Delusions are false unshakable beliefs of morbid origin & are divided into: true delusions

(primary), and delusion like ideas (secondary).

Overvalued ideas occur in healthy individuals which is a thought that take precedence overall
other ideas for a long time because of the associated affect tone.

PRIMARY DELUSIONS are considered diagnostic of schizophrenia, although similar experience

occurs in organic states like epilepsy. Delusion like ideas occur in all psychosis. In primary
delusions a new meaning arises in connection with some psychological events. Schnieder
suggested three experiences: delusional mood, delusional perception, and sudden delusional
idea. While Conrad has put the term apophany as a better term to describe the primary
delusional experience. Conrad has proposed 5 stages in the development of delusional
psychosis: Trema (delusional mood), Apophany (searching to find a meaning), Anastrophy
(heightening of psychosis), consolidation (formation of new world), and Residuum (eventual
autistic state).

In the delusional mood the patient knows that there is something going on around him but do not
know what it is. The meaning of this mood become obvious when a sudden delusional idea
(autochthonous) or a delusional perception occur.

The delusional perception (also called apophanous perception) is the attribution of new meaning
to a normally perceived object. The new meaning is not arising from the patient's affect. If it did
arise from the patient's affect it will be called delusional misinterpretation (e.g. paranoid who
hear stairs creak and knows that a detective is spying on him).

Primary delusional experiences occur in acute schizophrenia and are not seen in chronic
schizophrenia.
SECONDARY DELUSTIONS occur as a result of other morbid phenomenon. Many have stressed
the role of projection in the formation of delusions. Freud tried to explain delusions of persecution
as a result of latent homosexuality. Gaupp and his student Kretschmer tried to explain paranoid
psychosis as a result of sensitive personalities. This sensitivity comes from a physical defect,
excessive masturbation, sexual perversion, membership of a minor group and so on. After years
of struggle some experience will expose the patient's weakness and he develops paranoid
psychosis. This is also called kretschmer's paranoia = sensitiver beziehungswahn = delirium of
self trance.

Paranoid delusions can occur in schizophrenia, endogenous depression, and psychogenic

reactions.
In schizophrenia once the primary delusional experience have occurred they are integrated into
some sort of system. This elaboration on delusions has been called DELUSIONAL WORK.

Delusions are said to be systemized when there is one basic delusion and the remainder of the
system is logically built on this error. Systematizations appear to be linked to the retention of
integrity of the personality. Completely systematized delusions are extremely rare.

CONTENT OF DELUSIONS depend on social and cultural background. Delusions have changed
with time. Yet Kranz found that as depressive delusions had not changed as much as
schizophrenia. Delusions of persecution occur in schizophrenia, depression and psychogenic
reactions.
Delusions of influence are a logical result of experience of passivity which is diagnostic to
schizophrenia.
Delusions of marital infidelity occur in schizophrenia and coarse brain disease esp. alcohol abuse.
Erotomania is also called the fantasy lover.

Grandiose delusions occur in schizophrenia, drug dependency and organic brain syndromes esp.
general paresis (was 50% before the advance in treatment).

Grandiose and expansive delusions may be part of fantastic hallucinosis in which all forms of
hallucination occur.

Delusions of grandeur occur in happiness psychosis when the patient believes that he is an
important person and able to help others.

Delusions of ill health are characteristic to depression but occur in schizophrenia and personality
disorders.

Hypochondriacal delusions e.g. belief he got lung cancer.

Nihilistic delusions are also called delusions of negation occur in depression but sometimes in
delirium and schizophrenia. St. nihilistic delusions are associated with delusions of enormity
when the patient believes that he can produce a catastrophe by some action, e.g. refuse to pass
water because he will flood the world.

Delusions of guilt & of poverty occur in depression.

REALITY OF DELUSIONS
When the illness become chronic there is discrepancy between delusion and behavior, e.g. the
grandiose patient may scrub the floor.
Delusions of jealousy seem to be the most dangerous kind and lead to hurting people more than
other type of delusions.