The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression.

CONTEXT Paranoid delusions are a common symptom of a range of psychotic disorders. A variety of psychological mechanisms have been implicated in their cause, including a tendency to jump to conclusions, an impairment in the ability to understand the mental states of other people (theory of mind), an abnormal anticipation of threat, and an abnormal explanatory style coupled with low self-esteem. OBJECTIVE To determine the structure of the relationships among psychological mechanisms contributing to paranoia in a transdiagnostic sample. DESIGN Cross-sectional design, with relationships between predictor variables and paranoia examined by structural equation models with latent variables. SETTING Publicly funded psychiatric services in London and the North West of England. PARTICIPANTS One hundred seventy-three patients with schizophrenia spectrum disorders, major depression, or late-onset schizophrenia-like psychosis, subdivided according to whether they were currently experiencing paranoid delusions. Sixty-four healthy control participants matched for appropriate demographic variables were included. MAIN OUTCOME MEASURES Assessments of theory of mind, jumping to conclusions bias, and general intellectual functioning, with measures of threat anticipation, emotion, self-esteem, and explanatory style. RESULTS The best fitting (chi(2)(96) = 131.69, P = .01; comparative fit index = 0.95; Tucker-Lewis Index = 0.96; root-mean-square error of approximation = 0.04) and most parsimonious model of the data indicated that paranoid delusions are associated with a combination of pessimistic thinking style (low self-esteem, pessimistic explanatory style, and negative emotion) and impaired cognitive performance (executive functioning, tendency to jump to conclusions, and ability to reason about the mental states of others). Pessimistic thinking correlated highly with paranoia even when controlling for cognitive performance (r = 0.65, P < .001), and cognitive performance correlated with paranoia when controlling for pessimism (r = -0.34, P < .001). CONCLUSIONS Both cognitive and emotion-related processes are involved in paranoid delusions. Treatment for paranoid patients should address both types of processes.

[1]  F. Rehman.  Schedules for clinical assessment in neuropsychiatry , 2011, BMJ : British Medical Journal.

[2]  D. Fergusson,et al.  Tests of causal links between alcohol abuse or dependence and major depression. , 2009, Archives of general psychiatry.

[3]  Michael F. Green,et al.  Social cognition in schizophrenia: an NIMH workshop on definitions, assessment, and research opportunities. , 2008, Schizophrenia bulletin.

[4]  R. Bentall,et al.  Paranoid Delusions in Schizophrenia Spectrum Disorders and Depression: The Transdiagnostic Role of Expectations of Negative Events and Negative Self-esteem , 2008, The Journal of nervous and mental disease.

[5]  P Kinderman,et al.  A transdiagnostic investigation of ‘theory of mind’ and ‘jumping to conclusions’ in patients with persecutory delusions , 2007, Psychological Medicine.

[6]  T. Woodward,et al.  Metacognitive training in schizophrenia: from basic research to knowledge translation and intervention , 2007, Current opinion in psychiatry.

[7]  Michael Moutoussis,et al.  Persecutory delusions and the conditioned avoidance paradigm: Towards an integration of the psychology and biology of paranoia , 2007, Cognitive neuropsychiatry.

[8]  M. Coltheart,et al.  Jumping to delusions? Paranoia, probabilistic reasoning, and need for closure , 2007, Cognitive neuropsychiatry.

[9]  M. Coltheart,et al.  The defensive function of persecutory delusions: An investigation using the Implicit Association Test , 2007, Cognitive neuropsychiatry.

[10]  R. Mccarthy,et al.  Probabilistic reasoning in schizophrenia: A comparison of the performance of deluded and nondeluded schizophrenic patients and exploration of possible cognitive underpinnings , 2006, Cognitive neuropsychiatry.

[11]  Michael F. Green,et al.  Baseline Neurocognitive Deficits in the CATIE Schizophrenia Trial , 2006, Neuropsychopharmacology.

[12]  Gernot von Collani,et al.  The inferiority complex in paranoia readdressed: A study with the Implicit Association Test , 2006, Cognitive neuropsychiatry.

[13]  C. Barrowclough,et al.  Attributional style, defensive functioning and persecutory delusions: symptom-specific or general coping strategy? , 2006, The British journal of clinical psychology.

[14]  R. Bentall,et al.  Reasoning under uncertainty: heuristic judgments in patients with persecutory delusions or depression , 2006, Psychological Medicine.

[15]  R. Bentall,et al.  Misunderstanding the intentions of others: an exploratory study of the cognitive etiology of persecutory delusions in very late-onset schizophrenia-like psychosis. , 2006, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[16]  P. Garety,et al.  Cognitive functioning in delusions: a longitudinal analysis. , 2006, Behaviour research and therapy.

[17]  L. Krabbendam,et al.  Data gathering: biased in psychosis? , 2006, Schizophrenia bulletin.

