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Rudalevičienė, Palmira, Virginija Adomaitienė, Thomas Stompe, Andrius Narbekovas, Kazimieras Meilius, Nijolė Raškauskienė, Jurgis Rudalevičius, and Robertas Bunevičius. "Delusions of persecution and poisoning in patients with schizophrenia: sociocultural and religious background." Medicina 46, no. 3 (March 10, 2010): 185. http://dx.doi.org/10.3390/medicina46030026.
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This article presents data on the phenomenology of delusions of persecution and poisoning in patients with schizophrenia and determines parallels between sociodemographic status and personal religiosity and this type of delusions. We have studied the content of delusions in patients with schizophrenia looking for persecution and poisoning themes using Fragebogen fuer psychotische Symptome (FPS). A total of 295 patients suffering from schizophrenia participated in this study; 74.7% reported delusions of persecution. The proportion of female patients (81.9%) who felt persecuted was almost one-third higher than the proportion of male patients (66.9%). The prevalence of delusions of persecution was lower in the group of persons for whom their faith was personally important (73.4%) than in the atheistic group (86.7%). Delusions of persecution and poisoning were strongly intercorrelated. Delusions of poisoning were reported by 57.8% of respondents: 54.8% by male and 60.6% by female patients. In multivariate analysis, delusions of persecution were more prevalent in women compared to men; in those with a chronic course of illness compared to those with periodic course; in those with small size of family compared to those with large family. The presence of delusions of being poisoned was related to older age of the patient, higher than secondary education, chronic course of schizophrenia, and younger parental age. Personal importance of the faith was not associated with prevalence of delusions of persecution and poisoning in patients with schizophrenia.
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Madeira, L. A., L. F. Manarte, D. Guerreiro, and C. Dias. "A case of delusional disorder, diagnostics and therapeutic questions." European Psychiatry 26, S2 (March 2011): 1709. http://dx.doi.org/10.1016/s0924-9338(11)73413-7.
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The Delusional disorder is uncommon, accounting for 2–8% of all hospital admissions for non-organic psychotic disorder and is usually initiated after the third decade of life. It is characterized primarily by one or more non-bizarre delusions, and according to the content of delusions, can be divided into five subtypes: persecution, jealousy, erotomanic, somatic and grandeur.We present a case of a patient with Jealousy Delusional Disorder and discuss the main difficulties that arise in the differential diagnosis and treatment.In the differential diagnosis is essential to eliminate the pathologies of organic causes that may have delusions as clinical manifestation. It is then necessary to distinguish delusion from obsessive ideas and overvalued ideas that can lead to misdiagnosis and therefore have serious implications in monitoring and treating of these patients.The subtype of jealousy seems to have a better evolution and prognosis compared with others subtypes reported.Although the Delusional Disorder present a more favorable course and usually is associated with a smaller disturbance in the overall functioning of the patients, they have a poor compliance to psychiatric treatment. So, they often stop psychiatry follow-up and discontinue therapy.
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BLAKEMORE, S. J., Y. SARFATI, N. BAZIN, and J. DECETY. "The detection of intentional contingencies in simple animations in patients with delusions of persecution." Psychological Medicine 33, no. 8 (October 30, 2003): 1433–41. http://dx.doi.org/10.1017/s0033291703008341.
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Background. It has been proposed that delusions of persecution are caused by the tendency to over-attribute malevolent intentions to other people's actions. One aspect of intention attribution is detecting contingencies between an agent's actions and intentions. Here, we used simplified stimuli to test the hypothesis that patients with persecutory delusions over-attribute contingency to agents' movements.Method. Short animations were presented to three groups of subjects: (1) schizophrenic patients; (2) patients with affective disorders; and (3) normal control subjects. Patients were divided on the basis of the presence or absence of delusions of persecution. Participants watched four types of film featuring two shapes. In half the films one shape's movement was contingent on the other shape. Contingency was either ‘intentional’: one shape moved when it ‘saw’ another shape; or ‘mechanical’: one shape was launched by the other shape. Subjects were asked to rate the strength of the relationship between the movement of the shapes.Results. Normal control subjects and patients without delusions of persecution rated the relationship between the movement of the shapes as stronger in both mechanical and intentional contingent conditions than in non-contingent conditions. In contrast, there was no significant difference between the ratings of patients with delusions of persecution for the conditions in which movement was animate. Patients with delusions of persecution perceived contingency when there was none in the animate non-contingent condition.Conclusions. The results suggest that delusions of persecution may be associated with the over-attribution of contingency to the actions of agents.
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Geroldi, Cristina, Lorena Bresciani, Orazio Zanetti, and Giovanni B. Frisoni. "Regional Brain Atrophy in Patients With Mild Alzheimer's Disease and Delusions." International Psychogeriatrics 14, no. 4 (December 2002): 365–78. http://dx.doi.org/10.1017/s1041610202008566.
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Background and Objective: The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer's disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. Methods: The setting of the study was the outpatients facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 ± 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. Results: AD patients without delusions had symmetrical enlargement of both temporal (8.1 ± 3.9 vs. 8.5 ± 4.5) and frontal horns (35.8 ± 4.8 vs. 35.9 ± 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 ± 3.3 vs. 7.7 ± 3.1, p = .06) and the frontal horn to the left (35.7 ± 4.3 vs. 37.5 ± 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model (interaction term between asymmetry and group: F1,38 = 5.5, p = .03). Discussion: AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.
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Cocho, C., M. Baquero, I. Vera, and J. Alvarez-arenas. "Folie à deux." European Psychiatry 33, S1 (March 2016): S576. http://dx.doi.org/10.1016/j.eurpsy.2016.01.2133.
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IntroductionThe induced delusional disorder or folie à deux, is a rare condition characterized by psychotic symptoms at least in two individuals in close association.ObjectivesWe report a case of shared psychotic disorder between mother and daughter. We briefly review both classical and current literature.MethodsWe summarized the results from articles identified via MEDLINE/PubMed using “induced delusional/shared psychotic disorder” as keywords. We report a case of a woman who develops psychotic symptoms characterized by delusions of persecution. Her daughter started, during the first high school grade with referring sexual threats and having delusions of persecution lived by her mother like a fact. They have very symbiotic relationship. Seven years later, the mother has required hospitalization for chronic delusions.ResultsThe term folie à deux was first coined by Lasègue and Falret, they assume the transmission of delusions was possible when an individual dominated the other and existed relative isolation. Recent studies found no significant differences in age and sex, although described higher comorbidity with other psychiatric diseases. Relative to treatment, separation by itself is insufficient; an effective neuroleptic treatment is required.ConclusionsOur case meets criteria for shared psychotic disorder. The daughter, with a ruling attitude who dominates the relationship, was the inducer. The mother showed no resistance in accepting delusions and remains them active after separation. This leads us to consider the possible predisposition to psychotic illness by both patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Allan, John A., and R. Julian Hafner. "Sex Differences in the Phenomenology of Schizophrenic Disorder." Canadian Journal of Psychiatry 34, no. 1 (February 1989): 46–48. http://dx.doi.org/10.1177/070674378903400112.
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The content and structure of delusions were compared in 30 women and 30 age-matched men with Shizophrenic Disorder. Men showed an excess of homosexual persecutory delusions and of grandiose delusions involving social status and personal power. Women showed an excess of delusions of fertility and of jealousy, and were more often than men objects rather than subjects in their grandiose delusions. There was an excess of women who reported co-objects of persecution, and who personally knew their persecutors, nearly always men. These differences mirrored aspects of the social environment, especially with regard to sex-role stereotyping.
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Musalek, M. "The Beauty of Delusions." European Psychiatry 26, S2 (March 2011): 2013. http://dx.doi.org/10.1016/s0924-9338(11)73716-6.
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As cosmopoets we create our world - but we do not create our world independently from our surroundings. What we are doing is not a poetry work in the sense of arbitrary inventions, but an attempt to transfer extensively and intensively psychical processes into communicable events. Patients suffering from delusions are also cosmopoets, they also create their world. It is a more or less understandable world, it is a world which is more or less similar to the world of the non-deluded, and it is a world which on the one hand terrorizes the patient but on the other hand attracts the patient by its sublime beauty. In this context W.Janzarik spoke from an ‘enemy/partnership’ of patients with delusions of persecution. The deluded world is a non-contingent terrifying but also in any case at least to some extent a beautiful and attractive world. Thrown in the risky and ugly world of mental disorders characterized by ambiguity and precariousness, patients are looking for islands of safety and sublime beauty; such islands may represent delusional convictions. As meanings of the disorder and the resulting ambivalence between attractiveness and suffering represent important disorder maintaining factors, knowledge about them provide the indispensable basis for effective treatment strategies (in particular psychotherapy) of delusional syndromes.
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Walsh, Joseph. "Clinical social work with clients having delusions of persecution." Practice 9, no. 4 (October 1997): 23–34. http://dx.doi.org/10.1080/09503159708411660.
