1
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Chau AKC, So SHW, Barkus E. The role of loneliness and negative schemas in the moment-to-moment dynamics between social anxiety and paranoia. Sci Rep 2023; 13:20775. [PMID: 38008774 PMCID: PMC10679161 DOI: 10.1038/s41598-023-47912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023] Open
Abstract
Social anxiety and paranoia often co-occur and exacerbate each other. While loneliness and negative schemas contribute to the development of social anxiety and paranoia separately, their role in the development of the two symptoms co-occurring is rarely considered longitudinally. This study examined the moment-to-moment relationship between social anxiety and paranoia, as well as the effects of loneliness and negative schemas on both experiences individually and coincidingly. A total of 134 non-clinical young adults completed experience sampling assessments of momentary social anxiety, paranoia, and loneliness ten times per day for six consecutive days. Participants' negative-self and -other schemas were assessed with the Brief Core Schema Scale. Dynamic structural equation modelling revealed a bidirectional relationship between social anxiety and paranoia across moments. Loneliness preceded increases in both symptoms in the next moment. Higher negative-self schema was associated with a stronger link from paranoia to social anxiety; whereas higher negative-other schema was associated with a stronger link from social anxiety to paranoia. Our findings support the reciprocal relationship between social anxiety and paranoia. While loneliness contributes to the development of social anxiety and paranoia, negative self and other schemas appear to modify the relationships between the two symptoms.
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Affiliation(s)
- Anson Kai Chun Chau
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, New Territories, 3/F Wong Foo Yuan Building, Hong Kong, People's Republic of China
- Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, People's Republic of China
| | - Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, New Territories, 3/F Wong Foo Yuan Building, Hong Kong, People's Republic of China.
| | - Emma Barkus
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
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2
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Sasaki J, Muranaka S, Arahata K, Sato A. Developing and validating the Japanese version of the Referential Thinking Scale: A cross-sectional study. PLoS One 2023; 18:e0283416. [PMID: 37418436 PMCID: PMC10328373 DOI: 10.1371/journal.pone.0283416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/08/2023] [Indexed: 07/09/2023] Open
Abstract
It has been shown that ideas of reference in the context of paranoia (IoR-P) and schizophrenia spectrum disorders (IoR-S) are caused by different psychological constructs. Although it is well known that both IoR-P and IoR-S are frequently evoked during the same period of life, how they interact with each other is unknown. The purpose of the present study was to develop the Japanese version of the Referential Thinking Scale (J-REF) to assess IoR-S, examine its validity and reliability, and explore the predictors of IoR-P and IoR-S. In this study, several subgroups of Japanese individuals in their 20s were included in the analysis. The J-REF had high internal consistency, high test-retest reliability, good convergent, and discriminant validity. Two hierarchical regression analyses showed that public self-consciousness predicted the manifestation of IoR-P, while the dimensions of schizotypy predicted that of IoR-S. Moreover, social anxiety and negative moods could cause IoR-P and IoR-S. This study directly showed the existence of two different types of ideas of reference in terms of their predictors. It is also significant in that it first examined referential thinking using the REF scale in the context of Asia and showed that there may not be much difference in the frequency of ideas of reference from other cultures. Future research directions are also discussed.
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Affiliation(s)
- Jun Sasaki
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Seiji Muranaka
- Graduate School of Human Sciences, Osaka University, Suita, Osaka, Japan
| | - Kotomi Arahata
- Toyama Prefectural Mental Health Center, Toyama, Toyama, Japan
| | - Atsushi Sato
- Graduate School of Humanities, Arts, and Social Sciences, University of Toyama, Toyama, Toyama, Japan
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3
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Aunjitsakul W, McGuire N, McLeod HJ, Gumley A. Candidate Factors Maintaining Social Anxiety in the Context of Psychotic Experiences: A Systematic Review. Schizophr Bull 2021; 47:1218-1242. [PMID: 33778868 PMCID: PMC8379542 DOI: 10.1093/schbul/sbab026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.
