Neurolupus as a manifestation of the first psychotic episode: case report.

Background: Systemic lupus erythematosus is a chronic mul-tisystemic autoimmune disease with diverse clinical manifestations. Women are the most vulnerable population and have the greatest neurological involvement with a higher risk of seizures. Neuropsychiatric manifestations occur in early stages of the disease and diagnosis since they can occur together with systemic manifestations or not. The frequency of neuropsychiatric manifestations in systemic lupus erythematosus has been described from 14 to 75%;being cognitive alterations one of the major symptoms to highlight. Which, in the same way can be accompanied by affective disorders such as depression and anxiety. Since psychosis, secondary to SLE, stands out for its low prevalence (10%), laboratory studies usually guide us towards a definitive diagnosis, being ribosomal P antibodies the ones that have been more specifically related to lupus psychosis. MRI is the test of choice and brain lesions are dominated by punctate white matter hyperintensities. In the following case report, we present a 20-year-old patient who had a history of diagnosed hepatic steatosis, MODY type diabetes and resection of the right ovary for mature teratoma of 9 years of evolution;but with no psychiatric history of importance at the time of her evaluation. However, she acutely presented a psychotic outbreak characterized by delusions of grandiosity and reference;as well as behavioral, cognitive, and affective alterations. For which she had to go to a 3rd level hospital during the period of health contingency in 2020. After a history of SARS-CoV-2 infection three months before her neuropsychiatric pathology, neurological symptoms secondary to COVID-19 infection were suspected, as well as isolated psychiatric pathology. Therefore, a study approach of the first psychotic outbreak was performed, diagnosing systemic lupus erythematosus with neuropsychiatric manifestations. Treatment was based on a bolus of methylprednisolone and antipsychotics;later modified by therapy with oral corticosteroids and depot antipsychotic. Conclusion: Systemic lupus erythematosus with neuropsychiatric manifestations is an infrequent presentation of the disease, because of the wide variation in its appearance, patients with psychiatric symptoms in a general hospital setting should be considered for extensive approaches. In the same way, having this knowledge of this case may broaden our knowledge about the complications of this rheumatologic pathology. And one of its most serious complications such as lupus psychosis to be able to make a better approach to the first psychotic outbreak in general hospitals, where the assessment of a specialist can be more complicated. (English) [ FROM AUTHOR] Antecedentes: El lupus eritematoso sistémico (LES) es una enfermedad auto inmunitaria crónica multisistémica con diversas manifestaciones clínicas. Siendo las mujeres la población vulnerable y con mayor afectación a nivel neurológico, al presentar mayor riesgo de convulsiones. Las manifestaciones neuropsiquiátricas ocurren en etapas tempranas de la enfermedad y del diagnóstico, ya que pueden presentarse junto con manifestaciones sistémicas o no. La frecuencia de manifestaciones neuropsiquiátricas en el lupus eritematoso sistémico se ha descrito del 14 al 75%, siendo las alteraciones cognitivas uno de los grandes síntomas a destacar1. La cual puede ir acompañada de trastornos afectivos de tipo depresión y ansiedad. Ya que la psicosis secundaria a LES se remarca por su baja prevalencia (10%)2, los estudios de laboratorio nos suelen orientar hacia el diagnóstico definitivo, siendo los anticuerpos ribosomales P los que se han relacionado más específicamente con la psicosis lúpica. La resonancia magnética es la prueba de elección y las lesiones cerebrales están dominadas por hiperintensidades de materia blanca en forma de punción3. En el siguiente reporte de caso, presentamos a una paciente de 20 años, la cual contaba con antecedentes de esteatosis hepática diagnosticado, diabetes tipo MODY y resección de ovario derecho por teratoma maduro de 9 años de evolución, pero sin antecedentes psiquiátricos de importancia para el momento de su valoración. Sin embargo, de forma aguda presentó un brote psicótico caracterizado por ideas delirantes de grandiosidad y referencia, así como alteraciones conductuales, cognitivas y afectivas. Por las que tuvieron que acudir a hospital de 3er nivel durante el periodo de contingencia sanitaria en el 2020. Tras el antecedente de presentar infección por SARS-CoV-2 tres meses antes de su patología neuropsiquiátricas. Se sospechó en síntomas neurológicos secundarios a infección por COVID-19, así como patología psiquiátrica aislada. Por lo que se realizó abordaje de estudio de primer brote psicótico, diagnosticándose lupus eritema-toso sistémico con manifestaciones neuropsiquiátricas. El tratamiento se basó en un bolo de metilprednisolona y antip-sicóticos, luego modificada por terapia con corticoesteroides orales y antipsicótico de depósito. Conclusión: El lupus eritematoso sistémico con manifestaciones neuropsiquiátricas es una presentación poco frecuente del padecimiento, por la amplia variación en este, los pacientes con síntomas psiquiátricos en contexto de hospital general deben de ser tomados en cuenta para abordajes extensos4. De la misma forma, el tener este conocimiento del caso podrá ampliar nuestro conocimiento sobre las complicaciones de esta patología reumatológica. Y una de sus complicaciones más graves como la psicosis lúpica para poder realizar un mejor abordaje del primer brote psicótico en hospitales generales, donde la valoración de un especialista puede ser más complicada para mejorar las condiciones médicas de estos pacientes. (Spanish) [ FROM AUTHOR] Copyright of Revista de la Facultad de Medicina de la UNAM is the property of UNAM, Facultad de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A Feasibility Study of LORETA Z-Score Neurofeedback Training in Adults with Schizophrenia-Spectrum Disorder Experiencing Treatment-Resistant Auditory Verbal Hallucinations

