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The British Journal of Clinical... Mar 2020Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment...
OBJECTIVES
Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality.
METHOD
We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre-registered the review protocol and followed PRISMA guidelines.
RESULTS
Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia.
CONCLUSIONS
The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia.
PRACTITIONER POINTS
There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
Topics: Female; Humans; Male; Object Attachment; Paranoid Disorders; Psychotic Disorders
PubMed: 31390076
DOI: 10.1111/bjc.12231 -
European Psychiatry : the Journal of... Jan 2019Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional...
BACKGROUND
Even if neurocognition is known to affect functional outcomes in schizophrenia, no previous study has explored the impact of cognition on functionality in delusional disorder (DD). We aimed to assess the effect of clinical characteristics, symptom dimensions and neuropsychological performance on psychosocial functioning and self-perceived functional impairment in DD.
METHODS
Seventy-five patients with a SCID-I confirmed diagnosis of DD underwent neurocognitive testing using a neuropsychological battery examining verbal memory, attention, working memory and executive functions. We assessed psychotic symptoms with the Positive and Negative Syndrome Scale, and calculated factor scores for four clinical dimensions: Paranoid, Cognitive, Affective and Schizoid. We conducted hierarchical linear regression models to identify predictors of psychosocial functioning, as measured with the Global Assessment of Functioning scale, and self-perceived functional impairment, as measured with the Sheehan's Disability Inventory.
RESULTS
In the final linear regression models, higher scores in the Paranoid (β= 0.471, p < .001, r = 0.273) and Cognitive (β = 0.325, p < .001, r = 0.180) symptomatic dimensions and lower scores in verbal memory (β = -0.273, p < .05, r = 0.075) were significantly associated with poorer psychosocial functioning in patients with DD. Lower scores in verbal memory (β= -0.337, p < .01, r = 0.158) and executive functions (β= -0.323, p < .01, r = 0.094) were significantly associated with higher self-perceived disability.
CONCLUSIONS
Impaired verbal memory and cognitive symptoms seem to affect functionality in DD, above and beyond the severity of the paranoid idea. This suggests a potential role for cognitive interventions in the management of DD.
Topics: Adult; Attention; Cognition; Cognitive Behavioral Therapy; Disability Evaluation; Executive Function; Female; Humans; Male; Memory; Middle Aged; Neuropsychological Tests; Paranoid Disorders; Psychotic Disorders; Schizophrenia, Paranoid; Self-Assessment; Social Skills
PubMed: 30388425
DOI: 10.1016/j.eurpsy.2018.09.010 -
Schizophrenia Bulletin Jun 2018
Topics: Adult; Female; Humans; Psychotic Disorders; Schizophrenia, Paranoid
PubMed: 29878273
DOI: 10.1093/schbul/sbx046 -
Psychological Medicine Sep 2023Psychotic experiences and negative symptoms (PENS) are common in non-clinical populations. PENS are associated with adverse outcomes, particularly when they persist....
Psychotic experiences and negative symptoms from adolescence to emerging adulthood: developmental trajectories and associations with polygenic scores and childhood characteristics.
BACKGROUND
Psychotic experiences and negative symptoms (PENS) are common in non-clinical populations. PENS are associated with adverse outcomes, particularly when they persist. Little is known about the trajectories of PENS dimensions in young people, nor about the precursory factors associated with these trajectories.
METHODS
We conducted growth mixture modelling of paranoia, hallucinations, and negative symptoms across ages 16, 17, and 22 in a community sample ( 12 049-12 652). We then described the emergent trajectory classes through their associations with genome-wide polygenic scores (GPS) for psychiatric and educational phenotypes, and earlier childhood characteristics.
RESULTS
Three trajectory classes emerged for paranoia, two for hallucinations, and two for negative symptoms. Across PENS, GPS for clinical help-seeking, major depressive disorder, and attention deficit hyperactivity disorder were associated with increased odds of being in the most elevated trajectory class (OR 1.07-1.23). Lower education GPS was associated with the most elevated trajectory class for hallucinations and negative symptoms (OR 0.77-0.91). Conversely for paranoia, higher education GPS was associated with the most elevated trajectory class (OR 1.25). Trajectory class associations were not significant for schizophrenia, obsessive-compulsive disorder, bipolar disorder, or anorexia GPS. Emotional/behaviour problems and life events in childhood were associated with increased odds of being in the most elevated trajectory class across PENS.
CONCLUSIONS
Our results suggest latent heterogeneity in the development of paranoia, hallucinations, and negative symptoms in young people that is associated with specific polygenic scores and childhood characteristics.
