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PubMedDate not supplied

On defining delusions.

The DSM-III-R definition of delusions bears inconsistencies and does not account for the way delusions are detected clinically. It can be traced back to Karl Jaspers who was the first to mention the three criteria of delusions, which are to be found in the textbooks ever since: (1) certainty, (2) incorrigibility, and (3) impossibility or falsity of content. Psychiatrists always felt uncomfortable with the third criterion, and Kurt Schneider pursued the most thorough attempt to dispose of this criterion by his definition of delusional perception. It can be shown that while his definition is wrong, the phenomena he had in mind do, in fact, have some distinctive features. Proceeding from the first two criteria of Jaspers, a new definition is proposed that emphasizes the way certain contents are stated and disregards the issue of right or wrong. Advantages of this definition are discussed and a distinction between delusions (about external reality) and certain actual experiences (happening in the patient's mind) is proposed.

Delusions↗
PubMed2006

Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations.

BACKGROUND: The role of emotion in psychosis is being increasingly recognised. Cognitive conceptualisations of psychosis (e.g. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195]) emphasise a central, normal, direct and non-defensive role for negative emotion in the development and maintenance of psychosis. This study tests specific predictions made by Garety et al. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195] about the role of emotion and negative evaluative beliefs in psychosis. METHODS: 100 participants who had suffered a recent relapse in psychosis were recruited at baseline for the Prevention of Relapse in Psychosis (PRP) trial. In a cross-sectional analysis, we examined the role of depression, self-esteem and negative evaluative beliefs in relation to specific positive symptoms (persecutory delusions, auditory hallucinations and grandiose delusions) and symptom dimensions (e.g. distress, negative content, pre-occupation and conviction). RESULTS: Analysis indicated that individuals with more depression and lower self-esteem had auditory hallucinations of greater severity and more intensely negative content, and were more distressed by them. In addition, individuals with more depression, lower self-esteem and more negative evaluations about themselves and others had persecutory delusions of greater severity and were more pre-occupied and distressed by them. The severity of grandiose delusions was related inversely to depression scores and negative evaluations about self, and directly to higher self-esteem. CONCLUSIONS: This study provides evidence for the role of emotion in schizophrenia spectrum-disorders. Mood, self-esteem and negative evaluative beliefs should be considered when conceptualising psychosis and designing interventions.

Adolescent↗
PubMed1998

Delusions of ocular parasitosis.

PURPOSE: To describe four cases of delusions of parasitosis in which self-inflicted ocular trauma occurred. Delusions of parasitosis is a somatic delusional disorder in which patients have the irrational belief that their bodies are infested by parasites or other infectious organisms. Self-inflicted trauma can result from attempts to eliminate the supposed infestation. METHODS: We reviewed the case histories of four patients (one male, three females, 35 to 45 years of age) who presented with complaints of ocular infestation but had no evidence of infectious ocular disease. The characteristics of these cases were compared with the features of delusions of parasitosis. RESULTS: All patients maintained their beliefs regarding infestation, despite extensive clinical and laboratory investigations that found no evidence of infectious diseases. Self-inflicted eye injury, associated with attempts to eliminate the infestation, occurred in each case. CONCLUSIONS: The cases presented in this report are consistent with a diagnosis of delusions of parasitosis. The eye can be a principal focus of attention in this disorder, which may lead to vision loss caused by self-inflicted injury.

Adult↗
PubMed2003

Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations.

Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of delusions and hallucinations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.

Delusions↗
PubMed2003

Neuroticism and visual memory impairments as predictors of the severity of delusions in schizophrenia.

This study examined whether levels of emotional distress and impairments in visual memory were uniquely associated with severity of delusions in schizophrenia. Severity of delusions was assessed using select items from the positive component of the Positive and Negative Syndrome Scale among 44 persons with schizophrenia or schizoaffective disorder in a post-acute phase of illness. Emotional distress was assessed using the neuroticism subscale of the NEO Five Factor Inventory, and visual memory was assessed using the Rey Complex Figure Test. Controlling for executive function, visual attention, and verbal memory, a multiple regression analysis revealed that visual memory and neuroticism were each significantly related to severity of delusions, with the two combined accounting for one quarter of the variance. These same variables were unrelated to negative and excitement symptoms. Severity of delusions is linked to both higher levels of neuroticism and greater impairment in visual memory.

