Academic literature on the topic 'Delusional ideation'

The DSM–IV definition of delusion is argued to be unsatisfactory because it does not explain the mechanism for delusion formation and maintenance, it implies that such beliefs are necessarily dysfunctional (pathological), it underestimates the social component to some delusions, and it is inconsistent with research indicating that delusions can be modified through techniques such as contradiction, confrontation, and cognitive-behavioral therapy. However, a well-replicated mathematical model of magical/delusional thinking based on a study of paranormal beliefs and experiences is consistent with the hypothesis that attributional processes play a central role in delusion formation and maintenance. The model suggests attributional processes serve the adaptive function of reducing fear associated with ambiguous stimuli and delusional thinking is on a continuum with nonpathological forms. Based on this collective research an amendment to the definition of delusion is proposed and its clinical implications are addressed.

Objective: The aim of this paper is to document regular nocturnal intensification of delusional nihilistic and persecutory ideas (Cotard delusion) linked with extreme depersonalisation and hypervivid dreaming. Clinical Picture: A 17-year-old man presented with Cotard and Capgras delusions after sustaining multiple cognitive impairments secondary to traumatic brain injury. Treatment and outcome: Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily. Conclusion: This patient's experience of perceptual abnormalities and impairments in meta-abilities related to self-monitoring and critical inferencing lends support to multicomponent sensory processing accounts of brain injury related, content-specific delusional syndromes.

BackgroundIn the UK and The Netherlands, people with high rates of psychosis are chronically exposed to discrimination.AimsTo test whether perceived discrimination is associated longitudinally with onset of psychosis.MethodA 3-year prospective study of cohorts with no history of psychosis and differential rates of reported discrimination on the basis of age, gender, disability, appearance, skin colour or ethnicity and sexual orientation was conducted in the Dutch general population (n=4076). The main outcome was onset of psychotic symptoms (delusions and hallucinations).ResultsThe rate of delusional ideation was 0.5% (n=19) in those who did not report discrimination, 0.9% (n=4) in those who reported discrimination in one domain, and 2.7% (n=3) in those who reported discrimination in more than one domain (exact P=0.027). This association remained after adjustment for possible confounders. No association was found between baseline discrimination and onset of hallucinatory experiences.ConclusionsPerceived discrimination may induce delusional ideation and thus contribute to the high observed rates of psychotic disorder in exposed minority populations.

IntroductionIt has been observed that children with auditory hallucinations (AH) may develop secondary delusional ideation, which is thought to increase the risk of need for care and patient status. Little is known about the cognitive vulnerabilities mediating delusion formation in children experiencing perceptual anomalies like AH. The ability to correctly interpret another person's intentions or emotions, referred to as mentalizing ability or ‘theory of mind’ (ToM), is shown to be impaired in children with psychotic symptoms and to be associated with delusional ideation in individuals at risk. A direct link between mentalizing ability and delusions is suggested by their presentation as alterations in social inference.ObjectiveTo examine the cognitive vulnerabilities mediating delusion formation in children presenting with AH.MethodIn a sample of 259 12- and 13-year-old children, AH, delusional experiences (’mind reading’,’paranoid ideas’ and’receiving media messages’) and theory of mind (ToM) were assessed, in order to examine the hypothesized moderating role of ToM in delusion formation.ResultsThe risk of delusion formation was significantly higher in AH children with lower ToM skills (OR = 2.9, 95% CI 1.3–6.4, P = 0.008), compared to AH children with higher ToM skills (OR = 1.7, 95% CI 0.9–3.4, P = 0.11).ConclusionOur results suggest that better mentalizing abilities confer protection against developing full-blown psychosis in children experiencing perceptual anomalies.

