Somatic Delusions

Introduction:

Somatic delusions are a delusion that can significantly impact a person's perception of their body and bodily functions. In this note, we will examine the definition, prevalence, causes, and treatment of somatic delusions.

Definition:

Somatic delusions are delusions in which an individual has a false belief or conviction about their body or bodily functions. The belief can manifest in various ways, such as a belief that the individual has a serious illness or medical condition, that parts of their body are missing or not functioning correctly, or infested with parasites or insects.

Prevalence:

Somatic delusions are commonly associated with psychiatric disorders such as schizophrenia, delusional disorder, or major depressive disorder with psychotic features. In addition, somatic delusions can also occur in medical conditions that affect the brain, such as dementia or traumatic brain injury.

Causes:

The precise cause of somatic delusions is not entirely clear. However, research suggests that factors such as genetics, environmental stressors, and abnormalities in brain function may contribute to the development of somatic delusions.

Treatment:

Treatment for somatic delusions typically involves a combination of medication and therapy, focusing on addressing the underlying psychiatric or medical condition causing the delusions. Cognitive-behavioral therapy (CBT) may also help address the patient's thought processes and beliefs about their body.

Conclusion:

Somatic delusions are a type of delusion that can have a significant impact on a person's perception of their body and overall well-being. Early detection and treatment can help individuals manage their symptoms and improve their quality of life.

References:

1. Somatic Delusions. Merck Manual. Retrieved from https://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/somatic-delusions
2. Somatic Delusions. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/view/somatic-delusions
3. Yonkers, K. A. (2018). Management of somatic symptom disorder. New England Journal of Medicine, 379(14), 1373-1382.

Obsession

An obsession is an intrusive thought or impulse that enters the mind despite efforts to exclude them. Most of the time, patients consider them false and totally against their own beliefs. For example, someone might think their hands are dirty and thus repeatedly wash their hands. But notice they clean their hands to reduce the distress of their intrusive thoughts. That is, they know their hands are clean, but due to the intrusive thoughts of dirt, they want to ensure that their hands are clean again. 

Delusion Definition and Types

A delusion is an unshakeable belief (we cannot change it with logical explanations or evidence) that is held on inadequate grounds (they do not have a valid explanation or evidence for their belief, and that is not a conventional belief that the person might be expected to hold given their educational, cultural, and religious background.  

Illusions are mostly but not always normal. Hallucinations are mostly but not always abnormal. But a delusion is something that is always abnormal. So, someone who believes to be possessed by the supernatural is not delusional because it’s a cultural common belief. In the west, many young girls become convinced that they need to be thin and take extreme measures, and their weight may reach life-threatening low levels and continue. And this is still not a delusion because they consider thinness socially desirable and they educate most people about the risks of obesity is dangerous and the need for thinness.

Persecutory delusions are the most common ones, in which they develop a belief that someone wants to harm them.

Common Types of Delusions

• Somatic delusions
• Grandiose delusions
• Bizzare delusion
• Capgras delusion
• Autochthonus delusion
• Cotard delusion
• Delusion of thought broadcasting
• Delusions of being controlled
• Delusions of reference
• Delusions of jealousy 
• Erotomanic delusions
• Foli a deux
• Fregoli delusion

A delusion may be primary or secondary. Primary delusions occur out of the blue, unexplainable by the patient's morbid experiences at the time. Secondary delusions arise occur against a background. For example, a patient with mania and grandiosity develops grandiose delusions. 

A delusional disorder is characterised by a single delusion or delusional system that persists for at least three months. Most of the time, these are persecutory delusions; delusions of jealousy, Foli a deux or Fregoli delusions may also occur.  In schizophrenia, delusions are more likely to be bizarre, primary, multiple and non-systematized. Grandiose delusion is more characteristic of mania. Patients with depression often have cotard delusions, delusions of poverty or hypochondriacal delusions. 

