scholarly journals Altered subcortical emotional salience processing differentiates Parkinson’s patients with and without psychotic symptoms

2019 ◽  
Author(s):  
F. Knolle ◽  
S. Garofalo ◽  
R. Viviani ◽  
A. Justicia ◽  
A.O. Ermakova ◽  
...  
Keyword(s):  
Psychotic Symptoms ◽  
Top Down ◽  
Dopaminergic Drugs ◽  
Brain Responses ◽  
Schizophrenia Spectrum ◽  
Clear Explanation ◽  
History Of ◽  
Patient Groups ◽  
Aberrant Salience ◽  
Emotional Salience

ABSTRACTBackgroundCurrent research does not provide a clear explanation for why some patients with Parkinson’s Disease (PD) develop psychotic symptoms. In the field of schizophrenia research the ‘aberrant salience hypothesis’ of psychosis has been influential. According to the theory, dopaminergic dysregulation leads to the inappropriate attribution of salience to otherwise irrelevant or non-informative stimuli, allowing for the formation of hallucinations and delusions. This theory has not yet been extensively investigated in the context of psychosis in PD.MethodsWe investigated salience processing in 14 PD patients with a history of psychotic symptoms, 23 PD patients without psychotic symptoms and 19 healthy controls. All patients received dopaminergic medication. We examined emotional salience using a visual oddball fMRI paradigm (Bunzeck and Düzel, 2006) that previously has been used to investigate early stages of schizophrenia spectrum psychosis, controlling for resting cerebral blood flow as assessed with arterial spin labelling fMRI.ResultsWe found significant differences between patient groups in brain responses to emotional salience. PD patients with psychotic symptoms revealed senhanced brain responses in the striatum, the hippocampus and the amygdala compared to PD patients without psychotic symptoms. PD patients with psychotic symptoms also showed significant correlations between the levels of dopaminergic drugs they were taking and BOLD signalling, as well as psychotic symptom scores. Furthermore, our data provide a first indication for dysfunctional top-down processes, measured in a ‘jumping to conclusions’ bias.ConclusionOur study suggests that enhanced signalling in the striatum, hippocampus and amygdala together with deficient top-down cognitive regulations is associated with the development of psychotic symptoms in PD which is similar to that proposed in the ‘aberrant salience hypothesis’ of psychosis in schizophrenia.

scholarly journals M145. ALTERED SUBCORTICAL EMOTIONAL SALIENCE PROCESSING AND A ‘JUMPING TO CONCLUSIONS’ BIAS IN PARKINSON’S PATIENTS WITH PSYCHOTIC SYMPTOMS

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S190-S191
Author(s):  
Franziska Knolle ◽  
Sara Garofalo ◽  
Roberto Viviani ◽  
Anna Ermakova ◽  
Graham Murray
Keyword(s):  
Psychotic Symptoms ◽  
Limited Attention ◽  
Top Down ◽  
Dopaminergic Drugs ◽  
Jumping To Conclusions ◽  
Brain Responses ◽  
Medication Dose ◽  
Patient Groups ◽  
Aberrant Salience ◽  
Emotional Salience

Abstract Background Current research does not provide a clear explanation for why some patients with Parkinson’s Disease (PD) develop psychotic symptoms. In schizophrenia research the ‘aberrant salience hypothesis’ of psychosis has been influential in explaining the development of psychotic symptoms. The theory proposes that dopaminergic dysregulation leads to inappropriate attribution of salience to otherwise irrelevant or non-informative stimuli, facilitating the formation of hallucinations and delusions, by providing irrational explanations. However, this theory has received very limited attention in the context of PD-psychosis. Methods In the study, we investigated salience processing in 14 PD-patients with psychotic symptoms, 23 PD-patients without psychotic symptoms and 19 healthy controls. All patients received dopaminergic medication. There was no difference in the medication dose between the two patient groups. We examined emotional salience using a visual oddball fMRI paradigm that has been used to investigate early stages of schizophrenia spectrum psychosis, controlling for resting cerebral blood flow (arterial spin labelling fMRI). Furthermore, a subgroup of the two patient groups complete a behavioural ‘jumping to conclusions’ task. Results We found significant differences in brain responses to emotional salience between the two patient groups. PD-patients with psychotic symptoms revealed enhanced brain responses in the striatum, the hippocampus and the amygdala compared to patients without psychotic symptoms. PD-patients with psychotic symptoms showed significant correlations between the levels of dopaminergic drugs they were taking and BOLD signalling, as well as psychotic symptom scores. Furthermore, our data provide first indications for dysfunctional top-down processes, measured in a ‘jumping to conclusions’ bias. Discussion Our study suggests that enhanced signalling in the striatum, hippocampus and amygdala together with deficient top-down cognitive regulations is associated with the development of psychotic symptoms in PD, similarly to that proposed in the ‘aberrant salience hypothesis’ of psychosis in schizophrenia.