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Affiliation(s)
- Warut Aunjitsakul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand,Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,To whom correspondence should be addressed; Glasgow Institute of Health and Wellbeing, Glasgow Mental Health Research Facility, University of Glasgow, Fleming Pavilion, West of Scotland Science Park (Todd Campus), Glasgow, G20 0XA, UK; tel: 0141-330-4852, e-mail:
| | - Nicola McGuire
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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4
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Kammerer MK, Bub K, Lincoln TM. The relationship between nightmares and psychotic experiences in young adults. Sleep Med 2020; 77:315-322. [PMID: 32980251 DOI: 10.1016/j.sleep.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/15/2020] [Accepted: 08/08/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND There is indication that frequent nightmares are an early indicator of psychotic disorders in adolescents and young adults. Yet which aspects of nightmares are relevant and how they contribute to psychotic experiences has remained unclear. METHODS We conducted a cross-sectional online survey in a community sample of young adults between the ages of 18 and 27 (n = 486) to identify aspects of nightmares (nightmare frequency (NF), nightmare distress (ND), nightmare contents), that are related to specific psychotic experiences (paranoid thoughts, hallucinations, negative symptoms) after controlling for sleep quality, and examined factors that potentially mediate this relationship (stress, depression). RESULTS Nightmare frequency and -distress were significantly associated with paranoid thoughts, hallucinations and negative symptoms (NF: rs = 0.293 - 0.139; ND: rs = 0.411 - 0.166). Nightmares significantly added to explaining paranoid thoughts and hallucinations, over and above sleep quality, but not to explaining negative symptoms. The relations between nightmare distress and psychotic experiences were partially mediated by stress (percentage mediated for paranoid thoughts: 38.20%; for hallucinations: 11.77%) and depression (percentage mediated for paranoid thoughts: 56.61%; for hallucinations: 28.02%). The most commonly reported nightmare contents revolved around being chased, falling and losing a close relative and specific contents were significantly related to the frequency of hallucinations (eg, threatening surroundings, OR = 1.73) or paranoia (eg, workspace bullying, OR = 2.02). CONCLUSIONS Thorough assessments of nightmares and sleep disturbances in young individuals could facilitate early detection of those at risk and help to target preventive treatments. However, longitudinal studies are needed to test for a causal relationship between nightmares and the development of psychotic symptoms.
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Affiliation(s)
- Mathias K Kammerer
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany.
| | - Konstantin Bub
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
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5
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The simulation heuristic, paranoia, and social anxiety in a non-clinical sample. J Behav Ther Exp Psychiatry 2019; 62:15-21. [PMID: 30149203 DOI: 10.1016/j.jbtep.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 07/29/2018] [Accepted: 08/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Quality of reasoning within non-clinical paranoia and mental simulation of future paranoia themed events was investigated by use of a simulation task to determine whether paranoid individuals would be restricted or more adept at reasoning about paranoia relevant material in comparison to a social anxiety group and a group with low paranoia and social anxiety. METHOD Participants (N = 63) were divided into the three groups based on paranoia and social anxiety scores. They were presented with the beginning and end of an imaginary situation and were asked to describe, step-by-step, what they imagined would happen between those two points. They were also administered a beads task to evaluate the jumping to conclusion decision making bias. RESULTS The prediction of more adept reasoning was not supported for paranoia. However, the social anxiety comparison group on average better simulated a scenario with congruent (socially anxious) thematic content compared to ones with non-congruent content. Further, in an exploratory analysis, jumping to conclusions bias was found to be positively related to goodness of simulation for paranoia themed scenarios within the paranoia group. LIMITATIONS Study groups were relatively small and so power was an issue. CONCLUSION The results are discussed in the context of the sometimes paradoxical findings in the area of cognitive biases and paranoia.
