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Hayashi, Naoki, Yoshito Igarashi, and Hirohiko Harima. "Delusion progression process from the perspective of patients with psychoses: A descriptive study based on the primary delusion concept of Karl Jaspers." PLOS ONE 16, no. 4 (April 27, 2021): e0250766. http://dx.doi.org/10.1371/journal.pone.0250766.
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Background Delusion occupies an important position in the diagnosis and treatment of patients with psychoses. Although Karl Jaspers’ concept of the primary delusion (PD) is a key hypothesis in descriptive phenomenology concerning the primordial experience of delusion, to our knowledge it has not been verified in empirical studies of patients with psychosis, and the relationship between PDs and fully developed delusions remains unclear. Methods The subjects were 108 psychiatric patients diagnosed with DSM-IV schizophrenia or schizoaffective disorder who had persisting delusions. This investigation used a newly devised semi-structured interview, the Delusion and its Origin Assessment Interview (DOAI), and the Positive and Negative Syndrome Scale. PDs enquired about in the DOAI were delusional perception, delusional memory, delusional mood, and delusional intuition. Associations of PDs with delusion themes and delusion features extracted from DOAI items by factor analysis were examined using correlational and MANCOVA regression analyses. Reliability studies of the DOAI were also conducted. Results The reliability and correlation analyses suggested robust psychometric properties of the DOAI. The percentages of subjects reporting PD phenomena as delusion origins and currently present were 93% and 84%, respectively. MANCOVA revealed several significant associations, including between delusional perception and delusional mood and persecutory themes, between delusional intuition and grandiose delusions, and between delusional perception and intuition and systematization of delusions. Discussion This study demonstrates that PDs can be considered as principal origins of delusions by subjects with psychosis, and have meaningful connections with the characteristics of their fully developed delusions. The associations between PDs and delusion characteristics can be interpreted in terms of progression processes of delusions, which are seen as intensification and generalization of cognitive and affective pathologies in PDs. The findings are also consistent with the neurobiological hypothesis that aberrant salience attribution to stimuli, as in PDs, is the primary phenomenon caused by abnormal dopamine system regulation. Further studies are needed to clarify delusion progression processes relating to PDs and to substantiate their clinical meanings.
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FREEMAN, D., P. A. GARETY, and E. KUIPERS. "Persecutory delusions: developing the understanding of belief maintenance and emotional distress." Psychological Medicine 31, no. 7 (October 2001): 1293–306. http://dx.doi.org/10.1017/s003329170100455x.
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Background. The objective of the study was to develop the cognitive understanding of persecutory delusions. It was hypothesized that safety behaviours contribute to the persistence of persecutory delusions by preventing disconfirmation. It was further hypothesized that emotional distress is associated with aspects of the content of delusions. An investigation was designed to establish whether individuals with persecutory delusions use safety behaviours, and to test predicted associations between delusion content and emotional distress.Method. A cross-sectional investigation was conducted on 25 individuals with persecutory delusions. A detailed assessment was made of the presence of safety behaviours, the content of delusions and emotional distress.Results. All participants had used at least one safety behaviour in the last month, most typically avoidance. Higher levels of anxiety were associated with greater use of safety behaviours. New data were obtained on the content of persecutory delusions. Aspects of the content of the delusions were associated with levels of depression, self-esteem, anxiety and delusional distress.Conclusions. Individuals with persecutory delusions use safety behaviours. The findings may develop the understanding of delusion persistence, acting upon delusions and the negative symptoms of schizophrenia. There are implications for cognitive interventions for psychosis. Support was also found for the hypothesis that emotional distress is linked to the content of delusional beliefs; it is speculated that prior emotional distress influences the content of delusions, and that delusion content in turn influences levels of emotional distress.
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Tzeng, Ray-Chang, Ching-Fang Tsai, Ching-Tsu Wang, Tzu-Yuan Wang, and Pai-Yi Chiu. "Delusions in Patients with Dementia with Lewy Bodies and the Associated Factors." Behavioural Neurology 2018 (2018): 1–8. http://dx.doi.org/10.1155/2018/6707291.
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Objective. Delusions are common neuropsychiatric symptoms in patients with dementia with Lewy bodies (DLB). The aim of this study was to investigate the associated factors of delusions in patients with DLB. Method. A retrospective study of outpatients with DLB registered in a regional hospital’s database was performed. The associated factors including cognitive performance, clinical features, vascular risk factors, and neuropsychiatric symptoms between delusional and nondelusional patients with DLB were compared. Results. Among 207 patients with DLB, 106 (51.2%) were delusional and 101 (48.8%) were not. Delusion of other persons are stealing was the most common symptom (35.3%). The delusional group had a significantly higher diagnostic rate of probable than possible DLB, higher disease severity, poorer cognitive performance, more severe neuropsychiatric symptoms, and higher caregiver burden (all p<0.05). In addition, the delusional group had a significantly lower frequency of diabetes compared to the nondelusional group (odds ratio=0.28, p<0.001). Conclusion. Delusion of other persons are stealing was the most common delusional symptom. The patients with DLB who presented with delusions had poorer cognitive function and more severe neuropsychiatric symptoms. A novel finding is that the DLB patients with diabetes had a lower frequency of delusions.
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Borrelli, D., R. Ottoni, S. Maffei, N. Fascendini, C. Marchesi, and M. Tonna. "The psychopathological trajectories to delusion in Schizophrenia: the affective and schizotypal pathways." European Psychiatry 65, S1 (June 2022): S762. http://dx.doi.org/10.1192/j.eurpsy.2022.1968.
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Introduction Delusions are a key feature of schizophrenia psychopathology. From a phenomenological approach, Jaspers (1913) differentiates between “primary” or true schizophrenic delusions, defined as an unmediated phenomenon that cannot be understood in terms of prior psychological origin or motivation, and “secondary” delusions, understandable from the patient’s mood state or personality. Primary delusions have been considered the hallmark of reality distorsion dimension in schizophrenia, disregarding a possible affective patwhay to delusional belief. Objectives The present study was aimed at elucidating the psychopathological trajectories to delusion in schizophrenia through the investigation of both affective and schizotypal trait dispositions. Methods Seventy-eight participants affected by schizophrenia were administered the Peters Delusional Inventory (PDI), the Positive and Negative Affective Scale (PANAS), the Experience of Shame Scale (ESS), the Referential Thinking Scale (REF), the Magical Ideation Scale (MIS) and the Perceptual Aberration Scale (PAS). Results The severity of delusional ideation (PDI) was positively related to both affective (PANAS positive dimension, ESS) and schizotypal traits (MIS, PAS and REF). Moreover, referential thinking (REF) mediated the relationship between “magical ideation” (MIS) and delusions severity (Fig. 1), whereas experience of shame (ESS) was a moderating factor in the between referential thinking and delusion severity (Fig. 2). Conclusions The study findings suggest that in schizophrenia patients, severity of delusions is underpinned by an intertwining of both affective and schizotypal pathways. Disclosure No significant relationships.
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Ningsih, Cahya. "An Analysis of Delusion on Alex in Francesca Zappia’s Made You Up." Journal of Literature, Linguistics, & Cultural Studies 1, no. 1 (October 31, 2022): 51–67. http://dx.doi.org/10.18860/lilics.v1i1.2231.
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Delusions are deeply held beliefs or false impressions, even though they contradict reality and what is generally thought to be true. This study uses the theory of literary criticism because literary criticism focuses on literary works. The researcher analyzed the delusional disorder experienced by Alex using literary criticism theory with a psychological approach. This study aims to examine Alex's mental disorder in the book Made You Up using delusional theory within the scope of Literary Psychology. The researcher tries to find the dominant form of delusion experienced by the character and how the delusion affects personality development. The data is taken from the memoir Made You Up by Francesca Zappia in the form of sentences, conversations, and statements. Data were analyzed using the delusional theory by Leeser and O'Donohue. This study aims to examine as well as distinguish several types of delusions that occur. Therefore, this study will examine the sequence by sequence that occurs in the book. In this study, the results showed that Alex's delusions included threatening feelings, and having beliefs that were considered subjective. Then how do delusions affect Alex's personality development where he becomes emotional quickly, feels excessively anxious, and becomes depressed because he locks himself up in his room a lot. Some delusions are quick and immediate, while others are more enduring and persist over a long period.
Keywords: literary criticism, psychology, mental disorder, delusion
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Lemonde, Ann-Catherine, Ridha Joober, Ashok Malla, Srividya Iyer, Martin Lepage, Patricia Boksa, and Jai Shah. "M114. DELUSIONAL CONTENT AT INITIAL PRESENTATION TO A CATCHMENT-BASED EARLY INTERVENTION SERVICE FOR PSYCHOSIS." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S178. http://dx.doi.org/10.1093/schbul/sbaa030.426.
