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Rittmannsberger H, Barth M, Lamprecht B, Malik P, Yazdi-Zorn K. [Interaction of somatic findings and psychiatric symptoms in COVID-19. A scoping review]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2024; 38:1-23. [PMID: 38055146 DOI: 10.1007/s40211-023-00487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
An infection with SARS-CoV‑2 can affect the central nervous system, leading to neurological as well as psychiatric symptoms. In this respect, mechanisms of inflammation seem to be of much greater importance than the virus itself. This paper deals with the possible contributions of organic changes to psychiatric symptomatology and deals especially with delirium, cognitive symptoms, depression, anxiety, posttraumatic stress disorder and psychosis. Processes of neuroinflammation with infection of capillary endothelial cells and activation of microglia and astrocytes releasing high amounts of cytokines seem to be of key importance in all kinds of disturbances. They can lead to damage in grey and white matter, impairment of cerebral metabolism and loss of connectivity. Such neuroimmunological processes have been described as a organic basis for many psychiatric disorders, as affective disorders, psychoses and dementia. As the activation of the glia cells can persist for a long time after the offending agent has been cleared, this can contribute to long term sequalae of the infection.
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Affiliation(s)
- Hans Rittmannsberger
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich.
| | - Martin Barth
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Bernd Lamprecht
- Med Campus III, Universitätsklinik für Innere Medizin mit Schwerpunkt Pneumologie, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
| | - Peter Malik
- Abteilung Psychiatrie und psychotherapeutische Medizin, Pyhrn-Eisenwurzen Klinikum Steyr, Steyr, Österreich
| | - Kurosch Yazdi-Zorn
- Neuromed Campus, Klinik für Psychiatrie mit Schwerpunkt Suchtmedizin, Kepler Universitätsklinikum GmbH, Linz, Österreich
- Medizinische Fakultät, Johannes Kepler Universität Linz, Linz, Österreich
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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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Fayyaz S, Nkire N, Nwosu B, Amjad N, Kinsella A, Gill M, McDonough C, Russell V, Waddington JL. Carepath for overcoming psychosis early (COPE): first 5 years of clinical operation and prospective research in the Cavan-Monaghan early intervention service. Ir J Psychol Med 2024; 41:23-36. [PMID: 34353408 DOI: 10.1017/ipm.2021.54] [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: 11/05/2022]
Abstract
OBJECTIVES As Ireland confronts the many challenges of broadening the introduction of early intervention services (EIS) for first episode psychosis (FEP) as national policy, this article describes Carepath for Overcoming Psychosis Early (COPE), the EIS of Cavan-Monaghan Mental Health Service, and presents prospective research findings during its first 5 years of operation. METHODS COPE was launched as a rural EIS with an embedded research protocol in early 2012, following an education programme for general practitioners (GPs). Here, operational activities are documented and research findings presented through to late 2016. RESULTS During this period, 115 instances of FEP were incepted into COPE, 70.4% via their GP and 29.6% via the Emergency Department. The annual rate of inception was 24.8/100,000 of population aged > 15 years and was 2.1-fold more common among men than women. Mean duration of untreated psychosis was 5.7 months and median time from first psychotic presentation to initiation of antipsychotic treatment was zero days. Assessments of psychopathology, neuropsychology, neurology, premorbid functioning, quality of life, insight, and functionality compared across 10 DSM-IV psychotic diagnoses made at six months following presentation indicated minimal differences between them, other than more prominent negative symptoms in schizophrenia and more prominent mania in bipolar disorder. CONCLUSIONS COPE illustrates the actuality of introducing and the challenges of operating a rural EIS for FEP. Prospective follow-up studies of the 5-year COPE cohort should inform on the effectiveness of this EIS model in relation to long-term outcome in psychotic illness across what appear to be arbitrary diagnostic boundaries at FEP.
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Affiliation(s)
- S Fayyaz
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - N Nkire
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - B Nwosu
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - N Amjad
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
| | - A Kinsella
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Gill
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - C McDonough
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Louth Mental Health Service, St. Brigid's Hospital, Ardee, Ireland
| | - V Russell
- Cavan-Monaghan Mental Health Service, Drumalee Primary Care Centre, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - J L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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Qi W, Wen Z, Chen J, Capichioni G, Ando F, Chen ZS, Wang J, Yoncheva Y, Castellanos FX, Milad M, Goff DC. Aberrant resting-state functional connectivity of the globus pallidus interna in first-episode schizophrenia. Schizophr Res 2023; 261:100-106. [PMID: 37716202 DOI: 10.1016/j.schres.2023.09.018] [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] [Received: 11/18/2022] [Revised: 04/05/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND The striatal-pallidal pathway plays an important role in cognitive control and modulation of behaviors. Globus pallidus interna (GPi), as a primary output structure, is crucial in modulating excitation and inhibition. Studies of GPi in psychiatric illnesses are lacking given the technical challenges of examining this small and functionally diverse subcortical structure. METHODS 71 medication-naïve first episode schizophrenia (FES) participants and 73 healthy controls (HC) were recruited at the Shanghai Mental Health Center. Clinical symptoms and imaging data were collected at baseline and, in a subset of patients, 8 weeks after initiating treatment. Resting-state functional connectivity of sub-regions of the GP were assessed using a novel mask that combines two atlases to create 8 ROIs in the GP. RESULTS Baseline imaging data from 63 FES patients and 55 HC met quality standards and were analyzed. FES patients exhibited less negative connectivity and increased positive connectivity between the right anterior GPi and several cortical and subcortical areas at baseline compared to HC (PFWE < 0.05). Positive functional connectivity between the right anterior GPi and several brain areas, including the right dorsal anterior cingulate gyrus, was associated with severity of positive symptoms (PFWE < 0.05) and predicted treatment response after 8 weeks (n = 28, adjusted R2 = 0.486, p < 0.001). CONCLUSIONS Our results implicate striatal-pallidal-thalamic pathways in antipsychotic efficacy. If replicated, these findings may reflect failure of neurodevelopmental processes in adolescence and early adulthood that decrease functional connectivity as an index of failure of the limbic/associative GPi to appropriately inhibit irrelevant signals in psychosis.
