Headache-Associated Phantosmia as a Harbinger of Lewy Body Dementia

Olfactory hallucinations, or phantosmias, can occur in many neurological, psychiatric, and medical conditions, but no widely used standardized approach exists to comprehensively assess qualitative olfactory dysfunction in the clinical setting. Additionally, medical professionals, patients, and their family members may not recognize phantosmia as a potentially neurological problem. Given the many possible etiologies for symptomatic phantosmia, it is important to recognize this unusual presentation and elicit a meaningful history to explore the potential underlying cause. We describe a 77-year-old gentleman with a two-year history of headaches accompanied by smelling a foul odor and discuss the differential diagnosis for new onset and persistent phantosmia. This unusual case ultimately manifested features consistent with Lewy body dementia, highlighting the varied clinical presentations that are possible with this neurodegenerative disorder. We discuss the possible pathophysiology of phantosmia in Lewy body disorders, including a proposed mechanism for olfactory hallucinations arising prior to the typical well-formed hallucinations in Lewy body dementia.

Cues to body-related distortions and hallucinations? Spontaneous sensations correlate with EEG oscillatory activity recorded at rest in the somatosensory cortices

Body awareness may arise in the total absence of sensory input, as suggested by the spontaneous occurrence of normal and pathological (i.e., hallucinatory) bodily sensations. These phenomena may arise due to back-projections from higher-order cortical areas to the primary (SI) and secondary (SII) somatosensory cortices, and would appear to be reflected in cortical oscillatory activity in both SI and SII. Here, we set to investigate the relationship of SI and SII in SPS. Healthy participants underwent an EEG recording session at rest, and then completed an experiment on the perception of spontaneous sensations occurring on the hands. Cortical oscillatory activity was extracted from specified ROIs in the somatosensory cortices. The findings showed that (i) SPS perceived in the fingers correlated positively with alpha-band oscillations recorded in SI, and that (ii) SPS perceived in the palm correlated positively with gamma-band oscillations and negatively with beta-band oscillations recorded in SII. Apart from supporting the idea that the somatosensory cortices are involved in bodily awareness even in the absence of sensory input, these findings also suggest that default oscillatory activity in the somatosensory cortices reflects individual differences in bodily awareness. The results are interpreted in terms of neural and cognitive processes that may give rise to bodily awareness and modulate it, and their importance in understanding body perception distortions and bodily delusions and hallucinations is discussed.

Recursive Copy and Paste GAN: Face Hallucination From Shaded Thumbnails

Existing face hallucination methods based on convolutional neural networks (CNNs) have achieved impressive performance on low-resolution (LR) faces in a normal illumination condition. However, their performance degrades dramatically when LR faces are captured in non-uniform illumination conditions. This paper proposes a Recursive Copy and Paste Generative Adversarial Network (Re-CPGAN) to recover authentic high-resolution (HR) face images while compensating for non-uniform illumination. To this end, we develop two key components in our Re-CPGAN: internal and recursive external Copy and Paste networks (CPnets). Our internal CPnet exploits facial self-similarity information residing in the input image to enhance facial details; while our recursive external CPnet leverages an external guided face for illumination compensation. Specifically, our recursive external CPnet stacks multiple external Copy and Paste (EX-CP) units in a compact model to learn normal illumination and enhance facial details recursively. By doing so, our method offsets illumination and upsamples facial details progressively in a coarse-to-fine fashion, thus alleviating the ambiguity of correspondences between LR inputs and external guided inputs. Furthermore, a new illumination compensation loss is developed to capture illumination from the external guided face image effectively. Extensive experiments demonstrate that our method achieves authentic HR face images in a uniform illumination condition with a 16× magnification factor and outperforms state-of-the-art methods qualitatively and quantitatively.

Targeted effects of ketamine on perceptual expectation during mediated learning in rats

RATIONALE

While neural correlates of hallucinations are known, the mechanisms have remained elusive. Mechanistic insight is more practicable in animal models, in which causal relationships can be established. Recent work developing animal models of hallucination susceptibility has focused on the genesis of perceptual expectations and perceptual decision-making. Both processes are encompassed within mediated learning, which involves inducing a strong perceptual expectation via associative learning, retrieving that memory representation, and deciding whether this internally generated percept is predictive of an external outcome. Mediated learning in rodents is sensitive to many psychotomimetic manipulations. However, we do not know if these manipulations selectively alter learning of perceptual expectations versus their retrieval because of their presence throughout all task phases.

OBJECTIVES

Here, we used mediated learning to study the targeted effect of a psychotomimetic agent on the retrieval of perceptual expectation.

METHODS

We administered (R,S)-ketamine to rats selectively during the devaluation phase of a mediated learning task, when the representation of the expected cue is retrieved, to test the hypothesis that internally generated perceptual experiences underlie this altered mediated learning.

RESULTS

We found that ketamine increased only mediated learning at a moderate dose in rats, but impaired direct learning at the high dose.

CONCLUSIONS

These results suggest that ketamine can augment retrieval of perceptual expectations and thus this may be how it induces hallucination-like experiences in humans. More broadly, mediated learning may unite the conditioning, perceptual decision-making, and even reality monitoring accounts of psychosis in a manner that translates across species.

A replication study of JTC bias, genetic liability for psychosis and delusional ideation

BACKGROUND

This study attempted to replicate whether a bias in probabilistic reasoning, or 'jumping to conclusions'(JTC) bias is associated with being a sibling of a patient with schizophrenia spectrum disorder; and if so, whether this association is contingent on subthreshold delusional ideation.

METHODS

Data were derived from the EUGEI project, a 25-centre, 15-country effort to study psychosis spectrum disorder. The current analyses included 1261 patients with schizophrenia spectrum disorder, 1282 siblings of patients and 1525 healthy comparison subjects, recruited in Spain (five centres), Turkey (three centres) and Serbia (one centre). The beads task was used to assess JTC bias. Lifetime experience of delusional ideation and hallucinatory experiences was assessed using the Community Assessment of Psychic Experiences. General cognitive abilities were taken into account in the analyses.

RESULTS

JTC bias was positively associated not only with patient status but also with sibling status [adjusted relative risk (aRR) ratio : 4.23 CI 95% 3.46-5.17 for siblings and aRR: 5.07 CI 95% 4.13-6.23 for patients]. The association between JTC bias and sibling status was stronger in those with higher levels of delusional ideation (aRR interaction in siblings: 3.77 CI 95% 1.67-8.51, and in patients: 2.15 CI 95% 0.94-4.92). The association between JTC bias and sibling status was not stronger in those with higher levels of hallucinatory experiences.

CONCLUSIONS

These findings replicate earlier findings that JTC bias is associated with familial liability for psychosis and that this is contingent on the degree of delusional ideation but not hallucinations.

