Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in a total upending of our daily lives. While anxiety and depression were frequently reported among the general population, the pandemic’s impact on patients with mental health problems remains unknown. Methods: A cross-sectional questionnaire survey involving 1,166 patients was conducted at one psychiatric hospital and one mental health clinic. Results: Symptom deterioration was reported in 23% to 34% of the patients and 9% to 20% reported increase in drug dosage. No significant differences were reported in these items among diagnostic categories. Patients with F3 (mood disorders) reported more psychological stress during the pandemic’s beginning and during the emergency. Patients with F2 (schizophrenia, schizotypal, and delusional disorders) did online shopping and meetings less frequently, and reported poorer adherence of 3C’s, while mask management was stricter in patients with F4 (neurotic, stress-related, and somatoform disorders). Symptom deterioration was significantly associated with increase in drug dosage, new physical symptoms, anxiety unrelated to COVID-19, stress at the beginning of pandemic, stress during the ‘state of emergency’, poor adaptability to environmental change, daily life changes, decrease in sleeping time, and decrease in time spent outside. Conclusion: One third of patients reported symptom deterioration during the pandemic, which was associated with stress and daily life changes. Patients with good adaptability to environmental changes might resilient against symptom deterioration. Providing continuous support to help patients manage their daily life in this COVID-19 era may minimize the risk of symptom deterioration.

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Background: While the symptom of "I am already dead" is a hallmark of Cotard's syndrome, also known as nihilistic delusions, the symptom of "you are already dead" has been neglected.Case presentation: A woman aged in her 60s diagnosed with schizophrenia was admitted to our hospital for psychotic symptoms, including delusions of reference, delusions of guilt, auditory hallucinations, cenesthetic hallucinations, agitation, depression, suicidal ideation, and catatonia. During hospitalization, her cenesthetic hallucinations progressed to include nihilistic delusions. She described cenesthetic hallucinations along with various delusional descriptions, including the belief that various objects, such as spoons, irons, nails, rulers, bins, and coins, were inside her body and that her body was being burned or in danger of exploding. She also claimed an altered sense of her own body, that her body was larger than normal or reversed. Moreover, she reported nihilistic delusions that her face and body did not exist, that her heart was not functioning, and that she was going to die soon or was already dead. She occasionally refused to eat because of the feeling of being dead. Notably, during a severe episode, she claimed that a doctor in front of her was dead. Clozapine was effective in improving her symptoms. Ultimately, the patient regained her sense of being alive and acknowledged that the doctor was alive. Conclusion:We report the case of a patient presenting with nihilistic delusions regarding both self and others, along with prior cenesthetic hallucinations. Aberrant interoceptive processing could be a potential link between these two forms of nihilistic delusions.

However, dopamine supersensitivity can be permanent as seen in tardive dyskinesia. Antipsychotic dose and D2 receptor occupancy follow a hyperbolic association. A similar hyperbolic relationship is seen with antipsychotic dose and therapeutic effects. 12,13 Applying this to perphenazine helps us understand that a maximum response can be expected at lower doses and less robust response at higher doses since most of the D2 receptors are already occupied. Similarly, in reverse, maximal chances of withdrawal are at lower dose ranges. This goes against the conventional linear tapering and demands a hyperbolic taper to prevent a large decrease in receptor occupancy at lower doses. 14 This would prevent a large reduction in D2 occupancy and thereby decrease the risk of withdrawal and relapse. Although this is a lesser-known side effect and a rare clinical occurrence, nevertheless it is an important point that clinicians should be aware of when prescribing antipsychotics with robust D2 antagonist action, especially when working with pediatric population.

Background Several cohort studies have recently reported associations between late‐life psychosis and dementia, and postmortem studies have demonstrated that most individuals with late‐onset schizophrenia and delusional disorder had tau pathologies. The present study was aimed to assess the prevalence and topology of tau pathologies by positron emission tomography (PET) with a specific probe, 18F‐PM‐PBB3 (18F‐APN‐1607), in patients with late‐onset psychosis (LOP). Method We included LOP patients who experienced the first episode of psychosis after 65 years old and excluded those with dementia. Fourteen patients with LOC (74.2 ± 4.0 years old; 7 females and 7 males)and 16 age‐matched healthy controls (HCs) (72.6 ± 5.7 years old; 9 females and 7 males) underwent PET scans with 18F‐PM‐PBB3 and an amyloid‐β probe, 11C‐PiB. The radioprobe retention was calculated as standardized uptake value ratio (SUVR), and the laterality index (LI) of SUVR was estimated as [Left‐Right/(Left+Right)]. We compared 18F‐PM‐PBB3 SUVRs and LIs in the frontal, temporal, parietal, and occipital cortices between patients and HCs using an independent t‐test after Bonferroni correction (p‐value ≤ 0.05/4). Result All HCs were negative for 11C‐PiB‐PET. By contrast, unequivocally increased 18F‐PM‐PBB3 retentions were found in 4 out of 4 11C‐PiB‐positive patients (100%) and 7 out of 10 11C‐PiB‐negative patients (70%) with variable localizations. Tau topologies in four 11C‐PiB‐positive cases were characteristic of Alzheimer’s disease and consisted of limbic predominant (N = 2), medial temporal lobe‐sparing (N = 1), and lateral temporal (N = 1) deposition subtypes. Meanwhile, tau topologies in 7 11C‐PiB‐negative cases were composed of lateral‐posterior diffuse (N = 3), posterior mild (N = 2), lateral temporal local (N = 1), and progressive supranuclear palsy‐like (N = 1) accumulations. None of the target regions exhibited significant differences in 18F‐PM‐PBB3 SUVR between patients and HCs, reflecting the heterogeneous distributions of tau deposits in patients. There was significant rightward lateralization of tau pathologies indicated by a reduced LI in the frontal cortex (P = 0.0093) but not the other cortical regions. Conclusion Our findings indicate that LOP is associated with tau topologies of diverse Alzheimer’s and non‐Alzheimer’s disease subtypes. The rightward lateralization of tau pathologies in the frontal cortex might be involved in the development of psychotic manifestations.