1
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Pagan FL, Schulz PE, Torres-Yaghi Y, Pontone GM. On the Optimal Diagnosis and the Evolving Role of Pimavanserin in Parkinson's Disease Psychosis. CNS Drugs 2024; 38:333-347. [PMID: 38587586 PMCID: PMC11026222 DOI: 10.1007/s40263-024-01084-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/09/2024]
Abstract
Parkinson's disease (PD) is associated with the development of psychosis (PDP), including hallucinations and delusions, in more than half of the patient population. Optimal PD management must therefore involve considerations about both motor and non-motor symptoms. Often, clinicians fail to diagnosis psychosis in patients with PD and, when it is recognized, treat it suboptimally, despite the availability of multiple interventions. In this paper, we provide a summary of the current guidelines and clinical evidence for treating PDP with antipsychotics. We also provide recommendations for diagnosis and follow-up. Finally, an updated treatment algorithm for PDP that incorporates the use of pimavanserin, the only US FDA-approved drug for the treatment of PDP, was developed by extrapolating from a limited evidence base to bridge to clinical practice using expert opinion and experience. Because pimavanserin is only approved for the treatment of PDP in the US, in other parts of the world other recommendations and algorithms must be considered.
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Affiliation(s)
- Fernando L Pagan
- Department of Neurology, Georgetown University Hospital, Washington DC, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yasar Torres-Yaghi
- Department of Neurology, Georgetown University Hospital, Washington DC, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N Wolfe St., Phipps 300, Baltimore, MD, 21287, USA.
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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2
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Xia Y, Sun Y, Zhi Q, Cui W, Liu X. A case report of a patient with Turner syndrome who develops catatonia secondary to psychotic symptoms. Medicine (Baltimore) 2024; 103:e37730. [PMID: 38579062 PMCID: PMC10994426 DOI: 10.1097/md.0000000000037730] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/06/2024] [Indexed: 04/07/2024] Open
Abstract
RATIONALE Turner syndrome (TS) is a genetic disorder associated with partial or complete monosomy X abnormalities; some patients may have a higher risk of psychiatric symptoms. Catatonia is associated with a wide range of life-threatening complications with complex pathogenesis; However, It very rare for patients with TS to develop psychotic symptoms and eventually progress to catatonia. This case report describes the diagnostic and therapeutic course of catatonia-associated TS. PATIENT CONCERNS In this study, we report the case of a patient with TS who initially developed sudden hallucinations, delusions, and emotional instability, followed by catatonia. DIAGNOSES The patient was diagnosed with: unspecified catatonia; TS. INTERVENTIONS Treatment included administering a combination of esazolam injections and olanzapine tablets, placing a gastric tube and urinary catheter, and providing nutritional support. OUTCOMES After treatment, the patient's hallucinations, delusions, and catatonia disappeared, with no residual sequelae, and social functioning returned to normal. LESSONS For patients with TS who present with psychotic symptoms and catatonia, a comprehensive evaluation is necessary, and treatment with antipsychotics and benzodiazepines is effective.
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Affiliation(s)
- Yong Xia
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yuyong Sun
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Qianna Zhi
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Wenjing Cui
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiaoyan Liu
- Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
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3
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Labouret M, Trebossen V, Ntorkou A, Bartoli S, Aubart M, Auvin S, Bader-Meunier B, Baudouin V, Corseri O, Dingulu G, Ducrocq C, Dumaine C, Elmaleh M, Fabien N, Faye A, Hau I, Hentgen V, Kwon T, Meinzer U, Ouldali N, Parmentier C, Pouletty M, Renaldo F, Savioz I, Benoist JF, Le Roux E, Ellul P, Melki I. Juvenile neuropsychiatric systemic lupus erythematosus: A specific clinical phenotype and proposal of a probability score. Lupus 2024; 33:328-339. [PMID: 38315109 DOI: 10.1177/09612033241229022] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Juvenile systemic lupus erythematosus (j-SLE) is a rare chronic auto-immune disease involving several organs. Neuropsychiatric (NP) SLE (NPSLE) is frequent in j-SLE and associated with increased morbidity/mortality. Although NPSLE classification criteria exist, attributing NP features to j-SLE remains a major challenge. The study objective is to thoroughly describe j-NPSLE patients and assist in their diagnosis. METHODS This is a 4-year retrospective monocentric study of j-SLE patients. NP events were attributed to j-SLE using standardised diagnostic criteria and multidisciplinary paediatric clinical expertise. Clinical features, brain magnetic resonance imaging (MRI)s and samples analysis including cerebrospinal fluid were assessed. A risk of j-NPSLE score was developed based on multivariable logistic regression analysis. RESULTS Of 39 patients included, 44% were identified as having j-NPSLE. J-NPSLE diagnosis was established at the onset of j-SLE in 59% of patients. In addition to frequent kidney involvement (76%) and chilblains (65%), all j-NPSLE patients displayed psychiatric features: cognitive symptoms (82%), hallucinations (76%), depressed mood (35%), acute confused state (18%) and catatonia (12%). Neurological involvement was often mild and nonspecific, with headache (53%) in about half of the patients. The main features reported on brain MRI were nonspecific T2/FLAIR white matter hyperintensities (65%), and cerebral atrophy (88%). Upon immunosuppressive treatment, clinical improvement of NP features was observed in all j-NPSLE patients. The score developed to attribute j-NPSLE probability, guide further investigations and appropriate treatments is based on hallucinations, memory, sleep and renal involvement (Sensitivity: 0.95 Specificity: 0.85). Cerebrospinal fluid (CSF) neopterin assessment increases the score sensitivity and specificity. CONCLUSION Physicians should carefully and systematically assess the presence of NP features at diagnosis and early stages of j-SLE. For j-NPSLE patients with predominant psychiatric features, a multidisciplinary collaboration, including psychiatrists, is essential for the diagnosis, management and follow-up.
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Affiliation(s)
- Mathilde Labouret
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Sorbonne Université, Paris, France
| | - Vincent Trebossen
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Alexandra Ntorkou
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Sophie Bartoli
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Mélodie Aubart
- Paediatric Neurology Department, Necker-Enfants Malades Hospital, University of Paris-Cité, AP-HP, Paris, France
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, French Institute of Health and Medical Research U1163, Imagine Institute, University of Paris-Cité, Paris, France
| | - Stéphane Auvin
- Department of Paediatric Neurology, Center for Rare Epilepsies & Epilepsy Unit, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Brigitte Bader-Meunier
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Laboratory of Immunogenetics of Paediatric Autoimmune Diseases, Imagine Institute, INSERM UMR 1163, Université Paris Cité, Paris, France
| | - Véronique Baudouin
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Olivier Corseri
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Glory Dingulu
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Camille Ducrocq
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Cécile Dumaine
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Monique Elmaleh
- Department of Paediatric Radiology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Nicole Fabien
- Immunology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Albert Faye
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- UMR1123 Inserm, Université Paris Cité, Paris, France
| | - Isabelle Hau
- Department of General Paediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Véronique Hentgen
- Department of General Paediatrics, French Reference centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Versailles Hospital, Le Chesnay, France
| | - Théresa Kwon
- Department of Paediatric Nephrology, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
| | - Ulrich Meinzer
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
- Center for Research on Inflammation, INSERM, Université Paris Cité, Paris, France
- Biology and Genetics of Bacterial Cell Wall Unit, Pasteur Institute, Paris, France
| | - Naim Ouldali
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Université Paris Cité, UFR de Médecine Paris Nord, Paris, France
| | - Cyrielle Parmentier
- Department of Paediatric Nephrology, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Marie Pouletty
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Florence Renaldo
- Department of Paediatric Neurology, Center for Neurogenetic Diseases, Armand-Trousseau Childrens' Hospital, AP-HP, Paris, France
| | - Isabelle Savioz
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
| | - Jean-François Benoist
- Metabolic Biochemistry Laboratory, Reference Centre for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, AP-HP, Paris, France
- Université Paris Saclay, UFR Pharmacie, France
| | - Enora Le Roux
- UMR1123 Inserm, Université Paris Cité, Paris, France
- Unité d'Épidémiologie Clinique, Inserm, CIC 1426, Robert Debré Mother-Child University Hospital, Nord-Université Paris Cité, AP-HP, Paris, France
| | - Pierre Ellul
- Department of Child and Adolescent Psychiatry, Robert Debré Mother-Child University Hospital, AP-HP, Paris, France
- Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
| | - Isabelle Melki
- General Paediatrics, Department of Infectious Disease and Internal Medicine, Robert Debré Mother-Child University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Department of Paediatric Haematology-Immunology And Rheumatology, Necker-Enfants-Malades University Hospital, Reference Centre for Rheumatic, AutoImmune and Systemic Diseases in Children (RAISE), AP-HP, Paris, France
- Imagine Institute, Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR 1163, Université Paris Cité, Paris, France
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
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4
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Parnas J, Yttri JE, Urfer-Parnas A. Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else? Schizophr Res 2024; 265:83-88. [PMID: 37024418 DOI: 10.1016/j.schres.2023.03.045] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
This study presents phenomenological features of auditory verbal hallucinations (AVH) in schizophrenia and associated anomalies of experience. The purpose is to compare the lived experience of AVH to the official definition of hallucinations as a perception without object. Furthermore, we wish to explore the clinical and research implication of the phenomenological approach to AVH. Our exposition is based on classic texts on AVH, recent phenomenological studies and our clinical experience. AVH differ on several dimensions from ordinary perception. Only a minority of schizophrenia patients experiences AVH localized externally. Thus, the official definition of hallucinations does not fit the AVH in schizophrenia. AVH are associated with several anomalies of subjective experiences (self-disorders) and the AVH must be considered as a product of self-fragmentation. We discuss the implications with respect to the definition of hallucination, clinical interview, conceptualization of a psychotic state and potential target of pathogenetic research.
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Affiliation(s)
- Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, DK-2300 Copenhagen S, Denmark; Mental Health Centre Glostrup, University Hospital of Copenhagen, DK-2605 Brøndby, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Janne-Elin Yttri
- Mental Health Centre Amager, University Hospital of Copenhagen, DK-1610 Copenhagen V, Denmark
| | - Annick Urfer-Parnas
- Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark; Mental Health Centre Amager, University Hospital of Copenhagen, DK-1610 Copenhagen V, Denmark.
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5
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Kubera KM, Rashidi M, Schmitgen MM, Barth A, Hirjak D, Otte ML, Sambataro F, Calhoun VD, Wolf RC. Functional network interactions in patients with schizophrenia with persistent auditory verbal hallucinations: A multimodal MRI fusion approach using three-way pICA. Schizophr Res 2024; 265:20-29. [PMID: 37024417 DOI: 10.1016/j.schres.2023.03.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 02/18/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023]
Abstract
Over the last decade, there have been an increasing number of functional magnetic resonance imaging (fMRI) studies examining brain activity in schizophrenia (SZ) patients with persistent auditory verbal hallucinations (AVH) using either task-based or resting-state fMRI (rs-fMRI) paradigms. Such data have been conventionally collected and analyzed as distinct modalities, disregarding putative crossmodal interactions. Recently, it has become possible to incorporate two or more modalities in one comprehensive analysis to uncover hidden patterns of neural dysfunction not sufficiently captured by separate analysis. A novel multivariate fusion approach to multimodal data analysis, i.e., parallel independent component analysis (pICA), has been previously shown to be a powerful tool in this regard. We utilized three-way pICA to study covarying components among fractional amplitude of low-frequency fluctuations (fALFF) for rs-MRI and task-based activation computed from an alertness and a working memory (WM) paradigm of 15 SZ patients with AVH, 16 non-hallucinating SZ patients (nAVH), and 19 healthy controls (HC). The strongest connected triplet (false discovery rate (FDR)-corrected pairwise correlations) comprised a frontostriatal/temporal network (fALFF), a temporal/sensorimotor network (alertness task), and a frontoparietal network (WM task). Frontoparietal and frontostriatal/temporal network strength significantly differed between AVH patients and HC. Phenomenological features such as omnipotence and malevolence of AVH were associated with temporal/sensorimotor and frontoparietal network strength. The transmodal data confirm a complex interplay of neural systems subserving attentional processes and cognitive control interacting with speech and language processing networks. In addition, the data emphasize the importance of sensorimotor regions modulating specific symptom dimensions of AVH.
