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Background: Delusional ideations, one of neuropsychiatric symptoms (NPSs), are frequently shown in the long-term progression of Alzheimer's disease (AD), and comorbid with other NPSs including depression or agitation. Despite various types of delusional ideations, the comorbidity between each delusional ideation and depressive symptoms has not been discussed. Objective: The present cross-sectional study is aimed at testing the hypothetical mechanism of comorbid pattern in AD. Methods: Among 421 patients with AD, we analyzed the dataset of the Clinical Antipsychotic Trials of Intervention Effectiveness–Alzheimer's Disease to compare age, sex, racial type, Mini-Mental State Examination (MMSE) scores, and Neuropsychiatric Inventory (NPI) depression score of between the presence and absence of each delusional ideation (delusion of persecution, theft, jealousy, abandonment, phantom boarder, Capgras syndrome, misidentification of place, or television sign). Next, with the stratification based on MMSE score of < or > = 15 points, we further explored association between delusional ideation and depressive symptom that was found significances in the primary analysis Results: Among eight subtypes of delusional ideations, depression score was higher in those with persecution delusion or Capgras syndrome. Moreover, the Capgras syndrome was associated with presence of depression in severer global cognitive impairment status. Conclusions: As comorbid NPSs of delusional ideation in AD, depressive severity is associated with specific delusional subtype: persecution delusion and Capgras syndrome. Capgras syndrome may be attributable to severe cognitive impairment in addition to depressive symptom. The consideration of pathogenetic differences in the distinct delusional ideations may be helpful for clinicians to select the treatment strategy. [ABSTRACT FROM AUTHOR]

Personality disorders refer to a collection of mental health conditions defined by persistent deviations from societal norms in thoughts, behaviors, and emotions. These deviations frequently result in challenges in interpersonal relationships, self-perception, and overall functioning, potentially causing distress in various aspects of life. The DSM-5 classifies personality disorders into three clusters. Cluster A contains paranoid, schizoid and schizotypal personality disorders which are characterized by strange and eccentric behaviors. Cluster B contains narcissistic, histrionic and antisocial personality disorders which are characterized by dramatic and emotional behaviors. Cluster C contains avoidant, dependent and obsessive-compulsive personality disorders which are characterized by anxious and fearful behaviors.

Introduction: Schizophrenia is a severe mental disorder characterised by positive symptoms such as delusions and hallucinations, as well as negative symptoms including anhedonia, asociality, avolition, and affective blunting. It may also be associated with cognitive deficits. Sleep disturbances are commonly encountered in schizophrenia, and there may be variations in sleep patterns among its different subtypes. These differences in sleep patterns could have prognostic implications for the various subtypes of schizophrenia. Effective management of sleep disturbances could contribute to the recovery and wellbeing of individuals diagnosed with schizophrenia. Aim: To compare the differences in sleep architecture between the various subtypes of schizophrenia and to compare them with socio-demographically matched healthy volunteers. Materials and Methods: A cross-sectional study was conducted at the Institute of Psychiatry-Centre of Excellence, Kolkata, West Bengal, India over a duration of one year (May 2016 to June 2017). The study included 60 medication-naïve patients diagnosed with schizophrenia according to International Classification of Diseases (ICD)-10 criteria, and a control group of 30 demographically matched healthy volunteers. All study participants were aged between 18 and 60 years and free from any co-morbid illnesses. Patients with schizophrenia were further classified into four groups based on the ICD-10 subtypes: paranoid, hebephrenic, catatonic, and undifferentiated. Overnight polysomnography was performed to assess sleep parameters, including total record time, total sleep time, sleep onset latency, Rapid Eye Movement (REM), sleep latency, sleep efficiency, durations of Total Non Rapid Eye Movement (NREM) Sleep, Total REM sleep, and the different phases of NREM sleep. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Analysis of Variance (ANOVA), Chi-square, and t-test were used as applicable, with a p-value

Introduction: Schizophrenia is a severe mental disorder characterised by positive symptoms such as delusions and hallucinations, as well as negative symptoms including anhedonia, asociality, avolition, and affective blunting. It may also be associated with cognitive deficits. Sleep disturbances are commonly encountered in schizophrenia, and there may be variations in sleep patterns among its different subtypes. These differences in sleep patterns could have prognostic implications for the various subtypes of schizophrenia. Effective management of sleep disturbances could contribute to the recovery and wellbeing of individuals diagnosed with schizophrenia. Aim: To compare the differences in sleep architecture between the various subtypes of schizophrenia and to compare them with socio-demographically matched healthy volunteers. Materials and Methods: A cross-sectional study was conducted at the Institute of Psychiatry-Centre of Excellence, Kolkata, West Bengal, India over a duration of one year (May 2016 to June 2017). The study included 60 medication-naïve patients diagnosed with schizophrenia according to International Classification of Diseases (ICD)-10 criteria, and a control group of 30 demographically matched healthy volunteers. All study participants were aged between 18 and 60 years and free from any co-morbid illnesses. Patients with schizophrenia were further classified into four groups based on the ICD-10 subtypes: paranoid, hebephrenic, catatonic, and undifferentiated. Overnight polysomnography was performed to assess sleep parameters, including total record time, total sleep time, sleep onset latency, Rapid Eye Movement (REM), sleep latency, sleep efficiency, durations of Total Non Rapid Eye Movement (NREM) Sleep, Total REM sleep, and the different phases of NREM sleep. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 20.0. Analysis of Variance (ANOVA), Chi-square, and t-test were used as applicable, with a p-value <0.05 considered statistically significant. Results: The results showed a decrease in sleep efficiency, total sleep time, and shorter duration of mean N1, N2, and N3 sleep in schizophrenia patients compared to the control group. There was a significant difference in N3 sleep duration, reduced duration of total NREM and REM sleep, reduced REM latency, increased sleep onset latency, and the number of awakenings during sleep in schizophrenia patients. Statistically significant differences (p-values <0.05) were also noted in some sleep parameters among the various subtypes of schizophrenia. The paranoid subtype had the shortest REM latency, while the catatonic subtype had the longest. The hebephrenic subtype had the lowest percentage of REM sleep and sleep efficiency, while the catatonic subtype had the highest. The duration of Slow Wave Sleep (SWS) was lowest in the undifferentiated subtype and highest in the catatonic subtype. Conclusion: This study reveals significant differences in sleep patterns between patients with schizophrenia and the control group, as well as among the various subtypes of schizophrenia. These distinctions provide insight into the relationship between schizophrenia subtypes, sleep irregularities, and clinical consequences. Further investigation is necessary to explore differences in sleep architecture among the various subtypes of schizophrenia and yield clinically meaningful results. [ABSTRACT FROM AUTHOR]

