Jumping to conclusions, neuropsychological functioning, and delusional beliefs in first episode psychosis

Optimizing differential diagnostics and identifying transdiagnostic treatment targets using virtual reality

Accurate diagnosis in psychiatry remains a significant challenge, often delaying appropriate treatment and resulting in poorer clinical outcomes. Identifying precise biomarkers for differential diagnosis is therefore crucial. This study aimed to identify distinct behavioral and psychophysiological markers of emotional reactivity in virtual reality (VR) settings among individuals with bipolar disorder (BD), borderline personality disorder (BPD), schizophrenia spectrum disorders (SSD), and healthy controls (HC). Participants (BD: n = 32, BPD: n = 21, SSD: n = 17, HC: n = 30) aged 19-60 were exposed to six immersive 360-degree social VR scenarios, ranging from neutral to highly emotional contexts (e.g., an elevator ride, a crying baby). Emotional responses were self-rated on a 1-5 scale, while galvanic skin response (GSR) was continuously recorded. Scenarios assessed feelings of unpleasantness, pleasantness, being observed, and the urge to comfort. Across diagnoses, individuals with mental health conditions reported more negative emotional responses (greater unpleasantness) across both neutral and negative scenarios (ps ≤ 0.02) despite similar GSR levels to HC. Specifically, in the elevator scenario, BPD and SSD experienced greater unpleasantness and feelings of being observed, coupled with stronger GSRs compared to BD (ps ≤ 0.03). SSD reported higher unpleasantness in the canteen scenario, less pleasantness in the happy baby scenario, and overall higher GSR than BD (ps ≤ 0.049). Negative emotional reactivity was consistent across BD, BPD, and SSD, with heightened emotional and physiological responses distinguishing SSD and BPD from BD in specific VR contexts. VR-based assessments of emotional and physiological markers show promise for improving differential diagnosis and identifying transdiagnostic treatment targets.

A Novel Approach to Assessing the Jumping to Conclusions bias: Evidence of Validity from the Real-Life Paradigm

The Jumping to Conclusions bias (JTC), characterized by hasty decision-making with insufficient information, is associated with delusion development. The beads task, a standard measure for JTC, assesses information-gathering behaviour but may yield inconsistent results due to comprehension difficulties and limited engagement. To address these shortcomings, we developed the Real-Life Paradigm -two novel tasks simulating social scenarios, tested alongside the beads task under three experimental conditions (baseline, time pressure and cost-benefit), along with measures of psychotic experiences, emotional states, and task appraisal. Using Confirmatory Factor Analysis with a multitrait-multimethod approach in a non-clinical sample (N = 253), the Real-Life Paradigm demonstrated strong convergent and discriminant validity, reflecting distinct but related JTC patterns across different scenarios. The type of information (neutral vs. social) and presentation (visual vs. verbal) influenced JTC patterns, with no correlation between positive psychotic experiences and any task. Participants found the new scenarios, particularly under cost-benefit conditions, more realistic and engaging than the beads task. These findings provide initial support for the Real-Life Paradigm as a method for assessing JTC. This paradigm addresses limitations of traditional JTC measures and offers a more ecologically valid approach to studying decision-making processes related to delusion formation.

The influence of gender in cognitive insight and cognitive bias in people with first-episode psychosis: an uncontrolled exploratory analysis

PURPOSE

Previous studies have investigated the role of gender in clinical symptoms, social functioning, and neuropsychological performance in people with first-episode psychosis (FEP). However, the evidence of gender differences for metacognition in subjects with FEP is still limited and controversial. The aim of the present study was to explore gender differences in cognitive insight and cognitive biases in this population.

METHODS

Cross-sectional study was carried out in a sample of 104 patients with FEP (35 females and 69 males) recruited from mental health services. Symptoms were assessed with the Positive and Negative Syndrome Scale, cognitive insight with the Beck Cognitive Insight Scale, and cognitive bias by the Cognitive Biases Questionnaire for Psychosis. The assessment also included clinical and sociodemographic characteristics.

RESULTS

After controlling for potential confounders (level of education, marital status, and duration of psychotic illness) analysis of covariance revealed that males presented greater self-reflectiveness (p = 0.004) when compared to females. However, no significant differences were found in self-certainty and composite index of the cognitive insight scale, as in the cognitive biases assessed.

CONCLUSIONS

Gender was an independent influence factor for self-reflectiveness, being better for males. Self-reflectiveness, if shown to be relatively lacking in women, could contribute to the design of more gender-sensitive and effective psychotherapeutic treatments, as being able to self-reflect predicts to better treatment response in psychosis.

Neurocognitive function and delusion severity in schizophrenia spectrum disorders

The role of basic neurocognitive function in delusions is unclear despite the association to difficulties in reasoning and decision-making. We investigated 812 individuals with schizophrenia spectrum disorders (SSD) using a broad neuropsychological test battery encompassing motor and mental processing speed, working memory, learning and memory, and executive function. Premorbid and current intellectual function was assessed with NART and WASI. Delusion level and other clinical symptoms were measured with the PANSS and GAF. Hierarchical and k-means cluster analysis using standardized scores showed the presence of two separate clusters where the group with the higher delusion level (n = 291) was characterized by more severe neurocognitive deficits (>1.5 standard deviations below the healthy control mean), higher PANSS scores, lower GAF scores, and lower intelligence levels compared to the cluster with mild impairments (n = 521). We conclude that a higher delusion level is related to neurocognitive deficits across domains. Further, the validity of the two separate clusters was indicated by significant differences in clinical symptoms, everyday function, and intellectual ability. Compared to those with mild delusion levels, SSD patients with higher delusion levels seem particularly disadvantaged, with co-occurring general symptoms and lower daily function, underscoring the need for clinical and psychosocial support programs. A limitation of this study is the cross sectional design. Longitudinal studies are needed to determine the causal relationship between delusions and neurocognitive function.

Neurocognitive performance and cognitive biases in young adults with schizotypal traits

Recent research suggests that neurocognitive deficits in patients with schizophrenia may increase the risk of developing cognitive biases. As such, we set out to determine this predictive relationship as it pertains to the development of a first-episode psychosis. We hypothesized that poorer performance in processing speed would be associated with jumping to conclusions and an externalizing bias. Poorer performance in working memory would be associated with belief inflexibility and jumping to conclusions, and poorer performance in attention would be associated with attention to threat. We hypothesized that all cognitive biases would be associated with subsyndromal positive symptoms, and schizotypal traits would moderate these relationships. Undergraduate students (N = 130) completed the Schizotypal Personality Questionnaire, DAVOS Assessment of Cognitive Biases, Community Assessment of Psychic Experiences, and a computerized neuropsychological assessment battery. Processing speed had a small effect on externalizing bias, which in turn affected subsyndromal positive symptoms. There was no moderating effect of schizotypal traits on externalizing bias, but it was significantly associated with subsyndromal positive symptoms. Only the externalizing bias was associated with subsyndromal positive symptomatology, which might be explained by a restricted range and reduced variance in performance as a result of using a university student sample. This is one of few studies that sought to explain the mechanism responsible for the development of subsyndromal positive symptoms in a healthy sample using self-report measures.

Information gathered through draws-to-decision, social functioning, and personal recovery among patients with schizophrenia in Japan

INTRODUCTION

In schizophrenia, social functioning and personal recovery are pivotal outcomes potentially influenced by cognitive biases such as Jumping to Conclusions (JTC). Despite their significance, the relationship between JTC, social functioning, and personal recovery remains unclear. This study aims to investigate this relationship to inform tailored interventions for schizophrenia management.

METHODS

Data were collected from 94 schizophrenia patients using standardised measures. The Beads Task assessed JTC, whereas the Brief PANSS, TMT-J, SLOF-J, and RAS-J evaluated psychiatric symptoms, neurocognitive functioning, social functioning, and personal recovery, respectively. Statistical analyses included correlation and hierarchical regression.

RESULTS

Correlation analyses revealed a significant negative correlation between JTC and personal recovery (r = -0.27, p < 0.05). Hierarchical regression indicated JTC as a significant negative predictor of personal recovery (β = -0.33, p = 0.01). No significant correlation was found between JTC and social functioning.

