Normal thinking involves goal-directed progression of ideas and associations leading to rational conclusions. Thought disorders involve errors in this process and can be categorized as disorders of form, progression, content, or possession. Delusions are a type of thought content disorder characterized by false beliefs that are firmly held despite evidence. Conrad proposed a 5-stage model of delusion development including mood changes, search for meaning, heightening of psychosis, formation of a new worldview, and eventual isolation. Delusions are classified based on origin, theme, mood congruence, reality value, and complexity. Common delusional themes include persecution, guilt, infidelity, grandeur, poverty, and somatic or religious beliefs. Case studies demonstrate delusional

2. NORMAL THINKING
“NORMAL’’ thinking is characterized by
 goal directed
 succession of ideas ,associations and
symbols
 leading to rational conclusion
Grave errors in any of the above mentioned steps
qualifies for a thought disorder

3.  The process of thinking was divided into
three types:
 Undirected fantasy thinking(autistic
thinking)
 Imaginative thinking
 Rational thinking

4. Thought disorders are broadly
of 4 types:
 Disorders of form
 Disorders of progression
 Disorders of content
 Disorders of possesion

5. Delusion is a type of disorder of
content of thought

7. DEFINATION
 It is a false, unshakable belief that is out
of keeping with the patients social and
cultural background

8. A false belief based on incorrect inference
about external reality that is firmly held
despite what everyone else believes and
despite what constitutes incontrovertible
and obvious proof or evidence to the
contrary. the belief is not ordinarily
accepted by other members of the
persons culture or subculture

9. Jaspers claim regarding
delusions are:
 They are false judgments
 They are held with extraordinary
convictions and incomparable subjective
certainty
 They are impervious to
counterarguments
 Their content is impossible
All four criteria have been subjected to
criticism

10. Kendler et all have proposed
several poorly correlated
dimensions of delusional
severity
 Conviction: the degree to which the patient
is convinced of the reality of delusions
 extension: the degree to which the belief
involves areas f pts life
 Bizareness: depicting degree of departure
from culturally determined consensual
reality
 Disorganization
 Pressure: preoccupation n concern with the
belief

12. Trema
apophany
anastrophy
consolidation
residuam

13. Origins of delusion
conrad proposed 5 stages in
the development of delusions
 Trema: delusional mood ;a total change in
perception of the world
 Apophany:a search for and the finding
of,new meaning for psychological events
 Anastrophy:heightening of psychosis
 Consolidation:forming of a new world or
psychological set based on new meanings
 Residuum:eventual autistic state

14. Conrad’s Stage Model of
Beginning Schizophrenia
StageI: Trema
 (derived from Greek, colloquial for stage
fright)
 Meaning :Delusional mood (or atmosphere)
Characteristics :
Undefinable, but increasingly upsetting
quality spreads from salient aspects to
entire perceptual field. Patient feels
anticipatory excitement, suspiciousness,
alienation, fear, guilt, depression, or
combination of these. Patient may perform
abrupt, seemingly meaningless actions

15.  II Apophany
 (Greek apo [away from] + phaenein to show → revelation)
 Meaning:Delusion as revelation (Aha-Erlebnis)
 Characteristics :Perceptual Gestalt experienced
incompletely in terms of its expressive rather than its
objective material holistic qualities. Inability to
transcend current perspective or to shift frame of
references. Abnormal connectedness between
seemingly unrelated meanings. Delusional
perception, misidentification. Relentless
(“monotonous, repetitive”) spreading of the delusion
as both “elastic” and fixed to new gestalts.Progression
of delusions from external to inner “space”, delusional
body sensations. Patient uncritically receptive and
unable to detach, as if trapped between sleeping and
waking. Thought insertion, thought broadcasting,
hallucinations

16. III Anastrophe
(Greek, ana- (back) + strephein (to turn) →
turning back)
Meaning: Patient feels self to be passive
middle point (subject-directed
complement to world-directed apophany)
Characteristics : Delusions of reference.
Events and perceptions are related to self

19. Classification of delusions
Parameter type
Depending on origin Primary and secondary
Depending on theme Grandiose, persecutory,
jealousy etc
Depending on congruency
with mood
Mood congruent or not
Depending on reality
value
Partial or complete
Depending on complexity Simple or complex

21. Primary and secondary
delusions
 Primary delusion: that is not occuring in
response to another psychopathological
form
 for eg :in schizophrenia patients
 Secondary delusion: occuring secondary
to some other psychopathological
condition
 For eg:delusion of grandiosity in mania

22. Primary delusions Secondary
delusions
 Ununderstanble
 Not in correlation with
some other
psychopathology
 Occur in schizophrenia
 Understandable
 In accordance with some
other psychopathological
condition.
 Occur in other conditions
.may be understood in
terms of persons
background ,culture or
emotional state

23. Types of primary delusions
 Autochthonous delusion(delusional
intuition: sudden delusional idea occurs
out of the blue
 Delusional percept:occurs in two stages
perception and then false interpretation
 Delusional atmosphere/mood
 Delusional memory/retrospective
delusions

24. Content of delusions
 delusion of persecution
 Delusion of guilt
 Morbid jealousy and delusion of infedility
 Delusion of love
 Grandiose delusion
 Delusion of poverty and nihilistic delusion
 Hypochondriacal delusion
 Somatic delusions
 Delusion of infestation
 Delusions of control
 Delusional misidentification(capgras syndrome)
 Religious delusion

25. Delusion of persecution
Incorrectly also known as paranoid delusion
Paranoid actually mean delusional derived from
The Greek word paranoia literal meaning
By the side of mind

26. Forms of Delusions of
persecution
 Delusion of reference : the patient knows
that people are talking about him,
slandering him or spying on him.ideas are
not confined to schizophrenia can also
occur in depression and other psychotic
illnesses
 Delusion of guilt :seen in patients with
severe depression who feel they are
extremely wicked thus,it is justified to spy
on him.
 Delusion of being poisoned
 Delusion of influence

28. Delusion of
guilt
The patients believe that
they are bad or evil. And
have ruined their family
Seen in cases of severe
depression.

