Dynamics of Religiosity in Endogenous Psychoses with ReligiousDepressive-Delusional Syndrome: Clinical and Follow-Up Study

Background: it remains unclear whether religiosity in depressive-delusional states represents exclusively a pathoplastic factor or whether the patterns of its changes at different stages of the disease constitute an independent prognostic marker. The Aim was to identi cate patterns of religiosity transformation at various stages of the course of endogenous disorders accompanied by religious-depressive-delusional syndrome (RDDS), and to substantiate their differential diagnostic and prognostic signi cance. Patients and Methods: a total of 104 patients with endogenous mental disorders (F31.5, F33.3, F25.1, F20.01, F20.0 on ICD-10) with clinical picture RDDS were included. There are two groups of patients: a clinical group (n = 58) and a follow-up group (n = 46; mean follow-up period 12.24 ± 2.7 years). Three typological variants of RDDS were identi ed: Type I (with predominance of affectcongruent depressive delusions) — 22 cases (21.2%), Type II (with acute sensory delusions) — 36 patients (34.6%). Type III (with predominance of Kandinsky–Clérambault syndrome) — 46 (44.2%) cases. Religiosity at the pre-manifest stage was assessed using the history analysis (n = 58) based on G. Allport's religious orientation concept and C.Y. Glock's multidimensional model. The Centrality of Religiosity Scale (CRS; S. Huber) and the Religious Coping Scale (K. Pargament) were applied in remission and follow-up stages (n = 46). Clinical-psychopathological, clinical-follow-up, psychometric, and statistical methods (χ² , Cramér's V) were used. Results: type-speci c patterns of religiosity dynamics were closely associated with disease follow-up outcome. Stable harmonious hyperreligiosity with a protective function developed (mean CRS score 4.1 [3.89; 4.37]) in Type I. Bidirectional changes in religious worldview were observed in Type II: in some cases religiosity declined (CRS subtype 1: 3.4 [3.33; 3.47]), in others it intensi ed (subtype 2: 4.1 [4.0; 4.2]). Pathological “patchwork” religiosity was found in Type III (CRS 4.48 [4.47; 4.6]), intricately associated with residual productive symptomatology. A statistically signi cant association was established between RDDS type and both the pattern of religiosity dynamics (χ² = 38.38; p < 0.001; V = 0.655) and follow-up outcome (χ² = 28.25; p < 0.001; V = 0.6). Conclusion: religiosity in religious depressive-delusional syndrome represents not only a pathoplastic factor determining the content of psychopathological experiences, but may also be regarded as a clinically signi cant indicator associated with the type of disease course and outcome, which substantiates the necessity of differentiated therapeutic management.

1. Popovich UO, Romanenko NV, Kaleda VG. To the Question about Pathological Religiosity in the Context of Clinical Psychiatry. Psychiatry (Moscow) (Psikhiatriya). 2020;18(4):114–126. (In Russ.). doi: 10.30629/2618-6667-2020-18-4-114-126

2. Smirnova EV, Alekseeva AG, Kopeyko GI, Borisova OA, Gedevani EV, Vladimirova TV, Kaleda VG. Psychopathology of depressive-delusional states with religious content. S.S. Korsakov Journal of Neurology and Psychiatry. 2023;123(11–2):101–107. (In Russ.) doi: 10.17116/jnevro2023123112101

3. Sofou N, Giannakopoulos O, Arampatzi Ε, Konstantakopoulos G. Religious delusions: Definition, diagnosis and clinical implications. Psychiatriki. 2021;32(3):224–231. doi: 10.22365/jpsych.2021.014. PMID: 33770751

4. Westhead M, Georgiades A. The Role of Spirituality and Religiosity in the Maintenance and Recovery of Psychosis: A Systematic Review. Early Interv Psychiatry. 2025;19(7):e70061. doi: 10.1111/eip.70061. PMID: 40605616; PMCID: PMC12223707

5. Peters E, Day S, McKenna J, Orbach G. Delusional ideation in religious and psychotic populations. Br J Clin Psychol. 1999;38(1):83–96. doi: 10.1348/014466599162683. PMID: 10212739.

