Vulnerable self, poor understanding of others' minds, threat anticipation and cognitive biases as triggers for delusional experience in schizophrenia: a theoretical model.

PubMed

Salvatore, Giampaolo; Lysaker, Paul H; Popolo, Raffaele; Procacci, Michele; Carcione, Antonino; Dimaggio, Giancarlo

2012-01-01

It remains unclear what processes lead to the establishment of persecutory delusions in acute phases of schizophrenia. Recently, it has been argued that persecutory delusions arise from an interaction among a range of emotional, cognitive and social factors. In this work, we explored this possibility by first discussing the relevant aspects of recent theoretical models of the causes of persecutory delusions. Then, we offered an analysis of the literature, illustrated with clinical observations suggesting that persecutory delusions are triggered during stressful intersubjective transactions by the interactions of (a) an alteration in empathetic perspective taking and in pragmatic understanding of others' minds; (b) a perception/representation of the self as vulnerable or subordinate and of the other as dominant and threatening; and (c) a hyperfunctioning of the threat/self-protection system when faced with perceived danger. Implications for future research and treatment of people suffering from this symptom are discussed. Copyright © 2011 John Wiley & Sons, Ltd.

Sequential Cotard and Capgras delusions.

PubMed

Wright, S; Young, A W; Hellawell, D J

1993-09-01

We report sequential Cotard and Capgras delusions in the same patient, KH, and offer a simple hypothesis to account for this link. The Cotard delusion occurred when KH was depressed and the Capgras delusion arose in the context of persecutory delusions. We suggest that the Cotard and Capgras delusions reflect different interpretations of similar anomalous experiences, and that the persecutory delusions and suspiciousness that are often noted in Capgras cases contribute to the patients' mistaking a change in themselves for a change in others ('they are impostors'), whereas people who are depressed exaggerate the negative effects of the same change whilst correctly attributing it to themselves ('I am dead'). This explains why there might be an underlying similarity between delusions which are phenomenally distinct.

The effects of reducing worry in patients with persecutory delusions: study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Our approach to advancing the treatment of psychosis is to focus on key single symptoms and develop interventions that target the mechanisms that maintain them. In our theoretical research we have found worry to be an important factor in the development and maintenance of persecutory delusions. Worry brings implausible ideas to mind, keeps them there, and makes the experience distressing. Therefore the aim of the trial is to test the clinical efficacy of a cognitive-behavioral intervention for worry for patients with persecutory delusions and determine how the worry treatment might reduce delusions. Methods/Design An explanatory randomized controlled trial - called the Worry Intervention Trial (WIT) - with 150 patients with persecutory delusions will be carried out. Patients will be randomized to the worry intervention in addition to standard care or to standard care. Randomization will be carried out independently, assessments carried out single-blind, and therapy competence and adherence monitored. The study population will be individuals with persecutory delusions and worry in the context of a schizophrenia spectrum diagnosis. They will not have responded adequately to previous treatment. The intervention is a six-session cognitive-behavioral treatment provided over eight weeks. The control condition will be treatment as usual, which is typically antipsychotic medication and regular appointments. The principal hypotheses are that a worry intervention will reduce levels of worry and that it will also reduce the persecutory delusions. Assessments will be carried out at 0 weeks (baseline), 8 weeks (post treatment) and 24 weeks (follow-up). The statistical analysis strategy will follow the intention-to-treat principle and involve the use of linear mixed models to evaluate and estimate the relevant between- and within-subjects effects (allowing for the possibility of missing data). Both traditional regression and newer instrumental variables analyses will examine mediation. The trial is funded by the UK Medical Research Council (MRC)/NHS National Institute of Health Research (NIHR) Efficacy and Mechanism Evaluation (EME) Programme. Discussion This will be the first large randomized controlled trial specifically focused upon persecutory delusions. The project will produce a brief, easily administered intervention that can be readily used in mental health services. Trial registration Current Controlled Trials ISRCTN23197625 PMID:23171601

Content and affect in persecutory delusions.

PubMed

Green, Catherine; Garety, Philippa A; Freeman, Daniel; Fowler, David; Bebbington, Paul; Dunn, Graham; Kuipers, Elizabeth

2006-11-01

The study aimed to explore the content of persecutory delusions and its potential links with levels of affective disturbance. Detailed examinations of the phenomenology of delusional beliefs have been rare, but are important for furthering theoretical and clinical understanding. A cross-sectional investigation of 70 individuals with current persecutory delusions was conducted. Taped semi-structured clinical interviews were transcribed for each participant. Using a coding frame devised for the current study, a detailed description of persecutory content was made. Scores on the Beck Depression and Anxiety Inventories, the Rosenberg Self-esteem Scale and the Psychotic Symptom Rating Scales were used as indicators of emotional distress. Data were gathered on the identity and type of persecutor, pervasiveness of threat and the power of the persecutor. Reliability was good. Beliefs involving multiple persecutors, human in nature and identifiable to the individual were common. For the majority threat was severe, ongoing and enduring and coupled with frequent feelings of vulnerability. Specific aspects of delusional content were found to be associated with emotional distress. For example, if participants felt more power in the face of persecution this was coupled with lower depression and higher self-esteem. Persecutory delusions are beliefs concerning severe threat, particularly of physical harm including death, which is personally significant, frequently involving multiple persecutors known to the individual. Depression is higher in those who felt less powerful than their persecutors. Associations, such as this, with emotional distress support a direct role for emotion in delusion formation and maintenance. It is consistent with cognitive models of delusions which emphasize the importance of considering emotional distress in the context of belief appraisal, although interpretation of the results is limited by the cross-sectional study design. Recognizing these links may in turn aid therapists in identifying aspects of beliefs that might be targeted to facilitate emotional change.

Reasoning under uncertainty: heuristic judgments in patients with persecutory delusions or depression.

PubMed

Corcoran, Rhiannon; Cummins, Sinead; Rowse, Georgina; Moore, Rosie; Blackwood, Nigel; Howard, Robert; Kinderman, Peter; Bentall, Richard P

2006-08-01

The substantial literature examining social reasoning in people with delusions has, to date, neglected the commonest form of decision making in daily life. We address this imbalance by reporting here the findings of the first study to explore heuristic reasoning in people with persecutory delusions. People with active or remitted paranoid delusions, depressed and healthy adults performed two novel heuristic reasoning tasks that varied in emotional valence. The findings indicated that people with persecutory delusions displayed biases during heuristic reasoning that were most obvious when reasoning about threatening and positive material. Clear similarities existed between the currently paranoid group and the depressed group in terms of their reasoning about the likelihood of events happening to them, with both groups tending to believe that pleasant things would not happen to them. However, only the currently paranoid group showed an increased tendency to view other people as threatening. This study has initiated the exploration of heuristic reasoning in paranoia and depression. The findings have therapeutic utility and future work could focus on the differentiation of paranoia and depression at a cognitive level.

Understanding attributional biases, emotions and self-esteem in 'poor me' paranoia: findings from an early psychosis sample.

PubMed

Fornells-Ambrojo, M; Garety, P A

2009-06-01

Trower and Chadwick's (1995) theory of two types of paranoia ('poor me' and 'bad me') provides a framework for understanding the seemingly contradictory evidence on persecutory delusions. Paranoia has been argued to defend against low self-esteem, but people with persecutory delusions report high levels of emotional distress and, in some instances, low self-worth. The current study investigates attributions and emotions in a sample of people with early psychosis who have persecutory delusions. 'Poor me' paranoia has been found to be more frequent than 'bad me' paranoia in the early stages of psychosis. Anger and a tendency to blame other people are hypothesized to characterize 'poor me' paranoia. The study had a cross-sectional design. Twenty individuals with early psychosis, 21 clinical controls with depression and 32 healthy volunteers completed a thorough assessment of emotions and attributions. The 'poor me' paranoia group showed higher levels of anger, anxiety and depression than the non-clinical control group. Self-esteem and guilt were however preserved. A tendency to blame others but not themselves was characteristic of the 'poor me' paranoia group whereas people in the clinical control group tended to self-blame for failures. Anger, but not self-esteem, was associated with an attributional bias characterized by blaming other people instead of oneself. In conclusion, anger, a previously overlooked emotion in the study of persecutory delusions, warrants further attention. The other-directed nature of this emotion highlights the potential role of interpersonal schemas in understanding paranoia.

The Perseverative Thinking Questionnaire in Patients with Persecutory Delusions.

PubMed

Černis, Emma; Dunn, Graham; Startup, Helen; Kingdon, David; Wingham, Gail; Evans, Nicole; Lister, Rachel; Pugh, Katherine; Cordwell, Jacinta; Mander, Helen; Freeman, Daniel

2016-07-01

Ruminative negative thinking has typically been considered as a factor maintaining common emotional disorders and has recently been shown to maintain persecutory delusions in psychosis. The Perseverative Thinking Questionnaire (PTQ) (Ehring et al., 2011) is a transdiagnostic measure of ruminative negative thinking that shows promise as a "content-free" measure of ruminative negative thinking. The PTQ has not previously been studied in a psychosis patient group. In this study we report for the first time on the psychometric properties of Ehring et al.'s PTQ in such a group. The PTQ was completed by 142 patients with current persecutory delusions and 273 non-clinical participants. Participants also completed measures of worry and paranoia. A confirmatory factor analysis was performed on the clinical group's PTQ responses to assess the factor structure of the measure. Differences between groups were used to assess criterion reliability. A three lower-order factor structure of the PTQ (core characteristics of ruminative negative thinking, perceived unproductiveness, and capturing mental capacity) was replicated in the clinical sample. Patients with persecutory delusions were shown to experience significantly higher levels of ruminative negative thinking on the PTQ than the general population sample. The PTQ demonstrated high internal reliability. This study did not include test-retest data, and did not compare the PTQ against a measure of depressive rumination but, nevertheless, lends support for the validity of the PTQ as a measure of negative ruminative thinking in patients with psychosis.

Association of violence with emergence of persecutory delusions in untreated schizophrenia.

PubMed

Keers, Robert; Ullrich, Simone; Destavola, Bianca L; Coid, Jeremy W

2014-03-01

Psychosis is considered an important risk factor for violence, but studies show inconsistent results. The mechanism through which psychotic disorders influence violence also remains uncertain. The authors investigated whether psychosis increased the risk of violent behavior among released prisoners and whether treatment reduced this risk. They also explored whether active symptoms of psychosis at the time of violent behavior explained associations between untreated psychosis and violence. The U.K. Prisoner Cohort Study is a prospective longitudinal study of prisoners followed up in the community after release. Adult male and female offenders serving sentences of 2 or more years for a sexual or violent offense were classified into four groups: no psychosis (N=742), schizophrenia (N=94), delusional disorder (N=29), and drug-induced psychosis (N=102). Symptoms of psychosis, including hallucinations, thought insertion, strange experiences, and delusions of persecution, were measured before and after release. Information on violence between release and follow-up was collected through self-report and police records. Schizophrenia was associated with violence but only in the absence of treatment (odds ratio=3.76, 95% CI=1.39-10.19). Untreated schizophrenia was associated with the emergence of persecutory delusions at follow-up (odds ratio=3.52, 95% CI=1.18-10.52), which were associated with violence (odds ratio=3.68, 95% CI=2.44-5.55). The mediating effects of persecutory delusions were confirmed in mediation analyses (β=0.02, 95% CI=0.01-0.04). The results indicate that the emergence of persecutory delusions in untreated schizophrenia explains violent behavior. Maintaining psychiatric treatment after release can substantially reduce violent recidivism among prisoners with schizophrenia. Better screening and treatment of prisoners is therefore essential to prevent violence.

Worry processes in patients with persecutory delusions.

PubMed

Startup, Helen; Pugh, Katherine; Dunn, Graham; Cordwell, Jacinta; Mander, Helen; Černis, Emma; Wingham, Gail; Shirvell, Katherine; Kingdon, David; Freeman, Daniel

2016-11-01

Worry may be common in patients with paranoia and a contributory causal factor in the occurrence of the delusions. A number of psychological mechanisms have been linked to the occurrence of worry in emotional disorders but these are yet to be investigated in psychosis. The primary aim of the study was to test the links between five main worry mechanisms - perseverative thinking, catastrophizing, stop rules, metacognitive beliefs, and intolerance of uncertainty - and the cognitive style of worry in patients with persecutory delusions. One hundred and fifty patients with persecutory delusions completed assessments of paranoia, worry, and worry mechanisms. Worry in patients with psychosis was associated with the following: a perseverative thinking style, an 'as many as can' stop rule, a range of metacognitive beliefs (cognitive confidence, worry as uncontrollable and the need to control thoughts), and intolerance of uncertainty. Higher levels of worry were associated with higher levels of paranoia. There was also evidence that intolerance of uncertainty and the metacognitive belief concerning the need to control thoughts were independently associated with paranoia. Worry in patients with persecutory delusions may well be understood by similar underlying mechanisms as worry in emotional disorders. This supports the use of interventions targeting worry, suitably modified, for patients with psychosis. Worry is a significant concern for patients with paranoia Worry in paranoia is likely to be caused by similar mechanisms as worry in emotional disorders The results support the recent trial findings that standard techniques for treating worry in anxiety, suitably modified, are applicable for patients with paranoia LIMITATIONS: The findings are limited by the self-report nature of measures and by the study design which precludes any assumptions about the direction of causality between the psychological mechanisms and worry. © 2016 The British Psychological Society.

Testing the continuum of delusional beliefs: an experimental study using virtual reality.

PubMed

Freeman, Daniel; Pugh, Katherine; Vorontsova, Natasha; Antley, Angus; Slater, Mel

2010-02-01

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose-response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables.

The use of intuitive and analytic reasoning styles by patients with persecutory delusions.

PubMed

Freeman, Daniel; Lister, Rachel; Evans, Nicole

2014-12-01

A previous study has shown an association of paranoid thinking with a reliance on rapid intuitive ('experiential') reasoning and less use of slower effortful analytic ('rational') reasoning. The objectives of the new study were to replicate the test of paranoia and reasoning styles in a large general population sample and to assess the use of these reasoning styles in patients with persecutory delusions. 30 Patients with persecutory delusions in the context of a non-affective psychotic disorder and 1000 non-clinical individuals completed self-report assessments of paranoia and reasoning styles. The patients with delusions reported lower levels of both experiential and analytic reasoning than the non-clinical individuals (effect sizes small to moderate). Both self-rated ability and engagement with the reasoning styles were lower in the clinical group. Within the non-clinical group, greater levels of paranoia were associated with lower levels of analytic reasoning, but there was no association with experiential reasoning. The study is cross-sectional and cannot determine whether the reasoning styles contribute to the occurrence of paranoia. It also cannot be determined whether the patient group's lower reasoning scores are specifically associated with the delusions. Clinical paranoia is associated with less reported use of analytic and experiential reasoning. This may reflect patients with current delusions being unconfident in their reasoning abilities or less aware of decision-making processes and hence less able to re-evaluate fearful cognitions. The dual process theory of reasoning may provide a helpful framework in which to discuss with patients decision-making styles. Copyright © 2014 Elsevier Ltd. All rights reserved.

Persecutory delusions: a cognitive perspective on understanding and treatment.

PubMed

Freeman, Daniel

2016-07-01

A spectrum of severity of paranoia (unfounded thoughts that others are deliberately intending to cause harm) exists within the general population. This is unsurprising: deciding whether to trust or mistrust is a vital aspect of human cognition, but accurate judgment of others' intentions is challenging. The severest form of paranoia is persecutory delusions, when the ideas are held with strong conviction. This paper presents a distillation of a cognitive approach that is being translated into treatment for this major psychiatric problem. Persecutory delusions are viewed as threat beliefs, developed in the context of genetic and environmental risk, and maintained by several psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and the use of safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering feared situations after reduction of the influence of the maintenance factors. An exciting area of development will be a clinical intervention science of how best to enhance learning of safety to counteract paranoia. Copyright © 2016 Elsevier Ltd. All rights reserved.

Covariation assessment for neutral and emotional verbal stimuli in paranoid delusions.

PubMed

Díez-Alegría, Cristina; Vázquez, Carmelo; Hernández-Lloreda, María J

2008-11-01

Selective processing of emotion-relevant information is considered a central feature in various types of psychopathology, yet the mechanisms underlying these biases are not well understood. One of the first steps in processing information is to gather data to judge the covariation or association of events. The aim of this study was to explore whether patients with persecutory delusions would show a covariation bias when processing stimuli related to social threat. We assessed estimations of covariation in-patients with current persecutory (CP) beliefs (N=40), patients with past persecutory (PP) beliefs (N=25), and a non-clinical control (NC) group (N=36). Covariation estimations were assessed under three different experimental conditions. The first two conditions focused on neutral behaviours (Condition 1) and psychological traits (Condition 2) for two distant cultural groups, while the third condition included self-relevant material by exposing the participant to either protective social (positive) or threatening social (negative) statements about the participant or a third person. Our results showed that all participants were precise in their covariation estimations. However, when judging covariation for self-relevant sentences related to social statements (Condition 3), all groups showed a significant tendency to associate positive social interaction (protection themed) sentences to the self. Yet, when using sentences related to social-threat, the CP group showed a bias consisting of overestimating the number of self-referent sentences. Our results showed that there was no specific covariation assessment bias related to paranoid beliefs. Both NCs and participants with persecutory beliefs showed a similar pattern of results when processing neutral or social threat-related sentences. The implications for understanding of the role of self-referent information processing biases in delusion formation are discussed.

The fear of others: a pilot study of social anxiety processes in paranoia.

PubMed

Newman Taylor, Katherine; Stopa, Luisa

2013-01-01

There is good reason to consider the role of social anxiety processes in paranoia; both the research and clinical literature indicate significant overlap between the two presentations. The aim of this study was to explore cognition and behaviour that are typically associated with social phobia, in people with paranoia, and then to draw out theoretical and clinical implications. We used a cross-sectional between-subjects design to compare participants with persecutory delusions (without social phobia), social phobia, a clinical control group with panic disorder, and a non-clinical control group. Ten to 15 people were recruited to each of four groups, with a final total of 48 participants. Each person completed measures of automatic thoughts, underlying assumptions, core beliefs and behaviour, and took part in a semi-structured interview designed to assess process (self-consciousness and attentional focus) and metacognitive beliefs. Surprisingly, measures of cognition and behaviour yielded no systematic differences between people with persecutory delusions and social phobia. People with persecutory delusions may experience overt and underlying cognition typically associated with social phobia, and behave in similar ways in response to perceived social threat. These initial results indicate: (i) that larger scale research is now warranted in order to draw firm conclusions about social anxiety processes in paranoia; (ii) more specific hypotheses to be tested; and (iii) a clinical model of paranoia, based on the cognitive model of social phobia, which might now usefully be validated.

Delusional Themes Across Affective and Non-Affective Psychoses

PubMed Central

Picardi, Angelo; Fonzi, Laura; Pallagrosi, Mauro; Gigantesco, Antonella; Biondi, Massimo

2018-01-01

The current debate about the diagnostic significance of delusion revolves around two positions. The neurocognitive position conceives delusion as a non-specific, though polymorphic, symptom. The psychopathological position views features of delusion such as content and structure as having meaningful connections with diagnostic entities. This study aims at contributing to this debate by examining the association between delusional themes and diagnosis in a sample of 830 adult psychotic patients. All diagnoses were made by experienced psychiatrists according to DSM-IV or ICD-10 criteria, and in 348 patients were established with the SCID-I. All patients were administered the Brief Psychiatric Rating Scale (BPRS). In each patient, the presence of somatic delusions and delusions of guilt, grandiosity, and persecution was determined by examining the scores on relevant BPRS items. Delusions of guilt were almost pathognomonic for a psychotic depressive condition (psychotic major depression 40%; psychotic bipolar depression 30%; depressed schizoaffective disorder 8%; bipolar and schizoaffective mixed states 6 and 7%, respectively). Only 1% of patients with schizophrenia and no patient with delusional disorder or bipolar or schizoaffective manic state showed such delusions. The difference between unipolar and bipolar depression and the other diagnostic groups was highly significant. Delusions of grandiosity characterized mostly patients with manic symptoms (bipolar mania 20%; bipolar mixed states 19%; manic schizoaffective disorder 10%). They were observed significantly more often in bipolar mania than in schizophrenia (7%). Persecutory delusions were broadly distributed across diagnostic categories. However, they were significantly more frequent among patients with schizophrenia and delusional disorder compared with depressed and manic patients. Somatic delusions were also observed in all diagnostic groups, with no group standing out as distinct from the others in terms of an increased prevalence of somatic delusions. Our findings suggest a middle position in the debate between the neurocognitive and the psychopathological approaches. On the one hand, the widespread observation of persecutory delusions suggests the usefulness of searching for non-specific pathogenic mechanisms. On the other hand, the association between some delusional contents and psychiatric diagnosis suggests that a phenomenological analysis of the delusional experience may be a helpful tool for the clinician in the diagnostic process. PMID:29674982

Current paranoid thinking in patients with delusions: the presence of cognitive-affective biases.

PubMed

Freeman, Daniel; Dunn, Graham; Fowler, David; Bebbington, Paul; Kuipers, Elizabeth; Emsley, Richard; Jolley, Suzanne; Garety, Philippa

2013-11-01

There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and self-consciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state paranoia in patients with delusions. 130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self. Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self. The study provides a clear demonstration that a range of emotion-related cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences.

Diurnal variation in Cotard's syndrome (copresent with Capgras delusion) following traumatic brain injury.

PubMed

Butler, P V

2000-08-01

The aim of this paper is to document regular nocturnal intensification of delusional nihilistic and persecutory ideas (Cotard delusion) linked with extreme depersonalisation and hypervivid dreaming. A 17-year-old man presented with Cotard and Capgras delusions after sustaining multiple cognitive impairments secondary to traumatic brain injury. Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily. This patient's experience of perceptual abnormalities and impairments in meta-abilities related to self-monitoring and critical inferencing lends support to multicomponent sensory processing accounts of brain injury related, content-specific delusional syndromes.

On two kinds of delusion of reference.

PubMed

Startup, Mike; Startup, Sue

2005-11-15

Although delusions of reference are one of the most common psychotic symptoms, they have been the focus of little research. The aims of the present research were, first, to determine whether it is possible to identify different kinds of referential delusions reliably and, if so, to investigate associations among them and between these delusions and other positive psychotic symptoms. Participants with a diagnosis of schizophrenia (n=57) were recruited from a volunteer register (n=26) and from inpatient psychiatric wards (n=31). They were interviewed with the Scale for the Assessment of Positive Symptoms (SAPS) except that the questions about ideas and delusions of reference were replaced with questions targeted at seven particular delusions and three content areas. Ratings were made independently by two assessors. Agreement between the assessors was high for all of the delusions of reference and other psychotic symptoms. A factor analysis of these ratings revealed two factors that represent delusions of communication and delusions of observation. Only delusions of observation were associated with hallucinations and persecutory ideation. Delusions of communication showed few significant correlations with other symptoms and therefore appear to require different explanations.

Current Paranoid Thinking in Patients With Delusions: The Presence of Cognitive-Affective Biases

PubMed Central

Freeman, Daniel

2013-01-01

Background: There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and self-consciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state paranoia in patients with delusions. Methods: 130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self. Results: Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self. Conclusions: The study provides a clear demonstration that a range of emotion-related cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences. PMID:23223342

Threatening auditory hallucinations and Cotard syndrome in Parkinson disease.

PubMed

Factor, Stewart A; Molho, Eric S

2004-01-01

Psychotic symptoms are commonly reported in patients with Parkinson disease (PD). In particular, patients experience nonthreatening visual hallucinations that can occur with insight (so called hallucinosis) or without. Auditory hallucinations are uncommon, and schizophrenialike symptoms such as pejorative and threatening auditory hallucinations and delusions that are persecutory, referential, somatic, religious, or grandiose have rarely been reported. The authors present 2 PD patients who experienced threatening auditory hallucinations, without visual hallucinations, and schizophrenialike delusions with detailed description of the clinical phenomenology including 1 patient with Cotard syndrome.

Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS).

PubMed

Green, C E L; Freeman, D; Kuipers, E; Bebbington, P; Fowler, D; Dunn, G; Garety, P A

2008-01-01

Paranoia is increasingly being studied in clinical and non-clinical populations. However there is no multi-dimensional measure of persecutory ideas developed for use across the general population-psychopathology continuum. This paper reports the development of such a questionnaire: the 'Green et al. Paranoid Thought Scales'. The aim was to devise a tool to assess ideas of persecution and social reference in a simple self-report format, guided by a current definition of persecutory ideation, and incorporating assessment of conviction, preoccupation and distress. A total of 353 individuals without a history of mental illness, and 50 individuals with current persecutory delusions completed a pool of paranoid items and additional measures to assess validity. Items were devised from a recent definition of persecutory delusions, current assessments of paranoia, the authors' clinical experience, and incorporated dimensions of conviction, preoccupation and distress. Test-retest reliability in the non-clinical group was assessed at 2 weeks follow-up, and clinical change in the deluded group at 6 months follow-up. Two 16-item scales were extracted, assessing ideas of social reference and persecution. Good internal consistency and validity was established for both scales and their dimensions. The scales were sensitive to clinical change. A hierarchical relationship between social reference and persecution was found. The data provide further evidence for a continuum of paranoid ideas between deluded and healthy individuals. A reliable and valid tool for assessing paranoid thoughts is presented. It will provide an effective way for researchers to ensure consistency in research and for clinicians to assess change with treatment.

Schizophrenia: Impact of psychopathology, faith healers and psycho-education on adherence to medications.

PubMed

Abdel Aziz, Karim; Elamin, Mohammed H; El-Saadouni, Nisrin M; El-Gabry, Dina Aly; Barakat, Mahmoud; Alhayyas, Fatima; Moselhy, Hamdy F

2016-12-01

Many patients suffering from psychosis are nonadherent to their medications. Nonadherence can range from treatment refusal to irregular use or partial change in daily medication doses. To investigate whether symptom dimensions, post-discharge care plans and being involved with faith healer affect the adherence to treatment in patients with schizophrenia. A total of 121 patients with schizophrenia were examined 6 weeks post-discharge from the inpatient unit and assessed for full, partial or nonadherence to medication. There was a significant association between family involvement and partial adherence and between community team involvement post-discharge and full adherence to medications. Psycho-education was a predictor for adherence to medications, persecutory delusions and lack of insight predicted partial adherence, while being involved with faith healers predicted nonadherence. Adherence to medications and socio-demographic variables are independent. This study demonstrated that nonadherence or partial adherence to medications is associated with lack of insight and persecutory delusions. Psycho-education could improve the adherence to medication compliances. © The Author(s) 2016.

A preliminary investigation into theory of mind and attributional style in adults with grandiose delusions.

PubMed

Boyden, Paul; Knowles, Rebecca; Corcoran, Rhiannon; Hamilton, Simon; Rowse, Georgina

2015-01-01

A preliminary cognitive model of grandiose delusions has been put forward suggesting that persecutory and grandiose delusions shared distinct, yet overlapping psychological processes. This study aims to test this model and hypothesises that participants experiencing grandiose delusions may demonstrate a theory of mind (ToM) impairment and differences in attributional style compared to a control group. A cross-sectional design compared the performance of 18 individuals with grandiose delusions to a control group of 14 participants with depression. ToM was measured using a non-verbal joke appreciation task and a verbal stories task. Attributional style was measured using the internal, personal and situational attributions questionnaire. Participants experiencing grandiose delusions performed significantly worse on both ToM tasks compared to controls. Furthermore, these participants provided significantly more atypical answers when explaining the joke behind the ToM cartoons. No differences for subjective funniness ratings or attributional style were found. This preliminary study indicated participants experiencing grandiose delusions have ToM impairments which may contribute to the maintenance of this symptom.

Defensive function of persecutory delusion and discrepancy between explicit and implicit self-esteem in schizophrenia: study using the Brief Implicit Association Test

PubMed Central

Nakamura, Mitsuo; Hayakawa, Tomomi; Okamura, Aiko; Kohigashi, Mutsumi; Fukui, Kenji; Narumoto, Jin

2015-01-01

Background If delusions serve as a defense mechanism in schizophrenia patients with paranoia, then they should show normal or high explicit self-esteem and low implicit self-esteem. However, the results of previous studies are inconsistent. One possible explanation for this inconsistency is that there are two types of paranoia, “bad me” (self-blaming) paranoia and “poor me” (non-self-blaming) paranoia. We thus examined implicit and explicit self-esteem and self-blaming tendency in patients with schizophrenia and schizoaffective disorder. We hypothesized that patients with paranoia would show lower implicit self-esteem and only those with non-self-blaming paranoia would experience a discrepancy between explicit and implicit self-esteem. Methods Participants consisted of patients with schizophrenia and schizoaffective disorder recruited from a day hospital (N=71). Participants were assessed for psychotic symptoms, using the Brief Psychiatric Rating Scale (BPRS), and self-blaming tendency, using the brief COPE. We also assessed explicit self-esteem, using the Rosenberg Self-Esteem Scale (RSES), implicit self-esteem, using Brief Implicit Association Test (BIAT), and discrepancy between explicit and implicit self-esteem. Results Contrary to our hypothesis, implicit self-esteem in paranoia and nonparanoia showed no statistical difference. As expected, only patients with non-self-blaming paranoia experienced a discrepancy between explicit and implicit self-esteem; other groups showed no such discrepancy. Conclusion These results suggest that persecutory delusion plays a defensive role in non-self-blaming paranoia. PMID:25565849

Decision Making about Children with Psychotic Symptoms: Using the Best Evidence in Choosing a Treatment

ERIC Educational Resources Information Center

Shaw, Philip; Rapoport, Judith L.

2006-01-01

This paper presents Peter, an 11-year-old boy, with brief self-limited hallucinations and persecutory ideation (if not frank delusions) on a background of a gradual deterioration in overall functioning. Affective symptoms are not prominent, and there is little to suggest an organic contribution. This raises the possibility that he has, or is on…

Attributional style and theory of mind in people with Alzheimer disease and persecutory delusions.

PubMed

Rowse, Georgina; McCarthy-Jones, Simon; Knowles, Rebecca; Corcoran, Rhiannon; Bentall, Richard P

2013-09-01

Between 7% and 40% of people with Alzheimer disease (AD) experience persecutory delusions (PDs) during the course of their dementia. Although attributional style and theory of mind processes have been linked with PDs in people with psychosis, they have not yet been examined in those with AD and PDs. The objective of this study was, hence, to explore the role of these cognitive processes in groups of participants with AD with and without PDs, as well as a nonclinical comparison group. Measures of attributional style and theory of mind were administered to three groups: people with AD and PDs (n = 22), people with AD without PDs (n = 22), and a nonclinical group (n = 23). Although no clear differences in attributional style between the three groups were found, the group with AD and PDs were found to perform worse on the first-order (but not second-order) theory of mind task than the other two groups. Interventions designed to enhance theory of mind skills might be beneficial for individuals with AD and PDs. Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Delusions of reference: a new theoretical model.

PubMed

Startup, Mike; Bucci, Sandra; Langdon, Robyn

2009-03-01

Although delusions of reference are one of the most common psychotic symptoms, they have been the focus of little research, possibly because they have been considered to be integral to persecutory delusions. Evidence has now emerged that there are two kinds of delusion of reference. One of these, referential delusions of communication, which involves beliefs that others are communicating in subtle, nonverbal ways, is the focus of this paper. We present a new model designed to account for the four crucial aspects of the phenomenology of these delusions: (1) that neutral stimuli are experienced as having personal significance; (2) that the neutral stimuli are experienced as communicating a message nonverbally; (3) that the content of the message concerns the self; (4) that the experience of a self-referent communication is believed rather than being dismissed as implausible. We used PsycINFO and Scopus, using the term "delusion* of reference", to search for publications with a bearing on our model. The amount of research we found that was designed to test aspects of this model is small but other published research appears to provide some support for its various steps. Much of this research was not explicitly intended to provide an account of delusions of reference but its relevance nevertheless seems clear. There is preliminary support for the plausibility of our model but much additional research is needed. We conclude by summarising what we consider to be the main desiderata.

Understanding the paranoid psychosis of James: Use of the repertory grid technique for case conceptualization

PubMed Central

García-Mieres, Helena; Ochoa, Susana; Salla, Marta; López-Carrilero, Raquel; Feixas, Guillem

2016-01-01

In this paper we illustrate the potential of the repertory grid technique as an instrument for case formulation and understanding of the personal perception and meanings of people with a diagnosis of psychotic disorders. For this purpose, the case of James is presented: A young man diagnosed with schizophrenia and personality disorder, with severe persecutory delusions and other positive symptoms that have not responded to antipsychotic medication, as well with depressive symptomatology. His case was selected because of the way his symptoms are reflected in his personal perception of self and others, including his main persecutory figure, in the different measures that result from the analysis of his repertory grid. Some key clinical hypotheses and possible targets for therapy are discussed. PMID:27679779

Recall of threat material is modulated by self or other referencing in people with high or low levels of non-clinical paranoia.

PubMed

Greer, J; Smailes, D; Spencer, H; Freeston, M; Dudley, R

2016-03-01

Biased processing of negatively valenced, and particularly threat-related material plays an important role in the development of paranoid thinking. This has been demonstrated by superior memory for threat-related information in patients with persecutory delusions and in non-clinical paranoia-prone participants. This study examined how emotional material was recalled having been encoded in relation to one self or to another person, in people high or low in paranoid ideation. It was predicted that people high in paranoia would recall more threat related material about others than people low in paranoia owing to being particularly alert to threats from other people. Participants who reported high (N = 30) or low (N = 30) levels of sub-clinical paranoid thinking were presented with a series of threat-related and positive words and were asked to process them in terms of the self, or in terms of a fictional character. As predicted, when words were processed in terms of another person, the high paranoia group recalled more threat-related words than positive words, but when words had been processed in terms of the self, recall of threat-related and positive words did not differ. In contrast, there was no interaction between word-valence and referent in the low paranoia group. These findings are drawn from an analogue sample. Replication in a sample of clinical participants who report persecutory delusions is required. People high in sub-clinical paranoid ideation recalled threat preferentially in relation to other people. Such information processing biases may help understand the development and maintenance of persecutory beliefs. Copyright © 2015 Elsevier Ltd. All rights reserved.

A transdiagnostic investigation of 'theory of mind' and 'jumping to conclusions' in patients with persecutory delusions.

PubMed

Corcoran, R; Rowse, G; Moore, R; Blackwood, N; Kinderman, P; Howard, R; Cummins, S; Bentall, R P

2008-11-01

A tendency to make hasty decisions on probabilistic reasoning tasks and a difficulty attributing mental states to others are key cognitive features of persecutory delusions (PDs) in the context of schizophrenia. This study examines whether these same psychological anomalies characterize PDs when they present in the context of psychotic depression. Performance on measures of probabilistic reasoning and theory of mind (ToM) was examined in five subgroups differing in diagnostic category and current illness status. The tendency to draw hasty decisions in probabilistic settings and poor ToM tested using story format feature in PDs irrespective of diagnosis. Furthermore, performance on the ToM story task correlated with the degree of distress caused by and preoccupation with the current PDs in the currently deluded groups. By contrast, performance on the non-verbal ToM task appears to be more sensitive to diagnosis, as patients with schizophrenia spectrum disorders perform worse on this task than those with depression irrespective of the presence of PDs. The psychological anomalies associated with PDs examined here are transdiagnostic but different measures of ToM may be more or less sensitive to indices of severity of the PDs, diagnosis and trait- or state-related cognitive effects.

The fear of others: a qualitative analysis of interpersonal threat in social phobia and paranoia.

PubMed

Stopa, Luisa; Denton, Ruth; Wingfield, Megan; Taylor, Katherine Newman

2013-03-01

The cognitive models indicate that people with social phobia and paranoia share a common fear of others. While we recognize clinical differences, it is likely that some of the same psychological processes contribute to the maintenance of both presentations, yet the nature and extent of these similarities and differences are not yet clearly understood. This study explored threat experiences in people with social phobia and persecutory delusions in order to elucidate these aspects of the respective cognitive models. Accounts of interpersonal threat experiences were examined in nine people with social phobia and nine people with persecutory delusions. Verbatim transcripts were analyzed using thematic analysis. Three major themes emerged from the data: participants' experience of threat, reactions while under threat, and subsequent reflections. Narrative coherence emerged as a superordinate theme. Typical fear responses were found in both groups, particularly in their reactions to threat. The key differences were in participants' perceptual experiences, ability to stand back from the threat following the event, and narrative coherence. The findings are discussed in relation to current cognitive models of social phobia and paranoia. Theoretical and clinical implications are drawn out, and highlight the need to examine attentional and metacognitive processes more closely if we are to understand the maintenance of perceived threat in these groups, and means of alleviating associated distress.

Suicidality in schizophrenia spectrum disorders: the relationship to hallucinations and persecutory delusions.

PubMed

Kjelby, E; Sinkeviciute, I; Gjestad, R; Kroken, R A; Løberg, E-M; Jørgensen, H A; Hugdahl, K; Johnsen, E

2015-10-01

Assessment of suicide risk is crucial in schizophrenia and results concerning risk contributed by hallucinations and persecutory delusions are inconsistent. We aimed to determine factors associated with suicidal ideation and plans at the time of acute admission in patients suffering from schizophrenia spectrum disorders. One hundred and twenty-four patients older than 18 years admitted to an acute psychiatric ward due to psychosis were consecutively included. Predictors of suicidal ideation and suicide plans at the time of admission were examined with multinominal logistic regression and structural equation modelling (SEM). The study design was pragmatic, thus entailing a clinically relevant representation. Depression Odds Ratio (OR) 12.9, Drug use OR 4.07, Hallucinations OR 2.55 and Negative symptoms OR 0.88 significantly predicted Suicidal ideation. Suspiciousness/ Persecution did not. Only Depression and Hallucinations significantly predicted Suicide plans. In the SEM-model Anxiety, Depression and Hopelessness connected Suspiciousness/Persecution, Hallucinations and Lack of insight with Suicidal ideation and Suicide plans. The study contributes to an increasing evidence base supporting an association between hallucinations and suicide risk. We want to emphasise the importance of treating depression and hallucinations in psychotic disorders, reducing hopelessness while working with insight and reducing drug abuse in order to lower suicide risk. ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

[Effect of culture to delusions: Introduction of the Truman Show delusion].

PubMed

Varga, É Júlia; Herold, Róbert; Tényi, Tamás

"People accepts the reality of the unfolded world" - says Peter Weir in his writing from 1998. The movie Truman Show demonstrates the life of a man, who - without knowing that - lived his life more than thirty years long at real time in a reality show. We could see the Truman Show delusion in international scientific literature in the past years, like a new, cultural formed shape of persecutory and grandiose delusions. The background of its maturation is given by the changed social norms and cultural effects, what let anybody to may get celebrity - without any vocation or hard work - within fifteen minutes and turning into the focus of millions. Patients, whom looking for the meaning of the feeling of "being changed" (depersonalisation, derealisation) constantly finds the answers in a kind of a directed reality, broadcasted by the television or other medias, where the people round them are playing pre-written roles. Similar as the Capgras sympton - they are different compared what they sound to be, need to execute tasks to avoid the unknown threats or gaining rewards. The paper gives not only a short overview about this rare psychopathological symptom, but also introduces this through three case studies observed at the Department of Psychiatry and Psychotherapy, University of Pecs, Hungary.

Cotard Syndrome.

PubMed

Dieguez, Sebastian

2018-01-01

Cotard's syndrome is often described as the delusional belief that one is dead or non-existent. However, Jules Cotard's initial description (1880) of the "delusion of negations" was much richer and also involved delusions and claims of immortality and enormity, feelings of damnation, and illusions of bodily dissolution and transformation. Alternatively conceived as an extreme case of depression, hypochondria, or psychosis, the condition is considered rare and remains poorly understood. Cotard himself provided a taxonomy and several explanations for the condition, focusing on its distinction from classical persecutory delusions and suggesting that it could be a kind of reversed grandiosity. He proposed a psychosensory basis in the dissolution of mental imagery, which he then extended to a more general psychomotor impairment of volition. Other early authors highlighted a disorder of the bodily self, and more recent theories postulated an impairment of right hemispheric functions, leading to perceptual and somatosensory feelings of unreality, which coupled with reasoning impairments and an internalized attributional style led in turn to beliefs of non-existence. However, despite its striking presentation and its relevance to our understanding of self-awareness, Cotard's syndrome remains an elusive condition, rarely reported and poorly researched. © 2018 S. Karger AG, Basel.

Self-esteem is associated with premorbid adjustment and positive psychotic symptoms in early psychosis

PubMed Central

2011-01-01

Background Low levels of self-esteem have been implicated as both a cause and a consequence of severe mental disorders. The main aims of the study were to examine whether premorbid adjustment has an impact on the subject's self-esteem, and whether lowered self-esteem contributes to the development of delusions and hallucinations. Method A total of 113 patients from the Thematically Organized Psychosis research study (TOP) were included at first treatment. The Positive and Negative Syndrome Scale (PANSS) was used to assess present symptoms. Premorbid adjustment was measured with the Premorbid Adjustment Scale (PAS) and self-esteem by the Rosenberg Self-Esteem Scale (RSES). Results Premorbid social adjustment was significantly related to lower self-esteem and explained a significant proportion of the variance in self-esteem. Self-esteem was significantly associated with the levels of persecutory delusions and hallucinations experienced by the patient and explained a significant proportion of the variance even after adjusting for premorbid functioning and depression. Conclusion There are reasons to suspect that premorbid functioning is an important aspect in the development of self- esteem, and, furthermore, that self-esteem is associated with the development of delusions and hallucinations. PMID:21854599

A cognitive neuropsychological approach to the study of delusions in late-onset schizophrenia.

PubMed

Phillips, M L; Howard, R; David, A S

1997-09-01

Hypotheses to explain delusion formation include distorted perceptual processing of meaningful stimuli (e.g. faces), abnormal reasoning, or a combination of both. The study investigated these hypotheses using standardized neuropsychological tests. A three-patient case-study, compared with a small group (n = 8) of age-matched normal control subjects. Hospital in- and outpatients. Age-matched normal controls were from local residential homes. Three subjects with late-onset schizophrenia, two currently deluded and one in remission. Both deluded subjects had persecutory beliefs. One had a delusion of misidentification. All subjects were administered standardized neuropsychological tests of facial processing and tests of verbal reasoning. The test scores of the three patients were compared with published normal values and the age-matched control data. The tests demonstrated impaired matching of unfamiliar faces in deluded subjects, particularly in the subject with delusional misidentification. Increasing the emotional content of logical reasoning problems had a significant effect on the deluded subjects' reasoning but not that of the normal controls. The findings suggest impaired visual processing plus abnormal reasoning in deluded subjects. However, these impairments are relatively subtle given the severity of psychiatric disorder in the patients studied.

Delusional Jealousy (Othello Syndrome) in 67 Patients with Parkinson’s Disease

PubMed Central

Kataoka, Hiroshi; Sugie, Kazuma

2018-01-01

Othello syndrome (OS) is a type of paranoid delusional jealousy, characterized by the false absolute certainty of the infidelity of a partner. Because OS has infrequently occurred in patients with Parkinson’s disease (PD), the characteristics of OS in PD remain unclear. We reviewed the clinical characteristics of this syndrome in PD. We reviewed 67 patients who had PD with OS. OS was more common in men (45 patients) than in women (22 patients), and it frequently occurred in middle-aged patients. Until the onset of OS, the duration of PD (range, 2–19.8 years) and the duration of treatment with PD medications (range, 2 months to 18.5 years) varied. At the onset of OS, cognition was preserved in most patients. 42 of 47 patients had other psychiatric disorders in addition to OS, and 5 patients had isolated OS. Persecutory or other paranoid delusions developed in 34 patients with OS. OS was associated with PD medication in 25 of 26 patients, especially in patients, used the dopamine agonists. The dose of the PD medication associated with OS was decreased or these drugs were withdrawn to facilitate the treatment of OS. In most patients, OS disappeared or the severity of OS was reduced. OS is infrequent in patients with PD, but is likely to be easily detected because OS is commonly accompanied by persistent paranoid and sexual delusions. When clinicians encounter such patients, the withdrawal or reduction of dopamine agonists should be attempted, and if necessary, additional treatment with clozapine is recommended. PMID:29563893

Virtual reality and paranoid ideations in people with an 'at-risk mental state' for psychosis.

PubMed

Valmaggia, Lucia R; Freeman, Daniel; Green, Catherine; Garety, Philippa; Swapp, David; Antley, Angus; Prescott, Corinne; Fowler, David; Kuipers, Elizabeth; Bebbington, Paul; Slater, Mel; Broome, Matthew; McGuire, Philip K

2007-12-01

Virtual reality provides a means of studying paranoid thinking in controlled laboratory conditions. However, this method has not been used with a clinical group. To establish the feasibility and safety of using virtual reality methodology in people with an at-risk mental state and to investigate the applicability of a cognitive model of paranoia to this group. Twenty-one participants with an at-risk mental state were assessed before and after entering a virtual reality environment depicting the inside of an underground train. Virtual reality did not raise levels of distress at the time of testing or cause adverse experiences over the subsequent week. Individuals attributed mental states to virtual reality characters including hostile intent. Persecutory ideation in virtual reality was predicted by higher levels of trait paranoia, anxiety, stress, immersion in virtual reality, perseveration and interpersonal sensitivity. Virtual reality is an acceptable experimental technique for use with individuals with at-risk mental states. Paranoia in virtual reality was understandable in terms of the cognitive model of persecutory delusions.

Paranoid delusions in schizophrenia spectrum disorders and depression: the transdiagnostic role of expectations of negative events and negative self-esteem.

PubMed

Bentall, Richard P; Rowse, Georgina; Rouse, Georgina; Kinderman, Peter; Blackwood, Nigel; Howard, Rob; Moore, Rosie; Cummins, Sinead; Corcoran, Rhiannon

2008-05-01

We aimed to identify transdiagnostic psychological processes associated with persecutory delusions. Sixty-eight schizophrenia patients, 47 depressed patients, and 33 controls were assessed for paranoia, positive and negative self-esteem, estimations of the frequency of negative, neutral, and positive events occurring to the self in the past and in the future and similar estimates for events affecting others in the future. Negative self-esteem and expectations of negative events were strongly associated with paranoia in all groups. Currently deluded patients were asked to rate whether their persecution was deserved on an analogue scale. Mean deservedness scores were higher in deluded-depressed patients than deluded-schizophrenia patients, but patients in both groups used the full range of scores. The findings indicate that negative self-esteem and negative expectations independently contribute to paranoia, but do not support a simple categorical distinction between poor-me (persecution undeserved) and bad-me (persecution deserved) patients.

Sexual Behavior in Patients with Psychosis Admitted to a Hospital Unit.

PubMed

Del Mar Baños-Martín, María; Márquez-Hernández, Verónica V; Gutiérrez-Puertas, Lorena; Aguilera-Manrique, Gabriel; Gutiérrez-Puertas, Vanesa; Granados-Gámez, Genoveva

2017-06-01

The sexual dimension is part of a person's functionality. Patients with mental disorders have the same sexual needs as any other person, although they may not always be recognized. This is a retrospective observational study to describe the information on sexuality of patients with mental disorders, admitted to an acute short-stay inpatient unit between 2011 and 2015. We analyzed 293 clinical histories of patients, comprising diagnoses in the ICD-10 (International Classification of Diseases) between F20 and F29, inclusively. The information collected corresponded to the beginning of hospitalization, its duration and discharge. The results showed that 24% of the patients had sexual delusions. These delusions were more frequent in women, who in turn had more emotional symptoms, persecutory deception being the most common. There were few reports found on sexual dysfunction. In conclusion, the lack of data in the reports shows little recognition of sexuality in hospitalized patients with mental disorder, highlighting the need to promote the training of health personnel.

A randomized placebo-controlled trial of an omega-3 fatty acid and vitamins E+C in schizophrenia.

PubMed

Bentsen, H; Osnes, K; Refsum, H; Solberg, D K; Bøhmer, T

2013-12-17

Membrane lipid metabolism and redox regulation may be disturbed in schizophrenia. We examined the clinical effect of adding an omega-3 fatty acid and/or vitamins E+C to antipsychotics. It was hypothesized that lower baseline levels of polyunsaturated fatty acids (PUFAs) would predict more benefit from the add-on treatment. The trial had a multicenter, randomized, double-blind, placebo-controlled 2 × 2 factorial design. Patients aged 18-39 years with schizophrenia or related psychoses were consecutively included at admission to psychiatric departments in Norway. They received active or placebo ethyl-eicosapentaenoate (EPA) 2 g day⁻¹ and active or placebo vitamin E 364 mg day⁻¹+vitamin C 1000 mg day⁻¹ (vitamins) for 16 weeks. The main outcome measures were Positive and Negative Syndrome Scale (PANSS) total and subscales scores, analyzed by linear mixed models. Ninety-nine patients were included. At baseline, erythrocyte PUFA were measured in 97 subjects. Given separately, EPA and vitamins increased drop-out rates, whereas when combined they did not differ from placebo. In low PUFA patients, EPA alone impaired the course of total PANSS (Cohen's d=0.29; P=0.03) and psychotic symptoms (d=0.40; P=0.003), especially persecutory delusions (d=0.48; P=0.0004). Vitamins alone impaired the course of psychotic symptoms (d= 0.37; P=0.005), especially persecutory delusions (d=0.47; P=0.0005). Adding vitamins to EPA neutralized the detrimental effect on psychosis (interaction d=0.31; P=0.02). In high PUFA patients, there were no significant effects of trial drugs on PANSS scales. In conclusion, given separately during an acute episode, EPA and vitamins E+C induce psychotic symptoms in patients with low levels of PUFA. Combined, these agents seem safe.

Association study between monoamine oxidase A (MAOA) gene polymorphisms and schizophrenia: lack of association with schizophrenia and possible association with affective disturbances of schizophrenia.

PubMed

Kim, Su Kang; Park, Hae Jeong; Seok, Hosik; Jeon, Hye Sook; Chung, Joo-Ho; Kang, Won Sub; Kim, Jong Woo; Yu, Gyeong Im; Shin, Dong Hoon

2014-05-01

Monoamine oxidase A (MAOA) catalyzes monoamine neurotransmitters including dopamine, 5-hydroxytryptamine (5-HT, serotonin), and norepinephrine. MAOA also plays a key role in emotional regulation. The aim of this study was to investigate the associations between the exonic single nucleotide polymorphisms (SNPs) of the MAOA gene located on the X chromosome and schizophrenia. We also analyzed the relationships between these SNPs and the common clinical symptoms of schizophrenia such as persecutory delusion, auditory hallucinations, affective disturbances, and poor concentration. Two hundred seventy five Korean schizophrenia patients and 289 control subjects were recruited. Three SNPs [rs6323 (Arg294Arg), rs1137070 (Asp470Asp), and rs3027407 (3'-untranslated region)] of the MAOA gene were selected and genotyped by direct sequencing. The common clinical symptoms of schizophrenia according to the Operation Criteria Checklist were analyzed. Three examined SNPs showed no associations with male and female schizophrenia, respectively (p>0.05). In the analysis of the common clinical symptoms of schizophrenia patients, three examined SNPs were associated with affective disturbances, especially restricted affect and blunted affect in male schizophrenia, respectively (restricted affect, p=0.002, OR=2.71, 95% CI 1.45-5.00; blunted affect, p=0.009, OR 2.25, 95% CI 1.22-4.12). The SNPs were not associated with other clinical symptoms of schizophrenia (persecutory delusion, auditory hallucinations, and poor concentration). These results suggest that exonic SNPs (rs6323, rs1137070, and rs3027407) of the MAOA gene may be contributed to affective disturbances of Korean males schizophrenia, especially restricted affect and blunted affect.

The effects of using cognitive behavioural therapy to improve sleep for patients with delusions and hallucinations (the BEST study): study protocol for a randomized controlled trial.

PubMed

Freeman, Daniel; Startup, Helen; Myers, Elissa; Harvey, Allison; Geddes, John; Yu, Ly-Mee; Zaiwalla, Zenobia; Luengo-Fernandez, Ramon; Foster, Russell; Lister, Rachel

2013-07-11

Patients with psychosis frequently report difficulties getting or staying asleep (insomnia). Dissatisfaction with sleep is high. Insomnia should be treated in this group, but typically it is not even assessed. Importantly, recent evidence indicates that insomnia triggers and exacerbates delusions and hallucinations. The clinical implication is that if the insomnia is treated then the psychotic symptoms will significantly lessen. In a case series with 15 patients with persecutory delusions resistant to previous treatment this is exactly what we found: cognitive behavioural therapy for insomnia (CBT-I) led to large reductions in both the insomnia and delusions. The clear next step is a pilot randomized controlled test. The clinical aim is to test whether CBT-I can reduce both insomnia and psychotic symptoms. The trial will inform decisions for a definitive large-scale evaluation. We will carry out a randomized controlled trial (the Better Sleep Trial, or the BEST study) with 60 patients with distressing delusions or hallucinations in the context of a schizophrenia spectrum diagnosis. Half of the participants will be randomized to receive CBT-I, in addition to their standard treatment, for up to eight sessions over 12 weeks. The other half will continue with treatment as usual. Blind assessments will take place at 0 weeks, 12 weeks (post-treatment) and 24 weeks (follow-up). The primary outcome hypotheses are that CBT-I added to treatment as usual will improve sleep, delusions and hallucinations compared with only treatment as usual. All main analyses will be carried out at the end of the last follow-up assessments and will be based on the intention-to-treat principle. The trial is funded by the NHS National Institute for Health Research (NIHR) Research for Patient Benefit Programme. Data collection will be complete by the end of 2014. This will be the first controlled test of CBT-I for patients with delusions and hallucinations. It will provide significant evidence for an easily administered intervention that is likely to prove very popular with patients experiencing the difficult-to-treat problems of delusions and hallucinations. Current Controlled Trials ISRCTN 33695128.

Schizophrenia-like symptoms in a patient with Leigh syndrome.

PubMed

Satogami, Kazumi; Takahashi, Shun; Kose, Asami; Shinosaki, Kazuhiro

2017-02-01

Leigh syndrome is a mitochondrial disease characterized by subacute necrotizing encephalomyelopathy. Almost all cases of Leigh syndrome develop at infancy or early childhood and die within several years due to rapidly progressive muscle weakness and respiratory failure. Here, we present a rare case of a patient who developed Leigh syndrome associated with thiamine-responsive pyruvate dehydrogenase-complex deficiency at 2 years of age and has survived to adolescence through effective high dose thiamin therapy. At 15 years of age, the patient presented persecutory delusions and auditory hallucinations, suggesting an association between mitochondrial dysfunction and schizophrenia-like psychotic symptoms. Copyright © 2016 Elsevier B.V. All rights reserved.

Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem.

PubMed

Wickham, S; Sitko, K; Bentall, R P

2015-05-01

A growing body of research has investigated associations between insecure attachment styles and psychosis. However, despite good theoretical and epidemiological reasons for hypothesising that insecure attachment may be specifically implicated in paranoid delusions, few studies have considered the role it plays in specific symptoms. We examined the relationship between attachment style, paranoid beliefs and hallucinatory experiences in a sample of 176 people with a diagnosis of schizophrenia spectrum disorders and 113 healthy controls. We also investigated the possible role of negative self-esteem in mediating this association. Insecure attachment predicted paranoia but not hallucinations after co-morbidity between the symptoms was controlled for. Negative self-esteem partially mediated the association between attachment anxiety and clinical paranoia, and fully mediated the relationship between attachment avoidance and clinical paranoia. It may be fruitful to explore attachment representations in psychological treatments for paranoid patients. If future research confirms the importance of disrupted attachment as a risk factor for persecutory delusions, consideration might be given to how to protect vulnerable young people, for example those raised in children's homes.

Evolutionary perspectives on stress and affective disorder.

PubMed

Gardner, R

2001-01-01

Three general approaches to evolutionary perspectives in psychiatry include the following domains. (1) information from general medicine and physiology that involves defenses against infectious disease and predators, with obsessive compulsive disorder and posttraumatic stress disorder (PTSD) amongst the psychiatric results of this. (2) Sociophysiology assumes that normal brain functions mediate social interactions, including social rank hierarchy, in-out group formation, and family bonding. At times these function maladroitly resulting in psychiatric symptoms, for example, mania, persecutory delusions, and depression. (3) Evolutionary psychology explains self-sacrificing and generous behavior despite how genes act selfishly in natural selection theory, via the helping of relatives, reciprocal altruism, and manipulation of social contracts. Copyright 2001 by W.B. Saunders Company

The effects of using cognitive behavioural therapy to improve sleep for patients with delusions and hallucinations (the BEST study): study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Patients with psychosis frequently report difficulties getting or staying asleep (insomnia). Dissatisfaction with sleep is high. Insomnia should be treated in this group, but typically it is not even assessed. Importantly, recent evidence indicates that insomnia triggers and exacerbates delusions and hallucinations. The clinical implication is that if the insomnia is treated then the psychotic symptoms will significantly lessen. In a case series with 15 patients with persecutory delusions resistant to previous treatment this is exactly what we found: cognitive behavioural therapy for insomnia (CBT-I) led to large reductions in both the insomnia and delusions. The clear next step is a pilot randomized controlled test. The clinical aim is to test whether CBT-I can reduce both insomnia and psychotic symptoms. The trial will inform decisions for a definitive large-scale evaluation. Methods/design We will carry out a randomized controlled trial (the Better Sleep Trial, or the BEST study) with 60 patients with distressing delusions or hallucinations in the context of a schizophrenia spectrum diagnosis. Half of the participants will be randomized to receive CBT-I, in addition to their standard treatment, for up to eight sessions over 12 weeks. The other half will continue with treatment as usual. Blind assessments will take place at 0 weeks, 12 weeks (post-treatment) and 24 weeks (follow-up). The primary outcome hypotheses are that CBT-I added to treatment as usual will improve sleep, delusions and hallucinations compared with only treatment as usual. All main analyses will be carried out at the end of the last follow-up assessments and will be based on the intention-to-treat principle. The trial is funded by the NHS National Institute for Health Research (NIHR) Research for Patient Benefit Programme. Data collection will be complete by the end of 2014. Discussion This will be the first controlled test of CBT-I for patients with delusions and hallucinations. It will provide significant evidence for an easily administered intervention that is likely to prove very popular with patients experiencing the difficult-to-treat problems of delusions and hallucinations. Trial registration Current Controlled Trials ISRCTN 33695128 PMID:23845104

Gut feelings, deliberative thought, and paranoid ideation: A study of experiential and rational reasoning

PubMed Central

Freeman, Daniel; Evans, Nicole; Lister, Rachel

2012-01-01

Rapid intuitive hunches or gut feelings may be a compelling source of evidence for paranoid ideas. Conversely, a failure to apply effortful analytic thinking may contribute to the persistence of such thoughts. Our main aim was to examine for the first time the associations of persecutory thinking with experiential and rational thinking styles. Five hundred individuals recruited from the general population completed self-report assessments of current persecutory ideation, general reasoning styles and personality traits. Persecutory ideation was independently associated with greater use of experiential reasoning and less use of rational reasoning. The correlations were small. Persecutory ideation was also positively associated with neuroticism and negatively correlated with extraversion, agreeableness and conscientiousness. There was no evidence of an interaction between neuroticism and experiential reasoning in the prediction of paranoia, but high experiential reasoning in the context of low rational reasoning was particularly associated with persecutory ideation. Overall, the study provides rare evidence of self-reported general reasoning styles being associated with delusional ideation. Perceived reliance on intuition is associated with paranoid thinking, while perceived reliance on deliberation is associated with fewer such thoughts. The dual process theory of reasoning may provide a framework to contribute to the understanding of paranoid thinking. PMID:22406393

Gut feelings, deliberative thought, and paranoid ideation: a study of experiential and rational reasoning.

PubMed

Freeman, Daniel; Evans, Nicole; Lister, Rachel

2012-05-15

Rapid intuitive hunches or gut feelings may be a compelling source of evidence for paranoid ideas. Conversely, a failure to apply effortful analytic thinking may contribute to the persistence of such thoughts. Our main aim was to examine for the first time the associations of persecutory thinking with experiential and rational thinking styles. Five hundred individuals recruited from the general population completed self-report assessments of current persecutory ideation, general reasoning styles and personality traits. Persecutory ideation was independently associated with greater use of experiential reasoning and less use of rational reasoning. The correlations were small. Persecutory ideation was also positively associated with neuroticism and negatively correlated with extraversion, agreeableness and conscientiousness. There was no evidence of an interaction between neuroticism and experiential reasoning in the prediction of paranoia, but high experiential reasoning in the context of low rational reasoning was particularly associated with persecutory ideation. Overall, the study provides rare evidence of self-reported general reasoning styles being associated with delusional ideation. Perceived reliance on intuition is associated with paranoid thinking, while perceived reliance on deliberation is associated with fewer such thoughts. The dual process theory of reasoning may provide a framework to contribute to the understanding of paranoid thinking. Copyright © 2012 Elsevier Ltd. All rights reserved.

Attribution style as a factor in psychosis and symptom resolution.

PubMed

Mizrahi, Romina; Addington, Jean; Remington, Gary; Kapur, Shitij

2008-09-01

Attribution (AT) style theory provides a framework for understanding the causal explanations that individuals give for their own behaviour and the behaviour of others. It has been suggested that patients with persecutory delusions excessively attribute hypothetical positive events to internal causes (self) and hypothetical negative events to external personal causes. Despite this, how AT associates with psychotic symptoms (not only persecutory delusions) and how it changes with the resolution of psychosis has never been investigated. We conducted a cross-sectional study to investigate how AT is associated with psychopathology and a longitudinal study to examine the change of AT during the first 6 weeks of antipsychotic treatment and the relationship with psychopathology improvement. 86 patients meeting DSM-IV criteria for schizophrenia and related psychotic disorders were included in the cross-sectional study, and 17 patients in the longitudinal study. The longitudinal group were free of antipsychotic drugs at baseline and followed for 6 weeks after being started on antipsychotic medication by their psychiatrist. We used the Internal, Personal and Situational Attributions Questionnaire (IPSAQ) as a measure of AT. Patients that tend to internalize (i.e. less self-serving bias), showed greater overall psychopathology, as measured by PANSS-Total (F(2,83)=6.59, p=0.002), with a trend toward significance for PANSS-Positive (F(2,83)=2.62 p=0.07). Longitudinally, having a low self-serving bias was associated with poorer response to antipsychotic treatment. Further, externalizing bias seems to change early on in treatment (F=9.65 df=1,15 p=0.007) and reach ceiling effects thereafter. AT is related to overall symptom severity, with internalizing style linked to higher global psychopathology. Antipsychotic treatment has little effect on AT, at least within 6 weeks of antipsychotic exposure, and only a modest effect is on EB which plateaus within 2 weeks. Finally, internalizing style appears associated with poorer response to antipsychotic treatment.

The relevance of self-esteem and self-schemas to persecutory delusions: a systematic review.

PubMed

Kesting, Marie-Luise; Lincoln, Tania Marie

2013-10-01

Self-esteem is frequently targeted in psychological approaches to persecutory delusions (PD). However, its precise role in the formation and maintenance of PD is unclear and has been subject to a number of theories: It has been hypothesized that PD function to enhance self-esteem, that they directly reflect negative conceptualizations of the self, that self-esteem follows from the perceived deservedness of the persecution (poor-me versus bad-me-paranoia) and that the temporal instability of self-esteem is relevant to PD. In order to increase our understanding of the relevance of self-esteem to PD, this article systematically reviews the existing research on self-esteem in PD in the light of the existing theories. We performed a literature search on studies that investigated self-esteem in PD. We included studies that either investigated self-esteem a) within patients with PD or compared to controls or b) along the continuum of subclinical paranoia in the general population. We used a broad concept of self-esteem and included paradigms that assessed implicit self-esteem, specific self-schemas and dynamic aspects of self-esteem. The literature search identified 317 studies of which 52 met the inclusion criteria. The reviewed studies consistently found low global explicit self-esteem and negative self-schemas in persons with PD. The studies therefore do not support the theory that PD serve to enhance self-esteem but underline the theory that they directly reflect specific negative self-schemas. There is evidence that low self-esteem is associated with higher perceived deservedness of the persecution and that PD are associated with instable self-esteem. Only few studies investigated implicit self-esteem and the results of these studies were inconsistent. We conclude by proposing an explanatory model of how self-esteem and PD interact from which we derive clinical implications. Copyright © 2013 Elsevier Inc. All rights reserved.

A randomized placebo-controlled trial of an omega-3 fatty acid and vitamins E+C in schizophrenia

PubMed Central

Bentsen, H; Osnes, K; Refsum, H; Solberg, D K; Bøhmer, T

2013-01-01

Membrane lipid metabolism and redox regulation may be disturbed in schizophrenia. We examined the clinical effect of adding an omega-3 fatty acid and/or vitamins E+C to antipsychotics. It was hypothesized that lower baseline levels of polyunsaturated fatty acids (PUFAs) would predict more benefit from the add-on treatment. The trial had a multicenter, randomized, double-blind, placebo-controlled 2 × 2 factorial design. Patients aged 18–39 years with schizophrenia or related psychoses were consecutively included at admission to psychiatric departments in Norway. They received active or placebo ethyl-eicosapentaenoate (EPA) 2 g day−1 and active or placebo vitamin E 364 mg day−1+vitamin C 1000 mg day−1 (vitamins) for 16 weeks. The main outcome measures were Positive and Negative Syndrome Scale (PANSS) total and subscales scores, analyzed by linear mixed models. Ninety-nine patients were included. At baseline, erythrocyte PUFA were measured in 97 subjects. Given separately, EPA and vitamins increased drop-out rates, whereas when combined they did not differ from placebo. In low PUFA patients, EPA alone impaired the course of total PANSS (Cohen's d=0.29; P=0.03) and psychotic symptoms (d=0.40; P=0.003), especially persecutory delusions (d=0.48; P=0.0004). Vitamins alone impaired the course of psychotic symptoms (d= 0.37; P=0.005), especially persecutory delusions (d=0.47; P=0.0005). Adding vitamins to EPA neutralized the detrimental effect on psychosis (interaction d=0.31; P=0.02). In high PUFA patients, there were no significant effects of trial drugs on PANSS scales. In conclusion, given separately during an acute episode, EPA and vitamins E+C induce psychotic symptoms in patients with low levels of PUFA. Combined, these agents seem safe. PMID:24346133

Poststroke delusions: What about the neuroanatomical and neurofunctional basis?

PubMed

Torrisi, Michele; De Luca, Rosaria; Pollicino, Patrizia; Leonardi, Simona; Marino, Silvia; Maresca, Giuseppa; Maggio, Maria Grazia; Piccolo, Adriana; Bramanti, Placido; Calabrò, Rocco Salvatore

2018-01-19

Delusion is a belief about yourself, people, or events that has no accordance with reality. Although it is known that stroke could cause various psychiatric and psychological effects, including depression, anxiety, and aggressiveness, psychotic symptoms, especially delusions, are rather uncommon. The most investigated poststroke delusions are paranoid type, nihilistic, and Fregoli syndrome. We will describe two patients showing delusion symptoms (Cotard-like and erotomanic ones) that occurred after a stroke involving the right temporal lobe, the basal ganglia and insular region, persisting for a long period after the stroke onset. We have, therefore, supposed that the simultaneous involvement of these brain areas could be involved in the neuroanatomical basis of delusions, as also demonstrated by the neurofunctional evaluation.

Specificity of jumping to conclusions and attributional biases: a comparison between patients with schizophrenia, depression, and anorexia nervosa.

PubMed

Wittorf, Andreas; Giel, Katrin E; Hautzinger, Martin; Rapp, Alexander; Schönenberg, Michael; Wolkenstein, Larissa; Zipfel, Stephan; Mehl, Stephanie; Fallgatter, Andreas J; Klingberg, Stefan

2012-05-01

The knowledge of the specificity of cognitive biases in psychiatric disorders is important in order to develop disorder-specific cognitive models and therapies. This cross-sectional study aimed to investigate the specificity of jumping to conclusions (JTC) and attributional biases (AB) for patients with schizophrenia. Twenty patients with paranoid schizophrenia were compared with patients with depression (n=20) and with anorexia nervosa (n=15) and nonclinical controls (n=55). All participants were administered a modified version of the beads task (JTC), a revised German version of the Internal, Personal, and Situational Attributions Questionnaire (AB), and several symptom and neurocognitive measures. The proportion of patients with JTC bias in the schizophrenia group was, at the descriptive level, higher than in the depression and the anorexia groups. Regarding AB, the schizophrenia group showed a significantly stronger externalising but not personalising bias than the clinical control groups. Neither JTC nor attributional biases were significantly associated with delusions in general or persecutory delusion. We found evidence for the specificity of an externalising bias for paranoid schizophrenia. Concerning JTC bias the evidence was less clear. Whether the modification of those biases through psychological interventions would have an effect on psychopathology should be investigated in the context of clinical trials.

Filicide, attempted filicide, and psychotic disorders.