Perceptual pathways to hallucinogenesis

Recent advances in computational psychiatry have provided unique insights into the neural and cognitive underpinnings of psychotic symptoms. In particular, a host of new data has demonstrated the utility of computational frameworks for understanding how hallucinations might arise from alterations in typical perceptual processing. Of particular promise are models based in Bayesian inference that link hallucinatory perceptual experiences to latent states that may drive them. In this piece, we move beyond these findings to ask: how and why do these latent states arise, and how might we take advantage of heterogeneity in that process to develop precision approaches to the treatment of hallucinations? We leverage specific models of Bayesian inference to discuss components that might lead to the development of hallucinations. Using the unifying power of our model, we attempt to place disparate findings in the study of psychotic symptoms within a common framework. Finally, we suggest directions for future elaboration of these models in the service of a more refined psychiatric nosology based on predictable, testable, and ultimately treatable information processing derangements.

Comparing psychotic experiences in low-and-middle-income-countries and high-income-countries with a focus on measurement invariance

BACKGROUND

The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias.

METHODS

A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses.

RESULTS

MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = -0.42) and underestimation (e.g. magical thinking, d = -0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition.

CONCLUSION

Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.

Symptoms of Idiopathic Environmental Intolerance associated with chemicals (IEI-C) are positively associated with perceptual anomalies

OBJECTIVE

Idiopathic Environmental Intolerance (IEI; i.e. the experience of somatic symptoms attributed to environmental agents) represents a functional somatic syndrome of unclear aetiology. Based on previous findings that suggest an association between IEI and perceptual anomalies, this study aimed to investigate the relationship between symptoms of IEI associated with chemicals (IEI-C) and facets of the schizotypy spectrum.

METHODS

A cross-sectional study design was used with N = 410 (78.3% female) persons responding to an online survey in which chemical odor sensitivity (COS) and modern health worries (MHW) that are associated with IEI-C, as well as schizotypal personality traits (SPQ), hallucination proneness (LSHS) and delusional ideation (PDI) as core components of the schizotypy spectrum were assessed.

RESULTS

Schizotypal traits were found to be significantly positively associated with MHWs (r = 0.20, p = .01), COS (r = 0.23, p = .01), and showed significant positive associations with hallucination proneness. Magical thinking was found to exhibit a significant positive relationship with both MHW (r = 0.17, p = .01) and COS (r = 0.21, p = .01). These small associations between IEI-C and facets of the psychosis spectrum remained significant even after statistically controlling for individual levels of trait anxiety and depression.

CONCLUSION

Schizotypal personality traits, particularly magical thinking, and hallucination proneness, appear positively related to facets of IEI-C. The findings are of relevance for the advancement of theoretical models of IEI.

A network approach to relationships between cannabis use characteristics and psychopathology in the general population

Cannabis use characteristics, such as earlier initiation and frequent use, have been associated with an increased risk for developing psychotic experiences and psychotic disorders. However, little is known how these characteristics relate to specific aspects of sub-clinical psychopathology in the general population. Here, we explore the relationships between cannabis use characteristics and psychopathology in a large general population sample (N = 2,544, mean age 29.2 years, 47% women) by employing a network approach. This allows for the identification of unique associations between two cannabis use characteristics (lifetime cumulative frequency of cannabis use, age of cannabis use initiation), and specific psychotic experiences and affective symptoms, while controlling for early risk factors (childhood trauma, urban upbringing). We found particularly pronounced unique positive associations between frequency of cannabis use and specific delusional experiences (persecutory delusions and thought broadcasting). Age of cannabis use initiation was negatively related to visual hallucinatory experiences and irritability, implying that these experiences become more likely the earlier use is initiated. Earlier initiation, but not lifetime frequency of cannabis use, was related to early risk factors. These findings suggest that cannabis use characteristics may contribute differentially to risk for specific psychotic experiences and affective symptoms in the general population.

Validation of ketamine as a pharmacological model of thalamic dysconnectivity across the illness course of schizophrenia

N-methyl-D-aspartate receptor (NMDAR) hypofunction is a leading pathophysiological model of schizophrenia. Resting-state functional magnetic resonance imaging (rsfMRI) studies demonstrate a thalamic dysconnectivity pattern in schizophrenia involving excessive connectivity with sensory regions and deficient connectivity with frontal, cerebellar, and thalamic regions. The NMDAR antagonist ketamine, when administered at sub-anesthetic doses to healthy volunteers, induces transient schizophrenia-like symptoms and alters rsfMRI thalamic connectivity. However, the extent to which ketamine-induced thalamic dysconnectivity resembles schizophrenia thalamic dysconnectivity has not been directly tested. The current double-blind, placebo-controlled study derived an NMDAR hypofunction model of thalamic dysconnectivity from healthy volunteers undergoing ketamine infusions during rsfMRI. To assess whether ketamine-induced thalamic dysconnectivity was mediated by excess glutamate release, we tested whether pre-treatment with lamotrigine, a glutamate release inhibitor, attenuated ketamine's effects. Ketamine produced robust thalamo-cortical hyper-connectivity with sensory and motor regions that was not reduced by lamotrigine pre-treatment. To test whether the ketamine thalamic dysconnectivity pattern resembled the schizophrenia pattern, a whole-brain template representing ketamine's thalamic dysconnectivity effect was correlated with individual participant rsfMRI thalamic dysconnectivity maps, generating "ketamine similarity coefficients" for people with chronic (SZ) and early illness (ESZ) schizophrenia, individuals at clinical high-risk for psychosis (CHR-P), and healthy controls (HC). Similarity coefficients were higher in SZ and ESZ than in HC, with CHR-P showing an intermediate trend. Higher ketamine similarity coefficients correlated with greater hallucination severity in SZ. Thus, NMDAR hypofunction, modeled with ketamine, reproduces the thalamic hyper-connectivity observed in schizophrenia across its illness course, including the CHR-P period preceding psychosis onset, and may contribute to hallucination severity.

Morvan's syndrome Presenting with Psychiatric Manifestations - A Case Report and Review of the Literature

The term "la chorιe fibrillare" was used by the French physician Augustine Marie Morvan to describe a syndrome showing hyperactivity features involving the central, autonomic, and peripheral nervous system. The central hyperactivity symptoms are confusion, behavioral problems, hallucinations, myoclonus, and insomnia; the autonomic hyperactivity symptoms are hyperhidrosis and variations in blood pressure; and peripheral hyperexcitability is characterized by painful cramps, myokymia, and neuromyotonia. Here, we present a case that has typical features of Morvan's syndrome and provides a brief description based on available literature.

Cross-sectional and longitudinal associations between psychotic and depressive symptoms in depressed adolescents

Adults with major depressive disorder (MDD) with psychotic features (delusions and/or hallucinations) have more severe symptoms and a worse prognosis. Subclinical psychotic symptoms are more common in adolescents than adults. However, the effects of psychotic symptoms on outcome of depressive symptoms have not been well studied in adolescents. Depressed adolescents aged 11-17 with and without psychotic symptoms were compared on depression severity scores at baseline and at 28- or 42-week follow-up in two large UK cohorts. Psychotic symptoms were weakly associated with more severe depression at baseline in both cohorts. At follow-up, baseline psychotic symptoms were only associated with depressive symptoms in one sample; in the other, the effect size was close to zero. This supports the DSM5 system of psychotic symptoms being a separate code to severity rather than the ICD10 system which only allows the diagnosis of psychotic depression with severe depression. There was no clear support for psychotic symptoms being a baseline marker of treatment response.

