Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada.
Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, Montréal, Quebec, Canada.
JAMA Psychiatry. 2024 Oct 1;81(10):1039-1046. doi: 10.1001/jamapsychiatry.2024.2040.
Despite growing interest in the phenomenology of delusions in psychosis, at present little is known about their content and evolution over time, including whether delusion themes are consistent across episodes.
To examine the course of delusions and thematic delusion content across relapse episodes in patients presenting to an early intervention service for psychosis.
DESIGN, SETTING, AND PARTICIPANTS: This longitudinal, observational study used clinical data systematically collected from January 2003 to March 2018 from a cohort of consenting patients with affective or nonaffective first-episode psychosis, followed up naturalistically for up to 2 years in an early intervention service for psychosis in Montréal, Quebec, Canada. Data included the thematic content and severity of delusions (scores ≥3 using the Scale for the Assessment of Positive Symptoms) and associated psychotic and nonpsychotic symptoms, both across an initial episode and, in the event of remission, a potential relapse. Data were analyzed from September 2021 to February 2023.
An early intervention service for psychosis, organized around intensive case management and a multidisciplinary team approach, which observed each patient for up to 2 years of care.
The primary outcome was positive symptom relapse and remission, including the presence and content of delusions, which was coded per the Scale for the Assessment of Positive Symptoms and accepted definitions. The main statistical measures included repeated paired-sample t tests and binary logistic regression analyses.
Of 636 consenting patients, mean (SD) age was 23.8 (4.75) years; 191 patients were female, 444 were male, and 1 patient was nonbinary. Remission rates were high, and relapse rates were relatively low: 591 individuals had baseline delusions, of which 558 (94.4%) achieved remission. Of these 558 patients, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis. Of the 182 patients who did relapse, however, a large proportion (115 [63.2%]) reported threshold-level delusions. Of these 115, 104 patients (90.4%) had thematic delusion content consistent with that reported during the index (first) episode. Those who relapsed with delusions had fewer delusion themes present during subsequent episodes of psychosis compared with the index episode and lower levels of other psychotic and nonpsychotic symptoms.
Specialized early intervention services for psychosis can achieve high rates of sustained remission. However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes. These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.
尽管人们对精神病中妄想的现象学越来越感兴趣，但目前对于妄想的内容及其随时间的演变知之甚少，包括妄想主题是否在各发作期之间保持一致。
研究在精神病早期干预服务机构就诊的患者中，在复发发作期间，妄想及其主题妄想内容的演变过程。
设计、地点和参与者：这是一项纵向、观察性研究，从 2003 年 1 月至 2018 年 3 月，从魁北克省蒙特利尔的一个早期精神病干预服务机构中，使用从同意参与情感或非情感首发精神病的患者中系统收集的临床数据，对符合条件的患者进行了前瞻性随访，最长达 2 年。数据包括（使用阳性症状评定量表评定）得分为≥3 的妄想的主题内容和严重程度，以及与精神病和非精神病症状相关的内容，包括首发发作期，以及在缓解期后潜在的复发期。数据于 2021 年 9 月至 2023 年 2 月进行分析。
精神病早期干预服务，围绕强化病例管理和多学科团队方法，对每个患者进行长达 2 年的护理观察。
主要结果是阳性症状的复发和缓解，包括存在和内容的妄想，这是根据阳性症状评定量表和公认的定义进行编码的。主要的统计措施包括重复配对样本 t 检验和二元逻辑回归分析。
在 636 名同意的患者中，平均（SD）年龄为 23.8（4.75）岁；191 名女性，444 名男性，1 名非二元性别。缓解率较高，复发率相对较低：591 名患者基线时有妄想，其中 558 名（94.4%）达到缓解。在这 558 名患者中，只有 182 名（32.6%）随后出现第二次或后续精神病发作的复发。然而，在这 182 名复发的患者中，很大一部分（115 名[63.2%]）报告存在阈下水平的妄想。在这 115 名患者中，104 名（90.4%）的主题妄想内容与首发（第一次）发作时报告的内容一致。那些复发时伴有妄想的患者在随后的精神病发作期间出现的妄想主题较少，其他精神病和非精神病症状的水平也较低。
专门的精神病早期干预服务可以实现高比例的持续缓解。然而，在这项研究中，后来复发并伴有妄想的患者在随后的发作期经历了与首发发作期相似的妄想主题。这些发现对妄想的概念化提出了重要的考虑，并对疾病轨迹和护理具有临床意义。