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Brown, Seth A. "The Reality of Persecutory Beliefs: Base Rate Information for Clinicians." Ethical Human Psychology and Psychiatry 10, no. 3 (December 2008): 163–78. http://dx.doi.org/10.1891/1559-4343.10.3.163.
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When an individual describes persecution, how does one know whether this constitutes reality or a delusion? An erroneous clinical decision can lead to unnecessary treatment or lack of appropriate treatment. Knowledge of base rates of relevant events can inform the decision-making process and potentially increase the accuracy of clinical judgments. This article reviews base rates of events that could be perceived as delusions as well as the correlates associated with these events. Commonly occurring events include discrimination, mental illness stigma, criminal victimization, infidelity, conspiracy beliefs, and stalking. Surveillance and intentional poisoning are rare events. Clinicians who possess accurate base rates of events and their correlates will likely engage in more informed and accurate clinical judgments.
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Oher, F. J., A. Demjaha, D. Jackson, C. Morgan, P. Dazzan, K. Morgan, J. Boydell, et al. "The effect of the environment on symptom dimensions in the first episode of psychosis: a multilevel study." Psychological Medicine 44, no. 11 (January 20, 2014): 2419–30. http://dx.doi.org/10.1017/s0033291713003188.
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BackgroundThe 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.MethodWe 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.ResultsReality 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).ConclusionsIn 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.
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Gangdev, Prakash S. "The Relationship Between Obsessive-Compulsive Disorder and Psychosis." Australasian Psychiatry 10, no. 4 (August 2002): 405–10. http://dx.doi.org/10.1046/j.1440-1665.2002.00505.x.
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Objective: To report on patients with comorbid Obsessive-Compulsive Disorder (OCD) and a psychotic disorder, and to discuss the relationship between OCD and psychosis. Method: Case histories of seven patients seen at a rural mental health clinic in New Zealand are presented. Six of them were treated with selective serotonin uptake inhibitors (SSRIs). Results: Four patients had sexual obsessions and two reported aggressive obsessions. One patient had obsessive doubts and checking compulsions. Six patients improved with the addition of an SSRI to their ongoing neuroleptic medication. Conclusions: 1) OCD and psychosis may coexist by chance and may be unrelated. 2) An obsession may become a delusion or vice versa. 3) A reactive delusion of guilt or persecution may develop. 4) An obsession may trigger a psychotic episode or vice versa. 5) Obsessions may be misdiagnosed as delusions or hallucinations. 6) Recognition and treatment of OCD may improve the outcome of psychosis.
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Green, C. E. L., D. Freeman, E. Kuipers, P. Bebbington, D. Fowler, G. Dunn, and P. A. Garety. "Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS)." Psychological Medicine 38, no. 1 (October 1, 2007): 101–11. http://dx.doi.org/10.1017/s0033291707001638.
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BackgroundParanoia 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.MethodA 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.ResultsTwo 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.ConclusionsA 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.
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Kjelby, E., I. Sinkeviciute, R. Gjestad, R. A. Kroken, E. M. Løberg, H. A. Jørgensen, K. Hugdahl, and E. Johnsen. "Suicidality in Schizophrenia Spectrum Disorders: The Relationship to Hallucinations and Persecutory Delusions." European Psychiatry 30, no. 7 (October 2015): 830–36. http://dx.doi.org/10.1016/j.eurpsy.2015.07.003.
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AbstractBackground: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.Methods: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.Results: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.Conclusions: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.Trial registration:ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/NCT00932529.
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Martí Garnica, V., M. D. Ortega Garcia, M. Á. Bernal López, J. R. Russo De león, and S. García Marín. "Somatic-type delusional disorder and comorbidity mood disorder." European Psychiatry 41, S1 (April 2017): S412. http://dx.doi.org/10.1016/j.eurpsy.2017.01.353.
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Chronic delusional disorder encompasses what classical termed as paranoia and paraphrenia. This disorder is characterized by the presence of one or more non-bizarre, permanent and systematized delusions. Cognitive functions of the patient not affected, judgment and reason are not affected if the subject is not addressed delirious. Delusional theme includes life-like experiences, including: persecution – persecutory type –, suffering from a disease – somatic type –, to be loved by someone famous – erotomaniac type –, the partner is unfaithful – jealous type – or having a special quality or gift – megalomaniac type –. Usually, patients lack awareness of mental illness and often prior to contact with mental health, made a pilgrimage by different specialists looking for an organic explanation.The description of a case report of a 47-year-old male who has a delusional belief body deformity secondary to manipulation by a physiotherapist suffering a muscular pain in the lumbar region is performed. Prior to psychiatric diagnosis, begins a long journey by different specialists.As a consequence, somatic-type delusional disorder is a challenge in the diagnosis and treatment in the medical field because it is required a multidisciplinary approach for these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Nepal, S., D. Gupta, and D. Neupane. "Symptom Profile of Patients with Psychotic Disorders." Journal of Psychiatrists' Association of Nepal 7, no. 2 (December 31, 2018): 55–58. http://dx.doi.org/10.3126/jpan.v7i2.24616.
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Introduction: According to WHO, schizophrenia is a severe mental disorder affecting about 23 million people worldwide. Psychoses, including schizophrenia, are characterized by distortions in thinking, perception, emotions, language, sense of self and behavior. The impacts of these disorders are severe, with approximately 1 million people committing suicide annually. There is also an increase in co morbidity of these different conditions. So, this study was carried out to assess the symptom profile of patients with schizophrenia and other psychotic disorders (excluding mood disorders, substance induced psychotic disorders, organic psychotic disorders).
Material and Method: Discharge record sheets of all cases admitted (Total 86) to the psychiatric ward over the study period were reviewed. Cases diagnosed as schizophrenia and other psychotic disorders were enrolled. Major symptoms were listed from the discharge papers.
Results: Out of the total number of patients enrolled in the research, 68.6% were male while 31.4% were female. The mean age of the patients was found to be 31.03 years with a minimum age of 16 years and maximum 63 years. Most were from lower middle class family, Hindu by religion and unmarried. Among 86 cases, 26(30.2%) were diagnosed as Unspecified nonorganic psychosis, 24(27.9%) as Schizophrenia, 19(22.1%) as Schizoaffective disorder, 14(16.3%) as Acute & Transient Psychotic Disorder, 3(3.5%) as Persistent delusional disorder. Delusion of persecution was present in 46 cases (53.5%), Delusion of reference in 33 cases (38.4%) and Hallucinations in 32 cases (37.2%). Out of the 86 patients enrolled in the study, 15 (17.4%) had at least one suicidal attempt.
Conclusion: Significant number of patients were diagnosed as Schizophrenia which is itself a chronic, debilitating illness. Hallucinations and delusions were present in most of the cases.
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Wilson, Simon, Charles Dempsey, Frank Farnham, Tony Manze, and Alice Taylor. "Stalking risks to celebrities and public figures." BJPsych Advances 24, no. 3 (April 25, 2018): 152–60. http://dx.doi.org/10.1192/bja.2017.22.
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SUMMARYProminent figures are frequently subjected to unwanted and intrusive attentions. Such stalking behaviour is often driven by psychotic illness, angrily blaming the public figure for delusional persecution (resentful motivation), or based on erotomanic delusions (intimacy seeking motivation), for example. This behaviour can cause psychological harm to both perpetrator and victim, and is unlawful. In the rare instances where a public figure has been attacked, the perpetrator has usually had a history of such stalking behaviour and of severe mental illness. For these reasons, early identification and diversion into appropriate care and treatment will be for the benefit of both parties and will prevent more serious violence in a minority of cases. The importance of the provision of education to improve both reporting rates by victims and an appropriate response from the criminal justice system is highlighted. A multi-agency approach involving the criminal justice system and mental health services is the most effective means of achieving these aims.DECLARATION OF INTERESTNone.LEARNING OBJECTIVES•Learn that severe mental illness, particularly psychosis, is often an important driver of stalking behaviour•Learn that delusional disorder is a treatable mental illness•Appreciate that prevention rather than prediction is the approach to managing the risks of high-harm low-probability outcomes.
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Renvoize, Edward B., and Allan W. Beveridge. "Mental illness and the late Victorians: a study of patients admitted to three asylums in York, 1880–1884." Psychological Medicine 19, no. 1 (February 1989): 19–28. http://dx.doi.org/10.1017/s0033291700010990.
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SynopsisThe case histories of the patients newly admitted to the Retreat Asylum in York between 1880–1884 were examined. Most patients were aged under 50 years, single and non-Quaker, and a majority satisfied the Research Diagnostic Criteria for a diagnosis of schizophrenia or affective disorder. It was found that 72·9% of the patients were deluded, the most common delusions being of persecution, grandeur and guilt; in 34·9% of the deluded patients, the delusion had a religious content. Suicidal ideation was recorded in the case records of 31·4% of the patients. Drug therapy was commonly prescribed, a history of assault on other patients or asylum staff was recorded in 38·1% of the patients, and 11% of patients were force fed at some stage during their illness. Within a year of admission 49·1% of the patients were discharged, the prognosis being better for patients with an affective illness than for schizophrenia, but 31·4% remained in the asylum for five or more years.The characteristics, alleged causes of mental illness, and treatment and outcome of the Retreat patients were compared with those of patients admitted during the same period to the two other York asylums which served different socio-economic groups of the population. Mortality rates were higher in the asylum admitting mainly pauper patients, and possible reasons for this are explored.
