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Mendelsohn A, Sato T, Subedi A, Wurcel AG. State-of-the-Art Review: Evaluation and Management of Delusional Infestation. Clin Infect Dis 2024; 79:e1-e10. [PMID: 39039925 DOI: 10.1093/cid/ciae250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Indexed: 07/24/2024] Open
Abstract
Delusional infestation is a condition encountered frequently by healthcare professionals across a variety of specialties in which patients have a fixed, false belief that they are infested with living creatures, such as bugs, parasites, worms, or mites, or nonliving objects, such as fibers. Delusional infestation can be debilitating for patients, who not only present with intense psychological distress and physical discomfort but are also at risk of developing numerous dermatological and psychiatric complications. This condition poses unique diagnostic challenges, as these symptoms can occur secondary to many metabolic or infectious causes, as well as unique treatment challenges, with patients frequently refusing psychiatric care and consequently seeking evaluation by other healthcare professionals. In this review, we aim to use existing literature to provide clinicians in infectious diseases or other specialties with sufficient clinical context and treatment guidance for the appropriate management of delusional infestation.
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Affiliation(s)
- Alexandra Mendelsohn
- Tufts University School of Medicine, Infectious Diseases, Boston, Massachusetts, USA
| | - Taisuke Sato
- Tufts Medicine, Department of Infectious Diseases and Geographic Medicine, Boston, Massachusetts, USA
| | - Ankita Subedi
- Tufts Medicine, Department of Infectious Diseases and Geographic Medicine, Boston, Massachusetts, USA
| | - Alysse G Wurcel
- Tufts University School of Medicine, Infectious Diseases, Boston, Massachusetts, USA
- Tufts Medicine, Department of Infectious Diseases and Geographic Medicine, Boston, Massachusetts, USA
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2
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Arıkan MK, İlhan R, Ozulucan MT, Aşık M. qEEG in the Diagnosis and Prognosis of a Case with Delusional Infestation. Clin EEG Neurosci 2024; 55:214-218. [PMID: 36945781 DOI: 10.1177/15500594231163383] [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: 03/23/2023]
Abstract
Stroke can have neuropsychological consequences, such as poststroke psychosis. One aspect of poststroke psychosis is delusional infestation (DI), also known as delusional parasitosis. Patients with DI have fixed sensations that they get infested by lice. Some explanations of DI indicate that striatal and fronto-cortical structural and functional abnormalities are related to DI symptomatology. In this case report, we present a patient with DI due to right intracarotid artery occlusion, which is detected radiologically. Before treatment with escitalopram and risperidone, the case had a frontal slowing in quantitative electroencephalography activity, which was normalized after 2 weeks of treatment. At the end of treatment, psychotic symptoms and OCD symptoms evaluated by the Yale-Brown Obsessive Compulsive Scale, the Scale for the Assessment of Positive Symptoms, were remarkably reduced. These results revealed the role of brain imaging studies in the diagnosis and prognosis of DI.
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Affiliation(s)
| | - Reyhan İlhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | | | - Murat Aşık
- Istanbul Medeniyet University, Istanbul, Turkey
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3
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Miao A, Wang K. Contribution of cerebrospinal fluid antibody titers and sex to acute cerebral blood flow in patients with anti-NMDAR autoimmune encephalitis. Front Immunol 2024; 15:1299898. [PMID: 38495877 PMCID: PMC10940436 DOI: 10.3389/fimmu.2024.1299898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Objective The objective of this study was to elucidate the contribution of cerebrospinal fluid (CSF) antibody titers (AT) and sex to acute cerebral blood flow (CBF) in patients diagnosed with anti-N-methyl-d-aspartate receptor autoimmune encephalitis (NMDAR AE). Methods Forty-five patients diagnosed with NMDAR AE were recruited from December 2016 to January 2023. The acute CBF in patients with NMDAR AE at the early stage of the disease was analyzed using arterial spin labeling. The groups were compared based on CSF AT and sex. The connectivity of the CBF in the region of interest was also compared between groups. Results The patients with different CSF AT exhibited varied brain regions with CBF abnormalities compared to the healthy subjects (p = 0.001, cluster-level FWE corrected). High antibody titers (HAT) in CSF contributed to more brain regions with CBF alterations in female patients than in female patients with low antibody titers (LAT) in CSF (p = 0.001, cluster-level FWE corrected). Female patients with HAT in CSF displayed more decreased CBF in the left post cingulum gyrus, left precuneus, left calcarine, and left middle cingulum gyrus than the male patients with the same AT in CSF (p = 0.001, cluster-level FWE corrected). All patients with NMDAR AE showed increased CBF in the left putamen (Putamen_L) and left amygdala (Amygdala_L) and decreased CBF in the right precuneus (Precuneus_R), which suggests that these are diagnostic CBF markers for NMDAR AE. Conclusion CSF AT and sex contributed to CBF abnormalities in the patients diagnosed with NMDAR AE. Altered CBF might potentially serve as the diagnostic marker for NMDAR AE.
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Affiliation(s)
- Ailiang Miao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Jiangsu, Nanjing, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China
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4
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Mindru FM, Radu AF, Bumbu AG, Radu A, Bungau SG. Insights into the Medical Evaluation of Ekbom Syndrome: An Overview. Int J Mol Sci 2024; 25:2151. [PMID: 38396826 PMCID: PMC10889746 DOI: 10.3390/ijms25042151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/30/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric disorder distinguished by an enduring conviction of parasitic infestation, persisting notwithstanding the presence of medical evidence to the contrary. Primarily affecting middle-aged women, DP can manifest either as isolated psychological distress or as a component within a more intricate psychiatric framework, substantially influencing the quality of life for affected individuals. Its pathophysiological mechanism involves uncertain dopaminergic imbalances and dysfunction in the dopamine transporter system. Dermatologists often play a pivotal role in diagnosis, as patients first seek dermatological assessments of their signs and symptoms. However, DP frequently originates from underlying psychiatric disorders or medical variables, manifesting with neurological and infectious causative factors. The diagnostic complexity is attributed to patients' resolute convictions, leading to delayed psychiatric intervention. First-line DP treatment involves antipsychotics, with newer agents demonstrating promising prospects, but the lack of standardized protocols poses a significant therapeutic challenge. In this narrative review, both a comprehensive approach to this uncommon pathology and an update on the state of knowledge in this medical subfield focused on optimizing the management of DP are provided. The complexity of DP underlying its uncommon nature and the incomplete understanding of its pathophysiology highlight the need for further research through multicenter studies and multidisciplinary teams to enhance therapeutic efficacy and safety.
