101
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Greenburgh A, Bell V, Raihani N. Paranoia and conspiracy: group cohesion increases harmful intent attribution in the Trust Game. PeerJ 2019; 7:e7403. [PMID: 31440431 PMCID: PMC6699476 DOI: 10.7717/peerj.7403] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/03/2019] [Indexed: 11/20/2022] Open
Abstract
Current theories argue that hyper-sensitisation of social threat perception is central to paranoia. Affected people often also report misperceptions of group cohesion (conspiracy) but little is known about the cognitive mechanisms underpinning this conspiracy thinking in live interactions. In a pre-registered experimental study, we used a large-scale game theory approach (N > 1,000) to test whether the social cohesion of an opposing group affects paranoid attributions in a mixed online and lab-based sample. Participants spanning the full population distribution of paranoia played as proposers in a modified Trust Game: they were allocated a bonus and chose how much money to send to a pair of responders which was quadrupled before reaching these responders. Responders decided how much to return to the proposers through the same process. Participants played in one of two conditions: against a cohesive group who communicated and arrived at a joint decision, or a non-cohesive group who made independent decisions. After the exchange, proposers rated the extent to which the responders’ decisions were driven by (i) self-interest and (ii) intent to harm. Although the true motives are ambiguous, cohesive responders were reliably rated by participants as being more strongly motivated by intent to harm, indicating that group cohesion affects social threat perception. Highly paranoid participants attributed harmful intent more strongly overall but were equally reactive to social cohesion as other participants. This suggests that paranoia involves a generally lowered threshold for social threat detection but with an intact sensitivity for cohesion-related group characteristics.
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Affiliation(s)
- Anna Greenburgh
- Department of Experimental Psychology, University College London, London, United Kingdom
| | - Vaughan Bell
- Department of Clinical, Education and Health Psychology, University College London, London, United Kingdom.,Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London & Maudsley NHS Foundation Trust, London, United Kingdon
| | - Nichola Raihani
- Department of Experimental Psychology, University College London, London, United Kingdom
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102
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Greenburgh A, Bell V, Raihani N. Paranoia and conspiracy: group cohesion increases harmful intent attribution in the Trust Game. PeerJ 2019; 7:e7403. [PMID: 31440431 DOI: 10.31234/osf.io/mgzjr] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/03/2019] [Indexed: 05/24/2023] Open
Abstract
Current theories argue that hyper-sensitisation of social threat perception is central to paranoia. Affected people often also report misperceptions of group cohesion (conspiracy) but little is known about the cognitive mechanisms underpinning this conspiracy thinking in live interactions. In a pre-registered experimental study, we used a large-scale game theory approach (N > 1,000) to test whether the social cohesion of an opposing group affects paranoid attributions in a mixed online and lab-based sample. Participants spanning the full population distribution of paranoia played as proposers in a modified Trust Game: they were allocated a bonus and chose how much money to send to a pair of responders which was quadrupled before reaching these responders. Responders decided how much to return to the proposers through the same process. Participants played in one of two conditions: against a cohesive group who communicated and arrived at a joint decision, or a non-cohesive group who made independent decisions. After the exchange, proposers rated the extent to which the responders' decisions were driven by (i) self-interest and (ii) intent to harm. Although the true motives are ambiguous, cohesive responders were reliably rated by participants as being more strongly motivated by intent to harm, indicating that group cohesion affects social threat perception. Highly paranoid participants attributed harmful intent more strongly overall but were equally reactive to social cohesion as other participants. This suggests that paranoia involves a generally lowered threshold for social threat detection but with an intact sensitivity for cohesion-related group characteristics.
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Affiliation(s)
- Anna Greenburgh
- Department of Experimental Psychology, University College London, London, United Kingdom
| | - Vaughan Bell
- Department of Clinical, Education and Health Psychology, University College London, London, United Kingdom
- Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London & Maudsley NHS Foundation Trust, London, United Kingdon
| | - Nichola Raihani
- Department of Experimental Psychology, University College London, London, United Kingdom
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103
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García-Mieres H, Niño-Robles N, Ochoa S, Feixas G. Exploring identity and personal meanings in psychosis using the repertory grid technique: A systematic review. Clin Psychol Psychother 2019; 26:717-733. [PMID: 31412423 DOI: 10.1002/cpp.2394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 01/25/2023]
Abstract
Current research and clinical practice in person-centred approaches highlight the importance of self, identity, and personal meanings in psychosis. Previous research has focused on dimensions of self, but less attention has been paid to the personal meanings involved in identity. The personal construct theory framework and the repertory grid technique (RGT) allow the study of identity and personal meanings within person-centred approaches of psychopathology and treatment in psychosis, as suggested by studies that began more than 40 years ago. However, their contributions have not yet been reviewed. We aimed to systematically review the evidence for the role of identity and personal meanings in psychotic disorders. We performed a systematic search using personal construct and RGT terms in PsycINFO, Web of Science, PubMed, EBSCO, Scopus, and Google Scholar. After identifying 2,574 articles, 15 were included. Nine studies followed an idiographic assessment, and six were nomothetic. Patients reported their subjective experience of isolation in terms of high self-ideal discrepancy and high perceived discrepancy with their significant others, which some studies associated with a lower degree of recovery or with the way in which positive symptoms were construed. Self-fragmentation either decreased with interventions or was associated with recovery. Evidence regarding interpersonal construing was less consistent, but there was a tendency for patients to show a more rigid cognitive structure than controls. To conclude, we found some evidence that self-discrepancies, fragmentation of self, and interpersonal construing are affected in psychosis and potentially modifiable through psychotherapy.
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Affiliation(s)
- Helena García-Mieres
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Noelia Niño-Robles
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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104
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Lavin R, Bucci S, Varese F, Berry K. The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:39-65. [PMID: 31390076 PMCID: PMC7028113 DOI: 10.1111/bjc.12231] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality. Method We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre‐registered the review protocol and followed PRISMA guidelines. Results Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia. Conclusions The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia. Practitioner points There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
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Affiliation(s)
- Rachel Lavin
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
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105
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Reininghaus U, Rauschenberg C, Ten Have M, de Graaf R, van Dorsselaer S, Simons CJP, Gunther N, Pries LK, Guloksuz S, Radhakrishnan R, Bak M, van Os J. Reasoning bias, working memory performance and a transdiagnostic phenotype of affective disturbances and psychotic experiences in the general population. Psychol Med 2019; 49:1799-1809. [PMID: 30160228 DOI: 10.1017/s0033291718002209] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The jumping to conclusions (JTC) reasoning bias and decreased working memory performance (WMP) are associated with psychosis, but associations with affective disturbances (i.e. depression, anxiety, mania) remain inconclusive. Recent findings also suggest a transdiagnostic phenotype of co-occurring affective disturbances and psychotic experiences (PEs). This study investigated whether JTC bias and decreased WMP are associated with co-occurring affective disturbances and PEs. METHODS Data were derived from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Trained interviewers administered the Composite International Diagnostic Interview (CIDI) at three time points in a general population sample (N = 4618). The beads and digit-span task were completed to assess JTC bias and WMP, respectively. CIDI was used to measure affective disturbances and an add-on instrument to measure PEs. RESULTS Compared to individuals with neither affective disturbances nor PEs, the JTC bias was more likely to occur in individuals with co-occurring affective disturbances and PEs [moderate psychosis (1-2 PEs): adjusted relative risk ratio (RRR) 1.17, 95% CI 0.98-1.41; and high psychosis (3 or more PEs or psychosis-related help-seeking behaviour): adjusted RRR 1.57, 95% CI 1.19-2.08], but not with affective disturbances and PEs alone, whereas decreased WMP was more likely in all groups. There was some evidence of a dose-response relationship, as JTC bias and decreased WMP were more likely in individuals with affective disturbances as the level of PEs increased or help-seeking behaviour was reported. CONCLUSION The findings suggest that JTC bias and decreased WMP may contribute to a transdiagnostic phenotype of co-occurring affective disturbances and PEs.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Margreet Ten Have
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Ron de Graaf
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Rajiv Radhakrishnan
- Department of Psychiatry,Yale University School of Medicine,New Haven, CT,USA
| | - Maarten Bak
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
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106
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Reininghaus U, Oorschot M, Moritz S, Gayer-Anderson C, Kempton MJ, Valmaggia L, McGuire P, Murray R, Garety P, Wykes T, Morgan C, Myin-Germeys I. Liberal Acceptance Bias, Momentary Aberrant Salience, and Psychosis: An Experimental Experience Sampling Study. Schizophr Bull 2019; 45:871-882. [PMID: 30189093 PMCID: PMC6581124 DOI: 10.1093/schbul/sby116] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cognitive models of psychosis posit that reasoning biases are an important mechanism contributing to the formation of psychotic symptoms, in part through transforming anomalous experiences of aberrant salience into frank psychotic symptoms. This study aimed to investigate the interplay of liberal acceptance (LA) bias, which is a specific type of reasoning bias, and momentary aberrant salience in the development of paranoid and psychotic experiences in daily life in first-episode psychosis patients (FEP), at-risk mental state participants (ARMS), and controls. We used a novel experimental Experience Sampling Methodology (eESM) task for measuring LA bias (ie, decisions based on low probability estimates) and ESM measures of momentary aberrant salience and paranoid and psychotic experiences in 51 FEP, 46 ARMS, and 53 controls. We found evidence that LA bias was more likely to occur in FEP than in controls. Further, LA bias was associated with psychotic and paranoid experiences (all P < .007) and modified the association between momentary aberrant salience and psychotic experiences (χ2(df) = 7.4(2), P = .025) in ARMS, such that momentary salience was associated with more intense psychotic experiences in the presence of LA bias in ARMS, but not in FEP and controls. Our findings suggest that LA bias may be central for anomalous experiences such as momentary aberrant salience to increase intensity of psychotic experiences in at-risk individuals. Further, LA bias appears to be more likely to be present, but not directly linked to current intensity of psychotic experiences, in treated FEP. Novel eESM tasks open new avenues for targeting psychological processes under real-world conditions.
