DSM-5 Classification of Delusions

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

The Psychotic Spectrum

“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

Types of Delusions

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.

Atypical vs. Typical Antipsychotics

Atypical antipsychotics are also called second-generation antipsychotics (SGAs). They’re a newer class of medications that work differently in your body than previous (first-generation or typical) antipsychotics. Both help to regulate neurotransmitters, chemicals in your body that allow neurons to signal to each other.

Studies have found that the brains of people with schizophrenia are more sensitive to the neurotransmitters dopamine, serotonin, and glutamate. High or low dopamine levels can lead to hallucinations and disordered thinking.

While typical antipsychotics (FGAs) block dopamine in the brain, SGAs block both dopamine and serotonin. This results in some key differences.

The most significant difference is that SGAs are less likely to cause extrapyramidal symptoms. These are movement disorders that are common and serious side effects of FGAs. Some of these side effects can become permanent.

Both types of antipsychotics work to treat positive symptoms of schizophrenia, such as hallucinations and delusions. But SGAs may also help treat negative symptoms, like decreased pleasure or lack of motivation.

Common Atypical Antipsychotics taken:

  • Aripiprazole (Abilify) can be prescribed for adults and adolescents ages 13 and up. You can take it as an injectable solution available through a healthcare professional, or in one of four oral forms:
    • tablet
    • oral solution
    • Abilify Discmelt, an orally disintegrating tablet
    • Abilify MyCite, a tablet with a patch sensor that lets your doctor know you’ve taken the drug
  • Aripiprazole lauroxil (Aristada) is a prodrug, which means it’s inactive until a chemical reaction in your body changes it into aripiprazole. It also requires a medical professional to administer an injection.
  • Asenapine maleate (Saphris) is unique in that it’s available as both a tablet and a patch. Studies show that it’s particularly good at preventing relapse. The FDA has approved its use for children older than 10 to treat bipolar disorder, but not schizophreniaTrusted Source.
  • Brexipiprazole (Rexulti) treats schizophrenia and depression. Doctors usually prescribe it as a once-daily tablet. A generic form is not yet available.
  • Cariprazine (Vraylar) is FDA-approved to treat schizophrenia and bipolar I disorder. It can take a long time to build up in your body and to leave your system. If you stop taking it, you might still feel its effects for up to 4 weeks.
  • Clozapine (Clozaril) is the oldest SGA and remains the “gold standard” for those with treatment-resistant schizophrenia. The FDA has approved its use for reducing suicidal behavior in people with schizophrenia. It’s available as a tablet, an orally disintegrating tablet (Fazaclo), and an oral suspension (Versacloz). Clozapine is not FDA-approved to treat schizophrenia in children or adolescents, but some doctors prescribe it off-label.
  • Iloperidone (Fanapt) is a twice-daily tablet that can treat both positive and negative symptoms of schizophrenia. It can cause serious problems, such as stroke or even death, in older adults with dementia.
  • Lumateperone (Caplyta) is approved to treat schizophrenia and depressive episodes of bipolar disorder. It can increase suicidal thoughts in adults ages 18-24. The FDA has not approved it for pediatric use.
  • Lurasidone (Latuda) is a once-daily tablet that doctors can prescribe for people ages 13 and older. A 2020 study found that lurasidone continued to reduce schizophrenia symptoms in adolescents for the full 2 years of the study.
  • Olanzapine (Zyprexa) is another drug used to treat schizophrenia or bipolar I disorder. It’s available as a tablet, orally disintegrating tablet, or long-acting injectable administered by a healthcare professional. This is one of the atypical antipsychotics that the FDA has approved for adolescents. It can cause serious side effects, such as drug reaction with eosinophilia and systemic symptoms (DRESS).
  • Paliperidone (Invega) is derived from a different drug, risperidone. It comes in different forms, including extended-release tablets and long-acting injectables with different brand names. Paliperidone is approved to treat schizophrenia in children ages 12 and older, but it could have broader potential.
  • Quetiapine (Seroquel) is available in an immediate-release tablet that you take two or three times a day, or an extended-release tablet that you take once daily. It’s the least likelyTrusted Source of the SGAs to cause extrapyramidal symptoms. It’s also FDA-approved for treating schizophrenia in adolescents.
  • Risperidone (Risperdal, Perseris) is one of the earliest SGAs and is the most commonly used SGA among children. Doctors prescribe it for children as young as 5 years to treat irritability associated with autism, but it’s only approved for treating schizophrenia in children 13 years and older. It comes in four forms:
    • regular tablet
    • orally disintegrating tablet
    • oral solution
    • injectable administered by a healthcare professional
  • Ziprasidone (Geodon) is available as a twice-daily capsule, or you can have a healthcare professional give you an immediate-release injection.

