Clinical Brain Disorders Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
Psychiatry Res. 2009 Dec 30;170(2-3):128-31. doi: 10.1016/j.psychres.2008.12.017. Epub 2009 Nov 8.
Although the phenomenology accompanying psychoses is fascinating, hitherto empirical examinations have been qualitative and thus limited in their clinical conclusions regarding the actual underlying cognitive mechanisms responsible for the formation and maintenance of the delusion, which is often distressing to the patient. We investigated the internal cognitive structure (i.e., connections) of some delusions pertaining to self and others in a patient with psychosis who was very fluent and thus able to provide a lucid account of his phenomenological experiences. To this end we employed a clustering method (HICLAS disjunctive model) in conjunction with standard neuropsychological tests. A well-fitting, but parsimonious solution revealed the absence of unique feature sets associated with certain persons, findings that provide a compelling case underlying the confusion in certain instances between real and delusional people. We illustrate the methodology in one patient and suggest that it is sensitive enough to explore the structure of delusions, which in conjunction with standard neuropsychological and clinical assessments promises to be useful in uncovering the mechanisms underlying delusions in psychosis.
尽管伴随精神病的现象学很吸引人，但迄今为止的实证研究都是定性的，因此在确定导致妄想形成和维持的实际潜在认知机制方面的临床结论有限，而这些妄想常常使患者感到痛苦。我们对一位非常流利的精神病患者的一些与自我和他人有关的妄想的内部认知结构（即连接）进行了研究，他能够清晰地描述自己的现象学体验。为此，我们采用了聚类方法（HICLAS 析取模型）结合标准神经心理学测试。一个拟合良好但简约的解决方案揭示了与某些人没有独特特征集相关的情况，这些发现为在某些情况下真实人和妄想者之间的混淆提供了一个令人信服的基础。我们在一个患者中说明了该方法，并表明它足够敏感，可以探索妄想的结构，结合标准神经心理学和临床评估有望揭示精神病中妄想的机制。