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Abstract Background During a psychotic episode, patients frequently suffer from severe maladaptive beliefs known as delusions. Despite the abundant literature investigating the simple presence or absence of these beliefs, there exists little detailed knowledge regarding their actual content and severity at the onset of illness. Investigating delusions in early clinical samples is critical, because their relatively young, treatment-naïve presentations are less likely to be confounded by the effects of long-term illness or previous interventions. Furthermore, a more detailed view of the association between clinical factors and delusion severity, both globally and per theme, in a larger and more representative sample may improve psychological models and ultimately treatment options. This study reports on delusions during the initiation of indicated treatment for a first episode psychosis (FEP). Methods Data were systematically collected from a sample of 637 service users entering an early intervention service for FEP. The FEP service provides a comprehensive standardized assessment battery with longitudinal follow-up for two years of treatment. The average severity and frequency of each delusional theme at baseline was reported using the Scale for Assessment of Positive Symptoms. Delusional severity, both globally and per theme, was examined across a number of sociodemographic and clinical variables. Results Delusions of a moderate severity or higher were present in the vast majority of individuals experiencing onset of a FEP (94.0%), with persecutory (77.7%), reference (65.5%), and grandiose (40.2%) being the most common themes. Eighty-one percent of service users presented with two or more delusion themes. Persecutory delusions remained consistent in severity across diagnoses, but were more severe with older age of onset (r = .144). No meaningful differences in delusional severity were observed across sex, affective versus non-affective psychosis, or presence/absence of substance abuse or dependence. Global delusion severity was associated with anxiety (r = .205) but not with depression (r = .052), with specific relationships emerging per theme. Delusions commonly referred to as passivity experiences and/or thought alienation, mind reading delusions (r = .242) and delusions of control (r = .247), were related to hallucinatory experiences. We will also examine delusions longitudinally by investigating their relationship to the duration of untreated psychosis and outcomes, along with the stability of delusional content across episodes. Discussion Unlike the more selected samples, confounded treatment effects, and/or varying levels of chronicity seen in previous reports, this community representative sample offers a rare clinical lens into the severity and content of delusions in FEP. While delusional severity remained consistent across certain sociodemographic and clinical variables, this was not always the case. Future work may wish to investigate the evolution of delusions over time, including focusing on specific themes and/or their overlaps, including with smaller samples and in-depth, phenomenologically oriented interviews.
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Migliorelli, R., G. Petracca, A. Tesón, L. Sabe, R. Leiguarda, and S. E. Starkstein. "Neuropsychiatric and neuropsychological correlates of delusions in Alzheimer's disease." Psychological Medicine 25, no. 3 (May 1995): 505–13. http://dx.doi.org/10.1017/s0033291700033420.
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SYNOPSISWe examined the prevalence, phenomenology, and clinical correlates of delusions in a consecutive series of 103 patients with probable Alzheimer's disease (AD). Patients were examined with the Present State Exam and the Dementia–Psychosis Scale. Twenty-one patients (20%) met DSM-III-R criteria for a delusional disorder. The most frequent delusion type was paranoid (71%), followed by hypochondriacal (67%), the Capgras syndrome (29%), house misidentification (29%), and grandiose delusions (29%). Out of the 21 AD patients with delusions, 76% had three or more different types of delusions simultaneously. The frequency of delusions was not significantly associated with age, education, or age at dementia onset, and the type and severity of cognitive impairments was similar for AD patients with and without delusions. However, AD patients with delusions had significantly higher mania and anosognosia scores.
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Porta Pelayo, D., and L. López Alonso. "The delusion of aurora (a structural and dynamic analysis)." European Psychiatry 33, S1 (March 2016): S533—S534. http://dx.doi.org/10.1016/j.eurpsy.2016.01.1974.
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IntroductionThe classical authors associate the insanity with delusions, without delusions there was not insanity. This axiom has changed nowadays, and it's also accepted that insanity can exist without delusions.AimWe aim to know and describe which factors are involved in the development of the delusion. Use these conclusions to drive the patient to the comprehension and acceptance of the reality.Objective(a) Unravel the mechanism of delusion, (b) seek the causes, (c) find out an explanation about the origin and development of the delusional thematic.MethodClinical biographic review, carried on in 2 steps: (a) review the delusions store in the Hermanas Hospitalarias Spanish hospitals (17 centres), (b) choose one of them, (c) use the inductive method for analyzing the details and for making conclusions in order to be apply in the delusional process.Results(a) Understand the internal dynamic of delusion and how the delusion becomes the main axis of the patient life. (b) The patient finds on the delusion a life motive, which did not exist before.ConclusionParaphrasing Dr.Castilla del Pino, “the delusion is a necessary mistake”. From the emotional point of view, it can be said “the delusion is a cry of a captured heart”.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Talasman, Ana-Anca, and Alexandra Dolfi. "Differential diagnosis: delusional disorder- somatic type vs anorexia nervosa." Romanian Journal of Psychiatry and Psychotherapy 20, no. 2 (June 30, 2018): 83–85. http://dx.doi.org/10.37897/rjpp.2018.2.9.
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Delusional disorder is an illness characterized by at least 1 month of delusions but no other psychotic symptoms, according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). (1) Somatic delusions are among the most frequent types of delusion encountered for inpatients, alongside persecutory, referential, grandiose and jealousy type. The differential diagnosis with psychosis is the first to be done and it's suggested by the fact that delusions are persistent and non-bizarre. (2,3) Then all somatic and psychiatric conditions associated with development of delusions must be eliminated. We present the case of a 38-year-old female with delusional disorder-somatic type who was admitted with conflicting symptoms suggesting rather anorexia nervosa associated with somatic symptom disorder. But after a thorough interview and a few days of admission, the delusional symptoms came out and the diagnosis became clear.
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Freeman, Daniel, Jonathan Bradley, Angus Antley, Emilie Bourke, Natalie DeWeever, Nicole Evans, Emma Černis, et al. "Virtual reality in the treatment of persecutory delusions: Randomised controlled experimental study testing how to reduce delusional conviction." British Journal of Psychiatry 209, no. 1 (July 2016): 62–67. http://dx.doi.org/10.1192/bjp.bp.115.176438.
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BackgroundPersecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed. Use of virtual reality could facilitate new learning.AimsTo test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours (virtual reality cognitive therapy) would lead to greater delusion reduction than exposure alone (virtual reality exposure).MethodConviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. Delusion conviction and real-world distress were then reassessed.ResultsIn comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, P = 0.024, Cohen's d = 1.3) and real-world distress (reduction 19.6%, P = 0.020, Cohen's d = 0.8).ConclusionCognitive therapy using virtual reality could prove highly effective in treating delusions.
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Buchanan, Alec, Alison Reed, Simon Wessely, Philippa Garety, Pamela Taylor, Don Grubin, and Graham Dunn. "Acting on Delusions. II: The Phenomenological Correlates of Acting on Delusions." British Journal of Psychiatry 163, no. 1 (July 1993): 77–81. http://dx.doi.org/10.1192/bjp.163.1.77.
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The aim of the study was to identify the phenomenological characteristics of those delusions which are associated with action. The sample consisted of 79 patients admitted to a general psychiatric ward, each of whom described at least one delusional belief. The variables studied included the phenomenology of the delusions, and behaviour. Two behavioural ratings were used, one derived from the subjects' own description of their behaviour and the other from information provided by informants. There was no association between delusional phenomenology and acting on a delusion when the subjects' behaviour was described by informants. When action was described by the subjects themselves, acting was associated with: being aware of evidence which supported the belief and with having actively sought out such evidence; a tendency to reduce the conviction with which a belief was held when that belief was challenged; and with feeling sad, frightened or anxious as a consequence of the delusion.
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Bronstein, Michael, Gordon Pennycook, Jutta Joormann, Philip Corlett, and Tyrone Cannon. "T70. DUAL-PROCESS THEORY, CONFLICT PROCESSING, AND DELUSIONAL BELIEF." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S258. http://dx.doi.org/10.1093/schbul/sbaa029.630.
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Abstract Background Individuals endorsing delusions exhibit multiple reasoning biases, including a bias toward lower decision thresholds, a bias toward gathering less data before forming conclusions, and a bias toward discounting evidence against one’s beliefs. Although these biases have been repeatedly associated with delusions, it remains unclear how they might arise, how they might be interrelated, and whether any of them play a causal role in forming or maintaining delusions. Progress toward answering these questions may be made by examining delusion-related reasoning biases from the perspective of dual-process theories of reasoning. Dual-process theories posit that human reasoning proceeds via two systems: an intuitive system (which is autonomous, does not require working memory) and an analytic system (which relies on working memory, supports hypothetical thought). Importantly, when the outputs of one or both systems conflict with one another, successful detection of this conflict is thought to produce additional engagement in analytic reasoning. Thus, the detection of and ensuing neurocognitive response to conflict may modulate analytic reasoning engagement. Working from this dual-process perspective, recent theories have hypothesized that more limited engagement in analytic reasoning, perhaps resulting from conflict processing deficits, may engender delusion-inspiring reasoning biases in people with schizophrenia. Methods Given this hypothesis, a literature review (Bronstein et al., 2019, Clinical Psychology Review, 72, 101748) was conducted to critically evaluate whether impaired conflict processing might be a primary initiating deficit in pathways relevant to the generation of delusion-relevant reasoning biases and the formation and/or maintenance of delusions themselves. Results Research examined in this review suggested that in healthy people, successful conflict detection raises decision thresholds. Conflict-processing deficits in delusional individuals with schizophrenia might impair this process. Consistent with this possibility, delusional individuals with schizophrenia (vs. healthy controls) make more decisions when they perceive their favored choice to be only marginally better than alternatives. Lower decision thresholds in individuals who endorse delusions may limit analytic thinking (which takes time). Reductions in decision-making thresholds and in analytic reasoning engagement may encourage these individuals to jump to conclusions, potentially promoting delusion formation, and may also increase bias against disconfirmatory evidence, which may help delusions persist. Discussion Extant literature suggests that conflict processing deficits might encourage delusion-related cognitive biases, which is broadly consistent with the idea that these deficits may be causally primary in pathways leading to delusions. This conclusion lends credence to previous theories suggesting that reduced modulation toward analytic reasoning in the presence of conflict might promote delusions. Future research should attempt to more specifically determine the source of deficits related to analytic reasoning engagement in delusional individuals with schizophrenia. It is often unclear whether analytic-reasoning-related deficits observed in existing literature result from impairments in conflict detection, responsiveness to conflict, or both. Tasks used to study dual-process reasoning in the general population may be useful platforms for specifying the nature of analytic-reasoning-related deficits in delusional individuals with schizophrenia.
