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Obsessional images Vivid images that sometimes they are mistaken for pseudo
hallucinations.
# being obsessed abt image of one’s own gravestone that clearly has
his name engraved on it.
Contrast thinking Obsessional thoughts take the form of contrast thinking in which the
patient is compelled to think the opposite of what is said.
This can be seen as COMPULSIVE BLASPHEMY. For example, in the
case of a devout patient who was compelled to make a blasphemous
rhymes so that when the priest said ‘god almighty’ she was compelled
to think and say ‘ sod allshitey’.
Obsessional fears or They consist of groundless fear that the ptt realizes is dominating w/o
phobias a cause,
THOUGHT ALIENATION
v/s
Obsessions
In obsessional thoughts, In thought alienation,
- ptt believes that their thoughts
- ptt knows that they are are under the control of an
compelled to think about outside /external force, or that
things against their will, others are participating in their
therefore do not associate thinking.
such obsessional thoughts with
external force Thought insertion
Thought deprivation
Thought broadcasting
- psychoanalytic interpretation :
that the boundary between the
ego and the surrounding world
has broken down.
- Thought alienation is an
important symptom in
diagnosis of schizo according to
ICD-10.
Psycho-analytic interpretation
- Experiences of thought alienation breaks the boundary b/w the ego and the
surrounding world.
- Therefore, it is classified as one of the symptom of schizophrenia by ICD-10.
2 imp.phenomenon to consider :
1.
Primary
delusions
-Are those delusions that are secondary to depressive moods and
psychogenic stress reactions. Therefore, unlike primary delusions they arise
2. from some other morbid phenomenon.
secondary
delusions -It has been established that projections play an important role in the
formation of delusions.
Personality also plays important role in the genesis of delusional states.
Delusions are unshakable false beliefs held by an individual despite being presented
with rational and logical arguments and evidence to support the contrary. These beliefs
are not shared by the people of the same cultural and religious background and cannot
be accounted for by the individual’s level of intelligence.
1. delusion of persecution o most common type of delusion
(suspicion) o believes that he is going to be harmed by a living or non-
living thing, another person, group, organization or some
force or power despite there being no evidence to support
such belief.
o Injury can be either physical injury or a damage to his
reputation.
# My office colleagues are ganging up against me as I am better than
them; they want to belittle me in front of my boss.
2. delusion of reference
o Patient knowns that ppl are talking abt him, slandering him or
spying on him.
o Such delusions are not confined to schizo and can occur in
depressive illness and other psychotic illnesses
3. delusion of guilt
o The individual believes that he is a bad person and has done
something terribly wrong for which he deserves to be punished.
These delusions usually start off by the individual being overly
critical of himself and by feelings of self-reproach. The patient
feels unworthy of himself. Usually seen in depressed patients
and can lead to suicide or homicide.
8. nihilistic delusions Delusions of negation occur when the ptt.denies the existence of
their body, mind, their loved ones, and the world aroundthem.
4. delusion of infedility
5. delusions of love = ‘the fantasy lover syndrome’ = ‘ erotomania’
o Person is convinced that some other person is in love with
them although the alleged love may never have spoken to
them.
o They may pester the victim with letters, unwanted
attention of all kinds.
o And if ther’s no response, they claim that their letters are
being intercepted by someone who is trying to stop them
from being together.
6. grandiose delusions o The individual believes that he or she is very famous, rich,
talented (e.g. performing artist, scientist, inventor), is related to
prominent people, etc. Delusions of grandeur is seen in mania
and schizophrenia.
o In the past it was associated with ‘general paralysis of the
insane’ i.e NEUROSYPHILIS.
7. Delusions of ill health o Characteristic feature of depressive illnesses
o Seen in schizo also
o It is a sort of delusion of persecution, believing that they a
serious illness.
Delusional dysmorpho-
phobia
9. Delusions of poverty
Since we depend mostly on speech to reveal thought many terms that end in -lalia
(echolalia), -logia or -phasia (bradyphasia) may reflect thought disorder.