Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling

Modelling the longitudinal dynamics of paranoia in psychosis: A temporal network analysis over 20 years

BACKGROUND

Paranoia is a key feature of psychosis that can be highly debilitating. Theories of paranoia mostly interface with short-scale or cross-sectional data models, leaving the longitudinal course of paranoia underspecified.

METHODS

We develop an empirical characterisation of two aspects of paranoia - persecutory and referential delusions - in individuals with psychosis over 20 years. We examine delusional dynamics by applying a Graphical Vector Autoregression Model to data collected from the Chicago Follow-up Study (n = 135 with a range of psychosis-spectrum diagnoses). We adjusted for age, sex, IQ, and antipsychotic use.

RESULTS

We found that referential and persecutory delusions are central themes, supported by other primary delusions, and are strongly autoregressive - the presence of referential and persecutory delusions is predictive of their future occurrence. In a second analysis we demonstrate that social factors influence the severity of referential, but not persecutory, delusions.

IMPLICATIONS

We suggest that persecutory delusions represent central, resistant states in the cognitive landscape, whereas referential beliefs are more flexible, offering an important window of opportunity for intervention. Our data models can be collated with prior biological, computational, and social work to contribute toward a more complete theory of paranoia and provide more time-dependent evidence for optimal treatment targets.

Self-concept and Narrative Identity in Youth at Clinical High Risk for Psychosis

BACKGROUND AND HYPOTHESIS

Disturbances of the narrative self and personal identity accompany the onset of psychotic disorders in late adolescence and early adulthood (a formative developmental stage for self-concept and personal narratives). However, these issues have primarily been studied retrospectively after illness onset, limiting any inferences about their developmental course.

STUDY DESIGN

Youth at clinical high risk for psychosis (CHR) (n = 49) and matched healthy comparison youth (n = 52) completed a life story interview (including self-defining memory, turning point, life challenge, and psychotic-like experience) and questionnaires assessing self-esteem, self-beliefs, self-concept clarity, and ruminative/reflective self-focus. Trained raters coded interviews for narrative identity themes of emotional tone, agency, temporal coherence, context coherence, self-event connections, and meaning-making (intraclass correlations >0.75). Statistical analyses tested group differences and relationships between self-concept, narrative identity, symptoms, and functioning.

STUDY RESULTS

CHR participants reported more negative self-esteem and self-beliefs, poorer self-concept clarity, and more ruminative self-focus, all of which related to negative symptoms. CHR participants narrated their life stories with themes of negative emotion and passivity (ie, lack of personal agency), which related to positive and negative symptoms. Reflective self-focus and autobiographical reasoning were unaffected and correlated. Autobiographical reasoning was uniquely associated with preserved role functioning.

CONCLUSIONS

This group of youth at CHR exhibited some, but not all, changes to self-concept and narrative identity seen in psychotic disorders. A core theme of negativity, uncertainty, and passivity ran through their semantic and narrative self-representations. Preserved self-reflection and autobiographical reasoning suggest sources of resilience and potential footholds for cognitive-behavioral and metacognitive interventions.

On the relationship between subjective decision criteria and paranoid ideations

Following the conjecture made by (Bliznashki and Hristova in Appetite 167:105645, 2021), we test the hypothesis that liberal subjective decision criteria exhibited during a task involving discrimination between random and systematically correlated patterns should be associated with elevated levels of paranoid ideations. Study 1 establishes the proposed association in the presence of several control measures while also demonstrating that the relationship in question is significantly moderated by subjects' working memory spans and tendencies to be overconfident in their judgments. Study 2 provides further evidence that these effects are indeed specific to tasks involving discrimination between random and systematic patterns and that the observed results are not due to some form of (anti) acquiescence bias or other general trends. Certain specifics of the correlation matrices involving cognitive measures significantly related to the paranoia continuum suggest that our results are consistent with the Entropic Brain Hypothesis. Finally, a simulation study employing a Neural Network demonstrates that increased entropy and liberal decision criteria might be connected to each other with said connection being amenable to an interpretation within the Bayesian paradigm.

Impaired Sleep Mediates the Relationship Between Interpersonal Trauma and Subtypes of Delusional Ideation

BACKGROUND AND HYPOTHESIS

Trauma is a robust risk factor for delusional ideation. However, the specificity and processes underlying this relationship are unclear. Qualitatively, interpersonal traumas (i.e., trauma caused by another person) appear to have a specific relationship with delusional ideation, particularly paranoia, given the commonality of social threat. However, this has not been empirically tested and the processes by which interpersonal trauma contributes to delusional ideation remain poorly understood. Given the role of impaired sleep in both trauma and delusional ideation, it may be a critical mediator between these variables. We hypothesized that interpersonal trauma, but not non-interpersonal trauma, would be positively related to subtypes of delusional ideation, especially paranoia, and that impaired sleep would mediate these relationships.

STUDY DESIGN

In a large, transdiagnostic community sample (N = 478), an exploratory factor analysis of the Peter's Delusion Inventory identified three subtypes of delusional ideation, namely magical thinking, grandiosity, and paranoia. Three path models, one for each subtype of delusional ideation, tested whether interpersonal trauma and non-interpersonal trauma were related to subtypes of delusional ideation, and impaired sleep as a mediating variable of interpersonal trauma.

STUDY RESULTS

Paranoia and grandiosity were positively related to interpersonal trauma and unrelated to non-interpersonal trauma. Furthermore, these relationships were significantly mediated by impaired sleep, which appeared strongest for paranoia. In contrast, magical thinking was unrelated to traumatic experiences.

CONCLUSIONS

These findings support a specific relationship between interpersonal trauma and paranoia as well as grandiosity, with impaired sleep appearing as an important process by which interpersonal trauma contributes to both.

Psychotic experiences and negative symptoms from adolescence to emerging adulthood: developmental trajectories and associations with polygenic scores and childhood characteristics

BACKGROUND

Psychotic experiences and negative symptoms (PENS) are common in non-clinical populations. PENS are associated with adverse outcomes, particularly when they persist. Little is known about the trajectories of PENS dimensions in young people, nor about the precursory factors associated with these trajectories.

METHODS

We conducted growth mixture modelling of paranoia, hallucinations, and negative symptoms across ages 16, 17, and 22 in a community sample (N = 12 049-12 652). We then described the emergent trajectory classes through their associations with genome-wide polygenic scores (GPS) for psychiatric and educational phenotypes, and earlier childhood characteristics.

RESULTS

Three trajectory classes emerged for paranoia, two for hallucinations, and two for negative symptoms. Across PENS, GPS for clinical help-seeking, major depressive disorder, and attention deficit hyperactivity disorder were associated with increased odds of being in the most elevated trajectory class (OR 1.07-1.23). Lower education GPS was associated with the most elevated trajectory class for hallucinations and negative symptoms (OR 0.77-0.91). Conversely for paranoia, higher education GPS was associated with the most elevated trajectory class (OR 1.25). Trajectory class associations were not significant for schizophrenia, obsessive-compulsive disorder, bipolar disorder, or anorexia GPS. Emotional/behaviour problems and life events in childhood were associated with increased odds of being in the most elevated trajectory class across PENS.

CONCLUSIONS

Our results suggest latent heterogeneity in the development of paranoia, hallucinations, and negative symptoms in young people that is associated with specific polygenic scores and childhood characteristics.

Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum

Background

The role of loneliness and social exclusion in the development of paranoia is largely unexplored. Negative affect may mediate potential associations between these factors. We investigated the temporal relationships of daily-life loneliness, felt social exclusion, negative affect, and paranoia across the psychosis continuum.

Method

Seventy-five participants, including 29 individuals with a diagnosis of non-affective psychosis, 20 first-degree relatives, and 26 controls used an Experience Sampling Method (ESM) app to capture the fluctuations in loneliness, feelings of social exclusion, paranoia, and negative affect across a 1-week period. Data were analysed with multilevel regression analyses.

