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Background: Daydreaming may contribute to the maintenance of grandiose delusions. Repeated, pleasant and vivid daydreams about the content of grandiose delusions may keep the ideas in mind, elaborate the details, and increase the degree of conviction in the delusion. Pleasant daydreams more generally could contribute to elevated mood, which may influence the delusion content. Aims: We sought to develop a brief questionnaire, suitable for research and clinical practice, to assess daydreaming and test potential associations with grandiosity. Method: 798 patients with psychosis (375 with grandiose delusions) and 4518 non-clinical adults (1788 with high grandiosity) were recruited. Participants completed a daydreaming item pool and measures of grandiosity, time spent thinking about the grandiose belief, and grandiose belief conviction. Factor analysis was used to derive the Qualities of Daydreaming Scale (QuOD) and associations were tested using pairwise correlations and structural equation modelling. Results: The questionnaire had three factors: realism, pleasantness, and frequency of daydreams. The measure was invariant across clinical and non-clinical groups. Internal consistency was good (alpha-ordinals: realism=0.86, pleasantness=0.93, frequency=0.82) as was test–retest reliability (intra-class coefficient=0.75). Daydreaming scores were higher in patients with grandiose delusions than in patients without grandiose delusions or in the non-clinical group. Daydreaming was significantly associated with grandiosity, time spent thinking about the grandiose delusion, and grandiose delusion conviction, explaining 19.1, 7.7 and 5.2% of the variance in the clinical group data, respectively. Similar associations were found in the non-clinical group. Conclusions: The process of daydreaming may be one target in psychological interventions for grandiose delusions. [ABSTRACT FROM AUTHOR]

Background: Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. Methods: A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. Results: Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. Conclusions: The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted. [ABSTRACT FROM AUTHOR]

Purpose: Following its introduction in the early 1990s, cognitive behavioural therapy for psychosis (CBTp) has been evaluated in a large number of clinical trials and is now established as a recommended treatment in the UK National Health Service and elsewhere in the world. Meta‐analyses, however, indicate modest effects compared to treatment as usual or comparison therapies such as supportive counselling. Here, we seek to identify factors impacting the effectiveness of CBTp, and avenues for future psychotherapy research that may improve outcomes. Method: We outline two recent umbrella reviews and discuss factors likely to impact the effectiveness of CBTp. Results: Modest effect sizes from meta‐analyses mask heterogeneous outcomes, with some people benefiting and others possibly being harmed by therapy. Common factors such as the therapeutic alliance play an important role in determining outcomes but have been largely neglected by CBTp researchers. There is also the promise of improving outcomes by identifying and targeting the psychological mechanisms that either maintain psychotic symptoms (e.g. worry) or are causally implicated (e.g. trauma). Conclusions: It is unlikely that everyone with psychosis will be equally responsive to the same therapeutic protocols. We need a new, personalised psychotherapy approach to CBTp research and practice, and can learn from research for anxiety and depression examining predictors of therapeutic response to inform treatment decisions. Precision psychological therapies informed by a combination of individual characteristics, common factors and a focus on specific mechanisms will require new research strategies and are likely to lead to improved outcomes for people with psychosis. [ABSTRACT FROM AUTHOR]

Background: The psychosis continuum implies that subclinical psychotic experiences (PEs) can be differentiated from clinically relevant expressions since they are not accompanied by a 'need for care'. Methods: Using data from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), the current study examined variation in functioning, symptomology and aetiological risk across the psychosis phenotype [i.e. variation from (i) no PEs, 'No PEs' to (ii) non-distressing PEs, 'PE-Experienced Only' to (iii) distressing PEs, 'PE-Impaired' to (iv) clinically defined psychotic disorder, 'Diagnosed']. Results: A graded trend was present such that, compared to those with no PEs, the Diagnosed group had the poorest functioning, followed by the PE-Impaired then PE-Experienced Only groups. In relation to symptom expression, the PE-Impaired group were more likely than the PE-Experienced Only and the Diagnosed groups to endorse most PEs. Predictors of group membership tended to vary quantitatively rather than qualitatively. Trauma, current mental health diagnoses (anxiety and depression) and drug use variables differentiated between all levels of the continuum, with the exception of the extreme end (PE-Impaired v. Diagnosed). Only a few variables distinguished groups at the upper end of the continuum: female sex, older age, unemployment, parental mental health hospitalisation and lower likelihood of having experienced physical assault. Conclusions: The findings highlight the importance of continuum-based interpretations of the psychosis phenotype and afford valuable opportunities to consider if and how impairment, symptom expression and risk change along the continuum. [ABSTRACT FROM AUTHOR]

