Are paranoid ideation and hallucination spectrum experiences differently associated with affect dynamics? A continuous-time modeling approach.

Psychotic experiences have been associated with distortions in affective functioning, including aberrancies in affect dynamics. However, it remains unclear whether the two principal symptom dimensions of psychosis, namely paranoid ideation and hallucination spectrum experiences, are differently associated with affect dynamics, and whether associations hold after statistically controlling for depressive symptoms. We investigate this by using a novel statistical approach, the hierarchical Ornstein-Uhlenbeck (OU) process model. This is a continuous-time stochastic differential equations model in a Bayesian framework that describes dynamics in affective valence and arousal via three core parameters: attractor point, variability, and attractor strength. In a community sample with varying levels of psychotic experiences (n = 116), we measured affective valence and arousal 10 times per day for 7 days, using the experience-sampling method. We found-while statistically controlling for depressive symptoms-credible between-subjects associations between paranoid ideation and attractor points of negative valence and high arousal. We also found a credible positive association between hallucination spectrum experiences and arousal variability. Limited evidence emerged for small associations between paranoid ideation and high valence variability as well as between paranoid ideation and high attractor strengths of valence and arousal. Hallucination spectrum experiences showed some evidence for a small association with high arousal attractor points. The detailed picture of affect dynamics provided by the OU model reveals different cross-sectional affective profiles associated with paranoid ideation versus hallucination spectrum experiences that suggest different affective mechanisms of their formation and maintenance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

New-Onset Paranoia in an Elderly Woman With Bipolar Disorder: Differential Diagnosis, Evaluation, and Treatment.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Paranoia is associated with impaired novelty detection and overconfidence in recognition memory judgments.

False recognition, or the mis-categorization of a "new" stimulus as "old," might support fixed false beliefs by blocking new learning or otherwise contributing to internal representations of the world that are at odds with reality. However, the mechanisms through which false recognition is facilitated among paranoid individuals remain unclear. We examined 2 phenomena that may contribute to this effect: an overreliance on fluency-based processes during recognition, manifesting as a lower threshold for judging items as recently studied, and a propensity to require less information to come to a highly confident judgment. The former would be expected to be particularly pronounced among items that are generally familiar, as opposed to completely novel. Here, we manipulated familiarity in a recognition memory paradigm by using stimuli that varied in their rate of extraexperimental exposure (i.e., real words vs. pseudowords). Further, to determine whether paranoia was associated with a tendency to differentially misallocate confidence to errors, we calculated a hierarchical Bayesian estimate of metacognitive sensitivity (meta-d') in addition to the more classic d'. In line with our hypotheses, paranoia was associated with an increased rate of false alarm errors, differentially so for familiar versus unfamiliar stimuli, suggesting that a context-agnostic, familiarity-based memory system might underlie observed memory distortions. What's more, paranoia was associated with heightened confidence on error trials and reduced metacognitive sensitivity. These findings highlight 2 distinct deficits-in both novelty detection and metacognitive monitoring-that contribute to false recognition judgments, offering targets for cognitive interventions to reduce memory distortion among paranoid individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Anxiety mediates the relationship between interpretation bias and paranoia in patients with persistent persecutory beliefs.

Background and Objectives: The role of interpretation bias in generating and maintaining persecutory beliefs/paranoid ideation is becoming established in the literature, but how negative mood affects this relationship remains unclear. The current study investigated the mediating role of anxiety and depression in the association between interpretation bias and paranoia in patients with persistent paranoia. Methods/Design: We applied the mediation model to clinical data gathered from patients with persistent paranoia (N = 62), and compared how levels of depression and anxiety affected the association between interpretation bias and paranoia. Results: Interpretation bias and anxiety accounted for 43% of the variance in paranoia, while interpretation bias and depression explained 31% of this variance. Levels of anxiety, but not depression, partially mediated the relationship between interpretation bias and paranoid beliefs. Our data suggest that the association between interpretation bias and paranoid beliefs takes effect partly, although not completely, through heightened levels of anxiety. Conclusions: The current study highlighted the role of anxiety as a mediator in the association between interpretation bias and paranoid beliefs in patients with distressing paranoia. These findings inform the potential mechanism underlying cognitive interventions for pathological paranoia. Trial registration: Current Controlled Trials ISRCTN: 90749868. Retrospectively registered on 12 May 2016.

