Persecutory Delusions Research Articles

Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review.

Virtual reality (VR) has emerged as a safe and non-invasive technology for the assessment of psychotic symptoms, social and cognitive impairments, and psychosocial intervention in improving outcomes in psychosis. This study systematically reviewed the current state of evidence in applying semi- and fully immersive VR for assessing and treating patients with psychosis. A systematic review was conducted adhering to the PRISMA statement and was conducted in Embase, PsycINFO, and PubMed databases for articles published between January 2013 and April 2022, which identified 28 eligible studies, including 12 for assessment and 16 for intervention. In the assessment studies, not all VR tasks could distinguish the differences between patients and healthy controls regarding their physiological responses, paranoid ideation, and certain aspects of cognitive functioning such as memory bias on the object tasks. Comparatively, VR-based interventions are more promising, especially for improving cognitive impairments, social skills, agoraphobic avoidance, negative and positive affective states, auditory verbal hallucination, paranoid ideation and persecutory delusions, and other psychiatric symptoms in patients. We conclude that more rigorous studies are needed to confirm treatment effectiveness and to understand the underlying mechanism of VR-based intervention for psychotic disorders. Future studies should also improve the reliability and validity of VR-based assessments for psychotic disorders.

LIVING IN A DOLL HOUSE: A CASE REPORT AND LITERATURE REVIEW OF REDUPLICATIVE PARAMNESIA

Introduction Reduplicative paramnesia (RP) is a very rare content-specific delusional misidentification syndrome (DMS). RP entails the delusion that a place, an object, or an event has been duplicated or exists in two different places at the same time. RP is thought to result from an organic rather than psychiatric cause distinguishing it from other DMS. It has been suggested that damage to the right frontal and temporal lobe plays a crucial role, although other areas involved in visuospatial processing have also been reported.ObjectivesThe aim of this study is to review the literature and report a clinical case of RP.MethodsWe describe a case of an 81 year old woman admitted in a Neurology ward, with a 2 week clinical presentation of temporo-spatial disorientation, behavioural changes, persecutory delusions and reduplicative paramnesia phenomena concerning her house. She had previous history of a stroke 3 years prior to admission and, about one year before, the patient also started to present cognitive decline in the context of Parkinson’s dementia. One month before admission, treatment with Rotigotine was started and later suspended when the aforementioned clinical manifestations started. Upon admission it was diagnosed an urinary tract infection and treatment with antibiotics was started. Two days afterwards, the patient recovered orientation and her usual behaviour, but persecutory delusions and RP persisted. She then started treatment with low dose Olanzapine. Following 2 weeks of treatment the psychotic symptoms fully remitted, including RP.ResultsWe underline CT-scan and EEG relevant findings upon admission. In the CT-scan sequelar lesions in left frontoparietal junction, right posterior frontal cortex, left inferior occipital cortex, bilateral cerebellar hemispheres, left caudate nucleae and thalamus were identified. The EEG showed a preserved posterior alpha rhythm associated with slow discontinuous right temporal and mainly left parieto-temporo-occipital activity, indicating dysfunction in these locations.ConclusionsIn line with literature our patient had lesions in the right frontal and temporal lobe. She also presented lesions in other areas involved with visuospatial processing. Particularly the involvement of the left hemisphere reported in our case seems to be an exception. Other factors potentially played a role triggering this episode, namely the cognitive compromise due to dementia interposed with infectious disease, and the rotigotine treatment as well. Another aspect worth mentioning in our case was the remission of symptoms with the use of Olanzapine, even though only a few cases in literature have fully remitted with treatment with antipsychotics.Disclosure of InterestNone Declared

Frequency and characteristics of delusions and hallucinations in first admitted patients.

