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Raihani NJ, Bell V. An evolutionary perspective on paranoia. Nat Hum Behav 2019; 3:114-121. [PMID: 30886903 PMCID: PMC6420131 DOI: 10.1038/s41562-018-0495-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/15/2018] [Indexed: 12/29/2022]
Abstract
Paranoia is the most common symptom of psychosis but paranoid concerns occur throughout the general population. Here, we argue for an evolutionary approach to paranoia across the spectrum of severity that accounts for its complex social phenomenology - including the perception of conspiracy and selective identification of perceived persecutors - and considers how it can be understood in light of our evolved social cognition. We argue that the presence of coalitions and coordination between groups in competitive situations could favour psychological mechanisms that detect, anticipate and avoid social threats. Our hypothesis makes testable predictions about the environments in which paranoia should be most common as well as the developmental trajectory of paranoia across the lifespan. We suggest that paranoia should not solely be viewed as a pathological symptom of a mental disorder but also as a part of a normally-functioning human psychology.
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Affiliation(s)
- Nichola J Raihani
- Department of Experimental Psychology, University College London, London, UK.
| | - Vaughan Bell
- Division of Psychiatry, University College London, London, UK
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Tibber MS, Kirkbride JB, Joyce EM, Mutsatsa S, Harrison I, Barnes TRE, Huddy V. The component structure of the scales for the assessment of positive and negative symptoms in first-episode psychosis and its dependence on variations in analytic methods. Psychiatry Res 2018; 270:869-879. [PMID: 30551337 PMCID: PMC6299359 DOI: 10.1016/j.psychres.2018.10.046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022]
Abstract
A secondary analysis was undertaken on Scales for the Assessment of Positive and Negative Symptoms (SAPS/SANS) data from 345 first-episode psychosis (FEP) patients gathered in the West London FEP study. The purpose of this study was to determine: (i) the component structure of these measures in FEP (primary analyses), and (ii) the dependence of any findings in these primary analyses on variations in analytic methods. Symptom ratings were exposed to data reduction methods and the effects of the following manipulations ascertained: (i) level of analysis (individual symptom vs. global symptom severity ratings), (ii) extraction method (principal component vs. exploratory factor analysis) and (iii) retention method (scree test vs. Kaiser criterion). Whilst global ratings level analysis rendered the classic triad of psychotic syndromes (positive, negative and disorganisation), symptom level analyses revealed a hierarchical structure, with 11 first-order components subsumed by three second-order components, which also mapped on to this syndrome triad. These results were robust across data reduction but not component retention methods, suggesting that discrepancies in the literature regarding the component structure of the SAPS/SANS partly reflect the level of analysis and component retention method used. Further, they support a hierarchical symptom model, the implications of which are discussed.
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Affiliation(s)
- Marc S Tibber
- Department of Clinical, Educational and Health Psychology, UCL, London, UK.
| | | | | | | | | | | | - Vyv Huddy
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, UK.
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Tortelli A, Nakamura A, Suprani F, Schürhoff F, Van der Waerden J, Szöke A, Tarricone I, Pignon B. Subclinical psychosis in adult migrants and ethnic minorities: systematic review and meta-analysis. BJPsych Open 2018; 4:510-518. [PMID: 30564447 PMCID: PMC6293451 DOI: 10.1192/bjo.2018.68] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is well established that migration and ethnic minority status are risk factors for psychotic disorders. Recent studies have aimed to determine if they are also associated with subclinical psychosis (psychotic-like experiences and schizotypal traits). AIMS We aimed to determine to what extent migrant and ethnic minority groups are associated with higher risk of subclinical psychosis. METHOD We conducted a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, and examined findings by ethnicity, migrant status, outcomes of subclinical psychosis and host country. A meta-analysis was carried out with robust variance estimation where possible, to handle statistically dependent effect size estimates. RESULTS We included 28 studies (19 studies on psychotic-like experiences and 9 studies on schizotypal traits) and found that ethnicity, but not migrant status, was associated with current and lifetime psychotic-like experiences. In the narrative analysis, we observed the effect of psychosocial risk factors on this association: Black ethnicity groups showed consistent increased prevalence of current and lifetime psychotic-like experiences compared with the reference population across countries. CONCLUSIONS More generalisable and standardised cohort studies of psychotic-like experiences and schizotypal traits in relation to migration/ethnicity are necessary to examine the effects of exposures and outcomes in different contexts, and to understand the underlying mechanisms of the association between subclinical psychosis and migrant and ethnic minority status. DECLARATION OF INTEREST None.
