Academic literature on the topic 'Delusions in literature'

Abstract Background Individuals endorsing delusions exhibit multiple reasoning biases, including a bias toward lower decision thresholds, a bias toward gathering less data before forming conclusions, and a bias toward discounting evidence against one’s beliefs. Although these biases have been repeatedly associated with delusions, it remains unclear how they might arise, how they might be interrelated, and whether any of them play a causal role in forming or maintaining delusions. Progress toward answering these questions may be made by examining delusion-related reasoning biases from the perspective of dual-process theories of reasoning. Dual-process theories posit that human reasoning proceeds via two systems: an intuitive system (which is autonomous, does not require working memory) and an analytic system (which relies on working memory, supports hypothetical thought). Importantly, when the outputs of one or both systems conflict with one another, successful detection of this conflict is thought to produce additional engagement in analytic reasoning. Thus, the detection of and ensuing neurocognitive response to conflict may modulate analytic reasoning engagement. Working from this dual-process perspective, recent theories have hypothesized that more limited engagement in analytic reasoning, perhaps resulting from conflict processing deficits, may engender delusion-inspiring reasoning biases in people with schizophrenia. Methods Given this hypothesis, a literature review (Bronstein et al., 2019, Clinical Psychology Review, 72, 101748) was conducted to critically evaluate whether impaired conflict processing might be a primary initiating deficit in pathways relevant to the generation of delusion-relevant reasoning biases and the formation and/or maintenance of delusions themselves. Results Research examined in this review suggested that in healthy people, successful conflict detection raises decision thresholds. Conflict-processing deficits in delusional individuals with schizophrenia might impair this process. Consistent with this possibility, delusional individuals with schizophrenia (vs. healthy controls) make more decisions when they perceive their favored choice to be only marginally better than alternatives. Lower decision thresholds in individuals who endorse delusions may limit analytic thinking (which takes time). Reductions in decision-making thresholds and in analytic reasoning engagement may encourage these individuals to jump to conclusions, potentially promoting delusion formation, and may also increase bias against disconfirmatory evidence, which may help delusions persist. Discussion Extant literature suggests that conflict processing deficits might encourage delusion-related cognitive biases, which is broadly consistent with the idea that these deficits may be causally primary in pathways leading to delusions. This conclusion lends credence to previous theories suggesting that reduced modulation toward analytic reasoning in the presence of conflict might promote delusions. Future research should attempt to more specifically determine the source of deficits related to analytic reasoning engagement in delusional individuals with schizophrenia. It is often unclear whether analytic-reasoning-related deficits observed in existing literature result from impairments in conflict detection, responsiveness to conflict, or both. Tasks used to study dual-process reasoning in the general population may be useful platforms for specifying the nature of analytic-reasoning-related deficits in delusional individuals with schizophrenia.

SummaryObjective – Delusions and lack of insight have traditionally been viewed as the defining characteristics of insanity and in modern psychiatry continue to be central to the diagnosis of psychosis. Little is known about the mechanisms of delusion formation and much of the research into delusions and lack of insight has been focussed on schizophrenia, in spite of the fact that these symptoms are also prominent in other disorders e.g., affective psychosis. The objective of this paper is to review the literature on existing theories of delusions and insight with reference to the effects of affective disturbance on memory processes. Method – Narrative review supplemented by literature searches using Medline, PsycINFO and EMBASE databases for the period 1980 to present using terms “delusion”, “insight” and “affect”. Results – The role of affect on memory in normal psychology and delusions in psychopathology is being increasingly recognised. We sketch out a theory which gives weight to locating the formation and maintenance of mood congruent and mood incongruent delusional beliefs (and insight into such beliefs) within a model of normal memory processes. Conclusion – We conclude that delusional beliefs may represent false or biased memories of internal or external events modified and strengthened of by affective states. We propose that insight rests on an ability to identify these memories as internally generated or biased. In view of the growing body of knowledge accumulating from the study of memory, emotion and their neuropsychological correlates we would suggest using this as an evidence base for the further neuropsychiatric investigation of delusional beliefs.Declaration of Interest: none.

http://dx.doi.org/10.5007/1808-1711.2015v19n3p379Clinical delusions have traditionally been characterized as beliefs in psychiatry. However, philosophers have recently engaged with the empirical literature and produced a number of objections to the so-called doxastic status of delusion, stemming mainly from the mismatch between the functional role of delusions and that expected of beliefs. In response to this, an appeal to dispositionalism about the nature of belief has been proposed to vindicate the doxastic status of delusion. In this paper, I first present the objections to attributing beliefs to delusional patients and the application of dispositionalism in the attempt to vindicate doxasticism. I then assess this application and some responses to the objections to the doxastic characterization. Finally, I offer some conclusions about the limits of folk-psychological concepts in the characterization and explanation of complex psychological phenomena such as delusions.

