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Hallucinations can have rather heterogeneous aetiology and presentation. This inspired the concept of different subtypes based on symptom profiles, especially in the field of auditory hallucinations. As many people experience hallucinations in more than one sensory modality, it seems important to investigate potential hallucination subtypes across different sensory modalities. We assessed the content of hallucinations as part of a large survey among the general Dutch population (n = 10,448) using the Questionnaire for Psychotic Experiences. Based on their descriptions, thematic categories were created in a data-driven cluster analysis. 2594 participants who experienced hallucinations over the past week that contained at least 2 different thematic categories were selected. Clustering of their hallucination content was performed with the HDBSCAN method. We identified 4 clusters, i.e., subtypes, which can be typified as 1. hallucinations of foul odors, 2. complex visual scenes, 3. a vast variety of rather common hallucinations possibly related to heightened alertness, and 4. possibly bereavement hallucinations. The bereavement subtype showed an increase in emotional loneliness and the presence of delusions. Our findings suggest that the content of hallucinations can be informative, especially when investigated across sensory modalities. Such subtypes may help to better understand their underlying mechanisms. [ABSTRACT FROM AUTHOR]

With a higher prevalence in schizophrenia, delusions of thought insertion (TI) are regarded as one of the most severe symptoms of psychosis. Patients suffering from TI report that external agents are able to place thoughts into their minds or skulls. A version of the doxastic approach characterizes delusions as abnormal beliefs rooted in anomalous experiences. Nonetheless, the exact role of these experiences in determining the content and the way in which delusional beliefs are fixated is still under debate. While endorsement models claim that the abnormal experience comprises the very content of the delusional beliefs, explanationist approaches claim that delusional beliefs emerge as explanations for abnormal experiences with less specific content. This paper combines conceptual analysis with phenomenological data to examine the merits of both endorsement and explanationist approaches to TI. I propose that potential solutions to the dispute could lay in finding a middle ground between the two approaches, and non-exhaustive ways in which hybrid doxastic approaches to TI could be formulated. [ABSTRACT FROM AUTHOR]

Background: Post-stroke psychosis (PSP) is a rare but serious neuropsychiatric condition characterized by delusions and/or hallucinations following a stroke. Despite its impact on prognosis and quality of life, PSP remains underdiagnosed and undertreated, with limited data on its prevalence and risk factors. The purpose of this study is to assess the prevalence and determinants of post-stroke psychosis (PSP), as well as to compare PSP and non-PSP patients in terms of improvement and daily living outcomes. This nested case–control study included 2,624 acute stroke patients from a university hospital between May 2017 and April 2022. Patients who developed PSP within 6 months post-stroke were identified as cases (n = 108), and 119 patients without PSP were randomly selected as controls. Comprehensive assessments included clinical, laboratory, and imaging evaluations at baseline. After 6 months, follow-up evaluations were conducted, including neurological examinations, psychiatric assessments, and stroke severity assessments using the Barthel index (BI). The psychiatric assessments included the Hamilton Depression Rating Scale for depression and the Mini-Mental State Examination for cognitive status. Results: The prevalence of PSP was 5.4%. risk factors significantly associated with PSP included older age, male patients, lower education level (≤ 5 years), hemiplegia, sphincter affection, cortical lesion, brain atrophy, small vessel disease, ischemic stroke, post-stroke dementia, and seizures. Non-specified psychosis and delusional disorder were the most common psychosis subtypes. There was a significantly higher percentage of excellent patients in the non-PSP group compared to those who had PSP regarding the observed improvement in the patient's condition. Also, there is a higher percentage of deteriorated patients in the PSP group (46.6%) compared to another group (18.9%) regarding BI. Conclusion: PSP is a prevalent post-stroke complication associated with distinct risk factors and poor functional outcomes. Early screening and identification of high-risk patients, along with multidisciplinary management strategies, are crucial for optimizing recovery and quality of life in stroke survivors. [ABSTRACT FROM AUTHOR]

Purpose of Review: The assessment of the risk of triggering psychosis upon exposure to grief is a challenge in clinical practice. Adequate diagnosis and early prevention are essential and may be helpful in the evolution of normal grief. We aimed to identify studies exploring grief as a risk factor for developing psychosis. Recent Findings: A systematic review of 3 databases (PubMed, EMBASE, and Cochrane Library) was conducted. Results: In the first approach 618 studies were identified. After the selection process, 15 studies were included in the review. The association between grief and the risk of developing psychosis occurred at younger ages (before 18 years of age) in a first-degree relative and as a consequence of suicide or accidental death. Summary: We found that risk factors such as comorbidity, mental problems, unemployment, economic difficulties, and close ties with the deceased have a negative impact on health causing greater vulnerability to psychosis with a risk of developing complicated grief, with statistically significant results regarding the associations between early parental death and the probability of developing psychosis in adulthood. [ABSTRACT FROM AUTHOR]

Why is there such a pervasive mistrust of science and expertise in the United States these days? This essay argues that, alongside the contribution made by the internet in facilitating the spread of misinformation, information silos, validation of kooky views, and so forth, the most significant factor derives from our failure to inculcate in our citizenry the basics of critical scientific thought and of its myriad extraordinary accomplishments. [ABSTRACT FROM AUTHOR]

The aim of this paper is twofold. First, I want to re-examine the epistemic status of elaborated delusions. Bortolotti (2016, 2020) claims that they can be epistemically innocent. However, I will show that this type of delusions is more unique than suggested by the existing analyses of their epistemic status. They typically cause more profound harms than other kinds of delusions, and in most cases, it would be counterproductive to classify them as epistemically beneficial or innocent. I will employ predictive and phenomenological models of delusions and the enactivist notion of sensus communis to explain the harms and possible benefits of elaborated delusions and why I think the existing definition does not fully grasp them. Based on this analysis, I will propose changes to the conditions for epistemic innocence. [ABSTRACT FROM AUTHOR]

This study sought to explore factors related to community transition after the mandatory evacuation of psychiatric inpatients to other hospitals owing to the Fukushima Daiichi Nuclear Power Plant accident. A retrospective cohort design was adopted and 391 psychiatric patients were examined. Univariate and multivariate analyses were conducted to confirm the association between the achievement or non-achievement of discharge to community living and their backgrounds (age, gender, evacuation destination, psychiatric diagnoses, and physical complications). Multivariate analysis indicated that patients with psychiatric diagnoses of schizophrenia, schizotypal, and delusional disorders (International Statistical Classification of Diseases and Related Health Problems 10th revision, F20–29), and those with physical diagnoses of the circulatory (I00–95) and digestive (K00–93) systems showed a significant association with the non-attainment of community transition. From these results, we hypothesized that difficulties in the management of medication during and immediately after the extremely chaotic settings of evacuation could have negative effects on the community transitions. Furthermore, another possible concern was that individuals' persistent psychotic status before the accident had been carried over to the destination hospitals. Therefore, pre-disaster daily cooperation across hospitals and challenges for vulnerable psychiatric patients' future community lives are also essential. [ABSTRACT FROM AUTHOR]

