Delusional Content Research Articles

An overview of treatment in paranoia/delusional disorder.

To examine delusional disorder (formerly paranoia) which has re-emerged as an important diagnosis in psychiatry and familiarize present-generation psychiatrists with this disorder and its treatment. To benefit other researchers, a bibliography is appended. Approximately 1,000 articles on paranoia/delusional disorder were analyzed in detail. These articles date from 1961 with the greater majority dating from 1980 onward. Case descriptions were often vague and only cases identifiable by DSM-IV diagnostic criteria were accepted. Eventually 257 cases were accumulated, but it was only possible to report on treatment aspects of 209 of these, due to lack of detail. Because the data are so disparate, and the literature is confusing in therapeutics aspects, only the broadest conclusions can be drawn. However, it does appear that when adequately treated, delusional disorder is an illness with a reasonably good prognosis. Cases respond equally well to treatment, whatever the specific delusional content, and pimozide currently appears to be the neuroleptic which produces the best results. There is an urgent need to raise standards in the study of delusional disorder and its treatment.

Theme and Content of Delusions in Asian Indian Psychotic Patients: Correlation with Diagnosis

The aim of this study was to investigate the types of delusions present in Asian Indian psychotic patients and evaluate correlation with patient diagnosis. Delusional narratives were collected from 50 Indian patients with schizophrenia or an affective disorder. These narratives were judged for delusional theme and content and were correlated with DSM-III-R diagnoses. Using simple categorical analysis, delusional themes of grandiosity and guilt correlated with affective diagnoses. Delusional themes of reference and Schneiderian types were more often associated with schizophrenia. These findings support the concept that delusional themes can be used as valid diagnostic clues in the assessment of psychotic Indian patients.

Computer content analysis of the Schreber case.

The text of Schreber's Memoirs of My Nervous Illness was analyzed by computer at the level of the individual word. These words then were grouped into 17 rational categories, and the categories were checked for reliability. The contents of Schreber's work then were compared with three other documents. In general, the Memoirs showed much greater delusional content than the other documents. Interestingly, sexual matters did not appear to be Schreber's principal problem at this atomistic level.

The social construction of criminal responsibility and insanity.

This study examines the effects of judicial instructions (traditional American Law Institute [ALI] not guilty by reason of insanity [NGRI] instructions contrasted with ALI instructions supplemented with the guilty but mentally ill [GBMI] alternative) and case information cues (delusional content and planfulness) on student and community subjects' attributions of responsibility. GBMI instructions substantially reduced the probability of NGRI and guilty verdicts in response to vignettes portraying highly psychotic defendants and altered the pattern of variability in responsibility construal ratings. Variation in delusional content cues (self-defense versus non-self-defense) influenced ratings of criminal appreciation but did not affect the verdict distributions. Less planfully commited crimes resulted in higher proportions of insanity verdicts. However, individual differences in responsibility construals of the defendant and in attitudes toward the insanity defense were stronger predictors of verdicts than the design variables, suggesting that individual differences in social-moral cognition are at least as relevant to the attribution of responsibility as are case cues or legal frames of reference. Contrary to previous studies,Witherspoon death penalty attitudes were not related to verdicts, but people without conscientious scruples toward the death penalty were more likely to render guilty verdicts.

Attributional style in paranoid vs. depressed patients

The Attributional Style Questionnaire was given to three groups of 15 adult patients: a group of paranoid patients who were not depressed, a group of depressed patients who were not paranoid, and a group of patients who were both paranoid and depressed. As predicted, the paranoid patients manifested an attributional style opposite to that of the depressed patients: that is, they tended to attribute good events to themselves and bad events to others or to chance, whereas the depressed patients tended to attribute bad events to themselves and good events to others or to chance. These findings confirm those of Kaney & Bentall (1989). The patients who were both paranoid and depressed fell in between the two other groups with respect to their attributions of good events but did not differ from the paranoid group in their attributions of bad events. In addition, differences among groups were manifest with respect to self-esteem, delusional content and suicidal ideation. The implications of these findings for therapy are discussed.

Consistency of delusions in schizophrenia and affective disorder

The content of delusions were studied in a group of schizophrenics and affective disorder patients who had an episodic course to ascertain if the content of delusions remained similar or became dissimilar during different episodes. There were 18 schizophrenics and 30 affective disorder cases in this study. Consistency of delusional content was noted in one third of the cases in each group. Delusional content was consistent over episodes more often in Hindus ( P<0.04), those married ( P<0.03),and those from a rural background in the schizophrenic group. These differences were not observed in the affective disorder cases. Possible reasons for the consistence or non-consistence of delusional content are discussed.

Recurrence of hallucinations in consecutive episodes of schizophrenia and affective disorder

48 patients with episodic psychosis (18 schizophrenia, 30 MDP) were studied to examine whether they had similar hallucinations in consecutive episodes. 34 cases reported hallucinations, 23 of whom had hallucinations in consecutive episodes. In 22 of these 23 cases, the same type of hallucination (in the same sense organ modality) recurred. A recurrence of similar content was found in nearly half of the cases. In cases in whom the hallucinatory content persisted, however, there was no persistence of delusional content. Similar neurophysiological disturbances in similar neuroanatomical regions may result in the persistence of the same hallucinations.

Persistence of delusional content among psychotics over consecutive episodes.

The present paper examines the persistence of content of delusions in 48 patients diagnosed as either affective disorder or schizophrenia. These patients were attending psychiatric clinic at National Institute of Mental Health and Neurosciences, Bangalore, India, between 1986 and 1988. The type and content of delusion was assessed in each patient at each psychotic episode. Persistence in delusional content was found in one-third of the patients. It is likely that cultural and psychological factors may be contributing to this complex phenomenon of delusional persistence.

