原发性妄想和印度的社会政治环境-一例病例报告和简短综述

概述：妄想一直是精神科研究的一个中心主题，研究涉及其病因、发病机制、诊断、治疗和司法精神病学的相关内容。许多精神科医生似乎对其中的原发性妄想尤为感兴趣。妄想的内容一直是文化精神病学感兴趣的领域。我们试图探讨原发性妄想的不同方面，试图解释在印度这样的国家中文化和社会政治环境如何决定原发性妄想的形成并影响其精神病理学。     

抑郁症与精神分裂症中妄想对照研究

目的：探讨精神病性抑郁症与精神分裂症妄想症状的差异。方法：对65例精神病性抑郁症及115例精神分裂症患者妄想差异的比较。结果：精神病性抑郁症妄想的发生率及多种妄想并存率显著低于精神分裂症;缺乏夸妄想,但罪恶、疑病等妄想发生率显著高于精神分裂症;被害妄想对象不如精神分裂症泛化,2次住院的妄想再现率明显低于精神分裂症。结论：精神病性抑郁症的妄想继发于情感症状,处于从属地位,没有与情感背景完全对立的妄想,与精神分裂症的妄想有诸多差异。     

Understanding the Delusion of Theft

The elderly with dementing illness often present with psychotic symptoms such as delusions, but the thematic content of delusions in the elderly differs from that of delusions expressed by younger individuals, and can be pathognomonic of early dementia. The aim of this paper is to review the recent literature on the delusion of theft, the most prevalent delusion in the elderly, in order to arrive at a deeper understanding of its sources and to identify successful therapeutic approaches. The literature from 2000 to the present was searched on the Google Scholar database using relevant search terms. Several older classical papers were also referenced. Understanding the origins of the delusion of theft – multiple losses, attempts at attributing such losses to an outside source, attempts at reliving a happier past – helps in devising responses that are comforting to the patient. The distress that often accompanies the delusion of having been robbed can be decreased by nursing home improvements in the handling of personal possessions, by the correction of sensory deficits, and by the provision of activities that distract from loneliness. Attention to stimuli that trigger the delusion helps to limit its occurrence. Medications may help, but can sometimes make matters worse. Understanding that delusional thinking can arise from sensory and cognitive deficits is critical to empathic caregiving and also to the lessening of caregiver burden.     

Capgras' syndrome of time

The delusion that the usual passage of time has been changed and that time has been interfered with or is repeating itself is rare. Four patients with the delusion of warped time are presented and the significance of the symptom is discussed. The perception of the passage of time and its disorders is discussed.     

Histoire du délire des actes

The author proposes an history about “acting delusion”, a short history, which started in the middle of xixth century to progressively decline at the beginning of xxth century. Originally, we can find this delusion in Pinel's and Esquirol's works but it wasn’t named like that. At present, we can find its repercussions in “psychopathic disorders”. We will see that it is in psychosis’ acting out that “acting delusion” can be compared. Of course, this expression is old-fashioned and quite confused but it seems to be also useful to consider, historically, that it asks us many interesting questions, for example: What could be a “delirious act”? The only act could be the sign of an underlying delusion? Finally, the “acting delusion” allows probably to return to the question of psychosis without delusion.     

Quelle définition du délire dans la psychose ? Pour une approche fonctionnelle du processus délirant

In referring to various theories from psychoanalytic epistemology, the author develops a definition of psychotic delusion as operating as possible. To do this, he compares, on the one hand, a conception of delusion based on the relation to reality with, on the other hand, a functional approach of delusional activity that takes into account subjective issues of delusion. Different theoretical paradigms are discussed in order to identify the respective implications of a realist conception of delusion and an approach of delusion from their subjective features. In this perspective, delusion is less regarded as an abnormal way of perceiving the world than as an attempt of solution to the resurgence of an unthought primary trauma. From a qualitative methodology based on a clinical case study, the author highlights three main functions achieved by the delusion in its attempt of self-therapy resolution. The first, conceptualized under the term “containing function”, carries out the shaping and the significant transformation of what could never be symbolized of the traumatic experience. The second, called “localizing function”, tries to locate outside of the subject the instinctual overflow inherent to the primary trauma. The third, named “identifying function”, enables the delusional person to assume an identificatory principle which, in a self-created way, compensates for the enigma of his senseless history. Furthermore, the analysis of clinical data underlines that these three functions of the delusional activity are not randomly accomplished but are organized according to a particular logic. From its triple operation, it appears that psychotic delusion tends to develop into a “delusional process”, by which the subject can make thinkable and bearable the trauma he has experienced during his history. Finally, referring to the various results of this study, the author proposes to reconsider the issues of clinical devices with delusional patients. Instead of trying to suppress delusion, it would be possible to accompany the subject in the development of inventive potentialities that sustain the delusional process.     

