Delusional Experiences Research Articles

Lifetime prevalence of psychotic-like experiences and associated factors in Chile.

Psychotic-like experiences (PLEs), which include hallucinations and delusional experiences, are usually present in healthy populations, and their persistence, quality, and severity are associated with the development of psychiatric diseases, including schizophrenia and other poor psychosocial outcomes. Urbanicity, depression, and other psychosocial stressors have been associated with PLEs. However, evidence of PLEs in Latin American (LATAM) countries is still scarce, and there are no studies about PLEs in Chile. The main aim of this study is to describe the prevalence of PLEs in a nationally representative sample according to othersocial determinants of health. The last results of the Chilean National Health Survey (ENS 2016-2017) were analyzed. PLEs were obtained from the Composite International Diagnostic Interview (CIDI) 3.0 and included in this survey. Other psychosocial variables (age, sex, educational level, financial stress, depressive symptoms, and urbanicity) were also included for further analysis. Exclusion criteria were (1) > = 65 and < 18years old, and (2) previous diagnosis or treatment for schizophrenia or bipolar disorder. Descriptive statistics were used to describe data, and Poisson regression models were performed to weight variables and find psychosocial correlations with PLEs. 2095 subjects were considered for this study (women 62.9% and mean age = 42.5, SD = 13.5). The lifetime prevalence of the PLEs (> = 1 PLE) in Chile was 12.9%. Visual hallucinations were the most common PLE (9.6%), and ideas of reference were the least common (0.4%). The Poisson regression model showed a higher prevalence of PLEs in the Gran Concepción conurbation (OR = 2.56) and Gran Valparaíso conurbation (OR = 1.69) compared with non-big cities. On the other hand, the 18-24year group had higher PLEs prevalence compared to other age groups. No correlations were found with educational status, financial stress, or depressive symptoms. A relatively high prevalence of PLEs was found in the Chilean general population, particularly in youth living in large urban areas (Gran Valparaíso and Gran Concepción), which is compatible with previous research. Considering that there were no correlations between low educational level and financial or depressive symptoms, it is necessary to have more studies that correlate other urban relevant variables, such as natural disasters, drug consumption, and domestic or neighborhood violence.

Childhood trauma associated with psychotic-like experiences among people living with HIV: The chain mediation effect of stigma and resilience

BackgroundPrevious research established the associations between childhood trauma and psychosis, but the effects of childhood trauma on psychotic-like experiences (PLEs) among people living with HIV (PLWH) and the potential mediation mechanisms in these associations remain unclear. ObjectiveThis study aimed to investigate the effects of childhood trauma on PLEs, as well as the chain mediation roles of stigma and resilience in this relationship. Furthermore, we explored whether the aforementioned associations differed when hallucinatory experiences (HEs) and delusional experiences (DEs) were separately modeled. Participants and settingThe sample included 333 outpatients participants (95.2 % males, Mage = 28.24 ± 7.12) living with HIV recruited from Hunan Province, China; and data were collected with a cross-sectional survey. MethodThe hypothesized chain mediation models were examined using SPSS PROCESS macro 3.3 software. ResultsVarious influencing mechanisms of childhood trauma on HEs and DEs were examined in this study. Our results showed that, (a) childhood trauma directly exerted negative effect on HEs, while the chain mediation effect of stigma and resilience were not statistically significant. Conversely, (b) childhood trauma exerted no direct influence on DEs but rather through the chain mediation effect of stigma and resilience. ConclusionsThe identification of two different routes between that childhood trauma can have on HEs and DEs highlighted the importance of tailored prevention and intervention among PLWH with a history of childhood trauma.

Perceived school bullying and psychotic-like experiences in sexual minority adolescents: the mediating and moderating roles of resilience

