Types Of Delusions Research Articles

Is content of delusions in psychotic depression related to the risk of dementia?

Introduction Some studies have shown that late-life depression is related to faster cognitive decline and may increase the risk of dementia.Identifying risk and protective factors for dementia is essential to develop preventive interventions. Some literature has suggested that mood disorders (namely depression) are potential modifiable risk factors for dementia.Thus, it is important to know clinical presentation of depression that is associated to dementia, as a manifestation of subclinical dementia or as a risk factor for neurocognitive disorders.ObjectivesWe aim to identify clinical characteristics related to dementia of inpatients admitted for first time due to depressive episode after 55 years old.MethodsRetrospective cohort study of inpatients admitted between January 1st 2010 and March 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.ResultsOur sample included 57 inpatients, 15,8% (n=9) with the diagnosis of dementia 5,2 (SD 5,6) years after admission. All of these patients presented a depressive episode with psychotic symptoms, namely delusion activity. In those with hallucinatory activity, no one developed dementia.Interestingly, 33,3% of patients with dementia (n=3) presented with delusion of ruin, 55,6% (n=5) with delusion of prejudice/persecutory delusion and 66,7% (n=6) manifested delusion of ruin and/or prejudice.We also found that 42,9% (n=3) of patients with dementia manifested Cotard delusion while this type of delusion was observed in 13,6% of patients without dementia (p=0,095).ConclusionsOur study has several limitations because is based on results of only one hospital, with a small sample size.However, since depressive symptoms are potentially modifiable risk factors for dementia, future studies are essential to understand the mechanisms that link depression to cognitive decline as well as clinical characteristics that may constitute predictors of dementia.Disclosure of InterestNone Declared

Different patterns of MRI structural alterations in schizophrenia spectrum disorders with delusions of influence vs persecution

IntroductionThere is strong evidence that delusions are associated with cortical and subcortical structural alterations. However, whether these abnormalities differ in different types of delusions within schizophrenia spectrum disorders remains unclear.ObjectivesWe aimed at exploring structural neural patterns underlying influence/persecutory delusions across diagnostic categories within the schizophrenia-spectrum disorders.MethodsTwenty six right-handed patients with delusional disorder (n=7) and schizophrenia (n=19), presenting with delusions were divided in two clinical subgroups. The first one was presented with persecutory delusions (n=12, 20.2-55.4 years, mean age 36.0±11.6, 2 females) and the second with delusions of influence (n=14, 21.2-47.6 years, mean age 36.7±8.4, 2 females). The control group consist of 26 matched healthy controls (20.2-53.6 years, mean age 36.3±9.9, 4 females). All participants underwent structural MRI at 3T scanner. MRI images were processed via FreeSurfer 6.0 to quantify cortical thickness (CTh) and volumes for subcortical and brainstem (midbrain, pons, superior cerebellar peduncle and medulla) structures.ResultsCompared to healthy controls, patients with delusions of influence showed decreased gray matter thickness in 17 cortical regions (Figure, A), and decreased volumes of thalamus bilaterally (left: F(1,35)=9.0, p=0.005; Cohen’s d=−0.8; right: F(1,35)=8.0, p=0.008; Cohen’s d=−0.8), left hippocampus (F(1,35)=8.8, p=0.005; Cohen’s d=−0.8), midbrain (F(1,35)=11.0, p=0.002; Cohen’s d=−0.9) and pons (F(1,35)=8.2, p=0.007; Cohen’s d=−0.8). Conversely, patients with delusions of persecution showed decreased thickness only in 4 cortical regions of the right hemisphere (figure, B) and no alterations in subcortical volumes compared to healthy controls.No differences in cortical or subcortical measures between two clinical subgroups survived corrections for multiple comparisons. No correlations between structural alterations and total PANSS or BABS scores were found in either clinical groups.Figure. Clusters of decreased cortical thickness according to atlas of Desikan et al. (2006) in delusions of influence (A) and delusions of persecution (B) subgroups compared to healthy controls.Image:Conclusions The findings suggest that patients with delusions of influence have more pronounced cortical, subcortical and brainstem structural deficit as compared to patients with delusions of persecution. However, the limited sample size and the lack of correlations with clinical scores do not allow to conclude definitely whether the revealed structural abnormalities underlies delusions of influence, which should be elucidated via further research.This study was supported by RFBR grant 21-515-12007Disclosure of InterestNone Declared

