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PubMed2006

Need for closure, jumping to conclusions, and decisiveness in delusion-prone individuals.

Need for closure refers to a motivated need for certainty. Jumping-to-conclusions bias refers to the gathering of minimal data when making overconfident probabilistic judgments. Both constructs have been associated independently with delusion-proneness. Fifty-eight nonclinical adults were assessed for jumping-to-conclusions bias using an experimental reasoning task, and need for closure, decisiveness concerning real-life dilemmas, and delusion-proneness using questionnaires. Delusion-proneness was associated independently with need for closure and jumping-to-conclusions bias, with no evidence of a direct relationship between the latter two. These results discount the view that need for closure motivates a jumping-to-conclusions bias, leading, in turn, to delusion-proneness. The various facets of need for closure proved to be independent; while intolerance of ambiguity correlated positively with delusion-proneness, decisiveness correlated negatively. The finding that delusion-prone individuals are more indecisive in everyday life was replicated using different scales. Delusion-proneness is associated independently with jumping-to-conclusions bias on experimental reasoning tasks, intolerance of ambiguity, and indecision concerning real-life dilemmas.

Adolescent↗

PubMed1993

Sequential Cotard and Capgras delusions.

We report sequential Cotard and Capgras delusions in the same patient, KH, and offer a simple hypothesis to account for this link. The Cotard delusion occurred when KH was depressed and the Capgras delusion arose in the context of persecutory delusions. We suggest that the Cotard and Capgras delusions reflect different interpretations of similar anomalous experiences, and that the persecutory delusions and suspiciousness that are often noted in Capgras cases contribute to the patients' mistaking a change in themselves for a change in others ('they are impostors'), whereas people who are depressed exaggerate the negative effects of the same change whilst correctly attributing it to themselves ('I am dead'). This explains why there might be an underlying similarity between delusions which are phenomenally distinct.

Adult↗

PubMed1998

Transcultural study of schizophrenic delusions. Tokyo versus Vienna and Tübingen (Germany).

Schizophrenic delusions of 324 inpatients in Tokyo, 101 in Vienna, and 150 in Tübingen (Germany) were compared according to the same classifications. Among the three areas, about 80% of the patients had equally 'negative' delusions (injury and/or belittlement), and about one-fourth had 'positive' delusions of grandeur. Transcultural influences were found in the detailed contents of the 'negative' delusions; specific and direct themes of persecutory delusion, i.e., delusions of poisoning, and religious themes of guilt/sin were conspicuous in Europe, while amorphous delusions of reference such as 'being slandered' were predominant in Japan. The latter may derive from the group-oriented self in Japanese 'shame culture'.

Adult↗

PubMed2005

Relationship between delusions and regional cerebral blood flow in Alzheimer's disease.

UNLABELLED: To investigate the association between delusions and cerebral functional deficits in Alzheimer's disease (AD), we evaluated probable AD patients with and without delusions. METHODS: Functional brain imaging was performed by single photon emission computed tomography with technetium-99m-labeled ethyl cysteinate dimer (99mTc-ECD) in 64 AD patients and 76 age-matched normal healthy volunteers. SPECT data were analyzed by statistical parametric mapping. RESULTS: In AD patients, no differences were found in age and cognitive activities between those with (n = 25) and without (n = 39) delusions. Compared with normal healthy volunteers, AD patients had significantly decreased perfusion in the posterior cingulate gyri, precunei, and parietal association cortex. Moreover, in the patients with delusions, perfusion was significantly decreased in the frontal lobe with right side dominance. In the comparison between the patients with and without delusions, the patients with delusions had significantly decreased perfusion in the prefrontal cortex, anterior cingulate gyri, inferior to middle temporal cortices, and parietal cortex of the right hemisphere (p < 0.01). CONCLUSION: The functional deficits in the right hemisphere may be the cause of delusions in AD.

Aged↗

PubMed1989

'Delusion of world destruction' (Wetzel). Comparative study between Japan and West Germany.