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Affiliation(s)
- Katharina M Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mahmoud Rashidi
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Mike M Schmitgen
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Anja Barth
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Marie-Luise Otte
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padua, Padua, Italy; Padua Neuroscience Center, University of Padua, Padua, Italy
| | - Vince D Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Robert C Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Germany.
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Pagonabarraga J, Bejr-Kasem H, Martinez-Horta S, Kulisevsky J. Parkinson disease psychosis: from phenomenology to neurobiological mechanisms. Nat Rev Neurol 2024; 20:135-150. [PMID: 38225264 DOI: 10.1038/s41582-023-00918-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024]
Abstract
Parkinson disease (PD) psychosis (PDP) is a spectrum of illusions, hallucinations and delusions that are associated with PD throughout its disease course. Psychotic phenomena can manifest from the earliest stages of PD and might follow a continuum from minor hallucinations to structured hallucinations and delusions. Initially, PDP was considered to be a complication associated with dopaminergic drug use. However, subsequent research has provided evidence that PDP arises from the progression of brain alterations caused by PD itself, coupled with the use of dopaminergic drugs. The combined dysfunction of attentional control systems, sensory processing, limbic structures, the default mode network and thalamocortical connections provides a conceptual framework to explain how new incoming stimuli are incorrectly categorized, and how aberrant hierarchical predictive processing can produce false percepts that intrude into the stream of consciousness. The past decade has seen the publication of new data on the phenomenology and neurobiological basis of PDP from the initial stages of the disease, as well as the neurotransmitter systems involved in PDP initiation and progression. In this Review, we discuss the latest clinical, neuroimaging and neurochemical evidence that could aid early identification of psychotic phenomena in PD and inform the discovery of new therapeutic targets and strategies.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain.
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.
| | - Helena Bejr-Kasem
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Saul Martinez-Horta
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jaime Kulisevsky
- Movement Disorder Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain
- Centro de Investigación en Red - Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
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7
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Schmitter CV, Straube B. Facilitation of sensorimotor temporal recalibration mechanisms by cerebellar tDCS in patients with schizophrenia spectrum disorders and healthy individuals. Sci Rep 2024; 14:2627. [PMID: 38297015 PMCID: PMC10830570 DOI: 10.1038/s41598-024-53148-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 02/02/2024] Open
Abstract
Core symptoms in patients with schizophrenia spectrum disorders (SSD), like hallucinations or ego-disturbances, have been associated with a failure of internal forward models to predict the sensory outcomes of self-generated actions. Importantly, forward model predictions must also be able to flexibly recalibrate to changing environmental conditions, for example to account for additional delays between action and outcome. We investigated whether transcranial direct current stimulation (tDCS) can be used to improve these sensorimotor temporal recalibration mechanisms in patients and healthy individuals. While receiving tDCS on the cerebellum, temporo-parietal junction, supplementary motor area, or sham stimulation, patients with SSD and healthy control participants were repeatedly exposed to delays between actively or passively elicited button presses and auditory outcomes. Effects of this procedure on temporal perception were assessed with a delay detection task. Similar recalibration outcomes and faciliatory effects of cerebellar tDCS on recalibration were observed in SSD and healthy individuals. Our findings indicate that sensorimotor recalibration mechanisms may be preserved in SSD and highlight the importance of the cerebellum in both patients and healthy individuals for this process. They further suggest that cerebellar tDCS could be a promising tool for addressing deficits in action-outcome monitoring and related adaptive sensorimotor processes in SSD.
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Affiliation(s)
- Christina V Schmitter
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Strasse 8, 35039, Marburg, Germany.
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Hans-Meerwein-Strasse 6, 35032, Marburg, Germany.
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Rudolf-Bultmann-Strasse 8, 35039, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Hans-Meerwein-Strasse 6, 35032, Marburg, Germany
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8
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Dollfus S, Letourneur F, Metivier L, Moulier V, Rothärmel M. A digital tool for self-assessment of auditory verbal hallucinations in schizophrenia. Schizophr Res 2024; 264:188-190. [PMID: 38154361 DOI: 10.1016/j.schres.2023.12.016] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 11/15/2023] [Accepted: 12/16/2023] [Indexed: 12/30/2023]
Abstract
Auditory verbal hallucinations (AVH) are experienced by approximately 70 % of patients with schizophrenia and are frequently associated with high levels of distress. Therefore, alleviating hallucinations is an important therapeutic challenge. However, for prescribing a personalized treatment adapted to the patient, an accurate and detailed assessment of AVH is necessary. Until now, there have been no self-evaluations; instead, only scales based on observer ratings have been used to assess AVH. Nevertheless, self-assessments may enhance patient symptom awareness and increase their insight and involvement in the treatment, promoting empowerment (Eisen et al., 2000). In this context, a mobile app called MIMO was devised in order to monitor AVHs assessed by the patients themselves. This app, including the Self-assessment of Auditory verbal Hallucinations (SAVH-https://sns-dollfus.com/), was devised as an ecological momentary assessment tool. The present study aimed to demonstrate the feasibility and acceptability of this app.
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Affiliation(s)
- Sonia Dollfus
- Normandie Univ, UNICAEN, Inserm U1237, PhIND, Neuropresage team, GIP Cyceron, 14000 Caen, France; Normandie Univ, UNICAEN, UFR de Médecine, 14000 Caen, France; CHU de Caen, Service de Psychiatrie, 14000 Caen, France; Fédération Hospitalo-Universitaire A2M2P-CHU, Caen 14000, France.
| | | | - Lucie Metivier
- Normandie Univ, UNICAEN, Inserm U1237, PhIND, Neuropresage team, GIP Cyceron, 14000 Caen, France; Normandie Univ, UNICAEN, UFR de Médecine, 14000 Caen, France; Fédération Hospitalo-Universitaire A2M2P-CHU, Caen 14000, France
| | - Virginie Moulier
- Centre Hospitalier du Rouvray, Service Hospitalo-Universitaire de Psychiatrie, Centre Thérapeutique d'Excellence, 76300 Sotteville-lès-Rouen, France; Unité de Recherche Clinique (URC), EPS Ville Evrard, Neuilly-sur-Marne, France
| | - Maud Rothärmel
- Normandie Univ, UNICAEN, Inserm U1237, PhIND, Neuropresage team, GIP Cyceron, 14000 Caen, France; Centre Hospitalier du Rouvray, Service Hospitalo-Universitaire de Psychiatrie, Centre Thérapeutique d'Excellence, 76300 Sotteville-lès-Rouen, France; Fédération Hospitalo-Universitaire A2M2P-CHU, Caen 14000, France
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9
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Yang J, Shen L, Long Q, Li W, Zhang W, Chen Q, Han B. Electrical stimulation induced self-related auditory hallucinations correlate with oscillatory power change in the default mode network. Cereb Cortex 2024; 34:bhad473. [PMID: 38061695 DOI: 10.1093/cercor/bhad473] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 01/19/2024] Open
Abstract
Self-related information is crucial in our daily lives, which has led to the proposal that there is a specific brain mechanism for processing it. Neuroimaging studies have consistently demonstrated that the default mode network (DMN) is strongly associated with the representation and processing of self-related information. However, the precise relationship between DMN activity and self-related information, particularly in terms of neural oscillations, remains largely unknown. We electrically stimulated the superior temporal and fusiform areas, using stereo-electroencephalography to investigate neural oscillations associated with elicited self-related auditory hallucinations. Twenty-two instances of auditory hallucinations were recorded and categorized into self-related and other-related conditions. Comparing oscillatory power changes within the DMN between self-related and other-related auditory hallucinations, we discovered that self-related hallucinations are associated with significantly stronger positive power changes in both alpha and gamma bands compared to other-related hallucinations. To ensure the validity of our findings, we conducted controlled analyses for factors of familiarity and clarity, which revealed that the observed effects within the DMN remain independent of these factors. These results underscore the significance of the functional role of the DMN during the processing of self-related auditory hallucinations and shed light on the relationship between self-related perception and neural oscillatory activity.
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Affiliation(s)
- Jing Yang
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Lu Shen
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Qiting Long
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Wenjie Li
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Wei Zhang
- Department of Neurology, Beijing Tsinghua Changgung Hospital, Litang Road No. 168, Changping District, 102218, Beijing, China
- Epilepsy Center, Shanghai Neuromedical Center, Gulang Road No. 378, Putuo District, 200331, Shanghai, China
| | - Qi Chen
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
| | - Biao Han
- Center for Studies of Psychological Application, South China Normal University, No.55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
- School of Psychology, South China Normal University, No. 55, West of Zhongshan Avenue, Tianhe District, 510631, Guangzhou, China
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10
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Tseng ST, Georgiades A. A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review. Clin Psychol Psychother 2024; 31:e2958. [PMID: 38358078 DOI: 10.1002/cpp.2958] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Borderline personality disorder (BPD) with auditory hallucinations (AHs) may inadvertently be misdiagnosed with a primary psychotic disorder, such as schizophrenia (SZ). This misidentification can lead to challenges in providing effective psychological treatment. This review therefore aims to identify the phenomenological characteristics of AHs in BPD in comparison to SZ, as well as psychological interventions that explicitly target AHs in BPD. METHODS A systematic review was conducted to summarise the existing evidence base regarding the phenomenological similarities and differences of AHs in BPD and SZ, along with the identification of psychological interventions for AHs in BPD. RESULTS Eighteen studies were eligible for inclusion. Compared to the SZ group, BPD clients were characterised by more persistent and repetitive AHs, significantly more voice-related distress and appraisals of omnipotence, and an earlier age of onset of AHs. The BPD group also reported more severe depression and anxiety, a higher incidence of childhood trauma, and more negative self-schema. Cognitive Behaviour Therapy Coping Strategy Enhancement (CBT-CSE) might be a promising intervention to reduce AH-related distress in BPD, although further studies are required to determine its effectiveness. CONCLUSION In order to prevent misdiagnosis of AHs in BPD, the DSM-5 may need to acknowledge the broader and more frequent occurrence of psychosis symptoms in BPD clients. Such clarification may enhance diagnostic practices and facilitate more timely access to treatment. There is also a need to develop and trial psychological interventions that explicitly target AHs in BPD.
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Affiliation(s)
- Shih-Ting Tseng
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Anna Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
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Venegas MA, Montoya JS. Hallucinations in patients with obstructive sleep apnea-hypopnea syndrome: report of 3 cases. J Clin Sleep Med 2024; 20:165-167. [PMID: 37589151 PMCID: PMC10758545 DOI: 10.5664/jcsm.10782] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/18/2023]
Abstract
Hallucinations are false sensory perceptions that occur in the absence of an external stimulus. Three cases of hallucinations related to obstructive sleep apnea-hypopnea syndrome are reported, 2 of which improved with the initiation of continuous positive airway pressure therapy. So far there are no published reports in the literature that account for this relationship in the absence of primary or structural mental pathology. All 3 reported patients had visual hallucinations that were uncomfortable and frightening. Polysomnography showed moderate-to-severe obstructive sleep apnea-hypopnea syndrome with severe oxygen desaturation. Initiation of continuous positive airway pressure therapy achieved control of hallucinations in 2 patients during follow-up. Very little information is available on the coexistence of obstructive sleep apnea-hypopnea syndrome and hallucinations. Observational and experimental studies are required to clarify whether there is a causal relationship between the 2 pathologies as well as the therapeutic role that continuous positive airway pressure may have. CITATION Venegas MA, Montoya JS. Hallucinations in patients with obstructive sleep apnea-hypopnea syndrome: report of 3 cases. J Clin Sleep Med. 2024;20(1):165-167.