AimsThis two-wave, longitudinal study aimed to examine the potential moderating and mediating effects of resilience on the association between perceived school bullying and psychotic-like experiences among Chinese sexual minority adolescents.MethodsA total of 4192 senior high students were included and 984 (23.5%) of them were identified as a sexual minority (mean age = 16.68 years, SD = 0.71). Participants completed two online surveys during April 21 to May 12, 2021 and December 17 to 26, 2021, respectively, as well as completed self-report measures of sample characteristics, perceived school bullying, resilience, and psychotic-like experiences (including two dimensions: delusional experiences and hallucinatory experiences).ResultsPerceived school bullying and resilience were associated with psychotic-like experiences in sexual minority adolescents. Resilience mediated the relationship between perceived school bullying and subsequent psychotic-like experiences (b = 0.03, 95% CI = 0.01 ~ 0.04)/ delusional experiences (b = 0.03, 95% CI = 0.01 ~ 0.04)/ hallucinatory experiences (b = 0.02, 95% CI = 0.01 ~ 0.03). Additionally, resilience only moderated the associations of perceived school bullying with hallucinatory experiences (b = −0.06, 95% CI = −0.12 ~ −0.01).ConclusionsThese findings indicated that resilience plays a crucial role in mediating or moderating the relationship between perceived school bullying and psychotic-like experiences. Assessing and reducing school bullying, as well as promoting resilience, may have important clinical implications for reducing the risk of psychotic-like experiences in sexual minority adolescents.

The association of psychotic experiences with clinical and sociodemographic characteristics in cannabis users

ABSTRACT Objective The term psychotic experiences (PEs) encompass subclinical hallucinatory and delusional experiences. There are limited number of studies on PEs clinical and socio-demographic characteristics. We aimed to investigate the association between PEs and patterns of cannabis use, cognitive functions, schizotypy and childhood traumas. Methods Participants were recruited from specialized units using the snowball method. All of the participants were regular cannabis users. Participants with PEs and without PEs were compared by looking into socio-demographic and clinical correlates. Significant variables at univariate comparisons were included in binary multivariate logistic regression analysis with PEs as the dependent variable. Results Forty participants were recruited (20 with PEs, 20 without PEs). Adolescence onset of cannabis use (χ2 = 8.120; p < 0.05), positive schizotypy (t = 3.762; p < 0.01), Trail Making Test A (TMT A) Scores (u = 98.5; p < 0.01) and emotional neglect (u = 128; p = 0.05) were significantly associated with PEs. The binary regression model included a significant contribution of positive schizotypy (OR = 1.16, CI 1.025–1.330) and TMT A Score (OR = 1.22, CI 1.03–1.44). Conclusions Results showed a novel positive association of PEs with adolescent-onset cannabis use, TMT A Scores, positive schizotypy and emotional neglect. PEs were predicted independently by positive schizotypy and TMT A Scores.

Sexual orientation and psychotic-like experiences among Chinese college students: the role of gender.

The mental health of sexual minorities has received increasing attention, but there are few studies on the risk of psychotic-like experiences (PLEs) among sexual minorities. The purpose of this study is to explore the relationship between different sexual orientations and PLEs among college students and the moderating effect of gender. A total of 4,460 college students from seven provinces participated in this cross-sectional survey. The χ2 test and logistic regression were used to investigate the relationship between sexual orientation and PLEs. Of the participants, 4.9% identified as bisexual, 1.1% as lesbian/gay, and 5.6% were questioning/unsure; 60.1% of the sample experienced at least one PLE item, 59.2% reported delusional experiences (DEs), and 20.6% had hallucinatory experiences (HEs). Compared with heterosexual college students, bisexual and questioning students showed a higher risk of PLEs, DEs, and HEs, and lesbian/gay students showed a higher risk of HEs. Stratified analysis indicated that sexual orientation was significantly associated with PLEs only for female college students. Sexual orientation is a predictive factor of PLEs. In particular, different sexual minority subgroups show the different effects on PLEs between male and female college students. Mental health interventions for PLEs could employ distinct strategies based on different sexual orientations and gender disparity.

Double bookkeeping in schizophrenia spectrum disorder: an empirical-phenomenological study

Double bookkeeping is a term introduced by Eugen Bleuler to describe a fundamental feature of schizophrenia where psychotic reality can exist side by side with shared reality even when these realities seem mutually exclusive. Despite increasing theoretical interest in this phenomenon over the recent years, there are no empirical studies addressing this issue. We have, therefore, conducted a phenomenologically descriptive qualitative study of 25 patients with schizophrenia in which we addressed the following issues: (1) Experience of double reality; (2) Emergence and development of two realities; (3) Truth quality of psychotic or private reality; (4) Insight into illness; (5) Communication of psychotic experiences. The most important result was that most patients felt to be in contact with another dimension of reality. Hallucinatory and delusional experience pertained to this different reality, which patients most frequently kept separated from the shared reality. This other dimension was considered by the patients as being more profound and real. The pre-psychotic and psychotic experiences were difficult to verbalize and typically described as totally different than ordinary experience. Double reality was persistent across remissions. None of the patients considered their condition as an illness analogous to a somatic disorder. Most patients described a vague sense of duality preceding the crystallization of double bookkeeping. This emergence of doubleness was associated with a fundamental alienation from oneself, the world, and others stretching back to childhood or early adolescence. We discuss the results with a special emphasis on the concept of psychosis, clinical interview, treatment, and pathogenetic research.