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6
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The Social Suspiciousness Scale: Development, Validation, and Implications for Understanding Social Anxiety Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019. [DOI: 10.1007/s10862-019-09724-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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7
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de Jong Y, Mulder CL, Boon AE, Deen M, van 't Hof M, van der Gaag M. Screening for psychosis risk among adolescents in Child and Adolescent Mental Health Services: a description of the first step with the 16-item version of the Prodromal Questionnaire (PQ-16). Early Interv Psychiatry 2018; 12:669-676. [PMID: 27860294 DOI: 10.1111/eip.12362] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 05/15/2016] [Accepted: 06/12/2016] [Indexed: 01/03/2023]
Abstract
AIM Although the 16-item version of the Prodromal Questionnaire (PQ-16) is used as a screener in the early detection of psychosis risk, little is known about PQ-16 scores among adolescents referred to the Child and Adolescent Mental Health Services. We assessed such scores in adolescents referred to these services in the Netherlands, and also their associations with age, gender, diagnosis and level of functioning. METHODS The PQ-16 was added to regular intake procedures. RESULTS The PQ-16 was completed by 176 adolescents (mean age 14.58 years; standard deviation = 1.50; 55.1% females), 34.7% of whom scored above the current cut-off score of ≥6 items. Positive item scores with the highest odds ratio for scoring above the cut-off were related to tasting or smelling things, seeing things and hearing thoughts out aloud. There were no age-, gender- or disorder-related differences in total scores on the PQ-16. Lower Global Assessment of Functioning scores were associated with higher total scores on the PQ-16. CONCLUSIONS The PQ-16 is easy to implement in routine assessment and can be useful to bring up potential psychotic symptoms for further exploration in an early stage, especially in adolescents with low Global Assessment of Functioning scores. The PQ-16 total scores were not confounded by differences in age, gender or disorder. Future research should investigate the true nature of PQ-16 items and whether the item scores and cut-off scores of the PQ-16 in adolescence have any predictive value regarding the development of an ultra high-risk status, a psychotic disorder or other mental disorders.
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Affiliation(s)
- Yvonne de Jong
- Lucertis Center for Child and Adolescence Psychiatry, Rotterdam, The Netherlands.,Department of Psychiatry, Epidemiological and Psychiatric Research institute, Rotterdam, The Netherlands
| | - Cornelis L Mulder
- Department of Psychiatry, Epidemiological and Psychiatric Research institute, Rotterdam, The Netherlands.,Parnassia Psychiatric Institute, Rotterdam, The Netherlands
| | - Albert E Boon
- Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Oegstgeest, The Netherlands.,Lucertis Center for Child and Adolescence Psychiatry, Capelle a/d IJssel, The Netherlands
| | - Mathijs Deen
- Scientific research department, Parnassia Academy, The Hague, The Netherlands.,Faculty of Social and Behavioural Sciences, Leiden University, Leiden, The Netherlands
| | - Maarten van 't Hof
- Lucertis Center for Child and Adolescence Psychiatry, Rotterdam, The Netherlands
| | - Mark van der Gaag
- VU University and, EMGO Mental Health and Care Research, Dept. of Clinical Psychology, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, Zoutkeetsingel, The Hague, The Netherlands
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8
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Klein HS, Kelsven S, Pinkham AE. Increased social cognitive bias in subclinical paranoia. Schizophr Res Cogn 2018; 12:74-76. [PMID: 29928600 PMCID: PMC6007081 DOI: 10.1016/j.scog.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Hans S Klein
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, USA
| | - Skylar Kelsven
- Department of Psychology, University of California, San Diego
- UCSD - Department of Psychiatry, 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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9
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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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10
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The Italian version of the 92-item Prodromal Questionnaire: Concurrent validity with the SIPS and factor analysis in a sample of 258 outpatients aged 11-36years. Schizophr Res 2017; 189:50-56. [PMID: 28254200 DOI: 10.1016/j.schres.2017.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Current early screeners for psychosis-risk states have still to prove ability in identifying at-risk individuals. Among screeners, the 92-item Prodromal Questionnaire (PQ-92) is often used. We aimed to assess the validity of its Italian translation in a large Italian adolescent and young adult help-seeking sample. METHODS We included all individuals aged 12-36years seeking help at psychiatric mental health services in a large semirural Roman area (534,600 population) who accepted to participate. Participants completed the Italian version of the PQ-92 and were subsequently assessed with the Structured Interview of Prodromal/Psychosis-Risk Syndromes (SIPS). We examined diagnostic accuracy (sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios) and content, concurrent, and convergent validity between PQ-92 and SIPS using Cronbach's alpha, Cohen's kappa, and Spearman's rho, respectively. We tested the validity of adopted cut-offs through Receiver Operating Characteristic (ROC) curves plotted against SIPS diagnoses and the instrument's factor-structure through Principal Component Analysis. RESULTS PQ-92 showed high internal consistency, acceptable diagnostic accuracy and concurrent validity, and excellent convergent validity. ROC analyses pointed to scores of 18 on the Positive subscale and 36 on the total PQ-92 as best cut-offs. The Scree-test identified a four-factor solution as fitting best. CONCLUSIONS Psychometric properties of Italian PQ-92 were satisfactory. Optimal cut-offs were confirmed at ≥18 on the positive subscale, but at ≥36 on the total scale was able to identify more SIPS-positive cases.