Aberrant Functional Connectivity Between Regions Involved in Belief Evaluation and Processing of Bodily Information in Patients with Somatic Delusions

Introduction According to the two-factor theory of delusional belief (Coltheart. Ann N Y Acad Sci 2010; 1191 16-26), explaining the presence of a delusion requires a combination of two neuropsychological impairments. The first deficit initially prompts the delusional belief and defines its content, whereas the second deficit – aberrant belief evaluation – interrupts the rejection of a delusional belief and is common for different types of delusions. The second deficit is associated with compromised functioning of the right ventral frontal/anterior insular cortex (r-VF/AI; Darby et al. Brain 2017; 140 497-507). However, neural correlates of the first deficit in different types of delusions remain obscure.ObjectivesThe aim of the study was to search for regions whose functional connectivity with r-VF/AI is different between patients with somatic delusions (SD) and persecutory delusions (PD) and to further clarify the results by comparing clinical groups with healthy controls. We hypothesized that each clinical group is characterized by aberrant functional connectivity between a region, associated with poor belief evaluation (r-VF/AI), and a region, presumably associated with a neuropsychological impairment specific to the corresponding type of delusions.Methods Patients with delusional disorder or paranoid schizophrenia (n = 23) and healthy controls (n = 9; 5 females; mean age 36.2 ± 1.3) underwent resting-state fMRI (Philips Ingenia 3T). Nine patients had SD (5 females; mean age 40.3 ± 7.9) and fourteen patients had PD (3 females; mean age 35.6 ± 10.2). The clinical groups were compared in terms of whole-brain functional connectivity of r-VF/AI (ROI-to-voxel analysis in CONN; RRID:SCR_009550; www.nitrc.org/projects/conn). Statistical thresholds were p < .005 voxelwise, p[FDR] < .05 clusterwise. Each clinical group was compared with controls in terms of functional connectivity between r-VF/AI and previously identified regions with between-group differences in connectivity (ROI-to-ROI analysis). Age was a covariate of no interest in all analyses.ResultsPatients with SD compared to patients with PD and healthy individuals had higher functional connectivity between the r-VF/AI and a cluster in the right precentral and postcentral gyri extending to supramarginal and superior frontal gyri (Figure 1).Image:ConclusionsThe regions whose functional connectivity with r-VF/AI was aberrant in patients with SD are involved in the processing of tactile, proprioceptive, and visceral information. Our results coincide with a suggestion that the evaluation of beliefs related to bodily sensations is disturbed in patients with SD.Research was supported by RFBR grant project 21-515-12007.Disclosure of InterestNone Declared

Moral learning and positive schizotypy: Social cognitive mechanisms in psychosis- proneness

BackgroundDelusional thoughts such as paranoia and conspiratorial thinking reflect beliefs in others' intentions to do harm. Given the integral role of harm evaluation in moral cognition, a better understanding of how psychosis-prone individuals process others' moral characters may provide insights into social cognitive mechanisms of these types of delusions. MethodsAn online sample of 293 participants was drawn from the general population, using Amazon Mechanical Turk. Participants performed a moral inference task, where they predicted and judged the binary choices of two fictitious agents (“good” or “bad”) to impose harm under different levels of financial incentives. An investment game involving the same agents then examined participants' trust behavior. Psychosis-proneness was measured with the Multidimensional Schizotypy Scale Brief Edition. ResultsA set of multiple regressions showed that positive schizotypy was associated with a lower yet more confident pre-experimental expectation of the agent's moral character, lower prediction accuracy of the agent's harm preferences, less belief revision, and undifferentiated perception of the good and bad agents' characters. Positive schizotypy was also related to higher expectations for reciprocity in the investment game, regardless of agent characters. ConclusionOur findings suggest that inflexible beliefs associated with psychosis-proneness extend beyond negative prior expectations, also reflecting difficulties in moral learning. The resulting undifferentiated moral impressions might contribute to undue suspicion of benevolent individuals and increased gullibility to malicious ones, potentially further strengthening conspiratorial beliefs.

