RESUMEN
BACKGROUND: The occurrence of visual hallucinations in visually impaired people without mental impairment is known as Charles Bonnet Syndrome (CBS). To date, the prevalence of CBS has been reported with high variance. The present study aims at evaluating the prevalence of CBS among low-vision patients. METHODS: From March 2018 to February 2022, 194 patients with a visual acuity ≥ 0.5 logMAR approached the low vision section of the Eye Clinic Sulzbach. Of these, 50 patients were found eligible, agreed to participate in the study and were screened for CBS. The course of the disease, its phenomenology and characteristics, the circumstance of onset, the ability to manipulate and resolve the hallucinations, and the psychosocial aspects of CBS were investigated. RESULTS: 26% of patients with low vision suffered from CBS. Women did not suffer from CBS significantly more often than men. Often, insight into the unreality of the images is not achieved immediately. Patterns or so-called "simple" hallucinations occurred just as frequently as other types of images such as people, body parts or faces. The most frequent images were animals. Visual hallucinations, lasting only for seconds in most cases, occurred more frequently during the day and in bright surroundings. All patients experienced the hallucinations exclusively with their eyes open. The hallucinations generally did not move with the eyes. Many sufferers did neither communicate about their hallucinations nor consult any physician. CONCLUSIONS: CBS among low-vision patients is common. Its prevalence constitutes clinical relevance. Future management of CBS may benefit from encouraging patients to share their experiences and consult a physician.
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Síndrome de Charles Bonnet , Baja Visión , Agudeza Visual , Humanos , Síndrome de Charles Bonnet/epidemiología , Síndrome de Charles Bonnet/complicaciones , Femenino , Masculino , Anciano , Baja Visión/epidemiología , Prevalencia , Persona de Mediana Edad , Anciano de 80 o más Años , Alucinaciones/epidemiología , Alucinaciones/etiología , AdultoRESUMEN
Motor dysfunction, which includes changes in gait, balance, and/or functional mobility, is a lesser-known feature of Alzheimer's Disease (AD), especially as it relates to the development of neuropsychiatric symptoms (NPS). This study (1) compared rates of NPS between autopsy-confirmed AD patients with and without early-onset motor dysfunction and (2) compared rates of non-AD dementia autopsy pathology (Lewy Body disease, Frontotemporal Lobar degeneration) between these groups. This retrospective longitudinal cohort study utilized National Alzheimer's Coordinating Center (NACC) data. Participants (N = 856) were required to have moderate-to-severe autopsy-confirmed AD, Clinical Dementia Rating-Global scores of ≤1 at their index visit, and NPS and clinician-rated motor data. Early motor dysfunction was associated with significantly higher NPI-Q total scores (T = 4.48, p < .001) and higher odds of delusions (OR [95%CI]: 1.73 [1.02-2.96]), hallucinations (2.45 [1.35-4.56]), depression (1.51 [1.11-2.06]), irritability (1.50 [1.09-2.08]), apathy (1.70 [1.24-2.36]), anxiety (1.38 [1.01-1.90]), nighttime behaviors (1.98 [1.40-2.81]), and appetite/eating problems (1.56 [1.09-2.25]). Early motor dysfunction was also associated with higher Lewy Body disease pathology (1.41 [1.03-1.93]), but not Frontotemporal Lobar degeneration (1.10 [0.71-1.69]), on autopsy. Our results suggest that motor symptoms in early AD are associated with a higher number and severity of NPS, which may be partially explained by comorbid non-AD neuropathology.
