Cultural themes in the psychotic symptoms of African American psychiatric patients.

Professional psychologists need to recognize ethnic/racial differences between African Americans and European Americans in psychotic symptom expression to treat individuals with severe mental illness from various cultural backgrounds. Specifically, they need to understand confluent paranoia or the interaction between culture and pathology in psychotic symptom expression. To assist mental health professionals, the present study identified cultural themes in the delusions and hallucinations of a sample of 156 African American psychiatric patients via content analysis. Race-related themes and religious themes were observed in the psychotic symptoms of these patients assessed with the Structured Clinical Interview for DSM IV. Race-related and religious content were manifested in different types of delusions. Race-related themes were more common in persecutory delusions, whereas religious themes occurred more often in other delusions. Race-related themes were associated more with delusions, while religious themes correlated with both delusions and hallucinations. Implications for the treatment of confluent paranoia in African Americans are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sentence verification and delusions: a content-specific deficit

BACKGROUND: A sentence verification task was developed to investigate semantic memory in schizophrenia. METHODS: The test consisted of three types of sentence (true, unlikely and nonsense) and seven different types of content (neutral, persecutory, grandiose, political, religious, relationships and somatic) representing common delusional themes present in schizophrenic patients. Sixty-three schizophrenic patients and 66 matched control subjects were asked to make true/false judgements to 143 sentences. RESULTS: Overall accuracy was similar across the two groups; sentences with some emotional themes and sentences of the unlikely type produced the most violations. Significant differences between the two subject groups were found specifically on nonsense sentences with persecutory and religious themes. Patients made significantly more incorrect responses (acceptance) to nonsense sentences that had an emotional content congruent with their delusional beliefs, past or present, and also on unlikely sentences (incorrect rejections) whose content was not congruent with their delusions. Further analysis of response bias in the patients showed, overall, that there were more incorrect rejections (a reflection of the large number of unlikely sentence errors) and more incorrect responses to sentences congruent with patients delusions. Furthermore, analysis of those patients currently experiencing delusions revealed more incorrect responses to sentences congruent with their delusional ideas compared with patients not currently deluded. CONCLUSIONS: These findings are indicative of cognitive bias in schizophrenia towards certain emotional themes that may underlie illogical semantic connections and delusions.     

Implicit and explicit self-esteem discrepancies in paranoia and depression.

The main purpose of the present study was to examine implicit and explicit self-esteem (SE) in patients with persecutory delusions. In samples of paranoid patients, depressed patients, and healthy controls, implicit SE was assessed using the experimental go/no-go association task, whereas explicit SE was measured using 2 self-reporting questionnaires: the self-worth subscale of the World Assumption Scale (Janoff-Bulman, 1989) and the self-acceptance subscale of the Scales of Psychological Well-Being (Ryff & Keyes, 1995). Our analysis revealed that depressed patients showed lower explicit SE than did paranoid and healthy control participants. However, participants with persecutory delusions had significantly lower implicit SE scores than did healthy controls. We interpret the discrepancies observed between overt and covert measures in the paranoid group as psychological defense mechanisms. The present study stresses the clinical and theoretical importance of the use of implicit measures in psychopathology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The pathogenesis of persecutory delusions in the light of the attribution theory

Among the present pathogenetic hypotheses of delusions the cognitive model based on the attribution theory presents interesting assumptions. The attribution theory describes the ways in which we explain causes of events and human behaviour from the point of view of common sense psychology, as well as biases found in explaining everyday events, known as attribution errors. One of them is self-serving bias, which protects self-esteem and distorts attribution processes. Kaney, Bentall and co-workers revealed the defensive attributional style in the patients with persecutory delusions and after empirical research they suggested that delusions are the extreme forms of self-serving bias. After presenting the studies of Kaney-Bentall the authors of the article express their doubts regarding attributional hypothesis of persecutory delusions.     

Confluent paranoia in African American psychiatric patients: An empirical study of Ridley's typology.

