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Perspectives in Psychiatric Care Jan 2020To explore and synthesize literature related to the nursing process addressing the focus "Delusion". (Review)
Review
PURPOSE
To explore and synthesize literature related to the nursing process addressing the focus "Delusion".
DESIGN AND METHODS
This literature review is integrated with a scoping study framework. From the total 252 papers found, 39 were selected.
FINDINGS
Relevant data and diagnostic activities, hypothetic nursing diagnoses, and interventions addressing the focus "Delusion" were identified.
PRACTICE IMPLICATIONS
This literature review allowed the development of a clinical data model addressing the focus "Delusion", based on the steps of the nursing process identified. This clinical data model may contribute towards improving nursing clinical decision-making and nursing care quality in relation to a client suffering from delusion as well as producing more reliable nursing-sensitive indicators.
Topics: Clinical Decision-Making; Delusions; Humans; Nursing Process; Primary Care Nursing
PubMed: 31355471
DOI: 10.1111/ppc.12401 -
Consciousness and Cognition Jan 2016One recent development in epistemology, the philosophical study of knowledge, is the notion of 'epistemic innocence' introduced by Bortolotti and colleagues. This... (Review)
Review
One recent development in epistemology, the philosophical study of knowledge, is the notion of 'epistemic innocence' introduced by Bortolotti and colleagues. This concept expresses the idea that certain suboptimal cognitive processes may nonetheless have epistemic (knowledge-related) benefits. The idea that delusion or confabulation may have psychological benefits is familiar enough. What is novel and interesting is the idea that such conditions may also yield significant and otherwise unavailable epistemic benefits. I apply the notion of epistemic innocence to research on the transformative potential of psychedelic drugs. The popular epithet 'hallucinogen' exemplifies a view of these substances as fundamentally epistemically detrimental. I argue that the picture is more complicated and that some psychedelic states can be epistemically innocent. This conclusion is highly relevant to policy debates about psychedelic therapy. Moreover, analysing the case of psychedelics can shed further light on the concept of epistemic innocence itself.
Topics: Consciousness Disorders; Delusions; Hallucinogens; Humans; Knowledge; Mysticism; Philosophy
PubMed: 26675408
DOI: 10.1016/j.concog.2015.11.012 -
Acta Dermato-venereologica Aug 2016Patients with a delusional infestation (DI) have an overwhelming conviction that they are being infested with (non) pathogens without any medical proof. The patients... (Review)
Review
Patients with a delusional infestation (DI) have an overwhelming conviction that they are being infested with (non) pathogens without any medical proof. The patients need a systematic psychiatric and dermatological evaluation to assess any possible underlying cause that could be treated. Because they avoid psychiatrists, a close collaboration of dermatologists and psychiatrists, who examine the patient together, seems to be a promising solution. It helps to start a trustful doctor-patient relationship and motivates the patient for psychiatric treatment. We here review diagnostic criteria, classification of symptoms, pathophysiology and treatment options of DI. Antipsychotic medication is the treatment of choice when any other underlying cause or disorder is excluded. Further research is needed to assess the pathophysiology, and other treatment options for patients with DI.
Topics: Antipsychotic Agents; Comorbidity; Delusions; Ectoparasitic Infestations; Humans; Morgellons Disease
PubMed: 27282746
DOI: 10.2340/00015555-2412 -
International Review of Psychiatry... 2020Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small... (Review)
Review
Ekbom's syndrome represents a relatively uncommon neuropsychiatric condition characterized by the recurrent and bizarre fixed delusional belief to be infested by small organisms or even unanimated materials ('Morgellons disease'), without any objective evidence of infestation/parasitosis. The condition, mainly diagnosed in a nonpsychiatric setting, is supposed to be largely underestimated and, hence, undermanaged. The present comprehensive review aims at investigating Ekbom's syndrome, from a historical, epidemiological, clinical and therapeutic perspective, by providing diagnostic-treatment strategies in managing this condition in routine psychiatric clinical settings. The prototypical patient is a middle-aged woman (or a younger subject in those cases in which substance and/or alcohol abuse is implicated), often single, divorced or widowed (loneliness component and social withdrawal), who has already consulted several specialists due to skin lesions associated with a firm and delusional belief to be infested. The identification and diagnosis are challenging due to poor patient's insight, poor knowledge and collaboration between specialists and differential diagnoses to be considered before asking for a psychiatric referral. Management and treatment strategies mainly derive from isolated case reports or observational studies with a small sample size. Further randomized clinical trials should be performed to evaluate the efficacy of newer antipsychotic drugs, including long-acting injectable formulations.
