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“The more things change…”? Stability of delusional themes across 12 years of presentations to an early intervention service for psychosis

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Abstract

Purpose

While the prevalence of delusional themes appears to be consistent across geographic contexts, little is known about the relative prevalence of such themes within a given setting over periods of time. We therefore investigated delusional themes across 12 years of presentation to a catchment-based early intervention service for first episode psychosis (FEP).

Methods

Systematically collected data from 500 patients at an early intervention service for FEP were analyzed. Four cohorts of 3 years each, from 2006 to 2017, were used to compare the frequency of delusion themes across cohorts. We also integrated into the analysis baseline sociodemographic factors such as gender, age, and highest level of education and clinical factors such as anxiety, depression, suicidality, hallucinations, and primary diagnosis (affective or non-affective psychosis).

Results

Sex and education level were stable across cohorts, while patient age varied (p = 0.047). Clinical anxiety, depression, and suicidality at entry were also stable. Across cohorts, the proportion of patients with affective versus non-affective diagnosis differed (p = 0.050), with no differences in global rating of delusion severity or theme prevalence except for delusions of guilt or sin (p = 0.001). This single theme difference was not correlated with age or diagnosis.

Conclusion

Our study suggests relatively stable prevalence of delusion themes across cohorts of individuals experiencing FEP. This demonstrates the potential utility of studying thematic content both for understanding delusions in clinical populations and in research. Future explorations of the relationships between delusion themes and across individual patient episodes should be conducted.

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Data availability

Data and material were sourced from the database of the Prevention and Early Intervention Program for Psychosis (PEPP-Montréal) at the Douglas Mental Health University Institute.

Code availability

Data were analyzed using SPSS Statistics for Macintosh (Version 27).

References

  1. Feyaerts J, Henriksen MG, Vanheule S, Myin-Germeys I, Sass LA (2021) Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective. Lancet Psychiatry 8(3):237–249. https://doi.org/10.1016/S2215-0366(20)30460-0

    Article  Google Scholar 

  2. Geddes J, Andreasen N, Goodwin G (eds) New Oxford textbook of psychiatry. Oxford University Press, Oxford. https://doi.org/10.1093/med/9780198713005.001.0001/med-9780198713005. Accessed 10 Sep 2021

  3. Kiran C, Chaudhury S (2009) Understanding delusions. Ind Psychiatry J 18(1):3–18. https://doi.org/10.4103/0972-6748.57851

    Article  Google Scholar 

  4. Andreasen N (1983) Scale for the assessment of positive symptoms (SAPS). Department of Psychiatry, University of Iowa College of Medicine, Iowa City

    Google Scholar 

  5. Kay SR, Opler LA, Lindenmayer JP (1989) The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. Br J Psychiatry Suppl 7:59–67. https://doi.org/10.1192/S0007125000291514

    Article  Google Scholar 

  6. Kala AK, Wig NN (1982) Delusion across cultures. Int J Soc Psychiatry 28(3):185–193. https://doi.org/10.1177/002076408202800304

    Article  CAS  Google Scholar 

  7. Stompe T, Ortwein-Swoboda G, Ritter K, Schanda H (2003) Old wine in new bottles? Psychopathology 36(1):6–12. https://doi.org/10.1159/000069658

    Article  CAS  Google Scholar 

  8. Tateyama M, Asai M, Hashimoto M, Bartels M, Kasper S (1998) Transcultural study of schizophrenic delusions. Psychopathology 31(2):59–68. https://doi.org/10.1159/000029025

    Article  CAS  Google Scholar 

  9. Sher L (2000) Sociopolitical events and technical innovations may affect the content of delusions and the course of psychotic disorders. Med Hypotheses 55(6):507–509

    Article  CAS  Google Scholar 

  10. Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M (2018) Delusional themes across affective and non-affective psychoses. Front Psychiatry 9:132–132. https://doi.org/10.3389/fpsyt.2018.00132