IntroductionDelusions and hallucinations are common in schizophrenia and related psychotic disorders and they are frequently reported at the first admission to psychiatry departments.ObjectivesThe study aims to examine the themes and frequency of delusions and hallucinations in first admitted patients.MethodsInformation was collected retrospectively from selected medical files of patients who were admitted for the first time to the department of psychiatry "A" of the university hospital Hedi Chaker, in Sfax, during the years 2020 and 2021.ResultsNinety patients were included in our study. Their mean age was 34.79 ± 11.4 years, with a sex ratio (M/F) = 1.3. They reached high school in 51.1% of the cases. Half of the patients were smokers, 30% used alcohol and 16.7% used cannabis.The average age of onset of the disorders was 30.36 years, and the duration of evolution of the illness before hospitalization was 56.54 days. The most common reason for hospitalization was environmental violence (62.5%). The diagnosis of schizophrenia was retained in 32.2% of the cases, and that of bipolar disorder in 23.3% of the cases.At initial presentation to the ward, 72.2% of patients were found to have delusional beliefs. The most commonly held delusions were delusions of persecution (62.2%), reference (28.9%) bewitchment (27.8%) and grandiosity (26.7%) with changes of behavior in 34.4 % of the patients in response to their delusional beliefs.Hallucinations reported by 43.3% of the patients were mainly auditory (30%), visual (20%) and 15.6% reported hearing internal voices. Olfactory hallucinations were only reported by 3.3% of the patients.ConclusionsDelusions of persecution and reference appear to be the main delusional themes in this patient group. Auditory hallucinations were also commonly reported.A better awareness of clinical presentations of the first admitted patients may aid early identification of the illness and engagement of the patients in the treatment process.Disclosure of InterestNone Declared

Acute confusional state in paediatric age - Case Report

Introduction Acute confusional state (ACS) or delirium is an acute neuropsychiatric syndrome due to an underlying organic pathological process. Despite its high prevalence, delirium can present a diagnostic challenge, particularly in paediatric patients. ACS can be defined as sudden impairment of mental status in a previously healthy child. The impairment varies; it may be global and severe or very specific and mild, such as impairment of short-term memory in “transient global amnesia.” The most common causes of ACS in the paediatric population are high fever, drugs, traumatic brain injury (TBI), and infection and inflammation of the nervous system. Traumatic brain injury is usually associated with some impairment of consciousness, although recovery can vary depending on the severity of the trauma. Objectives The aim of this work is to revisit the diagnostic approach and management of ACS associated with traumatic brain injury in the paediatric population. Methods Case report of an acute confusional state, secondary to a TBI and a non-systematic review of the literature. Results A 17-year-old female was admitted to the emergency department after being injured in a car accident. She was drowsy but easily awakened. She was conscious and partially oriented in time and space. She had amnesia for the episode. She spoke fluently and coherently but was hesitant regarding the hours before the accident, which was probably due to memory impairment. She exhibited sporadic hetero-aggressive behavior during the first few hours of the examination. She had no other thought or perceptual disorders. Head CT scan showed “a thin collection of blood from the frontal interhemispheric area and a discrete subarachnoid sulcal frontobasal hemorrhage, with no other significant changes.” Toxicology tests were positive for THC, cocaine, and MDMD and negative for blood alcohol. A forensic medical examination was required. After 48 hours of vigilance and improvement, she was discharged with a booked re-evaluation within a week. At the second evaluation, her mother described a change in her usual behavior with disorientation, drowsiness, difficulty managing daily life, and memory impairment. She had persecutory delusions regarding the physicians and was very agitated. She was admitted to a child and adolescent psychiatric hospital for further evaluation and stabilization. After 72 hours of inpatient stay, she fully recovered, receiving low-dose risperidone daily. She was discharged with the diagnosis of delirium due to another medical condition (TBI), acute, hyperactive. Since discharge, symptoms have not recurred even after discontinuation of antipsychotic medication. Conclusions Clinically, ACS can be divided into hypoactive, hyperactive, and mixed level of activity. Hyperactive forms may manifest as varying degrees of psychomotor agitation. With this case report, we’d like to raise awareness of ACS so that it’s diagnosed and treated correctly and in a timely manner. Disclosure of Interest None Declared

Stigma and self-stigma in patients with delusional disorder: a systematic review.

