DISORDERS OF THOUGHT

CONTENT
P R E S E N T E D B Y - D R .T E S I T A S H E R R Y ( P G S T U D E N T )
M O D R A T O R - D R .V I N O T H
 PRIMARY

1)
DELUSION
THERE ARE 2
TYPES OF
DISORDERS OF SECONDARY
THOUGHT
CONTENT :
2)
OVERVALUED
IDEAS
OVERVALUED IDEAS - Refers to a solitary, abnormal
belief that is neither delusional nor obsessional in
nature, but which is preoccupying to the extent of
dominating the sufferer’s life.(McKenna (1984).
 DEFINITION OF DELUSION

(CTP) DELUSION IS DEFINED AS A

(1) FALSE belief based on incorrect

inference about external reality
(2) FIRMLY held despite objective &
obvious contradictory proof or
evidence,
(3) despite the fact that other members
of the culture DONOT SHARE the belief.
A DELUSION IS A FALSE UNSHAKEABLE
BELIEF, which is out of keeping with the patient’s
social,culture,religious background or his/her level of
intelligence and it is due to internal morbid process(the
fact it is false makes it easy to recognise but this is not
its essential quality). (FISH)

A DELUSION IS A FALSE UNSHAKEABLE

BELIEF WHICH ARISES FROM INTERNAL MORBID
PROCESSES.It is easily recognisable when it is not
keeping with the person’s educational & cultural
background. (HAMILTON)
Karl Jaspers was the first to define the three main
criteria for a belief to be considered delusional in his
1913 book General Psychopathology.

These criteria are:

 Certainty (held with absolute conviction)
 Incorrigibility (not changeable by compelling
counterargument or proof to the contrary)
 Impossibility or falsity of content (implausible, bizarre or
patently untrue).
PRIMARY DELUSION - True delusions, result of
primary delusional experience ( due to faulty thinking
and self-monitoring) which cannot be deduced from
any other morbid phenomena(diagnostic of
schizophrenia but may be seen in organic disorders
like epileptic psychoses).
• Delusion is not occurring in response to
another psychopathology
SECONDARY DELUSION - Delusion-like ideas which can
be understandably derived from some other morbid
psychological phenomena;( perceptual disturbances,
intense emotions & personality disorder).
• Arising from some other morbid experience
 DISTINGUISED
OVERVALUED IDEAS
• Other members of the
culture share the belief.
• Associated with very strong
affect.
• Not held firmly.
• Atleast some level of doubt
as to its truthfulness
• Not recognized as absured.
• Acceptable.
• Can occur in both healthy
and mentally ill patients.
DELUSION
. • Other members of the
culture do not share the
belief.
• Need not be associated
with affect.
• Firmly sustained belief.
. • Convinced that delusion is
real.
• Recognized as absured.
• Cannot be accepted.
• Occur in mentally ill
patients.
KENDLER’S VECTORS FOR DELUSION:
 KENDLER’S VECTORS FOR DELUSION:

■CONVICTION: the degree to which the patient is convinced of the reality

of the delusional beliefs.
■EXTENSION: the degree to which the delusional belief involves areas of
the patient’s life.
■BIZARRENESS: the degree to which the delusional beliefs depart from
culturally determined consensual reality.
■DISORGANIZATION: the degree to which the delusional beliefs are
internally consistent, logical and systematized.
■PRESSURE: the degree to which the patient is preoccupied and
concerned with the expressed delusional beliefs.
■AFFECTIVE RESPONSE: the degree to which the patient’s emotions are
involved with such beliefs.
■DEVIANT BEHAVIOUR RESULTING FROM DELUSIONS: patients sometimes, but
not always, act on their delusions.
 Five stages in the development of
delusion(FISH & CONRAD)

■ TREMA: delusional mood representing a total change

in perception of the world.
■ APOPHANY: a search for a new meaning for
psychological events.
■ ANASTROPHY: heightening of the psychosis.
■ CONSOLIDATION: forming of a new world or
psychological set based on new meanings.
■ RESIDUUM: eventual autistic state.
 FACTORS CONCERNED WITH
GENERATION OF DELUSIONS
(1)Disorders of brain functioning.
(2) Background influences of temperament
& personality.
(3) Maintenance of self-esteem.
(4) role of affect.
(5) As a response to perceptual disturbances.
(6) As a response to depersonalisation.
(7) Associated with cognitive overload.
 PATHOPHYSIOLOGY OF DELUSIONS
• Uncertain and may differ from one disorder to another.

