Tuesday, 27 September 2022

An Experience of Meanings: Delusional Realities in Schizophrenia

This post is by Cherise Rosen. Cherise is a faculty member in the Departments of Psychiatry, Public Health, and Neuroscience at the University of Illinois at Chicago. She is a co-investigator in the Chicago Longitudinal Study (PI: Martin Harrow) and has conducted extensive research in the phenomenological construct of psychosis, with particular emphasis on auditory verbal hallucinations and delusions. 

 


Cherise Rosen

Cherise summarizes her recent paper (co-authored with Martin Harrow, Clara Humpston, Liping Tong, Thomas H. Jobe, and Helen Harrow) entitled ‘An experience of meanings’: A 20-year prospective analysis of delusional realities in schizophrenia and affective psychoses, recently published in Frontiers in Psychiatry. The authors would like to thank all the individuals who participated in the Chicago Longitudinal Study as their contributions over the 20 years of follow-up made this research possible. This work was supported in part by USPHS Grants MH-26341 and MH-068688 from the National Institute of Mental Health, USA (MH) and a Grant from the Foundation for Excellence in Mental Health Care G5014 (MH).

Delusional realities are transdiagnostic and heterogeneous phenomena with varying degrees of intensity, stability, and dimensional attributes where the boundaries between everyday beliefs and delusional thoughts can be clearly demarcated, fuzzy, or indistinguishable. Building on our previous research, we studied the course and trajectory of 16 distinct delusions categorized as either thought delusions (thought insertion, withdrawal, broadcasting, dissemination, referential, “made” feelings, “made” impulses, and “made” volitional acts), or thematic delusions (somatic, persecutory, self-depreciatory, nihilistic, grandeur, religious, fantastic, or sexual) (Harrow & Jobe, 2010; Rosen et al., 2016). 

We also examined the probability of recurrence (‘stickiness’) and the relationships between delusions and hallucinations, depression, anxiety, and negative symptoms. The sample consisted of 262 individuals diagnosed with schizophrenia versus an affective psychosis who were evaluated at index hospitalization and at least one of six subsequential follow-ups over 20 years in the Chicago Longitudinal Study. The formation and maintenance of delusions were conceptualized as a multimodal construct consisting of sensory, perceptual, emotional, social, and somatic embodiment of an “experience of meanings”, in which the content varied over time.

Our study showed that individuals diagnosed with schizophrenia had the highest probability of recurrence of referential (35%), persecutory (31%), thought dissemination (mind-reading; 25%), and thought insertion delusions (20%),whereas Individuals with an affective psychosis showed the highest probability of recurrence of delusions of grandeur (18%), thought dissemination (15%), reference (14%), and persecution (13%). Overall, individuals with psychosis (combined schizophrenia and affective psychoses) showed the highest probability of recurrence of referential (26%), persecutory (24%), and thought dissemination delusions (21%).

To explore the relationships between delusions, hallucinations, depression, anxiety, and negative symptoms, we fitted logistic GEE models for thematic, thought, and all delusions. From the fitted models, when controlling for sex and prognostic indices, we found that the presence of any type of hallucination was the strongest predictor for thought, thematic, and overall delusions over 20 years. The presence of negative symptoms was significantly associated with overall delusions. We also found a positive trend between negative symptoms and thought delusions. Our data also showed that severe anxiety was a strong predictor of thought, thematic, and overall delusions.

Delusional reality is a fundamental (if not ineffable) transformation in the experience of reality and the sense of being-in-the-world which is no longer embedded in the individual’s familiar experiential milieu (Humpston, 2022). In individuals with psychosis, delusional content can vary over time and typically manifests as a construct of multiple thought and/or thematic delusions that exist within a social and intersubjective structure. Individual interpretation and understanding of delusional realities are influenced by prior history within a cultural context, resulting in a highly individualized meaning that is given to the experience.

Delusional realities are held in the suspension of disbelief and are given meaning associated with underlying unconscious material as a reflection of the fundamental structure, organization, and articulation of the unconscious world turned inside out and experienced as an external, unconstrained, and elaborate experience of meaning.

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