PubMed

Valença, Alexandre M; Mendlowicz, Mauro V; Nascimento, Isabella; Nardi, Antonio E

2011-03-01

The objective of the study was to describe and discuss the cases of two women who faced criminal charges, one for attempting to murder her three children and the other for killing her 1-year-old boy. After a forensic psychiatric assessment of their level of criminal responsibility, these patients were considered not guilty by reason of insanity and were committed to forensic mental hospitals. These two patients received a diagnosis of paranoid schizophrenia, according to the DSM-IV-TR criteria. In both cases, psychotic symptoms were present before the manifestation of violent behavior, in the form of persecutory delusions, auditory hallucinations, and pathological impulsivity. The investigation into cases of filicide may contribute powerfully to expand our understanding of motivational factors underlying this phenomenon and enhance the odds for effective prevention. © 2011 American Academy of Forensic Sciences.

A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis.

PubMed

Marcus, Elena; Garety, Philippa; Weinman, John; Emsley, Richard; Dunn, Graham; Bebbington, Paul; Freeman, Daniel; Kuipers, Elizabeth; Fowler, David; Hardy, Amy; Waller, Helen; Jolley, Suzanne

2014-12-01

Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp. Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later. The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects. We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample. The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

A comparison of symptoms and family history in schizophrenia with and without prior cannabis use: implications for the concept of cannabis psychosis.

PubMed

Boydell, J; Dean, K; Dutta, R; Giouroukou, E; Fearon, P; Murray, R

2007-07-01

There is considerable interest in cannabis use in psychosis. It has been suggested that the chronic psychosis associated with cannabis use, is symptomatically distinct from idiopathic schizophrenia. Several studies have reported differences in psychopathology and family history in people with schizophrenia according to whether or not they were cannabis users. We set out to test the hypotheses arising from these studies that cannabis use is associated with more bizarre behaviour, more thought disorder, fewer negative symptoms including blunted affect, more delusions of reference, more paranoid delusions and a stronger family history of schizophrenia. We used a case register that contained 757 cases of first onset schizophrenia, 182 (24%) of whom had used cannabis in the year prior to first presentation, 552 (73%) had not and 3% had missing data. We completed the OPCRIT checklist on all patients and investigated differences in the proportion of people with distractibility, bizarre behaviour, positive formal thought disorder, delusions of reference, well organised delusions, any first rank symptom, persecutory delusions, abusive/accusatory hallucinations, blunted affect, negative thought disorder, any negative symptoms (catatonia, blunted affect, negative thought disorder, or deterioration), lack of insight, suicidal ideation and a positive family history of schizophrenia, using chi square tests. Logistic regression modelling was then used to determine whether prior cannabis use affected the presence of the characteristics after controlling for age, sex and ethnicity. There was no statistically significant effect of cannabis use on the presence of any of the above. There remained however a non-significant trend towards more insight (OR 0.65 p=0.055 for "loss of insight") and a finding of fewer abusive or accusatory hallucinations (OR 0.65 p=0.049) of borderline significance amongst the cannabis users. These were in the hypothesised direction. There was no evidence of fewer negative symptoms or greater family history amongst cannabis users. We found few appreciable differences in symptomatology between schizophrenic patients who were or were not cannabis users. There were no differences in the proportion of people with a positive family history of schizophrenia between cannabis users and non-users. This argues against a distinct schizophrenia-like psychosis caused by cannabis.

Testing the Trower and Chadwick model of paranoia: Is 'poor-me' and 'bad-me' paranoia acting as a defence?

PubMed

Marley, Charles; Jones, Jason; Jones, Christopher A

2017-12-01

The study tested the predicted differences in phenomenology (self-esteem and depression) and insecurity of the subgroups of paranoia proposed by the Trower and Chadwick (1995) model of paranoia. Thirty-two inpatients experiencing persecutory delusions were assigned to either the poor me or bad me paranoid group. Questionnaire assessment of depression and self-esteem were conducted. A Dot Probe task measured detection latency (reaction time) to poor me words, bad me words and neutral words. The poor me and bad me groups displayed the predicted phenomenological differences. The dot probe task did not support the predicted insecurities of the Trower and Chadwick model, but unexpected significant results for the poor me subgroup may offer support for an alternative explanation of paranoia as an unstable phenomenon. Copyright © 2017 Elsevier B.V. All rights reserved.

Cerebral blood flow changes in very-late-onset schizophrenia-like psychosis with catatonia before and after successful treatment.

PubMed

Tsujino, Naohisa; Nemoto, Takahiro; Yamaguchi, Taiju; Katagiri, Naoyuki; Tohgi, Nao; Ikeda, Ryu; Shiraga, Nobuyuki; Mizumura, Sunao; Mizuno, Masafumi

2011-10-01

The purpose of the present study was to investigate regional cerebral blood flow (rCBF) changes in a patient with very-late-onset schizophrenia-like psychosis (VLOS) with catatonia. A 64-year-old woman developed catatonia after experiencing persecutory delusions. The patient's rCBF was examined using single photon emission computed tomography (SPECT) with easy Z-score imaging system. Before treatment, hypoperfusion was observed in the striatum and the thalamus, whereas hyperperfusion was observed in the left lateral frontal cortex and the left temporal cortex. After treatment, the disproportions in rCBF disappeared, and hyperperfusion was observed in the motor cortex. Sequential SPECT findings suggest that rCBF abnormalities may be correlated with the symptomatology of catatonia in patients with VLOS. © 2011 The Authors. Psychiatry and Clinical Neurosciences © 2011 Japanese Society of Psychiatry and Neurology.

Dissociation and psychosis in dissociative identity disorder and schizophrenia.

PubMed

Laddis, Andreas; Dell, Paul F

2012-01-01

Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). Schizophrenia patients were diagnosed with the Structured Clinical Interview for the DSM-IV Axis I Disorders; DID patients were diagnosed with the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised. DID patients obtained significantly (a) higher dissociation scores; (b) higher passive-influence scores (first-rank symptoms); and (c) higher scores on scales that measure child voices, angry voices, persecutory voices, voices arguing, and voices commenting. Schizophrenia patients obtained significantly higher delusion scores than did DID patients. What is odd is that the dissociation scores of schizophrenia patients were unrelated to their reports of childhood maltreatment. Multiple regression analyses indicated that 81% of the variance in DID patients' dissociation scores was predicted by the MID's Ego-Alien Experiences Scale, whereas 92% of the variance in schizophrenia patients' dissociation scores was predicted by the MID's Voices Scale. We propose that schizophrenia patients' responses to the MID do not index the same pathology as do the responses of DID patients. We argue that neither phenomenological definitions of dissociation nor the current generation of dissociation instruments (which are uniformly phenomenological in nature) can distinguish between the dissociative phenomena of DID and what we suspect are just the dissociation-like phenomena of schizophrenia.

Delusions with religious content in patients with psychosis: how they interact with spiritual coping.

PubMed

Mohr, Sylvia; Borras, Laurence; Betrisey, Carine; Pierre-Yves, Brandt; Gilliéron, Christiane; Huguelet, Philippe

2010-01-01

Delusions with religious content have been associated with a poorer prognosis in schizophrenia. Nevertheless, positive religious coping is frequent among this population and is associated with a better outcome. The aim of this study was to compared patients with delusions with religious content (n = 38), patients with other sorts of delusions (n = 85) and patients without persistent positive symptoms (n = 113) clinically and spiritually. Outpatients (n = 236) were randomly selected for a quantitative and qualitative evaluation of religious coping. Patients presenting delusions with religious content were not associated with a more severe clinical status compared to other deluded patients, but they were less likely to adhere to psychiatric treatment. For almost half of the group (45%), spirituality and religiousness helped patients cope with their illness. Delusional themes consisted of: persecution (by malevolent spiritual entities), influence (being controlled by spiritual entities), and self-significance (delusions of sin/guilt or grandiose delusions). Both groups of deluded patients valued religion more than other patients, but patients presenting delusions with religious content received less support from religious communities. In treating patients with such symptoms, clinicians should go beyond the label of "religious delusion," likely to involve stigmatization, by considering how delusions interact with patients' clinical and psychosocial context.

Social anxiety disorder in first-episode psychosis: incidence, phenomenology and relationship with paranoia.

PubMed

Michail, Maria; Birchwood, Max

2009-09-01

Social anxiety disorder constitutes a significant problem for people with psychosis. It is unclear whether this is a by-product of persecutory thinking. To compare the phenomenology of social anxiety disorder in first-episode psychosis with that in a group without psychosis. The relationship between social anxiety and psychosis symptoms was investigated. A sample of people with first-episode psychosis (FEP group) was compared with a sample with social anxiety disorder without psychosis (SaD group). Of the individuals in the FEP group (n = 80) 25% were diagnosed with an ICD-10 social anxiety disorder (FEP/SaD group); a further 11.6% reported severe difficulties in social encounters. The FEP/SaD and SaD groups reported comparable levels of social anxiety, autonomic symptoms, avoidance and depression. Social anxiety in psychosis was not related to the positive symptoms of the Positive and Negative Syndrome Scale (PANSS) including suspiciousness/persecution. However, a significantly greater percentage of socially anxious v. non-socially anxious individuals with psychosis expressed perceived threat from persecutors, although this did not affect the severity of social anxiety within the FEP/SaD group. The majority of those in the FEP/SaD group did not have concurrent persecutory delusions. Social anxiety is a significant comorbidity in first-episode psychosis. It is not simply an epiphenomenon of psychotic symptoms and clinical paranoia, and it has more than one causal pathway. For a subgroup of socially anxious people with psychosis, anticipated harm is present and the processes that underlie its relationship with social anxiety warrant further investigation.

The predictive value of early maladaptive schemas in paranoid responses to social stress.

PubMed

Sundag, Johanna; Ascone, Leonie; Lincoln, Tania M

2018-01-01

Social stress and negatively valenced cognitive representations of the self (self-schemas) play an important role in the formation of delusions. However, it has not been investigated whether and which self-schemas explain paranoid responses to social stress. Building on the framework of schema theory, the aim of this study was thus to investigate whether more pronounced early maladaptive schemas (EMSs) were associated with increased paranoid ideation after a social stress induction in patients with persecutory delusions (PD). Patients with PD (n = 20) and healthy controls (n = 40) were assessed for EMSs with the Young Schema Questionnaire. They were then exposed to a social stress situation in which they were socially excluded in a Cyberball paradigm. Prior to and after the social stress induction, paranoid symptoms were assessed. Patients with PD responded with a stronger increase in paranoia and revealed a significantly higher EMS total score compared to the healthy controls. As expected, higher increases in paranoia following the social stress were accounted for by higher EMS total scores. Exploratory analyses showed that particularly the specific EMSs Defectiveness/Shame and Enmeshment/Undeveloped Self were associated with the increase in paranoia. EMSs are associated with stress-related symptom increases in patients with PD. It thus seems worthwhile to further investigate the relevance of specific schemas for paranoia. The findings also suggest that addressing EMSs in psychological treatment of patients with PD holds potential. Copyright © 2017 John Wiley & Sons, Ltd.

An unusual psychiatric presentation of polycythaemia ‘Difficulties lie in our habits of thought rather than in the nature of things’ Andre Tardieu

PubMed Central

Rai, Rahul; Pieters, Thirza

2013-01-01

Psychiatric symptoms are not always best explained in the context of psychological stress. The same mental, emotional and behavioural changes also arise from various medical conditions. For a clinician this dual origin of psychiatric symptoms creates an ongoing diagnostic challenge. Our patient is a 50-year-old gentleman who had been working in a company for around 33 years and always had good appraisals. He presented to mental health services with a 5-year history of persecutory beliefs, convinced that his employers were out to damage his reputation. Apart from a diagnosis of polycythaemia, a few months before the onset of abnormal beliefs, there is no personal or family history of psychiatric disorder or medical illness. His delusions did not respond to conventional treatment with psychotropic medication possibly due to non-adherence because of side effects. However, a series of venesections lead to an improvement in mental state. PMID:23576647

An unusual psychiatric presentation of polycythaemia 'Difficulties lie in our habits of thought rather than in the nature of things' Andre Tardieu.

PubMed

Rai, Rahul; Pieters, Thirza

2013-04-09

Psychiatric symptoms are not always best explained in the context of psychological stress. The same mental, emotional and behavioural changes also arise from various medical conditions. For a clinician this dual origin of psychiatric symptoms creates an ongoing diagnostic challenge. Our patient is a 50-year-old gentleman who had been working in a company for around 33 years and always had good appraisals. He presented to mental health services with a 5-year history of persecutory beliefs, convinced that his employers were out to damage his reputation. Apart from a diagnosis of polycythaemia, a few months before the onset of abnormal beliefs, there is no personal or family history of psychiatric disorder or medical illness. His delusions did not respond to conventional treatment with psychotropic medication possibly due to non-adherence because of side effects. However, a series of venesections lead to an improvement in mental state.

Associations between belief inflexibility and dimensions of delusions: A meta-analytic review of two approaches to assessing belief flexibility.

PubMed

Zhu, Chen; Sun, Xiaoqi; So, Suzanne Ho-Wai

2018-03-01

Belief inflexibility has been suggested to maintain delusions. Different measures of assessing belief inflexibility have been developed, and it remains unclear whether patients with delusions display belief inflexibility similarly across measures. As delusions consist of multiple dimensions, the aim of this meta-analytic review was to examine how belief inflexibility is related to different aspects of delusions (conviction, distress, and preoccupation) and to compare these associations between interview-based and task-based measures of belief inflexibility. We conducted a systematic database search (PsycINFO, PsycARTICLES, PubMed, and MEDLINE) and identified relevant articles using the following search items: belief*, delusion*, or overvalued idea*; psychosis or schizo*; flexib*, inflexib*, change, revision, or update. Meta-analyses were conducted for each dimension of delusions and were reported according to the PRISMA guidelines. A total of 16 studies, with a total sample of 1,065, were included in the analysis. Belief inflexibility was associated with global severity of delusions (Hedges' g = 0.452, p < .001). Specifically, all dimensions of delusions were significantly associated with belief inflexibility (conviction: Hedges' g = 0.678, p < .001; preoccupation: Hedges' g = 0.274, p = .002; distress: Hedges' g = 0.200, p = .025). There was no significant heterogeneity across studies for each dimension. Preliminary subgroup analysis did not find any significant between-measure differences in the relationship between belief inflexibility and overall severity of delusions. Belief inflexibility, across measures, was robustly associated with delusions, with a particularly strong association for delusional conviction. Our results carried implications for process-based interventions for delusions. Positive clinical implications Belief inflexibility is consistently associated with the maintenance of delusions. Assessing belief inflexibility in routine clinical practice will inform psychological interventions for patients with persistent delusions. Interview- and task-based measures of belief inflexibility may be used complementarily to facilitate our understanding of this reasoning bias. Aetiological factors may be more closely associated with some aspects of delusions than the others. In line with a multidimensional view of delusions, interventions targeting different dimensions of delusions may have different therapeutic emphases. Limitations The current review focused on three core dimensions of delusions only (conviction, preoccupation, distress). Other ways of dissecting delusions are possible. Comparisons between the two measures of belief inflexibility may benefit from further research. © 2017 The British Psychological Society.

'Theory of mind' skills during an acute episode of psychosis and following recovery.

PubMed

Drury, V M; Robinson, E J; Birchwood, M

1998-09-01

A neuropsychological formulation of schizophrenia has suggested that problems with meta-representation underpin both positive and negative symptoms. This study tested Frith's account by asking patients experiencing an acute episode of psychosis to complete a set of tasks that involved Theory of Mind (ToM) skills. Fourteen patients who fulfilled criteria for schizophrenia, 10 deluded patients who were suffering from psychotic disorders other than schizophrenia and 12 depressed patients completed second-order false belief tasks, a test which involved substitution of a co-referential term in a linguistic description of an event, and metaphor and irony tasks. The battery of tests was completed during the acute phase and following recovery. Selection of these patient groups allowed comparisons to be made between schizophrenia patients and non-schizophrenia patients and between patients with and without persecutory delusions. Schizophrenia patients, who had a multiplicity of positive and negative symptoms, performed significantly worse than non-schizophrenia patients on some of the ToM tasks during an acute episode. Patients with delusions of persecution and reference did not perform significantly worse than non-deluded patients on ToM tasks. There was no significant difference between groups in performance on any of the tasks at recovery. The results provide at best weak support for Frith's account and it remains unclear whether the ToM deficits demonstrated are genuine deficits or are a result of information-processing overload. However, it is clear that difficulties interpreting interpersonal contexts, as shown by some schizophrenia patients, are state rather than trait characteristics.

Adversity and persecutory ideation: A moderated mediational model.

PubMed

Valiente, Carmen; Espinosa, Regina; Villavicencio, Patricia; Cantero, Dolores; Fuentenebro, Filiberto

2017-12-01

Adversity has been identified as an important factor in models of psychopathology and can help in understanding persecutory ideation, although potential moderators and mediators for adult psychopathology have not been sufficiently examined. Experiential avoidance (EA) and Self-esteem (SE) are relevant factors to understand how adversity leads to persecutory ideation. This study hypothesized that adversity would be associated with persecutory ideation through heightened EA, and that this association would be strengthened in individuals with a discrepant high SE. Participants with persecutory ideation (n = 52), with depression (n = 35) and healthy controls (n = 51) were assessed with the Trauma History Screen, the Paranoia and Deservedness Scale, and the Beck Depression Inventory. A SE discrepancy index was calculated subtracting the normalized explicit SE score from the normalized implicit SE score (measured by a version of a Go/No-go association task). Our analysis revealed that adversity was associated with higher levels of paranoia and was mediated by EA. In addition, we found that the relationship between adversity and EA was moderated by SE discrepancy. Identification of moderating and mediating variables allows for increased understanding of persecutory ideation and the processes that should be targeted in the course of recovery. Copyright © 2017 Elsevier B.V. All rights reserved.

Perceived ethnic discrimination and persecutory paranoia in individuals at ultra-high risk for psychosis.

PubMed

Shaikh, Madiha; Ellett, Lyn; Dutt, Anirban; Day, Fern; Laing, Jennifer; Kroll, Jasmine; Petrella, Sabrina; McGuire, Philip; Valmaggia, Lucia R

2016-07-30

Despite a consensus that psychosocial adversity plays a role in the onset of psychosis, the nature of this role in relation to persecutory paranoia remains unclear. This study examined the complex relationship between perceived ethnic discrimination and paranoid ideation in individuals at Ultra High Risk (UHR) for psychosis using a virtual reality paradigm to objectively measure paranoia. Data from 64 UHR participants and 43 healthy volunteers were analysed to investigate the relationship between perceived ethnic discrimination and persecutory ideation in a virtual reality environment. Perceived ethnic discrimination was higher in young adults at UHR in comparison to healthy controls. A positive correlation was observed between perceived ethnic discrimination and paranoid persecutory ideation in the whole sample. Perceived ethnic discrimination was not a significant predictor of paranoid persecutory ideation in the VR environment. Elevated levels of perceived ethnic discrimination are present in individuals at UHR and are consistent with current biopsychosocial models in which psychosocial adversity plays a key role in the development of psychosis and attenuated symptomatology. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

'Theory of Mind', psychotic-like experiences and psychometric schizotypy in adolescents from the general population.

PubMed

Barragan, Marcela; Laurens, Kristin R; Navarro, José Blas; Obiols, Jordi E

2011-04-30

This study examined 'Theory of Mind' (ToM) functioning, its association with psychometric schizotypy and with self-reported psychotic-like experiences (PLEs) and depressive symptoms, in a community sample of adolescents. Seventy-two adolescents (mean age 14.51years) from Barcelona, Spain, completed questionnaires assessing PLEs, depressive symptoms, and schizotypy. A verbal ToM task and a vocabulary test were administered. The effect of symptomatology, vocabulary ability, age, and gender on task performance was explored. Neither total score on schizotypy nor PLEs were associated with ToM performance. A significant effect of vocabulary on adolescent's performance of both ToM and control stories was found. ToM showed significant negative associations with positive schizotypy, and with one cluster of positive PLEs: first-rank experiences. Positive significant associations between ToM and persecutory delusions and the impulsive aspects of schizotypy were found. Depressive symptoms did not affect ToM performance. Positive schizotypal traits and first-rank symptoms are associated with ToM deficits in adolescents. Results support the trait-(versus state-) dependent notion of ToM impairments in schizophrenia. ToM may be a developmental impairment associated with positive schizotypy and PLEs. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Antibodies to AChR, MuSK and VGKC in a patient with myasthenia gravis and Morvan's syndrome.

PubMed

Díaz-Manera, Jordi; Rojas-García, Ricard; Gallardo, Eduard; Juárez, Cándido; Martínez-Domeño, Alejandro; Martínez-Ramírez, Sergi; Dalmau, Josep; Blesa, Rafael; Illa, Isabel

2007-07-01

A 46-year-old woman presented to a local hospital with acute respiratory failure and a 2-year progressive history of fatigue, personality changes, increased sweating, dysphagia with substantial weight loss, dysarthria, and intermittent ptosis and diplopia. Neurological examination showed facial weakness, lingual atrophy and bulbar palsy, which necessitated the use of a feeding tube and ventilatory support. Mild limb weakness with severe muscle atrophy and diffuse muscle twitches were observed. The patient had also developed visual hallucinations and persecutory delusions. Her personal and family medical histories were unremarkable. Sensory and motor nerve conduction studies, repetitive nerve stimulation, electromyogram, blood-cell counts, general chemistry and metabolic function tests, a CT scan, an [(18)F]fluorodeoxyglucose-PET scan, and tests for serum antibodies to acetylcholine receptors, muscle-specific tyrosine kinase, voltage-gated potassium channels, P/Q-type voltage-gated calcium channels, and paraneoplastic antigens, were carried out. Myasthenia gravis associated with antibodies to acetylcholine receptor and muscle-specific tyrosine kinase, and Morvan's syndrome associated with antibodies to voltage-gated potassium channels in the absence of thymoma. Combined treatment with prednisone, intravenous immunoglobulin, ciclosporin, and rituximab.

Belief revision and delusions: how do patients with schizophrenia take advice?

PubMed

Kaliuzhna, Mariia; Chambon, Valérian; Franck, Nicolas; Testud, Bérangère; Van der Henst, Jean-Baptiste

2012-01-01

The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed.

Belief Revision and Delusions: How Do Patients with Schizophrenia Take Advice?

PubMed Central

Kaliuzhna, Mariia; Chambon, Valérian; Franck, Nicolas; Testud, Bérangère; Van der Henst, Jean-Baptiste

2012-01-01

The dominant cognitive model that accounts for the persistence of delusional beliefs in schizophrenia postulates that patients suffer from a general deficit in belief revision. It is generally assumed that this deficit is a consequence of impaired reasoning skills. However, the possibility that such inflexibility affects the entire system of a patient's beliefs has rarely been empirically tested. Using delusion-neutral material in a well-documented advice-taking task, the present study reports that patients with schizophrenia: 1) revise their beliefs, 2) take into account socially provided information to do so, 3) are not overconfident about their judgments, and 4) show less egocentric advice-discounting than controls. This study thus shows that delusional patients' difficulty in revising beliefs is more selective than had been previously assumed. The specificities of the task and the implications for a theory of delusion formation are discussed. PMID:22536329

An autopsy case of cortical superficial siderosis with persistent abnormal behavior.

PubMed

Torii, Youta; Iritani, Shuji; Fujishiro, Hiroshige; Sekiguchi, Hirotaka; Habuchi, Chikako; Umeda, Kentaro; Matsunaga, Shinji; Mimuro, Maya; Ozaki, Norio; Yoshida, Mari; Fujita, Kiyoshi

2016-12-01

In recent years, MRI has revealed cortical superficial siderosis (cSS), which exhibits hemosiderin deposition in only the cortical surface. However, the associations between the histological findings and clinical symptoms of cSS remain unclear. We herein report an autopsy case of a 75-year-old Japanese man with cSS with persistent abnormal behavior according to cognitive impairment, hallucination and delusion. At 73 years of age, the patient presented with unusual behavior that indicated auditory hallucination and delusion. One year later, he was admitted to the hospital for malignant lymphoma. On admission, cognitive impairment was detected by a screening test. Soon after hospitalization, he presented with active delirium including visual hallucination and delusion. The patient's excited behavior was improved by the administration of a major tranquilizer. However, the abnormal behavior and cognitive impairment persisted. At 75 years of age, he died of heart failure. A neuropathological investigation revealed hemosiderin depositions in the superficial layer of the cortex in the medial and lateral frontal lobe, the lateral temporal lobe, the parietal lobe, and the medial and lateral occipital lobe. Neuritic plaques and diffuse plaques were extensively observed, which corresponded to Braak stage C and CERAD B, although NFTs were observed that corresponded to Braak stage II. Cortical amyloid angiopathy was not observed in any regions. Ischemic change of brain was also mild. Our report suggests that localized deposition of hemosiderin in the cortex might affect the manifestation of cognitive impairments and hallucination. Further clinicopathological studies are needed to clarify the clinical manifestations of patients with cSS. © 2016 Japanese Society of Neuropathology.

Positive symptoms, substance use, and psychopathic traits as predictors of aggression in persons with a schizophrenia disorder.

PubMed

van Dongen, Josanne D M; Buck, Nicole M L; van Marle, Hjalmar J C

2016-03-30

It is still not clear what the unique contribution of particular psychopathological factors is in explaining aggression in schizophrenia. The current study examined whether persecutory ideations, psychopathy and substance use are associated with different measures of aggressive behavior. We expected that persecutory ideations are associated with reactive aggression, and psychopathic traits are more associated with proactive aggression of inpatients. 59 inpatients with schizophrenia were included. Persecutory ideations we assessed using the Persecutory Ideation Questionnaire (PIQ), psychopathic traits with the revised version of Psychopathic Personality Inventory (PPI-R) and substance use was assessed using the Comprehensive Assessment of Symptoms and History (CASH). In addition, aggression was measured with the Reactive and Proactive Aggression Questionnaire (RPQ), in an experimental task using the Point Subtraction Aggression Paradigm (PSAP) and on the ward using the Social Dysfunction and Aggression Scale (SDAS). Results showed that psychopathy explains most of the variance in self-reported proactive and reactive aggression. In contrast, persecutory ideations explain most of the variance in observed aggression on the ward. Results implicate that it is important to acknowledge comorbid factors in patients with schizophrenia for more precise risk assessment and appropriate treatment for aggressive patients with schizophrenia. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Efficacy of cognitive behavioural therapy for sleep improvement in patients with persistent delusions and hallucinations (BEST): a prospective, assessor-blind, randomised controlled pilot trial

PubMed Central

Freeman, Daniel; Waite, Felicity; Startup, Helen; Myers, Elissa; Lister, Rachel; McInerney, Josephine; Harvey, Allison G; Geddes, John; Zaiwalla, Zenobia; Luengo-Fernandez, Ramon; Foster, Russell; Clifton, Lei; Yu, Ly-Mee

2015-01-01

Summary Background Sleep disturbance occurs in most patients with delusions or hallucinations and should be treated as a clinical problem in its own right. However, cognitive behavioural therapy (CBT)—the best evidence-based treatment for insomnia—has not been tested in this patient population. We aimed to pilot procedures for a randomised trial testing CBT for sleep problems in patients with current psychotic experiences, and to provide a preliminary assessment of potential benefit. Methods We did this prospective, assessor-blind, randomised controlled pilot trial (Better Sleep Trial [BEST]) at two mental health centres in the UK. Patients (aged 18–65 years) with persistent distressing delusions or hallucinations in the context of insomnia and a schizophrenia spectrum diagnosis were randomly assigned (1:1), via a web-based randomisation system with minimisation to balance for sex, insomnia severity, and psychotic experiences, to receive either eight sessions of CBT plus standard care (medication and contact with the local clinical team) or standard care alone. Research assessors were masked to group allocation. Assessment of outcome was done at weeks 0, 12 (post-treatment), and 24 (follow-up). The primary efficacy outcomes were insomnia assessed by the Insomnia Severity Index (ISI) and delusions and hallucinations assessed by the Psychotic Symptoms Rating Scale (PSYRATS) at week 12. We did analysis by intention to treat, with an aim to provide confidence interval estimation of treatment effects. This study is registered with ISRCTN, number 33695128. Findings Between Dec 14, 2012, and May 22, 2013, and Nov 7, 2013, and Aug 26, 2014, we randomly assigned 50 patients to receive CBT plus standard care (n=24) or standard care alone (n=26). The last assessments were completed on Feb 10, 2015. 48 (96%) patients provided follow-up data. 23 (96%) patients offered CBT took up the intervention. Compared with standard care, CBT led to reductions in insomnia in the large effect size range at week 12 (adjusted mean difference 6·1, 95% CI 3·0–9·2, effect size d=1·9). By week 12, nine (41%) of 22 patients receiving CBT and one (4%) of 25 patients receiving standard care alone no longer had insomnia, with ISI scores lower than the cutoff for insomnia. The treatment effect estimation for CBT covered a range from reducing but also increasing delusions (adjusted mean difference 0·3, 95% CI −2·0 to 2·6) and hallucinations (−1·9, −6·5 to 2·7). Three patients, all in the CBT group, had five adverse events, although none were regarded as related to study treatment. Interpretation Our findings show that CBT for insomnia might be highly effective for improving sleep in patients with persistent delusions or hallucinations. A larger, suitably powered phase 3 study is now needed to provide a precise estimate of the effects of CBT for sleep problems, both on sleep and psychotic experiences. Funding Research for Patient Benefit Programme, National Institute for Health Research. PMID:26363701

Schizotypy and Performance on an Insight Problem-Solving Task: The Contribution of Persecutory Ideation.

PubMed

Cosgrave, Jan; Haines, Ross; Golodetz, Stuart; Claridge, Gordon; Wulff, Katharina; van Heugten-van der Kloet, Dalena

2018-01-01

Insight problem solving is thought to underpin creative thought as it incorporates both divergent (generating multiple ideas and solutions) and convergent (arriving at the optimal solution) thinking approaches. The current literature on schizotypy and creativity is mixed and requires clarification. An alternate approach was employed by designing an exploratory web-based study using only correlates of schizotypal traits (paranoia, dissociation, cognitive failures, fantasy proneness, and unusual sleep experiences) and examining which (if any) predicted optimal performance on an insight problem-solving task. One hundred and twenty-one participants were recruited online from the general population and completed the number reduction task. The discovery of the hidden rule (HR) was used as a measure of insight. Multivariate logistic regression analyses highlighted persecutory ideation to best predict the discovery of the HR (OR = 1.05; 95% CI 1.01-1.10, p = 0.017), with a one-point increase in persecutory ideas corresponding to the participant being 5% more likely to discover the HR. This result suggests that persecutory ideation, above other schizotypy correlates, may be involved in insight problem solving.

An experiential perspective on persecutory paranoia: a grounded theory construction.

PubMed

Boyd, Tom; Gumley, Andrew

2007-03-01

Recently there has been a large volume of research on persecutory paranoia. Evidence has emerged for the role of social factors in the development of paranoia. There have, however, been no studies that have collaborated with users to develop an experiential perspective on paranoia. This study used a social constructionist version of grounded theory to develop an experiential perspective on persecutory paranoia. Ten individuals who had experience of persecutory paranoia were interviewed. The interviews were transcribed and analysed using the grounded theory method. A core process of fear and vulnerability was constructed. Subcategories of confusion and uncertainty, and self under attack contributed to the core process. These processes led to an engaging of the safety systems. Subthemes of these categories were identified. Many of these factors interacted to create the complex and dynamic experience of paranoia. Participants were often responding to genuinely frightening experiences but were also attacking themselves. Paranoia evolved as a mechanism of keeping oneself safe in dangerous situations. The need to negotiate a shared meaning of paranoia with users is emphasized. Direction for future research was discussed.

Cognitive Mechanisms of Change in Delusions: An Experimental Investigation Targeting Reasoning to Effect Change in Paranoia

PubMed Central

Garety, Philippa; Waller, Helen; Emsley, Richard; Jolley, Suzanne; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Fowler, David; Hardy, Amy; Freeman, Daniel

2015-01-01

Background: Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. Methods: One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. Results: On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. Conclusion: The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention. PMID:25053650

Bullying victimisation and risk of psychotic phenomena: analyses of British national survey data.

PubMed

Catone, Gennaro; Marwaha, Steven; Kuipers, Elizabeth; Lennox, Belinda; Freeman, Daniel; Bebbington, Paul; Broome, Matthew

2015-07-01

Being bullied is an aversive experience with short-term and long-term consequences, and is incorporated in biopsychosocial models of psychosis. We used the 2000 and the 2007 British Adult Psychiatric Morbidity Surveys to test the hypothesis that bullying is associated with individual psychotic phenomena and with psychosis, and predicts the later emergence of persecutory ideation and hallucinations. We analysed two nationally representative surveys of individuals aged 16 years or older in Great Britain (2000) and England (2007). Respondents were presented with a card listing stressful events to identify experiences of bullying over the entire lifespan. We assessed associations with the dependent variables persecutory ideation, auditory and visual hallucinations, and diagnosis of probable psychosis. All analyses were controlled for sociodemographic confounders, intelligence quotient (IQ), and other traumas. We used data for 8580 respondents from 2000 and 7403 from 2007. Bullying was associated with presence of persecutory ideation and hallucinations, remaining so after adjustment for sociodemographic factors, IQ, other traumas, and childhood sexual abuse. Bullying was associated with a diagnosis of probable psychosis. If reported at baseline, bullying predicted emergence and maintenance of persecutory ideation and hallucinations during 18 months of follow-up in the 2000 survey. Controlling for other traumas and childhood sexual abuse did not affect the association between bullying and psychotic symptoms, but reduced the significance of the association with diagnosis of probable psychosis. Bullying was most strongly associated with the presence of concurrent persecutory ideation and hallucinations. Bullying victimisation increases the risk of individual psychotic symptoms and of a diagnosis of probable psychosis. Early detection of bullying and use of treatments oriented towards its psychological consequences might ameliorate the course of psychosis. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

Delusions in first-episode psychosis: Principal component analysis of twelve types of delusions and demographic and clinical correlates of resulting domains.

PubMed

Paolini, Enrico; Moretti, Patrizia; Compton, Michael T

2016-09-30

Although delusions represent one of the core symptoms of psychotic disorders, it is remarkable that few studies have investigated distinct delusional themes. We analyzed data from a large sample of first-episode psychosis patients (n=245) to understand relations between delusion types and demographic and clinical correlates. First, we conducted a principal component analysis (PCA) of the 12 delusion items within the Scale for the Assessment of Positive Symptoms (SAPS). Then, using the domains derived via PCA, we tested a priori hypotheses and answered exploratory research questions related to delusional content. PCA revealed five distinct components: Delusions of Influence, Grandiose/Religious Delusions, Paranoid Delusions, Negative Affect Delusions (jealousy, and sin or guilt), and Somatic Delusions. The most prevalent type of delusion was Paranoid Delusions, and such delusions were more common at older ages at onset of psychosis. The level of Delusions of Influence was correlated with the severity of hallucinations and negative symptoms. We ascertained a general relationship between different childhood adversities and delusional themes, and a specific relationship between Somatic Delusions and childhood neglect. Moreover, we found higher scores on Delusions of Influence and Negative Affect Delusions among cannabis and stimulant users. Our results support considering delusions as varied experiences with varying prevalences and correlates. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Jumping to conclusions and the continuum of delusional beliefs.

PubMed

Warman, Debbie M; Lysaker, Paul H; Martin, Joel M; Davis, Louanne; Haudenschield, Samantha L

2007-06-01

The present study examined the jumping to conclusions reasoning bias across the continuum of delusional ideation by investigating individuals with active delusions, delusion prone individuals, and non-delusion prone individuals. Neutral and highly self-referent probabilistic reasoning tasks were employed. Results indicated that individuals with delusions gathered significantly less information than delusion prone and non-delusion prone participants on both the neutral and self-referent tasks, (p<.001). Individuals with delusions made less accurate decisions than the delusion prone and non-delusion prone participants on both tasks (p<.001), yet were more confident about their decisions than were delusion prone and non-delusion prone participants on the self-referent task (p=.002). Those with delusions and those who were delusion prone reported higher confidence in their performance on the self-referent task than they did the neutral task (p=.02), indicating that high self-reference impacted information processing for individuals in both of these groups. The results are discussed in relation to previous research in the area of probabilistic reasoning and delusions.

A measure of state persecutory ideation for experimental studies.

PubMed

Freeman, Daniel; Pugh, Katherine; Green, Catherine; Valmaggia, Lucia; Dunn, Graham; Garety, Philippa

2007-09-01

Experimental research is increasingly important in developing the understanding of paranoid thinking. An assessment measure of persecutory ideation is necessary for such work. We report the reliability and validity of the first state measure of paranoia: The State Social Paranoia Scale. The items in the measure conform to a recent definition in which persecutory thinking has the 2 elements of feared harm and perpetrator intent. The measure was tested with 164 nonclinical participants and 21 individuals at high risk of psychosis with attenuated positive symptoms. The participants experienced a social situation presented in virtual reality and completed the new measure. The State Social Paranoia Scale was found to have excellent internal reliability, adequate test-retest reliability, clear convergent validity as assessed by both independent interviewer ratings and self-report measures, and showed divergent validity with measures of positive and neutral thinking. The measure of paranoia in a recent social situation has good psychometric properties.

Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia.

PubMed

Garety, Philippa; Waller, Helen; Emsley, Richard; Jolley, Suzanne; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Fowler, David; Hardy, Amy; Freeman, Daniel

2015-03-01

Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Ketamine Effects on Memory Reconsolidation Favor a Learning Model of Delusions

PubMed Central

Gardner, Jennifer M.; Piggot, Jennifer S.; Turner, Danielle C.; Everitt, Jessica C.; Arana, Fernando Sergio; Morgan, Hannah L.; Milton, Amy L.; Lee, Jonathan L.; Aitken, Michael R. F.; Dickinson, Anthony; Everitt, Barry J.; Absalom, Anthony R.; Adapa, Ram; Subramanian, Naresh; Taylor, Jane R.; Krystal, John H.; Fletcher, Paul C.

2013-01-01

Delusions are the persistent and often bizarre beliefs that characterise psychosis. Previous studies have suggested that their emergence may be explained by disturbances in prediction error-dependent learning. Here we set up complementary studies in order to examine whether such a disturbance also modulates memory reconsolidation and hence explains their remarkable persistence. First, we quantified individual brain responses to prediction error in a causal learning task in 18 human subjects (8 female). Next, a placebo-controlled within-subjects study of the impact of ketamine was set up on the same individuals. We determined the influence of this NMDA receptor antagonist (previously shown to induce aberrant prediction error signal and lead to transient alterations in perception and belief) on the evolution of a fear memory over a 72 hour period: they initially underwent Pavlovian fear conditioning; 24 hours later, during ketamine or placebo administration, the conditioned stimulus (CS) was presented once, without reinforcement; memory strength was then tested again 24 hours later. Re-presentation of the CS under ketamine led to a stronger subsequent memory than under placebo. Moreover, the degree of strengthening correlated with individual vulnerability to ketamine's psychotogenic effects and with prediction error brain signal. This finding was partially replicated in an independent sample with an appetitive learning procedure (in 8 human subjects, 4 female). These results suggest a link between altered prediction error, memory strength and psychosis. They point to a core disruption that may explain not only the emergence of delusional beliefs but also their persistence. PMID:23776445

"The foolmaster who fooled them".

PubMed Central

Young, J. H.

1980-01-01

Throughout the nineteenth century, physicians assumed the major task of analyzing and warning against quackery and unorthodoxy. The nature of this criticism is described, with key reliance on Worthington Hooker's Lessons from the History of Medical Delusions (1850). Most physicians viewed prospects for suppressing quackery more hopefully than Hooker did. Even he, however, would be shocked that delusion could persist so stubbornly despite advancing medical science, expanding education, and increasing regulation. Many factors help explain today's continuing-even burgeoning-quackery. These include a less cheerful view of both human nature and of the future, widespread skepticism about the fruits for science, impatience with governmental regulation, the vogue for self-help in health, increasing promotional sophistication on the part of unorthodox health vendors, and cooperation among various wings of unorthodoxy to maximize political pressure. Examples are given. Champions of alternative therapies predict their triumph over orthodox medical science in the contest being waged for the allegiance of the public. PMID:7018095

The role of fear in delusions of the paranormal.

PubMed

Lange, R; Houran, J

1999-03-01

Based on an extended process model derived from attribution theory, we hypothesized that pervasive and persistent delusions of the paranormal are characterized by the existence of a positive (self-reinforcing), rather than a negative (self-correcting), feedback loop involving paranormal beliefs, fears, and experiences, as moderated by gender and tolerance of ambiguity. A cross-cultural sample of "international" students who reported poltergeist-like experiences showing high fear of the paranormal was identified. As in earlier research, path analysis showed statistically significant and positive effects of belief on experience and/or fear on belief. However, paranormal experience now had a positive effect on fear as well. Thus, as predicted, increased fear removes the option of neutralizing ambiguous events by labeling them as "paranormal." Although female subjects showed significantly greater fear of the paranormal than male subjects, there is no evidence that the nature of the delusional process is gender specific.

Schizophrenia and monothematic delusions.

PubMed

Coltheart, Max; Langdon, Robyn; McKay, Ryan

2007-05-01

Numerous delusions have been studied which are highly specific and which can present in isolation in people whose beliefs are otherwise entirely unremarkable - "monothematic delusions" such as Capgras or Cotard delusions. We review such delusions and summarize our 2-factor theory of delusional belief which seeks to explain what causes these delusional beliefs to arise initially and what prevents them being rejected after they have arisen. Although these delusions can occur in the absence of other symptoms, they can also occur in the context of schizophrenia, when they are likely to be accompanied by other delusions and hallucinations. We propose that the 2-factor account of particular delusions like Capgras and Cotard still applies even when these delusions occur in the context of schizophrenia rather than occurring in isolation.

Psychotic-Like Experiences in Nonpsychotic Help-Seekers: Associations With Distress, Depression, and Disability

PubMed Central

Yung, Alison R; Buckby, Joe A; Cotton, Sue M; Cosgrave, Elizabeth M; Killackey, Eoin J; Stanford, Carrie; Godfrey, Katherine; McGorry, Patrick D

2006-01-01

Psychotic-like experiences (PLEs) increase the risk of schizophrenia and other psychotic disorders yet are common in the community. Some PLEs, such as those associated with depression, distress, and poor functioning, may confer increased risk. The aim of this study is to determine the prevalence of PLEs in a nonpsychotic clinical sample and to investigate whether any subtypes of PLEs are associated with the above factors. Consecutive referrals to a youth psychiatric service (N = 140) were assessed to measure PLEs, depression, and functioning. PLE data were factor analyzed, and the associations of psychotic subtypes and distress, depression, and disability were analyzed. Three subtypes of PLEs were identified: Bizarre Experiences, Persecutory Ideas, and Magical Thinking. Bizarre Experiences and Persecutory Ideas were associated with distress, depression, and poor functioning. Magical Thinking was not, unless accompanied by distress. Bizarre Experiences and Persecutory Ideas may be more malignant forms of psychotic symptoms, as they are associated with current disability, and may confer increased risk of development of full-blown psychotic disorder. PMID:16254060

Prevalence of psychotic symptoms among older adults in an Asian population.

PubMed

Subramaniam, Mythily; Abdin, Edimansyah; Vaingankar, Janhavi; Picco, Louisa; Shahwan, Shazana; Jeyagurunathan, Anitha; Zhang, Yunjue; Verma, Swapna; Chong, Siow Ann

2016-07-01

Psychotic symptoms are common among older adults and are seen in a wide range of conditions. Most studies examining the prevalence and correlates of psychotic symptoms among older adults have been conducted in Western populations. To address this gap the current study was undertaken to establish the prevalence and correlates of psychotic symptoms and paranoid ideation within a community sample of older adults without dementia in an Asian population. The Well-being of the Singapore Elderly (WiSE) study was a comprehensive single phase, cross-sectional survey. All respondents were assessed using the Geriatric Mental State examination (GMS). Specific questions of the GMS were then used to establish the prevalence of hallucinations and persecutory delusions. A total of 2,565 respondents completed the study giving a response rate of 65.6%. The prevalence of any psychotic symptoms in this population of older adults was 5.2%. The odds of hallucinations and any psychotic symptoms were significantly higher among those of Malay ethnicity, and those who had no formal education. Older adults aged 75-84 years were significantly associated with lower odds of having hallucinations (vs. older adult aged 60-74 years), while homemaker status was significantly associated with lower odds of having any psychotic symptoms. The prevalence of psychotic symptoms among older Asian adults without dementia was higher than that reported from Western countries. Psychotic symptoms were associated with Malay ethnicity, poor cognitive performance and fewer years of schooling, visual and hearing impairment as well as depression and irritability.

Making sense of theory of mind and paranoia: the psychometric properties and reasoning requirements of a false belief sequencing task.

PubMed

Corcoran, Rhiannon; Bentall, Richard P; Rowse, Georgina; Moore, Rosanne; Cummins, Sinead; Blackwood, Nigel; Howard, Robert; Shryane, Nick M

2011-11-01

INTRODUCTION. This study used Item-Response Theory (IRT) to model the psychometric properties of a false belief picture sequencing task. Consistent with the mental time travel hypothesis of paranoia, we anticipated that performance on this deductive theory of mind (ToM) task would not be associated with the presence of persecutory delusions but would be related to other clinical, cognitive, and demographic factors. METHOD. A large (N=237) and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed 2 ToM tasks: the false belief sequencing task and a ToM stories task that was used to assess the validity of the false belief sequencing task as a measure of ToM. RESULTS. A unidimensional IRT model was found to fit the data well. Latent ToM ability as measured by the false belief sequencing task was negatively related with age and positively with IQ. In contrast to the ToM stories measure, there was no association between clinical diagnosis or symptoms and false belief picture sequencing after controlling for age and IQ. CONCLUSIONS. In line with mental time travel hypothesis of paranoia (Corcoran, 2010 ), performance on this deductive nonverbal ToM task is not related to the presence of paranoid symptoms. This measure is best suited for assessing ToM functioning where participants' performance falls just short of the average latent ToM ability. Furthermore, it is sensitive to the effects of increasing age and decreasing IQ.

Case Report of Cushing's Syndrome with an Acute Psychotic Presentation

PubMed Central

WU, Yuejing; CHEN, Jiong; MA, Yongchun; CHEN, Zhenxin

2016-01-01

Summary A 36-year-old Chinese woman was brought to the emergency department of a general hospital with a 3-day history of mania, persecutory delusions, and suicidal ideation; she also had a 6-month history of disrupted sleep, hypervigilance, and somatic symptoms. Her physical exam on admission to the psychosomatic ward identified a moon-shaped face, exophthalmos, and purple striae on her legs, so acute psychiatric symptoms secondary to Cushing’s syndrome was suspected. Elevated plasma cortisol and adrenocorticotropic hormone (ACTH) and identification of a mass on her left adrenal gland on the computed tomography (CT) scan of her abdomen confirmed the diagnosis. Low dose quetiapine (75-125 mg/d) and alprazolam (0.4 mg/qn) were prescribed to control the psychotic symptoms and improve her sleep. After surgical removal of a benign ACTH-independent adrenal tumor, her cortisol and ACTH levels returned to normal and her psychiatric symptoms gradually diminished over a one-month period, at which point she was discharged. Low-dose quetiapine was continued for 2 months after discharge and then discontinued; by this time her psychiatric symptoms had completely disappeared. In this case the patient had pathognomonic symptoms of CS, so it was relatively easy to make the diagnosis; but acute psychotic symptoms in CS can be life-threatening and may not be associated with the typical physical symptoms of CS (if there is only modest hypercortisolemia), so psychiatric clinicians should always consider CS among the possible differential diagnoses for unexplained acute psychosis. PMID:28638188

Schizophrenia on YouTube.

PubMed

Nour, Matthew M; Nour, Murraih H; Tsatalou, Olga-Maria; Barrera, Alvaro

2017-01-01

YouTube ( www.youtube.com ) is the most popular video-sharing Web site on the Internet and is used by medical students as a source of information regarding mental health conditions, including schizophrenia. The accuracy and educational utility of schizophrenia presentations on YouTube are unknown. The purpose of this study was to analyze the accuracy of depictions of psychosis in the context of a diagnosis of schizophrenia (referred to in this article as "acute schizophrenia") on YouTube and to assess the utility of these videos as educational tools for teaching medical students to recognize the clinical features of acute schizophrenia. YouTube was searched for videos purporting to show acute schizophrenia. Eligible videos were independently rated by two consultant psychiatrists on two separate occasions 22 days apart for diagnostic accuracy, psychopathology, and educational utility. Videos (N=4,200) were assessed against predefined inclusion and exclusion criteria. The majority were not eligible for further analysis, mostly because they did not claim to show a patient with schizophrenia (74%) or contained duplicated content (11%). Of 35 videos that met the eligibility and adequacy criteria, only 12 accurately depicted acute schizophrenia. Accurate videos were characterized by persecutory delusions (83%), inappropriate affect (75%), and negative symptoms (83%). Despite the fact that 83% of accurate videos were deemed to have good educational utility compared with 15% of inaccurate videos, accurate and inaccurate videos had similar view counts (290,048 versus 186,124). Schizophrenia presentations on YouTube offer a distorted picture of the condition.

A PHENOMENOLOGICAL STUDY OF DELUSIONS IN SCHIZOPHRENIA

PubMed Central

Kulhara, P.; Chandiramani, K.; Mattoo, S.K.; Awasthi, A.

1986-01-01

SUMMARY 112 patients with final clinical diagnosis of schizophrenia were subjected to detailed mental sums examination using, a structured interview schedule the present state examination. Phenomenology of delusions was determined according to the definitions and criteria of this schedule. The relationships of phenomenology will) socio-demography variables were also studied. It was seen that delusions of persecution were significantly more in males and in patients above the age of 30 years. Educated patients had more delusional misinterpretation, delusions of references and delusions of thoughts being read. Systematization of delusions was more in younger patients. Married patients had more delusions of reference. PMID:21927190

Schizophrenia and Monothematic Delusions

PubMed Central

Coltheart, Max; Langdon, Robyn; McKay, Ryan

2007-01-01

Numerous delusions have been studied which are highly specific and which can present in isolation in people whose beliefs are otherwise entirely unremarkable — “monothematic delusions” such as Capgras or Cotard delusions. We review such delusions and summarize our 2-factor theory of delusional belief which seeks to explain what causes these delusional beliefs to arise initially and what prevents them being rejected after they have arisen. Although these delusions can occur in the absence of other symptoms, they can also occur in the context of schizophrenia, when they are likely to be accompanied by other delusions and hallucinations. We propose that the 2-factor account of particular delusions like Capgras and Cotard still applies even when these delusions occur in the context of schizophrenia rather than occurring in isolation. PMID:17372282

Phenomenological and neurocognitive perspectives on delusions: A critical overview.

PubMed

Sass, Louis; Byrom, Greg

2015-06-01

There is considerable overlap between phenomenological and neurocognitive perspectives on delusions. In this paper, we first review major phenomenological accounts of delusions, beginning with Jaspers' ideas regarding incomprehensibility, delusional mood, and disturbed "cogito" (basic, minimal, or core self-experience) in what he termed "delusion proper" in schizophrenia. Then we discuss later studies of decontextualization and delusional mood by Matussek, changes in self and world in delusion formation according to Conrad's notions of "apophany" and "anastrophe", and the implications of ontological transformations in the felt sense of reality in some delusions. Next we consider consistencies between: a) phenomenological models stressing minimal-self (ipseity) disturbance and hyperreflexivity in schizophrenia, and b) recent neurocognitive models of delusions emphasizing salience dysregulation and prediction error. We voice reservations about homogenizing tendencies in neurocognitive explanations of delusions (the "paranoia paradigm"), given experiential variations in states of delusion. In particular we consider shortcomings of assuming that delusions necessarily or always involve "mistaken beliefs" concerning objective facts about the world. Finally, we offer some suggestions regarding possible neurocognitive factors. Current models that stress hypersalience (banal stimuli experienced as strange) might benefit from considering the potential role of hyposalience in delusion formation. Hyposalience - associated with experiencing the strange as if it were banal, and perhaps with activation of the default mode network - may underlie a kind of delusional derealization and an "anything goes" attitude. Such an attitude would be conducive to delusion formation, yet differs significantly from the hypersalience emphasized in current neurocognitive theories. © 2015 World Psychiatric Association.

Recent Work on the Nature and Development of Delusions

PubMed Central

Miyazono, Kengo

2015-01-01

Abstract In this paper we review two debates in the current literature on clinical delusions. One debate is about what delusions are. If delusions are beliefs, why are they described as failing to play the causal roles that characterise beliefs, such as being responsive to evidence and guiding action? The other debate is about how delusions develop. What processes lead people to form delusions and maintain them in the face of challenges and counter‐evidence? Do the formation and maintenance of delusions require abnormal experience alone, or also reasoning biases or deficits? We hope to show that the focus on delusions has made a substantial contribution to the philosophy of the mind and continues to raise issues that are central to defining the concept of belief and gaining a better understanding of how people process information and learn about the world. PMID:27478490

Phenomenological and neurocognitive perspectives on delusions: A critical overview

PubMed Central

Sass, Louis; Byrom, Greg

2015-01-01

There is considerable overlap between phenomenological and neurocognitive perspectives on delusions. In this paper, we first review major phenomenological accounts of delusions, beginning with Jaspers’ ideas regarding incomprehensibility, delusional mood, and disturbed “cogito” (basic, minimal, or core self-experience) in what he termed “delusion proper” in schizophrenia. Then we discuss later studies of decontextualization and delusional mood by Matussek, changes in self and world in delusion formation according to Conrad's notions of “apophany” and “anastrophe”, and the implications of ontological transformations in the felt sense of reality in some delusions. Next we consider consistencies between: a) phenomenological models stressing minimal-self (ipseity) disturbance and hyperreflexivity in schizophrenia, and b) recent neurocognitive models of delusions emphasizing salience dysregulation and prediction error. We voice reservations about homogenizing tendencies in neurocognitive explanations of delusions (the “paranoia paradigm”), given experiential variations in states of delusion. In particular we consider shortcomings of assuming that delusions necessarily or always involve “mistaken beliefs” concerning objective facts about the world. Finally, we offer some suggestions regarding possible neurocognitive factors. Current models that stress hypersalience (banal stimuli experienced as strange) might benefit from considering the potential role of hyposalience in delusion formation. Hyposalience – associated with experiencing the strange as if it were banal, and perhaps with activation of the default mode network – may underlie a kind of delusional derealization and an “anything goes” attitude. Such an attitude would be conducive to delusion formation, yet differs significantly from the hypersalience emphasized in current neurocognitive theories. PMID:26043327

Delusion proneness and 'jumping to conclusions': relative and absolute effects.

PubMed

van der Leer, L; Hartig, B; Goldmanis, M; McKay, R

2015-04-01

That delusional and delusion-prone individuals 'jump to conclusions' is one of the most robust and important findings in the literature on delusions. However, although the notion of 'jumping to conclusions' (JTC) implies gathering insufficient evidence and reaching premature decisions, previous studies have not investigated whether the evidence gathering of delusion-prone individuals is, in fact, suboptimal. The standard JTC effect is a relative effect but using relative comparisons to substantiate absolute claims is problematic. In this study we investigated whether delusion-prone participants jump to conclusions in both a relative and an absolute sense. Healthy participants (n = 112) completed an incentivized probabilistic reasoning task in which correct decisions were rewarded and additional information could be requested for a small price. This combination of rewards and costs generated optimal decision points. Participants also completed measures of delusion proneness, intelligence and risk aversion. Replicating the standard relative finding, we found that delusion proneness significantly predicted task decisions, such that the more delusion prone the participants were, the earlier they decided. This finding was robust when accounting for the effects of risk aversion and intelligence. Importantly, high-delusion-prone participants also decided in advance of an objective rational optimum, gathering fewer data than would have maximized their expected payoff. Surprisingly, we found that even low-delusion-prone participants jumped to conclusions in this absolute sense. Our findings support and clarify the claim that delusion formation is associated with a tendency to 'jump to conclusions'. In short, most people jump to conclusions, but more delusion-prone individuals 'jump further'.

Delusions and underlying needs in older adults with Alzheimer's disease: influence of earlier life experiences and the current environment.

PubMed

Wang, Jing-Jy; Cheng, Wen-Yun; Lai, Pei-Ru; Pai, Ming-Chyi

2014-12-01

Delusions are one of the most severe psychiatric symptoms of individuals with Alzheimer's disease (AD), which often increase the stress experienced by caregivers. The purpose of this study was to understand the influences of earlier life experiences and the current environment on delusions, as well as the underlying needs of older adults with AD who experience delusions. Using an exploratory research design with a qualitative approach and purposive sampling, 20 family caregivers were interviewed. Two psychosocial types of attributes of delusion were categorized: Type A, the influence of earlier life experiences; and Type B, current environmental influences. The underlying needs of those with delusions include physical comfort, a desire to be secure, and a sense of belonging. The contents of delusions are easily influenced by patients' earlier negative experiences and responsibilities, whereas the current environment exerts a crucial influence on the occurrence, frequency, and severity of specific delusions. These results can facilitate planning for patient-centered care by enhancing health care providers' understanding of the psychosocial and environmental attributes and needs behind delusions. Copyright 2014, SLACK Incorporated.

How delusion is formed?

PubMed

Park, Jong Suk; Kang, Ung Gu

2016-02-01

Traditionally, delusions have been considered to be the products of misinterpretation and irrationality. However, some theorists have argued that delusions are normal or rational cognitive responses to abnormal experiences. That is, when a recently experienced peculiar event is more plausibly explained by an extraordinary hypothesis, confidence in the veracity of this extraordinary explanation is reinforced. As the number of such experiences, driven by the primary disease process in the perceptual domain, increases, this confidence builds and solidifies, forming a delusion. We tried to understand the formation of delusions using a simulation based on Bayesian inference. We found that (1) even if a delusional explanation is only marginally more plausible than a non-delusional one, the repetition of the same experience results in a firm belief in the delusion. (2) The same process explains the systematization of delusions. (3) If the perceived plausibility of the explanation is not consistent but varies over time, the development of a delusion is delayed. Additionally, this model may explain why delusions are not corrected by persuasion or rational explanation. This Bayesian inference perspective can be considered a way to understand delusions in terms of rational human heuristics. However, such experiences of "rationality" can lead to irrational conclusions, depending on the characteristics of the subject. Copyright © 2015 Elsevier Ltd. All rights reserved.

T84. DO SIMILAR COGNITIVE MECHANISMS ENCOURAGE DELUSION-LIKE IDEATION AND BELIEF IN FAKE NEWS?

PubMed Central

Bronstein, Michael; Pennycook, Gordon; Bear, Adam; Cannon, Tyrone; Rand, David

2018-01-01

Abstract Background Increasingly, the positive symptoms of psychosis are recognized as being on a continuum with phenomena that are experienced by many members of the general population (i.e., non-clinical samples). Delusions are no exception. These fixed false beliefs, which are common in individuals with psychosis, are echoed by inflexible false beliefs in the general population that have delusion-like qualities (e.g., belief in clairvoyance). In a series of studies, we sought to determine whether belief in a particular type of disinformation (fake news) might represent a point on the same continuum as delusions and delusion-like ideation. To this end, we examined whether individuals who endorsed more delusion-like ideation were also more prone to believing fake news. We then examined whether the cognitive mechanisms behind any relationship between delusion-like ideation and fake news were similar to those associated with delusion-like ideation generally. Methods 503 participants were recruited using Amazon’s Mechanical Turk (MTurk). Participants completed a test of ability to discriminate real from fake news along with several individual difference measures. These included measures of delusion-like ideation (the Peters et al. Delusion Inventory [PDI]), engagement in analytic thinking (the Cognitive Reflection Test [CRT]), and the degree to which one values evidence in forming and revising beliefs (the Actively Open-Minded Thinking Questionnaire [AOT]). Mediation tests were conducted using the PROCESS macro for SPSS (model 4, with 5000 bootstrapped samples and bias-corrected 95% confidence intervals). Results Delusion-like ideation was positively correlated with belief in fake news (rho(501) = .20, p < .001). The relationship between belief in fake news and delusion-like ideation was partially explained by lower levels of analytic thinking ability (as measured by the CRT; completely standardized 95% CI = [.02 .07]) and lower evidence valuation (as measured by AOT scores; completely standardized 95% CI = [.01 .06]). These indirect effects accounted for 39% of the relationship between delusion-like ideation and belief in fake news. Delusion-like ideation and belief in real news were not correlated (rho(501) = 0.01, p = .927). Discussion Consistent with the notion that belief in fake news represents a point on the same continuum as belief in delusional and delusion-like ideas, belief in fake news was associated with increased endorsement of delusion-like ideation. This relationship was partially explained by factors previously associated with delusions and delusion-like ideation (e.g., lower engagement in analytic thinking, lower valuation of evidence in belief formation and revision). The link between delusion-proneness and belief in fake news (which was established for the first time in these studies) may prove useful in helping to inoculate the public against the deleterious effects of purposely-spread misinformation. Identifying individuals who might be at high risk of falling for fake news is an essential first step in this direction. The present results suggest that individuals who endorse delusion-like ideation may be one population toward which interventions aimed at preventing belief in misinformation might usefully be aimed.

Understanding delusions

PubMed Central

Kiran, Chandra; Chaudhury, Suprakash

2009-01-01

Delusion has always been a central topic for psychiatric research with regard to etiology, pathogenesis, diagnosis, treatment, and forensic relevance. The various theories and explanations for delusion formation are reviewed. The etiology, classification and management of delusions are briefly discussed. Recent advances in the field are reviewed. PMID:21234155

Belief-bias reasoning in non-clinical delusion-prone individuals.

PubMed

Anandakumar, T; Connaughton, E; Coltheart, M; Langdon, R

2017-03-01

It has been proposed that people with delusions have difficulty inhibiting beliefs (i.e., "doxastic inhibition") so as to reason about them as if they might not be true. We used a continuity approach to test this proposal in non-clinical adults scoring high and low in psychometrically assessed delusion-proneness. High delusion-prone individuals were expected to show greater difficulty than low delusion-prone individuals on "conflict" items of a "belief-bias" reasoning task (i.e. when required to reason logically about statements that conflicted with reality), but not on "non-conflict" items. Twenty high delusion-prone and twenty low delusion-prone participants (according to the Peters et al. Delusions Inventory) completed a belief-bias reasoning task and tests of IQ, working memory and general inhibition (Excluded Letter Fluency, Stroop and Hayling Sentence Completion). High delusion-prone individuals showed greater difficulty than low delusion-prone individuals on the Stroop and Excluded Letter Fluency tests of inhibition, but no greater difficulty on the conflict versus non-conflict items of the belief-bias task. They did, however, make significantly more errors overall on the belief-bias task, despite controlling for IQ, working memory and general inhibitory control. The study had a relatively small sample size and used non-clinical participants to test a theory of cognitive processing in individuals with clinically diagnosed delusions. Results failed to support a role for doxastic inhibitory failure in non-clinical delusion-prone individuals. These individuals did, however, show difficulty with conditional reasoning about statements that may or may not conflict with reality, independent of any general cognitive or inhibitory deficits. Copyright © 2016 Elsevier Ltd. All rights reserved.

Belief-bias reasoning in non-clinical delusion-prone individuals.

PubMed

Anandakumar, T; Connaughton, E; Coltheart, M; Langdon, R

2017-09-01

It has been proposed that people with delusions have difficulty inhibiting beliefs (i.e., "doxastic inhibition") so as to reason about them as if they might not be true. We used a continuity approach to test this proposal in non-clinical adults scoring high and low in psychometrically assessed delusion-proneness. High delusion-prone individuals were expected to show greater difficulty than low delusion-prone individuals on "conflict" items of a "belief-bias" reasoning task (i.e. when required to reason logically about statements that conflicted with reality), but not on "non-conflict" items. Twenty high delusion-prone and twenty low delusion-prone participants (according to the Peters et al. Delusions Inventory) completed a belief-bias reasoning task and tests of IQ, working memory and general inhibition (Excluded Letter Fluency, Stroop and Hayling Sentence Completion). High delusion-prone individuals showed greater difficulty than low delusion-prone individuals on the Stroop and Excluded Letter Fluency tests of inhibition, but no greater difficulty on the conflict versus non-conflict items of the belief-bias task. They did, however, make significantly more errors overall on the belief-bias task, despite controlling for IQ, working memory and general inhibitory control. The study had a relatively small sample size and used non-clinical participants to test a theory of cognitive processing in individuals with clinically diagnosed delusions. Results failed to support a role for doxastic inhibitory failure in non-clinical delusion-prone individuals. These individuals did, however, show difficulty with conditional reasoning about statements that may or may not conflict with reality, independent of any general cognitive or inhibitory deficits. Copyright © 2016 Elsevier Ltd. All rights reserved.

"Jumping to conclusions" in delusion-prone participants: an experimental economics approach.

PubMed

van der Leer, Leslie; McKay, Ryan

2014-01-01

That delusional and delusion-prone individuals "jump to conclusions" on probabilistic reasoning tasks is a key finding in cognitive neuropsychiatry. Here we focused on a less frequently investigated aspect of "jumping to conclusions" (JTC): certainty judgments. We incorporated rigorous procedures from experimental economics to eliminate potential confounds of miscomprehension and motivation and systematically investigated the effect of incentives on task performance. Low- and high-delusion-prone participants (n = 109) completed a series of computerised trials; on each trial, they were shown a black or a white fish, caught from one of the two lakes containing fish of both colours in complementary ratios. In the betting condition, participants were given £4 to distribute over the two lakes as they wished; in the control condition, participants simply provided an estimate of how probable each lake was. Deviations from Bayesian probabilities were investigated. Whereas high-delusion-prone participants in both the control and betting conditions underestimated the Bayesian probabilities (i.e. were conservative), low-delusion-prone participants in the control condition underestimated but those in the betting condition provided accurate estimates. In the control condition, there was a trend for high-delusion-prone participants to give higher estimates than low-delusion-prone participants, which is consistent with previous reports of "jumping to conclusions" in delusion-prone participants. However, our findings in the betting condition, where high-delusion-prone participants provided lower estimates than low-delusion-prone participants (who were accurate), are inconsistent with the jumping-to-conclusions effect in both a relative and an absolute sense. Our findings highlight the key role of task incentives and underscore the importance of comparing the responses of delusion-prone participants to an objective rational standard as well as to the responses of non-delusion-prone participants.

Psychotic Symptoms Associated with the use of Dopaminergic Drugs, in Patients with Cocaine Dependence or Abuse.

PubMed

Roncero, Carlos; Abad, Alfonso C; Padilla-Mata, Antonio; Ros-Cucurull, Elena; Barral, Carmen; Casas, Miquel; Grau-López, Lara

2017-01-01

In the field of dual diagnosis, physicians are frequently presented with pharmacological questions. Questions about the risk of developing psychotic symptoms in cocaine users who need treatment with dopaminergic drugs could lead to an undertreatment. Review the presence of psychotic symptoms in patients with cocaine abuse/dependence, in treatment with dopaminergic drugs. Systematic PubMed searches were conducted including December 2014, using the keywords: "cocaine", dopaminergic drug ("disulfuram-methylphenidate-bupropion-bromocriptine-sibutramineapomorphine- caffeine") and ("psychosis-psychotic symptoms-delusional-paranoia"). Articles in English, Spanish, Portuguese, French, and Italian were included. Articles in which there was no history of cocaine abuse/dependence, absence of psychotic symptoms, systematic reviews, and animal studies, were excluded. 313 papers were reviewed. 7 articles fulfilled the inclusion-exclusion criteria. There is a clinical trial including 8 cocaine-dependent patients using disulfiram in which 3 of them presented psychotic symptoms and 6 case-reports: disulfuram (1), methylphenidate (1), disulfiram with methylphenidate (2), and bupropion (2), reporting psychotic symptoms, especially delusions of reference and persecutory ideation. Few cases have been described, which suggests that the appearance of these symptoms is infrequent. The synergy of dopaminergic effects or the dopaminergic sensitization in chronic consumption are the explanatory theories proposed by the authors. In these cases, a relationship was found between taking these drugs and the appearance of psychotic symptoms. Given the low number of studies found, further research is required. The risk of psychotic symptoms seems to be acceptable if we compare it with the benefits for the patients but a closer monitoring seems to be advisable.

Emotional, Cognitive and Behavioral Reactions to Paranoid Symptoms in Clinical and Nonclinical Populations.

