Perceptual Disturbances Research Articles

Visual release hallucinations presenting as psychosis - a scoping review.

Visual release hallucinations are perceptual disturbances that occur in individuals who have experienced vision loss. Almost 50 million people worldwide are believed to experience visual release hallucinations, yet they are profoundly underdiagnosed. Although first described within the Charles Bonnet syndrome, the paradigm underlying this syndrome precludes their consideration in many populations, such as those with underlying psychiatric illness or dementia. Consequently, visual release hallucinations have rarely been studied in patients presenting with psychosis. We conducted a scoping review to determine whether visual-release hallucinations occur in psychotic patients. The PubMed research database was searched from inception through April 2023. Cases were collected reporting on psychotic patients experiencing suspected visual release hallucinations. Individual treatment courses and responses were extracted. Thirteen cases compiled from 11 different studies were summarized to provide baseline characteristics and overall trends in treatment response. Most patients did not remit from pharmacological management alone. All patients who received reafferentation therapy remitted, though many were not candidates. Almost half of the patients did not achieve remission. Visual release hallucinations can manifest in psychosis and may contribute to treatment-resistant psychosis among psychiatric populations. A shift in our understanding of visual release hallucinations may aid their recognition in psychotic patients by shifting the focus toward visual release features. Recognizing release features among patients with hallucinatory conditions may open new treatment avenues for managing patients with psychosis. A preliminary screening index for visual release features is provided to support this shift.

The effect of deep versus awake removal of the laryngeal mask airway on the incidence of emergence delirium in paediatric tonsillectomy: A randomised controlled trial.

Emergence delirium, characterised by inconsolable crying, perceptual disturbances and thrashing, occurs in young children during the recovery phase from general anaesthesia. Our aim was to determine whether timing of laryngeal mask airway removal (deeply anaesthetised versus awake) influenced the incidence of emergence delirium in children after tonsillectomy. A single-centre, randomised controlled trial was conducted at Albury Wodonga Health, a regional hospital in Australia. Included patients were two to seven years old, American Society of Anesthesiologists physical status classification 1-2, undergoing elective tonsillectomy (with or without adenoidectomy or grommet insertion) under general anaesthesia. Patients were randomised to have their laryngeal mask removed whilst deeply anaesthetised (in the operating theatre) or after awakening (in the post-anaesthesia care unit (PACU)). Pediatric Anesthesia Emergence Delirium score was determined at 5 and 20 min after eye opening, and frequency of complications (cough, vomiting, excessive salivation, oxygen desaturation and laryngospasm) in the PACU were recorded. Sixty-two patients were randomised to deep laryngeal mask removal and 62 to awake. In the awake versus deep groups, 33 (53%) versus 40 (65%) participants had emergence delirium at 5 min (odds ratio (OR) 0.63, 95% confidence interval (CI) 0.30 to 1.29, P = 0.20). At 20 min, 18 (29%) vs. 19 (31%) participants had emergence delirium (OR 0.93, 95% CI 0.43 to 2.00, P = 0.88). A greater incidence of most PACU complications was observed in the awake versus deep group; cough (24% vs. 8%), vomiting (8% vs. 0%), excessive salivation (23% vs. 8%) and oxygen desaturation (16% vs. 0%). We found no significant difference between the two techniques in terms of preventing emergence delirium. However, other PACU complications were more frequent with awake removal.

Prevalence of disturbance of body image perception and engagement in risky behaviors for eating disorders motivated by the Korean wave.

the global expansion of the Korean wave (hallyu) has led to the idealization of Korean beauty standards among fans. Celebrities share extreme diets and exercise routines through social media that help them lose weight and adhere to this standard, which has been shown in some studies conducted in Asia to significantly influence negative body image perception and risk for eating disorders. to describe the prevalence of disturbance of body image perception and engagement in risky behaviors for eating disorders among Spanish-speaking fans residing in Western countries, motivated by the Korean wave. this cross-sectional and descriptive study employed a quantitative method for data collection. The data were collected through an anonymous online survey created by the author on the Google Forms platform; the survey included demographic questions, information about exposure to hallyu, body perception, body image perception disturbance and engagement in risky behaviors motivated by the Korean wave. A total of 121 participants were recruited to answer through social network X Prevalence was then calculated for each category. a total of 67.8% of the participants reported comparing their bodies to those of Korean celebrities, and 53.7% experienced a disturbance in their body image perception after exposure to hallyu. Risk behaviors related to exercise were more prevalent among participants than were those related to eating. The majority of participants engaging in these behaviors were females aged 18 years or younger. disturbance of the body image perception and engagement in risky behaviors for EDs motivated by the Korean wave are prevalent among its fans, especially female adolescents. More research is needed to understand the extent of this influence on body image perception and the risk of ED, which have a negative impact on physical and mental health.

