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Van Assche L, Takamiya A, Van den Stock J, Van de Ven L, Luyten P, Emsell L, Vandenbulcke M. A voxel- and source-based morphometry analysis of grey matter volume differences in very-late-onset schizophrenia-like psychosis. Psychol Med 2024; 54:592-600. [PMID: 37577955 DOI: 10.1017/s0033291723002258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Very-late-onset schizophrenia-like psychosis (VLOSLP) is associated with significant burden. Its clinical importance is increasing as the global population of older adults rises, yet owing to limited research in this population, the neurobiological underpinnings of VLOSP remain insufficiently clarified. Here we address this knowledge gap using novel morphometry techniques to investigate grey matter volume (GMV) differences between VLOSLP and healthy older adults, and their correlations with neuropsychological scores. METHODS In this cross-sectional study, we investigated whole-brain GMV differences between 35 individuals with VLOSLP (mean age 76.7, 26 female) and 36 healthy controls (mean age 75.7, 27 female) using whole-brain voxel-based morphometry (VBM) and supplementary source-based morphometry (SBM) on high resolution 3D T1-weighted MRI images. Additionally, we investigated relationships between GMV differences and cognitive function assessed with an extensive neuropsychological battery. RESULTS VBM showed lower GMV in the thalamus, left inferior frontal gyrus and left insula in patients with VLOSLP compared to healthy controls. SBM revealed lower thalamo-temporal GMV in patients with VLOSLP. Processing speed, selective attention, mental flexibility, working memory, verbal memory, semantic fluency and confrontation naming were impaired in patients with VLOSLP. Correlations between thalamic volumes and memory function were significant within the group of individuals with VLOSLP, whereas no significant associations remained in the healthy controls. CONCLUSIONS Lower GMV in the thalamus and fronto-temporal regions may be part of the underlying neurobiology of VLOSLP, with lower thalamic GMV contributing to memory impairment in the disorder.
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Affiliation(s)
- Lies Van Assche
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Akihiro Takamiya
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jan Van den Stock
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Luc Van de Ven
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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Affiliation(s)
- Isaac Kah Siang Ng
- NUHS Internal Medicine Residency Programme, Department of Medicine, National University Hospital, Singapore
| | - Joo Wei Chua
- Fast and Chronic Programme, Alexandra Hospital; Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
| | - Yit Shiang Lui
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Li Feng Tan
- Healthy Ageing Programme, Alexandra Hospital, Singapore
| | - Desmond Boon Seng Teo
- Fast and Chronic Programme, Alexandra Hospital; Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
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Catatonia associated with late-life psychosis successfully treated with lithium: a case report. Ann Gen Psychiatry 2021; 20:14. [PMID: 33602282 PMCID: PMC7893876 DOI: 10.1186/s12991-021-00336-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/07/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Catatonia is a psychomotor syndrome that presents various symptoms ranging from stupor to agitation, with prominent disturbances of volition. Its pathogenesis is poorly understood. Benzodiazepines and electroconvulsive therapy (ECT) are safe and effective standard treatments for catatonia; however, alternative treatment strategies have not been established in cases where these treatments are either ineffective or unavailable. Here, we report a case of catatonia associated with late-life psychosis, which was successfully treated with lithium. CASE PRESENTATION A 66-year-old single man with hearing impairment developed hallucination and delusions and presented with catatonic stupor after a fall. He initially responded to benzodiazepine therapy; however, his psychotic symptoms became clinically evident and benzodiazepine provided limited efficacy. Blonanserin was ineffective, and ECT was unavailable. His catatonic and psychotic symptoms were finally relieved by lithium monotherapy. CONCLUSIONS Catatonic symptoms are common in patients with mood disorders, suggesting that lithium may be effective in these cases. Moreover, lithium may be effective for both catatonic and psychotic symptoms, as it normalizes imbalances of excitatory and inhibitory systems in the brain, which underlies major psychosis. Cumulative evidence from further cases is needed to validate our findings.
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Kelley JL. Outline for a future psychiatry: the transcendent meaning model (TMM). Int Rev Psychiatry 2020; 32:555-564. [PMID: 31990233 DOI: 10.1080/09540261.2020.1713057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The now-dominant medical model of psychiatry has recently been challenged by the post-psychiatry movement. However, the former discounts the agential or subjective aspect of the human being; the latter misses the axiological aspect. A new model is proposed-the Transcendent Meaning Model (TMM)-that nests the individual person within the social (the interperson), and the social within the transcendent or ideological. The study concludes that TMM, with its integration of the personal, the social and the religious-ideological with the material, is a viable blueprint for a future psychiatry that can address some of the current model's vulnerabilities.
