What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation

Threat Responses in Schizophrenia: A Negative Valence Systems Framework

PURPOSE OF REVIEW

Emotions are prominent in theories and accounts of schizophrenia but are largely understudied compared to cognition. Utilizing the Research Domain Criteria (RDoC) Negative Valence Systems framework, we review the current knowledge of emotions in schizophrenia. Given the pivotal role of threat responses in theories of schizophrenia and the substantial evidence of altered threat responses, we focus on three components of Negative Valence Systems tied to threat responses: responses to acute threat, responses to potential threat, and sustained threat.

RECENT FINDINGS

Individuals with schizophrenia show altered responses to neutral stimuli during acute threat, bed nucleus of the stria terminalis connectivity in response to potential threat, and threat responses associated with sustained threat. Our review concludes that Negative Valence Systems are altered in schizophrenia; however, the level and evidence of alterations vary across the types of threat responses. We suggest avenues for future research to further understand and intervene on threat responses in schizophrenia.

Explaining paranoia: cognitive and social processes in the occurrence of extreme mistrust

BACKGROUND

Paranoia-incorrectly thinking that others are deliberating trying to harm you-causes distress, undermines social interactions and leads to withdrawal. It presents across multiple psychiatric diagnoses.

OBJECTIVE

The primary aim was to determine the extent that cognitive and social processes may explain paranoia. The secondary aim was to identify explanatory factors that distinguished paranoia and social anxiety.

METHODS

10 382 UK adults, quota sampled to match the population for age, gender, ethnicity, income and region, participated in a non-probability survey. All participants completed a paranoia measure and assessments of cognitive and social processes. Structural equation modelling was conducted.

FINDINGS

2586 (24.9%) participants described being mistrustful of other people. 1756 (16.9%) participants wanted help to trust more. 66.7% of variance in paranoia was explained by a model comprising (in descending order of importance): within-situation defence behaviours, negative images, negative self-beliefs, discrimination, dissociation, aberrant salience, anxiety sensitivity, agoraphobic distress, worry, less social support, agoraphobic avoidance, less analytical reasoning and alcohol use. All explanatory factors were associated with paranoia and social anxiety. Ten factors were more closely associated with paranoia than social anxiety, including discrimination, hallucinations, negative images, aberrant salience and alcohol use. Nine factors were more closely associated with social anxiety, including less positive self-belief, an external locus of control, worry and less analytical reasoning.

CONCLUSIONS

Multiple causes are likely to be involved in paranoia. Cognitive and social processes may explain a high degree of paranoia.

CLINICAL IMPLICATIONS

Multiple clear targets for intervention to reduce paranoia are identified.

Mediation Effects of Social Cognition on the Relationship between Neurocognition and Social Functioning in Major Depressive Disorder and Schizophrenia Spectrum Disorders

BACKGROUND

In schizophrenia spectrum disorders (SSD), social cognition mediates the relationship between neurocognition and social functioning. Although people with major depressive disorder (MDD) also exhibit cognitive impairments, which are often prolonged, little is known about the role of social cognition in MDD.

METHODS

Using data obtained through an internet survey, 210 patients with SSD or MDD were selected using propensity score matching based on their demographics and illness duration. Social cognition, neurocognition, and social functioning were evaluated using the Self-Assessment of Social Cognition Impairments, Perceived Deficits Questionnaire, and Social Functioning Scale, respectively. The mediation effects of social cognition on the relationship between neurocognition and social functioning were examined in each group. Invariances of the mediation model across the two groups were then analyzed.

RESULTS

The SSD and MDD groups had mean ages of 44.49 and 45.35 years, contained 42.0% and 42.8% women, and had mean illness durations of 10.76 and 10.45 years, respectively. In both groups, social cognition had significant mediation effects. Configural, measurement, and structural invariances across the groups were established.

CONCLUSION

The role of social cognition in patients with MDD was similar to that in SSD. Social cognition could be a common endophenotype for various psychiatric disorders.

Belief updating in psychosis, depression and anxiety disorders: A systematic review across computational modelling approaches

Alterations in belief updating are proposed to underpin symptoms of psychiatric illness, including psychosis, depression, and anxiety. Key parameters underlying belief updating can be captured using computational modelling techniques, aiding the identification of unique and shared deficits, and improving diagnosis and treatment. We systematically reviewed research that applied computational modelling to probabilistic tasks measuring belief updating in stable and volatile (changing) environments, across clinical and subclinical psychosis (n = 17), anxiety (n = 9), depression (n = 9) and transdiagnostic samples (n = 9). Depression disorders related to abnormal belief updating in response to the valence of rewards, evidenced in both stable and volatile environments. Whereas psychosis and anxiety disorders were associated with difficulties adapting to changing contingencies specifically, indicating an inflexibility and/or insensitivity to environmental volatility. Higher-order learning models revealed additional difficulties in the estimation of overall environmental volatility across psychosis disorders, showing increased updating to irrelevant information. These findings stress the importance of investigating belief updating in transdiagnostic samples, using homogeneous experimental and computational modelling approaches.

Connectome-based predictive modeling predicts paranoid ideation in young men with paranoid personality disorder: a resting-state functional magnetic resonance imaging study

Paranoid personality disorder (PPD), a mental disorder that affects interpersonal relationships and work, is frequently neglected during diagnosis and evaluation at the individual-level. This preliminary study aimed to investigate whether connectome-based predictive modeling (CPM) can predict paranoia scores of young men with PPD using whole-brain resting-state functional connectivity (rs-FC). College students with paranoid tendencies were screened using paranoia scores ≥60 derived from the Minnesota Multiphasic Personality Inventory; 18 participants were ultimately diagnosed with PPD according to the Diagnostic and Statistical Manual of Mental Disorders and subsequently underwent resting-state functional magnetic resonance imaging. Whole-brain rs-FC was constructed, and the ability of this rs-FC to predict paranoia scores was evaluated using CPM. The significance of the models was assessed using permutation tests. The model constructed based on the negative prediction network involving the limbic system-temporal lobe was observed to have significant predictive ability for paranoia scores, whereas the model constructed using the positive and combined prediction network had no significant predictive ability. In conclusion, using CPM, whole-brain rs-FC predicted the paranoia score of patients with PPD. The limbic system-temporal lobe FC pattern is expected to become an important neurological marker for evaluating paranoid ideation.