Introduction: The incomplete effectiveness of interventions demands new ways to help people diagnosed with schizophrenia who experience auditory verbal hallucinations (SZ-AVH). We aimed to perform a feasibility study of low-resolution electromagnetic tomography analysis (LORETA) neurofeedback with people exhibiting treatment-resistant SZ-AVH. Method(s): We examined changes in resting-state quantitative electroencephalogram (qEEG) in four people with SZ-AVH (three male, one female) after LORETA Z-score neurofeedback training. Result(s): The study design had to be amended due to a national COVID-19 lockdown. Neurofeedback was well tolerated and no participants dropped out. Recruitment was the main feasibility issue. Barriers included a lack of knowledge of neurofeedback by patients and mental health teams, as well as the travel and time commitment involved. For the only patient who completed all 20 sessions, elevated frontal, central, and temporal theta absolute power measured at baseline normalized after treatment, but decreased temporal delta and an increase in coherence for all frequency bands were also found. Conclusion(s): Two key lessons were drawn for the feasibility of trials of EEG neurofeedback in this population. First, significant effort is needed to educate mental health professionals and patients about neurofeedback. Second, the equipment employed for neurofeedback training needs to be physically based at a site where patients routinely attend.Copyright © 2022. Amico et al.

The Language of Smell: Code Failure

In today's world filled with complex signs and symbols, visual and auditory channels are the most intensive in semiotic terms. The language of smell, associated with the most ancient reactions, is usually considered as secondary and supplementary, and its possibilities for conveying meanings are limited to simple recognition. However, experts have been using the alphabet of smells to convey emotional messages from ancient times to date. The assessment of the role of odors in the modern world became possible due to the Covid-19 pandemic which often involved the loss, change or intensification of the sense of smell. In the course of the study 250 cases were considered, representing the stories associated with the disease and deviations in the perception of odors. The loss of the perception of unpleasant odors makes it impossible to learn about the dangers which cannot be perceived visually like in ancient times (spoiled food, poisoned air, etc.). Phantom interpretation of odors is often unpleasant: people can identify the smells of burning, ammonia, acetone, decomposition, feces, and others, and sometimes the excessiveness of an ordinary smell is unpleasant as well. The change of sign recognition can cause serious consequences for people. Phantom unpleasant odors can result in changes in eating habits and cause problems in communication. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Can COVID-19 Cause Acute Psychosis in Pediatric Patients? A Case Report

ObjectivesTo demonstrate that COVID-19-associated acute psychosis, though rare, can happen in the pediatric patient population. Patients with new-onset psychosis should be tested for COVID-19 infection, and other organic causes of psychosis should also be considered (e.g., delirium, medication-induced psychosis, and catatonia).MethodPatient X, a 14-year-old female with no known past psychiatric history, presented to the local emergency room following odd behavior for 3 days and having tested positive for COVID-19 2 weeks prior. The patient's mother reported odd behaviors, including the patient claiming her fish was calling her name and her name was being repeated on TV. She had been moving slowly with occasional staring. The patient's mother reported episodes in which the patient was repeating phrases over and over and where she would require redirection to a task. When the patient planned to have a bath, her mother noted that she was naked in her room while looking for something and then needed redirection to go take a bath. She did not have any episodes of agitation. A thorough psychiatric evaluation indicated she was experiencing visual hallucinations. Her vitals were within normal ranges, except for a mildly elevated heart rate. The patient was admitted for further testing, assessment, and management. She was started on chlorpromazine 10 mg daily as needed for psychosis.ResultA complete blood count with differential (CBC), complete metabolic panel (CMP), and thyroid function results were all within the normal range. Urine drug screening was negative. EKG, CSF analysis, chest X-ray, and brain MRI showed no significant abnormalities. Mild background slowing was noted on EEG, with no interictal/epileptiform discharges or any delta brushes. Therefore, a tentative diagnosis of COVID-19-associated psychosis was made. Treated with chlorpromazine 10 mg daily, the patient gradually improved with no hallucinations or bizarre behavior. She was discharged after 5 days and was not prescribed any medication at discharge. Nine days after discharge, the patient was seen by a pediatric neurologist. She did not report any hallucinations or delusions, but her mother reported that the patient moved slowly and had difficulty identifying common objects. An autoimmune panel, physical exam, and repeat EEG were all unremarkable. The neurologist concluded that her psychosis was most likely post-viral sequelae. The patient continued to improve and returned to school over the span of 2 months.ConclusionAcute psychosis after COVID-19 infection is a new and emerging diagnosis with no consensus on management strategies for pediatric or adult patient populations. This case highlights the need for clinicians to be vigilant of subtle, fluid psychotic symptoms, in addition to patients' general mental well-being. We do not have research regarding the long-term consequences of acute psychosis episodes. Further studies are needed to investigate the neuropsychiatric etiology of post-COVID-19 psychosis and the optimum treatment for this group of patients.FundingNo Funding

