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PubMed1986

Patients with delusions in a community psychiatric service. A follow-up study.

Case records of 546 patients referred for the first time to a community psychiatric service were studied. Fifty-six patients revealed delusions of various types. The female/male ratio was 2:1, and the mean age 57 years. The majority of the paranoid patients belonged to the lowest socio-economic groups. Symptomatology, including type of delusion, treatment given and diagnostic classification is presented. The delusions occurred as part of all major psychotic syndromes with a preponderance of organic and affective psychoses. After 5-20 years of observation a full remission without relapse was seen in only 5%. However, the predictive value of delusions has not been sufficiently established, and the need for prospective studies of course and prognosis of psychoses with delusions is stressed.

Adolescent↗
PubMed1997

The effect of self-referent material on the reasoning of people with delusions.

People with delusions have been shown to have both generalized (Huq, Garety & Hemsley, 1988) and content-specific biases in reasoning (Bentall, 1994). Our concern here was whether the hastiness that has been found when people with delusions reason on relatively abstract tasks would be present on a more realistic task. A second concern was whether reasoning with salient or emotional material would increase the hastiness bias in people with delusions. Two versions of a probabilistic reasoning task were used to study the data gathering of people with delusions. The first version employed realistic but emotionally neutral material. People with delusions requested less evidence before making a decision than psychiatric and normal comparison groups. Therefore, the hastiness found previously with abstract materials was seen to generalize to a more realistic task. In the second version participants were required to reason with material that had an emotional content and may have been regarded as being personally meaningful. In this condition all groups reduced the amount of evidence requested before making a decision.

Adult↗
PubMed1994

Attentional bias, persecutory delusions and the self-concept.

Recent studies of cognitive processes associated with persecutory delusions suggest that such delusions are associated with abnormalities in the processing of information relevant to the self. Attention to positive and negative trait words was studied in subjects suffering from persecutory delusions, matched subjects with depressed mood and normal controls using an emotional Stroop task. Subjects were required to name the ink colours of: (i) meaningless strings of Os, (ii) low self-esteem personal adjectives, (iii) high self-esteem adjectives and (iv) neutral adjectives. subjects were also asked to rate the degree to which they endorsed as self-descriptive these and other personally descriptive adjectives. The subjects with persecutory delusions demonstrated a significantly higher rate of endorsement for positive adjectives than negative adjectives, but showed a marked degree of interference when colour-naming both positive and negative words. The relevance of these findings to a model of persecutory delusions involving the self-concept is discussed.

Adult↗
PubMed2001

Delusions in first-admitted patients: gender, themes and diagnoses.

Whether there is a specific link between certain delusional symptoms and particular etiologies has not yet been completely clarified. In this study, 639 first ever admitted deluded patients were investigated in order to find out whether age and gender are associated with certain delusional contents, whether age at first admission may be linked to certain etiologies and whether it is possible to detect indicators particularly related to basic dysfunctions. At first admission, delusional female patients were older than men with a significant predomination of delusions of persecution, while men presented significantly more frequently delusions of jealousy and grandiosity. Within delusions of persecution, of religious or metaphysical content and of grandiosity, women were even significantly older than men. Religious or metaphysical and grandiosity contents occurred significantly more frequently in ICD-8 schizophrenia, indicating that these themes seem to be particularly linked to ICD-8 schizophrenia. Additionally, some target symptoms not included in the delusional symptomatology were investigated to test the relationship between delusions and schizophrenia. Overall, the results of the present investigation indicate that delusions are not specific for schizophrenia, and therefore, other symptomatological criteria should be applied for the nosographic attribution.

Adolescent↗
PubMedDate not supplied

Phenomenology of delusions in Pakistani patients: effect of gender and social class.

The present study aimed to assess the actual content of delusions of Pakistani schizophrenic patients by gender and social class. A total of 98 schizophrenic patients (48 men and 50 women) from the two psychiatric units in Lahore, Pakistan, were interviewed using the Present State Examination categories. When the sample was analysed as a whole, the delusion of persecution was found to be the most common one followed by the delusion of grandiose identity. When the sample was divided according to gender and social class, two subgroups with surprisingly similar themes of delusions emerged from the analysis, one male and wealthy and the other female and poor. The themes of having special powers and being a star were more frequently found among the former, whereas the themes of black magic, persecution, being controlled and erotomania appeared to be more conspicuous among the latter. The results indicated that the phenomenology of delusions differs in subgroups of the population depending on their socio-cultural roles and specific vulnerabilities.

Adult↗
PubMed1991

Depressive delusion.