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Enfermedad de Alzheimer , Autopsia , Humanos , Enfermedad de Alzheimer/patología , Enfermedad de Alzheimer/fisiopatología , Masculino , Femenino , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Estudios Longitudinales , Enfermedad por Cuerpos de Lewy/patología , Enfermedad por Cuerpos de Lewy/fisiopatología , Degeneración Lobar Frontotemporal/patología , Degeneración Lobar Frontotemporal/fisiopatología , Alucinaciones/fisiopatología , Alucinaciones/etiología , Trastornos del Movimiento/fisiopatología , Trastornos del Movimiento/etiología , Deluciones/fisiopatología , Deluciones/etiología , Deluciones/patologíaRESUMEN
Post-Traumatic Stress Disorder (PTSD) is a prevalent and disabling disorder with a high degree of comorbidity. Clinical studies have focused on hallucinations, which could be associated with the severity of the disorder and treatment resistance. Auditory illusions have received little attention so far, possibly because they are particularly difficult to assess. However, they may impact functioning, and underdiagnosis could impair prognosis. To provide a clearer understanding of PTSD psychopathology, this paper proposes to focus on these auditory illusions. A monocentric case-control study was conducted on 30 subjects with PTSD and 30 controls, based on an original design. False recognitions were estimated during a sound test created with a vocoder. Additionally, differences in emotional valence, dissociation, hyperarousal, and reliving were assessed. The study found that individuals with PTSD experience a higher frequency of auditory illusions compared to healthy controls (65% versus 20%, p < 0.001). Additionally, the emotional valence of these illusions was more negative in individuals with PTSD than in controls. The study also identified a correlation between dissociation symptoms, hyperarousal and reliving with auditory illusions. These findings are in line with neurobiological studies of PTSD, as well as cognitive predictive models, and support the hypothesis of a significant prevalence of auditory illusions in PTSD. Like hallucinations, auditory illusions may be influenced by dissociation. Although these results are preliminary, they suggest a need for further investigation into auditory illusions in PTSD and their effect on prognosis.
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Ilusiones , Trastornos por Estrés Postraumático , Humanos , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/diagnóstico , Femenino , Masculino , Estudios de Casos y Controles , Adulto , Ilusiones/fisiología , Persona de Mediana Edad , Alucinaciones/fisiopatología , Alucinaciones/etiología , Alucinaciones/diagnóstico , Percepción Auditiva/fisiología , Adulto JovenRESUMEN
OBJECTIVE: To develop a systematics of chronic delusional psychoses in schizophrenia and pathology of the schizophrenic spectrum that takes into account psychopathological structure (the mechanism of delusional formation) and the trajectories of the disease course (the ratio of negative/positive dimensions). MATERIAL AND METHODS: The study sample was recruited from the large Moscow psychiatric hospital in 2019-2024 and included 126 patients (94 male, 32 female, mean age 36.5±12.1 years) hospitalized with ICD-10 diagnosis of paranoid schizophrenia (F20.00) or delusional disorder (F22). A clinical-psychopathological method was used. RESULTS: The study identifies three variants of paranoid domains, the typology of which takes into account both the psychopathological structure and the trajectories of their development, which determine the dominance of predominantly negative or positive symptoms throughout the disease: 1) psychosis with delusional interpretations and predominant orientation of symptoms towards the negative pole of the schizophrenia psychopathology (n=37, 29.4%); 2) psychosis with hallucinatory delusions and predominant direction of symptoms towards the positive pole of the schizophrenia psychopathology (n=50, 39.7%); and 3) «combined¼ hallucinatory-delusional psychosis with a simultaneous orientation of symptoms to the negative/positive poles of the schizophrenia psychopathology (n=39, 30.9%). Detailed phenomenological characteristics of each of the three presented variants are given. CONCLUSION: The developed three-component taxonomy confirms, on the model of chronic delusional psychoses appearing in schizophrenia and the pathology of the schizophrenia spectrum, the concept of simultaneous representation of two relatively independent domains determined by neurobiological processes in the schizophrenia psychopathology positive and negative disorders.
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Esquizofrenia Paranoide , Esquizofrenia , Humanos , Femenino , Masculino , Adulto , Esquizofrenia Paranoide/psicología , Persona de Mediana Edad , Psicología del Esquizofrénico , Trastornos Psicóticos , Deluciones/etiología , Alucinaciones/etiología , Moscú , Enfermedad Crónica , Adulto Joven , Clasificación Internacional de EnfermedadesRESUMEN
Neuropsychiatric symptoms (including anxiety, depression, apathy, impulse-compulsive behaviors and hallucinations) are among the most common non-motor features of Parkinson's disease. Whether these symptoms should be considered as a direct consequence of the pathophysiologic mechanisms of Parkinson's disease is controversial. Morphometric similarity network analysis and epicenter mapping approach were performed on T1-weighted images of 505 patients with Parkinson's disease and 167 age- and sex-matched healthy participants from Parkinson's Progression Markers Initiative database to reveal the commonalities and specificities of distinct neuropsychiatric symptoms. Abnormal cortical co-alteration pattern in patients with neuropsychiatric symptoms was in somatomotor, vision and frontoparietal regions, with epicenters in somatomotor regions. Apathy, impulse-compulsive behaviors and hallucinations shares structural abnormalities in somatomotor and vision regions, with epicenters in somatomotor regions. In contrast, the cortical abnormalities and epicenters of anxiety and depression were prominent in the default mode network regions. By embedding each symptom within their co-alteration space, we observed a cluster composed of apathy, impulse-compulsive behaviors and hallucinations, while anxiety and depression remained separate. Our findings indicate different structural mechanisms underlie the occurrence and progression of different neuropsychiatric symptoms. Based upon these results, we propose that apathy, impulse-compulsive behaviors and hallucinations are directly related to damage of motor circuit, while anxiety and depression may be the combination effects of primary pathophysiology of Parkinson's disease and psychosocial causes.
