ImportanceDespite growing interest in the phenomenology of delusions in psychosis, at present little is known about their content and evolution over time, including whether delusion themes are consistent across episodes.ObjectiveTo examine the course of delusions and thematic delusion content across relapse episodes in patients presenting to an early intervention service for psychosis.Design, Setting, and ParticipantsThis longitudinal, observational study used clinical data systematically collected from January 2003 to March 2018 from a cohort of consenting patients with affective or nonaffective first-episode psychosis, followed up naturalistically for up to 2 years in an early intervention service for psychosis in Montréal, Quebec, Canada. Data included the thematic content and severity of delusions (scores ≥3 using the Scale for the Assessment of Positive Symptoms) and associated psychotic and nonpsychotic symptoms, both across an initial episode and, in the event of remission, a potential relapse. Data were analyzed from September 2021 to February 2023.ExposureAn early intervention service for psychosis, organized around intensive case management and a multidisciplinary team approach, which observed each patient for up to 2 years of care.Main Outcomes and MeasuresThe primary outcome was positive symptom relapse and remission, including the presence and content of delusions, which was coded per the Scale for the Assessment of Positive Symptoms and accepted definitions. The main statistical measures included repeated paired-sample t tests and binary logistic regression analyses.ResultsOf 636 consenting patients, mean (SD) age was 23.8 (4.75) years; 191 patients were female, 444 were male, and 1 patient was nonbinary. Remission rates were high, and relapse rates were relatively low: 591 individuals had baseline delusions, of which 558 (94.4%) achieved remission. Of these 558 patients, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis. Of the 182 patients who did relapse, however, a large proportion (115 [63.2%]) reported threshold-level delusions. Of these 115, 104 patients (90.4%) had thematic delusion content consistent with that reported during the index (first) episode. Those who relapsed with delusions had fewer delusion themes present during subsequent episodes of psychosis compared with the index episode and lower levels of other psychotic and nonpsychotic symptoms.Conclusions and RelevanceSpecialized early intervention services for psychosis can achieve high rates of sustained remission. However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes. These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.

中文翻译：

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精神病第一次和后续发作的妄想主题的一致性


重要性尽管人们对精神病妄想的现象学越来越感兴趣，但目前对其内容和随时间演变知之甚少，包括妄想主题在发作之间是否一致。目的检查接受精神病早期干预服务的患者复发发作的妄想过程和主题妄想内容。设计、设置和参与者这项纵向观察性研究使用了从 2003 年 1 月至 2018 年 3 月系统收集的临床数据，这些数据是从一组同意的情感性或非情感性首发精神病患者那里收集的，在加拿大魁北克省蒙特利尔的精神病早期干预服务中自然地随访长达 2 年。数据包括妄想的主题内容和严重程度（使用阳性症状评估量表得分 ≥3）以及相关的精神病和非精神病症状，包括初始发作和缓解时可能复发。从 2021 年 9 月到 2023 年 2 月对数据进行了分析。暴露精神病的早期干预服务，围绕强化病例管理和多学科团队方法组织，观察每位患者长达 2 年的护理。主要结局和措施主要结局是阳性症状复发和缓解，包括妄想的存在和内容，根据阳性症状评估量表和公认的定义进行编码。主要统计指标包括重复配对样本 t 检验和二元 logistic 回归分析。结果在 636 例同意的患者中，平均 （SD） 年龄为 23.8 （4.75） 岁;191 例患者为女性，444 例为男性，1 例患者为非二元性别。 缓解率高，复发率相对较低：591 人有基线妄想，其中 558 人 （94.4%） 达到缓解。在这 558 名患者中，只有 182 名 （32.6%） 随后复发为第二次或更晚的精神病发作。然而，在 182 名复发的患者中，很大一部分 （115 [63.2%]）报告了阈值水平的妄想。在这 115 例患者中，104 例 （90.4%） 的主题妄想内容与指数 （第一次） 发作期间报告的主题妄想内容一致。与指示发作相比，那些以妄想复发的患者在随后的精神病发作中出现的妄想主题较少，其他精神病和非精神病症状的水平较低。结论和相关性 精神病的专业早期干预服务可实现较高的持续缓解率。然而，在这项研究中，少数后来复发的妄想患者在随后的发作中经历了类似的妄想主题。这些发现为妄想的概念化提出了重要的考虑，并对疾病和护理的轨迹具有临床意义。