Delusion

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Delusion
Specialty Psychiatry

A delusion [lower-alpha 1] is a false fixed belief that is not amenable to change in light of conflicting evidence. [2] As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

Contents

"The distinction between a delusion and a strongly held idea is sometimes difficult to make and depends in part on the degree of conviction with which the belief is held despite clear or reasonable contradictory evidence regarding its veracity." [2]

Delusions have been found to occur in the context of many pathological states (both general physical and mental) and are of particular diagnostic importance in psychotic disorders including schizophrenia, paraphrenia, manic episodes of bipolar disorder, and psychotic depression.

Types

Delusions are categorized into four different groups:

Themes

In addition to these categories, delusions often manifest according to a consistent theme. Although delusions can have any theme, certain themes are more common. Some of the more common delusion themes are:

Grandiose delusions

Grandiose delusions or delusions of grandeur are principally a subtype of delusional disorder but could possibly feature as a symptom of schizophrenia and manic episodes of bipolar disorder. [10] Grandiose delusions are characterized by fantastical beliefs that one is famous, omnipotent or otherwise very powerful. The delusions are generally fantastic, often with a supernatural, science-fictional, or religious bent. In colloquial usage, one who overestimates one's own abilities, talents, stature or situation is sometimes said to have "delusions of grandeur". This is generally due to excessive pride, rather than any actual delusions. Grandiose delusions or delusions of grandeur can also be associated with megalomania. [11]

Persecutory delusions

Persecutory delusions are the most common type of delusions and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or otherwise obstructed in the pursuit of goals. Persecutory delusions are a condition in which the affected person wrongly believes that they are being persecuted. Specifically, they have been defined as containing two central elements: [12] [ page needed ] The individual thinks that:

According to the DSM-IV-TR , persecutory delusions are the most common form of delusions in schizophrenia, where the person believes they are "being tormented, followed, sabotaged, tricked, spied on, or ridiculed". [13] In the DSM-IV-TR, persecutory delusions are the main feature of the persecutory type of delusional disorder. When the focus is to remedy some injustice by legal action, they are sometimes called "querulous paranoia". [14]

Causes

Explaining the causes of delusions continues to be challenging and several theories have been developed. [15] [16] One is the genetic or biological theory, which states that close relatives of people with delusional disorder are at increased risk of delusional traits. Another theory is the dysfunctional cognitive processing, which states that delusions may arise from distorted ways people have of explaining life to themselves. A third theory is called motivated or defensive delusions. This one states that some of those persons who are predisposed might experience the onset of delusional disorder in those moments when coping with life and maintaining high self-esteem becomes a significant challenge. In this case, the person views others as the cause of their personal difficulties in order to preserve a positive self-view. [17]

This condition is more common among people who have poor hearing or sight. Also, ongoing stressors have been associated with a higher possibility of developing delusions. Examples of such stressors are immigration, low socioeconomic status, and even possibly the accumulation of smaller daily struggles. [18]

Specific delusions

The top two factors mainly concerned in the germination of delusions are disorder of brain functioning and background influences of temperament and personality. [19]

Higher levels of dopamine qualify as a sign of disorders of brain function. That they are needed to sustain certain delusions was examined by a preliminary study on delusional disorder (a psychotic syndrome) instigated to clarify if schizophrenia had a dopamine psychosis. [20] There were positive results - delusions of jealousy and persecution had different levels of dopamine metabolite HVA and homovanillyl alcohol (which may have been genetic). These can be only regarded as tentative results; the study called for future research with a larger population.

It is simplistic to say that a certain measure of dopamine will bring about a specific delusion. Studies show age [21] [22] and gender to be influential and it is most likely that HVA levels change during the life course of some syndromes. [23]

On the influence of personality, it has been said: "Jaspers considered there is a subtle change in personality due to the illness itself; and this creates the condition for the development of the delusional atmosphere in which the delusional intuition arises." [24]

Cultural factors have "a decisive influence in shaping delusions". [25] For example, delusions of guilt and punishment are frequent in a Western, Christian country like Austria, but not in Pakistan, where it is more likely persecution. [26] Similarly, in a series of case studies, delusions of guilt and punishment were found in Austrian patients with Parkinson's being treated with l-dopa, a dopamine agonist. [27]