DISCUSSION

Increased JTC was associated with lower levels of personal recovery in schizophrenia patients, independent of demographic and clinical factors. In the case of individuals with schizophrenia who demonstrate JTC, there is a potential to suggest the paradox of insight or apparent personal recovery scores.

Associations of conservatism and jumping to conclusions biases with aberrant salience and default mode network

AIM

While conservatism bias refers to the human need for more evidence for decision-making than rational thinking expects, the jumping to conclusions (JTC) bias refers to the need for less evidence among individuals with schizophrenia/delusion compared to healthy people. Although the hippocampus-midbrain-striatal aberrant salience system and the salience, default mode (DMN), and frontoparietal networks ("triple networks") are implicated in delusion/schizophrenia pathophysiology, the associations between conservatism/JTC and these systems/networks are unclear.

METHODS

Thirty-seven patients with schizophrenia and 33 healthy controls performed the beads task, with large and small numbers of bead draws to decision (DTD) indicating conservatism and JTC, respectively. We performed independent component analysis (ICA) of resting functional magnetic resonance imaging (fMRI) data. For systems/networks above, we investigated interactions between diagnosis and DTD, and main effects of DTD. We similarly applied ICA to structural and diffusion MRI to explore the associations between DTD and gray/white matter.

RESULTS

We identified a significant main effect of DTD with functional connectivity between the striatum and DMN, which was negatively correlated with delusion severity in patients, indicating that the greater the anti-correlation between these networks, the stronger the JTC and delusion. We further observed the main effects of DTD on a gray matter network resembling the DMN, and a white matter network connecting the functional and gray matter networks (all P < 0.05, family-wise error [FWE] correction). Function and gray/white matter showed no significant interactions.

CONCLUSION

Our results support the novel association of conservatism and JTC biases with aberrant salience and default brain mode.

Paranoia and Data-Gathering Biases in Autism

Previous research has identified contradictory patterns in autism upon probabilistic reasoning tasks, and high levels of self-report paranoia symptoms have also been reported. To explore this relationship, the present study assessed 64 non-autistic and 39 autistic adults on two variants of a probabilistic reasoning task which examined the amount of evidence required before making a decision and 'jumping to conclusions' (a neutral beads task and an emotionally-salient words variant). The autism group was found to require significantly more evidence before making a decision and to have significantly less jumping to conclusions than the non-autistic group. For those with relatively low levels of paranoia, the emotionally-salient variant impacted on the non-autistic group, but not the autism group.

Validation of a modified Chinese-language version of the Davos Assessment of Cognitive Biases Scale (MCL-DACOBS) in a sample of Chinese patients with schizophrenia

INTRODUCTION

The Davos Assessment of Cognitive Biases Scale (DACOBS) is widely used to assess cognitive biases in patients who have schizophrenia. However, the lack of a modified Chinese-language version of the DACOBS (MCL-DACOBS) precludes Chinese schizophrenic patients from treatment aimed at normalizing cognitive biases, impacting their prognosis. Here, we aimed to produce a DACOBS for China and test the validity and reliability of the resultant MCL-DACOBS.

METHODS

Eighteen researchers collaborated to develop the MCL-DACOBS: A total of 15 researchers modified and translated the English version of the DACOBS, 1 native-English-speaking researcher back-translated the scale, and 2 Chinese sinologists localized and optimized the language of the MCL-DACOBS. Forty-two volunteers checked the scale items' comprehensibility, and the two sinologists performed further localization and optimization based on their feedback. The final version of the MCL-DACOBS used in this study was thus derived from the harmonized English-language version of the scale. Confirmatory factor analyses (CFAs) were used to examine the best latent structure of the MCL-DACOBS. Cronbach's α and intraclass correlation coefficients (ICCs) were used to check the reliability. The discriminative ability of the MCL-DACOBS was assessed according to the area under the receiver operating characteristic curve.

RESULTS

The CFA showed that all items loaded onto factors with loadings >0.400. A two-factor structure showed a good model fit (root mean square error of approximation = .018, Tucker-Lewis index = .978, comparative fit index = .984). Promax rotation demonstrated that each item had a high factor load (0.432-0.774). Cronbach's α coefficient and ICC for the MCL-DOCABS were .965 and .957, respectively, indicating that the scale has ideal reliability.

CONCLUSION

The MCL-DACOBS has good validity and good reliability, and its psychometric properties indicate that it is a valid tool for measuring cognitive biases in Chinese patients with schizophrenia.

Cognitive biases in first-episode psychosis with and without attention-deficit/hyperactivity disorder

Introduction

Psychotic disorders such schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with social cognitive deficits. Specifically, biased interpretation of social information can result in interpersonal difficulties. Cognitive biases are prevalent in psychosis, but no previous study has investigated whether the type and severity of cognitive biases differ between subjects experiencing first-episode psychosis (FEP) with (FEP-ADHD⁺) and without ADHD (FEP-ADHD^-).

Methods

A total of 121 FEP outpatients at the Early Intervention Service of Reus were screened for childhood ADHD through the Diagnostic Interview for ADHD (DIVA). Cognitive biases were assessed by the Cognitive Biases Questionnaire for Psychosis (CBQp). CBQp scores of FEPs groups were compared with those of healthy controls (HCs) with an analysis of covariance. Spearman correlation analysis explored associations between CBQp scores and psychopathology.

Results

Thirty-one FEPs met the criteria for childhood ADHD and reported significantly more cognitive bias [median (interquartile range): 47 (38-56)] than FEP-ADHD^- [42 (37-48)] and HCs [38 (35.5-43)]. CBQp scores did not differ between FEP-ADHD-and HCs when adjusted for age and sex. After controlling for clinical differences, Intentionalising (F = 20.97; p < 0.001) and Emotional Reasoning biases (F = 4.17; p = 0.04) were more strongly associated with FEP-ADHD⁺ than FEP-ADHD^-. Cognitive biases were significantly correlated with positive psychotic symptoms in both groups but only with depressive symptoms in FEP-ADHD^- (r = 0.258; p = 0.03) and with poor functioning in FEP-ADHD⁺ (r = -0.504; p = 0.003).

Conclusion

Cognitive bias severity increased from HCs to FEP-ADHD-patients to FEP-ADHD⁺ patients. FEP-ADHD⁺ patients may be a particularly vulnerable group in which metacognitive targeted interventions are needed.

A pilot 1-year follow-up randomised controlled trial comparing metacognitive training to psychoeducation in schizophrenia: effects on insight

Poor insight in schizophrenia spectrum disorders (SSD) is linked with negative outcomes. This single-centre, assessor-blind, parallel-group 1-year follow-up randomised controlled trial (RCT) tested whether metacognitive training (MCT) (compared to psychoeducation) may improve insight and outcomes in outpatients with SSD assessed: at baseline (T0); after treatment (T1) and at 1-year follow-up (T2). Insight (primary outcome) was measured with (i) the Schedule for Assessment of Insight-Expanded version- (SAI-E), including illness recognition (IR), symptom relabelling (SR), treatment compliance (TC) and total insight scores (TIS); and (ii) the Beck Cognitive Insight Scale (BCIS). Between-group comparisons were nonsignificant, while within the MCT group (but not within controls) there was a significant medium effect size for improved TIS at T2 (d = 0.67, P = 0.02). Secondary outcomes included cognitive measures: Jumping to Conclusions (JTC), Theory of Mind (ToM), plus symptom severity and functioning. Compared to psychoeducation, MCT improved the PANSS excitement (d = 1.21, P = 0.01) and depressed (d = 0.76, P = 0.05) factors at T2; and a JTC task both at T1 (P = 0.016) and at T2 (P = 0.031). Participants in this RCT receiving MCT showed improved insight at 1-year follow-up, which was associated with better mood and reduced JTC cognitive bias. In this pilot study, no significant benefits on insight of MCT over psychoeducation were detected, which may have been due to insufficient power.