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Houran, James, and Rense Lange. "Redefining Delusion Based on Studies of Subjective Paranormal Ideation." Psychological Reports 94, no. 2 (April 2004): 501–13. http://dx.doi.org/10.2466/pr0.94.2.501-513.
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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.
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Sherchan, Surendra, and Devavrat Joshi. "The Man Behind the Royal Massacre." Journal of Nepal Medical Association 53, no. 200 (December 31, 2015): 291–94. http://dx.doi.org/10.31729/jnma.2749.
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Delusional disorder is a relatively uncommon psychiatric condition in which patients present with non-bizarre delusions, but with no accompanying prominent perceptual disturbances, thought disorder or significant and sustained mood symptoms. Apart from their delusions, people with delusional disorder may continue to socialize and function in a normal manner and their behavior does not generally seem odd or bizarre to others for many years of the onset of their symptoms. Because of this, they are brought to the clinician many years after the onset of their symptoms, only when their delusional behavior becomes overt. Thus, identifying and treating delusional disorders in time is a challenging task.
Keywords: delusion; grandiose; persistent delusional disorder.
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Porcher, José Eduardo. "Can dispositionalism about belief vindicate doxasticism about delusion?" Principia: an international journal of epistemology 19, no. 3 (December 31, 2015): 379. http://dx.doi.org/10.5007/1808-1711.2015v19n3p379.
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http://dx.doi.org/10.5007/1808-1711.2015v19n3p379Clinical delusions have traditionally been characterized as beliefs in psychiatry. However, philosophers have recently engaged with the empirical literature and produced a number of objections to the so-called doxastic status of delusion, stemming mainly from the mismatch between the functional role of delusions and that expected of beliefs. In response to this, an appeal to dispositionalism about the nature of belief has been proposed to vindicate the doxastic status of delusion. In this paper, I first present the objections to attributing beliefs to delusional patients and the application of dispositionalism in the attempt to vindicate doxasticism. I then assess this application and some responses to the objections to the doxastic characterization. Finally, I offer some conclusions about the limits of folk-psychological concepts in the characterization and explanation of complex psychological phenomena such as delusions.
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Pochueva, V., and V. Sheshenin. "Prodromal stage and clinical features of late-onset schizophrenia and schizophrenia-like psychosis." European Psychiatry 66, S1 (March 2023): S1003. http://dx.doi.org/10.1192/j.eurpsy.2023.2130.
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IntroductionThe early diagnostic of schizophrenia and other psychosis is very important for the early therapeutic interventions.ObjectivesThe aim is to describe the connection between the prodromal stage of psychosis and clinical features.Methods74 patients with late-onset psychosis (mean age 64,33±9, 2 male; age of onset 55,3±11,2): late-onset schizophrenia (LOS) (n=49, mean age 63,0±8,47, age of onset 53,9±9,56), late-onset schizoaffective disorder (LOSaD) (n=17, mean age 62,4±6,5, age of onset 54,6±10,6, 2 male), late onset delusion disorder (LODD) (n=8, mean age 76,6±4,3, age of onset 65,2±17,0). Psychopathological, statistical methods were applied.ResultsAllocated 4 types of prodromal stage – 1st without psychopathological signs (n=24, 33%), 2nd – with affective signs like disturbances of mood, anxiety (n=18, 24%), 3rd – with paranoid signs like acute stress-related paranoid reactions without medication; 4th - with schizoid signs with overvaluated ideas. In the 1st group next syndromes prevailed: with secondary persecutory mood-congruent delusions (n=10, 41,7%); with auditory second-person pseudohallucinations with sistematyzed persecutory delusions (n=9, 37,5%); with only systematized persecutory delusions (n=1, 4,1%); with bizzarre delusions (n=3, 12,5%) and with polymorphic symptoms, include different hallucinations, catatonia disorders and with some oneiroid state signs (n=1, 4,1%). In this group 9 patients were diagnosed with LOS (37,5%); 12 patients with LOSaD (50%) and 3 patients with LODD (12,5%). The 2nd group was presented with auditory second-person pseudohallucinations with sistematyzed persecutory delusions (n=5, 27.7%), with secondary persecutory delusions with delusion mood (n=11, 61%), with systemized persecutory delusional - 5.5% (n=1) and with catatonia (n=1, 5.5%). In this group 12 patients were diagnosed with LOS (66%), 5 patients with LOSaD (28%) and 1 patient with LODD (5.5%). In the 3rd group these syndromes prevailed: with auditory second-person pseudohallucinations with sistematyzed persecutory delusions (n=7, 63%), with secondary persecutory delusions with delusion mood - in 2 cases (18.2%), with bizarre delusions - in 2 cases (18.2%). 12 patients were diagnosed with LOS (n=10.91%) and 1 patient with LODD (1.9%). The 4th group was presented with auditory second-person pseudohallucinations with sistematyzed persecutory delusions (n=5, 23.8%), with secondary persecutory delusions with delusion mood (n=3, 14.3%), with bizarre delusions (n=6, 28.6%), with systemized persecutory delusions (n=1, 4.7%), with catatonia (n=2, 9.5%) and with polymorphic symptoms (n=4, 20%). 18 patients were diagnosed with LOS (85.7%) and 3 patients - with LODD (14.3%).ConclusionsThere are different types of prodromal stage in late-onset psychosis that concluded with clinical features.Disclosure of InterestNone Declared
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Mullen, Richard. "Delusions: The Continuum Versus Category Debate." Australian & New Zealand Journal of Psychiatry 37, no. 5 (October 2003): 505–11. http://dx.doi.org/10.1046/j.1440-1614.2003.01239.x.
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Objective: In this paper I critically review the recently developed idea that delusions are best considered as part of a continuum along with more ordinary human beliefs. Method: A literature review of the area was guided by a Medline search, and supplemented with material already known to the author. Claims that recent research supports the continuum hypothesis is critiqued. Results: The argument and evidence advanced for the continuum approach to delusions depends largely on: (i) inadequacies of prevailing definitions of delusion, particularly in the light of evidence that delusional conviction is often not absolute; and (ii) the high prevalence of unusual beliefs in community populations. To the extent that the delusion construct contains much in addition to conviction and unusual or false belief content, the continuity approach is weak. The category of delusions continues to have some validity. Conclusion: Both categorical and continuous approaches to delusions have validity that depends at any time on our immediate clinical or scientific needs. No definitive resolution of the category versus continuum debate is likely to emerge.
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Geroldi, Cristina, Lorena Bresciani, Orazio Zanetti, and Giovanni B. Frisoni. "Regional Brain Atrophy in Patients With Mild Alzheimer's Disease and Delusions." International Psychogeriatrics 14, no. 4 (December 2002): 365–78. http://dx.doi.org/10.1017/s1041610202008566.
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Background and Objective: The pathophysiology and the neurobiology of the behavioral disturbances in Alzheimer's disease (AD) are far from understood. The aim of the study was to assess whether delusional AD patients have a specific pattern of regional brain atrophy. Methods: The setting of the study was the outpatients facility of a memory clinic. Subjects were 41 AD patients with mild dementia severity (Mini-Mental State Exam score of 22 ± 3, range 18 to 27). Delusions were assessed with the pertinent subscale of the UCLA Neuropsychiatric Inventory (NPI). Nondelusional (n = 22) AD and delusional (n = 19) AD were defined on the basis of absence (NPI delusions subscale = 0) or presence (NPI delusions subscale = 1 or higher) of delusions. Thirteen (68%) of the delusional patients had isolated theft delusions, and 6 (32%) had theft associated with another paranoid delusion (of jealousy or persecution). None of the patients had misidentifications or other delusions of nonparanoid content. Temporal lobe and frontal lobe atrophy were assessed with linear measures (radial width of the temporal horn, rWTH, and frontal index, FI) taken from computed tomographic films. Temporal and frontal asymmetries were computed as right/left ratio of the rWTH and FI. Results: AD patients without delusions had symmetrical enlargement of both temporal (8.1 ± 3.9 vs. 8.5 ± 4.5) and frontal horns (35.8 ± 4.8 vs. 35.9 ± 4.6). On the contrary, AD with delusions showed temporal horns larger to the right (9.1 ± 3.3 vs. 7.7 ± 3.1, p = .06) and the frontal horn to the left (35.7 ± 4.3 vs. 37.5 ± 4.2, p = .02). This different pattern was confirmed with a gender-adjusted repeated measures analysis of variance model (interaction term between asymmetry and group: F1,38 = 5.5, p = .03). Discussion: AD patients with delusions are characterized by a specific pattern of frontal and temporal asymmetry of brain atrophy, whereas nondelusional patients are symmetric. Because the asymmetry pattern of the delusional patients is similar to the physiological pattern of asymmetry of individuals without dementia, the data indicate that the absence of theft delusions in the mild stage of AD rather than their presence is associated with an abnormal asymmetry pattern.