A recent suicidal drive hypothesis posits that psychotic experiences (PEs) may serve to externalize internally generated and self-directed threat (i.e., self-injurious/suicidal behavior [SIB]) in order to optimize survival; however, it must first be demonstrated that such internal threat can both precede and inform PEs. The current study conducted the first known bidirectional analysis of SIB and PEs to test whether SIB could be considered as a plausible antecedent for PEs. Prospective data were utilized from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative birth cohort of 2232 twins, that captured SIB (any self-harm or suicidal attempt) and PEs at ages 12 and 18 years. Cross-lagged panel models demonstrated that the association between SIB at age 12 and PEs at age 18 was as strong as the association between PEs at age 12 and SIB at age 18. Indeed, the best representation of the data was a model where these paths were constrained to be equal (OR = 2.48, 95% CI = 1.63–3.79). Clinical interview case notes for those who reported both SIB and PEs at age 18, revealed that PEs were explicitly characterized by SIB/threat/death-related content for 39% of cases. These findings justify further investigation of the suicidal drive hypothesis. [ABSTRACT FROM AUTHOR]

Aim: Traumatic events are involved in the development and maintenance of psychotic symptoms. There are few trials exploring trauma‐focused treatments as interventions for psychotic symptoms, especially in individuals with early psychosis. This trial will evaluate the feasibility and acceptability of conducting a definitive trial of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in people with early psychosis. Methods: Sixty participants with first episode psychosis and a history of a traumatic/adverse life event(s)will be recruited from early intervention services in the North West of England and randomized to receive16 sessions of EMDRp + Treatment as Usual (TAU) or TAU alone. Participants will be assessed at baseline, 6 and 12 months post‐randomization using several measures of psychotic symptoms, trauma symptoms, anxiety, depression, functioning, service‐user defined recovery, health economics indicators and quality of life. Two nested qualitative studies to assess participant feedback of therapy and views of professional stakeholders on the implementation of EMDRp into services will also be conducted. The feasibility of a future definitive efficacy and cost‐effectiveness evaluation of EMDRp will be tested against several outcomes, including ability to recruit and randomize participants, trial retention at 6‐ and 12‐month follow‐up assessments, treatment engagement and treatment fidelity. Conclusions: If it is feasible to deliver a multi‐site trial of this intervention, it will be possible to evaluate whether EMDRp represents a beneficial treatment to augment existing evidence‐based care of individuals with early psychosis supported by early intervention services. [ABSTRACT FROM AUTHOR]

Objectives: People from ethnic minority groups experience higher rates of paranoid delusions compared with people from ethnic majority groups. Identifying with social groups has been shown to protect against mental health symptoms; however, no studies have investigated the relationship between social identification and paranoia in ethnic minority populations. Here, we investigated the association between British identification and paranoia in a sample of people from African and African Caribbean backgrounds living in the United Kingdom. We also assessed the role of potential mediating (self‐esteem and locus of control) and moderating (contact with White British people) factors. Design: Cross‐sectional quantitative survey design. Methods: We recruited 335 people from African and African Caribbean backgrounds who completed online self‐report measures of identification with Great Britain, self‐esteem, locus of control, positive and negative contact with White British people, and paranoia. Results: A parallel moderated mediation model indicated that British identification was associated with lower paranoia when participants experienced primarily positive contact with White British people. British identification was associated with higher paranoia when participants had primarily negative contact with White British people. Both effects were mediated by changes in locus of control, but self‐esteem was not implicated in either pathway. Conclusions: Identification with the majority culture is associated both positively and negatively with paranoid beliefs depending on the types of social interactions people experience. The findings have implications for preventative social prescribing initiatives and for understanding the causes of the high rates of psychosis in ethnic minority populations. Practitioner points: People from African and African Caribbean backgrounds experience high rates of paranoia, which may stem from social causes such as lack of belonging and negative social experiences.Among people from African backgrounds living in the UK, British identification is associated with lower paranoia when people's social experiences with White British people are positive and higher paranoia when their social experiences with White British people are negative.It is recommended that social interventions designed to reduce paranoia in vulnerable groups foster positive social contact and community belonging, which should enhance feelings of personal control.Understanding the complex interplay between social identity and social contact in the development of paranoia may help therapists and researchers better understand the phenomenology and risk factors of paranoid symptomology. [ABSTRACT FROM AUTHOR]

Objective: Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk. Methods: The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson–Holm–Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and paranoia/AVH. Socio‐demographic confounders were included in analyses. Results: Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and paranoia. Conclusions: Sexual minority status appears to have a specific association with paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross‐sectional nature of the study limits direct inference about causality of such symptoms. Practitioner points: Sexual minority groups may be more likely to experience symptoms of paranoia.It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of paranoia within these groups. [ABSTRACT FROM AUTHOR]