Effects of Disturbed Body Perception on Arm Function in Patients With Frozen Shoulder.

Purpose Considering pain-related beliefs, this study aimed to investigate the influence of disturbed body perception on arm function in patients with frozen shoulder (FS). Methods This study included 90 patients with FS who visited the orthopedic outpatient clinic. We recorded measurements including the Visual Analog Scale (VAS) for pain at rest and during movement, the quick disability of the arm, shoulder, and hand (QDASH) questionnaire for perceived arm function, the short version of the Pain Self-Efficacy Questionnaire-2 (PSEQ-2) for self-efficacy in pain, the short version of the Pain Catastrophizing Scale (PCS-6) for catastrophic thoughts about pain, the short version of the Tampa Scale for Kinesiophobia (TSK-11) for fear of movement, and the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) for disturbed perception around the shoulder. For statistical analysis, we constructed three models. Model 1 used the QDASH score as the dependent variable, with gender, age, duration of disease onset, VAS score at rest, and VAS score during movement as control variables. Model 2 included pain-related beliefs (PSEQ-2, PCS-6, and TSK-11) added to the variables in Model 1. Model 3 further included the FreSHAQ to the variables in Model 2. We calculated the difference in the adjusted coefficients of determination (R² adj) from Model 1 to Model 2 and Model 3 to determine the amount of change (ΔR² adj). Additionally, we calculated the standardized regression coefficient (β-value) of the input factors to examine their effects. Result Hierarchical multiple regression analysis showed a ΔR² adj of 0.13 and 0.17 for Models 2 and 3, respectively, indicating an increase in ΔR²adj after adding the FreSHAQ. Furthermore, the FreSHAQ had the largest effect of all factors, with β = 0.27 (p<0.05). Conclusions The influence of disturbed body perception on perceived arm function in patients with FS was demonstrated, suggesting the importance of considering somatosensory factors in clinical practice.

Occipital lobe epilepsy surgery: treating seizures in the posterior cortex.

Occipital lobe epilepsy (OLE) is an uncommon type of extratemporal epilepsy constituting roughly 2-13% of symptomatic partial epilepsies and epilepsy surgery cases. Over two-thirds of patients with OLE present with two characteristics: (1) ictal semiology compatible with an occipital seizure focus (e.g., ictal blindness, visual perceptual disturbance, eye blinking, nystagmus), and (2) lateralizing features referable to the posterior cortex (e.g., visual field defects, contralateral head deviation). The remaining one-third of patients present with ≥ 2 seizure types, indicative of spread to other lobes. A common representation of this cortical spread is the altered mental status and generalized tonic-clonic activity seen in patient with OLE. While the key clinical symptoms include visual hallucinations, it may be difficult to elicit on history, especially from children, and are not always present.

The Relationship between Clinical and Psychophysical Assessments of Visual Perceptual Disturbances in Individuals at Clinical High Risk for Psychosis: A Preliminary Study.

This study investigated relations between a measure of early-stage visual function and self-reported visual anomalies in individuals at clinical high risk for psychosis (CHR-P). Eleven individuals at CHR identified via the Structured Interview for Psychosis-Risk Syndromes (SIPS) were recruited from a CHR-P research program in NYC. The sample was ~36% female, ranging from 16 to 33 years old (M = 23.90, SD = 6.14). Participants completed a contrast sensitivity task on an iPad with five spatial frequencies (0.41-13 cycles/degree) and completed the self-report Audio-Visual Abnormalities Questionnaire. Higher contrast sensitivity (better performance) to low spatial frequencies was associated with higher perceptual (r = 0.616, p = 0.044) and visual disturbances (r = 0.667, p = 0.025); lower contrast sensitivity to a middle spatial frequency was also associated with higher perceptual (r = -0.604, p = 0.049) and visual disturbances (r = -0.606, p = 0.048). This relation between the questionnaire and contrast sensitivity to low spatial frequency may be indicative of a reduction in lateral inhibition and "flooding" of environmental stimuli. The association with middle spatial frequencies, which play a critical role in face processing, may result in a range of perceptual abnormalities. These findings demonstrate that self-reported perceptual anomalies occur in these individuals and are linked to performance on a measure of early visual processing.

