Body integrity identity disorder using augmented reality: A symptom reduction study

Body integrity identity disorder (BIID) is a rare condition characterised by a discrepancy between specific areas of an individual's perceived body image and body schema which causes the individual to disassociate those physical areas of their body from their internal representation. There are currently no efficacious, ethically unambiguous means for achieving long-lasting symptom reductions. In the case we present, two patients with BIID underwent an augmented reality (AR)-based simulation that virtually amputated their alienated limbs, allowing them to experience their ideal selves. During the exposure, both patients reported reductions in BIID-related complaints. These preliminary results suggest the existence of a possible therapeutic and diagnostic potential that AR possesses, which warrants further consideration within clinical healthcare settings

Affective and Physiological Responses During Acute Pain in Virtual Reality: The Effect of First-Person Versus Third-Person Perspective

Background: Virtual reality (VR) has been previously shown as a means to mitigate acute pain. The critical parameters involved in the clinical efficacy of mitigating acute pain from different perspectives remains unknown. This study attempted to further deconstruct the critical parameters involved in mitigating acute pain by investigating whether affective and physiological responses to painful stimuli differed between a first and a third person perspective in virtual reality. Methods: Two conditions were compared in a repeated-measures within subject study design for 17 healthy participants: First person perspective (i.e., where participants experienced their bodies from an anatomical and egocentric perspective) and third person perspective (i.e., where participants experienced their bodies from an anatomical perspective from across the room). The participants received noxious electrical stimulation at pseudorandom intervals and anatomical locations during both conditions. Physiological stress responses were measured by means of electrocardiography (ECG) and impedance cardiography (ICG). Subjective scores measuring tension, pain, anger, and fear were reported after every block sequence. Results: There were no significant differences in physiological stress responses between conditions. However, the participants reported significantly higher tension during the third person condition. Conclusion: Relative to a third person perspective, there are no distinct physiological benefits to inducing a first person perspective to mitigate physiological stress responses to acute pain in healthy individuals. However, there may be additional clinical benefits for doing so in specific clinical populations that have shown to benefit from relaxation techniques. Further research is needed in order to refine the clinical utility of different perspectives during virtual reality immersions that serve to act as a non-pharmacological analgesic during acute pain

Social media and smartphone technology in the symptomatology of OCD

Obsessive-compulsive disorder (OCD) is a disabling and heterogeneous psychiatric disorder. In line with the trend towards globalisation and modern technology, the thematic content of obsessions and compulsions is bound to evolve over time. However, assessment scales such as the Yale-Brown Obsessive-Compulsive Scale symptom checklist are not adapted accordingly. By means of two case reports, we would like to introduce social media and smartphone technology in the content of obsessions and compulsions. Our aim is to raise awareness among clinicians of these topics in key symptomatology of OCD and to propose a flexible adaptation of the Y-BOCS symptom checklist. Furthermore, we encourage the development of exposure and response prevention exercises with a focus on social media and smartphone technology

Virtual Reality Objectifies the Diagnosis of Psychiatric Disorders: A Literature Review

BACKGROUND: To date, a diagnosis in psychiatry is largely based on a clinical interview and questionnaires. The retrospective and subjective nature of these methods leads to recall and interviewer biases. Therefore, there is a clear need for more objective and standardized assessment methods to support the diagnostic process. The introduction of virtual reality (VR) creates the possibility to simultaneously provoke and measure psychiatric symptoms. Therefore, VR could contribute to the objectivity and reliability in the assessment of psychiatric disorders. OBJECTIVE: In this literature review, we will evaluate the assessment of psychiatric disorders by means of VR environments. First, we investigate if these VR environments are capable of simultaneously provoking and measuring psychiatric symptoms. Next, we compare these measures with traditional diagnostic measures. METHODS: We performed a systematic search using PubMed, Embase, and Psycinfo; references of selected articles were checked for eligibility. We identified studies from 1990 to 2016 on VR used in the assessment of psychiatric disorders. Studies were excluded if VR was used for therapeutic purposes, if a different technique was used, or in case of limitation to a non-clinical sample. RESULTS: A total of 39 studies were included for further analysis. The disorders most frequently studied included schizophrenia (n = 15), developmental disorders (n = 12), eating disorders (n = 3), and anxiety disorders (n = 6). In attention-deficit hyperactivity disorder, the most comprehensive measurement was used including several key symptoms of the disorder. Most of the studies, however, concerned the use of VR to assess a single aspect of a psychiatric disorder. DISCUSSION: In general, nearly all VR environments studied were able to simultaneously provoke and measure psychiatric symptoms. Furthermore, in 14 studies, significant correlations were found between VR measures and traditional diagnostic measures. Relatively small clinical sample sizes were used, impeding definite conclusions. Based on this review, the innovative technique of VR shows potential to contribute to objectivity and reliability in the psychiatric diagnostic process