[18]  Tyrone D. Cannon,et al.  Endophenotypes in the genetic analyses of mental disorders. , 2006, Annual review of clinical psychology.

[19]  J. Os,et al.  Attribution style and psychosis: evidence for an externalizing bias in patients but not in individuals at high risk , 2006, Psychological Medicine.

[20]  Douglas Turkington,et al.  Cognitive behavior therapy for schizophrenia. , 2006, The American journal of psychiatry.

[21]  S. Hutton,et al.  Cognitive heterogeneity in first-episode schizophrenia , 2005, British Journal of Psychiatry.

[22]  P. Chadwick,et al.  Phenomenological Evidence for Two Types of Paranoia , 2005, Psychopathology.

[23]  S. Kapur,et al.  From dopamine to salience to psychosis—linking biology, pharmacology and phenomenology of psychosis , 2005, Schizophrenia Research.

[24]  M. Coltheart,et al.  Paranoia, persecutory delusions and attributional biases , 2005, Psychiatry Research.

[25]  G. Dunn,et al.  Reasoning, emotions, and delusional conviction in psychosis. , 2005, Journal of abnormal psychology.

[26]  R. Siegert,et al.  Theory of mind in schizophrenia: A critical review , 2005, Cognitive neuropsychiatry.

[27]  Steffen Moritz,et al.  Jumping to conclusions in delusional and non-delusional schizophrenic patients. , 2005, The British journal of clinical psychology.

[28]  Stan Lipovetsky,et al.  Generalized Latent Variable Modeling: Multilevel,Longitudinal, and Structural Equation Models , 2005, Technometrics.

[29]  G. Dunn,et al.  Psychological investigation of the structure of paranoia in a non-clinical population , 2005, British Journal of Psychiatry.

[30]  R. DeRubeis,et al.  Cognitive therapy vs medications in the treatment of moderate to severe depression. , 2005, Archives of general psychiatry.

[31]  R. Siegert,et al.  Schizophrenia, theory of mind, and persecutory delusions , 2005, Cognitive neuropsychiatry.

[32]  R. Bentall,et al.  Persecutory delusions and recall of threat-related, depression-related, and neutral words , 1995, Cognitive Therapy and Research.

[33]  Martin E. P. Seligman,et al.  The attributional Style Questionnaire , 1982, Cognitive Therapy and Research.

[34]  M. Brüne.  "Theory of mind" in schizophrenia: a review of the literature. , 2005, Schizophrenia bulletin.

[35]  N. Tarrier,et al.  Is there evidence that cognitive behaviour therapy is an effective treatment for schizophrenia? A cautious or cautionary tale? , 2004, Behaviour research and therapy.

[36]  D. Flora,et al.  An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. , 2004, Psychological methods.

[37]  David R. Foxcroft,et al.  Multitrait-multimethod confirmatory factor analysis of the attributional style questionnaire , 2004 .

[38]  L. Abramson,et al.  Is there a universal positivity bias in attributions? A meta-analytic review of individual, developmental, and cultural differences in the self-serving attributional bias. , 2004, Psychological bulletin.

[39]  R. Bentall,et al.  Persecutory beliefs, attributions and theory of mind: comparison of patients with paranoid delusions, Asperger's syndrome and healthy controls , 2004, Schizophrenia Research.

[40]  Philip D. Harvey,et al.  The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery , 2004, Schizophrenia Research.

[41]  S. Kapur,et al.  A Model of Antipsychotic Action in Conditioned Avoidance: A Computational Approach , 2004, Neuropsychopharmacology.

[42]  O. Gureje,et al.  Self-Esteem in Patients who have Recovered from Psychosis: Profile and Relationship to Quality of Life , 2004, The Australian and New Zealand journal of psychiatry.

[43]  R. Savage,et al.  Brief Report: A Brief Neuropsychological Testing Battery for Evaluating Patients with Schizophrenia , 2003, Community Mental Health Journal.

[44]  P. Garety,et al.  Characteristics of delusional experience , 2004, European archives of psychiatry and neurological sciences.

[45]  R. Bentall,et al.  Attention, theory of mind, and causal attributions in people with persecutory delusions: A preliminary investigation , 2003, Cognitive neuropsychiatry.

[46]  Nicole A. Lazar,et al.  Statistical Analysis With Missing Data , 2003, Technometrics.

[47]  Nigel Lester,et al.  Madness Explained: Psychosis and Human Nature , 2003, BMJ : British Medical Journal.

[48]  D. Over,et al.  People with delusions jump to conclusions: a theoretical account of research findings on the reasoning of people with delusions , 2003 .

[49]  R. de Graaf,et al.  Discrimination and delusional ideation. , 2003, The British journal of psychiatry : the journal of mental science.

