The lonely road to paranoia. A path-analytic investigation of loneliness and paranoia

Loneliness and paranoia are related, but the mechanisms that link them to each other remain unclear. Systematic reviews on loneliness propose a social–cognitive model in which loneliness leads to negative evaluations of other persons and a lack of interpersonal trust. However, the data discussed in these reviews are based on healthy individuals. Building on this model, the present study investigated 1) whether negative interpersonal schemata mediate the association between loneliness and paranoia and 2) whether a low level of perceived social support and less frequent social contact are related to loneliness.Using a cross-sectional design, sixty-five participants with a diagnosis of schizophrenia were recruited online and completed questionnaire-based measures of loneliness, paranoia, negative interpersonal schemata, perceived social support and frequency of social contact. Data were analyzed taking a path-analytic approach.The association between loneliness and paranoia was significantly and fully mediated by negative schemata of others. Moreover, a low level of perceived social support was significantly associated with loneliness, whereas self-reported frequency of social contact was not. The present results highlight the potential role of interpersonal negative schemata in the formation and maintenance of paranoia and elucidate the crucial role of loneliness in the way individuals construe themselves within a social environment.     

Facial emotion perception differs in young persons at genetic and clinical high-risk for psychosis

A large body of literature has documented facial emotion perception impairments in schizophrenia. More recently, emotion perception has been investigated in persons at genetic and clinical high-risk for psychosis. This study compared emotion perception abilities in groups of young persons with schizophrenia, clinical high-risk, genetic risk and healthy controls. Groups, ages 13–25, included 24 persons at clinical high-risk, 52 first-degree relatives at genetic risk, 91 persons with schizophrenia and 90 low risk persons who completed computerized testing of emotion recognition and differentiation. Groups differed by overall emotion recognition abilities and recognition of happy, sad, anger and fear expressions. Pairwise comparisons revealed comparable impairments in recognition of happy, angry, and fearful expressions for persons at clinical high-risk and schizophrenia, while genetic risk participants were less impaired, showing reduced recognition of fearful expressions. Groups also differed for differentiation of happy and sad expressions, but differences were mainly between schizophrenia and control groups. Emotion perception impairments are observable in young persons at-risk for psychosis. Preliminary results with clinical high-risk participants, when considered along findings in genetic risk relatives, suggest social cognition abilities to reflect pathophysiological processes involved in risk of schizophrenia.     

Theory of mind, neurocognition, and functional status in schizotypy

The present study is the first to concurrently examine social cognition, neurocognition, and social functioning in psychometric schizotypes. Screening of 2108 undergraduates with the Schizotypal Personality Questionnaire-Brief (SPQ-B) identified 52 persons high in schizotypy and 40 persons low in schizotypy. All participants were administered a test battery designed to assess two elements of neurocognition, verbal secondary memory (California Verbal Learning Test) and executive functioning (Wisconsin Card Sorting Test), two elements of social cognition, emotion perception (The Awareness of Social Inference Test-Part 1) and theory of mind (The Awareness of Social Inference Test-Parts 2 and 3), and social functioning (Social Adjustment Scale-Self Report). Although the persons with high schizotypy were impaired in social functioning relative to the persons with low schizotypy, they were not impaired in theory of mind, emotion perception, verbal secondary memory, or executive functioning. Theory of mind and verbal secondary memory were correlated in persons with high schizotypy. The present findings suggest that psychometric schizotypes are not impaired in the domains of social cognition and neurocognition examined.     

Gender in Voice Perception in Autism

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.     

Psychiatric heterogeneity in antisocial alcoholics: relation to familial alcoholism.

There is some indication that addicts who qualify for a diagnosis of antisocial personality disorder (ASP) do not comprise a homogeneous group with respect to psychopathology. This preliminary study attempted to determine the extent to which DSM-III diagnosed ASP alcoholics with alcoholism on both sides of their family could be differentiated with respect to childhood behavioral problems and additional adult psychopathology from ASP alcoholics with low degrees of familial alcoholism. Two groups of ASP alcoholic patients were compared: (1) 11 high familial (bilineal) alcoholics, and (2) 22 low familial (nonfamilial or unilineal) alcoholics. Few group differences were found in sociodemographic or alcohol-related characteristics, although the high familial group tended to be younger. However, the high familial alcoholism group tended to report more childhood antisocial behaviors and more childhood behavior problems overall. The high familial alcoholism group also reported more psychopathology on three of the 10 Minnesota Multiphasic Personality Inventory (MMPI) clinical scales, paranoia (P less than .05), schizophrenia (P less than .06), and masculine-feminine (P less than .025). Effect sizes for these three variables were in the moderate range. The group MMPI profile of the high familial alcoholism group was indicative of serious characterological disturbances, while that of the low familial alcoholism group was much more normal. The results of this preliminary study provided evidence suggesting that antisocial individuals with a high degree of familial alcoholism are more likely to manifest psychopathology than antisocial individuals with a lesser degree of familial alcoholism.     

