Delusion Formation Research Articles

T70. DUAL-PROCESS THEORY, CONFLICT PROCESSING, AND DELUSIONAL BELIEF

BackgroundIndividuals endorsing delusions exhibit multiple reasoning biases, including a bias toward lower decision thresholds, a bias toward gathering less data before forming conclusions, and a bias toward discounting evidence against one’s beliefs. Although these biases have been repeatedly associated with delusions, it remains unclear how they might arise, how they might be interrelated, and whether any of them play a causal role in forming or maintaining delusions.Progress toward answering these questions may be made by examining delusion-related reasoning biases from the perspective of dual-process theories of reasoning. Dual-process theories posit that human reasoning proceeds via two systems: an intuitive system (which is autonomous, does not require working memory) and an analytic system (which relies on working memory, supports hypothetical thought). Importantly, when the outputs of one or both systems conflict with one another, successful detection of this conflict is thought to produce additional engagement in analytic reasoning. Thus, the detection of and ensuing neurocognitive response to conflict may modulate analytic reasoning engagement.Working from this dual-process perspective, recent theories have hypothesized that more limited engagement in analytic reasoning, perhaps resulting from conflict processing deficits, may engender delusion-inspiring reasoning biases in people with schizophrenia.MethodsGiven this hypothesis, a literature review (Bronstein et al., 2019, Clinical Psychology Review, 72, 101748) was conducted to critically evaluate whether impaired conflict processing might be a primary initiating deficit in pathways relevant to the generation of delusion-relevant reasoning biases and the formation and/or maintenance of delusions themselves.ResultsResearch examined in this review suggested that in healthy people, successful conflict detection raises decision thresholds. Conflict-processing deficits in delusional individuals with schizophrenia might impair this process. Consistent with this possibility, delusional individuals with schizophrenia (vs. healthy controls) make more decisions when they perceive their favored choice to be only marginally better than alternatives. Lower decision thresholds in individuals who endorse delusions may limit analytic thinking (which takes time). Reductions in decision-making thresholds and in analytic reasoning engagement may encourage these individuals to jump to conclusions, potentially promoting delusion formation, and may also increase bias against disconfirmatory evidence, which may help delusions persist.DiscussionExtant literature suggests that conflict processing deficits might encourage delusion-related cognitive biases, which is broadly consistent with the idea that these deficits may be causally primary in pathways leading to delusions. This conclusion lends credence to previous theories suggesting that reduced modulation toward analytic reasoning in the presence of conflict might promote delusions. Future research should attempt to more specifically determine the source of deficits related to analytic reasoning engagement in delusional individuals with schizophrenia. It is often unclear whether analytic-reasoning-related deficits observed in existing literature result from impairments in conflict detection, responsiveness to conflict, or both. Tasks used to study dual-process reasoning in the general population may be useful platforms for specifying the nature of analytic-reasoning-related deficits in delusional individuals with schizophrenia.

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

BackgroundDeficits 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.MethodsA 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.ResultsPeople 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).DiscussionWe 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.

T64. LINKING SUBCLINICAL PERSECUTORY IDEATION TO INFLEXIBLE SOCIAL INFERENCE UNDER UNCERTAINTY

BackgroundPersecutory delusions (PD) are a prominent symptom in first episode psychosis and psychosis patients. PD have been linked to abnormalities in probabilistic reasoning and social inference (e.g., attribution styles). Predictive Coding theories of delusion formation suggest that rigid delusional beliefs could be formalized as precise (i.e. held with certainty) high-level prior beliefs, which were formed to explain away overly precise low-level prediction errors (PEs). Rigid reliance on high-level prior beliefs would in turn lead to diminished updating of high-level PEs, i.e. decreased learning and updating of high-level beliefs.MethodsWe tested the prediction that subclinical PD ideation is related to altered social inference and beliefs about others’ intentions. To that end, N=1’145 participants from the general population were pre-screened with the Paranoia Checklist (PCL) and assigned to groups of high (“high PD”) or low PD tendencies (“low PD”). Participants with intermediate scores were excluded, participants assigned to either group filled in the PCL again after four weeks, only individuals whose score remained inside the cut-offs for either group were subsequently invited to the study. We invited 162 participants and included 151 participants in the analyses based on exclusion criteria defined in an analysis plan, which was time-stamped before the conclusion of data acquisition. Participants performed a probabilistic advice-taking task with dynamic changes in the advice-outcome mapping (volatility) under one of two experimental frames. These frames differentially emphasised possible reasons behind unhelpful advice: (i) the adviser’s possible intentions (dispositional frame) or (ii) the rules of the game (situational frame). Our design was thus 2-by-2 factorial (high vs. low delusional ideation, dispositional vs. situational frame). Participants were matched regarding age, gender, and education in years. In addition to analyses of variance on participants’ behaviour, we applied computational modeling to test the predictions regarding prior beliefs and belief updating mentioned above.ResultsWe found significant group-by-frame interactions, indicating that in the situational frame high PD participants took advice less into account than low scorers (df = (1,150), F = 5.77, p = 0.018, partial η2= 0.04). This was also reflected in the model parameters of the model explaining participants’ learning under uncertainty best in comparison to other learning models (e.g. tonic evolution rate omega2: df = (1,150), F = 4.75, p = 0.03).DiscussionOur findings suggest that social inference in individuals with subclinical PD tendencies is shaped by rigid negative prior beliefs about the intentions of others. High PD participants were less sensitive to the attributional framing and updated their beliefs less vs. low PD participants thereby preventing them to make adaptive use of social information in “safe” contexts.