The full spectrum of clinical stages of psychosis at prison entry: prevalence and concurrent validity of symptom screening.

Despite the high rates of psychotic disorders amongst people in prison, current prison mental health screening approaches have not included assessment of the full psychosis spectrum to capture those at-risk of an emerging psychosis as well as those with established illness nor assessed the concurrent validity of psychosis symptom screening. Using a clinical staging approach to establish the prevalence of Ultra High Risk (UHR), first episode of psychosis (FEP) and established psychosis (EP) groups, 291 adults entering custody in two prison reception centres in NSW completed a two-stage (screening and validation) interview process. The Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to determine the clinical stages of psychosis and concurrent validity of symptom screening in identifying individuals on the psychosis spectrum was formally assessed. Amongst men and women entering prison, almost one quarter (24.1%) met UHR criteria, 5.1% met the FEP threshold and 10.6% had an established psychosis. Those on the psychosis spectrum reported greater disadvantage across sociodemographic and justice factors. The presence of perceptual disturbance and paranoid beliefs emerged as the two best screening items for identifying those with an underlying psychosis spectrum illness. The prevalence of psychosis spectrum illness, including the UHR state, amongst those entering prison is high. Current prison mental health approaches should include screening for the presence of perceptual disturbances and paranoid beliefs to improve the detection of psychosis spectrum illness.

Determination of Nutritional Status, Biochemical Parameters and Stroke Severity in Acute Ischemic Stroke Patients: A Cross-Sectional Study

Nutritional problems and nutritional deficiencies resulting from impaired consciousness, dysphagia, fatique and perceptual disturbances can frequently be observed in ischemic stroke patients after acute stroke. Weight loss in patients with dysphagia can often cause malnutrition. This study was conducted to determine the severity of stroke and nutritional status in acute ischemic stroke patients and to screen the risk of malnutrition. In this study, the nutritional status of ischemic stroke patients was evaluated with NRI and NRS 2002 and some biochemical parameters were examined from the patient file. All patients had moderate to severe ischaemic stroke (NIHSS: 9.9±2.51) and the majority were at risk of malnutrition according to NRS 2002 (92.3% vs. 93.8%, p=0.55). The majority of acute ischaemic stroke patients were found to be moderately malnourished (moderate risk, 52.4%), followed by mild malnutrition risk (23.8%) according to NRI risk score. Patients had low levels of albumin (3.1±0.58 g/dL), prealbumin (13.0±5.40 mg/dL), and hemoglobin (11.6±2.34 g/dL). Total cholesterol (188.7±35.43), triglycerides (134.2±57.43 mg/dL), and LDL (118.7±31.42 mg/dL) were within normal limits, while HbA1c (6.8±2.40) and fasting plasma glucose (150.0±69.00 mg/dL) levels were high. As a result, this study highlights the importance of malnutrition assessment and monitoring of biochemical parameters.

Associations of Cognitive Expectancies With Auditory Hallucinations and Hallucinatory-Like Experiences in Patients With Schizophrenia.

Various neurocognitive models explore perceptual distortions and hallucinations in schizophrenia and the general population. A variant of predictive coding account suggests that strong priors, like cognitive expectancy, may influence perception. This study examines if stronger cognitive expectancies result in more auditory false percepts in clinical and healthy control groups, investigates group differences, and explores the association between false percepts and hallucinations. Patients diagnosed with schizophrenia with current auditory hallucinations (n = 51) and without hallucinations (n = 66) and healthy controls (n = 51) underwent the False Perception Task under various expectancy conditions. All groups were examined for the presence and severity of hallucinations or hallucinatory-like experiences. We observed a main effect of condition across all groups, ie, the stronger the cognitive expectancy, the greater the ratio of auditory false percepts. However, there was no group effect for the ratio of auditory false percepts. Despite modest pairwise correlations in the hallucinating group, the ratio of auditory false percepts was not predicted by levels of hallucinations and hallucinatory-like experiences in a linear mixed model. The current study demonstrates that strong priors in the form of cognitive expectancies affect perception and play a role in perceptual disturbances. There is also a tentative possibility that overreliance on strong priors may be associated with hallucinations in currently hallucinating subjects. Possible, avoidable confounding factors are discussed in detail.

