Differential diagnosis of obsessive-compulsive symptoms from delusions in schizophrenia: A phenomenological approach

Several studies suggest increased prevalence-rates of obsessive-compulsive symptoms(OCS) and even of obsessive-compulsive disorder(OCD) in patients with schizophrenic disorders. Moreover, it has been recently proposed the existence of a distinct diagnostic subgroup of schizo-obsessive disorder. However, the further investigation of the OCS or OCD-schizophrenia diagnostic comorbidity presupposes the accurate clinical differential diagnosis of obsessions and compulsions from delusions and repetitive delusional behaviours, respectively. In turn, this could be facilitated by a careful comparative examination of the phenomenological features of typical obsessions/compulsions and delusions/repetitive delusional behaviours, respectively. Thiswas precisely the primary aim of the present investigation. Our examination included seven features of obsessions/delusions(source of origin and sense of ownership of the thought, conviction, consistency with one's belief-system, awareness of its inaccuracy, awareness of its symptomatic nature, resistance, and emotional impact) and five features of repetitive behaviours(aim of repetitive behaviours, awareness of their inappropriateness, awareness of their symptomatic nature, and their immediate effect on underlying thought, and their emotional impact). Several of these clinical features, if properly and empathically investigated, can help discriminate obsessions and compulsive rituals from delusions and delusional repetitive behaviours, respectively, in patients with schizophrenic disorders. We comment on the results of our examination as well as on those of another recent similar investigation. Moreover, we also address several still controversial issues, such as the nature of insight, the diagnostic status of poor insight in OCD, the conceptualization and differential diagnosis of compulsions from other categories of repetitive behaviours, as well as the diagnostic weight assigned to compulsions in contemporary psychiatric diagnostic systems. We stress the importance of the feature of mental reflexivity for understanding the nature of insight and the ambiguous diagnostic status of poor insight in OCD which may be either a marker of the chronicity of obsessions, or a marker of their delusionality. Furthermore, we criticize two major shortcomings of contemporary psychiatric diagnostic systems(DSM-IV, DSM-V, ICD-10) in their criteria or guidelines for the diagnosis of OCD or OCS: first, the diagnostic parity between obsessions and compulsions and, second, the inadequate conceptualization of compulsions. We argue that these shortcomings might artificially inflate the clinical prevalence of OC symptoms in the course of schizophrenic disorders. Still, contrary to a recent proposal, we do not exclude on purely a priori grounds the possibility of a concurrence of genuine obsessions along with delusions in patients with schizophrenia.

Gut microbiome in alcohol use disorder:Implications for health outcomes and therapeutic strategies-a literature review

Alcohol use disorder(AUD)represents a major public health issue which affects millions of people globally and consist a chronic relapsing condition associated with substantial morbidity and mortality.The gut microbiome plays a crucial role in maintaining overall health and has emerged as a significant contributor to the pathophysiology of various psychiatric disorders.Recent evidence suggests that the gut microbiome is intimately linked to the development and progression of AUD,with alcohol consumption directly impacting its composition and function.This review article aims to explore the intricate relationship between the gut microbiome and AUD,focusing on the implications for mental health outcomes and potential therapeutic strategies.We discuss the bidirectional communication between the gut microbiome and the brain,highlighting the role of microbiotaderived metabolites in neuroinflammation,neurotransmission,and mood regulation.Furthermore,we examine the influence of AUD-related factors,such as alcohol-induced gut dysbiosis and increased intestinal permeability,on mental health outcomes.Finally,we explore emerging therapeutic avenues targeting the gut microbiome in the management of AUD,including prebiotics,probiotics,and fecal microbiota transplantation.Understanding the complex interplay between the gut microbiome and AUD holds promise for developing novel interventions that could improve mental health outcomes in individuals with AUD.

Electroconvulsive therapy:80 years old and still going strong

Electroconvulsive therapy(ECT),which is among the oldest and most controversial treatments in the field of psychiatry,has its 80th birthday this year.In this brief historical overview,the discovery of the therapeutic effects of convulsive therapy by LaszlóMeduna,and the circumstances that motivated Ugo Cerletti and Lucio Bini to use electricity as a means of seizure induction are described.Meduna’s original theory about the antagonism between epilepsy and schizophrenia has been replaced by hypotheses on the mechanism of action of ECT.The position of ECT in modern psychiatry is also discussed with special attention to its most important clinical indications,including catatonia,and preand postpartum affective and psychotic states that are responsive to ECT and in which ECT may even be lifesaving.Adverse effects and comparison of ECT with recently developed brain stimulation methods are also reviewed.The negative media portrayal of ECT and its earlier misuse may have contributed to its negative professional and public perceptions indicated repeatedly in attitude surveys.This negative attitude has played an important role in the decreasing use of ECT in the developed world and a reduction in access to ECT,which constitutes a violation of psychiatric patients’right to an effective treatment.

Dysmorphic Concern Questionnaire: Greek Translation, Validation and Psychometric Properties

Aim of this study is to assess the reliability, validity and psychometric properties of the Greek language version of the Dysmorphic Concern Questionnaire (DCQ). Method: The Greek language version of the DCQ scale was presented to 88 healthy individuals (57 women and 31 men) and 32 subjects suffering from body dysmorphic disorder BDD (20 women and 12 men) matched for age and sex. All the BDD group subjects and 57 subjects from the healthy individual group were also assessed according to the following psychometric scales: Symptom Checklist-90-R (SCL-90) scale, Eysenck Personality Questionnaire (EPQ), State-Trait Anxiety Inventory (STAI 1 and STAI-2) and the Zung Self-Rating Depression scales. Results: Regarding the DCQ scale, the analysis revealed that one single factor was extracted that accounted for 71.4% of the total variance. Cronbach’s alpha was 0.933, indicating a high level of internal consistency. Comparison between groups, healthy individuals vs BDD patients, showed statistically significant differences in almost every item of the SCL-90 scale (p < 0.05). The Spearman correlations of DCQ score, the DCQ factor score and DCQ T factor with SCL-90, EPQ, as well as the ZUNG depressive scales present high correlation with most items of SCL-90 and ZUNG and STAI-2 (p < 0.005). Conclusion: The Greek version of the Dysmorphic Concern Questionnaire (DCQ) is a valid and reliable instrument, appropriate for both research and clinical settings where dysmorphic concern or body image is a variable which needs to be measured or screened for.