Delusional Experiences Research Articles

EPA-1632 – Phenomenology of acute psychosis

The experience of an inaugural episode of acute psychosis is initially a confrontation with an indefinable experience. However, with the introduction of operationalized classifications (for example the DSM), the clinicians attaches sometimes less importance to the subjective patient's experience than to the possible presence of symptoms, lidding to a not-comprehensibility of delusional experience. Following the phenomenological tradition of Minkowski, Binswanger, Conrad, Tellenbach Blankenburg and Kimura, some authors from the end of the twentieth century like Stanghellini, Parnas, Bovet and Grivois reaffirmed this approach that put between brackets the 'objective’ concepts of descriptive psychopathology to make possible a more immediate encounter with patient. Thus, the intersubjectivity becomes a principal object of analysis. For example, Minkowski speaks about a diminished sense of dynamic and vital connection to the world, 'the loss of vital contact’; and Blankenburg emphasizes the patient's loss of the normal sense of obviousness or 'natural self-evidence’. In a more empirical way, Conrad studied the first 117 episodes of psychosis and proposed a nomenclature of the initial phases of the disease (trema, apophany, anastrophe and apocalypses), to describe the becoming of the patient in a strange world, that's finish in a subjective’reorganization of meaning’. The objective of the present article is to review the different phenomenological concepts from Minkoswki to nowadays authors to offer a better comprehensibility of psychotic experience.

Delusions in the phenomenological perspective

The aim of the article is to present the contemporary concepts of delusions from the phenomenological perspective. The difficulties to define delusions and the examples of delusional disorders, such as delusional mood, Cotard’s syndrome, or Capgras delusions, serve as the point of departure for this analysis. The questions of the phenomenological understanding of delusions are presented in the context of Karl Jaspers' theory of the incomprehensibility of psychotic thinking (primary delusions, delusional mood). The subsequent analysis presents the constraints of contemporary cognitive theories of delusions. The criticism of said theories highlights the need for creating a broader concept of experience and cognition and results in the proposition to use the terms background and “embodiment as theoretical tools for a more complete understanding of the peculiarities of delusional experience.

Jumping to conclusions: the association between delusional ideation and reasoning biases in a healthy student population

Cognitive theorists have focused specifically on reasoning biases, in particular ‘Jumping to Conclusions’ (JTC), in an attempt to understand delusional experiences. The present study aimed to assess the association between the JTC reasoning bias and dimensions of delusional ideation among a sample of healthy undergraduate university students. Delusional ideation was assessed using the Peters Delusion Inventory (PDI-21). The JTC reasoning bias was assessed using two ratios of the Beads Task. The findings revealed that those participants who completed the 85:15 ratio beads task and who exhibited higher levels of delusional ideation did not demonstrate a JTC bias. However, participants who completed the more difficult 60:40 variant of the beads task and who exhibited higher levels of delusional ideation were more likely to demonstrate a JTC bias. JTC made a significant contribution to the total variance explained for the PDI Total, and each of the three subscales of the PDI. Healthy individuals display a tendency to ‘JTC’ and this is associated with delusional ideation, therefore representative of the continuum perspective, that these experiences are not confined to clinical populations. Implications of these findings and future directions for research in this area are also discussed.

Opportunities, threats and limitations of neuroscience data in forensic psychiatric evaluation

In the last decade, a number of studies have been published to shed light on the interaction between neuroscience and the law, notably on the introduction of neuroscience data in forensic psychiatric evaluation (FPE). Even if there is a growing consensus on the relevance of neuroscience in clinical practice, the role of neuroscience in FPE is still controversial. The use of neuroscience data in FPE can support the detection of psychopathological disabilities (e.g. deficit of self-control, aggressiveness) that may be involved in criminal action. Traumatic brain injury-related clinical disorders that may lead to misconduct have a relevant role in the debate. Traditionally, literature refers also to rare and weird cases in which brain tumours, infections and morphological abnormalities were supposed to be significantly associated with disorders leading to criminal action. After reviewing recent literature from both legal and neuroscientific perspectives, we consider a broader range of clinical conditions (e.g. disorders of consciousness in sleepwalking, dopamine replacement therapy in Parkinson's disease, misattributions of self in delusional experience) that may have implications in legal settings. Obviously, it would be possible to consider also different clinical conditions. We conclude by suggesting further experimental and theoretical analysis.