Dissecting Schizotypy and Its Association With Cognition and Polygenic Risk for Schizophrenia in a Nonclinical Sample.

Schizotypy is a multidimensional construct that captures a continuum of risk for developing schizophrenia-spectrum psychopathology. Existing 3-factor models of schizotypy, consisting of positive, negative, and disorganized dimensions have yielded mixed evidence of genetic continuity with schizophrenia using polygenic risk scores. Here, we propose an approach that involves splitting positive and negative schizotypy into more specific subdimensions that are phenotypically continuous with distinct positive symptoms and negative symptoms recognized in clinical schizophrenia. We used item response theory to derive high-precision estimates of psychometric schizotypy using 251 self-report items obtained from a non-clinical sample of 727 (424 females) adults. These subdimensions were organized hierarchically using structural equation modeling into 3 empirically independent higher-order dimensions enabling associations with polygenic risk for schizophrenia to be examined at different levels of phenotypic generality and specificity. Results revealed that polygenic risk for schizophrenia was associated with variance specific to delusional experiences (γ = 0.093, P = .001) and reduced social interest and engagement (γ = 0.076, P = .020), and these effects were not mediated via the higher-order general, positive, or negative schizotypy factors. We further fractionated general intellectual functioning into fluid and crystallized intelligence in 446 (246 females) participants that underwent onsite cognitive assessment. Polygenic risk scores explained 3.6% of the variance in crystallized intelligence. Our precision phenotyping approach could be used to enhance the etiologic signal in future genetic association studies and improve the detection and prevention of schizophrenia-spectrum psychopathology.

Psilocybin as an antidepressant strategy - a review of safety aspects

IntroductionPsilocybin is considered a classical psychedelic and is increasingly attracting scientific and media attention as an alternative approach to the treatment of various mental disorders.Apart from its efficacy, an important question is the tolerability and safety of psilocybin in general and in a controlled environment. Accurate knowledge of drug safety aspects might be essential for applicability in clinical practice and for drug adherence.ObjectivesThis paper aims to provide an overview of drug safety aspects of psilocybin.MethodsA narrative review was conducted. The literature search was conducted using the bibliographic database MEDLINE.ResultsThe literature search of papers published in recent years showed no serious side effects under psilocybin in controlled study conditions. Common reported ADRs were headache, gastrointestinal complaints such as nausea, diarrhoea and vomiting, tachycardia and arterial hypertension. The lethal dose of psilocybin is many times higher than the therapeutic dose and overdose deaths have not been identified.An often mentioned problem is the occurrence of hallucinogenic persisting perception disorder (HPPD) which, however, did not occur in the studies examined and is most likely to be a problem in the context of recreational use. The results on the safety of psilocybin must be regarded as preliminary; in the studies conducted, risk populations were predominantly excluded, which is, however, relevant for everyday clinical practice. The risk of delusional experiences and so-called “bad trips” is also a relevant safety risk, as it can be associated with risky behaviours. However, these would also be observed more in the area of recreational use.ConclusionsThe use of psilocybin in rigorously controlled study designs appears to be predominantly safe and without serious side effects. At the same time, it should be noted that the results must be considered preliminary and many questions remain open. Many of the risks are more likely to occur in uncontrolled recreational use of psilocybin. At the same time, we see a certain risk in the use of a substance associated with high expectations and a certain “fame” that, without appropriate regulations, the boundaries between sensible therapeutic use and abusive use could become blurred and permeable.Disclosure of InterestNone Declared

Influence of Maternal and Paternal History of Mental Health in Clinical, Social Cognition and Metacognitive Variables in People with First-Episode Psychosis.