Objectives: Psychological models of voice‐hearing propose that auditory‐verbal hallucinations occur when inner speech is attributed to a source external to the self. Approximately half of the world's population is multilingual, and the extent to which they use a second language for inner speech depends on their experience and competency in it. Bilingualism therefore provides a natural window into the processes operating in auditory‐verbal hallucinations, but no systematic study of voice‐hearing in bilinguals has hitherto been conducted. Design: A mixed‐methods observational study of psychiatric service users who hear voices and who are Welsh–English bilingual. Methods: Thirty‐seven participants were interviewed about their history and use of Welsh and English and divided into three groups: those who learnt Welsh first (L1 Welsh), those who learnt English first (L1 English), and those who learnt the two languages simultaneously. Detailed phenomenological data were collected using The Mental Health Research Institute Unusual Perceptions Schedule. Results: Both qualitative and quantitative data indicated very considerable variation in the extent to which voices were in Welsh, English, or both, with some voice‐hearers reporting that the predominant language of their voices had changed with time. There were modest but statistically significant associations between the predominant language of voices and age of language acquisition (late Welsh learners did not hear voices in Welsh), frequency of language use (more frequent use of Welsh was associated with more Welsh voices), and subjective language proficiency (proficiency in English was associated with a tendency to hear English voices). Conclusions: Although this was a small study, it was the first of its kind. There is a need for more research on the implications of bilingualism for psychosis in particular and mental illness more generally. The results are broadly consistent with the hypothesis that hallucinated voices are misattributed inner speech. Practitioner points: Assessments of people with mental health difficulties should routinely inquire whether they are multilingual and, if so, which language they prefer to use.People with mental health difficulties may have difficulty expressing complex issues and emotions in a second language, despite apparent fluency.When working with bilingual people who hear voices, mental health professionals should consider the language used by the voices when conducting assessments and proposing formulations. [ABSTRACT FROM AUTHOR]

Background: Poor social cognition is prevalent in schizophrenia spectrum disorders. Some authors argue that these effects are symptom-specific and that socio-cognitive difficulties (e.g. theory of mind) are strongly associated with thought disorder and symptoms of disorganisation.AimsThe current review tests the strength of this association.Method: We meta-analysed studies published between 1980 and 2016 that tested the association between social cognition and these symptoms in schizophrenia spectrum disorders.Results: Our search (PsycINFO, MEDLINE and Web of Science) identified 123 studies (N = 9107). Overall effect size as r = -0.313, indicating a moderate association between symptoms and social cognition. Subanalyses yielded a moderate association between symptoms and theory of mind (r = -0.349) and emotion recognition (r = -0.334), but smaller effect sizes for social perception (r = -0.188), emotion regulation (r = -0.169) and attributional biases (r = -0.143).Conclusions: The association is interpreted within models of communication that highlight the importance of mentalisation and processing of partner-specific cues in conversational alignment and grounding.Declaration of interestsNone. [ABSTRACT FROM AUTHOR]

Suicidal ideation/behaviour (SIB) and psychosis are highly associated phenomena. We propose that psychosis, for some, may be consequential to SIB. More specifically we hypothesise that psychosis may serve to externalise internally generated and self-directed threat among those experiencing SIB. Using prospective data from a Danish population cohort, we first sought to test the temporal occurrence of suicidal behaviour and psychotic disorder. Next, using cross-sectional epidemiological survey data (UK), we sought to demonstrate that psychotic experiences (PEs) were more commonly reported by those who experienced SIB and that the strength of the association varied according to (i) SIB recency and (ii) severity. Chi-square comparison tests on the Danish data revealed that suicidal behaviour was statistically more likely to precede (41.4%) rather than follow psychotic disorder (20.7%). Regression analyses of the UK data indicated that individuals who thought about suicide in their lifetime were up to eight times more likely to experience specific PEs while those who thought about and attempted suicide in their lifetime and in the year of assessment were up to 48 times more likely to experience PEs, compared to SIB free members of the population. The findings provide preliminary support for a novel suicidal drive hypothesis for psychosis. [ABSTRACT FROM AUTHOR]

Negative ‐self and ‐others core schemas have been implicated in the development and maintenance of psychotic experiences. One component of the self‐system is gender‐role strain (GRS; perceived discrepancy between actual self and gender‐role norms). Although the role of gender in the formation of core schemas has been underscored in social and developmental psychology literatures, GRS has not been investigated in relation to psychosis. We examined whether it might be associated with negative schemas and psychotic experiences in women consistent with the trend toward sex‐ and gender‐based analysis (SGBA) in health research. Forty‐four women with a schizophrenia spectrum disorder diagnosis and 48 female nonclinical participants completed a series of questionnaires measuring GRS, femininity ideology, core schemas, childhood trauma, and implicit femininity stereotypes (The Gender Stereotype Implicit Association Test). Half the total sample comprised women with minority‐ethnic status. Women in the psychosis group reported higher levels of GRS than comparison participants. Differences in endorsement of femininity ideology between the two groups narrowly missed significance with a trend toward greater femininity ideology in the psychosis group and significantly greater endorsement of the sexual purity domain for minority‐ethnic women. There was no difference in implicit femininity stereotypes. Analyses suggested that the relationship between GRS and symptoms was mediated by negative ‐self and ‐others schemas. Childhood sexual trauma, though higher for women with psychosis, was associated with gender‐role strain in the nonclinical sample only. Findings warrant further investigation with larger samples. SGBA has the potential to fill gaps in our current knowledge with regard to psychosis theory, research, and practice. [ABSTRACT FROM AUTHOR]

