoses in schizophrenia and pathology of the schizophrenic spectrum that takes into account psychopathological structure (the mechanism of delusional formation) and the trajectories of the disease course (the ratio of negative/positive dimensions). The study sample was recruited from the large Moscow psychiatric hospital in 2019-2024 and included 126 patients (94 male, 32 female, mean age 36.5±12.1 years) hospitalized with ICD-10 diagnosis of paranoid schizophrenia (F20.00) or delusional disorder (F22). A clinical-psychopathological method was used. The study identifies three variants of paranoid domains, the typology of which takes into account both the psychopathological structure and the trajectories of their development, which determine the dominance of predominantly negative or positive symptoms throughout the disease: 1) psychosis with delusional interpretations and predominant orientation of symptoms towards the negative pole of the schizophrenia psychopathology (n=37, 29.4%); 2) psychosis with hallucinatory delusions and predominant direction of symptoms towards the positive pole of the schizophrenia psychopathology (n=50, 39.7%); and 3) «combined» hallucinatory-delusional psychosis with a simultaneous orientation of symptoms to the negative/positive poles of the schizophrenia psychopathology (n=39, 30.9%). Detailed phenomenological characteristics of each of the three presented variants are given. The developed three-component taxonomy confirms, on the model of chronic delusional psychoses appearing in schizophrenia and the pathology of the schizophrenia spectrum, the concept of simultaneous representation of two relatively independent domains determined by neurobiological processes in the schizophrenia psychopathology positive and negative disorders.

Huntington’s disease associated with psychotic features

Abstract: Huntington’s disease (HD) is a rare, progressive, fatal, and autosomal dominant neurodegenerative disorder characterized by a triad of abnormal choreatic movements, cognitive disorders, and psychotic symptoms. A very small group presents with psychotic features. In this report, we present a case of HD with psychotic features and a diagnosis of HD. We describe a 29-year-old male with a history of behavior changes, delusions of persecution, and auditory hallucinations, which on mental status examination were suggestive of organic delusional disorder (schizophrenia-like).

Application of the MMPI-2 inventory in the differential diagnosis of psychotic disorders – based on profile analysis of a patient diagnosed with persistent delusional disorder and personality disorder

Aim: Paranoid states or traits can be present in various mental disorders; hence, their clarification is valuable for establishing a reliable nosological diagnosis. Clinical practice and literature on the subject highlight a range of defence mechanisms specific to the discussed nosological group. These mechanisms can impede the process of psychiatric and psychotherapeutic diagnosis and treatment. In contemporary evidence-based medical practice, the prevalent clinical approach is based on qualitative methods (e.g. free interviews and observations) complemented by standardised diagnostic tools. This approach assists the clinician in supplementing, organising, and objectifying clinical data related to the patient’s mental state. It is particularly beneficial for handling data that may be uncertain or unavailable in an observational study for various reasons. The article presents insightful and pragmatic theoretical, empirical, and case-related information on the potential application of the Minnesota Multiphasic Personality Inventory (MMPI-2) in the psychological diagnosis of patients with persistent delusional disorders. Methods: The paper explores theoretical issues and analyses a case study involving a female patient with a suspected diagnosis of delusional disorder and co-occurring personality disorder. In the case study, the authors employed qualitative methods, including observation and free psychological interview, and supplemented clinical data with insights gained through the use of a standardised psychometric method: the MMPI-2. Reflections and practical recommendations are divided into two groups. One group comprises the potential applications of the MMPI-2 in clinical psychological diagnosis. The other focuses on the importance of the diagnostic alliance and its roles in the process of planning the psychological diagnosis in patients with delusional disorders.

Frecuencia de trastornos mentales y sus características sociodemográficas en pacientes con COVID-19 ingresados en un hospital psiquiátrico de Lima Metropolitana

Introduction. The description of the characteristics and diagnoses of psychiatric patients with COVID-19 during the pandemic has been poorly described in Peru. Objective. To describe the frequency of mental disorders and the associated sociodemographic characteristics of patients with a positive antigen test for COVID-19 in a peruvian psychiatric hospital from July 2020 to July 2021. Methods. For this descriptive study we analyzed 100 medical records of patients between 18 and 70 years old. The variables studied were the diagnosis according to ICD-10 and sociodemographic features such as age, gender, educational status, employment, days of admission. Results. The most common diagnoses were “Schizophrenia, schizotypal disorders and delusional disorders” (49%) and “mood disorders” (37%), 66% belonged to the lowest socioeconomic levels and 60% were recurrent patients. The month of April 2021 presented the highest number of admissions (n=15). Conclusion. In a year of observation during the COVID-19 outbreak, 100 patients with psychiatric diagnosis who also had SARS-CoV-2 infection were admitted to a reference psychiatric hospital, most of these patients had psychotic disorders.

