Dimensions Of Delusions Research Articles

18-month trajectories of delusional dimensions in young adults: Relationship with reasoning biases and worry.

It has been argued that what differentiates delusional ideation from full-blown delusions (indicating need for care) is not the number of beliefs, but the experiential dimensions such as conviction, distress, and preoccupation. However, how these dimensions evolve over time and affect outcomes is under-researched. While delusional conviction and distress are associated with reasoning biases and worry respectively in clinical samples, how these processes predict trajectories of delusional dimensions in the general population remains unclear. Young adults (age 18-30) were screened for delusional ideation on the Peters et al. Delusions Inventory. Participants with at least one delusional ideation were randomly selected for a 4-wave assessment (6-month apart). Trajectories of delusional dimensions were separately identified by latent class growth analyses, then compared on baseline levels of jumping-to-conclusions bias, belief inflexibility, worry, and meta-worry. The longitudinal sample consisted of 356 individuals (drawn from a community sample of 2,187). For each of the three dimensions (conviction, distress, and preoccupation), four-group linear models were identified-high stable, moderate stable, moderate decreasing, and low stable. The high stable group exhibited worse emotional and functional outcomes at 18 months than the other three groups. Worry and meta-worry predicted group differences, and notably differentiated the moderate decreasing groups from the moderate stable groups. Contrary to hypothesis, jumping-to-conclusions bias was milder in the high/moderate stable groups than the low stable group for conviction. Distinct trajectories of delusional dimensions were predicted by worry and meta-worry. Differences between the decreasing and stable groups carried clinical implications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Supplemental Material for 18-Month Trajectories of Delusional Dimensions in Young Adults: Relationship With Reasoning Biases and Worry

Supplemental Material for 18-Month Trajectories of Delusional Dimensions in Young Adults: Relationship With Reasoning Biases and Worry

M12. INCREASED SAFETY BEHAVIOR IN SUBJECTS WITH CHILDHOOD TRAUMA AND DELUSIONS

BackgroundPersonal space is the safe area around us causing discomfort when violated by others. Previous research has shown that our need for personal space can be shaped by previous and current experiences. For instance, childhood maltreatment is associated with altered personal space in healthy controls. Additionally, space regulation is altered in schizophrenia (with personal space being increased in patients with paranoia). Whether childhood maltreatment and dimensions of delusions are associated with increased safety behaviour in patients with schizophrenia is unknown. We therefore aim to test the association of childhood trauma and delusions with interpersonal distance in schizophrenia patients and healthy controls.MethodsWe assessed childhood trauma (CT) in both, healthy subjects and schizophrenia patients (matched for age, gender and education) with the childhood trauma scale. This scale is a self-report screening tool for experiences of abuse & neglect during childhood. Additionally, we assessed delusions in schizophrenia patients, using the dimensions of delusional experience scale (DDE), which includes ‘conviction’, ‘extension’, ‘bizarreness’, ‘disorganization’, and ‘pressure’ dimensions. We compared the interpersonal distance (stop-distance test) and comfort ratings at predetermined distances (fixed-distance test) between subjects with low/medium and high CT ratings. Likewise, interpersonal distance and comfort ratings of patients with and without delusions were compared.ResultsIn our preliminary data (n = 27), subjects with high CT ratings showed an increased need for interpersonal space compared to subjects with low/medium CT. Additionally, the high CT group showed reduced comfort ratings at varying fixed distances. Likewise, patients with delusions had an increased interpersonal space and reduced comfort at fixed distances. Moreover, interpersonal space was associated with the severity of childhood trauma, and in particular with emotional neglect. Finally, interpersonal distance was associated with the degree to which the delusional belief involves various areas of patients’ lives (‘extension’ dimension of the DDE).DiscussionOur preliminary data suggests that childhood maltreatment and dimensions of delusions are associated with increased safety behaviour in patients with schizophrenia. These findings are in line with previous studies, which found associations of interpersonal distance and childhood maltreatment in healthy controls as well as paranoia in patients with schizophrenia. Our findings are of particular interest, as increased safety behaviour may impact social functioning (i.e. lead to more social withdrawal) in patients with schizophrenia.

Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis \u2013 a secondary analysis of a randomized-controlled therapy trial

BackgroundCognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients’ social life: the quality of their therapeutic relationship.MethodsPatients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy.ResultsIn comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist.ConclusionsCognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.

