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Senescence as a manifestation of Mirror Autoprosopometamorphopsia
- S. Kalita, D. Birwatkar, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S689
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Introduction
Obligate autoscopic mirror hallucinations of senescence have not heretofore been described.
ObjectivesTo reveal that perception of looking older in the mirror may be the manifestation of Mirror Autoprosopometamorphopsia.
MethodsA 37 year old right handed female, with schizoaffective disorder, bipolar subtype She described that when she would gaze at herself in the mirror, she would not see her current face, but rather the visage of an “old person”. This would recur whenever she would directly look at herself in the mirror, and would avoid glancing at any mirrors because she was fearful of looking at her transform senescent countenance. She realised it was not another person but rather herself in the future, having become her geriartric self.
ResultsAbnormalities in Physical Examination: Mental Status Examination: Hyperverbal, grandiose with expansive affect, poor insight and judgment. Recalls 3 out of 4 objects in 3 minutes and all 4 with reinforcement. Proverb testing: correct abstraction. Neuropsychiatric Testing: The Patient Health Questionnaire 9:7 (mild depression). Other: Magnetic Resonance Imaging/ Magnetic Resonance Angiography of Brain with Infusion: Normal.
ConclusionsAutoscopic mirror hallucinations appearing only when embedded in a mirror are obligate autoscopic mirror hallucinations and suggest occipital and parietal lobe dysfunction (Virk, 2018). The inability to recognize the perception of another image or another person replacing the individual looking in the mirror, while defined as a mirror sign, may also be viewed as “a capgras syndrome for the mirror image” (Feinberg, 2005). Distortion of one’s own face only when viewed in a mirror is autoprosopometamorphopsia. With such distortion, this may be a misidentification of one’s own image. This phenomenon is classified as a form of delusional misidentification syndrome with inability to recognise one’s image in the mirror (Postal, 2005). Autoprosopometamorphopsia, obligate to mirror reflection, but metamorphosized to enhance perceived senescence, has not been specifically localized. Possibly a single lesion in the non dominant inferior parietal lobe may have caused this phenomenon. Somatoparaphrenia with somatosensory illusions involving body image are seen with parietal lobe dysfunction (Nightingale, 1982). In the general population, an individual’s focus on a mild facial imperfection often is associated with a negative view of their image. Exaggeration of this to involve the entire face, with projection of imperfection of aging, may be a somatic manifestation of such negative self image. It is possible that such senescent autoprospometamorphopsia may be prevalent, to a lesser degree, in the general population and may be a nidus for younger people seeking cosmetic and plastic surgical intervention of the face.
Disclosure of InterestNone Declared
To Sleep Perchance to Dream - Not; Nyctophobia From COVID-19 Induced Hyposmia
- S. Kalita, D. Birwatkar, R. Cosme, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S807
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Introduction
Fear of sleep (nyctophobia), has been attributed to myriad conditions ranging from benign nocturnal panic attacks and Morvan’s syndrome (Ekambaram, 2021). Positional dependent hyposmia as an origin of nyctophobia has not heretofore been described.
ObjectivesIncrease awareness for correlation between nyctophobia and hyposmia in individuals with COVID-19.
MethodsThis 52-year-old woman presented with sudden onset of loss of smell and taste with COVID-19, which returned to 85% of normal. Five months prior to presentation she was reinfected with COVID-19, and her smell and taste dropped to 20-50% of normal which improved. However, her symptoms worsened when she would lie down, to 30% of normal, but would improve with standing, moving and sitting. Even reclining for a short nap caused her sense of smell to drop, requiring her to stand for hours before her sense of smell would return leading to her nyctophobia that forced her to move around all the time. She altered her lifestyle and assiduously avoided lying down. When so overwhelmed by tiredness she would sleep sitting up. Prior to her chemosensory problems she slept well without any fear of lying down or sleeping.
ResultsPsychiatric exam: speech: coherent, relevant without circumstantiality, normal pace and volume. Mood: normal. Oriented x 3. Able to remember 7 digits forward and 5 backwards. Able to recall 3/4 objects without reinforcement. Interpretation of similarities: normal. Proverbs: normal. Calculation: normal. Neuropsychiatric testing: Clock Drawing Test: 4/4 (normal). Animal Fluency Test: 22 (normal).
ConclusionsNyctophobia, fear of positional dependent loss of smell, highlights the importance of smell to narcissistic perception of self. More than just one of senses, olfaction is important for mood regulation, memories and quality of life. Associated with chemosensory dysfunction, this is associated with 96% incidence of DSM-IIIR Axis I or II diagnoses, with the most common Axis I diagnosis being generalized anxiety disorder and dysthymia (Hirsch, 1996). This can be understood that the olfactory lobe is anatomically part of limbic system (MacLean, 1973). Smell fascilitates socialisation as well as maintaining interelationships; sexual dysfunctioning is seen in 17% of the population with olfactory loss (Hirsch, 1998). Deposition of memory engrams are facilitated as manifest with olfactory evoked nostalgia seen in 84% of the general population (Hirsch, 1992). Quality of life is reduced in 68% of patients who demonstrate smell loss (Deems, 1991). The importance of smell is thus intrinsic to an individual’s wellbeing, and the threat of loss of such sensation with change in position with sleep, was the precipitating event leading to nyctophobia in this subject. Assessing for fear of loss of smell in those with nyctophobia, especially with past COVID-19 infection, allows for increased understanding of etiology and indicates potential treatment approaches.
