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OBJECTIVES: Psychosis is characterized by paranoid delusions, social withdrawal, and distrust towards others. Trust is essential for successful social interactions. It remains unknown which aspects of social functioning are associated with reduced trust in psychosis. Therefore, we investigated the association between social behaviour, trust, and its neural correlates in a group of individuals with psychotic symptoms (PS-group), consisting of first episode psychosis patients combined with individuals at clinical high risk. METHODS: We compared 24 PS individuals and 25 healthy controls. Affect and social withdrawal were assessed using the Experience Sampling Method. Trust was measured during functional magnetic resonance imaging (fMRI) scanning, using a trust game with a cooperative and unfair counterpart. RESULTS: The PS-group showed lower baseline trust compared to controls and reported less positive and more negative general affect. Social withdrawal did not differ between the groups. Social withdrawal and social reactivity in affect (i.e., changes in affect when with others compared to when alone) were not associated with trust. On the neural level, in controls but not in the PS-group, social withdrawal was associated with caudate activation during interactions with an unfair partner. An increase in positive social reactivity, was associated with reduced insula activation in the whole sample. CONCLUSIONS: Social withdrawal and social reactivity were not associated with reduced initial trust in the PS-group. Like controls, the PS-group showed a positive response in affect when with others, suggesting a decrease in emotional distress. Supporting patients to keep engaging in social interactions, may alleviate their emotional distress. PRACTITIONER POINTS: Individuals with psychotic symptoms show reduced initial trust towards unknown others. Trust in others is not associated with social withdrawal and reported affect when with others, nor when alone. Like controls, individuals with psychotic symptoms showed reduced negative affect and increased positive affect when with others compared to when alone. We emphasize to support individuals with psychotic symptoms to keep engaging in social interactions, given it may reduce social withdrawal and alleviate their emotional distress.
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Trastornos Psicóticos , Confianza , Emociones , Humanos , Imagen por Resonancia Magnética/métodos , Trastornos Psicóticos/diagnóstico por imagen , Trastornos Psicóticos/psicología , Conducta Social , Confianza/psicologíaRESUMEN
This study examined the feasibility and effectiveness of an interactive smartphone application that aimed to improve daily-life social functioning and symptoms in schizophrenia spectrum disorders (SZ) with Experience Sampling Method (ESM) derived personalised feedback.Two groups of outpatients with a diagnosis of SZ were included (one receiving ESM-derived personalised feedback (n = 27) and one without feedback (n = 23)) and used the interactive smartphone application for three weeks. Main outcomes were momentary symptoms and social functioning, as assessed by ESM questionnaires. Additionally, feasibility and user-friendliness of the application were assessed. The response rate was 64% for the ESM questionnaires. In the feedback group, participants indicated that on 49% of the ESM days they acted on at least one personalised feedback prompt per day. Momentary psychotic symptoms significantly decreased over time only in the feedback group. Momentary loneliness and questionnaire-assessed psychotic symptoms decreased over time, irrespective of feedback. Participants evaluated the app as user-friendly and understandable. Momentary personalised feedback may impact momentary psychosis in daily life. Feelings of loneliness and questionnaire-based measured psychotic symptoms may be more responsive to non-specific effects of daily-life self-monitoring, not requiring specific feedback. Ecological momentary interventions offer opportunities for accessible and effective interventions in SZ.