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Affiliation(s)
- Andrea Tortelli
- U955-15, INSERM, Créteil and Pôle GHT Psychiatrie Précarité, Paris, France
| | - Aurélie Nakamura
- UMR_S 1136, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, France
| | - Federico Suprani
- Department of Medical and Surgical Sciences, Bologna University, Italy
| | - Franck Schürhoff
- U955-15, INSERM and Pôle de Psychiatrie et d'Addictologie, DHU PePSY, Hôpitaux universitaires Henri-Mondor, AP-HP and Fondation FondaMental Scientific Cooperation Foundation, F-94010 Creteil and Faculté de médecine, University Paris-Est Créteil, France
| | - Judith Van der Waerden
- UMR_S 1136, INSERM, Pierre Louis Institute of Epidemiology and Public Health, Sorbonne Universités, l'université Pierre et Marie Curie, France
| | - Andrei Szöke
- U955-15, INSERM and Pôle de Psychiatrie et d'Addictologie, DHU PePSY, Hôpitaux universitaires Henri-Mondor, AP-HP and Fondation FondaMental, France
| | - Ilaria Tarricone
- Department of Medical and Surgical Sciences, Bologna University, Italy
| | - Baptiste Pignon
- U955-15, INSERM and Pôle de Psychiatrie et d'Addictologie, DHU PePSY, Hôpitaux universitaires Henri-Mondor, AP-HP and Fondation FondaMental and Faculté de médecine, University Paris-Est Créteil, France
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Wei DM, Au Yeung SL, He JR, Xiao WQ, Lu JH, Tu S, Chen NN, Lam KBH, Cheng KK, Leung GM, Xia HM, Schooling CM, Qiu X. The role of social support in family socio-economic disparities in depressive symptoms during early pregnancy: Evidence from a Chinese birth cohort. J Affect Disord 2018; 238:418-423. [PMID: 29913379 DOI: 10.1016/j.jad.2018.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/22/2018] [Accepted: 06/04/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Few studies have examined the association between a composite measure of family socio-economic position (SEP)2 and depressive symptoms among Chinese pregnant women, nor any potential underlying mechanisms which may be amenable to preventative interventions. METHODS We investigated the association between a composite SEP measure and depressive symptoms during early pregnancy, and tested for mediation by social support and moderation by parity in the Born in Guangzhou Cohort Study (n = 12,382) using adjusted logistic regression and causal mediation analysis. RESULTS In this population, 18.4% of women experienced depressive symptoms before the 20th gestational week. Compared with the highest quartile, the lowest SEP score quartile was associated with a higher risk of depressive symptoms (OR 1.50, 95% CI 1.31-1.71), which was more pronounced among multiparous women than nulliparous women (P for interaction <0.001). Social support mediated the association between SEP and depressive symptoms, with greater proportion mediated in nulliparous women (73.4% for the lowest SEP score quartile) than multiparous women (30.5%). LIMITATIONS Depressive symptoms were measured by Self-rated Depression Scale, which is not designed as a clinical diagnosis tool for depression. We only had information on perceived social support but not actual social support, although these two parameters were modestly correlated. CONCLUSION Lower SEP was associated with higher risk of depressive symptoms in pregnant women, driven by social support. And the association between SEP and depressive symptoms and mediation by social support were modified by parity. Whether this association extends to the post pregnancy period or is amenable to cost-effective interventions should be investigated in further studies.
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Affiliation(s)
- Dong-Mei Wei
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China
| | - Shiu Lun Au Yeung
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Jian-Rong He
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China
| | - Wan-Qing Xiao
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China
| | - Jin-Hua Lu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China
| | - Si Tu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China
| | - Nian-Nian Chen
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China
| | | | - Kar-Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Hui-Min Xia
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Neonatal Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China.
| | - C Mary Schooling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Xiu Qiu
- Division of Birth Cohort Study, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China; Department of Woman and Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No. 9 Jinsui Road, Zhujiang Newtown, Tianhe District, Guangzhou, China.
