Acting on delusions in patients suffering from schizophrenia
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Senior Resident, Department of Psychiatry, Medical College Baroda, Gujarat, India
Assistant Professor, Department of Psychiatry, Medical College Baroda, Gujarat, India
Professor and Head, Psychiatry Dept., Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India 442001.
Consultant Psychiatrist, Antara Psychiatric Hospital, Kolkata, West Bengal, India
Submission date: 2018-11-16
Final revision date: 2019-04-18
Acceptance date: 2019-04-27
Online publication date: 2019-12-18
Publication date: 2019-12-18
Corresponding author
Anu Hasmukh Patel   

Senior Resident, Department of Psychiatry, Medical College Baroda, Gujarat, India
Arch Psych Psych 2019;21(4):52-61
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.

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.

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.

Content of behavior can help understand the treating physician the probable precipitating factor, the psychopathology of the patient’s illness.

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