Visual worry in patients with schizophrenia

OBJECTIVE

Worrying is a pervasive transdiagnostic symptom in schizophrenia. It is most often associated in the literature with verbal modality due to many studies of its presence in generalised anxiety disorder. The current study aimed to elucidate worry in different sensory modalities, visual and verbal, in individuals with schizophrenia.

METHOD

We tested persons with schizophrenia (n = 92) and healthy controls (n = 138) in a cross-sectional design. We used questionnaires of visual and verbal worry (original Worry Modality Questionnaire), trait worry (Penn State Worry Questionnaire) and general psychopathology symptoms (General Functioning Questionnaire-58 and Brief Psychiatric Rating Scale).

RESULTS

Both visual and verbal worry were associated with psychotic, anxiety and general symptoms of psychopathology in both groups with medium to large effect sizes. Regression analyses indicated that visual worry was a single significant predictor of positive psychotic symptoms in a model with verbal and trait worry, both in clinical and control groups (β's of 0.49 and 0.38, respectively). Visual worry was also a superior predictor of anxiety and general psychopathology severity (β's of 0.34 and 0.37, respectively) than verbal worry (β's of 0.03 and -0.02, respectively), under control of trait worry, in the schizophrenia group. We also proposed two indices of worry modality dominance and analysed profiles of dominating worry modality in both groups.

CONCLUSIONS

Our study is the first to demonstrate that visual worry might be of specific importance for understanding psychotic and general psychopathology symptoms in persons with schizophrenia.

Domains of Vulnerability, Resilience, Health Habits, and Mental and Physical Health for Health Disparities Research

Health disparities associated with severe mental illness (SMI) have become a major public health concern. The disparities are not directly due to the SMI. They involve the same leading causes of premature death as in the general population. The causes of the disparities are therefore suspected to reflect differences in health-related behavior and resilience. As with other problems associated with SMI, studying non-clinical populations at risk for future onset provides important clues about pathways, from vulnerability to unhealthy behavior and compromised resilience, to poor health and reduced quality of life. The purpose of this study was to identify possible pathways in a sample of public university students. Four domains of biosystemic functioning with a priori relevance to SMI-related vulnerability and health disparities were identified. Measures reflecting various well-studied constructs within each domain were factor-analyzed to identify common sources of variance within the domains. Relationships between factors in adjacent domains were identified with linear multiple regression. The results reveal strong relationships between common factors across domains that are consistent with pathways from vulnerability to health disparities, to reduced quality of life. Although the results do not provide dispositive evidence of causal pathways, they serve as a guide for further, larger-scale, longitudinal studies to identify causal processes and the pathways they follow to health consequences.

Everything is connected: Inference and attractors in delusions

Delusions are, by popular definition, false beliefs that are held with certainty and resistant to contradictory evidence. They seem at odds with the notion that the brain at least approximates Bayesian inference. This is especially the case in schizophrenia, a disorder thought to relate to decreased - rather than increased - certainty in the brain's model of the world. We use an active inference Markov decision process model (a Bayes-optimal decision-making agent) to perform a simple task involving social and non-social inferences. We show that even moderate changes in some model parameters - decreasing confidence in sensory input and increasing confidence in states implied by its own (especially habitual) actions - can lead to delusions as defined above. Incorporating affect in the model increases delusions, specifically in the social domain. The model also reproduces some classic psychological effects, including choice-induced preference change, and an optimism bias in inferences about oneself. A key observation is that no change in a single parameter is both necessary and sufficient for delusions; rather, delusions arise due to conditional dependencies that create 'basins of attraction' which trap Bayesian beliefs. Simulating the effects of antidopaminergic antipsychotics - by reducing the model's confidence in its actions - demonstrates that the model can escape from these attractors, through this synthetic pharmacotherapy.

Clustering in a newly forming social network by subjective perceptions of loneliness

Objectives: To determine whether first-year college students cluster in networks based on subjective perceptions of loneliness. Participants: 492 first-year Notre Dame students completed surveys across two semesters and provided communication data used to reconstruct their social networks. Methods: Subjective perceptions of loneliness are measured using the Social and Emotional Loneliness Scale for Adults (SELSA). Correlations between an individual's loneliness and the average loneliness of their alters are compared to associations in random networks created using a rewiring algorithm to determine statistical significance. Results: During their first semester, students are more likely than chance to form ties with other students with similar levels of family and romantic loneliness. In their second semester, students cluster on romantic loneliness but not on family or social loneliness. Conclusions: Students are more likely than chance to form ties with people with similar self-perceived levels of loneliness, but only for certain types of loneliness and during certain periods.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The co-occurrence of multidimensional loneliness with depression, social anxiety and paranoia in non-clinical young adults: A latent profile analysis

INTRODUCTION

Loneliness is a negative experience arising from a mismatch between perceived and actual social relationships. Several dimensions of loneliness have been suggested, namely intimate, relational and collective loneliness. Loneliness has been linked to poorer mental health, with its co-occurrence with depression, social anxiety, and paranoia most widely reported. While expressions of these symptoms are heterogeneous across individuals in the non-clinical population, it remains unclear how these symptoms co-occur with one another and with various dimensions of loneliness. It is also of interest how trait factors such as core schemas about self/others may moderate these relationships between loneliness and co-occurring symptoms.

METHODS

A demographically diverse sample of young adults was recruited from multiple sources. The validated sample consisted of 2,089 participants (68.4% female), who completed an online survey consisting of questionnaires assessing levels of multidimensional loneliness, depression, social anxiety, paranoia, core schemas, and demographic characteristics. Latent profile analysis (LPA) was used to identify distinct profiles of loneliness and the three symptoms. Positive and negative core schemas about self and others were modeled as predictors of these profiles.

RESULTS

Five distinct profiles were identified. Profile 1 had low levels across all symptoms and dimensions of loneliness (n = 1,273, 60.9%). Profiles 2-5 were elevated on dimensions of loneliness, and were heightened in depression (n = 189, 9.0%), social anxiety (n = 206, 9.9%), paranoia (n = 198, 9.5%), and all symptoms (n = 223, 10.7%), respectively. Relative to Profile 1, the other four profiles scored higher on negative-self (adjusted ORs = 1.36-1.49, ps < 0.001) and negative-other schemas (adjusted ORs = 1.24-1.44, ps < 0.001), and lower on positive-self (adjusted ORs = 0.82-0.85, ps < 0.001) and positive-other schemas (adjusted ORs = 0.81-0.90, ps < 0.001).

