University Department of Psychiatry, Hospital of Sainte Marguerite, University of Marseilles, Marseilles, France.
Schizophr Bull. 2010 Jul;36(4):667-79. doi: 10.1093/schbul/sbq001. Epub 2010 Feb 8.
Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV) treats the presence of bizarre delusions (BD) as the heaviest-weighted clinical criterion of schizophrenia. Although BD play a major role in contemporary diagnostic systems, only a few empirical studies explore this issue. These studies provide highly heterogenous results because they are based on different experimental paradigms, in terms of definition, clinical sample, and number of raters. Here, we first discuss the psychopathological sources of the concept of BD, which were initially described as either nonsensical or incomprehensible. Then, we provide a critical review of contemporary studies on the reliability of BD and their methodological and conceptual limitations. Current approaches have focused intensely on BD's reliability and have defined BD strictly in terms of delusional content--mainly in terms of the physical impossibility or the cultural or historical incomprehensibility of the delusional claims. These approaches have neglected formal features of experience that underlie BD and the crucial issue of the nature and validity of BD. In the discussion, we argue that clinical diagnosis of BD cannot be limited to delusional contents alone and requires taking into account the subjective side of BD (how altered experience manifests itself) as well as the conditions of intersubjective encounter (how BD are expressed to and experienced by the clinician). The notion of "bizarreness" in schizophrenia is not purely theoretical; it has practical relevance for the therapeutic encounter and implications on further empirical research and on diagnostic approaches.
《精神障碍诊断与统计手册》第四版（DSM-IV）将奇特妄想（BD）的存在视为精神分裂症最重的临床标准。尽管 BD 在当代诊断系统中起着重要作用，但只有少数实证研究探讨了这个问题。这些研究提供了高度异质的结果，因为它们基于不同的实验范式，涉及定义、临床样本和评估者数量。在这里，我们首先讨论了 BD 概念的心理病理学来源，这些来源最初被描述为荒谬或不可理解。然后，我们对当代关于 BD 可靠性的研究进行了批判性回顾，并分析了它们在方法学和概念上的局限性。目前的方法集中在 BD 的可靠性上，并严格按照妄想内容来定义 BD，主要是从妄想主张的物理不可能或文化或历史上不可理解的角度。这些方法忽略了构成 BD 的经验的形式特征以及 BD 的本质和有效性的关键问题。在讨论中，我们认为，BD 的临床诊断不能仅仅局限于妄想内容，还需要考虑到 BD 的主观方面（改变的经验如何表现出来）以及主体间相遇的条件（BD 如何向临床医生表达和被其体验）。精神分裂症中的“奇特”概念并非纯粹是理论上的；它对治疗性相遇具有实际意义，并对进一步的实证研究和诊断方法产生影响。