Abstract Background During a psychotic episode, patients frequently suffer from severe maladaptive beliefs known as delusions. Despite the abundant literature investigating the simple presence or absence of these beliefs, there exists little detailed knowledge regarding their actual content and severity at the onset of illness. Investigating delusions in early clinical samples is critical, because their relatively young, treatment-naïve presentations are less likely to be confounded by the effects of long-term illness or previous interventions. Furthermore, a more detailed view of the association between clinical factors and delusion severity, both globally and per theme, in a larger and more representative sample may improve psychological models and ultimately treatment options. This study reports on delusions during the initiation of indicated treatment for a first episode psychosis (FEP). Methods Data were systematically collected from a sample of 637 service users entering an early intervention service for FEP. The FEP service provides a comprehensive standardized assessment battery with longitudinal follow-up for two years of treatment. The average severity and frequency of each delusional theme at baseline was reported using the Scale for Assessment of Positive Symptoms. Delusional severity, both globally and per theme, was examined across a number of sociodemographic and clinical variables. Results Delusions of a moderate severity or higher were present in the vast majority of individuals experiencing onset of a FEP (94.0%), with persecutory (77.7%), reference (65.5%), and grandiose (40.2%) being the most common themes. Eighty-one percent of service users presented with two or more delusion themes. Persecutory delusions remained consistent in severity across diagnoses, but were more severe with older age of onset (r = .144). No meaningful differences in delusional severity were observed across sex, affective versus non-affective psychosis, or presence/absence of substance abuse or dependence. Global delusion severity was associated with anxiety (r = .205) but not with depression (r = .052), with specific relationships emerging per theme. Delusions commonly referred to as passivity experiences and/or thought alienation, mind reading delusions (r = .242) and delusions of control (r = .247), were related to hallucinatory experiences. We will also examine delusions longitudinally by investigating their relationship to the duration of untreated psychosis and outcomes, along with the stability of delusional content across episodes. Discussion Unlike the more selected samples, confounded treatment effects, and/or varying levels of chronicity seen in previous reports, this community representative sample offers a rare clinical lens into the severity and content of delusions in FEP. While delusional severity remained consistent across certain sociodemographic and clinical variables, this was not always the case. Future work may wish to investigate the evolution of delusions over time, including focusing on specific themes and/or their overlaps, including with smaller samples and in-depth, phenomenologically oriented interviews.

Objective: In this paper I critically review the recently developed idea that delusions are best considered as part of a continuum along with more ordinary human beliefs. Method: A literature review of the area was guided by a Medline search, and supplemented with material already known to the author. Claims that recent research supports the continuum hypothesis is critiqued. Results: The argument and evidence advanced for the continuum approach to delusions depends largely on: (i) inadequacies of prevailing definitions of delusion, particularly in the light of evidence that delusional conviction is often not absolute; and (ii) the high prevalence of unusual beliefs in community populations. To the extent that the delusion construct contains much in addition to conviction and unusual or false belief content, the continuity approach is weak. The category of delusions continues to have some validity. Conclusion: Both categorical and continuous approaches to delusions have validity that depends at any time on our immediate clinical or scientific needs. No definitive resolution of the category versus continuum debate is likely to emerge.

SummaryOrganic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxicmetabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.

Objective To present a case report of folie simultanée in monozygotic twins. The literature describing folie à deux in twins is also reviewed and the common clinical findings are presented. Method Case presentation and review of the literature. Results Clinical observations of monozygotic twins with folie simultanée suggest that the delusions tend to progress over time with each twin reinforcing the delusion in the second. Conclusions The concept of a delusion resonating between individuals may account for the rapid progression and escalation of these delusions.

The aim: to provide an overview of domestic and international studies examining various aspects of issue of depressive delusional ideas in endogenous delusional depression disease patternMaterials and method: in order to compile a literature review for the keywords depressive delusions and delusional depressions, data from scientific articles posted in MedLine and PubMed databases as well as other bibliographic sources have been searched and analyzed during the formation of scientific psychiatry to the present.Discussion: based on the analysis of scientific publications, this paper presents data on the psychopathological description of depressive delusions and its relatedness to the depressive affect. The researchers’ viewpoints on primary and secondary characteristics of depressive delusions are being analyzed. We have identified pathogenetic characteristics of the latter that affect the prognostic assessment, such as features of the depressive triad in endogenous depression, severity and type of depressive affect, risk of suicidal behavior, characteristics of premorbid personality traits, genetic background, as well as therapeutic efficacy of treatment methods for depressive delusions in patients with delusional depression. This research reveals the controversial nature of some provisions of scientific publications that gradually divert from clinical diagnostic approaches, which tend to be replaced by psychological and psychoanalytic ones when carrying out prognostic assessment in cases of depressive delirium, which is characteristic of current psychiatric science.Conclusions: scientific publications data analysis testifies to the priority of the clinical and psychopathological method in studying the issues of depressive delusions structure in delusional depression disease pattern as well as in clinical differentiation of depressive delusions, justifies its clinical and prognostic value and enables to choose the treatment effectively.

