Category: Mental Health

DSM-5 Classification of Delusions

Delusions, Mental Health

Types of Delusions:

Erotomanic type: This subtype applies when the central theme of the delusion is that another person is in love with the individual.

Grandiose type: This subtype applies when the central theme of the delusion is the conviction of having some great (but unrecognized) talent or insight or having made some important discovery.

Jealous type: This subtype applies when the central theme of the individual’s delusion is that his or her spouse or lover is unfaithful.

Persecutory type: This subtype applies when the central theme of the delusion involves the individual’s belief that he or she is being conspired against, cheated, spied on, followed, poisoned or drugged, maliciously maligned, harassed, or obstructed in the pursuit of long-term goals.

Somatic type: This subtype applies when the central theme of the delusion involves bodily functions or sensations.

Mixed type: This subtype applies when no one delusional theme predominates.

Unspecified type: This subtype applies when the dominant delusional belief cannot be clearly determined or is not described in the specific types (e.g., referential delusions without a prominent persecutory or grandiose component).

Bizarre content: Delusions are deemed bizarre if they are clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., an individual’s belief that a stranger has removed his or her internal organs and replaced them with someone else’s organs without leaving any wounds or scars).

Source: Diagnostic and Statistical Manual of Mental Disorders 5

Why People Lie in Therapy

Mental Health, Therapies

People who lie in therapy do so because: 

  • They’re worried about being judged or that the therapist won’t like them.
  • They are embarrassed or feel shame about their actions or emotions.
  • If they suspect they have a problem with, say, substance use, they’re afraid that they’ll be expected to go to rehab or drug treatment.
  • They’re afraid the therapist will find that they have a serious problem such as an eating disorder or sex addiction. It should be noted that many people who engage in self-destructive behaviors also tend to withhold information (your therapist knows this by the way).
  • It’s difficult to stay in denial if you’re beginning to voice the truth out loud (and you may not be ready to deal with the consequences).
  • They’re afraid of being hospitalized.

What to Know Before Admitting Yourself to an Inpatient Psychiatric Hospital

Coping Strategies, Mental Health, Psychiatric Hospitals

A few ideas and options:

  1. Bring your best advocate with you. It may be your spouse, parent, close friend, or relative—someone who knows you and is familiar with your situation.
  2. Breathe. Recognize that the staff wants to help you, not hurt you.
  3. Be patient. It’s a process—there are steps to go through and paperwork to be completed
  4. Once inside, advocate for yourself. The doctor will see you. Be honest with him.
  5. Your picture will be taken, and no, they are not stealing your soul.
  6. You will be in a secured unit, locked in. At times they let you out of the unit for visits or short excursions.
  7. Do your best to cooperate with staff and your fellow patients. It may be a while before you are discharged, so bear in mind you are there to get better. Plus, you’ll earn extra “points” for being polite and pleasant.
  8. Read your patient rights and understand them.
  9. Your personal belongings will be inventoried, so they will take out shoestrings, belts, hoodies, nail clippers, razors, and anything else deemed potentially dangerous.
  10. Don’t mind the eccentric behaviors of the other patients, they’re fighting a similar battle.
  11. Accept that the insides of the building may not be the most aesthetically pleasing. (That said, don’t concentrate on abstract paintings if they have them. Abstract art is a bad idea for psychotic symptoms).
  12. If you are in a state of psychosis, the TV may sound as if it’s calling your name. It’s not, but if the AV stimulation is too much, try to leave the room or focus on a different activity.
  13. Be mindful of the opposite sex (or the same sex if you’re so inclined). Establish personal boundaries and adhere to them; the psych ward is not a place to start a romance.
  14. Listen to the staff and don’t give them a hard time.
  15. Be friendly and polite. Remember, there are human beings here with feelings.
  16. Seek out a friend and get to know some people.
  17. Read.
  18. Give yourself time and space. You are on a journey to getting better and that takes time and space.
  19. Take a photograph in your mind’s eye. Journal about it. Capture the chaotic and colorful journey. Write about it. Express yourself. Get to know who you are at this time.
  20. Be kind, regardless. Don’t expect people to respect you because a.) everyone’s imperfect and b.) they can’t respect others if they don’t respect themselves.
  21. Challenge your mind and do a puzzle, but don’t read into it—it’s just a brain exercise.
  22. Take advantage of physical activity when there’s recreation time. Your body needs a physical outlet to help process the stress your mind is going through.