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Franzek, E. J. "Cocaine Use and Liability to Psychotic Symptoms." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)70263-9.
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In a pilot study with 55 inpatients, primarily admitted for cocaine addiction, the following hypotheses were found: Patients with cocaine addiction and comorbide core schizophrenia (according to Kreapelin, n=17) respond completely different on cocaine use than all other groups of patients including a schizophrenia spectrum group (without core schizophrenia according to Kraepelin). When using cocaine the schizophrenic patients do not experience new psychotic symptoms and existing symptoms do not get worse. Most of them are less bothered of negative symptoms and some of them are, even more, less bothered of positive symptoms. In all other patients with various comorbidity (n=28) and without comorbide psychiatric disorders (n=10) positive psychotic symptoms occur dependent on the dosage of cocaine. In some of them the positive symptoms are also triggered by stress alone. The symptoms occurred in a dosage dependent hierarchical structure: mistrust - delusions of reference with fear - delusions of persecution and illusions with anxiety or panic - threatening voices and noises - disorganized and catatonic behavior.The psychopathology induced by cocaine prooved to be similar to one of the core symptoms of cycloid psychoses.The hypothesis is raised that there is an individual genetically and/or environmentally caused liability to the developing of positive psychotic symptoms under various stress factors including drugs. These reactive psychoses have to be distinguished from schizophrenia. Their relationship to the spectrum of cycloid psychoses is discussed.
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Halouani, N., F. Guermazi, K. Yaich, R. Ennaoui, S. Chouayakh, J. Aloulou, and O. Amami. "First acute psychotic episode: Factors associated with evolution to schizophrenia." European Psychiatry 41, S1 (April 2017): s814. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1580.
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IntroductionThe acute psychotic episode have often a dramatic expression. Although it is easily diagnosed, it is not easy to predict the evolution and much less the prognosis that are of concern both for the therapist and the patients’ families.AimsTo describe the profile of a population of patients with a first psychotic episode. To identify factors correlated with evolution to schizophrenia.MethodsThis is a retrospective study conducted among 55 patients hospitalized for a first acute psychotic episode, in the psychiatry B department during the period extending between January 2010 and December 2015.ResultsThe average age of patients was 26.5. The majority was single male. The prodromal phase was present with predominantly psychotic symptoms (80%). Schizophrenia was the most frequently encountered scalable diagnosis (38%). Some factors are associated with the evolution to schizophrenia. We can mention male gender (P = 0.004) and premorbid schizoid personality (P = 0.047). About correlated clinical factors, we have found an initial symptomatology dominated by loss of interest (P = 0.05), withdrawal and isolation (P = 0.017), impulsivity (P = 0.011), breaking with the usual functioning (P = 0.04), mental automatism (P = 0.033), the delusions of persecution (P = 0.025) and intuitive mechanism (P = 0.023).ConclusionWhen a first acute delusional experience occurs in a young adult, it is always a test of uncertain outcome. However, schizophrenia remains the most feared evolutionary. A better understanding of poor prognosis and early and appropriate management seem paramount to reduce the prevalence of this dreaded evolution.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Shirahama, M., J. Akiyoshi, Y. Ishitobi, Y. Tanaka, J. Tsuru, H. Matsushita, H. Hanada, and K. Kodama. "A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr disease." Acta Psychiatrica Scandinavica 121, no. 1 (January 2010): 75–77. http://dx.doi.org/10.1111/j.1600-0447.2009.01423.x.
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Santillan, G. Hernandez, and I. Mirapeix Bedia. "Quixotic delirium, around the fourth centenary of the publication of the second part of Don Quixote de la Mancha: About a case." European Psychiatry 41, S1 (April 2017): S513—S514. http://dx.doi.org/10.1016/j.eurpsy.2017.01.667.
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Psychosis, understood as a judgment out of reality, is sometimes considered as a defensive mechanism in the face of an overflowing situation. However, beyond the pathological, given its fantastic nature, has also brought its form and content to art in its various manifestations. Thus, we bring up a similar case. A 51-year-old male, who has one brother with schizophrenia; in his childhood and adolescence excelled by an excellent academic performance, even won a national prize of Economy; and very scarce emotional ties outside the family environment. At the age of 23, during his stay in a foreign country after obtaining a scholarship in a world-renowned company, he presented disorganized behavior and thought, disinhibition, delusions of persecution, prejudice and referentiality; then, he was repatriated by his family to enter in a psychiatric center. After, he continued psychiatric monitoring irregularly, with no disease awareness and little therapeutic adherence. In his last decompensation, he shown a megalomaniacal delusion, he defined himself as “a living being, brother of all living beings, who fought to defend peace, justice and the good of mankind”. The last year, he had been helping economically the homeless, interceding before the authorities for strangers and needy people; he restored and prayed in temples of different religions. Furthermore, with a significant deterioration in their self-care and family life. In consequence, he required a third forced psychiatric admission. After two months, he received discharge for clinical improvement and treatment with injectable paliperidone. Eight months later, he continues to be monitored and markedly recovered.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Perez, M. M., M. R. Trimble, N. M. F. Murray, and I. Reider. "Epileptic Psychosis: An Evaluation of PSE Profiles." British Journal of Psychiatry 146, no. 2 (February 1985): 155–63. http://dx.doi.org/10.1192/bjp.146.2.155.
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SummaryData are presented on 24 patients with epilepsy and psychosis whose clinical presentation was rated using the Present State Examination (PSE). Seventeen had complex partial seizures and a diagnosis of temporal lobe epilepsy, seven had generalised epilepsy. An association between a CATEGO category of nuclear schizophrenia (NS) and a lesion of the left side was noted. No clear link between depressive symptoms and a right-sided focus was discovered. Affective disorders were noted in both groups of epileptic patients, although paranoid psychoses were commoner in the temporal lobe group. There was also a tendency for the latter to have more delusions of persecution, ideas of reference, and special features of depression. The group rated as NS appear less likely to show evidence of intellectual deterioration than the other psychotic patients; in addition, the interval between the onset of their epilepsy and the onset of their psychosis is shorter. Radiological assessment by CAT reveals few differences between groups, but the psychotic samples do show higher than expected values on a number of variables, in particular the bilateral septum-caudate distance and the size of the third and fourth ventricle.
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Rojas-Estapé, M., C. Iglesias Rodriguez, and L. Garcia Murillo. "Hospitalized psychoses after liver transplantation." European Psychiatry 26, S2 (March 2011): 395. http://dx.doi.org/10.1016/s0924-9338(11)72103-4.
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Calcineurin inhibitors can cause neurological and psychiatric side effects. Mild symptoms to severe complications can be found.Case presentationWe report a 49 year old man who received an orthotopic liver transplantation in May 2010. He received tacrolimus. Ten days later, while he was still in Hospital, he suffered behavioural disorders, being psychotic with delusions of persecution; he called the police thinking that he was being poisened by the staff of the Hospital. Although his Tacrolimus blood concentration had been kept in the normal range, his symptoms improved dramatically when the Tacrolimus was changed into Cyclosporine and Haloperidol was introduced at high doses (7 mg/day) for 10 days when the dose was reduced to 4 mg/day.Medical historyChronic hepatitis VHC 1a in 1994. Received treatment with Interferon alfa in 1997 with no antiviral answer. In 2001 new treatment with pegylated Interferon and Ribavirine with positive virological answer but had to be stopped because of psychoses secondary to treatment. New treatment in March 2006 to March 2007 with Pegasys+Ribavirine with rapid virologycal answer with prophylactic Olanzapine 5 mg during a year with no psychotic symptons. In May 2009, Child Pugh C10, in list for liver transplantation.We discuss the implications of these findings and the relevance for future clinical care in these patients.
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Kıyak, J., S. Köse, and B. Özbaran. "Differential diagnosis of recurrent hypersomnia. Case report of primary narcolepsy and acute transient psychotic attack." European Psychiatry 33, S1 (March 2016): S354. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1261.
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IntroductionWe report a case of 17-year-old boy with excessive daytime sleepiness.ObjectivesCase presented in our study is an example of atypical narcolepsy with coexistence of psychotic symptoms that were especially prominent during the first attack. Excessive daytime sleepiness period was followed by psychotic symptoms including delusions of reference and persecution, as well as visual and acoustic hallucinations. However, during the second attack, negative psychotic symptoms were more prominent.AimsClinicians should not forget that child and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be evaluated for a diagnosis of primary hypersomnia.MethodPatient did not exhibit any comorbidities that would match with secondary hypersomnia. The initial sleep study did however reveal increased REM sleep latency (43% of total sleep time). The result of polysomnographic study was abnormal and suggestive of narcolepsy. In multi-sleep latency test mean REM latency was 1.7 min, sleep-onset REM (SOREM) was observed 3 times. Between the tests he had no episodes of cataplexy.ResultPatient was diagnosed with primary hypersomnia-narcolepsy without cataplexy. We found that mixed symptoms of narcolepsy and psychotic attack improved with anti-psychotic agent treatment.ConclusionChild and adolescent patients, which demonstrate psychotic symptoms and excessive daytime sleepiness component, should be evaluated for a diagnosis of primary hypersomnia following a multidisciplinary cooperation of neurologists, pediatricians and psychiatrists.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Oliveira, S. G., S. M. Pereira, and J. C. Mendes. "Psychosis and autoimmune disorders." European Psychiatry 26, S2 (March 2011): 1186. http://dx.doi.org/10.1016/s0924-9338(11)72891-7.