The notion of the setting and the extinction drive

The author describes the analysis of a woman patient in the absence of the analytic setting during the long period of confinement due to Covid-19. Bleger's distinctions between the analytic process and the frame are explored in this context, and Green's formulation on the function of the framing structure in the construction and elaboration of phantasy life, as well the function of the hallucinatory wish fulfilment in the movement towards symbolization. The production of a sculpture during this time is on the pathway towards the elaboration of the work of mourning. (PsycInfo Database Record (c) 2023 APA, all rights reserved) Abstract (French) L'auteur decrit l'analyse d'une patiente, par telephone, dans le contexte du confinement du a la Covid-19, alors que la dimension physique du cadre analytique est absente. Elle interroge la theorie de Bleger et sa distinction entre cadre et processus analytiques ainsi que celle de Green sur la fonction de la structure encadrante et la fonction de l'accomplissement hallucinatoire de souhait dans le mouvement vers la symbolisation. La production d'une sculpture pendant l'analyse amorce l'elaboration d'un travail de deuil. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Experience of psychosis during the COVID-19 pandemic among hospitalized patients

The content of auditory hallucinations (AHs) and delusions is malleable and reflects the social environment and the local culture. COVID-19 is a significant new feature of the social environment, yet research has not yet determined how the phenomenology of psychosis has changed since the COVID-19 outbreak. Adult patients (N = 17) receiving care within an acute inpatient psychiatric care setting in Boston were recruited to participate in an hour-long Zoom interview about their psychosis phenomenology and the potential impact of COVID-19. Thematic analysis of interview data found that for many, ideas about COVID-19 were present in the content of their AHs and shaped their paranoid ideation. Some felt that the frequency and loudness of the AHs had increased. However, not all participants spoke in ways that suggested the virus had affected their experience. Results demonstrate that COVID-19 influenced the content of psychosis for many, but the effect of COVID-19 on psychosis was not uniform. The increased social isolation, financial insecurity, and socio-political climate of the period also seemed to negatively impact individuals with psychosis. Understanding how COVID-19 specifically has influenced psychosis helps to illustrate how societal and external factors may shape this experience.

The effect of psilocybin on personality

As classic psychedelics are increasingly legalized and reintroduced into the psychotherapeutic frame, a deeper understanding of their effect on personality and overall wellbeing - as well as their clinical contraindications and potential pitfalls - will prove essential. As a result, this study represents a preliminary investigation into the effect of psilocybin exposure on a range of personality constructs.Methods: Data was collected through a collaboration with The Psychedelic Society, an organization that legally administers psilocybin in the Netherlands to self-selecting retreat attendees who have been screened for mental health disorders in accordance with Johnson et al.'s (2008) widely accepted safety guidelines. Participants completed the following measures via online questionnaire the day before psilocybin exposure, two days after psilocybin exposure, and at a one-month follow-up: Brief Symptom Inventory (BSI), Experiences in Close Relationships-Revised (ECR-R), Mentalization Scale (MentS), Inventory of Personality Organization (IPO), Pathological Narcissism Inventory (PNI), Pro-Environmental Behavior (PEB) and the Ryff Scale of Psychological Well-Being (Ryff). As rigorous double-blind clinical studies have linked psychedelic-occasioned mystical experiences to sustained improvement in personality-related domains (Maclean et al., 2011;Griffiths et al., 2006;Griffiths et al., 2008, Griffiths et al., 2011), the Mystical Experience Questionnaire (MEQ) was also administered. Lastly, participants provided self-report responses to open-ended questions regarding subjective experiences following psilocybin exposure. Results: Due to the Covid-19 pandemic, data collection was prematurely cut short, and only preliminary conclusions can be drawn. Those provisional conclusions include significantly improved overall symptomatology (BSI GSI), identity diffusion (IPO-ID) and reality testing (IPO-RT) following psilocybin exposure. Significant interactions were also identified for primitive defenses (IPO-PD) and narcissistic grandiosity (PNI-G), with the non-mystical experience group trending toward improvement, and the mystical-experience group remaining largely unchanged over time. Due to methodological constraints encountered, these findings remain preliminary. Nevertheless, the presence of multiple significant findings (however nascent) within the context of so few participants suggests the possibility of more robust findings in the context of a larger sample size. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The Language of Smell: Code Failure

