Paranoid Research Articles

Can neurocognitive performance account for dimensional paranoid ideation?

Paranoid ideation underlies numerous psychological disorders and has debilitating effects on daily life. Deficits in neurocognition are highlighted as a contributing factor to paranoid-related disorders, but the impact on the symptom-level experience of paranoid ideation is unclear. This study aimed to employ a dimensional approach to understand the association between neurocognition and the severity and presence of paranoid ideation. 400 participants, representative of the general population of the USA, completed an online questionnaire consisting of the Brief Symptom Inventory-53, and demographic and clinical questions. The participants then completed four computerised neurocognitive tasks measuring working memory, shifting, inhibition, and speed of processing. Speed of processing accounted for unique variance in the severity of paranoid ideation with a small effect size, after controlling for covariates. Working memory, shifting, and inhibition could not uniquely or collectively, account for paranoid ideation. Neurocognitive performance could not distinguish between individuals with and without paranoid ideation experiences. This research supports the body of literature that speed of information processing may be a key feature of paranoid ideation. Future research should employ non-linear dynamic methods to better understand the potential interactions between neurocognitive components and how this may relate to paranoid ideation.

Cognitive performance, mental health, and quality of life in β-thalassemia individuals: a comprehensive analysis

IntroductionBeta-thalassemia is a prevalent autosomal recessive haemolytic disorder, particularly in the Middle East. Patients with beta-thalassemia major (βTM) require iron chelation therapy and regular blood transfusions, while those with beta-thalassemia intermedia (βTI) exhibit milder symptoms. This study aimed to evaluate cognitive function, behavioural problems, quality of life, and related aspects in individuals with βTM and βTI.MethodsThe cross-sectional study included 20 βTM participants, 20 βTI participants, and 19 healthy controls. Participants underwent psychiatric interviews, the Wechsler Adult Intelligence Scale (WAIS-III), Symptom Checklist-90 Revised (SCL-90R), and Short-Form Health Survey (SF-36). Clinical data and laboratory investigations were also collected.ResultsβTM participants exhibited lower vocabulary and picture completion scores on the WAIS-III compared to other groups. βTI participants had significantly higher scores on SCL-90R subscales for somatization, depression, anxiety, paranoid ideation, and psychoticism. Both patient groups reported poorer quality of life across all SF-36 domains compared with controls. Longer disease duration correlated with lower levels of somatization, interpersonal sensitivity, depression, anxiety, and paranoid ideation. Less frequent blood transfusions were associated with better physical and mental health summary scores but also higher somatization. Elevated serum iron levels corresponded with increased anxiety, hostility, and psychoticism symptoms, while higher serum ferritin related to more obsessive–compulsive behaviours but less somatization and psychoticism.ConclusionsIndividuals with thalassemia exhibit cognitive deficits, psychological disturbances, and diminished quality of life, with distinct patterns depending on disease severity. Regular monitoring and appropriate interventions are crucial for optimizing their overall well-being and functioning.

Exacerbation of paranoia-like thoughts following exposure to common misophonia trigger sounds

Paranoia-like thoughts refer to heightened suspicions and unfounded beliefs about being watched or persecuted by others. Recent research has found a significant correlation between misophonia symptoms, a form of decreased sound tolerance, and paranoia-like thoughts, both of which are linked to heightened negative emotions in clinical and non-clinical populations. Notably, it has been observed that misophonia may also be associated with the tendency to attribute hostile intent to those producing triggering sounds, a feature consistent with paranoid ideation (i.e., perceptions of intentional harm). However, existing research is based on correlational data, limiting causal inference. Therefore, an online study involving a non-clinical sample (N = 487) employed an experimental approach to examine the relationship between misophonia symptoms, negative emotional response, and paranoia-like thoughts. Participants were randomly assigned to one of four task conditions, each related to exposure to different stimulus types: orofacial human-produced sounds, non-human sounds, sounds without visual context, or visuals devoid of sound. The results of mixed model ANOVA and mediation analysis revealed that exposure to common misophonia trigger sounds with a human-related visual context raised, but not significantly, the levels of paranoia-like thoughts. However, it did lead to a significant increase in negative emotions, which, in turn, proved to be a significant mediator of an increase in paranoia-like thoughts. Conversely, exposure to non-human sounds or to only audio/visual stimuli either decreased both negative emotions and paranoia-like thoughts or showed no significant change. This emphasized the role of context and the involvement of negative emotional response to human-made sounds in amplifying paranoia-like thoughts. Importantly, this effect was observed in individuals who do not meet the provisional diagnostic criteria for misophonia, suggesting that symptoms of misophonia may extend beyond clinical diagnoses, with milder manifestations potentially being present within the general population.