Two case reports: ‘delusions’ arising in virtual reality

The role of the internet is increasingly pertinent in the daily lives of both clinicians and patients. We present two case reports, concerning patients recently presented to our service, involving beliefs concerning the social media website, Facebook. We consider the basis of a delusional experience from both categorical and dimensional perspectives. We consider the context of the nature of social networking media and the internet, including examples of how it has been used therapeutically, as well as the potential for detrimental use. Whilst keeping the principle of a delusion in mind we also explore some of the challenges that are presented in the assessment of such beliefs and how, or indeed whether, to incorporate them into the understanding of a patient's presentation. We also briefly consider the impact that beliefs arising from and incorporating social media and the internet may have on the practice of clinicians, descriptive phenomenology research, diagnosis and management of mental disorder.

Mental disorders as “brain diseases” and Jaspers’ legacy

Mental disorders as “brain diseases” and Jaspers’ legacy

1279 – The ego - self axis in patients with schizophrenia

Understanding the meaning and dynamics of the phenomenological expression of schizophrenia enables the possibility of having a dialogue with schizophrenic individual. The theoretical framework of analytical psychology offers the possibility of understanding the schizophrenic world. The identity of a person consists of two centers of organization (Ego and Self) which are connected (Ego- Self axis). The nature of the Ego-Self relationship is determined by the developmental cycles, but also by everything that changes the relationship between the conscious and subconscious. In schizophrenia, the unconscious contents flood the Ego consciousness which looses the ability to distinguish between internal and external reality. The boundaries of the Ego are lost and it is assimilated in the Self. The Ego becomes uninterested with reality which appears to be insignificant in comparison to the unlimited possibilities of the unconscious. The assimilated Ego takes possession of the attributes of the Self, and thus the illusion of immortality, powerfulness, omniscience, as the content of consciousness and as personal attributes, most frequently in the form of delusional ideas and experiences of omnipotence. In schizophrenia, the assimilation and inflation of the Ego can be caused by the weakness of the Ego or the increase in the pressure from non-integrated complexes in the unconscious. The Ego-Self axis in schizophrenia is moved towards the Self, marking the retreat of the Ego which actively participates in the reality, in which Ego observes and passively bears witness to the content of the unconscious both at an individual and collective level.

“Transferring” and transference

This paper is part of my research into psychotic transference and is also related to the psychotic aspect of any adult or infantile patient in analysis. In my research, I studied the origin of the concept of transference in Charcot's time before Freud, and the transformation of this concept in psychoanalysis. Freud thought that psychotic patients were not able to establish a transference relationship, but some of his early papers show the opposite. In fact, Freud himself and then several other analysts were able to develop a personal experience regarding the possibility of contact and transferring feelings and delusional experiences in a therapeutic context – individual, group, or institution. I provide some clinical examples in this paper, as well as some theoretical, personal views regarding intrapersonal and interpersonal transference. Like Freud and Melanie Klein, I believe that transference starts with life, but that in psychoanalysis it has a particular meaning.

Season of birth effect on psychotic-like experiences in Japanese adolescents

A number of studies have investigated seasonality of birth in schizophrenia. Most of the studies have consistently observed an excess of winter births, often associated with decreased summer births. We postulated that psychotic-like experiences (PLEs), subclinical hallucinatory and delusional experiences, may also be affected by birth season. In the present study, we assessed the season of birth effect on the prevalence of PLEs using data from the cross-sectional survey of 19,436 Japanese adolescents. As a result, significant excess of winter births was observed in the prevalence of PLEs, accompanied by a decreased proportion of summer births. The odds ratios for the prevalence of PLEs were estimated to be 1.11, which was on the same order with those for the development of schizophrenia in the previous meta-analytic studies. To our knowledge, this is the first to show the seasonality of birth in the prevalence of PLEs and implicate the winter birth effect on subclinical stage of schizophrenia.Electronic supplementary materialThe online version of this article (doi:10.1007/s00787-012-0326-1) contains supplementary material, which is available to authorized users.