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Affiliation(s)
- Ulrich Reininghaus
- Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.,Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Margaret Oorschot
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Gayer-Anderson
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Robin Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Til Wykes
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Leuven, Belgium
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107
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Perchtold CM, Weiss EM, Rominger C, Fink A, Weber H, Papousek I. Cognitive reappraisal capacity mediates the relationship between prefrontal recruitment during reappraisal of anger-eliciting events and paranoia-proneness. Brain Cogn 2019; 132:108-117. [PMID: 30980988 DOI: 10.1016/j.bandc.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023]
Abstract
Difficulties in emotion regulation, particularly in using adaptive regulation strategies such as cognitive reappraisal, are a commonly observed correlate of paranoia. While it has been suggested that poor implementation of cognitive reappraisal in dealing with aversive events precedes the onset of subclinical paranoid thinking, there is little empirical research on neural activation patterns during cognitive reappraisal efforts that might indicate vulnerability towards paranoid thinking. Prefrontal EEG alpha asymmetry changes were recorded while n = 57 participants were generating alternative appraisals of anger-eliciting events, and were linked to a behavioral measure of basic cognitive reappraisal capacity and self-reported paranoia proneness (assessed by personality facets of hostility and suspiciousness; Personality Inventory for DSM-5). Mediation analysis revealed that less left-lateralized activation at ventrolateral prefrontal sites during reappraisal efforts predicted a higher degree of paranoia proneness. This relationship was mediated through poorer cognitive reappraisal capacity. Matching previous evidence, findings suggest that inappropriate brain activation during reappraisal efforts impairs individuals' capacity to come up with effective alternative interpretations for anger-evoking situations, which may accentuate personality features related to increased paranoid thinking. The findings add to our understanding of neurally underpinned impairments in the capacity to generate cognitive reappraisals and their link to maladaptive personality and behavior.
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Affiliation(s)
| | | | | | - Andreas Fink
- Department of Psychology, University of Graz, Austria.
| | - Hannelore Weber
- Department of Psychology, University of Greifswald, Germany.
| | - Ilona Papousek
- Department of Psychology, University of Graz, Austria. https://psychologie.uni-graz.at/en/biological-psychology/team/
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108
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Muñoz-Negro JE, Prudent C, Gutiérrez B, Cervilla JA. Paranoia and risk of personality disorder in the general population. Personal Ment Health 2019; 13:107-116. [PMID: 30989831 DOI: 10.1002/pmh.1443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/14/2019] [Accepted: 03/13/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND We hypothesized that paranoia is associated with personality disorder (PD) in the general population. METHOD This was a population-based cross-sectional survey carried out in Andalusia (Spain) using a representative sample of 4 507 participants. Paranoia was measured using the Green Paranoid Thought Scale, and risk of having a PD was screened using the Standardized Assessment of Personality Abbreviated Scale whilst borderline personality disorder (BPD) was measured with the CEPER-III Exploratory Interview of Personality disorder. Adjusted Pearsons' correlations between paranoia and PD or BPD were calculated. RESULTS Paranoia was associated with the risk of having PD and, more robustly, with BPD. Both associations held true for both personality outcomes (PD and BPD) when tested for two Green Paranoid Thought Scale paranoia subtypes (persecutory and reference) after accounting for the effects of age, sex and child abuse. CONCLUSIONS Paranoia seems to either augment the risk for, or be part of, PD/BPD. © 2019 John Wiley & Sons, Ltd.
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Affiliation(s)
- José E Muñoz-Negro
- Unidad de Salud Mental, Hospital Universitario San Cecilio de Granada, Instituto Biosanitario de Granada, Servicio Andaluz de Salud, Granada, Spain
| | - Cécile Prudent
- Equipe Émergente de Recherche, BePsyLab, Université d' Angers, Angers, France
| | - Blanca Gutiérrez
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Jorge A Cervilla
- Unidad de Salud Mental, Hospital Universitario San Cecilio de Granada, Instituto Biosanitario de Granada, Servicio Andaluz de Salud, Granada, Spain.,Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, Spain
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109
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Butler R, Berry K, Ellett L, Bucci S. An experimental investigation of the impact of critical and warm comments on state paranoia in a non-clinical sample. J Behav Ther Exp Psychiatry 2019; 62:30-37. [PMID: 30179728 DOI: 10.1016/j.jbtep.2018.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 08/28/2018] [Accepted: 08/28/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Interpersonal stress is key to the development and maintenance of paranoia. Much attention has been given to the impact of interpersonal stressors, such as criticism, on outcomes in psychosis. Less attention has been given to the potentially protective effects of positive interpersonal factors. This study tested experimentally whether criticism and warm comments elicited changes in state paranoia. Whether warm comments provided protective effects when participants faced subsequent social exclusion was also examined. METHOD A nonclinical sample (N = 97) was randomised to criticism, warm comments, or neutral comments conditions. Participants then played a virtual ball game (Cyberball), during which they were systematically excluded from the game. State paranoia was measured before and after the affective stimuli and after social exclusion. Self-esteem and trait paranoia were also measured. RESULTS Paranoia levels increased following exposure to criticism (p = .011). Paranoia was not significantly lower following exposure to warm comments (p = .203). Warm comments did not provide protection against the effects of subsequent social exclusion. The warm comments condition was the only condition in which significant increases in paranoia were seen following social exclusion (p = .004). LIMITATIONS Use of a non-clinical sample limits generalisation to clinical populations. CONCLUSIONS Criticism is sufficient to elicit increases in paranoia in non-clinical participants. Warm comments are insufficient to significantly reduce paranoia or provide protective effects against subsequent negative interpersonal experiences, highlighting the need to balance therapeutic warmth with amelioration of social stressors in paranoia.
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Affiliation(s)
- Rebecca Butler
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Lyn Ellett
- Department of Psychology Health and Well-being, Royal Holloway, University of London, United Kingdom
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
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110
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Reductions in reported persecutory ideation and psychotic-like experiences during exposure therapy for posttraumatic stress disorder. Psychiatry Res 2019; 272:190-195. [PMID: 30584951 DOI: 10.1016/j.psychres.2018.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 11/22/2022]
Abstract
While psychotic-like experiences (PLEs), including persecutory ideation and auditory or visual hallucinations, are common in PTSD, questions remain about their relationships to core PTSD symptoms and responsiveness to treatment. This study examined data from a waitlist (WL) controlled clinical study of the effect of virtual reality (VR) and prolonged exposure (PE) in a sample of active-duty service members with deployment-related trauma (n = 161). PLEs were assessed and examined with regard to their responsiveness to trauma focused treatment (combining conditions) relative to the WL, as well as their relationships to PTSD symptoms. Persecutory ideation symptoms, which were most closely related to PTSD Cluster C (avoidance and numbing) symptoms, were reduced post-treatment in the trauma-focused condition relative to WL. Auditory and visual hallucinations-which were most closely associated with PTSD re-experiencing-decreased from baseline to post-treatment assessments for WL and exposure therapy participants. The presence of PLEs at baseline did not predict a reduced PTSD symptom response to treatment. Trauma-focused treatments appear effective in addressing psychotic-like experiences that can emerge in individuals with PTSD.
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111
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Masillo A, Valmaggia LR, Saba R, Brandizzi M, Lo Cascio N, Telesforo L, Venturini P, Izzo A, Mattioli MT, D'Alema M, Girardi P, Fiori Nastro P. Interpersonal sensitivity, bullying victimization and paranoid ideation among help-seeking adolescents and young adults. Early Interv Psychiatry 2019; 13:57-63. [PMID: 28560857 DOI: 10.1111/eip.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/12/2017] [Accepted: 03/18/2017] [Indexed: 01/08/2023]
Abstract
AIM The effects of a negative interpersonal experience, such as bullying victimization in childhood and adolescence, can be strong and long lasting. Bullying victimization is associated with paranoid ideation and suspiciousness. Few studies have focused on personality traits of victims of bullying. The aim of this study is to investigate whether a particular personality trait called interpersonal sensitivity may be related to suspiciousness in those who experienced bullying victimization. METHODS The study sample consisted of 147 help-seeking adolescents (mean age 17 years) selected after a screening phase (Prodromal Questionnaire) and evaluated with the Structured Interview for Psychosis-risk Syndromes (SIPS). All participants were specifically asked if they had experienced either psychological bullying or physical bullying, and they completed the Interpersonal Sensitivity Measure (IPSM). RESULTS Of the whole sample, 30 (20%) participants had experienced psychological bullying or physical bullying at least once in their life. Performing a multiple regression, bullying victimization was found to be an independent predictor of subtle paranoid ideation and suspiciousness. Interpersonal sensitivity was also found to be an independent predictor of subtle paranoid ideation; in particular, two IPSM subscales, fragile inner-self and separation anxiety, showed a significant correlation with subtle paranoid ideation. CONCLUSIONS Our results confirmed that bullying victimization is a negative interpersonal experience associated with paranoid ideation and suspiciousness. However, being overly sensitive and having negative beliefs about the self as fragile and vulnerable to threat also lead to a tendency to attribute experiences as externally caused and, in turn, facilitate the formation and maintenance of paranoid ideation.
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Affiliation(s)
- Alice Masillo
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Lucia R Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Martina Brandizzi
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Nella Lo Cascio
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Ludovica Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Paola Venturini
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Aniello Izzo
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | | | - Marco D'Alema
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
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112
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Diaconescu AO, Hauke DJ, Borgwardt S. Models of persecutory delusions: a mechanistic insight into the early stages of psychosis. Mol Psychiatry 2019; 24:1258-1267. [PMID: 31076646 PMCID: PMC6756090 DOI: 10.1038/s41380-019-0427-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/27/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022]
Abstract
Identifying robust markers for predicting the onset of psychosis has been a key challenge for early detection research. Persecutory delusions are core symptoms of psychosis, and social cognition is particularly impaired in first-episode psychosis patients and individuals at risk for developing psychosis. Here, we propose new avenues for translation provided by hierarchical Bayesian models of behaviour and neuroimaging data applied in the context of social learning to target persecutory delusions. As it comprises a mechanistic model embedded in neurophysiology, the findings of this approach may shed light onto inference and neurobiological causes of transition to psychosis.