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Affiliation(s)
- Marco Aurelio Venegas
- Somnarum Clinic for the Study and the Treatment of Sleep Disorders, Bogotá, Colombia
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12
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Panikratova YR, Lebedeva IS, Akhutina TV, Tikhonov DV, Kaleda VG, Vlasova RM. Executive control of language in schizophrenia patients with history of auditory verbal hallucinations: A neuropsychological and resting-state fMRI study. Schizophr Res 2023; 262:201-210. [PMID: 37923596 DOI: 10.1016/j.schres.2023.10.026] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND As demonstrated by a plethora of studies, compromised executive functions (EF) and language are implicated in mechanisms of auditory verbal hallucinations (AVH), but the contribution of their interaction to AVH remains unclear. We hypothesized that schizophrenia patients with history of AVH (AVHh+) vs. without history of AVH (AVHh-) have a specific deficit of executive control of language and alterations in functional connectivity (FC) between the brain regions involved in EF and language, and these neuropsychological and neurophysiological traits are associated with each other. METHODS To explore the executive control of language and its contribution to AVH, we used an integrative approach involving analysis of neuropsychological and resting-state fMRI data of 34 AVHh+, 16 AVHh-, and 40 healthy controls. We identified the neuropsychological and FC measures that differentiated between AVHh+, AVHh-, and HC, and tested the associations between them. RESULTS AVHh+ were characterized by decreased category and phonological verbal fluency, utterance length, productivity in the planning tasks, and poorer retelling. AVHh+ had decreased FC between the left inferior frontal gyrus and the anterior cingulate cortex. Productivity in category verbal fluency was associated with the FC between these regions. CONCLUSIONS Poor executive control of word retrieval and deficient programming of sentence and narrative related to more general deficits of planning may be the neuropsychological traits specific for AVHh+. A neurophysiological trait specific for AVHh+ may be a decreased FC between regions involved in language production and differentiation between alien- vs. self-generated speech and between language production vs. comprehension.
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Affiliation(s)
- Yana R Panikratova
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia.
| | - Irina S Lebedeva
- Laboratory of Neuroimaging and Multimodal Analysis, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia
| | - Tatiana V Akhutina
- Laboratory of Neuropsychology, Faculty of Psychology, Lomonosov Moscow State University, 125009, 11/9 Mokhovaya street, Moscow, Russia
| | - Denis V Tikhonov
- Department of Youth Psychiatry, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia
| | - Vasilii G Kaleda
- Department of Youth Psychiatry, Mental Health Research Center, 115522, 34 Kashirskoye shosse, Moscow, Russia
| | - Roza M Vlasova
- Department of Psychiatry, University of North Carolina, 101 Manning Dr # 1, Chapel Hill, NC 27514, United States of America
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Hinkley LBN, Haas SS, Cheung SW, Nagarajan SS, Subramaniam K. Reduced neural connectivity in the caudate anterior head predicts hallucination severity in schizophrenia. Schizophr Res 2023; 261:1-5. [PMID: 37678144 PMCID: PMC10878029 DOI: 10.1016/j.schres.2023.08.030] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/13/2023] [Accepted: 08/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Caudate functional abnormalities have been identified as one critical neural substrate underlying sensory gating impairments that lead to auditory phantom hallucinations in both patients with schizophrenia (SZ) and tinnitus, characterized by the perception of internally generated sounds in the absence of external environmental auditory stimuli. In this study, we tested the hypothesis as to whether functional connectivity abnormalities in distinct caudate subdivisions implicated in sensory gating and auditory phantom percepts in tinnitus, which are currently being localized for neuromodulation targeting using deep brain stimulation techniques, would be associated with auditory phantom hallucination severity in SZ. METHODS Twenty five SZ and twenty eight demographically-matched healthy control (HC) participants, completed this fMRI resting-state study and clinical assessments. RESULTS Between-group seed-to-voxel analyses revealed only one region, the caudate anterior head, which showed reduced functional connectivity with the thalamus that survived whole-brain multiple comparison corrections. Importantly, connectivity between the caudate anterior head with thalamus negatively correlated with hallucination severity. CONCLUSIONS In the present study, we deliver the first evidence of caudate subdivision specificity for the neural pathophysiology underlying hallucinations in schizophrenia within a sensory gating framework that has been developed for auditory phantoms in patients with tinnitus. Our findings provide transdiagnostic convergent evidence for the role of the caudate in the gating of auditory phantom hallucinations, observed across patients with SZ and tinnitus by specifying the anterior caudate division is key to mediation of hallucinations, and creating a path towards personalized treatment approaches to arrest auditory phantom hallucinations from reaching perceptual awareness.
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Affiliation(s)
- Leighton B N Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Shalaila S Haas
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA 94143, USA; Surgical Services, San Francisco Veterans Health Care System, San Francisco, CA 94121, USA
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143, USA
| | - Karuna Subramaniam
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA 94143, USA.
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Muscat WM, Arleo K. A - 27 Early-Onset Alzheimer's Disease: Indications of Psychosis Severity and Disease Progression. Arch Clin Neuropsychol 2023; 38:1188. [PMID: 37807146 DOI: 10.1093/arclin/acad067.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Early-onset Alzheimer's disease (EOAD) comprises about 5% of ad cases and is associated with delays in diagnosis and aggressive course. Psychotic symptoms are frequent in ad and often include delusions of infidelity and hallucinations. When present, ad with psychosis is accompanied by elevated levels of depression and greater functional impairment. This case expands upon the existing literature on EOAD through the timeline of a complex psychosis presentation accompanied by rapid cognitive decline. METHOD 63-year-old, Hispanic, woman with progressive cognitive changes (e.g., confusion, forgetfulness, word-finding difficulties, disorganization) that emerged 5 years prior to seeking neurological consultation. Psychosis symptoms (i.e., auditory/visual hallucinations, delusions), in the context of real events (i.e., husband's previous infidelity), developed simultaneously. These pervasive symptoms have contributed to social withdrawal, persistent suicidal tendencies, and impaired IADLs. Neuroimaging suggested hypometabolism in the parietotemporal regions with precuneus and posterior cingulate gyri involvement. RESULTS The evaluation revealed fairly generalized cognitive decline. Basic attention, working memory, visual abstract reasoning, and phonemic fluency were intact. Visual integration/visuoconstruction were reduced. Impairments emerged in processing speed, rapid cognitive flexibility, cognitive inhibition, conceptualization, visuospatial orientation, semantic fluency, confrontation naming, and visual and verbal encoding and retention (with rapid forgetting). She endorsed moderately elevated symptoms of depression and anxiety. CONCLUSIONS The pattern of cognitive and functional deficits are all suggestive of an ad process. Her age, sex, significant neuroimaging findings, report of earliest cognitive symptoms, and family history reinforce an EOAD etiology. Significant behavioral changes are often associated with increased cognitive impairment and in turn, may mark the progression/stage of the disease.
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Felegy K, Keaveney J. A - 46 Mild Neurocognitive Disorder Due to Multiple Etiologies Case Study. Arch Clin Neuropsychol 2023; 38:1207-1209. [PMID: 37807161 DOI: 10.1093/arclin/acad067.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
OBJECTIVE Frank, a 68-year-old male, is seeking a neuropsychological evaluation based on a referral from the concussion legacy foundation. He wants to know if he has impairment and if so, what the cause is. He has been told by previous providers that he has Lewy Body Dementia, Alzheimer's Disease, or CTE. METHOD Frank has had over 20 concussions from football, car accidents, and assaults. For approximately a year, Frank has noticed short-term memory loss, word-finding problems, difficulty concentrating, and forgetting things. Frank indicated his balance is poor, as he stumbles and falls 3-4 times/day. In 2022, Frank began having visual hallucinations. Frank's medical history includes diabetes, hypertension, and high cholesterol. He is prescribed Seroquel, Aricept, Depakote DR, Zoloft, Wellbutrin, and Prazosin. RESULTS A test of premorbid functioning indicated Frank' abilities were in the Above Average range, which relative to his scores on this evaluation indicates a significant decline in cognitive functioning. There are significant impairments in Frank' auditory working memory, verbal learning and memory, visual learning and memory, visual planning and organization, and mental flexibility. CONCLUSIONS Deficits are consistent with Mild Neurocognitive Disorder due to multiple etiologies. Possible etiologies include multiple concussions, vascular risk factors such as hypertension, high cholesterol, and diabetes, as well as possible degenerative brain changes. The data suggests deficits with attention, learning, retrieval, impulsivity, mental flexibility, which is consistent with frontal subcortical executive deficits. The pattern of findings is consistent with Lewy Body changes due to visual hallucinations, fluctuating cognition, motor symptoms, and dysexecutive patterns on testing.
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Schumacher J, Ray NJ, Hamilton CA, Bergamino M, Donaghy PC, Firbank M, Watson R, Roberts G, Allan L, Barnett N, O'Brien JT, Thomas AJ, Taylor JP. Free water imaging of the cholinergic system in dementia with Lewy bodies and Alzheimer's disease. Alzheimers Dement 2023; 19:4549-4563. [PMID: 36919460 DOI: 10.1002/alz.13034] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION Degeneration of cortical cholinergic projections from the nucleus basalis of Meynert (NBM) is characteristic of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD), whereas involvement of cholinergic projections from the pedunculopontine nucleus (PPN) to the thalamus is less clear. METHODS We studied both cholinergic projection systems using a free water-corrected diffusion tensor imaging (DTI) model in the following cases: 46 AD, 48 DLB, 35 mild cognitive impairment (MCI) with AD, 38 MCI with Lewy bodies, and 71 controls. RESULTS Free water in the NBM-cortical pathway was increased in both dementia and MCI groups compared to controls and associated with cognition. Free water along the PPN-thalamus tract was increased only in DLB and related to visual hallucinations. Results were largely replicated in an independent cohort. DISCUSSION While NBM-cortical projections degenerate early in AD and DLB, the thalamic cholinergic input from the PPN appears to be more selectively affected in DLB and might associate with visual hallucinations. HIGHLIGHTS Free water in the NBM-cortical cholinergic pathways is increased in AD and DLB. NBM-cortical pathway integrity is related to overall cognitive performance. Free water in the PPN-thalamus cholinergic pathway is only increased in DLB, not AD. PPN-thalamus pathway integrity might be related to visual hallucinations in DLB.
