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Weerasekera A, Ion-Mărgineanu A, Nolan GP, Mody M. Subcortical-cortical white matter connectivity in adults with autism spectrum disorder and schizophrenia patients. Psychiatry Res Neuroimaging 2024; 340:111806. [PMID: 38508025 DOI: 10.1016/j.pscychresns.2024.111806] [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: 09/01/2023] [Revised: 11/20/2023] [Accepted: 02/29/2024] [Indexed: 03/22/2024]
Abstract
Autism spectrum disorder (ASD) and schizophrenia (SZ) are neuropsychiatric disorders that overlap in symptoms associated with social-cognitive impairment. Alterations of the cingulate cortex, subcortical, medial-temporal, and orbitofrontal structures are frequently reported in both disorders. In this study, we examined white-matter connectivity between these structures in adults with ASD and SZ patients compared with their respective neurotypical controls and indirectly with each other, using probabilistic and local DTI tractography. This exploratory study utilized publicly available neuroimaging databases, of adults with ASD (ABIDE II; n = 28) and SZ (COBRE; n = 38), age-gender matched neurotypicals (NT) and associated phenotypic data. Tractography was performed using Freesurfer and MRtrix software, and diffusion metrics of white-matter tracts between cingulate-, orbitofrontal- cortices, subcortical structures, parahippocampal, entorhinal cortex were assessed. In ASD, atypical diffusivity parameters were found in the isthmus cingulate and parahippocampal connectivity to subcortical and rostral-anterior cingulate, which were also associated with IQ and social skills (SRS). In contrast, atypical diffusivity parameters were observed between the medial-orbitofrontal cortex and subcortical structures in SZ, and were associated with executive function (i.e., IQ, processing speed) and emotional regulation. Overall, the results suggest that defects in the isthmus cingulate, medial-orbitofrontal, and striato-limbic white matter connectivity may help unravel the neural underpinnings of executive and social-emotional dysfunction at the core of neuropsychiatric disorders.
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Affiliation(s)
- Akila Weerasekera
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA.
| | - Adrian Ion-Mărgineanu
- ESAT - STADIUS, KU Leuven, Leuven. Belgium; Biomed Artificial Intelligence LLC, Bucharest, Romania
| | - Garry P Nolan
- Department of Microbiology & Immunology, Stanford University School of Medicine, United States
| | - Maria Mody
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02115, USA
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2
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Filosa M, De Rossi E, Carbone GA, Farina B, Massullo C, Panno A, Adenzato M, Ardito RB, Imperatori C. Altered connectivity between the central executive network and the salience network in delusion-prone individuals: A resting state eLORETA report. Neurosci Lett 2024; 825:137686. [PMID: 38364996 DOI: 10.1016/j.neulet.2024.137686] [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: 10/30/2023] [Revised: 01/30/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024]
Abstract
Although the Triple Network (TN) model has been proposed as a valid neurophysiological framework for conceptualizing delusion-like experiences, the neurodynamics of TN in relation to delusion proneness have been relatively understudied in nonclinical samples so far. Therefore, the main aim of the current study was to investigate the functional connectivity of resting state electroencephalography (EEG) in subjects with high levels of delusion proneness. Twenty-one delusion-prone (DP) individuals and thirty-seven non-delusion prone (N-DP) individuals were included in the study. The exact Low-Resolution Electromagnetic Tomography (eLORETA) software was used for all EEG analyses. Compared to N-DP participants, DP individuals showed an increas of theta connectivity (T = 3.618; p = 0.045) between the Salience Network (i.e., the left anterior insula) and the Central Executive Network (i.e., the left posterior parietal cortex). Increased theta connectivity was also positively correlated with the frequency of delusional experiences (rho = 0.317; p = 0.015). Our results suggest that increased theta connectivity between the Salience Network and the Central Executive Network may underline brain correlates of altered resting state salience detection, information processing, and cognitive control processes typical of delusional thinking.
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Affiliation(s)
- Margherita Filosa
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Italy
| | - Elena De Rossi
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Italy
| | | | - Benedetto Farina
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Italy
| | - Chiara Massullo
- Experimental Psychology Laboratory, Department of Education, Roma Tre University, Italy
| | - Angelo Panno
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Italy
| | | | - Rita B Ardito
- Department of Psychology, University of Turin, Italy
| | - Claudio Imperatori
- Experimental and Applied Psychology Laboratory, Department of Human Sciences, European University of Rome, Italy
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3
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Van Assche L, Takamiya A, Van den Stock J, Van de Ven L, Luyten P, Emsell L, Vandenbulcke M. A voxel- and source-based morphometry analysis of grey matter volume differences in very-late-onset schizophrenia-like psychosis. Psychol Med 2024; 54:592-600. [PMID: 37577955 DOI: 10.1017/s0033291723002258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
BACKGROUND Very-late-onset schizophrenia-like psychosis (VLOSLP) is associated with significant burden. Its clinical importance is increasing as the global population of older adults rises, yet owing to limited research in this population, the neurobiological underpinnings of VLOSP remain insufficiently clarified. Here we address this knowledge gap using novel morphometry techniques to investigate grey matter volume (GMV) differences between VLOSLP and healthy older adults, and their correlations with neuropsychological scores. METHODS In this cross-sectional study, we investigated whole-brain GMV differences between 35 individuals with VLOSLP (mean age 76.7, 26 female) and 36 healthy controls (mean age 75.7, 27 female) using whole-brain voxel-based morphometry (VBM) and supplementary source-based morphometry (SBM) on high resolution 3D T1-weighted MRI images. Additionally, we investigated relationships between GMV differences and cognitive function assessed with an extensive neuropsychological battery. RESULTS VBM showed lower GMV in the thalamus, left inferior frontal gyrus and left insula in patients with VLOSLP compared to healthy controls. SBM revealed lower thalamo-temporal GMV in patients with VLOSLP. Processing speed, selective attention, mental flexibility, working memory, verbal memory, semantic fluency and confrontation naming were impaired in patients with VLOSLP. Correlations between thalamic volumes and memory function were significant within the group of individuals with VLOSLP, whereas no significant associations remained in the healthy controls. CONCLUSIONS Lower GMV in the thalamus and fronto-temporal regions may be part of the underlying neurobiology of VLOSLP, with lower thalamic GMV contributing to memory impairment in the disorder.
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Affiliation(s)
- Lies Van Assche
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Akihiro Takamiya
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jan Van den Stock
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Luc Van de Ven
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Patrick Luyten
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Research Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Louise Emsell
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
- Translational MRI, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, University Psychiatric Center KU Leuven, Leuven, Belgium
- Neuropsychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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4
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Abstract
BACKGROUND AND HYPOTHESIS The neurocomputational framework of predictive processing (PP) provides a promising approach to explaining delusions, a key symptom of psychotic disorders. According to PP, the brain makes inferences about the world by weighing prior beliefs against the available sensory data. Mismatches between prior beliefs and sensory data result in prediction errors that may update the brain's model of the world. Psychosis has been associated with reduced weighting of priors relative to the sensory data. However, delusional beliefs are highly resistant to change, suggesting increased rather than decreased weighting of priors. We propose that this "delusion paradox" can be resolved within a hierarchical PP model: Reduced weighting of prior beliefs at low hierarchical levels may be compensated by an increased influence of higher-order beliefs represented at high hierarchical levels, including delusional beliefs. This may sculpt perceptual processing into conformity with delusions and foster their resistance to contradictory evidence. STUDY DESIGN We review several lines of experimental evidence on low- and high-level processes, and their neurocognitive underpinnings in delusion-related phenotypes and link them to predicted processing. STUDY RESULTS The reviewed evidence supports the notion of decreased weighting of low-level priors and increased weighting of high-level priors, in both delusional and delusion-prone individuals. Moreover, we highlight the role of prefrontal cortex as a neural basis for the increased weighting of high-level prior beliefs and discuss possible clinical implications of the proposed hierarchical predictive-processing model. CONCLUSIONS Our review suggests the delusion paradox can be resolved within a hierarchical PP model.
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Affiliation(s)
- Predrag Petrovic
- Center for Psychiatry Research (CPF), Center for Cognitive and Computational Neuropsychiatry (CCNP), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Philipp Sterzer
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland
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5
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Diamantaras AA, Blondiaux E, Schumacher R, Müri RM, Blanke O, Heydrich L. The neuropsychology and neuroanatomy of reduplicative paramnesia. Cortex 2023; 167:12-24. [PMID: 37515831 DOI: 10.1016/j.cortex.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 06/06/2023] [Indexed: 07/31/2023]
Abstract
Reduplicative paramnesia refers to the delusional belief that there are identical places in different locations. In this case-control study we investigated the clinical, phenomenological, neuropsychological and neuroanatomical data of eleven patients with reduplicative paramnesia and compared them against a control group of eleven patients with severe spatial disorientation without signs of reduplicative paramnesia. We show that most patients with reduplicative paramnesia report that a current place is reduplicated and/or relocated to an other familiar place. Patients with reduplicative paramnesia show a higher prevalence of deficits in the executive functions compared to the control patients, while mnestic and visuo-spatial deficits were both frequent in patients with reduplicative paramnesia and the control group. Patients with reduplicative paramnesia mostly suffer from right hemispheric lesions with a maximal overlap in the dorsolateral prefrontal cortex. Using lesion network mapping we show that lesions causing reduplicative paramnesia are connected to bilateral anterior insula and the right cingulate cortex. We argue that patients with reduplicative paramnesia fail to integrate the actual context with visuo-spatial memories and personal relevant emotional information due to a disruption of the neural network within the anterior temporal lobe, the cingulate cortex and the anterior insula. Also patients with reduplicative paramnesia are not able to resolve this conflict due to the lesion of the dorsolateral prefrontal cortex and executive dysfunction.