Adult↗
PubMed1998

Schizophrenic delusions: the detection of warning signals.

Schizophrenic delusions are important target symptoms for treatment. This study aims to identify predictors of delusion formation. Two samples of schizophrenic patients (total n = 131) are examined prospectively every second week during a period of 6 months. In one sample (n = 60) delusion formation (n = 27; 45%) is correlated significantly with a change in score of eight individual items from the Early Signs Scale (ESS): sleep, anxiety, concentration, irritability, coping, tiredness, depression and confusion. These eight items form the Warning Signals Scale (WSS). The predictive validity of the scale is tested in another sample (n = 71), of which 43 patients (61%) have reemergence of delusions. A criterion cut-off score of > or = 5 points combines an acceptable sensitivity (77%) and specificity (68%). The scale is acceptable to patients, manageable for clinicians, and it has a high degree of predictive validity and reliability. This makes it relevant for implementation in ordinary clinical practice.

Adult↗
PubMed1998

Sentence verification and delusions: a content-specific deficit.

BACKGROUND: A sentence verification task was developed to investigate semantic memory in schizophrenia. METHODS: The test consisted of three types of sentence (true, unlikely and nonsense) and seven different types of content (neutral, persecutory, grandiose, political, religious, relationships and somatic) representing common delusional themes present in schizophrenic patients. Sixty-three schizophrenic patients and 66 matched control subjects were asked to make true/false judgements to 143 sentences. RESULTS: Overall accuracy was similar across the two groups; sentences with some emotional themes and sentences of the unlikely type produced the most violations. Significant differences between the two subject groups were found specifically on nonsense sentences with persecutory and religious themes. Patients made significantly more incorrect responses (acceptance) to nonsense sentences that had an emotional content congruent with their delusional beliefs, past or present, and also on unlikely sentences (incorrect rejections) whose content was not congruent with their delusions. Further analysis of response bias in the patients showed, overall, that there were more incorrect rejections (a reflection of the large number of unlikely sentence errors) and more incorrect responses to sentences congruent with patients delusions. Furthermore, analysis of those patients currently experiencing delusions revealed more incorrect responses to sentences congruent with their delusional ideas compared with patients not currently deluded. CONCLUSIONS: These findings are indicative of cognitive bias in schizophrenia towards certain emotional themes that may underlie illogical semantic connections and delusions.

Adult↗
PubMed1992

Mood theme and bizarreness of delusions in schizophrenia and mood psychosis.

Narratives of the delusions of 83 schizophrenic and 55 nonschizophrenic psychiatric subjects were categorized as of one or more of 12 types. Narratives were also independently assessed along dimensional scales of bizarreness and mood theme. Schneiderian and grandiose types were found to be more common in schizophrenics and mood psychotics, respectively. Dimensional measures showed that the delusions of schizophrenics were more unlikely and that those of mood psychotics had a stronger mood theme. Regression analysis determined that Schneiderian delusions and a dimensional estimate of mood theme best differentiated schizophrenics from mood psychotics. Assessments along dimensions of other parameters, particularly those represented by Schneiderian delusions, may further discriminate the functional psychoses.

Adult↗
PubMed1999

What is a delusion? Epistemological dimensions.

Although the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) clearly indicates delusions have an epistemic dimension, it fails to accurately identify the epistemic properties of delusions. The authors explicate the regulative causes of belief revision for rational agents and argue that delusions are unresponsive to these. They argue that delusions are (a) protected beliefs made unfalsifiable either in principle or because the agent refuses to admit anything as a potential falsifier; (b) the protected belief is not typically considered a "properly basic" belief; (c) the belief is not of the variety of protected scientific beliefs; (d) in response to an apparent falsification, the subject posits not a simple, testable explanation for the inconsistency but one that is more complicated, less testable, and provides no new corroborations; (e) the subject has a strong emotional attachment to the belief; and (f) the belief is typically supported by (or originates from) trivial occurrences that are interpreted by the subject as highly unusual, significant, having personal reference, or some combination of these.

