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PubMed1987

[Delusions and society in Japan and China from a transcultural-psychiatric viewpoint].

The relationship between contents of schizophrenic delusions and sociocultural background in the modern society of Japan and China were studied from transcultural psychiatric aspects. The data of this study were derived from the public mental hospitals in Tokyo and Shanghai in a similar size; of 186 cases (88 cases of male, 98 cases of female) of the first admission in Tokyo Metropolitan Matsuzawa Hospital during 1981-1983, 112 cases with delusions (53 cases of male, 59 cases of female) were selected, and of 200 cases (112 cases of male, 88 cases of female) of the first admission in Shanghai Psychiatric Hospital in 1983, 129 cases with delusions (70 cases of male, 59 cases of female) were chosen. The incidence of delusions of physical persecution and grandeur was relatively high in patients of both hospitals in Tokyo and Shanghai, while the incidence of delusions with hypochondria and guilt was low in both hospitals. Only the incidence of delusion of poisoning was significantly higher in Shanghai than in Tokyo (mean 2 = 12.97, p less than 0.001). After the World War II, the patriarchally oriented family system was abolished in Japan which caused shifting the system from a large family to a nuclear family. In China where the property (land) and daily life were closely connected the close human relationship among generations had important values in relation to the labor power within the frame of a large family. It is believed that occurrence of the delusion of poisoning might be a reflection of the disturbed human relationship within the family member in dining which should be helpful for making further understanding and reliance. It's occurrence conflict and struggle in the community of the outside of the family. At present there is a marked difference between Chinese and Japanese in their structure of consciousness. The former places high value and meaningfulness on the participation to the group and seeks protection and safety of individuals. The latter reveals a less strong tie with the traditional conformity and dependency to the mass due to the conformation of the nuclear family. It can not be ignored the possible effect of the close horizontal interaction and cautious human relationships among neighbours with fear of rumor and watching in the Chinese community on the occurrence of the delusion of persecution. After the World War II, abolishment of the principle of vertical control system and introduction of multiple value system together with loss of authority had taken place in Japan.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1997

Normal and abnormal reasoning in people with delusions.

People who experience delusions have been found to request less information prior to making a decision than control participants on tasks that are unrelated to the theme of the delusion (Huq, Garety & Hemsley, 1988). Two studies investigated whether people with delusions have an absolute deficit in reasoning or a more specific data-gathering bias. In Expt 1, 12 people with delusions, 12 people with depression and 12 normal controls were shown the results of spinning a supposedly biased coin. The evidence provided varied in the number of heads to tails. In normal controls a high ratio of head to tails produces a high estimate that the coin is biased. In this experiment, where the evidence gathered was predetermined by the experimenter, all groups of participants were shown to reason in a similar way. Experiment 2 tested whether a difference would exist between the groups in conditions where participants were free to determine the amount of evidence seen, in contrast to when all of them viewed the same evidence. Two jars of beads in opposite but equal ratios (e.g. 85:15, 15:85) were shown to 15 people with delusions, 15 with depression and 15 normal controls. On the basis of beads being drawn one at a time, it was the participants' task to determine which jar they came from. When free to decide when they wished, people with delusions decided on the basis of less evidence than the other groups. However, as in Expt 1, the group with delusions did not differ when made to view the same amount of beads as other participants. Therefore, people with delusions have a data-gathering bias rather than a difficulty in employing the data in reasoning. This "jump to conclusions' bias generalized to a less discriminable ratio of beads (60:40), and was not a consequence of impulsiveness or memory deficit.

Adolescent↗
PubMed1998

The London-East Anglia randomized controlled trial of cognitive-behaviour therapy for psychosis. IV: Self-esteem and persecutory delusions.

