[Characteristics of elderly patients diagnosed with delusional disorders during the COVID-19 pandemic: A study in a memory clinic].

AIM: Since the declaration of an emergency following the spread of COVID-19, the number of elderly patients complaining of delusions has increased. Therefore, we investigated the characteristics of patients diagnosed with delusional disorders in our clinic. METHODS: A total of 1,884 patients ≥ 65 years old who visited the Center for Comprehensive Care on Memory Disorders at Kyorin University Hospital from January 2017 to December 2021 were included in the study. The 17 patients diagnosed with delusional disorders were divided into 2 groups based on the timing of the first declaration of emergency, and the characteristics of each group were investigated. RESULTS: Seven patients were diagnosed with delusional disorder before the first declaration of emergency and 10 after the declaration. The proportion of patients increased by approximately three-fold after the declaration. Post-emergency patients were less motivated to be active than those encountered before the declaration, and many had no history of mental illness. Seven of the 10 post-emergency patients visited the Memory Clinic within 1 year of the onset of delusions. CONCLUSIONS: After the first declaration of an emergency, elderly patients with no history of psychiatric disorders acutely developed delusional disorders.The physical and psychological effects of COVID-19 on the elderly should be considered.

Assessing Transcendental Experiences vs Mental Illnesses.

In our experience, being able to differentiate between mental illness and transcendent experiences has led patients to remain engaged in treatment. This is important since those who have experienced religious preoccupation are the least likely to seek out mental health care. We have developed a "Transcendent Assessment Tool" to assist clinicians and clients in discerning whether an experience is a delusion or part of a transcendent experience.

[Possible Signs of Sensory Overload]. / Mögliche Kennzeichen der Reizüberflutung.

Objective To identify, synthesize and structure the defining characteristics of overstimulation. Methods The literature search was conducted in relevant international databases (Pubmed, Medline, CINAHL, Psyndex, PsycArticles, PsychINFO). The literature analysis was conducted according to Mayring's method of qualitative content analysis. Results Despite the scanty data available on symptoms or effects of sensory overload, twelve literature-sources were identified, describing signs and symptoms of sensory overload. A cluster of psychopathological and behavioral characteristics of sensory overload was developed. Conclusions Further research is needed to obtain an evidence-based description of the defining characteristics of sensory overload.

[Involuntary treatment in psychiatry]. / Zwangsunterbringung und Zwangsbehandlung in der Psychiatrie.

Involuntary treatment in psychiatry should be reflected under the German constitutional right of self-determination und the ethical principles of autonomy and beneficience. Forced treatment in psychiatry should be applied only as a last resort. A narrative perspective reconstructs the case of Gustl Mollath who was hospitalized in forensic-psychiatric institutions because of an alleged delusion. Psychiatric experts should be aware of the potential of misuse when defining what is real and what seems to be a delusion.

Schizophrenia or possession?

Schizophrenia is typically a life-long condition characterized by acute symptom exacerbations and widely varying degrees of functional disability. Some of its symptoms, such as delusions and hallucinations, produce great subjective psychological pain. The most common delusion types are as follows: "My feelings and movements are controlled by others in a certain way" and "They put thoughts in my head that are not mine." Hallucinatory experiences are generally voices talking to the patient or among themselves. Hallucinations are a cardinal positive symptom of schizophrenia which deserves careful study in the hope it will give information about the pathophysiology of the disorder. We thought that many so-called hallucinations in schizophrenia are really illusions related to a real environmental stimulus. One approach to this hallucination problem is to consider the possibility of a demonic world. Demons are unseen creatures that are believed to exist in all major religions and have the power to possess humans and control their body. Demonic possession can manifest with a range of bizarre behaviors which could be interpreted as a number of different psychotic disorders with delusions and hallucinations. The hallucination in schizophrenia may therefore be an illusion-a false interpretation of a real sensory image formed by demons. A local faith healer in our region helps the patients with schizophrenia. His method of treatment seems to be successful because his patients become symptom free after 3 months. Therefore, it would be useful for medical professions to work together with faith healers to define better treatment pathways for schizophrenia.