    Article  Google Scholar 

  11. Freeman D, Bold E, Chadwick E, Taylor KM, Collett N, Diamond R, Černis E, Bird JC, Isham L, Forkert A, Carr L, Causier C, Waite F (2019) Suicidal ideation and behaviour in patients with persecutory delusions: prevalence, symptom associations, and psychological correlates. Comp Psychiatry 93:41–47. https://doi.org/10.1016/j.comppsych.2019.07.001

    Article  Google Scholar 

  12. Lemonde AC, Joober R, Malla A, Iyer SN, Lepage M, Boksa P, Shah JL (2020) Delusional content at initial presentation to a catchment-based early intervention service for psychosis. Br J Psychiatry 218(4):217–223. https://doi.org/10.1192/bjp.2020.157

    Article  Google Scholar 

  13. Iyer S, Jordan G, MacDonald K, Joober R, Malla A (2015) Early intervention for psychosis: a Canadian perspective. J Nerv Ment Dis 203(5):356–364. https://doi.org/10.1097/NMD.0000000000000288

    Article  Google Scholar 

  14. Malla A, Norman R, Scholten D, Manchanda R, McLean T (2005) A community intervention for early identification of first episode psychosis: impact on duration of untreated psychosis (dup) and patient characteristics. Soc Psychiatry Psychiatr Epidemiol 40(5):337–344. https://doi.org/10.1007/s00127-005-0901-6

    Article  Google Scholar 

  15. Overall JE, Gorham DR (1962) The brief psychiatric rating scale. Psychol Rep 10(3):799–812. https://doi.org/10.2466/pr0.1962.10.3.799

    Article  Google Scholar 

  16. First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition with psychotic screen (SCID-I/P W/PSY SCREEN). New York State Psychiatric Institute, New York

    Google Scholar 

  17. Addington D, Addington J, Maticka-Tyndale E (1993) Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry Suppl 22:39–44. https://doi.org/10.1192/S0007125000292581

    Article  Google Scholar 

  18. Malla A, Iyer SN, Thara R, Padmavati R, Mohan G, Taksal A, Margolese HC, Schmitz N, Joober R (2020) Comparison of clinical outcomes following 2 years of treatment of first-episode psychosis in urban early intervention services in Canada and India. Br J Psychiatry 217(3) 514–520. https://doi.org/10.1192/bjp.2020.126

    Article  Google Scholar 

  19. Andreasen NC, Carpenter WT Jr., Kane JM, Lasser RA, Marder SR, Weinberger DR (2005) Remission in schizophrenia: proposed criteria and rationale for consensus. Am J Psychiatry 162(3):441–449. https://doi.org/10.1176/appi.ajp.162.3.441

    Article  Google Scholar 

  20. IBM Corp. Released (2020) IBM SPSS statistics for Macintosh, version 27.0. IBM Corp, Armonk

    Google Scholar 

  21. Tseng W-S (2001) Handbook of cultural psychiatry. Academic Press, Cambridge. https://doi.org/10.1016/B978-0-12-701632-0.X5066-9

    Book  Google Scholar 

  22. Gold J, Gold I (2014) Suspicious minds: how culture shapes madness (First Free Press trade paperback). Free Press, New York

    Google Scholar 

  23. Jarvis GE, Iyer SN, Andermann L, Fung KP (2020) Culture and psychosis in clinical practice. A clinical introduction to psychosis. Academic Press, Cambridge, pp 85–112

    Chapter  Google Scholar 

  24. Gold J, Gold I (2012) The “Truman Show” delusion: psychosis in the global village. Cogn Neuropsychiatry 17(6):455–472. https://doi.org/10.1080/13546805.2012.666113

    Article  Google Scholar 

  25. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Association, Arlington. https://doi.org/10.1176/appi.books.9780890423349

    Book  Google Scholar 

  26. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Association, Arlington

    Book  Google Scholar 

  27. David AS (1999) On the impossibility of defining delusions. Philos Psychiatry Psychol 6(1):17–20

    Google Scholar 

  28. Parnas J (2015) Delusions, epistemology and phenophobia. World Psychiatry 14(2):174–175. https://doi.org/10.1002/wps.20206