Pathophysiology

The two-factor model of delusions posits that dysfunction in both belief formation systems and belief evaluation systems are necessary for delusions. Dysfunction in evaluations systems localized to the right lateral prefrontal cortex, regardless of delusion content, is supported by neuroimaging studies and is congruent with its role in conflict monitoring in healthy persons. Abnormal activation and reduced volume is seen in people with delusions, as well as in disorders associated with delusions such as frontotemporal dementia, psychosis and Lewy body dementia. Furthermore, lesions to this region are associated with "jumping to conclusions", damage to this region is associated with post-stroke delusions, and hypometabolism this region associated with caudate strokes presenting with delusions.[ citation needed ]

The aberrant salience model suggests that delusions are a result of people assigning excessive importance to irrelevant stimuli. In support of this hypothesis, regions normally associated with the salience network demonstrate reduced grey matter in people with delusions, and the neurotransmitter dopamine, which is widely implicated in salience processing, is also widely implicated in psychotic disorders.[ citation needed ]

Specific regions have been associated with specific types of delusions. The volume of the hippocampus and parahippocampus is related to paranoid delusions in Alzheimer's disease, and has been reported to be abnormal post mortem in one person with delusions. Capgras delusions have been associated with occipito-temporal damage and may be related to failure to elicit normal emotions or memories in response to faces. [28]

Diagnosis

James Tilly Matthews illustrated this picture of a machine called an "air loom", which he believed was being used to torture him and others for political purposes. Airloom.gif
James Tilly Matthews illustrated this picture of a machine called an "air loom", which he believed was being used to torture him and others for political purposes.

The modern definition and Jaspers' original criteria have been criticised, as counter-examples can be shown for every defining feature.

Studies on psychiatric patients show that delusions vary in intensity and conviction over time, which suggests that certainty and incorrigibility are not necessary components of a delusional belief. [29]

Delusions do not necessarily have to be false or 'incorrect inferences about external reality'. [30] Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not. [31] In other situations the delusion may turn out to be true belief. [32] For example, in delusional jealousy, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings), it may actually be true that the partner is having sexual relations with another person. In this case, the delusion does not cease to be a delusion because the content later turns out to be verified as true or the partner actually chose to engage in the behavior of which they were being accused.

In other cases, the belief may be mistakenly assumed to be false by a doctor or psychiatrist assessing it, just because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person's claims leading to some true beliefs to be erroneously classified as delusional. [33] This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal activity was taking place in the White House. At the time, her claims were thought to be signs of mental illness, and only after the Watergate scandal broke was she proved right (and hence sane).

Similar factors have led to criticisms of Jaspers' definition of true delusions as being ultimately 'un-understandable'. Critics (such as R. D. Laing) have argued that this leads to the diagnosis of delusions being based on the subjective understanding of a particular psychiatrist, who may not have access to all the information that might make a belief otherwise interpretable. R. D. Laing's hypothesis has been applied to some forms of projective therapy to "fix" a delusional system so that it cannot be altered by the patient. Psychiatric researchers at Yale University, Ohio State University and the Community Mental Health Center of Middle Georgia have used novels and motion picture films as the focus. Texts, plots and cinematography are discussed and the delusions approached tangentially. [34] This use of fiction to decrease the malleability of a delusion was employed in a joint project by science-fiction author Philip Jose Farmer and Yale psychiatrist A. James Giannini. They wrote the novel Red Orc's Rage , which, recursively, deals with delusional adolescents who are treated with a form of projective therapy. In this novel's fictional setting other novels written by Farmer are discussed and the characters are symbolically integrated into the delusions of fictional patients. This particular novel was then applied to real-life clinical settings. [35]

Another difficulty with the diagnosis of delusions is that almost all of these features can be found in "normal" beliefs. Many religious beliefs hold exactly the same features, yet are not universally considered delusional. For instance, if a person was holding a true belief then they will of course persist with it. This can cause the disorder to be misdiagnosed by psychiatrists. These factors have led the psychiatrist Anthony David to note that "there is no acceptable (rather than accepted) definition of a delusion." [36] In practice, psychiatrists tend to diagnose a belief as delusional if it is either patently bizarre, causing significant distress, or excessively pre-occupying the patient, especially if the person is subsequently unswayed in belief by counter-evidence or reasonable arguments.

