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PubMed1994

Delusions of psychological change of the self.

Delusions of psychological change of the self are becoming increasingly appreciated as a type of misidentification delusions. Most available knowledge on delusions of psychological change of the self derives from single case studies. In this article, we present a study encompassing 30 cases of this delusion. Diagnostic and phenomenologic aspects of this delusion are discussed as well as its relation to other types of misidentification delusions.

Adult↗
PubMed2005

Duration of untreated psychosis and time to treatment response for delusions and hallucinations.

OBJECTIVE: Duration of untreated psychosis is associated with time to treatment response among patients with schizophrenia. However, individual psychotic symptoms have not been investigated in this context. The authors examined the relationship between duration of untreated psychosis and time to response for hallucinations and delusions. METHOD: Data were available for 118 patients with first-episode schizophrenia in a longitudinal treatment study. Patients received open-label treatment with conventional antipsychotics and were followed for up to 5 years. Duration of untreated psychosis was correlated with time to response for delusions and hallucinations, and predictors of time to response were examined. RESULTS: Time to response for delusions was significantly longer than that for hallucinations. Duration of untreated psychosis was significantly correlated with time to response for delusions but not for hallucinations. In regression analyses, duration of untreated psychosis was the only predictor for time to response for delusions; it was not a predictor for hallucinations. CONCLUSIONS: The results suggest that duration of untreated psychosis may be specifically associated with time to response for delusions. This association may have clinical implications.

Adult↗
PubMed1982

Delusion across cultures.

The delusions of 200 patients attending a general hospital psychiatric clinic in India were studied; the frequencies of the various types were then compared with results reported from other countries. Delusions of bodily control and of poisoning of food occurred more frequently in the present sample. Grandiose delusions were more commonly seen in the first-born, while in the last-born, delusions of persecution and of reference were more frequent. Females were more likely to develop delusions of infidelity. Possible causes of the relationship between types of delusions and socio-demographic factors are discussed.

Adult↗
PubMed1998

Delusions and self-esteem.

OBJECTIVE: To investigate the hypothesis that the content of delusions and hallucinations is significantly influenced by subjects' global self-esteem and by 5 specific areas of self-esteem. METHOD: The delusions and hallucinations of 40 psychotic patients were assessed by 2 independent raters for content indicative of positive or negative self-esteem and for the extent to which the delusional content would be self-enhancing (or diminishing) and comforting (or discomforting) to the subject. These ratings were correlated with the results of self-esteem inventories completed by the subjects. RESULTS: The content of delusions reflects both global self-esteem and self-regard. CONCLUSIONS: This study demonstrates that 2 specific personality factors, global self-esteem and self-regard, are reflected in the content of delusions and influence whether those delusions are experienced as comfortable (or uncomfortable) and enhancing (or diminishing). Delusional content is therefore consistent with patients' views of themselves, and this may partially account for the persistence of delusions.

Adult↗
PubMed1999

Effectiveness of cognitive therapy for delusions in routine clinical practice.

BACKGROUND: Previous studies have suggested that cognitive therapy is effective in modifying delusions. AIMS: To assess the effectiveness of cognitive therapy on patients seen in routine clinical work. METHOD: Eighteen patients with chronic delusions were treated using cognitive therapy, after the method of Chadwick and Lowe. A single-case multiple-baseline experimental design was used, including a control treatment. Each subject was used as their own control. RESULTS: Six patients reduced conviction in their delusions during cognitive therapy and not during the control treatment. Seven patients' conviction ratings did not change. Five patients showed a variable response. Degree of conviction did not fall to zero in any patient. All patients reported that the therapy had been helpful; six spontaneously mentioned changes in psychotic thinking. CONCLUSIONS: One-third of patients with chronic delusions whom we treated responded to delusion modification with a reduction in degree of belief. Change within therapy sessions predicted outcome, as did variation in the conviction during baseline. Cognitive therapy with delusions should aim at reducing distress as well as conviction.

Case-Control Studies↗
PubMed1984

The anatomic basis of delusions after right cerebral infarction.

We studied the nature and causes of delusions after infarction of the right cerebral hemisphere. Delusions involved orientation in time and place, events in the recent past, and the identities of familiar individuals. Some were transient and disorganized, and others were more fixed. No particular site in the right hemisphere was associated with particular delusions. The different delusions may be varied manifestations of a basic disorder of thought and memory. The major determinant of the delusions was cerebral atrophy. Age, location, and size of lesion had no major effect. The superimposition of a new right hemisphere lesion on a diffusely atrophied brain seems to cause delusions that can be expressed verbally because the left hemisphere is relatively preserved.

Aged↗
PubMed1999

Cognitive approaches to delusions: a critical review of theories and evidence.

