Disorders of Thought

Disorders of Content

Delusion

• A delusion is a false unshakeable idea or belief which is out keeping with the patient’s educational , cultural and social background. It is held with extraordinary conviction and subjective certainty.

• Subjectively or phenomenologically it is indistinguishable from true belief

Case Vignette• Christina , a 44 year old woman, was arrested after harassing a local

television newscaster with telephone calls and letters asserting that he had fathered, then absconded with her child. She denied any wish to harm him but steadfastly pursued him with demands that he give her “visitation rights” to “their” child. She said she understood that he would be unable to marry her, or even to outwardly acknowledge his love for her, because of his delicate public position.

• There was no indication that the newscaster had ever had a relationship with Chris, although evidence from her files and from her apartment indicated that her fantasized relationship with him had existed for several years. There was no indication of hallucinations, disturbance of affect, significant Mood Disorder, or organic illness, and the woman had never been treated for a psychiatric disorder.

• English word “ delude” means - to mock, to cheat, defrauding etc

• The decision to call a belief as a DELUSION is not made by the person holding the belief , but by an external observer.

• The person who is holding the delusion holds the belief with the same conviction as he holds his other non delusional belief about himself .

• Stoddart’s definition of delusion• A judgement which cannot be accepted by

people of the same class, education, race, period of life as the person who experiences it.

• Hamilton defined delusion as a ‘ a false unshakeable belief which arises from internal morbid processes

• Jaspers regarded delusion as a perverted view of reality, incorrigibly held so giving delusion 3 components

A.They are held with unusual convictionB.They are not amenable to logicC.The absurdity or erroneousness of their

content is manifest to other people.

Dimensions or Vectors of a delusion

• Conviction – degree of conviction• Extension- degree to which delusional belief

involve areas of patients life• Bizarreness- departure from reality• Disorganization- degree to which delusional

beliefs are internally consistent, logical and systemized

• Pressure- patients preoccupation with delusion

• Affective response – the degree to which patient’s emotions are involved with such beliefs

• Deviant behavior- acting upon delusions

Origins of a Delusion- Conrad

• Trema – delusional mood• Apophany – search for and finding a new

meaning for psychological events• Anastrophy- heightening of psychosis• Consolidation- forming a new world or

psychological set based on new meanings• Residuum – eventual autistic state

Primary delusions

• Delusion is not occurring in response to another psychopathology

• “ apophany”• New meaning arises in connection with some

other psychological event• Arises ‘ de novo

• Core feature of a primary or autochthonous delusion is that it is ultimately “ Ununderstandable” - Jaspers

• Eg: a female patient with schizophrenia believes that men enter her flat anesthetize her and gang rape her every night.

Schneider classified primary delusions..

• Delusional mood- patient has a knowledge that something is going around him that concerns him, but he does not know what it is.

• Sudden delusional idea – the delusion occurs fully formed ( autochthonous delusions)

• Delusional perception-• Attribution of new meaning in the sense of

self reference to a normally perceived object• The new meaning cannot be understood as

arising from the patient’s affective state or previous attitudes

• ‘two memberedness’ ( Schneider)-

‘two memberedness’

• there is a link from the perceived object to the subjects perception of this object and a second link to the new significance of this perception

• Schneider divided delusional memory into delusional perception and sudden delusional ideas

Secondary delusions

• Arising from some other morbid experience• Are Understandable• Systematization ?...• Completely systematized delusion- there is

one basic delusion and the remainder of the system is logically built on this error

Content of delusions

Delusional misidentification

• The capgras syndrome– familiar person is been replaced by stranger

• Syndrome of Fregoli- stranger is familiar

• Syndrome of intermetamorphosis- familiar person who is the persecuter shares physical and psychologicalsimilarities with stranger

• Syndrome of subjective doubles- another person is physically transformed to his own self

• Ekbom syndrome- patient believes that he is infested with small but macroscopic organisms.

• Cotard’s syndrome- typically seen in psychotic depression usually in elderly

• Shared delusion – communicated insanity, Folie a deux, Folie a Communique

Overvalued ideas

• Thought that ,because of the associated feeling tone ,takes precedence over other ideas and maintains this precedence permanently for a long period of time.

• Can occur in normal individuals also

• Overvalued idea is an acceptable, comprehensible idea pursued by the patient beyond the bounds of reason.

• It becomes so dominant that all other ideas are secondary and relate to it.

• This term was introduced by Wernicke ( 1906)

Disorders of Possession

obsessions

• A thought that persists and dominates an individuals thinking despite that individual’s awareness that the thought is either entirely without a purpose or else has persisted and dominated their thinking beyond the point of relevance.

• It is a thought, idea, imagery or impulse which is repetitive , intrusive, irrational, recognised as ones own thought and ego dystonic.

• Compulsions- are repetitive ritualistic motor or cognitive acts which are used to control anxiety secondary to obsessions

• Contamination obsessions• Aggressive obsessions• Pathological doubts• Sexual obsessions• Blasphemic obsessions• Obsessive ruminations• miscellenaeous

compulsions

Thought alienation

Thank You..!