.jpg)
we heard that khameneni's speech with some women a few days ago. Ali Khamenei's mental illness and narcissism and delusions due to 34 years of power in Iran.
we investigated that he is ill and suffers from strong mental illnesses such as schizophrenia, paranoia, mania. Dictators use all kinds of dirty and anti-human tactics to create oppression and suffocation in the country under their control.
We have different types of dictators with different thoughts, but the most dangerous type of dictatorship in the world is religious and superstitious dictatorship.
Religious dictators known as religious fascism are misogynistic and have a pathological jealousy
What means does a dictator use to defend his power?
A dictatorship secures its survival through control and to some extent popular support. Control of the population is maintained by the security apparatus, the military, the regular police and the secret police. In a communist one-party state, the party can be responsible for significant control of the citizens.
Dictators become delusional when they are in power for a long time and no matter how much time passes, the dictator believes that he is superior and better than all beings and can control the world and impose his policy model on other countries.
The UN human rights office in Geneva said on Tuesday that Iran has executed 220 people so far this year - in the past four months and nine days - a record it called "disgusting" and called for an end to it. Meanwhile, the Harana news agency reports that the process of executions has accelerated in recent days, so that 57 people have been executed in this country in 11 days.
Ravina Shamdasani, spokeswoman for the UN human rights office, told a press conference: "Volker Turk, the head of the UN human rights office, has expressed his dismay at the appalling number of executions this year in Iran."
"This year, on average, more than 10 people have been executed in Iran every week, making the country one of the highest executioners in the world," he said.
Most of these were due to drug-related crimes, he said.
Ali Khamenei suffers from hallucinations and delusions.
Delusional syndrome was previously referred to as paranoid psychosis, which according to Kraepelin was an unusual illness separate from schizophrenia and characterized by chronic, non-bizarre delusions, which were related to past life events. According to Kraepelin, during the course of the illness of paranoid psychosis there was no development of a functional impairment.
In 1977, the new term "Delusional Disorder" was coined with roughly the same meaning as Kraepelin intended for paranoid psychosis. Delusional syndrome was thought to be its own disorder separate from the schizophrenic disorders, and still very rare. Current categorical perspectives are nowadays often supplemented with a dimensional perspective where one thinks that psychotic syndromes belong to the same continuum.
Delusional syndrome is one of the psychotic disorders, which means that the people affected have a distorted perception of reality. The most important diagnostic symptom is that the person in question must have one or more non-bizarre delusions. The patient must also be able to function reasonably normally and not have a functional impairment, in addition to what has to do with the delusion itself. In general, delusional disorder is considered a serious mental illness distinctly different from schizophrenia. People with delusional syndrome are usually older at the time of illness and have had better premorbid functioning than people with schizophrenia.
Epidemiology
Studies have shown a fairly low prevalence of the disease/disorder in the population with a lifetime prevalence of 0.18% in a normal population. In clinical populations, a prevalence of 0.4-1% has been found.
AETIOLOGY
The etiology of delusional disorder is unknown, but it is believed that delusional disorder is on the spectrum between severe psychotic illness, such as schizophrenia, and delusional ideas.
It has been difficult to conduct research on this patient group as those affected by delusional syndrome can be a heterogeneous group, and are often very reluctant to seek care or treatment, as they often lack insight into the disease.
It has been shown that paranoid personality disorder is more common in first-degree relatives of patients with delusional disorder compared to control subjects. One study found that 64% of people with delusional disorder had a premorbid personality disorder. The most common personality disorder was paranoid followed by schizoid and obsessive-compulsive. However, no increased incidence of schizophrenia has been found in first-degree relatives of patients with delusional disorder.
Other factors suggested have been polymorphism on the D2 receptor gene and hyperdopaminergic states. As patients with delusional disorders have been shown to have similar cognitive dysfunction to patients with paranoid schizophrenia, it has been suggested that these disorders may have a common etiology. However, this is disputed.
A study using magnetic resonance imaging found lower gray matter volume in people with paranoia compared to healthy subjects.
On the other hand, people with delusional syndrome are similar to people with schizophrenia in many ways, for example that both groups have cognitive deficits.
Psychological factors
People with delusional disorder tend to be selective when seeking information and explanations. They like to draw conclusions based on insufficient information. They also often have difficulty understanding other people's opinions and reactions.
CLINICAL PICTURE
The most common symptoms of a person with delusional disorder are delusions. Other prominent symptoms are usually:
Irritability
Self-absorption
Depressiveness
Aggressive symptoms
In a study that attempted to identify psychopathological dimensions using the PANSS (Positive and Negative Syndrome Scale) in people with schizophrenia, schizoaffective syndrome and delusional disorder, it was found:
5 dimensions: manic, negative, positive, cognitive and psychomotor symptoms.
That both positive and negative symptoms were less frequent in people with delusional disorder.
That people with delusional syndrome had a lower level of education, compared to people in the other diagnostic groups.
