Paranoid delusions and threatening hallucinations: a prospective study of sleep paralysis experiences

Previously we reported a three-factor structure for hallucinations accompanying sleep paralysis (SP). These earlier analyses were, however, based on retrospective accounts. In a prospective study, 383 individuals reported individual episodes online providing further evidence for the three-factor structure as well as clearer conceptually meaningful relations among factors than retrospective studies. In addition, reports of individual episodes permitted a more fine-grained analysis of the internal structure of factors to assess predictions based on the hypothesis that a sensed or felt presence (FP) is a core experience affecting other SP hallucinations. Results were generally consistent with this hypothesis. In particular, associations among, and temporal stability of, sensory hallucinations were largely explained by their common association with FP. The findings are consistent with REM initiation of a threat activated vigilance system with pervasive effects on the SP experience and suggest a potential model for the thematic organization of nightmares and dreams more generally.     

Frontal lobe functioning in adolescents with attention deficit hyperactivity disorder

A prominent hypothesis regarding the etiology of attention deficit hyperactivity disorder (ADHD) is that its presence and magnitude reflect frontal lobe dysfunction. Past tests of this hypothesis have been inconsistent. The present study examined frontal lobe functioning in adolescents with ADHD. A sample of 10 ADHD adolescents and 10 controls between the ages of 12 and 17 served as participants for the study. The control group was matched on age (within six months) and gender. This study aided in clarifying past contradictory studies by using clearly defined criteria to determine ADHD, a representative age range of participants, carefully selected tests, and a control task. The two measures that were administered to assess frontal lobe functioning were the Wisconsin Card Sorting Test and the Stroop Color and Word Test. The Purdue Pegboard was used as a control measure that did not assess frontal lobe functioning. The findings indicate that the ADHD group performed significantly worse on the following: color score, color/word score, and interference score of the Stroop Color and Word Test; percent of perseverative responses, percent of perseverative errors, and number of completed categories of the Wisconsin Card Sorting Test. No differences were found on the Purdue Pegboard task.     

A comparison of metacognitions in patients with hallucinations,delusions, panic disorder,and non-patient controls

This study tested the hypothesis that metacognitions are a general vulnerability factor for psychological disorder. It was predicted that patients with psychosis (hallucinations or delusions), and patients with panic disorder would score higher than non-patients on measures of metacognition. Moreover, it was hypothesised that patients showing most dysregulation of thinking (voice-hearers) would endorse significantly higher metacognition scores than individuals in the other groups. The Meta-Cognitions Questionnaire (MCQ: ) was administered to patients who met DSM-IV criteria for schizophrenia spectrum disorders with auditory hallucinations, patients who met DSM-IV criteria for schizophrenia spectrum disorders with persecutory delusions, patients who met DSM-IV criteria for panic disorder and non-patients. The results showed that psychotic patients who experience auditory hallucinations tended to exhibit higher levels of dysfunctional metacognitive beliefs than other patient groups, scoring significantly higher than at least two of the three control groups on positive beliefs about worry, negative beliefs about uncontrollability and danger, cognitive confidence and negative beliefs including superstition, punishment and responsibility. It was also found that the metacognitive beliefs of patients with persecutory delusions and panic patients were often similar to each other, and elevated in comparison to non-patients, suggesting that such beliefs are generic vulnerability factors. The theoretical and clinical implications of these findings are discussed.     

Frontal lobe functions in attention deficit disorder with and without hyperactivity: A review and research report