PubMed

Carvalho, Célia Barreto; da Motta, Carolina; Pinto-Gouveia, José; Peixoto, Ermelindo Manuel Bernardo

Paranoia is a disruptive belief that can vary across a continuum, ranging from persecutory delusions presented in clinical settings to paranoid cognitions that are highly prevalent in the general population. The literature suggests that paranoid thoughts derive from the activation of a paranoid schema or information processing biases that can be sensitive to socially ambiguous stimuli and influence the processing of threatening situations. Four groups (schizophrenic participants in active psychotic phases, n=61; stable participants in remission, n=30; participants' relatives, n=32; and, healthy controls, n=64) were assessed with self-report questionnaires to determine how the reactions to paranoia of clinical patients differ from healthy individuals. Cognitive, emotional and behavioral dimensions of their reactions to these paranoid thoughts were examined. Paranoid individuals were present in all groups. Most participants referred to the rejection by others as an important trigger of paranoid ideations, while active psychotics were unable to identify triggering situations to their thoughts and reactions. This may be a determinant to the different reactions and the different degree of invalidation caused by paranoid thoughts observed across groups. Clinical and nonclinical expressions of paranoid ideations differ in terms of their cognitive, emotional and behavioral components. It is suggested that, in socially ambiguous situations, paranoid participants (presenting lower thresholds of paranoid schema activation) lose the opportunity to disconfirm their paranoid beliefs by resourcing to more maladaptive coping strategies. Consequently, by dwelling on these thoughts, the amount of time spent thinking about their condition and the disability related to the disease increases.

Combined NMDA Inhibitor Use in a Patient With Multisubstance-induced Psychotic Disorder.

PubMed

Caloro, Matteo; Calabrò, Giuseppa; de Pisa, Eleonora; Rosini, Enrico; Kotzalidis, Georgios D; Lonati, Davide; Locatelli, Carlo Alessandro; Papa, Pietro; Schifano, Fabrizio; Girardi, Paolo

: Novel psychoactive substance use is a major social concern. Their use may elicit or uncover unpredictably as yet undescribed clinical pictures. We aimed to illustrate a multisubstance use case indistinguishable from paranoid schizophrenia, so to alert clinicians on possibly misdiagnosing substance-induced psychotic disorders. We describe a case of a 32-year-old man who started at 18 years with cannabinoids and ketamine, and is currently using N-methyl-D-aspartate (NMDA) antagonists. At age 23, he developed social withdrawal after being assaulted by a stranger, but did not consult psychiatrists until age 26; during this period, he was using internet-purchased methoxetamine and ketamine, and was persecutory, irritable, suspicious, and insomniac and discontinued all received medical prescriptions. He added dextromethorphan to his list of used substances. At age 31, while using phencyclidine, and, for the first time, methoxphenidine, he developed a religious delusion, involving God calling him to reach Him, and the near-death experiences ensured by NMDA antagonists backed his purpose. He received Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnosis of multisubstance-induced psychotic disorder and was hospitalized 8 times, 6 of which after visiting the emergency room due to the development of extreme anguish, verbal and physical aggression, and paranoia. He reportedly used methoxphenidine, methoxyphencyclidine, ethylnorketamine, norketamine, and deschlorketamine, to achieve near-death experiences, and eventually to reach God in heavens. This case points to the need for better control of drugs sold on the internet. It also illustrates that people using NMDA antagonists may present clinical pictures indistinguishable from those of major psychoses and are likely to be misdiagnosed.

Relationship between Delusion of Theft and Cognitive Functions in Patients with Mild Alzheimer's Disease.

PubMed

Na, Hae-Ran; Kang, Dong Woo; Woo, Young-Sup; Bahk, Won-Myong; Lee, Chang-Uk; Lim, Hyun Kook

2018-04-01

Although delusion of theft (DT) is the most frequent type of delusion in Alzheimer's disease (AD), its relationship to cognitive functions remains unclear. The aim of this study was to demonstrate the relationship between DT and cognitive functions in mild AD. Two hundred eighty-nine mild AD patients were enrolled in this study. These subjects were classified into three groups: patients with no delusions (ND, n=82), patients with paranoid delusions (PD, n=114) and patients with DT (n=93). Cognitive functions and their associations with the degree of delusion were compared among the three groups. The results showed that verbal Fluency scores were significantly lower in the PD group than in the DT and ND groups. Word List Recall scores were significantly lower in the DT group than in the PD and ND groups. Interestingly, delusion severity measured with the Neuropsychiatric Inventory delusion subscale correlated negatively with the Word List Recall scores in the DT group. In this study, we demonstrated that episodic memory functions in mild AD patients were associated with DT, but not with PD. Further studies might be needed to clarify the pathophysiology of delusions associated with AD.

Relationship between Delusion of Theft and Cognitive Functions in Patients with Mild Alzheimer’s Disease

PubMed Central

Na, Hae-Ran; Kang, Dong Woo; Woo, Young-Sup; Bahk, Won-Myong; Lee, Chang-Uk; Lim, Hyun Kook

2018-01-01

Although delusion of theft (DT) is the most frequent type of delusion in Alzheimer’s disease (AD), its relationship to cognitive functions remains unclear. The aim of this study was to demonstrate the relationship between DT and cognitive functions in mild AD. Two hundred eighty-nine mild AD patients were enrolled in this study. These subjects were classified into three groups: patients with no delusions (ND, n=82), patients with paranoid delusions (PD, n=114) and patients with DT (n=93). Cognitive functions and their associations with the degree of delusion were compared among the three groups. The results showed that verbal Fluency scores were significantly lower in the PD group than in the DT and ND groups. Word List Recall scores were significantly lower in the DT group than in the PD and ND groups. Interestingly, delusion severity measured with the Neuropsychiatric Inventory delusion subscale correlated negatively with the Word List Recall scores in the DT group. In this study, we demonstrated that episodic memory functions in mild AD patients were associated with DT, but not with PD. Further studies might be needed to clarify the pathophysiology of delusions associated with AD. PMID:29669410

Reducing the burden of caring for Alzheimer's disease through the amelioration of "delusions of theft" by drug therapy.

PubMed

Shigenobu, Kazue; Ikeda, Manabu; Fukuhara, Ryuji; Maki, Naruhiko; Hokoishi, Kazuhiko; Nebu, Akihiko; Komori, Kenjiro; Tanabe, Hirotaka

2002-03-01

Delusions of theft (delusions involving the theft of possessions) are one of the most frequent neuropsychiatric manifestations of Alzheimer's disease (AD). The current study investigated the presence and extent of such delusions before and after drug treatment in a group of AD patients, and the consequent effects on the burden of care on caregivers. The study was an open-label cohort design. The delusions studied consisted only of those involving theft of possessions. Sixteen AD patients served as subjects in order to assess the efficacy of Risperidone administration, in the reduction or elimination of these delusions. The caregiver burden was evaluated using the Zarit Caregiver Burden Interview (ZBI) before the administration of Risperidone and 12 weeks after administration, for cases where delusions of theft were eliminated or reduced. The burden of care on caregivers was significantly reduced (p < 0.001) through the elimination or reduction of delusions of theft. Delusions of theft are considered to be a major factor in increasing the burden of care, and the treatment of these, through appropriate drug therapy, is therefore of great importance in the continuation of satisfactory care in the home. Copyright 2002 John Wiley & Sons, Ltd.

Cognitive correlates of hallucinations and delusions in Parkinson's disease.

PubMed

Factor, Stewart A; Scullin, Michael K; Sollinger, Ann B; Land, Julia O; Wood-Siverio, Cathy; Zanders, Lavezza; Freeman, Alan; Bliwise, Donald L; McDonald, William M; Goldstein, Felicia C

2014-12-15

Hallucinations and delusions that complicate Parkinson's disease (PD) could lead to nursing home placement and are linked to increased mortality. Cognitive impairments are typically associated with the presence of hallucinations but there are no data regarding whether such a relationship exists with delusions. We hypothesized that hallucinations would be associated with executive and visuospatial disturbance. An exploratory examination of cognitive correlates of delusions was also completed to address the question of whether they differ from hallucinations. 144 PD subjects completed a neuropsychological battery to assess cognition and the SAPS to examine psychosis. Correlational analyses assessed associations between hallucinations and delusions with cognitive domains. 48 subjects (33%) reported psychotic symptoms: 25 (17%) experienced hallucinations without delusions, 23 (16%) had symptoms dominated by delusions. Severity and/or number of hallucination subtypes were significantly correlated with lower scores in language, memory, attention, executive functioning, and visuospatial ability. Correlations with delusions were non-significant. Tests of differences in the size of the correlations between groups revealed a significant relationship between language and visuospatial performance with hallucinations. Cognitive correlates of hallucinations and delusions appear to be different in PD, suggesting distinct pathogenic mechanisms and possibly anatomical substrates. Hence, delusions may not share the same associations with dementia as hallucinations. Since this is a new finding, further studies will be needed to confirm our results. Copyright © 2014 Elsevier B.V. All rights reserved.

Hypnotic illusions and clinical delusions: a hypnotic paradigm for investigating delusions of misidentification.

PubMed

Cox, Rochelle E; Barnier, Amanda J

2009-01-01

In 2 experiments, the authors created a hypnotic analogue of delusions of misidentification and explored their impact on autobiographical memory. In Experiment 1, to establish the paradigm, high and low hypnotizable participants were given a suggestion to become someone similar or dissimilar to themselves. In Experiment 2, to further test the paradigm and to examine autobiographical remembering, highs were given a suggestion to become a same-sex sibling, administered 2 challenges to the temporary delusion, and asked to generate autobiographical memories. For high hypnotizable participants, the suggested delusions of misidentification were compelling and resistant to challenge. During these temporary delusions, participants generated specific autobiographical memories that reflected previously experienced events viewed from the perspective of the suggested identity. These findings highlight the instrumental value of hypnosis to the investigation and understanding of delusions and autobiographical memory.

Hypnosis and belief: A review of hypnotic delusions.

PubMed

Connors, Michael H

2015-11-01

Hypnosis can create temporary, but highly compelling alterations in belief. As such, it can be used to model many aspects of clinical delusions in the laboratory. This approach allows researchers to recreate features of delusions on demand and examine underlying processes with a high level of experimental control. This paper reviews studies that have used hypnosis to model delusions in this way. First, the paper reviews studies that have focused on reproducing the surface features of delusions, such as their high levels of subjective conviction and strong resistance to counter-evidence. Second, the paper reviews studies that have focused on modelling underlying processes of delusions, including anomalous experiences or cognitive deficits that underpin specific delusional beliefs. Finally, the paper evaluates this body of research as a whole. The paper discusses advantages and limitations of using hypnotic models to study delusions and suggests some directions for future research. Copyright © 2015 Elsevier Inc. All rights reserved.

Redefining delusion based on studies of subjective paranormal ideation.

PubMed

Houran, James; Lange, Rense

2004-04-01

The DSM-IV definition of delusion is argued to be unsatisfactory because it does not explain the mechanism for delusion formation and maintenance, it implies that such beliefs are necessarily dysfunctional (pathological), it underestimates the social component to some delusions, and it is inconsistent with research indicating that delusions can be modified through techniques such as contradiction, confrontation, and cognitive-behavioral therapy. However, a well-replicated mathematical model of magical/delusional thinking based on a study of paranormal beliefs and experiences is consistent with the hypothesis that attributional processes play a central role in delusion formation and maintenance. The model suggests attributional processes serve the adaptive function of reducing fear associated with ambiguous stimuli and delusional thinking is on a continuum with nonpathological forms. Based on this collective research an amendment to the definition of delusion is proposed and its clinical implications are addressed.

Why do people with delusions fail to choose more realistic explanations for their experiences? An empirical investigation.

PubMed

Freeman, Daniel; Garety, Philippa A; Fowler, David; Kuipers, Elizabeth; Bebbington, Paul E; Dunn, Graham

2004-08-01

Delusions can be viewed as explanations of experiences,. By definition, the experiences are insufficient to merit the delusional explanations. So why have delusions been accepted rather than more realistic explanations? The authors report a study of alternative explanations in 100 individuals with delusions. Patients were assessed on the following criteria: symptom measures, the evidence for the delusions, the availability of alternative explanations, reasoning, and self-esteem. Three quarters of the patients did not report any alternative explanation for the experiences on which the delusions were based. These patients reported significantly more internal anomalous experiences and had a more hasty reasoning style than patients who did have alternative explanations available. Having doubt in a delusion, without an alternative explanation, was associated with lower self-esteem. Clinicians will need to develop plausible and compelling alternative accounts of experience in interventions rather than merely challenge patients' delusional beliefs.

[The role of the jumping to conclusion bias in delusions formation].

PubMed

Rózycka, Jagoda; Prochwicz, Katarzyna

2013-01-01

The results of many researches indicate that individuals with delusions reveal the reasoning bias. In probabilistic reasoning tasks they reveal hastiness in decision-making. The individuals with delusions request less information than non-deluded individuals, even if additional data is easily available. What is more, they also prove to be convinced to a greater extend of having made the right decision. This finding has been replicated by a number of studies. However, the previous researches have not confirmed the origins of 'jumping to conclusion' bias, and its role in the process of forming delusions has not been yet confirmed. The article in question contains the review of the results of the jumping to conclusion bias in people with delusions. It discusses the main hypotheses explaining the relations between the hasty decision making and the delusions formation. The article also deals with the specifics of 'jumping to conclusion' bias in case of individuals with delusions, as well as summarizes its relation to factors such as the level of intelligence or the intensity of delusion.

Models of misbelief: Integrating motivational and deficit theories of delusions.

PubMed

McKay, Ryan; Langdon, Robyn; Coltheart, Max

2007-12-01

The impact of our desires and preferences upon our ordinary, everyday beliefs is well-documented [Gilovich, T. (1991). How we know what isn't so: The fallibility of human reason in everyday life. New York: The Free Press.]. The influence of such motivational factors on delusions, which are instances of pathological misbelief, has tended however to be neglected by certain prevailing models of delusion formation and maintenance. This paper explores a distinction between two general classes of theoretical explanation for delusions; the motivational and the deficit. Motivational approaches view delusions as extreme instances of self-deception; as defensive attempts to relieve pain and distress. Deficit approaches, in contrast, view delusions as the consequence of defects in the normal functioning of belief mechanisms, underpinned by neuroanatomical or neurophysiological abnormalities. It is argued that although there are good reasons to be sceptical of motivational theories (particularly in their more floridly psychodynamic manifestations), recent experiments confirm that motives are important causal forces where delusions are concerned. It is therefore concluded that the most comprehensive account of delusions will involve a theoretical unification of both motivational and deficit approaches.

Referential delusions of communication and reality discrimination deficits in psychosis.

PubMed

Bucci, Sandra; Startup, Mike; Wynn, Paula; Heathcote, Andrew; Baker, Amanda; Lewin, Terry J

2008-09-01

There appear to be two kinds of delusion of reference, which vary independently: delusions of observation and delusions of communication. It has been suggested that delusions of communication might derive from an impairment in reality discrimination, though the impairment would be centred on non-verbal channels in delusions of communication as opposed to verbal channels in auditory hallucinations. Patients (N=64) with acute psychotic symptoms were recruited according to a 2 x 2 design: presence versus absence of delusions of communication crossed with presence versus absence of auditory hallucinations. They were presented with 100 brief video clips in which an actor either made a well-known gesture or an incidental movement, with the clips being obscured by visual noise. For each clip, the patients indicated how confident they were that a gesture was portrayed. According to a signal detection analysis, all groups showed adequate sensitivity and the groups did not differ in sensitivity, but patients with delusions of communication showed a bias to report gestures which was not shown by patients with hallucinations. A control group of healthy volunteers (N=57) showed significantly greater sensitivity than the patients and a more conservative bias than patients with delusions of communication. A bias to report gestures is not part of a general tendency to externalize one's own thoughts but may be the result of a reality discrimination deficit that is specific to delusions of communication. A possible theoretical explanation for such a deficit is discussed.

Why Do People with Delusions Fail to Choose More Realistic Explanations for Their Experiences? An Empirical Investigation

ERIC Educational Resources Information Center

Freeman, Daniel; Garety, Philippa A.; Fowler, David; Kuipers, Elizabeth; Bebbington, Paul E.; Dunn, Graham

2004-01-01

Delusions can be viewed as explanations of experiences. By definition, the experiences are insufficient to merit the delusional explanations. So why have delusions been accepted rather than more realistic explanations? The authors report a study of alternative explanations in 100 individuals with delusions. Patients were assessed on the following…

Delusions as performance failures.

PubMed

Gerrans, P

2001-08-01

Delusions are explanations of anomalous experiences. A theory of delusion requires an explanation of both the anomalous experience and the apparently irrational explanation generated by the delusional subject. Hence, we require a model of rational belief formation against which the belief formation of delusional subjects can be evaluated. I first describe such a model, distinguishing procedural from pragmatic rationality. Procedural rationality is the use of rules or procedures, deductive or inductive, that produce an inferentially coherent set of propositions. Pragmatic rationality is the use of procedural rationality in context. I then apply the distinction to the explanation of the Capgras and the Cotard delusions. I then argue that delusions are failures of pragmatic rationality. I examine the nature of these failures employing the distinction between performance and competence familiar from Chomskian linguistics. This approach to the irrationality of delusions reconciles accounts in which the explanation of the anomalous experience exhausts the explanation of delusion, accounts that appeal to further deficits within the reasoning processes of delusional subjects, and accounts that argue that delusions are not beliefs at all. (Respectively, one-stage, two-stage, and expressive accounts.) In paradigm cases that concern cognitive neuropsychiatry the irrationality of delusional subjects should be thought of as a performance deficit in pragmatic rationality.

Schizophrenic delusions in Seoul, Shanghai and Taipei: a transcultural study.

PubMed Central

Kim, K.; Hwu, H.; Zhang, L. D.; Lu, M. K.; Park, K. K.; Hwang, T. J.; Kim, D.; Park, Y. C.

2001-01-01

In this transcultural study of schizophrenic delusions among patients in Seoul, Shanghai and Taipei, we discovered that both the frequency and content of delusions differed among the three groups; and that these differences could perhaps be explained by varying sociocultural and political situations. Delusional themes that are sensitive to sociocultural or political situations include guilt, love/sex, religion, somatic damage, economy/business and politics. Delusions regarding longevity, love/sex, dysmorphophobia/dysosmophobia, religion or supernatural matters, and espionage/spy stories were most frequent in Seoul patients. Those in Taipei predominantly had delusions about possession, religion or supernatural matters, hypnotism, and mass media/computers. Shanghai patients often had delusions of poisons, being prickled by poisoned needles, their brain and viscera extracted and being a family member of political authorities. PMID:11289407

Reduced autonomic responses to faces in Capgras delusion.

PubMed

Ellis, H D; Young, A W; Quayle, A H; De Pauw, K W

1997-07-22

People experiencing the Capgras delusion claim that others, usually those quite close emotionally, have been replaced by near-identical impostors. Ellis & Young suggested in 1990 that the Capgras delusion results from damage to a neurological system involved in orienting responses to seen faces based on their personal significance. This hypothesis predicts that people suffering the Capgras delusion will be hyporesponsive to familiar faces. We tested this prediction in five people with Capgras delusion. Comparison data were obtained from five middle-aged members of the general public, and a psychiatric control group of five patients taking similar anti-psychotic medication. Capgras delusion patients did not reveal autonomic discrimination between familiar and unfamiliar faces, but orienting responses to auditory tones were normal in magnitude and rate of initial habituation, showing that the hyporesponsiveness is circumscribed.

Reduced autonomic responses to faces in Capgras delusion.

PubMed Central

Ellis, H D; Young, A W; Quayle, A H; De Pauw, K W

1997-01-01

People experiencing the Capgras delusion claim that others, usually those quite close emotionally, have been replaced by near-identical impostors. Ellis & Young suggested in 1990 that the Capgras delusion results from damage to a neurological system involved in orienting responses to seen faces based on their personal significance. This hypothesis predicts that people suffering the Capgras delusion will be hyporesponsive to familiar faces. We tested this prediction in five people with Capgras delusion. Comparison data were obtained from five middle-aged members of the general public, and a psychiatric control group of five patients taking similar anti-psychotic medication. Capgras delusion patients did not reveal autonomic discrimination between familiar and unfamiliar faces, but orienting responses to auditory tones were normal in magnitude and rate of initial habituation, showing that the hyporesponsiveness is circumscribed. PMID:9263474

Schizophrenic delusions in Seoul, Shanghai and Taipei: a transcultural study.

PubMed

Kim, K; Hwu, H; Zhang, L D; Lu, M K; Park, K K; Hwang, T J; Kim, D; Park, Y C

2001-02-01

In this transcultural study of schizophrenic delusions among patients in Seoul, Shanghai and Taipei, we discovered that both the frequency and content of delusions differed among the three groups; and that these differences could perhaps be explained by varying sociocultural and political situations. Delusional themes that are sensitive to sociocultural or political situations include guilt, love/sex, religion, somatic damage, economy/business and politics. Delusions regarding longevity, love/sex, dysmorphophobia/dysosmophobia, religion or supernatural matters, and espionage/spy stories were most frequent in Seoul patients. Those in Taipei predominantly had delusions about possession, religion or supernatural matters, hypnotism, and mass media/computers. Shanghai patients often had delusions of poisons, being prickled by poisoned needles, their brain and viscera extracted and being a family member of political authorities.

Folie a deux and delusional disorder by proxy: an atypical presentation.

PubMed

Daulatabad, Deepashree; Sonthalia, Sidharth; Srivastava, Ankur; Bhattacharya, Sambit Nath; Kaul, Subuhi; Moyal, Deepak

2017-08-01

Delusion of parasitosis is a rare condition characterised by an individual harbouring the delusion of being infested with insects or parasites. We report a rare and interesting case of delusion of parasitosis presenting as folie a deux, that is, the delusion is shared by both the parents of an 18-month-old child, with proxy projection of parental delusion on the child. The case highlights the rare concomitant occurrence of two psychocutaneous disorders and emphasizes the importance of early recognition and appropriate intervention to safeguard the well-being of the child. © 2016 The Australasian College of Dermatologists.

The Capgras and Cotard delusions.

PubMed

Young, A W; Leafhead, K M; Szulecka, T K

1994-01-01

We explore the relation between the Capgras delusion (the belief that your relatives have been replaced by impostors) and the Cotard delusion (the delusional belief that you have died). At first sight, these delusions would seem to have little to do with each other, except that they both involve bizarre claims about existence (for self or others). On closer examination, however, there are other parallels. Here, we summarise similarities in associated impairments of face perception, and argue that both delusions reflect an interaction of impairments at two levels. One set of contributory factors involves perceptual impairment, or anomalous perceptual experience. The other factors lead to an incorrect interpretation of this, for which we offer an explanation in terms of attribution theory. Although the Capgras and Cotard delusions are phenomenally distinct, they may therefore represent attempts to make sense of fundamentally similar experiences.

The nature of delusion: psychologically explicable? psychologically inexplicable? philosophically explicable? Part 2.

PubMed

Cutting, J; Musalek, M

2016-03-01

The first part of this article dealt with the extant formulations of delusion, psychiatric and psychological, suggestions which, respectively, regard delusion as psychologically inexplicable or explicable. All this was subjected to critique. This second part puts forward informed philosophical thesis whereby delusion can be explained within the philosophical movement known as phenomenology and, in particular, Max Scheler's version of this. © The Author(s) 2015.

An investigation of a novel transdiagnostic model of delusions in a group with positive schizotypal symptoms.

PubMed

Cameron, Clare; Kaplan, Ryan A; Rossell, Susan L

2014-01-01

Although several theories of delusions have been put forward, most do not offer a comprehensive diagnosis-independent explanation of delusion aetiology. This study used a non-clinical sample to provide empirical support for a novel transdiagnostic model of delusions that implicates aberrant semantic memory and emotion perception processes as key factors in delusion formation and maintenance. It was hypothesised that among a non-clinical sample, people high in schizotypy would demonstrate differences in semantic memory and emotion perception, relative to people low in schizotypy. Using the Cognitive Disorganisation subscale of the Oxford-Liverpool Inventory of Feelings and Experiences, 41 healthy participants were separated into high and low schizotypy groups and completed facial emotion perception and semantic priming tasks. As expected, participants in the high schizotypy group demonstrated different performance on the semantic priming task and reduced facial affect accuracy for the emotion anger, and reaction time differences to fearful faces. These findings suggest that such processes may be involved in the development of the sorts of unusual beliefs which underlie delusions. Investigation of how emotion perception and semantic memory may interrelate in the aetiology of delusions would be of value in furthering our understanding of their role in delusion formation.

History of religious delusions and psychosocial functioning among Mexican patients with paranoid schizophrenia.

PubMed

Robles-García, Rebeca; López-Luna, Sonia; Páez, Francisco; Escamilla, Raúl; Camarena, Beatriz; Fresán, Ana

2014-12-01

The association between global functionality and religiosity among patients from developing and predominantly Catholic countries warrants attention. To compare religiosity and psychosocial functioning in Mexican schizophrenia patients with and without a history of religious delusions, seventy-four patients with paranoid schizophrenia were recruited. Patients with a history of religious delusions had more psychiatric hospitalizations and poorer psychosocial functioning compared with those without a history of religious delusions. No differences emerged between groups in the total scores of religiosity scales. A history of religious delusions rather than religiosity itself may have an influence on psychosocial functioning among Mexican patients with schizophrenia.

Can delusions be understood linguistically?

PubMed Central

Hinzen, Wolfram; Rosselló, Joana; McKenna, Peter

2016-01-01

ABSTRACT Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The “un-Cartesian” cognitive-linguistic hypothesis maintains (a) that there is no thought separate from language, that is, there is no distinct mental space removed from language where “thinking” takes place; and (b) that a somewhat broadened concept of grammar is responsible for bestowing meaning on propositions, and this among other things gives them their quality of being true or false. It is argued that a loss of propositional meaning explains why delusions are false, impossible and sometimes fantastic. A closely related abnormality, failure of linguistic embedding, can additionally account for why delusions are held with fixed conviction and are not adequately justified by the patient. The un-Cartesian linguistic approach to delusions has points of contact with Frith’s theory that inability to form meta-representations underlies a range of schizophrenic symptoms. It may also be relevant to the nature of the “second factor” in monothematic delusions in neurological disease. Finally, it can inform the current debate about whether or not delusions really are beliefs. PMID:27322493

Can delusions be understood linguistically?

PubMed

Hinzen, Wolfram; Rosselló, Joana; McKenna, Peter

2016-07-01

Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The "un-Cartesian" cognitive-linguistic hypothesis maintains (a) that there is no thought separate from language, that is, there is no distinct mental space removed from language where "thinking" takes place; and (b) that a somewhat broadened concept of grammar is responsible for bestowing meaning on propositions, and this among other things gives them their quality of being true or false. It is argued that a loss of propositional meaning explains why delusions are false, impossible and sometimes fantastic. A closely related abnormality, failure of linguistic embedding, can additionally account for why delusions are held with fixed conviction and are not adequately justified by the patient. The un-Cartesian linguistic approach to delusions has points of contact with Frith's theory that inability to form meta-representations underlies a range of schizophrenic symptoms. It may also be relevant to the nature of the "second factor" in monothematic delusions in neurological disease. Finally, it can inform the current debate about whether or not delusions really are beliefs.

Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: a retrospective cohort study.

PubMed

Nygaard, Mette; Sonne, Charlotte; Carlsson, Jessica

2017-01-05

A substantial amount of refugees (10-30%) suffer from Post-Traumatic Stress Disorder (PTSD). In Denmark there are different facilities specialised in psychiatric treatment of trauma-affected refugees. A previously published case report from such a facility in Denmark shows that some patients suffer from secondary psychotic symptoms alongside their PTSD. The aim of this study was to illustrate the characteristics and estimate the prevalence of psychotic features in a clinical population of trauma-affected refugees with PTSD. Psychiatric records from 220 consecutive patients at Competence Centre for Transcultural Psychiatry (CTP) were examined, and all the PTSD patients were divided into two groups; one group with secondary psychotic features (PTSD-SP group) and one without (PTSD group). A categorisation and description of the secondary psychotic features was undertaken. One hundred eighty-one patients were diagnosed with PTSD among which psychotic symptoms were identified in 74 (40.9, 95% CI 33.7-48.1%). The majority of symptoms identified were auditory hallucinations (66.2%) and persecutory delusions (50.0%). There were significantly more patients diagnosed with enduring personality change after catastrophic experience in the PTSD-SP group than in the PTSD group (P = 0.009). Furthermore the PTSD-SP group included significantly more patients exposed to torture (P = 0.001) and imprisonment (P = 0.005). This study provides an estimation of PTSD-SP prevalence in a clinical refugee population with PTSD. The study points to the difficulties distinguishing psychotic features from flashbacks and the authors call for attention to psychotic features in PTSD patients in order to improve documentation and understanding of the disorder.

Psychotic Symptoms Associated with the use of Dopaminergic Drugs, in Patients with Cocaine Dependence or Abuse

PubMed Central

Roncero, Carlos; Abad, Alfonso C.; Padilla-Mata, Antonio; Ros-Cucurull, Elena; Barral, Carmen; Casas, Miquel; Grau-López, Lara

2017-01-01

Background In the field of dual diagnosis, physicians are frequently presented with pharmacological questions. Questions about the risk of developing psychotic symptoms in cocaine users who need treatment with dopaminergic drugs could lead to an undertreatment. Objective Review the presence of psychotic symptoms in patients with cocaine abuse/dependence, in treatment with dopaminergic drugs. Methods Systematic PubMed searches were conducted including December 2014, using the keywords: “cocaine”, dopaminergic drug (“disulfuram-methylphenidate-bupropion-bromocriptine-sibutramine-apomorphine-caffeine”) and (“psychosis-psychotic symptoms-delusional-paranoia”). Articles in English, Spanish, Portuguese, French, and Italian were included. Articles in which there was no history of cocaine abuse/dependence, absence of psychotic symptoms, systematic reviews, and animal studies, were excluded. Results 313 papers were reviewed. 7 articles fulfilled the inclusion-exclusion criteria. There is a clinical trial including 8 cocaine-dependent patients using disulfiram in which 3 of them presented psychotic symptoms and 6 case-reports: disulfuram (1), methylphenidate (1), disulfiram with methylphenidate (2), and bupropion (2), reporting psychotic symptoms, especially delusions of reference and persecutory ideation. Conclusion Few cases have been described, which suggests that the appearance of these symptoms is infrequent. The synergy of dopaminergic effects or the dopaminergic sensitization in chronic consumption are the explanatory theories proposed by the authors. In these cases, a relationship was found between taking these drugs and the appearance of psychotic symptoms. Given the low number of studies found, further research is required. The risk of psychotic symptoms seems to be acceptable if we compare it with the benefits for the patients but a closer monitoring seems to be advisable. PMID:27009114

[Clinical aspects of witchcraft delusions].

PubMed

Pashkovskiĭ, V E

2005-01-01

To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.

Delusion in general and forensic psychiatry--historical and contemporary aspects.

PubMed

Hoff, Paul

2006-01-01

Delusion has always been a central topic for psychiatric research with regard to etiology and pathogenesis and to diagnosis, treatment, and forensic relevance. Throughout the history of psychiatry as a scientific discipline, there has been dissent on the issue of whether chronic delusion is a nosological entity of its own or just a specific type of another mental disorder, e.g. schizophrenia, mania, or personality disorder, and there already is a considerable literature on this. This article seeks to elucidate the central lines of thought that have governed the scientific debate on delusions and delusion-associated phenomena since the early 19th century. Special attention is given to the practical relevance of these theoretical considerations for forensic questions and psychiatric research. Due to the complex features of delusions, research in this area may well become paradigmatic for many other complicated psycho(patho)logical phenomena, e.g. consciousness, hallucinations and psychotic depression.

[Delusion and Gender in Paranoid Schizophrenia: Results of a Clinical Study].

PubMed

Rössler, V; Richter, R; Walter, M H

2016-11-01

Aim: The aim of the present study was to investigate whether men and women differ in the frequency and phenomenology of delusions. Sample: Medical records of all patients who had been admitted to a psychiatric hospital in Germany between 2008 and 2011 for paranoid schizophrenia were analyzed. The sample consisted of 182 delusional inpatients (90 women, 92 men) with the diagnosis of a paranoid schizophrenia. Results: Men and women did not differ in the frequency of delusional themes. Analysis of delusional content, however, revealed considerable differences between them. Women with delusion of reference felt more often as being under constant surveillance compared to men. Men with delusion of reference showed a tendency to involve unspecified persons in their delusions and more often had the feeling of being talked about. Delusion of grandeur in women was more often built upon significant relationships with others. © Georg Thieme Verlag KG Stuttgart · New York.

SU34. A Systematic Review of Behavioral Research and Lesion Evidence for the 2-Factor Theory of Monothematic Delusions

PubMed Central

Neustadter, Eli; Pinder, Juno; Corlett, Philip

2017-01-01

Abstract Background: Two-factor theory (TFT) posits monothematic delusion formation requires damage producing delusion content (factor 1) and a deficit in belief evaluation (factor 2, posited to be localized in right frontal cortex). The purpose of the current study was 2-fold: (1) to review the behavioral data supporting TFT and (2) to assess whether locations of delusion-inducing lesions were consistent with TFT predictions: ie, common factor 1 damage within a particular monothematic delusion and common factor 2 damage across delusions. Furthermore, factor 2 damage ought to distinguish Capgras syndrome (the delusion that a previously familiar person is an imposter) from nondelusional-affective agnosia (unfamiliarity without delusion). Methods: We reviewed all papers concerned with TFT and all studies of galvanic skin response (GSR) in monothematic delusions (frequently cited as behavioral evidence for TFT). Next, we reviewed case reports of lesion-induced monothematic delusions including Capgras, Fregoli, Cotard, and somatoparaphrenia, as well as affective agnosia. We report lesion location frequencies in 12 regions of interest. Results: We found 27 articles on TFT. Only 3 contained empirical evidence (11%, all hypnosis studies): one had no direct hypothesis regarding TFT, one was inconclusive, and another failed to support TFT. We found 7 additional GSR studies of Capgras, 6 of which reported statistically significant abnormal GSR, but no effects were specific to the familiar person accused of being an imposter. One neuroimaging case study of Capgras did find fMRI correlates of perceiving the imposter in the left hemisphere. One study of somatoparaphrenia reported a GSR deficit to noxious stimuli approaching the denied limb. There were no published studies testing TFT predictions about Cotard or Fregoli. We analyzed 46 reports of lesion-induced delusions and 20 cases of affective agnosia. Right hemisphere damage was most common in monothematic delusion cases (χ2(1, N = 46) = 40.09, P < .0001). Within the right hemisphere, frontal and temporal damage were most common (46% of cases had damage in these regions). The patterns of regional codamage were not consistent within delusion contents (as factor 1 would demand). Contrary to TFT, affective agnosia was associated with bilateral frontal damage more frequently than Capgras delusion (P < .005), which calls into question a right frontal locus for factor 2. Conclusion: Overall, this study found no strong hypothesis-driven support of TFT. GSR findings often failed to account for the specificity of delusional content and no common pattern of brain damage for factor 2 emerged. However, the anatomical analysis was coarse (by dint of the data available in the case reports), and diaschesis effects (wherein damage in one region effects function of a distant region) are also potentially important.

Self-esteem and delusion proneness.

PubMed

Warman, Debbie M; Lysaker, Paul H; Luedtke, Brandi; Martin, Joel M

2010-06-01

The present study was an examination of global self-esteem and various types of unusual beliefs in a nonclinical population. Individuals with no history of psychotic disorder (N = 121) completed a measure of delusion-proneness and also a measure of self-esteem. Results indicated high delusion prone individuals had lower self-esteem than low delusion prone individuals (p = 0.044). In addition, higher levels of paranoid ideation and suspiciousness were associated with lower self-esteem (p < 0.001). Significant, yet smaller relationships also emerged between low self-esteem and higher levels of beliefs related to thought disturbances, catastrophic ideation/thought broadcasting, and ideation of reference/influence. The significance of these findings as they relate to theories of delusion formation is discussed.

[Follow-up of a 16-year-old adolescent with early-onset schizophrenia and catatonic symptoms].

PubMed

Menard, M-L; Yagoubi, F; Drici, M; Lavrut, T; Askenazy, F

2013-05-01

The aim of this paper is to underline the need of a systematic monitoring (1) of atypical antipsychotics and (2) of catatonic symptoms in child psychiatry. We present in this paper the clinical history of a 16-year-old adolescent inpatient needing a prescription of atypical antipsychotic drug. We present the most relevant results of our clinical monitoring over 7 months. A 16-year-old Caucasian male adolescent, by the name of Paul, was admitted in August 2009 to an Adolescent University Psychiatry Unit for an acute psychotic disorder. On admission, he presented paranoid delusion, auditory hallucinations and impulsive movements. The score on the Bush-Francis Catatonia Rating Scale (BFCRS) was 17 (the threshold score for the diagnosis of catatonic symptoms is 2). Laboratory tests showed the lack of blood toxic levels, creatine phosphokinase (CPK) level was 684 IU/L. Paul was treated with clonazepam (0.05 mg/kg/d). This particular day was considered to be day #1 of the clinical drug monitoring. Immediately after, regular follow-up of catatonic symptoms was performed. On day #15, the CPK level returned to normal with improvement of clinical catatonia but with still a score of 4 on the BFCRS scale. Auditory hallucinations and delusion persisted. Risperidone treatment was begun (1mg/d and 1.5mg/d after 24 hours), associated with oral clonazepam (0.05 mg/kg/d). On day #17, after 48 hours of improvement of delusion, the catatonic symptoms rapidly worsened. Risperidone was stopped; Paul was transferred to intensive care where he was treated with clonazepam IV (0.1mg/kg/d). The score on BFCRS scale was 20, Paul presented no fever and the CPK level was below 170 IU/L. The diagnosis was a relapse of the catatonic episode, which was caused by the administration of risperidone. On day #24, no improvement in the state of catatonia was obtained. The treatment was changed with the following combination of medicine: clonazepam (0.1mg/kg/d)-lorazepam (5mg/d)-carbamazepine (10mg/kg/d). With this combination, the state of catatonia improved quickly and on day #31, he was transferred to the adolescent psychiatry unit. However, delusion and hallucinations persisted; a treatment with olanzapine was started at 5mg/d and then progressively increased to 20mg/d for 10 days. On day #115, after 3 months with olanzapine, no improvement of the hallucinatory and delusional symptoms was observed; the diagnosis of early-onset refractory schizophrenia was established. The Therapeutic Drug Monitoring (TDM) confirmed the good compliance; clozapine was introduced and progressively increased up to 250 mg/d. On day #199, after 3 months under clozapine (250 mg/d), the speech was coherent and delusion was rare. During this period, no relapse of the catatonic state was observed. In this case, the BFCRS scale was sensitive to catatonic symptom diagnosis. CPK levels vary differently for each atypical antipsychotic and are not a specific complication indicator. In complex cases, the TDM seems useful when choosing atypical antipsychotics. The association of two benzodiazepines (clonazepam-lorazepam) with carbamazepin allowed the improvement of catatonic symptoms. Plasma levels of atypical antipsychotics helped the practitioner in deciding the type of care required: plasma levels confirmed the patient's treatment adherence and thus reinforced the choice of clozapine. Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Disrupted prediction-error signal in psychosis: evidence for an associative account of delusions

PubMed Central

Corlett, P. R.; Murray, G. K.; Honey, G. D.; Aitken, M. R. F.; Shanks, D. R.; Robbins, T.W.; Bullmore, E.T.; Dickinson, A.; Fletcher, P. C.

2012-01-01

Delusions are maladaptive beliefs about the world. Based upon experimental evidence that prediction error—a mismatch between expectancy and outcome—drives belief formation, this study examined the possibility that delusions form because of disrupted prediction-error processing. We used fMRI to determine prediction-error-related brain responses in 12 healthy subjects and 12 individuals (7 males) with delusional beliefs. Frontal cortex responses in the patient group were suggestive of disrupted prediction-error processing. Furthermore, across subjects, the extent of disruption was significantly related to an individual’s propensity to delusion formation. Our results support a neurobiological theory of delusion formation that implicates aberrant prediction-error signalling, disrupted attentional allocation and associative learning in the formation of delusional beliefs. PMID:17690132

The effects of angry and happy expressions on recognition memory for unfamiliar faces in delusion-prone individuals.

PubMed

Larøi, Frank; D'Argembeau, Arnaud; Van der Linden, Martial

2006-12-01

Numerous studies suggest a cognitive bias for threat-related material in delusional ideation. However, few studies have examined this bias using a memory task. We investigated the influence of delusion-proneness on identity and expression memory for angry and happy faces. Participants high and low in delusion-proneness were presented with happy and angry faces and were later asked to recognise the same faces displaying a neutral expression. They also had to remember what the initial expressions of the faces had been. Remember/know/guess judgments were asked for both identity and expression memory. Results showed that delusion-prone participants better recognised the identity of angry faces compared to non-delusional participants. Also, this difference between the two groups was mainly due to a greater number of remember responses in delusion-prone participants. These findings extend previous studies by showing that delusions are associated with a memory bias for threat-related stimuli.

The delusion of the Master: the last days of Henry James.

PubMed

Bartolomeo, Paolo

2013-11-01

The novelist Henry James shared with his brother William, the author of the Principles of Psychology, a deep interest in the ways in which personal identity is built through one's history and experiences. At the end of his life, Henry James suffered a vascular stroke in the right hemisphere and developed a striking identity delusion. He dictated in a perfectly clear and coherent manner two letters as if they were written by Napoleon Bonaparte. He also showed signs of reduplicative paramnesia. Negative symptoms resulting from right hemisphere damage may disrupt the feelings of "warmth and intimacy and immediacy" and the "resemblance among the parts of a continuum of feelings (especially bodily feelings)", which are the foundation of personal identity according to William James. On the other hand, a left hemisphere receiving inadequate input from the damaged right hemisphere may produce positive symptoms such as delusional, confabulatory narratives. Other fragments dictated during Henry James's final disease reveal some form of insight, if partial and disintegrated, into his condition. Thus, even when consciousness is impaired by brain damage, something of its deep nature may persist, as attested by the literary characteristics of the last fragments of the Master.

Delusional Confusion of Dreaming and Reality in Narcolepsy

PubMed Central

Wamsley, Erin; Donjacour, Claire E.H.M.; Scammell, Thomas E.; Lammers, Gert Jan; Stickgold, Robert

2014-01-01

Study Objectives: We investigated a generally unappreciated feature of the sleep disorder narcolepsy, in which patients mistake the memory of a dream for a real experience and form sustained delusions about significant events. Design: We interviewed patients with narcolepsy and healthy controls to establish the prevalence of this complaint and identify its predictors. Setting: Academic medical centers in Boston, Massachusetts and Leiden, The Netherlands. Participants: Patients (n = 46) with a diagnosis of narcolepsy with cataplexy, and age-matched healthy healthy controls (n = 41). Interventions: N/A. Measurements and Results: “Dream delusions” were surprisingly common in narcolepsy and were often striking in their severity. As opposed to fleeting hypnagogic and hypnopompic hallucinations of the sleep/wake transition, dream delusions were false memories induced by the experience of a vivid dream, which led to false beliefs that could persist for days or weeks. Conclusions: The delusional confusion of dreamed events with reality is a prominent feature of narcolepsy, and suggests the possibility of source memory deficits in this disorder that have not yet been fully characterized. Citation: Wamsley E; Donjacour CE; Scammell TE; Lammers GJ; Stickgold R. Delusional confusion of dreaming and reality in narcolepsy. SLEEP 2014;37(2):419-422. PMID:24501437

Epistemic injustice in assessment of delusions.

PubMed

Sanati, Abdi; Kyratsous, Michalis

2015-06-01

Delusions are one of the most elusive concepts in psychiatry. There have been several theories on the nature and definition of delusions. Jaspers described them as entailing a total transformation of reality and considered primary delusions as un-understandable. When it comes to clinical practice, psychiatrists resort to criteria of falsity, incorrigibility, conviction and being out of keeping with the person's culture. All these criteria have been subject to various criticisms, some of which will be discussed in the paper. We will use the concept of epistemic injustice to explore the role of stereotypes and prejudice in the identification of delusions. We will discuss cases where patients are suffering from testimonial injustice by virtue of having a mental disorder that is so often associated with attributions of irrationality, bizarreness and incomprehensibility. Two vignettes will be presented to show that this is often the case in clinical practice. We will discuss relevant issues around the epistemology of the delusions. We think that in order to challenge the testimonial injustice, there needs to be an awareness of its possibility and thus recognition of the role of certain stereotypes in assessing these mental states. Challenging the stigma against mentally ill and adopting a holistic view of delusions can help tackle the prejudice that pre-empt the testimonial injustice. © 2015 John Wiley & Sons, Ltd.

Impairment in flexible emotion-based learning in hallucination- and delusion-prone individuals.

PubMed

Cella, Matteo; Dymond, Simon; Cooper, Andrew

2009-11-30

Deficits in emotion-based learning are implicated in many psychiatric disorders. Research conducted with patients with schizophrenia using one of the most popular tasks for the investigation of emotion-based learning, the Iowa Gambling Task (IGT), has largely been inconclusive. The present study employed a novel, contingency-shifting variant IGT with hallucination- and delusion-prone university students to determine whether previous findings were due merely to the presence of psychosis. Following initial screening of a sample of 253 students (mean age = 20.13 years, S.D. = 3.27), 28 high (10 male, 18 female) and 27 low (12 male, 15 female) hallucination-prone and 27 high (7 male, 20 female) and 26 low (11 male, 15 female) delusion-prone individuals completed the contingency-shifting variant IGT. Results showed no significant differences between the performances of high and low hallucination- and delusion-prone individuals during the original phase of the task. Differences only emerged following the onset of the contingency-shift phases, with individuals high in hallucination- and delusion-proneness having impaired performance compared with low hallucination- and delusion-prone individuals. Overall, the present findings demonstrate that impairments associated with hallucination- and delusion-proneness are specific to the shift phase of the contingency-shifting variant IGT, which supports previous findings with patients with schizophrenia.

Life hassles and delusional ideation: Scoping the potential role of cognitive and affective mediators.

PubMed

Kingston, Cara; Schuurmans-Stekhoven, James

2016-12-01

An intertemporal association between major psychological stress and subsequent delusion formation has been established by others. The current study explores (1) whether the stress from life hassles predicts delusional ideation and (2) if so, do self-criticism, self-reassurance, and positive and negative affectivity (PA and NA, respectively) mediate this link. This paper thus aimed to scope-out viable psychological processes involved in the formation of stress-induced delusions. A cross-sectional survey using a non-clinical community sample. Responses (N = 251) to an online community survey were tested via a nonparametric bootstrap sampling approach to examine the effects of multiple mediators. Self-criticism and NA appear to mediate a connection found between life hassles and delusions. A second mediation analysis found that life hassles positively predicts NA directly and indirectly (via self-criticism). NA in turn predicted delusional tendencies. Life events had direct statistical effects on delusions in all models. Neither PA nor self-reassurance mediated the stress-delusion link. Self-criticism and NA seem to be viable mediators worth contemplating when elaborating upon the connection between life hassles and delusions. Compared to self-criticism, NA appears to be the intervening variable most proximal to delusions and explains more variance. Even if these cross-sectional results were interpreted as causative, life hassles and delusions remained directly interconnected in all mediation models (suggesting much of the association remains unexplained). Although the results are theory-consistent, investigations using longitudinal, known-group, and experimental methods are now warranted to establish causation and possible feedback loops - especially from delusion to life hassles. Self-criticism and negative affectivity (NA) mediate the link between stressful life events and delusions suggesting they might actively elicit delusional ideation, whereas self-reassurance and PA (although negatively associated with life hassles) have no unique predictive link to delusions. This study offers initial evidence that NA and self-criticism may be viable clinical intervention targets for early psychosis-sufferers under stress - especially for medically non-compliant and marginal (where drug treatment is not clinically indicated) cases. The clinical efficacy of alleviating self-criticism and/or negative emotional processes in those displaying early psychosis or at high risk appear worthy of exploration using both practice-based case studies and formal experimental research methods. © 2016 The British Psychological Society.

Creativity and positive symptoms in schizophrenia revisited: Structural connectivity analysis with diffusion tensor imaging.

PubMed

Son, Shuraku; Kubota, Manabu; Miyata, Jun; Fukuyama, Hidenao; Aso, Toshihiko; Urayama, Shin-ichi; Murai, Toshiya; Takahashi, Hidehiko

2015-05-01

Both creativity and schizotypy are suggested to be manifestations of the hyperactivation of unusual or remote concepts/words. However, the results of studies on creativity in schizophrenia are diverse, possibly due to the multifaceted aspects of creativity and difficulties of differentiating adaptive creativity from pathological schizotypy/positive symptoms. To date, there have been no detailed studies comprehensively investigating creativity, positive symptoms including delusions, and their neural bases in schizophrenia. In this study, we investigated 43 schizophrenia and 36 healthy participants using diffusion tensor imaging. We used idea, design, and verbal (semantic and phonological) fluency tests as creativity scores and Peters Delusions Inventory as delusion scores. Subsequently, we investigated group differences in every psychological score, correlations between fluency and delusions, and relationships between these scores and white matter integrity using tract-based spatial statistics (TBSS). In schizophrenia, idea and verbal fluency were significantly lower in general, and delusion score was higher than in healthy controls, whereas there were no group differences in design fluency. We also found positive correlation between phonological fluency and delusions in schizophrenia. By correlation analyses using TBSS, we found that the anterior part of corpus callosum was the substantially overlapped area, negatively correlated with both phonological fluency and delusion severity. Our results suggest that the anterior interhemispheric dysconnectivity might be associated with executive dysfunction, and disinhibited automatic spreading activation in the semantic network was manifested as uncontrollable phonological fluency or delusions. This dysconnectivity could be one possible neural basis that differentiates pathological positive symptoms from adaptive creativity. Copyright © 2015 Elsevier B.V. All rights reserved.

Cognitive therapy for punishment paranoia: a single case experiment.

PubMed

Chadwick, P; Trower, P

1996-04-01

There is growing agreement that at least certain kinds of delusions defend against negative self-evaluation, and in consequence that cognitive therapy for delusions needs to address issues of self-evaluation more explicitly. However, in practice it can be difficult to enable clients to see the connection between delusions and self-esteem. The present single-case study exemplifies the conceptual and practical application of cognitive therapy for individuals who are both paranoid and have strong negative self-evaluative beliefs. A multiple-baseline approach is used, whereby one man's negative self-evaluative belief and two paranoid delusions are challenged sequentially. Conviction in two of the three beliefs changes at the point of intervention; conviction in the third changes prior to intervention. We discuss the details of the case, as well as the wider implications for cognitive approaches to delusions.

The Capgras delusion: a critique of its psychodynamic theories.

PubMed

Sinkman, A M

1983-07-01

The psychodynamic explanations for the Capgras delusion are reviewed. A critique is offered, showing how these theories fail to account for several important clinical phenomena found in patients with the Capgras delusion. A new psychodynamic theory is suggested that attempts to encompass all of the significant clinical phenomena. This hypothesis is based on findings in a series of fourteen schizophrenic patients with the typical delusion. The focus is on the patient's loss of a stable sense of identity. By the process of projection the patient ascribes his identity diffusion to those around him who are then seen as unreal impostors.

The interactions between religion, religiosity, religious delusion/hallucination, and treatment-seeking behavior among schizophrenic patients in Taiwan.

PubMed

Huang, Charles Lung-Cheng; Shang, Chi-Yung; Shieh, Ming-Shien; Lin, Hsin-Nan; Su, Jin Chung-Jen

2011-05-30

Religion could influence the psychopathology, treatment-seeking behavior, and treatment outcome in schizophrenia, but the associations between these factors have never been explored thoroughly, and the data in Han-Chinese society are scarcer still. The current study recruited 55 schizophrenic patients to explore the relationship between religion, psychopathology with religious content, treatment-seeking behavior, and outcome. Subjects with religious delusions/hallucinations had lower scores on functioning and higher scores on religiosity. The higher religiosity scores were correlated with older age, longer duration of illness, religious affiliation, lower preference of psychiatric treatment, lower functioning score, and delusion/hallucination. As to treatment-seeking behavior, patients with religious affiliation showed less preference toward psychiatric treatment. Individuals with religious delusion/hallucination were more likely to receive magico-religious healing and not to be satisfied with psychiatric treatment. A more positive view of psychiatric treatment was predicted by lower religiosity score, higher satisfaction with psychiatric treatment, and lower years of education. The religiosity level seems not directly related to clinical severity, but it seems to be a better predictor of religious delusions/hallucinations than religious affiliation status. Patients with religious delusions/hallucinations did not necessarily have more severe psychopathology. There are different profiles associated with religious affiliation/religiosity and religious delusions/hallucinations in relation to treatment-seeking behavior among schizophrenia patients in Han-Chinese society. Copyright © 2010 Elsevier Ltd. All rights reserved.

[Cotard's syndrome: Case report and a brief review of literature].

PubMed

Moschopoulos, N P; Kaprinis, S; Nimatoudis, J

2016-01-01

The term "Cotard's syndrome" is used to describe a number of clinical features, mostly hypochondriac and nihilistic delusions, the most characteristic of which are the ideas "I am dead" and "my internal organs do not exist". Besides, anxious and depressed mood, delusions of damnation, possession and immortality, suicidal and self-mutilating behavior are included. The first description of the syndrome was made in 1880 by Cotard, who presented the case of a female patient in a lecture. He originally named it "hypochondriac delusion", and some years later "delusion of negations", while it was named "Cotard delusion" after his death. In international literature, the terms "nihilistic delusion" and "Cotard's syndrome" prevailed over "delusion of negations" and "Cotard delusion". In the present study we report the case of a 59 year-old woman, who was admitted to our department after a suicide attempt, and who showed symptoms of Cotard's syndrome for about two years, namely depressed mood, hypochondriac and nihilistic delusions, delusions of immortality and damnation, suicidal ideation, severe psychomotor retardation, diminished motivation and tendency to stay in bed. She never took the medication she was prescribed, and at times she refused to eat. During her hospitalization, there was performed a full blood panel and medical imaging, that showed chronic ischemic infarctions, periventricular leukoencephalopathy and diffuse cerebral atrophy in MRI. All the other test results were normal. She was administered treatment with haloperidol, mirtazapine and venlafaxine. Gradually, her psychomotor ability, motivation and mood improved, she didn't express suicidal ideation, her delusions were less intense and she was able to question them, but they weren't eliminated. She was discharged in improved condition, after 44 days. Cotard's syndrome isn't mentioned in the current classification systems (ICD-10, DSM-5). In literature though, it has been divided into three types, according to the clinical symptoms: psychotic depression, Cotard type I, and Cotard type II, and three stages have been proposed: germination stage, blooming stage and chronic stage. It has been associated with various medical conditions, such as cerebral infractions, frontotemporal atrophy, epilepsy, encephalitis, brain tumors, traumatic brain injury. Furthermore, it has been associated with psychiatric conditions, such as mental retardation, postpartum depression, depersonalization disorder, catatonia, Capgras syndrome, Fregoli syndrome, Odysseus syndrome, koro syndrome. Several reports about successful pharmacological treatments have been published, both monotherapies with antidepressants, antipsychotics or lithium, and by antidepressant and antipsychotic combination treatments. The most reported successful treatment strategy for Cotard's syndrome is electroconvulsive therapy (ECT), administration of which should follow current treatment guidelines of the underlying conditions.

Risk factors for delusion of theft in patients with Alzheimer's disease showing mild dementia in Japan.

PubMed

Murayama, N; Iseki, E; Endo, T; Nagashima, K; Yamamoto, R; Ichimiya, Y; Arai, H; Sato, K

2009-07-01

The mechanism underlying delusion in Alzheimer's disease patients has not been fully clarified; however, the occurrence of delusion is a critical issue for dementia patients and their caregivers. In Japan, delusion of theft is the most frequent delusion in AD patients. We examined the risk factors for delusion of theft in AD patients showing mild dementia. Fifty-six AD patients were administered HDS-R, MMSE and COGNISTAT, including the 'speech sample', to assess their neuropsychological and social cognitive functions. The age, years of education, presence of cohabiting family members and premorbid personality traits were obtained from family members. About 25.0% of AD patients showed delusion of theft (D-group), and 75% did not (non-D-group). About 33.3% of female patients and 5.9% of male patients were included in the D-group (p < 0.05). About 13.6% of patients who were cohabiting with family members and 66.7% of patients who were living alone were included in the D-group (p < 0.05). About 35.1% of patients who had a neurotic personality and 5.3% of patients who did not were included in the D-group (p < 0.05). There were no significant differences in scores on HDS-R, MMSE and COGNISTAT sub-scales, except for 'speech sample', between the two groups. In the 'speech sample', 38.7% of patients who understood a relationship between two boys and 12.0% of patients who did not were included in the D-group (p < 0.05). These results indicated that delusion of theft in AD patients was related to female gender, absence of cohabiting family members, neurotic personality and retained social cognitive function.

Multiple Realities and Hybrid Objects: A Creative Approach of Schizophrenic Delusion

PubMed Central

Cermolacce, Michel; Despax, Katherine; Richieri, Raphaëlle; Naudin, Jean

2018-01-01

Delusion is usually considered in DSM 5 as a false belief based on incorrect inference about external reality, but the issue of delusion raises crucial concerns, especially that of a possible (or absent) continuity between delusional and normal experiences, and the understanding of delusional experience. In the present study, we first aim to consider delusion from a perspectivist angle, according to the Multiple Reality Theory (MRT). In this model inherited from Alfred Schütz and recently addressed by Gallagher, we are not confronting one reality only, but several (such as the reality of everyday life, of imaginary life, of work, of delusion, etc.). In other terms, the MRT states that our own experience is not drawing its meaning from one reality identified as the outer reality but rather from a multiplicity of realities, each with their own logic and style. Two clinical cases illustrate how the Multiple Realities Theory (MRT) may help address the reality of delusion. Everyday reality and the reality of delusion may be articulated under a few conditions, such as compossibility [i.e., Double Book-Keeping (DBK), in Bleulerian terms] or flexibility. There are indeed possible bridges between them. Possible links with neuroscience or psychoanalysis are evoked. As the subject is confronting different realities, so do the objects among and toward which a subject is evolving. We call such objects Hybrid Objects (HO) due to their multiple belonging. They can operate as shifters, i.e., as some functional operators letting one switch from one reality to another. In the final section, we will emphasize how delusion flexibility, as a dynamic interaction between Multiple Realities, may offer psychotherapeutic possibilities within some reality shared with others, entailing relocation of the present subjects in regained access to some flexibility via Multiple Realities and perspectivism. PMID:29487553

What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation.

PubMed

Freeman, D; Gittins, M; Pugh, K; Antley, A; Slater, M; Dunn, G

2008-08-01

In recent years a close association between anxiety and persecutory ideation has been established, contrary to the traditional division of neurosis and psychosis. Nonetheless, the two experiences are distinct. The aim of this study was to identify factors that distinguish the occurrence of social anxiety and paranoid thoughts in an experimental situation. Two hundred non-clinical individuals broadly representative of the UK general population were assessed on a range of psychological factors, experienced a neutral virtual reality social environment, and then completed state measures of paranoia and social anxiety. Clustered bivariate logistic regressions were carried out, testing interactions between potential predictors and the type of reaction in virtual reality. The strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with paranoia and social anxiety. The study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of 'things not seeming right'. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia.

What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation

PubMed Central

Freeman, D.; Gittins, M.; Pugh, K.; Antley, A.; Slater, M.; Dunn, G.

2008-01-01

Background In recent years a close association between anxiety and persecutory ideation has been established, contrary to the traditional division of neurosis and psychosis. Nonetheless, the two experiences are distinct. The aim of this study was to identify factors that distinguish the occurrence of social anxiety and paranoid thoughts in an experimental situation. Method Two hundred non-clinical individuals broadly representative of the UK general population were assessed on a range of psychological factors, experienced a neutral virtual reality social environment, and then completed state measures of paranoia and social anxiety. Clustered bivariate logistic regressions were carried out, testing interactions between potential predictors and the type of reaction in virtual reality. Results The strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with paranoia and social anxiety. Conclusions The study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of ‘things not seeming right’. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia. PMID:18533055

The structure of paranoia in the general population.

PubMed

Bebbington, Paul E; McBride, Orla; Steel, Craig; Kuipers, Elizabeth; Radovanovic, Mirjana; Brugha, Traolach; Jenkins, Rachel; Meltzer, Howard I; Freeman, Daniel

2013-06-01

Psychotic phenomena appear to form a continuum with normal experience and beliefs, and may build on common emotional interpersonal concerns. We tested predictions that paranoid ideation is exponentially distributed and hierarchically arranged in the general population, and that persecutory ideas build on more common cognitions of mistrust, interpersonal sensitivity and ideas of reference. Items were chosen from the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) questionnaire and the Psychosis Screening Questionnaire in the second British National Survey of Psychiatric Morbidity (n = 8580), to test a putative hierarchy of paranoid development using confirmatory factor analysis, latent class analysis and factor mixture modelling analysis. Different types of paranoid ideation ranged in frequency from less than 2% to nearly 30%. Total scores on these items followed an almost perfect exponential distribution (r = 0.99). Our four a priori first-order factors were corroborated (interpersonal sensitivity; mistrust; ideas of reference; ideas of persecution). These mapped onto four classes of individual respondents: a rare, severe, persecutory class with high endorsement of all item factors, including persecutory ideation; a quasi-normal class with infrequent endorsement of interpersonal sensitivity, mistrust and ideas of reference, and no ideas of persecution; and two intermediate classes, characterised respectively by relatively high endorsement of items relating to mistrust and to ideas of reference. The paranoia continuum has implications for the aetiology, mechanisms and treatment of psychotic disorders, while confirming the lack of a clear distinction from normal experiences and processes.

[The sense of the senseless, psychoanalytic aspects of delusion in psychosis].

PubMed

Chaperot, Christophe

2011-01-01

The psychoanalytic approach to delusion in psychosis leads us to examine the function of a "furrow". It is necessary to remain in the furrow in order not to become delusional. References to Sigmund Freud, Jacques Lacan, Mélanie Klein and Jean-Claude Maleval enlighten us as to the origin and the function of delusion as an attempt to give meaning.

Pathologies of hyperfamiliarity in dreams, delusions and déjà vu

PubMed Central

Gerrans, Philip

2014-01-01

The ability to challenge and revise thoughts prompted by anomalous experiences depends on activity in right dorsolateral prefrontal circuitry. When activity in those circuits is absent or compromised subjects are less likely to make this kind of correction. This appears to be the cause of some delusions of misidentification consequent on experiences of hyperfamiliarity for faces. Comparing the way the mind responds to the experience of hyperfamiliarity in different conditions such as delusions, dreams, pathological and non-pathological déjà vu, provides a way to understand claims that delusions and dreams are both states characterized by deficient “reality testing.” PMID:24600415

Pathologies of hyperfamiliarity in dreams, delusions and déjà vu.

PubMed

Gerrans, Philip

2014-01-01

The ability to challenge and revise thoughts prompted by anomalous experiences depends on activity in right dorsolateral prefrontal circuitry. When activity in those circuits is absent or compromised subjects are less likely to make this kind of correction. This appears to be the cause of some delusions of misidentification consequent on experiences of hyperfamiliarity for faces. Comparing the way the mind responds to the experience of hyperfamiliarity in different conditions such as delusions, dreams, pathological and non-pathological déjà vu, provides a way to understand claims that delusions and dreams are both states characterized by deficient "reality testing."

Frontotemporal hypoactivity during a reality monitoring paradigm is associated with delusions in patients with schizophrenia spectrum disorders.

PubMed

Thoresen, Christian; Endestad, Tor; Sigvartsen, Niels Petter B; Server, Andres; Bolstad, Ingeborg; Johansson, Mikael; Andreassen, Ole A; Jensen, Jimmy

2014-01-01

Impaired monitoring of internally generated information has been proposed to be one component in the development and maintenance of delusions. The present study investigated the neural correlates underlying the monitoring processes and whether they were associated with delusions. Twenty healthy controls and 19 patients with schizophrenia spectrum disorders were administrated a reality monitoring paradigm during functional magnetic resonance imaging. During encoding participants were instructed to associate a statement with either a presented (viewed condition) or an imagined picture (imagined condition). During the monitoring session in the scanner, participants were presented with old and new statements and their task was to identify whether a given statement was associated with the viewed condition, imagined condition, or if it was new. Patients showed significantly reduced accuracy in the imagined condition with performance negatively associated with degree of delusions. This was accompanied with reduced activity in the left dorsolateral prefrontal cortex and left hippocampus in the patient group. The severity of delusions was negatively correlated with the blood-oxygenation-level dependent response in the left hippocampus. The results suggest that weakened monitoring is associated with delusions in patients with schizophrenia spectrum disorder, and that this may be mediated by a frontotemporal dysfunction.

Grey matter atrophy in mild cognitive impairment / early Alzheimer disease associated with delusions: a voxel-based morphometry study.

PubMed

Ting, Windsor Kwan-Chun; Fischer, Corinne E; Millikin, Colleen P; Ismail, Zahinoor; Chow, Tiffany W; Schweizer, Tom A

2015-01-01

Grey matter atrophy in the right hemisphere has been shown to be more severe in dementia patients with delusions, suggesting a neuroanatomical localization that may be pertinent to impending neurodegeneration. Delusional symptoms may arise when atrophy in these areas reduces the regulatory functions of the right hemisphere, in tandem with asymmetric neuropathology in the left hemisphere. We hypothesized that delusional patients with either amnestic mild cognitive impairment (MCI) or early Alzheimer Disease (AD) would experience more pronounced grey matter atrophy in the right frontal lobe compared with matched patients without delusions. We used neuroimaging and clinical data obtained from the Alzheimer's Disease Neuroimaging Initiative. A comparison group of twenty-nine nondelusional MCI/early AD participants were compared with twenty-nine delusional participants using voxel-based morphometry, matched at baseline by age, sex, education, and Mini-Mental State Exam score. All included participants were diagnosed with amnestic MCI at study baseline. Fifteen voxel clusters of decreased grey matter in participants with delusions were detected. Prominent grey matter decrease was observed in the right precentral gyrus, right inferior frontal gyrus, right insula, and left middle occipital gyrus, areas that may be involved in control of thought and emotions. Greater right fronto-temporal grey matter atrophy was observed in MCI or early AD participants with delusions compared to matched patients without delusions. Consistent with our predictions, asymmetric grey matter atrophy in the right hemisphere may contribute to development of delusions through loss of executive inhibition.

Humans, elephants, diamonds and gold: patterns of intentional design in Girolamo Cardano's natural philosophy.

PubMed

Giglioni, Guido

2014-01-01

Distancing himself from both Aristotelian and Epicurean models of natural change, and resisting delusions of anthropocentric grandeur, Cardano advanced a theory of teleology centred on the notion of non-human selfhood. In keeping with Plato, he argued that nature was ruled by the mind, meaning by "mind" a universal paragon of intelligibility instantiated through patterns of purposive action ("noetic" teleology). This allowed Cardano to defend a theory of natural finalism in which life was regarded as a primordial attribute of being, already in evidence in the most elementary forms of nature, whose main categories were ability to feign, self-interest, self-preservation and indefinite persistence.

Dense amnesia in a professional musician following herpes simplex virus encephalitis.

PubMed

Wilson, B A; Baddeley, A D; Kapur, N

1995-10-01

We describe the memory functioning of C, a professional musician who became amnesic following herpes simplex encephalitis in 1985. Although transient amnesia in a professional musician has previously been described, this is the first reported case of chronic amnesia in a highly talented professional musician. C is unusual in three respects. First, his amnesia is particularly severe. Second, his amnesia includes semantic as well as episodic memory deficits. Third, he believes he has just woken up and his preoccupation with this state of 'just wakening' has persisted for over 9 years. This appears to be the result of a delusion rather than the consequence of his amnesia.

Effect and tolerability of blonanserin in severe delusion with various types of dementia.

PubMed

Takaki, Manabu; Honda, Hajime; Terada, Seishi; Uchitomi, Yosuke

2015-06-01

Low-dose blonanserin was effective for treating severe delusions in six patients with various types of dementia, and it was also well tolerated. Delusion and hallucination scores, as measured by the Neuropsychiatric Inventory, improved, and extrapyramidal symptom scores, as measured by the Drug-Induced Extrapyramidal Symptoms Scale, were unchanged. Blonanserin has strong dopamine D 2 receptor-, 5-hydroxytryptamine 2A receptor-, and dopamine D 3 receptor-blocking activities and weak 5-hydroxytryptamine-2C, α 1 -, histamine H 1 -, and muscarinic M 1 -blocking activities. Its unique characteristics may make it suitable for treating severe delusions and hallucination in patients with dementia. © 2014 The Authors. Psychogeriatrics © 2014 Japanese Psychogeriatric Society.

Capgras' syndrome in dementia with Lewy bodies.

PubMed

Marantz, Andrew G; Verghese, Joe

2002-01-01

We report the occurrence of Capgras' syndrome, or the delusion of doubles, in a patient with dementia with Lewy bodies. The patient believed that several similar-looking impostors had replaced his wife of over 50 years. Uncharacteristically, he adopted a friendly attitude with these impostors. This unusual convivial reaction to the impostors may result from differential involvement of the dual visual pathways processing facial recognition and emotional responses to faces. The delusion resolved spontaneously, coincident with worsening of the dementia. In a retrospective chart review of 18 autopsy-confirmed cases of dementia with Lewy bodies, delusions were reported in 5 subjects (27.8%), of whom 1 had misidentification delusions much like Capgras' syndrome.