Topics: Antipsychotic Agents; Delusions; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Loneliness; Referral and Consultation; Social Isolation; Syndrome
PubMed: 32436416
DOI: 10.1080/09540261.2020.1757306 -
International Journal of Law and... 2016The paper outlines the difference between the so-called normal (common) lying and pathological lying. Pathological lying is an intriguing topic, still lacking any strong... (Review)
Review
The paper outlines the difference between the so-called normal (common) lying and pathological lying. Pathological lying is an intriguing topic, still lacking any strong professional consensus, clear etiology, treatment options and prognoses. The paper explores some possible psychological mechanisms of pathological lying, reviews biological factors in pathological lying, and considers forensic significance of normal and pathological lying. The relationship between pathological lying and mental disorders is also discussed. The authors suggest that lying should be considered as a heterogenic and multidimensional behavioral pattern. The paper highlights how important it is to assess the patient's control over lying, the function of lying, insight into and awareness of lying, as well as the effect of lying on everyday functioning.
Topics: Awareness; Deception; Delusions; Diagnosis, Differential; Humans; Malingering; Mental Disorders; Motivation; Personality Disorders
PubMed: 27048622
DOI: 10.1016/j.ijlp.2016.02.036 -
American Journal of Alzheimer's Disease... Jun 2015Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy. (Review)
Review
BACKGROUND
Delusions can complicate practically all brain disorders. They may be dramatic and bizarre. An example is the so-called delusion of pregnancy.
OBJECTIVE
To identify the characteristic of a psychotic symptom, the phenomenon of delusion of pregnancy, in the context of dementia.
METHOD
MEDLINE and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2014. Search terms used included delusion of pregnancy, uncommon presentation, behavioral and psychological symptoms, dementia, Alzheimer's disease, and frontotemporal dementia (FTD). Publications found through this indexed search were reviewed for further relevant references. We included case reports that highlight the relationship and overlap between dementia presenting as schizophrenia-like psychosis and schizophrenia.
RESULTS
Literature on delusion of pregnancy in the course of dementia consists mostly of case reports and small samples of patients.
CONCLUSION
Psychotic phenomena such as delusion of pregnancy may be a feature in some cases of dementia. If this bizarre features of dementia appears as early presentation of FTD whose usual onset is in the presenium, it may be mistaken for schizophrenia.
Topics: Delusions; Dementia; Humans
PubMed: 25193999
DOI: 10.1177/1533317514549412 -
Cognitive Neuropsychiatry Jul 2016Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The "un-Cartesian" cognitive-linguistic hypothesis... (Review)
Review
Delusions are widely believed to reflect disturbed cognitive function, but the nature of this remains elusive. The "un-Cartesian" cognitive-linguistic hypothesis maintains (a) that there is no thought separate from language, that is, there is no distinct mental space removed from language where "thinking" takes place; and (b) that a somewhat broadened concept of grammar is responsible for bestowing meaning on propositions, and this among other things gives them their quality of being true or false. It is argued that a loss of propositional meaning explains why delusions are false, impossible and sometimes fantastic. A closely related abnormality, failure of linguistic embedding, can additionally account for why delusions are held with fixed conviction and are not adequately justified by the patient. The un-Cartesian linguistic approach to delusions has points of contact with Frith's theory that inability to form meta-representations underlies a range of schizophrenic symptoms. It may also be relevant to the nature of the "second factor" in monothematic delusions in neurological disease. Finally, it can inform the current debate about whether or not delusions really are beliefs.
Topics: Cognition Disorders; Delusions; Humans; Language; Linguistics; Psychological Theory; Schizophrenia; Schizophrenic Psychology; Thinking
PubMed: 27322493
DOI: 10.1080/13546805.2016.1190703 -
Journal of Psychosomatic Obstetrics and... Mar 2022Delusions of pregnancy are associated with functional impairment and psychological distress. Previous works have focused on characterizing their etiology and identifying... (Review)
Review
PURPOSE
Delusions of pregnancy are associated with functional impairment and psychological distress. Previous works have focused on characterizing their etiology and identifying contributory social and cultural factors. The purpose of this review is to give an overview of the literature on medical or surgical comorbidities associated with delusions of pregnancy.