Disclosure of InterestNone Declared
Bluetooth Hyperosmia: Chemosensory Variant of Delusional Somatic Symptom Disorder
- S. Kalita, D. Birwatkar, A. Hirsch
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S689-S690
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Introduction
Subjective hyperosmia, as a manifestation of belief of exposure to Bluetooth transmission, with testing demonstrating the absence of true hyperosmia, has not heretofore been described.
ObjectivesCorrelation of Bluetooth transmission with subjective hyperosmia.
MethodsThis 53-year-old right-handed single woman presented with a 10-year history of increase in sensitivity to aroma and enhanced perception of smells upon exposure to Wi-Fi electromagnetic radiation. She noted an intensity-duration effect: with higher intensity and duration of Wi-Fi exposure, her sense of smell would escalate and persist: after a few hours of exposure, her smell would jump to a 190% of normal and last for two weeks. When she drives toward a metropolitan area, she can feel that the Wi-Fi is more intense and gets an electrical sensation like “I am an antenna”. Because of this, she refuses to use a cell phone or have Wi-Fi in her home.
ResultsMental Status Examination: Able to recall 3 out of 4 objects in 3 minutes without reinforcement. Chemosensory Testing: Olfaction: Brief Smell Identification Test: 9 (normosmia). Alcohol Sniff Test: 8 (hyposmia). Gustation: Waterless Emperical Taste Test: brothy: 4/8 (hypogeusia), total: 46 (normogeusia).
ConclusionsNidus for such hyperosmic delusions may be a primary olfactory system disorder, with induction of ephaptic transmissions, causing intermittent phantosmia or otherwise misperceived odor, misattributed to the ambient environment. Paradoxically, such perceived hyperosmia may be due to a specific or isolated hyposmia or anosmia, the olfactory equivalent to monochromatic color blindness. The assignment of the source of the hyperosmia to that of Bluetooth is consistent with the zeitgeist of mistrust and paranoia of higher technology. Thus, the subjective hyperosmia would only occur when the patient perceives there was a kippage of radiation/ Bluetooth/ electromagnetic waves present, independent of these actually being present. This may be a form of expectation effect due to visual evidence (high tower wires); suggestion combined with subcultural group dynamics with belief in harm of such electromagnetic/Bluetooth waves, with distorted information recall and misattribution. Such group dynamics and shared misperceptions may act to fuel such a delusion as in the Mandela effect (French, 2018). This may represent the chemosensory equivalent of somatosensory amplification due to external intensification (Brascher, 2017). Perchance, this case represents not delusional hyperosmia, due to a functional psychiatric disorder, but rather has a neuroanatomic basis. Those with subjective hyperosmia and hypersensitivity to aromas have demonstrated hypertrophied gray matter volume in the posterior subregion of the right hippocampus, left precuneus, left superior frontal gyrus, and right hypothalamus (Han, 2020). In those with subjective hyperosmia, neurological investigation is warranted.
Disclosure of InterestNone Declared
Management of subjects with Intermittent Explosive Disorder and Autism Spectrum Disorder with Lumateperone
- N. Mehdiratta, S. Kalita, D. Birwatkar, A. Hirsch
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- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S583
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Introduction
Use of lumateperone in reduction of aggression in patients with both autism spectrum disorder and intermittent explosive disorder has not heretofore been described.
ObjectivesExplore the impact of lumateperone treatment for intermittent explosive disorder in autism spectrum disorder.
MethodsCase A: An illiterate non-verbal 18-year-old male, presented with history of behavior problems, developmental and intellectual delays. He attended special education programs at school where he had difficulty interacting with peers and teachers. For three weeks prior to presentation, he has displayed more anger and aggression, biting his hands, pounding on the walls and furniture, and screaming.
Case B: This 18-year-old male, presented with a history of hypsarrhythmia, Lennox-Gastaut syndrome, severe developmental delay, deficit in socializing with lack of interaction with others and autism, presented with aggression, agitation, and hostility, banging on walls and furniture and throwing objects. Coincident with this was an increase in frequency of myoclonic seizures occurring up to twenty-five seizures per day followed by a postictal period of shouting and screaming.
ResultsCase A: Psychiatric examination: Nonverbal, intermittently grunting and screaming, eyes darting, not responding to verbal commands. Posturing of arms in the air, in a hostile stance. Ten days post starting nightly lumateperone 42 mg, patient was no longer banging furniture nor biting. He remained non-verbal but without screaming and hostile behavior.
Case B: Psychiatric examination: Non-verbal screaming, throwing furniture, hitting walls and uncooperative to verbal commands. One month post starting lumateperone 42 mg nightly, while the seizures persisted, patient’s violent attacks were not severe. Two months later, the aggression was much less severe, that he could attend school. Behavioral problems with aggression would recur an hour before the next evening’s lumateperone dose.