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IntroductionPsoriasis is a common, chronic, erythematous dermatosis with prevalence estimates ranging from 0, 3% to 2, 5%. This recurring disorder is associated with significant psychological distress, a decrease in health-related quality of life and psychiatric morbidity. The most common psychiatric comorbidities are mental retardation, personality disorder and affective disorders.ObjectivesThe authors’ aim is to present a clinical vignette of a 27-year-old male suffering from psoriasis who was admitted to the psychiatric yard exhibiting psychotic symptoms. A literature's review about the association between psychosis and autoimmune disorders, particularly with psoriasis vulgaris, was also made.Case reportThe patient is a 27-year-old single male with normal IQ. He had no physical ilnesses during childhood and adolescence. There was no history of psychiatric or developmental disorders in the patient and his family. In early adulthood he was diagnosed with psoriasis vulgaris. The patient's father also suffered from the same skin disorder. At the age of 27 he began to hear voices commenting on his behaviour and he exhibited psychomotor agitation, delusions of persecution, and sexual disinhibition. Admission in psychiatric yard was necessary to treat psychotic symptoms.ConclusionsThe skin and the brain are embryologically related. Consequently, a relationship between psychological factors and skin diseases has long been hypothesized. Schizophrenia has been associated with nearly 50% higher lifetime prevalence of one or more autoimmune disorders but further studies are necessary to elucidate the possible association between psoriasis vulgaris and psychosis.
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Larmo, I. "Four European countries survey of patients with schizophrenia treated in everyday clinical practice: characteristics of patients in short-term hospitalization." European Psychiatry 26, S2 (March 2011): 1428. http://dx.doi.org/10.1016/s0924-9338(11)73133-9.
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AimThe survey performed in four European countries (Germany, Greece, Italy, Spain) aimed at characterizing patients with schizophrenia treated in everyday clinical practice in terms of demographic characteristics, presenting symptomatology, and current antipsychotic treatement. We present here characteristics of patients in short term hospitalization.MethodsA survey involving 744 psychiatrists gathered anonimous retrospective data from 3,996 patients with schizophrenia. To ensure representativeness of participating physicians, the dataset was adjusted post hoc. Principal component analysis was used to structure the patient attributes relevant for antipsychotic choice, identifying two discriminating variables (disease severity and socioeconomic level) accounting for 91% of the variance in the data. Methodology is described in full detail by Gorwood (2010).ResultsOut of 3,996 surveyed patients, 21.7% were in short term hospitalization, with a mean of 7.5 previous episodes and 5.5 previous hospitalizations. Two thirds of subjects lived with theirfamily, with primary caregiver in 47% of subjects) being a relative. Most frequently observed symptoms were delusions (in 54% of subjects) and ideals of persecution (in 41% of subjects). 71% of subjects were smokers, 21% had drug and 18% alcohol addiction. 43% of subjects had a verified cardiometabolic comorbidity and 21% were obese. 29% of subjects had verified medication non-adherence. Most frequently used drug was risperidone (in 22% of subjects). Ziprasidone was used in 11% of subjects. 10% of subjects were on depot medication and 19% on orally disintegrating tablets.ConclusionSubjects with schizophrenia in current short-term hospitalization have high rates of cardiometabolic risk factors or cardiometabolic comorbidity.
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Lopes, A., and P. Sales. "The late-onset bipolar disease: A case report." European Psychiatry 33, S1 (March 2016): S335. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1171.
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The prevalence of bipolar disorder after 65 years is 0.1 to 0.4%. Mania represents 4.6% to 18.5% of all psychiatric admissions in geriatrics in the USA. It has some specificity in terms of clinical presentation, evolution, prognosis and treatment.We report the case of a patient who presented a first manic episode after 65 years. E.H, AP, 67 years old, single, without personal and familial psychiatric history, addressed to psychiatric emergencies for psychomotor agitation and euphoric mood. He presented two months ago a manic access with almost total insomnia, euphoria, psychomotor agitation and delusions of grandeur. The balance sheet reveals no incorrections (blood count, thyroid balance, serology: TPHA, VDRL, hepatitis B and C, HIV). The cerebral CT was normal. The patient has been received a quetiapine 200 mg/day, olanxapine 10 mg/day and valproate 1000 mg/day. The evolution after three weeks was favorable.The late-onset bipolar disorder is characterized by: a less intense euphoria, replaced by anger and irritability, a more elements of persecution, disinhibiting and impulsivity. Respecting to that, this case is an exception. The most common confounding symptoms and behavioral disorders. A higher frequency of neurological diseases is noted in elderly subjects with a bipolar disorder and, so, a neuropsychiatric rigorous evaluation is fundamental to exclude the possibility of an organic pathology for the manic access. The prescription of psychotropic drugs in the elderly must be under monitoring.Disclosure of interest The authors have not supplied their declaration of competing interest.
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Rizza, M. C., S. Di Marco, C. Delicato, C. Vecchi, C. Gramaglia, P. Prosperini, R. Cantello, and P. Zeppegno. "Psychiatric Disturbances in a Patient with Melas Syndrome: a Case Report." European Psychiatry 33, S1 (March 2016): S466—S467. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1699.
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IntroductionMitochondrial disorders of energetic metabolism (MD) represent a heterogeneous group of diseases manifesting at any age and its one of a number of mitochondria syndromes that share the common characteristics of encephalopathy and myopathy. The clinical expression of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis and Stroke-like episodes) is highly variable and ppsychiatric symptoms are rarely reported in literature even if are more common in MELAS syndrome than in the general population.ObjectiveThe first aim of the study is describing the clinically observed primary psychiatric symptoms in a patient affected by MELAS syndrome admitted to the Psychiatric ward. The second aim is to go back over the diagnostic process, which led, from the uncommon psychiatric symptoms and signs to the final genetic diagnosis of MD.Methods and resultsWe report the case of a 44-year-old male with MELAS in whom psychiatric symptoms preceded the establishment of the clinical diagnosis for several months. Diagnosis was initially based on the neuroimaging and metabolic findings and subsequently confirmed with genetic analysis.ConclusionsIn case of aggressive and paranoid behaviour with delusions of persecution and disorganised behaviour mmitochondrial disorders deserve consideration as part of the differential diagnosis, especially if there is suspected involvement of other organ groups or positive family history of MD. There is no specific consensus approach for treating MELAS syndrome. Management is largely symptomatic and should involve a multidisciplinary team.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Richard-Devantoy, S., R. Gourevitch, M. N. Vacheron, M. Voyer, J. L. Senon, and J. B. Garré. "FC02-03 - Is there an association between neurocognitive factors and homicide in schizophrenia ?" European Psychiatry 26, S2 (March 2011): 1817. http://dx.doi.org/10.1016/s0924-9338(11)73521-0.
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ObjectiveThe objective of this systematic review was to investigate which specific and especially neurocognitive factors related to schizophrenia, were associated with homicide risk.MethodsA systematic English-French Medline literature search of cohort studies, case-control studies and transversal studies published from January 1999 to December 2009 was performed combining the MeSH terms “schizophrenia”, “homicide”, “violence”, “mental process”, “cognition”, “risk”, “risk factors”,. Abstract selection was based on the STROBE checklist for observational studies and on the consort statement for clinical trials.ResultsOf the 366 selected studies, 65 observational or prospective studies, 10 systematic reviews and meta-analysis and 2 interventional studies met the selection criteria and were included in the final analysis. Firstly, we highlighted that historical (past violence, juvenile detention, physical abuse, parental arrest record), dispositional (male gender, young age, low socioeconomic status) and contextual (recent divorce, unemployment, victimisation) factors could be considered as general homicide-related factors. Clinical factors (clinical paranoid, delusions of persecution or thought insertion, substance abuse, disorganized thinking, long duration of untreated psychosis, stopped monitoring or treatment) were more schizophrenia-specific factors for homicide. Most of the excess risk appears to be mediated by substance abuse. Secondly, our results suggested that schizophrenics with a history of aggressive behaviour compared to those without such history, had better performances on global neuropsychological tests exploring executive functions but performed more poorly as considering orbitofrontal functions.ConclusionsWe suggest that every comprehensive psychiatric assessment should explore the risk of homicide, including historical, dispositional, contextual, clinical and neurocognitive (low insight capacity, impaired frontal functions) factors of violence.