In today's world filled with complex signs and symbols, visual and auditory channels are the most intensive in semiotic terms. The language of smell, associated with the most ancient reactions, is usually considered as secondary and supplementary, and its possibilities for conveying meanings are limited to simple recognition. However, experts have been using the alphabet of smells to convey emotional messages from ancient times to date. The assessment of the role of odors in the modern world became possible due to the Covid-19 pandemic which often involved the loss, change or intensification of the sense of smell. In the course of the study 250 cases were considered, representing the stories associated with the disease and deviations in the perception of odors. The loss of the perception of unpleasant odors makes it impossible to learn about the dangers which cannot be perceived visually like in ancient times (spoiled food, poisoned air, etc.). Phantom interpretation of odors is often unpleasant: people can identify the smells of burning, ammonia, acetone, decomposition, feces, and others, and sometimes the excessiveness of an ordinary smell is unpleasant as well. The change of sign recognition can cause serious consequences for people. Phantom unpleasant odors can result in changes in eating habits and cause problems in communication. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

COVID-19: How can we support each other (and ourselves)?

The Chair of The National Hearing Voices Network (http://www.hearing-voices.org/HVN) prepared this document, on behalf of the HVN Board, to provide some sources of information and support for its members, and others, during the Covid-19 pandemic. At the request of the journal Editor (also a member of the HVN Board), the document is published here, verbatim, for Psychosis readers around the world. Although targeted at people in the UK who hear voices or see visions, much of the information is potentially also relevant for other people, including mental health professionals. Like HVN, neither the journal nor ISPS endorse or recommend specific mental health services or practitioners. We recognise that different things are helpful for different people. The document is published merely to increase the range of options for people to choose from if they feel the need for additional support or information. All at HVN, Psychosis and ISPS wish readers a safe passage though the current stormy waters, which, despite all the fears and losses, are providing us all with opportunities to take care of one another like many of us have never experienced before. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

A Rare and Complex Case of Non-suicidal Self-Mutilation in a Patient With Schizophrenia.

The literature describing acts of non-suicidal self-mutilation (NSSM) in the adult population is limited. Of the cases that document NSSM, a disproportionate number of these individuals have a history of psychiatric illnesses. Although the motivation to perform NSSM varies across patients, the literature suggests that past self-injurious behaviors, extreme religious delusions, and command hallucinations are the most significant risk factors. The primary forms of NSSM include ocular, genital, and limb mutilation. Limb mutilation is the least common of the three and typically occurs proximal to the wrist or hand. Here, we present a rare case involving a 42-year-old man with schizophrenia who was hospitalized due to osteomyelitis of his autoamputated digits. This case is unique in involving multiple digits of the hand and using a rare amputation method. We aim to compare this case with the existing body of work on NSSM and identify factors that may predispose patients to act on these extreme impulses. We also highlight a novel interventional program that reduces psychiatric and medical comorbidities.

Multisite randomised controlled trial of trauma-focused cognitive behaviour therapy for psychosis to reduce post-traumatic stress symptoms in people with co-morbid post-traumatic stress disorder and psychosis, compared to treatment as usual: study protocol for the STAR (Study of Trauma And Recovery) trial.