Heidelberg Coping Scales for Delusions: Psychometric Evaluation of an Expert Rating Instrument

Background: Coping is of substantial relevance in the treatment and course of psychiatric disorders. Standardized instruments to assess coping with psychotic symptoms, particularly delusions, are rare. The aim of this study was to develop and evaluate the psychometric properties of a new instrument to assess coping strategies in the context of delusional experiences: the Heidelberg Coping Scales for Delusions (HCSD). Methods: Two hundred and twelve inpatients with schizophrenia spectrum disorders and affective disorders currently experiencing delusions were interviewed with the HCSD and other coping assessment instruments. Psychometric properties and factor structure were analyzed. Results: The HCSD showed good inter-rater reliability and convergent validity. Factor analysis yielded an interpretable structure with five factors: resource-oriented coping, medical care, distraction, cognitive coping, and depressive coping. Symptomatic behavior, due to its particular characteristics, was considered apart. Conclusion: The HCSD is a reliable and valid instrument for the assessment of coping strategies in patients with delusions. Further research is needed to evaluate coping changes over time and their influence on treatment and clinical outcomes.

Vulnerable Self, Poor Understanding of Others' Minds, Threat Anticipation and Cognitive Biases as Triggers for Delusional Experience in Schizophrenia: A Theoretical Model

It remains unclear what processes lead to the establishment of persecutory delusions in acute phases of schizophrenia. Recently, it has been argued that persecutory delusions arise from an interaction among a range of emotional, cognitive and social factors. In this work, we explored this possibility by first discussing the relevant aspects of recent theoretical models of the causes of persecutory delusions. Then, we offered an analysis of the literature, illustrated with clinical observations suggesting that persecutory delusions are triggered during stressful intersubjective transactions by the interactions of (a) an alteration in empathetic perspective taking and in pragmatic understanding of others' minds; (b) a perception/representation of the self as vulnerable or subordinate and of the other as dominant and threatening; and (c) a hyperfunctioning of the threat/self-protection system when faced with perceived danger. Implications for future research and treatment of people suffering from this symptom are discussed.

P03-48 - Coping with delusion in schizophrenia and psychotic depression

IntroductionCoping plays an important role in processes involved in the development of mental disorders, influencing decompensation and recovery from patients. Coping is defined as an active self-generation of cognitive and behavioural procedures, which impact directly on the symptom or reduce distress caused by it. How patients cope with delusions lack empirical evidence. Although, in the last years, delusion has been considered a multidimensional phenomenon where emotional, cognitive and action-oriented aspects were recognized, the impact of delusional dimensions on coping is still unknown.ObjectivesTo assess coping strategies used by patients with schizophrenia and psychotic depression to deal with delusion. The relationships between coping, psychopathology and the dimensions of delusional experience will be examined.MethodsThirty deluded schizophrenics and 30 psychotic depressed patients were investigated. Instruments to the assessment of delusion were used, as the Positive and Negative Syndrome Scale (PANSS) and the Heidelberger Delusion Profile (HDP).Correlations between psychopathology, coping and delusion dimensions were calculated.ResultsCoping strategies used to deal with delusion were different in the 2 groups of patients. Schizophrenic patients use more medical care, while psychotic depressed patients use more depressive coping. Significant correlations between psychopathology, coping and delusion dimensions could be shown. In contrast to depressive patients, the emotional and cognitive dimensions of delusion seem to influence coping in patients with schizophrenia.ConclusionsCoping strategies are different depending on the diagnosis. In schizophrenia, the emotional and the cognitive dimensions seem to influence how patients cope with delusional experience.

P03-49 - Delusion and hallucinations - an empirical correlation analysis

IntroductionDelusion and hallucinations occur in a variety of psychiatric disorders. In the last years they have been considered multidimensional phenomena, since emotional, cognitive and action-oriented aspects were recognized. According to the cognitive model of the development of positive symptoms, emotional processes play an important role for the relationship between delusion and hallucinations. Although delusion and hallucinations often coexist, there are few empirical studies, which explore this relationship.ObjectivesAim of the study is to elucidate the relationship between delusion and hallucinations taking into consideration their multidimensionality.MethodsEighty-two patients with delusion and hallucinations with a schizophrenia spectrum disorder were examined. Several instruments to the exploration of delusion and hallucinations were used as the Psychotic Symptoms Rating Scales (PSYRATS), MacArthur-Maudsley Delusions Asessment Scchedule (MMDAS), Dimensions of Delusional Experience (DDE), Positive and Negative Syndrom Scale (PANSS), Brown Assessment of Beliefs Scale (BABS), Clinical Delusion Rating Scale (CDRS) and the Heidelberger Delusion Profile (HDP). The correlations between formal hallucination and delusion criteria, as well as formal hallucination criteria and delusion content were calculated. The causal relationship between delusion and hallucinations was tested through a structural equation modelling.ResultsCorrelations between delusion and hallucinations dimensions could be found, at item, subscale and scale levels. Emotional and cognitive delusion dimensions correlated significantly with hallucinations magnitude. The delusion content showed a significant influence on the occurrence and emotional dimension of hallucinations. Delusion secondary to hallucinations could only be partially confirmed.ConclusionsThe results confirm the complex structure of the relationship between delusion and hallucinations.

