夸大妄想的困境：危害、挑战及对治疗参与的影响。
The Difficulties of Grandiose Delusions: Harms, Challenges, and Implications for Treatment Engagement.
机构信息
Department of Psychiatry, University of Oxford, Oxford, UK.
Oxford Health NHS Foundation Trust, Oxford, UK.
出版信息
Schizophr Bull. 2023 Sep 7;49(5):1194-1204. doi: 10.1093/schbul/sbad016.
BACKGROUND AND HYPOTHESIS
Grandiose delusions may entail difficult responsibilities and detrimental actions for patients. Recognition of these consequences by patients may provide an avenue for engagement in treatment. Furthermore, when patients carry out actions within the delusional system ("immersion behaviors") or spend considerable time thinking about their grandiose beliefs this may contribute to the persistence of the grandiosity and further harmful consequences. We, therefore, investigated grandiose-related subjective harm, immersion behaviors, and perseverative thinking.
STUDY DESIGN
A cross-sectional study with 798 patients with psychosis (375 of whom had grandiose delusions) and 4518 nonclinical adults. Factor analyses using data from participants scoring highly on grandiosity were used to form 3 scales: subjective harm from exceptional experiences questionnaire; immersion behaviors questionnaire; and thinking about exceptional experiences questionnaire. Associations with grandiosity were tested using structural equation modeling.
STUDY RESULTS
A total of 268 (77.9%) patients with grandiose delusions identified grandiose-related harms in the past 6 months and 199 (55.1%) wanted help. Immersion behaviors and perseverative thinking were highly prevalent, and explained 39.5% and 20.4% of the variance in grandiosity, respectively. Immersion behaviors and perseverative thinking were significantly associated with subjective harm, even when severity of grandiosity was controlled. Requests for help were associated with higher levels of subjective harm, use of immersion behaviors, and perseverative thinking but not severity of grandiosity.
CONCLUSIONS
Acting on grandiose delusions, including harmful behaviors and excessive thinking about grandiose delusions, may be routes for clinicians to engage patients in treatment. This could be a starting point for targeted psychological interventions for grandiose delusions.
背景和假设
夸大妄想可能会给患者带来困难的责任和不利的行动。患者对这些后果的认识可能为参与治疗提供途径。此外，当患者在妄想系统内采取行动（“沉浸行为”）或花费大量时间思考他们的夸大信念时，这可能会导致夸大的持续存在和进一步的有害后果。因此，我们调查了与夸大有关的主观伤害、沉浸行为和持续思考。
研究设计
一项横断面研究，纳入了 798 名精神病患者（其中 375 名患有夸大妄想）和 4518 名非临床成年人。使用在夸大维度上得分较高的参与者的数据进行因子分析，形成了 3 个量表：非凡体验主观伤害问卷；沉浸行为问卷；非凡体验思考问卷。使用结构方程模型测试与夸大相关的关联。
研究结果
共有 268 名（77.9%）患有夸大妄想的患者在过去 6 个月内识别出与夸大相关的伤害，199 名（55.1%）希望得到帮助。沉浸行为和持续思考非常普遍，分别解释了夸大的 39.5%和 20.4%的变异。即使控制了夸大的严重程度，沉浸行为和持续思考仍与主观伤害显著相关。寻求帮助与更高水平的主观伤害、沉浸行为和持续思考有关，但与夸大的严重程度无关。
结论
实施夸大妄想，包括有害行为和过度思考夸大妄想，可能是临床医生让患者参与治疗的途径。这可能是针对夸大妄想的有针对性的心理干预的起点。
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