BACKGROUND: People with psychosis have high rates of trauma, with a post-traumatic stress disorder (PTSD) prevalence rate of approximately 15%, which exacerbates psychotic symptoms such as delusions and hallucinations. Pilot studies have shown that trauma-focused (TF) psychological therapies can be safe and effective in such individuals. This trial, the largest to date, will evaluate the clinical effectiveness of a TF therapy integrated with cognitive behaviour therapy for psychosis (TF-CBTp) on post-traumatic stress symptoms in people with psychosis. The secondary aims are to compare groups on cost-effectiveness; ascertain whether TF-CBTp impacts on a range of other meaningful outcomes; determine whether therapy effects endure; and determine acceptability of the therapy in participants and therapists. METHODS: Rater-blind, parallel arm, pragmatic randomised controlled trial comparing TF-CBTp + treatment as usual (TAU) to TAU only. Adults (N = 300) with distressing post-traumatic stress and psychosis symptoms from five mental health Trusts (60 per site) will be randomised to the two groups. Therapy will be manualised, lasting 9 months (m) with trained therapists. We will assess PTSD symptom severity (primary outcome); percentage who show loss of PTSD diagnosis and clinically significant change; psychosis symptoms; emotional well-being; substance use; suicidal ideation; psychological recovery; social functioning; health-related quality of life; service use, a total of four times: before randomisation; 4 m (mid-therapy); 9 m (end of therapy; primary end point); 24 m (15 m after end of therapy) post-randomisation. Four 3-monthly phone calls will be made between 9 m and 24 m assessment points, to collect service use over the previous 3 months. Therapy acceptability will be assessed through qualitative interviews with participants (N = 35) and therapists (N = 5-10). An internal pilot will ensure integrity of trial recruitment and outcome data, as well as therapy protocol safety and adherence. Data will be analysed following intention-to-treat principles using generalised linear mixed models and reported according to Consolidated Standards of Reporting Trials-Social and Psychological Interventions Statement. DISCUSSION: The proposed intervention has the potential to provide significant patient benefit in terms of reductions in distressing symptoms of post-traumatic stress, psychosis, and emotional problems; enable clinicians to implement trauma-focused therapy confidently in this population; and be cost-effective compared to TAU through reduced service use. TRIAL REGISTRATION: ISRCTN93382525 (03/08/20).

The double penalty of the coronavirus: Decidedly this virus has not yet revealed all its secrets!

Introduction: The direct and indirect effects of the COVID-19 pandemic on the mental health of the population have become a concern in the field of research in psychiatry. First psychotic episodes following infection with SARS cov2 have been reported. Objective(s): Through a clinical case, we will illustrate the association of psychiatric symptoms with SARS cov2 infection. Method(s): We discussed , through a clinical case, the association of psychiatric symptoms with infection by the coronavirus 19. Result(s): L.R, Tunisian 52-year-old, diabetic (type 2) women, with no personal or family psychiatric history and no toxic habits. she did not receive receive covid 19 vaccination. Twenty days before her admission to the psychiatry departement , she had fever, cough, myalgia, and anosmia .The diagnosis of a SARS COv2 infection was retained by her general practitioner. Two weeks later she suddenly presented a persecutory delirium, distressing auditory hallucinations, and attempted rat poison suicide. On admission, The patient had a delirium of persecution towards her entourage and an auditory hallucinatory syndrome with distressing content. She was put on 1 mg of Risperidone with restitution ad integrum after 7 days. COVID-19 serology test detected IgM antibodies which allowed us to conclude that the symptomatology was related to the infection by this virus. For the etiological research, we performed a serology that confirmed the recent exposure to SARS COV2 and. The diagnosis retained is a brief psychotic disorder post-Sars Cov2. Conclusion(s): The advanced hypothesis that infection with SARS CoV-2 could be the cause of the psychiatric manifestations remains unclear to this day.

The COVID-19 Pandemic and Psychosis: The Unusual Insight

Background: COVID, believed to have emerged in Wuhan, China in Nov, 19 and swiftly spread like wildfire across the continents. It wasn't much of a fantasy that it would become a headache for governments all over the world and would have a devastating impact on every sector alike, ravaging economies, especially medicine and healthcare. It was declared as a global pandemic in March, 2020. Predominantly thought of causing only pulmonary complications, it was soon revealed to be causing multiple neuropsychiatric complications in a few cases. Although it was with limited evidence, it was significant enough much like it's counterparts SARS-CoV-1 and MERS. Neurological problems ranged from a spectrum of anxiety to delusions, to even psychosis in some patients. However, the origin and pathogenesis of a COVID induced psychosis is still very much of a question mark. Since, many of the patient's diagnosis could be traced back to their family roots or some kind of substance abuse. In this review, the aim is to assess various associations which could be leading patients to developing new onset psychosis and the possible complications arising out of COVID-19 pandemic. Objective: The purpose of this review article is to analyse the multiple case reports and their data interpretation reported throughout the world during COVID pandemic and give a summarised view. Methodology: Various articles were searched individually containing significant key words that are in relevance to the mental illnesses comprising words like COVID, psychosis, schizophrenia, pandemic, mental illness across various platforms that is PubMed, Google scholar, BMJ, Medline, Frontiers, Sage journals and various news articles and were summed up so as in an attempt to come to a conclusion which could lead to a certain possible ethology and the risk factors involved.

The impact of the first UK COVID-19 lockdown on presentations with psychosis to mental health services for older adults: An electronic health records study in South London.