This study investigates, for the first time, clinical, cognitive, social cognitive and metacognitive differences in people diagnosed with first-episode of psychosis (FEP) with and without a family history of mental disorder split by maternal and paternal antecedents. A total of 186 individuals with FEP between 18 and 45 years old were recruited in community mental-health services. A transversal, descriptive, observational design was chosen for this study. Results suggest that there is a higher prevalence of maternal history of psychosis rather than paternal, and furthermore, these individuals exhibit a specific clinical, social and metacognitive profile. Individuals with a maternal history of mental disorder scored higher in delusional experiences, inhibition of the response to a stimulus and higher emotional irresponsibility while presenting a poorer overall functioning as compared to individuals without maternal history. Individuals with paternal history of mental disorder score higher in externalizing attributional bias, irrational beliefs of need for external validation and high expectations. This study elucidates different profiles of persons with FEP and the influence of the maternal and paternal family history on clinical, cognitive, social and metacognitive variables, which should be taken into account when offering individualized early treatment.

Psychotic-like experiences among university female students in Qatar: A qualitative-phenomenological study.

Background and aimsPsychotic-like experiences (PLEs) are hallucinatory or delusional experiences that fall below the threshold of a diagnosable psychotic disorder. Although PLEs are common across the spectrum of psychiatric disorders, they also have been commonly reported in the general population. In this study, we aimed to describe the types of PLEs experienced by university students in Qatar. Furthermore, we aimed to examine how students frame, explain, and deal with these experiences as well as understand how culture and religion may shape the way students attribute and respond to these experiences.MethodThis study used a qualitative phenomenological approach. For collecting the data, we conducted semi-structured interviews using the Questionnaire for Psychotic Experiences (QPE). The QPE is a valid and reliable tool to assess the phenomenology of psychotic-like experiences. The questionnaire was translated into Arabic and tested and validated in Qatar (a fast-developing Muslim country in the Arabian Peninsula). We conducted interviews in Arabic with 12 undergraduate female students at Qatar University (the only national university in Qatar). The interviewees were of different Arab nationalities. Interviews were transcribed verbatim and two authors conducted the content-thematic analysis separately, as a strategy to validate the findings. The study was part of a larger nationally funded project that was approved by the Qatar University Institutional Review Board. The approvals were granted before any interview was conducted.ResultsThe PLEs were prevalent in our non-clinical sample. The content-thematic analysis revealed the following main themes about these experiences: type, impact on daily function, frequency, immediate reaction, attribution style, assumptions about the root cause of these experiences, other associations, and religious links to experiences. The results also highlighted that religion and culture play a role in shaping the types of hallucinations and some delusions.ConclusionOur findings support the importance of culture and religion in relation to the types and explanations that students provided when describing PLEs. Notably, it was common among those who reported having these experiences to normalize and link PLEs to real-life events. This may be a defense mechanism to protect the self against the stigma of mental illness and from being labeled as “abnormal”.

Psychotic-like experiences and associated socio-demographic factors among pregnant women in each trimester in China.

ObjectivePsychotic-like experiences (PLEs) are quite common in the general populations without a clinical diagnosis, but pregnant women have been neglected in earlier literature. This study aimed to investigate the prevalence and correlates of PLEs among pregnant women without previous psychiatric history in each trimester.MethodA total of 950 pregnant women participated in a cross-sectional survey, with social and demographic information collected. The Positive Subscale of Community Assessment of Psychic Experiences (CAPE) was used to measure PLEs, and the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) and the Edinburgh Postnatal Depression Scale (EPDS) were used to examine anxious and depressive symptoms, respectively. Logistic regression analyses were conducted to investigate the risk factors for pregnant women with PLEs.ResultsIn our study, 37.2% of the pregnant women in this sample experienced at least one episode of PLEs, while 4.3% reported “often” having PLEs. More pregnant women experienced PLEs, delusional experiences, and hallucinatory experiences in the first two trimesters than in the third trimester. Factors associated with a higher risk for more frequent PLEs include: rural setting, unplanned pregnancy, parity 1, and EPDS scores. High positive correlations were shown between frequency scores among experiences of PLEs and GAD-7 scores, EPDS scores.ConclusionEpisodes of PLEs are common in Chinese pregnant women; however, only a small proportion has persistent PLEs. It is vital to pay attention to women with psychosis risk in pregnancy.