The active therapeutic processes of acceptance and commitment therapy for persistent symptoms of psychosis: clients' perspectives.

BACKGROUND: There is limited research on the applicability and effectiveness of Acceptance and Commitment Therapy (ACT) for people experiencing psychotic disorders. Clinical trials suggest ACT may be efficacious in reducing distress and rehospitalization rates in psychosis. Mindfulness and reduced literal believability of thought content have been associated with reduced distress for this population. AIMS: To better understand ACT for psychosis, this study investigated clients' perspectives of the hypothesized active therapeutic processes of ACT. METHOD: Semi­structured interviews, conducted with nine adults diagnosed with schizophrenia or schizoaffective disorder and persistent positive symptoms, were analysed thematically. RESULTS: Four themes emerged: Usefulness of therapy; Changes attributed to ACT; Understanding of therapy; and Non-specific therapy factors. All participants found therapy useful and recommended ACT. Mindfulness, defusion, acceptance and values work were described as the most useful therapy components and contributing to positive changes. Self-rated frequency of symptoms did not change; however a reduction in the intensity and distress associated with symptoms was reported. Non-specific therapy factors were deemed useful by participants but not directly related to outcome. CONCLUSIONS: These findings are consistent with the theoretically defined underlying active processes of ACT and are relevant for this population. The findings also indicate important clinical implications for ACT for this client group: greater attention to the client connecting metaphors and concepts to the intended meaning may be valuable; caution should be used with some mindfulness and defusion techniques for intense experiences; and values work may be particularly useful for this population.

[Between faith and delusion]. / Zwischen Glauben und Wahn.

Religious beliefs can lead to difficulties in psychiatric diagnosis, when it comes to distinguishing between faith and delusion. Delusion is defined as a false assessment of reality combined with subjective certainty, which is in contrast with the reality of the social environment. The problem with this definition is that reality cannot be examined with scientific methods/criteria and that the assessment of reality itself underlies historical and cultural fluctuations. The current diagnostic manuals for psychiatric disorders DSM 5 and ICD-10 require, that the content of the belief has to be inadequate even in the subculture of the patient (ICD-10) and that the cultural and socioeconomic background of the patient has to be taken into account (DSM 5). On the basis of this case-report and of selected publications on this topic we want to discuss this diagnostic problem. After that we present a diagnostic model for delusion, which is easy to handle in the daily routine of psychiatrists.

The effective use of hypnosis in schizophrenia: structure and strategy.

Many schizophrenia patients seek hypnosis when they have not improved with psychopharmacological therapy. However, there has been controversy regarding the use and effectiveness of hypnosis in schizophrenia. Hypnotherapeutic methods such as direct and indirect suggestions, psycho-strengthening suggestions and imagery, hypnoprojective restructuring, guidance, and neutralization of affect associated with delusions have been effective in selected highly hypnotizable patients. Details of the hypnotherapeutic structure and strategy used for managing delusions in schizophrenia are presented with representative cases.

The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman symptoms, and aberrant salience.

Following the publication of Karl Jaspers' General Psychopathology (1913), delusions have been characterized as being nonunderstandable in terms of the person's biography, motivations, and historical-cultural context. According to Jaspers, this loss of understandability is due to an underlying neurobiological process, which has interrupted the normal development of the individual's personality. Inheriting the 19th-century division between the natural- and human-historical sciences, Jaspers emphasizes the psychological understanding of mental disorders as narrative-based, holistic, and contextual. By doing so, he embraces cultural, ethnic, and individual differences and anticipates a person-centered medicine. However, he also affirms the value of explanatory neurobiological approaches, especially in the research and diagnosis of delusions. The phenomenological approach leads to neurobiological hypotheses, which can be tested experimentally. The present article addresses these issues by illustrating Jaspers' fundamental contribution to current neurobiological research concerning the formation of delusions during early phases of psychosis. Specifically, we present delusional mood and Truman symptoms as core phenomenological features at the origin of psychosis onset, and we discuss their neurobiological substrate with the aberrant salience and dopamine dysregulation models. Jaspers and his successors' phenomenological approach suggests that delusion is formed through loss of context in its experiential-perceptual origins. This is consistent with the more recent neurobiological models.