Aim: Interpersonal sensitivity and mistrust are the main characteristics of cluster A personality disorders (CAPD) which might be due to the high accessibility to negative suggestions from environments. Yet the exact associations between hypnotic suggestibility and their personality disorder functioning styles remain unclear. Methods: We invited 36 patients with CAPD and 115 healthy volunteers to undergo the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) and Parker Personality Measure (PERM). Results: Compared to controls; patients scored higher on PERM paranoid; schizoid; schizotypal; borderline; avoidant; and dependent styles; on the SHSS:C total and "challenge suggestions", and the passing rates of "hand lowering", "arm rigidity", "dream", and "arm immobilization". In patients, "dream" negatively predicted the schizoid; "hallucinated voice" negatively the schizotypal; "mosquito hallucination" positively the histrionic and dependent; and "arm immobilization" negatively the avoidant style. Conclusions: Our results suggested that the insusceptibility to perceptual suggestions from others and the high control over body contribute to the paranoid attitude and interpersonal avoidance in CAPD. These findings help to understand the cause of interpersonal problems in these patients and suggest the trial of hypnotherapy for them. [ABSTRACT FROM AUTHOR]

Schizophrenia is a mental condition not only affecting routine of daily life but also the Quality of life with devastating consequences for affected individuals and their families. This review aims to detect the scope of homoeopathy in the management of schizophrenia. A search is done in search engines of Google Scholar, PubMed, Cochrane, CINAHL PsycINFO, Hom-Inform, etc in the English language from anytime. Identified articles on homoeopathy in schizophrenia is collected and summarised in this review. Though studies are scarce, the available data shows scope for future research in homoeopathy in schizophrenia. [ABSTRACT FROM AUTHOR]

IEI-EMF refers to an environmental illness whose primary feature is the occurrence of symptoms that are attributed to exposure to weak electromagnetic fields (EMFs). There is a growing evidence that this condition is characterized by marked individual differences thus a within-subject approach might add important information beyond the widely used nomothetic method. A mixed qualitative/quantitative idiographic protocol with a threefold diagnostic approach was tested with the participation of three individuals with severe IEI-EMF. In this qualitative paper, the environmental, psychosocial, and clinical aspects are presented and discussed (results of ecological momentary assessment are discussed in Part II of this study). For two participants, psychopathological factors appeared to be strongly related to the condition. Psychological assessment indicated a severe pre-psychotic state with paranoid tendencies, supplemented with a strong attentional focus on bodily sensations and health status. The psychological profile of the third individual showed no obvious pathology. Overall, the findings suggest that the condition might have uniformly been triggered by serious psychosocial stress for all participants. Substantial aetiological differences among participants with severe IEI-EMF were revealed. The substantial heterogeneity in the psychological and psychopathological profiles associated with IEI-EMF warrants the use of idiographic multimodal assessments in order to better understand the different ways of aetiology and to facilitate person-taylored treatments.

Introduction Parental Alienation Syndrome (PAS) was proposed by Richard A. Gardner in 1985. It is assumed to occur in some distressing marriage break-ups, when a parent “brainwashes” his children so they reject the other parent in an unjustified way. But, is it the result of a conscious act as Gardner suggests? Or could it also appear as part of a shared psychosis? Objectives To assess the possibility of the appearance of PAS as a consequence of paranoid contagion or shared psychosis. Methods We present the case of a 45-year-old patient and her 9-year-old daughter, who is allegedly assaulted by her father during visits, according to both. Mother and daughter continually request attention in the emergency department for this reason, with no obvious injuries. A bibliographic review is carried out on the PAS and shared psychosis. We compare the existing data with our case. Results A paranoid cognitive style is observed in the 45-year-old patient, and it is observed that her daughter stops rejecting the father when she spends time separated from her. The contagion of delirium is the nuclear mechanism of shared psychosis. It is known that children with PAS may have distorted memories and incorporate beliefs of others through suggestion. There is also an inverse relationship between the number of visits by the alienated parent and the undervaluation of the child. We have not found any studies linking shared psychosis with PAS. Conclusions The existing bibliography on PAS is scarce. The possibility of an existing paranoid contagion mechanism has not been addressed yet. Disclosure No significant relationships.