A network approach to relationships between cannabis use characteristics and psychopathology in the general population

Cannabis use characteristics, such as earlier initiation and frequent use, have been associated with an increased risk for developing psychotic experiences and psychotic disorders. However, little is known how these characteristics relate to specific aspects of sub-clinical psychopathology in the general population. Here, we explore the relationships between cannabis use characteristics and psychopathology in a large general population sample (N = 2,544, mean age 29.2 years, 47% women) by employing a network approach. This allows for the identification of unique associations between two cannabis use characteristics (lifetime cumulative frequency of cannabis use, age of cannabis use initiation), and specific psychotic experiences and affective symptoms, while controlling for early risk factors (childhood trauma, urban upbringing). We found particularly pronounced unique positive associations between frequency of cannabis use and specific delusional experiences (persecutory delusions and thought broadcasting). Age of cannabis use initiation was negatively related to visual hallucinatory experiences and irritability, implying that these experiences become more likely the earlier use is initiated. Earlier initiation, but not lifetime frequency of cannabis use, was related to early risk factors. These findings suggest that cannabis use characteristics may contribute differentially to risk for specific psychotic experiences and affective symptoms in the general population.

A pilot study of trained ICU doulas providing early psychological support to critically ill patients

BackgroundOver a third of critical illness survivors suffer from mental health problems following hospitalization. Memories of delusional experiences are a major risk factor. In this project, ICU doulas delivered a unique positive suggestion intervention targeting the vulnerable time period during critical illness when these memories are formed.MethodsAdult critically ill patients were recruited for this single-arm, prospective pilot study. These ICU patients received a positive suggestion intervention daily during their ICU stay in parallel with their medical treatment. The intervention was designed to be delivered over a minimum of two sessions. Feasibility was defined as intervention delivery on ≥ 70% of ICU days after patient enrollment. As a secondary analysis, psychometric questionnaires were compared to those of a historic control cohort of patients receiving standard care in the ICU using adjusted linear regression models.ResultsOf the 97 patients who received the intervention and were alive at the end of their ICU course, 54 were excluded from analyses mostly for having received only one session because of a short ICU length of stay of < 2 days, transitioning to comfort care or not wanting to answer the study questionnaires. Forty-three patients who completed 2 or more sessions of the positive therapeutic suggestion intervention provided by two trained ICU doulas received it for a median of 4 days (IQR 3, 5), with each session lasting for a median of 20 min (IQR 14, 25). The intervention was delivered on 71% of days, meeting our pre-determined feasibility goal. Compared to historical controls (N = 299), patients receiving the intervention had higher severity of illness and longer length of stay. When adjusted for baseline differences, patients both with and without mechanical ventilation who received the intervention scored lower on the Hospital Anxiety and Depression Scale (HADS)—Depression subscale. The intervention was also associated with reduced HADS-Anxiety subscale among ventilated patients.ConclusionsPositive therapeutic suggestion delivered by ICU doulas is feasible in the ICU setting. A randomized trial is warranted to better delineate the role that positive suggestion and ICU doulas may play in ongoing interprofessional efforts to humanize critical care medicine.The study was registered on clinicaltrials.gov (NCT03736954) on 03/14/2018 prior to the first patient enrollment https://clinicaltrials.gov/ct2/show/NCT03736954?cond=ICU+Doulas+Providing+Psychological+Support&draw=2&rank=1.

Uncovering the realities of delusional experience in schizophrenia: a qualitative phenomenological study in Belgium

Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to a different kind of reality experience. How this alteration of reality experience should be characterised, which dimensions of experiential life are involved, and whether delusional reality might differ from standard reality in various ways is unclear and little is known about how patients with delusions value and relate to these experiential alterations. This study aimed to investigate the nature of delusional reality experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. In this qualitative phenomenological study, we recruited individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis from two psychiatric-hospital services in Belgium using homogenous sampling. Criteria for participation were having undergone at least one psychotic episode with occurring delusional symptoms, present at least 1 year before participation, on the basis of clinical notes assessed by the attending psychiatrist; a schizophrenia-spectrum diagnosis, ascertained through clinical interview by the attending psychiatrist upon admission; being aged between 18 years and 65 years; and having the capacity to give informed consent. Exclusion criteria included worries concerning capacity to consent and risk of distress caused by participation. We did phenomenologically driven semi-structured interviews with the participants to explore the nature of delusional reality experience and their subjective valuation of these experiences. We used interpretative phenomenological analysis, a qualitative method tailored to the in-depth exploration of participants' first-person perspective, to analyse their accounts. Between March 2, 2020, and Sept 30, 2020, 18 adults (13 men and five women, aged 19-62 years) participated in the interview study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants' sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality experience can differ from standard reality in various ways (ie, in a hypo-real and hyper-real form), across multiple dimensions (eg, meaningfulness, necessity and contingency, and detachment and engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. Increased awareness and recognition of the distinctive nature of delusional reality experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for individuals with delusions whose lived realities are not always evident from an everyday perspective. FWO Flanders. For the Dutch translation of the abstract see Supplementary Materials section.

