From Fostering to Delusional Disorder of Filiation

Introduction: Fostering is a widespread practice in West Africa. It played an essential role in the circulation of children. The failure of its community regulation, not compensated by a legal framework, has made its practice precarious. Observation: A case study was conducted on Dior, who was hospitalised in a psychiatric ward for a delusional disorder of filiation. Dior was entrusted to her maternal grandmother and aunt at ages 2 and 9. During these fosterings, the place of the symbolic father was not substituted, causing a void that challenged her imagination. The outcome was an inscription in a genealogy where she had found herself with prestigious parents. Discussion: Fostering has strongly disrupted the family dynamics in Dior’s case. One of her options was to assume the paternal function, the use of which was perceived as a defiance or even a transgression. This same function would be a starting point of a psychosis whose filial character would only be an attempt at rectification where reality and imagination collide. Conclusion: Our study reveals the importance of stable parental figures at stake in fostering contexts, which constitute a risk factor for the development of a subsequent psychosis.

Delusional disorder with depression and history of early trauma: A case report

BACKGROUND The case report supports the recent findings regarding the correlation of posttraumatic stress disorder(PTSD)and schizophrenia.The report accomplished the following objectives:(1)To present a case of an adult female manifesting with somatic type of delusion(foul body odor)and history of PTSD;(2)To discuss the biopsychosocial factors,psychodynamics and management of the patient;and(3)To differentiate delusional disorder from schizophrenia according to recent studies.Schizophrenia and delusional disorder have certain defining features that separate the two.However,at times it may be difficult to actually classify one from the other.A psychiatrist must be able to carefully examine and assess the history of the patient,helping them share early life experiences of past traumatic events.The early past traumatic experiences and life events greatly influence the predisposition of a patient to develop schizophrenia.However,people with schizophrenia were known to underreport their trauma experience.CASE SUMMARY This is a case of a young adult female diagnosed with delusional disorder with a history of PTSD and associated depression.The patient manifested with somatic type of delusion with a fixed false belief that a foul body odor was coming from her underarms.CONCLUSION Developing a therapeutic alliance is vital in achieving therapy goals through empathy,support and warmth between the patient and physician.History of PTSD predisposes patients with schizophrenia to develop depressive disorders as a comorbidity.

Pseudocyesis, delusional pregnancy, and psychosis: The birth of a delusion

Both pseudocyesis and delusional pregnancy are said to be rare syndromes, but are reported frequently in developing countries. A distinction has been made between the two syndromes, but the line of demarcation is blurred. The aim of this paper is to review recent cases of pseudocyesis/delusional pregnancy in order to learn more about biopsychosocial antecedents. The recent world literature(2000-2014) on this subject(women only) was reviewed, making no distinction between pseudocyesis and delusional pregnancy. Eighty case histories were found, most of them originating in developing countries. Fifty patients had been given a diagnosis of psychosis, although criteria for making the diagnosis were not always clear. The psychological antecedents included ambivalence about pregnancy, relationship issues, and loss. Very frequently, pseudocyesis/delusional pregnancy occurred when a married couple was infertile and living in a pronatalist society. The infertility was attributed to the woman, which resulted in her experiencing substantial distress and discrimination. When antipsychotic medication was used to treat psychotic symptoms in these women, it led to high prolactin levels and apparent manifestations of pregnancy, such as amenorrhea and galactorrhea, thus reinforcing a false conviction of pregnancy. Developing the erroneous belief that one is pregnant is an understandable process, making the delusion of pregnancy a useful template against which to study the evolution of other, less explicable delusions.

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.

Moderators and mediators of antipsychotic response in delusional disorder:Further steps are needed

Delusional disorder(DD)has been traditionally considered a relatively rare and treatment-resistant psychotic disorder.In the last decade,increasing attention has focused on therapeutic outcomes of individuals affected by this disorder.The aim of this paper is to provide a synthesis of the literature addressing two very important questions arising from DD research:(1)For which patients with DD do antipsychotic medications work best(the moderators of response);and(2)What variables best explain the relationship between such treatments and their effectiveness(the mediators of response).We searched PubMed and Google Scholar databases for English,German,French and Spanish language papers published since 2000.We also included a few classic earlier papers addressing this topic.Variables potentially moderating antipsychotic response in DD are gender,reproductive status,age,duration of illness,the presence of comorbidity(especially psychiatric comorbidity)and its treatment,brain structure,and genetics of neurochemical receptors and drug metabolizing enzymes.Antipsychotic and hormonal blood levels during treatment,as well as functional brain changes,are potential mediating variables.Some,but not all,patients with DD benefit from antipsychotic treatment.Understanding the circumstances under which treatment works best can serve to guide optimal management.