• Dysfunction of prefrontal and temporal lobes 1

and the basal ganglia 2 has
been suggested.

• Dysregulation of Dopamine.

• Endocannabinoid and adenosine systems may be involved.3

1.(Leposavic et al,2009)
2,3. (Morrison and murray,2009)
 PRIMARY DELUSIONS
1.Autochthonous delusion (delusional intuition)

2.Delusional percept

3.Delusional atmosphere

4.Delusional memory
 1.Autochthonous delusion (delusional intuition)
• These are delusions that appear to arise suddenly
‘out of the blue’.

• It suddenly appears fully formed in patient’s mind.

• Diagnostic of schizophrenia only if they are BIZARRE

• They can occur in normal individuals secondary to mood &

personality disorder.
 2.Delusional percept-(APOPHANOUS)
This is present when the patient receives a normal perception that is
then interpreted with delusional meaning.

It is a first rank symptom of schizophrenia.

EXAMPLE:
A woman said, ‘every night blood is being injected out of my arms.
When asked for her evidence, she explained that
she had little brown spots on her arms and therefore knew
that she was being injected. The interviewer looked at the
spots on her arms, rolled up his sleeve and showed her spots
identical in appearance on his own arm. He said that they had
been on his arm as long as he could remember and were
called ‘freckles’. She agreed that both sets of spots looked
similar and accepted his explanation of his own spots, but she
still insisted that her freckles proved that she was being
injected in her sleep. This was a delusional percept.
 3.Delusional atmosphere(DELUSIONAL MOOD)

In this state patient has the knowledge that there is

something going on around him which concerns him,
but he does not know what it is.
 4.Delusional memory

delusional memory is the delusional interpretation of a normal

memory. These are sometimes called retrospective delusions. An
event that occurred in the past is explained in a delusional way.
EXAMPLE:
A man aged 50 whose mental illness had lasted for about
two years claimed that his health had been permanently
affected since the age of 16, when he had had ‘an operation
to remove his appendix’. He now believed that the operation
had been an excuse to ‘implant a golden convolvulus’ in his
bowels.
 SECONDARY DELUSIONS
Can be understood as arising from some other morbid
experience-
1) Projection: projection occurs in the non-psychotic some other
explanation is necessary to account for the excessive projection
which occurs in delusions, particularly those of persecution.
2) Latent homosexuality (Freud): the different ways in which this is
denied gave rise to delusions of persecution, erotomania, jealousy
and grandeur.
3) Depressive moods
4) Hallucinations
5) Psychogenic reaction : In abnormally suspicious personalities.
6) Sensitive personalities
 SYSTEMATIZATION

DEFINITION: Elaboration of delusions & their integration into some

sort of system(DELUSIONAL WORK); i.e delusions are built
logically on one basic delusion; they are commonly seen in older
schizophrenics.

EXAMPLE:
The patient relates an elaborate tale of persecution spanning more
than 20years,incorporating numerous details that fit together
perfectly.
 DELUSIONS ON THE BASIS OF
CONTENT OF DELUSIONS
(1) DELUSIONS OF PERSECUTION
(2) DELUSIONS OF JEALOUSY
(3) DELUSIONS OF LOVE
(4) GRANDIOSE DELUSIONS
(5) DELUSIONS OF ILL HEALTH
(6) DELUSIONS OF GUILT
(7) NIHILISTIC DELUSIONS
(8) DELUSIONS OF POVERTY
DELUSIONS OF PERSECUTION
DELUSIONS OF JEALOUSY
DELUSIONS OF LOVE
GRANDIOSE DELUSIONS
DELUSIONS OF ILL HEALTH
DELUSIONS OF GUILT
NIHILISTIC DELUSIONS
DELUSIONS OF POVERTY