This study examined C. R. Ridley's (1984) typology of paranoia in African Americans, which assumes orthogonal dimensions of culture and pathology in symptom expression. Median split of scores on the Cultural Mistrust Inventory and the scale of False Beliefs and Perceptions represented high and low levels of cultural paranoia and pathological paranoia, respectively. The 4 groups of Black patients were nonparanoia, cultural paranoia, pathological paranoia, and confluent paranoia. A Fenigstein Paranoia Scale manipulation check indicated that differences in paranoid symptom expression among the groups were partially supportive of Ridley's model, as were measures of perceptions of hostility and self-esteem. Omnibus tests of between-groups differences were significant for global assessment of functioning and number of symptoms recorded in patients' charts. Predicted pattern testing revealed a significant severity dimension in mean scores across paranoia groups for some measures of clinician-rated functioning but not others. SCID interviewers' ratings of cultural mistrust and number of times restrained (or secluded) were more consistent with a pattern representing a cultural dimension than a severity dimension across paranoia groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The search for dimensional structure differences between normality and abnormality: A statistical review of published data on personality and psychopathology.

A statistical review of published data for 37 personality and psychopathology inventories was conducted to determine whether there are dimensional structure differences between clinical and nonclinical respondents. Correlation and factor-loading matrices from multiscale inventories and from specialized measures were tested for structural invariance across populations. There was relatively consistent evidence for high levels of similarity between normal and abnormal populations both in the number of factors that exist in the data matrices and in the factor patterns. The dimensional universes of normality and abnormality are apparently the same, at least according to data derived from contemporary assessment instruments. Categorical-taxonic differences between clinical and nonclinical populations, which were not examined, may nevertheless exist within contexts of dimensional structure similarity. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Factor structure of the Paranoia scale of the MMPI–2 in relation to the Harris-Lingoes subscales and Comrey factor analysis.

A 3-factor structure for the Paranoia (Pa) scale of the Minnesota Multiphasic Personality Inventory—2 (J. N. Butcher. W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) was derived in a sample of 378 patients with substance use disorders and validated by confirmatory factor analysis in a separate sample of 226 patients. Factors labeled Paranoia and Low Morale were positively correlated with each other but inversely correlated with Naiveté, and factor correlations were largely explained by a General Maladjustment construct, as defined by Welsh's Anxiety scale. The content of the Paranoia factor was obviously related to the concept of paranoia, and Low Morale had a high correlation with General Maladjustment. Naiveté was defined primarily by "false" responses to items that endorse cynical attitudes. The 3 factors corresponded well with the Harris-Lingoes Pa subscales of Persecutory Ideas, Poignancy, and Naiveté and aligned closely with groups of factors from the 9-factor solution of Comrey (1958). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fabrication of delusional thinking in normals.

Tested a learning model for paranoid development by requiring Ss in the laboratory to fabricate ideation under conditions approximating those thought to be conducive to actual clinical delusions. Measures used on the 92 male undergraduate Ss included the Parent Attitude Research Instrument, the Parent–Child Interaction Rating Scales, and the Adjective Check List. Ss proposed to be susceptible to paranoid ideation, that is, late-adolescent males who have adopted an open style of adapting to the aversive-maternal-control experience, demonstrated the proposed signs of delusional thinking in their belief systems. Ss were required to formulate a rationale for the view that they believed others held concerning them. The open-style group, relative to control groups, provided beliefs that were more extensive, less credible, more concerned with negative information, and, for the more extended beliefs, better integrated and more presumptive of outside social influence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pharmacotherapy for Delusional Disorder and Associated Conditions.