Results

In all groups, loneliness and feelings of social exclusion were independent predictors of paranoia over time (b = 0.05, p < .001 and b = 0.04, p < .05, respectively). Negative affect predicted paranoia (b = 0.17, p < .001) and partially mediated the associations between loneliness, social exclusion, and paranoia. It also predicted loneliness (b = 0.15, p < .0001), but not social exclusion (b = 0.04, p = .21) over time. Paranoia predicted social exclusion over time, with more pronounced effects in controls (b = 0.43) than patients (b = 0.19; relatives: b = 0.17); but not loneliness (b = 0.08, p = .16).

Conclusion

Paranoia and negative affect worsen in all groups following feelings of loneliness and social exclusion. This highlights the importance of a sense of belonging and being included for mental well-being. Loneliness, feeling socially excluded, and negative affect were independent predictors of paranoid thinking, suggesting they represent useful targets in its treatment.

Associations among internalized and perceived stigma, state mindfulness, self-efficacy, and depression symptoms among men who have sex with men in China: A serial mediation model

Previous research has demonstrated that stigma is strongly related to depressive symptoms among men who have sex with men (MSM). However, data are limited regarding the associations between stigma, state mindfulness, self-efficacy, and depression symptoms. The current study aimed to analyze state mindfulness and self-efficacy as possible mediators between internalized and perceived stigma and depression symptoms. A sample of 2610 Chinese MSM (Mage = 23.99, SD = 6.09, age range: 18-68 years) was recruited from an online survey platform and completed the HIV and Homosexuality Related Stigma Scale, Patient Health Questionnaire-9, the short version of Five Facet Mindfulness Questionnaire, and the Chinese General Self-Efficacy Scale. Results indicated that state mindfulness significantly mediated the linkage between internalized and perceived stigma and depressive symptoms, and self-efficacy significantly mediated the relation between state mindfulness and depression symptoms. Furthermore, internalized and perceived stigma were associated with depression symptoms through a serial mediation of state mindfulness and self-efficacy. This study highlights that state mindfulness and self-efficacy might play important roles in the psychological response of MSM to stigmatization and psychopathology symptoms.

Insomnia and distress as mediators on the relationship from cyber-victimization to self-reported psychotic experiences: a binational study from Tunisia and Lebanon

BACKGROUND

While expansive research has accumulated concerning the association between traditional, face-to-face peer victimization and psychosis, a paucity of empirical research has been undertaken so far to investigate these associations with experiences of new and evolving ways of victimization through the digital world. Exploring these associations is highly relevant and timely, given that emerging adults are heavy users of digital technologies, highly exposed to online risks, and are at the peak age of onset of psychosis. This study aimed to test the hypothesis that psychological distress and insomnia symptoms have a significant indirect mediating effect on the association between cyber-victimization and self-reported positive psychotic experiences (SRPEs) in a binational sample of Tunisian and Lebanese community adults.

METHOD

The total sample was composed of 3766 participants; 3103 were from Lebanon (Mean age: 21.73 ± 3.80 years, 63.6% females) and 663 from Tunisia (Mean age: 26.32 ± 4.86 years, 59.9% females). Online anonymous self-report questionnaires were administered to all participants.

RESULTS

Higher SRPEs were found in Lebanese participants compared to Tunisians, in single participants compared to married ones, in those with a university level of education compared to secondary or less, in those who live in rural areas compared to urban, in those who do not smoke, do not drink alcohol and do not use marijuana or any other illegal drug. Furthermore, more cyber-victimization, a higher insomnia severity and psychological distress were significantly associated with higher SRPEs. After adjusting for potential confounders, mediation analysis demonstrated that higher cyber-victimization was significantly associated with more insomnia severity/psychological distress; which were, in turn, significantly associated with greater SRPEs. Finally, more cyber-victimization was significantly and directly associated with more positive dimension.

CONCLUSION

Identifying insomnia and distress as mediators could provide novel insight for psychosis prevention efforts and intervention targets for cyber-victimized individuals prone to experience subclinical psychotic symptoms.

Do antidepressants prevent transition to psychosis in individuals at clinical high-risk (CHR-P)? Systematic review and meta-analysis

BACKGROUND

Emerging meta-analytical evidence indicates that baseline exposure to antipsychotics in individuals at clinical high-risk for psychosis (CHR-P) is associated with a higher risk of an imminent transition to psychosis. Despite their tolerability profile and potential beneficial effects, baseline exposure to antidepressants (AD) in CHR-P has surprisingly received far less attention as a potential risk modulator for transition to psychosis. The current systematic review and meta-analysis were performed to fix such a knowledge gap.

METHODS

Systematic scrutiny of Medline and Cochrane library, performed up to 1 August 2021, searching for English-language studies on CHR-P reporting numeric data about the sample, the transition outcome at a predefined follow-up time and raw data on AD baseline exposure in relation to such outcome.

RESULTS

Of 1942 identified records, 16 studies were included in the systematic review and meta-analysis. 26% of the participants were already exposed to AD at baseline; at the end of the follow-up 13.5% (95% CI 10.2-17.1%) of them (n = 448) transitioned to psychosis against 21.0% (18.9 to 23.3%) of non-AD exposed CHR-P (n = 1371). CHR-P participants who were already under AD treatment at baseline had a lower risk of transition than non-AD exposed CHR-P. The RR was 0.71 (95% CI 0.56-0.90) in the fixed-effects model (z = -2.79; p = 0.005), and 0.78 (0.58-1.05) in the random-effects model (z = -1.77; p = 0.096; tau-squared = 0.059). There was no relevant heterogeneity (Cochran's Q = 18.45; df = 15; p = 0.239; I2 = 18.7%).

CONCLUSIONS

Ongoing AD exposure at inception in CHR-P is associated to a reduced risk of transition to psychosis at follow up.

Longitudinal symptomatic interactions in long-standing schizophrenia: a novel five-point analysis based on directed acyclic graphs

BACKGROUND

Recent network models propose that mutual interaction between symptoms has an important bearing on the onset of schizophrenic disorder. In particular, cross-sectional studies suggest that affective symptoms may influence the emergence of psychotic symptoms. However, longitudinal analysis offers a more compelling test for causation: the European Schizophrenia Cohort (EuroSC) provides data suitable for this purpose. We predicted that the persistence of psychotic symptoms would be driven by the continuing presence of affective disturbance.

METHODS

EuroSC included 1208 patients randomly sampled from outpatient services in France, Germany and the UK. Initial measures of psychotic and affective symptoms were repeated four times at 6-month intervals, thereby furnishing five time-points. To examine interactions between symptoms both within and between time-slices, we adopted a novel technique for modelling longitudinal data in psychiatry. This was a form of Bayesian network analysis that involved learning dynamic directed acyclic graphs (DAGs).

RESULTS

Our DAG analysis suggests that the main drivers of symptoms in this long-term sample were delusions and paranoid thinking. These led to affective disturbance, not vice versa as we initially predicted. The enduring relationship between symptoms was unaffected by whether patients were receiving first- or second-generation antipsychotic medication.

CONCLUSIONS

In this cohort of people with chronic schizophrenia treated with medication, symptoms were essentially stable over long periods. However, affective symptoms appeared driven by the persistence of delusions and persecutory thinking, a finding not previously reported. Although our findings as ever remain hostage to unmeasured confounders, these enduring psychotic symptoms might nevertheless be appropriate candidates for directly targeted psychological interventions.

Interactions between mood and paranoid symptoms affect suicidality in first-episode affective psychoses

BACKGROUND

Suicide prevention is a major challenge in the treatment of first-episode affective psychoses. The literature reports that combinations of manic, depressive and paranoid symptoms, which may interact, are associated with an increased risk of suicide. The present study investigated whether interactions between manic, depressive and paranoid symptoms affected suicidality in first-episode affective psychoses.

