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To examine clinical and sociodemographic differences between patients with delusional disorder; with and without diagnoses of an additional severe mental disorder (SMD) or cognitive impairment. Population-based study including all individuals diagnosed with DD between 2005 and 2021 from a large catchment area in Madrid, Spain. Sociodemographic and clinical characteristics and the antipsychotic prescription patterns of the study population was described. Patients were divided into (i) patients with DD and no additional diagnosis of SMD or cognitive impairment (DD group), (ii) patients with DD and a diagnosis of an additional SMD (DD-SMD group), and (iii) patients with DD and cognitive impairment (DD-CI group). Of 1109 patients with a DD diagnosis (62.5 % female), 131 (11.8 %) patients were diagnosed with an additional SMD, and 69 (6.2 %) were diagnosed with cognitive impairment. DD-SMD patients were on average 10 years younger and had longer time between first mental healthcare contact and DD disorder than DD patients. DD-CI patients were on average 10 years older and had a higher proportion of females. Paliperidone (21.9 %) and aripiprazole (20.6 %) were the modal antipsychotic drugs chosen overall. DD-SMD patients were more likely to receive paliperidone and to be prescribed long-acting injectable medication; DD-CI were more likely to receive risperidone or quetiapine; and DD patients were more likely to receive olanzapine. Sociodemographic and clinical characteristics and choice of antipsychotic drug and delivery method for individuals with DD vary based on its comorbidity. [ABSTRACT FROM AUTHOR]

Paranoia is a key feature of psychosis that can be highly debilitating. Theories of paranoia mostly interface with short-scale or cross-sectional data models, leaving the longitudinal course of paranoia underspecified. We develop an empirical characterisation of two aspects of paranoia - persecutory and referential delusions - in individuals with psychosis over 20 years. We examine delusional dynamics by applying a Graphical Vector Autoregression Model to data collected from the Chicago Follow-up Study (n = 135 with a range of psychosis-spectrum diagnoses). We adjusted for age, sex, IQ, and antipsychotic use. We found that referential and persecutory delusions are central themes, supported by other primary delusions, and are strongly autoregressive – the presence of referential and persecutory delusions is predictive of their future occurrence. In a second analysis we demonstrate that social factors influence the severity of referential, but not persecutory, delusions. We suggest that persecutory delusions represent central, resistant states in the cognitive landscape, whereas referential beliefs are more flexible, offering an important window of opportunity for intervention. Our data models can be collated with prior biological, computational, and social work to contribute toward a more complete theory of paranoia and provide more time-dependent evidence for optimal treatment targets. [Display omitted] [ABSTRACT FROM AUTHOR]

The role of basic neurocognitive function in delusions is unclear despite the association to difficulties in reasoning and decision-making. We investigated 812 individuals with schizophrenia spectrum disorders (SSD) using a broad neuropsychological test battery encompassing motor and mental processing speed, working memory, learning and memory, and executive function. Premorbid and current intellectual function was assessed with NART and WASI. Delusion level and other clinical symptoms were measured with the PANSS and GAF. Hierarchical and k-means cluster analysis using standardized scores showed the presence of two separate clusters where the group with the higher delusion level (n = 291) was characterized by more severe neurocognitive deficits (>1.5 standard deviations below the healthy control mean), higher PANSS scores, lower GAF scores, and lower intelligence levels compared to the cluster with mild impairments (n = 521). We conclude that a higher delusion level is related to neurocognitive deficits across domains. Further, the validity of the two separate clusters was indicated by significant differences in clinical symptoms, everyday function, and intellectual ability. Compared to those with mild delusion levels, SSD patients with higher delusion levels seem particularly disadvantaged, with co-occurring general symptoms and lower daily function, underscoring the need for clinical and psychosocial support programs. A limitation of this study is the cross sectional design. Longitudinal studies are needed to determine the causal relationship between delusions and neurocognitive function. [ABSTRACT FROM AUTHOR]

To improve understanding of Capgras syndrome (CS) in the pediatric population, this study investigates its clinical features and discerns similarities and differences compared to CS in adults. We conducted a descriptive systematic review of case reports following PRISMA guidelines, including cases of pediatric patients with CS. Patient demographics, medical and psychiatric history, imposter identity, underlying diagnosis, clinical manifestation, treatments, and outcomes were extracted and analyzed. We included 37 articles comprising 38 cases. The median age of patients was 15, with 23 (60.5%) being male. The most prevalent underlying diagnoses were schizophrenia spectrum and other psychotic disorders (47.3%). Imposter identity involved parents in 32 cases (84.2%). Associated symptoms included persecutory delusions (63.1%), auditory hallucinations (42.1%), aggression (31.5%), and depression (21.0%). There is a significant gap in our understanding of CS, particularly in pediatric patients. This is the first systematic review of CS in pediatric patients, encompassing all cases found in English literature since 1923. [ABSTRACT FROM AUTHOR]

Hallucinations are a core feature of psychosis, and their severity during the acute phase of illness is associated with a range of poor outcomes. Various clinical and sociodemographic factors may predict hallucinations and other positive psychotic symptoms in first episode psychosis (FEP). Despite this, the precise factors associated with hallucinations at first presentation to an early intervention service have not been extensively researched. Through detailed interviews and chart reviews, we investigated sociodemographic and clinical predictors in 636 minimally-medicated patients who entered PEPP-Montréal, an early intervention service for FEP, between 2003 and 2018. Hallucinations were measured using the Scale for the Assessment of Positive Symptoms (SAPS), while negative symptoms were assessed using the Scale for the Assessment of Negative symptoms (SANS). Depressive symptoms were evaluated through the Calgary Depression Scale for Schizophrenia (CDSS), and anxiety symptoms via the Hamilton Rating Scale for Anxiety (HAS). A majority (n = 381, 59.9 %) of the sample presented with clinically significant hallucinations (SAPS global hallucinations score ≥ 3) at program entry. These patients had an earlier age at onset, fewer years of education, and a higher severity of delusions, depression and negative symptoms than those without clinical-level hallucinations. These results suggest that individuals with clinically significant hallucinations at admission tend to be younger and have a greater overall symptom burden. This makes it especially important to monitor hallucinations alongside delusions, depression and negative symptoms in order to identify who might benefit from targeted interventions. The implications of these findings for early intervention and person-centered care are discussed. [ABSTRACT FROM AUTHOR]

Schizophrenia is a complex neuropsychiatric disorder characterized by positive symptoms, negative symptoms, cognitive deficits, and co-occurring mood symptoms. Network analysis offers a novel approach to investigate the intricate relationships between these symptom dimensions, potentially informing personalized treatment strategies. A cross-sectional study was conducted from November 2019 to October 2021, involving 1285 inpatients with schizophrenia in Liaoning Province, China. Symptom severity was assessed using the Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HAMD-17), Hamilton Anxiety Rating Scale (HAMA-14), and Montreal Cognitive Assessment (MoCA). Network analysis was conducted to investigate the network structure, central symptoms, and bridge symptoms. The network analysis uncovered profound interconnectivity between core symptoms and the anxiety-depression community. Central symptoms, such as psychic anxiety, poor rapport, delusions, and attention, were identified as potential therapeutic targets. Bridge symptoms, including insomnia, depressed mood, anxiety-somatic, conceptual disorganization, and stereotyped thinking, emerged as key nodes facilitating interactions between symptom communities. The stability and reliability of the networks were confirmed through bootstrapping procedures. The findings highlight the complex interplay between schizophrenia symptoms, emphasizing the importance of targeting affective symptoms and cognitive impairment in treatment. The identification of central and bridge symptoms suggests potential pathways for personalized interventions aimed at disrupting self-reinforcing symptom cycles. The study underscores the need for a transdiagnostic, personalized approach to schizophrenia treatment. [ABSTRACT FROM AUTHOR]

Bodily self-disturbances have long been considered central to schizophrenia. Exposure to childhood trauma has been linked to the development of both psychosis and bodily self-disturbances, yet little work has examined the role of bodily self-disturbances in the relationship between childhood trauma and schizophrenia symptomatology. This study uses network analysis to bridge this gap. Networks were constructed to examine relationships between schizophrenia symptoms (Positive and Negative Symptom Scale; PANSS), bodily self-disturbances (Perceptual Aberration Scale; PAS), and self-reported exposure to childhood trauma (Childhood Trauma Questionnaire, Short-Form; CTQ-SF) in 152 people with a schizophrenia-spectrum disorder. Shortest path and bridge analyses were conducted to assess the role of bodily self-disturbances in linking childhood trauma to schizophrenia symptomatology. Three networks were constructed: 1) PAS, childhood trauma, and PANSS sub-scale composites (positive, negative, general); 2) PAS, childhood trauma, and positive symptoms, 3) PAS, childhood trauma, and distress symptoms. Shortest path analysis revealed that bodily self-disturbances were on the shortest path between childhood trauma and positive and general symptoms (Network 1), between trauma and hallucinations (Network 2), and between trauma and depression (Network 3). Bodily self-disturbances were also found to serve as a bridge between childhood trauma and positive symptoms of schizophrenia, particularly delusions and hallucinations. Using a novel, data-driven approach, we showed that bodily self-disturbances play a key role in linking childhood trauma to positive and co-morbid affective symptoms of schizophrenia. Threat experiences (i.e., abuse) specifically relate to bodily self-disturbances and psychotic symptoms. [ABSTRACT FROM AUTHOR]

