Phenomenological Overlap Research Articles

“Theory of mind” is impaired in Huntington's disease

Huntington's disease (HD) is an autosomal dominant degenerative brain disorder that is characterized by motor, cognitive, and affective symptoms. There is, to some, degree, phenomenological overlap with schizophrenia. Schizophrenia patients are frequently impaired in "theory of mind" (ToM), that is, the ability to reflect on the mental states of self and others, with mixed evidence for a ToM deficit in HD. We examined ToM and neurocognitive functioning in 25 patients diagnosed with HD. For comparison, 25 patients with schizophrenia and 25 healthy controls, matched for age and gender, were included. Patients with HD were impaired in ToM relative to controls. The pattern of neurocognitive deficits including ToM strikingly resembled the one found in schizophrenia, suggesting a selectively impaired ToM. In contrast to previous schizophrenia research, ToM was not associated with functional measures on the Unified Huntington's Disease Rating Scale (UHDRS). The present study shows that patients with HD have deficits in ToM similar to schizophrenia. The association of impaired ToM with function needs to be established in future studies using rating scales that more specifically address interpersonal problems.

Morgellons Disease, or Antipsychotic-Responsive Delusional Parasitosis, in an HIV Patient: Beliefs in The Age of the Internet

“Which was worse, the real condition or the self-created one; and did it matter?” — Don DeLillo: “White Noise” Viking Press © 1985 Morgellons disease (also referred to as Morgellons syndrome or Morgellons) has been publicized through the Internet as an unexplained syndrome presenting with cutaneous dysesthesias associated with foreign material like fibers or parasites. A lay person, Mary Leitao, was instrumental in naming the disease after her 2-year-old son developed sores and began to complain about bugs. She established a nonprofit research organization, the Morgellons Research Foundation (MRF) and lobbied for widespread recognition. Under public and political pressure (e.g., letters to the Centers for Disease Control [CDC] from Senators Schumer and Clinton) the CDC has launched an epidemiologic investigation into this unexplained dermopathy. Table 1 shows how this condition rose to relative prominence in less than a decade. The phenomenological overlap, however, with delusional parasitosis has not escaped attention. A brief look at a proposed case definition (Table 2) shows the phenomenological overlap with regard to a core feature of delusional parasitosis (the sense of something moving in or under one’s skin), as well as a host of nonspecific symptoms. Is the creation of this new syndrome necessary or useful? Vila-Rodriguez and MacEwan have raised awareness about the facilitative role of the Internet in the spread of bizarre beliefs and shared delusional ideation, which raises the question of whether the propagation of new syndromes by laypersons is unavoidable in the age of the Internet. Herein, the authors describe the case of a patient with human immunodeficiency virus (HIV) disease and classic delusions of parasitosis, who diagnosed himself with Morgellons disease, yet responded to antipsychotic medication. The authors propose an infectious-disease, vectorbased model to explain the emergence and rapid rise of Morgellons and suggest principles of management for cases of antipsychotic-responsive cases of Morgellons.

Morgellons Disease, or Antipsychotic-Responsive Delusional Parasitosis, in an HIV Patient: Beliefs in The Age of the Internet

“Which was worse, the real condition or the self-created one; and did it matter?” — Don DeLillo: “White Noise” Viking Press © 1985 Morgellons disease (also referred to as Morgellons syndrome or Morgellons) has been publicized through the Internet as an unexplained syndrome presenting with cutaneous dysesthesias associated with foreign material like fibers or parasites. A lay person, Mary Leitao, was instrumental in naming the disease after her 2-year-old son developed sores and began to complain about bugs. She established a nonprofit research organization, the Morgellons Research Foundation (MRF) and lobbied for widespread recognition. Under public and political pressure (e.g., letters to the Centers for Disease Control [CDC] from Senators Schumer and Clinton) the CDC has launched an epidemiologic investigation into this unexplained dermopathy. Table 1 shows how this condition rose to relative prominence in less than a decade. The phenomenological overlap, however, with delusional parasitosis has not escaped attention. A brief look at a proposed case definition (Table 2) shows the phenomenological overlap with regard to a core feature of delusional parasitosis (the sense of something moving in or under one’s skin), as well as a host of nonspecific symptoms. Is the creation of this new syndrome necessary or useful? Vila-Rodriguez and MacEwan have raised awareness about the facilitative role of the Internet in the spread of bizarre beliefs and shared delusional ideation, which raises the question of whether the propagation of new syndromes by laypersons is unavoidable in the age of the Internet. Herein, the authors describe the case of a patient with human immunodeficiency virus (HIV) disease and classic delusions of parasitosis, who diagnosed himself with Morgellons disease, yet responded to antipsychotic medication. The authors propose an infectious-disease, vectorbased model to explain the emergence and rapid rise of Morgellons and suggest principles of management for cases of antipsychotic-responsive cases of Morgellons.