OBJECTIVES: Social distancing restrictions in the COVID-19 pandemic may have had adverse effects on older adults' mental health. Whereby the impact on mood is well-described, less is known about psychotic symptoms. The aim of this study was to compare characteristics associated with psychotic symptoms during the first UK lockdown and a pre-pandemic comparison period. METHODS: In this retrospective observational study we analysed anonymised records from patients referred to mental health services for older adults in South London in the 16-week period of the UK lockdown starting in March 2020, and in the comparable pre-pandemic period in 2019. We used logistic regression models to compare the associations of different patient characteristics with increased odds of presenting with any psychotic symptom (defined as hallucinations and/or delusion), hallucinations, or delusions, during lockdown and the corresponding pre-pandemic period. RESULTS: 1991 referrals were identified. There were fewer referrals during lockdown but a higher proportion of presentations with any psychotic symptom (48.7% vs. 42.8%, p = 0.018), particularly hallucinations (41.0% vs. 27.8%, p < 0.001). Patients of non-White ethnicity (adjusted odds ratio (OR): 1.83; 95% confidence interval (CI): 1.13-2.99) and patients with dementia (adjusted OR: 3.09; 95% CI: 1.91-4.99) were more likely to be referred with psychotic symptoms during lockdown. While a weaker association between dementia and psychotic symptoms was found in the pre-COVID period (adjusted OR: 1.55; 95% CI: 1.19-2.03), interaction terms indicated higher odds of patients of non-White ethnicity or dementia to present with psychosis during the lockdown period. CONCLUSIONS: During lockdown, referrals to mental health services for adults decreased, but contained a higher proportion with psychotic symptoms. The stronger association with psychotic symptoms in non-White ethnic groups and patients with dementia during lockdown suggests that barriers in accessing care might have increased during the COVID-19 pandemic.

Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19.

Objectives: To explore the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19. Design: Retrospective review using medical records of patients with COVID-19 and admitted to the acute inpatient rehabilitation unit (ARU). Setting: A public hospital in southern California, specializing in rehabilitation medicine. Participants: Patients with COVID-19 and hallucinations who were consecutively admitted from January 1st to April 30th, 2021. Interventions: Not applicable. Main Outcome Measures: Types and themes of hallucinations. Results: Eight of the 37 patients (21.6%) admitted to the ARU with COVID-19 exhibited hallucinations. All were Hispanic and 7 of them were men; their average age was 56.5 (range: 38-71). Seven patients had COVID-19 pneumonia and 1 developed respiratory distress secondary to Guillain-Barre Syndrome. One patient had posterior reversible encephalopathy syndrome. The average length of stay in the intensive care unit (ICU) was 31.3 days (range: 8-48). Most of the hallucinations occurred during their ICU stay and 2 continued to their ARU stay. All recalled details of hallucinations with 7 exhibiting visual hallucinations, consistent with peduncular hallucinosis with or without auditory and/or tactile components. One patient experienced tactile hallucinations. The themes of hallucinations identified to reflect the contents of the hallucinations were patients' comfort-seeking, fearfulness, and seeing deceased family members. All patients had impaired cognition at the ARU admission but improved at discharge. Four patients had depressed mood/anxiety and 1 had depressed mood alone but without a history of psychiatric illness. ICU delirium was documented in 5 patients. The negative experience of hallucinations seemed to affect their participation of the ARU stay. Conclusions: More than 20% of patients with COVID-19 who were transferred to attend inpatient rehabilitation exhibited hallucinations. It remains uncertain if these hallucinations were related to the SARS-CoV-2 infection. Multidisciplinary rehabilitation team should be aware to support patients with COVID-19 who experience hallucinations.

Safety Profile of Tyrosine Kinase Inhibitors Approved for Gastrointestinal Stromal Tumors: Analysis from the European Spontaneous Adverse Event Reporting System: An International Journal of Medical Toxicology and Drug Experience