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Affiliation(s)
- Florina Madalina Mindru
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
| | - Andrei-Flavius Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Adrian Gheorghe Bumbu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Ada Radu
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
| | - Simona Gabriela Bungau
- Doctoral School of Biomedical Sciences, University of Oradea, 410087 Oradea, Romania; (F.M.M.); (A.R.); (S.G.B.)
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
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5
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Song W, Daneman L, Cohen-Oram A, Aradi S. A Case Series of Delusional Infestation in Huntington's Disease. J Huntingtons Dis 2024; 13:399-401. [PMID: 38905053 DOI: 10.3233/jhd-240013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
Huntington's disease (HD) is an autosomal dominant disorder that affects the basal ganglia, caused by CAG repeats in the huntingtin gene. Delusional infestation (DI) is a rare psychotic manifestation of the disease. This report presents two cases of HD patients with DI, both middle-aged females. The first patient achieved remission of DI with olanzapine, later cross-tapered to risperidone, but had spontaneous relapses. The second experienced gradual resolution of DI with risperidone in the setting of iron repletion and amantadine discontinuation, although her other psychotic symptoms remained. These cases shed light on an uncommon condition and may help guide understanding of the most effective treatment for it.
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Affiliation(s)
- Wenxin Song
- USF Health Morsani College of Medicine, Tampa, FL, USA
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6
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Messina A, Cuccì G, Crescimanno C, Signorelli MS. Clinical anatomy of the precuneus and pathogenesis of the schizophrenia. Anat Sci Int 2023:10.1007/s12565-023-00730-w. [PMID: 37340095 DOI: 10.1007/s12565-023-00730-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/12/2023] [Indexed: 06/22/2023]
Abstract
Recent evidence has shown that the precuneus plays a role in the pathogenesis of schizophrenia. The precuneus is a structure of the parietal lobe's medial and posterior cortex, representing a central hub involved in multimodal integration processes. Although neglected for several years, the precuneus is highly complex and crucial for multimodal integration. It has extensive connections with different cerebral areas and is an interface between external stimuli and internal representations. In human evolution, the precuneus has increased in size and complexity, allowing the development of higher cognitive functions, such as visual-spatial ability, mental imagery, episodic memory, and other tasks involved in emotional processing and mentalization. This paper reviews the functions of the precuneus and discusses them concerning the psychopathological aspects of schizophrenia. The different neuronal circuits, such as the default mode network (DMN), in which the precuneus is involved and its alterations in the structure (grey matter) and the disconnection of pathways (white matter) are described.
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Affiliation(s)
- Antonino Messina
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy.
| | | | | | - Maria Salvina Signorelli
- Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Catania, Catania, Italy
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7
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Ahmed A, Affleck AG, Angus J, Assalman I, Baron SE, Bewley A, Goulding JMR, Jerrom R, Lepping P, Mortimer H, Shah R, Taylor RE, Thompson AR, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of adults with delusional infestation 2022. Br J Dermatol 2022; 187:472-480. [PMID: 35582951 DOI: 10.1111/bjd.21668] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Alia Ahmed
- Frimley Health Foundation Trust, Windsor, SL4 3DP, UK.,Barts Health NHS Trust, London, E1 2ES, UK
| | | | - Janet Angus
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Avon, BS1 3NU, UK
| | - Iyas Assalman
- East London NHS Foundation Trust, London, E1 8DE, UK
| | - Susannah E Baron
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Anthony Bewley
- Barts Health NHS Trust, London, E1 2ES, UK.,Queen Mary University of London, London, E1 4NS, UK
| | | | - Richard Jerrom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Peter Lepping
- Wrexham Maelor Hospital Liaison Psychiatry, Betsi Cadwaladr University Health Board, Wrexham, LL13 7TD, UK
| | - Helen Mortimer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2GW, UK
| | - Reena Shah
- Central and North West London NHS Foundation Trust, London, NW1 3AX, UK
| | | | - Andrew R Thompson
- Cardiff and Vale University Health Board, Cardiff, CF14 4XW, UK.,Cardiff University, Cardiff, Wales, CF10 3AT, UK.,British Psychological Society, London, EC2A 4UE, UK
| | | | - Lina Manounah
- Willan House, British Association of Dermatologists, London, W1T 5HQ, UK
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8
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Zhang T, Xie X, Li Q, Zhang L, Chen Y, Ji GJ, Hou Q, Li T, Zhu C, Tian Y, Wang K. Hypogyrification in Generalized Anxiety Disorder and Associated with Insomnia Symptoms. Nat Sci Sleep 2022; 14:1009-1019. [PMID: 35642211 PMCID: PMC9148579 DOI: 10.2147/nss.s358763] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Insomnia is a recognized feature of generalized anxiety disorder (GAD). The underlying neural substrate of insomnia in GAD is still unclear. Cortical folding is a reliable index and possibly an endophenotype of psychiatric disease. The aim of this study was to explore whether the aberrant cortical morphology was associated with insomnia in GAD. PATIENTS AND METHODS We enrolled 73 patients with GAD and 74 matched healthy controls (HCs) to undergo neuropsychiatric assessment and 3.0 T magnetic resonance imaging scanning. Neuropsychiatric batteries included the 14-item Hamilton Anxiety Rating Scale (HAMA) and the Insomnia Severity Index (ISI). Using FreeSurfer7.1.1, we calculated local gyrification index, cortical thickness and surface area and identified group differences in these parameters. Then, we calculated the functional connectivity of these identified regions and determined functional alterations. The relationship between these neuroimaging indicators and clinical measurement was explored. RESULTS Compared with HCs, the LGI in the bilateral orbitofrontal cortex (OFC), bilateral insula, left middle frontal gyrus, left temporal pole, and left fusiform area was significantly decreased in GAD. GAD patients had concurrent decreased surface area in the left OFC and thicker right OFC. GAD patients also exhibited increased functional connectivity between the left insula and frontoparietal control network. In addition, a negative relationship was observed between decreased LGI in these limbic regions and ISI score. CONCLUSION GAD patients presented aberrant cortical folding in limbic network. Cortical morphology is a potential endophenotype in GAD, corresponding to an insomnia phenotype.
