“The more things change…”? Stability of delusional themes across 12 years of presentations to an early intervention service for psychosis

Abstract: Delusional ideation is characteristic of psychopathology (e.g., psychosis, bipolar disorder) and is also found among the general population. Contemporary case studies have documented delusional ideation as a feature of meditation-induced psychosis, and Buddhist literature on the side effects and adverse effects of meditation also includes discussion of transient experiences that could be considered delusional or delusion-like ideation. Drawing upon interviews with more than 100 Buddhist meditation practitioners and meditation experts (teachers and clinicians) in the West, this paper presents a mixed-methods study of delusion-like ideation (DLI) associated with meditation. We establish a typology of eight types of DLI and report their relative frequencies among the sample; we identify impacts and treatment outcomes associated with DLI; and we provide four case studies that illustrate the risk factors, trajectories, outcomes, and appraisals associated with DLI. We show how responses to DLI are shaped not only by the type of DLI but also by their duration, severity, and impact, as well as the associated appraisals made both by meditators and by meditation teachers and psychiatrists. In some cases, the phenomenology of DLI suggests influences from the lived context of Buddhist meditation cultures. Furthermore, although DLI are normalized in Buddhist meditation culture under certain circumstances, meditation experts also noted the potential severity of meditation-related DLI, with some identifying it as a “red flag” meriting close monitoring if not immediate intervention. Finally, we discuss various explanatory models that could account for the presence, content, and impacts of DLI among meditators, drawing upon the environmental conditions and social contexts of meditation retreats, the role of attention and sensory attenuation in meditation practice, and the ways in which meditation-related DLI can function as a cultural and spiritual “idiom of distress.”

Abstract: Background Research exploring delusions among individuals with psychosis often focuses on form, rather than content, and on prevalence, rather than change in a cohort over time. While delusional forms are mostly consistent across cultures and historical periods, the content of delusions is shaped by sociopolitical factors. Aims We explored the form and content of delusions in a modern sample of individuals with psychosis, examining the extent to which the internet and new technologies become incorporated into delusional frameworks. We investigated whether there was a change in the prevalence of technology delusions over time and how gender, age and education level impacted the probability that a subject would experience technology delusions. Method We reviewed the medical records of 228 adults with psychosis who were seeking treatment at a large academic medical centre between 2016 and 2024 and extracted any description of delusional thought content. We characterised delusions into subtypes and explored the ways these delusions feature the internet and new technologies. To examine temporal trends in the content of delusions, we conducted a binary logistic regression analysis with year as the predictor variable and the presence of technology-related content in delusions as the outcome variable. Results Most subjects (88.2%) reported delusional thought content, with over half (51.7%) describing technology delusions. Logistic regression between the year and technology-related delusion outcome revealed statistically significant ( β = 0.139, p = 0.038, 95% CI (0.008, 0.270)) correlation. For each 1-year increase, the odds of a subject presenting with technology delusions increased by approximately 15% (odds ratio 1.15). Conclusions Among individuals with psychotic disorders, the internet and new technologies are increasingly salient in delusional frameworks. Clinicians should be aware of these themes while eliciting symptoms from patients and also while educating trainees.

TL;DR: The Brief Psychiatric Rating Scale (BRS) as mentioned in this paper was developed to provide a rapid assessment technique particularly suited to the evaluation of patient change, and it is recommended for use where efficiency, speed, and economy are important considerations.

TL;DR: The first consensus-based operational criteria for symptomatic remission in schizophrenia are based on distinct thresholds for reaching and maintaining improvement, as opposed to change criteria, allowing for alignment with traditional concepts of remission in both psychiatric and nonpsychiatric illness.