Schizophrenia – When the senses go haywire

Those affected by schizophrenia can suffer from various delusions. UFOs from space, working for the Secret Service and voices calling on you to end your meaningless life: these are common delusions. But when does delusion occur, and how vulnerable are you to it?

What is delusion?

“You’re crazy” or “What you’re just making sense of” are just two of many idioms intended to express that the other person perceives a situation differently than you do. However, a different perception of a situation does not automatically mean that Delusions are present: Only in delusions is reality judged pathologically and irremediably wrong – a change of point of view (“maybe my opinion is not correct”), which is possible in discussions between healthy people, becomes impossible; delusion is a rigid belief that is wrong in content.

 

Definition of delusions

Delusions are among the thought disorders and are often embedded in a complex delusional reality that can only be understood by the patient. This delusional reality can exist alongside actual reality or completely dominate the patient’s thinking. In delusion, people, memories, ideas, and moods are misjudged, and the delusional perception often becomes life-determining.

For those affected, this reality is uncorrectably correct – they are not in a position to critically question their ideas. This leads to the fact that he is isolated in his delusion, which in turn supports the pathological self-centeredness that occurs in the delusion. A delusion is often preceded by a delusional mood in which the affected person sees the world as threatening.

Schizophrenia: delusions and the delusional system

The delusional perception leads to everyday occurrences being “reinterpreted”. When this happens to events from earlier times, it is called delusional memory. Delusions, of which the work for a secret service is best known, are embedded in a delusional system – the delusional work that is done serves, among other things, to explain all delusional ideas (so-called explanation delusion).

Common themes for delusions include:

• Persecutory thoughts 
• thoughts of guilt and sin
• A massive concentration on oneself (mania of relationships, “everything is happening only because of me”, and delusions of impairment, “everything is supposed to harm me”)
• love and jealousy

In addition, there is the delusion of grandeur and, conversely, the delusion of smallness or insignificance; furthermore, the spermatozoa delusion, in which the person concerned is convinced that animal pathogens have penetrated his skin, and the delusion of impoverishment.

 

Delusion in schizophrenia

Some delusional themes typically occur in certain disorders—in schizophrenia, for example, relational, impairment, persecution, spermatozoa, and megalomania.

To get a comprehensive picture of the extent of the delusion, the attending physician uses the so-called psychopathological findings. The affected person is usually unable to perceive the delusions, compare the course of his thought processes with those in healthy phases of life and name the sometimes very stressful changes.

When Do Delusions Occur?

Although delusions also occur with brain tumours or a brain infection after taking medication or drugs, these are relatively rare causes. The delusion of jealousy in chronic alcohol addiction or the delusional misrecognition of people with dementia occurs, as well as delusional depression.

There are usually delusions that go well with the depressive mood, such as delusions of impoverishment or sin, hypochondriacal delusions and delusions of smallness or insignificance. So here, the underlying illness is the cause of the delusion.

Schizophrenia and its causes

However, delusions are most commonly found in schizophrenia, one of the most common mental illnesses. The chance of developing schizophrenia at some point worldwide is one per cent.

The causes of schizophrenia consist of a network of psychosocial and genetic-biological factors. Acute stressful situations can lead to the outbreak of the disease if the person is predisposed to it.

Dopamine plays a central role in the development of psychotic symptoms by flooding the brain’s systems responsible for emotions. People with schizophrenia have more dopamine and dopamine receptors, which could be responsible for symptoms such as delusions, hallucinations and paranoia.

 

Symptoms of schizophrenia

One speaks of schizophrenia if one of the following symptoms persists for at least a month:

• Vocalization of thoughts, inspiration of thoughts, withdrawal of thoughts or propagation of thoughts (so-called ego disorders)
• Control mania, the mania for influence, the feeling of being done, delusions (so-called content-related thought disorders)
• commenting, dialogic or other voices coming from part of the body (so-called auditory hallucinations)
• persistent, culturally inappropriate or completely unrealistic (bizarre) delusion (for example, being able to control the weather or being in contact with aliens) 
• or two of the following symptoms:
• persistent hallucinations of any sensory modality
• Thought tearing or insertions into the flow of thoughts, resulting in distraction, stuttering, or new word formation (called formal thinking disorder)
• Arousal, postural stereotypes or waxy flexibility, negativism (doing the opposite when prompted), mutism (silence), and stupor (known as catatonic symptoms)
• Conspicuous apathy, lack of speech, flattened or inadequate affect, usually with social withdrawal and reduced social performance (so-called “negative” symptoms)
• very definite and consistent changes in certain broad aspects of behaviour, manifesting in aimlessness, laziness, a “lost-in-self attitude”, and social withdrawal