Dream formation and psychosis are related but not identical. The nature of the anxiety represented in a dream is an important indication of psychopathology. Fear of dissolution of the ego (not defined further in this article) has a grave prognostic meaning when it appears in dreams. Inability to distinguish dream from reality upon awakening is also an ominous sign. Many investigators believe that dreams can presage psychotic decompensations. Such dreams can be viewed as emergences of overwhelming instinctual urges or as last ditch efforts to reconfirm the fantasy nature of disturbing thoughts. Sometimes the manifest content of a preceding dream is incorporated into a delusion. Dreams can give information about the dreamer's psychopathology only when they are examined in context.