PURPOSE: To review critically the evidence for three contemporary theories of delusions. METHODS: The theoretical approaches to delusions proposed by Frith and colleagues ('theory of mind' deficits), Garety and colleagues (multi-factorial, but involving probabilistic reasoning biases) and Bentall and colleagues (attributional style and self-discrepancies) are summarised. The findings of empirical papers directly relevant to these proposals are critically reviewed. These papers were identified by computerised literature searches (for the years 1987-1997) and a hand search. RESULTS: The evidence does not unequivocally support any of the approaches as proposed. However, strong evidence is found to support modifications of Garety and colleagues' and Bentall and colleagues' theories. Studies have replicated a 'jumping to conclusions' data-gathering bias and an externalising attributional bias in people with delusions. There is preliminary evidence for a 'theory of mind' deficit, as proposed by Frith, although possibly related to a more general reasoning bias. Evidence for an underlying discrepancy between ideal and actual self-representations is weaker. CONCLUSIONS: A multi-factorial model of delusion formation and maintenance incorporating a data-gathering bias and attributional style, together with other factors (e.g. perceptual processing, meta-representation) is consistent with the current evidence. It is recommended that these findings be incorporated into cognitive therapy approaches. However, there are limitations to existing research. Future studies should incorporate longitudinal designs and first episode studies, and should not neglect the co-morbidity of delusions, including affective processes, or the multi-dimensional nature of delusions.

Cognition Disorders↗
PubMed2003

Anomalous experiences and the contents of persecutory delusions during acute psychotic episodes.

Criteria for judging the presence of persecutory delusions, and theoretical distinctions between different kinds of persecutory delusions, depend on the identification of the contents of such delusions. The first aim of this study was to assess whether contents can be assessed reliably. It has been suggested that anomalous experiences are involved in the formation and maintenance of delusions. The second aim of this study was to assess whether independent judges could agree when persecutory delusions depend on such experiences. Twenty-two inpatients suffering from acute psychotic episodes were recruited. Two independent raters categorized the contents of their delusions in terms of the timing, agent, intention, motivation, type, and severity of harm using information from a variety of sources. Agreement between the raters was adequate for all content areas and for judgments of associations with anomalous experiences. Using ideas of reference as evidence for the persecution was associated with believing that the harm is already very severe, that multiple types of harm are occurring, and that worse persecution is imminent. Theoretical explanations need to be elaborated to account for the variety of contents that can be identified reliably. Associations with anomalous experiences might guide such elaborations.

Acute Disease↗
PubMed2006

Delusion, narrative, and affects.

Delusions and narrations have very different communicative characteristics. Delusion, when reported, places itself outside of a shared communication, of an interactive field; it is presented as an absolute, non-modifiable, saturated truth, that can only be believed or refuted. A clinical vignette is an example on the possibility that psychoanalytic treatments might be sometime able to at least partly transform a delusion into an account narrated in an interactive situation. The possibility of treatment of a delusion by means of psychotherapy, which deals both with the delusion as a symptom and with the structures underlying it, by creating a relationship whose development can leave the person free to shed his or her delusion, should caution us against too hastily declaring that symptom inaccessible and thus considering it-as not infrequently happens -a sort of "marker" denoting a pathology which, from a psychological perspective, cannot be treated.

Adult↗
PubMed2001

Delusions of parasitosis. A dermatologist's guide to diagnosis and treatment.

Delusions of parasitosis is a rare psychiatric disorder in which the patient has a fixed, false belief that he or she is infested by parasites. Even though it is a psychiatric disorder, these patients usually present to a dermatologist because they are convinced that they have a dermatological problem. Patients with delusions of parasitosis generally reject psychiatric referral. The diagnosis of delusions of parasitosis can often be made on the basis of the history alone, but it is important to make sure that the patient does not have a organic skin disorder, and the delusion is not secondary to another mental or physical illness. The current treatment of choice is the antipsychotic medication pimozide. The principal difficulty in management is convincing patients to take the drug. This results from the obvious discrepancy between the patients' belief system and the clinician's understanding of the situation. The most common adverse effects of pimozide are extrapyramidal symptoms such as stiffness and, less frequently, a special inner sense of restlessness called akathisia. Effective treatment of such extrapyramidal reactions includes benztropine 1 to 2 mg up to 4 times daily as needed, or diphenhydramine 25 mg 3 times daily as needed. Pimozide can have cardiotoxic effects at high dosages. Traditionally, it has been recommended to check pretreatment and post-treatment electrocardiograms even for patients who have no history or cardiac conduction abnormalities or arrhythmia. However, a more recent publication questions the need for this if the patient takes < 10 mg/day, is not elderly, and has no history of cardiac arrhythmia. Effective dosages of pimozide for delusions of parasitosis have ranged from 1 to 10 mg/day. The lowest effective dosage of pimozide should be used for the shortest possible duration to minimize the risk of tardive dyskinesia developing in these patients. Significant improvements in quality of life have been achieved with successful treatment with pimozide. Atypical antipsychotics such as risperidone with a much safer adverse effect profile may prove to be effective for the treatment of delusions of parasitosis in the future.