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Affiliation(s)
- Andreea Oliviana Diaconescu
- Department of Psychiatry (UPK), University of Basel, Basel, Switzerland. .,Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zurich & Swiss Federal Institute of Technology (ETH Zurich), Zurich, Switzerland.
| | - Daniel Jonas Hauke
- 0000 0004 1937 0642grid.6612.3Department of Psychiatry (UPK), University of Basel, Basel, Switzerland ,0000 0004 1937 0642grid.6612.3Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - Stefan Borgwardt
- 0000 0004 1937 0642grid.6612.3Department of Psychiatry (UPK), University of Basel, Basel, Switzerland ,0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies PO63, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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113
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Bortolon C, Lopes B, Capdevielle D, Macioce V, Raffard S. The roles of cognitive avoidance, rumination and negative affect in the association between abusive supervision in the workplace and non-clinical paranoia in a sample of workers working in France. Psychiatry Res 2019; 271:581-589. [PMID: 30554106 DOI: 10.1016/j.psychres.2018.11.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
This study examined the relationship between abusive supervision and non-clinical paranoia and explored which cognitive mechanisms are mediating this association (i.e. rumination, cognitive avoidance and negative affect). A sample of two hundred and five French-speaking workers currently in employment in France was recruited to fill in a battery of online questionnaires comprising of the French adaptations of the Abusive Supervision Scale, the State Social Paranoia Scales, the Depression and Anxiety and Stress Scales, the Cognitive Avoidance Questionnaire and the Mini-Cambridge Exeter Repetitive Thought Scale. Mediation analyses showed that the experience of supervisory abuse directly influences state paranoia, however, there were significant mediation effects. Abusive supervision impacted on cognitive avoidance that led to more rumination, which in its turn increased negative affect and this increased state paranoia. Rumination impacted on state paranoia but through the effect of negative affect only. This study showed that abusive supervision works together with cognitive and affective factors to impact on non-clinical paranoia. It is recommended that Cognitive and Behavioural therapy (CBT) is tailored to help workers to cope with experiences of supervisory abuse and associated paranoid thoughts by focusing on replacing rumination and cognitive avoidance strategies for more adaptive cognitive strategies and on how to manage depression.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social - Université Grenoble Alpes, Grenoble, France; CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France.
| | - Bárbara Lopes
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Apartado 602, 3001-802, Coimbra, Portugal.
| | - Delphine Capdevielle
- CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, Montpellier, France
| | - Valéry Macioce
- Department of Medical Information, CHU Montpellier, Clinical Research and Epidemiology Unity, Montpellier, France
| | - Stéphane Raffard
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, F34000, Montpellier, France; CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France
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114
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Spontaneous future cognitions: an integrative review. PSYCHOLOGICAL RESEARCH 2018; 83:651-665. [PMID: 30535833 DOI: 10.1007/s00426-018-1127-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/04/2018] [Indexed: 12/16/2022]
Abstract
Spontaneous future cognitions refer to mental representations about the future that enter consciousness with no immediately preceding attempt of bringing them to mind. They are studied under different terms in several areas of psychology, but with little interdisciplinary exchange of findings and theoretical developments. Different conceptions of spontaneous future cognition derive from separate literatures and are rarely considered together, leaving their potential conceptual overlaps as well as their unique features unclarified. In this article, I review research on spontaneous future cognitions in relation to mind wandering, involuntary episodic future thoughts, and intrusive future imagery in cravings and clinical disorders. I conclude that more research is needed to clarify the potential functions served by spontaneous future cognitions in everyday life, under which conditions they may become dysfunctional, how they are triggered by situational cues, and how their content may be constrained by motivational factors and beliefs. The burgeoning field of spontaneous future cognitions forms a promising novel approach to the cognitive and motivational regulation of behavior in everyday life.
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115
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Depp CA, Villa J, Schembari BC, Harvey PD, Pinkham A. Social cognition and short-term prediction of suicidal ideation in schizophrenia. Psychiatry Res 2018; 270:13-19. [PMID: 30243127 PMCID: PMC6376982 DOI: 10.1016/j.psychres.2018.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/27/2018] [Accepted: 09/03/2018] [Indexed: 02/08/2023]
Abstract
Despite recent research acknowledging social cognition as an important feature of interpersonal functioning in schizophrenia, little work has evaluated the role of social cognition in suicidal ideation and behavior in psychosis. In a short-term longitudinal study, we evaluated the association between concurrent and near term suicidal ideation with social cognition, including emotion recognition and related biases (ER-40; BLERT), attribution biases (AIHQ), and evaluations of trustworthiness (trustworthiness task) in a sample of 179 outpatients with schizophrenia or schizoaffective disorder. Adjusting for severity of positive and general mental health symptoms, greater reactivity to extreme stimuli (trustworthiness measure), BLERT negative affect accuracy, and AIHQ Blame Scores were associated with suicidal ideation at baseline. AIHQ Blame Scores also longitudinally predicted the presence of ideation 2 weeks later and were highest among participants with ideation across the two time points. The present findings provide support that biased interpretations, and, concurrently with ideation, reactivity and selective accuracy to negative stimuli, are associated with suicidal ideation in schizophrenia. Further understanding the role of social cognitive ability and biases on suicidal ideation could contribute to the understanding of social cognition as a treatment target in prevention of suicidal behavior in schizophrenia.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0664, United States; VA San Diego Healthcare System, San Diego, CA, United States.
| | - Jennifer Villa
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | | | - Philip D Harvey
- Research Service, Bruce W. Carter Veterans Affairs (VA) Medical Center, Miami, FL, United States; Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Amy Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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116
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Klein HS, Pinkham AE. Examining reasoning biases in schizophrenia using a modified "Jumping to Conclusions" probabilistic reasoning task. Psychiatry Res 2018; 270:180-186. [PMID: 30261407 DOI: 10.1016/j.psychres.2018.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/15/2018] [Accepted: 09/12/2018] [Indexed: 01/05/2023]
Abstract
Although the Jumping To Conclusion (JTC) bias has been extensively studied in relation to schizophrenia and persecutory delusions, the relationship between JTC and other reasoning biases implicated in delusional ideation is not fully understood. We modified the traditional JTC task to assess co-occurrence of reasoning biases in decision making. Forty-six patients with schizophrenia and 46 healthy controls completed two versions [neutral colored beads and salient comments] of the modified task. We replicated previous findings indicating that patients showed a greater JTC bias, and in both groups, the JTC bias was more pronounced for the salient task. However, we observed a significant effect for non-Bayesian judgments, indicating that patients showed greater difficulty in probabilistic reasoning. When controlling for probabilistic reasoning ability, the observed JTC bias effects were diminished. Our findings that faulty probability assessment accounts for the JTC bias indicates that the traditional JTC bias task may not represent an inherent hasty decision-making bias, but rather an inability to fully understand and execute the stated goals of the task. These results call into question the current understanding of the JTC bias and the independence of this bias apart from the cognitive demands of the task.
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Affiliation(s)
- Hans S Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA.
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA; Department of Psychiatry, University of Texas Southwestern Medical School, Dallas, TX, USA
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117
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Okkenhaug A, Tanem T, Myklebust TÅ, Gjervan B, Johansen A. Self-reported premorbid health in 15 individuals who later developed schizophrenia compared with healthy controls: Prospective data from the Young-HUNT1 Survey (The HUNT Study). ACTA ACUST UNITED AC 2018. [DOI: 10.15714/scandpsychol.5.e8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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118
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Peyroux E, Prost Z, Danset-Alexandre C, Brenugat-Herne L, Carteau-Martin I, Gaudelus B, Jantac C, Attali D, Amado I, Graux J, Houy-Durand E, Plasse J, Franck N. From "under" to "over" social cognition in schizophrenia: Is there distinct profiles of impairments according to negative and positive symptoms? SCHIZOPHRENIA RESEARCH-COGNITION 2018; 15:21-29. [PMID: 30534527 PMCID: PMC6260279 DOI: 10.1016/j.scog.2018.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 10/10/2018] [Indexed: 12/04/2022]
Abstract
Interactions between social cognition and symptoms of schizophrenia have been investigated, but mostly component by component. Here we tested the assumption that two categories of deficits exist depending on clinical profiles, one corresponding to a defect in social cognition – “under-social cognition” – and one corresponding to excessive attributions leading to social cognitive impairments – “over-social cognition”. To conduct the investigation, we performed a Hierarchical Clustering Analysis using positive and negative symptoms in seventy patients with schizophrenia and we compared the clusters obtained to a group of healthy controls on social cognitive measures. We distinguished two social cognitive profiles based on prevailing symptoms for emotion processes and Theory of Mind. Actually, patients with negative symptoms showed lower performances in emotion recognition task than both those with positive symptoms and controls. Concerning Theory of Mind, patients with positive symptoms had a significant tendency to make over interpretative errors than both patients with negative symptoms and controls. For other processes assessed, further explorations are needed. Actually, concerning social perception and knowledge both patients' groups presented significant impairments compared to controls. Assessment of attribution bias showed that patients in the positive group presented a significant hostility bias and a higher intentionality score compared to healthy controls. These results favor the existence of different categories of impairments depending more on the clinical characteristics of patients than on nosographical categories, but further investigations are now necessary to specify these profiles. It nevertheless showed the importance of assessing symptoms in relationship with cognitive functioning.
