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2.
Psychopharmacol Bull ; 54(1): 33-39, 2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38449474

RESUMO

Synthetic cannabinoids (SCs), a class of new psychoactive substances (NPS) commonly known as "spice," has rapidly gained popularity and become the most ubiquitous NPS on the illegitimate drug market. SCs, unlike natural cannabis (NC), are not controlled by international drug conventions, posing a significant risk to public health. These substances are easily accessible, relatively inexpensive, and challenging to detect in routine drug screenings. The existing literature provides strong evidence of an association between NC use and psychosis, but there is significantly less data on SC psychosis. We present a clinical case report of a 51-year-old African American female with no known psychiatric history who was admitted to the inpatient psychiatric unit after reported paranoia and altered mental status for the preceding six days. During hospitalization, she exhibited disorganization, persecutory delusions, extreme agitation, and bizarre behaviors that included the concealment of a set of stolen keys in her vagina, necessitating an ethics consult. After consideration of differentials, the patient was diagnosed with substance-induced psychotic disorder secondary to SC. The patient was stabilized on 3 mg Risperidone at bedtime. After 16-day hospitalization, she reached her baseline and later revealed that she had recently smoked SC for the first time. The primary goal of this case is to highlight the sequelae of SC-associated psychosis. A SC-associated psychosis could drastically vary from NC and is often undetectable on a typical UDS, which may result in a lifelong primary psychotic disorder misdiagnosis.


Assuntos
Canabinoides , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Feminino , Humanos , Pessoa de Meia-Idade , Transtornos Psicóticos/tratamento farmacológico , Delusões , Psicoses Induzidas por Substâncias/etiologia , Hospitalização , Canabinoides/efeitos adversos
3.
BMC Neurol ; 24(1): 89, 2024 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-38448803

RESUMO

BACKGROUND: Neuropsychiatric symptoms and delusions are highly prevalent among people with dementia. However, multiple roots of neurobiological bases and shared neural basis of delusion and cognitive function remain to be characterized. By utilizing a fine-grained multivariable approach, we investigated distinct neuroanatomical correlates of delusion symptoms across a large population of dementing illnesses. METHODS: In this study, 750 older adults with mild cognitive impairment and Alzheimer's disease completed brain structural imaging and neuropsychological assessment. We utilized principal component analysis followed by varimax rotation to identify the distinct multivariate correlates of cortical thinning patterns. Five of the cognitive domains were assessed whether the general cognitive abilities mediate the association between cortical thickness and delusion. RESULTS: The result showed that distributed thickness patterns of temporal and ventral insular cortex (component 2), inferior and lateral prefrontal cortex (component 1), and somatosensory-visual cortex (component 5) showed negative correlations with delusions. Subsequent mediation analysis showed that component 1 and 2, which comprises inferior frontal, anterior insula, and superior temporal regional thickness accounted for delusion largely through lower cognitive functions. Specifically, executive control function assessed with the Trail Making Test mediated the relationship between two cortical thickness patterns and delusions. DISCUSSION: Our findings suggest that multiple distinct subsets of brain regions underlie the delusions among older adults with cognitive impairment. Moreover, a neural loss may affect the occurrence of delusion in dementia largely due to impaired general cognitive abilities.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Humanos , Idoso , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico por imagem , Delusões , Disfunção Cognitiva/diagnóstico por imagem , Cognição , Encéfalo/diagnóstico por imagem
4.
BMC Psychiatry ; 24(1): 218, 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38509502

RESUMO

BACKGROUND: Although the impact of internet usage on mental health is extensively documented, there is a notable scarcity of reports in the literature concerning internet-induced erotomania. Erotomania is a rare and likely underdiagnosed delusional disorder. It is characterized by an irrational belief held by the affected persons that someone of higher socioeconomic status harbor romantic feelings toward them. Here, we describe the psychopathology of erotomanic delusion induced by online romantic fraud in a female patient. Employing this case as a focal point, we illuminate novel aspects of erotomania that warrant attention and examination. CASE PRESENTATION: We present a compelling case involving a 70-year-old married Caucasian woman diagnosed with medically controlled persistent depressive disorder for several years. The intricacies of her condition became evident as she became deeply engrossed in online profiles featuring the image of a renowned musician, inadvertently falling victim to an online romantic fraud. Subsequently, this distressing experience triggered the emergence of erotomanic delusions and a suicide attempt. The patient's history reveals an array of medical conditions and stressful life events, contributing to her vulnerability. The diagnosis of erotomanic delusional disorder, dysthymia, and mild cognitive impairment with cerebral vascular background was established. Treatment involved her previous antidepressant with low-dose risperidone, alongside supportive individual and group therapy. Her delusion showed remission four weeks later, prompting her discharge for outpatient follow-up. Although she retained some false beliefs, the intensity of the symptoms had notably diminished and her functionality improved. CONCLUSION: This case underscores the complex interplay between mental health, online activities, and the consequences of delusions, including suicidal thoughts, shedding light on the need for a comprehensive approach in addressing such challenging psychiatric scenarios.