It has been said that the delusion of world destruction (Weltuntergangserlebnis) in schizophrenia is closely related to Christian culture, and is less frequent in Oriental than in Western countries. Schizophrenic inpatients with delusions of world destruction treated at the Universitäts-Nervenklinik, Tübingen, FRG, were compared with corresponding inpatients at Keio University Hospital and allied hospitals in Japan. As a result, in West Germany, there were 7 (4.7%) patients with delusions of world destruction among 150 schizophrenic patients, accounting for 5.3% of all 131 patients with some delusion. In Japan, 5 (2.8%) of 178 schizophrenic patients had such delusions, accounting for 3.0% of all 166 patients with some delusion. There was no statistically significant difference between the two countries. These incidences were similar to those reported by Kranz (5, 3 and 8% in 1886, 1916 and 1946, respectively) and by Huber and Gross (5.8%). Accordingly, it seems that, although the delusion of world destruction, as a form of world catastrophe, is rare, it occurs among schizophrenic patients at a rather constant incidence, irrespective of the culture or area.

Adult↗

PubMed1994

The frontal lobes and content-specific delusions.

Contemporary research has shown that delusions are often the product of identifiable neurologic disease, particularly when the delusions have a specific theme or are confined to one topic--monosymptomatic or content-specific delusions. Although these delusions are considered rare, some of them can be found at high rates in certain populations and settings. The literature on several classes of content-specific delusions (misidentification, sexual, and somatic) is critically reviewed. The review demonstrates that when adequate diagnostic workups are conducted, a high proportion of such delusions are found to have a neurologic basis. Lesions of the frontal lobes and the right hemisphere are shown to be critical to the development and persistence of many content-specific delusions.

Brain Damage, Chronic↗

PubMed2000

Reality and discourse: a critical analysis of the category of 'delusions'.

Delusions are seen in psychiatric research and practice as central indicators of the psychotic loss of contact with reality. In this paper the psychiatric concept of 'delusions' is critically examined both theoretically and through the analysis of extracts from interviews with individuals diagnosed as 'delusional'. The diagnostic criteria for delusions, implausibility, idiosyncrasy, conviction and incorrigibility, are scrutinized, and the notion of reality that underlies the concept of delusions is deconstructed through the use of social constructionist approaches. The main arguments pursued in the paper are: first, that delusions are meaningful, not because they express something about the world or the speaker, but rather because they employ culturally available discourses and discursive strategies for their construction; second, that delusions are claims which are argued and negotiated in speech with similar strategies to those used by 'non-delusional' individuals; and third, that delusions are statements about the self and the world whose truth and falsity cannot be definitely settled in speech. All three claims are discussed through the analysis of extracts from two interviews with 'delusional' individuals, which focuses on the assumptions underlying the negotiation of claims on reality, the discursive strategies adopted in this negotiation and the way disputes on reality are conversationally produced and settled.

Delusions↗

PubMed2006

[Clinical features of messianic delusions in schizophrenic spectrum disorders].

Clinical features of messianic delusions in endogenous psychoses have been retrospectively studied in 75 patients (33 male, 42 female, aged 16-62 years, illness duration from 0.5 to 39 years) with diagnosis paranoid schizophrenia, continuous type (F20.00)--18 patients, attack like progressive type (F20.02)--17 patients, schizoaffective disorder (F25)--27 and acute polymorphic psychotic disorder (F23.03)--13. Being a kind of delusion of grandeur, messianic delusion is characterized by destruction of "self" as break with the past experience, transformation to mythological characters (total depersonalization) and assignment of supernatural power. Its content is similar to apocalyptical, mystical, antagonistic (Manicheam) delusions. Formation of the delusion plot occurred in the framework of hallucinate-paranoid syndrome received its greatest expression in the structure of paraphrenic and oneiroid syndromes. The volume of its content, duration and mechanisms of delusion formation (hallucinative, sensual and delusion of imagination) were defined by a form of schizophrenic psychosis. Sometimes such patients confer social danger and demand more attention from psychiatrists.

