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Published on Nov View 15 Download To investigate the hypothesis that the content of delusions and hallucinations is significantly influenced by subjects global self-esteem and by 5 specific areas of self-esteem. The delusions and hallucinations of nenetap psychotic patients were assessed by 2 independent raters for content indicative of positive or negative self-esteem and for gangvuan extent to which the delusional content would be self-enhancing or diminishing and comforting or discomforting to the subject.

These ratings were correlated with the results of self-esteem inventories completed by the subjects. The content of delusions reflects both global self-esteem and self-regard. This study demonstrates that 2 specific personality factors, global self-esteem and self-regard, are reflected in the content of delusions and influence whether those delusions are experienced as comfortable or uncomfortable and enhancing or diminishing.

Delusional content is therefore consistent with patients views of themselves, and this may partially account for the persistence of tangguan.

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Can J Psychiatry ; Many psychological factors may be relevant, but few have been systematically and objectively investigated 1. Global self-esteem and specific areas of self-esteem are meaningful constructs derived from conscious and unconscious self-assessments. Thus self-esteem is one intrapsychic factor that may be considered likely to influence the content of delusions and hallucinations.

If the content of gangghan and hallucinations reflects an individuals self-esteem, lower self-esteem would promote less favourable content while higher self-esteem would be reflected by more positive content. Alternatively, if the content of delusions and hallucinations defends self-esteem, lower self-esteem would produce more favourable, self-enhancing content.

Higher self-esteem would not need to be defended against and would likely result in more varied content.

The literature supports both alternatives. Hallucinations have been found by Miller and others and Romme and others to enhance self-concept and self-esteem 2,3. Kaney and Bentall suggest that delusions of persecution maintain self-esteem by attributing blame for negative events to other people or circumstances 4.

By contrast, Federn believes that psychosis itself is not meenetap defence but a defeat 5. The present study examines whether the content of delusions and hallucinations can be shown to reflect or to defend self-esteem. Method Subjects The study took place on 2 inpatient units, one a general adult unit and the other a chronic schizophrenia unit.


Both were at the Clarke Institute of Psychiatry, a university-affiliated teaching centre in Toronto, Canada. Forty-seven successive admissions were recruited who met inclusion criteria for the study, such as having experienced active psychosis within the past month.


Forty subjects gave informed consent and completed the study within 2 weeks. Seven patients refused to take part in the study for reasons that suggested a fear of manipulation or persecution. All subjects had been actively psychotic within the wahqm prior gajgguan testing, and no subject was free of psychotic symptoms when tested. Instruments The following scales were used in the study: The PSE is a structured interview that focuses mainly on the psychotic symptoms a subject has experienced during the preceding month 6.

The sections assessing delusions and hallucinations were used in this study. The PSE includes criteria for highly probable and less memetap ratings. Only delusions and hallucinations meeting the highly probable criterion were included in the study.

This increased the probability that overvalued ideas and illusions were excluded. The SEI measures global self-esteem 7. Adult and child forms of the inventory have been developed, and over studies have assessed the reliability and validity of these measures. Testretest reliability is 0. Reliability coefficients for internal stability were 0. Kokenes confirmed the construct validity of the subscales as measuring sources of self-esteem 9, The adult SEI form used in this study contains 25 items.

Factor analysis of the SRS produced 5 clusters of self-esteem: These clusters represent relatively independent wxham of self-esteem.

Testretest reliability of the SRS is significant beyond the 0.

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The remainder of the scales were designed for the present study. Two of these scales rated subjects reactions to each delusion or hallucination they experienced. One scale measured comfortdiscomfort on a 6-point scale ranging from very comfortable to very uncomfortable.

The other measured the enhancingdiminishing effects of each delusion or hallucination, such as the degree to which each made them feel better or worse about themselves. The menegap scale ranged from very negative to very positive. Three scales were designed for use waha the raters.

One scale asked raters to independently assess each delusion and hallucination for content related to global self-esteem or to each of the 5 specific areas of self-esteem measured by the SRS. This was a forced choice with no neutral 0 rating provided. Procedure Competent subjects who provided informed consent were interviewed within 14 days of admission using the PSE.

Immediately upon reporting a delusion or hallucination, the subject ganbguan asked to complete the scales assessing the comforting or discomforting and the enhancing or diminishing effects of the psychotic experience.

Following the structured interview, subjects completed the SEI and SRS, and this ended their participation in the study. Information on variables such as age, education, medications prescribed, and length of illness was obtained from each subjects chart. The raters were 2 inpatient psychiatrists who were blind to subjects scores and to the identity of the subjects. Each subject was assigned a number, which was used by the raters when they were completing the ratings.


The raters completed their assessments independently. Schizoaffective disorder, manic episode and major depressive episode with psychotic features were each diagnosed in 5 subjects.

Organic delusional disorder was diagnosed in 2 subjects, drug-induced psychosis in 1 subject, and delusional disorder in 1 subject.

Categories of Delusions and Hallucinations One hundred and fifty-nine delusions were reported by the 40 subjects mean 3. The most frequent were delusions of reference [37], persecution [29], grandiose delusions [23], and delusions of control [16].

Less frequent were thought insertion [9], thought broadcasting [8], somatic delusions [7], delusions of mmenetap [7], thought withdrawal [7], thought reading mejetap, religious delusions [4], delusions of jealousy [2], delusions of catastrophe [2], delusions of thought control [1], and sexual delusions [1].

The number of hallucinations reported by the 40 subjects was 58 mean 1. Auditory hallucinations were most frequent [30], followed by visual [19], tactile [4], olfactory [3], and gustatory [2] hallucinations. Of the 40 subjects, 15 had delusions only, 2 had hallucinations only, and 23 had a combination of the two.

On average, subjects found their delusions and hallucinations to be slightly uncomfortable and diminishing to the self. For delusions, the mean comfort level meentap 2.

The mean enhancement effect was 2.

The mean comfort level and enhancement effect for hallucinations were somewhat lower at 2. These are lower than the scores reported for the general population of As shown in Table 1, all 6 of the self-esteem measures were highly intercorrelated, particularly global self-esteem and self-regard. This pattern indicates that these 6 areas of self-esteem are partially independent but also share varying amounts of overlap. The lowest shared variance is for school and work abilities and physical appearance 0.

Correlations and shared variance between global self-esteem and 5 specific areas menetwp self-esteem Self-regard Interpersonal relationships School and work abilities Physical appearance Physical abilities The Coopersmith Self-Esteem Inventory CorrelationShared variance 0.

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