Delusional thoughts such as paranoia and conspiratorial thinking reflect beliefs in others' intentions to do harm. Given the integral role of harm evaluation in moral cognition, a better understanding of how psychosis-prone individuals process others' moral characters may provide insights into social cognitive mechanisms of these types of delusions. An online sample of 293 participants was drawn from the general population, using Amazon Mechanical Turk. Participants performed a moral inference task, where they predicted and judged the binary choices of two fictitious agents ("good" or "bad") to impose harm under different levels of financial incentives. An investment game involving the same agents then examined participants' trust behavior. Psychosis-proneness was measured with the Multidimensional Schizotypy Scale Brief Edition. A set of multiple regressions showed that positive schizotypy was associated with a lower yet more confident pre-experimental expectation of the agent's moral character, lower prediction accuracy of the agent's harm preferences, less belief revision, and undifferentiated perception of the good and bad agents' characters. Positive schizotypy was also related to higher expectations for reciprocity in the investment game, regardless of agent characters. Our findings suggest that inflexible beliefs associated with psychosis-proneness extend beyond negative prior expectations, also reflecting difficulties in moral learning. The resulting undifferentiated moral impressions might contribute to undue suspicion of benevolent individuals and increased gullibility to malicious ones, potentially further strengthening conspiratorial beliefs. [ABSTRACT FROM AUTHOR]

A clear understanding of the pathophysiology of schizophrenia and related spectrum disorders has been limited by clinical heterogeneity. We investigated whether relative severity and predominance of one or more delusion subtypes might yield clinically differentiable patient profiles. Patients (N = 286) with schizophrenia spectrum disorders (SSD) completed the 21-item Peters et al. Delusions Inventory (PDI-21). We performed factor analysis followed by k-means clustering to identify delusion factors and patient subtypes. Patients were further assessed via the Brief Psychiatric Rating Scale, Brief Negative Symptom Scale, Digit Symbol and Digit Substitution tasks, use of cannabis and tobacco, and stressful life events. The overall patient sample clustered into subtypes corresponding to Low-Delusion, Grandiose-Predominant, Paranoid-Predominant, and Pan-Delusion patients. Paranoid-Predominant and Pan-Delusion patients showed significantly higher burden of positive symptoms, while Low-Delusion patients showed the highest burden of negative symptoms. The Paranoia delusion factor score showed a positive association with Digit Symbol and Digit Substitution tasks in the overall sample, and the Paranoid-Predominant subtype exhibited the best performance on both tasks. Grandiose-Predominant patients showed significantly higher tobacco smoking severity than other subtypes, while Paranoid-Predominant patients were significantly more likely to have a lifetime diagnosis of Cannabis Use Disorder. We suggest that delusion self-report inventories such as the PDI-21 may be of utility in identifying sub-syndromes in SSD. From the current study, a Paranoid-Predominant form may be most distinctive, with features including less cognitive impairment and a stronger association with cannabis use. [ABSTRACT FROM AUTHOR]

Religiosity is a multidimensional construct known to influence the occurrence of hallucinations. However, it remains unknown how different religiosity types affect clinically relevant phenomenological features of hallucinations. Therefore, we wished to explore associations between intrinsic and extrinsic (non-organizational and organizational) religiosity and hallucinations severity, distress or impact on daily function in a non-clinical Muslim population. We recruited a representative sample of full-time students at Qatar's only national university via systematic random sampling and administered the Questionnaire of Psychotic Experiences online. The study design was cross-sectional. Using structural equation modeling, we estimated effects of the religiosity types on hallucinations severity, distress or impact on daily function in the past week while accounting for sociodemographic variables, anxiety, depressive symptoms, and, delusions. Extrinsic non-organizational religiosity (ENORG) was associated with experiencing reduced distress or impact on daily function from hallucinations both directly and indirectly through intrinsic religiosity. In contrast, extrinsic non-organizational religiosity (EORG) was associated with increased hallucinations distress or impact albeit only through higher intrinsic religiosity. We found no association between any religiosity types and hallucinations severity. Younger and married participants from lower socio-economic class had comparatively more severe hallucinations and more distress from them. Qatari nationality was positively associated EORG and negatively associated with hallucinations distress or impact. Evidence of differential associations between the religiosity types, socioeconomic and cultural groups, and distress or impact from past week's hallucinations supports the importance of alignment between religious, mental health, and well-being education. [ABSTRACT FROM AUTHOR]

The co-occurrence of delusions and other symptoms at the onset of psychosis is a challenge for theories about the aetiology of psychosis. This paper explores the relatedness of delusions about the experience of thinking (thought insertion, thought withdrawal, and thought broadcasting) and auditory verbal hallucinations by describing their trajectories over a 20-year period in individuals diagnosed with schizophrenia, affective and other psychosis, and unipolar depression nonpsychosis. The sample consisted of 407 participants who were recruited at index hospitalization and evaluated over six follow-ups over 20 years. The symptom structure associated with thought insertion included auditory verbal hallucinations, somatic hallucinations, other hallucinations, delusions of thought-dissemination, delusions of control, delusion of self-depreciation, depersonalization and anxiety. The symptom constellation of thought withdrawal included somatic hallucinations, other hallucinations, delusions of thought dissemination, delusions of control, sexual delusions, depersonalization, negative symptoms, depression, and anxiety. The symptom constellation of thought broadcasting included auditory verbal hallucinations, somatic hallucinations, delusions of thought-dissemination, delusion of self-depreciation, fantastic delusions, sexual delusions, and depersonalization. Auditory verbal hallucinations and delusions of self-depreciation were significantly associated with both thought insertion and thought broadcasting. Thought insertion and thought withdrawal were significantly associated with other hallucinations, delusions of control, and anxiety; thought withdrawal and thought broadcasting were significantly related to sexual delusions. We hypothesize that specific symptom constellations over time might be explained as the product of pseudo-coherent realities created to give meaning to the experience of the world and the self of individuals in psychosis based on both prior top-down and ongoing bottom-up elements. [ABSTRACT FROM AUTHOR]

Visual illusions provide a unique opportunity to understand cognitive and perceptual alterations in schizophrenia-spectrum conditions. Schizophrenia patients often exhibit increased susceptibility to the Müller-Lyer illusion. Here, we investigate susceptibility to the Müller-Lyer visual illusion in the general population with different levels of schizotypy. We assessed a population-based convenience sample (N = 263) on an online platform. In addition to basic demographics, participants completed the Müller-Lyer illusion, the Cardiff Anomalous Perceptions Scale (CAPS) to measure perceptual anomalies, and the Multidimensional Schizotypy Scale – Brief (MSS-B) for schizotypic traits. To evaluate what predicts susceptibility to the illusion, we fitted a large set of multilevel logistic regression models and performed model averaging over the coefficients. We found support for increased illusion susceptibility among individuals with high positive schizotypy. However, we did not find a comparable effect for anomalous perceptions alone, or for negative or disorganized schizotypy. The increased Müller-Lyer effect in positive schizotypy might be specific to delusion-like beliefs and magical ideation. Further research is needed to clarify how a hierarchical Bayesian formulation of brain function (e.g. imbalances between bottom-up perceptual processing and substantial reliance on prior expectations) can account for the Müller-Lyer effect in schizophrenia-spectrum conditions. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia spectrum disorder (SSD) experience disrupted temporality on the immediate timescale. However, insufficient information is available for longer time frames, and the interaction of temporal perspectives with the clinical manifestations of SSD is unknown. We explored the association between unbalanced time perspectives and symptom severity. Thirty-seven Italian mental health services participating in the DiAPAson project recruited 620 patients with DSM-5 SSD (68 % males, mean age = 41.3 ± 9.5 years). Time perspective biases were measured using the Deviation from the Balanced Time Perspective-revisited (DBTP-r) indicator, based on Zimbardo Time Perspective Inventory (ZTPI) scores. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS) and Brief Negative Symptoms Scale (BNSS). Preliminary analyses examined the associations between ZTPI/DBTP-r and BPRS/BNSS total scores. In secondary analyses, we first tested the associations between the ZTPI/DBTP-r and BPRS/BNSS subscales and then compared ZTPI differences between patients with and without hallucinations, delusions, and conceptual disorganisation. Statistical significance was set at Holm-Bonferroni corrected p < 0.05. Low-to-moderate positive correlations were found between the DBTP-r and BPRS/BNSS total scores (r = 0.29/0.22). The strongest associations were between DBTP-r/ZTPI_Past-Negative and anxiety/depression (r = 0.34/0.36), followed by DBTP-r/ZTPI_Present-Fatalistic with thought disturbances (r = 0.22/0.20). DBTP-r was associated with BNSS anhedonia and avolition (r = 0.21/0.24). DBTP-r was higher in patients with hallucinations (ES = 0.391) and conceptual disorganisation (ES = 0.397) than in those without these symptoms. Unbalanced time perspective was positively associated with the severity of primary and secondary SSD features. These findings provide a rationale for empirical tests focused on balancing time perspectives in patients with SSD. [ABSTRACT FROM AUTHOR]

