[ExI] Top ten dumbest remarks

Stathis Papaioannou stathisp at gmail.com
Tue Oct 9 11:31:13 UTC 2007

On 09/10/2007, BillK <pharos at gmail.com> wrote:

> But *non-bizarre* irrational beliefs on their own, without any of the
> other symptoms of schizophrenia, come under the heading of Delusional
> Disorder.
> <http://psychologytoday.com/conditions/delusional.html>
> <http://www.psychnet-uk.com/dsm_iv/delusional_disorder.htm>
> Quote:
> Delusional disorder refers to a condition associated with one or more
> non-bizarre delusions of thinking—such as expressing beliefs that
> occur in real life such as being followed, being poisoned, being loved
> or deceived, or having an illness, provided no other symptoms of
> schizophrenia are exhibited.
> Delusions may seem believable at face value, and patients may appear
> normal as long as an outsider does not touch upon their delusional
> themes.

True, but in practice it is almost always obvious even to a layperson
that the delusional belief is delusional. The best single test of a
delusion (other than a trial of antipsychotic)  is to put yourself in
the patient's shoes and ask, Could I believe the same things given his
background and experience?

The other comment about subtypes of psychotic illnesses is that we
don't really have a test which can be used to show that these are
pathologically distinct entities. Different patterns are recognised,
but they all appear to merge seamlessly at the edges: delusional
disorder with paranoid schizophrenia, schizophrenia with
schizoaffective disorder, schizoaffective disorder with bipolar
disorder. The multiple genes implicated in each subtype overlap, and a
family history of one predisposes to all of the others. Moreover, they
all respond in much the same way to antipsychotic medication. Thus, it
may turn out that there is only one psychotic illness with different
symptoms in different cases.

> And, yes, anti psychotic drugs are often very effective in treatment.
> But there are problems with long-term use of anti psychotics, so
> treatment can get complicated.


Stathis Papaioannou

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