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Affiliation(s)
- Wei Qi
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Zhenfu Wen
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Jingyun Chen
- Clinical Consult Department, Icometrix, Boston, MA, United States of America
| | - Gillian Capichioni
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Fumika Ando
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Zhe Sage Chen
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America; Department of Biomedical Engineering, NYU Tandon School of Engineering, Brooklyn, NY, United States of America
| | - Jijun Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yuliya Yoncheva
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Francisco X Castellanos
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America; Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Mohammed Milad
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America
| | - Donald C Goff
- Psychiatry Department, NYU Grossman School of Medicine, New York, NY, United States of America; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, United States of America.
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Williams T, Rollings-Mazza P. Understanding psychosis. Nursing 2023; 53:22-28. [PMID: 37734014 DOI: 10.1097/01.nurse.0000977564.10896.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT Psychotic behavior is often unpredictable; thus, there can be an increased risk of violence toward others and oneself. This article details the etiology and diagnosis of psychosis and nursing interventions to provide appropriate care.
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Affiliation(s)
- Tommy Williams
- Tommy Williams is a clinical research and informatics nurse and Pamela Rollings-Mazza is the chief medical officer of PrimeCare Medical, Inc
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Balcerac A, Baldacci A, Romier A, Annette S, Lemarchand B, Bihan K, Bottemanne H. Drug-induced delusion: A comprehensive overview of the WHO pharmacovigilance database. Psychiatry Res 2023; 327:115365. [PMID: 37517106 DOI: 10.1016/j.psychres.2023.115365] [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] [Received: 03/28/2023] [Revised: 07/08/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023]
Abstract
INTRODUCTION A number of prescribed medicines have been reported in cases of drug-induced delusion, such as dopaminergic agents or psychostimulants. But to this day, most studies are based on a limited number of cases and focus on a few drug classes, so a clear overview of this topic remains difficult. To address this issue, we provide in this article a comprehensive analysis of drug-induced delusion, based on the World Health Organization (WHO) pharmacovigilance database. METHODS We performed a disproportionality analysis of this database using the information component (IC). The IC compares observed and expected values to find associations between drugs and delusion, using disproportionate Bayesian reporting. An IC0.25 (lower end of the IC 95% credibility interval) > 0 is considered statistically significant. RESULTS Here we present an analysis of 4559 suspected drug-induced delusion reports in the WHO pharmacovigilance database. These results identified 66 molecules statistically associated with delusion and an extensive analysis of confounding factors and coprescriptions was performed, using full database as background with an IC0.25 > 0. The main drug classes involved were antidepressants, antiepileptics, dopaminergic agents, opioids, antiinfective agents, benzodiazepines, anti-dementia drugs and psychostimulants. CONCLUSION These results will help clinicians identify potential suspected drugs associated with delusion and decide which drug to discontinue and eventually lead to a re-evaluation of drug labels for some molecules.
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Affiliation(s)
- Alexander Balcerac
- Neurology Unit, HIA Percy Hospital, 101 Avenue Henri Barbusse, BP 406, 92141 Clamart; Department of Neurology, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, AP-HP, Paris, France.