In this study of 160 consecutively admitted inpatients who met ICD-9 criteria of endogenous depression, mood-congruent depressive delusions were ascertained in 14.4% (n = 23). The total HRSD score was significantly higher in the delusional than in the nondelusional group. Delusions of guilt were recorded by far the most frequently. There was a correlation between delusions of guilt in the current depressive episode and suicide attempts in the past. In the delusional patients the individual courses of the illness were characterized by marked symptomatological differences from one depressive episode to another. In all but one of the patients, depressive delusions coincided with a thematically identical experience of anxiety. How often anxiety occurs in delusional form depends substantially on the respective theme of anxiety. In accordance with earlier psychopathological literature the findings confirm that depressive delusion is closely linked to the experience of anxiety.

Adult↗
PubMed1994

The Capgras and Cotard delusions.

We explore the relation between the Capgras delusion (the belief that your relatives have been replaced by impostors) and the Cotard delusion (the delusional belief that you have died). At first sight, these delusions would seem to have little to do with each other, except that they both involve bizarre claims about existence (for self or others). On closer examination, however, there are other parallels. Here, we summarise similarities in associated impairments of face perception, and argue that both delusions reflect an interaction of impairments at two levels. One set of contributory factors involves perceptual impairment, or anomalous perceptual experience. The other factors lead to an incorrect interpretation of this, for which we offer an explanation in terms of attribution theory. Although the Capgras and Cotard delusions are phenomenally distinct, they may therefore represent attempts to make sense of fundamentally similar experiences.

Adult↗
PubMed2005

Genotype-phenotype studies in bipolar disorder showing association between the DAOA/G30 locus and persecutory delusions: a first step toward a molecular genetic classification of psychiatric phenotypes.

OBJECTIVE: The authors previously reported an association between the D-amino acid oxidase activator (DAOA)/G30 locus and both schizophrenia and bipolar affective disorder. Given the presumed role of DAOA/G30 in the neurochemistry of psychosis and its localization in a schizophrenia and bipolar affective disorder linkage region (13q34), it was hypothesized that the bipolar affective disorder finding would be mainly due to an association with psychotic features. METHOD: The marker/haplotype associations obtained in a subset of 173 bipolar affective disorder patients with psychotic features were similar to those in the overall patient group, suggesting that stratification on the basis of psychotic features in general might be too crude a procedure. The authors therefore tested whether confining caseness to specific psychotic features would improve detection of genotype-phenotype correlations. RESULTS: In a logistic regression, "persecutory delusions" were found to be the only significant explanatory variable for the DAOA/G30 risk genotype among 21 OPCRIT symptoms of psychosis. The authors therefore tested for association between DAOA/G30 and bipolar affective disorder in the 90 cases with a history of persecutory delusions. Whereas this subset showed strong association (odds ratio=1.83 for the best marker), the remaining larger sample of 165 patients with no such history did not differ from comparison subjects, suggesting that the association between DAOA/G30 and bipolar affective disorder is due to persecutory delusions. This was confirmed in an independent study of 294 bipolar affective disorder patients and 311 comparison subjects from Poland, in which an association between bipolar affective disorder and DAOA/G30 was only seen when case definition was restricted to cases with persecutory delusions. CONCLUSIONS: These data suggest that bipolar affective disorder with persecutory delusions constitutes a distinct subgroup of bipolar affective disorder that overlaps with schizophrenia.

Adult↗
PubMed1998

Alteration of regional cerebral glucose utilization with delusions in Alzheimer's disease.

The authors examined 65 patients with Alzheimer's disease for delusions and explored the relationship of delusions with regional cerebral glucose metabolism determined by [18F]fluorodeoxyglucose PET. In patients with delusions (n = 26), normalized glucose metabolism was significantly increased in the left inferior temporal gyrus and significantly decreased in the left medial occipital region as compared with those without delusions (n = 39). The two groups were similar in age, sex, and dementia severity. These results suggest that delusions in Alzheimer's disease are attributable to a dysfunction in specific brain areas rather than a simple reaction to intellectual deficits.

Aged↗
PubMed1991

Delusions in dementia syndromes: investigation of behavioral and neuropsychological correlates.

A prospective cross-sectional investigation examining the relationship of neuropsychological and behavioral changes to the occurrence of delusions in dementia syndromes was conducted. Nineteen patients had Alzheimer's disease (AD), and 14 had multi-infarct dementia (MID). Patients with and without delusions were compared with regard to demographic characteristics, neuropsychological and neurological features, and a variety of behavioral disturbances. Delusional patients were more aggressive and exhibited more severe activity disturbances than nondelusional patients. Delusional patients were more severely cognitively impaired, but the neuropsychological differences between the two groups were not outstanding. These observations suggest that specific neuropsychological deficits are not compelling predictors of delusions and that delusional patients are more behaviorally disturbed than those without delusions. It is hypothesized that delusions are independent noncognitive manifestations of the neurobiology of AD and MID.