OBJECTIVES: There has been a resurgence of interest in the view that persecutory delusions serve a function of defending self-esteem. An alternative account of levels of self-esteem in individuals with persecutory delusions is that they result from processes similar to those studied in people with depression (i.e. from the occurrence of a range of life experiences and how the individual interprets and copes with them). This study aimed to examine both hypotheses together for the first time, and, as the literature indicates that delusions may not share a common cause, attention was given to the possibility of the presence of subgroups. DESIGN: Data were examined cross-sectionally and longitudinally from a randomized controlled trial of cognitive behaviour therapy for 60 people with drug-resistant psychosis. METHOD: The study is based on the initial assessment of all participants on self-esteem, delusional conviction and a large number of demographic, clinical and cognitive measures. Longitudinal analyses were also carried out, and are reported separately for those who received the therapy intervention and those in the control group. RESULTS: Almost three-quarters of participants with persecutory delusions reported low self-esteem. Changes over time in total self-esteem correlated with changes in measures of mood and social functioning, but not conviction in persecutory delusions. The individuals who initially had normal levels of self-esteem displayed a different pattern of results from the majority of participants. CONCLUSION: Low self-esteem in people with drug-resistant persecutory delusions is common and, in most cases, can best be understood in terms of normal emotional processes. There was evidence that the majority of persecutory delusions do not fit either strong or weak formulations of the delusion-as-defence explanation and that there may be subgroups with differing aetiologies. These results need to be replicated, and extended to groups in which symptoms are not resistant to medication.

Adaptation, Psychological↗
PubMedDate not supplied

Comparison of delusions among schizophrenics in Austria and in Pakistan.

One of the central purposes of cross-cultural psychiatry is to scrutinize the sociocultural influences on the phenomenology of psychiatric diseases. On the other hand it is possible to lay bare a nucleus of symptoms, common to all cultures, which, independently of all influences, occupies a central position for an understanding of the disease considered. In this study an attempt was made to approach this problem by means of investigating the contents of delusion of schizophrenic patients in Austria and Pakistan. The contents of delusion among 126 Austrian and 108 Pakistani patients diagnosed as having schizophrenia according to DSM-III-R (art. 295) were compared following the classification of Huber and Gross. Additionally the kind of persecution and the type of the persecutor were registered. However it appeared that only a few contents of delusion are frequent in both countries. In both countries persecution was the most frequently mentioned content of delusion. The comparison of the contents of delusion revealed significantly higher frequencies of delusions of grandeur, guilt and religious delusions in Austrian patients. Significant differences could also be found with the kind of persecution and the persecutor's type. Cultural factors seem to have a decisive influence on shaping the contents of delusion.

Adult↗
PubMed2000

Violence and delusions: data from the MacArthur Violence Risk Assessment Study.

OBJECTIVE: Previous work has suggested that delusions are associated with a higher risk of violence, particularly delusions in which patients believe that people are seeking to harm them or that outside forces are controlling their minds (denoted as "threat/control override" delusions). This study explores the relationship between delusions and violence among patients recently discharged from acute psychiatric hospitalization. METHOD: Data were drawn from the MacArthur Violence Risk Assessment Study, a study of violence in the community that followed 1,136 recently discharged psychiatric patients for 1 year. Interviews at discharge and at five 10-week intervals gathered clinical, historical, situational, and dispositional information, including the presence and nature of delusional thoughts. Violence was ascertained from reports of subjects, collateral informants, and official records. RESULTS: Neither delusions in general nor threat/control override delusions in particular were associated with a higher risk of violent behavior. Comparisons with prior studies suggest that reliance on subject self-reports of delusional symptoms may result in mislabeling as delusions other phenomena that can contribute to violence. CONCLUSIONS: Although delusions can precipitate violence in individual cases, these data suggest that they do not increase the overall risk of violence in persons with mental illness in the year after discharge from hospitalization.

Adolescent↗
PubMed1985

Organic delusions: phenomenology, anatomical correlations, and review.

Organic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxic-metabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.

Aged↗
PubMed1993

Acting on delusions. I: Prevalence.

Associations between delusions and abnormal behaviour were retrospectively assessed in a sample of 83 consecutively admitted deluded subjects. All were interviewed about events in the previous month using a new measure of delusional phenomenology and action. For 59 subjects this information was supplemented by informant interviews. Clinical consensus was reached concerning the probability that actions reported by informants were linked to delusions. Half of the sample reported that they had acted at least once in accordance with their delusions. Violent behaviour in response to delusions was uncommon. Information provided by informants suggested that some aspect of the actions of half of the sample was either probably or definitely congruent with the content of their delusions. However, there was no link between self-reports and informants' reports of such action. A latent class analysis of self-reported delusional action suggested three classes of action, namely aggressive to self or other, defensive action, and either none or single action. Self-reported action was associated with delusions of catastrophe. Informant data suggested that persecutory delusions were the most likely to be acted upon, but in contrast delusions of guilt or catastrophe appeared to decrease the chance of delusional behaviour. Actions associated with abnormal beliefs are more common than has been suggested.