| | - Antoine Baldacci
- Psychiatry Unit, HIA Begin Hospital, 69 Avenue de Paris, 94160 Saint-Mandé
| | - Alix Romier
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, AP-HP, Paris, France
| | - Sophie Annette
- Psychiatry Unit, HIA Percy Hospital, 101 Avenue Henri Barbusse, BP 406, 92141 Clamart
| | - Baptiste Lemarchand
- Department of Pharmacology, Pitié-Salpêtrière Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Kevin Bihan
- Department of Pharmacology, Pitié-Salpêtrière Hospital, Sorbonne Université, AP-HP, Paris, France
| | - Hugo Bottemanne
- Department of Psychiatry, Pitié-Salpêtrière Hospital, DMU Neuroscience, Sorbonne University, AP-HP, Paris, France; Paris Brain Institute - Institut du Cerveau (ICM), INSERM, CNRS, Sorbonne University, Paris, France; Department of Philosophy, Sorbonne University, SND Research Unit, UMR 8011, CNRS, Paris, France
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Corredor-Orlandelli D, Valenzuela-Vallejo L, Aguirre-Ruiz JF, Valenzuela Rincon A. Ectopic parathyroid adenoma causing hyperparathyroidism-induced psychosis: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231180752. [PMID: 37434899 PMCID: PMC10331202 DOI: 10.1177/2050313x231180752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/22/2023] [Indexed: 07/13/2023] Open
Abstract
Primary hyperparathyroidism is a disease with multisystemic and heterogeneous manifestations, characterized by underlying high parathormone concentrations. Despite neuropsychiatric involvement being one of the manifestations, psychosis is rare. This is the case of a 68-year-old female with a 10-day clinical course of anorexia, mutism, dysphagia, constipation, and weight loss. The patient had disorganized speech associated with paranoid delusions. Prior to this visit, the patient was recently diagnosed with a mixed anxiety-depressive disorder. For this reason, treatment with antidepressants in combination with atypical antipsychotics was administered without a satisfactory response. Neuroimaging, infectious panel, and toxicology screening showed no abnormal findings. Hypercalcemia secondary to a retropharyngeal ectopic parathyroid adenoma was the causative etiology of her primary hyperparathyroidism, and hypercalcemia treatment resolved the psychotic episode. We highlight the importance of recognizing psychosis as a possible initial presentation of hyperparathyroidism and hypercalcemia. Ruling out organic etiologies prior to diagnosing a primary cause of psychosis is crucial, as their treatment can reverse the psychotic symptoms.
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Affiliation(s)
- David Corredor-Orlandelli
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil—LaCardio, Bogotá, Colombia
| | - Laura Valenzuela-Vallejo
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Fundación Cardioinfantil—LaCardio, Bogotá, Colombia
| | - Juan Felipe Aguirre-Ruiz
- Fundación Cardioinfantil—LaCardio, Bogotá, Colombia
- Internal Medicine Department, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Alex Valenzuela Rincon
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
- Departments of Endocrinology and Internal Medicine, Fundación Cardioinfantil—LaCardio, Bogotá, Colombia
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Zwir I, Arnedo J, Mesa A, Del Val C, de Erausquin GA, Cloninger CR. Temperament & Character account for brain functional connectivity at rest: A diathesis-stress model of functional dysregulation in psychosis. Mol Psychiatry 2023; 28:2238-2253. [PMID: 37015979 PMCID: PMC10611583 DOI: 10.1038/s41380-023-02039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/06/2023]
Abstract
The human brain's resting-state functional connectivity (rsFC) provides stable trait-like measures of differences in the perceptual, cognitive, emotional, and social functioning of individuals. The rsFC of the prefrontal cortex is hypothesized to mediate a person's rational self-government, as is also measured by personality, so we tested whether its connectivity networks account for vulnerability to psychosis and related personality configurations. Young adults were recruited as outpatients or controls from the same communities around psychiatric clinics. Healthy controls (n = 30) and clinically stable outpatients with bipolar disorder (n = 35) or schizophrenia (n = 27) were diagnosed by structured interviews, and then were assessed with standardized protocols of the Human Connectome Project. Data-driven clustering identified five groups of patients with distinct patterns of rsFC regardless of diagnosis. These groups were distinguished by rsFC networks that regulate specific biopsychosocial aspects of psychosis: sensory hypersensitivity, negative emotional balance, impaired attentional control, avolition, and social mistrust. The rsFc group differences were validated by independent measures of white matter microstructure, personality, and clinical features not used to identify the subjects. We confirmed that each connectivity group was organized by differential collaborative interactions among six prefrontal and eight other automatically-coactivated networks. The temperament and character traits of the members of these groups strongly accounted for the differences in rsFC between groups, indicating that configurations of rsFC are internal representations of personality organization. These representations involve weakly self-regulated emotional drives of fear, irrational desire, and mistrust, which predispose to psychopathology. However, stable outpatients with different diagnoses (bipolar or schizophrenic psychoses) were highly similar in rsFC and personality. This supports a diathesis-stress model in which different complex adaptive systems regulate predisposition (which is similar in stable outpatients despite diagnosis) and stress-induced clinical dysfunction (which differs by diagnosis).
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Affiliation(s)
- Igor Zwir
- Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, USA
- University of Granada, Department of Computer Science, Granada, Spain
- University of Texas, Rio Grande Valley School of Medicine, Institute of Neuroscience, Harlingen, TX, USA
| | - Javier Arnedo
- Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, USA
- University of Granada, Department of Computer Science, Granada, Spain
| | - Alberto Mesa
- University of Granada, Department of Computer Science, Granada, Spain
| | - Coral Del Val
- University of Granada, Department of Computer Science, Granada, Spain
| | - Gabriel A de Erausquin
- University of Texas, Long School of Medicine, Department of Neurology, San Antonio, TX, USA
- Laboratory of Brain Development, Modulation and Repair, Glenn Biggs Institute of Alzheimer's & Neurodegenerative Disorders, San Antonio, TX, USA
| | - C Robert Cloninger
- Washington University School of Medicine, Department of Psychiatry, St. Louis, MO, USA.
