Pseudociesis. Reporte de caso / Psedocyesis. Case report

Introducción: Según el DSM-V, la pseudociesis se incluye en la categoría "otros síntomas somáticos específicos y trastornos relacionados" y se define como la falsa creencia de estar embarazada que se asocia con signos objetivos y síntomas de embarazo. La confirmación de la pseudociesis se consigue con un resultado negativo de la gonadotropina coriónica humana beta en la sangre y/o la orina asociado a un hallazgo ecográfico negativo. Materiales y métodos: se presenta el caso de mujer con síntomas y signos de embarazo que corresponden a pseudociesis, la paciente siguió creyendo que estaba embarazada debido a sus síntomas, a pesar de que las pruebas de embarazo dieron negativo. Conclusión: La pseudociesis es una enfermedad poco frecuente que a menudo se asocia a otras comorbilidades psiquiátricas y diagnósticos diferenciales poco claros. Es necesario la realización de más estudios, incluyendo series de casos y revisiones sistemáticas para comprender mejor esta infrecuente condición y sus otras variantes.

Introduction: According to the DSM-V, pseudocyesis is included in the category "other specific somatic symptoms and related disorders" and is defined as a false belief of being pregnant that is associated with objective signs and symptoms of pregnancy. Confirmation of pseudocyesis is achieved with a negative blood and/or urine beta-human chorionic gonadotropin result and a negative ultrasound finding. Materials and methods: We present a case of a woman with symptoms and signs of pregnancy corresponding to pseudocyesis, the patient continued to believe she was pregnant because of her symptoms, despite negative pregnancy tests. Conclusion: Pseudocyesis is a rare condition that is often associated with other psychiatric comorbidities and unclear differential diagnoses. Further studies, including case series and systematic reviews, are needed to better understand this rare condition and its other variants.

Exploring depression in people with schizophrenia spectrum disorders: a cross-sectional analysis of the clinical relationship with Positive and Negative Syndrome Scale dimensions

Objective: Evidence on the relationship between depression and clinical dimensions of schizophrenia remains limited. This cross-sectional study investigated the association between depression and Positive and Negative Syndrome Scale (PANSS) dimensions in people with schizophrenia spectrum disorders. Methods: Trained assessors administered the PANSS to measure symptoms of schizophrenia and the Calgary Depression Scale for Schizophrenia to measure depression. The association of depression with overall PANSS score and related dimensions was investigated in multiple logistic regression analyses. Results: We included 231 inpatients with schizophrenia spectrum disorders (mean age: 42.4 (SD: 12.9) years; men: 58.9%; mean overall PANSS score: 82.5 (SD: 20.1); drug-free or naïve: 39.3%), including 78 (33.8%) with clinically significant depressive symptoms. Depression was associated with higher overall (regression coefficient, SE: 0.029, 0.008; p < 0.001) and general psychopathology (regression coefficient, SE: 0.118, 0.023; p < 0.001) PANSS scores. We found an inverse relationship between depression and positive symptoms (regression coefficient, SE: -0.088, 0.028; p = 0.002). No association between depression and negative symptoms was found. Conclusion: Despite some limitations, our study shows that people affected by schizophrenia spectrum disorders with depression are likely to show more overall and general psychopathology symptoms but lower positive symptoms. Additional studies are needed to explore the generalizability of our findings.

El problema etiológico de los delirios en la esquizofrenia para la neuropsiquiatría actual / The Etiological Problem of Psychotic Delusions in Current Neuropsychiatry / O problema etiológico dos delírios na esquizofrenia para a neuropsiquiatria atual

Introducción: el delirio constituye uno de los síntomas más complejos y severos de la psicosis. Uno de los problemas más fundamentales que enfrenta la investigación en el campo de la neuropsiquiatría tiene que ver con el desafío de producir teorías explicativas para la producción de este tipo de estado mental, a lo que se denomina problema etiológico de los delirios psicóticos. Desarrollo: se analizan críticamente las principales alternativas dentro de la neuropsiquiatría contemporánea al problema etiológico en el contexto de la esquizofrenia. Conclusión: el análisis indica que las tres teorías fundamentales que conviven en la actualidad poseen problemas para avanzar en el desafío de explicar la etiología de los delirios. Por lo anterior, se propone la idea de que, a la luz del estado del debate reciente, la hibridación teórica podría perfilarse como el mejor candidato metodológico para generar progreso real en la disciplina

