Paranoid Ideation Without Psychosis Is Associated With Depression, Anxiety, and Suicide Attempts in General Population

Digitally Enhanced Psychological Assessment and Treatment of Paranoia: A Systematic Review

BACKGROUND

Paranoia is relatively common but can lead to significant distress, impairment and need for care. Digital technologies offer a valuable extension to service provision and are increasingly being integrated into healthcare. This systematic review evaluated feasibility, acceptability, and effectiveness of digitally enhanced psychological assessments and treatments for paranoia across the paranoia continuum (PROSPERO: CRD42023393257).

METHODS

Databases PsychINFO, EMBASE, MEDLINE and Web of Science were searched until 12 June 2023; the Effective Public Health Practice Project (EPHPP) quality assessment tool evaluated studies; and a narrative synthesis was conducted.

RESULTS

Twenty-seven studies met inclusion criteria (n = 3457, 23 assessment and 4 treatment, 2005-2023, most in Europe). Technologies included virtual reality (VR, n = 23), experience sampling methodology (ESM, n = 2), an app (n = 1) and a combination of VR and ESM (n = 1). Assessments involved monitoring paranoia under various virtual conditions or in everyday life. Treatments were generally integrated with Cognitive Behaviour Therapy (CBT), which involved using VR to test out threat beliefs and drop safety behaviours or using an app to support slowing down paranoid thinking. EPHPP ratings were strong (n = 8), moderate (n = 12) and weak (n = 7).

CONCLUSIONS

Digitally enhanced assessments and treatments showed promising acceptability, feasibility and treatment effectiveness. Limitations of studies include small sample sizes, lack of comparison groups and long-term data and limited randomised controlled trials. Results support the potential future integration of VR in the assessment of paranoia and show promise for treatments such as CBT, although further clinical trials are required. Investigation of other technologies is limited.

Antidepressant and anti-suicidal effects of ketamine in treatment-resistant depression associated with psychiatric and personality comorbidities: A double-blind randomized trial

OBJECTIVE

To evaluate the effects of ketamine treatment on depression and suicidal ideation in treatment resistant depression (TRD) and to determine whether they are influenced by other psychiatric and personality comorbidities.

METHODS

A randomized double-blind parallel-arm controlled study on 36 patients with TRD. Patients were divided into two treatment groups: ketamine (K group) and placebo (P group). Patients in the K and P groups received one infusion of medicine per week for two weeks. All participants were assessed using the Structured Interview for the Five-Factor Personality Model (SIFFM), Hamilton Depression Rating Scale (HDRS), Suicide Probability Scale (SPS), and Symptom Checklist 90 (SCL 90).

RESULTS

After treatment, there was a significant decrease in the total HDRS and SPS scores in the K group compared to the P group, but the magnitude of response was not influenced by the presence of other psychiatric symptoms. Regression model, only receive ketamine treatment was significant factor for improve suicide and depression scores.

LIMITATIONS

lack of data on other outcomes that are important to patients (e.g., quality of life, cognition) and need for a larger sample size.

CONCLUSIONS

Ketamine infusions in TRD reduce suicidal ideation and depression despite the presence other psychiatric and personality disorders.

Erroneous Thought in Inpatients with Major Depressive Disorder: The Role of Psychological Trauma During Childhood and Adulthood

BACKGROUND

The pathogenic role of trauma in psychotic-like experiences has yet to be clarified. The aim of this study was to investigate the role of childhood and adulthood trauma on erroneous thoughts among patients with major depressive disorder.

MATERIALS AND METHODS

Inpatients with major depressive disorder (MDD) and healthy controls (HCs) were enrolled, and paper-and-pencil questionnaires were applied. Clinical rating and self-reported scales were used to measure levels of depression, dissociation, psychological trauma, parental maltreatment, and erroneous thoughts. Pearson's correlation analysis was conducted to explore potentially significant associations between erroneous thoughts and other independent variables, and standardized regression coefficients of hierarchical regression analysis were used to predict the significant relationships between erroneous thoughts and adulthood or childhood trauma.

RESULTS

A total of 99 participants were included into the analysis, of whom 59 were patients with MDD and 40 were HCs. After treatment, the patients with MDD showed significantly higher levels of depression, childhood maltreatment, interpersonal trauma and erroneous thoughts than the HCs. After estimating and verifying correlations with hierarchical regression among the patients with MDD, a link between adulthood betrayal trauma and higher level of conviction along with the number of erroneous thoughts was found. However, no significant association was identified between childhood trauma and erroneous thought. The concurrent level of depression significantly predicted a higher level of being preoccupied, along with the number of erroneous thoughts.