This study investigated sociodemographic and clinical differences between the sexes in individuals affected by schizophrenia-spectrum disorders (SSD) who accessed outpatient mental health services. Within a retrospective cohort of 45,361 outpatients receiving care in Ferrara (Italy) from 1991 to 2021, those with a SSD diagnosis were compared between the sexes for sociodemographic and clinical characteristics before and after the index date (when the ICD-9: 295.*diagnosis was first recorded) to assess early trajectory, age and type of diagnosis, and severity of illness indicated by medication use, hospitalization, and duration of psychiatric care. Predictors of discharge were also investigated. Among 2439 patients, 1191 were women (48.8%). Compared to men, women were significantly older at first visit (43.7 vs. 36.8 years) and at index date (47.8 vs. 40.6) with peak frequency at age 48 (vs. 30). The most frequent last diagnosis recorded before the index date was delusional disorder (27.7%) or personality disorder (24.3%) in men and depression (24%) and delusional disorder (30.1%) in women. After the index date, long-acting antipsychotics and clozapine were more frequently prescribed to men (46.5% vs. 36.3%; 13.2% vs. 9.4%, p < 0.05) and mood stabilizers and antidepressants to women (24.3% vs. 21.1%; 50.1% vs. 35.5%; p < 0.05). Women had fewer involuntary admissions (10.1% vs. 13.6%) and were more likely to be discharged as the time under care increased (p = 0.009). After adjusting for covariates, sex was not a significant predictor of discharge. Our study confirmed that sex differences exist in clinical and sociodemographic characteristics of outpatients with SSD and that gender considerations might influence the rapidity of diagnosis and medications prescribed. These findings highlight the need to implement a women-tailored approach in specialist care programs for psychoses. [ABSTRACT FROM AUTHOR]

In this rejoinder, I comment on Irmak's 2014 article titled "Schizophrenia or Possession?" published in the Journal of Religion and Health (Irmak, 2014; JORH 53(3):773–777. https://doi.org/10.1007/s10943-012-9673-y). After providing a brief overview of the article and two commentaries on it, I examine the role that demonic possession may or may not play in the development and course of schizophrenia. While keeping an open mind to the possibility of evil influences on the course of illness in those with or without psychosis, I emphasize that schizophrenia is a neurobiological illness that requires compassionate care and expert psychobiological treatment. [ABSTRACT FROM AUTHOR]

Paranoia is a common experience in adolescence that may entail the use of safety behaviours (e.g. avoidance), which are assumed to maintain paranoia in the long run. As the development of paranoia and related safety behaviours in youth may be influenced by their caregivers, we aimed to investigate the associations of paranoia and safety behaviours in adolescents and their parents. Adolescents from the general population aged 14–17 and one of their parents (N = 142 dyads) were recruited via Qualtrics to complete online surveys including measures of paranoia, safety behaviour use, anxiety, and demographics. We fitted an Actor-Partner-Interdependence Model (APIM) for testing dyadic parent–child interaction by using structural equation modelling and controlled for adolescents' and parents' anxiety. Results indicated that paranoia positively predicted safety behaviour use in adolescents and in parents. There were significant positive intra-dyad (i.e. parent-adolescent) correlations for both paranoia and safety behaviour use. One partner effect was significant: parental paranoia positively predicted the safety behaviour use of their adolescent child. Conversely, adolescents' paranoia did not predict their parents' safety behaviour use. Our findings corroborate prior research demonstrating an association between paranoia and safety behaviours among adults, and extend this association to adolescents. Children of parents experiencing paranoia are at increased risk of developing paranoia and safety behaviours, which indicates the need for interventions that target paranoia and safety behaviours in family systems. [ABSTRACT FROM AUTHOR]

Olfactory Reference Disorder (ORD) is a known clinical entity for several decades; however, it is only in ICD 11 that it has found its niche. Long considered a delusional disorder, it is currently classified as an obsessive–compulsive (OC) spectrum disorder. ORD is characterised by an erroneous conviction that the body is emitting an unpleasant smell. Patients harbour referential thinking, practise rituals to eliminate or mask the perceived odour, and avoid social interactions. While the conviction can be at a delusional level in some patients, the preoccupation has an obsessive quality in others. The level of insight can be varied. Patients present to mental health settings after traversing a long pathway of care comprising of various specialists. Medical and psychiatric conditions which can present with ORD-like symptoms need to be ruled out. Establishing a therapeutic alliance is the first step in management. There are no randomised controlled trials comparing treatment options in ORD. Antidepressants, antipsychotics, and their combinations have been used with varying degrees of success, in addition to psychotherapy and electroconvulsive therapy. Data on prognosis is limited. [ABSTRACT FROM AUTHOR]

The article is a personal account written by David Richards, a survivor of severe acute respiratory distress syndrome (ARDS) during the swine flu pandemic in 2009-2010. Richards spent six weeks in the intensive care unit (ICU) and received mechanical ventilation and ECMO treatment. His former partner, Rose, kept a diary during his time in the ICU, documenting his medical updates, conversations, and the emotional impact on their family. Richards reflects on the importance of the diary in helping him understand his prognosis, extract true memories from delusions, and appreciate the care he received. The diary also helped him cope with anxiety and depression and serves as a reminder of his recovery journey. Richards emphasizes the value of ICU diaries in providing a timeline of events, filtering out false memories, and supporting mental health. [Extracted from the article]

Hallucinations and delusions can be symptoms of psychiatric illness, but more often—though less commonly known—are actually part of a healthy range of experiences found throughout the general population. The studies in this Special Collection paint a picture of the wide range of hallucinatory and delusional experiences across diverse populations, as well as comparative perspectives between clinical and non-clinical samples. In this editorial, I make three related points that are exemplified in the articles published here. First, that hallucinations and delusions are part of a normal distribution of human diversity; their mere presence does not indicate psychosis or psychiatric illness. Second, that the ubiquity of hallucinatory and delusional experiences across clinical and non-clinical populations suggests common cognitive and neural mechanisms. Finally, despite these commonalities, it is important to understand the difference between psychiatric symptoms and healthy experience. In summary, I conclude that it is important to investigate both common mechanisms and distinguishing factors to comprehensively elucidate these oft-misunderstood experiences. This Special Collection provides a showcase of the cutting-edge research that encompasses these objectives. [ABSTRACT FROM AUTHOR]

Background: Trends in cannabis use suggest a global increase in the past decade. Current evidence associates cannabis use with an increased risk of psychosis. This association has prompted a growing research interest in the association between cannabis use and psychiatric disorders, especially psychotic disorders. This study aims to gain a better understanding of the effect of cannabis on psychosis and its clinical progression. Results: We conducted a retrospective chart review of cannabis use in patients hospitalized for a psychosis episode over five years at the American University of Beirut Medical Center (AUBMC). Cannabis users were more likely to be young single males using other substances compared to non-cannabis users. Frequent cannabis use was associated with a higher likelihood of paranoia and legal problems. Other psychotic symptoms did not significantly differ between frequent cannabis users and non-users. The length of hospital stay and the duration of the psychotic episode did not significantly differ between cannabis users and non-users. Family stressors and family history of a psychotic disorder were associated with a higher likelihood of personal history of violence. Conclusions: This study is the first in Lebanon to reproduce findings supporting the association between cannabis and psychosis previously highlighted in other populations. Further prospective research is needed to better understand the effect of cannabis use on psychosis and to accordingly revise policies on cannabis legalization to reduce the global burden of psychotic disorders. [ABSTRACT FROM AUTHOR]

