Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Lucknow
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Calcutta National Medical College & Hospital , Kolkata




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On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case Series
Year : 2023 | Month : August | Volume : 17 | Issue : 8 | Page : VR01 - VR03 Full Version

Delusional Content in Patients with Schizophrenia- A Case Series


Published: August 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/63088.18291
Arti Tyagi, Vivek Kumar, Zebaish Rehman

1. Assistant Professor, Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India. 2. Professor, Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India. 3. Senior Resident, Department of Psychiatry, Subharti Medical College, Meerut, Uttar Pradesh, India.

Correspondence Address :
Dr. Arti Tyagi,
704, Mahavir Bhawan, Subharti Medical College, Meerut-250002, Uttar Pradesh, India.
E-mail: artityagi009@gmail.com

Abstract

Schizophrenia is a chronic and severe mental disorder that affects more than 21 million people worldwide. It is characterised by distortions in thinking, perception, emotions, language, sense of self, and behaviour. Common experiences include hallucinations, mostly involving hearing voices or seeing things that are not there, and delusions, which involve having fixed, false beliefs. This case series presents three patients with schizophrenia who came to the Department of Psychiatry with peculiar delusions. One patient, a 65-year-old, complained of an inability to walk due to the fear of being electrocuted. The second patient, a 25-year-old female, reported the ability to communicate with people in America without the use of any technology. The third patient, aged 20 years, presented with nihilistic delusions. These patients were managed with psychotropics, along with symptomatic treatment for their physical problems. They improved with the interventions and rehabilitation provided to them.

Keywords

Mental disorder, Nihilistic delusions, Psychiatry, Psychosis

Schizophrenia is a chronic mental disorder manifested by positive symptoms, negative symptoms, disorganised behaviour and thought, and cognitive impairments. These symptoms have a substantial impact on quality of life, well-being, and functional outcome. These patients are more likely to be at a higher risk of cardiovascular and metabolic co-morbidities than the general population due to their poor physical fitness and sedentary lifestyle (1). Delusions are an important symptom of psychosis, but they are false beliefs that are rigidly held with strong conviction despite contradictory evidence (2). A delusion is a belief that is clearly false and indicates an abnormality in the affected person’s thought content. The false belief is not accounted for by the person’s cultural or religious background or their level of intelligence. The key feature of a delusion is the degree to which the person is convinced that the belief is true. A person with a delusion will hold firmly to the belief regardless of evidence to the contrary. Distinguishing delusions from overvalued ideas can be difficult. Overvalued ideas are unreasonable ideas that a person believes, but they have at least some level of doubt about their truthfulness.

In contrast, a person with a delusion is absolutely convinced that the delusion is real. Delusions are a symptom of either a medical, neurological, or mental disorder (3). The debate about the nature of delusion has persisted for over a century without resolution. Currently, psychologists propose various theories to explain delusion psychologically, while psychiatrists generally regard delusion as inexplicable (4). The concept of bizarre delusions plays a significant role in the diagnosis of schizophrenia. However, applying this concept in the clinical world may be challenging. A study measuring the inter-rater reliability to distinguish bizarre versus non-bizarre delusions consistently reported low reliability (5). Major reviews have concluded that current conceptualisations of bizarre delusions may require rethinking and refinement. One study emphasised the importance of understanding the “primary experience traceable to the illness” in acknowledging the true nature of “delusions proper” in schizophrenia, going beyond the external characteristics of extraordinary conviction, imperviousness, and impossible content (6),(7).

Case Report

Case 1

A 65-year-old male patient was admitted to the Department of Psychiatry in Meerut. He presented with complaints of hearing voices on and off, suspiciousness, wandering behaviour, decreased self-care, self-muttering, and aggression for the past 40 years. These complaints were continuous and gradually progressive. The main reason for admission was a sudden onset of a new complaint in which the patient claimed that he would get electrocuted if he stepped on the ground. As a result, he had been bedridden for the past year and became completely dependent on caretakers for his daily activities. His sleep and appetite had also reduced in the past two weeks. During the general physical examination, bilateral pedal oedema and multiple scaly lesions on both lower limbs were noted. The Department of Dermatology diagnosed him with dermatitis neglecta. Neurological examination was challenging as the patient refused to let anyone touch his legs due to his psychopathology. However, normal deep tendon reflexes and elicitable plantar flexor response were observed. Gait assessment was not possible as the patient was bedridden and unwilling to walk. He was lying on the bed with his feet uncovered, which was inconsistent with the environment and season. The patient was poorly dressed, unkempt, and had improper hygiene with foul-smelling breath.