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Gibbs, Ayana A., and Anthony S. David. "Delusion formation and insight in the context of affective disturbance." Epidemiologia e Psichiatria Sociale 12, no. 3 (September 2003): 167–74. http://dx.doi.org/10.1017/s1121189x00002943.
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SummaryObjective – Delusions and lack of insight have traditionally been viewed as the defining characteristics of insanity and in modern psychiatry continue to be central to the diagnosis of psychosis. Little is known about the mechanisms of delusion formation and much of the research into delusions and lack of insight has been focussed on schizophrenia, in spite of the fact that these symptoms are also prominent in other disorders e.g., affective psychosis. The objective of this paper is to review the literature on existing theories of delusions and insight with reference to the effects of affective disturbance on memory processes. Method – Narrative review supplemented by literature searches using Medline, PsycINFO and EMBASE databases for the period 1980 to present using terms “delusion”, “insight” and “affect”. Results – The role of affect on memory in normal psychology and delusions in psychopathology is being increasingly recognised. We sketch out a theory which gives weight to locating the formation and maintenance of mood congruent and mood incongruent delusional beliefs (and insight into such beliefs) within a model of normal memory processes. Conclusion – We conclude that delusional beliefs may represent false or biased memories of internal or external events modified and strengthened of by affective states. We propose that insight rests on an ability to identify these memories as internally generated or biased. In view of the growing body of knowledge accumulating from the study of memory, emotion and their neuropsychological correlates we would suggest using this as an evidence base for the further neuropsychiatric investigation of delusional beliefs.Declaration of Interest: none.
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Deutsch, Caroline J., Noelle Robertson, and Janis M. Miyasaki. "Psychological Impact of Parkinson Disease Delusions on Spouse Caregivers: A Qualitative Study." Brain Sciences 11, no. 7 (June 29, 2021): 871. http://dx.doi.org/10.3390/brainsci11070871.
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There is growing research on carers of people with Parkinson’s disease (PD) experiences. However, the impact on carers by PD delusions is not specifically examined. We conducted a qualitative study using semi-structured interviews of spouse carers of PD patients with delusions. Thematic analysis was employed using MAXQDA 2018. Twelve spouse participants (SPs) were interviewed. Four themes emerged: Managing incredulity: trying to make sense of delusion content; Hypervigilance: constant alertness to bizarre and threatening discourse and behavior; Defensive strategizing: anticipating delusions and potential consequences; Concealing and exposing: ambivalence about disclosing the effect of delusions yet wanting support. SPs reported effects on their emotional well-being and marital relationship and challenges to an orderly, predictable life. SPs were reluctant to share their experiences due to delusion content (often infidelity and sexual in nature) and a desire to protect their spouses’ image. SPs’ awareness of the potential for delusional thought was low prior to their occurrence. Conclusions: education surrounding potential neurobehavioral changes should occur for patients and carers. Clinicians should be aware that the impact of delusions on carers is often greater than disclosed in clinical interviews. Interdisciplinary teams speaking separately to spousal carers may improve disclosure and delivery of appropriate psychological support.
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Kaleda, V., U. Popovich, and N. Romanenko. "Religious delusions in adolescence and young adults: Features of psychopathology and clinic." European Psychiatry 64, S1 (April 2021): S804. http://dx.doi.org/10.1192/j.eurpsy.2021.2126.
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IntroductionReligious delusions is a complex psychopathological phenomenon. The delusional disorders with religious content in young age, the need for an additional detailed study of the conditions of their formation, patterns of the course and outcome of the disease determine the relevance of this study.ObjectivesTo identify the psychopathological features, the conditions of formation, the characteristics of the course of psychosis with religious delusions in young age.Methods95 patients (62 male and 33 female) with religious delusions (delusion of sin - 33,7%, delusion of demonic possession (40,0%), messianic and antagonistic delusion - 18,9%, oneiroid with religious content – 7,4 %) in psychotic episode (F20, F25 according to the ICD-10) at a young age (16-25 years) were included in the study and examined with clinical-psychopathological, clinical-follow-up and psychometric (PSP, SANS) methods. The average duration of follow-up was 7.4 ± 2.3 years.ResultsIn a post-psychotic period it is possible to preserve or form religiosity, as well as a complete reduction of the religious worldview in patients who had been indifferent to religious issues before the first episode of the disease. Though, the formation of residual psychotic symptoms with religious content were noted with greater frequency. The delusions of demon obsession in a psychosis episode is unfavorable prognostic factor.ConclusionsGeneral psychopathological features of psychotic states with religious delusions, according to the specificity of young age, were identified. A role of the previous religiosity, including overvalued religious ideas, was clarified.DisclosureNo significant relationships.
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Khoury, Marc A., Mohamad-Ali Bahsoun, Ayad Fadhel, Shukrullah Shunbuli, Saanika Venkatesh, Abdollah Ghazvanchahi, Samir Mitha, et al. "Delusional Severity Is Associated with Abnormal Texture in FLAIR MRI." Brain Sciences 12, no. 5 (May 5, 2022): 600. http://dx.doi.org/10.3390/brainsci12050600.
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Background: This study examines the relationship between delusional severity in cognitively impaired adults with automatically computed volume and texture biomarkers from the Normal Appearing Brain Matter (NABM) in FLAIR MRI. Methods: Patients with mild cognitive impairment (MCI, n = 24) and Alzheimer’s Disease (AD, n = 18) with delusions of varying severities based on Neuropsychiatric Inventory-Questionnaire (NPI-Q) (1—mild, 2—moderate, 3—severe) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) were analyzed for this task. The NABM region, which is gray matter (GM) and white matter (WM) combined, was automatically segmented in FLAIR MRI volumes with intensity standardization and thresholding. Three imaging biomarkers were computed from this region, including NABM volume and two texture markers called “Integrity” and “Damage”. Together, these imaging biomarkers quantify structural changes in brain volume, microstructural integrity and tissue damage. Multivariable regression was used to investigate relationships between imaging biomarkers and delusional severities (1, 2 and 3). Sex, age, education, APOE4 and baseline cerebrospinal fluid (CSF) tau were included as co-variates. Results: Biomarkers were extracted from a total of 42 participants with longitudinal time points representing 164 imaging volumes. Significant associations were found for all three NABM biomarkers between delusion level 3 and level 1. Integrity was also sensitive enough to show differences between delusion level 1 and delusion level 2. A significant specified interaction was noted with severe delusions (level 3) and CSF tau for all imaging biomarkers (p < 0.01). APOE4 homozygotes were also significantly related to the biomarkers. Conclusion: Cognitively impaired older adults with more severe delusions have greater global brain disease burden in the WM and GM combined (NABM) as measured using FLAIR MRI. Relative to patients with mild delusions, tissue degeneration in the NABM was more pronounced in subjects with higher delusional symptoms, with a significant association with CSF tau. Future studies are required to establish potential tau-associated mechanisms of increased delusional severity.
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Gawęda, Ł., and K. Prochwicz. "A comparison of cognitive biases between schizophrenia patients with delusions and healthy individuals with delusion-like experiences." European Psychiatry 30, no. 8 (October 13, 2015): 943–49. http://dx.doi.org/10.1016/j.eurpsy.2015.08.003.
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AbstractBackgroundThe role of psychosis-related cognitive biases (e.g. jumping to conclusions) in a delusion continuum is well-established. Little is known about the role of types of cognitive biases. The aim of this study was to investigate the role of psychosis-related and “Beckian” (i.e. anxiety- and depression-related) cognitive biases assessed with a clinical questionnaire in the delusion continuum and its dimensions.MethodsSchizophrenia patients with (n = 57) and without (n = 35) delusions were compared to healthy subjects who had a low (n = 53) and high (n = 57) level of delusion-like experiences (DLEs) on the Cognitive Biases Questionnaire for Psychosis (CBQp). Delusion dimensions in the clinical sample were assessed with the semi-structured interview PSYRATS. DLEs were measured with the Peters Delusion Inventory (PDI).ResultsHigh DLEs participants scored significantly higher than low DLEs, and patients with delusions scored higher than patients without delusions on the total scores of the CBQp. High DLEs participants scored significantly higher than low DLEs on catastrophisation and JTC. Schizophrenia patients with delusions scored significantly higher when compared to patients without delusions on intentionalising, dichotomous thinking, JTC and emotional reasoning. Patients with delusions and high DLEs participants scored similarly on JTC. Stepwise regression analysis revealed that catastrophising predicted total severity of clinical delusions and JTC predicted the cognitive dimension of clinical delusions. Both JTC and catastrophisation predicted the frequency and conviction associated with DLEs.ConclusionsBoth “Beckian” and psychosis-related cognitive biases may underlie delusions. Different aspects of clinical delusions and delusion-like experiences may be related to different cognitive biases.