    Article  Google Scholar 

  29. Rhodes J, Jakes S, Robinson J (2005) A qualitative analysis of delusional content. J Ment Health 14(4):383–398. https://doi.org/10.1080/09638230500195445

    Article  Google Scholar 

  30. Ritunnano R, Bortolotti L (2021) Do delusions have and give meaning? Phenomenol Cogn Sci. https://doi.org/10.1007/s11097-021-09764-9

    Article  Google Scholar 

  31. Ritunnano R, Kleinman J, Oshodi DW, Michail M, Nelson B, Humpston CS, Broome MR (2022) Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis. Lancet Psychiatry 9(6):458–476

    Article  Google Scholar 

  32. Bell V, Halligan PW, Ellis HD (2006) Explaining delusions: a cognitive perspective. Trends Cogn Sci 10(5):219–226

    Article  Google Scholar 

  33. Davies M, Coltheart M, Langdon R, Breen N (2001) Monothematic delusions: towards a two-factor account. Philos Psychiatr Psychol 8(2):133–158. https://doi.org/10.1353/ppp.2001.0007

    Article  Google Scholar 

  34. Coltheart M, Langdon R, McKay R (2007) Schizophrenia and monothematic delusions. Schizophr Bull 33(3):642–647. https://doi.org/10.1093/schbul/sbm017

    Article  Google Scholar 

  35. Coltheart M (2013) On the distinction between monothematic and polythematic delusions. Mind Lang 28(1):103–112. https://doi.org/10.1111/mila.12011

    Article  Google Scholar 

  36. Feyaerts J, Kusters W, Van Duppen Z, Vanheule S, Myin-Germeys I, Sass L (2021) Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium. Lancet Psychiatry 8(9):784–796. https://doi.org/10.1016/S2215-0366(21)00196-6

    Article  Google Scholar 

  37. Ritunnano R, Humpston C, Broome M (2021) Finding order within the disorder: a case study exploring the meaningfulness of delusions. BJPsych Bull. https://doi.org/10.1192/bjb.2020.151

    Article  Google Scholar 

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Funding

This work was supported by salary awards from the Fonds de Recherche Du Québec–Santé (RJ, ML, JLS), the Canadian Institutes of Health Research (SNI), and the Canada Research Chairs program (AM).

Author information

Authors and Affiliations

  1. Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada

    Gil Grunfeld, Ann-Catherine Lemonde, Ian Gold, Srividya N. Iyer, Ashok Malla, Martin Lepage, Ridha Joober, Patricia Boksa & Jai L. Shah

  2. Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, QC, Canada

    Gil Grunfeld, Ann-Catherine Lemonde, Srividya N. Iyer, Ashok Malla, Martin Lepage, Ridha Joober & Jai L. Shah

  3. Department of Philosophy, Faculty of Arts, McGill University, Montréal, QC, Canada

    Ian Gold

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  1. Gil Grunfeld
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  2. Ann-Catherine Lemonde
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  3. Ian Gold
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  4. Srividya N. Iyer
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  8. Patricia Boksa
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  9. Jai L. Shah
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Contributions

GG, ACL, IG and JS contributed to the study conception and design. RJ, AM, SNI, and JS were primary curators of the database at PEPP-Montréal. Data analysis was carried out by GG; the first draft of the manuscript was also written by GG, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jai L. Shah.

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Conflict of interest

The authors declare they have no conflicts of interest.

Ethical approval

The procedure for data collection was approved by the Institutional Review Board for Human Subjects Research of the Douglas Hospital Research Centre.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Grunfeld, G., Lemonde, AC., Gold, I. et al. “The more things change…”? Stability of delusional themes across 12 years of presentations to an early intervention service for psychosis. Soc Psychiatry Psychiatr Epidemiol 58, 35–41 (2023). https://doi.org/10.1007/s00127-022-02324-9

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  • DOI: https://doi.org/10.1007/s00127-022-02324-9

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