scholarly journals Schizophrenia and delusional disorders with onset in later life

2002 ◽  
Vol 24 (suppl 1) ◽  
pp. 81-86 ◽  
Author(s):  
Anne Hassett
Keyword(s):  
Clinical Presentation ◽  
Late Onset ◽  
Early Adulthood ◽  
Treatment Strategies ◽  
Later Life ◽  
Psychotic Symptoms ◽  
Sensory Impairment ◽  
Schizophrenia Spectrum ◽  
History Of ◽  
First Time

Schizophrenia-spectrum illness is most commonly associated with an onset in early adulthood. When non-affective psychotic symptoms emerge for the first time in later life, the clinical presentation has both similarities and differences with earlier-onset syndromes. This situation has resulted in continuing debate about the nosological status of late-onset psychosis, and whether there are particular risk factors associated with this late-life peak in incidence. Although early cognitive decline is frequently identified in these patients, studies, to date, have not established if there is a relationship with the dementing illnesses of old age. Sensory impairment, social isolation, and a family history of schizophrenia have been associated with late-onset psychosis, but appear to exert a nonspecific influence on vulnerability. While diagnostic issues remain unresolved, clinicians need to formulate treatment strategies that most appropriately address the constellation of symptoms in the clinical presentation of their psychotic elderly patients.

scholarly journals Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases

2005 ◽  
Vol 187 (6) ◽  
pp. 510-515 ◽  
Author(s):  
Mikkel Arendt ◽  
Raben Rosenberg ◽  
Leslie Foldager ◽  
Gurli Perto ◽  
Povl Munk-Jørgensen
Keyword(s):  
Psychotic Disorders ◽  
Psychotic Symptoms ◽  
Separate Analysis ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum ◽  
Central Register ◽  
Increased Risk ◽  
History Of ◽  
Spectrum Disorders ◽  
Incident Cases

BackgroundFew studies have examined samples of people with cannabis-induced psychotic symptoms.AimsTo establish whether cannabis-induced psychotic disorders are followed by development of persistent psychotic conditions, and the timing of their onset.MethodData on patients treated for cannabis-induced psychotic symptoms between 1994 and 1999 were extracted from the Danish Psychiatric Central Register. Those previously treated for any psychotic symptoms were excluded. The remaining 535 patients were followed for at least 3 years. In a separate analysis, the sample was compared with people referred for schizophrenia-spectrum disorders for the first time, but who had no history of cannabis-induced psychosis.ResultsSchizophrenia-spectrum disorders were diagnosed in 44.5% of the sample. New psychotic episodes of any type were diagnosed in 77.2%. Male gender and young age were associated with increased risk. Development of schizophrenia-spectrum disorders was often delayed, and 47.1% of patients received a diagnosis more than a year after seeking treatment for a cannabis-induced psychosis. The patients developed schizophrenia at an earlier age than people in the comparison group (males, 24.6 v. 30.7 years, females, 28.9 v. 33.1 years).ConclusionsCannabis-induced psychotic disorders are of great clinical and prognostic importance.

Effect of Marriage on Pre-existing Psychoses: A Convenient or Futile Solution for Severe Mental Disorders?

