Psychopathology

Uzun Çakir, Aylin Deniz; Çakir, Burak; Yalin Sapmaz, Şermin; Bilaç, Öznur; Taneli, Fatma; Kandemir, Hasan

2024 Psychopathology

doi: 10.1159/000539695pmid: 38934178

AbstractIntroduction: Considering the importance of neuroinflammation and neurodegeneration in the pathophysiology of major depressive disorder (MDD), peripheral blood biomarkers are promising for the prediction of diagnosis and treatment outcomes. We aimed to elucidate the neuroinflammatory pathophysiology of depression by evaluating serum levels of FAM19A5 as a new biomarker of inflammatory activation, proinflammatory cytokines, brain-derived neurotrophic factor (BDNF), and oxidative stress parameters. Methods: Adolescents diagnosed with first-episode drug-naive MDD (n = 35) were compared neurobiologically healthy control group (n = 33). Serum FAM19A5 levels, cytokine levels, BDNF and oxidative stress parameters were evaluated using the enzyme-linked immunoassay method. All participants were assessed with the Level-2 Depression Severity Scale, Sleep Disturbance Scale, Somatic Symptom Scale. Results: BDNF levels were significantly higher in the patient group compared to the control group. While BDNF showed a positive correlation with all scale scores; BDNF was significantly higher in the suicide risk groups than the control group. IL-1β levels displayed a negative correlation with the severity of sleep disturbances. Conclusions: In adolescents with MDD, inflammatory and oxidative stress markers were not raised in peripheral blood, unlike in adults. However, BDNF levels, which typically decrease in neurodegenerative conditions, were higher in those with MDD.

von Schrottenberg, Victoria; Kerber, André; Sterner, Philipp; Teusen, Clara; Beigel, Pauline; Linde, Klaus; Henningsen, Peter; Herpertz, Sabine C. ; Gensichen, Jochen; Schneider, Antonius

2024 Psychopathology

doi: 10.1159/000540161pmid: 39245035

AbstractIntroduction: According to ICD-11, personality disorders (PDs) are defined by the severity of self and interpersonal dysfunction in terms of personality functioning (PF) and an optional assessment of specific maladaptive personality trait expressions. Also, somatoform disorders are replaced by somatic symptom disorder (SSD). This study examines associations using the novel diagnostic criteria of SSD in an unselected primary care sample, PF, and maladaptive traits in patients with and without SSD. Methods: An anonymized cross-sectional study was conducted. A questionnaire including SSD-12 (Somatic Symptom Disorder B Criteria Scale-12) and PHQ-15 (Patient Health Questionnaire-15), LPFS-BF 2.0 (Level of Personality Functioning Scale – Brief Form) and PID-5BF+M (Modified Personality Inventory for DSM-5 – Brief Form Plus) was used. A bifactor (S-1) model was calculated with PF (reference for general factor) and personality traits (specific factors) to estimate associations between PF, specific maladaptive personality traits, and SSD. Differences in personality scales between SSD and non-SSD patients were calculated with the Mann-Whitney U test. Results: A total of 624 patients in six general practices participated (mean age 47 years; 60.4% female). SSD-12 and PHQ-15, respectively, showed significant associations with PF (γ = 0.51; γ = 0.48; p < 0.001), negative affectivity (γ = 0.50; γ = 0.38, p < 0.001) and psychoticism (γ = 0.29; γ = 0.28; p < 0.010). Besides, SSD-12 was significantly associated with disinhibition (γ = −0.38; p < 0.010) and anankastia (γ = −0.16; p < 0.010). Patients with SSD showed significantly impaired PF and maladaptive traits in all scales (p < 0.001). Conclusion: Impaired PF explains moderate to large amounts of the SSD symptoms and maladaptive personality traits negative affectivity, psychoticism, disinhibition, and anankastia show specific associations beyond PF. An in-depth understanding of these relations might be helpful to improve doctor-patient communication and treatment in SSD.

Kratzer, Leonhard; Tschöke, Stefan; Schröder, Johanna; Shevlin, Mark; Hyland, Philip; Eckenberger, Christine; Heinz, Peter; Karatzias, Thanos

2024 Psychopathology

doi: 10.1159/000539740pmid: 39038445

AbstractIntroduction: The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) contains a dissociative subtype of post-traumatic stress disorder (PTSD) characterized by depersonalization and derealization. Yet, there is evidence that dissociative symptoms in PTSD go beyond this kind of detachment dissociation and that some patients present with additional compartmentalization dissociation in the form of auditory-verbal hallucination, amnesia, and identity alteration. Methods: Hence, in this study, we examined latent profiles of childhood trauma (Childhood Trauma Questionnaire), PTSD (Impact-of-Event Scale-Revised), and pathological dissociation (Dissociative Experiences Scale-Taxon; DES-T) in a large sample of severely traumatized inpatients with PTSD (N = 1,360). Results: Results support a three-class solution of the latent profile analysis with a PTSD class, a dissociative subtype class, and a third class characterized by more complex and more severe dissociative symptoms. Importantly, in our inpatient sample of patients with severe PTSD, the latter class was found to be the most prevalent. Both the exploratory character of our retrospective analysis of clinical routine data and the use of the DES-T limit the generalizability of our findings, which require methodologically more rigorous replication. Conclusion: In severe PTSD, dissociative symptoms beyond detachment are highly prevalent. Diagnostic and treatment implications are discussed.

