Delusions

A false idea of reality which does not agree with what other people in the same environment believe. The idea cannot be corrected and is not shared by a group of like-thinking people. It is not always possible to draw a clear dividing-line distinguishing delusion from bigotry, prejudice, idealism and other very firm and consistently maintained opinions. A person suffering from delusions usually displays enough other psychotic symptoms, such as lowered consciousness and hallucinations, to confirm that the patient has a delusion. Some common delusions are paranoia, delusions of guilt, poverty and sinfulness in depressions, delusions of wealth in alcohol psychosis and mania, delusion of sex change in schizophrenia, erroneous ideas concerning the new-born baby in childbed psychosis, delusion of jealousy in alcoholism, and delusions of grandeur. A delusion is always caused by a psychiatric disorder in which the perception of reality is disturbed: this occurs in psychoses and sometimes in states of disturbed consciousness. The subject of the delusion is usually determined by the patient’s problems. It is possible that he is ‘projecting’ his own guilt feelings or that he is trying, by means of the delusion, to explain the feelings or emotions which he is experiencing. Treatment is directed against the causal sickness. General deterioration of mental faculties caused by gradual decay of brain cells. The condition is sometimes temporary, particularly if it results from conditions such as epilepsy, brain tumours or an increase in brain pressure caused by disorders such as hydrocephalus. In such cases dementia is the result of a treatable disorder, but senile and presenile dementia are untreatable. The most important form of persistent dementia is senile dementia, caused by atherosclerosis (fatty degeneration of the blood vessels of the brain, which can lead to a stroke). It usually occurs between the ages of 60 and 70, with amnesia, reduced emotional control and character changes. As a consequence concentration and other mental attributes are reduced, and behaviour is disturbed. The patient starts to move stiffly, and take very small steps. Epilepsy can also occur. There may be temporary debilities such as speech difficulties (aphasia) and paralysis on one side of the body as a result of associated infarctions. Presenile dementia is less common; it usually occurs before the 60th year. Known examples are Alzheimer’s disease, Jakob-Creuzfeldt disease and Pick’s disease. Alzheimer’s disease can occur from the 45th year, often showing a clear pattern over a number of years; the cause is unknown. Initial symptoms are loss of memory, followed by aphasia and the inability to perform simple tasks (apraxia), sometimes associated with epileptic fits; the condition finally develops into dementia. Jakob-Creuzfeldt disease also occurs in middle age and is probably caused by a slow virus infection. There are known cases of contagion. All mental faculties fail, followed by ataxia (lack of muscular co-ordination) and myoclonus (muscular spasms). This condition can also end quite suddenly. Pick’s disease is also one of middle age, but is not of limited duration. The cause is not clear, but hereditary factors may be significant. Cell loss occurs in the frontal lobe of the brain, causing character changes. Loss of initiative, apathy and impoverished speech are the first symptoms, associated with an inability to perform routine tasks, and leading to increasing loss of memory and aphasia; the patient finally stops speaking altogether. Persistent dementia can also be associated with Parkinson’s disease, Huntington’s chorea, and can be a residual symptom of encephalitis. Various psychiatric clinical pictures imitate dementia; social isolation for example caused by a patient’s increasing inability to see, may cut him off from new stimuli. If patients show symptoms of dementia it is important in the first place to establish that the condition really exists, and then whether there is an underlying condition that can be treated. The pattern of the illness and physical examination can be supplemented by an EEG and a CAT scan of the brain. If possible, the underlying condition should be treated, but senile and presenile dementia are untreatable, and admission to an institution is often unavoidable. It is possible to administer drugs to reduce associated symptoms

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