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German Journal of Psychiatry

ISSN 1433-1055

 

Poster

On the fourth primordial delusion in schizophrenia

Yasushi Sasaki  M.D.

Munechika Hospital

Corresponding Address :

 

Y. Sasaki, M.D.

            Munechika Hospital, 703, Misonou,

            Saijo-cho, Higashi-Hiroshima city,

            Hiroshima, 739-0024 Japan.

 

Tel : ++81(0)824-23-2726

Fax : ++81(0)824-23-3737

E-mail :           y-sasaki@mx4.tiki.ne.jp

 

 

Introduction

 

On observation of the clinical states of patients, it was noted that patients with schizophrenia experience pathological consciousness of meaning (PCM) in primordial delusion. The author tried to classify this phenomenon and found one delusional symptom.

 

Intuitive delusion

 

One patient with schizophrenia showed reconnoitered delusion. Once he said that there is a feeling of reality which can not be expressed by a word other than "reconnaissance".

This means that PCM lies at the foundation of his delusion and when he expresses it in words, we can recognize his delusion.

 

PCM --> Linguistic expression 

 

Delusional perception

 

K. Jaspers 1) described delusional perception as not being considered interpretations but direct experiences of meaning, while perception itself remains normal and unchanged. This means that patient experiences PCM directly with the object (perception) and when he expresses it in words, we can recognize his delusion.

 

 Thing

     |

     Normal meaning --> Expression 

     

PCM --> Linguistic expression 

 

 

delusional mood

 

In a delusional mood, PCM involves the absence of perceiving anything concrete and it cannot be expressed clearly in words.

 

Thing

  |

PCM --> Linguistic expression

 

 

Discussion

 

There are some cases in primary delusion:

A patient experienced the PCM with or without perception of a concrete object then PCM can or can not be expressed linguistically.

Then, we obtained the next table.

 

            PCM                                        A         B         C         D

            Combination with object        No       Yes      No       Yes

            Ability in expression              No       No       Yes      Yes 

 

                                                                                   A : delusional mood

                                                                                   C : intuitive delusion

                                                                                   D : delusional perception

 

What is B ?

According to the Table, B is an experience of PCM combined with an object (perception) that can not be expressed in words.

We call this symptom "pathological mood on phenomenon" in this presentation.

 

 Thing

      |

     Normal meaning --> Expression

  

PCM -->

 

This symptom has been incompletely discussed using the term of "Bedeutungswahn 1) (Jaspers)" or as the first stage of delusional perception  (Conrad). These discussions are in the context of delusional perception. However, the author thought that this symptom should be studied separately in its own context.

 

Pathological mood on phenomenon

 

In this symptom, the patient feels an unusual meaning in relation to an object, while he cannot express it clearly.

Case : one of our outpatients came to the hospital and told me that his agricultural machine was in good condition. However, he also said that the machine was always kept in good condition and that there was no special meaning, such as put-up job by anyone. Thereafter, he left the hospital. The purpose for consulting me was unclear. However, in this case, it was suggested that he felt some unusual meaning for the usual conditions of the machine and this unusual meaning which the patient can not explain clearly caused the patient to seek consultation.

 

Effects of pathological mood on phenomenon

 

1: If the subject experiences this symptom along with the phenomenon, it will mask the normal consciousness of the meaning of the phenomenon to some extent. The normal consciousness of meaning on the phenomenon is thought to be the "nat¸lichen Selbstverstdlichkeit " of the phenomenon, so it is possible that "Der Verlust der nat¸lichen Selbstverst‰dlichkeit" 3) (Blankenburg) is based on the pathological mood on phenomenon.

It was suggested that this symptom has an anti-meaning effect.

 

2: This pathological mood is thought to be able to make the phenomenon strange to patient and to make the phenomenon an attention-getter.  If the attention-getter is a background-thought and if the patient experiences it as an auditory sense, the thought can become an auditory hallucination 4) (Nakayasu). If it is an interference idea to the patient in background, the idea can make the patient feel ambivalent or can cause confused thinking such as lack of association. This shows that pathological mood on phenomenon can also become the basis of hallucination and certain negative symptoms.

 

Conclusion

 

Pathological mood on phenomenon is not only a peculiar symptom in schizophrenia but also have some pathological effects that may cause many symptoms of schizophrenia.

 

References

 

Jaspers K.: Allgemeine Psychopathologie für studierende Ärzte und Psychologen. Verlag

   von Julius Springer, Berlin 1913.

Conrad K.: Die beginnende Schizophrenie - Versuch einer Gestaltanalyse des Wahns.

   George Thieme Verlag, Stuttgart 1966.

Blankenburg W. : Der Verlust der natürlichen Selbstverständlichkeit. Ferdinand Enke   

   Verlag, Stuttgart 1971.

Nakayasu N : Symptomatology of schizophrenia. Seiwa syoten, Tokyo 1991 (written in

   Japanese)