29. Delusion of infidelity
Also known incorrectly
As delusion of jealousy
Patients of delusions of infidelity
Have morbid jealousy
Instead of delusion of jealousy

30.  Can occur in both organic and functional
disorders . also very common in alcohol
dependence

31. Delusion of love
Oh ! salman
khan is in love
wiith me
Also known as fantasy lover syndrome
And erotomania.
The patient is convinced that
someone is in
Love with them although the
alleged lover
may have never spoken to them.
.these may Be a part of
schizophrenia or they may
also Be isolated
symptoms in certain
personality. Margaret Mary "Peggy" Ray (1952 – October 5, 1998)
was an American woman who suffered from schizophrenia ..
She is best known for stalking American television talk show host
David Letterman and retired astronaut Story Musgrave.

32. Delusion of grandiosity
Primary are seen in
schizophrenia
Secondary in mania.
PATIENT believes that
He is special or has
Special powers.

34. Nihilistic
delusion
The patient denies the
existence of their body
,their mind,their loved
ones and the world
around them.
Seen in severe agitated
depression,
schizophrenia and states
of delirium.

35. Delusion of poverty
The patient is convinced that
they are impoverished and
believe that destitution is facing
them and their family.

36. Hypochondriacal
delusion/delusions
of Ill health/somatic
delusions
Patients believe that they
have some serious illness
Seen in depression,
schizophrenia etc.patient
may also feel his body is
diseased or changed

39. Delusion of
infestation
In ekboms syndrome,
the patient believes
that he is infested with
small but macroscopic
organisms.
Seen in hypochondriasis.
persistent delusional
disorder, organic brain
syndromes.

40. Delusion of
control
The core belief of the patient is that
he is no longer in sole control of his
own body,
thoughts,feelings,impulses or
behavior.

41. Delusion of
misidentification/capgras
syndrome/fregoli
syndrome
Capgras is a rare syndrome in
which the patient believes that a
person usually closely related has
been replaced by an exact double.
Fregolis syndrome the delusional
misidentification of an unfamiliar
person as a familiar one,even
though there is no physical
resemblance.

43. Religious delusions
 Patient is preoccupied
with false beliefs of
religious nature.
sometimes they exist
within the context of a
conventional religious
system, such as
antichrist or ideas
about nirvana etc.

44. Not all delusions lead to action. Depressive delusions of
Guilt and hypochondriasis may lead to action if the patient
Does not exhibit psychomotor retardation.
Hypochondriacal delusions may lead to suicide or
if involve the family may lead to homicide.

45. Case study 1:
 Mrs. K is a 39-year-old woman who was brought to the
inpatient psychiatric unit by police after being arrested for
trespassing on Mr. L’s property. Upon arrival, Mrs. K was
adamant about being released, stating that she was
simply entering her husband’s home, adamantly declaring
that Mr. L was her husband. She elaborated a story about
how much the two of them loved each other, when they
got married, and how she was currently pregnant with his
child. In actuality, Mr. L used to be Mrs. K’s boss, and had
fired her because of her inappropriate romantic advances
several years prior. Mrs. K was married to another man in
Florida, with whom she denied any relationship, stating
that she was kidnapped for 4 years, and after escaping,
had come to California to be with her husband, Mr. L. Mrs.
K was diagnosed with delusional disorder, erotomanic
type, and was started on risperidone.

46. Case study 2:
 50 yr male patient Mr.A came to the psychiatry opd on his
own ,alone with complains of sleep disturbance and
headache on further asking he said his wife was having
an affair with his neighbour, which was very distressing to
him due to which he used to remain anxious the whole
day. the was asked to bring a close relative in the next
follow up after 7 days. He was brought after one month
forcefully by his sons and nephew complaining that he
doesn’t sleep at night and is very suspicious on their
mother and also beats her at times . They clarified that
she was NOT HAVING AN AFFAIR with their neighbour.
Despite availability of many facts to prove the same
patients belief was consistent. Otherwise his functioning
was absolutely normal .he was started on tab.risperidone
.

47. Case study 3:
 55 yr old blind female patient named mrs
r.was referred to the psychiatry OPD by
general surgeon with complains of tingling
sensation, like something was moving
inside her abdomen following hysterectomy
since last 5 yrs .patient was very distressed
because of the same. she had been
investigated thoroughly by the surgeon and
the obstetrician with no significant findings.
She was started on tab olanzapine and on
follow up after one month she reported
much improvement in the symptoms

48.  Scoring of delusions

50. Bibliography:
book author
Sims’ symptoms in the
mind
femi oyebode
Fish's clinical
psychopathology
Patricia casey ans brenden
kelly
Internet , PUBMED,industrialpsychiatry
journal