Contemporary models of psychosis imply that cognitive biases such as the jumping to conclusions (JTC), the bias against disconfirmatory evidence (BADE), and the liberal acceptance (LA) bias play a role in the pathogenesis of delusions. Most of the studies investigating the role of cognitive biases, however, have been conducted with socially neutral or abstract stimuli and have assessed patients with established psychoses. For the present study, we aimed to concurrently investigate multiple biases (i.e., the JTC, BADE, and LA biases) in a community sample with a new paradigm using more socially engaging stimuli. A large sample of participants (N = 874) recruited via Amazon Mechanical Turk was subdivided into two groups based on the frequency of their psychotic-like experiences (PLEs) according to the positive subscale score of the Community Assessment of Psychic Experiences (CAPE) and matched based on major demographics variables, resulting in two equally sized groups called High-PLE (at least 2 SD above the mean) and Low-PLE (maximum 0.5 above the mean; n = 46 for each group). Using a modified version of the written-scenarios BADE task, which emphasized social interactions between agents embedded in the scenario, participants rated the plausibility of response options in the face of new information. In line with previous findings, the High-PLE group demonstrated the JTC, BADE, and LA biases. That is, the members of this group made more decisions after the initial piece of information, were less likely to revise their beliefs in light of new information, and provided higher plausibility ratings for implausible response options compared to the Low-PLE group. Results corroborate prior findings suggesting that the JTC, BADE, and LA biases may be contributing factors in delusional ideation and that metacognitive biases extend to social situations. [ABSTRACT FROM AUTHOR]

Si l'amalgame anorexie masculine/psychose qui a longtemps prévalu dans la littérature psychiatrique classique doit donc être nettement relativisé, il n'en demeure pas moins que les relations entre anorexie masculine et psychose froide, psychose mono-symptomatique ou syndrome d'influence méritent d'être explorées pour les patients développant les symptomatologies les plus chronicisées. Des similitudes et des résonnances assez surprenantes seront établies à partir de l'analyse croisée des fantasmes d'un patient souffrant d'une anorexie mentale restrictive évoluant depuis l'âge de douze ans et des écrits autobiographiques ou littéraires de Franz Kafka témoignant de la présence d'un imaginaire singulier en lien avec des préoccupations alimentaires particulièrement envahissantes. Cette étude analytique comparative des fantasmes et des fantasmorphoses en jeu dans la problématique anorexique et dans l'univers kafkaïen met en exergue le rôle majeur de ce que Tausk a pu décrire sous les termes de « machines à influencer », celles-ci trouvant leur origine dans la projection du corps propre considéré dans son entier comme organe génital. Paradoxalement, ces machines à influencer, en agissant avant tout comme agent inhibiteur de la pulsion, contribueront surtout à affaiblir la virilité des sujets. Pour cerner les motifs d'un tel rejet du pubertaire et de la génitalité, il convient d'envisager un défaut de structuration du Surmoi, en lien avec un échec de la bisexualisation de ce même Surmoi. L'une des hypothèses cliniques développées est que cet échec ou cette dislocation de l'instance surmoïque s'avère responsable de l'advenue d'un idéal du Moi mégalomaniaque et asexué. Là où Kafka aura su puiser dans cet imaginaire des ressources créatives et sublimatoires, les modalités défensives sollicitées par les patients anorexiques développant les symptomatologies les plus inquiétantes ne suffiront généralement pas à masquer totalement l'impact déréalisant des fantasmorphoses ou les sentiments d'étrangeté induits par la présence sous-jacente de ces « appareils à influencer ». Although the amalgam of male anorexia and psychosis that has long dominated classical psychiatric literature needs to be put into perspective, the relations between male anorexia and "cold" psychosis, mono-symptomatic psychosis, or delusions of passivity nevertheless warrant further exploration in cases of patients who develop the most chronic symptoms. Rather surprising similarities and echoes will be shown through the cross-analysis of the fantasies of a patient suffering from restrictive mental anorexia since the age of twelve and the autobiographical and literary writings of Franz Kafka that attest to the presence of a unique imaginary world linked to particularly invasive preoccupations with food and eating. This comparative analytical study of fantasies and fantasmorphoses involved in the issues of anorexia and in Kafka's universe highlights the important role of what Tausk described as "influencing machines," which originate in the projection of one's own body considered in its entirety as a genital organ. Paradoxically, these influencing machines, by acting primarily as inhibitors of the drives, will mainly contribute to a weakening of the subjects' virility. To identify the reasons behind this rejection of the pubertary process and genitality, we must consider that there is a defect in the structuring of the Superego, associated with a failure of bisexualization in this same Superego. One of the clinical hypotheses offered is that this failure or dislocation of the agency of the Superego is responsible for the emergence of a megalomaniacal and asexual Ego ideal. Whereas Kafka was able to draw creative and sublimatory resources from this imaginary world, the defensive modes elicited by anorexic patients who develop the most troubling symptoms will generally not be enough to completely conceal the de-realizing impact of fantasmorphoses or the uncanny feelings caused by the underlying presence of such "influencing machines." [ABSTRACT FROM AUTHOR]

Metacognition refers to appraising one's thoughts and behaviours. Deficits in metacognition are associated with psychosis-spectrum experiences, such as hallucinations and delusions, in both clinical and non-clinical populations. Assessments of metacognitive function and abilities in clinical populations often vary in administration duration, and subjectivity of scores. This study investigates associations between different measures of metacognition and their prediction of psychosis spectrum experiences using objective and self-report measures in a cross-sectional study of psychosis-spectrum disorder (PSD) participants and controls. Twenty-three individuals with PSD and forty-four controls were recruited online and completed in-the-moment objective ratings of metacognitive accuracy (meta-Dots Task), and retrospective self-report of metacognitive self-reflection (Beck Cognitive Insight Scale) and abilities (Metacognition Self-Assessment Scale). There were group differences in self-reported metacognition, with PSD participants having lower scores of metacognitive ability, but no differences in self-reflectiveness or objective metacognitive accuracy. In the PSD group, only self-reported metacognitive ability was associated with and predicted distress about, and conviction in, delusional thoughts. The findings demonstrate group differences in some self-reported, but not objective, measures of metacognition, and highlight that prediction of PSD experiences depends on the metacognitive construct being measured, and the type of measurement used. [ABSTRACT FROM AUTHOR]

Our study aimed to develop a machine learning ensemble to distinguish "at-risk mental states for psychosis" (ARMS) subjects from control individuals from the general population based on facial data extracted from video-recordings. 58 non-help-seeking medication-naïve ARMS and 70 healthy subjects were screened from a general population sample. At-risk status was assessed with the Structured Interview for Prodromal Syndromes (SIPS), and "Subject's Overview" section was filmed (5–10 min). Several features were extracted, e.g., eye and mouth aspect ratio, Euler angles, coordinates from 51 facial landmarks. This elicited 649 facial features, which were further selected using Gradient Boosting Machines (AdaBoost combined with Random Forests). Data was split in 70/30 for training, and Monte Carlo cross validation was used. Final model reached 83 % of mean F1-score, and balanced accuracy of 85 %. Mean area under the curve for the receiver operator curve classifier was 93 %. Convergent validity testing showed that two features included in the model were significantly correlated with Avolition (SIPS N2 item) and expression of emotion (SIPS N3 item). Our model capitalized on short video-recordings from individuals recruited from the general population, effectively distinguishing between ARMS and controls. Results are encouraging for large-screening purposes in low-resource settings. [ABSTRACT FROM AUTHOR]