METHODS

We prospectively studied 380 first-episode psychosis patients enrolled in an early intervention programme and diagnosed with affective or non-affective psychoses. We compared intensity and presence of suicidal thoughts and occurrence of suicide attempts over a three-year follow-up period and investigated the impact of interactions between manic, depressive and paranoid symptoms on level of suicidality.

RESULTS

At 12 months follow-up, we observed a higher level of suicidal thoughts and higher occurrence of suicide attempts among the affective psychoses patients compared to non-affective psychoses patients. Combined presence of either depressive and paranoid symptoms, or manic and paranoid symptoms, was significantly associated with increased suicidal thoughts. However, the combination of depressive and manic symptoms showed a significant negative association with suicidal thoughts.

CONCLUSIONS

This study suggests that paranoid symptoms combined with either manic or depressive symptoms are associated with an increased risk of suicide in first-episode affective psychoses. Detailed assessment of these dimensions is therefore warranted in first-episode affective patients and integrated treatment should be adapted to increased suicidal risk, even if patients do not display full-blown depressive or manic syndromes.

Association of Psychotic Experiences and Incident Depression in a Longitudinal Population-Based Community Survey

Objective

The present study aims to determine if psychotic experiences in a general population sample are a risk factor for depressive disorders at a 15-year follow-up visit.

Method

A longitudinal population cohort of adults over age 18 from East Baltimore were followed from 1981 to 1996 with 1409 participants included in analyses. Delusions and hallucinations and depressive disorders were assessed using DSM-III criteria. Odds ratios were obtained using logistic regression with psychotic experiences modeled both dichotomously and as count variables as predictors of major and minor depressive disorders at wave three. Age, race, and sex were included as covariates in the model.

Results

Both delusions and hallucinations were associated with an increased odds of incident depressive disorders. Delusions, but not hallucinations, were associated with increased odds of major depressive disorder (adjusted odds ratio, 3.04 [95% CI = 1.29-7.13]) and both delusions and hallucinations were associated with increased odds of minor depressive disorder (adjusted odds ratios, 4.6 [95% CI = 2.11-10.04] and 3.93 [95% CI = 2.11-7.32]). There was a dose-response relationship in number of psychotic experiences reported and odds of depressive disorders.

Conclusions

Lifetime psychotic experiences, particularly delusions, in the absence of mental disorders, are associated with later depressive disorders. Results persist in a dose-response manner. Future research should determine whether transitory versus persistent psychotic experiences have a differential effect on later depression.

Psychotic spectrum features in borderline and bipolar disorders within the scope of the DSM-5 section III personality traits: a case control study

BACKGROUND

Psychotic spectrum features in borderline personality disorder (PD) are a long-standing phenomenon, but remarkably, to date, they have not been the focus of many empirical studies. Moreover, the comparative studies that acknowledge their links to affective psychoses are even more scarce. Likewise, the contributions of empirical research on the DSM-5 dimensional approach to this topic are also uncommon. This study seeks to identify the best set of pathological personality traits and/or symptoms that are predictors of psychotic features (psychoticism and ideation paranoid symptoms) in borderline PD and in bipolar disorder, based on the framework of the DSM-5 section III personality traits.

METHODS

A cross-sectional study of two clinical samples: 1) Borderline PD group of 63 participants; 2) Bipolar disorder group of 65 participants. Self-reported assessment: Personality Inventory for DSM-5 (PID-5); Brief Symptom Inventory (BSI). A series of linear and logistic regression analyses were computed.

RESULTS

Overall, the data emerging as common predictors are detachment, negative affectivity, psychoticism, depressivity, grandiosity, suspiciousness and interpersonal sensitivity symptoms. Borderline PD has the highest score in BSI paranoid ideation which emerges as its discriminating trait (Nagelkerke R² = .58): cognitive and perceptual dysregulation (OR: 13.02), restricted affectivity (OR: 12.09), withdrawal (OR: 11.70), anhedonia (OR: 10.98) and emotional lability (OR: 6.69).

CONCLUSIONS

Besides the commonality that appears to overlap both disorders with a psychosis superspectrum, the patterns of the pathological personality-symptoms underlying the psychotic features appear to reinforce a position between schizophrenia and bipolar disorders that borderline PD may occupy, highlighting the possibility of its intersection with schizoaffective/psychosis spectra. The pathological personality nature of the psychotic features emerges as a potential comprehensive trait of the phenomenological dimensions.

Post-traumatic stress disorder and depressive symptoms among firefighters: a network analysis

Background

Firefighters, as first responders with a high risk of occupational exposure to traumatic events and heavy working stress, have a high prevalence of PTSD symptoms and depressive symptoms. But no previous studies analyzed the relationships and hierarchies of PTSD and depressive symptoms among firefighters. Network analysis is a novel and effective method for investigating the complex interactions of mental disorders at the symptom level and providing a new understanding of psychopathology. The current study was designed to characterize the PTSD and depressive symptoms network structure in the Chinese firefighters.

Method

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5) and the Self-Rating Depression Scale (SDS) were applied to assess PTSD and depressive symptoms, respectively. The network structure of PTSD and depressive symptoms was characterized using "expected influence (EI)" and "bridge EI" as centrality indices. The Walktrap algorithm was conducted to identify communities in the PTSD and depressive symptoms network. Finally, Network accuracy and stability were examined using the Bootstrapped test and the case-dropping procedure.

Results

A total of 1,768 firefighters were enrolled in our research. Network analysis revealed that the relationship between PTSD symptoms, "Flashback" and "Avoidance," was the strongest. "Life emptiness" was the most central symptom with the highest EI in the PTSD and depression network model. Followed by "Fatigue" and "Interest loss." Bridge symptoms connecting PTSD and depressive symptoms in our study were "Numb," "High alertness," "Sad mood," and "Compunction and blame," successively. The data-driven community detection suggested the differences in PTSD symptoms in the clustering process. The reliability of the network was approved by both stability and accuracy tests.

Conclusion

To the best of our knowledge, the current study first demonstrated the network structure of PTSD and depressive symptoms among Chinese firefighters, identifying the central and bridge symptoms. Targeting interventions to the symptoms mentioned above may effectively treat firefighters suffering from PTSD and depressive symptoms.

Facing the pandemic and lockdown: an insight on mental health from a longitudinal study using diaries

We conducted a longitudinal online study to examine attenuated psychotic symptoms (APS) over time in a sample of locked-down individuals. We used (i) questionnaires and (ii) the automatic analysis of the emotional content of narratives. Participants (N = 162) were recruited to complete an online survey 4 times between March and June 2020 (T1, T2, T3, T4). T1 completion coincided with the beginning of the lockdown, and T4 with the pandemic trough. Depression, anxiety, and stress were assessed with the DASS-42 and APS with the PQ-16. Psychosocial data such as the feeling of loneliness and social network size were also collected. The participants wrote daily narratives during the lockdown period. Anxiety and APS were the highest at T1 and decreased over time. APS and APS-associated distress were correlated with the DASS-42 at all times. APS arose acutely at the beginning of the pandemic, despite participants being socio-economically advantaged, and were related with negative emotions.

Modelling the temporal interplay between stress and affective disturbances in pathways to psychosis: an experience sampling study

BACKGROUND

One putative psychological mechanism through which momentary stress impacts on psychosis in individuals with increased liability to the disorder is via affective disturbance. However, to date, this has not been systematically tested. We aimed to investigate whether (i) cross-sectional and temporal effects of momentary stress on psychotic experiences via affective disturbance, and (ii) the reverse pathway of psychotic experiences on stress via affective disturbance were modified by familial liability to psychosis.