Reported visual imagery and apparent motion: an event-related potential study

A previous behavioral study showed that a group of individuals with high vividness of visual imagery (High group), as determined from the score for the Vividness of Visual Imagery Questionnaire (VVIQ), could perceive the apparent motion path more strongly than a group of individuals with low vividness of visual imagery (Low group). To examine the physiological differences underlying these differences in perception, we compared the brain activity during an apparent motion task for the High and the Low groups using electroencephalography. We initially screened 60 potential participants using the VVIQ. On the basis of their scores, we invited 20 people from the lower and the higher ends of the VVIQ distribution to participate in our event-related potential study. Our results showed that individuals in both the High and the Low groups were sensitive to the apparent motion content of the task. Perception of apparent motion evoked a negative potential starting around 90 ms, followed by a positive potential beginning at 150-170 ms after the second stimulus. The scalp distributions of both negative and positive potentials for the High group were broader than those for the Low group. Moreover, the onset of positivity in the High group (150 ms) was earlier than that in the Low group (170 ms). We believe that these results may be mechanistically associated with the differences in the perception of apparent motion between individuals with high and low vividness of visual imagery.     

Late-life paranoia: Possible association with early trauma and infertility

We have collected data on 39 persons with late-life onset of paranoid symptoms, all but two of whom are women. We identified a subset of nine patients that met the criteria for delusional disorder. This group differed significantly from both demented and long-term schizophrenic patients on a number of variables. There was only one live birth among these nine women; more than half were refugees or holocaust survivors; there was an absence of a predicted sensory loss; and the manifestation of the paranoia was qualitatively different. Several issues are discussed: there is a late-life delusional state that is neither schizophrenia nor dementia; the paranoia in these delusionally disordered patients cannot be accounted for exclusively by the social isolation hypothesis; there is an interaction among early trauma, the absence of children, and the appearance of paranoid ideation late in life.     

Comparison of the personality and other psychological factors of students with internet addiction who do and do not have associated social dysfunction

Background

There is ongoing controversy about whether or not internet addiction should be considered a non-substance behavioral addiction (like gambling disorder) and, if so, what diagnostic criteria should be used to define the condition. Current criteria for internet addiction give equal diagnostic weight to the physiological symptoms and the social consequences of internet addiction.

Aim

Assess the psychological correlates of social dysfunction among individuals with internet addiction.

Methods

A total of 133 students who sought treatment at the Guangji Psychiatric Hospital from July 2011 to December 2013 for psychological problems related to excessive internet use and who currently met Young criteria for internet addiction were identified; 31 of the 38 students who meet rigorous criteria for concurrent internet-related social dysfunction and a random sample of 44 of the 95 students without concurrent social dysfunction completed a battery of psychosocial measures: seven supplementary scales of the Minnesota Multiphasic Personality Inventory (MMPI), the Egna Minnen av Barndoms Uppfostran perceived parenting scale, the Perceived Social Support Scale, the Trait Coping Style Questionnaire, and the Symptom Checklist 90.

Results

Compared to persons with internet addiction without accompanying social dysfunction, those with social dysfunction had higher levels of interpersonal sensitivity, hostility, and paranoia; lower levels of social responsibility, anxiety, self-control, and family social support; and they were more likely to employ negative coping strategies. There were however, no differences in perceived parenting styles between the two groups.

Conclusions

A relatively small proportion of individuals who meet the physiological markers of internet addiction simultaneously report significant internet-related social dysfunction. There are several psychosocial measures that distinguish persons with internet addiction who do or do not have concurrent social dysfunction. Further research is needed to determine whether or not these are two distinct subtypes of internet addiction and whether or not persons with internet addiction without concurrent social dysfunction should be classified as suffering from a ‘mental disorder’.     