Temporal associations between sleep quality and paranoia across the paranoia continuum: An experience sampling study.

Sleep disturbances are prevalent among individuals with a psychotic disorder and have been linked to symptoms of paranoia across the entire psychosis continuum. Emerging evidence suggests that rather than a secondary symptom, poor quality of sleep may contribute to elevated paranoid ideation. We investigated the temporal dynamics of sleep quality and paranoid ideation using the experience sampling method in 42 acutely paranoid individuals with a psychotic disorder, 32 nonparanoid individuals with psychotic disorder, and 41 individuals with high schizotypy traits. We applied time-lagged mixed multilevel modeling to tease apart the effect of poor sleep quality on morning paranoia and negative affect, and the impact of evening paranoid ideation and negative affect on subsequent sleep quality. In the whole sample, poor subjective sleep quality predicted elevated paranoia the following morning, a relationship that was fully mediated by morning negative affect. No significant association between evening paranoia and poor sleep the following night emerged. In the everyday lives of individuals on the paranoia continuum, low quality of sleep appears to drive paranoia through its impact on negative affect. These findings identify sleep quality as an important target of transdiagnostic interventions for psychotic and affective symptomatology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

An Experimental Investigation into the Effect of State-Anxiety on State-Paranoia in People Experiencing Psychosis.

BACKGROUND: There is strong evidence to suggest that anxiety is associated with paranoia in clinical and non-clinical samples. However, no research to date has directly manipulated anxiety to investigate if state-anxiety has a causal role in state-paranoia in clinical populations. AIMS: To investigate whether an anxious-mood induction leads to greater paranoia than a neutral-mood induction in people experiencing psychosis and paranoia and, if so, whether this is predicted by anxiety over and above other variables. METHOD: 22 participants with a psychosis-spectrum diagnosis took part in a two condition cross-over experimental design. Participants underwent a neutral-mood and an anxious-mood induction with levels of state-anxiety, state-affect and state-paranoia being measured before and after each condition. RESULTS: State-paranoia was significantly higher after the anxious condition compared with the neutral condition. State-anxiety and negative-affect were significant predictors of levels of state-paranoia after the anxious condition. When both predictors were included in a regression model, only negative-affect was a significant predictor of state-paranoia after the anxious condition. There were a number of methodological limitations. CONCLUSIONS: State-anxiety and negative-affect may both be involved in the maintenance of paranoia in clinical populations, as predicted by cognitive models. Negative-affect may be the strongest predictor of state-paranoia in clinical populations. Reasons for this are discussed, as well as the implications. Interventions that seek to reduce negative state-affect may be beneficial in managing state-paranoia. Further research is warranted to explore the suggested clinical and theoretical implications of these findings.

Paranoia Symptoms Moderate the Impact of Emotional Context Processing on Community Functioning of Individuals with Schizophrenia.

This study examined whether better emotional context processing is associated with better community functioning among persons with schizophrenia, and whether the relationship between the two variables is moderated by level of paranoid symptoms. The Brief Psychiatric Rating Scale-Expanded Version, Emotional Context Processing Scale, and Multnomah Community Ability Scale were administered to 39 community-dwelling participants with schizophrenia or schizoaffective disorder. Emotional context processing had a small-to-moderate association with community functioning. However, the association between emotional context processing and community functioning was moderated by level of paranoid symptoms. Emotional context processing in participants with mild paranoid symptoms was strongly associated with better community functioning, whereas emotional context processing in those with severe paranoid symptoms was not. Emotional context processing and the degree of paranoia should be considered in treatment plans designed to enhance the community functioning of individuals with schizophrenia to help them improve their understanding of social situations.

Sleeping Paranoia Away? An Actigraphy and Experience-Sampling Study with Adolescents.