Associations between belief inflexibility and dimensions of delusions: A meta‐analytic review of two approaches to assessing belief flexibility

Belief inflexibility has been suggested to maintain delusions. Different measures of assessing belief inflexibility have been developed, and it remains unclear whether patients with delusions display belief inflexibility similarly across measures. As delusions consist of multiple dimensions, the aim of this meta-analytic review was to examine how belief inflexibility is related to different aspects of delusions (conviction, distress, and preoccupation) and to compare these associations between interview-based and task-based measures of belief inflexibility. We conducted a systematic database search (PsycINFO, PsycARTICLES, PubMed, and MEDLINE) and identified relevant articles using the following search items: belief*, delusion*, or overvalued idea*; psychosis or schizo*; flexib*, inflexib*, change, revision, or update. Meta-analyses were conducted for each dimension of delusions and were reported according to the PRISMA guidelines. A total of 16 studies, with a total sample of 1,065, were included in the analysis. Belief inflexibility was associated with global severity of delusions (Hedges' g=0.452, p<.001). Specifically, all dimensions of delusions were significantly associated with belief inflexibility (conviction: Hedges' g=0.678, p<.001; preoccupation: Hedges' g=0.274, p=.002; distress: Hedges' g=0.200, p=.025). There was no significant heterogeneity across studies for each dimension. Preliminary subgroup analysis did not find any significant between-measure differences in the relationship between belief inflexibility and overall severity of delusions. Belief inflexibility, across measures, was robustly associated with delusions, with a particularly strong association for delusional conviction. Our results carried implications for process-based interventions for delusions. Positive clinical implications Belief inflexibility is consistently associated with the maintenance of delusions. Assessing belief inflexibility in routine clinical practice will inform psychological interventions for patients with persistent delusions. Interview- and task-based measures of belief inflexibility may be used complementarily to facilitate our understanding of this reasoning bias. Aetiological factors may be more closely associated with some aspects of delusions than the others. In line with a multidimensional view of delusions, interventions targeting different dimensions of delusions may have different therapeutic emphases. Limitations The current review focused on three core dimensions of delusions only (conviction, preoccupation, distress). Other ways of dissecting delusions are possible. Comparisons between the two measures of belief inflexibility may benefit from further research.

The Proximity between Hallucination and Delusion Dimensions: An Observational, Analytic, Cross-Sectional, Multicentre Study.

In psychiatric classifications, hallucinations (mainly auditory hallucinations) are one of the fundamental criteria for establishing a schizophrenia diagnosis or any of the related psychotic disorder's diagnoses. The conceptual proximity between delusions and hallucinations was maintained until the end of the XIX century, with several supporters during the XX century. Their limits were not yet definitely defined in terms of Descriptive Psychopathology, and much less so in terms of biochemical and anatomical models. In this article we aimed to analyse the dimensions of both hallucinations and delusions in a sample of patients with schizophrenia and schizoaffective disorder. We also intend to find the determinants of the main dimensions of hallucinations. One hundred patients with schizophrenia (80) or schizoaffective disorder (20), 64% males, mean age 39.75, from the outpatient and inpatient units of the Psychiatry Department of Hospital de Santa Maria and the Centro Hospitalar Psiquiátrico de Lisboa were assessed by means of the Psychotic Symptom Rating Scales (PSYRATS) and a structured interview. In this study we designed an empirical based model by means of bivariate Spearman's rank correlation coefficient, and multivariate statistics (linear regression and multiple multivariate linear regression), where the main dimensions of hallucinations are determined by the central dimensions of delusions.

The relationship between cognitive biases and psychological dimensions of delusions: The importance of jumping to conclusions

Background and objectivesCognitive biases play a role in the development and maintenance of delusions. However, delusions are multidimensional (i.e., emotional and cognitive facets) and often co-occur with auditory hallucinations. Therefore, further refinement of the precise relationship between cognitive biases, delusions, and hallucinatory experiences is warranted. MethodsA total sample of 167 patients with schizophrenia spectrum disorders was split into two groups consisting of patients with active delusions (n = 127) and active hallucinations (n = 92). All patients were assessed for delusions and hallucinations using the semi-structured psychotic symptom rating scales (PSYRATS), which assesses the emotional (i.e., distress) and cognitive (i.e., conviction, preoccupation) dimensions of these symptoms. Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQp) self-report questionnaire (assessing jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking biases). Multiple stepwise regressions were performed to investigate the relationship between delusions and cognitive biases, while controlling for auditory hallucinations (and vice-versa). ResultsThe only cognitive bias to significantly predict delusions after controlling for the severity of auditory hallucinations was the jumping to conclusions (JTC) bias (predicted both emotional and cognitive dimensions). Only the emotional dimension of auditory hallucinations was predicted by the intentionalising and dichotomous thinking biases, after delusional severity was controlled for. LimitationsThe cross-sectional design precludes causal inferences. Only positive psychotic symptoms were assessed and no wider psychopathology assessment was utilised (e.g., negative symptoms, anxiety, depression). ConclusionsThe jumping to conclusions bias is associated with both delusional conviction and emotional distress.