COVID-19 conspiracy theories have become widespread since the onset of the pandemic and compound the existing challenges of decisional capacity assessment. This paper aims to review the literature pertaining to decisional capacity assessment in the context of COVID-19 conspiracy beliefs and synthesize a practical approach with an emphasis on differential diagnosis and clinical pearls for the practicing physician. We reviewed papers on decisional capacity assessment and differential diagnosis in the context of COVID-19 conspiracy beliefs. A literature search was conducted using the US National Library of Medicine's PubMed.gov resource and Google Scholar. The resulting article content was utilized to synthesize a practical approach to decisional capacity assessment in the context of COVID-19 conspiracy beliefs. Specifically, aspects related to the history, taxonomy, evaluation, and management are reviewed. Appreciating the nuanced differences between delusions, overvalued ideas, and obsessions while with integrating the non-cognitive domains of capacity into the assessment are crucial to navigating the wide differential diagnosis of COVID-19 conspiracy beliefs. It is important to attempt to clarify and optimize patient decision-making abilities by addressing circumstances, attitudes, and cognitive styles specific to patients with seemingly irrational beliefs about COVID-19. [ABSTRACT FROM AUTHOR]

Ocular microtremor (OMT) is a high frequency tremor of the eyes. The mean OMT peak count frequency in the normal population is 87 Hz. It is an activity which originates in the brainstem. Parameters of eye movements between saccades go beyond the resolution of the most popular modern video recording means. We used high-speed video recording of eye microtremor. The working hypothesis of the study is that the eye tremor indicators are objective and adequate indicators of the functional state (FS) of a person. We received data on the changes in the frequency and amplitude of tremor in schizophrenia and patients with hallucinatory and delusional disorder. [ABSTRACT FROM AUTHOR]

Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention. [ABSTRACT FROM AUTHOR]

Reasoning biases have been suggested as risk factors for delusional ideation in both patients and non-clinical individuals. Still, it is unclear how these biases are longitudinally related to delusions in the general population. We hence aimed to investigate longitudinal associations between reasoning biases and delusional ideation in the general population. We conducted an online cohort study with 1184 adults from the German and Swiss general population. Participants completed measures on reasoning biases (jumping-to-conclusion bias [JTC], liberal acceptance bias [LA], bias against disconfirmatory evidence [BADE], possibility of being mistaken [PM]) and delusional ideation at baseline, and delusional ideation 7 to 8 months later. A greater JTC bias was associated with a greater increase in delusional ideation over the following months. This association was better described by a positive quadratic relationship. Neither BADE, LA nor PM were associated with subsequent changes in delusional ideation. This study suggests that jumping-to-conclusions predicts delusional ideation in the general population but that this association may follow a quadratic trajectory. While no other associations turned significant, future studies with shorter temporal distances may shed further light on the role of reasoning biases as risk factors for delusional ideation in non-clinical samples. [ABSTRACT FROM AUTHOR]

Multiple different cognitive biases, among them the liberal acceptance (LA) bias, have been suggested to contribute to reality distortion in psychotic disorders. Earlier studies have been cross-sectional and considered a limited set of cognitive correlates of psychosis, thus the relationship between LA bias and psychosis remains poorly known. We studied a similar bias (acceptance of the implausible (AOI)) in 62 first-episode psychosis (FEP) patients and 62 control subjects, who watched movie scenes with varying degrees of realism and were asked to evaluate the probability of these events occurring in real life. We assessed theory of mind (ToM) performance using the Hinting task and delusion severity using Brief Psychiatric Rating Scale item 11. We correlated the magnitude of AOI with the severity of delusions and performance in the ToM task. Furthermore, we used 1-year follow-up data from 40 FEP patients and 40 control subjects to disentangle state vs trait-like characteristics of AOI. At baseline FEP patients expressed more AOI than control subjects, and the magnitude of AOI correlated positively with the severity of delusions and negatively with ToM performance. At the one-year follow-up, when most patients were in remission, patients still displayed increased AOI, which no longer correlated with delusions. These findings support the notion that the AOI bias could represent a trait rather than a state feature and support further studies to test the hypothesis that it could be one of the causal factors of psychotic disorders, possibly associated with ToM. [ABSTRACT FROM AUTHOR]

In 1874, the German neuropsychiatrist Richard von Krafft-Ebing (RKE) published one of the most influential monographs on melancholia in the latter half of the 19th century entitled "Melancholia: A Clinical Study." This monograph has not been translated into English nor extensively discussed in the modern Anglophonic literature. The monograph has three chapters describing, respectively, Melancholia without Delusions, Melancholia with precordial anxiety and Psychotic Melancholia. The last chapter includes a discussion of retarded and agitated forms of melancholia. The text combines detailed vivid clinical descriptions with etiologic theories involving mental, brain and autonomic processes. RKE supports the psychalgic theory of melancholia in which, analogous to Tic Douloureux causing terrible pain to a normal touch, brain ganglia became hypersensitive and create a sustained mental pain in response to normal intrapsychic or environmental stimuli. RKE was especially interested in the development of delusions in melancholia, for which he proposed several distinct pathways. His clinical description of melancholia, including 8 of 9 DSM-5 A criteria for major depression, is quite modern. This essay, accompanied by an on-line complete English translation of RKE's essay, provides the opportunity for Anglophonic clinicians, students, and scholars to access this historically important essay on Melancholia. The psychophysiological framework of psychalgia adopted by RKE could explained how normal social and introspective experiences would, in melancholic patients, be interpreted in a distorted manner, reinforcing themes of inadequacy, failure, and worthlessness, thereby producing a sustained mood state of intense mental pain of melancholia or psychalgia. • In 1874, Richard Krafft-Ebing wrote a major monograph on melancholia. • This monograph contained 3 chapters and 10 case histories. • It provides an overview of the symptoms, signs and causes of melancholia. [ABSTRACT FROM AUTHOR]

Impaired insight into delusions is associated with a lower probability of remission of psychotic depression, independent of illness severity. The relationship between participant characteristics and impaired insight into delusions in remitted psychotic depression, and whether impaired insight is associated with risk of relapse of psychotic depression during continuation pharmacotherapy were examined. Data were analyzed from 126 participants in the STOP-PD II study who experienced sustained remission of psychotic depression during 8-week stabilization treatment with sertraline plus olanzapine and were then randomized to 36 weeks of continuation treatment with sertraline plus either olanzapine or placebo. Insight into delusions was assessed with the Resolution of Delusions Scale (RODS). Linear regression analyses examined the associations between participant characteristics and insight into delusions. Cox proportional-hazards models examined whether i) change in RODS during stabilization treatment; or ii) RODS at the end of stabilization treatment predicted risk of relapse during 36 weeks of continuation treatment. Severity of psychosis before initiation of treatment was the only participant characteristic associated with the change in insight during stabilization treatment. Neither change in insight during stabilization treatment nor insight at the end of stabilization treatment was associated with risk of relapse. Insufficient statistical power and the lack of variability in RODS scores at the time of randomization may have contributed to the absence of a relationship between RODS and risk of relapse. Residual or reemergent insight impairment following acute treatment does not preclude patients from sustaining remission of psychotic depression in a randomized placebo-controlled trial. • Impaired insight into delusions in remitted psychotic depression was not associated with risk of relapse of the disorder. • Inability to gain full insight into a remitted delusion may not preclude patients from sustained remission of psychotic depression. • This finding can be reassuring for clinicians, patients, and caregivers. [ABSTRACT FROM AUTHOR]

• First study examining self-structure in persecutory delusions using the card sort task. • First study examining whether mindfulness changes self-structure in any clinical group. • Self-structure differed between people with persecutory delusions and healthy controls. • There was no association between self-structure and delusion symptom severity. • Mindfulness therapy changed self-structure with medium-large effect sizes. There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes. In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control. In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking. [ABSTRACT FROM AUTHOR]

Participants with schizophrenia (SCZ) and bipolar disorder (BD) have challenges in self-evaluation of their cognitive and functional abilities, referred to as introspective accuracy (IA). Although psychotic symptoms are commonly found to be uncorrelated with cognitive performance, many models of the development of delusions focus on failures in self-assessment and responses biases during momentary monitoring. We performed a single 4-test cognitive assessment on 240 participants (schizophrenia n = 126; bipolar disorder n = 114) and asked them to make a judgment about their performance immediately after completion of each task. We related performance and these judgments to results of Ecological Momentary Assessments (EMA) of the momentary occurrence of psychotic symptoms (Voices, paranoid ideas, other delusions) collected over up to 90 surveys over a 30 days prior to the single cognitive assessment. We examined test performance and the accuracy of self-assessment at that assessment, looking at diagnostic differences in performance and mis-estimation of performance. Participants with bipolar disorder had better cognitive performance, but there were no differences in mis-estimation. Analyses of the correlation between cognitive performance and self-assessment were all significant and better cognitive performance predicted reduced errors in self-assessment. Examination of the 30-day course of psychotic symptoms and IA could only be performed in participants with schizophrenia, revealing correlations between more common occurrences of all three psychotic symptoms and increased absolute values for IA errors. These data are consistent with theories of cognitive response biases and the formation of delusions. [ABSTRACT FROM AUTHOR]