Loosening of Association

A loss of the normal structure of thinking.  The patient’s discourse seems muddled and illogical and does not become clearer with further questioning; there is a lack of general clarity, and the interviewer has the experience that the more he/she tries to clarify the patient’s thinking, the less we understand it.   Loosening of associations occurs mostly in patients with schizophrenia. Earlier psychopathologists have described three kinds of loosening of association:

Knight’s move thinking (Derailment, Entgleisen): 

There is a change in the train of thought. There is retained but misled determining of the objective of thought. There is a disordered intermixture of constituent parts of one complex thought. 

Talking past the point (vorbeireden) 

where the patient gets close to the point of discussion, but skirts around it and never actually reach it

Verbigeration (word salad, schizophasia, paraphrasia) 

where speech is reduced to a senseless repetition of sounds and phrases (this is more of a disorder of thought form)

Three types of loosening of associations. Word salad is the most severe form. 

Disorders of the Form of Thought

Form of thought

Form of thought is the way people experience or express thoughts and the way thoughts proceed one after the other irrespective of their quantity. It helps in the diagnosis of psychiatric disorders.

Normal thinking forms include the following. 

• Dereistic Thinking (daydreams)
• Imaginative thinking
• Rational thinking

Formal Thought Disorder

• The term ‘formal thought disorder’ is a synonym for disorders of conceptual or abstract thinking that are most seen in schizophrenia and organic brain disorders.
• In schizophrenia, disorders in the form of thinking may coexist with deficits in cognition, and these forms of thought disturbance may prove difficult to distinguish in certain cases.
• Cameron used the term ‘Asyndesis’ to describe the lack of adequate connections between successive thoughts.
• Cameron placed particular emphasis on ‘over-inclusion’, which is an inability to narrow down the operations of thinking and bring into action the organized attitudes and specific responses relevant to the task at hand

Perseveration: 

the patient retains a constellation of ideas long after they have ceased to be appropriate, for example, “where do you live?”, “London”, “How old are you”, “London”…

Explanatory concepts for formal thought disorder

• Loss of association (asyndesis)
• Concrete Thinking – inability to think abstractly; unable to differentiate between primary and secondary meanings of words
• Loss of redundancy (Cloze technique)
• Loss of internal monitoring with consequent inability to ‘repair’ thought processes (Frith)
• Impaired semantic memory or impaired access to this.

Schneider named five features of formal thought disorder: 

1. Derailment

2. Substitution

3. Omission

4. Fusion

5. Driveling

Schneider claimed that individuals with schizophrenia complained of three different disorders of thinking that correspond to these three features of normal or non-disordered thinking. 

Transitory thinking

Transitory thinking is characterized by derailments, substitutions, and omissions. An omission is distinguished from desultory thinking because in desultoriness the continuity is loosened but in omission, the intention itself is interrupted and there is a gap. The grammatical and syntactical structures are both disturbed in transitory thinking.

Driveling thinking

With driveling thinking, the patient has a preliminary outline of a complicated thought with all its necessary details but loses the preliminary organization of the thought, so that all the constituent parts get muddled together. A patient with driveling has a critical attitude towards their thoughts, but these are not organized and the inner material relationships between them become obscured and change significance.

Desultory thinking

In desultory thinking, speech is grammatically correct, but sudden ideas force their way in from time to time.

• Verschmelzung: fusion, ‘melting’,
• Faseln: muddling
• Entgleiten: snapping off
• Entgleisen: derailment

Disorders of the form of thought include flight of ideas, loosening of associations, circumstantiality, etc.

Restlessness

Restlessness has two components: akathisia (subjective "inner" restlessness) and psychomotor agitation (an excess of motor activity).

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Zoophilia

One of the paraphilias, is characterized by marked distress over, or acting on, urges to indulge in sexual activity that involves animals.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Würgstimme (Wurgstimme) Definition

Würgstimme refers to whispering or speaking in an odd, muffled, or strangled voice. We mainly see it in schizophrenia, and may be a mannerism.

