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PubMed2006

Attributional style, defensive functioning and persecutory delusions: symptom-specific or general coping strategy?

OBJECTIVE: Previous research has suggested that individuals with persecutory delusions use an exaggerated self-serving bias to protect themselves from real or delusional threats to their underlying self-concept. However, the research to date has been inconsistent thereby limiting the conclusion that can be inferred. A possible explanation for these discrepant findings may be due to the use of measures with questionable validity and reliability such as the Attributional Style Questionnaire and the Rosenberg Self-Esteem Inventory. The present study aims to re-examine this theory using an improved methodology to determine whether defensive functioning is a defining feature of persecutory delusions. DESIGN AND METHODS: Thirty-five participants suffering from recent onset psychosis were assessed in a cross-sectional design. Three tests of attributional style were used, two overt measures (Attributional Style Questionnaire, ASQ; and the Internal Personal and Situational Attributions Questionnaire, IPSAQ) and one covert measure (Pragmatic Inference Test). Self-esteem was measured using the Rosenberg Self-Esteem Inventory (SEI) and a semi-structured interview (Self-Evaluation and Social Support interview - schizophrenia version). RESULTS: A self-serving bias (SSB) was found in the total sample using the ASQ but not specifically in participants with persecutory delusions. In addition, the SSB was unrelated to levels of paranoia on any measure of attributional style. An underlying depressive attributional style was found in both subjects with and without persecutory delusions, but was not associated with levels of paranoia. Lower positive and higher negative self-esteem was associated with increased paranoia and was associated with a SSB. CONCLUSION: The results indicate that the attributional biases observed in individuals with persecutory delusions are not symptom-specific as previously suggested. The presence of an attributional, SSB was associated with lower psychotic experiences. The theoretical implications of the results will be discussed.

Adaptation, Psychological↗
PubMed2006

Content and affect in persecutory delusions.

OBJECTIVES: The study aimed to explore the content of persecutory delusions and its potential links with levels of affective disturbance. Detailed examinations of the phenomenology of delusional beliefs have been rare, but are important for furthering theoretical and clinical understanding. DESIGN: A cross-sectional investigation of 70 individuals with current persecutory delusions was conducted. METHODS: Taped semi-structured clinical interviews were transcribed for each participant. Using a coding frame devised for the current study, a detailed description of persecutory content was made. Scores on the Beck Depression and Anxiety Inventories, the Rosenberg Self-esteem Scale and the Psychotic Symptom Rating Scales were used as indicators of emotional distress. RESULTS: Data were gathered on the identity and type of persecutor, pervasiveness of threat and the power of the persecutor. Reliability was good. Beliefs involving multiple persecutors, human in nature and identifiable to the individual were common. For the majority threat was severe, ongoing and enduring and coupled with frequent feelings of vulnerability. Specific aspects of delusional content were found to be associated with emotional distress. For example, if participants felt more power in the face of persecution this was coupled with lower depression and higher self-esteem. CONCLUSIONS: Persecutory delusions are beliefs concerning severe threat, particularly of physical harm including death, which is personally significant, frequently involving multiple persecutors known to the individual. Depression is higher in those who felt less powerful than their persecutors. Associations, such as this, with emotional distress support a direct role for emotion in delusion formation and maintenance. It is consistent with cognitive models of delusions which emphasize the importance of considering emotional distress in the context of belief appraisal, although interpretation of the results is limited by the cross-sectional study design. Recognizing these links may in turn aid therapists in identifying aspects of beliefs that might be targeted to facilitate emotional change.

Adolescent↗
PubMed2001

Schizophrenic delusions in Seoul, Shanghai and Taipei: a transcultural study.

In this transcultural study of schizophrenic delusions among patients in Seoul, Shanghai and Taipei, we discovered that both the frequency and content of delusions differed among the three groups; and that these differences could perhaps be explained by varying sociocultural and political situations. Delusional themes that are sensitive to sociocultural or political situations include guilt, love/sex, religion, somatic damage, economy/business and politics. Delusions regarding longevity, love/sex, dysmorphophobia/dysosmophobia, religion or supernatural matters, and espionage/spy stories were most frequent in Seoul patients. Those in Taipei predominantly had delusions about possession, religion or supernatural matters, hypnotism, and mass media/computers. Shanghai patients often had delusions of poisons, being prickled by poisoned needles, their brain and viscera extracted and being a family member of political authorities.