Acting Out↗
PubMed2006

[What is a delusion? A phenomenological view].

BACKGROUND: The debate about dimensional or categorised classification ofsymptoms has widened to include the concept of delusions, one of the key notions in psychiatry. Although interrater agreement concerning the delusion concept is considerable, it is extremely doubtful whether approval also extends to the construct validity. Can the delusion concepts till be described according to the DSM-criteria? AIM: To describe the history of the delusion concept and to present current views on the subject. METHOD: The literature was reviewed with the help ofPubMed. RESULTS: A delusion can best be described as an individual and personal view which cannot befalsifted and to which patientsfeel emotionally attached. Most people consider a delusion to be implausible because it is expressed with such unshakeable certainty. With regard to a a dimension such as conviction there seems to be a continuum that extends from normal ideas to impaired reality-testing. CONCLUSION: If delusions are to be considered as dimensional constructs this will give rise to questions concerning discriminant validity. It will become increasingly difficult to discriminate between delusions and other types of belief that are associated with impaired reality-testing.

Delusions↗
PubMed1990

[Sex differences in schizophrenic delusions].

The authors compared delusions of male schizophrenics (56 cases) with those of female schizophrenics (41 cases) on the following points: 1) characteristics of objects of delusions, i) existence of the central object, ii) their description on this central object, iii) sex of this central object, 2) existence of the erotic-heterosexual delusion, 3) existence of the descent delusion, 4) existence of the sexual cenestopathy, and found that both sexes have many more male objects in their delusions than female objects, and that more women than men have delusions about acquaintances, erotic-heterosexual delusions, and sexual cenestopathy, while more men than women have delusions about distant or abstract objects. Comparing these findings with those of the other authors, the authors discuss them from clinical, psychopathological and psychodynamic perspectives.

Delusions↗
PubMed1998

[Delusions and intuition].

Taking into account the different concepts of delusion and analysing rational and intuitive cognition, the present phenomenological-conceptual study aims at defining the essential nature of delusion. Intuitive cognition as a result of holistic processing is founded in the development of polysensoric-kinaesthetic basic pictures (eidetic matrices), which are recognized preverbally and prereflexively by subliminal perception of corresponding eidetic structures. A positive match between a matrix and a given phenomenon produces an eidetic feeling. This eidetic feeling encompasses three aspects. The first is a preverbal knowledge of something as something definite. As a direct self-reference, the second is the feeling of an object-inherent significance of the given phenomenon for the subject itself. Thirdly, a power vector is perceived to derive from the object. The application of this concept allows us to consider delusion as a disturbance in the system of holistic information processing. This disturbance is characterized by a disinhibition and actualization of eidetic matrices in different ways. The resulting eidetic feeling we call delusion; its expression in thoughts and words we call a delusional idea. All features of an eidetic feeling can be demonstrated in delusion. Owing to their special intensity and suspended reason, they mostly appear to be unique. The analysis of the eidetic structures of delusion allows a deeper understanding of delusion and facilitates both its diagnosis and its differentiation. Heterogeneous terms, such as delusional mood, idea of meaning, idea of reference, delusional notion and delusional perception emerge in an understandable context.

Delusions↗
PubMed2004

Misattribution of external speech in patients with hallucinations and delusions.

BACKGROUND: One of the main cognitive models of positive symptoms in schizophrenia proposes that they arise through impaired self-monitoring. This is supported by evidence of behavioural deficits on tasks designed to engage self-monitoring, but these deficits could also result from an externalising response bias. We examined whether patients with hallucinations and delusions would demonstrate an externalising bias on a task that did not involve cognitive self-monitoring. METHOD: Participants passively listened (without speaking) to recordings of single adjectives spoken in their own and another person's voice, and made self/nonself judgements about their source. The acoustic quality of recorded speech was experimentally manipulated by altering the pitch. Fifteen patients with schizophrenia who were currently experiencing hallucinations and delusions, 13 patients with schizophrenia not experiencing current hallucinations and delusions and 15 healthy controls were compared. RESULTS: When listening to distorted words, patients with hallucinations and delusions were more likely than both the group with no hallucinations and delusions and the control group to misidentify their own speech as alien (i.e. spoken by someone else). Across the combined patient groups, the tendency to misidentify self-generated speech as alien was positively correlated with current severity of hallucinations but not with ratings of delusions or positive symptoms in general. CONCLUSIONS: These findings indicate that patients with hallucinations and delusions are prone to misidentifying their own verbal material as alien in a task which does not involve cognitive self-monitoring. This suggests that these symptoms are related to an externalising bias in the processing of sensory material, and not solely a function of defective self-monitoring.