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DRURY, V. M., E. J. ROBINSON, and M. BIRCHWOOD. "‘Theory of mind’ skills during an acute episode of psychosis and following recovery." Psychological Medicine 28, no. 5 (September 1998): 1101–12. http://dx.doi.org/10.1017/s0033291798006850.
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Background. 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.Methods. 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.Results. 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.Conclusions. 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.
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Younes, S., R. Ben Soussia, K. Hajji, I. Marrag, L. Zarrouk, and M. Nasr. "Acute Psychotic Disorder and Forensic Acts: About 25 Cases." European Psychiatry 33, S1 (March 2016): S459. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1670.
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BackgroundThe aim of this study was to identify the socio-demographic status and clinical features of patients with acute psychotic disorder and who committed a medicolegal act, seek acute psychosis implicated and raise the characteristics of this medicolegal acts.MethodsWe performed a retrospective study of 25 male patients with acute psychotic disorder. They were involuntary hospitalized in the medicolegal department of Razi, according to Article 29 of Law after committing a medicolegal act because of dementia within the meaning of article 38 of the Tunisian Penal Code.ResultsIt was about a young person, average age of 27.32 years, family cohesion was often present (80%), with forensic history (20%), violence history (20%) and substance abuse (40%), having a personality disorder (25%), having a precipitating factor (32%), having an acute psychotic episode (72%), repetitive acute psychotic episode (16%), a first manic episode (8%) and drug-related psychotic disorder (4%). They had committed by order of frequency serious physical assault (43.5%), attempted murder, assault and injury followed by attacks against property (40%). The victim was mostly a family member (40%), without determination, under the influence of toxic substances (16%) and motivated by delusions of persecution (51%). The acting out was recognized (68%). The majority was indifferent (92%) and does nothing (68%).ConclusionThe first-episode psychosis have a high-risk of acting out, early treatment may prevent some medicolegal acts. Preventing of acting out in the psychotic involves the identification of risk factors and an early treatment of mental disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Santillan, G. Hernandez, K. Lazo-Chávez, and M. Blanco-Prieto. "Combined pharmacotherapy involving aripiprazole and clozapine for controlling the positive symptoms refractory to other antipsychotic treatments in a patient with schizophrenia." European Psychiatry 41, S1 (April 2017): s814. http://dx.doi.org/10.1016/j.eurpsy.2017.01.1581.
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IntroductionTreatment resistance is considered a challenging problem of antipsychotic pharmacotherapy in schizophrenia, especially, when it is associated with other factors, such as cultural aspects, diverse clinical presentation, furthermore functional impact. Then, combination approaches are commonly used, for instance, the add-on of aripiprazole to clozapine; which allows increasing of efficacy and safety.ObjectiveAssess the response to clozapine–aripiprazole combination treatment in the management of resistant schizophrenia.AimTreatment of resistant schizophrenia.MethodAnalysis of a clinical case.ResultA 27-year-old male resident in an Iberian country two years ago, is from a Latin American country, lives with his mother, his sister and his nephew. Their parents were separated. Eight years ago, his father died and shortly thereafter, he started impaired behavior, auditory and visual hallucinations, delusions about referentiality, persecution and prejudice, which required a brief hospitalization in their country. Upon arrival, he is included in the network of Mental Health, with positive symptoms, significant behavioral and cognitive disorganization and he needed hospitalization again. Then, treatment is instituted in different lines with risperidone, quetiapine, olanzapine, haloperidol, amisulpride, without results. Then, combined clozapine therapy is initiated up to 400 mg/day, more aripiprazole 20 mg/day, which switch after to pattern injectable depot, with informed consent. Six months after, he presents encapsulated delirium and improvement of disorganization, allowing the patient to retake studies.ConclusionClozapine–aripiprazole combination was associated with 22% reduction of clozapine dose. There was improvement in positive and negative symptoms, social functions and amelioration in their metabolic profile.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Khouadja, S., S. Younes, S. Chatti, R. Ben Soussia, L. Zarrouk, and M. Nasr. "The acting out in patients with Schizophrenia examined in a forensic psychiatric assessment." European Psychiatry 41, S1 (April 2017): S591. http://dx.doi.org/10.1016/j.eurpsy.2017.01.906.
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IntroductionMany studies have shown that schizophrenic patients are responsible for the highest rates of violence among all the mentally ill patients.Aims of the studyDescribe the socio-demographic and clinical characteristics of patients with schizophrenia examined in a forensic psychiatric assessment and identify the risk factors of violence in these patients.MethodologyA retrospective study carried out in the psychiatric department of university hospital of Mahdia during fifteen years involving 40 patients with schizophrenia examined in a forensic psychiatric assessment following a forensic act. These patients were compared to a population of 40 patients followed in the same establishment for the same disease and without criminal record.ResultsAge average of 36.08 years, male (95%), rural origin (65%), primary level education (47.5%), single (65%), unemployed (65%) and average socio-economic level (65%). Personal psychiatric history (87.5%), personality disorder (12.5%), judiciary history (12.5%) and substance abuse (57.5%). Subtypes of schizophrenia: undifferentiated (52.5%) and paranoid (30%). They have committed serious physical assaults (55%) and aggression against property (27.5%). The victim was mostly a family member (40%), under the influence of toxic (22%), driven by delusions of persecution (61%), with hallucinatory mechanism (55%). The psychiatric expert has concluded an abolition of discernment in 77.5% of cases. Risk factors of acting out were: rural origin, alcohol and psychoactive substances use, productive forms of schizophrenia, poor adherence and irregular monitoring.ConclusionThe knowledge of risk factors improves the management and allows us better prevention of violence among our patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Roncero, C., L. Rodriguez-Cintas, L. Grau-López, E. Ros-Cucurull, J. Perez-Pazos, C. Barral, F. Palma-Alvarez, et al. "Clinical features of kinesthetic hallucinations in cocaine-dependent patients." European Psychiatry 33, S1 (March 2016): S293. http://dx.doi.org/10.1016/j.eurpsy.2016.01.996.
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IntroductionLegal and illegal drugs can cause psychotic symptoms, in cocaine-dependent patients the prevalence of these symptoms may reach 86% (Vorspan, 2012). It is estimated that 13–32% of cocaine-dependent patients have kinaesthetic hallucinations (Siegel, 1978; Mahoney, 2008; Roncero, 2012).ObjectivesTo compare the prevalence of substance-induced psychotic symptoms and compare the use of welfare/social resources and social adjustment among cocaine-dependent patients (CD) and other substances dependences (OtherD).MethodsTwo hundred and six patients seeking treatment at the Addictions and Dual Diagnosis Unit of the Vall d’Hebron. Patients were assessed by ad hoc questionnaire designed to collect demographic data and psychotic symptoms associated with consumption, a record of the care/social resources used by the patient and the scale of social adaptation (SASS). A descriptive and bivariate analysis of the data was performed.ResultsCD were 47.1% vs. 52.9% OtherD (66.1% alcohol, 17.4% cannabis, 8.3% opioid, 8.3% benzodiazepines/other drugs). Of cocaine dependent-patients, 65.6% present psychotic symptoms vs. 32.1% for the OtherD. Different exhibiting psychotic symptoms are: self-referential (69.7% vs. 30.7%), delusions of persecution (43.4% vs. 12.2%), hallucinations (49.4% vs. 14.3%), auditory hallucinations (43.5% vs. 11.4%), visual hallucinations (30.4% vs. 5.7%) and kinaesthetic hallucinations (7.2% vs. 2.9%).Cocaine-dependent patients significantly use more health care resources in reference addiction unit (76.3% vs. 62.4%, P:.035) and infectious diseases (22.7% vs. 5.5%, P:.000) and justice-related (50.5% vs. 26 resources 0.6%; P:1.001) and less resources and mental health (25.8% vs. 43.1%; P:.013).Regarding social adaptation, no differences were found in the SASS. Kinaesthetic hallucinations do not appear to be related to a greater use of resources and in social adaptation.References not available.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Orsolini, L., A. Valchera, R. Vecchiotti, M. Panichi, and D. De Berardis. "Psychosis and polydrug abuse in a patient with Dandy-Walker variant." European Psychiatry 33, S1 (March 2016): S310. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1061.