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Retroalimentación Psicológica , Esquizofrenia/terapia , Psicología del Esquizofrénico , Adolescente , Adulto , Evaluación Ecológica Momentánea , Emociones , Estudios de Factibilidad , Femenino , Retroalimentación Formativa , Humanos , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Pacientes Ambulatorios/psicología , Proyectos de Investigación , Teléfono Inteligente , Resultado del Tratamiento , Adulto JovenRESUMEN
Initial affective and psychotic reactivity to daily stressors is altered in psychosis, and most notably in early psychosis. In addition to altered initial stress reactivity, results from studies using Experience Sampling Methodology (ESM) and psychophysiological measures indicate that impaired recovery from mild stressors may also be a risk factor for mental illness. The current ESM study investigated affective recovery from daily stressors in chronic psychosis patients (CP; nâ¯=â¯162), individuals at early stages of psychosis (EP; nâ¯=â¯127), and healthy volunteers (HV; nâ¯=â¯220) assessing fluctuations in negative affect (NA), tension, and suspiciousness ten times a day on six consecutive days. Recovery was operationalized for all three variables as the return to baseline (i.e., level at t-1) following the first stressful event of a day (i.e., t0). The EP group showed a delayed recovery of NA (t1-t3: Bâ¯=â¯0.185; pâ¯=â¯.007 and Bâ¯=â¯0.228; pâ¯=â¯.002) and suspiciousness (t1: Bâ¯=â¯0.223; pâ¯=â¯.010 and Bâ¯=â¯0.291; pâ¯=â¯.002) compared to HV and CP, respectively. Delayed recovery was detected for tension as well (t1-t2: EPâ¯>â¯HV: Bâ¯=â¯0.242; pâ¯=â¯.040 and EPâ¯>â¯CP: Bâ¯=â¯0.284; pâ¯=â¯.023), but contrary to both other momentary states, this effect disappeared when controlling for subsequent stressful events. There were no significant differences in recovery between HV and CP. These results suggest that in EP, stressful daily events have longer-lasting effects on overall negative affect and subclinical psychotic-like experiences. Future studies should incorporate physiological and endocrine measures in order to integrate recovery patterns of the different stress systems.
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Síntomas Afectivos/fisiopatología , Trastornos Psicóticos/fisiopatología , Esquizofrenia/fisiopatología , Estrés Psicológico/fisiopatología , Adulto , Enfermedad Crónica , Evaluación Ecológica Momentánea , Femenino , Humanos , Masculino , Riesgo , Adulto JovenRESUMEN
The DSM-5 appended the conceptualization of asociality in psychotic disorders as the manifestation of diminished interest in social interactions, but it also admitted that it might merely be the result of limited opportunities for social interactions. In an effort to investigate this apparent dichotomy, we used experience sampling data from 149 patients with psychotic disorder and 143 controls, and divided their social interactions into those occurring in the context of work and other structured activities that patients have limited access to, and those occurring in the context of unstructured activities such as visits and conversations that both groups can choose relatively more freely. Patients spent significantly smaller proportion of their time in structured social context, but matched the controls in the time spent in unstructured social contexts, and endorsed intact hedonic experience of both social contexts. Moreover, employment and living situation, in addition to the severity of symptoms of avolition, predicted the proportion of time patients spent in structured and unstructured social contexts, supporting the notion that both lifestyle as well as disease-specific factors contribute to real-life social behavior in psychosis.
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Anhedonia , Relaciones Interpersonales , Estilo de Vida , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Medio Social , Adulto , Anhedonia/fisiología , Apatía/fisiología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Evaluación Ecológica Momentánea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos Psicóticos/epidemiología , Muestreo , Conducta SocialRESUMEN
OBJECTIVE: Tardive dyskinesia (TD) is an antipsychotic-induced movement disorder that typically occurs after long-term exposure to antipsychotic drugs. There is evidence that switching to clozapine reduces TD. This meta-analysis reviews the effect of switching to clozapine on the severity of TD. DATA SOURCES: The PubMed, PsycINFO, and Embase databases were searched for clozapine, tardive dyskinesia, and related keywords. The search was restricted to articles written in English and Dutch, and it was last updated on October 13, 2015. STUDY SELECTION: Sixteen studies were included in the meta-analysis. Inclusion criteria were a diagnosis of schizophrenia or a related disorder, a switch to clozapine monotherapy, and reports of scores on a TD rating scale before and after the switch to clozapine. DATA EXTRACTION: Two independent investigators extracted the data. Data were converted to standardized mean change scores and analyzed in a random-effects model. RESULTS: A random-effects model showed that the overall effect of switching to clozapine was a significant reduction in TD (npatients = 1,060, d = -0.40, P < .01), especially in the 4 studies that investigated the severity of TD as a primary outcome (npatients = 48, d = -2.56, P = .02). CONCLUSIONS: The overall results show that clozapine treatment can yield a slight reduction in TD. The severity of TD was reduced greatly in patients with moderate to severe TD. In patients with minimal to mild TD, switching to clozapine seldom worsens TD and a trend toward reduction is seen. These results support that a switch to clozapine should be considered for patients with moderate to severe TD and/or patients who experience substantial discomfort due to TD.