An extremely rare case of delusional parasitosis in a chronic hepatitis C patient during pegylated interferon alpha-2b and ribavirin treatment

During treatment of chronic hepatitis C patients with interferon and ribavirin, a lot of side effects are described. Twenty-three percent to 44% of patients develop depression. A minority of patients evolve to psychosis. To the best of our knowledge, no cases of psychogenic parasitosis occurring during interferon therapy have been described in the literature. We present a 49-year-old woman who developed a delusional parasitosis during treatment with pegylated interferon alpha-2b weekly and ribavirin. She complained of seeing parasites and the larvae of fleas in her stools. This could not be confirmed by any technical examination. All the complaints disappeared after stopping pegylated interferon alpha-2b and reappeared after restarting it. She had a complete sustained viral response.

Woman diagnosed with obsessive-compulsive disorder became delusional after childbirth:A case report

BACKGROUND Obsessive-compulsive disorder(OCD)is a common mental disorder that varies greatly in manifestation and causes much distress to individuals.We describe a case in which a Chinese woman with OCD became delusional after childbirth,and discuss the possible phenomenological and psychological alterations.CASE SUMMARY A 27-year-old woman presented to the Psychiatry Department of our hospital with obsessions and compulsions.After taking medication,her symptoms were alleviated.Three years later,during her pregnancy,the obsessions returned and even progressed into paranoid delusions after childbirth.After multiple adjustments of treatment along with several fluctuations,she finally achieved remission and gained reasonable insight.CONCLUSION This case suggests that the patient with OCD appeared to move along a continuum of beliefs,and highlights the importance of effective intervention during pregnancy,which would exert a significant impact on postpartum exacerbation outcomes.

Delusional parasitosis as premotor symptom of parkinson's disease:A case report

BACKGROUND Delusional parasitosis is characterized by a false belief of being infested with parasites,insects,or worms.This illness is observed in patients with Parkinson’s disease and is usually related to dopaminergic treatment.To our knowledge,no cases of delusional parasitosis have been reported as a premotor symptom or nonmotor symptom of Parkinson’s disease.CASE SUMMARY A 75-year-old woman presented with a complaint of itching that she ascribed to the presence of insects in her skin,and she had erythematous plaques on her trunk,arms,buttocks,and face.These symptoms started two months before the visit to the hospital.She took medication,including antipsychotics,with a diagnosis of delusional parasitosis,and the delusion improved after three months.A year later,antipsychotics were discontinued,and anxiety and depression were controlled with medication.However,she complained of bradykinesia,masked face,hand tremor,and mild rigidity,and we performed fluorinated N-3-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl)nortropane positron emission tomography(PET),which showed mildly decreased DAT binding in the right anterior putamen and caudate nucleus.Parkinson’s disease was diagnosed on the basis of PET and clinical symptoms.CONCLUSION In conclusion,delusional parasitosis can be considered a non-motor sign of Parkinson’s disease along with depression,anxiety,and constipation.

Differences between delusional disorder and schizophrenia:A mini narrative review

Psychotic syndromes are divided into affective and non-affective forms.Even among the non-affective forms,substantial differences exist.The aim of this relatively brief review is to synthesize what is known about the differences between two non-affective psychoses,schizophrenia and delusional disorder(DD),with respect to clinical,epidemiological,sociodemographic,and treatment response characteristics.A PubMed literature search revealed the following:in schizophrenia,hallucinations,negative symptoms and cognitive symptoms are prominent.They are rare in DD.Compared to schizophrenia patients,individuals with DD maintain relatively good function,and their delusions are believable;many are beliefs that are widely held in the general population.Treatments are generally similar in these two forms of psychosis,with the exception that antidepressants are used more frequently in DD and,for acute treatment,effective antipsychotic doses are lower in DD than in schizophrenia.It is with the hope that the contrasts between these two conditions will aid in the provision of safe and effective treatment for both that this review has been conducted.

