Delusional Thinking Research Articles

Auditory hallucinations and delusional thinking: A review and critique of outcome studies

AbstractThis paper reviews the literature in which behavioral interventions were applied in an attempt to reduce hallucinatory and delusional verbalizations in psychiatric patients. Subject characteristics, dependent variables and treatment variations, as well as generalization of effects, are considered. It is concluded that even though operant procedures, such as extinction, aversive stimulation, and token reinforcement, have been successful in decreasing hallucinatory‐delusional verbalizations, further research examining generalization is needed. Methodological issues influencing interpretation are discussed and suggestions for further research are offered.

Measurement and modification of delusional beliefs.

It has been proposed that delusional thinking may be on a continuum with normal behavior and can be assessed by taking account of factors such as the client's degree of belief conviction or the extent of preoccupation with the belief. In our research a number of measures were used to assess the delusional thinking of people diagnosed as schizophrenic. Two interventions were used: (a) a structured verbal challenge and (b) a reality test in which the belief was subject to an empirical test. We used a multiple-baseline, across-subjects design. Of the 6 clients, 2 completely rejected their beliefs, and 3 others significantly reduced their belief conviction. Maintenance was good, and there was evidence that the intervention had enabled 5 of the 6 clients to effectively regulate their delusional thinking.

Verbal control of delusions

The verbal descriptions or rules people formulate to describe both themselves and their interactions with others can profoundly influence their subsequent behavior and rule formation. Delusions may be thought of as being one class of rules. Two single-case experiments, each comprising a multiple-baseline design across three behaviors (delusions), are reported. Each experiment incorporated a number of measures of delusional thinking and an intervention designed to challenge these delusions and to provide the clients concerned with alternative rules with which to organize their behavior. In both experiments the intervention proved highly effective in reducing the degree of conviction in the delusional beliefs, and there was some generalization of the effects across beliefs. A number of secondary measures helped to identify associated clinical benefits, and there was evidence that both clients used the alternative rules to regulate their behavior during a 6-month follow-up phase.

Content specific information processing and persecutory delusions: an investigation using the emotional Stroop test.

Attentional bias was investigated in patients suffering from persecutory delusions and matched psychiatric and normal controls, using the emotional Stroop task. Subjects were required to colour name words which were either meaningless strings of Os, neutral words, words indicating negative affect, or words judged to be of paranoid content. In comparison with the control subjects the deluded patients demonstrated a selective increase of response time for the paranoid words. A second analysis using indices of interference produced even more marked results. The relevance of these findings for the understanding of delusional thinking is discussed.

Aspects of the dynamics of delusions

Delusion ist the outcome of psychotic experience, but can also be seen as a structure of meaning with patterns of mental and anthropological significance of its own. In schizophrenic delusion, there is some 'effort after meaning' manifest, compensating for psychotic disintegration. In the light of generative linguistics, there seems creating of delusional ideas to be performed in separated steps, but contextually linked to integrate them into a holistic delusional view of reality. Subjective evidence of delusional thinking is analyzed on the basis of semantic logics.

A randomized, controlled dose response study of intravenous sodium diethyldithiocarbamate in patients with advanced human immunodeficiency virus infection

Sodium diethyldithiocarbamate (Imuthiol, DTC) has previously been observed to promote T-cell maturation in animal models and to reduce lymphadenopathy and improve survival in a murine AIDS model. In addition, several clinical studies have suggested that one dosage regimen may be active in patients with HIV infection. We conducted a randomized, controlled dose response study of intravenous DTC in patients with the acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). Drug associated toxicities included gastrointestinal upset, burning at the infusion site, metallic taste, sneezing, confusional states, hyperactivity, delusional thinking, and myoclonus. Toxicity was ameliorated by dose reduction. The maximally tolerated dose varied for individual patients from 200 mg/m 2 weekly to 800 mg/m 2 twice weekly. No myelosuppression was observed. In patients with greater than 200 CD4+ cells/uL, a statistically significant reduction of lymphadenopathy occurred; whereas no beneficial effects were observed in patients with less than 200 CD4+ cells/uL. Improvement in symptom score and stabilization of CD4+ count also occured in the treated group, although these trends did not reach statistical significance. Further controlled clinical trials of DTC in earlier HIV infection are warranted.

