Addison’s disease (AD) is a rare disorder of the adrenal glands which causes deficiency of cortisol and aldosterone. It presents with a variety of symptoms, including neuropsychiatric manifestations. We discuss the case of a patient who exhibited psychotic symptoms in clear consciousness and no other clinical sign of AD.

To investigate the association between AD and neuropsychiatric symptoms; to make clinicians aware of psychotic manifestations of AD as first presentation.

Case Presentation of a patient with psychosis and AD. A review of the literature was conducted in PubMed using the following keywords: Addison’s disease, Addison crisis, psychosis, psychotic, neuropsychiatric

A 32-year-old alert male patient presented with delusions of persecution, auditory hallucinations and mild psychomotor agitation after a stressful life event. Lab tests showed hyponatremia (132 mEq/L). Patient exhibited rapid clouding of consciousness after admission and further lab results showed low levels of cortisol. He was therefore started treatment with high doses of hydrocortisone with good response. A close association between AD and psychiatric manifestations was indicated by the literature review, especially in males and those with thyroid dysfunction comorbidity. These include a wide range of symptoms, such as apathy, catatonia, anxiety, depression, lethargy, delirium, cognitive disorder, irritability, behavioural disorders, agitation, delusions, hallucinations, and rarely psychotic symptoms in clear consciousness. The aetiopathogenetic mechanism involves electrolyte disturbances, cortisole deficiency and increase in endogenous endorphines

Clinicians should be alert of the manifestation of AD with psychiatric symptoms ;patients with AD should be informed of the risk for Addison crisis after stress.

No significant relationships.

A delusion of pregnancy is defined as a fixed false belief that one is pregnant in the absence of any evidence to support the pregnant state. Different mechanisms have been advanced to explain this phenomenon.

Herein, we present a case of hyperprolactinemia with delusion of pregnancy during the use of Amisulpride.

Herein, we present a case of hyperprolactinemia with delusion of pregnancy during the use of Amisulpride.

This case concerns a 39-year-old, divorced Tunisian woman with the diagnosis of schizoaffective disorder,She has never been pregnant. She was taking Amisulpride at the dose of 400 mg per day with 100mg of Haldol Decanoate. In June 2021, she was admitted to our department as she expressed the thought that she was pregnant. No other psychotic symptoms were reported. There was no history of alcohol or illicit drug use. The physical examination was normal. The blood pregnancy test was negative. A measure of serum prolactin was performed and revealed a high prolactin level at 700 ng/ml. Amisulpride was discontinued. We then recorded the serum prolactin level at one month and then at three months after we stopped Amisulpride. We found that as her prolactin levels decreased her complaint of pregnancy also diminished. Actually, the patient has a normal level of prolactin and has no pregnancy delusion.

Clinicians should be aware that delusion of pregnancy in psychotic patients may be caused by side effects of the treatment. Monitoring of serum prolactin levels in patients under Amisulpride may help to improve the management of these patients.

No significant relationships.

The prevalence of substance use disorder has rapidly increased recently. It is believed that the occurrence of mental disorders is strongly associated with substance use.

To identify prevelance of different psychiatric mobidity & symptomatology as Comorbidity amon the diagnosed patients of Substance Use Disorder

This study was conducted from June till December 2021. A total of 486 PDUs were recruited for this study. A self-administered questionnaire was distributed among PDUs admitted at the Rehabilitation Centre during the period of the study. The questionnaire inquired about the demographic details of the PDUs, their substance history and the occurrence of any MDs.

The mean age of the PDUs was 25.9 + 6.0 years. A total of (95%) men and (5%) women reported their gender. There were single (74.7%), married (23.1%), divorced (1.4%) and separated (0.7%) PDUs. A large majority of the PDUs (n = 159, 55.6%) had been using different drugs for more than three years. The various MDs reported among the PDUs were delusion (n = 100, 35.2%); paranoia (n = 51, 17.8%); mania (n = 36, 12.6%); depression (n = 156, 54.5%); (n = 100, 35.2%); auditory hallucinations (n = 73, 25.7%); visual hallucinations (n = 106, 37.3%) and anxiety (n = 46, 16.2%). Among 164 cannabis users, hallucinations (n = 35, 21.3%; p = 0.04) was the only significant MD.

