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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.

当前关于妄想（delusion）诊断意义的学术争论主要围绕两种核心立场展开。神经认知立场将妄想视为一种虽具有多形性，但属于非特异性的症状；精神病理学立场则认为，妄想的内容、结构等特征与特定诊断类别存在具有临床意义的关联。本研究纳入830名成年精神病性障碍患者作为研究队列，通过分析妄想主题与诊断结果之间的关联，旨在为该学术争论提供新的实证依据。所有诊断均由经验丰富的精神科医师依据《精神障碍诊断与统计手册第四版》（DSM-IV）或《国际疾病分类第十版》（ICD-10）标准作出，其中348名患者的诊断通过《临床定式访谈第一版》（SCID-I）确认。所有患者均接受了简明精神病评定量表（Brief Psychiatric Rating Scale, BPRS）测评。通过分析简明精神病评定量表相关条目得分，判断每位患者是否存在躯体妄想、罪恶妄想、夸大妄想及被害妄想。罪恶妄想几乎是精神病性抑郁障碍的特征性症状：精神病性重性抑郁患者占比40%，精神病性双相抑郁患者占比30%，抑郁型分裂情感障碍患者占比8%，双相及分裂情感混合状态患者占比分别为6%和7%。精神分裂症患者中仅1%存在此类妄想，妄想性障碍、双相躁狂或躁狂型分裂情感障碍患者则无一出现。单相抑郁、双相抑郁与其余诊断组患者的罪恶妄想检出率差异具有极高统计学显著性。夸大妄想多见于存在躁狂症状的患者：双相躁狂患者占比20%，双相混合状态患者占比19%，躁狂型分裂情感障碍患者占比10%。双相躁狂患者的夸大妄想检出率显著高于精神分裂症患者（7%）。被害妄想在各诊断类别中均有分布，但精神分裂症及妄想性障碍患者的被害妄想检出率显著高于抑郁及躁狂患者。躯体妄想在所有诊断组中均有检出，未发现某一诊断组的躯体妄想患病率显著高于其余组别。本研究结果支持神经认知与精神病理学两种立场的折中观点：一方面，被害妄想在各群体中的广泛检出提示，探寻非特异性致病机制具有临床价值；另一方面，部分妄想内容与精神疾病诊断之间的关联表明，对妄想体验的现象学分析可成为临床医师诊断过程中的有效辅助工具。