Externalizing and personalizing biases in persecutory delusions: the relationship with poor insight and theory-of-mind

The presence of externalizing bias (EB) for negative events together with personalizing bias (PB) (a bias to blame others rather than circumstances) may jointly constitute a vulnerability to develop persecutory delusions (PDs). Whereas EB purportedly serves to defend a vulnerable self-concept by avoiding negative self-attributions and might therefore exacerbate poor insight, PB may reflect cognitive deficits, including theory-of-mind impairment. We investigated these proposals in 34 schizophrenic patients with a history of PDs and 21 healthy controls. Patients with moderate- to severe-PDs and patients without a current PD showed excessive EB which was, surprisingly, absent in patients with mild persecutory delusions (mild-PDs). That EB might wax and wane with fluctuating delusional intensity was interpreted in accord with a new dynamic model of attribution self-representation cycles. As predicted, EB exacerbated poor insight. However, counter to predictions, theory-of-mind impairment did not increase PB, which was marked in all participants, whether clinical or non-clinical; instead, theory-of-mind impairment was also correlated with poor insight. Our findings indicate multiple pathways to poor insight, one of which is a theory-of-mind difficulty, impairing the capacity to simulate other perspectives for the purpose of critically evaluating one's own beliefs and circumstances.     

HiTOP thought disorder,DSM-5 psychoticism,and five factor model openness

HiTOP internalizing, detachment, antagonistic externalizing, and disinhibited externalizing align comfortably with respective domains of the Five-Factor Model (FFM) of general personality. The alignment of HiTOP thought disorder and DSM-5 Section III psychoticism with FFM openness though has been disputed, with the existing research obtaining weak and/or inconsistent results. The purpose of the current paper is to discuss possible reasons for this problematic alignment. The strength of the relationship is hindered in part because it is an alignment of a largely adaptive domain of personality with an entirely maladaptive domain (whereas this is not the case for the other four HiTOP-FFM alignments). The strength of the relationship is also affected by how both openness and psychoticism have been conceptualized and/or assessed.     

Revelation,delusion or disillusion: subjective interpretation of religious and spiritual experiences in bipolar disorder

The objective of this study is to explore the interpretation of religious and spiritual experiences during mania, depression and recovery, from the perspective of bipolar clients and to inquire into their expectations of treatment in relation to these experiences. For this purpose, a qualitative pilot study is designed, which includes interviews with 10 outpatients of Altrecht, a Dutch mental health institution. The meaning of religious and spiritual experiences and the question of their authenticity proved to be an important theme for the participants. The support of spirituality for illness management was brought to the fore, as well as the temporary lack of this support during depression by some participants. Participants considered it desirable that more attention be paid to the topic during treatment, and to establish better cooperation between spiritual counsellors of the institution and other professionals. Thus, a more existential or hermeneutical approach towards religious experiences in relation to bipolar disorder would be a desirable contribution to standard treatment. The exact outlines of such an approach demand more empirical research.     

Abnormal Certainty: Examining the Epistemological Status of Delusional Beliefs

ABSTRACT

This article intends to reconsider the epistemological status of delusional beliefs on the basis of Wittgenstein’s conception of certainty. Several works over the last two decades have compared delusional beliefs with so-called hinge propositions, which – according to Wittgenstein – function as expressions of objective certainty. This gives rise to a paradox. On the one hand, delusions are compatible to Wittgensteinian certainties in some respects; on the other hand, they contradict beliefs shared by other members of the community, which makes them different from ‘normal’ certainties. In order to address this issue, I use Moyal-Sharrock’s taxonomy of hinge propositions. This taxonomy allows one to distinguish between different types of hinge propositions; all types share the same features, but these features are manifested in a variety of ways. Thus, delusional beliefs might also be regarded as constituting a specific type of hinge propositions. This move makes it possible to resolve the paradox and to identify the special epistemic features of delusional beliefs.     

Psychoanalytic Controversies: The relationship between psychoanalysis and schizophrenia

In this article, the author considers psychoanalysts' current attitudes towards schizophrenia. After early optimism of a psychoanalytic approach, interest has waned, other than in the field of first-onset psychosis. This was because of poor outcome figures and regarding schizophrenia as now having a biological, rather than psychological, base. The author argues that there is a paradox, because only psychoanalysis offers a framework for relating to psychotic patients in a way that helps them to make sense of their experiences. A framework is described, with clinical examples, to illustrate the application of analytic thinking to patients with schizophrenia. Psychoanalysis needs to revitalise its attitude to psychosis, as it has a significant contribution to make within general psychiatry, not least in the training of the next generation of psychiatrists.     