Persistent psychotic symptoms after long-term heavy use of mephedrone: A two-case series.

PubMed

Barrio, Pablo; Gaskell, Matthew; Goti, Javier; Vilardell, Sergi; Fàbregas, Josep Maria

2016-06-15

Mephedrone (4-methylmethcathinone) is a synthetic stimulant drug of the cathinone class. Similar effects to those of cocaine and ecstasy are reported by users, with a high addictive potential. Given its increasing rate of consumption in Europe, it is getting more and more attention from the addiction field. In spite of that, little is known about the long-term consequences of prolonged heavy use. The two following cases might depict some of them. Case 1 was a middle-age man who reported three years of intravenous use of mephedrone. He used to binge for several days in a row. Psychotic symptoms appeared after a few months, especially paranoid delusions. Sent to aftercare in a therapeutic community, delusions kept reappearing after prolonged abstinence. A good response to risperidone was observed. Case 2 was a young man who used mephedrone heavily for two years, always snorted. Upon admission to the therapeutic community, the patient reported auditory hallucinations that partially remitted with olanzapine. Both cases showed a good insight and no personality deterioration. Given its similarities to other substances that are known to induce psychotic symptoms, and the increasing consumption of mephedrone around Europe, similar cases are expected in the near future. Conventional antipsychotic treatment seems a reasonable pharmacological approach.

Toward a Neurobiology of Delusions

PubMed Central

Corlett, P.R.; Taylor, J.R.; Wang, X.-J.; Fletcher, P.C.; Krystal, J.H.

2013-01-01

Delusions are the false and often incorrigible beliefs that can cause severe suffering in mental illness. We cannot yet explain them in terms of underlying neurobiological abnormalities. However, by drawing on recent advances in the biological, computational and psychological processes of reinforcement learning, memory, and perception it may be feasible to account for delusions in terms of cognition and brain function. The account focuses on a particular parameter, prediction error – the mismatch between expectation and experience – that provides a computational mechanism common to cortical hierarchies, frontostriatal circuits and the amygdala as well as parietal cortices. We suggest that delusions result from aberrations in how brain circuits specify hierarchical predictions, and how they compute and respond to prediction errors. Defects in these fundamental brain mechanisms can vitiate perception, memory, bodily agency and social learning such that individuals with delusions experience an internal and external world that healthy individuals would find difficult to comprehend. The present model attempts to provide a framework through which we can build a mechanistic and translational understanding of these puzzling symptoms. PMID:20558235

Testing a model of the relationship between childhood sexual abuse and psychosis in a first-episode psychosis group: the role of hallucinations and delusions, posttraumatic intrusions, and selective attention.

PubMed

Bendall, Sarah; Hulbert, Carol Anne; Alvarez-Jimenez, Mario; Allott, Kelly; McGorry, Patrick D; Jackson, Henry James

2013-11-01

Several theories suggest that posttraumatic intrusive symptoms are central to the relationship between childhood trauma (CT) and hallucinations and delusions in psychosis. Biased selective attention has been implicated as a cognitive process underlying posttraumatic intrusions. The current study sought to test theories of the relationship between childhood sexual abuse (CSA), hallucinations and delusions, posttraumatic intrusions, and selective attention in first-episode psychosis (FEP). Twenty-eight people with FEP and 21 nonclinical controls were assessed for CT and psychotic and posttraumatic stress symptoms and completed an emotional Stroop test using CSA-related and other words. Those with FEP and CSA had more severe hallucinations and delusions than those with FEP and without CSA. They also reported posttraumatic intrusions at clinical levels and showed selective attention to CSA-related words. The results are consistent with the posttraumatic intrusions account of hallucinations and delusions in those with CSA and psychosis.

What is a delusion? Epistemological dimensions.

PubMed

Leeser, J; O'Donohue, W

1999-11-01

Although the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) clearly indicates delusions have an epistemic dimension, it fails to accurately identify the epistemic properties of delusions. The authors explicate the regulative causes of belief revision for rational agents and argue that delusions are unresponsive to these. They argue that delusions are (a) protected beliefs made unfalsifiable either in principle or because the agent refuses to admit anything as a potential falsifier; (b) the protected belief is not typically considered a "properly basic" belief; (c) the belief is not of the variety of protected scientific beliefs; (d) in response to an apparent falsification, the subject posits not a simple, testable explanation for the inconsistency but one that is more complicated, less testable, and provides no new corroborations; (e) the subject has a strong emotional attachment to the belief; and (f) the belief is typically supported by (or originates from) trivial occurrences that are interpreted by the subject as highly unusual, significant, having personal reference, or some combination of these.

Use of the delusions-symptoms-states inventory to detect psychiatric symptoms in a sample of homeless men.

PubMed Central

Shanks, N J; Priest, R G; Bedford, A; Garbett, S

1995-01-01

BACKGROUND. Previous research, often using the symptom-sign inventory, had demonstrated a high prevalence of psychiatric disorder among homeless people. The delusions-symptoms-states inventory detects the presence or absence of four classes of psychiatric illness--delusions of disintegration, integrated delusions, neurotic symptoms and dysthymic states. AIM. A study was undertaken to determine the utility of the delusions-symptoms-states inventory in a sample of homeless men, and the prevalence of psychiatric symptoms in this group. METHOD. The inventory was administered to 55 homeless men in a reception centre in Sheffield. RESULTS. Nearly half of the men obtained scores on the inventory suggesting that they had psychiatric symptoms. There was an overlap of syndromes, particularly among those with severe psychiatric illness. For example, seven men had all four classes of psychiatric illness. CONCLUSION. Use of the questionnaire proved satisfactory. The findings support the contention that reception centres and similar accommodation are repositories for homeless mentally ill people. PMID:7612322

Emotional awareness and delusions in schizophrenia and schizoaffective disorder.

PubMed

D'Antonio, Emily; Kahn, Jennifer; McKelvey, Jennifer; Berenbaum, Howard; Serper, Mark R

2015-02-01

Emotion plays a significant role in schizophrenia. Emotional awareness (i.e., attention to and clarity of emotions) is associated with a wide range of outcomes. Given that individuals with schizophrenia and schizoaffective disorder differ in the significance of their mood symptoms, the present research examined whether the association between emotional awareness and delusions differs for these two groups of patients. Emotional awareness (i.e., attention to and clarity of emotions) was measured with self-report in a sample of 44 individuals diagnosed with either schizophrenia or schizoaffective disorder. Clinical ratings of delusions were made using the Scale for the Assessment of Positive Symptoms. For the sample as a whole, individuals with higher levels of attention to emotion tended to have more severe delusions. In addition, diagnostic group significantly moderated the relation between emotional clarity and delusions. Conclusions regarding causality cannot be drawn due to the cross-sectional design. Replication is particularly important given the small sample sizes. The present research indicates that emotional awareness is associated with delusions. The results raise the possibility that the emotional factors that contribute to delusional beliefs among individuals with schizophrenia differ in at least some ways from the emotional factors that contribute to delusional beliefs among individuals with schizoaffective disorder. Copyright © 2014 Elsevier Inc. All rights reserved.

Attributional style in a case of Cotard delusion.

PubMed

McKay, Ryan; Cipolotti, Lisa

2007-06-01

Young and colleagues (e.g. Young, A. W., & Leafhead, K. M. (1996). Betwixt life and death: case studies of the Cotard delusion. In P. W. Halligan & J. C. Marshall (Eds.), Method in madness: Case studies in cognitive neuropsychiatry. Mahway, NJ: Lawrence Erlbaum Associates.) have suggested that cases of the Cotard delusion (the belief that one is dead) result when a particular perceptual anomaly (caused by a disruption to the affective component of visual recognition) occurs in the context of an internalising attributional style. This hypothesis has not previously been tested directly. We report here an investigation of attributional style in a 24-year-old woman with Cotard delusion ("LU"). LU's attributional style (and that of ten healthy control participants) was assessed using the Internal, Personal and Situational Attributions Questionnaire (Kinderman, P., & Bentall, R. P. (1996). A new measure of causal locus: the internal, personal and situational attributions questionnaire. Personality and Individual Differences, 20(2), 261-264.). LU showed a significantly greater proportion of internalising attributions than the control group, both overall and for negative events specifically. The results obtained thus support an association of Cotard delusion with an internalising attributional style, and are therefore consistent with the account of Young and colleagues. The potential brain basis of Cotard delusion is discussed.

When a loved one feels unfamiliar: a case study on the neural basis of Capgras delusion.

PubMed

Thiel, Christiane M; Studte, Sara; Hildebrandt, Helmut; Huster, Rene; Weerda, Riklef

2014-03-01

Perception of familiar faces depends on a core system analysing visual appearance and an extended system dealing with inference of mental states and emotional responses. Damage to the core system impairs face perception as seen in prosopagnosia. In contrast, patients with Capgras delusion show intact face perception but believe that closely related persons are impostors. It has been suggested that two deficits are necessary for the delusion, an aberrant perceptual or affective experience that leads to a bizarre belief as well as an impaired ability to evaluate beliefs. Using functional magnetic resonance imaging, we compared neural activity to familiar and unfamiliar faces in a patient with Capgras delusion and an age matched control group. We provide evidence that Capgras delusion is related to dysfunctional activity in the extended face processing system. The patient, who developed the delusion for the partner after a large right prefrontal lesion sparing the ventromedial and medial orbitofrontal cortex, lacked neural activity to the partner's face in left posterior cingulate cortex and left posterior superior temporal sulcus. Further, we found impaired functional connectivity of the latter region with the left superior frontal gyrus and to a lesser extent with the right superior frontal sulcus/middle frontal gyrus. The findings of this case study suggest that the first factor in Capgras delusion may be reduced neural activity in the extended face processing system that deals with inference of mental states while the second factor may be due to a lesion in the right middle frontal gyrus. Copyright © 2013 Elsevier Ltd. All rights reserved.

More Delusions May Be Observed in Low-Proficient Multilingual Alzheimer's Disease Patients.

PubMed

Liu, Yi-Chien; Liu, Yen-Ying; Yip, Ping-Keung; Akanuma, Kyoko; Meguro, Kenichi

2015-01-01

Language impairment and behavioral symptoms are both common phenomena in dementia patients. In this study, we investigated the behavioral symptoms in dementia patients with different language backgrounds. Through this, we aimed to propose a possible connection between language and delusion. We recruited 21 patients with Alzheimer's disease (AD), according to the DSM-IV and NINCDS-ADRDA criteria, from the memory clinic of the Cardinal Tien Hospital in Taipei, Taiwan. They were classified into two groups: 11 multilinguals who could speak Japanese, Taiwanese and Mandarin Chinese, and 10 bilinguals who only spoke Taiwanese and Mandarin Chinese. There were no differences between age, education, disease duration, disease severity, environment and medical care between these two groups. Comprehensive neuropsychological examinations, including Clinical Dementia Rating (CDR), Mini-Mental Status Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), Verbal fluency, Chinese version of the Boston naming test (BNT) and the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), were administered. The multilingual group showed worse results on the Boston naming test. Other neuropsychological tests, including the MMSE, CASI and Verbal fluency, were not significantly different. More delusions were noted in the multilingual group. Three pairs of subjects were identified for further examination of their differences. These three cases presented the typical scenario of how language misunderstanding may cause delusions in multilingual dementia patients. Consequently, more emotion and distorted ideas may be induced in the multilinguals compared with the MMSE-matched controls. Inappropriate mixing of language or conflict between cognition and emotion may cause more delusions in these multilingual patients. This reminds us that delusion is not a pure biological outcome of brain degeneration. Although the cognitive performance was not significantly different between our groups, language may still affect their delusion.

More Delusions May Be Observed in Low-Proficient Multilingual Alzheimer’s Disease Patients

PubMed Central

Liu, Yi-Chien; Liu, Yen-Ying; Yip, Ping-Keung; Akanuma, Kyoko; Meguro, Kenichi

2015-01-01

Background Language impairment and behavioral symptoms are both common phenomena in dementia patients. In this study, we investigated the behavioral symptoms in dementia patients with different language backgrounds. Through this, we aimed to propose a possible connection between language and delusion. Methods We recruited 21 patients with Alzheimer’s disease (AD), according to the DSM-IV and NINCDS-ADRDA criteria, from the memory clinic of the Cardinal Tien Hospital in Taipei, Taiwan. They were classified into two groups: 11 multilinguals who could speak Japanese, Taiwanese and Mandarin Chinese, and 10 bilinguals who only spoke Taiwanese and Mandarin Chinese. There were no differences between age, education, disease duration, disease severity, environment and medical care between these two groups. Comprehensive neuropsychological examinations, including Clinical Dementia Rating (CDR), Mini-Mental Status Examination (MMSE), Cognitive Abilities Screening Instrument (CASI), Verbal fluency, Chinese version of the Boston naming test (BNT) and the Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD), were administered. Results The multilingual group showed worse results on the Boston naming test. Other neuropsychological tests, including the MMSE, CASI and Verbal fluency, were not significantly different. More delusions were noted in the multilingual group. Three pairs of subjects were identified for further examination of their differences. These three cases presented the typical scenario of how language misunderstanding may cause delusions in multilingual dementia patients. Consequently, more emotion and distorted ideas may be induced in the multilinguals compared with the MMSE-matched controls. Conclusion Inappropriate mixing of language or conflict between cognition and emotion may cause more delusions in these multilingual patients. This reminds us that delusion is not a pure biological outcome of brain degeneration. Although the cognitive performance was not significantly different between our groups, language may still affect their delusion. PMID:26554588

Strange and scary memories of the intensive care unit: a qualitative, longitudinal study inspired by Ricoeur's interpretation theory.

PubMed

Svenningsen, Helle; Egerod, Ingrid; Dreyer, Pia

2016-10-01

To describe the content of former intensive care unit patients' memories of delusions. Intensive care unit patients often have strange and frightening experiences during the critical stage of illness. Earlier studies have provided small-sample in-depth descriptions of patient experiences in intensive care unit, but large-scale studies are also needed to inform intensive care unit follow-up. The study had a qualitative design using phenomenological hermeneutic analysis inspired by Ricoeur's interpretive theory. Patients were assessed with Confusion Assessment Method of the Intensive Care Unit for delirium in intensive care unit, and after discharge, memories of delusions were described by 114 of 325 patients in face-to-face (after two weeks) and telephone interviews (after two and six months) using the Intensive Care Unit Memory Tool. Four themes emerged: the ever-present family, dynamic spaces, surviving challenges and constant motion. Memories of delusions were a vivid mix of fact and fiction, demonstrating dynamic shifts in time, place and motion, but not dependent on the presence of delirium assessed by Confusion Assessment Method of the Intensive Care Unit. Analysis based on Ricoeurian phenomenological hermeneutics provided insights into themes in intensive care unit patients' memories of delusions. More studies are needed to understand the meaning of memories of delusions, the commonality of themes and the association between delusions and delirium after an intensive care unit stay. Understanding patients' memories of delusions is beneficial to nurses caring for patients that are anxious, upset or agitated. It opens a window to the world of the patient who is unable to communicate due to intubation and general weakness. We recommend the provision of nurse-led intensive care unit follow-up enabling patients to describe and discuss their intensive care unit experiences. © 2016 John Wiley & Sons Ltd.

[Cotard's syndrome: historical and conceptual aspects].

PubMed

Luque Luque, R; Valls Blanco, J M

1994-01-01

The history of the concept of Cotard's syndrome is traced from its inception in 1880 to the present day. Nihilistic delusions were described by Cotard to refer to a special type of hypochondriacal delusion associated to melancholia. Although Cotard himself and other XIX and XX centuries' psychiatrists have considered it from different approaches a specific clinical entity, most of the authors estimate that nihilistic delusion is either a syndrome or a symptom which can appear in different psychiatric disorders.

Anti-social personality characteristics and psychotic symptoms: Two pathways associated with offending in schizophrenia.

PubMed

Van Dongen, Josanne D M; Buck, Nicole M L; Barendregt, Marko; Van Beveren, Nico M; De Beurs, Edwin; Van Marle, Hjalmar J C

2015-07-01

Several research groups have shown that people with schizophrenia who offend do not form a homogenous group. A three-group model claimed by Hodgins proposes distinguishing between people who start offending before the onset of psychosis (early starters), after psychosis onset but at age 34 years or under (late starters) and after psychosis onset but at age 35 years or older (late first offenders). This study aimed to test the hypotheses (1) that the personality of early starters and non-psychotic offenders would be similar, but different from either late-starter group; (2) that the late-starter groups would be more likely to have positive psychotic symptoms than non-criminal patients with schizophrenia; and (3) that symptom types would differentiate the psychotic groups. A retrospective file study was conducted on cases of 97 early starters, 100 late starters and 26 late first offenders all drawn from the Netherlands Institute of Forensic Psychiatry and Psychology (NIFP) archives 1993-2008, 115 non-psychotic offenders from 2005-2008 NIFP archives and 129 patients with schizophrenia and no criminal history from one general service in Rotterdam. Early starters closely resembled the non-psychotic offenders in their premorbid anti-social personality characteristics. The two late-onset offending psychosis groups were more likely to have persecutory and/or grandiose delusions than non-offenders with psychosis, but so were the early starters. In a first study to compare subgroups of offenders with psychosis directly with non-psychotic offenders and non-offenders with psychosis, we found such additional support for a distinction between early and late starters with psychosis that different treatment strategies would seem indicated, focusing on personality and substance misuse for the former but psychotic symptoms for all. It remains to be seen whether the higher rate of alcohol misuse amongst late first offenders is a fundamental distinction or a function of age difference. Copyright © 2014 John Wiley & Sons, Ltd.

Psychosis associated with usage of herbal slimming products adulterated with sibutramine: a case series.

PubMed

Chen, Sammy P L; Tang, Magdalene H Y; Ng, Sau Wah; Poon, Wing Tat; Chan, Albert Y W; Mak, Tony W L

2010-10-01

Sibutramine, or its structurally related analogs, is often found as an adulterant in proprietary herbal slimming products in Hong Kong. A few solitary case reports of sibutramine-associated psychosis have been published since 2000. As the only tertiary referral center for clinical toxicology analysis in Hong Kong, we noticed that psychosis was an unusually common feature in patients taking "herbal slimming products" adulterated with sibutramine or its structurally related analogs over the past 5 years. To examine the association between psychosis and the use of sibutramine-adulterated herbal products, in an attempt to elucidate this possible adverse drug reaction. This retrospective study reviewed all cases hospitalized with psychotic symptoms confirmed to have used herbal slimming products adulterated with sibutramine, or its analogs, between January 2004 and October 2009. The cases' clinical features, outcome, drug history, and analytical findings of the offending slimming products were studied. Results. Among the 16 confirmed cases, 15 (94%) were female; the median age was 19 years (range: 15-47). Auditory hallucination was documented in 10 (63%), visual hallucination in 6 (38%), persecutory ideas in 6 (38%), delusions in 4 (25%), and suicidal ideation in 2 (13%). For 20 "herbal" slimming products analyzed, 16 were found to have been adulterated with sibutramine, 2 with N-desmethyl-sibutramine, and 1 with N-bisdesmethyl-sibutramine. Other concomitant adulterants were also found and included phenolphthalein in 9, fenfluramine, mazindol, animal thyroid tissue in 2, hydrochlorothiazide and spironolactone in 1. Eight patients disclosed the source of the products: four through the Internet, one obtained over-the-counter locally, with three acquired outside Hong Kong. Slimming products claimed "herbal" in origin could often be adulterated with sibutramine and other Western medications. We observed an association between the use of these products and psychotic features. Further studies are warranted to study whether these adverse events are an uncommon adverse drug reaction of sibutramine.

Postpartum Psychosis

MedlinePlus

... of postpartum psychosis never had delusions containing violent commands. Delusions take many forms, and not all of them are destructive. Most women who experience postpartum psychosis do not harm themselves or anyone else. However, there ...

Hallucinations, Delusions and Paranoia

MedlinePlus

... of objects or events and is sensory in nature. When individuals with Alzheimer’s have a hallucination, they ... frightening, and not all delusions are paranoid in nature. See the doctor. When helping someone who is ...

Destructive women and the men who can't leave them: pathological dependence or pathological omnipotence?

PubMed

Friedman, Henry J

2012-06-01

Clinicians have focused more on the troubling issue of women who are dominated and abused by men than they have on those occasions where men are abused by women. While usually not involving physical abuse, the destructiveness of some women, expressed in terms of harsh and destructive verbal and interpersonal behavior can be so striking and persistent that it should remain of interest to psychoanalysts. This clinical paper examines two examples of male patients who, while accomplished in many spheres of their lives, are nevertheless engaged in marriages to women whose hateful behavior toward them is impossible to deny. Despite considerable awareness of how much they are damaged by their wives, they are either unwilling or unable to utilize separation and divorce as tools to protect themselves, with the ultimate goal of starting life again free of the persecutory other. The dynamics involved for men stuck in such dyads are considered, including the possible negative role of a systems approach to couples' therapy that assumes mutual responsibility for the couples' dysfunction and distress.

Psychotic Disorders

MedlinePlus

... main symptoms are delusions and hallucinations. Delusions are false beliefs, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something ...

[Chronic Koro-like Syndrome (KLS) in recurrent depressive disorder as a variant of Cotard's delusion in an italian male patient. A case report and historical review].

PubMed

Bandinelli, Pier Luca; Trevisi, Manuela; Kotzalidis, Giorgio Demetrio; Manfredi, Giovanni; Rapinesi, Chiara; Ducci, Giuseppe

2011-01-01

Cotard’s syndrome is a delusional syndrome, first described in the 1880ies by Cotard, characterized by a nihilistic delusions about the self and/or the world. In same other cases there is an intense nihilistic belief that the patient’s entire body or parts of it are disintegrated or dead. The syndrome is often associated with severe depression, but are also described neurological cases. Koro was described a little later from Asia and consisted in the belief that one’s own genitalia are shrinking or disappearing and death will ensue thereafter, but there are many cultural variants and the syndrome may present in an incomplete form. We report on a KLS sharing more features with annihilation delusions, such as Cotard’s syndrome. In KLS, the délire de négation may be limited to localized systems or organs. We believe that some complete and incomplete forms of Koro, when embedded in a depressive core, may represent a variant of Cotard’s delusion. In fact, our patient did not reach a complete denial of his entire body, but rather focused on sexual identity. We analysed the psychosexual issues of our case according to Kretschmer’s 1918 view of a “bipolar setting” between sthenic and asthenic characters of a patient suffering from sensitive delusions of (self-) reference. This view may allow us to relate the personological character to the genetic comprehensibility of the delusion.

Delusions and decision-making style: use of the Need for Closure Scale.

PubMed

Freeman, Daniel; Garety, Philippa; Kuipers, Elizabeth; Colbert, Susannah; Jolley, Suzanne; Fowler, David; Dunn, Graham; Bebbington, Paul

2006-08-01

Clinicians and researchers have suggested that rapidity in belief formation, due to having a high 'need for closure' (NFC), may contribute to the acceptance of delusional explanations. The aim of the study is to determine whether NFC has such a direct link with delusions. A secondary aim is to examine if NFC is related to the delusion-associated reasoning process of 'jumping to conclusions'. One hundred and eighty-seven patients with psychosis, recruited for a treatment trial of psychological therapy (the PRP trial), completed the Need for Closure Scale (NFCS), symptom measures, and probabilistic reasoning tasks. The NFCS was considered in terms of its two dimensions: a desire for simple structure and a preference for quick, decisive answers. The individuals with psychosis reported being poor at making quick, decisive answers but required a greater need for simple structure. NFC was associated with levels of anxiety and depression. There were weak links between NFC and both positive and negative symptoms of psychosis, but these were explained by differences in affect. NFCS scores were unrelated to jumping to conclusions. Contrary to the argument that NFC is directly linked to delusions, individuals with delusions actually perceive themselves as indecisive. There was no evidence that NFC-at least as assessed by the NFCS-could be a proximal cause of delusions. Any potential effect on psychotic symptom presentation is indirect, mediated through affect. The use of the NFCS on its own in the study of psychotic symptoms cannot be recommended.

The affective neuropsychology of confabulation and delusion.

PubMed

Fotopoulou, Aikaterini

2010-01-01

The paper reviews the history of the scientific understanding of the role of emotion in confabulation and delusion. I argue that the significance of emotion in the pathogenesis of these symptoms was obscured by academic polarisation between psychodynamic and neurocognitive traditions and was also often obfuscated by rigid distinctions between psychogenic and neurogenic explanations. This tradition of epistemic dualism was implicitly maintained in the fields of cognitive neuropsychology and cognitive neuropsychiatry. This paper focuses on memory-related confabulation following ventromedial frontal lobe lesions, awareness-related confabulation following right perisylvian lesions, and delusions of various aetiologies. Ambiguity regarding the definition and taxonomy of symptoms renders direct comparison difficult, but certain overriding principles are becoming discernible. Recent findings suggest that emotion and motivation influence both confabulation and delusion. These influences may be instigated directly by neural dysfunction or indirectly by life changes and altered social circumstances, or by a combination of these. Importantly, the rejection of epistemic dualism in the conceptualisation of both symptoms can allow us to study them in parallel and draw conclusions about the relation between cognition and emotion. Specifically, confabulation and delusion can be described as faulty attempts to balance the conflicting demands of accurate and self-serving reality representation.

Avatar Therapy for Persistent Auditory Verbal Hallucinations in an Ultra-Resistant Schizophrenia Patient: A Case Report.

PubMed

Dellazizzo, Laura; Potvin, Stéphane; Phraxayavong, Kingsada; Lalonde, Pierre; Dumais, Alexandre

2018-01-01

Effective treatment strategies for schizophrenia remain very challenging and many treatment-resistant patients will suffer from persistent auditory verbal hallucinations (AVH). While clozapine is the gold-standard medication for this complex population, many will not respond to this molecule. For these ultra-resistant patients, limited options are available. Cognitive-behavioral therapy (CBT) is the most widely used psychological intervention, though it offers modest effects. With the interpersonal dimension of AVH being recognized, Avatar Therapy (AT), a novel experiential treatment enabling patients to create an avatar of their persecutor and allowing them to gain control over their symptoms, was developed and tested. Results have shown significant improvements in AVH symptomatology. This paper details a case report showcasing the beneficial results of AT for even the most severe and symptomatic cases of schizophrenia. Mr. Smith has been afflicted with the persistency of all his voices for almost 20 years. To our knowledge, this patient tried almost all possible treatments with little efficacy. This case highlights the difficulty of finding an adequate treatment for ultra-resistant patients. Mr. Smith first followed CBT before initiating AT. With AT, he significantly improved in a way that was not observed with any other intervention and these improvements remained afterward. The severity of his positive symptoms as well as his depressive symptoms diminished, and his most distressing persecutory voice disappeared. He was able to regain a life. The effects of AT went well beyond the patient, the morale of the entire family improved. This ultra-resistant case suggests that AT may be a promising intervention for refractory AVH in schizophrenia.

Wittgenstein and the limits of empathic understanding in psychopathology.

PubMed

Thornton, Tim

2004-08-01

The aim of this paper is three-fold. Firstly, to briefly set out how strategic choices made about theorising about intentionality or content have actions at a distance for accounting for delusion. Secondly, to investigate how successfully a general difficulty facing a broadly interpretative approach to delusions might be eased by the application of any of three Wittgensteinian interpretative tools. Thirdly, to draw a general moral about how the later Wittgenstein gives more reason to be pessimistic than optimistic about the prospects of a philosophical psychopathology aimed at empathic understanding of delusions.

The relation between emotional awareness and hallucinations and delusions in acute psychiatric inpatients.

PubMed

Serper, Mark; Berenbaum, Howard

2008-04-01

Although negative affect has been frequently implicated in the formation of cognitive and perceptual disturbances ranging from odd perceptions and beliefs to delusions and hallucinations it represents only one of the many aspects of emotional disturbances that may contribute to psychopathology. Surprisingly, no past research has examined in a psychiatric sample whether levels of cognitive-perceptual symptoms are associated with levels of emotional awareness (i.e., attention to emotion and clarity of emotion). In the present study we examined, in an acute psychiatric inpatient sample, the relations between emotional awareness and the severity of delusions and hallucinations. Two groups were included: 34 schizophrenia and schizophrenia spectrum disordered inpatients and 30 mood and substance use disordered inpatients. Patients were assessed on emotional awareness (attention to emotion and emotional clarity) and severity of psychiatric symptomatology. We found that lower levels of emotional clarity were associated with more severe hallucination ratings in both groups of patients. Among schizophrenia spectrum patients, lower levels of attention to emotion were also associated with more severe hallucination ratings. Among mood/substance disorder participants, higher levels of attention to emotion were associated with more severe delusion ratings, whereas the opposite pattern was found among schizophrenia spectrum participants. Consistent with the results of past research using college and community samples, we found that diminished emotional clarity is associated with elevated levels of hallucinations in both mood disorder/substance abuse and schizophrenia spectrum inpatients. We also found that greater attention to emotion was associated with more severe delusions, though only among the mood disorder/substance use group. The present research findings support the role of emotional awareness in hallucination formation and suggest that the factors that contribute to delusions in schizophrenia spectrum patients differ, in part, from the factors that contribute to delusion formation in other groups of individuals.

[Between faith and delusion].

PubMed

Rosenleitner, Jan; Rittmannsberger, Hans

2013-01-01

Religious beliefs can lead to difficulties in psychiatric diagnosis, when it comes to distinguishing between faith and delusion. Delusion is defined as a false assessment of reality combined with subjective certainty, which is in contrast with the reality of the social environment. The problem with this definition is that reality cannot be examined with scientific methods/criteria and that the assessment of reality itself underlies historical and cultural fluctuations. The current diagnostic manuals for psychiatric disorders DSM 5 and ICD-10 require, that the content of the belief has to be inadequate even in the subculture of the patient (ICD-10) and that the cultural and socioeconomic background of the patient has to be taken into account (DSM 5). On the basis of this case-report and of selected publications on this topic we want to discuss this diagnostic problem. After that we present a diagnostic model for delusion, which is easy to handle in the daily routine of psychiatrists.

A cognitive account of belief: a tentative road map

PubMed Central

Connors, Michael H.; Halligan, Peter W.

2015-01-01

Over the past decades, delusions have become the subject of growing and productive research spanning clinical and cognitive neurosciences. Despite this, the nature of belief, which underpins the construct of delusions, has received little formal investigation. No account of delusions, however, would be complete without a cognitive level analysis of belief per se. One reason for this neglect is the assumption that, unlike more established and accessible modular psychological process (e.g., vision, audition, face-recognition, language-processing, and motor-control systems), beliefs comprise more distributed and therefore less accessible central cognitive processes. In this paper, we suggest some defining characteristics and functions of beliefs. Working back from cognitive accounts of delusions, we consider potential candidate cognitive processes that may be involved in normal belief formation. Finally, we advance a multistage account of the belief process that could provide the basis for a more comprehensive model of belief. PMID:25741291

Commentary: delusions and homicide in women--stories, old and new.

PubMed

Kelly, Brendan D

2013-01-01

It is not possible to predict homicide in an actuarial or statistical sense with any appreciable degree of accuracy. In an important and interesting study, Ferranti and colleagues highlight the centrality of religious delusions in women who kill children, consistent with the long-standing recognition that delusions are especially important in the context of violence by the mentally ill. They also note, among other findings, high rates of borderline personality disorder among female homicide offenders found not guilty by reason of insanity (60%) compared with their male counterparts (9%). As a result, the combination of religious delusions, unstable affect, access to children, and features of borderline personality disorder can usefully guide clinical decision-makers toward higher levels of treatment and follow-up, especially in women with aggressive tendencies. Despite the importance of this kind of risk stratification and treatment, however, homicide remains impossible to predict at an individual level.

Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy.

PubMed

Ward, Thomas; Garety, Philippa A

2017-09-16

The recent literature on reasoning biases in psychosis and delusions is reviewed. The state-of-the-art knowledge from systematic reviews and meta-analyses on the evidence for jumping to conclusions is briefly summarised, before a fuller discussion of the more recent empirical literature on belief flexibility as applied to delusions. The methodology and evidence in relation to studies of belief flexibility and the Bias Against Disconfirmatory Evidence (BADE) across the delusional continuum will be critically appraised, and implications drawn for improving cognitive therapy. It will be proposed that dual process models of reasoning, which Kahneman (Kahneman, 2011) popularised as 'fast and slow thinking', provide a useful theoretical framework for integrating further research and informing clinical practice. The emergence of therapies which specifically target fast and slow thinking in people with distressing delusions will be described. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

From paranoia querulans to vexatious litigants: a short study on madness between psychiatry and the law. Part 1.

PubMed

Lévy, Benjamin

2014-09-01

The first part of this two-part paper presents a comparative history of paranoia querulans, also known as litigants' delusion, in German-speaking countries and France from the nineteenth century onwards. We first focus on two classic literary works which describe litigious behaviours that were later pathologized, then give an insight into the history of Querulantenwahn (litigants' delusion), a term coined in 1857 by Johann Ludwig Casper and adopted by German-speaking psychiatrists and forensic experts. The last section is devoted to its French equivalent, the delusion of the litigious persecuted-persecutors. We show how this category, widely popular among French fin-de-siècle alienists, was replaced by another: the delusion of revendication (litigious subtype). The history of the vexatious litigants in the English-speaking world will be explored in the Part 2. © The Author(s) 2014.

Beads task vs. box task: The specificity of the jumping to conclusions bias.

PubMed

Balzan, Ryan P; Ephraums, Rachel; Delfabbro, Paul; Andreou, Christina

2017-09-01

Previous research involving the probabilistic reasoning 'beads task' has consistently demonstrated a jumping-to-conclusions (JTC) bias, where individuals with delusions make decisions based on limited evidence. However, recent studies have suggested that miscomprehension may be confounding the beads task. The current study aimed to test the conventional beads task against a conceptually simpler probabilistic reasoning "box task" METHODS: One hundred non-clinical participants completed both the beads task and the box task, and the Peters et al. Delusions Inventory (PDI) to assess for delusion-proneness. The number of 'draws to decision' was assessed for both tasks. Additionally, the total amount of on-screen evidence was manipulated for the box task, and two new box task measures were assessed (i.e., 'proportion of evidence requested' and 'deviation from optimal solution'). Despite being conceptually similar, the two tasks did not correlate, and participants requested significantly less information on the beads task relative to the box task. High-delusion-prone participants did not demonstrate hastier decisions on either task; in fact, for box task, this group was observed to be significantly more conservative than low-delusion-prone group. Neither task was incentivized; results need replication with a clinical sample. Participants, and particularly those identified as high-delusion-prone, displayed a more conservative style of responding on the novel box task, relative to the beads task. The two tasks, whilst conceptually similar, appear to be tapping different cognitive processes. The implications of these results are discussed in relation to the JTC bias and the theoretical mechanisms thought to underlie it. Copyright © 2016 Elsevier Ltd. All rights reserved.

Attentional focus moderates the relationship between attention to threat bias and delusion-like experiences in healthy adults.

PubMed

Prochwicz, K; Kłosowska, J

2017-01-01

The role of cognitive biases in delusion and delusion-like experiences has been widely investigated in recent years. However, little is known about individual differences, which may influence association between cognitive biases and formation of delusional beliefs. The aim of this study was to examine the moderating effect of self-reported attentional control on the relationship between attention to threat bias (ATB) and delusion-like experiences (DLEs) in healthy adults. Participants (n=138) completed the Davos Assessment of the Cognitive Biases Scale (DACOBS), the Attentional Control Scale (ACS) and the Peters et al. Delusions Inventory (PDI). The moderation analysis was performed to check the influence of different components of attentional control (i.e. general ability to allocate attention, focusing, shifting and divide attention) on the interplay between ATB and DLEs. The results supported the moderation model. Specifically, we found that a higher level of ability to focus attention is associated with a stronger effect of attention to threat bias on the overall frequency of DLEs. Our results indicate that ATB contributes to the number of DLEs only in individuals with high and moderate capacity to focus attention, whereas in those who scored low on the ACS focusing attention subscale, the presence of attentional bias does not influence the frequency of DLEs. Our findings show that the individual difference variable, such as ability to voluntarily focus attention, may moderate the relationship between attention to threat bias and delusion-like experiences in healthy adults. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Jumping to Conclusions, a Lack of Belief Flexibility and Delusional Conviction in Psychosis

PubMed Central

So, Suzanne H.; Freeman, Daniel; Dunn, Graham; Kapur, Shitij; Kuipers, Elizabeth; Bebbington, Paul; Fowler, David; Garety, Philippa A.

2012-01-01

Two reasoning biases, jumping to conclusions (JTC) and belief inflexibility, have been found to be associated with delusions. We examined these biases and their relationship with delusional conviction in a longitudinal cohort of people with schizophrenia-spectrum psychosis. We hypothesized that JTC, lack of belief flexibility, and delusional conviction would form distinct factors, and that JTC and lack of belief flexibility would predict less change in delusional conviction over time. Two hundred seventy-three patients with delusions were assessed over twelve months of a treatment trial (Garety et al., 2008). Forty-one percent of the sample had 100% conviction in their delusions, 50% showed a JTC bias, and 50%–75% showed a lack of belief flexibility. Delusional conviction, JTC, and belief flexibility formed distinct factors although conviction was negatively correlated with belief flexibility. Conviction declined slightly over the year in this established psychosis group, whereas the reasoning biases were stable. There was little evidence that reasoning predicted the slight decline in conviction. The degree to which people believe their delusions, their ability to think that they may be mistaken and to consider alternative explanations, and their hastiness in decision making are three distinct processes although belief flexibility and conviction are related. In this established psychosis sample, reasoning biases changed little in response to medication or psychological therapy. Required now is examination of these processes in psychosis groups where there is greater change in delusion conviction, as well as tests of the effects on delusions when these reasoning biases are specifically targeted. PMID:21910515

Self-Disturbance and the Bizarre: On Incomprehensibility in Schizophrenic Delusions.

PubMed

Sass, Louis A; Byrom, Greg

2015-01-01

The notion of 'bizarre delusion' has come into question in contemporary anglophone psychopathology. In DSM-5, it no longer serves as a special criterion for diagnosing schizophrenia nor as an exclusion criterion for delusional disorder. Empirical studies influencing this development have, however, been relatively sparse and subject to methodological criticism. Major reviews have concluded that current conceptualizations of bizarre delusions may require rethinking and refinement. Defining bizarreness entails a return to Jaspers, whose influential views on the supposed incomprehensibility of bizarre delusions and schizophrenic experience are more nuanced than is generally recognized. Jaspers insisted we must 'get behind' three 'external characteristics' (extraordinary conviction, imperviousness, impossible content) in order to acknowledge a 'primary experience traceable to the illness' in the 'delusions proper' of schizophrenia. He also denied that one could empathize with or otherwise 'understand' this basis. Here, we focus on three features of bizarre delusions that Jaspers foregrounded as illustrating schizophrenic incomprehensibility: disturbance of the cogito, certitude combined with inconsequentiality, delusional mood. We link these with the contemporary ipseity disturbance model of schizophrenia, arguing that Jaspers' examples of incomprehensibility can be understood as manifestations of the three complementary aspects of ipseity-disturbance: diminished self-presence, hyperreflexivity and disturbed grip/hold. We follow Jaspers' lead in acknowledging a distinctive strangeness that defies ready comprehension, but we challenge the absolutism of Jaspers' skepticism by offering a phenomenological account that comprehends bizarreness in two ways: rendering it psychologically understandable, and fitting the various instances of bizarreness into a comprehensive explanatory framework. © 2015 S. Karger AG, Basel.

SALMON RECOVERY: DEFENDING REALITY, DELUSIONS, AND OTHER ASSORTED TRUTHS

EPA Science Inventory

Are professional fisheries scientists collectively guilty of encouraging delusions about the possibilities for restoring wild salmon to the Pacific Northwest? Do they perpetuate the fantasy that the Pacific Northwest will (or could, absent pervasive life-style changes) support w...

[Delusional jealousy and obsessive love--causes and forms].

PubMed

Bogerts, Bernhard

2005-02-10

Obsessive love and delusional jealousy as persistent mental disorders, are well-known but rare psychiatric conditions, the prevalence of which is estimated to be less than 0.1%. Delusional jealousy should not be confused with exaggerated "pathological" jealousy, which is characterized by excessive suspicion and possessiveness on the part of individuals who, as a rule, suffer from considerably disordered self-esteem. As a paranoid development, delusional jealousy occurs in particular among male chronic alcoholics. As in all delusional disorders, trivial events are evaluated with unshakeable certainty as proof of the correctness of the delusive notion. Obsessive love is seen predominantly in women. In the differential diagnosis, other mental disorders such as schizophrenia, manic or organic brain syndrome must be excluded.

Reasoning, emotions, and delusional conviction in psychosis.

PubMed

Garety, Philippa A; Freeman, Daniel; Jolley, Suzanne; Dunn, Graham; Bebbington, Paul E; Fowler, David G; Kuipers, Elizabeth; Dudley, Robert

2005-08-01

The aim of the study was to elucidate the factors contributing to the severity and persistence of delusional conviction. One hundred participants with current delusions, recruited for a treatment trial of psychological therapy (PRP trial), were assessed at baseline on measures of reasoning, emotions, and dimensions of delusional experience. Reasoning biases (belief inflexibility, jumping to conclusions, and extreme responding) were found to be present in one half of the sample. The hypothesis was confirmed that reasoning biases would be related to delusional conviction. There was evidence that belief inflexibility mediated the relationship between jumping to conclusions and delusional conviction. Emotional states were not associated with the reasoning processes investigated. Anxiety, but not depression, made an independent contribution to delusional conviction. Copyright (c) 2005 APA, all rights reserved.

Metacognitive training for delusions (MCTd): effectiveness on data-gathering and belief flexibility in a Chinese sample

PubMed Central

So, Suzanne Ho-Wai; Chan, Arthur P.; Chong, Catherine Shiu-Yin; Wong, Melissa Hiu-Mei; Lo, William Tak-Lam; Chung, Dicky Wai-Sau; Chan, Sandra S.

2015-01-01

Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy of a four-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions (JTC) bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after 4 weeks of treatment as usual (TAU). Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. JTC and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to TAU, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. JTC bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approaches. PMID:26124726

The Fregoli delusion: a disorder of person identification and tracking.

PubMed

Langdon, Robyn; Connaughton, Emily; Coltheart, Max

2014-10-01

Fregoli delusion is the mistaken belief that some person currently present in the deluded person's environment (typically a stranger) is a familiar person in disguise. The stranger is believed to be psychologically identical to this known person (who is not present) even though the deluded person perceives the physical appearance of the stranger as being different from the known person's typical appearance. To gain a deeper understanding of this contradictory error in the normal system for tracking and identifying known persons, we conducted a detailed survey of all the Fregoli cases reported in the literature since the seminal Courbon and Fail (1927) paper. Our preliminary reading of these cases revealed a notable lack of definitional clarity. So, we first formulated a classification scheme of different person misidentification delusions so as to identify those cases that qualified as instances of Fregoli according to the above characterization: the mistaken belief that a known person is present in the environment in a different guise to his or her typical appearance. We identified 38 clear cases of this type and set out to answer a series of questions motivated by current hypotheses about the origin of the Fregoli delusion. We asked whether the patients misidentified particular strangers, made reference to the misidentified known persons using wigs or plastic surgery (or other techniques to disguise their appearance), misidentified many different strangers or only one, showed other symptoms (in particular, other misidentification delusions), and made inferences about the motives of the known persons in disguise. We conclude by discussing the implications of our findings for current hypotheses concerning the origin of the Fregoli delusion. Copyright © 2014 Cognitive Science Society, Inc.

REALITY, DELUSIONS, AND OTHER ASSORTED TRUTHS: THE FUTURE OF SALMON IN THE PACIFIC NORTHWEST

EPA Science Inventory

Are professional fisheries scientists collectively guilty of encouraging delusions about the possibilities for restoring wild salmon to the Pacific Northwest? Do they perpetuate the fantasy that the Pacific Northwest will (or could, absent pervasive life-style changes) support w...

Cotard's delusion or syndrome?: a conceptual history.

PubMed

Berrios, G E; Luque, R

1995-01-01

This report offers an account of the historical construction of Cotard's syndrome showing that by délire des négations the French author meant a subtype of depressive illness. Subsequent debate led first to the belief that it was just a collection of symptoms associated with agitated depression (anxious melancholia) or general paralysis, and later to the view that it might after all constitute a separate entity. At the present moment, and impervious to the fact that the French term délire means far more than "delusion," some authors use Cotard's syndrome to refer to the belief of being dead and suggest that such a delusion might have a specific brain location. From the clinical and evolutionary perspective, it is unclear why a delusion should merit, simply because of its "nihilistic" content, a special brain location or presage chronicity. It is suggested here that before neurobiologic speculation starts, efforts should be made to map out the clinical features and correlations of the délire des négations.

Is semantic fluency differentially impaired in schizophrenic patients with delusions?

PubMed

Rossell, S L; Rabe-Hesketh, S S; Shapleske, J S; David, A S

1999-10-01

The study of cognitive deficits in schizophrenia has recently focused upon semantics: the study of meaning. Delusions are a plausible manifestation of abnormal semantics because by definition they involve changes in personal meaning and belief. A symptom-based approach was used to investigate semantic and phonological fluency in a group of schizophrenic patients subdivided into those with delusions and those with no current delusions. The results demonstrated that deluded patients only were differentially impaired on a test of semantic fluency in comparison to phonological fluency. All subjects showed the same decline in performance over the time course of both tests indicating that retrieval speed in schizophrenia is no different from that of normal controls. Further analysis of word associations in two semantic categories (animals and body parts), revealed that deluded subjects have a more idiosyncratic organisation for animals. The findings of reduced semantic fluency production and poor logical word associations may represent a disorganised storage of semantic information in deluded patients, which in turn affects efficient access.

Delusions and the Right Hemisphere: A Review of the Case for the Right Hemisphere as a Mediator of Reality-Based Belief.

PubMed

Gurin, Lindsey; Blum, Sonja

2017-01-01

Delusions are beliefs that remain fixed despite evidence that they are incorrect. Although the precise neural mechanism of delusional belief remains to be elucidated, there is a predominance of right-hemisphere lesions among patients with delusional syndromes accompanied by structural pathology, suggesting that right-hemisphere lesions, or networks with key nodes in the right hemisphere, may be playing a role. The authors discuss the potential theoretical basis and empiric support for a specific right-hemisphere role in delusion production, drawing on its roles in pragmatic communication; perceptual integration; attentional surveillance and anomaly/novelty detection; and belief updating.

Jumping to conclusions and delusions: the impact of discussion of the bias on the bias.

PubMed

Warman, Debbie M; Martin, Joel M; Lysaker, Paul

2013-11-01

The present study was an investigation of the impact a brief intervention designed to raise awareness of a cognitive bias known to be robust for individuals with delusions has on the reasoning strategies of individuals with delusions. Individuals with delusions (n=57) were randomly assigned either to receive or not to receive a discussion of the jumping to conclusions bias and its pitfalls. Participants' performance on 3 reasoning trials - 1 emotionally neutral (beads) and 2 emotionally salient (self-referred survey words) - was then assessed; the number of stimuli participants requested before making a decision was evaluated to determine if the Jumping to Conclusions Discussion resulted in increased data gathering. There was no difference between groups (those who received and those who did not receive the Jumping to Conclusions Discussion) in terms of how many beads they gathered (p=.36), but there were significant differences on both reasoning trials of emotionally salient stimuli (p's<.05), such that participants who received the Jumping to Conclusions Discussion requested more stimuli on those tasks than individuals who did not receive the discussion. Thus, results suggest that discussion of the jumping to conclusions bias may impact the bias directly, at least for material that is emotional in nature. Results are discussed in terms of their relevance to cognitive behavioral therapies for psychosis and existing research on reasoning and delusions. © 2013.

Studying and Treating Schizophrenia Using Virtual Reality: A New Paradigm

PubMed Central

Freeman, Daniel

2008-01-01

Understanding schizophrenia requires consideration of patients’ interactions in the social world. Misinterpretation of other peoples’ behavior is a key feature of persecutory ideation. The occurrence and intensity of hallucinations is affected by the social context. Negative symptoms such as anhedonia, asociality, and blunted affect reflect difficulties in social interactions. Withdrawal and avoidance of other people is frequent in schizophrenia, leading to isolation and rumination. The use of virtual reality (VR)—interactive immersive computer environments—allows one of the key variables in understanding psychosis, social environments, to be controlled, providing exciting applications to research and treatment. Seven applications of virtual social environments to schizophrenia are set out: symptom assessment, identification of symptom markers, establishment of predictive factors, tests of putative causal factors, investigation of the differential prediction of symptoms, determination of toxic elements in the environment, and development of treatment. The initial VR studies of persecutory ideation, which illustrate the ascription of personalities and mental states to virtual people, are highlighted. VR, suitably applied, holds great promise in furthering the understanding and treatment of psychosis. PMID:18375568

Delusion of inanimate doubles: description of a case of focal retrograde amnesia.

PubMed

Abbate, Carlo; Trimarchi, Pietro Davide; Salvi, Gian Pietro; Quarenghi, Anna Maria; Vergani, Carlo; Luzzatti, Claudio

2012-01-01

This paper reports the case of a patient, M.P., who developed delusion of inanimate doubles, without Capgras syndrome, after traumatic brain injury. His delusional symptoms were studied longitudinally and the cognitive impairments associated with delusion were investigated. Data suggest that M.P. did 'perceive' the actual differences between doubles and originals rather than 'confabulate' them. The cognitive profile, characterized by retrograde episodic amnesia, but neither object processing impairment nor confabulations, supports this hypothesis. The study examines the nature of object misidentification based on Ellis' and Staton's account and proposes a new account based on concurrent unbiased retrieval of semantic memory traces and biased recollection of episodic memory traces.

[Neuropsychological approach to elucidating delusion and psychotic symptoms].

PubMed

Kato, Motoichiro

2012-01-01

Neuropsychological symptom-oriented approach is a critical method to elucidate delusion and psychotic symptoms in patients with focal brain damages and schizophrenia. In Capgras delusion (CD), the delusional misidentification of familiar people disguised as others, the patients with right amygdala damage and bilateral ventromedial prefrontal lesions have a deficient or reduced emotional valence of the person with intact configurational processes of the face. Reduplicative paramnesia (RP) is a specific phenomenon characterized by subjective certainty that a familiar place or person has been duplicated. Clinical evidences indicated that the patient with RP following right prefrontal damages showed the lack of emotional valence for the present hospital. This abnormal sense of familiarity triggered the deficits of the orientation of self to the outside world, that is, double orientation, resulting in the development of geographical reduplicative paramnesia. In line with the pathogenesis of CD and RP after brain damages, the delusion in schizophrenia may have a germ as developmental origins, which include the aberrant or salient perceptual experiences and abnormal sense of agency, and might be further aggravated by the impairment of causal reasoning process such as the jumping-to-conclusions bias.

Perception of self and other in psychosis: a method for analyzing the structure of the phenomenology

PubMed Central

Dean, Claire; Elvevåg, Brita; Storms, Gert; Diaz-Asper, Catherine

2009-01-01

Introduction Although the phenomenology accompanying psychoses is fascinating, hitherto empirical examinations have been qualitative and thus limited in their clinical conclusions regarding the actual underlying cognitive mechanisms responsible for the formation and maintenance of the delusion, which is often distressing to the patient. Methods We investigated the internal cognitive structure (i.e., connections) of some delusions pertaining to self and others in a patient with psychosis who was very fluent and thus able to provide a lucid account of his phenomenological experiences. To this end we employed a clustering method (HICLAS disjunctive model) in conjunction with standard neuropsychological tests. Results A well-fitting, but parsimonious solution revealed the absence of unique feature sets associated with certain persons, findings that provide a compelling case underlying the confusion in certain instances between real and delusional people. Conclusions We illustrate the methodology in one patient and suggest that it is sensitive enough to explore the structure of delusions, which in conjunction with standard neuropsychological and clinical assessments promises to be useful in uncovering the mechanisms underlying delusions in psychosis. PMID:19900718

Analytic cognitive style predicts paranormal explanations of anomalous experiences but not the experiences themselves: Implications for cognitive theories of delusions.

PubMed

Ross, Robert M; Hartig, Bjoern; McKay, Ryan

2017-09-01

It has been proposed that delusional beliefs are attempts to explain anomalous experiences. Why, then, do anomalous experiences induce delusions in some people but not in others? One possibility is that people with delusions have reasoning biases that result in them failing to reject implausible candidate explanations for anomalous experiences. We examine this hypothesis by studying paranormal interpretations of anomalous experiences. We examined whether analytic cognitive style (i.e. the willingness or disposition to critically evaluate outputs from intuitive processing and engage in effortful analytic processing) predicted anomalous experiences and paranormal explanations for these experiences after controlling for demographic variables and cognitive ability. Analytic cognitive style predicted paranormal explanations for anomalous experiences, but not the anomalous experiences themselves. We did not study clinical delusions. Our attempts to control for cognitive ability may have been inadequate. Our sample was predominantly students. Limited analytic cognitive style might contribute to the interpretation of anomalous experiences in terms of delusional beliefs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Religiosity and religious delusions in schizophrenia - An observational study in a Hindu population.

PubMed

Mishra, Anand; Das, Basudeb; Goyal, Nishant

2018-02-01

Religion exerts a significant effect on the lives of many individuals including people with mental illness. As evidences keep accumulating, role of religion in mental illness is gaining importance. The study was designed to study the effects of religiosity on religious delusions, its presentation, acute course and outcome in schizophrenia. The study was a naturalistic observational study. Subjects with schizophrenia were grouped into those with religious (RG) and with non-religious delusions (NG). Their premorbid religiosity was assessed with Brief Multi-dimensional measurement of Religiosity/spirituality (BMMRS) and were rated on Scale for Assessment of Positive Symptoms (SAPS), Brown's Assessment of Belief Scale (BABS) and Positive and Negative Symptom Scale (PANSS) at baseline and 4 weeks. Scores on private religious practices, baseline scores of SAPS, BABS & PANSS and duration of untreated psychosis (DUP) were significantly higher for RG in comparison to NG. On component analysis, higher scores were seen on private praying, watching religious programs on TV, reading religious books and prayers at meals. But no significant correlation was found between the private religious practices and the baseline scores of (DUP), SAPS, BABS, PANSS and outcome measure. Also no significant difference was noted in measures of improvement between groups. Private religious practices are more prominent in patients of schizophrenia with religious delusions and this group of patient seems to present with a more severe illness, and a longer duration of untreated psychosis in comparison to those with non-religious delusions. Copyright © 2017 Elsevier B.V. All rights reserved.

Reasoning heuristics across the psychosis continuum: the contribution of hypersalient evidence-hypothesis matches.

PubMed

Balzan, Ryan; Delfabbro, Paul; Galletly, Cherrie; Woodward, Todd

2012-01-01

Hypersalience of evidence-hypothesis matches has recently been proposed as the cognitive mechanism responsible for the cognitive biases which, in turn, may contribute to the formation and maintenance of delusions. However, the construct lacks empirical support. The current paper investigates the possibility that individuals with delusions are hypersalient to evidence-hypothesis matches using a series of cognitive tasks designed to elicit the representativeness and availability reasoning heuristics. It was hypothesised that hypersalience of evidence-hypothesis matches may increase a person's propensity to rely on judgements of representativeness (i.e., when the probability of an outcome is based on its similarity with its parent population) and availability (i.e., estimates of frequency based on the ease with which relevant events come to mind). A total of 75 participants (25 diagnosed with schizophrenia with a history of delusions; 25 nonclinical delusion-prone; 25 nondelusion-prone controls) completed four heuristics tasks based on the original Tversky and Kahnemann experiments. These included two representativeness tasks ("coin-toss" random sequence task; "lawyer-engineer" base-rates task) and two availability tasks ("famous-names" and "letter-frequency" tasks). The results across these four heuristics tasks showed that participants with schizophrenia were more susceptible than nonclinical groups to both the representativeness and availability reasoning heuristics. These results suggest that delusional ideation is linked to a hypersalience of evidence-hypothesis matches. The theoretical implications of this cognitive mechanism on the formation and maintenance of delusions are discussed.

Frontal responses during learning predict vulnerability to the psychotogenic effects of ketamine: linking cognition, brain activity, and psychosis.

PubMed

Corlett, Philip R; Honey, Garry D; Aitken, Michael R F; Dickinson, Anthony; Shanks, David R; Absalom, Anthony R; Lee, Michael; Pomarol-Clotet, Edith; Murray, Graham K; McKenna, Peter J; Robbins, Trevor W; Bullmore, Edward T; Fletcher, Paul C

2006-06-01

Establishing a neurobiological account of delusion formation that links cognitive processes, brain activity, and symptoms is important to furthering our understanding of psychosis. To explore a theoretical model of delusion formation that implicates prediction error-dependent associative learning processes in a pharmacological functional magnetic resonance imaging study using the psychotomimetic drug ketamine. Within-subject, randomized, placebo-controlled study. Hospital-based clinical research facility, Addenbrooke's Hospital, Cambridge, England. The work was completed within the Wellcome Trust and Medical Research Council Behavioral and Clinical Neuroscience Institute, Cambridge. Fifteen healthy, right-handed volunteers (8 of whom were male) with a mean +/- SD age of 29 +/- 7 years and a mean +/- SD predicted full-scale IQ of 113 +/- 4 were recruited from within the local community by advertisement. Subjects were given low-dose ketamine (100 ng/mL of plasma) or placebo while performing a causal associative learning task during functional magnetic resonance imaging. In a separate session outside the scanner, the dose was increased (to 200 ng/mL of plasma) and subjects underwent a structured clinical interview. Brain activation, blood plasma levels of ketamine, and scores from psychiatric ratings scales (Brief Psychiatric Ratings Scale, Present State Examination, and Clinician-Administered Dissociative States Scale). Low-dose ketamine perturbs error-dependent learning activity in the right frontal cortex (P = .03). High-dose ketamine produces perceptual aberrations (P = .01) and delusion-like beliefs (P = .007). Critically, subjects showing the highest degree of frontal activation with placebo show the greatest occurrence of drug-induced perceptual aberrations (P = .03) and ideas or delusions of reference (P = .04). These findings relate aberrant prediction error-dependent associative learning to referential ideas and delusions via a perturbation of frontal cortical function. They are consistent with a model of delusion formation positing disruptions in error-dependent learning.

The "doses" of initial, untreated hallucinations and delusions: a proof-of-concept study of enhanced predictors of first-episode symptomatology and functioning relative to duration of untreated psychosis.

PubMed

Compton, Michael T; Gordon, Tynessa L; Weiss, Paul S; Walker, Elaine F

2011-11-01

A prominent limitation of literature on duration of untreated psychosis (DUP) is that researchers have studied only unidimensional duration as an early-course predictor, neglecting potential effects of frequency/severity of initial, untreated psychosis. This study demonstrates utility of the concept of "doses" of initial, untreated hallucinations and delusions-representing more complete measures of "exposure"-as enhanced predictors of symptomatology/functioning relative to DUP alone. 109 first-episode patients with a psychotic disorder based on Structured Clinical Interview for DSM-IV Axis I Disorders criteria were assessed at 3 public-sector psychiatric units serving an urban, socially disadvantaged, predominantly African American community between July 2004 and June 2008. Dependent variables included negative symptoms, general psychopathology, insight, and global functioning at initial hospitalization. When added to a baseline model (age, gender, and premorbid academic and social functioning), DUP predicted current negative symptoms (P = .02, model R(2) = 0.20), though dose of hallucinations and dose of delusions did not. However, regarding general psychopathology symptoms, DUP was not predictive, though dose of delusions was, when controlling for the other 5 variables (P = .02, model R(2) = 0.15). DUP was not a significant predictor of insight, though dose of hallucinations was, such that a greater dose of initial, untreated hallucinations was associated with better insight at initial hospitalization (P < .01, model R(2) = 0.20). DUP was associated with global functioning (P = .05), and dose of delusions added significantly to this prediction (P = .04; model R(2) = 0.13). Doses of initial, untreated hallucinations and delusions add substantively, though differentially, to the prediction of early-course symptomatology and functioning. Findings suggest a need for focused research on frequency/severity of pretreatment psychotic symptoms beyond duration measures. © Copyright 2011 Physicians Postgraduate Press, Inc.

Capgras syndrome related to diazepam treatment.

PubMed

Stewart, Jonathan T

2004-01-01

Capgras syndrome, the delusion that identical-appearing impostors have replaced familiar people, is an unusual phenomenon usually seen in schizophrenia or dementia. We recently cared for a 78 year old man who seemed to develop Capgras syndrome as an adverse reaction to diazepam. An iatrogenic cause should be considered in the differential diagnosis of any new delusion, including Capgras syndrome.

Long lasting effects of chronic heavy cannabis abuse.

PubMed

Nestoros, Joannis N; Vakonaki, Elena; Tzatzarakis, Manolis N; Alegakis, Athanasios; Skondras, Markos D; Tsatsakis, Aristidis M

2017-06-01

The purpose of this study was to evaluate the extent of short-term memory impairment and schizophrenia-like symptoms in heavy and systematic cannabis users and the association between the severity of abuse and the longevity of its persistent symptoms after refraining from such use. A complete psychiatric examination and a psychometric evaluation were performed in 48 solely cannabis users. Additionally, head hair samples were analyzed and the detected cannabinoids levels were correlated with the psychometric findings. A total of 33.3% (n = 16) of the total examined cannabis users were currently imprisoned. The years of abuse ranged from 1 to 35 years and the median daily dose was 5.84.4 gr and 4.84.0 gr for prisoners (n = 16) and non prisoners (n = 32), respectively. A total of 39.6% of the users experienced hallucinations (mostly auditory), 54.2% experienced delusions (mostly ideas of reference and persecution), 85.4% had organic brain dysfunction in a test addressing visual-motor functioning and visual perception skills, and all users (100%) were found to have organic brain dysfunction in a test of visual memory immediate recall. The cannabinoid metabolite levels in the hair samples were consistent with the reported history of substance abuse and total grams of consumption for the participants below 35 years old (p < .001). Statistically elevated cannabinoids levels were observed in users with auditory hallucinations compared to users without any hallucinations (p = .019). The existence of hallucinations, delusions, and organic brain dysfunction in heavy cannabis users seems to be associated with cannabinoid levels in hair. The continuation of persistent symptoms 3 months after the discontinuation of cannabis abuse, was a remarkable finding. We provide evidence that chronic and heavy cannabis abuse results in long-lasting brain dysfunction in all users and in long-lasting schizophrenia-like psychotic symptoms in more than half of all users. These findings suggest a reevaluation of the current classification of cannabis as a "soft narcotic" which erroneously, therefore, is typically considered harmless. (Am J Addict 2017;26:335-342). © 2017 American Academy of Addiction Psychiatry.

Fronto-limbic novelty processing in acute psychosis: disrupted relationship with memory performance and potential implications for delusions

PubMed Central

Schott, Björn H.; Voss, Martin; Wagner, Benjamin; Wüstenberg, Torsten; Düzel, Emrah; Behr, Joachim

2015-01-01

Recent concepts have highlighted the role of the hippocampus and adjacent medial temporal lobe (MTL) in positive symptoms like delusions in schizophrenia. In healthy individuals, the MTL is critically involved in the detection and encoding of novel information. Here, we aimed to investigate whether dysfunctional novelty processing by the MTL might constitute a potential neural mechanism contributing to the pathophysiology of delusions, using functional magnetic resonance imaging (fMRI) in 16 unmedicated patients with paranoid schizophrenia and 20 age-matched healthy controls. All patients experienced positive symptoms at time of participation. Participants performed a visual target detection task with complex scene stimuli in which novel and familiar rare stimuli were presented randomly intermixed with a standard and a target picture. Presentation of novel relative to familiar images was associated with hippocampal activation in both patients and healthy controls, but only healthy controls showed a positive relationship between novelty-related hippocampal activation and recognition memory performance after 24 h. Patients, but not controls, showed a robust neural response in the orbitofrontal cortex (OFC) during presentation of novel stimuli. Functional connectivity analysis in the patients further revealed a novelty-related increase of functional connectivity of both the hippocampus and the OFC with the rostral anterior cingulate cortex (rACC) and the ventral striatum (VS). Notably, delusions correlated positively with the difference of the functional connectivity of the hippocampus vs. the OFC with the rACC. Taken together, our results suggest that alterations of fronto-limbic novelty processing may contribute to the pathophysiology of delusions in patients with acute psychosis. PMID:26082697

Ways of understanding of religious delusions associated with a change of identity on the example of identification with Jesus Christ.

PubMed

Dyga, Krzysztof; Stupak, Radosław

2018-02-28

Identification with Christ among psychiatric patients is an example of a complex and multifaceted phenomenon. As a delusion it includes a misidentification (change of identity) in the layer of content and, usually, grandiosity and/or paranoid traits in the formal aspect. What is more, it fits in the category of religious delusions, which are perhaps the most controversial type of delusions and as such require special sensitivity as well as knowledge beyond psychology or psychiatry. The aim of the articleis to show the phenomenon of identification with Christ among psychiatric patients, taking into account different ways of its explaining and understanding. Papers relating to the topic, both theoretical considerations and case studies, found in the EBSCO database were analyzed. Searching for the articles the following key words were used: identity, identification, delusion, Jesus/Christ/Messiah, psychosis, schizophrenia. The analysis included all (actually not numerous) articles except for the one linked to cognitive approach which did not significantly contribute to the issue. Given the multiplicity of ways of explaining and understanding the experience of identification with the figure of the Messiah, it seems to be a mistake to hold both objectivist and one-sided, based on one theory, attitude towards it. Such an experience should be recognized in the context of the history of patient's life and the all possible mechanisms leading to its occurrence, as well as the meanings hidden beneath the symptom, should be take into account. It is also important to be well-oriented in the system of religious beliefs and spiritual needs of the patient.

Religious content of hallucinations in paranoid schizophrenia.

PubMed

Krzystanek, Marek; Krysta, Krzysztof; Klasik, Adam; Krupka-Matuszczyk, Irena

2012-09-01

Different environmental factors are thought to be responsible for 15-20% of schizophrenia pathogenesis. Religion has long been considered a major force in human life, regardless of economic, social or political affiliation. How the perception of religion has changed over time, especially in the context of mental illness, was the focal point of this long-term comparative study. A random selection of 100 case histories from the years 1932, 1952, 1972 and 1992 was selected. By reviewing the subject history and medical notes, information on the presence of religious hallucinations and/or delusions were collected and grouped. Religious topics were demonstrated in 46.8% of the test population. Whereas there was a clear diversity of religious-themed delusions, "God", "Christ", "Mary", "Satan/devil" and "hell" all figured prominently across all reviewed years. There is a progressive decrease in the number of religious topics in paranoid schizophrenia. The transfer of holiness from historical saints onto a subject was observed. Evil dominates over good in productive symptoms in paranoid schizophrenia. The phenomenon of apocalyptic subjects in paranoid hallucinations and delusions increased after the Second World War. Religious topics of hallucinations and delusions change over time and relate to objective historical events and reflect changes in religiosity in society.

Mirror agnosia and the mirrored-self misidentification delusion: a hypnotic analogue.

PubMed

Connors, Michael H; Cox, Rochelle E; Barnier, Amanda J; Langdon, Robyn; Coltheart, Max

2012-05-01

Mirrored-self misidentification is the delusional belief that one's reflection in the mirror is a stranger. Current theories suggest that one pathway to the delusion is mirror agnosia (a deficit in which patients are unable to use mirror knowledge when interacting with mirrors). This study examined whether a hypnotic suggestion for mirror agnosia can recreate features of the delusion. Ten high hypnotisable participants were given either a suggestion to not understand mirrors or to see the mirror as a window. Participants were asked to look into a mirror and describe what they saw. Participants were tested on their understanding of mirrors and received a series of challenges. Participants then received a detailed postexperimental inquiry. Three of five participants given the suggestion to not understand mirrors reported seeing a stranger and maintained this belief when challenged. These participants also showed signs of mirror agnosia. No participants given the suggestion to see a window reported seeing a stranger. Results indicate that a hypnotic suggestion for mirror agnosia can be used to recreate the mirrored-self misidentification delusion. Factors influencing the effectiveness of hypnotic analogues of psychopathology, such as participants' expectations and interpretations, are discussed.

Jules Cotard (1840-1889): his life and the unique syndrome which bears his name.

