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Dömötör Z, Szabolcs Z, Bérdi M, Witthöft M, Köteles F, Szemerszky R. An idiographic approach to idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF) part I. Environmental, psychosocial and clinical assessment of three individuals with severe IEI-EMF. Heliyon 2022; 8:e09987. [PMID: 35874058 DOI: 10.1016/j.heliyon.2022.e09987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/19/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022] Open
Abstract
IEI-EMF refers to an environmental illness whose primary feature is the occurrence of symptoms that are attributed to exposure to weak electromagnetic fields (EMFs). There is a growing evidence that this condition is characterized by marked individual differences thus a within-subject approach might add important information beyond the widely used nomothetic method. A mixed qualitative/quantitative idiographic protocol with a threefold diagnostic approach was tested with the participation of three individuals with severe IEI-EMF. In this qualitative paper, the environmental, psychosocial, and clinical aspects are presented and discussed (results of ecological momentary assessment are discussed in Part II of this study). For two participants, psychopathological factors appeared to be strongly related to the condition. Psychological assessment indicated a severe pre-psychotic state with paranoid tendencies, supplemented with a strong attentional focus on bodily sensations and health status. The psychological profile of the third individual showed no obvious pathology. Overall, the findings suggest that the condition might have uniformly been triggered by serious psychosocial stress for all participants. Substantial aetiological differences among participants with severe IEI-EMF were revealed. The substantial heterogeneity in the psychological and psychopathological profiles associated with IEI-EMF warrants the use of idiographic multimodal assessments in order to better understand the different ways of aetiology and to facilitate person-taylored treatments.
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Pearce D, Gould RL, Roughley M, Reynolds G, Ward EV, Bhome R, Reeves S. Paranoid and misidentification subtypes of psychosis in dementia. Neurosci Biobehav Rev 2022; 134:104529. [PMID: 35032536 DOI: 10.1016/j.neubiorev.2022.104529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/22/2021] [Accepted: 01/09/2022] [Indexed: 11/24/2022]
Abstract
This study aimed to review the neurobiological and neuropsychological correlates of paranoid (persecutory delusions) and misidentification (misidentification delusions and/or hallucinations) subtypes of psychosis in dementia, to establish if they represent distinct subphenotypes. Nine studies were eligible, all included patients with Alzheimer's disease. Greater global cognitive deficits and an accelerated global cognitive decline were observed in the misidentification subtype. Neuroimaging studies showed more marked volume loss in multiple regions in patients with the misidentification subtype, including those involved in object recognition and the processing of information on spatial and temporal context. A single study found greater impairment in visual sustained attention and object recognition in the misidentification subtype. The small number of studies and methodological heterogeneity limit interpretation of the findings. Nevertheless, these findings would tentatively suggest that there may be additional or accelerated pathological change in functional networks involved in visuoperceptual processing in the misidentification subtype. This should be further explored in prospective studies and the investigation extended to other forms of dementia, to gain a transdiagnostic perspective.
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Affiliation(s)
- Danielle Pearce
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Rebecca L Gould
- Division of Psychiatry, University College London, W1T 7NF, UK
| | | | - Gemma Reynolds
- Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Emma V Ward
- Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Rohan Bhome
- Division of Psychiatry, University College London, W1T 7NF, UK
| | - Suzanne Reeves
- Division of Psychiatry, University College London, W1T 7NF, UK.
