To the Editors,

We read with interest the recent report on the definition, diagnosis, and clinical implications of religious delusions (RD).1 In our sample of 929 delusional schizophrenia patients who had been admitted to two psychiatric hospitals in Germany between 2010 and 2014, 138 patients (15%) reported RD. In 569 cases, information on religious affiliation was available. Patients with religious affiliation did not differ from patients without religious affiliation in the frequency of RD [χ2(1,569)= 0.02, p= 0.885]. Furthermore, patients with RD did not differ from patients with other types of delusion (OD) in the duration of hospitalisation [t(924)= -0.39, p= 0.695], or the number of hospitalisations [t(927)= -0.92, p= 0.358]. Additionally, in 185 cases, information on Clinical Global Impressions (CGI) and Global Assessment of Functioning (GAF) was available at the beginning and end of the hospital stay. By CGI-scores, no difference was seen in morbidity of subjects with RD relative to subjects with OD on admission [t(183)= -0.78, p= 0.437] and discharge t(183)= -1.10, p= .273 . Likewise, GAF-scores on admission did not differ in these groups [t(183)= 1.50, p= 0.135]. However, a trend was noted for lower GAF-scores on discharge in subjects with RD [t(183)= 1.91, p= .057, d= 0.39, CI 95% (-0.12-0.78)]. While RD have often been associated with a poorer prognosis in schizophrenia,2,3 we argue that this need not apply to all domains. Mohr et al4 reported that patients with RD were less likely to maintain psychiatric treatment, but did not have a more severe clinical status than patients with OD. Iyassu et al5 found higher levels of positive, but also lower levels of negative symptoms in patients with RD compared to patients with OD. Groups did not differ in terms of length of illness or level of medication. Siddle et al6 reported higher symptom scores in patients with RD at their first presentation, but a similar response to treatment when compared to patients with OD after 4 weeks of treatment. Furthermore, Ellersgaard et al7 iindicated that first-episode psychosis patients with RD at baseline were more likely to be non-delusional at follow-ups conducted after years 1, 2 and 5 when compared to patients with OD at baseline. We conclude that RD may thus interfere with short-term clinical outcome. With regard to long-term effects more favourable observations exist8 and the interplay of psychotic delusions with non-psychotic beliefs still warrants further research.

Vera Rössler
Department of Education & Rehabilitation, Faculty of Psychology & Education, Ludwig-Maximilians-University of Munich, Munich
& Centre of Psychiatry, Psychotherapy and Special Education Bezirkskrankenhaus Kaufbeuren, Kaufbeuren, Germany

Philipp Sand
Department of Psychiatry, Faculty of Medicine, University of Regensburg, Regensburg, Germany


  1. Sofou N, Giannakopoulos O, Arampatzi Ε, Konstantakopoulos G. Religious delusions: definition, diagnosis and clinical implications. Psychiatriki 2021, 32:224-31, doi:10.22365/jpsych.2021.014
  2. Siddle R, Haddock G, Tarrier N, Faragher EB. Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 2002, 37:130-8, doi:10.1007/s001270200005
  3. Mishra A, Das B, Goyal N. Religiosity and religious delusions in schizophrenia - an observational study in a Hindu population. Asian J Psychiatr 2018, 32:35-9, doi:10.1016/j.ajp.2017.11.011
  4. Mohr S, Borras L, Betrisey C, Pierre-Yves B, Gilliéron C, Huguelet P. Delusions with religious content in patients with psychosis: how they interact with spiritual coping. Psychiatry 2010, 73:158-72, doi:10.1521/psyc.2010.73.2.158
  5. Iyassu R, Jolley S, Bebbington P, Dunn G, Emsley R, Freeman D et al. Psychological characteristics of religious delusions. Soc Psychiatry Psychiatr Epidemiol 2014, 49:1051-61, doi:10.1007/s00127-013-0811-y
  6. Siddle R, Haddock G, Tarrier N, Faragher E. Religious beliefs and religious delusions: response to treatment in schizophrenia. Ment Health Relig 2004, 7:211–23, doi:10.1080/13674670310001602454
  7. Ellersgaard D, Mors O, Thorup A, Jørgensen P, Jeppesen P, Nordentoft M. Prospective study of the course of delusional themes in first-episode non-affective psychosis. Early Interv Psychiatry 2014, 8:340-7, doi:10.1111/eip.12059
  8. McCabe MS, Fowler RC, Cadoret RJ, Winokur G. Symptom differences in schizophrenia with good and poor prognosis. Am J Psychiatry 1972, 128:1239-43, doi:10.1176/ajp.128.10.1239


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