Aspects Of Delusions Research Articles

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis \u2013 a secondary analysis of a randomized-controlled therapy trial

BackgroundCognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients’ social life: the quality of their therapeutic relationship.MethodsPatients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy.ResultsIn comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist.ConclusionsCognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.

Associations between belief inflexibility and dimensions of delusions: A meta‐analytic review of two approaches to assessing belief flexibility

Belief inflexibility has been suggested to maintain delusions. Different measures of assessing belief inflexibility have been developed, and it remains unclear whether patients with delusions display belief inflexibility similarly across measures. As delusions consist of multiple dimensions, the aim of this meta-analytic review was to examine how belief inflexibility is related to different aspects of delusions (conviction, distress, and preoccupation) and to compare these associations between interview-based and task-based measures of belief inflexibility. We conducted a systematic database search (PsycINFO, PsycARTICLES, PubMed, and MEDLINE) and identified relevant articles using the following search items: belief*, delusion*, or overvalued idea*; psychosis or schizo*; flexib*, inflexib*, change, revision, or update. Meta-analyses were conducted for each dimension of delusions and were reported according to the PRISMA guidelines. A total of 16 studies, with a total sample of 1,065, were included in the analysis. Belief inflexibility was associated with global severity of delusions (Hedges' g=0.452, p<.001). Specifically, all dimensions of delusions were significantly associated with belief inflexibility (conviction: Hedges' g=0.678, p<.001; preoccupation: Hedges' g=0.274, p=.002; distress: Hedges' g=0.200, p=.025). There was no significant heterogeneity across studies for each dimension. Preliminary subgroup analysis did not find any significant between-measure differences in the relationship between belief inflexibility and overall severity of delusions. Belief inflexibility, across measures, was robustly associated with delusions, with a particularly strong association for delusional conviction. Our results carried implications for process-based interventions for delusions. Positive clinical implications Belief inflexibility is consistently associated with the maintenance of delusions. Assessing belief inflexibility in routine clinical practice will inform psychological interventions for patients with persistent delusions. Interview- and task-based measures of belief inflexibility may be used complementarily to facilitate our understanding of this reasoning bias. Aetiological factors may be more closely associated with some aspects of delusions than the others. In line with a multidimensional view of delusions, interventions targeting different dimensions of delusions may have different therapeutic emphases. Limitations The current review focused on three core dimensions of delusions only (conviction, preoccupation, distress). Other ways of dissecting delusions are possible. Comparisons between the two measures of belief inflexibility may benefit from further research.

Current Treatments for Delusional Disorder

Delusional disorders form part of the spectrum of psychotic disorders in psychiatry. They are poorly understood in practically every aspect of their nature, including cause, phenomenology, prevalence, comorbidity, course, treatment, and prognosis. The key symptom in delusional disorders is one or more delusions. A cardinal characteristic of delusional disorder, conviction that one is not mentally ill, contributes complexity to the treatment challenges and profoundly affects the therapeutic relationship. Diagnosis and differential diagnosis are critical tasks. Delusional conditions may arise from many sources and, only when the case conforms to the criteria and is clearly idiopathic—is a primary delusional disorder—can we feel confident that the patient suffers from delusional disorder rather than a secondary delusional condition. Adequate treatment follows principles for the treatment of delusions. First line pharmacological treatment for delusional disorder is antipsychotic medication, both first and second-generation agents, and some evidence suggests that clozapine may be effective in certain cases. The assumption in such a formulation is that the delusion(s) encountered in delusional disorders respond as a class of symptoms found in different disorders. Hence, the approach for failed interventions with these agents may be similar to that proposed for the treatment of schizophrenia or other psychotic disorders. Namely, searching for evidence of failure to take medication, inadequate dosing, a missed diagnosis of a substance disorder, medical condition, or even another psychiatric disorder should be considered. For individuals with delusional disorders who are also experiencing comorbid depression or anxiety, the addition of appropriate agents for those symptoms may provide a synergistic strategy for overall effectiveness. Psychotherapy is another important clinical tool. Cognitive behavioral therapy focusing on different aspects of delusions (i.e., anxiety, reasoning biases, faulty logic, etc.) has demonstrated some value for at least short-term improvement. Various techniques may be useful in allying with the patient and supplying means to assist in managing their thinking and approach to circumstances and factors that promote delusion formation and encourage actions taken to respond. A significant problem in applying what we know about delusional disorders to treatment is the limited available evidence. Lack of randomized controlled trials, which form the standard in most clinical disorders, is a major shortcoming. Recent observations of compromised cognitive functioning in working memory, attention, and executive function should be replicated with similar standards. Systematic case studies and large series are useful, and a growing effort to be more rigorous methodologically in all contributions including case registries and longer follow-up studies is promising. Nevertheless, our knowledge remains less than optimal. These comments apply not only to pharmacological observations but also to those of neuropsychological and psychotherapeutic studies.