Whodunit - A novel video-based task for the measurement of jumping to conclusions in the schizophrenia spectrum

Jumping to conclusions (JTC) is implicated in the formation and maintenance of the positive symptoms of psychosis and over the years has become a prominent treatment target. Yet, measures designed to detect JTC are compromised by a number of limitations. We aimed to address some of these shortcomings with a new video-based "Whodunit task" among participants scoring high and low on the Community Assessment of Psychic Experiences (CAPE). We recruited a large sample (N = 979) from the general population who were divided into subgroups high vs. low on psychotic-like experiences (PLE), matched for depression and background characteristics. In the Whodunit task, participants were asked to rate the likelihood that one out of six suspects was the perpetrator of a crime (deliberately ambiguous with no clear clues until the end). The primary measure was the number of sequences-to-decision (STD). In line with the hypothesis, participants scoring high on the CAPE positive subscale displayed significantly lower STD and a higher rate of JTC. Response confidence in the assessments was elevated in the PLE-High group. The number of overall decisions was also significantly elevated for the PLE-High group. No group differences were found when comparing those scoring high versus low on depression. The STD index correlated significantly with a corresponding index from another JTC task. The study presents a new paradigm for the measurement of data gathering in the schizophrenia spectrum. Speaking to its validity, the Whodunit task was correlated with another JTC measure. Future research should test abbreviated versions of the paradigm, preferably using multiple trials with differing topics/emotional themes.

Heterogeneity in Response to MCT and Psychoeducation: A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis

Metacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatments.

Jumping to Conclusions and Its Associations With Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11

BACKGROUND

The jumping to conclusions (JTC) bias, ie, making decisions based on inadequate evidence, is associated with psychosis in adults and is believed to underlie the formation of delusions. Knowledge on the early manifestations of JTC and its associations with psychotic experiences (PE) in children and adolescents is lacking.

DESIGN

Preadolescent children (mean age 11.9 y, SD 0.2) at familial high risk of schizophrenia (FHR-SZ, n = 169) or bipolar disorder (FHR-BP, n = 101), and controls (n = 173) were assessed with the Beads Task to examine JTC. The number of beads drawn before making a decision, "draws to decision" (DTD) was used as a primary outcome. PE were ascertained in face-to-face interviews. General intelligence was measured with Reynolds Intellectual Screening Test.

RESULTS

Children at FHR-SZ took fewer DTD than controls (4.9 vs 5.9, Cohen's d = 0.31, P = .004). Differences were attenuated when adjusting for IQ (Cohen's d = 0.24, P = .02). Higher IQ was associated with a higher number of DTD (B = 0.073, P < .001). Current subclinical delusions compared with no PE were associated with fewer DTD in children at FHR-SZ (P = .04) and controls (P < .05). Associations between delusions and DTD were nullified when accounting for IQ.

CONCLUSIONS

JTC marks familial risk of psychosis in preadolescence, not reducible to general intelligence. JTC is associated with subclinical delusions, but this may be an expression of intellectual impairment. Future studies should establish temporality between JTC and delusion formation and examine JTC as a target for early intervention.

Rethinking delusions: A selective review of delusion research through a computational lens

Delusions are rigid beliefs held with high certainty despite contradictory evidence. Notwithstanding decades of research, we still have a limited understanding of the computational and neurobiological alterations giving rise to delusions. In this review, we highlight a selection of recent work in computational psychiatry aimed at developing quantitative models of inference and its alterations, with the goal of providing an explanatory account for the form of delusional beliefs in psychosis. First, we assess and evaluate the experimental paradigms most often used to study inferential alterations in delusions. Based on our review of the literature and theoretical considerations, we contend that classic draws-to-decision paradigms are not well-suited to isolate inferential processes, further arguing that the commonly cited 'jumping-to-conclusion' bias may reflect neither delusion-specific nor inferential alterations. Second, we discuss several enhancements to standard paradigms that show promise in more effectively isolating inferential processes and delusion-related alterations therein. We further draw on our recent work to build an argument for a specific failure mode for delusions consisting of prior overweighting in high-level causal inferences about partially observable hidden states. Finally, we assess plausible neurobiological implementations for this candidate failure mode of delusional beliefs and outline promising future directions in this area.

Jumping to conclusions correlates with negative symptoms, poor response inhibition, and impaired functioning in individuals diagnosed with schizophrenia

BACKGROUND

The jumping to conclusions (JTC) bias is the tendency to make immediate decisions based on little information. There are few studies that have investigated the relationship between JTC and frontal lobe function. We examined the association between JTC and the Brief Psychiatric Rating Scale (BPRS), Frontal Assessment Battery (FAB), and Global Assessment of Functioning (GAF) scale in individuals with schizophrenia.

METHODS

In total, 50 individuals diagnosed with schizophrenia and 50 healthy control individuals were administered the beads task. Individuals diagnosed with schizophrenia were assessed using the FAB, BPRS, and GAF.

RESULTS

There was a significant negative correlation between JTC and the negative symptoms of the BPRS (rs=-.368, p = .008). There was a significant positive correlation between JTC and the Go/No-Go task of the FAB (rs=.319, p = .026), and the GAF (rs=.433, p = .002).

CONCLUSION

JTC in individuals with schizophrenia may be categorized according to several causes, including negative symptoms and poor response inhibition.

The relationship between jumping to conclusions and social cognition in first-episode psychosis

Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JTC and SC in a sample with FEP. We conducted a cross-sectional study with 121 patients with FEP, with measures to assess JTC (easy, hard, and salient probability tasks) and SC (emotional recognition, attributional style, and theory of mind). We performed Student's t-test and logistic regression in order to analyse these associations.We found a statistically significant and consistent relationship of small-moderate effect size between JTC (all three tasks) and impaired emotional recognition. Also, our results suggest a relationship between JTC and internal attributions for negative events. Relationships between JTC and theory of mind were not found. These results highlight the importance of psychological treatments oriented to work on a hasty reasoning style and on improving processing of social information linked to emotional recognition and single-cause attributions.

Distressing psychotic-like experiences, cognitive functioning and early developmental markers in clinically referred young people aged 8-18 years

PURPOSE

Neurocognitive difficulties and early childhood speech/motor delays are well documented amongst older adolescents and young adults considered at risk for psychosis-spectrum diagnoses. We aimed to test associations between unusual or psychotic-like experiences (PLEs), co-occurring distress/emotional symptoms, current cognitive functioning and developmental delays/difficulties in young people (aged 8-18 years) referred to Child and Adolescent Mental Health Services in South London, UK.

METHODS

Study 1 examined receptive language, verbal learning and caregiver-reported speech and motor delays/difficulties in a sample of 101 clinically-referred children aged 8-14 years, comparing those reporting no PLEs (n = 19), PLEs without distress (n = 16), and PLEs with distress (n = 66). Study 2 tested associations of severity of distressing PLEs with vocabulary, perceptual reasoning, word reading and developmental delays/difficulties in a second sample of 122 adolescents aged 12-18 years with distressing PLEs.

RESULTS

In Study 1, children with distressing PLEs had lower receptive language and delayed recall and higher rates of developmental delays/difficulties than the no-PLE and non-distressing PLE groups (F values: 2.3-2.8; p values: < 0.005). Receptive language (β = 0.24, p = 0.03) and delayed recall (β = - 0.17, p = 0.02) predicted PLE distress severity. In Study 2, the cognitive-developmental variables did not significantly predict PLE distress severity (β values = 0.01-0.22, p values: > 0.05).

CONCLUSION

Findings may be consistent with a cognitive-developmental model relating distressing PLEs in youth with difficulties in cognitive functioning. This highlights the potential utility of adjunctive cognitive strategies which target mechanisms associated with PLE distress. These could be included in cognitive-behavioural interventions offered prior to the development of an at-risk mental state in mental health, educational or public health settings.

The relationship between early symptom severity, improvement and remission in first episode psychosis with jumping to conclusions

It is suggested that Jumping To Conclusions (JTC) reasoning bias might contribute to the distortion of external reality. However, the association between psychotic manifestations and JTC is obscure, especially if general intelligence is considered as a mediator. The aim of this study is to investigate the relation between severity, early clinical improvement and remission of symptoms in First Episode Psychosis (FEP) with JTC as an explanatory factor. One hundred seventy-one FEP individuals were evaluated with the Positive and Negative Syndrome Scale (PANSS) at baseline and one month after treatment initiation. Clinical improvement was ascribed as symptom change one-month post-baseline measurements. Symptomatic remission was assessed with the Andreasen severity criteria and JTC with the Beads Task, operationalized through Draws To Decision (DTD) (the lower the number of DTD, the higher the JTC bias). Regarding symptoms severity, total psychotic, total positive psychotic, and hallucinations-item PANSS scores showed a negative association with JTC after controlling for IQ. Regarding early clinical improvement, the association with JTC was non-significant. No significant association was detected between one month remission status of FEP and JTC. Our findings indicate that severity of positive symptoms is not associated with hastiness in decision-making, but rather with a heightened conservatism in terms of increased data gathering. Further research is required to replicate the results and clarify the cognitive processes involved.

