Pharmacotherapy for Delusional Disorder and Associated Conditions.

Delusional disorder, according to current psychiatric nosology, is the presence of one or more nonbizarre delusions (i.e., false beliefs that nonetheless may be plausible or derived from ordinary life experiences) that do not occur in the context of schizophrenia and often exist in the presence of generally acceptable levels of psychosocial functioning. Currently recognized subtypes of delusional disorder are erotomanic (a delusion that another is in love with the patient), grandiose, jealous, persecutory, or somatic (Manschreck, 2000). As Manschreck noted, the diagnosis is complicated by disagreements over the distinction between bizarre and nonbizarre delusions, as well as the fact that the features of certain subtypes of delusional disorder may closely resemble those found in other conditions. Very little data, aside from anecdotal or case reports, exist to inform practice regarding the treatment of delusional disorder. Much of the recent literature addresses delusions that exist in the context of dementia or another underlying neurological disorder. It is important to recognize the substantial differences between these conditions and a primary delusional disorder. This brief review examines not only pharmacological management of primary delusional disorder but also delusions in the context of dementia and related disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Cognitive-behavioral therapy for bipolar disorder and Cognitive therapy for delusions, voices, and paranoia.

Reviews the books, Cognitive-behavioral therapy for bipolar disorder by Monica Ramirez Basco and A. John Russo (see record 1996-98072-000) and Cognitive therapy for delusions, voices, and paranoia by Paul Chadwick, Max Birchwood, and Peter Trower (see record 1996-97983-000). The mental health service system is largely based on the oft encountered, often implicit, belief among professionals that, since Schizophrenia, Bipolar Disorder, and other severe forms of mental illnesses have been shown to have a biological basis, there is no point in providing psychotherapy for individuals afflicted with these disorders. These two books represent a welcome exception to this situation. While different in many ways, including their treatment goals and many of their theoretical underpinnings, both books represent an attempt to allow the severely mentally ill to benefit from techniques which have been demonstrated to be effective for less severely disturbed populations. Both approaches illustrate ways that the severely mentally ill may be able to be helped through psychosocial intervention, and both acknowledge the importance of client collaboration in treatment, a consideration easy to overlook when the client has a severe mental illness. The books are also similar in that neither one offers sufficient empirical data to support the effectiveness of its approach. The two books reviewed here represent, in the reviewer's opinion, significant contributions to the field of psychotherapy. Even if the clinician takes issue with the techniques presented or with the theoretical assumptions underlying the approaches, he/she should come away with a renewed appreciation of the importance of including the client in treatment planning, even if the client has a severe mental illness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pursuing the kernel of truth in the psychotherapy of schizophrenia.

This article concerns the utility of pursuing the kernels of truth in the delusions of schizophrenic patients as a means of empathizing with their unique personal experience of events. Pursuing the kernel of truth implies listening for the real interpersonal experiences past and present that are represented within delusions, as opposed to focusing on derivatives of infantile fantasy. This orientation restores the rights of the schizophrenic person as a perceptive observer of events with a valid, although not commonly understood, point of view. A clinical case example is presented in which the delusion of being raped while others stand idly by both literally and metaphorically described a wide variety of interpersonal experiences which had shaped the patient's life. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Testing the continuum of delusional beliefs: An experimental study using virtual reality.

A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose–response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural themes in the psychotic symptoms of African American psychiatric patients.

Professional psychologists need to recognize ethnic/racial differences between African Americans and European Americans in psychotic symptom expression to treat individuals with severe mental illness from various cultural backgrounds. Specifically, they need to understand confluent paranoia or the interaction between culture and pathology in psychotic symptom expression. To assist mental health professionals, the present study identified cultural themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients via content analysis. Race-related themes and religious themes were observed in the psychotic symptoms of these patients assessed with the Structured Clinical Interview for DSM IV. Race-related and religious content were manifested in different types of delusions. Race-related themes were more common in persecutory delusions, whereas religious themes occurred more often in other delusions. Race-related themes were associated more with delusions, while religious themes correlated with both delusions and hallucinations. Implications for the treatment of confluent paranoia in African Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Overinclusive thinking and delusions in schizophrenic patients.