CONCLUSION

More marked intimate, relational and collective loneliness were evident across profiles that had heightened depression, social anxiety and/or paranoia, suggesting that loneliness may serve as a general risk factor for these psychopathologies. Our findings shed light on the heterogeneity of the co-occurrence of loneliness and various mental health difficulties in non-clinical young adults. Core schemas are suggested to be putative psychological mechanisms underlying their co-occurrence and even development.

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

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

Employee state paranoia: linking abusive supervision with employee voice behavior

Purpose

Utilizing affective event theory (AET), this paper aims to understand the affective reasoning behind choosing to speak up for or against abusive supervision. For this purpose, the authors examine the underlying mechanism of employee state paranoia in the relationship between abusive supervision and promotive and prohibitive voice of employees.

Design/methodology/approach

Data from 307 microfinance bank employees were collected using supervisor–subordinate nested design and time-lag approach. The analysis was performed through partial least square (PLS) structural equation modeling using Smart PLS software.

Findings

The results support the direct relationship of abusive supervision with promotive and prohibitive voice. They also support the mediating relation of paranoia arousal between abusive supervision and promotive voice. However, the results do not support the mediating relationship of paranoia arousal between abusive supervision and prohibitive voice.

Originality/value

In light of the literature drawn from AET and empirical data, this study forwards robust recommendations for theory and practice and may assist future researchers interested in the role of employee paranoia arousal.

Candidate Factors Maintaining Social Anxiety in the Context of Psychotic Experiences: A Systematic Review

Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.

A randomised controlled trial of metacognitive training for psychosis, depression, and belief flexibility

BACKGROUND

Metacognitive training (MCT) has been shown to be effective in reducing psychotic symptoms, including delusions. However, less is known on whether MCT, or its specific modules, are effective in ameliorating reasoning biases e.g. belief flexibility. As inflexibility in appraisal has been associated with psychosis and major depressive disorder (MDD), this study examined the efficacy of a 4-session MCT on delusions, depression, and belief flexibility, in two clinical groups (Psychosis and Depression).

METHODS

This study adopted a single-blind randomised controlled design, with patients with schizophrenia spectrum disorders (and delusions) and patients with MDD being randomised, respectively, into the MCT condition or a treatment-as-usual (TAU) condition. The MCT intervention consisted of specific modules targeting belief flexibility. Participants were assessed before and after treatment, and at 1- and 6-month follow-ups.

RESULTS

Among the 113 participants, 27 patients with psychosis and 29 patients with MDD attended MCT. There were significant improvements in psychotic symptoms, especially delusions, for the Psychosis group, and in depressive symptoms for the MDD group. Symptom improvements following MCT were of large effect sizes, were significantly greater than TAU, and persisted at 6-month. Belief flexibility also improved in both groups, although changes were smaller in size and were not significantly greater than TAU.

LIMITATIONS

An active control condition was not included.

CONCLUSIONS

This study demonstrated large and stable symptom reductions in delusions and depression, and smaller (yet stable) improvement in belief flexibility across groups, following a 4-session MCT, carrying implications for transdiagnostic process-based interventions and their mechanisms of change.

Adherence to safety and self-isolation guidelines, conspiracy and paranoia-like beliefs during COVID-19 pandemic in Poland - associations and moderators

BACKGROUND

Due to coronavirus pandemic, governments have ordered a nationwide isolation. In this situation, we hypothesised that people holding conspiracy beliefs are less willing to adhere to medical guidelines. Furthermore, we explored what possible factors may modify relationships between conspiracy, paranoia-like beliefs, and adherence to epidemiological guidelines. Also, we examined the prevalence of different coronavirus conspiracy beliefs.

METHODS

Two independent internet studies. Study 1 used a proportional quota sample that was representative of the population of Poles in terms of gender and settlement size (n=507). Study 2 employed a convenience sample (n=840).

RESULTS

Coronavirus conspiracy beliefs are negatively related to safety guidelines. Mixed results suggest that paranoia-like beliefs are related negatively to safety guidelines. Prevalence of firmly held coronavirus conspiracy beliefs is rare. Nevertheless, certain percentage of participants agree with conspiracy beliefs at least partially. Coronavirus related anxiety, trust in media, and internal motivation to isolation moderate the relationship between conspiracy beliefs and adherence to safety guidelines. Paranoia-like beliefs partially mediate between boredom and conspiracy beliefs.

CONCLUSIONS

Conspiracy beliefs concerning coronavirus are present in the population and are negatively related to adherence to safety guidelines. Conspiracy beliefs originate partially from boredom and paranoia proneness. Certain factors - trust in media and internal motivation to isolation - are potentially worthwhile to address to enhance adherence to safety guidelines. Non-probabilistic sampling suggests caution in interpretation of the present findings.

Social Anxiety Status of Left-Behind Children in Rural Areas of Hunan Province and its Relationship with Loneliness

OBJECTIVE

This study was designed to investigate the situation of social anxiety among left-behind children in rural areas of Hunan Province, China, and to study the effect of social anxiety on loneliness.

METHODOLOGY

A total of 797 left-behind children were selected from rural areas in Hunan Province, China. The basic information questionnaire for left-behind children, Social Anxiety Scale for Children, Perceived Social Support Scale and UCLA Loneliness Scale were used for investigation.

RESULTS

(1) The social anxiety score of left-behind children in China is 6.84 ± 4.28, higher than non-left-behind children, and the score of boys is lower than that of girls, with no significant difference. The score of left-behind children in grade 5 is significantly lower than that of left-behind children in other grades. (2) The overall loneliness score is 16.30 ± 5.10, higher than non-left-behind children, and the score of boys is significantly higher than that of girls. (3) Social anxiety has a significant positive predictive effect on loneliness (P < 0.01). Regression analysis shows that social anxiety not only affects loneliness directly, but also affects loneliness indirectly through the mediating role of perceived social support.

CONCLUSIONS

Social anxiety is a risk factor for loneliness of left-behind children in rural areas. In the influence of social anxiety on loneliness, social support plays a partial mediating role.

