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Introduction: Delusions are core symptoms of schizophrenia-spectrum and related disorders. Despite their clinical relevance, the neural correlates underlying such phenomena are unclear. Recent research suggests that specific delusional content may be associated with distinct neural substrates. Objective: Here, we used structural magnetic resonance imaging to investigate multiple parameters of brain morphology in patients presenting with paranoid type delusional disorder (pt-DD, n = 14) compared to those of healthy controls (HC, n = 25). Methods: Voxel- and surface-based morphometry for structural data was used to investigate gray matter volume (GMV), cortical thickness (CT) and gyrification. Results: Compared to HC, patients with pt-DD showed reduced GMV in bilateral amygdala and right inferior frontal gyrus. Higher GMV in patients was found in bilateral orbitofrontal and in left superior frontal cortices. Patients also had lower CT in frontal and temporal regions. Abnormal gyrification in patients was evident in frontal and temporal areas, as well as in bilateral insula. Conclusions: The data suggest the presence of aberrant GMV in a right prefrontal region associated with belief evaluation, as well as distinct structural abnormalities in areas that essentially subserve processing of fear, anxiety and threat in patients with pt-DD. It is possible that cortical features of distinct evolutionary and genetic origin, i.e. CT and gyrification, contribute differently to the pathogenesis of pt-DD.

Background There is abundant evidence for cerebellar involvement in schizophrenia, where the cerebellum has been suggested to contribute to cognitive, affective and motor dysfunction. More recently, specific cerebellar regions have also been associated with psychotic symptoms, particularly with auditory verbal hallucinations. In contrast, little is known about cerebellar contributions to delusions, and even less is known about whether cerebellar involvement differs by delusional content. Methods Using structural magnetic resonance imaging at 1.0 T together with cerebellum-optimized segmentation techniques, we investigated gray matter volume (GMV) in 14 patients with somatic-type delusional disorder (S-DD), 18 patients with non-somatic delusional disorder (NS-DD) and 18 patients with schizophrenia (SZ) with persistent non-somatic delusions. A total of 32 healthy controls (HC) were included. Between-group comparisons were adjusted for age, gender, chlorpromazine equivalents and illness duration. Results Compared to HC, S-DD patients showed decreased GMV in left lobule VIIIa. In addition, S-DD patients showed decreased GMV in lobule V and increased GMV in bilateral lobule VIIa/crus II compared to NS-DD. Patients with SZ showed increased GMV in right lobule VI and VIIa/crus I compared to HC. Significant differences between HC and NS-DD were not found. Conclusions The data support the notion of cerebellar dysfunction in psychotic disorders. Distinct cerebellar deficits, predominantly linked to sensorimotor processing, may be detected in delusional disorders presenting with predominantly somatic content.

anorectal malformations an at first glance invisible disorder - triggers the affected children and young people and their parents strong unease and is therefore often concealed and secretive. The problems are not less if the affected children grown up. Incontinence can affect quality of life and massive psychosocial developmental disorders can arrive (JenetzkyBlack 2008). Affected children and adolescents must make diets, they suffer from abdominal pain, incontinence and constipation, feel impaired in their body image and often they have feelings of fear and shame. In the social sphere, the children have to get difficulties to get in contact with their classmates and they are in school often absent or distracted (Grano et al. 2013). Objective: The aim of the present literature review is to describe the quality of life of children and adolescents with anorectal malformations and show developmental change in physical, psychological and social area. Method: To answer the question, a literature search was conducted. For this the relevant databases PubMed". " CINAHL with full text", ,,PsycInfo" and ,,Cochrane" were used. Results: The literature research shows, that children and young people with anorectal malformations have a worse quality of life than their healthy peers. They are ashamed, feel different than others and are afraid that they smell badly, They see themselves as unattractive and are often dissatisfied with their bodies. Among the adolescents there are significant gender differences: female adolescents, whether health or with anorectal malformations, have a worse quality of life than male adolescents (Michel et al 2009, cited by Grano et al 2013). Obviously pubertal development specificities of the two genders are responsible for this result (Patton et al. 2007, Petersen et al. 1991, cited in Grano et al. 2013). Children with fecal incontinence are in their behavior more prominent than their healthy peers and have more psychological/ psychosocial problems as their classmates in the exercise of activities of daily living, for example during routine school activities, during sports or if they say with friends (Hamid et al. 2007, cited by Grano et al. 2012). Conclusion: The multiple problems in the social, physical and psychological area make it necessary for children and adolescents with anorectal malformations to get early support (bowel management program, psychologist, group therapy). For example, affected children may begin already with 3¹/₂ years with a bowel management program to prevent negative consequences and/or to avoid social exclusion (Bischoff et al. 2009. cited in Grano et al. 2012). For parents, it is important that they learn to accept the child's illness and to help the children to cope their illness better. With this support in childhood it will be possible to accept the disease better and to integrate it into their self-image (Schmidt et al. 2010).