2020 ◽  
Vol 2 (3-4) ◽  
pp. 273-276
Author(s):  
Prakash B. Behere ◽  
Aniruddh P. Behere ◽  
Debolina Chowdhury ◽  
Amit B. Nagdive ◽  
Richa Yadav
Keyword(s):  
Mental Disorders ◽  
Age Of Onset ◽  
Social Stigma ◽  
Positive Family History ◽  
Mental Illnesses ◽  
Psychotic Symptoms ◽  
Antipsychotic Treatment ◽  
Contractual Relationship ◽  
History Of ◽  
Paranoid Type

Marriage can be defined as the state of being united as spouses in a consensual and contractual relationship recognized by law. The general population generally believes marriage to be a solution to mental illnesses. It can be agreed that mental disorders and marital issues have some relation. Parents of patients with psychoses expect that marriage is the solution to the illness and often approach doctors and seek validation about the success of the marriage of their mentally ill child, which is a guarantee no doctor can give in even normal circumstances. Evidence on sexual functioning in patients of psychosis is limited and needs further understanding. Studies show about 60%–70% women of the schizophrenia spectrum and illness to experience sexual difficulties. Based on available information, sexual dysfunction in population with psychosis can be attributed to a variety of psychosocial factors, ranging from the psychotic symptoms in itself to social stigma and institutionalization and also due to the antipsychotic treatment. Despite the decline in sexual activity and quality of life in general, it is very rarely addressed by both the treating doctor and by the patient themselves hence creating a lacuna in the patient’s care and availability of information regarding the illness’ pathophysiology. Patients become noncompliant with medications due to this undesirable effect and hence it requires to be given more attention during treatment. It was also found that paranoid type of schizophrenia patient had lower chances of separation than patients with other types of schizophrenia. The risk of relapse in cases with later age of onset of the disease, lower education, a positive family history of psychosis or a lower income increased more than other populations.

scholarly journals Acoustic speech markers for schizophrenia-spectrum disorders: a diagnostic and symptom-recognition tool

2021 ◽  
pp. 1-11
Author(s):  
J. N. de Boer ◽  
A. E. Voppel ◽  
S. G. Brederoo ◽  
H. G. Schnack ◽  
K. P. Truong ◽  
...  
Keyword(s):  
Negative Symptoms ◽  
Structured Interview ◽  
Diagnostic Value ◽  
Spectrum Disorder ◽  
Psychotic Symptoms ◽  
Schizophrenia Spectrum Disorders ◽  
Schizophrenia Spectrum Disorder ◽  
Speech Technology ◽  
Schizophrenia Spectrum ◽  
Spectrum Disorders

Abstract Background Clinicians routinely use impressions of speech as an element of mental status examination. In schizophrenia-spectrum disorders, descriptions of speech are used to assess the severity of psychotic symptoms. In the current study, we assessed the diagnostic value of acoustic speech parameters in schizophrenia-spectrum disorders, as well as its value in recognizing positive and negative symptoms. Methods Speech was obtained from 142 patients with a schizophrenia-spectrum disorder and 142 matched controls during a semi-structured interview on neutral topics. Patients were categorized as having predominantly positive or negative symptoms using the Positive and Negative Syndrome Scale (PANSS). Acoustic parameters were extracted with OpenSMILE, employing the extended Geneva Acoustic Minimalistic Parameter Set, which includes standardized analyses of pitch (F0), speech quality and pauses. Speech parameters were fed into a random forest algorithm with leave-ten-out cross-validation to assess their value for a schizophrenia-spectrum diagnosis, and PANSS subtype recognition. Results The machine-learning speech classifier attained an accuracy of 86.2% in classifying patients with a schizophrenia-spectrum disorder and controls on speech parameters alone. Patients with predominantly positive v. negative symptoms could be classified with an accuracy of 74.2%. Conclusions Our results show that automatically extracted speech parameters can be used to accurately classify patients with a schizophrenia-spectrum disorder and healthy controls, as well as differentiate between patients with predominantly positive v. negatives symptoms. Thus, the field of speech technology has provided a standardized, powerful tool that has high potential for clinical applications in diagnosis and differentiation, given its ease of comparison and replication across samples.

Deficits on the continuous performance test within the schizophrenia spectrum and the mediating effects of family history of schizophrenia.