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Affiliation(s)
- Ting Zhang
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China
| | - Xiaohui Xie
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Qianqian Li
- Department of Psychiatry, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China
| | - Lei Zhang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Department of Psychiatry, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Yue Chen
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Gong-Jun Ji
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Qiangqiang Hou
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Tianxia Li
- Anhui Mental Health Center, Hefei, Anhui Province, People's Republic of China
| | - Chunyan Zhu
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Department of Psychiatry, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China
| | - Yanghua Tian
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Department of Neurology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China
| | - Kai Wang
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, Anhui Province, People's Republic of China.,Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, Anhui Province, People's Republic of China.,Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, People's Republic of China
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9
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Bachmann S, Beck M, Tsai DH, Haupt F. Neurological Soft Signs (NSS) in Census-Based, Decade-Adjusted Healthy Adults, 20 to >70 Years of Age. Front Psychiatry 2021; 12:670539. [PMID: 34248707 PMCID: PMC8264425 DOI: 10.3389/fpsyt.2021.670539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Neurological soft signs (NSS) represent minor neurological features and have been widely studied in psychiatric disease. The assessment is easily performed. Quantity and quality may provide useful information concerning the disease course. Mostly, NSS scores differ significantly between patients and controls. However, literature does not give reference values. In this pilot study, we recruited 120 healthy women and men to build a cross-sectional, census-based sample of healthy individuals, aged 20 to >70 years, subdivided in 10-year blocks for a close approach to the human lifeline. Testing for NSS and neurocognitive functioning was performed following the exclusion of mental and severe physical illness. NSS scores increased significantly between ages 50+ and 60+, which was primarily accountable to motor signs. Gender and cognitive functioning were not related to changes of scores. Although the number of individuals is small, study results may lay a foundation for further validation of NSS in healthy individuals.
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Affiliation(s)
- Silke Bachmann
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University Hospitals and Martin-Luther University, Halle, Germany
| | - Michaela Beck
- Geriatriezentrum Zwenkau, Sana Kliniken AG, Zwenkau, Germany
| | - Dai-Hua Tsai
- Swiss Centre for Occupational and Environmental Health (SCOEH), Winterthur, Switzerland
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10
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Wolf RC, Hildebrandt V, Schmitgen MM, Pycha R, Kirchler E, Macina C, Karner M, Hirjak D, Kubera KM, Romanov D, Freudenmann RW, Huber M. Aberrant Gray Matter Volume and Cortical Surface in Paranoid-Type Delusional Disorder. Neuropsychobiology 2021; 79:335-344. [PMID: 32160619 DOI: 10.1159/000505601] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 12/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are unclear. Recent research suggests that specific delusional content may be associated with distinct neural substrates. OBJECTIVE Here, we used structural magnetic resonance imaging to investigate multiple parameters of brain morphology in patients presenting with paranoid type delusional disorder (pt-DD, n = 14) compared to those of healthy controls (HC, n = 25). METHODS Voxel- and surface-based morphometry for structural data was used to investigate gray matter volume (GMV), cortical thickness (CT) and gyrification. RESULTS Compared to HC, patients with pt-DD showed reduced GMV in bilateral amygdala and right inferior frontal gyrus. Higher GMV in patients was found in bilateral orbitofrontal and in left superior frontal cortices. Patients also had lower CT in frontal and temporal regions. Abnormal gyrification in patients was evident in frontal and temporal areas, as well as in bilateral insula. CONCLUSIONS The data suggest the presence of aberrant GMV in a right prefrontal region associated with belief evaluation, as well as distinct structural abnormalities in areas that essentially subserve processing of fear, anxiety and threat in patients with pt-DD. It is possible that cortical features of distinct evolutionary and genetic origin, i.e. CT and gyrification, contribute differently to the pathogenesis of pt-DD.