Suicide attempts correlate with delusional content in major depression.

A retrospective analysis of all medically serious suicide attempts made by 45 patients hospitalized consecutively at the Payne Whitney Clinic with the Diagnostic and Statistical Manual III discharge diagnosis of unipolar major depression recurrent with psychotic features was undertaken. Patients with delusions of persecution in combination with delusions of guilt were significantly more likely to make medically serious suicide attempts than patients with single categories of delusions or combinations other than guilt and persecution.

The relation of delusional content in psychotic depression to life-threatening behavior.

A retrospective analysis of all medically serious suicide attempts made by 45 patients hospitalized consecutively at the Payne Whitney Clinic with the DSM-III discharge diagnosis of Unipolar Major Depression, Recurrent, With Psychotic Features was undertaken. Patients with delusions of bodily disease, damage, and malfunction were significantly less likely to make medically serious suicide attempts than patients with delusions of sinfulness, guilt, deserved punishment, or persecution.

100 years of DSM-III paranoia. How stable a diagnosis over time?

Modified stricter criteria for DSM-III paranoia were fulfilled by 63 (37%) of 169 Heidelberg probands given a diagnosis of "Case Record Paranoia" (CRP) during a 100-year period (1878-1977). Clinical findings were chiefly interpreted in light of the controversial issues of age, illness duration and type of delusional content pertinent to the formulation of a present-day valid definition for this disorder. With respect to diagnostic consistency over time, 56% of DSM-III paranoia cases with at least one further Heidelberg admission proved to be non-stable, non-consistency being overwhelmingly due to a change in a DSM-III schizophrenic direction.

Dealing with delusional patients: discovering the distorted truth.

This study describes how certain delusional people view their world. Patients' names and delusional content have been altered slightly to protect the identity of patients and their families without changing the meaning of the participant observation. Using grounded theory techniques, the investigators discovered the meaning or kernel of the distorted truth in several delusions. Five categories of delusions were found.A recurrent aim in our nursing care was to increase the patient's self-esteem. We found that certain nursing modalities worked better than others. Thorough and continuous assessment, sometimes bordering on detective work and always incorporating hunches, was necessary to decode delusions and validate the patient's experiences.

&amp;lsquo;Paranoid Psychoses&amp;rsquo;

After a presentation of the traditional principles of diagnosis and a precise definition of terms, the Vienna approach to the classification of delusional conditions is introduced. This approach is multiaxial: the first axis consists of a classification of delusional syndromes based on a cross-sectional description of their structural and constituting elements; on the second axis, the relationship between the delusional world and the real one is described; the third axis is for the recording of delusional contents; the fourth axis serves for an attempt at etiological attribution. The Vienna approach differs principally from the usual systems of classification in that it is purely syndromatological and thus it avoids giving an a priori nosological meaning to the various symptoms making up the delusion (for example, certain delusional themes, certain forms of hallucinations). A definitive nosological diagnosis is only possible when an organic cause is clearly evident, otherwise the suffix '-morphic' (endogenomorphic-schizophrenic, endogenomorphic-cyclothymic, and organomorphic axial syndromes) is added to denote the close resemblance of clinical states to certain disorders whose nosological homogeneity should not be taken for granted. Next, the results of our own catamnestic study on a patient population selected solely on syndromatological grounds are presented. It is shown that no prognostic significance can be attributed to the delusional pictures classified according to their description (paranoic syndromes, systematic and unsystematized paraphrenia); on the other hand, such significance certainly falls to one of the axial syndromes formulated on axis 4 (the endogenomorphic-cyclothymic axial syndrome). Nevertheless, a relatively large portion of the patients eluded attribution to one of the axial syndromes, even after a course of several years. Aside from the possibility that a number of them could be so classified after further cross-sectional evaluation, one may suspect that this group contains patients whose delusional formation stems from a psychogenic etiology; or it may be that these patients represent a third illness entity, distinct from the other two groups of endogenous psychoses.

5. South America

F. SAFADI studied the delusional content of lower-class schizophrenic patients hospitalized in Guayaquil, Ecuador. Significant differences were found between patients of different cultural and geographic origin. Three papers by M. DOBKIN deal with folk medicine in Peru.

The toxic psychoses and allied states

Like convulsions and coma, delirium represents a non-specific response to distortions of cerebral metabolism. The factors determining the onset of a delirious reaction are multiple; the most important are: the extent of exposure to the toxic agent, the premorbid personality structure, and the existing physical and psychic situation. The distinctive delirial pattern, with its delusional and hallucinatory content, is predominantly a reflection of the uncovered unconscious guilt, anxiety and depression. Recognition of the toxic psychoses can be difficult, since organic and functional brain disorders and certain systemic diseases also participate in the delirial type of response. It is rare to encounter a toxic substance that produces a characteristic symptom complex, so that the differentiation of these agents often cannot be made on a clinical basis. The management of this condition is fundamentally an effort to remove the offending toxin or to supply a missing metabolite. At the same time psychic and physiologic equilibrium must be restored. Neither the psychic nor somatic aspects of treatment should be ignored.

De la psychose paranoïaque dans ses rapports avec la personnalité

This is a highly technical discussion of the subject of the paranoic psychoses, giving a lucid and exhaustive exposition of the teachings of Kraepelin, Sérieux and Capgras, Kretschmer, Kehrer, Lange and others. There is also an excellent report in detail of a case. The third and final part of the book discusses, in a manner that is admittedly speculative, the significance of the paranoid states, based mainly on a psychoanalytic interpretation of the delusional contents. The views offered are largely repetitions of authoritative statements rather than original concepts. The book will be of little interest to the general physician, but it contains much of value for the graduate student and the psychiatrist.