Delusional disorder, according to current psychiatric nosology, is the presence of one or more nonbizarre delusions (i.e., false beliefs that nonetheless may be plausible or derived from ordinary life experiences) that do not occur in the context of schizophrenia and often exist in the presence of generally acceptable levels of psychosocial functioning. Currently recognized subtypes of delusional disorder are erotomanic (a delusion that another is in love with the patient), grandiose, jealous, persecutory, or somatic (Manschreck, 2000). As Manschreck noted, the diagnosis is complicated by disagreements over the distinction between bizarre and nonbizarre delusions, as well as the fact that the features of certain subtypes of delusional disorder may closely resemble those found in other conditions. Very little data, aside from anecdotal or case reports, exist to inform practice regarding the treatment of delusional disorder. Much of the recent literature addresses delusions that exist in the context of dementia or another underlying neurological disorder. It is important to recognize the substantial differences between these conditions and a primary delusional disorder. This brief review examines not only pharmacological management of primary delusional disorder but also delusions in the context of dementia and related disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The facets of anxiety sensitivity represented in the Childhood Anxiety Sensitivity Index: Confirmatory analyses of factor models from past studies.

Results of past factor analytic studies of the Childhood Anxiety Sensitivity Index and Anxiety Sensitivity Index were used to formulate hypotheses about factor models of anxiety sensitivity. Using a nonclinical sample of 767 children and adolescents and confirmatory factor analysis, hypothesized models with 2, 3, and 4 lower order factors (facets) were tested. Goodness-of-fit criteria indicated that a model with 4 facets fits these data well. Support was found for factorial invariance of the 4 facets across age and gender, using nonclinical and clinical samples. Results support a hierarchical factor model in that there was a strong general factor, explaining 71% of the variance. Findings are discussed in the context of anxiety sensitivity theory and research with children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autoregulatory vasodilation of parenchymal vessels is impaired during cerebral vasospasm

OBJECTIVE: A recent study (Arnow, Kenardy, & Agras, 1995, Journal of Behavioral Medicine, 15, 155-170) has reported on the development and preliminary validation of the Emotional Eating Scale (EES), a questionnaire measure of the tendency to eat in response to affective state. The EES showed high levels of validity among obese binge eaters, but there was no attempt to validate the measure among nonclinical groups. The present study assessed the validity of the EES among nonclinical women, in order to determine whether or not emotional eating is related to unhealthy eating characteristics among the general population. METHODS: The participants were 51 women with no current or past eating disorder. Each completed the EES and the Eating Disorders Inventory (EDI). Validity of the EES was tested using measures of internal consistency and correlations with EDI scales. RESULTS: The EES scales showed a high level of internal consistency and specific associations with EDI scales (particularly Bulimia, Ineffectiveness, and Interpersonal Distrust). The normative scores for this population were substantially lower than among binge eaters, but similar to those found among other clinical groups. CONCLUSIONS: The EES has good levels of validity. It demonstrates that emotional eating is related to bulimic eating attitudes in the broader population, although issues of causality need to be considered. The EES may have a role in the early identification of eating problems in nonclinical groups. Its utility with other eating-disordered groups remains to be established, but there are potential roles in the targeting and evaluation of treatment.     

The behavioral pathology in Alzheimer's Disease Scale (BEHAVE-AD): factor structure among community-dwelling Alzheimer's disease patients

OBJECTIVE: The aims of this study were to (a) determine the factor structure of the Behavioral Pathology in Alzheimer's Disease Scale (BEHAVE-AD), and (b) examine the associations of the observed factors to the level of cognitive impairment. DESIGN: Cross-sectional study of geriatric patients evaluated at an outpatient memory disorders clinic. SAMPLE: One hundred and fifty-one consecutive patients diagnosed with Alzheimer's disease (AD) according to NINCDS-ADRDA diagnostic criteria. RESULTS: Principal factors analysis with Varimax rotation resulted in a five-factor solution that accounted for 40.0% of the common variance. The factors included agitation/anxiety (agitation, anxiety of upcoming events; other anxiety), psychosis (delusions of theft, suspiciousness/paranoia; visual hallucinations), aggression (verbal aggressiveness; physical threats/violence; fear of being left alone; other delusions), depression (tearfulness; depressed mood) and activity disturbance (wandering; delusion one's house is not one's home). Several factors were associated with level of cognitive impairment as assessed by the Mini-Mental State Examination (MMSE). CONCLUSION: The results of this study suggest that the BEHAVE-AD measures a wide range of behavioral pathology that can be empirically represented by five independent symptom clusters among outpatient AD patients.     

