Example of delusion in schizophrenia

Schizophrenia - Symptoms and causes


Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

People with schizophrenia require lifelong treatment. Early treatment may help get symptoms under control before serious complications develop and may help improve the long-term outlook.

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Schizophrenia involves a range of problems with thinking (cognition), behavior and emotions. Signs and symptoms may vary, but usually involve delusions, hallucinations or disorganized speech, and reflect an impaired ability to function. Symptoms may include:

  • Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.
  • Hallucinations. These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.
  • Disorganized thinking (speech). Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad.
  • Extremely disorganized or abnormal motor behavior. This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn't focused on a goal, so it's hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.
  • Negative symptoms. This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn't make eye contact, doesn't change facial expressions or speaks in a monotone). Also, the person may lose interest in everyday activities, socially withdraw or lack the ability to experience pleasure.

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.

Symptoms in teenagers

Schizophrenia symptoms in teenagers are similar to those in adults, but the condition may be more difficult to recognize. This may be in part because some of the early symptoms of schizophrenia in teenagers are common for typical development during teen years, such as:

  • Withdrawal from friends and family
  • A drop in performance at school
  • Trouble sleeping
  • Irritability or depressed mood
  • Lack of motivation

Also, recreational substance use, such as marijuana, methamphetamines or LSD, can sometimes cause similar signs and symptoms.

Compared with schizophrenia symptoms in adults, teens may be:

  • Less likely to have delusions
  • More likely to have visual hallucinations

When to see a doctor

People with schizophrenia often lack awareness that their difficulties stem from a mental disorder that requires medical attention. So it often falls to family or friends to get them help.

Helping someone who may have schizophrenia

If you think someone you know may have symptoms of schizophrenia, talk to him or her about your concerns. Although you can't force someone to seek professional help, you can offer encouragement and support and help your loved one find a qualified doctor or mental health professional.

If your loved one poses a danger to self or others or can't provide his or her own food, clothing, or shelter, you may need to call 911 or other emergency responders for help so that your loved one can be evaluated by a mental health professional.

In some cases, emergency hospitalization may be needed. Laws on involuntary commitment for mental health treatment vary by state. You can contact community mental health agencies or police departments in your area for details.

Suicidal thoughts and behavior

Suicidal thoughts and behavior are common among people with schizophrenia. If you have a loved one who is in danger of attempting suicide or has made a suicide attempt, make sure someone stays with that person. Call 911 or your local emergency number immediately. Or, if you think you can do so safely, take the person to the nearest hospital emergency room.

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It's not known what causes schizophrenia, but researchers believe that a combination of genetics, brain chemistry and environment contributes to development of the disorder.

Problems with certain naturally occurring brain chemicals, including neurotransmitters called dopamine and glutamate, may contribute to schizophrenia. Neuroimaging studies show differences in the brain structure and central nervous system of people with schizophrenia. While researchers aren't certain about the significance of these changes, they indicate that schizophrenia is a brain disease.

Risk factors

Although the precise cause of schizophrenia isn't known, certain factors seem to increase the risk of developing or triggering schizophrenia, including:

  • Having a family history of schizophrenia
  • Some pregnancy and birth complications, such as malnutrition or exposure to toxins or viruses that may impact brain development
  • Taking mind-altering (psychoactive or psychotropic) drugs during teen years and young adulthood


Left untreated, schizophrenia can result in severe problems that affect every area of life. Complications that schizophrenia may cause or be associated with include:

  • Suicide, suicide attempts and thoughts of suicide
  • Anxiety disorders and obsessive-compulsive disorder (OCD)
  • Depression
  • Abuse of alcohol or other drugs, including nicotine
  • Inability to work or attend school
  • Financial problems and homelessness
  • Social isolation
  • Health and medical problems
  • Being victimized
  • Aggressive behavior, although it's uncommon


There's no sure way to prevent schizophrenia, but sticking with the treatment plan can help prevent relapses or worsening of symptoms. In addition, researchers hope that learning more about risk factors for schizophrenia may lead to earlier diagnosis and treatment.