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Affiliation(s)
- Elodie Peyroux
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France.,Reference Center for Rare Diseases (GénoPsy), Le Vinatier hospital, 95 Bd Pinel, 69500 Bron, France
| | - Zelda Prost
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Charlotte Danset-Alexandre
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Lindsay Brenugat-Herne
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Isabelle Carteau-Martin
- Espace de la Chevalerie, CHRU Bretonneau, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France.,UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France
| | - Baptiste Gaudelus
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Célia Jantac
- INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - David Attali
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Isabelle Amado
- Centre ressource et référent en remédiation cognitive et réhabilitation psychosociale de l'île de France (C3RP), 7 rue Cabanis, 75014 Paris, France.,INSERM U 894, Institut de Psychiatrie, Université Paris Descartes, Centre Hospitalier Sainte Anne, 7 rue Cabanis, 75014 Paris, France
| | - Jérôme Graux
- Espace de la Chevalerie, CHRU Bretonneau, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France.,UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France
| | - Emmanuelle Houy-Durand
- UMR INSERM 930, Université François-Rabelais de Tours, 10 Boulevard Tonnellé, Faculté de médecine, 37032 Tours Cedex 01, France.,Centre Universitaire de Pédopsychiatrie, 2 Boulevard Tonnellé, 37044 Tours Cedex 09, France
| | - Julien Plasse
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France
| | - Nicolas Franck
- University Department of Rehabilitation (SUR-CL3R), Le Vinatier hospital, 4 rue Jean Sarrazin, 69008 Lyon, France.,UMR 5229, CNRS et Université Claude Bernard Lyon 1, Université de Lyon, Institut des Sciences Cognitives Marc Jeannerod, 67 Boulevard Pinel, 69675 Bron Cedex, France
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119
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Murphy P, Bentall RP, Freeman D, O'Rourke S, Hutton P. The paranoia as defence model of persecutory delusions: a systematic review and meta-analysis. Lancet Psychiatry 2018; 5:913-929. [PMID: 30314852 DOI: 10.1016/s2215-0366(18)30339-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND An influential psychological model of persecutory delusions proposed that they are caused by a bias towards holding others responsible for negative events (an externalising attributional bias), preventing the individual from becoming aware of underlying low self-esteem. An early version of the model predicted self-esteem would, therefore, be preserved in people with these delusions, but a later version suggested it would be unstable, and that there would be a discrepancy between explicit and implicit self-esteem, with the latter being lower. We did a comprehensive meta-analytical test of the key predictions of this model and assessed the quality of evidence. METHODS We searched PubMed from Jan 1, 1994, to July 31, 2018, and collated systematic reviews of the defensive model's predictions in relation to persecutory delusions. We also searched PsycINFO, MEDLINE, Embase, and Web of Science for articles published from Jan 1, 2012, to Sept 10, 2016. Cross-sectional data from case-control, longitudinal, or experimental studies that examined self-esteem or the externalising attributional bias in individuals diagnosed as having schizophrenia-spectrum disorder were eligible for meta-analyses of group differences if at least 50% of participants with psychosis also had current persecutory delusions. Uncontrolled and longitudinal studies were included in meta-analyses of correlations and self-esteem instability, respectively. Study and outcome quality were assessed with the Agency for Healthcare Research and Quality assessment tool, and a modified version of Grading of Recommendations Assessment, Development and Evaluation, respectively. The study protocol is registered with PROSPERO, number CRD42016032782. FINDINGS We screened 3053 records, examined 104 full-text reports, and included 64 eligible studies. Consistent with the predictions of both versions of the model, paranoia severity in psychosis was positively correlated with the degree of externalising attributional bias (21 studies involving 1128 individuals; r=0·18, 95% CI 0·08 to 0·27, with moderate quality evidence). People with persecutory delusions also had a greater externalising attributional bias than non-clinical individuals (27 studies involving 1442 individuals; g=0·48, 95% CI 0·23 to 0·73) and depressed individuals (ten studies involving 421 individuals; g=1·06, 0·48 to 1·63), and people with psychosis without persecutory delusions (11 studies involving 480 individuals; g=0·40, 0·12 to 0·68), all based on moderate quality evidence. Contrary to the predictions in the early version of the model, paranoia severity in psychosis was negatively correlated with explicit self-esteem (23 studies involving 1866 individuals; r=-0·26, 95% CI -0·34 to -0·17, with high quality evidence). People with persecutory delusions also had lower explicit self-esteem than non-clinical individuals (22 studies involving 1256 individuals; g=-0·88, 95% CI -1·10 to -0·66, with high quality evidence) and explicit self-esteem similarly low to that in people with psychosis without persecutory delusions (11 studies involving 644 individuals; g=-0·26, -0·54 to 0·02, with moderate quality evidence). Consistent with the predictions in the later version of the model, self-esteem instability was positively correlated with paranoia severity in psychosis (four studies involving 508 individuals; r=0·23, 95% CI 0·11-0·34, with high quality evidence), and people with persecutory delusions had a greater discrepancy between their implicit and explicit self-esteem than depressed individuals (seven studies involving 398 individuals; g=0·61, 95% CI 0·37 to 0·85, with moderate quality evidence). They had higher explicit self-esteem than depressed individuals (13 studies involving 647 individuals; g=0·89, 95% CI 0·51 to 1·28, with moderate quality evidence), but similarly low implicit self-esteem (seven studies involving 398 individuals; g=-0·19, -0·45 to 0·07, with low quality evidence). In contrast to the later predictions, people with persecutory delusions did not have a greater self-esteem discrepancy than non-clinical individuals (ten studies involving 592 individuals; g=-0·17, 95% CI -0·45 to 0·12), although the evidence was very low quality. People with psychosis with or without persecutory delusions did not differ for implicit self-esteem (four studies involving 167 individuals; g=-0·24, 95% CI -0·77 to 0·30, with low quality evidence) or self-esteem discrepancies (four studies involving 165 individuals; g=0·17, -0·19 to 0·53, with moderate quality evidence). INTERPRETATION The predictions that self-esteem would be preserved in people with persecutory delusions in the early version of the paranoia as defence model and that implicit-explicit self-esteem discrepancy would be greater in people with persecutory delusions than in non-clinical individuals and people with psychosis without persecutory delusions in the later version of the model were not supported. By contrast, the later version correctly predicted that people with persecutory delusions have a greater self-esteem discrepancy than people with depression and a greater externalising attributional bias than all control groups, and that both this bias and self-esteem instability are associated with increased paranoia severity. Nevertheless, the reviewed data had limitations. Experimental studies, which might include interventionist-causal trials, are needed. FUNDING None.
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Affiliation(s)
- Philip Murphy
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Prestwich, Manchester, UK.
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Suzanne O'Rourke
- Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
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120
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Shawyer F. Is the paranoia as defence model of persecutory delusions defensible? Lancet Psychiatry 2018; 5:861-862. [PMID: 30314853 DOI: 10.1016/s2215-0366(18)30386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 09/22/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Frances Shawyer
- School of Psychology and Psychiatry, Monash University, Southern Synergy, Dandenong Hospital, Dandenong, VIC 3175, Australia.
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121
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Psychological mediators of the association between childhood adversities and psychosis: A systematic review. Clin Psychol Rev 2018; 65:175-196. [DOI: 10.1016/j.cpr.2018.05.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 01/03/2023]
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122
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Abstract
Paranoid ideation is a core feature of psychosis, and models of paranoia have long proposed that it arises in the context of disturbances in the perception of the self. However, to develop targeted interventions, there is a benefit in clarifying further, which aspects of self-perception are implicated. Interpersonal sensitivity is a personality trait which has been associated with the risk of paranoid thinking in the general population. However, not all studies have found this link. We aimed to review the empirical literature assessing the association between interpersonal sensitivity and paranoia in both general population and clinical samples; and to explore if associations found differed depending on whether state or trait paranoia was assessed. The review followed PRISMA guidelines. Articles were identified through a literature search in OVID (PsychINFO, MEDLINE) and Web of Science up to December 2016. Fourteen studies with a total of 12 138 participants were included. All studies were of 'fair' or 'good' quality. A robust association was found between interpersonal sensitivity and paranoia in clinical and general population samples alike, regardless of the method of assessment of both paranoia and interpersonal sensitivity. Although this finding was more pronounced in studies of trait paranoia, it is likely that differences in study purpose, measurement, and power explain these differences. Findings from this review support the hypothesis that feelings of personal vulnerability and exaggerated socially evaluative concerns are central for both onset and maintenance of paranoid symptoms, suggesting avenues for future research in targeted interventions.
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Affiliation(s)
- Susanne F Meisel
- Department of Psychology,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
| | - Philippa A Garety
- Department of Psychology,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
| | - Lucia R Valmaggia
- Department of Psychology,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
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123
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Nolan E, Murphy S, O’Neill T, Houston J, Murphy J, Shevlin M. Prevalence of psychotic-like experiences and associated distress in adolescent community, sexual-trauma and clinical samples. PSYCHOSIS 2018. [DOI: 10.1080/17522439.2018.1511745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Emma Nolan
- School of Psychology, Ulster University, Londonderry, Northern Ireland, UK
| | - Siobhan Murphy
- National Centre for Psychotraumatology, Southern Danish University
| | - Tara O’Neill
- School of Psychology, Queen’s University Belfast, Northern Ireland, UK
| | - James Houston
- School of Psychology, Ulster University, Londonderry, Northern Ireland, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Londonderry, Northern Ireland, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Londonderry, Northern Ireland, UK
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124
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Rosser BA. Intolerance of Uncertainty as a Transdiagnostic Mechanism of Psychological Difficulties: A Systematic Review of Evidence Pertaining to Causality and Temporal Precedence. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9964-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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125
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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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Lamster F, Kiener J, Wagner K, Rief W, Görge SC, Iwaniuk S, Leube D, Falkenberg I, Kluge I, Kircher T, Mehl S. Ist Wahn indirekt veränderbar? Ein stimmungsverbesserndes Konzept der kognitive Verhaltenstherapie für die stationäre Standardversorgung von Patienten mit schizophrenen Störungen. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000486966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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127
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Mehl S. Kognitiven Verzerrungen und Wahn wirksam begegnen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2018. [DOI: 10.1026/1616-3443/a000497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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128
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Sun X, So SHW, Chiu CD, Chan RCK, Leung PWL. Paranoia and anxiety: A cluster analysis in a non-clinical sample and the relationship with worry processes. Schizophr Res 2018; 197:144-149. [PMID: 29398206 DOI: 10.1016/j.schres.2018.01.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/08/2017] [Accepted: 01/21/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Worry processes are implicated in paranoia and anxiety. However, clinical studies focused on patients with co-occurring paranoia and anxiety. As both paranoia and anxiety are distributed across clinical and non-clinical groups, an investigation on worry processes among non-clinical individuals will allow us to delineate the specific worry mechanisms in paranoia and anxiety respectively. AIMS To identify clusters of non-clinical individuals who report varied levels of paranoia and anxiety, and to compare worry processes across clusters. METHOD An online survey, consisting of self-report questionnaires on generalized anxiety, paranoia, and worry processes, was completed by 2796 undergraduate students. A multiple-step validity check procedure resulted in a subsample of 2291 students, upon which cluster analyses and multivariate analyses of variance were conducted. RESULTS Four clusters of individuals were identified: (1) high paranoia/moderate anxiety, (2) average paranoia/high anxiety, (3) average paranoia/average anxiety, and (4) low paranoia/low anxiety. A unique cluster of individuals with high paranoia but low/average level of anxiety was not found. Cluster 1 reported a significantly higher intensity of day-to-day worries, a higher level of meta-worry, and more extreme meta-cognitive beliefs about worry than other clusters. CONCLUSIONS Individuals with high paranoia tended to report anxiety as well, but not vice versa. Our findings supported a hierarchical structure of anxiety and paranoia. All worry processes were exacerbated in individuals with paranoia and anxiety than those with anxiety alone.
