Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis

Ritunnano, Rosa; Kleinman, J.; Oshodi, Danniella Whyte; Michail, Maria; Nelson, Barnaby; Humpston, Clara; Broome, Matthew R.

doi:10.1016/s2215-0366(22)00104-3

Cited by 45 publications

(23 citation statements)

References 70 publications

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“…In contrast to the experience of meaning, there is far less consensus surrounding potential sources, but common themes include: positive interpersonal relationships, environmental mastery, autonomy, altruism, religion, spirituality, positive affect, personal growth, personal achievement, and being treated fairly. [9][10][11][12][13][14][15][16][17] The concept of meaning in life has been applied to delusions more broadly 18,19 but not examined specifically for grandiose delusions.…”

Section: Introductionmentioning

confidence: 99%

The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland

Isham¹,

Loe²,

Hicks³

et al. 2022

The Lancet Psychiatry

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Section: Introductionmentioning

confidence: 99%

The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland

Isham¹,

Loe²,

Hicks³

et al. 2022

The Lancet Psychiatry

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“…This experience-based, patient-generated framework can then be translated into patient-valued targets for psychological intervention. Similarly, phenomenological insights gained from co-written bottom-up reviews of the lived experience of psychosis (Fusar-Poli et al ., 2022 ) or from systematic reviews and qualitative meta-syntheses (Ritunnano et al ., 2022b ) could help create measures and develop treatments that are more faithful to the first-person perspective. Without this approach, the risk is that we continue to rely on outdated, researcher-generated constructs that may or may not reflect the real nature of the phenomena under investigation, and may or may not matter to patients.…”

Section: Identifying Meaningful Outcomes and New Targets For Psycholo...mentioning

confidence: 99%

Phenomenology as a resource for translational research in mental health: methodological trends, challenges and new directions

Ritunnano

Papola

Broome

et al. 2023

Epidemiol Psychiatr Sci

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This editorial reflects on current methodological trends in translational research in mental health. It aims to build a bridge between two fields that are frequently siloed off from each other: interventional research and phenomenologically informed research. Recent years have witnessed a revival of phenomenological approaches in mental health, often – but not only – as a means of connecting the subjective character of experience with neurobiological explanatory accounts of illness. Rich phenomenological knowledge accrued in schizophrenia, and wider psychosis research, has opened up new opportunities for improving prediction, early detection, diagnosis, prognostic stratification, treatment and ethics of care. Novel qualitative studies of delusions and hallucinations have challenged longstanding assumptions about their nature and meaning, uncovering highly complex subjective dimensions that are not adequately captured by quantitative methodologies. Interdisciplinary and participatory research efforts, informed by phenomenological insights, have prompted revisions of pre-established narratives of mental disorder dominated by a dysfunction framework and by researcher-centric outcome measures. Despite these recent advances, there has been relatively little effort to integrate and translate phenomenological insights across applied clinical research, with the goal of producing more meaningful, patient-valued results. It is our contention that phenomenological psychopathology – as the basic science of psychiatry – represents an important methodology for advancing evidence-based practices in mental health, and ultimately improving real-world outcomes. Setting this project into motion requires a greater emphasis on subjectivity and the structures of experience, more attention to the quality and patient-centredness of outcome measures, and the identification of treatment targets that matter most to patients.

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“…For example, Kusters (95) describes the lives of several individuals with psychosis who have interpreted, and navigated experiences otherwise classified as "delusions" by synthesizing the experience within the context of self, social, and cultural factors (95). Along these lines (96), conducted a systematic review of qualitative studies highlighting multiple themes, one of which examines the hyper-salient atmospheric changes in which the boundaries of self become porous, "At that moment, I believe you are in contact with the universe. Every step that I took was rhythmical, and after a while, everything I did was rhythmical, every step, every eye movement.…”

Section: Relationships Between Delusions Hallucinations Depression An...mentioning

confidence: 99%

“…Every step that I took was rhythmical, and after a while, everything I did was rhythmical, every step, every eye movement. You have a better feeling for timing in which you master each moment, a moment in which you lose time and space, hour and time (1,96)." In a mixed-methods publication conducted by Jones et al (48) examining agency and meaning-making in the formation and maintenance of delusional reality, the experience was described as "actually kind of interesting... the way that the delusions [and hallucinations] that I had were kind of teleological, in a certain sense.…”

Section: Relationships Between Delusions Hallucinations Depression An...mentioning

confidence: 99%

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

et al. 2022

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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.

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Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis

Cited by 45 publications

References 70 publications

The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland

The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland

Phenomenology as a resource for translational research in mental health: methodological trends, challenges and new directions

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

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