Delusional Psychosis Research Articles

Schizophrenia spectrum disorders: does the non-psychotic schizophrenia exist?

Current understanding of schizophrenia comes from Kraepelin’s dementia praecox doctrine, a disease that combined Kalbaum’s catatonia, Hecker’s hebephrenia and chronic delusional psychoses and later renamed to schizophrenia thanks to Bleuler. Since the beginning of the XX century, the systematics of schizophrenia has undergone a serious evolution and narrowing of diagnostic boundaries, which is reflected in various revisions of the ICD and editions of the DSM. Currently, the existence of non-psychotic forms of schizophrenia, mainly manifested by negative symptoms, is being questioned. In addition, the need for diagnostic differentiation of schizophrenia from autism spectrum disorder, which have only external similarities, but require fundamentally different therapeutic interventions, is emphasized.

Consistency of Delusion Themes Across First and Subsequent Episodes of Psychosis

Despite growing interest in the phenomenology of delusions in psychosis, at present little is known about their content and evolution over time, including whether delusion themes are consistent across episodes. To examine the course of delusions and thematic delusion content across relapse episodes in patients presenting to an early intervention service for psychosis. This longitudinal, observational study used clinical data systematically collected from January 2003 to March 2018 from a cohort of consenting patients with affective or nonaffective first-episode psychosis, followed up naturalistically for up to 2 years in an early intervention service for psychosis in Montréal, Quebec, Canada. Data included the thematic content and severity of delusions (scores ≥3 using the Scale for the Assessment of Positive Symptoms) and associated psychotic and nonpsychotic symptoms, both across an initial episode and, in the event of remission, a potential relapse. Data were analyzed from September 2021 to February 2023. An early intervention service for psychosis, organized around intensive case management and a multidisciplinary team approach, which observed each patient for up to 2 years of care. The primary outcome was positive symptom relapse and remission, including the presence and content of delusions, which was coded per the Scale for the Assessment of Positive Symptoms and accepted definitions. The main statistical measures included repeated paired-sample t tests and binary logistic regression analyses. Of 636 consenting patients, mean (SD) age was 23.8 (4.75) years; 191 patients were female, 444 were male, and 1 patient was nonbinary. Remission rates were high, and relapse rates were relatively low: 591 individuals had baseline delusions, of which 558 (94.4%) achieved remission. Of these 558 patients, only 182 (32.6%) had a subsequent relapse to a second or later episode of psychosis. Of the 182 patients who did relapse, however, a large proportion (115 [63.2%]) reported threshold-level delusions. Of these 115, 104 patients (90.4%) had thematic delusion content consistent with that reported during the index (first) episode. Those who relapsed with delusions had fewer delusion themes present during subsequent episodes of psychosis compared with the index episode and lower levels of other psychotic and nonpsychotic symptoms. Specialized early intervention services for psychosis can achieve high rates of sustained remission. However, in this study, the minority of individuals with delusions who later relapsed experienced similar delusion themes during subsequent episodes. These findings raise important considerations for the conceptualization of delusions and have clinical implications for trajectories of illness and care.

Clinical systematics of chronic delusional psychoses in schizophrenia and schizophrenia-spectrum pathology

To develop a systematics of chronic delusional psychoses in schizophrenia and pathology of the schizophrenic spectrum that takes into account psychopathological structure (the mechanism of delusional formation) and the trajectories of the disease course (the ratio of negative/positive dimensions). The study sample was recruited from the large Moscow psychiatric hospital in 2019-2024 and included 126 patients (94 male, 32 female, mean age 36.5±12.1 years) hospitalized with ICD-10 diagnosis of paranoid schizophrenia (F20.00) or delusional disorder (F22). A clinical-psychopathological method was used. The study identifies three variants of paranoid domains, the typology of which takes into account both the psychopathological structure and the trajectories of their development, which determine the dominance of predominantly negative or positive symptoms throughout the disease: 1) psychosis with delusional interpretations and predominant orientation of symptoms towards the negative pole of the schizophrenia psychopathology (n=37, 29.4%); 2) psychosis with hallucinatory delusions and predominant direction of symptoms towards the positive pole of the schizophrenia psychopathology (n=50, 39.7%); and 3) «combined» hallucinatory-delusional psychosis with a simultaneous orientation of symptoms to the negative/positive poles of the schizophrenia psychopathology (n=39, 30.9%). Detailed phenomenological characteristics of each of the three presented variants are given. The developed three-component taxonomy confirms, on the model of chronic delusional psychoses appearing in schizophrenia and the pathology of the schizophrenia spectrum, the concept of simultaneous representation of two relatively independent domains determined by neurobiological processes in the schizophrenia psychopathology positive and negative disorders.

The anthropological method for diagnosing mental diseases: On the theory of time structure of Bin Kimura.