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Affiliation(s)
- Xiaoqi Sun
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| | - Chui-De Chiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Raymond Chor-Kiu Chan
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Patrick Wing-Leung Leung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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Mehl S, Schlier B, Lincoln TM. Does CBT for Psychosis Have an Impact on Delusions by Improving Reasoning Biases and Negative Self-Schemas? ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract. Cognitive-behavioral therapy for psychosis (CBTp) builds on theoretical models that postulate reasoning biases and negative self-schemas to be involved in the formation and maintenance of delusions. However, it is unclear whether CBTp induces change in delusions by improving these proposed causal mechanisms. This study reports on a mediation analysis of a CBTp effectiveness trial in which delusions were a secondary outcome. Patients with psychosis were randomized to individualized CBTp (n = 36) or a waiting list condition (WL; n = 34). Reasoning biases (jumping to conclusions, theory of mind, attribution biases) and self-schemas (implicit and explicit self-esteem; self-schemas related to different domains) were assessed pre- and post-therapy/WL. The results reveal an intervention effect on two of four measures of delusions and on implicit self-esteem. Nevertheless, the intervention effect on delusions was not mediated by implicit self-esteem. Changes in explicit self-schemas and reasoning biases did also not mediate the intervention effects on delusions. More focused interventions may be required to produce change in reasoning and self-schemas that have the potential to carry over to delusions.
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Affiliation(s)
- Stephanie Mehl
- Department of Social Work and Health, University of Applied Sciences Frankfurt am Main, Germany
- Department of Psychiatry and Psychotherapy & Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-Universität Marburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
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Bell V, O'Driscoll C. The network structure of paranoia in the general population. Soc Psychiatry Psychiatr Epidemiol 2018; 53:737-744. [PMID: 29427197 PMCID: PMC6003969 DOI: 10.1007/s00127-018-1487-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 01/21/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE Bebbington and colleagues' influential study on 'the structure of paranoia in the general population' used data from the British National Psychiatric Morbidity Survey and latent variable analysis methods. Network analysis is a relatively new approach in psychopathology research that considers mental disorders to be emergent phenomena from causal interactions among symptoms. This study re-analysed the British National Psychiatric Morbidity Survey data using network analysis to examine the network structure of paranoia in the general population. METHODS We used a Graphical Least Absolute Shrinkage and Selection Operator (glasso) method that estimated an optimal network structure based on the Extended Bayesian Information Criterion. Network sub-communities were identified by spinglass and EGA algorithms and centrality metrics were calculated per item and per sub-community. RESULTS We replicated Bebbington's four component structure of paranoia, identifying 'interpersonal sensitivities', 'mistrust', 'ideas of reference' and 'ideas of persecution' as sub-communities in the network. In line with previous experimental findings, worry was the most central item in the network. However, 'mistrust' and 'ideas of reference' were the most central sub-communities. CONCLUSIONS Rather than a strict hierarchy, we argue that the structure of paranoia is best thought of as a heterarchy, where the activation of high-centrality nodes and communities is most likely to lead to steady state paranoia. We also highlight the novel methodological approach used by this study: namely, using network analysis to re-examine a population structure of psychopathology previously identified by latent variable approaches.
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Affiliation(s)
- Vaughan Bell
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ciarán O'Driscoll
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- North East London NHS Foundation Trust, London, UK
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Raihani NJ, Bell V. Conflict and cooperation in paranoia: a large-scale behavioural experiment. Psychol Med 2018; 48:1523-1531. [PMID: 29039293 PMCID: PMC6088528 DOI: 10.1017/s0033291717003075] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/19/2017] [Accepted: 09/19/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Paranoia involves thoughts and beliefs about the harmful intent of others but the social consequences have been much less studied. We investigated whether paranoia predicts maladaptive social behaviour in terms of cooperative and punitive behaviour using experimental game theory paradigms, and examined whether reduced cooperation is best explained in terms of distrust as previous studies have claimed. METHODS We recruited a large population sample (N = 2132) online. All participants completed the Green et al. Paranoid Thoughts Scale and (i) a Dictator Game and (ii) an Ultimatum Game, the former with an option for costly punishment. Following distrust-based accounts, we predicted highly paranoid people would make higher offers when the outcome depended on receiving a positive response from their partner (Ultimatum Game) but no difference when the partner's response was irrelevant (Dictator Game). We also predicted paranoia would increase punitive responses. Predictions were pre-registered in advance of data collection. Data and materials are open access. RESULTS Highly paranoid participants actually made lower offers than non-paranoid participants both in the Dictator Game and in the Ultimatum Game. Paranoia positively predicted punitive responses. CONCLUSIONS These findings suggest that distrust is not the best explanation for reduced cooperation in paranoia and alternative explanations, such as increased self-interest, may apply. However, the tendency to attribute harmful intent to partners was important in motivating punitive responses. These results highlight differing motivations underlying adverse social behaviour in paranoia and suggest that accounts based solely on the presenting features of paranoia may need to be rethought.
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Affiliation(s)
- N. J. Raihani
- Department of Experimental Psychology, University College London, London, UK
| | - V. Bell
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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An Experimental Investigation into the Effect of State-Anxiety on State-Paranoia in People Experiencing Psychosis. Behav Cogn Psychother 2018; 47:52-66. [PMID: 29938626 DOI: 10.1017/s1352465818000401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is strong evidence to suggest that anxiety is associated with paranoia in clinical and non-clinical samples. However, no research to date has directly manipulated anxiety to investigate if state-anxiety has a causal role in state-paranoia in clinical populations. AIMS To investigate whether an anxious-mood induction leads to greater paranoia than a neutral-mood induction in people experiencing psychosis and paranoia and, if so, whether this is predicted by anxiety over and above other variables. METHOD 22 participants with a psychosis-spectrum diagnosis took part in a two condition cross-over experimental design. Participants underwent a neutral-mood and an anxious-mood induction with levels of state-anxiety, state-affect and state-paranoia being measured before and after each condition. RESULTS State-paranoia was significantly higher after the anxious condition compared with the neutral condition. State-anxiety and negative-affect were significant predictors of levels of state-paranoia after the anxious condition. When both predictors were included in a regression model, only negative-affect was a significant predictor of state-paranoia after the anxious condition. There were a number of methodological limitations. CONCLUSIONS State-anxiety and negative-affect may both be involved in the maintenance of paranoia in clinical populations, as predicted by cognitive models. Negative-affect may be the strongest predictor of state-paranoia in clinical populations. Reasons for this are discussed, as well as the implications. Interventions that seek to reduce negative state-affect may be beneficial in managing state-paranoia. Further research is warranted to explore the suggested clinical and theoretical implications of these findings.
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133
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Pot-Kolder R, Veling W, Counotte J, van der Gaag M. Self-reported Cognitive Biases Moderate the Associations Between Social Stress and Paranoid Ideation in a Virtual Reality Experimental Study. Schizophr Bull 2018; 44:749-756. [PMID: 29040776 PMCID: PMC6007229 DOI: 10.1093/schbul/sbx119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cognitive biases are associated with psychosis liability and paranoid ideation. This study investigated the moderating relationship between pre-existing self-reported cognitive biases and the occurrence of paranoid ideation in response to different levels of social stress in a virtual reality environment. METHODS This study included 170 participants with different levels of psychosis liability (55 recent onset psychosis, 20 ultrahigh risk for psychosis, 42 siblings of psychotic patients, and 53 controls). All participants were exposed to virtual environments with different levels of social stress. The level of experienced paranoia in the virtual environments was measured with the State Social Paranoia Scale. Cognitive biases were assessed with a self-report continuous measure. Also, cumulative number of cognitive biases was calculated using dichotomous measures of the separate biases, based on general population norm scores. RESULTS Higher belief inflexibility bias (Z = 2.83, P < .001), attention to threat bias (Z = 3.40, P < .001), external attribution bias (Z = 2.60, P < .001), and data-gathering bias (Z = 2.07, P < .05) were all positively associated with reported paranoid ideation in the social virtual environments. Level of paranoid response increased with number of cognitive biases present (B = 1.73, P < .001). The effect of environmental stressors on paranoid ideation was moderated by attention to threat bias (Z = 2.78, P < .01) and external attribution bias (Z = 2.75, P < .01), whereas data-gathering bias and belief inflexibility did not moderate the relationship. CONCLUSION There is an additive effect of separate cognitive biases on paranoid response to social stress. The effect of social environmental stressors on paranoid ideation is further enhanced by attention to threat bias and external attribution bias.
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Affiliation(s)
- Roos Pot-Kolder
- Department of Clinical Psychology, VU University and Public Mental Health Research Institute, Amsterdam, the Netherlands,Parnassia Psychiatric Institute, The Hague, the Netherlands,To whom correspondence should be addressed; tel: +31-651108129; fax: +31-503611699; e-mail:
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Public Mental Health Research Institute, Amsterdam, the Netherlands,Parnassia Psychiatric Institute, The Hague, the Netherlands
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Bellido-Zanin G, Perona-Garcelán S, Senín-Calderón C, López-Jiménez AM, Ruiz-Veguilla M, Rodríguez-Testal JF. Childhood memories of threatening experiences and submissiveness and its relationship to hallucination proneness and ideas of reference: The mediating role of dissociation. Scand J Psychol 2018; 59:407-413. [PMID: 29808908 DOI: 10.1111/sjop.12455] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 03/28/2018] [Indexed: 11/30/2022]
Abstract
Recent studies have emphasized the importance of childhood memories of threatening experiences and submissiveness in a diversity of psychological disorders. The purpose of this work was to study their specific relationship with hallucination proneness and ideas of reference in healthy subjects. The ELES scale for measuring memory of adverse childhood experiences, the DES-II scale for measuring dissociation, the LSHS-R scale for measuring hallucination proneness, and the REF for ideas of reference were applied to a sample of 472 subjects. A positive association was found between childhood memories of adverse experiences and hallucination proneness and ideas of reference, on one hand, and dissociation on the other. A mediation analysis showed that dissociation was a mediator between the memory of adverse childhood experiences and hallucination proneness on one hand, and ideas of reference on the other. When the role of mediator of the types of dissociative experiences was studied, it was found that absorption and depersonalization mediated between adverse experiences and hallucination proneness. However, this mediating effect was not found between adverse experiences and ideas of reference. The relationship between these last two variables was direct. The results suggest that childhood memories of adverse experiences are a relevant factor in understanding hallucination proneness and ideas of reference. Similarly, dissociation is a specific mediator between adverse childhood experiences and hallucination proneness.