Association Between Failures in Perceptual Updating and the Severity of Psychosis in Schizophrenia

IMPORTANCE

Recent accounts suggest that delusions and hallucinations may result from alterations in how prior knowledge is integrated with new information, but experimental evidence supporting this idea has been complex and inconsistent. Evidence from a simpler perceptual task would make clear whether psychotic symptoms are associated with overreliance on prior information and impaired updating.

OBJECTIVE

To investigate whether individuals with schizophrenia or schizoaffective disorder (PSZ) and healthy control individuals (HCs) differ in the ability to update their beliefs based on evidence in a relatively simple perceptual paradigm.

DESIGN, SETTING, AND PARTICIPANTS

This case-control study included individuals who met DSM-IV criteria for PSZ and matched HC participants in 2 independent samples. The PSZ group was recruited from the Maryland Psychiatric Research Center, Yale University, and community clinics, and the HC group was recruited from the community. To test perceptual updating, a random dot kinematogram paradigm was implemented in which dots moving coherently in a single direction were mixed with randomly moving dots. On 50% of trials, the direction of coherent motion changed by 90° midway through the trial. Participants were asked to report the direction perceived at the end of the trial. The Peters Delusions Inventory and Brief Psychiatric Rating Scale (BPRS) were used to quantify the severity of positive symptoms. Data were collected from September 2018 to March 2020 and were analyzed from approximately March 2020 to March 2021.

MAIN OUTCOMES AND MEASURES

Critical measures included the proportion of responses centered around the initial direction vs the subsequent changed direction and the overall precision of motion perception and reaction times.

RESULTS

A total of 48 participants were included in the PSZ group (31 [65%] male; mean [SD] age, 36.56 [9.76] years) and 36 in the HC group (22 [61%] male; mean [SD] age, 35.67 [10.74] years) in the original sample. An independent replication sample included 42 participants in the PSZ group (29 [69%] male; mean [SD] age, 33.98 [11.03] years) and 34 in the HC group (20 [59%] male; mean [SD] age, 34.29 [10.44] years). In line with previous research, patients with PSZ were less precise and had slower reaction times overall. The key finding was that patients with PSZ were significantly more likely (original sample: mean, 27.88 [95% CI, 24.19-31.57]; replication sample: mean, 26.70 [95% CI, 23.53-29.87]) than HC participants (original sample: mean, 18.86 [95% CI, 16.56-21.16]; replication sample: mean, 15.67 [95% CI, 12.61-18.73]) to report the initial motion direction rather than the final one. Moreover, the tendency to report the direction of initial motion correlated with the degree of conviction on the Peters Delusions Inventory (original sample: r = 0.32 [P = .05]; replication sample: r = 0.30 [P = .05]) and the Brief Psychiatric Rating Scale Reality Distortion score (original sample: r = 0.55 [P = .001]; replication sample: r = 0.35 [P = .03]) and severity of hallucinations (original sample: r = 0.39 [P = .02]; replication sample: r = 0.30 [P = .05]).

CONCLUSIONS AND RELEVANCE

The findings of this case-control study suggest that the severity of psychotic symptoms is associated with a tendency to overweight initial information over incoming sensory evidence. These results are consistent with predictive coding accounts of the origins of positive symptoms and suggest that deficits in very elementary perceptual updating may be a critical mechanism in psychosis.

Investigating the Role of Insight, Decision-Making and Mentalizing in Functional Outcome in Schizophrenia: A Cross-Sectional Study

BACKGROUND

Recovery has become a priority in schizophrenia spectrum disorders (SSDs). This study aimed to investigate predictors of objective-general functioning and disability-and subjective-quality of life (QoL)-measures of functional outcomes in SSD.

METHODS

Sample: n = 77 SSD outpatients (age 18-64, IQ > 70) participating in a randomised controlled trial. Baseline data were used to build three multivariable linear regression models on: (i) general functioning-General Assessment of Functioning (GAF); (ii) disability-the World Health Organization Disability Assessment Schedule (WHODAS-2.0); and (iii) QoL-Satisfaction Life Domains Scale (SLDS).

RESULTS

Young age and being employed (R2 change = 0.211; p = 0.001), late adolescence premorbid adjustment (R2 change = 0.049; p = 0.0050), negative symptoms and disorganization (R2 change = 0.087; p = 0.025) and Theory of Mind (R2 change = 0.066, p = 0.053) predicted general functioning. Previous suicidal behaviour (R2 change = 0.068; p = 0.023) and negative and depressive symptoms (R2 change = 0.167; p = 0.001) were linked with disability. Previous suicidal behaviour (R2 change = 0.070, p = 0.026), depressive symptoms (R2 change = 0.157; p < 0.001) and illness recognition (R2 change = 0.046, p = 0.044) predicted QoL.

CONCLUSIONS

Negative, disorganization and depressive symptoms, older age, unemployment, poor premorbid adjustment, previous suicide attempts and illness awareness appear to underlie a poor global functional outcome in SSD. Achieving recovery in SSD appears to require both symptomatic remission (e.g., through antipsychotics) and measures to improve mastery and relieve low mood.

Males and females with first episode psychosis present distinct profiles of social cognition and metacognition

Deficits in social cognition and metacognition impact the course of psychosis. Sex differences in social cognition and metacognition could explain heterogeneity in psychosis. 174 (58 females) patients with first-episode psychosis completed a clinical, neuropsychological, social cognitive, and metacognitive assessment. Subsequent latent profile analysis split by sex yielded two clusters common to both sexes (a Homogeneous group, 53% and 79.3%, and an Indecisive group, 18.3% and 8.6% of males and females, respectively), a specific male profile characterized by presenting jumping to conclusions (28.7%) and a specific female profile characterized by cognitive biases (12.1%). Males and females in the homogeneous profile seem to have a more benign course of illness. Males with jumping to conclusions had more clinical symptoms and more neuropsychological deficits. Females with cognitive biases were younger and had lower self-esteem. These results suggest that males and females may benefit from specific targeted treatment and highlights the need to consider sex when planning interventions.

Persons with first episode psychosis have distinct profiles of social cognition and metacognition

Subjects with first-episode psychosis experience substantial deficits in social cognition and metacognition. Although previous studies have investigated the role of profiles of individuals in social cognition and metacognition in chronic schizophrenia, profiling subjects with first-episode psychosis in both domains remains to be investigated. We used latent profile analysis to derive profiles of the abilities in 174 persons with first-episode psychosis using the Beck's Cognitive Insight Scale, the Faces Test, the Hinting Task, the Internal, Personal and Situational Attributions Questionnaire, and the Beads Task. Participants received a clinical assessment and a neuropsychological assessment. The best-fitting model was selected according to the Bayesian information criterion (BIC). We assessed the importance of the variables via a classification tree (CART). We derived three clusters with distinct profiles. The first profile (33.3%) comprised individuals with low social cognition. The second profile (60.9%) comprised individuals that had more proneness to present jumping to conclusions. The third profile (5.7%) presented a heterogeneous profile of metacognitive deficits. Persons with lower social cognition presented worse clinical and neuropsychological features than cluster 2 and cluster 3. Cluster 3 presented significantly worst functioning. Our results suggest that individuals with FEP present distinct profiles that concur with specific clinical, neuropsychological, and functional challenges. Each subgroup may benefit from different interventions.

Jumping to conclusions and suicidal behavior in depression and psychosis

Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99-4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.

Jumping to conclusions, general intelligence, and psychosis liability: findings from the multi-centre EU-GEI case-control study

BACKGROUND

The 'jumping to conclusions' (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ.

METHODS

A total of 817 first episode psychosis patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC, and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia.

RESULTS

The estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia polygenic risk score was non-significantly associated with a higher number of beads drawn (B = 0.47, 95% CI -0.21 to 1.16, p = 0.17); whereas IQ PRS (B = 0.51, 95% CI 0.25-0.76, p < 0.001) significantly predicted the number of beads drawn, and was thus associated with reduced JTC bias. The JTC was more strongly associated with the higher level of psychotic-like experiences (PLEs) in controls, including after controlling for IQ (B = -1.7, 95% CI -2.8 to -0.5, p = 0.006), but did not relate to delusions in patients.

