Misattributing speech and jumping to conclusions: A longitudinal study in people at high risk of psychosis

AbstractBiases in cognition such as Jumping to Conclusions (JTC) and Verbal Self-Monitoring (VSM) are thought to underlie the formation of psychotic symptoms. This prospective study in people with an At Risk Mental State (ARMS) for psychosis examined how these cognitive biases changed over time, and predicted clinical and functional outcomes. Twenty-three participants were assessed at clinical presentation and a mean of 31 months later. Performance on a JTC and VSM tasks were measured at both time points. Relationships to symptom severity, level of function and the incidence of psychotic disorder were then examined. The levels of symptoms, function and VSM all improved over time, while JTC was stable. Five participants (22%) developed a psychotic disorder during the follow-up period, but the risk of transition was not related to performance on either task at baseline, or to longitudinal changes in task performance. JTC performance correlated with symptom severity at baseline and follow-up. Similarly, performance on the two tasks was not related to the level of functioning at follow-up. Thus, while the ARMS is associated with both VSM and JTC biases, neither predict the onset of psychosis or the overall functional outcome.

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Negative psychotic symptoms and impaired role functioning predict transition outcomes in the at-risk mental state: a latent class cluster analysis study

Psychological Medicine ◽

10.1017/s0033291713000251 ◽

2013 ◽

Vol 43 (11) ◽

pp. 2311-2325 ◽

Cited By ~ 71

Author(s):

L. R. Valmaggia ◽

D. Stahl ◽

A. R. Yung ◽

B. Nelson ◽

P. Fusar-Poli ◽

...

Keyword(s):

At Risk ◽

Cluster Analysis ◽

Mental State ◽

Latent Class ◽

Mental States ◽

Psychotic Symptoms ◽

Role Functioning ◽

Latent Class Cluster Analysis ◽

At Risk Mental State

BackgroundMany research groups have attempted to predict which individuals with an at-risk mental state (ARMS) for psychosis will later develop a psychotic disorder. However, it is difficult to predict the course and outcome based on individual symptoms scores.MethodData from 318 ARMS individuals from two specialized services for ARMS subjects were analysed using latent class cluster analysis (LCCA). The score on the Comprehensive Assessment of At-Risk Mental States (CAARMS) was used to explore the number, size and symptom profiles of latent classes.ResultsLCCA produced four high-risk classes, censored after 2 years of follow-up: class 1 (mild) had the lowest transition risk (4.9%). Subjects in this group had the lowest scores on all the CAARMS items, they were younger, more likely to be students and had the highest Global Assessment of Functioning (GAF) score. Subjects in class 2 (moderate) had a transition risk of 10.9%, scored moderately on all CAARMS items and were more likely to be in employment. Those in class 3 (moderate–severe) had a transition risk of 11.4% and scored moderately severe on the CAARMS. Subjects in class 4 (severe) had the highest transition risk (41.2%), they scored highest on the CAARMS, had the lowest GAF score and were more likely to be unemployed. Overall, class 4 was best distinguished from the other classes on the alogia, avolition/apathy, anhedonia, social isolation and impaired role functioning.ConclusionsThe different classes of symptoms were associated with significant differences in the risk of transition at 2 years of follow-up. Symptomatic clustering predicts prognosis better than individual symptoms.

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Two-year follow-up of a Chinese sample at clinical high risk for psychosis: timeline of symptoms, help-seeking and conversion

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796016000184 ◽

2016 ◽

Vol 26 (3) ◽

pp. 287-298 ◽

Cited By ~ 21

Author(s):

T. H. Zhang ◽

H. J. Li ◽

K. A. Woodberry ◽

L. H. Xu ◽

Y. Y. Tang ◽

...