Paranoia, hallucinations and compulsive buying during the early phase of the COVID-19 outbreak in the United Kingdom: A preliminary experimental study

This study examines the impact of COVID-19 (in the early phase of the outbreak) on symptoms of psychosis, namely paranoia and hallucinations. Three hundred and sixty-one people in the United Kingdom participated in a 2 (self-isolation vs. no self-isolation) x 2 (perceived COVID-19 symptomatology vs. no perceived COVID-19 symptomatology) x 2 (exposure to COVID-19 news vs. control) experiment online. Participants completed measures of political trust, social network, fear of COVID-19, current paranoid thoughts, hallucinatory experiences and compulsive buying. Kruskal-Wallis results showed that employed people and students are more prone to paranoia and hallucinatory experiences in response to COVID-19 news. A multigroup model showed a moderation effect of the news conditions - in the COVID-19 news condition, fear of COVID-19 and political trust significantly predict the variance of paranoia, hallucinatory experiences and compulsive buying and these co-vary with each other but not in the control condition. In line with cognitive and social theories of paranoia, results suggest that negative affect and low political trust are linked to the presence of paranoid thoughts and hallucinatory experiences and compulsive buying amid COVID-19. Digitized and Tailored Cognitive and Behavioral Therapy are proposed to address the psychiatric impact of COVID-19.

Paranoia, sensitization and social inference: findings from two large-scale, multi-round behavioural experiments

The sensitization model suggests that paranoia is explained by over-sensitivity to social threat. However, this has been difficult to test experimentally. We report two preregistered social interaction studies that tested (i) whether paranoia predicted overall attribution and peak attribution of harmful intent and (ii) whether anxiety, interpersonal sensitivity and worry predicted the attribution of harmful intent. In Study 1, we recruited a large general population sample (N = 987) who serially interacted with other participants in multi-round dictator games and matched to fair, partially fair or unfair partners. Participants rated attributions of harmful intent and self-interest after each interaction. In Study 2 (N = 1011), a new sample of participants completed the same procedure and additionally completed measures of anxiety, worry and interpersonal sensitivity. As predicted, prior paranoid ideation was associated with higher and faster overall harmful intent attributions, whereas attributions of self-interest were unaffected, supporting the sensitization model. Contrary to predictions, neither worry, interpersonal sensitivity nor anxiety was associated with harmful intent attributions. In a third exploratory internal meta-analysis, we combined datasets to examine the effect of paranoia on trial-by-trial attributional changes when playing fair and unfair dictators. Paranoia was associated with a greater reduction in harmful intent attributions when playing a fair but not unfair dictator, suggesting that paranoia may also exaggerate the volatility of beliefs about the harmful intent of others.

Anxiety Mediates the Relationship between Psychotic-Like Experiences and Social Functioning in the General Population

INTRODUCTION

Within the psychosis continuum that includes schizophrenia (SZ) at the severe end and the general population at the mild end, anxiety may negatively impact social functioning more than psychosis or psychotic-like experiences (PLE). This claim is supported by previous reports that show anxiety mediates the relationship between psychosis and social functioning in SZ, suggesting anxiety is critical to social functioning in SZ. Yet no studies have examined a similar relationship in the general population, and this is important because people with PLE are at a significantly higher risk for developing full-blown psychosis.

METHODS

Similar to those with SZ, we predicted heightened anxiety would mediate the relationship between PLE, as measured by The -Oxford-Liverpool Inventory of Feelings and Experiences, and social functioning, as measured by Social Adjustment Scale - Self-Report, in the general population.

RESULTS

Indeed, the current study showed that the relationship between PLE and social functioning was mediated by anxiety (z = 7.81, p < 0.001) within an unselected crowdsourcing sample representative of the general population (Amazon M-Turk; n = 197, mean age 32.38 years).

CONCLUSION

Taken together with previous reports, the current findings suggest that anxiety is a functionally relevant dimension across the psychosis continuum and improving anxiety may improve social functioning across this continuum.

Worry and metacognitions as predictors of the development of anxiety and paranoia

Recent studies have shown that worry and related negative metacognitions are characteristic in generalized anxiety and paranoia respectively. However, most of these studies did not take into account common co-occurrence of anxiety and paranoia, and longitudinal modelling of the role of worry and metacognitions on the development of anxiety and paranoia is rare. The current study aimed at examining the bidirectional longitudinal relationship between anxiety and paranoia, as well as the importance of worry and metacognitions in the development of these symptoms. Our validated sample consisted of 2291 participants recruited from universities, among whom 1746 participants (76.21%) completed online questionnaires at baseline and at one year, reporting levels of anxiety, paranoia, worry, and negative metacognitions. Structural equation modeling analyses, followed by path comparisons, revealed that anxiety and paranoia mutually reinforced each other over time. Negative metacognitions, rather than worry itself, were contributive to the development of both symptoms over time. Negative metacognitions showed bi-directional relationships with anxiety over the time period assessed and showed uni-directional relationships with paranoia. Clinical implications of our findings are discussed.

Digital Phenotyping With Mobile and Wearable Devices: Advanced Symptom Measurement in Child and Adolescent Depression

With an estimated 75% of all mental disorders beginning in the first two decades of life,¹ childhood and adolescence are crucial developmental periods to identify and intercept the unfolding of mental health problems, their relationships with physical health, and the multiple, interwoven connections to the surrounding environment.² Because an individual's mental health is best conceptualized, captured, and treated by taking into account the network of physiological and social functions that constitute the context of individual experience, accessing and analyzing data on multiple health indicators simultaneously can accelerate prediction of disease progression. With the advent of new technologies, dense and extensive amounts of biopsychosocial readouts that can be translated into clinically relevant information have become available in real time, with the potential to revolutionize the practice of medicine. However, challenges to this more ecological and comprehensive approach to mental health measurement include the actual capacity of capturing, safely storing, and analyzing dense data sets (encompassing, for example, mood, cognitions, physical activity, sleep, social interactions) from multiple synchronized sources, and identifying which among multiple indicators ultimately prove useful to improve prediction of a deterioration in symptoms and of initiating early intervention. In this Translations article, we focus on digital phenotyping (DP), which relates to the capturing of the aforementioned relevant biopsychosocial data. This concept is rapidly growing and gaining relevance to child and adolescent psychiatry, and is connected with overarching data science themes of "big data" (extremely large data sets, including data from electronic medical records, imaging, genomics, and patients' smartphones),^3,4 in addition to "machine learning" (the science of getting computers to act without being explicitly programmed)⁵ and "precision medicine" (the practice of custom tailoring treatments to a patient's disease processes),⁶ which have all received attention in this journal. We will describe principles and current applications of DP, together with its potential to facilitate improved outcomes and its limits, using depression in children and adolescents as an illustrative example.