Pro-UIGAN: Progressive Face Hallucination From Occluded Thumbnails

In this paper, we study the task of hallucinating an authentic high-resolution (HR) face from an occluded thumbnail. We propose a multi-stage Progressive Upsampling and Inpainting Generative Adversarial Network, dubbed Pro-UIGAN, which exploits facial geometry priors to replenish and upsample ( 8× ) the occluded and tiny faces ( 16×16 pixels). Pro-UIGAN iteratively (1) estimates facial geometry priors for low-resolution (LR) faces and (2) acquires non-occluded HR face images under the guidance of the estimated priors. Our multi-stage hallucination network upsamples and inpaints occluded LR faces via a coarse-to-fine fashion, significantly reducing undesirable artifacts and blurriness. Specifically, we design a novel cross-modal attention module for facial priors estimation, in which an input face and its landmark features are formulated as queries and keys, respectively. Such a design encourages joint feature learning across the input facial and landmark features, and deep feature correspondences will be discovered by attention. Thus, facial appearance features and facial geometry priors are learned in a mutually beneficial manner. Extensive experiments show that our Pro-UIGAN attains visually pleasing completed HR faces, thus facilitating downstream tasks, i.e., face alignment, face parsing, face recognition as well as expression classification.

Associations Between Neuropsychiatric Symptoms and Neuropathological Diagnoses of Alzheimer Disease and Related Dementias

IMPORTANCE

Understanding associations of Alzheimer disease (AD) and related dementias (ADRD) pathologies with common neuropsychiatric symptoms (NPS) may have implications for diagnosis and management.

OBJECTIVE

To evaluate ADRD neuropathological diagnoses and NPS without consideration of clinical diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective cohort study evaluated 1808 brains from 39 sites in the US National Alzheimer Coordinating Center v. 10 collection for participants among whom the Neuropsychiatric Inventory Questionnaire (NPIQ) was administered annually. Brain autopsy diagnoses of AD, Lewy body disease (LBD), cerebral amyloid angiopathy, frontotemporal lobar degeneration, cerebrovascular disease, hippocampal sclerosis, and no known pathology were examined. Autopsy data collected from January 2012 to January 2018 were deidentified and compiled into the publicly available v. 10 database. Data were analyzed from February 2021 to August 2021.

MAIN OUTCOMES AND MEASURES

The primary outcome was NPIQ domain score, if present at any time point, and mean NPIQ domain score during follow-up was secondary. Associations of ADRD diagnoses with 12 NPIQ symptom domains were examined in regression analyses, correcting for multiple comparisons.

RESULTS

The study sample of 1808 adults had a mean (SD) age of 80.0 (11.0) years, and 987 participants (54.6%) were male. Apathy was the most prevalent NPS, reaching 80% (203 of 254 individuals) in those with hippocampal sclerosis. Cerebrovascular disease showed few NPS associations. Frontotemporal lobar degeneration was associated with increased apathy, increased disinhibition, and decreased psychosis and agitation compared with AD. Hippocampal sclerosis was associated with increased apathy (odds ratio, 2.60; 95% CI; 1.86-3.66, false discovery rate controlled P < .001) and disinhibition (odds ratio, 2.15; 95% CI, 1.63-2.84; false discovery rate controlled P < .001). In multiple regression analyses that included concomitant neuropathologies, the main findings remained. More severe pathology was consistently associated with increased NPS (eg, LBD was associated with an increase in hallucinations from brain stem [β, 0.23; 95% CI, 0.07-0.76; P = .02] to limbic [β, 1.69; 95% CI, 1.27-2.27; P < .001] to neocortical [β, 4.49; 95% CI, 3.27-6.16; P < .001] pathology). Hallucinations were more common in participants with AD and LBD (168 of 534 [31.5%]) compared with those with AD without LBD (152 of 704 [21.6%]) and those with LBD without AD (23 of 119 [19.6%]).

CONCLUSIONS AND RELEVANCE

In this cohort study of 1808 brains from the US National Alzheimer Coordinating Center, patients with LBD and AD showed a higher prevalence of hallucinations compared with those with LBD without AD. Neuropsychiatric symptom criteria of apathy and disinhibition in behavioral variant frontotemporal lobar degeneration were supported in this study. In hippocampal sclerosis, the findings of increased apathy and disinhibition merit further investigation. Severity of neuropathology was associated with NPS severity, indicating that NPS may reflect underlying ADRD pathology and highlighting the importance of diagnosing and treating NPS.

Association of Variation in Behavioral Symptoms With Initial Cognitive Phenotype in Adults With Dementia Confirmed by Neuropathology

IMPORTANCE

Behavioral and psychological symptoms of dementia (BPSDs) in association with amnestic and nonamnestic cognitive phenotypes have not been evaluated across diagnoses of Alzheimer disease pathology (ADP), Lewy body-related pathology (LRP), and mixed pathology (ADP-LRP).

OBJECTIVES

To determine the clinical phenotypes at the initial visit that are associated with the nature and severity of BPSDs in patients with ADP, LRP, and ADP-LRP.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective longitudinal cohort study included 2422 participants with neuropathologically confirmed ADP, LRP, or mixed ADP-LRP in the National Alzheimer Coordinating Center database from June 20, 2005, to September 4, 2019. Participants had a mean (SD) interval of 5.5 (2.8) years from initial visit to autopsy.

MAIN OUTCOMES AND MEASURES

Clinician-determined diagnosis of change across 10 BPSDs (agitation, apathy, depression, delusions, disinhibition, auditory hallucinations, visual hallucinations, irritability, personality change, and rapid eye movement [REM] sleep behavior) and the highest severity score for behavioral change on the Neuropsychiatric Inventory Questionnaire (NPI-Q).