Background: Whether the false memory dysfunction in schizophrenia is at the early (encoding, perceptual) or later (retrieval) stages and how delusions affect it remains unclear. Method: In this study, we examined the perception and memory biases in schizophrenia patients with (Sch/D; n = 31) and without delusions (Sch/Nd; n = 32) and compared them with healthy controls (HCs; n = 35). We used the Deese Roediger McDermott (DRM) Paradigm and the Noise Task to measure the false memory and illusory pattern perception (IPP) biases, respectively. Results: We found that the patient groups performed lower in both the recall and recognition phases for the DRM and the Noise tasks and made more errors compared to the HC group. Additionally, the performance of the Sch/D group was remarkably lower than the Sch/Nd and HC groups. Conclusions: Our results indicated that the information-processing problem in schizophrenia exists in both the encoding and retrieval stages. Also found significant relationship between the presence of delusions and the increase in cognitive deficits. [ABSTRACT FROM AUTHOR]

Schizophrenia is a psychiatric disorder characterised by symptoms in three domains: positive (e.g. delusions, hallucinations), negative (e.g. social withdrawal, lack of motivation) and cognitive (e.g. working memory and executive function impairment). Cognitive impairment associated with schizophrenia (CIAS) is a major burden for patients and negatively impacts many aspects of a patient's life. Antipsychotics are the standard-of-care treatment for schizophrenia but only address positive symptoms. So far there are no approved pharmacotherapies for the treatment of CIAS. Iclepertin (BI 425809) is a novel, potent and selective glycine transporter 1 (GlyT1) inhibitor, under development by Boehringer Ingelheim for the treatment of CIAS. Phase I studies have shown it to be safe and well tolerated in healthy volunteers, and central target engagement (inhibition of GlyT1) was achieved in a dose-dependent manner from 5 to 50 mg in healthy volunteers. A Phase II study has demonstrated that iclepertin is safe and well tolerated in patients with schizophrenia and improves cognition at doses of 10 mg and 25 mg. Phase III studies are ongoing to confirm these initial positive safety and efficacy findings with the 10 mg dose, and if successful, iclepertin could become the first approved pharmacotherapy used to treat CIAS. [ABSTRACT FROM AUTHOR]

Although the COVID-19 pandemic has had detrimental effects on mental health in the general population, the impact on those with schizophrenia-spectrum disorders has received relatively little attention. Assessing pandemic-related changes in positive symptoms is particularly critical to inform treatment protocols and determine whether fluctuations in hallucinations and delusions are related to telehealth utilization and treatment adherence. In the current longitudinal study, we evaluated changes in the frequency of hallucinations and delusions and distress resulting from them across three-time points. Participants included: (1) outpatients with chronic schizophrenia (SZ: n = 32) and healthy controls (CN: n = 31); (2) individuals at clinically high risk for psychosis (CHR: n = 25) and CN (n = 30). A series of questionnaires were administered to assess hallucination and delusion severity, medication adherence, telehealth utilization, and protective factors during the pandemic. While there were no significant increases in the frequency of hallucinations and delusions in SZ and CHR, distress increased from pre-pandemic to early pandemic in both groups and then decreased at the third time point. Additionally, changes in positive symptom severity in SZ were related to psychiatric medication adherence. Findings suggest that positive symptoms are a critical treatment target during the pandemic and that ongoing medication services will be beneficial. [ABSTRACT FROM AUTHOR]

The aim of this article is to analyze those theories that interpret misidentification delusions in terms of mentalization. The hypothesis under examination holds that a mentalization framework is useful for describing misidentification delusions when identification is thought to be partially based on mentalization. The article provides both a characterization and possible interpretations of such delusions, and possible relations between misidentification and mentalization are scrutinized. Whether the mentalization approach may explain or describe such kinds of mental disorders is considered, with the conclusion that while this approach is unsatisfactory, there is some room for future improvement. [ABSTRACT FROM AUTHOR]

Multiple measures of decision-making under uncertainty (e.g. jumping to conclusions (JTC), bias against disconfirmatory evidence (BADE), win-switch behavior, random exploration) have been associated with delusional thinking in independent studies. Yet, it is unknown whether these variables explain shared or unique variance in delusional thinking, and whether these relationships are specific to paranoia or delusional ideation more broadly. Additionally, the underlying computational mechanisms require further investigation. To investigate these questions, task and self-report data were collected in 88 individuals (46 healthy controls, 42 schizophrenia-spectrum) and included measures of cognitive biases and behavior on probabilistic reversal learning and explore/exploit tasks. Of those, only win-switch rate significantly differed between groups. In regression, reversal learning performance, random exploration, and poor evidence integration during BADE showed significant, independent associations with paranoia. Only self-reported JTC was associated with delusional ideation, controlling for paranoia. Computational parameters increased the proportion of variance explained in paranoia. Overall, decision-making influenced by strong volatility and variability is specifically associated with paranoia, whereas self-reported hasty decision-making is specifically associated with other themes of delusional ideation. These aspects of decision-making under uncertainty may therefore represent distinct cognitive processes that, together, have the potential to worsen delusional thinking across the psychosis spectrum. [ABSTRACT FROM AUTHOR]

Metacognition among those reporting psychotic symptoms is associated with a distortion in the way they understand their own and others' mental states. Recent advances suggest that distortion in the form of self-criticism may activate a threat response and fuel symptom expression. At high level of self-criticism metacognition may reduce its protective role towards psychosis. Here, we explored whether the associations between impaired self-reflectivity and delusional ideation would decrease in the presence of self-criticism. A moderated regression model confirmed our hypothesis in a large sample of healthy young adults (N = 2065) even when controlled for sex, education, and family income. Our findings suggest how interventions aimed at reducing symptoms and promoting metacognition should always be interconnected with those targeting self-criticism. [ABSTRACT FROM AUTHOR]

Background: Across clinical settings, black individuals are disproportionately less likely to be diagnosed with bipolar disorder compared to schizophrenia, a traditionally more severe and chronic disorder with lower expectations for remission. The causes of this disparity are likely multifactorial, ranging from the effects of implicit bias, to developmental and lifelong effects of structural racism, to differing cultural manifestations of psychiatric symptoms and distress. While prior studies examining differences have found a greater preponderance of specific psychotic symptoms (such as persecutory delusions and hallucinations) and a more dysphoric/mixed mania presentation in Black individuals, these studies have been limited by a lack of systematic phenotypic assessment and small sample sizes. In the current report, we have combined data from two large multi-ethnic studies of bipolar disorder with comparable semi-structured interviews to investigate differences in symptoms presentation across the major clinical symptom domains of bipolar disorder. Results: In the combined meta-analysis, there were 4423 patients diagnosed with bipolar disorder type I, including 775 of self-reported as Black race. When symptom presentations were compared in Black versus White individuals, differences were found across all the major clinical symptom domains of bipolar disorder. Psychotic symptoms, particularly persecutory hallucinations and both persecutory and mood-incongruent delusions, were more prevalent in Black individuals with bipolar disorder type I (ORs = 1.26 to 2.45). In contrast, Black individuals endorsed fewer prototypical manic symptoms, with a notably decreased likelihood of endorsing abnormally elevated mood (OR = 0.44). Within depression associated symptoms, we found similar rates of mood or cognitive related mood symptoms but higher rates of decreased appetite (OR = 1.32) and weight loss (OR = 1.40), as well as increased endorsement of initial, middle, and early-morning insomnia (ORs = 1.73 to 1.82). Concurrently, we found that black individuals with BP-1 were much less likely to be treated with mood stabilizers, such as lithium (OR = 0.45), carbamazepine (OR = 0.37) and lamotrigine (OR = 0.34), and moderately more likely to be on antipsychotic medications (OR = 1.25). Conclusions: In two large studies spanning over a decade, we found highly consistent and enduring differences in symptoms across the major clinical symptom domains of bipolar disorder. These differences were marked by a greater burden of mood-incongruent psychotic symptoms, insomnia and irritability, and fewer prototypical symptoms of mania. While such symptoms warrant better recognition to reduce diagnostic disparities, they may also represent potential targets of treatment that can be addressed to mitigate persistent disparities in outcome. [ABSTRACT FROM AUTHOR]