Stephensen, Helene; Urfer-Parnas, Annick; Parnas, Josef

2024 Psychopathology

doi: 10.1159/000538707pmid: 39013366

AbstractIntroduction: In this paper, we wish to elucidate alterations of basic existential and intersubjective configurations in schizophrenia spectrum disorders (SSD) through the phenomenon of Anderssein (“feeling different”). Anderssein is an important yet neglected notion from German psychiatry, referring to a specific sense of feeling profoundly different from others occurring in SSD. Although phenomenological-psychopathological research mentions it as an aspect of the core disturbance of SSD (namely, “self-disorders”), the phenomenon has not yet been explored in empirical or theoretical detail. Method: We present material from a phenomenological-empirical study on the mode and onset of psychosis based on qualitative interviews with 25 patients with SSD. Results: Most of the participants in our study report having felt fundamentally and often ineffably different since childhood and articulate it as a sense of existing “outside” of the shared reality. Intersubjective reality appears progressively unreal or inauthentic, and simultaneously, the patient’s intimate, subjective sphere is permeated by an alien otherness. Importantly, this outside position should be understood carefully as it is often accompanied by the sense of being invaded by social rules, other people’s thoughts, or emotions. Incipient psychosis is described as a gradual extension of precedent alterations of the structures of (inter)subjectivity. Conclusion: We conceptualize the ontological feature of Anderssein as an altered “being in-between” – that is, some sort of halting of the dynamic movement between particularity and intersubjectivity. Finally, we discuss the critical implications of these results for research into the “onset” of schizophrenia.

Denfield, George H.; Kyzar, Evan J.

2024 Psychopathology

doi: 10.1159/000540319pmid: 39084192

AbstractBackground: Subjective experience is central to the nature of mental illness, yet it has not played a central role in most empirical approaches to psychopathology. While phenomenological perspectives in psychiatry have seen a recent resurgence, there remains a need for more detailed models of psychopathological processes based on explicit phenomenological and enactive foundations. Summary: We present a framework derived from the Nested States Model (NSM) through which such phenomenologically-grounded models might be constructed. The NSM describes the dynamic structure of subjective experience as a system of nested states that reciprocally influence one another across hierarchical layers. Here, we show how the NSM provides a scheme for characterizing patterns of experience that comprise various psychopathological processes. We demonstrate the utility of this scheme both for clinical practice and for building our knowledge of psychopathological processes more broadly. Key Messages: The NSM can advance three aims that we see as critical for the lasting integration of phenomenological approaches to psychopathology within psychiatry. First, we show that the NSM provides a means for constructing clinical formulations and treatment considerations that center squarely on an individual’s subjective experiences. Second, the NSM supplies a framework for organizing findings from clinical-phenomenological research that can guide the construction of broader phenomenologically-grounded models of psychopathological processes. Lastly, the NSM aligns our perspective on subjective experience with emerging perspectives on brain dynamics, helping to bridge phenomenological work with ongoing neurophysiological research.

Blom, Jan Dirk

2024 Psychopathology

doi: 10.1159/000540003pmid: 39047712

AbstractIntroduction: Vitamin B12 deficiency is primarily associated with pernicious anaemia, polyneuropathy, and spinal-cord disease, but publications on its association with hallucinations are on the rise. Methods: I carried out a systematic literature search on these hallucinations in PubMed, PsycINFO, and Google Scholar, up until July 1, 2023. Results: The search yielded 50 case studies published between 1960 and 2023. The hallucinations described therein are predominantly visual and/or auditory in nature, with 20% being specified as complex, compound, or panoramic. They are often described in the context of vitamin B12-related neuropsychiatric conditions such as dementia, delirium, epilepsy, psychotic disorder, schizoaffective disorder, bipolar disorder, depressive disorder, catatonia, or obsessive-compulsive disorder. In the context of such disorders, they tend to appear first and also often appear to be the first to disappear with cobalamin treatment. Within an average of 2 months, full amelioration was thus obtained in 75% of the cases and partial amelioration in the remaining 25%. Remarkably, a quarter of the cases involved therapy-resistant hallucinations that fully resolved under cobalamin monotherapy, while other neuropsychiatric manifestations of vitamin B12 deficiency disappeared in 60% of the treated cases. Only 32% of the cases involved comorbid pernicious anaemia. This suggests that two separate or diverging pathways exist for perceptual and haematological symptoms of vitamin B12 deficiency. Conclusion: In the light of the high prevalence rate of vitamin B12 deficiency in the general population, the findings here presented should be interpreted with great caution. Nonetheless, they offer cues for further research and experimental application in clinical practice. This may be especially relevant in light of the recent increase in the popularity of vegetarianism and the recreational use of nitrous oxide (laughing gas), which are both risk factors for vitamin B12 deficiency.

