Delusions in first-episode psychosis: Principal component analysis of twelve types of delusions and demographic and clinical correlates of resulting domains

Abstract

Although delusions represent one of the core symptoms of psychotic disorders, it is remarkable that few studies have investigated distinct delusional themes. We analyzed data from a large sample of first-episode psychosis patients (n=245) to understand relations between delusion types and demographic and clinical correlates. First, we conducted a principal component analysis (PCA) of the 12 delusion items within the Scale for the Assessment of Positive Symptoms (SAPS). Then, using the domains derived via PCA, we tested a priori and exploratory hypotheses related to delusional content. PCA revealed five distinct components: Delusions of Influence, Grandiose/Religious Delusions, Paranoid Delusions, Negative Affect Delusions (jealousy, and sin or guilt), and Somatic Delusions. The most prevalent type of delusion was Paranoid Delusions, and such delusions were more common at older ages at onset of psychosis. The level of Delusions of Influence was correlated with the severity of hallucinations and negative symptoms. We ascertained a general relationship between different childhood adversities and delusional themes, and a specific relationship between Somatic Delusions and childhood neglect. Moreover, we found higher scores on Delusions of Influence and Negative Affect Delusions among cannabis and stimulant users. Our results support considering delusions as varied experiences with varying prevalences and correlates.

Auditory and non-auditory hallucinations in first-episode psychosis: Differential associations with diverse clinical features

“…With respect to the association between delusion domains and hallucination domains, a strong correlation between hallucinations (total summary score) and delusions of influence had been previously shown in this sample (Paolini et al, 2016), as well as by Kimhy et al (2005), though specific types of hallucinations were not examined. Here, we found that among the PCA-derived types of delusions (Paolini et al, 2016), the strongest correlation—for both Auditory Hallucinations and Non-Auditory Hallucinations —was with the delusions of influence domain (e.g., delusions of being controlled, mind reading, thought insertion).…”

“…Results of correlation analyses pertaining to the PCA-derived hallucination domains and PCA-derived delusion domains (Paolini et al, 2016), SANS total score, and the three childhood adversity factors are summarized in Table 4. Concerning the association between hallucination domains and delusion domains, the strongest correlation was between both the Auditory Hallucinations subscale score and Non-Auditory Hallucinations subscale score and the delusions of influence (e.g., mind reading, thought broadcasting) subscale score ( ρ =.45, and ρ =.33, respectively).…”

“…The SAPS has 34 items and contains four subscales: hallucinations, delusions, bizarre behavior, and positive formal thought disorder. We previously performed a PCA involving the 12 SAPS delusions items in this sample (Paolini et al, 2016), which uncovered five delusion domains: (1) delusions of influence (being controlled, mind reading, thought broadcasting, thought insertion, and thought withdrawal), (2) grandiose/religious delusions, (3) paranoid delusions (persecutory delusions and delusions of reference), (4) negative affect delusions (jealousy and sin/guilt delusions), and (5) somatic delusions. Those domains are used in the present analysis.…”

Psychopathology in Sri Lankan patients with first-episode psychosis

“…This is further exemplified by the study done by Paolini et al, which reported paranoia to be the most common delusional theme in first episode psychosis (11). However, in a study on first-episode psychosis done by GutierrezLobos et al, jealous, religious, erotomanic and hypochondriacal delusional themes too featured prominently (12).…”

Inefficient Neural Self-Stabilization: A theory of spontaneous resolutions and recurrent relapses in psychosis

“…The insidious prodromal stage in schizophrenia frequently presents with anxiety related to often numerous random coincidental associations and primitive perceptual aberrations [13][14][15] ; but at the peak of a fully evolved episode, psychosis is characterised by a limited number of stereotyped and fully formed delusions and hallucinations that tend to repeat 16 . As psychosis evolves, patients often appear to add further elaborations to this limited set of delusions and hallucinations, rather than forming completely unrelated ideas (see Table 1 for First Person Accounts from [17][18][19] ).…”