Sense of coherence among delusional patients: prediction of remission and risk of relapse

Delusional diseases are characterized by a remitting/relapsing course, which, in current studies, is not contextualized with experience and well-being. This study applied the salutogenic model in order to predict the course of delusional disease, using the “sense of coherence” (SOC) concept, which reflects patients' experiences of their disorder. In a prospective study, 48 delusional schizophrenic inpatients were interviewed, using self-report scales for delusions, SOC, depression and expressed emotion (EE), at 3 time points over a 1-year period, with an additional 6-month follow-up based on treatment staff reports and medical files. Sense of coherence was found to be strongly correlated with delusional symptoms over the study period. Higher SOC scores at the “acute delusional state” predicted better prognosis with regard to delusions. However, SOC was found to be lower during remission, suggesting decreased well-being during remission. Sense of coherence was found to be a stronger predictor of 1-year prognosis for delusions when EE or depression were high at the acute state. A complex relationship was found between delusions, SOC, depression, and EE, suggesting possible use of the SOC scale as a prognostic tool. In addition, the results stress the necessity of an integrative biopsychosocial treatment approach, which would include interventions aimed at enhancing elements of SOC, particularly during periods of remission. To the best of our knowledge, this is the first longitudinal study of SOC in delusional patients moving through remissions and relapses.