Delusional content at initial presentation to a catchment-based early intervention service for psychosis

Abstract

Background During a psychotic episode, patients frequently suffer from severe maladaptive beliefs known as delusions. Despite the abundant literature investigating the simple presence or absence of these beliefs, there exists little detailed knowledge regarding their actual content and severity at the onset of illness. Aims This study reports on delusions during the initiation of indicated treatment for first-episode psychosis (FEP). Method Data were systematically collected from a sample of 636 patients entering a catchment-based early intervention service for FEP. The average severity and frequency of each delusional theme at baseline was reported with the Scale for the Assessment of Positive Symptoms. Delusional severity (globally and per theme) was examined across a number of sociodemographic and clinical variables. Results Delusions were present in the vast majority of individuals experiencing onset of FEP (94%), with persecutory (77.7%) being the most common theme. Persecutory delusions remained consistent in severity across diagnoses, but were more severe with older age at onset of FEP. No meaningful differences in delusional severity were observed across gender, affective versus non-affective psychosis, or presence/absence of substance use disorder. Globally, delusion severity was associated with anxiety, but not depression. Delusions commonly referred to as passivity experiences were related to hallucinatory experiences. Conclusions This community sample offers a rare clinical lens into the severity and content of delusions in FEP. Although delusional severity was consistent across certain sociodemographic and clinical variables, this was not always the case. Future research should now consider the course of delusion themes over time.

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

“…Here we find a largely stable presentation of delusional themes over more than a decade, providing a comparison point for future studies examining the evolution of delusional themes over time in conjunction with better appreciating their meaning via first-person accounts. Among other topics, subsequent investigations could focus on the relationship among delusional themes, including an examination of changes across individual patient episodes [12,35,36]. Note: *Assessed using the BPRS; ▵Assessed using the CDSS; † Assessed using SAPS (frequency of hallucinations and delusions determined at ≥ 3 SAPS severity rating).…”

Using dimensionality-reduction techniques to understand the organization of psychotic symptoms in persistent psychotic illness and first episode psychosis

“…We included all items and determined inclusion for statistical testing in a data-driven manner (see "Statistical methods"). and SANS by trained raters 48 with moderate to high interrater reliability (IRR) 49 . Clinical assessments took place within 1-month of first intake into the PEPP-Montreal clinical services program and participants were asked to recall their most acute state from the last 3 months during assessment.…”

Reducing the dimensions of psychotic illness

“…All participants had a diagnosis of affective or non-affective psychotic illness according to SCID-IV and received antipsychotic medications for no more than 30 days upon entry (average at the date of assessment was 21.7 days). They were administered the SAPS and SANS by trained raters 26 with moderate to high interrater reliability (IRR) 27 . Clinical assessments took place within 1-month of first intake into the PEPP-Montreal clinical services program and participants were asked to recall their most acute state from the last 3 months during assessment.…”