Adult↗
PubMed2005

[Clinical aspects of witchcraft delusions].

To distinguish clinical variants and to specify nosologic entity of witchcraft delusions, 69 patients (10 males, aged 15-72 years) have been examined. It was found that witchcraft delusions exist in passive and active forms. In a passive form, the patient is sure that unknown (mystic) power damaged him/her; in an active form the patient, possessing a gift for unusual abilities, can influence the others (bewitches, heals, etc). Five clinical syndromes, in the structure of which the above delusions were found, namely, paranoiac-hypochondriac, hallucination-paranoid, depressive-paranoid, paraphrenic and delirious, were identified. Psychoses of schizophrenia spectrum were diagnosed in 52 patients, organic--in 8, alcoholic--in 7 and recurrent depressive disorder--in 2. Clinical significance of witchcraft delusions is closely related to its social aspect. Being combined with ideas of persecution, poisoning and damage, it results in the brutal forms of delusions defense and may be considered as an unfavorable prognostic trait.

Adolescent↗
PubMed2005

[The efficacy of olanzapine for delusion in patients with Parkinson's disease].

We investigated the usefulness of quetiapine and olanzapine for delusion in nine patients with Parkinson's disease (PD). Two of five patients initially treated with quetiapine showed resolution of delusion on low dose (25 mg and 50 mg/day), whereas three patients had no improvement in spite of increasing the dose to 300 mg/day. Quetiapine non-responders had a tendency to more severe delusion and dementia compared with responders. Not only all four patients initially treated but also two of three quetiapine non-responders showed a remarkable resolution of delusion on olanzapine. In particular, three of seven patients responded to an extremely low dose of 0.625 mg/day. However, severe motor debilitation was observed in one patient treated with 1.25 mg/day. Olanzapine might be useful for delusion of PD in patients not responded to quetiapine, although it should be started at a very low dosage to ameliorate worsening parkinsonism.

Aged↗
PubMed2006

"Internet delusions": the impact of technological developments on the content of psychiatric symptoms.

The inclusion of computers and the Internet in our daily lives has become an increasingly pervasive phenomenon. Naturally, this phenomenon found its reflection in the quick inclusion of these technologies in the content of delusions. There have already been a few reports describing patients with Internet delusions. In this report, we describe two patients and their social background who were without previous psychiatric history and whose first psychosis involved delusions surrounding the Internet. Our opinion is that Internet delusions do not represent a new diagnostic entity, but rather modified delusions of persecution, broadcasting and control.

Adult↗
PubMedDate not supplied

[Factor analysis of the features of delusions].

The aim of the study was the analysis of the frequency of various traits of delusions and the search for smaller number of factors which create delusional beliefs by using the factor analysis. The cohort consisted of 100 patients with the diagnosis of paranoid schizophrenia according to DSM-III who presented delusions at the time of evaluation. Author's Scale of Delusional Dimension which consisted of 34 items describing several traits of delusions, was used. Statistical elaboration of data allowed to point out following conclusions: 1. Analysis of the frequency of particular traits of delusions shows their high subjective variability in several patients, with the exception of features which indicate the deep conviction in truthful beliefs, and features indicating their influence of patient's behaviour. 2. Factor analysis revealed that all evaluated traits create 5 independent factors: I. engagement-eccentricity, II. certainty, III. influence on behaviour-extent, IV. range of influence, V. delusional construction. 3. Results show the complexity of the phenomenon of delusions and suggest further investigations especially with dynamic aspects.

Adult↗
PubMedDate not supplied

[Delusions as a multidimensional phenomenon].

The new scientific approach to the problem of delusions--the search for their internal structure, emerges in the literature. The aim of the study is both the presentation of self-constructed Scale of Delusional Dimensions, and the presentation of results obtained by the use of the that particular scale. The scale consists of seven subscales dealing with various dimensions of delusional thinking: conviction, preoccupation, coherence, objectivity, range, eccentricity, and the influence on behaviour. Each of the subscales includes five statements which describe the traits of delusions and their dimensions. One hundred paranoid schizophrenic patients were examined by the use of Scale and data were statistically analysed. The significant correlations between the features in each dimensions prove their independence from each other. It raises the conclusion that delusions are multidimensional phenomenon, i.e., they possess a complex structure. On this basis one may predict that each dimension may change independently in the course of disease and healing. It appeared that relatively low correlations exist between some features of delusions located in various dimensions, which allows to predict only the tendency to coupling of individual traits of delusions.

