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PubMed1999

Dimensional approach to delusions: comparison across types and diagnoses.

OBJECTIVE: A dimensional approach to the characterization of delusions was used to examine the use of non-content-related descriptors of delusions in revealing differences across diagnostic categories and delusion types. METHOD: Interviews with 1,136 acutely hospitalized psychiatric patients identified subjects as definitely or possibly delusional on the basis of screening questions derived from the Diagnostic Interview Schedule. Subjects with delusions were given the MacArthur-Maudsley Delusions Assessment Schedule, which generates scores on six dimensions of delusions. Delusions were classified by type, and diagnoses were assigned by using the DSM-III-R checklist. RESULTS: A total of 328 subjects (29%) were rated as definitely or possibly delusional. Their ratings on dimensions of the MacArthur-Maudsley Delusions Assessment Schedule were significantly but modestly intercorrelated. Subjects with schizophrenia generally had more intense delusions than those in other diagnostic categories. Grandiose and religious delusions were held with the greatest conviction, whereas persecutory delusions were marked by strong negative affect and a propensity to act. Factor analysis of the dimensions revealed a consistent two factor solution-"intensity and scope" and "affect and action"-regardless of the diagnosis or delusion type. CONCLUSIONS: The stability of the dimensional structure of delusions across diagnoses and delusion types suggests that even seemingly diverse delusions are more like than unlike each other; this is consistent with common etiologic mechanisms. The utility of a dimensional approach is indicated, in addition, by the ability to characterize delusions of different types and diagnoses so as to highlight therapeutic and other implications.

Acute Disease↗
PubMed2001

Persecutory delusions: developing the understanding of belief maintenance and emotional distress.

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.

Adult↗
PubMed2005

Delusions in individuals with schizophrenia: factor structure, clinical correlates, and putative neurobiology.

BACKGROUND: Delusions are a central feature of schizophrenia, yet our understanding of their neurobiology is limited. Attempt to link dimensions of psychopathology to putative neurobiological mechanisms depends on careful delineation of symptoms. Previous factor analytic studies of delusions in schizophrenia were limited by several methodological problems, including the use of patients medicated with antipsychotics, inclusion of nondelusion symptoms in the analyses, and/or inclusion of patients with psychotic disorders other than schizophrenia. These problems may have possibly biased the resulting factor structure and contributed to the inconclusive findings regarding the neurobiology of positive symptoms. Our goal is to examine the factor structure of delusions in antipsychotic-free individuals with diagnoses of schizophrenia/schizoaffective disorder. SAMPLING AND METHODS: We assessed 83 antipsychotic-free individuals with DSM-IV diagnoses of schizophrenia/schizoaffective disorder. A principal component analysis was conducted on the delusions symptoms of the SAPS. RESULTS: The principal component analysis resulted in three distinct and interpretable factors explaining 58.3% of the variance. The Delusions of Influence factor was comprised by delusions of being controlled, thought withdrawal, thought broadcasting, thought insertion, and mind reading. The Self-Significance Delusions factor was comprised by delusions of grandeur, reference, religious, and delusions of guilt/sin. The Delusions of Persecution factor was comprised solely by persecutory delusions. The three factors displayed distinct associations with hallucinations, bizarre behavior, attention, positive formal thought disorder, and avolition/apathy. CONCLUSIONS: The results indicate that delusions are best described by three distinct subtypes. The authors propose a novel model linking the three delusion subtypes, attributions to self/other, and putative neurobiological mechanisms. Implications for future research are discussed, as well as links to cognitive-behavioral conceptualizations of delusions.

Adolescent↗
PubMed2003

Delusions of Japanese patients with Alzheimer's disease.

BACKGROUND: Delusions constitute one of the most prominent psychiatric complications in Alzheimer's disease (AD). However, there is little consensus of the prevalence and associated factors for delusions in AD. AIMS: To reveal the characteristics of delusions among Japanese patients with AD. METHOD: 112 consecutive patients with AD were recruited over a one year period and administered the Neuropsychiatric Inventory (NPI). RESULTS: Delusions were present in 53 patients (47.3%). Delusions of theft were the most common type of delusion (75.5% of patients with delusions), followed by misidentification delusions and delusions of suspicion. More hallucination, agitation, and female gender were found in the delusions group. CONCLUSIONS: The authors found a high frequency of delusions, particularly of delusions of theft and suggested that gender was associated with the expression of delusions in Japanese patients with AD.

