MSE

Question 1

Kendler et al (1983) proposed several dimensions of delusional severity:

Answer 1

 Conviction: the degree to which the patient is convinced of the reality of the delusional beliefs.
 Extension: the degree to which the delusional beliefs involves the area of patient’s life.
 Bizarreness: the degree to which the delusional beliefs depart from the culturally determined consensual reality.
 Disorganization: the degree to which the delusional beliefs are internally consistent, logical and systematized.
 Pressure: the degree to which the patient is preoccupied and concerned with the expressed delusional beliefs.
 Affective response: the degree to which the patient’s emotions are involved with such beliefs.
 Deviant behaviour resulting from delusion: Patients sometimes act on their delusions.

Question 2

Types of delusions- onset, theme

Answer 2

Types of delusions:
According to Onset:
Primary: also called autochthonous delusion, is the one that appears suddenly and with full conviction, but without any mental events leading up to it.
Secondary: these are apparently derived from preceding morbid experiences like a hallucination, change of mood or an existing delusion.
According to Theme:
Persecution: delusion that persons or organizations are trying to inflict harm on the patient, damage their reputation or make them insane.
Reference: delusion that objects, events or people unconnected with the patient have a personal significance for them.
Grandiosity: delusion of exaggerated self-importance.
Guilt and worthlessness: most often found in depressive illness. Typical themes are that of minor infringement of laws in the past will be discovered and bring shame.
Nihilism: delusion that some person or thing has ceased or is about to cease to exist. When occurs in in a severe depressive disorder, the condition is known as Cotard’s Syndrome.
Hypochondriacal: the patient believes wrongly despite all the evidence to contrary that they are suffering from a disease.
Religious: a firmly held abnormal religious belief.
Delusion of jealousy: related to spouse’s infidelity. They are particularly important because they may lead to dangerously aggressive behaviours
a) Delusion of love: usually occur in women. The person believes that she is loved by a man who is usually inaccessible to her, and often of higher social status.
Delusion of Control: Delusion that one’s actions, impulses or thoughts are controlled by an outside agency.
Misidentification: they are of four types
a) Capgras’ delusion: person believes that a closely related person has been replaced by an exact double / imposter.
b) Fregoli’s delusion: the person misidentifies an unfamiliar person as a familiar one, despite no physical resemblance.
c) Intermetamorphosis: belief that others undergo radical changes in physical and psychological identity, resulting in a different person altogether.
d) Doppelganger: Delusion of subjective doubles
Delusion concerning the possession of thought / thought alienation: They are of three types:
a) Thought insertion: beliefs that certain thoughts are not the patient’s own and implanted by an outside agency.
b) Thought withdrawal: beliefs that thoughts have been taken out of patient’s mind.
c) Thought broadcasting: beliefs that unspoken thoughts are known to other people through radio, telepathy or in some other way.

Question 3

Overvalued ideas

Answer 3

Overvalued ideas: It is an isolated preoccupying belief which is neither delusional nor obsessional in nature and comes to dominate a person’s life and sometimes affect their actions. The belief itself may be understandable when the person’s background is known

Question 4

Obsessions and compulsions

Answer 4

Obsessions: these are recurrent and persistent unwanted thoughts, impulses or images. They are recognised as one’s own and are regarded as senseless distinguishing them from delusions.
Compulsions: these are repetitive and seemingly purposeful behaviours performed in a stereotyped way. They are accompanied by a subjective sense that the behaviour must be carried out and by an urge to resist. They may be associated with an obsession where they serve the purpose of relieving the anxiety generated by the obsession (for example, compulsion of washing hands repeatedly accompanied with obsession of contamination).

Question 5

five definitions of hallucination:

Answer 5

Hallucinations are, phenomenological, the most significant type of false perceptions. Here are five definitions of hallucination:
 A perception without an object (Esquirol, 1817).
 Hallucinations proper are false perceptions that are not in any way distortions of real perceptions but spring up on their own as something quite new and occur simultaneously with and alongside real perception (Jaspers, 1962).
 A hallucination is an exteroceptive or interoceptive percept that does not correspond to an actual object (Smythies, 1956).
 According to Slade (1976a), three criteria are essential for an operational definition:
(a) percept-like experience in the absence of an external stimulus; (b) percept-like experience that has the full force and impact of a real perception; and (c) percept-like experience that is unwilled, occurs spontaneously and cannot be readily controlled by the percipient. This definition is derived from Jasper’s formal characteristics of a normal perception.
 A hallucination is a perception without an object (within a realistic philosophical framework) or the appearance of an individual thing in the world without any corresponding material event