The impact of personality on the reporting of unfounded symptoms and illness.

This study examined the role of personality in the reporting of symptoms and illness not supported by underlying pathology. After assessment of the Big Five personality factors, 276 healthy volunteers were inoculated with a common cold virus. On each of the following 5 days, objective indicators of pathology, self-reported symptoms, and self-reported illness onset were assessed. Neuroticism was directly associated with reports of unfounded (without a physiological basis) symptoms in individuals at baseline and postinoculation in those with and without colds. Neuroticism was also indirectly associated with reports of unfounded illness through reports of more symptoms. Openness to Experience was associated with reporting unfounded symptoms in those with verifiable colds, whereas Conscientiousness was associated with reporting unfounded illness in those who were not ill. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fluctuations in self-esteem and paranoia in the context of daily life.

Studies investigating the relationship between self-esteem and paranoia have specifically focused on self-esteem level, but have neglected the dynamic aspects of self-esteem. In the present article, the authors investigated the relationship between self-esteem and paranoia in two different ways. First, 154 individuals ranging across the continuum in level of paranoia were studied with the Experience Sampling Method (a structured self-assessment diary technique) to assess the association between trait paranoia and level and fluctuation of self-esteem in daily life. Results showed that trait paranoia was associated with both lower levels and higher instability of self-esteem. Second, the temporal relationship between momentary (state) paranoia and self-esteem was investigated in the daily life of these individuals. Results showed that a decrease in self-esteem was associated with an immediate increase in paranoia. The findings indicate that paranoid individuals are not only characterized by a lower level of self-esteem but also by more fluctuations in their self-esteem and that fluctuations in self-esteem predict the degree of subsequent paranoia. These results are consistent with the hypothesis that paranoia is associated with dysfunctional strategies of self-esteem regulation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The reliability and validity of discrete and continuous measures of psychopathology: A quantitative review.

[Correction Notice: An erratum for this article was reported in Vol 137(6) of Psychological Bulletin (see record 2011-24066-002). In the Samples section of Meta-Analysis 1: Reliability, third paragraph, the number of studies reporting data on clinical samples is incorrect. The sentence “Four studies included clinical samples, and eight studies included nonclinical samples” should read “Twenty-four studies included clinical samples, and eight studies included nonclinical samples.”] In 2 meta-analyses involving 58 studies and 59,575 participants, we quantitatively summarized the relative reliability and validity of continuous (i.e., dimensional) and discrete (i.e., categorical) measures of psychopathology. Overall, results suggest an expected 15% increase in reliability and 37% increase in validity through adoption of a continuous over discrete measure of psychopathology alone. This increase occurs across all types of samples and forms of psychopathology, with little evidence for exceptions. For typical observed effect sizes, the increase in validity is sufficient to almost halve sample sizes necessary to achieve standard power levels. With important caveats, the current results, considered with previous research, provide sufficient empirical and theoretical basis to assume a priori that continuous measurement of psychopathology is more reliable and valid. Use of continuous measures in psychopathology assessment has widespread theoretical and practical benefits in research and clinical settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Distinguishing psychotic depression from melancholia

We contrast 25 patients with "psychotic depression" (PD) against two age- and sex-matched groups of melancholic depressed patients. In terms of clinical features, specificity of PD was suggested for several features, including delusions, morbid cognitions (involving guilt and a sense of deserving punishment), hallucinations and constipation. In addition, the PDs had significantly higher levels of behaviourally rated psychomotor disturbance. A comprehensive list of risk factors to depression (e.g., socio-demographic, family history, parental influences, medical disorders, anxiety, stressors and personality style) were examined, without clear differentiation between the comparison groups apart from the suggestion that being a "worrier" and having tenuous stability under stress was over-represented in the PDs. Findings favour the view that psychotic depression is a sub-type of melancholic depression (accounting for the similar expression of the majority of clinical and possible aetiological variables across our contrasted "types'). Findings also suggest possible benefits from future phenomenological studies of psychotic depression relying more on observer-based rather than self-report or symptom data sets. Aetiological studies would benefit from focussing on those features identified as distinguishing the condition from melancholic depression.     