RESULTS

A total of 2422 participants (1187 with ADP, 904 with ADP-LRP, and 331 with LRP) were included in the analysis (1446 men [59.7%]; mean [SD] age, 74.4 [10.1] years). Compared with initial amnestic symptoms, executive symptoms were associated with a higher risk for 7 of the 10 BPSDs (hazard ratio [HR] range, 1.28-2.45), and visuospatial symptoms were associated with a higher risk for 2 of the 10 BPSDs (HR range, 1.91-2.51), but neither were associated with a low risk for any BPSD. Language symptoms were associated with a low risk of onset for 3 of 10 BPSDs (HR range, 0.43-0.79) and a high risk for 1 BPSD (personality change) (HR, 1.42 [95% CI, 1.10-1.83]). Participants with LRP had a lower risk for agitation (HR, 0.74 [95% CI, 0.60-0.92]), disinhibition (HR, 0.78 [95% CI, 0.62-0.99]), and irritability (HR, 0.81 [95% CI, 0.68-0.96]) and a higher risk for apathy (HR, 1.19 [95% CI, 1.02-1.38]), depression (HR, 1.32 [95% CI, 1.12-1.55]), auditory (HR, 2.00 [95% CI, 1.37-2.93]) and visual (HR, 2.78 [95% CI, 2.21-3.49]) hallucinations, and REM sleep behavior changes (HR, 4.77 [95% CI, 3.61-6.31]) compared with the ADP group. The ADP-LRP group had a higher risk for delusions (HR, 1.27 [95% CI, 1.08-1.48]), auditory (HR, 1.62 [95% CI, 1.21-2.15]) and visual (HR, 1.57 [95% CI, 1.30-1.89]) hallucinations, and REM sleep behavior changes (HR, 2.10 [95% CI, 1.63-2.70]) than the ADP group and a lower risk for visual hallucinations (HR, 0.56 [95% CI, 0.45-0.71]) and REM sleep behavior changes (HR, 0.44 [95% CI, 0.34-0.57) than the LRP group. Overall, women showed a lower risk of agitation (HR, 0.86 [95% CI, 0.75-0.98]), apathy (HR, 0.79 [95% CI, 0.71-0.87]), visual hallucinations (HR, 0.76 [95% CI, 0.64-0.90]), irritability (HR, 0.77 [95% CI, 0.69-0.86]), and REM sleep behavior change (HR, 0.45 [95% CI, 0.35-0.58]) and a higher risk of depression (HR, 1.26 [95% CI, 1.13-1.41]). Older age was associated with a lower risk of most BPSDs (HR range, 0.98-0.99) except delusions (HR, 1.00 [95% CI, 1.00-1.01]) and auditory hallucinations (HR, 0.99 [95% CI, 0.97-1.00]) and a low NPI-Q composite score (β = -0.07 [95% CI, -0.08 to -0.05]; P < .001).

CONCLUSIONS AND RELEVANCE

These findings suggest that the risks of BPSDs differ with respect to the initial cognitive phenotype, underlying neuropathology, age, and sex. Awareness of these associations could be helpful in dementia management.

Folie à Deux During Self-Quarantine in the COVID-19 Pandemic: a Case Report

Folie à deux is also known as psychosis of association or shared paranoid disorder. We describe a mother and her two daughters who experienced shared delusions and hallucinations during self-quarantine in COVID-19 pandemic. The mother was later diagnosed with schizophrenia and prescribed brexpiprazole, whereas her two daughters were diagnosed with psychosis of association affected by their mother.

How we continue bonds with deceased persons: The proximity-seeking behavior scale

Continuing bonds is a multifaceted process, encompassing perceptions, beliefs, illusions and hallucinations, and overt behaviors. We developed the Proximity-Seeking Behavior Scale (PSBS) to assess overt behavior to continue bonds with the deceased person. We had 694 bereaved adults complete an online survey. Exploratory and confirmatory factor analyses yielded a one-factor model for PSBS items. PSBS reliability was good. PSBS scores correlated positively with rumination and yearning, feeling connected to the deceased person, and prolonged grief and depression symptoms. The PSBS appears a reliable and valid instrument to assess proximity-seeking behaviors.

Mapping brain structural differences and neuroreceptor correlates in Parkinson's disease visual hallucinations

Parkinson's psychosis (PDP) describes a spectrum of symptoms that may arise in Parkinson's disease (PD) including visual hallucinations (VH). Imaging studies investigating the neural correlates of PDP have been inconsistent in their findings, due to differences in study design and limitations of scale. Here we use empirical Bayes harmonisation to pool together structural imaging data from multiple research groups into a large-scale mega-analysis, allowing us to identify cortical regions and networks involved in VH and their relation to receptor binding. Differences of morphometrics analysed show a wider cortical involvement underlying VH than previously recognised, including primary visual cortex and surrounding regions, and the hippocampus, independent of its role in cognitive decline. Structural covariance analyses point to the involvement of the attentional control networks in PD-VH, while associations with receptor density maps suggest neurotransmitter loss may be linked to the cortical changes.

Dual-Path Deep Fusion Network for Face Image Hallucination

Along with the performance improvement of deep-learning-based face hallucination methods, various face priors (facial shape, facial landmark heatmaps, or parsing maps) have been used to describe holistic and partial facial features, making the cost of generating super-resolved face images expensive and laborious. To deal with this problem, we present a simple yet effective dual-path deep fusion network (DPDFN) for face image super-resolution (SR) without requiring additional face prior, which learns the global facial shape and local facial components through two individual branches. The proposed DPDFN is composed of three components: a global memory subnetwork (GMN), a local reinforcement subnetwork (LRN), and a fusion and reconstruction module (FRM). In particular, GMN characterize the holistic facial shape by employing recurrent dense residual learning to excavate wide-range context across spatial series. Meanwhile, LRN is committed to learning local facial components, which focuses on the patch-wise mapping relations between low-resolution (LR) and high-resolution (HR) space on local regions rather than the entire image. Furthermore, by aggregating the global and local facial information from the preceding dual-path subnetworks, FRM can generate the corresponding high-quality face image. Experimental results of face hallucination on public face data sets and face recognition on real-world data sets (VGGface and SCFace) show the superiority both on visual effect and objective indicators over the previous state-of-the-art methods.

['Home away from house': an example of a reduplicative paramnesia]

We describe a 78-year old male patient with Parkinson&rsquo;s disease and without a past psychiatric history, who had hallucinations and a very particular form of a delusional misidentification syndrome. His belief that he was not at home and that his home was on a different location, even in another country, is a form of 'reduplicative paramnesia'. This delusion is seen more often in association with neurodegenerative disease, for example in Parkinson&rsquo;s disease. We describe the characteristics of this delusion, provide possible explanations and delineate several therapeutic options.

Presentation of Mucopolysaccharidosis As Very Early Onset Schizophrenia Like Illness in Psychiatry Settings

Schizophrenia is very rare before the age of 13, which is known as very early onset schizophrenia. There are few reports which document cases of schizophrenia before 5 years of age. Childhood onset schizophrenia has more chronic course characterized by sever social and cognitive consequences and increased negative and disorganization symptoms. Although diagnostic criteria of schizophrenia according to DSM5 are same as of adult onset but it's very difficult to explore psychopathology such as delusion and hallucination which depend upon cognitive development of the child. Further, the diagnosis of early onset schizophrenia is difficult because of similarity with neurological and metabolic disorder of childhood. This warrants comprehensive evaluation of such cases by multidisciplinary team consisting pediatrician, neurologist and psychiatrist.