Prevalence of Ringing Delusion among Mobile Phone Users

The exponential application of mobile technology has led to a concern about implications of electromagnetic radiation on human health. As we are aware that mobile phone radiates EMR when users communicate to others and that time subscribers of the device are regularly exposed nearby 40% - 50% of total mobile irradiation. We analyzed the risk of "Ringing Delusion" among normal users, moderate users and heavy users when compared to low users. Although the "Ringing Delusion" has not been added in medical terminology but we found frequently such kind of symptoms among mobile phone users. "Ringing Delusion" may be considered as an imagination of ringing voice from cellular phone. The risk was also compared between urban and rural, male and female and adult and children population. The information was gathered through well designed questionnaires for cellular user’s demographic and social characteristics, adopted safety measures and calling duration. Prevalence of “Ringing Delusion” among rural users was higher than the urban users. A trend for the risk was also observed in male users in comparison to female. Study may support innovators to re-examine health effects of mobile phones.

Acute Normalization of Thyroxine Induced Hallucinations and Delusions

The association between disorders of thyroid function and psychiatric symptoms is well established. Generally, hypo-thyroidism is recognized as being able to induce psychotic symptoms. However, psychotic symptoms without affective and cognitive disturbances are rare in hyperthyroidism. We presented a patient with Graves’ disease who suffered from delusions and hallucinations without affective and cognitive disturbances following abrupt normalization of thyroid function. Furthermore, the patient was clinically and biochemically euthyroid when the psychotic symptoms developed. There was resolution of psychotic symptoms in this case. It is suggested that the abrupt change of thyroxine may cause susceptible individuals to become transient psychotic state.

The Case Against Delusional Parasitosis

The body of knowledge on delusional parasitosis incriminates ＂delusional patients＂ as having imaginary external and/or internal symptoms that feel like parasite movements, dismisses them as psychiatric cases, and confuses cause with effect. The author is critical of these arguments and believes that the symptoms of crawling and pin-pricking are genuine; just misinterpreted as parasite movements. Based on the author＇s research on over 1000 ＂delusional＂ patients since 1996 at the Parasitology Center, Inc. （PCI）, the author has established that the symptoms of crawling and pin-pricking are caused by toxicity from exposure to incompatible dental materials, implants, environmental toxins among others that alter the propagation of normal nerve impulses. The author has also observed that external parasites/organisms including springtails （Collembola）, other arthropods, bacteria, and fungi represent only opportunistic infections of skin sites compromised by the toxicity disorder involving the elimination of toxins through the skin. The author has described a new pathological disorder, Neuro-cutaneous Syndrome （NCS） primarily associated with dental toxicity to which ＂delusional parasitosis＂ and Morgellons disease cases could be assigned. The author has developed a protocol for the resolution of the symptoms of NCS cases. When followed to the letter, all symptoms of NCS, conventionally called delusional parasitosis, are invariably and irreversibly resolved; each individual＇s unique circumstances taken into account. The author is also presenting a detailed case history of an NCS patient that has recovered from her experiential personal perspective.

What Are the Current and Developing Treatments for Cotard’s Syndrome, Alice in Wonderland Syndrome, and Catatonic Schizophrenia?

