Self-attacking and self-reassurance in persecutory delusions: A comparison of healthy,depressed and paranoid individuals

Previous research has found that reduced self-reassurance and heightened verbal ‘self-attacking’ of a sadistic and persecutory nature are both associated with greater subclinical paranoia. Whether these processes are also linked to clinical paranoia remains unclear. To investigate this further, we asked 15 people with persecutory delusions, 15 people with depression and 19 non-psychiatric controls to complete several self-report questionnaires assessing their forms and functions of self-attacking. We found that people with persecutory delusions engaged in more self-attacking of a hateful nature and less self-reassurance than non-psychiatric controls, but not people with depression. Participants with persecutory delusions were also less likely than both healthy and depressed participants to report criticising themselves for self-corrective reasons. Hateful self-attacking, reduced self-reassurance and reduced self-corrective self-criticism may be involved in the development or maintenance of persecutory delusions. Limitations, clinical implications and directions for future research are discussed.     

Attributional style in delusional patients: a comparison of remitted paranoid, remitted nonparanoid, and current paranoid patients with nonpsychiatric controls

Many studies have found that people experiencing persecutory delusions have a marked tendency to use external-personal attributions when establishing the causes of negative events. Although nonclinical populations also tend to attribute negative events to external causes, those causes are typically believed to be universal in nature, rather than personal. The central goal of the present study was to investigate whether individuals with remitted persecutory delusions would display this external-personal bias regarding negative events, in comparison to remitted patients whose delusions were not paranoid in nature and to nonpsychiatric controls. Results indicate that currently paranoid patients were significantly more likely than all other groups, including the remitted paranoid group, to use external-personal attributions in negative events. Interestingly, all patient groups also were found to be significantly more likely than the controls to use internal-personal and internal-universal attributions when explaining negative events.     

Impaired theory of mind in first-episode schizophrenia: comparison with community, university and depressed controls

First order theory of mind, as measured by the 'Reading the Mind in the Eyes Test' Revised, is impaired in schizophrenia. However, no study has investigated whether this occurs in first-episode schizophrenia. Also, it is unclear whether such a deficit is specific to schizophrenia, and whether convenience control samples, particularly undergraduate university students, represent valid comparison groups. This study investigated theory of mind ability, measured by the 'Reading the Mind in the Eyes Test' Revised, in a group of first-episode schizophrenia outpatients (n=13) and three control groups: outpatients with non-psychotic major depression (n=14), individuals from the general community (n=16) and from an undergraduate university course (n=27). The schizophrenia group exhibited significant theory of mind impairments compared to both non-psychiatric control groups but not the depression group. Unexpectedly, the depression group was not significantly impaired compared to the community control group, and the university control group exhibited superior theory of mind ability relative to all three groups. The findings indicate theory of mind deficits in first episode schizophrenia and support the implementation of theory of mind interventions in first-episode schizophrenia treatment programs. Results also indicate that community rather than university control groups represent more valid comparison groups in first-episode schizophrenia research.     

Comparison of personality beliefs between depressed patients and healthy controls

Introduction

According to the cognitive model, the common mechanism underlying all psychological disorders is distorted or dysfunctional thoughts that affect mood and behaviors. Dysfunctional thoughts predispose an individual to depression and are among the processes that form the basis of personality traits. Elucidating the personality beliefs associated with depression and dysfunctional thoughts is important to understanding and treating depression. The aim of the present study is to determine whether depressed patients exhibited pathological personality beliefs compared with healthy controls. Furthermore, we investigated which personality beliefs were more common among such depressed patients.

Methods

A total of 70 patients who were admitted to the Department of Psychiatry at Ankara Diskapi Yildirim Beyazit Training and Research Hospital (Ankara, Turkey) and diagnosed with major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnostic criteria were included in the study. Additionally, 70 healthy controls matched for age, marital status, and education were included in the study. The Sociodemographic Data Form and Personality Belief Questionnaire-Short form (PBQ-SF) were administered to the participants.

Results

A comparison of the depression group with the healthy controls revealed higher scores in dependent, passive–aggressive, obsessive–compulsive, antisocial, histrionic, paranoid, borderline, and avoidant personality subscales in the depressive group.

Conclusions

These results suggest that personality beliefs at the pathological level are more common in depressive patients and that the detection of these beliefs would be useful for predicting the prognosis of the disease and determining appropriate treatment methods.     

