delusions
TRANSCRIPT
NORMAL THINKING
“NORMAL’’ thinking is characterized by
goal directed
succession of ideas ,associations and
symbols
leading to rational conclusion
Grave errors in any of the above mentioned steps
qualifies for a thought disorder
The process of thinking was divided into
three types:
Undirected fantasy thinking(autistic
thinking)
Imaginative thinking
Rational thinking
Thought disorders are broadly
of 4 types:
Disorders of form
Disorders of progression
Disorders of content
Disorders of possesion
DEFINATION
It is a false, unshakable belief that is out
of keeping with the patients social and
cultural background
A false belief based on incorrect inference
about external reality that is firmly held
despite what everyone else believes and
despite what constitutes incontrovertible
and obvious proof or evidence to the
contrary. the belief is not ordinarily
accepted by other members of the
persons culture or subculture
Jaspers claim regarding
delusions are:
They are false judgments
They are held with extraordinary convictions and incomparable subjective certainty
They are impervious to counterarguments
Their content is impossible
All four criteria have been subjected to criticism
Kendler et all have proposed
several poorly correlated
dimensions of delusional
severity Conviction: the degree to which the patient
is convinced of the reality of delusions
extension: the degree to which the belief involves areas f pts life
Bizareness: depicting degree of departure from culturally determined consensual reality
Disorganization
Pressure: preoccupation n concern with the belief
Origins of delusion
conrad proposed 5 stages in
the development of delusions
Trema: delusional mood ;a total change in
perception of the world
Apophany:a search for and the finding
of,new meaning for psychological events
Anastrophy:heightening of psychosis
Consolidation:forming of a new world or
psychological set based on new meanings
Residuum:eventual autistic state
Conrad’s Stage Model of
Beginning Schizophrenia
StageI: Trema
(derived from Greek, colloquial for stage fright)
Meaning :Delusional mood (or atmosphere)Characteristics :Undefinable, but increasingly upsetting quality spreads from salient aspects to entire perceptual field. Patient feels anticipatory excitement, suspiciousness, alienation, fear, guilt, depression, or combination of these. Patient may perform abrupt, seemingly meaningless actions
II Apophany
(Greek apo [away from] + phaenein to show → revelation)
Meaning:Delusion as revelation (Aha-Erlebnis)
Characteristics :Perceptual Gestalt experienced incompletely in terms of its expressive rather than its objective material holistic qualities. Inability to transcend current perspective or to shift frame of references. Abnormal connectedness between seemingly unrelated meanings. Delusional perception, misidentification. Relentless (“monotonous, repetitive”) spreading of the delusion as both “elastic” and fixed to new gestalts.Progressionof delusions from external to inner “space”, delusional body sensations. Patient uncritically receptive and unable to detach, as if trapped between sleeping and waking. Thought insertion, thought broadcasting, hallucinations
III Anastrophe
(Greek, ana- (back) + strephein (to turn) →
turning back)
Meaning: Patient feels self to be passive
middle point (subject-directed
complement to world-directed apophany)
Characteristics : Delusions of reference.
Events and perceptions are related to self
Classification of delusions
Parameter type
Depending on origin Primary and secondary
Depending on theme Grandiose, persecutory,
jealousy etc
Depending on congruency
with mood
Mood congruent or not
Depending on reality
value
Partial or complete
Depending on complexity Simple or complex
Primary and secondary
delusions
Primary delusion: that is not occuring in response to another psychopathological form
for eg :in schizophrenia patients
Secondary delusion: occuring secondary to some other psychopathological condition
For eg:delusion of grandiosity in mania
Primary delusions Secondary
delusions
Ununderstanble
Not in correlation with
some other
psychopathology
Occur in schizophrenia
Understandable
In accordance with some
other psychopathological
condition.
Occur in other conditions
.may be understood in
terms of persons
background ,culture or
emotional state
Types of primary delusions
Autochthonous delusion(delusional
intuition: sudden delusional idea occurs
out of the blue
Delusional percept:occurs in two stages
perception and then false interpretation
Delusional atmosphere/mood
Delusional memory/retrospective
delusions
Content of delusions delusion of persecution
Delusion of guilt
Morbid jealousy and delusion of infedility
Delusion of love
Grandiose delusion
Delusion of poverty and nihilistic delusion
Hypochondriacal delusion
Somatic delusions
Delusion of infestation
Delusions of control
Delusional misidentification(capgras syndrome)
Religious delusion
Delusion of persecution
Incorrectly also known as paranoid delusion
Paranoid actually mean delusional derived from
The Greek word paranoia literal meaning
By the side of mind
Forms of Delusions of
persecution Delusion of reference : the patient knows
that people are talking about him, slandering him or spying on him.ideas are not confined to schizophrenia can also occur in depression and other psychotic illnesses
Delusion of guilt :seen in patients with severe depression who feel they are extremely wicked thus,it is justified to spy on him.