Het Alice in Wonderland-syndroom en psychotische ervaringen: een differentiaaldiagnostische uitdaging

Alice in Wonderland syndrome and psychotic experiences: a challenging differential diagnosis Alice in Wonderland syndrome (AIWS) is an understudied condition associated with a variety of symptoms, from visual and somesthetic perceptual distortions to disturbances in time perception and symptoms in the psychotic spectrum. The syndrome is pathophysiologically associated with cortical dysfunction in sensory brain areas. When AIWS symptoms occur, possible underlying neurological conditions should be investigated as they may be amenable to treatment. From a psychiatric perspective, distinguishing it from disorders within the psychotic spectrum poses a challenge. This article aims to clearly describe the phenomenology and definition of AIWS and to explore whether a strict differential diagnosis with psychotic experiences is possible. To the best of the authors’ knowledge, psychiatric disorders have to this date only been associated with AIWS in adults. A case of a 14-year-old girl with depression and subclinical psychotic symptoms with an unclear origin of AIWS is presented. Presumably, there was a looping effect and the subclinical psychotic symptoms were mistakenly identified as AIWS symptoms. Due to substantial differences in prognosis and treatment, the authors want to emphasize the importance of differentiating AIWS from a (subclinical) psychotic syndrome. It is crucial to thoroughly examine each individual AIWS symptom phenomenologically in all its facets. Additionally, clinicians should be aware of the influence of the looping effect.

Enfacement illusions: Filling a knowledge gap in eating disorder risk assessment, prevention, and intervention?

Body image disturbance (BID) is central to eating disorders (EDs), yet the role of self-face perception has received limited empirical attention despite rising sociocultural pressures emphasizing facial appearance through technologies such as social media. Emerging evidence suggests impairments in self-face recognition accuracy and distorted perceptions of facial appearance among individuals with EDs. Enfacement illusions, involving the experimental induction of perceived ownership over another's face, offer a novel paradigm to comprehensively investigate the perceptual multisensory integration processes underlying self-face perception disturbances in ED populations. Such an approach may hold promise for elucidating core pathological mechanisms contributing to BID and ED psychopathology. We discuss how rigorous investigation of self-face perception through the enfacement illusion paradigm represents an innovative direction of research and/or clinical application that may advance etiological models of EDs and possibly inform interventions targeting the potentially multidimensional nature of body and facial image disturbances characterizing EDs. PUBLIC SIGNIFICANCE STATEMENT: Body image disturbance is central to eating disorders (EDs), yet, the role of face-related disturbances remains critically under-investigated. After summarizing findings on face-related disturbances in EDs we propose how enfacement illusions (i.e., the experimental induction of ownership over another's face) may elucidate self-face perception disturbances in EDs, and their underlying mechanisms. Enfacement illusions may also offer an intervention to potentially address multifaceted face and body image disturbances characterizing EDs.

Body awareness disturbances in patients with low back pain: a systematic review.

The pain-neuroscience literature has recently emphasized body perception or awareness. Impaired body perception results have been reported in many different chronic pain problems. Studies have reported that individuals with low back pain (LBP) also have body perception disturbances related to the lumbar spine. This review aimed to determine the evidence that body awareness alterations in individuals with LBP. Systematic review. Studies were searched in PubMed, Cochrane Library, and Pedro databases up to January 2021. Each database was searched independently, according to a specific iteration research string. The protocol record of the systematic review was entered into the PROSPERO system. Nine studies were included in this research. We found evidence to support more perceptual impairments in patients with LBP than healthy counterparts. In addition, the results of the studies showed an association between disrupted body awareness and pain severity, pain catastrophizing, and disability. Body perception disturbances in LBP seem to be a promising path that needs to be further explored, with the ultimate goal of developing treatment contents targeting body awareness as a more comprehensive and valid evaluation and therapeutic method. The registration number was CRD42021235934.

Bipolar I disorder and anxiety disorder with spontaneous ejaculations

Anxiety and ejaculation share similar sympathetic neuronal pathways and hence they may coincide. In this case report, we describe a 30-year-old male with ongoing perceptual disturbances and spontaneous ejaculations that occur without sexual arousal. The patient ultimately benefited from pharmacological therapy with risperidone.

