Abstract
BackgroundA worry thinking style has been identified as one of the proximal causal factors for paranoia (Freeman & Garety, 2014). This argument has been supported by the finding that patients with paranoia worry as much as patients with generalized anxiety disorder, and that worry predicts paranoia in non-clinical individuals. Wells (1995) argued that it is when metacognitions about worry (i.e. beliefs about worry and meta-worry) exaggerate worrying that anxiety disorders emerge. It was not clear how metacognitions interact with trait worry in the development of non-clinical paranoia.AimsTo examine the predictive effect of dysfunctional metacognitions and trait worry on change in paranoia over one year within a large university sample.MethodsAn online survey encompassing measures of metacognitions, trait worry, and paranoia was conducted at baseline (valid N=2291) and one year (N=1746). A series of longitudinal structural equation models were tested, with baseline level of metacognitions as latent variable, baseline trait worry and paranoia at both time points as observed variables. Model fit indices were compared across models (CTI, RMSEA, AIC, BIC).ResultsA final trimmed model with the best goodness-of-fit (χ2=82.78, p<.001, CFI=0.99, RMSEA=0.069) suggested that dysfunctional metacognitions contributed to paranoia at 1-year follow-up, both directly (β=0.21, p<.001) and via baseline paranoia (β=0.09, p=.001). Trait worry at baseline did not predict paranoia at either time point.DiscussionOur results indicated a critical role of dysfunctional metacognitions in paranoid ideation both concurrently and prospectively. Future interventions may focus more on modifying beliefs and worry about worry.
Highlights
The association between caffeine consumption and various psychiatric manifestations has long been observed
Formal thought disorder has a close relation to disorganized symptoms in schizophrenia, which were independently associated with treatment resistance and poor response to standard antipsychotics
We investigated the association between Formal thought disorder (FTD), remission and treatment resistance in patients with schizophrenia
Summary
There is uncertainty about the required duration of long-term antipsychotic maintenance medication after a first episode of psychosis. The present study aimed to determine the proportion of young people who discontinue their antipsychotic medication after a first episode of psychosis, the proportion who experience relapse, and predictors of relapse. A Cox regression analysis was conducted to identify predictors of relapse. Median duration of antipsychotic medication prior to first trial of discontinuation was 174.50 days. Amongst those trialing discontinuation, 149 (45.8%) experienced relapse in a median follow-up time post discontinuation of 372 days. Predictors of relapse were a diagnosis of cannabis abuse disorder (HR: 1.40), and longer duration of antipsychotic medication (HR: 1.05). Individuals with a diagnosis of cannabis abuse are more likely to experience relapse and addressing this substance abuse prior to discontinuation could possibly reduce relapse rates. Amedeo Minichino*,1, Grazia Rutigliano, Sergio Merlino, Cathy Davies, Dominic Oliver, Andrea De Micheli, Philip McGuire, Paolo Fusar-Poli5 1University of Oxford; 2Institute of Psychiatry, Psychology & Neuroscience, King’s College London; 3University of Pisa; 4Institute
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