This is the introduction of the Synthese Topical Collection Epistemological Issues in Neurodivergence and Atypical Cognition written by the guest editors. In order to justify the relevance of the topic, a minimum context is given on the notions of neurodivergence as well as some brief remarks on the neurodiversity advocacy movement. This serves as a basis to establish the importance of increasing the scope of epistemology to include issues that do not fit in the descriptions of typical subjects and cognitive processes. [ABSTRACT FROM AUTHOR]

People with Alzheimer's disease (AD) and delusions have worse quality of life and prognosis. However, early markers of delusions have not been identified yet. The present study investigated whether there are any detectable differences in grey matter (GM) volume and cognitive changes in the year before symptom onset between patients with AD who did and did not develop delusions. Two matched samples of AD patients, 63 who did (PT-D) and 63 who did not develop delusions (PT-ND) over 1 year, were identified from the Alzheimer's Disease Neuroimaging Initiative database. The Neuropsychiatric Inventory (NPI) was used to assess the presence of delusions. Sixty-three additional matched healthy controls (HC) were selected. Repeated-measures ANCOVA models were used to investigate group-by-time effects on the volume of selected GM regions of interest and on cognitive performance. No neurocognitive differences were observed between patient groups prior to symptom onset. Greater episodic memory decline and GM loss in bilateral caudate nuclei, medio-temporal and midline cingulo-parietal regions were found in the PT-D compared with the PT-ND group. A pattern of faster GM loss in brain areas typically affected by AD and in cortical and subcortical targets of dopaminergic pathways, paralleled by worsening of episodic memory and behavioural symptoms, may explain the emergence of delusions in patients with AD. [ABSTRACT FROM AUTHOR]

Objectives. To carry out a clinical and immunological study of the potential impact of coronavirus infection on the course of endogenous psychoses. Materials and methods. A total of 33 female patients aged 16–48 years with depressive-delusional states (F20.01, F21, F31) developing after coronavirus infections took part; group 1 consisted of 15 people who developed depressive-delusional states 1–2 months after COVID-19; group 2 consisted of 18 people with similar psychoses developing at later time points (2–6 months). The severity of psychopathological symptoms was assessed using the PANSS and HDRS-21 scales. The activity of inflammatory markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) was determined in patients' blood. Absolute neutrophil and lymphocyte contents and their ratio (the neutrophil:lymphocyte index) were also evaluated. Standard values for indicators from healthy donors corresponding to patients in terms of age and sex were used as control values. Results. Endogenous psychosis developing at longer intervals after coronavirus infection (group 2) was found to be associated with "typical" inflammatory reactions, with increases in the activity of acute-phase proteins (α1-PI: 43.0 (35.6–49.7) IU/ml, p = 0.001) and neutrophil degranulation activity (LE – 254.8 (238.0–271.0) nmol/min·ml, p < 0.001), which was associated with the development of depressive-delusional states with dominance of manifestations of positive affectivity (anxiety, melancholy) and the extended nature of delusional disorders, which were mostly incongruent to affect. Conversely, development of endogenous psychosis during the first two months after COVID-19 (group 1) was characterized by a spectrum of inflammatory biomarkers with a decrease in neutrophil count ((2.6 ± 0.9)·109/liter, p < 0.05) and low LE activity (196 (172–209.4) nmol/min·ml, p < 0.001). This immunological profile was associated with predominance of manifestations of negative affectivity (apathy, asthenia, adynamia) in the structure of depressive-delusional states and the relatively undeveloped nature of delusional disorders, which were predominantly congruent to affect. Conclusions. The clinical and biological correlates found here presumptively indicate that experience of COVID-19 infection has a modulatory effect on neuroinflammation and the structure of endogenous psychosis. [ABSTRACT FROM AUTHOR]

Despite numerous benefits of practicing meditation, a growing body of evidence posits possible detrimental effects on one's mental health and well-being. As meditation's popularity is steadily increasing in the general population, it is critical to assess, discuss and educate the public of any possible risks associated with available practices. Here, we review existing literature on the adverse effects (AEs) of meditation in non-clinical samples. Relevant original research articles were found through various academic search engines. The bibliographies of the selected studies were reviewed to identify additional articles of interest. A total of 39 studies were retained. These articles were divided into one of three categories: Observational (n = 19), Experimental (n = 9), or Case Studies (n = 11). AEs varied substantially across the studies, yet trends were identified. Common AEs included affective difficulties, distorted senses of self, derealization, hallucinations, delusions, interpersonal challenges, and susceptibility to false memory. Other AEs that were less commonly reported are also summarized. Meditation-related AEs in non-clinical samples are apparent in the literature. We discuss how the perceived valence of a meditative experience can vary, particularly if the experience is considered beyond the secular framework. We conclude that the general public should be aware of any potential effects derived from meditation in order to assert the meditation community's safety and well-being. [ABSTRACT FROM AUTHOR]

Purpose: While the prevalence of delusional themes appears to be consistent across geographic contexts, little is known about the relative prevalence of such themes within a given setting over periods of time. We therefore investigated delusional themes across 12 years of presentation to a catchment-based early intervention service for first episode psychosis (FEP). Methods: Systematically collected data from 500 patients at an early intervention service for FEP were analyzed. Four cohorts of 3 years each, from 2006 to 2017, were used to compare the frequency of delusion themes across cohorts. We also integrated into the analysis baseline sociodemographic factors such as gender, age, and highest level of education and clinical factors such as anxiety, depression, suicidality, hallucinations, and primary diagnosis (affective or non-affective psychosis). Results: Sex and education level were stable across cohorts, while patient age varied (p = 0.047). Clinical anxiety, depression, and suicidality at entry were also stable. Across cohorts, the proportion of patients with affective versus non-affective diagnosis differed (p = 0.050), with no differences in global rating of delusion severity or theme prevalence except for delusions of guilt or sin (p = 0.001). This single theme difference was not correlated with age or diagnosis. Conclusion: Our study suggests relatively stable prevalence of delusion themes across cohorts of individuals experiencing FEP. This demonstrates the potential utility of studying thematic content both for understanding delusions in clinical populations and in research. Future explorations of the relationships between delusion themes and across individual patient episodes should be conducted. [ABSTRACT FROM AUTHOR]

Depressive state is a common complication of spinocerebellar ataxia type 3 (SCA3). To the best of our knowledge, cases of SCA3 presenting with cenesthopathy have not been described. Here, we present a case of a severe depressive state with cenesthopathy and delusion in a young Japanese man with SCA3. A 43-year-old Japanese man with SCA3 developed a severe depressive state with associated cenesthopathy and delusion. He was treated with escitalopram (10 mg/day) and olanzapine (2.5 mg/day). Computed tomography showed atrophy of the cerebellum, bilateral superior cerebellar peduncle, and tegmentum of the pons. Single-photon emission computed tomography demonstrated reduced blood flow in the cerebellum, vermis, and brainstem. After 8 weeks, his depressive state and delusion improved; however, his cenesthopathy persisted. We encountered a case of a severe depressive state with cenesthopathy and delusion in a young Japanese man with SCA3. This case supports previous studies that the cerebellum could have a role beyond motor functions. [ABSTRACT FROM AUTHOR]

