2017 Resarch Forum

PSY: M-2 Applicant & Principal Investigator: Sabina Bera MD MS

Religious delusions and hallucinations: Classification, etiology, and effect on the length of stay on the inpatient unit: A Pilot Study Sabina Bera MD MS Maranda Stokes MS III Kelsey Stevens MD, Jason Anderson MS IV, Bianca Puello MS III, Sarah Samuels BS, Sara Abdidajid DO MS INTRODUCTION Religious delusions and hallucinations (RD/H) have been documented throughout history as a prominent in mental illness. Limited consensus of definition and classification of these symptoms and differentiating RD/H from a religious experience exists. The symptom mechanism remains unknown- theories revolve around the temporolimbic region of the brain. Limited studies suggest RD/H symptoms are not specific to any set of diagnostic criteria and patients with RD/H have a worse prognosis. There is no standard of treatment for patients who specifically display these symptoms when also mentally ill. PURPOSE To determine if the presence of RD/H predicts the length of inpatient psychiatric unit stay. Consideration of a religious background and inpatient antipsychotic treatment for patients with RD/H was included. We also asked if a neurological workup could predict whether a patient will display RD/H. METHOD Data collection included 400 patients on the inpatient psychiatric unit (July - October 2016). The first 100 of the 400 patients are presented here. Variables included RD/H, LOS, discharge diagnosis, antipsychotic treatment, neuroimaging /EEG, and history of religious background. Reporting and detection bias was controlled for by data inclusion of the attending physician (ID coded) for each patient. Statistical analysis was performed using R statistical software. RESULTS A p-value of 0.0288 was found when comparing the presence of RD/H and length of stay. Difference in median length of stay was 3.5 days longer for the RD/H group. 85% of patients with religious delusions identified as having a religious background, compared to 75% of those without RD/H. 85% of patients with RD/H were treated with an atypical antipsychotic. 15% of patients with religious delusions were treated with a long acting injectable antipsychotic. 12% of patients had neuroimaging performed, and 10% had an EEG. Both p-values were > 0.28. DISCUSSION Statistical significance (p-value <0.05) was found when comparing RD/H and length of stay, confirming longer hospitalizations, and questioning the appropriate approach to treatment. A larger number of patients with RD/H identified as having a religious background compared to those without RD/H. Most (85%) patients with RD/H were treated with an atypical antipsychotic. There was no statistical significance for a neurological workup predicting the presence of RD/H. CONCLUSIONS There has been a shift to simplify the classification of psychiatric disorders in the Diagnostic and Statistical Manual (DSM-V). Our findings indicate significant value to a prior system of classification (including subtypes for hallmark psychiatric disorders). This is especially important when taking into account patient prognosis and treatment plans for RD/H. We encourage revisiting this topic in the next version of the DSM.