We investigated (a) whether psychosocial factors (experienced stress, anticipatory worry, social detachment, sleeping disturbances, alcohol use) predict the course of paranoid ideation between the ages of 24 to 50 years and (b) whether the predictive relationships are more likely to proceed from the psychosocial factors to paranoid ideation, or vice versa. The participants (N = 1534–1553) came from the population-based Young Finns study. Paranoid ideation and psychosocial factors were assessed by reliable self-report questionnaires in 2001, 2007, and 2011/2012. The data were analyzed using growth curve and structural equation models. High experienced stress, anticipatory worry, social detachment, frequent sleeping disturbances, and frequent alcohol use predicted more paranoid ideation. More risk factors predicted increasing paranoid ideation. There were bidirectional predictive relationships of paranoid ideation with experienced stress, anticipatory worry, social detachment, and sleeping disturbances. The link between alcohol use and paranoid ideation was only correlative. In conclusion, paranoid ideation increases by reciprocal interactions with stress, worry, social detachment, and sleeping disturbances. The findings support the threat–anticipation model of paranoid ideation, providing important implications for treatment of paranoia. [ABSTRACT FROM AUTHOR]

Objective: Rare coexistence of disease or pathology. Background: Schizophrenia and anorexia nervosa are challenging mental disorders. In cases in which the cognitive-affective drivers eliciting abnormal eating behaviors strongly influence diagnostic accuracy and treatment planning, it is important to be extremely thorough in differentiating between the phenomenology of delusions, obsessions, and overvalued ideas. Case Report: Here we present an unusual relationship between anorexia nervosa and schizophrenia and also an update on diagnosing them according to the new ICD-11 classification system. The case illustrates a 44-year-old Romanian woman who had met the criteria for eating disorder from the age of 15 to 22 years, subsequently developed a psychotic break, and ultimately had schizophrenia from the age of 22 to 44 years (present time). This case report focuses on the dual diagnosis of a psychotic disorder and an eating disorder, with discussions based on the literature available on the topic. Conclusions: Schizophrenia can be considered a disabling mental disorder, but in association with a diagnosis of anorexia nervosa, the patient usually requires immediate admission and medical care in a coordinated and sustained manner. Symptoms of anorexia nervosa might manifest in the active phase of psychosis, precede psychosis, or, less commonly, manifest during the residual phase of the illness. Nevertheless, when these 2 disorders are combined, we can assume that the treatment plan is even more difficult to handle, requiring a multi-disciplinary team. Therefore, to provide adequate clinical care, a proper diagnosis must be made. The complex nature of the interrelationship between psychotic disorders and eating disorders requires further research. [ABSTRACT FROM AUTHOR]

GABAergic interneuron dysfunction has been implicated in the pathophysiology of schizophrenia. Expression of glutamic acid decarboxylase (GAD), a key enzyme in GABA synthesis, may also be altered. Here, we have simultaneously evaluated GAD-immunoreactive (GAD-ir) neuropil and cell profiles in schizophrenia-relevant brain regions, and analysed disease-course related differences. GAD65/67 immunoreactivity was quantified in specific brain regions for profiles of fibres and cell bodies of interneurons by automated digital image analysis in post-mortem brains of 16 schizophrenia patients from paranoid (n = 10) and residual (n = 6) diagnostic subgroups and 16 matched controls. Regions of interest were superior temporal gyrus (STG) layers III and V, mediodorsal (MD) and laterodorsal (LD) thalamus, and hippocampal CA1 and dentate gyrus (DG) regions. A reduction in GAD-ir neuropil profiles (p < 0.001), particularly in STG layer V (p = 0.012) and MD (p = 0.001), paralleled decreased GAD-ir cell profiles (p = 0.029) in schizophrenia patients compared to controls. Paranoid schizophrenia patients had lower GAD-ir neuron cell profiles in STG layers III (p = 0.007) and V (p = 0.001), MD (p = 0.002), CA1 (p = 0.001) and DG (p = 0.043) than residual patients. There was no difference in GAD-ir neuropil profiles between paranoid and residual subgroups (p = 0.369). These results support the hypothesis of GABAergic dysfunction in schizophrenia. They show a more prominent reduction of GAD-ir interneurons in paranoid versus residual patients, suggestive of more pronounced GABAergic dysfunction in the former. Fully automated analyses of histological sections represent a step towards user-independent assessment of brain structure. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have examined paranoid, schizotypal, social anxiety, and social problem-solving traits, but research that examines the relationship between paranoid and schizotypal traits with social anxiety and social problem-solving among students has been neglected. Aims: The purpose of this study was to investigate the relationship between paranoid and schizotypal traits with social anxiety and social problem solving among students. Method: The research method was correlation. In this study 387 students of Payam Noor University of Tabriz were selected by stratified random sampling. Research questionnaires included the Paranoid Scales of Green et al. (2008); Schizotypy Claridge and Brooks (1984); Druzila et al. (2002) problem solving ability; Data were analyzed using Pearson correlation test and multiple regression. Results: The results showed a significant negative relationship between schizotypal traits with logical problem solving and paranoid traits with positive orientation and logical problem solving (P< 0/01). Also, paranoid and schizotypal traits had a significant positive relationship with negative orientation, arousal style, avoidant style and social anxiety components (P< 0/01). Concurrent regression results showed that predictors of social anxiety and social problem solving predict 46% and 17% variance of paranoid and schizotypal traits, respectively. Conclusions: Paranoid and schizotypal traits can predict social anxiety.