Are you looking at me? Paranoid psychosis in pre-existing social phobia.

Three patients presenting with a first episode of psychosis each had a past history of social phobia. We sought to explore the literature on the co-occurrence of these disorders and investigate three hypotheses to explain this: (1) the chance co-occurrence of two illnesses with distinct aetiologies; (2) two clinical presentations reflecting different points on the same spectrum of illness; and (3) two distinct disorders representing different end points resulting from the same aetiology. A literature review of Embase, PubMed and Psych Lit was performed. We found no reports on social phobia preexisting an episode of psychosis, and prevalence studies indicate that their chance co-occurrence is extremely unlikely. Psychological explanations for co-occurrence include attributional theories, and theories related to cognitive biases and loss of self-esteem. There is a phenomenological overlap between social phobia and paranoia but the two concepts should and can be distinguished. Epidemiological studies indicate that their chance occurrence as two unrelated disorders is unlikely. Most people with one of these disorders do not develop the other and hypothesis (2) is also unlikely. There is increasing speculation that anxiety, and in particular social phobic symptoms have a central role in the development of psychotic symptoms. The greatest evidence was found to support hypothesis (3). However, it seems more likely that social phobia and psychosis, rather than representing manifestations of the same illness, instead are implicated in a complex interaction where symptoms which characterise social phobia and psychosis, have the capacity to affect, alter and possibly provoke each other. The recognition and treatment of co-occurring anxiety disorders, especially social phobia with psychosis, may have an important impact on prognosis and quality of life.

Olfactory reference syndrome: issues for DSM-V

The published literature on olfactory reference syndrome (ORS) spans more than a century and provides consistent descriptions of its clinical features. The core symptom is preoccupation with the belief that one emits a foul or offensive body odor, which is not perceived by others. This syndrome is associated with substantial distress and disability. DSM-IV and ICD-10 do not explicitly mention ORS, but note convictions about emitting a foul body odor in their description of delusional disorder, somatic type. However, the fact that such symptoms can be nondelusional poses a diagnostic conundrum. Indeed, DSM-IV also mentions fears about the offensiveness of one's body odor in the social phobia text (as a symptom of taijin kyofusho). There also seems to be phenomenological overlap with body dysmorphic disorder, obsessive-compulsive disorder, and hypochondriasis. This article provides a focused review of the literature to address issues for DSM-V, including whether ORS should continue to be mentioned as an example of another disorder or should be included as a separate diagnosis. We present a number of options and preliminary recommendations for consideration for DSM-V. Because research is still very limited, it is unclear how ORS should best be classified. Nonetheless, classifying ORS as a type of delusional disorder seems problematic. Given this syndrome's consistent clinical description across cultures for more than a century, substantial morbidity and a small but growing research literature, we make the preliminary recommendation that ORS be included in DSM-Vs Appendix of Criteria Sets Provided for Further Study, and we suggest diagnostic criteria.

Selbstverletzendes Verhalten und Suizidversuche: Fundierung der Differenzialdiagnostik

Three criteria for differential diagnosis of non-suicidal self-injury and suicide attempts were validated by means of more recent empirical studies. Criteria concerning motives (functions), methods of self-injury (medical severity), lifetime frequency and lifetime number of episodes were investigated. Literature research showed only a few studies concentrated on a direct comparison of non-suicidal self-injury and suicide attempts. Therefore, studies examing the relationship of suicide intent to the relevant features, are considered, too. Empirical results concerning motives (functions), methods (medical severity), lifetime frequency and number of episodes were compared to the three criteria. Except for lifetime frequency, studies support the criteria. However, in the case of motives, a more differentiated examination is needed to distinguish between non-suicidal self-injury and suicide attempts. To optimize the assessment, guidelines should be slightly modified. Because of the phenomenological overlap of non-suicidal self-injury and suicide attempts, a dimensional assessment can be helpful.