Nous aborderons les grandes modalités et les principaux jalons dans les conceptions psychiatriques de 1852 à nos jours. L'épistémologie dans l'histoire contemporaine possède une spécificité dans sa démarche qui consiste à examiner l'état du développement historique des sciences. Et l'épistémologie de l'école de Piaget nous aide particulièrement à individualiser les différentes phases de la compréhension de la psychiatrie dans l'évolution de la Société Médico-Psychologique. Les membres fondateurs de notre Société représentent des disciplines très diversifiées (psychiatrie, philosophie, médecine, physiologie, administration, etc.), et nous distinguerons trois domaines : les grands paradigmes des 170 ans d'activité ; les grandes démarches épistémologiques ; les évaluations récentes, au milieu des différentes crises. Les grands paradigmes des 170 ans d'activité ont été particulièrement bien étudiés par Georges Lanteri-Laura. Nous distinguerons avec lui trois grandes phases : la période de l'aliénation mentale (1791–1854), de Pinel à Boismont, où sont bien présents les précurseurs spiritualistes de l'époque. La période des maladies mentales (1854–1926) de Falret, Magnan à Auguste Comte. La période des grandes structures (1926–1977), du Congrès de Genève-Lausanne, avec la présentation en français de Bleuler sur sa conception de la schizophrénie, à la mort de Henri Ey, avec les œuvres de Charcot, Broca, Clérambault, Régis, Guiraud et la présence de Bergson, Merleau-Ponty, et la phénoménologie allemande, jusqu'à la grande œuvre de Henri Ey. Et enfin la période du système classificatoire (à partir de 1975–1980), que nous ajoutons aux études précédentes, avec l'arrivée des différents DSM, et la classification internationale des troubles mentaux CIM 10. Nous citerons la célèbre réunion franco-américaine de 1978, et les contributions de nombreux membres de la Société Médico-Psychologique tout au long de cette période. Les grandes démarches épistémologiques sont importantes à préciser tout au long de ces phases, surtout dans les deux dernières périodes. Les rapports entre la clinique et l'épistémologie sont très concernés dans deux domaines particulièrement : la transformation des concepts, et la dialectique des modèles (avec les très importantes études de C.J. Blanc). Nous distinguerons les quatre grandes démarches : les démarches descriptives et explicatives, les démarches explicitantes et compréhensives. C'est à ce niveau que nous pouvons considérer l'œuvre très importante de Pierre Marchais. Et nous pouvons alors bien situer la place considérable de la démarche compréhensive. Les jalons et les prolongements contemporains concernent les deux grandes dimensions qui apparaissent dans les activités de la Société Médico-Psychologique depuis trente à quarante ans. Les modalités de la connaissance et l'épistémologie sont très concernées dans les courants scientifiques récents de la psychiatrie (neuro-cognitivisme, biochimie, génétique, etc.) et la place de la compréhension des troubles et des personnes est indispensable à associer à toutes les démarches d'explication. Les sciences du vivant sont en rapport avec l'épistémologie en apportant à l'objectivité les dimensions subjectives du vivant, car la vie est, dans son essence, un processus subjectif d'auto-affection, de conscience de soi, et de l'identité (G. Canguilhem ; M. Henry). Les conclusions de cette longue étude dans le temps nous amènent à souligner deux domaines : d'un point de vue général, les approches épistémologiques de la psychiatrie nous confrontent toujours aux différentes conceptions de l'homme, portant en elles diverses modalités du sens de l'existence. D'un point de vue particulier, dans chaque période considérée, nous constatons une certaine diversité des paradigmes, où les psychiatres considèrent la clinique psychiatrique selon des modalités épistémologiques diverses et complémentaires. We discuss the major modalities and milestones in psychiatric conceptions from 1852 to the present day. Epistemology in contemporary history has a specificity in its approach, which consists in examining the state of the historical development of science. And the epistemology of the Piaget school particularly helps us to individualize the different phases of the understanding of psychiatry in the evolution of the Medico-Psychological Society. The founding members of our Society represent very diverse disciplines (psychiatry, philosophy, medicine, physiology, administration, etc.) and we distinguish three areas : The major paradigms of 170 years of activity ; The major epistemological approaches; Recent assessments, in the midst of various crises; The major paradigms of 170 years of activity have been particularly well studied by Georges Lanteri-Laura. We differentiate his three main phases: The period of insanity (1791–1854), from Pinel to Boismont, where the spiritualist precursors of the time are present. The period of mental illness (1854–1926) from Falret, Magnan to Auguste Comte. The period of large structures (1926–1977), from the Congress of Geneva-Lausanne, with the presentation in French of Bleuler's conception of schizophrenia, to the death of Henri Ey, with the works of Charcot, Broca, Clérambaud, Régis, Guiraud and the presence of Bergson, Merleau-Ponty, and German phenomenology, to the great work of Henri Ey. And finally, we deal with the period of the classification system (from 1975 to1980), which we include with the previous studies, with the promulgation of the different DSM, and the international classification of mental disorders ICD10. We mention the famous Franco-American meeting of 1978, and the contributions of many members of the Medico-Psychological Society throughout this period. It is important to specify the major epistemological approaches throughout these phases, especially during the last two periods. The relationship between the clinic and epistemology is greatly concerned in two areas in particular: the transformation of concepts, and the dialectic of models (with the very important studies of C.J. Blanc). We delineate the four main approaches: descriptive, explanatory, explicit, and comprehensive approaches. It is at this point that we can consider the very important work of Pierre Marchais. And we can then clearly situate the considerable importance of the comprehensive approach. The contemporary milestones and extensions concern two major dimensions that have been present in the activities of the Medico-Psychological Society for the past thirty to forty years. The modalities of knowledge and epistemology are very much involved in the recent scientific currents of psychiatry (neuro-cognitivism, biochemistry, genetics, etc.) and the importance of understanding disorders and people must be associated with all approaches to explanation. The life sciences are related to epistemology through including objectivity together with the subjective dimensions of the living, because life is, in its essence, a subjective process of self-affection, self-awareness, and identity (G. Canguilhem; M. Henry). The conclusions of this lengthy study over time lead us to highlight two areas: From a general point of view, epistemological approaches to psychiatry always confront us with different conceptions of man, carrying within them various modalities of the meaning of existence. From a particular point of view, in each period considered, we note a certain diversity of paradigms, where psychiatrists consider the psychiatric clinic according to various and complementary epistemological modalities. [ABSTRACT FROM AUTHOR]

L'interprétation par Joseph Capgras et Paul Carrette en 1924 du deuxième cas rapporté d'« illusion des sosies » (futur syndrome de Capgras) en termes psychanalytiques a préparé la voie qui s'est imposée pendant la plus grande partie du siècle. Capgras, malgré le mérite qu'il avait eu en isolant le phénomène au sein d'un riche délire, avait aussi affirmé l'absence chez ces malades de tout déficit intellectuel et cela même alors que l'une d'elles était gravement « cérébrolésée ». Il est actuellement constaté que le syndrome peut s'observer aussi bien lors de troubles psychotiques primaires que lors de certaines affections démentielles débutantes. Cette situation doit être mise à profit pour progresser dans la compréhension du phénomène. The psychanalytic interpretation by Joseph Capgras and Paul Carrette in 1924 of the second reported case of "look-alike delusion" (later known as Capgras syndrome) paved the way for what was to become the dominant approach for most of the century. Capgras, in spite of the merit he had in isolating the phenomenon within a rich delusional state, had also affirmed the absence in these patients of any intellectual deficit and this even though one of his patients was severely brain damaged. It is currently held that Capgras syndrome can be seen as well in primary psychotic disorders such as in the beginning of certain early dementias. This situation must be exploited in order to further understand the phenomenon. [ABSTRACT FROM AUTHOR]

This study investigated the effectiveness of a metacognitive intervention program for symptom relief and improvement in social cognitive functioning among adults with schizophrenia. The program focused on enhancing metacognition to encourage self-awareness and step-by-step perspective expansion. There were 24 participants in the experimental group and 19 participants in the control group. Delusions decreased, and social cognition and social functioning improved in the experimental group compared to the control group. The program demonstrated utility as a treatment modality, which can be part of an overall program of a mental health promotion institution to improve functioning in patients with schizophrenia. • Metacognitive ability improved through stepwise expansion of perspective • Metacognitive intervention for Schizophrenia (MCI-S) reduced delusional thinking in patients with schizophrenia • Metacognitive intervention for Schizophrenia (MCI-S) can improve social functioning in patients with schizophrenia [ABSTRACT FROM AUTHOR]

