Organic delusional syndrome

Delusions may be the most prominent manifestations of brain dysfunction, and a host of medical and neurologic conditions can present with or produce delusions. Recognition of the underlying disorder frequently aids in successful treatment. Comparison of organic delusional syndromes with schizophrenia suggests that limbic system abnormality and dopamine dysfunction are common underlying factors shared by different causes of delusions.     

Shared obsessive-compulsive disorder

BACKGROUND: Shared psychotic disorder (folie à deux) is an uncommon entity reported mainly in the context of delusions. Obsessions and compulsions occur very rarely as shared psychopathology. MATERIAL AND METHODS: We present two sisters who manifested shared obsessive-compulsive disorder. RESULTS: Both sisters were managed in keeping with their shared obsessive-compulsive disorder leading onto a similar pattern of response. CONCLUSIONS: Shared obsessions could represent the continuum concept of obsessions and delusions, and their relationship needs to be evaluated in greater detail.     

A remarkable case of folie à deux

This article reports the noteworthy case of a couple who developed three clearly separate delusions after marriage. An elaborated delusion of descent was shared by the two people, while two further delusions remained private convictions. Probable biographical connections of the shared delusions and diagnostic problems are discussed, especially the monocausal etiologic hypotheses behind the respective categories for shared psychotic disorders of ICD and DSM.     

Origins of delusions in Alzheimer's disease

Research over the past two decades supports a shared aetiology for delusions in Alzheimer's disease (AD) and schizophrenia. Functional networks involved in salience attribution and belief evaluation have been implicated in the two conditions, and striatal D2/3 receptors are increased to a comparable extent. Executive/frontal deficits are common to both disorders and predict emergent symptoms. Putative risk genes for schizophrenia, which may modify the AD process, have been more strongly implicated in delusions than those directly linked with late-onset AD. Phenotypic correlates of delusions in AD may be dependent upon delusional subtype. Persecutory delusions occur early in the disease and are associated with neurochemical and neuropathological changes in frontostriatal circuits. In contrast, misidentification delusions are associated with greater global cognitive deficits and advanced limbic pathology. It is unclear whether the two subtypes are phenomenologically and biologically distinct or are part of a continuum, in which misidentification delusions manifest increasingly as the pathological process extends. This has treatment implications, particularly if they are found to have discrete chemical and/or pathological markers.     

The frequency of shared delusions in delusions of infestation

Summary The phenomenon of shared delusions was found in 9 (8.4%) of 107 personally investigated patients suffering from delusions of infestation (88 females, 19 males). A greater number of females (ratio of females to males 3.5:1) induced others, whereas a gender ratio of 1:1 was evident in the group of affected patients. Since the ratio of blood relations to non-blood relations was 1:2.3, genetic factors seem to play a less important role than the direct impact of deluded patients on their environment. The rare occurrence of shared delusions of infestation leads to the conclusion that only persons with a paranoid predisposition(paranoide Bereitschaft) may be affected. Cases of induced delusions are also described in which attending physicians act as inducers.     

Folie à six: a case report on induced psychotic disorder

A case of folie à six is described in which the persecutory delusions of the central figure spread to her husband and their 2 sons, and even to her sister-in-law and a nephew. The main factor in the development of this shared paranoid disorder seems to have been the dominant personality of the inducer. In contrast to reports in the literature, there was no family history of such disorders and there were no adverse social or environmental circumstances.     

Persecutory delusions in dementia.

BACKGROUND: Persecutory delusions are common in dementia. This study was undertaken to investigate the prevalence, associated factors, and characteristics of persecutory delusions in demented patients. METHOD: The sample population included 167 demented patients (DSM-III-R criteria) admitted to a geropsychiatric ward. Patients were assessed for the occurrence of any persecutory delusions since the onset of dementia. The content of persecutory delusions, the patients' response to the delusions, and any concomitant psychiatric symptoms were also explored. RESULTS: Of the 167 demented patients, 45 (26.9%) showed symptoms of persecutory delusions. Patients with persecutory delusions had a higher prevalence of other delusions, hallucinations, and physically aggressive behaviors. The deluded patients often thought that their caregivers were their persecutors and had a wide range of responses to their delusions. After they were hospitalized, many of these patients attacked medical staff and were uncooperative with treatment. CONCLUSION: Persecutory delusions are common in dementia of various types. Deluded patients often have vigorous responses to their delusions including physically aggressive behaviors and suicide attempts. Careful evaluation is needed to assess the potential for violent and suicidal behaviors in these patients. Medical staff should be alert to clinical strategies for handling the treatment of such patients when they become violent or uncooperative.     