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Förster A, Model V, Gos T, Frodl T, Schiltz K, Dobrowolny H, Meyer-Lotz G, Guest PC, Mawrin C, Bernstein HG, Bogerts B, Schlaaff K, Steiner J. Reduced GABAergic neuropil and interneuron profiles in schizophrenia: Complementary analysis of disease course-related differences. J Psychiatr Res 2021; 145:50-59. [PMID: 34864489 DOI: 10.1016/j.jpsychires.2021.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/12/2021] [Accepted: 11/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND GABAergic interneuron dysfunction has been implicated in the pathophysiology of schizophrenia. Expression of glutamic acid decarboxylase (GAD), a key enzyme in GABA synthesis, may also be altered. Here, we have simultaneously evaluated GAD-immunoreactive (GAD-ir) neuropil and cell profiles in schizophrenia-relevant brain regions, and analysed disease-course related differences. METHODS GAD65/67 immunoreactivity was quantified in specific brain regions for profiles of fibres and cell bodies of interneurons by automated digital image analysis in post-mortem brains of 16 schizophrenia patients from paranoid (n = 10) and residual (n = 6) diagnostic subgroups and 16 matched controls. Regions of interest were superior temporal gyrus (STG) layers III and V, mediodorsal (MD) and laterodorsal (LD) thalamus, and hippocampal CA1 and dentate gyrus (DG) regions. RESULTS A reduction in GAD-ir neuropil profiles (p < 0.001), particularly in STG layer V (p = 0.012) and MD (p = 0.001), paralleled decreased GAD-ir cell profiles (p = 0.029) in schizophrenia patients compared to controls. Paranoid schizophrenia patients had lower GAD-ir neuron cell profiles in STG layers III (p = 0.007) and V (p = 0.001), MD (p = 0.002), CA1 (p = 0.001) and DG (p = 0.043) than residual patients. There was no difference in GAD-ir neuropil profiles between paranoid and residual subgroups (p = 0.369). CONCLUSIONS These results support the hypothesis of GABAergic dysfunction in schizophrenia. They show a more prominent reduction of GAD-ir interneurons in paranoid versus residual patients, suggestive of more pronounced GABAergic dysfunction in the former. Fully automated analyses of histological sections represent a step towards user-independent assessment of brain structure.
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Affiliation(s)
- Antonia Förster
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Vera Model
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Tomasz Gos
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Thomas Frodl
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Kolja Schiltz
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Forensic Psychiatry, Mental Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Gabriela Meyer-Lotz
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, University of Campinas (UNICAMP), Campinas, Brazil
| | - Christian Mawrin
- Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Hans-Gert Bernstein
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Bernhard Bogerts
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany; Salus Institute, Magdeburg, Germany
| | - Konstantin Schlaaff
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany
| | - Johann Steiner
- Department of Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; Laboratory of Translational Psychiatry, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany; German Center for Mental Health (DZP), Center for Intervention and Research on Adaptive and Maladaptive Brain Circuits Underlying Mental Health (C-I-R-C), Jena-Magdeburg-Halle, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany.
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Supit T, Pujisriyani, Subiyakto, Nugroho T, Fitrikasari A, Najatullah. Giant conjunctival melanoma in a paranoid schizophrenic man: A case report. Ann Med Surg (Lond) 2021; 62:391-394. [PMID: 33552501 PMCID: PMC7851416 DOI: 10.1016/j.amsu.2021.01.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION and importance: Conjunctival melanoma (CM) is a rare and potentially lethal ocular tumor. As with any oncologic disease, early diagnosis and appropriate treatment of CM is paramount to limit morbidity and increase life expectancy. However, patients with severe mental disability with social isolation are usually presented in late-stage disease. CASE PRESENTATION This report presents a case of a 55-year-old man with paranoid schizophrenic man with an extraordinarily large CM due to neglect. The patient suffered from complete left eye blindness with no clinical and radiological evidence of metastasis. CLINICAL DICUSSION Clinicians must bear in mind the limited patient compliance and family support of mentally-ill patients that restricts treatment modalities that would have otherwise been applicable for cooperative patients. The importance multidisciplinary approach, choosing the simpler but effective surgical technique should be prioritized. INTERVENTION AND OUTCOME Left exenteration and tumor wide excision was performed. The left orbital defect was reconstructed using forehead flap and split-thickness skin graft (STSG). The uncooperative nature of the patient posed early post-operative challenges that necessitates subsequent operation to drain seroma. The patient was discharged 16-days after operation with acceptable cosmetic and clinical results. However, the patient failed to return to the clinic for longer post-operative evaluation. CONCLUSION A multidisciplinary approach is mandatory to treat complex cases such as this report. Surgeons are advised to adopt simpler surgical approach that will require minimal self-care and should encourage family members to continuously support the patient.
