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PubMed1985

Delusions of infestation treated with pimozide: a follow-up study.

Fourteen patients with monosymptomatic delusions of infestation were followed-up 19-48 months after treatment with pimozide was terminated. Seven patients had remained in remission since the treatment. Three had developed relapses, but were without symptoms with intermittent treatment. Four patients responded poorly to pimozide and had still symptoms at the follow-up. The study indicates, that a large proportion of patients with monosymptomatic delusions of infestation treated with pimozide will be able to discontinue the medication for years without recurrence of their delusions.

Aged↗
PubMed1989

[Delusions of parasitic skin infestation in elderly dermatologic patients].

In a study on 21 patients, who had been treated at the Erlangen Dept. Dermat. for delusion of parasitosis during the last 17 years, we compiled catamnestic data, evaluated the personality profiles, and focussed upon the interrelations between the clinical symptoms, the outcome of various psychological tests, and the course of the disease. Our sociographic results agreed well with those of earlier studies (i.e. social isolation, conflicts in or loss of partnership and sexuality). Nearly half of the patients complained about depressive moods which, however, could not be psychometrically proved. In every fifth patient, we detected a propensity to paranoia both clinically and psychopathometrically, indicating the development into paranoic delusion. In general, the patients' aggressiveness was found rather low. Nor were there any hints for organic psychosyndromes in the majority of the patients. We conclude that delusion of parasitosis usually represents a solitary phenomenon of primary psychosis, which can largely be regarded as a monosymptomatic hypochondriac disorder. Successful treatment with neuroleptic drugs depends on a confidential interrelation between patient and physician.

Adult↗
PubMed1988

Cocaine abuse and delusions of parasitosis.

We report two persons in their thirties with the shared delusion of parasitosis. Both abused cocaine, and both recovered from their delusions after a period of abstinence. Although the literature does not stress that a specific cause is usually found for delusions of parasitosis, this may be changing for persons in groups among whom cocaine and possibly other illicit drug use is common. It is a service to these desperate patients to establish their confidence and then discretely ask about the use of illegal drugs, especially cocaine.

Adult↗
PubMed1987

[Paranoid conspiratory delusion].

Taking paranoid conspiratory delusion as example, it is attempted to describe the connection between structure and content of delusions. Inspired by Freuds interpretation of the case Schreber, the cathexis of socially recognized meanings with subjective interest is described as a matrix of cathexis. Delusion is seen as a "filling" of "cathexis-holes".

Cathexis↗
PubMed1983

[Superstition, faith, delusion].

The superstitious person makes use of various projective mechanisms and establishes a connection between two events or between an object and an event which are not causally related. Superstition can be understood as a narcissistic attempt at compensation by persons lacking self-confidence, who feel themselves to be under an existential threat. Religious belief can be defined as a commitment to an ultimate meaning in life. Absolute faith requires hope, in fact genuine faith is unthinkable without hope. A prerequisite, an underlying emotional substrate, of the development of faith is trust, in the sense of basic trust. A characteristic of genuine religious belief is orthopraxy, the practical application of faith in this world. The integrity of religious belief is in itself vulnerable, since, unlike delusion, it can be modified. Delusion is a disturbance of thought content which is maintained with absolute conviction. The deluded person is not capable of doubting or correcting the false belief. Transition from faith to superstition and vice versa is often fluid. Superstition can be the starting point for delusional ideas. It must be distinguished from delusion and in most cases it is easy to do so. The superstitious person feels secure in his world, while the deluded person breaks out of this security and places himself outside the community, outside the society that supports him.

Delusions↗
PubMed1982

Delusions of innocence and antagonistic delusory ideas.

The author describes a patient who developed a delusion of persecution followed by a secondary delusion of innocence. The patient was felt to suffer from a paranoid state previously described only in incarcerated prisoners and schizophrenics. The relationship between his delusions and his unconscious impulses is considered.

Delusions↗
PubMed1994

[Age-delusion: (age-misidentification of chronic schizophrenic patients)].

I noted that some of the schizophrenic patients chronically institutionalized at our hospital mistook their age (age-delusion), and studied the primary symptoms and the psychodynamics of this schizophrenic phenomenon. The subjects were divided into a core group of 24 patients who had schizophrenia without any overt organic brain diseases and a peripheral group of 8 patients who had schizophrenia associated with organic brain diseases. I divided the core group patients into 3 categories. I. Underestimators: These patients insisted that they were much younger than their real age, and they could be divided into a dynamic subgroup (subjective age increased in parallel with time) and a static subgroup (subjective aging did not occur). II. Overestimators: these patients believed that they were much older than their real age. III. Vacillators: These patients sometimes underestimated and sometimes overestimated their age. They could be divided into a subgroup in which the age was decided on the basis of their systematic delusions and a subgroup in which one of two fixed and different ages was always given (one being over and the other under the real age). I compared these schizophrenic age-delusional patients to other organic brain disease patients without schizophrenia who also mistook their age. Organic brain disease patients had a temporal recognition disorder as their primary symptom, while the schizophrenic patients had abnormal time experience as the primary symptom. This abnormality of time experience, mixed with the patient's psychodynamics that they want to objectify and manipulate their age as a number, appeared as a discrepancy between the subjective length of hospitalization and the actual duration, which means the age-delusion. These schizophrenic age-delusional patients had lost the essential 'Zeitlichkeit' and shut themselves up in the unessential 'Zeitlichkeit' according to the concept of Heidegger. Believing in their subjective age seems to allow them to reunify or rewrite their own past history and gain some hope for the future.