Shared paranoid disorder preceded by cannabis abuse: case report

A case is presented of a socially isolated married couple who developed a shared paranoid disorder preceded by their cannabis abuse with the wife initiating the delusions. After the couple were separated the wife feared that she would be killed and assaulted her child and mother. Delusions in the pair ceased quickly and a return to cohabitation did not result in relapse in the absence of cannabis abuse.     

The French connection: folie à quatre

A socially isolated family in which the three children shared their mother's delusional beliefs is reported. After separation, the children rapidly adjusted to normal school and foster family life. Difficulties in establishing the family's true identity and problems raised in reuniting the family, while the mother was felt to be concealing her remaining delusions, are discussed.     

Delusions and hallucinations, definitions and mechanisms

The semiology of delusions and hallucinations corresponds to precise definitions. Systematised or not, their mechanisms and their themes are varied. Psychodynamic and biological approaches give an insight into the therapies to use with patients who are affected.     

Attributional style in schizophrenia: an investigation in outpatients with and without persecutory delusions

The attributional style of outpatients with schizophrenia with and without persecutory delusions was investigated. Thirty individuals with schizophrenia were divided into persecutory-deluded and non-persecutory-deluded groups based on a score of 5 or higher on the suspiciousness item from the Expanded Brief Psychiatric Rating Scale (BPRS-E). The two resulting groups, and a nonclinical control group, were administered a battery of attributional measures, and their attributional responses were coded by both the subjects themselves and a pair of independent raters. The results showed evidence of a self-serving bias for subjects with persecutory delusions; however, this bias was not unique to those with persecutory delusions, and it disappeared when independent raters evaluated subjects' causal statements on a reliable measure of attributional style. Subjects with persecutory delusions tended to show a stronger bias toward blaming others rather than situations for negative outcomes, and there was a linear association between persecutory ideation and a self-serving attributional style. Finally, there were significant discrepancies between the attributional ratings of the persecutory-deluded subjects and those of independent judges. Implications for future research are discussed.     

Followup of psychotic outpatients: dimensions of delusions and work functioning in schizophrenia

We studied three characteristics or dimensions of delusions in schizophrenia patients living in the community, including their influence on work and community functioning. The 149-patient sample included 57 delusional schizophrenia and nonschizophrenia outpatients, 50 nondelusional outpatient controls, and 42 delusional inpatient controls. The data indicated the strength and prominence of acute-phase psychopathology on characteristics of delusions, with large significant differences in intensity of delusions between the acute inpatient phase and the postacute inpatient and outpatient phases. Contrary to some views, the data indicate that the overall presence of any delusions in general, and the various dimensions of delusions, both influence work performance and community functioning, with the greater part of the variance due to the presence of delusions in general. Despite their outpatient status, delusional outpatients showed surprisingly poor self-monitoring about whether others would regard their delusional ideation as unrealistic. Schizophrenia and affectively disordered patients with high emotional commitment to their delusions showed significantly poorer work functioning and were significantly more likely to be rehospitalized (p < 0.05), indicating the important impact on functioning of patients' feelings of immediacy and urgency about their unrealistic beliefs.     

Misattribution of external speech in patients with hallucinations and delusions

BACKGROUND: One of the main cognitive models of positive symptoms in schizophrenia proposes that they arise through impaired self-monitoring. This is supported by evidence of behavioural deficits on tasks designed to engage self-monitoring, but these deficits could also result from an externalising response bias. We examined whether patients with hallucinations and delusions would demonstrate an externalising bias on a task that did not involve cognitive self-monitoring. METHOD: Participants passively listened (without speaking) to recordings of single adjectives spoken in their own and another person's voice, and made self/nonself judgements about their source. The acoustic quality of recorded speech was experimentally manipulated by altering the pitch. Fifteen patients with schizophrenia who were currently experiencing hallucinations and delusions, 13 patients with schizophrenia not experiencing current hallucinations and delusions and 15 healthy controls were compared. RESULTS: When listening to distorted words, patients with hallucinations and delusions were more likely than both the group with no hallucinations and delusions and the control group to misidentify their own speech as alien (i.e. spoken by someone else). Across the combined patient groups, the tendency to misidentify self-generated speech as alien was positively correlated with current severity of hallucinations but not with ratings of delusions or positive symptoms in general. CONCLUSIONS: These findings indicate that patients with hallucinations and delusions are prone to misidentifying their own verbal material as alien in a task which does not involve cognitive self-monitoring. This suggests that these symptoms are related to an externalising bias in the processing of sensory material, and not solely a function of defective self-monitoring.     