Introduction: Paranoid thoughts are common symptom in schizophrenia spectrum disorders. Evidence reveals the role of cognitive factors in these thoughts. Aim: The present study was conducted in other to predict the paranoid thoughts basing on cognitive biases and self-reflection in patients with schizophrenia. Method: The correlational method was used in this study. The whole patients with schizophrenia, hospitalized in Isar and Fatemi psychiatric hospitals of Ardabil city in the second half of 2017 year, comprised statistical population of this study. Among this population, One hundred and twenty six patients were selected by purposeful sampling method and participated in this study. Paranoid thoughts questionnaire, Davos Assessment of Cognitive Biases Scale and self-reflection and insight scale were used to gather data. The gathered data were analyzed by Pearson correlation and multivariate regression tests. Results: The correlational results showed that paranoid thoughts are positively related to Jumping to conclusions bias, belief inflexibility bias, attention for threat bias, external attribution bias, social cognition problems, subjective cognitive problems, safety behavior and total score of cognitive biases, but related negatively to insights and total score of self-reflection and insight. The results of regression analysis also showed that 57% of variance of the paranoid thoughts was explained by cognitive biases, and 36% of them explained by self-reflection and insight. Conclusion: The results of this study demonstrated that cognitive biases in thoughts and low self-reflection can be predictive factors for paranoid thoughts in patients with schizophrenia. Thus, the cognitive interventions targeted these variables can be used to improve the paranoid thought in these patients.

Aim: Interpersonal sensitivity and mistrust are the main characteristics of cluster A personality disorders (CAPD) which might be due to the high accessibility to negative suggestions from environments. Yet the exact associations between hypnotic suggestibility and their personality disorder functioning styles remain unclear. Methods: We invited 36 patients with CAPD and 115 healthy volunteers to undergo the Stanford Hypnotic Susceptibility Scale: Form C (SHSS:C) and Parker Personality Measure (PERM). Results: Compared to controls; patients scored higher on PERM paranoid; schizoid; schizotypal; borderline; avoidant; and dependent styles; on the SHSS:C total and “challenge suggestions”, and the passing rates of “hand lowering”, “arm rigidity”, “dream”, and “arm immobilization”. In patients, “dream” negatively predicted the schizoid; “hallucinated voice” negatively the schizotypal; “mosquito hallucination” positively the histrionic and dependent; and “arm immobilization” negatively the avoidant style. Conclusions: Our results suggested that the insusceptibility to perceptual suggestions from others and the high control over body contribute to the paranoid attitude and interpersonal avoidance in CAPD. These findings help to understand the cause of interpersonal problems in these patients and suggest the trial of hypnotherapy for them.

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OBJECTIVE: Schizophrenia, commonly develops in adolescents and young adults and Paranoid is the most common type. Newly progress in molecular biology and imaging techniques has enabled new insight into schizophrenia research. Recent research reveals the key roles of D3, D4 and D5 dopamine receptor in presenting types of schizophrenia, particularly the paranoid. The purpose of this study was to the evaluation of D5 along with D3 dopamine receptor expression in schizophrenia patients. METHOD: 96 venous blood from 51 drug-free, 15 naive and 30 healthy were prepared and their expression level of mRNA for D3 and D5 dopamine receptor were investigated based on β-actin expression as housekeeping gene. RESULTS: D3 expressed about 33.3%, 73.3% and 27.4% in healthy, naive and drug-free patients respectively, but D5 just expressed in 86.6% of healthy samples and none of the patients were expressed D5. CONCLUSION: Expression frequency of D3 and D5 dopamine receptor reveals significant differences between naïve and drug-free patient against healthy individuals. D3 and D5, both have the possible potential for almost more accurate diagnosis usage, and the severity of the disease could be related to the D5 dopamine receptor.

Introduction The suspiciousness of a paranoid patient could reach extremes. Objectives To present the lessons learned after an interview with a similar patient. Methods Case report. Results Fifty-two year old woman suffering from paranoid schizophrenia (F20.0). Symptoms almost identical to her previous (two) hospitalizations: delusions of thought reading and of being surveilled by electronic equipment in her house/neighborhood. This time, though, she was additionally convinced of being the object of medical experiments and of being electronically surveilled even within the ward. Treatment: risperidone 12mg/day, lorazepam 3.75mg/day, biperiden 2mg/day. Three weeks after admission, the author noted a slight tremor in her hands (most certainly of extrapyramidal origin). I asked her to place both hands in front of her, fingers wide open, to assess it better. The patient followed with the fingers attached, though. Consequently, I approached my hands to hers -to show how it should be done correctly-, touching them lightly. Then, a spark was generated between our hands. Evidently, it was an electrostatic discharge (I was wearing a wool sweater that day; static electricity could easily accumulate on wool). She became outraged: “what kind of experiments are you doing to me?”, “what electronic devices are you using?”, “this is the proof of what I have been constantly saying”. Conclusions The symptoms of psychotic relapses could evolve over time. A clinician should refrain from any strictly unnecessary physical contact with an exceedingly paranoid patient, particularly when the latter claims that is the object of “medical experiments”. The elaborative “ability” of such patients could be, simply, astounding. Disclosure No significant relationships.