Aged↗
PubMed1995

Understanding delusions.

Delusions traditionally have been considered as fixed, false beliefs, born of morbidity. Whereas this definition serves to orient the clinician to the phenomena at hand, each element breaks down under scrutiny. It has been shown that delusions are not necessarily false, although in some sense they are discordant with reality. When delusions coincide with actual events their judgements can be shown to be independent of this evidential basis; when they refer to disorders of experience, such as first rank symptoms, the experience usually contains a distorted meaning. The supposition that delusions are a variety of belief has itself been questioned. On the one hand, they do not always refer in a meaningful way to anything, or when they do they fail to function as evaluative judgments; instead, delusions are experienced subjectively in ways that are characteristic of knowing rather than believing. On the other hand, delusions are not ascertained clinically by surveying the patient's belief system; rather their failure to achieve the status of objective knowledge leads to the post hoc relegation of delusions to the epistemologic waste basket of beliefs. To treat delusions as necessarily the product of morbidity is essentially tautologous insofar as delusions are, by definition, pathologic; that is, as defective judgments delusions are not simply erroneous, they are disordered. Finally, the fixity of delusions is an empirical matter and varies widely. Underlying this perceived intractability, however, are the subjective certainty and incorrigibility that Jaspers identified and which Spitzer has recast in the form of "epistemological asymmetry" misapplied to external reality. Although delusions typically have been recognized and categorized according to their manifest content, these formal considerations are crucial to understanding the nature of delusions.

Delusions↗
PubMed1993

Comparison of schizophrenic delusions between Japan and Germany.

The content of schizophrenic delusions of 150 German patients in the Psychiatrische Universitätsklinik Tübingen and those of 324 Japanese patients (ICD-9:295) were compared according to the classification of Huber and Gross. The comparison revealed significantly higher frequencies of delusions of poisoning (18 vs. 8%; p < 0.01) and jealousy (6 vs. 1.9%; p < 0.05) in the German cases, but there was no significant difference in the incidence of comprehensive injury delusions. There was also no significant difference in the incidence of comprehensive grandeur delusions. However, comprehensive belittlement delusions were more frequent in the German group (24 vs. 13.3%; p < 0.01). Among the delusions of this type, the themes of guilt/sin (15.3 vs. 4.9%; p < 0.001), particularly those related to religion, were more frequent in the German group. Although religious delusions were more frequent in the German group (21.3 vs. 6.8%; p < 0.001), the difference regarding the incidence of 'delusions of world destruction' was not statistically significant. Among the persecution/injury delusions, themes of direct persecution from others (Verfolgungswahn) were conspicuous in the German group, whereas delusions of reference (Beziehungswahn) related to harassment, such as 'being slandered by others' or 'being known', were common in the Japanese group. Namely, the difference in the content of these persecution/injury delusions may derive from the different types of self in the two countries: the individually oriented self in Germany and the group-oriented self in Japan. Delusions of guilt/sin in the German group may reflect the characteristics of sin in Christianity.

Adult↗
PubMed2002

Religious delusions in patients admitted to hospital with schizophrenia.

BACKGROUND: Religious delusions are clinically important because they may be associated with selfharm and poorer outcomes from treatment. They have not been extensively researched. This study sought to investigate the prevalence of religious delusions in a sample of patients admitted to hospital with schizophrenia, to describe these delusions and to compare the characteristics of the patients with religious delusions with schizophrenia patients with all other types of delusion. METHOD: A cross-sectional investigation was carried out. The prevalence of religious delusions was assessed and comparisons were made between religiously deluded patients and a control group on demographic, symptom, functioning and religious variables. One hundred and ninety-three subjects were examined of whom 24% had religious delusions. RESULTS: Patients with religious delusions had higher symptom scores (as measured by the PANSS), they were functioning less well (as measured by the GAF) and they were prescribed more medication than those patients with schizophrenia who had other types of delusion. CONCLUSION: It is concluded that religious delusions are commonly found in schizophrenia and that by comparison with other patients who have schizophrenia, those patients with religious delusions appear to be more severely ill. This warrants further investigation.

Adult↗
PubMed2002

Regional brain atrophy in patients with mild Alzheimer's disease and delusions.

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 outpatient 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.

Aged↗