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Ansiedad , Apatía , Corteza Cerebral , Alucinaciones , Imagen por Resonancia Magnética , Enfermedad de Parkinson , Humanos , Enfermedad de Parkinson/diagnóstico por imagen , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/psicología , Enfermedad de Parkinson/patología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Alucinaciones/fisiopatología , Alucinaciones/etiología , Alucinaciones/diagnóstico por imagen , Alucinaciones/patología , Corteza Cerebral/diagnóstico por imagen , Corteza Cerebral/patología , Corteza Cerebral/fisiopatología , Apatía/fisiología , Ansiedad/fisiopatología , Ansiedad/diagnóstico por imagen , Depresión/diagnóstico por imagen , Depresión/fisiopatología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/fisiopatología , Trastornos Disruptivos, del Control de Impulso y de la Conducta/diagnóstico por imagenRESUMEN
In this case report we describe a pregnant woman with newly developed auditory hallucinations, initially seen by a psychiatrist of the psychiatric emergency service. The day after assessment , the patient developed epileptic seizures and was referred to the hospital. After additional blood and liquor tests and an MRI scan, an autoimmune encephalitis was diagnosed. She was treated with prednisolone and immunoglobulins. She made a full recovery and gave birth to a healthy son at term. In this article we describe the diagnostic considerations, the course and treatment, the importance of being alert to a somatic cause of psychiatric symptoms and of multidisciplinary collaboration.
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Encefalitis , Alucinaciones , Complicaciones del Embarazo , Humanos , Femenino , Embarazo , Alucinaciones/etiología , Alucinaciones/tratamiento farmacológico , Adulto , Complicaciones del Embarazo/tratamiento farmacológico , Encefalitis/diagnóstico , Encefalitis/complicaciones , Enfermedad de Hashimoto/complicaciones , Enfermedad de Hashimoto/tratamiento farmacológico , Enfermedad de Hashimoto/diagnóstico , Prednisolona/uso terapéutico , Resultado del Tratamiento , Resultado del EmbarazoRESUMEN
BACKGROUND: We aimed to explore gender-related differences in the associations of insight impairment with clinical symptoms, metacognition, and social cognition in psychosis. METHODS: Regression analysis of several clinical insight dimensions was conducted on the data from 116 men and 56 women with first-episode psychosis. Various clinical symptoms and measures of metacognition and social cognition were entered as predictors. RESULTS: In both men and women, delusions emerged as a strong predictor of all insight dimensions, and verbal hallucinations as a strong predictor of symptom relabelling. In men, certain negative symptoms as well as self-certainty, lack of self-reflectiveness, impaired theory of mind, attributional biases, and a jumping-to-conclusions bias were additional predictors of poor insight, while good insight was associated with depression, anxiety, avolition, blunted affect, and impaired emotional recognition. In women, poor insight was associated with a self-serving/externalising bias, impaired emotional recognition, and attention disorders. CONCLUSIONS: Poor insight in first-episode psychosis is strongly linked to deficits in metacognition and social cognition, with marked differences between men and women with respect to the specific skills involved in the impairment. Meanwhile, good insight is linked to a variety of affective manifestations in men. These findings suggest new avenues for more targeted cognitive interventions to improve clinical insight in psychosis.