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Affiliation(s)
- Tommy Supit
- Department of General Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Pujisriyani
- Department of Plastic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Subiyakto
- Department of Oncologic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Trilaksana Nugroho
- Department of Ophthalmology, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Alifiati Fitrikasari
- Department of Psychiatry, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
| | - Najatullah
- Department of Plastic Surgery, Faculty of Medicine Diponegoro University, Dr. Kariadi General Hospital, Jl. Dr. Sutomo No. 16, Randusari, Semarang Selatan, Semarang, Jawa Tengah, 50244, Indonesia
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Krämer J, Huber M, Mundinger C, Schmitgen MM, Pycha R, Kirchler E, Macina C, Karner M, Hirjak D, Kubera KM, Depping MS, Romanov D, Freudenmann RW, Wolf RC. Abnormal cerebellar volume in somatic vs. non-somatic delusional disorders. Cerebellum Ataxias 2020; 7:2. [PMID: 31993210 DOI: 10.1186/s40673-020-0111-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/16/2022]
Abstract
Background There is abundant evidence for cerebellar involvement in schizophrenia, where the cerebellum has been suggested to contribute to cognitive, affective and motor dysfunction. More recently, specific cerebellar regions have also been associated with psychotic symptoms, particularly with auditory verbal hallucinations. In contrast, little is known about cerebellar contributions to delusions, and even less is known about whether cerebellar involvement differs by delusional content. Methods Using structural magnetic resonance imaging at 1.0 T together with cerebellum-optimized segmentation techniques, we investigated gray matter volume (GMV) in 14 patients with somatic-type delusional disorder (S-DD), 18 patients with non-somatic delusional disorder (NS-DD) and 18 patients with schizophrenia (SZ) with persistent non-somatic delusions. A total of 32 healthy controls (HC) were included. Between-group comparisons were adjusted for age, gender, chlorpromazine equivalents and illness duration. Results Compared to HC, S-DD patients showed decreased GMV in left lobule VIIIa. In addition, S-DD patients showed decreased GMV in lobule V and increased GMV in bilateral lobule VIIa/crus II compared to NS-DD. Patients with SZ showed increased GMV in right lobule VI and VIIa/crus I compared to HC. Significant differences between HC and NS-DD were not found. Conclusions The data support the notion of cerebellar dysfunction in psychotic disorders. Distinct cerebellar deficits, predominantly linked to sensorimotor processing, may be detected in delusional disorders presenting with predominantly somatic content.
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Steiner J, Brisch R, Schiltz K, Dobrowolny H, Mawrin C, Krzyżanowska M, Bernstein HG, Jankowski Z, Braun K, Schmitt A, Bogerts B, Gos T. GABAergic system impairment in the hippocampus and superior temporal gyrus of patients with paranoid schizophrenia: A post-mortem study. Schizophr Res 2016; 177:10-17. [PMID: 26922657 DOI: 10.1016/j.schres.2016.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/07/2016] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Glutamic acid decarboxylase (GAD) is a key enzyme in GABA synthesis and alterations in GABAergic neurotransmission related to glial abnormalities are thought to play a crucial role in the pathophysiology of schizophrenia. This study aimed to identify potential differences regarding the neuropil expression of GAD between paranoid and residual schizophrenia. METHODS GAD65/67 immunostained histological sections were evaluated by quantitative densitometric analysis of GAD-immunoreactive (ir) neuropil. Regions of interest were the hippocampal formation (CA1 field and dentate gyrus [DG]), superior temporal gyrus (STG), and laterodorsal thalamic nucleus (LD). Data from 16 post-mortem schizophrenia patient samples (10 paranoid and 6 residual schizophrenia cases) were compared with those from 16 matched controls. RESULTS Overall, schizophrenia patients showed a lower GAD-ir neuropil density (P=0.014), particularly in the right CA1 (P=0.033). However, the diagnostic subgroups differed significantly (P<0.001), mainly because of lower right CA1 GAD-ir neuropil density in paranoid versus residual patients (P=0.036) and controls (P<0.003). Significant GAD-ir neuropil reduction was also detected in the right STG layer V of paranoid versus residual schizophrenia cases (P=0.042). GAD-ir neuropil density correlated positively with antipsychotic dosage, particularly in CA1 (right: r=0.850, P=0.004; left: r=0.800, P=0.010). CONCLUSION Our finding of decreased relative density of GAD-ir neuropil suggests hypofunction of the GABAergic system, particularly in hippocampal CA1 field and STG layer V of patients with paranoid schizophrenia. The finding that antipsychotic medication seems to counterbalance GABAergic hypofunction in schizophrenia patients suggests the possibility of exploring new treatment avenues which target this system.