Premji, Shahirose Sadrudin ; Lalani, Sharifa; Ghani, Farooq; Nausheen, Sidrah; Forcheh, Ntonghanwah; Omuse, Geoffrey; Letourneau, Nicole; Babar, Neelofur; Sulaiman, Salima; Wangira, Musana; Ali, Shahnaz Shahid ; Islam, Nazneen; Dosani, Aliyah; Yim, Ilona S

2024 Psychopathology

doi: 10.1159/000540579pmid: 39342939

AbstractIntroduction: The complex biopsychosocial pathways linking maternal mental health with preterm birth (PTB) are not well understood. This study aimed to explore allostatic load (AL) as a mediator and perceived chronic stress as a moderator in the pathway linking maternal mental health and PTB. Methods: A cohort study of pregnant women (n = 1,567) recruited at clinic visits within 10–19 weeks of gestation was assessed for maternal mental health (i.e., pregnancy-related anxiety, state anxiety, depressive symptoms) and perceived chronic stress. Blood pressure and levels of cortisol, total cholesterol, C-reactive protein, and glycosylated hemoglobin were used to create a composite measure of AL. Results: AL had the most significant effect on PTB (odds ratio (OR) = 1.84, 95% CI = 1.26–12.67, p = 0.001), while systolic blood pressure emerged as the only significant individual marker using variable selection (OR = 22%, 95% CI = 1.06–1.40, p < 0.001) in multiple logistic regression analysis. A mediation analysis revealed that maternal mental health did not have a significant direct effect on PTB (p = 0.824), but its indirect effect mediated by AL was significant (z = 2.33, p < 0.020). Low and high levels of perceived chronic stress, relative to the mean, moderated this indirect effect (z = 3.66, p < 0.001). Conclusions: AL has a significant direct influence on PTB and mediates the effect of maternal mental health on PTB; however, the indirect effect of AL is indistinguishable between women with higher or lower levels of perceived chronic stress than normal.

Nischk, Daniel; Gutschmidt, Rico

2024 Psychopathology

doi: 10.1159/000540120pmid: 39089226

AbstractBackground: Spiritual, metaphysical, or eschatological elements in delusions (SMEDs) are frequent and often subjectively regarded as profound transformational experiences, similar to mystical experiences. This study aimed (1) to explore how SMEDs are experienced and in which aspects they are similar to mystical experiences and (2) to investigate how individuals make sense of SMED. Methods: Seven participants were interviewed, and their expressions were analyzed using interpretative phenomenological analysis. Results: We found that SMEDs were similar to mystical experiences with regard to alterations in perception of space, time, and unity. Furthermore, SMEDs were accompanied by a sense of enlightenment that however remained ineffable. SMEDs were interpreted from different viewpoints, i.e., as a source of ontological insight, as a mental health issue, as an inspiration for a new orientation in the world, and, for some participants, as an example of the limits of knowledge. Making sense of SMED appeared to follow a lively internal dialogue in which various, sometimes contradictory positions were reflected upon. Participants usually struggled to align the ostensible ontological significance of SMED to the dominating illness explanation. Conclusion: SMEDs have similarities to mystical experiences, but integrating SMED into one’s own life is challenging. We propose a philosophical, non-pathological interpretation of SMED derived from a novel perspective on mystical experience which may also have some therapeutic utility.

Sarasso, Pietro; Billeci, Martina; Ronga, Irene; Raffone, Fabiola; Martiadis, Vassilis; Di Petta, Gilberto

2024 Psychopathology

doi: 10.1159/000539714pmid: 39173608

AbstractIntroduction: Dissociative experiences are considered undesirable ketamine’s adverse events. However, they might be crucial for ketamine’s antidepressant effects, at least in some depression subtypes. Current understandings of ketamine’s therapeutic potentials converge on the so-called “relaxed prior hypothesis,” suggesting that glutamatergic blockage up-weights bottom-up surprising somatosensory/affective states. As a result, ketamine improves short-term plasticity in depression by enhancing sensitivity to interoceptive signals. Methods: We selected 2 case studies for their paradigmatic description of “depersonalized depression” (Entfremdungsdepression) symptoms. Patients were included in a 6-month-long esketamine program for treatment resistant depression, during which we collected their spontaneous experience with esketamine. According to a neurophenomenological approach, we combined subjective reports from unstructured clinical interviews and the review of previous objective neuroimaging results and neurocomputational models to unveil the relation between esketamine antidepressant effects and interoceptive sensitivity. Results: According to our clinical observations, esketamine-induced dissociation might be particularly effective in the depersonalized depression subtype, in which interoceptive awareness and interaffectivity are particularly compromised. Ketamine and esketamine’s dissociative effects and particularly disembodiment might suspend previously acquired patterns of feeling, sensing, and behaving. Conclusions: Coherently with previous research, we suggest that esketamine-induced disembodiment allows for a transient window of psychological plasticity and enhanced sensitivity, where the body recovers its permeability to affective affordances.