By Mayo Clinic Staff


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Schizophrenia Delusions: Definition, Types, and Treatments

Schizophrenia Delusions: Definition, Types, and Treatments

Beliefs That Aren’t Real: How Doctors Define Schizophrenia Delusions

Schizophrenia is a severe mental health condition that can cause a number of symptoms, including problems thinking clearly, hallucinations, and delusions.

Those with schizophrenia often experience symptoms doctors describe as positive, negative, or cognitive (or a combination of each).1 Delusions are an example of a positive symptom along with hallucinations. Negative symptoms include lack of emotional response while cognitive symptoms include difficulty communicating with others.

This article will describe what delusions are, how they affect a person with schizophrenia, and how a doctor will treat the delusions.

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What are delusions?

Schizophrenia delusions are a schizophrenia symptom that causes a person to believe something that isn’t true — even when others try to tell them or show them their beliefs are untrue.1 Specifically, the Diagnostic and Statistical Manual of Mental Disorders 5, Text Revision (DSM-5-TR), define delusions as “fixed believes that are not amenable to change in light of conflicting evidence.”2

The DSM-5-TR names delusions as one of the five key criteria mental health experts use to diagnose schizophrenia. 2

A common schizophrenia delusion type is the paranoid delusion.1 Another word for these are persecutory delusions. These are delusions where a person believes they are being harassed, harmed, or otherwise watched by others. Examples of paranoid schizophrenia delusions may include:

  • ”The FBI are following me.”
  • ”My spouse is trying to poison me.”
  • “My family is pumping medicine through the air conditioner to try and make me look crazy.”

Additional Schizophrenia Delusion Types

Paranoid delusions aren’t the only schizophrenia delusion type. Schizophrenia delusions examples may include2,3:

  • Delusions of control: A person believes others are trying to control their thoughts or behaviors. An example would be: ”My doctor is trying to plant thoughts inside my head.”
  • Delusions of erotomania: A person with this delusion type believes that another person or persons are in love with them. An example would be “Taylor Swift is in love with me and writes me love letters every day.”
  • Delusions of grandeur: A person believes they are a historical figure of great importance. An example would be: “I am the reincarnation of Julius Caesar.”
  • Delusions of reference: A person believes that messages are for them, such as something on a billboard, on the television, or in a movie. An example would be: “The President is speaking directly to me through the television.”

In one study of patients with schizophrenia delusions, delusions of reference were the most common delusion type, followed closely by persecutory delusions.3 However, some studies find persecutory delusions are the most common type. A person can experience multiple delusion types.

Doctors may call delusions “bizarre” if they are so implausible that they are difficult to understand or interpret.

Schizophrenia Delusions Treatments

Doctors may have a hard time helping a person treat delusions because the person doesn’t recognize their thoughts or beliefs are incorrect. They will use both pharmacological and non-pharmacological treatments, which include:4

Non-pharmacological Treatments

  • Cognitive behavioral therapy
  • Group therapy
  • Social skills therapy
  • Vocational/employment rehabilitation

Non-pharmacological treatments are important in treating schizophrenia and delusions because traditionally patients with schizophrenia have poor adherence to their medications.4 Using non-pharmacological approaches can help improve treatment adherence.

Pharmacological Treatments

  • First-line treatments for maintenance are second-generation atypical anti-psychotics, such as aripiprazole, risperidone, and ziprasidone
  • First-generation anti-psychotics usually cause more severe symptoms and aren’t first-line treatments. They include chlorpromazine and haloperidol
  • Doctors may prescribe clozapine, a second-generation atypical anti-psychotic, for treatment-resistant schizophrenia. This medication can cause more side effects than other anti-psychotics (including increased risks for seizures)

When a mental health professional is establishing a therapeutic environment with a client who experiences delusions, it’s important that they recognize how the delusion may make their client feel. Some clients may find their delusion is scary or makes their client feel unsafe. While they should not validate the delusion, validating how the delusion makes the client feel can be important.