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Affiliation(s)
- A A Diamantaras
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - E Blondiaux
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland
| | - R Schumacher
- University Neurorehabilitation, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - R M Müri
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland; University Neurorehabilitation, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - O Blanke
- Laboratory of Cognitive Neuroscience, Brain-Mind Institute, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland; Center for Neuroprosthetics, School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne, Switzerland; Department of Neurology, University Hospital Geneva, Switzerland
| | - L Heydrich
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland; CORE Lab, Psychosomatic Competence Center, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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6
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Foley JA, Chen C, Paget A, Cipolotti L. A Bayesian predictive processing account of Othello syndrome in Parkinson's disease. Cogn Neuropsychiatry 2023; 28:269-284. [PMID: 37366042 DOI: 10.1080/13546805.2023.2229080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 03/24/2023] [Indexed: 06/28/2023]
Abstract
Introduction: Although delusions in Parkinson's disease (PD) are rare, when they occur they frequently take the form of "Othello syndrome": the irrational belief that a spouse or partner is being unfaithful. Hitherto dismissed as either a by-product of dopamine therapy or cognitive impairment, there are still no convincing theoretical accounts to explain why only some patients fall prey to this delusion, or why it persists despite clear disconfirmatory evidence.Methods: We discuss the limitations of existing explanations of this delusion, namely hyperdopaminergia-induced anomalous perceptual experiences and cognitive impairment, before describing how Bayesian predictive processing accounts can provide a more comprehensive explanation by foregrounding the importance of prior experience and its impact upon computation of probability. We illustrate this new conceptualisation with three case vignettes.Results: We suggest that in those with prior experience of romantic betrayal, hyperdominergic-induced aberrant prediction errors enable anomalous perceptual experiences to accrue greater prominence, which is then maintained through Bayes-optimal inferencing to confirm cognitive distortions, eliciting and shaping this dangerous delusion.Conclusions: We propose the first comprehensive mechanistic account of Othello syndrome in PD and discuss implications for clinical interventions.
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Affiliation(s)
- Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Cliff Chen
- Department of Clinical Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andrew Paget
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
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7
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Fornaro S, Vallesi A. Functional connectivity abnormalities of brain networks in obsessive–compulsive disorder: a systematic review. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Abstract
Obsessive-compulsive disorder (OCD) is characterized by cognitive abnormalities encompassing several executive processes. Neuroimaging studies highlight functional abnormalities of executive fronto-parietal network (FPN) and default-mode network (DMN) in OCD patients, as well as of the prefrontal cortex (PFC) more specifically. We aim at assessing the presence of functional connectivity (FC) abnormalities of intrinsic brain networks and PFC in OCD, possibly underlying specific computational impairments and clinical manifestations. A systematic review of resting-state fMRI studies investigating FC was conducted in unmedicated OCD patients by querying three scientific databases (PubMed, Scopus, PsycInfo) up to July 2022 (search terms: “obsessive–compulsive disorder” AND “resting state” AND “fMRI” AND “function* *connect*” AND “task-positive” OR “executive” OR “central executive” OR “executive control” OR “executive-control” OR “cognitive control” OR “attenti*” OR “dorsal attention” OR “ventral attention” OR “frontoparietal” OR “fronto-parietal” OR “default mode” AND “network*” OR “system*”). Collectively, 20 studies were included. A predominantly reduced FC of DMN – often related to increased symptom severity – emerged. Additionally, intra-network FC of FPN was predominantly increased and often positively related to clinical scores. Concerning PFC, a predominant hyper-connectivity of right-sided prefrontal links emerged. Finally, FC of lateral prefrontal areas correlated with specific symptom dimensions. Several sources of heterogeneity in methodology might have affected results in unpredictable ways and were discussed. Such findings might represent endophenotypes of OCD manifestations, possibly reflecting computational impairments and difficulties in engaging in self-referential processes or in disengaging from cognitive control and monitoring processes.
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8
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Margariti MM, Vlachos II. The concept of psychotic arousal and its relevance to abnormal subjective experiences in schizophrenia. A hypothesis for the formation of primary delusions. Med Hypotheses 2022. [DOI: 10.1016/j.mehy.2022.110915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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9
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Extending the two-component model of delusion to substance use disorder etiology and recovery. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Dobson GP. Wired to Doubt: Why People Fear Vaccines and Climate Change and Mistrust Science. Front Med (Lausanne) 2022; 8:809395. [PMID: 35186977 PMCID: PMC8849212 DOI: 10.3389/fmed.2021.809395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/08/2021] [Indexed: 11/13/2022] Open
Abstract
We all want to be right in our thinking. Vaccine hesitancy and global warming denial share much in common: (1) both are threats to personal, community and global health, (2) action is contingent on co-operation and social policy, and (3) public support relies on trust in science. The irony is, however, as the science has become more convincing, public opinion has become more divided. A number of early polls showed that ~70% of people supported COVID-19 vaccine use and global warming, ~20% adopted a wait-and-see approach, and ~10% were staunch objectors. Although these percentages are approximate, what factors are responsible for the differences in engagement, doubt and distrust? How can we reduce the consensus gap? One approach is to return to grass roots and provide a brief history of the issues, understand the difference between fact and opinion, truth and falsehood, the problem of certainty, and how scientific consensus is reached. To doubt is a healthy response to new information, and it too has a scientific basis. Doubt and distrust reside in that region of the brain called the dorsolateral prefrontal cortex, which is responsible for suppressing unwanted representations. Bridging the consensus gap requires shifting human thinking patterns from doubt to belief, and belief to action. Education and improved public messaging are key, and social media providers require urgent oversight or regulation to remove false and harmful/dangerous content from our digital lives. Delays to vaccinate and failure to reduce greenhouse gases will dramatically change the way we live. The new norm may be more deadly COVID variants, strained healthcare systems, extreme weather patterns, diminished food supply, delays in goods and services, damage to world's economies and widespread global instability.
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Affiliation(s)
- Geoffrey P. Dobson
- Heart and Trauma Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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11
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Nielsen KM, Nordgaard J, Henriksen MG. Delusional Perception Revisited. Psychopathology 2022; 55:325-334. [PMID: 35588694 DOI: 10.1159/000524642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/13/2022] [Indexed: 11/19/2022]
Abstract
Delusional perception designates a sudden, idiosyncratic, and often self-referential delusion triggered by a neutral perceptual content. In classical psychopathology, delusional perception was considered almost pathognomonic for schizophrenia. Since delusional perception has been erased from ICD-11 and always been absent in DSM, it risks slipping out of clinical awareness. In this article, we explore the clinical roots of delusional perception, elucidate the psychopathological phenomenon, and discuss its two predominant conceptualizations, i.e., Schneider's well-known two-link model and Matussek's lesser known one-link model. The two-link model posits that delusional perception amounts to an abnormal interpretation of an intact perception, whereas the one-link model posits that the delusional meaning is contained within a changed perception. Despite their differences, both models stress that delusional perception is a primary delusion that takes place within an altered experiential framework that is characteristic of the psychopathological Gestalt of schizophrenia. We discuss the role of delusional perception in future psychopathological and diagnostic assessment and argue that such assessments must be conducted in comprehensive manner, eliciting the psychopathological context within which symptoms and signs are embedded. Finally, we discuss the compatibility of the two models of delusional perception with contemporary cognitive models on delusion and cognitive psychotherapeutic approaches.
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Affiliation(s)
- Kasper Møller Nielsen
- Mental Health Center Amager, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark
| | - Julie Nordgaard
- Mental Health Center Amager, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Center Amager, Copenhagen University Hospital, Mental Health Services, CPH, Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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12
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Alves PN, Silva DP, Fonseca AC, Martins IP. Mapping delusions of space onto a structural disconnectome that decouples familiarity and place networks. Cortex 2021; 146:250-260. [PMID: 34923302 DOI: 10.1016/j.cortex.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/04/2021] [Accepted: 11/12/2021] [Indexed: 11/03/2022]
Abstract
Interpretation of space is an important determinant of human behaviour. Delusions of space, or reduplicative paramnesias, are a particularly disturbing form of spatial disorientation characterized by the patients' strong belief of place reduplication, transformation or mislocation. Their occurrence following focal brain damage provides a unique opportunity to unveil the structural-functional basis of space misinterpretations. First, we identified reports of lesion-associated reduplicative paramnesias with brain images available through a systematic review of the literature (n = 24). Each lesion was matched with 4 stroke controls and the sample was randomly split in an exploratory (n = 60) and in a validation (n = 60) dataset. Second, we used 178 7T tractographies to compute structural disconnectome maps and analysed lesion topography and disconnection patterns. Delusions of space were significantly associated with structural disconnection of right ventrolateral prefrontal and right temporal regions, and this finding was replicated in the validation sample. Third, we performed a functional meta-analysis of syndrome-related terms. We demonstrated that the structural disconnectomes of delusions of space were spatially correlated with the functional meta-analytic maps of familiarity and place, and replicated the previous evidence that the lesion topography maps are spatially correlated with belief-related functional networks. No association was found with control terms. These results reveal that structural disconnection putatively mediates functional changes associated with reduplicative paramnesias and provide a possible neural basis for the content specificity for places that characterizes these delusional beliefs.
