Oh my god, pathogen, I just had a great idea, you’ll love this… it’s a solution for our disagreement.
I say you have a thought disorder, a delusion, a shared persecutory delusion – I’m being very specific, an ICD-10 diagnosis of F24 – a real thing.
You say you don’t. You say your thinking is just fine, you are rational and don’t have a delusion.
So how do we resolve this? I say you have a delusional disorder and you say you don’t. I know, a Mental Status Exam of thought and perception – of frontal lobe executive function systems.
Google “mental status exam” and read the NCBI entry, better yet, here it is:
Mental Status Examhttps://www.ncbi.nlm.nih.gov/books/NBK320/
Oh my gosh, we actually have a clinical diagnostic assessment procedure that will answer our question. Isn’t that great? We don’t have to argue about it, we’ll just get it diagnosed. See there where it says,
From NCBI: “Does the patient harbor realistic concerns, or are these concerns elevated to the level of irrational fear? Is the patient responding in exaggerated fashion to actual events, or is there no discernible basis in reality for the patient’s beliefs or behavior?”
Perfect assessment protocol, right?
Oh, but it says it’s hard to do the MSE of thought and perception. See, it says,
From the NCBI: “Of all portions of the mental status examination, the evaluation of a potential thought disorder is one of the most difficult and requires considerable experience. The primary-care physician will frequently desire formal psychiatric consultation in patients exhibiting such disorders.”
Good news, pathogen. I have that “considerable experience” in the Mental Status Exam of thought and perception (frontal lobe executive function systems) from 12 years of annual training at a UCLA project on schizophrenia in the MSE of thought and perception.
Holy cow, pathogen, I’m one of the most experienced professionals around at diagnosing delusional pathology. Tell ya what, how ’bout a bonus… how about we rate how severe your delusion is? Not just whether or not you are delusional… how about we tell you just how delusional you are on a 7-point scale?
The Brief Psychiatric Rating Scale – look it up on Wikipedia – the BPRS, “one of the oldest, most widely used scales to measure psychotic symptoms.”
Well waddya know. For 12 years I was trained annually in the MSE of thought and perception, rating the severity of the delusions on the BPRS, “one of the oldest, most widely used scales to measure psychotic symptoms.”
Is that just not the best news, pathogen. Dr. Childress is one of THE most experienced psychologists in diagnosing delusional pathology… AND… there is a way to do it, the Mental Status Exam of thought and perception.
Yay. Isn’t that great news? So not only can we tell IF you are delusional… we can tell how severe it is on a 7-point scale. With this court-involved shared delusional disorder of the child with the allied parent, I’d likely rate the child’s delusional beliefs as around a 5 Moderately Severe on the BPPS. There’s full conviction and impairment to functioning.
For you Trump-mind cult people, you might be a 4, full conviction but encapsulated and no functional impairment, or you could go all the way to 7 Extremely Severe if you’re QAnon preoccupied with the delusional beliefs.
The BPRS, it has excellent psychometrics, that’s why it’s used so regularly in rating psychotic symptoms. Or we could use the PANSS if you’d like, the Positive and Negative Symptom Scale. Up to you, it’s your assessment, which scale would you like to use?
My-oh-my, the Mental Status Exam of thought and perception. Perfect. They’re tricky, the frontal lobe executive functions are subtle and you have to know what you’re doing, the “evaluation of a potential thought disorder is one of the most difficult and requires considerable experience,” that is true.
And whoa, whaddya know, I have exactly that “considerable experience.” Must be kismet, don’t ya think there pathogen buddy? Such good news.
There’s actually a way to diagnose thought disorders. Do you know why? Because they’re not rational, they’re delusions, they don’t make sense. What an MSE of thought an perception does is not look at the content… we look at the process – the way and how of the reasoning systems.
If it’s logical and rational, it doesn’t matter the content, the process of thinking is clean. If there’s a delusion present, however, the process of thinking is all out-of-kilter… the process doesn’t make sense… it’s not coherent, it’s illogical and internally inconsistent. It doesn’t make sense – not the content, the process.
It’s called a Mental Status Exam of thought and perception, of the frontal lobe executive function systems. Useful thing to know when dealing with delusional pathology, how to diagnose it.
I thought you’d be thrilled to hear that pathogen, that Dr. Childress is one of the foremost clinical experts in the diagnosis of thought disorders and delusional pathology.
ICD-10 F24 – a real thing, a real diagnosis. The MSE of thought and perception – a real thing, a real assessment for delusional beliefs. The BPRS – a real thing, a real rating scale for delusions.
Oh my goodness, well would you look at that… reality exists.
Craig Childress, Psy.D.Clinical Psychologist, PSY 18857
Craivghttps://www.ncbi.nlm.nih.gov/books/NBK320/