PubMed

Pearn, J; Gardner-Thorpe, C

2002-05-14

Dr. Jules Cotard (1840-1889) was a Parisian neurologist who first described the délire des négations. Cotard's syndrome or Cotard's delusion comprises any one of a series of delusions ranging from the fixed and unshakable belief that one has lost organs, blood, or body parts to believing that one has lost one's soul or is dead. In its most profound form, the delusion takes the form of a professed belief that one does not exist. Encountered primarily in psychoses such as schizophrenia and bipolar disorder, Cotard's syndrome has also been described in organic lesions of the nondominant temporoparietal cortex as well as in migraine. Cotard's delusion is the only self-certifiable syndrome of delusional psychosis. Jules Cotard, a Parisian neurologist and psychiatrist and former military surgeon, was one of the first to induce cerebral atrophy by the experimental embolization of cerebral arteries in animals and a pioneer in studies of the clinicopathologic correlates of cerebral atrophy secondary to perinatal and postnatal pathologic changes. He was the first to record that unilateral cerebral atrophy in infancy does not necessarily lead to aphasia and was also the pioneer of studies of altered conscious states in diabetic hyperglycemia.

Paramnesic multiplication of autobiographical memory as a manifestation of interictal psychosis.

PubMed

Murai, Toshiya; Fukao, Kenjiro

2003-01-01

This report describes a male patient with temporal lobe epilepsy who developed a persistent paranoid-hallucinatory state at the age of 23. The essential feature of his delusion was that he had repeatedly lived part of his life, namely between the ages of 21 and 25 years. The patient repeatedly attempted suicide to escape the endless repetition. His paramnesia has some similarity with a déjà vu phenomenon, which is a common ictal manifestation of temporal lobe epilepsy. However, while only a sense of vague familiarity is evoked in a déjà vu phenomenon, conscious recollection is experienced during his paramnesia. We attempted to explain the pathophysiological mechanism of the patient's paramnesia in the framework of the current neurobiological theory of human memory. Copyright 2003 S. Karger AG, Basel

Affective Correlates of Psychosis in Parkinson's Disease.

PubMed

Factor, Stewart A; Scullin, Michael K; Freeman, Alan; Bliwise, Donald L; McDonald, William M; Goldstein, Felicia C

2017-01-01

To examine the nature of the association between affective disorders and psychosis in Parkinson's disease (PD). In PD, psychosis and affective disorders are common and independently impact quality of life and mortality. Both depression and psychosis are correlated with the occurrence of cognitive dysfunction, suggesting that they may share neurobiological substrates. Anxiety has not been examined as a correlate of psychosis. 144 PD subjects were evaluated with the Schedule for Assessment of Positive Symptoms to assess psychotic features, while depression and anxiety were examined by the Structured Clinical Interview for DSM-IV-TR (SCID) and self-assessment scales Beck Depression Inventory II (BDI-II) and Beck Anxiety Inventory (BAI). Correlational analyses assessed associations between hallucinations and delusions with depression and anxiety. A diagnosis of anxiety (SCID) was significantly (p=.015) associated with hallucinations (OR=4.81, CI=1.36-16.99). Severity of anxiety (BAI) significantly predicted (p=.03) the presence of hallucinations (OR=1.08, CI=1.01-1.15) and delusions (OR=1.09, CR=1.01-1.17). Current depression (SCID) was significantly (p=.001) associated with the presence of hallucinations (OR=6.12, CI=2.04-18.39) and delusions (OR=7.14, CI=2.23-22.93). Multiple linear regressions revealed that severity of anxiety remained an independent predictor (p<.05) of both the number of types of hallucinations (t=3.06, p=.003) and delusions (t=2.87, p=.005). Severity of depression was a significant predictor of the total number of delusions (t=2.28, p=.024). This study demonstrates an association between depression and psychosis and, for the first time, an association between anxiety and psychosis. These associations may have implications on pathophysiology and treatment of psychosis in PD.

Delusion proneness and emotion appraisal in individuals with high psychosis vulnerability.

PubMed

Szily, Erika; Kéri, Szabolcs

2013-01-01

Evidence suggests that emotional processes play an important role in the development of delusions. The aim of the present study was to investigate emotion appraisal in individuals with high and low psychosis proneness. We compared 30 individuals who experienced a transient psychotic episode followed by a complete remission with 30 healthy control volunteers. The participants received the Peters et al. Delusion Inventory (PDI) and the Scherer's Emotion Appraisal Questionnaire. We also assessed the IQ and the severity of depressive and anxiety symptoms. Results revealed that individuals with high psychosis proneness displayed increased PDI scores and more pronounced anxiety compared with individuals with low psychosis proneness. There was a specific pattern of emotion appraisal in individuals with high psychosis proneness. In the case of fear, they achieved higher scores for external causality and immorality, and lower scores for coping ability and self-esteem compared with individuals with low proneness. The PDI scores were weakly related to external causality (r = 0.41) and self-esteem (r = -0.37). In the case of sadness and joy, no emotion appraisal differences were found between participants with low and high proneness. These results suggest that individuals who had a history of psychotic breakdown and therefore exhibit high psychosis proneness display an altered appraisal of fear, emphasizing external circumstances, feeling less power to cope and experience low self-esteem. Patients remitted from a transient psychotic episode still exhibit milder forms of delusion proneness. Emotion appraisal for fear is related to delusion proneness. Clinicians should pay a special attention to self-esteem and attribution biases in psychosis-prone individuals. Copyright © 2011 John Wiley & Sons, Ltd.

Cotard's syndrome: analysis of 100 cases.

PubMed

Berrios, G E; Luque, R

1995-03-01

In 1880, Jules Cotard reported a clinical state he believed was a new type of agitated melancholia. A statistical analysis has been carried out of 100 cases of Cotard's syndrome to determine how this clinical concept has fared since its inception. In terms of clinical profile, no difference was found between men and women or between underlying diagnostic categories; age seemed to increase the likelihood of developing délire des négations. Depression was reported in 89% of subjects; the most common nihilistic delusions concerned the body (86%) and existence (69%). Anxiety (65%) and guilt (63%) were also common, followed by hypochondriacal delusions (58%) and delusions of immortality (55). An exploratory factor analysis extracted 3 factors: psychotic depression, Cotard type I and Cotard type II. The psychotic depression factor included patients with melancholia and few nihilistic delusions. Cotard type 1 patients, on the other hand, showed no loadings for depression or other disease and are likely to constitute a pure Cotard syndrome whose nosology may be closer to the delusional than the affective disorders. Type II patients showed anxiety, depression and auditory hallucinations and constitute a mixed group. This new grouping cuts across the more traditional view and may have therapeutic implications. Authors, in general, have considered délire des négations as a syndrome rather than a new disease and do not seem to support the view that the completeness of the syndrome is a function of presence or severity of depression. The view that délire des négations refers only to the delusion of being dead has also carried little favour as its likely to waste information.

Dual-stream modulation failure: a novel hypothesis for the formation and maintenance of delusions in schizophrenia.

PubMed

Speechley, William J; Ngan, Elton T C

2008-01-01

Delusions, a cardinal feature of schizophrenia, are characterized by the development and preservation of false beliefs despite reason and evidence to the contrary. A number of cognitive models have made important contributions to our understanding of delusions, though it remains unclear which core cognitive processes are malfunctioning to enable individuals with delusions to form and maintain erroneous beliefs. We propose a modified dual-stream processing model that provides a viable and testable mechanism that can account for this debilitating symptom. Dual-stream models divide decision-making into two streams: a fast, intuitive and automatic form of processing (Stream 1); and a slower, conscious and deliberative process (Stream 2). Our novel model proposes two key influences on the way these streams interact in everyday decision-making: conflict and emotion. Conflict: in most decision-making scenarios one obvious answer presents itself and the two streams converge onto the same conclusion. However, in instances where there are competing alternative possibilities, an individual often experiences dissonance, or a sense of conflict. The detection of this conflict biases processing towards the more deliberative Stream 2. Emotion: highly emotional states can result in behavior that is reflexive and action-oriented. This may be due to the power of emotionally valenced stimuli to bias reasoning towards Stream 1. We propose that in schizophrenia, an abnormal response to these two influences results in a pathological schism between Stream 1 and Stream 2, enabling erroneous intuitive explanations to coexist with contrary logical explanations of the same event. Specifically, we suggest that delusions are the result of a failure to reconcile the two streams due to both a failure of conflict to bias decision-making towards Stream 2 and an accentuated emotional bias towards Stream 1.

Strategic retrieval, confabulations, and delusions: theory and data.

PubMed

Gilboa, Asaf

2010-01-01

Based on Moscovitch and Winocur's "working with memory" framework, confabulation is described as a deficit in strategic retrieval processes. The present paper suggests that only a confluence of deficits on multiple memory-related processes leads to confabulation. These are divided into three categories. Core processes that are unique to confabulation and required for its evolution include: (1) an intuitive, rapid, preconscious "feeling of rightness" monitoring, (2) an elaborate conscious "editor" monitoring, and (3) control processes that mediate the decision whether to act upon a retrieved memory. The second category is deficits on constitutional processes which are required for confabulation to occur but are not unique to it. These include the formation of erroneous memory representation, (temporal) context confusion, and deficits in retrieval cue generation. Finally, associated Features of confabulations determine the content "flavour" and frequency of confabulation but are not required for their evolution. Some associated features are magnification of normal reconstructive memory processes such as reliance on generic/schematic representations, and positivity biases in memory, whereas others are abnormal such as perseveration or source memory deficits. Data on deficits in core processes in confabulation are presented. Next, the apparent correspondences between confabulation and delusion are discussed. Considering confabulation within a strategic memory framework may help elucidate both the commonalities and differences between the two symptoms. Delusions are affected by a convergence of abnormal perception and encoding of information, associated with aberrant cognitive schema structure and disordered belief monitoring. Whereas confabulation is primarily a disorder of retrieval, mnemonic aspects of delusions can be described as primarily a disorder of input and integration of information. It is suggested that delusions might share some of the associated features of confabulation but not its core and constitutional processes. Preliminary data in support of this view are presented.

Symptoms of Depression, Positive Symptoms of Psychosis, and Suicidal Ideation Among Adults Diagnosed With Schizophrenia Within the Clinical Antipsychotic Trials of Intervention Effectiveness.

PubMed

Bornheimer, Lindsay A; Jaccard, James

2017-01-01

Suicide is among leading causes of death for adults diagnosed with schizophrenia. While symptoms of depression are consistently supported factors involved in suicidal ideation, findings on the role of positive symptoms of psychosis have been mixed with limited understandings of risk. Accordingly, this study aimed to identify the pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), and suicidal ideation. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1,460). Suicidal ideation and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). The data were analyzed using Structural Equation Modeling (SEM). As symptoms of depression and positive symptoms of psychosis independently increased, on average there were associated increases in suicidal ideation. The present study provides support for the relationship between positive symptoms of psychosis, specifically hallucinations and delusions, and suicidal ideation. Future prospective longitudinal study designs are needed to further increase understandings of the roles that hallucinations, delusions, and additional symptoms of schizophrenia play in both suicidal ideation and attempt to ultimately inform evidence-based interventions aiming to reduce suicidal death.

Cotard Delusion in the Context of Schizophrenia: A Case Report and Review of the Literature

PubMed Central

Bott, Nicholas; Keller, Corey; Kuppuswamy, Malathy; Spelber, David; Zeier, Joshua

2016-01-01

Background: The Cotard delusion (CD) is one of a variety of narrowly defined monothematic delusions characterized by nihilistic beliefs about the body’s existence or life itself. The presence of CD within the context of schizophrenia is rare (<1%), and remains understudied. Case: ‘Mr. C’ is a 58-year-old veteran with a prior diagnosis of schizophrenia, who presented with CD in the context of significant depression, suicidal ideation, violence, and self-harm behavior. He perseverated in his belief that he was physically dead and possessed by demons for several weeks. This delusion was reinforced by his religious belief that life was an attribute of God, and by inference, he as a human, was dead. His condition gradually improved over the course of treatment with Divalproex and quetiapine with discussions about the rationale for his belief. Upon discharge, Mr. C. demonstrated awareness of his fixation on death and an ability to redirect himself. Discussion: This case highlights the need to better understand the co-occurrence of CD in schizophrenia, their differentiation, the increased risk of violence and self-harm behavior in this presentation, and how specific events and religious factors can influence delusional themes of CD. Pharmacotherapy and aspects of cognitive-behavioral therapy may be effective in ameliorating these symptoms in CD. PMID:27656159

Comparing schizophrenia symptoms in the Iban of Sarawak with other populations to elucidate clinical heterogeneity.

PubMed

McLean, Duncan; Barrett, Robert; Loa, Peter; Thara, Rangaswamy; John, Sujit; McGrath, John; Gratten, Jake; Mowry, Bryan

2015-03-01

The symptom profile of schizophrenia can vary between ethnic groups. We explored selected symptom variables previously reported to be characteristic of schizophrenia in the Iban of Sarawak in transethnic populations from Australia, India, and Sarawak, Malaysia. We tested site differences to confirm previous research, and to explore implications of differences across populations for future investigations. We recruited schizophrenia samples in Australia (n = 609), India (n = 310) and Sarawak (n = 205) primarily for the purposes of genetic studies. We analyzed seven identified variables and their relationship to site using logistic regression, including: global delusions, bizarre delusions, thought broadcast/insertion/withdrawal delusions, global hallucinations, auditory hallucinations, disorganized behavior, and prodromal duration. We identified a distinct symptom profile in our Sarawak sample. Specifically, the Iban exhibit: low frequency of thought broadcast/insertion/withdrawal delusions, high frequency of auditory hallucinations and disorganized behavior, with a comparatively short prodrome when compared with Australian and Indian populations. Understanding between-site variation in symptom profile may complement future transethnic genetic studies, and provide important clues as to the nature of differing schizophrenia expression across ethnically distinct groups. A comprehensive approach to subtyping schizophrenia is warranted, utilizing comprehensively ascertained transethnic samples to inform both schizophrenia genetics and nosology. Copyright © 2013 Wiley Publishing Asia Pty Ltd.

A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr disease.

PubMed

Shirahama, M; Akiyoshi, J; Ishitobi, Y; Tanaka, Y; Tsuru, J; Matsushita, H; Hanada, H; Kodama, K

2010-01-01

Fahr disease (FD) is a rare neurological and psychiatric disorder. The disease is classified by intracranial calcification of the basal ganglia with the globus pallidus region being particularly affected. We examined a young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible third-generation FD. Case report of third-generation FD. A 23-year-old woman was arrested for two arsons: i) The patient exhibited progressive psychotic symptoms, including visual hallucinations, delusion of injury, irritability, lability of mood, mental retardation and visual disorders and ii) Computed tomography (CT) imaging demonstrated bilateral calcifications of the basal ganglia (globus pallidus) in the patient, her mother and her grandmother. We found a family with a three-generation history of FD who exhibited calcification in the brain and mental retardation. Compared to her mother, the patient described here displayed anticipation of disease onset.

Psychosis, agnosia, and confabulation: an alternative two-factor account.

PubMed

Turner, Mark A

2014-01-01

Theories of delusions which rely on a combination of abnormal experience and defective belief evaluation and/ or cognitive bias are the subject of an emerging consensus. This paper challenges the validity of these theories and constructs a two factor alternative. The paper starts by identifying the difficulty the current theories have explaining the complex delusions of schizophrenia and then, by considering, first, the aetiology of somatopsychotic symptoms, and second, the literature on the relationship between confabulation and allopsychotic symptoms, demonstrates that the natural solution is to retain the experiential factor whilst replacing the second factor with confabulation. The paper is then able to demonstrate that the resultant two-factory theory can clarify recent work on the aetiological role of autonoetic agnosia and on the relationships between confabulation, delusion, and thought disorder. The theory supersedes currently available theories in terms of its simplicity, fruitfulness, scope and conservatism and represents an advance in the search for unified theory of psychosis.

the God Particle & the Delusion of Grandeur

NASA Astrophysics Data System (ADS)

Maksoed, Wh-

2016-11-01

It had been established that it was crystalline The inner core is isolated from the rest of earth by the low-viscosity fluid outer core, and it can rotate, nod, precess, wobble, oscillate and even flip over, being only loosely constrained by the surrounding shells- Anderson, 2002. Furthers in accordances of PMRI from Dr.Robert K. Sembiring to ASTRANOMICS, herewith Richard Dawkins: "the God delusion" - 2006 ever quotes by the Rector of the University of INDONESIA 2006 HE. Mr. Prof. Dr.derSoz Gumilar Rusliwa SOMANTRI: "Beyond 'delusion of grandeur' menuju INDONESIA baru Bebas Kemiskinan"ever retrieves Lester G. Telser- 1994: "the Usefulness of Core Theory in Economics" - "core theory furnishes a useful framework for a wide variety of economic problems. It has an undeserved reputation of being too abstract owing mainly to the manner in which it is employed in the theory of general equilibrium." Heartfelt Gratitudes to HE. Mr. Prof. Ir. Handojo.

Mental illness, violence and delusional misidentifications: the role of Capgras' syndrome in matricide.

PubMed

Carabellese, Felice; Rocca, Gabriele; Candelli, Chiara; Catanesi, Roberto

2014-01-01

Violent behavior has frequently been reported in cases of Capgras' delusion, a misidentification syndrome characterized by the false belief that imposters have replaced people familiar to the individual. To better understand the relationship between Capgras' syndrome and violence. After a brief overview of the scientific knowledge of delusional misidentification syndromes, we present two cases of psychotic sons suffering from this kind of delusion who killed their mothers and we analyzed the phenomenology of Capgras' delusion in-depth, focusing on the role of this syndrome in the etiology of violence. Capgras' syndrome may be a specific risk factor for violence towards others, particularly the murder of the delusionally misidentified person. Looking for the signs of Capgras' syndrome may be crucial to assessing the risk of violence in mentally disordered patients. Copyright © 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Severe Mental Illness, Somatic Delusions, and Attempted Mass Murder.

PubMed

Sarteschi, Christine M

2016-01-01

A case of an attempted mass shooting at a large psychiatric hospital in the United States by a 30-year-old male with severe mental illness, somatic delusions, and exceptional access to healthcare professionals is reported. Six persons were shot, one died at the scene, and the shooter was then killed by the police. Data were gathered from court documents and media accounts. An analysis of the shooter's psychiatric history, his interactions with healthcare professionals, and communications prior to the shooting suggest a rare form of mass murder, a random attack by a documented psychotic and delusional individual suffering with somatic delusions. Despite his being psychotic, the killer planned the attack and made a direct threat 1 month prior to the shootings. This case highlights problems with the healthcare system, indicating that it might be ill equipped to appropriately deal with severe mental illness. © 2015 American Academy of Forensic Sciences.

Abnormal visual scan paths: a psychophysiological marker of delusions in schizophrenia.

PubMed

Phillips, M L; David, A S

1998-02-09

The role of the visual scan path as a psychophysiological marker of visual attention has been highlighted previously (Phillips and David, 1994). We investigated information processing in schizophrenic patients with severe delusions and again when the delusions were subsiding using visual scan path measurements. We aimed to demonstrate a specific deficit in processing human faces in deluded subjects by relating this to abnormal viewing strategies. Scan paths were measured in six deluded and five non-deluded schizophrenics (matched for medication and negative symptoms), and nine age-matched normal controls. Deluded subjects had abnormal scan paths in a recognition task, fixating non-feature areas significantly more than controls, but were equally accurate. Re-testing after improvement in delusional conviction revealed fewer group differences. The results suggest state-dependent abnormal information processing in schizophrenics when deluded, with reliance on less-salient visual information for decision-making.

Left globus pallidus abnormality in never-medicated patients with schizophrenia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Early, T.S.; Reiman, E.M.; Raichle, M.E.

1987-01-01

Schizophrenia is a severe psychiatric disorder characterized by onset in young adulthood, the occurrence of hallucinations and delusions, and the development of enduring psychosocial disability. The pathophysiology of this disorder remains unknown. Studies of cerebral blood flow and metabolism designed to identify brain abnormalities in schizophrenia have been limited by inadequate methods of anatomical localization and the possibility of persistent medication effects. The authors have now used positron emission tomography and a validated method of anatomical localization in an attempt to identify abnormalities of regional cerebral blood flow in newly diagnosed never-medicated patients with schizophrenia. An exploratory study of 5more » patients and 10 normal control subjects identified abnormally high blood flow in the left globus pallidus of patients with schizophrenia. A replication study of 5 additional patients and 10 additional control subjects confirmed this finding. No other abnormalities were found.« less

Charles Bonnet Syndrome in a Patient With Right Medial Occipital Lobe Infarction: Epileptic or Deafferentation Phenomenon?

PubMed

Kumral, Emre; Uluakay, Arzu; Dönmez, İlknur

2015-07-01

Charles Bonnet syndrome (CBS) is an uncommon disorder characterized by complex and recurrent visual hallucinations in patients with visual pathway pathologic defects. To describe a patient who experienced complex visual hallucinations following infarction in the right occipital lobe and epileptic seizure who was diagnosed as having CBS. A 65-year-old man presented acute ischemic stroke caused by artery to artery embolism involving the right occipital lobe. Following ischemic stroke, complex visual hallucinations in the left visual field not associated with loss of consciousness or delusion developed in the patient. Hallucinations persisted for >1 month and during hallucination, no electrographic seizures were recorded through 24 hours of videoelectroencephalographic monitoring. CBS may develop in a patient with occipital lobe infarction following an embolic event. CBS associated with medial occipital lobe infarction and epilepsy may coexist and reflects the abnormal functioning of an integrated neuronal network.

Bayesian accounts and black swans: Questioning the erotetic theory of delusional thinking.

PubMed

McKay, Ryan

2015-01-01

Parrott and Koralus argue that a particular cognitive factor--"impaired endogenous question raising"--offers a parsimonious account of three delusion-related phenomena: (1) the development of the Capgras delusion; (2) evidence that patients with schizophrenia outperform healthy control participants on a conditional reasoning task; and (3) evidence that deluded individuals "jump to conclusions". In this response, I assess these claims, and raise my own questions about the "erotetic" theory of delusional thinking.

Aberrant functioning of the putamen links delusions, antipsychotic drug dose, and compromised connectivity in first episode psychosis--Preliminary fMRI findings.

PubMed

Raij, Tuukka T; Mäntylä, Teemu; Kieseppä, Tuula; Suvisaari, Jaana

2015-08-30

The dopamine theory proposes the relationship of delusions to aberrant signaling in striatal circuitries that can be normalized with dopamine D2 receptor-blocking drugs. Localization of such circuitries, as well as their upstream and downstream signaling, remains poorly known. We collected functional magnetic resonance images from first-episode psychosis patients and controls during an audiovisual movie. Final analyses included 20 patients and 20 controls; another sample of 10 patients and 10 controls was used to calculate a comparison signal-time course. We identified putamen circuitry in which the signal aberrance (poor correlation with the comparison signal time course) was predicted by the dopamine theory, being greater in patients than controls; correlating positively with delusion scores; and correlating negatively with antipsychotic-equivalent dosage. In Granger causality analysis, patients showed a compromised contribution of the cortical salience network to the putamen and compromised contribution of the putamen to the default mode network. Results were corrected for multiple comparisons at the cluster level with primary voxel-wise threshold p < 0.005 for the salience network contribution, but liberal primary threshold p < 0.05 was used in other group comparisons. If replicated in larger studies, these findings may help unify and extend current hypotheses on dopaminergic dysfunction, salience processing and pathogenesis of delusions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Threatening events theme of cognitive biases mediates the relationship between fear of social situations and delusion-like experiences among healthy adults.

PubMed

Prochwicz, Katarzyna; Kłosowska, Joanna; Karpowska, Milena

2017-10-01

Social anxiety (SA) is frequently observed among patients diagnosed with psychosis as well as among individuals with delusion-like experiences (DLEs). A heightened level of SA has been recognized to precede the development of psychotic symptoms; however, the detailed mechanisms that link SA to delusional ideation remain unrecognized. Since social anxiety is associated with the presence of cognitive biases and biased cognitive processes have been found to play a role in the development and maintenance of delusions, we hypothesized that cognitive biases may mediate in the relationship between social anxiety and DLEs. A total sample of 202 healthy individuals with mean age 35.59 (SD = 17.15) was assessed for the presence of delusion-like experiences, social anxiety, as well as the threatening events theme and anomalous perception theme of cognitive biases. The threatening events theme was found to fully mediate the linkage between fear of social situations and DLEs (β = 0.12, p < 0.05). The threatening events theme was also found to be a partial mediator in the association between social avoidance and DLEs (β = 0.20, p < 0.05), and between the overall level of social anxiety and DLEs (β = 0.18, p < 0.05). Our findings suggest that social anxiety may influence DLEs by providing the threatening events theme of cognitive biases. Copyright © 2017 Elsevier B.V. All rights reserved.

Using hypnosis to disrupt face processing: mirrored-self misidentification delusion and different visual media

PubMed Central

Connors, Michael H.; Barnier, Amanda J.; Coltheart, Max; Langdon, Robyn; Cox, Rochelle E.; Rivolta, Davide; Halligan, Peter W.

2014-01-01

Mirrored-self misidentification delusion is the belief that one’s reflection in the mirror is not oneself. This experiment used hypnotic suggestion to impair normal face processing in healthy participants and recreate key aspects of the delusion in the laboratory. From a pool of 439 participants, 22 high hypnotisable participants (“highs”) and 20 low hypnotisable participants were selected on the basis of their extreme scores on two separately administered measures of hypnotisability. These participants received a hypnotic induction and a suggestion for either impaired (i) self-face recognition or (ii) impaired recognition of all faces. Participants were tested on their ability to recognize themselves in a mirror and other visual media – including a photograph, live video, and handheld mirror – and their ability to recognize other people, including the experimenter and famous faces. Both suggestions produced impaired self-face recognition and recreated key aspects of the delusion in highs. However, only the suggestion for impaired other-face recognition disrupted recognition of other faces, albeit in a minority of highs. The findings confirm that hypnotic suggestion can disrupt face processing and recreate features of mirrored-self misidentification. The variability seen in participants’ responses also corresponds to the heterogeneity seen in clinical patients. An important direction for future research will be to examine sources of this variability within both clinical patients and the hypnotic model. PMID:24994973

The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression.

PubMed

Bentall, Richard P; Rowse, Georgina; Shryane, Nick; Kinderman, Peter; Howard, Robert; Blackwood, Nigel; Moore, Rosie; Corcoran, Rhiannon

2009-03-01

Paranoid delusions are a common symptom of a range of psychotic disorders. A variety of psychological mechanisms have been implicated in their cause, including a tendency to jump to conclusions, an impairment in the ability to understand the mental states of other people (theory of mind), an abnormal anticipation of threat, and an abnormal explanatory style coupled with low self-esteem. To determine the structure of the relationships among psychological mechanisms contributing to paranoia in a transdiagnostic sample. Cross-sectional design, with relationships between predictor variables and paranoia examined by structural equation models with latent variables. Publicly funded psychiatric services in London and the North West of England. One hundred seventy-three patients with schizophrenia spectrum disorders, major depression, or late-onset schizophrenia-like psychosis, subdivided according to whether they were currently experiencing paranoid delusions. Sixty-four healthy control participants matched for appropriate demographic variables were included. Assessments of theory of mind, jumping to conclusions bias, and general intellectual functioning, with measures of threat anticipation, emotion, self-esteem, and explanatory style. The best fitting (chi(2)(96) = 131.69, P = .01; comparative fit index = 0.95; Tucker-Lewis Index = 0.96; root-mean-square error of approximation = 0.04) and most parsimonious model of the data indicated that paranoid delusions are associated with a combination of pessimistic thinking style (low self-esteem, pessimistic explanatory style, and negative emotion) and impaired cognitive performance (executive functioning, tendency to jump to conclusions, and ability to reason about the mental states of others). Pessimistic thinking correlated highly with paranoia even when controlling for cognitive performance (r = 0.65, P < .001), and cognitive performance correlated with paranoia when controlling for pessimism (r = -0.34, P < .001). Both cognitive and emotion-related processes are involved in paranoid delusions. Treatment for paranoid patients should address both types of processes.

The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study.

PubMed

Oher, F J; Demjaha, A; Jackson, D; Morgan, C; Dazzan, P; Morgan, K; Boydell, J; Doody, G A; Murray, R M; Bentall, R P; Jones, P B; Kirkbride, J B

2014-08-01

The extent to which different symptom dimensions vary according to epidemiological factors associated with categorical definitions of first-episode psychosis (FEP) is unknown. We hypothesized that positive psychotic symptoms, including paranoid delusions and depressive symptoms, would be more prominent in more urban environments. We collected clinical and epidemiological data on 469 people with FEP (ICD-10 F10-F33) in two centres of the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study: Southeast London and Nottinghamshire. We used multilevel regression models to examine neighbourhood-level and between-centre differences in five symptom dimensions (reality distortion, negative symptoms, manic symptoms, depressive symptoms and disorganization) underpinning Schedules for Clinical Assessment in Neuropsychiatry (SCAN) Item Group Checklist (IGC) symptoms. Delusions of persecution and reference, along with other individual IGC symptoms, were inspected for area-level variation. Reality distortion [estimated effect size (EES) 0.15, 95% confidence interval (CI) 0.06-0.24] and depressive symptoms (EES 0.21, 95% CI 0.07-0.34) were elevated in people with FEP living in more urban Southeast London but disorganized symptomatology was lower (EES -0.06, 95% CI -0.10 to -0.02), after controlling for confounders. Delusions of persecution were not associated with increased neighbourhood population density [adjusted odds ratio (aOR) 1.01, 95% CI 0.83-1.23], although an effect was observed for delusions of reference (aOR 1.41, 95% CI 1.12-1.77). Hallucinatory symptoms showed consistent elevation in more densely populated neighbourhoods (aOR 1.32, 95% CI 1.09-1.61). In people experiencing FEP, elevated levels of reality distortion and depressive symptoms were observed in more urban, densely populated neighbourhoods. No clear association was observed for paranoid delusions; hallucinations were consistently associated with increased population density. These results suggest that urban environments may affect the syndromal presentation of psychotic disorders.

["Junk-food"-intervention in poisoning delusion].

PubMed

Schwerthöffer, Dirk; Bäuml, Josef

2007-11-01

Case report about a 29-year old US-American patient who suddenly flew to Germany due to a schizoaffektive disorder. During a stay in our psychiatric hospital she refused food, liquid and medication because of fear of being poisoned. After four days her general condition had worsened rapidly so that parenteral nutrition was discussed. Surprisingly her poisoning delusion could be overcome by offering American "Junk-Food". From this moment on compliance in taking of medication improved too, so that renormalisation of her condition was achieved.

Delusions of parasitosis.

PubMed

Wong, Jillian W; Koo, John Ym

2013-01-01

Patients with delusions of parasitosis (DOP) are more commonly recognized in dermatology practices today. However, dermatologists may feel uncomfortable treating these patients because of the psychiatric nature of their disorder. As a result of the fact that DOP patients strongly prefer to seek treatment from dermatologists rather than mental health professionals, it is important for dermatologists to be well equipped with a basic understanding of the disorder and with tools to assist this patient population. In this review, we discuss the epidemiology, presentation, differential diagnosis and treatment strategy for patients with DOP.

[Psychopathologic language. 1. The double-meaning dialogue].

PubMed

Fernandez-Zoila, A

1982-01-01

The psychopathological language is analysed in three forms about the intra-personnal and the inter-personnal relations: 1) The double without dialogue; 2) The ego in the soliloque; 3) The sex of the words. In this first part a clinical case is proposed by "The double" than by F. Dostoïevski. The most obscure part of the personality, the non-self, is the origine of a delusion. The development of delusion is favorised by a non-control of the dialogical structure of the language under social pressures.

COTARD SYNDROME IN SEMANTIC DEMENTIA

PubMed Central

Mendez, Mario F.; Ramírez-Bermúdez, Jesús

2011-01-01

Background Semantic dementia is a neurodegenerative disorder characterized by the loss of meaning of words or concepts. semantic dementia can offer potential insights into the mechanisms of content-specific delusions. Objective The authors present a rare case of semantic dementia with Cotard syndrome, a delusion characterized by nihilism or self-negation. Method The semantic deficits and other features of semantic dementia were evaluated in relation to the patient's Cotard syndrome. Results Mrs. A developed the delusional belief that she was wasting and dying. This occurred after she lost knowledge for her somatic discomforts and sensations and for the organs that were the source of these sensations. Her nihilistic beliefs appeared to emerge from her misunderstanding of her somatic sensations. Conclusion This unique patient suggests that a mechanism for Cotard syndrome is difficulty interpreting the nature and source of internal pains and sensations. We propose that loss of semantic knowledge about one's own body may lead to the delusion of nihilism or death. PMID:22054629

Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder

PubMed Central

2015-01-01

Background: Religious themes are commonly encountered in delusions and hallucinations associated with major mental disorders, and the form and content of presentation are significant in relation to both diagnosis and management. Aims: This study aimed to establish what is known about the frequency of occurrence of religious delusions (RD) and religious hallucinations (RH) and their inter-relationship. Methods: A review was undertaken of the quantitative empirical English literature on RD and RH. Results: A total of 55 relevant publications were identified. The lack of critical criteria for defining and classifying RD and RH makes comparisons between studies difficult, but prevalence clearly varies with time and place, and probably also according to personal religiosity. In particular, little is known about the content and frequency of RH and the relationship between RH and RD. Conclusion: Clearer research criteria are needed to facilitate future study of RD and RH, and more research is needed on the relationship between RD and RH. PMID:25770205

NBOMe and 2C substitute phenylethylamine exposures reported to the National Poison Data System.

PubMed

Srisuma, Sahaphume; Bronstein, Alvin C; Hoyte, Christopher O

2015-01-01

Hallucinogenic designer drugs, especially NBOMe and the 2C substitute phenylethylamine series, have been increasing ubiquitous in past years. The purpose of this study is to characterize and compare clinical features of NBOMe and 2C exposures in humans. This is a retrospective cohort study of all single agent exposures to NBOMe and 2C substitute phenylethlamine reported to the National Poison Data System (NPDS) from 1st September 2012 to 30th September 2014. Over the study period, there were a total 341 cases including 148 NBOMe exposures and 193 2C exposures. The majority cases involved men (73.9%); median age was 18 years (Interquartile-range, 16-21). Similar clinical effects were reported in both groups including tachycardia (45.2%), agitation/irritable (44.3%), hallucination/delusion (32.0%), confusion (19.1%) and hypertension (18.5%). There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe exposures (40.5%, 8.8% and 50.0%respectively) than those of 2C exposures (25.4%, 3.1%, and 32.6% respectively). There were 2.3% death; no difference between two groups. The higher rate of symptoms in NBOMe is consistent with the higher 5HT2A agonistic effects of NBOMe described in both molecular and animal studies. Common clinical effects of NBOMe and 2C exposures were tachycardia, agitation/irritable, hallucination/delusion, confusion, and hypertension. There were higher incidences of hallucination/delusion, single episode seizure and benzodiazepine administration in NBOMe.

[Analysis of the Structure of Acute Psychotic Disorder].

PubMed

Gerardo, Téllez R; Ricardo, Sánchez P; Luis, Eduardo Jaramillo

2012-03-01

Schizophrenia is a clinically heterogeneous disorder. A multifactorial structure of this syndrome has been described in previous reports. The aim of this study was to evaluate what are the possible diagnostic categories in patients having acute psychotic symptoms, studying their clinical characteristics in a cross-sectional study. An instrument for measuring psychotic symptoms was created using previous scales (SANS, SAPS, BPRS, EMUN, Zung depression scale). Using as criteria statistical indexes and redundance of items, the initial instrument having 101 items has been reduced to 57 items. 232 patients with acute psychotic symptoms, in most cases schizophrenia, attending Clínica Nuestra Señora de la Paz in Bogotá and Hospital San Juan de Dios in Chía have been evaluated from April, 2008 to December, 2009. Multivariate statistical methods have been used for analyzing data. A six-factor structure has been found (Deficit, paranoid-aggressive, disorganized, depressive, bizarre delusions, hallucinations). Cluster analysis showed eight subtypes that can be described as: 1) bizarre delusions-hallucinations; 2) deterioration and disorganized behavior; 3) deterioration; 4) deterioration and paranoid-aggressive behavior; 5) bizarre delusions; 6) paranoia-anxiety- aggressiveness; 7) depressive symptoms and bizarre delusions; 8) paranoia and aggressiveness with depressive symptoms These subtypes allow a more exhaustive characterization that those included in standard classification schemes and should be validated in longitudinal studies. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

Clinical characteristics of cough mixture abusers referred to three substance abuse clinics in Hong Kong: a retrospective study.

PubMed

Tang, A K; Tang, W K; Liang, H J; Chan, F; Mak, S C; Ungvari, G S

2012-12-01

OBJECTIVES. Cough mixture is the third most commonly abused substance in patients attending the Prince of Wales Hospital Substance Abuse Clinic. The content of the local cough mixture is not well researched. Paranoid psychosis manifesting as persecutory delusions and derogatory hallucination, as well as mood symptoms, is common in these patients. The natural history and outcome of such psychoses associated with cough mixture abuse are not well known. This study aimed to address these questions. METHODS. This was a retrospective study of cough mixture abuse in Hong Kong. Case records of cough mixture abusers currently receiving treatment at the 3 substance abuse clinics at the Prince of Wales Hospital, Alice Ho Miu Ling Nethersole Hospital, and the North District Hospital were retrieved for data collection. The patients' demographic data, duration and intake pattern of cough mixture, and use of any other drugs were documented. The presenting psychopathology, first urine toxicology results, diagnosis, treatment, number of hospitalizations, and course of the illness were also recorded. RESULTS. A total of 63 patients with the diagnosis of cough mixture abuse were identified in the database; 89% were male. The mean +/- SD age of the patients was 34.4 +/- 6.2 years; 67% were single and 83% were unemployed. The mean +/- SD age of onset of cough mixture abuse was 20 +/- 5 years. Psychiatric symptoms developed a mean +/- SD of 7.6 +/- 6.0 years after onset of abuse. According to the ICD-10 Mental and Behavioural Disorders criteria, the top psychiatric diagnoses were substance-induced psychotic disorder (67%), schizophrenia (19%), depressive disorder (11%), and dysthymia (10%). The most common ingredients in the urine sample at first presentation were promethazine (75%), pseudoephedrine (67%), codeine (60%), ephedrine (57%), zopiclone (17%), and hydrocodone (16%). Additionally, 16% of patients were in the priority follow-up group. The mean +/- SD follow-up period was 6.2 +/- 7.1 years during which there were 3.2 +/- 3.7 episodes of hospitalizations, with a mean +/- SD length of stay in each admission of 25.0 +/- 40.9 days. CONCLUSIONS. Promethazine, ephedrine, pseudoephedrine, codeine, and hydrocodone are the most common ingredients of cough mixture abused in this locality. Psychotic disorders are the most frequent psychiatric diagnosis associated with cough mixture abuse.

New findings in delusions of parasitosis.

PubMed

Fellner, Michael J

2012-01-01

Two new cases are presented with delusions of parasitosis. Both were women, one middle-aged and one elderly, and exhibited classic symptoms of parasites and "strings" in the skin indicative of Morgellons disease. Each had an additional psychiatric disorder: drug addiction to cocaine and senile dementia. They also illustrate the difficulty encountered by the dermatologist in providing adequate therapy because of resistance to psychiatric referral as well as to standard accepted medication. Newer psychotropics, such as risperdal and lexapro, show promise in helping these patients and add to the therapeutic armamentarium of pimozide.

Treating Sleep Problems in Patients with Schizophrenia.

PubMed

Waite, Felicity; Myers, Elissa; Harvey, Allison G; Espie, Colin A; Startup, Helen; Sheaves, Bryony; Freeman, Daniel

2016-05-01

Sleep disturbance is increasingly recognized as a major problem for patients with schizophrenia but it is rarely the direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy, which we have been evaluating for patients with current delusions and hallucinations in the context of non-affective psychosis. In this article we describe the lessons we have learned about clinical presentations of sleep problems in schizophrenia and the adaptations to intervention that we recommend for patients with current delusions and hallucinations. Twelve factors that may particularly contribute to sleep problems in schizophrenia are identified. These include delusions and hallucinations interfering with sleep, attempts to use sleep as an escape from voices, circadian rhythm disruption, insufficient daytime activity, and fear of the bed, based upon past adverse experiences. Specific adaptations for psychological treatment related to each factor are described. Our experience is that patients want help to improve their sleep; sleep problems in schizophrenia should be treated with evidence-based interventions, and that the interventions may have the added benefit of lessening the psychotic experiences. A treatment technique hierarchy is proposed for ease of translation to clinical practice.

Gray matter atrophy in patients with mild cognitive impairment/Alzheimer's disease over the course of developing delusions.

PubMed

Fischer, Corinne E; Ting, Windsor Kwan-Chun; Millikin, Colleen P; Ismail, Zahinoor; Schweizer, Tom A

2016-01-01

We conducted a neuroimaging analysis to understand the neuroanatomical correlates of gray matter loss in a group of mild cognitive impairment and early Alzheimer's disease patients who developed delusions. With data collected as part of the Alzheimer's Disease Neuroimaging Initiative, we conducted voxel-based morphometry to determine areas of gray matter change in the same Alzheimer's Disease Neuroimaging Initiative participants, before and after they developed delusions. We identified 14 voxel clusters with significant gray matter decrease in patient scans post-delusional onset, correcting for multiple comparisons (false discovery rate, p < 0.05). Major areas of difference included the right and left insulae, left precuneus, the right and left cerebellar culmen, the left superior temporal gyrus, the right posterior cingulate, the right thalamus, and the left parahippocampal gyrus. Although contrary to our initial predictions of enhanced right frontal atrophy, our preliminary work identifies several neuroanatomical areas, including the cerebellum and left posterior hemisphere, which may be involved in delusional development in these patients. Copyright © 2015 John Wiley & Sons, Ltd.

[Depression in the elderly. Clinical aspects].

PubMed

Barbier, D

2001-02-24

DIFFICULT DIAGNOSIS: Depression in the elderly can take on many often misleading aspects. Sadness may be considered legitimate or "normal" for an elderly person. Depression may masquerade as an organic disorder where somatic complaints, pain and anxiety predominate. All these different clinical forms may mislead the clinician. THE MASK OF HYPOCHONDRIA: A tendency to hypochondria, found in more than one-half of all depressed elderly subjects, may be reinforced by bouts of complementary examinations. The patient is convinced of having an unrecognized organic disease. The mask of hypochondria must be considered with special care because it is a major risk factor for attempted and successful suicide. THE MASK OF DELUSIONS: Elderly patients often develop a state of melancolia-like depression with delusions. Delusions may be congruent with the predominant depressed mood, for example a guilt feeling for an act never committed, or inversely, non-congruent with the thymic state (persecution, negation delusin), for example Cotard syndrome where the patient is persuaded that his/her organs are malfunctioning or have disappeared. Despite these impressive mood disorders that often incite prescription of a neuroleptic, these elderly patients respond favorably to antidepressor treatment.

How psychotic-like are paranormal beliefs?

PubMed

Cella, Matteo; Vellante, Marcello; Preti, Antonio

2012-09-01

Paranormal beliefs and Psychotic-like Experiences (PLE) are phenotypically similar and can occur in individuals with psychosis but also in the general population; however the relationship of these experiences for psychosis risk is largely unclear. This study investigates the association of PLE and paranormal beliefs with psychological distress. Five hundred and three young adults completed measures of paranormal beliefs (Beliefs in the Paranormal Scale), psychological distress (General Health Questionnaire), delusion (Peters et al. Delusions Inventory), and hallucination (Launay-Slade Hallucination Scale) proneness. The frequency and intensity of PLE was higher in believers in the paranormal compared to non-believers, however psychological distress levels were comparable. Regression findings confirmed that paranormal beliefs were predicted by delusion and hallucination-proneness but not psychological distress. The use of a cross-sectional design in a specific young adult population makes the findings exploratory and in need of replication with longitudinal studies. The predictive value of paranormal beliefs and experiences for psychosis may be limited; appraisal or the belief emotional salience rather than the belief per se may be more relevant risk factors to predict psychotic risk. Copyright © 2012 Elsevier Ltd. All rights reserved.

DSM-IV "criterion A" schizophrenia symptoms across ethnically different populations: evidence for differing psychotic symptom content or structural organization?

PubMed

McLean, Duncan; Thara, Rangaswamy; John, Sujit; Barrett, Robert; Loa, Peter; McGrath, John; Mowry, Bryan

2014-09-01

There is significant variation in the expression of schizophrenia across ethnically different populations, and the optimal structural and diagnostic representation of schizophrenia are contested. We contrasted both lifetime frequencies of DSM-IV criterion A (the core symptom criterion of the internationally recognized DSM classification system) symptoms and types/content of delusions and hallucinations in transethnic schizophrenia populations from Australia (n = 776), India (n = 504) and Sarawak, Malaysia (n = 259), to elucidate clinical heterogeneity. Differences in both criterion A symptom composition and symptom content were apparent. Indian individuals with schizophrenia reported negative symptoms more frequently than other sites, whereas individuals from Sarawak reported disorganized symptoms more frequently. Delusions of control and thought broadcast, insertion, or withdrawal were less frequent in Sarawak than Australia. Curiously, a subgroup of 20 Indian individuals with schizophrenia reported no lifetime delusions or hallucinations. These findings potentially challenge the long-held view in psychiatry that schizophrenia is fundamentally similar across cultural groups, with differences in only the content of psychotic symptoms, but equivalence in structural form.

Visual scan paths are abnormal in deluded schizophrenics.

PubMed

Phillips, M L; David, A S

1997-01-01

One explanation for delusion formation is that they result from distorted appreciation of complex stimuli. The study investigated delusions in schizophrenia using a physiological marker of visual attention and information processing, the visual scan path-a map tracing the direction and duration of gaze when an individual views a stimulus. The aim was to demonstrate the presence of a specific deficit in processing meaningful stimuli (e.g. human faces) in deluded schizophrenics (DS) by relating this to abnormal viewing strategies. Visual scan paths were measured in acutely-deluded (n = 7) and non-deluded (n = 7) schizophrenics matched for medication, illness duration and negative symptoms, plus 10 age-matched normal controls. DS employed abnormal strategies for viewing single faces and face pairs in a recognition task, staring at fewer points and fixating non-feature areas to a significantly greater extent than both control groups (P < 0.05). The results indicate that DS direct their attention to less salient visual information when viewing faces. Future paradigms employing more complex stimuli and testing DS when less-deluded will allow further clarification of the relationship between viewing strategies and delusions.

Catatonia, Neuroleptic Malignant Syndrome, and Cotard Syndrome in a 22-Year-Old Woman: A Case Report

PubMed Central

Weiss, C.; Santander, J.; Torres, R.

2013-01-01

The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as “I do not have a heart,” “my heart is not beating,” “I can not breathe,” “I am breaking apart,” “I have no head” (ideas of negation) and statements about the patient being responsible for the “death of the whole world” (ideas of enormity). Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed. PMID:24093068

Catatonia, neuroleptic malignant syndrome, and cotard syndrome in a 22-year-old woman: a case report.

PubMed

Weiss, C; Santander, J; Torres, R

2013-01-01

The following case study describes a 22-year-old woman with depression and symptoms of psychosis who developed neuroleptic malignant syndrome after using Risperidone, thus requiring life support equipment and Bromocriptine, later recovering after seven days. From a psychiatric and neurological point of view, however, the persistence of catatonic syndrome and Cotard syndrome delusions was observed, based on assertions such as "I do not have a heart," "my heart is not beating," "I can not breathe," "I am breaking apart," "I have no head" (ideas of negation) and statements about the patient being responsible for the "death of the whole world" (ideas of enormity). Brain NMR revealed leukoencephalopathy, interpreted as scar lesions caused by perinatal neurological damage, after discarding other pathologies. The patient responded well to electroconvulsive therapy after 11 sessions. Organic vulnerability to these syndromes, as well as their coexistence and clinical differentiation is discussed in the light of the data observed.

[A case of pervasive developmental disorder with chromosomal translocation (X; 4) (p11; q13)].

PubMed

Azzoni, A; Raja, M

2006-01-01

Chromosomal aberrations, with or without congenital physical abnormalities, have been frequently found associated with neuropsychiatric disorders, including mental retardation, psychosis, autism, and criminal behaviour. The meaning of the association frequently remains unclear. However, consistent findings of association between specific chromosomal abnormalities and clinical phenotype may provide evidence of a causal relationship and shed light on the pathogenesis of obscure disorders. Here, we present the case of a 28 year-old, Caucasian male affected by pervasive developmental disorder, associated with chromosomal translocation 46, XY, t (X; 4) (p11; q13), and abnormal facial features. A few days after birth, the patient was taken away from his parents and adopted for unknown reasons. No information is available about his biological relatives. Mild delay in the development of spoken language was reported. Since early childhood, the patient's behaviour was characterized by troublesome relationship with his parents and his fellows, and persistent violation of norms and rules at home and at school. Consequently, social and school functioning was poor. When he was eight, verbal and motor stereotypy appeared for the first time. As an adolescent, he was more and more aggressive. He exhibited countless episodes of rage and verbal and physical aggressiveness. After he had completed secondary school, his way of life was chaotic. He got into the habit of staying away from home, sleeping in the day and vagabonding at night. He began to abuse alcohol. Grandiosity and persecutory delusions became evident. He claimed to hate the Vatican, the Pope, and the Polish people and to be the Devil, the Antichrist. He feared that his food was poisoned by his mother and refused to eat at home any more. He loved to remain in a cage with two wild dogs, accumulating and keeping bottles full of his urine. He often engaged in violent fights in the street with tramps and foreigners. Finally, he was involuntary admitted to a psychiatric intensive care unit. He was hostile, uncooperative, and violent. Magnetic resonance imaging of brain was normal, Wechsler Adult Intelligence Scale IQ score was 96 (total), 108 (verbal), 80 (non verbal), and Standard Progressive Matrices score was 44/60, chromosomal examination [banding R (RBG)] revealed an apparently balanced translocation 46, XY, t (X; 4) (p11; q13). The patient was treated with risperidone (8 mg/day) and valproate (1500-2000 mg/day) with improvement. Psychotic symptoms, hostility and violence vanished. Amazingly, his behaviour and attitude became normal. Very early onset of symptoms, absence of negative signs, and dysmorphic features suggesting an underlying medical disease do not support the diagnosis of schizophrenia. The diagnosis of pervasive developmental disorder, not otherwise specified, could be made, considering the delay in the development of spoken language, the large discordance between verbal and non verbal WAIS IQ score, the presence of stereotypy, abnormal facial features, and motor clumsiness. The late onset of symptoms precludes the diagnosis of autism, while the delay in language does not permit the diagnosis of Asperger's disorder. The lack of information on his biological relatives did not permit us to assess the presence of genetic, physical or mental abnormalities in his family. Therefore, the causal relationship between the chromosomal translocation and the psychiatric disorder is uncertain in this patient. Similar genetic abnormalities found in patients affected by neuropsychiatric disorders could confirm an etiological link.

[Delirium in delusions of negations of Cotard: syndrome versus disorder].

PubMed

Huertas, D; Molina, J D; Chamorro, L; Toral, J

1997-01-01

This article constitutes the first of a series directed to review fundamental disorders in clinical psychogeriatrics. This sort of publication is intended to retrieve clinical practice as the cornerstone for research and teaching in psychiatry. Besides, and particularly in geriatry, we try to expand the strategy of liaison work with primary physicians. In this case, a nosological review of the so called "delusion of negations" is presented. The Jules Cotard's original concept of subtype of delusional melancholia is contrasted to the view of numerous authors in this century who have described it as a form of non-specific delusional syndrome.

The erotic transference: dream or delusion?

PubMed

De Masi, Franco

2012-12-01

The erotic transference can be seen as the Janus face of clinical work in psychoanalysis: it may either arise out of the positive emotions necessary for the building of new shared realities, or be fueled by falsified and distorted constructions. In the former case, the erotic transference expresses the capacity to anticipate, or "dream," the emotional relationship with the object-which is why Freud valued its transformative aspect as one of the "forces impelling [the patient] to . . . make changes"-whereas in the latter it is equivalent to a flight from psychic reality and may be imperceptibly transformed into an actual delusion.

Implications for neurobiological research of cognitive models of psychosis: a theoretical paper.

PubMed

Garety, Philippa A; Bebbington, Paul; Fowler, David; Freeman, Daniel; Kuipers, Elizabeth

2007-10-01

Cognitive models of the positive symptoms of psychosis specify the cognitive, social and emotional processes hypothesized to contribute to their occurrence and persistence, and propose that vulnerable individuals make characteristic appraisals that result in specific positive symptoms. We describe cognitive models of positive psychotic symptoms and use this as the basis of discussing recent relevant empirical investigations and reviews that integrate cognitive approaches into neurobiological frameworks. Evidence increasingly supports a number of the hypotheses proposed by cognitive models. These are that: psychosis is on a continuum; specific cognitive processes are risk factors for the transition from subclinical experiences to clinical disorder; social adversity and trauma are associated with psychosis and with negative emotional processes; and these emotional processes contribute to the occurrence and persistence of psychotic symptoms. There is also evidence that reasoning biases contribute to the occurrence of delusions. The benefits of incorporating cognitive processes into neurobiological research include more sophisticated, bidirectional and interactive causal models, the amplification of phenotypes in neurobiological investigations by including emotional processes, and the adoption of more specific clinical phenotypes. For example, there is potential value in studying gene x environment x cognition/emotion interactions. Cognitive models and their derived phenotypes constitute the missing link in the chain between genetic or acquired biological vulnerability, the social environment and the expression of individual positive symptoms.

The US Food and Drug Administration's Perspective on the New Antipsychotic Pimavanserin.

PubMed

Mathis, Mitchell V; Muoio, Brendan M; Andreason, Paul; Avila, Amy M; Farchione, Tiffany; Atrakchi, Aisar; Temple, Robert J

2017-06-01

To summarize the US Food and Drug Administration's (FDA's) review of the safety and effectiveness for pimavanserin, an atypical antipsychotic, for the treatment of hallucinations and delusions associated with Parkinson's disease psychosis. We describe the regulatory and clinical issues important to the FDA's approval of this New Drug Application, with special focus on the risk-benefit balance. We also describe a new labeling feature that presents additional efficacy data to clinicians. Data sets for all relevant clinical trials of pimavanserin and the Applicant's and FDA's analyses of these data were considered in this review. Data were available from 616 patients with Parkinson's disease with hallucinations and delusions who received at least 1 dose of pimavanserin, with a total exposure of 825 patient-years in the Parkinson's disease psychosis population. Pimavanserin 34 mg/d was effective in treating hallucinations and delusions associated with Parkinson's disease. In the Applicant's single pivotal trial, 80.5% of pimavanserin patients experienced at least some improvement in symptoms compared to 58.1% of patients taking placebo. Pimavanserin did not worsen motor function, an adverse effect commonly observed with other antipsychotics, probably because of a lack of consequential dopamine binding. Pimavanserin is the only FDA-approved treatment for the hallucinations and delusions seen in patients with psychosis of Parkinson's disease. Although pimavanserin appears to have a pharmacologic mechanism that is different from other atypical antipsychotics, concern remained that the increased risk of death seen with antipsychotic use in elderly demented patients, and described in all approved antipsychotic labels, would also occur with pimavanserin. Pimavanserin bears the same boxed warning about the risk of death associated with antipsychotic use in elderly patients with dementia. © Copyright 2017 Physicians Postgraduate Press, Inc.

Culture-specific delusions. Sense and nonsense in cultural context.

PubMed

Gaines, A D

1995-06-01

It can be said that a definition of delusions requires the invocation of cultural understandings, standards of acceptability, as well as conceptions of reality and the forces that animate it. For these reasons, the determination of delusional or normative ideation can only be effected properly within particular cultural contexts. The cross-cultural record suggests that it is difficult to separate the delusional from the cultural; a belief that is patterened and culturally specific is, by definition a cultural, not a delusional belief. One must rely upon particular, relevant local cultural understandings to ascertain when the bounds of culture have been transgressed and meaning has given way to unshareable nonsense.

Law & psychiatry: Death row delusions: when is a prisoner competent to be executed?

PubMed

Appelbaum, Paul S

2007-10-01

This column examines a recent U.S. Supreme Court decision in Panetti v. Quarterman, which embraced a broader view of what makes death row prisoners incompetent to be executed. Although the defendant understood that he was to be executed and the state's purported reason for seeking his death--two criteria suggested by the Court's 1986 decision in Ford v. Wainwright--he suffered from a fixed delusion about the actual reason for his death. The Court indicated that competent prisoners must have a "rational understanding" of the reason that a death penalty is being imposed but declined to define a clear standard.

The Cotard syndrome. Report of two patients: with a review of the extended spectrum of 'délire des négations'.

PubMed

Gardner-Thorpe, C; Pearn, J

2004-08-01

The Cotard syndrome is characterized by the delusion where an individual insists that he has died or part of his body has decayed. Although described classically in schizophrenia and bipolar disorder, physical disorders including migraine, tumour and trauma have also been associated with the syndrome. Two new cases are described here, the one associated with arteriovenous malformations and the other with probable multiple sclerosis. The delusion has been embarrassing to each patient. Study of such cases may have wider implications for the understanding of the psychotic interpretation of body image, for example that occurring in anorexia nervosa.

When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard's Syndrome.

PubMed

Machado, Leonardo; Filho, Luiz Evandro de Lima; Machado, Liliane

2016-01-01

Cotard's Syndrome (CS) is a rare clinical event described for the first time in 1880 by the neurologist and psychiatrist Jules Cotard and characterized by negation delusions (or nihilists). Immortality and hypochondriac delusions are also typical. Nowadays, it is known that CS can be associated with many neuropsychiatric conditions. In this article, we describe the case of a patient that believed not having more organs and having the body deformed and whose CS was associated with a bigger depressive disorder. Although the electroconvulsive therapy is the most described treatment modality in the literature, the reported case had therapeutic success with association of imipramine and risperidone.

Jumping to the wrong conclusions? An investigation of the mechanisms of reasoning errors in delusions

PubMed Central

Jolley, Suzanne; Thompson, Claire; Hurley, James; Medin, Evelina; Butler, Lucy; Bebbington, Paul; Dunn, Graham; Freeman, Daniel; Fowler, David; Kuipers, Elizabeth; Garety, Philippa

2014-01-01

Understanding how people with delusions arrive at false conclusions is central to the refinement of cognitive behavioural interventions. Making hasty decisions based on limited data (‘jumping to conclusions’, JTC) is one potential causal mechanism, but reasoning errors may also result from other processes. In this study, we investigated the correlates of reasoning errors under differing task conditions in 204 participants with schizophrenia spectrum psychosis who completed three probabilistic reasoning tasks. Psychotic symptoms, affect, and IQ were also evaluated. We found that hasty decision makers were more likely to draw false conclusions, but only 37% of their reasoning errors were consistent with the limited data they had gathered. The remainder directly contradicted all the presented evidence. Reasoning errors showed task-dependent associations with IQ, affect, and psychotic symptoms. We conclude that limited data-gathering contributes to false conclusions but is not the only mechanism involved. Delusions may also be maintained by a tendency to disregard evidence. Low IQ and emotional biases may contribute to reasoning errors in more complex situations. Cognitive strategies to reduce reasoning errors should therefore extend beyond encouragement to gather more data, and incorporate interventions focused directly on these difficulties. PMID:24958065

Cortical Brain Changes in Patients With Locked-In Syndrome Experiencing Hallucinations and Delusions.

PubMed

Sarà, Marco; Cornia, Riccardo; Conson, Massimiliano; Carolei, Antonio; Sacco, Simona; Pistoia, Francesca

2018-01-01

Previous evidence suggests that hallucinations and delusions may be detected in patients with the most severe forms of motor disability including locked-in syndrome (LIS). However, such phenomena are rarely described in LIS and their presence may be underestimated as a result of the severe communication impairment experienced by the patients. In this study, we retrospectively reviewed the clinical history and the neuroimaging data of a cohort of patients with LIS in order to recognize the presence of hallucinations and delusions and to correlate it with the pontine damage and the presence of any cortical volumetric changes. Ten patients with LIS were included (5 men and 5 women, mean age 50.1 ± 14.6). According to the presence of indicators of symptoms, these patients were categorized as hallucinators ( n  = 5) or non-hallucinators ( n  = 5). MRI images of patients were analyzed using Freesurfer 6.0 software to evaluate volume differences between the two groups. Hallucinators showed a selective cortical volume loss involving the fusiform ( p  = 0.001) and the parahippocampal ( p  = 0.0008) gyrus and the orbital part of the inferior frontal gyrus ( p  = 0.001) in the right hemisphere together with the lingual ( p  = 0.01) and the fusiform gyrus ( p  = 0.01) in the left hemisphere. Moreover, a volumetric decrease of bilateral anterior portions of the precuneus was recognized in the hallucinators (right p  = 0.01; left p  = 0.001) as compared to non-hallucinators. We suggested that the presence of hallucinations and delusions in some LIS patients could be accounted for by the combination of a damage of the corticopontocerebellar pathways with cortical changes following the primary brainstem injury. The above areas are embedded within cortico-cortical and cortico-subcortical loops involved in self-monitoring and have been related to the presence of hallucinations in other diseases. The two main limitations of our study are the small sample of included patients and the lack of a control group of healthy individuals. Further studies would be of help to expand this field of research in order to integrate existing theories about the mechanisms underlying the generation of hallucinations and delusions in neurological patients.

Sustained and "sleeper" effects of group metacognitive training for schizophrenia: a randomized clinical trial.

PubMed

Moritz, Steffen; Veckenstedt, Ruth; Andreou, Christina; Bohn, Francesca; Hottenrott, Birgit; Leighton, Lucy; Köther, Ulf; Woodward, Todd S; Treszl, András; Menon, Mahesh; Schneider, Brooke C; Pfueller, Ute; Roesch-Ely, Daniela

2014-10-01

Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions. To examine the long-term efficacy of group MCT for schizophrenia in order to explore whether previously established effects were sustained. A 2-center, randomized, controlled, assessor-blind, parallel group trial was conducted. A total of 150 inpatients or outpatients with DSM-IV diagnoses of schizophrenia spectrum disorders were enrolled. All patients were prescribed antipsychotic medication. The second follow-up assessment took place 3 years later after the intervention phase was terminated. Group MCT targeting cognitive biases vs neuropsychological training (COGPACK). Patients received a maximum of 16 sessions. The primary outcome measure was a delusion score derived from the Positive and Negative Syndrome Scale (PANSS). The PANSS positive syndrome and total scores, the Psychotic Symptom Rating Scales, the jumping to conclusions bias, self-esteem, and quality of life served as secondary outcome measures. The intention-to-treat analyses demonstrated that patients in the MCT group had significantly greater reductions in the core PANSS delusion score, after 3 years compared with the control group (η2partial = .037; P = .05). Among the secondary outcomes, the intention-to-treat analyses also demonstrated that patients in the MCT group had significantly greater reductions in the PANSS positive syndrome score (η2partial = .055; P = .02) and the Psychotic Symptom Rating Scales delusion score (η2partial = .109; P = .001). Significant group differences at the 3-year follow-up were also found on measures of self-esteem and quality of life, which did not distinguish groups at earlier assessment points. Attention was improved in the neuropsychological training group relative to the MCT group. The completion rate was 61.3% after 3 years. Metacognitive training demonstrated sustained effects in the reduction of delusions, which were over and above the effects of antipsychotic medication. Moreover, there were some unanticipated ("sleeper") effects as both self-esteem and quality of life were improved after 3 years. Effects on self-esteem and well-being were found even in the absence of an improvement on the jumping to conclusions bias. isrctn.org Identifier: ISRCTN95205723.

Projective identification, self-disclosure, and the patient's view of the object: the need for flexibility.

PubMed

Waska, R T

1999-01-01

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful. (The Journal of Psychotherapy Practice and Research 1999; 8:225-233)

From Hallucination to Fiction: The Invention of Meaning in Psychosis.

PubMed

Lippi, Silvia; Lehaire, Célia; Petit, Laetitia

2016-12-01

Taking their inspiration from a case history, the authors explore the effects of a writing workshop led by a professional writer for patients in a psychiatric hospital. This workshop allowed different modes of transference to unfold: transference to the analyst-therapist, transference to the writer who led the workshop, and transference to the other members of the group. The writing activity created conditions in which there could be a movement from hallucination to delusion-a delusion expressed in fiction through the act of writing. Psychotic patients "invent" a writing that remains unfinished and that relates to the experiences of persecution. Writing thus makes it possible for them to tolerate language, through its transformation into writing.

When the Patient Believes That the Organs Are Destroyed: Manifestation of Cotard's Syndrome

PubMed Central

Machado, Liliane

2016-01-01

Cotard's Syndrome (CS) is a rare clinical event described for the first time in 1880 by the neurologist and psychiatrist Jules Cotard and characterized by negation delusions (or nihilists). Immortality and hypochondriac delusions are also typical. Nowadays, it is known that CS can be associated with many neuropsychiatric conditions. In this article, we describe the case of a patient that believed not having more organs and having the body deformed and whose CS was associated with a bigger depressive disorder. Although the electroconvulsive therapy is the most described treatment modality in the literature, the reported case had therapeutic success with association of imipramine and risperidone. PMID:28003827

Cycloserine Induced Late Onset Psychosis and Ethambutol Induced Peripheral Neuropathy Associated with MDR-TB Treatment in an Indian Patient- A Rare Case Report

PubMed Central

Holla, Sadhana; Bhandarypanambur, Rajeshkrishna; Kamalkishore, Meenakumari; Janardhanan, Manju

2015-01-01

Adverse reactions and toxicity inevitably accompany all treatment courses for drug-resistant TB. Our case underscores the importance of awareness regarding neuropsychiatric adverse reactions due to MDR-TB therapy and reversible nature of it. Cycloserine induced psychosis is most life threatening complication and sometimes could be fatal. A 42-year-old male on MDR-TB therapy got admitted for his persistent psychotic complaints like hallucinations, delusions and suicidal ideations, despite being treated with quetiapine/olanzapine. Eventually patient was rehabilitated, cycloserine was stopped and psychotic events regressed slowly. Other culprit drugs like ethambutol and levofloxacin causing psychosis was ruled out because there was no relapse of psychotic events despite being continued with these drugs. He also complained of tingling, numbness, swaying, pain and weakness. On examination, he had distal motor weakness in lower limbs, tandem gait positive, altered position sense, and tenderness over toes and positive Romberg’s sign with ataxia. He was diagnosed to have drug induced sensorimotor peripheral neuropathy. All these symptoms persisted after stopping cycloserine and patient continued to have neuropathy with ethambutol and ethionamide. Considering the nature of neuropathy which was mild, mixed sensorimotor and resolved completely after 2-3 weeks of stopping, it was more in favour of ethambutol. However, we could not rule out the possibility of ethionamide or (ethionamide + ethambutol) causing neuropathy or both could have accelerated the neurotoxic effects of cycloserine which remained elusive. PMID:25859468

Cycloserine Induced Late Onset Psychosis and Ethambutol Induced Peripheral Neuropathy Associated with MDR-TB Treatment in an Indian Patient- A Rare Case Report.

PubMed

Holla, Sadhana; Amberkar, Mohan Babu; Bhandarypanambur, Rajeshkrishna; Kamalkishore, Meenakumari; Janardhanan, Manju

2015-02-01

Adverse reactions and toxicity inevitably accompany all treatment courses for drug-resistant TB. Our case underscores the importance of awareness regarding neuropsychiatric adverse reactions due to MDR-TB therapy and reversible nature of it. Cycloserine induced psychosis is most life threatening complication and sometimes could be fatal. A 42-year-old male on MDR-TB therapy got admitted for his persistent psychotic complaints like hallucinations, delusions and suicidal ideations, despite being treated with quetiapine/olanzapine. Eventually patient was rehabilitated, cycloserine was stopped and psychotic events regressed slowly. Other culprit drugs like ethambutol and levofloxacin causing psychosis was ruled out because there was no relapse of psychotic events despite being continued with these drugs. He also complained of tingling, numbness, swaying, pain and weakness. On examination, he had distal motor weakness in lower limbs, tandem gait positive, altered position sense, and tenderness over toes and positive Romberg's sign with ataxia. He was diagnosed to have drug induced sensorimotor peripheral neuropathy. All these symptoms persisted after stopping cycloserine and patient continued to have neuropathy with ethambutol and ethionamide. Considering the nature of neuropathy which was mild, mixed sensorimotor and resolved completely after 2-3 weeks of stopping, it was more in favour of ethambutol. However, we could not rule out the possibility of ethionamide or (ethionamide + ethambutol) causing neuropathy or both could have accelerated the neurotoxic effects of cycloserine which remained elusive.

Are Psychotic Experiences Related to Poorer Reflective Reasoning?