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Affiliation(s)
- Pedro N Alves
- Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.
| | - Daniela P Silva
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Ana C Fonseca
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Isabel P Martins
- Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal; Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal; Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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13
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Rigoli F, Martinelli C, Pezzulo G. I want to believe: delusion, motivated reasoning, and Bayesian decision theory. Cogn Neuropsychiatry 2021; 26:408-420. [PMID: 34558392 DOI: 10.1080/13546805.2021.1982686] [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: 10/20/2022]
Abstract
Introduction: Several arguments suggest that motivated reasoning (occurring when beliefs are not solely shaped by accuracy, but also by other motives such as promoting self-esteem or self-protection) is important in delusions. However, classical theories of delusion disregard the role of motivated reasoning. Thus, this role remains poorly understood.Methods: To explore the role of motivated reasoning in delusions, here we propose a computational model of delusion based on a Bayesian decision framework. This proposes that beliefs are not only evaluated based on their accuracy (as in classical theories), but also based on the cost (in terms of reward and punishment) of rejecting them.Results: The model proposes that, when the values at stake are high (as often it is the case in the context of delusion), a belief might be endorsed because rejecting it is evaluated as too costly, even if the belief is less accurate. This process might contribute to the genesis of delusions.Conclusions: Our account offers an interpretation of how motivated reasoning might shape delusions. This can inspire research on the affective and motivational processes supporting delusions in clinical conditions such as in psychosis, neurological disorders, and delusional disorder.
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Affiliation(s)
- Francesco Rigoli
- Department of Psychology, City, University of London, Northampton Square, London, UK
| | - Cristina Martinelli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychology, Kingston University, Surrey, UK
| | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council of Italy, Rome, Italy
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14
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Takamiya A, Dols A, Emsell L, Abbott C, Yrondi A, Soriano Mas C, Jorgensen MB, Nordanskog P, Rhebergen D, van Exel E, Oudega ML, Bouckaert F, Vandenbulcke M, Sienaert P, Péran P, Cano M, Cardoner N, Jorgensen A, Paulson OB, Hamilton P, Kampe R, Bruin W, Bartsch H, Ousdal OT, Kessler U, van Wingen G, Oltedal L, Kishimoto T. Neural Substrates of Psychotic Depression: Findings From the Global ECT-MRI Research Collaboration. Schizophr Bull 2021; 48:514-523. [PMID: 34624103 PMCID: PMC8886602 DOI: 10.1093/schbul/sbab122] [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] [Indexed: 11/14/2022]
Abstract
Psychotic major depression (PMD) is hypothesized to be a distinct clinical entity from nonpsychotic major depression (NPMD). However, neurobiological evidence supporting this notion is scarce. The aim of this study is to identify gray matter volume (GMV) differences between PMD and NPMD and their longitudinal change following electroconvulsive therapy (ECT). Structural magnetic resonance imaging (MRI) data from 8 independent sites in the Global ECT-MRI Research Collaboration (GEMRIC) database (n = 108; 56 PMD and 52 NPMD; mean age 71.7 in PMD and 70.2 in NPMD) were analyzed. All participants underwent MRI before and after ECT. First, cross-sectional whole-brain voxel-wise GMV comparisons between PMD and NPMD were conducted at both time points. Second, in a flexible factorial model, a main effect of time and a group-by-time interaction were examined to identify longitudinal effects of ECT on GMV and longitudinal differential effects of ECT between PMD and NPMD, respectively. Compared with NPMD, PMD showed lower GMV in the prefrontal, temporal and parietal cortex before ECT; PMD showed lower GMV in the medial prefrontal cortex (MPFC) after ECT. Although there was a significant main effect of time on GMV in several brain regions in both PMD and NPMD, there was no significant group-by-time interaction. Lower GMV in the MPFC was consistently identified in PMD, suggesting this may be a trait-like neural substrate of PMD. Longitudinal effect of ECT on GMV may not explain superior ECT response in PMD, and further investigation is needed.
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Affiliation(s)
- Akihiro Takamiya
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan,Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Annemiek Dols
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Louise Emsell
- Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Christopher Abbott
- Department of Psychiatry, University of New Mexico, Albuquerque, NM, USA
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU Toulouse, Hospital Purpan, ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Carles Soriano Mas
- Department of Psychiatry, Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain,CIBERSAM, Carlos III Health Institute, Madrid, Spain,Department of Psychobiology and Methodology in Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Martin Balslev Jorgensen
- Psychiatric Centre Copenhagen, Copenhagen, Denmark,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pia Nordanskog
- Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
| | - Didi Rhebergen
- Mental Health Care Institute, GGZ Centraal, Amersfoort, the Netherlands
| | - Eric van Exel
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mardien L Oudega
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Filip Bouckaert
- Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Department of Neurosciences and Neuropsychiatry, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Pascal Sienaert
- Academic Center for ECT and Neurostimulation (AcCENT), University Psychiatric Center (UPC)—KU Leuven, Kortenberg, Belgium
| | - Patrice Péran
- ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - Marta Cano
- CIBERSAM, Carlos III Health Institute, Madrid, Spain,Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Barcelona, Spain,Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Narcis Cardoner
- Mental Health Department, Unitat de Neurociència Traslacional, Parc Tauli University Hospital, Institut d’Investigació i Innovació Sanitària Parc Taulí (I3PT), Barcelona, Spain
| | - Anders Jorgensen
- Psychiatric Centre Copenhagen, Copenhagen, Denmark,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Olaf B Paulson
- Neurobiological Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Paul Hamilton
- Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
| | - Robin Kampe
- Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience (CSAN), Linköping University, Linköping, Sweden
| | - Willem Bruin
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Hauke Bartsch
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway,Department of Research and Innovation, Haukeland University Hospital, Bergen, Norway,Department of Informatics, University of Bergen, Bergen, Norway
| | - Olga Therese Ousdal
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway,Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Ute Kessler
- Department of Clinical Medicine, University of Bergen, Bergen, Norway,Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands
| | - Leif Oltedal
- Department of Radiology, Mohn Medical Imaging and Visualization Centre, Haukeland University Hospital, Bergen, Norway,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan,To whom correspondence should be addressed; Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan; tel: +81-3-5363-3829; fax: +81-3-5379-0187; e-mail:
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15
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Lana Frankle BS. In defense of the one-factor doxastic account: A phenomenal account of delusions. Conscious Cogn 2021; 94:103181. [PMID: 34418637 DOI: 10.1016/j.concog.2021.103181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 05/04/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
According to the doxastic model, delusions are beliefs. In the metacognitive model, delusions are imaginings mistaken for beliefs. I argue that endorsement of false second-order beliefs could also create unpleasant dissonance, that mentally healthy people often endorse irrational or conflicting beliefs, and that the lack of delusion-motivated action can be explained by the influence of nonbelief factors on action. The two-factor doxastic model posits irrationality as necessary, and one metric of rationality many scholars employ is whether a response is easily understood by folk psychology. A precedent for folk-psychological acceptance of contextually bizarre beliefs as a result of personal experience can already be found in the lack of imaginative resistance encountered not in response to the impossibilities portrayed in speculative fiction, but in response to the characters' ability to incorporate these occurrences into their mental frameworks, despite them often being at odds with these characters' bedrock understanding of the world.
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Affiliation(s)
- B S Lana Frankle
- Kent State University, College of Arts and Sciences, School of Biomedical Sciences, 1275 University Esplanade, Kent, OH 44242, United States.
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16
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Naasan G, Shdo SM, Rodriguez EM, Spina S, Grinberg L, Lopez L, Karydas A, Seeley WW, Miller BL, Rankin KP. Psychosis in neurodegenerative disease: differential patterns of hallucination and delusion symptoms. Brain 2021; 144:999-1012. [PMID: 33501939 DOI: 10.1093/brain/awaa413] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023] Open
Abstract
Although psychosis is a defining feature of Lewy body disease, psychotic symptoms occur in a subset of patients with every major neurodegenerative disease. Few studies, however, have compared disease-related rates of psychosis prevalence in a large autopsy-based cohort, and it remains unclear how diseases differ with respect to the nature or content of the psychosis. We conducted a retrospective chart review of 372 patients with autopsy-confirmed neurodegenerative pathology: 111 with Alzheimer's disease, 59 with Lewy body disease and concomitant Alzheimer's disease, 133 with frontotemporal lobar degeneration (FTLD) with tau inclusions (including progressive supranuclear palsy, corticobasal degeneration or Pick's disease), and 69 with FTLD and TDP inclusions (FTLD-TDP, including types A-C). Psychosis content was classified by subtype, and the frequency of each subtype was compared among pathological diagnoses using logistic regression. A total of 111 of 372 patients had psychosis. Compared to other groups, patients with Lewy body disease/Alzheimer's disease pathology were significantly more likely to have hallucinations and were more likely to have more than one subtype of hallucination. Patients with Braak Parkinson stage 5-6 Lewy body disease were significantly more likely than those with no Lewy body disease to have visual hallucinations of misperception, peripheral hallucinations, hallucinations that moved, hallucinations of people/animals/objects, as well as delusions regarding a place and delusions of misidentification. The feeling of a presence occurred significantly more frequently in patients with Lewy body disease/Alzheimer's disease than all other pathologies. Patients with FTLD-TDP were significantly more likely to have delusions, and for the delusions to occur in the first 3 years of the disease, when compared to patients with Alzheimer's disease and FTLD-tau, though rates were not significantly greater than patients with Lewy body disease/Alzheimer's disease. Paranoia occurred more frequently in the FTLD-TDP and Lewy body disease/Alzheimer's disease categories compared to patients with Alzheimer's disease or FTLD-tau. Patients with FTLD-TDP pathology had delusions of misidentification as frequently as patients with Lewy body disease/Alzheimer's disease, and were significantly more likely to have self-elevating delusions such as grandiosity and erotomania compared to patients with other pathologies including FTLD-tau. These data show that the nature and content of psychosis can provide meaningful information about the underlying neurodegenerative pathology, emphasizing the importance of characterizing patients' psychoses for prediction of the neuropathological diagnosis, regardless of a patient's clinical syndrome.