Characteristics and clinical correlates of dimensions of delusional experience in schizophrenia and delusional disorder

This study aimed at examining the clinical correlates of dimensions of delusional experience in schizophrenia and delusional disorder. One-hundred and forty six subjects with schizophrenia and the same number of subjects with delusional disorder were assessed for dimensions of delusional experience including conviction, extension, bizarreness, disorganization and pressure, and for a number of clinical variables including familial liability to psychotic and mood disorders, illness characteristics, index episode symptoms, response to treatment and one-year psychosocial functioning. The associations between delusional dimensions and clinical variables were examined in each diagnostic group by means of linear regression analyses. Compared with subjects with delusional disorder, those with schizophrenia displayed higher levels of disorganization and bizarreness and lower levels of conviction, extension and pressure. Dimensions of delusional experience showed a rather different pattern of associations with clinical features both within and between diagnoses, with much more significant associations in schizophrenia than delusional disorder. Unlike schizophrenia in that dimensions of delusional experience showed a variety of associations with clinical features, most of the associations in delusional disorder were confined to the dimensions of extension and bizarreness. In schizophrenia, disorganization was the most central characteristic of delusions in that it showed associations with at least one validator within each clinical domain; furthermore all delusional dimensions but bizarreness impacted on some measure of psychosocial functioning. These findings point out the very complexity of delusions and their multidimensional character along with their distinct clinical correlates in schizophrenia and delusional disorder.

Group cognitive behaviour therapy combining early intervention with an exclusive focus on single medication-resistant delusional beliefs: a service evaluation

AbstractCognitive behaviour therapy (CBT) is now the psychological treatment of choice for psychosis but meta-analyses indicate a low effect size on delusions, so further innovations are clearly needed, and group CBT for psychosis (GCBTp) is an under-researched area. This study aimed to service-evaluate the feasibility, satisfaction, safety, and effectiveness of a CBT group specifically targeting medication-resistant single delusions in early psychosis patients (EI-GCBTp). Three separate EI-GCBTp groups were run resulting in a total of 11 medication-resistant early psychosis patients. A within-subjects design tested for group change across two time points: pre-baseline (4 weeks before treatment) to baseline (session 1 of treatment) and sessions 1–8 (the treatment period). Thirteen delusion dimensions were measured from three psychosis-specific questionnaires: The Psychotic Symptom Rating Scale (PSYRATS), Characteristics of Delusion Rating Scale, and the Belief Rating Scale. At least three patients attended each group, satisfaction scores were high, and no harm to patients was identified. With reference to effectiveness, the pre-baseline period showed virtually no change. In contrast, across the EI-GCBTp treatment period, the PSYRATS total demonstrated a statistically significant decrease in delusional severity (p &lt; 0.01), a 31% symptom reduction, and a large effect size (Cohen's d = 1.2, 95% confidence interval = −2.53 to 0.05), statistically significant across four delusion dimensions. EI-GCBTp appears feasible, acceptable, safe, and preliminary uncontrolled effectiveness results suggest merit for larger-scale more rigorous testing of this treatment format for possible dimensional improvements of persistent delusions.

Dimensions of Delusions and Attribution Biases along the Continuum of Psychosis.

This study compared delusional dimensions and attribution biases along the continuum of psychosis. Participants completed questionnaires on delusion-like beliefs and attributions. Although patients with first-episode psychosis (N = 70) endorsed fewer delusion-like beliefs than non-clinical individuals with psychotic-like experiences (N = 12), they scored highest on delusional conviction, distress and preoccupation, followed by non-clinical individuals with psychotic-like experiences, and then healthy controls (N = 642). Self-serving bias was found in patients and non-clinical individuals with psychotic-like experiences, but not in healthy controls. Personalizing bias for negative events was not significantly different across the three groups. When compared with healthy controls, non-clinical individuals with psychotic-like experiences had an exaggerated self-serving bias, but were not more marked in personalizing bias. Self-serving bias and personalizing bias were both associated with delusional dimensions. However, the association between self-serving bias and number of delusion-like beliefs was stronger among patients than non-clinical participants. Future research could investigate the extent to which self-serving bias, in combination with an appraisal of delusional ideation as convincing, distress, and preoccupying, contributes to the development of clinical delusions.