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Affiliation(s)
- Johann Steiner
- Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany.
| | - Ralf Brisch
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Kolja Schiltz
- Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Henrik Dobrowolny
- Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Christian Mawrin
- Institute of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Marta Krzyżanowska
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Hans-Gert Bernstein
- Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany
| | - Zbigniew Jankowski
- Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Katharina Braun
- Center for Behavioral Brain Sciences, Magdeburg, Germany; Department of Zoology/Developmental Neurobiology, Institute of Biology, University of Magdeburg, Magdeburg, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Bernhard Bogerts
- Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - Tomasz Gos
- Department of Psychiatry and Psychotherapy, University of Magdeburg, Magdeburg, Germany; Department of Forensic Medicine, Medical University of Gdańsk, Gdańsk, Poland; Department of Zoology/Developmental Neurobiology, Institute of Biology, University of Magdeburg, Magdeburg, Germany
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Rao S, Kota LN, Li Z, Yao Y, Tang J, Mao C, Jain S, Xu Y, Xu Q. Accelerated leukocyte telomere erosion in schizophrenia: Evidence from the present study and a meta-analysis. J Psychiatr Res 2016; 79:50-56. [PMID: 27174400 DOI: 10.1016/j.jpsychires.2016.04.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 02/06/2023]
Abstract
Human telomeres consist of tandem nucleotide repeats (TTAGGG) and associated proteins, and telomere length (TL) is reduced progressively with cell division over the lifespan. Telomere erosion might be accelerated or prevented to varying degrees when exposure to serious medical illnesses. In previous studies, an association between TL decrease and schizophrenia has been extensively reported; however, the results remain largely controversial. To further investigate TL in schizophrenia patients and reconcile this controversy, we first measured leucocyte TL (LTL) in our samples (52 paranoid schizophrenia, 89 non-paranoid patients and 120 controls), and then conducted a comprehensive meta-analysis of the existing results of LTL in patients of schizophrenia compared to healthy subjects. Totally, 11 studies encompassing 1243 patients of schizophrenia and 1274 controls were included in the final meta-analysis model. In our samples, significant reduction of LTL in paranoid schizophrenia was observed compared to controls (F = 50.88, P < 0.001); whereas there was no significant difference in LTL between non-paranoid schizophrenia and controls (F = 0.842, P = 0.360). For meta-analysis, random-effects model showed significant LTL decrease in patients of schizophrenia when compared to controls (Z = 2.07, P = 0.039, SMD = -0.48, 95% CI = -0.94 to -0.03). Moreover, a marginal decrease in LTL was observed in medicated patients (Z = 1.92, P = 0.055, SMD = -0.58, 95% CI = -1.18-0.01) and those patients with poor response to antipsychotics (Z = 1.76, P = 0.078, SMD = -0.60, 95% CI = -1.27-0.07). In conclusion, we observed significant reduction of LTL in individuals with schizophrenia compared with controls. However, all the studies included in the meta-analysis were cross-sectional, and better controlled long-term studies are needed to replicate this result.