Aged↗
PubMed2002

Effect of culture and environment on the phenomenology of delusions and hallucinations.

BACKGROUND: The present study was conducted to compare the influence of culture and immediate environment on the phenomenology of schizophrenic symptoms by examining the actual content of delusions and hallucinations in three groups of schizophrenic patients. METHOD: Pakistanis living in Britain (BP; N = 53), Pakistanis in Pakistan (PP; N = 98) and British White (BW; N = 50). The content of the patients' delusions and hallucinations was obtained from medical records and key-workers' reports from All-Saints Hospital, Birmingham and two psychiatric units in Lahore. All references to delusions and hallucinations were coded in accordance with the classification scheme developed for the Present State Examination (Wing et al., 1974). RESULTS: Comparisons indicated greater differences in phenomenology of delusions and hallucinations between the Pakistani pair (BP vs. PP) than between the British groups (BP vs. BW). The findings suggested a stronger influence of the immediate environment on the pathogenesis of delusions and hallucinations. CONCLUSIONS: The results are discussed with reference to the cultural and religious values of the ethnic groups.

Adult↗
PubMed1993

Schizophrenic delusions among Koreans, Korean-Chinese and Chinese: a transcultural study.

In this transcultural study of schizophrenic delusions among Koreans, Korean-Chinese and Chinese, many delusions were shown to be different among the three groups in their frequency and content and the differences could be explained by sociocultural and political factors. Delusional themes sensitive to influence by sociocultural or political situations and changes seem to be 'family', 'love affairs', 'religious matters', 'economic matters', 'specific physical damage' and 'political themes.' Delusions about 'family', 'love affair', 'being raped', 'religious matters' and 'economic and business matters' were most frequent in Koreans. Delusions of 'blood-relatedness', 'longevity' and 'political themes' were most frequent in Korean-Chinese. Delusions of 'bloodsucking and brain or viscera extracted' and 'poison or being pricked by poisoned needle' were most prominent in Chinese.

Adult↗
PubMed1995

Somatic delusions in schizophrenia and the affective psychoses.

BACKGROUND: Delusions relating to the body, a ready source of information about the immediate experiences of psychotic patients, have not been systematically studied. We attempted an account of the phenomena, looking for differences between diagnostic groupings in the type and lateralisation of such phenomena, and for evidence of localisation. METHOD: Somatic delusions elicited at interview with 550 Research Diagnostic Criteria-diagnosed psychotic patients were categorised according to content, and the results were compared across diagnostic groupings. RESULTS: Significant differences were demonstrated, both at the level of individual delusions and in the nature and overall pattern of such delusions. There were also differences between diagnostic groups in the choice of body parts involved. Among male patients there were significant differences in laterality between the groups, with schizophrenic subjects locating abnormal phenomena principally on the left and depressive subjects on the right. A provisional taxonomy of bodily delusions was developed. CONCLUSION: Phenomenological differences between the psychoses were demonstrated and the results offer some support for current hypotheses of localisation of brain dysfunction in the psychotic illnesses.

Adult↗
PubMed2005

Role of distress in delusion formation.

BACKGROUND: Contemporary cognitive psychological theories suggest that distress plays a mediating role in delusion formation. AIMS: To study the amplifying role of distress from early perceptual intrusions to delusion formation. METHOD: A general population sample of 7076 individuals was interviewed with the Composite International Diagnostic Interview (CIDI) in 1996 (baseline), 1997 (T1) and 1999 (T2). At T2, clinicians also scored the Brief Psychiatric Rating Scale (BPRS) item "unusual thought content". Analyses compared hallucinatory experiences with and without subjective distress at baseline for risk of delusion formation at follow-up. RESULTS: Individuals experiencing hallucinations with distress, compared with those without distress had a fourfold increased risk of subsequent delusion formation. CONCLUSIONS: This finding corroborates the hypothesis that distress associated with early perceptual intrusions serves as a catalyst in the development of delusions.

Adolescent↗
PubMed2000

Incidence of and risk factors for hallucinations and delusions in patients with probable AD.

