Delusion

What is delusion, types of delusion

1. Delusion Dr. S ushma R athee assistant clinical psychologist PGIMER, Chandigarh email: [email protected]

2. Schneider suggested there were three features of healthy thinking: Constancy: this is characteristic of a completed thought that does not change in content unless and until it is superseded by another consciously-derived thought. Organisation : the contents of thought are related to each other in consciousness and do not blend with each other, but are separated in an organised way. Continuity : there is a continuity of the sense continuum, so that even the most heterogenous subsidiary thoughts, sudden ideas or observations that emerge are arranged in order in the whole content of consciousness.

3. Schneider (1930) claimed that five features of formal thought disorder could be identified: Derailment: the thought slides on to a subsidiary thought. Substitution: a major thought is substituted by a subsidiary one. Omission: consists of the senseless omission of a thought or part of it. Fusion: heterogeneous elements of thought are interwoven with each other. Drivelling : there is disordered intermixture of constituent parts of one complex thought. These disorders may be difficult to distinguish from each other in the clinical setting.

4. Delusion A belief that would be seen by most members of a society as a misrepresentation of reality is called a disorder of thought content, or a delusion . Because of its importance in schizophrenia, delusion has been called “the basic characteristic of madness ”. A  delusion  is a firm and fixed belief based on inadequate grounds not amenable to rational argument or evidence to contrary, not in sync with regional, cultural and educational background. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation,  belief,  illusion, or some other misleading effects of perception.

5. Cont ….. Disorders of the content of thinking. There is also a distinction between true delusions and delusion-like ideas . True delusions are the result of a primary delusional experience that cannot be deduced from any other morbid phenomenon. Delusion like idea is secondary and can be understandably derived from some other morbid psychological phenomenon – these are also described as secondary delusions.

6. Cont … Delusions have been found to occur in the context of many pathological states (both general physical and mental) and are of particular diagnostic importance in  psychotic disorders including schizophrenia,  paraphrenia , manic episodes of bipolar disorder, and psychotic depression .

7. Signs of Delusion: Delusions are characterized by: Unshakable belief in things that are not true, There is a continued belief in the delusion despite contrary evidence. Though not all delusions are the same . Some might involve non-bizarre beliefs that could theoretically occur in real life. Others may be bizarre, fantastical, or impossible .  The delusional symptom may play a role in the diagnosis. Delusional disorder, for example, is characterized by non-bizarre delusions that often involve the misinterpretation of an experience or perception . Schizophrenia, however, may be marked by bizarre delusions, or beliefs that are absurd and not rooted in reality.

8. Delusions are categorized into four different groups: Bizarre delusion:   Delusions are deemed bizarre if they are clearly implausible and not understandable to same-culture peers and do not derive from ordinary life experiences .  An example named by the DSM-5 is a belief that someone replaced all of one's internal organs with someone else's without leaving a scar, depending on the organ in question. Non-bizarre delusion:   A delusion that, though false, is at least technically possible , e.g., the affected person mistakenly believes that they are under constant police surveillance, which is unlikely, but nonetheless still a plausible reality. Mood-congruent delusion:   Any delusion with content consistent with either a depressive or manic state , e.g., a depressed person believes that news anchors on television highly disapprove of them, or a person in a manic state might believe they are a powerful deity. Mood-neutral delusion:   A delusion that does not relate to the sufferer's emotional state ; for example, a belief that an extra limb is growing out of the back of one's head is neutral to either depression or mania .

9. Causes It appears a variety of genetic, biological, psychological, and environmental factors are at play . Psychotic disorders seem to run in families , so researchers suspect there is a genetic component to delusions .  Children born to a parent with schizophrenia, for example, may be at a higher risk of developing delusions. Abnormalities in the brain may also play a role. An imbalance of neurotransmitters (chemical messengers in the brain) may increase the likelihood that an individual will develop delusions. Trauma and stress also can trigger delusions . Meanwhile, individuals who tend to be isolated appear more vulnerable to developing the delusional disorder as well. Sometimes, people share delusions . This experience is most common in individuals who reside together and have little contact with the outside world.