Adult↗
PubMed2004

Redefining delusion based on studies of subjective paranormal ideation.

The DSM-IV definition of delusion is argued to be unsatisfactory because it does not explain the mechanism for delusion formation and maintenance, it implies that such beliefs are necessarily dysfunctional (pathological), it underestimates the social component to some delusions, and it is inconsistent with research indicating that delusions can be modified through techniques such as contradiction, confrontation, and cognitive-behavioral therapy. However, a well-replicated mathematical model of magical/delusional thinking based on a study of paranormal beliefs and experiences is consistent with the hypothesis that attributional processes play a central role in delusion formation and maintenance. The model suggests attributional processes serve the adaptive function of reducing fear associated with ambiguous stimuli and delusional thinking is on a continuum with nonpathological forms. Based on this collective research an amendment to the definition of delusion is proposed and its clinical implications are addressed.

Delusions↗
PubMed2000

HMPAO SPECT imaging of Alzheimer's disease patients with similar content-specific autobiographic delusion: comparison using statistical parametric mapping.

UNLABELLED: Delusional behavior and thinking are common symptoms in Alzheimer's disease (AD). In the past, these delusions have been considered to be psychotic complications of global neurologic dysfunction. Recently, authors have suggested that content-specific delusions in AD are associated with discrete regional abnormalities of the right hemisphere. METHOD: This study compared 99mTc-hexamethyl propyleneamine oxime (HMPAO) SPECT images of a group of AD patients with a similar autobiographic delusion with a group of AD patients without delusions and a group of AD patients with a range of delusions but without autobiographic content. The reconstructed SPECT data were compared using a statistical parametric mapping technique. RESULTS: The autobiographic AD group had a significant area of hypoperfusion in the right frontal lobe when compared with the 2 other groups. The area of hypoperfusion included parts of Brodmann's areas 9 and 10. Region 9 has been identified previously as having a role in episodic memory retrieval. CONCLUSION: This result suggests that autobiographic delusions in AD may have an identifiable neuropsychologic mechanism and that it may be possible to identify an organic cause in some patients using 99mTc-HMPAO SPECT.

Aged↗
PubMed1989

[Comparison of the content of delusions of schizophrenics in China and Japan: cross-cultural psychiatric investigation].

A comparative cross-cultural psychiatric study was carried out in order to evaluate the theme of delusions of the present day between China and Japan in schizophrenia in relation to their socio-cultural background. The data base was comprised of the schizophrenic cases with the first admission in each hospital--Shanghai in the period 1983, Tokyo in the period 1981-1983 (Shanghai 200 cases, Tokyo 186 cases), and the analysis was focused on those cases with delusions (Shanghai: 129 cases with 70 male and 59 female; Tokyo: 112 cases with 53 male and 59 female). The incidence of delusions with persecution, reference, physical persecution and grandeur was relatively high in patients in Shanghai or Tokyo, while the incidence of delusions with hypochondriacal and guilt was low in both hospitals. Only the incidence of delusion of poisoning was significantly higher in Shanghai than in Tokyo (chi 2 = 12.97, P less than 0.001). The authors have discussed the influence of social-cultural background on the formation of delusions of poisoning, persecution, grandeur, descent and possession about two countries.

Adult↗
PubMed1982

[Conforming delusions].

A number of schizophrenic patients with the delusion homogeneous in its contents (conformant delusion) were examined. The results of the examination have shown that the delusion of this type can develop not only simultaneously, by the inter-induction mechanism, but also by way of transfer, suggestion of the delusional idea, i.e. by the type of suggestive psychoses. The leading role in the mechanism of the conformant delusion formation belongs to endogenous factors, and namely, to the regularities of the basic disease development that determine the peculiarities of the time course and outcome of the conformant delusion. A slowly progressing course of the disease without gross negative changes, a tendency to formation of "worshipped" delusional ideas, and formation of acquired reactive lability are the peculiarities of a schizophrenic process which are the "grounds" for conformant delusion formation.

Adolescent↗
PubMed1994

Erotomanic delusions and electroconvulsive therapy: a case series.