Assuntos
Disfunção Cognitiva , Transtorno Depressivo , Humanos , Feminino , Idoso , Delusões/diagnóstico , Emoções , Tentativa de Suicídio
5.
J Nerv Ment Dis ; 212(4): 235-239, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38536048

RESUMO

ABSTRACT: Mixed connective tissue disease (MCTD) is a systemic autoimmune disease with features overlapping multiple autoimmune disorders. One study found that over 55% of patients with MCTD experienced neuropsychiatric symptoms, the most common of which was an "aseptic meningitis-like syndrome." We present a case of a 17-year-old adolescent girl presenting with abnormal speech and behavior, auditory hallucinations, and paranoid delusions after an isolated episode of fever. She was treated for her psychotic symptoms but later developed symptoms resembling neuroleptic malignant syndrome. An antibody screen revealed elevated anti-U1-ribonucleoprotein antibodies with a possible diagnosis of MCTD. She finally responded to steroid therapy. To our knowledge, this is the first reported case of MCTD initially presenting with psychosis. A diagnosis of autoimmune disorders should be kept in the differential of similar clinical presentations including connective tissue disorders and autoimmune thyroid conditions.


Assuntos
Doenças Autoimunes , Doença Mista do Tecido Conjuntivo , Transtornos Psicóticos , Adolescente , Feminino , Humanos , Delusões
7.
J Affect Disord ; 351: 588-597, 2024 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-38307134

RESUMO

BACKGROUND: Existing literature suggests the co-occurrence of post-traumatic stress disorder (PTSD) and psychosis among young adults is related to hazardous drinking. However, the influencing mechanisms among these co-occurrences are inconclusive. Thus, this study aimed to investigate the symptomatic associations between PTSD, psychosis, and hazardous drinking. METHODS: This study included 96,218 young Chinese adults, divided into three groups (PTSD, Psychosis, and co-occurring PTSD-Psychosis). PTSD, psychosis, and hazardous drinking were measured by the ten-item Trauma Screening Questionnaire, the seven-item Psychosis Screener Scale, and the four-item Alcohol Use Disorders Identification Test, respectively. Network analysis was utilized to explore and compare the symptomatic correlation between PTSD, psychosis, and hazardous drinking. RESULTS: In this study, the most crucial symptom (both central and bridge) was "delusion of control" among the three networks. Hazardous drinking was another main bridge symptom. Compared to the Psychosis group and the co-occurring PTSD-Psychosis group, "Delusion of reference or persecution" to "Grandiose delusion" was the strongest edge in "the network structure of the PTSD group". LIMITATIONS: The cross-sectional study cannot determine the causal relationship. Applying self-reporting questionnaires may cause inherent bias. Young adult participants limited the generalization of the results to other groups. CONCLUSIONS: Among the three network structures, delusion of control was the most crucial symptom, and hazardous drinking was another bridge symptom; the edge of delusion of reference or persecution and grandiose delusion was strongest in the PTSD group's network. Efforts should be taken to develop diverse targeted interventions for these core symptoms to relieve PTSD, psychosis, and hazardous drinking in young adults.


Assuntos
Alcoolismo , Transtornos Psicóticos , Transtornos de Estresse Pós-Traumáticos , Humanos , Adulto Jovem , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Estudos Transversais , Transtornos Psicóticos/epidemiologia , Delusões , Consumo de Bebidas Alcoólicas
8.
Behav Cogn Psychother ; 52(3): 262-276, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38372129