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Affiliation(s)
- Shuquan Rao
- Laboratory of Molecular Evolution and Applied Biology, School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China.
| | - Lakshmi Narayanan Kota
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Zongchang Li
- Institute of Mental Health, The Second Xiangya Hospital, State Key Laboratory of Medical Genetics, Central South University, Changsha, 410011, China
| | - Yao Yao
- Department of Fundamental Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, 611137, China
| | - Jinsong Tang
- Institute of Mental Health, The Second Xiangya Hospital, State Key Laboratory of Medical Genetics, Central South University, Changsha, 410011, China
| | - Canquan Mao
- Laboratory of Molecular Evolution and Applied Biology, School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, 610031, China
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Yong Xu
- Department of Psychiatry, First Clinical Medical College/First Hospital of Shanxi Medical University, Taiyuan, 030000, China
| | - Qi Xu
- National Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China
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Perez DL, Pan H, Weisholtz DS, Root JC, Tuescher O, Fischer DB, Butler T, Vago DR, Isenberg N, Epstein J, Landa Y, Smith TE, Savitz AJ, Silbersweig DA, Stern E. Altered threat and safety neural processing linked to persecutory delusions in schizophrenia: a two-task fMRI study. Psychiatry Res 2015; 233. [PMID: 26208746 PMCID: PMC5003172 DOI: 10.1016/j.pscychresns.2015.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Persecutory delusions are a clinically important symptom in schizophrenia associated with social avoidance and increased violence. Few studies have investigated the neurobiology of persecutory delusions, which is a prerequisite for developing novel treatments. The aim of this two-paradigm functional magnetic resonance imaging (fMRI) study is to characterize social "real world" and linguistic threat brain activations linked to persecutory delusions in schizophrenia (n=26) using instructed-fear/safety and emotional word paradigms. Instructed-fear/safety activations correlated to persecutory delusion severity demonstrated significant increased lateral orbitofrontal cortex and visual association cortex activations for the instructed-fear vs. safety and instructed-fear vs. baseline contrasts; decreased lateral orbitofrontal cortex and ventral occipital-temporal cortex activations were observed for the instructed-safety stimuli vs. baseline contrast. The salience network also showed divergent fear and safety cued activations correlated to persecutory delusions. Emotional word paradigm analyses showed positive correlations between persecutory delusion severity and left-lateralized linguistic and hippocampal-parahippocampal activations for the threat vs. neutral word contrast. Visual word form area activations correlated positively with persecutory delusions for both threat and neutral word vs. baseline contrasts. This study links persecutory delusions to enhanced neural processing of threatening stimuli and decreased processing of safety cues, and helps elucidate systems-level activations associated with persecutory delusions in schizophrenia.
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Affiliation(s)
- David L. Perez
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Hong Pan
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Daniel S. Weisholtz
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Neurology, Boston, MA, USA
| | - James C. Root
- Memorial Sloan Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, New York, NY, USA
| | - Oliver Tuescher
- University Medical Center Freiburg, Department of Neurology, Freiburg im Breisgau, Germany,University Medical Centre Mainz, Department of Psychiatry and Psychotherapy, Mainz, Germany
| | - David B. Fischer
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Tracy Butler
- Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - David R. Vago
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Nancy Isenberg
- Neuroscience Institute, Virginia Mason Medical Center, Seattle, WA, USA
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA
| | - Yulia Landa
- Weill Cornell Medical Center, Department of Psychiatry, New York, NY, USA
| | - Thomas E. Smith
- New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Adam J. Savitz
- Weill Cornell Medical Center, Department of Psychiatry, New York, NY, USA
| | - David A. Silbersweig
- Functional Neuroimaging Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Department of Psychiatry, Chestnut Hill, MA, USA,Brigham and Women’s Hospital, Department of Neurology, Boston, MA, USA
| | - Emily Stern
- Functional Neuroimaging Laboratory, Brigham and Women's Hospital, Harvard Medical School, Department of Psychiatry, 824 Boylston Street, Chestnut Hill, MA 02467, USA; Brigham and Women's Hospital, Department of Radiology, Harvard Medical School, Boston, MA, USA.
