Illusions and Delusions
Posted by lahar9jhadav on September 24, 2011
At all ages, a substantial proportion of patients who complain of memory difficulty or other cognitive symptoms are suffering from depression rather than a neurodegenerative disease. Vitamin deficiencies and chronic infections may also occur at any age; they usually cause other symptoms before dementia occurs, but occasionally mimic degenerative dementia. These include deficiencies of vitamin B12, folate or niacin, and infective causes including cryptococcal meningitis, HIV, Lyme disease, progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis, syphilis and Whipple’s disease.
About 4% of people will have an unprovoked epileptic seizure by the age of 80. Some people have seizures that are not noticeable to others. Sometimes, the only clue that a person is having an absence seizure is rapid blinking, extreme confusion for a few seconds or sometimes into hours. A seizure can also be as subtle as a fleeting numbness of a part of the body, a brief or long term loss of memory, visual changes, sensing/discharging of an unpleasant odor, a strange epigastric sensation, or a sensation of fear and total state of confusion. Some symptoms experienced by the person before a seizure may include dizziness, lightheadedness, tightening of the chest, and some experience things in slow-motion just prior to the seizure.
Some Causes: sleep deprivation, intoxication, infection, fever, metabolic disturbances, withdrawal from drugs, binaural beat brainwave entrainment
Women often complain of unexplained bruising on legs, thighs, buttocks and upper arms. Also, the tendency of unexplained bruising is often seen particular in families. Thinner people are more prone to bruising as they lack the fat cushion that helps prevent injury. It may also be due to deficiency of vitamin C, vitamin B12, folic acid and vitamin K.
Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his 1913 book General Psychopathology These criteria are:
- certainty (held with absolute conviction)
- incorrigibility (not changeable by compelling counterargument or proof to the contrary)
- impossibility or falsity of content (implausible, bizarre or patently untrue)
Furthermore, when a false belief involves a value judgment, it is only considered as a delusion if it is so extreme that it cannot be or ever can be proven true (example: a man claims that he flew into the sun and flew back home. This would be considered a delusion)
Delusions are categorized into four different groups:
Bizarre delusion: A delusion that is very strange and completely implausible; an example of a bizarre delusion would be that aliens have removed the affected person’s brain.
Non-bizarre delusion: A delusion that, though false, is at least possible, e.g., the affected person mistakenly believes that he is under constant police surveillance.
Mood-congruent delusion: Any delusion with content consistent with either a depressive or manic state, e.g., a depressed person believes that news anchors on television highly disapprove of him, or a person in a manic state might believe he is a powerful deity.
Mood-neutral delusion: A delusion that does not relate to the sufferer’s emotional state; for example, a belief that an extra limb is growing out of the back of one’s head is neutral to either depression or mania.
The illusion of visitors is a common occurrence amongst the elderly. It may be associated with any of the following: impairment in visual acuity, disturbance in visual association, dysfunction in the temporal or frontal areas of the brain due to dementia or stroke, and/or medication toxicity. In many cases, a combination of these factors interacts to cause the visual hallucinations and/or delusions.
In 1769, Charles Bonnet, a Swiss philosopher and naturalist, published an account of visual hallucination in his psychologically normal, visually impaired grandfather. Since then, numerous reports have been made of visual hallucinations accompanying visual loss. Conditions such as cataracts, glaucoma, macular degeneration and diabetic retinopathy are common in the elderly. The visual hallucination can be benign, simple visual distortions, or elaborate and at times menacing visual hallucinations and delusions.
Hallucinations and delusions commonly occur in conjunction with dementia. J L Cummings et al studied hallucinations and delusions in 30 patients with dementia of the Alzheimer’s Type (DAT) and 15 patients with multinfarct dementia (MID). Delusions were found in 30% of DAT and 40% of MID patients. Most delusions were of the paranoid type, and involved elementary misbeliefs, such as theft of possessions.
Visual hallucinations and/or delusions occur in at least half of patients with senile dementia and no previous psychiatric history. In degenerative dementia, such as Alzheimer’s disease, these symptoms are usually transient phenomena, occurring in the early to middle stages of the illness and disappearing when cognitive deficits become severe. In cerebrovascular disease, it can occur acutely and persist for months or even years. There may be an association between development of delusions and pathology of the frontal, right temporal and parietal lobes of the brain.
Families need to know more about the nature of these phenomena and their non-volitional nature to develop more realistic expectations of behavior.
Delusions are commonly seen in conjunction with dementia. Simple delusions of theft and vague suspicions directed at relatives are commonly observed. It usually represents an attempt by the amnesic patient to explain the loss of articles that have been misplaced. Unable to remember losing the object, the demented patient imagines an explanation involving theft by someone close at hand, often a caregiver. Many of the delusions that evolve from the visual experience of imaginary visitation can be viewed as an attempt to make sense out of bizarre. This input nonetheless seems real to the patient (if there are strangers in the house, they must be there for a purpose).
Dementia is overwhelmingly a condition associated with aging and predominately affects the elderly. Truly reversible causes of dementia are quite unusual and the common causes (AD, dementia caused by cerebrovascular diseases, Parkinson’s disease) are chronic diseases. These conditions will not go away. There is a great need to seek treatment that will minimize the effects of the disease.
Hallucinations and dementia are hard to take when seen in our parents. Trying to persuade the individual that they are not seeing these things may be counter-productive. Professional intervention can help deal with these situations.