What leads a person to suicide?

Anxiety, Depression, Mental Health, Suicide, Suicide Ideation, Youth (18 and under)

There’s no single cause for suicide. Suicide most often occurs when stressors and health issues converge to create an experience of hopelessness and despair. Depression is the most common condition associated with suicide, and it is often undiagnosed or untreated. Conditions like depression, anxiety, and substance problems, especially when unaddressed, increase risk for suicide. Yet it’s important to note that most people who actively manage their mental health conditions go on to engage in life.

Risk Factors:

Health
  • Mental health conditions
    • Depression
    • Substance use problems
    • Bipolar disorder
    • Schizophrenia
    • Personality traits of aggression, mood changes and poor relationships
    • Conduct disorder
    • Anxiety disorders
  • Serious physical health conditions including pain
  • Traumatic brain injury
Environmental
  • Access to lethal means including firearms and drugs
  • Prolonged stress, such as harassment, bullying, relationship problems or unemployment
  • Stressful life events, like rejection, divorce, financial crisis, other life transitions or loss
  • Exposure to another person’s suicide, or to graphic or sensationalized accounts of suicide
Historical
  • Previous suicide attempts
  • Family history of suicide
  • Childhood abuse, neglect or trauma

Warning Signs:

Talk

If a person talks about:

  • Killing themselves
  • Feeling hopeless
  • Having no reason to live
  • Being a burden to others
  • Feeling trapped
  • Unbearable pain
Behavior

Behaviors that may signal risk, especially if related to a painful event, loss or change:

  • Increased use of alcohol or drugs
  • Looking for a way to end their lives, such as searching online for methods
  • Withdrawing from activities
  • Isolating from family and friends
  • Sleeping too much or too little
  • Visiting or calling people to say goodbye
  • Giving away prized possessions
  • Aggression
  • Fatigue
Mood

People who are considering suicide often display one or more of the following moods:

  • Depression
  • Anxiety
  • Loss of interest
  • Irritability
  • Humiliation/Shame
  • Agitation/Anger
  • Relief/Sudden Improvement

Protective Factors:

  • Access to mental health care, and being proactive about mental health
  • Feeling connected to family and community support
  • Problem-solving and coping skills
  • Limited access to lethal means
  • Cultural and religious beliefs that encourage connecting and help-seeking, discourage suicidal behavior, or create a strong sense of purpose or self-esteem

The Psychotic Spectrum

Auditory Hallucinations, Delusions, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

“Psychotic” is a term that gets tossed around a lot in American culture.

To start, psychosis represents a spectrum of disorders with many different origins. People are most familiar with the term schizophrenia, but schizophrenia is probably going to turn out to be an umbrella diagnosis for many different conditions. People can be psychotic for all kinds of reasons, in the wake of substance abuse — with hallucinogens, for example— or because of schizophrenia. People who are bipolar can become psychotic, and so can people with various degenerative disorders. The interaction between biological and genetic vulnerabilities with family and cultural factors is known to be complex.

What are the chief symptoms?

The symptoms most people are familiar with are what we call positive symptoms: hallucinations, delusions, paranoid beliefs, unusual behavioral or mood manifestations. Those are often treated acutely with medications and patients respond well to that.

Once the positive symptoms have been treated, people can enter what’s called the negative phase of a psychotic disorder: lack of motivation, lack of direction, flatness. There’s a quality of just being slowed down, and a withdrawal or social isolation. This can be debilitating. It is also much harder to identify and treat. Everyone is familiar with the worst-case psychotic disorder, which is the disheveled person in the street who makes everyone anxious. That’s the more obvious, positive symptom.

People in the negative phase don’t look so disorganized because they’re not having hallucinations or delusions, but they can be very isolated and shut down. They often don’t really know what they want to do. They may feel lost and ashamed. They’ve gotten help from medication, but they have a whole other road ahead of them. How are they going to pick up the pieces of their lives, go on and adapt?

