The first generation of cognitive-behavioral therapy for psychosis, when added to standard care, has demonstrated efficacy in treating patients with delusions and hallucinations. Details in this article. Psychosis refers to an abnormal condition of the mind described as involving a 'loss of contact with reality'. People with psychosis are described as psychotic. People experiencing psychosis may exhibit some personality. Paranoid or persecutory delusions are a subtype of delusional beliefs. In essence, a delusion is a fixed, false belief. In clinical settings the belief is likely to be distressing or disruptive for the. This page contains some basic information about voices, visions and other unusual sensory perceptions. If you feel you know little about the experience of hearing voices or seeing visions, it’s a good place to start. Www.getselfhelp.co.uk/psychosis.htm Page 1 of 4 www.get.gg Self Help for Paranoia, Delusions & Voices Cognitive Behaviour Therapy will not cure or treat the underlying cause of the delusions or hallucinations (most. Elsevier: Article Locator. Helping patients with paranoid and suspicious thoughts: a cognitive–behavioural approach. Abstract. Paranoid and suspicious thoughts are a significant clinical topic. They regularly occur in 1. In the past, patients were discouraged from talking about paranoid experiences. In contrast, it is now recommended that patients are given time to talk about them, and cognitive–behavioural techniques are being used to reduce distress. In this article we present the theoretical understanding of paranoia that underpins this transformation in the treatment of paranoid thoughts and summarise the therapeutic techniques derived. Emphasis is placed on the clinician approaching the problem from a perspective of understanding and making sense of paranoid experiences rather than simply challenging paranoid thoughts. Ways of overcoming difficulties in engaging people with paranoid thoughts are highlighted. In the past the content of paranoid thoughts was not to be discussed with patients. In the influential textbook Clinical Psychiatry, the view was expressed throughout the three editions from 1. Such ideas were not confined to psychiatry. A number of psychologists applied reinforcement techniques to try to reduce the time that patients spoke about delusions (e. Wincze et al, 1. 97. Liberman et al, 1. Hearing voices, or auditory hallucinations as psychiatrists call them, is a common experience for people living with schizophrenia. In fact, it is so common that it is considered to be one of the. However, there has been a remarkable transformation in how delusions are viewed. Together with medication, recommended treatment now encourages clinicians to give most patients time to talk about their experiences and to use particular cognitive–behavioural therapeutic techniques to reduce distress (National Institute for Clinical Excellence, 2. Upon completion of this course, you should be able to: Outline the characteristics and impact of Alzheimer's disease. Summarize the pathophysiological changes in the brain related to dementia and Alzheimer's disease. Not long ago the Bipolar Burble had a commenter ask me about delusions of grandeur in mania as a part of bipolar disorder. She was feeling alone in her experiences and so was hesitant to talk about her own delusions of. Lehman et al, 2. 00. But how should the content of delusional ideas be discussed? There are clearly lingering uncertainties in the mental health professions about this, as illustrated by a study of psychiatrist–patient routine consultations (Mc. Cabe et al, 2. 00. It was found that patients repeatedly tried to talk about the content of their psychotic symptoms and in response doctors hesitated, responded with a question rather than an answer and, when a carer was present, even smiled and laughed. In this article we focus on paranoid and suspicious thoughts, drawing on developments in the cognitive understanding and treatment of such experiences to describe how best to talk with patients about them. What is paranoia? Paranoid or persecutory delusions are a subtype of delusional beliefs. In essence, a delusion is a fixed, false belief. In clinical settings the belief is likely to be distressing or disruptive for the individual. However, there has long been debate about such definitions, in that most proposed criteria do not apply to all delusions. A more sustainable position is that of Oltmanns (1. Assessing the presence of a delusion may best be accomplished by considering a list of characteristics or dimensions, none of which is necessary or sufficient, that with increasing endorsement produces greater agreement on the presence of a delusion. For instance, the more a belief is implausible, unfounded, strongly held, not shared by others, distressing and preoccupying, the more likely it is to be considered a delusion. The practical importance of the debate about defining delusions is that it informs us that there is individual variability in the characteristics of delusional experience (Table 1. Delusions are definitely not discrete discontinuous entities. They are complex, multidimensional phenomena (Garety & Hemsley, 1. There can be no simple answer to the question ? What causes the degree of belief conviction? What causes resistance to change? What causes the distress? And clinicians need to think with patients about the aspect of delusional experience that they are hoping will change during the course of an intervention. Table 1. The multidimensional nature of delusions. In contrast to the debates about defining delusions, diagnostic criteria for subtypes of delusional beliefs based on content have not been a topic of comment. This is perhaps because the issue is thought to be self- evident, but it is more complex than might be considered at first