Bin Kimura (1931-2021), the Japanese anthropological psychopathologist and philosopher, attached importance to clinical impressions at psychiatric consultations in order to diagnose mental diseases precisely, and thus proposed his original theory of time structure. According to Kimura's theory of time structure, whether we live by giving weight to the past, the present, or the future can be called "time structure," and is essentially related to the way we live with others and experience the world. We can obtain some signs for diagnosing mental diseases from the viewpoint of the time structure of each patient. "Ante-festum" is the time structure in which one lives ahead to the future, and is typical of schizophrenic patients. "Post-festum" is the time structure in which one is late for oneself, and is typical of patients with endogenous depression. "Intra-festum" is the time structure in which one lives directly in the present, and is typical of patients with epilepsy or bipolar disorders. The anthropological diagnosis according to Kimura's theory of time structure could complement the operational diagnostic criteria, such as the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases and Related Health Problems, in daily clinical practice. For example, Kimura's theory of time structure could exercise its ability to discriminate between endogenous and neurotic depression, and between schizophrenia and other delusional psychoses. The theory of time structure and anthropological diagnosis which Bin Kimura proposed in the late 20th century can give us many hints for assessing patients with mental diseases even today.

MEDICAL FITNESS IN WORKERS WITH PSYCHIATRIC DISORDERS

IntroductionMental health disorders are among the most burdensome health concerns in the world; it affects more than 970 million people in 2019. These disorders deteriorate all aspects of life, especially the professional field, impacting mainly physical capability, daily functioning, and productivity among the working-age population.ObjectivesTo study the socio-professional and medical characteristics of workers with psychiatric disorders and to assess the repercussions of these pathologies on work ability.MethodsA descriptive and retrospective study included all the medical files of workers with psychiatric disorders who were referred to the occupational medicine department at Charles Nicolle Hospital for a medical opinion of fitness for work during the period from January 1, 2014, to December 31, 2020.ResultsThe average age of the 224 cases collected was 41.74± [25-60 years] with a sex ratio of 0.67. The average professional seniority was 13.4 years±8.27 years. The most common occupational sectors were health (38.1%) and communication (20.2%). The patients were mainly suffering from either an anxiety-depressive disorder (36.6%) or psychosis (11.6%). These included 21 cases of bipolar disorder, 21 cases of schizophrenia, two cases of chronic hallucinatory psychosis and 3 cases of delusional psychosis. Forty-three patients were fit to continue working, 133 patients were fit with restrictions and twenty-six were unfitted to work.A professional reclassification was recommended for 37 patients in positions with a lower mental load. One employee suffering from advanced schizophrenia was offered early retirement on grounds of disability. Permanent unfitness was pronounced in 11.6% of cases.ConclusionsThe impact of mental disorders on cognitive abilities can be so significant as to result in temporary or permanent unfitness for work. However, the decision of medical fitness for work for the same psychiatric pathology may vary from one individual to another and from one workstation to another.Disclosure of InterestNone Declared

Investigating Specific Associations Between Childhood Victimization Profiles and Positive Psychosis Symptoms: The Mediating Roles of Anxiety, Depression, and Schema.

Childhood trauma is a risk factor for psychosis. It is proposed this is due to traumatic events giving rise to psychological mechanisms that are implicated in the development and maintenance of symptoms. Investigation of the psychological mechanisms accounting for relationships between trauma and psychosis will be assisted by focusing on specific trauma profiles, hallucination modalities, and delusion subtypes. In 171 adults with schizophrenia-spectrum diagnoses and high-conviction delusions, associations between childhood trauma classes, and hallucination and delusion factors, were tested using structural equation models (SEMs). Anxiety, depression, and negative schema were examined as potential mediators of trauma class-psychosis symptom factor links. Significant associations were found between the emotional abuse/neglect and poly-victimization classes with persecutory delusions and delusions of influence, that were all mediated through anxiety (β = 1.24-0.23, P = < .05). There was an association between the physical abuse class and grandiose/religious delusions that was not explained by the mediators (β = 1.86, P = < .05). Trauma class was not significantly associated with any hallucination modality (β = 0.004-1.46, P = > .05). In a sample of people with strongly held delusions, this study demonstrates that childhood victimization is associated with delusions of influence and grandiose beliefs, as well as with persecutory delusions in psychosis. Consistent with previous findings, the potent, mediating role of anxiety supports affective pathway theories and the utility of targeting threat-related processes when treating trauma effects in psychosis.