Topics: Humans; Adolescent; Adult; Depressive Disorder, Major; Psychotic Disorders; Schizophrenia; Bipolar Disorder; Hallucinations; Longitudinal Studies
PubMed: 36189779
DOI: 10.1017/S0033291722002914 -
JMIR Human Factors Dec 2023Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a...
BACKGROUND
Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP ("Successful Treatment of Paranoia").
OBJECTIVE
This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype.
METHODS
We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts.
RESULTS
All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ≥1; control items: ≤1, readability: ≥3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users' ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful.
CONCLUSIONS
Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users.
Topics: Humans; Paranoid Disorders; User-Centered Design; User-Computer Interface; Telemedicine; Mobile Applications
PubMed: 38064256
DOI: 10.2196/45453 -
The Journal of Nervous and Mental... Sep 2022Individuals belonging to ethnic minority groups are less likely to experience symptoms of psychosis, such as paranoia, if they live in areas with high proportions of...
Individuals belonging to ethnic minority groups are less likely to experience symptoms of psychosis, such as paranoia, if they live in areas with high proportions of people from the same ethnic background. This effect may be due to processes associated with group belonging (social identification). We examined whether the relationship between perceived discrimination and paranoia was moderated by explicit and implicit Pakistani/English identification among students of Pakistani heritage (N = 119). Participants completed measures of explicit and implicit Pakistani and English identity, a measure of perceived discrimination, and a measure of paranoia. Perceived discrimination was the strongest predictor of paranoia (0.31). Implicit identities moderated the relationship between perceived discrimination and paranoia (-0.17). The findings suggest that higher levels of implicit Pakistani identity were most protective against high levels of paranoia (0.26, with low implicit English identity; 0.78, with medium English identity; 1.46, with high English identity). Overall, a complex relationship between identity and paranoia was apparent.
Topics: Ethnicity; Humans; Minority Groups; Pakistan; Paranoid Disorders; Perceived Discrimination; Students
PubMed: 36037323
DOI: 10.1097/NMD.0000000000001520 -
American Journal of Medical Genetics.... Jun 2018This study aimed to test for overlap in genetic influences between psychotic-like experience traits shown by adolescents in the community, and clinically-recognized...
This study aimed to test for overlap in genetic influences between psychotic-like experience traits shown by adolescents in the community, and clinically-recognized psychiatric disorders in adulthood, specifically schizophrenia, bipolar disorder, and major depression. The full spectra of psychotic-like experience domains, both in terms of their severity and type (positive, cognitive, and negative), were assessed using self- and parent-ratings in three European community samples aged 15-19 years (Final N incl. siblings = 6,297-10,098). A mega-genome-wide association study (mega-GWAS) for each psychotic-like experience domain was performed. Single nucleotide polymorphism (SNP)-heritability of each psychotic-like experience domain was estimated using genomic-relatedness-based restricted maximum-likelihood (GREML) and linkage disequilibrium- (LD-) score regression. Genetic overlap between specific psychotic-like experience domains and schizophrenia, bipolar disorder, and major depression was assessed using polygenic risk score (PRS) and LD-score regression. GREML returned SNP-heritability estimates of 3-9% for psychotic-like experience trait domains, with higher estimates for less skewed traits (Anhedonia, Cognitive Disorganization) than for more skewed traits (Paranoia and Hallucinations, Parent-rated Negative Symptoms). Mega-GWAS analysis identified one genome-wide significant association for Anhedonia within IDO2 but which did not replicate in an independent sample. PRS analysis revealed that the schizophrenia PRS significantly predicted all adolescent psychotic-like experience trait domains (Paranoia and Hallucinations only in non-zero scorers). The major depression PRS significantly predicted Anhedonia and Parent-rated Negative Symptoms in adolescence. Psychotic-like experiences during adolescence in the community show additive genetic effects and partly share genetic influences with clinically-recognized psychiatric disorders, specifically schizophrenia and major depression.
Topics: Adolescent; Anhedonia; Bipolar Disorder; Depressive Disorder, Major; Female; Genetic Predisposition to Disease; Genetic Testing; Genome-Wide Association Study; Hallucinations; Humans; Linkage Disequilibrium; Male; Multifactorial Inheritance; Paranoid Disorders; Polymorphism, Single Nucleotide; Psychotic Disorders; Risk Factors; Schizophrenia; White People; Young Adult
PubMed: 29603866
DOI: 10.1002/ajmg.b.32630 -
Noise & Health 2016Environmental noise causes cognitive impairment, particularly in executive function and episodic memory domains, in healthy populations. However, the possible moderating...