It has recently been discovered that large companies and nations "observe" their customers and citizens, disregarding any remaining moral and technological lines, being able to listen to telephone conversations and monitoring communications, through powerful monitoring and surveillance programs. Elsewhere on the planet, nations in turmoil or wrapped in a cloak of censorship persecute their citizens, controlling them by denying them access to the free Web without the threat of repercussions that threatens their dignity. To support the present research, an analysis of platforms that allow anonymous and secure browsing and a study of technologies and programs with potential privacy breach and computer intrusion were performed. The main objective of this work was to analyse the computer monitoring and surveillance technologies, identifying the available tools, trying to find potential solutions, developing and providing a methodology that enhances any desktop, server or mobile operating system, with characteristics that combat the exposed in this summary. [ABSTRACT FROM AUTHOR]

Introduction: Paranoid thoughts are common symptom in schizophrenia spectrum disorders. Evidence reveals the role of cognitive factors in these thoughts. Aim: The present study was conducted in other to predict the paranoid thoughts basing on cognitive biases and self-reflection in patients with schizophrenia. Method: The correlational method was used in this study. The whole patients with schizophrenia, hospitalized in Isar and Fatemi psychiatric hospitals of Ardabil city in the second half of 2017 year, comprised statistical population of this study. Among this population, One hundred and twenty six patients were selected by purposeful sampling method and participated in this study. Paranoid thoughts questionnaire, Davos Assessment of Cognitive Biases Scale and self-reflection and insight scale were used to gather data. The gathered data were analyzed by Pearson correlation and multivariate regression tests. Results: The correlational results showed that paranoid thoughts are positively related to Jumping to conclusions bias, belief inflexibility bias, attention for threat bias, external attribution bias, social cognition problems, subjective cognitive problems, safety behavior and total score of cognitive biases, but related negatively to insights and total score of self-reflection and insight. The results of regression analysis also showed that 57% of variance of the paranoid thoughts was explained by cognitive biases, and 36% of them explained by self-reflection and insight. Conclusion: The results of this study demonstrated that cognitive biases in thoughts and low self-reflection can be predictive factors for paranoid thoughts in patients with schizophrenia. Thus, the cognitive interventions targeted these variables can be used to improve the paranoid thought in these patients. [ABSTRACT FROM AUTHOR]

Law is a justice system defend those, who cannot defend themselves. In Pakistan, many cases of death sentence with severe psychosis illness are reported from last couple of years. It seems, there is no mercy in law for severe mental illness. The main objective of the research is to review the existing practice of law for convicted person with severe mental illness as schizophrenia. In a murder case, Imdad Ali was sentenced to death in 2002. The death penalty was endorsed by The High Court, Supreme Court and president of Pakistan. The Supreme Court not only rejected the plea, also ordered that mental illnesses such as schizophrenia does not amount to mental disorder, hence cannot subjugate the execution of death penalty. The Law in Pakistan defend the insanity or lunatic according to the Law defined by Pakistan Penal Code (1860) section 84. In Light of Law, anyone who is charged of any offence committed by him/her due to any mental impairment, should not held liable for any criminal act. The Supreme Court of Pakistan had made an erroneous judgment in the case of Imdad Ali and punished a diagnosed schizophrenic person (categorized as paranoid schizophrenia). Findings of research suggest to introduce evidencebased practice to create awareness of laws, mental health (assessment and treatment) under supervision of legal advisors, forensic psychologists and psychiatric practitioners. More research is needed for deep insight for mental health and effective policy making and law enforcement. [ABSTRACT FROM AUTHOR]

Background: Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP ("Successful Treatment of Paranoia")., Objective: This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype., Methods: We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts., Results: All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ≥1; control items: ≤1, readability: ≥3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users' ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful., Conclusions: Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users., (©Che-Wei Hsu, Daniel Stahl, Elias Mouchlianitis, Emmanuelle Peters, George Vamvakas, Jeroen Keppens, Miles Watson, Nora Schmidt, Pamela Jacobsen, Philip McGuire, Sukhi Shergill, Thomas Kabir, Tia Hirani, Ziyang Yang, Jenny Yiend. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 08.12.2023.)

(SC); both deficits are associated with symptom severity, neuro-cognitive deficits, and prognosis. This study aimed to determine symptom severity and two domains of SC deficit by assessing specific areas of PMA in schizophrenia patients. Methods: This cross-sectional study included 60 male and 60 female patients with paranoid schizophrenia aged 20 to 35 years from two psychiatric inpatient departments of Chhattisgarh state of India. They were assessed using the Scale for Assessment of Positive Symptoms, Scale for Assessment of Negative Symptoms, Premorbid Adjustment Scale, Recognition of Facial Expression Task, and Picture Arrangement Test. Results: Deficits in premorbid sociability and in scholastic performance were the best predictors of severity of positive symptoms, social knowledge, and negative emotion recognition deficit in schizophrenia patients. Conclusion: Given the important role of SC and PMA, assessing premorbid functioning can help in deciding early and appropriate intervention for schizophrenia. [ABSTRACT FROM AUTHOR]