Humans possess a basic need to belong and will join groups even when they provide no practical benefit. Paranoid symptoms imply a disruption of the processes involved in belonging and social trust. Past research suggests that joining social groups and incorporating those groups into one's identity (social identification) promotes positive self-views and better physical and mental health. However, no research has investigated whether social identity is associated with paranoia, nor the mechanisms by which this effect may emerge. Here, we examined the relationship between social identity and mental health (paranoia, auditory verbal hallucinations [AVHs], and depression), and tested the mediating role of self-esteem. In study 1, we analyzed data collected from 4319 UK residents as part of the NIHR CLAHRC NWC Household Health Survey. Study 2 comprised data collected from 1167 students attending a large UK university. The studies provided convergent evidence that social identification reduces symptoms of paranoia and depression by furnishing people with self-esteem. There was no consistent effect of social identification on AVHs. People developing mental health assessments, treatments, and policies are encouraged to consider the notion that joining and identifying with social groups may reduce people's risk of paranoia and depression. [ABSTRACT FROM AUTHOR]

This study examined the impact of stigma on subjective recovery from psychosis, and whether self-esteem and internalised stigma (self-directed negative attitudes and thoughts regarding one's mental health issues) mediates the observed associations between stigmatising experiences and outcome. Fifty-nine services-users with schizophrenia or bipolar affective disorder diagnoses completed symptom (Positive and Negative Syndrome Scale) and subjective recovery (Process of Recovery Questionnaire) measures, as well as stigma measures (the King Stigma Scale, Internalised Stigma of Mental Illness Scale), and the Self-Esteem Rating Scale. Diagnosis was a persistently significant factor in all analyses, suggesting a negative effect of the term "schizophrenia"on subjective recovery. In a multiple serial mediation analysis, experiences of stigma predicated subjective recovery and this effect was mediated through internalised stigma, which consequently impaired self-esteem. Internalised stigma is an important psychological mechanism in recovery. Interventions aimed at improving self-esteem and recovery feelings for psychosis-spectrum service-users may benefit from taking the role of internalised stigma into account. [ABSTRACT FROM AUTHOR]

Objectives Research has suggested that the extent to which voices (i.e., auditory verbal hallucinations) are experienced as distressing might be influenced by negative beliefs about voices as well as maladaptive metacognitive styles involving the negative appraisal and maladaptive control of mental experiences. This cross-sectional study examined the contribution of both specific appraisals of voices and a metacognitive factor (i.e., experiential avoidance) to voice-related distress. Methods Self-report measurers of voice characteristics (voice frequency, duration as well as amount and intensity of voice-related distress), experiential avoidance, and appraisals of voices were collected in a sample of 101 voice-hearers. Results Experiential avoidance and negative beliefs about voices were associated with higher levels of voice-related distress, but not to measures of voice frequency and duration. Experiential avoidance and negative 'metaphysical' beliefs about voices were significant predictors of voice-related distress even after accounting for the effect of frequency and duration of voices, and explained similar proportions of unique variance in distress. Conclusions These findings suggest that the appraisals of voices and experiential avoidance are predictive of voice-related distress and that cognitive-behavioural interventions targeting both voice-specific appraisals and general maladaptive metacognitive processes could prove useful treatment approaches for clients with distressing voices. Practitioner points Experiential avoidance ( EA) and negative appraisals predict voice-related distress caused by voices, but not their frequency and duration., Interventions for voices should consider targeting EA and negative appraisals (e.g., cognitive-behavioural therapy, Acceptance and Commitment Therapy) to ameliorate distress. [ABSTRACT FROM AUTHOR]

Great strides have been made in understanding the impact of social inequality on the risk of developing psychotic experiences. However, little is known about the influence of intersecting social categories such as gender, race and class on the experience and expression of psychotic phenomena. Intersectionality, a framework recently advanced in psychology, examines the joint impact of multiple forms of marginalisation on well-being. We adopted this approach to develop a codebook and analyse the voice content of 44 women diagnosed with schizophrenia for the ways in which social categories are used to undermine and/or affirm voice-hearers. Over half of the sample included women with ethnic-minority status. The coding system was reliable. Gendered conditions of worth were used by voices to undermine by far the majority (40) of women and racialised conditions of worth over half (14) the ethnic-minority women. We conclude that voice content often reflects social categories and structural inequalities in society and discuss implications for CBT for psychosis when working with women of majority and ethnic-minority statuses. [ABSTRACT FROM AUTHOR]

Epidemiological studies have suggested that there may be associations between specific adversities and specific psychotic symptoms. There is also evidence that beliefs about justice may play a role in paranoid symptoms. In this study, we determined whether these associations could be replicated in a patient sample and whether beliefs about a just world played a specific role in the relationship between adversity and paranoia. We examined associations between childhood trauma, belief in justice, and paranoia and hallucinatory experiences in 144 individuals: 72 individuals with a diagnosis of schizophrenia spectrum disorders and 72 comparison controls. There was a dose-response relationship between cumulative trauma and psychosis. When controlling for comorbidity between symptoms, childhood sexual abuse predicted hallucinatory experiences, and experiences of childhood emotional neglect predicted paranoia. The relationship between neglect and paranoia was mediated by a perception of personal injustice. The findings replicate in a patient sample previous observations from epidemiological research. [ABSTRACT FROM AUTHOR]