Keyword(s):

High Risk ◽

Symptom Onset ◽

Help Seeking ◽

Cox Regression ◽

Clinical Population ◽

Psychotic Symptoms ◽

Clinical High Risk ◽

Chinese Sample ◽

Over Time

Background.Chinese psychiatrists have gradually started to focus on those who are deemed to be at ‘clinical high-risk (CHR)’ for psychosis; however, it is still unknown how often those individuals identified as CHR from a different country background than previously studied would transition to psychosis. The objectives of this study are to examine baseline characteristics and the timing of symptom onset, help-seeking, or transition to psychosis over a 2-year period in China.Method.The presence of CHR was determined with the Structured Interview for Prodromal Syndromes (SIPS) at the participants' first visit to the mental health services. A total of 86 (of 117) CHR participants completed the clinical follow-up of at least 2 years (73.5%). Conversion was determined using the criteria of presence of psychotic symptoms (in SIPS). Analyses examined baseline demographic and clinical predictors of psychosis and trajectory of symptoms over time. Survival analysis (Kaplan–Meier) methods along with Log-rank tests were performed to illustrate the relationship of baseline data to either conversion or non-conversion over time. Cox regression was performed to identify baseline predictors of conversion by the 2-year follow-up.Results.In total 25 (29.1%) of 86 completers transitioned to a psychotic disorder over the course of follow-up. Among the CHR sample, the mean time between attenuated symptom onset and professional help-seeking was about 4 months on average, and converters developed fully psychotic symptoms about 12 months after symptom onset. Compared with those CHR participants whose risk syndromes remitted over the course of the study, converters had significantly longer delays (p = 0.029) for their first visit to a professional in search of help. At baseline assessment, the conversion subgroup was younger, had poorer functioning, higher total SIPS positive symptom scores, longer duration of untreated prodromal symptoms, and were more often given psychosis-related diagnoses and subsequently prescribed antipsychotics in the clinic.Conclusions.Chinese CHR identified primarily by a novel clinical screening approach had a 2-year transition rate comparable with those of specialised help-seeking samples world-wide. Early clinical intervention with this functionally deteriorating clinical population who are suffering from attenuated psychotic symptoms, is a next step in applying the CHR construct in China.

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Relationship between jumping to conclusions and clinical outcomes in people at clinical high-risk for psychosis

Psychological Medicine ◽

10.1017/s0033291720003396 ◽

2020 ◽

pp. 1-9

Author(s):

Ana Catalan ◽

Stefania Tognin ◽

Matthew J. Kempton ◽

Daniel Stahl ◽

Gonzalo Salazar de Pablo ◽

...

Keyword(s):

High Risk ◽

Clinical Outcomes ◽

Cox Regression ◽

Mental States ◽

Clinical High Risk ◽

Level Of Functioning ◽

Jumping To Conclusions ◽

Reasoning Bias ◽

Beads Task

Abstract Background Psychosis is associated with a reasoning bias, which manifests as a tendency to ‘jump to conclusions’. We examined this bias in people at clinical high-risk for psychosis (CHR) and investigated its relationship with their clinical outcomes. Methods In total, 303 CHR subjects and 57 healthy controls (HC) were included. Both groups were assessed at baseline, and after 1 and 2 years. A ‘beads’ task was used to assess reasoning bias. Symptoms and level of functioning were assessed using the Comprehensive Assessment of At-Risk Mental States scale (CAARMS) and the Global Assessment of Functioning (GAF), respectively. During follow up, 58 (16.1%) of the CHR group developed psychosis (CHR-T), and 245 did not (CHR-NT). Logistic regressions, multilevel mixed models, and Cox regression were used to analyse the relationship between reasoning bias and transition to psychosis and level of functioning, at each time point. Results There was no association between reasoning bias at baseline and the subsequent onset of psychosis. However, when assessed after the transition to psychosis, CHR-T participants showed a greater tendency to jump to conclusions than CHR-NT and HC participants (55, 17, 17%; χ2 = 8.13, p = 0.012). There was a significant association between jumping to conclusions (JTC) at baseline and a reduced level of functioning at 2-year follow-up in the CHR group after adjusting for transition, gender, ethnicity, age, and IQ. Conclusions In CHR participants, JTC at baseline was associated with adverse functioning at the follow-up. Interventions designed to improve JTC could be beneficial in the CHR population.

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The reality of at risk mental state services: a response to recent criticisms

Psychological Medicine ◽

10.1017/s003329171900299x ◽

2019 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Alison R. Yung ◽

Stephen J. Wood ◽

Ashok Malla ◽

Barnaby Nelson ◽

Patrick McGorry ◽

...