Forehead Tactile Hallucination Is Augmented by the Perceived Risk and Accompanies Increase of Forehead Tactile Sensitivity

Tactile hallucinations frequently occur after mental illnesses and neurodegenerative diseases like Alzheimer’s and Parkinson’s disease. Despite their common occurrence, there are several complicating factors that make it difficult to elucidate the tactile hallucinations. The forehead tactile hallucination, evoked by the physical object approaching to the forehead, can be easily and consistently evoked in healthy-bodied subjects, and therefore it would help with investigating the mechanism of tactile hallucinations. In this pilot study, we investigated the principles of the forehead tactile hallucination with eight healthy subjects. We designed the experimental setup to test the effect of sharpness and speed of objects approaching towards the forehead on the forehead tactile hallucination, in both a physical and virtual experimental setting. The forehead tactile hallucination was successfully evoked by virtual object as well as physical object, approaching the forehead. The forehead tactile hallucination was increased by the increase of sharpness and speed of the approaching object. The forehead tactile hallucination also increased the tactile sensitivity on the forehead. The forehead tactile hallucination can be solely evoked by visual feedback and augmented by the increased perceived risk. The forehead tactile hallucination also increases tactile sensitivity. These experimental results may enhance the understanding of the foundational mechanisms of tactile hallucinations.

Impaired self-recognition in individuals with no full-blown psychotic symptoms represented across the continuum of psychosis: a meta-analysis

BACKGROUND

Impairments in self-recognition (i.e. recognition of own thoughts and actions) have been repeatedly shown in individuals with schizophrenia. According to classical clinical characterizations, schizophrenia is included in a continuum encompassing a large range of genetic statuses, psychotic states and symptoms. The current meta-analysis aims to determine whether self-recognition is affected by individuals within the psychosis continuum.

METHOD

Three populations were considered: people with an at-risk mental state for psychosis (ARMS), hallucination-prone individuals and unaffected relatives of patients with schizophrenia. Eleven studies contrasted self-recognition between these three populations (n = 386) and healthy controls (n = 315) and four studies used correlational analysis to estimate comparable effects (n = 629). Eligible studies used experimental paradigms including source-monitoring and self-monitoring.

RESULTS

We observed significantly reduced self-recognition accuracy in these populations [g = -0.44 (-0.71 to -0.17), p = 0.002] compared to controls. No influence of the type of population, experimental paradigm or study design was observed.

CONCLUSION

The present analysis argues for self-recognition deficits in populations with no full-blown psychotic symptoms represented across the continuum of psychosis.

Investigating the association between physical health comorbidities and disability in individuals with severe mental illness

BACKGROUND

Research suggests that an increased risk of physical comorbidities might have a key role in the association between severe mental illness (SMI) and disability. We examined the association between physical multimorbidity and disability in individuals with SMI.

METHODS

Data were extracted from the clinical record interactive search system at South London and Maudsley Biomedical Research Centre. Our sample (n = 13,933) consisted of individuals who had received a primary or secondary SMI diagnosis between 2007 and 2018 and had available data for Health of Nations Outcome Scale (HoNOS) as disability measure. Physical comorbidities were defined using Chapters II-XIV of the International Classification of Diagnoses (ICD-10).

RESULTS

More than 60 % of the sample had complex multimorbidity. The most common organ system affected were neurological (34.7%), dermatological (15.4%), and circulatory (14.8%). All specific comorbidities (ICD-10 Chapters) were associated with higher levels of disability, HoNOS total scores. Individuals with musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders were found to be associated with significant difficulties associated with more than five HoNOS domains while others had a lower number of domains affected.

CONCLUSIONS

Individuals with SMI and musculoskeletal, skin/dermatological, respiratory, endocrine, neurological, hematological, or circulatory disorders are at higher risk of disability compared to those who do not have those comorbidities. Individuals with SMI and physical comorbidities are at greater risk of reporting difficulties associated with activities of daily living, hallucinations, and cognitive functioning. Therefore, these should be targeted for prevention and intervention programs.

Network of autoscopic hallucinations elicited by intracerebral stimulations of periventricular nodular heterotopia: An SEEG study

Periventricular nodular heterotopias (PVNH) are areas of neurons abnormally located in the white matter that might be involved in physiological cortical functions. Autoscopic hallucinations are changes in self-consciousness determined by a mismatch in integration of multiple sensory inputs. Our goal is to highlight the brain network involved in generation of autoscopic hallucination elicited by electrical stimulation of a PVNH in a drug resistant epilepsy patient. Our patient was explored using stereo-electroencephalography with electrodes covering the right posterior temporal PVNH and the adjacent cortex. Direct electrical high frequency stimulation of the PVNH elicited autoscopic hallucinations mainly involving the face and upper trunk. We then used multiple modalities to determine brain connectivity: single pulse electrical stimulation of the PVNH and stimulation-evoked potentials were used to highlight resting state effective connectivity. High-frequency stimulation using alternating polarity pulses enabled us to identify the network involved, time-locked to the clinical effect and to map symptom-related effective connectivity. Functional connectivity using a non-linear regression method was used to determine dependencies between different cortical regions following the stimulation. Finally, structural connectivity was highlighted using deterministic fiber tracking. Multi-modal connectivity analysis identified a network involving the PVNH, occipital and temporal neocortex, fusiform gyrus and parietal cortex.

Depth Privileged Scene Recognition via Dual Attention Hallucination

RGB-D scene recognition has achieved promising performance because depth could provide complementary geometric information to RGB images. However, the inaccessibility of depth sensors severely limits RGB-D applications. In this paper, we focus on depth privileged setting, in which depth information is only available during training but not available during testing. Considering that the information obtained from RGB and depth images are complementary while attention is informative and transferable, our idea is using RGB input to hallucinate depth attention. We build our model upon modulated deformable convolutional layer and hallucinate dual attention: post-hoc importance weight and trainable spatial transformation. Specifically, we use modulation (resp., offset) learned from RGB to mimic Grad-CAM (resp., offset) learned from depth, to combine the strength of dual attention. We also design a weighted loss to avoid negative transfer according to the quality of depth attention. Extensive experiments on two benchmarks, i.e., SUN RGB-D and NYUDv2, demonstrate that our method outperforms the state-of-the-art methods for depth privileged scene recognition.

On Hallucinations in Tomographic Image Reconstruction

Tomographic image reconstruction is generally an ill-posed linear inverse problem. Such ill-posed inverse problems are typically regularized using prior knowledge of the sought-after object property. Recently, deep neural networks have been actively investigated for regularizing image reconstruction problems by learning a prior for the object properties from training images. However, an analysis of the prior information learned by these deep networks and their ability to generalize to data that may lie outside the training distribution is still being explored. An inaccurate prior might lead to false structures being hallucinated in the reconstructed image and that is a cause for serious concern in medical imaging. In this work, we propose to illustrate the effect of the prior imposed by a reconstruction method by decomposing the image estimate into generalized measurement and null components. The concept of a hallucination map is introduced for the general purpose of understanding the effect of the prior in regularized reconstruction methods. Numerical studies are conducted corresponding to a stylized tomographic imaging modality. The behavior of different reconstruction methods under the proposed formalism is discussed with the help of the numerical studies.