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Affiliation(s)
- Julia Schumacher
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock-Greifswald, Rostock, Germany
| | - Nicola J Ray
- Health, Psychology and Communities Research Centre, Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Calum A Hamilton
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Maurizio Bergamino
- Barrow Neurological Institute, Neuroimaging Research, Phoenix, Arizona, USA
| | - Paul C Donaghy
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Michael Firbank
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Rosie Watson
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Gemma Roberts
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - Louise Allan
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
- University of Exeter Medical School, Exeter, UK
| | - Nicola Barnett
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - John T O'Brien
- Department of Psychiatry, University of Cambridge School of Medicine, Cambridge, UK
| | - Alan J Thomas
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
| | - John-Paul Taylor
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, Nebraska4 5PL , UK
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Nowak U, Wood J, Dinu AN, Wittkamp MF, Clamor A, Oravecz Z, Lincoln TM. Are paranoid ideation and hallucination spectrum experiences differently associated with affect dynamics? A continuous-time modeling approach. Emotion 2023; 23:1294-1305. [PMID: 36107656 DOI: 10.1037/emo0001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Psychotic experiences have been associated with distortions in affective functioning, including aberrancies in affect dynamics. However, it remains unclear whether the two principal symptom dimensions of psychosis, namely paranoid ideation and hallucination spectrum experiences, are differently associated with affect dynamics, and whether associations hold after statistically controlling for depressive symptoms. We investigate this by using a novel statistical approach, the hierarchical Ornstein-Uhlenbeck (OU) process model. This is a continuous-time stochastic differential equations model in a Bayesian framework that describes dynamics in affective valence and arousal via three core parameters: attractor point, variability, and attractor strength. In a community sample with varying levels of psychotic experiences (n = 116), we measured affective valence and arousal 10 times per day for 7 days, using the experience-sampling method. We found-while statistically controlling for depressive symptoms-credible between-subjects associations between paranoid ideation and attractor points of negative valence and high arousal. We also found a credible positive association between hallucination spectrum experiences and arousal variability. Limited evidence emerged for small associations between paranoid ideation and high valence variability as well as between paranoid ideation and high attractor strengths of valence and arousal. Hallucination spectrum experiences showed some evidence for a small association with high arousal attractor points. The detailed picture of affect dynamics provided by the OU model reveals different cross-sectional affective profiles associated with paranoid ideation versus hallucination spectrum experiences that suggest different affective mechanisms of their formation and maintenance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ulrike Nowak
- Institute of Psychology, Faculty of Psychology and Movement Sciences, Universitat Hamburg
| | - Julie Wood
- Department of Human Development and Family Studies, Pennsylvania State University
| | - Alina N Dinu
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf
| | - Martin F Wittkamp
- Institute of Psychology, Faculty of Psychology and Movement Sciences, Universitat Hamburg
| | - Annika Clamor
- Institute of Psychology, Faculty of Psychology and Movement Sciences, Universitat Hamburg
| | - Zita Oravecz
- Department of Human Development and Family Studies, Pennsylvania State University
| | - Tania M Lincoln
- Institute of Psychology, Faculty of Psychology and Movement Sciences, Universitat Hamburg
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Villalobos-López P, Maldonado-Contreras A. [Sleep paralysis during naptime as initial symptom of narcolepsy]. Rev Neurol 2023; 77:S7-S12. [PMID: 37477028 PMCID: PMC10831718 DOI: 10.33588/rn.77s01.2023197] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION Narcolepsy is a disease of unknown etiology, with a very low prevalence (0.02-0.16% in adults, although it must be higher, given the underdiagnosis), characterized by the presence of excessive daytime sleepiness, hypnagogic and/or hypnopompic hallucinations, sleep paralysis and/or cataplexy (if present, we speak of type 1 narcolepsy and, if not, type 2 narcolepsy), whose average diagnostic delay is between 10 and 15 years. CASE REPORT A 16-year-old male who consulted after visiting different specialists for presenting sleep paralysis during naps, which cause him fear and occasional objects falling from his hands (diagnosed as possible myoclonus). In the anamnesis we were surprised by the presence of sleep paralysis immediately after the start of the naps and, in the directed anamnesis, these sudden movements caused by emotions were compatible with cataplexies, so we performed a nocturnal polysomnographic study and a multiple sleep latency test. With evolution came hypnopompic hallucinations and fragmented nocturnal sleep, as well as occasional daytime sleepiness (thus completing the typical symptomatic tetrad of type 1 narcolepsy with cataplexy). CONCLUSION Knowledge of this disease is important, considering it as a differential diagnosis in patients with episodes of intractable sleepiness, send these patients to expert doctors in sleep disorders and doing a good anamnesis, performing the necessary complementary tests for the diagnosis of this underdiagnosed disease for its correct management, which is decisive for improving the quality of life of these patients.
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Affiliation(s)
- P Villalobos-López
- Clínica Neurodem, Almería, España
- Hospital Universitario Torrecárdenas, Almería, España
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Wang J, Dong W, Li Y, Wydell TN, Quan W, Tian J, Song Y, Jiang L, Li F, Yi C, Zhang Y, Yao D, Xu P. Discrimination of auditory verbal hallucination in schizophrenia based on EEG brain networks. Psychiatry Res Neuroimaging 2023; 331:111632. [PMID: 36958075 DOI: 10.1016/j.pscychresns.2023.111632] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
Auditory verbal hallucinations (AVH) are a core positive symptom of schizophrenia and are regarded as a consequence of the functional breakdown in the related sensory process. Yet, the potential mechanism of AVH is still lacking. In the present study, we explored the difference between AVHs (n = 23) and non-AVHs (n = 19) in schizophrenia and healthy controls (n = 29) by using multidimensional electroencephalograms data during an auditory oddball task. Compared to healthy controls, both AVH and non-AVH groups showed reduced P300 amplitudes. Additionally, the results from brain networks analysis revealed that AVH patients showed reduced left frontal to posterior parietal/temporal connectivity compared to non-AVH patients. Moreover, using the fused network properties of both delta and theta bands as features for in-depth learning made it possible to identify the AVH from non-AVH patients at an accuracy of 80.95%. The left frontal-parietal/temporal networks seen in the auditory oddball paradigm might be underlying biomarkers of AVH in schizophrenia. This study demonstrated for the first time the functional breakdown of the auditory processing pathway in the AVH patients, leading to a better understanding of the atypical brain network of the AVH patients.
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Affiliation(s)
- Jiuju Wang
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Wentian Dong
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Yuqin Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, Sichuan 611731, China; School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Taeko N Wydell
- Centre for Cognitive Neuroscience, Brunel University London, Uxbridge, UK
| | - Wenxiang Quan
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Ju Tian
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Yanping Song
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Lin Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, Sichuan 611731, China; School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Fali Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, Sichuan 611731, China; School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China; Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu 2019RU035, China.
| | - Chanlin Yi
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, Sichuan 611731, China; School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Yangsong Zhang
- School of Computer Science and Technology, Southwest University of Science and Technology, Mianyang 621010, China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, Sichuan 611731, China; School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China; Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu 2019RU035, China; School of Electrical Engineering, Zhengzhou University, Zhengzhou 450001, China
| | - Peng Xu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, No. 2006, Xiyuan Ave, West Hi-Tech Zone, Chengdu, Sichuan 611731, China; School of Life Science and Technology, Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu 611731, China; Research Unit of NeuroInformation, Chinese Academy of Medical Sciences, Chengdu 2019RU035, China.
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20
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Raugh IM, Luther L, Bartolomeo LA, Gupta T, Ristanovic I, Pelletier-Baldelli A, Mittal VA, Walker EF, Strauss GP. Negative Symptom Inventory-Self-Report (NSI-SR): Initial development and validation. Schizophr Res 2023; 256:79-87. [PMID: 37172500 PMCID: PMC10262695 DOI: 10.1016/j.schres.2023.04.015] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/13/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
Negative symptoms (i.e., anhedonia, avolition, asociality, blunted affect, alogia) are frequently observed in the schizophrenia-spectrum (SZ) and associated with functional disability. While semi-structured interviews of negative symptoms represent a gold-standard approach, they require specialized training and may be vulnerable to rater biases. Thus, brief self-report questionnaires measuring negative symptoms may be useful. Existing negative symptom questionnaires demonstrate that this approach may be promising in schizophrenia, but no measure has been devised for use across stages of psychotic illness. The present study reports initial psychometric validation of the Negative Symptom Inventory-Self-Report (NSI-SR), the self-report counterpart of the Negative Symptom Inventory-Psychosis Risk clinical interview. The NSI-SR is a novel transphasic negative symptoms measure assessing the domains of anhedonia, avolition, and asociality. The NSI-SR and related measures were administered to two samples: 1) undergraduates (n = 335), 2) community participants, including: SZ (n = 32), clinical-high risk for psychosis (CHR, n = 25), and healthy controls matched to SZ (n = 31) and CHR (n = 30). The psychometrically trimmed 11-item NSI-SR showed good internal consistency and a three-factor solution reflecting avolition, asociality, and anhedonia. The NSI-SR demonstrated convergent validity via moderate to large correlations with clinician-rated negative symptoms and related constructs in both samples. Discriminant validity was supported by lower correlations with positive symptoms in both samples; however, correlations with positive symptoms were still significant. These initial psychometric findings suggest that the NSI-SR is a reliable and valid brief questionnaire capable of measuring negative symptoms across phases of psychotic illness.
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Affiliation(s)
- Ian M Raugh
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Lauren Luther
- Department of Psychology, University of Georgia, Athens, GA, USA
| | | | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Ivanka Ristanovic
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | | | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, IL, USA
| | - Elaine F Walker
- Department of Psychology, Emory University, Atlanta, GA, USA
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21
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Gibson LL, Grinberg LT, Ffytche D, Leite REP, Rodriguez RD, Ferretti-Rebustini REL, Pasqualucci CA, Nitrini R, Jacob-Filho W, Aarsland D, Suemoto CK. Neuropathological correlates of neuropsychiatric symptoms in dementia. Alzheimers Dement 2023; 19:1372-1382. [PMID: 36150075 PMCID: PMC10033459 DOI: 10.1002/alz.12765] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Neuropsychiatric symptoms (NPS) are common in Lewy body disease (LBD), but their etiology is poorly understood. METHODS In a population-based post mortem study neuropathological data was collected for Lewy body (LB) neuropathology, neurofibrillary tangles (NFT), amyloid beta burden, TDP-43, lacunar infarcts, cerebral amyloid angiopathy (CAA), and hyaline atherosclerosis. Post mortem interviews collected systematic information regarding NPS and cognitive status. A total of 1038 cases were included: no pathology (NP; n = 761), Alzheimer's disease (AD; n = 189), LBD (n = 60), and AD+LBD (n = 28). RESULTS Hallucinations were associated with higher LB Braak stages, while higher NFT Braak staging was associated with depression, agitation, and greater number of symptoms in the Neuropsychiatric Inventory. Cases with dual AD+LBD pathology had the highest risk of hallucinations, agitation, apathy, and total symptoms but a multiplicative interaction between these pathologies was not significant. DISCUSSION LB and AD pathology contribute differentially to NPS likely with an additive process contributing to the increased burden of NPS.
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Affiliation(s)
- Lucy L Gibson
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology and Pathology, University of California San Francisco, San Francisco, California, USA
- University of São Paulo Medical School, São Paulo, Brazil
| | - Dominic Ffytche
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | | | | | | | - Dag Aarsland
- Old Age Psychiatry Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Age-Related Disease, Stavanger University Hospital, Stavanger, Norway
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22
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Astill Wright L, McElroy E, Barawi K, Roberts NP, Simon N, Zammit S, Bisson JI. Associations among psychosis, mood, anxiety, and posttraumatic stress symptoms: A network analysis. J Trauma Stress 2023; 36:385-396. [PMID: 36862599 DOI: 10.1002/jts.22916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 03/03/2023]
Abstract
The associations among psychotic experiences (i.e., hallucinations and delusions), trauma exposure, and posttraumatic stress symptoms are complex and multidirectional. Using network analysis to understand how psychotic experiences and symptoms of posttraumatic stress disorder (PTSD) relate to one another may identify new interventional targets to treat comorbidity and its underlying pathological processes. This study aimed to use network analysis to examine the associations among psychotic experiences; negative symptoms of psychosis; and symptoms of PTSD, anxiety, and depression. In this population-based cohort study, 4,472 participants (36.7% male) were assessed for psychotic experiences, negative symptoms of psychosis, PTSD, anxiety, and depression at age 23 (M = 23.86 years, SD = 0.520) or 24 years (M = 24.03, SD = 0.848). Associations among symptoms were assessed via network analysis. Exploratory graph analysis identified three clusters of densely connected symptoms within the overall network: psychotic experiences; PTSD symptoms; and depressive and anxiety symptoms and negative symptoms of psychosis. Psychotic experiences had the strongest associations with other symptoms in the network, and symptoms of anxiety played a key role in bridging psychotic experiences, symptoms of PTSD, and depressive symptoms. Consistent with the stress reactivity and affective models for psychotic experiences, the results suggest that symptoms of anxiety and emotional distress (e.g., hyperarousal, panic) may have a key role in the development and maintenance of psychotic experiences and symptoms of PTSD. Targeting these symptoms may ameliorate symptom burden transdiagnostically.