Delusion-like experiences are related to negative perceptions of self and others in non-clinical individuals

ABSTRACT Background Delusions are a core feature of psychosis and are thought to exist on a continuum from healthy individuals to clinical populations. This study examined the relationship between delusion-like experiences, using the Peters Delusional Inventory (PDI), and two aspects of personal worldview: core schemas (positive and negative views of the self and others) and locus of control (LOC). Methods 258 healthy participants without a history of psychiatric illness completed an online survey assessing these constructs. Stepwise regression controlling for age and negative affect, revealed that negative self-schemas significantly predicted the presence of delusion–like experiences whilst negative schemas of others significantly predicted both the presence of delusion–like experiences and associated levels of distress and preoccupation. Results Positive schemas did not relate to delusions as measured by the PDI. Hierarchical regression demonstrated that LOC did not significantly predict delusion–like experiences. Discussion The findings highlight that negative schemas of others may be more critically related to delusional experiences than negative self-schemas. Replication in clinical samples is required, while some implications for future research and clinical interventions in prodromal psychosis are examined.

System of Psychological Support Based on Positive Suggestions to the Critically Ill Using ICU Doulas.

Background:Surviving critical illness often creates a lasting psychological impact, including depression, anxiety, and post-traumatic stress. Memories of frightening and delusional experiences are the largest potentially modifiable risk factor, but currently, there is no proven intervention to improve these inciting factors. Psychological support based on positive suggestion is a psychotherapeutic approach that can be provided even to patients in altered cognitive states and is therefore a viable psychotherapy intervention throughout the ICU stay. Traditional ICU care team members have limited time and training to provide such psychological support to patients. Doulas are trained supportive companions who have been effectively used to provide patient advocacy and emotional support in other clinical settings and may address this need. Our aim was to train and implement a psychological support based on positive suggestion program for the critically ill using doulas, and measure acceptance of this intervention through stakeholder feedback.Methods:Doula training included three objectives: an introduction to ICU practice structure and policies; education about fundamental aspects of critical care conditions and procedures; and didactic and hands-on learning experiences in effective use of psychological support based on positive suggestion in the critically ill. Doulas were evaluated at the end of their training and during subsequent clinical activities using competency-based assessments as well as through survey-based questions and interviews with key stakeholders.Results:The ICU doulas performed psychological support based on positive suggestion on 43 critically ill patients in the ICU setting. Stakeholder feedback from nurses, patients, and patient families was positive. The majority (28/32) of surveyed bedside ICU nurses reported that the doulas’ involvement was helpful for both patients and nurses alike. All interviewed family members offered positive comments about the ICU doula presence and of the 40 patients who recalled the intervention 37 found it comforting.Conclusions:Our program successfully trained two doulas to work effectively in the ICU setting performing patient-centered psychological support based on positive suggestion interventions. Their training improved their skill sets and was reported as beneficial by patients, families, and critical care nursing. This training program offers a proof of concept that could be applied in other medical centers, bringing doulas more commonly into the ICU practice to help humanize the experience for patients, families, and medical teams.

Underlying delusion: Predictive processing, looping effects, and the personal/sub-personal distinction

ABSTRACT What is the relationship between the concepts of the predictive processing theory of brain functioning and the everyday concepts with which people conduct and explain their mental lives? To answer this question, we focus on predictive processing explanations of mental disorder that appeal to false inference. After distinguishing two concepts of false inference, we survey four ways of understanding the relationship between explanations of mental phenomena at the personal and sub-personal level. We then argue that if predictive processing accurately accounts for psychological and socio-cultural dynamics, then personal and sub-personal concepts must display a looping relationship that can impact the nature of at least some mental phenomena. In particular, explaining the phenomenon of delusion in terms of the sub-personal concept of false inference should change the nature of delusional experiences themselves.