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Affiliation(s)
- Georges Naasan
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Icahn School of Medicine, Mount Sinai, New York, NY, USA
| | - Suzanne M Shdo
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA.,Department of Psychology, University of California Berkeley, Berkeley, CA, USA
| | - Estrella Morenas Rodriguez
- Biomedizinisches Centrum (BMC), Biochemistry Chair, Ludwig-Maximilians-Universität and Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Munich, Germany
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lea Grinberg
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Lucia Lopez
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Anna Karydas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA, 94158, USA
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17
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Associations between long-term psychosis risk, probabilistic category learning, and attenuated psychotic symptoms with cortical surface morphometry. Brain Imaging Behav 2021; 16:91-106. [PMID: 34218406 DOI: 10.1007/s11682-021-00479-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 10/20/2022]
Abstract
Neuroimaging studies have consistently found structural cortical abnormalities in individuals with schizophrenia, especially in structural hubs. However, it is unclear what abnormalities predate psychosis onset and whether abnormalities are related to behavioral performance and symptoms associated with psychosis risk. Using surface-based morphometry, we examined cortical volume, gyrification, and thickness in a psychosis risk group at long-term risk for developing a psychotic disorder (n = 18; i.e., extreme positive schizotypy plus interview-rated attenuated psychotic symptoms [APS]) and control group (n = 19). Overall, the psychosis risk group exhibited cortical abnormalities in multiple structural hub regions, with abnormalities associated with poorer probabilistic category learning, a behavioral measure strongly associated with psychosis risk. For instance, the psychosis risk group had hypogyria in a right posterior midcingulate cortical hub and left superior parietal cortical hub, as well as decreased volume in a right pericalcarine hub. Morphometric measures in all of these regions were also associated with poorer probabilistic category learning. In addition to decreased right pericalcarine volume, the psychosis risk group exhibited a number of other structural abnormalities in visual network structural hub regions, consistent with previous evidence of visual perception deficits in psychosis risk. Further, severity of APS hallucinations, delusional ideation, and suspiciousness/persecutory ideas were associated with gyrification abnormalities, with all domains associated with hypogyria of the right lateral orbitofrontal cortex. Thus, current results suggest that structural abnormalities, especially in structural hubs, are present in psychosis risk and are associated both with poor learning on a psychosis risk-related task and with APS severity.
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18
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Abstract
INTRODUCTION In accounts of the two-factor theory of delusional belief, the second factor in this theory has been referred to only in the most general terms, as a failure in the processes of hypothesis evaluation, with no attempt to characterise those processes in any detail. Coltheart and Davies ([2021]. How unexpected observations lead to new beliefs: A Peircean pathway. Consciousness and Cognition, 87, 103037. https://doi.org/10.1016/j.concog.2020.103037) attempted such a characterisation, proposing a detailed eight-step model of how unexpected observations lead to new beliefs based on the concept of abductive inference as introduced by Charles Sanders Peirce. METHODS In this paper, we apply that model to the explanation of various forms of delusional belief. RESULTS We provide evidence that in cases of delusion there is a specific failure of the seventh step in our model: the step at which predictions from (delusional) hypotheses are considered in the light of relevant evidence. CONCLUSIONS In the two-factor theory of delusional belief, the second factor consists of a failure to reject hypotheses in the face of disconfirmatory evidence.
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Affiliation(s)
- Max Coltheart
- Department of Cognitive Science, Macquarie University, Sydney, 2109 NSW, Australia
| | - Martin Davies
- Corpus Christi College, Oxford OX1 4JF, UK.,Philosophy Department, Monash University, Clayton, 3800 VIC, Australia
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19
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Abstract
Introduction: Delusions demand an explanation in terms of their neural, psychological, and sociological mechanisms. We must bridge these levels of explanation in order to understand and ultimately treat delusions. To this end, debates continue as to the number of contributing factors, how those factors interact, and their underlying computational mechanisms.Methods: One popular family of models suggests that two separate insults are necessary, a problem with perception and an independent problem with belief. In particular, new work proposes that the belief problem entails a bias against disconfirmatory evidence - yielding the characteristic fixity of delusions. Here, we evaluate that claim, as well as explanations of delusions more broadly.Results: We suggest that such a bias may not explain enough of the variance in belief updating in delusional participants, and, more fundamentally, it might rule out specific accounts of delusions, since, such a bias might prevent them from forming in the first place, under particular assumptions about cognitive architectures.Conclusion: We suggest conceptualising delusions as an evolving uncertainty driven negotiation between beliefs and evidence, in which initial formation is fuelled by unexpected uncertainty, but, once formed, the delusion engenders new expectations about uncertainty that tune down updating but also facilitate the elastic assimilation of contradictory evidence.
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Affiliation(s)
- Philip R Corlett
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Paul Fletcher
- Department of Psychiatry, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.,Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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20
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Sakamoto K, Yokoi K, Kawakatsu S, Kobayashi R, Kunihiro K, Okada O, Sato Y, Otani K, Hirayama K. Delusions Without Hallucinations After Midbrain Infarction. J Neuropsychiatry Clin Neurosci 2021; 32:302-304. [PMID: 31564235 DOI: 10.1176/appi.neuropsych.19040097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kazutaka Sakamoto
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Kayoko Yokoi
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Shinobu Kawakatsu
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Ryota Kobayashi
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Kana Kunihiro
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Oyuki Okada
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Yuichiro Sato
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Koichi Otani
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
| | - Kazumi Hirayama
- The Department of Rehabilitation, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Sakamoto, Okada, Sato); the Department of Occupational Therapy, Graduate School of Health Sciences, Yamagata Prefectural University of Health Sciences, Yamagata City, Yamagata, Japan (Sakamoto, Yokoi, Hirayama); the Medical Center for Dementia, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kawakatsu, Kobayashi); the Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Tanisawa, Kawahigashi, Aizuwakamatsu City, Fukushima, Japan (Kawakatsu); the Department of Psychiatry, Yamagata University School of Medicine, Yamagata City, Yamagata, Japan (Kobayashi, Otani); and the Department of Neurosurgery, Shinoda General Hospital, Yamagata City, Yamagata, Japan (Kunihiro)
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21
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Alves PN, Fonseca AC, Silva DP, Andrade MR, Pinho-E-Melo T, Thiebaut de Schotten M, Martins IP. Unravelling the Neural Basis of Spatial Delusions After Stroke. Ann Neurol 2021; 89:1181-1194. [PMID: 33811370 DOI: 10.1002/ana.26079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Knowing explicitly where we are is an interpretation of our spatial representations. Reduplicative paramnesia is a disrupting syndrome in which patients present a firm belief of spatial mislocation. Here, we studied the largest sample of patients with delusional misidentifications of space (ie, reduplicative paramnesia) after stroke to shed light on their neurobiology. METHODS In a prospective, cumulative, case-control study, we screened 400 patients with acute right-hemispheric stroke. We included 64 cases and 233 controls. First, lesions were delimited and normalized. Then, we computed structural and functional disconnection maps using methods of lesion-track and network-mapping. The maps were compared, controlling for confounders. Second, we built a multivariate logistic model, including clinical, behavioral, and neuroimaging data. Finally, we performed a nested cross-validation of the model with a support-vector machine analysis. RESULTS The most frequent misidentification subtype was confabulatory mislocation (56%), followed by place reduplication (19%), and chimeric assimilation (13%). Our results indicate that structural disconnection is the strongest predictor of the syndrome and included 2 distinct streams, connecting right fronto-thalamic and right occipitotemporal structures. In the multivariate model, the independent predictors of reduplicative paramnesia were the structural disconnection map, lesion sparing of right dorsal fronto-parietal regions, age, and anosognosia. Good discrimination accuracy was demonstrated (area under the curve = 0.80 [0.75-0.85]). INTERPRETATION Our results localize the anatomic circuits that may have a role in the abnormal spatial-emotional binding and in the defective updating of spatial representations underlying reduplicative paramnesia. This novel data may contribute to better understand the pathophysiology of delusional syndromes after stroke. ANN NEUROL 2021;89:1181-1194.