Public knowledge, beliefs and attitudes towards patients with schizophrenia: Buenos Aires

Objective

The purpose of our study was to assess the knowledge, social distance and perception of social discrimination towards persons with schizophrenia in the general adult population of Buenos Aires, Argentina.

Methods

One thousand two-hundred fifty-four persons were surveyed at different neighborhoods of the city of Buenos Aires. Their knowledge about schizophrenia, personal social distance and perception of social discrimination were assessed with several questions. Afterwards, a scale for each one of these measures was built.

Results

Almost half of the general population believed that patients with schizophrenia suffer from split personality and that most of them are dangerous and violent. Knowledge about schizophrenia in the general population was moderate and it was associated with age and education. Almost 80% of the population had less than one-third of the maximum possible social distance score, but their perception of social discrimination was high. Social distance was greater in the elderly. Knowledge was correlated weakly with social distance. Respondents directly related with patients suffering from schizophrenia were more knowledgeable about the illness, but had the same social distance and perception of social discrimination than the rest of the general population.

Conclusions

The persons surveyed felt their own attitudes are more favorable to people with schizophrenia than ??most other people??s?? attitudes. The elderly should be specifically addressed in specially designed anti-stigma campaigns.     

Life stress and social support in diabetes: association with glycemic control

The interrelationship of life stress, social support, and glucose regulation was studied in eighty patients with diabetes mellitus (insulin-dependent = 40, non-insulin-dependent = 40). Glucose control was measured using glycosylated hemoglobin (HbA1); stress and social support were determined by the Social Readjustment Rating Scale and a Visual Analog Scale of social support. A two-way analysis of variance [social support (high/low) by life stress (high/low)] revealed that neither social support nor life stress was independently associated with HbA1. However, a significant interaction between these parameters was found. When reported stress was low, the HbA1 means were not statistically different for both high and low social support groups. As stress increased, variations in social support were associated with differences in glucose control. Under conditions of high stress, low social support subjects had significantly higher HbA1 than subjects with high social support (mean = 11.8% vs. mean = 9.9%, p = .04). These data suggest that during stressful times social support may insulate patients with diabetes from the adverse physiologic and behavioral consequences of stress and thereby foster better glucose control.     

A Population Based Analysis of Subclinical Psychosis and Help-Seeking Behavior

Clinically defined psychosis is recognizable and distinguishable from nonclinical or subclinical psychosis by virtue of its clinical relevance (ie, its associated distress and its need for care and/or treatment). According to the continuum hypothesis, subclinical psychosis is merely quantitatively different from more extreme phenotypic expressions and as such should also be indicative of distress and help-seeking behavior but to a lesser extent. Using data from the Adult Psychiatric Morbidity Survey, the current study focused on self-reported psychosis and help-seeking experiences in a general population sample free from clinically defined psychosis (N = 7266). After statistically controlling for the effects of a series of potential help-seeking correlates the findings showed that subclinical psychosis symptom experience was significantly associated with various forms of help-seeking behavior. Individuals who reported subclinical experiences of thought control, paranoia, and strange experiences were on average 2 times more likely to attend their general practitioner for emotional problems compared with those individuals who reported no psychosis. Individuals who reported subclinical experiences of paranoia were 3 times more likely to be in receipt of counseling/therapy compared with those with no experience of paranoia. Multiple subclinical psychotic experiences also predicted elevated help-seeking behavior. These findings may have a positive impact on the detection of individuals who are at increased risk of psychological distress and aid in the design and implementation of more effective treatments at both clinical and subclinical levels.     

Differentiating social phobia from shyness

To clarify the relationship between social phobia and shyness, this study examined the characteristics of highly shy persons with social phobia, highly shy persons without social phobia, and non-shy persons. Those with social phobia reported more symptomatology, more functional impairment, and a lower quality of life than those without social phobia. About one-third of the highly shy without social phobia reported no social fears, highlighting heterogeneity of the shy. The social phobia group reported similar levels of anxiety as the shy without social phobia during analogue conversation tasks, but they reported more anxiety during a speech task. The social phobia group performed less effectively across tasks than those without social phobia. All groups’ perceptions of anxiety and effectiveness during behavioral tasks were consistent with ratings of independent observers. None of the groups differed on psychophysiological measures. Results are discussed in the context of theoretical models of social phobia.     

