精神病患者の「比喩的世界」:妄想に関する概念を根本的に転換する新研究(Psychosis patients ‘living in metaphor’ – new study radically shifts ideas about delusions)

2026-01-13 バーミンガム大学

<関連情報>

• https://www.birmingham.ac.uk/news/2026/psychosis-patients-living-in-metaphor-new-study-radically-shifts-ideas-about-delusions
• https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(25)00341-4/fulltext

妄想は感情として体現される:英国における初発精神病に関する質的・多方法論的研究 Delusion as embodied emotion: a qualitatively driven, multimethod study of first-episode psychosis in the UK

Rosa Ritunnano, MD PhD ∙ Prof Jeannette Littlemore, PhD ∙ Prof Barnaby Nelson, PhD ∙ Clara S Humpston, PhD ∙ Prof Matthew R Broome, MBChB PhD
The Lancet Psychiatry  Published: January 12, 2026
DOI:https://doi.org/10.1016/S2215-0366(25)00341-4

Summary

Background

Delusions in psychosis involve complex and dynamic experiential, affective, cognitive, behavioural, and interpersonal alterations. Their pattern of emergence during the early stages of illness remains poorly understood and the origin of their thematic content unclear. Phenomenological accounts have emphasised alterations of selfhood and reality experience in delusion formation but have not considered the role of life events and other contextual factors in the development of these disturbances. This study aimed to investigate the relationship between self-experience and the lived world in first-episode psychosis by situating the phenomenological analysis of delusions in the context of the person’s life narrative.

Methods

In this qualitatively driven study, we recruited individuals with lived experience of delusions receiving care from three Early Intervention in Psychosis (EIP) teams in the UK. People with lived experience were involved in the development of the study design and protocol. Inclusion criteria were that the individual was being treated within an EIP service; past or current experience of clinically significant delusions, assessed by the attending psychiatrist to be at least of moderate severity; aged between 18 and 65 years; and willing and able to give informed consent and able to undertake interviews in English. Exclusion criteria included presence of a psychotic disorder solely related to substance intoxication or withdrawal. We used a novel multi-perspectival design to investigate delusions across three analytical standpoints: standard clinical psychopathology (third person), phenomenological psychopathology (a top-down approach to eliciting first-person data), and narrative inquiry (a bottom-up approach to eliciting first-person data). Delusion content was classified based on the definitions provided by the Scale for the Assessment of Positive Symptoms. Participants completed standardised psychometric scales, a narrative interview (ad-hoc Life Story Interview), and a phenomenological (Examination of Anomalous World Experience [EAWE]) interview. Findings were integrated through meta-inference across analytical frameworks.

Findings

Between Jan 4, 2023, and June 14, 2023, 33 interview sessions were completed with ten adults with first-episode psychosis and lived experience of delusions (three men, six women, and one person who was non-binary; median age 24·5 years [IQR 14·8]; eight White, two White and Black Caribbean). The three most common delusion themes were: persecutory (ten [100%]), reference (nine [90%]), and grandiose or religious (nine [90%]). No theme occurred in isolation. The phenomenological component of the analysis revealed a global, qualitative shift in the subjective experience of the lived world, with total EAWE scores ranging from 13 to 48 (mean 26·5 [SD 10·85]). The first narrative theme highlighted the role of early and repeated negative interpersonal emotions (especially shame) and subsequent experiential avoidance or immersion and absorption to understand the embodied phenomenology of delusions emerging in later life: (1) recurrent shame, anger, fear, and feelings of being controlled; and (2) “it really turned my whole life upside down”: coping with emotional upheavals before the onset of delusions. The second narrative theme revealed three main patterns of emotional transformation of the world and the self: (1) being under the spotlight: from embodied shame to almighty invincibility; (2) being part of something bigger: from meaninglessness and absence to embodied love, awe, and hope; and (3) being in a simulation: life without a body, cut off from others.

Interpretation

The emergence and evolution of delusions reflected a temporally extended, embodied, and cognitive–linguistic process characterised by an emotional transformation of the self and the world​ as a unified conscious experience. Metonymic thinking and language linked to contiguous bodily experiences appeared to explain some of the apparently incomprehensible or extreme delusional appraisals of self and world, such as being a bad person or being connected to God. Prevention and intervention models for psychosis should consider the role of the lived body for the regulation of emotions, and the effect of the surrounding material and social environments as central affective–regulatory mechanisms, and potential targets for intervention and support.

Funding

Priestley Scholarship and the Wellcome Trust.