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Affiliation(s)
- Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany,
| | - Viviane Hildebrandt
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Mike M Schmitgen
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Roger Pycha
- Department of Psychiatry, General Hospital Bruneck, Bruneck, Italy
| | - Erwin Kirchler
- Department of Psychiatry, General Hospital Bruneck, Bruneck, Italy
| | - Christian Macina
- Department of Psychiatry, General Hospital Bruneck, Bruneck, Italy
| | - Martin Karner
- Department of Radiology, General Hospital Bruneck, Bruneck, Italy
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Dmitry Romanov
- Department of Psychiatry and Psychosomatics, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | | | - Markus Huber
- Department of Psychiatry, General Hospital Bruneck, Bruneck, Italy
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11
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Colpo GD, Rocha NP, Furr Stimming E, Teixeira AL. Gene Expression Profiling in Huntington's Disease: Does Comorbidity with Depressive Symptoms Matter? Int J Mol Sci 2020; 21:E8474. [PMID: 33187165 PMCID: PMC7697115 DOI: 10.3390/ijms21228474] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022] Open
Abstract
Huntington's disease (HD) is an inherited neurodegenerative disease. Besides the well-characterized motor symptoms, HD is marked by cognitive impairment and behavioral changes. In this study, we analyzed the blood of HD gene carries using RNA-sequencing techniques. We evaluated samples from HD gene carriers with (n = 8) and without clinically meaningful depressive symptoms (n = 8) compared with healthy controls (n = 8). Groups were age- and sex-matched. Preprocessing of data and between-group comparisons were calculated using DESeq2. The Wald test was used to generate p-values and log2 fold changes. We found 60 genes differently expressed in HD and healthy controls, of which 21 were upregulated and 39 downregulated. Within HD group, nineteen genes were differently expressed between patients with and without depression, being 6 upregulated and 13 downregulated. Several of the top differentially expressed genes are involved in nervous system development. Although preliminary, our findings corroborate the emerging view that in addition to neurodegenerative mechanisms, HD has a neurodevelopmental component. Importantly, the emergence of depression in HD might be related to these mechanisms.
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Affiliation(s)
- Gabriela Delevati Colpo
- Neuropsychiatry Program, Louis A Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA;
| | - Natalia Pessoa Rocha
- HDSA Center of Excellence at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (N.P.R.); (E.F.S.)
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Erin Furr Stimming
- HDSA Center of Excellence at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (N.P.R.); (E.F.S.)
- Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Antonio Lucio Teixeira
- Neuropsychiatry Program, Louis A Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77054, USA;
- HDSA Center of Excellence at The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; (N.P.R.); (E.F.S.)
- Instituto de Ensino & Pesquisa, Santa Casa BH, Belo Horizonte 30150-221, Brazil
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12
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Kong L, Lv B, Wu T, Zhang J, Fan Y, Ouyang M, Huang H, Peng Y, Liu Y. Altered structural cerebral cortex in children with Tourette syndrome. Eur J Radiol 2020; 129:109119. [PMID: 32593075 DOI: 10.1016/j.ejrad.2020.109119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/24/2020] [Accepted: 06/04/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE In this study, we used magnetic resonance imaging (MRI) to investigate the anatomical alterations of cerebral cortex in children with Tourette syndrome (TS) and explore whether such deficits were related with their clinical symptoms. METHODS All subjects were scanned in a 3.0T MRI scanner with three-dimensional T1-weighted images (3DT1WI). Then, some surface-based features were extracted by using the FreeSurfer software. After that, the between-group differences of those features were assessed. RESULTS Sixty TS patients and 52 age- and gender-matched healthy control were included in this study. Surface-based analyses revealed altered cortical thickness, cortical sulcus, cortical curvature and local gyrification index (LGI) in TS group compared with healthy controls. The brain regions with significant-group differences in cortical thickness included postcentral gyrus, superiorparietal gyrus, rostral anterior cingulate cortex in the left hemisphere and frontal pole, lateral occipital gyrus, inferior temporal gyrus in the right hemisphere. In addition, the superior temporal gyrus, medial orbitofrontal gyrus, supramarginal gyrus, medial orbitofrontal gyrus, superiorparietal gyrus and lateral occipital gyrus showed significant between-group differences for cortical sulcus. Moreover, the brain regions with significant between-group differences in cortical curvature were located in caudal anterior cingulate cortex, supramarginal gyrus, inferior parietal gyrus and lateral occipital gyrus. The alteration of LGI were most prominent in the inferior temporal gyrus and insula. Additionally, there was no statistical difference in brain surface area for TS children compared with controls. CONCLUSION The results of this study revealed that cortical thickness, sulcus, cortical curvature and LGI were changed in multiple brain regions for children with TS.
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Affiliation(s)
- Lei Kong
- The Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China; The Department of Radiology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Bin Lv
- China Academy of Information and Communications Technology, Beijing, China; Ping An Technology (Shenzhen) Company Limited, Shenzhen, China
| | - Tongning Wu
- China Academy of Information and Communications Technology, Beijing, China
| | - Jishui Zhang
- The Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yang Fan
- Beijing Intelligent Brain Cloud Incorporated, Beijing, China
| | - Minhui Ouyang
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, United States
| | - Hao Huang
- Radiology Research, Children's Hospital of Philadelphia, Philadelphia, United States; The Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States
| | - Yun Peng
- The Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yue Liu
- The Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
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13
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Rohleder C, Koethe D, Fritze S, Topor CE, Leweke FM, Hirjak D. Neural correlates of binocular depth inversion illusion in antipsychotic-naïve first-episode schizophrenia patients. Eur Arch Psychiatry Clin Neurosci 2019; 269:897-910. [PMID: 29556734 DOI: 10.1007/s00406-018-0886-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 03/13/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Binocular depth inversion illusion (BDII), a visual, 'top-down'-driven information process, is impaired in schizophrenia and particularly in its early stages. BDII is a sensitive measure of impaired visual information processing and represents a valid diagnostic tool for schizophrenia and other psychotic disorders. However, neurobiological underpinnings of aberrant BDII in first-episode schizophrenia are largely unknown at present. METHODS In this study, 22 right-handed, first-episode, antipsychotic-naïve schizophrenia patients underwent BDII assessment and MRI scanning at 1.5 T. The surface-based analysis via new version of Freesurfer (6.0) enabled calculation of cortical thickness and surface area. BDII total and faces scores were related to the two distinct cortical measurements. RESULTS We found a significant correlation between BDII performance and cortical thickness in the inferior frontal gyrus and middle temporal gyrus (p < 0.003, Bonferroni corr.), as well as superior parietal gyrus, postcentral gyrus, supramarginal gyrus, and precentral gyrus (p < 0.05, CWP corr.), respectively. BDII performance was significantly correlated with surface area in the superior parietal gyrus and right postcentral gyrus (p < 0.003, Bonferroni corr.). CONCLUSION BDII performance may be linked to cortical thickness and surface area variations in regions involved in "adaptive" or "top-down" modulation and stimulus processing, i.e., frontal and parietal lobes. Our results suggest that cortical features of distinct evolutionary and genetic origin differently contribute to BDII performance in first-episode, antipsychotic-naïve schizophrenia patients.