The Mental Suffering of Cocaine-Addicted Patients: A Retrospective Analysis of Personality Disorders' Prevalence and Their Association with Psychopathological Symptoms.

(1) Background: The observational retrospective study aimed to investigate the prevalence of personality disorders (PDs) and their association with psychopathological symptoms in a group of patients with cocaine addiction. (2) Methods: Ninety-five medical records of the Pathological Addictions Service of the National Health Service of Lecce (Italy) were analyzed. PDs were diagnosed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and psychopathological symptoms were investigated through the Symptom Checklist 90-Revised (SCL-90-R). (3) Results: Ninety-two out of ninety-five patients met the criteria for at least one PD (96.8%), almost 35% had two Cluster B PDs, and over 25% had three Cluster B PDs. Nine out of ninety-five people met the criteria for all Cluster B PDs. Among the Cluster B PDs, it emerged that the most frequent diagnosis was that of narcissistic-borderline-antisocial (over 20% of the total sample). The analysis highlighted that mental suffering is prevalent in those with multiple comorbid Cluster B PDs. Specifically, depression and psychoticism exceed the clinical cut-off (T score > 63) in all patient groups. At the same time, anxiety and obsessions-compulsions are complained of only by those with more than two PDs as well as the level of general distress. Furthermore, anxiety, hostility, and paranoid ideation are significantly higher in the group of patients with more than three PDs. (4) Conclusions: Further studies should better investigate the relationship between the two aspects and describe the causal effects of PDs on psychopathological symptoms or, on the contrary, the effects of the substance on mental health and the worsening of personality alterations.

Psychopathology in asthma patients: analysis of demographic and clinical associations.

Asthma, a chronic inflammatory condition affecting the airways, significantly impacts both respiratory function and quality of life. Recent studies have highlighted the psychological dimensions of chronic diseases like asthma. Despite growing evidence linking asthma with various psychopathological conditions, comprehensive data remains scarce. This study aims to explore the psychopathological status of asthma patients and identify demographic and clinical factors associated with higher levels of psychopathological symptoms. Data were collected from 42 asthma patients attending the Asthma Outpatient Clinic at the University of Thessaly, Greece. Participants completed a detailed questionnaire on demographics and clinical parameters, along with the Symptoms Checklist-90 (SCL-90) to assess psychological symptoms. The sample included patients with varying asthma severity: 38% with severe asthma and 62% with mild-moderate asthma, with a mean age of 60.8 ± 15.6 years. Results indicated that 23.8% exhibited somatization symptoms, 23.8% showed compulsive behaviors, 33.8% reported interpersonal sensitivity, and 38.1% experienced depression and 38.1% aggressiveness. Additionally, 45.2% struggled with fearful anxiety, 4.8% showed paranoid ideation, and 11.9% had traits of psychoticism. Women had significantly higher psychopathology scores than men. Factors such as longer disease duration, uncontrolled asthma, severe asthma, and comorbid conditions like atopy and gastroesophageal reflux disease (GERD) were linked to higher psychopathological scores. The study found a high prevalence of psychopathological symptoms among asthma patients. Female gender, prolonged asthma duration, persistent symptoms, comorbid diseases (GERD, atopy) and greater disease severity were significantly associated with higher psychopathology, underscoring the need for integrated mental health care in asthma management.