Delusion and paranoia were amongst the most highly prevalent MDs reported. The occurrence of auditory hallucinations, mania and paranoia were significantly associated with cannabis, heroin and cocaine use, respectively.

No significant relationships.

Delusions are a key feature of schizophrenia psychopathology. From a phenomenological approach, Jaspers (1913) differentiates between “primary” or true schizophrenic delusions, defined as an unmediated phenomenon that cannot be understood in terms of prior psychological origin or motivation, and “secondary” delusions, understandable from the patient’s mood state or personality. Primary delusions have been considered the hallmark of reality distorsion dimension in schizophrenia, disregarding a possible affective patwhay to delusional belief.

The present study was aimed at elucidating the psychopathological trajectories to delusion in schizophrenia through the investigation of both affective and schizotypal trait dispositions.

Seventy-eight participants affected by schizophrenia were administered the Peters Delusional Inventory (PDI), the Positive and Negative Affective Scale (PANAS), the Experience of Shame Scale (ESS), the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS) and the Perceptual Aberration Scale (PAS).

The severity of delusional ideation (PDI) was positively related to both affective (PANAS positive dimension, ESS) and schizotypal traits (MIS, PAS and REF). Moreover, referential thinking (REF) mediated the relationship between “magical ideation” (MIS) and delusions severity (Fig. 1), whereas experience of shame (ESS) was a moderating factor in the between referential thinking and delusion severity (Fig. 2).

The study findings suggest that in schizophrenia patients, severity of delusions is underpinned by an intertwining of both affective and schizotypal pathways.

No significant relationships.

The suspiciousness of a paranoid patient could reach extremes.

To present the lessons learned after an interview with a similar patient.

Case report.

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”.

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.

No significant relationships.

Delusion of pregnancy has been described as a false and fixed belief of being pregnant despite factual evidence to the contrary. Pseudocyesis is a condition in which the patient has all signs and symptoms of pregnancy except for the confirmation of the presence of a fetus. There has been described symptoms as abdominal distention, cessation of menses, morning sickness, etc.

The aim of this work was to distinguish between pseudocyesis and pseudopregnancy. This case presents a single 49-year-old woman, who developed the delusion of being pregnant after months of lonely confinement during Covid-19 quarantine.

She had missed her period for 10 months. She was convinced that she could feel the fetal movements. Her thought content revealed delusion of persecution, reference, and delusion of being pregnant. She did not reveal any hallucinations. Blood tests and brain imaging revealed no abnormalities. □The treatment was started with Paliperidone 100mg/month, and clonazepam 2mg/d.

The patient showed a substantial improvement within 10 weeks of treatment. Pseudocyesis and delusional pregnancy have been rarely described on scientific bibliography. A distinction has been demonstrated based on the consideration of the associated psychotic features that might be present in delusions of pregnancy, which were described in the current case. On the other hand, pseudocyesis clinical presentation is centered on the false signs and symptoms of pregnancy.

Antipsychotics played a key role in the delusion of pregnancy. Psychodynamic and supportive psychotherapy could play a pivotal role in the management of pseudocyesis.

No significant relationships.

No significant relationships.

Most research exploring the link between traumatic events and psychotic experiences has focused on either Australia, Europe or North America. In this study, we expand the existing knowledge to Thailand and investigate the impact of the type and the number of traumatic events on psychotic experiences in Thailand.