15 schizophrenics with paranoid delusions, 15 schizophrenics with no delusions, and a control group of 15 nonschizophrenic hospitalized patients were given the Benjamin Proverbs test, the Mill Hill Vocabulary Scale, and 3 of Babcock's psychomotor speed tests. As predicted, there was a significant relationship between the presence or absence of delusions, and overinclusive thinking, as assessed by the average number of words needed to explain the proverbs and 2 time scores. Overinclusive patients tend to have paranoid delusions. There was no significant relationship between retardation, as assessed by the Babcock tests, and the presence of delusions. This finding complements an earlier finding of Harris and Metcalfe (see 32: 719) that slowness in schizophrenic patients is specifically associated with inappropriate affect and a poor prognosis, and Payne's (see 37: 5499) finding that a group of chronic schizophrenics was not overinclusive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The jumping to conclusions bias in delusions: Specificity and changeability.

There are indications that a jumping to conclusions bias (JTC) plays a role in the formation and maintenance of delusions and should be targeted in therapy. However, it is unclear whether (a) JTC is uniquely associated with delusions or simply an epiphenomenon of schizophrenia or impaired intellectual functioning and (b) it can be changed by varying task demands, motivational factors, or feedback. Seventy-one patients with schizophrenia spectrum disorders and either acute or remitted delusions and 68 healthy controls were included. Patients were assessed with self- and observer-rated symptom measures. All participants were assessed for intellectual ability and performed the classic beads task with a ratio of 80:20. They were then presented with task variations that involved increasing the difficulty of the ratio to 60:40, introducing a rule for which correct decisions were rewarded by monetary gains and false decisions led to financial losses, and providing feedback on the accuracy of the previous decisions. Participants with current delusional symptoms took fewer draws to decision (DTD) than did those in remission and healthy controls. DTD were associated with observer-rated delusions, but controlling for negative symptoms or intelligence rendered this association insignificant. DTD increased after the difficulty of the task increased and after feedback. The study demonstrated that JTC is linked to delusions but that this association is not unique. Patients with delusions are principally able to adapt their decisions to altered conditions but still decide relatively quickly even when decisions have negative consequences. These difficulties might stem in part from impaired intellectual functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implicit and explicit self-esteem discrepancies in paranoia and depression.

The main purpose of the present study was to examine implicit and explicit self-esteem (SE) in patients with persecutory delusions. In samples of paranoid patients, depressed patients, and healthy controls, implicit SE was assessed using the experimental go/no-go association task, whereas explicit SE was measured using 2 self-reporting questionnaires: the self-worth subscale of the World Assumption Scale (Janoff-Bulman, 1989) and the self-acceptance subscale of the Scales of Psychological Well-Being (Ryff & Keyes, 1995). Our analysis revealed that depressed patients showed lower explicit SE than did paranoid and healthy control participants. However, participants with persecutory delusions had significantly lower implicit SE scores than did healthy controls. We interpret the discrepancies observed between overt and covert measures in the paranoid group as psychological defense mechanisms. The present study stresses the clinical and theoretical importance of the use of implicit measures in psychopathology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Increased hindsight bias in schizophrenia.

An underlying theme common to prominent theoretical accounts of cognition in schizophrenia is that information processing is disproportionately influenced by recently/currently encountered information relative to the influence of previously learned information. In this study, the authors tested this account by using the hindsight bias or knew-it-all-along (KIA) paradigm, which demonstrates that newly acquired knowledge influences recall of past events. In line with the account that patients with schizophrenia display a disproportionately strong influence of recently encountered information relative to the influence of previously learned information, patients displayed a KIA effect that was significantly greater than in controls. This result is discussed in the context of the cognitive underpinnings of the KIA effect and delusion formation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The criterion and discriminant validity of the Referential Thinking (REF) scale.

The Referential Thinking (REF) scale was designed to be a comprehensive self-report measure of both simple and guilty ideas of reference in the general population. One aim of the present study was to test the proposed interpretations of REF scores by comparing REF scores with ratings of delusions among psychotic patients. A 2nd aim was to test whether REF scores are better predicted by the severity of patients’ delusions of reference (DoRs) than by the severity of their auditory verbal hallucinations (AVHs), thus supporting the scores’ ability to discriminate between proneness to the 2 different symptoms. The REF scale was completed by 56 healthy controls and 53 acutely psychotic patients. The severity of the patients’ DoRs and AVHs were assessed in structured clinical interviews. REF scores differed significantly not only between the patients and controls but also between patients with versus without DoRs. REF scores correlated significantly with the severity of the patients’ DoRs but not their AVHs. The interpretation of REF scores as a measure of proneness to simple and guilty ideas of reference was supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)