Summary: Introduction: Psychotic spectrum disorder (PSD) links the syndromes of bipolar disorder, psychotic depression, and schizophrenia, often viewed as unique disorders. Aims: Application of the PSD concept to a single patient rather than across groups of patients and demonstration of a remarkable remission of schizophrenia phenotype with recovery of gray matter in specific brain regions. Results: We report a woman who experienced discrete, nonoverlapping periods of each of the above syndromes, in the order noted, over a 30‐year period, followed by abrupt ending of psychosis and full remission lasting at least 7 years. This patient had 2 episodes of Bipolar 1 mania, followed by a 20‐year period of psychotic depression. From ages 35‐48, she manifested severe, paranoid schizophrenia with marked functional decline. She became refractory to antipsychotic drugs, including oral risperidone and clozapine. At age 48, while participating in a double‐blind, 6‐month clinical trial of long‐acting injectable risperidone (Consta®, 100 mg IM biweekly) for treatment‐resistant schizophrenia, at week 23, upon awakening, complete disappearance of psychosis and marked improvement in function was noted, which persisted until the present (approximately 7 years). Remarkably, cognitive test performance in most domains improved beginning at 6 weeks and reached normal levels in executive function, despite minimal improvement in psychosis until week 23. MRI studies before and after remission revealed unique and substantial increases in gray matter of the cingulate and parietal cortex, and subthalamic nucleus, not seen in other patients in this study. Conclusions: The 3 discrete periods of psychopathology support the diagnosis of PSD. The unusual course and outcome, including remarkable improvement, in executive function and enhanced cortical gray matter in selective brain regions may have been the result of unique endogenous genetic and epigenetic factors and effect of medication. [ABSTRACT FROM AUTHOR]

Background: Glutamic acid decarboxylase (GAD) is a key enzyme in GABA synthesis and alterations in GABAergic neurotransmission related to glial abnormalities are thought to play a crucial role in the pathophysiology of schizophrenia. This study aimed to identify potential differences regarding the neuropil expression of GAD between paranoid and residual schizophrenia.Methods: GAD65/67 immunostained histological sections were evaluated by quantitative densitometric analysis of GAD-immunoreactive (ir) neuropil. Regions of interest were the hippocampal formation (CA1 field and dentate gyrus [DG]), superior temporal gyrus (STG), and laterodorsal thalamic nucleus (LD). Data from 16 post-mortem schizophrenia patient samples (10 paranoid and 6 residual schizophrenia cases) were compared with those from 16 matched controls.Results: Overall, schizophrenia patients showed a lower GAD-ir neuropil density (P=0.014), particularly in the right CA1 (P=0.033). However, the diagnostic subgroups differed significantly (P<0.001), mainly because of lower right CA1 GAD-ir neuropil density in paranoid versus residual patients (P=0.036) and controls (P<0.003). Significant GAD-ir neuropil reduction was also detected in the right STG layer V of paranoid versus residual schizophrenia cases (P=0.042). GAD-ir neuropil density correlated positively with antipsychotic dosage, particularly in CA1 (right: r=0.850, P=0.004; left: r=0.800, P=0.010).Conclusion: Our finding of decreased relative density of GAD-ir neuropil suggests hypofunction of the GABAergic system, particularly in hippocampal CA1 field and STG layer V of patients with paranoid schizophrenia. The finding that antipsychotic medication seems to counterbalance GABAergic hypofunction in schizophrenia patients suggests the possibility of exploring new treatment avenues which target this system. [ABSTRACT FROM AUTHOR]

Working to establish analytic contact (Waska, 2007) with a patient involves the verbal act of interpretation. But, how one interprets and what we try to hold in words is not the same with each patient. Each patient requires, invites, provokes and responds to a unique mixture of interpretive elements or approaches. The projective identification process that is so often the bedrock of the transference, and therefore the catalyst of the counter-transference, forms the psychological climate between patient and analyst. Case material is used to explore a Modern Kleinian interpretive approach with both a very entrenched depressive position (Klein, 1935, 1940) patient and a very primitive paranoid-schizoid (Klein, 1946) patient. Both these individuals desired relief from their symptoms of anxiety, anger, emptiness, and guilt. But, their unbearable unconscious phantasies offered pathological security that they were familiar with and therefore they preferred the known internal trauma and chaos to facing the unknown and undefined reality of self and other that change, grief, and growth would bring. [ABSTRACT FROM AUTHOR]

Human telomeres consist of tandem nucleotide repeats (TTAGGG) and associated proteins, and telomere length (TL) is reduced progressively with cell division over the lifespan. Telomere erosion might be accelerated or prevented to varying degrees when exposure to serious medical illnesses. In previous studies, an association between TL decrease and schizophrenia has been extensively reported; however, the results remain largely controversial. To further investigate TL in schizophrenia patients and reconcile this controversy, we first measured leucocyte TL (LTL) in our samples (52 paranoid schizophrenia, 89 non-paranoid patients and 120 controls), and then conducted a comprehensive meta-analysis of the existing results of LTL in patients of schizophrenia compared to healthy subjects. Totally, 11 studies encompassing 1243 patients of schizophrenia and 1274 controls were included in the final meta-analysis model. In our samples, significant reduction of LTL in paranoid schizophrenia was observed compared to controls (F = 50.88, P < 0.001); whereas there was no significant difference in LTL between non-paranoid schizophrenia and controls (F = 0.842, P = 0.360). For meta-analysis, random-effects model showed significant LTL decrease in patients of schizophrenia when compared to controls (Z = 2.07, P = 0.039, SMD = −0.48, 95% CI = −0.94 to −0.03). Moreover, a marginal decrease in LTL was observed in medicated patients (Z = 1.92, P = 0.055, SMD = −0.58, 95% CI = −1.18–0.01) and those patients with poor response to antipsychotics (Z = 1.76, P = 0.078, SMD = −0.60, 95% CI = −1.27–0.07). In conclusion, we observed significant reduction of LTL in individuals with schizophrenia compared with controls. However, all the studies included in the meta-analysis were cross-sectional, and better controlled long-term studies are needed to replicate this result. [ABSTRACT FROM AUTHOR]