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Borisova, O., G. Kopeyko, E. Gedevani, and P. Orehova. "The end-world delusion with religious content, apocalyptic variant." European Psychiatry 64, S1 (April 2021): S770. http://dx.doi.org/10.1192/j.eurpsy.2021.2038.
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IntroductionDiagnostics of Apocalyptic variant of end-world Delusion with Religious Content (ADRC) in schizophrenia is related with insufficient exploration and recognizability, despite the severity of the state, social risks and resistance to psychopharmacotherapy.ObjectivesTo define psychopathological and phenomenological features of ADRC in schizophrenia, to identify the clinical dynamics of delusional disorders due to specifics of the delusional behavior, and to develop diagnostic and prognostic criteria.Methods28 patients with ADRC in schizophrenia were examined (ICD-10: F20.0, F20.01, F20.02). Clinical-psychopathological and statistical methods were applied.Results Delusional ideas of end-world, Apocalyptic variant, occurred in the structure of affective-delusional state (acute sensual delusion with fantastic content). Two types of ADRC were identified: with the predominance of acute sensory delusions of perception and with the predominance of visual-figurative delusions of the imagination. These types differed in the severity and depth of psychotic manifestations and in the specifics of a delusion formation, were characterized by the mono- or polythematic delusional disorders.ConclusionsCases of ADRC differ both in the clinical-psychopathological specifics of delusional constructions, and in the socio-behavioral aspect. Among these cases, there is a high risk of delusional destructive behavior, with auto-aggressive, suicidal attempts and hetero-aggressive behavior. In cases with ADRC the strong persistence of delusional pseudo-religious beliefs occurs, with the refusal of any medical and psychological assistance, as well as implication of socially dangerous acts associated with the spread of delusional ideas and their induction of religiously inclined persons, which leads to the emergence of pathological pseudoreligiosity (distortion of traditional canonical religious views).DisclosureNo significant relationships.
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Madeira, L. A., L. F. Manarte, D. Guerreiro, and C. Dias. "A case of delusional disorder, diagnostics and therapeutic questions." European Psychiatry 26, S2 (March 2011): 1709. http://dx.doi.org/10.1016/s0924-9338(11)73413-7.
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The Delusional disorder is uncommon, accounting for 2–8% of all hospital admissions for non-organic psychotic disorder and is usually initiated after the third decade of life. It is characterized primarily by one or more non-bizarre delusions, and according to the content of delusions, can be divided into five subtypes: persecution, jealousy, erotomanic, somatic and grandeur.We present a case of a patient with Jealousy Delusional Disorder and discuss the main difficulties that arise in the differential diagnosis and treatment.In the differential diagnosis is essential to eliminate the pathologies of organic causes that may have delusions as clinical manifestation. It is then necessary to distinguish delusion from obsessive ideas and overvalued ideas that can lead to misdiagnosis and therefore have serious implications in monitoring and treating of these patients.The subtype of jealousy seems to have a better evolution and prognosis compared with others subtypes reported.Although the Delusional Disorder present a more favorable course and usually is associated with a smaller disturbance in the overall functioning of the patients, they have a poor compliance to psychiatric treatment. So, they often stop psychiatry follow-up and discontinue therapy.
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Klyushnik, T. P., A. B. Smulevich, S. A. Zozulya, D. V. Romanov, and V. M. Lobanova. "Clinical and Immunological Aspects of Delusional Disorders in Paranoid Schizophrenia." Psikhiatriya 21, no. 2 (May 6, 2023): 6–16. http://dx.doi.org/10.30629/2618-6667-2023-21-2-6-16.
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Background: insufficient study of heterogeneous delusional disorders in schizophrenia and the role of inflammation in the development of the disease served as the basis for this study. The aim: to establish the role of immune mechanisms in the processes of the interaction of different forms of delusional symptom complexes in schizophrenia. Patients: 60 patients (mean age 38.4 ± 1.11 years) with the diagnosis “paranoid schizophrenia, continuous progressive course” (F20.00, ICD-10) were included in the study. The state of patients was defined by persistent delusional/hallucinatory delusional disorders. Based on the clinical assessment, patients were divided into three groups: 27 patients (group 1) with interpretative delusion, 22 patients (group 2) with delusion of influence based on the phenomena of mental automatism, and 11 examinees (group 3) with mixed forms of delusions (interpretative and delusions of influence with mental automatism). The control group consisted of 17 mentally and somatically healthy people, comparable with the patients by sex and age. Methods: inflammatory and autoimmune markers leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI) activity, leukocyte inhibitor index (LII) and antibody (aAb) level to S100B and MBP were determined in the blood. Results: in all groups of patients, an increase in the activity of LE and α1-PI was revealed compared with the control (p < 0.05). In group 2, an increase in aAb level to S100B was also detected (p < 0.05). Intra-group differences in LE activity served as the basis for dividing patients into three clusters. Cluster 1 was characterized by moderate activation of the immune system and was represented mainly by patients with interpretative delusions (54.5% of patients in the corresponding clinical group). Clusters 2 and 3 were distinguished by a higher level of immune system activation. A distinctive feature of cluster 3 was low LE activity against the background of high α1-PI activity and elevated level of aAb to S100B. Clusters 2 and 3 were represented mainly by patients with delusion of influence (74.1%). Сonclusion: the study confirmed the involvement of inflammation in the pathophysiology of delusional disorders in paranoid schizophrenia and allowed us to identify the relationship between the psychopathological structure of these disorders and the features of the spectrum of immune markers. The highest level of activation of the immune system, as well as immunological features presumably indicating impaired permeability of the blood-brain barrier, were associated mainly with delusions of influence with the phenomena of mental automatism.
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Nakatsuka, Masahiro, Kenichi Meguro, Hiroshi Tsuboi, Kei Nakamura, Kyoko Akanuma, and Satoshi Yamaguchi. "Content of delusional thoughts in Alzheimer's disease and assessment of content-specific brain dysfunctions with BEHAVE-AD-FW and SPECT." International Psychogeriatrics 25, no. 6 (February 22, 2013): 939–48. http://dx.doi.org/10.1017/s1041610213000094.
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ABSTRACTBackground: A consensus on the brain dysfunction(s) underlying the delusions of Alzheimer's Dementia (AD) remains to be achieved. The aim of the present study was to test the hypothesis that content-based categorization of delusional ideas manifests as dysfunction of category-specific brain regions.Methods: Fifty-nine consecutive first-visit AD outpatients underwent Single Photon Emission Computed Tomography (SPECT), Mini-Mental State Examination, and Behavioral Pathology in Alzheimer's Disease Frequency-Weighted Severity scale (BEHAVE-AD-FW) to assess cerebral blood flow (CBF), cognitive function, and delusion, respectively. SPECT images were analyzed by SPM5.Results: CBF decreased at the temporal poles and right inferior temporal gyrus in “delusion of theft,” at the temporal poles in “suspiciousness/paranoia,” at the right parahippocampal gyrus and insula in “abandonment,” and at the right amygdala in “Residence is not home.”Conclusions: Our findings offer a perspective on the discrete categories of the pathological thoughts of AD patients that have previously been lumped together as “delusions.” Dysfunction of the temporal poles may be associated with a socioemotional deterioration that may include pathological suspiciousness. Delusion of theft may be a manifestation of socioemotional deterioration and poor insight. Emotional factors may be essential for delusions of abandonment and “not home.”
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Nemeh, Michael, John Koo, and Mio Nakamura. "When Should Dermatologists Refer Delusions of Parasitosis Patients to Psychiatry: An Expert Recommendation." SKIN The Journal of Cutaneous Medicine 8, no. 1 (January 16, 2024): 1337–39. http://dx.doi.org/10.25251/skin.8.1.23.
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Many patients with delusions of parasitosis (DoP) prefer to be managed by dermatologists rather than mental health professionals (MHPs). While some patients with DoP can be managed by dermatologists, others must be referred to MHPs. The purpose of this article is to assist dermatologists in determining when to refer their DoP patients to a MHP. We propose 3 criteria for making this determination: whether the delusion is primary or secondary, whether the delusion is encapsulated and realistic or global and bizarre, and the patient’s degree of delusional intensity. Patients with secondary DoP, delusion that is global and bizarre, and DoP with a high degree of delusional intensity should be referred to a MHP.
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Brar, Pavan, Melissa Kalarchian, and Donna Beck. "S191. A SCOPING REVIEW AND PHENOMENOLOGICAL EVALUATION OF METACOGNITIVE TRAINING FOR SCHIZOPHRENIA." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S111. http://dx.doi.org/10.1093/schbul/sbaa031.257.