RESUMO

BACKGROUND: Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas in mind, elaborate the details, and increase the degree of conviction in the delusion. Pleasant daydreams more generally could contribute to elevated mood, which may influence the delusion content. AIMS: We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess daydreaming and test potential associations with grandiosity. METHOD: 798 patients with psychosis (375 with grandiose delusions) and 4518 non-clinical adults (1788 with high grandiosity) were recruited. Participants completed a daydreaming item pool and measures of grandiosity, time spent thinking about the grandiose belief, and grandiose belief conviction. Factor analysis was used to derive the Qualities of Daydreaming Scale (QuOD) and associations were tested using pairwise correlations and structural equation modelling. RESULTS: The questionnaire had three factors: realism, pleasantness, and frequency of daydreams. The measure was invariant across clinical and non-clinical groups. Internal consistency was good (alpha-ordinals: realism=0.86, pleasantness=0.93, frequency=0.82) as was test-retest reliability (intra-class coefficient=0.75). Daydreaming scores were higher in patients with grandiose delusions than in patients without grandiose delusions or in the non-clinical group. Daydreaming was significantly associated with grandiosity, time spent thinking about the grandiose delusion, and grandiose delusion conviction, explaining 19.1, 7.7 and 5.2% of the variance in the clinical group data, respectively. Similar associations were found in the non-clinical group. CONCLUSIONS: The process of daydreaming may be one target in psychological interventions for grandiose delusions.


Assuntos
Delusões , Transtornos Psicóticos , Adulto , Humanos , Delusões/psicologia , Fantasia , Reprodutibilidade dos Testes , Transtornos Psicóticos/psicologia , Transtornos do Humor
10.
Neurosci Lett ; 825: 137686, 2024 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-38364996

RESUMO

Although the Triple Network (TN) model has been proposed as a valid neurophysiological framework for conceptualizing delusion-like experiences, the neurodynamics of TN in relation to delusion proneness have been relatively understudied in nonclinical samples so far. Therefore, the main aim of the current study was to investigate the functional connectivity of resting state electroencephalography (EEG) in subjects with high levels of delusion proneness. Twenty-one delusion-prone (DP) individuals and thirty-seven non-delusion prone (N-DP) individuals were included in the study. The exact Low-Resolution Electromagnetic Tomography (eLORETA) software was used for all EEG analyses. Compared to N-DP participants, DP individuals showed an increas of theta connectivity (T = 3.618; p = 0.045) between the Salience Network (i.e., the left anterior insula) and the Central Executive Network (i.e., the left posterior parietal cortex). Increased theta connectivity was also positively correlated with the frequency of delusional experiences (rho = 0.317; p = 0.015). Our results suggest that increased theta connectivity between the Salience Network and the Central Executive Network may underline brain correlates of altered resting state salience detection, information processing, and cognitive control processes typical of delusional thinking.


Assuntos
Encéfalo , Delusões , Humanos , Eletroencefalografia/métodos , Mapeamento Encefálico/métodos , Lobo Parietal , Imageamento por Ressonância Magnética/métodos
12.
Psychiatry Clin Neurosci ; 78(4): 248-258, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38318694

RESUMO

AIM: This study investigated the impact of an 8-month daily-guided intensive meditation-based intervention (iMI) on persistent hallucinations/delusions and health-related quality of life (QoL) in male inpatients with schizophrenia with treatment-refractory hallucinations and delusions (TRHDs). METHODS: A randomized controlled trial assigned 64 male inpatients with schizophrenia and TRHD equally to an 8-month iMI plus general rehabilitation program (GRP) or GRP alone. Assessments were conducted at baseline and the third and eighth months using the Positive and Negative Syndrome Scale (PANSS), 36-Item Short Form-36 (SF-36), and Five Facet Mindfulness Questionnaire (FFMQ). Primary outcomes measured PANSS reduction rates for total score, positive symptoms, and hallucinations/delusions items. Secondary outcomes assessed PANSS, SF-36, and FFMQ scores for psychotic symptoms, health-related QoL, and mindfulness skills, respectively. RESULTS: In the primary outcome, iMI significantly improved the reduction rates of PANSS total score, positive symptoms, and hallucination/delusion items compared with GRP at both the third and eighth months. Treatment response rates (≥25% reduction) for these measures significantly increased in the iMI group at the eighth month. Concerning secondary outcomes, iMI significantly reduced PANSS total score and hallucination/delusion items, while increasing scores in physical activity and mindfulness skills at both the third and eighth months compared with GRP. These effects were more pronounced with an 8-month intervention compared with a 3-month intervention. CONCLUSIONS: An iMI benefits patients with TRHDs by reducing persistent hallucinations/delusions and enhancing health-related QoL. Longer iMI duration yields superior treatment outcomes.