Aim There is evidence that psychotic-like phenomena can be detected within the general population and that psychotic experiences lie on a continuum that also spans affective states. We aimed to investigate comparisons of a first-episode psychosis group, an 'at-risk mental state group' and a help-seeking control group with non-patients to explore whether affective states lie on a continuum of psychosis. Method Measures of psychotic-like experiences, social anxiety and depression were administered to 20 patients experiencing first-episode psychosis ( FEP), 113 patients experiencing an 'at-risk' mental state ( ARMS), 28 patients who were help-seeking but not experiencing a FEP or ARMS ( HSC) and 30 non-clinical participants ( NC). Results For distress in relation to psychotic-like experiences, the FEP, ARMS and HSC groups scored significantly higher than the NC group for the perceptual abnormalities and non-bizarre ideas. In terms of severity of psychotic experiences, the FEP scored the highest, followed by the ARMS group, followed by the HSC and NC groups. The clinical groups scored significantly higher for depression than the non-clinical group. Interestingly, only the FEP and the ARMS groups scored significantly higher than non-patients for social anxiety. Conclusions These findings suggest that a psychosis continuum exists; however, this does not suggest that both psychosis and affective symptoms lie on the same continuum, rather it would appear the presence of such affective states that may affect help-seeking behaviour and clinical status. The implications of these findings for clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis. [Copyright &y& Elsevier]

Background: Parental communication deviance (CD) has long been suggested as a potential risk factor for the development of psychosis and thought disorder in genetically sensitive offspring. However, the findings of the studies on the prevalence of CD in parents of psychotic patients have never been submitted to quantitative synthesis. Method: PsycINFO was searched from January 1959 to January 2012 for studies on the prevalence of CD in parents of psychotic patients. This search was supplemented with the results from a much larger systematic search (PsycINFO, PubMed, EMBASE, and Web of Science) on childhood trauma and psychosis. Results: A total of 20 retrieved studies (n = 1753 parents) yielded a pooled g of large magnitude (0.97; 95% CI [0.76; 1.18]) with a significant amount of heterogeneity (Q = 33.63; P = .014; I2 = 46.47). Subgroup and sensitivity analysis of methodological features (study’s design, comparison group, diagnostic criteria, CD rating method, inter-rater reliability not reported, year of publication, and verbosity) and demographic characteristics (level of education or offspring’s age) revealed that pooled effect size was stable and unlikely to have been affected by these features. Conclusion: CD is highly prevalent in parents of psychotic offspring. This is discussed in the broader context of adoption and longitudinal studies that have reported a G × E interaction in the development of psychosis and thought disorder. A potential developmental mechanism is suggested to explain how CD may affect the developing offspring. The importance of further studies on CD and its potential value as a clinical concept are discussed. [ABSTRACT FROM PUBLISHER]

Objective: Experience sampling (ES) involves participants rating ambulant phenomena at unpredictable intervals. Despite its perceived benefits, there is little published research evaluating the limitations of this method.Method: Predictors of compliance were investigated across three studies using ES in psychotic populations.Results: Regression analyses indicated that none of the demographic or clinical variables significantly (p.05) predicted the number of valid reports or compliance as defined by traditionally used cut-off points (33%).Conclusions: We conclude that it is difficult to predict compliance in ES research, which is likely to be an accessible methodology, even for people experiencing distressing symptoms. [ABSTRACT FROM PUBLISHER]

Background: Psychiatric taxonomists have sometimes argued for a unitary psychosis syndrome and sometimes for a pentagonal model, including 5 diagnostic constructs of positive symptoms, negative symptoms, cognitive disorganization, mania, and depression. This continues to be debated in preparation for impending revisions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. We aimed to identify general and specific dimensions underlying psychopathological features of psychosis. Methods: The samples comprised 309 patients admitted to psychiatric services in the acute phase of their first or second episode of psychosis and 507 patients with enduring psychosis recruited from community mental health teams. Patients’ symptoms were assessed on the Positive and Negative Symptom Scale. Analyses compared unitary, pentagonal, and bifactor models of psychosis. Results: In both samples, a bifactor model including 1 general psychosis factor and, independently, 5 specific factors of positive symptoms, negative symptoms, disorganization, mania, and depression gave the best fit. Scores of general and specific symptom dimensions were differentially associated with phase of illness, diagnosis, social functioning, insight, and neurocognitive functioning. Conclusions: The findings provide strong evidence for a general psychosis dimension in both early and enduring psychosis. Findings further allowed for independent formation of specific symptom dimensions. This may inform the current debate about revised classification systems of psychosis. [ABSTRACT FROM PUBLISHER]