Establishing rapport was difficult as he had a guarded attitude. Psychomotor activity was markedly reduced, although the patient was conscious and aware. His speech rate and volume were decreased. The patient displayed a blunt affect with a restricted range and absence of relatedness. In terms of thought content, he had persecutory delusions towards family members and a bizarre delusion that he would be electrocuted if he stepped on the ground. Auditory hallucinations of a second-person male voice were also present. His social judgment was impaired as he would urinate and defecate in public. Baseline investigations were conducted, and an abnormality in the Electrocardiography (ECG) was found, prompting further clarification through echocardiography. The echocardiogram showed a left ventricular ejection fraction of 40%. Consequently, the patient was immediately referred to the Department of Cardiology. He was also reviewed by the Department of Surgery due to complaints of pain in both lower limbs. He was advised to undergo a B/L lower limb venous and arterial doppler, which revealed atherosclerotic changes. Other investigations showed age-related cerebral atrophy on a computed tomography of the head, and derangements in Liver Function Tests (LFT) with the following results: serum albumin- 2.9 g/dL, serum globulin- 4.9 g/dL, and A/G ratio- 0.59, suggestive of hypoproteinemia. The patient’s treatment started immediately in collaboration with various other specialties in the hospital.

According to the International Classification of Diseases-10 (ICD-10) criteria, the patient was diagnosed with schizophrenia (8). The patient was initiated on Tablet (Tab.) Olanzapine 10 mg at night and continued on the same dose for another six weeks. Throughout the patient’s six-week stay, the nursing staff provided bedside care to maintain good hygiene. By the end of the third week, with the assistance of attendants, the patient was able to walk for the first time. Through proper nursing, physiotherapy, pycho-education of the attendants, and a combination of medications (Olanzapine 10 mg at bedtime) from the Psychiatry Department, Medicine Department (tablet Dytor plus OD and capsule Ecosprin AV 75/25 at bedtime), and Dermatology Department (topical Glycolic acid and emollients), the patient underwent vigorous rehabilitation. At the time of discharge after six weeks, the patient was walking comfortably and able to carry out daily activities independently.

Case 2

A 25-year-old educated unmarried female patient presented to the Outpatient Department of psychiatry. She was brought by her brother with complaints of self-isolation, self-muttering, increased anger outbursts, and suspiciousness towards family members for the past year. She believed that her father had adopted her from his friend who lives in America and that she belonged to America. She claimed to communicate with this friend through magic, without any actual means of communication. As a result, she started performing daily activities at night, such as eating, cooking, and bathing.

Her symptoms began two months after her brother’s marriage. Following the marriage, she became withdrawn, decreased her social interactions, and stopped eating meals with her family. She also avoided going out with friends and attending family functions. The patient’s attendant reported multiple episodes of anger outbursts and physical violence, particularly directed towards her sister-in-law. The patient developed suspiciousness towards her family members, believing they were talking about her and plotting to harm her. She felt her sister-in-law was jealous of her due to her perceived beauty and intelligence. The patient’s parents also noticed her engaging in self-muttering and self-smiling when alone. She refused to eat homemade food, suspecting her sister-in-law of poisoning it.

On general physical examination, the patient appeared thin and dehydrated. During the mental status examination, she exhibited decreased psychomotor activity, a guarded attitude, and avoided maintaining eye contact by hiding her face under a blanket. Her speech rate and volume were decreased, and she exhibited increased reaction time with irrelevant speech. Her affect was blunt with a restricted range and incongruence. In perceptual abnormalities, there were second-person auditory hallucinations. In the mental status examination, her abstract thinking and test judgment were not intact. All baseline investigations, including Complete Blood Count (CBC), Random Blood Sugar (RBS), Liver Function Test (LFT), and Kidney Function Tests (KFT), were conducted and were within normal limits.

