Tardive dyskinesia in 2 patients treated with ziprasidone. (41/323)

Ziprasidone is an atypical antipsychotic drug that is believed to have a low propensity for inducing extrapyramidal symptoms, including tardive dyskinesia (TD). Two of our patients developed TD after 23 months and 34 months of ziprasidone monotherapy, respectively. One of the patients had had earlier exposure to typical antipsychotic drugs, but no other predisposing factors for TD were noted. Therefore, patients on long-term therapy with atypical antipsychotic drugs should be screened periodically for TD.  (+info)

Placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder. (42/323)

OBJECTIVE: Although body dysmorphic disorder often responds to serotonin reuptake inhibitors (SRIs), most patients do not respond or respond only partially. However, placebo-controlled studies of augmentation of SRIs have not been done. Furthermore, although 40%-50% of patients are delusional, studies of antipsychotic medications have not been done. METHOD: Twenty-eight patients with body dysmorphic disorder or its delusional variant participated in an 8-week, placebo-controlled, double-blind, parallel-group study of pimozide augmentation of fluoxetine. RESULTS: Pimozide was not more effective than placebo: two (18.2%) of 11 subjects responded to pimozide and three (17.6%) of 17 subjects responded to placebo. There was no significant effect of baseline delusionality on endpoint severity of body dysmorphic disorder. Delusionality did not decrease significantly more with pimozide than placebo. CONCLUSIONS: Pimozide augmentation of fluoxetine treatment for body dysmorphic disorder was not more effective than placebo, even in more delusional patients. Further studies of augmentation for SRIs are needed.  (+info)

A theory of mind investigation into the appreciation of visual jokes in schizophrenia. (43/323)

BACKGROUND: There is evidence that groups of people with schizophrenia have deficits in Theory of Mind (ToM) capabilities. Previous studies have found these to be linked to psychotic symptoms (or psychotic symptom severity) particularly the presence of delusions and hallucinations. METHODS: A visual joke ToM paradigm was employed where subjects were asked to describe two types of cartoon images, those of a purely Physical nature and those requiring inferences of mental states for interpretation, and to grade them for humour and difficulty. Twenty individuals with a DSM-lV diagnosis of schizophrenia and 20 healthy matched controls were studied. Severity of current psychopathology was measured using the Krawiecka standardized scale of psychotic symptoms. IQ was estimated using the Ammons and Ammons quick test. RESULTS: Individuals with schizophrenia performed significantly worse than controls in both conditions, this difference being most marked in the ToM condition. No relationship was found for poor ToM performance and psychotic positive symptomatology, specifically delusions and hallucinations. CONCLUSION: There was evidence for a compromised ToM capability in the schizophrenia group on this visual joke task. In this instance this could not be linked to particular symptomatology.  (+info)

Schizotypy and conditional reasoning. (44/323)

This study investigated the role of reasoning biases in delusion formation and maintenance. Reasoning judgments have been shown to be influenced by prior knowledge, beliefs, and experience--that is, information stored in semantic memory. It was hypothesized that high schizotypes would exhibit a "jump to conclusions" style of reasoning as a result of not using implicit information concerned with cause-effect relationships. Research into human reasoning has traditionally adopted logic as a normative framework to assess human reasoning. Conditional inference tasks are direct tests of logical performance, and we employed an established design that depends upon the reasoner's ability to access and use implicit information. In an effort to negate some of the difficulties of research with schizophrenia patients, schizotypy measures were employed in a normal population. The results confirmed that high scorers on one dimension of schizotypy (Impulsive Nonconformity) failed to take account of the number of counterexamples that characterized the cause-effect conditional statement. These observations supported previous research demonstrating a jump to conclusions style of reasoning that it has been suggested plays a role in the formation and maintenance of delusions. Furthermore, these findings suggest a possible link between semantic memory and reasoning biases.  (+info)

Measuring delusional ideation: the 21-item Peters et al. Delusions Inventory (PDI). (45/323)

There is increasing evidence that in the general population there are schizotypal traits and symptoms that can be measured psychometrically. Norms are reported for a new 21-item version of the Peters et al. Delusions Inventory (PDI; Peters et al. 1999b). The PDI, originally based on the Present State Examination, incorporates the multidimensionality of delusions by including measures of distress, preoccupation, and conviction. A total of 444 healthy individuals completed the 21-item PDI and two other questionnaires measuring florid delusions and social desirability. A subsample also filled out an in-depth schizotypal personality scale. Thirty-three deluded inpatients also completed the PDI. The PDI's psychometric properties confirmed that it remains a reliable and valid instrument to measure delusional ideation in the general population. Consistent with the 40-item PDI, it was normally distributed, no sex differences were found, and there was an inverse relationship with age. Individual items were endorsed by just over one in four healthy adults. Although the deluded sample scored significantly higher, the range of scores overlapped considerably, with 11 percent of healthy adults scoring higher than the mean of the deluded group. As with our previous findings, the two samples were differentiated by their ratings on the distress, preoccupation, and conviction scales. These results suggest that these dimensions may be more important than the content of belief alone for placing an individual on the continuum between normal and delusional thinking.  (+info)