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Background and purposeDandy Walker “syndrome” (DWS) was firstly defined by Dandy and Blackfan, and then described by Hart et al. [1] as a series of neurodevelopmental anomalies in the posterior fossa, including Dandy-Walker (DW) malformation, DW variant (cerebellar hypoplasia/aplasia of the cerebellar vermis and cystic dilatation of the fourth ventricle), mega-cisterna magna and posterior fossa arachnoid cyst. Mental symptoms have been associated with DWS in previous reports, but the spectrum of mental symptomatology widely varies between clinical cases, ranging from psychotic/schizophrenia-like to mood/cognitive symptoms [2].MethodsHere we describe a case of psychosis and polydrug abuse in a 27-year-old man with DW variant a 4-year history of polydrug abuse, sporadic alcohol abuse, epilepsy and psychotic symptoms including delusions of reference/persecution, suspiciousness, associated with obsessive thoughts, mood lability and persistent anxiety.ResultsHe was recovered for a 28-day program of detoxification from drug addiction/stabilization of psychiatric symptoms. Family history of Bipolar Disorder, gambling disorder (father) and depression (mother). The mental status examination at baseline revealed slowness of thought, psychomotor retardation, aboulia/anhedonia/apathy/hypomimic facies/asthenia/social withdrawal/deflected mood/poor thought content/blunted affect/self-neglect/poor insight, cognitive impairment and oppositive and partially collaborative attitude and behaviour. Borderline intelligence activity was found on WAIS-R (IQ = 79). At the baseline, he was taking carbamazepine 400 mg BID (baseline serum level: 6.720 μg/ml), gabapentin (400 mg BID), paroxetine (20 mg/d), olanzapine (10 mg/d) and methadone (70 ml/d), with a poor response/control both on psychotic and seeking drug symptomatology.References not available.ConclusionsFurther DWS clinical cases should be evaluated in order to better investigate the role of this variant to addictive and psychotic symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Li, Danni, Samuel Law, and Lisa Andermann. "Association between degrees of social defeat and themes of delusion in patients with schizophrenia from immigrant and ethnic minority backgrounds." Transcultural Psychiatry 49, no. 5 (November 2012): 735–49. http://dx.doi.org/10.1177/1363461512464625.
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Immigrants have a heightened risk of developing schizophrenia, suggesting that social factors play an important role in the pathogenesis of schizophrenia. This study aimed to examine the relationship between degrees of social defeat and themes of delusion in patients with schizophrenia from immigrant and ethnic minority backgrounds. Retrospective chart review was conducted. Patients’ psychosocial history, particularly employment history, level of education, and subjective feelings of societal integration before and after immigration, were compared to determine the degree of social defeat. It was found that delusional themes of psychological persecution, such as control and reference, were more common in those with either moderate or severe degrees of social defeat.
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Benedetti, G., and M. Peciccia. "Psychodynamic reflections on the delusion of persecution." Nordic Journal of Psychiatry 48, no. 6 (January 1994): 391–96. http://dx.doi.org/10.3109/08039489409078156.
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Yorston, Graeme. "The life of Leopoldo Fregoli." Psychiatric Bulletin 19, no. 12 (December 1995): 764–66. http://dx.doi.org/10.1192/pb.19.12.764.
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The Fregoli delusion is one of a number of misidentification syndromes. It is characterised by a patient recognising a familiar person, usually seen as a persecutor, in various strangers who, although they do not show physical resemblance, are believed to be psychologically identical to the familiar person. It usually occurs in the context of a schizophrenic illness but has been reported in affective disorders and organic psycho-syndromes (Förstl et al, 1991). It was first described by the French authors Courbon & Fail in 1927, who used the term ‘Fregoli illusion’ after the Italian actor who enjoyed enormous popular success on the Paris stage at the time. It has also been called the ‘illusion of negative doubles'. However, as the psychopathology is a delusional interpretation of normal visual stimuli rather than an abnormal perception the terms Fregoli delusion or ‘delusional hyper-identification of the Fregoli type’ are preferable. The original case description has recently been translated and annotated (Ellis et al 1994) but there remains little background information available on the figure of Fregoli himself. Biographies have appeared in French and Italian but there are few English language references and this paper is intended to provide an account of the life and career of one of the most extraordinary entertainers in theatre history.
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de Velasco Soriano, R. Martínez, E. Benítez Cerezo, M. F. Pando Velasco, C. Erausquin Sierra, I. Gobernado Ferrando, F. Suárez Martín, A. Soto Ruano, and A. Chinchilla Moreno. "Shared-induced Paranoid Disorder (Folie á Deux) between Two Sisters. A Case Report." European Psychiatry 24, S1 (January 2009): 1. http://dx.doi.org/10.1016/s0924-9338(09)71351-3.
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Introduction:Induced delusional disorder (also known as shared paranoid disorder or folie à deux) is an uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most commonly a primary case can be distinguished from other one or more cases, in whom the symptoms are induced. the patients implied in the shared delusional symptoms are frequently linked by close relationship bonds, mostly family ties. Its epidemiology remains unclear, because very few data is available. There are some requirements concerning the persons involved for the development of this disorder:1.Close coexistence and intimate emotional links between the two people are observed;2.The delusional content is plausible and can be based on past events or expectations;3.Typically, the induced individual has an easily influenciable personality.Case report:We describe and comment one case of shared paranoid disorder between a 29 year old schizophrenic patient and her 43 years old sister. both share a persecution and prejudice delusion involving the Chinese community of their hometown. after a few days of inward treatment at separated psychiatric wards, the delusional symptoms in the older sister started to improve.Conclusion:Our intention is making a review on a diagnosis that remains controversial nowadays. Treatment should begin with the separation of the induced and the inducer. Anyhow, a psychopharmacological treatment is required in both individuals. It seems clear, however, that the prognosis of the induced and the inducer is different, according to a variety of factors.
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Davis, James. "The Christian Brethren and the Dissemination of Heretical Books." Studies in Church History 38 (2004): 190–200. http://dx.doi.org/10.1017/s0424208400015813.
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The illicit influx of William Tyndale’s vernacular New Testament and other reforming works into England in the late 1520s was considered an affront to the ecclesiastical authorities and an encouragement to lay heretical thought. No one was more vitriolic in condemnation than Thomas More, the lawyer-turned-polemicist, who was to become Chancellor from 1529. He declared, ‘Nothynge more detesteth then these pestylent bokes that Tyndale and suche other sende in to the realme, to sette forth here theyr abomynable heresyes.’ As Chancellor, More was renowned for his zealous persecution of heretics and booksellers, which he justified as a moral and legal imperative in order to uphold the Catholic faith. He also wrote several works, initially at the request and licence of Bishop Tunstall in March 1528, and thereafter in reply to the treatises of Tyndale and other Antwerp exiles. These writings provide tantalizing insights into the activities of Tyndale and the Christian Brethren as seen through the eyes of their chief protagonist. It was not only the New Testament, emanating from Cologne and Worms, that worried More, but Tyndale’s polemical works from the printing press of Johannes Hoochstraten in Antwerp, especiallyThe Parable of the Wicked Mammon, The Obedience of a Christen Man, andThe Practice of Prelates. Fellow exiles, such as George Joye, John Frith, and Simon Fish, were also writing popular and doctrinal works, includingA Disputation of Purgatorye, The Revelation of Antichrist, David’s Psalter, andA Supplication for the Beggars. Thomas More regarded William Tyndale, the Antwerp exiles, and their ‘Brethren’ in England as the most active producers and distributors of vernacular heretical books. However, his perceptions of the Brethren, their sympathizers, and their organization have been under-utilized by historians, who often rely more on the post-contemporary reflections of John Foxe. There perhaps remains the suspicion that More was conveniently coalescing all sedition under a single banner as a rhetorical device, or due to prejudice and unfounded conspiracy theories. Indeed,The Confutation of Tyndale’s Answeroutlined a smuggling network as an attempt to demoralize Tyndale’s supporters, by describing how various individuals had renounced their doctrines and betrayed their fellows. These were his tools of polemics, but More’s testimonies should not be dismissed as the mere delusions of a staunch anti-heretical zealot. He had studied the reforming works and interrogated significant figures in the Brethren. His conspiracy theories, it can be argued, were based on fact.
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Hoprekstad, Gunnhild, Rolf Gjestad, Eirik Kjelby, Silje Skrede, Erik Johnsen, and Rune A. Kroken. "T16. SCHIZOPHRENIA SPECTRUM DISORDER: DEPRESSION TRAJECTORIES AND IMMUNE MARKERS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S237. http://dx.doi.org/10.1093/schbul/sbaa029.576.
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Abstract Background Genetic findings imply a role of the immune system in the complex psychopathology of schizophrenia, and elevated serum levels of pro-inflammatory cytokines have been found in patients. Altered levels of cytokines are linked to severe depression and cognitive dysfunction, both of which are common among patients suffering from schizophrenia. Depression is important to diagnose in this patient population as consequences of untreated depression can be severe. In this study we will investigate if the level and change of immune markers in blood are related to depression in patients with schizophrenia spectrum disorders. Methods The study is part of the Bergen-Stavanger-Innsbruck-Trondheim study (BestIntro) which is a multicenter randomized controlled trial comparing treatment with amisulpride, aripirazole and olanzapine. The study included patients with schizophrenia spectrum disorders (ICD-10 F20-F29) above 18 years with a score of 4 or more one of the following items on the Positive and Negative Syndrome scale (PANSS): Delusions, hallucinations, grandiosity, suspiciousness/persecution and unusual thought content. Participants were followed throughout one year, and for this sub-study participants from all treatment arms were analyzed together. Blood samples were drawn at week 0, 1, 3, 6, 12, 26, 39 and 52. Depression was measured with the Calgary Depression Scale (CDSS) which distinguishes depression from negative symptoms. A panel of 9 immune markers were analyzed: interferon gamma (IFN-γ), interleukin 1-β (IL-1β), interleukin 10 (IL-10), interleukin 12p70 (IL-12p70), interleukin 17A (IL-17A), interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-α). We examined whether the level and change in inflammation parameters could be predicted by latent classes describing CDSS trajectories. Results The preliminary results suggest three different CDSS trajectories: high, moderate and low level of depression. In the three class model, the different groups were found to be related to some differences in level and change in the inflammation parameters. Baseline differences were found with higher IL-10 in the high depression group. In the 0–1 week interval, the low depression trajectory group reduced their IL1-beta, while the other two groups did not. Discussion Different courses of change in depression were identified suggesting that trajectories exist. With regard to temporal patterns of inflammatory parameters, findings point in the opposite direction of the established links between pro-inflammatory cytokines and depression. Further studies should explore if cytokine alterations in schizophrenia per se can explain this difference, or if depression in schizophrenia differs in its underlying biology from regular depressive states.