Paranoid symptoms co-occur with distress and poor functioning and constitute a risk for psychosis and other mental disorders. Poor sleep is known to be associated with paranoid symptoms, but the direction of the effect and the mediating factors have not been studied thoroughly. In an experience-sampling study, 61 adolescents wore an actigraph over eight nights and also rated their sleep, symptoms of paranoia, and potentially mediating factors. Shorter sleep time and more dreaming predicted paranoid symptoms in multilevel regression models. Paranoid symptoms did not significantly predict sleep parameters. Positive and negative affect partially mediated the effect of sleep time on paranoid symptoms. The effects were small, but encourage further research that might then be used to improve the prevention of paranoid symptoms.

Negative schemata about the self and others and paranoid ideation in at-risk states and those with persisting positive symptoms.

BACKGROUND: The objective of this study is to test the conflicting theories concerning the association of negative self and other schemata and paranoid ideation. METHODS: A risk-based approach, including risk stratification, is used to gain insight into the association of the negative self and other schemata that may be shared by individuals or differentiate between individuals at clinical high risk (CHR) for a first-episode psychosis and those with full-blown psychosis. The dataset includes a sample of individuals at CHR (n = 137) and a sample of individuals with persisting positive symptoms (PPS, n = 211). The CHR sample was subdivided according to a prognostic index yielding 4 CHR sub-classes with increasing risk for transition to psychosis. RESULTS: Negative beliefs about the self were associated with paranoid ideation in CHR and a lower risk state. In the highest risk state and full-blown psychosis, there is an association with negative beliefs about others. CONCLUSION: These findings are in line with theories suggesting a switch from a predominantly activated negative self-schema to a malevolent others-schema in association with paranoid ideation along the risk-continuum. However, due to methodological limitations these results should be replicated by future studies.

A structural equation model of the relationship between insomnia, negative affect, and paranoid thinking.

BACKGROUND: A growing body of evidence points to relationships between insomnia, negative affect, and paranoid thinking. However, studies are needed to examine (i) whether negative affect mediates the relation between insomnia and paranoid thinking, (ii) whether different types of insomnia exert different effects on paranoia, and (iii) to compare the impact of objective and self-reported sleeping difficulties. METHOD: Structural equation modelling was therefore used to test competing models of the relationships between self-reported insomnia, negative affect, and paranoia. n = 348 participants completed measures of insomnia, negative affect and paranoia. A subset of these participants (n = 91) went on to monitor their sleep objectively (using a portable sleep monitor made by Zeo) for seven consecutive nights. Associations between objectively recorded sleep, negative affect, and paranoia were explored using linear regression. RESULTS: The findings supported a fully mediated model where self-reported delayed sleep onset, but not self-reported problems with sleep maintenance or objective measures of sleep, was directly associated with negative affect that, in turn, was associated with paranoia. There was no evidence of a direct association between delayed sleep onset or sleep maintenance problems and paranoia. CONCLUSIONS: Taken together, the findings point to an association between perceived (but not objective) difficulties initially falling asleep (but not maintaining sleep) and paranoid thinking; a relationship that is fully mediated by negative affect. Future research should seek to disentangle the causal relationships between sleep, negative affect, and paranoia (e.g., by examining the effect of an intervention using prospective designs that incorporate experience sampling). Indeed, interventions might profitably target (i) perceived sleep quality, (ii) sleep onset, and / or (iii) emotion regulation as a route to reducing negative affect and, thus, paranoid thinking.

Adversity and persecutory ideation: A moderated mediational model.

Adversity has been identified as an important factor in models of psychopathology and can help in understanding persecutory ideation, although potential moderators and mediators for adult psychopathology have not been sufficiently examined. Experiential avoidance (EA) and Self-esteem (SE) are relevant factors to understand how adversity leads to persecutory ideation. This study hypothesized that adversity would be associated with persecutory ideation through heightened EA, and that this association would be strengthened in individuals with a discrepant high SE. Participants with persecutory ideation (n = 52), with depression (n = 35) and healthy controls (n = 51) were assessed with the Trauma History Screen, the Paranoia and Deservedness Scale, and the Beck Depression Inventory. A SE discrepancy index was calculated subtracting the normalized explicit SE score from the normalized implicit SE score (measured by a version of a Go/No-go association task). Our analysis revealed that adversity was associated with higher levels of paranoia and was mediated by EA. In addition, we found that the relationship between adversity and EA was moderated by SE discrepancy. Identification of moderating and mediating variables allows for increased understanding of persecutory ideation and the processes that should be targeted in the course of recovery.

