51
|
Ajnakina O, Trotta A, Oakley-Hannibal E, Di Forti M, Stilo SA, Kolliakou A, Gardner-Sood P, Gaughran F, David AS, Dazzan P, Pariante C, Mondelli V, Morgan C, Vassos E, Murray RM, Fisher HL. Impact of childhood adversities on specific symptom dimensions in first-episode psychosis. Psychol Med 2016; 46:317-326. [PMID: 26383785 DOI: 10.1017/s0033291715001816] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The relationship between childhood adversity (CA) and psychotic disorder is well documented. As the adequacy of the current categorical diagnosis of psychosis is being increasingly questioned, we explored independent associations between different types of CA and specific psychotic symptom dimensions in a well-characterized sample of first-episode psychosis (FEP) patients. METHOD This study involved 236 FEP cases aged 18-65 years who presented for the first time to psychiatric services in South London, UK. Psychopathology was assessed with the Positive and Negative Syndrome Scale and confirmatory factor analysis was used to evaluate the statistical fit of the Wallwork/Fortgang five-factor model of psychosis. CA prior to 17 years of age (physical abuse, sexual abuse, parental separation, parental death, and being taken into care) was retrospectively assessed using the Childhood Experience of Care and Abuse Questionnaire. RESULTS Childhood sexual abuse [β = 0.96, 95% confidence interval (CI) 0.40-1.52], childhood physical abuse (β = 0.48, 95% CI 0.03-0.93) and parental separation (β = 0.60, 95% CI 0.10-1.11) showed significant associations with the positive dimension; while being taken into care was associated with the excited dimension (β = 0.36, 95% CI 0.08-0.65), independent of the other types of CA. No significant associations were found between parental death and any of the symptom dimensions. CONCLUSIONS A degree of specificity was found in the relationships between different types of CA and psychosis symptom dimensions in adulthood, suggesting that distinct pathways may be involved in the CA-psychosis association. These potentially different routes to developing psychosis merit further empirical and theoretical exploration.
Collapse
Affiliation(s)
- O Ajnakina
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - A Trotta
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - E Oakley-Hannibal
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - M Di Forti
- MRC Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - S A Stilo
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - A Kolliakou
- Department of Psychological Medicine,Institute of Psychiatry, Psychology & Neuroscience,King's College London,London,UK
| | - P Gardner-Sood
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - F Gaughran
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - A S David
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - P Dazzan
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - C Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,London,UK
| | - V Mondelli
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,London,UK
| | - C Morgan
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London,London,UK
| | - E Vassos
- MRC Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - R M Murray
- Department of Psychosis Studies,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| | - H L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre,Institute of Psychiatry, Psychology & Neuroscience, King's College London,London,UK
| |
Collapse
|
52
|
Taylor MJ, Gregory AM, Freeman D, Ronald A. Do sleep disturbances and psychotic-like experiences in adolescence share genetic and environmental influences? J Abnorm Psychol 2015; 124:674-684. [PMID: 25938536 PMCID: PMC4532318 DOI: 10.1037/abn0000057] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 02/26/2015] [Accepted: 03/01/2015] [Indexed: 12/12/2022]
Abstract
Sleep disturbances regularly co-occur with clinical psychotic disorders and dimensions of psychotic-like experiences (PLEs). One possible explanation for this, which has yet to be tested, is that similar genetic or environmental influences underlie sleep disturbances and vulnerability to PLEs. We conducted a twin study to test this possibility in relation to sleep disturbances and six specific PLEs in adolescence in the general population. Approximately 5,000 16-year-old twin pairs completed the Pittsburgh Sleep Quality Index and Insomnia Severity Index. PLEs were assessed using the Specific PLEs Questionnaire, comprising five self-report subscales (Paranoia, Hallucinations, Cognitive Disorganization, Grandiosity, and Anhedonia) and one parent-report subscale (Negative Symptoms). The associations between these measures were tested using structural equation twin model fitting. Paranoia, Hallucinations, and Cognitive Disorganization displayed moderate and significant correlations with both sleep measures (0.32-.42), while Negative Symptoms, Anhedonia, and Grandiosity showed lower correlations (0.01-0.17). Genetic and environmental influences significantly overlapped across PLEs (Paranoia, Hallucinations, Cognitive Disorganization) and both types of sleep disturbance (mean genetic and nonshared environmental correlations = 0.54 and 0.24, respectively). These estimates reduced, yet remained significant, after controlling for negative affect. The association between PLEs with sleep disturbances in adolescence is partly due to genetic and environmental influences that are common to them both. These findings indicate that the known neurobiology of sleep disturbance may provide clues regarding the causes of PLEs in adolescence.
Collapse
Affiliation(s)
- Mark J Taylor
- Genes Environment Lifespan Laboratory, Centre for Brain and Cognitive Development, Birkbeck, University of London
| | | | | | - Angelica Ronald
- Genes Environment Lifespan Laboratory, Centre for Brain and Cognitive Development, Birkbeck, University of London
| |
Collapse
|
53
|
Henry JD, Moses E, Castellini J, Scott J. Mental health problems in adolescence and the interpretation of unambiguous threat. PLoS One 2015; 10:e0127167. [PMID: 26039081 PMCID: PMC4454485 DOI: 10.1371/journal.pone.0127167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 04/12/2015] [Indexed: 11/21/2022] Open
Abstract
Aberrant threat perception has been linked to paranoia, anxiety and other mental health problems, and is widely considered to be a core, transdiagnostic feature of psychopathology. However, to date there has been only limited investigation of whether mental health problems are associated with a biased interpretation of stimuli that have explicit (as opposed to ambiguous) connotations of threat. In the present study, 41 adolescents diagnosed with a mental illness and 45 demographically matched controls were asked to provide danger ratings of stimuli normatively rated as being either low or high in potential threat. All participants were also asked to complete background measures of cognitive function, mental health and wellbeing. The results indicated that the two groups did not differ in their capacity to discriminate between low and high threat stimuli, nor did they differ in the absolute level of threat that they attributed to these stimuli. However, for the control group, the overall level of threat perceived in facial stimuli was correlated with two important indices of mental health (depression and anxiety). No associations emerged in the clinical group. These data are discussed in relation to their potential implications for the role of aberrant threat perception in transdiagnostic models of mental health.
Collapse
Affiliation(s)
- Julie D. Henry
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Ernestina Moses
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Julieta Castellini
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - James Scott
- School of Medicine, The University of Queensland Centre for Clinical Research, St Lucia, QLD, Australia
- Australia Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| |
Collapse
|
54
|
Freeman D, Sheaves B, Goodwin GM, Yu LM, Harrison PJ, Emsley R, Bostock S, Foster RG, Wadekar V, Hinds C, Espie CA. Effects of cognitive behavioural therapy for insomnia on the mental health of university students: study protocol for a randomized controlled trial. Trials 2015; 16:236. [PMID: 26016697 PMCID: PMC4448545 DOI: 10.1186/s13063-015-0756-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/13/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Insomnia, defined as repeated difficulties getting or staying asleep, is common in the general population. Such sleep difficulties are a problem in their own right, but increasingly it is being recognised that they may also be a contributory factor in the development of a wide range of mental health problems. Our focus is upon the relationship between insomnia and psychotic experiences, such as paranoia and hallucinations. Psychotic experiences commonly occur in mild forms in the general population and have been linked to disrupted sleep. These psychotic-like experiences raise the risk of development of a clinical disorder. Our aim is to reduce insomnia in a large general population group, and examine the effect on paranoia and hallucinations at the age when mental health problems typically emerge. The primary hypotheses are that cognitive behaviour therapy (CBT) for insomnia will reduce insomnia and also levels of paranoia and hallucinations. The theoretical links will be substantiated by a planned mediation analysis. Improvements in a number of other mental health outcomes are also predicted. METHODS/DESIGN We will carry out a parallel group, randomised controlled trial of 2,614 students with insomnia in universities across the UK. In the Oxford Access for Students Improving Sleep (OASIS) trial, participants will be randomised to digital CBT for insomnia (in addition to treatment as usual) or treatment as usual. Online assessments will take place at zero, three, 10 (post-treatment), and 22 (follow-up) weeks. Primary outcomes are insomnia and psychotic-like experiences (paranoia or hallucinatory experiences) at 10 weeks. Secondary outcomes are levels of mania, depression, anxiety, nightmares, psychological wellbeing, and the development of mental health disorders. All main analyses will be carried out at the end of the last follow-up assessment and will be based on the intention-to-treat principle. The trial is funded by the Wellcome Trust. DISCUSSION This study will be the first large-scale causal test of the relationship between sleep disturbance and psychotic experiences. It will provide evidence concerning the clinical effects of treating insomnia in young adults. TRIAL REGISTRATION This trial was registered with Current Controlled Trials (identifier: ISRCTN61272251 ) on 29 January 2015.