Life hassles, experiential avoidance and distressing delusional experiences

Life hassles have been implicated in both the formation and maintenance of psychosis symptoms. However, little is understood about the mechanism through which these stressors impact on psychosis. The current study proposed experiential avoidance (EA), a psychological coping style that is a central focus for change in Acceptance and Commitment Therapy (ACT), as a potential mediator of the link between life hassles and both the emergence and maintenance of delusional ideation. Participants were recruited to a non-clinical sample ( N = 133) and a clinical sample of psychosis patients ( N = 100). All participants completed a self-report questionnaire including a measure of delusions and delusional distress (Peters Delusions Inventory), life hassles (Survey of Recent Life Experiences) and EA (Acceptance and Action Questionnaire-II). Mediation testing (bootstrapping) indicated a significant mediation effect of EA in the relationship between life hassles and both delusions and delusional distress, in both clinical and non-clinical samples. The findings suggest that individuals (irrespective of their diagnostic status) with a tendency to suppress or avoid unwanted thoughts are significantly more likely to experience distressing delusions in response to stressful life occurrences. The use of ACT and Cognitive Behavioural Therapy to reduce EA in those at risk of emerging delusions and in patients with an already established psychosis is discussed.

Predicting the Occurrence, Conviction, Distress, and Disruption of Different Delusional Experiences in the Daily Life of People with Schizophrenia

Recent research has shown that negative emotional states of increased anxiety and sadness prospectively predict the occurrence of persecutory ideation, but it is not known whether these findings extend to other subtypes of delusions. The current study explored whether these negative emotional states, as well as hallucinations, biased reasoning style (ie, jumping to conclusions), and negative self-esteem prospectively predict the occurrence and various dimensions of delusions of control, reference, and grandiosity in real time, as they occur in daily life. One hundred and thirty community-dwelling participants with schizophrenia or schizoaffective disorder completed laboratory measures and momentary self-reports generated by a personal digital assistant multiple times per day, over 7 consecutive days. Analyses were time lagged allowing simultaneous examination of person-level and within-person time-varying relationships among the variables. Approximately, half of the participants reported having at least one delusional experience during the week, and approximately, a quarter of those individuals reported experiencing all 3 delusion subtypes. Hallucinations were a significant predictor of the occurrence of delusions of control and reference over the subsequent hours of the same day, but negative emotional states of anxiety and sadness were not. Negative self-esteem predicted the frequency of all 3 delusion subtypes during the week, and a reasoning style characterized by reduced information gathering was a significant predictor of the frequency of delusions of control. Delusional dimensions of conviction, distress, and disruption had different associations with the variables tested for each delusion subtype.

Is It Reasonable to Consider Delusions as Mainly a Thought Disorder?

This review reflects on the question whether delusions are predominantly a thought disorder, characterized by defective cognitive processes. As background, a general model describing the aetiology of delusions is presented. Research in the positivist epistemology, especially the cognitive approach, focuses on defects in reasoning processes, but increasingly recognizes the relevance of emotions, and attempts to integrate them into explanatory models. First person accounts point to the high level of emotionality in delusional experiences. It will be argued that emotions exert an influence in multiple and pervasive ways. Theory and evidence regarding direct reflection of emotions in delusional content and for delusions as defence against unwanted feelings is considered. Research in the interactionist tradition suggests that delusions can develop in response to severe affective disturbances, for example through traumatising experiences, and that adverse social factors contribute to development and maintenance of delusions via their impact on feelings about self and others. A social account of delusions explains delusions as a relational problem, characterized by disturbed affective relations to others. Considering the pervasive presence of emotions in the development and maintenance of delusions, this leads to the conclusion that it would be too narrow to understand delusions as a purely cognitive disorder.