P.3.f.012 Positive schizotypy associated negative facial emotion recognition and neurocognitive deficits

It has been suggested that different aspects of delusions (conviction, distress, preoccupation) respond to treatment at different rates, and that the cognitive bias of ‘Jumping to Conclusions’ (JTC) may predict treatment outcome. This study investigates changes in delusion dimensions using Experience Sampling Methodology (ESM) and the role of JTC as a predictor of change during the initial 2 weeks of antipsychotic treatment on admission to hospital. Sixteen acute patients with delusions were assessed seven times per day for 14 days using computerised ESM. ESM assessed moment-by-moment experiences of affect, psychotic symptoms, and delusion dimensions. Clinical ratings were completed at baseline, 1 week and 2 weeks later. The 'beads' task was used to measure JTC at baseline. Delusion dimensions improved over the two weeks of antipsychotic treatment and admission to hospital. Different delusional dimensions changed at different rates, with distress and disruption being more responsive than conviction and preoccupation on both PSYRATS and ESM ratings. Eight out of 16 participants showed a JTC bias on the beads task at baseline. Exploratory analyses showed that JTC predicted changes in the ESM ratings of delusion conviction and distress, suggesting that reasoning biases may predict treatment response.

Changes in delusions in the early phase of antipsychotic treatment – An experience sampling study

It has been suggested that different aspects of delusions (conviction, distress, preoccupation) respond to treatment at different rates, and that the cognitive bias of ‘Jumping to Conclusions’ (JTC) may predict treatment outcome. This study investigates changes in delusion dimensions using Experience Sampling Methodology (ESM) and the role of JTC as a predictor of change during the initial 2 weeks of antipsychotic treatment on admission to hospital. Sixteen acute patients with delusions were assessed seven times per day for 14 days using computerised ESM. ESM assessed moment-by-moment experiences of affect, psychotic symptoms, and delusion dimensions. Clinical ratings were completed at baseline, 1 week and 2 weeks later. The 'beads' task was used to measure JTC at baseline. Delusion dimensions improved over the two weeks of antipsychotic treatment and admission to hospital. Different delusional dimensions changed at different rates, with distress and disruption being more responsive than conviction and preoccupation on both PSYRATS and ESM ratings. Eight out of 16 participants showed a JTC bias on the beads task at baseline. Exploratory analyses showed that JTC predicted changes in the ESM ratings of delusion conviction and distress, suggesting that reasoning biases may predict treatment response.

An experience sampling study of worry and rumination in psychosis

Increasing research effort is being dedicated to investigating the links between emotional processes and psychosis, despite the traditional demarcation between the two. Particular focus has alighted upon two specific anxious and depressive processes, worry and rumination, given the potential for links with aspects of delusions and auditory hallucinations. This study rigorously explored the nature of these links in the context of the daily life of people currently experiencing psychosis. Experience sampling methodology (ESM) was used to assess the momentary links between worry and rumination on the one hand, and persecutory delusional ideation and auditory hallucinations on the other. Twenty-seven participants completed the 6-day experience sampling period, which required repeated self-reports on thought processes and experiences. Multilevel modelling was used to examine the links within the clustered data. We found that antecedent worry and rumination predicted delusional and hallucinatory experience, and the distress they elicited. Using interaction terms, we have shown that the links with momentary symptom severity were moderated by participants' trait beliefs about worry/rumination, such that they were reduced when negative beliefs about worry/rumination (meta-cognitions) were high. The current findings offer an ecologically valid insight into the influence of worry and rumination on the experience of psychotic symptoms, and highlight possible avenues for future intervention strategies.

