Cognitive functioning in delusions: a longitudinal analysis

BACKGROUND: This study explored the longitudinal course of the relationship between delusions and different aspects of cognitive functioning. METHODS: Deluded patients were compared to psychiatric and non-clinical controls on three tasks: negative priming, a probabilistic judgement task (the 'beads' task), and the pragmatic inference task (PIT). All groups were tested at two time points, once when actively symptomatic, and once when in remission. RESULTS: Deluded individuals exhibited a 'jump-to-conclusions' (JTC) reasoning bias: i.e., they made decisions on the basis of limited evidence and were more likely to revise their estimates when faced with disconfirmatory evidence. This JTC bias remained stable over time, although probability judgments seemed to normalise in remission. No deficits in cognitive inhibition were found on negative priming. The deluded group displayed an excessive self-focus on the PIT at both time points, but did not show a depressive attributional style. Only a small sub-sample, characterised by the "bad-me" type of paranoia [Trower & Chadwick, 1995 Clinical Psychology: Science and Practice, 2, 263-278.], demonstrated depressive schemas when symptomatic, but no longer did so when remitted. Few relationships were found between tasks, suggesting that different areas of functioning are relatively independent. The only measures associated with delusion symptom scores were from the 'beads' task. CONCLUSIONS: Overall these findings suggest that the JTC bias is a stable factor associated with delusional thinking, while the depressive attributional style characteristic of a small sub-sample of paranoid patients fluctuates with delusional course.     

Psychotic panic and feared sexual assault – ‘homosexual panic’: the historical role of feared homosexual assault as a contributing factor to self-attack

Some psychotic patients fall into acute persecutory panic, a subjective experience of helpless terror in the face of anticipated imminent annihilation or dismemberment. These states occur in a wide range of psychotic illnesses and are often associated with command hallucinations and fear of homosexual assault. In a desperate attempt to escape from imaginary enemies, such patients often attack themselves and imagine suicide is survivable. This article addresses the dread of homosexual assault, previously referred to as homosexual panic, and its relationship to patients who attack themselves in a state of desperate psychotic persecution.     

Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence

In a recent theoretical account of persecutory delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41(4), 331-347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory delusions. Thirty individuals with current persecutory delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory delusions was also followed up at 3 months to assess predictors of delusion persistence. At its most severe, 21% of individuals with persecutory delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory delusion distress and with the persistence of delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory delusions may be warranted.     

Bored to fears: Boredom proneness,paranoia, and conspiracy theories

The present study examines the relationships between paranoia, conspiracist ideation, and boredom proneness. A sample of the general public (N = 150) completed the Paranoia scale, the Boredom Proneness scale, and the Generic Conspiracist Beliefs scale. Bivariate correlations revealed significant interrelationships between the three traits. Further analysis revealed that the relationship between boredom proneness and conspiracist ideation was fully mediated by paranoia. That is, proneness to experiencing boredom is associated with stronger endorsement of conspiracy theories only in as much as boredom proneness is associated with increased paranoia.     

Unpleasant and pleasant referential thinking: Relations with self-processing, paranoia, and other schizotypal traits

Referential thinking is the tendency to view innocuous stimuli as having a specific meaning for the self and is associated with personality traits and disorders. In three studies, this research examined the relations among referential thinking, self-processing, and paranoia. In Study 1, follow-up questions on the Referential Thinking Scale (Lenzenweger, Bennett, & Lilenfeld, 1997) revealed that referential thoughts are experienced as unpleasant and pleasant. In Study 2, unpleasant referential thinking was more strongly associated with paranoia and maladaptive self-processing and personality. CFAs in Studies 1 and 2 found that unpleasant and pleasant referential thinking loaded on different factors. In Study 3, a group of participants with elevated schizotypal personality reported more unpleasant and pleasant referential thoughts than a control group.     