Psychometric Evaluation of the Characteristics of Delusions Rating Scale as an Expert Rating Scale

Background: Research suggests delusions may be better viewed as multidimensional rather than dichotomous phenomena. The aim of this study was to assess the reliability and validity of a German version of the Characteristics of Delusions Rating Scale (CDRS) as an expert rating scale. Method: 200 inpatients with schizophrenic spectrum and affective disorders with delusions were assessed with the CDRS and other delusion rating scales. Factorial validity was analysed, and differences between diagnostic groups on the CDRS subscales as well as on the total score were examined. Results: The CDRS was found to have good inter-rater reliability and internal consistency as an expert rating. Factor analysis yielded an interpretable structure with 3 factors – cognition, emotion and bizarreness – accounting for 70% of the variance. The convergent and differential validity of the scales was supported. Compared to other scales, the CDRS measures all dimensions of delusional experience that have been suggested to date with the exception of behavioural aspects. Conclusions: The results support the view of delusions as multidimensional phenomena. The CDRS as an expert rating is a reliable and valid assessment tool for dimensions of delusional experience and an economical instrument for research and clinical practice. Further research is needed to examine the dimensional structure underlying delusional phenomena and the relationship of the dimensions to neurobiological and psychotherapeutic processes.

Delusional profiles among young adults: A latent class analysis of delusion proneness

Delusional beliefs and experiences can predict the development of mental disorders within the spectrum of psychosis. The nature, content and prevalence of delusional experiences in the general population are still disputed topics. This study investigates the latent structure of delusion proneness in the non-clinical population. Eight hundred young adults (400 from Italy and 400 from the United Kingdom) completed the Peters et al. delusions inventory, a general population measure of delusional proneness. Latent class analysis was used to explore the latent structure of delusion proneness. Four classes were identified: low delusion proneness (including 28% of the sample), grandiosity (13%), paranoid thinking (41%) and positive psychotic beliefs (18%). Latent structures of sub-clinical symptoms can be observed also in non-clinical population; paranoid thinking is the most common delusional theme.

Dimensions of Delusional Experience Scale: A Psychometric Evaluation of a German Version

Background: Delusional experience is a fundamental symptom of psychotic illness. Over recent years, a multidimensional perspective has become increasingly important regarding this phenomenon. Several instruments to measure different dimensions of delusions have been constructed. The aims of this study were to examine the reliability and validity of a German version of the Dimensions of Delusional Experience Scale (DDE). Methods: Two hundred inpatients with a schizophrenic spectrum disorder or an affective disorder with delusions were examined with the DDE, the Positive and Negative Syndrome Scale (PANSS) and other rating scales for delusional experiences. Results: The scale was found to have good reliability and excellent inter-rater reliability. The 2 factors, delusional involvement and delusional construct, found by Kendler et al. [Am J Psychiatry 1983;140:466–469] could be replicated. The convergent and differential validity of the scale was supported. Besides the content-related aspect ‘bizarreness’, the DDE mainly assesses cognitive aspects, emotional and behavioral aspects are not incorporated. Conclusions: The results support the value of a multidimensional perspective of delusional experiences. The German version of the DDE is a reliable and valid assessment tool for different dimensions of delusions, and an economical instrument for research and clinical practice. Further research is needed to reveal the dimensional structure underlying delusional experience.

An interpretative phenomenological analysis of delusions in people with Parkinson's disease

Purpose. The aim of this qualitative study was to explore what delusional experiences mean for people with Parkinson's disease (PD) and to examine how psychosocial factors contribute to the development and maintenance of delusional beliefs.Method. Eight participants were interviewed, and interpretative phenomenological analysis was used to identity themes within their accounts. Participants were either recruited from a hospital-based outpatient movement disorder clinic or from a PD support group in the north-west of England.Results. Four themes emerged from the analysis: (1) ‘I got very frightened’: The emotional experience associated with delusions; (2) ‘Why the hell's that happening?’: Sense of uncertainty and of losing control; (3) ‘I feel like I'm disintegrating’: Loss of identity and sense of self; (4) ‘I've just tried to make the best of things’: Acceptance and adjustment to experience of delusions. These interconnected themes in participants’ accounts of delusional beliefs were reflected in their descriptions of living with, and adjusting to, PD.Conclusions. The results of this study add to the evidence base indicating the urgent examination of psychological alternatives to conventional, medication-based approaches to alleviating the distress caused by delusions in people with PD.