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Affiliation(s)
- Laurence Astill Wright
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Eoin McElroy
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Kali Barawi
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
- Directorate of Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, United Kingdom
| | - Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
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23
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王 美, 马 菁, 李 思, 张 岚. [Narcolepsy Type 1 With Comorbid Schizophrenia: A Case Report]. Sichuan Da Xue Xue Bao Yi Xue Ban 2023; 54:444-446. [PMID: 36949713 PMCID: PMC10409159 DOI: 10.12182/20230360104] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Indexed: 03/24/2023]
Abstract
We present the case of an 18-year-old male patient who had narcolepsy type 1 and comorbid schizophrenia. The patient's first symptom was mainly excessive daytime sleepiness, which was followed by psychotic symptoms, including hallucinations, delusions, and abnormal speech and behaviors. After admission to the hospital, the patient underwent a number of ancillary tests. Multiple sleep latency test (MSLT) showed that the mean sleep latency was 2 min and the hypocretin-1 was found to be 90.56 pg/mL. The patient was diagnosed with: 1) schizophrenia; 2) narcolepsy. After receiving antipsychotic drugs and behavioral therapy, the patient's hallucinations and abnormal speech and behaviors disappeared, and delusions and excessive daytime sleepiness decreased significantly. The symptoms and manifestations of narcolepsy type 1 overlaps with those of schizophrenia, which may lead to misdiagnosis and underdiagnosis in clinical practice. The case is presented with a view to providing a reference for the clinical diagnosis and treatment of narcolepsy type 1 with comorbid schizophrenia.
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Affiliation(s)
- 美鸥 王
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 菁 马
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 思迅 李
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 岚 张
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
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24
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Soler-Vidal J, Fuentes-Claramonte P, Salgado-Pineda P, Ramiro N, García-León MÁ, Torres ML, Arévalo A, Guerrero-Pedraza A, Munuera J, Sarró S, Salvador R, Hinzen W, McKenna P, Pomarol-Clotet E. Brain correlates of speech perception in schizophrenia patients with and without auditory hallucinations. PLoS One 2022; 17:e0276975. [PMID: 36525414 PMCID: PMC9757556 DOI: 10.1371/journal.pone.0276975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 10/18/2022] [Indexed: 12/23/2022] Open
Abstract
The experience of auditory verbal hallucinations (AVH, "hearing voices") in schizophrenia has been found to be associated with reduced auditory cortex activation during perception of real auditory stimuli like tones and speech. We re-examined this finding using 46 patients with schizophrenia (23 with frequent AVH and 23 hallucination-free), who underwent fMRI scanning while they heard words, sentences and reversed speech. Twenty-five matched healthy controls were also examined. Perception of words, sentences and reversed speech all elicited activation of the bilateral superior temporal cortex, the inferior and lateral prefrontal cortex, the inferior parietal cortex and the supplementary motor area in the patients and the healthy controls. During the sentence and reversed speech conditions, the schizophrenia patients as a group showed reduced activation in the left primary auditory cortex (Heschl's gyrus) relative to the healthy controls. No differences were found between the patients with and without hallucinations in any condition. This study therefore fails to support previous findings that experience of AVH attenuates speech-perception-related brain activations in the auditory cortex. At the same time, it suggests that schizophrenia patients, regardless of presence of AVH, show reduced activation in the primary auditory cortex during speech perception, a finding which could reflect an early information processing deficit in the disorder.
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Affiliation(s)
- Joan Soler-Vidal
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
- Universitat de Barcelona, Barcelona, Spain
- Benito Menni Complex Asistencial en Salut Mental, Sant Boi de Llobregat, Spain
| | - Paola Fuentes-Claramonte
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
| | | | - María Ángeles García-León
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
| | | | | | | | - Josep Munuera
- Diagnostic Imaging and Image Guided Therapy, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, Spain
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Barcelona, Spain
- Hospital de Sant Joan de Déu, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
| | - Raymond Salvador
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
| | - Wolfram Hinzen
- Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Peter McKenna
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
- * E-mail:
| | - Edith Pomarol-Clotet
- FIDMAG Hermanas Hospitalarias Research Foundation, Sant Boi de Llobregat, Spain
- CIBERSAM (G15), Barcelona, Spain
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Isaksson J, Angenfelt M, Frick MA, Olofsdotter S, Vadlin S. Psychotic-like experiences from adolescence to adulthood: A longitudinal study. Schizophr Res 2022; 248:1-7. [PMID: 35907346 DOI: 10.1016/j.schres.2022.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/05/2022] [Accepted: 07/10/2022] [Indexed: 11/18/2022]
Abstract
Psychotic-like experiences (PLEs), such as delusions and hallucinations, are regarded to occur along a spectrum and to be present also in non-help-seeking individuals from the general population. However, it remains unclear whether the occurrence of PLEs is a unique risk factor for future PLEs or a symptom of general psychopathology. In this study, we investigated whether PLEs during adolescence predict future PLEs in adulthood. A community-based cohort of 1146 young adolescents (mean age, 14.38 years) were assessed and then reassessed 6 years later (mean age, 20.15 years). Participants reported PLEs experienced in the past year, as well as symptoms of depression, anxiety, attention-deficit/hyperactivity disorder, and conduct problems. We adjusted the analysis for other forms of psychopathology and sex differences. Participants who reported PLEs in adulthood had higher ratings for all preceding and co-occurring symptoms of psychopathology. In the adjusted logistic regression model, having PLEs and, to a smaller degree, anxiety during adolescence predicted PLEs in early adulthood. The association between baseline and future PLEs did not differ between males and females, although females were more likely to report PLEs during adolescence. Participants with persistent PLEs reported more hallucinations during adolescence than those with transient symptoms. Our findings suggest that the early occurrence of PLEs is an important and independent predictor of future PLEs and should be monitored to identify individuals with a high risk of future psychopathology and to enable early interventions.
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Affiliation(s)
- Johan Isaksson
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden; Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Max Angenfelt
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden
| | - Matilda A Frick
- Department of Medical Sciences, Child and Adolescent Psychiatry Unit, Uppsala University, Uppsala, Sweden; Emotion Division, Department of Psychology, Uppsala University, Sweden
| | - Susanne Olofsdotter
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden
| | - Sofia Vadlin
- Centre for Clinical Research, Västmanland County Hospital Västerås, Uppsala University, Sweden.
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26
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Meier L, Weinrebe W, Annoni JM, Petersen JA. Confusion and Hallucination in a Geriatric Patient. Pitfalls of a Rare Differential: Case Report of an Anti-LGI1-Encephalitis. Clin Interv Aging 2022; 17:1423-1432. [PMID: 36187571 PMCID: PMC9524277 DOI: 10.2147/cia.s380316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/05/2022] [Indexed: 11/23/2022] Open
Abstract
Background Confusion and hallucinations in geriatric patients are frequent symptoms and typically associated with delirium, late-life psychosis or dementia syndromes. A far rarer but well-established differential in patients with rapid cognitive deterioration, acute psychosis, abnormal movements and seizures is autoimmune encephalitis. Exemplified by our case we highlight clinical and economic problems arising in management of geriatric patients with cognitive decline and psychotic symptoms. Case Presentation A 77-year-old female caucasian patient with an unremarkable medical history was hospitalized after a fall in association with diarrhea and hyponatremia. Upon adequate therapy, disorientation and troubled short-term memory persisted. Within a week the patient developed visual hallucinations. Basic blood and urine samples and imaging (cranial computed tomography and magnetic resonance imaging) were unremarkable. With progressive cognitive decline, amnestic impairment, word finding difficulty and general apathy, psychiatric and neurologic expertise was introduced. Advanced diagnostics did not resolve a final diagnosis; an electroencephalogram showed unspecific generalized slowing. Extended clinical observation revealed visual hallucinations and faciobrachial dystonic seizures. A treatment with anticonvulsants was initiated. Cerebrospinal fluid ultimately tested positive for voltage-gated potassium channel LGl1 (leucine-rich-inactivated-1) antibodies confirming diagnosis of autoimmune anti-LGI1 encephalitis. Immediate immunotherapy (high-dose glucocorticoids and administration of intravenous immunoglobulin G) led to a rapid improvement of the patient’s condition. After immunotherapy was tapered, the patient had one relapse and completely recovered with reintroduction of glucocorticoids and initiation of therapy with rituximab. Conclusion Rapidly progressive dementia in geriatric patients demands a structured and multidisciplinary diagnostic approach. Accurate management and financially supportable care is a major issue in rare diseases such as anti-LGI1-encephalitis. Education and awareness about autoimmune encephalitis of all physicians treating a geriatric population is important in order to involve expertise and establish treatment within reasonable time.
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Affiliation(s)
- Luzia Meier
- Internal Medicine, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Wolfram Weinrebe
- Internal Medicine, Salemspital Hirslanden Bern, Bern, Switzerland
- Correspondence: Wolfram Weinrebe, Department Allgemeine Innere Medizin, Salemspital Bern, Hirslanden Kliniken, Schänzlihalde 33, Bern, 3007, Switzerland, Email
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27
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Angelopoulou E, Bougea A, Papageorgiou SG, Villa C. Psychosis in Parkinson's Disease: A Lesson from Genetics. Genes (Basel) 2022; 13:genes13061099. [PMID: 35741861 PMCID: PMC9222985 DOI: 10.3390/genes13061099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
Psychosis in Parkinson's disease (PDP) represents a common and debilitating condition that complicates Parkinson's disease (PD), mainly in the later stages. The spectrum of psychotic symptoms are heterogeneous, ranging from minor phenomena of mild illusions, passage hallucinations and sense of presence to severe psychosis consisting of visual hallucinations (and rarely, auditory and tactile or gustatory) and paranoid delusions. PDP is associated with increased caregiver stress, poorer quality of life for patients and carers, reduced survival and risk of institutionalization with a significant burden on the healthcare system. Although several risk factors for PDP development have been identified, such as aging, sleep disturbances, long history of PD, cognitive impairment, depression and visual disorders, the pathophysiology of psychosis in PD is complex and still insufficiently clarified. Additionally, several drugs used to treat PD can aggravate or even precipitate PDP. Herein, we reviewed and critically analyzed recent studies exploring the genetic architecture of psychosis in PD in order to further understand the pathophysiology of PDP, the risk factors as well as the most suitable therapeutic strategies.