6. Siddle R, Haddock G, Tarrier N, Faragher EB. Religious delusions in patients admitted to hospital with schizophrenia. Soc Psychiatry Psychiatr Epidemiol. 2002;37(3):130–8. doi: 10.1007/s001270200005. PMID: 11990010

7. Bhavsar V, Bhugra D. Religious delusions: finding meanings in psychosis. Psychopathology. 2008;41(3):165–72. doi: 10.1159/000115954. Epub 2008 Feb 11. PMID: 18264027.

8. Allport G. Stanovlenie lichnosti: izbrannye trudy / per. s angl. L.V. Trubicynoj i D.A. Leonteva; pod obsh. red. D.A. Leonteva. M. Smysl, 2002:462.

9. Francis LJ. Introducing the New Indices of Religious Orientation (NIRO): Conceptualization and measurement. Mental Health, Religion and Culture. 2007;10(6):585–602. doi: 10.1080/13674670601035510

10. Sheldon KM. Catholic guilt? Comparing Catholics' and Protestants' religious motivations. The International Journal for the Psychology of Religion. 2006;16(3):209– 223. doi: 10.1207/s15327582ijpr1603_5

11. Rip B, Vallerand RJ, Lafrenière MA. Passion for a cause, passion for a creed: on ideological passion, identity threat, and extremism. J Pers. 2012;80(3):573–602. doi: 10.1111/j.1467-6494.2011.00743.x. Epub 2012 Apr 26. Erratum in: J Pers. 2012 Aug;80(4):1146. PMID: 22091560.

12. Cohen AB, Mazza GL, Johnson KA, Enders CK, Warner CM, Pasek MH, Cook JE. Theorizing and Measuring Religiosity Across Cultures. Pers Soc Psychol Bull. 2017;43(12):1724–1736. doi: 10.1177/0146167217727732

13. Glock CY. On the study of religious commitment. Religious Education, 1962;57(4):98–110. doi: 10.1080/003440862057S407

14. Borisova OA, Gusev VV, Dvoinin AM, Kopeyko GI. Structure and Contents of the Value and Meaning System of Mentally Ill Patients with the Religious Outlook. Cultural-Historical Psychology. 2019;15(4),56–67. (In Russ.). doi: 10.17759/chp. 2019150406

15. 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(2):158–72. doi: 10.1521/psyc.2010.73.2.158 PMID: 20557227.

16. Ouwehan E, Zock T, Muthert J, Boeije H, Braam A. “The Awful Rowing toward God”: Interpretation of Religious Experiences by Individuals with Bipolar Disorder. Pastoral Psychology. 2019;68(10). doi: 10.1007/s11089-019-00875-4

17. Pearce M J., Pargament K I., Oxhandler H K., Vieten C, Wong S. A novel training program for mental health providers in religious and spiritual competencies. Spirituality in Clinical Practice. 2019;6(2):73–82. doi: 10.1037/scp0000195

18. Huber S, Huber OW. The Centrality of Religiosity Scale (CRS). Religions. 2012;3(3):710–724. doi: 10.3390/rel3030710

19. Kaleda VG. Endogenous psychoses with a first episode at the juvenile age: course and outcome (follow-up study). S.S. Korsakov Journal of Neurology and Psychiatry 2008;108(9):11–23. (In Russ.).

20. Kopejko GI, Borisova OА, Kaz'mina OYu. Religious coping strategies in rehabilitations of mentally ill. Psychiatry (Moscow) (Psikhiatriya). 2016;(71):40– 49. (In Russ.). doi: 10.30629/2618-6667-2016-70-40-49

21. Krylova ES. Clinical and psychopathological aspects of youth depression with a picture of “methaphysic intoxication” Psychiatry (Moscow) (Psikhiatriy). 2003;(6):29–35.

22. Kaleda VG, Popovich UO, Romanenko NV, Kopeiko GI. Endogenous episodes of juvenile psychosis with religious delusions. S.S. Korsakov Journal of Neurology and Psychiatry. 2017;117(12):13–20. (In Russ.). doi: 10.17116/jnevro201711712113-20

23. Wuthnow R. After Heaven: Spirituality in America Since the 1950s. Berkeley: University of California Press. 1998. https://www.jstor.org/stable/jj.2711549