‘An experience of meaning’: A 20-year prospective analysis of delusional realities in schizophrenia and affective psychoses

Abstract

Delusions are transdiagnostic and heterogeneous phenomena with varying degrees of intensity, stability, and dimensional attributes where the boundaries between everyday beliefs and delusional beliefs can be experienced as clearly demarcated, fuzzy, or indistinguishable. This highlights the difficulty in defining delusional realities. All individuals in the current study were evaluated at index and at least one of six subsequential follow-ups over 20 years in the Chicago Longitudinal Study. We assessed 16 distinct delusions categorized as thought or thematic delusions. We also examined the probability of recurrence and the relationships between delusions and hallucinations, depression, anxiety, and negative symptoms. The sample consisted of 262 individuals with schizophrenia vs. affective psychosis. Thought delusions were significantly different between groups at all follow-up evaluations except the 20-year timepoint. Thematic delusions were more common than thought delusions and show a significant decreasing pattern. In general, delusional content varied over time. Referential, persecutory, and thought dissemination delusions show the highest probability of recurrence. Hallucinations were the strongest indicator for thought, thematic, and overall delusions. 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”. Given the significant associations between delusions and hallucinations, future work incorporating participatory research is needed to better define and align subjective and objective perspectives. Our research also points to the need for future clinical interventions that specifically evaluate and target the coexistence and entanglement of delusions and hallucinations.

Modelling the Longitudinal Dynamics of Paranoia in Psychosis: A Temporal Network Analysis Over 20 Years

“…The evaluation of social functioning included items Total Social Satisfaction, Quality of Friends, Time with Friends, and Number of Close Friends at each of the six follow-up time points. All follow-up measures were administered by clinical raters who were blinded to previous ratings and diagnoses (see Harrow et al, 2021; Rosen et al, 2022 for a detailed description of rating and follow-up schedules).…”

“…While approximately 70%-85% of individuals cease to be delusional after a year (Appelbaum et al, 2004; Gupta et al, 1997; Morgan et al, 2014), only a third of are expected to demonstrate good clinical response to current treatment (Morrison et al, 2020). In the likelihood that treatment is unsuccessful, delusions may remain over three (Dollfus & Petit, 1995), seven (Harrow et al, 1995), ten (Morgan et al, 2014), and twenty years (Harrow & Jobe, 2010; Harrow et al, 2012; Rosen et al, 2022).…”

What are delusions? Examining the typology problem

“…To be mad was to be deluded" (p. 93). Nowadays, delusions are clinically characterized as a transdiagnostic phenomenon with a higher prevalence in schizophrenia (L opez-Silva, Harrow, et al, 2022;Rosen et al, 2016Rosen et al, , 2022. Delusions are heterogeneous in scope, theme, and phenomenological features (Coltheart et al, 2011); and, for the last 20 years, delusions have especially attracted attention from philosophers and psychiatrists due to the ways in which their phenomenal and representational features challenge different claims about, among many others, the nature of self-awareness (Billon, 2023;Guillot, 2017;L opez-Silva, 2016;Stephens & Graham, 2000), the nature of rationality (Bortolotti, 2010;Campbell, 1999Campbell, , 2001, self-knowledge (Bortolotti & Broome, 2009;Rothenfluch, 2020), and the ontology (Gibbs, 2000;O'Brien & Soteriou, 2009;Strawson, 2003) and the phenomenology of thinking (Gallagher, 2015;Humpston, 2022;L opez-Silva, 2020;Mishara & Zaytseva, 2019).…”

Using latent class analysis to investigate enduring effects of intersectional social disadvantage on long-term vocational and financial outcomes in the 20-year prospective Chicago Longitudinal Study

“…The CLRP is a prospective study designed to examine the naturalistic course of psychopathology, neurocognition, and recovery in individuals diagnosed with schizophrenia and primary mood disturbances (Bonner-Jackson, Grossman, Grinker & Harrow, 1987;Harrow & Jobe, 2005b;Harrow, Jobe, Faull, & Yang, 2017;Harrow, Sands, Silverstein, & Goldberg, 1997, 2004Harrow, Grossman, Jobe, & Herbener, 2005a;Humpston, Harrow, & Rosen, 2020;Jobe & Harrow, 2010;López-Silva et al, 2022;Rosen, Grossman, Harrow, Bonner-Jackson, & Faull, 2011;Rosen et al, 2022;Strauss, Harrow, Grossman, & Rosen, 2010). The CLRP was initiated in 1970 at two urban hospitals in the Chicago southside neighborhood.…”