General Models of Pessimism in Afghanistan and Ways to Treat it in Islam

Pessimism is a type of delusion and false imagination in people regarding the occurrence of a disaster or affliction. It is widespread in different regions of Afghanistan, especially in villages and rural areas. pessimism in Afghanistan have many models involving humans, animals, birds, reptiles, beasts, the sun, moon, thunder, lightning, and more. From an Islamic perspective, believing in such pessimism is generally illegitimate, because such beliefs attribute disasters and calamities to other than Allah Almighty, as if these things themselves cause problems. However, considering the famous hadith narrated from the Prophet Muhammad, peace be upon him, pessimism have been created in some creatures by Allah's will, which can sometimes cause hardship for people, such as an evil woman, a horse that harms its rider or others, or a house in which a person cannot find comfort. There are three scholarly opinions on the ruling regarding this type of pessimism: The strongest view is that pessimisms are originally impermissible, but these three were exempted by Allah's will. Therefore, believing in pessimism undermines a Muslim's creed, instills fear and terror in his heart, and prevents him from carrying out many deeds. To remedy this evil phenomenon, Muslims must understand Islam in its true meaning, return to the Quran and Sunnah, have complete trust in Allah, proceed to accomplish the deed they want, supplicate and beseech Allah Almighty to protect them from the evil of Superstitions and false beliefs.

The Survey of Prevalence and Content of Hallucinations and Delusions in Methamphetamine Dependents

Background: Methamphetamine use can lead to hallucinations and delusions, which can severely disrupt perception, thinking, emotion, and behavior and even cause self-harm and harm to others. Therefore, it is crucial to pay attention to the content of these experiences. Objectives: This study aimed to investigate the prevalence and content of hallucinations and delusions in individuals with methamphetamine dependence. Patients and Methods: This analytical cross-sectional study was conducted on 198 methamphetamine users recruited from compulsory residences using convenience sampling. The participants were interviewed individually using a structured checklist based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Data were analyzed using SPSS software using descriptive statistics, independent sample t-test, and the chi-square test. Results: Auditory hallucinations (41.4%) and visual hallucinations (26.8%) were the most participants' common types of hallucinations. Persecution delusion (31.3%), grandeur delusion (17.7%), and reference delusion (16.7%) were the most common types of delusions reported. There were significant differences between the methamphetamine psychosis and non-psychosis groups regarding the rate, duration, and age of onset of methamphetamine use, as well as the prevalence of psychiatric diseases, suicide attempts, non-suicidal self-injury, and history of intoxication. Conclusions: The early detection of psychosis symptoms in methamphetamine users through follow-up reviews can prevent the occurrence of more destructive individual and social complications caused by these experiences. It is essential to consider all types of hallucinations and delusions to implement timely preventive actions for individuals with methamphetamine dependence.

The Epistemic Innocence of Elaborated Delusions Re-Examined

The aim of this paper is twofold. First, I want to re-examine the epistemic status of elaborated delusions. Bortolotti (2016, 2020) claims that they can be epistemically innocent. However, I will show that this type of delusions is more unique than suggested by the existing analyses of their epistemic status. They typically cause more profound harms than other kinds of delusions, and in most cases, it would be counterproductive to classify them as epistemically beneficial or innocent. I will employ predictive and phenomenological models of delusions and the enactivist notion of sensus communis to explain the harms and possible benefits of elaborated delusions and why I think the existing definition does not fully grasp them. Based on this analysis, I will propose changes to the conditions for epistemic innocence.

The frequency of psychotic symptoms in types of dementia: a systematic review.