[50]  H. Connery,et al.  A Scottish survey of attitudes to depression in older and younger adults , 2003 .

[51]  E. Kuipers,et al.  A cognitive model of persecutory delusions. , 2002, The British journal of clinical psychology.

[52]  T. T. Haug,et al.  The validity of the Hospital Anxiety and Depression Scale. An updated literature review. , 2002, Journal of psychosomatic research.

[53]  D. Penn,et al.  Attributional style in schizophrenia: an investigation in outpatients with and without persecutory delusions. , 2002, Schizophrenia bulletin.

[54]  R. Bentall,et al.  Persecutory delusions: a review and theoretical integration. , 2001, Clinical psychology review.

[55]  R. Gur,et al.  Neuropsychological differences among empirically derived clinical subtypes of schizophrenia. , 2001, Neuropsychology.

[56]  D. Penn,et al.  Social cognition and subclinical paranoid ideation. , 2001, The British journal of clinical psychology.

[57]  E. Kuipers,et al.  A cognitive model of the positive symptoms of psychosis , 2001, Psychological Medicine.

[58]  T. Goldberg,et al.  Thought Disorder in Schizophrenia: A Reappraisal of Older Formulations and an Overview of Some Recent Studies , 2000 .

[59]  D. Jeste,et al.  Late-Onset Schizophrenia and Very-Late-Onset Schizophrenia-Like Psychosis: An International Consensus , 2000 .

[60]  B. Zumbo,et al.  Construct Validity of Attributional Style: Modeling Context-Dependent Item Sets in the Attributional Style Questionnaire , 1999 .

[61]  T. Stompe,et al.  Comparison of Delusions among Schizophrenics in Austria and in Pakistan , 1999, Psychopathology.

[62]  J. Perner,et al.  Development of theory of mind and executive control , 1999, Trends in Cognitive Sciences.

[63]  K. Nuechterlein,et al.  Should schizophrenia be treated as a neurocognitive disorder? , 1999, European Neuropsychopharmacology.

[64]  P. Garety,et al.  Cognitive approaches to delusions: a critical review of theories and evidence. , 1999, The British journal of clinical psychology.

[65]  E. Brunet,et al.  Investigating theory of mind in schizophrenia: influence of verbalization in disorganized and non-disorganized patients , 1999, Schizophrenia Research.

[66]  R. Murray,et al.  Problem-solving and spatial working memory in patients with schizophrenia and with focal frontal and temporal lobe lesions , 1999, Schizophrenia Research.

[67]  P. Stratta,et al.  Tower of Hanoi and WCST performance in schizophrenia: problem-solving capacity and clinical correlates. , 1999, Journal of psychiatric research.

[68]  P. Bentler,et al.  Cutoff criteria for fit indexes in covariance structure analysis : Conventional criteria versus new alternatives , 1999 .

[69]  B. Everitt,et al.  The effects of neurocognitive remediation on executive processing in patients with schizophrenia. , 1999, Schizophrenia bulletin.

[70]  G. Dunn,et al.  The London-East Anglia randomized controlled trial of cognitive-behaviour therapy for psychosis. IV: Self-esteem and persecutory delusions. , 1998, The British journal of clinical psychology.

[71]  M. Birchwood,et al.  ‘Theory of mind’ skills during an acute episode of psychosis and following recovery , 1998, Psychological Medicine.

[72]  B. Bowins,et al.  Delusions and Self-Esteem , 1998, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[73]  R. Heinrichs,et al.  Neurocognitive deficit in schizophrenia: a quantitative review of the evidence. , 1998, Neuropsychology.

[74]  J. Seltzer,et al.  A review of neuropsychological differences between paranoid and nonparanoid schizophrenia patients. , 1998, Schizophrenia bulletin.

[75]  A. Young,et al.  The effect of self-referent material on the reasoning of people with delusions. , 1997, The British journal of clinical psychology.

[76]  Two predictions about paranoid ideation: deluded, depressed and normal participants' subjective frequency and consensus judgments for positive, neutral and negative events. , 1997, The British journal of clinical psychology.

[77]  R. Bentall,et al.  Causal attributions in paranoia and depression: internal, personal, and situational attributions for negative events. , 1997, Journal of abnormal psychology.

[78]  A. Young,et al.  Normal and abnormal reasoning in people with delusions. , 1997, The British journal of clinical psychology.

[79]  C. Frith,et al.  The appreciation of visual jokes in people with schizophrenia: a study of ‘mentalizing’ ability , 1997, Schizophrenia Research.

[80]  W T Carpenter,et al.  Attentional impairments in deficit and nondeficit forms of schizophrenia. , 1997, The American journal of psychiatry.

[81]  J. Seltzer,et al.  Neuropsychological profiles in schizophrenia: paranoid versus undifferentiated distinctions , 1997, Schizophrenia Research.