Psychotic symptoms (hallucinations and delusions) are a type of neuropsychiatric symptom found during Alzheimer's Disease (AD). This systematic review aims to comprehensively capture, analyse, and evaluate the body of evidence that has investigated associations between brain regions/networks and psychotic symptoms in AD. The protocol, created according to the PRISMA guidelines, was pre-registered on OSF (https://osf.io/tg8xp/). Searches were performed using PubMed, Web of Science and PsycInfo. A partial coordinate-based meta-analysis (CBMA) was performed based on data availability. Eighty-two papers were selected: delusions were found to be associated mainly with right fronto-temporal brain regions and the insula; hallucinations mainly with fronto-occipital areas; both were frequently associated with the anterior cingulate cortex. The CBMA, performed on the findings of fourteen papers on delusions, identified a cluster in the frontal lobe, one in the putamen, and a smaller one in the insula. The available evidence highlights that key brain regions, predominantly in the right frontal lobe, the anterior cingulate cortex, and temporo-occipital areas, appear to underpin the different manifestations of psychotic symptoms in AD and MCI. The fronto-temporal areas identified in relation to delusions may underpin a failure to assimilate correct information and consider alternative possibilities (which might generate and maintain the delusional belief), and dysfunction within the salience network (anterior cingulate cortex and insula) may suggest a contribution for how internal and external stimuli are identified; the fronto-occipital areas linked to hallucinations may indicate diminished sensory processing and non-optimal predictive processing, that together contribute to misinterpretation of stimuli and misperceptions; the fronto-temporal and occipital areas, as well as the anterior cingulate cortex were linked to the psychotic cluster. • A review of 82 papers assessing psychotic symptoms and brain regions/networks. • Delusions were mainly related to the right fronto-temporal regions and insula. • Hallucinations were mainly associated with fronto-occipital areas. • Misidentification was mainly related to frontal, occipital and temporal lobe regions. • Paranoia was related to the temporal lobe, with less contribution of frontal areas. [ABSTRACT FROM AUTHOR]

Neuropsychiatric symptoms may impact prognosis in individuals with mild cognitive impairment (MCI); however, data on frequency of psychotic symptoms are sparse. We searched MEDLINE, EMBASE, PsychoINFO from inception to June 2023. We included studies reporting patients with MCI prevalence of (delusions and/or hallucinations. Random effects model were performed to estimate the prevalence, and subgroup and meta-regression analyses were performed to explore heterogeneity. Of 3145 records identified, 36 studies were included, enrolling 20,426 patients. Overall prevalence of hallucinations was 1.78 % (95 % CI, 1.17 – 2.71) and delusions 3.84 % (95 % CI, 2.71 – 5.42), both with significant heterogeneity (/2 = 90 %). Prevalence of hallucinations and delusions were lower when measured by NPI scales and in population-based samples. Delusions and hallucinations occur in MCI patients at low rates. Prevalence can be partially explained by the assessment method, sample source and study heterogeneity. • Delusions and hallucinations occur in mild cognitive impairment at low rates. • There was a high degree of heterogeneity among the studies. • Prevalence can be explained by assessment methods and sample source. [ABSTRACT FROM AUTHOR]

Previous studies have clearly established the impact of culture on design creativity. For example, the presence of cultural values with low uncertainty avoidance (UA, the degree of anxiety and risk aversion that people feel during ambiguous situations) is linked to low workability of creative ideas. Currently, there is limited research on potential remedies to alleviate the impact of culture, specifically with respect to UA. Therefore, this study investigates the use of technology to prime UA cultural values and mitigate their potential negative impacts on design creativity. This was achieved using stimuli that had been generated by virtual reality (VR) technology and presented in an immersive environment. Participants in an experimental study were exposed to VR stimuli designed to either decrease or increase their UA. The results showed that the VR stimuli had successfully increased and decreased low and high UA values, respectively, which mitigated the influence of UA on design creativity. Furthermore, the VR stimuli influenced the emphasis of the participants on ideation, with lowered and enhanced UA values leading to them prioritizing novelty and usefulness, respectively. Overall, the findings provided evidence that VR could be leveraged from a psychological standpoint to reduce cultural influences on creativity through targeted priming. These findings indicated the essential implications of the study in terms of understanding the effect of immersive technologies in shaping human behaviors and mindsets. • Virtual reality stimuli can successfully prime the UA values of participants. • Primed high UA leads to a prioritization of the usefulness of ideas. • Primed low UA leads to a prioritization of the novelty of ideas. • VR stimuli is a promising tool for mitigating cultural influences on creativity. [ABSTRACT FROM AUTHOR]

Psychotic-like experiences (PLEs), such as delusions and hallucinations, are regarded to occur along a spectrum and to be present also in non-help-seeking individuals from the general population. However, it remains unclear whether the occurrence of PLEs is a unique risk factor for future PLEs or a symptom of general psychopathology. In this study, we investigated whether PLEs during adolescence predict future PLEs in adulthood. A community-based cohort of 1146 young adolescents (mean age, 14.38 years) were assessed and then reassessed 6 years later (mean age, 20.15 years). Participants reported PLEs experienced in the past year, as well as symptoms of depression, anxiety, attention-deficit/hyperactivity disorder, and conduct problems. We adjusted the analysis for other forms of psychopathology and sex differences. Participants who reported PLEs in adulthood had higher ratings for all preceding and co-occurring symptoms of psychopathology. In the adjusted logistic regression model, having PLEs and, to a smaller degree, anxiety during adolescence predicted PLEs in early adulthood. The association between baseline and future PLEs did not differ between males and females, although females were more likely to report PLEs during adolescence. Participants with persistent PLEs reported more hallucinations during adolescence than those with transient symptoms. Our findings suggest that the early occurrence of PLEs is an important and independent predictor of future PLEs and should be monitored to identify individuals with a high risk of future psychopathology and to enable early interventions. [ABSTRACT FROM AUTHOR]

Objective: Poor insight is a major problem in psychosis, being detrimental for treatment compliance and recovery. Previous studies have identified various correlates of insight impairment, mostly in chronic samples. The current study aimed to determine clinical, neurocognitive, metacognitive, and socio-cognitive predictors of insight in first-episode psychosis.Methods: Regression analyses of different insight dimensions were conducted in 190 patients with first-episode psychosis. Measures of clinical symptoms, neurocognition, metacognition, social cognition, and 'jumping to conclusions' bias were entered as predictors.Results: Delusions, disorganisation, and certain negative symptoms were associated with unawareness in various domains, while depression was associated with greater awareness of illness. Deficit in theory of mind and self-reflective processes, as well as a 'jumping to conclusions' bias, contributed to poor insight. Several neuropsychological scores also contributed to this but their contribution was no longer observed in regression analyses that included all the previously identified clinical and cognitive predictors. A measure of perseverative errors was still associated with unawareness and misattribution of symptoms.Conclusion: In models that account for 28 % to 50 % of the variance, poor insight in first-episode psychosis is mainly associated with delusions and certain negative symptoms. At the cognitive level it does not appear to result from neuropsychological impairment but rather from altered reasoning bias and dysfunction in metacognitive processes. Therapeutic strategies specifically directed at these mechanisms could help improve the evolution of insight in first episode psychosis. [ABSTRACT FROM AUTHOR]

Previous reports have suggested a cross-sectional association between autistic traits and psychotic experiences (PEs) in adolescents. However, while both autistic traits and PEs show sex-related differences, no studies have directly assessed whether such differences exist in the longitudinal association between autistic traits and PEs. Using a population-based adolescent cohort sample (n = 3007), we tested whether the longitudinal association between autistic traits and positive PEs was affected by sex-based differences using regression analyses. Autistic traits were assessed at 12 years old (timepoint 1 [T1]), and PEs were assessed at 12 and 14 years old (T1 and T2). Subsequently, we tested whether subdomains of autistic traits (difficulties in social interaction, communication, imagination, attention to detail, and attention switching) were associated with subtypes of PEs (auditory hallucinations, visual hallucinations, and delusions) using structural equation modeling, after controlling for PEs at T1, socio-economic status, school performance and parents' psychiatric disorders. After controlling for PEs at T1, we did not find any associations between autistic traits at T1 and PEs at T2 in both sexes. There was no significant positive or negative association between all subdomains of autistic traits and subtypes of PEs in both sexes. Autistic traits do not seem to predict future PEs in general adolescents regardless of sex. [ABSTRACT FROM AUTHOR]

