Oxford Cognitive Approaches to Psychosis, Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
The Psychometrics Centre, Cambridge Judge Business School, University of Cambridge, Cambridge, UK.
Lancet Psychiatry. 2022 Oct;9(10):792-803. doi: 10.1016/S2215-0366(22)00236-X. Epub 2022 Aug 29.
The content of grandiose delusions-inaccurate beliefs that one has special powers, wealth, mission, or identity-is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning.
We did a cross-sectional self-report questionnaire study in two cohorts: non-clinical participants aged 18 years and older, with UK or Irish nationality or residence; and patients with affective or non-affective psychosis diagnoses, aged 16 years and older, and accessing secondary care mental health services in 39 National Health Service providers in England and Wales. Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions (Grandiosity Meaning Measure [termed gram]) and one assessing the sources of meaning (Grandiosity Meaning Measure-Sources [termed grams]). The Grandiosity Meaning Measure and Grandiosity Meaning Measure-Sources were developed using exploratory factor analysis and confirmatory factor analysis. Structural equation modelling was used to test the associations of meaning with the severity of grandiosity. The primary outcome measure for grandiosity was the Specific Psychotic Experiences Questionnaire (grandiosity subscale) and associations were tested with the Grandiosity Meaning Measure and the Grandiosity Meaning Measure-Sources.
From Aug 30, 2019, to Nov 21, 2020, 13 323 non-clinical participants were enrolled. 2821 (21%) were men and 10 134 (76%) were women, 11 974 (90%) were White, and the mean age was 39·5 years (SD 18·6 [range 18-93]). From March 22, 2021, to March 3, 2022, 798 patients with psychosis were enrolled. 475 (60%) were men and 313 (39%) were women, 614 (77%) were White, and the mean age was 43·4 years (SD 13·8 [range 16-81]). The experience of meaning in relation to grandiose delusions had three components: coherence, purpose, and significance. The sources of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self among others, greater good, supporting loved ones, and happiness. The measurement of meaning was invariant across clinical and non-clinical populations. In the clinical population, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion. Meaning in grandiose delusions was strongly associated with severity of grandiosity, explaining 53·5% of variance, and with grandiose delusion conviction explaining 27·4% of variance. Grandiosity was especially associated with sense of purpose, and grandiose delusion conviction with coherence. Similar findings were found for the non-clinical population.
Meaning is inherently tied to grandiose delusions. This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity. The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed.
Health Education England and National Institute for Health and Care Research.
夸大妄想的内容——不准确地认为自己拥有特殊权力、财富、使命或身份——可能具有高度的意义。例如，这种意义可以为患者提供目标感，这可能是妄想产生的关键因素。我们旨在通过实证定义和开发夸大妄想体验和意义来源的测量方法，并检验临床和非临床人群中夸大程度与意义水平之间的关系。
我们在两个队列中进行了横断面自我报告问卷调查研究：18 岁及以上具有英国或爱尔兰国籍或居住权的非临床参与者；以及年龄在 16 岁及以上、在英格兰和威尔士的 39 家国家卫生服务提供者中接受二级保健心理健康服务的情感或非情感精神病患者。高夸大妄想的参与者完成了两个大型项目池：一个评估夸大妄想中的意义体验（称为“宏大意义量表”[简称 gram]），另一个评估意义来源（称为“宏大意义量表-来源”[简称 grams]）。宏大意义量表和宏大意义量表-来源是使用探索性因素分析和验证性因素分析开发的。结构方程模型用于检验意义与夸大程度的关联。夸大妄想的主要衡量标准是特定精神体验问卷（夸大妄想亚量表），并使用宏大意义量表和宏大意义量表-来源进行检验。
2019 年 8 月 30 日至 2020 年 11 月 21 日，共招募了 13323 名非临床参与者。2821 名（21%）为男性，10134 名（76%）为女性，11974 名（90%）为白人，平均年龄为 39.5 岁（标准差 18.6[范围 18-93]）。2021 年 3 月 22 日至 2022 年 3 月 3 日，共招募了 798 名精神病患者。475 名（60%）为男性，313 名（39%）为女性，614 名（77%）为白人，平均年龄为 43.4 岁（标准差 13.8[范围 16-81]）。与夸大妄想相关的意义有三个组成部分：连贯性、目的性和重要性。意义的来源有七个组成部分：积极的社会看法、精神性、克服逆境、对他人的自信、更大的善、支持所爱的人、幸福。意义的衡量在临床和非临床人群中是不变的。在临床人群中，每个人通常都为夸大妄想的意义和来源确定了多种意义和来源。夸大妄想中的意义与夸大程度强烈相关，解释了 53.5%的方差，与夸大妄想信念解释了 27.4%的方差。意义与目的性尤其相关，而夸大妄想信念与连贯性相关。在非临床人群中也发现了类似的发现。
意义与夸大妄想密切相关。本研究为研究和临床实践提供了一个框架，以了解夸大的不同类型的意义。该框架在心理治疗中可能具有临床应用价值，有助于引导患者从生活的其他领域寻找同等意义的来源，从而减少对夸大妄想的需求。
英格兰卫生与保健署和国家卫生与保健研究所。