Introduction: Gastrointestinal stromal tumors (GISTs), soft tissue sarcomas of the digestive tract, are associated with oncogenic mutations that led to the approval of tyrosine kinase inhibitors (TKIs) [1-2]. Considering the increased use of TKIs in clinical practice, it may be useful to identify unexpected adverse drug reactions (ADRs). Objective: The aim of this study was to describe better ADRs and to identify unexpected potential safety signals through the analysis of individual case safety reports (ICSRs) among TKIs approved for GIST collected into the European Spontaneous Reporting System (SRS) database. Methods: All ICSRs recorded starting from the drug approval up to 31 December 2021 with one of the following TKIs reported as suspected drug were included: imatinib (IM), sunitinib (SU), avapritinib (AVA), regorafenib (REG), and ripretinib (RIP). A descriptive analysis was conducted to assess all demographic characteristics. Moreover, a disproportionality analysis was performed using the Reporting Odds Ratio (ROR) with the corresponding 95% Confidence Interval (CI) to evaluate the frequency of ADRs for each TKI compared to all other TKIs. Results The number of analyzed ICSRs was 8,512 (Figure 1 Flowchart of ICSRs selection process): the 57.9% were related to IM, followed by SU (24.2%), AVA (13.1%), REG (2.7%), and RIP (2.1%). ICSRs were mainly serious (87.5%), related to males (51.7%), and to adults (44.7%);moreover, the 25.5% were fatal. The disproportionality analysis showed a higher reporting frequency of some unexpected ADRs for each TKI: gait disturbance (ROR 2.86;95% CI 1.90-4.29), hyperhidrosis (2.57;1.06-6.20), and hyperammonemia (3.92;1.05-14.60) for SU;cerebrovascular accident (6.23;2.18-17.84), hemoglobin decreased (2.23;1.08-4.61), and internal haemorrhage (14.44;3.94-52.92) for RIP;gastrointestinal ulcer (10.88;2.98-39.81) for REG;hepatic and lung cancer for IM (12.79;8.04-20.37 and 7.71;3.33-17.84, respectively);hallucination (24.33;9.02-65.68), mood swings (8.02;2.44-26.33), and stress (6.68;1.93-23.11), nephrolithiasis (6.69;2.15-20.77), pollakiuria (3.08;1.17-8.13), and dialysis (6.68;1.67-26.73), sinusitis (3.34;1.14-9.78), cellulitis (4.17;1.36-12.78), and COVID-19 (7.25;3.40-15.45), chills (2.36;1.22-4.58), limb fracture (3.53;1.63-7.60), hernia (9.23;3.71-23.00), diabetes mellitus (5.02;2.11-11.95), hyposideraemia (5.02;2.11-11.95), tinnitus (3.64;1.34-9.87), parosmia (5.00;1.12-22.38), Raynaud's phenomenon (5.00;1.12-22.38), and thyroid function test abnormal (8.90;1.99-39.83) for AVA. Conclusion: This study is largely consistent with results from literature but some unexpected ADRs were shown. Further studies are necessary to increase the awareness about the safety profiles of new TKIs approved for GISTs.

Pfizer-BioNTech COVID-19 Vaccine Associated Risk of Olfactory Hallucinations-Signal Review: An International Journal of Medical Toxicology and Drug Experience

Introduction: Pfizer-BioNTech Covid-19 vaccine is highly purified single-stranded messenger RNA (mRNA) produced using a cell-free in vitro transcription from the corresponding DNA templates indicated for preventing coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1]. Olfactory hallucination is a condition in which a person perceives odors that aren't present. Some might notice the odor in just one nostril, while others have it in both [2]. Objective: The purpose of this review is to assess the risk of olfactory hallucinations from the Pfizer-BioNTech Covid-19 vaccine and, if necessary, make regulatory recommendations. Methods: The Signal Detection (SD) team at SFDA performed a signal review using the National Pharmacovigilance Center (NPC) database and World WHO database, VigiBase, with literature screening to retrieve all related information to assess the causality between olfactory hallucinations and Pfizer-BioNTech Covid-19 vaccine use. The search was conducted on January 4th, 2022. The disproportionality of the observed and the expected reporting rates for drug/adverse drug reaction pair was estimated using an information component (IC), a tool developed by WHO-UMC to measure the reporting ratio. Positive IC reflects higher statistical association, while negative values indicate less statistical association. Results: Local Cases: The SD team at SFDA has searched the NPC database for individual case safety reports (ICSR) reporting olfactory hallucinations in association with the Pfizer-BioNTech COVID-19 vaccine. The search resulted in one ISCR and, on the basis of WHO-UMC causality assessment criteria, olfactory hallucinations were considered probably associated with the vaccine. Global Cases: A search was conducted in the WHO database (Vigibase) to retrieve all reported cases using a signal detection tool (Vigilyze) [3]. The search yielded 59 ICSRs. The signal detection team applied the WHO-UMC causality assessment tool on cases with a completeness score of (0.8) and above (n = 13). 11 cases were found supportive of the association, with 10 being probable and one being possible. Literature: Late November 2021, a case report of a 57-year-old woman seeking medical care after complaining of "smelling smoke" after receiving her second dose of the vaccine was published [4]. Datamining: The results of (IC = 1.9) revealed a positive statistical association for the vaccine/ADR combination. Conclusion: The weighted cumulative evidence identified from local and global cases is sufficient to suggest a causal association between the Pfizer-BioNTech COVID-19 vaccine and olfactory hallucinations. While a more thorough review of safety data is needed to confirm the risk, health care professionals should be aware of the risk that could happen after vaccination.