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Bugarski-Kirola, Dragana, Rene Nunez, Ramzey Odetalla, Mohammed A. Bari, Istvan Bitter, Peter D. Feldman, I.-Yuan (Cathy) Liu, and Srdjan Stankovic. "T41. SAFETY PROFILE OF ADJUNCTIVE PIMAVANSERIN IN THE ENHANCE STUDY, A PHASE 3 TRIAL FOR THE POTENTIAL TREATMENT OF SCHIZOPHRENIA IN PATIENTS WITH AN INADEQUATE RESPONSE TO ANTIPSYCHOTIC TREATMENT." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S247. http://dx.doi.org/10.1093/schbul/sbaa029.601.
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Abstract Background Many patients with schizophrenia (SCZ) do not fully respond to antipsychotic (AP) treatment despite adherence and require augmentation, often with an AP with similar mode of action. Evidence supporting polypharmacy is limited and adding another AP increases associated risks of adverse effects, including extrapyramidal symptoms and cardiometabolic disturbances. Pimavanserin (PIM) is a highly selective serotonin 5-HT2A inverse agonist/antagonist approved for the treatment of Parkinson’s disease psychosis. The phase 3 ENHANCE study evaluated adjunctive PIM in patients with SCZ and inadequate response to their current AP. As previously reported (ACNP 2019), the primary efficacy endpoint of ENHANCE (change in Positive and Negative Syndrome Scale [PANSS] total score) did not achieve statistical significance. Other prespecified analyses did yield nominal statistical separation from placebo, including changes in PANSS Negative Symptoms subscale, and in PANSS total score for the subgroup of European patients. Here we describe key safety results. Methods ENHANCE was a 6-week, randomized, double-blind, placebo (PBO)-controlled study of adjunctive PIM in patients with SCZ and inadequate response to their prescribed AP (aripiprazole, olanzapine, risperidone, and others). Patients included were age 18–55 years with PANSS total score of ≥65 and ≤110, and scores of ≥4 on ≥2 items including delusions, hallucinatory behavior, and/or suspiciousness/persecution; Clinical Global Impression-Severity scale score ≥4 was also required. The starting dose of PIM or PBO was 20 mg daily and could be adjusted up to 34 mg or down to 10 mg daily after 1 week based on investigator discretion. Safety was evaluated in all randomized patients who received ≥1 dose of study drug. Results All 396 randomized patients (PIM, n=198; PBO, n=198) were included in the safety analysis set. Treatment-emergent adverse events (TEAEs) were reported in 39.9% and 36.4% of patients in the PIM and PBO groups, respectively; most frequent TEAEs were headache (PIM 6.6%, PBO 9.1%), somnolence (PIM 6.6%, PBO 3.5%), and insomnia (PIM 5.1%, PBO 3.5%). Changes from baseline in Abnormal Involuntary Movement Scale (AIMS), Barnes Akathisia Scale global clinical assessment of akathisia (GCAA), and Simpson–Angus Scale (SAS) scores were similar in the PIM and PBO groups. No patient developed dyskinesia (defined as a score ≥3 on any, or ≥2 on 2 of the first 7 AIMS items). Akathisia (GCAA score ≥2) in patients without baseline akathisia occurred in 4/186 (2.2%) patients receiving PIM and 1/189 (0.5%) receiving PBO. Parkinsonism (SAS total score >3) in patients without Parkinsonism at baseline occurred in 3/181 (1.7%) patients receiving PIM and 4/182 (2.2%) receiving PBO. No patient in either treatment arm had QTcF prolongation >500 msec or Torsades de Pointes during the study period; 2 (1.1%) patients in the PIM arm and 0 in the PBO arm had post-baseline QTcF prolongation >60 msec. Hypotension was reported in 1 patient in each treatment group; no patient had clinically important changes from baseline in blood pressure during treatment. Weight increase ≥7% from baseline was reported in 5/189 (2.6%) patients in the PIM group and 3/191 (1.6%) in the PBO group. Mean changes from baseline in PIM and PBO groups for fasting glucose were 0.07 mmol/L and 0.01 mmol/L; for triglycerides were -0.007 mmol/L and -0.136 mmoL/L, and for cholesterol were -0.10 mmol/L and -0.03 mmol/L, respectively. Discussion Results of ENHANCE provide evidence that the addition of PIM to frequently used APs is well tolerated in patients with SCZ.
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Drosos, Petros, Erik Johnsen, Christoffer A. Bartz-Johannessen, and Rune A. Kroken. "M41. TRAJECTORIES AND PREDICTORS OF OUTCOME IN SCHIZOPHRENIA: THE BENEFICIAL ROLE OF AMISULPRIDE." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S149—S150. http://dx.doi.org/10.1093/schbul/sbaa030.353.
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Abstract Background Schizophrenia is a serious illness and treatment with antipsychotic drugs remains one of the most effective types of treatment. The course of schizophrenia, however, is highly heterogeneous and currently it is not possible to predict which patient will respond adequately to which antipsychotic drug. The aim of our study was to define trajectories regarding response to antipsychotic drug treatment in patients with schizophrenia spectrum disorders. A second aim was to evaluate demographic factors and antipsychotic drugs as predictors for the different trajectories. Methods Best Intro is a randomized, rater-blind, head-to-head comparison of amisulpride, aripiprazole and olanzapine. Adult patients with a diagnosis in the schizophrenia spectrum (ICD-10 diagnoses F20-29) were included. Participants had symptoms of ongoing psychosis as determined by a score of four or more on at least one of the following PANSS (Positive and Negative Syndrome Scale) items: P1 (delusions), P3 (hallucinations), P5 (grandiosity), P6 (suspiciousness/persecution) or G9 (unusual thought content). Patients were followed over a period of 52 weeks and the assessment points were at baseline, after one week, three weeks, six weeks, three months, six months, nine months, and 12 months. Totally 359 patients were assessed for eligibility, and 144 of them were enrolled and randomized to one of the study drugs. We used the R statistical program to define trajectories of antipsychotic response. Results We identified three different trajectories regarding the reduction of PANSS total score, with Bayesian information criterion (BIC) = 6157 (BIC for two groups=6164 and for four groups=6171). A large group of patients (N=106, 74%) showed a trajectory of good improvement in PANSS total score over the first 26 weeks of follow-up and maintained it after one year with a total of 35% reduction in PANSS total score (Good response group). A second group of patients (N=19, 13%) followed a trajectory of quick response (already at one week) and a large reduction of PANSS total score (Strong response group). After one year, the reduction of PANSS total score was 58%. There was a difference in the starting point for PANSS total score in these two groups with a higher value at baseline in the Strong response group, but the ending point was quite similar. A third group of patients (N= 19, 13%) followed a trajectory of poor improvement and a 9% reduction in PANSS total score over the studied period (Slight response group). The demographic variables age, sex, civil status and living alone, or drug naivety did not predict participants grouping in the various trajectories. Furthermore, we examined the predictive value of different antipsychotic drug treatment for the different trajectories with the “Intention to treat” method. There was a statistically significant difference in favor of amisulpride treatment for belonging to the Strong response group, while olanzapine strongly predicted the belonging to the Slight response group. There was no significant difference among the antipsychotic drugs regarding the Good response group. Discussion Most patients (74%) with a schizophrenia spectrum diagnosis showed a good response during the one year follow-up and another 13% showed a remarkable strong improvement. That means that a total of 87% of patients had a satisfactory course of illness during the first year. Use of amisulpride predicts a better course compared to aripiprazole and olanzapine. This finding can be useful for clinicians when selecting antipsychotic drugs for their patients.
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Voicu, Tiana, Ana Maria Chipeșiu, and Simona Trifu. "PARANOID SCHIZOPHRENIA AND THE PARADOXICAL PATH TO PARAPHRENIA AND AFFECTIVITY – A CASE STUDY." International Journal of Research -GRANTHAALAYAH 8, no. 5 (May 31, 2020): 15–21. http://dx.doi.org/10.29121/granthaalayah.v8.i5.2020.71.