Adolescent↗

PubMed2006

Delusions related to infant and their association with mother-infant interactions in postpartum psychotic disorders.

The relationship between mother infant interactions and psychopathology in postpartum psychotic disorders has been recognised as being clinically important, however data in the field is sparse. The current study had two aims--firstly, to study the prevalence and nature of delusions towards the infant among mothers with postpartum onset severe mental illness and secondly, to study the association between delusional symptoms towards the infant and mother infant interactions. 108 consecutive women with onset of severe mental illness in the postpartum, who were admitted to an inpatient psychiatric unit in South India over a two-year period, were systematically assessed for presence of delusions related to the infant, using the Kannada version of the Birmingham Interview for Maternal Mental Health. Fifty-three percent of subjects reported delusions related to the infant, with 34% reporting more than one delusion. Mothers with infant related persecutory delusions were more likely to show affectionate behaviour and had normal competence and caring for baby's basic needs; however, they were more likely to get disturbed and agitated if separated from the baby. Mothers who had delusions that the baby was a devil or ill fated or someone else's baby, were more likely to have significant abusive incidents towards the baby. Overall, the mothers who had delusions related to the infant were seen to have more significant abusive incidents and were more likely to be considered unsafe in looking after the baby alone. The study emphasises the need for systematic clinical assessment of psychopathology in mothers with postpartum psychosis.

Adolescent↗

PubMed2003

The detection of intentional contingencies in simple animations in patients with delusions of persecution.

BACKGROUND: It has been proposed that delusions of persecution are caused by the tendency to over-attribute malevolent intentions to other people's actions. One aspect of intention attribution is detecting contingencies between an agent's actions and intentions. Here, we used simplified stimuli to test the hypothesis that patients with persecutory delusions over-attribute contingency to agents' movements. METHOD: Short animations were presented to three groups of subjects: (1) schizophrenic patients; (2) patients with affective disorders; and (3) normal control subjects. Patients were divided on the basis of the presence or absence of delusions of persecution. Participants watched four types of film featuring two shapes. In half the films one shape's movement was contingent on the other shape. Contingency was either 'intentional': one shape moved when it 'saw' another shape; or 'mechanical': one shape was launched by the other shape. Subjects were asked to rate the strength of the relationship between the movement of the shapes. RESULTS: Normal control subjects and patients without delusions of persecution rated the relationship between the movement of the shapes as stronger in both mechanical and intentional contingent conditions than in non-contingent conditions. In contrast, there was no significant difference between the ratings of patients with delusions of persecution for the conditions in which movement was animate. Patients with delusions of persecution perceived contingency when there was none in the animate non-contingent condition. CONCLUSIONS: The results suggest that delusions of persecution may be associated with the over-attribution of contingency to the actions of agents.

Adult↗

PubMed2001

Delusions as performance failures.

UNLABELLED: Delusions are explanations of anomalous experiences. A theory of delusion requires an explanation of both the anomalous experience and the apparently irrational explanation generated by the delusional subject. Hence, we require a model of rational belief formation against which the belief formation of delusional subjects can be evaluated. METHOD: I first describe such a model, distinguishing procedural from pragmatic rationality. Procedural rationality is the use of rules or procedures, deductive or inductive, that produce an inferentially coherent set of propositions. Pragmatic rationality is the use of procedural rationality in context. I then apply the distinction to the explanation of the Capgras and the Cotard delusions. I then argue that delusions are failures of pragmatic rationality. I examine the nature of these failures employing the distinction between performance and competence familiar from Chomskian linguistics. RESULTS: This approach to the irrationality of delusions reconciles accounts in which the explanation of the anomalous experience exhausts the explanation of delusion, accounts that appeal to further deficits within the reasoning processes of delusional subjects, and accounts that argue that delusions are not beliefs at all. (Respectively, one-stage, two-stage, and expressive accounts.) CONCLUSION: In paradigm cases that concern cognitive neuropsychiatry the irrationality of delusional subjects should be thought of as a performance deficit in pragmatic rationality.