We review 22 neuropsychological studies of frontal lobe functions in children with attention deficit disorder with and without hyperactivity (ADD/+H,ADD/-H). Some measures presumed to assess frontal lobe dysfunctions were not reliably sensitive to the deficits occurring in either form of ADD. Tests of response inhibition more reliably distinguished ADD/+H from normal children. Where impairments were found on other tests between ADD and normal subjects, they were highly inconsistent across studies and seemed strongly related to age of the subjects and possibly to the version of the test employed. Other methodological differences across studies further contributed to the discrepant reports. The co-morbidity of other disorders, such as learning disabilities (LD) and conduct problems, with ADD may be an additional confounding factor in some, though not all, of these studies. In a separate study, children with ADD/+H (n=12) were then compared on frontal lobe tests to three other groups: ADD/-H (n=12), LD but no ADD (n=11),and normal children (n=12) statistically covarying for differences in conduct problems across groups. Most measures did not distinguish among these groups. Both ADD groups made more omission errors on a Continuous Performance Test (CPT) than the normal group. All three clinical groups performed more poorly on the word and interference portions of the Stroop Test. Thus, while both types of ADD share some apparent similarities in deficits on a few frontal lobe tests in this study, the totality of existing findings suggests an additional problem with perceptual-motor speed and processing in the ADD/-H group.This research was supported by NIMH grant MH41464 and by funds from the Department of Psychiatry, University of Massachusetts Medical Center. The authors are grateful to Judy Tessier and Ellen Mintz-Lennick for their assistance with some of the data collection and scoring. The comments of Virginia Douglas on an earlier draft of this paper are greatly appreciated.     

Psychic skin: psychotic defences, borderline process and delusions

In this paper, I apply the concept of psychic skin to analytic work with people suffering from personality disorders and psychoses. When psychoses emerge, the defensive skin which protects the ego is breached and violent unconscious forces rip through the personality. Some of the patients diagnosed as schizophrenic with whom I work have identified with archetypal characters such as Christ, Satan, John Lennon and the Queen. I attempt to show how the adoption of these inflated personas can serve as secondary psychic skins. Such delusional identifications can provide a protective shield to hide the denuded self and prevent intrusion from the external world. Through clinical example, I try to demonstrate how these archetypal 'second skins' can preserve life until internal and external conditions make it possible for the self to emerge. I contrast such psychotic identifications with 'thin-skinned' and 'thick-skinned' narcissism as well as 'defences of the self' in borderline states where the psychic skin may be damaged but does not disintegrate. I also look at the ways in which Jung's own personal experience was different from this and how he managed to avert psychotic breakdown.     

Understanding symptoms of medical frontal lobe disorder: A clinical case study

A case of anterior communicating artery aneurysm with damage to inferior medial frontal areas (Brodmann areas 25, 32, 24-inferior) is presented. Four prominent deficits are discussed: (1) anterograde amnesia, (2) inert perseverative card sorting, (3) motor stereotypies, and (4) reduplicative paramnesia. These four deficits are discussed as negative or positive symptoms, related either to damage in inferior medial frontal (Brodmann areas 25, 32, 24-inferior) regions or release phenomena of superior medial frontal (Brodmann areas 6-medial and 24-superior) regions. It is concluded that the inferior and superior medial frontal regions act as opponent processors, with the inferior (B25, 32) area functioning to switch current mental set while the superior (B24-superior, 6-medial) region functions to maintain current mental set. Testable hypotheses about the opponent processor mechanism are suggested, as applied to neuropsychiatric disorders.     

Frontal lobe dementia and subcortical vascular dementia: a neuropsychological comparison

We compared the performance of 40 patients with frontal lobe dementia to that of 40 patients with subcortical vascular dementia (80 patients including, 46 men and 34 women) in a set of tasks assessing attentional, executive, and behavioural tasks. The frontal lobe dementia represents an important cause for degenerative disruption and is increasingly recognised as an important form (up to 25%) of degenerative dementia among individuals of late-middle-age. The main involvement is the frontal-subcortical pathway, which is the final target of impairment even in subcortical vascular dementia. A wider involvement of the cortical (decisional) layers in frontal dementia, in contrast with the prominent and widespread involvement of the subcortical pathways (refinement and corrections programs) creates the different profiles of the two groups. Frontal patients have more difficulties in abstract reasoning, focusing attention, and implementing strategies to solve problems. They exhibit more profound behavioural alterations in personality and social conduct and show only moderate depression, and a total lack of insight concerning their dinical condition. In contrast, the patients with subcortical vascular dementia have poor general cognitive functions, high insight, and important depression and apathy as the principal and most salient characteristic of their behavioral conduct.     