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Affiliation(s)
- Cathrin Rohleder
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany.,Institute of Radiochemistry and Experimental Molecular Imaging, University Hospital of Cologne, Cologne, Germany
| | - Dagmar Koethe
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - Cristina E Topor
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany
| | - F Markus Leweke
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany.,Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany.
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14
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Katsoulis K, Rutledge KJ, Jafferany M. Delusional infestation: a prototype of psychodermatological disease. Int J Dermatol 2019; 59:551-560. [PMID: 31773724 DOI: 10.1111/ijd.14709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 08/09/2019] [Accepted: 10/19/2019] [Indexed: 01/10/2023]
Abstract
Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a typical grasp on reality with relatively normal cognitive functioning. Although classified as a somatic delusional disorder, DI requires special consideration due to its complicated clinical presentation, requiring attention to several possible explanations for the symptoms the patients describe. The purpose of the current review is to first summarize the clinical background and features of the diagnosis then explore treatment options. DI is a rare disorder though has reported cases dating back to the 19th century and spanning across the globe. Patients often experience the disorder as secondary to a medical condition, including substance use/withdrawal. However, there have also been many reported cases of primary DI, occurring in the absence of any other psychiatric or medical disorder. Clinically, DI is a diagnosis of exclusion, where the physician must rule out other medical conditions, including genuine dermatological disorders or infestations, or contributions from medications or substances. Patients with the disorder more commonly present to nonpsychiatric healthcare providers, making it essential for all clinicians to be able to identify the disease. Treatment can include either first or second generation antipsychotics, but it is important to proceed tactfully in discourse with the patient, being careful to address patients in a straightforward manner without reinforcing or questioning the delusion and focusing conversation on what can be done for the symptoms. Future research can continue to evaluate pathophysiology underlying primary DI, which historically has been an under-studied topic.
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15
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Hirjak D, Rashidi M, Fritze S, Bertolino AL, Geiger LS, Zang Z, Kubera KM, Schmitgen MM, Sambataro F, Calhoun VD, Weisbrod M, Tost H, Wolf RC. Patterns of co-altered brain structure and function underlying neurological soft signs in schizophrenia spectrum disorders. Hum Brain Mapp 2019; 40:5029-5041. [PMID: 31403239 DOI: 10.1002/hbm.24755] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 12/14/2022] Open
Abstract
Neurological soft signs (NSS) comprise a broad range of subtle neurological deficits and are considered to represent external markers of sensorimotor dysfunction frequently found in mental disorders of presumed neurodevelopmental origin. Although NSS frequently occur in schizophrenia spectrum disorders (SSD), specific patterns of co-altered brain structure and function underlying NSS in SSD have not been investigated so far. It is unclear whether gray matter volume (GMV) alterations or aberrant brain activity or a combination of both, are associated with NSS in SSD. Here, 37 right-handed SSD patients and 37 matched healthy controls underwent motor assessment and magnetic resonance imaging (MRI) at 3 T. NSS were examined on the Heidelberg NSS scale. We used a multivariate data fusion technique for multimodal MRI data-multiset canonical correlation and joint independent component analysis (mCCA + jICA)-to investigate co-altered patterns of GMV and intrinsic neural fluctuations (INF) in SSD patients exhibiting NSS. The mCCA + jICA model indicated two joint group-discriminating components (temporoparietal/cortical sensorimotor and frontocerebellar/frontoparietal networks) and one modality-specific group-discriminating component (p < .05, FDR corrected). NSS motor score was associated with joint frontocerebellar/frontoparietal networks in SSD patients. This study highlights complex neural pathomechanisms underlying NSS in SSD suggesting aberrant structure and function, predominantly in cortical and cerebellar systems that critically subserve sensorimotor dynamics and psychomotor organization.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Mahmoud Rashidi
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alina L Bertolino
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lena S Geiger
- Department of Psychiatry and Psychotherapy, Research Group Systems Neuroscience in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Zhenxiang Zang
- Department of Psychiatry and Psychotherapy, Research Group Systems Neuroscience in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Mike M Schmitgen
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
| | - Vince D Calhoun
- The Mind Research Network, Albuquerque, New Mexico.,Department of Electrical and Computer Engineering, The University of New Mexico, Albuquerque, New Mexico.,Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, Georgia
| | - Matthias Weisbrod
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany.,Department of Adult Psychiatry, SRH-Klinikum, Karlsbad-Langensteinbach, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Research Group Systems Neuroscience in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
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16
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Schmitgen MM, Depping MS, Bach C, Wolf ND, Kubera KM, Vasic N, Hirjak D, Sambataro F, Wolf RC. Aberrant cortical neurodevelopment in major depressive disorder. J Affect Disord 2019; 243:340-347. [PMID: 30261449 DOI: 10.1016/j.jad.2018.09.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is strong neuroimaging evidence that cortical alterations represent a core pathophysiological feature of major depressive disorder (MDD). Differential contributions of cortical features of neurodevelopmental origin, which may distinctly contribute to MDD vulnerability, disease-onset, or symptom expression, are unclear at present. METHODS We investigated distinct markers of cortical neurodevelopment, i.e. local cortical gyrification (LGI) and thickness (CT) in patients with MDD (n = 38) and healthy controls (HC, n = 22) using 3 T structural magnetic resonance imaging data and surface-based data analysis techniques. CT and LGI were computed using the Computational Anatomy Toolbox (CAT12). Analyses were performed for the entire cortical surface followed by a complementary regions-of-interest approach. RESULTS MDD patients showed significantly greater LGI in frontal, cingulate, parietal, temporal, and occipital regions compared to HC (FDR-corrected at p < 0.05 using threshold-free cluster enhancement). No significant differences of CT were found. In the MDD-group, correlations were found between duration of illness in years and number of depressive episodes and LGI of frontal, temporal, and parietal regions (p < 0.05). LIMITATIONS Main limitations are the relatively modest sample size and a cross-sectional study design. We did not control for early environmental factors potentially influencing neurodevelopment, such as childhood trauma. We report associations uncorrected for multiple comparisons. CONCLUSIONS The data suggest different local trajectories of cortical change in MDD. In addition, our data support the notion that aberrant cortical development may serve as a vulnerability marker of MDD, as well as a potential predictor of disease course.