We used data from the nationally representative 2013 Thai National Mental Health Survey (TNMHS), including questions on traumatic events and psychotic experiences. We regressed the lifetime experience of hallucinations or delusions against the following independent variables: the experience of any traumatic event during lifetime (dichotomous; hypothesis 1); the experience of either no traumatic event, one interpersonal, one unintentional or both interpersonal and unintentional traumatic events (categorical; hypothesis 2) and the number of traumatic events experienced during lifetime (categorical; hypothesis 3). We adjusted the regression models for sociodemographic indicators and psychiatric disorders, and considered survey weights.

About 6% (95% confidence interval: 4.9–7.0) of the respondents stated that they had either hallucinatory or delusional experiences during their lifetime. The risk of reporting such experiences was more than doubled as high among respondents who had experienced at least one traumatic event during their lifetime than among those who had not yet experienced one, with higher risks for interpersonal or multiple traumatic events. Our results further indicated an increase in the risk of psychotic experiences as the number of traumatic events increased, with up to an eight-fold higher risk for people exposed to five or more traumatic events in their lifetime, compared to those with no traumatic events.

Individuals reporting interpersonal or multiple traumatic events face much higher risk of psychotic experiences. Effective and widely accessible secondary prevention programmes for people having experienced interpersonal or multiple traumatic events constitute a key intervention option.

Schizophrenia (SZ) is a complex disorder characterized by a range of behavioral and cognitive symptoms as well as structural and functional alterations in multiple cortical and subcortical structures. SZ is associated with reduced functional network connectivity involving core regions such as the anterior cingulate cortex (ACC) and the thalamus. However, little is known whether effective coupling, the directed influence of one structure over the other, is altered during rest in the ACC–thalamus network.

We collected resting-state fMRI and diffusion-weighted MRI data from 18 patients and 20 healthy controls. We analyzed fronto-thalamic effective connectivity using dynamic causal modeling for cross-spectral densities in a network consisting of the ACC and the left and right medio-dorsal thalamic regions. We studied structural connectivity using fractional anisotropy (FA).

We found decreased coupling strength from the right thalamus to the ACC and from the right thalamus to the left thalamus, as well as increased inhibitory intrinsic connectivity in the right thalamus in patients relative to controls. ACC-to-left thalamus coupling strength correlated with the Positive and Negative Syndrome Scale (PANSS) total positive syndrome score and with delusion score. Whole-brain structural analysis revealed several tracts with reduced FA in patients, with a maximum decrease in white matter tracts containing fronto-thalamic and cingulo-thalamic fibers.

We found altered effective and structural connectivity within the ACC–thalamus network in SZ. Our results indicate that ACC–thalamus network activity at rest is characterized by reduced thalamus-to-ACC coupling. We suggest that positive symptoms may arise as a consequence of compensatory measures to imbalanced fronto-thalamic coupling.

During threat, interpersonal distance is deliberately increased. Personal space regulation is related to amygdala function and altered in schizophrenia, but it remains unknown whether it is particularly associated with paranoid threat.

We compared performance in two tests on personal space between 64 patients with schizophrenia spectrum disorders and 24 matched controls. Patients were stratified in those with paranoid threat, neutral affect or paranoid experience of power. In the stop-distance paradigm, participants indicated the minimum tolerable interpersonal distance. In the fixed-distance paradigm, they indicated the level of comfort at fixed interpersonal distances.

Paranoid threat increased interpersonal distance two-fold in the stop-distance paradigm, and reduced comfort ratings in the fixed-distance paradigm. In contrast, patients experiencing paranoid power had high comfort ratings at any distance. Patients with neutral affect did not differ from controls in the stop-distance paradigm. Differences between groups remained when controlling for gender and positive symptom severity. Among schizophrenia patients, the stop-distance paradigm detected paranoid threat with 93% sensitivity and 83% specificity.

Personal space regulation is not generally altered in schizophrenia. However, state paranoid experience has distinct contributions to personal space regulation. Subjects experiencing current paranoid threat share increased safety-seeking behavior.