Pavlov's conceptualization of paranoia within the theory of higher nervous activity

1. George Windholz

Abstract
In 1934, I. P. Pavlov conceptualized paranoia within his theory of higher nervous activity. The conceptualization was based on the case study method used in the Psychiatric Clinic where Pavlov observed five cases diagnosed by psychiatrists as paranoiac or paranoid states. Furthermore, experiments with dogs as subjects produced behaviours that appeared analogous to paranoiac characteristics observed in the clinic. Pavlov's paranoia theory did not differ much from Ernst Kretschmer's 1927 explanation of the formation of paranoia. Hereditary predisposition and traumatic life experiences make, according to Pavlov, some centres in the brain more active than nearby areas, which results in preoccupation with certain ideas. Imbalance between neural excitation and inhibition creates a condition where weak external stimuli produce strong reactions, which explains paranoiac overreaction to the feeling of inferiority. Some suggestions as to Pavlov's interest in paranoia are offered.

Delusional diagnosis? The history of paranoia as a disease concept in the modern era History of Psychiatry 2000 11: 037 Ian Dowbiggin

In recent years there has been a mounting interest among scholars in the history of diagnosis and classification in psychiatry. For most of the 1960s and 1970s scholars tended to concentrate on other matters in the history of psychiatry, such as the origins, growth and management of mental hospitals, the professionalization of psychiatry as a medical specialty, or the evolution of policies towards the mentally ill. Beginning in the 1980s, however, more and more historians have devoted their attention to issues such as the relations between psychiatrists and their patients and how these encounters have shaped the way physicians diagnose and classify mental diseases. There is growing agreement that a history of psychiatric classification would be almost tantamount to a history of psychiatry.

Like hysteria, paranoia has become one of those terms that has passed from the lexicon of psychiatry into everyday language. Almost always the popular use of paranoia refers to delusions of persecution, the notion that a person suspects unrealistically that other people are covertly trying to harm him or her. The frequent use of the word paranoia suggests that there is a firm idea of what paranoia is clinically. But nothing could be further from the truth. Historically, no word has created more controversy and confusion in psychiatry. The latest edition (1994) of the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM) has dropped the term paranoia entirely. It is now called delusional disorder

(DD), a mostly chronic psychosis characterized by the presence of one or more non-bizarre delusions that persist for at least one month. Persecutory delusions actually constitute only one type of delusion in DD, other types being erotic, grandiose, jealous and hypochondriacal. Differential diagnosis presents a formidable problem when it comes to DD. Because delusions - or incorrect beliefs - are symptoms in a wide variety of psychological and organic diseases, the diagnostic boundaries between DD and other disorders like schizophrenia, mood disorders, obsessive-compulsive disorders, and geriatric conditions are in perpetual flux.

http://pro.psychcentral.com/2013/dsm-5-changes-schizophrenia-psychotic-disorders/004336.html#

Delusional Disorder
Mirroring the change in the schizophrenia diagnostic criteria, delusions in delusion disorder are no longer required to be of the non-bizarre type. A person can now be diagnosed with delusional disorder with bizarre delusions, via a new specifier in the DSM-5. So how does a clinician make a differential diagnosis from other disorders, such as body dysmorphic disorder or obsessive-compulsive disorder? Easy through a new exclusion criterion for delusional disorder, which states that the symptoms must not be better explained by conditions such as obsessive-compulsive or body dysmorphic disorder with absent insight/delusional beliefs. Also, the APA notes that the DSM-5 no longer separates delusional disorder from shared delusional disorder. If criteria are met for delusional disorder then that diagnosis is made. If the diagnosis cannot be made but shared beliefs are present, then the diagnosis other specified schizophrenia spectrum and other psychotic disorder is used.

https://sites.google.com/site/psych54000/early-dsm/paranoia

Paranoia This is the description of the Paranoia diagnosis from the DSM-I:

"This type of psychotic disorder is extremely rare. It is characterized by intricate, complex, and slowly developing paranoid system, often logically elaborate after a false interpretation of an actual occurrence, Frequently, the patient considers himself endowed with superior of unique ability. The paranoid system is particularly isolate from much of the normal stream of consciousness, without

hallucinations and with relative intactness and preservation of the remainder of the personality, in spite of a chronic and prolonged course" (APA, 1952, p. 28).

For comparison, the current multiaxial paranoia diagnosis is available under the DSM-III and DSM-IV section.

https://sites.google.com/site/psych54000/b/paranoid-personality-disorder

The DSM-III and DSM-I Paranoid Personality Disorder PARANOID PERSONALITY DISORDER 301.0

A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following:

1) suspects, without sufficient basis that others are exploiting, harming, or deceiving him or her

2) is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates

3) is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her

4) reads hidden demeaning or threatening meanings into benign remarks or events

5) persistently bears grudges, i.e., is unforgiving of insults, injuries, or slights

6) perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack

7) has recurrent suspicions, without justification, regarding fidelity of spouse.

A Historical Dictionary of Psychiatry

By Edward Shorter Hannah Chair in the History of Medicine and Professor of Psychiatry University of Toronto PAGE 206

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