[A Mini Dictionary of Visual Hallucination Syndromes]

Visual hallucinations occur in individuals with paroxysmal neurological diseases, such as epilepsy and migraine, alcohol withdrawal, use of anticholinergic or hallucinogenic drugs, neurodegenerative diseases, focal brain injury, and schizophrenia spectrum disorders. In this review, I discuss the phenomenology and pathophysiology of the 11 clinical conditions associated with visual hallucinations and their related symptoms.

Visual hallucinations and sight loss in children and young adults: a retrospective case series of Charles Bonnet syndrome

BACKGROUND/AIMS

Charles Bonnet syndrome (CBS) is a complication of sight loss affecting all ages; yet, few childhood cases have been reported. Our aim is to raise awareness of this under-reported association occurring in children and young adults in order to prevent psychological harm in this age group.

METHODS

A retrospective case series reviewing medical notes of patients <25 years of age with sight loss and reported CBS at a single centre hospital eye service in London, United Kingdom. Search of electronic patient records identified 13 patients experiencing hallucinatory events over a 9-year period. Outcomes were patient demographics including ocular diagnosis, visual acuity at time of onset, characteristics of hallucinations, clinical management strategies and patient-reported affliction.

RESULTS

Eight patients were diagnosed with progressive inherited retinal diseases, primarily Stargardt disease (N=5). Clinical history indicated patients had significantly reduced best-corrected visual acuity (BCVA) in at least one eye at onset; median (IQR) worse eye BCVA was 1.0 (0.86-1.6) logarithm of minimum angle of resolution(LogMAR). CBS significantly affected patients' personal lives including education, diet and sleep. Clinical management was varied, mostly relating to reassurance at the point of contact.

CONCLUSION

We describe the clinical features of young patients with CBS, with management strategies and aspects of negative outcomes. High potential caseload and risk of psychological harm merit further research. Increased awareness among healthcare professionals and patient education to forewarn susceptible individuals may reduce the overall impact and improve coping with symptoms.

Transcranial direct current stimulation (tDCS) enhances internal source monitoring abilities in healthy participants

Source monitoring refers to the ability to identify the origin of a memory, for example, whether you remember saying something or thinking about it, and confusions of these sources have been associated with the experience of auditory verbal hallucinations (AVHs). Both AVHs and source confusions are reported to originate from dysfunctional brain activations in the prefrontal cortex (PFC) and the superior temporal gyrus (STG); specifically, it is assumed that a hypoactive PFC and a hyperactive STG gives rise to AVHs and source confusions. We set out to test this assumption by trying to mimic this hypertemporal/hypofrontal model in healthy individuals with transcranial direct current stimulation (tDCS): the inhibitory cathode was placed over the left PFC and the excitatory anode over the left dorsolateral STG. Participants completed a reality monitoring task (distinguishing between external and internal memory sources) and an internal source monitoring task (distinguishing between two or more internal memory sources) in two separate experiments (offline vs. online tDCS). In the offline experiment (n = 34), both source monitoring tasks were completed after tDCS stimulation, and in the online experiment (n = 27) source monitoring tasks were completed while simultaneously being stimulated with tDCS. We found that internal source monitoring abilities were significantly enhanced during active online tDCS, while reality monitoring abilities were unaffected by stimulation in both experiments. We speculate, based on combining the present findings with previous studies, that there might be different brain areas involved in reality and internal source monitoring. While internal source monitoring seems to involve speech production areas, specifically Broca’s area, as suggested in the present study, reality monitoring seems to rely more on the STG and DLPFC, as shown in other studies of the field.

Person-ness of voices in lived experience accounts of psychosis: combining literary linguistics and clinical psychology

In this paper, we use concepts and insights from the literary linguistic study of story-world characters to shed new light on the nature of voices as social agents in the context of lived experience accounts of voice-hearing. We demonstrate a considerable overlap between approaches to voices as social agents in clinical psychology and the perception of characters in the linguistic study of fiction, but argue that the literary linguistic approach facilitates a much more nuanced account of the different degrees of person-ness voices might be perceived to possess. We propose a scalar Characterisation Model of Voices and demonstrate its explanatory potential by comparing two lived experience descriptions of voices in interviews with voice-hearers in a psychosis intervention. The new insights into the phenomenology of voice-hearing achieved by applying the model are relevant to the understanding of voice-hearing as well as to therapeutic interventions.

Psychosis symptoms associated with Niemann-Pick disease type C

Niemann-Pick disease type C (NP-C) is a severe neurovisceral lipid storage disease that results in the accumulation of unesterified cholesterol in lysosomes or endosomes. The clinical presentations of NP-C are variable which include visceral symptoms, neurologic symptoms and psychiatric symptoms. Psychosis is the most common psychiatric manifestation of NP-C and is indistinguishable from a typical psychosis presentation of schizophrenia. The common psychotic presentations in NP-C include visual hallucinations, delusions, auditory hallucinations and thought disorders. Psychosis symptoms are more common in adult or adolescent-onset forms compared with pediatric-onset forms. The underlying pathophysiology of psychosis in NP-C is most probably due to dysconnectivity particularly between frontotemporal connectivity and subcortical structures. NP-C sometimes is mistaken for schizophrenia which causes delay in treatment due to lack of awareness and literature review. This review aims to summarize the relevant case reports on psychosis symptoms in NP-C and discuss the genetics and pathophysiology underlying the condition.

Deep HDR Hallucination for Inverse Tone Mapping

Inverse Tone Mapping (ITM) methods attempt to reconstruct High Dynamic Range (HDR) information from Low Dynamic Range (LDR) image content. The dynamic range of well-exposed areas must be expanded and any missing information due to over/under-exposure must be recovered (hallucinated). The majority of methods focus on the former and are relatively successful, while most attempts on the latter are not of sufficient quality, even ones based on Convolutional Neural Networks (CNNs). A major factor for the reduced inpainting quality in some works is the choice of loss function. Work based on Generative Adversarial Networks (GANs) shows promising results for image synthesis and LDR inpainting, suggesting that GAN losses can improve inverse tone mapping results. This work presents a GAN-based method that hallucinates missing information from badly exposed areas in LDR images and compares its efficacy with alternative variations. The proposed method is quantitatively competitive with state-of-the-art inverse tone mapping methods, providing good dynamic range expansion for well-exposed areas and plausible hallucinations for saturated and under-exposed areas. A density-based normalisation method, targeted for HDR content, is also proposed, as well as an HDR data augmentation method targeted for HDR hallucination.