Introduction: Delusions constitute one of the most complex and severe symptoms of psychosis. One of the most fundamental problems within current research in neuropsychiatry has to do with the challenge of producing explanatory theories of the aetiology of the phenomenon. I call this the etiological problem of psychotic delusions. Development: The main alternatives to the etiological problem in schizophrenia in current neuropsychiatry are critically assessed. Conclusion: The three current co-existing approaches possess a number of problems to make real progress in the etiological debate. For this reason, I suggest that, in light of the current state of the art, theoretical hybridization could become the best methodologi- cal candidate to make progress within the target debate

Introdução: o delírio é um dos sintomas mais complexos e graves da psicose. Um dos problemas mais fundamentais enfrentados atualmente pelas pesquisas no campo da neuropsiquiatria diz respeito ao desafio de produzir teorias explicativas para a produção desse tipo de estado mental, que chamo de o problema etiológico dos delírios psicóticos. Desenvolvimento: são analisadas criticamente as principais alternativas da neuropsiquiatria contemporânea ao problema etiológico no contexto da esquizofrenia. Conclusão: a análise indica que as três teorias fundamentais que coexistem atualmente têm problemas para avançar no desafio de explicar a etiologia dos delírios. Portanto, propõe-se a ideia de que, à luz do estado atual do debate, a hibridação teórica poderia surgir como o melhor candidato metodológico para gerar um progresso real na disciplina.

The frequency of psychotic symptoms in types of dementia: a systematic review / A frequência de sintomas psicóticos em tipos de demência: uma revisão sistemática

ABSTRACT The frequency of psychotic symptoms in older adults is high, mainly in neurocognitive cognitions of the most varied etiologies. Objectives: This study aimed to review the studies that analyze the frequency of the types of delusions, hallucinations, and misidentifications in dementia conditions of different etiologies. Methods: A systematic review was conducted on August 9, 2021, in the PubMed, PsycInfo, Embase, Web of Science, and Scopus databases with the following descriptors: (dementia OR alzheimer disease OR dementia with Lewy bodies OR frontotemporal dementia OR mixed dementia OR vascular dementia OR major neurocognitive disorder OR parkinson disease dementia) AND (psychotic symptoms OR psychosis OR hallucinations OR delusions OR psychopathology OR misidentification) AND (prevalence OR epidemiology). Results: A total of 5,077 articles were found, with a final inclusion of 35. The overall frequency of psychotic symptoms ranged from 34 to 63% in dementia conditions of the most varied etiologies. Alzheimer's disease (AD) presents more delusions and hallucinations and has a higher frequency regarding the presence of misidentifications. On the contrary, Dementia with Lewy bodies (DLB) seems to present more hallucinations, even auditory, when compared to the other dementias, concomitantly with delusions. Vascular and frontotemporal dementia present fewer psychotic symptoms than DLB and AD. Conclusions: We identified a gap in the literature on the description of the psychotic symptoms of dementia, mainly in those of non-AD etiologies. Studies that assess the neuropsychiatric symptoms of dementias deeply might contribute in a more definite manner to the causal diagnosis of dementia.