Methylphenidate-induced Delusional Disorder in A Child With Attention Deficit Disorder With Hyperactivity

ABSTRACT A 6-year-old child with an Attention Deficit Disorder with Hyperactivity developed a florid psychotic disturbance in conjunction with methylphenidate therapy. The child's presentation was highly unusual in that delusional thinking was a predominant feature. This case study is considered within the context of other reported instances of children's psychotic reactions to stimulant-induced medications. It is suggested that there is a spectrum of stimulant-induced psychoses in children that parallels well-known signs of stimulant intoxication in general.

Major Depression with Delusional Features in a Preschool-Age Child

This is a report of major depression with possible delusional thinking in a 5-year-old boy. Data from clinical interviews, behavioral observations, and psychological testing are briefly discussed.

The right to refuse treatment in Oregon: A two‐year statewide experience

AbstractThe right to refuse treatment seems well established for psychiatric patients. Individual states, however, have very different procedures for managing this right and for overriding the refusal. Oregon's administrative procedure for override depends on an evaluation by an independent examining psychiatrist. This article empirically examines the 432 refusals leading to override requests in three Oregon psychiatric institutions in 1983 and 1984. Treatment refusal was found to be a common occurrence in all age groups. Those who refused treatment were seriously ill, unemployed, single individuals with previous psychiatric hospitalizations. Most refused treatment because of denial of their illness or delusional thinking about medication. Most refusals were overridden following the independent psychiatrist's examination. Because of the significant cost of the override procedure to the patient and the mental health system, the authors propose a new procedure which combines parts of the current procedure with a requirement that, at the time of the civil commitment hearing, the judge makes a separate decision as to the patient's competency to make treatment decisions.

Delusional Thinking in Psychotics: Correlates of Religious Content

Manic ( n = 18) and schizophrenic ( n = 23) patients were subdivided on the basis of delusional status, with special reference to religious delusions, and compared to a control sample of normal subjects. Assessments of religious attitudes and beliefs, as well as demographic factors, were conducted. No differences existed in the characteristics of manic and schizophrenic patients with delusions, and it was difficult to differentiate delusional patients with and without religious content in their symptoms, although these patients differed in several ways from nondelusional patients and normals. These data are discussed in terms of their implications for theories about the development of delusions.

Civil defence in the United Kingdom.

What must be avoided in the nuclear age is wishful thinking. Wishful thinking occurs in an atmosphere of maximum terror (as in Mutual Assured Destruction), and where there is little opportunity for reality testing (as in the East‐West communication barrier). In the small, densely populated island of Britain, the size of today's growing nuclear threat will create responses where delusional thinking can easily dominate. A belief in effective civil defence may induce a sense of false security which may in turn direct attention from the fundamental problem of East‐West mistrust.

Disturbances of perception in depressive patients.

In a sample of 121 depressive patients hospitalized at Eginition Hospital from 1976 to 1980, 22 (18.2%) patients manifested disturbances of perception and, with 1 exception, all patients had hallucinations. Auditory and visual hallucinations were the most frequent. The group of patients with disturbances of perception had a positive family history for affective illness (p less than 0.025), a smaller number of previous depressive episodes (p less than 0.05), a greater frequency of delusional thinking (p less than 0.001) and psychomotor agitation (p less than 0.05).

Delusions and delusional thinking in psychotics: A review of the literature

Delusional thinking in psychotics is discussed in terms of definition, classification, and relevance to diagnosis. Theoretical explanations of delusions are then reviewed. While many explanations and theories on delusional thinking exist, some merely restate in different terms the same relationships, and most do not enjoy empirical support. It is concluded that existing theories, can be usefully organized into two main themes: motivational and defect. The motivational theme assumes that the individual develops the delusion either to explain unusual perceptual experiences or to reduce uncomfortable psychic states (e.g., unfullfilled need). The defect theme argues that delusional thinking results from some fundamental cognitive-attentional deficit. Future empirical work ought to pursue specific models which address some important distinctions among delusion types.

A response to Dr. Cohen's recommendations concerning the legalization of marijuana.

Dr S. Cohen stated he elected not to “offer a critique closely tied” to my article. By taking this position, I believe he has made it more difficult for the reader to appreciate our points of agreement and disagreement. For example, he failed to address many specific points which I raised (e.g., the fact that nearly all of the negative psychobiosocial consequences of using marijuana are associated with heavy, chronic, daily use, as well as the specific criteria I proposed for distinguishing between marijuana use and marijuana abuse). Instead, he cited a number of strawman positions, referred to as “myths,” which he attacked in his article. Very few of these “myths” reflected positions I had taken in my article.I also believe his choice of the word “myth” was unfortunate, since “myth” is a derogatory term which connotes ignorance and delusional thinking. I don't believe such labeling contributes to an objective consideration of a complex, sociopolitical, health problem.My response to his article will be to...