What makes delusions pathological?

Bortolotti argues that we cannot distinguish delusions from other irrational beliefs in virtue of their epistemic features alone. Although her arguments are convincing, her analysis leaves an important question unanswered: What makes delusions pathological? In this paper I set out to answer this question by arguing that the pathological character of delusions arises from an executive dysfunction in a subject’s ability to detect relevance in the environment. I further suggest that this dysfunction derives from an underlying emotional imbalance—one that leads delusional subjects to regard some contextual elements as deeply puzzling or highly significant.     

What is the role of narcissism in the relationship between impulsivity and driving anger expression?

The contributing factors of aggressive driving have been studying in the last decades. Both impulsivity and narcissism are associated with aggressive driver behaviors. Although the role of these two factors were examined in the same studies, the combined role of these two factors hasn’t been studied yet. To understand the combined effect of them, in the present study, the moderated mediation model for examining the relationships of narcissism, impulsivity, and aggressive driver behavior was developed and tested. Three hundred and four participants completed an online survey battery comprised of Demographic Information Form, Five-Factor Narcissism Inventory-Short Form, Barrat Impulsiveness Scale- Short Form, and Driving Anger Expression Inventory. The moderated mediation analyses were conducted using PROCESS macro developed by Hayes and Preacher (2013). The results revealed that only the relationship between vulnerable narcissism and the use of vehicle to express anger is mediated by attentional impulsiveness. Also, this relationship is moderated by grandiose narcissism. In detail, grandiose narcissism moderates the direct effect of vulnerable narcissism on attentional impulsivity and also the direct effect of attentional impulsivity on the use of vehicle to express anger. Theoretical and practical implications of these findings and recommendations for future studies are discussed.     

Narcissism and recollections of early life experiences

Recent studies have found associations between narcissistic personality features and retrospective accounts of early experiences. The current study sought to extend these previous findings by examining whether adaptive and maladaptive features of narcissism were associated with recollections of early life experiences in a non-clinical sample of undergraduate students (N = 334). Results revealed that the Entitlement/Exploitativeness feature of narcissism was associated with low security, high parental discipline, and high threats of separation. Narcissistic Grandiosity was positively associated with peer affectional support and parental discipline, whereas Narcissistic Vulnerability was not uniquely associated with memories of early life experiences. The results provide partial support for models of narcissism in which parents are recalled as failing to provide a secure base while inducing threats of separation and discipline.     

Does Symptom Type Moderate the Relationship Between Insight and Outcome in Cognitive Behavioral Therapy for Psychosis? A Preliminary Investigation

Insight has emerged as a potential predictor variable in cognitive behavioral therapy for psychosis (CBTp). However, previous research has produced mixed results. The present study aimed to clarify whether symptom type is a moderating variable. A group of psychotic patients (n = 44) were assessed through pre- and post-treatment in a CBTp specialty track in a partial hospital-based program in the USA. The Insight Scale was used to measure insight, and psychotic symptomatology was assessed using the Mini-International Neuropsychiatric Interview and the Behavior and Symptom Identification Scale. Patients showed a significant decrease in psychotic symptom scores over the course of treatment [t(43) = 3.59, p < .001, Cohen's d = .64]. Furthermore, illness awareness was specifically associated with a decrease in psychotic symptoms for patients who endorsed visual hallucinations (r = ? .68, p < .01), auditory hallucinations (r = ? .49, p = .01), and/or ideas of reference (r = ? .66, p < .01). Insight did not confer additional benefit for patients with paranoid delusions, mind reading, or thought insertion symptoms. These results are discussed in relation to treatment implications within the current US health care delivery system.     

Phenomenology of delusions and hallucinations in schizophrenia by religious convictions

This study was conducted to assess the impact of religious affiliations on the phenomenology of delusions and hallucinations. Fifty-three Pakistani Muslim patients with schizophrenia were interviewed using the Present State Examination and Religiosity Index. The results indicated that the more religious patients had greater themes of grandiose ability and identity. These differences were more obvious in groups divided on the basis of practice of Islam. Similar results were obtained in the content of hallucinations. More religious patients were more likely to hear voices of paranormal agents and had visions of the same. The results of this study have strong implications for mental health professionals who, without reinforcing threatening and pathological beliefs of patients, can utilise this knowledge to create and maintain a therapeutic alliance with the patients as well as to more effectively manage the disorder.