ConclusionsLumateperone modulates a variety of neurotransmitters including glutamate, functions as a presynaptic partial dopamine agonist and postsynaptic dopamine antagonist, and enhances N-methyl-d-aspartate, an inhibitor of serotonin reuptake (Reddy, 2020), input, on any of these, may be its mechanism of action (Vyas, 2020). Perchance, its action as a 5HT-2A receptor antagonist may be its method of reducing aggression, as has been posited for its anti aggression effect in schizophrenia (Vyas, 2020). Lumateperone impacts on neurotransmitters, including substance P, which modulate aggression (Gretchen, 2020). Alternativity ASD correlated with dysfunction of Area VIIIA of the right posterior cerebellum and its connection with the left frontal cortex (Heemkerk, 2021). Lumateperone may act to stabilize these areas and thus inhibit aggression (Heemkerk, 2021). In those with aggression associated with ASD and IED, a trial of lumateperone may be worthwhile.
Disclosure of InterestNone Declared
The adaptiveness of fear (and other emotions) considered more broadly: Missed literature on the nature of emotions and its functions
- Margaret S. Clark, Chance Adkins, Jennifer Hirsch, Hannah S. Elizabeth, Noah T. Reed
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- Journal:
- Behavioral and Brain Sciences / Volume 46 / 2023
- Published online by Cambridge University Press:
- 08 May 2023, e58
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We agree with Grossmann that fear often builds cooperative relationships. Yet he neglects much extant literature. Prior researchers have discussed how fear (and other emotions) build cooperative relationships, have questioned whether fear per se evolved to serve this purpose, and have emphasized that human cooperation takes many forms. Grossmann's theory would benefit from a wider consideration of this work.
Too Sweet to Eat: Delusional Hypergeusia
- S. Kalita, D. Birwatkar, A. Sundar, A.R Hirsch
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, pp. 225-226
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Introduction
Delusional hypergeusia has not heretofore been reported.
Methods: Case reportA 62-year-old right-handed woman described a plethora of complaints after exposure to a solvent aroma, including headaches, diffuse weakness, fatigue, hallucinated smells and tastes, burning mouth syndrome, and panic attacks. The apogee of her symptoms was that salty taste was 800% of normal, making food taste disgustingly salty. She was unable to tolerate potato chips, pizza, spaghetti sauce, Coca Cola, root beer, Sprite, 7 Up, and even bottled water. Sugar was also too sweet, 600% of normal. Foods which were unbearably sweet included cookies, sugar, and breakfast cereals. Sour and bitter were normal.
ResultsAbnormalities in Neurological Examination: Mental Status Examination: hyperverbal, loud, overly inclusive, irritable with pressured speech; disheveled, racing thoughts, and tangential. Motor Examination: Drift Test: right pronator drift with right abductor digiti mini sign. Gait Examination: heel walking with bilateral decreased arm swing. Reflexes: bilateral quadriceps femoris 3+, positive left (L) Hoffman’s reflex. Chemosensory Testing: Olfaction: Brief Smell Identification Test: 12 (normosmia). Retronasal Olfactory Testing: Retronasal Smell Index: 1 (Anosmia). Gustatory Testing: Propylthiouracil Disc Taste Test: 10 (normogeusia). Waterless Empirical Taste Test: sweet: 4, sour: 3, salty: 7, bitter: 5, brothy: 0, total: 30 (ageusia to umami, otherwise normogeusia). Neuropsychiatric Testing: Go-No-Go Test: 2/6 (abnormal).
DiscussionPerhaps hypergeusia may not have been true hypergeusia but a misperception of retronasal smell associated hyperosmia with physiologic synesthesia manifested as taste. Peradventure, the perceived hypergeusia, is just one component of a generalized delusional paradigm, where many sensory perceptions are intensified. The perceived delusional hyperosmia may be intensification of the sensory misperception due to an underlying dysgeusia. This may represent a variant of the two-factor hypothesis of delusions whereby a distorted sensory perception is then misrepresented in a delusion. Dysfunction of the right hemisphere, which normally acts to censor the left, allows the delusion to manifest. While two different anatomical abnormalities (one left and one right hemisphere) have been postulated to be the foundation of such delusions, it is distinctly possible that a single lesion of the inferior parietal lobule may be sufficient for both sensory distortions to be produced as well as loss of inhibition of delusional interpretation of distorted sensation of the frontal lobe by the right parietal lobe, yclept the sensorialist hypothesis. In those who present with hypergeusia, search for delusional origin is warranted and in those who present with delusions, query as to perceived hypergeusia may be revealing.
FundingNo Funding
Careful, Women! Is Orgasm Worth the Cost of Your Cerebellum? Flibanserin-Induced Cerebellar Dysfunction
- D. Birwatkar, S. Kalita, A.R Hirsch
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- Journal:
- CNS Spectrums / Volume 28 / Issue 2 / April 2023
- Published online by Cambridge University Press:
- 14 April 2023, p. 225
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Introduction
Flibanserin, a serotonin antagonist currently indicated for treatment of female sexual dysfunction disorder, has not heretofore been described to worsen cerebellar function. Such a case is presented.