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Jacob L, Haro JM, Koyanagi A. Relationship between attention-deficit hyperactivity disorder symptoms and problem gambling: A mediation analysis of influential factors among 7,403 individuals from the UK. J Behav Addict 2018; 7:781-791. [PMID: 30238788 PMCID: PMC6426384 DOI: 10.1556/2006.7.2018.72] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS Our goal was to examine the association between attention-deficit hyperactivity disorder (ADHD) symptoms and gambling problems, and to identify potential mediating factors of this association. METHODS This study used cross-sectional, community-based data from 7,403 people aged ≥16 years who participated in the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale (ASRS) Screener. Problem gambling was assessed using a questionnaire based on the 10 DSM-IV diagnostic criteria for pathological gambling. Respondents were classified as having no problem, at-risk, or problem gambling. Logistic regression and mediation analyses were conducted to analyze the association between ADHD symptoms (i.e., ASRS score ≥14) and problem gambling and the role of several variables in this association. RESULTS The prevalence of at-risk (5.3% vs. 2.4%) and problem gambling (2.4% vs. 0.6%) was higher in individuals with ADHD symptoms than in those without ADHD symptoms. ADHD symptoms were significantly associated with both at-risk (OR = 2.15; 95% CI = 1.22-3.79) and problem gambling (OR = 3.57; 95% CI = 1.53-8.31) when adjusted for age, sex, and ethnicity. Common mental disorders (CMDs; i.e., depression and anxiety disorders) (mediated percentage = 22.4%), borderline personality disorder (BPD) traits (22.1%), stressful life events (13.2%), stress at work or home (12.6%), alcohol dependence (11.8%), and impulsivity (11.2%) were significant mediators in the ADHD-gambling association. DISCUSSION AND CONCLUSIONS Overall, ADHD symptoms were positively associated with problem gambling. CMDs, BPD traits, and stressful life events were important mediators in this relationship.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France,Corresponding author: Dr. Louis Jacob; Faculty of Medicine, University of Paris 5, 15 rue de l’École de Médecine, Paris 75006, France; Phone: +33 6 27 88 37 06; E-mail:
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
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McCutcheon R, Bloomfield MAP, Dahoun T, Quinlan M, Terbeck S, Mehta M, Howes O. Amygdala reactivity in ethnic minorities and its relationship to the social environment: an fMRI study. Psychol Med 2018; 48:1985-1992. [PMID: 29328019 PMCID: PMC5933521 DOI: 10.1017/s0033291717003506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ethnic minority individuals have an increased risk of developing a psychotic disorder, particularly if they live in areas of ethnic segregation, or low own group ethnic density. The neurobiological mechanisms underlying this ethnic minority associated risk are unknown. We used functional MRI to investigate neural responses to faces of different ethnicity, in individuals of black ethnicity, and a control group of white British ethnicity individuals. METHODS In total 20 individuals of black ethnicity, and 22 individuals of white British ethnicity underwent a 3T MRI scan while viewing faces of black and white ethnicity. Own group ethnic density was calculated from the 2011 census. Neighbourhood segregation was quantified using the Index of Dissimilarity method. RESULTS At the within-group level, both groups showed greater right amygdala activation to outgroup faces. Between groups, the black ethnicity group showed greater right amygdala activation to white faces, compared to the white ethnicity group. Within the black ethnicity group, individuals living in areas of lower own group ethnic density showed greater right amygdala reactivity to white faces (r = -0.61, p = 0.01). CONCLUSIONS This is the first time an increased amygdala response to white faces has been demonstrated in individuals of black ethnicity. In the black ethnicity group, correlations were observed between amygdala response and neighbourhood variables associated with increased psychosis risk. These results may have relevance for our understanding of the increased rates of paranoia and psychotic disorders in ethnic minority individuals.
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Affiliation(s)
- Robert McCutcheon
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Michael A. P. Bloomfield
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London WC1T 7NF, UK
- Clinical Psychopharmacology Unit, Research Department of Clinical, Educational and Health Psychology, University College London, 1–19 Torrington Place, London WC1E 6BT, UK
| | - Tarik Dahoun
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Marina Quinlan
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
| | - Sylvia Terbeck
- School of Psychology, Plymouth University, Drake Circus, Plymouth PL48AA, UK
| | - Mitul Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - Oliver Howes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Psychiatric Imaging Group, Robert Steiner MR Unit, MRC London Institute of Medical Sciences, Hammersmith Hospital, London W12 0NN, UK
- Faculty of Medicine, Psychiatric Imaging Group, Institute of Clinical Sciences, Imperial College London, Du Cane Road, London W12 0NN, UK