Introduction Delusional disorder (DD) is defined by the presence of one or more delusions, of at least one month’s duration, in the absence of prominent hallucinations or other symptoms of schizophrenia. Although functioning may not be markedly impaired, the delusion(s) or its ramifications may have a significant impact in the patient’s life. With a life-time prevalence of 0.18%, DD is still neglected in terms of approved treatment recommendations. Objectives We present the case of a patient diagnosed with DD and discuss the treatment of DD according to current evidence. Methods Relevant clinical information was extracted from the patient’s clinical process. A non-systematic review was made in Pubmed database with the terms “Delusional Disorder” and “Treatment”. Results Male, 76 years old, divorced, living alone, autonomous. First admitted at age 62 in our inpatient psychiatry ward for a persecutory delusion regarding his neighbors. He was discharged with the diagnosis of DD and started a follow-up in a mental health community team. He abandoned treatment and psychiatric consultation after 9 years. During 17 years he moved home more than 10 times due to a progressive dynamism of the delusion, leading to recent marked behavior changes towards his neighbors. He is again admitted in our inpatient psychiatry ward. Conclusions This case illustrates the impact that untreated DD can have on its patients. Although consensus using antipsychotics, there are still insufficient studies to make evidence-based recommendations to treat people with DD. Further research is needed in this sense. Disclosure No significant relationships.

IntroductionThe delusional misidentification syndromes (syndromes of Frégoli, Intermetamorphosis, Subjective Doubles and Capgras) are characterized by delusions of misidentification of other persons or of one-self. Aggressive ideas or behaviours often go with these delusions, but the problem received relatively little attention. Capgras’ Syndrome is characterized by the delusional belief that a well-known person has been replaced by a double. The delusion frequently involves significant others and takes place in a paranoid atmosphere with feelings of strangeness and unreality. We stress the importance of considering the potential dangerousness and homicidal acts directed towards family members of patients with Capgras’ Syndrome.MethodsWe report a case with histories of paranoid schizophrenia and alcohol and cannabis intoxications who developed a Capgras’ Syndrome associated with homicidal behaviours toward his wife.ResultsOur case met DSM IV-TR diagnostic criteria for paranoid schizophrenia, according to previous studies which show that paranoid schizophrenia is the most frequent mental disorder associated with delusional misidentification. The psychopathological analysis show that homicidal acts are connected to anguish of the ego disintegration and failure of defense mechanisms.ConclusionsAccording to the most recent literature, our findings suggest that Capgras’ Syndrome may be linked to a genesis of aggressive behaviours; alcohol and substance intoxications facilitates impulsivity and dissociation. The patients’ acting out directed toward family members occurs during a psychotic breakdown. Capgras’ Syndrome should always be evaluated in order to prevent violent acts.

The following study is an examination of the deluded heroine in the novel between 1740 and 1820. Through close readings of fiction by Samuel Richardson, Charlotte Lennox, Frances Burney, Charlotte Smith, Ann Radcliffe and Jane Austen, and discussion of relevant works by other authors of the period, the reasons for the prevalence of this figure are considered. The thesis proposes that this choice of protagonist enabled the exploration of a number of the issues that most concerned contemporary novelists. Principal amongst these was the question of identification between reader and literary protagonist. Throughout this period authors engaged in attempts to develop and control the audience's response. The desired end was the "improvement" of readers by the experience of the situations, mistakes and trials of the text's central characters. Increasingly though, the unpredictable and fluctuating nature of the readers' reactions was recognised. The result was a conflict between "text as instruction", the moral education that authors professed to offer, and "text as fiction", the attractions of story, adventure and imagination which were ostensibly valued only as they brought readers to works intended to improve them. The connection of the latter to romance was a further source of tension. The establishment of the novel as a model for life was premised on claims to probability, but aspects of the texts remained which worked against mimetic representation. These oppositions explain the contemporary popularity of the quixotic narrative, since the quixote both enacted the "madness" of excessive imaginative involvement with literature and could also be shown learning to make a "correct" choice of genre for reading. The strategies that can be observed within the quixote novel have a wider application when they are considered alongside the patterns of imitation, influence and parody which characterise the fiction of the period. In order to examine these features, the thesis includes an analysis of two important literary dialogues: those between Richardson and Lennox, and between Radcliffe and Austen. My focus on the heroine acknowledges the significance of gender in the period's fiction. Created by both female and male authors, such figures could be either exemplary models or quixotic warnings. They nevertheless share an experience of delusion followed by enlightenment constructed in order to benefit the "reading Misses" following their adventures. Unlike much recent criticism, however, my concern is more with the author as creative artist, text as literary process and reader as imaginative participant, than with historical or sociological contexts.

This thesis first focuses on reviewing the literature in the field of persecutory and grandiose delusions and the role of self-esteem in their development and maintenance. An empirical study exploring first person accounts of grandiose beliefs is then considered. A systematic review of the literature was conducted to elucidate the role of self-esteem in persecutory and grandiose delusions. Electronic databases were searched and thirty four studies were included. The review yielded largely mixed results. A number of higher quality studies indicated that persecutory delusions are associated with low self-esteem and that they are predicted by fluctuations in self-esteem. There was some evidence showing that grandiose delusions are associated with higher self-esteem. Studies investigating grandiose delusions are scarce, suggesting a need for further high quality research in this area. An empirical study was conducted to explore the lived experience of individuals with grandiose beliefs, with the purpose of developing a theory of grandiose beliefs. Seven individuals were interviewed using a Semi-Structured Interview Schedule. A Grounded Theory method was used. The findings demonstrated a number of shared processes: Expanding Sense of Self, Higher Consciousness, Search for Healing, Re-gaining Control and Element of Truth and Validation. The developed theory suggested that multiple pathways could lead to the onset of grandiose beliefs, including a pathway leading from the experience of paranoid to grandiose beliefs. The implications of the developed framework of grandiose beliefs for future research and clinical practice are considered.