Clinical characteristic, laboratory biomarkers, treatment regimen and psychiatry problems predictors of outcomes of alopecia areata: a prospective study

Background Alopecia areata (AA) has multiple aetiology such as genetic and environmental triggers. Aims To assess the recovery rate of AA and examine the associated psychiatric problems. Additionally, the relationship between clinical, psychiatric, and laboratory biomarkers and alopecia outcomes were investigated, along with potential risk factors that could aid in treating alopecia. Patients and methods A prospective cohort research included 42 AA patients and 45 healthy controls. Group A (active disease), group B (inactive disease), and group C (healthy control) were based on illness outcomes after 3 months of treatment. The Severity of Alopecia Tool (SALT), treatment regimens, laboratory investigation Interleukins 19 and 33 (IL-19 and IL-33), Symptom Checklist 90, and post-traumatic stress disorder Checklist for DSM-5 (PCL-5) were evaluated. Results After 3 months of therapy, the incidence of inactive AA was found to be 57.14%. Being females with family history of dermatitis were highly related with active illness, while smoking and unmarried patients were associated with inactive disease. After 3 months of treatment, active illness had the highest mean IL-33 and IL-19 levels. Conclusion The active disease group exhibited the highest mean IL-33 and IL-19 levels at baseline following three months of treatment. Our patients had 7.1% somatization, 7.1% obsessive-compulsive symptoms, 4.8% depression, 4.8% anxiety, 15.9% anger-hostility, 35.7% phobic-anxiety, 26.2% paranoid ideation, 4.8% psychoticism, and 61.9% post-traumatic stress disorder. AA outcomes were linked to females, a family history of dermatological disorders, smoking, being single, and higher mean IL-33 and IL-19 levels. Psychosis was highly linked with active AA. Only khellin and Ultraviolet A improved AA results.

Long-term psychological implication of the COVID-19 pandemic: a network analysis among the Italian population

The enduring psychological impact of the COVID-19 pandemic is a subject of growing concern. Despite existing research highlighting immediate challenges, there is a lack of comprehensive studies elucidating specific pathways through which psychological variables contribute to the pandemic’s long-lasting implications. Through a network analysis approach, we aimed to investigate the mutual relationships and associations between eating disorder symptoms, guilt- and shame-proneness, psychopathological symptoms, self-esteem, defence mechanisms, and mentalization and understand how they might interact two years after the pandemic's outbreak. From March to August 2022, 651 Italian young adults (females = 593, 91.1%) aged between 18 and 38 (Mage = 23.84, SD = 3.74) were recruited online and completed a digital booklet of self-report questionnaires. A weighted, undirected graphical LASSO network was performed to investigate the structure of the nodes. A stable and accurate network structure showed that the most interconnected nodes were psychoticism, interpersonal sensitivity, obsessive-compulsive symptoms, depression, anxiety, paranoid ideation, and immature defences, suggesting their central role in the network functioning. Findings emphasized the enduring psychological impact of the pandemic, elucidating the complex interplay and dynamic impact of key psychopathological symptoms and defence mechanisms. The network tested also provides valuable insights for developing targeted interventions and effective strategies to address post-pandemic mental health challenges.

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.

Manifestations of Paranoid Personality in Workaholic Middle Managers.

The problem of paranoid disorders is widespread and difficult to diagnose due to the many mental symptoms that a person often perceives as character traits. Passion for work, the so-called pathological workaholism, harms not only the suffering person but also all the people around them, affecting their quality of life and disrupting social and family ties. The purpose of study was to determine the level of pathological workaholism and its main symptoms. The objectives of the study included interviewing respondents and identifying the correlation between the level of workaholism and mental manifestations, and finding differences in the manifestations of workaholism in men and women. For this purpose, 78 people were examined, including 38 women and 40 men. All participants worked as middle managers in multinational companies. The aim was to identify people with pathological workaholism among the participants using the "Work Addiction Risk Test" questionnaire. Among managers, a high degree of predisposition to workaholism was diagnosed. We found that women have a strong tendency to be fixated on work, and as a result, they have increased rumination anxiety. Regardless of gender, managers who took part in the study showed a pronounced manifestation of paranoid and obsessive-phobic disorders, depression, and asthenic manifestations. Regarding the relationship between neurotic symptoms and a tendency to workaholism, a high correlation was observed ( p < 0.05). The results of this study may be useful for specialists to develop means of preventing and effectively treating paranoid workaholism, as a disease that is increasingly having a negative impact on society.