In another study, when comparing patients with schizophrenia and delusional disorder, it was found that people with schizophrenia were more disorganized and had more bizarre symptoms than patients with delusional disorder.
People with delusional disorder are usually diagnosed quite late in their illness (40-50 years of age) and women tend to be diagnosed later in life than men. People with delusional syndrome are, as a rule, treated less often in inpatient psychiatric care than patients with schizophrenia.
Tactile hallucinations and olfactory hallucinations may occur in the disease picture, but persistent auditory hallucinations and blunted affect are not compatible with the diagnosis of delusional syndrome. The course of illness in those with delusional disorder tends to be less chronic compared to people with schizophrenia.
Patients with delusional disorder have been shown to have impaired cognitive functions. The cognitive functions that have been impaired have been attention, memory, executive functions and learning.
DIFFERENTIAL DIAGNOSTICS
In ICD-10 it is stipulated that the delusion or delusions must have existed for at least three months and in DSM-5 for at least one month. In diagnostics where delusional syndrome is considered, organic genesis to the patient's symptomatology should be ruled out. Other forms of psychosis such as schizophrenia, drug-induced psychosis or other types of psychosis should be ruled out before making the diagnosis. It is also of great importance to rule out that the delusions are related to a premood syndrome. Another differential diagnostic challenge is vis-à-vis OCD with dysmorphophobia. Whether a person has a delusional disorder or a fanatical belief can also be very difficult to determine. There should also be no signs of organic damage or neurodegenerative disease.
Criteria for delusional disorder according to DSM-5
The delusion or delusions must have had a
duration of at least one month. Delusions can be, for example, feeling persecuted, poisoned, infected, admired from a distance, having an illness or being deceived by one's partner.
Criterion A for schizophrenia has never been met. Sensory and olfactory hallucinations may occur if they have some connection with the theme of the delusion.
Apart from the impact that the delusions, or their further developments, may have in themselves, everyday functioning is not significantly impaired, and the behavior is not perceived as obviously odd or bizarre.
If premonitory episodes occurred simultaneously with the delusions, their total duration is short compared to the periods of delusions.
The disorder is not due to direct physiological effects of any substance (for example, drug of abuse or medication) or any somatic disease/injury. The disorder is also not due to any other psychiatric disorder such as dysmorphobia or obsessive-compulsive disorder.
DIVISION
The delusional syndromes are usually divided into chronic or lasting delusional syndromes and acute ones. ICD-10 has the diagnosis F22.0 delusional syndrome and this category includes: Paraphrenia, paranoia, paranoid psychosis, paranoid state and "Sensitive Beziehungswahn" (ideas of reference in a sensitive person). F22.8 according to the ICD includes, for example, dysmorphophobia of a delusional nature and F22.9 includes chronic delusional syndrome. There are a few subtypes that are usually specified according to DSM-5. The following subtypes are described according to DSM-5:
ِErotomania (Clerambault syndrome)
This delusional syndrome is characterized by the patient being convinced that another person, often of high social status, is in love with them. It doesn't have to be about sexual attraction, but is usually more about an idealized, romantic love. Women are considered to be overrepresented for this type of delusional disorder.
Delusion syndrome can lead to serious crime, and a famous Swedish example is the woman who burned down poet Evert Taube's summer residence in the Stockholm archipelago. A common behavior in erotomania is to stay close to the desired person, make contact by phone and letter and court the person in question in a completely unwanted way. These behaviors are usually referred to as stalking.
Erotomania can also be found in schizophrenia and bipolar disorder and can be difficult to treat.
Delusional syndrome with delusions of grandeur or grandiose type
Central is an unshakable perception of one's own importance. In the past, this subtype used to be called megalomania. The person affected by this has the belief that they are unique and they may claim that they have a special gift or talent. In terms of differential diagnosis, it is important to distinguish delusional syndrome from bipolar disorder where a grandiose self-perception may be present during hypomanic or manic relapses.
Jealousy paranoia
Patients with jealousy paranoia have a mistaken belief that the partner is unfaithful and consider themselves to find "proof" of the partner's infidelity, stains in underwear or sheets, patches, etc. The sick person can start spying on the partner and can make life very difficult through their pathological behavior for their partner. Patients who have jealous paranoia may feel that they are "within their right" to act on their morbid beliefs. Often, jealousy paranoia can lead to severe relationship problems. The partner of the sufferer may be subject to aggressive acts, which may include violence and even murder. This condition can be very difficult to treat.
Persecution paranoia
The sufferer has delusions about persecution of various kinds, may be convinced that conspiracies or surveillance, wiretapping, poisoning or harassment are taking place. Often there is a story that deals with the fact that the person considers himself to have been exposed to various injustices. People with persecution may have legalistic tendencies and often write letters to various authorities. This type of delusional syndrome has also been referred to as querulous paranoia. Patients may have aggressive tendencies and are often lashing out when contradicted.