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Pattnaik JI, Panda UK, Chandran S, Padhy S, Ravan JR. Treatment resistant psychosis in children and adolescents and clozapine: Nuances. Front Psychiatry 2023; 14:1014540. [PMID: 36911129 PMCID: PMC9998521 DOI: 10.3389/fpsyt.2023.1014540] [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] [Received: 08/08/2022] [Accepted: 01/25/2023] [Indexed: 03/14/2023] Open
Abstract
With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group.
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Affiliation(s)
| | - Udit Kumar Panda
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Suhas Chandran
- Child and Adolescent Psychiatry, St. Johns Medical College and Hospital, Bengaluru, India
| | - Susanta Padhy
- Department of Psychiatry, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
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Andrews JP, Wozny TA, Yue JK, Wang DD. Improved psychotic symptoms following resection of amygdalar low-grade glioma: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22362. [PMID: 36443957 PMCID: PMC9705519 DOI: 10.3171/case22362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown. OBSERVATIONS In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms. LESSONS This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.
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Affiliation(s)
- John P. Andrews
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Thomas A. Wozny
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - John K. Yue
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Doris D. Wang
- Department of Neurosurgery, University of California San Francisco, San Francisco, California; and ,Department of Neurosurgery, San Francisco Veterans Affairs Medical Center, San Francisco, California
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Teixeira-Dias M, Dadwal AK, Bell V, Blackman G. Neuropsychiatric Features of Fregoli Syndrome: An Individual Patient Meta-Analysis. J Neuropsychiatry Clin Neurosci 2022; 35:171-177. [PMID: 36172691 DOI: 10.1176/appi.neuropsych.22010011] [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: 11/30/2022]
Abstract
OBJECTIVE Fregoli syndrome is a rare delusion characterized by the belief that familiar people are presenting themselves disguised as others to the affected person. Theories of delusional misidentification have suggested secondary ("organic") underlying mechanisms; however, the pathoetiology of Fregoli syndrome has not been systematically evaluated. The investigators aimed to compare the neuropsychiatric features of Fregoli syndrome in primary and secondary psychoses. METHODS A systematic review and patient-level meta-analysis were conducted. Five databases were searched, ultimately yielding 83 studies that met selection criteria. Demographic characteristics, diagnosis, delusional content, neuropsychiatric features, investigations, and treatment information were extracted. Random-effects models were calculated, and odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. RESULTS A total of 119 patients with Fregoli syndrome were identified: 62 patients (52%) with primary psychosis, 50 (42%) with secondary psychosis, and seven (6%) with an unclear etiology. Patients with secondary psychosis were less likely than patients with primary psychosis to experience persecutory features (OR=0.26, 95% CI=0.10, 0.67; p=0.0057). Moreover, patients with secondary psychosis were more likely to experience Fregoli syndrome during a first episode of psychosis (OR=11.00, 95% CI=2.45, 49.39; p=0.0017). Right-sided brain lesions were more prominent than left-sided brain lesions in the total sample (χ2=5.0, df=1, p=0.025) and in the secondary psychosis subgroup (χ2=4.26, df=1, p=0.039). CONCLUSIONS This is the first meta-analysis to investigate Fregoli syndrome. An estimated 42% of the reported cases involved a secondary etiology. These findings provide clinicians with a better understanding of the symptomatology of Fregoli syndrome and have potential to be applied in future research and clinical practice.
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Affiliation(s)
- Maria Teixeira-Dias
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, London (Teixeira-Dias, Dadwal, Blackman); Research Department of Clinical, Educational and Health Psychology, University College London (Bell); South London and Maudsley National Health Service Foundation Trust, London (Bell, Blackman)
| | - Amber Kaur Dadwal
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, London (Teixeira-Dias, Dadwal, Blackman); Research Department of Clinical, Educational and Health Psychology, University College London (Bell); South London and Maudsley National Health Service Foundation Trust, London (Bell, Blackman)
| | - Vaughan Bell
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, London (Teixeira-Dias, Dadwal, Blackman); Research Department of Clinical, Educational and Health Psychology, University College London (Bell); South London and Maudsley National Health Service Foundation Trust, London (Bell, Blackman)
| | - Graham Blackman
- Section of Cognitive Neuropsychiatry, Institute of Psychiatry, Psychology and Neuroscience, London (Teixeira-Dias, Dadwal, Blackman); Research Department of Clinical, Educational and Health Psychology, University College London (Bell); South London and Maudsley National Health Service Foundation Trust, London (Bell, Blackman)
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Dhavala A, Samitinjay A, Khairkar P, Podder V, Price A, Fatima SH, Biswas R. Integrated case-based clinical approach in understanding pathways, complexities, pitfalls and challenges in neurodegenerative disorders. AMERICAN JOURNAL OF NEURODEGENERATIVE DISEASE 2022; 11:22-33. [PMID: 35874938 PMCID: PMC9301093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This paper presents 5 cases of neurodegenerative disorders from our tertiary care rural hospital in south India. The purpose of this paper is to generate an emerging common theme by thematic analysis of clinical data from each of these patients. A theme emerged, we identified that there was a common clinical ground in patients with movement disorders and psychiatric symptoms. From this common theme, these patients eventually went on to develop different courses of illnesses. METHODOLOGY Clinical analysis of a case series of 5 patients with neurodegenerative disorders attending the Medicine or Psychiatry services of our hospital. CONCLUSION A clear & consistent association between movement disorders and psychiatric symptoms was found. Although our data is limited, we conclude that movement disorders can be early clinical markers of organic psychopathology. However, we are aware that this association can be confounded by substance abuse, stress, sleep disruption and even therapeutic interventions, and thus these factors were accounted for and yet we conclude that movement disorders can be early clinical indictors of organic psychopathology.