Journal Article↗

PubMed2006

Suicide associated with the Antichrist delusion.

The Antichrist delusion is a relatively infrequently observed religious delusion. Some cases of the Antichrist delusion have been associated with violence toward others. The aim of this article is to document a case of suicide secondary to the delusion. At age 17 a woman with no history of mental illness developed the belief that she was the Antichrist. For several years she did not discuss this with anyone and functioned appropriately in society. Then, at age 32, after the birth of her first child, her delusion intensified and she ultimately committed suicide to protect others from the harm she felt she was destined to cause them. The Antichrist delusion as a misidentification state may involve danger to a patient who harbors the delusion, as well as to other individuals.

Adult↗

PubMed2006

Delusions in patients with very mild, mild and moderate Alzheimer's disease.

PURPOSE: To compare the prevalence of delusions in different stages in Taiwanese patients with very mild to moderate Alzheimer's disease (AD). METHODS: A consecutive series of 91 patients with probable Alzheimer's disease visited the dementia clinic in a regional hospital in mid-Taiwan were enrolled in this study. All patients were examined with the Neuropsychiatric Inventory (NPI), the Cognitive Abilities Screening Instrument (CASI), and the Clinical Dementia Rating (CDR) scale. RESULTS: The prevalence rate of any delusion in very mild, mild and moderate AD was 35.2%. Delusions of other persons are stealing was most common (27.5%), followed by delusions of self is in danger (15.4%), house is not his/her home (5.5%), family plans to abandon him/her (4.4%), spouse is having an affair (2.2%), an unwelcome guest is living in the house (2.2%), media persons are in the house (2.2%), and others aren't who they claim (1.1%). The prevalence rates of delusions is 33% in very mild AD, 30% in mild AD and 48% in moderate AD. AD (P>0.05). CONCLUSIONS: Delusions are common neuropsychiatric symptoms in very early stage as well as in later stages of Taiwanese patients with AD and it deserves the attention that delusions may be characteristic of very mild AD.

Aged↗

PubMed2000

Delusions and hallucinations in Alzheimer's disease: prevalence and clinical correlates.

OBJECTIVES: The purpose of this study was to examine the frequency of delusions and hallucinations in patients with Alzheimer's disease (AD) and to investigate factors associated with each or the combination of the two. DESIGN: This was a cross-sectional, case-control study. SETTING: Neuropsychiatry and Memory Group, The Johns Hopkins University, USA. PARTICIPANTS: Three hundred and forty-two community-residing patients with probable AD according to NINCDS/ADRDA criteria were included in the study. MEASURES: Patients were assessed clinically for the presence of psychotic symptoms using the DSM-IV glossary definitions. The patients were also rated on standardized measures of cognitive impairment, depression, extrapyramidal symptoms, functional impairment and general health. RESULTS: Seventy-five (22%) AD patients had delusions only, nine (3%) had hallucinations only and 30 (9%) had both delusions and hallucinations. Hallucinations were associated with less education, African-American race, more severe dementia, longer duration of illness, falls and use of anxiolytics. Delusions were associated with older age, depression, aggression, poor general health and use of antihypertensives. Patients with both delusions and hallucinations were similar to the patients with delusions only. CONCLUSIONS: This study confirms the high prevalence of psychotic symptoms in AD patients encountered in clinical practice and suggests that individual psychotic symptoms have different associations.

Aged↗

PubMed2003

Prevalence and relationship to delusions and hallucinations of anxiety disorders in schizophrenia.