Collapse
Affiliation(s)
- Daniel Freeman
- Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Bryony Sheaves
- Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Guy M Goodwin
- Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building 1st Floor, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Paul J Harrison
- Sleep & Circadian Neuroscience Institute, Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 1.304 Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Sophie Bostock
- Sleepio Ltd, 60-62 Commercial Street, London, E1 6LT, UK.
| | - Russell G Foster
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 5-6 West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Vanashree Wadekar
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Colin A Espie
- Sleepio Ltd, 60-62 Commercial Street, London, E1 6LT, UK.
- Sleep & Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 5-6 West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| |
Collapse
|
55
|
|
56
|
Bouchard JP. [Mental disorders and dangerous acting out]. Soins Psychiatr 2015:12-16. [PMID: 25751907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The major mental disorders which are most likely to lead to dangerous acting out are adult psychoses (schizophrenia and paranoia) and severe mood disorders (major depressive episodes and mania). Good knowledge of the symptomatology of these pathologies and their identification can help to anticipate and prevent much of the violence which people with these disorders may inflict on others or themselves. After mental assessment, those who commit wrongful and criminal acts may be ruled to be criminally irresponsible. They are then handed over to the relevant health care authorities for treatment for their mental disorders.
Collapse
|
57
|
Vizin G, Unoka Z. [The role of shame in development of the mental disorders II. Measurement of shame and relationship]. Psychiatr Hung 2015; 30:278-296. [PMID: 26471030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Our review is an overview of research literature aimed at evaluating the differential association of shame with various mental disorders. In the first part of this review, we present questionnaire and experimental methods applied in clinical trials for measuring shame. In the second part of our review, we review research that investigated the association between shame, and shame induced behavioral and emotional reactions, as well as the following mental disorders: anxiety disorders (social phobia, PTSD, agoraphobia, generalized anxiety disorder, specific phobias, OCD), mood disorders (unipolar depression, bipolar disorder), suicide attempts, self-harm behavior, eating disorders, somatization, personality disorders, aggression, addictions, autism and paranoia. The results of the reviewed studies suggest that this excessive emotional state associated with negative self-esteem on global self plays a central role in mental disorders, although shame is very rarely applied as diagnostic criterion in DSM.
Collapse
Affiliation(s)
- Gabriella Vizin
- Semmelweis Egyetem Pszichiatriai es Pszichoterapias Klinika, Budapest, Hungary, E-mail:
| | | |
Collapse
|
58
|
Hella PO, Niemi J, Tirkkonen JM, Hintikka J, Koponen H, Koivumaa-Honkanen H. Talking about paranoid experiences: Interactional dynamics of accomplishing disclosure of psychotic symptoms in triadic conversation. Commun Med 2015; 12:25-40. [PMID: 29115790 DOI: 10.1558/cam.v12i1.20214] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study is the first to investigate, using conversation analysis, the effects of a family member’s participation in conversation regarding the assessment of need for treatment. We aim at describing the course of a treatment negotiation, focusing on interactional dynamics and on disclosure of paranoid symptoms in a clinically challenging situation characterized by an acutely psychotic patient with (1) disorganized discourse, (2) poor insight, (3) aspiration to avoid hospital treatment, and (4) a relative who was supporting in-patient care. In the triadic conversation, in which the patient, his relative, and the psychiatrist participated, different consecutive phases were distinguished. The Relative Prominent Information Phase (RIP) was characterized by the relative’s statements on the patient’s problematic behavior, and conflicting views between the patient and his relative led to denial of symptoms by the patient. When the patient was prominent in the latter Patient Prominent Information Phase (PIP), the display of several different social actions and corresponding linguistic devices were linked with more overt talk about paranoid experiences by the patient, albeit in a disorganized manner. RIP and PIP were followed by an Evaluation and Decision Phase (EDP).
Collapse
|
59
|
Morrison AP, Shryane N, Fowler D, Birchwood M, Gumley AI, Taylor HE, French P, Stewart SLK, Jones PB, Lewis SW, Bentall RP. Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: a multi-level modelling analysis. Psychol Med 2015; 45:2675-2684. [PMID: 26165380 DOI: 10.1017/s0033291715000689] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we aimed to test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness). METHOD We used data from 117 participants from the Early Detection and Intervention Evaluation for people at risk of psychosis (EDIE-2) trial of cognitive–behaviour therapy, comparing them with samples of psychiatric in-patients and healthy students from a previous study. Multi-level modelling was utilized to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness. RESULTS Our sample of at-risk mental state participants was not as paranoid, but reported higher levels of ‘bad-me’ deservedness, compared with psychiatric in-patients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness. CONCLUSIONS This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.
Collapse
|
60
|
Abstract
BACKGROUND AND OBJECTIVES This experiment examined whether reflecting on a core value-value-affirmation-was effective in attenuating state paranoia in students. METHODS University students (N = 55) were randomised to either a value-affirmation or non-affirmation control condition before exposure to a paranoia-induction manipulation (high self-awareness plus failure feedback). Paranoid cognitions were measured before (T1) and after (T2) the value-affirmation task and after the paranoia-induction task (T3). Depressive cognitions were also measured at T3. RESULTS Affirming a valued domain had a direct and significant effect on reducing state paranoia prior to the paranoia-induction task (T2), such that the overall impact of the paranoia-induction on state paranoia was not significantly different from baseline. This effect was not attributable to differential changes in depression across groups. LIMITATIONS Use of a nonclinical sample limits generalisation to clinical groups. Repeat testing of key variables is a limitation, although this was necessary to assess change over time, and use of randomisation increased the internal validity of the study. CONCLUSIONS These findings suggest that self-affirmation is effective in reducing state paranoia in a nonclinical sample.
Collapse
Affiliation(s)
- Jessica Kingston
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW200EX, UK
| | - Lyn Ellett
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW200EX, UK.
| |
Collapse
|
61
|
Mendelsohn R. Revisiting the sadomasochistic marriage: the paranoid-masochistic relationship. Psychoanal Rev 2014; 101:647-673. [PMID: 25247285 DOI: 10.1521/prev.2014.101.5.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The sadomasochistic marriage is thought to be very resistant to change because of the object relations of each member of a couple as well as the sadomasochistic dynamics within the couple. However, the picture may be even more complex because there are times when a psychoanalytic therapist may mistakenly believe he or she is treating a sadomasochistic couple when the couple actually is functioning in a paranoid-masochistic relationship. The present paper reexamines the sadomasochistic marriage by revisiting the work of Nydes, who formulated the concept of paranoid-masochism in individuals and contrasted it to the more commonly understood sadomasochist dynamic. This paper applies his concepts to couples: Just as we understand some couples to be sadomasochistic, other couples may have paranoid-masochistic dynamics, which may require a somewhat different kind of understanding and technical approach than the dynamics of a sadomasochistic couple at the same level of object relations. This may be the reason why some marriages, misdiagnosed as sadomasochistic, are even more difficult to treat than others, because they might be more accurately treated as paranoid-masochistic.
