Christina, a 44-year-old woman, was arrested for harassing a local television newscaster, asserting he had fathered and taken her child. However, there was no evidence of a relationship and the newscaster denied it. Christina maintained her delusional belief with extraordinary conviction despite no signs of hallucinations, mood disorder, or organic illness. Her delusional beliefs had existed for years and involved fantasizing about a relationship with the newscaster that did not exist in reality. This case demonstrates a primary delusion arising de novo that is held with unusual conviction and not amenable to logic despite the absurdity being apparent to others.

1. Disorders of Thought

2. Disorders of Content

3. Delusion
• A delusion is a false unshakeable idea or belief
which is out keeping with the patient’s
educational , cultural and social background. It
is held with extraordinary conviction and
subjective certainty.
• Subjectively or phenomenologically it is
indistinguishable from true belief

4. Case Vignette
• Christina , a 44 year old woman, was arrested after harassing a local
television newscaster with telephone calls and letters asserting that
he had fathered, then absconded with her child. She denied any
wish to harm him but steadfastly pursued him with demands that
he give her “visitation rights” to “their” child. She said she
understood that he would be unable to marry her, or even to
outwardly acknowledge his love for her, because of his delicate
public position.
• There was no indication that the newscaster had ever had a
relationship with Chris, although evidence from her files and from
her apartment indicated that her fantasized relationship with him
had existed for several years. There was no indication of
hallucinations, disturbance of affect, significant Mood Disorder, or
organic illness, and the woman had never been treated for a
psychiatric disorder.

5. • English word “ delude” means - to mock, to
cheat, defrauding etc
• The decision to call a belief as a DELUSION is
not made by the person holding the belief ,
but by an external observer.

6. • The person who is holding the delusion holds
the belief with the same conviction as he
holds his other non delusional belief about
himself .

7. • Stoddart’s definition of delusion
• A judgement which cannot be accepted by
people of the same class, education, race,
period of life as the person who experiences
it.
• Hamilton defined delusion as a ‘ a false
unshakeable belief which arises from internal
morbid processes

8. • Jaspers regarded delusion as a perverted view
of reality, incorrigibly held so giving delusion 3
components
C.They are held with unusual conviction
D.They are not amenable to logic
E. The absurdity or erroneousness of their
content is manifest to other people.

9. Dimensions or Vectors of a delusion

10. • Conviction – degree of conviction
• Extension- degree to which delusional belief
involve areas of patients life
• Bizarreness- departure from reality
• Disorganization- degree to which delusional
beliefs are internally consistent, logical and
systemized

11. • Pressure- patients preoccupation with
delusion
• Affective response – the degree to which
patient’s emotions are involved with such
beliefs
• Deviant behavior- acting upon delusions

12. Origins of a Delusion- Conrad

13. • Trema – delusional mood
• Apophany – search for and finding a new
meaning for psychological events
• Anastrophy- heightening of psychosis
• Consolidation- forming a new world or
psychological set based on new meanings
• Residuum – eventual autistic state

14. Primary delusions
• Delusion is not occurring in response to
another psychopathology
• “ apophany”
• New meaning arises in connection with some
other psychological event
• Arises ‘ de novo

15. • Core feature of a primary or autochthonous
delusion is that it is ultimately “
Ununderstandable” - Jaspers
• Eg: a female patient with schizophrenia
believes that men enter her flat anesthetize
her and gang rape her every night.

16. Schneider classified primary
delusions..

17. • Delusional mood- patient has a knowledge
that something is going around him that
concerns him, but he does not know what it is.
• Sudden delusional idea – the delusion occurs
fully formed ( autochthonous delusions)

18. • Delusional perception-
• Attribution of new meaning in the sense of
self reference to a normally perceived object
• The new meaning cannot be understood as
arising from the patient’s affective state or
previous attitudes
• ‘two memberedness’ ( Schneider)-

19. ‘two memberedness’
• there is a link from the perceived object to the
subjects perception of this object and a
second link to the new significance of this
perception
• Schneider divided delusional memory into
delusional perception and sudden delusional
ideas

20. Secondary delusions
• Arising from some other morbid experience
• Are Understandable
• Systematization ?...
• Completely systematized delusion- there is
one basic delusion and the remainder of the
system is logically built on this error

21. Content of delusions

22. Delusional misidentification
• The capgras syndrome– familiar person is
been replaced by stranger
• Syndrome of Fregoli- stranger is familiar

23. • Syndrome of intermetamorphosis- familiar
person who is the persecuter shares physical
and psychologicalsimilarities with stranger
• Syndrome of subjective doubles- another
person is physically transformed to his own
self

24. • Ekbom syndrome- patient believes that he is
infested with small but macroscopic
organisms.
• Cotard’s syndrome- typically seen in psychotic
depression usually in elderly
• Shared delusion – communicated insanity,
Folie a deux, Folie a Communique

25. Overvalued ideas
• Thought that ,because of the associated
feeling tone ,takes precedence over other
ideas and maintains this precedence
permanently for a long period of time.
• Can occur in normal individuals also

26. • Overvalued idea is an acceptable,
comprehensible idea pursued by the patient
beyond the bounds of reason.
• It becomes so dominant that all other ideas
are secondary and relate to it.
• This term was introduced by Wernicke ( 1906)

27. Disorders of Possession

28. obsessions
• A thought that persists and dominates an
individuals thinking despite that individual’s
awareness that the thought is either entirely
without a purpose or else has persisted and
dominated their thinking beyond the point of
relevance.

29. • It is a thought, idea, imagery or impulse
which is repetitive , intrusive, irrational,
recognised as ones own thought and ego
dystonic.
• Compulsions- are repetitive ritualistic motor
or cognitive acts which are used to control
anxiety secondary to obsessions

30. • Contamination obsessions
• Aggressive obsessions
• Pathological doubts
• Sexual obsessions
• Blasphemic obsessions
• Obsessive ruminations
• miscellenaeous

31. compulsions

32. Thought alienation

33. Thank You..!