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 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.

Methods

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.

Findings

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.

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 individuals with delusions whose lived realities are not always evident from an everyday perspective.

Funding

FWO Flanders.

Translation

For the Dutch translation of the abstract see Supplementary Materials section.

中文翻译：

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揭示精神分裂症妄想体验的现实：比利时的定性现象学研究

背景

精神分裂症中的妄想通常被视为对日常现实的经验性错误信念。相比之下，现象学的解释表明，妄想被更充分地理解为与一种不同的现实体验有关。应如何表征这种现实体验的改变，涉及体验生活的哪些维度，以及妄想现实是否可能在各种方面与标准现实不同，尚不清楚，而且人们对妄想患者如何评价这些体验改变并与之相关知之甚少。本研究旨在调查具有妄想生活经验和精神分裂症谱系诊断的个体的妄想现实体验的性质及其主观理解。

方法

在这项定性现象学研究中，我们使用同质抽样从比利时的两家精神病院服务处招募了具有妄想和精神分裂症谱系诊断的个体。根据主治精神病医生评估的临床记录，参与标准是至少经历过一次精神病发作并出现妄想症状，至少在参与前 1 年出现；精神分裂症谱系诊断，由主治精神科医生在入院时通过临床面谈确定；年龄在 18 岁至 65 岁之间；并有能力给予知情同意。排除标准包括对同意能力的担忧和参与造成的痛苦风险。我们对参与者进行了现象学驱动的半结构化访谈，以探索妄想现实体验的本质以及他们对这些体验的主观评价。我们使用解释性现象学分析（一种专为深入探索参与者的第一人称视角而量身定制的定性方法）来分析他们的陈述。

发现

2020 年 3 月 2 日至 2020 年 9 月 30 日期间，18 名成年人（13 名男性和 5 名女性，年龄在 19-62 岁之间）参与了访谈研究。研究结果表明，妄想通常嵌入在基本现实体验的广泛改变中，涉及几乎不可言喻的大气和本体论品质，这些品质削弱了参与者对世界的明确真实、完全呈现和与他人共享的感觉。我们还发现，妄想的现实体验可以在多个方面（例如，意义、必要性和偶然性，以及超脱和参与）以各种方式（即，以亚真实和超真实形式）与标准现实不同，并且参与者往往隐含或明确地意识到妄想现实和标准现实之间的区别。

解释

在临床和研究环境中，提高对妄想现实体验的独特性质的认识和认识，可以提高诊断准确性、解释模型和对患有妄想的个体的治疗支持，这些个体的生活现实并不总是从日常生活的角度来看总是显而易见的。

资金

FWO法兰德斯。

翻译

有关摘要的荷兰语翻译，请参阅补充材料部分。