Diagnostic concordance in consultation liaison psychiatry – Referring physicians to psychiatrists

Psychiatric co-morbidity in patients with physical illness is known to influence the course and outcome of both conditions. Consultation liaison psychiatry [CLP] can be regarded as an essential service between psychiatry and other medical specialties. Efficient communication between different levels of care is known to have an impact on the quality of health care. To study the patterns of referrals to the department of psychiatry and diagnostic concordance between referring physicians to CL-Psychiatrist.The present study was a cross-sectional study conducted in the Department of Psychiatry of a tertiary care hospital. All the patients referred to the Psychiatry department for 4 months were taken after excluding referrals sent for disability assessment. Socio-demographic details, source of referral, reason for referral, and the psychiatric diagnosis by both the referring doctor and CL-psychiatrist were recorded. Statistical analysis was done using SPSS 25.0 software and kappa value was used to estimate the diagnostic concordance.In the sample of 100 referrals studied, the mean age of the sample was 40.96±13.42 years. The majority of the cases referred were inpatients (61%), from the department of general medicine and allied branches (85%), (General medicine -55, Neurology- 21). The most common diagnosis was alcohol dependence syndrome 24 (24%), followed by depression (18%) and phobic anxiety (18%).The concordance of the diagnosis between the referral and the psychiatry team was in perfect agreement (κ=0.81- 1.00) for paranoid schizophrenia, bipolar affective disorder, delirium, dissociative disorder, delusional disorder, and alcohol dependence syndrome. Very low concordance was observed in diagnosing obsessive-compulsive disorder (k=0) and adjustment disorder (k=0).The overall diagnostic concordance was poor for adjustment disorder, OCD, and vascular dementia, and good for paranoid schizophrenia, delirium, dissociative disorder, delusional disorder, and BPAD.

Characteristics of older patients in the largest French psychiatric emergency centre.

Despite an increasing number of adults older than 60 years with psychiatric disorders, there are few studies on older patients in psychiatric emergencies and no European data. We aimed to describe the population of patients aged 60 years and older who presented to the main French psychiatric emergency centre and identify predictors of psychiatric hospitalization. This monocentric study included 300 consecutive patients aged 60 years and older. Patients presenting because of psychiatric emergencies were frequently female and lived autonomously. More than 40% had a history of at least one psychiatric hospitalization and 44% had consulted a psychiatrist in the previous 6 months. The most common reasons for consultation were depression, anxiety, sleep disorders and suicidal thoughts. Psychiatric disorders were mainly mood disorders; neurotic, stress-related and somatoform disorders; and schizophrenic, schizotypal and delusional disorders. Only 10% had a diagnosis of organic mental disorders. Overall, 39% of the patients were admitted to the psychiatric hospital. Factors predicting hospitalization were a history of psychiatric hospitalization, suicidal thoughts and a diagnosis of a mood disorder or schizophrenia/schizotypal/delusional disorder. In conclusion, among people aged 60 years and older who consulted for psychiatric emergencies, 39% had to be hospitalized in psychiatry and only psychiatric factors influenced the decision to hospitalize. Our study highlights the need for further studies of older people in psychiatric emergencies in Europe, to anticipate the needs of this specific population and adapt multidisciplinary mental health care.

Psychological Problem Of The Main Character In Shutter Island Movie: Psychoanalysis Approach

This study aims to analyze and identify the psychological aspects of Sigmund Freud's psychoanalysis of the main character in the film Shutter Island, starring Leonardo DiCaprio as Edward ‘Teddy’ Daniels, who suffers from delusional disorders due to past conflicts. Teddy’s internal conflict causes him to experience delusions that lead to subconscious conflicts that trigger inappropriate and irrational beliefs that make it difficult for him to accept reality and control his id, ego and superego. Qualitative methods are used in this research because this research does not refer to numbers and statistical calculations. The writer analyzes the main characters in the film in depth based on dialogue scripts and storylines. Based on the research results, psychoanalytic data was found on the main character with 5 id data, 3 ego data, 6 superego data, with Id as part of psychoanalysis which dominates the main character’s personality caused by unresolved subconscious conflicts by always trying to ignore and reject reality by fulfilling the will of the id which is contrary to the state of reality.
 