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.

Delusion, Proper Function, and Justification

Among psychiatric conditions, delusions have received significant attention in the philosophical literature. This is partly due to the fact that many delusions are bizarre, and their contents interesting in and of themselves. But the disproportionate attention is also due to the notion that by studying what happens when perception, cognition, and belief go wrong, we can better understand what happens when these go right. In this paper, I attend to delusions for the second reason—by evaluating the epistemology of delusions, we can better understand the epistemology of ordinary belief. More specifically, given recent advancements in our understanding of how delusions are formed, the epistemology of delusions motivates a proper functionalist account of the justification of belief. Proper functionalist accounts of the justification of belief hold that whether a belief is justified is partly determined by whether the system that produces the belief is functioning properly. Whatever pathology is responsible for delusion formation, restoring it to its proper function resolves the epistemic condition, an effect which motivates proper functionalism.

Altered subcortical emotional salience processing differentiates Parkinson's patients with and without psychotic symptoms.

Current research does not provide a clear explanation for why some patients with Parkinson's Disease (PD) develop psychotic symptoms. The 'aberrant salience hypothesis' of psychosis has been influential and proposes that dopaminergic dysregulation leads to inappropriate attribution of salience to irrelevant/non-informative stimuli, facilitating the formation of hallucinations and delusions. The aim of this study is to investigate whether non-motivational salience is altered in PD patients and possibly linked to the development of psychotic symptoms. We investigated salience processing in 14 PD patients with psychotic symptoms, 23 PD patients without psychotic symptoms and 19 healthy controls. All patients were on dopaminergic medication for their PD. We examined emotional salience using a visual oddball fMRI paradigm that has been used to investigate early stages of schizophrenia spectrum psychosis, controlling for resting cerebral blood flow as assessed with arterial spin labelling fMRI. We found significant differences between patient groups in brain responses to emotional salience. PD patients with psychotic symptoms had enhanced brain responses in the striatum, dopaminergic midbrain, hippocampus and amygdala compared to patients without psychotic symptoms. PD patients with psychotic symptoms showed significant correlations between the levels of dopaminergic drugs they were taking and BOLD signalling, as well as psychotic symptom scores. Our study suggests that enhanced signalling in the striatum, dopaminergic midbrain, the hippocampus and amygdala is associated with the development of psychotic symptoms in PD, in line with that proposed in the 'aberrant salience hypothesis' of psychosis in schizophrenia.

Atypical processing of uncertainty in individuals at risk for psychosis.

Current theories of psychosis highlight the role of abnormal learning signals, i.e., prediction errors (PEs) and uncertainty, in the formation of delusional beliefs. We employed computational analyses of behaviour and functional magnetic resonance imaging (fMRI) to examine whether such abnormalities are evident in clinical high risk (CHR) individuals. Non-medicated CHR individuals (n=13) and control participants (n=13) performed a probabilistic learning paradigm during fMRI data acquisition. We used a hierarchical Bayesian model to infer subject-specific computations from behaviour - with a focus on PEs and uncertainty (or its inverse, precision) at different levels, including environmental 'volatility' - and used these computational quantities for analyses of fMRI data. Computational modelling of CHR individuals' behaviour indicated volatility estimates converged to significantly higher levels than in controls. Model-based fMRI demonstrated increased activity in prefrontal and insular regions of CHR individuals in response to precision-weighted low-level outcome PEs, while activations of prefrontal, orbitofrontal and anterior insula cortex by higher-level PEs (that serve to update volatility estimates) were reduced. Additionally, prefrontal cortical activity in response to outcome PEs in CHR was negatively associated with clinical measures of global functioning. Our results suggest a multi-faceted learning abnormality in CHR individuals under conditions of environmental uncertainty, comprising higher levels of volatility estimates combined with reduced cortical activation, and abnormally high activations in prefrontal and insular areas by precision-weighted outcome PEs. This atypical representation of high- and low-level learning signals might reflect a predisposition to delusion formation.

Delusion formation as an inevitable consequence of a radical alteration in lived experience

ABSTRACT The definition of delusion is usually couched in terms of false beliefs held with conviction despite evidence to the contrary. Such beliefs are usually seen as impossible or implausible by others. In order to be classed as clinically significant, a delusion would lead a person to be distressed or to have significant problems with functioning. We note that a person ordinarily understands and negotiates the world based on familiar patterns derived from her cultural and historical experience. Thus, when her lived experience is altered, these assumptions about how the world works may be called in to question. Drawing on interviews conducted with people experiencing clinically significant delusions, we show how this alteration in lived experience manifests as emotional, affective and/or perceptual anomalies. We adopt the framework of the Enactive Approach which posits that a person interacts with her environment in terms of sense-making and we argue that radical alterations in lived experience can demand a renegotiating of how a person makes sense of this new world. We suggest that if the alteration in lived experience is sufficiently radical, then delusion formation is inevitable.