Objective: The main purpose of this study was the assay of language disorders in paranoid and non – paranoid long-stay Schizophrenic patients in Razi Psychiatric Center. Materials & Methods: Language disorders in 40 Schizophrenic Patients who were divided in 2 groups (paranoid and non – paranoid No: 20) male and female and studied by using Farsi Aphasia Test. All of the subjects were matched on the basis of gender, age, education, duration of illness and length of stay in hospital. The evaluated language skills were composed of Spontaneus Verbal Fluency, Descriptive Verbal Fluency, Quality of Spontaneus Speech, Quality of Descriptive Speech, Listening Comprehension, Oral Reading (Expression), Written Comprehension, Writing, (words), Repetition and Number of Words. Data were analysed by using of SPSS windows analysis. Results: show a global reduction in scores of skills compared with normal subjects and the most reduction is seen in Quality of Descriptive Speech, Fluency of Descriptive speech and Number of Words Skills. Conclusion: Paranoid patients versus non paranoids show significant differences in Fluency of Descriptive Speech, Listening Comprehension, Oral Reading and Number of Words, and global score of the test. among demographic variants, only educational situation has significant relevance with some items of the test.

This report presents a 52-year-old woman who was admitted to nephrology ward with hypernatremia. She shared a persecutory delusion of poisoning with her 22-year-old daughter and did not feed her 8-year-old son due to her delusion.

Persecutory delusions are a clinically important symptom in schizophrenia associated with social avoidance and increased violence. Few studies have investigated the neurobiology of persecutory delusions, which is a prerequisite for developing novel treatments. The aim of this two-paradigm functional magnetic resonance imaging (fMRI) study is to characterize social “real world” and linguistic threat brain activations linked to persecutory delusions in schizophrenia ( n =26) using instructed-fear/safety and emotional word paradigms. Instructed-fear/safety activations correlated to persecutory delusion severity demonstrated significant increased lateral orbitofrontal cortex and visual association cortex activations for the instructed-fear vs. safety and instructed-fear vs. baseline contrasts; decreased lateral orbitofrontal cortex and ventral occipital-temporal cortex activations were observed for the instructed-safety stimuli vs. baseline contrast. The salience network also showed divergent fear and safety cued activations correlated to persecutory delusions. Emotional word paradigm analyses showed positive correlations between persecutory delusion severity and left-lateralized linguistic and hippocampal–parahippocampal activations for the threat vs. neutral word contrast. Visual word form area activations correlated positively with persecutory delusions for both threat and neutral word vs. baseline contrasts. This study links persecutory delusions to enhanced neural processing of threatening stimuli and decreased processing of safety cues, and helps elucidate systems-level activations associated with persecutory delusions in schizophrenia. [ABSTRACT FROM AUTHOR]

The central serotonergic system is implicated in the pathogenesis of schizophrenia, where the imbalance between dopamine, serotonin and glutamate plays a key pathophysiological role. The dorsal raphe nucleus (DRN) is the main source of serotonergic innervation of forebrain limbic structures disturbed in schizophrenia patients. The study was carried out on paraffin-embedded brains from 17 (8 paranoid and 9 residual) schizophrenia patients and 28 matched controls without mental disorders. The transcriptional activity of ribosomal DNA (rDNA) in DRN neurons was evaluated by the AgNOR silver-staining method. An increased rDNA transcriptional activity was found in schizophrenia patients in the cumulative analysis of all DRN subnuclei ( t test, P = 0.02). Further subgroup analysis revealed that it was an effect specific for residual schizophrenia versus paranoid schizophrenia or control groups (ANOVA, P = 0.002). This effect was confounded neither by suicide nor by antipsychotic medication. Our findings suggest that increased activity of rDNA in DRN neurons is a distinct phenomenon in schizophrenia, particularly in residual patients. An activation of the rDNA transcription in DRN neurons may represent a compensatory mechanism to overcome the previously described prefrontal serotonergic hypofunction in this diagnostic subgroup. [ABSTRACT FROM AUTHOR]

This article is a literature review that aims to characterize the Paranoid Personality Disorder, identify the etiological factors, disease course and analyze some successful psychotherapeutic interventions with this Person- ality Disorder. The main features of the Paranoid Personality Disorder are distrust, hostility, coldness and rigidity to others. Referring to its etiology, the studies indicate that there is still no specific cause of the disorder, however it may be related to biological and genetic factors, and also with social and family factors. According to the studies analyzed, the course of the disorder is variable, may the symptoms remain over the time or reduce its intensity with the passage of time itself. Treatments may be of pharmacological and/or of psychotherapeutic nature, studies prove the effectiveness of various psychotherapeutic approaches. [ABSTRACT FROM AUTHOR]

The current study was the first one to reveal the contribution of DRD3 methylation to the risk of different (SCZ) subtypes. This study comprised a total of 30 paranoid (15 males and 15 females) and 29 undifferentiated (15 males and 14 females) SCZ patients and 26 age- and gender-matched controls. Our results showed a significant association of CpG2 with SCZ. A breakdown analysis by gender showed that CpG2 and CpG3 methylation were significantly higher in male patients than male controls, and that CpG5 methylation was significantly higher in female patients than female controls. A further breakdown analysis by both gender and SCZ subtype showed that CpG2 and CpG3 methylation were significantly higher in male paranoid SCZ and male undifferentiated SCZ than male controls. In contrast, CpG2 and CpG3 methylation were significantly lower in female undifferentiated SCZ than female controls. Additionally, CpG5 methylation was significantly higher in female paranoid SCZ than female controls. In conclusion, our findings supported that DRD3 gene body hypermethylation was significantly associated with the risk of SCZ. Future study is needed to clarify the mechanisms by which DRD3 gene body hypermethylation contributes to the risk of SCZ. [ABSTRACT FROM AUTHOR]

