Descriptive Psychopathology: The Signs and Symptoms of ...

289 Chapter 11: Delusions and abnormal thought contentbut homicidal ideas do not always translate into murder. Persons engaged inrepeated illicit drug use, or who are alcoholics, psychotic, have a traumatic braininjury, or antisocial personality disorder are most likely to harm others. Assessmentof risk of violence is presented in Chapter 5.Culturally deviant ideasSome thoughts and behaviors that appear deviant in the abstract are not consideredpsychopathology when they are culturally consistent. Harakiri and Kamikazewere suicidal behaviors acceptable in World War II Japan and are still admired insome segments of Japanese culture. During the Viet Nam War, Buddhist monksimmolated themselves to protest the policies of the American-backed SouthVietnamese government. Suicide killing in support of Islam is accepted amongsome Islamists. In ancient India, some women committed suicide or Satifollowing their husband’s death. In Africa, genital mutilation of young womenis still practiced. In the USA on any football day, the stands are filled withcolorfully body-painted and be-wigged screaming young men half naked evenin the worst weather. These behaviors are understood as unusual, but not asillness by the respective cultures.In the psychiatric evaluation, deviant culturally related behavior is elicitedduring the focus on family relations, hobbies and interests, typical daily activities,and social and interpersonal relationships. Whether the behavior representsillness is based on the form of the ideas or emotions that elicit the behavior.SummaryDelusions are associated with many psychiatric, general medical and neurologicdisorders. No form is pathognomonic and most often the delusion is a sign ofseverity, not specific pathophysiology. Isolated delusions occurring without associatedpsychopathology, however, are most often found within a general medicalor definable neurologic illness. Isolated simple persecutory delusions (e.g. “thenurse is trying to kill me”) are associated with degenerative brain disease. Isolatedelaborate persecutory delusional stories are associated with encephalopathy andtemporal lobe involvement. 71Certain delusional content suggests diagnosis 72 and involvement of specificbrain areas. 73 Delusions of jealousy are rare in schizophrenia and are frequent inalcoholics. Alcohol-induced psychosis is a likely diagnosis in a middle-agedpsychotic patient with delusional jealousy and full affect. Delusions of passivityare more frequent in schizophrenia than in mood disorder, while nihilisticdelusions occur more frequently in manic-depression. Misidentification delusionspoint toward right cerebral hemisphere disease.