Call to Action: Ready to dig deeper into delusions associated with schizophrenia? Symptom Media’s accredited CE course includes an in-depth discussion of these delusions as well as both pharmacological and non-pharmacological treatments.

Written by Rachel Nall, RN, MSN, CRNA

Crazy ideas (strange judgments, delirium)

Most often they are perceived by relatives and others as strange judgments that do not correspond to reality. At the same time, a person with delusions cannot be persuaded, even if he does not know what to object to attempts to persuade him. Crazy ideas don't need proof. It is rather "knowledge", conviction. Because of this, the behavior of a person with delusional ideas is determined by the content of these ideas. According to the content, the main forms of delusions can be divided into delusions of persecution (what is popularly called “persecution mania”: the patient is pursued by special services or other organizations, they try to poison or rob relatives or neighbors; people on the street somehow in a special way, look unfriendly and whisper about him), delusions of grandeur (the patient is the heir to the royal family, the inventor of the time machine or the law of immortality, the ruler of the world, sometimes the messenger of God or God himself, or the devil, etc.) and delusions of self-abasement (accusing oneself of sins, numerous errors, delirium of a physical defect). A patient with delusional judgments needs to be treated by a psychiatrist.

It is important to be able to distinguish delusional ideas from prejudices, superstitions and erroneous unshakable judgments that are characteristic of absolutely healthy people. If a person believes in psychics, healers, witches and sorcerers, this does not mean that pathological processes are taking place in his psyche that affect the thinking of this individual, and you should immediately contact a psychiatrist. It is rather the person’s environment that inspired him with these false judgments, which prevent him from sensibly perceiving some of the events of our life, is to blame.

Limited knowledge also contributes to the development of the superstition of the individual, in the Middle Ages, almost the entire population of the earth was superstitious, and all because of the lack of any natural knowledge about the world and the universe. Most often in the process of enlightenment, a superstitious person admits the fallacy of his judgments and accepts a scientifically proven point of view. A person possessed by delusional ideas can stop persisting in his strange judgments only after the cessation of the pathological process of the patient sitting in the psyche.

Crazy ideas or delusions are dangerous due to their obsession and require close attention of specialists to the patient in order to avoid unpredictable situations and dangerous consequences.

Delusional disorders are speech that causes confusion and confusion. A person's statements do not correspond to reality, his interpretations of what is happening do not correspond to generally accepted ones, he also forms false beliefs over a significant period of time. A subtle point in diagnosing a delusional disorder is determining how delusional reality does not correspond to the consensus reality, the opinion of the majority. This subtle point was a vulnerability of psychiatry, since the diagnosis made it possible to persecute a person and treat him with political opinions different from the generally accepted ones. Now, when people allow pluralism of opinions, there are still such areas of social tension and tension of opinions in which people's judgments and statements may seem strange and similar to delusional.

Delirium is a syntactically coherent speech, subject to a certain logic, sometimes not at all obvious to others, but inherent in a sick person. Delusional disorder is one of the symptoms of schizophrenia, but sometimes it manifests itself as an independent manifestation; without schizophrenia, delusional disorder is less common. Delirium can be caused by clouding of consciousness during poisoning, at a high temperature, for example, with influenza, and then, with recovery, the person stops delirious. In everyday life, delusional disorder is diagnosed on average, more often in old age.

Crazy ideas most often do not look special, quasi-scientific or eccentric, but are somehow connected with the situations of the patient's former and present life, it can be persecution, fear of getting sick with something contagious, love experiences, deception on the part of the spouse. When asked to substantiate a crazy idea, the patient can apply a whole system of evidence, sometimes illogical.

The most common erotomaniac nonsense about love for a suffering person on the part of someone. How to notice nonsense? Well, for example, the gesture of a film actor in the cinema is interpreted as a sign of attention, love. A person's behavior, due to a delusional idea, may include acts of persecution, surveillance, writing love letters, sometimes going beyond the law.

If a person suffers from delusions of grandeur , he is convinced that he has a significant and undiscovered talent or has made an important scientific discovery.