Collapse
Affiliation(s)
- Robert Mendelsohn
- Derner Institute of Advanced Psychological Studies, Adelphi University, Garden City, NY 11530. E-mail:
| |
Collapse
|
62
|
Cohen A. [A psychiatrist on the "other side of the fence"]. Soins Psychiatr 2014:6. [PMID: 25335212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
|
63
|
Abstract
PURPOSE Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions. METHODS A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia. RESULTS Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments. CONCLUSIONS There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.
Collapse
Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK,
| | | |
Collapse
|
64
|
Freeman D, Antley A, Ehlers A, Dunn G, Thompson C, Vorontsova N, Garety P, Kuipers E, Glucksman E, Slater M. The use of immersive virtual reality (VR) to predict the occurrence 6 months later of paranoid thinking and posttraumatic stress symptoms assessed by self-report and interviewer methods: a study of individuals who have been physically assaulted. Psychol Assess 2014; 26:841-847. [PMID: 24708073 PMCID: PMC4151801 DOI: 10.1037/a0036240] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Presentation of social situations via immersive virtual reality (VR) has the potential to be an ecologically valid way of assessing psychiatric symptoms. In this study we assess the occurrence of paranoid thinking and of symptoms of posttraumatic stress disorder (PTSD) in response to a single neutral VR social environment as predictors of later psychiatric symptoms assessed by standard methods. One hundred six people entered an immersive VR social environment (a train ride), presented via a head-mounted display, 4 weeks after having attended hospital because of a physical assault. Paranoid thinking about the neutral computer-generated characters and the occurrence of PTSD symptoms in VR were assessed. Reactions in VR were then used to predict the occurrence 6 months later of symptoms of paranoia and PTSD, as assessed by standard interviewer and self-report methods. Responses to VR predicted the severity of paranoia and PTSD symptoms as assessed by standard measures 6 months later. The VR assessments also added predictive value to the baseline interviewer methods, especially for paranoia. Brief exposure to environments presented via virtual reality provides a symptom assessment with predictive ability over many months. VR assessment may be of particular benefit for difficult to assess problems, such as paranoia, that have no gold standard assessment method. In the future, VR environments may be used in the clinic to complement standard self-report and clinical interview methods.
Collapse
Affiliation(s)
| | | | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, Manchester University
| | - Claire Thompson
- Department of Psychology, Institute of Psychiatry, King's College London
| | - Natasha Vorontsova
- Department of Psychology, Institute of Psychiatry, King's College London
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, King's College London
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, King's College London
| | | | - Mel Slater
- Department of Computer Science, University College London
| |
Collapse
|
65
|
Sündermann O, Onwumere J, Kane F, Morgan C, Kuipers E. Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety. Soc Psychiatry Psychiatr Epidemiol 2014; 49:359-66. [PMID: 23955376 PMCID: PMC4081600 DOI: 10.1007/s00127-013-0754-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 07/31/2013] [Indexed: 12/11/2022]
Abstract
PURPOSE To investigate social support and network features in people with first-episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia. METHOD Thirty-eight people with first-episode psychosis were recruited for a cross-sectional study. Self-report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted. RESULTS One-third of the sample (34%) had no confidant [95% CI (18.4, 50.0%)]. The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (0.35 < rs < 0.60). The association between loneliness and paranoia was mediated through anxiety (ab = 0.43, z = 3.5; p < 0.001). CONCLUSIONS Even at first episode, a large proportion of people with psychosis have poor perceived support, no confidant and report several lonely days a week. Patients without a confidant appear to be more susceptible to feeling lonely and anxious. Anxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated.
Collapse
Affiliation(s)
- Oliver Sündermann
- South London Maudsely NHS Foundation Trust, Anxiety Disorders Residential Unit, Bethlem Royal Hospital, Monks Orchard Road, London, BR3 3BX, UK,
| | | | | | | | | |
Collapse
|
66
|
Palmier-Claus JE, Taylor PJ, Ainsworth J, Machin M, Dunn G, Lewis SW. The temporal association between self-injurious thoughts and psychotic symptoms: a mobile phone assessment study. Suicide Life Threat Behav 2014; 44:101-10. [PMID: 24261643 DOI: 10.1111/sltb.12064] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 08/12/2013] [Indexed: 01/04/2023]
Abstract
The relationship between psychotic symptoms and self-injurious thoughts (SITs) remains unclear. The short-term temporal associations between psychotic symptoms and SITs were explored. A sample of 36 people with a diagnosis of a psychotic disorder or at-risk mental state completed mobile phone-based measures at multiple times each day for 1 week. Clustered regression with time-lagged variables supported a relationship between paranoia and subsequent SITs. Hallucinations did not predict these thoughts when controlling for paranoia. The role of specific psychotic symptoms in triggering SITs is highlighted and the importance of considering these factors in risk management is discussed.
Collapse
Affiliation(s)
- Jasper E Palmier-Claus
- Division of Clinical Psychology, School of Psychological Science, the University of Manchester, Manchester, UK
| | | | | | | | | | | |
Collapse
|
67
|
van Os J, Lataster T, Delespaul P, Wichers M, Myin-Germeys I. Evidence that a psychopathology interactome has diagnostic value, predicting clinical needs: an experience sampling study. PLoS One 2014; 9:e86652. [PMID: 24466189 PMCID: PMC3900579 DOI: 10.1371/journal.pone.0086652] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 12/15/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND For the purpose of diagnosis, psychopathology can be represented as categories of mental disorder, symptom dimensions or symptom networks. Also, psychopathology can be assessed at different levels of temporal resolution (monthly episodes, daily fluctuating symptoms, momentary fluctuating mental states). We tested the diagnostic value, in terms of prediction of treatment needs, of the combination of symptom networks and momentary assessment level. METHOD Fifty-seven patients with a psychotic disorder participated in an ESM study, capturing psychotic experiences, emotions and circumstances at 10 semi-random moments in the flow of daily life over a period of 6 days. Symptoms were assessed by interview with the Positive and Negative Syndrome Scale (PANSS); treatment needs were assessed using the Camberwell Assessment of Need (CAN). RESULTS Psychotic symptoms assessed with the PANSS (Clinical Psychotic Symptoms) were strongly associated with psychotic experiences assessed with ESM (Momentary Psychotic Experiences). However, the degree to which Momentary Psychotic Experiences manifested as Clinical Psychotic Symptoms was determined by level of momentary negative affect (higher levels increasing probability of Momentary Psychotic Experiences manifesting as Clinical Psychotic Symptoms), momentary positive affect (higher levels decreasing probability of Clinical Psychotic Symptoms), greater persistence of Momentary Psychotic Experiences (persistence predicting increased probability of Clinical Psychotic Symptoms) and momentary environmental stress associated with events and activities (higher levels increasing probability of Clinical Psychotic Symptoms). Similarly, the degree to which momentary visual or auditory hallucinations manifested as Clinical Psychotic Symptoms was strongly contingent on the level of accompanying momentary paranoid delusional ideation. Momentary Psychotic Experiences were associated with CAN unmet treatment needs, over and above PANSS measures of psychopathology, similarly moderated by momentary interactions with emotions and context. CONCLUSION The results suggest that psychopathology, represented as an interactome at the momentary level of temporal resolution, is informative in diagnosing clinical needs, over and above traditional symptom measures.