MethodsA 60-year-old woman, 8 months prior to presentation, had an acute onset of fainting and hitting her head into a wall without loss of consciousness. She could not stand up, had left-sided weakness, and vomiting, with garbled, slow speech and severe headache. Findings in the emergency room showed a left cerebellar parenchymal hemorrhage of 3.2 x 3.1 x 2 cm with the epicenter at the dentate nucleus, extending medially towards midline into the cerebellar vermis, with surrounding perilesional edema extending into the middle cerebellar peduncle. Also, 5.2 cm of the hemorrhage extended from the petrous of the tentorium to the cerebellar vermis. Moreover, a ventral left thalamic hemorrhage with subependymal clot at the foramen of Monroe extended into the dependent portion of lateral ventricles without midline shift. Post one month of physical therapy, speech, walking, and coordination improved but she continued to have delayed speech and trouble getting up, with a wide stance.
ResultsNeurologic Examination: Cranial Nerve (CN) Examination: CN XI: Sternocleidomastoid hypertrophy, horizontal titubation. Motor examination: Drift test: L pronator drift with L abductor digiti mini sign. Gait examination: heel walking, dystonic posture of L hand. Tandem gait: unstable, wide based. Cerebellar examination: Both (B) finger-to-nose dysmetria, Left > Right. Slow rapid alternating movements (RAM) L Upper Extremity (UE). Due to absent sexual desire she started 100 mg of flibanserin nightly. Maintaining this for 5 weeks, her coordination markedly worsened with poor balance and a need for a cane to ambulate. She would stumble, with a wider gait, and found climbing stairs challenging. Physical examination displayed worse cerebellar function: prominent horizontal titubation. Finger-to-nose—dysmetria L>R. Decreased RAM, L UE. Markedly positive Holmes Rebound phenomenon, Bilateral UE. Tandem gait: unstable. A week post stopping flibanserin, gait and cerebellar examination returned to baseline.
DiscussionThe temporal correlation between the use of flibanserin and transient worsening of cerebellar function strongly suggests that this is the causative agent. Since serotonin is essential in cerebellar function, including its action on the cerebellar cortex and deep cerebellar nuclei, it strongly suggests that its action as a serotonin antagonist is the mechanism whereby flibanserin is causing cerebellar symptoms. In those on flibanserin, investigation to detect the presence of cerebellar dysfunction is warranted. Assessment for the presence of cerebellar dysfunction in those who are on anti-serotonin drugs, such as cyproheptadine and methysergide, may be worthwhile.
FundingNo Funding
National trends and disparities in retail food environments in the USA between 1990 and 2014
- Part of
- Jana A Hirsch, Yuzhe Zhao, Steven Melly, Kari A Moore, Nicolas Berger, James Quinn, Andrew Rundle, Gina S Lovasi
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- Journal:
- Public Health Nutrition / Volume 26 / Issue 5 / May 2023
- Published online by Cambridge University Press:
- 16 January 2023, pp. 1052-1062
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Objective:
To describe national disparities in retail food environments by neighbourhood composition (race/ethnicity and socio-economic status) across time and space.
Design:We examined built food environments (retail outlets) between 1990 and 2014 for census tracts in the contiguous USA (n 71 547). We measured retail food environment as counts of all food stores, all unhealthy food sources (including fast food, convenience stores, bakeries and ice cream) and healthy food stores (including supermarkets, fruit and vegetable markets) from National Establishment Time Series business data. Changes in food environment were mapped to display spatial patterns. Multi-level Poisson models, clustered by tract, estimated time trends in counts of food stores with a land area offset and independent variables population density, racial composition (categorised as predominantly one race/ethnicity (>60 %) or mixed), and inflation-adjusted income tertile.
Setting:The contiguous USA between 1990 and 2014.
Participants:All census tracts (n 71 547).
Results:All food stores and unhealthy food sources increased, while the subcategory healthy food remained relatively stable. In models adjusting for population density, predominantly non-Hispanic Black, Hispanic, Asian and mixed tracts had significantly more destinations of all food categories than predominantly non-Hispanic White tracts. This disparity increased over time, predominantly driven by larger increases in unhealthy food sources for tracts which were not predominantly non-Hispanic White. Income and food store access were inversely related, although disparities narrowed over time.
Conclusions:Our findings illustrate a national food landscape with both persistent and shifting spatial patterns in the availability of establishments across neighbourhoods with different racial/ethnic and socio-economic compositions.
Uneven Growth in Social Capital Organizations After Disasters by Pre-Disaster Conditions in the United States 2000–2014
- Yvonne L. Michael, Kevin T. Smiley, Lauren Clay, Jana A. Hirsch, Gina S. Lovasi
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 17 / 2023
- Published online by Cambridge University Press:
- 12 December 2022, e278
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Introduction:
Community-level social capital organizations are critical pre-existing resources that can be leveraged in a disaster.
Aim:The study aimed to test the hypothesis that communities with larger pre-disaster stocks of social capital organizations would maintain pre-disaster levels or experience growth.
Methodology:An annual panel dataset of counties in the contiguous United States from 2000 to 2014 totaling 46620 county-years, including longitudinal data on disasters and social capital institutions was used to evaluate the effect of disaster on growth of social capital.
Results:When a county experienced more months of disasters, social capital organizations increased a year later. These findings varied based on the baseline level of social capital organizations. For counties experiencing minor disaster impacts, growth in social capital organizations tends to occur in counties with more social capital organizations in 2000; this effect is a countervailing finding to that of major disasters, and effect sizes are larger.
Conclusion:Given the growing frequency of smaller-scale disasters and the considerable number of communities that experienced these disasters, the findings suggest that small scale events create the most common and potentially broadest impact opportunity for intervention to lessen disparities in organizational growth.