Denial of lineage: clinical investigation of 50 cases

Fifty randomly selected Chinese schizophrenic patients with denial of lineage were investigated. This delusion concerns the generation of parents, sisters, but not the offspring. Twenty-four of them manifested delusion of high-ranking lineage or of distinguished leadership lineage. Denial of lineage, involving the delusion of high-ranking lineage and the delusion of leadership lineage, may occur at the onset or during the course of schizophrenia. The clinical characteristics of this delusion are described and its concept, diagnosis, differential diagnosis, course and also possible mechanism are discussed. One possible mechanism is of psychodynamical origin. Emotional conflicts resulting from dissatisfaction of the primary need of being loved from birth may contribute to the onset of the denial of lineage. The second possible mechanism is a sociocultural fact. Far Eastern culture is based on the clan whereas occidental culture is based on the self. Thus can observe the denial of lineage in the Far East, but in the occident we can experience instead the idea of surmounting our self so as to be god or now to experience the omnipotence in form of technical ideas, e.g. the rays.     

Pathodynamics of symbiotic psychoses

The definition and division of symbiontic psychoses (induced insanity, folieà deux,, psychosis of association) and their significance for the genesis of delusional developments are referred to at the beginning of the paper. After a presentation of environmental reactions on delusion, personality traits and mutual dependence in the predominance-subordination relationship of the partners of delusional symbioses are pointed out. The isolation of this symbiosis against the environment and its influence on this loneliness by twos are demonstrated. Besides the described suppositions, the primary delusion is essential for the pathodynamics of symbiontic psychoses because the delusional structure of the primary delusion, its compositional elements and especially the delusional motif are decisive for the transformation of a symbiosis which is still stable into a pathological we-formation. 5 case histories illustrate the pathodynamics of symbiontic psychoses.     

新型抗抑郁药治疗妄想性抑郁症对照观察

目的:探讨帕罗西汀和文拉法辛对妄想性和非妄想性抑郁症的疗效。方法:48例妄想性抑郁症患者和76例非妄想性抑郁症患者各分为两组,分别用帕罗西汀和文拉法辛治疗。疗程6周。采用汉密尔顿抑郁量表(HAMD)评定抑郁的严重程度。结果:帕罗西汀和文拉法辛对妄想性抑郁症和非妄想性抑郁症的疗效差异均无显著性(P均>0.05)。结论:帕罗西汀和文拉法辛治疗妄想性抑郁症和非妄想性抑郁症均有效。     

Is mythical delusion a factor blocking schizophrenic symptoms?

Abstract It has been stated that mythical delusion can block schizophrenic symptoms. However, there are some schizophrenics in whom mythical delusion does not react against schizophrenic symptoms. Three cases are reported of mythical delusion and what conditions are necessary for the mythical delusion to "block" schizophrenic symptoms are considered. Such 'blocking' can be found in the mythical delusion which mediates between schizophrenic symptoms and reality. Conversely, when there is no relationship between mythical delusion and schizophrenic symptoms 'blocking' cannot be expected.     

试析老年痴呆患者的被窃妄想

目的了解老年痴呆患者被窃妄想的临床特征。方法将83例老年痴呆患者按有无嫉妒妄想分为两组,并就痴呆严重度、类型、伴随症状等进行对照分析。结果被窃妄想在老年痴呆患者中的发生率较高（56．％）;痴呆严重程度轻于无被窃妄想者;被窃妄想在阿尔茨海默病（AD）中的发生率高于血管性痴呆（VD）;有被窃妄想者伴有较多嫉妒妄想（P均〈0．05）。结论被窃妄想可能是老年痴呆较敏感的临床症状之一,尤其对轻度AD的诊断有一定意义。     

La fonction cicatrisante du délire dans la schizophrénie

Psychoanalytic epistemology considers psychosis to be linked to the resurgence of traumatic experiences that have not been assimilated by subjectivity. The hallucinatory return of this primitive agony faces the psychotic subject with a driving encroachment that attacks his body and disintegrates its unitary organisation. Considering this reliving of traumatic experiences, the authors will present schizophrenic delusion less as a pathological result than as a subjective response that aims to treat the psychic over tension, which fractures the subject's body identity. Based on several clinical studies, this article will question the healing effect of delusion in schizophrenia. It is therefore concerned with investigating the different functions of delusion and identifying their incidence on the subject's body image. Using the different clinical examples cited, the authors will then attempt to develop certain therapeutic applications, which contribute to a possible reduction of the body disintegration phenomena in schizophrenia.     

Hyperprolactinemia and delusion of pregnancy

We describe the case of a 44-year-old woman admitted with mania with psychotic symptoms who presented with delusion of twin pregnancy a month after admission, which temporally correlated with hyperprolactinemia secondary to antipsychotic medication. Modification of antipsychotic medication was associated with fall in serum prolactin and disappearance of delusion of pregnancy. In light of this clinically striking temporal association between hyperprolactinemia and delusion of pregnancy, we review the literature to examine the hypothetical relationship. We highlight the clinical significance of examining the various factors, including antipsychotic-induced hyperprolactinemia, which could trigger the development of delusion of pregnancy.     