Delirium of jealousy , a person is convinced that his spouse is unfaithful to him. At the same time, the facts that prompt the patient to believe so are misunderstood, distorted or hypertrophied. From ordinary jealousy, delirium is distinguished by its pretentiousness, absurdity. For example, if a footprint in front of the door or the appearance of a man on the stairwell leads to a chain of arguments about adultery, this is the delusion of jealousy. Such a disorder is quite dangerous, because of the real threat of physical violence against the “infidel”.

And, which has become a classic, delusions of persecution , sung by many literary works of the detective genre, with him a person thinks and expresses ideas that something evil is being planned against him, they are watching him in order to cause some harm. A patient with delusional persecution disorder strives for justice and turns to various institutions, sometimes at the wrong address. Delusional disorder with delusions of persecution is also dangerous, since the person suffering from it can commit violent acts.

There is also a dysmorphomania disorder, delusions about one's appearance, about a non-existent physical defect, about a bad smell or the presence of parasites. At the same time, the content of delusional ideas can be initiated by some kind of “norms of beauty”. Sometimes a minor defect hypertrophies and makes the patient unhappy. Currently, the beauty industry is facing a significant number of such people who are dissatisfied with their appearance. Such people, even after plastic surgery with a good outcome, are not satisfied.

The speech of a patient with a delusional disorder most often frightens others, making the sufferer an outcast, moving him away from real communication. In psychotherapy, as a rule, special techniques are used, for example, creating a safe space for delusions of persecution and vulnerability, the patient himself is allowed to take care of his security and asked to realize whether it has become safer, whether anxious expectations have decreased. Also helps to return to reality tactile contact and productive activities such as occupational therapy. Delusions as a symptom are reduced or disappear in the treatment of schizophrenia with medications.

Types of delusions in schizophrenia - Family Practice clinic

Among the symptoms characteristic of schizophrenia, delusion stands out separately - an acute condition in which the patient loses the ability to really realize what is really happening due to a painful distortion of the world around him. 8 out of 10 people diagnosed with schizophrenia have this symptom.

The occurrence of delusional states is directly caused by violations of either mental function or sensory perception. In this regard, it is customary to differentiate nonsense into primary secondary.



Child psychiatrist


Group psychotherapy

Adolescent psychologist

Family psychologist

Family therapy

Classification of delusions

Primary (autochthonous) delusions are characterized by a violation of rational thinking and the loss of causal relationships. The patient interprets what is happening around him consistently, but extremely subjectively and even paradoxically. An obsessive belief is a consequence of an event and, accordingly, the primary symptom of a disease. However, cases are known in psychiatry when delusional perception arose spontaneously, without a specific cause or event. Primary delirium, having arisen once, with a high degree of probability, will have a relapse, which allows us to speak of it as a chronic phenomenon.

Treatment programs

Treatment of depression

Panic attacks

Treatment of schizophrenia

Neuroses, phobias

Secondary delirium is a consequence of a certain pathological experience, in which a violation of the sensory (figurative) perception of the world is recorded. It is expressed in the onset of an acute state of affect, the occurrence of severe hallucinations. Example: a patient develops hallucinations in which the "voice" of his deceased friend or relative speaks to him. Hallucinations are inexplicable, including from the standpoint of medical knowledge. The patient tries to explain to himself what is happening to him at a level accessible to him. So there is a delirium about communicating with a cast.

Diagnosis and treatment

Schizophrenia is not the only disease where delusions are one of the important symptoms. With other diseases, such as tumors, vascular disorders, fever, etc., a delusional state may also occur. For example, delusions are common in Fregoli syndrome, which is caused by damage to the right temporal lobe and fusiform gyrus.

It is not possible to self-diagnose schizophrenia. At the first suspicion of a disease, you should immediately contact the appropriate specialist. Psychiatric consultation involves a series of tests, neurophysiological examinations and MRI, allowing not only to establish an accurate diagnosis, but also to prescribe appropriate therapy.

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