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Affiliation(s)
| | - Salvador Perona-Garcelán
- University Hospital Virgen del Rocío, Spain.,University of Seville Personality, Evaluation and Psychological Treatment Department, Spain
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135
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Gollwitzer A, Wilczynska M, Jaya ES. Targeting the link between loneliness and paranoia via an interventionist-causal model framework. Psychiatry Res 2018. [PMID: 29524907 DOI: 10.1016/j.psychres.2018.02.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Targeting the antecedents of paranoia may be one potential method to reduce or prevent paranoia. For instance, targeting a potential antecedent of paranoia - loneliness - may reduce paranoia. Our first research question was whether loneliness heightens subclinical paranoia and whether negative affect may mediate this effect. Second, we wondered whether this potential effect could be targeted via two interventionist pathways in line with an interventionist-causal model approach: (1) decreasing loneliness, and (2) intervening on the potential mediator - negative affect. In Study 1 (N = 222), recollecting an experience of companionship reduced paranoia in participants high in pre-manipulation paranoia but not in participants low in pre-manipulation paranoia. Participants recollecting an experience of loneliness, on the other hand, exhibited increased paranoia, and this effect was mediated by negative affect. In Study 2 (N = 196), participants who utilized an emotion-regulation strategy, cognitive reappraisal, to regulate the negative affect associated with loneliness successfully attenuated the effect of loneliness on paranoia. Targeting the effect of loneliness on paranoia by identifying interventionist pathways may be one promising route for reducing and preventing subclinical paranoia.
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Affiliation(s)
- Anton Gollwitzer
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06511, USA.
| | - Magdalena Wilczynska
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Advance Technology Centre, Level 3, Callaghan, New South Wales, Australia
| | - Edo S Jaya
- Faculty of Psychology, Universitas Indonesia, Depok 16424, Indonesia; Clinical Psychology and Psychotherapy, Universität Hamburg, Von-Melle-Park 5, D-20146 Hamburg, Germany
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Rüegg N, Moritz S, Berger T, Lüdtke T, Westermann S. An internet-based intervention for people with psychosis (EviBaS): study protocol for a randomized controlled trial. BMC Psychiatry 2018; 18:102. [PMID: 29653532 PMCID: PMC5899332 DOI: 10.1186/s12888-018-1644-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/28/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence shows that internet-based self-help interventions are effective in reducing symptoms for a wide range of mental disorders. To date, online interventions treating psychotic disorders have been scarce, even though psychosis is among the most burdensome disorders worldwide. Furthermore, the implementation of cognitive-behavioral therapy (CBT) for psychosis in routine health care is challenging. Internet-based interventions could narrow this treatment gap. Thus, a comprehensive CBT-based online self-help intervention for people with psychosis has been developed. The aim of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting list control group. METHODS The intervention includes modules on delusion, voice hearing, social competence, mindfulness, and seven other domains. Participants are guided through the program by a personal moderator. Usage can be amended by an optional smartphone app. In this randomized controlled trial, participants are allocated to a waiting list or an intervention of eight weeks. Change in positive psychotic symptoms of both groups will be compared (primary outcome) and predictors of treatment effects will be assessed. DISCUSSION To our knowledge, this project is one of the first large-scale investigations of an internet-based intervention for people with psychosis. It may thus be a further step to broaden treatment options for people suffering from this disorder. TRIAL REGISTRATION NCT02974400 (clinicaltrials.gov), date of registration: November 28th 2016.
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Affiliation(s)
- Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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Saarinen A, Hintsanen M, Hakulinen C, Pulkki-Råback L, Lehtimäki T, Raitakari O, Keltikangas-Järvinen L. The co-occurrence between depressive symptoms and paranoid ideation: A population-based longitudinal study. J Affect Disord 2018; 229:48-55. [PMID: 29306058 DOI: 10.1016/j.jad.2017.12.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/17/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND The aim of this study was to examine longitudinally in the general population (a) whether depressive symptoms co-occur with paranoid ideation from late adolescence to middle age (b) whether depressive subsymptoms are differently linked with paranoid ideation (c) whether depressive symptoms are associated with state-level or trait-level paranoid ideation. METHODS Altogether 2109 subjects of the Young Finns study completed the Paranoid Ideation Scale of the Symptom Checklist-90 Revised and a modified version of the Beck Depression Inventory in 1992, 1997, 2001, 2007, and 2012, and the Beck Depression Inventory-II in 2007, 2011, and 2012. RESULTS Higher self-rated depressive symptoms were associated with the course of more severe paranoid ideation over age, especially in late adolescence and early adulthood. Regarding depressive subsymptoms, the associations of negative attitude and performance difficulties with paranoid ideation were evident over age, whereas the influence of somatic symptoms (such as changes in sleep and appetite) was not significant until after early adulthood. Additionally, depressive symptoms were more evidently associated with the development of trait- than state-level paranoid ideation. LIMITATIONS Our study mostly captured mild depressive and paranoid symptoms. The results cannot be directly generalized to clinical populations. CONCLUSIONS Depressive symptoms were associated with the course of paranoid ideation from late adolescence to middle age. Patients with paranoid ideation might merit from evaluation of potential depressive symptoms, especially in late adolescence and early adulthood. Among patients with co-occurring depressive symptoms and paranoid ideation, there may be a substantial need for neurocognitive rehabilitation and community-based treatments.
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Affiliation(s)
- Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center in Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Olli Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
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Eddy CM. Social cognition and self-other distinctions in neuropsychiatry: Insights from schizophrenia and Tourette syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:69-85. [PMID: 29195921 DOI: 10.1016/j.pnpbp.2017.11.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/08/2023]
Abstract
Impairments in social cognition may reflect dysfunction of disorder specific or disorder general mechanisms. Although cross-disorder comparison may prove insightful, few studies have compared social cognition in different neuropsychiatric disorders. Parallel investigation of schizophrenia and Tourette syndrome (TS) is encouraged by similarities including the presence of problematic social behavior, echophenomena, emotional dysregulation and dopamine dysfunction. Focusing on tests of social cognition administered in both disorders, this review aims to summarize behavioral, neurophysiological and neuroimaging findings, before exploring how these may contribute to clinical symptoms. Studies investigating social cognition (imitation, emotion recognition, and understanding of beliefs or intentions) in patients with schizophrenia or TS were identified through Web of Science and PubMed searches. Although findings indicate that social cognitive deficits are more apparent in schizophrenia, adults with TS can exhibit similar task performance to patients with paranoia. In both disorders, behavioral and neuroimaging findings raise the possibility of increased internal simulation of others' actions and emotions, in combination with a relative under-application of mentalizing. More specifically, dysfunction in neurobiological substrates such as temporo-parietal junction and inferior frontal gyrus may underlie problems with self-other distinctions in both schizophrenia and TS. Difficulties in distinguishing between actions and mental states linked to the self and other may contribute to a range of psychiatric symptoms, including emotional dysregulation, paranoia, social anhedonia and socially disruptive urges. Comparing different patient populations could therefore reveal common neuro-cognitive risk factors for the development of problematic social behaviors, in addition to markers of resilience, coping strategies and potential neuro-compensation mechanisms.
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Affiliation(s)
- Clare M Eddy
- BSMHFT National Centre for Mental Health, Birmingham, and College of Medical and Dental Sciences, University of Birmingham, UK.
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139
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Hundal H, Lister R, Evans N, Antley A, Englund A, Murray RM, Freeman D, Morrison PD. The effects of cannabidiol on persecutory ideation and anxiety in a high trait paranoid group. J Psychopharmacol 2018; 32:276-282. [PMID: 29086614 DOI: 10.1177/0269881117737400] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have suggested that cannabidiol has anxiolytic and antipsychotic properties, raising hopes that cannabidiol will translate to the psychiatric clinic. Cannabidiol may be particularly useful for anxiety and paranoia in those at-risk of major mental illness. METHODS Immersion in a controlled 3D virtual-reality scenario was used to assay persecutory ideation and anxiety in a sample of non-clinical volunteers ( n=32) pre-selected for high paranoid traits. Participants were randomised to receive oral cannabidiol (600 mg) or placebo 130 min prior to entering virtual-reality. Well-validated rating scales were used to assay persecutory thinking and anxiety. Salivary cortisol concentration, heart rate and blood pressure were measured over the course of the experimental session. RESULTS Immersion in the virtual-reality session elicited anxiety as indexed by the Beck's anxiety inventory ( p<0.005), and increased cortisol concentration ( p=0.05), heart rate ( p<0.05) and systolic blood pressure ( p<0.05). However, cannabidiol had no impact upon any of these effects, except for a strong trend to increase anxiety ( p=0.09). Cannabidiol had no effect on persecutory ideation as assayed by the Community Assessment of Psychic Experiences questionnaire or the State Social Paranoia Scale. CONCLUSIONS In contrast to previous studies, there was no evidence of any benefits of cannabidiol on anxiety or persecutory ideation in healthy volunteers with high trait paranoia. However, a larger sample will be required for a definitive study.