Delusions: Analysis and criteria

HAT CRITERIA should we use in identifying delusions? The question is important since the concept of a delusion figures prominently in many diagnostic schemes. 1*2,3 Moreover, the way in which the concept of a delusion is applied can have significant implications for society. For example, whether or not a person is considered competent to stand trial or is found not guilty by reason of insanity may depend upon whether or not it can be established that he is delusional. In another context. repressive political actions in the name of medical treatment may be carried out on the grounds that deviance in political viewpoint should be regarded as delusional thinking. Obviously, how we understand what a delusion is can have important consequences. Consider the following statements: (1) A physician believes that it’s his destiny to serve mankind and that he has been specially chosen for this: (2) A woman believes that her neighbor is trying to poison her by spraying poison into her house late at night; (3) A man believes that his thoughts are capable of destroying people: (4) A devoutly religious person believes that God spoke to him and told him to spend the rest of his life working for God and the church; (5) An early 16th-century scientist believes that the earth revolves around the sun: (6) An embassy worker believes that his office is being bombarded with microwaves that are making him sick, and (71 A Russian believes there is a better form of government than the one currently existing in the USSR. To what extent do these statements describe delusions’? What further information. if any, is needed to decide whether a delusion is occurring in each case? It is the intent of this paper to propose some criteria for identifying delusions. but it is necessary to begin by pointing to some of the defects in standard accounts of delusions. Standard definitions of “delusion” often emphasize such factors as having a fcrlsr belief or having a deviant boliqf. For example, the APA glossary defines a delusion as, “A false belief out of keeping with the individual’s level of knowledge and his cultural group.“” In the Conzprehensir~e Te.rtbm.4 c?f’ Psychiatry (ed 31, we find, “A delusion is a false belief that arises without appropriate external stimulation and that is maintained unshakably in the face of reason. Furthermore, the belief held is not one ordinarily shared by other members of the patient’s socio-cultural and educational group.“” Redlich and Freedman state “Delusions are incorrigible false beliefs that are not shared or

Exacerbation of Psychosis by Tricyclic Antidepressants in Delusional Depression

The authors describe three patients with delusional unipolar depression whose delusional thinking worsened markedly following administration of tricyclic antidepressant drugs. The patients had met Research Diagnostic Criteria for major depressive episode and had no evidence of schizophrenia or mania. Since tricyclic antidepressants are known to exacerbate psychosis in schizophrenic patients, it is sometimes suggested that the exacerbation of psychotic thinking in depressed patients indicates schizophrenia. The authors suggest that such an exacerbation does not in itself indicate schizophrenia but may occur in patients with an affective disorder who are prone to depressive delusions. The authors discuss the use of antipsychotic medication in this patient group and present a neurochemical hypothesis to explain the interaction of the drug with the illness, which results in exacerbation of psychotic thinking.

An evaluation of the validity of the Freudian theory of paranoia.

This paper evaluates the validity of the Freudian theory of paranoia on the basis of the available research evidence. This theory essentially states that delusional thinking arises as a result of the reaction-formation and projection of threatening unconscious homosexual wishes. It is concluded that a positive association between paranoid and homosexual tendencies has been found, but only for the case of male paranoid patients. The research leading to this conclusion has not, however, demonstrated that a defensive attempt against unconscious homosexual impulses causes delusional thinking. Rather, the argument is made that it is more parsimonious to assume that only the second step in the Freudian etiological mechanism, a continuous tension-reducing projection of the patient's threatening and intense hostility, need be invoked to account for paranoia.

Delusional Depressions: Natural History and Response to Treatment

A review of the abundant literature concerning the distinction between delusional and non-delusional depressions, especially of the work of Aubrey Lewis, reveals that before the introduction of specific therapies most in-patients with major depressive illness eventually recovered; the small percentage who did not almost all came from the delusional group. The dichotomy lost its clinical significance after the introduction of ECT, as both groups were equally responsive. However, accumulating evidence indicates that unipolar delusional depressives are significantly less responsive to tricyclic anti-depressant therapy than non-delusional depressives. The presence or absence of delusional thinking should be considered as a significant criterion in the classification of depressive disorders, and the presence or absence of delusional thinking should influence the choice of treatment for severely depressed patients.

Fabrication of delusional thinking in normals.

Fabrication of delusional thinking in normals.

Fabrication of delusional thinking in normals.

Fabrication of delusional thinking in normals.