CONCLUSIONS

Our findings suggest that the JTC reasoning bias in psychosis might not be a specific cognitive deficit but rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to PLEs, independent of IQ. The work has the potential to inform interventions targeting cognitive biases in early psychosis.

Social cognition and interaction training for recent-onset schizophrenia: A preliminary randomized trial

Comprehensive social cognition training programs have been effective to improve social cognition in people with chronic schizophrenia, although there is insufficient quality evidence for recent-onset psychosis. The aim of this study was to assess the effects of Social Cognition and Interaction Training (SCIT) in a sample of recent-onset schizophrenia outpatients. Sixteen participants who had their first psychotic episode for less than 2 years were randomly allocated to the SCIT group during 20 weeks (weekly sessions) or to a psychoeducation group and completed baseline and post-training assessment for cognitive biases, social cognition, clinical symptoms and functioning. Permutation-based analysis revealed improvements in overall functioning (P = 0.036) and blame score (P = 0.070) in the SCIT group compared to the psychoeducation intervention, with large effect sizes (d = 1.438 and d = 1.204, respectively). There were also large effect sizes for hostility, emotion recognition, social perception, positive and total symptoms (d = 0.833-1.158). These results suggest that SCIT may be an effective tool to improve attributional biases and functional outcomes in recent-onset schizophrenia outpatients. Future controlled trials with larger sample size and follow-up assessments should be developed to further understand effective intervention outcomes for this population.

Hit the chronic… physical activity: are cannabis associated mental health changes in adolescents attenuated by remaining active?

PURPOSE

High-frequency cannabis use in adolescents has been associated with adult mental illness. In contrast, physical activity has been demonstrated to benefit mental health status. The purpose of this study was to examine whether, within a 1-year prospective study design, changes in cannabis use frequency are associated with changes in mental health, and whether meeting physical activity guidelines moderates these associations.

METHODS

COMPASS (2012-2021) is a hierarchical longitudinal health data survey from a rolling cohort of secondary school students across Canada; student-level mental health data linked from Years 5 (2016/17) and 6 (2017/18) were analysed (n = 3173, 12 schools). Multilevel conditional change regression models were used to assess associations between mental health scores change, cannabis use change and physical activity guideline adherence change after adjusting for covariates.

RESULTS

Adopting at least weekly cannabis use was associated with increases in depressive and anxiety symptoms and decreases in psychosocial well-being. Maintaining physical activity guidelines across both years improved psychosocial well-being regardless of cannabis use frequency, and offset increases in depressive symptoms among individuals who adopted high frequency cannabis use. Physical activity adherence had no apparent relationship with anxiety symptoms.

CONCLUSION

Regardless of the sequence of events, adopting high frequency cannabis use may be a useful behavioural marker of current or future emotional distress, and the need for interventions to address mental health. Physical activity adherence may be one approach to minimizing potential changes in mental health associated with increasing cannabis use.

Glutamatergic Contribution to Probabilistic Reasoning and Jumping to Conclusions in Schizophrenia: A Double-Blind, Randomized Experimental Trial

BACKGROUND

Impaired probabilistic reasoning and the jumping-to-conclusions reasoning bias are hallmark features of schizophrenia (SCZ), yet the neuropharmacological basis of these deficits remains unclear. Here we tested the hypothesis that glutamatergic neurotransmission specifically contributes to jumping to conclusions and impaired probabilistic reasoning in SCZ.

METHODS

A total of 192 healthy participants received either NMDA receptor agonists/antagonists (D-cycloserine/dextromethorphan), dopamine type 2 receptor agonists/antagonists (bromocriptine/haloperidol), or placebo in a randomized, double-blind, between-subjects design. In addition, we tested 32 healthy control participants matched to 32 psychotic inpatients with SCZ-a state associated with compromised probabilistic reasoning due to reduced glutamatergic neurotransmission. All experiments employed two versions of a probabilistic reasoning (beads) task, which required participants to either sample individual amounts of sensory information to infer correct decisions or provide explicit probability estimates for presented sensory information. Our task instantiations assessed both information sampling and explicit probability estimates in different probabilistic contexts (easy vs. difficult conditions) and changing sensory information through random transitions among easy, difficult, and ambiguous trial types.

RESULTS

Following administration of D-cycloserine, haloperidol, and bromocriptine, healthy participants displayed data-gathering behavior that was normal compared with placebo and was adequate in the context of all employed task conditions and trial level difficulties. However, healthy participants receiving dextromethorphan displayed a jumping-to-conclusions bias, abnormally increased probability estimates, and overweighting of sensory information. These effects were mirrored in patients with SCZ performing the same versions of the beads task.

CONCLUSIONS

Our findings provide novel neuropharmacological evidence linking reduced glutamatergic neurotransmission to impaired information sampling and to disrupted probabilistic reasoning, namely to overweighting of sensory evidence, in patients with SCZ.

The influence of risk factors on the onset and outcome of psychosis: What we learned from the GAP study

The GAP multidisciplinary study carried out in South London, recruited 410 first episode of psychosis patients and 370 controls; the aim was to elucidate the multiple genetic and environmental factors influencing the onset and outcome of psychosis. The study demonstrated the risk increasing effect of adversity in childhood (especially parental loss, abuse, and bullying) on onset of psychosis especially positive symptoms. Adverse life events more proximal to onset, being from an ethnic minority, and cannabis use also played important roles; indeed, one quarter of new cases of psychosis could be attributed to use of high potency cannabis. The "jumping to conclusions" bias appeared to mediate the effect of lower IQ on vulnerability to psychosis. We confirmed that environmental factors operate on the background of polygenic risk, and that genetic and environment act together to push individuals over the threshold for manifesting the clinical disorder. The study demonstrated how biological pathways involved in the stress response (HPA axis and immune system) provide important mechanisms linking social risk factors to the development of psychotic symptoms. Further evidence implicating an immune/inflammatory component to psychosis came from our finding of complement dysregulation in FEP. Patients also showed an upregulation of the antimicrobial alpha-defensins, as well as differences in expression patterns of genes involved in NF-κB signaling and Cytokine Production. Being of African origin not only increased risk of onset but also of a more difficult course of illness. The malign effect of childhood adversity predicted a poorer outcome as did continued use of high potency cannabis.

Cognitive biases are associated with clinical and functional variables in psychosis: A comparison across schizophrenia, early psychosis and healthy individuals

OBJECTIVE

We investigated the presence of cognitive biases in people with a recent-onset psychosis (ROP), schizophrenia and healthy adolescents and explored potential associations between these biases and psychopathology.

METHODS

Three groups were studied: schizophrenia (N=63), ROP (N=43) and healthy adolescents (N=45). Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQ). Positive, negative and depressive symptoms were assessed with the PANSS and Calgary Depression Scale (ROP; schizophrenia) and with the CAPE-42 (healthy adolescents). Cannabis use was registered. The association between CBQ and psychopathology scales was tested with multiple linear regression analyses.

RESULTS

People with schizophrenia reported more cognitive biases (46.1±9.0) than ROP (40±5.9), without statistically significant differences when compared to healthy adolescents (43.7±7.3). Cognitive biases were significantly associated with positive symptoms in both healthy adolescents (Standardized β=0.365, p=0.018) and people with psychotic disorders (β=0.258, p=0.011). Cognitive biases were significantly associated with depressive symptoms in healthy adolescents (β=0.359, p=0.019) but in patients with psychotic disorders a significant interaction between schizophrenia diagnosis and CBQ was found (β=1.804, p=0.011), which suggests that the pattern differs between ROP and schizophrenia groups (positive association only found in the schizophrenia group). Concerning CBQ domains, jumping to conclusions was associated with positive and depressive symptoms in people with schizophrenia and with cannabis use in ROP individuals. Dichotomous thinking was associated with positive and depressive symptoms in all groups.

CONCLUSIONS

Cognitive biases contribute to the expression of positive and depressive symptoms in both people with psychotic disorders and healthy individuals.