RESUMO A frequência de sintomas psicóticos em idosos é alta, principalmente em cognições neurocognitivas das mais variadas etiologias. Objetivos: Revisar os estudos que analisam a frequência dos tipos de delírios, alucinações e erros de identificação em quadros demenciais de diferentes etiologias. Métodos: Foi realizada uma revisão sistemática em 9 de agosto de 2021, nas bases de dados PubMed, PsycInfo, Embase, Web of Science e Scopus, com os seguintes descritores: (demência OR doença de alzheimer OR demência com corpos de Lewy OR demência frontotemporal OR demência mista OR vascular demência OU transtorno neurocognitivo maior OU demência da doença de Parkinson) E (sintomas psicóticos OU psicose OU alucinações OU delírios OU psicopatologia OU identificação errônea) E (prevalência OU epidemiologia). Resultados: Foram encontrados 5.077 artigos, com inclusão final de 35. A frequência geral de sintomas psicóticos foi de 34 a 63% em quadros demenciais das mais variadas etiologias. A doença de Alzheimer (DA) apresenta mais delírios, alucinações e maior frequência quanto à presença de erros de identificação. Por outro lado, a demência com corpos de Lewy (DCL) parece apresentar mais alucinações, inclusive auditivas, quando comparada às demais demências, concomitantemente aos delírios. As demências vascular e frontotemporal apresentam menos sintomas psicóticos do que a DCL e a DA. Conclusões: Identificamos lacuna na literatura quanto à descrição dos sintomas psicóticos das demências, principalmente naquelas de etiologia não DA. Estudos que aprofundem os sintomas neuropsiquiátricos das demências podem contribuir de forma mais definitiva para o diagnóstico causal da demência.

La hipótesis de la saliencia aberrante: unificando la neurobiología y la fenomenología de la esquizofrenia / A hipótese da saliência aberrante: unificando a neurobiologia e a fenomenologia da esquizofrenia / The aberrant salience hypothesis: Unifying the neurobiology and phenomenology of schizophrenia / L'hypothèse de la saillance aberrante: unifier la neurobiologie et la phénoménologie de la schizophrénie

Introducción: La popularización del reduccionismo neurobiológico en psicopatología conlleva la idea de que la esquizofrenia puede entenderse simplemente como el producto de alteraciones en el funcionamiento cerebral. Por otro lado, y criticando esta tradición, el enfoque fenomenológico propone que la esquizofrenia debería entenderse como un trastorno del yo. Si bien ambas tradiciones son relevantes en la actualidad, creemos que una comprensión completa del fenómeno psicótico envuelve una integración de ambas. Objetivo: Este artículo plantea que la hipótesis de la saliencia aberrante es un buen candidato para unificar la tradición fenomenológica y la neuropsiquiátrica en el estudio de la esquizofrenia. Procedimiento: Luego de examinar la hipótesis en cuestión en profundidad, exploramos la forma en que podría explicar algunos de los síntomas positivos de la esquizofrenia de forma consistente con sus descripciones fenomenológicas. Conclusiones: Finalmente, se ofrecen algunas consideraciones generales respecto de las consecuencias de nuestro análisis para el campo de la psicopatología.

Introdução: A popularização do reducionismo neurobiológico na psicopatologia traz a ideia de que a esquizofrenia pode ser entendida simplesmente como o produto de alterações na função cerebral. Por outro lado, e criticando essa tradição, a abordagem fenomenológica propõe que a esquizofrenia seja entendida como uma desordem do eu. Embora ambas as tradições sejam relevantes hoje, acreditamos que uma compreensão completa do fenômeno psicótico envolve uma integração de ambas. Objetivo: Este artigo argumenta que a hipótese da saliência aberrante é uma boa candidata para unificar as tradições fenomenológica e neuropsiquiátrica no estudo da esquizofrenia. Procedimento: Depois de examinar a hipótese em questão em profundidade, exploramos como ela pode explicar alguns dos sintomas positivos da esquizofrenia de maneira consistente com suas descrições fenomenológicas. Conclusões: Por fim, são oferecidas algumas considerações gerais sobre as consequências de nossa análise para o campo da psicopatologia.

Background: The popularization of neurobiological reductionism in psychopathology involves the idea that schizophrenia can be fully understood as the mere product of brain-functioning alterations. Criticizing this tradition, the phenomenological approach proposes that schizophrenia should be understood as a self-disturbance. Although both traditions are relevant, we believe that a comprehensive understanding of schizophrenia involves the integration of these two frameworks. Aim: This article proposes that the aberrant salience hypothesis is a good candidate for unifying the phenomenological tradition with the neuropsychiatric approach to psychosis. Methods: After examining the aberrant salience hypothesis in detail, we explore the way in which it can explain the positive symptoms of schizophrenia respecting being consistent with their phenomenological descriptions. Conclusion: we conclude with some considerations about the consequences of our analysis for the field of psychopathology.