[82]  R. O’Reilly,et al.  A computational approach to prefrontal cortex, cognitive control and schizophrenia: recent developments and current challenges. , 1996, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[83]  C. Frith,et al.  Exploring ‘theory of mind’ in people with schizophrenia , 1996, Psychological Medicine.

[84]  R. Bentall,et al.  Sensible Hypothesis Testing in Deluded, Depressed and Normal Subjects , 1996, British Journal of Psychiatry.

[85]  R. Bentall,et al.  A new measure of causal locus: the internal, personal and situational attributions questionnaire , 1996 .

[86]  C. Fear,et al.  Cognitive Processes in Delusional Disorders , 1996, British Journal of Psychiatry.

[87]  C. Frith,et al.  Schizophrenia, symptomatology and social inference: Investigating “theory of mind” in people with schizophrenia , 1995, Schizophrenia Research.

[88]  P. Garety,et al.  The measurement of delusional ideation in the normal population—-introducing the PDI (PEters et al. delusions inventory) , 1995, Schizophrenia Research.

[89]  E. Caine,et al.  Older Age and the Underreporting of Depressive Symptoms , 1995, Journal of the American Geriatrics Society.

[90]  R. Bentall,et al.  The Defensive Function of Persecutory Delusions , 1994, British Journal of Psychiatry.

[91]  A. Satorra,et al.  Corrections to test statistics and standard errors in covariance structure analysis. , 1994 .

[92]  P. Jørgensen,et al.  Delusional beliefs in first admitters. A clinical description. , 1994, Psychopathology.

[93]  Duane T. Wegener,et al.  The problem of equivalent models in applications of covariance structure analysis. , 1993, Psychological bulletin.

[94]  W. Nugent,et al.  Validation of a Clinical Measure of Self-Esteem , 1993 .

[95]  R. Bentall,et al.  Persecutory delusions and recall of threatening propositions. , 1992, The British journal of clinical psychology.

[96]  P. White.  Ambiguity in the internal/external distinction in causal attribution , 1991 .

[97]  S. Wessely,et al.  Reasoning in Deluded Schizophrenic and Paranoid Patients: Biases in Performance on a Probabilistic Inference Task , 1991, The Journal of nervous and mental disease.

[98]  D. Romney,et al.  Attributional style in paranoid vs. depressed patients. , 1990, The British journal of medical psychology.

[99]  J. H. Steiger.  Structural Model Evaluation and Modification: An Interval Estimation Approach. , 1990, Multivariate behavioral research.

[100]  P. Bentler,et al.  Comparative fit indexes in structural models. , 1990, Psychological bulletin.

[101]  K. Dobson.  A meta-analysis of the efficacy of cognitive therapy for depression. , 1989, Journal of consulting and clinical psychology.

[102]  R. Bentall,et al.  Persecutory delusions and attributional style. , 1989, The British journal of medical psychology.

[103]  P. Garety,et al.  Probabilistic Judgements in Deluded and Non-Deluded Subjects , 1988, The Quarterly journal of experimental psychology. A, Human experimental psychology.

[104]  D. Rubin,et al.  Statistical Analysis with Missing Data. , 1989 .

[105]  J. S. Tanaka.  "How Big Is Big Enough?": Sample Size and Goodness of Fit in Structural Equation Models with Latent Variables. , 1987 .

[106]  G. Huston.  The Hospital Anxiety and Depression Scale. , 1987, The Journal of rheumatology.

[107]  IN Teens,et al.  MANIC-DEPRESSIVE ILLNESS , 1986, The Lancet.

[108]  D. Ndetei,et al.  Frequency and clinical significance of delusions across cultures , 1984, Acta psychiatrica Scandinavica.

[109]  C. Ross,et al.  Paranoia and the structure of powerlessness. , 1983, American sociological review.

[110]  P. Bentler.  MULTIVARIATE ANALYSIS WITH LATENT VARIABLES: CAUSAL MODELING , 1980 .

[111]  L. Tucker,et al.  A reliability coefficient for maximum likelihood factor analysis , 1973 .

[112]  D. Lindley,et al.  Bayes Estimates for the Linear Model , 1972 .

[113]  B. Angrist,et al.  The phenomenology of experimentally induced amphetamine psychosis--preliminary observations. , 1970, Biological psychiatry.

[114]  F. Samejima.  Estimation of latent ability using a response pattern of graded scores , 1968 .

[115]  W. Edwards,et al.  Conservatism in a simple probability inference task. , 1966, Journal of experimental psychology.

[116]  Melvin R. Novick,et al.  Some latent train models and their use in inferring an examinee's ability , 1966 .

[117]  F. Lord.  LARGE‐SAMPLE COVARIANCE ANALYSIS WHEN THE CONTROL VARIABLE IS FALLIBLE* , 1958 .