Appreciating the 4 "Ts" of Loneliness When Providing Psychiatric Care for the Lonely Patient

Loneliness can be evaluated from a 4-concept viewpoint of territory, threat, trauma and trust (4 Ts). Territory refers to an area of ownership that is controlled on a daily basis and is fundamental to one's daily life. Lonely individuals often manage boundaries by gaining greater control over their physical environment by territorial behavior. They guard personal territory well as the only area where they can exert dominance and feel safe. Perceptions of social isolation or loneliness increase vigilance for threats, decrease trust, and heighten feelings of vulnerability. Clinical teams caring for the lonely must be especially attentive to a history of prior trauma. Clinicians who ask permission, who pay attention to nonverbal cues, distance, and speed as they enter the lonely person's space, and who respect boundaries may be more successful in gaining trust. Achieving trust diminishes the risk of physical harm, while allowing lonely persons the perceived control they need to permit health care interventions. Veterans are at higher risk for loneliness. Given their military training, they may be particularly attentive to boundaries, protecting the perimeter, watching for threats, and defending their space. In this article, we discuss the successful mental health treatment of a lonely male veteran in a Veterans Affairs Medical Center, by paying attention to the 4 Ts of loneliness. We used a 4-step approach of validation, mentalization, reality testing, and socialization to decrease the sense of threat as we sought acceptance to the patient's territory, followed by building trust and working on past trauma.

Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis

Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP). Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics. Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented. Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.

Interpersonal processes in paranoia: a systematic review

Paranoid ideation is a core feature of psychosis, and models of paranoia have long proposed that it arises in the context of disturbances in the perception of the self. However, to develop targeted interventions, there is a benefit in clarifying further, which aspects of self-perception are implicated. Interpersonal sensitivity is a personality trait which has been associated with the risk of paranoid thinking in the general population. However, not all studies have found this link. We aimed to review the empirical literature assessing the association between interpersonal sensitivity and paranoia in both general population and clinical samples; and to explore if associations found differed depending on whether state or trait paranoia was assessed. The review followed PRISMA guidelines. Articles were identified through a literature search in OVID (PsychINFO, MEDLINE) and Web of Science up to December 2016. Fourteen studies with a total of 12 138 participants were included. All studies were of 'fair' or 'good' quality. A robust association was found between interpersonal sensitivity and paranoia in clinical and general population samples alike, regardless of the method of assessment of both paranoia and interpersonal sensitivity. Although this finding was more pronounced in studies of trait paranoia, it is likely that differences in study purpose, measurement, and power explain these differences. Findings from this review support the hypothesis that feelings of personal vulnerability and exaggerated socially evaluative concerns are central for both onset and maintenance of paranoid symptoms, suggesting avenues for future research in targeted interventions.

The effect of arousal and eye gaze direction on trust evaluations of stranger's faces: A potential pathway to paranoid thinking

BACKGROUND AND OBJECTIVES

When asked to evaluate faces of strangers, people with paranoia show a tendency to rate others as less trustworthy. The present study investigated the impact of arousal on this interpersonal bias, and whether this bias was specific to evaluations of trust or additionally affected other trait judgements. The study also examined the impact of eye gaze direction, as direct eye gaze has been shown to heighten arousal.

METHODS

In two experiments, non-clinical participants completed face rating tasks before and after either an arousal manipulation or control manipulation. Experiment one examined the effects of heightened arousal on judgements of trustworthiness. Experiment two examined the specificity of the bias, and the impact of gaze direction.

RESULTS

Experiment one indicated that the arousal manipulation led to lower trustworthiness ratings. Experiment two showed that heightened arousal reduced trust evaluations of trustworthy faces, particularly trustworthy faces with averted gaze. The control group rated trustworthy faces with direct gaze as more trustworthy post-manipulation. There was some evidence that attractiveness ratings were affected similarly to the trust judgements, whereas judgements of intelligence were not affected by higher arousal.

LIMITATIONS

In both studies, participants reported low levels of arousal even after the manipulation and the use of a non-clinical sample limits the generalisability to clinical samples.

CONCLUSIONS

There is a complex interplay between arousal, evaluations of trustworthiness and gaze direction. Heightened arousal influences judgements of trustworthiness, but within the context of face type and gaze direction.

Perceived neighbourhood affluence, mental health and wellbeing influence judgements of threat and trust on our streets: An urban walking study

This study aimed to understand how people respond to different urban neighbourhoods. We explored whether participants' mental health and wellbeing, judgements of resident wealth, family SES and sentiments reflected in descriptions of place features predicted in situ sense of threat and trust. Forty-six student participants walked in groups through 2 urban neighbourhoods, separated by a park, in the North West of England, noting responses at pre-determined stops. Significant differences existed in participants' sense of trust and threat between the 2 neighbourhoods along with differences in perceived resident wealth and sentiments expressed. Participants' levels of persecutory ideas and their sense of residents' wealth predicted in situ trust in both neighbourhoods while level of personal resilience predicted the extent of threat felt in the more deprived neighbourhood. Demonstrating the value of the method, these findings have implications for the governance of urban neighbourhoods whereby obvious cues signalling a harsh environment need to be minimised to create more positive psychological responses to places.

Experimentally induced social threat increases paranoid thinking

The ability to attribute intentions to others is a hallmark of human social cognition but is altered in paranoia. Paranoia is the most common positive symptom of psychosis but is also present to varying degrees in the general population. Epidemiological models suggest that psychosis risk is associated with low social rank and minority status, but the causal effects of status and group affiliation on paranoid thinking remain unclear. We examined whether relative social status and perceived group affiliation, respectively, affect live paranoid thinking using two large-N (N = 2030), pre-registered experiments. Interacting with someone from a higher social rank or a political out-group led to an increase in paranoid attributions of harmful intent for ambiguous actions. Pre-existing paranoia predicted a general increase in harmful intent attribution, but there was no interaction with either type of social threat: highly paranoid people showed the same magnitude of increase as non-paranoid people, although from a higher baseline. We conclude social threat in the form of low social status and out-group status affects paranoid attributions, but ongoing paranoia represents a lowered threshold for detecting social threat rather than an impaired reactivity to it.