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Dai D, Cheng J, Zhou K, Lv Y, Zhuang Q, Zheng R, Zhang K, Jiang D, Gao S, Duan S. Significant association between DRD3 gene body methylation and schizophrenia. Psychiatry Res 2014; 220:772-7. [PMID: 25262640 DOI: 10.1016/j.psychres.2014.08.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 08/14/2014] [Accepted: 08/18/2014] [Indexed: 11/24/2022]
Abstract
The current study was the first one to reveal the contribution of DRD3 methylation to the risk of different (SCZ) subtypes. This study comprised a total of 30 paranoid (15 males and 15 females) and 29 undifferentiated (15 males and 14 females) SCZ patients and 26 age- and gender-matched controls. Our results showed a significant association of CpG2 with SCZ. A breakdown analysis by gender showed that CpG2 and CpG3 methylation were significantly higher in male patients than male controls, and that CpG5 methylation was significantly higher in female patients than female controls. A further breakdown analysis by both gender and SCZ subtype showed that CpG2 and CpG3 methylation were significantly higher in male paranoid SCZ and male undifferentiated SCZ than male controls. In contrast, CpG2 and CpG3 methylation were significantly lower in female undifferentiated SCZ than female controls. Additionally, CpG5 methylation was significantly higher in female paranoid SCZ than female controls. In conclusion, our findings supported that DRD3 gene body hypermethylation was significantly associated with the risk of SCZ. Future study is needed to clarify the mechanisms by which DRD3 gene body hypermethylation contributes to the risk of SCZ.
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Affiliation(s)
- Dongjun Dai
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Jia Cheng
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang 315201, China.
| | - Kena Zhou
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Yuelong Lv
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Qidong Zhuang
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Rongjiong Zheng
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Kai Zhang
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Danjie Jiang
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China
| | - Shugui Gao
- Department of Psychiatry, Ningbo Kangning Hospital, Ningbo, Zhejiang 315201, China.
| | - Shiwei Duan
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, China.
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Dar MA, Rather YH, Shah MS, Wani RA, Hussain A. Rapid Response of Long-Standing, Treatment-Resistant Non-Catatonic Mutism in Paranoid Schizophrenia with Single ECT session. N Am J Med Sci 2014; 6:591-4. [PMID: 25535609 PMCID: PMC4264296 DOI: 10.4103/1947-2714.145480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Mutism is a common manifestation of catatonia, but mutism due to other forms of psychopathology and neurological disorders have also been described. Although not common, long-standing mutism has also been a feature of non-catatonic schizophrenia and traditionally responds less to conventional therapies. Case Report: We describe a rare case of paranoid schizophrenia presenting with continuous mutism for about 4 years. This 26-year-old male had symptoms of schizophrenia without catatonia. After failed trial of adequate pharmacotherapy and psychological intervention and considering his level of dysfunction, he was started on electroconvulsive therapy (ECT). To our surprise, he improved with a single session of ECT while he was on concurrent pharmacotherapy. We also discuss the possible explanation for this rapid effect of ECT in such clinical presentation. To our knowledge, this is the first case of non-catatonic mutism of schizophrenia of this long duration responding so promptly to ECT, although there are other reports as well in literature, but multiple ECT sessions were applied in those cases. Conclusion: Non-catatonic mutism is perhaps presenting as a cultural variant in this part of the world and whenever encountered, ECT should be an option. Further research should be carried out to validate this idea.
