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

Delusion is a type of disorder of

content of thought

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

Trema

apophany

anastrophy

consolidation

residuam

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

Can occur in both organic and functional

disorders . also very common in alcohol

dependence

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

Scoring of delusions

Bibliography:

book author

Sims’ symptoms in the

mind

femi oyebode

Fish's clinical

psychopathology

Patricia casey ans brenden

kelly

Internet , PUBMED,industrialpsychiatry

journal