Predictors and mediators of trait anger across the psychosis continuum: The role of attachment style, paranoia and social cognition.

Anger in the context of psychosis has a significant impact on treatment outcomes and serious implications for risk management. Understanding mechanisms underlying anger will improve interventions and inform strategies for prevention. This study is the first to examine the relationships between anger and key theoretical drivers across different phases of the psychosis continuum. A battery including measures of theory of mind, attachment, hostile attribution bias, paranoia and anger was administered to 174 participants (14 ultra-high risk, 20 first-episode, 20 established psychosis, 120 non-clinical participants). We tested the model that insecure attachment, paranoia, impaired theory of mind and hostile attribution bias would predict trait anger using multiple regression. Attachment avoidance, paranoia and hostile attribution bias were significantly associated with anger but attachment anxiety and theory of mind were not. Mediation analysis showed that paranoia partially mediated the relationship between avoidant attachment and anger but hostile attribution bias did not. Findings emphasise the importance of interventions targeting paranoia to reduce anger and the potential of preventive strategies focused on attachment relationships in early life or adulthood to reduce adult paranoia and anger.

Scanning to conclusions? Visual attention to neutral faces under stress in individuals with and without subclinical paranoia.

BACKGROUND AND OBJECTIVES: A promising candidate for a vulnerability indicator for psychosis is the restricted scanpath. Restricted scanning of social stimuli, such as faces, might also contribute to misinterpretations of facial expressions and thus increase the likelihood of delusional interpretations. Moreover, similar to other vulnerability indicators of psychosis, scanpaths may be susceptible to stress. Thus, we hypothesized that scanpath restriction would increase as a function of delusion-proneness, stress and their interaction. METHODS: Participants were asked to look at neutral faces and rate their trustworthiness under a stress and a non-stress condition, while the eye gaze was recorded. The non-clinical sample was classified into low- and high-paranoia scorers using a median split. Eye-tracking parameters of interest were number of fixations, fixations within emotion-relevant facial areas, scanpath length and duration of fixations. RESULTS: In general, high-paranoia scorers had a significantly shorter scanpath compared to low-paranoia scorers (F(1, 48) = 2.831, p = 0.05, ηp2 = 0.056) and there was a trend towards a further decrease of scanpath length under stress in high-paranoia scorers relative to low-paranoia scorers (interaction effect: F(1, 48) = 2.638, p = 0.056, ηp2 = 0.052). However, no effects were found for the other eye-tracking parameters. Moreover, trustworthiness ratings remained unaffected by group or condition. LIMITATIONS: The participants of this study had only slight elevations of delusion-proneness, which might explain the absence of differences in trustworthiness ratings. CONCLUSIONS: Restricted scanpaths appear to be partly present in individuals with subclinical levels of paranoia and appear to be susceptible to stress in this group. Nevertheless, further research in high-risk groups is necessary before drawing more definite conclusions.

Feasibility and Effects of a Brief Compassion-Focused Imagery Intervention in Psychotic Patients with Paranoid Ideation: A Randomized Experimental Pilot Study.

