Although delusions represent one of the core symptoms of psychotic disorders, it is remarkable that few studies have investigated distinct delusional themes. We analyzed data from a large sample of first-episode psychosis patients (n=245) to understand relations between delusion types and demographic and clinical correlates. First, we conducted a principal component analysis (PCA) of the 12 delusion items within the Scale for the Assessment of Positive Symptoms (SAPS). Then, using the domains derived via PCA, we tested a priori and exploratory hypotheses related to delusional content. PCA revealed five distinct components: Delusions of Influence, Grandiose/Religious Delusions, Paranoid Delusions, Negative Affect Delusions (jealousy, and sin or guilt), and Somatic Delusions. The most prevalent type of delusion was Paranoid Delusions, and such delusions were more common at older ages at onset of psychosis. The level of Delusions of Influence was correlated with the severity of hallucinations and negative symptoms. We ascertained a general relationship between different childhood adversities and delusional themes, and a specific relationship between Somatic Delusions and childhood neglect. Moreover, we found higher scores on Delusions of Influence and Negative Affect Delusions among cannabis and stimulant users. Our results support considering delusions as varied experiences with varying prevalences and correlates.
Data from 247 first-episode psychosis patients were used to explore associations between types of hallucinations and nine diverse clinical characteristics. Psychopathology was rated using the Scale for the Assessment of Positive Symptoms and Scale for the Assessment of Negative Symptoms (SANS). Childhood adversity was assessed with seven instruments; family history with an adapted version of the Family Interview for Genetic Studies; age at onset of psychosis and duration of untreated psychosis (DUP) with the Symptom Onset in Schizophrenia inventory; and insight with the Birchwood Insight Scale. Both principal component analysis-derived Auditory and Non-Auditory Hallucinations were similarly associated with delusions of influence, negative affect delusions (jealousy and sin/guilt), interpersonal childhood abuse, DUP, and insight. However, the two hallucination domains had different associations with grandiose/religious, paranoid, and somatic delusions; SANS score; childhood violence exposure; cannabis use disorders; and cocaine/other drug use disorders. Neither Auditory nor Non-Auditory Hallucinations were associated with childhood neglect, age at onset, alcohol use disorders, family history, or mode of onset of psychosis. Findings supports considering hallucinations not as a unitary psychopathological construct. They represent at least two domains and are correlated in different ways with diverse clinical variables.
Neurodegeneration with brain iron accumulation (NBIA) is a collective term to indicate a group of neurodegenerative diseases presenting accumulation of iron in the basal ganglia. These disorders can result in progressive dystonia, spasticity, parkinsonism, neuropsychiatric abnormalities, and optic atrophy or retinal degeneration. Onset age ranges from infancy to late adulthood and the rate of progression is very variable. So far, the genetic bases of nine types of NBIA have been identified, pantothenate-kinase-associated neurodegeneration (PKAN) being the most frequent type. The brain MRI “eye-of-the-tiger” sign, T2-weighted hypointense signal in the globus pallidus with a central region of hyperintensity, has been considered virtually pathognomonic for PKAN but recently several reports have denied this. A significant percentage of individuals with clinical and radiographic evidence of NBIA do not have an alternate diagnosis or mutation of one of the nine known NBIA-associated genes (idiopathic NBIA). Here we present an adult-onset case of “undiagnosed” NBIA with the brain MRI “eye-of-the-tiger” sign, and with psychotic symptoms which were successfully treated with antipsychotic and mood stabilizer medications. Here, the term “undiagnosed” is used because the patient has not been screened for all known NBIA genes, but only for two of them.
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