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The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors

  • Daniel Freeman (a1), Anthony Morrison (a2), Jessica C. Bird (a3), Eleanor Chadwick (a4), Emily Bold (a4), Kathryn M. Taylor (a4), Rowan Diamond (a3), Nicola Collett (a5), Emma Černis (a5), Louise Isham (a3), Rachel Lister (a3), Miriam Kirkham (a4), Ashley-Louise Teale (a4), Eve Twivy (a4) and Felicity Waite (a6)...

Abstract

Background

The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding.

Aims

To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors – identified from a cognitive model – before delusion onset.

Method

A total of 100 patients with persecutory delusions completed a checklist about their subjective experiences in the weeks before belief onset. The checklist included items concerning worry, images, low self-esteem, poor sleep, mood dysregulation, dissociation, manic-type symptoms, aberrant salience, hallucinations, substance use and stressors. Time to reach certainty in the delusion was also assessed.

Results

Most commonly it took patients several months to reach delusion certainty (n = 30), although other patients took a few weeks (n = 24), years (n = 21), knew instantly (n = 17) or took a few days (n = 6). The most frequent experiences occurring before delusion onset were: low self-confidence (n = 84); excessive worry (n = 80); not feeling like normal self (n = 77); difficulties concentrating (n = 77); going over problems again and again (n = 75); being very negative about the self (n = 75); images of bad things happening (n = 75); and sleep problems (n = 75). The average number of experiences occurring was high (mean 23.5, s.d. = 8.7). The experiences clustered into six main types, with patients reporting an average of 5.4 (s.d. = 1.0) different types.

Conclusions

Patients report numerous different experiences in the period before full persecutory delusion onset that could be contributory causal factors, consistent with a complex multifactorial view of delusion occurrence. This study, however, relied on retrospective self-report and could not determine causality.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-ncnd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.

Corresponding author

Correspondence: Daniel Freeman, Oxford Cognitive Approaches to Psychosis, University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK. Email: daniel.freeman@psych.ox.ac.uk

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The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors

  • Daniel Freeman (a1), Anthony Morrison (a2), Jessica C. Bird (a3), Eleanor Chadwick (a4), Emily Bold (a4), Kathryn M. Taylor (a4), Rowan Diamond (a3), Nicola Collett (a5), Emma Černis (a5), Louise Isham (a3), Rachel Lister (a3), Miriam Kirkham (a4), Ashley-Louise Teale (a4), Eve Twivy (a4) and Felicity Waite (a6)...
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