METHODS

The Experience Sampling Method was used in a pooled data set of six studies with three groups of 245 individuals with psychotic disorder, 165 unaffected first-degree relatives, and 244 healthy control individuals to index familial liability. Multilevel moderated mediation models were fitted to investigate indirect effects across groups cross-sectionally and multilevel cross-lagged panel models to investigate temporal effects in the proposed pathways across two measurement occasions.

RESULTS

Evidence on indirect effects from cross-sectional models indicated that, in all three groups, effects of stress on psychotic experiences were mediated by negative affect and, vice versa, effects of psychotic experiences on stress were mediated by negative affect, with all indirect effects being weakest in relatives. Longitudinal modelling of data provided no evidence of temporal priority of stress in exerting its indirect effects on psychotic experiences via affective disturbance or, vice versa.

CONCLUSIONS

Our findings tentatively suggest a rapid vicious cycle of stress impacting psychotic experiences via affective disturbances, which does, however, not seem to be consistently modified by familial liability to psychosis.

Longitudinal symptom network structure in first-episode psychosis: a possible marker for remission

BACKGROUND

Network approach has been applied to a wide variety of psychiatric disorders. The aim of the present study was to identify network structures of remitters and non-remitters in patients with first-episode psychosis (FEP) at baseline and the 6-month follow-up.

METHODS

Participants (n = 252) from the Korean Early Psychosis Study (KEPS) were enrolled. They were classified as remitters or non-remitters using Andreasen's criteria. We estimated network structure with 10 symptoms (three symptoms from the Positive and Negative Syndrome Scale, one depressive symptom, and six symptoms related to schema and rumination) as nodes using a Gaussian graphical model. Global and local network metrics were compared within and between the networks over time.

RESULTS

Global network metrics did not differ between the remitters and non-remitters at baseline or 6 months. However, the network structure and nodal strengths associated with positive-self and positive-others scores changed significantly in the remitters over time. Unique central symptoms for remitters and non-remitters were cognitive brooding and negative-self, respectively. The correlation stability coefficients for nodal strength were within the acceptable range.

CONCLUSION

Our findings indicate that network structure and some nodal strengths were more flexible in remitters. Negative-self could be an important target for therapeutic intervention.

Network analysis of psychiatric symptoms in schizophrenia: Findings from the Research on Asian Psychotropic Prescription Patterns for Antipsychotics (REAP-AP)

AIMS

Schizophrenia is a major mental disorder with a wide range of psychiatric symptoms. This study explored the structure of psychiatric symptoms of schizophrenia using network analysis in a large representative Asian sample based on a survey of clinical features and treatment used in schizophrenia patients across 15 countries/territories in Asia.

METHODS

Data on the demographic characteristics and psychiatric symptoms in schizophrenia patients were extracted from the dataset of the fourth Research on Asia Psychotropic Prescription for Antipsychotics (REAP-AP) project. The presence of the following psychiatric symptoms including delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, negative symptoms, social/occupational dysfunction, verbal aggression, physical aggression, and affective symptoms were analyzed.

RESULTS

A total of 3681 patients were included. The network analysis revealed that verbal aggression, hallucinations, and social/occupational dysfunction were the most central symptoms, while the connections between social/occupational dysfunction and verbal aggression, and between hallucinations and disorganized speech were the two strongest edges. There were significant gender differences in the network structure based on the network structure invariance test (M=0.74, P = 0.03) and invariant edge strength test. The positive correlation between verbal aggression and hallucinations was significantly stronger in the female network than that in the male network (P = 0.03), while a negative correlation between affective symptoms and negative symptoms was found in the female, but not the male network (P < 0.01).

CONCLUSION

Central symptoms including verbal aggression, hallucinations, and socio-occupational dysfunction should be addressed in developing targeted treatment strategy for schizophrenia patients.

Relationships among subclinical psychotic symptoms in young adults over time

BACKGROUND

Subclinical psychotic symptoms are common in the general population and are often benign. However, those that become distressing or persistent may increase risk for the development of a psychotic disorder. Cognitive models have proposed that certain appraisals of hallucinatory experiences can lead to delusional beliefs, particularly if an individual is experiencing negative mood. However, the dynamic relationships among these symptoms are poorly understood. This study examined the longitudinal relationships among subclincal hallucinations, delusional ideation, and depression in a sample of young adults.

METHODS

677 college students completed baseline questionnaires to assess: delusional ideation (Peters Delusions Inventory), hallucinations (Launay-Slade Hallucinations Scale-Extended), and depression (Beck Depression Inventory). These measures were repeated 7, 13, 19, and 25 months later.

RESULTS

Higher baseline severity of hallucinations was strongly predictive of severity of delusions across all future follow-up timepoints, specifically when baseline depression was high. However, the severity of hallucinations did not change over time, nor were they predicted by baseline delusional ideation.

CONCLUSIONS

These findings support the proposal that hallucinations frequently precede more severe delusional ideation, rather than the reverse sequence, particularly when depressive symptoms are present. Such longitudinal relationships provide clues to the underlying mechanisms of psychosis, highlighting one pathway for intervention.

Schematic beliefs, negative affect and paranoia in at-risk youth

OBJECTIVES

Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria.

METHODS

This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137).

RESULTS

While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status.

CONCLUSIONS

While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.

Role of polygenic and environmental factors in the co-occurrence of depression and psychosis symptoms: a network analysis

Depression and psychosis are often comorbid; they also have overlapping genetic and environmental risk factors, including trauma and area-level exposures. The present study aimed to advance understanding of this comorbidity via a network approach, by (1) identifying bridge nodes that connect clusters of lifetime depression and psychosis symptoms and (2) evaluating the influence of polygenic and environmental risk factors in these symptoms. This study included data from European ancestry participants in UK Biobank, a large population-based sample (N = 77,650). In Step 1, a network model identified bridge nodes between lifetime symptoms of depression and psychosis and functional impairment. In Step 2, genetic and environmental risk factors were incorporated to examine the degree to which symptoms associated with polygenic risk scores for depression and schizophrenia, lifetime exposure to trauma and area-level factors (including deprivation, air pollution and greenspace). Feelings of worthlessness, beliefs in unreal conspiracy against oneself, depression impairment and psychosis impairment emerged as bridges between depression and psychosis symptoms. Polygenic risk scores for depression and schizophrenia were predominantly linked with depression and psychosis impairment, respectively, rather than with specific symptoms. Cumulative trauma emerged as a bridge node associating deprivation with feelings of worthlessness and beliefs in unreal conspiracy, indicating that the experience of trauma is prominently linked with the co-occurrence of depression and psychosis symptoms related to negative views of oneself and others. These key symptoms and risk factors provide insights into the lifetime co-occurrence of depression and psychosis.

'Thinking about Them is only making me feel worse'. The mediating role of metacognitive factors in the relationship between paranoia-like beliefs and psychopathology symptoms in a community sample

INTRODUCTION

Paranoia in community samples is associated with higher levels of depression, anxiety symptoms and suicidality. The metacognitive model assumes the role of metacognitive factors in these associations. Positive and negative metacognitive beliefs (PMB and NMB, respectively) and cognitive-attentional syndrome (CAS) are to mediate between paranoia-like beliefs and psychopathology symptoms. The current study is an attempt to test this prediction.

METHODS

A cross-sectional community study with n = 840 participants. We used R-GPTS's persecutory subscale to measure paranoia-like beliefs, CAS-1 for CAS and metacognitive beliefs and SCL-27-plus for psychopathology symptoms.

RESULTS

Indirect effects of PMB, CAS and NMB accounted for 22% to 56% (CI 95%) of total effects of relationships between paranoia-like beliefs and vegetative symptoms, symptoms of social phobia, agoraphobia, depression and suicidality screening.