IntroductionThe association between insight, stigma and self-concept has been considered as a potential predictor of poor clinical outcomes and global functioning in psychosis. In patients with delusional disorder (DD), the effects of stigma and self-stigma have been poorly explored.ObjectivesOur main goal was to systematically review studies addressing stigma and self-stigma in DD to assess whether these phenomena have an impact on clinical symptoms.MethodsA systematic review was conducted through PubMed and Google Scholar databases from inception to 2022 (PRISMA guidelines). Search terms: (Stigma OR self-stigma) AND (“delusional disorder” OR psychosis OR paranoia). Studies were considered eligible if they included patients with DD.ResultsA total of 875 records were retrieved, from which 18 were included.Stigma: (1) Stigma is associated with poor quality of life, poor adherence to medications and acceptation of diagnosis. (2) Support at workplaces would improve stigma and discrimination in DD. (3) Poor interpersonal competence may increase stigma experience in DD.Self-stigma: (1) Women show higher level of self-stigma than men. (2) Higher rates of psychiatric hospitalizations and higher severity of symptoms associated with greater degree of self-stigma. (3) Suicidal ideation was associated with negative self-schema but not self-stigma, particularly in patients with persecutory delusions. (4) Self-stigmatization negatively associated with quality of life. (5) Depressive symptoms associated with higher levels of self-stigma. (6) Promotion interventions should address self-stigma content.ConclusionsFurther longitudinal studies are needed to test the influence of stigma and self-stigma on adherence to follow-up and specific interventions to improve them.Disclosure of InterestNone Declared

Psychosis in Parkinson’s Disease: a Case Report of Diagnosis and Management

IntroductionPsychosis is a frequent complication in patients diagnosed with Parkinson’s Disease (PD). Characterized mainly by visual hallucinations and paranoid delusions, it occurs most frequently, but not exclusively, as an adverse effect of antiparkinson medications. Nevertheless, cognitive impairment and dementia, as a frequent feature of PD, needs to be considered for differential diagnosis.ObjectivesOur main objective is to report a case of PD Psychosis, its diagnosis and management and complement it with a non-systematic review of literature.MethodsPatient file consultation and an additional research, based on the key words “Psychosis” and “Parkinson’s Disease”, using Pubmed as database.ResultsA 53-year-old female, diagnosed with Juvenile Parkinson’s Disease since age 45 and, as expected, polimedicated with antiparkinson medication. Without any relevant psychiatric background, she was admitted to the emergency department for disorganized behaviour, with 2 weeks of evolution. There, it was also possible to determine the presence of auditive hallucinations and persecutory delusions, associated with marked anguish.After exclusion of any underlying cause for this symptomatology, inpatient treatment was proposed and accepted by the patient. In collaboration with the Neurology Department, a gradual reduction and optimization of antiparkinson drugs was conducted, associated with introduction of low doses of antipsychotic drugs, in this case Olanzapine. With this medication adjustments, clinical improvement was accomplished, with eventual fading and cessation of psychotic symptoms. Additionally, an irregularly intake of antiparkinson drugs was considered the most probably cause of this clinical decompensation.ConclusionsAs present in literature, due to the chronicity and complexity of PD, stopping all antiparkinson drugs is not an option, even when psychotic symptoms, that could be a consequence of these drugs, are present. Therefore, a rigorous evaluation and management are mandatory, including the exclusion of other underlying causes and a careful therapeutic adjustment, with gradual reduction of antiparkinson drugs, addressing an eventual temporal relationship between the beginning of a specific drug and the onset of symptoms, and verification of therapeutic compliance, including an involuntary overdose. In cases of refractory symptoms, and after a risk-benefit assessment, pharmacologic treatment directed at these symptoms, low doses of anti-psychotics, may be necessary.Disclosure of InterestNone Declared

