Delusion and hallucinations - an empirical correlation analysis

Introduction

Delusion and hallucinations occur in a variety of psychiatric disorders. In the last years they have been considered multidimensional phenomena, since emotional, cognitive and action-oriented aspects were recognized. According to the cognitive model of the development of positive symptoms, emotional processes play an important role for the relationship between delusion and hallucinations. Although delusion and hallucinations often coexist, there are few empirical studies, which explore this relationship.

Objectives

Aim of the study is to elucidate the relationship between delusion and hallucinations taking into consideration their multidimensionality.

Methods

Eighty-two patients with delusion and hallucinations with a schizophrenia spectrum disorder were examined. Several instruments to the exploration of delusion and hallucinations were used as the Psychotic Symptoms Rating Scales (PSYRATS), MacArthur-Maudsley Delusions Asessment Scchedule (MMDAS), Dimensions of Delusional Experience (DDE), Positive and Negative Syndrom Scale (PANSS), Brown Assessment of Beliefs Scale (BABS), Clinical Delusion Rating Scale (CDRS) and the Heidelberger Delusion Profile (HDP). The correlations between formal hallucination and delusion criteria, as well as formal hallucination criteria and delusion content were calculated. The causal relationship between delusion and hallucinations was tested through a structural equation modelling.

Results

Correlations between delusion and hallucinations dimensions could be found, at item, subscale and scale levels. Emotional and cognitive delusion dimensions correlated significantly with hallucinations magnitude. The delusion content showed a significant influence on the occurrence and emotional dimension of hallucinations. Delusion secondary to hallucinations could only be partially confirmed.

Conclusions

The results confirm the complex structure of the relationship between delusion and hallucinations.

Zur empirischen Unterscheidung von Scham und Schuld

Zusammenfassung: Aus unterschiedlichen theoretischen Perspektiven ist die Bedeutung der Emotionen Scham und Schuld für die Entstehung psychischer Störungen kontrovers diskutiert worden. Bislang wurden die unterstellten Zusammenhänge empirisch noch nicht zufrieden stellend untersucht, da derzeit wenige gut evaluierte Erhebungsinstrumente zur Erfassung und Differenzierung von Scham und Schuld vorliegen. Aufgrund dieses Mangels soll in der vorliegenden Arbeit die deutsche Version des “Test of Self-Conscious Affects” (TOSCA) vorgestellt und hinsichtlich der Gütekriterien evaluiert werden. Der TOSCA erfasst typische affektive, kognitive und verhaltensbezogene Aspekte, die mit einer Neigung, mit Schuld bzw. Scham zu reagieren, assoziiert sind. Darüber hinaus werden Stolz sowie emotionsrelevante Attributionsmuster erfasst. Ergebnisse aus Studien mit einer klinischen Stichprobe stationärer psychiatrischer Patienten (N = 127) und einer nicht-klinischen studentischen Stichprobe (N = 194) weisen auf hohe interne Konsistenzen und Retest-Reliabilitäten der Subskalen hin. Die empirische Differenzierbarkeit beider Emotionen bestätigt sich durch das Muster der Skaleninterkorrelation; Hinweise auf die klinische Bedeutung von Scham gegenüber Schuld ergeben sich aus den Zusammenhängen mit störungsrelevanten Persönlichkeitseigenschaften.

[Effect of personality factors and structure on the course of major depression]

The extent to which personality characteristics predict the course of severe depression has been controversially discussed. In a sample of 50 depressed inpatients, the significance of personality characteristics for the prediction of relapse was studied prospectively over 2 years. More than half of the patients studied suffered relapses within this period. Well-known predictors such as the number of previous episodes were confirmed. The personality characteristics studied showed different predictive effects at 1- and 2-year follow-up. Neurosis proved predictive of the 1-year course and outcome but not the 2-year course. In the 2nd year of follow-up, a melancholic personality structure was associated with favourable outcome. This personality type therefore seems to be more appropriate as a predictor of long-term outcome. Comparison with predictive factors described earlier showed that in this study, personality traits influence outcome independently and were not confused by other predictors. Implications for relapse prevention and psychotherapeutic management are discussed.

[The family emotional involvement and criticism scale]

The construct of expressed emotion is regarded as one of the most important predictors of the course of schizophrenia and has also proven to be a predictor of the course of depressive disorders, psychosomatic disorders and physical illness. Despite its clinical significance, the utility of the EE-construct has been limited since measurement by interview is time-consuming, and to date only applicable to psychotic illness. Questionnaires as a practicable alternative to the structured interview are also mostly applicable solely to psychotic disorders. One exception is the Family Emotional Involvement and Criticism Scale (FEICS, Shields et al.). This questionnaire allows a general assessment of EE and thus a practical application of EE to the general area of family research. In a sample of n = 202 patients, the German version of this instrument proved to be reliable in our research. The two-factor structure of the original American version was replicated. We found good correlation between the measured factors, and clinical and other diagnostic markers particular to family pathology. This questionnaire is therefore a brief, reliable and valid instrument for measuring EE in many disorders.