Paranoia is characterized by a lack of perceived social safeness and associated negative affect. Low self-esteem, negative self-concepts and negative emotions have been shown to contribute to paranoid symptom formation. Thus, interventions focusing on affiliation and positive affect might be particularly helpful for patients with paranoia. The present study experimentally tested the effect of a one-session, brief compassion-focused imagery derived from Compassion-Focused Therapy (Gilbert, ) versus a control imagery condition in a repeated measures randomized design. A negative affective state was induced via in-sensu exposure to a recent distressful social situation in order to provide a minimum level of threat-related arousal to be down-regulated by the interventions thereafter. The sample consisted of psychotic patients with paranoid ideation (N = 51) who were randomly assigned to one of the experimental conditions. Effects on postulated causal mechanisms, i.e., self-relating (self-reassurance, self-compassion, self-criticism), and affect (self-reported affective states, skin conductance levels) as well as on state paranoia, were tested. Subjective benefit and appraisals of the intervention were explored. There were no specific intervention effects on negative self-relating, negative affect and skin-conductance or on paranoia. However, compassion-focused imagery had significant effects on self-reassurance and happiness. Explorative analyses revealed that the majority of the participants appraised the intervention in a positive manner, indicating good acceptance. The intervention showed an effect on some of the postulated mechanisms but not on others, which might have been because of its brevity. Further investigation of interventions targeting affiliation for people with paranoid experiences appears worthwhile. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Affiliative imagery work is feasible and appraised positively in psychotic patients. Brief compassion focused imagery increased feelings of happiness and reassurance but did not improve negative self-relating, negative affect or paranoia. Further investigation is warranted to identify which patients benefit most from affiliative imagery.

Negative affect and a fluctuating jumping to conclusions bias predict subsequent paranoia in daily life: An online experience sampling study.

BACKGROUND AND OBJECTIVES: Negative affect and a tendency to "jump to conclusions" (JTC) are associated with paranoia. So far, only negative affect has been examined as a precursor of subsequent paranoia in daily life using experience sampling (ESM). We addressed this research gap and used ESM to test whether JTC fluctuates in daily life, whether it predicts subsequent paranoia, and whether it mediates the effect of negative affect on paranoia. METHODS: Thirty-five participants with schizophrenia spectrum disorders repeatedly self-reported negative affect, JTC, and paranoia via online questionnaires on two consecutive days. We measured JTC with a paradigm consisting of ambiguous written scenarios. Multilevel linear models were conducted. RESULTS: Most participants showed JTC consistently on two days rather than only on one day. When time was used as a predictor of JTC, significant slope variance indicated that for a subgroup of participants JTC fluctuated over time. For 48% of participants, these fluctuations equaled changes of approximately ±1 point on the four-point JTC scale within one day. There was no mediation. However, negative affect and JTC both significantly predicted subsequent paranoia. LIMITATIONS: The ESM assessment period was short and encompassed few assessments (8 in total). CONCLUSIONS: Our findings indicate that JTC is both stable (regarding its mere occurrence) and fluctuating simultaneously (regarding its magnitude). Although JTC was not a mediator linking negative affect and paranoia, it did predict paranoia. Further ESM studies on JTC are needed to confirm our findings in longer assessment periods and with other JTC paradigms.

Do depressive symptoms predict paranoia or vice versa?

BACKGROUND AND OBJECTIVES: Affective versus nonaffective psychoses are today no longer regarded as mutually exclusive disorders. Theorists have recently highlighted the role of affective symptoms in the formation of paranoid beliefs, particularly negative beliefs about the self, interpersonal sensitivity, sleep disturbances, and worrying, which exist along a continuum in the general population. For the present study, we tested the bidirectional causal relationships between paranoia and affect. METHOD: A large population sample (N = 2,357) was examined at three time-points (baseline, six months, two years) as to the severity of subclinical paranoid beliefs (Paranoia Checklist, PCL) and depressive symptoms (Patient Health Questionnaire-9, PHQ-9). Worrying and avoidance were measured with items from the Maladaptive and Adaptive Coping Style Questionnaire (MAX). RESULTS: Depression and paranoid symptoms were strongly cross-sectionally related (r = 0.69) and showed high stability (r > 0.72). Depressive symptoms at T2 predicted paranoid symptoms at T3 (beta = 0.16; no significant relationship from T1 to T2), whereas paranoid symptoms predicted depressive symptoms from T1 to T2 (beta = 0.09; no significant relationship from T2 to T3). LIMITATIONS: Results should be replicated in a sample of paranoid patients, as risk factors for subclinical versus manifest paranoia may differ. Some constructs were measured with single items derived from a new scale. CONCLUSIONS: The predictive association of depression to subsequent paranoia was small and confined to the long interval from T2 to T3. Treatments should target both paranoia and depression - irrespective of their causal relationship - particularly as patients with psychosis consider treatment of their emotional problems a priority.

