RESUMEN
BACKGROUND: The aims of this study were to identify (1) the factor structure of anomalous experiences across the psychosis continuum; (2) qualitative and quantitative differences in psychotic experiences (PEs) between "non need-for-care" and two clinical groups: psychosis patients and individuals at ultra high risk (UHR) of psychosis. We aimed to distinguish which types of experiences would be related to malign (need-for-care and/or help-seeking) versus benign outcomes. METHODS: Component scores obtained from a Principal Components Analysis of PEs from lifetime scores on the Appraisals of Anomalous Experience Inventory (Brett et al., 2007) were compared across 96 participants: patients diagnosed with a psychotic disorder (n=37), help-seeking UHR people (n=21), and non-clinical individuals presenting with enduring PEs (n=38). RESULTS: A five-component structure provided the best solution, comprising dissociative-type experiences, subjective cognitive deficits, and three separate components relating to "positive" symptoms. All groups reported "positive" experiences, such as ideas of reference and hallucinations, with the non-clinical group displaying more PEs in the Paranormal/Hallucinatory component than both clinical groups. "Cognitive/Attentional anomalies" was the only component where the clinical groups reported significantly more anomalies than the non-clinical group. However psychosis patients reported more frequent first-rank type symptoms and "hypomanic" type PEs than the other groups. DISCUSSION: "Positive" PEs were common across the psychosis spectrum, although first-rank type symptoms were particularly marked in participants diagnosed with a psychotic disorder. Help-seeking and need-for-care were associated with the presence of subjective cognitive disturbances. These findings suggest that anomalies of cognition and attention may be more relevant to poorer outcomes than the presence of anomalous experiences.
Asunto(s)
Aceptación de la Atención de Salud/psicología , Trastornos Psicóticos/psicología , Trastornos Psicóticos/terapia , Autoimagen , Adulto , Cognición , Femenino , Alucinaciones/diagnóstico , Alucinaciones/terapia , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Current psychological models of psychotic symptoms suggest that metacognitive beliefs impact on an individual's appraisal of anomalous experiences, and thereby influence whether these lead to distress and become clinical symptoms. This study examined the relationship between maladaptive metacognitive beliefs, anomalous experiences, anomaly-related distress, anxiety and depression and diagnostic status. METHOD: The Metacognitions Questionnaire (MCQ), Symptom Checklist 90 - Revised, and Appraisals of Anomalous Experiences interview were administered to 27 people diagnosed with a psychotic disorder, 32 people meeting At Risk Mental State (ARMS) criteria, 24 people with psychotic-like experiences but no need for care, and 32 healthy volunteers. RESULTS: The two clinical groups scored higher than non-patient controls and individuals experiencing psychotic-like anomalies with no need for care on most subscales of the MCQ, particularly the 'general negative beliefs about thoughts' (NEG) subscale. However, most group differences became non-significant when anxiety and depression were controlled for. Few relationships were found between the MCQ subscales and psychotic-like anomalies and anomaly-related distress. Cognitive/attentional difficulty was the only type of anomaly to be significantly associated with maladaptive metacognitive beliefs. Anomaly-related distress was associated with only the NEG subscale of the MCQ. CONCLUSIONS: Maladaptive metacognitive beliefs, as measured by the MCQ, appear to be related more to elevated levels of general psychopathology in psychotic and at-risk groups than to the presence of, and distress associated with, psychotic experiences. Processes by which metacognitions may impact upon the need for care are discussed.
Asunto(s)
Trastornos de Ansiedad/psicología , Cognición , Trastorno Depresivo/psicología , Trastornos Psicóticos/psicología , Estrés Psicológico/psicología , Adolescente , Adulto , Análisis de Varianza , Trastornos de Ansiedad/diagnóstico , Trastorno Depresivo/diagnóstico , Femenino , Humanos , Entrevista Psicológica , Masculino , Persona de Mediana Edad , Autoimagen , Estrés Psicológico/diagnóstico , Reino Unido , Adulto JovenRESUMEN
BACKGROUND: Cognitive models of psychosis suggest that whether anomalous experiences lead to clinically relevant psychotic symptoms depends on how they are appraised, the context in which they occur and the individual's emotional response. AIMS: To develop and validate a semi-structured interview (the Appraisals of Anomalous Experiences Interview; AANEX) to assess (a) anomalous experiences and (b) appraisal, contextual and response variables. METHOD: Following initial piloting, construct validity was tested via cross-sectional comparison of data from clinical and non-clinical samples with anomalous experiences. Interrater reliability was also assessed. RESULTS: Scores from AANEX measuring appraisals, responses and social support differentiated the clinical and nonclinical groups. Interrater reliability was satisfactory for 65 of the 71 items. Six items were subsequently amended. CONCLUSIONS: The AANEX is a valid multidimensional instrument that provides a detailed assessment of psychotic-like experiences and subjective variables relevant to the development of a need for clinical care.