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Affiliation(s)
- Aashitha Dhavala
- Junior Resident in General Medicine, Kamineni Institute of Medical SciencesNarketpally, India
| | - Aditya Samitinjay
- Senior Resident in General Medicine, Government General & Chest HospitalErragada, Hyderabad, India
| | - Praveen Khairkar
- HOD & Professor in Psychiatry, Kamineni Institute of Medical SciencesNarketpally, India
| | - Vivek Podder
- Visiting Lecturer, The University of AdelaideAustralia
| | - Amy Price
- Senior Research Scientist Stanford School of MedicineCA, USA
| | - Syeda Hira Fatima
- Junior Resident in Psychiatry, Kamineni Institute of Medical SciencesNarketpally, India
| | - Rakesh Biswas
- HOD & Professor in General Medicine, Kamineni Institute of Medical SciencesNarketpally 508254, India
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13
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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.
AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.
METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).
RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.
CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Abstract
It is considered that certain drugs might induce delusional infestation, yet, to date, no studies have been performed to identify the pharmacodynamics associated with these treatments. The aim of this review is to summarize current available knowledge of drug-induced delusional infestation. A literature search was performed for primary studies on suspected drugs reported to induce delusional infestation. Included articles were evaluated systematically using the Naranjo criteria. In addition, drug mechanisms of action were compared. The final selection included 31 studies, in which a total of 26 classes of drugs were identified. Anti-Parkinson drugs were most frequently associated with delusional infestation, followed by antidepressants, antiepileptics, antibiotics, prescription stimulants, and a few other drug groups. The current available literature suggests that the onset of delusional infestation is initiated by drug-induced alterations in neurotransmitter levels, predominantly dopamine, in the central nervous system.
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Affiliation(s)
- Patrick M J H Kemperman
- Department of Dermatology, Amsterdam UMC location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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15
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Couto RAS, Moreira Gonçalves L. A medical algorithm for Cotard delusion based on more than 300 literature cases. Int J Psychiatry Clin Pract 2021; 25:220-232. [PMID: 32935595 DOI: 10.1080/13651501.2020.1819335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Cotard delusion (CD) is a rare psychiatric disorder in which the patient believes to be dead, i.e., the patient holds nihilistic delusions concerning his/her own existence. Taking into account its rarity, and possible subdiagnosis due to unawareness, most of the literature consists of case studies, complicating a more systematic approach and leading to difficulties in deciding the best clinical guidance to offer the patient suffering from CD. The objective of this work is to review the literature and propose an algorithm to help the differential diagnosis and the management of this condition. METHOD To do so, an extensive literature research was performed using several bibliographic databases. Since data on this topic is scarce, references in every article were cross-checked, aiming to obtain all available peer-reviewed works on CD. RESULTS Research resulted in 328 cases. Several treatment modalities were reported to improve the symptoms of CD, from pharmacotherapy - mainly consisting of antipsychotics and antidepressants - to electroconvulsive therapy. CONCLUSIONS Despite its challenging diagnosis, the delusion can be treated with readily available care. Hopefully, this work can be a useful tool to doctors when encountering this odd affliction.
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Affiliation(s)
- Rosa A S Couto
- School of Medicine, University of Minho, Braga, Portugal.,REQUIMTE, LAQV, Laboratory of Applied Chemistry, Department of Chemical Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Luís Moreira Gonçalves
- Departamento de Química Fundamental, Instituto de Química, Universidade de São Paulo (USP), São Paulo, Brazil
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16
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Brucella-Induced Acute Psychosis: A Novel Cause of Acute Psychosis. Case Rep Infect Dis 2021; 2021:6649717. [PMID: 33747578 PMCID: PMC7954612 DOI: 10.1155/2021/6649717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/17/2021] [Accepted: 02/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Infections have long been linked to psychosis and categorised within “secondary” psychoses. To date, there have been few reports of psychosis linked to brucellosis. This case report aims to present one such case. Case Presentation. A 31-year-old man was admitted to a general hospital with pyrexia, severe right upper quadrant pain, and an acute psychosis following a two-week holiday in South East Asia and the Mediterranean. Serological tests revealed that he had brucellosis. Following antibiotic treatment, the psychotic symptoms abated and he was discharged within ten days of hospitalisation. Conclusions This case of organic psychosis highlights the importance of considering brucellosis as a rare cause of acute psychosis. The exact mechanism of Brucella-induced psychosis remains unclear.