We comment on a recently published article inSchizophrenia Bulletin: ‘The treatment of hallucinations in schizophrenia spectrum disorders’ (Sommer et al., 2012). Contrary to the recommendations made in this piece, we suggest that, on the basis of available evidence, psychological therapies (including, but not limited to cognitive behavioural therapy) should be proposed as a treatment of choice, medication as a possible augmentation strategy, and electroconvulsive therapy and transcranial magnetic stimulation not recommended at all. [ABSTRACT FROM PUBLISHER]

Recent conceptualisations of recovery from psychosis have recognised the importance of psychosocial aspects as well as the presence or absence of symptoms. Qualitative research and personal accounts of recovery highlight its subjective and idiosyncratic nature. This study aims to explore subjective judgements of recovery from the perspective of service users, and examine the agreement and consistency in such judgements across different measures of recovery. It also aims to investigate the relationships between subjective judgements of recovery and psychosocial factors. A total of 122 participants with experience of psychosis completed three self-report measures of recovery judgements, as well as measures of psychological functioning (including self-esteem, optimism, anxiety and depression) and socio-demographic measures. Judgements about recovery from psychosis across the three measures, while showing a trend, also show within-person variability. Recovery judgements were significantly correlated with each other and with all psychological variables, but were not associated with socio-demographic variables except for age. Regression analyses showed that recovery judgements were predicted by mood, optimism and self-esteem. Subjective judgements of recovery were seen to be idiosyncratic, with people appearing to have different thresholds for perceived recovery. The conclusions of the existing qualitative research and first-person accounts appear generalisable to larger samples. [ABSTRACT FROM AUTHOR]

Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41 803) and 8 population-based cross-sectional studies (n = 35 546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34–3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90–3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12–4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17–3.47]). The estimated population attributable risk was 33% (16%–47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis. [ABSTRACT FROM PUBLISHER]

Much research has begun to focus on the identification of people who are at high risk of developing psychosis, and clinical services have been initiated for this population. However, only a small number of studies have reported on the efficacy of interventions for preventing or delaying the onset of psychosis. The results of prior work suggest that cognitive therapy (CT) may be an effective, well-tolerated treatment. We report on the rationale and design for a large-scale, multi-site randomized, controlled trial of CT for people who are assessed to be at high risk of psychosis because of either state or state-plus-trait risk factors. The study employs a single-blind design in which all participants receive frequent mental-state monitoring, which will efficiently detect transition to psychosis, and half are randomized to weekly sessions of CT for up to 6 months. Participants will be followed-up for a minimum of 12 months and to a maximum of 2 years. We report the characteristics of the final sample at baseline ( n = 288). Our study aimed to expand the currently limited evidence base for best practice in interventions for individuals at high risk of psychosis. [ABSTRACT FROM AUTHOR]

Aversive processing plays a central role in human phobic fears and may also be important in some symptoms of psychosis. We developed a temporal-difference model of the conditioned avoidance response, an important experimental model for aversive learning which is also a central pharmacological model of psychosis. In the model, dopamine neurons reported outcomes that were better than the learner expected, typically coming from reaching safety states, and thus controlled the acquisition of a suitable policy. The model accounts for normal conditioned avoidance learning, the persistence of responding in extinction, and critical effects of dopamine blockade, notably that subjects experiencing shocks under dopamine blockade, and hence failing to avoid them, nevertheless develop avoidance responses when both shocks and dopamine blockade are subsequently removed. These postulated roles of dopamine in aversive learning can thus account for many of the effects of dopaminergic modulation seen in laboratory models of psychopathological processes. [ABSTRACT FROM AUTHOR]

There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis. A randomized controlled trial compared cognitive therapy (CT) over 6 months with monthly monitoring in 58 patients meeting criteria for ultrahigh risk of developing a first episode of psychosis. Participants were followed up over a 3-year period. Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a 3-year period, but it did not affect transition to psychosis defined using the Positive and Negative Syndrome Scale (PANSS) or probable Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. Follow-up rate at 3 years was 47%. There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of developing psychosis. [ABSTRACT FROM PUBLISHER]

A qualitative study, investigating the representations and explanatory models of 'madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood 'madness' as spiritual or physiological, whereas religious healers also held psychological models. Healers' understandings of 'madness' are inextricably linked with the historical and sociopolitical context and may be useful to individuals with psychotic experiences, however, it is likely that these models are dynamic and continually changing. [ABSTRACT FROM AUTHOR]

A review of the article "Delusions: A Different Kind of Belief?," by Richard Mullen and Grant Gillett, which appeared in the 2014 issue is presented.