This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.

Differential diagnosis of delusional symptoms in schizophrenia: Brain tractography data

Delusion is an extreme distortion of cognitive processes evaluating reward and prediction, where the damage in structural connectivity between several brain regions responsible for actualization of acquired socioemotional experience and adequate analysis of what is happening serve as a pathomorphological substrate. Referring to the assumption on various neurophysiological developmental mechanisms of two types of delusion, i.e. persecutory and fantastic, we hypothesized that the neural pathways or white matter tracts significantly differ between patients with one of the two types of delusions. Materials and methods40 patients suffering from schizophrenia were examined, 25 of them diagnosed with fantastic/paraphrenic delusions and 15 of them having persecutory/interpretative delusions. The control group comprised 42 healthy age- and sex-matched volunteers. Diffusion MR tractography of the brain was performed using 3 T MRI Magnetom Verio, Siemens. Resultsstatistical decrease in white matter fibers connecting right frontal regions with left motor cortex and certain cerebellar zones was identified in patients with interpretative delusions compared to healthy individuals. Elevated number of white matter fibers was found between the occipital regions and calcarine sulcus of the left hemisphere, and between medial occipitotemporal sulcus of the right hemisphere and right fusiform gyrus when comparing the tracts of patients with fantastic delusions and healthy controls. Conclusionsinterpretative delusions are associated with impaired connectivity in the brain regions responsible for adequate monitoring of current reality, whereas fantastic delusions are accompanied by altered connectivity of regions controlling multimodal sensory integration of signals from various analyzers based on long-term memory attributions.

Characteristics of very late-onset schizophrenia-like psychosis as prodromal dementia with Lewy bodies: a cross-sectional study

BackgroundThis study aimed to identify cases of potential prodromal DLB in very late-onset schizophrenia-like psychosis (VLOSLP), using indicative biomarkers of dementia with Lewy bodies (DLB), and to evaluate the characteristics of psychosis as prodromal DLB.MethodsData of patients with VLOSLP without dementia and Parkinsonism, who underwent testing for at least one indicative biomarker of DLB, were retrospectively collected from the database of the psychiatry clinic at the Osaka University Hospital. Patients were divided into two groups based on the positive (VLOSLP+LB) and negative (VLOSLP–LB) results of the indicative biomarkers of DLB. Age, gender, cognitive battery scores, prevalence of each type of delusions and hallucinations, cerebral volume, and cerebral perfusion were compared between the two groups.ResultsEleven VLOSLP+LB and 23 VLOSLP–LB participants were enrolled. There were no significant differences in age, proportion of females, and MMSE scores between the two groups. The standardized score of the digit symbol substitution test was significantly lower in the VLOSLP+LB than in VLOSLP–LB group (6.9 [3.1] vs. 10.0 [2.7], p = 0.005). The prevalence of visual hallucinations was significantly higher in the VLOSLP+LB group than in the VLOSLP-LB group (81.8% vs. 26.1%, p = 0.003). Auditory hallucinations were prevalent in both groups (43.5% in VLOSLP–LB, and 45.5% in VLOSLP+LB). Among patients with auditory hallucinations, auditory hallucinations without coexistent visual hallucinations tended to be more prevalent in VLOSLP–LB (7 out of 10) than in VLOSLP+LB patients (1 out of 5). Although cerebral volume was not different in any region, cerebral perfusion in the posterior region, including the occipital lobe, was significantly lower in the VLOSLP+LB group.ConclusionsPsychomotor slowing, visual hallucinations, and reduced perfusion in the occipital lobe may be suggestive of prodromal DLB in VLOSLP patients, even though the clinical manifestations were similar in many respects between VLOSLP+LB and VLOSLP–LB. Although auditory hallucinations were prevalent in both groups, most patients in VLOSLP+LB complained of auditory hallucinations along with visual hallucinations. Future studies with a larger number of patients without selection bias are desirable.