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Jacob L, Haro JM, Koyanagi A. Attention deficit hyperactivity disorder symptoms and disordered eating in the English general population. Int J Eat Disord 2018; 51:942-952. [PMID: 30256445 DOI: 10.1002/eat.22934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Attention deficit hyperactivity disorder (ADHD) symptoms and eating problems often coexist, but many of the previous studies have not taken into account key variables which may be important in this association. Thus, the goal of this study was to assess the association between ADHD symptoms and disordered eating, while taking into account of a variety of factors. METHOD This study used cross-sectional, nationally representative data from 7,403 people aged ≥16 years from England who participated in the 2007 Adult Psychiatric Morbidity Survey (APMS). ADHD symptoms were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener. Questions from the five-item SCOFF screening instrument were used to identify possible ED. Multivariable logistic regression analyses were conducted. RESULTS The prevalence of possible eating disorder (ED) was much higher among those with ADHD symptoms (ASRS score ≥14) compared to those without ADHD symptoms (19.2 vs. 5.7%). ADHD symptoms were associated with possible ED (odds ratio [OR] = 3.48; 95% confidence interval [CI] = 2.56-4.72) after adjustment for age, sex, and ethnicity. After further adjustment for alcohol dependence, drug use, intelligence quotient, stressful life events, perceived stress, impulsivity, depression, anxiety disorder, and borderline personality disorder (BPD) traits, the OR was attenuated to 1.32 (95% CI = 0.82-2.13). Anxiety and BPD were the factors that led to the largest degree of attenuation. DISCUSSION A high prevalence of disordered eating in individuals with ADHD was observed. Factors such as co-existing anxiety and BPD traits may be particularly important in this association. Future research should focus on the factors involved in the association between ADHD symptoms and disordered eating behavior.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, Paris, France
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain
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Saalfeld V, Ramadan Z, Bell V, Raihani NJ. Experimentally induced social threat increases paranoid thinking. ROYAL SOCIETY OPEN SCIENCE 2018; 5:180569. [PMID: 30225050 PMCID: PMC6124070 DOI: 10.1098/rsos.180569] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/02/2018] [Indexed: 05/18/2023]
Abstract
The ability to attribute intentions to others is a hallmark of human social cognition but is altered in paranoia. Paranoia is the most common positive symptom of psychosis but is also present to varying degrees in the general population. Epidemiological models suggest that psychosis risk is associated with low social rank and minority status, but the causal effects of status and group affiliation on paranoid thinking remain unclear. We examined whether relative social status and perceived group affiliation, respectively, affect live paranoid thinking using two large-N (N = 2030), pre-registered experiments. Interacting with someone from a higher social rank or a political out-group led to an increase in paranoid attributions of harmful intent for ambiguous actions. Pre-existing paranoia predicted a general increase in harmful intent attribution, but there was no interaction with either type of social threat: highly paranoid people showed the same magnitude of increase as non-paranoid people, although from a higher baseline. We conclude social threat in the form of low social status and out-group status affects paranoid attributions, but ongoing paranoia represents a lowered threshold for detecting social threat rather than an impaired reactivity to it.
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Affiliation(s)
- Vanessa Saalfeld
- Department of Experimental Psychology, University College London, 26 Bedford Way, London WC1H 0AP, UK
| | - Zeina Ramadan
- Division of Psychiatry, University College London, London, UK
| | - Vaughan Bell
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nichola J. Raihani
- Department of Experimental Psychology, University College London, 26 Bedford Way, London WC1H 0AP, UK
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Abstract
Humans possess a basic need to belong and will join groups even when they provide no practical benefit. Paranoid symptoms imply a disruption of the processes involved in belonging and social trust. Past research suggests that joining social groups and incorporating those groups into one's identity (social identification) promotes positive self-views and better physical and mental health. However, no research has investigated whether social identity is associated with paranoia, nor the mechanisms by which this effect may emerge. Here, we examined the relationship between social identity and mental health (paranoia, auditory verbal hallucinations [AVHs], and depression), and tested the mediating role of self-esteem. In study 1, we analyzed data collected from 4319 UK residents as part of the NIHR CLAHRC NWC Household Health Survey. Study 2 comprised data collected from 1167 students attending a large UK university. The studies provided convergent evidence that social identification reduces symptoms of paranoia and depression by furnishing people with self-esteem. There was no consistent effect of social identification on AVHs. People developing mental health assessments, treatments, and policies are encouraged to consider the notion that joining and identifying with social groups may reduce people's risk of paranoia and depression.