Adult↗
PubMed1996

[Sensitive delusion of reference--only of historical significance? A current case example].

In 1918, Ernst Kretschmer published the monograph "Der Sensitive Beziehungswahn" [The Sensitive Delusion of Reference], one of his most important contributions to psychiatry. It reflects the lively discussion on psychogenic psychoses that was going on at the turn of the century. An actual case is used to demonstrate that even today the "sensitive delusion of reference" can be clearly delimited as a distinct syndrome. On the basis of the current literature, possible reasons for the fact that this diagnosis is relatively rarely made today are discussed. The sensitive delusion of reference is also an example of socio-cultural change in psychiatric diagnosis.

Adult↗
PubMed1998

Delusions and hallucinations in an adult day care population. A longitudinal study.

The frequency of the manifestation of delusions and hallucinations (d/h) among participants of adult day care centers was examined, as was the relationship of d/h to demographic and medical variables, agitation, depressed affect, and dementia. Changes in d/h were also assessed over a 1-year period, and those changes were compared with changes in agitation, depressed affect, and dementia. Depressed affect and agitation were related both to delusions and to hallucinations. Dementia was also related to d/h, although a substantial percentage of individuals who were not diagnosed with dementia also experienced some type of d/h. Finally, delusions were more prevalent and generally tended to relate more strongly to agitation, depressed affect, and dementia than did hallucinations.

Aged↗
PubMed1999

A case of Capgras delusion following critical illness.

Hallucinations and paranoid delusions are recognised complications of critical illness. However, the occurrence of Capgras syndrome, in response to critical illness, where patients are convinced that doubles have replaced close family has not been described in the literature. There have been isolated case histories in the literature in response to medical procedures or illness but mostly in patients suffering from schizophrenia. A 42 year old woman was admitted to the intensive care unit (ICU) with pneumonia, following extensive surgery for a squamous cell carcinoma, secondary to Crohns disease. She had no history of previous head injury, cerebro-vascular problems or psychiatric disorder. She reported having memories of all her family, with the exception of her mother, being replaced by aliens while she was on the ICU. The delusion was only diagnosed once it had resolved and the patient was able to talk, and this highlights the difficulty of diagnosing delusions while patients are still intubated and unable to verbalise their concerns. It has been suggested that a defect in the ability to recognise the emotional significance of the face lies at the root of Capgras syndrome.

Adult↗
PubMed1996

Delusions demand attention.

We used a variant of the Stroop paradigm to investigate attention bias in a young woman (JK) with delusional beliefs that she had died and that members of her family had changed. JK was shown sets of words printed in different colours of ink, and was asked to name the colour of each word. Sets of words were chosen which related to her delusions, and to possible contributory moods. The times taken by JK to colour-name words in these lists were compared with her times to colour-name sets of neutral words. There were three separate testing sessions which took place over a two-year period. In comparison to her times to name the colours of words in the neutral lists, JK was significantly slower to colour-name test lists containing words related to her delusional beliefs. When she was no longer experiencing these delusions, however, she was no slower to colour-name any of the test word lists. The results indicate that the Stroop paradigm can be useful in investigating individual cases of delusions and in monitoring changes in attentional bias over time.

Journal Article↗
PubMed2001

Faith or delusion? At the crossroads of religion and psychosis.

In clinical practice, no clear guidelines exist to distinguish between "normal" religious beliefs and "pathological" religious delusions. Historically, psychiatrists such as Freud have suggested that all religious beliefs are delusional, while the current DSM-IV definition of delusion exempts religious doctrine from pathology altogether. From an individual standpoint, a dimensional approach to delusional thinking (emphasizing conviction, preoccupation, and extension rather than content) may be useful in examining what is and is not pathological. When beliefs are shared by others, the idiosyncratic can become normalized. Therefore, recognition of social dynamics and the possibility of entire delusional subcultures is necessary in the assessment of group beliefs. Religious beliefs and delusions alike can arise from neurologic lesions and anomalous experiences, suggesting that at least some religious beliefs can be pathological. Religious beliefs exist outside of the scientific domain; therefore they can be easily labeled delusional from a rational perspective. However, a religious belief's dimensional characteristics, its cultural influences, and its impact on functioning may be more important considerations in clinical practice.

Journal Article↗
PubMed1980

An objective study of relationships and discontinuities between paranoid schizophrenia and Kretschmer's syndrome of sensitive delusions of reference.