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Motivation: Analyzing a case of paranoid schizophrenia is a challenge to understand the mechanisms underlying the mind of a schizophrenic. The study became captivating because in the patient's delusional cofabulations there were many fingerprints that the communist period of that time left on the woman's psyche, thus observing the repressions following personal failures that probably led to the current state.
Objective: Carrying out an analysis of the life history of a patient with paranoid schizophrenia who, although voluntarily presenting at the hospital, does not recognize her diagnosis and treatment. It presents symptoms that include the delusional ideas of persecution or greatness. It has two possible admissions, currently admitted to the psychiatric department in Bucharest.
Results: The patient presents disorders regarding perception, memory, affectivity, observing a disorganized discourse that includes a qualitative perceptual disorder, schizophrenia-specific hypoprosexias, disorders of the immediate mental synthesis with illusions of non-recognition, impossibility of evoking recent events, mental and ideation disorganization, the reversal of the affective, which generates conflicting emotional experiences.
Conclusion: Although the patient is under treatment, insight is still not present, so patient supervision is recommended. The paranoid nucleus has diminished, but delusional ideas still persist, and the patient became affected during hospitalization.
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Pahuja, Erika, Narayana Manjunatha, Channaveerachari Naveen Kumar, Suresh Bada Math, Priyanka Rajmohan, and Abdu Salam OK. "Repetitive superficial self harm as an acting out on delusion of persecution: A case report and mini review." Asian Journal of Psychiatry 48 (February 2020): 101904. http://dx.doi.org/10.1016/j.ajp.2019.101904.
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Maria Iulia, V., and B. D. Diane. "Hypersensitivity to electricity: What place in clinical psychiatry?" European Psychiatry 33, S1 (March 2016): S635—S636. http://dx.doi.org/10.1016/j.eurpsy.2016.01.2391.
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Hypersensitivity to electricity (EHS) is a self-defined syndrome where individuals experience symptoms while using or being in the proximity of equipment or devices that use electric, magnetic or electromagnetic fields. We present the case of a 45-year-old patient who received an EHS diagnosis several years ago. This patient was first sent to us for hospitalization in the psychiatric ward with mystic delusions and secondary behavior disorders. He had no remarkable psychiatric history and the thorough somatic examinations performed showed no anomaly. The EHS had first appeared 10 years ago with associated symptoms like fatigue, dizziness, headache, cognitive disturbances, as well as physically painful sensations. These symptoms had become gradually invalidating, preventing the patient from pursuing his professional activity. Nevertheless, he maintained his social and familial obligations, and, together with his wife, was still able to care for his 2 children. The patient presented, in the emergency ward, with delusions of mystical and persecuting nature of multiple mechanisms with total adherence. The initial symptomatology gradually improved under antipsychotic treatment without any real improvement of the EHS complaint. This case brought several questions. What is the place of the EHS diagnosis within the framework of a delirious episode? Is there a link between these two diagnoses and more generally is there a psychiatric profile more frequently found in EHS patients?Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Iseki, Eizo, Wami Marui, Namiko Nihashi, and Kenji Kosaka. "Psychiatric symptoms typical of patients with dementia with Lewy bodies – similarity to those of levodopa-induced psychosis." Acta Neuropsychiatrica 14, no. 5 (October 2002): 237–41. http://dx.doi.org/10.1034/j.1601-5215.2002.140507.x.
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We examined psychiatric symptoms in eight cases with dementia with Lewy bodies (DLB), which included visual hallucination of persons or small animals, visual illusion, metamorphosia, leibhaftige Bewusstheit, personal or topographical misidentification, Capgras' syndrome and reduplicative paramnesia as well as depressive state and delusion of persecution. These psychiatric symptoms are identical to those of levodopa-induced psychosis, although these symptoms appeared before medication with anti-Parkinson drugs. The hypersensitivity of the dopamine receptor in the meso-limbic dopaminergic system has been presumed in levodopa-induced psychosis. We previously showed disturbance of the nigro-amygdaloid dopaminergic connections in DLB brains on pathological studies. Hypoperfusion or glucose hypometabolism in the occipital lobe has been demonstrated in DLB patients using SPECT or PET. The amygdala has reciprocal connections with the visual cortex in the occipital lobe. From these findings, it is supposed that the disturbance of the nigro-amygdaloid connections induces hypersensitivity of the dopamine receptor in the amygdala, causing psychiatric symptoms with dysfunction of the visuo-amygdaloid connections.
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Ghajati, B., S. Ghezaiel, R. Chebbi, I. Berrahal, and R. Ridha. "When Patients With Paranoia Commit Medicolegal Acts: A Descriptive Study." European Psychiatry 33, S1 (March 2016): S458. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1666.
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Patients with paranoia have always been an attractive and redoubtable group of mentally ill to mental health professionals. In fact, beyond complex psychopathology and relatively better functioning, these patients do represent a real threat to themselves and their presumed persecutors.ObjectivesTo explore criminological aspects of medicolegal acts committed by patients with paranoia.MethodsWe conducted a retrospective and descriptive study, based on medical charts consult. Were included, patients suffering from paranoia (persistent delusional disorder: jealous/persecutory/erotomania type, DSM-IV), hospitalized in the forensic psychiatry department of Razi hospital between 1995 and 2015. This psychiatry department provides medical care for male patients not held by reason of insanity, according to article 38 of the Tunisian Criminal Code. Patients’ socio-demographic characteristics were collected as well as criminological details of their acts of violence (victim, weapon type, crime scene, premeditation…).ResultsWe collected 23 patients. Delusional disorder types were: jealousy (17), persecution (4), erotomania (1) and claim (1). The majority was married (18), undereducated (17), with irregular work (13). Forensic acts were uxoricide (15), attempted murder (5), violence against people (2) and destruction of public properties (1). Patients used bladed weapon in most of the cases (13), in the victim's residence (19), with premeditation in (17) of the crimes. Nine patients reported their act of violence to the authorities.ConclusionOur results do expose further data concerning potential dangerosity of patients with delusional disorders, and by that invites mental health professionals to prevent these acts with screening for violence predictors and risk factors.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Ranjan, S., R. Shakya, and PM Shyangwa. "Clinico-demographic profile of patients with acute and transient psychotic disorders." Health Renaissance 10, no. 3 (December 4, 2012): 215–19. http://dx.doi.org/10.3126/hren.v10i3.7138.
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Background: There are only few studies on the clinico-demographic profile of acute and transient disorders, which is a common disorder in developing countries. Objective: To study the clinical presentation and socio-demographic profile of patients with Acute and transient psychotic disorders. Methods: Thirty patients diagnosed as Acute and transient psychotic disorders were assessed to record their socio-demographic profile, presence of stress, onset, presenting complains and the phenomenology using standard questionnaire. Results: ATPDs was more common in persons below thirty years of age (63.3%), residing in rural areas (90%), unemployed (76.7%), low middle socioeconomic status (53.3%), married (63.3%), and member of nuclear family (63.3%). Abrupt onset was seen in 73% of cases. Delusion of persecution was the most common psychopathology (86.7%). All patients had impaired biorhythm and poor insight. Conclusions: Married unemployed persons below the age of thirty of low middle socioeconomic status residing in nuclear families in rural areas suffer from ATPDs more than others. DOI: http://dx.doi.org/10.3126/hren.v10i3.7138 Health Renaissance; September-December 2012; Vol 10 (No.3);215-219
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Ghajati, B., G. Sahar, B. Imen, and R. Rim. "Paranoia: When criminology predicts vocational prognosis." European Psychiatry 41, S1 (April 2017): S586. http://dx.doi.org/10.1016/j.eurpsy.2017.01.888.
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Patients with paranoia have always been a group of exiting but daunting patients for mental health professionals. Indeed, the risk of a violent acting out with important aggressive discharges confers to these patients an elevated dangerosity potential. If various criminological aspects of violence in paranoia have been described, their link to functional prognosis of patients have been seldom addressed.AimTo determine if criminological details of violence acts in paranoia patients predict their functional prognosis.MethodsA retrospective, descriptive and analytic study have been conducted, based on a chart consult. Twenty-three patients with paranoia (i.e. Chronic delusional disorder type jealousy or erotomania in DSM IV) patients have been included. These patients have been hospitalized in the forensic psychiatry department of Razi hospital of Tunis (Tunisia), between 1995 and 2015, after not being held by reason of insanity, according to article 38 of the Tunisian Criminal Code.ResultsDelusional disorder types were: jealousy (17), persecution (4), erotomania (1) and claim (1). The majority were married (18), undereducated (17), with irregular work (13). Forensic acts were uxoricide (15), attempted murder (5), violence against people (2) and destruction of public properties (1). Patients used bladed weapon in most of the cases (13), in the victim's residence (19), with premeditation in (17) of the crimes. Only 5 patients worked regularly after discharge.ConclusionIf our results expose further data concerning potential dangerosity of patients with delusional disorders, they also highlight the marginalized situation of these patients when released back into society.Disclosure of interestThe authors have not supplied their declaration of competing interest.