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IntroductionPsychosis itself may be associated with an increased risk of atrial fibrillation. Moreover, antipscyhotic treatment increases this risk. Recently D’Urso et al. reported aripiprazole-induced atrial fibrillation in a patient with concomitant risk factors.ObjectivesTo the best of author’s knowledge no data has been published about the safety and the efficacy of lurasidone treatment in psychotic patient with comorbid atrial fibrillation.MethodsA 68 years old patient with persistent atrial fibrillation and hypertension in treatment with amiodarone 100 mg/day, lurasidone 25 mg/day, rivaroxaban 15 mg/day, clopidogrel 75 mg/day, bisoprolol 1,25 mg/day, tamsulosin 0,4 mg/day presented delusional ideas of jealousy for not real betrayal by his wife, social withdrawal, reduced sleep. Blood pressure 130/80 mmHg, heart rate 70 bpm, Qtc 420 msec. The patient was drug-naïve for any psychotropic treatment. The authors decided to start lurasidone treatment at the dosage of 18,5 mg/day.ResultsAfter the first administration of lurasidone treatment sleep was resolved. After two weeks delusional ideas and social withdrawal were markedly improved. After one month of treatment, blood pressure, heart rate and Qtc remained almost stable. The authors decided not to increase the dosage of lurasidone because of the age of the patient and the comorbid cardiovascular pathologies.ConclusionsLurasidone has showed safety and efficacy in the treatment of this patient with delusional disorder and comorbid atrial fibrillation. This is a preliminary data that requires follow up and further studies to confirm the usefulness of lurasidone in psychotic patients with atrial fibrillation and cardiovascular risks.DisclosureNo significant relationships.

(1) Background: Delirium is a serious condition in patients undergoing treatment for somatic diseases, leading to poor prognosis. However, the pathophysiology of delirium is not fully understood and should be clarified for its adequate treatment. This study analyzed the relationship between confusion symptoms in delirium and resting-state electroencephalogram (EEG) power spectrum (PS) profiles to investigate the heterogeneity. (2) Methods: The participants were 28 inpatients in a general hospital showing confusion symptoms with an Intensive Care Delirium Screening Checklist (ICDSC) score of 4 or above. EEG was measured at Pz in the daytime awake state for 100 s with the eyes open and 100 s with the eyes closed on the day of the ICDSC evaluation. PS analysis was conducted consecutively for each 10 s datum. (3) Results: Two resting EEG PS patterns were observed regarding the dominant rhythm: the presence or absence of a dominant rhythm, whereby the PS showed alpha or theta peaks in the former and no dominant rhythm in the latter. The patients showing a dominant EEG rhythm were frequently accompanied by hallucination or delusion (p = 0.039); conversely, those lacking a dominant rhythm tended to exhibit fluctuations in the delirium symptoms (p = 0.020). The other ICDSC scores did not differ between the participants with these two EEG patterns. (4) Discussion: The present study indicates that the presence and absence of a dominant EEG rhythm in delirious patients are related to different symptoms of delirium. Using EEG monitoring in the care of delirium will help characterize its heterogeneous pathophysiology, which requires multiple management strategies.

The bottom line Consider delusional infestation in patients who present with a fixed belief that they are infested with living or non-living organisms in the absence of medical evidence for this Always exclude real infestations first, with examination, review by a dermatologist or infectious disease specialist, and appropriate tests Acknowledge the patient's distress without reinforcing false beliefs Most patients require antipsychotic treatment (amisulpride, olanzapine, or risperidone), which may be offered as a means to alleviate symptoms Management ideally requires a multidisciplinary approach, but, as patients rarely agree to full psychiatric assessment, physicians who have engaged patients in a trusting relationship should offer medication, if possible with psychiatric advice Delusional infestation (previously also known as delusional parasitosis or Ekbom's syndrome) is a rare disorder, but it commonly poses disproportionate practical problems to healthcare systems. 1 It is characterised by a patient's fixed belief that his or her skin, body, or immediate environment is infested by small, living (or less often inanimate) pathogens despite the lack of any medical evidence for this. 1 Delusional infestation is neither a single disease nor a single diagnostic entity. First generation antipsychotics may lead to more full remissions than newer antipsychotics. 17 However, we cannot recommend pimozide for reasons of drug safety, especially because of problems with postural hypotension, extrapyramidal side effects, and QT prolongation. 1 8 14 17 The best way to approach antipsychotics with patients is by discussing them as a means to relieve distressing symptoms (box 1).

