Types Of Delusions Research Articles

Corollary Discharge, Hallucinations, and Dreaming

Corollary Discharge, Hallucinations, and Dreaming

Delusions of persecution and poisoning in patients with schizophrenia: sociocultural and religious background

This article presents data on the phenomenology of delusions of persecution and poisoning in patients with schizophrenia and determines parallels between sociodemographic status and personal religiosity and this type of delusions. We have studied the content of delusions in patients with schizophrenia looking for persecution and poisoning themes using Fragebogen fuer psychotische Symptome (FPS). A total of 295 patients suffering from schizophrenia participated in this study; 74.7% reported delusions of persecution. The proportion of female patients (81.9%) who felt persecuted was almost one-third higher than the proportion of male patients (66.9%). The prevalence of delusions of persecution was lower in the group of persons for whom their faith was personally important (73.4%) than in the atheistic group (86.7%). Delusions of persecution and poisoning were strongly intercorrelated. Delusions of poisoning were reported by 57.8% of respondents: 54.8% by male and 60.6% by female patients. In multivariate analysis, delusions of persecution were more prevalent in women compared to men; in those with a chronic course of illness compared to those with periodic course; in those with small size of family compared to those with large family. The presence of delusions of being poisoned was related to older age of the patient, higher than secondary education, chronic course of schizophrenia, and younger parental age. Personal importance of the faith was not associated with prevalence of delusions of persecution and poisoning in patients with schizophrenia.

Delusion of Oral Parasitosis and Thalamic Pain Syndrome

Delusional parasitosis is an uncommon psychiatric condition in which patients have the immutable conviction that small, living organisms, such as worms, insects, or larvae infest their skin or other organs. The authors describe a case of an unusual association of delusional parasitosis and thalamic pain syndrome after left-posterior thalamic hemorrhage. The patient initially suffered from dysesthesia and burning pain typical of thalamic pain syndrome and subsequently developed delusional oral parasitosis ("worms" infesting her mouth). Sulpiride 100 mg/day administered in addition to amitriptyline gradually improved her delusions within 3 months. The authors speculate that this specific type of delusion can be elicited by the disruption of the somatosensory pathway and that the subsequent cortical sensory deafferentiation and reorganization arising from this disruption may contribute to the development of delusional parasitosis.

Christ/Messiah Delusions Revisited: Toward an Anthropological Definition of Religious Delusions

Certain themes in the delusions of psychotics have puzzled clinicians and anthropologists of this secular age because of the frequency of their occurrence. Patients who are indifferent to religion while in a nondelusional state identify with heroes of the religious or mythical pantheon, even though they may have been raised in homes without religion or literary culture. Among these types of delusions, Christ, or the Messiah, is a frequent figure of identification. The frequency of religious-mythical themes in the delusions of patients has remained remarkably constant over half a century. Kranz (1955) found (from German-speaking sources) that the frequency of religious-mythical delusions between 1886 and 1946 ranged from 43 percent to 45 percent. The issue of the Christ delusion as a specific form of religious-mythical identification touches upon other psychopathological schemes and points to some of their limitations. Since at least the time of Bleuler, it is no longer possible to evade the challenge of understanding delusions with the argument that they are nothing more than the accidental products of deranged minds. We also have learned the therapeutic value of understanding delusional communications as a way to improve verbal interactions with patients who have only this enigmatic vehicle of self-expression at their disposal. The striking similarity of the imagery and ideology of these religious-mythical delusions to those of some charismatic sects and their apocalyptic visions is a further theoretical challenge. Even if we are reluctant to extend the realm of psychopathology