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17
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Nkire N, Scully PJ, Browne DJ, Baldwin PA, Kingston T, Owoeye O, Kinsella A, O'Callaghan E, Russell V, Waddington JL. Systematic epidemiological and clinical comparisons across all 12 DSM-IV psychotic diagnoses in the Cavan-Monaghan First Episode Psychosis Study (CAMFEPS). Psychol Med 2021; 51:607-616. [PMID: 31858926 DOI: 10.1017/s0033291719003520] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research on psychotic illness is loosening emphasis on diagnostic stringency in favour of including a more dimensionally based conceptualization of psychopathology and pathobiology. However, to clarify these notions requires investigation of the full scope of psychotic diagnoses. METHODS The Cavan-Monaghan First Episode Psychosis Study ascertained cases of first episode psychosis across all 12 DSM-IV psychotic diagnoses via all routes to care: public, private or forensic; home-based, outpatient or inpatient. There was no arbitrary upper age cut-off and minimal impact of factors associated with variations in social milieu, ethnicity or urbanicity. Cases were evaluated epidemiologically and assessed for psychopathology, neuropsychology, neurology, antecedent factors, insight and quality of life. RESULTS Among 432 cases, the annual incidence of any DSM-IV psychotic diagnosis was 34.1/100 000 of population and encompassed functional psychotic diagnoses, substance-induced psychopathology and psychopathology due to general medical conditions, through to psychotic illness that defied contemporary diagnostic algorithms. These 12 DSM-IV diagnostic categories, including psychotic disorder not otherwise specified, showed clinical profiles that were consistently more similar than distinct. CONCLUSIONS There are considerable similarities and overlaps across a broad range of diagnostic categories in the absence of robust discontinuities between them. Thus, psychotic illness may be of such continuity that it cannot be fully captured by operational diagnostic algorithms that, at least in part, assume discontinuities. This may reflect the impact of diverse factors each of which acts on one or more overlapping components of a common, dysfunctional neuronal network implicated in the pathobiology of psychotic illness.
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Affiliation(s)
- Nnamdi Nkire
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Paul J Scully
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David J Browne
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrizia A Baldwin
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Tara Kingston
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Olabisi Owoeye
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Anthony Kinsella
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Vincent Russell
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - John L Waddington
- Cavan-Monaghan Mental Health Service, St. Davnet's Hospital, Monaghan, and Cavan General Hospital, Cavan, Ireland
- Molecular & Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
- Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric-Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou, China
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18
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Agrawal R, Verma S, Vatsalya V, Halappanavar M, Oraka K. Dilemma of Treating Psychosis Secondary to Stroke. Cureus 2021; 13:e12763. [PMID: 33614355 PMCID: PMC7888683 DOI: 10.7759/cureus.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Post-stroke psychosis is prevalent and disabling with increased mortality risk. Treatment for post-stroke psychosis is limited in this staggering medical concern. The most commonly used medications are antipsychotics, however, the risk for stroke increases further with the use of antipsychotics. Furthermore, interventional clinical studies have not been carried out to test the efficacy and safety of antipsychotics in the management of post-stroke psychosis. We present a case of post-stroke psychosis to highlight the risks faced by these patients in terms of daily function and safety concerns and the challenges encountered in treatment due to poor response to the conventional antipsychotics; and so calling attention to early diagnosis and improved treatment options. More clinical investigations are needed to address the pathology associated with the clinical presentation and exploring the pharmacotherapies to improve efficacy and safety of treatment for post-stroke psychosis.
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Affiliation(s)
| | - Shikha Verma
- Psychiatry and Behavioral Health, Rosalind Franklin University, North Chicago, USA.,Child and Adolescent Psychiatry, Rogers Behavioral Health, Kenosha, USA
| | - Vatsalya Vatsalya
- Medicine, University of Louisville School of Medicine, Louisville, USA
| | - Monica Halappanavar
- Psychiatry and Behavioral Sciences, University of Louisville, Louisville, USA
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19
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González-Rodríguez A, Seeman MV. Two Case Studies of Delusions Leading to Suicide, a Selective Review. Psychiatr Q 2020; 91:1061-1073. [PMID: 32761556 DOI: 10.1007/s11126-020-09802-w] [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: 10/23/2022]
Abstract
Many questions pertaining to delusional disorder (DD) remain unanswered. It is unclear what syndromes to include under this category of psychotic illness and when to treat with antidepressants, cognitive therapy, or antipsychotic medication. DD is associated with psychiatric comorbidity, especially depression, and rates of suicidal behavior are high when the two conditions co-exist. In this selective review, we present two instances of suicide in the context of DD, one illustrating risks for the somatic subtype and the second, risks for the persecutory subtype. The frequency of suicidal behaviour in these two subtypes of DD is estimated at 8-21%. The literature suggests a prominent role for social emotions (shame, humiliation) in the pathway leading to suicide. In addition, risk factors found in our two patients point to factors such as poverty, living alone, vulnerable risk periods, stigma, and lack of trust in mental health services. Building trust may be the most effective preventive measure.
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Affiliation(s)
- Alexandre González-Rodríguez
- Department of Mental Health, Parc Tauli University Hospital. I3PT. Autonomous University of Barcelona (UAB), Sabadell, Barcelona, Spain
| | - Mary V Seeman
- Department of Psychiatry, University of Toronto, 260 Heath Street West, Suite #605, Toronto, ON, M5P 3L6, Canada.