Migration, perceived discrimination and the development of psychosis

IntroductionMigration is a rapidly growing phenomenon in European countries and its association with psychotic disorders is a public health concern. Psychosis is more prevalent among migrants, which suggests that adverse social experiences play an important role in its pathogenesis. Throughout the migration process, migrants are exposed to several social disadvantages, including in the post-immigration context, where perceived discrimination appears to be an important stressor. In fact, the highest incidence rates of psychosis occur in the most discriminated populations, namely migrants with darker skin complexion, particularly when living in low-ethnic-density neighborhoods, where both discrimination and social isolation are more prominent.ObjectivesTo conduct an updated review about the association between migration, perceived discrimination and psychosis, aiming to better understand the mechanisms involved.MethodsNarrative literature review using the keywords “migration”; “psychosis”; “discrimination”; “racism” on PubMed database, in conjunction with presentation of a clinical case concerning a patient from Guinea-Bissau, admitted to our hospital in the context of first-episode psychosis (FEP), with onset months after completing the Mediterranean migration route to Europe.ResultsLiterature suggests that experiences of racism and social exclusion contribute to feelings of imminent danger, fear and general anxiety, which may develop into paranoid ideas of ubiquitous persecution. Furthermore, intense social defeat experiences, common in migrants, are associated with more distressing forms of delusional content, with delusions of psychological persecution being more common. However, there is also evidence that migrants with FEP have better occupational and social functioning profiles compared to natives, suggesting that, in these patients, there is a higher burden of social-environmental risk factors, with the onset of psychosis occurring only when this burden overcomes a higher threshold. Our patient fits this description. After completing his migratory route and while living in an Italian refugee camp, he described suffering experiences of severe discrimination. Real or not, these experiences escalated to become delusional ideas of persecution involving European governments, thought to seek for his humiliation. Despite the presence of psychotic symptoms, this patient was able to maintain a reasonable level of functioning during years, up to his psychiatric admission.ConclusionsGiven the notorious effect of perceived discrimination and racism on the increased risk of psychosis in immigrants, it is urgent to adopt policies that promote the social protection of these vulnerable groups, namely through enhancing their integration in the host countries.Disclosure of InterestNone Declared

A Case Report of Low-Dose Steroid Induced Psychosis in an Older Adult with Rheumatoid Arthritis

IntroductionRheumatoid arthritis (RA) is typically known for its intra-articular manifestations in the joints, and steroids are considered one of the first-line medications for it. Steroids are known for neuropsychiatric manifestations, but it is rarely reported in low-dose steroids.Objectives We describe a case of psychosis in an older adult with RA precipitated by low-dose prednisone with no past history of neuropsychiatric symptoms from steroids in the past five years.MethodsMiss X is a 63-year-old female with past history of RA, major depressive disorder, hypothyroidism, chronic obstructive pulmonary disease, and hypertension, presented with one-week history of irritable mood, increased psychomotor agitation, decreased need for sleep and appetite, and delusions of grandeur and persecution. Her depression had been treated with oral duloxetine 60mg twice daily, oral buspirone 10mg at night, and oral trazodone 150mg at night. She did have a urinary tract infection a week prior, but the psychotic symptoms persisted with antibiotic treatment. Miss X had also been on a monthly taper regimen of low-dose oral prednisone for RA (from 15mg to 5mg) for the past three months and had completed the regimen one week ago. On mental status examination, she was alert and oriented to time, place, and person. Her mood was irritable with lability. She demonstrated tangential speech along with persecutory and grandiose delusions. Attention and concentration was normal with intact immediate and remote memory and impaired recent memory. Abstract ability, judgment, and insight were impaired. Physical examination and vital signs were within normal limits. Laboratory investigations of complete blood count, urine analysis, urine drug screen, thyroid function panel, renal function panel, hepatic function panel, serum sodium, potassium, calcium, thiamine, vitamin B12, folate, and vitamin D did not show any significant abnormalities.ResultsMiss X was admitted to the inpatient psychiatric unit with the diagnosis of medication-induced psychotic disorder, with onset after medication use as per The Diagnostic and Statistical Manual of Mental Disorders 5th edition- Text Revision. Oral olanzapine 10mg at night and oral lithium 300mg twice daily was started along with her home medications of oral duloxetine 60 mg twice daily and oral trazodone 150mg at night. During hospital stay, oral olanzapine was gradually increased to 15mg in the night but had to be reduced back to 10mg in the night due to sedation. Miss X’s symptoms improved during hospital stay and she was discharged on the 13th day of hospitalization with the same psychotropic medication regimen.ConclusionsOur case demonstrates the need for caution in prescribing steroids in older adults as it can precipitate neuropsychiatric symptoms even with a change in use or after withdrawal of steroids.Disclosure of InterestNone Declared

