Delusions

simplest way to understand delusions

1. DELUSIONS

2. 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

3. The process of thinking was divided into three types: Undirected fantasy thinking(autistic thinking) Imaginative thinking Rational thinking

4. Thought disorders are broadly of 4 types: Disorders of form Disorders of progression Disorders of content Disorders of possesion

5. Delusion is a type of disorder of content of thought

6. definition

7. DEFINATION It is a false, unshakable belief that is out of keeping with the patients social and cultural background

8. 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

9. 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

10. 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

11. Origin of delusions

12. Conrad's stages of delusion residuam

13. 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

14. 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

15. 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.Progression of 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Delusion of guilt The patients believe that they are bad or evil. And have ruined their family Seen in cases of severe depression.

25. Delusion of infidelity Also known incorrectly As delusion of jealousy Patients of delusions of infidelity Have morbid jealousy Instead of delusion of jealousy

26. Can occur in both organic and functional disorders . also very common in alcohol dependence

27. 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 .

28. Delusion of grandiosity Primary are seen in schizophrenia Secondary in mania. PATIENT believes that He is special or has Special powers.

29. 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.

30. Delusion of poverty The patient is convinced that they are impoverished and believe that destitution is facing them and their family.

31. 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

32. Delusion of infestation In ekboms syndrome, the patient believes that he is infested with small but macroscopic organisms. Seen in hypochondriasis. persistent delusional disorder, organic brain syndromes.

33. Delusion of control The core belief of the patient is that he is no longer in sole control of his own body, thoughts,feelings,impulses or behavior.

34. 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.

35. 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.

36. Reality of delusions 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.

37. 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, erotomanic type, and was started on risperidone .

38. 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 .

39. Case study 3: 55 yr old blind female patient named mrs r.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

40. Scoring of delusions

41. Bibliography: book author Sims’ symptoms in the mind femi oyebode Fish's clinical psychopathology Patricia casey ans brenden kelly Internet , PUBMED,industrialpsychiatry journal

42. By Dr. sarandha srivastava