The study examined how religious beliefs and practices impact upon medication and illness representations in chronic schizophrenia. One hundred three stabilized patients were included in Geneva's outpatient public psychiatric facility in Switzerland. Interviews were conducted to investigate spiritual and religious beliefs and religious practices and religious coping. Medication adherence was assessed through questions to patients and to their psychiatrists and by a systematic blood drug monitoring. Thirty-two percent of patients were partially or totally nonadherent to oral medication. Fifty-eight percent of patients were Christians, 2% Jewish, 3% Muslim, 4% Buddhist, 14% belonged to various minority or syncretic religious movements, and 19% had no religious affiliation. Two thirds of the total sample considered spirituality as very important or even essential in everyday life. Fifty-seven percent of patients had a representation of their illness directly influenced by their spiritual beliefs (positively in 31% and negatively in 26%). Religious representations of illness were prominent in nonadherent patients. Thirty-one percent of nonadherent patients and 27% of partially adherent patients underlined an incompatibility or contradiction between their religion and taking medication, versus 8% of adherent patients. Religion and spirituality contribute to shaping representations of disease and attitudes toward medical treatment in patients with schizophrenia. This dimension should be on the agenda of psychiatrists working with patients with schizophrenia.

Our results highlight the clinical significance of religion in the care of patients with schizophrenia. Religion is neither a strictly personal matter nor a strictly cultural one. Spirituality should be integrated into the psychosocial dimension of care. Our results suggest that the complexity of the relationship between religion and illness requires a highly sensitive approach to each unique story.

Religion is an important issue for patients with schizophrenia, and it is often not related to the content of their delusions. Clinicians were commonly not aware of their patients' religious involvement, even if they reported feeling comfortable with such an issue.

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Based on theorization on the four basic dimensions of religiousness, Believing, Bonding, Behaving, and Belonging, and corresponding cognitive, emotional, moral, and social motives and functions of religion, we developed a measure and investigated cross-cultural consistency of the four dimensions as well interindividual and cross-cultural variability. Data were collected from 14 countries varying in religious heritage: Catholicism, Protestantism, Orthodox Christianity, Judaism, Islam, and Buddhism/Taoism ( N = 3,218). Beyond their high interrelation and common personality correlates, that is, agreeableness and conscientiousness, the four dimensions were distinct across cultures and religions, less interrelated in Eastern Asia compared to the West, differentially preferred across cultural zones, and characterized by distinct features. Believing and bonding, to which spirituality was primarily related, were preferred in Western secular societies. Behaving and belonging, valued in religious societies, were importantly related to fundamentalism, authoritarianism, and low openness. Bonding and behaving were primordial in, respectively, Israel and Turkey. Furthermore, belonging (marked by extraversion) and bonding were uniquely associated with increased life satisfaction, whereas believing was uniquely related to existential quest and decreased life satisfaction. Thus, the multidimensionality of religiousness seems deeply rooted in distinct psychological dispositions evident at both the individual and the cultural levels.

Delusions with religious content have been associated with a poorer prognosis in schizophrenia. Nevertheless, positive religious coping is frequent among this population and is associated with a better outcome. The aim of this study was to compared patients with delusions with religious content (n = 38), patients with other sorts of delusions (n = 85) and patients without persistent positive symptoms (n = 113) clinically and spiritually. Outpatients (n = 236) were randomly selected for a quantitative and qualitative evaluation of religious coping. Patients presenting delusions with religious content were not associated with a more severe clinical status compared to other deluded patients, but they were less likely to adhere to psychiatric treatment. For almost half of the group (45%), spirituality and religiousness helped patients cope with their illness. Delusional themes consisted of: persecution (by malevolent spiritual entities), influence (being controlled by spiritual entities), and self-significance (delusions of sin/guilt or grandiose delusions). Both groups of deluded patients valued religion more than other patients, but patients presenting delusions with religious content received less support from religious communities. In treating patients with such symptoms, clinicians should go beyond the label of "religious delusion," likely to involve stigmatization, by considering how delusions interact with patients' clinical and psychosocial context.

A ddressing cultural issues associated with health care among patients with severe mental disorders is part of recovery-oriented care (1). This is in line with the concept of "psychiatry for the person," which has been advanced in recent years by the World Psychiatric Association. The concept places the patient's whole person at the center of clinical care and health promotion, at both individual and community levels (2).Obviously, religion is part of the cultural dimension of humans. Religion, in its broadest sense, encompasses spirituality (concern with the transcendent and with the significance and meaning of life and similar issues) and religiousness (specific behavioral, social, and doctrinal practices and denominational characteristics). Spirituality and religiousness have been identified as pivotal in the psychological process of recovery from severe mental disorders such as schizophrenia, in that they may provide meaning and hope in suffering (3,4). Nevertheless, ways of addressing religion in clinical settings remain to be established, particularly among individuals with severe disorders, such as psychosis (5).Some studies have shown the importance of religion to patients with psychosis. A study of 406 persons with persistent mental illness found that 80% used religious beliefs or practices to cope with daily difficulties or frustrations, particularly those

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