Lacan on paranoiac knowledge.

For Lacan, all knowledge is imbued with paranoia. Although this claim was largely unarticulated by Lacan himself, I attempt to give conceptual clarity to the epistemological process of paranoiac knowledge situated in Lacan's three contexts of being. Developmentally, knowledge is paranoiac because it is acquired through our imaginary relation to the other as a primordial misidentification or illusory self-recognition of autonomy, control, and mastery, thus leading to persecutory anxiety and self-alienation. Secondarily, through the symbolic structures of language and speech, desire is foisted upon us as a foreboding demand threatening to invade and destroy our uniquely subjective inner experiences. And finally, the process of knowing itself is paranoiac because it horrifically confronts the real, namely, the unknown. Through our examination of a clinical case study, paranoiac knowledge manifests itself as the desire not to know. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Markon et al. (2011).

Reports an error in "The reliability and validity of discrete and continuous measures of psychopathology: A quantitative review" by Kristian E. Markon, Michael Chmielewski and Christopher J. Miller (Psychological Bulletin, 2011[Sep], Vol 137[5], 856-879). In the Samples section of Meta-Analysis 1: Reliability, third paragraph, the number of studies reporting data on clinical samples is incorrect. The sentence “Four studies included clinical samples, and eight studies included nonclinical samples” should read “Twenty-four studies included clinical samples, and eight studies included nonclinical samples.” (The following abstract of the original article appeared in record 2011-09705-001.) In 2 meta-analyses involving 58 studies and 59,575 participants, we quantitatively summarized the relative reliability and validity of continuous (i.e., dimensional) and discrete (i.e., categorical) measures of psychopathology. Overall, results suggest an expected 15% increase in reliability and 37% increase in validity through adoption of a continuous over discrete measure of psychopathology alone. This increase occurs across all types of samples and forms of psychopathology, with little evidence for exceptions. For typical observed effect sizes, the increase in validity is sufficient to almost halve sample sizes necessary to achieve standard power levels. With important caveats, the current results, considered with previous research, provide sufficient empirical and theoretical basis to assume a priori that continuous measurement of psychopathology is more reliable and valid. Use of continuous measures in psychopathology assessment has widespread theoretical and practical benefits in research and clinical settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Causal attributions in paranoia and depression: Internal, personal, and situational attributions for negative events.

Causal attributions for positive and negative hypothetical social events made by paranoid patients, depressed patients, and nonpatient participants were examined via a novel measure of causal locus, the Internal, Personal and Situational Attributions Questionnaire. Depressed patients tended to attribute negative social events to internal (self-blaming) causes. Nonpatient participants and patients with delusions of persecution tended to avoid such self-blame. However, whereas nonpatient participants tended to choose situational or circumstantial external attributions, paranoid patients tended to choose external attributions that located blame in other individuals. These findings support R. P. Bentall, P. Kinderman, and S. Kaney's (1994) defensive attributional model of persecutory delusions, suggest some modifications to that model, and have implications for the understanding of the relationship between causal attributions and social and self-perception. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Topical bleomycin for the treatment of dysplastic oral leukoplakia

The objective of this study was to predict suicidality in people with schizophrenia. Ninety-six patients with recent-onset schizophrenia were rated every 2 weeks for 1 year to examine (1) the temporal course of suicidal ideation and suicide attempts and (2) the extent to which anxiety, depression, and mild suicidal ideation were followed by significant suicidal ideation or a suicide attempt. The severity of suicidality changed rapidly. Low levels of suicidal ideation increased the risk for significant suicidal ideation or a suicide attempt during the subsequent 3 months. Depression was moderately correlated with concurrent suicidality, but not independently associated with future suicidality. Therefore, low levels of suicidal ideation may predict future suicidal ideation or behavior better than depressed mood in individuals with schizophrenia.