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Affiliation(s)
- Harneet Hundal
- 1 The Biomedical Research Centre, King's College London, UK
| | - Rachel Lister
- 2 Department of Psychiatry, University of Oxford, UK
| | - Nicole Evans
- 2 Department of Psychiatry, University of Oxford, UK
| | - Angus Antley
- 3 Department of Computer Science, University College London, UK
| | - Amir Englund
- 1 The Biomedical Research Centre, King's College London, UK
| | - Robin M Murray
- 1 The Biomedical Research Centre, King's College London, UK
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140
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Moritz S, Bentall RP, Kolbeck K, Roesch-Ely D. Monocausal attribution and its relationship with reasoning biases in schizophrenia. Schizophr Res 2018; 193:77-82. [PMID: 28732799 DOI: 10.1016/j.schres.2017.06.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aberrant attributional styles are counted to a set of circumscribed cognitive biases that are implicated in the pathogenesis of (paranoid) psychosis. However, evidence for a specific profile (e.g., an exaggerated self-serving bias, other-blaming bias) has become equivocal over the years. More recently, one-sided (monocausal) attributions have been reported in patients with psychosis. METHODS We compared a large sample of patients with diagnosed schizophrenia (n=145) to nonclinical controls (n=30) on a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R). In this task, participants have to assign probability estimates to each of three potential causes (i.e., myself, others, circumstances) for a specific (negative or positive) event. RESULTS Participants with schizophrenia displayed an abolished self-serving bias and showed a significant preference for one-sided/monocausal attributions, which was neither correlated with jumping to conclusions nor overconfidence in errors. School education correlated with less monocausal attributions. We did not find any congruence between attributional styles with core delusional ideas. CONCLUSIONS Our study corroborates earlier investigations showing that monocausal attributions may play a role in the pathogenesis of psychosis; this bias unlikely represents an epiphenomenon of established biases. Unexpectedly, attributional styles (e.g., external-blaming) did not shape delusional contents. The true prevalence of monocausal attributions in psychosis is perhaps underestimated in the study, as groups were equated on school education, which was correlated with monocausal attributions.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Richard P Bentall
- School of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Roesch-Ely
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany
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141
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Pot-Kolder RMCA, Geraets CNW, Veling W, van Beilen M, Staring ABP, Gijsman HJ, Delespaul PAEG, van der Gaag M. Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: a single-blind randomised controlled trial. Lancet Psychiatry 2018; 5:217-226. [PMID: 29429948 DOI: 10.1016/s2215-0366(18)30053-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 01/12/2018] [Accepted: 01/15/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Many patients with psychotic disorders have persistent paranoid ideation and avoid social situations because of suspiciousness and anxiety. We investigated the effects of virtual-reality-based cognitive behavioural therapy (VR-CBT) on paranoid thoughts and social participation. METHODS In this randomised controlled trial at seven Dutch mental health centres, outpatients aged 18-65 years with a DSM-IV-diagnosed psychotic disorder and paranoid ideation in the past month were randomly assigned (1:1) via block randomisation to VR-CBT (in addition to treatment as usual) or the waiting list control group (treatment as usual). VR-CBT consisted of 16 individual therapy sessions (each 1 h long). Assessments were done at baseline, after treatment (ie, 3 months from baseline), and at a 6 month follow-up visit. The primary outcome was social participation, which we operationalised as the amount of time spent with other people, momentary paranoia, perceived social threat, and momentary anxiety. Analysis was by intention to treat. This trial was retrospectively registered with ISRCTN, number 12929657. FINDINGS Between April 1, 2014, and Dec 31, 2015, 116 patients with a psychotic disorder were randomly assigned, 58 to the VR-CBT group and 58 to the waiting list control group. Compared with the control, VR-CBT did not significantly increase the amount of time spent with other people at the post-treatment assessment. Momentary paranoid ideation (b=-0·331 [95% CI -0·432 to -0·230], p<0·0001; effect size -1·49) and momentary anxiety (-0·288 [-0·438 to -0·1394]; p=0·0002; -0·75) were significantly reduced in the VR-CBT group compared with the control group at the post-treatment assessment, and these improvements were maintained at the follow-up assessment. Safety behaviour and social cognition problems were mediators of change in paranoid ideation. No adverse events were reported relating to the therapy or assessments. INTERPRETATION Our results suggest that the addition of VR-CBT to standard treatment can reduce paranoid ideation and momentary anxiety in patients with a psychotic disorder. FUNDING Fonds NutsOhra, Stichting tot Steun VCVGZ.
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Affiliation(s)
- Roos M C A Pot-Kolder
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Parnassia Psychiatric Institute, The Hague, Netherlands.
| | - Chris N W Geraets
- Department of Psychiatry, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Marije van Beilen
- Department of Psychiatry, University of Groningen and University Medical Center Groningen, Groningen, Netherlands
| | - Anton B P Staring
- First Episode and Early Detection and Intervention Service, Altrecht Psychiatric Institute, Utrecht, Netherlands
| | | | - Philippe A E G Delespaul
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands; Mondriaan Psychiatric Institute zuid-Limburg, Maastricht, Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Parnassia Psychiatric Institute, The Hague, Netherlands
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142
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Masillo A, Brandizzi M, Valmaggia LR, Saba R, Lo Cascio N, Lindau JF, Telesforo L, Venturini P, Montanaro D, Di Pietro D, D'Alema M, Girardi P, Fiori Nastro P. Interpersonal sensitivity and persistent attenuated psychotic symptoms in adolescence. Eur Child Adolesc Psychiatry 2018; 27:309-318. [PMID: 28918440 DOI: 10.1007/s00787-017-1047-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
Abstract
Interpersonal sensitivity defines feelings of inner-fragility in the presence of others due to the expectation of criticism or rejection. Interpersonal sensitivity was found to be related to attenuated positive psychotic symptom during the prodromal phase of psychosis. The aims of this study were to examine if high level of interpersonal sensitivity at baseline are associated with the persistence of attenuated positive psychotic symptoms and general psychopathology at 18-month follow-up. A sample of 85 help-seeking individuals (mean age = 16.6, SD = 5.05) referred an Italian early detection project, completed the interpersonal sensitivity measure and the structured interview for prodromal symptoms (SIPS) at baseline and were assessed at 18-month follow-up using the SIPS. Results showed that individuals with high level of interpersonal sensitivity at baseline reported high level of attenuated positive psychotic symptoms (i.e., unusual thought content) and general symptoms (i.e., depression, irritability and low tolerance to daily stress) at follow-up. This study suggests that being "hypersensitive" to interpersonal interactions is a psychological feature associated with attenuated positive psychotic symptoms and general symptoms, such as depression and irritability, at 18-month follow-up. Assessing and treating inner-self fragilities may be an important step of early detection program to avoid the persistence of subtle but very distressing long-terms symptoms.
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Affiliation(s)
- Alice Masillo
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy.
| | - M Brandizzi
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - L R Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - R Saba
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - N Lo Cascio
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - J F Lindau
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - L Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Venturini
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - D Montanaro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - D Di Pietro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - M D'Alema
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - P Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Fiori Nastro
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
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143
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Saarinen A, Rosenström T, Hintsanen M, Hakulinen C, Pulkki-Råback L, Lehtimäki T, Raitakari OT, Cloninger CR, Keltikangas-Järvinen L. Longitudinal associations of temperament and character with paranoid ideation: A population-based study. Psychiatry Res 2018; 261:137-142. [PMID: 29304427 DOI: 10.1016/j.psychres.2017.12.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 12/15/2017] [Indexed: 11/18/2022]
Abstract
The aim of this study was to examine (a) the associations of temperament and character dimensions with paranoid ideation over a 15-year follow-up in the general population (b) the associations of explosive temperament and organized character profiles with paranoid ideation. 2137 subjects of the Young Finns Study completed the Temperament and Character Inventory and the Paranoid Ideation Scale of the Symptom Checklist-90 Revised in 1997, 2001, and 2012. Temperament dimensions of high novelty seeking, high harm avoidance, low reward dependence and explosive temperament profile were associated with the development of higher paranoid ideation. Regarding character, high self-directedness, high cooperativeness, and low self-transcendence and organized character profile were associated with lower paranoid ideation. These associations sustained after controlling for age, gender, and socioeconomic factors. However, the associations between temperament and paranoia mostly disappeared after taking character into account. Our study supported the hypothesis that personality dimensions contribute to the development of paranoid ideation. Temperament and character might combine a variety of single previously found risk factors into a more comprehensive framework for the developmental etiology of paranoia. Our findings provide evidence for psychotherapeutic interventions that support the self-regulation of temperamental vulnerabilities by internalizing mature concepts about the self and social relationships.
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Affiliation(s)
- Aino Saarinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | | | - Christian Hakulinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland; Helsinki Collegium for Advanced Studies, University of Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Finland; Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Finland
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144
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Nittel CM, Lincoln TM, Lamster F, Leube D, Rief W, Kircher T, Mehl S. Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:291-312. [PMID: 29460461 DOI: 10.1111/bjc.12174] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/09/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Although emotional instability and problems in emotion regulation (ER) are known to be linked to the formation and maintenance of psychosis and paranoia, it remains unclear whether the use of specific ER strategies is associated with it. The first aim of the study was to explore the association between emotional instability and paranoia. The second and third aims were to investigate whether the use of maladaptive ER strategies leads to paranoia in patients with psychosis in daily life and whether the use of more adaptive ER strategies reduces paranoia. DESIGN A prospective momentary assessment study over the course of 6 days was performed. METHOD Participants with psychosis (n = 32) reported repeatedly over six consecutive days on the presence and instability of positive and negative emotions, their use of adaptive (reappraisal, acceptance, distraction, social sharing, reflection) and maladaptive ER strategies (rumination, expressive suppression) and momentary paranoia in their daily life. RESULTS Hierarchical linear regression analysis revealed that patients with psychosis who presented pronounced instability of negative emotions showed more severe levels of state paranoia. In addition, patients with psychosis who used expressive suppression when confronted with negative emotions at one point in time presented more pronounced levels of state paranoia at the following point in time. CONCLUSION The results presented here suggest that both emotional instability and the use of expressive suppression might cause state paranoia and thus add to our understanding of causal mechanisms related to paranoia such as instability of negative emotions and the use of less adaptive ER strategies. PRACTITIONER POINTS Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.