The Risk of Sexually Transmitted Infections Following First-Episode Schizophrenia Among Adolescents and Young Adults: A Cohort Study of 220 545 Subjects

Young people are disproportionately affected by sexually transmitted infections (STIs). The risk of STIs in young people following first-episode schizophrenia is unknown. This study using Taiwan's National Health Insurance Research Database enrolled 44 109 adolescents and young adults with first-episode schizophrenia and 176 436 age- and sex-matched controls without schizophrenia from 2001 through 2009 and followed to the end of 2011. New-onset STIs were identified. Survival analysis was performed. Cox regression analysis was used to examine the effects of comorbid substance use disorder (SUD), schizophrenia medications, and schizophrenia severity. The E value for causality of evidence was calculated. We found that young people had a higher risk of STIs following first-episode schizophrenia compared with controls without schizophrenia (hazard ratio [HR] = 2.35, 95% CI = 2.08-2.64); these STIs included human immunodeficiency virus (HIV) (3.70, 2.60-5.28) and syphilis (5.35, 3.96-7.23). They also showed a disproportionate distribution of STIs, with an increased proportion of syphilis (20.4% vs 8.2%) and HIV (9.1% vs 6.0%). When presenting with SUD, the risks of HIV (11.00, 7.02-17.25) and syphilis (9.11, 6.16-13.47) were further increased. The severe schizophrenia group had an extremely high risk of syphilis (41.26, 27.69-61.47) and HIV (7.50, 3.85-14.62). Schizophrenia medications may provide beneficial effects against contracting STIs (0.77, 0.68-0.89). We concluded that following first-episode schizophrenia, young patients are at higher risk of STIs, particularly HIV and syphilis. The risk further increased when subjects presented with SUD or severe schizophrenia. Importantly, antipsychotic treatment may lower the risk of STIs.

Inflexibility of beliefs and jumping to conclusions in active schizophrenia

Jumping to conclusions (JTC) has been questioned as sufficient cognitive bias for the onset, maintenance, and severity of delusions compared to the bias of inflexibility of beliefs. The WIT (What is this?) test was designed to evaluate JTC and its capacity for classifying participants into a group of patients with active schizophrenia and a comparison group. It was also attempted to determine whether the presence/absence of answer choices, considered a measure of induced inflexibility of beliefs, influences decision-making and is related to the tendency to repeat the first decision, or spontaneous inflexibility of beliefs. The sample was made up of 160 participants, 80 patients with schizophrenia diagnosed at hospital admission and 80 healthy controls. The Beads Task and the WIT test were administered. The WIT classified the participants reasonably well (82.7%) compared to the Beads Task (86.3%). The presence of answer choices favored JTC (d = 0.33), decreasing the number of lines necessary to make a decision (d = 1.78), and influencing keeping to the original answer (d = 1.36), in interaction with the group (d = 0.42). The WIT test overcame some limitations of the Beads Task. The presence/absence of answer choices influenced decision-making and how thinking was flexibilized, more clearly in the case of controls.

Jumping to conclusions at first onset of psychosis predicts longer admissions, more compulsory admissions and police involvement over the next 4 years: the GAP study

BACKGROUND

Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case-control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years.

METHODS

One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning 'Beads' Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment - the Mental Health Act (MHA) - and inpatient days).

RESULTS

FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92-83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68-83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91-13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions.

CONCLUSIONS

JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.

Reasoning bias, working memory performance and a transdiagnostic phenotype of affective disturbances and psychotic experiences in the general population

BACKGROUND

The jumping to conclusions (JTC) reasoning bias and decreased working memory performance (WMP) are associated with psychosis, but associations with affective disturbances (i.e. depression, anxiety, mania) remain inconclusive. Recent findings also suggest a transdiagnostic phenotype of co-occurring affective disturbances and psychotic experiences (PEs). This study investigated whether JTC bias and decreased WMP are associated with co-occurring affective disturbances and PEs.

METHODS

Data were derived from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Trained interviewers administered the Composite International Diagnostic Interview (CIDI) at three time points in a general population sample (N = 4618). The beads and digit-span task were completed to assess JTC bias and WMP, respectively. CIDI was used to measure affective disturbances and an add-on instrument to measure PEs.

RESULTS

Compared to individuals with neither affective disturbances nor PEs, the JTC bias was more likely to occur in individuals with co-occurring affective disturbances and PEs [moderate psychosis (1-2 PEs): adjusted relative risk ratio (RRR) 1.17, 95% CI 0.98-1.41; and high psychosis (3 or more PEs or psychosis-related help-seeking behaviour): adjusted RRR 1.57, 95% CI 1.19-2.08], but not with affective disturbances and PEs alone, whereas decreased WMP was more likely in all groups. There was some evidence of a dose-response relationship, as JTC bias and decreased WMP were more likely in individuals with affective disturbances as the level of PEs increased or help-seeking behaviour was reported.

CONCLUSION

The findings suggest that JTC bias and decreased WMP may contribute to a transdiagnostic phenotype of co-occurring affective disturbances and PEs.

Does uncertainty breed conviction? On the possible role of compensatory conviction in jumping to conclusions and overconfidence in psychosis

Background: Jumping to conclusions (JTC) and overconfidence in errors are well established in individuals with a liability to psychosis. Experimental research suggests that subjecting individuals to dilemmas and doubt prompts a subsequent hardening of attitudes and may foster delusion-like convictions. For the present study, we examined whether this compensatory conviction process is exaggerated in individuals with a liability to psychosis and might in part explain JTC and overconfidence. Methods: A large sample of participants from the general population were screened for psychotic experiences with the Community Assessment of Psychic Experiences scale (CAPE) and then randomly allocated to either a condition in which they should experience doubt or a control condition. Participants (final sample, n = 650) were then tested on JTC and overconfidence. Results: Participants who scored high on the positive subscale of the CAPE made fewer draws to decision, showed greater confidence, and made more errors relative to low scorers. Yet, none of the parameters was modulated by experimental condition. Conclusions: Our results at present do not support the idea that JTC is elevated by a prior experience of a dilemma or doubt. Yet, this possibility should not be entirely dismissed as the presumed process may take time to evolve and perhaps needs to be more pervasive.

The relationship between jumping to conclusions and neuropsychological functioning in schizophrenia

Jumping to conclusions (JTC) is defined as a tendency to make decisions based on insufficient information. JTC has been reported in patients with psychosis, but the mechanisms of this cognitive bias remain unknown. The main aim of our study was to investigate the relationship between JTC and neuropsychological functioning in schizophrenia. A total of 85 schizophrenia patients were assessed with neuropsychological tests, including executive functions, verbal memory, working memory, processing speed and attention. JTC was assessed with the Fish Task (probability 80:20 and 60:40) and a self-report scale (The Davos Assessment of Cognitive Biases Scale, DACOBS). Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS). The relationship between JTC and neuropsychological functioning was investigated with correlation and regression analyses. The regression analyses model, when controlling for duration of illness, age and symptoms, showed that verbal memory and working memory were specifically related to JTC measured by Fish Task 60:40. JTC measured using Fish Task 60:40 was correlated only with severity of symptoms of disorganization (PANSS). The results from the present study suggest that the relationship between decision making during the reasoning task and neuropsychological functioning is modulated by task demands.

Investigation of sex differences in delusion-associated cognitive biases

In the past few decades, sex differences have been identified in a number of clinical, cognitive and functional outcomes in patients with schizophrenia spectrum disorders. However, to date, sex differences in higher-order cognitive biases have not been systematically studied. The present study aimed to examine sex differences in jumping-to-conclusions and evidence integration impairment based on data collected in two previous studies in patients with schizophrenia spectrum disorders and healthy controls. For this purpose, data from n = 58 patients and n = 60 healthy controls on the Fish Task (as a measure of jumping to conclusions) and bias against disconfirmatory evidence (BADE; as a measure of evidence integration) task were analyzed. Results indicated a lack of sex differences in jumping-to-conclusions and evidence integration impairment both in patients with schizophrenia spectrum disorders and healthy controls. Although the present study was adequately powered to detect sex differences of a low medium effect size, larger studies are warranted to exclude differences of a smaller magnitude between men and women regarding delusion-associated cognitive biases.