Paranoia and anxiety: A cluster analysis in a non-clinical sample and the relationship with worry processes

BACKGROUND

Worry processes are implicated in paranoia and anxiety. However, clinical studies focused on patients with co-occurring paranoia and anxiety. As both paranoia and anxiety are distributed across clinical and non-clinical groups, an investigation on worry processes among non-clinical individuals will allow us to delineate the specific worry mechanisms in paranoia and anxiety respectively.

AIMS

To identify clusters of non-clinical individuals who report varied levels of paranoia and anxiety, and to compare worry processes across clusters.

METHOD

An online survey, consisting of self-report questionnaires on generalized anxiety, paranoia, and worry processes, was completed by 2796 undergraduate students. A multiple-step validity check procedure resulted in a subsample of 2291 students, upon which cluster analyses and multivariate analyses of variance were conducted.

RESULTS

Four clusters of individuals were identified: (1) high paranoia/moderate anxiety, (2) average paranoia/high anxiety, (3) average paranoia/average anxiety, and (4) low paranoia/low anxiety. A unique cluster of individuals with high paranoia but low/average level of anxiety was not found. Cluster 1 reported a significantly higher intensity of day-to-day worries, a higher level of meta-worry, and more extreme meta-cognitive beliefs about worry than other clusters.

CONCLUSIONS

Individuals with high paranoia tended to report anxiety as well, but not vice versa. Our findings supported a hierarchical structure of anxiety and paranoia. All worry processes were exacerbated in individuals with paranoia and anxiety than those with anxiety alone.

Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness

Over the last two decades, there has been a rapid increase of studies testing the efficacy and acceptability of virtual reality in the assessment and treatment of mental health problems. This systematic review was carried out to investigate the use of virtual reality in the assessment and the treatment of psychosis. Web of Science, PsychInfo, EMBASE, Scopus, ProQuest and PubMed databases were searched, resulting in the identification of 638 articles potentially eligible for inclusion; of these, 50 studies were included in the review. The main fields of research in virtual reality and psychosis are: safety and acceptability of the technology; neurocognitive evaluation; functional capacity and performance evaluation; assessment of paranoid ideation and auditory hallucinations; and interventions. The studies reviewed indicate that virtual reality offers a valuable method of assessing the presence of symptoms in ecologically valid environments, with the potential to facilitate learning new emotional and behavioural responses. Virtual reality is a promising method to be used in the assessment of neurocognitive deficits and the study of relevant clinical symptoms. Furthermore, preliminary findings suggest that it can be applied to the delivery of cognitive rehabilitation, social skills training interventions and virtual reality-assisted therapies for psychosis. The potential benefits for enhancing treatment are highlighted. Recommendations for future research include demonstrating generalisability to real-life settings, examining potential negative effects, larger sample sizes and long-term follow-up studies. The present review has been registered in the PROSPERO register: CDR 4201507776.

A Possible Link between Anxiety and Schizophrenia and a Possible Role of Anhedonia

In the prodromal phase of schizophrenia, severe alterations of the visual appearance of the environment have been found, accompanied by a state of intense anxiety. The present study considers the possibility that these alterations really exist in the appearance of objects, but that healthy people do not see them. The image of the world that we see is continuously deformed and fragmented by foreshortenings, partial overlapping, and so on and must be constantly reassembled and interpreted; otherwise, it could change so much that we would hardly recognize it. Since pleasure has been found to be involved in visual and cognitive information processing, the possibility is considered that anhedonia (the reduction of the ability to feel pleasure) might interfere with the correct reconstruction and interpretation of the image of the environment and alter its appearance. The possibility is also considered that these alterations might make the environment hostile, might at times evoke the sensation of being trapped by a predator, and might be the cause of the anxiety that accompanies them. According to some authors, they might also induce delusional ideas, in an attempt to restore meaning in a world that has become chaotic and frightening.

Sleep quality and paranoia: The role of alexithymia, negative emotions and perceptual anomalies

Recent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N = 401, study 2, N = 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia.

Psychological symptomatology and impaired prepulse inhibition of the startle reflex are associated with cannabis-induced psychosis

BACKGROUND

Cannabis-induced psychotic disorder (CIPD) is a psychiatric disorder induced by cannabis consumption. The psychological and psychophysiological features of this disorder are still unknown. We aimed to examine the psychological, personality and psychophysiological features of patients with CIPD. This study is an analytical extension of our previously published data, which previously found prepulse inhibition (PPI) deficits in the CIPD group used in this current paper.

METHODS

We used a sample of 45 patients with CIPD. After 9 months of follow up, these patients were assessed with a Symptom Checklist-90-R (SCL-90-R) questionnaire of psychopathology, with the Eysenck Personality Questionnaire, and with a psychophysiological paradigm of inhibition of the startle reflex (PPI). These results were compared with a group of patients with schizophrenia and cannabis abuse (SCHZ) ( n = 54); patients with cannabis dependence (CD) ( n = 21); and healthy controls ( n = 50).

RESULTS

CIPD patients obtained significant higher scores in the SCL-90-R subscale of neuroticism. These patients showed PPI percentages similar to SCHZ patients within early attentional levels (30 ms). The variables with greater correlation, and that appeared in the CIPD group were interpersonal sensitivity, depression and phobia.

CONCLUSIONS

Neurotic symptomatology and difficulties in inhibition of the startle reflex might be risk factors for developing CIPD.