First episode psychosis in a young person with a diagnosis of Autistic Spectrum Disorder: A Case report

IntroductionPsychotic disorders are significant comorbidities in young people with Autistic Spectrum Disorder (ASD). Evidence suggests that ASD &amp; psychosis present with overlapping clinical features &amp; cognitive symptoms leading to misdiagnosis (Trevisan et al. Front.Psych 2020;11:548). Clinicians encounter diagnostic dilemma during assessment of psychosis in adolescents with ASD.ObjectivesTo discuss the clinical challenges in the assessment &amp; treatment of young people with ASD &amp; comorbid psychosis.MethodsA case report of a young girl with ASD &amp; comorbid psychotic illness.ResultsA young girl with ASD was admitted to CAMHS inpatient Unit with unusual beliefs &amp; perceptual disturbances. She reported hearing the voice of ‘Hydrogis’ who was talking to her about his girlfriend. She made a voodoo doll &amp; tried to set it on fire, as she believed that this would kill the girlfriend. She also heard voices of characters from a TV show, discussing her in third person. She absconded from home due to the distress associated. She attempted suicide by tying a ligature. She was seen responding to external stimuli, laughing incongruously &amp; was thought disordered. Despite never being to USA, she spoke in American accent. She lacked insight &amp; struggled to differentiate reality from fantasy. The aim of admission was to determine if the symptoms were part of ASD or a psychotic disorder. She had medication free assessment but continued to be very distressed. We commenced Aripiprazole which was optimised. She responded well to the treatment &amp; was discharged to the care of Early Intervention in Psychosis team with partial remission of symptoms.ConclusionsHistorically psychotic illnesses &amp; ASD were thought to be closely linked. Research suggest that they are two separate disorders with specific onset, progress, signs &amp; symptoms. ASD might be misdiagnosed as psychosis as difficulties in communication may resemble thought disorder, ‘melt down’ may mimic catatonia &amp; difficulties in recognising others’ intentions may mimic paranoia. Our patient was experiencing first episode psychosis in late adolescence. This age of onset is consistent with research findings. A study to differentiate between ASD &amp; psychosis found that positive symptoms like hallucinations &amp; delusions were suggestive of psychosis while odd emotional gestures, stereotyped speech &amp; restricted interests indicated ASD. Our patient predominantly had positive symptoms of delusions, hallucinations &amp; thought disorder, hence our diagnosis of psychotic episode. In some cases, it is difficult to differentiate childhood fantasies from delusional beliefs (Ribolsi et al. Front.Psych 2022;13:768586). Bleuler explains that children with ASD replace imperfect realities with imaginations &amp; hallucinations but Michael Rutter claims that autistic children lack fantasy. There are varying views on this subject &amp; this is the challenge we faced when treating this young person.Disclosure of InterestNone Declared

Exploring the legacy of Ibn Imrân’s Treatise on melancholia in contemporary psychiatry

IntroductionMelancholia is a concept deeply intertwined with the history of mood disorders in psychiatry. Isháq Ibn Imrân, a prominent Arab-Muslim physician of the 12th century, contributed significantly to the understanding of melancholia in his era, its. His treatise is the oldest surviving work entirely dedicated to melancholia, making it a pivotal milestone in the history of psychiatry. It is noteworthy that Ibn Imrân’s work has often been overlooked in Western psychiatry. This oversight highlights the enduring relevance of his insights within the context of modern psychiatry.ObjectivesThe objective of this study is to assess the clinical and therapeutic aspects delineated by Ibn Imrân in his treatise on melancholia for their contemporary accuracy and relevance within the field of modern psychiatry.MethodsThe review method for the Isháq Ibn Imrân treatise involves a detailed analysis of the original Arabic text and its French translation by Adel Omrani and Radhi Jazi from the Tunisian Academy of Sciences, Letters, and Arts Beit el Hekma. This includes studying the content, structure, and historical context, as well as comparing the Arabic and French versions for accuracy.ResultsThe treatise is divided into two parts to clinical examination and treatment. While some of the terminology may differ from contemporary classifications, the core observations resonate with modern psychiatric knowledge. The clinical form is described as sadness, loss of pleasure, social withdrawal, dark thoughts, and loss of interest, along with somatic manifestations: sleep disturbances such as onset insomnia or hypersomnia, as well as weight loss. Additionally, perceptual disturbances, including elementary visual hallucinations (black silhouettes), are mentioned. Regarding etiologies, perinatal factors are mentioned in the treatise (“mood of the uterus”), along with six postnatal acquired causes that must be balanced in an individual: movement and rest, sleep and wakefulness, food and drink, depletion and retention, ambient air and location and psychological torment. A seasonal pattern is described, with an association between melancholia and autumn. Several clinical forms are described, with the most prominent being catatonia compared to epilepsy, in its two agitated and inhibited forms. The second part of his treatise is dedicated to treatment, focusing on individualized approaches such as talk therapy, music therapy, and dietary interventions. Ibn Imrân also describes mental strategies to correct false beliefs. For the pharmacological treatment, specific herbs has been used via oral, nasal, or intra-rectal.ConclusionsIn conclusion, Isháq Ibn Imrân’s treatise on melancholia represents a timeless cornerstone in the history of psychiatry. This historical treasure serves as a reminder of the enduring quest to understand and alleviate the complexities of mental health.Disclosure of InterestNone Declared