Mindfulness for paranoid beliefs: evidence from two case studies.

BACKGROUND: Emerging evidence suggests that mindfulness can be beneficial for people with distressing psychosis. This study examined the hypothesis that for people with persecutory delusions in the absence of voices, mindfulness training would lead to reductions in conviction, distress, preoccupation and impact of paranoid beliefs, as well as anxiety and depression. METHOD: Two case studies are presented. Participants completed measures of mindfulness, anxiety and depression at baseline, end of therapy and 1 month follow-up, and bi-weekly ratings of their paranoid belief on the dimensions of conviction, preoccupation, distress and impact. RESULTS: Ratings of conviction, distress, impact and preoccupation, and measures of anxiety and depression, reduced for both participants from baseline to end of intervention. Improvements in mindfulness of distressing thoughts and images occurred for both participants. These gains were maintained at 1 month follow-up. CONCLUSIONS: Findings suggest that mindfulness training can impact on cognition and affect specifically associated with paranoid beliefs, and is potentially relevant to both Poor Me and Bad Me paranoia.

Applying mindfulness therapy in a group of psychotic individuals: a controlled study.

BACKGROUND: There are already several existing studies that show the effectiveness of mindfulness-based approaches in varying types of disorders. Only a few studies, however, have analyzed the effectiveness of this intervention in psychosis, and without finding, up to now, significant differences from the control group. AIMS: The aim of this study is two-fold: to replicate previous studies, and to focus on analyzing the feasibility and effectiveness of applying mindfulness in a group of people with psychosis. METHOD: Eighteen patients with psychosis were randomly assigned to experimental and control groups. The experimental group received eight 1-hour sessions of Mindfulness-Based Cognitive Therapy (MBCT), while the control group was relegated to a waiting list to receive MBCT therapy. RESULTS: The experimental group scored significantly higher than the control group in their ability to respond mindfully to stressful internal events. CONCLUSIONS: Both the usefulness and effectiveness of implementing a mindfulness-based program have been replicated in a controlled manner in patients with psychosis.

Idiom of distress or delusional state? Cultural clash as the cause of misdiagnosis: a case report.

The Beta Israel (House of Israel) represent a total number of more than 100,000 individuals. Ethiopian Jewish culture is based on a tribal cultural model. With their arrival in Israel, many difficulties surfaced. Ethiopian Jews had to deal with cultural choices that challenged their traditions. It has been suggested that the trauma of their journey coupled to the difficulties of the adaptation process to Israeli society, ( the culture shock), was directly responsible for psychopathology found among this population. It also appeared that culture plays a central role in the construction of the clinical picture, blurring at times the boundary between expressions of distress and pathology. It became increasingly difficult to draw the line between culturally normative behavior and psychopathology. The following case report underlines the importance of socio cultural considerations in both staff and patients, and illustrates the dangers of misdiagnosis due to patient therapeutic team cultural clash. A 41 year old woman of Ethiopian origin was hospitalized for suspected schizophrenia. Because of the striking contrast between the patients behavior, responses and so called psychotic content, possible misunderstanding based on cultural differences was considered by the clinical management team. This case underlines the dangers of the psychiatric diagnostic process, emphasizes the important role of sociocultural backgrounds of both staff and patients in patient management and encourages the consideration of cultural factors in all patient evaluations.

Schizophrenia-like psychotic episode precipitated by cobalamin deficiency.

Although cobalamin deficiency is widely known and usually presents with hematologic and neuropsychiatric manifestations, the psychiatric symptoms are not usually the predominant manifestation. We describe a young single male vegetarian who developed a cobalamin-induced psychotic episode without preceding neurologic manifestations and without any hematologic symptoms. He recovered after a short course of antipsychotics and oral cobalamin supplementation and remained asymptomatic and functionally independent at 1 year of follow-up.