2006 ◽  
Vol 115 (4) ◽  
pp. 771-778 ◽  
Author(s):  
Matthew T. Avila ◽  
Olalla Robles ◽  
L. Elliot Hong ◽  
Theresa A. Blaxton ◽  
Carol S. Myers ◽  
...  
Keyword(s):  
Family History ◽  
Performance Test ◽  
Continuous Performance Test ◽  
Continuous Performance ◽  
Mediating Effects ◽  
Schizophrenia Spectrum ◽  
History Of

scholarly journals Identification of Risk Factors to Predict the Occurrences of Relapses in Individuals with Schizophrenia Spectrum Disorder in Iran

2021 ◽  
Vol 18 (2) ◽  
pp. 546
Author(s):  
Omran Davarinejad ◽  
Tahereh Mohammadi Majd ◽  
Farzaneh Golmohammadi ◽  
Payam Mohammadi ◽  
Farnaz Radmehr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Suicide Attempts ◽  
Disease Onset ◽  
Sudden Onset ◽  
Spectrum Disorder ◽  
Therapeutic Interventions ◽  
Schizophrenia Spectrum Disorder ◽  
Schizophrenia Spectrum ◽  
History Of ◽  
Log Normal

Schizophrenia Spectrum Disorder (SSD) is a chronic psychiatric disorder with a modest treatment outcome. In addition, relapses are commonplace. Here, we sought to identify factors that predict relapse latency and frequency. To this end, we retrospectively analyzed data for individuals with SSD. Medical records of 401 individuals with SSD were analyzed (mean age: 25.51 years; 63.6% males) covering a five-year period. Univariate and multivariate Penalized Likelihood Models with Shared Log-Normal Frailty were used to determine the correlation between discharge time and relapse and to identify risk factors. A total of 683 relapses were observed in males, and 422 relapses in females. The Relapse Hazard Ratio (RHR) decreased with age (RHR = 0.99, CI: (0.98–0.998)) and with participants’ adherence to pharmacological treatment (HR = 0.71, CI: 0.58–0.86). In contrast, RHR increased with a history of suicide attempts (HR = 1.32, CI: 1.09–1.60), and a gradual compared to a sudden onset of disease (HR = 1.45, CI: 1.02–2.05). Gender was not predictive. Data indicate that preventive and therapeutic interventions may be particularly important for individuals who are younger at disease onset, have a history of suicide attempts, have experienced a gradual onset of disease, and have difficulties adhering to medication.

Dynamic networks of psychotic symptoms in adults living in precarious housing or homelessness

2021 ◽  
pp. 1-11
Author(s):  
Andrea A. Jones ◽  
Kristina M. Gicas ◽  
Sara Mostafavi ◽  
Melissa L. Woodward ◽  
Olga Leonova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Psychotic Disorder ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Dynamic Networks ◽  
Premature Mortality ◽  
Psychotic Symptoms ◽  
Network Measures ◽  
History Of ◽  
Precarious Housing

Abstract Background People living in precarious housing or homelessness have higher than expected rates of psychotic disorders, persistent psychotic symptoms, and premature mortality. Psychotic symptoms can be modeled as a complex dynamic system, allowing assessment of roles for risk factors in symptom development, persistence, and contribution to premature mortality. Method The severity of delusions, conceptual disorganization, hallucinations, suspiciousness, and unusual thought content was rated monthly over 5 years in a community sample of precariously housed/homeless adults (n = 375) in Vancouver, Canada. Multilevel vector auto-regression analysis was used to construct temporal, contemporaneous, and between-person symptom networks. Network measures were compared between participants with (n = 219) or without (n = 156) history of psychotic disorder using bootstrap and permutation analyses. Relationships between network connectivity and risk factors including homelessness, trauma, and substance dependence were estimated by multiple linear regression. The contribution of network measures to premature mortality was estimated by Cox proportional hazard models. Results Delusions and unusual thought content were central symptoms in the multilevel network. Each psychotic symptom was positively reinforcing over time, an effect most pronounced in participants with a history of psychotic disorder. Global connectivity was similar between those with and without such a history. Greater connectivity between symptoms was associated with methamphetamine dependence and past trauma exposure. Auto-regressive connectivity was associated with premature mortality in participants under age 55. Conclusions Past and current experiences contribute to the severity and dynamic relationships between psychotic symptoms. Interrupting the self-perpetuating severity of psychotic symptoms in a vulnerable group of people could contribute to reducing premature mortality.

