Evidence-Based Reviews

How to care for patients who have delusions with religious content

Current Psychiatry. 2012 January;11(1):47-51

References

1. Siddle R, Haddock G, Tarrier N, et al. Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2002;37(3):130-138.

2. Appelbaum PS, Robbins PC, Roth LH. Dimensional approach to delusions: comparison across types and diagnoses. Am J Psychiatry. 1999;156(12):1938-1943.

3. Field HL, Waldfogel S. Severe ocular self-injury. Gen Hosp Psychiatry. 1995;17(3):224-227.

4. Kushner AW. Two cases of auto-castration due to religious delusions. Br J Med Psychol. 1967;40(3):293-298.

5. Waugh AC. Autocastration and biblical delusions in schizophrenia. Br J Psychiatry. 1986;149:656-658.

6. Silva JA, Leong GB, Weinstock R. Violent behaviors associated with the antichrist delusion. J Forensic Sci. 1997;42(6):1058-1061.

7. Atallah SF, El-Dosoky AR, Coker EM, et al. A 22-year retrospective analysis of the changing frequency and patterns of religious symptoms among inpatients with psychotic illness in Egypt. Soc Psychiatry Psychiatr Epidemiol. 2001;36(8):407-415.

8. Bhavsar V, Bhugra D. Religious delusions: finding meanings in psychosis. Psychopathology. 2008;41(3):165-172.

9. Kim K, Hwu H, Zhang LD, et al. Schizophrenic delusions in Seoul, Shanghai and Taipei: a transcultural study. J Korean Med Sci. 2001;16(1):88-94.

10. Kennedy BL, Feldmann TB. Self-inflicted eye injuries: case presentations and a literature review. Hosp Community Psychiatry. 1994;45(5):470-474.

11. Diagnostic and statistical manual of mental disorders, 4th ed, text rev. Washington DC: American Psychiatric Association; 2000.

12. Sanderson S, Vandenberg B, Paese P. Authentic religious experience or insanity? J Clin Psychol. 1999;55(5):607-616.

13. O’Connor S, Vandenberg B. Psychosis of faith? Clinicians’ assessment of religious beliefs. J Consult Clin Psychol. 2005;73(4):610-616.

14. Spitzer M. On defining delusions. Compr Psychiatry. 1990;31(5):377-397.

15. Pierre JM. Faith or delusion? At the crossroads of religion and psychosis. J Psychiatr Pract. 2001;7(3):163-172.

16. Blass DM. A pragmatic approach to teaching psychiatry residents the assessment and treatment of religious patients. Acad Psychiatry. 2007;31(1):25-31.

17. Westermeyer J. Cultural factors in clinical assessment. J Consult Clin Psychol. 1987;55(4):471-478.

18. Clark RA. Self-mutilation accompanying religious delusions: a case report and review. J Clin Psychiatry. 1981;42(6):243-245.

19. Mohr S, Borras L, Betrisey C, et al. Delusions with religious content in patients with psychosis: how they interact with spiritual coping. Psychiatry. 2010;73(2):158-172.

20. Greenberg D, Witztum E. Problems in the treatment of religious patients. Am J Psychother. 1991;45(4):554-565.

21. Peteet JR. Issues in the treatment of religious patients. Am J Psychother. 1981;35(4):559-564.

22. Borras L, Mohr S, Brandt PY, et al. Religious beliefs in schizophrenia: their relevance for adherence to treatment. Schizophr Bull. 2007;33(5):1238-1246.

23. Ng F. The interface between religion and psychosis. Australas Psychiatry. 2007;15(1):62-66.

24. Sacks JM. Religious issues in psychotherapy. J Relig Health. 1985;24(1):26-30.

25. Shore D, Anderson DJ, Cutler NR. Prediction of self-mutilation in hospitalized schizophrenics. Am J Psychiatry. 1978;135(11):1406-1407.

26. Huguelet P, Mohr S, Betrisey C, et al. A randomized trial of spiritual assessment of outpatients with schizophrenia: patients’ and clinicians’ experience. Psychiatr Serv. 2011;62(1):79-86.