We investigated the prevalence of anxiety disorders in a sample of individuals with chronic schizophrenia, controlling for anxiety symptoms that may be related to delusions and hallucinations, and the possible differences in clinical variables between the groups. Individuals with a diagnosis of schizophrenia and able to give informed consent were recruited from the community. The Mini International Neuropsychiatric Interview (MINI) was administered to both confirm the DSM-IV diagnosis of schizophrenia and screen for comorbid anxiety disorders. If a comorbid anxiety disorder was found, its relation to the individual's delusions and hallucinations was examined. Clinical rating scales for schizophrenia were administered as well as rating scales for specific anxiety disorders where appropriate. Overall, anxiety disorders ranged from 0% [ for Post Traumatic Stress Disorder (PTSD)] to 26.7% [ for generalized anxiety disorder (GAD) and agoraphobia without panic] with lower rates when controlled for anxiety symptoms related to delusions and hallucinations. In investigating clinical variables, the cohort was initially divided into schizophrenics with no anxiety disorders and those with an anxiety disorder; with further analyses including schizophrenics with anxiety disorders related to delusions and hallucinations and those with anxiety disorders not related to delusions and hallucinations. The most consistent difference between all the groups was on the PANSS-G subscale. No significant differences were found on the remaining clinical variables. Comorbid anxiety disorders in schizophrenia can be related to the individual's delusions and hallucinations, though anxiety disorders can occur exclusive of these positive symptoms. Clinicians must be aware that this comorbidity exists in order to optimize an individual's treatment.

Adult↗

PubMed2006

Gender, threat/control-override delusions and violence.

This study brings together the threat/control-override perspective and the literature on gender and stress coping to argue that gender moderates the association between threat delusions and violence. We suggest that men are more likely than women to respond to stressors such as threat delusions with violence. We test these ideas using data from the MacArthur Violence Risk Assessment Study, a multi-wave study of post-discharge psychiatric patients. Within-person results from two-level hierarchical models support the idea that men and women cope with threat delusions differently. Specifically, we find that men are significantly more likely to engage in violence during periods when they experience threat delusions, compared with periods when they do not experience threat delusions. In contrast, women are significantly less likely to engage in violence during times when they experience threat delusions, compared with periods when they do not. We discuss these findings in light of the literature on gender and stress coping.

Adaptation, Psychological↗

PubMed1994

A cognitive approach to measuring and modifying delusions.

The present paper summarizes and integrates with the existing literature the results of three studies we have conducted on the measurement and modification of delusions. The findings of two of these studies have been presented previously; the third is briefly reported here. A total of 12 people with delusions took part. Ten participated in two investigations that used between-subject multiple-baseline designs; the remaining two, each of whom held three distinct delusions, took part in a study using an across-beliefs multiple-baseline design. A variety of dimensions of delusional experience were monitored over baseline periods of at least 4 weeks, and two distinct cognitive interventions were used: a structured verbal challenge and a planned empirical test. Our focus in the present article is on intervention and the process of change as people come to question and sometimes reject their delusions. We also address related issues, including problems of measurement (i.e. demand characteristics, independent validation), the connection between depression and delusions and the prediction of treatment response. We conclude with specific recommendations for cognitive therapy for delusions.

Adult↗

PubMedDate not supplied

Persistence and stability of delusions over time.

Traditional descriptions of delusions have emphasized the conviction with which they are held and their resistance to change. This study utilizes data from a large cohort of delusional subjects to assess the persistence and stability of delusional beliefs, and the predictors of change. Data were collected from 1,136 acutely hospitalized psychiatric patients, reinterviewed at 10-week intervals for 1 year. Persistence of delusional beliefs was determined for those delusional subjects with at least one follow-up visit (n = 405), and stability for the subset with delusions at two or more points in time (n = 262). Marked plasticity in delusional beliefs was observed, with one third of delusional subjects at any interview no longer delusional 10 weeks later. Persistence of delusions was associated with schizophrenia, global psychopathology, and having acted on a delusion, among other variables. Most subjects showed variation in the content of their primary delusion over time. Delusions appear to be more fluid over relatively short periods of time than has been suggested by many classic descriptions and contemporary formulations.

Acute Disease↗