Religious delusions in older adults: Diagnoses, combinations, and delusional characteristics

Spiritually significant hallucinations: a patient-centred approach to tackle epistemic injustice

SUMMARY

This article uses three fictitious case vignettes to raise questions and educate on how clinicians can appropriately approach patients experiencing spiritually significant hallucinations. Religious hallucinations are common but are not pathognomonic of mental illness. They are often intimate experiences for the patient that raise complex questions about psychopathology for clinicians. When assessing a patient with religious hallucinations it is important that clinicians hold at the centre that person's personal experience and create a safe space in which they are listened to and epistemic injustices are avoided. Involvement of chaplaincy services is important not just to support the patient but also to ensure that as clinicians we seek support in understanding the religious nature of these experiences.

Religious delusions in Dutch older adults in treatment for psychosis: a follow-up study

OBJECTIVE

The course over time of religious delusions (RDs) in late-life schizophrenia and psychotic depression may be relevant to know how long certain aspects of RDs may affect treatment. The present study examines (1) the 1-year follow-up of RDs and other prevalent delusions, (2) the association between RDs and the clinical course of psychotic depression and schizophrenia compared to those without RDs, and (3) associations of RDs and other prevalent delusions with "indicators of complexity" (e.g., suicidality, refusing medication).

DESIGN

Prospective study (half year and 1-year follow-up combined).

SETTING

Outpatients and inpatients in Geriatric Psychiatry Institution of Yulius, South-Holland, the Netherlands.

PARTICIPANTS

One hundred and thirty seven older adult patients, mean age 76.3 (s.d. 8.1).

INTERVENTION

Natural follow-up study.

MEASUREMENTS

Diagnostic interview measures included Schedules for Clinical Assessment in Neuropsychiatry (SCAN 2.1), positive psychosis items of the Community Assessment of Psychic Experiences-42 (CAPE), and the 20-item measures from the Centre for Epidemiologic Studies Depression Scale (CES-D).

RESULTS

Although RDs in older adults decline in the clinical course of psychotic depression, the course is unfavorable compared to psychotic depression without RDs with regard to depressive symptom severity as measured by CES-D. No significant differences were noted in relation to clinical course of positive psychotic symptoms for both psychotic depression and schizophrenia. In schizophrenia, RDs persist more frequently compared to the most prevalent delusions. No significant difference was observed between patients with RDs compared to patients without RDs regarding indicators of clinical complexity.

CONCLUSIONS

RDs predicting a less favorable course over time in psychotic depression. In schizophrenia, RDs appears to be relatively pervasive.

Religious hallucinations in Lebanese patients with schizophrenia and their association with religious coping

PURPOSE

to evaluate the relationship between religious hallucinations and religious coping among Lebanese patients with schizophrenia.

METHODS

We have studied the prevalence of religious hallucinations (RH) among 148 hospitalized Lebanese patients suffering from schizophrenia or schizoaffective disorder in November 2021 exhibiting religious delusions (RD), and their relationship with religious coping using the brief Religious Coping Scale (RCOPE). The PANSS scale was used to evaluate psychotic symptoms.

RESULTS

After adjustment over all variables, more psychotic symptoms (higher total PANSS scores) (aOR = 1.02) and more religious negative coping (aOR = 1.11) were significantly associated with higher odds of having religious hallucinations, whereas watching religious programs (aOR = 0.34) was significantly associated with lower odds of having religious hallucinations.

CONCLUSION

This paper highlights the important role of religiosity that has to play in the formation of religious hallucinations in schizophrenia. Significant association was found between negative religious coping and the emergence of religious hallucinations.

Entity encounters and the therapeutic effect of the psychedelic mystical experience

Research suggests that the clinical and therapeutic effects of psychedelics are related to their ability to induce a mystical-type experience. One particularly interesting feature of the psychedelic mystical experience is the entity encounter - people who take psychedelics sometimes describe meetings with seemingly autonomous entities which appear to possess intelligence and agency. While there has been little empirical research into psychedelic entity phenomena, qualitative studies and anecdotal reports suggest that entity encounters can have profound and lasting positive after-effects. Based on the existing data, this article argues that there is value in exploring the therapeutic potential of psychedelic entity encounters. Specifically, it proposes three possible ways that entity encounters might mediate the therapeutic effect of the psychedelic mystical experience.

Religious Hallucinations and Religious Delusions among Older Adults in Treatment for Psychoses in the Netherlands

Background. Although religious delusions (RDs) are common in geriatric psychiatry, we know little about their frequency and content. Our study examines the prevalence and content of religious hallucinations (RHs) and RDs and how they relate to the diagnosis and the patients’ denominational background and other aspects of religiousness. Methods. Semi-structured diagnostic interviews were conducted with inpatients and outpatients (N = 155, mean age 76.5) at a geriatric psychiatry department in the Netherlands. We used the Schedules for Clinical Assessment in Neuropsychiatry 2.1. Results. The prevalences of RHs and RDs were 19% and 32%, respectively. RHs were mostly auditory. There was no statistically significant difference between the prevalence of RHs in schizophrenia (17.5%) and in psychotic depression (9.4%). Compared to non-affiliated patients and mainline Protestants, RDs were significantly more prevalent in raised and current strict Protestants, especially in those with psychotic depression. RHs were more prevalent in Evangelical (e.g., Pentecostal) and strict Protestant patients. The presence of RDs was associated with several measures of religiousness (e.g., dogmatism, religious coping). Conclusions. Religion is likely to act as a symptom-formation factor for psychotic symptoms in strict Protestant older adults. More detailed research might lead to a fuller understanding of how strict religious beliefs may affect the content of psychotic symptoms and unintentionally add a component of existential suffering. It is important for mental health professionals, especially the predominantly secular professionals in the Netherlands, to recognize and address religious themes.