Assuntos
Meditação , Esquizofrenia , Humanos , Masculino , Esquizofrenia/complicações , Esquizofrenia/terapia , Delusões/terapia , Qualidade de Vida , Pacientes Internados , Alucinações/etiologia , Alucinações/terapia
13.
Cancer Discov ; 14(2): 211-213, 2024 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-38327191

RESUMO

Mutant p53 proteins are often highly expressed in human cancers and have been thought to have oncogenic driver gain-of-function (GOF) properties. Wang and colleagues show, surprisingly, that this is not the case because removing the TP53-mutant gene from human and mouse cancer cells using CRISPR technology has no effect on cancer cell growth in vitro or in vivo. See related article by Wang et al., p. 362 (10) .


Assuntos
Mutação com Ganho de Função , Proteína Supressora de Tumor p53 , Humanos , Camundongos , Animais , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo , Delusões , Linhagem Celular Tumoral , Genes p53 , Mutação
14.
Soins Gerontol ; 29(165): 39-41, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38331523

RESUMO

Psychotic disorders, such as delusions and hallucinations, cause stress for individuals, their caregivers and healthcare professionals. Attitudes, perceived as behavioral tendencies, in the presence of these symptoms, can either alleviate or exacerbate them. How should we position ourselves in the presence of these disorders? What are the most effective attitudes for calming day-to-day situations?


Assuntos
Transtornos Psicóticos , Humanos , Cuidadores , Delusões/etiologia , Delusões/psicologia
15.
World J Urol ; 42(1): 109, 2024 Feb 29.
Artigo em Inglês | MEDLINE | ID: mdl-38421483

RESUMO

PURPOSE: The present paper takes a different and more critical look at the role of alpha-blockers, sometimes nicknamed as "magical pills", in particular for stone disease and medical expulsive therapy (MET). METHODS: A non-systematic narrative review was performed, synthesizing pertinent information from selected articles, and critically evaluating their conclusions. Sometimes different views on alpha-blockers were laid bare, including curiosities or other entertaining nuances suitable to the present topic, but always maintaining sharp objectivity and the foremost scientific rigor. RESULTS AND CONCLUSIONS: Alpha-blockers seem to be a panacea, being used to treat a wide variety of non-urological diseases and conditions. Urological applications include erectile dysfunction to benign prostatic hyperplasia, from incontinence to urinary retention, or even to facilitate urinary stone passage along the urinary tract. Due to its versatility, alpha-blockers appear to be the Swiss army knife of urological medications. However, the efficacy of alpha-blockers for MET, pain management, or facilitating upper tract access is very disappointing, bringing no, or in some instances, only marginal benefits. Their treatment results are far from being significant or impressive let alone magical. Regular sexual intercourse is an effective alternative to alpha-blockers, providing faster ureteral stone expulsion rates and reducing the need for pain medication. Most of the research supporting alpha-blockers has been based on single-center, underpowered, low-quality studies. These low-quality studies biased several subsequent meta-analyses, contaminating them with their low-quality data, enhancing and prolonging this delusion. These results emphasize the need for large, multi-centric, unbiased, randomized, double-blinded, placebo-controlled trials to prevent future year-long delusions that may afflict any medical field.


Assuntos
Delusões , Disfunção Erétil , Masculino , Humanos , Antagonistas Adrenérgicos alfa/uso terapêutico , Confiabilidade dos Dados , Disfunção Erétil/tratamento farmacológico , Etnicidade
16.
Cogn Neuropsychiatry ; 29(1): 41-54, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38305230

RESUMO

Introductions: Reduplicative paramnesia (RP) is a rare and poorly understood phenomenon in which a person believes the place they are in has been replicated and exists in two places at once. There is minimal extant theoretical work addressing possible cognitive mechanisms subtending RP.Method: We present a new case of RP and discuss the therapeutic and theoretical implications of this case for the management and understanding of this phenomenon. Using the hypothetico-deductive approach to a neuropsychological case, we examine the phenomenon in the light of one and two-factor approaches to understanding the genesis of delusions.Results: The individual discussed in this case showed some evidence of relatively efficient incorporation of new evidence (belief updating) despite concurrently maintaining a delusional belief system.Conclusion: This case raises novel challenges for the two-factor account of neurological delusions.