Uncovering the Realities of Delusional Experience: A Qualitative Phenomenological Study

Background: Delusions in schizophrenia are commonly approached as empirical false beliefs about everyday reality. Phenomenological accounts, by contrast, have suggested that delusions are more adequately understood as pertaining to different kind of reality-experience. To date, however, the specific nature of delusional reality-experience has not been subject to systematic empirical study. It is also unclear how this alteration of reality-experience should be characterized, which dimensions of experiential life are involved and whether delusional reality may differ from standard reality in various ways. Furthermore, little is known about how delusional patients value and relate to these experiential alterations. This study aimed to investigate the nature of delusional reality-experience, and its subjective apprehension, in individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis. Methods: In this study, individuals with lived experience of delusions and a schizophrenia-spectrum diagnosis formed a purposeful sample. Phenomenologically driven semi-structured interviews were conducted to explore the nature of delusional reality-experience and participants’ subjective valuation of these experiences. Interpretative Phenomenological Analysis (IPA), a qualitative method tailored to the in-depth exploration of participants’ first-person perspective, was used to analyze participants’ accounts. Findings: Between Mar 2, 2020 and Sep 30, 2020, 18 adults with a clinical schizophrenia-spectrum diagnosis and lived experience of delusions participated in the interview-study. The findings suggest that delusions are often embedded in wide-ranging alterations of basic reality-experience, involving quasi-ineffable atmospheric and ontological qualities that undermine participants’ sense of the world as unambiguously real, fully present, and shared with others. We also found that delusional reality-experience can differ from standard reality in various way (i.e., in a hypo –and hyper-real form), across multiple dimensions (e.g., meaningfulness, necessity/contingency, detachment/engagement), and that participants are often implicitly or explicitly aware of the distinction between delusional and standard reality. Finally, delusional experience can have an enduring value and meaning that is not fully captured by a strictly medical perspective. Interpretation: Increased awareness and recognition of the distinctive nature of delusional reality-experience, in both clinical and research settings, can improve diagnostic accuracy, explanatory models, and therapeutic support for delusional individuals whose lived realities are not always evident from an everyday perspective. Funding Statement: FWO Flanders - 12Q3319N Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethical approval for the study was obtained from Ghent University Hospital Ethics Committee (EC/2019/0042). All participants gave written informed consent, including for use of anonymized quotes.

A Chaplain's View on Religious Delusions (and Other Extraordinary Experiences): Towards a Theological Framework of Understanding.

In this article, the author discusses the question of how to evaluate delusions with religious or spiritual content from a theological perspective. How does a spiritual care practitioner listen to such delusions? The author proposes a theory of meaning that can account for both ordinary and extraordinary experiences and discusses a list of theological criteria in terms of which spiritual care practitioners can understand delusional and other extraordinary experiences and beliefs with spiritual content.

Cognitive Biases Questionnaire for Psychosis (CBQp): Spanish Validation and Relationship With Cognitive Insight in Psychotic Patients.

Introduction: Cognitive biases are key factors in the development and persistence of delusions in psychosis. The Cognitive Biases Questionnaire for Psychosis (CBQp) is a new self-reported questionnaire of 30 relevant situations to evaluate five types of cognitive biases in psychosis. In the context of the validation of the Spanish version of the CBQp, our objectives were to (1) analyze the factorial structure of the questionnaire with a confirmatory factor analysis (CFA), (2) relate cognitive biases with a widely used scale in the field of delusion cognitive therapies for assessing metacognition, specifically, Beck's Cognitive Insight Scale (BCIS) (1), and, finally, (3) associate cognitive biases with delusional experiences, evaluated with the Peters Delusions Inventory (PDI) (2).Materials and Methods: An authorized Spanish version of the CBQp, by a translation and back-translation procedure, was obtained. A sample of 171 patients with different diagnoses of psychoses was included. A CFA was used to test three different construct models. Associations between CBQp biases, the BCIS, and the PDI were made by correlation and mean differences. Comparisons of the CBQp scores between a control group and patients with psychosis were analyzed.Results: The CFA showed comparative fit index (CFI) values of 0.94 and 0.95 for the models with one, two, and five factors, with root mean square error of approximation values of 0.031 and 0.029. The CBQp reliability was 0.87. Associations between cognitive biases, self-certainty, and cognitive insight subscales of the BCIS were found. Similarly, associations between total punctuation, conviction, distress, and concern subscales of the PDI were also found. When compared with the group of healthy subjects, patients with psychoses scored significantly higher in several cognitive biases.Conclusion: Given the correlation between biases, a one-factor model might be more appropriate to explain the scale's underlying construct. Biases were associated with a greater frequency of delusions, distress, conviction, and concern as well as worse cognitive insight in patients with psychosis.