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Affiliation(s)
- Clara Marie Nittel
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tania Marie Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany
| | - Fabian Lamster
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany.,Center for Acute Psychiatric Disorders, University Hospital of Psychiatry Zurich, Switzerland
| | - Dirk Leube
- AWO Center of Mental Health, Halle, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Health and Social Work, University of Applied Science, Frankfurt am Main, Germany
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145
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Pos K, Meijer CJ, Verkerk O, Ackema O, Krabbendam L, de Haan L. Metacognitive training in patients recovering from a first psychosis: an experience sampling study testing treatment effects. Eur Arch Psychiatry Clin Neurosci 2018; 268:57-64. [PMID: 28828697 PMCID: PMC5778181 DOI: 10.1007/s00406-017-0833-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/06/2017] [Indexed: 11/29/2022]
Abstract
Cognitive biases, negative affect and negative self-esteem are associated with paranoia in people with psychotic disorders. Metacognitive group training (MCT) aims to target these biases although research has shown mixed results. Our objective was to establish the effect of MCT on paranoid ideation in patients with recent onset psychosis in a powerful experience sampling design. 50 patients between the age of 18 and 35 were included in a single-blind, parallel group RCT comparing MCT with occupational therapy (OT) as an active control condition. We assessed via questionnaires and experience sampling treatment effects on paranoid ideation, delusional conviction, the cognitive bias jumping to conclusion (JTC), and cognitive insight, as well as treatment effects on associations between negative affect, negative self-esteem and paranoid ideation. Patients in the MCT group did not show a decrease in paranoid ideation, delusional conviction, JTC-bias or an increase in cognitive insight compared with OT. However, negative affect showed a weaker association with paranoid ideation post-treatment in the MCT condition. In the OT condition, this association was stronger post-treatment. We tentatively suggest that patients with an early psychosis seemed to benefit from MCT in emotional learning compared with the OT condition. Despite the fact that the group training is well-received by patients, subsequent individual MCT (MCT+) may be indicated for stronger favorable effects on paranoid ideation.
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Affiliation(s)
- Karin Pos
- Department of Psychiatry, Academic Medical Center (AMC), Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Carin J. Meijer
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Oukje Verkerk
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Onno Ackema
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Lydia Krabbendam
- Department of Educational Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands ,LEARN! Research Institute for Learning and Education, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
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146
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Picardi A, Fonzi L, Pallagrosi M, Gigantesco A, Biondi M. Delusional Themes Across Affective and Non-Affective Psychoses. Front Psychiatry 2018; 9:132. [PMID: 29674982 PMCID: PMC5895977 DOI: 10.3389/fpsyt.2018.00132] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 03/27/2018] [Indexed: 02/01/2023] Open
Abstract
The current debate about the diagnostic significance of delusion revolves around two positions. The neurocognitive position conceives delusion as a non-specific, though polymorphic, symptom. The psychopathological position views features of delusion such as content and structure as having meaningful connections with diagnostic entities. This study aims at contributing to this debate by examining the association between delusional themes and diagnosis in a sample of 830 adult psychotic patients. All diagnoses were made by experienced psychiatrists according to DSM-IV or ICD-10 criteria, and in 348 patients were established with the SCID-I. All patients were administered the Brief Psychiatric Rating Scale (BPRS). In each patient, the presence of somatic delusions and delusions of guilt, grandiosity, and persecution was determined by examining the scores on relevant BPRS items. Delusions of guilt were almost pathognomonic for a psychotic depressive condition (psychotic major depression 40%; psychotic bipolar depression 30%; depressed schizoaffective disorder 8%; bipolar and schizoaffective mixed states 6 and 7%, respectively). Only 1% of patients with schizophrenia and no patient with delusional disorder or bipolar or schizoaffective manic state showed such delusions. The difference between unipolar and bipolar depression and the other diagnostic groups was highly significant. Delusions of grandiosity characterized mostly patients with manic symptoms (bipolar mania 20%; bipolar mixed states 19%; manic schizoaffective disorder 10%). They were observed significantly more often in bipolar mania than in schizophrenia (7%). Persecutory delusions were broadly distributed across diagnostic categories. However, they were significantly more frequent among patients with schizophrenia and delusional disorder compared with depressed and manic patients. Somatic delusions were also observed in all diagnostic groups, with no group standing out as distinct from the others in terms of an increased prevalence of somatic delusions. Our findings suggest a middle position in the debate between the neurocognitive and the psychopathological approaches. On the one hand, the widespread observation of persecutory delusions suggests the usefulness of searching for non-specific pathogenic mechanisms. On the other hand, the association between some delusional contents and psychiatric diagnosis suggests that a phenomenological analysis of the delusional experience may be a helpful tool for the clinician in the diagnostic process.
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Affiliation(s)
- Angelo Picardi
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Laura Fonzi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mauro Pallagrosi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Antonella Gigantesco
- Centre of Behavioural Sciences and Mental Health, Italian National Institute of Health, Rome, Italy
| | - Massimo Biondi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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147
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Kaltsi M, Bucci S, Morrison AP. Experimental manipulation of metacognitive beliefs and paranoia in a non-clinical population. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1413128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maria Kaltsi
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P. Morrison
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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148
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Butjosa A, Gómez-Benito J, Myin-Germeys I, Barajas A, Baños I, Usall J, Grau N, Granell L, Sola A, Carlson J, Dolz M, Sánchez B, Haro JM, Ochoa S. Development and validation of the Questionnaire of Stressful Life Events (QSLE). J Psychiatr Res 2017; 95:213-223. [PMID: 28886449 DOI: 10.1016/j.jpsychires.2017.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 02/01/2023]
Abstract
Stressful life events (SLEs) are important indicators prior to the onset of first-episode psychosis (FEP). Although there are well-validated interviews and self-reports for assessing SLE on proximate events, unfortunately there are no instruments to assess SLE covering an entire lifetime. This study includes detailed specific items of childhood, adolescence, and adulthood focused on the presence of SLE, emotional impact (stressfulness), and the age at which the event occurred. Our research describes 2 studies designed to develop and validate a new scale to assess SLE: the Questionnaire of Stressful Life Events (QSLE). In Study 1, an over-inclusive item pool was generated based on review of group of experts at Parc Sanitari Sant Joan de Déu and content validity was examined by an Expert Survey. The whole scale represents the content domain. In Study 2, item-level analyses revealed good distributional properties, intra-rater reliability, and convergent and discriminant validity. In the sensitivity and specificity analysis, 18 items had high relevance in the discriminability between patients with FEP and healthy controls. We note that there was an AUC of 0.676, indicating a good predictor. Using 7 as a cutoff to predict an individual as a patient would yield a sensitivity of 64.8% and a specificity of 65%. Overall, the QSLE displayed satisfactory psychometric characteristics in a Spanish population. These results suggest that QSLE gives us the opportunity to investigate childhood, adolescent, and adult life events by measuring the stress and age at the moment on a continuous scale.
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Affiliation(s)
- Anna Butjosa
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain; Facultad de Psicología, Universidad de Barcelona, Barcelona, Spain.
| | - Juana Gómez-Benito
- Facultad de Psicología, Universidad de Barcelona, Barcelona, Spain; Instituto de Neurociencias (UB Neuro), Universidad de Barcelona, Barcelona, Spain
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ana Barajas
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain; Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain; Centro de Higiene Mental de Les Corts, Barcelona, Spain
| | - Iris Baños
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain
| | - Norma Grau
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain
| | - Luis Granell
- Hospital Universitario de Fuenlabrada, Madrid, Spain
| | - Andrea Sola
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain
| | - Janina Carlson
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain; Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Montserrat Dolz
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Bernardo Sánchez
- Hospital Infanto-juvenil Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, CIBERSAM, Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain
| | | | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, CIBERSAM, Barcelona, Spain.
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Udachina A, Bentall RP, Varese F, Rowse G. Stress sensitivity in paranoia: poor-me paranoia protects against the unpleasant effects of social stress. Psychol Med 2017; 47:2834-2843. [PMID: 28578719 DOI: 10.1017/s0033291717001362] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The attributional theory of paranoia suggests that paranoid beliefs may protect individuals from low self-esteem and distress (Bentall et al. 2001). The current study tested this theory by investigating a hypothesis that paranoid beliefs in combination with low perceived deservedness of persecution (poor-me beliefs) confer protection against the distress caused by social but not activity related stress. METHODS Paranoid symptoms, perceived deservedness of persecution, self-esteem, mood, and stress levels of individuals diagnosed with schizophrenia spectrum disorders (N = 91) and healthy controls (N = 52) were assessed in the context of daily life using the experience sampling method. RESULTS Individuals holding poor-me beliefs (poor-me individuals) showed blunted sensitivity to social but not activity stress. In contrast, individuals holding paranoid beliefs in combination with high perceived deservedness of persecution (bad-me individuals) showed heightened sensitivity to social stress. No consistent differences in reactions to activity stress emerged. Although both poor-me and bad-me individuals reported low self-esteem, this disturbance was particularly characteristic of bad-me individuals. CONCLUSIONS The results suggest that poor-me paranoid beliefs may protect individuals against the distress associated with unpleasant social situations. The specificity of reactions to social stress is discussed in the context of wider literature. Future directions for research are suggested.
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Affiliation(s)
- A Udachina
- Greater Manchester Mental Health NHS Foundation Trust,UK
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150
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The effect of social exclusion on state paranoia and explicit and implicit self-esteem in a non-clinical sample. J Behav Ther Exp Psychiatry 2017; 57:62-69. [PMID: 28419917 DOI: 10.1016/j.jbtep.2017.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 04/05/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The relationship between self-esteem and paranoia may be influenced by social stress. This study aimed to replicate previous research on the impact ofsocial exclusion on paranoia and self-esteem in a non-clinical sample and to extend this work by examining the effect of exclusion on self-esteem at the 'implicit' level. METHODS Non-clinical participants (N = 85) were randomly allocated to the Inclusion or Exclusion condition of a virtual ball-toss game ('Cyberball'). They completed self-reportmeasures of state paranoia and self-esteem, and two implicit measures of self-esteem - theImplicit Association Task (IAT) and Implicit Relational Assessment Procedure (IRAP) -prior to and after exposure to Cyberball. RESULTS Social exclusion increased state paranoia. This effect was moderated by distress associated with trait paranoia. Exclusion was also associated with decreased self-reported self-esteem, as well as reduced implicit self-esteem on the IAT. Changes in self-reported self-esteem were associated with state paranoia at post-Cyberball. The IRAP indicated that reductions in implicit self-esteem may be due to increases in 'Me-Negative' and 'Others-Positive' biases (rather than reductions in 'Me-Positive' bias). LIMITATIONS The current study involved a non-clinical sample and so findings cannot be generalized to clinical paranoia. CONCLUSIONS These findings are consistent with previous evidence that paranoia is associated with negative self-evaluations, whereas positive self-evaluations can persist in paranoia. They also provide support for the suggestion that investigations of self-esteem in paranoia should extend beyond global self-esteem and might benefit from a distinction between positive and negative components.
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