Delusions and reasoning: a study involving cognitive behavioural therapy

INTRODUCTION

Anomalies on probabilistic reasoning, theory of mind (ToM) tasks, and attributional biases have been found in delusional people. Delusions are also effectively modified by cognitive behavioural therapy (CBT). We sought to examine whether CBT reduces delusional conviction by changing such general reasoning anomalies.

METHOD

Sixteen patients commenced an 8-11 week CBT programme that targeted their delusions. Probabilistic reasoning, attributional biases, and ToM were assessed pre- and post-treatment. Delusional conviction, preoccupation, and distress were rated at each session. Pretreatment task performances were compared to norms. Repeated measures analyses compared pre- and posttreatment task performances and ratings of delusions. Correlational analyses were used to identify factors associated with reduced delusional conviction.

RESULTS

At baseline, 11 patients showed some form of abnormal probabilistic reasoning, 13 excessive attributional biases, and 13 defective ToM compared to norms. Fourteen patients completed the CBT programme and showed significant reductions in delusional conviction and preoccupation. Despite some inconsistent evidence of improvement in verbal ToM tasks, reasoning styles in these 14 patients were largely unchanged by CBT.

CONCLUSION

Reasoning anomalies associated with delusions in this sample mark a vulnerability that persists and is independent of the effectiveness of CBT.

Patients with deliberate self-harm seen by a consultation-liaison service

OBJECTIVE

To examine Australian trends in deliberate self-harm in order to explore aetiological factors and improve clinical practice.

METHOD

A database recording 5 years of activity of a consultation-liaison service from a large tertiary referral hospital in Sydney was analysed to discover trends in types of self-harm, sex, age, marital status, repetition rates, diagnoses and follow up.

RESULTS

1295 patients with deliberate self-harm were referred to the Service over the 5 years. Of these patients, women exceeded men (ratio of 1.48:1). Self-poisoning constituted 79.5% of the referrals. Rates of self-harm referrals increased from 1999 to 2001, but appeared to plateau in 2002 and 2003. Eighty-eight per cent of referrals were first presentations of self-harm. Most referrals received the diagnosis of adjustment disorder with depressed mood, but a significant proportion was diagnosed with major depressive disorder and schizophrenia, particularly in those that violently self-harmed. There was a significant decline in the rate of admission to hospital over the study period.

CONCLUSIONS

While patient characteristics did not change significantly, there was a decline in admission rates to hospital. Many patients had serious mental illnesses, highlighting the importance of a thorough psychiatric assessment of people who self-harm.

Multiple cerebral infarcts following septic shock

A 60-year-old female in septic shock developed neurological signs and symptoms. She had left-sided hemiparesis, left homonymous hemianopia, bimanual coordination disorder, a language dysfunction of anomic aphasic type and a non-aphasic right hemispheric communication disorder. Computer tomography demonstrated bilateral anterior and posterior watershed as well as territorial infarctions. Risk factors included chronic airways limitation, cardiac failure and heavy smoking. Carotid duplex studies were normal. The mechanisms can be explained by flow changes and thrombus formation.