Interpersonal consequences of paranoid ideation, negative symptoms and sleep problems in a transdiagnostic sample of individuals with psychosis

Paranoid ideation is a transdiagnostic construct that is associated with social impairment and often occurs in psychotic spectrum disorders. Little research has examined how paranoid ideation is related to social behaviors that underlie social impairment and may ultimately lead to social rejection. It is important to consider that negative symptoms and sleep problems also contribute to social impairment. No research has assessed the unique and combined influence of paranoid ideation, negative symptoms, and sleep problems on social impairment. Therefore, the current study examined how paranoid ideation, negative symptoms, and sleep problems contribute to poorer social skills and social rejection in a transdiagnostic sample of persons with psychosis and community members (N = 112). Assessments included diagnostic and symptom interviews, questionnaires, behavioral ratings of social skill and facial displays of affect, and naive observer reactions utilizing thin-slice methodology. Greater paranoid ideation, negative symptoms, and sleep problems were each related to poorer social skill and more negative reactions from observers. When considered in path analyses, negative symptoms were associated with observer reports of less willingness to interact with participants through poorer social skill. These findings demonstrate the symptom correlates of social rejection and how interpersonal behavior may contribute to social exclusion.

Immersive virtual reality as a novel approach to investigate the association between adverse events and adolescent paranoid ideation

Immersive virtual reality as a novel approach to investigate the association between adverse events and adolescent paranoid ideation

On the relationship between subjective decision criteria and paranoid ideations.

Following the conjecture made by (Bliznashki and Hristova in Appetite 167:105645, 2021), we test the hypothesis that liberal subjective decision criteria exhibited during a task involving discrimination between random and systematically correlated patterns should be associated with elevated levels of paranoid ideations. Study 1 establishes the proposed association in the presence of several control measures while also demonstrating that the relationship in question is significantly moderated by subjects' working memory spans and tendencies to be overconfident in their judgments. Study 2 provides further evidence that these effects are indeed specific to tasks involving discrimination between random and systematic patterns and that the observed results are not due to some form of (anti) acquiescence bias or other general trends. Certain specifics of the correlation matrices involving cognitive measures significantly related to the paranoia continuum suggest that our results are consistent with the Entropic Brain Hypothesis. Finally, a simulation study employing a Neural Network demonstrates that increased entropy and liberal decision criteria might be connected to each other with said connection being amenable to an interpretation within the Bayesian paradigm.

Bridging the Gap between Psychophysiological and Audiological Factors in the Assessment of Tinnitus: An EEG Investigation in the Beta Band.

Despite substantial progress in investigating its psychophysical complexity, tinnitus remains a scientific and clinical enigma. The present study, through an ecological and multidisciplinary approach, aims to identify associations between electroencephalographic (EEG) and psycho-audiological variables. EEG beta activity, often related to stress and anxiety, was acquired from 12 tinnitus patients (TIN group) and 7 controls (CONT group) during an audio cognitive task and at rest. We also investigated psychological (SCL-90-R; STAI-Y; BFI-10) and audiological (THI; TQ12-I; Hyperacusis) variables using non-parametric statistics to assess differences and relationships between and within groups. In the TIN group, frontal beta activity positively correlated with hyperacusis, parietal activity, and trait anxiety; the latter is also associated with depression in CONT. Significant differences in paranoid ideation and openness were found between groups. The connection between anxiety trait, beta activity in the fronto-parietal cortices and hyperacusis provides insights into brain functioning in tinnitus patients, offering quantitative descriptions for clinicians and new multidisciplinary treatment hypotheses.

