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PubMed2000

Diurnal variation in Cotard's syndrome (copresent with Capgras delusion) following traumatic brain injury.

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.

Adolescent↗
PubMed2006

A neuropsychiatric model of biological and psychological processes in the remission of delusions and auditory hallucinations.

This selective review combines cognitive models and biological models of psychosis into a tentative integrated neuropsychiatric model. The aim of the model is to understand better, how pharmacotherapy and cognitive-behavior therapy come forward as partners in the treatment of psychosis and play complementary and mutually reinforcing roles. The article reviews the dominant models in literature. The focus in this review is on one hand on neural circuits that are involved in cognitive models and on the other hand on cognitive processes and experiences involved in biological models. In this way, a 4-component neuropsychiatric model is tentatively constructed: (1) a biological component that leads to aberrant perceptions and salience of stimuli, (2) a cognitive component that attempts to explain the psychic abnormal events, (3) a mediating component with psychological biases which influences the reasoning process in the direction of the formation of (secondary) delusions, and (4) a component of psychological processes that maintains delusions and prevents the falsification of delusional ideas. Remission consists actually of 2 processes. Biological remission consists of the dampening of mesolimbic dopamine releases with antipsychotic medication and decreases the continuous salient experiences. Psychological remission consists of the reappraisal of primary psychotic experiences. Both forms of remission are partially independent. We expect that a full remission including biological and psychological remission could prevent relapse.

Cognitive Behavioral Therapy↗
PubMed2001

Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care.

OBJECTIVE: To examine prospectively the relationship between memories of intensive care (ICU) and levels of anxiety after ICU discharge, the stability of these memories with time, and their relationship to the development of acute posttraumatic stress disorder (PTSD)-related symptoms. DESIGN: Case series cohort assessed by interview at 2 and 8 wks after ICU discharge. SETTING: District general hospital (serving a population of 350,000) general intensive care unit. PATIENTS: Memories of ICU and anxiety levels were studied in 45 patients after ICU discharge. Thirty patients were examined again at 8 wks to assess memory stability and development of acute PTSD-related symptoms. MEASUREMENTS AND MAIN RESULTS: Standardized interviews and questionnaires were used to assess memory for ICU, anxiety, and depression 2 wks after ICU discharge. In addition, PTSD-related symptoms and panic were assessed 8 wks after ICU discharge. A total of 33 of 45 patients had delusional memories from ICU at 2 wks; nine of the patients with delusional memories had no factual memories, and these patients had higher anxiety levels 2 wks after ICU discharge (p < .0001). Thirty patients had paired assessments at 2 and 8 wks. Those patients who had no factual recall of ICU but had delusional memories at 2 wks scored highly for PTSD-related symptoms and panic attacks at 8 wks (p = .023 and .014, respectively). The only predictors of possible acute PTSD-related symptoms at the 8-wk assessment were trait anxiety (p = .006) and having delusional memories without recall of factual events in the ICU at 2 wks (p < .0001). Only delusional memories were retained over time, whereas the recall of factual events in the ICU declined. CONCLUSIONS: We propose that the development of acute PTSD-related symptoms may be related more to recall of delusions alone. This study suggests that even relatively unpleasant memories for real events during critical illness may give some protection from anxiety and the later development of PTSD-related symptoms when memories of delusions are prominent.

Acute Disease↗
PubMed1977

Telepathy in mental illness: deluge or delusion?

The belief that one can read others' minds has long been considered a symptom of psychosis, despite reports in the parapsychological literature of veridical telepathy. All patients admitted to an inpatient psychiatric unit were screened for paranormal beliefs, and those claiming telepathic abilities were tested in a free-response ESP task. Eighteen per cent of the inpatient population claimed telepathic abilities; of the nine patients who completed the task, none performed above chance expectations. Higher frequencies of paranormal experiences than those reported previously in the psychiatric literature were attributed to the context of the study. Schneider's first rank symptoms and a belief in telepathy discriminated schizophrenics more reliably than other paranormal experiences. Possible psychodynamics of delusions of telepathy were discussed in view of the predominance of women and younger men reporting them, as were the possible effects of such research on patients' delusions.

Adolescent↗
PubMed1983

Hallucinations vs. delusions. A developmental approach.

The developmental levels of three samples of paranoid and nonparanoid schizophrenic patients who manifested hallucinations, delusions, or both symptoms were compared. The patient sample consisted of 432 men and 207 women. Developmental level was assessed by the Zigler-Phillips Social Competence Index. Patients who manifested delusions were found to be at a higher developmental level than those who suffered hallucinations. The social competence of patients having both symptoms tended to fall between the levels of the single symptom groups. Females had higher competence scores than males, and paranoid patients had higher scores than nonparanoid patients. The results were discussed in terms of the significance of developmental level as a pervasive dimension of the individual which relates to the expression of specific symptoms and other facets of psychiatric disorder.

