Descriptive Psychopathology: The Signs and Symptoms of ...

274 Section 3: Examination domainsIntense emotionIf perceptual processing is intact, a secondary delusion may still develop if theperson’s self-monitoring ability is overwhelmed by intense and prolonged emotion,the delusional content taking on the valence of the abnormal emotionalstate. Delusions associated with depressive illness and manic states are examples.Delusional patients with right cerebral hemisphere disease have associated visual–perceptual disturbances and intense disturbances of emotion. 8 Strong emotionalstates compromise assessment of the validity of the statements of others 9 and altermemory function with recall bias toward memories with the same emotionalvalence. 10 The identification of emotionally salient stimuli related to persecutorybeliefs is associated with amygdala and anterior insula activation for threat andadverse response. 11 The abnormal emotional state evokes abnormal memoriesand compromises judgment. The memory bias reinforces the abnormal emotionalstate. The compromised judgment confirms the validity of the abnormalmemory and emotional experience, leading to the delusional idea. Delusionalmemories are reported to be rated as perceptually and somatosensory richerthan memories of actual events. 12Faulty thinking and self-monitoringIf perceptual processes and emotional expression are intact, a delusion may stillemerge if thinking is faulty and self-monitoring is compromised. These delusionsare characterized as primary. The delusions associated with cognitive disorders areexamples. Compromised thinking is commonly associated with these delusionalideas. Patients with delusions “jump to conclusions” and tend not to change theconclusions in the “face of evidence” for emotionally neutral content. 13Memory disturbanceDelusions also occur when perceptual processing is normal but the memory ofwhat is being perceived is faulty or not fully accessible. The continuous mismatchis first disturbing, then frightening and, compromising judgment, leads to thedelusional conclusion.Unlike non-ill persons, delusional patients are reported to be unable to suppressnon-relevant experiences. The experiences are incorporated into theirthought process and become part of their memory for the experience, distortingits accuracy. They quickly attach importance to the irrelevant pieces of memorywhich become intrusive. For example, a person with such a memory bias sees agarbage truck in front of his neighbor’s house, but his memory of previous trucksis altered, eliciting the consideration that the truck he sees is different and thedifference important. He sees his neighbor talking to the truck driver and gives