DSM-IV-TR cultural formulation of psychiatric cases: Two proposals for clinicians.

This article reviews some limitations of the current guideline for the DSM-IV-TR Cultural Formulation (CF) from the perspective of psychiatric practice that are based on the author's experience conducting doctoral courses on cultural psychiatry from 1996 to 2007 in the Department of Psychiatry at the Universidad Autónoma de Madrid (Spain). Two proposals are presented for facilitating use of the CF by general clinicians. These proposals offer a procedure for embedding only the most relevant clinical information in a psychiatric history, followed by a brief cultural formulation. The approach is illustrated with a clinical case. Although the CF has considerable promise for revealing knowledge about patients, health practices, and health systems that is essential for clinical care, substantial research must be carried out to facilitate widespread use of the CF in clinical practice.

Impact of state anxiety on the jumping to conclusions delusion bias.

OBJECTIVE: This is the first study to investigate the relationship between the level of state anxiety and the jumping to conclusions (JTC) reasoning bias in patients with first-episode psychosis using an experimental manipulation procedure. METHOD: Thirty patients with psychotic delusions and 30 non-clinical controls, from Hong Kong, were randomized into an anxiety induction or an anxiety reduction imagery condition. Questionnaires were used to measure trait emotions, psychotic symptoms and delusional thinking at baseline. After the anxiety manipulation, participants completed two versions of an assessment of the JTC reasoning bias, the beads task. RESULTS: Both the patients and the non-clinical controls were responsive to the anxiety reduction imagery, but only the non-clinical controls responded to the anxiety induction imagery. The JTC reasoning bias was, as hypothesized, more common in patients than in controls, but was not significantly different between the anxiety manipulation conditions. Both patients and controls had higher rates of JTC than in previous studies. CONCLUSIONS: Patients with psychotic delusions have a marked JTC cognitive bias. This is the first JTC study in a Chinese sample, and the results suggest that the bias applies cross-culturally. The results indicate that state anxiety does not influence JTC. Limitations of the study include an inadequate anxiety state manipulation effect in psychotic patients using brief imagery, and unusually high rates of JTC in both patients and controls.

Responding mindfully to distressing psychosis: A grounded theory analysis.

This study investigates the psychological process involved when people with current distressing psychosis learned to respond mindfully to unpleasant psychotic sensations (voices, thoughts, and images). Sixteen participants were interviewed on completion of a mindfulness group program. Grounded theory methodology was used to generate a theory of the core psychological process using a systematically applied set of methods linking analysis with data collection. The theory inducted describes the experience of relating differently to psychosis through a three-stage process: centering in awareness of psychosis; allowing voices, thoughts, and images to come and go without reacting or struggle; and reclaiming power through acceptance of psychosis and the self. The conceptual and clinical applications of the theory and its limits are discussed.

Responding mindfully to unpleasant thoughts and images: reliability and validity of the Southampton mindfulness questionnaire (SMQ).

OBJECTIVE: To assess the reliability and validity of the Southampton mindfulness questionnaire (SMQ), a 16-item measure of mindful awareness of distressing thoughts and images. METHODS: A total of 256 people participated, comprising a non-clinical community sample of 134 (83 meditators and 51 non-meditators) and a clinical sample of 122 people with a current distressing psychosis. To assess concurrent validity, non-clinical participants and half clinical participants (total 197 participants) completed the mindful attention awareness scale (MAAS). Predicted links were assessed with affect, and 59 patients completed a validated measure to assess link between mindfulness and intensity of 'delusional' experience. RESULTS: The scale has a single factor structure, was internally reliable, significantly correlated with the MAAS, showed expected associations with affect, and distinguished among meditators, non-meditators and people with psychosis. CONCLUSIONS: The data support use of the SMQ in clinical practice and research to assess mindful responding to distressing thoughts and images.