Cognitive Flexibility as a Mediator in the Relationship Between Generalized Anxiety and Paranoid Ideation: The Role of Perceived Control

The clinical literature encourages further exploration of the relationship between anxiety and paranoid ideation with the overall objective of identifying processes that mitigate such relationship, thus establishing targets for cognitive intervention. Empirical studies demonstrate that increased levels of anxiety precede the emergence of paranoid cognitions. Yet, possible mediators are still to be investigated. In all, 273 adults completed a battery of standardized questionnaires, and collated data were analyzed statistically. Generalized anxiety was positively associated with paranoid ideation, for both ideas of reference and persecutory beliefs. Although the relationship was not mediated by cognitive flexibility in its entirety, perceived control over internal experiences and external events, an essential constituent of cognitive flexibility, acted as a significant mediator. The results highlight the importance of increasing adaptive perceptions of control among individuals experiencing generalized anxiety, which would likely reduce the co-occurrence of paranoid ideation and lower the risk of transitioning into clinical levels of paranoia.

Risk factors and their association network for young adults' suicidality: a cross-sectional study.

Understanding the intricate influences of risk factors contributing to suicide among young individuals remains a challenge. The current study employed interpretable machine learning and network analysis to unravel critical suicide-associated factors in Chinese university students. A total of 68,071 students were recruited between Sep 2016 and Sep 2020 in China. Students reported their lifetime experiences with suicidal thoughts and behaviors, categorized as suicide ideation (SI), suicide plan (SP), and suicide attempt (SA). We assessed 36 suicide-associated factors including psychopathology, family environment, life events, and stigma. Local interpretations were provided using Shapley additive explanation (SHAP) interaction values, while a mixed graphical model facilitated a global understanding of their interplay. Local explanations based on SHAP interaction values suggested that psychoticism and depression severity emerged as pivotal factors for SI, while paranoid ideation strongly correlated with SP and SA. In addition, childhood neglect significantly predicted SA. Regarding the mixed graphical model, a hierarchical structure emerged, suggesting that family factors preceded proximal psychopathological factors, with abuse and neglect retaining unique effects. Centrality indices derived from the network highlighted the importance of subjective socioeconomic status and education in connecting various risk factors. The proximity of psychopathological factors to suicidality underscores their significance. The global structures of the network suggested that co-occurring factors influence suicidal behavior in a hierarchical manner. Therefore, prospective prevention strategies should take into account the hierarchical structure and unique trajectories of factors.

Symptom Checklist-90-Revised: Factor structure and relevance as a measure for the Hierarchical Taxonomy of Psychopathology model

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a recently proposed dimensional model of psychopathology that aims to provide a more comprehensive understanding of the organization of mental disorders. The Symptom Checklist-90-Revised (SCL-90-R) is a widely used self-report questionnaire that assesses nine broad dimensions of psychopathologies. The current study reexamined the optimum factor structure of the SCL-90-R (first aim), and its usefulness for the assessment of psychological dimensions from a HiTOP perspective (second aim). These were examined in a community sample of adolescents from Cyprus. A total of 839 adolescents (males = 352, females = 485; no response = 2) with ages ranging from 14 to 18 years [mean (SD) = 15.52 years (0.64 years)] completed the SCL-90-R and the Fünf-Faktoren-Fragebogen für Kinder (FFFK), a personality measure of the Five-Factor Model of personality. Relevant to the first aim, the findings showed the most support for an exploratory structural equal model, with the nine theorized SCL-90-R factors/dimensions. Relevant to the second aim, the SCL-90 dimensions of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety were associated with the five factors in the FFFK as theoretically predicated by the HiTOP model. The SCL-90-R dimensions for paranoid ideation and psychoticism did not. The findings indicated reasonable support for the theorized nine-factor SCL-90 model; and the use of the SCL-90-R dimension scales of somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety for measuring the dimensions with similar names in the HiTOP model.