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Metacognición , Trastornos Psicóticos , Humanos , Masculino , Femenino , Trastornos Psicóticos/psicología , Adulto , Adulto Joven , Metacognición/fisiología , Cognición Social , Deluciones , Caracteres Sexuales , Alucinaciones/etiología , Alucinaciones/psicología , Adolescente , Factores SexualesRESUMEN
Psychosis can be considered a dimension that in its most severe extreme can be expressed with alterations in sensory perception, mainly hallucinations. Their presence is a fact that is frequently observed in severe psychiatric pathologies such as schizophrenia (EZQ) and bipolar disorder (BD) where they can be markers of severity. However, sensory-perceptual disturbances are not pathognomonic of these disorders, nor do they signal any of these illnesses as an isolated event. Such symptomatology can be described in a variety of situations both within and outside psychopathology. In this sense, proposing a direct line between hallucinations and diseases such as CZS or TB disregards their occurrence in other pathologies, as is the case of Borderline Personality Disorder (BPD). It is feasible that we may find the expression of pseudo hallucinations or hallucinations in patients with this disorder and their presence may have etiological, clinical and therapeutic connotations that should be reviewed and taken into account in our clinical practice.
La psicosis puede ser considerada una dimensión que en su extremo de mayor gravedad puede expresarse con alteraciones en la sensopercepción, principalmente alucinaciones. Su presencia es un hecho que se constata con frecuencia en patologías psiquiátricas severas como la esquizofrenia (EZQ) y el trastorno bipolar (TB) donde pueden ser marcadores de gravedad. No obstante, las alteraciones sensoperceptivas no son patognomónicas de estos trastornos ni señalan ninguna de estas enfermedades como un hecho aislado. Dicha sintomatología puede ser descripta en diversas situaciones dentro y fuera de la psicopatología. En este sentido, proponer una línea directa entre las alucinaciones con enfermedades tales como la EZQ o el TB desestima su ocurrencia en otras patologías, como es el caso del Trastorno límite de la personalidad (TLP). Es factible que constatemos la expresión de alucinaciones en pacientes con este trastorno y su presencia puede tener connotaciones etiológicas, clínicas y terapéuticas que deben ser revisadas para tener en cuenta en nuestra práctica clínica.
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Trastorno Bipolar , Trastorno de Personalidad Limítrofe , Alucinaciones , Esquizofrenia , Humanos , Trastorno de Personalidad Limítrofe/complicaciones , Esquizofrenia/complicaciones , Alucinaciones/etiología , Trastorno Bipolar/complicaciones , Psicología del EsquizofrénicoRESUMEN
BACKGROUND: Individuals with schizophrenia (SZ) and auditory hallucinations (AHs) display a distorted sense of self and self-other boundaries. Alterations of activity in midline cortical structures such as the prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) during self-reference as well as in the superior temporal gyrus (STG) have been proposed as neuromarkers of SZ and AHs. METHODS: In this randomized, participant-blinded, sham-controlled trial, 22 adults (18 males) with SZ spectrum disorders (SZ or schizoaffective disorder) and frequent medication-resistant AHs received one session of real-time fMRI neurofeedback (NFB) either from the STG (n = 11; experimental group) or motor cortex (n = 11; control group). During NFB, participants were instructed to upregulate their STG activity by attending to pre-recorded sentences spoken in their own voice and downregulate it by ignoring unfamiliar voices. Before and after NFB, participants completed a self-reference task where they evaluated if trait adjectives referred to themselves (self condition), Abraham Lincoln (other condition), or whether adjectives had a positive valence (semantic condition). FMRI activation analyses of self-reference task data tested between-group changes after NFB (self>semantic, post>pre-NFB, experimental>control). Analyses were pre-masked within a self-reference network. RESULTS: Activation analyses revealed significantly (p < 0.001) greater activation increase in the experimental, compared to the control group, after NFB within anterior regions of the self-reference network (mPFC, ACC, superior frontal cortex). CONCLUSIONS: STG-NFB was associated with activity increase in the mPFC, ACC, and superior frontal cortex during self-reference. Modulating the STG is associated with activation changes in other, not-directly targeted, regions subserving higher-level cognitive processes associated with self-referential processes and AHs psychopathology in SZ. CLINICALTRIALS: GOV: Rt-fMRI Neurofeedback and AH in Schizophrenia; https://clinicaltrials.gov/study/NCT03504579.
