Psychosis With Religious Delusions in a Reportedly Intersex Transgender Person

There is limited research on mental illness in intersex and transgender individuals. This case report describes psychosis in a self-identified intersex transgender individual with a past psychiatric history of schizoaffective disorder. The patient and collateral information reported colpocleisis as a newborn, was assigned and raised as a male, then transitioned to a female. When the patient discussed her experiences as a transgender person, she would become significantly more psychotic with disorganized speech and grandiose Christian delusions. A psychological assessment including a projective test was completed to better understand the patient's psychotic symptoms along with her views of self, others, and the world. This case explores how the psychotic process interacts with gender dysphoria in a predominantly cisnormative, Christian society, with discussions of psychological defenses and psychodynamic theory.

Religious delusions: Definition, diagnosis and clinical implications

The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the patient's family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a greater extent the individual's whole experience. Their presence is associated with more severe symptoms, higher medication dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms with religious content for the first time. Other important prognostic factors are patients' lack of adherence to treatment, their greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special characteristics of religious delusions, which seem more corrosive to the patients' psyche than other delusions. Religion and spirituality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice. Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both preventing and treating psychotic disorders.

Delusions of Possession and Religious Coping in Schizophrenia: A Qualitative Study of Four Cases

The notion of evil spirits influencing human behavior or mental processes is used in many cultures to justify various symptoms or experiences. It is also expressed in psychotic delusions of possession, but there is limited research in this area. This study explores how patients with schizophrenia came to the conclusion that they were possessed, and how this affected help-seeking. Interviews with two men and two women about their experiences and meaning-making were subjected to interpretative phenomenological analysis. Three main themes were identified: (1) Links between traumatic experiences and psychotic symptoms, (2) The emergence of religious themes in delusional contents, and (3) Reluctance to use medical treatment and instead to seek exorcism. In each case, attributing problems to possession was supported by the local environment and media, led to seeking spiritual help, and delayed diagnostic assessment and treatment. However, using religious coping contributed to the sense of predictability and social support. Clinicians are encouraged to explore the experiences and conflicts expressed by the symptoms which people ascribe to possession and to negotiate alternative explanatory models with their patients.

Religious delusions in older adults: Diagnoses, combinations, and delusional characteristics

OBJECTIVE

Religious delusions (RDs) tend to occur relatively often in patients with affective or non-affective psychosis. Few studies exist about RDs in later life. The current study explores (1) the distribution of RDs across diagnosis, (2) how RDs relate to other types of delusions, and (3) how RDs relate to several dimensions or characteristics of delusions.

METHODS

Inpatients and outpatients in a Geriatric Psychiatry Department in the Netherlands (N = 155; mean age 76.5 years), and who were diagnosed with an affective or non-affective psychotic disorder, participated in semi structured diagnostic interviews, using the Schedules for Clinical Assessement in Neuropsychiatry 2.1.

RESULTS

Religious delusions were most common among patients with psychotic depression (47%) and schizophrenia (32%). The RDs frequently co-occurred with other types of delusions. When combined with delusions of grandeur, RDs were more often classified as bizarre and were accompanied by higher levels of positive psychotic symptoms. When combined with delusions of guilt, RDs were associated with higher levels of distress and a shorter disease duration. The delusional characteristics bizarreness, frequency of psychotic symptoms, and degree of distress were more prevalent for RDs than for any other type of delusion.

CONCLUSIONS

The current study suggests that the prevalence of RDs in older adults is particularly high in late life psychotic depression. Also, in later life, RDs can be perceived of as independent marker of complex psychotic states, and as a denominator of severe arousal with respect to existential concerns.

[Psychopathology and phenomenology of religious delusion of possession in schizophrenia]

AIM

To analyze psychopathological features of religious delusion of possession, determine the place of this phenomenon in psychotic syndrome, and identify the prognosis and dynamics of schizophrenia due to this disorder.

MATERIAL AND METHODS

Thirteen patients with religious delusion of possession were examined in 1994-2016 by psychopathological and follow-up methods.

RESULTS AND CONCLUSION

Hallucinations of a general feeling are the crucial psychopathological phenomenon of states with religious delusion of possession. Other delusional disorders (delusion of possession itself or metamorphosis - 'reincarnation in a demon', delusions of spoilage, witchcraft or hypochondriacal delusion) and delusional behavior (special forms of defense), haptic, olfactory hallucinations, and affective (depressive) disorders, suicidal activity are connected with this phenomena. Disease course is either continuous or attack-like. The type of disease course in most cases is complied with the development of stereotype of paranoid schizophrenia. A characteristic feature of disease was the combination of psychopathological disorders, reflecting the continuous nature of the endogenous disease (interpretive delusions, overvalued religious constructions) with disorders, that are more representative for the paroxysmal course (the phenomena of acute sensual delusions, expressed affective disorders), at the manifest stage of the disease. However, in most cases, unlike the classical hallucinatory type of paranoid schizophrenia, the disease began with circular bipolar affective disorders. In most cases, outcome of a manifesting psychosis is unfavorable.

Ways of understanding of religious delusions associated with a change of identity on the example of identification with Jesus Christ

Identification with Christ among psychiatric patients is an example of a complex and multifaceted phenomenon. As a delusion it includes a misidentification (change of identity) in the layer of content and, usually, grandiosity and/or paranoid traits in the formal aspect. What is more, it fits in the category of religious delusions, which are perhaps the most controversial type of delusions and as such require special sensitivity as well as knowledge beyond psychology or psychiatry. The aim of the articleis to show the phenomenon of identification with Christ among psychiatric patients, taking into account different ways of its explaining and understanding. Papers relating to the topic, both theoretical considerations and case studies, found in the EBSCO database were analyzed. Searching for the articles the following key words were used: identity, identification, delusion, Jesus/Christ/Messiah, psychosis, schizophrenia. The analysis included all (actually not numerous) articles except for the one linked to cognitive approach which did not significantly contribute to the issue. Given the multiplicity of ways of explaining and understanding the experience of identification with the figure of the Messiah, it seems to be a mistake to hold both objectivist and one-sided, based on one theory, attitude towards it. Such an experience should be recognized in the context of the history of patient's life and the all possible mechanisms leading to its occurrence, as well as the meanings hidden beneath the symptom, should be take into account. It is also important to be well-oriented in the system of religious beliefs and spiritual needs of the patient.

[Endogenous episodes of juvenile psychosis with religious delusions]

AIM

To identify clinical and psychopathological features, conditions of formation and prognostic significance of delusions with religious content in endogenous psychotic states in adolescence.

MATERIAL AND METHODS

Fifty-three male patients, aged from 16 to 25 years, with juvenile endogenous psychosis, with a psychotic episode with religious content of delusion were examined. Clinical, psychopathological, psychometrical (The Dawkins scale) and statistical methods were used.

RESULTS AND CONCLUSION

General psychopathological features of psychotic states with religious delusions, according to the specificity of adolescent age, were identified. Common types of religious delusional episodes, forming by primal interpretive (delusion of sin, delusion of demonic possession) and sensual (messianic and antagonistic delusion, religious oneiroid) mechanisms were distinguished. A role of the previous religiosity, including overvalued religious ideas, was clarified. It was found out that the duration of the pre-manifest stage, hospitalization and the period of 'untreated psychosis', was longer in patients with religious delusions compared to patients with other types of delusions. Patients with interpretive mechanism of delusion formation demonstrated the subsequent intensification of religiosity that was not common for psychotic episodes with the sensual mechanism of delusion formation.