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Abstract Background The self-disorder (SD) approach to schizophrenia posits that although schizophrenia involves a core disruption, this alteration nonetheless leaves room for variable experiential pathways toward delusion formation, which are held to account for variation in thematic content. This view of delusions, then, complicates the picture provided by the theory and research that supports MCT, raising the question of how these separate bodies of empirical evidence might be weighed against each other and reconciled. A major point of difference between these two perspectives is on the issue of “normalizing”. Given that the self-disorder approach posits anomalous alterations in self and world experience, the way the patient with schizophrenic delusions is taken as believing is radically different than the individual whose experience cannot be characterized by such anomalous experience. Thus, although the biases posited by MCT may indeed reflect some general and common errors of cognition and reasoning, there is reason to be cautious about interpreting the observation of such biases in the context of schizophrenia as implying that they play the same role as in the development of erroneous beliefs in non-schizophrenic populations. Moreover, while it is of course possible that a specific metacognitive skill taught during a MCT module may nonetheless prove useful for managing delusional ideation, the variable experiential pathways from which different types of delusions emerge may render a given type of delusion as more or less amenable to treatment by means of a specific MCT module and its corresponding metacognitive skill. However, unless MCT studies have thus far considered the relative impact of individual modules on specific types of delusions, the question of which metacognitive skills can be shown as effective for a specific type of delusion remains unknown. Methods A scoping review was conducted in order to discern if published MCT studies have examined the impact of individual MCT modules on types of delusions as they occur in the context of schizophrenia spectrum disorders. Results It was found that 2% of the 38 MCT studies reviewed provided explicit information about the types of delusions treated, with 5% of such studies reporting on module-specific effects, one study of which specified effects on paranoid delusions. Discussion This scoping review is novel in its demonstration that, overall, published MCT studies have not taken into consideration the heterogeneity of delusions, nor have they extensively evaluated whether or not there are differential, module specific, outcomes for different types of delusions. From a phenomenological perspective, this risks ignoring how differences in the thematic content of delusions emerge from differing experiential precursors. How each cognitive and affective mechanism targeted by MCT modules may differently contribute to the maintenance or treatment of different types of delusions will be critically evaluated in consideration of the phenomenology of delusions, and suggestions for further research and practice, which aim toward the goal of individualized medicine, will also be considered.
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Suehiro, Takashi, Yuto Satake, Mamoru Hashimoto, Hisahiro Yu, and Manabu Ikeda. "551 - Case Report: De Archambault’s syndrome in the early stage of dementia with Lewy bodies." International Psychogeriatrics 33, S1 (October 2021): 92–93. http://dx.doi.org/10.1017/s1041610221002465.
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Background:Dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia after Alzheimer’s disease. In some patients with DLB, relatively rare delusions are known to emerge, such as Othello syndrome, delusional parasitosis and delusion of duplication. Erotomania, also known as de Clerambault’s syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to patients with DLB.Case presentation:The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. Although small doses of quetiapine, brexpiprazole and risperidone were prescribed for the treatment of the delusion, each of them was discontinued soon because of the adverse reactions. Finally, the delusion was successfully treated with a small dose of blonanserin without sever side effects.Discussions and Conclusions:This case report suggests the possibility of de Clerambault’s syndrome during the early stages of DLB. Recently, psychiatric-onset DLB has increasingly gained attention in recent years. Further accumulation of knowledge about delusions in patients with DLB for an early diagnosis.
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McGuire, Lynanne, John Junginger, Serrhel G. Adams, Richard Burright, and Peter Donovick. "Delusions and delusional reasoning." Journal of Abnormal Psychology 110, no. 2 (2001): 259–66. http://dx.doi.org/10.1037/0021-843x.110.2.259.
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Wessely, S., A. Buchanan, A. Reed, J. Cutting, B. Everitt, P. Garety, and P. J. Taylor. "Acting on Delusions. I: Prevalence." British Journal of Psychiatry 163, no. 1 (July 1993): 69–76. http://dx.doi.org/10.1192/bjp.163.1.69.
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Associations between delusions and abnormal behaviour were retrospectively assessed in a sample of 83 consecutively admitted deluded subjects. All were interviewed about events in the previous month using a new measure of delusional phenomenology and action. For 59 subjects this information was supplemented by informant interviews. Clinical consensus was reached concerning the probability that actions reported by informants were linked to delusions. Half of the sample reported that they had acted at least once in accordance with their delusions. Violent behaviour in response to delusions was uncommon. Information provided by informants suggested that some aspect of the actions of half of the sample was either probably or definitely congruent with the content of their delusions. However, there was no link between self-reports and informants' reports of such action. A latent class analysis of self-reported delusional action suggested three classes of action, namely aggressive to self or other, defensive action, and either none or single action. Self-reported action was associated with delusions of catastrophe. Informant data suggested that persecutory delusions were the most likely to be acted upon, but in contrast delusions of guilt or catastrophe appeared to decrease the chance of delusional behaviour. Actions associated with abnormal beliefs are more common than has been suggested.
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Cummings, Jeffrey L. "Organic Delusions: Phenomenology, Anatomical Correlations, and Review." British Journal of Psychiatry 146, no. 2 (February 1985): 184–97. http://dx.doi.org/10.1192/bjp.146.2.184.
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SummaryOrganic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxicmetabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.
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Butler, Peter V. "Diurnal Variation in Cotard's Syndrome (Copresent with Capgras Delusion) Following Traumatic Brain Injury." Australian & New Zealand Journal of Psychiatry 34, no. 4 (August 2000): 684–87. http://dx.doi.org/10.1080/j.1440-1614.2000.00758.x.
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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.
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Smurzyńska, Adrianna. "The Role of Emotions in Delusion Formation." Studies in Logic, Grammar and Rhetoric 48, no. 1 (December 1, 2016): 253–63. http://dx.doi.org/10.1515/slgr-2016-0066.
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Abstract The text concerns the role of emotions in delusion formation. Provided are definitions from DSM-V and DSM-IV-R and the problems found in those definitions. One of them, the problem of delusion formation, is described when providing cognitive theories of delusions. The core of the paper is a presentation of the emotional and affective disorders in delusions, especially Capgras delusion and Cotard delusion. The author provides a comparison of the kinds of delusions and the conclusions taken from neuroimaging studies. As a result of the fact that an explanation of delusion formation focusing on emotional problems turns out to be insufficient, the author provides examples of the reasoning impairments which coexist with them. At the end of the article, some hypotheses are proposed concerning the role of emotions and reasoning in delusion formation and the relation between belief disorders and emotional disorders.
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Ongchuan, Samantha, and Sahil Munjal. "New Onset Capgras and Cotard Delusions in Schizoaffective Disorder." CNS Spectrums 28, no. 2 (April 2023): 259. http://dx.doi.org/10.1017/s1092852923002067.
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AbstractBackgroundCotard is a syndrome characterized by ideas of damnation or rejection, anxious melancholia, and nihilistic delusions concerning one’s own body or existence. Capgras is a syndrome in which the patient believes that the identities of close relatives or friends are replaced by others. Capgras and Cotard delusion are rarely reported in one individual simultaneously, which we will describe in this poster.Case ReportDD is a 38-year-old female with history of schizoaffective disorder, bipolar type, PTSD, and reported TBI who presented to the ED exhibiting paranoia and delusions in the setting of medication non-adherence and increased psychosocial stressors. She endorsed her organs were rotting, and that she was stolen by imposters who claim to be her family from birth. Chart review revealed previous hospitalizations involving mania and paranoid delusions; however, these Cotard and Capgras delusions were new. She also had reported TBI injury from domestic abuse, as well as emotional and sexual trauma. Her Cotard delusions resolved with risperidone 6 mg daily and valproic acid 500 mg BID. However, her Capgras delusions were maintained after 22 days of inpatient hospitalization. On discharge, she continued to refuse reconnecting with her family and was subsequently set up with an intensive outpatient program.DiscussionCotard and Capgras delusions are considered to reflect different interpretations of similar anomalous experiences. The persecutory delusions and suspiciousness often noted in Capgras contribute to the patient’s mistaking a change in themselves for a change in others, whereas people who are depressed in Cotard exaggerate the negative effects of the same change whilst attributing it to themselves. Although these two delusions are phenomenally distinct, they may therefore represent attempts to make sense of fundamentally similar experiences. The anatomical origin of these disorders have been reported to be from a disconnection between the temporal cortex and the limbic system as described in a patient with ischemic stroke. DD’s PTSD and TBI with possible damage to her left tempoparietal lobe may have predisposed her to comorbid delusions. Although DD’s Cotard delusions abated with antipsychotic treatment, her Capgras delusions were maintained. Recently losing custody of children may have contributed to the depression that precipitated her Cotard subtype 1 delusion. Her response to risperidone is consistent with a previous case report that highlighted the effectiveness of antipsychotics in the absence of ECT with Cotard delusion. In regards to her ongoing Capgras delusion, the chronic abuse by DD’s family may have led to a more persistent psychodynamically meaningful negation of DD’s sense of relationship to her family.ConclusionCapgras and Cotard syndromes, though rare, can present together. Additional studies are needed to understand the pathophysiology and treatment outcomes.FundingNo Funding
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Soyka, M., G. Naber, and A. Völcker. "Prevalence of Delusional Jealousy in Different Psychiatric Disorders." British Journal of Psychiatry 158, no. 4 (April 1991): 549–53. http://dx.doi.org/10.1192/bjp.158.4.549.
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The prevalence of delusional jealousy in 8134 psychiatric in-patients was 1.1%. Delusions of jealousy were most frequent in organic psychoses (7.0%), paranoid disorders (6.7%), alcohol psychosis (5.6%) and schizophrenia (2.5%), while in affective disorder delusions of jealousy could be found in only 0.1%. Because schizophrenia and affective disorder were the most common diagnoses, most patients with delusions of jealousy were schizophrenics. In schizophrenia, women were more likely to suffer from delusional jealousy, while in alcohol psychosis, men were more likely than women to suffer from delusional jealousy.