Collapse
Affiliation(s)
- Jim van Os
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
- * E-mail:
| | - Tineke Lataster
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Philippe Delespaul
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Marieke Wichers
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Inez Myin-Germeys
- Dept of Psychiatry and Psychology, Centre of Contextual Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
| |
Collapse
|
68
|
Abstract
Paranoid personality disorder (PPD) is currently included in DSM-IV's "odd cluster" or "cluster A." In the present article, the authors review available information pertaining to the psychometric properties of PPD, as derived from the relevant literature and from databases of personality disorder study groups. There is comparatively little published evidence for the reliability and validity of PPD, and researchers by and large have tended not to study the disorder, either because of investigators' difficulty recruiting individuals with PPD into research studies, or (as seems more likely) because the trait-paranoia from which many psychiatric patients suffer has seemed better explained by other DSM-IV disorders on Axis I and/or Axis II than by PPD. Given the scant empirical evidence on PPD, it seems reasonable to remove it as an independent diagnosis from the next edition of DSM, and instead to encourage clinicians to code trait-paranoia using a dimensional approach.
Collapse
|
69
|
Sullivan S, Bentall RP, Fernyhough C, Pearson RM, Zammit S. Cognitive styles and psychotic experiences in a community sample. PLoS One 2013; 8:e80055. [PMID: 24244608 PMCID: PMC3828222 DOI: 10.1371/journal.pone.0080055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 09/30/2013] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION In clinical populations paranoid delusions are associated with making global, stable and external attributions for negative events. Paranoia is common in community samples but it is not known whether it is associated with a similar cognitive style. This study investigates the association between cognitive style and paranoia in a large community sample of young adults. METHODS 2694 young adults (mean age 17.8, SD 4.6) from the ALSPAC cohort provided data on psychotic experiences and cognitive style. Psychotic experiences were assessed using a semi-structured interview and cognitive style was assessed using the Cognitive Styles Questionnaire-Short Form (CSQ-SF) on the same occasion. Logistic regression was used to investigate associations between paranoia and CSQ-SF scores, both total and domain-related (global, stable, self, external). The role of concurrent self-reported depressive symptoms in the association was explored. RESULTS Paranoia was associated with Total CSQ-SF scores (adjusted OR 1.69 95% CI 1.29, 2.22), as well as global (OR 1.56 95% CI 1.17, 2.08), stable (OR 1.56 95% CI 1.17, 2.08) and self (OR 1.37 95% CI 1.05, 1.79) domains, only Total score and global domain associations remained after additional adjustment for self-reported depression. There was no association between paranoia and external cognitive style (OR 1.10 95% CI 0.83, 1.47). CONCLUSION Paranoid ideation in a community sample is associated with a global rather than an external cognitive style. An external cognitive style may be a characteristic of more severe paranoid beliefs. Further work is required to determine the role of depression in the association between cognitive style and paranoia.
Collapse
Affiliation(s)
- Sarah Sullivan
- Academic Centre for Mental Health Research, University of Bristol, Bristol, United Kingdom
| | - Richard P. Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, United Kingdom
| | | | - Rebecca M. Pearson
- Academic Centre for Mental Health Research, University of Bristol, Bristol, United Kingdom
| | - Stanley Zammit
- Academic Centre for Mental Health Research, University of Bristol, Bristol, United Kingdom
- Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
70
|
Collip D, Geschwind N, Peeters F, Myin-Germeys I, van Os J, Wichers M. Putting a Hold on the Downward Spiral of Paranoia in the Social World: A Randomized Controlled Trial of Mindfulness-Based Cognitive Therapy in Individuals with a History of Depression. PLoS One 2013; 8:e66747. [PMID: 23826125 PMCID: PMC3694971 DOI: 10.1371/journal.pone.0066747] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 05/08/2013] [Indexed: 12/25/2022] Open
Abstract
Context Paranoia embodies altered representation of the social environment, fuelling altered feelings of social acceptance leading to further mistrust. Mindfulness-based cognitive therapy (MBCT) may relieve paranoia and reduce its impact on social acceptance. Objective To determine whether MBCT alters momentary feeling of paranoia and social acceptance in daily life. Design Randomized controlled trial of daily-life repeated measures (up to 120 per participant) before and after allocation to MBCT or waiting list control. Participants Volunteer sample of 130 eligible men and women with residual affective dysregulation after at least one episode of major depressive disorder. Interventions Eight weeks of MBCT in groups of 10–15 participants in addition to participants' usual treatment. Outcome Measures Daily-life ratings of paranoia and social acceptance. This manuscript concerns additional analyses of the original trial; hypotheses were developed after data collection (focus initially on depressive symptoms) but before data analysis. Results Sixty-six participants were assigned to the waiting list control group and 64 to the MBCT intervention group, of whom 66 and 61 respectively were included in the per-protocol analyses. Intention-to-treat analyses revealed a significant group by time interaction in the model of momentary paranoia (b = −.18, p<0.001, d = −0.35) and social acceptance (b = .26, p<0.001, d = 0.41). Paranoia levels in the intervention group were significantly reduced (b = −.11, p<0.001) and feelings of social acceptance significantly increased (b = .18, p<0.001), whereas in the Control condition a significant increase in paranoia (b = .07, p = 0.008) and a decrease in social acceptance was apparent (b = −.09, p = 0.013). The detrimental effect of paranoia on social acceptance was significantly reduced in the MBCT, but not the control group (group by time interaction: b = .12, p = 0.022). Conclusions MBCT confers a substantial benefit on subclinical paranoia and may interrupt the social processes that maintain and foster paranoia in individuals with residual affective dysregulation. Trial Registration Netherlands Trial Register NTR1084
Collapse
Affiliation(s)
- Dina Collip
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- * E-mail:
| | - Nicole Geschwind
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Health Psychology Group, CLEP, University of Leuven, Leuven, Belgium
| | - Frenk Peeters
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Inez Myin-Germeys
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, King's Health Partners, King's College London, London, United Kingdom
| | - Marieke Wichers
- Department of Psychiatry and Psychology, School of Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
71
|
Isnanda RG, Brinkman WP, Veling W, van der Gaag M, Neerincx M. Priming to induce paranoid thought in a non clinical population. Stud Health Technol Inform 2013; 191:95-99. [PMID: 23792851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Freeman et al. reported that a substantial minority of the general population has paranoid thoughts while exposed in a virtual environment. This suggested that in a development phase of a virtual reality exposure system for paranoid patients initially a non-clinical sample could be used to evaluate the system's ability to induce paranoid thoughts. To increase the efficiency of such an evaluation, this paper takes the position that when appropriately primed a larger group of a non-clinical sample will display paranoid thoughts. A 2-by-2 experiment was conducted with priming for insecurity and vigilance as a within-subject factor and prior-paranoid thoughts (low or high) as a between-subjects factor. Before exposure into the virtual world, participants (n=24) were shown a video and read a text about violence or about mountain animals. While exposed, participants were asked to comment freely on their virtual environment. The results of the experiment confirmed that exposure in a virtual environment could induce paranoid thought. In addition, priming with an aim to create a feeling of insecurity and vigilance increased paranoid comments in the non-clinical group that otherwise would less often exhibit ideas of persecution.
Collapse
|
72
|
Budiša D, Gavrilov-Jerković V, Dickov A, Mitrovic SM, Dragin D. Attitude towards oneself and others in non-clinical population, depressed and paranoid examinees. Psychiatr Danub 2012; 24:373-380. [PMID: 23132188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The theoretical concept of existential/life positions describes person's basic beliefs about oneself and others. Most of authors on TA postulated that every person has one of four possible basic life positions: I'm OK, you're OK; I'm not OK, you're OK; I'm OK, you're not OK and I'm not OK, you're not OK. The aim of this study was the authentication of Existential positions as theoretical concepts in Transaction Analysis, and it's potential to discriminate clinical from non-clinical examinees, and paranoid from depressive examinees within the clinical population. SUBJECTS AND METHODS The research conducted was co-relational. The sample belongs to the convenience sample type, and comprised 200 examinees, 100 from the non-clinical and 100 from the clinical population of adults. RESULTS The results of the research confirm a statistically significant difference between the non-clinical and clinical part of the sample in the examined theoretical concept. The "I am not OK" existential position is more expressed in the clinical part of the sample. The differences between the examinees with depressive and paranoid disorders indicate that the examinees with the depressive disorder are more likely to express the "I am not OK, you are OK" and "I am not OK, you are not OK" Existential position. CONCLUSION In general, we can infer that the assumptions which the research was aimed at testing received partial validation. Examinees from the clinical part of the sample have a statistically significantly higher score at the position "I am not OK". Examinees with depressive characteristics have a more pronounced "I am not OK, you are not OK" position.