Background. Most of the existing studies suggest that suicide is one of the leading causes of premature death in patients with chronic psychotic disorders. However, very few studies have specifically investigated suicidal behaviour in patients with delusional disorder. Thus, our objective was to review the literature regarding the percentage of lifetime ideation and suicidal behaviour in delusional disorder in order to provide suggestions for clinical practice.Methods. MEDLINE and PsycINFO were searched from January 1980 to September 2012 using the following keywords: delusional disorder, paranoia, suicidal ideation, and suicidal behaviour.Results. A total of 10 studies were identified and included in the review. The percentage of suicidal behaviour in delusional disorder was established between 8 and 21%, which is similar to schizophrenia. Suicidal ideation and suicide attempts were more frequent in patients showing persecutory and somatic delusions in the reviewed studies.Conclusions. To the best of our knowledge this is the first attempt to specifically review the suicide phenomenon in patients with delusional disorder. Interestingly, our results support the notion that percentages of both suicidal ideation and behaviour in delusional disorder are similar to patients with schizophrenia.

ObjectiveThe relationship between personality and delusional ideation in still debated. The present study was aimed to evaluate the role of personality features and trait affectivity on the severity of delusional beliefs, through the lens of a dimensional approach. In fact, robust evidence suggests that delusional experience presents a dimensional structure rather than an all-or-nothing fashion with a severity gradient of delusional beliefs from general population to full-blown delusional disorder (DD).MethodForty-nine inpatients affected by DD and 42 non-delusional outpatients were administered the structured interview for DSM-IV Personality Disorders, the Pathological Narcissism Inventory–Italian Version, the Positive and Negative Affect Schedule and the Peters et al. 33–Italian version.ResultsSeverity of delusional ideation was positively related to “hiding the self” (HS) domain of narcissistic vulnerability and to paranoid traits and negatively related to “positive affect” (PA). Paranoid traits and HS significantly interacted in influencing delusional dimension severity (Fig. 1). Low PA represents a trait affectivity of sadness and lethargy whereas HS is closely related to the experience of shame. We speculate that lower levels of PA and higher levels of HS may grasp the “asthenic” pole of Kretschmer's “sensitive character”.ConclusionThe study findings suggest that the severity of delusional ideation depends, at least in part, on a complex interplay between specific affective and paranoid dispositions within personality. Delusion may constitute the superficial shell, which develops from and cover inner affective vulnerabilities of personality.Fig. 1Disclosure of interestThe authors have not supplied their declaration of competing interest.

BackgroundPrevious work suggests that exposure to childhood adversity is associated with the combination of delusions and hallucinations. In the present study, associations between (severity of) auditory vocal hallucinations (AVH) and (i) social adversity [traumatic experiences (TE) and stressful events (SE)] and (ii) delusional ideation were examined.MethodA baseline case-control sample of children with and without AVH were re-assessed on AVH after 5 years and interviewed about the experience of social adversity and delusions.ResultsA total of 337 children (mean age 13.1 years, s.d.=0.5) were assessed: 40 children continued to hear voices that were present at baseline (24%, persistent group), 15 heard voices only at follow-up (9%, incident group), 130 children no longer reported AVH that were present at baseline (remitted group) and 152 never heard voices (referent group). Both TE and SE were associated with both incident and persistent AVH, as well as with greater AVH severity and delusional ideation at follow-up. In addition, the combination of AVH and delusions displayed a stronger association with TE and SE compared with either AVH or delusions alone.ConclusionsEarly childhood AVH are mostly benign and transitory. However, experience of social adversity is associated with persistence, severity and onset of new AVH closer to puberty, and with delusional ideation.

AbstractBackgroundSubclinical delusional ideas, including persecutory beliefs, in otherwise healthy individuals are heritable symptoms associated with increased risk for psychotic illness, possibly representing an expression of one end of a continuum of psychosis severity. The identification of variation in brain function associated with these symptoms may provide insights about the neurobiology of delusions in clinical psychosis.MethodsA resting-state functional magnetic resonance imaging scan was collected from 131 young adults with a wide range of severity of subclinical delusional beliefs, including persecutory ideas. Because of evidence for a key role of the amygdala in fear and paranoia, resting-state functional connectivity of the amygdala was measured.ResultsConnectivity between the amygdala and early visual cortical areas, including striate cortex (V1), was found to be significantly greater in participants with high (n = 43) v. low (n = 44) numbers of delusional beliefs, particularly in those who showed persistence of those beliefs. Similarly, across the full sample, the number of and distress associated with delusional beliefs were positively correlated with the strength of amygdala-visual cortex connectivity. Moreover, further analyses revealed that these effects were driven by those who endorsed persecutory beliefs.ConclusionsThese findings are consistent with the hypothesis that aberrant assignments of threat to sensory stimuli may lead to the downstream development of delusional ideas. Taken together with prior findings of disrupted sensory-limbic coupling in psychosis, these results suggest that altered amygdala-visual cortex connectivity could represent a marker of psychosis-related pathophysiology across a continuum of symptom severity.