Delusions↗
PubMed1988

[Psychopathology of patients with delusions of ectoparasitic infestation].

This paper presents a literature review as well as a study in 13 patients suffering from delusion of infestation. Symptoms found in MMPI are related to clinical experience. Our results suggest the distinction of three different groups of these patients: 1. Patients with predominantly hypochondric traits, with a distinct conviction to suffer from a severe, physical illness that is often looked at as incurable (hypochondriacal delusion of parasitosis). 2. Patients with paranoid symptoms and without hypochondric apprehensions. These patients usually hopelessly fight against their parasites, that impair their sphere of existence. Physical illness is denied. ("delusion of infestation"). 3. Patients with signs of both, hypochondrical as well as paranoid delusions ("hypochondriacal delusion of infestation").

Adult↗
PubMed1979

The element of the irrational at the beginning and during the course of delusion.

Delusion is described from a phenomenological point of view. Based on the observation of 15 cases of delusion over a period of several years and 3 cases described by Japanese and American authors, I have concluded that delusion cannot be understood from a genetic, psychological or sociological standpoint alone. My aim was to discover symptoms which could not be explained by psychodynamic, sociological or other causes. Such symptoms may be called irrational (incomprehensible) symptoms. Their irrationality is analogous to the same symptoms which are described in their autobiographies by two great mystics about their ecstasy. We can see these symptoms in the accounts of Zen Buddhists. These symptoms represent experience of evidence, pseudohallucination, suffering in delusion, a message to do something, loss of awareness of time and space, the polarity of guilt and blessedness following each other in close succession and the feeling of shame. We will better understand delusion if we bear in mind the irrational factor.

Affective Symptoms↗
PubMed1995

Psychiatric factors associated with dangerous misidentification delusions.

The delusional misidentification syndromes are characterized by misidentification delusions of others or of the self. Aggressive ideas or behaviors often accompany these delusions. The relationship between delusional misidentification and dangerousness remains for the most part poorly understood. In the present article, we compare a group of dangerous individuals suffering from dangerous misidentification delusions with a group of dangerous individuals suffering from other types of delusions. Individuals with dangerous misidentification delusions were more likely to experience grandiose ideation, thought disorder, generalized hostility, excitement, general psychopathology, and a previous history of violence than dangerous delusional individuals with no delusional misidentification. The group with dangerous delusional misidentification syndromes was less likely to attack others with weapons than were the dangerous delusional group with no delusional misidentification.

Adult↗
PubMed1995

[Delusions in the aged. A contribution to anthropological understanding].

About delusions in old people: a contribution to anthropological understanding A review of the literature demonstrates that there are a number of different definitions of "delusions". There are examples of different ways in which delusions develop. The anthropological perspective ist extensively commented upon. The main purpose of this paper is to create an understanding of delusions from the point of view of Anthropology and thereby to demonstrate how such understanding can help in dealing with old people who suffer from delusions.

Aged↗
PubMed1995

Pharmacologic treatment of delusions.

Delusions usually respond to antipsychotic medications. When delusions are present within certain diagnostic categories, however, pharmacotherapy other than or in addition to antipsychotic agents is indicated. Many delusional disorders have been found to respond to pimozide even after failing to respond to other antipsychotic agents. Delusions accompanied by affective symptomatology should be treated with both antipsychotic medications and antidepressants or mood stabilizers. When delusions are the result of a medical condition, treatment of the medical condition may lead to resolution of the delusion.

Antidepressive Agents↗
PubMed1996

Forensic implications of the difficulties of defining delusions.

Delusions are evasive to define: (1) Within the process of defining, one uses part of the final conclusion, which should derive from the basic definition (in other words, Circular reasoning); (2) Many, if not most, of so-called normal persons, hold delusion-like ideas; (3) Delusion becomes, usually, more understandable and less bizarre when investigated; (4) Delusions are not unique by remaining resistible to reason; (5) For every delusional content, as bizarre and remote as it may be, there is at least one cultural niche, in which the same content is considered legitimate and reasonable, (if no important and dignified). The forensic implications of these difficulties (to define delusions), will be discussed and elaborated.