Bimodal model of delusional psychoses (on the problem of the correlation of paranoid dimensions in the psychopathological space of schizophrenia)

To establish clinico-pathogenetic ratios of delusional psychoses constituting the psychopathological space of paranoid schizophrenia and to determine clinical and pathogenetic validity of concepts of a single delusional psychosis (a model of chronic delusion with a staged course) and two endogenous delusional psychoses. A sample consisted of 56 patients (19 women, 37 men; the average age 39.7±9.3 years; average duration of the disease 10.6±9.1 years) with a diagnosis of paranoid schizophrenia, continuous type of course (F20.00), developed at the age above 18 years. At the time of examination, the condition of the patients was determined by persistent delusional or hallucinatory delusional disorders. Clinical, pathopsychological, psychometric (SANS, SAPS, PANSS), immunological and statistical methods were used. The study substantiates a bimodal model of a single delusional psychosis with a polar arrangement of interpretive delusions and delusions of influence based on the phenomena of mental automatism, both in terms of the vector of development (toward the poles of negative/positive disorders) and in terms of the rate of progression. Psychopathological manifestations of interpretive delusions correlate with the slow evolving development of psychosis, the dimensional structure of the paranoid is limited to the limits of the delusional register; functional activity is represented by affiliation to negative changes, integration with personality anomalies ends with the transformation of positive disorders into pathocharacterological ones, corresponding to the post-processual development of the personality. Manifestation of delusional impact (syndrome of mental automatism) is manifested by the complication and maximum expansion of the spectrum of positive disorders; the dimensional structure is represented by a wide range of psychopathological disorders and is formed with the participation of processes of mental dissociation, reaching the level of delusional depersonalization; functional activity is high, which creates conditions for the formation of a «new» subpsychotic structure, a «psychotic character», which is an attenuated duplicate of delusional psychosis. In both groups of patients, a significant increase in the activity of inflammatory markers of leukocyte elastase (249.2 ((231.1-270.0); 272.2 (236.0-292.6) nmol/min∙ml) and alpha - 1 proteinase inhibitor (48.8 (46.0-55.0); 50.4 (42.1-54.8) IU/ml) was shown compared with controls (205.0 (199.8-217.3) nmol/min∙mL and 33.0 (31.0-36.0) IU/mL, p<0.01, respectively). In the group of patients with delusions of influence, an increased level of antibodies to S-100B was also observed (0.88 (0.67-1.0) opt.density units) compared with the control values (0.7 (0.65-0.77) opt.density units, p<0.05). The concept of the model is supported by the results of the immunological study, according to which interpretive delusions and delusion based on the mental automatism, indicates the different level of immunity tension, and a qualitative changes in immune reactivity (also due to different genetic burden).

Epidemiological, clinical and ethnological particularities of puerperal psychosis in Toamasina, Madagascar

Introduction: A descriptive retrospective study in the Psychiatry service of the Analankininina University Hospital Center of Toamasina Madagascar was conducted from January 1st to December 31st, 2018 to know the epidemiological, clinical and ethnological particularities of puerperal psychosis affecting women hospitalized in this service. Methodology and results: Women presenting mental disorders corresponding to the diagnostic of puerperal psychosis coded F.53 from the Tenth version of the International Classification of Diseases of the WHO were included. Then, among the 451 patients hospitalized at the Toamasina Psychiatry Service, 27 women presented puerperal psychosis. The average age was 25 years with extreme ages of 18 and 34 years. The age between 20 to 24 years was the most affected. According to the level of education, 55.55% of patients attended secondary school and 29.62% had a school break in primary level. They were housewives in 51.85% of cases, married in 59.25%. Obstetrically, 59.25% of patients are primiparous, delivered vaginally in 92.59% and by caesarean surgery in 7.40 % of cases. They had full-term births in 92.59% of cases and premature births in 7.40%. Psychiatrically, no family past of mental troubles was reported in 88.88% of the patients while 7.40 % have had it with first-degree relatives. Furthermore, no personal history of psychosis was found in 74.07% of the patients, while 22.22% had a history of psychosis and 3.70% a history of bipolar disorders. A traumatic experience of childbirth was reported in 22.22% of patients, while 18.51% reported traumatic previous pregnancies and/or deliveries. Marital conflicts (14.81%) and financial difficulties (11, 11%) were the most present stressors. Clinically, puerperal psychosis appeared on average within 8 to 14 days postpartum in 37% of cases. The most presented clinical signs were insomnia (81.48%), delusional state (59.25%), behavioral dissociation (51.85%), anorexia and weight loss (44. 44%) and psychomotor agitation (37.03%). Polymorphic thema of delusions were the most observed in 44.44% of cases. Brief delusional psychoses were the most reported (51.85%), followed by depressive states (25.92%) and schizophrenic troubles (14.81%). Conclusion: Psychological preparation and support for women during pregnancy, childbirth and postpartum are importants. It is suggested that the population would be concious of the existence of appropriate psychiatric care and specific place in Toamasina to treat puerperal psychosis.

Karl Grassmann's 1896 paper "critical overview of contemporary theories of the heredity of the psychoses".