Violence and delusions: data from the MacArthur Violence Risk Assessment Study

OBJECTIVE: Previous work has suggested that delusions are associated with a higher risk of violence, particularly delusions in which patients believe that people are seeking to harm them or that outside forces are controlling their minds (denoted as "threat/control override" delusions). This study explores the relationship between delusions and violence among patients recently discharged from acute psychiatric hospitalization. METHOD: Data were drawn from the MacArthur Violence Risk Assessment Study, a study of violence in the community that followed 1,136 recently discharged psychiatric patients for 1 year. Interviews at discharge and at five 10-week intervals gathered clinical, historical, situational, and dispositional information, including the presence and nature of delusional thoughts. Violence was ascertained from reports of subjects, collateral informants, and official records. RESULTS: Neither delusions in general nor threat/control override delusions in particular were associated with a higher risk of violent behavior. Comparisons with prior studies suggest that reliance on subject self-reports of delusional symptoms may result in mislabeling as delusions other phenomena that can contribute to violence. CONCLUSIONS: Although delusions can precipitate violence in individual cases, these data suggest that they do not increase the overall risk of violence in persons with mental illness in the year after discharge from hospitalization.     

The Seven Sleepers: a folie à deux case originating from a religious-cultural belief

Folie à deux is an uncommon psychiatric entity characterized by the transfer of delusional ideas and/or abnormal behavior from one person to another, or many others, who are in close contact with the primarily affected patient. In this paper we present a case of folie à deux, involving a married couple who suffered from a shared psychotic disorder with delusional interpretations of specific suras of the Koran. These mystical delusions were derived from the Anatolian legend of The Seven Sleepers. The case resulted in the death of the wife. This study illustrates the role of cultural and religious factors in folie à deux.     

Coexistence of delusions of pregnancy and infestation in a male

The coexistent appearance of delusions of pregnancy and infestation is reported in a male patient with posttraumatic epilepsy. While published organic cases of delusions of pregnancy have involved patients with severe or mild mental retardation, our reported patient had a higher than average IQ. The interpretative role of these delusions in a probable perceptual symptomatology cannot be excluded, as both delusions can be based on sensations in the abdomen or on the skin.     

Simultaneous Folie à Deux and Capgras syndrome

A young male presented both Capgras syndrome and Folie à Deux. Both of his parents shared the same delusions with the patient. A dynamic explanation is provided for the simultaneous occurrence of both syndromes. The case report and the management of this patient may be of interest to clinicians.     

Defective recognition of one's own actions in patients with schizophrenia

OBJECTIVE: The possibility that delusions of influence could be related to abnormal recognition of one's own actions was investigated in persons with schizophrenia. METHOD: Schizophrenic patients with (N=6) and without (N=18) delusions of influence were compared with normal subjects (N=29) on an action recognition task. The image of a virtual right hand holding a joystick was presented to the subjects through a mirror so that the image was superimposed on their real hand holding a real joystick. Subjects executed discrete movements in different directions. Angular biases and temporal delays were randomly introduced in some trials, such that the movement of the virtual hand departed from the movement executed by the subjects. After each trial, subjects were asked whether the movement they saw was their own. RESULTS: Compared with normal subjects, both patient groups made significantly more recognition errors in trials with temporal delays. In trials with angular biases, the error rate of patients with delusions of influence significantly differed from that of comparison subjects and from that of patients without delusions of influence. CONCLUSIONS: The findings support the hypothesis that delusions of influence are associated with a quantifiable difficulty in correct self-attribution of actions. This difficulty may be related to a specific impairment of a neural action attribution system.