Side Effects of Antipsychotics:

All atypicals carry a risk of mild to severe side effects. These side effects differ from person to person and drug to drug.

Some common side effects include:

  • sedation
  • dizziness
  • low blood pressure when standing up (orthostatic hypotension)
  • significant weight gain
  • metabolic syndrome
  • diabetes
  • hypertension
  • abnormal cholesterol
  • heart disease
  • complications in the third trimester of pregnancy
  • suicidal thoughts and behaviors

With some SGAs, extrapyramidal symptoms may still occur, especially at high doses.

It’s important that you take care of your physical health while using antipsychotics. SGAs can cause you to gain weight or worsen overweight or obesity if you already have it, leading to other chronic conditions.

You may also become resistant to your medication, so it’s important to stay in touch with your healthcare team and keep them updated if your medicine stops working.

Finally, be sure to continue your medication, even if you feel better. Suddenly stopping the medication can cause problems and may increase your risk of a relapse of symptoms.

On Schizoaffective Disorder

On Schizoaffective Disorder & Hallucinations:

“I awoke, went to drink a glass of water and walked back toward my room. I stopped dead in my tracks. My room was red and four cloaked figures floated above my bed with fire circling around them. Inside of the cloaks was a black abyss and I knew they had come for me. As long as I stayed out of my room they wouldn’t see me. I stared at them for what seemed like an hour before they went away. I slept on the couch that night.”

~ Thomas Wallingford, The Mighty Contributor

#MentalHealth #SchizoaffectiveDisorder #Hallucinations #EndStigma

Schizophrenia and Breakthrough Symptoms

This seems like a good time to discuss breakthrough symptoms of schizophrenia. This is not easy for me to admit, but important if I want people to understand what it’s like to have a psychotic disorder.

“People can be on the best psychotropic medication targeting a mental health disorder and still experience disruptive and paralysing symptoms. These breakthrough symptoms can be voices, delusions, paranoia, anxiety, or perhaps even depressive features that go unchallenged and uncontrolled by medication. Breakthrough symptoms can be very disturbing, and demoralising, due to the chronic, sporadic, and their seemingly unpredictable nature. This type of symptom activation can be triggered by something external.”

~ psychreg.org

I’ve been feeling numb for a few weeks now and hoping to control it through positive coping strategies such as increased meditation as I did not want to go through a med change of increasing my antipsychotic medication.

It didn’t work and this past week breakthrough symptoms of thought broadcasting and thought insertion which drives my paranoia continued rising to the level of needing a change. After consultation with my psychiatrist I’ve increased my antipsychotics, anti-anxiety medications and one on my antidepressants which is a noradrenergic and specific serotonergic antidepressant (NaSSA) and encourages sleep, i.e. drowsiness is one of it’s side effects.

My breakthrough symptoms can best be summed up as more invasive auditory hallucinations, paranoia and delusions that people can read my mind and insert thoughts into my head against my will. At this time I realize it is just a delusion and not real. If I didn’t make the med change it wouldn’t be long before I believed my delusions despite all evidence to the contrary which would probably require hospitalization. The med change will probably take a couple of weeks until I am completely back at my baseline. It’ll be an interesting couple of weeks, but this is part of the reality of living with a severe mental illness.

#MySchizLife #BreakthroughSymptoms #PsychoticDisorders

Do I Dare Ask

Do I Dare Ask

Do I dare ask what we already know,

There shall indeed me time to answer,

Do I presuppose in the depths of a binge,

To burn through our ignorance into truth.