BACKGROUND: Erotomania, as a primary disorder, is categorized in DSM-III-R under delusional (paranoid) disorder. However, erotomanic delusions also are seen frequently in the context of other psychiatric disorders. There is increasing evidence that patients with such delusions often have an underlying affective disorder and effective treatment of the underlying disorder can lead to resolution of the erotomanic delusions. METHOD: The case histories of three patients with prominent affective features and erotomanic delusions are presented. RESULTS: Each patient was treated with bilateral electroconvulsive therapy (ECT) after experiencing treatment failure with numerous other somatic therapies. One showed only a slight and transient improvement, while two demonstrated resolution of the erotomanic delusions. CONCLUSION: Bipolar and schizoaffective disorder should be considered in patients with erotomanic delusions, and ECT may offer an effective alternative when other somatic treatments have failed.

Adult↗
PubMed1976

[Delusions of self-justification, innocence, forgiveness and justification in schizophrenia].

Delusions of selfjustification directed towards a denial of imaginary guiltiness are characterized by an activity of delusional speech and behaviour. In delusions of innocence the patients partially acknowledge imaginary guiltiness, their opinions and behaviour are passive. These forms of delusions are encountered in the structure of depressions with delusions, paranoid-depressive, hallucinatory-paranoid, acute delusional and paraphrenic syndromes. Delusions of appeal and justification are frequently seen in the structure of paraphrenic syndromes. These forms of delusions occupy a subordinate position in relation to other forms of psychopathological structures.

Adult↗
PubMed2002

The role of affect and reasoning in a patient with a delusion of misidentification.

INTRODUCTION: This study investigated a patient with a delusion of misidentification (DM) resembling a Capgras delusion. Instead of the typical Capgras delusion--the false belief that someone has been replaced by an almost identical impostor--patient MF misidentified his wife as his former business partner. METHOD: Detailed investigation of MF's face processing, affective response and affect perception, and ability to evaluate, and reject, implausible ideas was undertaken. RESULTS: MF's visual processing of identity, gender, and age of familiar and unknown faces was intact but he was unable to identify the facial expressions of anger, disgust, and fear, or to match faces across expressions. MF also showed a reduced affective responsiveness to his environment, and impaired reasoning ability. CONCLUSIONS: We propose that MF's delusion of misidentification resulted from a combination of affective deficits, including impairment of both affective response and affect perception, in addition to an inability to evaluate, and reject, implausible ideas. These deficits, in combination with specific life events at the time of onset of the delusion, may have contributed to the form and content of the delusion. In addition, the results raise the possibility that the processing of face identity and facial expression are not as independent as previously proposed in models of face processing.

Journal Article↗
PubMed2005

Delusions and hallucinations are associated with worse outcome in Alzheimer disease.

BACKGROUND: Delusions and hallucinations are common in Alzheimer disease (AD) and there are conflicting reports regarding their ability to predict cognitive decline, functional decline, and institutionalization. According to all previous literature, they are not associated with mortality. OBJECTIVE: To examine whether the presence of delusions or hallucinations has predictive value for important outcomes in AD. DESIGN, SETTING, AND PARTICIPANTS: A total of 456 patients with AD at early stages (mean Folstein Mini-Mental State Examination [MMSE] score of 21 of 30 at entry) were recruited and followed up semiannually for up to 14 years (mean, 4.5 years) in 5 university-based AD centers in the United States and Europe. Using the Columbia University Scale for Psychopathology in AD (administered every 6 months, for a total of 3266 visit-assessments, average of 7.2 per patient), the presence of delusions and hallucinations was extracted and examined as time-dependent predictors in Cox models. The models controlled for cohort effect, recruitment center, informant status, sex, age, education, a comorbidity index, baseline cognitive and baseline functional performance, behavioral symptoms, and use of neuroleptics and cholinesterase inhibitors. MAIN OUTCOME MEASURES: Cognitive (Columbia MMSE score of < or =20/57 [approximate Folstein MMSE score of < or =10/30]), functional (Blessed Dementia Rating Scale [parts I and II] score of > or =10), institutionalization equivalent index, and death. RESULTS: During the full course of follow-up, 38% of patients reached the cognitive, 41% the functional, 54% the institutionalization, and 49% the mortality end point. Delusions were noted for 34% of patients at baseline and 70% at any evaluation. Their presence was associated with increased risk for cognitive (risk ratio [RR], 1.50; 95% confidence interval [CI], 1.07-2.08) and functional decline (RR, 1.41; 95% CI, 1.02-1.94). Hallucinations were present in 7% of patients at initial visit and in 33% at any visit. Their presence was associated with increased risk for cognitive decline (RR, 1.62; 95% CI, 1.06-2.47), functional decline (RR, 2.25; 95% CI, 1.54-2.27), institutionalization (RR, 1.60; 95% CI, 1.13-2.28), and death (RR, 1.49; 95% CI, 1.03-2.14). CONCLUSIONS: Delusions and hallucinations are very common in AD and predict cognitive and functional decline. Presence of hallucinations is also associated with institutionalization and mortality.

Aged↗