<abstract>'In Two Minds' is a novel of false beliefs. Set in contemporary Sydney, it deals with the relationship between two sisters in their late thirties, Kara and Linda Hille. Told in the second person singular from the point of view of the elder sister, Linda, it is based around the neurological delusion of the younger sibling, Kara. Kara wrongly believes that their mother, Stella, has been replaced by an impostor, 'Mrs. Whitegloves'. For the greater part, the narrative 'you' relates events in the sisters' lives and deals with issues such as the consequences of condoned child abuse, the dilemma of human cloning and the future of 'the brand' in the light of contemporary global marketing. Linda, an advertising executive, struggles with a formidable work-project, an account that is lost to a competitor, and the mistaken belief that she is responsible for her sister's plight. Shocking graffiti about herself, which appears at the same time as she wins an advertising award, proves to be the catalyst that brings beneficial change to her life. Through the tragedy of confronting her sister's devastation and her own challenges, Linda leaves her job, believing this will allow her to start again - differently. In the final chapter, the difference is registered in a shift from the second person to the consolidated first person method of narration. ABSTRACT EXEGESIS The dissertation 'A Singular Voice' documents aspects of authorial, psychoanalytical and literary significance in the creation of a fiction which draws on personal material confrontational to the writer. It also discusses some wider (non-fictional and other) uses of the narrative 'you' in order to establish the literary tradition in which the novel 'In Two Minds' may be situated. This disseration examines the use of the second-person singular pronoun 'you' as narrator, mainly in contemporary fiction. It concentrates on the ways in which the narrative 'you' was employed to achieve a 'cover', mask or persona for the 'I' behind the text in the novel 'In Two Minds', and explains why it was necessary to seek such subterfuge. It describes how certain grammatical and rhetorical resources were used to build and maintain 'cover', while at the same time allowing the narrative 'you' to express a particular aspect of the fictional protagonist, address the reader, and sustain the story of which it is the intradiegetic narratee. Related narrative elements include construction of the characters through the use of the narrative 'you', for example the narcissistic mother, Stella; the phantom double, 'Mrs. Whitegloves'; the sufferer of Capgras' delusion, Kara; and the ultimate bearer of the singular 'you' voice, the protagonist Linda.

Slaughterhouse-Five by Kurt Vonnegut provides a profound discussion on how the many traumas of war affect the human psyche. The novel’s protagonist, Billy Pilgrim, is a direct witness of many horrific events in World War II, which causes certain life-changing symptoms later in his life. This essay examines the psychological processes of Billy Pilgrim in relation to the traumatic events he experiences in the war. More specifically, Billy’s delusions of supernatural nature are discussed in an attempt to find a connection to the war-trauma. In doing this, the analysis utilizes a psychoanalytic approach to explore the theoretical concepts of trauma and delusion. The essay then identifies certain key moments that are of significance to the development of Billy Pilgrim’s psychological processes and investigates how the different events affect his psyche. Furthermore, Billy’s delusions are discussed to identify their cognitive functions. The analysis finds a clear connection between Billy’s delusions and his trauma, and the essay finds that several of his psychological mechanisms are supported by the corresponding ideas within the psychoanalytic framework. Moreover, a progression of his symptoms is identified and discussed in relation to his experiences in World War II.

This study examines the psychology of fictional and real-life serial killers and the behavioral similarities between them. Three fictional murderers, mainly Macbeth (William Shakespeare’s Macbeth), Buffalo Bill (The Silence of the Lambs), and the Creature (Frankenstein),as well as real life killers such as Charles Manson, Ed Gein, and Edmund Kemper were researched in depth. The data for this study was gathered from a variety of sources such as biographies, television interviews, published novels, articles, and documentaries. This study also focuses on predispositional factors and personality traits that led these killers to a life of crime. While no single behavioral trait was found to be present in every murderer studied, some of the psychological factors that were found to have predictive value included: abusive upbringings, mother hate, adoption, pornography, and brain damage were also reliable predictors in the lives of fictional and nonfictional perpetrators.