Introduction: Hallucinations and delusions present with psychosis are debilitating non-motor symptoms of Parkinson's disease, with a prevalence of up to 50–70% at some point during the course of the disease. Often patients and caregivers do not report the presence of hallucinations or delusions unless specifically questioned. A panel of experts in neurology and geriatric psychiatry convened to develop a simple screening tool and guidance on diagnosis and treatment of Parkinson's disease psychosis (PDP). Methods: The working group reviewed literature for existing PDP guidelines on diagnosis and management and identified gaps in recommendations. The group discussed and developed a screening tool and treatment guidance that addressed the gaps in existing methodology based on their clinical experience. Results: The proposed screening tool consists of two parts: (1) a brief pre-visit screening portion to be completed by the patient and caregiver, and (2) a clinician portion to be completed via clinical interview of the patient and caregiver. If psychotic symptoms are present, an appropriate treatment plan is developed for PDP based on evaluation. Conclusions: This simple screening tool and treatment guidance offers a practical clinical approach for clinicians in the diagnosis and management of PDP. Plain Language Summary: Symptoms relating to psychosis are debilitating, progressive, and often emerge in patients with Parkinson's disease. Symptoms of Parkinson's disease psychosis include illusions, a false sense of presence, and hallucinations or delusions or both. While there are established consensus criteria for the diagnosis of Parkinson's disease psychosis, there is currently a lack of simple and standardized criteria for the screening of Parkinson's disease psychosis. This can make it challenging to identify patients who may benefit from treatment for Parkinson's disease psychosis symptoms. A group of clinical experts met to discuss guidance for the screening, clinical diagnosis, and management of Parkinson's disease psychosis. The group identified a paucity of screening tools, weaknesses in existing criteria for diagnosing Parkinson's disease psychosis, and variability in treatment recommendations. The group proposed a screening tool that includes two parts: (1) a simple pre-visit screening to be completed by the patient and caregiver before an appointment, and (2) a clinician portion to be discussed with the patient and caregiver during the appointment. If a patient has hallucinations and/or delusions that require treatment, the proposed guidance includes potential interventions or medications, which were established by review of evidence-based literature and the US Food and Drug Administration guidelines. This provides a quick and relatively simple clinical tool for a patient and caregiver to report symptoms of Parkinson's disease psychosis, and for the clinician to formulate an accurate diagnosis and a decision tree to consider treatment options. [ABSTRACT FROM AUTHOR]

Rationale: Mania (or manic episodes) is a common symptom of bipolar disorder and is frequently accompanied by hyperactivity and delusions; given the cost and resources available, there is a paucity of evidence for direct comparison of different drugs. Objectives: We aimed to provide evidence-based recommendations on the efficacy of overall currently used pharmacological treatments for patients with acute bipolar mania. Method: We conducted a systematic review and network meta-analysis (NMA) using a Bayesian network frame. We searched the primary literature databases without language restrictions until Dec 18, 2021, for reports of randomized controlled trials (RCTs) of suspected antimanic drugs used as monotherapy for patients with acute bipolar mania, with the primary outcomes being efficacy (mean difference (MD), standardized mean difference (SMD) in the change of mania score). Results: Eighty-seven studies were included in which 18,724 manic participants (mean age = 34.6 years, with 50.36% males) were allocated at random to one of 25 active medication drug therapies or placebo, resulting in 87 direct comparisons on 192 data points. Tamoxifen (− 22·00 [− 26·00 to − 18·00]) had the best efficacy over the placebo. Meanwhile, risperidone (− 6·60 [− 8·40 to − 4·90]) was substantially more effective than placebo in treating acute mania. Carbamazepine, haloperidol, ziprasidone, cariprazine, olanzapine, quetiapine, aripiprazole, lithium, paliperidone, asenapine, and divalproex were noticeably more effective than placebo. Conclusions: Overall, tamoxifen appears to be the most effective of the currently known pharmaceutical therapy available to treat acute mania or manic episodes; however, this conclusion is restricted by the scale of RCTs conducted, and risperidone was found to be the most effective medication among antipsychotics. Carbamazepine, haloperidol, ziprasidone, cariprazine, olanzapine, quetiapine, aripiprazole, lithium, paliperidone, asenapine, and divalproex were noticeably effective in treating acute mania or manic episodes. [ABSTRACT FROM AUTHOR]

There is now substantial evidence that childhood adverse events are a significant risk factor for symptoms of psychosis in both clinical and community samples. Both childhood trauma and positive symptoms of psychosis are associated with an increased risk of self-harming behaviours. Therefore the current study aimed to consider the relationship between retrospective reports of childhood adversity, sub-clinical positive symptoms of psychosis and self-harm in a non-clinical community sample. The study employed a cross-sectional survey design, distributed online. Participants were asked to complete psychometric assessments relating to: demographic characteristics including past-year substance misuse; childhood adversity; sub-clinical symptoms of psychosis (delusions and hallucinations) and self-harming behaviours. The results found that, after controlling for substance misuse, childhood adversity predicted significant variance in sub-clinical delusions and hallucinations in the general population. Both symptoms of psychosis and childhood adversity increased the risk of self-harming behaviours. Positive symptoms partially mediated the relationship between early adversity and self-harming behaviours. For some people, the sequelae of early adversity including sub-clinical delusions and hallucinations may increase the risk of self-harming behaviours. Future research would benefit from considering the role of dissociation in these relationships and the affective impact of pseudo-psychotic experiences. Practitioners should consider the impact of childhood adversity, unusual perceptual experiences and distorted beliefs when working with people who self-harm. The current research was limited by the cross-sectional survey design and non-random sampling methodology. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) has rapidly spread worldwide, leading to increased concerns about long-term patients' neuropsychiatric consequences. This study aims to describe the presence of depressive and anxiety symptoms in severe COVID-19 survivors and to identify associated baseline, in-hospital and post-discharge factors. This study is part of the MAPA longitudinal project conducted with severe COVID-19 patients admitted in Intensive Care Medicine Department (ICMD) of a University Hospital (CHUSJ) in Porto, Portugal. Patients with ICMD length of stay ≤ 24 h, terminal illness, major auditory loss or inability to communicate at follow-up assessment were excluded. All participants were assessed by telephone post-discharge (median = 101 days), with a comprehensive protocol assessing depressive and anxiety symptoms, cognition, Intensive Care Unit (ICU) memories recall and health-related quality of life. Out of a sample of 56 survivors (median age = 65; 68% males), 29% and 23% had depressive and anxiety symptoms, respectively. Depressive and anxiety symptoms were significantly more prevalent among younger survivors and were associated with cognitive complaints, emotional and delusions ICU memories and fear of having COVID-19 sequelae, sleep problems and pain after discharge (all p < 0.05). An important proportion of these survivors suffers from depression and anxiety symptoms post-discharge, namely younger ones and those who reported more cognitive complaints, ICU memories, fear of having COVID-19 sequelae, sleep problems and pain. These findings highlight the importance of psychological consequences assessment and planning of appropriate and multidisciplinary follow-up care after hospitalization due to COVID-19. [ABSTRACT FROM AUTHOR]