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Zöllner R, Hübener AF, Dannlowski U, Kircher T, Sommer J, Zavorotnyy M. Theta-Burst Stimulation for Auditory-Verbal Hallucination in Very-Late-Onset Schizophrenia-Like Psychosis-A Functional Magnetic Resonance Imaging Case Study. Front Psychiatry 2020; 11:294. [PMID: 32425822 PMCID: PMC7212466 DOI: 10.3389/fpsyt.2020.00294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/25/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Treating very-late-onset (>60 years) schizophrenia-like psychosis (VLOSLP) is challenging. Age-related factors in elderly individuals (e.g., metabolism, medication side effects, drug-interaction, somatic morbidity) may adversely affect treatment. Novel therapeutic approaches are needed to ensure the favorable therapeutic outcome in geriatric patients. Previously, theta-burst stimulation (TBS), a novel form of repetitive transcranial magnetic stimulation, was reported being beneficial in the treatment for auditory-verbal hallucination (AVH) in young and middle-aged schizophrenia (SZ) patients. CASE PRESENTATION Here we present a case of a male patient aged 73. His first psychotic episode manifested with paranoid delusions, auditory-verbal and tactile hallucinations at the age of 66, and first remitted following a second-generation antipsychotics (SGA). Years later, after a relapse the AVH did not respond to previously effective olanzapine, whereas its augmentation with an inhibitory TBS over the left temporal lobe led to a stable remission. During his second relapse, TBS was again capable of facilitating therapeutic action of SGA in the same patient. Extending to our clinical observation, a series of functional MRI scans employing a tonal activation paradigm depicted altered auditory processing during AVH as well as brain activation change during remission. CONCLUSIONS The current case might indicate to favorable effects of combining conventional medicament therapy and non-invasive brain stimulation techniques for elderly patients. Also, we speculate that despite obviously distinct etiologies, the present functional imaging and clinical observation may also demonstrate a possible common pathophysiological pathway underlying AVH in VLOSLP and SZ.
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Affiliation(s)
- Rebecca Zöllner
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior - MCMBB, University of Marburg, Marburg, Germany.,Health Protection Authority, Frankfurt am Main, Germany
| | - Anne-Friederike Hübener
- Department of Social Psychiatry, University of Applied Science Niederrhein, Krefeld, Germany
| | - Udo Dannlowski
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany.,Department of Psychiatry and Psychotherapy, University of Muenster, Muenster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Jens Sommer
- Marburg Center for Mind, Brain and Behavior - MCMBB, University of Marburg, Marburg, Germany.,Core-Unit Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Maxim Zavorotnyy
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany.,Marburg Center for Mind, Brain and Behavior - MCMBB, University of Marburg, Marburg, Germany.,Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Academic Hospital of the University of Zurich, Brugg, Switzerland
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Van Assche L, Morrens M, Luyten P, Van de Ven L, Vandenbulcke M. The neuropsychology and neurobiology of late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: A critical review. Neurosci Biobehav Rev 2017; 83:604-621. [DOI: 10.1016/j.neubiorev.2017.08.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 01/20/2023]
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Subbotskaya NV. [Acute paraphrenic states in the clinical presentation of attack-like schizophrenia]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:49-56. [PMID: 26978252 DOI: 10.17116/jnevro201511511249-56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study a psychopathological structure of the acute paraphrenic syndrome in different variants of schizophrenia course. MATERIAL AND METHODS Sixty patients were examined. RESULTS AND CONCLUSION Three variants of acute paraphrenic syndrome with the domination of sensitive delusions, Kandinsky-Clerambault's syndrome or confabulatory disorders were singled out. Acute paraphrenic syndrome with sensitive delusions was characteristic of recurrent schizophrenia. Slow-progressive attack-like schizophrenia was characterized by the acute paraphrenic syndrome with sensitive delusions in the combination with interpretative delusions. Juvenile malignant schizophrenia was characterized by the acute paraphrenic syndrome with the domination of Kandinsky-Clerambault's syndrome and sensitive delusions. Acute paraphrenic syndrome with the domination of Kandinsky-Clerambault's syndrome and acute paraphrenic syndrome with confabulatory disorders were identified in patients with paranoid attack-like schizophrenia similar to chronic schizophrenia. The nosologic specificity of the acute paraphrenic syndrome for attack-like schizophrenia was confirmed.
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