A comparison of cognitive biases between schizophrenia patients with delusions and healthy individuals with delusion-like experiences

BackgroundThe role of psychosis-related cognitive biases (e.g. jumping to conclusions) in a delusion continuum is well-established. Little is known about the role of types of cognitive biases. The aim of this study was to investigate the role of psychosis-related and “Beckian” (i.e. anxiety- and depression-related) cognitive biases assessed with a clinical questionnaire in the delusion continuum and its dimensions. MethodsSchizophrenia patients with (n=57) and without (n=35) delusions were compared to healthy subjects who had a low (n=53) and high (n=57) level of delusion-like experiences (DLEs) on the Cognitive Biases Questionnaire for Psychosis (CBQp). Delusion dimensions in the clinical sample were assessed with the semi-structured interview PSYRATS. DLEs were measured with the Peters Delusion Inventory (PDI). ResultsHigh DLEs participants scored significantly higher than low DLEs, and patients with delusions scored higher than patients without delusions on the total scores of the CBQp. High DLEs participants scored significantly higher than low DLEs on catastrophisation and JTC. Schizophrenia patients with delusions scored significantly higher when compared to patients without delusions on intentionalising, dichotomous thinking, JTC and emotional reasoning. Patients with delusions and high DLEs participants scored similarly on JTC. Stepwise regression analysis revealed that catastrophising predicted total severity of clinical delusions and JTC predicted the cognitive dimension of clinical delusions. Both JTC and catastrophisation predicted the frequency and conviction associated with DLEs. ConclusionsBoth “Beckian” and psychosis-related cognitive biases may underlie delusions. Different aspects of clinical delusions and delusion-like experiences may be related to different cognitive biases.

Body image disorders: anorexia nervosa versus reverse anorexia (muscle dysmorphia)

BackgroundAmong body image disorders, anorexia nervosa (AN) in females and muscle dysmorphia (MD) in males, emerge as the more representative. ObjectiveTo describe the relationship of clinical characteristics between AN and MD. MethodA review of specialised textbooks and the available literature in Medline/PubMed and SciELO was made. ResultsThere are similarities and differences between both disorders. They begin in adolescence, show a great diagnostic crossover, use/abuse of pharmacological drugs, similar co-morbidities, improvement with selective serotonin reuptake inhibitors and behavioural-cognitive psychotherapy, they are focused in body image, but AN pursuits thinness while MD muscle development. From a psychosocial perspective, body image disorders come out due to western socio-cultural pressures related to gender role stereotypes, which emphasise a slim feminine figure versus a vigorous masculine one. The nosological classification of MD is controversial and it has been including within the obsessive-compulsive spectrum of the DSM-5. ConclusionsBoth disorders imply body dissatisfaction with different degrees of body image distortion, even reaching delusional dimensions. Future studies are required which can lay the foundations of new categorisations of these disorders that better clarify their essence.

Changes in delusional dimensions and emotions over eight weeks of antipsychotic treatment in acute patients

Delusional experiences can be considered on a range of dimensions including conviction, distress, preoccupation, and disruption, which have been shown to be related to depression and anxiety. This study aimed to test the hypotheses that delusional conviction is less responsive to antipsychotic treatment than delusional distress and preoccupation, and that depression and anxiety reduce alongside improvements in delusional dimensions. Forty acutely ill inpatients with delusions were assessed during their early stage of antipsychotic treatment. Interview data were analysed using mixed models for repeated measures. There was a significant reduction in psychotic symptoms over eight weeks, after controlling for baseline dosage of antipsychotics. We found no differential rate of improvement across delusional dimensions, and all dimensions improved over time. However, conviction ratings remained relatively high throughout the eight weeks. There was no significant improvement in anxiety and depression, and delusional preoccupation covaried with anxiety and depression throughout eight weeks, suggesting a relationship between emotional and delusional processes during the early recovery phase of psychosis.

Dimensions of Delusions in Major Depression: Socio-demographic and Clinical Correlates in an Unipolar-Bipolar Sample.