Collapse
Affiliation(s)
- Danijela Budiša
- Centre for prolonged treatment drug addicts, Clinic for Drug Addiction, Institute of Psychiatry Clinical Centre "Vojvodina", Novi Sad, Serbia.
| | | | | | | | | |
Collapse
|
73
|
van Dongen JDM, Buck NML, van Marle HJC. The role of ideational distress in the relation between persecutory ideations and reactive aggression. Crim Behav Ment Health 2012; 22:350-359. [PMID: 22936559 DOI: 10.1002/cbm.1836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND People with schizophrenia are more likely to be violent than the people without it. Feeling driven to act on persecutory delusions may be one explanation for this, but it remains unclear why some should act on such delusions but some not. Acquisition of data from people who are very ill is problematic. Our study explores testing of hypotheses on similar ideational and behavioural associations among healthy recruits from the general population. AIMS This study aims to test the effect of distress induced by persecutory ideas on any relationships between those ideas and aggressive behaviour, and the effect of gender. METHODS Twenty-four men and 53 women from the general population participated in this study. The measures of aggressive behaviour were experimentally induced aggressive responding, self-reported aggressive behaviour in general, and self-reported reactive and proactive aggressive behaviours. RESULTS Among men, persecutory ideation predicted reactive aggressive responding and aggressive style of behaviour only in those who experienced higher levels of persecutory ideational distress. Among women, with generally lower levels of aggression, the role of ideational distress was more complicated; Women in the low distress group responded with higher aggression on the task. Women in the higher distress group responded with higher aggressive style. For neither men nor women were there links between persecutory ideation and proactive aggression, regardless of distress. CONCLUSIONS Ideational distress moderates the relation between persecutory ideation and aggression in different measures of aggression in men and women. IMPLICATIONS FOR PRACTICE AND/OR RESEARCH: Recognition of a relation between persecutory ideations and aggression is also important in the general population. Insight in the theory of acting upon delusions may lead to more accurate violence risk assessment. Facilitation of early detection of experienced delusional distress may lead to development of more specific psychotherapeutic interventions to manage violence risk.
Collapse
|
74
|
Pallagrosi M, Majorana M, Carlone C, Marini I, Todini L, Fonzi L, Biondi M. [Sensitive delusion of reference, rivisitation of a concept: clinical accounts on onset paranoid psychosis]. Riv Psichiatr 2012; 47:440-446. [PMID: 23160055 DOI: 10.1708/1175.13035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM In this work it is discussed whether and how Kretchmer's psychopathological reflections about sensitive delusion of reference can offer a relevant interpretative key for clinicians who face cases of acute persecutory psychosis. It is argued the utility and topicality of those psychopathological concepts that aren't commonly investigated, especially in the evaluation and management of onset paranoid psychosis in an emergency ward. METHODS We provide clinical vignettes of two young patients, admitted in the emergency psychiatry ward, who represent a concrete example of the dynamic-affective comprehension of delusional elaboration, through its embodiment in the individual biographical development. RESULTS An interpretative key, based on this specific conceptual frame, seems to provide an integrated intervention tool that aims both to a causal comprehension and demolition of the delusional solution in onset psychotic cases. CONCLUSIONS The rediscovery of classical psychopathological concepts appears to be a necessary process, especially in the clinical management of onset psychotic disorders. Further and more accurate researches are, in any case, needed.
Collapse
Affiliation(s)
- Mauro Pallagrosi
- Dipartimento di Neurologia e Osichiatria, Sapienza Universita di Roma, Italy.
| | | | | | | | | | | | | |
Collapse
|
75
|
Freeman D, Evans N, Lister R. Gut feelings, deliberative thought, and paranoid ideation: a study of experiential and rational reasoning. Psychiatry Res 2012; 197:119-22. [PMID: 22406393 PMCID: PMC3584280 DOI: 10.1016/j.psychres.2011.12.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/07/2011] [Accepted: 12/21/2011] [Indexed: 11/19/2022]
Abstract
Rapid intuitive hunches or gut feelings may be a compelling source of evidence for paranoid ideas. Conversely, a failure to apply effortful analytic thinking may contribute to the persistence of such thoughts. Our main aim was to examine for the first time the associations of persecutory thinking with experiential and rational thinking styles. Five hundred individuals recruited from the general population completed self-report assessments of current persecutory ideation, general reasoning styles and personality traits. Persecutory ideation was independently associated with greater use of experiential reasoning and less use of rational reasoning. The correlations were small. Persecutory ideation was also positively associated with neuroticism and negatively correlated with extraversion, agreeableness and conscientiousness. There was no evidence of an interaction between neuroticism and experiential reasoning in the prediction of paranoia, but high experiential reasoning in the context of low rational reasoning was particularly associated with persecutory ideation. Overall, the study provides rare evidence of self-reported general reasoning styles being associated with delusional ideation. Perceived reliance on intuition is associated with paranoid thinking, while perceived reliance on deliberation is associated with fewer such thoughts. The dual process theory of reasoning may provide a framework to contribute to the understanding of paranoid thinking.
Collapse
|
76
|
Abstract
The cognitive dimension of Borderline Personality Disorder has received relatively little attention in the clinical literature and is poorly understood. This article illustrates how a range of cognitive problems including attention deficit disorder and learning disabilities may contribute to the cognitive disturbances identified in the disorder including dissociation, paranoia, all or nothing thinking, overvalued ideas, and denial and splitting. A review of relevant research supporting the presence of cognitive deficits is summarized along with a developmental pathway for the expression of the cognitive dimension. Clinical examples are provided. Recommendations for inclusion of assessment and treatment strategies that address cognitive deficits within a psychodynamically based psychotherapy are discussed.
Collapse
Affiliation(s)
- Patricia A Judd
- Department of Psychiatry, University of California, San Diego, CA 92103, USA.
| |
Collapse
|
77
|
Carbuto M, Sewell RA, Williams A, Forselius-Bielen K, Braley G, Elander J, Pittman B, Schnakenberg A, Bhakta S, Perry E, Ranganathan M, D'Souza DC. The safety of studies with intravenous Δ⁹-tetrahydrocannabinol in humans, with case histories. Psychopharmacology (Berl) 2012; 219:885-96. [PMID: 21845389 DOI: 10.1007/s00213-011-2417-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 07/13/2011] [Indexed: 12/19/2022]
Abstract
RATIONALE Delta-9-tetrahydrocannabinol (THC) is one of the few cannabinoid receptor ligands that can be used to probe the cannabinoid system in humans. Despite increasing interest in the cannabinoid receptor system, use of intravenous THC as a research tool has been limited by concerns about its abuse liability and psychoactive effects. OBJECTIVES This study aims to evaluate the safety of all intravenous THC studies conducted at this center for the past 13 years. METHODS Included were 11 studies with 266 subjects (14 schizophrenia patients and 252 healthy subjects, of whom 76 were frequent cannabis users), 351 active THC infusions, and 226 placebo infusions. Subjects were monitored for subjective and physical adverse events and followed up to 12 months beyond study participation. RESULTS There was one serious and 70 minor adverse events in 9.7% of subjects and 7.4% of infusions, with 8.5% occurring after the end of the test day. Nausea and dizziness were the most frequent side effects. Adverse events were more likely to be associated with faster infusion rates (2-5 min) and higher doses (>2.1 mg/70 kg). Of 149 subjects on whom long-term follow-up data were gathered, 94% reported either no change or a reduction in their desire to use cannabis in the post-study period, 18% stated that their cannabis use decreased, and 3% stated that it increased in the post-study period. CONCLUSIONS With careful subject selection and screening, risk to subjects is relatively low. Safeguards are generally sufficient and effective, reducing both the duration and severity of adverse events.