Background Hypersensitivity to antipsychotic drugs is one of the supportive features of dementia with Lewy bodies, and side effects to drugs other than antipsychotics are also known to occur frequently. We experienced a case of dementia with Lewy bodies in which hallucinations and delusions repeatedly appeared and disappeared after administration and discontinuation of mirogabalin and pregabalin. Case presentation The patient, a woman in her late 70s, developed hallucinations and delusional misidentification of places and persons immediately after receiving a prescription of mirogabalin (15 mg daily) for neuropathic pain. After discontinuation of mirogabalin, her hallucinatory delusions improved but remained. Mild dementia and mild parkinsonism were associated, cognitive fluctuations were evident, and dopamine-transporter scintigraphy showed bilateral striatal uptake reduction. Residual psychosis resolved with donepezil. Later, when the pain worsened, pregabalin (25 mg daily) was administered, and the psychosis recurred and resolved with discontinuation. Conclusions Although pregabalin-induced psychosis has been reported at higher doses (300–450 mg daily), it has not been reported at doses as low as those used in this patient. Gabapentinoids may cause psychosis in patients with dementia with Lewy bodies even at low doses, likely due to hypersensitivity to gabapentinoids in DLB.

ABSTRACTBackgroundSeveral etiologies can underlie the development of late-onset psychosis, defined by first psychotic episode after age 40 years. Late-onset psychosis is distressing to patients and caregivers, often difficult to diagnose and treat effectively, and associated with increased morbidity and mortality. MethodsThe literature was reviewed with searches in Pubmed, MEDLINE, and the Cochrane library. Search terms included “psychosis,” “delusions,” hallucinations,” “late onset,” “secondary psychoses,” “schizophrenia,” bipolar disorder,” “psychotic depression,” “delirium,” “dementia,” “Alzheimer’s,” “Lewy body,” “Parkinson’s, “vascular dementia,” and “frontotemporal dementia.” This overview covers the epidemiology, clinical features, neurobiology, and therapeutics of late-onset psychoses. ResultsLate-onset schizophrenia, delusional disorder, and psychotic depression have unique clinical characteristics. The presentation of late-onset psychosis requires investigation for underlying etiologies of “secondary” psychosis, which include neurodegenerative, metabolic, infectious, inflammatory, nutritional, endocrine, and medication toxicity. In delirium, psychosis is common but controlled evidence is lacking to support psychotropic medication use. Delusions and hallucinations are common in Alzheimer’s disease, and hallucinations are common in Parkinson’s disease and Lewy body dementia. Psychosis in dementia is associated with increased agitation and a poor prognosis. Although commonly used, no medications are currently approved for treating psychosis in dementia patients in the USA and nonpharmacological interventions need consideration. ConclusionThe plethora of possible causes of late-onset psychosis requires accurate diagnosis, estimation of prognosis, and cautious clinical management because older adults have greater susceptibility to the adverse effects of psychotropic medications, particularly antipsychotics. Research is warranted on developing and testing efficacious and safe treatments for late-onset psychotic disorders.

This prospective observational study was designed to explore the relationships between post-traumatic stress disorder (PTSD), patients' memories of the intensive care unit (ICU) and sedation practices. Prospective multi-centre follow-up study out to 3 months after ICU discharge. Two district general hospitals and three teaching hospitals across Europe. Two hundred and thirty-eight recovering, post-ventilated ICU patients. None. Assessment of patients' memories of ICU was undertaken at 1-2 weeks post ICU discharge. Patients' psychological recovery was assessed by examining the level of PTSD-related symptoms and rate of PTSD by 3 months post ICU. The rate of defined PTSD was 9.2%, ranging from 3.2% to 14.8% in the different study ICUs. Independent of case mix and illness severity, the factors found to be related to the development of PTSD were recall of delusional memories, prolonged sedation, and physical restraint with no sedation. The development of PTSD following critical illness is associated with a number of different precipitating factors that are in part related to how patients are cared for within intensive care. This study raises the hypothesis that the impact of care within the ICU has an impact on subsequent psychological morbidity and therefore must be assessed in future studies looking at the way patients are sedated in the ICU and how physical restraint is used.