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Affiliation(s)
- Jason C McIntyre
- Institute of Psychology, Health and Society, University of Liverpool
| | - Sophie Wickham
- The Farr Institute @ HeRC, University of Liverpool, Waterhouse Building, Liverpool, UK
| | - Ben Barr
- Institute of Psychology, Health and Society, University of Liverpool
| | - Richard P Bentall
- Department of Psychology, The University of Sheffield, Sheffield, UK
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Psychotic-like experiences and happiness in the English general population. J Affect Disord 2017; 222:211-217. [PMID: 28711798 DOI: 10.1016/j.jad.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) have been associated with a variety of adverse outcomes but how they affect happiness in individuals with PLE is unknown. Thus, the aim of the study was to assess the association between PLEs and happiness, and the factors that may influence this association. METHODS Nationally representative data from the 2007 Adult Psychiatric Morbidity Survey including adults aged ≥ 16 years was analyzed. The Psychosis Screening Questionnaire was used to assess past 12-month PLE. Individuals who endorsed at least one of the following were considered to have any PLE: thought control, paranoia, strange experiences, auditory hallucinations. Happiness (3-point scale) was assessed with a validated question with higher scores indicating lower levels of happiness. The association between PLE and happiness was assessed by multivariable ordinal logistic regression. Mediation analysis was also performed. RESULTS Among the 7363 individuals included in the analysis, the prevalence of any PLE increased with decreasing levels of happiness [very happy (2.3%), fairly happy (5.4%), not too happy (14.9%)]. This was also shown in the multivariable analysis adjusted for sociodemographic factors and stressful life events (from very happy to not too happy: OR = 2.41; 95%CI = 1.86-3.12). Mediation analysis showed that anxiety disorders explained the largest proportion of the association (38.8%) followed by depressive episode (28.5%), insomnia (21.9%), disability (16.5%), pain (12.5%), social support (10.0%), and physical health conditions (6.0%). LIMITATIONS The cross-sectional design limits causal inference. CONCLUSION Interventions to identify and address conditions that may have a negative impact on happiness in individuals with PLE may be important to improve their well-being.
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Thomas J, Bentall RP, Hadden L, O'Hara L. Ethnic identity and paranoid thinking: Implicit out-group preference and language dominance predict paranoia in Emirati women. J Behav Ther Exp Psychiatry 2017; 56:122-128. [PMID: 28029348 DOI: 10.1016/j.jbtep.2016.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 10/16/2016] [Accepted: 10/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Psychotic experiences including persecutory beliefs are elevated among immigrant and minority populations, especially when living in low ethnic density neighbourhoods (the ethnic density effect). Discrimination, victimization and experiencing a sense of 'not belonging' are hypothesized to play a role in this effect. Because a secure ethnic identity protects against poor self-esteem it may also protect against paranoia. This study explores the relationship between language proficiency (Arabic/English), in-group identity (implicit and explicit) and paranoia in female Emirati university students. METHODS Female citizens of the United Arab Emirates (UAE), Emirati college women (N = 208), reported English/Arabic language proficiencies, and performed a computerized affective priming task engineered to implicitly assess in-group (Emirati) versus out-group (American) positivity. Participants also completed self-report measures of in-group identity (MIIS), and paranoia (PaDs). RESULTS Arabic proficiency was negatively correlated with paranoia, as was implicit in-group positivity. Furthermore, participants reporting English language dominance, and those demonstrating an implicit out-group preference, reported the highest levels of paranoia. LIMITATIONS The study is limited by its use of an all female sample. CONCLUSIONS Implicit in-group attitudes and linguistic competence protect against paranoia and may help to explain the ethnic density effect.
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Affiliation(s)
| | | | | | - Lily O'Hara
- Emirates College for Advanced Education, United Arab Emirates
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63
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Freeman D, Waite F. Persistent persecutory delusions: The spirit, style and content of targeted treatment. World Psychiatry 2017; 16:208-209. [PMID: 28498594 PMCID: PMC5428187 DOI: 10.1002/wps.20425] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Haaksma ML, Vilela LR, Marengoni A, Calderón-Larrañaga A, Leoutsakos JMS, Olde Rikkert MGM, Melis RJF. Comorbidity and progression of late onset Alzheimer's disease: A systematic review. PLoS One 2017; 12:e0177044. [PMID: 28472200 PMCID: PMC5417646 DOI: 10.1371/journal.pone.0177044] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/23/2017] [Indexed: 01/18/2023] Open
Abstract
Background Alzheimer’s disease is a neurodegenerative syndrome characterized by multiple dimensions including cognitive decline, decreased daily functioning and psychiatric symptoms. This systematic review aims to investigate the relation between somatic comorbidity burden and progression in late-onset Alzheimer’s disease (LOAD). Methods We searched four databases for observational studies that examined cross-sectional or longitudinal associations of cognitive or functional or neuropsychiatric outcomes with comorbidity in individuals with LOAD. From the 7966 articles identified originally, 11 studies were included in this review. The Newcastle-Ottawa quality assessment was used. The large variation in progression measures, comorbidity indexes and study designs hampered the ability to perform a meta-analysis. This review was registered with PROSPERO under DIO: 10.15124/CRD42015027046. Results Nine studies indicated that comorbidity burden was associated with deterioration in at least one of the three dimensions of LOAD examined. Seven out of ten studies investigating cognition found comorbidities to be related to decreased cognitive performance. Five out of the seven studies investigating daily functioning showed an association between comorbidity burden and decreased daily functioning. Neuropsychiatric symptoms (NPS) increased with increasing comorbidity burden in two out of three studies investigating NPS. Associations were predominantly found in studies analyzing the association cross-sectionally, in a time-varying manner or across short follow-up (≤2 years). Rarely baseline comorbidity burden appeared to be associated with outcomes in studies analyzing progression over longer follow-up periods (>2 years). Conclusion This review provides evidence of an association between somatic comorbidities and multifaceted LOAD progression. Given that time-varying comorbidity burden, but much less so baseline comorbidity burden, was associated with the three dimensions prospectively, this relationship cannot be reduced to a simple cause-effect relation and is more likely to be dynamic. Therefore, both future studies and clinical practice may benefit from regarding comorbidity as a modifiable factor with a possibly fluctuating influence on LOAD.
