摘要:

A study sample of 88 delusional patients has been examined prospectively from first admission and during three personal follow-up sessions. After 8 years of observation, the diagnostic distribution is presented according to the ICD-10 and the DSM-III-R classification systems, among which a large degree of agreement is found. Schizophrenia turned out to be the most frequent diagnosis but almost half of the patients belong to another diagnostic category. Diagnostic assignment was changed in only a few patients when compared to the time of discharge after the first admission. From the time of index admission, the patients’ preceding course and global functioning differ. A major finding is the fact that in general short-term course and outcome are very similar to those of medium-term observation. Forty-three per cent of the patients still alive remained delusional throughout the observation period. Delusional beliefs do not persist in all patients with the diagnosis of persistent delusional disorder. Most patients with continuous delusional beliefs belong to the diagnostic category of schizophrenia. Global assessment functioning at 8-year follow-up is: schizophrenia, 35; affective disorder, 82; persistent delusional disorder, 50, and acute and transient psychotic disorder, 72.

ISSN:0254-4962    

DOI:10.1159/000284852

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

A group of 88 delusional patients has been followed prospectively from first admission. The 2-, 4-, and 8-year course and outcome for 75 patients still alive are presented according to main delusional theme at index admission and from a dimensional approach. From the time of index admission, the groups of patients differ with respect to preceding course and global functioning. In general, these differences are maintained although some become more pronounced. The most optimistic perspective appears for patients with main delusion of reference or a low dimensional severity of delusional beliefs and the most pessimistic for patients with main delusions of persecution or influence and for those with a high dimensional severity of delusional beliefs. Thirty-two patients remained delusional throughout the observation period, in most cases with unchanged thematic content; 57% had an episodic and 43% a chronic course. When distributed according to main delusional theme at index admission, Global Assessment Functioning at 8-year follow-up is: persecution, 43; reference, 69; influence, 34; guilt, 58; others, 55; and, on average, 52. Only minor changes occurred between the three follow-up investigations. After the 8-year observation period, more than 50% of the patients were diagnosed schizophrenia. During the observation period 5 patients committed suicide, which means that delusional first admitters have a risk of suicide which is 31.5 times greater than in the general population. The dimensional severity of delusional beliefs is of importance when course and outcome are concerned and may be complementary to a traditional description.

ISSN:0254-4962    

DOI:10.1159/000284853

出版商:S. Karger AG    

年代:1994

数据来源: Karger

摘要:

Delusional beliefs in first admitters with no organic disorder are studied. The study sample of 88 patients provides a representation of delusional beliefs in first admitters. A scale for dimensions of delusional beliefs is proposed and applied to the patient group. The scale includes dimensions of conviction, extension, systematization, probability, pressure and global state. Adequate interobserver agreement is achieved. The patients are distributed according to ICD-10 and DSM-III-R with schizophrenia as the most frequent diagnostic category. More than half of the patients are, however, diagnosed differently. It is obvious that many patients with schizophrenia and persistent delusional disorder are seriously dysfunctioning at their entry into hospital. In contrast patients with affective disorder and acute and transient psychotic disorder are, on the average, functioning reasonably well. Identical delusional themes appear in different diagnostic categories while the dimensional severity of delusional beliefs varies from one category to another. When assessed at admission patients with a discharge diagnosis of schizophrenia have delusional beliefs with a high degree of dimensional severity in contrast to patients with affective disorder. Delusional beliefs in patients with persistent delusional disorder seem more systematized and probable than those diagnosed differently. In interpreting the findings one has to remember that the presence and theme of delusional beliefs are in no way independent aspects of diagnostic category. Description of delusional dimensions may, however, be important for the conceptualization of delusional beliefs and a method to study psychotic decompensation and resolution. Later on the patients were followed in search of the predictive significance of a qualified assessment of delusional beliefs in contrast to syndromes when defined according to new classification systems.

ISSN:0254-4962    

DOI:10.1159/000284854

出版商:S. Karger AG    

年代:1994

数据来源: Karger