Alterations of Resting EEG in Hallucinating and Nonhallucinating Schizophrenia Patients

Auditory hallucinations (AHs) are a common symptom of schizophrenia and contribute significantly to disease burden. Research on schizophrenia and AHs is limited and fails to adequately address the effect of AHs on resting EEG in patients with schizophrenia. This study assessed changes in frequency bands (delta, theta, alpha, beta) of resting EEG taken from hallucinating patients (n = 12), nonhallucinating patients (n = 11), and healthy controls (n = 12). Delta and theta activity were unaffected by AHs but differed between patients with schizophrenia and healthy controls. Alpha activity was affected by AHs: nonhallucinators had more alpha activity than hallucinators and healthy controls. Additionally, beta activity was inversely related to trait measures of AHs. These findings contribute to the literature of resting eyes closed EEG recordings of schizophrenia and AHs, and indicate the role of delta, theta, alpha, and beta as markers for schizophrenia and auditory hallucinations.

Cortico-cortical connectivity behind acoustic information transfer to mouse orbitofrontal cortex is sensitive to neuromodulation and displays local sensory gating: relevance in disorders with auditory hallucinations?

BACKGROUND

Auditory hallucinations (which occur when the distinction between thoughts and perceptions is blurred) are common in psychotic disorders. The orbitofrontal cortex (OFC) may be implicated, because it receives multiple inputs, including sound and affective value via the amygdala, orchestrating complex emotional responses. We aimed to elucidate the circuit and neuromodulatory mechanisms that underlie the processing of emotionally salient auditory stimuli in the OFC — mechanisms that may be involved in auditory hallucinations.

METHODS

We identified the cortico-cortical connectivity conveying auditory information to the mouse OFC; its sensitivity to neuromodulators involved in psychosis and postpartum depression, such as dopamine and neurosteroids; and its sensitivity to sensory gating (defective in dysexecutive syndromes).

RESULTS

Retrograde tracers in OFC revealed input cells in all auditory cortices. Acoustic responses were abolished by pharmacological and chemogenetic inactivation of the above-identified pathway. Acoustic responses in the OFC were reduced by local dopaminergic agonists and neurosteroids. Noticeably, apomorphine action lasted longer in the OFC than in auditory areas, and its effect was modality-specific (augmentation for visual responses), whereas neurosteroid action was sex-specific. Finally, acoustic responses in the OFC reverberated to the auditory association cortex via feedback connections and displayed sensory gating, a phenomenon of local origin, given that it was not detectable in input auditory cortices.

LIMITATIONS

Although our findings were for mice, connectivity and sensitivity to neuromodulation are conserved across mammals.

CONCLUSION

The corticocortical loop from the auditory association cortex to the OFC is dramatically sensitive to dopamine and neurosteroids. This suggests a clinically testable circuit behind auditory hallucinations. The function of OFC input–output circuits can be studied in mice with targeted and clinically relevant mutations related to their response to emotionally salient sounds.

EFFECT OF APPLYING "ACCEPTANCE AND COMMITMENT THERAPY" ON AUDITORY HALLUCINATIONS AMONG PATIENTS WITH SCHIZOPHRENIA

Experiencing persistent auditory hallucinations may contribute to unproductive struggle and interference with valued living among patients with schizophrenia. Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies that proposes active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. Utilization of acceptance commitment therapy may assist in reducing auditory hallucinations and may increase patient's feeling of control.

AIM

Determine the effect of applying acceptance and commitment therapy on auditory hallucinations among patients with schizophrenia.

SETTING

The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt.

SUBJECTS

A random sample of 70 male inpatients with schizophrenia was selected and divided equally into a study and a control groups (35 patients in each group). Both groups were matched as much as possible in relation to socio- demographic and clinical data. Tools: Psychotic Symptom Rating Scales (PSYRATS-AHs) and Voices Acceptance and Action Scale (VAAS). A quasi-experimental research design was utilized in this study.

RESULTS

Significant differences were found between the study and control groups immediately post and after 3 months of ACT on baseline PSYRATS& VAAS scores.

CONCLUSION

ACT offers a promising new treatment for auditory hallucination among patients with schizophrenia. A significant improvement in auditory hallucination was found in the study group immediately after implementing ACT and after 3 months. As well as a decrement in re hospitalization rate and improvement in drug compliance for the study group compares to control one.

RECOMMENDATIONS

ACT should be integrated in psychiatric treatment and nursing interventions of inpatients with schizophrenia who experiencing auditory hallucination.

Common and distinct brain networks of autoscopic phenomena

OBJECTIVE

Autoscopic phenomena (AP) are illusory own body reduplications characterized by the visual perception of a second own body in extrapersonal space, and include three main forms: autoscopic hallucination (AH), heautoscopy (HAS) and out-of-body-experience (OBE). Past research showed that lesions were heterogeneously distributed and affected many different brain regions within and across patients, while small case series suggested that AP lesions converge in temporo-parietal and parieto-occipital cortex. As only few studies investigated each form of AP separately, it remains unknown whether the three AP are characterized by common and distinct brain mechanisms.

METHODS

Here, we applied lesion network analysis in 26 neurological AP patients and determined their common and distinct functional connectivity patterns.

RESULTS

We report that all localize to a single common brain network at the bilateral temporo-parietal junction, further associated with specific patterns of functional connectivity, defining each type of AP. OBE resulted from a brain network connected to bilateral angular gyrus, right precuneus, and right inferior frontal gyrus, differing from AH with a brain network connected to bilateral precuneus, inferior temporal gyrus, and cerebellum. HAS resulted from a brain network connected to left inferior frontal gyrus, left insula and left parahippocampus.

CONCLUSION

The present data identify the temporo-parietal junction as the common core region for AP and show that each form of AP recruits additional specific networks, associated with different sensorimotor and self-related sub-networks.

The Centroid Cannot Hold: Comparing Sequential and Global Estimates of Coherence as Indicators of Formal Thought Disorder

Thought disorder (TD) as reflected in incoherent speech is a cardinal symptom of schizophrenia and related disorders. Quantification of the degree ofTD can inform diagnosis, monitoring, and timely intervention. Consequently, there has been an interest in applying methods ofdistributional semantics to quantify incoherence ofspoken language. Prior studies have generally involved few participants and utilized speech data collected in on-site structured interviews. In this paper we conduct a comprehensive evaluation ofapproaches to quantify incoherence using distributional semantics, including a novel variant that measures the global coherence oftext. This evaluation is conducted in the context of "audio diaries" collected from participants experiencing auditory verbal hallucinations using a smartphone application. Results reveal our novel global coherence metric using the centroid (weighted vector average) outperforms established approaches in their agreement with human annotators, supporting their preferential use in the context of short recordings ofunstructured and largely spontaneous speech.

The therapeutic processes of avatar therapy: A content analysis of the dialogue between treatment-resistant patients with schizophrenia and their avatar

OBJECTIVE

Because the therapeutic processes of Avatar Therapy remain equivocal, the current study aims to further extend our previous findings by analysing the evolution of the avatars' and patients' speech and changes in patient responses as sessions progressed.

DESIGN

Eighteen patients with treatment-resistant schizophrenia were selected from two clinical trials on Avatar Therapy. Three coders analysed both the avatars' and patients' discourse during immersive therapy sessions using content analysis methods.