Assuntos
Delusões , Transtornos da Memória , Humanos , Delusões/psicologia , Testes Neuropsicológicos
17.
Cogn Neuropsychiatry ; 29(1): 10-28, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38348821

RESUMO

INTRODUCTION: Koro is a delusion whereby a man believes his penis is shrinking into his abdomen and this may result in his death. This socially-transmitted non-neuropsychological delusional belief occurs (in epidemic form) in South-East and South Asia. We investigated whether the two-factor theory of delusion could be applied to epidemic Koro. METHODS: We scrutinised the literature on epidemic Koro to isolate features relevant to the two questions that must be answered to provide a two-factor account: What could initially prompt the Koro delusional hypothesis? Why is this hypothesis adopted as a belief? RESULTS: We concluded that the Koro hypothesis is usually prompted by the surprising observation of actual penis shrinkage-but only if the man has access to background beliefs about Koro. Whether the hypothesis is then adopted as a belief will depend on individual factors such as prior belief in the Koro concept or limited formal education and sociocultural factors such as deference to culture, to media, or to rumours spread by word of mouth. Social transmission can influence how the first factor works and how the second factor works. CONCLUSION: The two-factor theory of delusion can be applied to a socially-transmitted delusion that occurs in epidemic form.


Assuntos
Koro , Masculino , Humanos , Koro/epidemiologia , Koro/psicologia , Delusões/psicologia
18.
J Exp Med ; 221(3)2024 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-38345557

RESUMO

Proliferation of HIV-1-infected cells contributes to viral persistence despite antiretroviral therapy. A new study by Kufera et al. (https://doi.org/10.1084/jem.20231511) demonstrates that proliferative growth of cells infected with genome-intact HIV-1 is not limitless; rather, these cells seem to be at least partially refractory to TCR stimulation, restricting their ability to proliferate in response to antigenic challenge.


Assuntos
Infecções por HIV , HIV-1 , Humanos , Linfócitos T CD4-Positivos , Delusões , Proliferação de Células , Replicação Viral
19.
J Psychiatr Res ; 171: 75-83, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38246028

RESUMO

A clear understanding of the pathophysiology of schizophrenia and related spectrum disorders has been limited by clinical heterogeneity. We investigated whether relative severity and predominance of one or more delusion subtypes might yield clinically differentiable patient profiles. Patients (N = 286) with schizophrenia spectrum disorders (SSD) completed the 21-item Peters et al. Delusions Inventory (PDI-21). We performed factor analysis followed by k-means clustering to identify delusion factors and patient subtypes. Patients were further assessed via the Brief Psychiatric Rating Scale, Brief Negative Symptom Scale, Digit Symbol and Digit Substitution tasks, use of cannabis and tobacco, and stressful life events. The overall patient sample clustered into subtypes corresponding to Low-Delusion, Grandiose-Predominant, Paranoid-Predominant, and Pan-Delusion patients. Paranoid-Predominant and Pan-Delusion patients showed significantly higher burden of positive symptoms, while Low-Delusion patients showed the highest burden of negative symptoms. The Paranoia delusion factor score showed a positive association with Digit Symbol and Digit Substitution tasks in the overall sample, and the Paranoid-Predominant subtype exhibited the best performance on both tasks. Grandiose-Predominant patients showed significantly higher tobacco smoking severity than other subtypes, while Paranoid-Predominant patients were significantly more likely to have a lifetime diagnosis of Cannabis Use Disorder. We suggest that delusion self-report inventories such as the PDI-21 may be of utility in identifying sub-syndromes in SSD. From the current study, a Paranoid-Predominant form may be most distinctive, with features including less cognitive impairment and a stronger association with cannabis use.


Assuntos
Esquizofrenia , Humanos , Esquizofrenia/complicações , Esquizofrenia/diagnóstico , Delusões/etiologia , Transtornos do Humor/complicações , Escalas de Graduação Psiquiátrica Breve
20.
Lancet Psychiatry ; 11(4): 295-302, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38242143

RESUMO

Attempts to understand psychosis-the experience of profoundly altered perceptions and beliefs-raise questions about how the brain models the world. Standard predictive coding approaches suggest that it does so by minimising mismatches between incoming sensory evidence and predictions. By adjusting predictions, we converge iteratively on a best guess of the nature of the reality. Recent arguments have shown that a modified version of this framework-hybrid predictive coding-provides a better model of how healthy agents make inferences about external reality. We suggest that this more comprehensive model gives us a richer understanding of psychosis compared with standard predictive coding accounts. In this Personal View, we briefly describe the hybrid predictive coding model and show how it offers a more comprehensive account of the phenomenology of delusions, thereby providing a potentially powerful new framework for computational psychiatric approaches to psychosis. We also make suggestions for future work that could be important in formalising this novel perspective.


Assuntos
Delusões , Transtornos Psicóticos , Humanos , Delusões/psicologia , Transtornos Psicóticos/psicologia , Cognição
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