One feature of these disorders is tremendous denial that a person is troubled, or needs treatment. It can be very hard to treat someone who other people think is impaired when that person doesn’t think so. Typically, you see problems with family members, problems in employment. These individuals see themselves in the world quite differently, and often aren’t interested in receiving any treatment. This creates a lot of frustration in attempting to offer help.

Sources: Austen Riggs Center

Cure for Hysteria of Antiquity

History of Psychology, Hysteria, Medical, Therapies

In antiquity, women who had anxiety, mood swings and depression were sent by their husbands to the doctor, who diagnosed them with a disease called ′′hysteria.” Their treatment was based on a ′′pelvic massage” with the purpose of achieving hysterical paroxysm, now known as orgasm.

There were so many women who began to attend consultations to have their ′′treatment for hysteria′′ that doctors at the end of the workday were exhausted and their hands were shaky; that’s why they decided to invent a useful device that produced rhythmic vibrations and that hysterical paroxysm was achieved easier and faster in the patient without the need for the common manual massage: this is the origin of the vibrator. At that time it was seen as a healing artifact, even the wealthiest women had them in their homes for when they felt ′′bouts of hysteria.”

A Few Facts About Schizophrenia

Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

~ It is estimated approximately 50% of patients with schizophrenia do not take their prescribed medications as directed. The most common reason is anosognosia, meaning they are unaware of their condition.

~ Lack of treatment leads to severe negative health outcomes, including a life expectancy shortened by an average of 28.5 years. 

~ Approximately half of individuals with schizophrenia have co-occurring mental or behavioral health disorders.

~ Co-occurring medical conditions such as heart disease, liver disease, and diabetes contribute to the higher premature mortality rate among individuals with schizophrenia.

~ Following illness onset, 25-50% of those living with schizophrenia attempt suicide.

~ At least 50% of people with severe psychiatric illnesses like schizophrenia smoke, compared to 23% of the general population. 

~ Smoking-related illnesses cause half of all deaths among people with psychiatric disorders. 

~ Those diagnosed with schizophrenia smoke more than half of all cigarettes produced in the United States, and they are only half as likely as other smokers to quit.

Types of Delusions

Delusions, Mental Health, Psychosis, Schizoaffective Disorder, Schizophrenia

1) Collapse delusion: A transient condition that occurs frequently in acute illnesses, coinciding with the cessation of febrile states; 

2) Reference delusion: The patient attributes a special meaning to objects, events or people close to him; 

3) Touch delusion: It consists in the excessive mania of touching certain objects; 

4) Nihilistic delusion: It is found in melancholic depressions, and is made up of an incoherent mass of negative ideas; 

5) Oneiric delusion: It consists in a disturbance of the conscience that leads to emotions similar to those present in the oneiric phase (the conscience of the disturbed person enters a phase such that it is unable to distinguish reality from the oneiric profile of itself); 

6) Professional or occupational delusion: It consists in recreating, on the patient’s part, the usual conditions and places of work; 

7) Residual delusion: Represented by the persistence of delusional representations at the level of thought, even after the perturbation has ceased; 

8) Interpretative delusion: The subject interprets random facts as facts linked to him, feeling that he is the main actor or feeling indicated as a party in the case; 

9) Persecution delusion: The patient believes he is the object of persecution (a situation often identified also with the term paranoia); 

10) Bizarre delusion: The patient adheres to a system of totally implausible beliefs (in the culture of reference); 

11) Control delusion: The patient is convinced that his thoughts or emotions are under the control of some external force; 

12) Insertion delusion: Similar to the previous one; the patient is convinced that some of his thoughts are imposed on him by an external force; 

13) Erotomanic delusion: The patient is convinced that a certain person (often a celebrity) is secretly in love with him; 

14) Jealousy delusion: The patient has the unfounded and obsessive belief that he is betrayed by his partner. Among delusions, it is the most frequent; 

15) Delusion of grandeur (megalomania): The patient has the conviction that he is extremely important, for example, that he has been chosen by God to carry out a mission of fundamental importance, or that he is the only holder of extraordinary knowledge or powers; 

16) Somatic delusion: The patient is convinced that his body has something unusual, such as a rare disease, some kind of parasite or an unpleasant smell; 

17) Religious delusion: The patient is convinced that religious forces (almost always belonging to his own religion) protect him from misfortune, or from a disease (real and existing); 

18) Identity delusion: He who is affected believes he is another person, often important people such as Kings, Princes or Presidents.