Different trajectories of depression, anxiety and anhedonia symptoms in the first 12 months of the COVID-19 pandemic in a UK longitudinal sample
- Christine E. Parsons, Kirstin L. Purves, Megan Skelton, Alicia J. Peel, Molly R. Davies, Fruhling Rijsdijk, Shannon Bristow, Thalia C. Eley, Gerome Breen, Colette R. Hirsch, Katherine S. Young
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- Journal:
- Psychological Medicine / Volume 53 / Issue 14 / October 2023
- Published online by Cambridge University Press:
- 05 December 2022, pp. 6524-6534
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Background
While studies from the start of the COVID-19 pandemic have described initial negative effects on mental health and exacerbating mental health inequalities, longer-term studies are only now emerging.
MethodIn total, 34 465 individuals in the UK completed online questionnaires and were re-contacted over the first 12 months of the pandemic. We used growth mixture modelling to identify trajectories of depression, anxiety and anhedonia symptoms using the 12-month data. We identified sociodemographic predictors of trajectory class membership using multinomial regression models.
ResultsMost participants had consistently low symptoms of depression or anxiety over the year of assessments (60%, 69% respectively), and a minority had consistently high symptoms (10%, 15%). We also identified participants who appeared to show improvements in symptoms as the pandemic progressed, and others who showed the opposite pattern, marked symptom worsening, until the second national lockdown. Unexpectedly, most participants showed stable low positive affect, indicating anhedonia, throughout the 12-month period. From regression analyses, younger age, reporting a previous mental health diagnosis, non-binary, or self-defined gender, and an unemployed or a student status were significantly associated with membership of the stable high symptom groups for depression and anxiety.
ConclusionsWhile most participants showed little change in their depression and anxiety symptoms across the first year of the pandemic, we highlight the divergent responses of subgroups of participants, who fared both better and worse around national lockdowns. We confirm that previously identified predictors of negative outcomes in the first months of the pandemic also predict negative outcomes over a 12-month period.
Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK
- K. S. Young, K. L. Purves, C. Hübel, M. R. Davies, K. N. Thompson, S. Bristow, G. Krebs, A. Danese, C. Hirsch, C. E. Parsons, E. Vassos, B. N. Adey, S. Bright, L. Hegemann, Y. T. Lee, G. Kalsi, D. Monssen, J. Mundy, A. J. Peel, C. Rayner, H. C. Rogers, A. ter Kuile, C. Ward, K. York, Y. Lin, A. B. Palmos, U. Schmidt, D. Veale, T. R. Nicholson, T. A. Pollak, S. A. M. Stevelink, T. Moukhtarian, A. R. Martineau, H. Holt, B. Maughan, A. Al-Chalabi, K. Ray Chaudhuri, M. P. Richardson, J. R. Bradley, P. F. Chinnery, N. Kingston, S. Papadia, K. E. Stirrups, R. Linger, M. Hotopf, T. C. Eley, G. Breen
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- Journal:
- Psychological Medicine / Volume 53 / Issue 12 / September 2023
- Published online by Cambridge University Press:
- 26 July 2022, pp. 5428-5441
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Background
The impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health is still being unravelled. It is important to identify which individuals are at greatest risk of worsening symptoms. This study aimed to examine changes in depression, anxiety and post-traumatic stress disorder (PTSD) symptoms using prospective and retrospective symptom change assessments, and to find and examine the effect of key risk factors.
MethodOnline questionnaires were administered to 34 465 individuals (aged 16 years or above) in April/May 2020 in the UK, recruited from existing cohorts or via social media. Around one-third (n = 12 718) of included participants had prior diagnoses of depression or anxiety and had completed pre-pandemic mental health assessments (between September 2018 and February 2020), allowing prospective investigation of symptom change.
ResultsProspective symptom analyses showed small decreases in depression (PHQ-9: −0.43 points) and anxiety [generalised anxiety disorder scale – 7 items (GAD)-7: −0.33 points] and increases in PTSD (PCL-6: 0.22 points). Conversely, retrospective symptom analyses demonstrated significant large increases (PHQ-9: 2.40; GAD-7 = 1.97), with 55% reported worsening mental health since the beginning of the pandemic on a global change rating. Across both prospective and retrospective measures of symptom change, worsening depression, anxiety and PTSD symptoms were associated with prior mental health diagnoses, female gender, young age and unemployed/student status.
ConclusionsWe highlight the effect of prior mental health diagnoses on worsening mental health during the pandemic and confirm previously reported sociodemographic risk factors. Discrepancies between prospective and retrospective measures of changes in mental health may be related to recall bias-related underestimation of prior symptom severity.
Alliaceous Axilla as a Manifestation of Olfactory Reference Syndrome
- Anton S. Lima, Jenish V. Patel, Tiffany Chang, Alan R. Hirsch
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- Journal:
- CNS Spectrums / Volume 27 / Issue 2 / April 2022
- Published online by Cambridge University Press:
- 28 April 2022, p. 231
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Introduction
Olfactory reference syndrome (ORS) is a delusion in which a person believes that he or she exudes a displeasing body aroma that others perceive negatively. The axilla has been reported as a single primary source in only one patient. Furthermore, ORS is rarely reported to be associated with food odor. In these instances, the food is not edible. Delusions of ORS presenting as alliaceous edible food aromas have not heretofore been described.