No final do século XIX, devido às mudanças socioculturais alavancadas por novidades científicas como a teoria evolucionista de Darwin e a ciência psicológica de Freud, histórias que quebravam as fórmulas tradicionais da escrita passaram a ganhar cada vez mais espaço, adicionando nuance e incerteza à prática narrativa. 1 Um dos fenómenos literários que surgiu neste período foi o conceito do narrador não fidedigno, ou seja, um narrador que, por incapacidade de perceber seu mundo ficcional de forma objetiva, desonestidade ou inabilidade narrativa, não dá ao leitor uma visão precisa sobre a realidade da história que conta. A análise dessa estratégia literária começou com Wayne C. Booth e Seymour Chatman, que defendiam que a deteção de um narrador não fidedigno dependia da distância entre o narrador e o autor implícito ao texto. James Phelan e Ansgar Nünning, por sua vez, propunham que o essencial para a deteção de um narrador não fidedigno era a distância entre esse narrador e o leitor implícito ao texto. Devido a essas diferenças ideológicas e à complexidade do assunto, a deteção e análise do narrador não confiável tornou-se uma área de debate entre os teóricos da literatura até os dias atuais, nos quais duras críticas são encontradas a essas teorias. De uma forma ou de outra, todas estas teorias utilizam-se de elementos externos ao texto para avaliar fatores internos a ele, e, através de diversas falácias lógicas, usam de métodos prolixos e desnecessários para chegar a um resultado aceitável mas impreciso de deteção do narrador não confiável. Tais teorias desconsideram o fator das interferências entre a intenção do narrador e o que está de facto escrito no texto e a impossibilidade de verificação de interpretações pessoais subjetivas. Ao mesmo tempo, todas baseiam-se de uma forma ou de outra no texto, antes de seguir para conclusões diferentes. Ao focar uma análise textual no texto em si, encontra-se uma forma de respeitar seu nível ontológico, de manter-se focado apenas em informações diretamente ligadas ao narrador e de garantir que todos os argumentos tenham uma origem verificável. Theresa Heyd propõe uma teoria de deteção do narrador não fidedigno que leva, justamente, tais parâmetros em consideração. Esta teoria é mais confiável e verificável por fazer uma análise textual e pragmática sobre os contextos envolvidos em cada parte do texto e por buscar contradições expressadas pelo narrador dentro da ficção de forma a detetar seu status como não fidedigno. Com base nessa teoria, conduzo uma análise do texto escolhido para a dissertação, “The Repairer of Reputations”, primeiro conto na coletânea de contos The King in Yellow (1895), de Robert W. Chambers. O narrador deste conto é Hildred Castaigne, um estudioso que acaba de sair de um sanatório após uma queda de cavalo. Durante seu tratamento, Hildred leu uma peça banida por seu conteúdo subversivo, homónima à coletânea. Durante as primeiras páginas do conto, Hildred expõe viver numa Nova Iorque dos anos 1920, futurista em relação à data de publicação do livro. Hildred descreve o contexto social e histórico dessa América, de forma simples e vaga, pintando um retrato curioso do país: uma distopia nacionalista, militarista e eugenista, onde a segregação é a lei e até doentes mentais são incentivados a um suicídio legal através da instalação de Câmaras Letais por todo o país. Este retrato, no entanto, é apresentado de forma positiva por Hildred, que certamente compartilha destas ideologias sociopolíticas. Afinal, segundo o narrador, ele nunca teve qualquer problema psicológico, e seu internamento foi desnecessário e injusto. De facto, Hildred crê ser o herdeiro da Dinastia Imperial da América, e que seu internamento e o casamento de seu primo são golpes políticos para impedi-lo de assumir o trono. Numa análise mais objetiva a seguir o modelo de Heyd, conclui-se que Hildred é um narrador extremamente não fidedigno. Ele demonstra discordar de muitas coisas aceitas por outros personagens, mente ou omite informações do leitor e de outros personagens, descreve-se de formas que não condizem com seu comportamento, falha em manter descrições consistentes de seus arredores, e por fim, termina a história capturado por organizar uma tentativa de assassinato, e falece em um manicómio para os criminalmente insanos, enquanto continua a julgar-se como vítima de um golpe político. É também suspeito que toda a descrição da América de Hildred seja tão próxima de seus próprios valores pessoais, tendo influências estilísticas da mesma era da história militar que o narrador tem em sua biblioteca, e adotando características que refletem seus interesses e sentimentos pessoais. Mesmo a descrição positiva feita por ele quebra quando analisada com mais cuidado, e diversos problemas morais e sociais podem ser encontrados nessa sociedade apresentada como ideal pelo personagem. Com isto em mente, seria fácil descartar quase todos os aspetos da narrativa de Hildred como não fidedignos, mas há pontos que os complicam. Outros personagens, tidos como relativamente e até mesmo muito fidedignos na narrativa, em certos pontos, interagem com a realidade descrita por Hildred, e mesmo oferecem testemunhos e fazem comentários que apoiam as teorias de conspiração que o guiam. É praticamente impossível determinar com precisão onde terminam os delírios do narrador e começa sua realidade. No entanto, o foco desta dissertação é estabelecer um panorama da psicologia de Hildred, não detetar os limites de sua realidade ficcional. O que percebe-se é que Hildred lida com a leitura da peça e seus conteúdos como um trauma, e, como muitas pessoas que têm traumas não tratados, entra em negação sobre a experiência traumática. Neste estado de negação, transforma o objeto de seu trauma em uma ferramenta que o dará poder (a peça é o que lhe faz descobrir sua suposta linhagem nobre), permitindo-lhe revisitar a experiência traumática de forma ativa. Aliena-se ao resto do mundo, julgando-os ignorantes por não terem lido a peça, e permite verdadeira conexão apenas com aqueles que concordam e apoiam aquilo que ele pensa. Todos os outros, a seu ver, são mal-intencionados ou mal-informados, e portanto suas opiniões não contam. Hildred distancia-se da sociedade normal, nega as próprias limitações, e por fim constrói uma narrativa delirante em que ele é sempre a vítima, mas tem um grande destino a cumprir; que valida sua paranoia e desconfiança expressa através do conto, e que o permite manter uma auto-imagem heroica mesmo enquanto pratica ações amorais e por vezes abertamente imorais – para Hildred, é tudo culpa de outros, e para garantir seu destino, tudo é permitido. Este padrão de pensamento faz um paralelo extremamente próximo ao descrito por Theodor W. Adorno, Else Frenkel-Brunswik, Daniel J. Levinson e R. Nevitt Sanford em The Authoritarian Personality e com a forma de governo descrita por Hannah Arendt em The Origins of Totalitarianism . As duas obras detetam uma forma de pensar que aprende a avaliar a si e a outros conforme uma performance de conformidade a determinados valores. O que importa são as aparências, e não há conexão profunda entre um indivíduo e qualquer ideologia específica, mas apenas a performance desta ideologia e o quanto esta performance lhe permite expressar frustração e projetar culpa àqueles que não se encaixam nela (como é o caso dos segregados no país fictício de Hildred). É um padrão de pensamento fortemente influenciado pela divisão de pessoas em grupos e uma falta de compreensão de igualdade, guiado por busca de poder e autoridade de forma a diminuir a sensação de insegurança causada pelo confronto com a realidade, e as ansiedades causadas por suas próprias limitações humanas. Para o autoritário, isto acontece a nível individual. Para o estado totalitário, isto acontece ao nível de um país inteiro. No conto, percebe-se isto no personagem narrador, que constitui uma representação ficcional porém realista de um processo mental como este.<br>The concept of the unreliable narrator has been studied and debated ever since its appearance at the end of the XIX century, with several theories attempting to analyse it and determine how best to detect it. By analysing the prevalent canonized theories critically, and creating a panorama of the discussion, this dissertation detects several issues with their proposed methodologies, and finds more common ground with newer theories such as Theresa Heyd's pragmatic approach. By utilizing these methods, this dissertation analyses Hildred Castaigne, the narrator character of “The Repairer of Reputations”, the first short story in the anthology The King in Yellow , (1985) by Robert W. Chambers. Hildred is found to be an extremely unreliable narrator, to the point where it is impossible to determine precisely where his delusions end and his reality begins. His psychological processes also parallel the psychological processes described in Adorno et al.'s The Authoritarian Personality and the sociological processes in Hannah Arendt's The Origins of Totalitarianism . By creating a layer of denial and delusion through which he can protect his self-image and project his evil deeds as justified in attempts to protect against perceived greater evils, Hildred, the authoritarian individual and the totalitarian government seek to impose their will on the world, and thus protect themselves from feeling helpless and vulnerable ever again.