10. Major types of Delusion:

11. Primary Delusions Some researchers put delusions into five categories : Mood or atmosphere:  This involves an uncanny, strange feeling that the world around you is threatening or odd . People who have this type of delusion feel tense and confused because they can’t figure out what about their environment has changed, but they’re convinced something is wrong. Perception:  This type of  delusion is about the person who’s affected rather than about the outside world. What the person believes is real, but they put an unreal amount of importance on it. This intense focus goes beyond what makes sense rationally or emotionally and can feel urgent and personal. Memory:  In this case, the person’s delusion is an inaccurate recollection of something that happened in the past . Ideas:  This sort of delusion involves complicated, fully formed thoughts that come out of nowhere . Awareness:   people are aware of a particular experience . They don’t hear, see, or feel it happening in the world around them -- it’s merely an intensely vivid idea .

12. Types of Delusions The types are based on the main theme of the delusion: Erotomanic :  The person believes someone is in love with them and might try to contact that person. Often it’s someone important or famous. This can lead to stalking behavior. Grandiose:  This person has an over-inflated sense of worth, power, knowledge, or identity. They could believe they have a great talent or made an important discovery. Jealous:  A person with this type believes their spouse or sexual partner is unfaithful. Persecutory:  Someone who has this believes they (or someone close to them) are being mistreated, or that someone is spying on them or planning to harm them. They might make repeated complaints to legal authorities. Somatic:  They believe they have a physical defect or medical problem. Mixed:  These people have two or more of the types of delusions listed above.

13. Cont …. 7. Delusion of control : False belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behavior . 8. Cotard delusion / Nihilistic delusions : False belief that oneself does not exist or has died. 9. Delusion of guilt or sin (or delusion of self-accusation) : Ungrounded feeling of remorse or guilt of delusional intensity . 10. Delusion of mind being read : False belief that other people can know one's thoughts . 11. Delusion of thought insertion : Belief that another thinks through the mind of the person . 12. Delusion of reference : False belief that insignificant remarks, events, or objects in one's environment have personal meaning or significance. "Usually the meaning assigned to these events is negative, but the 'messages' can also have a grandiose quality."

14. Cont …. 13. Religious delusion : Belief that the affected person is a god or chosen to act as a god . 14. Somatic delusion : Delusion whose content pertains to bodily functioning, bodily sensations or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal or changed . Delusion in which one feels infested with insects, bacteria, mites, spiders, lice, fleas, worms, or other organisms . 15. Delusion of poverty : Person strongly believes they are financially incapacitated. Although this type of delusion is less common now, it was particularly widespread in the days preceding state support.

15. Delusion in psychiatric illness: Brief psychotic disorder : People   experience hallucinations, delusions, or disorganized speech that can be triggered by a stressful event. Symptoms usually persist for one month or less. Delusional disorder : People   experience "non-bizarre" types of delusions and can usually act normally and don't have markedly impaired functioning. With only an estimated 0.2% of the population meeting the criteria, this disorder is considered a rare mental illness. Dementia : Roughly one-third of individuals with dementia experience delusions. Often, the delusions involve paranoia, such as thinking family members or caretakers are stealing from them. Mood disorders :   Sometimes, individuals with mood disorders like depression or bipolar disorder may experience delusions. Parkinson’s disease : The prevalence varies widely but it's estimated that up to 70% of patients with advanced Parkinson’s disease experience hallucinations and delusions. Postpartum psychosis :   Hormonal shifts after giving birth may trigger postpartum psychosis in some women. Some research indicates it's also linked to bipolar disorder.

16. Cont …. 7. Schizoaffective disorder : This disorder involves symptoms of schizophrenia as well as a mood issue, like depression or mania. 8. Schizophrenia :   The disorder involves “positive symptoms,” such as hallucinations or delusions. It also involves “negative symptoms,” such as flat affect, reduced feelings of pleasure in everyday life, difficulty beginning and sustaining activities, and reduced speaking.  9. Schizophreniform disorder :   This disorder involves symptoms similar to schizophrenia but for less than six months. 10. Substance/medication-induced psychotic disorder :   Drug or alcohol intoxication or withdrawal may cause some individuals to experience delusions.  Symptoms are usually brief and tend to resolve once the drug is cleared, though psychosis triggered by amphetamines, cocaine, or PCP may persist for weeks.

17. Thanks