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Affiliation(s)
- Efthalia Angelopoulou
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (A.B.); (S.G.P.)
| | - Anastasia Bougea
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (A.B.); (S.G.P.)
| | - Sokratis G. Papageorgiou
- Department of Neurology, Eginition University Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece; (E.A.); (A.B.); (S.G.P.)
| | - Chiara Villa
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-02-6448-8138
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Sabesan P, Palaniyappan L. Therapeutic abstention in the treatment of depression in first-episode psychosis. J Psychiatry Neurosci 2020; 45. [PMID: 33119488 PMCID: PMC7595739 DOI: 10.1503/jpn.200059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Priyadharshini Sabesan
- From the Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario London, Ont., Canada (Sabesan, Palaniyappan); and the Robarts Research Institute & Lawson Health Research Institute, London, Ont., Canada (Palaniyappan)
| | - Lena Palaniyappan
- From the Department of Psychiatry, Schulich School of Medicine & Dentistry, University of Western Ontario London, Ont., Canada (Sabesan, Palaniyappan); and the Robarts Research Institute & Lawson Health Research Institute, London, Ont., Canada (Palaniyappan)
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29
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Chen C, Wang GH, Wu SH, Zou JL, Zhou Y, Wang HL. Abnormal Local Activity and Functional Dysconnectivity in Patients with Schizophrenia Having Auditory Verbal Hallucinations. Curr Med Sci 2020; 40:979-984. [PMID: 33123911 DOI: 10.1007/s11596-020-2271-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
Auditory verbal hallucination (AVH) is emphasized as a pathological hallmark of schizophrenia. Neuroimaging studies provide evidence linking AVH to overlapping functional abnormalities in distributed networks. However, no clear conclusion has still been reached. This study aimed to further explore the brain activity of patients with schizophrenia having AVH from both local activity (LA) and functional connectivity (FC) insights, while excluding confounding factors from other positive symptoms. A total of 42 patients with AVH (AVH patients group, APG), 26 without AVH (non-AVH patients group, NPG), and 82 normal controls (NC) underwent resting-state functional magnetic resonance imaging (fMRI). LA measures, including regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuations (fALFF), and FC measures were evaluated to understand the neuroimaging mechanism of AVH. APG showed increased ReHo and fALFF in the bilateral putamen (Put) compared with NPG and NC. FC analysis (using bilateral putamen as seeds) revealed that all patients showed abnormal FC of multiple resting-state network regions, including the anterior and post cingulate cortex, middle frontal gyrus, inferior parietal gyrus, and left angular gyrus. Interestingly, APG showed significantly decreased FC of insula extending to the superior temporal gyrus and inferior frontal gyrus compared with NPG and NC. The present findings suggested a significant correlation of abnormal LA and dysfunctional putamen-auditory cortical connectivity with the neuropathological mechanism of AVH, providing evidence for the functional disconnection hypothesis of schizophrenia.
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Affiliation(s)
- Cheng Chen
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Gao-Hua Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
- Hubei Institute of Neurology and Psychiatry Research, Wuhan, 430060, China
| | - Shi-Hao Wu
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ji-Lin Zou
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuan Zhou
- Institute of Psychology, CAS Key Laboratory of Behavioral Science, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Hui-Ling Wang
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
- Hubei Provincial Key Laboratory of Developmentally Originated Disease, Wuhan, 430071, China.
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Abstract
Although hallucinations are not one of the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) criteria for posttraumatic stress disorder (PTSD), they are increasingly documented in PTSD. They are noted in the absence of clear delusions, formal thought disorganization, disorganized speech, or behavior, ruling out a comorbid psychotic disorder like schizophrenia as a better explanation for these hallucinations. Hallucinations in both PTSD and schizophrenia share phenomenological features. We propose that hallucinations in PTSD, like those in schizophrenia, might be explained in terms of aberrant predictive coding, specifically the misapplication of strong prior beliefs that vitiate perceptual inference. This approach highlights the broader relationship between trauma and psychosis. Under predictive coding, the nervous system organizes past sensory data into an internal model of the world. Under stress, the brain prioritizes speed over accurate encoding. However, memories for traumatic experiences are typically strongly consolidated, to avoid similar experiences in future. In PTSD, this could lead to a world model comprised of inaccurate but overly precise prior beliefs, that can be triggered by stimuli tangentially related to the index trauma, resulting in hallucinations. Crucially, this evidence accumulation depends upon the relative precision of prior beliefs and sensory evidence (supplied in the form of prediction errors). Our basic argument is that stressful situations induce belief updating, in terms of precise prior beliefs, that are difficult to undo. These unduly precise, trauma-related beliefs then constitute perceptual hypotheses, memories, or narratives that bias subsequent experience. This prior bias may be so severe that sensory evidence is effectively ignored; that is, treated as very imprecise, in relation to prior beliefs. Such an account may lead to cognitive therapies for hallucinations aimed at strong prior beliefs, and the exciting prospect of combining such therapies with drugs that modulate neuroplasticity and enhance the adaptive consolidation of more appropriate priors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- S. Lyndon
- Yale University, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, USA, 06511
| | - P.R. Corlett
- Yale University, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, USA, 06511
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Ban KY, Osborn DPJ, Hameed Y, Pandey S, Perez J, Jones PB, Kirkbride JB. Personality disorder in an Early Intervention Psychosis cohort: Findings from the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PLoS One 2020; 15:e0234047. [PMID: 32502161 PMCID: PMC7274401 DOI: 10.1371/journal.pone.0234047] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/17/2020] [Indexed: 11/19/2022] Open
Abstract
AIM Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services. METHODS Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed. RESULTS Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density. CONCLUSIONS Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.
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Affiliation(s)
- Ka-Young Ban
- Division of Psychiatry, UCL, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, London, United Kingdom
| | - Yasir Hameed
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Santvana Pandey
- Norfolk & Suffolk Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire & Peterborough Foundation Trust, and NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridge, Cambridgeshire, United Kingdom
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Affiliation(s)
- Marissa P Caan
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Boston, MA.
| | - Christopher T Lim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA; Harvard Medical School, Boston, MA
| | - Mark Howard
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA
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Sluys M, Güzelcan Y, Casteelen G, de Haan L. Risperidone-induced leucopenia and neutropenia: a case report. Eur Psychiatry 2020; 19:117. [PMID: 15051112 DOI: 10.1016/j.eurpsy.2003.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2002] [Revised: 01/20/2003] [Accepted: 03/02/2003] [Indexed: 11/22/2022] Open
Affiliation(s)
- Myrthe Sluys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Di Michele V, Bolino F. Adjunctive citalopram is effective on hallucinations and depersonalization symptoms: a case report. Eur Psychiatry 2020; 19:185. [PMID: 15158931 DOI: 10.1016/j.eurpsy.2003.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2003] [Accepted: 07/04/2003] [Indexed: 11/25/2022] Open
Abstract
The treatment of depressive symptoms in patients affected by schizophrenia is often a concern for clinicians [2] due to potential interaction, in terms of safety and efficacy. Citalopram seems to be a safe SSRI as adjunctive treatment to Olanzapine because of the lack of interactions. We report a serendipitous finding showing that the adjunction of Citalopram to Olanzapine, led to disappearence of residual hallucinations and depersonalization symptoms in a few weeks.Mr A is a 27-year-old male, living in the community, with a 4-year history of schizophrenia,. He was treated with low doses of Olanzapine (10 mg/daily) since 2000 because of an intolerance to dose increments (weight gain and mydriasis).The persistence of sporadic hallucinations (commenting voices) and depersonalization symptoms (when he walked alone he felt his self leaving the body) was well tolerated by the patient. The social functioning was satisfactory: he had a protected job and was involved in a comprehensive rehabilitation programme.
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Wilson S, Farnham F, Taylor A, Taylor R. Reflections on working in public-figure threat management. Med Sci Law 2019; 59:275-281. [PMID: 31462151 DOI: 10.1177/0025802419861168] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The Fixated Threat Assessment Centre (FTAC) manages the risk posed to public figures by fixated individuals by paying attention to their correspondence and approaches and liaising with the mental health and criminal justice agencies responsible for their management. This paper offers a narrative reflection on the clinical experience of this unusual work. The clinical population is significantly different from that seen in mainstream mental health services, with a preponderance of delusional disorders and paraphrenias. The interface with mental health and criminal justice systems around the UK and internationally also offers a unique perspective on the functioning and malfunctioning of these services, and we attempt to describe and make sense of these experiences.
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Affiliation(s)
- Simon Wilson
- North London Forensic Service, Barnet Enfield and Haringey Mental Health Trust, UK
- UCL Department of Security and Crime Science, UK
| | - Frank Farnham
- North London Forensic Service, Barnet Enfield and Haringey Mental Health Trust, UK
- UCL Department of Security and Crime Science, UK
| | - Alice Taylor
- North London Forensic Service, Barnet Enfield and Haringey Mental Health Trust, UK
| | - Richard Taylor
- North London Forensic Service, Barnet Enfield and Haringey Mental Health Trust, UK
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Abstract
OBJECTIVE Subthreshold perceptual abnormalities are commonly used to identify individuals at clinical high risk (CHR) for developing a psychotic disorder. Predictive validity for modality-specific perceptual abnormality severity on psychosis risk is unknown. METHODS We examined prospectively collected data from 164 individuals age 12-35 meeting criteria for CHR followed for 6-24 months or until conversion to psychosis. Using intake interview notes, baseline perceptual abnormality scores were split into auditory, visual, somatic/tactile, and olfactory/gustatory components, and auditory scores were further split into those for verbal vs non-verbal content. Relationships between perceptual abnormality characteristics and conversion were assessed with Cox proportional hazards regression and logistic regression. RESULTS Unusual thought content and paranoia were predictive of conversion, but no modality-specific perceptual abnormality score predicted conversion status or days to conversion. However, when auditory perceptual abnormalities were further categorized as verbal vs non-verbal, the severity of verbal experiences was predictive of conversion to psychosis (P = 0.007). CONCLUSIONS Perceptual abnormality scores failed to meaningfully predict conversion to psychosis in either direction in this CHR sample. However, verbal auditory experiences may identify a group of CHR individuals at elevated risk of conversion. Further exploration of the relationship between phenomenological aspects of perceptual abnormalities and conversion risk is warranted.
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Affiliation(s)
- Halsey F. Niles
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Barbara C. Walsh
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Scott W. Woods
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Albert R. Powers
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
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Dudek A, Krzystanek M, Krysta K, Górna A. Evolution of Religious Topics in Schizophrenia in 80 Years Period. Psychiatr Danub 2019; 31:524-529. [PMID: 31488785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Environment and culture are shown to be an important factor influencing characteristics of psychotic symptoms. Content of hallucinations and delusions is a projection of internal processes on external world. Religion plays a central role to lives of many people, but in schizophrenia religious experience and spirituality is confounded by psychotic symptoms. The aim of this study was to find how content of hallucinations and delusions interact with cultural conditions, that were changing over the decades. SUBJECTS AND METHODS 100 of case histories from 2012 were randomly selected. From the medical record, content of hallucinations and delusion was extracted and categorized. Data from 2012 was compared with previous study by the authors, obtaining perspective of 80 years of history in the one hospital. RESULTS Religious content of delusions and hallucinations appeared in 26% of patients. Diversity of the religious and spiritual themes in schizophrenia has been gradually decreasing. Many minor religious entities and figures such as "saints" and "angels" disappeared in 2012. Although, occurrence of contact with God and other religious figures was similar as in previous years, number of "visions" abruptly decreased. All of the religious content was culture-specific. CONCLUSIONS Religious topics express general plasticity over a time, following cultural changes in society.
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Affiliation(s)
- Arkadiusz Dudek
- Department of Psychiatric Rehabilitation, Medical University of Silesia, Katowice, Poland,
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Abstract
PURPOSE OF REVIEW Neuropsychiatric syndromes (NPS) are common in neurodegenerative disorders (NDD). This review describes the role of NPS in the diagnosis of NDD, criteria for the diagnosis of NPS, management of NPS, and agents in clinical trials for NPS. RECENT FINDINGS NPS play an increasingly important role in the diagnosis of NDD. Consensus diagnostic criteria have evolved for psychosis, depression, agitation, and apathy in NDD. With one exception-pimavanserin is approved for the treatment of hallucinations and delusions in Parkinson's disease-there are no drugs approved by the FDA for treatment of NPS in NDD. Trials show that atypical antipsychotics reduce psychosis in AD and in Parkinson's disease, although side effect concerns have constrained their use. Antidepressants show benefit in treatment of Parkinson's disease with depression. Several agents are in clinical trials for treatment of NPS in NDD. Neuropsychiatric syndromes play a major role in NDD diagnosis. Clinical criteria allow recognition of NPS in NDD. Psychotropic medications are often useful in the treatment of NPS in NDD; efficacious, safe, and approved agents are needed.
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Affiliation(s)
- Jeffrey Cummings
- Department of Brain Health, School of Integrated Health Sciences, University of Nevada Las Vegas (UNLV), 4505 S Maryland Pkwy, Las Vegas, NV, 89154, USA.