Humans navigate complex situations that require the accurate estimation of the controllability of the environment. Aberrant controllability computation might lead to maladaptive behaviors and poor mental health outcomes. Illusion of control, which refers to a heightened sense of control while the environment is uncontrollable, is one such manifestation and has been conceptually associated with delusional ideation. Nevertheless, this association has not yet been formally characterized in a computational framework. To address this, we used a computational psychiatry approach to quantify illusion of control in human participants with high (n = 125) or low (n = 126) trait delusion. Participants played a two-party exchange game in which their choices either did ("Controllable condition") or did not ("Uncontrollable condition") influence the future monetary offers made by simulated partners. We found that the two groups behaved similarly in model-agnostic measures (i.e., offer size, rejection rate). However, computational modeling revealed that compared to the low trait delusion group, the high delusion group overestimated their influence ("expected influence" parameter) over the offers made by their partners under the Uncontrollable condition. Highly delusional individuals also reported a stronger sense of control than those with low trait delusion in the Uncontrollable condition. Furthermore, the expected influence parameter and self-reported beliefs about controllability were significantly correlated in the Controllable condition in individuals with low trait delusion, whereas this relationship was diminished in those with high trait delusion. Collectively, these findings demonstrate that delusional ideation is associated with aberrant computation of and belief about environmental controllability, as well as a belief-behavior disconnect. [ABSTRACT FROM AUTHOR]

Delusions are, by popular definition, false beliefs that are held with certainty and resistant to contradictory evidence. They seem at odds with the notion that the brain at least approximates Bayesian inference. This is especially the case in schizophrenia, a disorder thought to relate to decreased - rather than increased - certainty in the brain's model of the world. We use an active inference Markov decision process model (a Bayes-optimal decision-making agent) to perform a simple task involving social and non-social inferences. We show that even moderate changes in some model parameters - decreasing confidence in sensory input and increasing confidence in states implied by its own (especially habitual) actions - can lead to delusions as defined above. Incorporating affect in the model increases delusions, specifically in the social domain. The model also reproduces some classic psychological effects, including choice-induced preference change, and an optimism bias in inferences about oneself. A key observation is that no change in a single parameter is both necessary and sufficient for delusions; rather, delusions arise due to conditional dependencies that create 'basins of attraction' which trap Bayesian beliefs. Simulating the effects of antidopaminergic antipsychotics - by reducing the model's confidence in its actions - demonstrates that the model can escape from these attractors, through this synthetic pharmacotherapy. [ABSTRACT FROM AUTHOR]

Delusions are rigid beliefs held with high certainty despite contradictory evidence. Notwithstanding decades of research, we still have a limited understanding of the computational and neurobiological alterations giving rise to delusions. In this review, we highlight a selection of recent work in computational psychiatry aimed at developing quantitative models of inference and its alterations, with the goal of providing an explanatory account for the form of delusional beliefs in psychosis. First, we assess and evaluate the experimental paradigms most often used to study inferential alterations in delusions. Based on our review of the literature and theoretical considerations, we contend that classic draws-to-decision paradigms are not well-suited to isolate inferential processes, further arguing that the commonly cited 'jumping-to-conclusion' bias may reflect neither delusion-specific nor inferential alterations. Second, we discuss several enhancements to standard paradigms that show promise in more effectively isolating inferential processes and delusion-related alterations therein. We further draw on our recent work to build an argument for a specific failure mode for delusions consisting of prior overweighting in high-level causal inferences about partially observable hidden states. Finally, we assess plausible neurobiological implementations for this candidate failure mode of delusional beliefs and outline promising future directions in this area. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of delusional information processing in psychopathology and everyday life, formal characterizations of such inferences are lacking. In this article, we propose a generative framework that entails a computational mechanism which, when implemented in a virtual agent and given new information, generates belief updates (i.e., inferences about the hidden causes of the information) that resemble those seen in individuals with delusions. We introduce a particular form of Dirichlet process mixture model with a sampling-based Bayesian inference algorithm. This procedure, depending on the setting of a single parameter, preferentially generates highly precise (i.e. over-fitting) explanations, which are compartmentalized and thus can co-exist despite being inconsistent with each other. Especially in ambiguous situations, this can provide the seed for delusional ideation. Further, we show by simulation how the excessive generation of such over-precise explanations leads to new information being integrated in a way that does not lead to a revision of established beliefs. In all configurations, whether delusional or not, the inference generated by our algorithm corresponds to Bayesian inference. Furthermore, the algorithm is fully compatible with hierarchical predictive coding. By virtue of these properties, the proposed model provides a basis for the empirical study and a step toward the characterization of the aberrant inferential processes underlying delusions. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) epidemic has forced a sudden global implementation of telemedicine strategies, including in long-term care (LTC) facilities where many people with dementia and Parkinson disease (PD) reside. Telemedicine offers a unique set of advantages for residents in LTC facilities if effectively supported and implemented, including expanded access to specialists in rural or underserved areas or for people with dementia who cannot travel for off-site visits. Many medical and psychiatric organizations have recently issued new or updated guidelines on the use of telemedicine. On October 22, 2020, a multidisciplinary consensus panel was convened to collate a list of best practices for LTC facilities and specialists when conducting telemedicine with residents with dementia-related psychosis or PD-related psychosis (PDP). A collaborative effort between specialists, facility administrators, and facility staff is essential for the success of telemedicine in the LTC setting. Telemedicine in LTC facilities comes with increased administrative and technical challenges that fall heavily on the shoulders of the LTC facility administrators and staff. Specialists can ease this burden by maintaining flexibility and ensuring expression of empathy and thanks to the staff who are facilitating the visits. LTC staff can provide specialists with valuable information about their patients to aid in evaluation and diagnosis. Specialists can facilitate this exchange of information by speaking to staff who work closely with the resident about any signs of hallucinations or delusions they may have observed. Educational efforts can increase staff understanding of dementia and PDP and empower them to engage with, and facilitate the resident's treatment plan. Using these strategies to take advantage of the benefits of telemedicine, specialists and LTC staff can together expand and improve care for LTC facility residents with dementia-related psychosis or PDP. [ABSTRACT FROM AUTHOR]

The coronavirus (COVID-19) pandemic has caused major disruptions to social and other forms of functioning, which may influence schizotypy expression. The current study aimed to explore possible distal and proximal predictors contributing to schizotypy in a sample of the Australian general population during the COVID-19 pandemic. The COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project is an online mental health study aimed at tracking key mental health indicators over the progression of the pandemic. Adults residing in Australia were invited to take part using non-discriminative snowball sampling. Demographic-clinical information was collected for 850 participants in either October 2020 or January 2021. To assess schizotypy facets, the Launay-Slade Hallucinations Scale-Extended (LSHS-E) and Peters Delusions Inventory (PDI-21) were used to measure hallucination and delusion proneness respectively. Generalised linear models (with gamma and negative binomial distributions) were employed. Age, negative emotions and loneliness significantly contributed to both hallucination and delusion proneness; gender, education and religiosity also significantly contributed to delusion proneness, in the final regression models. Our study corroborated the specific contribution of loneliness, amongst other factors, in the prediction of schizotypy facets. Tackling loneliness represents a public health challenge that needs to be urgently addressed, especially in the face of the ongoing COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

• We suggest new treatment solutions including the use of cell therapy to cure Parkinson's disease (PD). • The implantation of cardiac Sinoatrial node-like pacemakers (SANLP (cells in the substantia nigra (SN) of the brain may cure PD. • Transplantation of SANLP cells to the SN may lead to the production of dopamine and be effective in the treatment of PD. Parkinson's disease (PD) is one of the most common diseases of the central nervous system. This disease stems from damage to the dopaminergic neurons in the substantia nigra (SN). Patients with PD experience a spectrum of motor and non-motor symptoms. Common motor symptoms comprise bradykinesia, stiffness, and resting tremors. Alongside these primary motor symptoms, patients often deal with non-motor issues such as depression, anxiety, and cognitive impairment. For years, drugs such as L-Dopa and other medications have been used to alleviate the symptoms of this disease. However, prolonged use of these medications may lead to serious health complications such as impulsive and compulsive behaviors, hallucinations or delusions, and dyskinesia. Additionally, deep brain stimulation of the SN and stem cell therapy represent relatively novel and experimental treatment approaches for PD, each with its limitations. As an alternative approach, we propose the implantation of sinoatrial node-like pacemaker cells (SANLPCs) in the SN of the brain in PD patients. SANLPCs are engineered to generate continuous action potentials. Our hypothesis posits that implanting SANLPCs in the SN could result in sustained stimulation of the cells within the SN pars compacta, thereby potentially enhancing dopamine production. We anticipate that this innovative intervention may pave the way for more targeted and effective treatments for individuals afflicted with PD. [ABSTRACT FROM AUTHOR]