Accuracy of self-reported premorbid functioning in schizophrenia

BACKGROUND: Information on premorbid functioning is often based on patients recalling their past. Premorbid functioning is relevant as it is associated with treatment response and other outcomes. The extent to which memory impairments of persons with schizophrenia may bias such reporting has not been investigated. The purpose of the current study was to assess the extent to which persons with schizophrenia might exhibit biased reporting relative to controls. METHODS: Seventy males with schizophrenia or schizoaffective disorder and 51 males with no psychiatric symptoms participated in the study. Contemporaneous and retrospective reports from a behavioral functioning assessment conducted as part of the Israeli Draft Board were compared. This assessment routinely administered to all 17 years old males in the country assesses social functioning, individual autonomy, organizational ability, physical activity and functioning in structured environments. We compared the groups on the Draft Board behavioral measures at age 17 and at re-assessment. We also examined the relationship between symptom severity, neuropsychological performance and differences between age 17 and current behavioral assessment scores. RESULTS: In a repeated measures MANCOVA of the five measures there was no overall significant difference in accuracy of reporting between persons with schizophrenia and those without. Both groups showed a slight tendency to glorify their past. Consistency of reporting was not significantly correlated with neuropsychological performance or levels of psychotic symptoms. CONCLUSIONS: We found that when reporting on personal and social functioning during teen age years persons with schizophrenia report with the same level of consistency as persons without schizophrenia. This suggests that self-report of premorbid functioning of persons with schizophrenia can be trusted as being reasonably accurate.     

The impact of social stress on self-esteem and paranoid ideation

BACKGROUND: Vulnerability-stress models propose that social stress triggers psychotic episodes in high risk individuals. Previous studies found not only stress but also a decrease in self-esteem to precede the formation of delusions. As evidence for causal conclusions has not been provided yet, the present study assessed the direct impact of social stress on paranoid beliefs using an experimental design and considered a decrease in self-esteem as a mediator and the proneness to psychosis and paranoia as moderators of the effect. METHODS: A nonclinical population sample (n?=?76) was randomly assigned to an experimental (EG) or a control group condition (CG). In the EG, participants were excluded during a virtual ball game (Cyberball) by the other two players and received a negative feedback after performing a test. The CG was included in the game and received a neutral feedback. Before and after the experimental conditions, emotions, self-esteem and paranoid beliefs were assessed using state-adapted questionnaires. RESULTS: After the social stress induction, the EG reported a higher increase in subclinical paranoid beliefs compared to the CG. The impact of social stress on paranoid ideation was mediated by a decrease in self-esteem and moderated by proneness to paranoia. Individuals who felt distressed by paranoid thoughts at baseline were more likely to react with an increase in paranoid ideation under social stress. LIMITATIONS: The results need to be confirmed in a patient sample to draw conclusions about the processes involved in the formation of delusions in clinically relevant stages. CONCLUSIONS: The impact of social stress on symptom formation and self-esteem is discussed in terms of recent models of symptom formation and interventions in psychosis.     

Assessing Alzheimer's disease patients with the Cohen-Mansfield Agitation Inventory: scoring and clinical implications.

We explored the applicability of the standard scoring of the Cohen-Mansfield Agitation Inventory (CMAI), a widely used nursing-home derived instrument, to community-dwelling persons with Alzheimer's disease (AD). Item responses to the CMAI were gathered from participants in two large clinical studies, one of which specifically included patients with behavioral disturbances. Confirmatory factor analysis in these two groups of well-characterized AD patients suggested that conventional CMAI subscoring did not adequately describe the responses of these two groups. Exploratory factor analysis indicated that the four CMAI subscores, based on a verbal-physical and aggressive-non-aggressive conceptualization of behavioral disturbance, did not fit community dwelling persons with AD. Based on cross-sectional and longitudinal analyses, there was suggestive evidence for three behavioral clusters, but these clusters did not achieve statistical significance Overall, the CMAI seemed best suited to describe the overall level rather than the specific subtypes of behavioral dyscontrol in community-dwelling persons with AD.     

