Johns Hopkins Psychiatry Guide

Delusions

Patrick Barta, M.D., Ph.D., Paul Rivkin, M.D.
Delusions is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

  • A delusion is a fixed, false, and idiosyncratic belief and is one of the trilogy of psychotic symptoms: hallucinations, delusions and thought disorder.
    • "Fixed" refers to the strength of the patient’s belief. The patient is certain, and not persuaded by any arguments to the contrary.
    • "False" relates to the veracity of the patient’s belief.
    • "Idiosyncratic" means the belief is characteristic of the individual patient.
  • Beliefs about which the truth cannot be known with reasonable certainty, such as cultural or religious beliefs should not be classified as delusions without careful consideration.
  • Beliefs shared by a group of people, for example, a belief in UFOs, are not delusions.
  • Several of Schneider’s first rank symptoms (FRS) of schizophrenia are delusions. These include:
    • Delusions of control or being controlled
    • Thought withdrawal
    • Thought insertion
    • Mind reading
    • Delusional perception (ordinary perception given a bizarre interpretation)
  • Delusions can be divided by theme (e.g. persecutory, grandiose), plausibility (bizarre, non-bizarre), relationship to mood (congruent or non-congruent) or along other dimensions.
  • Most patients with delusions have more than one.
  • Delusions and hallucinations frequently co-occur.
  • The time course of delusions is highly variable and depends on the underlying diagnosis.
  • An "overvalued idea" is a belief which narrowly fails to satisfy the definition of a delusion. One example would be an anorexic patient’s belief that he or she is fat.
  • "... madmen put wrong ideas together, and so make wrong propositions, but argue and reason right from them; but idiots make very few or no propositions, and reason scarce at all." John Locke [1]

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Last updated: October 17, 2014