Impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia during the COVID-19 crisis

Psychiatric and non-psychiatric patients during the midst of Covid-19: Pandemic distress, psychosis and the belief in conspiracy theories

BACKGROUND

The COVID-19 pandemic was associated with increased levels of psychological distress in the general population, at the same time providing a perfect breeding ground for conspiracy beliefs. Psychiatric patients are considered as a population with an increased vulnerability for stressful events, and conspiracy beliefs show overlaps with paranoid ideations. The aim of the present study was to investigate if psychiatric patients experienced higher levels of pandemic distress than non-psychiatric patients, if they were more prone to conspiracy beliefs and if pandemic distress as well as other mental health variables were associated with believing in conspiracy theories.

METHODS

Indicators for mental health (pandemic distress, depressive symptoms, general anxiety symptoms, perceived stress) and indicators for believing in conspiracy theories were assessed within psychiatric (n = 73) and non-psychiatric patients (n = 29) during the midst of the pandemic.

RESULTS

Psychiatric patients reported higher levels of pandemic distress than non-psychiatric patients. Conspiracy measurements correlated positively with pandemic distress, but not with anxiety and depression. No differences were found between psychiatric patients with or without psychotic disorder and non-psychiatric patients in regard to conspiracy measurements.

CONCLUSION

Our findings suggest a higher susceptibility of psychiatric patients to pandemic distress, but not an increased level of believing in conspiracy theories. The common notion that people suffering from psychosis are more likely to believe in conspiracy theories was not supported. Furthermore, distress caused by a specific event and not anxiety per se seems to be related to the degree of conspiracy beliefs.

Effects of Beliefs, Conspiracy Theories, and Vaccine Hesitancy on the Vaccination Status of Patients with Severe Mental Illness in a Tertiary Psychiatric Care Hospital in Türkiye

Background

The aim of the study was to investigate the relationship between the vaccination rates and vaccine hesitancy and the adoption of conspiracy theories by patients with severe mental illness in Türkiye.

Methods

Ninety-eight outpatients with schizophrenia and 105 outpatients with bipolar disorder were included. A sociodemographical data form, a survey on beliefs and conspiracy theories on vaccines and Vaccine Hesitancy Scale were obtained. Vaccinated and unvaccinated groups were compared and evaluated separately for patients with schizophrenia and bipolar disorder.

Results

Sixty-one (62.24%) patients in the schizophrenia group and 86 (81.90%) patients in the bipolar disorder group were vaccinated, and the vaccination rate in the schizophrenia group was significantly lower (P = .002). There was no significant difference in terms of Vaccine Hesitancy Scale scores or adoption of any particular conspiracy theory between patients with schizophrenia and bipolar groups. However, vaccinated and unvaccinated patients of schizophrenia and bipolar disorder groups differed in terms of adopting beliefs and conspiracy theories on vaccines. Sixty-five (75.58%) of the vaccinated patients in the bipolar group agreed with the statement "vaccines are safe," while this rate was 8 (42.11%) in the unvaccinated patients (P = .004). In the schizophrenia group, however, the main difference between the vaccinated and unvaccinated patients was adopting the beliefs that "vaccines have serious side effects" and "vaccines may cause homosexuality" (P = .0341 and P = .003, respectively).

Conclusion

The vaccination status of patients with schizophrenia might be under the stronger influence of conspiracy theories and specialized mental health interventions may be needed to ensure vaccination in patients with schizophrenia.

Schizophrenia and the COVID-19 pandemic: A narrative review from the biomedical perspective

The outbreak of the Coronavirus Disease 2019 (COVID-19) pandemic in 2020 caused a rapid worsening of global mental health. Patients with severe mental disorders, including schizophrenia, are at higher risk of being infected. The neuroinvasive potential of the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) has been confirmed. The aim of this article was to present a narrative and comprehensive review of multidimensional associations between schizophrenia and COVID-19 with special emphasis on common biological pathways. Online searches were performed in the PubMed database and covered the publication period until September 17, 2022. Search terms included "psychosis", "schizophrenia", "inflammation" and "COVID-19". Viewed as a neuroinflammatory state, schizophrenia shares several neurobiological mechanisms with the COVID-19. Environmental stress, common comorbidities of schizophrenia and adverse effects of antipsychotic treatment are associated with the higher severity and mortality of the COVID-19. Additionally, more frequent relapses of psychosis have been observed, and might be related to lower treatment adherence. In the context of clinical manifestation, higher level of negative symptoms has been identified among patients with schizophrenia during the pandemic. Improvements in mental health care policy and treatment adjustment are necessary to protect people with schizophrenia who are the population that is particularly vulnerable to the consequences of the COVID-19 pandemic. Future research will show if prenatal infection with the SARS-CoV-2 increases a risk of psychosis.

