Sensitive delusion of reference, "sensitiver Beziehungswahn". Some reflections on diagnostic practice

Screening and assessing ideas and delusions of reference using a semi-structured interview scale: a validation study of the Ideas of Reference Interview Scale (IRIS) in early psychosis patients

BACKGROUND

Ideas and delusions of reference (IOR/DOR) are an important but underrecognized research target. Difficulty in their reliable assessment has been a barrier. A screening and assessment tool incorporating a self-information processing framework, the Ideas of Reference Interview Scale (IRIS), was developed and validated in patients with early psychosis.

METHODS

Comprehensive review of IOR/DOR phenomena in the literature and pilot interviews were conducted for scale item development. Self-referential themes were summarized into 15 items. A consecutive sample of 137 outpatients with early psychosis was interviewed using IRIS. Their IOR/DOR experiences were also rated independently by clinicians on the Scale for the Assessment of Positive Symptoms (SAPS) and self-rated using the IOR subscale on the Schizotypal Personality Questionnaire (SPQ). Inter-rater reliability of IRIS was examined in a subsample of 15 participants.

RESULTS

IRIS demonstrated good internal consistency (Cronbach's alpha 0.80), inter-rater reliability (intraclass correlation coefficient 0.95), and divergent validity with other symptoms. IRIS correlated satisfactorily with the IOR/DOR item or subscale on SAPS and SPQ (Spearman's rho = 0.71 and 0.47, respectively).

DISCUSSION

IRIS provided a reliable high-resolution tool for progressing single-symptom research into IOR/DOR, a potential target feature of schizophrenia. The scale allows future investigation into self-referential processing and detailed phenomenological comparison in different clinical, subclinical, and healthy populations.

Therapy and prevention of affective illness by total sleep deprivation

The therapeutic effect of total sleep deprivation (SD) given twice a week, for 4 weeks, was investigated in 16 drug-free patients with major affective disorders. The response was excellent in five patients, satisfactory in three and minimal in eight patients. Six of these patients were treated prophylactically once a week, and four had an excellent response. Additionally, out of five normothymic drug-free patients with affective illness treated prophylactically with SD, without prior therapeutic SD treatment, three had an excellent response. The majority of responders were rapid cycling patients. This method is worth applying to patients resistant to classical treatment.

An objective study of relationships and discontinuities between paranoid schizophrenia and Kretschmer's syndrome of sensitive delusions of reference

The nosological status of Kretschmer's syndrome of sensitive delusions of reference (Sensitiver Beziehungswahn) has been a matter of discussion over many years. In an attempt to resolve the matter, a series of 147 consecutive patients who had been diagnosed as schizophrenic were reviewed. A group of 13 patients met specified criteria for Kretschmer's syndrome of sensitive delusions of reference, and these patients were compared with the remainder in a variety of ways. The patients with the syndrome of sensitive delusions of reference differed from the remainder in their antecedents (family history and premorbid personality), their EEG status, stresses at time of onset, and response to treatment. The evidence offered here points to the separateness of this syndrome from the other schizophrenic illnesses displayed by the patients reviewed.