According to the ICD-10 criteria, the patient was diagnosed with schizophrenia and started on a nightly dose of 10 mg of olanzapine, along with 300 mg of Oxcarbazepine twice daily. The olanzapine dose was gradually increased to 20 mg and continued for six months. Within two weeks, she began to show improvement in her symptoms, such as decreased hallucinations and resolution of delusions, with the combination of pharmacological treatment and cognitive-behavioural therapy.

Case 3

A 20-year-old educated unmarried female patient presented to the Outpatient Department of Psychiatry. She was brought by her parents with complaints of panic attacks and multiple episodes of unprovoked crying spells for the past month. One month ago, 2she experienced panic attacks with palpitations and dryness of mouth, accompanied by inconsolable crying for 2-3 hours. Her family noticed decreased social interaction, self-care, appetite, and difficulty in initiating and maintaining sleep. These symptoms worsened within a week, leading to complete loss of eating, talking, and general weakness, causing her to be unable to move her legs or lift her body without assistance. When asked about the reason for crying, she claimed that her parents and siblings had died in a road traffic accident and that everything around her had vanished.

The patient arrived in the examination room on a wheelchair, displaying thinness, dehydration, complete loss of eye contact, dull facial expressions, a guarded attitude, and failure to establish rapport. Psychomotor activity was significantly reduced, although the patient remained conscious and aware. Speech rate, tone, and volume decreased, with increased reaction time, hesitancy, and whispering. Affect was blunt and had a restricted range, with inappropriateness. Thought productivity was decreased, continuity was not maintained, and the content of thought revealed a nihilistic delusion, as she believed her family members had died and everything around her had vanished. Higher mental functions, such as abstract thinking, social judgment, and test judgment, were impaired.

Based on the ICD-10 criteria, the patient was diagnosed with schizophrenia. Baseline investigations were conducted, revealing an abnormality in CBC, with a hemoglobin level of 10.6 gm/dL. Medical consultation was sought, and intravenous fluids with multivitamin injections, as well as iron (100 mg) and folic acid (1.5 mg) tablets once a day for the next three months, were initiated. Anti-psychotic treatment was started with 10 mg of olanzapine and 1 mg of lorazepam at night. The olanzapine dosage was gradually increased to 20 mg at night. After three weeks, amisulpride 200 mg was added at night. Within 2-3 weeks, the patient began to show improvement in symptoms such as panic attacks and unprovoked crying spells, and she started eating and taking care of herself with the help of pharmacotherapy and cognitive-behavioural therapy.

Discussion

Delusions are erroneous and inflexible beliefs held with certainty, even in the face of contradictory evidence (6). The most common symptom of psychosis in schizophrenia is delusion, which can be severely distressing and impair social functioning (7). However, the cognitive mechanisms underlying this symptom remain elusive. Understanding these mechanisms, particularly at the computational and algorithmic levels, is crucial for advancing our understanding of psychosis. The preceding case series demonstrates the presence of different bizarre delusions in schizophrenic patients, emphasising the need for treatment from psychiatric departments and the importance of better understanding the co-occurrence of bizarre delusions in these patients. Similar case reports and series have been published in the past, addressing unusual delusional and hallucinatory content. Solomon S and Singaravelu R presented a case report on auditory hallucinations with unusual content, discussing the case of a young adult male who experienced recurrent hair pulling due to command auditory hallucinations and highlighting the distinguishing features of hair pulling in this patient compared to trichotillomania (9). Lebelo LT and Grobler GP reported a case of a patient with severe delusions who engaged in self-mutilation (10). Sashikar AC et al., conducted a case series on Erotomania, discussing three cases of secondary erotomania involving delusions of being loved by a well-known actor, a popular guy from school, and a church personnel (11).

Kuppili PP et al., presented a unique case of Cotard syndrome, describing a 24-year-old housewife in the second week of the postpartum period who complained of not taking care of her baby, denying her pregnancy altogether (12). Similarly, Gold J and Gold I reported a novel delusion, primarily persecutory in form, in which the patient believed that they were being filmed and that the films were being broadcast for the entertainment of others (13). In the present case series, Case 1 presented with a sudden onset of a bizarre delusion that they were unable to walk due to fear of getting electrocuted. In Case 2, the patient claimed to have the ability to communicate with people in America without the use of any technology. In Case 3, the patient experienced a nihilistic delusion. The prevalence of bizarre delusions in schizophrenic patients in India was found to be 2.56%, primarily consisting of unnatural bodily sensations, misidentification, changes in sexual orientation, and religion (14). According to Jaspers and his successors’ phenomenological approach, delusions are formed through a loss of context in experiment-perceptual origin and due to dysregulation of dopamine levels (15). Delusions arise from immediate consciousness and perception of the surroundings, making it difficult to infer the credibility of bizarre delusions and gather evidence (16). Presenting such cases broadens our understanding of various types of delusional content, which further aids in the proper management of these patients.