Four years before the rediscovery of Mendel's work in 1900, Karl Grassmann published a detailed, scholarly review of the heredity of psychosis which we here review. A full translation is in the appendix. We emphasize seven major conclusions from this review. First, while recognizing the key importance of heredity in the etiology of psychosis. Grassmann was critical of many of the highly speculative extant theories. Second, he reviewed most of the major methodologic concerns in the literature from what kinds of heredity to investigate to the problems with the global use of insanity as a diagnostic category. Third, he discussed in detail genetic theories associated with Degeneration theory, maintaining considerable skepticism. Fourth, he recognized nongenetic contribution to familial transmission. Fifth, he reviewed evidence for both homogeneous and heterogeneous transmission of forms of mental illness in families, suggesting that both were important. Sixth, while he noted that mania, melancholia, and cyclothymia commonly replaced each other in families, Verrücktheit (delusional psychoses) rarely co-segregated in families with these mood disorders. Seventh, Grassmann, like other 19th century writers, saw relatives to be of value only in assessing the level of hereditary predisposition in patients and had limited appreciation of the need for controlled studies.

Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis

Delusions are a common transdiagnostic feature of psychotic disorders, and their treatment remains suboptimal. Despite the pressing need to better understand the nature, meaning, and course of these symptoms, research into the lived experience of delusional phenomena in psychosis is scarce. Thus, we aimed to explore the lived experience and subjective apprehension of delusions in help-seeking individuals with psychosis, regardless of diagnosis and thematic content of the delusion. In our systematic review and qualitative evidence synthesis, we searched MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science for qualitative studies published in English from database inception, with the last search on Sept 9, 2021. Grey literature search and hand-searching of relevant journals were also done. Studies were eligible if they provided an analysis of lived experience of delusions or predelusional phenomena presented from the perspective of individuals (age 14-65 years) who had developed a clinical high-risk stage of psychosis, or a diagnosable affective or non-affective psychotic disorder (as clinically defined, self-reported, or assessed within the primary study). Studies with only a subset of relevant participants were eligible only if data for the population of interest were reported separately. Studies that did not discriminate between the experience of delusion and other positive symptoms (eg, hallucinations) were included only if data for delusions were reported separately or could be extracted. First-person accounts (and author interpretations) discussing changes in the sense of self, lived world, and meaning in relation to delusions were extracted and synthesised using a novel thematic synthesis approach informed by a critical realist stance and a phenomenological theoretical framework. Analytic themes were developed into a new overarching framework for understanding the emergence of delusional phenomena. The study was registered with PROSPERO, CRD42020222104. Of the 3265 records screened, 2115 were identified after duplicate removal. Of these, 1982 were excluded after title and abstract screening and 106 after full-text eligibility assessment. Of the 27 studies entering quality assessment, 24 eligible studies were included in the qualitative evidence synthesis, representing the perspectives of 373 help-seeking individuals with lived experience of delusions in the context of psychosis. Gender was reported as male (n=210), female (n=110), transgender (n=1), or not reported (n=52). Only 13 studies reported ethnicity, with White being predominant. The age of most participants ranged from 15 to 65 years. We found no eligible studies investigating subclinical or predelusional experiences in at-risk mental state populations through qualitative methods. Most studies were undertaken in western, educated, industrialised, rich, and democratic (WEIRD) societies, and most included participants had received or self-reported a diagnosis within the schizophrenia spectrum. Studies differed in relation to whether they focused on one kind or theme of delusion or delusional phenomena more generally as a unified category. Three superordinate themes relating to experiential changes and meanings in delusion were identified: (1) a radical rearrangement of the lived world dominated by intense emotions; (2) doubting, losing, and finding oneself again within delusional realities; and (3) searching for meaning, belonging, and coherence beyond mere dysfunction. Based on the review findings and thematic synthesis, we propose the Emergence Model of Delusion to advance understanding of delusional phenomena in psychosis. Delusions are best understood as strongly individualised and inherently complex phenomena emerging from a dynamic interplay between interdependent subpersonal, personal, interpersonal, and sociocultural processes. Integrative approaches to research on delusion, which consider their potential adaptiveness and favour explanatory pluralism, might be advantageous. Effective clinical care for individuals with psychosis might need adapting to match more closely, and take account of, the subjective experience and meaning of delusions as they are lived through, which might also help redress power imbalances and enduring epistemic injustices in mental health. Priestley Scholars, Wellcome Trust.

Long–Short Ensemble Network for Bipolar Manic-Euthymic State Recognition Based on Wrist-Worn Sensors

Manic episodes of bipolar disorder can lead to uncritical behavior and delusional psychosis, often with destructive consequences for those affected and their surroundings. Early detection and intervention of a manic episode are crucial to prevent escalation, hospital admission, and premature death. However, people with bipolar disorder may not recognize that they are experiencing a manic episode and symptoms, such as euphoria and increased productivity can also deter affected individuals from seeking help. This work proposes to perform user-independent, automatic mood-state detection based on actigraphy and electrodermal activity acquired from a wrist-worn device during mania and after recovery (euthymia). This article proposes a new deep learning-based ensemble method leveraging long (20 h) and short (5 min) time intervals to discriminate between the mood states. When tested on 47 bipolar patients, the proposed classification scheme achieves an average accuracy of 91.59% in euthymic/manic mood-state recognition.