Keyword(s):

At Risk ◽

High Risk ◽

Psychotic Disorder ◽

Mental State ◽

Help Seeking ◽

Psychotic Symptoms ◽

Ultra High Risk ◽

Psychological Medicine ◽

Poor Outcomes ◽

At Risk Mental State

AbstractBackgroundIn the 1990s criteria were developed to detect individuals at high and imminent risk of developing a psychotic disorder. These are known as the at risk mental state, ultra high risk or clinical high risk criteria. Individuals meeting these criteria are symptomatic and help-seeking. Services for such individuals are now found worldwide. Recently Psychological Medicine published two articles that criticise these services and suggest that they should be dismantled or restructured. One paper also provides recommendations on how ARMS services should be operate.MethodsIn this paper we draw on the existing literature in the field and present the perspective of some ARMS clinicians and researchers.ResultsMany of the critics' arguments are refuted. Most of the recommendations included in the Moritz et al. paper are already occurring.ConclusionsARMS services provide management of current problems, treatment to reduce risk of onset of psychotic disorder and monitoring of mental state, including attenuated psychotic symptoms. These symptoms are associated with a range of poor outcomes. It is important to assess them and track their trajectory over time. A new approach to detection of ARMS individuals can be considered that harnesses broad youth mental health services, such as headspace in Australia, Jigsaw in Ireland and ACCESS Open Minds in Canada. Attention should also be paid to the physical health of ARMS individuals. Far from needing to be dismantled we feel that the ARMS approach has much to offer to improve the health of young people.

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Antipsychotic treatment beyond antipsychotics: metacognitive intervention for schizophrenia patients improves delusional symptoms

Psychological Medicine ◽

10.1017/s0033291710002618 ◽

2011 ◽

Vol 41 (9) ◽

pp. 1823-1832 ◽

Cited By ~ 95

Author(s):

S. Moritz ◽

R. Veckenstedt ◽

S. Randjbar ◽

F. Vitzthum ◽

T. S. Woodward

Keyword(s):

Group Intervention ◽

Rating Scales ◽

Cognitive Biases ◽

Cognitive Remediation ◽

Behavioural Therapy ◽

Medium Effect ◽

Psychotic Symptoms ◽

Antipsychotic Treatment ◽

Jumping To Conclusions ◽

Oriented Approach

BackgroundAlthough antipsychotic medication still represents the treatment of choice for schizophrenia, its objective impact on symptoms is only in the medium-effect size range and at least 50% of patients discontinue medication in the course of treatment. Hence, clinical researchers are intensively looking for complementary therapeutic options. Metacognitive training for schizophrenia patients (MCT) is a group intervention that seeks to sharpen the awareness of schizophrenia patients on cognitive biases (e.g. jumping to conclusions) that seem to underlie delusion formation and maintenance. The present trial combined group MCT with an individualized cognitive-behavioural therapy-oriented approach entitled individualized metacognitive therapy for psychosis (MCT+) and compared it against an active control.MethodA total of 48 patients fulfilling criteria of schizophrenia were randomly allocated to either MCT+ or cognitive remediation (clinical trial NCT01029067). Blind to intervention, both groups were assessed at baseline and 4 weeks later. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS). Jumping to conclusions was measured using a variant of the beads task.ResultsPANSS delusion severity declined significantly in the combined MCT treatment compared with the control condition. PSYRATS delusion conviction as well as jumping to conclusions showed significantly greater improvement in the MCT group. In line with prior studies, treatment adherence and subjective efficacy was excellent for the MCT.ConclusionsThe results suggest that the combination of a cognition-oriented and a symptom-oriented approach ameliorate psychotic symptoms and cognitive biases and represents a promising complementary treatment for schizophrenia.

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Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies

Psychological Medicine ◽

10.1017/s0033291719000904 ◽

2019 ◽

Vol 50 (6) ◽

pp. 991-1001 ◽

Cited By ~ 2

Author(s):

Olesya Ajnakina ◽

Brendon Stubbs ◽

Emma Francis ◽

Fiona Gaughran ◽

Anthony S. David ◽

...