Collapse
Affiliation(s)
- Michelle Carbuto
- Psychiatry Service, VA Connecticut Healthcare System, 116A, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Rabin MP, Testard I, Landazuri F. [Sensitive paranoia, concepts and a clinical case study]. Soins Psychiatr 2012:19-22. [PMID: 22423446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Sensitive paranoia, classified by Ernst Kretschmer, is a combination of a paranoid disorder with solitude and mental distress. Sensitive paranoiacs, often depressive and anxious, perceive themselves as being excluded from society while at the same time cultivating a resentment towards it. They also constantly put themselves down. Group therapy can help these patients to find appeasement in their social life.
Collapse
Affiliation(s)
- Marie-Paule Rabin
- CMP/CATTP de L'Arbresle, Centre Hospitalier Saint-Cyr-au-Mont-d'Or secteur G 23, Saint-Cyr-au-Mont-d'Or
| | | | | |
Collapse
|
79
|
Carros C. [The vigilante, a romantic figure according to paranoid logic]. Soins Psychiatr 2012:31-34. [PMID: 22423449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
When patients "transform" themselves into vigilantes, they respond only to their own law and logic. In two examples taken from fiction, "vigilante" characters have experienced an initial trauma.What is the situation in daily clinical practice and how can we open the treatment door for patients suffering from paranoia?
Collapse
|
80
|
Bouchard JP, Brulin-Solignac D. [Paranoid delusions and homicides inside or outside the family]. Soins Psychiatr 2012:23-27. [PMID: 22423447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Paranoia is a mental pathology which severely complicates interpersonal relationships. Its mechanisms and its delusional themes often mean that paranoid subjects have strained, or even violent relations inside and/or outside their family. These difficuIt relationships can sometimes even lead to serious assaults without causing death or more rarely result in homicides with frequent pre-incident indicators.
Collapse
Affiliation(s)
- Jean-Pierre Bouchard
- Laboratoire de psychologie clinique et de psychopathologie, université Paris-Descartes.
| | | |
Collapse
|
81
|
Trégouet S. [Paranoid psychoses]. Soins Psychiatr 2012:13. [PMID: 22423444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
|
82
|
Goullieux E. [Erotomania, adapting to the engendered dangerousness]. Soins Psychiatr 2012:28-30. [PMID: 22423448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Erotomania is a dangerous pathology which is based up on the three stages of hope, pique and rancour. In the relationship, it implies the personal commitment of the therapist who must proceed with great care. Reducing, or eliminating this dangerousness is one aim but must not constitute the only goal.
Collapse
|
83
|
Lallart X. [Paranoia and persecution]. Soins Psychiatr 2012:14-18. [PMID: 22423445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The idea of paranoia has existed since Antiquity, but it was only in the 19th centurythat psychiatrists became interested in it and sought to describe it. Delusion and the feeling of persecution are common in all paranoiacs. The origins of the disease can be found in the patient's psychic structure. Establishing and maintaining contact with a caregiver is one way of helping the patient.
Collapse
Affiliation(s)
- Xavier Lallart
- Etablissement Public de Santé de Ville-Evrard, Neuilly-sur-Marne.
| |
Collapse
|
84
|
|
85
|
Abstract
HIV/AIDS conspiracy theories constitute a loosely grouped set of meanings that share the notion of secret collusion among allied parties. This paper traces one woman's etiological narrative of HIV/AIDS. Such embodied experience and cultural understanding when placed against the backdrop of current thinking on the topic in the United States builds a new framework for understanding the emergence and circulation of HIV/AIDS conspiracy theories as "counter-narratives" employed by individuals and publics in the face of the AIDS pandemic. Such counter-narrative creates a rhetorical space for challenges to power through the articulation of oppositional ideas about dominant scientific knowledge. Without a critical exploration of HIV/AIDS conspiracy theories that examines their emergence and effects as a form of discourse circulating in the public domain, public health advocates will not be able to trace and respond to these narratives' impact on HIV prevention efforts or consider their relevance for other emerging infectious diseases.
Collapse
Affiliation(s)
- Sonja Mackenzie
- Health Equity Institute at San Francisco State University, San Francisco, CA 94132, USA.
| |
Collapse
|
86
|
Hussain S, Kayne E, Guwanardane N, Petrides G. Varenicline induced mania in a 51 year old patient without history of bipolar illness. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1162-3. [PMID: 21396974 DOI: 10.1016/j.pnpbp.2011.02.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 02/09/2011] [Accepted: 02/28/2011] [Indexed: 11/29/2022]
|
87
|
Abstract
BACKGROUND Experimental studies have indicated that social contact, even when it is neutral, triggers paranoid thinking in people who score high on clinical or subclinical paranoia. We investigated whether contextual variables are predictive of momentary increases in the intensity of paranoid thinking in a sample of participants ranging across a psychometric paranoia continuum. METHOD The sample (n=154) consisted of 30 currently paranoid patients, 34 currently non-paranoid patients, 15 remitted psychotic patients, 38 high-schizotypy participants, and 37 control subjects. Based on their total score on Fenigstein's Paranoia Scale (PS), three groups with different degrees of paranoia were defined. The Experience Sampling Method (ESM), a structured diary technique, was used to assess momentary social context, perceived social threat and paranoia in daily life. RESULTS There were differences in the effect of social company on momentary levels of paranoia and perceived social threat across the range of trait paranoia. The low and medium paranoia groups reported higher levels of perceived social threat when they were with less-familiar compared to familiar individuals. The medium paranoia group reported more paranoia in less-familiar company. The high paranoia group reported no difference in the perception of social threat or momentary paranoia between familiar and unfamiliar contacts. CONCLUSIONS Paranoid thinking is context dependent in individuals with medium or at-risk levels of trait paranoia. Perceived social threat seems to be context dependent in the low paranoia group. However, at high levels of trait paranoia, momentary paranoia and momentary perceived social threat become autonomous and independent of social reality.
Collapse
Affiliation(s)
- D Collip
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, Maastricht, The Netherlands
| | | | | | | | | | | |
Collapse
|
88
|
Ulman AM, Bar F. Idiom of distress or delusional state? Cultural clash as the cause of misdiagnosis: a case report. Isr J Psychiatry Relat Sci 2011; 48:60-64. [PMID: 21572245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Beta Israel (House of Israel) represent a total number of more than 100,000 individuals. Ethiopian Jewish culture is based on a tribal cultural model. With their arrival in Israel, many difficulties surfaced. Ethiopian Jews had to deal with cultural choices that challenged their traditions. It has been suggested that the trauma of their journey coupled to the difficulties of the adaptation process to Israeli society, ( the culture shock), was directly responsible for psychopathology found among this population. It also appeared that culture plays a central role in the construction of the clinical picture, blurring at times the boundary between expressions of distress and pathology. It became increasingly difficult to draw the line between culturally normative behavior and psychopathology. The following case report underlines the importance of socio cultural considerations in both staff and patients, and illustrates the dangers of misdiagnosis due to patient therapeutic team cultural clash. A 41 year old woman of Ethiopian origin was hospitalized for suspected schizophrenia. Because of the striking contrast between the patients behavior, responses and so called psychotic content, possible misunderstanding based on cultural differences was considered by the clinical management team. This case underlines the dangers of the psychiatric diagnostic process, emphasizes the important role of sociocultural backgrounds of both staff and patients in patient management and encourages the consideration of cultural factors in all patient evaluations.