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Okuneye, Victoria, Brett Clementz, Elliot Gershon, Matcheri Keshavan, Jennifer E. McDowell, Godfrey Pearlson, Carol Tamminga, John Sweeney, and Sarah Keedy. "O2.6. DELUSIONS ASSOCIATED WITH ABNORMAL FRONTOSTRIATAL EFFECTIVE CONNECTIVITY IN A SPECTRAL DCM ANALYSIS OF RESTING STATE FMRI." Schizophrenia Bulletin 46, Supplement_1 (April 2020): S5. http://dx.doi.org/10.1093/schbul/sbaa028.011.
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Abstract Background Delusions, false beliefs held in the face of disconfirming evidence, are a prevalent and highly distressing feature of psychotic disorders. The neurobiology of delusions remains unknown but recent evidence suggests a role for abnormal prediction error neural signaling. Prediction error is neurocognitive process in which the brain signals the need to update beliefs when presented with information that disconfirms expectations. Task based neuroimaging studies have identified delusional beliefs correlate with altered activation in frontal and subcortical brain regions during prediction error, though such work is limited in scope. In a large sample of transdiagnostic psychotic patients we modeled the resting state effective connectivity of the delusion-associated predication error (D-PE) circuit. Methods Resting state fMRI was obtained from 289 psychotic subjects (schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features) and 219 healthy controls, recruited as part of the multisite Bipolar & Schizophrenia Network on Intermediate Phenotypes (BSNIP1) study. Neuroimaging data were processed using CONN software with strict quality control criteria. Five D-PE regions of interest (ROIs) were created based on peak coordinates from published task-based prediction error fMRI studies: right Dorsolateral Prefrontal Cortex [r DLPFC], r Ventrolateral Prefrontal Cortex [r VLPFC], r Caudate, l Caudate and l Midbrain. In each subject the first eigenvariate was extracted from the rs-fMRI timeseries of each D-PE ROI. Spectral Dynamic Causal Modeling (spDCM) was performed on a fully connected model of the 5 ROIs. Parameters for the full model were fit using Parameter Empirical Bayes (PEB) and then passed to the group level where they were reduced using Bayesian Model Averaging (BMA). The association of effective connectivity with current delusional severity was tested using PEB-BMA controlling for antipsychotic medication, sex, age and scanner site. Significant effective connectivity was identified as parameters with free energy evidence greater than 95% probability. Additionally, we assessed the effective connectivity differences of this circuit between psychotic probands and healthy controls. Results Greater delusional severity was significantly associated with inhibition of the r Caudate by the r VLPFC, excitation of the r DLPFC by the l Caudate, and decreased self-inhibition of the r VLPFC and r DLPFC. Effective connectivity of the D-PE network in psychotic probands compared to healthy controls was associated with inhibition of the r Caudate by the r VLPFC, the r DLPFC by the l Midbrain, the l Midbrain by the r Caudate, and decreased self-inhibition of the r Caudate, r VLPFC, and r DLPFC. Discussion We found that resting state effective connectivity of the prediction error circuit is disrupted in psychotic subjects experiencing delusions. Specifically, delusion severity was associated with both increased bottom-up and decreased top-down frontostriatal connectivity along with greater disinhibition of the r VLPFC and r DLPFC. These effective connectivity results provide novel insight into the causal paths which may underlie delusion neural circuitry. This provides further evidence that dysconnectivity of prediction error system is a biomarker of delusions in psychosis. Furthermore, these transdiagnostic results implicate frontostriatal dysconnectivity as common neuropathology in delusions.
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Bowins, B., and G. Shugar. "Delusions and Self-Esteem." Canadian Journal of Psychiatry 43, no. 2 (March 1998): 154–58. http://dx.doi.org/10.1177/070674379804300204.
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Objective: To investigate the hypothesis that the content of delusions and hallucinations is significantly influenced by subjects ' global self-esteem and by 5 specific areas of self-esteem. Method: The delusions and hallucinations of 40 psychotic patients were assessed by 2 independent raters for content indicative of positive or negative self-esteem and for the extent to which the delusional content would be self-enhancing (or diminishing) and comforting (or discomforting) to the subject. These ratings were correlated with the results of self-esteem inventories completed by the subjects. Results: The content of delusions reflects both global self-esteem and self-regard. Conclusions: This study demonstrates that 2 specific personality factors, global self-esteem and self-regard, are reflected in the content of delusions and influence whether those delusions are experienced as comfortable (or uncomfortable) and enhancing (or diminishing). Delusional content is therefore consistent with patients ' views of themselves, and this may partially account for the persistence of delusions.
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Howard, Robert, David Castle, Simon Wessely, and Robin Murray. "A Comparative Study of 470 Cases of Early-Onset and Late-Onset Schizophrenia." British Journal of Psychiatry 163, no. 3 (September 1993): 352–57. http://dx.doi.org/10.1192/bjp.163.3.352.
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The presence or absence of 22 schizophrenic symptoms was recorded with the age at onset of illness in 470 patients with non-affective, non-organic psychoses. Positive and negative formal thought disorder, affective symptoms, inappropriate affect, delusions of grandiosity or passivity, primary delusions other than delusional perception, and thought insertion and withdrawal were all more common in early-onset cases (age at onset 44 years or less;n= 336). Persecutory delusions with and without hallucinations, organised delusions, and third-person, running commentary and accusatory or abusive auditory hallucinations were all more common in late-onset cases (age at onset 45 years or more;n= 134). There was no difference between cases of early and late onset in the prevalence of delusions of reference, bizarre delusions, delusional perception, or lack of insight. We conclude that although there are clinical similarities between cases of schizophrenia with early and late onset, there are sufficient differences between them to suggest that they are not phenotypically homogeneous.
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Chaudhry, Ahmed A., and Jack W. Hirsch. "Thanatotic Infestation: Ekbom’s Syndrome as an Exordium to Cotard’s Delusion." CNS Spectrums 28, no. 2 (April 2023): 214. http://dx.doi.org/10.1017/s1092852923001256.
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AbstractIntroductionEkbom’s delusion as a prelude to Cotard’s syndrome, has not heretofore been described.MethodsCase study: A 45-year-old woman with a past diagnosis of bipolar disorder with psychotic features was admitted, having been up all night conversing with spirits, proclaiming that she had made a deal with Satan. Convinced that her grandmother was possessed by the devil, she smashed her grandmother’s head with a two-by-four. Results: Mental Status Examination: self conversing with her eyes darting around the room. Poor hygiene. Behavior: guarded and withdrawn. Oriented x2. Speech: hyperverbal. Insight and judgment: poor. Mood: hostile, aggressive, and angry. Thought process disorganized, incongruent, and tangentiality. She was convinced she was infested with little black bugs crawling around her insides which had been placed there by the devil. After two days of olanzapine she reported the bugs were no longer present, but rather that she herself was dead and that her organs were decomposing, which persisted through the remainder of the hospitalization.DiscussionNeuroimaging abnormalities in Ekbom’s syndrome involve the striatum, basal ganglia (putamen and caudate nucleus), insular and cingulate cortices, cortex (prefrontal, right parietal, and temporal lobes), right lingual and orbitofrontal gyri, and thalamus. In Cotard’s syndrome, abnormalities have been identified in the striatum, frontal and temporal lobes, and right-sided and bilateral hemispheres. An overlap between the delusions exists in the striatum, inferior parietal, and temporal lobes. A single lesion in the nondominant inferior parietal lobe may cause both syndromes, due to its substantial interconnection with the temporo-limbic areas. Since the parietal lobe is also involved in somatosensory processing, peradventure distorted sensory perception with associated sensation of formication may have been the nidus for the delusional infestation as well as a nidus for the perception of thanatos habitus. Such misperception may have then been amplified into a delusion because of a hyperconnection between the parietal lobe and the limbic system. This may represent a variant of the two-factor hypothesis of delusions whereby a distorted sensory perception is then misrepresented in a delusion. Dysfunction of the right hemisphere, which normally acts to censor the left, allows the delusion to manifest. A single lesion of the inferior parietal lobule may be sufficient for both sensory distortions and loss of inhibition of delusional interpretation of distorted sensation by the frontal lobe, yclept the sensorialist hypothesis.ConclusionIn those with monothematic delusions, the search for transient fluctuation in delusional states may be revealing.FundingNo Funding
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Freeman, Daniel, and Philippa A. Garety. "WORRY, WORRY PROCESSES AND DIMENSIONS OF DELUSIONS: AN EXPLORATORY INVESTIGATION OF A ROLE FOR ANXIETY PROCESSES IN THE MAINTENANCE OF DELUSIONAL DISTRESS." Behavioural and Cognitive Psychotherapy 27, no. 1 (January 1999): 47–62. http://dx.doi.org/10.1017/s135246589927107x.