Theory of mind in obsessive-compulsive disorder: Comparison with healthy controls

AimTheory of mind (ToM) is the ability to represent one's own or another's mental states and has been found to be impaired in many psychiatric disorders. Our objective was to compare ToM abilities of patients with obsessive-compulsive disorder (OCD) with healthy controls and to investigate the relation between some illness features, other cognitive functions and ToM abilities of patients.MethodThirty OCD patients and age, sex and education matched 30 healthy controls were compared according to their performances on ToM tasks (including first and second order false belief, hinting task and double-bluff task), verbal memory processes test, Weschler memory test (WMT) (logical memory, visual reproduction and digit span sub-tests), stroop test.ResultsPatients’ performances were worse than healthy controls on all of the ToM tasks, but the results were significant for only for double-bluff task (t = ?3.992, df = 36.157, p < 0.01). Performance on double-bluff task was significantly and positively correlated with visual reproduction-immediate recall (r = ?0.411, p < 0.05) and visual reproduction-delayed recall (r = 0.478, p < 0.05), hinting task was significantly and positively correlated with verbal memory (r = 0.481, p < 0.05).ConclusionThese results show “basic” ToM abilities of OCD patients are generally preserved, but they show significant reduction in their “advanced” ToM abilities, which seem to be related to their reduced memory capacities. The possible reasons for the relation between memory and ToM impairments, as well as the clinical significance of ToM deficits in OCD are discussed.     

Hypochondriacal delusions in paranoid psychoses. Course and outcome compared with other types of delusions

From a large series of patients with delusional psychoses, first-time admitted to the Psychiatric Department, University of Oslo, hypochondriacal delusions were coded as the main delusion in 15 patients (0.4% of all admissions). These patients have been personally followed up by one of the authors (N.R.) after 5-18 years, and by the other author (S.O.) after 23-39 years (mean 30 years). The results are presented, also according to the newer diagnostic systems (DSM-III, DSM-III-R), and the course and outcome of hypochondriacal delusions are compared with those of other types of delusions. Course and outcome are mainly dependent on the diagnostic category, not the type of delusion. It is also demonstrated that the course and outcome in major affective disorders are more favourable than in paranoid disorders, with the latter being significantly different from schizophrenia.     

Persecutory delusions and the self: An investigation of implicit and explicit self-esteem

Persecutory delusions are proposed to be a defence against low self-esteem reaching conscious awareness (Bentall, Corcoran, Howard, Blackwood, & Kinderman, 2001). Key predictions of this proposal are that individuals with persecutory delusions will have lower implicit self-esteem and equivalent levels of explicit self-esteem compared to healthy controls. This study aims to test the predictions regarding implicit and explicit self-esteem in people with persecutory delusions. Of 22 people screened for persecutory delusions, 16 were recruited to the study. 20 healthy control participants were recruited. The Implicit Association Test was used to measure implicit self-esteem and the Rosenberg self-esteem scale was used to assess explicit self-esteem. Positive and negative self and other schemas were also assessed using the Brief Core Schema Scales. People with persecutory delusions had positive implicit self-esteem, comparable to that of the control group. Explicit self-esteem was lower for the persecutory delusion group, but was associated with increased depression and anxiety. Negative self and other schemas were higher in the clinical group. The results do not support the contention that persecutory delusions defend against negative self-representations and low self-esteem reaching conscious awareness. Non-defensive cognitive models are discussed as an alternative way of understanding persecutory delusions.     

Perceived relationships with parents and paranoid delusions: comparisons of currently ill, remitted and normal participants

BACKGROUND: Paranoid delusions are associated with abnormal attributions and abnormal beliefs about the self. Some researchers have also reported an association between paranoid beliefs and abnormal attachment representations. SAMPLING AND METHODS: Perceptions of relationships with the family of origin were measured in 14 currently ill paranoid patients, 9 remitted paranoid patients and 15 healthy controls, using two methods: the Parental Bonding Instrument (PBI), and the Relationship with Family of Origin Scale (REFAMOS), an interview-based assessment. RESULTS AND CONCLUSIONS: On the PBI, both currently ill and remitted patients reported low parental care and overprotectiveness during childhood. Similar negative accounts of relationships with parents during the 16-20 years age period, and also at the time of assessment, were elicited from both the ill and remitted patients on the REFAMOS. These findings might reflect the influence of illness on patients' perceptions of their parents. However, the fact that the remitted patients did not differ from the currently ill patients raises the possibility that dysfunctional relationships are a common feature of the history of paranoid patients, perhaps contributing to the development of paranoid thinking.     

