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Cited by 50Schizophrenia research and treatmentMental Health and PsychiatryBipolar Disorder and Treatment

Delusional themes across affective and non-affective psychoses

Open access
Picardi, Angelo, Fonzi, Laura, Pallagrosi, Mauro, Gigantesco, Antonella, Biondi, Massimo·2018·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2018.00132PMC PMC5895977
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Abstract

The current debate about the diagnostic significance of delusion revolves around two positions. The neurocognitive position conceives delusion as a non-specific, though polymorphic, symptom. The psychopathological position views features of delusion such as content and structure as having meaningful connections with diagnostic entities. This study aims at contributing to this debate by examining the association between delusional themes and diagnosis in a sample of 830 adult psychotic patients. All diagnoses were made by experienced psychiatrists according to DSM-IV or ICD-10 criteria, and in 348 patients were established with the SCID-I. All patients were administered the Brief Psychiatric Rating Scale (BPRS). In each patient, the presence of somatic delusions and delusions of guilt, grandiosity, and persecution was determined by examining the scores on relevant BPRS items. Delusions of guilt were almost pathognomonic for a psychotic depressive condition (psychotic major depression 40%; psychotic bipolar depression 30%; depressed schizoaffective disorder 8%; bipolar and schizoaffective mixed states 6 and 7%, respectively). Only 1% of patients with schizophrenia and no patient with delusional disorder or bipolar or schizoaffective manic state showed such delusions. The difference between unipolar and bipolar depression and the other diagnostic groups was highly significant. Delusions of grandiosity characterized mostly patients with manic symptoms (bipolar mania 20%; bipolar mixed states 19%; manic schizoaffective disorder 10%). They were observed significantly more often in bipolar mania than in schizophrenia (7%). Persecutory delusions were broadly distributed across diagnostic categories. However, they were significantly more frequent among patients with schizophrenia and delusional disorder compared with depressed and manic patients. Somatic delusions were also observed in all diagnostic groups, with no group standing out as distinct from the others in terms of an increased prevalence of somatic delusions. Our findings suggest a middle position in the debate between the neurocognitive and the psychopathological approaches. On the one hand, the widespread observation of persecutory delusions suggests the usefulness of searching for non-specific pathogenic mechanisms. On the other hand, the association between some delusional contents and psychiatric diagnosis suggests that a phenomenological analysis of the delusional experience may be a helpful tool for the clinician in the diagnostic process.

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  • This pattern is largely consistent with findings in other communities, where persecution and grandiosity are often reported as the most common delusional experiences both in patient populations and in general healthy individuals.

    “This is largely consistent with findings in other communities, where persecution and grandiosity are often reported as the most common delusional experiences both in patient populations (Grunfeld et al., 2023; Pappa et al., 2025; Picardi et al., 2018) and in general healthy individuals (Freeman, 2006).”

    From “I was trying to save the world”: delusion-like ideation and associated impacts reported by Western practitioners of Buddhist meditation (2025) · cites this paper as Picardi et al., 2018

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Research works printed but not linked: 2

  1. [38]First MB Spitzer RL Gibbon M Williams JBW Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute (2002).
  2. [51]Bhuyan D Chaudhury PK Nature and types of delusion in schizophrenia and mania – is there a difference? IOSR J Dental Med Sci (2016) 15: 1– 6. 10.9790/0853-1505020106 · DOI

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Authors
Picardi, A., Fonzi, L., Pallagrosi, M., Gigantesco, A., & Biondi, M.
Affiliations
  • Istituto Superiore di Sanità (IT)
  • Sapienza University of Rome (IT)
Corresponding author
Picardi, Angelo
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2018-04-05
Volume
9
Pages
132-132
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2018.00132
PMC
PMC5895977
OpenAlex
W2796247108
Cited by
50
References
49
Citations by year
2026: 9 · 2025: 8 · 2024: 7 · 2023: 6 · 2022: 9 · 2021: 5 · 2020: 5 · 2019: 1
FWCI
2.16
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
Keywords
delusions, psychotic depression, bipolar mania, schizophrenia, delusional disorder, schizoaffective disorder, persecutory delusions, somatic delusions, Brief Psychiatric Rating Scale

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