Psychotic presentations are discussed in context of ten personality disorders (PDs). The PDs were examined across the literature for associations with psychosis. Hallucinations and delusions are often symptoms of paranoid, schizoid, and schizotypal PDs. Patients with borderline PD present with both auditory and visual hallucinations, and range of delusional thinking. Hallucinations are generally absent among patients with antisocial, histrionic, and narcissistic PDs. Various delusions, however, are common symptoms of these disorders. Patients with avoidant, dependent, and obsessive-compulsive PDs present with delusional thinking, olfactory hallucinations (in cases of avoidant, obsessive-compulsive PDs), and possibly tactile hallucinations (in cases of avoidant PD). Approaching PDs from multiple disciplines across neurobiological and cognitive behavioral domains could further inform treatments of psychosis in PDs. Exploration of transdiagnostic domains of emotion, cognition, motivation, and social behavior could provide vital information for diagnostic and clinical purposes. More investigation is needed to draw further associations between psychosis, PDs, and co-occurring conditions.

Black feminist writers of the early twenty-first century exposed imperial culture’s delusions of omnipotence and its fears of destruction while also figuring Black feminist paranoia as a form of occult knowledge in the service of collective preservation. This chapter analyzes how Black feminist writers crafted livable realities on the other side of terror in literature after 9/11. It discusses how the convergence between racial power and literary consumerism is acutely apparent in those texts that position the September 11 attacks as a definitive moment that changed the direction of racial discourse in the United States. While the chapter covers such texts—narrative fiction such as Randall’s Rebel Yell and Danielle Evans’s short story “Someone Ought to Tell Her There’s Nowhere to Go”—to suggest that their feminist critiques of the long war on terror lay bare the intimacy between its modes of subjection and Black culture’s means to success, it ends with an analysis of Gloria Naylor’s paranoid memoir 1996, which refuses the aspiration and success of which Randall and Evans are so critical.