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Affiliation(s)
- Pedro N Alves
- Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Ana C Fonseca
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Daniela P Silva
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Matilde R Andrade
- Institute of Psychiatry, Psychology and Neuroscience, King's College of London, University of London, London, UK
| | - Teresa Pinho-E-Melo
- Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
| | - Michel Thiebaut de Schotten
- Brain Connectivity and Behaviour Laboratory, Sorbonne Universities, Paris, France.,Groupe d'Imagerie Neurofonctionnelle, CEA, Univ. Bordeaux, CNRS, IMN, UMR 5293, Bordeaux, France
| | - Isabel P Martins
- Language Research Laboratory, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.,Department of Neurosciences and Mental Health, Neurology, Hospital de Santa Maria, CHULN, Lisbon, Portugal.,Instituto de Medicina Molecular João Lobo Antunes, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal
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22
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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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23
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Coltheart M, Davies M. How unexpected observations lead to new beliefs: A Peircean pathway. Conscious Cogn 2021; 87:103037. [DOI: 10.1016/j.concog.2020.103037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/25/2020] [Accepted: 10/10/2020] [Indexed: 11/24/2022]
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24
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Kim S, Kim S. Searching for General Model of Conspiracy Theories and Its Implication for Public Health Policy: Analysis of the Impacts of Political, Psychological, Structural Factors on Conspiracy Beliefs about the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E266. [PMID: 33396494 PMCID: PMC7796329 DOI: 10.3390/ijerph18010266] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 11/16/2022]
Abstract
Along with the spread of the COVID-19 pandemic, beliefs in conspiracy theories are spreading within and across countries. This study aims to analyze predictors of beliefs in conspiracy theories. Because previous studies have emphasized only specific political, psychological, or structural factors or variables, this study constructs an integrated analytical model that includes all three factors. We analyze data from a large-scale survey of Koreans (N = 1525) and find several results. First, political, psychological, and structural factors influence beliefs in conspiracy theories. Second, when we examine the specific influences of the variables, we find that authoritarianism, support for minority parties, religiosity, trust in SNS (social networking services), perceived risk, anxiety, negative emotions, blame attribution, the quantity of information, health status, and health after COVID-19, all positively influence beliefs in conspiracy theories. Conversely, support for President Moon Jae-In's government, Christianity, trust in the government, perceived control, analytic thinking, knowledge, the quality of information, and gender, all negatively impact these beliefs. Among the predictors, the quality of information, health status, support for President Moon Jae-In's government, perceived risk, and anxiety have the most decisive impacts on beliefs in conspiracy theories.
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Affiliation(s)
- Seoyong Kim
- Department of Public Administration, Ajou University, Suwon 16499, Korea;
| | - Sunhee Kim
- Department of Local Government Administration, Gangneung-Wonju National University, Gangneung-si 25457, Korea
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25
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Belli E, Nicoletti V, Radicchi C, Bonaccorsi J, Cintoli S, Ceravolo R, Tognoni G. Confabulations in Cases of Dementia: Atypical Early Sign of Alzheimer’s Disease or Misleading Feature in Dementia Diagnosis? Front Psychol 2020; 11:553886. [PMID: 33117224 PMCID: PMC7550794 DOI: 10.3389/fpsyg.2020.553886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/07/2020] [Indexed: 11/21/2022] Open
Abstract
Confabulations, also known as false memories, have been associated with various diseases involving mainly the frontal areas, such as Wernicke–Korsakoff syndrome or frontal epilepsy. The neuropsychological dysfunctions underlying mechanisms of confabulation are not well known. We describe two patients with memory impairment and confabulations at the onset speculating about neuropsychological correlates of confabulations and self-awareness. Both patients, a 77-year-old woman and a 57-years-old man, exhibited confabulations as first symptom of cognitive decline. She later developed memory impairment without awareness of her memory deficits and her cognitive and imaging profile suggested an amnesic mild cognitive impairment due to Alzheimer’s disease (AD). Unlike her, he developed a prevalent involvement of frontal functions despite a clear consciousness of his cognitive deficits. However, the clinical diagnostic hypothesis of behavioral variant of frontotemporal dementia was not supported by imaging findings, which suggested AD. Both patients underwent neuropsychological evaluation including the Confabulation Battery. Despite that the exact anatomical correlation of confabulations is still not defined, imaging data shown by our patients is consistent with recent theories according to which at the origin of confabulatory tendency in AD there is an impairment of the connections between crucial hubs in frontal and mediotemporal areas, mainly involving the right hemisphere. Besides, it would be reasonable to hypothesize that self-awareness and confabulations should not be considered as necessarily associated dimensions.
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26
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Nuara A, Nicolini Y, D'Orio P, Cardinale F, Rizzolatti G, Avanzini P, Fabbri-Destro M, De Marco D. Catching the imposter in the brain: The case of Capgras delusion. Cortex 2020; 131:295-304. [PMID: 32540160 DOI: 10.1016/j.cortex.2020.04.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/21/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
Here we describe a rare case of Capgras delusion - a misidentification syndrome characterized by the belief that a person has been replaced by an imposter - in a patient without evident neurological or psychiatric symptoms. Intriguingly, delusional belief was selective for both person and modality, as the patient believed that his son - not his daughter or other relatives - was substituted with an imposter only while being in presence of him and looking at his face, but not when merely listening to his voice. A neuroanatomical reconstruction obtained integrating morphological and functional patient's neuroimaging data highlighted two main peculiarities: a compression of the rostral portion of right temporal lobe due to a large arachnoid cyst, and a bilaterally reduced metabolism of frontal areas. Autonomic data obtained from thermal infra-red camera and skin conductance recordings showed that a higher sympathetic activation was evoked by the observation of daughter's face, relative to the observation of the son's face as well as of not-familiar faces; conversely, daughter and son voices elicited a similar sympathetic activation, higher relative to not-familiar voices, indicating a modality-dependent dissociation consistent with the delusional behavior. Our case supports the "two-hit hypothesis" about Capgras delusion etiopathogenesis: here, the first hit is represented by the right-temporal lesion impairing the association between familiar faces and emotional values, the second one is the frontal bilateral hypometabolism favoring delusional behavior. The selective occurrence of "imposter" delusion for a particular subject and for a specific perceptual modality suggests the involvement of modality-specific interactions in the retrieval of affective properties during familiar people recognition.
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Affiliation(s)
- Arturo Nuara
- CNR Neuroscience Institute, Parma, Italy; Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Italy.
| | - Ylenia Nicolini
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, Italy
| | - Piergiorgio D'Orio
- CNR Neuroscience Institute, Parma, Italy; «Claudio Munari» Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
| | - Francesco Cardinale
- «Claudio Munari» Centre for Epilepsy Surgery, ASST GOM Niguarda, Milan, Italy
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27
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Affiliation(s)
- Ema Sullivan-Bissett
- Department of Philosophy, Ema Sullivan-Bissett is at University of Birmingham, Birmingham, UK
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28
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Connors MH, Halligan PW. Delusions and theories of belief. Conscious Cogn 2020; 81:102935. [DOI: 10.1016/j.concog.2020.102935] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 03/28/2020] [Accepted: 04/08/2020] [Indexed: 02/01/2023]
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29
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D'Antonio F, Di Vita A, Zazzaro G, Brusà E, Trebbastoni A, Campanelli A, Ferracuti S, de Lena C, Guariglia C, Boccia M. Psychosis of Alzheimer's disease: Neuropsychological and neuroimaging longitudinal study. Int J Geriatr Psychiatry 2019; 34:1689-1697. [PMID: 31368183 DOI: 10.1002/gps.5183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 07/28/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Psychosis of Alzheimer's disease (AD) may represent a distinct disease phenotype; however, neuropsychological profile and neural basis linked to this phenotype have not yet been clarified. In this study, we aimed at detecting whether impairment in specific cognitive domains predicts the onset of psychosis in AD patients and what grey matter alterations, their location, and the rate of atrophy are associated with psychosis of AD. METHODS Longitudinal neuropsychological data from AD patients with and without psychosis were analysed to determine whether the neuropsychological profile can predict the onset of psychosis. A voxel-based morphometry (VBM) on longitudinal T1-weighted images was used to explore differences in grey matter volume and in the rate of atrophy between groups. RESULTS Noncognitive domain predicted the psychosis onset. However, AD patients with psychosis exhibited greater atrophy in the right anterior-inferior temporal lobe, including the fusiform gyrus (cluster-p-family-wise error [pfwe] < 0.05; peak-p uncorrected [pUNC] < 0.001) as well as greater rate of atrophy in the right insula than nonpsychotic patients (cluster-pFWE = 0.075; peak-pUNC < 0.001). The anterior-inferior temporal lobe is part of the ventral visual stream, and the insula plays a key role in the salience network. CONCLUSIONS This finding suggests that damage in these areas underpins an impairment in the visual processing of the objects and an impairment in the attribution of salience to the misperceived stimuli, which in turn leads to the onset of psychosis. These findings tie in well with the neuropsychological model of psychosis, according to which the simultaneous presence of two factors, namely misperception and misattribution, underlies psychosis in dementia.
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Affiliation(s)
- Fabrizia D'Antonio
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,PhD Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Antonella Di Vita
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Giulia Zazzaro
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Erica Brusà
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | | | | | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Carlo de Lena
- Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Cecilia Guariglia
- Department of Psychology, Sapienza University of Rome, Rome, Italy.,Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Maddalena Boccia
- Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome, Italy
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30
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Abstract
Introduction: In this paper we present and defend a hybrid theory of the development of delusions that incorporates the central ideas of two influential (yet sometimes bitterly opposing) theoretical approaches to delusions-the two-factor theory and the prediction error theory. Method: After introducing the central ideas of the two-factor theory and the prediction error theory, we describe the motivations for our conciliatory project, explain the theoretical details of the hybrid theory we propose, and answer potential objections to our proposal. Results: According to the hybrid theory we advance, the first factor of a delusion is physically grounded in an abnormal prediction error, and the second factor is physically grounded in the overestimation of the precision of the abnormal prediction error. Against anticipated objections, we argue that the hybrid theory is internally coherent, and that it constitutes a genuine hybrid between the two-factor theory and the prediction error theory. Conclusion: A rapprochement between the two-factor theory and the prediction error theory is both possible and desirable. In particular, our hybrid theory provides a parsimonious and unified account of delusions, whether monothematic or polythematic, across a wide variety of medical conditions.