Sexuality in young patients with Parkinson's disease: a population based comparison with healthy controls

Answers from a multiple choice questionnaire on the opinions about public sexual attitudes, on emotion from personal sexual practice, on personal sexual function, and on general health perception were compared between 121 patients with Parkinson's disease (mean age 45 years) and 126 age and sex matched community derived controls. Patients were more dissatisfied with their present sexual functioning and relationship, and perceived their general health as poorer than the controls, whereas opinions about public sexual attitudes were only marginally different. No differences were found for sexual function. Further analysis showed that the perception of sexual functioning and general health in younger patients with Parkinson's disease is considerably influenced by depression and state of unemployment.     

Neurological soft signs in juvenile patients with Asperger syndrome, early-onset psychosis, and healthy controls

Aim: The study of neurological soft signs (NSS) in patients with Asperger syndrome may help us to elucidate the neurological basis of this disorder and to clarify its relationship with other neurodevelopmental disorders. The goal of this study was to compare the prevalence of NSS in a sample of patients with Asperger syndrome, early-onset psychosis and healthy controls. Method: NSS were assessed by means of the Neurological Evaluation Scale in a sample of 29 patients with Asperger syndrome (mean age = 12.86 ± 2.58 years), 30 patients with first-episode early-onset psychoses (mean age 14.17 ± 1.02 years) and 30 healthy controls (mean age 12.33 ± 2.69 years). Results: Significant group differences were found between Asperger syndrome patients and healthy controls both in all the Neurological Evaluation Scale subscales and in the Neurological Evaluation Scale total score. There were no significant differences between both groups of patients in any of the Neurological Evaluation Scale scores. Conclusions: NSS are more prevalent in Asperger syndrome than in healthy controls. The NSS profile was not disorder-specific in our samples of patients with Asperger syndrome and early-onset psychoses.     

Assessing illness representations of breast cancer: a comparison of patients with healthy and benign controls

OBJECTIVE: Illness representations of cancer may comprise inaccurate information, misconceptions, or negative conceptualizations of the disease, which may influence screening behaviors. This study examined the differences between healthy women's and breast cancer patients' representations of breast cancer. METHODS: The cross-sectional design involved 147 consecutive women free from breast diseases, or with benign breast conditions, and 102 patients with breast cancer recruited from the outpatient breast clinic of a public cancer hospital. Respondents completed a modified version of the Illness Perception Questionnaire (IPQ) that assessed six dimensions of illness representations of breast cancer. RESULTS: Multiple comparison tests revealed that nonmalignant women's illness representations were characterized by weak beliefs concerning breast cancer curability/controllability, combined with an overestimation of the negative physical, social, and economic consequences of breast cancer. Moreover, these women held stronger beliefs about the role of environmental factors (radiation exposure, diet, and pollution) in breast cancer causation and expressed greater disagreement on the role of chance in the onset and course of the illness. CONCLUSION: Illness representations of breast cancer appear to play a significant role in determining the unfavorable and exaggerated way in which laywomen perceive breast cancer. This is discussed within the framework of the social construction of the disease, which portrays breast cancer as a fatal and disfiguring disease, and the strong influence lay literature and the media exert on it.     

Asperger's syndrome: diagnosis, treatment, and outcome

Should Asperger's syndrome be distinguished as a separate clinical entity? Unfortunately, relatively little empiric information is available on this issue. The data suggest, however, that even compared to high-functioning autistic children of equivalent IQ, Asperger's syndrome children have better social and language skills. Anecdotal evidence also suggests that they have a different outcome, although this needs to be confirmed in proper, controlled follow-up studies. Although some differences in etiology between autism and Asperger's syndrome have been identified, these are of uncertain clinical significance. It may be that, for purposes of recognition and research, Asperger's syndrome should be considered a separate entity. This ensures that such children are identified for treatment and included in research protocols. This, in itself, would be of considerable benefit, even if it is acknowledged that Asperger's syndrome and autism probably represent different endpoints of a similar pathogenic mechanism. Asperger's syndrome represents a type of developmental disability that profoundly limits a child's participation in the process of growing up. After all, childhood is a time of play and of learning how to communicate with others. As clinicians, we need to understand these limitations and not put up artificial barriers to appropriate diagnostic and treatment services. It is hoped that the growing recognition of the predicament of these children will stimulate greater interest in research and treatment. Not only will children with Asperger's syndrome benefit from this, but, by extension, so will all children with developmental disabilities.     