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Affiliation(s)
- Mansoor Ahmad Dar
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Yasir Hassan Rather
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Majid Shafi Shah
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Rayees Ahmad Wani
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Arshad Hussain
- Department of Psychiatry, Government Medical College, Srinagar, Jammu and Kashmir, India
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Huang CL, Hsiao S, Hwu HG, Howng SL. Are there differential deficits in facial emotion recognition between paranoid and non-paranoid schizophrenia? A signal detection analysis. Psychiatry Res 2013; 209:424-30. [PMID: 23598059 DOI: 10.1016/j.psychres.2013.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 03/21/2013] [Accepted: 03/24/2013] [Indexed: 11/23/2022]
Abstract
This study assessed facial emotion recognition abilities in subjects with paranoid and non-paranoid schizophrenia (NPS) using signal detection theory. We explore the differential deficits in facial emotion recognition in 44 paranoid patients with schizophrenia (PS) and 30 non-paranoid patients with schizophrenia (NPS), compared to 80 healthy controls. We used morphed faces with different intensities of emotion and computed the sensitivity index (d') of each emotion. The results showed that performance differed between the schizophrenia and healthy controls groups in the recognition of both negative and positive affects. The PS group performed worse than the healthy controls group but better than the NPS group in overall performance. Performance differed between the NPS and healthy controls groups in the recognition of all basic emotions and neutral faces; between the PS and healthy controls groups in the recognition of angry faces; and between the PS and NPS groups in the recognition of happiness, anger, sadness, disgust, and neutral affects. The facial emotion recognition impairment in schizophrenia may reflect a generalized deficit rather than a negative-emotion specific deficit. The PS group performed worse than the control group, but better than the NPS group in facial expression recognition, with differential deficits between PS and NPS patients.
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Choi JH, Lee HS, Kim SM, Kim HY, Kwon SK. Paranoid Adipsia-induced Severe Hypernatremia and Uremia treated with Hemodialysis. Electrolyte Blood Press 2013; 11:29-32. [PMID: 23946763 PMCID: PMC3741440 DOI: 10.5049/ebp.2013.11.1.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 06/25/2013] [Indexed: 12/03/2022] Open
Abstract
We describe a patient with severe hypernatremia and uremia caused by paranoid adipsia who was treated successfully with hydration and hemodialysis. A previously healthy 40-year-old woman developed the paranoid idea that her water was poisoned, so she refused to drink any water. On admission, her blood urea nitrogen was 208mg/dL, creatinine 4.90mg/dL, serum osmolality 452mOsm/L, serum sodium 172mEq/L, urine specific gravity ≥1.030, urine osmolality 698mOsm/L, and urine sodium/potassium/chloride 34/85.6/8mEq/L. We diagnosed her with uremic encephalopathy and started intravenous dextrose, but the sodium correction was incomplete. She underwent two sessions of hemodialysis to treat the uremic encephalopathy and hypernatremia, and recovered fully without neurological sequelae. Although the standard treatment for severe hypernatremia is hydration, hemodialysis can be an additional treatment in cases of combined uremic encephalopathy.
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Affiliation(s)
- Jae-Hyun Choi
- Department of Medicine, School of Medicine, Chungbuk National University, Cheongju, Korea
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Jolfaei AG, Isfahani MN, Bidaki R. Folie à deux and delusional disorder by proxy in a family. J Res Med Sci 2011; 16 Suppl 1:S453-5. [PMID: 22247734 PMCID: PMC3252781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 04/07/2011] [Indexed: 11/09/2022]
Abstract
This report presents a 52-year-old woman who was admitted to nephrology ward with hypernatremia. She shared a persecutory delusion of poisoning with her 22-year-old daughter and did not feed her 8-year-old son due to her delusion.
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Affiliation(s)
- Atefeh Ghanbari Jolfaei
- Assistant Professor, Department of Psychiatry, Tehran Psychiatry Institute, Tehran University of Medical Sciences, Tehran, Iran., Corresponding Author E-mail:
| | - Mehdi Nasr Isfahani
- Associate Professor, Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Bidaki
- Psychiatrist, Rasoul-e-Akram Hospital, Tehran, Iran
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