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Affiliation(s)
- Kengo Miyazono
- Graduate School of Integrated Arts and Sciences, Hiroshima University , Higashi-Hiroshima City , Japan
| | - Ryan McKay
- Department of Psychology, Royal Holloway, University of London , Egham , UK
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31
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Bronstein MV, Pennycook G, Joormann J, Corlett PR, Cannon TD. Dual-process theory, conflict processing, and delusional belief. Clin Psychol Rev 2019; 72:101748. [PMID: 31226640 DOI: 10.1016/j.cpr.2019.101748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/25/2019] [Accepted: 06/11/2019] [Indexed: 01/10/2023]
Abstract
Many reasoning biases that may contribute to delusion formation and/or maintenance are common in healthy individuals. Research indicating that reasoning in the general population proceeds via analytic processes (which depend upon working memory and support hypothetical thought) and intuitive processes (which are autonomous and independent of working memory) may therefore help uncover the source of these biases. Consistent with this possibility, recent studies imply that impaired conflict processing might reduce engagement in analytic reasoning, thereby producing reasoning biases and promoting delusions in individuals with schizophrenia. Progress toward understanding this potential pathway to delusions is currently impeded by ambiguity about whether any of these deficits or biases is necessary or sufficient for the formation and maintenance of delusions. Resolving this ambiguity requires consideration of whether particular cognitive deficits or biases in this putative pathway have causal primacy over other processes that may also participate in the causation of delusions. Accordingly, the present manuscript critically evaluates whether impaired conflict processing is the primary initiating deficit in the generation of reasoning biases that may promote the development and/or maintenance of delusions. Suggestions for future research that may elucidate mechanistic pathways by which reasoning deficits might engender and maintain delusions are subsequently offered.
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Affiliation(s)
- Michael V Bronstein
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA.
| | - Gordon Pennycook
- Hill/Levene Schools of Business, University of Regina, Regina, Saskatchewan, Canada
| | - Jutta Joormann
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA
| | - Philip R Corlett
- Department of Psychiatry, Yale University, 300 George Street, New Haven, CT, USA
| | - Tyrone D Cannon
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT, USA; Department of Psychiatry, Yale University, 300 George Street, New Haven, CT, USA
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32
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Van Assche L, Van Aubel E, Van de Ven L, Bouckaert F, Luyten P, Vandenbulcke M. The Neuropsychological Profile and Phenomenology of Late Onset Psychosis: A Cross-sectional Study on the Differential Diagnosis of Very-Late-Onset Schizophrenia-Like Psychosis, Dementia with Lewy Bodies and Alzheimer's Type Dementia with Psychosis. Arch Clin Neuropsychol 2019; 34:183-199. [PMID: 29635309 DOI: 10.1093/arclin/acy034] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 03/27/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Late onset psychosis not only occurs as a prodromal symptom to neurodegeneration, but it can also be associated with a non-progressive mild cognitive deficit. Studying the phenomenology of psychotic symptoms and the neuropsychological profile may serve as sensitive and non-invasive tools for differential diagnosis. Method We compared 57 individuals with very-late-onset schizophrenia-like psychosis (VLOSLP), 49 participants with Dementia with Lewy Bodies (DLB) and 35 patients with Alzheimer's type Dementia and psychosis (AD+P) concerning the phenomenology of psychotic symptoms and the neuropsychological profile using several measures of cognitive function in a cross-sectional study. Results Participants with DLB exhibited more visual hallucinations, especially those involving animals, and less partition/paranoid delusions than both other groups. VLOSLP showed more partition delusions and auditory hallucinations of human voices than both other groups. Hence, patients with DLB and VLOSLP showed greater dissimilarity in the phenomenology of psychosis, whereas individuals with AD+P held an intermediate position. Processing speed and executive function were comparably impaired among the three groups, as was expected considering a common underlying set of neurobiological abnormalities for psychosis. However, AD+P showed more strongly reduced learning and consolidation skills, whereas DLB was associated with prominent visuoconstructive deficits. Conclusions Phenomenology of psychosis may prove especially informative when comparing individuals with DLB to those with VLOSLP. Neuropsychological profiles are able to further aid differential diagnosis of the three groups.
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Affiliation(s)
- Lies Van Assche
- Section of Old Age Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Leuven, Belgium
| | - Evelyne Van Aubel
- Section of Old Age Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Leuven, Belgium
| | - Lucas Van de Ven
- Section of Old Age Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Leuven, Belgium
| | - Filip Bouckaert
- Section of Old Age Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Leuven, Belgium
| | - Patrick Luyten
- Department of Psychology, University of Leuven, Leuven, Belgium.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mathieu Vandenbulcke
- Section of Old Age Psychiatry, Department of Psychiatry, University Hospitals Leuven, KUL, Leuven, Belgium
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33
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Corp DT, Joutsa J, Darby RR, Delnooz CCS, van de Warrenburg BPC, Cooke D, Prudente CN, Ren J, Reich MM, Batla A, Bhatia KP, Jinnah HA, Liu H, Fox MD. Network localization of cervical dystonia based on causal brain lesions. Brain 2019; 142:1660-1674. [PMID: 31099831 PMCID: PMC6536848 DOI: 10.1093/brain/awz112] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/27/2019] [Accepted: 02/24/2019] [Indexed: 12/12/2022] Open
Abstract
Cervical dystonia is a neurological disorder characterized by sustained, involuntary movements of the head and neck. Most cases of cervical dystonia are idiopathic, with no obvious cause, yet some cases are acquired, secondary to focal brain lesions. These latter cases are valuable as they establish a causal link between neuroanatomy and resultant symptoms, lending insight into the brain regions causing cervical dystonia and possible treatment targets. However, lesions causing cervical dystonia can occur in multiple different brain locations, leaving localization unclear. Here, we use a technique termed 'lesion network mapping', which uses connectome data from a large cohort of healthy subjects (resting state functional MRI, n = 1000) to test whether lesion locations causing cervical dystonia map to a common brain network. We then test whether this network, derived from brain lesions, is abnormal in patients with idiopathic cervical dystonia (n = 39) versus matched controls (n = 37). A systematic literature search identified 25 cases of lesion-induced cervical dystonia. Lesion locations were heterogeneous, with lesions scattered throughout the cerebellum, brainstem, and basal ganglia. However, these heterogeneous lesion locations were all part of a single functionally connected brain network. Positive connectivity to the cerebellum and negative connectivity to the somatosensory cortex were specific markers for cervical dystonia compared to lesions causing other neurological symptoms. Connectivity with these two regions defined a single brain network that encompassed the heterogeneous lesion locations causing cervical dystonia. These cerebellar and somatosensory regions also showed abnormal connectivity in patients with idiopathic cervical dystonia. Finally, the most effective deep brain stimulation sites for treating dystonia were connected to these same cerebellar and somatosensory regions identified using lesion network mapping. These results lend insight into the causal neuroanatomical substrate of cervical dystonia, demonstrate convergence across idiopathic and acquired dystonia, and identify a network target for dystonia treatment.
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Affiliation(s)
- Daniel T Corp
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Cognitive Neuroscience Unit, School of Psychology, Deakin University, 221 Burwood Highway, Burwood, VIC, Australia
| | - Juho Joutsa
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Department of Neurology, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | - R Ryan Darby
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Division of Cognitive and Behavioral Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Bart P C van de Warrenburg
- Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Danielle Cooke
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Jianxun Ren
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Martin M Reich
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Deparment of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Amit Batla
- UCL Institute of Neurology, Queen Square, London, UK
| | - Kailash P Bhatia
- Sobell Department of Movement Neuroscience, Institute of Neurology, UCL, National Hospital for Neurology, Queen Square, London, UK
| | - Hyder A Jinnah
- Department of Neurology, Emory University, Atlanta, Georgia, USA
| | - Hesheng Liu
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
| | - Michael D Fox
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, USA
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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34
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Abstract
Corlett (Corlett, P. (this issue). Factor one, familiarity and frontal cortex: A challenge to the two-factor theory of delusions. Cognitive Neuropsychiatry) provides a robust critique of the two-factor theory of delusions. The heart of his critique is two challenges he derives from a paper by Tranel and Damasio (Tranel, D., & Damasio, H. (1994). Neuroanatomical correlates of electrodermal skin conductance responses. Psychophysiology, 31(5), 427-438), who illuminate the autonomic responses and brain damage of four patients often cited in support of the two-factor theory of Capgras delusion. I defend the two-factor theory against Corlett's two key challenges, arguing that his first challenge has been previously addressed, and that his second challenge is overstated. In my view, these challenges do not negate the two-factor account. Nevertheless, two-factor theorists - and computational psychiatrists - should continue to devise and test falsifiable predictions of their respective theories.
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Affiliation(s)
- Ryan McKay
- a Department of Psychology , Royal Holloway, University of London , Egham , UK
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35
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Corlett PR. Factor one, familiarity and frontal cortex: a challenge to the two-factor theory of delusions. Cogn Neuropsychiatry 2019; 24:165-177. [PMID: 31010382 PMCID: PMC6686846 DOI: 10.1080/13546805.2019.1606706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Two-factor theory suggests delusions require two neuropsychological impairments, one in perception (which furnishes content), and a second in belief evaluation (that augers formation and maintenance). Capgras delusion; the belief that one's loved one has been replaced by an imposter, then entails two independent processes; first a lack of skin conductance response to familiar faces so the loved one feels different. This has been demonstrated in four patients with damage to the ventromedial prefrontal cortex (vmPFC) but who do not have delusions. Thus two-factor theorists demand a second factor: a change in belief evaluation, which is associated with damage to the right dorsolateral prefrontal cortex (rDLPFC). METHODS Literature review of foundational and related papers on the cognitive neuropsychology of delusions, perception and belief. RESULTS The four vmPFC patients appear together in another publication, uncited by two-factor theorists, in which the full extent of their damage is documented. These four cases not only lack skin responses to familiar faces, but lack responses to salient psychological stimuli more generally, which challenges factor one. They also have damage outside vmPFC, including damage to rDLPFC, which challenges factor two. CONCLUSION Two-factor theory is found lacking and should be reappraised.
