Psychotic symptoms and violence toward others — a literature review of some preliminary findings: Part 2. Hallucinations

According to the clinical impressions of a number of authors and mental health professionals, an increased risk of violence is associated with the presence of hallucinations and — in particular — command hallucinations. In contrast to this, some empirical studies have reported that there is no evidence of such a relationship. The present review examines the role of hallucinations in violence toward others. Possible empirical evidence for a violence-escalating interaction between delusions and hallucinations is also analyzed. Among the main findings were: There appears to be no evidence that auditory command hallucinations are dangerous per se. However, there is some evidence that voices ordering acts of violence toward others may increase compliance and thereby be conducive to violent behavior. Finally, the evidence for or against the existence of a possible violence-escalating interaction between delusions and hallucinations is inconclusive. The findings are discussed particularly in relation to problems of measurement and other research design factors. Discrepancies between some of the findings of the present review and current clinical lore are also briefly considered.     

Automatic attentional orienting to other people’s gaze in schizophrenia

Explicit tests of social cognition have revealed pervasive deficits in schizophrenia. Less is known of automatic social cognition in schizophrenia. We used a spatial orienting task to investigate automatic shifts of attention cued by another person’s eye gaze in 29 patients and 28 controls. Central photographic images of a face with eyes shifted left or right, or looking straight ahead, preceded targets that appeared left or right of the cue. To examine automatic effects, cue direction was non-predictive of target location. Cue–target intervals were 100, 300, and 800?ms. In non-social control trials, arrows replaced eye-gaze cues. Both groups showed automatic attentional orienting indexed by faster reaction times (RTs) when arrows were congruent with target location across all cue–target intervals. Similar congruency effects were seen for eye-shift cues at 300 and 800?ms intervals, but patients showed significantly larger congruency effects at 800?ms, which were driven by delayed responses to incongruent target locations. At short 100-ms cue–target intervals, neither group showed faster RTs for congruent than for incongruent eye-shift cues, but patients were significantly slower to detect targets after direct-gaze cues. These findings conflict with previous studies using schematic line drawings of eye-shifts that have found automatic attentional orienting to be reduced in schizophrenia. Instead, our data indicate that patients display abnormalities in responding to gaze direction at various stages of gaze processing—reflected by a stronger preferential capture of attention by another person’s direct eye contact at initial stages of gaze processing and difficulties disengaging from a gazed-at location once shared attention is established.     

Shame behind the corner? A daily diary investigation of pathological narcissism

This study investigated the association between narcissism and shame, considering different measures of narcissism, different levels of analysis, and different situational conditions. Nonclinical participants (N = 196) completed baseline measures, followed by daily questionnaires for 28 days. Multilevel models indicated that trait and daily vulnerable narcissism, as well as trait neuroticism, were positively associated with daily shame. When controlling for vulnerable narcissism, trait grandiose narcissism was unrelated to shame, and daily grandiose narcissism was mostly negatively related to it. As for situations, social stress and workload were related to increased shame, especially in those high in trait neuroticism, or narcissism scales with neurotic content. Results highlight the key role of shame in pathological narcissistic functioning.     

The targets of all treachery: Delusional ideation,paranoia, and the need for uniqueness as mediators between two forms of narcissism and conspiracy beliefs

The present cross-sectional study (N_Participants = 397; N_Informants = 460) examined the association of both grandiose narcissism and vulnerable narcissism with conspiracy beliefs in the context of four theoretically-relevant mediators. Participants who were higher in grandiose narcissism and vulnerable narcissism were more likely to believe in conspiracy theories, seemingly because they were more likely to hold unusual beliefs. There was, likewise, some evidence to suggest that those high in vulnerable narcissism believe in conspiracy theories because they suffer from paranoia, whereas those high in grandiose narcissism believe in conspiracy theories because of a desire to be unique. Together, these results suggest that the conspiracist ideation seen among those high in grandiose narcissism and vulnerable narcissism is a consequence of features that are shared between and unique to each of the traits.     

Negation Theory as a Cause of Delusion: The Case of the Unabomber

The case of the Unabomber is examined as a test of the authors' theory of negation, which is based on four steps: (1) negation, (2) persecutory ideation, (3) attachment to a transcendental source, and (4) evangelism/martyrdom. The Unabomber sent bombs that killed three persons and injured others, and became a cause celebre in the 1990s when he threatened to blow up an airliner in flight if his 36,000 word manifesto was not published in a leading periodical. Eventually captured and tried, he refused an insanity defense but accepted a sentence of life imprisonment without possibility of parole. The authors' theory is a phenomenological model which encourages an intensive analysis of observations of behavior, with the goal of abstracting dimensions that serve to integrate the observations, codify them, and bind them into a unitary system.     