This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation. [ABSTRACT FROM PUBLISHER]

Despite promising findings from small-scale studies suggesting that body psychotherapy may be an effective treatment for negative symptoms, these results were not replicated in a recent multisite trial. In this trial a far smaller proportion of women were recruited relative to earlier studies, which may be an issue given the gender mix of the sample evaluated has been found to affect trial outcomes in schizophrenia. Using data from our multisite trial, the interaction between gender and treatment allocation as a predictor of outcomes was examined in 275 participants (72 women and 203 men) randomised to either a body psychotherapy or Pilates group. Negative symptoms were found to significantly reduce in women randomised to the body psychotherapy condition in comparison to Pilates, while no such effect was detected in men. Consistent with the smaller trials, this improvement was found to relate predominantly to expressive deficits. These findings suggest that body psychotherapy may be an effective treatment for negative symptoms in women. These findings emphasise the importance of sample characteristics in determining trial outcome in psychological treatment studies. [ABSTRACT FROM AUTHOR]

Abstract: Previous research suggests that negative schizotypes may be impaired in their ability to savour pleasant events (Applegate et al., 2009) and that schizophrenia patients believe that everyday tasks are excessively difficult to complete so that they attempt these tasks less frequently (MacCarthy et al., 1986; Bentall et al., 2010). It is possible that these beliefs and behaviours underpin negative symptoms such as anhedonia, avolition, apathy and associality. In the present study, 50 schizophrenia patients and 100 matched controls (half employed and half unemployed) completed self-report measures of self-efficacy and savouring. Patients reported savouring past, present and future events less than employed and unemployed groups, irrespective of mood state and I.Q. Patients also rated everyday tasks as more difficult to master. Inpatients compared to outpatients rated tasks more difficult but less important although they did not differ on the savouring measure. Abnormal judgements of difficulty and the reduced propensity to mentally rehearse past or future positive experiences to up-regulate mood could explain negative symptom patients' lack of engagement in everyday activities and eventual social withdrawal. These findings suggest the need to develop cognitive-behavioural savouring and self-efficacy interventions for patients experiencing the negative symptoms of schizophrenia. [Copyright &y& Elsevier]

Abstract: This study investigates the relationship between attachment, paranoid beliefs and hallucinatory experiences. Five hundred and three students completed online questionnaires, including the persecution and deservedness scale, the Launay–Slade hallucination scale, Bartholomew and Horowitz’s relationship questionnaire, Levenson’s multidimensional locus of control scale and measures of self-esteem and anticipation of threatening events. After comorbidity between paranoia and hallucinations was controlled for, insecure attachment predicted paranoia (persecution) but not hallucinations. The extent to which persecution was perceived to be deserved was predicted by low self-esteem. Negative self-esteem, anticipation of threatening events and a perception of others as powerful mediated the relationship between attachment insecurity and persecutory paranoia. The findings indicate that insecure attachment is specifically related to paranoid beliefs. [Copyright &y& Elsevier]

Abstract: This paper examines the relationships between service providers involved in caring for people with ‘psychosis’ in Uganda. Data from qualitative research investigating conceptualisations of ‘madness’ held by indigenous, religious and allopathic healers in urban Uganda are used to explore the attitudes of these different service providers towards each other. Case-vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers and real cases were discussed by allopathic doctors, and their discourse was analysed. The healers varied in their attitudes towards other parts of the healing context. The indigenous and religious healers were tolerant of allopathic medicine, although the religious healers were inclined to explain its success in terms of a Christian or Islamic framework. In contrast, the allopathic healers made little reference to religious healers and were ambivalent towards indigenous healers. Finally, the relationship between the religious and indigenous healers emerged as one of conflict. The religious healers negated the beliefs and methods of the indigenous healers, whilst the indigenous healers regarded indigenous spirituality and evangelical Christianity as incompatible. Historical and social psychological perspectives are used to understand these differences. There appear to be opportunities for greater dialogue between indigenous and religious healers and allopathic doctors and this could contribute to a more integrative model of care for individuals with psychotic experiences in Uganda. [Copyright &y& Elsevier]

Abstract: The previously reported but still poorly investigated link between deafness or hearing impairment (DHI) and the onset of positive psychotic experiences was investigated prospectively in a general population sample. Of the 109 DHI subjects at baseline, 11 (10.1%) displayed psychotic experiences at T 2 versus 137 (2.9%) of the non-DHI subjects (OR=3.8, 95% CI: 2.0, 7.2). This effect size was only slightly attenuated after adjustment for baseline psychotic experiences (OR=3.2, 95% CI: 1.6, 6.5) and after adjustment for T 0 psychotic experiences and a range of other confounders (OR=3.0, 95% CI: 1.4, 6.2) These results confirm previous findings of an association between hearing impairments and psychosis and show that this association can also be found prospectively in a nonclinical population. [Copyright &y& Elsevier]