Experimental variation of social stress in virtual reality - Feasibility and first results in patients with psychotic disorders.

BACKGROUND AND OBJECTIVES: Social interaction might lead to increased stress levels in patients with psychotic disorders. Impaired social stress tolerance is critical for social functioning and closely linked with symptom relapse and hospitalization. We present an interactive office built-up in virtual reality (VR). METHODS: Patients with psychotic disorders (PP, N = 26 including N = 5 dropouts) and matched healthy controls (HC, N = 20) were examined with a VR simulating an open-plan office. In a randomized, controlled cross-over design, participants were introduced to virtual co-workers (avatars) and requested to ask them for task assistance. Social feedback in each of the two sessions was either cooperative or rejective in randomized order. RESULTS: The office environment was tolerable for most PP and all HC, five PP and none of the HC dropped out for any reason. Drop-outs reported simulator sickness, influence on thoughts and symptom exacerbations. Statistical trends indicated heightened paranoid ideations for PP after social rejection. State measures of paranoid ideations showed high convergent validity with conventional measures of delusions. Of note, measures of presence were higher for PP than for HC. LIMITATIONS: The exploratory design limits the robustness of the findings. Only statistical trends on paranoid ideation were found. CONCLUSION: The use of VR to assess the effects of social rejection is feasible and tolerable for most PP (87%). However, its implementation for PP is challenged by increased simulator sickness and an additional stress load for some patients. Further studies continuing on these first results that point towards an increased paranoid ideation evoked by negative social feedback and generally higher subjective presence are needed.

An n=1 Clinical Network Analysis of Symptoms and Treatment in Psychosis.

INTRODUCTION: Dynamic relationships between the symptoms of psychosis can be shown in individual networks of psychopathology. In a single patient, data collected with the Experience Sampling Method (ESM-a method to construct intensive time series of experience and context) can be used to study lagged associations between symptoms in relation to illness severity and pharmacological treatment. METHOD: The patient completed, over the course of 1 year, for 4 days per week, 10 daily assessments scheduled randomly between 10 minutes and 3 hours apart. Five a priori selected symptoms were analysed: 'hearing voices', 'down', 'relaxed', 'paranoia' and 'loss of control'. Regression analysis was performed including current level of one symptom as the dependent variable and all symptoms at the previous assessment (lag) as the independent variables. Resulting regression coefficients were printed in graphs representing a network of symptoms. Network graphs were generated for different levels of severity: stable, impending relapse and full relapse. RESULTS: ESM data showed that symptoms varied intensely from moment to moment. Network representations showed meaningful relations between symptoms, e.g. 'down' and 'paranoia' fuelling each other, and 'paranoia' negatively impacting 'relaxed'. During relapse, symptom levels as well as the level of clustering between symptoms markedly increased, indicating qualitative changes in the network. While 'hearing voices' was the most prominent symptom subjectively, the data suggested that a strategic focus on 'paranoia', as the most central symptom, had the potential to bring about changes affecting the whole network. CONCLUSION: Construction of intensive ESM time series in a single patient is feasible and informative, particularly if represented as a network, showing both quantitative and qualitative changes as a function of relapse.

Loneliness over time: The crucial role of social anxiety.

Loneliness is known to be associated with multiple adverse physical outcomes, including higher mortality and morbidity risk. However, the impact of loneliness on mental health is less well researched, with most studies assessing how loneliness relates to depressive symptoms alone. We hypothesized that 2 mental health symptoms that relate to the fear of others-social anxiety and paranoia-would contribute to loneliness. We examined how loneliness relates to social anxiety, paranoia, and depression symptoms in a general community sample aged 18-87 years old (N = 1,010). We administered online measures over 3 time points across a 6-month period. In a cross-lagged structural equation model controlling for trait levels and prior states, our results indicated that earlier loneliness positively predicted future states of social anxiety, paranoia, and depression. However, in the same model, earlier social anxiety was the only predictor of future loneliness. These results suggest that loneliness may be a potential antecedent to emerging mental health symptoms and that identifying and treating co-occurring social anxiety symptoms may reduce the severity of loneliness. (PsycINFO Database Record