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Affiliation(s)
- Philip R. Corlett
- Department of Psychiatry, Yale University, School of Medicine. New Haven, CT, USA,Corresponding author.
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36
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Tan EJ, Fletcher K, Rossell SL. Exploring the relationship between fantasy proneness and delusional beliefs in psychosis and non-clinical individuals. Psychiatry Res 2019; 272:80-85. [PMID: 30579186 DOI: 10.1016/j.psychres.2018.12.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/19/2018] [Accepted: 12/16/2018] [Indexed: 12/15/2022]
Abstract
Delusions are a core feature of psychopathology while fantasy proneness (FP) is a trait that describes a predisposition towards fantastical thinking, vivid mental imagery and an overactive imagination. The relationship between FP and delusional experiences has not yet been examined in the literature. The current study hypothesised that FP would be significantly associated with and predict delusion severity as well as the associated delusional distress, preoccupation and conviction. Ninety-five patients with current psychosis (schizophrenia and bipolar I disorder) were assessed for overall delusional severity using the PANSS (clinician-rated) and the Peters Delusions Inventory (PDI; self-report). FP was assessed using the Creative Experiences Questionnaire (CEQ). Forty-six healthy control participants also completed the PDI and CEQ. Significant positive correlations were observed between FP and delusion severity in both groups; and distress, preoccupation and conviction in patients only. Linear regression analyses, controlling for manic and depressive symptoms, revealed that greater FP predicted higher levels of severity, distress, preoccupation, and conviction associated with delusions in patients, and higher severity only in healthy controls. The findings highlight the role of specific cognitive biases in delusional experiences, and empirically support models of unusual belief formation and maintenance.
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Affiliation(s)
- Eric J Tan
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, VIC, Australia.
| | - Kathryn Fletcher
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia; St Vincent's Mental Health Service, St Vincent's Hospital, Melbourne, VIC, Australia
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37
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Abstract
Capgras syndrome is one of a variety of delusional misidentification syndromes that can be associated with acute ischemic stroke, neurodegenerative disease, or metabolic conditions. Most cases reported in the literature are associated with frontal and/or parietal lobe involvement. Transient Capgras syndrome is rare but has been reported. We present a case of transient Capgras syndrome following bilateral cerebral ischemic infarcts in the frontal, parietal, and temporal regions, and involving the right prefrontal cortex. To our knowledge, transient Capgras syndrome with rapid resolution over a period of days is rare.
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38
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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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39
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"Capgras" Delusions Involving Belongings, Not People, and Evolving Visual Hallucinations Associated with Occipital Lobe Seizures. Case Rep Psychiatry 2018; 2018:1459869. [PMID: 29707400 PMCID: PMC5863322 DOI: 10.1155/2018/1459869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/18/2018] [Accepted: 02/06/2018] [Indexed: 11/17/2022] Open
Abstract
Capgras syndrome is characterized by the delusional belief that a familiar person has been replaced by a visually similar imposter or replica. Rarely, the delusional focus may be objects rather than people. Numerous etiologies have been described for Capgras to include seizures. Similarly, visual hallucinations, both simple and complex, can occur secondary to seizure activity. We present, to our knowledge, the first reported case of visual hallucinations and Capgras delusions for objects that developed secondary to new onset occipital lobe epilepsy. We then discuss the possible underlying neurologic mechanisms responsible for the symptomatology.
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40
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Sottile F, De Luca R, Bonanno L, Finzi G, Casella C, Calabrò RS. Cotard's Syndrome Triggered by Fear in a Patient with Intellectual Disability: Causal or Casual Link? Issues Ment Health Nurs 2018; 39:353-356. [PMID: 29436880 DOI: 10.1080/01612840.2017.1417520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cotard's syndrome is a neuropsychiatric disease characterized by a variety of nihilistic delusions, commonly associated with several psychotic and major affective disorders, and neurological diseases, including stroke, dementia, and mental retardation. A 39-year-old male with mental retardation developed Cotard's syndrome, following an important episode of fear. During admission to our neurological unit, the patient underwent an accurate assessment, including neuroradiological, clinical, and neuropsychological examinations. At the psychiatric evaluation, he presented nihilistic delusions, in which he negated the existence of his body parts and the existence of his family members. The neuropsychological assessment ruled out other possible causes of misidentification, including the post-traumatic stress disorder. Thus, since also organic causes of Cotard's syndrome were excluded, the correlation between fear and the syndrome has been postulated and the patient opportunely treated, using a multidisciplinary approach. Our case suggests that in predisposed individuals negative emotions, including fear, may lead to delusional syndromes.
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Affiliation(s)
| | | | - Lilla Bonanno
- a IRCCS Centro Neurolesi "Bonino-Pulejo" , Messina , Italy
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41
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Huber M, Wolf RC, Lepping P, Kirchler E, Karner M, Sambataro F, Herrnberger B, Corlett PR, Freudenmann RW. Regional gray matter volume and structural network strength in somatic vs. non-somatic delusional disorders. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:115-122. [PMID: 29180231 DOI: 10.1016/j.pnpbp.2017.11.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/11/2017] [Accepted: 11/23/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Monothematic delusional disorders are characterized by a single tenacious belief. They provide a great opportunity to study underlying brain structures in the absence of confounding symptoms that accompany delusions in schizophrenia. Delusional beliefs include persecution, jealousy or somatic delusions including infestation. It is unclear whether specific delusional content is associated with distinct neural substrates. METHODS We used magnetic resonance imaging in patients presenting with somatic vs. non-somatic delusional disorders. Patients with delusional infestation (DI, n=18), and individuals with non-somatic delusional disorders (n=19) were included, together with healthy volunteers (n=20). Uni- and multivariate techniques for structural data analysis were applied to provide a comprehensive characterization of abnormal brain volume at both the regional and neural network level. RESULTS Patients with DI showed lower gray matter volume in thalamic, striatal (putamen), insular and medial prefrontal brain regions in contrast to non-somatic delusional disorders and healthy controls. Importantly, these differences were consistently detected at regional and network level. Compared to healthy controls, patients with delusional disorders other than DI showed lower gray matter volume in temporal cortical regions. CONCLUSION The data support the notion that dysfunctional somatosensory and peripersonal networks could mediate somatic delusions in patients with DI in contrast to delusional disorders without somatic content. The data also suggest putative content-specific neural signatures in delusional disorders and in delusion formation per se.
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Affiliation(s)
- Markus Huber
- Department of Psychiatry, General Hospital Bruneck, South Tyrol, Italy
| | - Robert Christian Wolf
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Germany.
| | - Peter Lepping
- Betsi Cadwaladr University Health Board, Maelor Hospital, Centre for Mental Health and Society, Wrexham, Wales, UK
| | - Erwin Kirchler
- Department of Psychiatry, General Hospital Bruneck, South Tyrol, Italy
| | - Martin Karner
- Department of Radiology, General Hospital Bruneck, South Tyrol, Italy
| | - Fabio Sambataro
- Department of Experimental & Clinical Medical Sciences, Udine University, Italy
| | | | - Philip R Corlett
- Department of Psychiatry, Yale University, Connecticut Mental Health Center, New Haven, CT, USA
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42
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McLachlan E, Bousfield J, Howard R, Reeves S. Reduced parahippocampal volume and psychosis symptoms in Alzheimer's disease. Int J Geriatr Psychiatry 2018; 33:389-395. [PMID: 28741694 DOI: 10.1002/gps.4757] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/31/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Establishing structural imaging correlates of psychosis symptoms in Alzheimer's disease (AD) could localise pathology and target symptomatic treatment. This study investigated whether psychosis symptoms are associated with visuoperceptual or frontal networks, and whether regional brain volume differences could be linked with the paranoid (persecutory delusions) or misidentification (misidentification phenomena and/or hallucinations) subtypes. METHODS A total of 104 patients with probable AD (AddNeuroMed; 47 psychotic, 57 non-psychotic), followed up for at least one year with structural MRI at baseline. Presence and subtype of psychosis symptoms were established using the Neuropsychiatric Inventory. Volume and cortical thickness measures in visuoperceptual and frontal networks were explored using multivariate analyses to compare with both a global (psychotic versus not) and subtype-specific approach, adjusting for potential confounding factors. RESULTS There was a significant main effect of psychosis subtypes on the ventral visual stream region of interest (F30,264 = 1.65, p = 0.021, np2 = 0.16). This was explained by reduced left parahippocampal gyrus volume (F1,97 = 11.1, p = 0.001, np2 = 0.10). When comparisons were made across psychosis subtypes, left parahippocampal volume reduction remained significant (F7,95 = 3.94, p = 0.011, np2 = 0.11) and was greatest for the misidentification and mixed subtypes compared to paranoid and non-psychotic groups. CONCLUSIONS These findings implicate the ventral visual stream in psychosis in AD, consistent with integrative theories regarding origins of psychosis, and provide further evidence for a role in the misidentification subtype. Specifically, reduced volume in the parahippocampal gyrus is implicated in misidentification delusion formation, which we hypothesise is due to its role in context attribution. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Emma McLachlan
- Department of Old Age Psychiatry, King's College London, UK.,Division of Psychiatry, University College London, UK
| | | | - Robert Howard
- Department of Old Age Psychiatry, King's College London, UK.,Division of Psychiatry, University College London, UK
| | - Suzanne Reeves
- Department of Old Age Psychiatry, King's College London, UK.,Division of Psychiatry, University College London, UK
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43
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Van Assche L, Morrens M, Luyten P, Van de Ven L, Vandenbulcke M. The neuropsychology and neurobiology of late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: A critical review. Neurosci Biobehav Rev 2017; 83:604-621. [DOI: 10.1016/j.neubiorev.2017.08.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/25/2017] [Accepted: 08/30/2017] [Indexed: 01/20/2023]
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44
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Parlikar R, Dinakaran D, Bose A, Rao NP, Venkatasubramanian G. Neural Basis of Delusions in Schizophrenia: Translational Implications for Therapeutic Neuromodulation. J Indian Inst Sci 2017. [DOI: 10.1007/s41745-017-0058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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45
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Affiliation(s)
- Paul C Fletcher
- a Department of Psychiatry , University of Cambridge , Cambridge , UK
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46
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van Schalkwyk GI, Volkmar FR, Corlett PR. A Predictive Coding Account of Psychotic Symptoms in Autism Spectrum Disorder. J Autism Dev Disord 2017; 47:1323-1340. [PMID: 28185044 DOI: 10.1007/s10803-017-3065-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The co-occurrence of psychotic and autism spectrum disorder (ASD) symptoms represents an important clinical challenge. Here we consider this problem in the context of a computational psychiatry approach that has been applied to both conditions-predictive coding. Some symptoms of schizophrenia have been explained in terms of a failure of top-down predictions or an enhanced weighting of bottom-up prediction errors. Likewise, autism has been explained in terms of similar perturbations. We suggest that this theoretical overlap may explain overlapping symptomatology. Experimental evidence highlights meaningful distinctions and consistencies between these disorders. We hypothesize individuals with ASD may experience some degree of delusions without the presence of any additional impairment, but that hallucinations are likely indicative of a distinct process.