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Affiliation(s)
- Miriam L. Haaksma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Lara R. Vilela
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute, IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Carlos III Health Institute, Madrid, Spain
| | - Jeannie-Marie S. Leoutsakos
- Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Marcel G. M. Olde Rikkert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
| | - René J. F. Melis
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatric Medicine, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- * E-mail:
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Gooding PA, Littlewood D, Owen R, Johnson J, Tarrier N. Psychological resilience in people experiencing schizophrenia and suicidal thoughts and behaviours. J Ment Health 2017. [PMID: 28635432 DOI: 10.1080/09638237.2017.1294742] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Negative stressors can aggravate the impact of schizophrenia. However, some people find ways of combating such stressors. There is a dearth of research examining factors which enable individuals with schizophrenia to show psychological resilience.Aims: The goal of this study was to investigate resilience to negative stressors in people with disorders on the schizophrenia spectrum using a qualitative methodology.Methods: Data were collected from 23 participants who had experienced schizophrenia and suicidal thoughts and behaviours. Semi-structured interviews followed a topic guide. Participants were asked (i) what resilience meant to them, (ii) which stressors they had experienced over 12 months and (iii) how they had counteracted those stressors. Thematic analysis was conducted to identify re-occurring themes across interviews.Results: A continuum of psychological mechanisms described participants' views about the meaning of resilience which ranged from passive acceptance to resistance (e.g. withstanding pressure), and then to active strategies to counter stressors (e.g. confronting). These themes were also evident in narratives expressing personal resilience strategies but, additionally, included emotional coping techniques. External factors were highlighted that supported resilience including social support, reciprocity and religious coping.Conclusions: People with schizophrenia develop ways of being resilient to negative events which should inform therapeutic interventions.
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Affiliation(s)
| | - Donna Littlewood
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Rebecca Owen
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK.,Bradford Institute of Health Research, Bradford Teaching Hospitals, Bradford, UK, and
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Rosen C, Jones N, Longden E, Chase KA, Shattell M, Melbourne JK, Keedy SK, Sharma RP. Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis. Front Psychiatry 2017; 8:57. [PMID: 28469582 PMCID: PMC5395710 DOI: 10.3389/fpsyt.2017.00057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 03/29/2017] [Indexed: 01/27/2023] Open
Abstract
Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that "Happened," demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that "Happened" and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious-spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.
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Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Nev Jones
- Felton Institute, San Francisco, CA, USA
| | - Eleanor Longden
- Greater Manchester West Mental Health NHS Foundation Trust, Psychosis Research Unit, Manchester, UK
| | - Kayla A Chase
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
| | - Mona Shattell
- Department of Community, Systems, and Mental Health Nursing, Rush University, Chicago, IL, USA
| | | | - Sarah K Keedy
- Department of Psychiatry, University of Chicago, Chicago, IL, USA
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.,Department of Psychiatry, Jesse Brown Veterans Affairs Medical Center, Chicago, IL, USA
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Abstract
BACKGROUND This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions. METHOD Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect. RESULTS Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose-response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted. CONCLUSIONS The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.