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11
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Moritz S, Göritz AS, McLean B, Westermann S, Brodbeck J. Do depressive symptoms predict paranoia or vice versa? J Behav Ther Exp Psychiatry 2017; 56:113-121. [PMID: 27817827 DOI: 10.1016/j.jbtep.2016.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/30/2016] [Accepted: 10/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Affective versus nonaffective psychoses are today no longer regarded as mutually exclusive disorders. Theorists have recently highlighted the role of affective symptoms in the formation of paranoid beliefs, particularly negative beliefs about the self, interpersonal sensitivity, sleep disturbances, and worrying, which exist along a continuum in the general population. For the present study, we tested the bidirectional causal relationships between paranoia and affect. METHOD A large population sample (N = 2,357) was examined at three time-points (baseline, six months, two years) as to the severity of subclinical paranoid beliefs (Paranoia Checklist, PCL) and depressive symptoms (Patient Health Questionnaire-9, PHQ-9). Worrying and avoidance were measured with items from the Maladaptive and Adaptive Coping Style Questionnaire (MAX). RESULTS Depression and paranoid symptoms were strongly cross-sectionally related (r = 0.69) and showed high stability (r > 0.72). Depressive symptoms at T2 predicted paranoid symptoms at T3 (beta = 0.16; no significant relationship from T1 to T2), whereas paranoid symptoms predicted depressive symptoms from T1 to T2 (beta = 0.09; no significant relationship from T2 to T3). LIMITATIONS Results should be replicated in a sample of paranoid patients, as risk factors for subclinical versus manifest paranoia may differ. Some constructs were measured with single items derived from a new scale. CONCLUSIONS The predictive association of depression to subsequent paranoia was small and confined to the long interval from T2 to T3. Treatments should target both paranoia and depression - irrespective of their causal relationship - particularly as patients with psychosis consider treatment of their emotional problems a priority.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany
| | - Benjamin McLean
- School of Psychology, Flinders University, South Australia, Australia
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Jeannette Brodbeck
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
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12
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Astill S, Ricketts N, Singh LA, Kurtz D, Gim YH, Huang B. Environmental and perceived stress in Australian dental undergraduates: Preliminary outcomes. J Dent Res Dent Clin Dent Prospects 2016; 10:270-279. [PMID: 28096955 PMCID: PMC5237676 DOI: 10.15171/joddd.2016.043] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/07/2016] [Indexed: 11/26/2022] Open
Abstract
Background. Dental students have reported a high prevalence of psychological stress and the causes are associated with the challenging dental environmental and demographic factors. This study aimed to conduct a preliminary investigation on dental students’ stress status, using a sample of first-to-third-year Bachelor of Dental Surgery students in an Australian university. Special interests included causes of dental environmental stress and access to help services. Methods. A sample of 145 students was surveyed with a modified Dental Environmental Survey and Depression Anxiety Stress Scale in 2014. The participants’ demographic information was also collected. Results. The response rate was 95.4%. Second-year (P = 0.042), third-year (P < 0.001) and employed students (P = 0.027) were more likely to report stress resulting from transition to clinical learning. Third-year students were more often stressed about communicating and approaching staff (P = 0.023) as well as different opinions between staff (P < 0.001) and reduced holidays (P < 0.001). Students that were younger than 21 years of age (P = 0.001), that were first years (P < 0.001), and that were not in a relationship (P = 0.010) more often found difficulty of course work stressful. Students who were not in a relationship more often considered learning manual dexterity a source of stress (P = 0.034). Students previously seeking professional help were more likely to be stressed (P = 0.010). Conclusion. Causes of dental environment stress varied among years of study and demographic backgrounds. Professional support to stressed students should be enhanced. Further investigation is indicated.
