Las ideas de referencia y la preocupación por su presencia: estudio sobre su relevancia para la caracterización de las psicosis

Aberrant Salience and Disorganized Symptoms as Mediators of Psychosis

Introduction

Ideas of reference (IR) are frequent in psychopathology, mainly in psychotic disorders. The frequency of IR and preoccupation about them are related to the psychotic dimension, and to a lesser extent, to negative or emotional disorganized dimensions. Aberrant salience (AS), has been proposed as an indicator of the onset of psychosis, particularly of schizophrenia. This study analyzed the mediating role of AS, disorganized symptoms and preoccupation about IR in the relationship between IR and the psychotic dimension.

Method

The sample consisted of 330 participants (116 university students and 214 clinically active patients), 62.4% of whom were women aged 18-79. The Referential Thinking Scale, the Aberrant Salience Inventory, and the Brief Psychiatric Rating Scale were administered.

Results

Evidence of a partial mediation model showed that the relationships between IR and the psychotic dimension were mediated jointly by AS and the disorganized dimension, and preoccupation about IR no longer had a role. This relationship was significantly influenced by participant age. The variables in the model explained 54.16% of the variance.

Conclusion

The model proposed enabled a set of vulnerabilities (unusual thought content) to be predicted that could lead to a high-risk general pathological state and proneness to psychosis in particular. These findings are discussed with regard to early detection and prevention of psychosis.

Examining the structure of ideas of reference in clinical and community samples

AIMS

This study addresses the psychometric properties of a Spanish validation of the REF scale of ideas of reference (IRs) in detecting and following at-risk mental states and psychosis.

METHODS

A total of 9447 participants were distributed in three groups: 676 patients with various diagnoses-154 with psychotic disorders, 6291 youths aged 11 to 20, and 2480 adult participants aged 21 to 84.

RESULTS

Youths had higher scores than adults on IRs, observing a progressive decrease and stabilization in the twenties. Exploratory factor analysis provided a structure for the overall IRs score, with five first-order dimensions and one second-order dimension. Confirmatory factor analysis supported the structure with excellent fit. The REF scale was invariant across sex and samples. The internal consistency of the complete scale was excellent and acceptable across the five first-order factors. Strong relationships were found with the positive dimension of the community assessment of psychic experience-42, as well as with aberrant salience. Low and moderate relationships were found with public self-consciousness, anxiety, and depression. Youths and patients diagnosed with schizophrenia and other psychotic disorders had a high mean IRs frequency. Male sex, greater age (among the adults), and the "causal explanations", "Songs, newspapers, books" and "laughing and commenting" REF subscales showed predictive power in the diagnostic categories of schizophrenia and other psychotic disorders.

CONCLUSIONS

The results provide satisfactory that the REF scale could be used to study psychosis.

Childhood memories of threatening experiences and submissiveness and its relationship to hallucination proneness and ideas of reference: The mediating role of dissociation

Recent studies have emphasized the importance of childhood memories of threatening experiences and submissiveness in a diversity of psychological disorders. The purpose of this work was to study their specific relationship with hallucination proneness and ideas of reference in healthy subjects. The ELES scale for measuring memory of adverse childhood experiences, the DES-II scale for measuring dissociation, the LSHS-R scale for measuring hallucination proneness, and the REF for ideas of reference were applied to a sample of 472 subjects. A positive association was found between childhood memories of adverse experiences and hallucination proneness and ideas of reference, on one hand, and dissociation on the other. A mediation analysis showed that dissociation was a mediator between the memory of adverse childhood experiences and hallucination proneness on one hand, and ideas of reference on the other. When the role of mediator of the types of dissociative experiences was studied, it was found that absorption and depersonalization mediated between adverse experiences and hallucination proneness. However, this mediating effect was not found between adverse experiences and ideas of reference. The relationship between these last two variables was direct. The results suggest that childhood memories of adverse experiences are a relevant factor in understanding hallucination proneness and ideas of reference. Similarly, dissociation is a specific mediator between adverse childhood experiences and hallucination proneness.

A Mediation Model for Ideas of Reference

Ideas of reference are common in human beings, but they are frequent in certain psychopathological disorders, mainly those concerning the psychotic spectrum. The purpose of this study was to attempt to construct a model predicting the appearance of ideas of reference and to test the relationship of personality (based on the Gray model), emotional, and self-consciousness variables. Five-hundred and seventy-four participants (287 patients with several different psychopathological diagnoses) filled in the Referential Thinking Scale (REF), the GHQ-28, the Self-Consciousness Scale (SCS-R), and the SPSRQ Scale. The resulting model found full mediation of sensitivity to punishment, sensitivity to reward, depression, and public self-consciousness between anxiety and ideas of reference, regardless of the group they were in (patients vs. nonpatients). This result, based on the appearance of anxiety symptomatology, explains 43% of the variance in scores, showing the presence of ideas of reference and therefore enables prediction of a set of vulnerabilities (established with self-reports) which could lead to a psychological state of high general pathological risk and proneness to psychosis in particular.