Defining a DSM Infrastructure

Defining a DSM Infrastructure

Neuropsychological correlates of reality distortion in schizophrenic patients

The present study aims at exploring the relationship between content-related aspects of delusions and hallucinations in schizophrenia and the basic domains of cognition, controlling for the other clinical and demographic variables that could produce bias in the interpretation of the results. Seventy stable schizophrenic patients were evaluated through psychiatric assessment and a neuropsychological battery including tests on attention, memory, perceptual-motor speed and executive functions. We found that the severity of negative symptoms was strongly correlated with poor performance in almost all domains of cognitive functions, while only the attentional deficit was correlated with positive symptoms. The relationships between different cognitive domains and specific types of delusions and hallucinations showed that thought insertion, guilt, grandiose, religious and somatic delusions were associated with impairment in different cognitive functions (verbal and visual memory, attention and executive functions). Voices arguing and tactile hallucinations were correlated to delay-recall memory function. Our results suggest that no specific cognitive pattern is associated with typical-content delusions and hallucinations. On the basis of our findings, cognitive impairments associated with delusions and hallucinations, as measured by our battery, seem not to play a central role in the genesis and the maintenance of these symptoms, suggesting a more complex model of pathogenesis.

Awakening the kundalini of humour

Byline: Harish. Shetty While conducting training sessions for judicial officers on mental health for the past three years I would always ask them a question: 'Why is it that they do not smile?' The reply I always got was that 'It will be misunderstood and trivialize such a responsible activity.' Not very long ago, when I was conducting a session for senior medical teachers in a reputed teaching hospital, an orthopaedic surgeon shared that he would never smile at a patient in pain as the latter would feel offended. My question to him was: 'If your close relative knocks at your door to seek help for some aches and pains, will you not greet him with a smile?' Humour and its brethren (i.e. smile/laughter/a naughty giggle) all contribute to healing. As the recipient feels better, the giver feels ecstatic. Humour is a lost art and the casualty of a fast-paced world. I believe that the day should begin with humour. As far as possible, I begin my day with laughter and it could be with anybody. Well, the auto rickshaw driver could be nudged by 'Chal Dhanno'. Many a time the drive is recklessly dangerous but the point is that the human connection is established. This bond is losing its shine as doctors have forgotten this basic need under the belt of effective molecules or therapies. Swaminath has made this point very effectively. I remember the session with a bunch of students in a hostel recently following the suicide of their colleague. As the session moved very seriously with tears and fears expressed, one little girl shared a joke sent through sms. Nervous smiles erupted and as I nodded a subtle sanction, more jokes flowed with no guilt or apprehension. Deeper sharing erupted and the kids moved ahead in their process of healing. In 1993, after the devastating earthquake at Latur (Maharashtra) we had organized a Manaswasthya Shibir-a mental health camp. This session was organized in the famous Neelkanteshwar temple at Killari which was also partially devastated. We had just began our 'funda' with our PTSD business, when the villagers cracked a joke on their own. As they continued, the session became hilarious and we fulfilled our agenda. The fantastic component was that the villagers set the agenda and the method of healing through their own cultural and mental processes. Most of my teachers have been grim, racking their brains to differentiate between the different types of delusions. Yet all of them were so different with a glass of whisky. I always wonder why they could never reveal this side as clinicians in their day-to-day life. Why were their chats with patients so formal, so cold, so clinical?The flesh and bones were dissected by a set of questions evolved by many OCPD clinicians. Sexual innuendos alone are not humour. And compart-mentalizing it during different times for self-conceived reasons is like going away from God-moving away from Mother Nature. As I smile at the cops on the road chatting away with my 'Lord Krishna' (the guy who drives me around), I was stopped by one. …

Drug-Induced Psychosis in Parkinson Disease

To describe further the phenomenology of drug-induced psychosis (DIP) in patients with Parkinson disease (PD) and assess which items on two common psychosis rating instruments-the Brief Psychiatric Rating Scale (BPRS) and the Neuropsychiatric Inventory (NPI)-are the best measure of DIP by comparing them with the Clinical Global Impression Scale (CGIS). Baseline data from two placebo-controlled, double-blind studies of olanzapine in PD patients with DIP were collected and analyzed. A total of 157 of 160 patients had hallucinations, with visual hallucinations being the most common (97% of subjects), followed by auditory (48%), tactile (23%), and olfactory (16%). Seventy-six percent of subjects experienced delusions, and all types of delusions occurred with relatively equal frequency. The CGIS correlated with suspiciousness, hallucinatory behavior, unusual thought content, and hostility on the BPRS; and delusions, hallucinations, agitation, aberrant motor behavior, and sleep on the NPI. Nonvisual hallucinations and delusions may occur more frequently in DIP than previously thought. These symptoms, plus agitation and hostility, may ultimately be the best measure of DIP in patients with PD.

