Pappa Elisavet, Baah Fidelia, Lynch Jessica, Shiel Lisha, Blackman Graham, Raihani Nichola, Bell Vaughan
Division of Psychiatry, University College London, London, WC1E 6BT, UK.
Clinical, Educational and Health Psychology, University College London, London, WC1E 6BT, UK.
Schizophr Bull. 2025 May 8;51(3):637-645. doi: 10.1093/schbul/sbae225.
Delusions are classified into themes but the range of themes reported in the literature has never been examined and the extent to which they differ in prevalence, or relate to clinical characteristics or cultural variation, remains poorly understood.
We identified studies reporting delusional theme prevalence in adults with psychosis and completed two multivariate, multilevel, random-effects meta-analyses: one including data from structured assessment scales only and another also including data from ad hoc and clinical assessments to include themes from a wider range of countries and contexts. Sensitivity and meta-regression analyses examined the association with clinical and methodological variables. Analysis code and open data are available online. PROSPERO registration (CRD42019151889).
A total of 155 studies from 37 countries met inclusion criteria. The meta-analysis of data from structured assessments included 110 studies and 173 920 patients. A total of 21 themes were identified from "persecutory/paranoid" (57.33%, 53.75-60.88) to "primary" (5.18%, 1.07-11.55). The meta-analysis of all data included 155 studies and 240 901 patients. Thirty-seven themes were identified, from "persecutory/paranoid" (57.39%, 54.38-60.37) to "made impulse" (4.90%, 0.87-11.26). Ad hoc theme classifications were more common in non-Western contexts. Including these did not substantially alter heterogeneity but increased interaction with cultural clusters. There was no evidence of publication bias or association with risk of bias rating.
We report the first comprehensive meta-analysis of delusional themes. Many commonly reported themes are not included in standard classifications. Relationship to culture was modest but more present when not relying solely on established scales.
妄想可按主题分类，但文献中报道的主题范围从未被研究过，它们在患病率上的差异程度，或与临床特征或文化差异的关联，仍知之甚少。
我们确定了报告成年精神病患者妄想主题患病率的研究，并完成了两项多变量、多层次、随机效应的荟萃分析：一项仅纳入来自结构化评估量表的数据，另一项还纳入来自特设评估和临床评估的数据，以纳入来自更广泛国家和背景的主题。敏感性分析和元回归分析检验了与临床和方法学变量的关联。分析代码和开放数据可在线获取。PROSPERO注册编号（CRD42019151889）。
来自37个国家的155项研究符合纳入标准。对结构化评估数据的荟萃分析纳入了110项研究和173920名患者。共确定了21个主题，从“被害妄想/偏执妄想”（57.33%，53.75 - 60.88）到“原发性妄想”（5.18%，1.07 - 11.55）。对所有数据的荟萃分析纳入了155项研究和240901名患者。共确定了37个主题，从“被害妄想/偏执妄想”（57.39%，54.38 - 60.37）到“冲动控制障碍”（4.90%，0.87 - 11.26）。特设主题分类在非西方背景中更为常见。纳入这些并未显著改变异质性，但增加了与文化集群的相互作用。没有证据表明存在发表偏倚或与偏倚风险评级相关。
我们报告了第一项关于妄想主题的全面荟萃分析。许多常见报道的主题未包含在标准分类中。与文化的关系不大，但在不单纯依赖既定量表时更为明显。