Use of Care and Care Arrangements for Pupils and Students Who Use Drugs in the Addiction Center in Grand-Bassam (Côte d&amp;apos;Ivoire)

The use of drug use by pupils and students is a global public health problem. This consumption has a considerable impact on the physical and psychological health as well as on the academic performance of pupils and students. <i>Objective:</i> To understand the modalities of care for pupils and students who use drugs received at the Addiction Center of Grand-Bassam. <i>Material and method:</i> This is a retrospective cross-sectional study with a descriptive purpose, carried out over a period of 03 months and which covered 52 files. <i>Results: </i>Patients had an age between 15 and 25 years (69.20%) with a male predominance (83%) and having a first-time early use (36.5%). 61.5% had an interruption of schooling. The demand for care was mainly therapeutic injunctions (84.5%). The consequences of this drug use were the deterioration of the physical and mental health of the users, making it difficult to continue their schooling. The main psychiatric pathologies encountered were transient acute delusional psychoses (36.5%) and schizophrenia (26.9%). The most widely used drug was cannabis (69.2%). 94% of the respondents had benefited from hospitalization against 6% followed by the ambulance. All patients admitted to the centre had received withdrawal, antipsychotic treatment and psychotherapy. 85.7% of patients had a length of hospitalization of more than 30 days. <i>Conclusion:</i> This would achieve quality care for pupils and students who use drugs by encouraging the use of free care among this population, but also by increasing the number of adapted specialized structures that will use teams of specialized therapists.

Brain Atrophy in First-Episode Psychosis of the Elderly Is Associated With Cognitive Decline.

Objective: To study brain atrophy and cognitive decline in elderly patients with first-episode psychosis (FEP).Methods: Elderly patients aged ≥ 60 years with FEP and onset of psychotic symptoms of ≤ 1 year remitted to the Helsinki University Hospital from December 2009 to December 2011 were included in the study. Diagnoses were made using DSM-IV-TR criteria. All patients had a brain scan, magnetic resonance imaging, or computed tomography. Cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer`s Disease cognitive test battery.Results: Of the 85 patients with FEP, 18 had very late-onset schizophrenia-like psychosis (VLOSP), 20 had delusional psychosis, 12 had depressive psychosis, and 35 had psychosis due to a general medical condition. Fifteen of the patients had an earlier history of schizophrenia not known at the time of admittance. These patients were analyzed separately. A vast majority of the FEP patients in all diagnostic groups exhibited signs of cortical atrophy, which was associated with early stage cognitive decline. Multivariate analyses showed that brain atrophy was associated with a decline in Mini-Mental State Examination, Clock Drawing Test, and verbal fluency scores in FEP patients.Conclusions: Brain atrophy is a frequent finding in elderly FEP patients and is associated with cognitive decline. Elderly patients with FEP should always undergo brain atrophy and cognition screening, as they may constitute an etiologic factor in such patients.

Digitally supported CBT to reduce paranoia and improve reasoning for people with schizophrenia-spectrum psychosis: the SlowMo RCT