PubMed Central

Mækelæ, Martin J.; Moritz, Steffen; Pfuhl, Gerit

2018-01-01

Background: Cognitive biases play an important role in the formation and maintenance of delusions. These biases are indicators of a weak reflective mind, or reduced engaging in reflective and deliberate reasoning. In three experiments, we tested whether a bias to accept non-sense statements as profound, treat metaphorical statements as literal, and suppress intuitive responses is related to psychotic-like experiences. Methods: We tested deliberate reasoning and psychotic-like experiences in the general population and in patients with a former psychotic episode. Deliberate reasoning was assessed with the bullshit receptivity scale, the ontological confabulation scale and the cognitive reflection test (CRT). We also measured algorithmic performance with the Berlin numeracy test and the wordsum test. Psychotic-like experiences were measured with the Community Assessment of Psychic Experience (CAPE-42) scale. Results: Psychotic-like experiences were positively correlated with a larger receptivity toward bullshit, more ontological confabulations, and also a lower score on the CRT but not with algorithmic task performance. In the patient group higher psychotic-like experiences significantly correlated with higher bullshit receptivity. Conclusion: Reduced deliberate reasoning may contribute to the formation of delusions, and be a general thinking bias largely independent of a person's general intelligence. Acceptance of bullshit may be facilitated the more positive symptoms a patient has, contributing to the maintenance of the delusions. PMID:29483886

Jumping to the wrong conclusions? An investigation of the mechanisms of reasoning errors in delusions.

PubMed

Jolley, Suzanne; Thompson, Claire; Hurley, James; Medin, Evelina; Butler, Lucy; Bebbington, Paul; Dunn, Graham; Freeman, Daniel; Fowler, David; Kuipers, Elizabeth; Garety, Philippa

2014-10-30

Understanding how people with delusions arrive at false conclusions is central to the refinement of cognitive behavioural interventions. Making hasty decisions based on limited data ('jumping to conclusions', JTC) is one potential causal mechanism, but reasoning errors may also result from other processes. In this study, we investigated the correlates of reasoning errors under differing task conditions in 204 participants with schizophrenia spectrum psychosis who completed three probabilistic reasoning tasks. Psychotic symptoms, affect, and IQ were also evaluated. We found that hasty decision makers were more likely to draw false conclusions, but only 37% of their reasoning errors were consistent with the limited data they had gathered. The remainder directly contradicted all the presented evidence. Reasoning errors showed task-dependent associations with IQ, affect, and psychotic symptoms. We conclude that limited data-gathering contributes to false conclusions but is not the only mechanism involved. Delusions may also be maintained by a tendency to disregard evidence. Low IQ and emotional biases may contribute to reasoning errors in more complex situations. Cognitive strategies to reduce reasoning errors should therefore extend beyond encouragement to gather more data, and incorporate interventions focused directly on these difficulties. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion

PubMed Central

Seeman, Mary V

2014-01-01

Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature (2000-2014) on this subject (women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions. PMID:25133144

Cardiocentric neurophysiology: the persistence of a delusion.

PubMed

Smith, C U M

2013-01-01

Aristotle is well known to have taught that the brain was a mere coolant apparatus for overheated blood and to have located the hegemonikon in the heart. This teaching was hotly disputed by his immediate successors in the Alexandrian Museum, who showed that the brain played the central role in psychophysiology. This was accepted and developed by the last great biomedical figure of classical antiquity - Claudius Galen. However, Aristotle's cardiocentric theory did not entirely disappear and this article traces its influence through the Arabic physicians of the Islamic ascendancy, into the European Middle Ages where Albertus Magnus' attempt to reconcile cardiocentric and cerebrocentric physiology was particularly influential. It shows how cardiocentricity was sufficiently accepted to attract the attention of, and require refutation by, many of the great names of the Renaissance, including Vesalius, Fernel, and Descartes, and was still taken seriously by luminaries such as William Harvey in the mid-seventeenth century. The article, in rehearsing this history, shows the difficulty of separating the first-person perspective of introspective psychology and the third-person perspective of natural science. It also outlines an interesting case of conflict between philosophy and physiology.

Electroconvulsive therapy

MedlinePlus

Shock treatment; Shock therapy; ECT; Depression - ECT; Bipolar - ECT ... ECT is a highly effective treatment for depression, most commonly ... who: Are having delusions or other psychotic symptoms with ...

Projective Identification, Self-Disclosure, and the Patient's View of the Object: The Need for Flexibility

PubMed Central

Waska, Robert T.

1999-01-01

Certain patients, through projective identification and splitting mechanisms, test the boundaries of the analytic situation. These patients are usually experiencing overwhelming paranoid-schizoid anxieties and view the object as ruthless and persecutory. Using a Kleinian perspective, the author advocates greater analytic flexibility with these difficult patients who seem unable to use the standard analytic environment. The concept of self-disclosure is examined, and the author discusses certain technical situations where self-disclosure may be helpful.(The Journal of Psychotherapy Practice and Research 1999; 8:225–233) PMID:10413442

Cotard's Syndrome in a Patient with Schizophrenia: Case Report and Review of the Literature

PubMed Central

Ledesma-Gastañadui, Mario

2016-01-01

Jules Cotard described, in 1880, the case of a patient characterized by delusions of negation, immortality, and guilt as well as melancholic anxiety among other clinical features. Later this constellation of symptoms was given the eponym Cotard's syndrome, going through a series of theoretical vicissitudes, considering itself currently as just the presence of nihilistic delusions. The presentation of the complete clinical features described by Cotard is a rare occurrence, especially in the context of schizophrenia. Here we present the case of a 50-year-old male patient with schizophrenia who developed Cotard's syndrome. The patient was treated with aripiprazole, showing improvement after two weeks of treatment. A review of the literature is performed about this case. PMID:28053798

Cotard's Syndrome in a Patient with Schizophrenia: Case Report and Review of the Literature.

PubMed

Huarcaya-Victoria, Jeff; Ledesma-Gastañadui, Mario; Huete-Cordova, Maria

2016-01-01

Jules Cotard described, in 1880, the case of a patient characterized by delusions of negation, immortality, and guilt as well as melancholic anxiety among other clinical features. Later this constellation of symptoms was given the eponym Cotard's syndrome, going through a series of theoretical vicissitudes, considering itself currently as just the presence of nihilistic delusions. The presentation of the complete clinical features described by Cotard is a rare occurrence, especially in the context of schizophrenia. Here we present the case of a 50-year-old male patient with schizophrenia who developed Cotard's syndrome. The patient was treated with aripiprazole, showing improvement after two weeks of treatment. A review of the literature is performed about this case.

Affective modulation of external misattribution bias in source monitoring in schizophrenia.

PubMed

Costafreda, S G; Brébion, G; Allen, P; McGuire, P K; Fu, C H Y

2008-06-01

Schizophrenic patients tend to attribute internal events to external agents, a bias that may be linked to positive symptoms. We investigated the effect of emotional valence on the cognitive bias. Male schizophrenic subjects (n=30) and an experimenter alternatively produced neutral and negative words. The subject then decided whether he or the experimenter had generated the item. External misattributions were more common than self-misattributions, and the bias was greater for patients with active hallucinations and delusions relative to patients in remission. Actively psychotic patients but not patients in remission were more likely to generate external misattributions with negative relative to neutral words. Affective modulation of the externalizing cognitive bias in source monitoring is evident in patients with hallucinations and delusions.

Childhood traumatic events and types of auditory verbal hallucinations in first-episode schizophrenia patients.

PubMed

Misiak, Błażej; Moustafa, Ahmed A; Kiejna, Andrzej; Frydecka, Dorota

2016-04-01

Evidence is accumulating that childhood trauma might be associated with higher severity of positive symptoms in patients with psychosis and higher incidence of psychotic experiences in non-clinical populations. However, it remains unknown whether the history of childhood trauma might be associated with particular types of auditory verbal hallucinations (AVH). We assessed childhood trauma using the Early Trauma Inventory Self-Report - Short Form (ETISR-SF) in 94 first-episode schizophrenia (FES) patients. Lifetime psychopathology was evaluated using the Operational Criteria for Psychotic Illness (OPCRIT) checklist, while symptoms on the day of assessment were examined using the Positive and Negative Syndrome Scale (PANSS). Based on ETISR-SF, patients were divided into those with and without the history of childhood trauma: FES(+) and FES(-) patients. FES(+) patients had significantly higher total number of AVH types and Schneiderian first-rank AVH as well as significantly higher PANSS P3 item score (hallucinatory behavior) in comparison with FES(-) patients. They experienced significantly more frequently third person AVH and abusive/accusatory/persecutory voices. These differences remained significant after controlling for education, PANSS depression factor score and chlorpromazine equivalent. Linear regression analysis revealed that the total number of AVH types was predicted by sexual abuse score after controlling for above mentioned confounders. This effect was significant only in females. Our results indicate that the history of childhood trauma, especially sexual abuse, is associated with higher number AVH in females but not in males. Third person AVH and abusive/accusatory/persecutory voices, representing Schneiderian first-rank symptoms, might be particularly related to childhood traumatic events. Copyright © 2015 Elsevier Inc. All rights reserved.

The functional anatomical distinction between truth telling and deception is preserved among people with schizophrenia.

PubMed

Kaylor-Hughes, Catherine J; Lankappa, Sudheer T; Fung, Robert; Hope-Urwin, Alexandra E; Wilkinson, Iain D; Spence, Sean A

2011-02-01

A recently emergent functional neuroimaging literature has described the functional anatomical correlates of deception among healthy volunteers, most often implicating the ventrolateral prefrontal and anterior cingulate cortices. To date, there have been no such imaging studies of people with severe mental illness. To discover whether the brains of people with schizophrenia would manifest a similar functional anatomical distinction between the states of truthfulness and deceit. It is hypothesised that, as with healthy people, persons with schizophrenia will show activation in the ventrolateral prefrontal and anterior cingulate cortices when lying. Fifty-two people satisfying Diagnostic and Statistical Manual of Mental Disorder-IV criteria for schizophrenia or schizoaffective disorder underwent functional magnetic resonance imaging at 3 T while responding truthfully or with lies to questions concerning their recent actions. Half the sample was concurrently experiencing delusions. As hypothesised, patients exhibited greater activity in ventrolateral prefrontal cortices while lying. Truthful responses were not associated with any areas of relatively increased activation. The presence or absence of delusions did not substantially affect these findings, although subtle laterality effects were discernible upon post hoc analyses. As in healthy cohorts, the brains of people with schizophrenia exhibit a functional anatomical distinction between the states of truthfulness and deceit. Furthermore, this distinction pertains even in the presence of delusions. Copyright © 2010 John Wiley & Sons, Ltd.

Association of religion with delusions and hallucinations in the context of schizophrenia: implications for engagement and adherence.

PubMed

Gearing, Robin Edward; Alonzo, Dana; Smolak, Alex; McHugh, Katie; Harmon, Sherelle; Baldwin, Susanna

2011-03-01

The relationship of religion and schizophrenia is widely acknowledged, but often minimized by practitioners and under investigated by researchers. In striving to help fill this gap, this paper focuses on examining four aims: 1) how research has investigated the association between religiosity and schizophrenia; 2) how is religiosity associated with delusions and hallucinations; 3) what are the risk and protective factors associated with religiosity and schizophrenia; and 4) does religion influence treatment adherence with individuals diagnosed with schizophrenia. A systematic literature search of PsycINFO and MEDLINE databases from January 1, 1980 through January 1, 2010 was conducted using the terms schizophrenia, schizoaffective, schizophreniform, psychotic disorder not otherwise specified (NOS) and religion, religiosity, spirituality, or faith. Seventy (n=70) original research studies were identified. Religion can act as both a risk and protective factor as it interacts with the schizophrenia symptoms of hallucination and delusions. Cultural influences tend to confound the association of religion and schizophrenia. Adherence to treatment has a mixed association with religiosity. The relationship between religion and schizophrenia may be of benefit to both clinicians and researchers through enhancing adherence to treatment, and enhancement of the protective aspects while minimizing associated risk. The relationship of religion and schizophrenia needs further research that is more nuanced and methodologically rigorous, specifically concerning its influence on engagement and adherence to treatment. Copyright © 2010 Elsevier B.V. All rights reserved.

Assessment of documentation of DSM-IV-TR Criteria A for diagnosis of schizophrenia in psychiatric unit, tertiary hospital, Malaysia.

PubMed

Maung, K; Ohnmar, H; Than, W; Ramli, M; Najwa Hanim, M R; Ali Sabri, R; Ahmad Zafri, A B

The purposes of this study were to investigate the documentation of the DSM-IV-TR- Criteria A in diagnoses of schizophrenia and to identify the symptoms associated with over diagnosis of schizophrenia. This study involved a retrospective review and analysis of data from case notes. Data of 107 newly diagnosed patients with schizophrenia were keyed in and analyzed using SPSS v 19. The cases were then evaluated for the use of the DSM-IV-TR- Criteria A. Over diagnosis was noted in 37.39% of the patients. Disorganised behaviour (12.5%), affective flattening (12.5%), hallucination (16%) and non-bizarre delusion (18.3%) significantly contributed to the over-diagnosis of schizophrenia. Symptoms such as non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia and were statistically significant with p ≤0.05. There was a significant lack of DSM-IV-TR Criteria A among the data documented to diagnose schizophrenia and non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia. This key problem needs to be addressed. The reliability of a diagnosis is indispensable and achievable with the proper clinical application of DSM-IV-TR Criteria A. The DSM-IV-TR Criteria have been perceived to be useful and reliable and is most widely used throughout the world.

Pimavanserin

MedlinePlus

... hallucinations and delusions in people with psychosis from Parkinson's disease (PD; a disorder of the nervous system ... Nuedexta), and sotalol (Betapace, Sorine, Sotylize); moxifloxacin (Avelox); phenytoin (Dilantin, Phenytek); rifampin (Rifadin, Rimactane, in Rifamate, in ...

Fluphenazine

MedlinePlus

Fluphenazine is an antipsychotic medication used to treat schizophrenia and psychotic symptoms such as hallucinations, delusions, and ... are in the last few months of your pregnancy, or if you plan to become pregnant or ...

Bath Salts

MedlinePlus

... panic attacks depression suicidal thoughts paranoia delusions and hallucinations distorted sense of reality decreased ability to think ... of bath salts may cause people to have hallucinations, hear voices, feel paranoid, and develop a psychosis ...

'Paranoia and its historical development (systematized delusion)', by Eugenio Tanzi (1884).

PubMed

Castagnini, Augusto

2016-06-01

This was the first paper by the Italian alienist Eugenio Tanzi (1856-1934). It surveyed existing works and provided an analysis of clinical categories such as monomania, sensory madness, moral insanity, Wahnsinn, Verrücktheit and systematized delusions, which had been used in France, Germany, Britain and Italy since the early nineteenth century to deal with paranoia. As pointed out by Tanzi, discrepancies and discontinuities in diagnostic concepts affected both psychiatric nosology and practice. Paranoia (from the Greek παρά and νοια) made for greater clarity in psychiatric terminology, and denoted a broad category, including both acute and chronic delusional states which were considered to be distinct from mania and melancholia, and usually not to lead to mental deterioration. © The Author(s) 2016.

[Psychodynamic and forensic approach of constitutional mythomania: a case report].

PubMed

Ben Thabet, J; Zouari, N; Charfeddine, F; Zouari, L; Maâlej, M

2012-12-01

Constitutional mythomania presents several diagnostic, aetiopathogenic and forensic problems for the doctor. We have discussed these aspects through the analysis of a case report. The case report relates to a 43 year-old man, who was subjected to a penal expertise following the emission of cheques without provision. During the examination, he pretended being both a doctor and a lawyer at the same time. He was in charge, among other things, of sale contracts dealing sometimes with high value transactions, obviously without following the required legal procedure. He was pursued subsequently for many other affairs of swindle. Data collected from his medical file indicated that he was the only boy of his family. Since his father had suffered from psychotic episodes, his grandfather had reared him; which he did it in a strictly religious way. He spent his childhood isolated. He was 15 years old when his grandfather died. He had then expressed religious and megalomaniac ideas that had motivated psychiatric management. Later on, he expressed imaginative ideas evoking unsystematized delusion (he pretended to have made a trip to America and to have seen a fish flying and turning into a woman). From a psychodynamic point of view, constitutional mythomania is considered as a borderline personality. It reflects an important narcissisic cleavage. The deceitfulness of the mythomaniac allows him to keep in touch with reality and to avoid mental disintegration. The recognition, by others, of these delusions allows the mythomaniac to have access to his proper level of existence. For a while, to the experts our patient appeared to be suffering from schizophrenia. Therefore, we can apply the Maleval theory to him, which identifies four periods as delusion structuring levels in psychosis : P0 (consequence of the phallic signification deficiency, it includes anxiety, annihilation, perplexity, interrogative attitude), P1 (stage of paranoid delusion), P2 (stage of paranoiac delusion) and P3 (ambitious stage evoking paraphrenia and squaring with mythomaniac behaviour). According to the Maleval theory, our patient would have experimented a repetitive cycle: he tried to escape instable and anxious positions (P0, P1) by committing sacrificial acting out (offence), or by reaching stable positions which are P2 and P3. The mythomaniac behaviour would appear during the latest period. The delusional decompensation would indicate a return to the first two periods. On the other hand, the personal myth might be seen as the result of the failure of the assimilation of actual experiences. Several psychoanalysts consider the use of myths by some psychotics as an attempt to reduce their ego disintegration. The mythomaniac may create his own myth in order to reduce the psychotic anxiety. The personal myth does not represent the pain of the patient but his remedy against his disorders. Therefore, identifying a personal myth may help the psychotic to turn his delusion into supportable logic of life. Myth may also be used in less deep pathologies such as borderline context, where it dominates the clinical picture. On the forensic level, we could a priori postulate that the mythomaniac sufficiently perceives reality to be considered as lucid. In fact, he hardly masters the totality of his intentions, being guided by an irrepressible mechanism that makes mythomania a "serious" and handicapping illness; its prima victim being the patient him/herself. No measures could actually prevent the latter from infringing the law, except, perhaps, a permanent administrative control; but this would not be without practical and ethical problems. Copyright © 2012 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Differences in Clinical Features of Methamphetamine Users with Persistent Psychosis and Patients with Schizophrenia.

PubMed

Wang, Liang-Jen; Lin, Shih-Ku; Chen, Yi-Chih; Huang, Ming-Chyi; Chen, Tzu-Ting; Ree, Shao-Chun; Chen, Chih-Ken

Methamphetamine exerts neurotoxic effects and elicits psychotic symptoms. This study attempted to compare clinical differences between methamphetamine users with persistent psychosis (MAP) and patients with schizophrenia. In addition, we examined the discrimination validity by using symptom clusters to differentiate between MAP and schizophrenia. We enrolled 53 MAP patients and 53 patients with schizophrenia. The psychopathology of participants was assessed using the Chinese version of the Diagnostic Interview for Genetic Studies and the 18-item Brief Psychiatric Rating Scale. Logistic regression was used to examine the predicted probability scores of different symptom combinations on discriminating between MAP and schizophrenia. The receiver operating characteristic (ROC) analyses and area under the curve (AUC) were further applied to examine the discrimination validity of the predicted probability scores on differentiating between MAP and schizophrenia. We found that MAP and schizophrenia demonstrated similar patterns of delusions. Compared to patients with schizophrenia, MAP experienced significantly higher proportions of visual hallucinations and of somatic or tactile hallucinations. However, MAP exhibited significantly lower severity in conceptual disorganization, mannerism/posturing, blunted affect, emotional withdrawal, and motor retardation compared to patients with schizophrenia. The ROC analysis showed that a predicted probability score combining the aforementioned 7 items of symptoms could significantly differentiate between MAP and schizophrenia (AUC = 0.77). Findings in the current study suggest that nuanced differences might exist in the clinical presentation of secondary psychosis (MAP) and primary psychosis (schizophrenia). Combining the symptoms as a whole may help with differential diagnosis for MAP and schizophrenia. © 2016 S. Karger AG, Basel.

Schizoaffective Disorder

MedlinePlus

... in which a person experiences a combination of schizophrenia symptoms, such as hallucinations or delusions, and mood ... disorder — both of which include some symptoms of schizophrenia — are: Bipolar type , which includes episodes of mania ...

Dementia: Diagnosis and Tests

MedlinePlus

... for is having problems with memory, language, and decision-making that seem to be getting worse, schedule an ... the person’s physical and mental abilities, mood, personality, decision-making, or behavior. Ask about possible delusions or hallucinations ...

[Hypochondria circumscripta (to the problem of coenesthesiopathic paranoia)].

PubMed

Smulevich, A B; Frolova, V I

2006-01-01

Hypochondria circumscripta manifests in patients with paranoial personality and signs of somatopsychic accentuation. A sample included 11 patients (6 men, 5 women, mean age 54 years) who referred to dermatologists or had been admitted to gastroenterological and psychiatric units. Pathokinesis of hypochondria circumscripta comprises three stages: idiopathic algias, overmastering sensations and possession of pain. In the latter stage, delusional behavior targeted to the elimination of a part of the body, which is perceived as the source of pain, develops. Psychopathological disorders are realized in limits of coenesthesiopathic spectrum without tendency to interpretive delusion manifestation as well as transformation to systematic delusion of persecution during the disease course. As a consequence of above mentioned peculiarities of psychopathological structure, the stage of possession of pain may be designated as coenesthesiopathic paranoia. Because of the small sample, the findings can be considered as preliminary ones.

Moderating effects of positive symptoms of psychosis in suicidal ideation among adults diagnosed with schizophrenia.

PubMed

Bornheimer, Lindsay A

2016-10-01

Suicide is among the leading causes of death for adults diagnosed with schizophrenia, with risk estimates being over eight folds greater than the general population. While the majority of research to date focuses on the role of symptoms of depression in suicide risk, there is a lack of consensus and understanding of the relationship between positive symptoms of psychosis and both suicidal ideation and attempt. The current study examined pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), hopelessness, and suicidal ideation among a population of adults diagnosed with schizophrenia. Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n=1460) at baseline. Suicidal ideation, hopelessness, and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). Data were analyzed with Structural Equation Modeling (SEM) using Mplus 7. Symptoms of depression, positive symptoms of psychosis, and hopelessness independently predicted suicidal ideation. Hopelessness significantly mediated the relationship between symptoms of depression and suicidal ideation. Lastly, positive symptoms of psychosis were found to moderate the relationship between symptoms of depression and suicidal ideation. The current study provides evidence for the role that positive symptoms of psychosis (specifically hallucinations and delusions) play in suicidal ideation, pointing towards the implication that beyond symptoms of depression, positive symptoms must be evaluated for and treated. Copyright © 2016 Elsevier B.V. All rights reserved.

Moderating effects of positive symptoms of psychosis in suicidal ideation among adults diagnosed with schizophrenia

PubMed Central

Bornheimer, Lindsay A.

2018-01-01

Background Suicide is among the leading causes of death for adults diagnosed with schizophrenia, with risk estimates being over eight folds greater than the general population. While the majority of research to date focuses on the role of symptoms of depression in suicide risk, there is a lack of consensus and understanding of the relationship between positive symptoms of psychosis and both suicidal ideation and attempt. The current study examined pathways of influence between symptoms of depression, positive symptoms of psychosis (i.e. hallucinations and delusions), hopelessness, and suicidal ideation among a population of adults diagnosed with schizophrenia. Methods Data were obtained from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE; n = 1460) at baseline. Suicidal ideation, hopelessness, and symptoms of depression were measured by the Calgary Depression Scale (CDRS) and hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS). Data were analyzed with Structural Equation Modeling (SEM) using Mplus 7. Results Symptoms of depression, positive symptoms of psychosis, and hopelessness independently predicted suicidal ideation. Hopelessness significantly mediated the relationship between symptoms of depression and suicidal ideation. Lastly, positive symptoms of psychosis were found to moderate the relationship between symptoms of depression and suicidal ideation. Conclusions The current study provides evidence for the role that positive symptoms of psychosis (specifically hallucinations and delusions) play in suicidal ideation, pointing towards the implication that beyond symptoms of depression, positive symptoms must be evaluated for and treated. PMID:27450776

Steroid-Responsive Chronic Schizophreniform Syndrome in the Context of Mildly Increased Antithyroid Peroxidase Antibodies.

PubMed

Endres, Dominique; Perlov, Evgeniy; Riering, Anne Nicole; Maier, Viktoria; Stich, Oliver; Dersch, Rick; Venhoff, Nils; Erny, Daniel; Mader, Irina; Tebartz van Elst, Ludger

2017-01-01

Schizophreniform syndromes can be divided into primary forms from polygenic causes or secondary forms due to immunological, epileptiform, monogenic, or degenerative causes. Steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is a secondary immunological form associated with increased thyroid antibodies, such as antithyroid peroxidase antibodies and shows a good response to corticosteroids. We present the case of a 41-year-old woman suffering from a schizophreniform syndrome. Starting at the age of 35, she developed psychotic exacerbations with formal thought disorder, acoustic hallucinations, cenesthopathic experiences, and loss of ego boundaries. At the same time, she began to suffer from chronic sexual delusions and olfactory hallucinations, which did not respond to neuroleptic medication. Her levels of antithyroid peroxidase antibodies were slightly increased, and the blood-brain barrier was disturbed. An electroencephalogram (EEG) showed intermittent generalized slowing, and cerebral magnetic resonance imaging (cMRI) depicted mild temporolateral atrophy. High-dose corticosteroid treatment led to convincing improvement of attentional performance and the disappearance of delusions and olfactory hallucinations. SREAT can mimic typical symptoms of schizophreniform syndromes. The increased titer of antithyroid peroxidase antibodies in combination with the EEG slowing, blood-brain barrier dysfunction, and the cMRI alterations were the basis for suspecting an immunological cause in our patient. Chronic delusions, olfactory hallucinations, and cognitive deficits were successfully treated with corticosteroids. The occurrence of secondary immunological forms of schizophreniform syndromes demonstrates the need for innovative immunosuppressive treatment options.

Uncovering Capgras delusion using a large-scale medical records database

PubMed Central

Marshall, Caryl; Kanji, Zara; Wilkinson, Sam; Halligan, Peter; Deeley, Quinton

2017-01-01

Background Capgras delusion is scientifically important but most commonly reported as single case studies. Studies analysing large clinical records databases focus on common disorders but none have investigated rare syndromes. Aims Identify cases of Capgras delusion and associated psychopathology, demographics, cognitive function and neuropathology in light of existing models. Method Combined computational data extraction and qualitative classification using 250 000 case records from South London and Maudsley Clinical Record Interactive Search (CRIS) database. Results We identified 84 individuals and extracted diagnosis-matched comparison groups. Capgras was not ‘monothematic’ in the majority of cases. Most cases involved misidentified family members or close partners but others were misidentified in 25% of cases, contrary to dual-route face recognition models. Neuroimaging provided no evidence for predominantly right hemisphere damage. Individuals were ethnically diverse with a range of psychosis spectrum diagnoses. Conclusions Capgras is more diverse than current models assume. Identification of rare syndromes complements existing ‘big data’ approaches in psychiatry. Declaration of interests V.B. is supported by a Wellcome Trust Seed Award in Science (200589/Z/16/Z) and the UCLH NIHR Biomedical Research Centre. S.W. is supported by a Wellcome Trust Strategic Award (WT098455MA). Q.D. has received a grant from King’s Health Partners. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28794897

Delusional infestation is typically comorbid with other psychiatric diagnoses: review of 54 patients receiving psychiatric evaluation at Mayo Clinic.

PubMed

Hylwa, Sara A; Foster, Ashley A; Bury, Jessica E; Davis, Mark D P; Pittelkow, Mark R; Bostwick, J Michael

2012-01-01

Delusional infestation, which encompasses both delusions of parasitosis and delusions of infestation with inanimate objects (sometimes called Morgellons disease), has been said to represent a distinct and encapsulated delusion, that is, a stand-alone diagnosis. Anecdotally, we have observed that patients with delusional infestation often have one or more psychiatric comorbid conditions and that delusional infestation should not be regarded as a stand-alone diagnosis. The purpose of this study was to identify whether patients with delusional infestation have psychiatric comorbid conditions. We therefore identified patients who had been formally evaluated in the Department of Psychiatry during their visit to Mayo Clinic. We retrospectively searched for and reviewed the cases of all patients with delusional infestation seen from 2001 through 2007 at Mayo Clinic, Rochester, Minnesota, and who underwent psychiatric evaluation. The diagnoses resulting from psychiatric evaluation were analyzed. During the 7-year study period, 109 patients seen for delusional infestation at Mayo Clinic were referred to the Department of Psychiatry, 54 (50%) of whom actually followed through with psychiatric consultation. Of these 54 patients, 40 (74%) received additional active psychiatric diagnoses; 14 patients (26%) had delusional infestation alone. Abnormal personality traits were rarely documented. Most patients with delusional infestation have multiple coexisting or underlying psychiatric disorders. Therefore, evaluation by a psychiatrist, when possible, is advised for all patients with delusional infestation. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

A Neuropsychiatric Analysis of the Cotard Delusion.

PubMed

Sahoo, Aradhana; Josephs, Keith A

2018-01-01

Cotard's syndrome, a condition in which the patient denies his or her own existence or the existence of body parts, is a rare illness that has been reported in association with several neuropsychiatric diagnoses. The majority of published literature on the topic is in the form of case reports, many of which are several years old. The authors evaluated associated diagnoses, neuroimaging, and treatments recorded in patients diagnosed with Cotard's syndrome at their institution. A search of the Mayo Clinic database for patients with mention of signs and symptoms associated with Cotard's in their records between 1996 and 2016 was conducted. The electronic medical records of the identified patients were then reviewed for evidence of a true diagnosis of Cotard's. Clinical and neuroimaging data were also recorded for these patients. The search identified 18 patients, 14 of whom had Cotard delusions. Two of the 14 were excluded due to them being under age 18. The resulting 12 patients had a median age of 52 years (range: 30-85 years). On neuroimaging, four patients exhibited frontal lobe changes, four demonstrated generalized volume loss, and five had ischemic changes; seven patients demonstrated right-sided or bilateral hemisphere lesions. Treatments included ECT, pharmacotherapy, behavioral therapy, psychotherapy, rehydration, and removal of offending drugs. To conclude, Cotard delusions occur in the context of a relatively wide spectrum of neurological, psychiatric, and medical disorders and present with various neural changes. Nondominant hemisphere lesions may play a role in the pathophysiology. A number of effective treatments are available.

Psychiatric co-morbidity associated with pheniramine abuse and dependence

PubMed Central

Pal, Hemraj; Kumar, Rajesh; Bhushan, Shashi; Berry, Neeraj

2005-01-01

The abuse of cough syrups containing antihistamines and codeine is being increasingly noted. The abuse of antihistamines alone has also been reported. The use of antihistamines alone or in combination with other substances of abuse may predispose individuals to develop psychiatric symptoms or syndromes as a part of intoxication, withdrawal or as co-morbid conditions. We present two case reports to highlight the occurrence of co-morbid psychopathology in association with antihistamine abuse and dependence. Case I used high doses of pheniramine for about 2 years and became suspicious of his wife; he even doubted the paternity of his yet-to-be-born child. The associated behavioural abnormalities suggested that he was acting out on the delusion. He also had seizures associated with the intake of a high dose of pheniramine. Case II had multiple substance use, and dependence on alcohol and pheniramine. He demonstrated abnormal behaviour suggestive of psychosis and organic brain syndrome that persisted for a few days and remitted on discontinuation of the substances. These two cases demonstrate the occurrence of psychotic syndromes associated with heavy pheniramine use. The psychopathology can vary from an independent psychotic syndrome to an organic brain syndrome-like disorder.

Beyond alcoholism: Wernicke-Korsakoff syndrome in patients with psychiatric disorders.

PubMed

McCormick, Laurie M; Buchanan, Judith R; Onwuameze, Obiora E; Pierson, Ronald K; Paradiso, Sergio

2011-12-01

Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present clinical histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS. A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop. Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome. Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency.

Beyond Alcoholism: Wernicke-Korsakoff Syndrome in Patients With Psychiatric Disorders

PubMed Central

McCormick, Laurie M.; Buchanan, Judith R.; Onwuameze, Obiora E.; Pierson, Ronald K.; Paradiso, Sergio

2013-01-01

Objective Wernicke encephalopathy and Korsakoff syndrome (the combined disorder is named Wernicke-Korsakoff syndrome [WKS]) are preventable, life-threatening neuropsychiatric syndromes resulting from thiamine deficiency. WKS has historically been associated with alcoholism; more recently, it has been recognized in patients who have anorexia nervosa or have undergone bariatric surgery for obesity. However, patients with nutritional deficiencies of any origin are at risk for WKS. We present clinical histories and neuroimaging data on 2 young adults with underlying psychiatric disorders who became malnourished and developed WKS. Methods A young woman with bipolar disorder and somatization disorder was hospitalized for intractable vomiting. A young man with chronic paranoid schizophrenia developed delusions that food and water were harmful, and was hospitalized after subsisting for 4 months on soda pop. Results Acute, life-threatening Wernicke encephalopathy was confirmed in both patients by brain magnetic resonance imaging showing classic thalamic injury. The patients were left with persistent cognitive and physical disabilities that were consistent with Korsakoff syndrome. Conclusions Failure to suspect a vitamin deficiency led to permanent cognitive and physical disabilities that may necessitate lifelong care for these patients. The neuropsychiatric consequences could have been prevented by prompt recognition of their thiamine deficiency. PMID:22134191

[Elements of a clinical differential diagnosis between Asperger syndrome and the schizoid/paranoid personality].

PubMed

Mottron, Laurent; Soulières, Isabelle; Ménard, Edith

2007-01-01

Individuals with Asperger syndrome may, when exposed to hostility (e.g. bullying at school or at work), develop hostile ideas against their social environment, sometimes leading to aggression. These ideas and acts may be confounded with those arising from a persecutory state in schizoid or schizotypal personality, or even schizophrenia. These entities can be confounded with Asperger syndrome due to their permanent nature, and the presence of atypical social and emotional behaviours. This paper proposes cognitive (Wechsler profile), developmental (course of hostile behaviours), discursive (qualitative features of discourse reporting hostile thoughts), which may contribute to differential diagnosis in the presence of hostile thoughts and behaviours. Consequences for case management are also reported.

The Impact of Delirium | NIH MedlinePlus the Magazine

MedlinePlus

... delusions Variable levels of consciousness or awareness Disrupted sleep patterns, drowsiness Confusion (disorientation) about time or place Declines in short-term memory and recall Disorganized thinking, talking in a way that doesn't make sense ...

Hypochondriacal delusion in an elderly woman recovers quickly with electroconvulsive therapy

PubMed Central

Dols, Annemieke; Rhebergen, Didi; Eikelenboom, Piet; Stek, Max L.

2012-01-01

A 72-year-old woman without any medical and psychiatric history, suffered from nausea, pain in the epigastria and constipation for over a year. She eventually lost 20 kilograms despite nightly drip-feeding. Extensive additional tests did not reveal any clues for her complaints. She remained convinced that her symptoms were a side-effect of anti-fungal medication she used. She was diagnosed with hypochondria. In the course of time her ideas about her somatic symptoms became delusional and she was diagnosed with a hypochondriacal delusion as part of melancholia, without depressed mood or loss of interest or pleasure as prominent features. It is important to recognize melancholia as soon as possible by continually evaluating other symptoms of depression. This may enable to avoid repetitive and exhaustive somatic examinations, which are not indicated, and to start effective treatment. In our patient electroconvulsive therapy resulted in a fast and complete recovery. PMID:24765410

Lethal violence and psychosis: a clinical profile.

PubMed

Nestor, P G; Haycock, J; Doiron, S; Kelly, J; Kelly, D

1995-01-01

To investigate the relationship between lethal violence and psychosis, the authors examined symptomatology, neuropsychological functioning, and the nature of perpetrator-victim relationships of patients with psychotic disorders who were committed to a forensic psychiatric hospital following violent, primarily criminal behavior. A severely violent group, composed primarily of psychotic patients charged with murder, was compared with a less severely violent group that was composed primarily of psychotic patients involved with property crimes. As compared with the less violent group, the severely violent group was more likely to have delusional beliefs about specific personal targets and to have delusions about significant others being replaced by impostors. These beliefs were accompanied by higher scores on neuropsychological tests of intellectual and academic abilities. A high number of their blood relatives were victims of psychotic murder. These results indicated that a higher incidence of lethal or near lethal acts of violence may characterize intellectually intact but psychotic individuals with organize delusions involving personal, accessible targets.

In what sense 'familiar'? Examining experiential differences within pathologies of facial recognition.

PubMed

Young, Garry

2009-09-01

Explanations of Capgras delusion and prosopagnosia typically incorporate a dual-route approach to facial recognition in which a deficit in overt or covert processing in one condition is mirror-reversed in the other. Despite this double dissociation, experiences of either patient-group are often reported in the same way--as lacking a sense of familiarity toward familiar faces. In this paper, deficits in the facial processing of these patients are compared to other facial recognition pathologies, and their experiential characteristics mapped onto the dual-route model in order to provide a less ambiguous link between facial processing and experiential content. The paper concludes that the experiential states of Capgras delusion, prosopagnosia, and related facial pathologies are quite distinct, and that this descriptive distinctiveness finds explanatory equivalence at the level of anatomical and functional disruption within the face recognition system. The role of skin conductance response (SCR) as a measure of 'familiarity' is also clarified.

Brain Metabolic Dysfunction in Capgras Delusion During Alzheimer's Disease: A Positron Emission Tomography Study.

PubMed

Jedidi, H; Daury, N; Capa, R; Bahri, M A; Collette, F; Feyers, D; Bastin, C; Maquet, P; Salmon, E

2015-11-01

Capgras delusion is characterized by the misidentification of people and by the delusional belief that the misidentified persons have been replaced by impostors, generally perceived as persecutors. Since little is known regarding the neural correlates of Capgras syndrome, the cerebral metabolic pattern of a patient with probable Alzheimer's disease (AD) and Capgras syndrome was compared with those of 24-healthy elderly participants and 26 patients with AD without delusional syndrome. Comparing the healthy group with the AD group, the patient with AD had significant hypometabolism in frontal and posterior midline structures. In the light of current neural models of face perception, our patients with Capgras syndrome may be related to impaired recognition of a familiar face, subserved by the posterior cingulate/precuneus cortex, and impaired reflection about personally relevant knowledge related to a face, subserved by the dorsomedial prefrontal cortex. © The Author(s) 2013.

A case of serial nightmares and oneiroid state under paroxetine for senile depression.

PubMed

Kobayashi, Toshiyuki; Yamauchi, Mina

2012-03-01

We report on rare side effects of paroxetine. A 67-year-old female patient who had been suffering from prolonged depression for over a year but had not received appropriate treatment was administered 20-mg paroxetine daily. However, the patient required hospital admission after 16 days because of behavioural disturbances and delusions that she was being chased by evil persons from a religious group. The delusions were ultimately confirmed to be serial nightmares and an oneiroid state. The nightmares gradually disappeared following discontinuation of paroxetine. The Adverse Drug Reaction Probability Scale showed a score of 6 (probable). Reports on paroxetine-induced nightmares are rare, and there is a possibility that, in this case, parexetine caused the nightmares in association with depression and assumed underlying brain dysfunction due to ageing. © 2012 The Authors. Psychogeriatrics © 2012 Japanese Psychogeriatric Society.

Cotard's Syndrome after breast surgery successfully treated with aripiprazole augmentation of escitalopram: a case report.

PubMed

De Berardis, Domenico; Brucchi, Maurizio; Serroni, Nicola; Rapini, Gabriella; Campanella, Daniela; Vellante, Federica; Valchera, Alessandro; Fornaro, Michele; Iasevoli, Felice; Mazza, Monica; Lucidi, Giuliana; Martinotti, Giovanni; di Giannantonio, Massimo

2015-01-01

In 1880 the French neurologist Jules Cotard described a condition characterized by delusion of negation (nihilistic delusion) in a melancholia context. Recently, there has been a resurgence of interest in Cotard's syndrome (CS), but the nosographical figure of CS remains unclear. It isn't determined if it pertains to the delusional themes area or if it is related to the sense of immanent ruin in some depressive episodes. For these reasons CS has recently been supposed to be an intermediate form. Furthermore, since even less is known about secondary CS in subjects who had never suffered of psychiatric disorders, in the present case we report the development of a secondary CS in a female patient who underwent a lumpectomy for the removal of a benign fibroadenoma. The patient responded well to aripiprazole augmentation of escitalopram and totally remitted.

Capturing the will: Imposture, delusion, and exposure in Alfred Russel Wallace's defence of spirit photography.

PubMed

Mitchell, Benjamin David

2014-06-01

The co-discoverer of natural selection, Alfred Russel Wallace, found himself deeply embroiled in a range of controversies surrounding the relationship between science and spiritualism. At the heart of these controversies lay a crisis of evidence in cases of delusion or imposture. He had the chance to observe the many epistemic impasses brought about by this crisis while participating in the trial of the American medium Henry Slade, and through his exchanges with the physiologist William Benjamin Carpenter and the psychical researcher Frederic Myers. These contexts help to explain the increasing value that Wallace placed on the evidence of spirit photography. He hoped that it could simultaneously break these impasses, while answering once and for all the interconnected questions of the unity of the psyche and the reliability of human observation. Copyright © 2014 Elsevier Ltd. All rights reserved.

The role of cognitive biases and personality variables in subclinical delusional ideation.

PubMed

Menon, Mahesh; Quilty, Lena Catherine; Zawadzki, John Anthony; Woodward, Todd Stephen; Sokolowski, Helen Moriah; Boon, Heather Shirley; Wong, Albert Hung Choy

2013-05-01

A number of cognitive biases, most notably a data gathering bias characterised by "jumping to conclusions" (JTC), and the "bias against disconfirmatory evidence" (BADE), have been shown to be associated with delusions and subclinical delusional ideation. Certain personality variables, particularly "openness to experience", are thought to be associated with schizotypy. Using structural equation modelling, we examined the association between two higher order subfactors ("aspects") of "openness to experience" (labelled "openness" and "intellect"), these cognitive biases, and their relationship to subclinical delusional ideation in 121 healthy, nonpsychiatric controls. Our results suggest that cognitive biases (specifically the data gathering bias and BADE) and the "openness" aspect are independently associated with subclinical delusional ideation, and the data gathering bias is weakly associated with "positive schizotypy". "Intellect" is negatively associated with delusional ideation and might play a potential protective role. Cognitive biases and personality are likely to be independent risk factors for the development of delusions.

Delusional misidentifications and duplications: right brain lesions, left brain delusions.

PubMed

Devinsky, Orrin

2009-01-06

When the delusional misidentification syndromes reduplicative paramnesia and Capgras syndromes result from neurologic disease, lesions are usually bifrontal and/or right hemispheric. The related disorders of confabulation and anosognosis share overlapping mechanisms and anatomic pathology. A dual mechanism is postulated for the delusional misidentification syndromes: negative effects from right hemisphere and frontal lobe dysfunction as well as positive effects from release (i.e., overactivity) of preserved left hemisphere areas. Negative effects of right hemisphere injury impair self-monitoring, ego boundaries, and attaching emotional valence and familiarity to stimuli. The unchecked left hemisphere unleashes a creative narrator from the monitoring of self, memory, and reality by the frontal and right hemisphere areas, leading to excessive and false explanations. Further, the left hemisphere's cognitive style of categorization, often into dual categories, leads it to invent a duplicate or impostor to resolve conflicting information. Delusions result from right hemisphere lesions. But it is the left hemisphere that is deluded.

Stable aesthetic standards delusion: changing 'artistic quality' by elaboration.

PubMed

Carbon, Claus-Christian; Hesslinger, Vera M

2014-01-01

The present study challenges the notion that judgments of artistic quality are based on stable aesthetic standards. We propose that such standards are a delusion and that judgments of artistic quality are the combined result of exposure, elaboration, and discourse. We ran two experiments using elaboration tasks based on the repeated evaluation technique in which different versions of the Mona Lisa had to be elaborated deeply. During the initial task either the version known from the Louvre or an alternative version owned by the Prado was elaborated; during the second task both versions were elaborated in a comparative fashion. After both tasks multiple blends of the two versions had to be evaluated concerning several aesthetic key variables. Judgments of artistic quality of the blends were significantly different depending on the initially elaborated version of the Mona Lisa, indicating experience-based aesthetic processing, which contradicts the notion of stable aesthetic standards.

Altered attentional and perceptual processes as indexed by N170 during gaze perception in schizophrenia: Relationship with perceived threat and paranoid delusions.

PubMed

Tso, Ivy F; Calwas, Anita M; Chun, Jinsoo; Mueller, Savanna A; Taylor, Stephan F; Deldin, Patricia J

2015-08-01

Using gaze information to orient attention and guide behavior is critical to social adaptation. Previous studies have suggested that abnormal gaze perception in schizophrenia (SCZ) may originate in abnormal early attentional and perceptual processes and may be related to paranoid symptoms. Using event-related brain potentials (ERPs), this study investigated altered early attentional and perceptual processes during gaze perception and their relationship to paranoid delusions in SCZ. Twenty-eight individuals with SCZ or schizoaffective disorder and 32 demographically matched healthy controls (HCs) completed a gaze-discrimination task with face stimuli varying in gaze direction (direct, averted), head orientation (forward, deviated), and emotion (neutral, fearful). ERPs were recorded during the task. Participants rated experienced threat from each face after the task. Participants with SCZ were as accurate as, though slower than, HCs on the task. Participants with SCZ displayed enlarged N170 responses over the left hemisphere to averted gaze presented in fearful relative to neutral faces, indicating a heightened encoding sensitivity to faces signaling external threat. This abnormality was correlated with increased perceived threat and paranoid delusions. Participants with SCZ also showed a reduction of N170 modulation by head orientation (normally increased amplitude to deviated faces relative to forward faces), suggesting less integration of contextual cues of head orientation in gaze perception. The psychophysiological deviations observed during gaze discrimination in SCZ underscore the role of early attentional and perceptual abnormalities in social information processing and paranoid symptoms of SCZ. (c) 2015 APA, all rights reserved).

Cultural Factors in Clinical Assessment.

ERIC Educational Resources Information Center

Westermeyer, Joseph

1987-01-01

Examines special issues in cross-cultural psychopathology, including culture-bound syndromes, variable distribution of psychopathology across cultures, and cultural distinctions between belief and delusion and between trance and hallucination. Offers suggestions for educating clinicians about cross-cultural conceptual issues and teaching the…

Symptoms of Lewy Body Dementia

MedlinePlus

... rest. Recurrent visual hallucinations of people, insects and animals may appear early in LBD. Delusions (i.e., fixed false beliefs), apathy (i.e., lack of initiative), agitation and depression are also common. REM sleep behavior disorder (i.e., vivid dreams with verbal or ...

Abortion in Adolescence.

ERIC Educational Resources Information Center

Campbell, Nancy B.; And Others

1988-01-01

Explored differences between 35 women who had abortions as teenagers and 36 women who had abortions as adults. Respondents reported on their premorbid psychiatric histories, the decision-making process itself, and postabortion distress symptoms. Antisocial and paranoid personality disorders, drug abuse, and psychotic delusions were significantly…

SALMON RECOVERY: CATEGORIZING AGENTS, DRIVERS, AND DELUSIONS

EPA Science Inventory

Throughout the southern region of western North America, many wild salmon stocks have declined and some have disappeared. The decline was induced by an extensively studied combination of causal agents. The public appears to support reversing the downward trajectory for wild sal...

[Cenesthopathies: a disorder of background emotions at the crossroads of the cognitive sciences and phenomenology].

PubMed

Graux, J; Lemoine, M; Gaillard, P; Camus, V

2011-10-01

Cenesthesia and cenesthopathy have played a fundamental role in 19th and early 20th century French and German psychiatry. Cenesthesia refers to the internal, global, implicit and affective perception of one's own body. The concept of cenesthopathy was coined by Dupre and Camus in 1907 to describe a clinical entity characterized by abnormal and strange bodily sensations. In this review, we examine the history of these concepts and the influence they have had on clinical, nosographical and phenomenological psychiatry and on cognitive neuropsychiatry. We performed a narrative review of the published research literature. Classical French and German psychiatrists have written extensively on cenesthesia and cenesthopathy although these notions are no longer in the mainstream of contemporary psychiatry. However, they are still present in contemporary psychiatric nosography in the form of some controversial clinical entities clearly related to cenesthesia such as cenesthetic schizophrenia, hypochondriacal monothematic delusions, or the Capgras and the Cotard syndromes. These clinical entities are all associated with a state of depersonalization. We point out the similarities between Ey's description of the depersonalization syndrome, especially in psychosis, and the characteristics of cenesthesia. Philosophers like Sartre or Merleau-Ponty have developed the concept of cenesthesia, and in particular have added new concepts like "body schema". Similarly, phenomenological psychiatrists like Minkowski or Tellenbach have attempted to describe psychiatric disorders associated with cenesthesia and have also proposed new concepts (i.e. atmospheric sense) in order to understand them better. More recently, cognitive neuropsychiatry has tried to discover the mechanisms, which cause or contribute to the genesis of delusions. The majority of delusion theories developed in cognitive neuropsychiatry consider that the explanation of monothematic delusions involves one or two explanatory stages. The first stage corresponds to an abnormal experience (the experiential stage) while the second is related to abnormal reasoning (the inferential stage). This theoretical first stage has been considered to be the result of a highly unusual or bizarre perceptual experience. According to the authors, this experience refers to a phenomenon of depersonalization, a loss of cenesthesia, or a loss of a feeling of familiarity. For example, the neurocognitive models of the Capgras and Cotard syndromes have in common the belief that they are both based on various kinds of unusual experiences. These unusual experiences are thought to include affective or emotional experiences. Capgras' syndrome is possibly triggered by an abnormal affective experience in response to the sight of closed-person's face. Similarly, the Cotard syndrome may result from a general flattening of affective responses to external stimuli. The inferential stage can also differentiate between the two syndromes. Some empirical validation has already been obtained in Capgras' syndrome but not yet in Cotard's syndrome. This review illustrates that the historical descriptions of cenesthesia and cenesthopathy remain relevant in contemporary neurocognitive models and more generally suggests that the comprehension of quite complex phenomena like delusion requires a multidisciplinary approach. Copyright © 2010 L’Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.

Portrait of an Illness.

ERIC Educational Resources Information Center

Ricci, Mary Lynne L.

1993-01-01

Author relates story of her own debilitation, survival, and ultimate rehabilitation from Systemic Lupus Erythematosus. Describes effects of disease process itself and of drug therapy that caused delusions and hallucinations. Traces how patient received art therapy through hospital occupational therapy department, describing her artwork and its…

Remission of depression in patients with schizophrenia and comorbid major depressive disorder: results from the FACE-SZ cohort.

PubMed

Fond, Guillaume; Boyer, Laurent; Berna, Fabrice; Godin, Ophélia; Bulzacka, Ewa; Andrianarisoa, Méja; Brunel, Lore; Aouizerate, Bruno; Capdevielle, Delphine; Chereau, Isabelle; Coulon, Nathalie; D'Amato, Thierry; Dubertret, Caroline; Dubreucq, Julien; Faget, Catherine; Leignier, Sylvain; Lançon, Christophe; Mallet, Jasmina; Misdrahi, David; Passerieux, Christine; Rey, Romain; Schandrin, Aurélie; Urbach, Mathieu; Vidailhet, Pierre; Leboyer, Marion; Schürhoff, Franck; Llorca, Pierre-Michel

2018-06-06

Major depressive disorder (MDD) is underdiagnosed and undertreated in schizophrenia, and has been strongly associated with impaired quality of life.AimsTo determine the prevalence and associated factors of MDD and unremitted MDD in schizophrenia, to compare treated and non-treated MDD. Participants were included in the FondaMental Expert Centers for Schizophrenia and received a thorough clinical assessment. MDD was defined by a Calgary score ≥6. Non-remitted MDD was defined by current antidepressant treatment (unchanged for >8 weeks) and current Calgary score ≥6. 613 patients were included and 175 (28.5%) were identified with current MDD. MDD has been significantly associated with respectively paranoid delusion (odds ratio 1.8; P = 0.01), avolition (odds ratio 1.8; P = 0.02), blunted affect (odds ratio 1.7; P = 0.04) and benzodiazepine consumption (odds ratio 1.8; P = 0.02). Antidepressants were associated with lower depressive symptoms score (5.4 v. 9.5; P < 0.0001); however, 44.1% of treated patients remained in non-remittance MDD. Nonremitters were found to have more paranoid delusion (odds ratio 2.3; P = 0.009) and more current alcohol misuse disorder (odds ratio 4.8; P = 0.04). No antidepressant class or specific antipsychotic were associated with higher or lower response to antidepressant treatment. MDD was associated with Metabolic syndrome (31.4 v. 20.2%; P = 0.006) but not with increased C-reactive protein. Antidepressant administration is associated with lower depressive symptom level in patients with schizophrenia and MDD. Paranoid delusions and alcohol misuse disorder should be specifically explored and treated in cases of non-remission under treatment. MetS may play a role in MDD onset and/or maintenance in patients with schizophrenia.Declaration of interestNone.

Subclinical delusional ideation and a self-reference bias in everyday reasoning.

PubMed

Galbraith, Niall; Manktelow, Ken; Morris, Neil

2008-02-01

Previous studies (e.g. Moller & Husby, 2000; Blackwood et al., 2004) have revealed that delusional thinking is accompanied by an exaggerated focus upon the self and upon stimuli that are perceived to be related to the self. The objective was to examine whether those high in subclinical delusional ideation exhibit a heightened tendency for self-reference. Using a mixed design, healthy individuals, classified into high- and low-scoring groups on the Peters et al. Delusions Inventory (Peters, Day, & Garety, 1996), were compared on everyday reasoning tasks across three experiments. High-PDI scorers, in contrast to the low-PDI group, rated self-referent objections to everyday arguments as stronger than other-referent objections and formulated more self-referent assertion-based objections to everyday arguments. The findings support the notion that subclinical delusional ideation is linked to a self-reference bias, which is evident in the sort of everyday thinking that people engage in when forming or evaluating their beliefs and which may contribute to delusion formation.

Analytic cognitive style, not delusional ideation, predicts data gathering in a large beads task study.

PubMed

Ross, Robert M; Pennycook, Gordon; McKay, Ryan; Gervais, Will M; Langdon, Robyn; Coltheart, Max

2016-07-01

It has been proposed that deluded and delusion-prone individuals gather less evidence before forming beliefs than those who are not deluded or delusion-prone. The primary source of evidence for this "jumping to conclusions" (JTC) bias is provided by research that utilises the "beads task" data-gathering paradigm. However, the cognitive mechanisms subserving data gathering in this task are poorly understood. In the largest published beads task study to date (n = 558), we examined data gathering in the context of influential dual-process theories of reasoning. Analytic cognitive style (the willingness or disposition to critically evaluate outputs from intuitive processing and engage in effortful analytic processing) predicted data gathering in a non-clinical sample, but delusional ideation did not. The relationship between data gathering and analytic cognitive style suggests that dual-process theories of reasoning can contribute to our understanding of the beads task. It is not clear why delusional ideation was not found to be associated with data gathering or analytic cognitive style.

Dopaminergic dysfunction in schizophrenia: salience attribution revisited.

PubMed

Heinz, Andreas; Schlagenhauf, Florian

2010-05-01

A dysregulation of the mesolimbic dopamine system in schizophrenia patients may lead to aberrant attribution of incentive salience and contribute to the emergence of psychopathological symptoms like delusions. The dopaminergic signal has been conceptualized to represent a prediction error that indicates the difference between received and predicted reward. The incentive salience hypothesis states that dopamine mediates the attribution of "incentive salience" to conditioned cues that predict reward. This hypothesis was initially applied in the context of drug addiction and then transferred to schizophrenic psychosis. It was hypothesized that increased firing (chaotic or stress associated) of dopaminergic neurons in the striatum of schizophrenia patients attributes incentive salience to otherwise irrelevant stimuli. Here, we review recent neuroimaging studies directly addressing this hypothesis. They suggest that neuronal functions associated with dopaminergic signaling, such as the attribution of salience to reward-predicting stimuli and the computation of prediction errors, are indeed altered in schizophrenia patients and that this impairment appears to contribute to delusion formation.

Using Co-Occurrence to Evaluate Belief Coherence in a Large Non Clinical Sample

PubMed Central

Pechey, Rachel; Halligan, Peter

2012-01-01

Much of the recent neuropsychological literature on false beliefs (delusions) has tended to focus on individual or single beliefs, with few studies actually investigating the relationship or co-occurrence between different types of co-existing beliefs. Quine and Ullian proposed the hypothesis that our beliefs form an interconnected web in which the beliefs that make up that system must somehow “cohere” with one another and avoid cognitive dissonance. As such beliefs are unlikely to be encapsulated (i.e., exist in isolation from other beliefs). The aim of this preliminary study was to empirically evaluate the probability of belief co-occurrence as one indicator of coherence in a large sample of subjects involving three different thematic sets of beliefs (delusion-like, paranormal & religious, and societal/cultural). Results showed that the degree of belief co-endorsement between beliefs within thematic groupings was greater than random occurrence, lending support to Quine and Ullian’s coherentist account. Some associations, however, were relatively weak, providing for well-established examples of cognitive dissonance. PMID:23155383

Delusions and prediction error: clarifying the roles of behavioural and brain responses

PubMed Central

Corlett, Philip Robert; Fletcher, Paul Charles

2015-01-01

Griffiths and colleagues provided a clear and thoughtful review of the prediction error model of delusion formation [Cognitive Neuropsychiatry, 2014 April 4 (Epub ahead of print)]. As well as reviewing the central ideas and concluding that the existing evidence base is broadly supportive of the model, they provide a detailed critique of some of the experiments that we have performed to study it. Though they conclude that the shortcomings that they identify in these experiments do not fundamentally challenge the prediction error model, we nevertheless respond to these criticisms. We begin by providing a more detailed outline of the model itself as there are certain important aspects of it that were not covered in their review. We then respond to their specific criticisms of the empirical evidence. We defend the neuroimaging contrasts that we used to explore this model of psychosis arguing that, while any single contrast entails some ambiguity, our assumptions have been justified by our extensive background work before and since. PMID:25559871

Understanding egorrhea from cultural-clinical psychology

PubMed Central

Sasaki, Jun; Wada, Kaori; Tanno, Yoshihiko

2013-01-01

Based on his observations in Japanese clinical settings, Fujinawa (1972) conceptualized egorrhea syndrome, which includes symptoms such as erythrophobia, fear of eye-to-eye confrontation, olfactory reference syndrome, delusions of soliloquy, delusions of sleep talking, and thought broadcasting. The key feature of this syndrome is self-leakage, a perceived sense that one's personal internal information, such as feelings and thoughts, are leaking out. To reach a more comprehensive understanding of egorrhea, this paper aims to present general overview and reconsider the phenomenon of self-leakage using cultural-clinical psychology as a framework. First, the symptoms of egorrhea are reviewed in relation to other related psychopathologies such as social anxiety disorder (SAD) and taijin kyofusho (TKS), as well as schizophrenia. Second, a series of empirical studies conducted using Japanese non-clinical samples are summarized. The results of these studies form the basis for subsequent discussions, which incorporates the cultural-clinical psychology perspective proposed by Ryder et al. (2011). This paper ends with a general discussion regarding implications for research and clinical practice. PMID:24348445

[Transsexualism or delusions of sex change? Avoiding misdiagnosis].

PubMed

Urban, Małgorzata

2009-01-01

The aim of this paper was to present basic data about gender identity disorders and psychotic transsexual desires. From time to time in scientific literature there are descriptions of a diagnosis of psychotic disorders in persons previously diagnosed and treated as transsexuals, in whom the transsexual thinking disappears after using antipsychotic agents. Coexistence of transsexualism and schizophrenia causes a lot of doubt--it is observed in scientists opinions but also in the diagnostic criteria of DSM-IV and ICD-10. Moreover, delusions of sex change are probably more frequent than it is thought. It causes, that in some cases the differential diagnosis of psychosis and gender identity disorders may be very difficult. Transsexuals treatment is on one hand connected with expected effects but on the other hand with many serious, often irreversible health consequences (e.g. cardiovascular disease, risk of neoplasma development, infertility, consequences of surgical sex reassignment). That is why the differential diagnosis of transsexualism and schizophrenia should be made carefully and thoughtfully.

A Parallel Distributed Processing Approach to Behavior and Biology in Schizophrenia

DTIC Science & Technology

1989-10-01

delusions) and the other that reflects dopamine underactivity (negative symptoms - e.g., avolition, amotivation and withdrawal). Several authors have... amotivation . While both may be related to frontal lobe Behavior and Biology in Schizophrenia Cohen and Servan-Schreiber 32 deficits, the models in their

Darth Vader: Masks, Power, and Meaning.

ERIC Educational Resources Information Center

Rojcewicz, Stephen

1987-01-01

Investigates Darth Vader's character from the "Star Wars" movies, stimulated by the psychiatric treatment of a schizophrenic male with the delusion that he was Darth Vader. Discusses the temptations and threats from Darth Vader, which coincide with themes and fantasies of childhood and adolescence. Suggests that Darth Vader's sacrifice…

"Gold Is Every Man's Opportunity": Castration Anxiety and the Economic Venture in "Deadwood"

ERIC Educational Resources Information Center

Wiggins, Kyle; Holmberg, David

2007-01-01

David Milch, creator of HBO's critically acclaimed Western series, "Deadwood," said, "The only reason the town of Deadwood exists is gold." Milch bluntly discards the Western genre's foundational ideology of self-determination, considering these principles a delusion that obscures the material realities of the late nineteenth…

[Self-neglect as a sign of decompensation].

PubMed

Jean-Louis, Eric

2015-01-01

A lack of hygiene to which the patient appears indifferent, self-neglect can be a sign of the decompensation of a mental pathology. This article presents the case of a patient who, after several months of stabilisation and a return home to a relatively clean environment, reactivates a delusion of persecution.

IQ Tests Are Not for Machines, Yet

ERIC Educational Resources Information Center

Dowe, David L.; Hernandez-Orallo, Jose

2012-01-01

Complex, but specific, tasks--such as chess or "Jeopardy!"--are popularly seen as milestones for artificial intelligence (AI). However, they are not appropriate for evaluating the intelligence of machines or measuring the progress in AI. Aware of this delusion, Detterman has recently raised a challenge prompting AI researchers to evaluate their…

Should psychology be 'positive'? Letting the philosophers speak: Commentary on... Hope, optimism and delusion.

PubMed

Oyebode, Femi

2014-04-01

This is a brief commentary on the value of optimism in therapy. It draws on the philosophical writings of Schopenhauer and Aristotle. It suggests that the modern preoccupation with optimism may be as extreme as the bleak pessimistic outlook favoured by Schopenhauer.

[Narcissism and religiosity].

PubMed

Emmanouilidis, C

2007-07-01

The author attempts a selective review of the concept of narcissism from Freud and its development from the theorists of objects relationships. He also describes the religiosity in the psychopathology and in every day life and at last he discusses how the defense structure of narcissism and religiosity interweaved and restrained the capability of the subject to love and create. There are used vignettes from the psychoanalysis of three patients and an allegory from the New Testament. The author suggests that the passing through the paranoid-schizoid to the depressive position helps the narcissistic personality to free itself not only of persecutory anxieties but also of depressive anxieties and to complete mourning. In this position he no needs any more to use the religion to protect himself from his pain but he can use it to "know" the other.

Are University Students Really Customers? When Illusion May Lead to Delusion for All!

ERIC Educational Resources Information Center

Svensson, Goran; Wood, Greg

2007-01-01

Purpose: The marketing concept is an idea that has been adopted in non-marketing contexts, such as the relationships between universities and their students. This paper aims to posit that marketing metaphors are inappropriate to describe the student-university relationship. Design/methodology/approach: The authors provide a conceptual discussion…

The Research Imagination in a World on the Move

ERIC Educational Resources Information Center

Kenway, Jane; Fahey, Johannah

2006-01-01

This paper focuses on the shifting terrain of mobile researchers beginning with an overview of research and research policy on "brain mobility", and then discussing what we call their optical illusions/delusions. Subsequently, our main purpose is to elaborate on a line of inquiry that offers richer notions of researcher mobility, connectivity and…

Cotard syndrome with catatonia: unique combination.

PubMed

Basu, Aniruddha; Singh, Priti; Gupta, Rajiv; Soni, Sandeep

2013-07-01

Cotard syndrome is a rare psychiatric condition characterized by extreme nihilistic delusions. Catatonia though common, its combination with the Cotard syndrome is exceeding rare and more so the response with the pharmacotherapy as in our case. Since, both are found in organic conditions the importance of studying such a case is to understand the underlying neurobiologic determinants.

Romantic Love: A Special Case of Social Competence.

ERIC Educational Resources Information Center

Warren, James D.

Two different clinical models provide different explanations of the interactions that typically occur in romantic love. One portrays love as one of the great delusions of the human experience, while the other suggests that romantic love is one of the great possibilities of the human experience. The delusional hypothesis, presented by Casler (1973)…

Browne's Capgas Delusion: The Destruction of the Public University

ERIC Educational Resources Information Center

Holligan, Chris; Chiang, Kuang-Hsu

2011-01-01

The recent publication of the UK government's Browne Review 2010 on university and student funding signifies a massive step towards embedding capitalist free-market consumerist values and practices into UK higher education. This paper critically examines that paradigm shift away from public sector provision from the perspective of French Theory,…

Psychotic symptoms in acromegaly

PubMed Central

Pinto, Denzil; Safeekh, A.T.; Trivedi, Mohit

2005-01-01

Various psychiatric symptoms have been reported in patients with acromegaly. Most of them are personality changes characterized by lack of initiative and spontaneity. There are few case reports of the presence of auditory and visual hallucinations, and delusions in patients with acromegaly. We report a patient with acromegaly who had psychotic symptoms including Schneiderian first-rank symptoms.

On the Delusiveness of Adopting a Common Space for Modeling IR Objects: Are Queries Documents?

ERIC Educational Resources Information Center

Bollmann-Sdorra, Peter; Raghavan, Vjay V.

1993-01-01

Proposes that document space and query space have different structures in information retrieval and discusses similarity measures, term independence, and linear structure. Examples are given using the retrieval functions of dot-product, the cosine measure, the coefficient of Jaccard, and the overlap function. (Contains 28 references.) (LRW)

Oppositional Culture Theory and the Delusion of Colorblindness

ERIC Educational Resources Information Center

Berlowitz, Marvin J.; Hutchins, Brandi N.; Jenkins, Derrick J.; Mussman, Mark P.; Schneider, Carri A.

2006-01-01

Oppositional culture theory is a widely accepted explanation for disparities in academic performance between middle class Whites and middle class African Americans. The authors make the case that oppositional culture theory has its roots in cultural deficit theory popularized in the early 1960s and present a significant body of evidence to refute…

Prefrontal cortex dysfunction and 'Jumping to Conclusions': bias or deficit?

PubMed

Lunt, Laura; Bramham, Jessica; Morris, Robin G; Bullock, Peter R; Selway, Richard P; Xenitidis, Kiriakos; David, Anthony S

2012-03-01

The 'beads task' is used to measure the cognitive basis of delusions, namely the 'Jumping to Conclusions' (JTC) reasoning bias. However, it is not clear whether the task merely taps executive dysfunction - known to be impaired in patients with schizophrenia - such as planning and resistance to impulse. To study this, 19 individuals with neurosurgical excisions to the prefrontal cortex, 21 unmedicated adults with Attention Deficit Hyperactivity Disorder (ADHD), and 25 healthy controls completed two conditions of the beads task, in addition to tests of memory and executive function as well as control tests of probabilistic reasoning ability. The results indicated that the prefrontal lobe group (in particular, those with left-sided lesions) demonstrated a JTC bias relative to the ADHD and control groups. Further exploratory analyses indicated that JTC on the beads task was associated with poorer performance in certain executive domains. The results are discussed in terms of the executive demands of the beads task and possible implications for the model of psychotic delusions based on the JTC bias. ©2011 The British Psychological Society.

Mad scientist: the unique case of a published delusion.

PubMed

Shelomi, Matan

2013-06-01

In 1951, entomologist Jay Traver published in the Proceedings of the Entomological Society of Washington her personal experiences with a mite infestation of her scalp that resisted all treatment and was undetectable to anyone other than herself. Traver is recognized as having suffered from Delusory Parasitosis: her paper shows her to be a textbook case of the condition. The Traver paper is unique in the scientific literature in that its conclusions may be based on data that was unconsciously fabricated by the author's mind. The paper may merit retraction on the grounds of error or even scientific misconduct "by reason of insanity," but such a retraction raises the issue of discrimination against the mentally ill. This article asks what responsibilities journals have when faced with delusions disguised as science, what right editors have to question the sanity of an author, and what should be done about the Traver paper itself. By placing higher emphasis on article content than author identity, scientific integrity is maintained and a balance is struck between avoiding discrimination against the mentally ill and not preventing patients from seeking needed treatment.

Creativity and psychopathology: higher rates of psychosis proneness and nonright-handedness among creative artists compared to same age and gender peers.