ObjectiveThe present study aims at exploring associations between a continuous measure of distorted thought contents and a set of demographic and clinical features in a sample of unipolar/bipolar depressed patients.MethodsOur sample included 1,833 depressed subjects. Severity of mood symptoms was assessed by the 21 items Hamilton Depression Rating Scale (HAM-D). The continuous outcome measure was represented by a delusion (DEL) factor, extracted from HAM-D items and including items: 2 (“Feelings of guilt”), 15 (“Hypochondriasis”), and 20 (“Paranoid symptoms”). Each socio-demographic and clinical variable was tested by a generalized linear model test, having depressive severity (HAM-D score–DEL score) as the covariate.ResultsA family history of major depressive disorder (MDD; p=0.0006), a diagnosis of bipolar disorder, type I ( p=0.0003), a comorbid general anxiety disorder (p<0.0001), and a higher number of manic episodes during lifetime (p<0.0001), were all associated to higher DEL scores. Conversely, an older age at onset (p<0.0001) and a longer duration of hospitalization for depression over lifetime (p=0.0003) had a negative impact over DEL scores. On secondary analyses, only the presence of psychotic features (p<0.0001) and depressive severity (p<0.0001) were found to be independently associated to higher DEL scores.ConclusionThe retrospective design and a non validated continuous measure for distorted thought contents were the main limitations of our study. Excluding the presence of psychotic features and depressive severity, no socio-demographic or clinical variable was found to be associated to our continuous measure of distorted thinking in depression.

Jumping to conclusions style along the continuum of delusions: delusion-prone individuals are not hastier in decision making than healthy individuals.

Literature comparing ‘jumping to conclusions’ (JTC) between patients and healthy controls has demonstrated the importance of the reasoning bias in the development of delusions. When groups that vary along the entire delusional continuum are included, the relationship between JTC and delusionality is less clear. This study compared JTC and delusional dimensions between 28 patients with delusions, 35 delusion-prone individuals and 32 non-delusion-prone individuals. Delusion proneness was defined by an established threshold based on the Peters et al. Delusions Inventory. Two versions of the beads task (85:15 and 60:40) were used to measure JTC. As hypothesized, patients manifested hastier data gathering than the two non-clinical groups on both beads tasks. However, delusion-prone individuals did not manifest a hastier decision making style than non-delusion prone individuals. Instead, non-delusion-prone participants showed more JTC bias than delusion-prone individuals on the easier beads task. There was no evidence for a dose-response relationship between JTC and delusional dimensions, with correlations between JTC and PDI scores found in the non-delusion-prone group only. The present finding confirms the link between an extreme JTC bias and the presence of clinical delusions, and argues against a linear relationship between JTC and delusionality along the symptomatic continuum.

Assessing Belief Flexibility with Experience Sampling Methodology in Patients with Acute Psychosis

Introduction Belief Flexibility (BF) has been shown to maintain delusional conviction in patients with psychosis, and is a target of psychological intervention for delusions. However, it is unclear how BF responds to antipsychotic treatment. While BF has typically been measured in interview-based assessment, it is of interest whether moment-to-moment changes in BF can be measured reliably using experience sampling methodology (ESM). Objectives Aims To assess changes in BF during the first two weeks of antipsychotics, and to examine the validity of assessing BF using ESM. Methods Sixteen acute in-patients with delusions completed an ESM assessment 7 times a day on a Personal Digital Assistant over 14 consecutive days (see Table). Symptomatology, delusional dimensions, and BF were also measured in interviews on the first, seventh and fourteenth days. Results Multilevel regression models revealed high internal consistency of the ESM items for BF, but low congruence between the ESM and interview measures of BF. Unexpectedly, patients with more flexibility at baseline (on one interview measure) reported increasing delusional conviction on ESM over 14 days (See Figure). On ESM, a higher momentary level of flexibility predicted an increase in conviction in the next moment. Conclusions The ESM data of BF were inconsistent with the interview measures and previous studies. The results challenge the validity of assessing BF with a self-report momentary measurement. Download : Download full-size image Figure 1 . Change over time in delusional conviction by baseline belief flexibility (Reaction to Hypothetical Contradiction interview)(N=15) Table . ESM items on Delusional Conviction and Belief Flexibility Item Response Delusional conviction −At this moment, to what extent do you believe this concern is true? 1 (not at all) – 7 (very much) Belief Flexibility − At this moment, to what extent do you think their aie other possible explanations for this concern? 1 (not at all) – 7 (very much) −At this moment, to what extent do you think you may be mistaken about this concern? 1 (not at all) – 7 (very much) − Since the last signal, have you noticed anything that makes you question this concern? 1 (not at all) 7 (very much)

P.3.f.012 Positive schizotypy associated negative facial emotion recognition and neurocognitive deficits