 Keywords: Psychoanalysis; Sigmund Freud; Movie

Multiple pathologies underlying a very late‐onset schizophrenia‐like psychosis

AbstractBackgroundVery late‐onset schizophrenia‐like psychosis term was recently introduced and includes schizophrenia, delusional disorders, and paranoid psychosis after 60 years. More than 60% of cases are due to secondary causes, mostly neurodegenerative diseases. We described clinical, neuropathological, and radiological findings of a woman with psychotic symptoms preceding cognitive impairment.MethodClinical data were obtained by interview with a next of kin. Both hemispheres were fixed in 4% buffered paraformaldehyde within 15 hours of death. The following samples from both fixed hemispheres were embedded in paraffin: middle and inferior frontal, middle and superior temporal, superior frontal and anterior cingulate gyri, angular gyrus, insula, visual cortex, hippocampal formation at the level of the lateral geniculate body, amygdala, basal ganglia at the level of the anterior commissure, thalamus, midbrain, brainstem, and cerebellar cortex and dentate nucleus. All areas were stained with hematoxylin and eosin (H&E), and immunohistochemistry with antibodies against β‐amyloid (4G8), phospho‐tau (AT8), phospho α‐synuclein (81A), phospho TDP‐43, and p62.ResultA 69‐year‐old woman started with visual and auditory hallucinations and delusions, followed by cognitive impairment and hyperorality. Three years later, she became bedridden and died at 73. Postmortem 7T MRI showed diffuse cortical atrophy more prominent in the temporal cortex and anterior hippocampus. Unfixed brain 887g weight. Macroscopy depicted cortical brain atrophy with enlargement of the lateral ventricles, depigmentation moderate of substantia nigra, and severe of locus coeruleus. Microscopy showed bilateral hippocampal sclerosis. At immunohistochemistry: diffuse Lewy‐type pathology corresponding to Braak stage 6 of PD‐related pathology, Braak staging VI for AD, amyloid deposits in diffuse, cored, and perivascular plaques in cortical and subcortical areas (CERAD B and Thal 5), and neuronal, glial TDP‐43 inclusions were found in cortical and limbic areas corresponding to LATE 3 and Staging 6.ConclusionLate‐onset psychosis is associated with frontotemporal involvement and is frequently observed in those with C9orf72 mutation. Co‐pathologies may influence clinical and neuropsychiatric presentation and disease progression in mixed dementias.

Outcome of Involuntary Mental Health Assessment in a Psychiatric Department in Greece.

Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with "F20-29 schizophrenia, schizotypal and delusional disorders" were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor's Office of regions that are located far from the psychiatric department of UGHA (Fisher's exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an "F20-29 schizophrenia, schizotypal and delusional disorders" diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures.

Analysis of inpatient cost burden and influencing factors of seniors’ patients with mental illness in Dalian, China

BackgroundAs China's aging population continues to grow, the prevalence of mental illness among the seniors has been steadily increasing. The aim of this study is to reveal the changing trends and characteristics of economic burden among seniors patients with long-term hospitalization for mental illness, and to analyze the influencing factors.MethodsThe data for this study were gathered from seniors’ patients with mental illness who were hospitalized and aged 60 years or older. The patients were admitted to four specialized and general hospitals located in Dalian city between January 2018 and December 2020. The types of diseases include affective mental disorders (mood disorders), Schizophrenia, schizotypal, and delusional disorders, Organic (including symptomatic) mental disorders, Neurotic, stress-related and somatoform disorders, Mental retardation, Mental and behavioral disorders due to substance use. (Identify the main diagnosis at discharge using ICD-10 coding). This study analyzed the basic characteristics and disease-related information of seniors patients with long-term psychiatric disorders who were hospitalized, and explored the factors influencing hospitalization costs among patients with different illnesses.ResultsAmong the 3871 study subjects, the average length of hospital stay was 127.51 days. The average hospitalization expenses per case were 33,656.07 yuan. Seniors’ patients with mental illness who receives treatment in specialized hospitals have higher hospitalization costs. Long-term hospitalization increases the total hospitalization costs. Age has an impact on hospitalization costs for patients with organic mental disorders. Patients with affective disorders (mood disorders) and neurotic, stress-related, and somatoform disorders who are covered by urban employee medical insurance have higher hospitalization costs.Patients with severe psychiatric disorders who have a 31-day readmission plan, as well as senior patients with somatoform disorders comorbid with other illnesses, incur higher hospitalization costs.ConclusionsWe should take corresponding measures to reduce the number of readmissions for patients with severe mental illnesses. The impact of treatment methods and differences in healthcare institutions on total hospitalization costs deserves further research. It is necessary to strengthen the prevention and diagnosis of comorbid physical illnesses in patients with mental disorders. The burden of mental illnesses in the seniors is significant, and medical insurance policies should be inclined towards providing support.

Behavioral Health–related Reasons for Permanent Duty Limitation Profiles in the U.S. Army: Population-Based Data from 2017 to 2019

ABSTRACT Introduction When warfighters are unable to fight, they are formally removed from battle through temporary or permanent duty limitation profiles. This study uses a population-based data repository to characterize permanent behavioral health (BH)–related profiles across the army for an identified 2-year period. The absolute risk of a permanent duty limitation for specific BH categories was also examined. Materials and Methods This study utilized a retrospective population-based design to identify all new BH diagnoses across the U.S. Army. Service members identified as having a new BH diagnosis were tracked for 12 months following the diagnosis to determine the recommendation of a permanent duty limitation profile. Results From 2017 to 2018, 16% (n = 102,440) of service members received a “new” BH diagnosis. Less than 10% (9.5%; n = 9,752) of soldiers diagnosed with a BH disorder were issued a permanent BH-related duty profile within 12 months of the initial diagnosis. The absolute risk of a permanent profile was highest for soldiers diagnosed with a psychotic or delusional disorder (42%; n = 324) followed by dissociative or somatoform disorders (26%; n = 178) and eating disorders (23%; n = 108). Conclusions Military regulations dictating medical readiness and retention standards reflect both the standards required for mission readiness and a layer of medical protection for the service member. This study provides important information on the relationship between a new BH diagnosis and the likelihood that a service member will be referred for a retirement evaluation.