[Stability of therapeutic outcome after child- and adolescent psychoanalytical therapy--a five-year catamnesis]

In the Heidelberg study about psychoanalytic therapy with children and adolescents 133 cases have been studied in a naturalistic design. Up to now results were published on the basis of assessments of experts only. This follow-up study has investigated the stability of therapy outcomes from the perspectives of different raters. For that outcome has been rated five years after the end of treatment by experts, parents and children themselves. Good outcomes have been stabile and have shown even after five years. Single variables showed further improvement in the time of follow-up, for example the social communicative impairment with parents. Thus the high rate of successful longterm psychoanalytic therapies with children and adolescents could be confirmed from different rater perspectives.

Family perception of interpersonal behavior as a predictor in eating disorders: a prospective, six-year followup study

This study assessed family perception patterns of interpersonal behavior in families with a daughter diagnosed with an eating disorder 6 years after treatment that used a prospective design. Family perception patterns of patients found to have a poor outcome at followup (n = 15) were compared with patients with a good outcome (n = 23), as well as a control group (n = 36). Using the system of multiple level observation of groups (SYMLOG), all 238 family members evaluated themselves and each other. The index patients with a poor outcome perceived themselves as friendlier and more positive than they were perceived by their families. In comparison to parents of daughters with a good outcome and the control group, parents of daughters in the poor outcome group perceived themselves to be less friendly than their partners perceived them to be. A rigid polarization of the perception of the index patient by family members and a discrepancy in this perception between the index patient and the rest of the family were found to be indicative of a poor prognosis. Implications for treatment based on family perception patterns of interpersonal behavior are discussed.

[Critical life events during the course of 2 years of 'major depression.' A prospective study with inpatients]

A number of studies has shown a significant relationship between life events/life conditions and depression. However, there is only a small number of studies investigating the effect of life events/life conditions in patients with severe depression from the endogenous subtype. The results are inconsistent. The present study examines the significance of the patients' life events/life conditions for the two year outcome of the illness in a prospective study with assessments every three months. Patients are compared to healthy controls with regard to the period three months prior to the admission to the hospital at the index episode. The results confirm the importance of life events and life conditions for the long term outcome of depressed patients with endogenous subtype respectively severe major depression in-patients. Relapsers show considerably more undesirable life conditions than non-relapsers three to six months prior to their relapse. Depressed patients indicate significantly more undesirable life events and life conditions and fewer desirable life conditions in comparison to the control group for the time span three months prior to their hospitalization. Clinical implications are discussed.

["Expressed emotion", marital quality and risk of recurrence in depressed patients]

Long-term course of depression appears to be clearly correlated to marital quality and quality of the relationship with spouses. Aim of the present study is the replication of results, indicating that expressed emotion (EE) is an important factor in prediction of relapse in depression. Additionally, the correlation between EE shown by spouses and the severeness of depressive symptomatology as well as the importance of martial quality as seen by patients for relapse are investigated. Results of our study indicate that spouses EE does not predict relapse, and status of EE does not correlate with the extent of depressive symptoms. However, patient self ratings of satisfaction with marital relationship and of perceived criticism are related to relapse frequency. Additionally, discrepant ratings of marital satisfaction given by spouses predict relapse to some extent. Implications for research in affective disorders and clinical practice are discussed.

The influence of psychopathology, personality, and marital interaction on the short-term course of major depression

By means of an aggregated variables design the domains of 'psychopathology', 'personality', and 'social interaction' were weighted according to their impact on the 2-year course of 50 patients with unipolar major depression. Preindex course ranked highest, asthenic personality second. Variables of social interaction disappeared in the second-order logistic regression. These findings fit in well with the recent literature. They are interpreted in terms of habituation processes and residual personality changes which lower the vulnerability threshold for relapse and unfavorable course. As a consequence of this conclusion early relapse prevention would be most important.

[Utilization of ambulatory psychotherapy by patients with endogenous depression after inpatient psychiatric treatment]

The long-term course of major depressive disorder is often accompanied by relapses or chronicity. Since psychosocial factors have been shown to be important predictors for the long-term outcome, psychotherapy along with drug therapy belongs to the standard methods of treatment. In spite of the effectiveness of psychotherapy, only some of the inpatients are treated with outpatient psychotherapy after hospital discharge. Within the framework of the Heidelberg depression study the authors examined what kind of, how many and for how long endogenously depressed patients sought out-patient psychotherapy after an inpatient treatment in a two-year follow-up. During the follow-up one half of patients were treated with outpatient psychotherapy. They were found to be younger, had suffered from more previous episodes, and their personality was more disturbed than those who had not undergone psychotherapy. The Expressed Emotion index did not make any further difference, whereas certain aspects of partnership quality did. The distinction between the two groups of patients is discussed regarding possible selection processes by treatment indication. It is pointed out that research on synergistic cooperation between members of the mental health services is highly desirable.