Purpose: Cotard’s syndrome, Alice in Wonderland Syndrome, and Catatonia are all rare psychiatric disorders that have relatively little research regarding their treatments. The aim of this article is to highlight any gaps in knowledge regarding represented demographics in these treatment studies, and to discuss the current and upcoming treatment options. Background: This literature review explores under-researched psychiatric conditions: Cotard’s syndrome, Alice in Wonderland syndrome, and Catatonic Schizophrenia. Understanding psychiatric disorders requires basic knowledge of brain anatomy. These conditions are often result of or associated with neurological issues, such as migraines or tumors. The brain has eight lobes, two of four kinds: frontal, parietal, occipital, and temporal lobes, which all govern different functions and abilities. Frontal lobes control judgment, decision-making, personality traits, and fine motor movements. Parietal lobes interpret pain and temperature, occipital lobes handle visual stimuli, and temporal lobes enable hearing. The pre-frontal cortex is associated with high intelligence, psychotic traits, and psychosis. The Broca’s Area in the frontal lobes controls expressive language. These areas and divisions of the brain contribute to the complexity of the psychiatric disorders discussed in this review. Introduction: Cotard’s syndrome is a psychiatric disorder characterized by delusions of being dead or not having certain limbs or organs. It is believed that there is a disconnect between their fusiform face area and the amygdala, causing a lack of familiarity between one’s mind and body. Alice in Wonderland Syndrome (AIWS) is another psychiatric disorder which is characterized by visual hallucinations, such as distorted perceptions of color, size, distance, and speed. The most common symptoms include micropsia and macropsia. Catatonia/Catatonic Schizophrenia is an uncommon type of schizophrenia. This type of schizophrenia is characterized by motor rigidity, verbal rigidity, the flat effect, psychomotor retardation, waxy flexibility, and overall negative symptoms. Thus, these people may come off as emotionally detached, and able to stay frozen in odd positions for periods on end. Treatments and Results: Cotard’s syndrome seemed to be most effectively treated by ECT (electroconvulsive therapy). Alice in Wonderland Syndrome (AIWS) had the highest positive responses to treatment by Valproate (an anti-epileptic drug), as well as intervention to treat the associated neurological conditions they had. Catatonia/Catatonic Schizophrenia seemed to be most effectively treated with a combination of benzodiazepines and ECT. Discussion and Demographics: In all 3 disorders, the Latino and African communities were underrepresented. There also seemed to be an underrepresentation of men in Cotard’s syndrome, and of women in Alice in Wonderland Syndrome. Japan and India seemed to have the highest density of treatment studies in all 3 disorders.

Hydroxytryptamine transporter gene-linked polymorphic region(5HTTLPR)is associated with delusions in Alzheimer’s disease

Background:Serotoninergic pathways underlying delusion symptoms in Alzheimer’s disease(AD)have not been fully clarified.5-Hydroxytryptamine transporter gene-linked polymorphic region(5-HTTLPR)is a variable number tandem repeats in the promoter region of serotonin transporter encoding-gene affecting transcription.Methods:We investigated the association of 5-HTTLPR with delusions in a total of 257 consecutive patients clinically diagnosed as AD according to the National Institute on Aging-Alzheimer’s Association criteria.All participants underwent a comprehensive evaluation with a standardized comprehensive geriatric assessment and Neuropsychiatric Inventory.Results:Delusion symptoms were observed in 171 patients(66.54%).In respect to AD patients without delusions,AD patients with delusions showed a low prevalence of S-plus carriers(5-HTTLPR-L/S+5-HTTLPR-S/S genotypes)[p<0.001;odds ratio(OR)=0.240,95% confidence interval(CI)=0.121–0.471].Logistic regression analysis adjusted for the apolipoprotein E polymorphism showed that in AD patients with delusions the presence of an 5-HTTLPR-S allele may reduce disease duration(p=0.005;OR=0.680,95% CI=0.522–0.886)and increase aberrant motor activity(p=0.013;OR=2.257,95% CI=1.195–4.260).The present findings suggested that 5-HTTLPR might be associated with delusions in AD.S-plus carriers might be associated with protective effect against delusions in AD.Conclusions:More studies on wider samples of high selected demented patients are needed to confirm our results.However,the present findings suggested that a genetic factor related to serotonin metabolism might exert a protective role on the clinical expression of neuropsychiatric clusters in AD with important implications regarding mechanisms underlying delusions and their possible treatment across the AD and dementia spectrum.

内囊前肢毁损术治疗妄想性障碍1例

妄想性障碍临床相对少见。在妄想症状的影响下,病人常不认为自己有病,因此治疗依从性较差,成为临床治疗的难点。本文报道1例18年病史的34岁男性妄想性障碍,曾多次就诊于外院精神科,曾口服帕罗西汀、富马酸喹硫平、氯硝西泮等药物,均以“病人认为药物不对症、有副作用”等原因不能坚持服药,症状持续无缓解,社会功能严重受损致中学辍学,长期由家人照看。就诊我院后,经取得病人家属充分知情同意,行双侧内囊前肢毁损术,病人妄想、强迫症状完全消失,焦虑情绪及睡眠明显改善。

Delusional Beliefs, Two-Factor Theories, and Bizarreness

In order to explain delusional beliefs, one must first consider what factors should be included in a theory of delusion. Unlike a one-factor theory, a two-factor theory of delusion argues that not only anomalous experience （the first factor） but also an impairment of the belief-evaluation system （the second factor） is required. Recently, two-factor theorists have adopted various Bayesian approaches in order to give a more accurate description of delusion formation. By reviewing the progression from a one-factor theory to a two-factor theory, I argue that in light of the second factor＇s requirements, different proposed impairments can be unified within a consistent belief-evaluation system. Under this interpretation of the second factor, I further argue that the role of a mechanism responsible for detecting bizarreness is wrongly neglected. I conclude that the second factor is a compound system which consists of differing functional parts, one of which functions to detect bizarreness in different stages of delusion; moreover, I hold that the impairment can be one or several of these functional parts.