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave., Las Vegas, NV, 89106, USA.
| | - Aaron Ritter
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave., Las Vegas, NV, 89106, USA
| | - Kasia Rothenberg
- Cleveland Clinic Lou Ruvo Center for Brain Health, Cleveland, OH, USA
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Lin W, Xie YC, Cheng PY, Dong LY, Hung GU, Chiu PY. Association of visual hallucinations with very mild degenerative dementia due to dementia with Lewy bodies. PLoS One 2018; 13:e0205909. [PMID: 30321234 PMCID: PMC6188892 DOI: 10.1371/journal.pone.0205909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 10/03/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Complex, well-formed, and detailed visual hallucinations (VHs) are among the core clinical features of dementia with Lewy bodies (DLB). We investigated the diagnostic value of VHs in different types of very mild degenerative dementia. METHODS Participants were required to complete a structured interview form recording their basic data, clinical history, neuropsychological tests, and neuropsychiatric symptoms. Basic demographic characteristics of the participants were summarized and compared. The frequency and association factors of VHs were compared among three major degenerative dementia groups, namely, Alzheimer's disease (AD), Parkinson's disease dementia (PDD), and DLB. RESULTS A total of 197 patients with dementia and a clinical dementia rating of 0.5 were investigated, comprising 124 with AD, 35 with PDD, and 38 with DLB. A significantly higher frequency of VHs was found in the DLB group compared with the other groups (DLB, PDD, and AD = 31.6%, 11.4%, and 4.0%; p < 0.001). A multivariable logistic regression test for associations of positive VHs revealed that DLB was the only independently predictive factor (odds ratio: 13.62; p < 0.001). CONCLUSION Our findings revealed a high diagnostic value of VHs in very mild degenerative dementia. VHs in this stage of dementia were significantly associated with DLB, and more than 30% of patients with very mild dementia caused by DLB presented with VHs.
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Affiliation(s)
- Wei Lin
- Department of Neurology, Chang Bin Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Yuan-Chang Xie
- Department of Neurology, Chang Bin Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Po-Ya Cheng
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Ling-Ying Dong
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Guang-Uei Hung
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan
- * E-mail: (PYC); (GUH)
| | - Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
- * E-mail: (PYC); (GUH)
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Abstract
RATIONALE Paraquat, an agent highly toxic to humans and animals, is a widely used herbicide and also commonly used for suicide attempts in Taiwan. The most common route of intoxication is oral ingestion, and parenteral poisoning is respectively rare. PATIENT CONCERNS A 39-year-old illicit abuser of heroin and amphetamine injected 0.5 mL of 24% paraquat directly into his right cephalic vein due to hallucination. The patient was brought to our emergency department for management 4 hours after injection. He was fully conscious and had normal vital signs. Systemic review showed mild dyspnea, abdominal pain and right wrist pain over the injection site. The only abnormal physical finding was erythema over the injection site and epigastric tenderness. DIAGNOSIS Laboratory investigations, including complete blood count, liver and renal function, and electrolytes initially yielded normal results. Urinalysis showed normal findings except a positive urine paraquat test (4+). The initial plasma paraquat concentration was 0.51 μg/mL. INTERVENTIONS He was admitted to the intensive care unit and underwent one session of charcoal hemoperfusion therapy. Acute kidney injury developed on the fourth day after intoxication, with the level of serum creatinine rising rapidly from 0.96 to 4.57 mg/dL and the daily urine output decreased noticeably from > 2000 to 900 mL. The serum creatinine level improved gradually with adequate fluid supplementation. OUTCOMES The patient was discharged 13 days later in a stable condition. LESSONS Intravenous paraquat intoxication is rare. Patients who suffer from intravenous intoxication may not directly suffer from mucosal irritation, but the clinical onset of systemic effects is more immediate and lethal. The prognosis of paraquat poisoning is determined by the time of poisoning and the plasma paraquat concentration before treatment. Proudfoot's curve provides a simple method of predicting the survival rate. The most effective mode of management is extracorporeal therapy, and immunosuppressive or antioxidant therapies have shown insufficient evidence of benefit.
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Affiliation(s)
- Chi-Wei Chen
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Yen-Hung Wu
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shun-Ching Chien
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
| | - Jhong-Ching Lin
- Department of Emergency Medicine, Kaohsiung Medical University Hospital
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Jongeneel A, Scheffers D, Tromp N, Nuij C, Delespaul P, Riper H, van der Gaag M, van den Berg D. Reducing distress and improving social functioning in daily life in people with auditory verbal hallucinations: study protocol for the 'Temstem' randomised controlled trial. BMJ Open 2018; 8:e020537. [PMID: 29511020 PMCID: PMC5879499 DOI: 10.1136/bmjopen-2017-020537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Auditory verbal hallucinations (AVH) are prevalent experiences that can induce distress and impede social functioning. While most voice hearers benefit from antipsychotic medication or cognitive-behavioural therapy, additional effective interventions are needed to reduce the burden of experiencing AVH. 'Temstem' is an easily accessible and useable smartphone application that was developed by designers in close cooperation with voice hearers and experts. By using language games, Temstem aims to reduce distress and improve social functioning. METHODS This is a single-blind multicentre randomised controlled trial with two arms: 'Temstem+AVH monitoring' versus 'AVH monitoring' (total n=100). Participants are adult patients who suffer daily from AVH and will be recruited in outpatient units. Primary assessment in daily life is made by the Experience Sampling Method (ESM) and daily monitoring with the PsyMate app. During an ESM period of 6 days, participants assess their mental state (including AVH and context) several times a day by filling in short questionnaires. There are three 6-day ESM periods: at baseline (week 0-1), post-treatment (weeks 5-6) and follow-up (weeks 9-10). In addition, during the entire 10-week study period, all participants monitor their AVH two times a day with a short assessment via the PsyMate app. Participants in the Temstem+AVH monitoring condition are provided with the Temstem app from week 1 to 6. Other assessments made at baseline, post-treatment and follow-up are based on questionnaires and a clinical interview. ETHICS AND DISSEMINATION The results from this study will provide an evaluation of the effectiveness of Temstem, a non-invasive and easily accessible app for voice hearers, and insight into the determinants of optimal use. Results will be disseminated unreservedly, irrespective of the magnitude or direction of the effects. This study protocol was approved by the Medical Ethics Committee of the VU University Medical Centre (METC number: 2015.435/NL53684.029.15). TRIAL REGISTRATION NUMBER ISRCTN75717636; Pre-results.
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Affiliation(s)
- Alyssa Jongeneel
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - Nynke Tromp
- Department of Industrial Design, Delft University of Technology, Delft, The Netherlands
| | - Chani Nuij
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Mondriaan, Heerlen, The Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - David van den Berg
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Affiliation(s)
- B Pitt
- Academic Unit, Psychiatry of Old Age, St Charles' Hospital, London
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Lansing A, Plante WY, Fennema-Notestine C, Golshan S, Beck AN. Psychotic-spectrum symptoms, cumulative adversity exposure and substance use among high-risk girls. Early Interv Psychiatry 2018; 12:74-86. [PMID: 29282872 PMCID: PMC5788710 DOI: 10.1111/eip.12533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/15/2017] [Accepted: 11/08/2017] [Indexed: 11/28/2022]
Abstract
AIM Psychotic-spectrum symptoms are linked to trauma, substance/alcohol use (SAU), criminality/violence and poor functional outcomes, supporting the need for early detection in vulnerable populations. To better understand high-risk girls' mental health, we assessed: (1) psychotic-spectrum symptoms; (2) cumulative trauma, adversity and loss exposures (C-TALE) and adversity-indicators (symptoms, maladaptive coping, stressor-reactivity); and SAU risk-factors; and (3) relationships among psychotic-spectrum symptoms, adversity-indicators and SAU risk-factors. METHODS We administered the Structured Clinical Interviews for Psychotic Spectrum, and Trauma and Loss Spectrum to 158 adolescent delinquent girls. RESULTS Girls' psychotic-spectrum profiles were similar to previously reported adult psychotic patients and characterized by typical symptoms (hallucinations/delusions, reported largely SAU-independent), interpersonal sensitivity, schizoid traits and paranoia (over-interpretation, anger over-reactivity, hypervigilance). Auditory/visual hallucinations (55.7%), delusions (92.4%), ideas of reference (96.8%) and adversity (90.0% ≥10/24 C-TALE-types) were common. Mean loss (4) and trauma (8) onset-age occurred before SAU-onset (12). Significant positive correlations were found among psychotic-spectrum symptoms, stressor-reactivity, C-TALE, adversity-indicators; and number of SAU-types; and a negative correlation occurred between psychotic-spectrum symptoms and earlier alcohol use onset. After controlling for number of SAU-types, stressor-reactivity and adversity-related numbing individually had the largest associations with total psychotic-spectrum symptoms (b = 2.6-4.3). Girls averaged more than 4 maladaptive coping strategies (e.g., 24.8% attempted suicide) in response to adversity, amplifying potential health-disparities. No racial/ethnic differences emerged on psychotic-spectrum symptoms. CONCLUSIONS This symptom constellation during adolescence likely interferes with social and academic functioning. Whether representing a prodromal phase, trauma-response or cross-diagnostic psychopathology, accurate early detection and appropriate treatment of psychotic-spectrum symptoms are warranted to improve functional outcomes in vulnerable populations.
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Affiliation(s)
- Amy Lansing
- Department of Psychiatry; University of California, San Diego, La Jolla, CA
- Department of Sociology, San Diego State University
| | - Wendy Y. Plante
- Department of Psychiatry; University of California, San Diego, La Jolla, CA
- Department of Sociology, San Diego State University
| | - Christine Fennema-Notestine
- Department of Psychiatry; University of California, San Diego, La Jolla, CA
- Department of Radiology; University of California, San Diego, La Jolla, CA
| | - Shahrokh Golshan
- Department of Psychiatry; University of California, San Diego, La Jolla, CA
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Chiu PY, Hsu MH, Wang CW, Tsai CT, Pai MC. Visual hallucinations in Alzheimer's disease is significantly associated with clinical diagnostic features of dementia with Lewy bodies. PLoS One 2017; 12:e0186886. [PMID: 29088240 PMCID: PMC5663381 DOI: 10.1371/journal.pone.0186886] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/09/2017] [Indexed: 12/01/2022] Open
Abstract
Visual hallucinations (VHs) are among the most striking features of dementia with Lewy bodies (DLB). Given that Lewy body pathology is frequently observed in the brains of patients with AD, we aimed to study factors associated with VHs in AD and examine their association with DLB features. This cross-sectional study enrolled a consecutive series of AD patients who visited the dementia clinic of a regional hospital. Clinically diagnosed possible or probable DLB cases were excluded. VH frequency and associated factors including age, sex, education, disease severity, DLB features, vascular risk factors, cognitive function, and neuropsychiatric symptoms were compared between AD patients with VHs (VH+) and those without VHs (VH−). Among a total of 295 patients analyzed, 42 (14.2%) had VHs. After adjusting for age, sex, and disease severity, DLB features including fluctuations in cognition scores, rapid-eye-movement behavioral disorder (RBD), and severe neuroleptic sensitivity were more frequent in the VH+ group. Furthermore, depression score, total Neuropsychiatric Inventory (NPI) score, and total caregiver burden score as assessed by the NPI were higher in the VH+ group. Among neuropsychiatric symptoms, delusions, hallucinations in the non-visual domains, anxiety, and disinhibition were more frequent in the VH+ group. Conversely, none of the vascular risk factors (VRFs) or cognitive domains of the Cognitive Abilities Screening Instrument (CASI) was associated with VHs in AD. In summary, VHs, albeit occurring at a low rate, had a high impact on AD. Diagnostic features of DLB, including fluctuations, RBD, and severe neuroleptic sensitivity were significantly associated with VHs in AD. AD patients with VHs tended to have more severe neuropsychiatric symptoms and greater caregiver burden.
