Macquarie Center for Cognitive Science, Macquarie University, Sydney NSW Australia 2109.
Annu Rev Psychol. 2011;62:271-98. doi: 10.1146/annurev.psych.121208.131622.
Delusional beliefs are seen in association with a number of neuropathological conditions, including schizophrenia, dementia, and traumatic brain injury. A key distinction exists between polythematic delusion (here the patient exhibits delusional beliefs about a variety of topics that are unrelated to each other) and monothematic delusion (here the patient exhibits just a single delusional belief or else a small set of delusional beliefs that are all related to a single theme). A great deal of recent research has focused on identifying and investigating various different forms of monothematic delusion. We discuss a general theoretical approach to the understanding of monothematic delusions--a two-factor approach according to which understanding the nature and genesis of any kind of monothematic delusion involves seeking answers to two questions. The first question is, what brought the delusional idea to mind in the first place? The second question is, why is this idea accepted as true and adopted as a belief when the belief is typically bizarre and when so much evidence against its truth is available to the patient? We discuss in detail six different kinds of monothematic delusion, showing for each how neuropsychological considerations allow a first factor (responsible for the content of the belief) and a second factor (responsible for the failure to reject the belief) to be plausibly identified. Five difficulties confronting this two-factor account of monothematic delusion are then identified, and attempts are made to address each one.
妄想信念与许多神经病理学状况有关，包括精神分裂症、痴呆和创伤性脑损伤。在多主题妄想（患者表现出对彼此无关的各种主题的妄想信念）和单主题妄想（患者仅表现出一种妄想信念或少数与单一主题相关的妄想信念）之间存在关键区别。最近的大量研究集中在识别和调查各种不同形式的单主题妄想。我们讨论了一种理解单主题妄想的一般理论方法——双因素方法，根据该方法，理解任何一种单主题妄想的性质和起源都需要回答两个问题。第一个问题是，是什么首先让妄想的想法出现在脑海中？第二个问题是，为什么当这个信念通常是离奇的，并且患者有很多证据表明其真实性时，这个信念会被接受为真实并被采纳为信仰？我们详细讨论了六种不同类型的单主题妄想，对于每一种妄想，我们都展示了神经心理学考虑因素如何能够合理地确定第一个因素（负责信念的内容）和第二个因素（负责不拒绝信念）。然后确定了这种单主题妄想的双因素解释所面临的五个困难，并尝试解决每一个困难。