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Antipsicóticos/efectos adversos , Clozapina/efectos adversos , Esquizofrenia/tratamiento farmacológico , Discinesia Tardía/tratamiento farmacológico , Antipsicóticos/administración & dosificación , Clozapina/administración & dosificación , Sustitución de Medicamentos , Humanos , Índice de Severidad de la Enfermedad , Discinesia Tardía/inducido químicamenteRESUMEN
Subjective quality of life (SQOL) is an established patient-reported outcome in psychosis. However, current self-report measures of SQOL may be affected by recall bias and may not fully capture dynamic changes in SQOL over time. This study aimed to examine the ecological validity of self-reported and momentary assessment measures of SQOL, and their association with emotional experience, social interaction and activity in real life, in both patients with psychotic disorder (n = 56) and controls (n = 71). Self-reported QOL was assessed with the WHO-QOL, momentary QOL and real life experiences were assessed with the Experience Sampling Method (ESM). Results show that both measures were significantly associated in patients and controls, and associations with emotional experience were most relevant, momentary QOL being a stronger predictor than self-reported QOL. The association between momentary QOL and negative affect was stronger in patients than in controls. Overall, momentary QOL was more consistently associated with affect, social interaction and activity, while self-reported QOL displayed a more narrow association with mostly affect. Concluding, concurrent assessment of self-reported QOL and momentary QOL showed that momentary QOL may enhance the ecological validity of SQOL measurement. Experience sampling research may broaden our perspective on SQOL and its associations with real life functioning.
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Trastornos Psicóticos/psicología , Calidad de Vida/psicología , Autoinforme , Actividades Cotidianas , Adulto , Afecto , Estudios de Casos y Controles , Evaluación Ecológica Momentánea , Emociones , Femenino , Humanos , Relaciones Interpersonales , Masculino , Análisis Multivariante , Participación Social/psicología , Adulto JovenRESUMEN
BACKGROUND: Compulsory admissions have a strong effect on psychiatric patients and represent a deprivation of personal liberty. Although the rate of such admissions is tending to rise in several Western countries, there is little qualitative research on the mental health-care process preceding compulsory admission. The objective of the study was to identify crucial factors in the mental health-care process preceding compulsory admission of adult psychiatric patients. METHODS: This retrospective, qualitative multiple-case study was based on the patient records of patients with severe mental illness, mainly schizophrenia and other psychotic disorders. Twenty two patient records were analyzed. Patients' demographic and clinical characteristics were heterogeneous. All were treated by Flexible Assertive Community Treatment teams (FACT teams) at two mental health institutions in the greater Rotterdam area in the Netherlands and had a compulsory admission in a predefined inclusion period. The data were analyzed according to the Prevention and Recovery System for Monitoring and Analysis (PRISMA) method, assessing acts, events, conditions, and circumstances, failing protective barriers and protective recovery factors. RESULTS: The most important patient factors in the process preceding compulsory admission were psychosis, aggression, lack of insight, care avoidance, and unauthorized reduction or cessation of medication. Neither were health-care professionals as assertive as they could be in managing early signs of relapse and care avoidance of these particular patients. CONCLUSION: The health-care process preceding compulsory admission is complex, being influenced by acts, events, conditions and circumstances, failing barriers, and protective factors. The most crucial factors are patients' lack of insight and cessation of medication, and health-care professionals' lack of assertiveness.
