Advances in understanding and treating persecutory delusions: a review - PubMed (original) (raw)

Review

Advances in understanding and treating persecutory delusions: a review

Daniel Freeman et al. Soc Psychiatry Psychiatr Epidemiol. 2014 Aug.

Abstract

Purpose: Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions.

Methods: A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia.

Results: Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments.

Conclusions: There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.

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Figures

Fig. 1

Fig. 1

The distribution of total paranoia scores in the general population [15]

Fig. 2

Fig. 2

The paranoia hierarchy [14]

Fig. 3

Fig. 3

Outline of factors involved in delusion formation [31]

References

    1. Freeman D, Garety PA, Kuipers E. Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychol Med. 2001;31:1293–1306. -PubMed
    1. Freeman D, Garety PA. Comments on the content of persecutory delusions: does the definition need clarification? Br J Clin Psychol. 2000;39:407–414. -PubMed
    1. Freeman D, Startup H, Dunn G, Wingham G, Cernis E, Evans N, Lister R, Pugh K, Cordwell J, Kingdon D (2014) Persecutory delusions and psychological well-being. Soc Psychiatry Psychiatr Epidemiol 49:1045–1050. doi:10.1007/s00127-013-0803-y -PubMed
    1. Hartley S, Barrowclough C, Haddock G. Anxiety and depression in psychosis. Acta Psychiatr Scand. 2013 -PubMed
    1. Vorontsova N, Garety P, Freeman D. Cognitive factors maintaining persecutory delusions in psychosis: the contribution of depression. J Abnorm Psychol. 2013;122:1121–1131. -PubMed

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