Context: Mutism is a common manifestation of catatonia, but mutism due to other forms of psychopathology and neurological disorders have also been described. Although not common, long-standing mutism has also been a feature of non-catatonic schizophrenia and traditionally responds less to conventional therapies. Case Report: We describe a rare case of paranoid schizophrenia presenting with continuous mutism for about 4 years. This 26-year-old male had symptoms of schizophrenia without catatonia. After failed trial of adequate pharmacotherapy and psychological intervention and considering his level of dysfunction, he was started on electroconvulsive therapy (ECT). To our surprise, he improved with a single session of ECT while he was on concurrent pharmacotherapy. We also discuss the possible explanation for this rapid effect of ECT in such clinical presentation. To our knowledge, this is the first case of non-catatonic mutism of schizophrenia of this long duration responding so promptly to ECT, although there are other reports as well in literature, but multiple ECT sessions were applied in those cases. Conclusion: Non-catatonic mutism is perhaps presenting as a cultural variant in this part of the world and whenever encountered, ECT should be an option. Further research should be carried out to validate this idea. [ABSTRACT FROM AUTHOR]

Objectives: In this study, through subtyping a group of schizophrenic patients according to DSM-IV diagnostic criteria, it is planned to find out whether these subtypes have different sociodemographic and clinical features and if so, what are these differences. Method: The study was conducted with 78 patients diagnosed as schizophrenia according to DSM-IV criteria. The sociodemographic and cllinical features of patients were assessed retrospectively. The three subtypes of schizophrenia (paranoid, disorganized and undifferentiated types) diagnosed in patients of research group were compared with each other in terms of sociodemographic and clinical features. Results: The patients with paranoid subtype were found significantly different from disorganized group with higher rates of marriage history, higher income levels, lower suicide rates, the tendency to be born in autumn-winter, later age of disease onset and more life events in the first psychotic episode. The undifferentiated type of schizophrenia was found similar to paranoid subtype in marriage rates and suicide history, but different from paranoid subtype in income levels, age of disease onset and reactivity to life events. Conclusion: The patients of paranoid, disorganized and undifferentiated type of schizophrenia seem to be different from each other in sociodemographic and clinical features. According to these results, in our sample, subtyping of schizophrenia in terms of present subtypes seems valid and useful in classification of the disorder. In future, the prospectively designed studies with larger samples may produce more significant results which show the validity of subtyping schizophrenia. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to compare the differential response to amisulpride in patients with paranoid versus disorganized schizophrenia. Method We reanalyzed the original data from five different randomized drug trials comparing Brief Psychiatric Rating Scale ( BPRS) scores in a database containing 427 paranoid and 296 disorganized patients with schizophrenia. Results Both the disorganized and the paranoid group showed a substantial improvement of the BPRS total score within the first 4 weeks. In the paranoid group, mean (± SD) BPRS reduction was 16.9 (±14.6) ( t = 24.06, df = 426, P < 0.001) and in the disorganized group 17.0 (±15.9) ( t = 18.49, df = 295, P < 0.001). An analysis of covariance ( ancova) controlling for BPRS at baseline and the influence of different trial protocols showed significant differences between diagnostic groups ( F = 13.47, df = 1, P < 0.001), Cohen's D 0.31 ( CI = 0.16-0.46). Paranoid patients improved by 4.8 BPRS points more than disorganized patients (adjusted means 18.90 ( CI = 17.33-20.37) for the paranoid and 14.1 ( CI = 12.04 - 16.11) for the disorganized group. Conclusion We conclude that amisulpride is effective in disorganized as well as in paranoid schizophrenia, but that symptom reduction in the disorganized subtype is less pronounced. [ABSTRACT FROM AUTHOR]

Objectives To analyze frequency and type of personality pattern in patients with myotonic dystrophy type 1 ( DM1), to correlate these findings with clinical data, and to assess its possible influence on quality of life ( Qo L). Materials and Methods This cross-sectional study comprised 62 patients with DM1. Following measures were used: Muscular Impairment Rating Scale, Raven's Standard Progressive Matrices ( RSPM), Millon Multiaxial Clinical Inventory I ( MMCI), SF-36, and Individualized Neuromuscular Quality of Life ( INQoL) questionnaires. Results The presence of at least one pathological personality trait with score above 85 on MMCI was found in 47 (75.8%) patients. After clinical interview, 36 (58.1%) subjects had significant personality impairment. The most common personality trait in our cohort of patients was dependent found in 51.6% of patients, followed by paranoid (38.7%). Higher score on dependent personality scale correlated with lower education (rho = −0.251, P = 0.049). Dependent personality scores significantly differed between patients with physical and intellectual work (93.1 ± 8.9 vs 66.9 ± 31.7, P = 0.011). Paranoid score was higher in patients with lower education (rho = −0.293, P = 0.021), lower score on RSPM test (rho = −0.398, P = 0.004) and larger number of CTG repeats (rho = 0.254, P = 0.046). Presence of dependent personality was not in association with Qo L scores ( P > 0.05). On the other hand, patients with paranoid personality trait had worse Qo L than those without it ( P < 0.05). Conclusion Almost 60% of our patients with DM1 had clinically significant personality impairment, with dependent and paranoid personality patterns being the most common. Paranoid personality may decrease QoL in these patients, which gives us new opportunities for symptomatic therapy in DM1. [ABSTRACT FROM AUTHOR]