CONCLUSIONS

We demonstrated that PMB, CAS and NMB mediate between paranoia-like beliefs and various psychopathological symptoms, as predicted by the metacognitive model of psychopathology. We also uncovered other indirect effects, including negative mediation effect of PMB on the relationship between paranoia-like beliefs and depressive symptoms and suicidality.

Why conspiracy theorists are not always paranoid: Conspiracy theories and paranoia form separate factors with distinct psychological predictors

Paranoia and belief in conspiracy theories both involve suspiciousness about the intentions of others but have rarely been studied together. In three studies, one with a mainly student sample (N = 496) and two with more representative UK population samples (N = 1,519, N = 638) we compared single and two-factor models of paranoia and conspiracy theories as well as associations between both belief systems and other psychological constructs. A model with two correlated factors was the best fit in all studies. Both belief systems were associated with poor locus of control (belief in powerful others and chance) and loneliness. Paranoid beliefs were specifically associated with negative self-esteem and, in two studies, insecure attachment; conspiracy theories were associated with positive self-esteem in the two larger studies and narcissistic personality traits in the final study. Conspiracist thinking but not paranoia was associated with poor performance on the Cognitive Reflection Task (poor analytical thinking). The findings suggest that paranoia and belief in conspiracy theories are distinct but correlated belief systems with both common and specific psychological components.

Verschwörungstheorien und paranoider Wahn: Lassen sich Aspekte kognitionspsychologischer Modelle zu Entstehung und Aufrechterhaltung von paranoiden Wahnüberzeugungen auf Verschwörungstheorien übertragen?

Der vorliegende narrative Übersichtsartikel stellt zunächst verschiedene Definitionen von Verschwörungstheorien und Verschwörungsmentalität vor und präsentiert Studien zu Zusammenhängen zwischen Persönlichkeitseigenschaften, Symptomen psychischer Störungen und Verschwörungstheorien. Anschließend werden die Kontinuumshypothese des Wahns sowie neuere Konzeptualisierungen von allgemeinem und paranoiden Wahn diskutiert, des Weiteren werden typische kognitionspsychologische Modelle präsentiert, die die Entstehung und Aufrechterhaltung von Wahnüberzeugungen durch eine Interaktion von biologischen Vulnerabilitätsfaktoren, psychologischen Faktoren und sozialen Faktoren erklären. In diesen Modellen mediieren sowohl kognitive Verarbeitungsstile („cognitive biases“) als auch emotionale Prozesse die Entstehung und Aufrechterhaltung von Wahn, beispielsweise die Tendenz, voreilige Schlussfolgerungen zu treffen („jumping to conclusions bias“), sowie externale Kontrollüberzeugungen und ein externalisierender personalisierender Kausalattributionsstil. Anschließend wird diskutiert, ob Menschen, die Verschwörungstheorien zugeneigt sind, ebenfalls ähnliche kognitive Verarbeitungsstile aufweisen, die auch bei Personen zu finden sind, die paranoiden Wahnüberzeugungen zustimmen und unter psychotischen Störungen leiden. Parallelen bestehen zwischen beiden Personengruppen beispielsweise im Hinblick auf eine Neigung zu externalen Kontrollüberzeugungen und einen external personalisierenden Kausalattributionsstil. Auch bestehen Ähnlichkeiten in der Neigung, voreilige Schlussfolgerungen zu treffen. Fragen nach Gemeinsamkeiten und Unterschieden zwischen beiden Phänomenen sollten in weiteren präregistrierten experimentellen Studien quer- sowie längsschnittlich untersucht werden. Möglicherweise könnten moderne niedrigschwellige Interventionsmethoden der kognitiven Verhaltenstherapie von Psychosen (CBTp) in die Beratung oder Prävention von Verschwörungstheorien implementiert werden.

Low-Dose Ziprasidone in Combination with Sertraline for First-Episode Drug-Naïve Patients with Schizophrenia: a Randomized Controlled Trial

Many patients with schizophrenia (SCZ) discontinue antipsychotics, frequently due to dose-related multiple and severe adverse effects. We hypothesized that a low-dose ziprasidone plus sertraline would reduce serious side effects without affecting treatment efficacy. Therefore, this clinical trial was designed to investigate the efficacy, safety, and tolerability of adding sertraline to ziprasidone in order to substantially reduce ziprasidone dose and potential side effects in first-episode and drug-naive (FEDN) patients with SCZ. This 24-week randomized, double-blinded, controlled clinical trial randomly allocated 452 FEDN SCZ patients to receive a usual dose of ziprasidone (control group) or half the dose of ziprasidone in combination with sertraline (ZS group). Treatment outcome included the Positive and Negative Syndrome Scale (PANSS), the Hamilton Depression Rating Scale (HAMD), CGI-Severity (CGI-S) and the Personal and Social Performance Scale (PSP) at baseline and weeks 2, 4, 8, 12, and 24. Repeated measures ANCOVA showed significant treatment by time interactions on the PANSS general psychopathology and total scores, as well as CGI-S, HAMD, and PSP scores (all p < 0.05). Furthermore, the ZS group had greater reductions in PANSS general psychopathology, total scores, HAMD, and CGI-S (all p < 0.05) and greater increases in the PSP total score (p < 0.01) than the control group. Importantly, adverse effects were lower in the ZS than control group. The reduction in PANSS, CGI-S, or HAMD scores was not correlated with the increase in PSP. Sex and duration of disease predicted PSP improvement from baseline to week 24 in the ZS group. Our FEDN patients with SCZ were effectively treated for their psychotic and depressive symptoms while experiencing significantly fewer adverse effects using half the usual ziprasidone dose when combined with sertraline. ClinicalTrials.gov, NCT04076371.

Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy

BACKGROUND

Unusual experiences in Tulpamancer and Autonomous Sensory Meridian Response (ASMR) communities are generally positive and sought after, unlike hallucinations and delusions in clinical populations. Metacognition, the ability to reflect on self-referential experiences, may aid sense-making around unusual experiences, reducing distress. This study investigated group differences in hallucination-proneness, delusion-proneness, and metacognition in these communities compared to controls, and whether metacognition predicted unusual experiences.

METHODS

243 participants reporting ASMR, Tulpamancy, or neither, with no history of psychosis, took part in an online observational study. Participants completed the Beck Cognitive Insight Scale, Metacognitions Questionnaire-30, and Brief Core Schema Scales to capture metacognition. A Tulpamancer+ (reporting ASMR) group was identified and included in analyses. ANCOVAs highlighted group differences in hallucination-proneness, with Tulpamancer+ scoring higher, and metacognitive beliefs, with Tulpamancers reporting lower metacognitive belief endorsement. There were no group differences in delusion-proneness, self-reflection, or self-schemas. Stepwise regression demonstrated metacognition does influence unusual experiences in the non-clinical population, and this influence varies across groups.

CONCLUSIONS

In non-clinical populations, unusual sensory experiences are not associated with increased metacognitive beliefs, but having multiple unusual experiences is associated with higher hallucination-proneness. Results suggest improving metacognition in clinical groups may help reduce distress related to unusual sensory experiences.

Pandemic paranoia, general paranoia, and their relationships with worry and beliefs about self/others - A multi-site latent class analysis

BACKGROUND

During the COVID-19 pandemic, an increase in paranoid thinking has been reported internationally. The development of the Pandemic Paranoia Scale (PPS) has provided a reliable assessment of various facets of pandemic paranoia. This study aimed to (i) identify classes of individuals with varying levels of general paranoia and pandemic paranoia, and (ii) examine associations between classification and worry, core beliefs, and pro-health behaviours.

METHODS

An international sample of adults (N = 2510) across five sites completed the Revised-Green Paranoid Thoughts Scale and the PPS. Latent class analysis (LCA) was conducted using these two paranoia variables. Classes were compared on trait worry (Penn State Worry Questionnaire), beliefs about self/others (Brief Core Schema Scales), and pro-health behaviour.