We stand by a forest in the cold of night,

We question what is to befall us,

Searching past the promises we must keep,

Only contemplating our forest of the night.

You have forged this cross along your journey,

You are preparing your self-crucifixion,

Tears trace over you,

Where blood desires to follow.

Two paths diverged in your souls journey,

One leaving you upon the cross to wither and blow away,

The second burns past this existence,

We slip into the void between them.

Crawling across the wasteland of dark sky,

A new birth opens before my eyes,

One not filled with the continuance of life,

One filled with peril of your immediate break from existence.

The question has come to a close,

The funeral procession wanders to the grave,

The coffin left open only for you,

We all stare deep at your face in the grave.

Trauma: The Next Morning, Every Morning

I inhale the stench of an eternal wait,

A breath, a gasp, a momentary lapse,

My eyes burn, my fingers bleed,

Scratching at my lack of patience,

I sigh, a tear trickles down my cheek,

A silent scream in the middle of the night,

Echoes through the darkness of my mind.

I’m consumed by the violation of my body,

The corruption of my soul,

Blood seeps from my eyes where tears once stood,

Involuntarily I wince as my body,

Wracked by the repeated violations,

Struggles to fight against my mind,

The disease of my own conception.

I stare transfixed upon the glistening mirror,

My clothes crumpled about my ankles,

The hollow eyes scrutinize my own,

The purple swelling and welts of my neck,

Coerce my eyes lower, down my bruised and battered torso,

My fingers trace over the blackish-purple festering welt,

Running down my throbbing ribcage.

My eyes linger over my aching waist,

Pleading me to stop, that I look away,

The stinging of my thighs makes me shudder,

Deep bruises traverse the muscles,

A yellowish fluid courses beneath my battered wounds,

Begging for release from my body,

Which holds it captive to my mind’s secrets.

I am engrossed as my body slowly turns in the mirror,

The lesions crisscross my stinging inner thighs,

My ass throbs as if a cruel joke,

Blood trickles down my thighs,

Reminding me of my past transgressions,

Conjuring visions of all that has been done,

My memories fashioned out of my past, my life.

The world around me swirls and contorts,

Reality drips down through my consciousness,

A gasp, a nightmare, a corruption of my mind.

A Day In My Life: My Most Common Delusions

A Day In My Life: My Most Common Delusions

Having delusions is one of the most feared and fear mongered symptoms of Schizophrenia and Schizoaffective Disorder. Some people believe God is speaking to them directly or through a TV or through the radio. Some people believe they have supernatural powers or is a chosen one to lead a religious or secular special mission. There is an incredible variety in the delusions which may afflict people. When properly medicated many people have these delusions completely disappear and then there are some that don’t.

I am one of those that always has my delusions in varying degree no matter what medication cocktail I have tried. Thankfully when medicated I know they are delusions and not part of reality, although everything around me, my feelings, my thoughts tell me they are true. Sometimes it’s a vicious fight between the part of me grounded in reality and the part that isn’t. The level of stress and anxiety I am going through largely determines which part of me will win the fight.

Thankfully I rarely have delusions like those I previously referenced. My delusions can be summed up as thought broadcasting and thought insertion which drives my paranoia. Thought broadcasting is when I believe that other people can hear or read my thoughts. Whereas thought insertion is when I have thoughts that feel foreign to me and seem as if they have been inserted by an outside person. I rarely have both at the same time, but when I do it is crippling. Having either of these delusions can lead me to isolating from society, my support structure, my friends and family, and even the people I believe are controlling or spying on my thoughts. It’s not often, but the more I am unable to separate reality from what I’m feeling the more paranoid I become.

As much as my medication cocktail helps me survive everyday life and be a functioning member of society it never fully eradicates either my delusions or auditory hallucinations. I find myself reality testing when I’m dealing with thought broadcasting by thinking nod your head if you can read my thoughts. Of course nobody ever does which only feeds my paranoia that they don’t want me to know. When my meds aren’t working I’ve narrowly escaped going inpatient in a mental hospital on multiple occasions. I have had several partial hospitalizations though where I spend my days at the hospital, but am allowed to sleep at home.