Data gathering ability contributes to visual organization and probabilistic reasoning

Individuals use data gathering methods to inform judgments and behaviors. Effective interaction with the environment depends on these having high accuracy and low noise, but when they become abnormal, aberrant thoughts and perceptions can occur. In this study, we examined if data gathering methods were consistent across tasks that relied on different cognitive abilities, specifically visual perception and probabilistic reasoning. Thirty-four non-clinical participants engaged in the Ebbinghaus Illusion and the Jumping to Conclusions tasks, while also completing questionnaires concerning aspects of delusion formation. A significant, positive correlation was observed between performance on the Ebbinghaus Illusion and the Jumping to Conclusions tasks. Both tasks were negatively correlated with the General Conspiracy Belief Scale. The results suggest an underlying mechanism for data gathering that is consistent across behavioral domains and exists on a continuum in the general population.

Effect of cognitive function on jumping to conclusion in patients with schizophrenia

The "jumping to conclusion" (JTC) bias is related to the formation and maintenance of delusions. Higher JTC bias can be based on both neurocognitive dysfunction and social cognitive dysfunction in patients with schizophrenia. The aim of this study was to assess the relationship between JTC bias, neurocognition, and social cognition in patients with schizophrenia. A total of 22 patients with schizophrenia and 21 controls participated in this study. Neurocognition and social cognition were assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) and Social Cognition Screening Questionnaire (SCSQ), respectively. The JTC bias and the decision confidence were assessed using the beads task. The patients were classified into the JTC group (with higher JTC bias; n = 10) and JTC-non group (n = 12). The JTC group scored significantly lower on verbal memory, working memory, and motor speed sub-scores of BACS than the JTC-non group. No difference in social cognition was observed between the two groups. The decision confidence was predicted by metacognition, which is an SCSQ sub-score. Similarly to the patients, the controls were classified into the JTC group (higher JTC bias; n = 9) and the JTC-non group (n = 12). There were no significant differences in neurocognition and social cognition between the control JTC and JTC-non groups. The present results indicated that JTC bias is related to neurocognition and decision confidence is related to social cognition in patients with schizophrenia. These findings may bridge the gaps between psychotic symptom and cognitive dysfunction in schizophrenia.

Neuropsychological functioning and jumping to conclusions in recent onset psychosis patients

BACKGROUND

The reasoning bias of jumping to conclusions (JTC) consists of a tendency to make assumptions having little information.

OBJECTIVE

The aim of this study was to estimate the differences in neuropsychological functioning between recent onset psychotic patients who jump to conclusions and those who do not jump to conclusions.

MATERIALS AND METHODS

One hundred and twenty-two patients with a recent onset of a psychotic disorder were assessed with three JTC tasks and a neuropsychological battery exploring verbal learning, memory, attention, psychomotor speed, visuoperceptual abilities, working memory, problem solving, executive functioning.

RESULTS

A total of 29.7% (n=36) of the individuals jumped to conclusions in Task 1, 14.0% (n=17) in Task 2, and 15.7% (n=19) in Task 3. People who jump to conclusions in three tasks scored significantly worse in many neuropsychological domain deficits, including attention (p<0.001-0.020), psychomotor speed (p<0.001), working memory (p<0.001-0.040), and executive functioning (p<0.001-0.042).

DISCUSSION

The present study demonstrates that JTC is present even in early stages of the illness, and that there is a relationship between JTC and neuropsychological functioning.

Higher schizotypy predicts better metabolic profile in unaffected siblings of patients with schizophrenia

RATIONALE

Type 2 diabetes (T2D) is more frequent in schizophrenia (Sz) than in the general population. This association is partly accounted for by shared susceptibility genetic variants.

OBJECTIVE

We tested the hypotheses that a genetic predisposition to Sz would be associated with higher likelihood of insulin resistance (IR), and that IR would be predicted by subthreshold psychosis phenotypes.

METHODS

Unaffected siblings of Sz patients (n = 101) were compared with a nonclinical sample (n = 305) in terms of IR, schizotypy (SzTy), and a behavioural experiment of "jumping to conclusions". The measures, respectively, were the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Structured Interview for Schizotypy-Revised (SIS-R), and the Beads Task (BT). The likelihood of IR was examined in multiple regression models that included sociodemographic, metabolic, and cognitive parameters alongside group status, SIS-R scores, and BT performance.

RESULTS

Insulin resistance was less frequent in siblings (31.7%) compared to controls (43.3%) (p < 0.05), and negatively associated with SzTy, as compared among the tertile groups for the latter (p < 0.001). The regression model that examined all relevant parameters included the tSzTy tertiles, TG and HDL-C levels, and BMI, as significant predictors of IR. Lack of IR was predicted by the highest as compared to the lowest SzTy tertile [OR (95%CI): 0.43 (0.21-0.85), p = 0.015].

CONCLUSION

Higher dopaminergic activity may contribute to both schizotypal features and a favourable metabolic profile in the same individual. This is compatible with dopamine's regulatory role in glucose metabolism via indirect central actions and a direct action on pancreatic insulin secretion. The relationship between dopaminergic activity and metabolic profile in Sz must be examined in longitudinal studies with younger unaffected siblings.

Overlapping and disease specific trait, response, and reflection impulsivity in adolescents with first-episode schizophrenia spectrum disorders or attention-deficit/hyperactivity disorder

BACKGROUND

Schizophrenia and attention-deficit/hyperactivity disorder (ADHD) are developmental disorders with shared clinical characteristics such as cognitive impairments and impulsivity. Impulsivity is a core feature of ADHD and an important factor in aggression, violence, and substance use in schizophrenia. Based on the hypothesis that schizophrenia and ADHD represent a continuum of neurodevelopmental impairments, the aim was to identify overlapping and disease specific forms of impulsivity.

METHODS

Adolescents between 12 and 17 years of age were assessed with the Schedule for Affective Disorders and Schizophrenia for School-aged Children - Present and Lifetime Version. Subjects with early-onset, first-episode schizophrenia spectrum disorders (EOS) (N = 29) or ADHD (N = 29) and healthy controls (N = 45) were compared on two performance measures (Information Sampling Task, Stop Signal Task) and a subjective personality trait measure of impulsivity (Barratt Impulsiveness Scale, Version 11 (BIS-11)).

RESULTS

Significantly increased reflection impulsivity was observed in ADHD but not in the EOS group. No significant response inhibition deficits (stop signal reaction time) were found in the two clinical groups. The ADHD and the EOS group showed significantly increased motor, attentional, and non-planning subtraits of impulsivity.

CONCLUSIONS

Impaired pre-decisional information gathering appeared to be specific for ADHD while the information gathering was not significantly reduced in subjects with EOS. Neither the ADHD nor EOS group showed impaired response inhibition but shared increased personality subtraits of attentional, non-planning, and motor impulsivity although the latter was significantly more pronounced in ADHD. These increased subtraits of impulsivity may reflect diagnostic non-specific neurodevelopmental impairments in ADHD and EOS in adolescence.

Developmental Aspects of Schizotypy and Suspiciousness: a Review

Purpose of the Review

This review identifies the early developmental processes that contribute to schizotypy and suspiciousness in adolescence and adulthood. It includes the most recent literature on these phenomena in childhood.

Recent Findings

The early developmental processes that affect schizotypy and paranoia in later life are complex. In contrast to existing studies of psychiatric patients and clinical/nonclinical adult populations, the study of schizotypy and suspiciousness in young children and adolescents is possible due to new child-appropriate dimensional assessments. New assessments and the advancement of technology (e.g., virtual reality in mental health) as well as statistical modeling (e.g., mediation and latent-class analyses) in large data have helped identified the developmental aspects (e.g., psychosocial, neurocognitive and brain factors, nutrition, and childhood correlates) that predict schizotypy and suspiciousness in later life.

Summary

Prospective longitudinal designs in community youths can enhance our understanding of the etiology of schizophrenia-spectrum disorders and, in the future, the development of preventive interventions by extending adult theories and interventions to younger populations.

The relationship between cognitive biases and psychological dimensions of delusions: The importance of jumping to conclusions

BACKGROUND AND OBJECTIVES

Cognitive biases play a role in the development and maintenance of delusions. However, delusions are multidimensional (i.e., emotional and cognitive facets) and often co-occur with auditory hallucinations. Therefore, further refinement of the precise relationship between cognitive biases, delusions, and hallucinatory experiences is warranted.