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Affiliation(s)
- Pai-Yi Chiu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Min-Hsien Hsu
- Department of Neurology, Show Chwan Memorial Hospital, Changhua, Taiwan
| | - Chein-Wei Wang
- Department of Neurology, Lin-Shin Hospital, Taichung, Taiwan
| | - Chun-Tang Tsai
- Department of Guidance and Counseling, National Changhua University of Education, Changhua, Taiwan
| | - Ming-Chyi Pai
- Division of Behavioral Neurology, Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Alzheimer's Disease Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Van Ranst A, Keereman V, Hemelsoet D, De Herdt V. Sensory deafferentation syndromes: a case of Charles Bonnet and musical ear syndrome. Acta Neurol Belg 2017; 117:769-770. [PMID: 28093697 DOI: 10.1007/s13760-016-0728-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
| | - Vincent Keereman
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Veerle De Herdt
- Department of Neurology, Ghent University Hospital, Ghent, Belgium.
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Canellas-Dols F, Delgado C, Arango-Lopez C, Peraita-Adrados R. Narcolepsy-cataplexy and psychosis: a case study. Rev Neurol 2017; 65:70-74. [PMID: 28675258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIMS To report a challenging patient a girl who developed narcolepsyy with cataplexy (NT1) and a psychosis during adolescence. To discuss diagnostic and therapeutic challenges of the comorbid cases. CASE REPORT A 14-year-old girl was referred to Sleep and Epilepsy Unit for excessive daytime sleepiness, impaired nocturnal sleep, binge eating and weight gain, over the last year. After being diagnosed with a NT1 the patient was treated with modafinil and sodium oxybate. She was hospitalized for psychotic symptoms after starting NT1 treatment. Withdrawal of the narcolepsy treatment and initiation of haloperidol 1 mg/day (the only antipsychotic treatment she could tolerate) improved the delusions, hallucinations and dysphoria but worsened the narcolepsy symptoms. Polysomnography showed fragmented nocturnal sleep and five sleep REM onset periods in MSLT. Positive HLA-QB1*06:02 and undetectable level of hypocretine in the cerebrospinal fluid were found. MRI and CT-scan were normal. Diagnostic Interview for Genetic Studies Adapted for Narcolepsy (DIGSAN) questionnaire confirmed that patient presented a dual diagnostic NT1 and psychotic symptoms. The last sleep follow-up while on psychopharmacological treatment, showed an increased sleep efficiency index. She currently has severe somnolence, obesity, and partial cataplectic attacks along with normal mood, academic failure and social isolation. CONCLUSION The coexistence of narcolepsy with psychoses is a rare clinical entity, more frequent in adolescents than in adults. The comorbidity of the two illnesses worsens clinical and therapeutic prognosis and also suggests interesting pathophysiological hypotheses.
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Affiliation(s)
- F Canellas-Dols
- Hospital Universitario Son Espases, Palma de Mallorca, Espana
| | - C Delgado
- CIBERSAM, Madrid, Espana
- Hospital General Universitario Gregorio Maranon, Madrid, Espana
| | - C Arango-Lopez
- Hospital General Universitario Gregorio Maranon, Madrid, Espana
- CIBERSAM, Madrid, Espana
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Milne E, Dickinson A, Smith R. Adults with autism spectrum conditions experience increased levels of anomalous perception. PLoS One 2017; 12:e0177804. [PMID: 28542171 PMCID: PMC5436824 DOI: 10.1371/journal.pone.0177804] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 05/03/2017] [Indexed: 11/18/2022] Open
Abstract
Autism spectrum condition (ASC) is characterised by differences in social interaction and behavioural inflexibility. In addition to these core symptoms, atypical sensory responses are prevalent in the ASC phenotype. Here we investigated anomalous perception, i.e. hallucinatory and/or out of body experiences in adults with ASC. Thirty participants with an ASC diagnosis and thirty neurotypical controls completed the Cardiff Anomalous Perception Scale (CAPS) and the Social Responsiveness Scale (SRS-2). The CAPS is a 32-item questionnaire that asks participants to indicate whether or not they experience a range of anomalous and out of body experiences, and to rate how intrusive and distressing these experiences are. The SRS-2 asks participants to rate the extent to which they identify with a series of 65 statements that describe behaviours associated with the autism phenotype. We found that total CAPS score was significantly higher in the participants with ASC (mean = 14.8, S.D. = 7.9) than the participants without ASC (mean = 3.6, S.D. = 4.1). In addition, the frequency of anomalous perception, the level of distraction and the level of distress associated with the experience were significantly increased in participants with ASC. Importantly, both the frequency of anomalous perceptual experiences and the level of distress caused by anomalous perception in this sample of adults with ASC were very similar to that reported previously in a sample of non-autistic participants who were being treated in hospital for a current psychotic episode. These data indicate that anomalous perceptual experiences are common in adults with ASC and are associated with a high level of distress. The origins of anomalous perception in ASC and the implication of this phenomenon are considered.
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Affiliation(s)
- Elizabeth Milne
- Sheffield Autism Research Lab, Department of Psychology, The University of Sheffield, Sheffield, South Yorkshire, United Kingdom
- * E-mail:
| | - Abigail Dickinson
- Sheffield Autism Research Lab, Department of Psychology, The University of Sheffield, Sheffield, South Yorkshire, United Kingdom
| | - Richard Smith
- Sheffield Adult Autism and Neurodevelopmental Service, Sheffield Health and Social Care NHS Trust, Sheffield, South Yorkshire, United Kingdom
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Wang J, Liu Q, Wydell TN, Liao J, Wang F, Quan W, Tian J, Wang P, Liu J, Dong W. Electrophysiological basis of reading related phonological impairment in Chinese speakers with schizophrenia: An ERP study. Psychiatry Res Neuroimaging 2017; 261:65-71. [PMID: 28131010 DOI: 10.1016/j.pscychresns.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 11/30/2022]
Abstract
It has been reported in alphabetic languages that individuals with schizophrenia showed language-related cognitive impairments including phonological deficits, which were in turn associated with clinical symptoms such as auditory hallucinations and thought disorders. To date, however, the phonological deficits involved in schizophrenia in Chinese and its neural basis have not been well established. In order to establish such a relationship we conducted a behavioral study using lexical tone judgment and digit span tasks as well as an event-related potential (ERP) study with an auditory oddball paradigm, in particular, for P300 effects, the event-related brain potential (ERP) index of discrimination. Chinese patients with schizophrenia and Chinese healthy controls in China participated in the current study. Compared to the healthy controls, the patients with schizophrenia showed significant impairments in phonological processing skills, which in turn significantly correlated with smaller P300 effects. Thus these behavioral and electrophysiological findings in Chinese patients with schizophrenia were critically evaluated in terms of their phonological processing abilities.
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Affiliation(s)
- Jiuju Wang
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Qi Liu
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Taeko N Wydell
- Centre for Cognition and Neuroimaging, Brunel University London, Uxbridge, UK
| | - Jinmin Liao
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Fang Wang
- Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Wenxiang Quan
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Ju Tian
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Pengfei Wang
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Jin Liu
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China
| | - Wentian Dong
- Peking University Sixth Hospital, Beijing 100191, China; Peking University Institute of Mental Health, Beijing 100191, China; Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing 100191, China.
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Tamune H, Nishimura F, Koshiyama D, Yamada K, Kondo S, Kano Y, Kasai K. [An Adult Case of 22q11.2 Deletion Syndrome with Congenital Abnormalities and Neurodevelopmental Disorders, Which Remained Undiagnosed Until Presentation of Auditory Hallucinations]. Seishin Shinkeigaku Zasshi 2017; 119:9-16. [PMID: 30629863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
22q11.2 deletion syndrome (22q11.2 DS) is characterized by cardiac defects, abnormal facial features, thymic hypoplasia, cleft palate, and hypocalcemia, including DiGeorge syndrome (DGS), velocardiofacial syndrome (VCFS), and conotruncal anomaly face (CTAF) syndrome. Psychiatric symptoms were recently shown to be very common in patients with 22q11.2 DS, prompting greater interest in this syndrome. Early diagnosis during childhood based on a con- stellation of physical features is optimal ; however, as some patients remain undiagnosed until the presentation of other symptoms in adult life, psychiatrists are well advised to familiarize themselves with basic information concerning 22q11.2 DS. A 25-year-old woman presenting with auditory hallucinations was referred to A hospital for examination and treatment. Her family history revealed both paternal and maternal rela- tives with schizophrenia. At birth, she presented a cleft palate and ventricular septum defect. She first became ambulatory at age 4 and became verbal a year later. Her intelligence quotient was estimated at around 40 and mental retardation (DSM-IV) with autistic features was diag- nosed at age 7. After graduating from a special high school, she obtained fulltime employment in a workshop. However, auditory hallucinations began disrupting her life from 22 years of age. Although olanzapine temporarily alleviated her symptoms, the resultant extrapyramidal symp- toms worsened and she was referred to A hospital again at age 25. The patient presented with micrognathia and a flat nasal root and spoke a maximum of 3 words per sentence in a very high and indistinct tone. A cardiac defect (ventricular septal defect), scoliosis, and low platelets were also observed. The diagnosis of 22qll.2 DS was confirmed using fluorescence in situ hybridization (FISH). The patient and her family were subsequently introduced to a 22q11.2 DS patients' support group. Careful genetic counseling is paramount, but the diagnosis of 22q11.2 DS can make updated information, official aid, and access to support groups available to patients and their family. Emergency complications such as seizures due to hypocalcemia can also be anticipated. The comparatively late diagnosis of 22q11.2 DS in our patient, which went undetected until the presentation of auditory hallucinations, in the context of mental retardation with autis- tic features (DSM-IV) underscores the importance of detailed clinical observation. "One rare variant" possibly points out the essence of psychiatric pathophysiology. Moreover, 22q11.2 DS has been listed as an intractable disease in Japan since 2015. When patients present with neurodevelopmental disorders and schizophrenic symptoms, we should carefully observe their physical features for clues to the possible diagnosis of 22q11.2 DS.
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Abstract
INTRODUCTION Dynamic relationships between the symptoms of psychosis can be shown in individual networks of psychopathology. In a single patient, data collected with the Experience Sampling Method (ESM-a method to construct intensive time series of experience and context) can be used to study lagged associations between symptoms in relation to illness severity and pharmacological treatment. METHOD The patient completed, over the course of 1 year, for 4 days per week, 10 daily assessments scheduled randomly between 10 minutes and 3 hours apart. Five a priori selected symptoms were analysed: 'hearing voices', 'down', 'relaxed', 'paranoia' and 'loss of control'. Regression analysis was performed including current level of one symptom as the dependent variable and all symptoms at the previous assessment (lag) as the independent variables. Resulting regression coefficients were printed in graphs representing a network of symptoms. Network graphs were generated for different levels of severity: stable, impending relapse and full relapse. RESULTS ESM data showed that symptoms varied intensely from moment to moment. Network representations showed meaningful relations between symptoms, e.g. 'down' and 'paranoia' fuelling each other, and 'paranoia' negatively impacting 'relaxed'. During relapse, symptom levels as well as the level of clustering between symptoms markedly increased, indicating qualitative changes in the network. While 'hearing voices' was the most prominent symptom subjectively, the data suggested that a strategic focus on 'paranoia', as the most central symptom, had the potential to bring about changes affecting the whole network. CONCLUSION Construction of intensive ESM time series in a single patient is feasible and informative, particularly if represented as a network, showing both quantitative and qualitative changes as a function of relapse.
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Affiliation(s)
- Maarten Bak
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Marjan Drukker
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Laila Hasmi
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
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