Background Reasoning may play a causal role in paranoid delusions in psychosis. SlowMo, a new digitally supported cognitive–behavioural therapy, targets reasoning to reduce paranoia. Objectives To examine the effectiveness of SlowMo therapy in reducing paranoia and in improving reasoning, quality of life and well-being, and to examine its mechanisms of action, moderators of effects and acceptability. Design A parallel-arm, assessor-blind, randomised controlled trial comparing SlowMo plus treatment as usual with treatment as usual alone. An online independent system randomised eligible participants (1 : 1) using randomly varying permuted blocks, stratified by site and paranoia severity. Setting Community mental health services in three NHS mental health trusts in England, plus patient identification centres. Participants A total of 362 participants with schizophrenia-spectrum psychosis. Eligibility criteria comprised distressing and persistent (≥ 3 months) paranoia. Interventions Eight face-to-face SlowMo sessions over 12 weeks plus treatment as usual, or treatment as usual alone (control group). Main outcome measures The primary outcome measure was paranoia measured by the Green Paranoid Thoughts Scale and its revised version, together with observer-rated measures of persecutory delusions (The Psychotic Symptom Rating Scales delusion scale and delusion items from the Scale for the Assessment of Positive Symptoms). The secondary outcome measures were reasoning (measures of belief flexibility, jumping to conclusions, and fast and slow thinking), well-being, quality of life, schemas, service use and worry. Results A total of 362 participants were recruited between 1 May 2017 and 14 May 2019: 181 in the SlowMo intervention group and 181 in the treatment-as-usual (control) group. One control participant subsequently withdrew. In total, 325 (90%) participants provided primary Green Paranoid Thoughts Scale outcome data at 12 weeks (SlowMo, n = 162; treatment as usual, n = 163). A total of 145 (80%) participants in the SlowMo group completed all eight therapy sessions. SlowMo was superior to treatment as usual in reducing paranoia on all three measures used: Green Paranoid Thoughts Scale total at 12 weeks (Cohen’s d = 0.30, 95% confidence interval 0.09 to 0.51; p = 0.005) and 24 weeks (Cohen’s d = 0.20, 95% confidence interval –0.02 to 0.40; p = 0.063); Psychotic Symptom Rating Scales delusions at 12 weeks (Cohen’s d = 0.47, 95% confidence interval 0.17 to 0.78; p = 0.002) and 24 weeks (Cohen’s d = 0.50, 95% confidence interval 0.20 to 0.80; p = 0.001); and Scale for the Assessment of Positive Symptoms persecutory delusions at 12 weeks (Cohen’s d = 0.43, 95% confidence interval 0.03 to 0.84; p = 0.035) and 24 weeks (Cohen’s d = 0.54, 95% confidence interval 0.14 to 0.94; p = 0.009). Reasoning (belief flexibility, possibility of being mistaken and Fast and Slow Thinking Questionnaire measure) improved, but jumping to conclusions did not improve. Worry, quality of life, well-being and self-concept also improved, improving most strongly at 24 weeks. Baseline characteristics did not moderate treatment effects. Changes in belief flexibility and worry mediated changes in paranoia. Peer researcher-led qualitative interviews confirmed positive experiences of the therapy and technology. Nineteen participants in the SlowMo group and 21 participants in the treatment-as-usual group reported 54 adverse events (51 serious events, no deaths). Limitations The trial included treatment as usual as the comparator and, thus, the trial design did not control for the effects of time with a therapist. Conclusions To the best of our knowledge, this is the largest trial of a psychological therapy for paranoia in people with psychosis and the first trial using a brief targeted digitally supported therapy. High rates of therapy uptake demonstrated acceptability. It was effective for paranoia, comparable to longer therapy, and equally effective for people with different levels of negative symptoms and working memory. Mediators were improvements in belief flexibility and worry. Our results suggest that targeting reasoning helps paranoia. Future work Further examination of SlowMo mechanisms of action and implementation. Trial registration Current Controlled Trials ISRCTN32448671. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a MRC and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 11. See the NIHR Journals Library website for further project information.

Cognitive Biases Questionnaire for Psychosis (CBQp): Spanish Validation and Relationship With Cognitive Insight in Psychotic Patients.

Introduction: Cognitive biases are key factors in the development and persistence of delusions in psychosis. The Cognitive Biases Questionnaire for Psychosis (CBQp) is a new self-reported questionnaire of 30 relevant situations to evaluate five types of cognitive biases in psychosis. In the context of the validation of the Spanish version of the CBQp, our objectives were to (1) analyze the factorial structure of the questionnaire with a confirmatory factor analysis (CFA), (2) relate cognitive biases with a widely used scale in the field of delusion cognitive therapies for assessing metacognition, specifically, Beck's Cognitive Insight Scale (BCIS) (1), and, finally, (3) associate cognitive biases with delusional experiences, evaluated with the Peters Delusions Inventory (PDI) (2).Materials and Methods: An authorized Spanish version of the CBQp, by a translation and back-translation procedure, was obtained. A sample of 171 patients with different diagnoses of psychoses was included. A CFA was used to test three different construct models. Associations between CBQp biases, the BCIS, and the PDI were made by correlation and mean differences. Comparisons of the CBQp scores between a control group and patients with psychosis were analyzed.Results: The CFA showed comparative fit index (CFI) values of 0.94 and 0.95 for the models with one, two, and five factors, with root mean square error of approximation values of 0.031 and 0.029. The CBQp reliability was 0.87. Associations between cognitive biases, self-certainty, and cognitive insight subscales of the BCIS were found. Similarly, associations between total punctuation, conviction, distress, and concern subscales of the PDI were also found. When compared with the group of healthy subjects, patients with psychoses scored significantly higher in several cognitive biases.Conclusion: Given the correlation between biases, a one-factor model might be more appropriate to explain the scale's underlying construct. Biases were associated with a greater frequency of delusions, distress, conviction, and concern as well as worse cognitive insight in patients with psychosis.

Modernism and the Machinery of Madness: Psychosis, Technology, and Narrative Worlds. Andrew Gaedtke. Cambridge: Cambridge University Press, 2017. Pp. vii+246.