Keyword(s):

Systematic Review ◽

Longitudinal Studies ◽

Meta Analysis ◽

First Episode Psychosis ◽

Psychotic Symptoms ◽

First Episode ◽

Hospitalised Patients ◽

Episode Psychosis ◽

Over Time

AbstractBackgroundReducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.MethodsStudies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.Results81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.ConclusionOne in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.

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From Speech Illusions to Onset of Psychotic Disorder: Applying Network Analysis to an Experimental Measure of Aberrant Experiences

Schizophrenia Bulletin Open ◽

10.1093/schizbullopen/sgaa025 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Lindy-Lou Boyette ◽

Adela-Maria Isvoranu ◽

Frederike Schirmbeck ◽

Eva Velthorst ◽

Claudia J P Simons ◽

...

Keyword(s):

Psychotic Disorder ◽

Psychotic Disorders ◽

Psychotic Symptoms ◽

Positive Symptoms ◽

Clinical High Risk ◽

Cross Sectional ◽

Affective Symptoms ◽

The Eu

Abstract Aberrant perceptional experiences are a potential early marker of psychosis development. Earlier studies have found experimentally assessed speech illusions to be associated with positive symptoms in patients with psychotic disorders, but findings for attenuated symptoms in individuals without psychotic disorders have been inconsistent. Also, the role of affect is unclear. The aim of this study was to use the network approach to investigate how speech illusions relate to individual symptoms and onset of a psychotic disorder. We estimated a network model based on data from 289 Clinical High-Risk (CHR) subjects, participating in the EU-GEI project. The network structure depicts statistical associations between (affective and all) speech illusions, cross-sectional individual attenuated positive and affective symptoms, and transition to psychotic disorder after conditioning on all other variables in the network. Speech illusions were assessed with the White Noise Task, symptoms with the BPRS and transition during 24-month follow-up with the CAARMS. Affective, not all, speech illusions were found to be directly, albeit weakly, associated with hallucinatory experiences. Hallucinatory experiences, in turn, were associated with delusional ideation. Bizarre behavior was the only symptom in the network steadily predictive of transition. Affective symptoms were highly interrelated, with depression showing the highest overall strength of connections to and predictability by other symptoms. Both speech illusions and transition showed low overall predictability by symptoms. Our findings suggest that experimentally assessed speech illusions are not a mere consequence of psychotic symptoms or disorder, but that their single assessment is likely not useful for assessing transition risk.

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Transition to Psychosis: 6-Month follow-up of a Chinese High-Risk Group in Hong Kong

Australian & New Zealand Journal of Psychiatry ◽

10.1080/j.1440-1614.2006.01817.x ◽

2006 ◽

Vol 40 (5) ◽

pp. 414-420 ◽

Cited By ~ 25

Author(s):

May M.L. Lam ◽

Se-Fong Hung ◽

Eric Y.H. Chen

Keyword(s):

At Risk ◽

High Risk ◽

Mental State ◽

Functional Decline ◽

High Risk Group ◽

Psychotic Symptoms ◽

Syndrome Scale ◽

History Of ◽

At Risk Mental State

Objectives: The identification of individuals at high risk of becoming psychotic within the near future creates opportunities for early intervention before the onset of psychosis. This study sets out to identify a group of symptomatic young people in a Chinese population with the high likelihood of transition to psychosis within a follow-up period of 6 months, and to determine the rate of transition to psychosis in this group. Method: Symptomatic individuals with a family history of psychotic disorder, subthreshold psychotic symptoms or brief transient psychotic symptoms were identified using the operationalized criteria of an ‘At Risk Mental State’. The individuals were prospectively assessed monthly on a measure of psychopathology for 6 months. Results: Eighteen out of 62 individuals (29%) made the transition to frank psychosis within a 6 month follow-up period, with the majority occurring within 3 months. In addition, significant differences were found in the intake Positive and Negative Syndrome Scale, Comprehensive Assessment of ‘At Risk Mental State’ and Global Assessment of Functioning scores between the group that ultimately became psychotic and the group that did not. Conclusion: The period of the highest risk of transition to psychosis was within the 3 months after the study began. Thus, distressed youths in our outpatient clinic, who meet the high-risk criteria should be monitored most closely in the initial 3 months, particularly those individuals with high levels of psychopathology and functional decline.