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The efficacy of CBT for psychosis will be enhanced by a greater understanding of the mechanisms underlying symptoms. Therefore, an investigation is reported that examined a role for a neglected factor, anxiety, in the maintenance of delusional beliefs. It was hypothesized that processes responsible for chronic worry, as detailed by Wells’ (1994a) meta-cognitive model, contribute to delusional distress. Questionnaire measures of anxiety, chronic worry and of meta-worry and related processes were administered to individuals with persecutory delusions (N=15) and individuals with generalized anxiety disorder (GAD) (N=14). Evidence was found for the presence of dysfunctional meta-cognitive processes in the clinically anxious group, which adds to the growing support for the model of GAD. Moreover, it was found that many of the individuals with persecutory delusions had high levels of general worry, and the factors implicated in the meta-cognitive model of anxiety were also present in this group. The results indicated that delusional distress is not simply related to content but is associated with whether the individual experiences meta-worry concerning the control of delusion-relevant worries, that is, whether he or she worries about not being able to control thoughts about the belief. This is the first theoretical development of the important dimension of delusional distress.
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Yumatova, P. E. "The Historical Aspect of Depressive Delusions Phenomenon Studies." Psikhiatriya 18, no. 3 (September 20, 2020): 65–75. http://dx.doi.org/10.30629/2618-6667-2020-18-3-65-75.
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The aim: to provide an overview of domestic and international studies examining various aspects of issue of depressive delusional ideas in endogenous delusional depression disease patternMaterials and method: in order to compile a literature review for the keywords depressive delusions and delusional depressions, data from scientific articles posted in MedLine and PubMed databases as well as other bibliographic sources have been searched and analyzed during the formation of scientific psychiatry to the present.Discussion: based on the analysis of scientific publications, this paper presents data on the psychopathological description of depressive delusions and its relatedness to the depressive affect. The researchers’ viewpoints on primary and secondary characteristics of depressive delusions are being analyzed. We have identified pathogenetic characteristics of the latter that affect the prognostic assessment, such as features of the depressive triad in endogenous depression, severity and type of depressive affect, risk of suicidal behavior, characteristics of premorbid personality traits, genetic background, as well as therapeutic efficacy of treatment methods for depressive delusions in patients with delusional depression. This research reveals the controversial nature of some provisions of scientific publications that gradually divert from clinical diagnostic approaches, which tend to be replaced by psychological and psychoanalytic ones when carrying out prognostic assessment in cases of depressive delirium, which is characteristic of current psychiatric science.Conclusions: scientific publications data analysis testifies to the priority of the clinical and psychopathological method in studying the issues of depressive delusions structure in delusional depression disease pattern as well as in clinical differentiation of depressive delusions, justifies its clinical and prognostic value and enables to choose the treatment effectively.
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Tasenko, Mykhailo. "DELUSION: POSSIBILITIES FOR ANALYSIS." Bulletin of Taras Shevchenko National University of Kyiv. Philosophy, no. 8 (2023): 44–48. http://dx.doi.org/10.17721/2523-4064.2023/8-8/8.
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The article presents the main concepts for defining and describing delusions and delusional ideas used in modern clinical psychiatry and philosophy of psychiatry. Their analysis and comparison are carried out, the main differences in the psychiatric and philosophical understanding of delusions are indicated. It is demonstrated that modern clinical psychiatry considers delusional ideas inaccessible to understanding, and therefore considers them purely as a symptom of mental disorder. The author proposes to reconsider this approach and focus on interpreting delusions, giving them meaning, and finding methods for their analysis. The author identifies the difficulties that arise in the process of interpreting delusions by a person who does not suffer from a mental disorder. The fundamental difference in building a picture of the world in mentally healthy people and people suffering from mental disorders is emphasised. The hypotheses put forward in the philosophy of psychiatry on how to understand delusional judgements are demonstrated. One of the hypotheses, the "doxastic" position, considers delusional judgements to be a special case of false statements and suggests that they should be analysed in the same way as any other false judgement. Another hypothesis, the reaction to pathological experience, suggests that delusional judgements are a reaction to a unique pathological experience. Delusional ideas arise in an attempt to explain these experiences, and this approach allows for a greater understanding of the mechanisms underlying delusional judgements. A rationalist approach to the interpretation of delusions is also presented, which assumes that pathological changes occur at a higher level than direct perceptions. This approach is based on the analysis of the delusional statements themselves, trying to find out what the changes in the patient's attitudes may be. According to the rationalist approach, the altered ideas of a mentally ill person are a consequence of their attitudes towards themselves and the world, and this is what sets the stage for the possible emergence of delusions. According to the rationalist approach, delusional ideas are not evaluated for their truth or falsity, as they are outside of any possible experience. Therefore, the rationalist approach allows us to understand what the patient's beliefs are that caused his or her delusions. It is determined that the described approaches change the perception of delusions as a sign or symptom of mental illness and do not ignore its own content in explaining mental disorder. The philosophy of psychiatry understands the space in which delusional discourse is constructed as a sphere that can be described and should be studied.
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Enache, Andreea. "Persistent delusional disorder versus OCD – how can we differentiate between delusions and obsessions without insight. A literature review." Romanian Journal of Psychiatry and Psychotherapy 22, no. 2 (June 30, 2020): 67–70. http://dx.doi.org/10.37897/rjpp.2020.2.5.
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Both obsessive-compulsive disorders and psychotic disorders are very common among inpatients and outpatients. Though at first these 2 seem to not have much in common there is an aspect that requires more attention from the clinician: differentiating between delusions and obsessions without insight. This could be facilitated by a careful comparative examination of the phenomenological features of typical obsessions (with or without compulsions) and delusions (with or without repetitive delusional behaviors). In this article we examined key clinical features of obsessions and delusions in order to help differentiate between them and several of these features, if properly and empathically investigated, can help discriminate obsessions and compulsive rituals from delusions and delusional repetitive behaviors. We also touch on the topic of beliefs as they are associated with most obsessions and compulsions in obsessive–compulsive disorder and as their characteristics can vary considerably, some of them have been regarded as delusions.
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Reichenberg, JS, M. Magid, and LA Drage. "Delusions of parasitosis: a fixed delusion." Journal of the European Academy of Dermatology and Venereology 22, no. 8 (August 2008): 1026–27. http://dx.doi.org/10.1111/j.1468-3083.2008.02837.x.
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Menon, M., J. Addington, and G. Remington. "Examining Cognitive Biases in Patients With Delusions of Reference." European Psychiatry 28, no. 2 (June 11, 2011): 71–73. http://dx.doi.org/10.1016/j.eurpsy.2011.03.005.
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AbstractCognitive biases may not be seen in all subtypes of delusions, and might be more involved in the etiology of some delusional subtypes than others. A sample of patients with delusions of reference did not show the jumping to conclusions (JTC) bias. JTC appears to be more closely related to paranoia than referential delusions.
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SIMPSON, JANE, and D. JOHN DONE. "Elasticity and confabulation in schizophrenic delusions." Psychological Medicine 32, no. 3 (April 2002): 451–58. http://dx.doi.org/10.1017/s003329170200538x.
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Background. This experiment examines two aspects of delusional cognition that have been reported clinically but not investigated empirically. These are the incorporation of potentially conflicting information into the recall of delusion-related scripts and the type and amount of material produced additional to that presented for recall, referred to here as confabulation.Methods. Three groups of patients – deluded schizophrenics, non-deluded schizophrenics and matched non-psychiatric controls – were asked to recall two 15-item scripts, which comprised 10 typical and five atypical components. It was hypothesized that deluded subjects whose delusion was relevant to one of the scripts would recall more of the atypical components of the script and would also be less likely to make script-atypical confabulations in the recall of this particular script.Results. Recall was assessed for the amount and type of content remembered and the amount and type of confabulation. The results did not support the hypothesis that atypical items would be incorporated into the recall of delusion-relevant material. However, deluded subjects did retain their schema boundaries in the recall of script items relevant to their own delusion but were less able to adhere to a script framework in the recall of material unrelated to their delusion.Conclusions. These results are discussed within a schema specific account of delusions, which conceptualizes the delusion as an overused schema whose preferential use leads to a failure to develop other scripts but whose own contents remain well-defined.
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Kennedy, H. G., L. I. Kemp, and D. E. Dyer. "Fear and Anger in Delusional (Paranoid) Disorder: The Association with Violence." British Journal of Psychiatry 160, no. 4 (April 1992): 488–92. http://dx.doi.org/10.1192/bjp.160.4.488.
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We report a series of 15 patients with delusional (paranoid) disorder as defined in DSM–III–R. All were supervised by a forensic psychiatry service after violent or threatening acts. We hypothesised that delusions and actions in these patients would be congruent with an abnormal mood characterised by fear and anger. Informants and the patients indicated a pervasive and persistent abnormality of mood (fear and defensive anger), with delusions and actions that were congruent with this mood during the offence and for over a month before. Other behaviours, such as fleeing or barricading to avoid delusional persecutors, were also consistent with congruence of mood and delusions. In all cases, violent acts and mood were congruent, but in three cases the violent act was unrelated to delusions. Although a study such as this does not demonstrate that the mood abnormality is primary, we believe moods of fear and anger in delusional disorder are not sufficiently recognised as part of the disorder.
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MacDonald, Angus W. "A sneaking suspicion: The semantics of emotional beliefs and delusions." Behavioral and Brain Sciences 31, no. 6 (December 2008): 719–20. http://dx.doi.org/10.1017/s0140525x08005955.
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AbstractThis commentary challenges Rogers & McClelland (R&M) to use their model to account for delusional belief formation and maintenance. The gradual development of delusions and the nature of disconnectivity in Capgras delusions are used to illustrate the role of emotional salience in delusions. It is not clear how this kind of emotional saliency can be represented within the current architecture.