Modernism and the Machinery of Madness: Psychosis, Technology, and Narrative Worlds. Andrew Gaedtke. Cambridge: Cambridge University Press, 2017. Pp. vii+246.

Psychotic Disorders in the Veterans of Local Wars

Objectives. To determine the frequency of leading psychopathological syndromes, dynamics, and comorbidities of schizophrenia and other endogenous psychoses in Russian veterans of local wars receiving hospital treatment. Materials and methods. A total of 685 patients receiving treatment in the psychiatric departments of a military hospital were studied: 264 veterans of local wars (the study group), 296 servicemen (personnel and reserves) who had not taken part in military engagements (reference group 1), whose mean age differed from that of the study group, and 125 servicemen (personnel and reserves) who had not taken part in military engagements and had the same mean age and age distribution as patients of the study group (reference group 2). Results and conclusions. Among veterans (patients of the study group), the frequency of delusional (schizotypic) psychoses was somewhat lower (7.2%) than among patients who had not taken part in military engagements (14.5% and 8.8%, respectively). Patients of all three groups were mainly diagnosed with schizophrenia (ICD-10 F20): 3.8% in the study group, 4.4% in reference group 1, and 4.0% in reference group 2. Other acute and chronic psychotic disorders (F22–F23) were rarer and were seen in 0.8%, 5.4%, and 3.2% of patients, respectively. Organic delusional disorders were diagnosed in 1.5% of veterans and 3.7% of patients in reference group 1 but were not seen in patients of reference group 2. Comorbidity with post-traumatic stress disorder (PTSD) and psychotic symptoms in veterans was less than 2% but was seen in 26.3% of patients with diagnoses of schizophrenia and other disorders. The incidence of PTSD symptoms in veterans with diagnosed schizophrenia and other delusional disorders was significantly lower than the incidence among all veterans (20% and 46.9%, respectively). No link was found between hallucinatory and delusional experiences and the actions of military stress factors in the study group. In most patients of the study group, psychotic symptomatology became manifest after combat stress ended, and the subsequent development and relapse of psychotic symptomatology occurred independently of the effects of wartime factors.

S80. CHILDHOOD TRAUMA AND SOCIAL COGNITION IN DELUSIONAL PSYCHOSES

BackgroundDeficits in social cognition could be involved in the pathogenesis of delusions in psychotic disorders (Bentall et al., 2009). Childhood trauma (CT) has been associated with an increased risk for psychosis (Varese et al., 2012). Neurocognitive and social cognition deficits could mediate in the association between CT and psychosis (Mansueto et al., 2019). Social cognition and childhood trauma have been understudied so far in delusional disorder (DD). We aimed to assess social cognition in a sample of patients with delusional psychoses (i.e., DD and schizophrenia) and healthy controls (HC) and to explore the potential effect of childhood trauma on social cognition and delusion.MethodsThis cross-sectional, transdiagnostic study included 69 patients with a DSM-IV-TR-confirmed diagnosis of DD (mean age 44.06 ± 11.39 years, 53.6% female), 77 with DSM-IV-TR-confirmed schizophrenia (mean age 38.12 ± 9.27 years, 27.3% female), and 63 HC (mean age 43.6 ± 13.0 years, 68.3% female). Attributional bias was assessed with the “Internal, Personal, and Situational Attributions Questionnaire.” Theory of Mind (ToM) performance was assessed with the “Reading the Mind in the Eyes Test” and the “Faux Pas Recognition Test.” Childhood trauma was measured with the “Childhood Trauma Questionnaire.” Neuropsychological functioning was measured with a comprehensive battery assessing attention, verbal learning, working memory, and executive function. We used ANCOVAs and linear regression analyses to assess the association between the three measures of social cognition and i) diagnosis, ii) dimensional measures of delusion proneness (Peters Delusion Inventory, PDI) and intensity (Maudsley Assessment of Delusion Schedule, MADS), and iii) childhood trauma; after controlling for potential confounders (age, sex, socioeconomic status, and estimated premorbid intelligence quotient).ResultsPatients with DD showed significantly poorer performance on the “Eyes Test” than HC (Cohen’s d=-0.44, p=0.037), after controlling for potential confounding variables. The difference was no longer significant after controlling for verbal memory. Patients with schizophrenia (d=-1.54, p<0.001) and DD (Cohen’s d=-0.60, p=0.002) showed significantly poorer performance than HC on the “Faux Pas Test,” after controlling for potential confounders. The difference between patients with schizophrenia and HC remained significant after controlling for neuropsychological functioning (Cohen’s d=-1.09, p<0.001), while differences between patients with DD and HC were no longer significant after controlling for executive function and working memory performance (Cohen’s d=-0.23, p=0.596). No significant differences were found between diagnostic groups in externalizing or personalizing attributional bias. In the fully adjusted models, intensity of the delusional idea was significantly associated with performance in the “Faux Pas Test” in DD, and with externalizing and personalizing attributional bias in schizophrenia. A positive history of CT was significantly associated with lower performance on the “Faux Pas Test” (Cohen’s d=-0.40, p=.022) and higher delusional proneness scores in the delusional psychosis samples (Cohen’s d=-0.49, p=.006), but not in HC.DiscussionSocial cognition deficits are associated with delusional intensity in delusional psychoses. Childhood trauma could increase the risk of psychosis through its effect on social cognition.

