Religious Delusions in a Xhosa Schizophrenia Population

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.

"Blessed are the Nations with High Levels of Schizophrenia": National Level Schizophrenia Prevalence and Its Relationship with National Levels of Religiosity

Schizophrenia is correlated with religious delusions but, heretofore, the relationship between schizophrenia prevalence and religiosity has not been explored at the national level. Examining this relationship, we find that national level schizophrenia prevalence is correlated with national level religiosity and strongly negatively correlated with national level atheism across 125 countries. When controlling for cognitive performance and economic development in multiple regression analyses, the proportion of the variance explained was 2.9% (p < .005) for Religiousness and 5.1% for Atheism (p < .00005). Alternative causal interpretations of this association are discussed.

Spirituality, dimensional autism, and schizotypal traits: The search for meaning

The relationships of spirituality with human social cognition, as exemplified in autism spectrum and schizophrenia spectrum cognitive variation, remain largely unstudied. We quantified non-clinical levels of autism spectrum and schizotypal spectrum traits (using the Autism Quotient and the Schizotypal Personality Questionnaire-Brief Revised) and dimensions of spirituality (using the Hardt Spirituality Questionnaire) in a large sample of undergraduate students. We tested in particular the hypothesis, based on the diametrical model of autism and psychosis, that autism should be negatively associated, and positive schizotypal traits should be positively associated, with spirituality. Our primary findings were threefold. First, in support of the diametric model, total Spirituality score was significantly negatively correlated with total Autism Quotient score, and significantly positively correlated with Positive Schizotypal traits (the Schizotypal Personality Cognitive-Perceptual subscale), as predicted. Second, these associations were driven mainly by opposite patterns regarding the Search for Meaning Spirituality subscale, which was the only subscale that was significantly negatively associated with autism, and significantly positively associated with Positive Schizotypal traits. Third, Belief in God was positively correlated with Positive Schizotypal traits, but was uncorrelated with autism traits. The opposite findings for Search for Meaning can be interpreted in the contexts of well-supported cognitive models for understanding autism in terms of weak central coherence, and understanding Positive Schizotypal traits in terms of enhanced salience.

Conference proceedings of the 4th Masterclass Psychiatry: Transcultural Psychiatry - Diagnostics and Treatment, Luleå, Sweden, 22-23 February 2018 (Region Norrbotten in collaboration with the Maudsley Hospital and Tavistock Clinic London)

BACKGROUND

According to estimates from the European Commission, Europe has experienced the greatest mass movement of people since the Second World War. More than one million refugees and migrants have arrived in the European Union in the past few years. Mental health and primary care professionals are more likely than ever to meet patients from different cultures and backgrounds.

AIMS

To equip mental health and primary care professionals with transcultural skills to deal with patients from unfamiliar backgrounds.

METHOD

Lectures and case discussions to explore the latest advances in the diagnosis and treatment of serious mental health problems in a transcultural context.

RESULTS

Lectures covered transcultural aspects of mental health problems, treatment in different cultural and ethnic contexts, and assessment of risk factors for self-harm and harm in migrant populations.

CONCLUSIONS

Clinicians require a sound grounding in transcultural skills to confidently and empathically deal with patients from unfamiliar backgrounds.

Delusion, possession and religion†

BACKGROUND

Religion and psychiatry may be both considered to be two different ways of explaining the unknown, of responding to questions about the meaning of life, and of bringing healing.

AIMS

To discuss the border between religion and psychiatry.

METHOD

This lecture explores the interface between religion and psychiatry and discusses the border between soul and mind.

RESULTS

Religious beliefs may affect behaviours and may been seen on a psychopathological continuum with overvalued ideas and delusions. There is an overlap between psychiatric and religious categories, in possession states described in research literature and by many cultural groups. Several studies suggest possible factors for differentiating schizophrenia from demonic influence and report on the efficacy of exorcism among possessed/psychotic subjects. Diagnostic criteria have been proposed for dissociative trance disorder or possession disorder.

CONCLUSIONS

Both mental health professionals and religious believers may require criteria to distinguish adaptive and maladaptive expressions of religious experience.

The content of delusions in a sample of South African Xhosa people with schizophrenia

BACKGROUND

Although the relationship between cultural beliefs and schizophrenia has received some attention, relatively little work has emerged from African contexts. In this study we draw from a sample of South African Xhosa people with schizophrenia, exploring their cultural beliefs and explanations of illness. The purpose of the article is to examine the relationship between this cultural context and the content of delusions.

METHODS

A sample comprising 200 Xhosa people with schizophrenia participating in a South African schizophrenia genomics study were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Participant delusions were thematically analyzed for recurring themes.

RESULTS

The majority of participants (n = 125 72.5%) believed that others had bewitched them in order to bring about their mental illness, because they were in some way jealous of the participant. This explanation aligns well with the understanding of jealousy-induced witchcraft in Southern African communities and highlights the important role that culture plays in their content of delusions.

CONCLUSIONS

Improved knowledge of these explanatory frameworks highlights the potential value of culturally sensitive assessment tools and stigma interventions in patient recovery. Furthermore such qualitative analyses contribute towards discussion about aspects of delusional thought that may be more universally stable, and those that may be more culturally variable.

Religious psychopathology: The prevalence of religious content of delusions and hallucinations in mental disorder

BACKGROUND

Religious themes are commonly encountered in delusions and hallucinations associated with major mental disorders, and the form and content of presentation are significant in relation to both diagnosis and management.

AIMS

This study aimed to establish what is known about the frequency of occurrence of religious delusions (RD) and religious hallucinations (RH) and their inter-relationship.

METHODS

A review was undertaken of the quantitative empirical English literature on RD and RH.

RESULTS

A total of 55 relevant publications were identified. The lack of critical criteria for defining and classifying RD and RH makes comparisons between studies difficult, but prevalence clearly varies with time and place, and probably also according to personal religiosity. In particular, little is known about the content and frequency of RH and the relationship between RH and RD.

CONCLUSION

Clearer research criteria are needed to facilitate future study of RD and RH, and more research is needed on the relationship between RD and RH.