Introduction: L'idéal du réductionnisme neurobiologique en psychopathologie implique l'idée que la schizophrénie peut être comprise simplement comme le produit d'altérations du fonctionnement cérébral. D'autre part, et critiquant cette tradition, l'approche phénoménologique propose que la schizophrénie soit comprise comme un trouble de soi. Bien que les deux traditions soient pertinentes aujourd'hui, nous pensons qu'une compréhension complète du phénomène psychotique implique une intégration des deux. Objectif: Cet article soutient que l'hypothèse de la saillance aberrante est un bon candidat pour unifier les traditions phénoménologique et neuropsychiatrique dans l'étude de la schizophrénie. Procédure: Après avoir examiné en profondeur l'hypothèse en question, nous explorons comment elle pourrait expliquer certains des symptômes positifs de la schizophrénie d›une manière cohérente avec leurs descriptions phénoménologiques. Conclusions: Enfin, quelques considérations générales sont proposées concernant les conséquences de notre analyse pour le domaine de la psychopathologie.

Eficacia del entrenamiento metacognitivo en una muestra chilena de personas con esquizofrenia / Efficacy of Metacognitive Training in a Chilean Sample of People with Schizophrenia

RESUMEN Introducción: El entrenamiento metacognitivo (EMC) de Moritz et al., una nueva dirección en terapia, es un programa de entrenamiento grupal manualizado, dirigido a corregir los sesgos cognitivos implicados en la formación y el mantenimiento de los síntomas psicóticos, principalmente los delirios. El objetivo de este estudio es evaluar la eficacia del EMC en una muestra chilena de personas con esquizofrenia. Métodos: Se aleatorizó a 50 pacientes ambulatorios del Hospital Del Salvador de Valparaíso, Chile, al grupo de intervención que recibió el EMC o al grupo de control que solo recibió el tratamiento habitual. Se evaluó a los sujetos al inicio y al término del estudio mediante la escala de los síndromes positivo y negativo (PANSS), el cuestionario de sesgos cognitivos para psicosis (CBQ) y la escala de insight cognitivo de Beck (BCIS). Resultados: En el grupo de EMC se registraron mayores mejorías estadísticamente significa tivas, tanto en síntomas y sesgos cognitivos como en insight cognitivo, que en el grupo de control. Al comparar ambos grupos, solo se observaron resultados significativos a favor del EMC en los síntomas positivos. Conclusiones: Los resultados de este estudio indican que el EMC es superior al tratamiento habitual en el tratamiento de los síntomas positivos. No fue posible demostrar su superio ridad en la mejoría de los sesgos cognitivos y el insight cognitivo.

ABSTRACT Introduction: Moritz et al.'s metacognitive training (MCT), a new development of cognitive therapy, is a manualized group training program, designed to correct cognitive biases involved in the formation and maintenance of psychotic symptoms, especially delusions. We report on the efficacy of MCT in a Chilean sample of people with schizophrenia. Methods: 50 outpatients from the Hospital Del Salvador at Valparaíso, Chile, were randomly assigned to the intervention group (MCT), or the control group, that only received treatment as usual (TAU). Subjects were assessed at the beginning and end of the study with the Positive and Negative Syndrome Scale (PANSS), Cognitive Biases Questionnaire for Psychosis (CBQ-P) and Beck Cognitive Insight Scale (BCIS). Results: In the MCT group, we found larger, statistically significant improvements, in symp toms, cognitive biases and cognitive insight, than in the control group. However, after a direct comparison of both groups, only the improvement in psychotic symptoms for the MCT group, remained significantly different. Conclusions: The results of this study suggest superiority of MCT over TAU in the amelioration of positive symptoms. We could not, however demonstrate its superiority in the improvement of the cognitive biases and cognitive insight.

