Descriptive Psychopathology: The Signs and Symptoms of ...

275 Chapter 11: Delusions and abnormal thought contentTable 11.1. Differential diagnostic considerations of the different sources of delusionaldevelopmentSource of disturbancePerceptionEmotionSelf-monitoringThinkingMemoryAll phasesConditions to considerTemporal–limbic disease (seizure disorder, traumatic braininjury, hallucinogenic drug use, schizophrenia andschizotypal disorders)Thalamic and parietal lobe disease and related syndromes ofmisidentification (injury, stroke)Mood disorders, temporal–limbic diseasePrefrontal cortex disease or dysfunctionPosterior non-dominant disease or dysfunctionPrefrontal cortex disease or dysfunctionAlzheimer’s diseaseFrontal–temporal dementiaAlcohol-related dementiasDelirium and encephalopathyfurther salience to the meeting. Does the conversation relate to him? Memoriesabout plots, neighbors, and garbage trucks (often used by Hollywood as sinisterimages) become connected and a delusional idea forms. 14The above understanding of the development of a delusional idea shapes theexamination and emphasizes that delusional content is not diagnostically critical.Each aspect of the delusional process is assessed as each is impacted by differentdiseases (Table 11.1).Examination of the sources of a delusionWhen a patient expresses ideas that may be delusional, the examiner immediatelyexpresses concerned interest and asks “How do you know this? Tell me how youfigured this out?” Some delusional patients respond “I just know” or “I feel it tobe so”. Others offer proof that may reveal the source leading to the false idea.These are systematically assessed.(1) Does the patient have perceptual aberrations explaining his beliefs? Perceptualdistortions and illusions are considered, as is the assessment of thalamicintegration problems.“Do the things you see or hear seem out of sync, like a movie where the sound and picturearen’t quite together? Are you experiencing any difficulty with your balance or coordination?Do you experience pins and needles in you hands and feet? Do parts of your bodyfeel numb or overly sensitive? Do they seem different from the way they should?”