Descriptive Psychopathology: The Signs and Symptoms of ...

277 Chapter 11: Delusions and abnormal thought contentsyndrome thought his wife was a dangerous imposter, because he perceived thatshe no longer had a southern USA accent. A woman with end-stage renal diseasethought one of her nurses was the housekeeper on the old Brady Bunch TV show.A manic-depressive man thought a fellow patient was Charlton Heston, the actor,and that another patient, a man, was Marilyn Monroe. Delusions of infestationby micro-organisms, hair, insects, dust or parasites (Ekbom’s syndrome) is typicallyassociated with tactile and visual hallucinations and identifiable neurologicdisease.But delusions of persecution are the most common and are as frequent inmood disorders as in schizophrenia. 20 Patients with degenerative brain diseasealso exhibit persecutory delusions. 21 Paranoid delusions reflect persecutory content.The content involves government plots, spouse or neighbor cabals, beingspied upon by various nefarious agencies, infidelities, and imminent attack byunknown forces.Delusional moodDelusional mood, or delusional atmosphere, is a state of unease during which theimmediate environment feels strange, threatening or ominously changed.The sufferer is apprehensive, puzzled and at times bewildered, but “senses” that“something odd is going on”. Delusional moods emerge in the early phase of apsychotic episode and may persist for weeks before fully formed delusions evolve.Idea of referenceIdeas of reference often emerge from a delusional mood. Ideas of reference aretypically based on biased perceptions that encourage a morbid self-reference.A passer-by’s cough, an ad in the newspaper, a cloud in the sky are perceived asbeing odd and then thought to have specific meaning for the patient. The actionsof others are understood as directed at the patient. They are being watchedor talked about; a public event assumes personal ominous significance. Ideas ofreference are common and occur in many different psychotic disorders.Autochthonous idea and primordial delusionA suddenly experienced, fully formed idea immediately accepted as true andimportant, despite being unlikely or impossible, is labeled autochthonous. 22Primordial delusion is a synonymous term. 23The American neuropsychiatrist, William Hammond, describes a man whowhile eating breakfast, suddenly realized that his wife had “endeavored to renderhim impotent, in order that a condition of forced faithfulness might be induced”.As he walked the streets, the man experienced ideas of reference about passers-byand their awareness of his situation. He developed the delusion that his testicles