Síndrome de Cotard en una paciente con lupus eritematoso sistémico y meningioma petroclival izquierdo / Cotard's syndrome in a female patient with systemic lupus erythematosus and left petroclival meningioma

El síndrome de Cotard es una entidad rara en la cual el paciente manifiesta ideas delirantes acerca de que se encuentra sin vida o que sus órganos internos se encuentran en estado de descomposición, entre otras alteraciones psicopatológicas. Existen diferentes reportes sobre el síndrome en diversas culturas y poblaciones. Usualmente tiene presentaciones neuropsiquiátricas y se lo identifica acompañando entidades neurológicas, metabólicas, infecciosas, entre otras. A través de este reporte de caso, se presenta una paciente con lupus eritematoso sistémico, que desarrolló este tipo de ideas delirantes y durante su hospitalización se detectó un meningioma petroclival izquierdo. Finalmente, se llegó a la conclusión de que no se encontraba en actividad lúpica y que la ubicación del tumor no sería la causante de la alteración conductual. El Síndrome de Cotard es un trastorno neuropsiquiátrico poco común, que debe ser considerado ante la existencia de ideas delirantes de tipo nihilistas

Cotard's syndrome is a rare entity in which the patient manifests delusional ideas about being lifeless or that his/her internal organs are in a state of decomposition, among other psychopathological alterations. There are different reports in different cultures and populations about the syndrome. It usually has neuropsychiatric presentations and is identified by accompanying neurological, metabolic, and infectious entities, among others. In this case report, a female patient with systemic lupus erythematosus is presented, who developed this type of delusions and during her hospitalization a left petroclival meningioma was detected. Finally, it was concluded that she was not in lupus activity and that the location of the tumor was not the cause of the behavioral alteration. Cotard's syndrome is a rare neuropsychiatric disorder, which should be considered when there are nihilistic delusions

Síndrome de Cotard y retraso mental: reporte de un caso / Cotard syndrome and intellectual disability: a case report

Resumen El síndrome de Cotard, descrito en la historia por presentar diferentes tipos de delirios siendo el principal el nihilista o de negación, ha sido reportado en diversos trastornos neuropsiquiátricos; sin embargo, existe poca literatura que lo refiera en el contexto de retraso mental, por lo que el objetivo del trabajo es examinar las características del Síndrome de Cotard a propósito de un reporte de caso. Presentamos a un paciente de 19 años que cumple con los criterios para Retraso mental y Síndrome de Cortad. Se revisó la literatura, hallando sucinta data en que se presente cuadros similares. Sería muy recomendable continuar evaluando con mayor profundidad la asociación entre retraso mental y síndrome de Cotard e investigar la respuesta al tratamiento, dado que no existen protocolos en nuestra región.

Cotard syndrome, described in the history for presenting different types of delusions being the principal as the nihilistic delusion or delusion of negation, was reported on neuropsychiatric disorders. However, there is little literature that refers to it in the context of mental retardation. The aim of this report case is to explore the characteristics of Cotard syndrome. We present a 19 year-old boy who complete criteria for intellectual disability and Cotard syndorme. The literature was reviewed, finding succinct data associated to cases like this. We recommend to evaluate deeply the association between intellectual disability and Cotard syndrome and to research the treatment, given that there are no protocols in our region.

Delusional Parasitosis: An Analysis of 177 Cases from a Tertiary General Hospital.

Introduction: Delusional parasitosis (DP) is a form ofmonohypochondriacalpsychosis characterized by a feelingthat there are parasites crawling beneath the skin and is seen inrarely in psychiatric or primary carepractice. The disorder haspoor prognosis with a varied course and multiple relapses. Thepresent paper reports an analysis of 177 cases of delusionalparasitosis seen in a tertiary general hospital over the last 11years.Material and methods: The present study is an analysis of177 cases of DP that presented to the psychiatry departmentof a tertiary general hospital over the past 11 years and thedata has been analyzed using a semi-structured proforma anddescriptive statistics.Results: The mean age of the sample was 34.6 ± 21.3 yearsand the mean age of onset of the disorder was 28.3 ± 17.1years. The mean duration of illness of the sample was 3.9 ±10.3 years. 103 (58.19%) had a magnetic resonance imagingof the brain done which was within normal limits. 56(31.63%) patients had repeated neuroimaging investigationslike EEG, MRI and CT Scans done which were also all withinnormal limits. Most patients were treated with Risperidoneand Aripiprazole while few were treated with Pimozide,Haloperidol and Amisulpride. 43 (24.29%) patients received acourse of electroconvulsive therapy (ECT) as well in additionto medications.Conclusion: DP though rare is seen in clinical practice andfurther longitudinal studies are needed to establish withgreater certainty facts about the course and prognosis of thedisorder