PubMed

Preti, Antonio; Vellante, Marcello

2007-10-01

Creative people have been found to score higher on psychopathologic scales in standardized tests, particularly on the scales that measure traits of psychoticism, and to be more likely to report an excess of nonright handedness compared with controls. However, results are inconsistent across surveys and methodologies, and the contribution of substance abuse has rarely been measured. In this study, 80 creative artists were compared with 80 matched noncreative controls on the Annett Hand Preference Questionnaire (HPQ), the Peters et al. Delusions Inventory, and the General Health Questionnaire. Creative artists were statistically more likely to admit the use of the left hand on the HPQ, with more widespread left hand use reported by artists involved in the creative activities traditionally associated with the right hemisphere (music and painting). They also scored higher on the Peters et al. Delusions Inventory independently from the level of psychopathology (measured with the General Health Questionnaire), from their laterality score (measured with the HPQ), and from their higher use of both licit and illicit drugs.

Lycanthropy as a culture-bound syndrome: a case report and review of the literature.

PubMed

Bou Khalil, Rami; Dahdah, Pierre; Richa, Sami; Kahn, David A

2012-01-01

Lycanthropy is an unusual belief or delusion that one has been transformed into an animal, or behaviors or feelings suggestive of such a belief. We report a case of lycanthropic delusions of becoming a snake in a 47-year-old woman who suffered from a major depressive disorder with psychotic features. We also present a literature review of articles published on the subject in English or French since 1975 identified via a MedLine search using the terms "lycanthropy" or "werewolf." Many case reports have described lycanthropy as a delusional disorder occurring acutely in patients who think they suffer from a demonic possession as a punishment for their acts. In these cases, symptoms are generally rapidly reversible. Lycanthropy seems to be a nonspecific manifestation of many psychiatric diseases, most commonly major depressive disorder with psychotic features. It is largely influenced by the cultural environment of the patient so that the animal species frequently represents the patient's delusional representation of evil. Lycanthropy could be considered a culture-bound syndrome that occurs in association with Axis I, DSM-IV psychiatric pathology.

Phenomenology of hallucinations, illusions, and delusions as part of seizure semiology.

PubMed

Kasper, B S; Kasper, E M; Pauli, E; Stefan, H

2010-05-01

In partial epilepsy, a localized hypersynchronous neuronal discharge evolving into a partial seizure affecting a particular cortical region or cerebral subsystem can give rise to subjective symptoms, which are perceived by the affected person only, that is, ictal hallucinations, illusions, or delusions. When forming the beginning of a symptom sequence leading to impairment of consciousness and/or a classic generalized seizure, these phenomena are referred to as an epileptic aura, but they also occur in isolation. They often manifest in the fully awake state, as part of simple partial seizures, but they also can be associated to different degrees of disturbed consciousness. Initial ictal symptoms often are closely related to the physiological functions of the cortical circuit involved and, therefore, can provide localizing information. When brain regions related to sensory integration are involved, the seizure discharge can cause specific kinds of hallucinations, for example, visual, auditory, gustatory, olfactory, and cutaneous sensory sensations. In addition to these elementary sensory perceptions, quite complex hallucinations related to a partial seizure can arise, for example, perception of visual scenes or hearing music. By involving psychic and emotional spheres of human perception, many seizures also give rise to hallucinatory emotional states (e.g., fear or happiness) or even more complex hallucinations (e.g., visuospatial phenomena), illusions (e.g., déjà vu, out-of-body experience), or delusional beliefs (e.g., identity change) that often are not easily recognized as epileptic. Here we suggest a classification into elementary sensory, complex sensory, and complex integratory seizure symptoms. Epileptic hallucinations, illusions, and delusions shine interesting light on the physiology and functional anatomy of brain regions involved and their functions in the human being. This article, in which 10 cases are described, introduces the fascinating phenomenology of subjective seizure symptoms. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Management of non-motor complications in Parkinson's disease.

PubMed

Fujimoto, Ken-ichi

2009-08-01

This paper summarizes the methods we devised for the treatment of psychosis, orthostatic hypotension, and mood disorders among the various non-motor complications of Parkinson's disease. Psychosis may not manifest when a patient believes in his/her delusions. If left untreated over a prolonged period, however, the delusions progress to paranoia that is very difficult to cure. Accordingly, enquiries should be made during routine examinations to detect the presence of psychosis and facilitate early discovery. Atypical antipsychotics are used when psychosis does not improve after reducing the doses of antiparkinson drugs. We achieved favorable results by using mianserin hydrochloride prior to this step, with efficacy being observed for hallucinations and mild delusions that often manifested at night. This drug does not act as a dopamine receptor blocker, so it has the advantage of not aggravating motor symptoms. With this therapy, it is also possible to improve motor symptoms without inducing psychosis by reducing the doses of antiparkinson drugs and locally stimulating the motor loop by deep brain stimulation of the subthalamic nucleus. We previously introduced leg-holding exercises for the treatment of orthostatic hypotension, through which blood pooled in the veins is returned to the systemic circulation by holding the knees. This can be done easily and is free of adverse reactions. Mood disorders are difficult to cope with in patients with Parkinson's disease, but may be treated by selecting an appropriate dopamine agonist while giving consideration to affinity for the dopamine D3 receptor. However, treatment becomes complicated when the dopamine receptor is overstimulated. Here we report on cases of successfully treated pathological gambling and dopamine dysregulation syndrome, which are considered difficult to manage. The solution may differ depending on a patient's environment, and it is not easy to prescribe therapy based on evidence-based medicine. The best therapy should be selected by maintaining communication with the patient and developing a relationship built on trust.

Modelling psychiatric and cultural possession phenomena with suggestion and fMRI.

PubMed

Deeley, Quinton; Oakley, David A; Walsh, Eamonn; Bell, Vaughan; Mehta, Mitul A; Halligan, Peter W

2014-04-01

Involuntary movements occur in a variety of neuropsychiatric disorders and culturally influenced dissociative states (e.g., delusions of alien control and attributions of spirit possession). However, the underlying brain processes are poorly understood. We combined suggestion and fMRI in 15 highly hypnotically susceptible volunteers to investigate changes in brain activity accompanying different experiences of loss of self-control of movement. Suggestions of external personal control and internal personal control over involuntary movements modelled delusions of control and spirit possession respectively. A suggestion of impersonal control by a malfunctioning machine modelled technical delusions of control, where involuntary movements are attributed to the influence of machines. We found that (i) brain activity and/or connectivity significantly varied with different experiences and attributions of loss of agency; (ii) compared to the impersonal control condition, both external and internal personal alien control were associated with increased connectivity between primary motor cortex (M1) and brain regions involved in attribution of mental states and representing the self in relation to others; (iii) compared to both personal alien control conditions, impersonal control of movement was associated with increased activity in brain regions involved in error detection and object imagery; (iv) there were no significant differences in brain activity, and minor differences in M1 connectivity, between the external and internal personal alien control conditions. Brain networks supporting error detection and object imagery, together with representation of self and others, are differentially recruited to support experiences of impersonal and personal control of involuntary movements. However, similar brain systems underpin attributions and experiences of external and internal alien control of movement. Loss of self-agency for movement can therefore accompany different kinds of experience of alien control supported by distinct brain mechanisms. These findings caution against generalization about single cognitive processes or brain systems underpinning different experiences of loss of self-control of movement. Copyright © 2014 Elsevier Ltd. All rights reserved.

Behavioural and psychological symptoms in general hospital patients with dementia, distress for nursing staff and complications in care: results of the General Hospital Study.

PubMed

Hessler, J B; Schäufele, M; Hendlmeier, I; Junge, M N; Leonhardt, S; Weber, J; Bickel, H

2018-06-01

Little is known about how behavioural and psychological symptoms of dementia (BPSD) manifest in the general hospital. The aim was to examine the frequency of BPSD in general hospitals and their associations with nursing staff distress and complications in care. Cross-sectional representative study with 1469 patients aged ≥65, including 270 patients with dementia, of 33 randomly selected general hospitals in Germany. BPSD and complications were reported by nurses. Overall frequency of BPSD was higher in patients with dementia (76%) than without (38%). The most frequent symptoms in patients with dementia were nighttime disturbances (38%), depression (29%) and aberrant motor behaviour (28%) and the most distressing symptoms for nursing staff were delusions, aggression and nighttime disturbances. The overall frequency of BPSD increased from 67% in mild dementia, to 76% in moderate dementia and to 88% in severe dementia. The most frequent symptoms in patients without dementia were depression (19%), nighttime disturbances (13%) and irritability (13%). The most distressing symptoms were aggression and delusions, while the same symptoms were consistently rated as less distressing than in patients with dementia. Factor analysis revealed three independent groups of BPSD that explained 45% of the total variance. First, expansive symptoms (aggression, irritability, nighttime disturbances, aberrant motor behaviour and disinhibition) were frequent, distressing for nursing staff and associated with many complications. Second, psychotic symptoms (delusions and hallucinations) were infrequent, distressing and associated with some complications. Third, affective symptoms (apathy, anxiety and depression) were frequent, non-distressing and associated with few complications. The results did not change when cases with delirium were excluded from both groups. BPSD are common in older hospital patients with dementia and associated with considerable distress in nursing staff, as well as a wide range of special treatments needs and additional behavioural and medical complications. Management strategies are needed to improve the situation for both patients and hospital staff.

Methamphetamine psychosis: epidemiology and management.

PubMed

Glasner-Edwards, Suzette; Mooney, Larissa J

2014-12-01

Psychotic symptoms and syndromes are frequently experienced among individuals who use methamphetamine, with recent estimates of up to approximately 40 % of users affected. Although transient in a large proportion of users, acute symptoms can include agitation, violence, and delusions, and may require management in an inpatient psychiatric or other crisis intervention setting. In a subset of individuals, psychosis can recur and persist and may be difficult to distinguish from a primary psychotic disorder such as schizophrenia. Differential diagnosis of primary vs. substance-induced psychotic disorders among methamphetamine users is challenging; nevertheless, with careful assessment of the temporal relationship of symptoms to methamphetamine use, aided by state-of-the art psychodiagnostic assessment instruments and use of objective indicators of recent substance use (i.e., urine toxicology assays), coupled with collateral clinical data gathered from the family or others close to the individual, diagnostic accuracy can be optimized and the individual can be appropriately matched to a plan of treatment. The pharmacological treatment of acute methamphetamine-induced psychosis may include the use of antipsychotic medications as well as benzodiazepines, although symptoms may resolve without pharmacological treatment if the user is able to achieve a period of abstinence from methamphetamine. Importantly, psychosocial treatment for methamphetamine dependence has a strong evidence base and is the optimal first-line treatment approach to reducing rates of psychosis among individuals who use methamphetamines. Prevention of methamphetamine relapse is the most direct means of preventing recurrence of psychotic symptoms and syndromes. Long-term management of individuals presenting with recurrent and persistent psychosis, even in the absence of methamphetamine use, may include both behavioral treatment to prevent resumption of methamphetamine use and pharmacological treatment targeting psychotic symptoms. In addition, treatment of co-occurring psychiatric disorders including depression and anxiety is important as a means of preventing relapse to methamphetamine use, which is often triggered by associated symptoms.

Methamphetamine Psychosis: Epidemiology and Management

PubMed Central

Glasner-Edwards, Suzette; Mooney, Larissa J.

2016-01-01

Psychotic symptoms and syndromes are frequently experienced among individuals who use methamphetamine, with recent estimates of up to approximately 40% of users affected. Though transient in a large proportion of users, acute symptoms can include agitation, violence, and delusions, and may require management in an inpatient psychiatric or other crisis intervention setting. In a subset of individuals, psychosis can recur and persist and may be difficult to distinguish from a primary psychotic disorder such as schizophrenia. Differential diagnosis of primary versus substance-induced psychotic disorders among methamphetamine users is challenging; nevertheless, with careful assessment of the temporal relationship of symptoms to methamphetamine use, aided by state-of-the art psychodiagnostic assessment instruments and use of objective indicators of recent substance use (i.e., urine toxicology assays), coupled with collateral clinical data gathered from the family or others close to the individual, diagnostic accuracy can be optimized and the individual can be appropriately matched to a plan of treatment. The pharmacological treatment of acute methamphetamine-induced psychosis may include the use of antipsychotic medications as well as benzodiazepines, although symptoms may resolve without pharmacological treatment if the user is able to achieve a period of abstinence from methamphetamine. Importantly, psychosocial treatment for methamphetamine dependence has a strong evidence base and is the optimal first-line treatment approach to reducing rates of psychosis among individuals who use methamphetamines. Prevention of methamphetamine relapse is the most direct means of preventing recurrence of psychotic symptoms and syndromes. Long-term management of individuals who present with recurrent and persistent psychosis, even in the absence of methamphetamine use, may include both behavioral treatment to prevent resumption of methamphetamine use and pharmacological treatment targeting psychotic symptoms. In addition, treatment of co-occurring psychiatric disorders including depression and anxiety is important as a means of preventing relapse to methamphetamine use, which is often triggered by associated symptoms. PMID:25373627

Delusions of Singularity: Aesthetics, Discomfort and Bewilderment in Kashmir

ERIC Educational Resources Information Center

Dinesh, Nandita

2015-01-01

In Kashmir, where the act of performing a script-based play on a proscenium stage is still seen by many as a controversial gesture, "Cages" involved the devised creation of a site responsive and immersive performance that placed two spectators, literally, in the shoes of an(Other). The potential of these forms of spectatorship, as…

Behavioral Experiments in the Treatment of Paranoid Schizophrenia: A Single Case Study

ERIC Educational Resources Information Center

Hagen, Roger; Nordahl, Hans M.

2008-01-01

Since the first description of cognitive therapy of paranoid delusions appeared in the literature, the empirical support for cognitive behavioral therapy in treating psychotic symptoms has been widely established. The aim of the present case study is to show how the behavioral experiment can be used as a powerful tool to change delusional thinking…

Cotard Syndrome with Catatonia: Unique Combination

PubMed Central

Basu, Aniruddha; Singh, Priti; Gupta, Rajiv; Soni, Sandeep

2013-01-01

Cotard syndrome is a rare psychiatric condition characterized by extreme nihilistic delusions. Catatonia though common, its combination with the Cotard syndrome is exceeding rare and more so the response with the pharmacotherapy as in our case. Since, both are found in organic conditions the importance of studying such a case is to understand the underlying neurobiologic determinants. PMID:24249939

Education, Politics and Religion: Reconciling the Civil and the Sacred in Education

ERIC Educational Resources Information Center

Arthur, James; Gearon, Liam; Sears, Alan

2010-01-01

In recent years a number of popular books have savaged religion arguing it is a dangerous delusion that poisons human societies and relationships. This is but the most recent manifestation of a secularising agenda that has been sweeping contemporary democratic societies since the Enlightenment. This book pushes back against that agenda, examining…

Cognitive Coping Tool Kit for Psychosis: Development of a Group-Based Curriculum

ERIC Educational Resources Information Center

Goldberg, Joel O.; Wheeler, Heather; Lubinsky, Tobi; Van Exan, Jessica

2007-01-01

This article outlines an 8-week curriculum that was created to help outpatients develop cognitive and behavioral skills for coping with delusions and hallucinations as well as to reduce patients' comorbid subjective levels of distress (e.g., depression, anxiety). The manualized protocol consisted of psychoeducation and training in a variety of CBT…

Research: Rags to Rags? Riches to Riches?

ERIC Educational Resources Information Center

Bracey, Gerald W.

2004-01-01

Everyone has read about what might be called the "gold gap"--how the rich in this country are getting richer and controlling an ever-larger share of the nation's wealth. The Century Foundation has started publishing "Reality Check", a series of guides to campaign issues that sometimes finds gaps in these types of cherished delusions. The guides…

Dangerous Knowledge: On the Epistemic and Moral Significance of Arts in Education

ERIC Educational Resources Information Center

Carr, David

2010-01-01

Despite differences, it would seem that Plato and Aristotle agreed in according epistemic and educational significance to the arts. Whereas Plato regarded the arts as (largely) sources of sophistry and delusion and was prepared to exile the artist from his ideal state, Aristotle clearly considered poetry to be of value for the education of…

[The clinico-psychopathological differentiation of schizoaffective psychoses with a predominance of affective disorders].

PubMed

Korenev, A N

1994-01-01

Basing on the clinico-psychopathological analysis of 43 patients with an affect-dominant form of schizoaffective psychosis, their typological division has been suggested. The interrelations of clinical types of delusional disturbances with affective disorders, their polarity, congruent and noncongruent delusions were shown. The discussion covers differential-diagnostic characteristics of affective states in schizoaffective and affective psychoses.

The Grand Strategy of the United States

DTIC Science & Technology

2014-10-01

as a new American ideology, based on notions of personal liberty, egalitarianism, individualism, republicanism, populism, and laissez - faire ...the global challenges of the moment in a larger framework of diplomacy, economic strength, military power, and global leadership . Presidents do...Nye, Soft Power: The Means to Succeed in World Politics (New York: PublicAf- fairs , 2004). 56 Christopher M. Schnaubelt, “The Illusions and Delusions

Delusions of Grandeur: The Search for a Vibrant Rural America. Staff Paper.

ERIC Educational Resources Information Center

Freshwater, David

Rural development is rarely defined and there is no clear definition of what the development process intends to accomplish. The nature of the larger economy in which rural places must operate has changed in ways that reduce the relative advantage of most rural areas and have left them struggling to define new economic functions. The political…

'We Are Equals'; Datum or Delusion: Perceptions of Muslim Women Academics in Three Malaysian Universities

ERIC Educational Resources Information Center

Shah, Saeeda

2018-01-01

Islam underlines equality between women and men regarding their spiritual and intellectual potential. However, given interpretations of religious texts are often availed to suppress women in most Muslim societies, with serious implications for gender equality in the domestic and the professional spheres. This article draws on data from a study of…

The Criterion and Discriminant Validity of the Referential Thinking (REF) Scale

ERIC Educational Resources Information Center

Startup, Mike; Sakrouge, Rebecca; Mason, Oliver J.

2010-01-01

The Referential Thinking (REF) scale was designed to be a comprehensive self-report measure of both simple and guilty ideas of reference in the general population. One aim of the present study was to test the proposed interpretations of REF scores by comparing REF scores with ratings of delusions among psychotic patients. A 2nd aim was to test…

The allusive cognitive deficit in paranoia: the case for mental time travel or cognitive self-projection.

PubMed

Corcoran, R

2010-08-01

Delusional beliefs are characteristic of psychosis and, of the delusions, the paranoid delusion is the single most common type associated with psychosis. The many years of research focused on neurocognition in schizophrenia, using standardized neurocognitive tests, have failed to find conclusive cognitive deficits in relation to positive symptoms. However, UK-based psychological research has identified sociocognitive anomalies in relation to paranoid thinking in the form of theory of mind (ToM), causal reasoning and threat-related processing anomalies. Drawing from recent neuroscientific research on the default mode network, this paper asserts that the common theme running through the psychological tests that are sensitive to the cognitive impairment of paranoia is the need to cognitively project the self through time, referred to as mental time travel. Such an understanding of the cognitive roots of paranoid ideation provides a synthesis between psychological and biological accounts of psychosis while also retaining the powerful argument that understanding abnormal thinking must start with models of normal cognition. This is the core theme running through the cognitive psychological literature of psychiatric disorders that enables research from this area to inform psychological therapy.

Symptomatology and social inference: a theory of mind study of schizophrenia and psychotic affective disorder.

PubMed

Marjoram, Dominic; Gardner, Clare; Burns, Jonathan; Miller, Patrick; Lawrie, Stephen M; Johnstone, Eve C

2005-11-01

There is evidence that certain patients with schizophrenia have deficits in theory of mind (ToM) capabilities. It is, however, unclear whether these are symptom or diagnosis-specific. A ToM hinting task was given to 15 patients with a DSM-IV diagnosis of schizophrenia, 15 patients with affective disorder and 15 healthy controls. Severity of the current psychopathology was measured using the Krawiecka standardised scale of psychotic symptoms (Krawiecka, Goldberg, & Vaughan, 1977); IQ was estimated via the Ammons and Ammons Quick Test (Ammons & Ammons, 1962). The group with schizophrenia performed significantly worse than the affective and control groups. Poor performance on the hinting task was found to be significantly related to the presence of positive symptoms (instead of negative ones) and specifically related to delusions and hallucinations. These findings remained when covariance for potentially confounding variables was applied. Individuals with high levels of delusions and hallucinations performed significantly worse on this ToM task, regardless of diagnosis, implying ToM impairment is not exclusive to schizophrenia but is evident in other forms of psychosis. Between-group analyses showed the schizophrenia group had a significantly poorer performance on this task than the others.

The messianic idea and messianic delusion.

PubMed

Perez, L

1978-01-01

The messianic delusional syndrome repeats an historical prototype that manifests itself in each patient with individual changes. The syndrome expresses a serious impairment of identity and reflects a social, cultural and religious reality through generations. The regularities of its clinical features comprise a delusional system, centered on the patient's conviction that he has been chosen by God for a special and intransferable mission. The patient has special powers for carrying out this mission. He is a savior and announces resurrection. His delusions have a clear symbolic character. For the patient's social group, the messianic idea is an attempt at annulling the effect of oppression or persecution that have become unbearable for the individual. They represent a flight from the human sphere and an attempt to be God. The patient's behavior is in consonance with this purpose; it expresses itself, on the one hand, through preaching repentance and compassion and, on the other hand, the patient gives up his earthly links and replaces them by parental relations with God. In the above-mentioned context, the author analyzes the different elements of the religious conception in the Christian, Moslem and Jewish religions, and the way each of them expresses itself in the general symptomatology.

Testing the connections within face processing circuitry in Capgras delusion with diffusion imaging tractography

PubMed Central

Bobes, Maria A.; Góngora, Daylin; Valdes, Annette; Santos, Yusniel; Acosta, Yanely; Fernandez Garcia, Yuriem; Lage, Agustin; Valdés-Sosa, Mitchell

2016-01-01

Although Capgras delusion (CD) patients are capable of recognizing familiar faces, they present a delusional belief that some relatives have been replaced by impostors. CD has been explained as a selective disruption of a pathway processing affective values of familiar faces. To test the integrity of connections within face processing circuitry, diffusion tensor imaging was performed in a CD patient and 10 age-matched controls. Voxel-based morphometry indicated gray matter damage in right frontal areas. Tractography was used to examine two important tracts of the face processing circuitry: the inferior fronto-occipital fasciculus (IFOF) and the inferior longitudinal (ILF). The superior longitudinal fasciculus (SLF) and commissural tracts were also assessed. CD patient did not differ from controls in the commissural fibers, or the SLF. Right and left ILF, and right IFOF were also equivalent to those of controls. However, the left IFOF was significantly reduced respect to controls, also showing a significant dissociation with the ILF, which represents a selective impairment in the fiber-tract connecting occipital and frontal areas. This suggests a possible involvement of the IFOF in affective processing of faces in typical observers and in covert recognition in some cases with prosopagnosia. PMID:26909325

[The Cotard syndrome in schizophrenic disorders].

PubMed

Stompe, Thomas; Schanda, Hans

2013-01-01

The Cotard-Syndrome (CS), the belief of being dead, was described for the first time in 1880. Since then it met the interest not only of psychopathologists but also of philosophers. With a few exceptions, the literature is mainly restricted to case reports of anxious-depressive, demented or paranoid patients. It was the aim of our study to investigate the prevalence and the psychopathological context of the CS. We analyzed the Austrian data (N = 346) of the International Study of Psychotic Symptoms in Schizophrenia. A CS could be diagnosed in three cases (0.87%). In all of them, CS developed on the basis of nihilistic-hypochondriac delusions and a progressive loss of energy. Two patients bridged the logical inconsistencies between obviously being alive and the belief of being dead by visual illusions, the third patient, however, by locating himself in an intermediate region between this world and the afterworld. On the one hand the CS can be considered as a special manifestation of the topic of death in schizophrenic delusions, on the other as a nihilistic delusional identity. Without doubt, this uncommon and bizarre psychotic phenomenon will be an object of interest for general psychopathology as well as for the philosophy of mind also in future.

Perceptual Anomalies in Schizophrenia: Integrating Phenomenology and Cognitive Neuroscience

PubMed Central

Uhlhaas, Peter J.; Mishara, Aaron L.

2007-01-01

From phenomenological and experimental perspectives, research in schizophrenia has emphasized deficits in “higher” cognitive functions, including attention, executive function, as well as memory. In contrast, general consensus has viewed dysfunctions in basic perceptual processes to be relatively unimportant in the explanation of more complex aspects of the disorder, including changes in self-experience and the development of symptoms such as delusions. We present evidence from phenomenology and cognitive neuroscience that changes in the perceptual field in schizophrenia may represent a core impairment. After introducing the phenomenological approach to perception (Husserl, the Gestalt School), we discuss the views of Paul Matussek, Klaus Conrad, Ludwig Binswanger, and Wolfgang Blankenburg on perception in schizophrenia. These 4 psychiatrists describe changes in perception and automatic processes that are related to the altered experience of self. The altered self-experience, in turn, may be responsible for the emergence of delusions. The phenomenological data are compatible with current research that conceptualizes dysfunctions in perceptual processing as a deficit in the ability to combine stimulus elements into coherent object representations. Relationships of deficits in perceptual organization to cognitive and social dysfunction as well as the possible neurobiological mechanisms are discussed. PMID:17118973

[Structural correlation of schizophrenic thought and language disorders with delusional perception and variations of intentionality].

PubMed

Holm-Hadulla, R

1988-01-01

This study originated from a phenomenological and speech-act theoretical concept of schizophrenic concretism. An experimental study was performed showing a highly significant lack in the schizophrenic patients' ability to use metaphors correctly. Basing on the interpretation of proverbs, the hypothesis is rejected that false interpretations of schizophrenic patients are due to intermingling of personal conflicts. On the other hand, it could be shown that concretistic interpretations of proverbs represent an avoidance of conflicts. The concepts of "substitution" and "transfer" enabled us to measure pathological concreteness and "deconflictualisation". The differentiation between schizophrenic and nonpsychotic patients was found to be highly significant. In a complementary study it could be shown that the chronic schizophrenics' disability to transfer images of proverbs to an interpersonally relevant context does not differ significantly from that of patients with their first schizophrenic episode. Discussing our empirical findings, we try to show that the concretistic reduction of thought and speech is also a paradigma of delusion. The "incorrigibility" of schizophrenic delusion was seen to be based on reification of verbal signs and metaphors. After trying to show a connection between the concretistic "Lebensform" (Wittgenstein) and the disordered intentionality of schizophrenic patients, pointers towards psychotherapeutic implications are given.

The criterion and discriminant validity of the Referential Thinking (REF) scale.

PubMed

Startup, Mike; Sakrouge, Rebecca; Mason, Oliver J

2010-03-01

The Referential Thinking (REF) scale was designed to be a comprehensive self-report measure of both simple and guilty ideas of reference in the general population. One aim of the present study was to test the proposed interpretations of REF scores by comparing REF scores with ratings of delusions among psychotic patients. A 2nd aim was to test whether REF scores are better predicted by the severity of patients' delusions of reference (DoRs) than by the severity of their auditory verbal hallucinations (AVHs), thus supporting the scores' ability to discriminate between proneness to the 2 different symptoms. The REF scale was completed by 56 healthy controls and 53 acutely psychotic patients. The severity of the patients' DoRs and AVHs were assessed in structured clinical interviews. REF scores differed significantly not only between the patients and controls but also between patients with versus without DoRs. REF scores correlated significantly with the severity of the patients' DoRs but not their AVHs. The interpretation of REF scores as a measure of proneness to simple and guilty ideas of reference was supported. PsycINFO Database Record (c) 2010 APA, all rights reserved.

The Structure of The Extended Psychosis Phenotype in Early Adolescence—A Cross-sample Replication

PubMed Central

Wigman, Johanna T. W.; Vollebergh, Wilma A. M.; Raaijmakers, Quinten A. W.; Iedema, Jurjen; van Dorsselaer, Saskia; Ormel, Johan; Verhulst, Frank C.; van Os, Jim

2011-01-01

The extended psychosis phenotype, or the expression of nonclinical positive psychotic experiences, is already prevalent in adolescence and has a dose-response risk relationship with later psychotic disorder. In 2 large adolescent general population samples (n = 5422 and n = 2230), prevalence and structure of the extended psychosis phenotype was investigated. Positive psychotic experiences, broadly defined, were reported by the majority of adolescents. Exploratory analysis with Structural Equation Modelling (Exploratory Factor Analysis followed by Confirmatory Factor Analysis [CFA]) in sample 1 suggested that psychotic experiences were best represented by 5 underlying dimensions; CFA in sample 2 provided a replication of this model. Dimensions were labeled Hallucinations, Delusions, Paranoia, Grandiosity, and Paranormal beliefs. Prevalences differed strongly, Hallucinations having the lowest and Paranoia having the highest rates. Girls reported more experiences on all dimensions, except Grandiosity, and from age 12 to 16 years rates increased. Hallucinations, Delusions, and Paranoia, but not Grandiosity and Paranormal beliefs, were associated with distress and general measures of psychopathology. Thus, only some of the dimensions of the extended psychosis phenotype in young people may represent a continuum with more severe psychopathology and predict later psychiatric disorder. PMID:20044595

Neuropsychiatric Inventory data in a Belgian sample of elderly persons with and without dementia.

PubMed

Squelard, Gilles P; Missotten, Pierre A; Paquay, Louis; De Lepeleire, Jan; Buntinx, Frank J V M; Fontaine, Ovide; Adam, Stephane R; Ylieff, Michel J D

2012-01-01

This study assesses and compares prevalence of psychological and behavioral symptoms in a Belgian sample of people with and without dementia. A total of 228 persons older than 65 years with dementia and a group of 64 non-demented persons were assessed using the Neuropsychiatric Inventory (NPI) in 2004. Within the group without dementia, the most frequent symptoms were depression, agitation, and irritability. Within the group with dementia, the most common symptoms were depression, irritability, apathy, and agitation. Prevalence of delusions (P < 0.05), hallucinations (P < 0.05), anxiety (P < 0.05), agitation (P < 0.05), apathy (P < 0.01), aberrant motor behavior (P < 0.01), and eating disorders (P < 0.05) were significantly higher in the group with dementia. Depression, elation, irritability, disinhibition, and sleeping disorders are not specific to dementia. Agitation, apathy, anxiety, and delusions are more frequent in dementia but were not specific to the dementia group because their prevalence rates were close to 10% in the group without dementia. Hallucinations, aberrant motor behavior, and eating disorders are specific to dementia. The distinction between specific and nonspecific symptoms may be useful for etiological research on biological, psychological, and environmental factors.

Caring for a relative with delusional beliefs: a qualitative exploration.

PubMed

Onwumere, J; Learmonth, S; Kuipers, E

2016-04-01

WHAT IS KNOWN ON THE SUBJECT?: Delusions are common experiences in psychosis and this is reflected in the number of studies focused on improving our understanding of their development, impact, and treatments. Many service users with psychosis are in informal caregiving relationships and carers can play an instrumental role in the recovery process. There remains a lack of knowledge and understanding about carer experiences and how they cope when their relative's delusions involve them or close others. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Data drawn from five individual carer interviews, which were subject to interpretative phenomenological analysis, identified the importance of six key themes. In addition to a carer's exposure to their relative's illness symptoms and a reported lack of understanding about their relative's delusions, was a fear of delusion-driven behaviours, and the carer's attempt to conceal the true extent of their caregiving challenges to others. Carers' relationships were fractured and their coping was best described as an ongoing process, mainly developed through trial and error. It extends our understanding of important issues faced by a subgroup of carers and facilitates discussion beyond their levels of stress and burden. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The study, with its limitations, indicates some carers may live in fear of harm from their relatives but also be reluctant to disclose to others the full story of what they are coping with. Health professionals must routinely assess for risks that informal carers may be exposed to as part of their role, and offer tailored support and interventions. Background In recent years, there has been a gradual shift towards the study of individual symptom presentations in psychosis, this is particularly found in studies of delusional beliefs. However, the literature remains sparse on informal caregiver experiences of individual symptoms. Aim The study sought to investigate carer experiences of supporting a relative with delusional beliefs, which involve family members. Methods Semi-structured interviews were undertaken with five caregivers and subject to interpretative phenomenological analysis. Results Interviews yielded six superordinate themes highlighting issues concerning a carer's exposure to symptoms of illness; lack of understanding about their relatives' delusional beliefs; concerns over coming to harm from their relative: efforts made by the carer to conceal their relative's delusional beliefs and their consequences; fractured relationships, and a long process of learning how to best cope. Conclusion Caring for a relative with psychosis who experiences delusional beliefs about the carer and family members can be challenging. The results underscore the importance of providing a programme of support to meet the varied needs of informal carers with an explicit aim of assisting carers in their day-to-day problem solving. It should also help to address issues carers may have about causality, including beliefs about self-blame, and identifying effective coping strategies. © 2016 John Wiley & Sons Ltd.

Validity of the Schizophrenia Diagnosis of the Psychopathology Instrument for Mentally Retarded Adults (PIMRA): A Comparison of Schizophrenic Patients with and without Mental Retardation.

ERIC Educational Resources Information Center

Linaker, Olav M.; Helle, Jon

1994-01-01

This study found that the schizophrenia subscale of the Psychopathology Instrument for Mentally Retarded Adults was a valid quantitative measure of schizophrenia if one item was removed from the scale. Comparison with a nonretarded population indicated that mentally retarded patients had less delusions and more incoherence and flat affect. They…

Delusion of fetal duplication in a Capgras patient.

PubMed

Silva, J A; Leong, G B; Longhitano, M; Botello, T E

1991-02-01

A case of Capgras syndrome in a pregnant patient is described. In addition to perceiving living family members as impostors, she believed that there was a double or twin of her fetus. She conceptualized her "twins" differently than the way she viewed doubles of family members. Her fetus may represent the youngest "person" to have been duplicated. The relationship of Capgras syndrome to misidentification phenomena is discussed.

Delusions of Liberty: Rethinking Democracy Promotion in American Grand Strategy

DTIC Science & Technology

2016-06-01

States’ first debates surrounding intervention in support of democratic uprisings. Edward Mead Earle describes American sentiment in 1821: “All educated...theories regarding human or state behavior are not unconditional or absolute in 3 Edward Mead ...property and to punish those who tread upon the rights of others.40 Thomas Jefferson’s rationale of popular revolt against King George III’s rule

Reversible dementia with psychosis: Hashimoto's encephalopathy.

PubMed

Mocellin, Ramon; Lubman, Dan I; Lloyd, John; Tomlinson, E Bruce; Velakoulis, Dennis

2006-12-01

A case of presumed Hashimoto's encephalopathy (HE) is presented. The presentation included memory loss, delusions, functional decline and culminated in a generalized seizure. Anti-thyroid antibodies were detected and symptoms resolved with prednisolone. Patients with HE may present with prominent neuropsychiatric symptoms, attract psychiatric diagnoses and present to psychiatric services. Primarily a diagnosis of exclusion, HE should be considered in cases of encephalopathy in which standard investigations are negative.

Art and Delusion: Unreality in Art School

ERIC Educational Resources Information Center

Neher, Ross

2010-01-01

The author teaches painting in a Master of Fine Arts (MFA) program at Pratt Institute in Brooklyn, New York. Each fall semester he asks his students why they have come to Pratt and what they want to do when they graduate. The common answer is to develop as artists and find a commercial gallery to show and sell their work. Some want the MFA degree…

NATOs Deterrence Strategy is Failing. The Enhanced Forward Presence: Delusion or Renewal

DTIC Science & Technology

2018-04-20

can credibly deter Russia. NATO, Enhanced Forward Presence, Deterrence, Multi -Domain Battle, Russia, Baltics Unclassified Unclassified Unclassified...Strategy. The contents of this paper reflect my own personal views and are not necessarily endorsed by the Joint Forces Staff College or the Department... multi -domain capabilities . . . [and] control information,”5 but in response, NATO has struggled to convincingly adjust to this changing character

Common psychotic symptoms can be explained by the theory of ecological perception.

PubMed

Golembiewski, Jan Alexander

2012-01-01

The symptoms of psychiatric illness are diverse, as are the causes of the conditions that cause them. Yet, regardless of the heterogeneity of cause and presentation, a great deal of symptoms can be explained by the failure of a single perceptual function--the reprocessing of ecological perception. It is a central tenet of the ecological theory of perception that we perceive opportunities to act. It has also been found that perception automatically causes actions and thoughts to occur unless this primary action pathway is inhibited. Inhibition allows perceptions to be reprocessed into more appropriate alternative actions and thoughts. Reprocessing of this kind takes place over the entire frontal lobe and it renders action optional. Choice about what action to take (if any) is the basis for the feeling of autonomy and ultimately for the sense-of-self. When thoughts and actions occur automatically (without choice) they appear to originate outside of the self, thereby providing prima facie evidence for some of the bizarre delusions that define schizophrenia such as delusional misidentification, delusions of control and Cotard's delusion. Automatic actions and thoughts are triggered by residual stimulation whenever reprocessing is insufficient to balance automatic excitatory cues (for whatever reason). These may not be noticed if they are neutral and therefore unimportant or where actions and thoughts have a positive bias and are desirable. Responses to negative stimulus, on the other hand, are always unwelcome, because the actions that are triggered will carry the negative bias. Automatic thoughts may include spontaneous positive feelings of love and joy, but automatic negative thoughts and visualisations are experienced as hallucinations. Not only do these feel like they emerge from elsewhere but they carry a negative bias (they are most commonly critical, rude and are irrationally paranoid). Automatic positive actions may include laughter and smiling and these are welcome. Automatic behaviours that carry a negative bias, however, are unwelcome and like hallucinations, occur without a sense of choice. These include crying, stereotypies, perseveration, ataxia, utilization and imitation behaviours and catatonia. Copyright © 2011 Elsevier Ltd. All rights reserved.

Finding the imposter: brain connectivity of lesions causing delusional misidentifications.

PubMed

Darby, R Ryan; Laganiere, Simon; Pascual-Leone, Alvaro; Prasad, Sashank; Fox, Michael D

2017-02-01

SEE MCKAY AND FURL DOI101093/AWW323 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Focal brain injury can sometimes lead to bizarre symptoms, such as the delusion that a family member has been replaced by an imposter (Capgras syndrome). How a single brain lesion could cause such a complex disorder is unclear, leading many to speculate that concurrent delirium, psychiatric disease, dementia, or a second lesion is required. Here we instead propose that Capgras and other delusional misidentification syndromes arise from single lesions at unique locations within the human brain connectome. This hypothesis is motivated by evidence that symptoms emerge from sites functionally connected to a lesion location, not just the lesion location itself. First, 17 cases of lesion-induced delusional misidentifications were identified and lesion locations were mapped to a common brain atlas. Second, lesion network mapping was used to identify brain regions functionally connected to the lesion locations. Third, regions involved in familiarity perception and belief evaluation, two processes thought to be abnormal in delusional misidentifications, were identified using meta-analyses of previous functional magnetic resonance imaging studies. We found that all 17 lesion locations were functionally connected to the left retrosplenial cortex, the region most activated in functional magnetic resonance imaging studies of familiarity. Similarly, 16 of 17 lesion locations were functionally connected to the right frontal cortex, the region most activated in functional magnetic resonance imaging studies of expectation violation, a component of belief evaluation. This connectivity pattern was highly specific for delusional misidentifications compared to four other lesion-induced neurological syndromes (P < 0.0001). Finally, 15 lesions causing other types of delusions were connected to expectation violation (P < 0.0001) but not familiarity regions, demonstrating specificity for delusion content. Our results provide potential neuroanatomical correlates for impaired familiarity perception and belief evaluation in patients with delusional misidentifications. More generally, we demonstrate a mechanism by which a single lesion can cause a complex neuropsychiatric syndrome based on that lesion's unique pattern of functional connectivity, without the need for pre-existing or hidden pathology. © The Author (2016). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Finding the imposter: brain connectivity of lesions causing delusional misidentifications

PubMed Central

Darby, R Ryan; Laganiere, Simon; Pascual-Leone, Alvaro; Prasad, Sashank; Fox, Michael D

2017-01-01

Abstract See McKay and Furl (doi:10.1093/aww323) for a scientific commentary on this article. Focal brain injury can sometimes lead to bizarre symptoms, such as the delusion that a family member has been replaced by an imposter (Capgras syndrome). How a single brain lesion could cause such a complex disorder is unclear, leading many to speculate that concurrent delirium, psychiatric disease, dementia, or a second lesion is required. Here we instead propose that Capgras and other delusional misidentification syndromes arise from single lesions at unique locations within the human brain connectome. This hypothesis is motivated by evidence that symptoms emerge from sites functionally connected to a lesion location, not just the lesion location itself. First, 17 cases of lesion-induced delusional misidentifications were identified and lesion locations were mapped to a common brain atlas. Second, lesion network mapping was used to identify brain regions functionally connected to the lesion locations. Third, regions involved in familiarity perception and belief evaluation, two processes thought to be abnormal in delusional misidentifications, were identified using meta-analyses of previous functional magnetic resonance imaging studies. We found that all 17 lesion locations were functionally connected to the left retrosplenial cortex, the region most activated in functional magnetic resonance imaging studies of familiarity. Similarly, 16 of 17 lesion locations were functionally connected to the right frontal cortex, the region most activated in functional magnetic resonance imaging studies of expectation violation, a component of belief evaluation. This connectivity pattern was highly specific for delusional misidentifications compared to four other lesion-induced neurological syndromes (P < 0.0001). Finally, 15 lesions causing other types of delusions were connected to expectation violation (P < 0.0001) but not familiarity regions, demonstrating specificity for delusion content. Our results provide potential neuroanatomical correlates for impaired familiarity perception and belief evaluation in patients with delusional misidentifications. More generally, we demonstrate a mechanism by which a single lesion can cause a complex neuropsychiatric syndrome based on that lesion’s unique pattern of functional connectivity, without the need for pre-existing or hidden pathology. PMID:28082298

Use of qualitative methods to explore the quality-of-life construct from a consumer perspective.

PubMed

Corring, Deborah J; Cook, Joanne V

2007-02-01

This study explored the construct of quality of life from the perspective of adults diagnosed as having severe and persistent mental illness, such as schizophrenia. Qualitative research strategies, specifically in-depth interviews (N=18) and focus groups (N=35), were used to collect data. Interviews and focus groups took place in hospitals, community clinics, community agencies, and clients' homes. A convenience, snowball sampling strategy was utilized. Analysis using the constant comparative method resulted in the identification of two dominant themes. These themes permeated the results, crossed all domains, influenced the linkages between domains, and clearly influenced how individuals frame their expectations regarding quality of life. The first theme was the presence of stigma and its effects on everyday life and future planning, and the second was the pervasive fear of the return of major positive symptoms of psychosis, such as hallucinations, delusions, and general loss of contact with reality. In addition, four quality-of-life domains were identified-the experience of illness, relationships, occupation, and sense of self. Many persons with mental illness simply wish for the basics in life-mental and physical health, supportive relationships, meaningful occupations, and a positive sense of self-believing that acquisition of these basics will lead to a more satisfactory quality of life. Ensuring that they are able to obtain the basics requires action on their part, by those who support them, by service providers that interact with them, and by a more accepting society.

Somatic Symptom Disorder in Semantic Dementia: The Role of Alexisomia.

PubMed

Gan, Joanna J; Lin, Andrew; Samimi, Mersal S; Mendez, Mario F

Semantic dementia (SD) is a neurodegenerative disorder characterized by loss of semantic knowledge. SD may be associated with somatic symptom disorder due to excessive preoccupation with unidentified somatic sensations. To evaluate the frequency of somatic symptom disorder among patients with SD in comparison to comparably demented patients with Alzheimer׳s disease. A retrospective cohort study was conducted using clinical data from a referral-based behavioral neurology program. Fifty-three patients with SD meeting criteria for imaging-supported semantic variant primary progressive aphasia (another term for SD) were compared with 125 patients with clinically probable Alzheimer disease. Logistic regression controlled for sex, age, disease duration, education, overall cognitive impairment, and depression. The prevalence of somatic symptom disorder was significantly higher among patients with SD (41.5%) compared to patients with Alzheimer disease (11.2%) (odds ratio = 6:1; p < 0.001). Somatic symptom disorder was associated with misidentification and preoccupation with normal bodily sensations such as hunger, bladder filling, borborygmi, rhinorrhea, and reflux; excessive concern over the incompletely understood meaning or source of pain or other symptoms; and Cotard syndrome or the delusion that unidentified somatic symptoms signify death or deterioration. SD, a disorder of semantic knowledge, is associated with somatic symptom disorder from impaired identification of somatic sensations. Their inability to read and name somatic sensations, or "alexisomia," results in disproportionate and persistent concern about somatic sensations with consequent significant disability. Copyright © 2016 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Behavioural and molecular endophenotypes in psychotic disorders reveal heritable abnormalities in glutamatergic neurotransmission

PubMed Central

Scoriels, L; Salek, R M; Goodby, E; Grainger, D; Dean, A M; West, J A; Griffin, J L; Suckling, J; Nathan, P J; Lennox, B R; Murray, G K; Bullmore, E T; Jones, P B

2015-01-01

Psychotic disorders such as schizophrenia are biologically complex and carry huge population morbidity due to their prevalence, persistence and associated disability. Defined by features such as delusions and hallucinations, they involve cognitive dysfunction and neurotransmitter dysregulations that appear mostly to involve the dopaminergic and glutamatergic systems. A number of genetic and environmental factors are associated with these disorders but it has been difficult to identify the biological pathways underlying the principal symptoms. The endophenotype concept of stable, heritable traits that form a mechanistic link between genes and an overt expression of the disorder has potential to reduce the complexity of psychiatric phenotypes. In this study, we used a genetically sensitive design with individuals with a first episode of psychosis, their non-affected first-degree relatives and non-related healthy controls. Metabolomic analysis was combined with neurocognitive assessment to identify multilevel endophenotypic patterns: one concerned reaction times during the performance of cognitive and emotional tests that have previously been associated with the glutamate neurotransmission system, the other involved metabolites involved directly and indirectly in the co-activation of the N-methyl-D-aspartate receptor, a major receptor of the glutamate system. These cognitive and metabolic endophenotypes may comprise a single construct, such that genetically mediated dysfunction in the glutamate system may be responsible for delays in response to cognitive and emotional functions in psychotic disorders. This focus on glutamatergic neurotransmission should guide drug discovery and experimental medicine programmes in schizophrenia and related disorders. PMID:25826115

The linguistics of schizophrenia: thought disturbance as language pathology across positive symptoms.

PubMed

Hinzen, Wolfram; Rosselló, Joana

2015-01-01

We hypothesize that linguistic (dis-)organization in the schizophrenic brain plays a more central role in the pathogenesis of this disease than commonly supposed. Against the standard view, that schizophrenia is a disturbance of thought or selfhood, we argue that the origins of the relevant forms of thought and selfhood at least partially depend on language. The view that they do not is premised by a theoretical conception of language that we here identify as 'Cartesian' and contrast with a recent 'un-Cartesian' model. This linguistic model empirically argues for both (i) a one-to-one correlation between human-specific thought or meaning and forms of grammatical organization, and (ii) an integrative and co-dependent view of linguistic cognition and its sensory-motor dimensions. Core dimensions of meaning mediated by grammar on this model specifically concern forms of referential and propositional meaning. A breakdown of these is virtually definitional of core symptoms. Within this model the three main positive symptoms of schizophrenia fall into place as failures in language-mediated forms of meaning, manifest either as a disorder of speech perception (Auditory Verbal Hallucinations), abnormal speech production running without feedback control (Formal Thought Disorder), or production of abnormal linguistic content (Delusions). Our hypothesis makes testable predictions for the language profile of schizophrenia across symptoms; it simplifies the cognitive neuropsychology of schizophrenia while not being inconsistent with a pattern of neurocognitive deficits and their correlations with symptoms; and it predicts persistent findings on disturbances of language-related circuitry in the schizophrenic brain.

Strategic Delusions - The Cold Start Doctrine: Proactive Strategy

DTIC Science & Technology

2016-05-26

recent tactical strike in Myanmar is miscued as a precursor for times to come in the regional context.10 These tactical actions also known as Hot...Attacks Militant Camps in Myanmar , Wall Street Journal, June 10, 2015, accessed August 24, 2015, http://www.wsj.com/articles/indian-army-attacks...militant-camps-in- myanmar -1433927858. 7 imperatives associated with the Indian PAS and its validation through the framework of strategy and the

The Myth of Meritocracy and Delusions of Equity: Cultural Impediments to Diversity in Natural Science Programs.

ERIC Educational Resources Information Center

Jones, Leslie S.

In an effort to determine why there is continued scarcity of all women and of men of color in the sciences, this study turns the lens of the social sciences onto social aspects of the sciences. Interviews with academic science faculty examined gender and racial/ethnic issues in the professional domain of a variety of scientists for clues as to how…

A young woman with seizures and psychosis

PubMed Central

Naha, Sowjanya; Naha, Kushal; Hande, H Manjunath; Vivek, Ganapathiraman

2014-01-01

We present a case of a 24-year-old woman with abnormal behaviour of recent onset. She had been diagnosed previously with epilepsy and had been started on antiepileptic medication. Clinical examination confirmed features of psychosis including paranoid delusions and auditory hallucination. Neurological examination showed nystagmus and dysmetria. Further evaluation revealed the underlying cause for her symptoms. She responded promptly to appropriate therapy with complete resolution of psychosis. PMID:25008334

How Much Is Transferred from Training to the Job? The 10% Delusion as a Catalyst for Thinking about Transfer

ERIC Educational Resources Information Center

Ford, J. Kevin; Yelon, Stephen L.; Billington, Abigail Q.

2011-01-01

This article explores the common belief that only a small amount of what is taught in a training program is actually transferred to the job. After providing evidence of the source of the generalization and the acceptance of the notion despite the lack of empirical, behavioral evidence, we take the opportunity to examine the likely reasons for that…

Metamemory in schizophrenia: retrospective confidence ratings interact with neurocognitive deficits.

PubMed

Eifler, Sarah; Rausch, Franziska; Schirmbeck, Frederike; Veckenstedt, Ruth; Mier, Daniela; Esslinger, Christine; Englisch, Susanne; Meyer-Lindenberg, Andreas; Kirsch, Peter; Zink, Mathias

2015-02-28

Prior studies with schizophrenia patients described a reduced ability to discriminate between correct and false memories in terms of confidence compared to control groups. This metamemory bias has been associated with the emergence and maintenance of delusions. The relation to neuropsychological performance and other clinical dimensions is incompletely understood. In a cross-sectional study, metamemory functioning was explored in 32 schizophrenia patients and 25 healthy controls. Metamemory was assessed using a verbal recognition task combined with retrospective confidence level ratings. Associations of metamemory performance with six neuropsychological domains (executive functioning/problem solving, speed of processing, working memory, verbal and visual learning, and attention/vigilance) and psychopathological measures were analyzed. Results revealed a significantly smaller discrepancy between confidence ratings for correct and incorrect recognitions in the patient group. Furthermore, patients showed significantly lower recognition accuracy in the metamemory task and marked deficits in all neuropsychological domains. Across all participants, metamemory performance significantly correlated with executive functioning and working memory. No associations with delusions were found. This data confirms prior findings of metamemory biases in schizophrenia. Selective neuropsychological abilities seem to be modulating factors of metamemory functioning. Longitudinal studies in at risk mental state and first-episode patients are needed to reveal causal interrelations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Severe Psychosis, Drug Dependence, and Hepatitis C Related to Slamming Mephedrone

PubMed Central

Rodríguez-Salgado, Beatriz; Sánchez-Mateos, Daniel

2016-01-01

Background. Synthetic cathinones (SCs), also known as “bath salts,” are β-ketone amphetamine compounds derived from cathinone, a psychoactive substance found in Catha edulis. Mephedrone is the most representative SC. Slamming is the term used for the intravenous injection of these substances in the context of chemsex parties, in order to enhance sex experiences. Using IV mephedrone may lead to diverse medical and psychiatric complications like psychosis, aggressive behavior, and suicide ideation. Case. We report the case of a 25-year-old man admitted into a psychiatric unit, presenting with psychotic symptoms after slamming mephedrone almost every weekend for the last 4 months. He presents paranoid delusions, intense anxiety, and visual and kinesthetic hallucinations. He also shows intense craving, compulsive drug use, general malaise, and weakness. After four weeks of admission and antipsychotic treatment, delusions completely disappear. The patient is reinfected with hepatitis C. Discussion. Psychiatric and medical conditions related to chemsex and slamming have been reported in several European cities, but not in Spain. Psychotic symptoms have been associated with mephedrone and other SCs' consumption, with the IV route being prone to produce more severe symptomatology and addictive conducts. In the case we report, paranoid psychosis, addiction, and medical complications are described. PMID:27247820

Morgellons disease and delusions of parasitosis.

PubMed

Robles, David T; Olson, Jonathan M; Combs, Heidi; Romm, Sharon; Kirby, Phil

2011-02-01

Morgellons disease is a controversial and poorly defined symptom cluster of skin lesions and somatic symptoms, most notably 'fibers' in the skin. Because of widespread coverage in the media and on the Internet, there are an increasing number of patients presenting to dermatologists. We present three patients who believed that they had fibers in their skin. We offer a discussion of delusions of parasitosis to demonstrate similarities between these conditions. It has been suggested by a limited number of healthcare providers that an unknown infectious agent underlies this symptom complex yet no available evidence supports this assertion. Laboratory values that would be reflective of an infectious process (e.g. elevated white blood cells, sedimentation rate, C reactive protein) are routinely normal and biopsies often reflect only nonspecific findings such as acute and chronic inflammation with erosion or ulceration. Patients with Morgellons disease generally lack insight into their disease and reject the need for psychiatric help. The goal is to build trust and refrain from minimizing what the patient experiences. Attentive examination of the patient's skin and fragments they present is necessary to rule out a true underlying pathologic process and to establish a trusting relationship. A supportive, non-confrontational approach is ideal. The patient is best treated by a team of practitioners of several specialties, including dermatologists, psychiatrists, and counselors.

The role of sleep dysfunction in the occurrence of delusions and hallucinations: A systematic review

PubMed Central

Reeve, Sarah; Sheaves, Bryony; Freeman, Daniel

2015-01-01

Background Sleep dysfunction is extremely common in patients with schizophrenia. Recent research indicates that sleep dysfunction may contribute to psychotic experiences such as delusions and hallucinations. Objectives The review aims to evaluate the evidence for a relationship between sleep dysfunction and individual psychotic experiences, make links between the theoretical understanding of each, and highlight areas for future research. Method A systematic search was conducted to identify studies investigating sleep and psychotic experiences across clinical and non-clinical populations. Results 66 papers were identified. This literature robustly supports the co-occurrence of sleep dysfunction and psychotic experiences, particularly insomnia with paranoia. Sleep dysfunction predicting subsequent psychotic experiences receives support from epidemiological surveys, research on the transition to psychosis, and relapse studies. There is also evidence that reducing sleep elicits psychotic experiences in non-clinical individuals, and that improving sleep in individuals with psychosis may lessen psychotic experiences. Anxiety and depression consistently arise as (partial) mediators of the sleep and psychosis relationship. Conclusion Studies are needed that: determine the types of sleep dysfunction linked to individual psychotic experiences; establish a causal connection between sleep and psychotic experiences; and assess treatments for sleep dysfunction in patients with non-affective psychotic disorders such as schizophrenia. PMID:26407540

Schizophrenia.

PubMed

van Os, Jim; Kapur, Shitij

2009-08-22

Schizophrenia is still one of the most mysterious and costliest mental disorders in terms of human suffering and societal expenditure. Here, we focus on the key developments in biology, epidemiology, and pharmacology of schizophrenia and provide a syndromal framework in which these aspects can be understood together. Symptoms typically emerge in adolescence and early adulthood. The incidence of the disorder varies greatly across places and migrant groups, as do symptoms, course, and treatment response across individuals. Genetic vulnerability is shared in part with bipolar disorder and recent molecular genetic findings also indicate an overlap with developmental disorders such as autism. The diagnosis of schizophrenia is associated with demonstrable alterations in brain structure and changes in dopamine neurotransmission, the latter being directly related to hallucinations and delusions. Pharmacological treatments, which block the dopamine system, are effective for delusions and hallucinations but less so for disabling cognitive and motivational impairments. Specific vocational and psychological interventions, in combination with antipsychotic medication in a context of community-case management, can improve functional outcome but are not widely available. 100 years after being so named, research is beginning to understand the biological mechanisms underlying the symptoms of schizophrenia and the psychosocial factors that moderate their expression. Although current treatments provide control rather than cure, long-term hospitalisation is not required and prognosis is better than traditionally assumed.

'No man is an island'. Testing the specific role of social isolation in formal thought disorder.

PubMed

de Sousa, Paulo; Spray, Amy; Sellwood, William; Bentall, Richard P

2015-12-15

Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

A failure of conflict to modulate dual-stream processing may underlie the formation and maintenance of delusions.

PubMed

Speechley, W J; Murray, C B; McKay, R M; Munz, M T; Ngan, E T C

2010-03-01

Dual-stream information processing proposes that reasoning is composed of two interacting processes: a fast, intuitive system (Stream 1) and a slower, more logical process (Stream 2). In non-patient controls, divergence of these streams may result in the experience of conflict, modulating decision-making towards Stream 2, and initiating a more thorough examination of the available evidence. In delusional schizophrenia patients, a failure of conflict to modulate decision-making towards Stream 2 may reduce the influence of contradictory evidence, resulting in a failure to correct erroneous beliefs. Delusional schizophrenia patients and non-patient controls completed a deductive reasoning task requiring logical validity judgments of two-part conditional statements. Half of the statements were characterized by a conflict between logical validity (Stream 2) and content believability (Stream 1). Patients were significantly worse than controls in determining the logical validity of both conflict and non-conflict conditional statements. This between groups difference was significantly greater for the conflict condition. The results are consistent with the hypothesis that delusional schizophrenia patients fail to use conflict to modulate towards Stream 2 when the two streams of reasoning arrive at incompatible judgments. This finding provides encouraging preliminary support for the Dual-Stream Modulation Failure model of delusion formation and maintenance. 2009 Elsevier Masson SAS. All rights reserved.

Dreams as a source of supernatural agent concepts.

PubMed

McNamara, Patrick; Bulkeley, Kelly

2015-01-01

We present a theory of the creativity of dreams as well as psychopathology of religious delusions with respect to production of fundamental forms of religious cognition-specifically supernatural agent (SA) cognitions. We suggest that dream cognitions are particularly efficient at producing highly memorable and impactful experiences with SAs because dreams involve three processes that are prerequisites for the generation of god concepts: (1) mental simulations of alternative realities, (2) theory of mind attributions to the extra-natural dream characters and divine beings, and (3) attribution of ultimate value (exemplified by 'good spirit beings'), and dis-value (exemplified by demonic monsters) to the supernatural dream characters. Because prefrontal cortex is deactivated during rapid eye movements (REM) sleep agentic impulses and internally generated ideas are not reliably attributed to Self or dreamer. Instead an exaggerated degree of agency is attributed to these supernatural dream characters who are then embedded in stories in dreams and in myths of waking life which explain their supernatural abilities. These dream-based SAs are salient characters that are processed in sleep-related memory systems according to rules of Lleweelyn's ancient art of memory model and therefore more easily remembered and reflected upon during waking life. When REM sleep intrudes into waking consciousness, as is the case with some forms of schizophrenia, religious delusions are more likely to emerge.

Overconfidence across the psychosis continuum: a calibration approach.

PubMed

Balzan, Ryan P; Woodward, Todd S; Delfabbro, Paul; Moritz, Steffen

2016-11-01

An 'overconfidence in errors' bias has been consistently observed in people with schizophrenia relative to healthy controls, however, the bias is seldom found to be associated with delusional ideation. Using a more precise confidence-accuracy calibration measure of overconfidence, the present study aimed to explore whether the overconfidence bias is greater in people with higher delusional ideation. A sample of 25 participants with schizophrenia and 50 non-clinical controls (25 high- and 25 low-delusion-prone) completed 30 difficult trivia questions (accuracy <75%); 15 'half-scale' items required participants to indicate their level of confidence for accuracy, and the remaining 'confidence-range' items asked participants to provide lower/upper bounds in which they were 80% confident the true answer lay within. There was a trend towards higher overconfidence for half-scale items in the schizophrenia and high-delusion-prone groups, which reached statistical significance for confidence-range items. However, accuracy was particularly low in the two delusional groups and a significant negative correlation between clinical delusional scores and overconfidence was observed for half-scale items within the schizophrenia group. Evidence in support of an association between overconfidence and delusional ideation was therefore mixed. Inflated confidence-accuracy miscalibration for the two delusional groups may be better explained by their greater unawareness of their underperformance, rather than representing genuinely inflated overconfidence in errors.

The Vicious Cycle of Family Atmosphere, Interpersonal Self-concepts, and Paranoia in Schizophrenia—A Longitudinal Study

PubMed Central

Hesse, Klaus; Kriston, Levente; Mehl, Stephanie; Wittorf, Andreas; Wiedemann, Wolfgang; Wölwer, Wolfgang; Klingberg, Stefan

2015-01-01

Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia. PMID:25925392

Ever-present threats from information technology: the Cyber-Paranoia and Fear Scale

PubMed Central

Mason, Oliver J.; Stevenson, Caroline; Freedman, Fleur

2014-01-01

Delusions involving technology, and specifically the internet, are increasingly common, and fear-reality statistics suggest computer-related fears are very widespread. These fears form a continuum from the widely understandable and realistic to the unrealistic, and frankly paranoid. The present study investigated the validity of this construct in a non-clinical population by constructing a novel self-report measure. The new Cyber-Paranoia and Fear Scale aims to measure the perception of information technology-related threats originating from or enabled by computers, smartphones, social networks, and digital surveillance. Psychometric properties of the new Cyber-Paranoia and Fear Scale are reported alongside an established measure of suspiciousness and paranoia in 181 participants including a sub-group of fifty information technology professionals. Exploratory factor analysis suggested the presence of two, related, dimensions that we term cyber-paranoia and cyber-fear. Both sub-scales were internally consistent and produced a normal distribution of scores. The relationships of the sub-scales with age, gender, trait paranoia, digital literacy, and digital inclusion are supportive of construct validity. The distinctiveness of ‘cyber-paranoia’ from general trait paranoia appears to mirror the clinical distinctiveness of ‘internet’ and other technology-fuelled delusions. Knowledge provision to increase technological proficiency and awareness may bring about a reduction in cyber-paranoia. PMID:25505431

Ever-present threats from information technology: the Cyber-Paranoia and Fear Scale.

PubMed

Mason, Oliver J; Stevenson, Caroline; Freedman, Fleur

2014-01-01

Delusions involving technology, and specifically the internet, are increasingly common, and fear-reality statistics suggest computer-related fears are very widespread. These fears form a continuum from the widely understandable and realistic to the unrealistic, and frankly paranoid. The present study investigated the validity of this construct in a non-clinical population by constructing a novel self-report measure. The new Cyber-Paranoia and Fear Scale aims to measure the perception of information technology-related threats originating from or enabled by computers, smartphones, social networks, and digital surveillance. Psychometric properties of the new Cyber-Paranoia and Fear Scale are reported alongside an established measure of suspiciousness and paranoia in 181 participants including a sub-group of fifty information technology professionals. Exploratory factor analysis suggested the presence of two, related, dimensions that we term cyber-paranoia and cyber-fear. Both sub-scales were internally consistent and produced a normal distribution of scores. The relationships of the sub-scales with age, gender, trait paranoia, digital literacy, and digital inclusion are supportive of construct validity. The distinctiveness of 'cyber-paranoia' from general trait paranoia appears to mirror the clinical distinctiveness of 'internet' and other technology-fuelled delusions. Knowledge provision to increase technological proficiency and awareness may bring about a reduction in cyber-paranoia.

Confabulations: a conceptual history.

PubMed

Berrios, G E

1998-12-01

Confabulations are inaccurate or false narratives purporting to convey information about world or self. It is the received view that they are uttered by subjects intent on "covering up" for a putative memory deficit. The epidemiology of confabulations is unknown. Speculated causes include amnesia, embarrassment, "frontal lobe" damage, a subtype of "personality", a dream-like event, and a disturbance of the self. Historical analysis shows that "confabulation" was constructed at the turn of the century as part of a network of concepts (e.g. delusion, fixed idea, etc.) meant to capture narratives with dubious content. This paper deals with the history of the construction of the word and concept of confabulation and with earlier recognitions of the behaviours that serve as their referent and puts forward a model based on historical data. Two phenomena are included under "confabulation": "untrue" utterances by subjects with memory impairment and "fantastic" utterances marshalled with conviction by subjects suffering from psychoses and no memory deficit. Under different disguises, the "covering up" or "gap filling" hypothesis is still going strong. Although superficially plausible, it poses problems in regards to the issue of "awareness of purpose": if full awareness is presumed then the semantics of the concept of "purpose" is severely stretched and confabulations cannot be differentiated from delusions.

I spy with my little eye - the detection of intentional contingency in early psychosis.

PubMed

Fett, Anne-Kathrin J; González Berdugo, Clara Isabel; Hanssen, Esther; Lemmers-Jansen, Imke; Shergill, Sukhi S; Krabbendam, Lydia

2015-01-01

Paranoid delusions have been associated with a tendency to over-attribute intentionality and contingency to others' actions and incidental events in individuals with chronic psychosis. However, this hyper-associative perception bias has not been investigated in the early illness stages of psychosis, during which it may play a particularly crucial role in the formation of symptoms. We used an experimental paradigm with 20 short film clips of simple animate and inanimate shapes that either moved in a contingent or non-contingent manner to investigate the perception of contingency in 38 adolescents with early psychosis and 93 healthy control adolescents. Participants rated the contingency between the shapes' movements on a scale from 0 to 10. The data were analysed with multilevel regression analyses to account for repeated measures within subjects. There were no significant differences between patients and controls; both perceived the contingency of the shapes' movements similarly across all conditions and patients' contingency perception was unrelated to their levels of paranoid delusions. Contingency perception was unimpaired in patients with early psychosis, suggesting that it might still be intact in the early illness stages. Future studies should set out to determine whether the early illness stages could offer a window for interventions that counteract the development of hyper-associative perceptions of contingency.

[Preventing dangerous psychotic acting out].

PubMed

Bouchard, Jean-Pierre

2015-01-01

Delusions of having been wronged, of persecution, of having a mission or order to execute, are frequently the causes of dangerous psychotic acting out. The regular clinical assessment of these patients and their treatment is essential for preventing this acting out, which can have dramatic consequences on the potential victims. If there is a treatment indication but refusal on the part of the patient to cooperate, it is necessary to resort to treatment without the patient's consent.

The Road from Foolishness to Fraud

NASA Astrophysics Data System (ADS)

Park, R. L.

2000-12-01

Ancient beliefs in demons and magic still sweep across the modern landscape, but they are now dressed in the language and symbols of science. This is pseudoscience. At least in the beginning, its practitioners may believe it to be science, just as witches and faith healers may truly believe they can call forth supernatural powers. What may begin as honest error, however, has a way of evolving through almost imperceptible steps from self-delusion to fraud.

The Road From Foolishness to Fraud

NASA Astrophysics Data System (ADS)

Park, Bob

2000-03-01

Ancient beliefs in demons and magic still sweep across the modern landscape, but they are now dressed in the language and symbols of science. This is pseudoscience. At least in the beginning, its practitioners may believe it to be science, just as witches and faith healers may truly believe they can call forth supernatural powers. What may begin as honest error, however, has a way of evolving through almost imperceptible steps from self-delusion to fraud.

JPRS Report, Soviet Union: Political Affairs.

DTIC Science & Technology

1988-07-07

or in the destiny of peoples. This dangerous delusion has been instilled in virtually all times with benefit to themselves by the powers that be...also this was contained in embryo . Having eliminated, as usual, the authors of this theory, Stalin put their ideas into practice. The corresponding...that it contained in embryo the future collective socialist economy. I am not making this up. Even at the 10th party congress, at which the

[Abortion and the man. Psychological and psychopathological manifestations in the face of lost fatherhood].

PubMed

Benvenuti, P; Borri, P; Buzzoni, P; Clerici, L; Rossi Monti, M

1983-01-01

This study examines the psychological and psychopathological reactions that may appear in a man when his partner aborts. The small amount of literature that exists on the subjects was examined, and several men were, interviewed at the time their partners aborted voluntarely. It turns out that in spite of the man's lack of recognition of any reactions (reinforced by current attitudes and by the scant psychological and medical interest in the subject), there is considerable emotional involvement in the lost parenthood, both for the man and the woman. As revealed by the interviews, this involvement may manifest itself in persecutory or depressive anxiety and psychosomatic symptoms. Moreover, but very rarely, real and typical psychopathological symptoms may appear, such as depression and behavioural disorders. The appearance of these reactions is linked to the problems and conflicts aroused by prospective fatherhood, leading to a comparison between the experiences of fuliwed fatherhood and those of fatherhood lost.

Stalking as paranoid attachment: a typological and dynamic model.

