Delusional disorders:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1995
|
| Schriftenreihe: | The psychiatric clinics of North America
18,2 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XV S., S. 199 - 432 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Delusional disorders |c Mark J. Sedler, guest ed. |
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| 490 | 1 | |a The psychiatric clinics of North America |v 18,2 | |
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| 650 | 4 | |a Delusions | |
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Datensatz im Suchindex
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| adam_text | DELUSIONAL DISORDERS
CONTENTS
Preface xiii
Mark J. Sedler
The Classification of Delusional Disorders 199
Alistair Munro
Recognition of a delusion in a psychiatric illness places that
illness in the broad category of psychotic disorders. The form and
content of the delusion are, in themselves, however, insufficient
to make a detailed diagnosis, and it is the context of the delusion
within a particular disorder that is more pathognomonic. Among
the large number of illnesses whose symptoms include delusions,
there is a discrete group known as the delusional disorders. After
many years of neglect, these are becoming of considerable interest
to psychiatrists, and research to define their characteristics is on
the rise. This article attempts to describe these illnesses, to indi¬
cate where possible their relationships to other psychiatric disor¬
ders, and to suggest promising areas of investigation.
Pathogenesis of Delusions 213
Theo C. Manschreck
The mechanisms underlying the formation and maintenance of
delusions have been theorized about for almost a century. Inade¬
quacies of definition of delusions and lack of laboratory tests for
delusions have slowed development of our understanding. Three
fundamental categories of explanation include (1) motivation,
(2) disordered reasoning, and (3) psychobiologic mechanisms.
Within these categories, several hypotheses have been proposed.
Empirical testing of these proposals has been limited but is ex¬
panding. At present, the view that anomalous perceptual experi
THE PSYCHIATRIC CLINICS OF NORTH AMERICA
VOLUME 18 • NUMBER 2 • JUNE 1995 vii
ence is central to delusion formation has the most compelling
support, although no approach is firmly established.
The Origin of the Concept of Paranoia 231
Michael Schifferdecker and Uwe Hendrik Peters
The concept of paranoia developed virtually simultaneously in
Germany and France at the beginning of the nineteenth century.
At the beginning of the twentieth century, the arising concept of
schizophrenia thrust the discussion of paranoia into the back¬
ground. The development of modern diagnostic manuals, how¬
ever, revived the old clinical picture mainly because of its clinical
evidence and the distinction from schizophrenia.
Understanding Delusions 251
Mark J. Sedler
The definition or clear conceptualization of delusions has proved
to be more difficult than often is recognized. Delusions tradition¬
ally have been considered as fixed, false beliefs, born of morbid¬
ity. When a rigorous effort is made to demarcate the boundaries
of this notion, however, this conventional account begins to reveal
its shortcomings. This article reviews the many approaches that
have attempted to understand the nature of delusions.
Evolutionary Perspectives on Paranoid Disorder 263
David Schlager
The discrete clustering of thematic content in delusional disorder
subtypes corresponds closely to several specific classes of normal
mental concerns and suspicions that, in turn, correspond to dis¬
tinct classes of enduring environmental challenges. Such content
specific normal mental configurations have been proposed pre¬
viously to represent evolved adaptations to certain aspects of
social reciprocity and mating. This article proposes that delu¬
sional disorders might represent disordered forms of such be¬
havioral adaptations produced by hypersensitivity—designed by
natural selection—to important environmental threats or opportu¬
nities or by behavioral misfiring triggered by exotic perceptions
or environmental cues.
Culture Specific Delusions: Sense and Nonsense in
Cultural Context 281
Atwood D. Gaines
The identification of delusional thinking is not an easy matter,
especially in the increasing brightness of cross cultural illumina¬
tion. This brief overview considers a variety of delusional beliefs
drawn from the cross cultural record and the author s research
to restate and expand a cultural view of delusions in the context
of a survey of culturally specific beliefs. The distinction between
viii CONTENTS
normal and delusional thinking is questioned by challenging the
notion of a universal standard. Use is made of a number of
delusional aspects of US and other western cultures upon which
psychiatric thinkers generally do not reflect. The lack of reflection
is shown to be one of the means by which western psychiatry
habitually constructs nonwestern others as irrational and prone
to delusional thinking. It is suggested that delusional thinking
can be identified only in cultural context, for ideas, however
strange or bizarre, are cultural, not delusional, if learned, shared,
and transmitted as part of culture.