Question 6

Hallucinations can be classified according to:

Answer 6

Complexity:
a) Elementary: refers to experiences such as whistles, bangs, flashes.
b) Complex: refers to voices, music, seeing faces and scenes.
Sensory Modality involved:
a) Auditory
b) Visual
c) Olfactory
d) Gustatory
e) Somatic
Special features:
a) Auditory
 Second person: voices talking to the patient
 Third person: voices talking about patient in third person
 Audible thoughts: hearing once own thoughts aloud
 Thought echo: hearing once own thoughts immediately after thinking them
 Extracampine: voices coming from long distance which are impossible to be heard otherwise due to geographical separation.
b) Visual
Extracampine: hallucinations located outside the field of vision, usually behind the head or in a different place altogether
Autoscopic hallucinations: experience of seeing one’s own body projected into external space, usually in front of oneself, for short periods.
Reflex hallucinations: stimulus in one sensory modality results in hallucination in another modality.
Functional hallucinations: in this type, an external stimulus is necessary to provoke hallucinations

Question 7

Pseudohallucinations

Answer 7

‘Pseudo-hallucinations’: Pseudohallucination is one of the least understood phenomena in psychopathology.
Part of the confusion over the meaning of the term pseudohallucination has arisen because it is often used in two different and mutually contradictory ways, according to Kräupl Taylor (1981). On the one hand, it refers to hallucinations with insight (Hare, 1973), and on the other hand to vivid internal images.
Hallucinations with insight would be those hallucinatory experiences in which the subject is aware that the hallucinatory percepts do not correspond to external reality despite the perceptions being veridical, and in external objective space. Vivid internal images are those phenomena that have all the clarity and vividness of a normal percept except that they occur in inner subjective space.

Jaspers identified pseudohallucination as similar to normal perception except that it occurs in inner subjective space. It shares this characteristic with imagery. However, it has all the vividness and clarity of a normal perception.
A recent work by Wearne and Genetti recommends that ‘pseudohallucinations’ or hallucinations described in non-psychotic illness like PTSD and complex trauma are often difficult to differentiate from hallucinations in Schizophrenia phenomenologically. However, hallucinations in Schizophrenia are more likely accompanied by complex delusional system. The voices were also more likely to be critical and negative towards the individual, consistent with the experience of abuse in people with PTSD

Question 8

Insight

Answer 8

In psychopathology, the term insight refers to awareness of morbid change in oneself, and a correct attitude to this change including a realisation there is a mental illness. Insight is best understood as a continuum rather than simply absent or present. The degree of insight can be best determined by asking following question:
1. Is the patient aware that there is a problem? (insight into symptom)
2. If so, do they understand the problem is attributable to the mental illness? (insight into illness)
3. If so, do they think it needs treatment?
Based on above, six levels of insight have been described:
i. Complete denial of illness
ii. Slight awareness of being sick and needing help, but denying at the same time
iii. Aware of being sick but blaming it on others, or external factors like physical illness
iv. Awareness that illness is caused by something unknown
v. Intellectual insight: awareness that there is mental illness without applying this knowledge to future experiences
vi. Emotional insight: emotional awareness into the feelings and illness and ability to modify behaviour accordingly.
Determining the degree of insight helps in predicting likelihood of compliance with treatment.

Question 9

Judgement

Answer 9

Judgment: It is the ability to anticipate the consequences of one’s behaviour and make decisions to safeguard their well-being and that of others.

Question 10

A recent study by Coulter et al concluded re overdiagnosis of schizophrenia

Answer 10

A recent study by Coulter et al concluded that potential overdiagnosis of schizophrenia is of considerable concern, given the treatment and prognostic implications of schizophrenia compared with alternative diagnoses. An important reason for overdiagnosis was identified as literal interpretation of patients’ self-reported symptoms, especially ‘hearing voices’. There is evidence that the experience of hallucinations, which may be common in the general population, is categorically different for individuals with schizophrenia. In addition, the term ‘hearing voices’ may be used imprecisely by patients to emphasize extreme emotional distress. This may be particularly common in individuals with cognitive, communication, language, or cultural limitations in their capacity for self-description.