The words ‘schizophrenia’ and ‘schizophrenic’ are often misused in daily con­versation, in literature and film, and even in the popular news media. They mean different things to different people: an attitude of mind, a type of personality, or a psychiatric illness. For example, someone who can’t make up his mind, or who has feelings of both love and hate for something, may be falsely called schizo­phrenic (‘ambivalent’ is the more proper term). In some cultures, especially in the past, schizophrenia was seen as a sign of possession by an evil spirit or even as a sign of religious superiority. Individuals with schizophrenia were either pun­ished or praised in accord with the beliefs of their culture.Today, the most common misconception is that a person with schizophrenia has a ‘split’ personality or multiple personalities. Examples of this in film include Me, Myself, and Irene, in which the main character is diagnosed with ‘advanced delusionary schizophrenia with involuntary narcissistic rage’ instead of what appears to be dissociative identity (formerly known as multiple personality) dis­order. Even films that do a decent job depicting schizophrenia can get some aspects wrong; for example, A Beautiful Mind, which we earlier cited as a rela­tively well-done depiction of the disorder, also misses the mark by exaggerating the role of visual hallucinations of full- figure humans in guiding the main char­acter through various and extensive ‘missions’.The correct use of the word ‘schizophrenia’ is as a diagnostic term used to define a specific mental condition based on clear criteria. As described in our chapters on symptoms and on how schizophrenia is diagnosed, differential diagnosis is essential; that is, determining if the symptoms are really indica­tive of schizophrenia or of other conditions. Recognizing if mood disturbances (including depression and/ or mania), delusions (particularly grandiosity and delusions of sin or guilt), hallucinations, and disorganization are not actually reflective of a mood disorder, substance use disorder, or developmental or neuro­logical disorder is essential, since each type of disorder has a different treatment. Furthermore, it is vital to consider cultural context when determining if behav­iour is truly bizarre and qualifies for a diagnosis or is simply normal within the individual’s social setting.

The imperial grammars of Blackness are the structures of communication that translate Black pain and Black thriving into the speech of US empire: not just words and phrases but gestures of affirmation and empowerment that weave Black aspiration into national delusions of domination. Throughout the late twentieth and early twenty-first centuries, fantasies, images, narratives, slogans, and trinkets of Black women’s freedom and achievement—in the chambers of Congress, on T-shirts and buttons, uniformed on street corners and offshore, on the stages of festivals and world meetings, and everywhere you can imagine—served as prosthetics for an empire desperate for multicultural representation as the sign of its righteousness and the ground of its tenuous authority. Black women writers and critics and foreign service officers and entertainers had a role to play in legitimizing power, in restoring order, no less than enlisters and university presidents and national security advisers. Black feminist literature—and by this I mean to refer not to the singular “great works” that make up the syllabus for the successive regimes of liberalism but the open, insurgent, actively mass-authored text, the ...

Paranoia/delusional disorder is unique in psychiatry in that it is virtually a newly discovered illness, yet much of the fundamental descriptive work was done a century or more ago. This long hiatus means that most practitioners have little knowledge or experience of the disorder, and the few who are aware of it usually only see a small part of the fabric. The dermatologist treats a case of delusional parasitosis, the cosmetic surgeon has an impossible patient wth a dysmorphic delusion, the lawyer does not know what to do with a totally unreasonable litigant, the police officer has to deal with a jealous murderer or an erotomanic stalker, and the personnel officer has an employee who is convinced his fellow workers are persecuting him, etc. How can we draw all this scattered material together and add it to the psychiatric literature to make a whole cloth? The answer is largely by consciousness raising and education. Kendler, an authority in this field, has said, ‘The paranoid disorders may be the third great group of functional psychoses, along with affective disorder and schizophrenia’. If he is correct, it is imperative that we hone our diagnostic and treatment skills in order to improve the help we might offer to delusional disorder sufferers and to facilitate research which is so badly needed.

IBM’s Watson got an avalanche of publicity when it won Jeopardy, but Watson is potentially far more valuable as a massive digital database for doctors, lawyers, and other professionals who can benefit from fast, accurate access to information. A doctor who suspects that a patient may have a certain disease can ask Watson to list the recognized symptoms. A doctor who notices several abnormalities in a patient, but isn’t confident about which diseases are associated with these symptoms, can ask Watson to list the possible diseases. A doctor who is convinced that a patient has a certain illness can ask Watson to list the recommended treatments. In each case, Watson can make multiple suggestions, with associated probabilities and hyperlinks to the medical records and journal articles that it relied on for its recommendations. Watson and other computerized medical data bases are valuable resources that take advantage of the power of computers to acquire, store, and retrieve information. There are caveats though. One is simply that a medical data base is not nearly as reliable as a Jeopardy data base. Artificial intelligence algorithms are very good at finding patterns in data, but they are very bad at assessing the reliability of the data and the plausibility of a statistical analysis. It could end tragically if a doctor entered a patient’s symptoms into a black-box data-mining program and was told what treatments to use, without any explanation for the diagnosis or prescription. Think for a moment about your reaction if your doctor said, I don’t know why you are ill, but my computer says, “Take these pills.” I don’t know why you are ill, but my computer recommends surgery. Any medical software that uses neural networks or data reduction programs, such as principal components and factor analysis, will be hard-pressed to provide an explanation for the diagnosis and prescribed treatment. Patients won’t know. Doctors won’t know. Even the software engineers who created the black-box system won’t know. Nobody knows. Watson and similar programs are great as a reference tool, but they are not a substitute for doctors because: (a) the medical literature is often wrong; and (b) these errors are compounded by the use of data-mining software.

