Bizarre Delusions: A Qualitative Study on Indian Schizophrenia Patients

BACKGROUND: Delusions are an important symptom for the diagnosis of schizophrenia (SZ) in both the commonly used international classificatory systems - the Diagnostic and Statistical Manual of Mental Disorders IV (DSM IV - American Psychiatric Association, 2000) and the International Classification of Diseases, X (ICD X - World Health Organization, 1992). Of special significance are “bizarre delusions” the presence of which is alone sufficient for a diagnosis of SZ in DSM IV. In an attempt to find out the frequency, criteria for classification, and other clinical aspects of bizarre delusions and justification of their importance in the diagnostic system, this retrospective study was conducted. METHODOLOGY: Records of 1952 Indian patients affected with SZ, recruited for various research projects at one center were included in this study. All had a diagnosis of DSM IV SZ; all symptoms of SZ from the Diagnostic Interview for Genetic Studies were asked regardless of the presence of specific symptoms - like bizarre delusions - sufficient for diagnosis. RESULTS: The prevalence of bizarre delusions was 2.56%. Five themes, identified on analyzing their contents are described. Main themes were unnatural, bodily sensation, change in identity, sexual, and religious. CONCLUSIONS: These themes were culture based, but definitely out of context, excessive or extremely odd. Moreover, the rarity of bizarre delusions makes it difficult to include them as a sole criterion for diagnosis.