Acting on delusion: a review

Acting on delusion and delusional inconsequentiality: A review

OBJECTIVES

Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act according to their delusions. This study proposes an investigation of how this issue is addressed in psychopathological literature.

METHODS

This article offers a critical review of psychopathological literature which focuses on the influence of delusional ideation on behaviour.

RESULTS

Phenomenological psychiatry has relied on the paradox pointed out by Bleuler and Jaspers to emphasize disorders of self-experience in psychosis whereas analytical philosophy of delusion has focused on the psychological status of delusion, regarded as belief, certainty, or imagination. The empirical studies conducted during the past three decades - which were devoted to acting on delusion - focused on violent and safety-seeking behaviours. These studies have shown that these behavioural disorders are motivated by an emotional outburst (anger and/or fear) rather than by delusional content.

CONCLUSION

Delusional inconsequentiality can be clarified by conceptual research in phenomenological psychiatry and analytical philosophy, even though its role in the psychopathological processes has not yet been clearly identified or conceptualised. Empirical psychopathology on acting on delusion confirms the delusional inconsequentiality, but only implicitly, by highlighting the role of affectivity (rather than beliefs) in delusional actions. Given the major implications of better understanding this phenomenon, in terms of psychopathology and clinical practices, we suggest considering delusional inconsequentiality as a promising concept which could guide further research in contemporary psychopathology.

Potent inhibition of human phosphodiesterase-5 by icariin derivatives

Plant extracts traditionally used for male impotence (Tribulus terrestris, Ferula hermonis, Epimedium brevicornum, Cinnamomum cassia), and the individual compounds cinnamaldehyde, ferutinin, and icariin, were screened against phosphodiesterase-5A1 (PDE5A1) activity. Human recombinant PDE5A1 was used as the enzyme source. Only E. brevicornum extract (80% inhibition at 50 microg/mL) and its active principle icariin (1) (IC50 5.9 microM) were active. To improve its inhibitory activity, 1 was subjected to various structural modifications. Thus, 3,7-bis(2-hydroxyethyl)icaritin (5), where both sugars in 1 were replaced with hydroxyethyl residues, potently inhibited PDE5A1 with an IC50 very close to that of sildenafil (IC50 75 vs 74 nM). Thus, 5 was 80 times more potent than 1, and its selectivity versus phosphodiesterase-6 (PDE6) and cyclic adenosine monophosphate-phosphodiesterase (cAMP-PDE) was much higher in comparison with sildenafil. The improved pharmacodynamic profile and lack of cytotoxicity on human fibroblasts make compound 5 a promising candidate for further development.

Insight in psychosis: an elusive target

Insight is a quality which has been highly valued by most clinicians in the mental health field, largely because a strong link is assumed between good insight and better quality of life. Yet it is a complex construct, one which has not until recently been subjected to much critical scrutiny or adequately explicated. All too often, particularly in the field of psychosis, the term has been used as shorthand for the degree of congruence between the explanatory models and views on the mode and conditions of treatment of the clinician and the patient. Conflicts about these matters are ubiquitous in the care of psychotic patients. Recently, there has been a recognition that there are a number of dimensions to the construct, and that some of these relate to differences in attributional perspective. This has opened up the issue to more sophisticated research drawing on established but untapped psychological and neurobiological theories, and has formed a better framework for the development of more effective research and therapeutic strategies.