Illness paranoia
In this subtype, the person has a delusion about being affected by a physical illness, such as cancer, AIDS or some serious illness. One type of delusion is that the person thinks they smell bad or have some kind of parasite/bacteria. In the case of this type of delusional syndrome, those affected often seek out various specialists in somatic illness or primary care.
SOMATIC EXAMINATION
It should be ruled out that there is any kind of neurodegenerative disease. Brain tumor, endocrine diseases, infectious conditions and vitamin deficiency should be ruled out. DT or MRI brain and a laboratory screening should be done. One should also inquire about possible abuse of alcohol or drugs and investigate this with relevant sampling, urine samples and laboratory tests.
TREATMENT
Patients with delusional syndrome generally have a poor understanding of the disease and in many cases do not want psychiatric care and drug treatment. Patients with delusional syndrome should, however, be treated by specialist psychiatry and also be offered psychosocial interventions, where counselor intervention can be particularly important. Cognitive behavioral therapy may also be tried. These patients should be treated according to the guidelines for patients with schizophrenia and schizophrenia-like conditions
Risperidone (Risperdal), olanzapine (Zyprexa), or quetiapine (Seroquel) can be used in low doses. Olanzapine and risperidone seem to have an equally good treatment effect. One should be cautious in general with antipsychotic treatment for the elderly. As co-morbidity with depression is common in this patient group, antidepressant treatment can also be considered.
Disease course
The course of the disease is variable and people with delusional disorder may have their delusions for years, but many develop other forms of the disease.
In one of the few studies that have been carried out, it has been found that the risk of contracting the disease is similar, but that women fell ill later than men. Few women (6.3%) have a transition to schizophrenia, while about a third (35.3%) of men develop schizophrenia. The women had a lower level of functioning than the men but were more compliant to suggested treatment than the men and they also received psychopharmacological treatment more often. It was found that there were no gender differences regarding the type of delusions exhibited.
In a Swedish study of patients hospitalized for a first episode of psychosis, it was found that many changed their original diagnosis during a five-year follow-up period. Of those with chronic delusional disorder, only 21% of patients retained their original diagnosis and 17% developed schizophrenia or schizoaffective syndrome. In the same study, it was found that more than 30% had been hospitalized for another previous diagnosis, before the onset of delusional disorder. Quite a few, 14%, had also been hospitalized due to substance abuse. The researchers also found that about a third of the patients had left primary school without grades or with incomplete ones. Almost half of the patients had had a first-degree relative who had been hospitalized for a psychiatric diagnosis.
It is well known that patients with psychosis have an increased risk of suicide and an increased mortality compared to other people in the population. This view is supported by another Swedish study where suicide was studied after the first onset of psychosis. In this study, it was found that the highest risk of suicide was found in depression with psychotic symptoms and in delusional disorder.
ICD-10
Delusional syndrome F22.0
Other specified chronic delusional syndromes F22.8
Chronic delusional syndrome, unspecified F22.9
DSM-5
Delusional syndrome 297.1
References
Björkenstam E, Björkenstam C, Hjern A, Reutfors J, Bodén R. A five year diagnostic follow-up of 1840 patients after a first episode non-schizophrenia and non-affective psychosis. Schizophrenia Research, 2013, 150, 205-210. Link
Björkenstam C, Björkenstam E, Hjern A, Bodén R, Reutfors J. Suicide in first episode psychosis: A nationwide cohort study. Schizophrenia Research, 2014, 157, 1-7. Link
De Portugal E, González N, del Amo V, Haro JM, Días-Caneja C M, de dios Luna del Castillo, Cervilla, J A. Empirical redefinition of delusional disorder and its phenomenology: The DELIREMP study. Comprehensive Psychiatry 54, 2013, 243-255. Link
Hedén F and Kristiansson M. Three cases illustrate that erotomania can have more explanations than just psychosis. Läkartidningen, 2003, no. 48, volume 100, 3962-3967. Link
Kulkarni K, Arasappa R, K Prasad, Zutshi A, Chand P K, Murthy P, Philip M, Muralidharan K. Risperidone versus olanzapine in the acute treatment of persistent delusional disorder: a retrospective analysis. Psychiatry Research, 2017, 253, 270-273. Link
Kraepelin E. Clinical Psychiatry: A textbook for Students and Physicians, Diefendorf AR, New York, MacMillan, 1904.
Morimoto K, Miyatake R, Nakamura M, Watanabe T, Hirao T, Suwaki H. Delusional Disorder: Molecular Genetic Evidence for Dopamine Psychosis. Neuropsychopharmacology, 2002, Vol 26, No 6, 795-801. Link
Muñoz-Negro, J E, Ibanez-Casas I, de Portugal E, Ochoa S, Dolz M, Haro J M, Ruiz-Veguilla M, de dios luna del Castillo, Cervilla J A. A dimensional comparison between delusional disorder, schizophrenia and schizoaffective disorder . Schizophrenia Research, 2015, 169, 248-254. Link
Inga kommentarer:
Skicka en kommentar