Joseph Pierre, M.D. states that one factor that helps differentiate delusions from other kinds of beliefs is that anomalous subjective experiences are often used to justify delusional beliefs. While idiosyncratic and self-referential content often make delusions impossible to share with others, [37] Dr. Pierre suggests that it may be more helpful to emphasize the level of conviction, preoccupation, and extension of a belief rather than the content of the belief when considering whether a belief is delusional. [38]

It is important to distinguish true delusions from other symptoms such as anxiety, fear, or paranoia. To diagnose delusions a mental state examination may be used. This test includes appearance, mood, affect, behavior, rate and continuity of speech, evidence of hallucinations or abnormal beliefs, thought content, orientation to time, place and person, attention and concentration, insight and judgment, as well as short-term memory. [39]

Johnson-Laird suggests that delusions may be viewed as the natural consequence of failure to distinguish conceptual relevance. That is, irrelevant information would be framed as disconnected experiences, then it is taken to be relevant in a manner that suggests false causal connections. Furthermore, relevant information would be ignored as counterexamples. [40]

Definition

Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the four main criteria for a belief to be considered delusional in his 1913 book General Psychopathology. [41] These criteria are:

  1. certainty (held with absolute conviction)
  2. incorrigibility (not changeable by compelling counterargument or proof to the contrary)
  3. impossibility or falsity of content (implausible, bizarre, or patently untrue) [42]
  4. not amenable to understanding (i.e., belief cannot be explained psychologically) [43]

Furthermore, when beliefs involve value judgments, only those which cannot be proven true are considered delusions. For example: a man claiming that he flew into the Sun and flew back home. This would be considered a delusion, [44] unless he were speaking figuratively, or if the belief had a cultural or religious source. Only the first three criteria remain cornerstornes of the current definition of a delusion in the DSM-5.

Robert Trivers writes that delusion is a discrepancy in relation to objective reality, but with a firm conviction in reality of delusional ideas, which is manifested in the "affective basis of delusion". [45]

Treatment

Delusions and other positive symptoms of psychosis are often treated with antipsychotic medication, which exert a medium effect size according to meta-analytic evidence. [46] Cognitive behavioral therapy (CBT) improves delusions relative to control conditions according to a meta-analysis. [47] A meta-analysis of 43 studies reported that metacognitive training (MCT) reduces delusions at a medium to large effect size relative to control conditions. [48]

Criticism

Some psychiatrists criticize the practice of defining one and the same belief as normal in one culture and pathological in another culture for cultural essentialism. They argue that it is not justified to assume that culture can be simplified to a few traceable, distinguishable and statistically quantifiable factors and that everything outside those factors must be biological since cultural influences are mixed, including not only parents and teachers but also peers, friends, and media, and the same cultural influence can have different effects depending on earlier cultural influences. Other critical psychiatrists argue that just because a person's belief is unshaken by one influence does not prove that it would remain unshaken by another. For example, a person whose beliefs are not changed by verbal correction from a psychiatrist, which is how delusion is usually diagnosed, may still change his or her mind when observing empirical evidence, only that psychiatrists rarely, if ever, present patients with such situations. [49] [50]

Anthropologist David Graeber have criticized psychiatry's assumption that an absurd belief goes from being delusional to "being there for a reason" merely because it is shared by many people by arguing that just as genetic pathogens like viruses can take advantage of an organism without benefitting said organism, memetic phenomena can spread while being harmful to societies, implying that entire societies can become ill. David Graeber argued that if somatic medicine did not have higher scientific standards than psychiatry's way of defining delusion, pandemics like the plague would have been considered to transsubstantiate from an illness to "a phenomenon that benefits the people" as soon as it had spread to a sufficiently large portion of the population. It was argued by Graeber that since deinstitutionalisation made sales of psychiatric medication profitable by no longer needing to spend money on keeping the patients in mental hospitals, corrupt incentives for psychiatry to allege "needs" for treatments have increased (in particular with regard to medicines that are said to be needed in daily doses, not so much regarding devices that can be kept for longer periods of time) which may itself be a harmful memetic pandemic in society that leads to diagnosing and medication of criticisms of widespread beliefs that are actually absurd and harmful, making the absurd belief that is not labelled as an illness profitable anyway by attracting criticisms that are labelled as illnesses. [51]