OBJECTIVE: To examine the incidence of and risk factors for hallucinations and delusions associated with patients clinically diagnosed with probable AD. BACKGROUND: Estimates of the incidence of psychosis in AD range widely from 10% to 75%. The risk factors for psychosis of AD are not known, although multiple studies indicate that AD patients with psychosis demonstrate greater cognitive and functional impairment. METHODS: The authors conducted psychiatric evaluations of 329 patients with probable AD from the University of California at San Diego Alzheimer's Disease Research Center to determine the incidence of hallucinations and delusions. They examined data from annual clinical and neuropsychological evaluations to determine whether there were specific risk factors for the development of hallucinations and delusions. RESULTS: Using Cox survival analyses, the cumulative incidence of hallucinations and delusions was 20.1% at 1 year, 36.1% at 2, 49.5% at 3, and 51.3% at 4 years. Parkinsonian gait, bradyphrenia, exaggerated general cognitive decline, and exaggerated semantic memory decline were significant predictors. Age, education, and gender were not significant predictors. CONCLUSIONS: The authors found a relatively high incidence of hallucinations and delusions in patients diagnosed with probable AD and suggest that specific neurologic signs, cognitive abilities, and accelerated decline may be predictive markers for their occurrence.

Alzheimer Disease↗
PubMed2000

Correspondence between delusions and personal goals: a qualitative analysis.

OBJECTIVES: This pilot study describes a qualitative method for exploring delusions in terms of motivational themes. DESIGN: A semi-structured interview schedule was developed on the basis of an elementary conceptual frame specifying research questions. The analysis of each case uses a structured format. Triangulation was used to check: (i) reliability of motive categories; (ii) their consistent application to delusions. METHODS OF ANALYSIS: All patients had delusions and were diagnosed as having a psychotic disorder. Two types of analysis were used: (i) Interpretative phenomenological analysis with features of grounded analysis was used to classify motives. Data from 14 participants was used for this. (ii) The second phase was an examination of a possible correspondence of themes and involved: (a) a category-led thematic analysis of the delusion in terms of motivations; (b) a category-led thematic analysis of life goals and problems again in terms of motivations; and (c) an examination of correspondence between (a) and (b). RESULTS: The classification of goals and difficulties suggested six main categories: social connection; competence; experiential base (i.e. states of mind and body); material base (e.g. housing); direction; and evaluation (i.e. how a person evaluates himself or believes others evaluate him). Four cases are presented, each exploring the correspondence of themes. CONCLUSION: The methods of analysis seemed coherent and useful. In the cases presented, the delusions appeared to relate to fundamental concerns in a person's life.

Adult↗
PubMed2001

Processing of threat-related affect is delayed in delusion-prone individuals.

OBJECTIVES: On the basis of previous reports of an attentional bias for threat-related emotional material in deluded schizophrenics (e.g. Bentall & Kaney, 1989), the present study examined the proposal that a similar bias would be demonstrated by delusion-prone individuals, reflected by longer response latencies for the task of processing threat-related facially displayed affects (e.g. anger, fear). DESIGN: A non-randomized matched group design was employed to examine the performance of delusion-prone individuals in comparison with a control group. METHODS: 50 psychiatrically healthy participants completed the Peters et al. Delusions Inventory (PDI) as an index of delusional ideation (Peters, Day, & Garety, 1996; Peters, Joseph, & Garety, 1999). Subjects were presented with a standard set of facial stimuli depicting happy, sad, neutral, fearful and angry emotion expressions (Mazurski & Bond, 1993). Reaction times for the task of identifying each type of affect were compared between groups of high and low scorers on the PDI. RESULTS: Highly delusion-prone individuals displayed a significant delay in processing angry facial expressions in comparison with low scorers on the PDI. CONCLUSIONS: The increased response latency for processing angry expressions was interpreted as evidence of attentional bias for material posing a threat to the self, supporting previous cognitive data in relation to deluded patients. Threatening facial expressions may be regarded with increased significance by delusion-prone individuals, and it is possible that this bias is involved in the formation of delusional beliefs.

Adolescent↗
PubMed2002

A cognitive model of persecutory delusions.

A multifactorial model of the formation and maintenance of persecutory delusions is presented. Persecutory delusions are conceptualized as threat beliefs. The beliefs are hypothesized to arise from a search for meaning for internal or external experiences that are unusual, anomalous, or emotionally significant for the individual. The persecutory explanations formed reflect an interaction between psychotic processes, pre-existing beliefs and personality (particularly emotion), and the environment. It is proposed that the delusions are maintained by processes that lead to the receipt of confirmatory evidence and processes that prevent the processing of disconfirmatory evidence. Novel features of the model include the (non-defended) direct roles given to emotion in delusion formation, the detailed consideration of both the content and form of delusions, and the hypotheses concerning the associated emotional distress. The clinical and research implications of the model are outlined.

Cognition Disorders↗