Psychotic symptoms in social anxiety disorder patients: report of three cases

"Truman syndrome" induced by online education: A case report in adolescent-Onset psychosis

Early-onset schizophrenia (EOS) is an important psychiatric problem characterized by the onset of psychotic symptoms before the age of 18 years. We present the case of a 14-year-old girl who had social anxiety symptoms in the premorbid period and whose psychotic symptoms increased with pandemic restrictions and online education. Our patient's distance from the peer environment and school as well as the fact that she used webcams and online education more frequently in her daily life were risk factors for EOS. In accordance with the case of Truman syndrome, she has delusions that her daily life is secretly filmed and that she is a "TV star." Anti-anxiety treatments were initiated during the pre-pandemic period. After a diagnosis of schizophrenia was made, antipsychotic treatment was initiated. A significant response was observed after paliperidone (extended release) treatment. Close follow-ups revealed decreased delusions and increased functionality. Further studies are required to elucidate whether Truman syndrome and social anxiety are different aspects of a similar spectrum. With increasing digitalization, the direction of psychiatric diseases, including EOS, and measures that can be taken for adolescent mental health in crisis, such as pandemics, should be discussed in future research.

Case report of visual hallucinations in anxiety

Hallucinations rarely occur in individuals with anxiety disorders. This case report describes a 36-year-old male with Social Phobia and Agoraphobia with Panic Attacks who had prominent visual hallucinations that were both distressing and incapacitating. Treatment with sertraline 200 mg/d, clonazepam 1 mg/d, and propranolol 20 mg/day for one month completely resolved both his anxiety and the hallucinations, after which he was able to return to his social and occupational life. The report underscores the fact that visual hallucinations are not always indicators of a psychotic disorder, they may be present across a spectrum of mental disorders. In cases where hallucinations occur in nonpsychotic disorders, treatment of the underlying condition usually simultaneously resolves the associated hallucinations without the need to resort to the use of antipsychotic medication. Detailed analyses of such unusual cases can help improve our understanding of the pathogenesis of psychotic-like symptoms.

A study of poor insight in social anxiety disorder

We investigated levels of insight among patients with Social Anxiety Disorder (SAD) as compared to patients with Obsessive-Compulsive Disorder (OCD) and evaluated whether levels of insight in SAD were related to specific sociodemographic and/or clinical features. Thirty-seven SAD patients and 51 OCD patients attending a tertiary obsessive-compulsive and anxiety disorders clinic were assessed with a sociodemographic and clinical questionnaire, a structured diagnostic interview, the Brown Assessment of Beliefs Scale (BABS), the Social Phobia Inventory (SPIN), the Beck Depression Inventory (BDI), the Sheehan Disability Scale (SDS), and the Treatment Adherence Survey-patient version (TAS-P). According to the BABS, SAD patients exhibited insight levels that were as low as those exhibited by OCD patients, with up to 29.7% of them being described as "poor insight" SAD. Although poor insight SAD patients were more frequently married, less depressed and displayed a statistical trend towards greater rates of early drop-out from cognitive-behavioral therapy, their insight levels were not associated with other variables of interest, including sex, age, employment, age at onset, duration of illness, associated psychiatric disorders, SPIN and SDS scores. Patients with poor insight SAD might perceive their symptoms as being less distressful and thus report fewer depressive symptoms and high rates of treatment non-adherence.

Anxiety Disorders and Perceptual Disturbances in Adolescents with 22q11.2 Deletion Syndrome Treated with SSRI: A Case Series

INTRODUCTION

Psychotic symptoms are highly prevalent in adolescents with 22q11.2 Deletion Syndrome (22qDS), with as many as half reporting transient psychotic symptoms. Anxiety is also commonly seen in this population, and patients frequently report both psychotic symptoms and anxiety.

OBJECTIVE

To describe the psychiatric presentation, course and management of primary anxiety disorders in patients with 22qDS who also presented with isolated perceptual disturbances.

METHOD

This report describes a 24-month clinical follow-up of three patients with 22qDS who were seen in the Medical Psychiatry clinic at the Hospital for Sick Children (Toronto, Canada).

RESULTS

Patients presented with primary anxiety disorders and perceptual disturbances. Patients were placed on selective serotonin reuptake inhibitor only, with improvement of both anxiety and perceptual disturbances being noted.

CONCLUSIONS

Some patients with 22qDS who present with psychotic symptoms do not develop a psychotic disorder; therefore, the use of antipsychotics for every child or adolescent with 22qDS who experience psychotic symptoms is debatable. Long-term follow-up, phenomenological and treatment efficacy studies in larger samples are needed to determine optimal treatment of psychotic symptoms in children and adolescents with 22qDS.