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Affiliation(s)
| | - Nikelle Ricketts
- School of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Love-Amrit Singh
- School of Medicine and Dentistry, James Cook University, Cairns, Australia
| | - Dylan Kurtz
- School of Medicine and Dentistry, James Cook University, Cairns, Australia
| | | | - Boyen Huang
- School of Dentistry and Health Sciences, Charles Sturt University, Orange, Australia
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13
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Pisano S, Catone G, Pascotto A, Iuliano R, Tiano C, Milone A, Masi G, Gritti A. Paranoid Thoughts in Adolescents with Social Anxiety Disorder. Child Psychiatry Hum Dev 2016; 47:792-8. [PMID: 26658937 DOI: 10.1007/s10578-015-0612-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Recently, social anxiety disorder (SAD) and paranoia have been demonstrated to be closely related. However, data were primarily drawn from adult community samples or patients with schizophrenia. The present study used a cross-sectional design to evaluate a sample of adolescents with SAD (n = 30, mean age 15.3 ± 0.9 years) compared with an age- and sex-matched group of healthy controls (n = 26, mean age 15.9 ± 1.6 years). The SAD group displayed more frequent and intense paranoid thoughts than the control group (t = 4.16, p < 0.001). The level of paranoid thoughts was significantly predicted by the degree of social phobia, even after adjusting for sex and other anxiety disorders, although adjusting for depression slightly reduced the extent and significance of the prediction. A lack of awareness about the association between SAD and paranoia may lead to incorrect diagnoses (e.g. misdiagnosis of psychotic disorders), or it may negatively influence the (psycho)therapeutic process and patient outcomes.
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Affiliation(s)
- S Pisano
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, via Pansini 5, 80131, Naples, Italy.
| | - G Catone
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, via Pansini 5, 80131, Naples, Italy
| | - A Pascotto
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, via Pansini 5, 80131, Naples, Italy
| | - R Iuliano
- Department of Pediatrics, Hospital ''F. Veneziale'', Isernia, Italy
| | - C Tiano
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, via Pansini 5, 80131, Naples, Italy
| | - A Milone
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - G Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
| | - A Gritti
- Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy
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14
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Paranoid delusional disorder follows social anxiety disorder in a long-term case series: evolutionary perspective. J Nerv Ment Dis 2015; 203:477-9. [PMID: 26034873 DOI: 10.1097/nmd.0000000000000311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Social anxiety disorder (SAD) patients may have self-referential ideas and share other cognitive processes with paranoid delusional disorder (PDD) patients. From an evolutionary perspective, SAD may derive from biologically instinctive social hierarchy ranking, thus causing an assumption of inferior social rank, and thus prompting concerns about mistreatment from those of perceived higher rank. This naturalistic longitudinal study followed four patients with initial SAD and later onset of PDD. These four patients show the same sequence of diagnosed SAD followed by diagnosed PDD, as is often retrospectively described by other PDD patients. Although antipsychotic medication improved psychotic symptoms in all patients, those who also had adjunctive serotonin-specific reuptake inhibitors for SAD had much more improvement in both psychosis and social functioning. From an evolutionary perspective, it can be conjectured that when conscious modulation of the SAD social rank instinct is diminished due to hypofrontality (common to many psychotic disorders), then unmodulated SAD can lead to paranoid delusional disorder, with prominent ideas of reference. Non-psychotic SAD may be prodromal or causal for PDD.
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Different combinations of perceptual, emotional, and cognitive factors predict three different types of delusional ideation during adolescence. J Nerv Ment Dis 2014; 202:668-76. [PMID: 25099297 DOI: 10.1097/nmd.0000000000000179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although adolescence is a particularly sensitive period for the development of schizotypy (Walker and Bollini [Schizophr Res 54:17-23, 2002]), there has been relatively limited research on the psychological factors that specifically predict delusional beliefs during adolescence. We studied 392 school students aged 11 to 16 years with a battery of behavioral and psychometric measures. Anxiety and negative-other schemas mediated the relationship between hallucinatory experiences and paranoid beliefs; anxiety mediated the relationship between hallucinatory experiences and grandiose beliefs; anxiety and self-negative schemas mediated the relationship between hallucinatory experiences and "other delusions" (Schneiderian/reference/misidentification). Furthermore, a jump-to-conclusions (JTC) bias moderated the relation between anxiety and other delusions: scores in the other delusions category were highest in adolescents who had both high anxiety and a JTC bias. Sex and age had only weak effects upon delusional belief. Our findings provide novel data by highlighting the different factors that underpin three delusional subtypes during the vulnerable period of adolescence.