Unusual Experiences, Reality Testing and Delusions of Alien Control

: Some monothematic types of delusions may arise because subjects have unusual experiences. The role of this experiential component in the pathogenesis of delusion is still not understood. Focussing on delusions of alien control, we outline a model for reality testing competence on unusual experiences. We propose that nascent delusions arise when there are local failures of reality testing performance, and that monothematic delusions arise as normal responses to these. In the course of this we address questions concerning the tenacity with which delusions are maintained, their often bizarre content, the patients’ inability to dismiss them, and their often circumscribed character.

Psicosis asociada a megacisterna magna

Megacisterna magna is a developmental malformation of the middle-line brain structures, which exists along a continuum with cerebellum hypoplasia (Dandy-Walker variant) and cerebellum agenesia (Dandy-Walker syndrome). Psychotic disorders, and particularly schizophrenia, are now conceptualised as disorders of neurodevelopment. We report on a patient who presented a psychotic disorder (delusional type), and mega cisterna magna. This is the first report of such an association, and it is suggested that both the psychotic disorder and the mega cisterna magna may be the expression of a single underlying neurodevelopment abnormality.

Cognitive Functioning and Other Discriminatory Variables in Anorexic Patients

This study is part of a larger research study (doctoral dissertation), in which a comparative study with adolescent samples is done: 50 anorexic restricting patients (ANP), 50 patients diagnosed with depression (DP) and 50 non patients (NP). The proposed objective is two-fold: 1) To try to clarify the existing relationship between Anorexia (AN) and Depression (D), investigated from diverse disciplines but without conclusive results. 2) To detect in the ANP personality different traits from those of other groups, which should, if possible, allow to detect them at an early stage for an adequate prognosis. The current article presents the Rorschach findings in relation to the cognitive functioning of the ANP. In them, the following has been detected: (1) An information processing similar to that of the other groups, even with a more complete (L ≤ .99), more complex (DQ+↑) and better discriminated (Zd↑) grasp of the stimulus; (2) Mediating processes very similar to those of the other groups, sharing with them the perceptive maladjustments (X–%↑) and an excessive individualism (Xu%↑); (3) A clearly differentiating ideation disorder. Definitely, the ANP use predominantly ideation (M↑), but their thought, usually well-adjusted (MQo↑), presents eventual operations of delusional type (MQnone↑). Above that, their thinking is marked by a great passivity (Mp↑), which makes them more vulnerable to accept ideas without criticizing them and it results in a very inefficient thinking, which spins around these concepts without finding solutions, entering into a sort of ruminating which is completely unproductive. The differences toward the obsessive pathology are established. The discriminant analysis conducted with all the Rorschach variables that resulted as significant throughout the research, provides quite a consistent function which discriminates the ANP: MQnone↑, Mp↑, FD↓, Ma↑, MQo↑, AdjD↑, Sum H↑, (H)↑. Based on this we can understand that these adolescents, being in a developmental period of big changes and disorientations in relation with their own image, confronted with life events, and possibly starting off with some biologic vulnerability: (1) Due to the alterations of their ideation, accept without criticism (Mp) irrational ideas dominating in our culture, in which slimness appears as the only model, synthesis of intelligence, beauty and success; remaining captured in this type of mental activity (MQnone), which they cannot escape nor criticize (Mp), despite they reason adequately on other topics (MQo); (2) Their alterations of self-perception [(H)] make them hide themselves in a fantasized image, which is the axis of their interests and the only thing that really matters to them; (3) The resources they have to decide on behaviors and to finish these deliberately (AdjD), and their scarce tendency to the introspection (FD) lead to their decision of not eating, based on distorted and passively accepted thinking, which has great power and thus, so difficult to modify. Finally, based on the Rorschach data obtained, the hypothesis of a personality disorder as underlying pathology is pointed out.