See also

Footnotes

  1. ↑ From Latin delusiolit. 'deceiving', from deludere'to mock, to deceive' [1]
  1. ↑ Harper, Douglas. "delusion". Online Etymology Dictionary .
  2. 1 2 Bortolotti L (7 June 2013). "Delusions in the DSM 5". Imperfect Cognitions.
  3. ↑ Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association. 2013.
  4. 1 2 3 4 5 6 7 8 9 "Delusions". Encyclopedia of Mental Disorders. Advameg.com. Retrieved 22 April 2018.
  5. ↑ Berrios GE, Luque R (March 1995). "Cotard's syndrome: analysis of 100 cases". Acta Psychiatrica Scandinavica. 91 (3): 185–188. doi:10.1111/j.1600-0447.1995.tb09764.x. PMID   7625193. S2CID   8764432.
  6. ↑ Ruminjo A, Mekinulov B (June 2008). "A Case Report of Cotard's Syndrome". Psychiatry. 5 (6): 28–29. PMC   2695744 . PMID   19727279.
  7. ↑ "Religious delusions are common symptoms of schizophrenia" . Retrieved 17 April 2011.
  8. ↑ Raja M, Azzoni A, Lubich L. "Religious delusion" (PDF). Archived from the original (PDF) on 22 March 2012. Retrieved 17 April 2011.
  9. ↑ Barker, p.. 1997. Assessment in Psychiatric and Mental Health Nursing in Search of the Whole Person. UK: Nelson Thornes Ltd. p. 241.
  10. ↑ Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000)
  11. ↑ Kunert HJ, Norra C, Hoff P (March 2007). "Theories of delusional disorders. An update and review". Psychopathology. 40 (3): 191–202. doi: 10.1159/000100367 . PMID   17337940.
  12. ↑ Freeman D, Garety PA (2004). Paranoia: The Psychology of Persecutory Delusions. Hove: PsychoIogy Press. ISBN   1-84169-522-X.
  13. ↑ Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 2000. p. 299. ISBN   0-89042-025-4.
  14. ↑ Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 2000. p. 325. ISBN   0-89042-025-4.
  15. ↑ Kiran C, Chaudhury S (January 2009). "Understanding delusions". Industrial Psychiatry Journal. 18 (1): 3–18. doi: 10.4103/0972-6748.57851 . PMC   3016695 . PMID   21234155.
  16. ↑ McKenna, Peter (25 July 2017). Delusions: Understanding the Un-understandable (1 ed.). Cambridge University Press. doi:10.1017/9781139871785. ISBN   978-1-139-87178-5.
  17. ↑ "Delusional Disorder" . Retrieved 6 August 2010.
  18. ↑ Kingston C, Schuurmans-Stekhoven J (December 2016). "Life hassles and delusional ideation: Scoping the potential role of cognitive and affective mediators". Psychology and Psychotherapy. 89 (4): 445–463. doi:10.1111/papt.12089. PMID   26846698.
  19. ↑ Sims A (2002). Symptoms in the mind: an introduction to descriptive psychopathology. Philadelphia: W. B. Saunders. p. 127. ISBN   0-7020-2627-1.
  20. ↑ Morimoto K, Miyatake R, Nakamura M, Watanabe T, Hirao T, Suwaki H (June 2002). "Delusional disorder: molecular genetic evidence for dopamine psychosis". Neuropsychopharmacology. 26 (6): 794–801. doi: 10.1016/S0893-133X(01)00421-3 . PMID   12007750.
  21. ↑ Mazure CM, Bowers MB (February 1998). "Pretreatment plasma HVA predicts neuroleptic response in manic psychosis". Journal of Affective Disorders. 48 (1): 83–86. doi: 10.1016/S0165-0327(97)00159-6 . PMID   9495606.
  22. ↑ Yamada N, Nakajima S, Noguchi T (February 1998). "Age at onset of delusional disorder is dependent on the delusional theme". Acta Psychiatrica Scandinavica. 97 (2): 122–124. doi:10.1111/j.1600-0447.1998.tb09973.x. PMID   9517905. S2CID   39266698.
  23. ↑ Tamplin A, Goodyer IM, Herbert J (February 1998). "Family functioning and parent general health in families of adolescents with major depressive disorder". Journal of Affective Disorders. 48 (1): 1–13. doi:10.1016/S0165-0327(97)00105-5. PMID   9495597.
  24. ↑ Sims A (2002). Symptoms in the mind: an introduction to descriptive psychopathology. Philadelphia: W. B. Saunders. p. 128. ISBN   0-7020-2627-1.
  25. ↑ Draguns JG, Tanaka-Matsumi J (July 2003). "Assessment of psychopathology across and within cultures: issues and findings". Behaviour Research and Therapy. 41 (7): 755–776. doi:10.1016/S0005-7967(02)00190-0. PMID   12781244.
  26. ↑ Stompe T, Friedman A, Ortwein G, Strobl R, Chaudhry HR, Najam N, Chaudhry MR (1999). "Comparison of delusions among schizophrenics in Austria and in Pakistan". Psychopathology. 32 (5): 225–234. doi:10.1159/000029094. PMID   10494061. S2CID   25376490.