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16
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Fisher JE, Miller GA, Sass SM, Silton RL, Edgar JC, Stewart JL, Zhou J, Heller W. Neural correlates of suspiciousness and interactions with anxiety during emotional and neutral word processing. Front Psychol 2014; 5:596. [PMID: 25018737 PMCID: PMC4073627 DOI: 10.3389/fpsyg.2014.00596] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/28/2014] [Indexed: 12/16/2022] Open
Abstract
Suspiciousness is usually classified as a symptom of psychosis, but it also occurs in depression and anxiety disorders. Though how suspiciousness overlaps with depression is not obvious, suspiciousness does seem to overlap with anxious apprehension and anxious arousal (e.g., verbal iterative processes and vigilance about environmental threat). However, suspiciousness also has unique characteristics (e.g., concern about harm from others and vigilance about social threat). Given that both anxiety and suspiciousness have been associated with abnormalities in emotion processing, it is unclear whether it is the unique characteristics of suspiciousness or the overlap with anxiety that drive abnormalities in emotion processing. Event-related brain potentials were obtained during an emotion-word Stroop task. Results indicated that suspiciousness interacts with anxious apprehension to modulate initial stimulus perception processes. Suspiciousness is associated with attention to all stimuli regardless of emotion content. In contrast, anxious arousal is associated with a later response to emotion stimuli only. These results suggest that suspiciousness and anxious apprehension share overlapping processes, but suspiciousness alone is associated with a hyperactive early vigilance response. Depression did not interact with suspiciousness to predict response to emotion stimuli. These findings suggest that it may be informative to assess suspiciousness in conjunction with anxiety in order to better understand how these symptoms interact and contribute to dysfunctional emotion processing.
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Affiliation(s)
- Joscelyn E Fisher
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences Bethesda, MD, USA
| | - Gregory A Miller
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychology, University of California Los Angeles Los Angeles, CA, USA ; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles Los Angeles, CA, USA
| | - Sarah M Sass
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychology and Counseling, University of Texas at Tyler Tyler, TX, USA
| | - Rebecca Levin Silton
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychology, Loyola University Chicago, IL, USA
| | - J Christopher Edgar
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Radiology, The Children's Hospital of Philadelphia Philadelphia, PA, USA
| | - Jennifer L Stewart
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA ; Department of Psychiatry, University of California San Diego San Diego, CA, USA
| | - Jing Zhou
- Department of Psychiatry, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences Bethesda, MD, USA
| | - Wendy Heller
- Department of Psychology, University of Illinois at Urbana-Champaign Champaign, IL, USA
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Bourne VJ, McKay RT. Paranoid males have reduced lateralisation for processing of negative emotions: An investigation using the chimeric faces test. Laterality 2014; 19:235-52. [DOI: 10.1080/1357650x.2013.809728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Freeman D, Startup H, Dunn G, Černis E, Wingham G, Pugh K, Cordwell J, Kingdon D. The interaction of affective with psychotic processes: a test of the effects of worrying on working memory, jumping to conclusions, and anomalies of experience in patients with persecutory delusions. J Psychiatr Res 2013; 47:1837-42. [PMID: 23871449 PMCID: PMC3905189 DOI: 10.1016/j.jpsychires.2013.06.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/30/2013] [Accepted: 06/26/2013] [Indexed: 11/29/2022]
Abstract
Worry has traditionally been considered in the study of common emotional disorders such as anxiety and depression, but recent studies indicate that worry may be a causal factor in the occurrence and persistence of persecutory delusions. The effect of worry on processes traditionally associated with psychosis has not been tested. The aim of the study was to examine the short-term effects of a bout of worry on three cognitive processes typically considered markers of psychosis: working memory, jumping to conclusions, and anomalous internal experience. Sixty-seven patients with persecutory delusions in the context of a non-affective psychotic disorder were randomised to a worry induction, a worry reduction, or a neutral control condition. They completed tests of the cognitive processes before and after the randomisation condition. The worry induction procedure led to a significant increase in worry. The induction of worry did not affect working memory or jumping to conclusions, but it did increase a range of mild anomalous experiences including feelings of unreality, perceptual alterations, and temporal disintegration. Worry did not affect the occurrence of hallucinations. The study shows that a period of worry causes a range of subtle odd perceptual disturbances that are known to increase the likelihood of delusions. It demonstrates an interaction between affective and psychotic processes in patients with delusions.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Helen Startup
