2. Schneider suggested there were three features of healthy
thinking:
1. 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does not change in content unless and until it is superseded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.
2. 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.
3. 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:
1. Derailment: the thought slides on to a subsidiary thought.
2. Substitution: a major thought is substituted by a subsidiary one.
3. Omission: consists of the senseless omission of a thought or
part of it.
4. Fusion: heterogeneous elements of thought are interwoven with
each other.
5. 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.
1. True delusions are the result of a primary delusional
experience that cannot be deduced from any other morbid
phenomenon.
2. 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:
1. Unshakable belief in things that are not true,
2. There is a continued belief in the delusion despite contrary
evidence.
3. Though not all delusions are the same.
4. Some might involve non-bizarre beliefs that could theoretically
occur in real life.
5. 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:
1. 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.
2. 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.
3. 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.
4. 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
1. It appears a variety of genetic, biological, psychological, and
environmental factors are at play.
2. 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.
3. 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.
4. Trauma and stress also can trigger delusions. Meanwhile,
individuals who tend to be isolated appear more vulnerable to
developing the delusional disorder as well.
5. Sometimes, people share delusions. This experience is most
common in individuals who reside together and have little
contact with the outside world.
12. Primary Delusions
• Some researchers put delusions into five categories:
1. 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.
2. 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.
3. Memory: In this case, the person’s delusion is an inaccurate
recollection of something that happened in the past.
4. Ideas: This sort of delusion involves complicated, fully formed
thoughts that come out of nowhere.
5. 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.
13.
14. Types of Delusions
• The types are based on the main theme of the delusion:
1. 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.
2. 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.
3. Jealous: A person with this type believes their spouse or sexual partner
is unfaithful.
4. 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.
5. Somatic: They believe they have a physical defect or medical
problem.
6. Mixed: These people have two or more of the types of delusions listed
above.
15. 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."
16. 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.
17. Delusion in psychiatric illness:
1. 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.
2. 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.
3. 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.
4. Mood disorders: Sometimes, individuals with mood disorders like
depression or bipolar disorder may experience delusions.
5. 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.
6. Postpartum psychosis: Hormonal shifts after giving birth may trigger
postpartum psychosis in some women. Some research indicates it's
also linked to bipolar disorder.
18. 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.
