How monitoring delusions may prevent psychotic relapse

Psychotic delusions are thought to be similar from one psychotic episode to the next and this clue could help prevent psychotic relapses in young adults and adolescents, according to a research team from McGill University.The results were published in JAMA Psychiatry in August.About 600 patients between 14 and 35 participated in the Prevention and Early Intervention Program for Psychosis (PEPP-Montréal) at the Douglas Mental Health University Institute in Montreal. Since 2003, individuals experiencing a first episode of psychosis received care and services, as well as a two-year followup by an interdisciplinary team. It is the relapses that occur during these two years that the researchers wanted to observe.In this cohort, the remission rate was particularly high. These results confirm the benefits of early intervention, especially during a first episode of psychosis. "By offering more intensive services at the very beginning of the intervention, it changes the trajectory of the illness. There is a reduced risk of relapse and a higher rate of remission," noted Dr. Jai Shah, psychiatrist and professor in the department of psychiatry at McGill University.By looking at the recurrence of delusions, it emerged that the themes of delusional ideas were particularly similar from one psychotic episode to another. If paranoia was present during a first psychosis, it was highly likely to be present again during a subsequent episode. On arrival at PEPP, most patients presented with at least three types of delusion. However, during relapses, only one or two themes persisted. "Delusions seem to become more personalized over time. Fewer themes seem to emerge during the second or subsequent episodes," explained Gil Grunfeld, principal author of the study and doctoral candidate in clinical psychology at Boston University.Early warningThe researchers also found that relapses could occur at any time during these two years. There are no signs to predict whether a patient is at greater risk of relapse at the beginning or at the end of their treatment. Sustained support would therefore enable the first signs to be detected. "Our data suggest that if we only consider delusions as being present or absent, we may miss certain information," noted Grunfeld. "For example, the presence of certain themes or recurring stories may be considered an early warning sign of a possible relapse, even if they do not meet all the criteria for delirium."Being on the lookout for the emergence of these recurring themes requires listening carefully to patients. "By focusing on each patient's story, I believe we are able to better understand their experience. What we call a delusion, for them, is a belief. We have to listen carefully to what patients tell us and what it means to them," concluded Dr. Shah.

How monitoring delusions may prevent psychotic relapse

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