Proneness to hallucinations and delusions in a non‐clinical sample: Exploring associations with metacognition and negative affect

Commonly, individuals prone to hallucinations and delusions hold dysfunctional metacognitive beliefs and report higher levels of negative affect, yet, these associations have not been clearly investigated in non‐clinical samples due to the failure to control for high intercorrelations between variables. The aim of the current study was to investigate how hallucination and delusion proneness are associated with dysfunctional metacognitions and negative affect. A cross‐sectional sample of 715 students free from psychiatric diagnoses (M_age = 28.1 years, SD = 10.9, range 18–65) completed the Launay‐Slade Hallucination Scale (LSHS‐R); Peters et al. Delusion Inventory (PDI‐21); Depression, Anxiety, and Stress Scale (DASS‐21); and the Metacognition Questionnaire (MCQ‐30). Findings that participants who were prone to both hallucinations and delusions reported elevated levels of negative affect support the need for targeted mental health treatment for individuals who experience psychological distress related to their hallucinatory and delusional experiences. While metacognition beliefs of need to control thoughts and cognitive self‐consciousness, along with the anxiety and stress DASS‐21 subscales appeared as significant cross‐sectional predictors of proneness to hallucinations and delusions, only metacognitions demonstrated any notable predictive value for delusion proneness. This finding questions the role of metacognitions in determining hallucination and delusion proneness in non‐clinical samples.     

Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations

Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of delusions and hallucinations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.     

Anxiety and depression and their links with delusions and hallucinations in people with a dual diagnosis of psychosis and substance misuse: a study using data from a randomised controlled trial

Rates of depression and anxiety have been linked to severity and distress associated with positive symptoms in psychosis. There is also tentative evidence to suggest that these concurrent symptoms might be related to delusional and hallucinatory content. Our aim was to assess the cross-sectional associations between anxiety and depression, and hallucination and delusion severity and distress in a sample of 327 people dually diagnosed with psychosis and substance misuse problems. In addition, the relationships between specific symptom content and levels of anxiety and depression were examined. Anxiety was associated with delusion distress and depression with hallucination distress, although neither was related to symptom severity. Auditory commands to harm or kill the self were associated with higher levels of depression. Delusions with themes pertaining to the paranormal, and those with references to celebrities were associated with lower levels of depression. No specific delusion or hallucination content was associated with level of anxiety, when other variables were controlled for. The results demonstrate that anxiety and depression are linked to distinct aspects of psychotic experience, highlighting the need to acknowledge the role of these concurrent symptoms in the context of psychosis. In addition, findings relating to specific types of delusions and hallucinations highlight avenues for further research.     

Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor

On the basis of the analogy between intrusive thoughts and auditory hallucinations established by Morrison et al. [(1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265-280], the present work compares the metacognitive beliefs and processes of five groups of patients (current hallucinators, never-hallucinated people with a diagnosis of schizophrenia, recovered hallucinators, obsessive-compulsive disorder (OCD) patients, and a clinical control group) and a non-clinical group. The results show that of the five metacognitive factors considered in this study, two were found to be different in the current hallucinators group in comparison to any other group in the design. Likewise, it is found that the metacognitive beliefs of the current hallucinators coincide with those of the OCD patients in various factors, particularly that relating to superstition, and this is interpreted as lending support to the model of Morrison et al. (1995). Furthermore, the results are discussed in the light of existing research on Thought-Action Fusion, stressing the role that may be played by superstitious beliefs and magical thinking in auditory hallucinations and OCD.     

Frontal lobe dysfunction and everyday problem-solving: social and non-social contributions

Everyday problem-solving involves both non-social executive processes, social and emotional processes, and draws upon social and practical knowledge. A series of studies including both adult-acquired lesions and neurodevelopmental disorders is reviewed examining problem-solving on a real-life-type task that involves generating a range of solutions to brief problem scenarios and selecting preferred solutions to solve the problems. Impairments in problem-solving are described in groups of participants with left anterior frontal lobe lesions, Tourette's syndrome and Asperger's syndrome. By contrast, healthy older people did not show problem-solving deficits on the same task. The possible contributions of non-social executive skills, social and emotional skills, and knowledge acquired from experience are each considered in relation to everyday performance. Multiple cognitive/emotional routes to the development of everyday life difficulties pose a complex challenge both in understanding the nature of the relevant processes and in developing adequate methods for management and rehabilitation.     