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Shevlin M, McElroy E, Christoffersen MN, Elklit A, Hyland P, Murphy J. Social, familial and psychological risk factors for psychosis: A birth cohort study using the Danish Registry System. PSYCHOSIS 2016. [DOI: 10.1080/17522439.2015.1113306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Wilson C, Smith ME, Thompson E, Demro C, Kline E, Bussell K, Pitts SC, DeVylder J, Reeves G, Schiffman J. Context matters: The impact of neighborhood crime and paranoid symptoms on psychosis risk assessment. Schizophr Res 2016; 171:56-61. [PMID: 26777883 DOI: 10.1016/j.schres.2016.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/29/2015] [Accepted: 01/02/2016] [Indexed: 11/18/2022]
Abstract
Psychosis risk assessment measures probe for paranoid thinking, persecutory ideas of reference, and suspiciousness as part of a psychosis risk construct. However, in some cases, these symptoms may reflect a normative, realistic, and even adaptive response to environmental stressors rather than psychopathology. Neighborhood characteristics, dangerousness for instance, are linked to levels of fear and suspiciousness that can be theoretically unrelated to psychosis. Despite this potential confound, psychosis-risk assessments do not explicitly evaluate neighborhood factors that might (adaptively) increase suspiciousness. In such cases, interviewers run the risk of misinterpreting adaptive suspiciousness as a psychosis-risk symptom. Ultimately, the degree to which neighborhood factors contribute to psychosis-risk assessment remains unclear. The current study examined the relation between neighborhood crime and suspiciousness as measured by the SIPS among predominantly African American help-seeking adolescents (N=57) living in various neighborhoods in Baltimore City. Uniform Crime Reports, including violent and property crime for Baltimore City, were used to calculate a proxy of neighborhood crime. This crime index correlated with SIPS suspiciousness (r(55)=.32, p=.02). Multiple regression analyses demonstrated that increased neighborhood crime significantly predicted suspiciousness over and above the influence of the other SIPS positive symptoms in predicting suspiciousness. Findings suggest that neighborhood crime may in some cases account for suspiciousness ascertained as part of a psychosis risk assessment, and therefore sensitivity to contextual factors is important when evaluating risk for psychosis.
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Affiliation(s)
- Camille Wilson
- University of Maryland, Baltimore County, Department of Human Services Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Melissa Edmondson Smith
- University of Maryland, School of Social Work, 525 W. Redwood St., Baltimore, MD 21201, United States
| | - Elizabeth Thompson
- University of Maryland, Baltimore County, Department of Human Services Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Caroline Demro
- University of Maryland, Baltimore County, Department of Human Services Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Emily Kline
- Beth Israel Deaconess Medical Center, Department of Public Psychiatry, 75 Fenwood Road, 5th Floor, Boston, MA 02115, United States
| | - Kristin Bussell
- University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 2120, United States
| | - Steven C Pitts
- University of Maryland, Baltimore County, Department of Human Services Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States
| | - Jordan DeVylder
- University of Maryland, School of Social Work, 525 W. Redwood St., Baltimore, MD 21201, United States
| | - Gloria Reeves
- Beth Israel Deaconess Medical Center, Department of Public Psychiatry, 75 Fenwood Road, 5th Floor, Boston, MA 02115, United States
| | - Jason Schiffman
- University of Maryland, Baltimore County, Department of Human Services Psychology, 1000 Hilltop Circle, Baltimore, MD 21250, United States.
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Rawlings J, Shevlin M, Corcoran R, Morriss R, Taylor PJ. Out of the blue: Untangling the association between impulsivity and planning in self-harm. J Affect Disord 2015; 184:29-35. [PMID: 26070044 DOI: 10.1016/j.jad.2015.05.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/19/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Planned and unplanned acts of self-harm may have distinct clinical and psychological correlates. Trait impulsivity is one factor that might be expected to determine whether self-harm is planned. Research so far has focussed on suicide attempts and little is known about how individuals engaging in planned and unplanned acts of self-harm differ. The aim of the current study was to examine how individuals who report planned self-harm, unplanned self-harm, and no self-harm differ in terms of impulsivity and affective symptoms (depression, anxiety, and activated mood). METHOD An online survey of University students (n = 1350) was undertaken including measures of impulsivity, affective symptoms and self-harm. Analyses made use of a multinomial logistic regression model with affective and cognitive forms of impulsivity estimated as latent variables. RESULTS Trait affective impulsivity, but not cognitive, was a general risk factor for whether self-harm occurred. There was no evidence of differences between planned and unplanned self-harm. Affective symptoms of depression and anxiety mediated the relationship between affective impulsivity and self-harm. LIMITATIONS The study was cross-sectional, relied on a student sample which may not generalise to other populations. CONCLUSIONS Trait affective impulsivity is associated with self-harm but it appears to be mediated by depression and anxiety symptoms. The exact relationships between trait affective impulsivity, depression, anxiety and self-harm require further longitudinal research in clinical populations but might lead to improved risk assessment and new therapeutic approaches to self-harm.
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Affiliation(s)
- Jodie Rawlings
- School of Psychology, University of Exeter, United Kingdom
| | - Mark Shevlin
- School of Psychology, University of Ulster, United Kingdom
| | - Rhiannon Corcoran
- Institute of Psychology, Health & Society, University of Liverpool, United Kingdom
| | - Richard Morriss
- Institute of Mental Health, University of Nottingham, United Kingdom
| | - Peter James Taylor
- Institute of Psychology, Health & Society, University of Liverpool, United Kingdom.