O2.6. DELUSIONS ASSOCIATED WITH ABNORMAL FRONTOSTRIATAL EFFECTIVE CONNECTIVITY IN A SPECTRAL DCM ANALYSIS OF RESTING STATE FMRI

BackgroundDelusions, false beliefs held in the face of disconfirming evidence, are a prevalent and highly distressing feature of psychotic disorders. The neurobiology of delusions remains unknown but recent evidence suggests a role for abnormal prediction error neural signaling. Prediction error is neurocognitive process in which the brain signals the need to update beliefs when presented with information that disconfirms expectations. Task based neuroimaging studies have identified delusional beliefs correlate with altered activation in frontal and subcortical brain regions during prediction error, though such work is limited in scope. In a large sample of transdiagnostic psychotic patients we modeled the resting state effective connectivity of the delusion-associated predication error (D-PE) circuit.MethodsResting state fMRI was obtained from 289 psychotic subjects (schizophrenia, schizoaffective disorder, bipolar disorder with psychotic features) and 219 healthy controls, recruited as part of the multisite Bipolar & Schizophrenia Network on Intermediate Phenotypes (BSNIP1) study. Neuroimaging data were processed using CONN software with strict quality control criteria. Five D-PE regions of interest (ROIs) were created based on peak coordinates from published task-based prediction error fMRI studies: right Dorsolateral Prefrontal Cortex [r DLPFC], r Ventrolateral Prefrontal Cortex [r VLPFC], r Caudate, l Caudate and l Midbrain. In each subject the first eigenvariate was extracted from the rs-fMRI timeseries of each D-PE ROI. Spectral Dynamic Causal Modeling (spDCM) was performed on a fully connected model of the 5 ROIs. Parameters for the full model were fit using Parameter Empirical Bayes (PEB) and then passed to the group level where they were reduced using Bayesian Model Averaging (BMA). The association of effective connectivity with current delusional severity was tested using PEB-BMA controlling for antipsychotic medication, sex, age and scanner site. Significant effective connectivity was identified as parameters with free energy evidence greater than 95% probability. Additionally, we assessed the effective connectivity differences of this circuit between psychotic probands and healthy controls.ResultsGreater delusional severity was significantly associated with inhibition of the r Caudate by the r VLPFC, excitation of the r DLPFC by the l Caudate, and decreased self-inhibition of the r VLPFC and r DLPFC. Effective connectivity of the D-PE network in psychotic probands compared to healthy controls was associated with inhibition of the r Caudate by the r VLPFC, the r DLPFC by the l Midbrain, the l Midbrain by the r Caudate, and decreased self-inhibition of the r Caudate, r VLPFC, and r DLPFC.DiscussionWe found that resting state effective connectivity of the prediction error circuit is disrupted in psychotic subjects experiencing delusions. Specifically, delusion severity was associated with both increased bottom-up and decreased top-down frontostriatal connectivity along with greater disinhibition of the r VLPFC and r DLPFC. These effective connectivity results provide novel insight into the causal paths which may underlie delusion neural circuitry. This provides further evidence that dysconnectivity of prediction error system is a biomarker of delusions in psychosis. Furthermore, these transdiagnostic results implicate frontostriatal dysconnectivity as common neuropathology in delusions.

IMAgery focused psychological therapy for persecutory delusions in PSychosis (iMAPS): a multiple baseline experimental case series.

Many people with psychosis experience persecutory delusions and report negative schematic beliefs and intrusive mental images which may be maintaining factors for psychotic symptoms. This study examined the feasibility and acceptability of a new psychological therapy targeting schemas and images (iMAPS therapy). The study used a randomised multiple baseline design. Participants with first episode psychosis were randomised using a multiple baseline design with 2-5 assessments. Six sessions of therapy, consisting of a combination of imagery techniques and imagery rescripting techniques, was used. In each session, participants completed a Mental Imagery in Psychosis Questionnaire (MIPQ) and imagery interview. Mood and delusional beliefs (PSYRATS) were also measured at each session. Five participants with first episode psychosis completed the baseline visits and attended all therapy sessions. One participant declined the final assessment. Results demonstrated significant reductions in negative schematic beliefs, delusions, imagery distress and other measures of schema (YSQ, SMI). Although multiple baseline randomisation strengthens the study, it lacked a control arm and blind assessments. iMAPS appears a feasible and acceptable treatment for psychosis, and further evaluation is indicated.