Case ReportOne week after undergoing catheter ablation for atrial fibrillation, this 42-year-old right-handed male experienced a sudden onset of loss of smell and taste. This has persisted on presentation and he described a complete lack of smell, only being able to smell different spices and herbs. Over time, his sense of smell selectively improved such that he was able to smell alliaceous substances, including onion and garlic, as well as a few other aromas. At the same time his smell returned, he noted that his own body exuded a smell of garlic. This occurred especially while weightlifting at the gym. He noticed that the shirts he had worn working out, in the axillary regions, were encumbered with a garlic/onion miasma. He was fearful that this mephitic aroma was being secreted through his armpits, and that others would recognize his tragomaschalia. As a result, he restricted his activities. Over a few months, his smell ability gradually worsened back to the condition he was in after the ablation. Coincident with this, his perception that he was exuding an alliaceous aroma resolved.
ResultsMotor examination: Drift testing: mild left pronator drift. Left abductor digiti minimal sign. Olfactory testing prior to the development of ORS: Alcohol Sniff Test (AST): 0 (anosmia). Brief Smell Identification Test (B-SIT): 3 (anosmia). Olfactory testing during ORS: AST: 16 (hyposmia). B-SIT: 9 (hyposmia). Olfactory testing after resolution of ORS: AST: 0 (anosmia).
DiscussionThis could be explained by a physiologic axillary odor or malodor, which he could not detect before or after the ORS. During the ORS, the odor may have been misperceived in a dysosmic manner due to his underlying olfactory deficit. Such dysosmia may have then been interpreted as the aroma of an alliaceous vegetable. The intensity of the aroma may have been greatest at the axillary area if compared to the other sources, but due to his underlying hyposmia, he was able to perceive only the axilla as a sole source of the aroma. Besides, psychodynamic preoccupation with bodily physique may have explained his hypersensitivity to minor flaws and his excessive preoccupation with possible harassment from others. He may have consequently misinterpreted individuals’ benign observations and attitudes to presume the presence of aroma. In individuals with olfactory deficit, this investigation for the presence of ORS with traditionally unpleasant food aromas or the presence of ORS in those with chemosensory dysfunction is warranted.
FundingNo funding
7 - Best, Worst, and Good Enough
- from Part III - Distant and Fluid Comparisons
- Edited by Michael Schnegg, Universität Hamburg, Edward D. Lowe
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- Comparing Cultures
- Published online:
- 08 May 2020
- Print publication:
- 28 May 2020, pp 155-179
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Summary
In this chapter, the authors trace out the “natural history” of an intensely collaborative multisited comparison, which was distinct from many other comparative research projects because research at each site was carried out by a PhD-level anthropologist who was involved in the scientific development of the project rather than only in the implementation of a centrally directed project. It draws on their experiences with this once-in-a-lifetime opportunity, a large, US National Institutes of Health–funded multisite project, to discuss ways in which that comparative research could have been even more powerful, things that future comparative research should strive to avoid, recommended best practices, and what the authors would call “minimum adequate” approaches to comparative ethnography.
801 – Comprehension and Companionship in the Emergency Department as Predictors of Treatment Adherence: a Prospective Study
- U. Nitzan, E. Hirsch, I. Luria, S. Aviram, G. Walter, Y. Bloch
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- Journal:
- European Psychiatry / Volume 28 / Issue S1 / 2013
- Published online by Cambridge University Press:
- 15 April 2020, 28-E276
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Introduction:
Lack of adherence to recommended treatment poses major clinical and economic challenges for psychiatry, and requires further study.
Objectives and aims:We aimed to prospectively investigate the association between the level of understanding of psychiatric emergency department (ED) discharge recommendations and presence of a companion with short term treatment adherence.
Methods:Sixty subjects were evaluated twice: upon ED discharge and a month later. Instruments included a structured questionnaire based on the MacArthur Competence Assessment Tool for Treatment, MMSE, and corroboration of data with the computerized hospital medical file.
Results:There was a significant association between patient understanding and adherence with medication instructions (p< .01) and adherence to psychiatric follow-up (p< .05). There was also an association between the presence of a companion and adherence to medication instructions (x2(1)=7.0, p< .01).
Conclusions:Ensuring patients' understanding of treatment recommendations and encouraging the company of patients are achievable, practical strategies that may improve adherence and thereby promote better outcomes.
A preliminary investigation of schematic beliefs and unusual experiences in children
- D. Noone, C. Ames, N. Hassanali, S. Browning, K. Bracegirdle, R. Corrigall, K.R. Laurens, C.R. Hirsch, E. Kuipers, L. Maddox, D. Fowler, S. Jolley
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- Journal:
- European Psychiatry / Volume 30 / Issue 5 / July 2015
- Published online by Cambridge University Press:
- 15 April 2020, pp. 569-575
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Background
In cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs.
MethodSixty-seven children aged 8–14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS).
ResultsThe BCSS was readily completed by participants, and scale psychometric properties were good. Children tended to view themselves and others positively. Internalising and externalising problems and UEDs were all associated with negative schematic beliefs; effect sizes were small to medium.