Postictal psychosis, a cause of secondary affective psychosis: A clinical description study of 77 patients

ObjectivePostictal psychosis (PIP) is a severe complication occurring at least in 2% of patients with epilepsy. Since the 19th century, psychiatrists have reported the specificity of PIP presentation, but descriptions did not clearly distinguish PIP from after-seizure delirium. This study aimed to provide a precise description of psychiatric signs occurring during PIP, and improve recognition of PIP. MethodsWe performed a review of clinical descriptions available in literature (48 patients), that we gathered with a retrospective multicentric case series of patients from three French epilepsy units (29 patients). For each patient, we collected retrospectively the psychiatric signs, and epilepsy features. ResultsWe found a high prevalence of persecutory (67.5%) and religious (55.8%) delusions, with almost systematic hallucinations (83.1%) and frequent mood disturbances (76.6%), especially euphoria. Severe consequences were not negligible (other-directed assault in 20.8%, self-directed in 13.0%). The type of delusion was associated with mood symptoms (p = 0.017). Episode onset was mainly sudden/rapid (90.9%), its duration was mostly between one and 14 days (64.9%) and the response to antipsychotic medication was good. Disorder was recurrent in more than a half of the sample (57.1% of patients with at least 2 episodes). ConclusionConsidering our findings, PIP resembles more an affective psychosis, than a purely psychotic disorder. The presence of affective signs differentiates PIP from other psychotic comorbidities in epilepsy. Additionally, resemblance between PIP and psychotic manic episode might help to discuss links between epilepsy and bipolar disorder.

Transdiagnostic assessment of temporal experience (TATE) a tool for assessing abnormal time experiences

Currently, anomalous lived temporality is not included in the main diagnostic criteria or standard symptom checklists. In this article, we present the Transdiagnostic Assessment of Temporal Experience (TATE), a structured interview that can be used by researchers and clinicians without a comprehensive phenomenological background to explore abnormal time experiences in persons with abnormal mental conditions regardless of their diagnosis. When extensive data gathered by this scale are available, it will be possible to delineate well-defined anomalous lived temporality profiles for each psychopathological disorder. This instrument may also prove useful for clinicians by providing a more refined assessment of relevant psychopathological symptoms (for instance, the differentiation of different types of delusions according to their temporal profile) and an in-depth understanding of the patient’s abnormal behaviour (e.g., impulsivity or social withdrawal) as related to specific types of time experience. In the first part of the article, we provide a brief overview of the phenomenological concept of temporality, including pre-phenomenal and phenomenal time, synthesis, conation and synchronization, and of abnormal time experiences in persons affected by psychopathological conditions. In the following part, we describe the basic structure of the interview that comprises seven categories corresponding to the abnormal features of lived temporality: anomalies of synchrony, of time structure, of implicit time flow, of explicit time flow, and anomalous experiences of the past, the present and the future. The paper also includes a section on administration and scoring of the TATE scale, the complete interview and a Likert table for quantifying the frequency, intensity and interference with daily life of the phenomena explored.

Abstract- Poster

Introduction:Delusion of misidentifications are characterized by delusional belief that familiar person, objects, or self have been replaced or transformed. There are four common types like Capgras syndrome, Fregoli syndrome, Syndrome of subjective doubles and syndrome of intermetamorphosis. Another type of delusion of misidentification is mirrored self- misidentification, where the delusional belief is that one’s reflection in the mirror is misidentified as a stranger.Case report:A 83 years old male patient Mr. X, graduate, married, retired from his job, belonging to middle socio-economic status, hailing from urban background was accompanied to the OPD by his daughter. Informant had complaints of suspiciousness, abusing family members, abnormal behavior, and memory impairment since 6 months. Patient started suspecting that there is stranger whenever he looked into the mirrored or any other reflecting surfaces. Later he started suspecting that stranger was coming to meet his wife. Apart from this he also had memory disturbances. All the investigations were normal and he was started on Tab. Quetiapine -25mg and Tab. Donepezil -5mg.Discussion:The ability to recognize oneself in the mirror has a potential way of testing self-awareness, but it is not clearly known how the brain does it. Mirrored-self misidentification has rarely been described in the literature. Most of the reported patients have global dementia of the Alzheimer type, making it difficult to infer the anatomical basis of this disorder.Conclusion:The loss of the ability to recognize oneself in the mirror is evidence of a fundamental change in the sense of self and this may cause interpersonal problems as well. Managing such cases may be difficult and challenging.