Delusions are often portrayed as paradigmatic instances of incomprehensibility and meaninglessness. Here we investigate the relationship between delusions and meaning from a philosophical perspective, integrating arguments and evidence from cognitive psychology and phenomenological psychopathology. We review some of the empirical and philosophical literature relevant to two claims about delusions and meaning: (1) delusions are meaningful, despite being described as irrational and implausible beliefs; (2) some delusions can also enhance the sense that one's life is meaningful, supporting agency and creativity in some circumstances. Delusions are not incomprehensible representations of reality. Rather, they can help make sense of one's unusual experiences and in some circumstances even support one's endeavours, albeit temporarily and imperfectly. Acknowledging that delusions have meaning and can also give meaning to people's lives has implications for our understanding of psychotic symptoms and for addressing the stigma associated with psychiatric conditions. [ABSTRACT FROM AUTHOR]

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Rationale: How striatal dopamine synthesis capacity (DSC) contributes to the pathogenesis of negative symptoms in first-episode schizophrenia (SZ) and delusional disorder (DD) has seldom been explored. As negative symptoms during active psychotic episodes can be complicated by secondary influences, such as positive symptoms, longitudinal investigations may help to clarify the relationship between striatal DSC and negative symptoms and differentiate between primary and secondary negative symptoms. Objective: A longitudinal study was conducted to examine whether baseline striatal DSC would be related to negative symptoms at 3 months in first-episode SZ and DD patients. Methods: Twenty-three first-episode age- and gender-matched patients (11 DD and 12 SZ) were consecutively recruited through an early intervention service for psychosis in Hong Kong. Among them, 19 (82.6%) patients (9 DD and 10 SZ) were followed up at 3 months. All patients received an 18F-DOPA PET/MR scan at baseline. Results: Baseline striatal DSC (Kocc;30–60) was inversely associated with negative symptoms at 3 months in first-episode SZ patients (rs = − 0.80, p = 0.010). This association remained in SZ patients even when controlling for baseline negative, positive, and depressive symptoms, as well as cumulative antipsychotic dosage (β = − 0.69, p = 0.012). Such associations were not observed in first-episode DD patients. Meanwhile, the severity of negative symptoms at 3 months was associated with more positive symptoms in DD patients (rs = 0.74, p = 0.010) and not in SZ patients. Conclusions: These findings highlight the role of striatal DSC in negative symptoms upon resolution of active psychotic episodes among first-episode SZ patients. Baseline striatal dopamine activity may inform future symptom expression with important treatment implications. [ABSTRACT FROM AUTHOR]

The rapid spread of conspiracy ideas associated with the recent COVID-19 pandemic represents a major threat to the ongoing and coming vaccination programs. Yet, the cognitive factors underlying the pandemic-related conspiracy beliefs are not well described. We hypothesized that such cognitive style is driven by delusion proneness, a trait phenotype associated with formation of delusion-like beliefs that exists on a continuum in the normal population. To probe this hypothesis, we developed a COVID-19 conspiracy questionnaire (CCQ) and assessed 577 subjects online. Their responses clustered into three factors that included Conspiracy, Distrust and Fear/Action as identified using principal component analysis. We then showed that CCQ (in particular the Conspiracy and Distrust factors) related both to general delusion proneness assessed with Peter's Delusion Inventory (PDI) as well as resistance to belief update using a Bias Against Disconfirmatory Evidence (BADE) task. Further, linear regression and pathway analyses suggested a specific contribution of BADE to CCQ not directly explained by PDI. Importantly, the main results remained significant when using a truncated version of the PDI where questions on paranoia were removed (in order to avoid circular evidence), and when adjusting for ADHD- and autistic traits (that are known to be substantially related to delusion proneness). Altogether, our results strongly suggest that pandemic-related conspiracy ideation is associated with delusion proneness trait phenotype. [ABSTRACT FROM AUTHOR]

While several scholars have argued that the rise of the internet has allowed an autistic culture to emerge over the past two decades, the question of whether people with autism or, as some members of this group refer to themselves, 'autists', are legally entitled to their own cultural rights has not been investigated. This article fills part of this lacuna by considering whether such entitlements exist from the perspective of human rights law. I start by showing that, insofar as (some) autists have their own culture(s), they are likely to be entitled to cultural rights under existing human rights treaties, before arguing that the absence of evidence that their beliefs, values, and behaviors are significantly shaped by distinct social norms renders it unclear whether they do in fact have their own culture(s). However, I end by arguing that, in terms of autists' entitlements from a human rights perspective, little seems to depend on this. [ABSTRACT FROM AUTHOR]

The insight experience (or 'Aha moment') generally evokes strong feelings of certainty and confidence. An 'Aha' experience for a false idea could underlie many false beliefs and delusions. However, for as long as insight experiences have been studied, false insights have remained difficult to elicit experimentally. That difficulty, in turn, highlights the fact that we know little about what causes people to experience a false insight. Across two experiments (total N = 300), we developed and tested a new paradigm to elicit false insights. In Experiment 1 we used a combination of semantic priming and visual similarity to elicit feelings of insight for incorrect solutions to anagrams. These false insights were relatively common but were experienced as weaker than correct ones. In Experiment 2 we replicated the findings of Experiment 1 and found that semantic priming and visual similarity interacted to produce false insights. These studies highlight the importance of misleading semantic processing and the feasibility of the solution in the generation of false insights. [ABSTRACT FROM AUTHOR]

What makes it permissible to reach out to hold someone's hand on a first date, or to rub a friend's back when she is crying? This paper, a contribution to the special issue on Doug Husak, argues that conventions, context, and relationships play a role in shifting normative boundaries, such that the default rule becomes that it is permissible to touch someone until she dissents (thereby creating a 'dissent-sensitive permission'). Part I of this paper focuses on convention-type cases, contrasting dates with the intentional touchings that occur on crowded streets or while playing football. Part II then addresses the range of normative justifications that track these different cases. Part III adds a different way that dissent-sensitive permissions can arise—from relationships and common ground. Part IV unearths the underlying rights-structure that my view presupposes and returns to the question of whether the theory I have on offer is one of consent. Part V argues that this approach, that these are alterations of permissibility, is superior to the view that conventions only impact the actor's blameworthiness by rendering his belief reasonable. Part VI raises questions of whether our understanding of consent dictates our understanding of dissent. [ABSTRACT FROM AUTHOR]