Frontal–striatal abnormalities underlying behaviours in the compulsive–impulsive spectrum

In this paper, we tentatively bring together the psychiatric, neurological and addiction perspectives on the impulsive–compulsive spectrum of neuropsychiatric disorders, in order to understand the pathophysiology of impulse control disorders (ICDs) in Parkinson's disease. In an attempt to try to pool the various levels of information we will therefore focus on three disorders within the impulse-compulsive spectrum, i.e., obsessive–compulsive disorder (OCD), ICDs in Parkinson's disease, and cocaine seeking behaviour. Whereas there are large differences between these three domains, each with their own nomenclature, hypotheses and study results, they share the focus on an imbalance within and between the frontal–striatal circuits as underlying substrate for the behaviours. For each disorder, we summarize the results from recent studies in order to describe in which way alterations in the frontal–striatal circuits contribute to the phenotype. The phenomenological overlap between ICDs in Parkinson's disease, addiction and OCD needs further investigation, since better understanding of the overlapping and differentiating characteristics will contribute to our understanding of the pathophysiology of the disturbances and treatment alternatives.

The genetic overlap of attention deficit hyperactivity disorder and autistic spectrum disorder

Autistic spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) are classified as distinct disorders within the DSM-IV-TR (1994). The manual excludes simultaneous use of both diagnoses in case of overlap on a symptomatic level. However this does not always represent clinical observations and findings of previous studies. This review explores the genetic basis of the phenomenological overlap between ADHD and ASD. Based on an extensive review of twin-, linkage-, association studies, and reported structural genomic abnormalities associated with these disorders, we have identified seventeen regions on the human genome that can be related to both disorders. These regions of shared genetic association are: 2q35, 3p14, 4p16.1, 4p16.3, 5p15.31, 5p15.33, 7p12.3, 7p22, 7q21, 8q24.3, 14q12, 15q11-12, 16p13, 17q11, 18q21-23, 22q11.2, Xp22.3. The presented data are of interest for future genetic studies and appear to suggest the existence of a phenotype partition that may differ from the current classification of psychiatric disorders.

Duration of untreated psychosis and social function: 1-year follow-up study of first-episode schizophrenia

BackgroundIn first-episode schizophrenia, longer duration of untreated psychosis (DUP) predicts poorer outcomes.AimsTo address whether the relationship between DUP and outcome is a direct causal one or the result of association between symptoms and/or cognitive functioning and social functioning at the same time point.MethodSymptoms, social function and cognitive function were assessed in 98 patients with first-episode schizphrenia at presentation and 1 year later.ResultsThere was no significant clinical difference between participants with short and long DUP at presentation. Linear regression analyses revealed that longer DUP significantly predicted more severe positive and negative symptoms and poorer social function at 1 year, independent of scores at presentation. Path analyses revealed independent direct relationships between DUP and social function, core negative symptoms and positive symptoms. There was no significant association between DUP and cognition.ConclusionsLonger DUP predicts poor social function independently of symptoms. The findings underline the importance of taking account of the phenomenological overlap between measures of negative symptoms and social function when investigating the effects of DUP.

Hubers coenästhetische Schizophrenie: 50 Jahre eines Konzeptes

50 years after the first description of cenesthetic schizophrenia as a concept by Gerd Huber, it can be valued as a starting point of fundamental insights into the course of schizophrenia and also for the development of the concept of basic symptoms assessment. Because patients suffering from cenesthetic schizophrenia are often misdiagnosed, it is still relevant for diagnostic and therapeutic purposes in practise today. Cenesthetic symptoms can be considered as substrate-close because they can be part of idiopathic psychosyndromes and also of organic brain lesions. Therefore they could be allocated as a typical example of the possible phenomenological identity or overlap of neurological and psychopathological symptomatology. The historical, psychopathological methodological and clinical foundations of the concept of cenesthetic schizophrenia will be demonstrated and the importance of this work for today will be emphasized.

What is the genetic relationship between anxiety and depression?

Anxiety and depression share a long, close history in psychiatric nosology and treatment. The anxiety disorders, individually and as a group, exhibit remarkably high rates of comorbidity with each other and with major depression. Analyses done in large-scale epidemiologic surveys have identified major patterns of phenomenological overlap between these conditions. Researchers have tested hypotheses of shared genetic etiologies as a potential basis of this relationship. In general, available family studies have found mixed evidence for co-aggregation of anxiety and depressive disorders, while twin studies more definitively indicate that shared genetic risk factors largely account for this comorbidity. Some of this appears to be accounted for by genetic variation in personality traits that broadly predispose to anxiety and depression. Molecular genetic studies of these conditions, though too early to draw firm conclusions, thus far provide tentative support for specific genetic loci that may generally influence susceptibility across the anxiety-depressive spectrum.