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Internamiento Obligatorio del Enfermo Mental/estadística & datos numéricos , Servicios Comunitarios de Salud Mental/organización & administración , Hospitales Psiquiátricos/organización & administración , Trastornos Mentales/terapia , Adulto , Femenino , Humanos , Tiempo de Internación , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Países Bajos , Investigación Cualitativa , Estudios Retrospectivos , Esquizofrenia/terapiaRESUMEN
IMPORTANCE: Compulsory admissions, defined as admissions against the will of the patient (according to local judicial procedures), have a strong effect on psychiatric patients. In several Western countries, the rate of such admissions is tending to rise. Its reduction is urgently needed. OBJECTIVE: To establish which interventions effectively reduce compulsory admissions in adult psychiatric patients in outpatient settings. DATA SOURCES: A systematic computerized literature search was performed using EMBASE, MEDLINE, Web of Science, PsycINFO, CINAHL, PubMed (not yet indexed for MEDLINE), Cochrane Central, and Google Scholar. Every database was searched from its inception until April 30, 2015. STUDY SELECTION: Randomized clinical trials (RCTs) that studied any kind of intervention designed to reduce compulsory admission rates in adult psychiatric patients (age range, 18-65 years) in outpatient settings were eligible. Eligibility was independently assessed by 2 of us. DATA EXTRACTION AND SYNTHESIS: Two of us independently extracted relevant data. The Cochrane Collaboration's tool was used for assessing risk of bias. Overall risk reduction (random-effects estimate) was calculated in the following 4 subgroups of interventions: advance statements, community treatment orders, compliance enhancement, and integrated treatment. MAIN OUTCOMES AND MEASURES: Relative risk (RR) was calculated on the basis of the number of patients who had been compulsorily admitted. RESULTS: Our meta-analyses included 13 RCTs comprising 2970 psychiatric patients. The meta-analysis of the RCTs on advance statements showed a significant 23% (RR, 0.77; 95% CI, 0.60-0.98; I2 = 2.2%) (n = 1102) risk reduction in compulsory admissions. In contrast, the RCTs on community treatment orders (RR, 0.95; 95% CI, 0.81-1.10; I2 = 0.0%) (n = 742), compliance enhancement (RR, 0.52; 95% CI, 0.11-2.37; I2 = 55.7%) (n = 250), and integrated treatment (RR, 0.71; 95% CI, 0.49-1.02; I2 = 49.0%) (n = 876) showed no significant risk reduction in compulsory admissions. CONCLUSIONS AND RELEVANCE: The meta-analysis of the RCTs on advance statements showed a statistically significant and clinically relevant 23% reduction in compulsory admissions in adult psychiatric patients, whereas the meta-analyses of the RCTs on community treatment orders, compliance enhancement, and integrated treatment showed no evidence of such a reduction. To date, only 13 RCTs have used compulsory admissions as their primary or secondary outcome measure. This demonstrates the need for more research in this field.