RESULTS

Three latent classes emerged: Class 1 with low R-GPTS and PPS scores, Class 2 with a high R-GPTS score and a moderate PPS score, and Class 3 with high R-GPTS and PPS scores. Compared to Class 1, Classes 2-3 were associated with more worry and negative self- and other-beliefs. Class 3 was further characterised by greater positive-self beliefs and less engagement in pro-health behaviours. Engagement in pro-health behaviours was positively correlated with interpersonal mistrust and negatively correlated with paranoid conspiracy and persecutory threat.

CONCLUSIONS

Individuals with a general paranoia tendency were more likely to respond to the global health threats in a suspicious and distrusting way. Our findings suggested that worry and negative self/other beliefs may contribute to not just general paranoia but also pandemic paranoia. The preliminary finding of a link between pro-health behaviours and interpersonal mistrust warrants further examination.

Maladaptive and Adaptive Cognitions About the Self and Others: Confirmatory Factor Analysis of the Brief Core Schemas Scales

The presence of dysfunctional cognitions about how individuals see themselves and others is a hallmark of psychopathology. The Brief Core Schemas Scale (BCSS) was developed to evaluate adaptive and dysfunctional beliefs about the self and others. This study describes the first psychometric analysis of the BCSS in the Portuguese population. Participants were recruited from community (N = 320, Mage=27.31, DP = 12.75). Confirmatory factor analysis (CFA) was used to confirm the BCSS factorial structure. Four-factor model revealed moderate to adequate goodness-of-fit indices (χ²/df = 717.1, (246) p = .01; SRMR = .044; RMSEA = .077; CFI/TLI < .90). Negative views of the self and others correlated positively with early maladaptive schemas, distress, and symptomatology and correlated negatively with psychological well-being. An inversed correlational pattern was found with the positive views of the self and others. Despite the model's moderate adherence to the data, results suggest that the BCSS may be an asset in the assessment of dysfunctional and adaptive cognitions about the self and others. Further analysis is required to deepen the psychometric properties of the BCSS in the Portuguese population.

Across the continuum: Associations between (fluctuations in) momentary self-esteem and psychotic experiences

OBJECTIVE

Low self-esteem has been suggested as a putative mechanism in the development and maintenance of psychosis. Uncertainty still exists about how unstable self-esteem relates to psychotic experiences. The present study examines the potential (temporal) associations between momentary self-esteem, fluctuations in self-esteem, and psychotic experiences in daily life.

METHODS

Experience sampling data were collected from 46 individuals presenting with an at-risk mental state (ARMS), 51 individuals with first-episode psychosis (FEP), and 53 controls, to investigate associations between (fluctuations in) self-esteem and psychotic experiences within and across FEP, ARMS, and controls, using linear mixed models.

RESULTS

In all three groups we found that lower momentary self-esteem was associated with a greater intensity of psychotic experiences (adj. β_FEP = -0.15, 95% CI -0.20 to -0.10, p = 0.000; adj. β_ARMS = -0.20, 95% CI -0.26 to -0.15, p = 0.000; adj. β_controls = -0.12, 95% CI -0.17 to -0.07, p = 0.000). Variability in momentary self-esteem was associated with a greater intensity of psychotic experiences only in ARMS (adj. β_ARMS = 0.08, 95% CI 0.04 to 0.11, p = 0.000) and controls (adj. β_controls = 0.04, 95% CI 0.01 to 0.08, p = 0.023). For instability this association held only in controls (adj. β_controls = 0.03, 95% CI 0.00 to 0.05, p = 0.020). Furthermore, findings may suggest a reciprocal temporal association between self-esteem and psychotic experiences.

CONCLUSIONS

Our findings suggest that self-esteem may be an important mechanism targetable by ecological momentary interventions to reduce the intensity of psychotic experiences and potentially prevent illness progression at an early stage.

Paranoia and negative schema about the self and others: A systematic review and meta-analysis

Negative self and negative other schema have been implicated in the development of paranoia. The current study provides a meta-analysis, narrative review and quality appraisal of quantitative studies investigating the relationship between negative self and negative other schema and paranoia across the paranoia continuum. A systematic search identified 43 eligible studies; 25 were included in the meta-analysis. Meta-analytic findings demonstrated a medium to large relationship between paranoia and negative self-schema (r = 0.46, 95% CI 0.39 to 0.53) and negative other schema (r = 0.48, 95% CI 0.38 to 0.56). The magnitude of associations was similar across people with and without psychosis. Findings demonstrated that associations between negative self-schema and paranoia were not always statistically significant when controlling for confounding variables, particularly depression. The association between negative other schema and paranoia tended to remain significant when controlling for confounding variables. Findings also demonstrated that negative schema may mediate relationships between adverse experiences in childhood and paranoia. Overall, findings support theoretical proposals that both negative self and negative other schema are associated with paranoia. Longitudinal studies are required to confirm the direction of effects. Findings provide support for incorporating and targeting negative self and negative other schema in psychological formulations and therapeutic work.

Relationship between cannabis use and psychotic experiences in college students

BACKGROUND

Emerging data suggest cannabis use is a component cause of psychotic disorders; however, the sequence of processes accounting for this association is poorly understood. Some clues have come from studies in laboratory settings showing that acute cannabis intoxication is associated with subclinical hallucinations and delusional thinking, i.e., "psychotic experiences". Although psychotic experiences are relatively common, those that are severe and distressing are linked to an increased risk of developing a psychotic disorder. This study aimed to investigate the association between the frequency of cannabis use and psychotic experiences in young adults.

METHODS

1034 U.S. college students completed questionnaires to assess: cannabis use in the past week, delusional ideation (Peters Delusions Inventory), hallucinations (Launay-Slade Hallucinations Scale-Extended), and depression (Beck Depression Inventory).

RESULTS

Participants reporting higher rates of weekly cannabis use were more likely to report hallucinatory experiences and delusional ideation. The relationship between cannabis use and hallucinatory experiences, but not the relationship between cannabis use and delusional ideation, remained significant after controlling for levels of depression. Moreover, those who reported greater amounts of cannabis use had more distressing delusional ideas, that were held with more conviction.

CONCLUSIONS

Cannabis use is linked to the presence of subclinical hallucinations and delusional ideation in U.S. college students.

An experimental study on the effectiveness of emotion regulation in patients with acute delusions

BACKGROUND

Patients with psychotic disorders report to apply more maladaptive and less adaptive emotion-regulation (ER) strategies compared to healthy controls. However, few studies have used experimental designs to investigate the success in ER and the results of those at hand are equivocal.

AIM

This study investigated whether patients with delusions show problems in downregulating negative affect via cognitive ER-strategies.

METHOD

Patients with schizophrenia spectrum disorders and acute delusions (n = 78) and healthy controls (n = 41) took part in an ER-experiment, in which they were instructed to downregulate anxiety and sadness via three ER-strategies (reappraisal, distraction, acceptance) or not to regulate their emotions (control-condition). ER-success was measured as the change in subjective emotion-intensity and physiological indicators (skin conductance and heart rate) from before to after regulation and was analyzed with mixed-repeated-measures ANOVAs.

RESULTS

We found a significant effect of the ER-strategy in the sense that the subjective emotion-intensity was significantly lower after applying the reappraisal- and distraction-strategies than after the just view-condition (p's < .001). This effect was not found for the acceptance strategy (p = .060). There was no ER-strategy ∗ time ∗ group interaction-effect F(4.918, 575.416) = 0.778, p = .564, ƞ²_partial = 0.007. In all conditions, skin conductance decreased from pre- to post regulation (p < .001).

CONCLUSION

Our results indicate that patients with acute delusions can successfully apply cognitive ER-strategies. Before pursuing the relevant clinical implications of this finding, further research is needed to explore the role that the type of instruction has on ER-success and the extent to which the findings can be generalized to real life settings.

