Dimensional approach to delusions: comparison across types and diagnoses.
Dimensional approach to delusions: comparison across types and diagnoses.
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DOI：
10.1176/ajp.156.12.1938
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发表时间：
1999-12
期刊：
影响因子：
--
通讯作者：
P. Appelbaum;P. Robbins;L. Roth
中科院分区：
文献类型：
--
作者：
P. Appelbaum;P. Robbins;L. Roth
目的：采用维度方法对妄想的特征进行表征，以检验非内容相关的妄想描述符在揭示诊断类别和妄想类型之间的差异方面的使用。方法对1136名急性住院精神病患者进行访谈，根据诊断访谈表中的筛选问题确定受试者为明确或可能的妄想。患有妄想的受试者被给予麦克阿瑟-莫兹利妄想评估表，该表在妄想的六个维度上产生分数。妄想按类型分类，并使用DSM-III-R检查表进行诊断。结果328人（29%）被评为明显妄想或可能妄想。他们在麦克阿瑟-莫兹利妄想量表各维度上的评分有显著但适度的相关。精神分裂症患者通常比其他诊断类别的患者有更强烈的妄想。宏伟妄想和宗教妄想是最坚定的信念，而迫害妄想则以强烈的负面影响和行为倾向为特征。对维度的因子分析揭示了一个一致的两因素解决方案——“强度和范围”和“影响和行动”——无论诊断或妄想类型如何。结论不同诊断和妄想类型的妄想维度结构的稳定性表明，即使是看似不同的妄想，其相似度也大于不同度；这与常见的病因机制一致。此外，通过表征不同类型和诊断的妄想，从而突出治疗和其他含义的能力，表明了维度方法的效用。
OBJECTIVE A dimensional approach to the characterization of delusions was used to examine the use of non-content-related descriptors of delusions in revealing differences across diagnostic categories and delusion types. METHOD Interviews with 1,136 acutely hospitalized psychiatric patients identified subjects as definitely or possibly delusional on the basis of screening questions derived from the Diagnostic Interview Schedule. Subjects with delusions were given the MacArthur-Maudsley Delusions Assessment Schedule, which generates scores on six dimensions of delusions. Delusions were classified by type, and diagnoses were assigned by using the DSM-III-R checklist. RESULTS A total of 328 subjects (29%) were rated as definitely or possibly delusional. Their ratings on dimensions of the MacArthur-Maudsley Delusions Assessment Schedule were significantly but modestly intercorrelated. Subjects with schizophrenia generally had more intense delusions than those in other diagnostic categories. Grandiose and religious delusions were held with the greatest conviction, whereas persecutory delusions were marked by strong negative affect and a propensity to act. Factor analysis of the dimensions revealed a consistent two factor solution-"intensity and scope" and "affect and action"-regardless of the diagnosis or delusion type. CONCLUSIONS The stability of the dimensional structure of delusions across diagnoses and delusion types suggests that even seemingly diverse delusions are more like than unlike each other; this is consistent with common etiologic mechanisms. The utility of a dimensional approach is indicated, in addition, by the ability to characterize delusions of different types and diagnoses so as to highlight therapeutic and other implications.