METHODS

A total sample of 167 patients with schizophrenia spectrum disorders was split into two groups consisting of patients with active delusions (n = 127) and active hallucinations (n = 92). All patients were assessed for delusions and hallucinations using the semi-structured psychotic symptom rating scales (PSYRATS), which assesses the emotional (i.e., distress) and cognitive (i.e., conviction, preoccupation) dimensions of these symptoms. Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQp) self-report questionnaire (assessing jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking biases). Multiple stepwise regressions were performed to investigate the relationship between delusions and cognitive biases, while controlling for auditory hallucinations (and vice-versa).

RESULTS

The only cognitive bias to significantly predict delusions after controlling for the severity of auditory hallucinations was the jumping to conclusions (JTC) bias (predicted both emotional and cognitive dimensions). Only the emotional dimension of auditory hallucinations was predicted by the intentionalising and dichotomous thinking biases, after delusional severity was controlled for.

LIMITATIONS

The cross-sectional design precludes causal inferences. Only positive psychotic symptoms were assessed and no wider psychopathology assessment was utilised (e.g., negative symptoms, anxiety, depression).

CONCLUSIONS

The jumping to conclusions bias is associated with both delusional conviction and emotional distress.

Negative affect and a fluctuating jumping to conclusions bias predict subsequent paranoia in daily life: An online experience sampling study

BACKGROUND AND OBJECTIVES

Negative affect and a tendency to "jump to conclusions" (JTC) are associated with paranoia. So far, only negative affect has been examined as a precursor of subsequent paranoia in daily life using experience sampling (ESM). We addressed this research gap and used ESM to test whether JTC fluctuates in daily life, whether it predicts subsequent paranoia, and whether it mediates the effect of negative affect on paranoia.

METHODS

Thirty-five participants with schizophrenia spectrum disorders repeatedly self-reported negative affect, JTC, and paranoia via online questionnaires on two consecutive days. We measured JTC with a paradigm consisting of ambiguous written scenarios. Multilevel linear models were conducted.

RESULTS

Most participants showed JTC consistently on two days rather than only on one day. When time was used as a predictor of JTC, significant slope variance indicated that for a subgroup of participants JTC fluctuated over time. For 48% of participants, these fluctuations equaled changes of approximately ±1 point on the four-point JTC scale within one day. There was no mediation. However, negative affect and JTC both significantly predicted subsequent paranoia.

LIMITATIONS

The ESM assessment period was short and encompassed few assessments (8 in total).

CONCLUSIONS

Our findings indicate that JTC is both stable (regarding its mere occurrence) and fluctuating simultaneously (regarding its magnitude). Although JTC was not a mediator linking negative affect and paranoia, it did predict paranoia. Further ESM studies on JTC are needed to confirm our findings in longer assessment periods and with other JTC paradigms.

Intranasal oxytocin does not modulate jumping to conclusions in schizophrenia: Potential interactions with caudate volume and baseline social functioning

BACKGROUND

Patients with schizophrenia (SCZ) tend to sample less information when making a decision, jumping to conclusions (JTC) without sufficient evidence. This "JTC bias" may be a trait marker of the disease and may not improve with antipsychotic treatment. We conducted a double-blind, placebo-controlled trial to test whether intranasal oxytocin could reduce JTC in stable, medicated patients with SCZ and healthy controls (HCs). We also explored whether striatal volume, clinical symptoms, and baseline social functioning (SF) was related to JTC performance.

METHODS

Forty-three male, medicated SCZ patients (Mean Age: 40.81±11.44) and sixteen HCs (Mean Age: 30.38±9.85) participated in a double-blind, placebo-controlled, cross-over study. Participants completed the Beads Task on two separate visits (minimum 20days apart). Participants were randomized to receive either intranasal oxytocin (50IU in solution) or intranasal placebo (saline). Twenty of the SCZ patients and all sixteen HCs also provided T1 MRIs (3-T).

RESULTS

Patients with SCZ took fewer draws to decision (DTD) than HCs (t(57)=2.78, p=0.007). Oxytocin did not significantly change DTD in patients (t(42)=-1.11, p=0.27), nor in HCs (t(15)=-0.62, p=0.55). Exploratory analyses found ventral caudate volumes were negatively correlated with DTD (r(18)=-0.50, p=0.03) in patients. Moreover, oxytocin was more likely to improve JTC in patients with lower baseline SF. However, these exploratory findings did not survive correction for multiple comparisons.

CONCLUSIONS

We replicate increased JTC in SCZ. However, acute intranasal oxytocin did not modify JTC. Future studies with larger samples should explore how brain morphology and SF are related to JTC performance in patients with SCZ.

Randomized control trial to assess the efficacy of metacognitive training compared with a psycho-educational group in people with a recent-onset psychosis

BACKGROUND

Aims were to assess the efficacy of metacognitive training (MCT) in people with a recent onset of psychosis in terms of symptoms as a primary outcome and metacognitive variables as a secondary outcome.

METHOD

A multicenter, randomized, controlled clinical trial was performed. A total of 126 patients were randomized to an MCT or a psycho-educational intervention with cognitive-behavioral elements. The sample was composed of people with a recent onset of psychosis, recruited from nine public centers in Spain. The treatment consisted of eight weekly sessions for both groups. Patients were assessed at three time-points: baseline, post-treatment, and at 6 months follow-up. The evaluator was blinded to the condition of the patient. Symptoms were assessed with the PANSS and metacognition was assessed with a battery of questionnaires of cognitive biases and social cognition.

RESULTS

Both MCT and psycho-educational groups had improved symptoms post-treatment and at follow-up, with greater improvements in the MCT group. The MCT group was superior to the psycho-educational group on the Beck Cognitive Insight Scale (BCIS) total (p = 0.026) and self-certainty (p = 0.035) and dependence self-subscale of irrational beliefs, comparing baseline and post-treatment. Moreover, comparing baseline and follow-up, the MCT group was better than the psycho-educational group in self-reflectiveness on the BCIS (p = 0.047), total BCIS (p = 0.045), and intolerance to frustration (p = 0.014). Jumping to Conclusions (JTC) improved more in the MCT group than the psycho-educational group (p = 0.021). Regarding the comparison within each group, Theory of Mind (ToM), Personalizing Bias, and other subscales of irrational beliefs improved in the MCT group but not the psycho-educational group (p < 0.001-0.032).

CONCLUSIONS

MCT could be an effective psychological intervention for people with recent onset of psychosis in order to improve cognitive insight, JTC, and tolerance to frustration. It seems that MCT could be useful to improve symptoms, ToM, and personalizing bias.

The Importance of Metamemory Functioning to the Pathogenesis of Psychosis

Many studies up to date have implied that biases in the metacognition of memory, so called metamemory, contribute to the development and maintenance of positive symptoms in schizophrenia. However, no study exists which has longitudinally followed patients experiencing positive symptoms. The present article therefore reviews cross-sectional studies on retrospective metamemory abilities in participants within different stages of a schizophrenia spectrum disorder, with heterogeneous symptom severities, creating a pseudo-longitudinal overview. Summarized, a deterioration of these abilities correlating with psychosis development can be inferred. The reviewed publications indicate that metamemory biases can already be found in patients with an at-risk mental state for psychosis (ARMS). Patients in their first episode of psychosis (FEP) seem to be more severely impaired than ARMS-patients but similarly affected compared to chronic patients. The contribution of these biases to the pathogenesis of psychosis is discussed, giving consideration to relations with other cognitive- and metacognitive functions, neurochemical processes and neural correlates. It is hypothesized that the biases represent early cognitive markers of the beginning and persisting psychotic state. An early treatment program could help patients to ameliorate the general course of illness or even to prevent the risk of a transition to psychosis.

Studying Delusions Within Research Domain Criteria: The Challenge of Configural Traits When Building a Mechanistic Foundation for Abnormal Beliefs

Our understanding of belief formation, maintenance, and change is in its infancy, yet it is absolutely essential to make progress in understanding these processes to parse the puzzle of psychotic delusions. In this companion to Bebbington and Freeman, I consider a number of Research Domain Criteria constructs that may be helpful for exploring these processes but ultimately conclude (following Risen) that delusions are likely the result of several systems failing. I close with 4 recommendations for making progress: (1) prepare to study a variable space defined by several relevant constructs, (2) include the study of "unsanctioned" constructs, (3) examine the relationships between brain regions, rather than the local abnormalities, and (4) develop rigorous computational models of delusions.