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Internamiento Obligatorio del Enfermo Mental/legislación & jurisprudencia , Internamiento Obligatorio del Enfermo Mental/tendencias , Adolescente , Adulto , Anciano , Centros Comunitarios de Salud Mental , Europa (Continente) , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación/tendencias , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto , Riesgo , Adulto JovenRESUMEN
INTRODUCTION: Stigma is an important environmental risk factor for a variety of outcomes in schizophrenia. In order to understand and remediate its effects, research is required to assess how stigma experiences are processed at the level of the individual. To this end, stereotype awareness (SA) with respect to people with mental illness and their families was explored in persons with psychotic disorder. METHOD: Data from the Dutch Genetic Risk and OUtcome of Psychosis project (GROUP) were analyzed. SA was measured using scales that assess a respondent's perception of common opinions about people with a mental illness and their families. RESULTS: People with higher level of self-esteem were less aware of stereotypes about patients and families. People with more severe psychopathology reported more awareness of stereotypes about families, not about patients. CONCLUSION: Enhancing psychological resources, by increasing self-esteem and the ability to cope with symptoms, can be targeted to diminish stereotype threat and improve stigma resilience. Interventions can be tailored to individual differences to increase their impact. Furthermore, in order to diminish detrimental consequences of negative stereotypes, mental health professionals, health educators and experts by experience can inform the public about mental illness and stigma.
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Trastornos Psicóticos/psicología , Autoimagen , Estereotipo , Adolescente , Adulto , Concienciación , Estudios Transversales , Salud de la Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Psicopatología , Trastornos Psicóticos/fisiopatología , Análisis de Regresión , Factores de Riesgo , Estigma Social , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Deficits in emotion processing are thought to underlie the key negative symptoms flat affect and anhedonia observed in psychotic disorders. This study investigated emotional experience and social behavior in the realm of daily life in a sample of patients with schizophrenia and schizoaffective disorder, stratified by level of negative symptoms. METHODS: Emotional experience and behavior of 149 patients with schizophrenia and schizoaffective disorder and 143 controls were explored using the Experience Sampling Method. RESULTS: Patients reported lower levels of positive and higher levels of negative affect compared with controls. High negative symptom patients reported similar emotional stability and capacity to generate positive affect as controls, whereas low negative symptom patients reported increased instability. All participants displayed roughly comparable emotional responses to the company of other people. However, in comparison with controls, patients showed more social withdrawal and preference to be alone while in company, particularly the high negative symptom group. CONCLUSIONS: This study revealed no evidence for a generalized hedonic deficit in patients with psychotic spectrum disorders. Lower rather than higher levels of negative symptoms were associated with a pattern of emotional processing which was different from healthy controls.
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Anhedonia/fisiología , Emociones/fisiología , Relaciones Interpersonales , Trastornos Psicóticos/fisiopatología , Esquizofrenia/fisiopatología , Adulto , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Trastornos Psicóticos/psicología , Psicología del Esquizofrénico , Encuestas y CuestionariosRESUMEN
BACKGROUND: Cross-sectional studies have indicated that alterations in social functioning, particularly interpersonal functioning, are associated with the occurrence of psychotic symptoms and experiences at different levels of the extended psychosis phenotype (ranging from population psychometric expression of liability to overt psychotic disorder). However, more research is needed on the development of this association over time. METHODS: Cross-lagged path modeling was used to analyze bidirectional, longitudinal associations between 4 dimensions of subclinical psychotic experiences (persecutory ideation, bizarre experiences, perceptual abnormalities, and magical thinking) and interpersonal functioning in an adolescent general population sample (N = 881 at T1, N = 652 at T2, and N = 512 at T3) assessed 3 times in 3 years. RESULTS: All symptom dimensions showed some association with interpersonal functioning over time, but only bizarre experiences and persecutory ideation were consistently and longitudinally associated with interpersonal functioning. Poorer interpersonal functioning predicted higher levels of bizarre experiences and persecutory ideation at later measurement points (both T1 to T2 and T2 to T3). CONCLUSIONS: Poor interpersonal functioning in adolescence may reflect the earliest expression of neurodevelopmental alterations preceding expression of psychotic experiences in a symptom-specific fashion.
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Relaciones Interpersonales , Trastornos Psicóticos/psicología , Adolescente , Femenino , Humanos , Estudios Longitudinales , Masculino , Modelos Psicológicos , Escalas de Valoración Psiquiátrica , Psicología del Esquizofrénico , Apoyo SocialRESUMEN
The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved ("poor me"; PM), b) individuals who believed that persecution is justified ("bad me"; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed.