Characteristics of Delirium in Patients with Hearing Disturbances / 신경정신의학

OBJECTIVES: Several studies have delineated the relationship between hearing disturbances and the prevalence or characteristics of psychotic symptoms; however, most of those studies focused on psychiatric patients and not general inpatients. Delirium has a high incidence among general inpatients, and patients with delirium are easily affected by psychotic symptoms that lead to irritable behaviors. This study examined the relationship between hearing disturbance and psychotic symptoms among patients with delirium. METHODS: At the Asan Medical Center in Seoul, South Korea, this study examined 27 inpatients who had both delirium and hearing disturbances between January 1, 2009 and December 31, 2018, and 146 inpatients at the Asan Medical Center who had delirium but no hearing disturbances between July 1, 2018 and December 31, 2018. This study investigated whether the two groups showed differences in the prevalence and characteristics of delirium symptoms, particularly psychotic symptoms. In addition, the correlation between clinical characteristics of delirium and the recommended dosage of antipsychotics was analyzed in patients who had been diagnosed with delirium and had hearing disturbances. RESULTS: Compared to inpatients who only had delirium, those who had both delirium and hearing disturbances had a significantly higher prevalence of hallucination and delusion. CONCLUSION: The prevalence of psychotic symptoms, such as hallucination and delusion, was higher in patients who had both delirium and hearing disturbances, which is in line with the results from previous studies on psychiatric patients. Physicians should focus on improving communication with such patients by employing non-verbal communication methods.

The delusional dimension of anorexia nervosa: phenomenological, neurobiological and clinical perspectives

Abstract Background Delusional characteristics have been largely ignored in patients suffering from anorexia nervosa (AN). Objectives To review the literature on delusional features in AN from phenomenological, neurobiological, and clinical viewpoints. Methods Data were obtained through searches of Medline, PubMed, SciELO and Cochrane Library. Results Distorted beliefs in AN may range from an overvalued idea to an overt delusion, involving affective, personality and/or psychotic disorders. Studies confirm alterations in monoaminergic systems. It has also been seen a decreased integration of visual/proprioceptive information, and alterations in neural networks involved in body processing. It is known that body image distortion may present "delusional proportions" as a consequence of great concern about body. Concomitantly, "embodied defence hypothesis" has been proposed. Restrictive AN exhibits higher levels of delusionality, and a particular delusional type of AN has been suggested, associated with a worse long-term outcome. Low doses of atypical antipsychotics are recommended combined with cognitive techniques. Discussion Delusional thinking in AN is likely a dynamic and dimensional phenomenon that can vary, both in nature and/or severity, whereas high insight levels, before and after refeeding, result in positive outcomes. Neurobiological research on this topic must be encouraged, since clinical and phenomenological approaches are comparatively more frequently reported.

New ray of hope for psychosis in parkinson’s: Pimavanserin.

Parkinson’s disease is often associated with hallucinations and psychosis. Till now typical and atypical antipsychotics (Clozapine & Quetiapine) are being used to manage these symptoms. Recently US FDA has approved a new drug Pimavanserin for the treatment of hallucination and delusion associated with parkinson’s disease psychosis in a dose of 34 mg.