Translation and Validation of the French Version of the Revised Green et al., Paranoid Thoughts Scale (R-GPTS) in Two Samples: Non-Clinical and Clinical Adults

Paranoia consists of unfounded beliefs that harm will be caused with intent to hurt the subject. Paranoid thoughts exist on a continuum of severity from severe forms in several psychological pathologies to milder forms in a significant minority of individuals of the general population (Freeman, 2007). It can be measured using several types of questionnaires. One recent questionnaire that measures paranoia in both clinical and non-clinical populations is the revised Green et al., Paranoid Thoughts Scale (R-GPTS) (Freeman et al., 2019). This questionnaire is an improved version of the Green et al., Paranoid Thoughts Scale (GPTS) (Green et al., 2008) and has excellent psychometric properties. In the present study, the R-GPTS was translated into French and the psychometric properties of the new French version were evaluated in a sample of the general population (N = 600) and in a clinical sample (N = 22). Confirmatory factor analysis supported the original two-factor structure (social reference and persecution subscales) of the R-GPTS. Evidence of excellent internal consistency of the R-GPTS was found. Furthermore, good convergent and discriminant validity was also found. Test-retest reliability showed significant positive correlations over a 1-month period. The findings discussed above were found in the non-clinical sample. Lastly, the R-GPTS revealed good preliminary criterion validity established from the comparison between the clinical and the non-clinical groups. In conclusion, the French version of the R-GPTS is a valid and reliable tool to measure paranoia in the general population. Due to the small sample size of the clinical sample, further studies are needed in order to confirm good psychometric properties in clinical populations, even though our preliminary findings are promising.     

Bayesian inferences about the self (and others): A review

Viewing the brain as an organ of approximate Bayesian inference can help us understand how it represents the self. We suggest that inferred representations of the self have a normative function: to predict and optimise the likely outcomes of social interactions. Technically, we cast this predict-and-optimise as maximising the chance of favourable outcomes through active inference. Here the utility of outcomes can be conceptualised as prior beliefs about final states. Actions based on interpersonal representations can therefore be understood as minimising surprise – under the prior belief that one will end up in states with high utility. Interpersonal representations thus serve to render interactions more predictable, while the affective valence of interpersonal inference renders self-perception evaluative. Distortions of self-representation contribute to major psychiatric disorders such as depression, personality disorder and paranoia. The approach we review may therefore operationalise the study of interpersonal representations in pathological states.     

The targets of all treachery: Delusional ideation,paranoia, and the need for uniqueness as mediators between two forms of narcissism and conspiracy beliefs

The present cross-sectional study (N_Participants = 397; N_Informants = 460) examined the association of both grandiose narcissism and vulnerable narcissism with conspiracy beliefs in the context of four theoretically-relevant mediators. Participants who were higher in grandiose narcissism and vulnerable narcissism were more likely to believe in conspiracy theories, seemingly because they were more likely to hold unusual beliefs. There was, likewise, some evidence to suggest that those high in vulnerable narcissism believe in conspiracy theories because they suffer from paranoia, whereas those high in grandiose narcissism believe in conspiracy theories because of a desire to be unique. Together, these results suggest that the conspiracist ideation seen among those high in grandiose narcissism and vulnerable narcissism is a consequence of features that are shared between and unique to each of the traits.     

Paranoia and instability of self-esteem in adolescents

This study examined whether paranoid beliefs are associated with instability of self-esteem (SE) as hypothesized by Bentall et al. [Bentall, R. P., Corcoran, R., Howard, R., Blackwood, N., & Kinderman, P. (2001). Persecutory delusions: A review and theoretical integration. Clinical Psychology Review, 21, 1143–1192] in a community-based sample. Measures assessing SE, SE instability, paranoid ideation, and depressive symptoms were completed by 131 adolescents. A significant association between paranoia and SE instability was observed, even when taking into account global SE and depressive symptomatology. The results replicate previous findings, providing further evidence for a relationship between paranoid ideation and SE instability. Further, this study utilises a new measure of SE instability and explores the relationship between paranoia and SE within a hitherto unstudied age group using a multidimensional model of paranoia.