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20
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Arjmand S, Kohlmeier KA, Behzadi M, Ilaghi M, Mazhari S, Shabani M. Looking into a Deluded Brain through a Neuroimaging Lens. Neuroscientist 2020; 27:73-87. [PMID: 32648532 DOI: 10.1177/1073858420936172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Delusions are irrational, tenacious, and incorrigible false beliefs that are the most common symptom of a range of brain disorders including schizophrenia, Alzheimer's, and Parkinson's disease. In the case of schizophrenia and other primary delusional disorders, their appearance is often how the disorder is first detected and can be sufficient for diagnosis. At this time, not much is known about the brain dysfunctions leading to delusions, and hindering our understanding is that the complexity of the nature of delusions, and their very unique relevance to the human experience has hampered elucidation of their underlying neurobiology using either patients or animal models. Advances in neuroimaging along with improved psychiatric and cognitive modeling offers us a new opportunity to look with more investigative power into the deluded brain. In this article, based on data obtained from neuroimaging studies, we have attempted to draw a picture of the neural networks involved when delusion is present and evaluate whether different manifestations of delusions engage different regions of the brain.
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Affiliation(s)
- Shokouh Arjmand
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Kristi A Kohlmeier
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mina Behzadi
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mehran Ilaghi
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Shahrzad Mazhari
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Shabani
- Institute of Neuropharmacology, Kerman Neuroscience Research Center, Kerman University of Medical Sciences, Kerman, Iran
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21
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Zhang S, Xu M, Liu ZJ, Feng J, Ma Y. Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications. World J Psychiatry 2020; 10:125-138. [PMID: 32742946 PMCID: PMC7360525 DOI: 10.5498/wjp.v10.i6.125] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/13/2020] [Accepted: 04/25/2020] [Indexed: 02/05/2023] Open
Abstract
A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Michael Xu
- Department of Clinical Medicine, International Education School, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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22
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Waddington JL. Psychosis in Parkinson's disease and parkinsonism in antipsychotic-naive schizophrenia spectrum psychosis: clinical, nosological and pathobiological challenges. Acta Pharmacol Sin 2020; 41:464-470. [PMID: 32139896 PMCID: PMC7470778 DOI: 10.1038/s41401-020-0373-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 01/27/2020] [Indexed: 01/13/2023] Open
Abstract
Following the formulation of operational criteria for the diagnosis of psychosis in Parkinson's disease, a neurodegenerative disorder, the past decade has seen increasing interest in such nonmotor psychopathology that appears to be independent of dopaminergic therapy. Similarly, there has been a resurgence of interest in motor aspects of the neurodevelopmental disorder of schizophrenia, including spontaneous parkinsonism that appears to be independent of antipsychotic treatment. This review first addresses the clinical and nosological challenges of these superficially paradoxical insights and then considers pathobiological challenges. It proposes that diverse modes of disturbance to one or more element(s) in a cortical-striatal-thalamocortical neuronal network, whether neurodegenerative or neurodevelopmental, can result in movement disorder, psychosis or both. It then proposes that time- and site-dependent dysfunction in such a neuronal network may be a generic substrate for the emergence of psychosis not only in Parkinson's disease and schizophrenia-spectrum disorders but also in other neuropsychiatric disorders in which psychosis, and sometimes movement disorders, can be encountered; these include substance abuse, cerebrovascular disease, cerebral trauma, cerebral neoplasia, epilepsy, Huntington's disease, frontotemporal dementia, Alzheimer's disease and multiple sclerosis.
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Affiliation(s)
- John L Waddington
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, 2, Ireland.
- Jiangsu Key Laboratory of Translational Research & Therapy for Neuro-Psychiatric Disorders and Department of Pharmacology, College of Pharmaceutical Sciences, Soochow University, Suzhou 215123, China.