Trichotillomania, stereotypic movement disorder, and related disorders

Trichotillomania is currently classified as an impulse control disorder not otherwise classified, whereas body-focused behaviors other than hair-pulling may be diagnosed as stereotypic movement disorder. A number of disorders characterized by repetitive, body-focused behaviors (eg, skin-picking) are prevalent and disabling and may have phenomenological and psychobiological overlap. Such disorders deserve greater recognition in the official nosology, and there would seem to be clinical utility in classifying them in the same diagnostic category.

Anxiety disorders and bipolar disorder: a review

Epidemiological, clinical and familial studies indicate that anxiety disorders (ADs) are highly comorbid in persons with bipolar disorder (BPD). The phenomenological overlap between ADs and BPD is reported more frequently in individuals with female predominant bipolar presentations (e.g., bipolar II disorder). Anxiety comorbidity in the BPD population poses a serious hazard. For example, it is associated with an intensification of symptoms, non-recovery, substance use comorbidity and harmful dysfunction (e.g., suicidality). The evidentiary base informing treatment decisions for the anxious bipolar patient is woefully inadequate. Several expert consensus and evidence-based treatment guidelines for BPD suggest various treatment avenues, although these have been insufficiently studied. The encompassing aim of this paper is to synthesize extant studies reporting on the co-occurrence of AD and BPD. Taken together, a compelling basis emerges for prioritizing the identification and management of anxiety symptomatology in the BPD population.

The specificity of cognitive vulnerabilities to emotional disorders: Anxiety sensitivity, looming vulnerability and explanatory style

Mood and anxiety disorders share considerable phenomenological and diagnostic overlap. Several models have advanced the understanding of the phenomenological overlap of anxiety and depression; however, identification of disorder-specific etiological mechanisms remains elusive. Recently, research has advanced several cognitive vulnerability-stress models proposing that one's characteristic way of attending to, interpreting, and remembering negative events contributes vulnerability to psychopathology. These cognitive vulnerabilities may elucidate specific etiological mechanisms that distinguish mood and anxiety pathology. The present study examines the specificity of three cognitive vulnerability constructs, the looming cognitive style, anxiety sensitivity, and explanatory style, in the prediction of latent anxiety disorder symptoms and latent depression symptoms. Structural equation modeling analyses indicated that the looming cognitive style demonstrated specificity predicting only anxiety disorder symptoms whereas anxiety sensitivity and a pessimistic explanatory style predicted both anxiety disorder and mood disorder symptoms. Implications for future research are discussed.

Obsessive-Compulsive Disorder in Tourette Syndrome

Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder.

Affective instability as rapid cycling: theoretical and clinical implications for borderline personality and bipolar spectrum disorders

The Diagnostic and Statistical Manual of Mental Disorders guidelines provide only a partial solution to the nosology and treatment of bipolar disorder in that disorders with common symptoms and biological correlates may be categorized separately because of superficial differences related to behavior, life history, and temperament. The relationship is explored between extremely rapid switching forms of bipolar disorder, in which manic and depressive symptoms are either mixed or switch rapidly, and forms of borderline personality disorder in which affective lability is a prominent symptom. A MedLine search was conducted of articles that focused on rapid cycling in bipolar disorder, emphasizing recent publications (2001-2004). Studies examined here suggest a number of points of phenomenological and biological overlap between the affective lability criterion of borderline personality disorder and the extremely rapid cycling bipolar disorders. We propose a model for the development of 'borderline' behaviors on the basis of unstable mood states that sheds light on how the psychological and somatic interventions may be aimed at 'breaking the cycle' of borderline personality disorder development. A review of pharmacologic studies suggests that anticonvulsants may have similar stabilizing effects in both borderline personality disorder and rapid cycling bipolar disorder. The same mechanism may drive both the rapid mood switching in some forms of bipolar disorder and the affective instability of borderline personality disorder and may even be rooted in the same genetic etiology. While continued clinical investigation of the use of anticonvulsants in borderline personality disorder is needed, anticonvulsants may be useful in the treatment of this condition, combined with appropriate psychotherapy.