Collapse
Affiliation(s)
- Anne-Marie Ulman
- Beer Yaakov Mental Health Center and Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
| | | |
Collapse
|
89
|
Karanfil R, Akçan R, Orhan FÖ. [False allegations of child sexual abuse and paranoid disorder: a report of 2 cases]. Turk Psikiyatri Derg 2011; 22:53-57. [PMID: 21360356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Allegations of child sexual abuse have considerable consequences for individuals and society. Herein, we report 2 cases of false allegations of child sexual abuse by mothers diagnosed as paranoid disorder. Case 1, a 31-year-old mother accused her husband of sexually abusing her 3 daughters, aged 2, 4, and 6 years. Case 2 is a 30-year-old mother that went to the public prosecutor with allegations of sexual abuse of her 6-year-old daughter by a nursery teacher and a stranger. Examination of both alleged victims did not reveal objective findings of sexual abuse. Based on psychiatric examinations, both mothers were diagnosed with paranoid disorder. Consequently, the public prosecutor decided not to prosecute. Considering the possibility of false allegations in such cases, psychiatric examination of the complainant should be performed in order to provide accurate information necessary for legal proceedings and to protect the child.
Collapse
Affiliation(s)
- Ramazan Karanfil
- Kahramanmaraş Sütçu Imam Univ. Tim Fak., Adli Tip AD, Kahramanmaraş.
| | | | | |
Collapse
|
90
|
Bentall RP, Kinderman P, Manson K. Self-discrepancies in bipolar disorder: Comparison of manic, depressed, remitted and normal participants. British Journal of Clinical Psychology 2010; 44:457-73. [PMID: 16368026 DOI: 10.1348/014466505x29189] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To study the role of self-discrepancies in different phases of bipolar disorder (manic-depression). METHOD AND DESIGN Patients with a diagnosis of bipolar disorder in three groups, currently depressed, currently manic or hypomanic, and currently in remission, together with healthy control participants, were administered a modified version of Higgins' Selves Questionnaire. Consistencies between the self-actual, self-ideal and self-ought representations were calculated, together with consistencies between the self-actual representation and the believed views of generalized others about the self. RESULTS In contrast to all other groups, bipolar depressed patients showed marked discrepancies between their self-actual and self-ideal representations, and between their self-actual and self-ought representations. Manic or hypomanic patients showed higher self-actual:self-ideal consistency than non-patient controls. The differences between the depressed participants and the other groups appeared to be accounted for by their very negative self-actual descriptions. Participants in all four groups showed high levels of consistency between self-perceptions and the believed perceptions of others about the self. CONCLUSIONS These findings confirm that beliefs about the self differ between different phases of bipolar disorder and are consistent with the hypothesis that the manic phase involves active avoidance of discrepancies between the self and self-ideals.
Collapse
|
91
|
Abstract
OBJECTIVES Persons with high levels of paranoid ideation may be more sensitive to emotional stimuli, particularly negative emotions, reflecting the operation of a paranoid schema. However, this finding has not been consistently supported and needs further study. This study examined the effect of paranoia, as measured on a continuum, on emotion perception. It was predicted that higher levels of paranoia would be associated with improved emotion perception scores with better recognition for negative emotions than positive. DESIGN A four-group ANOVA design was used to compare participants with clinical and sub-clinical paranoia to reflect the continuum view of paranoia. METHODS A group with persecutory delusions (N=30) was compared with three sub-clinical groups (N=88) on two posed emotion perception tasks. The sub-clinical participants were divided into high, moderate, and low groups based on scores from the Paranoia Scale, a widely used measure of sub-clinical paranoia. RESULTS Persons with persecutory delusions had lower overall emotion perception scores than all of the sub-clinical groups. For negative emotions, persons with persecutory delusions had lower identification scores than the moderate and low sub-clinical groups, but were no different than the high sub-clinical group. Anger was especially problematic for clinical participants. There were no differences for positive emotions. CONCLUSIONS Instead of an enhanced sensitivity for the recognition of emotional states, higher levels of paranoia were linked to a performance deficit on emotion perception tasks. The deficits in emotion perception may reflect the increased skepticism and scrutiny associated with posed emotion tasks (Davis & Gibson, 2000). Research should begin to focus on the underlying mechanisms of emotion perception deficits in paranoia.
Collapse
Affiliation(s)
- Dennis R Combs
- Department of Psychology, University of Tulsa, 600 South College Avenue, Tulsa, OK 74104, USA.
| | | | | |
Collapse
|
92
|
Lysaker PH, Salvatore G, Grant MLA, Procacci M, Olesek KL, Buck KD, Nicolò G, Dimaggio G. Deficits in theory of mind and social anxiety as independent paths to paranoid features in schizophrenia. Schizophr Res 2010; 124:81-5. [PMID: 20655179 DOI: 10.1016/j.schres.2010.06.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 06/24/2010] [Accepted: 06/28/2010] [Indexed: 11/19/2022]
Abstract
Research suggests paranoia among persons with schizophrenia may be the result of a number of different psychological processes including deficits in theory of mind (ToM) and social anxiety. To test this hypothesis, this study sought to determine whether a group of highly paranoid persons with and without a ToM deficit could be detected and whether the group with paranoia and better ToM might have high levels of social anxiety. To explore this, a cluster analysis was performed on a group of 102 adults with schizophrenia spectrum disorders in a non-acute phase of illness on the basis of ratings of paranoid features using the Positive and Negative Syndrome Scale and levels of ToM deficit using a factor score which summarized four different ToM assessments. Four groups were produced: High Paranoia/Poor ToM (n = 14); Low Paranoia/Good ToM (n = 22); Low Paranoia/Low Middle ToM (n=29); and High Paranoia/High Middle ToM (n = 23). Groups were then compared on self report of social anxiety. As predicted, the group with levels of high paranoid features and relatively better ToM performance had significantly higher levels of social anxiety than all other groups.
Collapse
Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Indianapolis, IN 46202, United States.
| | | | | | | | | | | | | | | |
Collapse
|
93
|
Freeman D, Brugha T, Meltzer H, Jenkins R, Stahl D, Bebbington P. Persecutory ideation and insomnia: findings from the second British National Survey of Psychiatric Morbidity. J Psychiatr Res 2010; 44:1021-6. [PMID: 20434169 PMCID: PMC2977847 DOI: 10.1016/j.jpsychires.2010.03.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 03/24/2010] [Accepted: 03/25/2010] [Indexed: 11/29/2022]
Abstract
It is clinically and theoretically plausible that insomnia contributes to the development and maintenance of paranoid fears. The primary aim of the study was to establish in a large sample whether insomnia and paranoia are associated more strongly than by chance. Cross-sectional data on paranoia, insomnia, anxiety, worry, depression, irritability, and cannabis use were obtained from the second British National Survey of Psychiatric Morbidity, a general population survey of adults aged 16-74 years living in Great Britain (N = 8580). It was found that insomnia was associated with an approximately two to threefold increase in paranoid thinking. Paranoia and insomnia were both strongly associated with the presence of anxiety, worry, depression, irritability and cannabis use. In a path analysis the association of paranoia and insomnia was partially explained by the affective symptoms, and, to a much lesser degree, cannabis use. The results are consistent with recent developments in the cognitive understanding of persecutory delusions, in which insomnia, negative affect, and substance use are identified as key factors. Longitudinal studies of insomnia and paranoia, and tests of the effects of sleep interventions on levels of paranoia, are now required to examine causality.