PubMed

Wilson, John S; Ermshar, Annette L; Welsh, Robert K

2006-06-01

Stalking encompasses a wide range of behavioral patterns, risk factors, interpersonal dynamics, and dangerousness. To account for these diverse phenomena, we propose that stalking behavior is best conceptualized by a dynamic interaction of attachment styles and psychodynamic phenomena. This paper articulates a model that explains stalking behavior within the framework of attachment theory. Four prototypical configurations of stalkers and their victims are developed. Each configuration is discussed in terms of a pattern of internal representations, affective constellations, combinations of aggression and narcissism, and potential for future violence. The four configurations proposed here are maintained through stalkers' over ideational linkage fantasies and projective identifications, which range from shame-prone and needy idealization to malevolent torment of the victim. Our model arrays erotomanic, jealous, and persecutory attachments along a continuum of increasingly paranoid and pathological identifications. We argue that these prototypical attachment configurations provide a theoretically driven means of differentiating phases of stalking, and as such provide useful leads in the empirical study and clinical assessment, treatment, and management of stalkers.

Prisons: the psychiatric institution of last resort?

PubMed

Huxter, M J

2013-10-01

The World Health Organization declared in 1948 that the enjoyment of the highest individual attainment of health for any person is a fundamental human right. Australia, the U.K. and the United States all legally ratified this declaration as becoming signatories to their founding treatise with the United Nations. Despite this, there are many conspicuous examples of inequities of public health as found within these nations. One of the more disparate and outrageous examples of inequities in public health has been an insidious trend towards criminalizing mental illness, and the largely unjust treatment of many mentally ill persons. This change has resulted in untold numbers of mentally ill persons being over-represented within the criminal justice system, experiencing higher morbidity, co-morbidity and mortality rates, and having difficulty in surviving in a society frequently dealing with their illness in a persecutory manner. Questions must be raised: that although over the passage of time medical science and technology has changed, but has western societies' attitudes to health equity kept pace? © 2012 John Wiley & Sons Ltd.

D-cycloserine in Schizophrenia: New Strategies for Improving Clinical Outcomes by Enhancing Plasticity

PubMed Central

Goff, Donald C.

2017-01-01

Background Dysregulation of N-methyl D-aspartate (NMDA) receptor signaling is strongly implicated in schizophrenia. Based on the ketamine model of NMDA receptor hypoactivity, therapeutic approaches designed to maintain a sustained increase in agonist activity at the glycine site of the NMDA receptor have produced promising, although inconsistent, efficacy for negative symptoms. Methods A review of the published literature on D-cycloserine (DCS) pharmacology in animal models and in clinical studies was performed. Findings relevant to DCS effects on memory and plasticity and their potential clinical application to schizophrenia were summarized. Results Studies in animals and clinical trials in patients with anxiety disorders have demonstrated that single or intermittent dosing with DCS enhances memory consolidation. Preliminary trials in patients with schizophrenia suggest that intermittent dosing with DCS may produce persistent improvement of negative symptoms and enhance learning when combined with cognitive behavioral therapy for delusions or with cognitive remediation. The pharmacology of DCS is complex, since it acts as a “super agonist” at NMDA receptors containing GluN2C subunits and, under certain conditions, it may act as an antagonist at NMDA receptors containing GluN2B subunits. Conclusions There are preliminary findings that support a role for D-cycloserine in schizophrenia as a strategy to enhance neuroplasticity and memory. However, additional studies with DCS are needed to confirm these findings. In addition, clinical trials with positive and negative allosteric modulators with greater specificity for NMDA receptor subtypes are needed to identify the optimal strategy for enhancing neuroplasticity in schizophrenia. PMID:26915421

[From querulous neurosis to querulous delusion: the psychopathological aspects of persistent dysfunctional complaining].

PubMed

Tewarie, P R M; van der Zwaard, R

2016-01-01

The clinical concept of querulous behaviour is used only sporadically in modern psychiatry, although the concept seems to be just as clinical relevant as it was many years ago. The extension of the right to complain has played a role in the acceptance of querulous behaviour. Judicial bodies and other government organisations are being kept busier than ever because people who feel they have been denied justice became entangled in interminable litigation. Gradually, querulous behaviour causes the initial sense of injustice to disappear and querulous patients are damaged economically, socially and personally and experience suffering and function less efficiently. To describe the history, clinical features, differential diagnosis, possible psychodynamic hypotheses and possible ways of treating querulous behaviour.
We studied the literature using PubMed, PsychInfo, Google and Google Scholar. There seems to be a spectrum with fluent transitions from normal complaining behaviour, querulous behaviour which is based on a paranoid, narcissistic or obsessive-compulsive personality structure, to severe pathologies like a delusional disorder. There is little evidence that pharmacotherapy or psychotherapy is effective. Nevertheless, there are opportunities for administering psychiatric treatment in order to alleviate the loss and suffering for the patients and their next-of-kin. Querulous behaviour is an old clinical concept that still has relevance today for the individual patient, complaints officers and society in general. Our current diagnostic systems provide sufficient opportunities for diagnosing patients correctly. Patients may be best served by judicial mediation at an early stage, combined with psychiatric treatment aimed at controlling emotions and restricting harmful behaviour.

The linguistics of schizophrenia: thought disturbance as language pathology across positive symptoms

PubMed Central

Hinzen, Wolfram; Rosselló, Joana

2015-01-01

We hypothesize that linguistic (dis-)organization in the schizophrenic brain plays a more central role in the pathogenesis of this disease than commonly supposed. Against the standard view, that schizophrenia is a disturbance of thought or selfhood, we argue that the origins of the relevant forms of thought and selfhood at least partially depend on language. The view that they do not is premised by a theoretical conception of language that we here identify as ‘Cartesian’ and contrast with a recent ‘un-Cartesian’ model. This linguistic model empirically argues for both (i) a one-to-one correlation between human-specific thought or meaning and forms of grammatical organization, and (ii) an integrative and co-dependent view of linguistic cognition and its sensory-motor dimensions. Core dimensions of meaning mediated by grammar on this model specifically concern forms of referential and propositional meaning. A breakdown of these is virtually definitional of core symptoms. Within this model the three main positive symptoms of schizophrenia fall into place as failures in language-mediated forms of meaning, manifest either as a disorder of speech perception (Auditory Verbal Hallucinations), abnormal speech production running without feedback control (Formal Thought Disorder), or production of abnormal linguistic content (Delusions). Our hypothesis makes testable predictions for the language profile of schizophrenia across symptoms; it simplifies the cognitive neuropsychology of schizophrenia while not being inconsistent with a pattern of neurocognitive deficits and their correlations with symptoms; and it predicts persistent findings on disturbances of language-related circuitry in the schizophrenic brain. PMID:26236257

Metacognitive training for schizophrenia: a multicentre randomised controlled trial.

PubMed

Briki, Malick; Monnin, Julie; Haffen, Emmanuel; Sechter, Daniel; Favrod, Jérôme; Netillard, Christian; Cheraitia, Elisabeth; Marin, Karine; Govyadovskaya, Svetlana; Tio, Grégory; Bonin, Bernard; Chauvet-Gelinier, Jean-Christophe; Leclerc, Stéphanie; Hodé, Yann; Vidailhet, Pierre; Berna, Fabrice; Bertschy, Anna Zinetti; Vandel, Pierre

2014-08-01

A psychotherapeutic approach for schizophrenia is now recommended as an adjuvant for psychopharmacology, since antipsychotic medications only have a partial impact especially as regards positive symptoms and insight. In addition, cognitive distortions and the lack of metacognitive skills might increase positive symptoms leading to poor social functioning. This underlines the need for specific approaches which target cognitive processes relevant for insight, and abilities in metacognition. Metacognitive training (MCT) is a structured group intervention, which enhances a patient's reflection on cognitive biases and improves problem-solving. The aim of our study was to assess MCTs' short term impact on insight, symptoms and quality of life. Fifty patients with schizophrenia or schizoaffective disorders and persistent positive symptoms (delusions or hallucinations) were enrolled in the study. After baseline assessment participants were randomised either to supportive therapy or MCT. Both groups used the same design (1h-session twice a week during 8weeks) although the basic knowledge given to participants was different between interventions. Participants were assessed at eight weeks based on the Scale to Assess Unawareness of Mental Disorder, Positive and Negative Syndrome Scale (PANSS), Psychotic Symptom Rating Scales, the Calgary Depression Scale for Schizophrenia and the Quality of Life Scale. Between-group differences were significant in favour of MCT on the PANSS positive scale. Between-group differences in post- and pre-test values showed a trend in favour of MCT for insight on hallucinations. Results of our study indicate that the MCT has an effect on reducing positive symptomatology, and a trend impact on insight and social functioning. Copyright © 2014 Elsevier B.V. All rights reserved.

Near-Death Experiences: An Exploration of Perceived Responses, Effects of Interventions, and Impact

DTIC Science & Technology

1991-01-01

Student Attending: University of Arizona AFIT/CI/CIA-91-080 9. SPONSORING MONITORING AGENCY NAME(S) AND ADDRESS(ES) ) . 10. SPONSORING, MONITORING AGENCY...includes hallucinations and delusions); wish-fulfilling dreams; depersonalization ; denial; and memory leftover from the birth experience (Freeman, 1985...had a "brief out of body experience" he was ready and eager to hear more about her NDE. [The students ] respond well because they’ve had a little

Cotard and Capgras syndrome after ischemic stroke.

PubMed

Sottile, Fabrizio; Bonanno, Lilla; Finzi, Giuseppina; Ascenti, Giorgio; Marino, Silvia; Bramanti, Placido; Corallo, Francesco

2015-04-01

Capgras and Cotard are delusional misidentification syndromes characterized by delusions about oneself, others, places, and objects. To date, there are few cases of comorbidity of both syndromes. We describe a case of aphasic stroke patient affected by cerebral ischemia localized in right temporoparietal region. The patient showed a typical clinical picture of delusional disorder attributable, through psychological assessment, to comorbidity of both Capgras and Cotard syndromes. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

On insight and psychosis: discussion paper.

PubMed Central

David, A S

1990-01-01

The concept of insight into psychosis has received scant attention in the psychiatric literature. Various types of insight are described after drawing on such sources as phenomenology, clinical observation and experimental psychology. It is proposed that insight is far from an all or none phenomenon but comprises three overlapping dimensions, namely, the recognition that one has a mental illness, compliance with treatment and the ability to re-label unusual mental events (delusions and hallucinations) as pathological. PMID:2199672

Immune markers of social cognitive bias in schizophrenia.

PubMed

Dunne, Patrick W; Roberts, David L; Quinones, Marlon P; Velligan, Dawn I; Paredes, Madelaine; Walss-Bass, Consuelo

2017-05-01

Social cognition is impaired in schizophrenia, is relatively independent of purely neurocognitive domains such as attention and executive functioning, and may be the strongest predictor of functional outcome in this disease. Within a motivated reasoning framework, we tested the hypothesis that the anti-inflammatory Th2-associated cytokines, IL-10 and MDC, would be correlated with behavioral measures of social cognitive threat-detection bias (self-referential gaze detection bias and theory of mind (ToM) bias) in delusional versus non-delusional patients. We administered to schizophrenia patients with delusions (n=21), non-delusional patients (n=39) and controls (n=20) a social cognitive task designed to be sensitive to psychosocial stress response (the Waiting Room Task) and collected plasma levels of inflammatory markers using a bead-based flow immunoassay. Results partially supported our hypothesis. The anti-inflammatory cytokine IL-10 was associated with self-referential ToM bias in the delusional cohort as predicted, and not with non-delusional patients or healthy controls. This bias reflects a documented tendency of schizophrenia patients with delusions to excessively attribute hostile intentions to people in their environment. Since this cytokine correlated only with ToM bias and only in delusional patients, elevated levels of this cytokine in the blood may eventually serve as a useful biomarker distinguishing delusional patients from both non-delusional patients and healthy controls. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Late Onset First Episode Psychosis Emerging as Delusional Misidentification of Familiar Sacred Places During a Holy Pilgrimage: A Case Report and Literature Review.

PubMed

Awara, Mahmoud A; Moselhy, Hamdy F; Elnenaei, Manal O

2017-11-07

The delusional misidentification syndromes (DMS) include a myriad of discrete but related syndromes, which have wide spectrum anomalies of familiarity. Several misidentification syndromes have been described in the psychiatric literature, the most common of these delusions are: the Capgras syndrome; the Fregoli syndrome; the syndrome of inter-metamorphosis; reduplicative paramnesia; and environmental reduplication. The reported case highlights the emergence of late onset first episode psychosis in a Middle Eastern 65-year-old female who has no previous psychiatric history. The nature of psychosis was mainly delusions of misidentification and persecution. DMS are relatively rare and occur predominantly in association with schizophrenia and affective psychosis. Between 25 and 40% are associated with organic conditions such as dementia, head injuries, brain tumors, and epilepsy. Only three cases of misidentification of sacred places have been reported previously in the literature. This case report is the first to present a DMS, emerging as a late onset first episode psychosis during the sacred journey of Hajj. The reported case highlights the importance of early recognition and treatment of mental health conditions that may appear de novo during the Hajj sacred journey. Readily available psychiatric resources, psychotropic medications, and psycho-education may be pivotal in ensuring mental well-being of pilgrims, which is fundamental to maintain the mental capacity required for completing these journeys.

Dreams as a source of supernatural agent concepts

PubMed Central

McNamara, Patrick; Bulkeley, Kelly

2015-01-01

We present a theory of the creativity of dreams as well as psychopathology of religious delusions with respect to production of fundamental forms of religious cognition—specifically supernatural agent (SA) cognitions. We suggest that dream cognitions are particularly efficient at producing highly memorable and impactful experiences with SAs because dreams involve three processes that are prerequisites for the generation of god concepts: (1) mental simulations of alternative realities, (2) theory of mind attributions to the extra-natural dream characters and divine beings, and (3) attribution of ultimate value (exemplified by ‘good spirit beings’), and dis-value (exemplified by demonic monsters) to the supernatural dream characters. Because prefrontal cortex is deactivated during rapid eye movements (REM) sleep agentic impulses and internally generated ideas are not reliably attributed to Self or dreamer. Instead an exaggerated degree of agency is attributed to these supernatural dream characters who are then embedded in stories in dreams and in myths of waking life which explain their supernatural abilities. These dream-based SAs are salient characters that are processed in sleep-related memory systems according to rules of Lleweelyn’s ancient art of memory model and therefore more easily remembered and reflected upon during waking life. When REM sleep intrudes into waking consciousness, as is the case with some forms of schizophrenia, religious delusions are more likely to emerge. PMID:25852602

Grey matter morphological anomalies in the caudate head in first-episode psychosis patients with delusions of reference.

PubMed

Tao, Haojuan; Wong, Gloria H Y; Zhang, Huiran; Zhou, Yuan; Xue, Zhimin; Shan, Baoci; Chen, Eric Y H; Liu, Zhening

2015-07-30

Delusions of reference (DOR) are theoretically linked with aberrant salience and associative learning. Previous studies have shown that the caudate nucleus plays a critical role in the cognitive circuits of coding prediction errors and associative learning. The current study aimed at testing the hypothesis that abnormalities in the caudate nucleus may be involved in the neuroanatomical substrate of DOR. Structural magnetic resonance imaging of the brain was performed in 44 first-episode psychosis patients (with diagnoses of schizophrenia or schizophreniform disorder) and 25 healthy controls. Patients were divided into three groups according to symptoms: patients with DOR as prominent positive symptom; patients with prominent positive symptoms other than DOR; and patients with minimal positive symptoms. All groups were age-, gender-, and education-matched, and patient groups were matched for diagnosis, duration of illness, and antipsychotic treatment. Voxel-based morphometric analysis was performed to identify group differences in grey matter density. Relationships were explored between grey matter density and DOR. Patients with DOR were found to have reduced grey matter density in the caudate compared with patients without DOR and healthy controls. Grey matter density values of the left and right caudate head were negatively correlated with DOR severity. Decreased grey matter density in the caudate nucleus may underlie DOR in early psychosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Theory of mind in Asperger's syndrome, schizophrenia and personality disordered forensic patients.

PubMed

Murphy, David

2006-03-01

The ability to conceptualise other individuals' mental states is dependent on having a 'theory of mind' (ToM). Individuals with Asperger's syndrome typically display ToM impairments, as do some individuals with schizophrenia, notably those with paranoid delusions. The presenting features of these and other individuals, such as those with some personality disorders, particularly in forensic patients, are often unclear. ToM performance was examined to see whether it could distinguish forensic patients with Asperger's syndrome from other patient groups. The performance of three male patient groups (N = 39) detained in high security psychiatric care, including those with Asperger's syndrome, schizophrenia (with paranoid delusions and/or auditory hallucinations as their predominant symptoms), or a dissocial and/or borderline personality disorder were compared using the revised eyes task and the modified advanced ToM test. The Asperger's syndrome and schizophrenia groups performed significantly worse than the personality disorder group on both ToM measures. However, the Asperger's syndrome and the personality disorder groups had significantly higher levels of general intellectual functioning than the schizophrenia group. Whilst ToM performance may help to discriminate patients with Asperger's syndrome or schizophrenia from personality disorder ed patients, a wide range in performance made it difficult to specify a patient to a particular group. Theoretical and methodological issues are discussed along with the usefulness of ToM assessments with forensic patients.

Beauty is in the Eyes of the Beholder: Definitions of Attractiveness among African American and Caucasian Women

DTIC Science & Technology

2005-01-01

format. A “yes” response to any of the auditory hallucinations questions (i.e., have you ever heard voices ?; do frequently hear things that other...disorganized thought processes in the form of delusion, hallucinations (e.g., visual and auditory ). Such symptomotology may have inhibited the prospective...disorder or endorse auditory or visual hallucinations by responding “yes” to phone screen questions were excluded (see Appendix B, questions 14A, 14A1

The Strategic Defense Initiative. Issues and Implications for the Atlantic Alliance.

DTIC Science & Technology

1988-05-01

Schwartz (Washington, D.C.: The Brookings Institution, 1984), p. 41. 10 Ibid., pp. 41-42. 11 Ibid., pp. 332-333. 12 Barash, p. 142. 13 Brian Green , "The...Initiative. New York: John Wiley and Sons, 1986. Freedman, Lawrence. Arms Control-Management or Reform? Chatham House Papers 31. London: Routledge and Kegan ...Delusions." Policy Review. (Summer 1986) : pp. 48-53. Green , Brian. "The New Case For Civil Defense." The Heritage Foundation Backgrounder. No. 377, August 29

The mystery of Morgellons disease: infection or delusion?

PubMed

Savely, Virginia R; Leitao, Mary M; Stricker, Raphael B

2006-01-01

Morgellons disease is a mysterious skin disorder that was first described more than 300 years ago. The disease is characterized by fiber-like strands extruding from the skin in conjunction with various dermatologic and neuropsychiatric symptoms. In this respect, Morgellons disease resembles and may be confused with delusional parasitosis. The association with Lyme disease and the apparent response to antibacterial therapy suggest that Morgellons disease may be linked to an undefined infectious process. Further clinical and molecular research is needed to unlock the mystery of Morgellons disease.

Did Mozart suffer from Asperger syndrome?

PubMed

Raja, Michele

2015-05-01

The most reliable biographies of Mozart highlight elements that are compatible with current diagnostic criteria for Asperger syndrome including qualitative impairment in social interaction and stereotyped and repetitive motor mannerisms. Furthermore, numerous features are documented including difficulty in communicating his emotional state and in inferring the mental state of his interlocutors, motor clumsiness, specific skills and genius, left-handedness, special sense of humour, physical developmental abnormalities, bizarre thinking, overvalued ideas and delusions. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Delusions and Responsibility for Action: Insights from the Breivik Case.

PubMed

Bortolotti, Lisa; Broome, Matthew R; Mameli, Matteo

2014-01-01

What factors should be taken into account when attributing criminal responsibility to perpetrators of severe crimes? We discuss the Breivik case, and the considerations which led to holding Breivik accountable for his criminal acts. We put some pressure on the view that experiencing certain psychiatric symptoms or receiving a certain psychiatric diagnosis is sufficient to establish criminal insanity. We also argue that the presence of delusional beliefs, often regarded as a key factor in determining responsibility, is neither necessary nor sufficient for criminal insanity.

The Vicious Cycle of Family Atmosphere, Interpersonal Self-concepts, and Paranoia in Schizophrenia-A Longitudinal Study.

PubMed

Hesse, Klaus; Kriston, Levente; Mehl, Stephanie; Wittorf, Andreas; Wiedemann, Wolfgang; Wölwer, Wolfgang; Klingberg, Stefan

2015-11-01

Recent cognitive models of paranoid delusions highlight the role of self-concepts in the development and maintenance of paranoia. Evidence is growing that especially interpersonal self-concepts are relevant in the genesis of paranoia. In addition, negative interpersonal life-experiences are supposed to influence the course of paranoia. As dysfunctional family atmosphere corresponds with multiple distressing dyadic experiences, it could be a risk factor for the development and maintenance of paranoia. A total of 160 patients with a diagnosis of schizophrenia were assessed twice within 12 months. Standardized questionnaires and symptom rating scales were used to measure interpersonal self-concepts, perceived family atmosphere, and paranoia. Data were analyzed using longitudinal cross-lagged structural equation models. Perceived negative family atmosphere was associated with the development of more pronounced negative interpersonal self-concepts 12 months later. Moreover, paranoia was related to negative family atmosphere after 12 months as well. As tests revealed that reversed associations were not able to explain the data, we found evidence for a vicious cycle between paranoia, family atmosphere, and interpersonal self-concepts as suggested by theoretical/cognitive model of paranoid delusions. Results suggest that broader interventions for patients and their caretakers that aim at improving family atmosphere might also be able to improve negative self-concepts and paranoia. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

On The Reality of Tooth Fairies: A Review of The God Delusion

PubMed Central

Zeiler, Michael D

2007-01-01

In The God Delusion, Richard Dawkins reviews the evidence for and against God. After considering arguments for a divine power, he says the main current one is that the characteristics of living creatures must be attributed to an all-powerful designer. Design is the only plausible account, because the excellent fit between each plant and animal and its environment could not possibly have appeared in one stroke by pure chance. Dawkins agrees that randomness could not have done the job, but he says that a designer is equally unlikely. The only viable explanation is evolution by natural selection, a process that operates without plan or design. He then turns to the adaptive value of religious belief. After failing to find any, he proposes that belief in divinities is the by-product of a powerful tendency to learn from others, an adaptive strategy produced by natural selection. Adults and other influential figures teach children many useful things, but they also train them to worship deities. Religious devotion is established through education, and it is maintained over generations by the social learning processes underlying all instances of cultural evolution. Dawkins' arguments together with other problems encountered in describing evolutionary processes highlight the importance of social learning. His discussion leads the reviewer to assert that only by knowing the mechanisms of social learning is it possible to understand how biological and cultural evolution interact to produce life as we find it.

Are delusional contents replayed during dreams?

PubMed

D'Agostino, Armando; Aletti, Giacomo; Carboni, Martina; Cavallotti, Simone; Limosani, Ivan; Manzone, Marialaura; Scarone, Silvio

2013-09-01

The relationship between dream content and waking life experiences remains difficult to decipher. However, some neurobiological findings suggest that dreaming can, at least in part, be considered epiphenomenal to ongoing memory consolidation processes in sleep. Both abnormalities in sleep architecture and impairment in memory consolidation mechanisms are thought to be involved in the development of psychosis. The objective of this study was to assess the continuity between delusional contents and dreams in acutely psychotic patients. Ten patients with a single fixed and recurring delusional content were asked to report their dreams during an acute psychotic break. Sixteen judges with four different levels of acquaintance to the specific content of the patients' delusions were asked to group the dreams, expecting that fragments of the delusional thought would guide the task. A mathematical index (f,t) was developed in order to compare correct groupings between the four groups of judges. Most judges grouped the dreams slightly above chance level and no relevant differences could be found between the four groups [F(3,12)=1.297; p=n.s.]. Scoring of dreams for specific delusional themes suggested a continuity in terms of dream and waking mentation for two contents (Grandiosity and Religion). These findings seem to suggest that at least some delusional contents recur within patients' dreams. Future studies will need to determine whether such continuity reflects ongoing consolidation processes that are relevant to current theories of delusion formation and stabilization. Copyright © 2013 Elsevier Inc. All rights reserved.

Symptom Dimensions of the Psychotic Symptom Rating Scales in Psychosis: A Multisite Study

PubMed Central

Woodward, Todd S.; Jung, Kwanghee; Hwang, Heungsun; Yin, John; Taylor, Laura; Menon, Mahesh; Peters, Emmanuelle; Kuipers, Elizabeth; Waters, Flavie; Lecomte, Tania; Sommer, Iris E.; Daalman, Kirstin; van Lutterveld, Remko; Hubl, Daniela; Kindler, Jochen; Homan, Philipp; Badcock, Johanna C.; Chhabra, Saruchi; Cella, Matteo; Keedy, Sarah; Allen, Paul; Mechelli, Andrea; Preti, Antonio; Siddi, Sara; Erickson, David

2014-01-01

The Psychotic Symptom Rating Scales (PSYRATS) is an instrument designed to quantify the severity of delusions and hallucinations and is typically used in research studies and clinical settings focusing on people with psychosis and schizophrenia. It is comprised of the auditory hallucinations (AHS) and delusions subscales (DS), but these subscales do not necessarily reflect the psychological constructs causing intercorrelation between clusters of scale items. Identification of these constructs is important in some clinical and research contexts because item clustering may be caused by underlying etiological processes of interest. Previous attempts to identify these constructs have produced conflicting results. In this study, we compiled PSYRATS data from 12 sites in 7 countries, comprising 711 participants for AHS and 520 for DS. We compared previously proposed and novel models of underlying constructs using structural equation modeling. For the AHS, a novel 4-dimensional model provided the best fit, with latent variables labeled Distress (negative content, distress, and control), Frequency (frequency, duration, and disruption), Attribution (location and origin of voices), and Loudness (loudness item only). For the DS, a 2-dimensional solution was confirmed, with latent variables labeled Distress (amount/intensity) and Frequency (preoccupation, conviction, and disruption). The within-AHS and within-DS dimension intercorrelations were higher than those between subscales, with the exception of the AHS and DS Distress dimensions, which produced a correlation that approached the range of the within-scale correlations. Recommendations are provided for integrating these underlying constructs into research and clinical applications of the PSYRATS. PMID:24936086

Birth experiences, trauma responses and self-concept in postpartum psychotic-like experiences.

PubMed

Holt, Lyndsey; Sellwood, William; Slade, Pauline

2018-02-02

The frequency of psychotic-like experiences (PLEs) amongst new mothers is beginning to be explored but the mechanisms underlying such experiences are yet to be understood. First time mothers (N=10,000) receiving maternity care via the UK National Health Service were contacted postnatally via Emma's Diary, an online resource for mothers. Measures assessed birth experience, trauma appraisals, post-traumatic stress symptoms, adjustment to motherhood, self-concept clarity and PLEs (in the form of hallucinations and delusions). There was a 13.9% response rate (N=1393) and 1303 participants reported experiencing at least one PLE (93.5%). Three competing nested path models were analysed. A more negative birth experience directly predicted delusions, but not hallucinations. Trauma appraisals and poorer adjustment to motherhood indirectly predicted PLEs, via disturbed self-concept clarity. Post-traumatic stress symptoms directly predicted the occurrence of all PLEs. PLEs in first time mothers may be more common than previously thought. A key new understanding is that where new mothers have experienced birth as traumatic and are struggling with adjustment to their new role, this can link to disturbances in a coherent sense of self (self-concept clarity) and be an important predictor of PLEs. Understanding the development of PLEs in new mothers may be helpful in postnatal care, as would public health interventions aimed at reducing the sense of abnormality or stigma surrounding such experiences. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

[EEG frequency and regional properties in patients with paranoid schizophrenia: effects of positive and negative symptomatology prevalence].

PubMed

Bochkarev, V K; Kirenskaya, A V; Tkachenko, A A; Samylkin, D V; Novototsky-Vlasov, V Yu; Kovaleva, M E

2015-01-01

EEG changes in schizophrenic patients are caused by a multitude of factors related to clinical heterogeneity of the disease, current state of patients, and conducted therapy. EEG spectral analysis remains an actual methodical approach for the investigation of the neurophysiological mechanisms of the disease. The goal of the investigation was the study of frequency and regional EEG correlating with the intensity of productive and negative disorders. Models of summary prevalence of positive/negative disorders and evidence of concrete clinical indices of the PANSS scale were used. Spectral characteristics of background EEG in the frequency range of 1-60 Hz were studied in 35 patients with paranoid schizophrenia free from psychoactive medication and in 19 healthy volunteers. It was established that the main index of negative symptomatology in summary assessment was diffuse increase of spectral power of gamma and delta ranges. Deficient states with the predominance of volitional disorders were characterized by a lateralized increase of spectral power of beta-gamma ranges in the left hemisphere, and of delta range - in frontal areas of this hemisphere. Positive symptomatology was noticeably less reflected in EEG changes than negative ones. An analysis of psychopathological symptom complexes revealed the significance of spatially structured EEG patterns in the beta range: for the delusion disturbances with psychic automatism phenomena - in frontal areas of the left hemisphere, and for the paranoid syndrome with primary interpretative delusion - in cortical areas of the right hemisphere.

Delusional disorder and schizophrenia: a comparative study across multiple domains.

PubMed

Peralta, V; Cuesta, M J

2016-10-01

Delusional disorder (DD) is an under-researched condition and its relationship to schizophrenia (SZ) controversial. This study aimed to further characterize DD and to examine multi-domain evidence for the distinction between DD and SZ. Using univariate analyses we examined 146 subjects with DD, 114 subjects with paranoid SZ and 244 subjects with non-paranoid SZ on 52 characteristics from several domains including demographics, risk factors, premorbid features, illness characteristics, index episode features, delusional-related features, response to treatment and outcome. In a further step, we searched for independent associations of the examined characteristics with DD v. SZ. Univariate analyses showed that DD differed from either form of SZ in 40 characteristics, the pattern of findings indicated that paranoid SZ was much more similar to non-paranoid SZ than DD. Relative to subjects with SZ, those with DD were more likely to have drug abuse before illness onset, better premorbid sexual adjustment, later age at illness onset, higher levels of affective symptoms and lack of insight, poorer response to antipsychotic medication, better functioning in the domains of personal care, paid work and social functioning; last, subjects with DD had fewer but more severe delusions and higher ratings of conviction of delusional experience than those with SZ. Predominance of jealousy and somatic delusions was confined to subjects with DD. DD and SZ represent two distinct classes of disorders, the differential features of DD being of nosological, aetiological and therapeutic relevance.

Resting-state thalamic dysconnectivity in schizophrenia and relationships with symptoms.

PubMed

Ferri, J; Ford, J M; Roach, B J; Turner, J A; van Erp, T G; Voyvodic, J; Preda, A; Belger, A; Bustillo, J; O'Leary, D; Mueller, B A; Lim, K O; McEwen, S C; Calhoun, V D; Diaz, M; Glover, G; Greve, D; Wible, C G; Vaidya, J G; Potkin, S G; Mathalon, D H

2018-02-15

Schizophrenia (SZ) is a severe neuropsychiatric disorder associated with disrupted connectivity within the thalamic-cortico-cerebellar network. Resting-state functional connectivity studies have reported thalamic hypoconnectivity with the cerebellum and prefrontal cortex as well as thalamic hyperconnectivity with sensory cortical regions in SZ patients compared with healthy comparison participants (HCs). However, fundamental questions remain regarding the clinical significance of these connectivity abnormalities. Resting state seed-based functional connectivity was used to investigate thalamus to whole brain connectivity using multi-site data including 183 SZ patients and 178 matched HCs. Statistical significance was based on a voxel-level FWE-corrected height threshold of p < 0.001. The relationships between positive and negative symptoms of SZ and regions of the brain demonstrating group differences in thalamic connectivity were examined. HC and SZ participants both demonstrated widespread positive connectivity between the thalamus and cortical regions. Compared with HCs, SZ patients had reduced thalamic connectivity with bilateral cerebellum and anterior cingulate cortex. In contrast, SZ patients had greater thalamic connectivity with multiple sensory-motor regions, including bilateral pre- and post-central gyrus, middle/inferior occipital gyrus, and middle/superior temporal gyrus. Thalamus to middle temporal gyrus connectivity was positively correlated with hallucinations and delusions, while thalamus to cerebellar connectivity was negatively correlated with delusions and bizarre behavior. Thalamic hyperconnectivity with sensory regions and hypoconnectivity with cerebellar regions in combination with their relationship to clinical features of SZ suggest that thalamic dysconnectivity may be a core neurobiological feature of SZ that underpins positive symptoms.

Bimanual coupling paradigm as an effective tool to investigate productive behaviors in motor and body awareness impairments.

PubMed

Garbarini, Francesca; Pia, Lorenzo

2013-11-05

When humans move simultaneously both hands strong coupling effects arise and neither of the two hands is able to perform independent actions. It has been suggested that such motor constraints are tightly linked to action representation rather than to movement execution. Hence, bimanual tasks can represent an ideal experimental tool to investigate internal motor representations in those neurological conditions in which the movement of one hand is impaired. Indeed, any effect on the "moving" (healthy) hand would be caused by the constraints imposed by the ongoing motor program of the 'impaired' hand. Here, we review recent studies that successfully utilized the above-mentioned paradigms to investigate some types of productive motor behaviors in stroke patients. Specifically, bimanual tasks have been employed in left hemiplegic patients who report illusory movements of their contralesional limbs (anosognosia for hemiplegia). They have also been administered to patients affected by a specific monothematic delusion of body ownership, namely the belief that another person's arm and his/her voluntary action belong to them. In summary, the reviewed studies show that bimanual tasks are a simple and valuable experimental method apt to reveal information about the motor programs of a paralyzed limb. Therefore, it can be used to objectively examine the cognitive processes underpinning motor programming in patients with different delusions of motor behavior. Additionally, it also sheds light on the mechanisms subserving bimanual coordination in the intact brain suggesting that action representation might be sufficient to produce these effects.

Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia.

PubMed

Anor, Cassandra J; O'Connor, Sean; Saund, Amardeep; Tang-Wai, David F; Keren, Ron; Tartaglia, Maria Carmela

2017-01-01

Neuropsychiatric symptoms (NPS) are common in Alzheimer disease (AD) and vascular dementia (VaD), and are distressful to patients and caregivers. NPS are likely related to the underlying pathology. Previous studies suggest that frontal lobe lesions and vascular changes such as white matter hyperintensities (WMH) have a significant association with specific NPS. The current study aimed to compare NPS in patients with AD, VaD, and mixed AD/VaD, and to evaluate the differences in the prevalence of NPS in relation to frontal WMH volume. In total, 180 patients with NPS and MRI data (92 probable AD, 51%; 34 probable VaD, 19%; and 54 probable mixed AD/VaD, 30%) were included in the study. Regression analyses were performed to determine the relationships between NPS prevalence and diagnosis, and between NPS and frontal WMH. VaD patients had significantly more agitation (p < 0.05; 40 vs. 14%) and sleep disturbances (p < 0.05; 57 vs. 32%) than AD patients, and significantly more depression (p < 0.05; 48 vs. 20%) and aberrant motor behaviors (p < 0.05; 31 vs. 13%) than mixed AD/VaD patients. AD patients with delusions had significantly greater right frontal WMH volumes than those without (p < 0.05; delusions 1/0 = 314.8/112.6 mm3). Differences in NPS prevalence are likely related to the underlying pathology and warrant further study as they have implications for treatment. © 2017 S. Karger AG, Basel.

Rating the severity and character of transient cocaine-induced delusions and hallucinations with a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP).

PubMed

Cubells, Joseph F; Feinn, Richard; Pearson, Deborah; Burda, Jeffrey; Tang, Yilang; Farrer, Lindsay A; Gelernter, Joel; Kranzler, Henry R

2005-10-01

Cocaine can induce transient psychotic symptoms. We examined the phenomenology of such cocaine-induced psychosis (CIP) using a modified version of the Scale for Assessment of Positive Symptoms (SAPS), a well-validated instrument for the assessment of schizophrenic psychosis. We developed a new instrument, the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP), based on the well-validated SAPS. We interviewed 243 unrelated cocaine-dependent adults using both the SAPS-CIP and an instrument for the identification of cocaine-induced paranoia, the Cocaine Experience Questionnaire (CEQ). One hundred and eighty-one (75%) of the subjects endorsed CIP using the CEQ. With the SAPS-CIP, hallucination (HAL) and delusion (DEL) scores correlated strongly, and the DEL domain showed excellent concurrent validity with the CEQ. We observed significant positive correlations, respectively, between severity of HAL and DEL, and lifetime number of episodes of cocaine use, and negative correlations with age at onset of cocaine use. The results suggest that CIP consists of transient delusional and hallucinatory symptoms, which tend to occur together and co-vary in severity. It appears that rating cocaine-induced paranoia alone (e.g., with the CEQ) can identify most subjects experiencing CIP. However, the SAPS-CIP is useful for quantifying the severity of CIP according to operational criteria. Our data provide additional evidence that CIP is a sensitizing response.

The neurobiology of schizotypy: Fronto-striatal prediction error signal correlates with delusion-like beliefs in healthy people

PubMed Central

Corlett, P.R.; Fletcher, P.C.

2012-01-01

Healthy people sometimes report experiences and beliefs that are strikingly similar to the symptoms of psychosis in their bizarreness and the apparent lack of evidence supporting them. An important question is whether this represents merely a superficial resemblance or whether there is a genuine and deep similarity indicating, as some have suggested, a continuum between odd but healthy beliefs and the symptoms of psychotic illness. We sought to shed light on this question by determining whether the neural marker for prediction error - previously shown to be altered in early psychosis – is comparably altered in healthy individuals reporting schizotypal experiences and beliefs. We showed that non-clinical schizotypal experiences were significantly correlated with aberrant frontal and striatal prediction error signal. This correlation related to the distress associated with the beliefs. Given our previous observations that patients with first episode psychosis show altered neural responses to prediction error and that this alteration, in turn, relates to the severity of their delusional ideation, our results provide novel evidence in support of the view that schizotypy relates to psychosis at more than just a superficial descriptive level. However, the picture is a complex one in which the experiences, though associated with altered striatal responding, may provoke distress but may nonetheless be explained away, while an additional alteration in frontal cortical responding may allow the beliefs to become more delusion-like: intrusive and distressing. PMID:23079501

[Schizophrenia spectrum disorders in elderly patients : Analysis of reasons for admission to a department of geriatric psychiatry].

PubMed

Jagsch, C; Dietmaier, G; Jagsch, M; Roller, R E

2018-02-01

The aim of this study was to analyze the possible reasons for acute admission to a department for geriatric psychiatry. The reasons for hospitalization, the psychiatric and somatic comorbidities of the patients over 65 years old with schizophrenia, schizoaffective disorder and delusional disorder were examined to identify patterns and risk profiles. A retrospective analysis was carried out using paper and electronic patient records of a department of acute care for geriatric psychiatry and psychotherapy. During the assessment period 206 successive patients over 65 years old were included in the study. The patient cohort included 64 patients with schizophrenia according to the international classification of diseases 10 (ICD-10, category F20), 78 patients with persistent delusional disorder (ICD-10, F22) and 64 patients with schizoaffective disorder (ICD-10, F25). The reason for admission for one third of the patients in all three groups was aggressive behavior, whereas delusions and hallucinations were more frequent in the groups of F20 and F22 patients than in patients with schizoaffective disorders (F25). Somatic comorbidities were seen significantly more often in the group of F22 patients than in the other two groups. Acute admission was essentially due to acute psychiatric symptoms. Additional somatic comorbidities and psychosocial influencing factors played only a minor role in this study. The patients examined in this study constituted a special group within the acute treatment of inpatient psychiatry because they showed distinctive psychopathological productive symptoms but were relatively healthy from a somatic point of view. Patients with the diagnosis of schizophrenia (F20) or schizoaffective disorder (F25) were significantly different from patients classified into the group of delusional disorders (F22).

Neuropsychiatric symptoms in geriatric patients admitted to skilled nursing facilities in nursing homes for rehabilitation after stroke: a longitudinal multicenter study.

PubMed

Buijck, Bianca I; Zuidema, Sytse U; Spruit-van Eijk, Monica; Geurts, Alexander C H; Koopmans, Raymond T C M

2012-07-01

To investigate the prevalence and course of neuropsychiatric symptoms (NPS) in geriatric patients admitted to skilled nursing facilities (SNFs) for rehabilitation after stroke. This was a longitudinal multicenter study within 15 SNFs in the Netherlands. NPS were assessed in 145 patients with stroke through the Neuropsychiatric Inventory-Nursing Home version (NPI-NH) with measurements on admission and at discharge. The prevalence and course of NPS were described in terms of cumulative prevalence (symptoms either on admission or at discharge), conversion (only symptoms at discharge), remission (only symptoms on admission), and persistence (symptoms both on admission and at discharge) for patients who were discharged to an independent living situation within one year after admission and patients who had to stay in the SNF for long term care. Eighty percent had a first-ever stroke and 74% could be successfully discharged. Overall, the most common NPS were depression (33%), eating changes (18%), night-time disturbances (19%), anxiety (15%), irritability (12%), and disinhibition (12%). One year after admission, the patients who were still in the SNF showed significantly more hallucinations (p = 0.016), delusions (p = 0.016), agitation (p = 0.004), depression (p = 0.000), disinhibition (p = 0.004), irritability (p = 0.018), and night-time disturbances (p = 0.001) than those who had been discharged. The overall prevalence of NPS in this study was lower than reported by other studies in different settings. There was a high prevalence of NPS in patients that could not be successfully discharged. The findings suggest that NPS should be optimally treated to improve outcome of rehabilitation. Copyright © 2011 John Wiley & Sons, Ltd.

Religion and psychosis: a common evolutionary trajectory?

PubMed

Dein, Simon; Littlewood, Roland

2011-07-01

In this article we propose that schizophrenia and religious cognition engage cognate mental modules in the over-attribution of agency and the overextension of theory of mind. We argue similarities and differences between assumptions of ultrahuman agents with omniscient minds and certain ''pathological'' forms of thinking in schizophrenia: thought insertion, withdrawal and broadcasting, and delusions of reference. In everyday religious cognition agency detection and theory of mind modules function ''normally,'' whereas in schizophrenia both modules are impaired. It is suggested that religion and schizophrenia have perhaps had a related evolutionary trajectory.

[Existence of emigrants and mental disorders].

PubMed

Pintér, E

1978-01-01

This paper's purpose is to define the immigrant's status and give evidence of psycho-social problems of the uprooted in a survey of hungarian and czech refugees. It is evident that morbidity of immigrant populations is generally increased. Also, certain nosological states are prevalent. Most of all, we have investigated delusions of reference in a culturally alien environment. Moreover, some psychoanalytical and sociological aspects pertaining to the immigrant's status (identity, assimilation, overadaptation, feelings of discrimination, socio-cultural hierarchy) are discussed. Ultimately, practical approaches to the psychological misery of immigrants are suggested.

A Chinese version of the Psychotic Symptom Rating Scales: psychometric properties in recent-onset and chronic psychosis.

PubMed

Chien, Wai-Tong; Lee, Isabella Yuet-Ming; Wang, Li-Qun

2017-01-01

The purpose of this study was to test the reliability, validity, and factor structure of a Chinese version of the Psychotic Symptom Rating Scale (PSYRATS) in 198 and 202 adult patients with recent-onset and chronic psychosis, respectively. The PSYRATS has been translated into different language versions and has been validated for clinical and research use mainly in chronic psychotic patients but not in recent-onset psychosis patients or in Chinese populations. The psychometric analysis of the translated Chinese version included assessment of its content validity, semantic equivalence, interrater and test-retest reliability, reproducibility, sensitivity to changes in psychotic symptoms, internal consistency, concurrent validity (compared to a valid psychotic symptom scale), and factor structure. The Chinese version demonstrated very satisfactory content validity as rated by an expert panel, good semantic equivalence with the original version, and high interrater and test-retest (at 2-week interval) reliability. It also indicated very good reproducibility of and sensitivity to changes in psychotic symptoms in line with the symptom severity measured with the Positive and Negative Syndrome Scale (PANSS). The scale consisted of four factors for the hallucination subscale and two factors for the delusion subscale, explaining about 80% of the total variance of the construct, indicating satisfactory correlations between the hallucination and delusion factors themselves, between items, factors, subscales, and overall scale, and between factors and relevant item and subscale scores of the PANSS. The Chinese version of the PSYRATS is a reliable and valid instrument to measure symptom severity in Chinese psychotic patients complementary to other existing measures mainly in English language.

Dopamine D2 receptor levels in striatum, thalamus, substantia nigra, limbic regions, and cortex in schizophrenic subjects.

PubMed

Kessler, Robert M; Woodward, Neil D; Riccardi, Patrizia; Li, Rui; Ansari, M Sib; Anderson, Sharlett; Dawant, Benoit; Zald, David; Meltzer, Herbert Y

2009-06-15

Studies in schizophrenic patients have reported dopaminergic abnormalities in striatum, substantia nigra, thalamus, anterior cingulate, hippocampus, and cortex that have been related to positive symptoms and cognitive impairments. [(18)F]fallypride positron emission tomography studies were performed in off-medication or never-medicated schizophrenic subjects (n = 11, 6 men, 5 women; mean age of 30.5 +/- 8.0 [SD] years; 4 drug-naive) and age-matched healthy subjects (n = 11, 5 men, 6 women, mean age of 31.6 +/- 9.2 [SD]) to examine dopamine D(2) receptor (DA D(2)r) levels in the caudate, putamen, ventral striatum, medial thalamus, posterior thalamus, substantia nigra, amygdala, temporal cortex, anterior cingulate, and hippocampus. In schizophrenic subjects, increased DA D(2)r levels were seen in the substantia nigra bilaterally; decreased levels were seen in the left medial thalamus. Correlations of symptoms with ROI data demonstrated a significant correlation of disorganized thinking/nonparanoid delusions with the right temporal cortex ROI (r = .94, p = .0001), which remained significant after correction for multiple comparisons (p < .03). Correlations of symptoms with parametric images of DA D(2)r levels revealed no significant clusters of correlations with negative symptoms but significant clusters of positive correlations of total positive symptoms, delusions and bizarre behavior with the lateral and anterior temporal cortex, and hallucinations with the left ventral striatum. The results of this study demonstrate abnormal DA D(2)r-mediated neurotransmission in the substantia nigra consistent with nigral dysfunction in schizophrenia and suggest that both temporal cortical and ventral striatal DA D(2)r mediate positive symptoms.

Symptoms of psychosis in schizophrenia, schizoaffective disorder, and bipolar disorder: A comparison of African Americans and Caucasians in the Genomic Psychiatry Cohort.

PubMed

Perlman, Greg; Kotov, Roman; Fu, Jinmiao; Bromet, Evelyn J; Fochtmann, Laura J; Medeiros, Helena; Pato, Michele T; Pato, Carlos N

2016-06-01

Several studies have reported differences between African Americans and Caucasians in relative proportion of psychotic symptoms and disorders, but whether this reflects racial bias in the assessment of psychosis is unclear. The purpose of this study was to examine the distribution of psychotic symptoms and potential bias in symptoms assessed via semi-structured interview using a cohort of 3,389 African American and 5,692 Caucasian participants who were diagnosed with schizophrenia, schizoaffective disorder, or bipolar disorder. In this cohort, the diagnosis of schizophrenia was relatively more common, and the diagnosis of bipolar disorder and schizoaffective disorder-bipolar type was less relatively common, among African Americans than Caucasians. With regard to symptoms, relatively more African Americans than Caucasians endorsed hallucinations and delusions symptoms, and this pattern was striking among cases diagnosed with bipolar disorder and schizoaffective-bipolar disorder. In contrast, the relative endorsement of psychotic symptoms was more similar among cases diagnosed with schizophrenia and schizoaffective disorder-depressed type. Differential item function analysis revealed that African Americans with mild psychosis over-endorsed "hallucinations in any modality" and under-endorsed "widespread delusions" relative to Caucasians. Other symptoms did not show evidence of racial bias. Thus, racial bias in assessment of psychotic symptoms does not appear to explain differences in the proportion of symptoms between Caucasians and African Americans. Rather, this may reflect ascertainment bias, perhaps indicative of a disparity in access to services, or differential exposure to risk factors for psychosis by race. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Clinico-Epidemiological Comparison of Delusion-Prominent and Hallucination-Prominent Clinical Subgroups of Paranoid Schizophrenia.

PubMed

Kreinin, Anatoly; Krishtul, Vladimir; Kirsh, Zvi; Menuchin, Michael

2015-01-01

Though hallucinations and delusions are prominent basic impairments in schizophrenia, reports of the relationship between hallucinatory and delusional symptoms among schizophrenia patients are scant. To examine the epidemiological and clinical differences between mainly hallucinatory and mainly delusional subgroups of paranoid schizophrenia patients. One hundred schizophrenia patients, paranoid type, were recruited. In a cross-sectional study, participants were divided into Mainly Hallucinatory (H) and Mainly Delusional (D) subgroups. Demographic variables were compared and clinical characteristics were evaluated using the Scale for the Assessment of Positive Symptoms, the Scale for the Assessment of Negative Symptoms, and the Clinical Global Impression Scale. The Quality-of-Life Enjoyment and Satisfaction Questionnaire-18 was used to assess quality of life. Clinically, the H group was more heterogeneous as expressed by the broader range of scores that described the clinical picture of patients in that subgroup (in 43 of 78 variables, 55.13%) and similar ranges of scores (31 of 78 variables, 39.74%) for patients in the D group. Duration of hospitalization was significantly longer in group H than in group D (p=0.047). There was no statistically significant difference between the H and D subgroups in demographic characteristics. There are distinct epidemiological and clinical differences between the H and D subgroups, with more severe positive and negative symptoms and greater functional impairment in the H group. Paranoid schizophrenia patients with prominent hallucinations have poorer prognosis and need intensive therapeutic rehabilitation beginning with onset-of-illness. Further genetic studies and comparisons of fMRI and/or PET findings are warranted to investigate additional distinctive characteristics of these subgroups.

Can virtual reality reduce reality distortion? Impact of performance feedback on symptom change in schizophrenia patients.

PubMed

Moritz, Steffen; Voigt, Miriam; Köther, Ulf; Leighton, Lucy; Kjahili, Besiane; Babur, Zehra; Jungclaussen, David; Veckenstedt, Ruth; Grzella, Karsten

2014-06-01

There is emerging evidence that the induction of doubt can reduce positive symptoms in patients with schizophrenia. Based on prior investigations indicating that brief psychological interventions may attenuate core aspects of delusions, we set up a proof of concept study using a virtual reality experiment. We explored whether feedback for false judgments positively influences delusion severity. A total of 33 patients with schizophrenia participated in the experiment. Following a short practice trial, patients were instructed to navigate through a virtual street on two occasions (noise versus no noise), where they met six different pedestrians in each condition. Subsequently, patients were asked to recollect the pedestrians and their corresponding facial affect in a recognition task graded for confidence. Before and after the experiment, the Paranoia Checklist (frequency subscale) was administered. The Paranoia Checklist score declined significantly from pre to post at a medium effect size. We split the sample into those with some improvement versus those that either showed no improvement, or worsened. Improvement was associated with lower confidence ratings (both during the experiment, particularly for incorrect responses, and according to retrospect assessment). No control condition, unclear if improvement is sustained. The study tentatively suggests that a brief virtual reality experiment involving error feedback may ameliorate delusional ideas. Randomized controlled trials and dismantling studies are now needed to substantiate the findings and to pinpoint the underlying therapeutic mechanisms, for example error feedback or fostering attenuation of confidence judgments in the face of incomplete evidence. Copyright © 2013 Elsevier Ltd. All rights reserved.

Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample.

PubMed

Lien, Yin-Ju; Kao, Yu-Chen; Liu, Yia-Ping; Chang, Hsin-An; Tzeng, Nian-Sheng; Lu, Chien-Wen; Lin, Shwu-Jon; Loh, Ching-Hui

2015-02-01

Studies on the association between psychopathology, perceived public stigma, and labeling in mental illness have focused primarily on severe but rare mental disorders, especially schizophrenia, or other clinically defined psychotic disorders. Although evidence is mounting that psychosis-like experiences show high prevalence in the general population and lead to an increased risk of psychotic disorders, little is known about how psychosis-like experiences independently affect perceived public stigma in the non-clinical population. The aim of the present study was to examine the relationship between psychosis-like experiences and perceived public stigma in a non-clinical sample. For this cross-sectional study, we recruited 524 individuals (239 male, 285 female) who had no lifetime history of psychiatric disorder. Participants completed questionnaires that asked for sociodemographic and clinical information, a measure of perceived public stigma (Perceived Psychiatric Stigma Scale [PPSS]), and two measures of psychosis-like experiences (Peters et al. Delusions Inventory [PDI]; Cardiff Anomalous Perceptions Scale [CAPS]). Of the sociodemographic characteristics analyzed in this study-gender, age, education level, marital status, and religion-only age simultaneously influenced PPSS, PDI, and CAPS scores. As hypothesized, perceived public stigma was positively correlated with measures of psychosis-like experiences, even after controlling for age. Furthermore, the perceived stigma was more strongly associated with delusion proneness than with anomalous perceptual experiences. The association between psychopathology and perceived public stigma appears to extend beyond clinically defined psychosis to more common psychosis-like experiences in a sample drawn from the general Han Chinese population.

Comparison of behavioral and psychological symptoms of Alzheimer's disease among institution residents and memory clinic outpatients.

PubMed

Cheng, Ting-Wen; Chen, Ta-Fu; Yip, Ping-Keung; Hua, Mau-Sun; Yang, Chi-Cheng; Chiu, Ming-Jang

2009-12-01

Behavioral and psychological symptoms of dementia (BPSD) cause caregiver distress and earlier institutionalization. We compared the prevalence and characteristics of BPSD between institution residents and memory clinic outpatients with Alzheimer's disease (AD) to test the hypothesis that there is more BPSD among institution residents than among their outpatient counterparts. We assessed BPSD by interviewing the patients' principal caregivers, either family or professionals, using the Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD). Data from 138 patients with probable AD from the memory clinic and 173 residents with possible AD living in the long-term care facilities were collected. The diagnoses followed the NINCDS-ADRDA criteria. BPSD profiles of the two groups were similar but not identical. The prevalence of at least one BPSD was high in both groups (community 81.9%, institution 74.9%). Activity disturbance was the most frequently reported BPSD in both groups (community 52.2%, institution 38.7%). Delusions, hallucinations, anxiety and aggressiveness were seen more frequently in memory clinic outpatients. The outpatients also had higher scores of BEHAVE-AD subscales in delusion/paranoid ideation, affective disturbance, and global rating of severity. With the increase of disease severity there were significantly more activity disturbance, psychosis, and aggressiveness in patients with AD. Caregiver factor and institution effect were two possible reasons for the higher prevalence and the greater severity of BPSD in community patients. BPSD caused more distress to family caregivers than the professional caregivers. High levels of psychotropic prescriptions for patients living in the long-term care facilities may also play a role.

Distress Associated with Dementia-Related Psychosis and Agitation in Relation to Healthcare Utilization and Costs.

PubMed

Maust, Donovan T; Kales, Helen C; McCammon, Ryan J; Blow, Frederic C; Leggett, Amanda; Langa, Kenneth M

2017-10-01

Explore the relationship between behavioral and psychological symptoms of dementia (BPSD; specifically, delusions, hallucinations, and agitation/aggression) and associated caregiver distress with emergency department (ED) utilization, inpatient hospitalization, and expenditures for direct medical care. Retrospective cross-sectional cohort of participants with dementia (N = 332) and informants from the Aging, Demographics, and Memory Study, a nationally representative survey of U.S. adults >70 years old. BPSD of interest and associated informant distress (trichotomized as none/low/high) were assessed using the Neuropsychiatric Inventory (NPI). Outcomes were determined from one year of Medicare claims and examined according to presence of BPSD and associated informant distress, adjusting for participant demographics, dementia severity, and comorbidity. Fifty-eight (15%) participants with dementia had clinically significant delusions, hallucinations, or agitation/aggression. ED visits, inpatient admissions, and costs were not significantly higher among the group with significant BPSD. In fully adjusted models, a high level of informant distress was associated with all outcomes: ED visit incident rate ratio (IRR) 3.03 (95% CI: 1.98-4.63; p < 0.001), hospitalization IRR 2.78 (95% CI: 1.73-4.46; p < 0.001), and relative cost ratio 2.00 (95% CI: 1.12-3.59; p = 0.02). A high level of informant distress related to participant BPSD, rather than the symptoms themselves, was associated with increased healthcare utilization and costs. Effectively identifying, educating, and supporting distressed caregivers may help reduce excess healthcare utilization for the growing number of older adults with dementia. Copyright © 2017 American Association for Geriatric Psychiatry. All rights reserved.

The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: a systematic review.

PubMed

Terum, Toril Marie; Andersen, John Roger; Rongve, Arvid; Aarsland, Dag; Svendsboe, Ellen J; Testad, Ingelin

2017-07-01

Neuropsychiatric symptoms (NPSs) are common in dementia, and they have been identified as important care-recipient variables in terms of their impact on caregiver burden. The aim of this review was to describe how individual NPSs in dementia, assessed using the Neuropsychiatric Inventory, are associated with caregiver burden. We performed a systematic review of English language, peer-reviewed articles retrieved from MEDLINE, PSYCINFO, and EMBASE. A total of 13 studies met the inclusion criteria. Four studies examined the association between individual NPSs and caregiver burden using the Spearman rank correlation test, while three used Pearson's correlation test. Of the remaining studies, five used multiple regression analyses and one the chi-squared test. The majority of included studies did not differentiate between dementia subtypes in the analysis or mainly included only caregivers of people with Alzheimer's disease. The Clinical Dementia Rating score and mean Mini-Mental State Examination score indicate mild to moderate dementia. The majority of caregivers were women, most of whom were children (53.8%) or spouses (36%). The data indicated that irritability, followed by agitation, sleep disturbances, anxiety, apathy, and delusion seem to impact caregiver burden the most. Our principal finding is that irritability, agitation, sleep disturbances, anxiety, apathy, and delusion seem to exert the most impact on caregiver burden. Heterogeneity in the measures and statistical analyses used, however, makes it difficult to make conclusive interpretations. Future research in this field would benefit from standardization of the scientific methodology in use. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Disorganization and real-world functioning in schizophrenia: Results from the multicenter study of the Italian Network for Research on Psychoses.

PubMed

Rocca, P; Galderisi, S; Rossi, A; Bertolino, A; Rucci, P; Gibertoni, D; Montemagni, C; Bellino, S; Aguglia, E; Amore, M; Bellomo, A; Biondi, M; Carpiniello, B; Cuomo, A; D'Ambrosio, E; dell'Osso, L; Girardi, P; Marchesi, C; Monteleone, P; Montemitro, C; Oldani, L; Pacitti, F; Roncone, R; Siracusano, A; Tenconi, E; Vita, A; Zeppegno, P; Steardo, L; Vignapiano, A; Maj, M

2018-06-10

A general consensus has not yet been reached regarding the role of disorganization symptoms in real-world functioning in schizophrenia. We used structural equations modeling (SEM) to analyze the direct and indirect associations between disorganization and real-world functioning assessed through the Specific Levels of Functioning Scale (SLOF) in 880 subjects with schizophrenia. We found that: 1) conceptual disorganization was directly and strongly connected with SLOF daily activities; difficulty in abstract thinking was associated with moderate strength to all SLOF domains, and poor attention was connected with SLOF work skills; 2) grandiosity was only related with poor work skills, and delusions were associated with poor functioning in all SLOF domains; interpersonal relationships were weakly indirectly influenced by hallucinatory behavior, delusions and unusual thought contents through the mediation of social cognition (SC); 3) among the negative symptoms, avolition had only direct links with SLOF work skills and SLOF activities; anhedonia had direct links with SLOF work skills and SLOF interpersonal and indirect link with SLOF work skills through functional capacity (FC); asociality with SLOF interpersonal; blunted affect had direct links with SLOF activities and indirect links with SLOF interpersonal relationships mediated by SC. Lastly, alogia had only indirect links mediated by SC, FC, and neurocognition (NC). Overall conceptual disorganization is the symptom that contributed more (both directly and indirectly) to the activities of community living in real-world. Thus, it should be considered as a treatment target in intervention programs for patients with schizophrenia. Copyright © 2018. Published by Elsevier B.V.

Stalking behavior in delusional jealousy.

PubMed

Silva, J A; Derecho, D V; Leong, G B; Ferrari, M M

2000-01-01

Stalking behavior has been associated with several mental disorders, both psychotic and non-psychotic. The most frequently associated condition appears to be an individual with primitive personality psychopathology regardless of co-occurring psychotic symptomatology. Among the psychotic symptoms, erotomanic, and jealousy delusions may be the most clinically and torensically relevant. However, delusional jealousy has not been well appreciated in the psychiatric literature as an important contributor to stalking behavior. In this article, we explore the psychiatric, psychosocial, and forensic aspects of stalking in the context of delusional jealousy. We use a case example to highlight important issues in this area.

Natal Tooth Associated with Fibrous Hyperplasia – A Rare Case Report

PubMed Central

Munjal, Deepti; Dhingra, Renuka; Malik, Narender Singh; Sidhu, Gagandeep Kaur

2015-01-01

Eruption of tooth at about 6 months of age is a significant stage in child’s life and is an emotional event for parents. However, a tooth present in the oral cavity of newborn can lead to a lot of delusions. Natal and neonatal teeth are of utmost importance not only for a dentist but also for a paediatrician due to parent’s anxiety, folklore superstitions and numerous associated complications with it. This paper reports a rare case, wherein a natal tooth has led to the development of a reactive fibrous hyperplasia in an 8-week-old infant. PMID:26023656

The Capgras syndrome in paranoid schizophrenia.

PubMed

Silva, J A; Leong, G B

1992-01-01

Capgras syndrome is characterized by a delusion of impostors who are thought to be physically similar but psychologically distinct from the misidentified person. This syndrome is generally thought to be relatively rare. Most of our knowledge about Capgras syndrome derives from single case studies and small series of cases usually from diagnostically heterogeneous groups. In this article, a series of 31 patients suffering from both paranoid schizophrenia and Capgras syndrome is described. Issues pertaining to the phenomenology of Capgras syndrome, the possible relation between Capgras syndrome and other delusional misidentification syndromes, and a neurobiological hypothesis aimed at explaining Capgras syndrome are discussed.

Cotard's syndrome: Two case reports and a brief review of literature.

PubMed

Grover, Sandeep; Aneja, Jitender; Mahajan, Sonali; Varma, Sannidhya

2014-11-01

Cotard's syndrome is a rare neuropsychiatric condition in which the patient denies existence of one's own body to the extent of delusions of immortality. One of the consequences of Cotard's syndrome is self-starvation because of negation of existence of self. Although Cotard's syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, it is less often reported to be seen in patients with catatonia. In this report we present two cases of Cotard's syndrome, both of whom had associated self-starvation and nutritional deficiencies and one of whom had associated catatonia.

Cotard's syndrome: Two case reports and a brief review of literature

PubMed Central

Grover, Sandeep; Aneja, Jitender; Mahajan, Sonali; Varma, Sannidhya

2014-01-01

Cotard's syndrome is a rare neuropsychiatric condition in which the patient denies existence of one's own body to the extent of delusions of immortality. One of the consequences of Cotard's syndrome is self-starvation because of negation of existence of self. Although Cotard's syndrome has been reported to be associated with various organic conditions and other forms of psychopathology, it is less often reported to be seen in patients with catatonia. In this report we present two cases of Cotard's syndrome, both of whom had associated self-starvation and nutritional deficiencies and one of whom had associated catatonia. PMID:25540544

[Psychiatric emergencies in the elderly].

PubMed

Zinetti, Jacqueline; Daraux, Jacques; Ploskas, Fabienne

2003-06-01

If it is common place to claim that old age is not a disease, however the losses and mournings related to that stage of life generate the production of acute psychopathological disorders. A few of them will be approached and treated as emergencies and required from the physician a good command of their existence and of specificities: atypical depressive disorders stressed by the risk of suicide, sits of delusions some themes of which are typical of senesence, excitement and aggressiveness inherent to dementia. As to the ill-treatment of the elderly often under-diagnosed, it requires urgent interventions both clinical and even juridical.

Agency and Anxiety: Delusions of Control and Loss of Control in Schizophrenia and Agoraphobia

PubMed Central

Gallagher, Shaun; Trigg, Dylan

2016-01-01

We review the distinction between sense of agency and sense of ownership, and then explore these concepts, and their reflective attributions, in schizophrenic symptoms and agoraphobia. We show how the underlying dynamics of these experiences are different across these disorders. We argue that these concepts are complex and cannot be reduced to neural mechanisms, but involve embodied and situated processes that include the physical and social environments. We conclude by arguing that the subjective and intersubjective dimensions of agency and ownership cannot be considered in isolation from one another, but instead form an interdependent pairing. PMID:27725796

Alzheimer and his disease: a brief history.

PubMed

Cipriani, Gabriele; Dolciotti, Cristina; Picchi, Lucia; Bonuccelli, Ubaldo

2011-04-01

More than 100 years ago, Alois Alzheimer first described the clinical and pathological features of an unusual brain disease during the meeting of the Society of Southwest German Psychiatrists in Tübingen: the patient, Auguste Deter, suffered memory loss, disorientation, hallucinations and delusions and died at the age of 55. In 1910, Emil Kraepelin named the condition with the eponym of "Alzheimer's disease" (AD) that is, now, the most common neurodegenerative disease with more than 25 million cases worldwide and a major medical problem nearing catastrophic levels. The present article discusses Alzheimer's work in the context of his life and time.

Under the shadow of maternity: birth, death and puerperal insanity in Victorian Britain.

PubMed

Marland, Hilary

2012-03-01

Death and fear of death in cases of puerperal insanity can be linked to a much broader set of anxieties surrounding childbirth in Victorian Britain. Compared with other forms of mental affliction, puerperal insanity was known for its good prognosis, with many women recovering over the course of several months. Even so, a significant number of deaths were associated with the disorder, and a large proportion of sufferers struggled with urges to destroy their infants and themselves. The disorder evoked powerful delusions concerning death, with patients expressing intimations of mortality and longing for death.

Shall we really say goodbye to first rank symptoms?

PubMed

Heinz, A; Voss, M; Lawrie, S M; Mishara, A; Bauer, M; Gallinat, J; Juckel, G; Lang, U; Rapp, M; Falkai, P; Strik, W; Krystal, J; Abi-Dargham, A; Galderisi, S

2016-09-01

First rank symptoms (FRS) of schizophrenia have been used for decades for diagnostic purposes. In the new version of the DSM-5, the American Psychiatric Association (APA) has abolished any further reference to FRS of schizophrenia and treats them like any other "criterion A" symptom (e.g. any kind of hallucination or delusion) with regard to their diagnostic implication. The ICD-10 is currently under revision and may follow suit. In this review, we discuss central points of criticism that are directed against the continuous use of first rank symptoms (FRS) to diagnose schizophrenia. We describe the specific circumstances in which Schneider articulated his approach to schizophrenia diagnosis and discuss the relevance of his approach today. Further, we discuss anthropological and phenomenological aspects of FRS and highlight the importance of self-disorder (as part of FRS) for the diagnosis of schizophrenia. Finally, we will conclude by suggesting that the theory and rationale behind the definition of FRS is still important for psychopathological as well as neurobiological approaches today. Results of a pivotal meta-analysis and other studies show relatively poor sensitivity, yet relatively high specificity for FRS as diagnostic marker for schizophrenia. Several methodological issues impede a systematic assessment of the usefulness of FRS in the diagnosis of schizophrenia. However, there is good evidence that FRS may still be useful to differentiate schizophrenia from somatic causes of psychotic states. This may be particularly important in countries or situations with little access to other diagnostic tests. FRS may thus still represent a useful aid for clinicians in the diagnostic process. In conclusion, we suggest to continue a tradition of careful clinical observation and fine-grained psychopathological assessment, including a focus on symptoms regarding self-disorders, which reflects a key aspect of psychosis. We suggest that the importance of FRS may indeed be scaled down to a degree that the occurrence of a single FRS alone should not suffice to diagnose schizophrenia, but, on the other hand, absence of FRS should be regarded as a warning sign that the diagnosis of schizophrenia or schizoaffective disorder is not warranted and requires specific care to rule out other causes, particularly neurological and other somatic disorders. With respect to the current stage of the development of ICD-11, we appreciate the fact that self-disorders are explicitly mentioned (and distinguished from delusions) in the list of mandatory symptoms but still feel that delusional perceptions and complex hallucinations as defined by Schneider should be distinguished from delusions or hallucinations of "any kind". Finally, we encourage future research to explore the psychopathological context and the neurobiological correlates of self-disorders as a potential phenotypic trait marker of schizophrenia. Copyright © 2016 Elsevier Masson SAS. All rights reserved.