Acoustic Stimulation↗
PubMed2006

Delusions and processing of discrepant information: an event-related brain potential study.

One possible explanation for why delusions persist despite the awareness of contradictory information is that the new information fails to be integrated. Interestingly, the amplitude of the N400 event-related brain potential (ERP) has been proposed as an index of the integration of information that is discrepant with expectancies whatever the task in which the potential is found. Thus, delusions may persist because of a deficit in integration as indexed by the N400. To test this hypothesis, ERPs were recorded in 35 schizophrenia patients (mean age=30.5+/-5.6 years) and 26 normal controls during a task in which they either had to decide whether or not each target word could be integrated into the category "animal", or had no decision to make, according to the prompt "animal?" or the prompt "inaction". In these conditions, the amplitudes of the N400s to target words that were discrepant with the category were found to be negatively correlated with delusion severity. The patient group was then dichotomized according to a median split of delusion severity, excluding the 5 patients with delusion scores at the median. Mean age, sex ratio, and severity of conceptual disorganization and hallucinations of the two subgroups differed. Controlling for these 4 covariates, the N400s for discrepant targets were found smaller in the 14 More-Delusional patients than in the 16 Less-Delusional patients. These results support the hypothesis that delusions are associated with smaller N400s in patients. Further studies should thus be done to test whether a deficit of N400 processes could have a causal role in the persistence of delusions.

Adolescent↗
PubMed2002

Elasticity and confabulation in schizophrenic delusions.

BACKGROUND: This experiment examines two aspects of delusional cognition that have been reported clinically but not investigated empirically. These are the incorporation of potentially conflicting information into the recall of delusion-related scripts and the type and amount of material produced additional to that presented for recall, referred to here as confabulation. METHODS: Three groups of patients--deluded schizophrenics, non-deluded schizophrenics and matched non-psychiatric controls--were asked to recall two 15-item scripts, which comprised 10 typical and five atypical components. It was hypothesized that deluded subjects whose delusion was relevant to one of the scripts would recall more of the atypical components of the script and would also be less likely to make script-atypical confabulations in the recall of this particular script. RESULTS: Recall was assessed for the amount and type of content remembered and the amount and type of confabulation. The results did not support the hypothesis that atypical items would be incorporated into the recall of delusion-relevant material. However, deluded subjects did retain their schema boundaries in the recall of script items relevant to their own delusion but were less able to adhere to a script framework in the recall of material unrelated to their delusion. CONCLUSIONS: These results are discussed within a schema specific account of delusions, which conceptualizes the delusion as an overused schema whose preferential use leads to a failure to develop other scripts but whose own contents remain well-defined.

Adult↗
PubMed1998

Delusions and hallucinations in patients with borderline personality disorder.

To clarify the nature of delusional and hallucinatory symptoms in borderline personality disorder (BPD), the authors investigated five patients with BPD who developed those symptoms, and discussed their duration, recurrence, types of variants and relation to the situation. The duration of these symptoms tended to vary widely, although six of 11 episodes lasted more than 7 days. Episodes tended to recur in all patients two or three times. Each episode could be classified into three types of delusions and hallucinations, such as delusions without hallucinations, complicated delusion and hallucination, and hallucinations without delusion. Delusions without hallucination occurred a total of four times in two patients and had a tendency to occur when the patient confronted personal adversities. They projected their feelings directly toward the person concerned. A complicated delusion and hallucination was observed three times in two patients. This type of symptom also tended to occur at the time of interpersonal problems but the patient's attitude was more passive. Hallucination without delusion occurred a total of four times in three patients. This symptom tended to occur when the patient avoided an interpersonal relationship. In this case the patients isolated themselves from others and withdrew.