sight. There is great variety in the content of thoughts of a persecutory nature, for instance, in the type and timing of threat, the target of the harm, and the identity and intention of the persecutor (Freeman et al, 2. Furthermore, terms such as paranoia, delusions of persecution and delusions of reference have been used interchangeably and to refer to different concepts. Freeman & Garety (2. Box 1. The second element of this definition distinguishes persecutory from anxious thoughts. Box 1. Criteria for a delusion to be classified as persecutory (Freeman & Garety, 2. Criteria A and B must be met: the individual believes that harm is occurring, or is going to occur, to him or herthe individual believes that the persecutor has the intention to cause harm. There are a number of points of clarification: harm concerns any action that causes the individual to experience distressharm only to friends or relatives does not count as a persecutory belief, unless the persecutor also intends this to have a negative effect on the individualthe individual must believe that the persecutor at present or in the future will attempt to harm him or herlusions of reference do not count within the category of persecutory beliefs. How common is persecutory thinking? Paranoid thoughts have traditionally been viewed as a symptom of severe mental illness. Sartorius et al(1. World Health Organization prospective study in ten countries of 1. Persecutory delusions were the second most common symptom of psychosis, after delusions of reference, occurring in almost 5. Persecutory beliefs are the most likely type of delusion to be acted on (Wessely et al, 1. Castle et al, 1. 99. There are many other psychiatric and neurological diagnoses in which persecutory delusions occur in a substantial minority of patients. These include depression, mania, post- traumatic stress disorder, dementia and epilepsy (Manschreck & Petri, 1. Increasingly, however, paranoid thoughts are considered not just as a symptom of a disorder but as an experience of interest in its own right, which occurs outside clinical groups and is frequently a cause of distress. The focus is on understanding and treating the distressing experience rather than on the diagnosis. Many have argued that psychotic symptoms such as delusions might be better understood on a continuum with normal experience (e. Delusions in psychosis represent the severe end of a continuum, although such experiences are present, often to a lesser degree, in the general population. Thus, a relationship of degree is suggested between, for example, a clinical persecutory delusion about government attempts to kill the person, non- clinical delusions about neighbours trying to get at the person and everyday suspicions about the intentions of others. However, it should be emphasised that there are different forms of the continuum view (Claridge, 1. The distribution of symptoms may well be quasi- continuous, lying between dichotomous (i. The frequency of delusional beliefs in non- clinical populations varies according to the content of the delusion studied and the characteristics of the sample population (e. About 1–3% of the non- clinical population have delusions of a level of severity comparable to clinical psychosis. A further 5–6% have a delusion but not of such a severity. Although less severe, these beliefs are still associated with a range of social and emotional difficulties. A further 1. 0–1. For example, Jim van Os and colleagues (2. Netherlands Mental Health Survey and Incidence Study (NEMESIS). In the sample, 2. DSM–III–R diagnosis of non- affective psychosis. However, a greater proportion had a . A separate group of people (3. Many studies do not differentiate between delusion subtypes, and therefore it is harder to estimate the prevalence of persecutory thinking in particular. A conservative estimate is that 1. Table 2. It is also likely that the studies underestimate the true frequency of paranoid thoughts since large epidemiological studies from a psychiatric perspective are unlikely to record more plausible fleeting everyday instances of paranoid thinking. Johns et al(2. 00. British survey of over 8. The results of individuals with probable psychosis were removed from the analysis. The assessment of delusions was fairly rudimentary but the results are still striking: 2. The least plausible paranoid item, fears of a plot, was endorsed by 1. Interestingly, there is evidence from more elaborate epidemiological research that odder, less plausible paranoid thoughts build on commoner, more plausible ones, indicating a hierarchical structure to paranoia (Fig. Consideration of the potentially hostile intentions of others can be a highly intelligent and appropriate strategy to adopt. Walking down certain streets can be dangerous. Friends are not always good ones. Whether to trust or mistrust is a judgement that lies at the heart of social interactions, and since it is not always an easy decision to make it can be prone to errors. Most people can think of instances where they have misread the intentions of others. Most obviously, this is particularly likely to be the case immediately after negative events that question our trust in others. For example, for several months after being mugged, people can understandably be very wary, vigilant and suspicious when walking in the street. Persecutory delusions are explicable in terms of normal psychological processes. However, there is an important caveat: no single factor is likely to account for paranoia. With colleagues, we have detailed a multi- factorial account of the formation and maintenance of persecutory delusions that addresses the complexity of the causal picture (Fig. Outline of factors involved in the development of delusions. Making sense of events.
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