Word-salad

Word Salad (derived from the German Wortsalat) is characterized by confused, and often repetitious, language with no apparent meaning or relationship attached to them. It is often symptomatic of various mental illnesses, such as psychoses, including schizophrenia. Compare Derailment.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Word approximation

Usage of words in an unconventional or inappropriate way (as in metonymy), or usage of new but understandable words that are conventionally constructed (e.g., handshoes for gloves, time measure for the clock, and easily for simplify), contrasting with neologisms which are new words whose origins cannot be understood.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Witzelsucht

Witzelsucht is a tendency to tell inappropriate jokes and create excessive facetiousness and inappropriate or pointless humour. It is seen in Frontal lobe disorders usually along with moria. Recent research has shown that it may also be seen in frontotemporal dementia.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Windigo Psychosis

Windigo (also Wendigo, Windago, Windiga, Witiko, and numerous other variants) psychosis is a culture-bound disorder which involves an intense craving for human flesh and the fear that one will turn into a cannibal. This was alleged to have occurred among Algonquian Indian cultures.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Waxy rigidity

Compare Mitmachen and Waxy flexibility.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Waxy Flexibility or Flexibilitas Cerea

Waxy flexibility, also known as cerea flexibilitas, is a catatonic motor symptom in which the patient's limbs can be placed in any position in which the position is maintained as if the person is made of wax. The examiner can move the patient's limbs even with the slightest pressure. An associated symptom is a "psychological pillow" in which the patient has raised neck and sleeps as if his neck lies over an invisible pillow.

Wahneinfall

Wahneinfall is an alternate term for autochthonous delusions or delusional intuition. This is one of the types of primary delusions in which a firm belief comes into the individual's mind 'out of the blue' or as an intuition, hence called delusional intuition. Other types of primary delusions include delusional mood (or atmosphere), delusional (apophanous) perception and delusional memories. Care must be taken not to impugn an otherwise rational individual's instinctive aversion or inexpressible sense of or belief about a thing by dismissing it as Wahneinfall.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Vorbeigehen; Vorbeireden

In vorbeigehen or vorbeireden, an individual will answer a question in such a way that it is clear the question was understood, though the answer itself is very obviously wrong. For example: "How many legs does a dog have?" – "Six". This condition occurs in Ganser syndrome and has been observed in prisoners awaiting trial. Vorbeigehen (giving approximate answers) was the original term used by Ganser but Vorbeireden (talking past the point) is the term generally in use (Goldin 1955). This behavior is also seen in people trying to feign psychiatric disorders (hence its association with prisoners).

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Verstimmung

It refers to an ill-humoured mood state often accompanied by low mood and depressive symptoms. The people surrounding the individual often feel upset by this condition.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Verbigeration

 Verbigeration

Verbigeration is a verbal stereotypy in which usually one or several sentences or strings of fragmented words are repeated continuously. Sometimes individuals will produce incomprehensible jargon in which stereotypes are embedded. The tone of voice is usually monotonous. This can be produced spontaneously or precipitated by questioning. The term verbigeration was first used in psychiatry by Karl Kahlbaum in 1874, and it referred to a manner of talking which was very fast and incomprehensible. At the time verbigeration was seen as a ‘disorder of language’ and represented a central feature of catatonia. The word is derived from the Latin word ‘verbum’ (also the source of ‘verbiage’), plus the verb ‘gerĕre’, to carry on or conduct, from which the Latin verb ‘verbigerāre’, to talk or chat, is derived. However, clinically the term verbigeration never achieved popularity and as such has virtually disappeared from psychiatric terminology. Compare Echolalia.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Unipolar depression

A serious mood disorder that consists of unremitting depression or periods of depression that do not alternate with periods of mania.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.

Trichotillomania

Also known as a hair-pulling disorder, Trichotillomania (TTM) is an impulse control disorder characterized by a long-term urge that results in the pulling out of one's hair. This occurs to such a degree that hair loss can be seen. Efforts to stop pulling hair typically fail. Hair removal may occur anywhere; however, the head and around the eyes are most common. The hair pulling is to such a degree that it results in distress.

Copyright Notice

Adapted from Wikipedia. Text is available under the Creative Commons Attribution-ShareAlike License 3.0; additional terms may apply.