Paranoids in the Legal System: The Litigious Paranoid and
the Paranoid Criminal 303
Robert Lloyd Goldstein
An overview of the paranoid person in the legal system is pre¬
sented. The litigious paranoid and the paranoid criminal are
described both in terms of their psychopathology and presenta¬
tion in a number of legal contexts. The relationship between
paranoid symptomatology and both litigiousness and criminality
is explored. Landmark legal cases and clinical cases are analyzed.
Paranoid delusion as the classic paradigm of the insanity defense
is examined.
Body Image Disturbance in Body Dysmorphic Disorder and
Eating Disorders: Obsessions or Delusions? 317
Katharine A. Phillips, Jennie M. Kim, and James I. Hudson
This article addresses the question of whether body dysmorphic
disorder and eating disorders, both characterized by disturbed
body image, consist of obsessional or delusional thinking. Clinical
descriptions and empirical evidence suggest that the answer is
both. In addition, it is likely that the delusional and nondelu
sional variants of these disorders constitute a single disorder that
encompasses a spectrum of insight, with the entire spectrum
characterized by obsessional thinking. This more dimensional
view was to some extent adopted by DSM IV for body dysmor¬
phic disorder (and obsessive compulsive disorder) after consider¬
able debate. These issues, including the relationship of obses¬
sional and delusional thinking more generally, have classification
and clinical implications for many psychiatric disorders and
touch on issues of broad relevance to the field.
Late Paraphrenia 335
Gerard C. Addonizio
This article reviews the historical development of the concept
of late paraphrenia. Studies that attempt to define symptoms,
demographics, and risk factors for late onset paranoid disorders
are reviewed. Differences between late onset schizophrenia and
early onset schizophrenia are highlighted. Current research on
CONTENTS ix
potential brain abnormalities in these disorders is examined criti¬
cally.
Delusional Infestation: The Interface of Delusions and
Hallucinations 345
Peggy B. Baker, Brian L. Cook, and George Winokur
Delusional infestation represents a unique subtype of the delu¬
sional disorder category. This article presents the phenomenol¬
ogy, etiology, and treatment of delusional infestation. This article
also reviews historical and theoretical attempts to distinguish
tactile sensory phenomena as either hallucinations or delusions.
Psychotic Disorder Caused by a General Medical Condition,
with Delusions: Secondary Organic Delusional Syndromes 363
Gregory L. Fricchione, Lisa Carbone, and William I. Bennett
Secondary delusional disorder is a condition with multiple medi¬
cal and neurologic causes. Despite this, an attempt can be made
to find an integrative pathophysiology for the final common
pathway to delusional thought. This requires a focus on cortico
striato thalamocortical loops that connect limbically related corti¬
cal regions with the restitutive mesolimbic mesostriatal dopa
mine system.
Pharmacologic Treatment of Delusions 379
Lewis A. Opler, David M. Klahr, and Paul Michael Ramirez
Delusions usually respond to standard antipsychotic medications.
When delusions do not respond adequately to this first line ap¬
proach, however, they must be conceptualized as distinct from
other positive symptoms. Additionally, when delusions are pres¬
ent within certain diagnostic categories, pharmacotherapy other
than or in addition to antipsychotic agents is indicated. In delu¬
sional disorder, pimozide appears to have a special role; in psy¬
chotic mood disorders, antidepressants or mood stabilizers, along
with antipsychotic medications, should be administered; and in
organic delusional disorders, treatment of the underlying medical
illness may be sufficient.
Convulsive Therapy in Delusional Disorders 393
Max Fink
This article seeks to define the role of convulsive therapy in the
management of psychoses dominated by persistent delusions. As
delusions are not diagnostic of any specific mental illness or
diagnostic group, this evaluation considers the psychiatric disor¬
ders in which delusions are defined and describes the role of
convulsive therapy in their management. The predictive value of
delusions for good outcome with electroconvulsive therapy is
noted, and the relation between these observations and the mech
X CONTENTS
anisms of action of convulsive therapy and the nosology of men¬
tal disorders is considered.
Delusions in the Transference: Psychotherapy with the
Paranoid Patient 407
Abby Altaian and Michael A. Selzer
The psychotherapy of paranoid patients and management of de¬
lusions in the transference are difficult and challenging but com¬
mon clinical presentations that deserve further attention. Clini¬
cians need to know themselves well and need to be prepared to
use this knowledge toward enabling patients to get acquainted
with themselves, accepting rather than disowning pieces of self
as projections. This is accomplished by relentless attention to
prevailing transference and countertransference responses oc¬
curring within a reliable treatment frame and therapeutic alliance.
Index 427
Subscription Information Inside back cover
CONTENTS X1
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