  27. ↑ Birkmayer W, Danielczyk W, Neumayer E, Riederer P (1972). "The balance of biogenic amines as condition for normal behaviour". Journal of Neural Transmission. 33 (2): 163–178. doi:10.1007/BF01260902. PMID   4643007. S2CID   28152591.
  28. ↑ Naasan G. "The Anatomy of Delusions". In Lehner T, Miller B, State M (eds.). Genomics, Circuits, and Pathways in Clinical Neuropsychiatry. Elsevier Science. pp. 366–369.
  29. ↑ Myin-Germeys I, Nicolson NA, Delespaul PA (April 2001). "The context of delusional experiences in the daily life of patients with schizophrenia". Psychological Medicine. 31 (3): 489–498. doi:10.1017/s0033291701003646. PMID   11305857. S2CID   25884819.
  30. ↑ Spitzer M (1990). "On defining delusions". Comprehensive Psychiatry. 31 (5): 377–397. doi:10.1016/0010-440X(90)90023-L. PMID   2225797.
  31. ↑ Young AW (2000). "Wondrous strange: The neuropsychology of abnormal beliefs". In Coltheart M., Davis M. (eds.). Pathologies of belief. Oxford: Blackwell. pp. 47–74. ISBN   0-631-22136-0.
  32. ↑ Jones E (1999). "The phenomenology of abnormal belief". Philosophy, Psychiatry, & Psychology. 6: 1–16.
  33. ↑ Maher BA (1988). "Anomalous experience and delusional thinking: The logic of explanations". In Oltmanns T., Maher B. (eds.). Delusional Beliefs. New York: Wiley Interscience. ISBN   0-471-83635-4.
  34. ↑ Giannini AJ (2001). "Use of fiction in therapy". Psychiatric Times. 18 (7): 56.
  35. ↑ Giannini AJ (1991). "Afterword". In Farmer PJ (ed.). Red Orc's Rage. NY: Tor Books. pp. 279–282.
  36. ↑ David AS (1999). "On the impossibility of defining delusions". Philosophy, Psychiatry, & Psychology. 6 (1): 17–20.
  37. ↑ Aftab A (2021). "There and Back Again: Joseph Pierre, M.D." Psychiatric Times. 38 (1).
  38. ↑ Pierre JM (May 2001). "Faith or delusion? At the crossroads of religion and psychosis". Journal of Psychiatric Practice. 7 (3): 163–172. doi:10.1097/00131746-200105000-00004. PMID   15990520. S2CID   22897500.
  39. ↑ "Diagnostic Test List for Delusions" . Retrieved 6 August 2010.
  40. ↑ Mujica-Parodi, L.R.; Sackeim, Harold A. (2001). "Cultural Invariance and the Diagnosis of Delusions". The Journal of Neuropsychiatry and Clinical Neurosciences. 13 (3). American Psychiatric Association Publishing: 403–409. doi:10.1176/jnp.13.3.403-a. ISSN   0895-0172. See section "A New Definition of Delusional Ideation in Terms of Model Restriction".
  41. ↑ Jaspers K (1913). Allgemeine Psychopathologie: Ein Leitfaden für Studierende, Ärzte und Psychologen. Berlin: J. Springer.
  42. ↑ Jaspers 1997 , p. 106
  43. ↑ Walker C (November 1991). "Delusion: what did Jaspers really say?". The British Journal of Psychiatry. Supplement. 159 (14): 94–103. doi:10.1192/S0007125000296566. PMID   1840789. S2CID   43018033.
  44. ↑ "Terms in the Field of Psychiatry and Neurology". Archived from the original on 19 August 2010. Retrieved 6 August 2010.
  45. ↑ Trivers R (2002). Natural Selection and Social Theory: Selected Papers of Robert Trivers. Oxford University Press. ISBN   978-0-19-513062-1.
  46. ↑ Huhn M, Nikolakopoulou A, Schneider-Thoma J, Krause M, Samara M, Peter N, et al. (September 2019). "Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis". Lancet. 394 (10202): 939–951. doi:10.1016/S0140-6736(19)31135-3. PMC   6891890 . PMID   31303314.
  47. ↑ Mehl S, Werner D, Lincoln TM (28 August 2019). "Corrigendum: Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis". Frontiers in Psychology. 10: 1868. doi: 10.3389/fpsyg.2019.01868 . PMC   6724716 . PMID   31555162.
  48. ↑ Penney D, Sauvé G, Mendelson D, Thibaudeau É, Moritz S, Lepage M (March 2022). "Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis: A Systematic Review and Meta-analysis". JAMA Psychiatry. 79 (5): 417–429. doi:10.1001/jamapsychiatry.2022.0277. PMC   8943641 . PMID   35320347.
  49. ↑ Double D (2006). Critical Psychiatry: The Limits of Madness. Springer. ISBN   978-0-230-59919-2.
  50. ↑ Davidson G, Campbell J, Shannon C, Mulholland C (December 2015). Models of mental health. Macmillan International Higher Education. ISBN   978-1-137-36591-0.
  51. ↑ David Graeber (May 2018). "Bullshit Jobs: A Theory"
Cited text