Uncinate fasciculus microstructural organisation and emotion recognition in schizophrenia: controlling for hit rate bias.

Schizophrenia (SCZ) is a complex neurodevelopmental disorder characterised by functional and structural brain dysconnectivity and disturbances in perception, cognition, emotion, and social functioning. In the present study, we investigated whether the microstructural organisation of the uncinate fasciculus (UF) was associated with emotion recognition (ER) performance. Additionally, we investigated the usefulness of an unbiased hit rate (UHR) score to control for response biases (i.e., participant guessing) during an emotion recognition task (ERT). Fifty-eight individuals diagnosed with SCZ were included. The CANTAB ERT was used to measure social cognition. Specific ROI manual tract segmentation was completed using ExploreDTI and followed the protocol previously outlined by Coad et al. (2020). We found that the microstructural organisation of the UF was significantly correlated with physical neglect and ER outcomes. Furthermore, we found that the UHR score was more sensitive to ERT subscale emotion items than the standard HR score. Finally, given the association between childhood trauma (in particular childhood neglect) and social cognition in SCZ, a mediation analysis found evidence that microstructural alterations of the UF mediated an association between childhood trauma and social cognitive performance. The mediating role of microstructural alterations in the UF on the association between childhood trauma and social cognitive performance suggests that early life adversity impacts both brain development and social cognitive outcomes for people with SCZ. Limitations of the present study include the restricted ability of the tensor model to correctly assess multi-directionality at regions where fibre populations intersect.

Associations between disturbed sleep and attenuated psychotic experiences in people at clinical high risk for psychosis.

Pre-diagnostic stages of psychotic illnesses, including 'clinical high risk' (CHR), are marked by sleep disturbances. These sleep disturbances appear to represent a key aspect in the etiology and maintenance of psychotic disorders. We aimed to examine the relationship between self-reported sleep dysfunction and attenuated psychotic symptoms (APS) on a day-to-day basis. Seventy-six CHR young people completed the Experience Sampling Methodology (ESM) component of the European Union Gene-Environment Interaction Study, collected through PsyMate® devices, prompting sleep and symptom questionnaires 10 times daily for 6 days. Bayesian multilevel mixed linear regression analyses were performed on time-variant ESM data using the brms package in R. We investigated the day-to-day associations between sleep and psychotic experiences bidirectionally on an item level. Sleep items included sleep onset latency, fragmentation, and quality. Psychosis items assessed a range of perceptual, cognitive, and bizarre thought content common in the CHR population. Two of the seven psychosis variables were unidirectionally predicted by previous night's number of awakenings: every unit increase in number of nightly awakenings predicted a 0.27 and 0.28 unit increase in feeling unreal or paranoid the next day, respectively. No other sleep variables credibly predicted next-day psychotic symptoms or vice-versa. In this study, the relationship between sleep disturbance and APS appears specific to the item in question. However, some APS, including perceptual disturbances, had low levels of endorsement amongst this sample. Nonetheless, these results provide evidence for a unidirectional relationship between sleep and some APS in this population.

Reduced body-image disturbance by body-image interventions is associated with neural-response changes in visual and social processing regions: a preliminary study.