Background. To assess the prevalence of delusional ideas in primary-care patients.Method. A survey was carried out with the Aquitaine Sentinel Network of general practitioners (GPs). Consecutive practice attenders were invited to complete the Peters et al. Delusional Inventory (PDI-21) self-report questionnaire, designed to measure delusional ideation in the normal population. GPs, blind to the questionnaire results, provided information on patients' psychiatric history.Results. Of the 1053 attenders included in the survey, 348 (35%) had a lifetime history of psychiatric disorder, of whom 20 (2%) had a history of broadly defined psychotic disorder. The self-report questionnaire was completed by 790 patients. The range of individual PDI-21 item endorsement in subjects with no psychiatric history varied between 5 and 70%, suggesting that delusional ideation is a dimensional phenomenon lying on a continuum with normality. The main discriminative items between psychotic and non-psychotic patients were those exploring persecutory (OR=15·2, 95% CI 4·3–53·7), mystic (OR=6·4, 95% CI 1·9–22·4) and guilt (OR=5·8, 95% CI 1·5–23·2) ideas.Conclusions. This survey demonstrates that questions that explore delusions and hallucinations are well-accepted by most primary-care patients. More research is needed on psychotic disorders in primary-care settings to improving early identification of these disorders.

IntroductionThe dimensional approaches regard delusions as a continuum of the daily beliefs, not being limited to the clinical population and it can also be found in the general population. Due to the multifaceted conceptualization of delusions, the analysis of the dimensions of distress, preoccupation and conviction may be more revealing than the content of the belief itself, whereby an evaluation that incorporates these dimensions is fundamental.ObjectiveTranslation, adaptation and study of the psychometric properties of the Peters et al. delusions inventory (PDI-21) for the Portuguese population.AimAssessing the multidimensionality of the delusional ideation in the community.MethodsThe sample consists of 249 adults from the general population, aged between 18 to 65. The brief symptom inventory, the social desirability scale of the eysenck personality questionnaire and the World Health Organization quality of life–bref were used in this study beyond the PDI-21.ResultsThe Portuguese version of the PDI-21 has shown good psychometric properties regarding its internal consistency and test-retest reliability. It demonstrated significant positive correlations with the psychopathological symptoms and negative associations with social desirability and with the quality of life, confirming its divergent and convergent validity. The analysis of the frequency of delusional ideas for the total of the sample and on the basis of gender has revealed prevalence rates very similar to the ones found in previous studies.ConclusionsThe Portuguese version of the PDI-21 has adequate psychometric properties and it can be used to assess the delusional ideation in the general population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Experiences that resemble delusions of psychiatric patients can be observed in the general healthy population. These experiences, named hereafter delusional-like ideations, are not the only fact in line with the idea that there is a continuum between clinical delusions and normality. Previous research suggests that at least two types of cognitive bias could be common to patients and healthy subjects: first, a tendency to jump to conclusions, which can play a role in the formation of delusional ideation and second, abnormal semantic processes, which could lead to the maintenance of these ideations. The present thesis was aimed at further investigating these two biases in the general population to see whether further support can be obtained for the continuum view. In addition, the impact of current paranoid feelings on these cognitive biases was assessed in these healthy participants.