A frontotemporal dementia-like case after high-altitude climbing

BackgroundWe report a case who developed long-term neuropsychiatric sequelae similar to frontotemporal dementia after suffering a "high altitude sickness" while climbing a high mountain without taking precautions against acute hypoxia.Case presentationThe 57-year-old patient showed symptoms of acute mountain sickness after climbing 3500 m. A few months after descending the mountain, he developed symptoms such as loss of empathy, decreased speech, perseveration, echolalia, and increased interest in sugary foods. The patient's MRI and PET/CT results were consistent with frontotemporal neurodegeneration. After the start of donepezil, persecution delusions developed, and the clinical picture worsened. In the process, he developed visual agnosia and anomic aphasia. Although there was no significant change in personality traits at the beginning, the patient developed apathy, loss of inhibition, lack of empathy, progressive aphasia, and problems perceiving and expressing emotions. A significant loss of function occurred within 4 years. The patient met the criteria for "probable behavioral variant frontotemporal dementia", but was defined as a frontotemporal dementia-like case due to possible relevance to a medical condition affecting the brain.ConclusionsThis case suggests that clinicians should be more careful about the chronic consequences of high-altitude diseases and avoid cholinesterase inhibitors such as donepezil, as it can worsen behavioral symptoms of frontotemporal dementia-like symptomatology.

Two Cases of Schizophrenia Treated with Individualized Homoeopathy

Background: Schizophrenia is a chronic, debilitating psychiatric disorder which is one of the leading causes of disability worldwide and has a large impact on individuals, families and society. There is paucity of literature on usefulness of Homoeopathy in Schizophrenia.
 Cases summary: Two cases of Schizophrenia are assessed symptomatically using Positive and Negative Syndrome Scale (PANSS) and treated in Psychiatry Department of (blinded for review)
 Case no.1 (Paranoid Schizophrenia) presented with sleeplessness, irritable mood, referential and persecutory delusions, auditory and olfactory hallucinations and thought broadcasting. The case was analyzed according to Kent’s method and Lycopodium 30c was prescribed. PANSS score of 135 at baseline turned to 30(Normal) within 4 months and maintained for the next 24 months of observation period.
 Case no.2 (Catatonic Schizophrenia) presented with sleeplessness, laughing and crying alternately, not responding to questions, silly smiling, slow activities, need for compulsion to do her daily activities, standing like a statue for hours assuming strange postures, poor sociability and delusion that her body is split vertically into two. The case was managed acutely with Ignatia 200C followed by a dose of Phosphorus 200C as a constitutional remedy. PANSS score of 157 at baseline turned to 30 (Normal) within 3 months and maintained for 24 months.
 There is reduction of positive, negative and general symptoms along with good psycho-social adaptation. Causal attribution of changes in condition to the homoeopathic treatment was depicted by the Modified Naranjo Criteria score.
 Conclusion: Homoeopathic medicines selected on the basis of individualization are useful in the management of Schizophrenia.

Utilizing pharmacogenetics when treating first episode psychosis.

The parents of a 21-year-old man brought him to an emergency psychiatric clinic for disturbed behaviour. He displayed significant hallucinatory behaviour, prominent delusions of persecution involving “special forces” and notable disorganization of speech, and had experienced more than 8 months

Investigating Specific Associations Between Childhood Victimization Profiles and Positive Psychosis Symptoms: The Mediating Roles of Anxiety, Depression, and Schema.