Delusions↗
PubMed1995

[Trans-subjective practice in schizophrenic delusions].

In schizophrenic delusion, the world of other humans is not so much the scope of events and actions; the patient rather sees himself as actually related to others, while including "the other persons" in the delusion of persecution as a crucial point of reference. Delusion, therefore, has a referential structure. When analysing the referential structure of "being persecuted", it is shown to be unilaterally transitive, the patient being, however, the ontological first reference point. The relationship to others in schizophrenic delusion cannot, however, achieve intersubjectivity; its significance is merely trans-subjective.

Communication↗
PubMed1992

Making sense of delusions.

True delusions have been conventionally regarded as primary or psychologically irreducible (Jaspers 1913/1959) and thus only explicable in organic terms. While Jaspers acknowledged the existence of secondary delusions, which may be understood in the light of related affect, other experiences, or hallucinations, these were of lesser theoretical importance than true delusions, in which he found a change in "the totality of understandable connections." Anglo-American psychiatry, in espousing Jaspers and rejecting psychoanalysis, has in consequence concentrated on the form and not the sense of delusions.

Adult↗
PubMed2002

Attributional style in schizophrenia: an investigation in outpatients with and without persecutory delusions.

The attributional style of outpatients with schizophrenia with and without persecutory delusions was investigated. Thirty individuals with schizophrenia were divided into persecutory-deluded and non-persecutory-deluded groups based on a score of 5 or higher on the suspiciousness item from the Expanded Brief Psychiatric Rating Scale (BPRS-E). The two resulting groups, and a nonclinical control group, were administered a battery of attributional measures, and their attributional responses were coded by both the subjects themselves and a pair of independent raters. The results showed evidence of a self-serving bias for subjects with persecutory delusions; however, this bias was not unique to those with persecutory delusions, and it disappeared when independent raters evaluated subjects' causal statements on a reliable measure of attributional style. Subjects with persecutory delusions tended to show a stronger bias toward blaming others rather than situations for negative outcomes, and there was a linear association between persecutory ideation and a self-serving attributional style. Finally, there were significant discrepancies between the attributional ratings of the persecutory-deluded subjects and those of independent judges. Implications for future research are discussed.

Adult↗
PubMed1994

Delusions in schizophrenia spectrum disorders: diagnostic issues.

Family studies of schizophrenia frequently include relatives of schizophrenia probands with diagnoses falling within the schizophrenia spectrum. As part of an ongoing genetic linkage study of schizophrenia, the authors examined case material from 50 relatives (of schizophrenia probands) who received a DSM-III-R diagnosis of a nonaffective psychotic disorder or schizotypal or paranoid personality disorder. Eleven exhibited episodic or chronic delusions that resulted in diagnostic dilemmas, often arising from issues pertaining to the classification of delusional phenomena. Four of these cases are presented here. Unusual beliefs were often difficult to classify as odd beliefs versus full delusions, brief/transient versus persistent delusions, bizarre versus non-bizarre delusions. It is suggested that these might be considered continuous rather than dichotomous dimensions. Several possible implications for genetic studies of schizophrenia are discussed.

Adult↗
PubMed1995

Vulnerability to delusions over time in schizophrenia and affective disorders.

This research used a prospective longitudinal design to study differences in vulnerability to delusions over time in 234 subjects with schizophrenia, schizoaffective disorder, or bipolar or unipolar affective disorder. Patients were assessed at three successive followups over a 7- to 8-year period. Over 60 percent of the schizophrenia and schizoaffective patients assessed experienced delusional activity at one of the three followups. Over 60 percent of the patients who initially had psychotic affective disorders also showed posthospital delusional activity. Significantly more schizophrenia patients than psychotic affective-disordered patients experienced consistent posthospital delusional activity at three successive followups. Unlike the schizophrenia subjects, affective patients showed a significant reduction in delusions after the first followup. After the initial acute psychotic episode that led to hospitalization, psychotic bipolar and unipolar affective patients showed a traitlike vulnerability to episodic delusional activity over time, but schizophrenia patients were vulnerable to more severe delusional activity and to more frequently recurring or sustained delusions. The study results question the views of several major theorists on the importance, persistance, and prognostic significance of delusions in schizophrenia.