Self-Schemas and Self-Esteem Discrepancies in Subclinical Paranoia: The Essential Role of Depressive Symptoms

Background : Self-concepts are being intensively investigated in relation to paranoia, but research has shown some contradictory findings. Studying subclinical phenomena in a non-clinical population should allow for a clearer understanding given that clinical confounding factors are avoided. We explored self-esteem, self-schemas, and implicit/explicit self-esteem discrepancies in three non-clinical groups with different psychopathological traits and a control group. Methods: Participants with elevated trait-paranoia (n = 41), depressive symptoms (n = 34), a combination of both traits (n = 32), and a control group (n = 71) were assessed on implicit and explicit self-esteem, self-schemas, depression, and paranoia. A dimensional approach with the total sample (n = 208) was also used to complement the information provided by the group approach. Results: All groups presented similar and positive levels of implicit self-esteem. Trait-paranoia participants had similar levels of explicit self-esteem and self-schemas compared with the control group. However, the group with a combination of trait-paranoia and depressive symptoms showed the lowest levels of positive self-schemas and self-esteem. Furthermore, this group and the control group displayed implicit/explicit self-esteem discrepancies, although in opposite directions and with different implications. The dimensional approach revealed associations of trait-paranoia and depressive symptoms with poor explicit self-esteem and self-schemas but not with implicit self-esteem. Conclusions: Trait-paranoia participants showed different self-representations depending on whether depressive symptoms were present or not. The interaction between subclinical neurotic and psychotic traits entailed a detrimental self-representation that might increase the risk for psychopathology.

Paranoia and Grandiosity in the General Population: Differential Associations With Putative Causal Factors

Worry, negative self-beliefs, and sleep disturbance have been identified as contributory factors to the onset, maintenance, and severity of paranoia. We tested the specificity of these contributory factors to paranoia compared to grandiosity, a different type of delusional ideation. Data were used from 814 adults from the Nathan Kline Institute-Rockland (NKI-Rockland) study, a general population dataset. Paranoid and grandiose delusional ideation was assessed using the Peters Delusions Inventory (PDI-21) and correlated with self-reported worry (n = 228), negative self-beliefs (n = 485), and sleep quality (n = 655). Correlations were compared using Fisher's r-to-z transform to examine whether the magnitude of relationships differed by delusion type. Paranoia was significantly associated with worry, negative self-belief, and sleep quality. Grandiosity demonstrated significantly weaker relationships with worry and negative self-beliefs. Relationships with sleep quality were similar. We replicate previous reports that worry, negative self-beliefs and sleep quality are associated with paranoid ideation in the general population. We extend these findings by demonstrating that these contributory factors, particularly worry and negative self-beliefs, are associated with paranoid ideation to a greater extent than grandiosity. This suggests a degree of specificity of contributory factors to different types of delusional thinking, supporting the pursuit of specific psychological models and treatments for each delusion type.

An Analysis of the Pattern of Adaptive Emotion Regulation Associated with Low Paranoid Ideation in Healthy and Clinical Samples

Background

Research on emotion regulation and paranoid ideation has mostly focused on isolated regulation strategies and has remained largely inconclusive. According to the emotion regulation model by Berking and Whitley (in: Affect Regulation Training, Springer, New York 2014) successful modification or acceptance/tolerance of emotions requires an adequate comprehension (awareness, clarity, understanding) of emotions and adequate self-support.

Method

Building on this model, we investigated whether comprehension and self-support strengthen the negative association between modification and acceptance/tolerance and paranoid ideation. In study 1, we examined the hypotheses cross-sectionally based on questionnaire data from a combined sample (N = 125) consisting of people with a psychotic disorder, people at risk of developing psychosis, and healthy controls. In study 2, we examined the same hypotheses longitudinally by employing the experience sampling method in people with clinically relevant psychopathology below diagnostic threshold (N = 138).

Results

In study 1, the association between modification and paranoid ideation was not moderated by comprehension or self-support. However, comprehension and self-support moderated the association between acceptance/tolerance and paranoid ideation. In study 2, the interaction effect between comprehension and acceptance/tolerance on paranoid ideation was confirmed.

Conclusion

The results indicate that comprehending and accepting/tolerating emotions could be protective against paranoid ideation.

Sexual minority status and symptoms of psychosis: The role of bullying, discrimination, social support, and drug use - Findings from the Adult Psychiatric Morbidity Survey 2007

OBJECTIVE

Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk.

METHODS

The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson-Holm-Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and paranoia/AVH. Socio-demographic confounders were included in analyses.

RESULTS

Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and paranoia.

CONCLUSIONS

Sexual minority status appears to have a specific association with paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross-sectional nature of the study limits direct inference about causality of such symptoms.

PRACTITIONER POINTS

Sexual minority groups may be more likely to experience symptoms of paranoia. It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of paranoia within these groups.

Deconstructing the relationships between self-esteem and paranoia in early psychosis: an experience sampling study

Background

No studies have examined the association between self‐esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self‐esteem relate to daily‐life paranoia across at‐risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self‐esteem and paranoia were examined.

Design

This study used a multilevel, cross‐sectional design.

Methods

One‐hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self‐esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self‐esteem were also collected.

Results

Global momentary and trait self‐esteem, and their positive and negative dimensions, were related to daily‐life paranoia in both ARMS and FEP groups. Conversely, implicit self‐esteem was not associated with daily‐life paranoia in either group. Anxiety negatively moderated the association between positive self‐esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self‐esteem and higher paranoia.

Conclusions

Different types, measures and dimensions of self‐esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily‐life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions.

Practitioner points

Different measures (trait and momentary) and dimensions (positive and negative) of explicit self‐esteem are distinctly related to paranoia across risk and first‐episode stages of psychosis.

Explicit, but not implicit, self‐esteem is associated with real‐life paranoia in incipient psychosis.

Anxiety boosted the association of poor self‐esteem and paranoia ideation in daily‐life.

Social closeness, but feeling cared for by others in particular, interacts with self‐esteem tempering the expression of paranoia in real life.

Virtual reality based cognitive behavioral therapy for paranoia: Effects on mental states and the dynamics among them

BACKGROUND

Negative affective processes may contribute to maintenance of paranoia in patients with psychosis, and vice versa. Successful treatment may break these pathological symptom networks. This study examined whether treatment with virtual reality based cognitive behavioral therapy (VR-CBT) for paranoia influences momentary affective states, and whether VR-CBT changes the adverse interplay between affective states and paranoia.

METHODS

Patients with a psychotic disorder (n = 91) were randomized to 16-session VR-CBT or treatment as usual (TAU). With the experience sampling method (structured diary technique) mental states were assessed for 6-10 days at baseline, posttreatment and 6-month follow-up. Multilevel analysis were performed to establish treatment effects and time-lagged associations between mental states, that were visualized with networks of mental states.

RESULTS

Average levels of paranoia (feeling suspicious [b = -032., p = .04], disliked [b = -49., p < .01] and hurt [b = -0.52, p < .01]) and negative affect (anxious [b = -0.37, p = .01], down [b = -0.33, p = .04] and insecure [b = -0.17, p = .03) improved more after VR-CBT than TAU, but positive affect did not. Baseline mental state networks had few significant connections, with most stable connections being autocorrelations of mental states. The interplay between affective states and paranoia did not change in response to treatment. A trend reduction in average intranode connections (autocorrelations) was found after VR-CBT (b = -0.07, p = .08), indicating that mental states reinforce themselves less after treatment.

CONCLUSIONS

VR-CBT reduced paranoid symptoms and lowered levels of negative affect in daily life, but did not affect the extent to which mental states influenced each other. Findings do suggest that as a result of treatment mental states regain flexibility.