Childhood trauma is a risk factor for psychosis. It is proposed this is due to traumatic events giving rise to psychological mechanisms that are implicated in the development and maintenance of symptoms. Investigation of the psychological mechanisms accounting for relationships between trauma and psychosis will be assisted by focusing on specific trauma profiles, hallucination modalities, and delusion subtypes. In 171 adults with schizophrenia-spectrum diagnoses and high-conviction delusions, associations between childhood trauma classes, and hallucination and delusion factors, were tested using structural equation models (SEMs). Anxiety, depression, and negative schema were examined as potential mediators of trauma class-psychosis symptom factor links. Significant associations were found between the emotional abuse/neglect and poly-victimization classes with persecutory delusions and delusions of influence, that were all mediated through anxiety (β = 1.24-0.23, P = < .05). There was an association between the physical abuse class and grandiose/religious delusions that was not explained by the mediators (β = 1.86, P = < .05). Trauma class was not significantly associated with any hallucination modality (β = 0.004-1.46, P = > .05). In a sample of people with strongly held delusions, this study demonstrates that childhood victimization is associated with delusions of influence and grandiose beliefs, as well as with persecutory delusions in psychosis. Consistent with previous findings, the potent, mediating role of anxiety supports affective pathway theories and the utility of targeting threat-related processes when treating trauma effects in psychosis.

Religious Intolerance, America, and the World: A History of Forgetting and Remembering

Religious Intolerance, America, and the World: A History of Forgetting and Remembering

Quashing Racism: Presenting the ‘comprehensive Socio-cultural Persecution Complex’ as a Logical Extension and a Practical Application of the Certainty Uncertainty Principle for the Social Sciences

Quashing Racism: Presenting the ‘comprehensive Socio-cultural Persecution Complex’ as a Logical Extension and a Practical Application of the Certainty Uncertainty Principle for the Social Sciences

Synthetic Cathinones in Belgium: Two Case Reports with Different Outcomes Observed in the Emergency Room.

We herein report two cases of cathinone intoxication. The first case is about a drug addict who was admitted to the emergency room after the injection of an unknown compound. He presented with tachycardia, palpitations, mydriasis, dyspnea, dizziness, headache and nausea. After leaving the hospital against medical advice, he returned the next day with police escort, presenting aggressiveness and agitation signs. One month later, he returned one more time for sleeping disorders, hallucinations and anxiety. He was finally transferred for his 21st detoxification treatment. The second case concerns a man who was wandering the streets and tried to escape when police officers called him. He confessed to snorting of N-ethylpentedrone and was admitted with severe agitation including delusion of persecution, tachycardia, mydriasis and fever. Because of renal failure, rhabdomyolysis and metabolic acidosis, he was transferred to the intensive care unit where he manifested worsening of the symptoms, turning into coma. He was intubated for 3 days before a complete resolution of the symptoms. A screening was performed by high-resolution mass spectrometry followed by quantifications made by high-performance liquid chromatography coupled with a diode array detector. In the first case, alpha-pyrrolidinohexiophenone was identified only during the first two admissions. However, as plenty of other psychotropic substances were also found, the cathinone alone could not be held directly responsible for the symptoms. In the second case, more than 2,000 ng/mL of N-ethylpentedrone was found without any decrease in the next 17 h, underlining the long half-life of this compound. Unlike the first case, symptoms could be clearly attributed to the cathinone. In conclusion, cathinones can be found on the Belgian illicit drug market, with various routes of administration and clinical consequences. In these two case reports, some common points were observed initially. However, one patient was finally able to leave the hospital without any treatment, whereas the other would most likely have died without intensive care.

Effects of autoimmune disorders on daily lifestyle

Systemic diseases of connective tissue are a group of diseases of unspecified aetiology and pathogenesis. They are based on the autoimmune process. It can involve single organs as well as whole systems. Neuropsychiatric complications in systemic connective tissue diseases are of interest to both neurologists and rheumatologists and specialists in other fields. These complications may occur with different frequency – from 30-80% and result from the involvement of individual structures of the central and peripheral nervous system. They can be divided into primary, i.e. resulting from the underlying disease, and secondary, which are most often the result of the applied treatment.&#x0D; The most common psychopathological symptoms include: progressive cognitive disorders, emotional lability, mood and sleep disorders, as well as memory disorders, psychosensory disorders, depersonalisation, derealisation, depressed mood, anxiety states, hallucinations, persecutory delusions. Diagnosing the cause of psychiatric disorders is the basis for introducing appropriate causal treatment, which should be supplemented by symptomatic psychiatric therapy.