Psychoneurotic symptoms among COVID infected patients;case series study

Introduction: After the initial COVID-19 outbreaks, caused by the SARS-CoV-2 virus, prolonged multiple post-infectious symptoms have continued to develop. Those who initially recovered from SARSCoV- 2 virus continue to experience a worsening life quality and a delayed return to work, which leads to great burden on the health care system. Up to date research reveals that psychiatric illness is both a risk factor for, and consequence of, COVID-19. The aim of this study is to describe the psychoneurotic symptoms among COVID infected patients. Patients and methods: A case series study of 101 patients infected with COVID virus of different severity of the disease in Tikrit city during 2020-2022. The patients were followed for 3 months. Information regarding age, gender other diseases, signs and symptoms, and psychoneurotic symptoms also were documented. Lung involvement percentage was assessed by CT. The SPO2% was reported for the patient at resting sitting position. The blood fasting sugar was tested;for all patients diastolic and systolic blood pressure were examined. Results: The reported cases with neuropsychiatric symptoms was 101. Case sleeplessness was reported among 60 (59%), tremor among 31(31%), and hallucination was reported among 10 (10%). The auditory hallucinations were reported among 4(40%), olfactory hallucinations reported among 5(50%), and visual hallucinations among 1(10%). Males were more affected than females regarding hallucinations 7(70%), and 3(30%) respectively, and tremor 17(54.8%), 14(45.2%). Sleeplessness was higher among females than males, 33(55%), 27(45%) respectively. The age groups 21-30 years and ≥ 61 years had the highest percentages of hallucination 3(30%), 3(30%), while age group 31-40 years had the higher percentage of sleeplessness 16(26.7%) and tremor was high among those aged ≥ 61 years, 11(35.5%). These relations were statistically significant. Conclusions: Neuropsychiatric symptoms were reported as follows;sleeplessness, tremor, and hallucination. Hallucinations mainly affected males, while tremor and sleeplessness mainly occured in females. The patients who had hallucinations had high lung involvement measured by CT of the chest. The patients eho had hyperglycemia had higher percentages of sleeplessness, and hallucinations. COVID 19 vaccinated persons had lower percentages of sleeplessness, hallucinations and tremor. [ FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Prevalence and risk factors of self-reported psychotic experiences among high school and college students: A systematic review, meta-analysis, and meta-regression.

BACKGROUND: Adolescents are at high risk of incident psychopathology. Fleeting psychotic experiences (PEs) that emerge in young people in response to stress may be warning signs that are missed by research that fails to study stressed populations, such as late high school and college/university students. Our aim in this systematic review was to conduct a meta-analysis that estimates prevalence rates of PEs in students, and to assess whether these rates differ by gender, age, culture, and COVID-19 exposure. METHOD: We searched nine electronic databases, from their inception until January 31, 2022 for relevant studies. We pooled the estimates using the DerSimonian-Laird technique and random-effects meta-analysis. Our main outcome was the prevalence of self-reported PEs in high school and college/university students. We subsequently analyzed our data by age, gender, population, country, culture, evaluation tool, and COVID-19 exposure. RESULTS: Out of 486 studies retrieved, a total of 59 independent studies met inclusion criteria reporting 210' 024 students from 21 different countries. Nearly one in four students (23.31%; 95% CI 18.41%-29.05%), reported having experienced PEs (heterogeneity [Q = 22,698.23 (62), p = 0.001] τ2  = 1.4418 [1.0415-2.1391], τ = 1.2007 [1.0205-1.4626], I2  = 99.7%, H = 19.13 [18.59-19.69]). The 95% prediction intervals were 04.01%-68.85%. Subgroup analyses showed that the pooled prevalence differed significantly by population, culture, and COVID-19 exposure. CONCLUSION: This meta-analysis revealed high prevalence rates of self-reported PEs among teen and young adult students, which may have significance for mental health screening in school settings. An important realization is that PEs may have very different mental health meaning in different cultures.

[COVID-19 with strange hallucinations and focal EEG abnormalities: Two case reports]. / Két Covid-19-beteg különös hallucinációkkal és fokális EEG-eltérésekkel.

Scientific literature about the ongoing COVID-19 disease and pandemic is considerable, though articles concentrate on the severe cases and their central nervous system manifestations. This article demonstrates two cases: middle-aged female patients who had serologically proven SARS-CoV-2 infection with mild upper airway and central nervous system symptoms. The patients reported vivid, strange, simple, and complex visual and auditory hallucinations. A characteristic element of these complex hallucinations was a talking human-shaped figure. Only three similar cases have been published; this article discusses common features of all five patients. This summary highlights that in COVID-19 cases, minor central nervous system symptoms can accompany mild or even missing upper respiratory symptoms. The cranial MRIs of the presented patients were normal, but the EEG showed focal abnormalities in localizations related to hallucinations, which emphasizes the importance of EEG in differential diagnostic procedures.