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Affiliation(s)
- Mike M Schmitgen
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Malte S Depping
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Claudia Bach
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Nadine D Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Katharina M Kubera
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany
| | - Nenad Vasic
- Department of Psychiatry and Psychotherapy, Clinical Center Christophsbad, Göppingen, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany
| | - Fabio Sambataro
- Department of Experimental and Clinical Medical Sciences (DISM), University of Udine, Italy
| | - Robert C Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Vosstrasse 4, 69115 Heidelberg, Germany.
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17
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Lai J, Xu Z, Xu Y, Hu S. Reframing delusional infestation: perspectives on unresolved puzzles. Psychol Res Behav Manag 2018; 11:425-432. [PMID: 30319296 PMCID: PMC6171510 DOI: 10.2147/prbm.s166720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Delusional infestation (DI), a debilitating psychocutaneous condition, featured as a false fixed belief of being infested accompanied by somatosensory abnormality, behavior alteration, and cognitive impairment. Although management of primary causes and pharmacotherapy with antipsychotics and/or antidepressants can help to alleviate symptoms in most patients, the underlying etiology of DI still remains unclear. Morgellons disease (MD), characterized by the presence of cutaneous filaments projected from or embedded in skin, is also a polemic issue because of its relationship with spirochetal infection. This review aims to discuss the following topics that currently confuse our understandings of DI: 1) the relationship of real/sham “infestation” with DI/MD; 2) behavior alterations, such as self-inflicted trauma; 3) neuroimaging abnormality and disturbance in neurotransmitter systems; and 4) impaired insight in patients with this disease. In discussion, we try to propose a multifactorial approach to the final diagnosis of DI/MD. Future studies exploring the neurobiological etiology of DI/MD are warranted.
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Affiliation(s)
- Jianbo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China, .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou 310003, China, .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China,
| | - Zhe Xu
- Zhejiang University School of Medicine, Hangzhou 310003, China.,Department of Psychiatry, Third People's Hospital of Huzhou, Hangzhou 313000, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China, .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou 310003, China, .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China,
| | - Shaohua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China, .,The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou 310003, China, .,Brain Research Institute of Zhejiang University, Hangzhou 310003, China,
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18
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Hirjak D, Kubera KM, Thomann PA, Wolf RC. Motor dysfunction as an intermediate phenotype across schizophrenia and other psychotic disorders: Progress and perspectives. Schizophr Res 2018; 200:26-34. [PMID: 29074330 DOI: 10.1016/j.schres.2017.10.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/02/2017] [Accepted: 10/06/2017] [Indexed: 02/07/2023]
Abstract
Primary motor abnormalities (PMA), as found in patients with schizophrenia, are quantitatively and qualitatively distinct markers of motor system abnormalities. PMA have been often referred to phenomena that are present across schizophrenia-spectrum disorders. A dysfunction of frontoparietal and subcortical networks has been proposed as core pathophysiological mechanism underlying the expression of PMA. However, it is unclear at present if such mechanisms are a common within schizophrenia and other psychotic disorders. To address this question, we review recent neuroimaging studies investigating the neural substrates of PMA in schizophrenia and so-called "nonschizophrenic nonaffective psychoses" (NSNAP) such as schizophreniform, schizoaffective, brief psychotic, and other unspecified psychotic disorders. Although the extant data in patients with schizophrenia suggests that further investigation is warranted, MRI findings in NSNAP are less persuasive. It is unclear so far which PMA, if any, are characteristic features of NSNAP or, possibly even specific for these disorders. Preliminary data suggest a relationship between relapsing-remitting PMA in hyper-/hypokinetic cycloid syndromes and neurodegenerative disorders of the basal ganglia, likely reflecting the transnosological relevance of subcortical abnormalities. Despite this evidence, neural substrates and mechanisms underlying PMA that are common in schizophrenia and NSNAP cannot be clearly delineated at this stage of research. PMA and their underlying brain circuits could be promising intermediate phenotype candidates for psychotic disorders, but future multimodal neuroimaging studies in schizophrenia and NSNAP patients and their unaffected first-degree relatives are needed to answer fundamental transnosologic questions.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University Mannheim, Germany.
| | - Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
| | - Philipp A Thomann
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany; Center for Mental Health, Odenwald District Healthcare Center, Erbach, Germany
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Germany
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19
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Middelveen MJ, Fesler MC, Stricker RB. History of Morgellons disease: from delusion to definition. Clin Cosmet Investig Dermatol 2018; 11:71-90. [PMID: 29467580 PMCID: PMC5811176 DOI: 10.2147/ccid.s152343] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. Further studies of the genetics, pathogenesis, and treatment of MD are warranted.