[The concept of schizoidia in psychiatry : From schizoidia to schizotypy and cluster A personality disorders]

From a perspective of conceptual evolution schizoidia was initially considered to describe features both of the premorbid personality of schizophrenic patients and of the personalities of non-psychotic family members (Bleuler, Kahlbaum, Kraepelin). On a psychopatholocial level a close link to the complex basic symptom of autism was stressed. From the very beginnings of modern psychiatry schizoidia was discussed within a conceptual frame of schizophrenia spectrum disorders (Kretschmer, Hoch, Polatin). Approaches to operationalize these conceptual works laid the basis for the cluster A personalities in DSM-III. Due to the prominent concept of schizotypy (Kety, Rado, Meehl) three split up diagnostic categories of schizotypal, schizoid and paranoid personality disorders resulted. Cluster A personality disorders are frequent in community-based epidemiological studies. Health-care seeking behaviour due to primary personality-related problems, however, seems to be less paramount compared to cluster B and C personality disorders. Many family- and twin-based genetic studies convincingly stress a close link between schizotypal personality disorder and schizophrenia. This link is less pronounced for paranoid personality disorder, and even vanishingly low for schizoid personality disorder. From a perspective of schizophrenia spectrum disorders a vast amount of data from molecular genetic, neurobiological, neuropsychological and psychosocial research has impressingly confirmed this link for schizotypal personality disorder. Major research deficits, however, have to be noticed for paranoid and schizoid personality disorder.

Childhood trauma, psychosis liability and social stress reactivity: a virtual reality study

BACKGROUND

Childhood trauma is associated with higher risk for mental disorders, including psychosis. Heightened sensitivity to social stress may be a mechanism. This virtual reality study tested the effect of childhood trauma on level of paranoid ideations and distress in response to social stress, in interaction with psychosis liability and level of social stress exposure.

METHOD

Seventy-five individuals with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) and 95 individuals with lower psychosis liability (42 siblings and 53 controls) were exposed to a virtual café in five experiments with 0-3 social stressors (crowded, other ethnicity and hostility). Paranoid ideation was measured after each experiment. Subjective distress was self-rated before and after experiments. Multilevel random regression analyses were used to test main effects of childhood trauma and interaction effects.

RESULTS

Childhood trauma was more prevalent in individuals with higher psychosis liability, and was associated with higher level of (subclinical) psychotic and affective symptoms. Individuals with a history of childhood trauma responded with more subjective distress to virtual social stress exposures. The effects of childhood trauma on paranoia and subjective distress were significantly stronger when the number of virtual environmental stressors increased. Higher psychosis liability increased the effect of childhood trauma on peak subjective distress and stress reactivity during experiments.

CONCLUSIONS

Childhood trauma is associated with heightened social stress sensitivity and may contribute to psychotic and affective dysregulation later in life, through a sensitized paranoid and stress response to social stressors.

Paranoid Thoughts in Adolescents with Social Anxiety Disorder

Recently, social anxiety disorder (SAD) and paranoia have been demonstrated to be closely related. However, data were primarily drawn from adult community samples or patients with schizophrenia. The present study used a cross-sectional design to evaluate a sample of adolescents with SAD (n = 30, mean age 15.3 ± 0.9 years) compared with an age- and sex-matched group of healthy controls (n = 26, mean age 15.9 ± 1.6 years). The SAD group displayed more frequent and intense paranoid thoughts than the control group (t = 4.16, p < 0.001). The level of paranoid thoughts was significantly predicted by the degree of social phobia, even after adjusting for sex and other anxiety disorders, although adjusting for depression slightly reduced the extent and significance of the prediction. A lack of awareness about the association between SAD and paranoia may lead to incorrect diagnoses (e.g. misdiagnosis of psychotic disorders), or it may negatively influence the (psycho)therapeutic process and patient outcomes.

Measuring fluctuations in paranoia: Validity and psychometric properties of brief state versions of the Paranoia Checklist

Research increasingly assesses momentary changes in paranoia in order to elucidate causal mechanisms. Observed or manipulated changes in postulated causal factors should result in fluctuations in state paranoid ideation. Previous studies often employed a state-adapted Paranoia Checklist (Freeman et al., 2005) to measure state paranoia. This study examined whether the Paranoia Checklist or subsets of its items are appropriate for this purpose. Thirteen studies (N=860) were subjected to meta-analyses of each Paranoia Checklist item. We selected items based on (1) whether they showed pre-to-post change in the expected direction and (2) whether this effect was larger in experimental vs. control conditions. All resulting item selections were cross-validated on a hold-out sample (n=1893). Finally, we explored how much variation in paranoia was captured by the state-adapted version in a brief ambulatory assessment study (N=32). A thirteen item State Paranoia Checklist as well as a five item and a three item Brief State Paranoia Checklist were extracted. Cross validation revealed better model fit and increased sensitivity to change. Multilevel analysis indicated 25-30% of the variance in the Brief State Paranoia Checklists to be due to intra-individual daily fluctuations in paranoia. Our analyses produced reliable and valid revised scales. Increases in change sensitivity indicate that future assessment of state paranoia in experimental and ambulatory assessment studies can be optimized by using the revised scales.

Atypical Sensory Modulation and Psychological Distress in the General Population

OBJECTIVE

Atypical sensory modulation (ASM) is characterized by over- or underresponsiveness to sensory stimuli in one or more sensory systems. Faulty sensory information processing could result in anxiety. Because the relation between ASM and psychological distress has not been examined, we explored psychological distress and ASM in the general population.

METHOD

A community-based sample of 204 adults (105 men; mean age = 27.4 yr, standard deviation = 3.71) completed the Sensory Responsiveness Questionnaire--Intensity Scale (SRQ-IS; Bar-Shalita, Seltzer, Vatine, Yochman, & Parush, 2009); the Brief Symptom Inventory (BSI; Derogatis & Coons, 1993); and the Short Form--36 Health Survey, Version 2 (SF-36; Ware, Kosinski, & Gandek, 2005).

RESULTS

The ASM group displayed considerably more distress symptoms than the comparison group. Multivariate linear regression showed SRQ-IS and SF-36 scores as significant predictors of BSI score (r = .64).

CONCLUSION

ASM may be a risk factor for developing other mental health concerns.

Persecutory delusions: a cognitive perspective on understanding and treatment

A spectrum of severity of paranoia (unfounded thoughts that others are deliberately intending to cause harm) exists within the general population. This is unsurprising: deciding whether to trust or mistrust is a vital aspect of human cognition, but accurate judgment of others' intentions is challenging. The severest form of paranoia is persecutory delusions, when the ideas are held with strong conviction. This paper presents a distillation of a cognitive approach that is being translated into treatment for this major psychiatric problem. Persecutory delusions are viewed as threat beliefs, developed in the context of genetic and environmental risk, and maintained by several psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and the use of safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering feared situations after reduction of the influence of the maintenance factors. An exciting area of development will be a clinical intervention science of how best to enhance learning of safety to counteract paranoia.