Introduction: Dementia-related psychosis (DRP) is characterized by hallucinations and delusions, which may increase the debilitating effects of underlying dementia. This network meta-analysis (NMA) evaluated the comparative efficacy, safety, and acceptability of atypical antipsychotics (AAPs) commonly used off label to treat DRP. Methods: We included 22 eligible studies from a systematic literature review of AAPs (quetiapine, risperidone, olanzapine, aripiprazole, and brexpiprazole) used off label to treat DRP. Study outcomes were: (1) efficacy—neuropsychiatric inventory-nursing home (NPI-NH psychosis subscale), (2) safety—mortality, cerebrovascular events (CVAEs), and others (somnolence, falls, fractures, injuries, etc.), and (3) acceptability—discontinuations due to all causes, lack of efficacy, and adverse events (AEs). We used random-effects modeling to estimate pooled standardized mean differences (SMDs) for NPI-NH psychosis subscale scores and odds ratios (OR) for other dichotomous outcomes, with their respective 95% confidence intervals (CIs). Results: Compared with placebo, aripiprazole (SMD − 0.12; 95% CI − 0.31, 0.06), and olanzapine (SMD − 0.17; 95% CI − 0.04; 0.02) demonstrated small, non-significant numerical improvements in NPI-NH psychosis scores (5 studies; n = 1891), while quetiapine (SMD 0.04; 95% CI − 0.23, 0.32) did not improve symptoms. The odds of mortality (15 studies, n = 4989) were higher for aripiprazole (OR 1.58; 95% CI 0.62, 4.04), brexpiprazole (OR 2.22; 95% CI 0.30, 16.56), olanzapine (OR 2.21; 95% CI 0.84, 5.85), quetiapine (OR 1.68; 95% CI 0.70, 4.03), and risperidone (OR 1.63; 95% CI 0.93, 2.85) than for placebo. Risperidone (OR 3.68; 95% CI 1.68, 8.95) and olanzapine (OR 4.47; 95% CI 1.36, 14.69) demonstrated significantly greater odds of CVAEs compared to placebo. Compared with placebo, odds of all-cause discontinuation were significantly lower for aripiprazole (OR 0.71; 95% CI 0.51, 0.98; 20 studies; 5744 patients) and higher for other AAPs. Aripiprazole (OR 0.5; 95% CI 0.31, 0.82) and olanzapine (OR 0.48; 95% CI 0.31, 0.74) had significantly lower odds of discontinuation due to lack of efficacy (OR 12 studies; n = 4382) compared to placebo, while results for quetiapine and risperidone were not significant. Compared with placebo, the odds of discontinuation due to AEs (19 studies, n = 5445) were higher for olanzapine (OR 2.62; 95% CI 1.75, 3.92), brexpiprazole (OR 1.80; 95% CI 0.80, 4.07), quetiapine (OR 1.25; 95% CI 0.82, 1.91), aripiprazole (OR 1.38; 95% CI 0.90, 2.13), and risperidone (OR 1.41; 95% CI 1.02, 1.94). Conclusions: Overall results demonstrate that, compared with placebo, quetiapine is not associated with improvement in psychosis in patients with dementia, while olanzapine and aripiprazole have non-significant small numerical improvements. These off-label AAPs (quetiapine, risperidone, olanzapine, aripiprazole, and brexpiprazole) are associated with greater odds of mortality, CVAEs, and discontinuations due to AEs than placebo. These results underscore the ongoing unmet need for newer pharmacological options with a more favorable benefit-risk profile for the treatment of DRP. [ABSTRACT FROM AUTHOR]

In this paper I explore health and illness through the lens of enactivism, which is understood and developed as a bodily-based worldly-engaged phenomenology. Various health theories – biomedical, ability-based, biopsychosocial – are introduced and scrutinized from the point of view of enactivism and phenomenology. Health is ultimately argued to consist in a central world-disclosing aspect of what is called existential feelings, experienced by way of transparency and ease in carrying out important life projects. Health, in such a phenomenologically enacted understanding, is an important and in many cases necessary part of leading a good life. Illness, on the other hand, by such a phenomenological view, consist in finding oneself at mercy of unhomelike existential feelings, such as bodily pains, nausea, extreme unmotivated tiredness, depression, chronic anxiety and delusion, which make it harder and, in some cases, impossible to flourish. In illness suffering the lived body hurts, resists, or, in other ways, alienates the activities of the ill person. [ABSTRACT FROM AUTHOR]

Our basic beliefs about reality can be impossible to prove and yet we can feel a strong intuitive conviction about them, as exemplified by insights that imbue an idea with immediate certainty. Here we presented participants with worldview beliefs such as "people's core qualities are fixed" and simultaneously elicited an aha moment. In the first experiment (N = 3000, which included a direct replication), participants rated worldview beliefs as truer when they solved anagrams and also experienced aha moments. A second experiment (N = 1564) showed that the worldview statement and the aha moment must be perceived simultaneously for this 'insight misattribution' effect to occur. These results demonstrate that artificially induced aha moments can make worldview beliefs seem truer, possibly because humans partially rely on feelings of insight to appraise an idea's veracity. Feelings of insight are therefore not epiphenomenal and should be investigated for their effects on decisions, beliefs, and delusions. [ABSTRACT FROM AUTHOR]

Though there is an extensive research literature on understanding and assessing individual modeling competencies, less attention has been given to characterizing the social context of the classroom in which modeling occurs. Yet a classroom's culture of modeling—its negotiated system of beliefs and values about the nature of modeling and what constitutes a complete, satisfactory solution to a modeling problem—has a shaping influence on its members' participation in modeling activities. Devising a means of assessing classroom modeling cultures is thus a crucial task for both research and praxis. In this article, we present an approach to operationally defining and assessing classroom modeling cultures, which is (a) based in quantitative analyses of discourse during whole-class presentations of modeling solutions, and (b) grounded in research in individual modeling competencies. We show how our assessment distinguishes the classroom modeling cultures of different classrooms and how it captures shifts over time in the modeling culture of a given classroom. Finally, we accompany our quantitative results with interpretive analyses of presentation discourse, to triangulate and to attribute meaning to the patterns our assessment detects. Our primary data sources include video recorded presentation and Q&A sessions for three modeling activities in each of two US middle school (Grades 5–8) classrooms. Our assessment approach is a significant contribution because it operationalizes the construct of a classroom's modeling culture, in terms that highlight potential connections with the research literature of individual modeling competencies. It therefore invites modeling research that coordinates learning and development across individual and social levels. [ABSTRACT FROM AUTHOR]

Objective. To analyze a set of EEG parameters and quantitative clinical assessments in patients with schizoaffective disorder to clarify the neurophysiological mechanisms of depressive-delusional states. Materials and methods. The study included 25 patients aged 22–40 years with depressive-delusional states. Patients' status was evaluated clinically before and at 4–6 weeks of treatment using the HDRS and PANSS scales. The EEG was recorded at each visit. Results. Significant correlations were found between spectral power in the initial baseline EEG in narrow frequency bands and quantitative assessments of patients' clinical status before and after treatment. Conclusions. The results clarify the cerebral mechanisms of depressive-delusional disorders and identify possible EEG predictors of therapeutic responses to treatment. [ABSTRACT FROM AUTHOR]

Monothematic delusions involve a single theme, and often occur in the absence of a more general delusional belief system. They are cognitively atypical insofar as they are said to be held in the absence of evidence, are resistant to correction, and have bizarre contents. Empiricism about delusions has it that anomalous experience is causally implicated in their formation, whilst rationalism has it that delusions result from top down malfunctions from which anomalous experiences can follow. Within empiricism, two approaches to the nature of the abnormality/abnormalities involved have been touted by philosophers and psychologists. One-factor approaches have it that monothematic delusions are a normal response to anomalous experiences whilst two-factor approaches seek to identify a clinically abnormal pattern of reasoning in addition to anomalous experience to explain the resultant delusion. In this paper we defend a one-factor approach. We begin by making clear what we mean by atypical, abnormal, and factor. We then identify the phenomenon of interest (monothematic delusion) and overview one and two-factor empiricism about its formation. We critically evaluate the cases for various second factors, and find them all wanting. In light of this we turn to our one-factor account, identifying two ways in which 'normal response' may be understood, and how this bears on the discussion of one-factor theories up until this point. We then conjecture that what is at stake is a certain view about the epistemic responsibility of subjects with delusions, and the role of experience, in the context of familiar psychodynamic features. After responding to two objections, we conclude that the onus is on two-factor theorists to show that the one-factor account is inadequate. Until then, the one-factor account ought to be understood as the default position for explaining monothematic delusion formation and retention. We don't rule out the possibility that, for particular subjects with delusions there may be a second factor at work causally implicated in their delusory beliefs but, until the case for the inadequacy of the single factor is made, the second factor is redundant and fails to pick out the minimum necessary for a monothematic delusion to be present. [ABSTRACT FROM AUTHOR]