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20
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Hefter D, Marti HH, Gass P, Inta D. Perinatal Hypoxia and Ischemia in Animal Models of Schizophrenia. Front Psychiatry 2018; 9:106. [PMID: 29651259 PMCID: PMC5884869 DOI: 10.3389/fpsyt.2018.00106] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 03/16/2018] [Indexed: 12/12/2022] Open
Abstract
Intrauterine or perinatal complications constitute a major risk for psychiatric diseases. Infants who suffered from hypoxia-ischemia (HI) are at twofold risk to develop schizophrenia in later life. Several animal models attempt to reproduce these complications to study the yet unknown steps between an insult in early life and outbreak of the disease decades later. However, it is very challenging to find the right type and severity of insult leading to a disease-like phenotype in the animal, but not causing necrosis and focal neurological deficits. By contrast, too mild, repetitive insults may even be protective via conditioning effects. Thus, it is not surprising that animal models of hypoxia lead to mixed results. To achieve clinically translatable findings, better protocols are urgently needed. Therefore, we compare widely used models of hypoxia and HI and propose future directions for the field.
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Affiliation(s)
- Dimitri Hefter
- RG Animal Models in Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany.,RG Neuro- and Sensory Physiology, Institute of Physiology and Pathophysiology, University of Heidelberg, Heidelberg, Germany
| | - Hugo H Marti
- RG Neurovascular Research, Institute of Physiology and Pathophysiology, University of Heidelberg, Heidelberg, Germany
| | - Peter Gass
- RG Animal Models in Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany
| | - Dragos Inta
- RG Animal Models in Psychiatry, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany.,Department of Psychiatry, University of Basel, Basel, Switzerland
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21
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Wang Q, Guo L, Thompson PM, Jack CR, Dodge H, Zhan L, Zhou J. The Added Value of Diffusion-Weighted MRI-Derived Structural Connectome in Evaluating Mild Cognitive Impairment: A Multi-Cohort Validation1. J Alzheimers Dis 2018; 64:149-169. [PMID: 29865049 PMCID: PMC6272125 DOI: 10.3233/jad-171048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
T1-weighted MRI has been extensively used to extract imaging biomarkers and build classification models for differentiating Alzheimer's disease (AD) patients from healthy controls, but only recently have brain connectome networks derived from diffusion-weighted MRI been used to model AD progression and various stages of disease such as mild cognitive impairment (MCI). MCI, as a possible prodromal stage of AD, has gained intense interest recently, since it may be used to assess risk factors for AD. Little work has been done to combine information from both white matter and gray matter, and it is unknown how much classification power the diffusion-weighted MRI-derived structural connectome could provide beyond information available from T1-weighted MRI. In this paper, we focused on investigating whether diffusion-weighted MRI-derived structural connectome can improve differentiating healthy controls subjects from those with MCI. Specifically, we proposed a novel feature-ranking method to build classification models using the most highly ranked feature variables to classify MCI with healthy controls. We verified our method on two independent cohorts including the second stage of Alzheimer's Disease Neuroimaging Initiative (ADNI2) database and the National Alzheimer's Coordinating Center (NACC) database. Our results indicated that 1) diffusion-weighted MRI-derived structural connectome can complement T1-weighted MRI in the classification task; 2) the feature-rank method is effective because of the identified consistent T1-weighted MRI and network feature variables on ADNI2 and NACC. Furthermore, by comparing the top-ranked feature variables from ADNI2, NACC, and combined dataset, we concluded that cross-validation using independent cohorts is necessary and highly recommended.
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Affiliation(s)
- Qi Wang
- Computer Science and Engineering, Michigan State University, East Lansing, MI
| | - Lei Guo
- Mathematics, Statistics & Computer Science Department, University of Wisconsin-Stout, Menomonie, WI
| | - Paul M. Thompson
- Imaging Genetics Center, University of Southern California, Marina del Rey, CA
| | | | - Hiroko Dodge
- Michigan Alzheimer's Disease Center and Department of Neurology, University of Michigan, Ann Arbor, MI
- Layton Aging and Alzheimer's Disease Center and Department of Neurology, Oregon Health & Science University, Portland, OR
| | - Liang Zhan
- Computer Engineering Program, University of Wisconsin-Stout, Menomonie, WI
| | - Jiayu Zhou
- Computer Science and Engineering, Michigan State University, East Lansing, MI
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22
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Gao S, Lu S, Shi X, Ming Y, Xiao C, Sun J, Yao H, Xu X. Distinguishing Between Treatment-Resistant and Non-Treatment-Resistant Schizophrenia Using Regional Homogeneity. Front Psychiatry 2018; 9:282. [PMID: 30127752 PMCID: PMC6088138 DOI: 10.3389/fpsyt.2018.00282] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/11/2018] [Indexed: 12/16/2022] Open
Abstract
Background: Patients with treatment-resistant schizophrenia (TRS) and non-treatment-resistant schizophrenia (NTRS) respond to antipsychotic drugs differently. Previous studies demonstrated that patients with TRS or NTRS exhibited abnormal neural activity in different brain regions. Accordingly, in the present study, we tested the hypothesis that a regional homogeneity (ReHo) approach could be used to distinguish between patients with TRS and NTRS. Methods: A total of 17 patients with TRS, 17 patients with NTRS, and 29 healthy controls (HCs) matched in sex, age, and education levels were recruited to undergo resting-state functional magnetic resonance imaging (RS-fMRI). ReHo was used to process the data. ANCOVA followed by post-hoc t-tests, receiver operating characteristic curves (ROC), and correlation analyses were applied for the data analysis. Results: ANCOVA analysis revealed widespread differences in ReHo among the three groups in the occipital, frontal, temporal, and parietal lobes. ROC results indicated that the optimal sensitivity and specificity of the ReHo values in the left postcentral gyrus, left inferior frontal gyrus/triangular part, and right fusiform could differentiate TRS from NTRS, TRS from HCs, and NTRS from HCs were 94.12 and 82.35%, 100 and 86.21%, and 82.35 and 93.10%, respectively. No correlation was found between abnormal ReHo and clinical symptoms in patients with TRS or NTRS. Conclusions: TRS and NTRS shared most brain regions with abnormal neural activity. Abnormal ReHo values in certain brain regions might be applied to differentiate TRS from NTRS, TRS from HC, and NTRS from HC with high sensitivity and specificity.