The tendency to jump to conclusion was evaluated with a reasoning task. Healthy people with delusional-like ideation needed less information to reach a conclusion than people without or with few delusional-like ideations, replicating findings obtained in deluded patients. Furthermore, paranoid feelings strengthened the relationship between delusional-like ideation and this jump to conclusion style of thinking. Results also show that people with delusional-like ideation jump to new conclusions when they experienced paranoid feelings, a finding that only tended to be significant when no paranoid feelings were induced. These results provide further support to the continuum idea and to the hypothesis that the jump to conclusion bias may be involved in delusion formation.
On the other hand, semantic processes of healthy participants were investigated by recording the N400 event-related brain potential in a semantic categorization task. When paranoid feelings were induced, delusional-like ideation scores were associated with smaller raw N400 amplitudes, as was found in schizophrenia patients with delusions. The analysis of the independent components of the N400 potential showed that delusional-like ideation had an influence on the N400 even when no paranoid feelings were induced. These results suggest that semantic processing of people with delusional-like ideation can be modulated by their current mental state. The implications for delusion formation and maintenance are explored.
In conclusion, both the results of the jump to conclusion and those of the semantic processes studies lend further support to the idea of a continuum between clinical delusions and delusional-like ideation.
Des expériences qui ressemblent aux idées délirantes psychiatriques peuvent être observées dans la population générale saine. Ces expériences, ci-nommées idées de type délirantes, ne sont pas les seuls faits en accord avec l'idée qu'il existe un continuum entre les idées délirantes et la normalité. Des études précédentes suggèrent qu'au moins deux types de biais cognitif sont communs aux patients et aux personnes saines: 1/la tendance à tirer des conclusions hâtives qui pourrait jouer un rôle dans la formation des idées délirantes et 2/les processus sémantiques anormaux qui pourraient conduire à la persistance de ces idées. La présente thèse a pour objectif d'explorer ces deux biais et d'évaluer s'ils soutiennent l'idée de continuum. De plus, l'influence de sentiments paranoïdes sur ces biais cognitifs est évaluée chez ces participants sains.
La tendance à tirer des conclusions hâtives a été testée avec une tache de raisonnement. Les personnes saines ayant des idées de type délirantes nécessitaient moins d'information pour arriver à une conclusion que ceux sans idées de type délirantes, ce qui réplique les résultats trouvés chez les patients délirants. De plus, les sentiments paranoïdes renforçaient le lien entre les idées de type délirantes et le saut aux conclusions des participants. Les résultats montrent aussi que les participants avec des idées de type délirantes tirent de nouvelles conclusions hâtives, ce qui n'était pas significatif lorsque les sentiments paranoïdes n'étaient pas induits. Ces résultats soutiennent l'idée du continuum ainsi que l'hypothèse proposant que tirer des conclusions hâtives pourrait participer à la formation des idées délirantes.
D'autre part, les processus sémantiques des participants sains ont été évalués en enregistrant le potentiel cérébral évoqué qu'est la N400, dans une tache de catégorisation sémantique. Quand des sentiments paranoïdes étaient induits, les scores d'idées de type délirantes étaient associés à de plus petites amplitudes brutes de N400, rappelant les résultats observés chez les patients. L'analyse des composantes indépendantes du potentiel N400 montre que les idées de type délirantes avaient une influence sur la N400, même lorsque les sentiments paranoïdes n'étaient pas induits chez les participants. Ces résultats suggèrent que les processus sémantiques des personnes avec des idées de type délirantes pourraient donc être modulés par leur état mental. Les implications pour la formation et la maintenance des idées délirantes sont explorées.
En conclusion, les résultats des études sur le fait de tirer des conclusions hâtives et ceux des études sur les processus sémantiques soutiennent l'idée de continuum entre les idées délirantes pathologiques et les idées de type délirantes.