27. Kroll J, Sheehan W. Religious beliefs and practices among 52 psychiatric inpatients in Minnesota. Am J Psychiatry. 1989;146(1):67-72.

28. Tepper L, Rogers SA, Coleman EM, et al. The prevalence of religious coping among persons with persistent mental illness. Psychiatr Serv. 2001;52(5):660-665.

29. Corrigan P, McCorkle B, Schell B, et al. Religion and spirituality in the lives of people with serious mental illness. Community Ment Health J. 2003;39(6):487-499.

30. Koenig HG, McCullough ME, Larson DB. Handbook of religion and health. New York NY: Oxford University Press; 2001.

31. Pargament KI, Koenig HG, Perez LM. The many methods of religious coping: development and initial validation of the RCOPE. J Clin Psychol. 2000;56(4):519-543.

32. Phillips RE, III, Stein CH. God’s will God’s punishment, or God’s limitations? Religious coping strategies reported by young adults living with serious mental illness. J Clin Psychol. 2007;63(6):529-540.

33. Mohr S, Brandt PY, Borras L, et al. Toward an integration of spirituality and religiousness into the psychosocial dimension of schizophrenia. Am J Psychiatry. 2006;163(11):1952-1959.

34. Breier A, Astrachan BM. Characterization of schizophrenic patients who commit suicide. Am J Psychiatry. 1984;141(2):206-209.

35. Jarbin H, Von Knorring AL. Suicide and suicide attempts in adolescent-onset psychotic disorders. Nord J Psychiatry. 2004;58(2):115-123.

36. Brewerton TD. Hyperreligiosity in psychotic disorders. J Nerv Ment Dis. 1994;182(5):302-304.

37. Getz GE, Fleck DE, Strakowski SM. Frequency and severity of religious delusions in Christian patients with psychosis. Psychiatry Res. 2001;103(1):87-91.

Addressing religion in treatment.

Although many studies have emphasized the importance of religion to patients with psychosis, evidence-based guidelines on how best to address religion/spirituality in the clinical setting in patients with psychosis have yet to be established. In a 2011 study, a spiritual assessment was well tolerated by 40 patients with psychotic disorders and improved patients’ appointment attendance compared with a control group who received traditional care only.²⁶

Many mental health providers feel ill-equipped or are uncomfortable exploring spiritual or religious issues with patients. Enlisting the help of spiritual care professionals when assessing patients with DRC may improve evaluation and care (Table 3). Spiritual care professionals typically are experienced in exploring subjects associated with DRC, such as guilt, morality, conscience, repentance, and confession.²⁴ Spiritual care professionals also may be able to assist patients with religious coping and provide comfort and support.

Finally, spiritual care professionals can help patients connect or reconnect to a spiritual or religious community. In Mr. D’s case, the hospital chaplain deterred him from focusing on the reason the evil spirits were trying to punish him and guided him toward positive religious coping. Mr. D felt we were listening to him on a deeper level and understanding his spiritual struggles. The chaplain’s involvement also enhanced Mr. D’s relationship with the psychiatrist.

Table 3

When to elicit help from spiritual care professionals

To better understand the patient’s religious background
To reduce biases when the clinician comes from a different religious background or no religious background
To help identify positive and negative religious coping, and to reinforce positive coping
To connect or reconnect patients to members of their faith community or to help them find a religious community

Clinical Point

Spiritual care professionals may provide comfort and support, and help patients connect to a religious or spiritual community

Related Resources

Mohr S, Borras L, Betrisey C, et al. Delusions with religious content in patients with psychosis: how they interact with spiritual coping. Psychiatry. 2010;73(2):158-172.
Huguelet P, Mohr S, Betrisey C, et al. A randomized trial of spiritual assessment of outpatients with schizophrenia: patients’ and clinicians’ experience. Psychiatr Serv. 2011;62(1):79-86.

Drug Brand Names

Risperidone • Risperdal
Zolpidem • Ambien

Disclosure

The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.

Acknowledgements

The authors acknowledge the support and guidance of Rev. Sean Doll O’Mahoney, Rev. Julie Hanada, Rev. Stephen King, PhD, Rev. George Fitchett, PhD, Patricia Murphy, PhD, LCPC, and Kevin Flannelly, PhD.