Delusions, under Manic depressive illness

The delusions generally fall into one of four types:
1. Delusions of guilt or unworthiness
The patient may feel that the misery he is experiencing is a form of purnishment and will seek events in his past life that could justify such a reward. He may become convinced that it is the result of some quite trivial misdeed that he performed many years ago, and will either seek constant reassurance on this score, or insist that he richly deserves his punishment and will refuse treatment on the grounds he does not deserve to be helped.
Some patients, who perhaps favour a slightly more grandiose explanation for their present sufferings, will become convinced they must have committed some enormous and unspecified crime. They talk in terms of committing the unforgivable sin of killing God or things too foul to mention. Others claim they killed their nearest and dearest, and persist in this claim even in the presence of those whom they state to be deceased.
2. Delusions of poverty
The patient insists that he is bankrupt and cannot support himself or his relatives, although his bank manager may produce evidence to the contrary. This type of delusion may indicate the lifelong preoccupation the patient has had with making money, and its loss represents the greatest disaster he could imagine.
3. Hypochondrialcal delusions
Many depressed patients present originally with complaints of physical illness, especially pain, but if the underlying depression is recognised, the patient is able to relate, in time his original symptoms to the alteration in mood. However, some patients become preoccupied with the physical accompaniments, and develop the conviction that there is some alteration in their body. A frequent delusion relates to constipation and loss of appetite, which are almost invariably present. The patient task about his bowels being blocked and the food rotting inside him. In their more extreme forms these ideas merge with those relating to death and nihilistic delusions may be expressed.
4. Nihilistic delusion
The patient becomes convinced that part of him is dead or has been destroyed. He will talk about being dead from the waist down or my bowels have rotted away or my brain has been destroyed. The ultimate nihilistic delusion is the idea that he is already dead.

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