Delusional Infestation Successfully Controlled With Neuroleptic Depot Injection: A Case Report

Delusional infestation is a psychiatric condition in which a patient belief that they are infested with living organisms in the absence of any objective evidence. The objective of this case report is to highlight a rare case of delusional infestations in a patient with schizophrenia who misusing polysubstance abuse. Methods: We report a case of 36-year-old Malay gentlemen, unemployed, married with three children, known case of schizophrenia since 2013, with history of polysubstance abuse presented to the emergency department with symptoms of itching followed by a sensation of insects crawling, biting and burrowing under the skin on his head causing an ulcerated wound. Results: He was diagnosed to be suffering from schizophrenia and was successfully treated with monthly antipsychotic depot injection in view of his poor adherence to medication On examination, ulcerated scalp wound measuring 4 x 4 cm was noted at the parieto-occipital region of the scalp. Skull X-ray and computerized tomography (CT) scan of the brain were normal. Electroconvulsive therapy (ECT) was introduced in view of slow treatment response and self-inflicted injury. The symptoms were successfully controlled after eight months, and no extrapyramidal side effect was observed. Conclusion: Patients with delusional infestation often poorly adhered to his treatment medication and the usage of depot injection of antipsychotic may benefited some patients to control the psychotic symptoms. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Neurocognitive Model of Delusion: Two-Factor Theory

The underlying nature of delusions remains unclear despite their importance in psychopathology. Here we present a review of the neurocognitive model of delusions from a cognitive neuroscience viewpoint. There have been numerous reports on cognitive impairments in delusional patients, such as in their reasoning, attention, metacognition, and attribution biases. These findings have been incorporated into several cognitive models that aim to explain the formation, maintenance, and content of delusion. Although delusions are commonly conceptualized as beliefs, not all models make reference to models of normal belief formation. This review focused on two-factor theory models that make a distinction between factors that explain the content of delusions and those that explain their presence. This cognitive theory that includes the 'pragmatic pathology' of delusions can address both the phenomenology and treatment of delusion-related distress.

Unusual Findings in Morgellons Disease and Delusions of Parasitosis.

We are presenting four new cases of delusions of parasitosis, two of which also had features of Morgellons disease. This illustrates the difficulties in therapy of these patients having almost universal refusal to accept the psychiatric component. Two of the patients responded to treatment while two did not. Of the two responders one was lost to follow up. The recommended treatments of pimozide, lexapro, and risperdone are examined. These rare diseases continue to be a challenge to the dermatologic community.

Management of Delusions of Parasitosis in Dermatology: A 3-year Retrospective Study of 32 Cases / 대한피부과학회지

BACKGROUND: Delusions of parasitosis (DOP) is a psychiatric disorder in which patients have a fixed, false belief that they are infested by parasites. Management of patients with DOP presents a challenge to dermatologists, because such patients usually refuse to see a psychiatrist. OBJECTIVE: The aim of this study was to investigate the clinical manifestations and responses to treatment in DOP patients. METHODS: Between January 2010 and December 2012, the medical records of 32 DOP patients were reviewed to obtain data on clinical presentation, family history, accompanied psychiatric disorders, and treatments. RESULTS: The male-to-female ratio was 1:4.3. Twenty-two patients (68.8%) had symptoms for over 6 months. Seven patients (21.9%) had apparent skin lesions. Eighteen patients (56.3%) had a positive specimen sign. Three patients had depression, 4 had insomnia, and 2 had other delusional disorders. Eight patients (25%) reported that their family members were also experiencing itching. Six patients underwent skin biopsies, the results of which were consistent with chronic dermatitis. With pimozide treatment, 6 patients (18.8%) achieved complete remission, 17 (53.1%) showed a partial response, and 9 (28.1%) showed no response. CONCLUSION: Because DOP patients depend on dermatologists for treatment, it is crucial for dermatologists to be prepared for the proper management of this condition. This study expands our understanding of the disease and suggests the optimal methods of treatment. Further studies on socioeconomic data and selection of effective antipsychotics are needed.

