Acting on delusions in patients suffering from schizophrenia

Abstract

Aim of the study Background: Schizophrenia patients are more prone to violent crimes because of associated risk factors- delusions, hallucinations, and substance misuse. The phenomenology of delusions associated with action provides a new way of understanding delusions and identifying key targets for risk management intervention secondary to medications. Aims: To assess the prevalence of delusional action in patients suffering from Schizophrenia and to identify the phenomenological characteristics of those delusions which are associated with action. Subject or material and methods A cross-sectional study was conducted on a sample of 77 patients and their informant using DSM- 5 diagnostic criteria for Schizophrenia and Maudsley Assessment of Delusion Schedule was applied. Results Fifty one (66.2%) acted on their delusions. Delusion of persecution was commonest being present in 58.4%. Actions on delusions consisted of protecting themselves (32.5%), losing temper (25.9%), hitting self/others (12.9%), moving/leaving house (15.6%), trying to stop it (27.2%). Informants reported that the patients felt unsafe, frightened or scared at home, suspicious of others, violent to someone, showed unusual behaviour. Discussion Acting on delusion occurs in significant proportion of patients. A higher proportion of the patients who reported feeling angry acted on their delusions and the difference was statistically significant. There was a higher rate of acting on delusions in those cases where the informant reported that the patient was frightened and had violent behaviour towards others. Both these differences were statistically significant. Conclusions Content of behavior can help understand the treating physician the probable precipitating factor, the psychopathology of the patient’s illness.