Nearly all of us end up in the hospital for something sooner or later. The unique problems of Lewy disorders and medications can challenge hospital care teams. On a related note, some individuals with DLB or PDD may require care in a nursing facility. This may be transient, requiring rehabilitation and stabilization following a hospitalization; in other cases, it is indefinite because of the complex care necessary for DLB and PDD. In this chapter, the focus is on the care teams in these facilities. Although many staff in these settings are familiar with the medications and problems of DLB and PDD, this knowledge is not universal. Little published literature addresses the special needs of those with PDD or DLB admitted to the hospital or living in extended care facilities. It is hoped that this chapter can be an aid in caring for those with PDD or DLB. People with DLB or PDD are, by definition, cognitively impaired. Sometimes this is associated with hallucinations or delusions. Most individuals also have dopamine deficiency states with parkinsonism. Another common component is autonomic nervous system dysfunction. This dysautonomia may be associated with bladder and bowel disorders but, more importantly, with orthostatic hypotension (potential for fainting when ambulating). Some people with PDD or DLB are mildly impaired by these problems, and others are quite compromised. What follows is a summary of crucial knowledge for nursing and paramedical staffs. 1. As with any dementia, novel environments are disorienting. 2. Hallucinations are a frequent component of DLB and PDD. These may be exacerbated by psychoactive medications, including narcotics for pain. 3. Carbidopa/levodopa is the least likely among the potent drugs for parkinsonism to provoke hallucinations. Other Parkinson drugs should generally not be started. 4. People with DLB or PDD commonly experience dream enactment behavior (REM sleep behavior disorder); this should not be misinterpreted as nocturnal hallucinations. 5. Anticholinergic medications for urinary urgency may cross the blood–brain barrier and impair cognition (e.g., oxybutynin). The only drug from this class that cannot get into the brain is trospium (Sanctura).

The purpose of this article is, through a clinical case, to review the literature on psychosis secondary to methadone withdrawal. Observation of the patient and consultation of the clinical file. Non-systematic literature review on methadone use, methadone discontinuation and dual pathology. A 47-year-old male, history of opioid and cannabinoid use disorder, currently in abstinence and under opioid substitution therapy with methadone. After abrupt discontinuation of methadone, he began presenting delusional ideas of jealousy and persecution with multiple delusional interpretations. A diagnosis of persistent delusional disorder was made, and he was medicated with long-term injectable aripiprazole. Methadone is a synthetic opioid agonist used to treat addictions to opioids, such as heroin. Methadone maintenance treatment (MMT) contributes to cessation or reduction of heroin use, reduced risk of HIV and hepatitis virus infections, decreased mortality, improved family and social relationships and employment status. Side effects include dizziness, drowsiness, vomiting, sweating, respiratory depression and prolongation of the QT interval. Other important consequences are precipitation of withdrawal symptoms with consequent relapse to heroin use and withdrawal from MMT. Methadone withdrawal leads to the classic symptoms of opiate withdrawal - abnormalities in vital signs, dilated pupils, agitation, irritability, insomnia, sneezing, nausea and vomiting. In a minority of cases, it can lead to the sudden onset of affective disorders and psychotic disorders. Although scarce, psychotic symptoms after opioid withdrawal have already been described in the literature. Opioids function not only as neurotransmitters, but also as neuromodulators that may be involved in the regulation of the dopaminergic system. An altered neuromodulation of the central opioid-dopamine systems due to long-term MTM may be related to psychotic pathogenesis. Considering the high prevalence of psychiatric comorbidity in patients with substance use disorder, it's important to pay attention and monitor any change in opioid medication, with close observation for possible psychotic symptoms.

Introduction: "Folie a deux" is defined as the transference of delusional ideas in individuals with a close and intimate relationship. While the relationship between cocaine use and psychosis is well described in the scientific literature, there are not many studies on how cocaine use affects individuals who share a “folie a deux”. Objective: To identify and compile the different factors that may drive the patient's psychotic episode. Material and methods: Review of the clinical history of a patient admitted to the Salamanca UHB with a diagnosis of substance-induced psychotic disorder. Clinical case: A 41 year old single man, who lives in a farm located in a village with 12,000 inhabitants, was referred with judicial authorisation from a Court of First Instance and Instruction for Psychiatric Assessment. He presented delusional ideation in relation to a neighbour. The Court report included occasional episodes of heteroaggressive behaviour. He also tested positive for cocaine (more than 900 ng/ml) in the hospital admission analysis. Interviewing his mother, who is still living in the same building as said neighbour, there was evidence of an increased delusional ideation in her regard. Results and conclusions: Despite incorporating the delusional ideation into his biography, the patient was able to develop his life away from the original focus. According to the reconstruction of the history, the behavioural alterations usually appeared in the context of consumption. The “folie a deux” develops slowly and is perpetuated chronically by the members who share it. On the other hand, about 60% of drug users have a psychotic episode during their lifetime. The coexistence of these two factors in the context of a psychotic episode opens up several lines of work in intervention and therapeutic orientation.