We investigated the prevalence of persecutory, grandiose, reference, control, and religious delusions in adult clinical populations worldwide and whether they differed according to country characteristics or age, gender, or year of publication. 123 studies met inclusion criteria, across 30 countries; 102 (115 samples, n = 20,979) were included in the main random-effects meta-analysis of studies measuring multiple delusional themes (21 in a separate analysis of studies in recording a single theme). Persecutory delusions were most common (pooled point estimate: 64.5%, CI = 60.6–68.3, k = 106, followed by reference (39.7%, CI 34.5–45.3, k = 65), grandiose (28.2, CI 24.8–31.9, k = 100), control 21.6%, CI 17.8–26.0, k = 53), and religious delusions 18.3%, CI 15.4–21.6, k = 50). Data from studies recording one theme were broadly consistent with these findings. There were no effects for study quality or publication date. Prevalences were higher in samples exclusively with psychotic patients but did not differ between developed and developing countries, or by country individualism, power distance, or prevalence of atheism. Religious and control delusions were more prevalent in countries with higher income inequality. We hypothesize that these delusional themes reflect universal human dilemmas and existential challenges. • The most prevalent delusional themes are persecutory (64.5%), reference (39.7%), grandiose (28.2%), control (21.6%), and religious (18.3%). • All five types of delusions were more common in samples restricted specifically to psychotic patients. • The prevalence of different delusional themes was unaffected by sociodemographic and cultural features of the samples. • These themes may reflect affected psychosocial mechanisms that have evolved to allow humans to cope with life dilemmas. [ABSTRACT FROM AUTHOR]

Eighty patients and thirty controls were interviewed using one interview that promoted personal disclosure and another about everyday topics. Speech was scored using the Thought, Language and Communication scale (TLC). All participants completed the Self-Concept Clarity Scale (SCCS) and the Varieties of Inner Speech Questionnaire (VISQ). Patients scored lower than comparisons on the SCCS. Low scores were associated the disorganized dimension of TD. Patients also scored significantly higher on condensed and other people in inner speech, but not on dialogical or evaluative inner speech. The poverty of speech dimension of TD was associated with less dialogical inner speech, other people in inner speech, and less evaluative inner speech. Hallucinations were significantly associated with more other people in inner speech and evaluative inner speech. Clarity of self-concept and qualities of inner speech are differentially associated with dimensions of TD. The findings also support inner speech models of hallucinations. [ABSTRACT FROM AUTHOR]

This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis. [ABSTRACT FROM AUTHOR]

Recent work has focused on the role of the environment in psychosis with emerging evidence that specific psychotic experiences are associated with specific types of adversity. One risk factor that has been often associated with psychosis is social isolation, with studies identifying isolation as an important feature of prodromal psychosis and others reporting that social networks of psychotic patients are smaller and less dense than those of healthy individuals. In the present study, we tested a prediction that social isolation would be specifically associated with formal thought disorder. 80 patients diagnosed with psychosis-spectrum disorder and 30 healthy participants were assessed for formal thought disorder with speech samples acquired during an interview that promoted personal disclosure and an interview targeting everyday topics. Social isolation was significantly associated with formal thought disorder in the neutral interview and in the salient interview, even when controlling for comorbid hallucinations, delusions and suspiciousness. Hallucinations, delusions and suspiciousness were not associated with social isolation when formal thought disorder was controlled for. Formal thought disorder is robustly and specifically associated with social isolation. Social cognitive mechanisms and processes are discussed which may explain this relationship as well as implications for clinical practice and future research. [ABSTRACT FROM AUTHOR]

Abstract: Research suggests that both psychosocial factors and neuropsychiatric factors are important predictors of outcome, but little research has examined their relative importance to self-rated recovery. We aim to investigate how such factors are associated with subjective judgements of recovery from psychosis. The participants comprised 122 individuals with experience of psychosis who completed measures of perceived recovery, as well as measures of psychological factors (including self-esteem, locus of control, and emotion) and psychiatric factors (including psychotic symptoms, neurocognition and insight). Measurement models developed using confirmatory factor analysis supported a hypothesis of separate recovery and negative emotion factors. Structural equation modelling showed that negative emotion and internal locus of control had a direct influence on self-rated recovery, and that positive symptoms and internal locus of control had an indirect effect on recovery, mediated via negative emotion. There did not appear to be any effect of insight, negative symptoms or neurocognitive functioning on either self-rated recovery or negative emotion. Psychosocial factors are more directly related to perceived recovery than neuropsychiatric factors. The implications of these findings are discussed. [Copyright &y& Elsevier]

Abstract: Treatment adherence in early psychosis individuals is considered problematic. Some studies have tried to understand reasons for medication non-adherence in this population, though few have also considered engagement in services. We conducted a cross-sectional study with 118 early psychosis individuals, assessing multiple constructs (symptoms, insight, personality traits, alliance, childhood trauma, substance abuse, social functioning and sociodemographics) suggested in the literature as potentially linked to medication adherence or engagement in services. Forward Wald logistic regression suggested that more positive symptoms, having witnessed violence as a child and high agreeableness as a personality trait predicted poor medication adherence. Forward linear regression revealed that physical abuse as a child, lack of knowledge regarding consumer rights, difficulties in building an alliance, low neuroticism and high agreeableness predicted poor service engagement. Profiles of non-adherers or low service engagement were strongly linked to childhood trauma, and high agreeableness, as well as more severe symptoms and poor alliance. Males with histories of legal problems were also more prevalent in both groups. No significant differences were found for insight or substance abuse. Overall, individuals with early psychosis who adhered less to treatment in general could have issues with trusting authority and place more importance on peer acceptance. Results are presented in light of the existing literature and clinical implications are discussed. [Copyright &y& Elsevier]