Delusions are deeply evidence-resistant. Patients with delusions are unmoved by evidence that is in direct conflict with the delusion, often responding to such evidence by offering obvious, and strange, confabulations. As a consequence, the standard view is that delusions are not evidence-responsive. This claim has been used as a key argumentative wedge in debates on the nature of delusions. Some have taken delusions to be beliefs and argued that this implies that belief is not constitutively evidence-responsive. Others hold fixed the evidence-responsiveness of belief and take this to show that delusions cannot be beliefs. Against this common assumption, I appeal to a large range of empirical evidence to argue that delusions are evidence-responsive in the sense that subjects have the capacity to respond to evidence on their delusion in rationally permissible ways. The extreme evidence-resistance of delusions is a consequence of powerful masking factors on these capacities, such as strange perceptual experiences, motivational factors, and cognitive biases. This view makes room for holding both that belief is constitutively evidence-responsive and that delusions are beliefs, and it has important implications for the study and treatment of delusions. [ABSTRACT FROM AUTHOR]

The dominant conception of delusion in psychiatry (in textbooks, research papers, diagnostic manuals, etc.) is predominantly epistemic. Delusions are almost always characterized in terms of their epistemic defects, i.e., defects with respect to evidence, reasoning, judgment, etc. However, there is an individualistic bias in the epistemic conception; the alleged epistemic defects and abnormalities in delusions relate to individualistic epistemic processes rather than social epistemic processes. We endorse the social epistemological turn in recent philosophical epistemology, and claim that a corresponding turn is needed in the study of delusions. It is a turn from the (purely) individualistic conception, which characterizes delusions only by individualistic epistemic defects and abnormalities, to the (partially) social epistemic conception, which characterizes delusions by individualistic as well as social epistemic defects and abnormalities. This paper is intended as an initial step toward such a social epistemological turn. In particular, we will develop a new model of the development of delusions according to which testimonial abnormalities, including testimonial isolation and testimonial discount, are a causal factor in the development of delusions. [ABSTRACT FROM AUTHOR]

Eugen Bleuler, the founder of the concept of schizophrenia, pointed out that psychotic patients were able to live in two disjoint worlds (namely, the social, intersubjective world and the delusional world). He termed this phenomenon "double bookkeeping," but did not provide any conceptual elaboration of this phenomenon or its possible mechanisms. Double bookkeeping has been neglected in mainstream psychiatry, but it has been addressed in recent theoretical work, however mainly concerned with the issue of delusion. In this article, we present clinical material that supports the view that double bookkeeping manifests itself across various psychotic phenomena and its antecedent may be observed in premorbid (pre-onset) phases as well as in the schizotypal disorder. We try to conceptualize double bookkeeping to concretize an often atmospheric perception of paradoxicality in the encounter with the patient. A phenomenological analysis of double bookkeeping suggests an instability in the affective ("auto-affection") articulation of selfhood. We point to four main implications of our presentation: (1) diagnostic, (2) epistemological, (3) therapeutic and (4) pathogenetic research. [ABSTRACT FROM AUTHOR]

Although the sense of agency is often reduced if not absent in dreams, our agentive dream experiences can at times be similar to or enhanced compared to waking. The sense of agency displayed in dreams is perplexing as we are mostly shut off from real stimulus whilst asleep. Theories of waking sense of agency, in particular, comparator and holistic models, are analysed in order to argue that despite the isolation from the real environment, these models can help account for dream experience. The dreamer might feel an increased sense of control of their dream bodies and a sense that they can directly control elements of the dream world. Such experiences may at times be caused by superstitious or delusional thinking due to altered cognition and changes to the sleeping brain. Here it is argued that some such experiences are akin to specific waking delusions, such as delusions of grandeur, with similar cognitive features. However, other instances of increased sense of agency in dreaming appear to be sui generis and nothing like what we experience when awake. Lucid control dreams, in which the dreamer realises that they are dreaming and that they can control the dream environment, are examples of such an experience although further nuance is required to account for their specific cognitive attributes. Future empirical research should focus on controlled dream reporting conditions in order to clarify the types of experience that occur and determine the relevant cognitive mechanisms that relate to each type. [ABSTRACT FROM AUTHOR]

This article contrasts two beliefs about the relation between the emotions and the intellect. Each sees emotional responses as fundamental and primary sources of thinking. Each sees a different role for the intellect following emotional responses to worldly phenomena. L. S. Vygotsky, articulating a belief common at his time, sees the intellect as a disciplining force, one that, after a pause or interlude, serves to temper emotions to produce a "catharsis" and what he calls "intelligent emotions," those subjected to rational thought and a higher plane of cognition than either emotion or intellect could produce alone. Jonathan Haidt, following Vygotsky by nearly a century, asserts that emotions control cognition, rather than as Vygotsky conceives, being subordinated by reason. Haidt, in the tradition of David Hume and with more empirical data than Vygotsky provides for his view, sees the passions ruling human thought and action. Any accompanying reason serves to rationalize gut feelings rather than to control them; reason, Haidt argues, is a "rationalist delusion" that gives emotional thinking the veneer of reason. This article outlines both positions and attempts to reach a synthesis of their views. [ABSTRACT FROM AUTHOR]

Aims: Our 1-year pilot study aims to compare Behavioral and Psychological Symptoms of Dementia (BPSDs): number and frequency, globally an in sub-domains, and distress, of 20 residents with dementia, during periods with companion clown intervention and BPSDs during periods without companion clown intervention. Methods: A duo of accompanying clowns intervened 24 times for a total of 72 h (two interventions of 3 h each per week for 4 weeks, 3 months of the year spaced 13 weeks apart) in the Special Care Unit. This unit was dedicated to residents with severe BPSDs. BPSDs were measured monthly by Health Care Professional using Neuro-Psychiatric Inventory (NPI). Results: Baseline NPI total score of the 20 residents (10 women, mean age 76.9 years; standard deviation, SD 8.1, 70.6% with Alzheimer's disease) was 37.5 (SD = ± 19.7). The total score of the NPI was not significantly different between the periods with the clowns (median total score at 63; 25p-75p = 57–67) and the periods without the clowns (59; 25p-75p = 43–76) (p = 0.08). Compared to the period without clowns, residents presented significantly fewer delusions, hallucinations, euphoria, aberrant motor behavior but significantly more depression, apathy, disinhibition and more appetite disorders (all p value < 0.05). No statistically significant difference was observed on the distress the symptoms caused on the HCP during periods with the clowns. Conclusion: Accompanying clowns may not significantly reduce the overall BPSD of the residents, but may have beneficial effects in some behavioral issues. [ABSTRACT FROM AUTHOR]