Dimensions of Delusions in Major Depression: Socio-demographic and Clinical Correlates in an Unipolar-Bipolar Sample

OBJECTIVE: The present study aims at exploring associations between a continuous measure of distorted thought contents and a set of demographic and clinical features in a sample of unipolar/bipolar depressed patients. METHODS: Our sample included 1,833 depressed subjects. Severity of mood symptoms was assessed by the 21 items Hamilton Depression Rating Scale (HAM-D). The continuous outcome measure was represented by a delusion (DEL) factor, extracted from HAM-D items and including items: 2 ("Feelings of guilt"), 15 ("Hypochondriasis"), and 20 ("Paranoid symptoms"). Each socio-demographic and clinical variable was tested by a generalized linear model test, having depressive severity (HAM-D score-DEL score) as the covariate. RESULTS: A family history of major depressive disorder (MDD; p=0.0006), a diagnosis of bipolar disorder, type I ( p=0.0003), a comorbid general anxiety disorder (p<0.0001), and a higher number of manic episodes during lifetime (p<0.0001), were all associated to higher DEL scores. Conversely, an older age at onset (p<0.0001) and a longer duration of hospitalization for depression over lifetime (p=0.0003) had a negative impact over DEL scores. On secondary analyses, only the presence of psychotic features (p<0.0001) and depressive severity (p<0.0001) were found to be independently associated to higher DEL scores. CONCLUSION: The retrospective design and a non validated continuous measure for distorted thought contents were the main limitations of our study. Excluding the presence of psychotic features and depressive severity, no socio-demographic or clinical variable was found to be associated to our continuous measure of distorted thinking in depression.

Delusions in Alzheimer's Disease

Alzheimer's disease (AD) is associated with cognitive and functional impairment as well as neuropsychiatric complications, including psychotic symptoms such as delusions and hallucinations. Recent studies strongly suggest that delusions should be separated from hallucinations. While AD with delusions is a phenotypically distinct from AD without delusions, subtypes of delusions may also define further distinct clinical entities. There has been also considerable debate as to whether delusions in patients with AD differ etiologically, phenomenologically, and therapeutically from delusions in other primary psychiatric illnesses. In other words, whether they are caused by changes to key areas of the brain that have been linked to the presence of delusions. This has led to speculation that these symptoms may respond better to certain drugs such as cholinesterase inhibitors. Integrating the epidemiology, clinical phenomenology, neuropathological and genetic literature for delusions in AD allows us to speculate on pathophysiology and is essential to making progress in the area of delusions in AD.

Delusiones de cambio de sexo, transexualismo y esquizofrenia: a propósito de un caso / Delusions of sexual change, transsexualism and schizophrenia: apropos of a case

Una importante proporción de personas con esquizofrenia experimenta delusiones de contenido sexual en algún momento del curso de su enfermedad; incluso, algunos pacientes pueden llegar a la convicción de que pertenecen a un sexo distinto del que poseen. Esto puede llevar a un diagnóstico inapropiado de transexualismo y eventualmente a procedimientos hormonales o quirúrgicos innecesarios. A partir del caso de una paciente con esquizofrenia y delusión de cambio de sexo revisamos la literatura pertinente en donde se evidencia la rareza de una real comorbilidad entre transexualismo y esquizofrenia aunque permanece pendiente profundizar en la compleja situación de la sexualidad de nuestros pacientes con esquizofrenia.

A significant number of people with schizophrenia experiences delusions of sexual content at some point in the course of their disease; moreover, some patients may be convinced that they belong to a different sex from their own. This can lead to inappropriate diagnosis of transsexualism and eventually unnecessary hormonal or surgical procedures. Taking the case of a patient with schizophrenia and delusion sex change as a starting point, we review and discuss relevant literature, where we find a real rarity of comorbidity between transsexualism and schizophrenia. However, the complex situation of the sexuality of our patients with schizophrenia remains pending of further study.

Behavioural and Psychological Symptoms of Dementia

Behavioural and psychological symptoms of dementia (BPSD) are common in dementia. They cause significant distress to people with dementia and their carers. In managing BPSD, medical causes such as delirium must be excluded. Non pharmacological management, such as environmental and behavioural interventions are effective first line strategies. Medication may be useful in moderate to severe BPSD but must be used carefully in view of the risk of side-effects.