The Role of Personal Identity on Positive and Negative Symptoms in Psychosis: A Study Using the Repertory Grid Technique

BACKGROUND

People with psychosis experience disruptions in personal identity that affect positive and negative symptoms, but the complexity of these phenomena needs to be addressed in an in-depth manner. Using the Personal Construct Theory, we examined whether distinct dimensions of personal identity, as measured with the Repertory Grid Technique along with other cognitive factors, might influence psychotic symptomatology.

METHOD

Eighty-five outpatients with schizophrenia-spectrum disorders completed a repertory grid, an observed-rated interview of psychotic symptoms, and measures of cognitive insight, depressive symptoms, neurocognition, and theory of mind.

RESULTS

Structural equation models revealed that interpersonal dichotomous thinking directly affected positive symptoms. Self-discrepancies influenced positive symptoms by mediation of depressive symptoms. Interpersonal cognitive differentiation and interpersonal cognitive richness mediated the impact of self-reflectivity and neurocognitive deficits in negative symptomatology.

CONCLUSIONS

This study is the first of its kind to examine the structure of personal identity in relation to positive and negative symptoms of psychosis. Results suggest interventions targeted to improving interpersonal dichotomous thinking, self-discrepancies, interpersonal cognitive differentiation, and interpersonal cognitive richness may be useful in improving psychotic symptoms.

Awareness and rumination moderate the affective pathway to paranoia in daily life

Numerous cross-sectional studies found psychosis to be associated with less awareness of emotions, a decreased use of adaptive (e.g. reappraisal) and an increased use of maladaptive emotion regulation (ER) strategies (e.g. suppression). In this study, we tested whether state levels of emotion awareness and momentary use of specific ER strategies moderate the link between negative affect at one timepoint (t-1) and paranoia at the next timepoint (t) in a six-day experience sampling study. Individuals with psychotic disorders (n = 71) reported on the presence of paranoia, negative affect, emotion awareness and the use of six ER strategies (reappraisal, acceptance, social sharing, distraction, suppression and rumination) ten times per day. Multilevel regression analysis revealed that higher awareness at t-1 reduced the association of negative affect at t-1 and paranoia at t, whereas rumination had an opposite, amplifying moderation effect. Our results provide novel insight into the conditions under which negative affect translates into delusional beliefs. The finding that emotion awareness and rumination have a relevant role corresponds with current psychological conceptualisations of psychosis and with the attempt to treat delusions by focusing on reducing ruminative thoughts. To investigate the causal effect, treatment trials with a focus on enhancing these components of emotion regulation are needed.

Cognitive Genomics: Recent Advances and Current Challenges

PURPOSE OF REVIEW

We review recent progress in uncovering the complex genetic architecture of cognition, arising primarily from genome-wide association studies (GWAS). We explore the genetic correlations between cognitive performance and neuropsychiatric disorders, the genetic and environmental factors associated with age-related cognitive decline, and speculate about the future role of genomics in the understanding of cognitive processes.

RECENT FINDINGS

Improvements in genomic methods, and the increasing availability of large datasets via consortia cooperation, have led to a greater understanding of the role played by common and rare variants in the genomics of cognition, the highly polygenic basis of cognitive function and dysfunction, and the multiple biological processes involved. Recent research has aided in our understanding of the complex biological nature of genomics of cognition. Further development of data banks and techniques to analyze this data hold significant promise for understanding cognitive ability, and for treating cognitively related disability.

Emotion regulation as a moderator of the interplay between self-reported and physiological stress and paranoia

Experience sampling method (ESM) studies have found an association between daily stress and paranoid symptoms, but it is uncertain whether these findings generalize to physiological indicators of stress. Moreover, the temporality of the association and its moderating factors require further research. Here, we investigate whether physiological and self-rated daily stress predict subsequent paranoid symptoms and analyze the role of emotion regulation as a putative moderator. We applied ESM during 24 h to repeatedly assess heart rate, self-rated stress, and subclinical paranoia in a sample of 67 psychosis-prone individuals as measured with Community Assessment for Psychotic Experiences (CAPE). Adaptive and maladaptive emotion regulation was assessed at baseline with the Emotion Regulation Skills Questionnaire (ERSQ-ES) and the Cognitive Emotion Regulation Questionnaire (CERQ). Linear mixed models were used to analyze the data. Heart rate (b = 0.004, p < 0.05) and self-rated stress (b = 0.238, p < 0.001) predicted subsequent paranoia. The reverse effect, paranoia as a predictor of subsequent heart rate (b = 0.230, p = 0.615) or self-rated stress (b = –0.009, p = 0.751) was non-significant. Maladaptive emotion regulation was a significant predictor of paranoia (b = 0.740, p < 0.01) and moderated the path from self-rated stress to paranoia (b = 0.188, p < 0.05) but not the path from heart rate to paranoia (b = 0.005, p = 0.09). Our findings suggest a one-way temporal link between daily stress and paranoia and highlight the importance of emotion regulation as a vulnerability factor relevant to this process.

Cognitive reappraisal capacity mediates the relationship between prefrontal recruitment during reappraisal of anger-eliciting events and paranoia-proneness

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.

Psychotic experiences and mood episodes predict each other bidirectionally: a 6-year follow-up study in a community-based population

BACKGROUND

Psychotic experiences (PEs) are not exclusive to psychotic disorders and highly correlated with mood episodes. In this representative general population-based study, longitudinal bidirectional associations between the extended psychosis phenotype and mood episodes were investigated, accounting for other possible causes.

METHODS

Households were contacted in a multistage clustered probability sampling frame covering 11 districts and 302 neighbourhoods at baseline (n = 4011) and at 6-year follow-up (n = 2185). Participants were interviewed with the relevant sections of the composite international diagnostic interview both at baseline and at follow-up. Sociodemographic, familial and environmental risk factors associated with the extended psychosis phenotype and mood episodes were assessed. Logistic regression and cross-lagged panel correlation models were used for the associations between the extended psychosis phenotype and mood episodes.

RESULTS

PEs were associated with subsequent depressive and manic episodes. There was bidirectionality in that mood episodes were associated with subsequent PEs, and PEs were associated with subsequent mood episodes. The associations occurred in a sub-additive pattern. There were substantial synchronous and cross-lagged correlations between these psychopathology domains, with reciprocally similar cross-lagged correlations. Familial risk and adverse life events were associated with both psychopathology domains, whereas some sociodemographic risk factors and alcohol/cannabis use were associated with only one domain.

CONCLUSION

The sub-additive bidirectional associations between PEs and mood episodes over time and the similarity of cross-lagged correlations are suggestive of mutually causal connections between affective and psychotic domains of psychopathology.

Traumatic life event exposure and psychotic-like experiences: A multiple mediation model of cognitive-based mechanisms

Several cognitive mechanisms have been proposed to account for the relationship between exposure to traumatic life events (TLEs) and the entire psychosis spectrum. However, only few of these mechanisms have been empirically tested and those that have been tested have not considered multiple mechanisms simultaneously. The purpose of this study was to examine whether perceived stress, dissociation, negative self-schemas, negative other-schemas, and/or external locus of control mediated the association between TLEs and psychotic-like experiences (PLEs). An undergraduate sample of 945 individuals completed a battery of self-report questionnaires. We found significant indirect effects from TLE exposure to PLEs through perceived stress, dissociation, external locus of control, negative self-schemas, and negative other-schemas. When controlling for comorbid psychological symptoms, only the indirect effect from TLE exposure to PLEs through dissociation continued to be significant. Targeting stress sensitivity, maladaptive schemas, dissociative tendencies, and externalizing attributional styles may prove useful in the amelioration of risk for various psychopathologies (e.g., mood, psychosis) in the aftermath of TLE exposure. Findings underscore the importance of targeting trauma-related cognitions in the prevention or reduction of psychotic-like experiences or disorders.