Adult↗
PubMed1992

Persecutory delusions and the self-serving bias. Evidence from a contingency judgment task.

The self-serving attributional bias was studied in matched groups of patients with persecutory delusions, patients with major affective disorder, and normal controls, (N = 14 in each group). On a preprogrammed computer task, subjects mainly won points in one condition and mainly lost points in the other. Subjects were asked to estimate the degree of control they thought they had over winning or losing in the two conditions. In comparison with the normal subjects and the psychiatric controls, the deluded subjects showed a greater self-serving bias, as evidenced by their perceived greater control over outcomes in the win condition. These findings are interpreted as consistent with the hypothesis that persecutory delusions function as a defense against low self-esteem.

Adult↗
PubMed2006

Misunderstanding the intentions of others: an exploratory study of the cognitive etiology of persecutory delusions in very late-onset schizophrenia-like psychosis.

OBJECTIVE: The objective of this study was to explore the cognitive etiology of persecutory delusion formation and maintenance in very late-onset schizophrenia-like psychosis (SLP). METHOD: Probabilistic reasoning, causal attributional style, and mentalizing ability were examined in 29 patients with SLP, 30 with onset of depression after the age of 60 years and 30 healthy comparison subjects. RESULTS: Patients with SLP made significantly more errors than the healthy comparison group in deception, but not false belief, mentalizing tasks. There were no significant performance differences between groups on the probabilistic reasoning task or the attributional style task. CONCLUSIONS: Mentalizing errors may contribute to the development and maintenance of persecutory delusions in SLP. These patients do not appear to show the wider range of cognitive biases described in deluded patients with schizophrenia with onset in younger adult life.

Age of Onset↗
PubMed2005

Confidence in errors as a possible basis for delusions in schizophrenia.

In two previous studies, it was observed that schizophrenic patients display increased confidence in memory errors compared with controls. The patient group displayed an increased proportion of errors in their knowledge system, quantified as the percentage of high-confident responses that are errors. The latter phenomenon has been termed knowledge corruption and is put forward as a risk factor for the emergence of delusions. In the present study, knowledge corruption was analyzed separately for different aspects of memory errors. A source-monitoring task was used, for which participants (30 schizophrenic patients with past or current paranoid ideas and 15 healthy controls) were asked to provide associates for each of 20 prime words. Later, participants were required to recognize studied words among distractor words, judge the original source, and provide a confidence rating for the most recent decision. Schizophrenic patients displayed greater confidence in memory errors compared with controls. Knowledge corruption was observed to be significantly greater in schizophrenic patients relative to controls for false-positive and false-negative judgments. It is proposed that reliance on false knowledge represents a candidate mechanism for the emergence of fixed false beliefs (i.e., delusions).

Adult↗
PubMed1982

Study of delusions in Kenyan schizophrenic patients diagnosed using a set of research diagnostic criteria.

Eighty 'psychotic' Kenyan patients of African origin were screened using the New Haven Schizophrenic Index (NHSI). Fifty-one of these (64%) were found positive. Delusions were found to be significantly more common (P less than 0.001) in the NHSI positive group than in the negative group. Sex and age had no effect on the distribution of delusions in general but level of education did. These findings are compared and contrasted with findings of similar investigations and some of their implications are discussed.

Adolescent↗
PubMed1985

Manic-depressive patients with delusions. Clinical and diagnostic course.

A study was made of the hospital records of 114 first admission patients under 60 years with a diagnosis of manic-depressive psychosis and coexisting paranoid symptoms. The male/female ratio was 1/1.4, and the females were significantly older. Symptomatology and treatment are presented. Seventy per cent disclosed delusions of reference and misinterpretation and 50% had synthymic delusions. During 11-15 years of admission 75% of the patients were re-admitted. The diagnostic concept was changed in 33%. Significantly more females were diagnosed unipolar manic-depressive. According to the general practitioners and hospital records psychotic traits were still present in 50% of the patients at follow-up. Significantly more patients diagnosed as unipolar manic-depressive had no relapse and no remaining psychotic traits. And significantly more patients with changed diagnosis had remaining psychotic traits. The need for prospective studies of patients with coexisting affective and paranoid symptomatology is stressed.

Adolescent↗
PubMed1992

Persecutory delusions and recall of threatening propositions.

Subjects suffering from persecutory delusions, psychiatric controls and normal subjects were required to recall immediately six passages of prose, half of which contained mildly threatening propositions. Deluded subjects recalled fewer propositions overall but more propositions of specifically threatening content. These findings suggest that the role of recall bias in persecutory delusions merits further study.

Adult↗
PubMed1985

Delusions: problems in definition and measurement.