What is Dopamine?

Biology, Chemistry, Mental Health

Dopamine is a type of neurotransmitter. Neurotransmitters are brain chemical messengers that help your nerve cells communicate with one another.

Different neurotransmitters attach (bind) to different receptors on nerve cells. When a neurotransmitter binds to the right receptor on a nerve cell, it triggers that cell to take a specific action. Think of it like a key in a lock. 

Different neurotransmitters are associated with many physical and psychological processes in the body. For example, dopamine is involved in things like:

  • motivation and reward
  • movement
  • mood
  • attention, learning, and memory
  • sleep and dreaming

Neurotransmitters travel along neuronal pathways, which are basically long chains of nerve cells (neurons) that help different parts of the brain talk with one another. 

Some pathways that appear to be associated with schizophrenia symptoms have been identified. These pathways use dopamine as their primary messenger, and include the mesolimbic pathway and the mesocortical pathway.

What is Complex PTSD?

Anxiety, Mental Health, PTSD, Trauma

Complex post-traumatic stress disorder (sometimes called complex PTSD or c-PTSD), is an anxiety condition that involves many of the same symptoms of PTSD along with other symptoms.

First recognized as a condition that affects war veterans, post-traumatic stress disorder (PTSD) can be caused by any number of traumatic events, such as a car accident, natural disaster, near-death experience, or other isolated acts of violence or abuse. 

When the underlying trauma is repeated and ongoing, however, some mental health professionals make a distinction between PTSD and its more intense sibling, complex PTSD (C-PTSD).

Complex PTSD has gained attention in the years since it was first described in the late 1980s. However, it is important to note that it is not recognized as a distinct condition in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the tool that mental health professionals use to diagnose mental health conditions.

Both PTSD and C-PTSD result from the experience of something deeply traumatic and can cause flashbacks, nightmares, and insomnia. Both conditions can also make you feel intensely afraid and unsafe even though the danger has passed. However, despite these similarities, there are characteristics that differentiate C-PTSD from PTSD according to some experts.

The main difference between the two disorders is the frequency of the trauma. While PTSD is caused by a single traumatic event, C-PTSD is caused by long-lasting trauma that continues or repeats for months, even years (commonly referred to as “complex trauma”).

Unlike PTSD, which can develop regardless of what age you are when the trauma occurred, C-PTSD is typically the result of childhood trauma.

When it comes to Complex PTSD, the harmful effects of oppression and racism can add layers to complex trauma experienced by individuals. This is further compounded if the justice system is involved.

The psychological and developmental impacts of complex trauma early in life are often more severe than a single traumatic experience—so different, in fact, that many experts believe that the PTSD diagnostic criteria don’t adequately describe the wide-ranging, long-lasting consequences of C-PTSD.

Symptoms of Complex PTSD:

In addition to all of the core symptoms of PTSD—re-experiencing, avoidance, and hyperarousal—C-PTSD symptoms generally also include:

  • Difficulty controlling emotions. It’s common for someone suffering from C-PTSD to lose control over their emotions, which can manifest as explosive anger, persistent sadness, depression, and suicidal thoughts.4
  • Negative self-view. C-PTSD can cause a person to view themselves in a negative light. They may feel helpless, guilty, or ashamed.5They often have a sense of being completely different from other people.
  • Difficulty with relationships. Relationships may suffer due to difficulties trusting others and a negative self-view.6 A person with C-PTSD may avoid relationships or develop unhealthy relationships because that is what they knew in the past.
  • Detachment from the trauma. A person may disconnect from themselves (depersonalization) and the world around them (derealisation). Some people might even forget their trauma.
  • Loss of a system of meanings. This can include losing one’s core beliefs, values, religious faith, or hope in the world and other people.

All of these symptoms can be life-altering and cause significant impairment in personal, family, social, educational, occupational, or other important areas of life.