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Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis. Schizophr Res 2015; 166:43-8. [PMID: 26036814 DOI: 10.1016/j.schres.2015.05.027] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 05/05/2015] [Accepted: 05/14/2015] [Indexed: 01/13/2023]
Abstract
According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zürich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p<.001) and negative (p<.001) symptoms and reported higher levels of stigma-related harm (p=.003) and stress (p=.009) at baseline. More perceived harm due to stigma at baseline predicted transition to schizophrenia (odds ratio 2.34, 95%-CI 1.19-4.60) after adjusting for age, gender, symptoms and functioning. Stigma stress may increase the risk of transition to schizophrenia. Research is needed on interventions that reduce public negative attitudes towards young people at risk and that support individuals at risk to cope with stigma-related stress.
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Bebbington P. Unravelling psychosis: psychosocial epidemiology, mechanism, and meaning. SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27:70-81. [PMID: 26120255 PMCID: PMC4466846 DOI: 10.11919/j.issn.1002-0829.215027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/23/2015] [Indexed: 12/17/2022]
Abstract
This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a
major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology
and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the
acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis,
and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality
experiments, experience sampling methodology, and treatment trials. The key element is to investigate social
and psychological measures in relation to each other. This research has confirmed the role of the external
social world in the development and persistence of psychotic disorder. In addition, several psychological
drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence
of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood
symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning
biases such as jumping to conclusions and belief inflexibility, though little is known about social influences
on such biases. It is now clear that there are many routes to psychosis and that it takes many forms.
Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation
in terms of psychological processes and social influences is an example of the required flexibility. Individual
mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the
hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches
described.
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Affiliation(s)
- Paul Bebbington
- Division of Psychiatry, Faculty of Brain Sciences, University College London, United Kingdom
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73
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Badcock JC. A Neuropsychological Approach to Auditory Verbal Hallucinations and Thought Insertion - Grounded in Normal Voice Perception. ACTA ACUST UNITED AC 2015; 7:631-652. [PMID: 27617046 PMCID: PMC4995233 DOI: 10.1007/s13164-015-0270-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A neuropsychological perspective on auditory verbal hallucinations (AVH) links key phenomenological features of the experience, such as voice location and identity, to functionally separable pathways in normal human audition. Although this auditory processing stream (APS) framework has proven valuable for integrating research on phenomenology with cognitive and neural accounts of hallucinatory experiences, it has not yet been applied to other symptoms presumed to be closely related to AVH – such as thought insertion (TI). In this paper, I propose that an APS framework offers a useful way of thinking about the experience of TI as well as AVH, providing a common conceptual framework for both. I argue that previous self-monitoring theories struggle to account for both the differences and similarities in the characteristic features of AVH and TI, which can be readily accommodated within an APS framework. Furthermore, the APS framework can be integrated with predictive processing accounts of psychotic symptoms; makes predictions about potential sites of prediction error signals; and may offer a template for understanding a range of other symptoms beyond AVH and TI.
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Affiliation(s)
- Johanna C Badcock
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Crawley, 6009 Western Australia
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Garety P. Therapeutic advances for people with delusions will come from greater specification and empirical investigation. World Psychiatry 2015; 14:180-1. [PMID: 26043332 PMCID: PMC4471971 DOI: 10.1002/wps.20210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College LondonLondon, UK
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75
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Wissow LS. Speeding the growth of primary mental health prevention. Isr J Health Policy Res 2015; 4:10. [PMID: 25793104 PMCID: PMC4365811 DOI: 10.1186/s13584-015-0008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/22/2015] [Indexed: 11/25/2022] Open
Abstract
While there is a strong case for primary prevention of mental health problems, relatively little mental health scholarship has been devoted to it in the last decade. Efforts to accelerate prevention scholarship could potentially benefit from strengthening pathways for interdisciplinary research; developing new training and working models for mental health professionals; developing a common language for public, policy, and scientific discussion of prevention; learning how to measure the common outcomes of heterogeneous interventions tailored to diverse communities.
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Affiliation(s)
- Lawrence S Wissow
- Johns Hopkins School of Public Health, 703 Hampton House, 624 North Broadway, Baltimore, MD 21205 USA
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Shevlin M, McAnee G, Bentall RP, Murphy J. Specificity of association between adversities and the occurrence and co-occurrence paranoia and hallucinations: Evaluating the stability of childhood risk in an adverse adult environment. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2014. [DOI: 10.1080/17522439.2014.980308] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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