Adult↗
PubMed1998

Delusions of the paranormal: a haunting question of perception.

The hypothesis that paranormal (poltergeist) experiences are delusions resulting from the affective and cognitive dynamics of percipients' interpretation of ambiguous stimuli was tested in two studies using a structural modeling approach. Consistent with attribution theory, study I indicated that such delusions are best modeled by a closed negative-feedback loop involving belief, experience, and fear as process variables. Using a more homogeneous sample of percipients, study II replicated this model and the relations among the process variables reached statistical significance. The findings extend established attributional models of delusions by incorporating psychosocial and cognitive factors, including age, gender, and tolerance of ambiguity. The model is proposed as a general framework for the understanding and study of delusions and contagious psychogenic illness, in particular.

Adolescent↗
PubMed2006

Camphor-related self-inflicted keratoconjunctivitis complicating delusions of parasitosis.

PURPOSE: To report a case of camphor-related self-inflicted keratoconjunctivitis secondary to delusions of parasitosis. METHODS: A 61-year-old man with delusions of parasitosis suffered from camphor-related self-inflicted ocular trauma that manifested with corneal epithelial defects and secondary anterior chamber reaction. Two episodes of exacerbation of the ocular conditions related to the use of camphor occurred. The left eye had secondary infection with Sternotrophomonas maltophilia and Staphylococcus aureus in the second episode of exacerbation. RESULTS: The right eye recovered well with the treatment of topical lubricants and corticosteroids and had best-corrected visual acuity (BCVA) of 20/25. The infection of the left eye led to corneal perforation, necessitating penetrating keratoplasty; BCVA was hand motions because of a mature cataract. Olanzapine therapy for 1 month to decrease the delusions of parasitosis and 24-hour watch to prevent the use of camphor led to the resolution of self-inflicted keratoconjunctivitis in the patient. CONCLUSIONS: Delusions of parasitosis may lead to vision-threatening self-inflicted ocular trauma. This may be the first case report of pure camphor-related self-inflicted toxic keratoconjunctivitis.

Anterior Chamber↗
PubMed1990

Disturbance of self-evidence and delusion.

Psychopathologically we study the process from the disturbance of self-evidence to the formation of delusions. When delusions arise on the basis of the disturbance of self-evidence, this disturbance impairs the way of judgment. We present a case of schizophrenia in which the unlimited questions about grounds make it impossible for the patient to establish the self-evident as itself and to judge inductively. The formation of delusions is the psychopathological extrication from the impairment of the inductive judgment. In the formation of delusions on the basis of the disturbance of self-evidence, we can observe the process from the weakening to the substantiation toward the outside of the transcendental organization.

Adult↗
PubMed2000

Hallucinations, delusions, and cognitive decline in Alzheimer's disease.

OBJECTIVES: To examine the occurrence of hallucinations and delusions in Alzheimer's disease over a 4 year period and their association with rate of cognitive decline. METHODS: A cohort of 410 persons with clinically diagnosed Alzheimer's disease underwent annual clinical evaluations over a 4 year period. Participation in follow up exceeded 90% in survivors. Evaluations included structured informant interview, from which the presence or absence of hallucinations and delusions was ascertained, and detailed testing of cognitive function. The primary cognitive outcome measure was a composite cognitive score based on 17 individual performance tests. The mini mental state examination (MMSE) and summary measures of memory, visuoconstruction, repetition, and naming were used in secondary analyses. RESULTS: At baseline, hallucinations (present in 41%) and delusions (present in 55%) were common and associated with lower cognitive function. In analyses that controlled for baseline level of cognitive function, demographic variables, parkinsonism, and use of antipsychotic medications, hallucinations, but not delusions, were associated with more rapid cognitive decline on each cognitive measure. In the primary model, there was a 47% increase in the average annual rate of decline on a composite cognitive measure in those with baseline hallucinations compared with those without them. This effect was mainly due to a subgroup with both auditory and visual hallucinations. CONCLUSION: These findings suggest that the presence of hallucinations is selectively associated with more rapid cognitive decline in Alzheimer's disease.

Aged↗