This thesis examines attentional and cognitive biases for particular facial expressions in delusion-prone and deluded individuals. The exploration of cognitive biases in delusion-prone individuals provides one means of elucidating psychological processes that might be involved in the genesis of delusions. Chapter 1 provides a brief review of the continuum approach to schizophrenia, and outlines recent theoretical conceptualisations of delusions. The study of schizophrenia phenomena at the symptom level has become a popular method of inquiry, given the heterogeneous phenotypic expression of schizophrenia, and the uncertainty surrounding the existence of a core neuropathology. Delusions are one of the most commonly experienced symptoms of schizophrenia, and have traditionally been regarded as fixed, false beliefs that are pathognomonic of an organic disease process. However, recent phenomenological evidence of delusional ideation in the general population has led to the conceptualisation of delusions as multi-dimensional entities, lying at the extreme end of a continuum from normal through to maladaptive beliefs. Recent investigations of the information processing abnormalities in deluded individuals are reviewed in Chapter 2. This strand of research has revealed evidence of various biases in social cognition, particularly in relation to threat-related material, in deluded individuals. These biases are evident in probabilistic reasoning, attribution style, and attention, but there has been relatively little investigation of cognitive aberrations in delusion-prone individuals. In the present thesis, social-cognitive biases were examined in relation to a standard series of faces that included threat-related (anger, fear) and non-threatening (happy, sad) expressions, in both delusion-prone and clinically deluded individuals. Chapters 3 and 4 present the results of behavioural (RT, affect recognition accuracy) and visual scanpath investigations in healthy participants assessed for level of delusion- proneness. The results indicate that delusion-prone individuals are slower at processing angry faces, and show a general (rather than emotion-specific) impairment in facial affect recognition, compared to non-prone healthy controls. Visual scanpath studies show that healthy individuals tend to direct more foveal fixations to the feature areas (eyes, nose, mouth) of threat-related facial expressions (anger, fear). By contrast, delusion-prone individuals exhibit reduced foveal attention to threat-related faces, combined with �extended� scanpaths, that may be interpreted as an attentional pattern of �vigilance-avoidance� for social threat. Chapters 5 and 6 extend the work presented in Chapters 3 and 4, by investigating the presence of similar behavioural and attentional biases in deluded schizophrenia, compared to healthy control and non-deluded schizophrenia groups. Deluded schizophrenia subjects exhibited a similar delay in processing angry faces, compared to non-prone control participants, while both deluded and non-deluded schizophrenia groups displayed a generalised affect recognition deficit. Visual scanpath investigations revealed a similar style of avoiding a broader range of negative (anger, fear, sad) faces in deluded schizophrenia, as well as a common pattern of fewer fixations with shorter duration, and reduced attention to facial features of all faces in both deluded and non-deluded schizophrenia. The examination of inferential biases for emotions displayed in facial expressions is presented in Chapter 7 in a study of causal attributional style. The results of this study provide some support for a �self-serving� bias in deluded schizophrenia, as well as evidence for an inability to appreciate situational cues when making causal judgements in both delusion-prone and deluded schizophrenia. A theoretical integration of the current findings is presented in Chapter 8, with regard to the implications for cognitive theories of delusions, and neurobiological models of schizophrenia phenomena, more generally. Visual attention biases for threat-related facial expressions in delusion-prone and deluded schizophrenia are consistent with proposals of neural dysconnectivity between frontal-limbic networks, while attributional biases and impaired facial expression perception may reflect dysfunction in a broader �social brain� network encompassing these and medial temporal lobe regions. Strong evidence for attentional biases and affect recognition deficits in delusion-prone individuals implicates their role in the development of delusional beliefs, but the weaker evidence for attributional biases in delusion-prone individuals suggests that inferential biases about others� emotions may be relevant only to the maintenance of delusional beliefs (or that attributional biases for others� emotional states may reflect other, trait-linked difficulties related to mentalising ability). In summary, the work presented in this thesis demonstrates the utility of adopting a single-symptom approach to schizophrenia within the continuum framework, and attests to the importance of further investigations of aberrant social cognition in relation to the development of delusions.

AbstractWe present the case of a 29-year-old single Bulgarian woman, Alice, who lived and worked alone in Germany at the time she presented with signs of acute psychosis, more specifically work-related paranoid ideation. She was diagnosed with Brief Psychotic Disorder and treated successfully with Perphenazine. A return to her home town in Bulgaria with concurrent discontinuation of antipsychotic treatment brought about a change in delusional content. She was now excessively preoccupied with religious themes, ancient rituals, and local traditions, and responded well to treatment with Olanzapine. Alice reluctantly returned to Germany but every time she started a new job she experienced depressive and paranoid exacerbations in spite of strict medication adherence. In the last 3 years, she has lived in Bulgaria and has been medication and episode free. We discuss the complex interaction between the experiences of expatriation, premorbid personality, and cultural values (of the patient and her family) in the etiology, course and outcome of brief psychotic disorder. We raise the possibility that contemporary Bulgarian cultural values (as described in a recent comparative international study) were important in Alice’s recovery and, as such, may have wider significance as protective factors for those at risk of mental disorder.