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Affiliation(s)
- Shuzhan Gao
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
| | - Shuiping Lu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xiaomeng Shi
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
| | - Yidan Ming
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
| | - Chaoyong Xiao
- Department of Radiology, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Sun
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
| | - Hui Yao
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
| | - Xijia Xu
- Department of Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China.,Department of Psychiatry, Nanjing Brain Hospital, Medical School, Nanjing University, Nanjing, China
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23
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Zhan L, Jenkins LM, Zhang A, Conte G, Forbes A, Harvey D, Angkustsiri K, Goodrich‐Hunsaker NJ, Durdle C, Lee A, Schumann C, Carmichael O, Kalish K, Leow AD, Simon TJ. Baseline connectome modular abnormalities in the childhood phase of a longitudinal study on individuals with chromosome 22q11.2 deletion syndrome. Hum Brain Mapp 2018; 39:232-248. [PMID: 28990258 PMCID: PMC5757536 DOI: 10.1002/hbm.23838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/09/2023] Open
Abstract
Occurring in at least 1 in 3,000 live births, chromosome 22q11.2 deletion syndrome (22q11DS) produces a complex phenotype that includes a constellation of medical complications such as congenital cardiac defects, immune deficiency, velopharyngeal dysfunction, and characteristic facial dysmorphic features. There is also an increased incidence of psychiatric diagnosis, especially intellectual disability and ADHD in childhood, lifelong anxiety, and a strikingly high rate of schizophrenia spectrum disorders, which occur in around 30% of adults with 22q11DS. Using innovative computational connectomics, we studied how 22q11DS affects high-level network signatures of hierarchical modularity and its intrinsic geometry in 55 children with confirmed 22q11DS and 27 Typically Developing (TD) children. Results identified 3 subgroups within our 22q11DS sample using a K-means clustering approach based on several midline structural measures-of-interests. Each subgroup exhibited distinct patterns of connectome abnormalities. Subtype 1, containing individuals with generally healthy-looking brains, exhibited no significant differences in either modularity or intrinsic geometry when compared with TD. By contrast, the more anomalous 22q11DS Subtypes 2 and 3 brains revealed significant modular differences in the right hemisphere, while Subtype 3 (the most anomalous anatomy) further exhibited significantly abnormal connectome intrinsic geometry in the form of left-right temporal disintegration. Taken together, our findings supported an overall picture of (a) anterior-posteriorly differential interlobar frontotemporal/frontoparietal dysconnectivity in Subtypes 2 and 3 and (b) differential intralobar dysconnectivity in Subtype 3. Our ongoing studies are focusing on whether these subtypes and their connnectome signatures might be valid biomarkers for predicting the degree of psychosis-proneness risk found in 22q11DS. Hum Brain Mapp 39:232-248, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Liang Zhan
- Computer Engineering ProgramUniversity of Wisconsin‐StoutWisconsin
| | | | - Aifeng Zhang
- Department of PsychiatryUniversity of IllinoisChicagoIllinois
| | - Giorgio Conte
- Department of Computer ScienceUniversity of IllinoisChicagoIllinois
| | - Angus Forbes
- Department of Computer ScienceUniversity of IllinoisChicagoIllinois
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, School of MedicineUniversity of CaliforniaDavisCalifornia
| | | | - Naomi J. Goodrich‐Hunsaker
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
- Department of PsychologyBrigham Young UniversityProvoUtah
| | - Courtney Durdle
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
| | - Aaron Lee
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
| | - Cyndi Schumann
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
| | - Owen Carmichael
- Pennington Biomedical Research Center, Louisiana State UniversityBaton RougeLouisiana
| | | | - Alex D. Leow
- Department of PsychiatryUniversity of IllinoisChicagoIllinois
- Department of BioengineeringUniversity of IllinoisChicagoIllinois
| | - Tony J. Simon
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
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24
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Trenton A, Pansare N, Tobia A, Bisen V, Kaufman KR. Delusional parasitosis on the psychiatric consultation service - a longitudinal perspective: case study. BJPsych Open 2017; 3:154-158. [PMID: 28630746 PMCID: PMC5465424 DOI: 10.1192/bjpo.bp.116.004358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 04/15/2017] [Accepted: 05/03/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Delusional parasitosis is infrequently seen in hospital-based consultation-liaison psychiatry. AIMS Although there are many publications on delusional parasitosis, this report reviews a unique case that was diagnosed during a hospital admission and treated over the next 36 months. METHOD Case report and literature review. RESULTS This case report describes a 65-year-old man who was diagnosed with delusional parasitosis during a hospital admission for congestive heart failure and acute kidney injury. A longitudinal description of the patient's condition during the hospital stay and in the 36 months following discharge, during which time he was treated by a consultation psychiatrist, is provided. CONCLUSIONS In discussing the treatment of a challenging presentation, this case demonstrates the opportunity for consultation psychiatrists to initiate care in patients who might not otherwise seek psychiatric services. Patients with somatic delusions represent one group of patients who are unlikely to independently seek psychiatric treatment. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
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Affiliation(s)
- Adam Trenton
- , DO, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Neha Pansare
- , MD, MPH, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Anthony Tobia
- , MD, Departments of Psychiatry and Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Viwek Bisen
- , DO, Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Kenneth R Kaufman
- , MD, FRCPsych, Departments of Psychiatry, Neurology, and Anaesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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