Self-Structure in Persecutory Delusions

There is currently limited research examining self-structure in clinical groups and no current data on the extent to which self-structure is amendable to change following psychological therapy. We address this important gap by examining self-structure in individuals with persecutory delusions using the card sort task, an established paradigm measuring key self-structure indices, including the degree to which self-structure is compartmentalized (characterized by primarily positive or negative attributes, as opposed to a mix of both), and the proportion and importance of negative attributes.In Study 1, individuals with a schizophrenia spectrum diagnosis with current persecutory delusions (clinical group, n = 27) and a healthy control group (n = 47) were compared on self-structure indices. In Study 2 (n = 27), the clinical group also completed the card sort task before and after randomization to either a 12-week mindfulness-based psychological therapy or treatment-as-usual control.In Study 1, self-structure differed significantly between the clinical and control groups. The clinical group had a greater proportion of negative attributes, assigned more importance to negative self-aspects, and had more compartmentalized self-structures compared with controls. In Study 2 there were no associations between delusion severity and self-structure. Large effect sizes for reductions in compartmentalization and proportion of negative attributes across self-aspects were found following mindfulness therapy. The findings highlight key differences in self-structure between individuals with persecutory delusions and healthy controls, and suggest that it might be possible to change self-structure following psychological therapy. These data support the central role of the self in theoretical models of paranoid thinking.     

John Nash's Delusional Decade: A Case of Paranoid Schizophrenia

Continues the psychoanalytic study of mathematical genius John Nash in Capps (2003) by focusing on the decade, during his thirties, when he was most delusional. Explores the connections between the content of his delusions and his life history and immediate circumstances, with particular attention to the way in which his delusions reflected the bisexual confusion discussed in the previous essay. Uses Freud's analysis of the mechanism of paranoia in his Dr. Schreber study to account for the nature and progression of Nash's delusions.     

Grandiose and Vulnerable Narcissism,Materialism, Money Attitudes,and Consumption Preferences

Narcissism is increasingly being investigated in the context of consumer attitudes and behavior. Previous research showed that narcissism is reflected in materialistic tendencies and money-related attitudes. However, almost all of these studies concerned the grandiose type of narcissism. We examined relationships of both grandiose and vulnerable narcissism with materialism, money attitudes, and consumption preferences in a nonstudent sample. The results showed that the two types of narcissism are equally associated with materialism and a tendency to conspicuous (public) consumption. Differences between grandiose and vulnerable narcissism with regard to money attitudes were observed. Materialism mediated most of the relationships between narcissism, money attitudes, and consumption preferences, but the patterns of mediation were different for grandiose and vulnerable subtypes. Mutual suppression occurred when grandiose narcissism and materialism predicted anxiety associated with money and when vulnerable narcissism and materialism predicted money perceived as a source of evil. The results suggested that not only grandiose, but also vulnerable narcissists may be prone to excessive consumption and that this can be explained by their materialistic tendencies.     

Religious delusions and filicide: a psychodynamic model

In this article, we present a psychodynamic explanation for the complex crime of filicide motivated by religious delusions. To begin, we provide an overview of filicide, including its typology and epidemiology. Second, we examine the psychoanalytic theories of Heinz Kohut and Otto Kernberg so as to better understand how family-of-origin experiences add to the ways in which psychotic disorders later take shape in filicide cases. Third, we offer an explication of the psychology of religion, including the role that religious defences and religious delusions play in cases involving filicide. Ultimately, we hypothesise that mothers with religious delusions commit acts of filicide due to the dynamic and reciprocal interaction between mental illness, psychological functioning, and the psychological role played by religion. We conclude our article with a case illustration to demonstrate our theoretical model.     

重视医患沟通产生的功效--从成功诊治一例寄生虫病妄想患者说起

良好医患沟通直接影响到医疗活动的正常进行,有效的医患沟通是构建和谐医患关系必要的途径和手段。而医患沟通技能和医患沟通方法是实现良好医患沟通的基础。本文从诊断、治疗一种罕见的精神性疾病---寄生虫病妄想个案过程中,具体应用医患沟通听、说基本活动的技能,融洽与患者交流,构建良好医患关系,成功治愈这一寄生虫病妄想患者。阐明临床医生不仅仅需要仁爱之心、专业的医学知识,还需重视医患沟通,掌握医患沟通技巧。