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Impaired self-recognition in individuals with no full-blown psychotic symptoms represented across the continuum of psychosis: a meta-analysis

Psychological Medicine ◽

10.1017/s003329172000152x ◽

2020 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Layla Lavallé ◽

Clément Dondé ◽

Łukasz Gawęda ◽

Jérome Brunelin ◽

Marine Mondino

Keyword(s):

Source Monitoring ◽

Large Range ◽

Recognition Accuracy ◽

Meta Analysis ◽

Psychotic Symptoms ◽

Experimental Paradigm ◽

Self Monitoring ◽

Self Recognition ◽

The Continuum ◽

At Risk Mental State

Abstract Background Impairments in self-recognition (i.e. recognition of own thoughts and actions) have been repeatedly shown in individuals with schizophrenia. According to classical clinical characterizations, schizophrenia is included in a continuum encompassing a large range of genetic statuses, psychotic states and symptoms. The current meta-analysis aims to determine whether self-recognition is affected by individuals within the psychosis continuum. Method Three populations were considered: people with an at-risk mental state for psychosis (ARMS), hallucination-prone individuals and unaffected relatives of patients with schizophrenia. Eleven studies contrasted self-recognition between these three populations (n = 386) and healthy controls (n = 315) and four studies used correlational analysis to estimate comparable effects (n = 629). Eligible studies used experimental paradigms including source-monitoring and self-monitoring. Results We observed significantly reduced self-recognition accuracy in these populations [g = −0.44 (−0.71 to −0.17), p = 0.002] compared to controls. No influence of the type of population, experimental paradigm or study design was observed. Conclusion The present analysis argues for self-recognition deficits in populations with no full-blown psychotic symptoms represented across the continuum of psychosis.

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M218. RELATIONSHIP BETWEEN JUMPING TO CONCLUSIONS AND OTHER COGNITIVE BIASES AND SOCIAL COGNITION IN PEOPLE WITH SCHIZOPHRENIA

Schizophrenia Bulletin ◽

10.1093/schbul/sbaa030.530 ◽

2020 ◽

Vol 46 (Supplement_1) ◽

pp. S218-S219

Author(s):

Mar Garcia-Franco ◽

Sonia Vilamala-Anton ◽

Gemma Prat ◽

Maria Jose EScandell ◽

Jose Ramón Martínez ◽

...

Keyword(s):

Social Cognition ◽

Theory Of Mind ◽

Attributional Style ◽

Cognitive Biases ◽

Psychotic Symptoms ◽

Rehabilitation Services ◽

Negative Events ◽

Schizotypal Personality ◽

Jumping To Conclusions ◽

Borderline Disorder

Abstract Background Deficits in jumping to conclusions and social cognition have been described in people with schizophrenia. The aims of the study are to relate jumping to conclusions with social cognition and other cognitive biases in people with schizophrenia attended in rehabilitation services. Methods A descriptive study was performed. The subjects of our study were persons from 18 to 65 years old, attended in rehabilitation services, with schizophrenia diagnoses and other diagnoses with presence of psychotic symptoms (depression, bipolar disorder, borderline disorder, delusional disease, schizoaffective, and schizotypal personality). The variables included were JTC considered three beads tasks with different proportions: 85:15%, 60:40% and 60:40% salient task. Moreover, cognitive insight (BCIS), attributional style (IPSAQ), and Hinting Task -Theory of Mind (ToM) were assessed. A T student analysis was done in order to compare JTC with the rest of the quantitative variables. Results People who jump to conclusions in the salient task scored higher in self-certainty BCIS (p=0.028), in self attribution for negative events (p=0.036) and lower in attribution to other people of negative events (p=0.028). A tendency was found between the presence of JTC and ToM (p=0.051). In the task of 85-15 only a tendency was found between presence of JTC and higher scores in the personalizing bias (p=0.079). Moreover, in the task of 60:40 a tendency was found between presence of JTC and worse performance in the ToM test (p=0.051). Discussion We found a relationship between jumping to conclusions and self-certainty and self-attributions for negative events; as well as, it is a tendency that higher jumping to conclusions is related with worst ToM. There are important clinic implications of this, because we know that jumping to conclusions and theory of mind is related with the formation and maintenance of delusions.

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