A review is made of definitions of 'delusion'. Problems with these are considered in terms of clarity and consistency with the evidence. Questions concerning the issues of fixity and intensity of delusions are raised and a proposal is made for attempting to operationalize these concepts using a 'personal questionnaire' method. The measurement in a pilot study of the fixity and intensity of the beliefs of two patients using this method is described and the results reported.

Adult↗
PubMed1989

Persecutory delusions and attributional style.

Seventeen psychotic patients with persecutory delusions were matched against depressed and normal controls and assessed for magical ideation, locus of control and attributional style. The deluded and depressed patients were found to make global and stable attributions when compared to the normal subjects. However, the deluded patients, in contrast with both control groups, made excessively external attributions for negative events and internal attributions for positive events. Highly significant differences were observed between the deluded group and the two control groups on magical ideation and on the 'powerful others' subscale of the locus of control questionnaire. Both psychiatric groups differed from the normal control group on 'chance' locus of control and a significant difference was observed between the persecuted and normal subjects on the 'internality' subscale of the questionnaire. The implications of these findings for the understanding and treatment of paranoid delusions are discussed.

Adult↗
PubMed1992

Defining delusion and the serving of professional interests: the case of 'paranoia'.

This paper examines the related concepts of paranoia and delusion from a broadly social constructionist perspective. Through an analysis of the American Psychiatric Association's (1987) definition of delusion, inherent inconsistencies and implied philosophical assumptions are highlighted. It is argued that psychiatric definitions are not merely academic and clinical but are a site of political and professional interest. The implications of such an analysis are discussed with particular reference to developing new directions for research and clinical practice.

Adult↗
PubMed1995

Shared delusions of doubles.

This is the first report of two partners in a folie à deux situation manifesting identical Capgras delusions. It is postulated that the Capgras syndrome developed as a result of interaction between a dominant patient with primarily paranoid psychopathology and a submissive one with primarily organic dysfunction. The submissive "neuro-organic" partner experienced a non-delusional misidentification that acquired a delusional component and developed into the Capgras syndrome as a result of elaboration by the dominant paranoid partner, who subsequently "imposed" the Capgras delusion on the submissive partner. The submissive patient, and, to a lesser extent the dominant patient, had evidence of organic cerebral dysfunction.

Adult↗
PubMedDate not supplied

Delusion of infestation with post-partum onset: case report.

Compared with men, women have a greater lifetime risk of delusions of infestation, with the risk appearing to increase around the menopause, when the blood levels of reproductive hormones are decreasing. Women also have a greater lifetime risk of depression and an increased incidence of depressive symptoms post partum, when the blood levels of these hormones are decreasing as well. The first case of a delusion of infestation with post-partum onset is described, and possible associations with reproductive function in women are discussed.

Adult↗
PubMed2005

Delusions or obsessions: the same only different? A case report.

The phenomenological distinction between delusions and obsessions has been the subject of much debate in psychiatry. Some authors feel these symptoms are distinct nosological entities, while others argue that they reflect manifestations of the same symptom and are distinguishable on the basis of the level of insight a patient displays. In this report we describe the case history of a lady who presented with an obsessional disorder. The symptom was resistant to standard treatments and subsequently became more delusional in nature. We review the literature in terms of the classification of obsessions and delusions and offer assistance to clinicians in terms of the diagnosis and treatment of cases where the distinction between these phenomena is not clear and offer alternative means of classifying these symptoms based on insight.

Adult↗
PubMed2006

Apolipoprotein E genotype influences presence and severity of delusions and aggressive behavior in Alzheimer disease.

AIM: We investigated differences in the prevalence and severity of 10 neuropsychiatric and behavioral symptoms according to apolipoprotein E (APOE) genotype and dementia severity in Alzheimer disease (AD). METHODS: Neuropsychiatric and behavioral symptoms of 110 AD patients were assessed using the Neuropsychatric Inventory. Dementia severity was assessed using the Mini Mental State Examination (MMSE). RESULTS: There were 27 APOE-epsilon4-negative patients, 65 heterozygous patients and 18 homozygous patients. There was a significant association between the number of APOE epsilon4 alleles and prevalence and severity of neuropsychiatric and behavioral symptoms that was mainly attributable to delusions and agitation/aggression, which were more common and severer among homozygous APOE epsilon4 carriers. In addition, the presence of hallucinations, anxiety, apathy and aberrant motor behavior increased with deteriorating MMSE score, independently of APOE epsilon4 status. CONCLUSIONS: The present study showed that the APOE epsilon4 genotype modifies neuropsychiatric and behavioral phenotype in AD. In particular, it was shown that delusions and agitation/aggression were more common and severer among homozygous APOE epsilon4 carriers than among heterozygous or APOE-epsilon4-negative patients.

Aged↗