It has been suggested that different aspects of delusions (conviction, distress, preoccupation) respond to treatment at different rates, and that the cognitive bias of ‘Jumping to Conclusions’ (JTC) may predict treatment outcome. This study investigates changes in delusion dimensions using Experience Sampling Methodology (ESM) and the role of JTC as a predictor of change during the initial 2 weeks of antipsychotic treatment on admission to hospital. Sixteen acute patients with delusions were assessed seven times per day for 14 days using computerised ESM. ESM assessed moment-by-moment experiences of affect, psychotic symptoms, and delusion dimensions. Clinical ratings were completed at baseline, 1 week and 2 weeks later. The 'beads' task was used to measure JTC at baseline. Delusion dimensions improved over the two weeks of antipsychotic treatment and admission to hospital. Different delusional dimensions changed at different rates, with distress and disruption being more responsive than conviction and preoccupation on both PSYRATS and ESM ratings. Eight out of 16 participants showed a JTC bias on the beads task at baseline. Exploratory analyses showed that JTC predicted changes in the ESM ratings of delusion conviction and distress, suggesting that reasoning biases may predict treatment response.

Changes in delusions in the early phase of antipsychotic treatment – An experience sampling study

It has been suggested that different aspects of delusions (conviction, distress, preoccupation) respond to treatment at different rates, and that the cognitive bias of ‘Jumping to Conclusions’ (JTC) may predict treatment outcome. This study investigates changes in delusion dimensions using Experience Sampling Methodology (ESM) and the role of JTC as a predictor of change during the initial 2 weeks of antipsychotic treatment on admission to hospital. Sixteen acute patients with delusions were assessed seven times per day for 14 days using computerised ESM. ESM assessed moment-by-moment experiences of affect, psychotic symptoms, and delusion dimensions. Clinical ratings were completed at baseline, 1 week and 2 weeks later. The 'beads' task was used to measure JTC at baseline. Delusion dimensions improved over the two weeks of antipsychotic treatment and admission to hospital. Different delusional dimensions changed at different rates, with distress and disruption being more responsive than conviction and preoccupation on both PSYRATS and ESM ratings. Eight out of 16 participants showed a JTC bias on the beads task at baseline. Exploratory analyses showed that JTC predicted changes in the ESM ratings of delusion conviction and distress, suggesting that reasoning biases may predict treatment response.

Do depression and anxiety mediate the relationship between meta-cognitive beliefs and psychological dimensions of auditory hallucinations and delusions in schizophrenia?

We investigated if depression and anxiety mediate the relationship between meta-cognitive beliefs and psychological dimensions of delusions and hallucinations in schizophrenia subjects (n=74). Depression, but not anxiety, mediated the relationship between certain dysfunctional meta-cognitive beliefs and psychological dimensions of delusions. Although direct effects between hallucination dimensions and certain meta-cognitive beliefs were found, anxiety and depression did not serve as mediators in this relationship. The results suggest a significant pathway from meta-cognition to delusions through depression.

P03-48 - Coping with delusion in schizophrenia and psychotic depression

IntroductionCoping plays an important role in processes involved in the development of mental disorders, influencing decompensation and recovery from patients. Coping is defined as an active self-generation of cognitive and behavioural procedures, which impact directly on the symptom or reduce distress caused by it. How patients cope with delusions lack empirical evidence. Although, in the last years, delusion has been considered a multidimensional phenomenon where emotional, cognitive and action-oriented aspects were recognized, the impact of delusional dimensions on coping is still unknown.ObjectivesTo assess coping strategies used by patients with schizophrenia and psychotic depression to deal with delusion. The relationships between coping, psychopathology and the dimensions of delusional experience will be examined.MethodsThirty deluded schizophrenics and 30 psychotic depressed patients were investigated. Instruments to the assessment of delusion were used, as the Positive and Negative Syndrome Scale (PANSS) and the Heidelberger Delusion Profile (HDP).Correlations between psychopathology, coping and delusion dimensions were calculated.ResultsCoping strategies used to deal with delusion were different in the 2 groups of patients. Schizophrenic patients use more medical care, while psychotic depressed patients use more depressive coping. Significant correlations between psychopathology, coping and delusion dimensions could be shown. In contrast to depressive patients, the emotional and cognitive dimensions of delusion seem to influence coping in patients with schizophrenia.ConclusionsCoping strategies are different depending on the diagnosis. In schizophrenia, the emotional and the cognitive dimensions seem to influence how patients cope with delusional experience.