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Alucinaciones , Imagen por Resonancia Magnética , Neurorretroalimentación , Esquizofrenia , Lóbulo Temporal , Humanos , Esquizofrenia/diagnóstico por imagen , Esquizofrenia/fisiopatología , Esquizofrenia/terapia , Masculino , Femenino , Adulto , Proyectos Piloto , Neurorretroalimentación/métodos , Alucinaciones/fisiopatología , Alucinaciones/diagnóstico por imagen , Alucinaciones/terapia , Alucinaciones/etiología , Lóbulo Temporal/fisiopatología , Lóbulo Temporal/diagnóstico por imagen , Método Simple Ciego , Trastornos Psicóticos/fisiopatología , Trastornos Psicóticos/diagnóstico por imagen , Trastornos Psicóticos/terapia , Persona de Mediana Edad , Autoimagen , Adulto JovenRESUMEN
This report discusses the case of a 54-year-old woman with a complex psychiatric history including schizophrenia, tardive dyskinesia, borderline intellectual function, and congenital deafness that reported auditory and visual hallucinations during an acute exacerbation of schizophrenia. After resuming a previous lithium regimen and introducing olanzapine, the patient improved and was discharged without hallucinations. In our report we explore some of the challenges we faced, discuss similar cases, and examine the unresolved debate about whether congenitally deaf patients can experience auditory hallucinations.
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Antipsicóticos , Sordera , Alucinaciones , Esquizofrenia , Humanos , Femenino , Esquizofrenia/complicaciones , Alucinaciones/etiología , Persona de Mediana Edad , Sordera/complicaciones , Antipsicóticos/uso terapéutico , Olanzapina/uso terapéutico , Benzodiazepinas/uso terapéuticoRESUMEN
BACKGROUND: Hereditary transthyretin amyloidosis, caused by transthyretin gene mutations, progresses with systemic impact and often presents peripheral neuropathy. Recent research reveals central nervous system involvement, marked by leptomeningeal amyloid accumulation and transient focal neurological episodes displaying cortical dysfunction. CASE PRESENTATION: A 47-year-old Caucasian man with hereditary transthyretin amyloidosis presented with motor aphasia, right hemiparesis, fever, and an altered state of consciousness. Tests ruled out stroke or infection. While improving, the patient reported an ongoing auditory repetition phenomenon for 48 hours despite efforts to shift focus or introduce new stimuli. CONCLUSION: This represents the first known case report documenting palinacousis in hereditary transthyretin amyloidosis attributed to central nervous system involvement. This case highlights the complexities in assessment and management of patients when neurological and psychiatric symptoms overlap.
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Neuropatías Amiloides Familiares , Humanos , Masculino , Persona de Mediana Edad , Neuropatías Amiloides Familiares/complicaciones , Neuropatías Amiloides Familiares/fisiopatología , Alucinaciones/etiología , Encéfalo/patología , Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética , Paresia/etiologíaRESUMEN
BACKGROUND: Previous research established the associations between childhood trauma and psychosis, but the effects of childhood trauma on psychotic-like experiences (PLEs) among people living with HIV (PLWH) and the potential mediation mechanisms in these associations remain unclear. OBJECTIVE: This study aimed to investigate the effects of childhood trauma on PLEs, as well as the chain mediation roles of stigma and resilience in this relationship. Furthermore, we explored whether the aforementioned associations differed when hallucinatory experiences (HEs) and delusional experiences (DEs) were separately modeled. PARTICIPANTS AND SETTING: The sample included 333 outpatients participants (95.2 % males, Mage = 28.24 ± 7.12) living with HIV recruited from Hunan Province, China; and data were collected with a cross-sectional survey. METHOD: The hypothesized chain mediation models were examined using SPSS PROCESS macro 3.3 software. RESULTS: Various influencing mechanisms of childhood trauma on HEs and DEs were examined in this study. Our results showed that, (a) childhood trauma directly exerted negative effect on HEs, while the chain mediation effect of stigma and resilience were not statistically significant. Conversely, (b) childhood trauma exerted no direct influence on DEs but rather through the chain mediation effect of stigma and resilience. CONCLUSIONS: The identification of two different routes between that childhood trauma can have on HEs and DEs highlighted the importance of tailored prevention and intervention among PLWH with a history of childhood trauma.