Different aspects of theory of mind in paranoid schizophrenia: evidence from a video-based assessment

In schizophrenia, impairments of theory of mind (ToM) may be due to excessive ('overmentalizing') or defective ('undermentalizing') attribution of mental states. However, most ToM tests differentiate neither between 'overmentalizing' and 'undermentalizing' nor between cognitive and affective ToM in schizophrenia. This study aimed at differentiating these aspects of ToM in 80 patients diagnosed with paranoid schizophrenia and 80 matched healthy controls using the 'Movie for the Assessment of Social Cognition' (MASC). Outcome parameters comprised 1) error counts representing 'undermentalizing' or 'overmentalizing', 2) decoding of cognitive or emotional mental states and 3) non-social inferencing. Multivariate analysis of covariance (MANCOVA) showed significantly abnormal scores for two dimensions of 'undermentalizing' as well as for cognitive and emotional ToM that were not explained by global cognitive deficits. Scores for 'overmentalizing' did not differ between groups, when age, gender, non-social reasoning and memory were controlled. In schizophrenic patients, negative symptoms were associated with a lack of a mental state concept, while positive symptoms like delusions were associated with 'overmentalizing', supporting respective etiological concepts of delusions.     

Cytokine production and modulation: comparison of patients with chronic fatigue syndrome and normal controls

We studied cytokine production in 15 patients with chronic fatigue syndrome (CFS) and 23 controls. CFS patients' peripheral blood mononuclear cells were cultured with lipopolysaccharide or phytohemagglutinin. Enzymatic immunoassay indicated cytokine concentration in culture supernatants. CFS patients showed significantly lower mRNA levels and transforming growth factor-beta1 (TGF-beta1) production. Cytokine dysregulation affects CFS pathogenesis. TGF-beta1 may aid treatment because it affects CFS inflammatory characteristics.     

A comparison of attributions, health beliefs, and negative emotions as predictors of fluid adherence in renal dialysis patients: A prospective analysis

Excessive fluid intake in hemodialysis patients can lead to serious cardiovascular complications. However, previous studies have not investigated factors that affect fluid adherence over time. The influence of three sets of factors—attributions, health beliefs, and negative emotions—was examined to determine their influence on changes in fluid adherence over time. We assessed patient's fluid-intake changes across two time periods, as well as their absolute level. The results indicated that attributions, while predicting absolute fluid adherence, did not predict changes in fluid adherence. On the other hand, health beliefs predicted changes in fluid adherence but not absolute levels. Negative emotions predicted neither absolute nor changes in fluid adherence. It is suggested that attributions are more responsible for maintenance and control of stable fluid adherence levels, while health beliefs are more responsible for motivational factors related to changes in fluid adherence over time. We thank Marci Lobel, Alan Christensen, and reviewers for their thoughtful comments and Paul Whitaker for his help in this project.     

Fibrinolytic activity in Chinese patients with diabetes or hyperlipidemia in comparison with healthy controls

Plasma tissue-type plasminogen activator (tPA), plasminogen activator inhibitor (PAI) and euglobulin lysis time (ELT) were determined before and after the venous occlusion test (VOT) in 3 groups of patients with mean age about 60 years: 29 diabetic patients (D group), 8 hyperlipidemic patients (H group) and 19 healthy controls (C group). In the D and H groups, the mean of morning tPA was significantly higher than that of the C group, but the means of PAI were not significantly different among the 3 groups. ELT was significantly shortened and tPA was markedly increased after the VOT in all 3 groups whereas PAI had not significantly changed. In conclusion, high tPA activity and good fibrinolytic response without significant change of PAI activity were found in the diabetic and hyperlipidemic patients, and no definite impairment of the fibrinolytic activity could be found in the Chinese patients with diabetes and hyperlipidemia. This might be one of the reasons why the Chinese has low incidence of thromboembolic diseases.