Religious beliefs and religious delusions: Response to treatment in schizophrenia

It has been suggested that patients with strong religious beliefs or religious delusions have poor outcome from psychiatric treatment. The aim of the investigation was to establish if the patients’ shorter-term response to psychiatric treatment was affected by these factors. A quasi-experimental design was used, in which patients with schizophrenia were assessed soon after admission to hospital. They were categorised as (1) religious or not religious, (2) experiencing religious delusions or not, using reliable criteria. Patients were given their routine treatment and their symptoms were then re-assessed after four weeks. There was no difference in response to treatment between the religious and non-religious patients. There was no difference between patients who had religious delusions and those who had other types of delusions. Though this study does not settle the debate, it suggests that strong religious beliefs or religious delusions do not adversely affect the patient's response to treatment in the shorter term.

Cross-sectional similarities and differences between schizophrenia, schizoaffective disorder and mania or mixed mania with mood-incongruent psychotic features

Background. – The cross-sectional clinical differentiation of schizophrenia or schizoaffective disorder from mood-incongruent psychotic mania or mixed mania is difficult, since pathognomonic symptoms are lacking in these conditions. Aims of the study. – To compare a series of clinical variables related to mood and cognition in patient groups with DSM-III-R diagnosis of schizophrenia, schizoaffective disorder, mood-incongruent psychotic mania and mood-incongruent psychotic mixed mania. Methods. – One hundred and fifty-one consecutive patients were evaluated in the week prior to discharge by using the structured clinical interview for DSM-III-R-patient edition (SCID-P). Severity of psychopathology was assessed by the 18-item version of the brief psychiatric rating scale (BPRS) and negative symptoms by the scale for assessment of negative symptoms (SANS). Level of insight was assessed with the scale to assess unawareness of mental disorders (SUMD). Results. – There were no differences in rates of specific types of delusions and hallucinations between subjects with schizophrenia, schizoaffective disorder, psychotic mania and psychotic mixed mania. SANS factors scores were significantly higher in patients with schizophrenia than in the bipolar groups. Patients with mixed state scored significantly higher on depression and excitement compared to schizophrenia group and, to a lesser extent, to schizoaffective group. Subjects with schizophrenia showed highest scores on the SUMD indicating that they were much more compromised on the insight dimension than subjects with psychotic mania or mixed mania. Conclusion. – Negative rather than affective symptomatology may be a useful construct to differentiate between schizophrenia or schizoaffective disorders from mood-incongruent psychotic mania or mixed mania.

Delusions of Japanese patients with Alzheimer's disease.

Delusions constitute one of the most prominent psychiatric complications in Alzheimer's disease (AD). However, there is little consensus of the prevalence and associated factors for delusions in AD. To reveal the characteristics of delusions among Japanese patients with AD. 112 consecutive patients with AD were recruited over a one year period and administered the Neuropsychiatric Inventory (NPI). Delusions were present in 53 patients (47.3%). Delusions of theft were the most common type of delusion (75.5% of patients with delusions), followed by misidentification delusions and delusions of suspicion. More hallucination, agitation, and female gender were found in the delusions group. The authors found a high frequency of delusions, particularly of delusions of theft and suggested that gender was associated with the expression of delusions in Japanese patients with AD.

Religious delusions in patients admitted to hospital with schizophrenia.

Religious delusions are clinically important because they may be associated with selfharm and poorer outcomes from treatment. They have not been extensively researched. This study sought to investigate the prevalence of religious delusions in a sample of patients admitted to hospital with schizophrenia, to describe these delusions and to compare the characteristics of the patients with religious delusions with schizophrenia patients with all other types of delusion. A cross-sectional investigation was carried out. The prevalence of religious delusions was assessed and comparisons were made between religiously deluded patients and a control group on demographic, symptom, functioning and religious variables. One hundred and ninety-three subjects were examined of whom 24% had religious delusions. Patients with religious delusions had higher symptom scores (as measured by the PANSS), they were functioning less well (as measured by the GAF) and they were prescribed more medication than those patients with schizophrenia who had other types of delusion. It is concluded that religious delusions are commonly found in schizophrenia and that by comparison with other patients who have schizophrenia, those patients with religious delusions appear to be more severely ill. This warrants further investigation.

Psychotic (delusional) major depression in late life: a clinical study.