Psychotic-like experiences (PLEs) are common in the general population and have been linked to alcohol misuse and abuse. However, much of this research has been undertaken in Western countries. To address this deficit, the current study examined the association between PLEs and problem drinking in the Japanese general population. Data were used from 3717 adults (age 18–89) collected in an online survey in 2023. Information was obtained on PLEs with the PRIME Screen-Revised (PS-R), while problem drinking was assessed with the CAGE questionnaire (where a score of ≥ 2 was used to categorize cases). Logistic regression was used to examine the associations. Problem drinking was prevalent in the study sample (12.5%). In an analysis that was adjusted for sociodemographic factors, self-rated health, smoking status and depressive symptoms, PLEs were associated with significantly higher odds for problem drinking in the total sample (OR: 1.70, 95%CI: 1.13–2.55). In a sex-stratified analysis PLEs were not linked to problem drinking in men (OR: 1.16, 95%CI 0.68–2.00), whereas women with PLEs had over 2.8 times higher odds for problem drinking (OR: 2.83, 95%CI: 1.54–5.21). PLEs are associated with problem drinking in the Japanese general population and this association is especially pronounced in women. As problem drinking has been linked to a number of detrimental outcomes, future research should examine the potential effects of problem drinking in individuals with PLEs. • Psychotic-like experiences (PLEs) have been linked to harmful alcohol use. • However, little is known about this association in non-Western settings. • PLEs were associated with problem drinking in Japanese adults. • The PLEs-problem drinking association was observed in women but not men. [ABSTRACT FROM AUTHOR]

Cognitive processes such as aberrant salience and the jumping to conclusions (JTC) bias are implicated in the development of delusions. Self-referential thinking is implicated in this process; however, it is unknown how it may interact with aberrant salience and JTC bias in individuals with schizophrenia-spectrum disorders (SSDs). This study examined associations of self-referential thinking with aberrant salience, JTC bias, and delusion severity, and whether self-referential stimuli led to an increase in aberrant salience and JTC bias in SSDs (n = 20) relative to psychiatrically healthy controls (n = 20). To assess aberrant salience and JTC bias, participants were asked to complete both self-referential and neutral versions of the Salience Attribution Test (SAT) and the Beads Task, as well as self-report measures of aberrant salience and JTC bias. Self-referential task condition interacted with clinical group to predict JTC beads task scores, such that participants with SSDs exhibited greater levels of JTC bias than psychiatrically healthy controls during the neutral task condition, when controlling for levels of motivation, cognitive insight, and functioning. Self-referential thinking was significantly associated with aberrant salience, JTC bias, and delusion severity. This experiment examined trait-level relationships between variables, so does not provide information about state-level interrelationships and would benefit from replication using more dynamic methods such as ecological momentary assessment. These findings highlight the interrelationships between self-referential thinking, JTC bias, aberrant salience, and delusion severity, in individuals with SSDs, and support the interactive role of self-referential thinking in predicting JTC bias. • Those with psychosis have greater levels of cognitive biases than controls. • Self-referential stimuli increased biases for only control participants. • Self-referential thinking at baseline is higher in groups with psychosis. [ABSTRACT FROM AUTHOR]

Context: Studies have shown that music can improve the neuropsychiatric symptoms in people with dementia. Personalized music has the greatest impact. However, people with dementia in residential care rarely listen to personalized music; in doing so, they themselves as well as their caregivers pass up the positive effects associated with it. As a result, customizable music systems have been developed that allow people with dementia to listen to their favorite music.Aim: To determine the effectiveness of personalized music systems on the neuropsychiatric symptoms of people with dementia in residential care and the perceived distress of caregivers.Method: 14 residents heard personalized music during personal care for eight weeks. Outcomes were derived from pre-post-follow up assessments of residents' neuropsychiatric symptoms and caregivers' distress using the Neuropsychiatric Inventory Questionnaire (NPI-Q). The frequency of the music systems' usage was recorded in log files. A control group of 14 residents received standard care.Results: Caregivers used the music systems among the residents with varying frequency. During the intervention, an increasing trend of the severity value of apathy was observed, while the severity values of delusions and nighttime disturbances tended to decrease. However, the trends did not reach statistical significance. Caregivers' perceived distress was not affected.Conclusion: A practicable solution for providing personalized music to people with dementia in residential care was tested. Possible positive effects were observed for delusions and nighttime disturbances in people with dementia, but a larger study will be required to verify these observations. [ABSTRACT FROM AUTHOR]

Background: Research has shown a strong relationship between psychosis and sexual assault. Theories on developmental trauma as a causal factor for psychosis suggest that exposure to sexual trauma in childhood would have a stronger association with psychosis than sexual trauma in adulthood. We hypothesized that exposure to sexual trauma earlier in childhood and adolescence would be more strongly associated with hallucinations, delusional beliefs and psychotic disorder than sexual trauma that occurred later in life.Methods: Using the 2007 and 2014 Adult Psychiatric Morbidity Surveys (N = 14,949) we calculated the prevalence of sexual assault, hallucinations, delusional beliefs, and psychotic disorder. We used logistic regression to examine the relationship between age of exposure to sexual assault (first exposure <16 vs first exposure ≥16) and odds of hallucinations, delusions, and psychotic disorder.Results: Sexual assault at any age was associated with an increased odds of hallucinations (aOR = 2.00, 95%CI = 1.63-2.46), delusional beliefs (aOR = 2.55, 95%CI = 2.24-2.89) and psychotic disorder (aOR = 5.28, 95%CI = 3.59-7.76). There was no significant difference, however, in the prevalence of hallucinations, delusional beliefs or psychotic disorders in individuals first exposed to sexual assault <16 and individuals first exposed ≥16.Conclusions: Contrary to our hypothesis, we did not find evidence that exposure to sexual assault in childhood and adolescence was more strongly associated with hallucinations, delusional beliefs or psychotic disorder than exposure to sexual assault age >16. Our findings do not support the idea that childhood and adolescence are uniquely sensitive periods for the emergence of psychotic experiences or psychotic disorder in relation to sexual trauma. [ABSTRACT FROM AUTHOR]

Pour beaucoup de cliniciens, le trouble délirant ou délire paranoïaque est source de pessimisme thérapeutique. Les conséquences psychologiques parfois importantes pour les patients, pour leur entourage ou autrui, ainsi que la classique dangerosité médicolégale, indiquent le besoin d'une meilleure connaissance sur le traitement de cette affection. Cette communication propose une synthèse rapide de la littérature sur la pharmacothérapie du trouble délirant, dans les banques de données PubMed, Scopus et Cochrane Database of Systematic Reviews, à la recherche depuis leur création jusqu'en septembre 2021 de revues systématiques ou narratives de bonne qualité. Les quelques revues systématiques ou narratives évoquent le manque d'études contrôlées ou prospectives, les données se limitant surtout à des séries de cas avec des risques de biais importants. Dans l'état actuel de nos connaissances, ces revues suggèrent cependant l'efficacité des antipsychotiques, l'intérêt des antidépresseurs et l'importance de l'adhésion au traitement, recommandant des études contrôlées randomisées et proposant d'intéressantes voies de recherche. Si les preuves scientifiques de l'efficacité de la pharmacothérapie dans le trouble délirant sont rares, cette pathologie est décrite comme répondant au traitement dans beaucoup de situations, sous réserve de son observance par le patient. For many clinicians, delusional disorder is associated with therapeutic pessimism. Psychological consequences of this disease, sometimes important for patients, family or other people, as well as the classical forensic reputation of dangerosity, indicate the needs for a best knowledge about the treatment of this disease. This communication is a rapid review on the pharmacotherapy of delusional disorder. A literature search from inception to September 2021 was performed in PubMed, Scopus and Cochrane Database of Systematic Reviews, looking for systematic or narrative reviews of good quality. Systematic and narrative reviews emphasize the lack of randomised controlled trials or prospective studies and a low quality of evidence, limited to retrospective case series with an important risk of biases. In the state of our knowledge, these reviews suggest nonetheless the efficacy of antipsychotics and the interest of antidepressants, highlighting the importance of adhesion and compliance to treatment. Randomised controlled trials are recommanded and interesting pathways for research are proposed. Evidence-based proofs are seldom about effectiveness of pharmacotherapy in delusional disorder, so that there is a lack of recommendations or guidelines for the treatment in clinical practice. This disease is however described as responding to treatment in many situations, if the patient is compliant. [ABSTRACT FROM AUTHOR]