Using virtual reality to investigate psychological processes and mechanisms associated with the onset and maintenance of psychosis: a systematic review

PURPOSE

In the last decade researchers have embraced virtual reality to explore the psychological processes and mechanisms that are involved in the onset and maintenance of psychosis. A systematic review was conducted to synthesise the evidence of using virtual reality to investigate these mechanisms.

METHODS

Web of Science, PsycINFO, Embase, and Medline were searched. Reference lists of collected papers were also visually inspected to locate any relevant cited journal articles. In total 6001 articles were potentially eligible for inclusion; of these, 16 studies were included in the review.

RESULTS

The review identified studies investigating the effect of interpersonal sensitivity, childhood bullying victimisation, physical assault, perceived ethnic discrimination, social defeat, population density and ethnic density on the real-time appraisal of VR social situations. Further studies demonstrated the potential of VR to investigate paranoid ideation, anomalous experiences, self-confidence, self-comparison, physiological activation and behavioural response.

CONCLUSIONS

The reviewed studies suggest that VR can be used to investigate psychological processes and mechanisms associated with psychosis. Implications for further experimental research, as well as for assessment and clinical practise are discussed. The present review has been registered in the PROSPERO register: CRD42016038085.

Paranoid thinking, cognitive bias and dangerous neighbourhoods: Implications for perception of threat and expectations of victimisation

BACKGROUND

Paranoid thinking is prevalent in the non-clinical population and cognitive mechanisms of heuristic reasoning and jumping to conclusions bias contributes to its formation and maintenance.

AIMS

This study investigated the degree to which paranoia, perceived environmental risk, heuristic reasoning and jumping to conclusions bias (measured with the beads task) contribute to misinterpretation of neutral stimuli, and whether this informed judgements regarding vulnerability to threat and crime. It is also investigated whether impulsiveness is a confounding factor on the beads task.

METHODS

Two hundred participants were recruited using a snowball-sampling method for a quantitative cross-sectional study. Participants reported demographic information, three psychometric questionnaires and two experimental tasks via an online paradigm hosted by the Bristol Online Survey tool.

RESULTS

Participants with high paranoia scores perceived their environment to be more dangerous than those with low scores. Participants with high paranoia scores also overestimated threat in neutral stimuli and had high expectations of future victimisation. Jumping to conclusions on the beads task did not predict fear of crime outcomes, but was predicted by impulsivity.

CONCLUSION

Participants who demonstrated paranoid thinking were more likely to reside in perceived dangerous neighbourhoods and overestimate threat. While this could indicate a paranoid heuristic, it is a potentially rational response to prior experiences of crime and victimisation. Implications and suggestions for future research are discussed.

Interpersonal sensitivity and functioning impairment in youth at ultra-high risk for psychosis

A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals.

'No man is an island'. Testing the specific role of social isolation in formal thought disorder

Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research.

Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients

BACKGROUND

Evidence suggests a relationship between exposure to trauma during childhood and functional impairments in psychotic patients. However, the impact of age at the time of exposure has been understudied in early psychosis (EP) patients.

METHOD

Two hundred and twenty-five patients aged 18-35 years were assessed at baseline and after 2, 6, 18, 24, 30 and 36 months of treatment. Patients exposed to sexual and/or physical abuse (SPA) were classified according to age at the time of first exposure (Early SPA: before age 11 years; Late SPA: between ages 12 and 15 years) and then compared to patients who were not exposed to such trauma (Non-SPA). The functional level in the premorbid phase was measured with the Premorbid Adjustment Scale (PAS) and with the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS) during follow-up.

RESULTS

There were 24.8% of patients with a documented history of SPA. Late SPA patients were more likely to be female (p = 0.010). Comparison with non-SPA patients revealed that: (1) both Early and Late SPA groups showed poorer premorbid social functioning during early adolescence, and (2) while patients with Early SPA had poorer functional level at follow-up with lower GAF (p = 0.025) and lower SOFAS (p = 0.048) scores, Late SPA patients did not.

CONCLUSION

Our results suggest a link between exposure to SPA and the later impairment of social functioning before the onset of the disease. EP patients exposed to SPA before age 12 may present long-lasting functional impairment, while patients exposed at a later age may improve in this regard and have a better functional outcome.

Evidence that environmental and genetic risks for psychotic disorder may operate by impacting on connections between core symptoms of perceptual alteration and delusional ideation

BACKGROUND

Relational models of psychopathology propose that symptoms are dynamically connected and hypothesize that genetic and environmental influences moderate the strength of these symptom connections. Previous findings suggest that the interplay between hallucinations and delusions may play a crucial role in the development of psychotic disorder. The current study examined whether the connection between hallucinations and delusions is impacted by proxy genetic and environmental risk factors.

METHODS

Hallucinations and delusions at baseline and at 3-year follow-up were assessed in a sample of 1054 healthy siblings and 918 parents of 1109 patients with psychosis, and in 589 healthy controls (no familial psychosis risk). Environmental factors assessed were cannabis use, childhood trauma, and urbanicity during childhood. Logistic regression analyses tested whether familial psychosis risk predicted increased risk of delusions, given presence of hallucinations. Moderating effects of environmental factors on the hallucination-delusion association were tested in a similar fashion, restricted to the control and sibling groups.

RESULTS

The risk of delusions, given hallucinations, was associated with proxy genetic risk: 53% in parents, 47% in siblings, and 36% in controls. The hallucination-delusion association was stronger in those reporting cannabis use (risk difference: 32%) and childhood trauma (risk difference: 15%) although not all associations were statistically conclusive (respectively: p = .037; p = .054). A directionally similar but nonsignificant effect was found for urb anicity during childhood (risk difference: 14%, p =.357).

CONCLUSION

The strength of the connection between delusions and hallucinations is associated with familial and environmental risks for psychotic disorder, suggesting that specific symptom connections in the early psychosis psychopathology network are informative of underlying mechanisms.