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UNIT 3 ■ Care of Patients With Psychiatric Disorders
MacCabe and associates (2013) identify that a sub- group of individuals with schizophrenia have no cog- nitive impairment, even in adulthood. Many factors contribute to functional impairment and decline beyond the symptoms themselves, including comor- bid metabolic conditions, chronic substance use, stress, frequency and intensity of episodes, residual symptoms, and social defeat (Bora, 2015). A sum- mary of positive and negative symptoms was pre- sented in Box 15–2 and is described in more detail in the following section. Positive Symptoms Positive symptoms are abnormal symptoms that are common manifestations of schizophrenia and referred to as positive because they are “added to” rather than deficits in the clinical picture. Disturbances in Thought Content Delusions are fixed false beliefs that are irrational and that the individual maintains as true despite evi- dence to the contrary. These beliefs are not explain- able as part of the person’s usual religious or cultural precepts. Delusions are subdivided according to their content. Some of the more common ones are listed here: ■■ Persecutory delusions: These are the most common type of delusion in which individuals believe they are being persecuted or malevolently treated in some way. Frequent themes include being plotted against, cheated or defrauded, followed and spied on, poisoned, or drugged. The individual may obsess about and exaggerate a slight rebuff (either real or imagined) until it becomes the focus of a delusional system. Repeated complaints may be directed at legal authorities. The individual feels threatened and believes that others intend harm or persecute them in some way (e.g., “The FBI has ‘bugged’ my room and intends to kill me”; “The government put a chip in my brain to erase my memories”). These may also be referred to as paranoid delusions, which describes the extreme suspiciousness of others and of their actions or perceived intentions (e.g., “I won’t eat this food; I know it has been poisoned”). Aggression or vio- lence may occur because the individuals believe that they must defend themselves against someone or something perceived to be a threat. ■■ Grandiose delusions: The individual with gran- diose delusions has an exaggerated feeling of importance, power, knowledge, or identity. These individuals may believe that they have a special
relationship with a famous person or even assume the identity of a famous person (believing that the actual person is an imposter). Grandiose delusions of a religious nature may lead to assumption of the identity of a deity or religious leader (e.g., “I am Jesus Christ”). ■■ Delusions of reference: Events in the environment are assumed by individuals with delusions of refer- ence to be referring to themselves (e.g., “Someone is trying to get a message to me through the articles in this magazine [or newspaper or TV program]; I must break the code so that I can receive the message”) and these beliefs become fixed (as with other delusions) despite evidence to the contrary. Ideas of reference are less rigid than delusions of refer- ence. For example, an individual with ideas of refer- ence may think that other people in the room who are giggling must be laughing about them but with additional information can acknowledge that there could be other explanations for their laughter. ■■ Delusions of control or influence: Individuals believe that certain objects or persons have control over their behavior (e.g., “The dentist put a filling in my tooth; I now receive transmissions through the filling that control what I think and do”) or they believe that their thoughts or behaviors have control over specific situations or people (e.g., the mother who believed that if she scolded her son in any way, he would die). This is similar to magical thinking, which is common in children (e.g., “The sky is raining because I’m sad”). ■■ Somatic delusions: Individuals have a false idea about the functioning of their body. This may be a false belief that they have some type of general medical condition or that there has been an alter- ation in a body organ or its function (e.g., “The doctor says I’m not pregnant, but I know I am”; “There is an alien force that is eating my brain”). ■■ Nihilistic delusions: The individual has a false idea that the self, a part of the self, others, or the world is nonexistent (e.g., “The world no longer exists”; “I have no heart”). ■■ Erotomanic delusions: Individuals with erotomanic delusions falsely believe that someone, usually of a higher status, is in love with them. Famous persons are often the subjects of erotomanic delusions. Sometimes the delusion is kept secret, but some individuals may follow, contact, or otherwise try to pursue the object of their delusion. ■■ Jealous delusions: The content of jealous delu- sions centers on the idea that the person’s sexual partner is unfaithful. The idea is irrational and
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