Psychotic (delusional) major depression (PMD) in the elderly is a common condition in inpatient settings. There is evidence that late age onset depressives are more likely to be psychotic. The aim of this study was to investigate the frequency, sociodemographic, and clinical characteristics of PMD in hospitalized elderly depressives. The sample consisted of 118 elderly patients consecutively admitted at three different clinics. All patients fulfilled DSM-IV criteria for major depression disorder and were diagnosed on the basis of Structured Clinical Interview for DSM-IV (SCID). The subjects were also assessed using the Hamilton Rating Scale for Depression, the Mini Mental State Examination (MMSE) and a physical health rating scale. PMD was positively associated with age of depression onset over 60 [corrected]. The PMD patients were also more severely depressed, more psychomotorically retarded and referred more past psychotic depressive episodes. Furthermore, age at onset influenced the type of delusions, so that PMD patients with age [corrected] over 60 at onset expressed delusions of hypochondriacal and nihilistic content more frequently. The results of our study demonstrated that PMD in the elderly has a later age at onset.

Alteration of rCBF in Alzheimer's disease patients with delusions of theft.

We investigated the neural substrate of the delusion of theft in patients with Alzheimer's disease (AD). Nine AD patients with only one type of delusion (delusions of theft) and nine age, cognitive function-matched AD patients without any type of delusions were selected from 334 consecutive outpatients of Ehime University Hospital. All subjects underwent (99m)Tc-HMPAO SPECT scanning, and SPECT images were analyzed by Statistical Parametric Mapping (SPM). AD patients with delusions of theft showed significant hypoperfusion in the right medial posterior parietal region compared to patients without delusions. Our data suggest that attention impairment or lack of awareness of illness caused by right parietal dysfunction might play a role in producing the delusion of theft.

Reply to Dr. Cutting and Dr. Fabrega

Reply to Dr. Cutting and Dr. Fabrega

“Delusions” of Space

Introduction: Delusions have received increased attention in the neuropsychological literature. However, there has been a relative lack of information published concerning delusions of “space.” More specifically, the belief that one is moving through space from “another world,” “planet,” or location, has infrequently been studied with respect to localization of dysfunction in cerebral structures. Given that other types of delusions often occur as a result of right hemisphere lesions, it is hypothesized that delusions of space occur with lesion to similar structures, and particularly the right parieto-temporal region. Several lines of converging evidence, which support this theory, are discussed. Method: In addition, a right parieto-temporo hypothesis for delusions of space is tested by use of single case study design of a male patient with closed head injury who specifically believed that he was from “another place” with someone forcing him through space to remain in a “box” (another body). Discussion: Results from neuropsychological evaluation and topographical brain mapping with QEEG lend support to this theory, with findings of right parieto-temporo dysfunction and relative asymmetry in beta (13-20 Hz) activity when left and right hemispheres were compared. Conclusions: The results provide case study evidence supporting the inclusion of QEEG as part of a neuropsychological evaluation. This approach lends itself both to double dissociation techniques in syndrome analysis and in a priori predictions using nomothetic comparisons.

A Rating Scale for Psychotic Symptoms (RSPS):: Part II: Subscale 2: distraction symptoms (catatonia and passivity experiences); Subscale 3: delusions and semi-structured interview (SSCI-RSPS)

In the second paper on the Rating Scale for Psychotic Symptoms (RSPS), distraction symptoms (Subscale 2) and delusions (Subscale 3) are described. Subscale 2 includes distraction symptoms, which arise from one of two mechanisms: the symptom may arise either by loss of attentional focus (LAF) due to a competing channel of information, or by the intrusion of the competing channel into the focus of attention [attentional intrusions (AI)]. The symptom classes resulting from loss of attentional focus (LAF) include motor catatonia, negativism, and thought blocking; the attentional intrusions (AI) symptoms rated include three types of passivity experiences (Schneiderian symptoms): (1) thought insertion, (2) movements or action controlled, and (3) speech controlled by an external force. Subscale 3, consisting of delusions, is organized on the basis of content identification. Nineteen types of delusions are rated. Each item of delusional content is rated along three axes (active elaboration, persistence and active extinction) and complexity, and optionally if primary or mixed (i.e. primary with secondary elaborations). The last section of the paper includes the semi-structured interview (SCI-RSPS) for each of the items, as well as guidelines for practical application of the interview.