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Experiencias Adversas de la Infancia , Infecciones por VIH , Trastornos Psicóticos , Resiliencia Psicológica , Estigma Social , Humanos , Masculino , Femenino , Adulto , Infecciones por VIH/psicología , Estudios Transversales , Adulto Joven , Experiencias Adversas de la Infancia/estadística & datos numéricos , China , Alucinaciones/etiología , Deluciones/etiología , Persona de Mediana Edad , Adultos Sobrevivientes de Eventos Adversos Infantiles/estadística & datos numéricos , Adultos Sobrevivientes de Eventos Adversos Infantiles/psicologíaRESUMEN
Schizophrenia continues its resistance to the pathogenetic understanding. We believe that one of the reasons is an oblivion of schizophrenia's characteristic Gestalt expressive of its psychopathological structure. In this article we argue for a crucial role of disorders of selfhood in the constitution of this Gestalt. First, we present a phenomenological account of the self. This is followed by an exposition of basic complaints in schizophrenia which are reflective of a disordered selfhood and which often date back to childhood. We then present characteristic features of the schizophrenic psychosis with its phenomenon of "double bookkeeping". Hallucinations, delusions and double bookkeeping are all associated with the instability of the self. Finally, we briefly address characteristic aspects of the encounter with a schizophrenia patient and argue that self-disorders play an important diagnostic role. We conclude by emphasizing the role of phenomenology in psychiatric research.
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Esquizofrenia , Psicología del Esquizofrénico , Humanos , Esquizofrenia/fisiopatología , Alucinaciones/fisiopatología , Alucinaciones/etiología , Autoimagen , Deluciones/fisiopatología , Deluciones/etiología , EgoRESUMEN
Importance: The emergence of psychotic symptoms in Alzheimer disease (AD) is associated with accelerated cognitive and functional decline that may be related to disease pathology. Objective: To investigate the longitudinal dynamics of plasma tau phosphorylated at threonine 181 (p-tau181) and neurofilament light chain protein (NfL) levels in association with the emergence of psychotic symptoms (delusions and hallucinations) in the context of AD. Design, Setting, and Participants: This cohort study used longitudinal data from the Alzheimer Disease Neuroimaging Initiative (ADNI). Baseline analyses compared patients with mild cognitive impairment (MCI) and AD (both with psychosis [AD+P] and without psychosis [AD-P]) and participants who were cognitively unimpaired (CU). For the longitudinal analysis, participants with MCI and AD were subdivided into patients with evidence of psychosis at baseline (AD+P baseline) and patients free of psychosis at baseline who showed incidence of psychosis over the course of the study (AD+P incident). Study data were analyzed between June and November 2023. Exposures: Plasma p-tau181 and NfL measures in individuals with MCI and AD, both with and without psychosis. Main Outcomes and Measures: Plasma p-tau181 and NfL quantifications up to 48 months and concurrent assessments of presence or absence of delusions and hallucinations via the Neuropsychiatric Inventory (NPI) questionnaire. Results: The cohort included 752 participants with AD (mean [SD] age, 74.2 [7.7] years; 434 male [57.7%]). A total of 424 CU participants had a mean (SD) age of 75.4 (6.6) years of whom 222 were female (52.4%). In the longitudinal analysis of p-tau181 trajectories of the AD+P group, the group of patients who showed incidence of psychosis over the course of follow-up (AD+P incident) demonstrated an associated increase in plasma p-tau181 levels compared with the group of patients who had psychosis at baseline (AD+P baseline) and showed an associated decrease in plasma p-tau181 levels (F4, 117 = 3.24; P = .01). The mean slope of p-tau181 change was significantly different in AD+P incident and AD+P baseline groups (F5,746 = 86.76, P < .0001) and when only individuals with amyloid-ß positivity (Aß+), which was determined using positron emission tomography, were compared (F5,455 = 84.60, P < .001). Patients who experienced psychosis at any time had increased levels of NfL relative to those who never experienced psychosis. Conclusions and Relevance: Results of this cohort study suggest that the emergence of psychosis in AD was associated with elevations in plasma levels of p-tau181, highlighting the potential utility of plasma p-tau181 as a biomarker of neuropsychiatric illness in AD, which could have implications for predictive and treatment response strategies.