A comparison of the efficacy of donepezil in Parkinson's disease with Dementia and Dementia with Lewy bodies

Parkinson's disease with dementia (PDD) and dementia with Lewy bodies (DLB) overlap in phenomenology and neurochemical deficits. We hypothesised they would not differ in their response to the cholinesterase inhibitor donepezil. We recruited 70 subjects, 30 DLB and 40 PDD, in an open label study to compare the efficacy of donepezil in these two patient groups. They were assessed at baseline, 4, 12 and 20 weeks. The main outcome measures were the Mini-Mental State Examination (MMSE), Neuropsychiatric Inventory (NPI) and motor sub-section of the Unified Parkinson's Disease Rating Scale (UPDRS III). PDD patients were younger than DLB and had more severe parkinsonism at baseline. The groups were similar on all other variables of interest. By 20 weeks the mean MMSE score increased by 3.9 points in the DLB group and by 3.2 points in PDD. The mean NPI score reduced by 14.6 points for DLB and 12.0 points for PDD. These treatment effects were all significant compared to baseline (p < 0.001) but there were no significant between-group treatment differences (MMSE p = 0.56, NPI p = 0.39). UPDRS III motor scores did not change significantly from baseline values in either group. Although adverse effects were common (69%) they were usually mild and 64 patients (91%) completed the study. The four patients who did withdraw with adverse effects all had a PDD diagnosis. Donepezil produced similar improvements in cognition and behaviour in DLB and PDD. This supports the hypothesis that the two disorders are closely related clinically and neurobiologically. Larger scale, placebo controlled clinical trials are needed to provide an evidence base to guide the clinical use of cholinesterase inhibitors in Lewy body disease.

Evaluation and management of medically unexplained physical symptoms.

Medically unexplained physical symptoms (MUPS) and related syndromes are common in medical care and the general population, are associated with extensive morbidity, and have a large impact on functioning. Much of medical practice emphasizes specific pharmacological and surgical intervention for discrete disease states. Medical science, with its emphasis on identifying etiologically meaningful diseases comprised of homogeneous groups of patients, has split MUPS into a number of diagnostic entities or syndromes, each with its own hypothesized pathogenesis. However, research suggests these syndromes may be more similar than different, sharing extensive phenomenological overlap and similar risk factors, treatments, associated morbidities, and prognoses. Examples of syndromes consisting of MUPS include chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, somatoform disorders, and 'Gulf War Syndrome.' This paper is a narrative review of the increasing body of evidence suggesting that MUPS and related syndromes are common, disabling, and costly. It emphasizes that MUPS occur along a continuum of symptom count, severity, and duration and may be divided into acute, subacute (or recurrent), and chronic types. Predisposing, precipitating, and perpetuating factors influence the natural history of MUPS. Effective symptom management involves collaborative doctor-patient approaches for identification of problems based on a combination of medical importance and patient readiness to initiate behavioral change, negotiated treatment goals and outcomes, gradual physical activation and exercise prescription. Additionally, efforts should be made to teach and support active rather than passive coping with the symptoms.

Posttraumatic disorders following injury: an empirical and methodological review

Although there has been a marked increase in research on psychological disorders following physical injury in recent years, there are many discrepancies between the reported findings. This paper reviews the prevalence outcomes of recent studies of the mental health sequelae of physical injury with a focus on posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression. The review critically outlines some of the methodological factors that may have contributed to these discrepancies. The phenomenological overlap between organic and psychogenic symptoms, the use of narcotic analgesia, the role of brain injury, the timing and content of assessments, and litigation are discussed in terms of their potential to confound findings with this population. Recommendations are proposed to clarify methodological approaches in this area. It is suggested that a clearer understanding of the psychological effects of physical injury will require the widespread adoption of more rigorous, standardized and transparent methodological procedures.

The longitudinal stability of autobiographical memory retrieval deficits in delusional inpatients

Pathological jealousy (PJ) is not defined as a unitary syndrome, but as a symptom of different disorders. After a definition of PJ, diagnostic criteria for PJ subtypes and its differentiation from normal jealousy are discussed. Based on a description of the clinical picture of non-delusional PJ in a functional analysis format, a cognitive-behavioural conceptualization of non-delusional PJ as an obsessive-compulsive spectrum disorder (OCSD) is presented. The emphasis is on phenomenological overlap with obsessive-compulsive disorder (OCD), including similarities of jealous intrusions with obsessions, of jealous checking, reassurance seeking and avoidance of jealousy-provoking situations with compulsive rituals and passive avoidance in OCD, and finally of the “illusion of control” in PJ (belief that safeguarding love relationships by control is possible) with magical thinking/superstitious behaviour in OCD. Some treatment suggestions based on an OCSD formulation of non-delusional PJ are outlined.