CONCLUSION

The current study fills a gap in the literature by showing a link between adulthood trauma and erroneous thoughts in non-psychotic patients. Further studies with well-controlled comparisons and prospective cohort with longer follow-up are warranted to extend the applicability and generalizability of the current study.

'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.

Correlates of Aggression in Men With Methamphetamine Use Disorder: Childhood Trauma and Methamphetamine-Use Characteristics

BACKGROUND

Aggression is common among individuals with methamphetamine use disorder (MAUD) and constitutes a serious public health issue. The current study aimed to examine associations of methamphetamine-use characteristics and childhood trauma with aggression in men with MAUD.

METHODS

This cross-sectional study was conducted from December 2017 to August 2018. MAUD patients recruited from a compulsory drug rehabilitation center (n = 360) and healthy comparison subjects (n = 604) completed a survey that measured aggression and childhood trauma, using the Chinese version of Buss-Perry Aggressive Questionnaire (AQ-CV), and the short form of Childhood Trauma Questionnaire (CTQ-SF), respectively. MAUD patients also provided information on methamphetamine-use characteristics such as the age of MAUD onset, MAUD severity, and co-occurring alcohol use disorder (AUD) and tobacco use disorder (TUD) using standard or self-designed questionnaires. Chi-square tests and t-tests were used to compare childhood trauma and aggression between the MAUD and comparison groups. Multiple linear regressions were conducted to determine correlates of overall aggression and its five sub-scales among the MAUD group.

RESULTS

The MAUD group had higher childhood trauma and aggression scores than the comparison group. Within the MAUD group, age of MAUD onset, having severe MAUD, co-occurring AUD, co-occurring TUD, and childhood trauma were associated with overall aggression, with slightly different correlates found for its five sub-scales.

CONCLUSIONS

Our study shows a high level of childhood trauma and aggression in the MAUD group. Both methamphetamine-use characteristics (age of MAUD onset, severe MAUD, co-occurring AUD/TUD) and childhood trauma were associated with aggression in MAUD. Our findings provide useful information on potential risk factors for aggression and inform future longitudinal research to establish causal relationships between these factors and aggression to guide further prevention and treatment programs.

Paranoia as a deficit in non-social belief updating

Paranoia is the belief that harm is intended by others. It may arise from selective pressures to infer and avoid social threats, particularly in ambiguous or changing circumstances. We propose that uncertainty may be sufficient to elicit learning differences in paranoid individuals, without social threat. We used reversal learning behavior and computational modeling to estimate belief updating across individuals with and without mental illness, online participants, and rats chronically exposed to methamphetamine, an elicitor of paranoia in humans. Paranoia is associated with a stronger prior on volatility, accompanied by elevated sensitivity to perceived changes in the task environment. Methamphetamine exposure in rats recapitulates this impaired uncertainty-driven belief updating and rigid anticipation of a volatile environment. Our work provides evidence of fundamental, domain-general learning differences in paranoid individuals. This paradigm enables further assessment of the interplay between uncertainty and belief-updating across individuals and species.

Everyone has had fleeting concerns that others might be against them at some point in their lives. Sometimes these concerns can escalate into paranoia and become debilitating. Paranoia is a common symptom in serious mental illnesses like schizophrenia. It can cause extreme distress and is linked with an increased risk of violence towards oneself or others. Understanding what happens in the brains of people experiencing paranoia might lead to better ways to treat or manage it.

Some experts argue that paranoia is caused by errors in the way people assess social situations. An alternative idea is that paranoia stems from the way the brain forms and updates beliefs about the world. Now, Reed et al. show that both people with paranoia and rats exposed to a paranoia-inducing substance expect the world will change frequently, change their minds often, and have a harder time learning in response to changing circumstances.

In the experiments, human volunteers with and without psychiatric disorders played a game where the best choices change. Then, the participants completed a survey to assess their level of paranoia. People with higher levels of paranoia predicted more changes would occur and made less predictable choices. In a second set of experiments, rats were put in a cage with three holes where they sometimes received sugar rewards. Some of the rats received methamphetamine, a drug that causes paranoia in humans. Rats given the drug also expected the location of the sugar reward would change often. The drugged animals had harder time learning and adapting to changing circumstances.

The experiments suggest that brain processes found in both rats, which are less social than humans, and humans contribute to paranoia. This suggests paranoia may make it harder to update beliefs. This may help scientists understand what causes paranoia and develop therapies or drugs that can reduce paranoia. This information may also help scientists understand why during societal crises like wars or natural disasters humans are prone to believing conspiracies. This is particularly important now as the world grapples with climate change and a global pandemic. Reed et al. note paranoia may impede the coordination of collaborative solutions to these challenging situations.