Symptômes psychotiques dans l’épisode maniaque. Un regard de psychiatre libéral

Private practice requires particular vigilance with regard to signs of mood instability in patients with bipolar disorders, in particular the manic aspect, because of the risk of disruption in care. Between the episodes, psychotic symptoms can be sequels or prodroms and, if so, often stereotyped from one episode to the next. During the manic episode, mood-congruent symptoms (grandiosity, possessing superpowers, having a special relationship with God or with celebrities) are most common, but mood-incongruent symptoms (delusions of persecution, auditory hallucinations, first-rank Schneiderian symptoms) are not uncommon. In the absence of delusions or hallucinations, the clinician must be alert to a decline in insight, or when the patient shows symptoms of formal thought disturbances. For certain classical authors, mania was, by itself, a psychotic experience. The relationship between the severity of mania and the existence of psychotic symptoms is strong, but not exclusive. Some patients that have not completely stopped their treatment can have moderate symptoms of mania, albeit with some psychotic symptoms. Congruent and non-congruent psychotic symptoms may persist beyond the manic episode, raising the question of schizoaffective (SA) disorder when elements of a diagnostic criteria for schizophrenia are met. SA is a disputed diagnostic category, whose stability over time is unsatisfactory. The management of psychotic symptoms with mania is difficult in private practice: a clinical case of a female bipolar patient with erotomania before and during manic episodes illustrates the difficulties of management when the patient's insight fluctuates. The side-effects of treatments, a hypomanic switch, induced by an antidepressant despite two mood stabilizers (lithium, valproate), followed by a period of mood instability and a lack of medical coordination had contributed to an interruption in care. Statistical multivariate analyses and the grouping of symptoms and patients together with factor and network analyses suggest a partial independence of psychotic symptoms from other manic symptoms and, in cluster analyses, the likelihood of a subgroup of manic patients with psychotic symptoms.

Louis XI était-il paranoïaque ?

ObjectivesClérambault issued the diagnosis that King Louis XI (1423–1483) was paranoid. The objective of this article is to enumerate the various elements that make it possible to question this “diagnosis”. MethodAfter reviewing the psychiatric literature about the “case” of Louis XI, we consulted historians, and then, considering all of this research, we highlight the king's pathological sense of “distrust” which we then analyze in the light of psychopathology and psychoanalytical orientation. ResultsKing Louis XI was nicknamed “the most suspicious man ever”. Beyond this characterized distrust, he also seems to have manifested a persecution complex and hypochondriac concerns. As far as the diagnosis of “paranoia” is concerned, – a non-triggered, non-deviant paranoia seems to us to be appropriate, especially in view of Clérambault's conception of it. DiscussionThe main discussion is related to the notion of “mistrust” in psychopathology, and the role it can play as a “successful defense” in paranoia. ConclusionGiven that there is a certain consensus – among psychiatric references, but also among historians – it is very likely that Louis XI presented a form of paranoia, with ideas of persecution, tyranny, cruelty, thirst for power, and hypochondriac concerns, All in a sense “contained” by an extreme distrust which seems to have sheltered him from a systematized delirium.

Early Diagnosis of Schizophrenia and Secondary Diagnose of Cerebral autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy: A Case Report

Background &amp; Objective: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare disease with a prevalence estimation of, 5 per, 100,000 individuals. Besides, it can highly be misdiagnosed with other psychiatric disorders.&#x0D; Case Presentation: We report a case of CADASIL in a 32-year-old Asian female presenting with schizophrenia symptoms such as auditory hallucination ،loosening of associations، persecutory delusions، referential delusions، decreased function, and complex hepatic hallucinations that the patient had said sometimes someone has intercourse with me since 2 years ago. After brain Magnetic Resonance Imaging (MRI) and gene checking, she showed up with NOTCH3 gene, besides Brain Magnetic resonance imaging confirmed the presence of CADASIL. Supportive treatments have been done and two years of following up showed a significant increase in patient life quality&#x0D; Conclusion: This case report demonstrates the challenges of CADASIL diagnosis in a patient with schizophrenia symptoms. The diagnosis should be considered in patients with schizophrenia symptoms. Hence, there is a need for timely diagnosis and management of this disorder.

Self-Structure in Persecutory Delusions

There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes.In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control.In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.