A Rare Form of Major Self-mutilation in a Patient with Delusional Disorder

Self-mutilation is defined as the intentional,direct injuring of body tissue without suicidal intent.In this article we report the case of a 45-year-old male who presented to the emergency department with a history of incising his abdomen and chopping his intestines into pieces.The patient also brought the chopped pieces along with himself.He was operated on,and a resection and anastomosis was done.Postoperative recovery of the patient was uneventful.After a psychiatric assessment was done,it was found that he was suffering from delusional disorder.Owing to such rare presentation of major self-mutilation in a patient with delusional disorder,this case is being reported here.

The Relationship between Exercise and Psychotic Symptoms in College Students: A Cross-Sectional Analysis

An increasing number of studies have suggested that increased physical activity is associated with less mental illness.However,the relationship between exercise and psychotic experiences(PEs)is still unknown.The purpose of this study was to explore the relationship between exercise and PEs in college students in the United States.Data from the Health Mind Survey(2020–2021 round)were analyzed.Respondents included 137,916 college students who were asked about exercise and PEs(lifetime psychotic experiences,delusions,and hallucinations).A multivariate logistic regression analysis was used to investigate the relationship between exercise and PEs while controlling for demographic characteristics.There was a significant correlation between exercise and PEs among college students.Compared to students who exercised less than one hour per week,students who exercisedfive or more hours per week had fewer lifetime psychotic experiences.This samefinding obtained for both male and female college students.Thefindings from the present study indicate that exercising forfive or more hours each week is most correlated with decreased PEs among college students.However,experimental studies are required to extend and confirm ourfindings and determine the causality of this relationship.

“Too Soon on Earth”: A Biophilosophical Model of Schizophrenia. Some Implications for Humanoid Robots

This paper presents a new explanatory model for schizophrenia based upon philosophical, molecular and neurobiological hypotheses as well as on years of experience in observing and treating these patients. To start with, a novel interpretation of the Hegelian concept of mediation is presented. Mediation is defined as the rejection of non-realizable programs, such as thoughts and ideas, at a certain point in time in the evolution of a living system. Whenever a system treats non-realizable programs as if they were realizable, its ability to “test the reality” is lost, and consequently a loss of ego-boundaries may occur. On the molecular level, I will try to show how “non-splicing” of introns during the mRNA splicing process is equivalent to a loss of the rejection function corresponding to mediation. At the cellular level in the brain, mediation can be explained in terms of glial-neuronal interactions. Glia exert a spatio-temporal boundary setting function determining the grouping of neurons into functional units. Mutations in genes that result in non-splicing of introns can produce truncated (“chimeric”) neurotransmitter receptors. I propose that such dysfunctional receptors are generated in glial cells and that they cannot interact properly with their cognate neurotransmitters. The glia will then lose their inhibitory-rejecting function with respect to the information processing within neuronal networks. This loss of glial boundary setting could be an explanation for the loss of ego or body boundaries in schizophrenia. Pertinent examples of case studies are given attempting to deduce the main symptoms of schizophrenia from the proposed hypothesis. Some implications for the design of delusional robots are also discussed. Finally, the evolutionary potency of non-coding introns is philosophically interpreted that schizophrenics may be “too soon on earth”.

迟发性运动障碍的治疗

迟发性运动障碍的治疗翟金国，郑先振ｌ．ＣＯＭＰＡＲＩＳＯＮＯＦＵＳＩＮＧＴＲＩＭ－ＩＰＲＡＭＩＮＥＡＮＤＡＭＩＴＲＩＰＴＹＬＩＮＥＷＩＴＨＰＥＲＰＨＥＮＡＺＩＮＥＦＯＲＴＨＥＴＲＥＡＴＭＥＮＴＯＦＤＥＬＵＳＩＯＮＡＬＤＥＰＲＥＳＳＩＯＮｂｙＺａｉＪｉ...