RESULTS

Our analyses enabled the categorization of the avatar discourse into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). Patients responded to these utterances using coping mechanism or by expressing emotions, beliefs, self-perceptions or aspirations. Through identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over the sessions from confrontation to a constructive dialogue. Assertiveness, emotional responses and prevention strategies seemed to be central to the therapeutic process, and these usually occur in response to positive techniques.

CONCLUSION

Investigating AT's therapeutic process may help to identify components to achieve positive outcomes and can enable the development of more effective treatments. Further studies should explore the association between these themes and therapeutic response to help predict which patients will better respond to Avatar Therapy.

Progression of Behavioral Disturbances and Neuropsychiatric Symptoms in Patients With Genetic Frontotemporal Dementia

IMPORTANCE

Behavioral disturbances are core features of frontotemporal dementia (FTD); however, symptom progression across the course of disease is not well characterized in genetic FTD.

OBJECTIVE

To investigate behavioral symptom frequency and severity and their evolution and progression in different forms of genetic FTD.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study, the international Genetic FTD Initiative (GENFI), was conducted from January 30, 2012, to May 31, 2019, at 23 multicenter specialist tertiary FTD research clinics in the United Kingdom, the Netherlands, Belgium, France, Spain, Portugal, Italy, Germany, Sweden, Finland, and Canada. Participants included a consecutive sample of 232 symptomatic FTD gene variation carriers comprising 115 with variations in C9orf72, 78 in GRN, and 39 in MAPT. A total of 101 carriers had at least 1 follow-up evaluation (for a total of 400 assessments). Gene variations were included only if considered pathogenetic.

MAIN OUTCOMES AND MEASURES

Behavioral and neuropsychiatric symptoms were assessed across disease duration and evaluated from symptom onset. Hierarchical generalized linear mixed models were used to model behavioral and neuropsychiatric measures as a function of disease duration and variation.

RESULTS

Of 232 patients with FTD, 115 (49.6%) had a C9orf72 expansion (median [interquartile range (IQR)] age at evaluation, 64.3 [57.5-69.7] years; 72 men [62.6%]; 115 White patients [100%]), 78 (33.6%) had a GRN variant (median [IQR] age, 63.4 [58.3-68.8] years; 40 women [51.3%]; 77 White patients [98.7%]), and 39 (16.8%) had a MAPT variant (median [IQR] age, 56.3 [49.9-62.4] years; 25 men [64.1%]; 37 White patients [94.9%]). All core behavioral symptoms, including disinhibition, apathy, loss of empathy, perseverative behavior, and hyperorality, were highly expressed in all gene variant carriers (>50% patients), with apathy being one of the most common and severe symptoms throughout the disease course (51.7%-100% of patients). Patients with MAPT variants showed the highest frequency and severity of most behavioral symptoms, particularly disinhibition (79.3%-100% of patients) and compulsive behavior (64.3%-100% of patients), compared with C9orf72 carriers (51.7%-95.8% of patients with disinhibition and 34.5%-75.0% with compulsive behavior) and GRN carriers (38.2%-100% with disinhibition and 20.6%-100% with compulsive behavior). Alongside behavioral symptoms, neuropsychiatric symptoms were very frequently reported in patients with genetic FTD: anxiety and depression were most common in GRN carriers (23.8%-100% of patients) and MAPT carriers (26.1%-77.8% of patients); hallucinations, particularly auditory and visual, were most common in C9orf72 carriers (10.3%-54.5% of patients). Most behavioral and neuropsychiatric symptoms increased in the early-intermediate phases and plateaued in the late stages of disease, except for depression, which steadily declined in C9orf72 carriers, and depression and anxiety, which surged only in the late stages in GRN carriers.

CONCLUSIONS AND RELEVANCE

This cohort study suggests that behavioral and neuropsychiatric disturbances differ between the common FTD gene variants and have different trajectories throughout the course of disease. These findings have crucial implications for counseling patients and caregivers and for the design of disease-modifying treatment trials in genetic FTD.

Examining tensions in the past and present uses of concepts

Examining tensions between the past and present uses of scientific concepts can help clarify their contributions as tools in experimental practices. This point can be illustrated by considering the concepts of mental imagery and hallucinations: despite debates over their respective referential reliabilities remaining unresolved within their interdependent histories, both are used as independently stable concepts in neuroimaging experiments. Building on an account of how these concepts function as tools structured for pursuit of diverging goals in experiments, this paper explores this tension by re-examining the continued reliance of each concept on inverse characterisations inherited from the nominally-discarded 'mediator-view' of sensory-like mental phenomena (SLMP). In doing so, I seek to demonstrate how examining unresolved tensions can help highlight that entrenched associations can remain both integral to, and obscured by, the uses of concepts as goal-directed tools within experimental practices.

Modeling perception and behavior in individuals at clinical high risk for psychosis: Support for the predictive processing framework

Early intervention in psychotic spectrum disorders is critical for maximizing key clinical outcomes. While there is some evidence for the utility of intervention during the prodromal phase of the illness, efficacy of interventions is difficult to assess without appropriate risk stratification. This will require biomarkers that robustly help to identify risk level and are also relatively easy to obtain. Recent work highlights the utility of computer-based behavioral tasks for understanding the pathophysiology of psychotic symptoms. Computational modeling of performance on such tasks may be particularly useful because they explicitly and formally link performance and symptom expression. Several recent studies have successfully applied principles of Bayesian inference to understanding the computational underpinnings of hallucinations. Within this framework, hallucinations are seen as arising from an over-weighting of prior beliefs relative to sensory evidence. This view is supported by recently-published data from two tasks: the Conditioned Hallucinations (CH) task, which determines the degree to which participants use expectations in detecting a target tone; and a Sine-Vocoded Speech (SVS) task, in which participants can use prior exposure to speech samples to inform their understanding of degraded speech stimuli. We administered both of these tasks to two samples of participants at clinical high risk for psychosis (CHR; N = 19) and healthy controls (HC; N = 17). CHR participants reported both more conditioned hallucinations and more pre-training SVS detection. In addition, relationships were found between participants' performance on both tasks. On computational modeling of behavior on the CH task, CHR participants demonstrate significantly poorer recognition of task volatility as well as a trend toward higher weighting of priors. A relationship was found between this latter effect and performance on both tasks. Taken together, these results support the assertion that these two tasks may be driven by similar latent factors in perceptual inference, and highlight the potential utility of computationally-based tasks in identifying risk.

[Somatic reasons for acute psychiatric disorders in children and adolescents]

Psychotic symptoms such as hallucinations and delusions can be the result of a primary psychiatric disorder. However, they may also be the manifestation of various underlying somatic diseases. Rapid diagnosis and treatment are crucial to the outcome of the prognosis. A common evidence-based diagnostic approach during the initial phase has yet to be established, but a comprehensive medical evaluation may detect treatable causes. This review presents several potential diagnostic considerations for children and adolescents with psychotic symptoms based on novel systematic reviews and guidelines.