Bucci Sandra, Startup Mike, Wynn Paula, Heathcote Andrew, Baker Amanda, Lewin Terry J
School of Psychology, University of Newcastle, Newcastle, Australia.
Br J Clin Psychol. 2008 Sep;47(Pt 3):323-34. doi: 10.1348/014466508X280952. Epub 2008 Feb 2.
There appear to be two kinds of delusion of reference, which vary independently: delusions of observation and delusions of communication. It has been suggested that delusions of communication might derive from an impairment in reality discrimination, though the impairment would be centred on non-verbal channels in delusions of communication as opposed to verbal channels in auditory hallucinations.
Patients (N=64) with acute psychotic symptoms were recruited according to a 2 x 2 design: presence versus absence of delusions of communication crossed with presence versus absence of auditory hallucinations. They were presented with 100 brief video clips in which an actor either made a well-known gesture or an incidental movement, with the clips being obscured by visual noise. For each clip, the patients indicated how confident they were that a gesture was portrayed.
According to a signal detection analysis, all groups showed adequate sensitivity and the groups did not differ in sensitivity, but patients with delusions of communication showed a bias to report gestures which was not shown by patients with hallucinations. A control group of healthy volunteers (N=57) showed significantly greater sensitivity than the patients and a more conservative bias than patients with delusions of communication.
A bias to report gestures is not part of a general tendency to externalize one's own thoughts but may be the result of a reality discrimination deficit that is specific to delusions of communication. A possible theoretical explanation for such a deficit is discussed.
存在两种独立变化的关系妄想：观察性妄想和交流性妄想。有人提出交流性妄想可能源于现实辨别能力的损害，尽管这种损害在交流性妄想中集中于非言语渠道，与幻听中的言语渠道相反。
根据2×2设计招募了64名有急性精神病症状的患者：存在或不存在交流性妄想与存在或不存在幻听交叉分组。向他们展示100个简短视频片段，其中一名演员要么做出一个知名手势，要么做出一个偶然动作，片段被视觉噪声遮挡。对于每个片段，患者表明他们对所描绘手势的自信程度。
根据信号检测分析，所有组都表现出足够的敏感性，且各组在敏感性上无差异，但有交流性妄想的患者表现出报告手势的偏差，而有幻听的患者则未表现出这种偏差。一组健康志愿者对照组（N = 57）表现出比患者更高的敏感性，且比有交流性妄想的患者有更保守的偏差。
报告手势的偏差并非将自己的想法外化的一般倾向的一部分，而是可能是交流性妄想特有的现实辨别缺陷的结果。讨论了对此种缺陷的一种可能的理论解释。