Collapse
Affiliation(s)
- Daniel Freeman
- King's College London, Department of Psychology, PO Box 077, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK.
| | | | | | | | | | | |
Collapse
|
94
|
Abstract
Theoretical models of persecutory delusions have emphasized the impact of reasoning biases and negative emotion at the early stages of symptom formation. However, the causal mechanisms remain unclear. This study tests the hypothesis that state anxiety will increase paranoid ideation and that this increase will be moderated by the level of individual vulnerability and mediated by the tendency to jump to conclusions. Healthy participants (n = 90) with varying levels of vulnerability (psychosis symptoms assessed by the Community Assessment of Psychic Experiences) were randomly assigned to either an anxiety or a nonanxiety condition. Anxiety was induced by pictures from the International Affective Picture System and by in sensu exposure to individual anxiety-provoking situations. During each condition, symptoms of paranoia were assessed by a state-adapted version of the Paranoia Checklist. Jumping to conclusions (JTC) was assessed using a modified version of the beads task. Overall, participants in the anxiety condition reported significantly more paranoid thoughts and showed more JTC than participants in the neutral condition. Participants with higher baseline vulnerability were more likely to show an increase in paranoia as reaction to the anxiety manipulation. Moreover, the association of anxiety and paranoia was mediated by the increased tendency to jump to conclusions in the beads task. The results are in line with a threat anticipation conceptualization of paranoia and provide evidence for an interaction of anxiety and reasoning biases in the development of paranoid beliefs. A combination of meta-cognitive training directed at reasoning biases and promoting emotion regulation skills might prove beneficial in preventing symptoms.
Collapse
Affiliation(s)
- Tania M Lincoln
- Section for Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-Universität Marburg, Gutenbergstr 18, 35032 Marburg, Germany.
| | | | | | | | | |
Collapse
|
95
|
Goldner-Vukov M, Moore LJ. Malignant Narcissism: from fairy tales to harsh reality. Psychiatr Danub 2010; 22:392-405. [PMID: 20856182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Malignant Narcissism has been recognized as a serious condition but it has been largely ignored in psychiatric literature and research. In order to bring this subject to the attention of mental health professionals, this paper presents a contemporary synthesis of the biopsychosocial dynamics and recommendations for treatment of Malignant Narcissism. METHODS We reviewed the literature on Malignant Narcissism which was sparse. It was first described in psychiatry by Otto Kernberg in 1984. There have been few contributions to the literature since that time. We discovered that the syndrome of Malignant Narcissism was expressed in fairy tales as a part of the collective unconscious long before it was recognized by psychiatry. We searched for prominent malignant narcissists in recent history. We reviewed the literature on treatment and developed categories for family assessment. RESULTS Malignant Narcissism is described as a core Narcissistic personality disorder, antisocial behavior, ego-syntonic sadism, and a paranoid orientation. There is no structured interview or self-report measure that identifies Malignant Narcissism and this interferes with research, clinical diagnosis and treatment. This paper presents a synthesis of current knowledge about Malignant Narcissism and proposes a foundation for treatment. CONCLUSIONS Malignant Narcissism is a severe personality disorder that has devastating consequences for the family and society. It requires attention within the discipline of psychiatry and the social science community. We recommend treatment in a therapeutic community and a program of prevention that is focused on psychoeducation, not only in mental health professionals, but in the wider social community.
Collapse
Affiliation(s)
- Mila Goldner-Vukov
- University of Auckland Faculty of Medical and Health Sciences, Manaaki House Community Mental Health Service, Auckland District Health Board, Panmure, Auckland, New Zealand.
| | | |
Collapse
|
96
|
Abstract
Delusional beliefs are characteristic of psychosis and, of the delusions, the paranoid delusion is the single most common type associated with psychosis. The many years of research focused on neurocognition in schizophrenia, using standardized neurocognitive tests, have failed to find conclusive cognitive deficits in relation to positive symptoms. However, UK-based psychological research has identified sociocognitive anomalies in relation to paranoid thinking in the form of theory of mind (ToM), causal reasoning and threat-related processing anomalies. Drawing from recent neuroscientific research on the default mode network, this paper asserts that the common theme running through the psychological tests that are sensitive to the cognitive impairment of paranoia is the need to cognitively project the self through time, referred to as mental time travel. Such an understanding of the cognitive roots of paranoid ideation provides a synthesis between psychological and biological accounts of psychosis while also retaining the powerful argument that understanding abnormal thinking must start with models of normal cognition. This is the core theme running through the cognitive psychological literature of psychiatric disorders that enables research from this area to inform psychological therapy.
Collapse
|
97
|
Sepić-Grahovac D, Ruzić Barsić A, Ruzić K, Grahovac T, Dadić-Hero E. Neurological and psychiatric aspects of corpus callosum genesis. Psychiatr Danub 2010; 22:282-285. [PMID: 20562763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This article reports the case of a patient with partial agenesis of the corpus callosum manifested with corpus callosum syndrome together with signs of brain hemispheres dysfunction: mental impairment, epilepsy and pyramidal signs. The patient's malformation is combined with left-handedness while signs of callosal disconnection are not present. Mild cognitive impairment and late epilepsy onset require a multidisciplinary approach since the patient also displays elements of central nervous system malformations.
Collapse
|
98
|
Pelizza L, Bonazzi F. [Paraphrenia: the modernity of Emil Kraepelin's thinking]. Riv Psichiatr 2010; 45:78-87. [PMID: 20568578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Paraphrenia is a chronic psychotic disorder similar to paranoid schizophrenia, but with a better-preserved affect and rapport, and a much less personality deterioration. It was at first described by Kraepelin in 1913 as a group of patients who exhibited delusional symptoms typical of dementia praecox, but with minimal disturbances of emotion and volition. After the publication of Mayer-Gross's report in 1921, the view to differentiate paraphrenia from schizophrenia was considered to be unfounded and the term "paraphrenia" was not included in the current DSM-IV-TR and ICD-10 diagnostic criteria. Consequently, this disorder is now diagnosed relatively infrequently. However, several authors have recently suggested that the paraphrenia concept has not lost its usefulness. It seems to be that many psychiatrists recognize the illness, but labelled it as "atypical psychosis", "schizoaffective disorder" or "psychotic disorder not otherwise specified" for the lack of a better diagnostic category. Very few systematic studies on paraphrenia have been conducted in the past 70 years. Aim of this article is to underline the modernity of Kraepelin's thinking and his "paraphrenia" concept, suggesting that it could be possible to define and recognize the illness if practitioners would be induced to use a viable diagnostic entity.
Collapse
Affiliation(s)
- Lorenzo Pelizza
- Centro di Salute Mentale di Guastalla (RE), Dipartimento di Salute Mentale di Reggio Emilia, AUSL di Reggio Emilia.
| | | |
Collapse
|
99
|
Lincoln TM, Peter N, Schäfer M, Moritz S. From stress to paranoia: an experimental investigation of the moderating and mediating role of reasoning biases. Psychol Med 2010; 40:169-171. [PMID: 19671213 DOI: 10.1017/s003329170999095x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
100
|
Aakre JM, Seghers JP, St-Hilaire A, Docherty N. Attributional style in delusional patients: a comparison of remitted paranoid, remitted nonparanoid, and current paranoid patients with nonpsychiatric controls. Schizophr Bull 2009; 35:994-1002. [PMID: 18495648 PMCID: PMC2728811 DOI: 10.1093/schbul/sbn033] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Many studies have found that people experiencing persecutory delusions have a marked tendency to use external-personal attributions when establishing the causes of negative events. Although nonclinical populations also tend to attribute negative events to external causes, those causes are typically believed to be universal in nature, rather than personal. The central goal of the present study was to investigate whether individuals with remitted persecutory delusions would display this external-personal bias regarding negative events, in comparison to remitted patients whose delusions were not paranoid in nature and to nonpsychiatric controls. Results indicate that currently paranoid patients were significantly more likely than all other groups, including the remitted paranoid group, to use external-personal attributions in negative events. Interestingly, all patient groups also were found to be significantly more likely than the controls to use internal-personal and internal-universal attributions when explaining negative events.
Collapse
Affiliation(s)
- Jennifer M Aakre
- Department of Psychology, Kent State University, Kent, OH 44240, USA.
| | | | | | | |
Collapse
|