Adolescent↗
PubMed1991

Delusions and hallucinations of cocaine abusers and paranoid schizophrenics: a comparative study.

We compared delusions and hallucinations of 100 cocaine abusers and 100 paranoid schizophrenic subjects admitted to an East Texas state psychiatric hospital. Subjects in both groups feared that individuals or organized groups might harm them in some way, but delusions of the paranoid schizophrenic subjects were more often bizarre than those of the cocaine abuse subjects. "Cocaine bugs" (parasitosis) were more often found in the cocaine abuse subjects. Command hallucinations were found in both groups, but the commands of the schizophrenic group more often related to harming or killing others. Cocaine abusers had a greater frequency of visual hallucinations (47 to 7), distinguished by shadows, flashing lights ("snow lights"), objects moving and bugs crawling on the arm. Finally, the most distinguishing characteristics were identity delusions, possession delusions, grandiose delusions (other than identities and possessions), and delusions that their families were imposters (Capgras Syndrome) reported by paranoid schizophrenics. No such delusions were reported by the cocaine abusers.

Adolescent↗
PubMed2007

The defensive function of persecutory delusions: an investigation using the Implicit Association Test.

INTRODUCTION: Bentall and colleagues (Bentall & Kaney, 1996; Kinderman & Bentall, 1996, 1997) claim that persecutory delusions are constructed defensively, for the maintenance of self-esteem. A central prediction of their model is that such delusions will be associated with discrepancies between overt and covert self-esteem. METHODS: The present study employed a new methodology that has been widely used in investigations of implicit attitudes, the Implicit Association Test (IAT; Greenwald, McGhee, & Schwartz, 1998), to assess covert self-esteem and to test the above prediction. Overt self-esteem was assessed using the Rosenberg Self-Esteem Scale and an adjective self-relevance ratings measure. These measures were administered to 10 patients with acute persecutory delusions, 10 patients with remitted persecutory delusions, and 19 healthy control participants. RESULTS: Patients with persecutory delusions were found to have lower covert self-esteem (as assessed using the IAT) than healthy controls and patients with remitted persecutory delusions. On two measures of overt self-esteem, however, the persecutory deluded group did not differ significantly from the other groups once the effects of comorbid depression had been taken into account. CONCLUSIONS: These results are thus consistent with a model of persecutory delusions as serving the defensive function of maintaining self-esteem.

Adult↗
PubMed2004

Followup of psychotic outpatients: dimensions of delusions and work functioning in schizophrenia.

We studied three characteristics or dimensions of delusions in schizophrenia patients living in the community, including their influence on work and community functioning. The 149-patient sample included 57 delusional schizophrenia and nonschizophrenia outpatients, 50 nondelusional outpatient controls, and 42 delusional inpatient controls. The data indicated the strength and prominence of acute-phase psychopathology on characteristics of delusions, with large significant differences in intensity of delusions between the acute inpatient phase and the postacute inpatient and outpatient phases. Contrary to some views, the data indicate that the overall presence of any delusions in general, and the various dimensions of delusions, both influence work performance and community functioning, with the greater part of the variance due to the presence of delusions in general. Despite their outpatient status, delusional outpatients showed surprisingly poor self-monitoring about whether others would regard their delusional ideation as unrealistic. Schizophrenia and affectively disordered patients with high emotional commitment to their delusions showed significantly poorer work functioning and were significantly more likely to be rehospitalized (p < 0.05), indicating the important impact on functioning of patients' feelings of immediacy and urgency about their unrealistic beliefs.

Activities of Daily Living↗
PubMed2001

Alteration of rCBF in Alzheimer's disease patients with delusions of theft.

We investigated the neural substrate of the delusion of theft in patients with Alzheimer's disease (AD). Nine AD patients with only one type of delusion (delusions of theft) and nine age, cognitive function-matched AD patients without any type of delusions were selected from 334 consecutive outpatients of Ehime University Hospital. All subjects underwent (99m)Tc-HMPAO SPECT scanning, and SPECT images were analyzed by Statistical Parametric Mapping (SPM). AD patients with delusions of theft showed significant hypoperfusion in the right medial posterior parietal region compared to patients without delusions. Our data suggest that attention impairment or lack of awareness of illness caused by right parietal dysfunction might play a role in producing the delusion of theft.

Age Factors↗