The context of delusional experiences in the daily life of patients with schizophrenia

Background. Global characteristics and psychosocial risk factors related to delusions have been identified. The present study extends these findings t o the level of everyday functioning, identifying characteristics of delusio nal moments (DMs) and contextual risk and protective factors for delusional exacerbations in dairy life. Methods. Data were collected using the Experience Sampling Method (ESM), a time-sampling technique. Forty-eight chronic patients diagnosed with schizo phrenia rated the intensity of pathological symptoms and mood states and de scribed their thoughts and the environmental context during consecutive mom ents in daily life. Delusions were defined on the basis of self-rated suspi cion, preoccupation, feeling controlled, and coded thought pathology. Daily context included current activity, persons present and location. Character istics of DMs and non-delusional moments (nDMs) were compared, and a multil evel logistic regression model was used to identify contexts that might tri gger or prevent DMs. Results. On average, patients experienced delusions less than one-third of the time. DMs were characterized by higher negative affect and lower positi ve affect. The presence of family or acquaintances decreased the risk of su bsequently experiencing a DM, whereas withdrawal from activities increased this risk. Conclusions. Data support the validity of ESM for investigating delusions i n schizophrenia. Daily life contexts appear to alter the probability that d elusions will occur. Knowledge about such contexts may therefore be useful in helping patients develop better coping strategies and in creating therap eutic interventions that can lessen emotional distress.