METHODS
We searched Google Scholar, PubMed, and PsycInfo using the terms "pregnancy delusion," "delusional pregnancy," "pseudocyesis", and "false/pseudo/phantom/spurious pregnancy" to identify all published cases of delusional pregnancies. We included cases in which medical or surgical factors might have contributed to the delusion. We extracted the following information from selected case reports: patient age, psychiatric diagnoses, medications, medical comorbidities, somatic complaints, treatment, and outcome.
RESULTS
We found that 23 of 140 cases (16.4%) were potentially influenced by concomitant medical or surgical conditions including gallstones, abdominal tumors, hyperprolactinemia, constipation, a tubal cyst, and esophageal achalasia. Medical or surgical treatment was pursued in 15 of these 23 cases, followed by mitigation of the delusion in ten cases.
CONCLUSIONS
We emphasize the importance of a thorough workup including physical and gynecological examinations in patients presenting with a delusion of pregnancy. Clinicians should recognize and overcome potential barriers to undertaking comprehensive assessments in order to prevent delays in management and treatment of underlying medical or surgical conditions.
Topics: Delusions; Female; Humans; Mental Disorders; Pregnancy; Pregnancy Trimester, Third
PubMed: 32597281
DOI: 10.1080/0167482X.2020.1779696 -
International Journal of Dermatology May 2020Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a... (Review)
Review
Delusional infestation (DI) is a disorder in which patients express a firm, unwavering belief that they are infested with some type of organism but otherwise have a typical grasp on reality with relatively normal cognitive functioning. Although classified as a somatic delusional disorder, DI requires special consideration due to its complicated clinical presentation, requiring attention to several possible explanations for the symptoms the patients describe. The purpose of the current review is to first summarize the clinical background and features of the diagnosis then explore treatment options. DI is a rare disorder though has reported cases dating back to the 19th century and spanning across the globe. Patients often experience the disorder as secondary to a medical condition, including substance use/withdrawal. However, there have also been many reported cases of primary DI, occurring in the absence of any other psychiatric or medical disorder. Clinically, DI is a diagnosis of exclusion, where the physician must rule out other medical conditions, including genuine dermatological disorders or infestations, or contributions from medications or substances. Patients with the disorder more commonly present to nonpsychiatric healthcare providers, making it essential for all clinicians to be able to identify the disease. Treatment can include either first or second generation antipsychotics, but it is important to proceed tactfully in discourse with the patient, being careful to address patients in a straightforward manner without reinforcing or questioning the delusion and focusing conversation on what can be done for the symptoms. Future research can continue to evaluate pathophysiology underlying primary DI, which historically has been an under-studied topic.
Topics: Antipsychotic Agents; Delusions; Diagnosis, Differential; Ectoparasitic Infestations; Humans; Physician-Patient Relations; Rare Diseases
PubMed: 31773724
DOI: 10.1111/ijd.14709 -
Schizophrenia Research Jul 2022Delusions are rigid beliefs held with high certainty despite contradictory evidence. Notwithstanding decades of research, we still have a limited understanding of the... (Review)
Review
Delusions are rigid beliefs held with high certainty despite contradictory evidence. Notwithstanding decades of research, we still have a limited understanding of the computational and neurobiological alterations giving rise to delusions. In this review, we highlight a selection of recent work in computational psychiatry aimed at developing quantitative models of inference and its alterations, with the goal of providing an explanatory account for the form of delusional beliefs in psychosis. First, we assess and evaluate the experimental paradigms most often used to study inferential alterations in delusions. Based on our review of the literature and theoretical considerations, we contend that classic draws-to-decision paradigms are not well-suited to isolate inferential processes, further arguing that the commonly cited 'jumping-to-conclusion' bias may reflect neither delusion-specific nor inferential alterations. Second, we discuss several enhancements to standard paradigms that show promise in more effectively isolating inferential processes and delusion-related alterations therein. We further draw on our recent work to build an argument for a specific failure mode for delusions consisting of prior overweighting in high-level causal inferences about partially observable hidden states. Finally, we assess plausible neurobiological implementations for this candidate failure mode of delusional beliefs and outline promising future directions in this area.
Topics: Delusions; Humans; Psychotic Disorders
PubMed: 33676820
DOI: 10.1016/j.schres.2021.01.023