Mental health in Europe during the COVID-19 pandemic: a systematic review

The COVID-19 pandemic caused immediate and far-reaching disruption to society, the economy, and health-care services. We synthesised evidence on the effect of the pandemic on mental health and mental health care in high-income European countries. We included 177 longitudinal and repeated cross-sectional studies comparing prevalence or incidence of mental health problems, mental health symptom severity in people with pre-existing mental health conditions, or mental health service use before versus during the pandemic, or between different timepoints of the pandemic. We found that epidemiological studies reported higher prevalence of some mental health problems during the pandemic compared with before it, but that in most cases this increase reduced over time. Conversely, studies of health records showed reduced incidence of new diagnoses at the start of the pandemic, which further declined during 2020. Mental health service use also declined at the onset of the pandemic but increased later in 2020 and through 2021, although rates of use did not return to pre-pandemic levels for some services. We found mixed patterns of effects of the pandemic on mental health and social outcome for adults already living with mental health conditions.

Approaching differential diagnosis and decisional capacity assessment in the context of COVID-19 conspiracy beliefs: A narrative review and clinical discussion

OBJECTIVE

COVID-19 conspiracy theories have become widespread since the onset of the pandemic and compound the existing challenges of decisional capacity assessment. This paper aims to review the literature pertaining to decisional capacity assessment in the context of COVID-19 conspiracy beliefs and synthesize a practical approach with an emphasis on differential diagnosis and clinical pearls for the practicing physician.

METHODS

We reviewed papers on decisional capacity assessment and differential diagnosis in the context of COVID-19 conspiracy beliefs. A literature search was conducted using the US National Library of Medicine's PubMed.gov resource and Google Scholar.

RESULTS

The resulting article content was utilized to synthesize a practical approach to decisional capacity assessment in the context of COVID-19 conspiracy beliefs. Specifically, aspects related to the history, taxonomy, evaluation, and management are reviewed.

CONCLUSIONS

Appreciating the nuanced differences between delusions, overvalued ideas, and obsessions while with integrating the non-cognitive domains of capacity into the assessment are crucial to navigating the wide differential diagnosis of COVID-19 conspiracy beliefs. It is important to attempt to clarify and optimize patient decision-making abilities by addressing circumstances, attitudes, and cognitive styles specific to patients with seemingly irrational beliefs about COVID-19.

Who falls for fake news? Psychological and clinical profiling evidence of fake news consumers

Awareness of the potential psychological significance of false news increased during the coronavirus pandemic, however, its impact on psychopathology and individual differences remains unclear. Acknowledging this, the authors investigated the psychological and psychopathological profiles that characterize fake news consumption. A total of 1452 volunteers from the general population with no previous psychiatric history participated. They responded to clinical psychopathology assessment tests. Respondents solved a fake news screening test, which allowed them to be allocated to a quasi-experimental condition: group 1 (non-fake news consumers) or group 2 (fake news consumers). Mean comparison, Bayesian inference, and multiple regression analyses were applied. Participants with a schizotypal, paranoid, and histrionic personality were ineffective at detecting fake news. They were also more vulnerable to suffer its negative effects. Specifically, they displayed higher levels of anxiety and committed more cognitive biases based on suggestibility and the Barnum Effect. No significant effects on psychotic symptomatology or affective mood states were observed. Corresponding to these outcomes, two clinical and therapeutic recommendations related to the reduction of the Barnum Effect and the reinterpretation of digital media sensationalism were made. The impact of fake news and possible ways of prevention are discussed.

'Feeling' or 'sensing' the future? Testing for anomalous cognitions in clinical versus healthy populations

In the study and treatment of psychosis, emotional intelligence (EI) and thinking styles are important patient characteristics for successful outcomes in clinical intervention. Anticipation of unpredictable stimuli (AUS) may be understood as an anomalous perception and anomalous cognition in which an individual supposedly senses and recognizes future stimuli in an unexpected way, also referred to as “hunches or premonitions.” This examined the roles of EI and thinking styles in AUSs in convenience samples of healthy participants (n = 237) versus patients diagnosed with psychosis (n = 118). We adjusted several quadratic and exponential regression models according to the obtained functions. Group means were also compared to examine differences in EI scores for participants with psychosis compared to healthy participants. In the healthy group, EI predicted AUSs with a weight between 42% and 58%. Thinking styles were not correlated with AUSs. However, EI was not correlated with AUSs in the clinical group. Patients with psychosis tended to score higher on AUSs and lower on EI and thinking styles compared to participants in the healthy group. We discuss EI as a variable that can contextualize some anomalous perceptions which are otherwise difficult to classify or measure within the classic psychosis continuum model.