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, Manchester University, Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK
| | - Emma Černis
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Gail Wingham
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, UK
| | - Katherine Pugh
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Jacinta Cordwell
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, UK
| | - David Kingdon
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, College Keep, 4-12 Terminus Terrace, Southampton SO14 3DT, UK
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19
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Paranoid thinking, suspicion, and risk for aggression: a neurodevelopmental perspective. Dev Psychopathol 2012; 24:1031-46. [PMID: 22781870 DOI: 10.1017/s0954579412000521] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article represents an effort to extend our understanding of paranoia or suspicion and its development by integrating findings across clinical, developmental, and neuroscience literatures. We first define "paranoia" or paranoid thought and examine its prevalence across typically and atypically developing individuals and theoretical perspectives regarding its development and maintenance. We then briefly summarize current ideas regarding the neural correlates of adaptive, appropriately trusting interpersonal perception, social cognition, and behavior across development. Our focus shifts subsequently to examining in normative and atypical developmental contexts the neural correlates of several component cognitive processes thought to contribute to paranoid thinking: (a) attention bias for threat, (b) jumping to conclusions biases, and (c) hostile intent attribution biases. Where possible, we also present data regarding independent links between these cognitive processes and aggressive behavior. By examining data regarding the behavioral and neural correlates of varied cognitive processes that are likely components of a paranoid thinking style, we hope to advance both theoretical and empirical research in this domain.
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20
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Ising HK, Veling W, Loewy RL, Rietveld MW, Rietdijk J, Dragt S, Klaassen RMC, Nieman DH, Wunderink L, Linszen DH, van der Gaag M. The validity of the 16-item version of the Prodromal Questionnaire (PQ-16) to screen for ultra high risk of developing psychosis in the general help-seeking population. Schizophr Bull 2012; 38:1288-96. [PMID: 22516147 PMCID: PMC3713086 DOI: 10.1093/schbul/sbs068] [Citation(s) in RCA: 277] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In order to bring about implementation of routine screening for psychosis risk, a brief version of the Prodromal Questionnaire (PQ; Loewy et al., 2005) was developed and tested in a general help-seeking population. We assessed a consecutive patient sample of 3533 young adults who were help-seeking for nonpsychotic disorders at the secondary mental health services in The Hague with the PQ. We performed logistic regression analyses and CHi-squared Automatic Interaction Detector decision tree analysis to shorten the original 92 items. Receiver operating characteristic curves were used to examine the psychometric properties of the PQ-16. In the general help-seeking population, a cutoff score of 6 or more positively answered items on the 16-item version of the PQ produced correct classification of Comprehensive Assessment of At-Risk Mental State (Yung et al., 2005) psychosis risk/clinical psychosis in 44% of the cases, distinguishing Comprehensive Assessment of At-Risk Mental States (CAARMS) diagnosis from no CAARMS diagnosis with high sensitivity (87%) and specificity (87%). These results were comparable to the PQ-92. The PQ-16 is a good self-report screen for use in secondary mental health care services to select subjects for interviewing for psychosis risk. The low number of items makes it quite appropriate for screening large help-seeking populations, thus enhancing the feasibility of detection and treatment of ultra high-risk patients in routine mental health services.
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Affiliation(s)
- Helga K. Ising
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands,To whom correspondence should be addressed; tel: +31653935513, fax: +31883584315, e-mail:
| | - Wim Veling
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands
| | - Rachel L. Loewy
- Department of Psychiatry, University of California at San Francisco, San Francisco, CA
| | - Marleen W. Rietveld
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands
| | - Judith Rietdijk
- VU University and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Sara Dragt
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Rianne M. C. Klaassen
- Department of Children and Adolescent Care, GGZ Rivierduinen, Leiden, The Netherlands
| | - Dorien H. Nieman
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Lex Wunderink
- Department of Education and Research, GGZ Friesland, Leeuwarden, The Netherlands
| | - Don H. Linszen
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Psychiatry, Parnassia Psychiatric Institute, Prinsegracht 63-65, 2512 EX, The Hague, The Netherlands,VU University and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
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