“Spiritual Starvation” in a Holy Space—a Form of “Jerusalem Syndrome”

The purpose of this article is to study the narratives of two religious tourists who have chosen self-starvation on the streets of Jerusalem as their idiom of distress. Both were hospitalized involuntarily due to self-endangering behavior. It appears that in specific groups, restrictions of food intake are regarded as particularly holy, pure, and blessed. Extreme cases of self-starvation using religious explanatory models could be regarded as forms of “spiritual starvation”. Patients involved in these acts of fasting differ in both religious and cultural backgrounds, as well as the extent to which their families regard the importance of religiosity. Representing extreme forms of religious practice, both spiritual starvation and Jerusalem Syndrome are rare phenomena. The so-called “Jerusalem syndrome” is a rather dramatic, cultural–religious phenomenon, rarely displayed by pilgrims and tourists visiting the Holy City. Jerusalem, the “axis mundi” of faith, is perceived as the arena where great events are about to occur. This eschatological core element is at times exploited in a broader sense in the service of a public or an individual, to the extent where boundaries between reality and imagination are blurred. For some vulnerable individuals (mostly with previous recorded psychiatric history), the extraordinary and overwhelming mental experience of facing the holy space of Jerusalem might yield an emotional response that exceeds an adequate reaction. The narratives described display a unique form of the so-called syndrome. The current study examines spiritual and cultural aspects of delusion and shared beliefs and the complex relationship between normal religious belief and “pathological” religious delusions. I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear.—Matthew 6:19. Who shall separate us from the love of Christ? Shall trouble or hardship or persecution or famine or nakedness or danger or sword?—Romans 8:30.

Esquizofrenia, psicopatologia e crime violento: uma revisão das evidências empíricas

OBJETIVO: Estudar, mediante uma revisão sistemática da literatura científica, a relação esquizofrenia, psicose e violência. MÉTODOS: Realizou-se uma busca eletrônica por meio das bases de dados Medline, SciELO e Lilacs, até a data de junho de 2006, considerando artigos de línguas inglesa e portuguesa. RESULTADOS: Um número de pesquisas revela associação entre esquizofrenia e comportamento violento, principalmente quando existe comorbidade com abuso de substâncias. Aspectos específicos dos delírios são relacionados com comportamento violento, como maior grau de convicção e presença de delírios de controle e perseguição. CONCLUSÕES: Apesar de limitações metodológicas, alguns aspectos da psicopatologia aguda da psicose e da comorbidade de abuso de substâncias parecem estar fortemente relacionados à presença de comportamento violento entre pacientes psicóticos. De acordo com os estudos analisados, somente uma pequena parcela da violência social poder ser atribuída a esse grupo de pacientes. Novas pesquisas deverão futuramente permitir prever antecipadamente o risco de um comportamento violento, permitindo com isso intervenções preventivas e redução do processo de estigmatização.

Neuropsychiatric Aspects of Delusions

Neuropsychiatric Aspects of Delusions

Anthropological and Ontoanalytical Aspects of Delusion

Anthropological and Ontoanalytical Aspects of Delusion

Cultural Aspects of Delusion

The analysis of symbolic behavior and communication, which was first described by Sapir and Whorf, is extended by Dr. Weinstein in clarifying the role of psychotic processes as a mode of adaptation in the social field. In previous publications the author described brain damaged patients, including those with diffuse injury or brain stem lesions, who then developed obscure language and gestural patterns which were nevertheless integrated patterns with social and dynamic significance. The thesis of this research is that symbols and symbolic behavior are structured early and provide one with a sense of reality. Under the stress of illness, whether it is organic (brain damage) or functional (schizophrenia), we select early learned preferred systems of intimate communication. The author chose the Virgin Islands to investigate the significance of cultural factors in delusions. There are four subcultures extant in these islands: native (British and American Virgin Islanders), continentals, French, and Puerto

Cultural Aspects of Delusion.

This well-known investigator of symbolic behavior and communication processes has extended his study of brain-damaged humans to psychotic patients in the Virgin Islands, where he spent two-and-one-half years in a psychiatric wing of a general hospital. Since his major hypothesis states that the social context of the psychotic patients' problems determines the content of his delusions, Weinstein chose the population of the Virgin Islands, where several fairly isolated cultures exist simultaneously within a small area. Delusions of psychotic patients are considered as ways of adaptation to stress specific to the culture, rather than as wish-fulfilling fantasies, denials, or projections derived from internal conflicts. Weinstein considers that, "Delusions are considered as symbolic or socially organized units rather than psychological or physiological entities." In situations of stress, as in impairment due to brain injury, language becomes more primitive, its symbols more condensed and concrete. Among the regressed modes of