First Department of Psychiatry, Athens University Medical School, Eginition Hospital, Athens, Greece.
251 Air Force General Hospital, Department of Psychiatry, Athens, Greece.
Psychiatriki. 2021 Sep 20;32(3):224-231. doi: 10.22365/jpsych.2021.014. Epub 2021 Mar 26.
The prevalence of the biopsychosocial model in psychiatry highlights the importance of investigating the clinical significance of religiosity in patients with psychotic disorders. Due to the spiritual and supernatural nature of religious beliefs, distinguishing them from religious delusions is a challenging endeavour. The self-referential nature of the beliefs, the presence of concomitant psychiatric symptomatology and the effect on functionality seem to play a key role in differential diagnosis. Religious psychotic symptoms are common in clinical practice. The study of these symptoms often becomes difficult due to varying definitions, the fluctuation they present over time and space and the strong influences of the social and cultural environment on them. There seems to be a positive correlation between religiosity and the occurrence of religious delusions in psychotic patients, but it is not clear that this indicates a causal relationship. The content of religious delusions seems to be significantly influenced by the immediate social environment rather than cultural background of the individual, as well as by the beliefs and attitudes of the patient's family environment. Religious delusions are characterized by increased conviction and pervasiveness, permeating to a greater extent the individual's whole experience. Their presence is associated with more severe symptoms, higher medication dosage, and poorer prognosis. The increased severity of psychosis with religious content symptomatology seems to be associated with genetic factors and greater genetic load. In addition, the increased duration of untreated psychosis is a determinant of prognosis. This may reflect a reduced alertness of the immediate environment of patients who develop psychotic symptoms with religious content for the first time. Other important prognostic factors are patients' lack of adherence to treatment, their greater resistance to psychiatric approach of the disorder and their exclusion from religious communities, as well as the special characteristics of religious delusions, which seem more corrosive to the patients' psyche than other delusions. Religion and spirituality are prominent in the lives of the majority of patients with psychosis, but they are often underestimated in clinical practice. Raising the awareness of mental health professionals on issues of a religious and spiritual nature can be beneficial in both preventing and treating psychotic disorders.
精神病学中生物-心理-社会模式的流行强调了研究精神病患者宗教信仰的临床意义的重要性。由于宗教信仰具有精神和超自然的性质，因此将其与宗教妄想区分开来是一项具有挑战性的任务。信仰的自我参照性质、伴随的精神症状的存在以及对功能的影响似乎在鉴别诊断中起着关键作用。宗教性精神病症状在临床实践中很常见。由于定义不同、随时间和空间的波动以及社会和文化环境对其的强烈影响，对这些症状的研究往往变得困难。在精神病患者中，宗教信仰和宗教妄想的发生之间似乎存在正相关关系，但尚不清楚这是否表明存在因果关系。宗教妄想的内容似乎受到即时社会环境的强烈影响，而不是个人的文化背景，以及患者家庭环境的信仰和态度的强烈影响。宗教妄想的特点是信念的坚定性和普遍性增强，更广泛地渗透到个体的整个体验中。它们的存在与更严重的症状、更高的药物剂量和更差的预后相关。具有宗教内容的精神病症状的严重程度增加似乎与遗传因素和更大的遗传负荷有关。此外，未经治疗的精神病持续时间延长是预后的决定因素。这可能反映了具有宗教内容的首次出现精神病症状的患者的即时环境警觉性降低。其他重要的预后因素包括患者对治疗的不依从、对精神疾病的更大抵抗力、以及被宗教社区排斥，以及宗教妄想的特殊特征，这些妄想似乎比其他妄想更能侵蚀患者的心灵。宗教和灵性在大多数精神病患者的生活中都很突出，但在临床实践中往往被低估。提高精神卫生专业人员对宗教和精神问题的认识，对于预防和治疗精神病障碍都可能有益。