Delusion of being poisoned
Delusion of influence
Delusion of
guiltThe patients believe that
they are bad or evil. And
have ruined their family
Seen in cases of severe
depression.
Delusion of infidelity
Also known incorrectly
As delusion of jealousy
Patients of delusions of infidelity
Have morbid jealousy
Instead of delusion of jealousy
Delusion of love
Oh ! salman
khan is in love
wiith me
Also known as fantasy lover syndrome
And erotomania.
The patient is convinced that
someone is in
Love with them although the
alleged lover
may have never spoken to them.
.these may Be a part of
schizophrenia or they may
also Be isolated
symptoms in certain
personality. Margaret Mary "Peggy" Ray (1952 – October 5, 1998)
was an American woman who suffered from schizophrenia ..
She is best known for stalking American television talk show host
David Letterman and retired astronaut Story Musgrave.
Delusion of grandiosity
Primary are seen in
schizophrenia
Secondary in mania.
PATIENT believes that
He is special or has
Special powers.
Nihilistic
delusion
The patient denies the
existence of their body
,their mind,their loved
ones and the world
around them.
Seen in severe agitated
depression,
schizophrenia and states
of delirium.
Delusion of poverty
The patient is convinced that
they are impoverished and
believe that destitution is facing
them and their family.
Hypochondriacal
delusion/delusions
of Ill health/somatic
delusions
Patients believe that they
have some serious illness
Seen in depression,
schizophrenia etc.patient
may also feel his body is
diseased or changed
Delusion of
infestationIn ekboms syndrome, the patient believes that he is infested with small but macroscopic organisms.Seen in hypochondriasis. persistent delusional disorder, organic brain syndromes.
Delusion of
controlThe core belief of the patient is that
he is no longer in sole control of his
own body,
thoughts,feelings,impulses or
behavior.
Delusion of
misidentification/capgras
syndrome/fregoli
syndrome
Capgras is a rare syndrome in
which the patient believes that a
person usually closely related has
been replaced by an exact double.
Fregolis syndrome the delusional
misidentification of an unfamiliar
person as a familiar one,even
though there is no physical
resemblance.
Religious delusions Patient is preoccupied
with false beliefs of
religious nature.
sometimes they exist
within the context of a
conventional religious
system, such as
antichrist or ideas
about nirvana etc.
Not all delusions lead to action. Depressive delusions of
Guilt and hypochondriasis may lead to action if the patient
Does not exhibit psychomotor retardation.
Hypochondriacal delusions may lead to suicide or
if involve the family may lead to homicide.
Case study 1:
Mrs. K is a 39-year-old woman who was brought to the inpatient psychiatric unit by police after being arrested for trespassing on Mr. L’s property. Upon arrival, Mrs. K was adamant about being released, stating that she was simply entering her husband’s home, adamantly declaring that Mr. L was her husband. She elaborated a story about how much the two of them loved each other, when they got married, and how she was currently pregnant with his child. In actuality, Mr. L used to be Mrs. K’s boss, and had fired her because of her inappropriate romantic advances several years prior. Mrs. K was married to another man in Florida, with whom she denied any relationship, stating that she was kidnapped for 4 years, and after escaping, had come to California to be with her husband, Mr. L. Mrs. K was diagnosed with delusional disorder, erotomanictype, and was started on risperidone.
Case study 2:
50 yr male patient Mr.A came to the psychiatry opd on his own ,alone with complains of sleep disturbance and headache on further asking he said his wife was having an affair with his neighbour, which was very distressing to him due to which he used to remain anxious the whole day. the was asked to bring a close relative in the next follow up after 7 days. He was brought after one month forcefully by his sons and nephew complaining that he doesn’t sleep at night and is very suspicious on their mother and also beats her at times . They clarified that she was NOT HAVING AN AFFAIR with their neighbour. Despite availability of many facts to prove the same patients belief was consistent. Otherwise his functioning was absolutely normal .he was started on tab.risperidone .
Case study 3:
55 yr old blind female patient named mrsr.was referred to the psychiatry OPD by general surgeon with complains of tingling sensation, like something was moving inside her abdomen following hysterectomy since last 5 yrs .patient was very distressed because of the same. she had been investigated thoroughly by the surgeon and the obstetrician with no significant findings. She was started on tab olanzapine and on follow up after one month she reported much improvement in the symptoms
Bibliography:
book author
Sims’ symptoms in the
mind
femi oyebode
Fish's clinical
psychopathology
Patricia casey ans brenden
kelly
Internet , PUBMED,industrialpsychiatry
journal