A transdiagnostic approach toA transdiagnostic approach to

Mikhail A.Vrubel, 1890

OUTLINEOUTLINE

Mikhail A.Vrubel, 1890

I. Levitan, 1899

Prevalences of hallucinations and delusions

PATIENT GROUPPATIENT GROUP PREVALENCEPREVALENCE SOURCESOURCE

schizophreniaschizophrenia 59% hallucinations 73% delusions 59% hallucinations 73% delusions Lecrubier et al. 2007 Lecrubier et al. 2007

bipolar disorderbipolar disorder 76% psychotic symptoms76% psychotic symptoms Tillman et al. 2008 Tillman et al. 2008

deliriumdelirium 86% hallucinations 43% delusions 86% hallucinations 43% delusions Perälä et al. 2010 Perälä et al. 2010

borderline personality disorderborderline personality disorder 50% psychotic symptoms50% psychotic symptoms Kingdon et al. 2010 Kingdon et al. 2010

narcolepsynarcolepsy 40% hallucinations 2% delusions 40% hallucinations 2% delusions Leu-Semenescu et a. 2011 Leu-Semenescu et a. 2011

Lewy body dementia Lewy body dementia 78% hallucinations 25% delusions 78% hallucinations 25% delusions Nagahama et al. 2007 Nagahama et al. 2007

anxiety disorderanxiety disorder 27% psychotic symptoms27% psychotic symptoms Wigman et al. 2012 Wigman et al. 2012

Parkinson's diseaseParkinson's disease 30% hallucinations 30% hallucinations 5% delusions 5% delusions Friedman et al. 2013 Friedman et al. 2013

Alzheimer's diseaseAlzheimer's disease 21% hallucinations 21% hallucinations 10% delusions 10% delusions Burghaus et al. 2012 Burghaus et al. 2012

multiple sclerosismultiple sclerosis 10% hallucinations 7% delusions10% hallucinations 7% delusions Diaz-Olavarietta et al. 1999 Diaz-Olavarietta et al. 1999

epilepsyepilepsy 25% psychotic symptoms25% psychotic symptoms Matsuura et al. 2003 Matsuura et al. 2003

post traumatic stress disorderpost traumatic stress disorder 12% psychotic symptoms12% psychotic symptoms Soosay et al. 2012 Soosay et al. 2012

visual acuity < 0.3visual acuity < 0.3 11% hallucinations11% hallucinations Teunisse et al. 1995 Teunisse et al. 1995

unipolar depressionunipolar depression 10% psychotic symptoms10% psychotic symptoms Quinlan et al. 1997 Quinlan et al. 1997

systemic lupus erythematosussystemic lupus erythematosus 6% psychotic symptoms6% psychotic symptoms Beltrao et al. 2013 Beltrao et al. 2013

mild-moderate hearing lossmild-moderate hearing loss 4% hallucinations4% hallucinations Teunisse et al. 2012 Teunisse et al. 2012

Diagnosis?Diagnosis?

Formele denkstoornissenFour subtypes that present across diagnoses

Subtype Perception AttentionReality Testing

Social Isolation

TraumaExcitability

Sensory Cortex

StriatalDopamine

Optimal Treatment

Hyper-dopaminergic

== =/=/ =/=/ =/=/ == Anti-psychotic Anti-psychotic medicationmedication

re-experiencing == == == == =/ =/ EMDREMDR

inattentive =/=/ =/=/ == == == =/=/ cholinesterase cholinesterase inhibitorsinhibitors

de-afferentiation

== == == == TMSTMS

Working with Domains Instead of DiagnosesWorking with Domains Instead of Diagnoses