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                    Other cases may exhibit megalomania, where the patient is
                    convinced he has extraordinary powers

                       There can be false ideas that can be divided into several
                    sub-groups, as follows:

                       [A] False thoughts of being pursued – the patient feels
                    that various people are trying to harm him or even kill him.

                       [B] Illusory thoughts about other people’s attitude – the
                    patient thinks that the people around him are mocking him
                    behind his back.

                       [C] Delusions of unfaithfulness – the patient is obses-
                    sively jealous of his/her spouse, suspects the spouse of un-
                    faithfulness or of planning to leave and forbids the spouse to
                    have any social life, all based on utterly insignificant details.

                       [D] Delusions of being loved – the patient believes that a
                    particular person loves him. The imagined admirer is often a
                    famous or powerful person [such as his treating physician].

                       [E] Delusions of grandeur – the patient believes himself
                    to be a prophet or Mashiach.

                       [F] Hearing “inner voices” – illusions of threatening ele-
                    ments [this sensation is expressed through sight, touch and
                    smell].

                       [G] In acute cases: extremely disturbed thinking, sudden
                    outbursts of anger, suspicion, anxiety and fear.

                       As the disease progresses the patient develops a rich, fab-
                    ricated worldview in which a particular group – the secret
                    police or the government, for example – are making numer-
                    ous attempts to harm him.

                       Paranoid schizophrenics tend to exhibit hostility to their
                    environment, cutting off social contact and in extreme cases
                    they are liable to be very dangerous to those around them
                    because they are liable to respond violently to any perceived
                    threat.

                       Similarly, alongside their delusional thinking schizo-
                    phrenics also suffer from perceptive and emotional irreg-
                    ularities: colors and sounds change and the body appears

214  1  Medical-Halachic Responsa of Rav Zilberstein
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