ConclusionsSchematic beliefs in young people can be measured using the BCSS, and negative schematic beliefs are associated with childhood psychopathology and with UEDs. Schematic beliefs may therefore form a useful target in psychological interventions for young people with UEDs.
German validation of the Conners Adult ADHD Rating Scales (CAARS) II: Reliability, validity, diagnostic sensitivity and specificity
- H. Christiansen, B. Kis, O. Hirsch, S. Matthies, J. Hebebrand, J. Uekermann, M. Abdel-Hamid, M. Kraemer, J. Wiltfang, E. Graf, M. Colla, E. Sobanski, B. Alm, M. Rösler, C. Jacob, T. Jans, M. Huss, B.G. Schimmelmann, A. Philipsen
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- European Psychiatry / Volume 27 / Issue 5 / July 2012
- Published online by Cambridge University Press:
- 15 April 2020, pp. 321-328
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Background
The German version of the Conners Adult ADHD Rating Scales (CAARS) has proven to show very high model fit in confirmative factor analyses with the established factors inattention/memory problems, hyperactivity/restlessness, impulsivity/emotional lability, and problems with self-concept in both large healthy control and ADHD patient samples. This study now presents data on the psychometric properties of the German CAARS-self-report (CAARS-S) and observer-report (CAARS-O) questionnaires.
MethodsCAARS-S/O and questions on sociodemographic variables were filled out by 466 patients with ADHD, 847 healthy control subjects that already participated in two prior studies, and a total of 896 observer data sets were available. Cronbach's-alpha was calculated to obtain internal reliability coefficients. Pearson correlations were performed to assess test-retest reliability, and concurrent, criterion, and discriminant validity. Receiver Operating Characteristics (ROC-analyses) were used to establish sensitivity and specificity for all subscales.
ResultsCoefficient alphas ranged from .74 to .95, and test-retest reliability from .85 to .92 for the CAARS-S, and from .65 to .85 for the CAARS-O. All CAARS subscales, except problems with self-concept correlated significantly with the Barrett Impulsiveness Scale (BIS), but not with the Wender Utah Rating Scale (WURS). Criterion validity was established with ADHD subtype and diagnosis based on DSM-IV criteria. Sensitivity and specificity were high for all four subscales.
ConclusionThe reported results confirm our previous study and show that the German CAARS-S/O do indeed represent a reliable and cross-culturally valid measure of current ADHD symptoms in adults.
Standards of Practice in Acute Ischemic Stroke Intervention International Recommendations
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- Laurent Pierot, Mahesh Jarayaman, Istvan Szikora, Joshua Hirsch, Blaise Baxter, Shigeru Miyachi, Jeyaledchumy Mahadevan, Winston Chong, Peter J. Mitchell, Alan Coulthard, Howard A. Rowley, Pina C. Sanelli, Donatella Tampieri, Patrick Brouwer, Jens Fiehler, Naci Kocer, Pedro Vilela, Alex Rovira, Urs Fischer, Valeria Caso, Bart van der Wort, Nobuyuki Sakai, Yuji Matsumaru, Shin-ichi Yoshimura, Luisa Biscoito, Manuel Pumar, Orlando Diaz, Justin Fraser, Italo Lifante, David S. Liebeskind, Raul G. Nogueira, Werner Hacke, Michael Brainin, Bernard Yan, Michael Soderman, Allan Taylor, Sirintara Pongpech, Karel Terbrugge
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 46 / Issue 3 / May 2019
- Published online by Cambridge University Press:
- 20 March 2019, pp. 269-274
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After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.
2 What’s Bugging You? Alliaceous Therapy for Ekbom Syndrome
- Fizah S. Chaudhary, Jasir T. Nayati, Ather M. Ali, Alan R. Hirsch
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- Journal:
- CNS Spectrums / Volume 24 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 12 March 2019, pp. 175-176
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Study Objective
Delusional parasitosis, or Ekbom syndrome, is a fixed false belief of being infested by parasites [Bellanger 2009]. With easy accessibility of the internet, serving as a vital tool in acquiring myriad information, these delusions typically arise and can be fueled by external sources as self-research [Bell2005]. For instance, garlic (allium sativum) has been reported to exhibit anthelmintic activity against cestodes (tapeworms), proving to be a natural treatmentoption [Abdel-Ghaffar 2010]. Without proper instructions, guidelines, or control of such information, psychopathological manifestations may be derived.
MethodsA young adult male presented with severe psychosis. He reports responding to an internal stimuli, non-command auditory hallucinations, and paranoid ideations specifically in regards to his body and health for several weeks. Prior to presentation, he experienced abdominal pain and constipation for five days, but attributed it to the belief of having tapeworms. He stated that he researched cures for several days using the internet and found garlic as a treatment option. He attempted to alleviate his symptoms by ingested 197 pills of 1,000 milligram (mg) garlic supplements, two 100mg bisacodyl laxatives, and five 100mg docusate stool softeners in one day. He denies any suicidal/homicidal ideations, illicit substance abuse, deja-vu, and jamais-vu.
ResultsPsychiatric examination is as follows: Mental Status Examination: awake, alert, and oriented x3. General Appearance: disheveled. Speech: soft, mumbling, and minimally non-responsive. Psychomotor Activity: moderately sedated. Eye Contact: poor. Mood: dysphoric. Affect: flat. Thought Process: flight of ideas. Thought Content: preoccupied. Judgement/Insight: poor. Immediate/Recent Recall: poor. Remote Memory: poor.