Interictal personality and behavioral traits in temporal lobe and generalized epilepsy

Fourteen patients with temporal lobe epilepsy (TLE) and 14 patients with primary generalized epilepsy (GE) were compared on a self-report questionnaire (Personal Inventory) which assesses 18 personality and behavioral traits hypothesized to characterize persons with TLE. Four traits (sense of personal destiny, dependence, paranoia, philosophical interest) were significantly elevated in the TLE group, thus lending some support to the notion of changes in behavior and thought which occur in TLE but not necessarily in other forms of epilepsy.     

Different perception of cognitive impairment, behavioral disturbances, and functional disabilities between persons with mild cognitive impairment and mild Alzheimer's disease and their caregivers

Insight in dementia is a multifaceted concept and ability, which includes the persons' perception of their behavioral and cognitive symptoms and functional disability. This ability seems to deteriorate as dementia progresses. The aim of this study was to evaluate the level of insight in the cognitive, behavioral, and functional disorders in a group of persons with mild cognitive impairment (MCI) or mild AD (Alzheimer's disease) and to compare their perception of their illness with that of their caregivers. The study involved a group of 121 persons with MCI and mild AD and their caregivers. The persons with MCI and mild AD were administered the tests Mini-Mental State Examination, Instrumental Activities of Daily Living, Activities of Daily Living, Neuropsychiatric Inventory, Schedule for the Assessment of Insight, Clinical Insight Rating Scale, and a short interview. Major differences were identified between how the persons with MCI or mild AD and their caregivers perceived the persons' cognitive and behavioral disorders. The group with MCI or mild AD underestimated their deficits, which were considered serious and disabling by their caregivers.     

Social skills deficits in schizotypal personality disorder

Evidence of long-standing social difficulties has been well documented in persons with schizophrenia. These deficits are often so rudimentary that a person with schizophrenia may never have developed the skills necessary to present as socially competent. Given the cognitive, biological, and neuroanatomical links between schizophrenia and schizotypal personality disorder (SPD), a study of social skills in persons with SPD may reveal a behavioral link. This study examined persons with SPD and their ability to label emotions in a recognition task, to display socially competent behaviors in a social role-play task, and to select appropriate behaviors from a multiple choice measure of social behavior. Results indicated that the performance of persons with SPD was similar to previously published findings in persons with schizophrenia. In terms of emotion recognition, the SPD group's ability to label positive emotions was significantly worse than their ability to label other emotions. Persons with SPD performed significantly worse than matched control participants on a social role-play task. However, the groups were equivalent in their ability to select socially appropriate behavior from a multiple choice measure. These results suggest that persons with SPD display social skills which mirror those previously reported in persons with schizophrenia.     

The role of cognition and adaptive behavior in employment of people with mental retardation

Few studies have specifically investigated the cognitive correlates of employment for persons with mental retardation. To evaluate the relationship of cognitive and adaptive functioning to work status, 56 competitively employed and 55 unemployed individuals with mental retardation underwent a comprehensive neuropsychological and adaptive behavioral evaluation. Results of multivariate analysis of covariance (MANCOVA) revealed significant group differences in cognitive and adaptive behavioral domains controlling for gender and severity of mental retardation. Follow-up ANCOVAs showed that the employed group performed significantly better than the unemployed group on measures of attention, memory, verbal comprehension, visual perception, and adaptive behavior. Using discriminant function analysis, 73.2 percent of the employed and 76.4 percent of the unemployed people were predicted correctly. These results suggest that adaptive behavior and specific aspects of cognitive functioning are significant predictors of successful employment for persons with mental retardation.     

Ictal fear in temporal lobe epilepsy: Association with interictal behavioral changes

We studied 40 patients with temporal lobe epilepsy to determine if ictal fear was associated with changes in cognition, personality, or psychopathology. Patients with ictal fear scored higher (p < 0.10) than those without ictal fear on the Minnesota Multiphasic Personality Inventory (MMPI) Social Introversion and Psychasthenia subscales, MMPI-derived scales including depression, poor morale, and delinquency and on the Spielberger Trait Anxiety Scale. These differences were not even marginally significant with Bonferoni correction for multiple comparisons. No differences were found between these groups in the Temporal Lobe (Bear-Fedio) Questionnaire, Buss-Durkey Hostility Inventory, or history of psychiatric hospitalization. However, a history of paranoid psychosis and anxiety disorder, as well as current treatment with a neuroleptic medication, were more common in patients with ictal fear. This study provides limited support for the thesis that ictal fear is associated with behavioral changes in epilepsy, particularly symptoms of anxiety, introversion, and paranoia.