The nosological status of Kretschmer's syndrome of sensitive delusions of reference (Sensitiver Beziehungswahn) has been a matter of discussion over many years. In an attempt to resolve the matter, a series of 147 consecutive patients who had been diagnosed as schizophrenic were reviewed. A group of 13 patients met specified criteria for Kretschmer's syndrome of sensitive delusions of reference, and these patients were compared with the remainder in a variety of ways. The patients with the syndrome of sensitive delusions of reference differed from the remainder in their antecedents (family history and premorbid personality), their EEG status, stresses at time of onset, and response to treatment. The evidence offered here points to the separateness of this syndrome from the other schizophrenic illnesses displayed by the patients reviewed.

Electroencephalography↗
PubMed1994

SPECT data in a case of secondary Capgras delusion.

Capgras' delusion (CD) may be secondary to a neurologic lesion, particularly in the right frontal or occipital regions. A 40-year-old woman with multiple sclerosis underwent SPECT during and after an episode of CD. Analysis during delusion showed an uptake defect in the right parietal cortex with an 11% index of asymmetry (normal: < or = 4%). Post-delusion SPECT showed decreased bifrontal and biparietal cortical uptake indices but a normal index of asymmetry. Functional brain imaging may provide clues to the psychopathology of CD.

Adult↗
PubMed1993

Face-processing impairments and the Capgras delusion.

Investigations of two cases of the Capgras delusion found that both patients showed face-processing impairments encompassing identification of familiar faces, recognition of emotional facial expressions, and matching of unfamiliar faces. In neither case was there any impairment of recognition memory for words. These findings are consistent with the idea that the basis of the Capgras delusion lies in damage to neuro-anatomical pathways responsible for appropriate emotional reactions to familiar visual stimuli. The delusion would then represent the patient's attempt to make sense of the fact that these visual stimuli no longer have appropriate affective significance.

Aged↗
PubMed2004

The contribution of metaphor and metonymy to delusions.

This article investigates the possible role of metaphorical thinking in psychotic delusions. Twenty-five participants with delusions were asked to give an account of how their ideas had formed and to describe recent experiences relevant to their delusional beliefs. The data suggest that for some participants there may have been a crucial period when the person has unusual experiences, psychosocial difficulties, and made attempts involving metaphor/metonymy to understand these experiences. Furthermore, some participants reported very recent unusual experiences using metaphorical terms, and we speculate on the possibility that the content of the metaphors contributes to a continuation of psychotic experience. The data form a series of case illustrations and are exploratory. No generalizations can be made, but the presence of significant metaphors and metonymy in 11 out of 25 case histories suggests the process may be an important one. We end by outlining a theoretical model of how metaphors might contribute to the formation of delusions: it is suggested that delusional statements are intended to be literal statements, but report on experiences transformed by metaphorical meaning. This transformation involves the 'fusion' of conceptual domains.

Adult↗
PubMed1985

Depression, drugs, and delusions.

This study, a retrospective review of clinical experience, investigated response to tricyclic antidepressants in a group of 34 depressives with delusions and a group of 22 depressives without delusions. There was no difference between the groups in terms of their age, sex, or dosage of tricyclic antidepressant. The pattern of when patients left tricyclic therapy for electroconvulsive therapy was similar in both groups. For those responding to tricyclics, the nondelusional group responded within the first three weeks of therapy, whereas for the delusional group the responders were more spread throughout the nine weeks. Delusional depressives were more likely to respond to tricyclic antidepressants than were nondelusional depressives.

Adult↗
PubMed1997

A cognitive neuropsychological approach to the study of delusions in late-onset schizophrenia.

OBJECTIVE: Hypotheses to explain delusion formation include distorted perceptual processing of meaningful stimuli (e.g. faces), abnormal reasoning, or a combination of both. The study investigated these hypotheses using standardized neuropsychological tests. DESIGN: A three-patient case-study, compared with a small group (n = 8) of age-matched normal control subjects. SETTING: Hospital in- and outpatients. Age-matched normal controls were from local residential homes. PATIENTS: Three subjects with late-onset schizophrenia, two currently deluded and one in remission. Both deluded subjects had persecutory beliefs. One had a delusion of misidentification. INTERVENTIONS: All subjects were administered standardized neuropsychological tests of facial processing and tests of verbal reasoning. MAIN OUTCOME MEASURES: The test scores of the three patients were compared with published normal values and the age-matched control data. RESULTS: The tests demonstrated impaired matching of unfamiliar faces in deluded subjects, particularly in the subject with delusional misidentification. Increasing the emotional content of logical reasoning problems had a significant effect on the deluded subjects' reasoning but not that of the normal controls. CONCLUSION: The findings suggest impaired visual processing plus abnormal reasoning in deluded subjects. However, these impairments are relatively subtle given the severity of psychiatric disorder in the patients studied.

Age of Onset↗