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Deluciones/psicología , Trastornos Paranoides/psicología , Esquizofrenia Paranoide/psicología , Autoimagen , Adulto , Femenino , Humanos , Control Interno-Externo , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
BACKGROUND: Hallucinations are a core feature of psychosis, often causing considerable distress. Reported prevalence ranges from 70% for auditory hallucinations (AHs) to 30% for visual hallucinations (VHs) and 4% for hallucinations in the tactile domain. AHs have been studied extensively but studies on VHs are scarce. The current study investigated the phenomenology of VHs and AHs in the realm of daily life, by analyzing their prevalence, course and co-occurrence over a 6-day period and their temporal relation to emotions and delusions. METHODS: The ESM, a structured diary technique, was used to investigate hallucinatory experiences in the context of daily life in a pooled data-set of 184 participants (71% males) with psychosis spectrum disorders, which were recruited from mental health facilities in the south of the Netherlands and Belgium. All self-assessments were rated on 7-point Likert scales. VHs were defined using participants' scores on the item "I see phenomena". AHs were measured using the item "I hear voices". RESULTS: Overall, 73 participants (40%) reported hallucinations. Ten participants reported VHs only, 38 reported both VHs and AHs, and 25 participants reported AHs only. AHs co-occurred with VHs in 40% of the hallucinatory moments. Patients with both VHs and AHs reported higher levels of negative affect, lower levels of positive affect and higher delusional intensity than non-hallucinating patients. Increased delusional intensity preceded the onset of hallucinatory episodes, whereas increases in positive or negative affect did not. DISCUSSION: These results show that VHs are common in patients with psychosis spectrum disorders and often co-occur with AHs in time. Furthermore delusional ideation may precede hallucinatory episodes in the realm of daily life, rather than result from a hallucination and affective dysregulation might not play a primary role in hallucination onset.
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Alucinaciones/etiología , Trastornos Psicóticos/complicaciones , Adolescente , Adulto , Anciano , Emociones/fisiología , Femenino , Alucinaciones/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Reproducibilidad de los Resultados , Autoevaluación (Psicología) , Adulto JovenRESUMEN
In this article, a data-driven approach was adopted to demonstrate how real-life diary techniques [ie, the experience sampling method (ESM)] could be deployed for assessment purposes in patients with psychotic disorder, delivering individualized and clinically relevant information. The dataset included patients in an acute phase of psychosis and the focus was on paranoia as one of the main psychotic symptoms (30 patients with high levels of paranoia and 34 with low levels of paranoia). Based on individual cases, it was demonstrated how (1) symptom and mood patterns, (2) patterns of social interactions or activities, (3) contextual risk profiles (eg, is being among strangers, as opposed to family, associated with higher paranoia severity?), and (4) temporal dynamics between mood states and paranoia (eg, does anxiety precipitate or follow the onset of increased paranoia severity?) substantially differ within individual patients and across the high vs low paranoid patient group. Most striking, it was shown that individual findings are different from what is found on overall group levels. Some people stay anxious after a paranoid thought came to mind. For others, paranoia is followed by a state of relaxation. It is discussed how ESM, surfacing the patient's implicit knowledge about symptom patterns, may provide an excellent starting point for person-tailored psychoeducation and for choosing the most applicable therapeutic intervention.