Environmental noise causes cognitive impairment, particularly in executive function and episodic memory domains, in healthy populations. However, the possible moderating influences on this relationship are less clear. This study assessed 54 healthy participants (24 men) on a cognitive battery (measuring psychomotor speed, attention, executive function, working memory, and verbal learning and memory) under three (quiet, urban, and social) noise conditions. IQ, subjective noise sensitivity, sleep, personality, paranoia, depression, anxiety, stress, and schizotypy were assessed on a single occasion. We found significantly slower psychomotor speed (urban), reduced working memory and episodic memory (urban and social), and more cautious decision-making (executive function, urban) under noise conditions. There was no effect of sex. Variance in urban noise-induced changes in psychomotor speed, attention, Trail Making B-A (executive function), and immediate recall and social noise-induced changes in verbal fluency (executive function) and immediate recall were explained by a combination of baseline cognition and paranoia, noise sensitivity, sleep, or cognitive disorganization. Higher baseline cognition (but not IQ) predicted greater impairment under urban and social noise for most cognitive variables. Paranoia predicted psychomotor speed, attention, and executive function impairment. Subjective noise sensitivity predicted executive function and memory impairment. Poor sleep quality predicted less memory impairment. Finally, lower levels of cognitive disorganization predicted slower psychomotor speed and greater memory impairment. The identified moderators should be considered in studies aiming to reduce the detrimental effects of occupational and residential noise. These results highlight the importance of studying noise effects in clinical populations characterized by high levels of the paranoia, sleep disturbances, noise sensitivity, and cognitive disorganization.
Topics: Adult; Age Factors; Attention; Cognition; Emotions; Executive Function; Female; Humans; Male; Memory; Middle Aged; Noise; Psychomotor Performance; Sleep; Young Adult
PubMed: 27157685
DOI: 10.4103/1463-1741.181995 -
Psychology and Psychotherapy Jun 2022Paranoia is most likely to emerge in adolescence. In adolescents with mental health disorders, the disruptive effect of paranoia on social relationships could worsen...
OBJECTIVES
Paranoia is most likely to emerge in adolescence. In adolescents with mental health disorders, the disruptive effect of paranoia on social relationships could worsen outcomes. However, little is known about clinical presentations of paranoia at this age. We therefore explored the development, experience, and impact of paranoia in adolescent patients.
DESIGN
A qualitative interview design with interpretative phenomenological analysis was used.
METHOD
Twelve adolescents (11-17 years) with paranoia attending child and adolescent mental health services were interviewed.
RESULTS
Adolescents described a journey starting with their awareness of paranoia beginning to a paranoid experience of mistrust and fear of others, and, subsequently, their adjustment to paranoia in daily life. Paranoia onset was rooted in the discovery of interpersonal threat and personal vulnerability, shaped by challenging peer interactions, becoming aware of danger in the world, and personal adverse experiences. The paranoia experience included a struggle to trust friends, anticipating threat with intense fear, and using defensive strategies to keep safe. Adolescents described how the paranoia experience was confusing, negatively impacted self-concept, held them back from teenage life, and caused disconnection from friends. Longer-term responses to paranoia reflected a tension between reluctantly resigning to the experience and trying to resist the impact.
CONCLUSIONS
The journey of paranoia in adolescence involves navigating multiple tensions, with young people balancing independence with vulnerability, trust with mistrust, and the desire to socialise with a fear of danger and deception. Decisions about how to respond to paranoia are likely to determine the next stage of their journey.
Topics: Adolescent; Child; Fear; Humans; Interpersonal Relations; Mental Health Services; Paranoid Disorders; Self Concept
PubMed: 35150474
DOI: 10.1111/papt.12385 -
PloS One 2023Status threat (i.e., concern that one's dominant social group will be undermined by outsiders) is a significant factor in current United States politics. While...
Status threat (i.e., concern that one's dominant social group will be undermined by outsiders) is a significant factor in current United States politics. While demographic factors such as race (e.g., Whiteness) and political affiliation (e.g., conservatism) tend to be associated with heightened levels of status threat, its psychological facets have yet to be fully characterized. Informed by a "paranoid" model of American politics, we explored a suite of possible psychological and demographic associates of perceived status threat, including race/ethnicity, political conservatism, analytic thinking, magical ideation, subclinical paranoia, and conspiracy mentality. In a small, quota sample drawn from the United States (N = 300), we found that conspiracy mentality, subclinical paranoia, conservatism, and age were each positively (and uniquely) associated with status threat. In addition to replicating past work linking conservatism to status threat, this study identifies subclinical paranoia and conspiracy mentality as novel psychological associates of status threat. These findings pave the way for future research regarding how and why status threat concerns may become exaggerated in certain individuals, possibly to the detriment of personal and societal wellbeing.
Topics: Humans; United States; Paranoid Disorders; Ethnicity; Thinking; Politics; White
PubMed: 37992025
DOI: 10.1371/journal.pone.0293930