scholarly journals An historical framework for psychiatric nosology

2009 ◽  
Vol 39 (12) ◽  
pp. 1935-1941 ◽  
Author(s):  
K. S. Kendler
Keyword(s):  
Psychiatric Illness ◽  
Theoretical Orientation ◽  
A Priori ◽  
Early History ◽  
Top Down ◽  
Species Definition ◽  
Psychiatric Nosology ◽  
Bottom Up ◽  
Starting Point ◽  
History Of

This essay, which seeks to provide an historical framework for our efforts to develop a scientific psychiatric nosology, begins by reviewing the classificatory approaches that arose in the early history of biological taxonomy. Initial attempts at species definition used top-down approaches advocated by experts and based on a few essential features of the organism chosena priori. This approach was subsequently rejected on both conceptual and practical grounds and replaced by bottom-up approaches making use of a much wider array of features. Multiple parallels exist between the beginnings of biological taxonomy and psychiatric nosology. Like biological taxonomy, psychiatric nosology largely began with ‘expert’ classifications, typically influenced by a few essential features, articulated by one or more great 19th-century diagnosticians. Like biology, psychiatry is struggling toward more soundly based bottom-up approaches using diverse illness characteristics. The underemphasized historically contingent nature of our current psychiatric classification is illustrated by recounting the history of how ‘Schneiderian’ symptoms of schizophrenia entered into DSM-III. Given these historical contingencies, it is vital that our psychiatric nosologic enterprise be cumulative. This can be best achieved through a process of epistemic iteration. If we can develop a stable consensus in our theoretical orientation toward psychiatric illness, we can apply this approach, which has one crucial virtue. Regardless of the starting point, if each iteration (or revision) improves the performance of the nosology, the eventual success of the nosologic process, to optimally reflect the complex reality of psychiatric illness, is assured.

scholarly journals Schizophrenia-spectrum psychopathology in obsessive–compulsive disorder: an empirical study

2019 ◽  
Vol 270 (8) ◽  
pp. 993-1002 ◽  
Author(s):  
Andreas Rosén Rasmussen ◽  
Julie Nordgaard ◽  
Josef Parnas
Keyword(s):  
Diagnostic Criteria ◽  
Obsessive Compulsive Disorder ◽  
Psychotic Symptoms ◽  
Main Diagnosis ◽  
Schizophrenia Spectrum Disorders ◽  
Obsessive Compulsive ◽  
Main Research ◽  
Compulsive Disorder ◽  
Diagnostic Potential ◽  
Schizophrenia Spectrum

Abstract The differential diagnosis of obsessive–compulsive disorder (OCD) and schizophrenia-spectrum disorders can be difficult. In the current diagnostic criteria, basic concepts such as obsession and delusion overlap. This study examined lifetime schizophrenia-spectrum psychopathology, including subtle schizotypal symptomatology and subjective anomalies such as self-disorders, in a sample diagnosed with OCD in a specialized setting. The study also examined the differential diagnostic potential of the classic psychopathological notions of true obsession (‘with resistance’) and pseudo-obsession. The study involved 42 outpatients diagnosed with OCD at two clinics specialized in the treatment of OCD. The patients underwent semi-structured, narrative interviews assessing a comprehensive battery of psychopathological instruments. The final lifetime research-diagnosis was based on a consensus between a senior clinical psychiatrist and an experienced research clinician. The study found that 29% of the patients fulfilled criteria of schizophrenia or another non-affective psychosis as main, lifetime DSM-5 research-diagnosis. Another 33% received a research-diagnosis of schizotypal personality disorder, 10% a research-diagnosis of major depression and 29% a main research-diagnosis of OCD. Self-disorders aggregated in the schizophrenia-spectrum groups. True obsessions had a specificity of 93% and a sensitivity of 58% for a main diagnosis of OCD. In conclusion, a high proportion of clinically diagnosed OCD patients fulfilled diagnostic criteria of a schizophrenia-spectrum disorder. The conspicuous obsessive–compulsive symptomatology may have resulted in a disregard of psychotic symptoms and other psychopathology. Furthermore, the differentiation of obsessions from related psychopathological phenomena is insufficient and a conceptual and empirical effort in this domain is required in the future.

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