ConclusionDelusional parasitosis and somatic parasitic infestation has dire consequences in which one's health can become compromised. For those suffering from parasitosis, addition of garlic in food as well as garlic supplements of 50mg/kg body weight has been reported as a possible naturopathic treatment option in Cryptosporidiosis and Schistosoma mansoni [Gaafar 2012; Nahed 2009]. In addition, it was found that a dose of 1.2mg for three days was efficient, safe, and shortens the duration of treatment for parasites [Soffar 1991]. However, this patient ingested 197,000mg of garlic supplements without experiencing symptoms of overdose. This may include burning sensation of the mouth or stomach, flatulence, nausea/vomiting, diarrhea, thrombocytopenia, and anaphylaxis [Bayan 2014]. The efficacy of garlic for treatment of true parasitosis is unknown, but can be found in common practice especially those who practice naturopathic medicine. In this case, it is unlikely to have a positive effect, especially when delusional in nature. The use of homeopathic medication in those with true parasitosis and delusional parasitosis should be queried.
Funding Acknowledgements: Smell & Taste Treatment and Research Foundation
24 CerefolinNAC Therapy-Induced Dysgeusia
- Jasir T. Nayati, Fizah S. Chaudhry, Tajinder Parhar, Ather M. Ali, Alan R. Hirsch
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- Journal:
- CNS Spectrums / Volume 24 / Issue 1 / February 2019
- Published online by Cambridge University Press:
- 12 March 2019, p. 186
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Introduction
CerefolinNAC (CFLN-NAC) is a prescription medical food reported to help with mild to moderate cognitive impairment [Pamlab 2017]. It contains L-methylfolate calcium (6mg), methylcobalamin (2mg), Schizochytrium (90.3mg), and N-acetylcysteine (NAC) (600mg) [Pamlab 2017]. However, dysgeusia secondary to CFLN-NAC therapy has not heretofore been described.
MethodsA 64 year-old female presented with an eight year history of progressively decreased ability to smell and taste of unknown origin. CFLN-NAC was prescribed off-label to treat her hypogeusia and hyposmia. Three days after treatment initiation, her taste sensations gradually returned and she was able to describe food as bitter, salty, sour and sweet. Also, she was able to decipher the taste of different nuts, such as almonds, macadamia, pecans, and peanuts at baseline. However, her taste sensations became distorted and she was unable to distinguish specific foods. She reported that most food tasted bland, but she was still able to sense textures of various foods describing them as, “crunchy, but without taste.” She denied any oral pain, xerostomia, hot flashes, and psychological distress. CFLN-NAC was continued for three months and her hypogeusia improved from 20% to 80%. Her dysgeusia persisted, but remitted once CFLN-NAC was discontinued.
ResultsAbnormalities in physical examination: General: scalloped tongue, decreased blink frequency, and hypokinesia. Cranial Nerve (CN) Examination: Olfaction (CN I) Testing: Alcohol Sniff Test: 8 (hyposmia). Pocket Smell Test: 2 (hyposmia). Olfactometer Identification Test: Left: 5 (anosmia); Right: 12 (hyposmia). CN III, IV, VI: saccadization on horizontal eye movement. Motor Examination: hypokinetic movements and 1+ cogwheel rigidity in bilateral upper extremities. Drift Test: bilateral abductor digiti minimi signs with cerebellar spooning. Reflexes: absent patellar and Achilles bilaterally. Hoffman’s Reflex: present bilaterally. Other: Magnetic resonance imaging (MRI) of the brain with contrast was unremarkable.
ConclusionWhen treating taste impairments, vitamins and minerals have been found to enhance the effect of non-injured nerves, but they do not repair damaged nerves. The presence of a scalloped tongue may suggest nerve injury of unknown proportion, and can either diminish or alter taste. CFLN-NAC may have enhanced the gustatory stimulus of the non-injured nerves. This transient increase could have either caused her dysgeusia or possibly unmasked the dysgeusia secondary to a scalloped tongue. Notable impairments found in her exam evince Parkinson’s disease as a possible etiology, but structural abnormalities were not seen on brain MRI, making this unlikely. Conversely, the relatively rapid resolution after terminating CFLN-NAC strongly suggests that this is not merely a coincidence, but rather an origin. Those initiated on CFLN-NAC should be queried for new onset of dysgeusia and warrant other treatment options.
Funding Acknowledgements: Smell & Taste Treatment and Research Foundation
Chapter 5 - Love Conceptualized as Mutual Communal Responsiveness
- Edited by Robert J. Sternberg, Cornell University, New York, Karin Sternberg, Cornell University, New York
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- Book:
- The New Psychology of Love
- Published online:
- 03 December 2018
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- 06 December 2018, pp 84-116
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Summary
The term love is used in many ways. It has been used to refer to sexual feelings for another person, motivation to be with a person, and selfless devotion to another (just to name a few). Many times it refers to a combination of these things. Very often the term is used without definition. No one usage is the right one. Each has value. Yet in conducting research and in writing about love for academic purposes, it is important to make one’s own conceptual definition clear.