Disorders of agency in schizophrenia correlate with an inability to compensate for the sensory consequences of actions. (46/323)

Psychopathological symptoms in schizophrenia patients suggest that the concept of self might be disturbed in these individuals [1]. Delusions of influence make them feel that someone else is guiding their actions, and certain kinds of their hallucinations seem to be misinterpretations of their own inner voice as an external voice, the common denominator being that self-produced information is perceived as if coming from outside. If this interpretation were correct, we might expect that schizophrenia patients might also attribute the sensory consequences of their own eye movements to the environment rather than to themselves, challenging the percept of a stable world. Indeed, this seems to be the case because we found a clear correlation between the strength of delusions of influence and the ability of schizophrenia patients to cancel out such self-induced retinal information in motion perception. This correlation reflects direct experimental evidence supporting the view that delusions of influence in schizophrenia might be due to a specific deficit in the perceptual compensation of the sensory consequences of one's own actions [1, 2, 3, 4, 5 and 6].  (+info)

Psychiatric side effects during methysergide treatment. (47/323)

A patient is reported with psychological change characterised by impaired concentration and thought projection, followed by both severe anxiety and depression, starting after three weeks on high dose methysergide. The acute problem settled slowly after methysergide withdrawal and is likely to represent an unusual and serious side effect of that drug.  (+info)

Vivid dreams, hallucinations, psychosis and REM sleep in Guillain-Barre syndrome. (48/323)

We conducted a prospective controlled study of the clinical and biological determinants of the mental status abnormalities in 139 patients with Guillain-Barre syndrome (GBS) and 55 patients without GBS placed in the intensive care unit (ICU controls). There were mental status changes in 31% of GBS patients and in 16% of controls (odds ratio = 2.3; P = 0.04). In GBS patients, they included vivid dreams (19%), illusions (30%, including an illusory body tilt), hallucinations (60%, mainly visual) and delusions (70%, mostly paranoid). They appeared a median 9 days after disease onset (range 1-40 days, during the progression or the plateau of the disease), and lasted a median 8 days. Seven (16%) patients experienced the symptoms before their admission to the ICU. Hallucinations were frequently hypnagogic, occurring as soon as the patients closed their eyes. Autonomic dysfunction, assisted ventilation and high CSF protein levels were significant risk factors for abnormal mental status in GBS patients. CSF hypocretin-1 (a hypothalamic neuropeptide deficient in narcolepsy) levels, measured in 20 patients, were lower in GBS patients with hallucinations (555 +/- 132 pg/ml) than in those without (664 +/- 71 pg/ml, P = 0.03). Since the mental status abnormalities had dream-like aspects, we examined their association with rapid eye movement sleep (REM sleep) using continuous sleep monitoring in 13 GBS patients with (n = 7) and without (n = 6) hallucinations and 6 tetraplegic ICU controls without hallucinations. Although sleep was short and fragmented in all groups, REM sleep latency was shorter in GBS patients with hallucinations (56 +/- 115 min) than in GBS patients without hallucinations (153 +/- 130 min) and in controls (207 +/- 179 min, P < 0.05). In addition, sleep structure was highly abnormal in hallucinators, with sleep onset in REM sleep periods (83%), abnormal eye movements during non-REM sleep (57%), high percentages of REM sleep without atonia (92 +/- 22%), REM sleep behaviour disorders and autonomic dysfunction (100%), reminiscent of a status dissociatus. The sleep abnormalities, that were almost absent in non-hallucinated GBS patients, were not exclusively related to ICU conditions, since they also appeared out of ICU, and were reversible, disappearing when the mental status abnormalities vanished while the patients were still in ICU. In conclusion, the mental status abnormalities experienced by GBS patients are different from the ICU delirium, are strongly associated with autonomic dysfunction, severe forms of the disease and possibly with a transitory hypocretin-1 transmission decrease. Sleep studies suggest that mental status abnormalities are wakeful dreams caused by a sleep and dream-associated disorder (status dissociatus).  (+info)