Impact of the COVID-19 pandemic on clinical and psychological aspects of temporomandibular disorders

BackgroundThe Coronavirus 2019 disease (COVID-19) caused drastic changes in people’s lifestyle that affected TMD characteristics through its physical and psychological influences. The aim of this study was to define the clinical and psychological characteristics of a large group of well-defined TMD patients and seek their differences between before and during the COVID-19 pandemic to establish points of care to be emphasized in the post-pandemic era.MethodsTMD patients diagnosed by the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) aged ≥ 18 were analyzed. Samples between September, 2017 to July, 2019 (n = 455) and March, 2021 to June, 2022 (n = 338) were collected to represent before and during COVID-19, respectively. The Graded Chronic Pain Scale (GCPS) and Symptom Checklist-90-Revision (SCL-90-R) were used to evaluate disability levels and psychological status. Clinical indices were compared between COVID periods and factors related to higher pain levels were investigated according to pandemic period.ResultsMore patients reported pain on palpation of the masticatory muscles during the pandemic (p = 0.021) while the number decreased for neck muscles (p = 0.001) and TMJ (p < 0.001) areas. Patients reporting nocturnal bruxism (23.3–29.6%) and clenching (45.1–54.7%) significantly increased during the pandemic. TMD patients with pain without disability were more common during the pandemic regardless of pain intensity (p < 0.001). The number of patients expressing interference in daily activities decreased drastically during COVID-19 regardless of disability level (p < 0.001). Factors associated with higher than moderate pain intensity (CPI ≥ 50) were insomnia (odds ratio [OR] = 1.603, p = 0.047) and somatization (OR = 1.082, p < 0.001) before the pandemic. During the pandemic, age (OR = 1.024, p = 0.007), somatization (OR = 1.070, p = 0.006), and paranoid ideation (OR = 1.117, p = 0.003) were significantly associated with higher pain intensity.ConclusionsThe results of our study underline the importance of evaluating psychological profiles of TMD patients, especially somatization, paranoid ideation and psychoticism, in exceptional situations that may cause a change in individual mental status. This will lead to a better understanding of the individual TMD patient and help in planning personalized treatment strategies that will assist the patient in adjusting to changes occurring in special environments such as the COVID-19 pandemic.

Insomnia Severity Predicts Psychiatric Symptoms: A Cross-Sectional Study Investigating the Partial Mediations of Worry and Rumination

Objective Insomnia as a disorder on its own or as a symptom of other mental disorders can lead to significant distress and lower quality of life. By exacerbating negative affect and emotion dysregulation, poor sleep and insomnia can contribute to the initiation and maintenance of mental disorders. The aim of this cross-sectional study was to investigate the relationship between insomnia severity and overall psychiatric symptoms (anxiety, depression, obsessive-compulsive symptoms, somatization, phobic anxiety, hostility, interpersonal sensitivity, paranoid ideation, and psychoticism), and the mediational roles of worry and rumination in this relationship. Method The data was collected from a community sample of 1444 participants (females 69.39%, Mage = 27.95, SD = 9.37) who completed self-report measures of insomnia severity, worry, rumination, and psychiatric symptoms. The mediational roles of worry and rumination were tested with mediation analysis using the PROCESS Macro. Results It was found that insomnia severity (β = 0.20, p < .001) significantly predicted psychiatric symptoms directly and via worry and rumination (β = 0.33, p < .001), meaning that worry and rumination partially mediated the relationship between insomnia severity and psychiatric symptoms. The findings were similar after controlling for smoking status, daily screen time, coffee consumption in the evening, weekly exercise frequency, and pre-sleep screen time. Conclusions Interventions targeting the reduction of insomnia severity and maladaptive emotion regulation strategies (e.g., worry and rumination), as well as the enhancement of adaptive emotion regulation strategies (e.g., positive refocusing and mindfulness), may alleviate the adverse effects of insomnia on psychiatric symptoms.