Delusion and Ignorance in the Structure of Guilt: Criminal Law Aspect

Guilt in criminal law in its essence is a very complex category, but at the same time, it is the main feature of the subjective side of the crime, which predetermines its rigorous and precise establishment within the framework of the classification of the crime. The paper states that the greatest difficulty in establishing guilt is in terms of subjective error, where the prerequisites are delusion and ignorance. At the same time, the non-identical nature of these concepts is emphasized. Based on a psychological and philosophical analysis, the author draws a conclusion about the causes of delusion and ignorance in criminal law relations, which are a defect in perception and a defect in information content. Taking into account the indicated reasons, as well as judicial enforcement practice, the author concludes that the main criterion for establishing guilt in terms of delusion or ignorance is an element of good faith. Given its application, the paper proposes levels of types of delusion and ignorance, and further their role in establishing the mental attitude of a person to a committed criminal act.

Looking for Autoimmune Psychosis: A Preliminary Report from Iran

Background: There is increasing attention toward the recognition of psychotic disorders with autoimmune etiologies, especially among first-episode psychosis patients. These patients may be underdiagnosed before they develop a full range of neurological symptoms. Objectives: We aimed to characterize the rate and clinical presentations of first-episode autoimmune psychosis patients. Methods: All patients with first-episode psychosis (FEP) with the onset of symptoms over a maximum course of three months were recruited and underwent a comprehensive examination and serum and cerebrospinal fluid autoimmune tests. Results: Seven out of 15 patients with FEP were under 20 years, and four were Afghans. Twelve patients developed prodromal symptoms, all had at least one type of delusion, and 11 patients had experience of hallucinations. Formal thought disorders were detected in seven patients. Five patients had catatonic symptoms. Conclusions: Certain sample features made our cases unique, including young age, high rate of prodromal symptoms, catatonic features, and formal thought disorders. Lack of specific criteria to arrive at the diagnosis of autoimmune psychosis would be a major milestone to achieve in future studies.

Homicides committed by delusional patients in the early 20th and 21st centuries: A study conducted in a French secure unit.

Homicides committed by delusional patients are the object of a rich scientific literature, which puts the risk of such acts occurring into perspective when analyzing the offenders' sociodemographic and clinical characteristics. However, few articles detail the themes and mechanisms underlying those patients' delusions. To help bridge that gap, the authors conducted this retrospective descriptive study, including two samples of delusional homicidal patients, one from near present day and one from nearly a century ago. This study considered similarities observed in the literature (such as patients' sociodemographic profile, clinical data, and acting-out dynamics), but also explored the characteristics of delusion. In the 2015-2019 sample, the typical patient profile was: single male (31.5years old on average), without child, unemployed, and with psychiatric history (56.6%). Most patients suffered from schizophrenic disease (83%) with non-systematized delusions exhibiting multiple themes in 80% of cases. Four principal types of delusion were observed: persecutive (100%), mystical (43.3%), megalomaniac (30%), and bodily (30%). The mechanisms were interpretative, hallucinatory, and intuitive. There was a societal influence in 23.3% of the cases (most often terrorist acts). The 1910-1914 historical sample revealed several differences: patients were older, more often married and employed. There were more diagnoses of chronic delusional disorder (30%). Persecutory delusion was constant (100%), and the other delusional themes were the "intimate relationship" type (50%)-jealousy, erotomanic-and the bodily type (40%). Additional studies are useful in order to reinforce our findings, and to further investigate the possibilities of prevention.

Responses and Interventions to Delusions Experienced by Community-Dwelling Older Persons With Dementia.