Delusions and hallucinations as a reflection of the subcultural milieu among psychotic patients of the 1930s and 1980s

Delusions and hallucinations reported in the social histories of 150 patients admitted to an East Texas state hospital during the 1930s and of 150 patients admitted during the 1980s were examined for content that would characterize and contrast the patient subcultural milieu of the two time periods. Patients admitted during the 1930s tended to reflect the material deprivation and personal powerlessness of the great depression in delusions of great wealth and positive "special powers." The hallucinatory visions and voices of the 1980s patients reflected a more threatening and negative subcultural milieu, with more visions of blood, snakes, and dead people or animals. Command hallucinations to hurt, to kill, or to do "perverse things" would also suggest that the subculture milieu of the 1980s had become more dangerous.     

Phonologically related lexical repetition disorder: a case study

Errors of repetition in aphasia are most often nonword substitutions. Phonologically related lexical errors, or formal errors, are real-word substitutions that overlap with target words in sound. In the present research we present the case of an aphasic patient, MMB, who produced an unusually high rate of formal paraphasias in repetition. Six experiments were conducted to investigate the combination of impairments contributing to MMB's pattern of repetition and to test the predictions made by two theories of formal errors. MMB's formal errors in repetition were influenced by target frequency, but not by target length or imageability. Formal errors tended to be more frequent than their targets and showed greatest phonological overlap with targets at initial consonant. These findings provided partial support for Martin and Saffran's fully interactive spreading activation account of formal errors and did not support Blanken's phonological interactive encoding account. In Experiment 6, the effect on repetition of increasing auditory verbal short-term memory (AVSTM) demands was examined using a paired word repetition experiment. Under these conditions, MMB produced semantic paraphasias for the first time, providing strong support for the Martin-Saffran hypothesis that phonologically related, and semantic, lexical repetition disorders lie on a continuum of severity moderated by the degree of AVSTM impairment.     

Remarks on a case of acute alcoholic hallucination with delusions of jealousy

A case of acute alcoholic hallucinosis accompanied by insane jealousy is reported, together with a discussion of various aspects of alcoholic psychosis, with consideration of the relevant literature. The most justifiable approach to the subject would appear to be one of a complex, multifactiorial ("universal genetic") nature.     

Deconstructing delusions: A qualitative study examining the relationship between religious beliefs and religious delusions

Delusions have been conceptualized as forming in response to experience, yet the relationship between religious belief, and beliefs regarded as delusional, has received little research attention. This is despite the high prevalence of delusions featuring religious content. Semi-structured interviews were conducted with seven participants who had been diagnosed as experiencing delusions. Participants from a range of religious backgrounds were asked about their religious experiences and beliefs, family background and experiences of psychosis. These interviews were analysed qualitatively. Whilst religious background affected the content of delusions, the nature of delusions appeared to be influenced by other factors, such as early family experiences, particularly an absent parent and conflict within the family. Individuals often used a religious framework to understand unusual experiences, and there seemed to be a role for the process of identification and wish fulfilment in influencing delusional content. Whilst this research is clearly limited by its exploratory nature, it offers a possible framework of understanding which helps make sense of religious delusions, and suggests approaches which may be helpful in recovery.     

Averbia as a selective naming disorder: A single case report

After a moderate head injury a 33-year-old woman presented a selective defect in finding verbs and name actions. Objects, colors, body parts, and qualities were named in a normal way. No other associated aphasic defects were observed. It was proposed that the selection and use of verbs in their correct forms implies two different aspects, which eventually can become dissociated: (1) the ability to retrieve the lexical item (the action name); and (2) the ability to use the correct affixation, that is, to select the morphological form according to the current context. Only the second would be associated with agrammatism. Defects in the first aspect (selection of the lexical item) would represent a particular form of anomia, a category-specific anomia, or anomia for verbs (averbia). Our patient illustrated this particular type of category-specific naming disorder.