Culture↗
PubMed2005

"Sleights of mind": delusions, defences, and self-deception.

Two different modes of theorising about delusions are explored. On the one hand is the motivational approach, which regards delusions as serving a defensive, palliative, even potentially adaptive function. On the other, is the cognitive deficit approach, which conceptualises delusions as explicitly pathological, involving abnormalities in ordinary cognitive processes. The former approach, prominently exemplified by the psychoanalytic tradition, was predominant historically, but has been challenged in recent years by the latter. Some grievances against psychoanalytic theory are briefly discussed, and it is argued that although the reasons for psychoanalysis falling into scientific disrepute are partly justified, the psychodynamic notion that motivation has access to the mechanisms of belief formation is of potentially crucial theoretical utility. A variety of possible syntheses of the two theoretical modes are therefore explored, in the belief that the most comprehensive account of delusions will involve a theoretical unification of both styles of explanation. Along the way, an attempt is made to locate the notions delusion, defence, and self-deception in a shared theoretical space.

Journal Article↗
PubMed2002

Need for closure and jumping-to-conclusions in delusion-prone individuals.

Members of the general population were screened for delusion-proneness using the Peters et al. Delusions Inventory (PDI). Two groups were formed from the participants who scored in the upper and lower quartiles of the PDI and compared on a probability judgment task and on the Need for Closure scale (NFC). The study investigated whether the "jump-to-conclusions" (JTC) reasoning bias, characteristic of deluded participants, could be found in delusion-prone individuals. NFC was investigated as a motivational factor that may correlate with this reasoning bias. Evidence for the existence of the data-gathering, but not the probability judgment, part of the JTC reasoning bias was found in the delusion-prone individuals. This group also scored significantly higher on the NFC scale. As the data-gathering reasoning bias was found in delusion-prone individuals this suggests that it may be involved in the formation, rather than merely the maintenance, of delusional beliefs.

Adolescent↗
PubMed2006

[The importance of Binswanger's phenomenology for the concept of delusion].

In his book entitled 'Wahn' (delusion), Binswanger develops a new line of thinking which is important for the neurosciences today. Unlike Jaspers, Binswanger believes that in a delusion normal perceptions do not acquire an abnormal significance. However, a delusion can develop as a result of a disturbance in sensations, perceptions and structure of consciousness. Binswanger was inspired to express these views after studying the philosophy of Heidegger, Aristotle, Kant and Husserl. In Binswanger's opinion, spontaneous mental activity is disturbed in delusion and perceptions are freezed. This can create a situation where the subject is dominated by mental images that can overpower and even destroy his own self-image. As a result the subject no longer has access to the human horizon which he would normally share with others. Consequently, the subject 'is convinced' that he is in the clutches of an alien power. On the basis of a case study, we investigate how a delusion arises and show how by analysing a patient's perceptions and sensations psychiatrists can help a patient to 'repossess his own mind'.

Adult↗
PubMed2002

Paranoid delusions and hallucinations and bright light therapy in Alzheimer's disease.

INTRODUCTION: Bright light therapy (BLT) is becoming increasingly popular as an adjunct in the treatment of non-SAD depression and circadian rhythm disturbances in demented patients. Although the rate of side-effects is low, special attention should be paid when treating new groups of patients. We present the case of an 80-year-old woman suffering from dementia of Alzheimer's type (DAT). METHOD: Bright light (2.500 lux) was administered two hours daily between 10 and 12 a.m. for 14 days. Changes in delusion or agitation were recorded using the confusion rating scale (CRS). RESULTS: Out of five patients, three already had delusional symptoms which slightly improved during the course of BLT, one patient never showed delusions before or during BLT, and one patient, which we present here, showed an increase in agitation and developed delusional symptoms. After eight days of treatment, the patient developed conjunctival irritation with marked red eyes and complained about blurred vision. After 12 days of treatment, the patient was disorientated in time and place and after 14 days the patient started to hallucinate and BLT had to be discontinued. The paranoid delusions and hallucinations stopped one day after treatment discontinuation. CONCLUSION: Looking at all the presented evidence, BLT seems to be a useful treatment supplement in DAT patients, when suffering from delusions or agitation. On the other hand, caution should be used when using BLT in demented patients if agitation develops or increases during BLT.

Aged↗