We examined how family caregivers react, and what interventions they use in response to delusions exhibited by relatives with dementia in a community setting. Structured interviews were conducted with 68 family caregivers whose relatives were described as experiencing delusions based on the BEHAVE-AD or the NPI. Quantitatively, we cross-tabulated the type of response to delusion by the type of person providing the response and by the type of delusion manifested. Qualitatively, we analyzed open-ended responses to understand the types of caregivers’ responses to delusions, the contextual circumstances, and the impact of the responses. Caregiver responses to delusions included “Explaining that the delusion was wrong” (34% of responses), “Trying to calm down” (27%), “Agreeing with the delusion” (13%), “Distracting” (12%), and “Ignoring” (10%). Responses including “Anger, yelling or scolding,” were rare. The vast majority of reactions were by family caregivers of the persons with dementia. The relative frequency of the type of reaction tended to be consistent across delusion types. The qualitative analyses added some categories of reactions, but mostly highlighted issues to be considered when examining responses and their efficacy, including the use of multiple responses, and the manner and mood in which responses are conveyed. To cope with delusions, family caregivers develop intuitive intervention techniques. Understanding those interventions and reactions by caregivers and their relative efficacy can inform guidance programs for family caregivers. Improved support for family caregivers has the potential to positively influence the behavior of caregivers and older adults with dementia and improve their respective quality of life.

Paranoia and Grandiosity in the General Population: Differential Associations With Putative Causal Factors.

Worry, negative self-beliefs, and sleep disturbance have been identified as contributory factors to the onset, maintenance, and severity of paranoia. We tested the specificity of these contributory factors to paranoia compared to grandiosity, a different type of delusional ideation. Data were used from 814 adults from the Nathan Kline Institute-Rockland (NKI-Rockland) study, a general population dataset. Paranoid and grandiose delusional ideation was assessed using the Peters Delusions Inventory (PDI-21) and correlated with self-reported worry (n = 228), negative self-beliefs (n = 485), and sleep quality (n = 655). Correlations were compared using Fisher's r-to-z transform to examine whether the magnitude of relationships differed by delusion type. Paranoia was significantly associated with worry, negative self-belief, and sleep quality. Grandiosity demonstrated significantly weaker relationships with worry and negative self-beliefs. Relationships with sleep quality were similar. We replicate previous reports that worry, negative self-beliefs and sleep quality are associated with paranoid ideation in the general population. We extend these findings by demonstrating that these contributory factors, particularly worry and negative self-beliefs, are associated with paranoid ideation to a greater extent than grandiosity. This suggests a degree of specificity of contributory factors to different types of delusional thinking, supporting the pursuit of specific psychological models and treatments for each delusion type.

Morphological alterations of the pyramidal and stellate cells of the visual cortex in schizophrenia.

Schizophrenia is a severe brain disorder characterized by certain types of delusion, hallucination and thought disorder. Studies have revealed impaired synaptic plasticity and reduced gamma-aminobutyric acid levels of the visual cortex in patients with schizophrenia. While previous work established a critical role for interneurons and cortical connectivity in the generation of hallucinations, the present study set out to examine the morphology of pyramidal cells and interneurons from layers 3 and 4 in the primary visual cortex from schizophrenic brains and to identify any dendritic and spinal alterations in comparison to normal control brains. The morphological and morphometric changes of the pyramidal cells and the interneurons of the visual cortices of 10 brains obtained from patients with schizophrenia, in comparison to 10 age-matched controls, were studied using the Golgi method and 3D neuronal reconstruction techniques. Analysis using the Golgi impregnation technique revealed a significant loss of distal dendritic segments, tortuous branches and varicosities and an overall restriction of the dendritic field in the brains of schizophrenic patients in both pyramidal cells and in aspiny interneurons. The present results may explain certain clinical phenomena associated with the visual cortex usually encountered in schizophrenia.

Patients With Refractory Bipolar Depression May Benefit From ECT

Patients With Refractory Bipolar Depression May Benefit From ECT