Misophonia: Phenomenology, comorbidity and demographics in a large sample

Objective Analyze a large sample with detailed clinical data of misophonia subjects in order to determine the psychiatric, somatic and psychological nature of the condition. Methods This observational study of 779 subjects with suspected misophonia was conducted from January 2013 to May 2017 at the outpatient-clinic of the Amsterdam University Medical Centers, location AMC, the Netherlands. We examined DSM-IV diagnoses, results of somatic examination (general screening and hearing tests), and 17 psychological questionnaires (e.g., SCL-90-R, WHOQoL). Results The diagnosis of misophonia was confirmed in 575 of 779 referred subjects (74%). In the sample of misophonia subjects (mean age, 34.17 [SD = 12.22] years; 399 women [69%]), 148 (26%) subjects had comorbid traits of obsessive-compulsive personality disorder, 58 (10%) mood disorders, 31 (5%) attention-deficit (hyperactivity) disorder, and 14 (3%) autism spectrum conditions. Two percent reported tinnitus and 1% hyperacusis. In a random subgroup of 109 subjects we performed audiometry, and found unilateral hearing loss in 3 of them (3%). Clinical neurological examination and additional blood test showed no abnormalities. Psychological tests revealed perfectionism (97% CPQ>25) and neuroticism (stanine 7 NEO-PI-R). Quality of life was heavily impaired and associated with misophonia severity (rs (184) = -.34 p = <.001, p = <.001). Limitations This was a single site study, leading to possible selection-and confirmation bias, since AMC-criteria were used. Conclusions This study with 575 subjects is the largest misophonia sample ever described. Based on these results we propose a set of revised criteria useful to diagnose misophonia as a psychiatric disorder

Systematic Review and Meta-Analysis of Virtual Reality in Mental Healthcare: Effects of Full Body Illusions on Body Image Disturbance

Background: Body image (BI) disturbances have been identified in both clinical and non-clinical populations. Virtual reality (VR) has recently been used as a tool for modulating BI disturbances through the use of eliciting a full body illusion (FBI). This meta-analysis is the first to collate evidence on the effectiveness of an FBI to reduce BI disturbances in both clinical and non-clinical populations. Methods: We performed a literature search in MEDLINE (PubMed), EMBASE, PsychINFO, and Web of Science with the keywords and synonyms for “virtual reality” and “body image” to identify published studies until September 2020. We included studies that (1) created an FBI with a modified body shape or size and (2) reported BI disturbance outcomes both before and directly after the FBI. FBI was defined as a head-mounted display (HMD)-based simulation of embodying a virtual body from an egocentric perspective in an immersive 3D computer-generated environment. Results: Of the 398 identified unique studies, 13 were included after reading full-texts. Four of these studies were eligible for a meta-analysis on BI distortion inducing a small virtual body FBI in healthy females. Significant post-intervention results were found for estimations of shoulder width, hip width, and abdomen width, with the largest reductions in size being the estimation of shoulder circumference (SMD = −1.3; 95% CI: −2.2 to −0.4; p = 0.004) and hip circumference (SMD = −1.0; 95% CI: −1.6 to −0.4; p = 0.004). Mixed results were found in non-aggregated studies from large virtual body FBIs in terms of both estimated body size and BI dissatisfaction and in small virtual body FBI in terms of BI dissatisfaction. Conclusions: The findings presented in this paper suggest that the participants' BIs were able to conform to both an increased as well as a reduced virtual body size. However, because of the paucity of research in this field, the extent of the clinical utility of FBIs still remains unclear. In light of these limitations, we provide implications for future research about the clinical utility of FBIs for modulating BI-related outcomes

Subjective effects of cannabis before the first psychotic episode

Objective: The aim of the present study was to gain more insight into the positive and negative effects of cannabis in the prodromal phase of schizophrenia and in the ultrahigh-risk (UHR) state for psychosis. Method: A theory-driven questionnaire was used to examine subjective effects in the prodromal phase in male subjects with a recent onset of schizophrenia or related disorder (n = 52) and in the UHR state in help-seeking male subjects screened for being at UHR for psychosis (n = 17); both groups were compared to cannabis-using controls from the general population (n = 52). Results: Recent-onset patients and UHR subjects reported feeling more anxious, depressed and suspicious immediately after cannabis use. Some patients also reported feeling less depressed after cannabis use. Recent-onset patients reported increased visual and acoustic hallucinations, and confusion after cannabis use. Of the recent-onset patients 37% reported that their very first psychotic symptoms occurred during cannabis intoxication. Long-term effects of cannabis reported more often by both patient groups were depression, less control over thoughts and social problems. Conclusions: These results suggest that schizophrenia patients in the prodromal phase and subjects at UHR for psychosis are more sensitive to some negative effects of cannabis, in particular psychotic effects, compared to cannabis users from the general population. Although limited by the retrospective design in the recent-onset patients, the present study adds qualitative evidence to longitudinal studies that suggest that cannabis is a component cause in the onset of the first psychotic episode. Further studies are needed on the objective and subjective effects of cannabis in UHR subject

Deep brain stimulation for obsessive-compulsive disorder is associated with cortisol changes

Deep brain stimulation (DBS) is an effective treatment for obsessive-compulsive disorder (OCD), but its mechanism of action is largely unknown. Since DBS may induce rapid symptomatic changes and the pathophysiology of OCD has been linked to the hypothalamic-pituitary-adrenal (HPA) axis, we set out to study whether DBS affects the HPA axis in OCD patients. We compared a stimulation ON and OFF condition with a one-week interval in 16 therapy-refractory OCD patients, treated with DBS for at least one year, targeted at the nucleus accumbens (NAc). We measured changes in 24-h urinary excretion of free cortisol (UFC), adrenaline and noradrenaline and changes in obsessive-compulsive (Y-BOCS), depressive (HAM-D) and anxiety (HAM-A) symptom scores. Median UFC levels increased with 53% in the OFF condition (from 93 to 143nmol/24h, p=0.12). There were no changes in urinary adrenaline or noradrenaline excretion. The increase in Y-BOCS (39%), and HAM-D (78%) scores correlated strongly with increased UFC levels in the OFF condition. Our findings indicate that symptom changes following DBS for OCD patients are associated with changes in UFC level