Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis.
Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis.
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精神病妄想的主观经验和意义：系统评价和定性证据综合。
DOI：
10.1016/s2215-0366(22)00104-3
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Broome,MatthewR
中科院分区：
文献类型：
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作者：
Ritunnano,Rosa;Kleinman,Joshua;WhyteOshodi,Danniella;Michail,Maria;Nelson,Barnaby;Humpston,ClaraS;Broome,MatthewR
背景精神障碍是精神障碍的一个常见的转诊特征，其治疗仍不理想。尽管迫切需要更好地了解这些症状的性质，意义和过程，但对精神病妄想现象的生活经验的研究很少。因此，我们的目的是探索生活经验和主观的妄想在寻求帮助的精神病患者的个人，无论诊断和主题内容的delusion.MethodsIn我们的系统回顾和定性证据合成，我们搜索MEDLINE，Embase，PsycINFO，CINAHL，和Web of Science的定性研究发表在英文数据库的开始，最后一次搜索在2021年9月9日。同时进行了相关期刊的灰色文献检索和手工检索。如果研究提供了从已发展为精神病临床高危期或可诊断的情感性或非情感性精神障碍（根据临床定义、自我报告或在主要研究中评估）的个体（年龄14-65岁）的角度分析妄想或妄想前现象的生活经历，则研究合格。只有在单独报告关注人群的数据时，只有相关受试者子集的研究才有资格。只有当妄想的数据单独报告或可以提取时，才纳入不区分妄想和其他阳性症状（如幻觉）的研究。第一人称帐户（和作者的解释）讨论的自我意识的变化，生活的世界，并与妄想的意义提取和合成使用一种新的主题合成方法通知批判现实主义的立场和现象学的理论框架。分析主题被发展成一个新的总体框架，用于理解妄想现象的出现。该研究在PROSPERO注册，CRD 42020222104。结果在筛选的3265份记录中，2115份在重复删除后被识别。其中，1982例在标题和摘要筛选后被排除，106例在全文合格性评估后被排除。在进入质量评估的27项研究中，24项合格的研究被纳入定性证据合成，代表了373名在精神病背景下有妄想生活经历的寻求帮助者的观点。性别报告为男性（n=210）、女性（n=110）、变性人（n=1）或未报告（n=52）。只有13项研究报告了种族，白色占主导地位。大多数参与者的年龄在15至65岁之间。我们发现没有合格的研究调查亚临床或妄想前的经验，在高危精神状态人群通过定性方法。大多数研究都是在西方，受过教育，工业化，富裕和民主（WEIRD）的社会中进行的，大多数参与者都接受过或自我报告了精神分裂症谱内的诊断。不同的研究是否集中在一种或一个主题的妄想或妄想现象更普遍地作为一个统一的类别。在妄想中，与经验变化和意义相关的三个高级主题被确定为：（1）由强烈情绪主导的生活世界的彻底重组;（2）在妄想现实中怀疑、迷失和重新找到自己;（3）超越单纯的功能障碍寻找意义、归属和连贯性。基于审查结果和专题综合，我们提出了Delerative的出现模型，以促进对妄想现象的理解。
BackgroundDelusions are a common transdiagnostic feature of psychotic disorders, and their treatment remains suboptimal. Despite the pressing need to better understand the nature, meaning, and course of these symptoms, research into the lived experience of delusional phenomena in psychosis is scarce. Thus, we aimed to explore the lived experience and subjective apprehension of delusions in help-seeking individuals with psychosis, regardless of diagnosis and thematic content of the delusion.MethodsIn our systematic review and qualitative evidence synthesis, we searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science for qualitative studies published in English from database inception, with the last search on Sept 9, 2021. Grey literature search and hand-searching of relevant journals were also done. Studies were eligible if they provided an analysis of lived experience of delusions or predelusional phenomena presented from the perspective of individuals (age 14–65 years) who had developed a clinical high-risk stage of psychosis, or a diagnosable affective or non-affective psychotic disorder (as clinically defined, self-reported, or assessed within the primary study). Studies with only a subset of relevant participants were eligible only if data for the population of interest were reported separately. Studies that did not discriminate between the experience of delusion and other positive symptoms (eg, hallucinations) were included only if data for delusions were reported separately or could be extracted. First-person accounts (and author interpretations) discussing changes in the sense of self, lived world, and meaning in relation to delusions were extracted and synthesised using a novel thematic synthesis approach informed by a critical realist stance and a phenomenological theoretical framework. Analytic themes were developed into a new overarching framework for understanding the emergence of delusional phenomena. The study was registered with PROSPERO, CRD42020222104.FindingsOf the 3265 records screened, 2115 were identified after duplicate removal. Of these, 1982 were excluded after title and abstract screening and 106 after full-text eligibility assessment. Of the 27 studies entering quality assessment, 24 eligible studies were included in the qualitative evidence synthesis, representing the perspectives of 373 help-seeking individuals with lived experience of delusions in the context of psychosis. Gender was reported as male (n=210), female (n=110), transgender (n=1), or not reported (n=52). Only 13 studies reported ethnicity, with White being predominant. The age of most participants ranged from 15 to 65 years. We found no eligible studies investigating subclinical or predelusional experiences in at-risk mental state populations through qualitative methods. Most studies were undertaken in western, educated, industrialised, rich, and democratic (WEIRD) societies, and most included participants had received or self-reported a diagnosis within the schizophrenia spectrum. Studies differed in relation to whether they focused on one kind or theme of delusion or delusional phenomena more generally as a unified category. Three superordinate themes relating to experiential changes and meanings in delusion were identified: (1) a radical rearrangement of the lived world dominated by intense emotions; (2) doubting, losing, and finding oneself again within delusional realities; and (3) searching for meaning, belonging, and coherence beyond mere dysfunction. Based on the review findings and thematic synthesis, we propose the Emergence Model of Delusion to advance understanding of delusional phenomena in …