Further reading

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<span class="mw-page-title-main">Schizophrenia</span> Mental disorder with psychotic symptoms

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<span class="mw-page-title-main">Delusional disorder</span> Mental illness featuring beliefs with inadequate grounding

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<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

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Folie à deux, also known as shared psychosis or shared delusional disorder (SDD), is a rare psychiatric syndrome in which symptoms of a delusional belief, and sometimes hallucinations, are "transmitted" from one individual to another.

<span class="mw-page-title-main">Persecutory delusion</span> Delusion involving perception of persecution

A persecutory delusion is a type of delusional condition in which the affected person believes that harm is going to occur to oneself by a persecutor, despite a clear lack of evidence. The person may believe that they are being targeted by an individual or a group of people. Persecution delusions are very diverse in terms of content and vary from the possible, although improbable, to the completely bizarre. The delusion can be found in various disorders, being more usual in psychotic disorders.

A Truman Show delusion, also known as Truman syndrome or Truman disorder, is a type of delusion in which the person believes that their life is a staged reality show, or that they are being watched on cameras. The term was coined in 2008 on film boards by brothers Joel Gold and Ian Gold, a psychiatrist and a neurophilosopher, respectively, after the 1998 film The Truman Show.

Childhood schizophrenia is similar in characteristics of schizophrenia that develops at a later age, but has an onset before the age of 13 years, and is more difficult to diagnose. Schizophrenia is characterized by positive symptoms that can include hallucinations, delusions, and disorganized speech; negative symptoms, such as blunted affect and avolition and apathy, and a number of cognitive impairments. Differential diagnosis is problematic since several other neurodevelopmental disorders, including autism spectrum disorder, language disorder, and attention deficit hyperactivity disorder, also have signs and symptoms similar to childhood-onset schizophrenia.

The diagnosis of schizophrenia, a psychotic disorder, is based on criteria in either the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or the World Health Organization's International Classification of Diseases (ICD). Clinical assessment of schizophrenia is carried out by a mental health professional based on observed behavior, reported experiences, and reports of others familiar with the person. Diagnosis is usually made by a psychiatrist. Associated symptoms occur along a continuum in the population and must reach a certain severity and level of impairment before a diagnosis is made. Schizophrenia has a prevalence rate of 0.3-0.7% in the United States.

A religious delusion is defined as a delusion, or fixed belief not amenable to change in light of conflicting evidence, involving religious themes or subject matter. Religious faith, meanwhile, is defined as a belief in a religious doctrine or higher power in the absence of evidence. Psychologists, scientists, and philosophers have debated the distinction between the two, which is subjective and cultural.

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