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Recolección de Datos/métodos , Trastornos Paranoides/fisiopatología , Trastornos Psicóticos/fisiopatología , Actividades Cotidianas , Enfermedad Aguda , Adulto , Recolección de Datos/instrumentación , Autoevaluación Diagnóstica , Femenino , Humanos , Individualidad , MasculinoRESUMEN
OBJECTIVES. The evidence to date for a causal role of emotions in the generation of paranoid symptoms is scarce, mainly because of a lack of studies investigating the longitudinal association between emotional processes and paranoia. The primary aim of this study was to investigate whether momentary emotional experiences (anxiety, depression, anger/irritability) and self-esteem predicted the onset and duration of a paranoid episode. We also studied whether levels of emotional experiences and self-esteem were respectively higher and lower during a paranoid episode. DESIGN. A 1-week, prospective momentary assessment study. METHODS. Data were collected using the experience sampling method, a structured self-assessment diary technique. The sample consisted of 158 individuals who ranged across the paranoia continuum. Participants with a psychotic disorder were recruited from in-patient and out-patient mental health services. Participants without psychotic disorder were sampled from the general population. RESULTS. Specific aspects of emotional experience were implicated in the onset and persistence of paranoid episodes. Both an increase in anxiety and a decrease in self-esteem predicted the onset of paranoid episodes. Cross-sectionally, paranoid episodes were associated with high levels of all negative emotions and low level of self-esteem. Initial intensity of paranoia and depression was associated with longer, and anger/irritability with shorter duration of paranoid episodes. CONCLUSIONS. Paranoid delusionality is driven by negative emotions and reductions in self-esteem, rather than serving an immediate defensive function against these emotions and low self-esteem. Clinicians need to be aware of the central role of emotion-related processes and especially self-esteem in paranoid thinking.
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Emociones , Trastornos Paranoides/psicología , Esquizofrenia Paranoide/psicología , Autoimagen , Adulto , Afecto , Ira , Ansiedad/psicología , Deluciones/diagnóstico , Deluciones/psicología , Depresión/psicología , Femenino , Alucinaciones/diagnóstico , Alucinaciones/psicología , Humanos , Genio Irritable , Masculino , Persona de Mediana Edad , Trastornos Paranoides/diagnóstico , Determinación de la Personalidad , Estudios Prospectivos , Esquizofrenia Paranoide/diagnóstico , Estadística como Asunto , Adulto JovenRESUMEN
Borderline Personality Disorder (BPD) is associated with interpersonal problems, such as intense, unstable relationships and fears of abandonment. It has been hypothesized that deficits in social cognitive capacities explain these difficulties. One important aspect of social cognition is theory of mind (ToM)-the capacity to infer others' mental state. We tested ToM capacities with Happé's advanced ToM-test in 16 BPD patients, 16 Cluster-C PD patient controls, and 28 nonpatients. Social reasoning (WAIS Picture Arrangement), general intelligence, and current mood were also assessed. With and without controlling for intelligence, social reasoning, and mood, no evidence for deficits in ToM in BPD patients was found. In fact, both Cluster B and Cluster C patient groups tended to show generally superior performance to the nonpatients on the subscales of Happé ToM-test. All tests correlated similarly with intelligence in the 3 groups. These findings do not support the hypothesis that BPD patients have inferior theory of mind capacities.
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Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Antisocial/psicología , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/psicología , Teoría de la Mente , Adolescente , Adulto , Femenino , Humanos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Adulto JovenRESUMEN
There is an expanding interest to study psychosis in the realm of daily life. The study of the person in the context of daily life may provide a powerful addition to more conventional and cross-sectional research strategies in the study of psychosis. This article first discusses the nature of experience sampling research in psychosis and demonstrates the feasibility and validity of studies using the experience sampling method (ESM) in this patient group. Second, the article presents a review of all ESM research in psychosis with a special focus on (a) the phenomenology, (b) the etiology, and (c) psychological models of psychosis. Variability over time and the dynamic interplay with the environment were found to be essential features of the positive symptoms of psychosis, whereas behavioral patterns as well as self-reported affect in daily life reality might be essential when studying negative symptomatology. ESM contributes to a better understanding of the interplay between psychotic experiences and environmental features, such as stress or cannabis exposure. Finally, the study of symptomatic variability may fuel new research into psychological models and treatment of psychosis and the study of the person-environment interplay may foster new Gene x Environment interaction studies.