The relation between autism and psychosis: overlapping and differing features

IntroductionAutism spectrum disorders (ASD) and schizophrenia (SCZ) have a strong historic connection. At the beginning of the 20th century when referring to schizophrenic patients Eugen Bleuler used the term autism to describe the apparent withdrawal from the outside world. Other authors also emphasized the association between this two entities. In fact, only in DSM-III were these disorders placed in different diagnostic categories. Today, even though this nosological vision still prevails, a growing number of studies have shown significant overlaps between the two disorders. Patients with the diagnosis of ASD often experience psychotic symptoms and similarly schizophrenic patients have a high prevalence of autistic traits.ObjectivesTo clarify the distinction between ASD and psychotic disorders, namely to help the clinical and phenomenological distinction between patients with a primary psychotic disorder versus patients with the diagnosis of an autism spectrum disorder that might also experience psychotic symptoms.MethodsResearch on UpToDate using the terms “Autism Spectrum Disorders”; “Schizophrenia” and “psychosis”.ResultsDelusional beliefs and paranoid ideation are common findings in autistic individuals in the same way that they constitute one of the main features of schizophrenia spectrum disorders. However, in ASD individuals one must be vigilant of its distinction with “childish fantasies”. Both disorders (ASD and SCZ spectrum disorders) share Theory of Mind (ToM) impairments that contribute to the development of paranoia.Sensory anomalies are common in ASD and might be confused with hallucinations. However, anomalous perceptual experiences can and do often happen in ASD and are clinically overlapping with hallucinatory phenomena. In the case of a neurodevelopment disorder, however, they could probably be better understood as a part of it more than the signal of a co-ocurring psychotic disorder. Attenuated psychotic symptoms pose an even more complex subject because of the overlap between autistic symptoms and subclinical psychotic symptoms. Another area that poses diagnostic difficulties has to do with the distinction between negative symptoms seen in schizophrenia and autistic symptoms. Lack of emotional reciprocity in ASD can be confused with “blunted” affect in schizophrenia.Other overlapping features between these two entities can be identified.ConclusionsThe diagnostic boundaries between ASD and SCZ are not always clear. Their overlapping characteristics and potential co-occurrence might pose important diagnostic challenges in clinical practice. The clinical course of both diseases frequently represents a key element for the differential diagnosis between autism and psychosis. The profound knowledge of these two entities is of extreme importance contributing to the implementation of more targeted and effective management strategies.Disclosure of InterestNone Declared

Review of Delusional Jealousy and Its Association with Sexual Dysfunctions

IntroductionMental state changes can affect one’s sexual life, while sexual dysfunction can lead to relationship challenges. Delusional jealousy, also called Othello syndrome, involves a paranoid belief in a partner’s infidelity, leading to controlling and violent behaviors. It can manifest as a paranoid disorder, as a delusional symptom of psychiatric, neurological or other medical conditions, or as side effect of dopaminergic medication. Although its exact prevalence remains uncertain, it has been identified in 0.5-1.4% of psychiatry inpatients.ObjectivesTo describe sexual dysfunctions associated with delusional jealousy and to explore strategies for addressing these dysfunction.MethodsA non-systematic review of the literature available at PubMed was conducted using the keywords “Sexual Dysfunction” AND “Delusional Jealousy OR Othello Syndrome”.ResultsA number of factors, including sexual dysfunction, can trigger or exacerbate delusional jealousy. This is especially true for middle-aged men who have a history of alcohol consumption, neurological or personality disorders. Individuals with sexual dysfunction experience feelings of insecurity, projecting these concerns onto their partners and suspecting extramarital relationships. On the other hand, sexual dysfunctions such as Hypoactive Sexual Desire Disorder, Female Sexual Arousal and Orgasmic Disorders, Erectile Dysfunction and Ejaculation Disturbance may occur as consequence of Othello Syndrome. Multiple factors contribute to these dysfunctions, including increased testosterone and cortisol levels, chronic alcohol use, comorbid psychiatric conditions and antipsychotics. There are reports of increased sexual desire, especially in cases of dementia.ConclusionsAlthough the evidence is limited and dated, it points to a bidirectional association between delusional jealousy and sexual dysfunction. Further studies are essential to determine the prevalence and types of sexual dysfunctions in Othello syndrome, and the causal relationship between them. Additionally, investigating gender differences is crucial, given the male-centric focus of existing studies. This research can contribute to clinical care by promoting the screening for sexual issues and their integration into delusional jealousy management.Disclosure of InterestNone Declared