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Affiliation(s)
| | - Fred R Volkmar
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Philip R Corlett
- Department of Psychiatry, Clinical Neuroscience Research Unit, Connecticut Mental Health Center, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06510, USA
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47
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Anandakumar T, Connaughton E, Coltheart M, Langdon R. Belief-bias reasoning in non-clinical delusion-prone individuals. J Behav Ther Exp Psychiatry 2017; 56:71-78. [PMID: 28318497 DOI: 10.1016/j.jbtep.2017.02.005] [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: 05/11/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES It has been proposed that people with delusions have difficulty inhibiting beliefs (i.e., "doxastic inhibition") so as to reason about them as if they might not be true. We used a continuity approach to test this proposal in non-clinical adults scoring high and low in psychometrically assessed delusion-proneness. High delusion-prone individuals were expected to show greater difficulty than low delusion-prone individuals on "conflict" items of a "belief-bias" reasoning task (i.e. when required to reason logically about statements that conflicted with reality), but not on "non-conflict" items. METHODS Twenty high delusion-prone and twenty low delusion-prone participants (according to the Peters et al. Delusions Inventory) completed a belief-bias reasoning task and tests of IQ, working memory and general inhibition (Excluded Letter Fluency, Stroop and Hayling Sentence Completion). RESULTS High delusion-prone individuals showed greater difficulty than low delusion-prone individuals on the Stroop and Excluded Letter Fluency tests of inhibition, but no greater difficulty on the conflict versus non-conflict items of the belief-bias task. They did, however, make significantly more errors overall on the belief-bias task, despite controlling for IQ, working memory and general inhibitory control. LIMITATIONS The study had a relatively small sample size and used non-clinical participants to test a theory of cognitive processing in individuals with clinically diagnosed delusions. CONCLUSIONS Results failed to support a role for doxastic inhibitory failure in non-clinical delusion-prone individuals. These individuals did, however, show difficulty with conditional reasoning about statements that may or may not conflict with reality, independent of any general cognitive or inhibitory deficits.
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Affiliation(s)
- T Anandakumar
- Department of Psychology, Macquarie University, NSW 2109, Australia; Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
| | - E Connaughton
- Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
| | - M Coltheart
- Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
| | - R Langdon
- Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
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48
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Abstract
A comprehensive understanding of psychosis requires models that link multiple levels of explanation: the neurobiological, the cognitive, the subjective, and the social. Until we can bridge several explanatory gaps, it is difficult to explain how neurobiological perturbations can manifest in bizarre beliefs or hallucinations, or how trauma or social adversity can perturb lower-level brain processes. We propose that the predictive processing framework has much to offer in this respect. We show how this framework may underpin and complement source monitoring theories of delusions and hallucinations and how, when considered in terms of a dynamic and hierarchical system, it may provide a compelling model of several key clinical features of psychosis. We see little conflict between source monitoring theories and predictive coding. The former act as a higher-level description of a set of capacities, and the latter aims to provide a deeper account of how these and other capacities may emerge.
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Affiliation(s)
- Juliet D Griffin
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom; ,
| | - Paul C Fletcher
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, United Kingdom; ,
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49
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Anandakumar T, Connaughton E, Coltheart M, Langdon R. Belief-bias reasoning in non-clinical delusion-prone individuals. J Behav Ther Exp Psychiatry 2017; 54:211-218. [PMID: 27614050 DOI: 10.1016/j.jbtep.2016.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES It has been proposed that people with delusions have difficulty inhibiting beliefs (i.e., "doxastic inhibition") so as to reason about them as if they might not be true. We used a continuity approach to test this proposal in non-clinical adults scoring high and low in psychometrically assessed delusion-proneness. High delusion-prone individuals were expected to show greater difficulty than low delusion-prone individuals on "conflict" items of a "belief-bias" reasoning task (i.e. when required to reason logically about statements that conflicted with reality), but not on "non-conflict" items. METHODS Twenty high delusion-prone and twenty low delusion-prone participants (according to the Peters et al. Delusions Inventory) completed a belief-bias reasoning task and tests of IQ, working memory and general inhibition (Excluded Letter Fluency, Stroop and Hayling Sentence Completion). RESULTS High delusion-prone individuals showed greater difficulty than low delusion-prone individuals on the Stroop and Excluded Letter Fluency tests of inhibition, but no greater difficulty on the conflict versus non-conflict items of the belief-bias task. They did, however, make significantly more errors overall on the belief-bias task, despite controlling for IQ, working memory and general inhibitory control. LIMITATIONS The study had a relatively small sample size and used non-clinical participants to test a theory of cognitive processing in individuals with clinically diagnosed delusions. CONCLUSIONS Results failed to support a role for doxastic inhibitory failure in non-clinical delusion-prone individuals. These individuals did, however, show difficulty with conditional reasoning about statements that may or may not conflict with reality, independent of any general cognitive or inhibitory deficits.
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Affiliation(s)
- T Anandakumar
- Department of Psychology, Macquarie University, NSW 2109, Australia; Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
| | - E Connaughton
- Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
| | - M Coltheart
- Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
| | - R Langdon
- Department of Cognitive Science, Macquarie University, NSW 2109, Australia; ARC Centre of Excellence in Cognition and its Disorders, NSW 2109, Australia.
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50
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Darby RR, Laganiere S, Pascual-Leone A, Prasad S, Fox MD. Finding the imposter: brain connectivity of lesions causing delusional misidentifications. Brain 2017; 140:497-507. [PMID: 28082298 DOI: 10.1093/brain/aww288] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 11/14/2022] Open
Abstract
SEE MCKAY AND FURL DOI101093/AWW323 FOR A SCIENTIFIC COMMENTARY ON THIS ARTICLE: Focal brain injury can sometimes lead to bizarre symptoms, such as the delusion that a family member has been replaced by an imposter (Capgras syndrome). How a single brain lesion could cause such a complex disorder is unclear, leading many to speculate that concurrent delirium, psychiatric disease, dementia, or a second lesion is required. Here we instead propose that Capgras and other delusional misidentification syndromes arise from single lesions at unique locations within the human brain connectome. This hypothesis is motivated by evidence that symptoms emerge from sites functionally connected to a lesion location, not just the lesion location itself. First, 17 cases of lesion-induced delusional misidentifications were identified and lesion locations were mapped to a common brain atlas. Second, lesion network mapping was used to identify brain regions functionally connected to the lesion locations. Third, regions involved in familiarity perception and belief evaluation, two processes thought to be abnormal in delusional misidentifications, were identified using meta-analyses of previous functional magnetic resonance imaging studies. We found that all 17 lesion locations were functionally connected to the left retrosplenial cortex, the region most activated in functional magnetic resonance imaging studies of familiarity. Similarly, 16 of 17 lesion locations were functionally connected to the right frontal cortex, the region most activated in functional magnetic resonance imaging studies of expectation violation, a component of belief evaluation. This connectivity pattern was highly specific for delusional misidentifications compared to four other lesion-induced neurological syndromes (P < 0.0001). Finally, 15 lesions causing other types of delusions were connected to expectation violation (P < 0.0001) but not familiarity regions, demonstrating specificity for delusion content. Our results provide potential neuroanatomical correlates for impaired familiarity perception and belief evaluation in patients with delusional misidentifications. More generally, we demonstrate a mechanism by which a single lesion can cause a complex neuropsychiatric syndrome based on that lesion's unique pattern of functional connectivity, without the need for pre-existing or hidden pathology.
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Affiliation(s)
- R Ryan Darby
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA .,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, McLean Psychiatric Hospital, Harvard Medical School, Belmont, MA, USA
| | - Simon Laganiere
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alvaro Pascual-Leone
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sashank Prasad
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael D Fox
- Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Centre for Biomedical Imaging, Charlestown, MA, USA
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