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Enfermedad de Alzheimer , Biomarcadores , Disfunción Cognitiva , Trastornos Psicóticos , Proteínas tau , Humanos , Enfermedad de Alzheimer/sangre , Masculino , Femenino , Anciano , Biomarcadores/sangre , Proteínas tau/sangre , Trastornos Psicóticos/sangre , Disfunción Cognitiva/sangre , Disfunción Cognitiva/etiología , Estudios Longitudinales , Proteínas de Neurofilamentos/sangre , Alucinaciones/sangre , Alucinaciones/etiología , Alucinaciones/epidemiología , Anciano de 80 o más Años , Deluciones/sangre , Deluciones/epidemiología , Fosforilación , Estudios de CohortesRESUMEN
Visual hallucinations in Lewy body disease (LBD) can be differentiated based on phenomenology into minor phenomena (MVH) and complex hallucinations (CVH). MVH include a variety of phenomena, such as illusions, presence and passage hallucinations occurring at early stages of LBD. The neural mechanisms of visual hallucinations are largely unknown. The hodotopic model posits that the hallucination state is due to abnormal activity in specialized visual areas, that occurs in the context of wider network connectivity alterations and that phenomenology of VH, including content and temporal characteristics, may help identify brain regions underpinning these phenomena. Here we investigated both the topological and hodological neural basis of visual hallucinations integrating grey and white matter imaging analyses. We studied LBD patients with VH and age matched healthy controls (HC). VH were assessed using a North-East-Visual-Hallucinations-Interview that captures phenomenological detail. Then we applied voxel-based morphometry and tract based spatial statistics approaches to identify grey and white matter changes. First, we compared LBD patients and HC. We found a reduced grey matter volume and a widespread damage of white tracts in LBD compared to HC. Then we tested the association between CVH and MVH and grey and white matter indices. We found that CVH duration was associated with decreased grey matter volume in the fusiform gyrus suggesting that LBD neurodegeneration-related abnormal activity in this area is responsible for CVH. An unexpected finding was that MVH severity was associated with a greater integrity of white matter tracts, specifically those connecting dorsal, ventral attention networks and visual areas. Our results suggest that networks underlying MVH need to be partly intact and functional for MVH experiences to occur, while CVH occur when cortical areas are damaged. The findings support the hodotopic view and the hypothesis that MVH and CVH relate to different neural mechanisms, with wider implications for the treatment of these symptoms in a clinical context.
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Sustancia Gris , Alucinaciones , Enfermedad por Cuerpos de Lewy , Sustancia Blanca , Humanos , Alucinaciones/fisiopatología , Alucinaciones/etiología , Alucinaciones/diagnóstico por imagen , Enfermedad por Cuerpos de Lewy/fisiopatología , Enfermedad por Cuerpos de Lewy/patología , Enfermedad por Cuerpos de Lewy/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Sustancia Gris/fisiopatología , Femenino , Sustancia Blanca/diagnóstico por imagen , Sustancia Blanca/patología , Sustancia Blanca/fisiopatología , Masculino , Anciano , Imagen por Resonancia Magnética , Anciano de 80 o más Años , Estudios de Casos y Controles , Persona de Mediana EdadAsunto(s)
Alucinaciones , Cefalea , Viaje , Humanos , Alucinaciones/etiología , Alucinaciones/diagnóstico , Cefalea/etiología , Adolescente , Masculino , Femenino , Diagnóstico DiferencialRESUMEN
BACKGROUND: Persistent auditory verbal hallucinations (pAVHs) are a fundamental manifestation of schizophrenia (SCZ), yet the exact connection between pAVHs and brain structure remains contentious. This study aims to explore the potential correlation between pAVHs and alterations in grey matter volume (GMV) within specific brain regions among individuals diagnosed with SCZ. METHODS: 76 SCZ patients with pAVHs (pAVH group), 57 SCZ patients without AVHs (non-AVH group), and 83 healthy controls (HC group) were investigated using 3 T magnetic resonance imaging. The P3 hallucination item of the Positive and Negative Syndrome Scale was used to assess the severity of pAVHs. Voxel-based morphometry was used to analyze the GMV profile between the three groups. RESULTS: Compared to the non-AVH and HC groups, the pAVH group exhibited extensive reduction in GMV within the frontotemporal cortex. Conversely, no significant difference in GMV was observed between the non-AVH and HC groups. The severity of pAVHs showed a negative correlation with GMV in several regions, including the right fusiform, right inferior temporal, right medial orbitofrontal, right superior frontal, and right temporal pole (p = 0.0036, Bonferroni correction). Stepwise linear regression analysis revealed that GMV in the right temporal pole (ß = -0.29, p = 0.001) and right fusiform (ß = -0.21, p = 0.01) were significantly associated with the severity of pAVHs. CONCLUSIONS: Widespread reduction in GMV is observed within the frontotemporal cortex, particularly involving the right temporal pole and right fusiform, which potentially contribute to the pathogenesis of pAVHs in individuals with chronic SCZ.