Conclusion

It is important to identify the evolving complexity of delusions and the potential danger they pose to the patient’s life. Spending adequate time assessing and labeling the theme of the delusion is key to preventing the risk of violence and self-harm, as well as aiding in the management of such cases.

Acknowledgement

The author wishes to acknowledge his colleagues who supported this project and their patients from whom they learned a great deal.

References

1.
Tréhout M, Dollfus S. Physical activity in patients with schizophrenia: From neurobiology to clinical benefits. Encephale. 2018;44(6):538-47. [crossref][PubMed]
2.
Baker SC, Konova AB, Daw ND, Horga G. A distinct inferential mechanism for delusions in schizophrenia. Brain. 2019;142(6):1797-812. [crossref][PubMed]
3.
Chaudhury S, Kiran C. Understanding delusions. Ind Psychiatry J. 2009;18(1):3. [crossref][PubMed]
4.
Cutting J, Musalek M. The nature of delusion: Psychologically explicable? Psychologically inexplicable? Philosophically explicable? Part 1. Hist Psychiatry 2015;26(4):404-17. [crossref][PubMed]
5.
Flaum M, Arndt S, Andreasen NC. The reliability of “bizarre” delusions. Compr Psychiatry. 1991;32(1):59-65. [crossref][PubMed]
6.
Jaspers K. General Psychopathology ed 7. Chicago, University of Chicago Press, 1997. [crossref]
7.
Sass LA, Byrom G. Self-Disturbance and the Bizarre: On Incomprehensibility in Schizophrenic Delusions. Psychopathology. 2015;48(5):293-300. [crossref][PubMed]
8.
The ICD 10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guideline. Geneva: World Health Organisation; 1992. https://www.who.int/publications/i/item/9241544228.
9.
Solomon S, Singaravelu R. Auditory hallucinations with an unusual content. J Clin of Diagn Res. 2015;9(5):VD06-VD07. [crossref][PubMed]
10.
Lebelo LT, Grobler GP. Case study: A patient with severe delusions who self- mutilates. S Afr J Psychiat. 2020;26:a1403. Doi: 10.4102/sajpsychiatry.v26i0.1403. [crossref][PubMed]
11.
Sashikar AC, Vasanthan N, Subhashini P. Erotomania: A rare psychiatric condition- a case series. J Clin of Diagn Res. 2022;16(11):VR01-VR04. [crossref]
12.
Kuppili PP, Gupta R, Pattanayak RD, Khandelwal SK. Delusional denial of pregnancy: Unique presentation of Cotard’s syndrome in a patient with schizophrenia. Elsevier 2017;30:26-27. [crossref][PubMed]
13.
Gold J, Gold I. The “Truman Show” delusion: Psychosis in the global village. Cognitive Neuropsychiatry. 2012;17(6):455-72. [crossref][PubMed]
14.
De S, Bhatia T, Thomas P, Chakraborty S, Prasad S, Nagpal R, et al. Bizarre delusions: A qualitative study on indian schizophrenia patients. Indian J Psychol Med. 2013;35(3):268-72. [crossref][PubMed]
15.
Mishara AL, Fusar-Poli P. The phenomenology and neurobiology of delusion formation during psychosis onset: Jaspers, Truman Symptoms, and Aberrant Salience. Schizophr Bull. 2013;39(2):278-86. [crossref][PubMed]
16.
Timlett A. Controlling bizarre delusions. Schizophr Bull. 2013;39(2):244-46. [crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/63088.18291

Date of Submission: Jan 25, 2023
Date of Peer Review: Feb 20, 2023
Date of Acceptance: Apr 19, 2023
Date of Publishing: Aug 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 03, 2023
• Manual Googling: Mar 15, 2023
• iThenticate Software: Apr 17, 2023 (11%)

ETYMOLOGY: Author Origin

EMENDATIONS: 6

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