Body-image disturbance is a major factor in the development of eating disorders, especially among young women. There are two main components: perceptual disturbance, characterized by a discrepancy between perceived and actual body size, and affective disturbance, characterized by a discrepancy between perceived and ideal body size. Interventions targeting body-image disturbance ask individuals to describe their own body without using negative expressions when either viewing it in a mirror or imagining it. Despite the importance of reducing body-image disturbance, its neural mechanisms remain unclear. Here we investigated the changes in neural responses before and after an intervention. We hypothesized that neuralresponses correlated with the degree of body-image disturbance would also be related to its reduction, i.e., a reduction in perceptual and affective disturbances would be related to changes in attentional and socio-cognitive processing, respectively. Twenty-eight young adult women without known psychiatric disorders underwent a single 40-min intervention. Participants completed tasks before and after the intervention, in which they estimated their perceived and ideal body sizes using distorted silhouette images to measure body-image disturbance. We analyzed the behavioral and neural responses of participants during the tasks. The intervention did not significantly reduce body-image disturbance. Analysis of individual differences showed distinct changes in neural responses for each type of disturbance. A decrease in perceptual disturbance was associated with bodily visuospatial processing: increased activation in the left superior parietal lobule, bilateral occipital gyri, and right cuneus. Reduced affective disturbance was associated with socio-cognitive processing; decreased activation in the right temporoparietal junction, and increased functional connectivity between the left extrastriate body area and the right precuneus. We identified distinct neural mechanisms (bodily visuospatial and socio-cognitive processing) associated with the reduction in each component of body-image disturbance. Our results imply that different neural mechanisms are related to reduced perceptual disturbance and the expression thereof, whereas similar neural mechanisms are related to the reduction and expression of affective disturbance. Considering the small sample size of this study, our results should be regarded as preliminary.

Characterizing clinical progression in patients with musculoskeletal pain by pain severity and central sensitization-related symptoms

Central sensitization-related symptoms (CSS) are associated with the severity and progression of pain. The relationship between the severity of pain/CSS and clinical progresses remains unclear. This multicenter, collaborative, longitudinal study aimed to characterize the clinical outcomes of patients with musculoskeletal pain by classifying subgroups based on the severity of pain/CSS and examining changes in subgroups over time. We measured the pain intensity, CSS, catastrophic thinking, and body perception disturbance in 435 patients with musculoskeletal pain. Reevaluation of patients after one month included 166 patients for pain intensity outcome and 110 for both pain intensity and CSS outcome analysis. We classified the patients into four groups (mild pain/CSS, severe pain/mild CSS, severe pain/CSS, and mild pain/severe CSS groups) and performed multiple comparison analyses to reveal the differences between the CSS severity groups. Additionally, we performed the adjusted residual chi-square to identify the number of patients with pain improvement, group transition, changing pain, and CSS pattern groups at baseline. The most characteristic result was that the mild and severe CSS groups showed worsening pain. Moreover, many of the group transitions were to the same group, with a few transitioning to a group with mild pain/CSS. Our findings suggest that the severity and improvement of CSS influence pain prognosis.

Hospital Hallucinosis - where to look for the cause of the delirious syndrome in a geriatric patient and what management to implement

Delirium syndrome is a serious, and often underestimated, problem arising in elderly patients. The number of accurate diagnoses of this acute condition is significantly lower than actuall present. This is often due to the attribution of its symptoms to the underlying disease. Delirium syndrome, by leading to perceptual disturbances in the patient, impairs his functioning and threatens health and even life of a patient. The pathophysiology of the onset of delirium is not well understood, with many factors influencing its development. Those directly related to the patient (predisposing), as well as triggering factors. In geriatric patients, the risk of developing delirium is much higher than in younger patients due to the depletion of the body's functional reserves. Homeostasis of the body's systems is disturbed even with small negative stimuli. It is important to closely observe the patient, taking a well-gathered history of the patient's baseline health status and the changes that have occurred in the patient's condition. A well-conducted physical examination and diagnostic imaging is essential. There is no universal scheme for managing a patient who is delirious. It is important to take an personalized approach and quickly find the cause and try to treat it. We can use commonly available scales and guidelines for diagnosing the delirious syndrome, such as ICD-10, DSM-5 or CAM, to make the accurate diagnosis easier. It has been shown that with the help of non-pharmacological preventive management, we can significantly reduce the number of consciousness disorders that appear in elderly patients under the course of delirium. In severe cases, pharmacotherapy comes to our aid.