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Sustancia Gris , Alucinaciones , Imagen por Resonancia Magnética , Esquizofrenia , Lóbulo Temporal , Humanos , Esquizofrenia/diagnóstico por imagen , Esquizofrenia/patología , Alucinaciones/diagnóstico por imagen , Alucinaciones/etiología , Alucinaciones/patología , Alucinaciones/fisiopatología , Masculino , Femenino , Adulto , Sustancia Gris/diagnóstico por imagen , Sustancia Gris/patología , Lóbulo Temporal/diagnóstico por imagen , Lóbulo Temporal/patología , Enfermedad Crónica , Lóbulo Frontal/diagnóstico por imagen , Lóbulo Frontal/patología , Persona de Mediana Edad , Adulto Joven , China , Pueblos del Este de AsiaRESUMEN
BACKGROUND AND HYPOTHESIS: Hearing voices is a common and often distressing experience for people with psychosis, and many individuals experience medication-resistant auditory verbal hallucinations (AVH). Psychosocial interventions are often employed to address distress over hearing voices. However, although links have been made between adverse social experiences and psychosis broadly, no work has yet delineated the relationship between day-to-day social stress and hallucination severity. We aimed to define that relationship in both clinical and non-clinical voice-hearers. STUDY DESIGN: A sample of 278 participants with a history of hearing voices was selected from the Yale Control Over Perceptual Experiences (COPE) Project. They were administered self-report measures of recent stress and recent auditory experiences within a cross-sectional design. Regression models were used to evaluate whether self-reported aspects of recent stress-and social stress in particular-were related to recent frequency of and distress over hearing voices. Related demographics and clinical characteristics were included as covariates. STUDY RESULTS: A significant relationship was observed between recent social stress and both recent frequency of and distress over hearing voices. While other aspects of recent stress were also related to recent distress over voices, social stressors uniquely predicted distress over voice-hearing, beyond the influence of other stressors. Depressive symptom severity was also related to distress over voices. CONCLUSIONS: Results suggest that daily social stress may be an important consideration and a potential treatment target for individuals experiencing clinical distress over auditory hallucinations.
Asunto(s)
Alucinaciones , Estrés Psicológico , Humanos , Alucinaciones/fisiopatología , Alucinaciones/etiología , Femenino , Masculino , Adulto , Estudios Transversales , Persona de Mediana Edad , Trastornos Psicóticos/fisiopatología , Adulto Joven , Autoinforme , Escalas de Valoración Psiquiátrica , Índice de Severidad de la EnfermedadRESUMEN
Hallucinations are a core feature of psychosis, and their severity during the acute phase of illness is associated with a range of poor outcomes. Various clinical and sociodemographic factors may predict hallucinations and other positive psychotic symptoms in first episode psychosis (FEP). Despite this, the precise factors associated with hallucinations at first presentation to an early intervention service have not been extensively researched. Through detailed interviews and chart reviews, we investigated sociodemographic and clinical predictors in 636 minimally-medicated patients who entered PEPP-Montréal, an early intervention service for FEP, between 2003 and 2018. Hallucinations were measured using the Scale for the Assessment of Positive Symptoms (SAPS), while negative symptoms were assessed using the Scale for the Assessment of Negative symptoms (SANS). Depressive symptoms were evaluated through the Calgary Depression Scale for Schizophrenia (CDSS), and anxiety symptoms via the Hamilton Rating Scale for Anxiety (HAS). A majority (n = 381, 59.9 %) of the sample presented with clinically significant hallucinations (SAPS global hallucinations score ≥ 3) at program entry. These patients had an earlier age at onset, fewer years of education, and a higher severity of delusions, depression and negative symptoms than those without clinical-level hallucinations. These results suggest that individuals with clinically significant hallucinations at admission tend to be younger and have a greater overall symptom burden. This makes it especially important to monitor hallucinations alongside delusions, depression and negative symptoms in order to identify who might benefit from targeted interventions. The implications of these findings for early intervention and person-centered care are discussed.