López-Silva Pablo, Harrow Martin, Jobe Thomas H, Tufano Michele, Harrow Helen, Rosen Cherise
Faculty of Social Sciences, School of Psychology, Universidad de Valparaíso, Chile.
Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States.
Schizophr Res. 2024 Mar;265:46-57. doi: 10.1016/j.schres.2022.07.005. Epub 2022 Aug 6.
The co-occurrence of delusions and other symptoms at the onset of psychosis is a challenge for theories about the aetiology of psychosis. This paper explores the relatedness of delusions about the experience of thinking (thought insertion, thought withdrawal, and thought broadcasting) and auditory verbal hallucinations by describing their trajectories over a 20-year period in individuals diagnosed with schizophrenia, affective and other psychosis, and unipolar depression nonpsychosis. The sample consisted of 407 participants who were recruited at index hospitalization and evaluated over six follow-ups over 20 years. The symptom structure associated with thought insertion included auditory verbal hallucinations, somatic hallucinations, other hallucinations, delusions of thought-dissemination, delusions of control, delusion of self-depreciation, depersonalization and anxiety. The symptom constellation of thought withdrawal included somatic hallucinations, other hallucinations, delusions of thought dissemination, delusions of control, sexual delusions, depersonalization, negative symptoms, depression, and anxiety. The symptom constellation of thought broadcasting included auditory verbal hallucinations, somatic hallucinations, delusions of thought-dissemination, delusion of self-depreciation, fantastic delusions, sexual delusions, and depersonalization. Auditory verbal hallucinations and delusions of self-depreciation were significantly associated with both thought insertion and thought broadcasting. Thought insertion and thought withdrawal were significantly associated with other hallucinations, delusions of control, and anxiety; thought withdrawal and thought broadcasting were significantly related to sexual delusions. We hypothesize that specific symptom constellations over time might be explained as the product of pseudo-coherent realities created to give meaning to the experience of the world and the self of individuals in psychosis based on both prior top-down and ongoing bottom-up elements.
妄想与精神病发作时的其他症状同时出现，这对精神病病因学理论构成了挑战。本文通过描述思维体验妄想（思维插入、思维被夺和思维播散）与幻听在20年期间的发展轨迹，探讨它们之间的关联性，研究对象为被诊断患有精神分裂症、情感性精神病及其他精神病，以及单相抑郁（非精神病性）的个体。样本包括407名参与者，他们在首次住院时被招募，并在20年中接受了6次随访评估。与思维插入相关的症状结构包括幻听、躯体幻觉、其他幻觉、思维播散妄想、被控制感妄想、自我贬低妄想、人格解体和焦虑。思维被夺的症状群包括躯体幻觉、其他幻觉、思维播散妄想、被控制感妄想、性妄想、人格解体、阴性症状、抑郁和焦虑。思维播散的症状群包括幻听、躯体幻觉、思维播散妄想、自我贬低妄想、怪异妄想、性妄想和人格解体。幻听和自我贬低妄想与思维插入和思维播散均显著相关。思维插入和思维被夺与其他幻觉、被控制感妄想和焦虑显著相关；思维被夺和思维播散与性妄想显著相关。我们假设，随着时间推移，特定的症状群可能被解释为基于先前自上而下和持续自下而上的因素，为使精神病患者对世界和自我的体验具有意义而构建的伪连贯现实的产物。