Background Monothematic delusional disorders are characterized by a single tenacious belief. They provide a great opportunity to study underlying brain structures in the absence of confounding symptoms that accompany delusions in schizophrenia. Delusional beliefs include persecution, jealousy or somatic delusions including infestation. It is unclear whether specific delusional content is associated with distinct neural substrates. Methods We used magnetic resonance imaging in patients presenting with somatic vs. non-somatic delusional disorders. Patients with delusional infestation (DI, n = 18), and individuals with non-somatic delusional disorders (n = 19) were included, together with healthy volunteers (n = 20). Uni- and multivariate techniques for structural data analysis were applied to provide a comprehensive characterization of abnormal brain volume at both the regional and neural network level. Results Patients with DI showed lower gray matter volume in thalamic, striatal (putamen), insular and medial prefrontal brain regions in contrast to non-somatic delusional disorders and healthy controls. Importantly, these differences were consistently detected at regional and network level. Compared to healthy controls, patients with delusional disorders other than DI showed lower gray matter volume in temporal cortical regions. Conclusion The data support the notion that dysfunctional somatosensory and peripersonal networks could mediate somatic delusions in patients with DI in contrast to delusional disorders without somatic content. The data also suggest putative content-specific neural signatures in delusional disorders and in delusion formation per se.

Although there is strong neuroimaging evidence that cortical alterations are a core feature of schizophrenia spectrum disorders, it still remains unclear to what extent such abnormalities occur in monothematic delusional disorders. In individuals with delusional infestation (DI), the delusional belief to be infested with pathogens, previous structural MRI studies have shown prefrontal, temporal, parietal, insular, thalamic and striatal gray matter volume changes. Differential contributions of cortical features of evolutionary and genetic origin (such as cortical thickness, area and folding) which may distinctly contribute to DI pathophysiology are unclear at present.In this study, 18 patients with DI and 20 healthy controls (HC) underwent MRI scanning at 1.0T. Using surface-based analyses we calculated cortical thickness, surface area and local gyrification index (LGI). Whole-brain differences between patients and controls were investigated.Surface analyses revealed frontoparietal patterns exhibiting altered cortical thickness, surface area and LGI in DI patients compared to controls. Higher cortical thickness was found in the right medial orbitofrontal cortex (p0.05, cluster-wise probability [CWP] corrected). Smaller surface area in patients was found in the left inferior temporal gyrus, the precuneus, the pars orbitalis of the right frontal gyrus, and the lingual gyrus (p0.05, CWP corr.). Lower LGI was found in the left postcentral, bilateral precentral, right middle temporal, inferior parietal, and superior parietal gyri (p0.01, CWP corr.).This study lends further support to the hypothesis that cortical features of distinct evolutionary and genetic origin differently contribute to the pathogenesis of delusional disorders. Regions in which atrophy was observed are part of neural circuits associated with perception, visuospatial control and self-awareness. The data are in line with the notion of a content-specific neural signature of DI.