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23
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Rossi M, Farcy N, Starkstein SE, Merello M. Nosology and Phenomenology of Psychosis in Movement Disorders. Mov Disord Clin Pract 2020; 7:140-153. [PMID: 32071931 DOI: 10.1002/mdc3.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/02/2019] [Accepted: 12/01/2019] [Indexed: 12/13/2022] Open
Abstract
Background Psychotic symptoms, such as delusions and hallucinations, are part of the clinical picture of several conditions presenting movement disorders. Phenomenology and epidemiology of psychosis in Parkinson's disease have received wide attention; however, the presence of psychosis in other movement disorders is, comparatively, less well known. Objectives To review psychotic symptoms present in different movement disorders. Methods A comprehensive and structured literature search was performed to identify and analyze data on patients with movement disorders and comorbid psychosis. Results In monogenic parkinsonisms, such as PARK-GBA, PARK-LRRK2, and PARK-SNCA, visual hallucinations related to dopamine replacement therapy are frequent as well as are delusions in PARK-LRRK2 and PARK-SNCA, but not in PARK-GBA. Different types of delusions and hallucinations are found in Huntington's disease and other choreic disorders. In Tourette's syndrome, paranoid delusions as well as visual, olfactory, and auditory hallucinations have been described, which usually develop after an average of 10 years of disease. Delusions in ataxias are more frequent in ATX-TBP, ATX-ATN1, and ATX-ATXN3, whereas it is rare in Friedreich's ataxia. Psychosis is also a prominent and frequent clinical feature in Fahr's disease, Wilson's disease, neurodegeneration with brain iron accumulation, and some lysosomal storage disorders, whereas it is uncommon in atypical parkinsonisms and dystonia. Psychosis usually occurs at late disease stages, but may appear as onset symptoms of the disease, especially in Wilson's disease, Huntington's disease, late-onset Tays-Sachs, and Niemann-Pick. Conclusion Psychosis is a frequent comorbidity in most hyper- and hypokinetic movement disorders. Appropriate recognition is relevant both in the early and late disease stages.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience Department Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina.,Pontificia Universidad Catolica Argentina (UCA) Buenos Aires Argentina
| | - Nicole Farcy
- Movement Disorders Section, Neuroscience Department Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina
| | - Sergio E Starkstein
- School of Psychiatry and Clinical Neurosciences University of Western Australia Crawley WA Australia
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience Department Raul Carrea Institute for Neurological Research (FLENI) Buenos Aires Argentina.,Pontificia Universidad Catolica Argentina (UCA) Buenos Aires Argentina.,Argentine National Scientific and Technological Research Council (CONICET) Buenos Aires Argentina
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24
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Parfianowicz D, Espiridion ED. Chronic Post-stroke Psychosis with Left Cortical and Bilateral Inferior Cerebellar Involvement. Cureus 2019; 11:e6437. [PMID: 31993274 PMCID: PMC6970439 DOI: 10.7759/cureus.6437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Post-stroke psychosis is the presence of delusions and/or hallucinations that result from an infarct in the cerebrovascular network. Involvement of a predominantly right-sided cortical pathology has been described in triggering the psychosis. In identified cases, patients often have little to no prior psychiatric history. We report a case of a 70-year-old female with chronic post-stroke psychosis consisting of auditory hallucinations and persecutory delusions. Our patient serves as a unique case in not only contributing to the limited number of documentations overall, but also in highlighting a presentation with infarction of the left parietal-temporal-occipital cortex and bilateral inferior cerebellum.
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25
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Novais F, Loureiro S, Andrea M, Figueira ML, Pimentel J, Câmara Pestana L. May the right-side epileptogenic zone be a predictor of psychiatric comorbidity in people with refractory epilepsy? Laterality 2019; 25:275-284. [DOI: 10.1080/1357650x.2019.1662431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Filipa Novais
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Susana Loureiro
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mafalda Andrea
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
| | - Maria Luísa Figueira
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - José Pimentel
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Department of Neurosciences and Mental Health, Neurology Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
| | - Luís Câmara Pestana
- Department of Neurosciences and Mental Health, Psychiatry Department, Hospital de Santa Maria (CHULN), Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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New Psychoactive Substances (NPS), Psychedelic Experiences and Dissociation: Clinical and Clinical Pharmacological Issues. CURRENT ADDICTION REPORTS 2019. [DOI: 10.1007/s40429-019-00249-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Zhen XC, Waddington J. Emerging and evolving concepts in the pathobiology and treatment of psychosis. CNS Neurosci Ther 2018; 24:583-585. [PMID: 29898285 DOI: 10.1111/cns.12974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Xue-Chu Zhen
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.,The Collaborative Innovation Center for Brain Science, Soochow University, Suzhou, China
| | - John Waddington
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, College of Pharmaceutical Sciences, Soochow University, Suzhou, China.,Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland
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28
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Joyce EM. Organic psychosis: The pathobiology and treatment of delusions. CNS Neurosci Ther 2018; 24:598-603. [PMID: 29766653 DOI: 10.1111/cns.12973] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 04/15/2018] [Accepted: 04/17/2018] [Indexed: 01/01/2023] Open
Abstract
Organic or secondary psychosis can be seen in diverse conditions such as toxic/metabolic disorders, neurodegenerative disease, and stroke. Poststroke psychosis is a rare phenomenon, but its study has significantly contributed to the understanding of delusion formation. The evidence from case studies of patients with focal strokes shows that delusions develop following unilateral damage of the right hemisphere. The majority of patients with right hemisphere stroke do not develop delusions however, and advanced neuroimaging analysis has elucidated why this symptom develops in only a small proportion. Lesions of the right lateral prefrontal cortex or lesions with connectivity to this area correlate with delusional beliefs in this subgroup. Studies of patients with primary psychosis, for example schizophrenia, or under the influence of the psychotogenic drug ketamine, also show abnormal function of this area in relation to the severity of their abnormal beliefs. The conclusion of these studies is that the right lateral prefrontal cortex is 1 hub in a neural network which includes the basal ganglia and limbic system and receives inputs from midbrain dopamine neurones. In patients with schizophrenia, or at risk of psychosis, dopamine is dysregulated and evidence suggests that faulty dopamine signaling is the precursor of delusion formation. It is therefore likely that the mechanism of delusion formation is the same in both primary and secondary psychosis. This is consistent with the mainstay of treatment of both conditions being antipsychotic medication. However, antipsychotic medication in people with cerebrovascular disease should be avoided if at all possible. This is because epidemiological studies have found that antipsychotic use is associated with an increased risk of stroke and will thus compound the possibility of a further cerebrovascular accident.
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