What we’ve said about Delusions

“it's not enough to say fixed false belief and by the way it's not even a uh doesn't have to be false and doesn't have to be fixed it just has to be relatively impervious to reasoning”

“The cleanest definition, again, is that you can locate some kind of a medical condition that responds to medical treatment, is not part of the person's baseline belief system, and that the belief is not acquired through normal rational, cultural, or social avenues”

“A delusion is a pathological belief that comes from a psychotic disorder. So you have to identify the psychotic disorder first. You have to identify the psychotic style of thinking first and also test it”

“it doesn't matter if the man's wife has actually happened to be cheating on him at the time, right? The reality status of that belief doesn't make it a delusion”

“there's actually two disorders that need to take place in order for it to manifest. One, you need to have the strange experience. And two, you need a second disorder that prevents that idea from going away”

“The first one I already mentioned, biased against disconfirmatory evidence. Basically, you're just less inclined to give an idea up”

“The longer that you're having a dysfunction in the way that you're processing the world, the more you're chipping out the beliefs. So if you're in psychosis for an hour, it's probably enough incorrect information going in that you might knock off some of the beliefs that aren't that important”

“I don't think rating it based on how bizarre it is is good either because truly psychotic people can have ordinary non-bizarre delusions. So what's left? I think what's left is how did this belief come up? How did this person come to the belief”

“Ask them, how is it that you came to understand this to be true? What experiences and when did you start to believe this, or suspect it at least”

“The more sudden religious insight, basically, you have into a strange idea or a very valued idea, the more likely it is to be from a psychotic disorder”

“You often don't see that in severe psychosis. You often don't see that for the strongest delusions. There's almost a short circuit of reasoning. Any outside information doesn't get absorbed in and processed in the thinking”

“I want you to imagine the exact last time you did this and I want you to rewind to the moment right before you got the idea for it and walk me through it step by step. Hallucinatory level of detail”

“I not only measure frequency of being bothered by or perceiving delusional beliefs, I also will ask, how much do you really believe that? Could it be something else that shows you sometimes the nature, the source of the apparently delusional belief”

“for people who have primarily delusions and hallucinations without negative symptoms or disorganization, Many of them will not tell you about the hallucinations or they don't perceive the hallucinations to be hallucinations. So all you're left with is delusions”

“The first thing that comes to mind, top of the differential for me, is overvalued idea. Why? It's a theory about... his illness. And people get all kinds of wild theories about their illnesses”

“even bipolar mania can mimic psychotic features uh the speed of distractible thoughts, rushing thoughts and speech can appear and has been defined in the literature as thought disorientation”

“I would say that category two and three, the substance induced and the mood induced, I would still consider those within the psychotic realm. It's simply that they're from a non-permanent or non-chronic is the better word”

“people who subscribe to new religions and cults tend to have more psychosis. They tend to have more mental illness. They tend to be more cluster A, okay”

“you need the same suspension of disbelief that you might have watching the new Avatar movie, you know, Blue Aliens. You're not sitting there skeptical”

“The way you should challenge in a clinical interview is not a true challenge. I think it should be with the air of disbelief of someone who really does want to understand more and believe”

“You can't just limit yourself to asking people about their delusions and testing them under delusions. You have to also test the deeply held beliefs, not in a mean way, but you should, you know, poke at and go into some death on the deeply held beliefs of people who are without psychotic disorders”

“in true psychotic disorders, is that sometimes in this discussion, somebody with schizophrenia will actually start to deny that they believe the delusion. Uh, because they, their ability to detect your social judgment is not impaired”

“some people, when you give them antipsychotics and they stop having that delusional perception anymore, they go like, well, I remember feeling that way about it, but that just seems strange now”

“Don't argue with the delusions, but also don't agree with the delusions. Right. You have to keep in mind that when you live in the world of the patient, you're not. agreeing with the delusions necessarily”

“i don't think i would ever say um not purposefully to one particular patient that's not real or that isn't reality i might suggest it even strongly uh most of the time it would be to ask them if they're willing to consider an alternative interpretation as reality”

“unless it's directly interfering with a very key or emergent part of the treatment plan, you shouldn't work too much on it. Acknowledge that it's there. If the patient is distressed by it, you can talk a little bit about that”