Reasoning and delusion proneness: confidence in decisions

The present study was an investigation into the reasoning of delusion prone individuals. Seventy healthy individuals in the general population completed a measure of delusion proneness and engaged in 8 trials of difficult probabilistic reasoning tasks, 4 emotionally neutral and 4 emotionally salient, and were asked to report their level of confidence in their decisions. While delusion prone individuals did not request any fewer stimuli on reasoning tasks than did individuals who were not delusion prone, delusion prone individuals were more confident in their decisions on the neutral task than individuals who were not delusion prone and were more confident in their decision on the first trial, regardless of the type of stimuli presented. Further, despite requesting less information on neutral than salient tasks, delusion prone individuals reported equivalent confidence on both tasks. Delusion proneness and delusion onset may be related to overconfidence in decisions, particularly overconfidence in initial judgment.     

La neuropsychologie cognitive et les délires d’identification des personnes

Following publication of the three classic misidentification syndromes (Capgras delusion, Capgras and Reboul-Lachaux, 1923; Frégoli delusion, Courbon and Fail, 1927; and intermetamorphosis, Courbon and Tusques, 1932), the most popular theoretical explanations were psychodynamically-based. More recently the precepts of cognitive neuropsychiatry have prevailed. Models of face recognition such as that of Bruce and Young (1986) suggest three stages in the process, in two of which may lie the origin of intermetamorphosis (FRU stage) and the Frégoli delusion (PIN stage); but the Capgras delusion cannot be easily accommodated. Ellis and Young (1990) introduced the element of the emotional response to known faces which manifests itself in autonomic responses. Ellis and Young suggested that it is a disruption to this emotional route that underlies the Capgras delusion. Experimental tests of this hypothesis provide confirming evidence and other studies with patients showing Capgras delusion further elucidate our understanding of face recognition.     

The Social Dynamics of the Physician’s Status†

The delusional belief that a close relative has been replaced by a look-alike impostor was named the Capgras delusion in honor of Joseph Capgras, who described the first case. Capgras's original patient, Mme M., had a complex mental illness with various symptoms in addition to the delusion of substitution. The focus in the literature has always been on her eponymous delusion, ignoring the rest of her condition. However, studying the substitution delusion in isolation from the rest of her illness has led to inadequate conclusions. It is necessary to understand the delusion within the broad context of her illness. Toward that goal, her mental illness is described here in detail. A particular pattern of delusions and illness is identified. This same pattern is noted in other cases of Capgras in the literature. Three new cases are reported here, each with the same overall pattern of illness that Mme M. had. This pattern is labeled the Syndrome of Capgras. A hypothesis is offered to explain the Capgras delusion within the context of this illness.     

家庭内伤害案司法鉴定资料分析

目的探讨家庭内部伤害案中精神病患者作案时辨认能力、控制能力及责任能力的影响因素。方法采用自行编制的家庭内部伤害案件鉴定资料登记表,对符合标准的95例家庭内伤害案件司法鉴定资料进行收集、整理,然后对辨认能力和控制能力与案发时的精神状态等因素的关系进行统计分析。结果幻觉、被害妄想、嫉妒妄想、其它（人格改变、被控制感等）与辨认能力和控制能力的关系具有统计学意义（P〈0.05）。结论幻觉、被害妄想、嫉妒妄想、其他（人格改变、被控制感等）可作为判别辨认能力和控制能力的因子。     

妄想性抑郁症55例临床对照分析

对５５例妄想性抑郁症与９２例非妄想性抑郁症病人进行临床对照分析。结果表明：妄想性抑郁症幻听、焦虑、自责自罪、绝望、自杀行为等症状出现率较高，自杀率为非妄想性抑郁症的３．７倍，往往需要联合治疗。     

341例精神分裂症被鉴定人精神症状与社会危害行为的关系

目的探讨精神分裂症被鉴定人精神症状与社会危害行为的相关性。方法采用自制的调查表,通过查阅委托单位的鉴定委托送交材料和鉴定意见书的方式对湖南省341名无责任能力精神分裂症被鉴定人实施社会危害行为时存在的主要精神症状如幻觉、妄想、同时存在幻觉和妄想、思维逻辑障碍、行为紊乱等与其社会危害行为包括严重暴力社会危害行为、非严重暴力社会危害行为等信息进行登记,并进行关联性检验。结果①严重暴力社会危害行为组与非严重暴力社会危害行为组间不同精神症状构成比存在差异(χ2=16.259,P=0.003),精神症状与社会危害行为之间有关联(列联系数为0.213)。②精神分裂症被鉴定人实施严重暴力社会危害行为时以妄想症状出现的频数最多128例(45.7%);实施非严重暴力社会危害行为时以思维逻辑障碍出现的频数最多27例(44.3%)。③与严重暴力社会危害行为有关的妄想症状类型以被害妄想为主占106例(82.8%)、幻觉症状类型以命令性幻觉为主占13例(54.2%)、同时存在幻觉、妄想症状的以其它言语性幻听和被害妄想为主占76.6%。结论精神分裂症被鉴定人严重暴力社会危害行为可能主要与妄想有关,其非严重暴力社会危害行为可能主要与思维逻辑障碍有关。其中被害妄想、命令性幻听、同时存在其它言语性幻听和被害妄想的精神症状类型可能与精神分裂症被鉴定人严重暴力社会危害行为有关。