To critically summarise the qualitative literature to understand patients’ experiences of delusional memories during their Intensive Care Unit stay. A systematic review of qualitative studies with meta-synthesis and meta-summary. We searched MEDLINE (via PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Web of Science to July 2022. All studies that provided qualitative insights into the subjective experience of adult patients with delusional memories in the Intensive Care Unit were selected. The Critical Assessment Skills Programme checklist was used for the quality assessment. Fourteen studies were included. The 33 codes that emerged from the inductive thematic analysis were grouped into three themes: ‘The sense of danger and the terrifying aspect of death’ (feeling in danger, surrounded by death, persecuted by people around, and feeling unsafe), ‘The presence of someone or something nearby’ (perceiving the loved ones, feeling overwhelmed by scary creatures, and being neglected by those around me), and ‘The reality behind the world perceived by the senses’ (travelling the world, stimulating the senses, feeling peaceful, and living in a fantasy world). The most frequent code in the studies was ‘Be with a family member’, with an intensity of 35.7%. The patient’s experience described as delusional is considered a real event by the person experiencing it. Further research is needed to investigate the extent to which these experiences lead to poorer early and late outcomes for patients, and to test strategies to prevent this. A deeper understanding of the phenomenon may help healthcare professionals to recognise precursors, symptoms and consequences of delusional memories and intervene with appropriate help. One strategy would be to further humanise care and focus on family involvement and communication with patients to overcome the factual events that can potentially alter patients’ quality of life.

Delusional parasitosis is a psychotic disorder where the patient has the delusion of being infested with some insect or parasite. In contrast, shared paranoid disorder or folie à deux is described when the same delusions affect two or more closely related people. It is common for these two situations to cause comorbidity in the family unit. This case report concerns a couple married for 37 years. The husband described that 2 years ago, he began with a tingling sensation throughout his body, related to the presence of parasites coming out from all his body orifices, with no evidence of self‐harm. Likewise, the wife reported symptoms of formication and the feeling that there were invisible animals, as mentioned by her husband, and that she felt the parasites running throughout her body. The husband was diagnosed with endoparasitic delusional parasitosis, which caused folie à deux in his wife due to ectoparasitic parasitosis. The patient’s treatment included sertraline and risperidone in oral dosage lasting 3 months reducing delirium, later biperidene was prescribed due to main treatment’s side effects such as akathisia and sialorrhea, however the patient could not take the medication due to economic reasons. The wife was asked to sleep in a separate room, and she reported that the sensory hallucinations disappeared as soon as she slept in a different room. We conclude that the pharmacological approach, the intervention in the family life, and the gradual reintegration of marital habits once the patient improves are crucial in the therapy of delusional disorder.

(Background) The period experienced during the COVID-19 virus and the respective social regulations associated with it caused enormous psychosocial stress. (Objective) The objective of the present work was to observe whether the lived period induced a change in delusional characterizations in subjects with schizophrenia spectrum disorder. (Methods) A systematic literature review was conducted following the PRISMA 2020 guidelines for systematic reviews of the PRISMA GROUP. The literature search was conducted from November 2021 to May 2022, using various scientific platforms including PubMed. (Results) A total of 865 articles were found, from which 176 duplicates were removed. The remaining articles were reviewed by reading the titles and abstracts; fourteen were included. (Conclusions) During this research, it was possible to confirm the initial thesis, namely that delirium absorbs external reality by being modified by it. It was observed that the speed of absorption is estimated to be directly proportional to the speed of the modification of social reality and to the impact that the latter has on the subject’s private sphere. Moreover, the situation of radical change represented a condition of abnormal psychosocial stress, which led to an increase in diagnoses of schizophrenia spectrum disorders and, specifically, a weighty increase in diagnoses of brief psychotic disorder (BDP). In the coming years, it is estimated that there will be an increase in diagnoses of schizophrenia spectrum disorder caused by both environmental and biological factors.

Koro is a culture-bound syndrome prevalent in South-East Asian cultures. It is characterised by acute anxiety due to the fear of genital retraction which is believed to lead to death. While predominantly observed in men, cases involving women at an early age have been reported during Koro outbreaks. This paper describes a sporadic case of Koro-like syndrome in a South Asian woman in her 70s focusing on the psychological underpinnings contributing to its development and the importance of adopting a comprehensive management plan that addresses both psychiatric symptoms and co-occurring somatic issues.