Jenner Lucy, Payne Mollie, Waite Felicity, Beckwith Helen, Diamond Rowan, Isham Louise, Collett Nicola, Emsley Richard, Freeman Daniel
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Department of Experimental Psychology, Oxford Cognitive Approaches to Psychosis, University of Oxford, Oxford, UK.
Psychol Med. 2024 Nov 18;54(15):1-9. doi: 10.1017/S0033291724002113.
We aimed to identify the common types of outcome trajectories for patients with psychosis who take up specialist psychological therapy for persecutory delusions. Knowing the different potential responses to therapy can inform expectations. Further, determining predictors of different outcomes may help in understanding who may benefit.
We analyzed delusion conviction data from 767 therapy sessions with 64 patients with persistent persecutory delusions (held with at least 60% conviction) who received a six-month psychological intervention (Feeling Safe) during a clinical trial. Latent class trajectory analysis was conducted to identify groups with distinct outcome profiles. The trajectories were validated against independent assessments, including a longer-term follow-up six months after the end of therapy. We also tested potential predictors of the trajectories.
There were four outcome trajectories: (1) Very high delusion conviction/Little improvement ( = 14, 25%), (2) Very high delusion conviction/Large improvement ( = 9, 16%), (3) High delusion conviction/Moderate improvement ( = 17, 31%) and (4) High delusion conviction/Large improvement ( = 15, 27%). The groups did not differ in initial overall delusion severity. The trajectories were consistent with the independent assessments and sustained over time. Three factors predicted trajectories: persecutory delusion conviction, therapy expectations, and positive beliefs about other people.
There are variable responses to psychological therapy for persecutory delusions. Patients with very high delusion conviction can have excellent responses to therapy, though this may take a little longer to observe and such high conviction reduces the likelihood of positive responses. A trajectory approach requires testing in larger datasets but may prove highly informative.
我们旨在确定接受针对被害妄想的专科心理治疗的精神病患者常见的结局轨迹类型。了解对治疗的不同潜在反应可以为预期提供信息。此外，确定不同结局的预测因素可能有助于理解谁可能从中受益。
我们分析了来自767次治疗疗程的数据，这些疗程涉及64名患有持续性被害妄想（坚信程度至少为60%）的患者，他们在一项临床试验中接受了为期六个月的心理干预（“感到安全”）。进行了潜在类别轨迹分析，以识别具有不同结局特征的组。这些轨迹通过独立评估进行了验证，包括在治疗结束后六个月的长期随访。我们还测试了轨迹的潜在预测因素。
有四种结局轨迹：（1）极高的妄想坚信程度/几乎无改善（n = 14，25%），（2）极高的妄想坚信程度/大幅改善（n = 9，16%），（3）高妄想坚信程度/中度改善（n = 17，31%）和（4）高妄想坚信程度/大幅改善（n = 15，27%）。这些组在初始总体妄想严重程度上没有差异。这些轨迹与独立评估一致且随时间持续存在。三个因素预测了轨迹：被害妄想坚信程度、治疗期望以及对他人的积极信念。
针对被害妄想的心理治疗存在不同的反应。妄想坚信程度极高的患者对治疗可能有出色的反应，尽管可能需要更长时间才能观察到，而且如此高的坚信程度会降低积极反应的可能性。轨迹方法需要在更大的数据集中进行测试，但可能证明具有很高的信息量。