Delusion Formation through Uncertainty and Possibility-blindness

Algunos autores han intentado considerar los delirios como certezas –entendidas en el sentido de Wittgenstein– debido a las similitudes que parecen existir entre sus respectivos estatus epistemológicos. Sin embargo, dicho intento ha sido criticado con agudeza, entre otras razones, porque el contenido de los delirios choca frontalmente con el contenido de las certezas, por lo que los delirios no pueden ser comprendidos debido a los cambios en las relaciones de significado. Pero es evidente que, aunque los delirios no se puedan contemplar como certezas, muchos delirios afectan de un modo u otro al sistema de certezas del paciente. Partiendo de esta base, no es descabellado pensar que dicha influencia pudiera ser también recíproca: en otras palabras, parece sumamente recomendable analizar si algunos delirios se podrían contemplar como el resultado de variaciones en certezas. En este artículo llevo a cabo dicho análisis al intentar mostrar que el origen de algunos delirios pedestres y severos puede ser hallado en lo que llamaré “ceguera a posibilidades” e “incertidumbre”, términos que he desarrollado teniendo en cuenta la obra del filósofo Ludwig Wittgenstein.

Inflexible social inference in individuals with subclinical persecutory delusional tendencies

It has been suspected that abnormalities in social inference (e.g., learning others' intentions) play a key role in the formation of persecutory delusions (PD). In this study, we examined the association between subclinical PD and social inference, testing the prediction that proneness to PD is related to altered social inference and beliefs about others' intentions. We included 151 participants scoring on opposite ends of Freeman's Paranoia Checklist (PCL). The participants performed a probabilistic advice-taking task with a dynamically changing social context (volatility) under one of two experimental frames. These frames differentially emphasised possible reasons behind unhelpful advice: (i) the adviser's possible intentions (dispositional frame) or (ii) the rules of the game (situational frame). Our design was thus 2 × 2 factorial (high vs. low delusional tendencies, dispositional vs. situational frame). We found significant group-by-frame interactions, indicating that in the situational frame high PCL scorers took advice less into account than low scorers. Additionally, high PCL scorers believed more frequently that incorrect advice was delivered intentionally and that such misleading behaviour was directed towards them personally. Overall, our results suggest that social inference in individuals with subclinical PD tendencies is shaped by negative prior beliefs about the intentions of others and is thus less sensitive to the attributional framing of adviser-related information. These findings may help future attempts of identifying individuals at risk for developing psychosis and understanding persecutory delusions in psychosis.

The weeks before 100 persecutory delusions: the presence of many potential contributory causal factors.

The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding. To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors - identified from a cognitive model - before delusion onset. A total of 100 patients with persecutory delusions completed a checklist about their subjective experiences in the weeks before belief onset. The checklist included items concerning worry, images, low self-esteem, poor sleep, mood dysregulation, dissociation, manic-type symptoms, aberrant salience, hallucinations, substance use and stressors. Time to reach certainty in the delusion was also assessed. Most commonly it took patients several months to reach delusion certainty (n = 30), although other patients took a few weeks (n = 24), years (n = 21), knew instantly (n = 17) or took a few days (n = 6). The most frequent experiences occurring before delusion onset were: low self-confidence (n = 84); excessive worry (n = 80); not feeling like normal self (n = 77); difficulties concentrating (n = 77); going over problems again and again (n = 75); being very negative about the self (n = 75); images of bad things happening (n = 75); and sleep problems (n = 75). The average number of experiences occurring was high (mean 23.5, s.d. = 8.7). The experiences clustered into six main types, with patients reporting an average of 5.4 (s.d. = 1.0) different types. Patients report numerous different experiences in the period before full persecutory delusion onset that could be contributory causal factors, consistent with a complex multifactorial view of delusion occurrence. This study, however, relied on retrospective self-report and could not determine causality. None.

Continuing commentary: challenges or misunderstandings? A defence of the two-factor theory against the challenges to its logic

ABSTRACTCorlett, P. R. (2019. Factor one, familiarity and frontal cortex: A challenge to the two-factor theory of delusions. Cognitive Neuropsychiatry, 24(3), 165–177. doi:10.1080/13546805.2019.1606706) raises two groups of challenges against the two-factor theory of delusions: One focuses on weighing “the evidence for … the two-factor theory”; the other aims to question “the logic of the two-factor theory” (ibid., p. 166). McKay, R. (2019. Measles, magic and misidentifications: A defence of the two-factor theory of delusions. Cognitive Neuropsychiatry, 24(3), 183–190. doi:10.1080/13546805.2019.1607273) has robustly defended the two-factor theory against the first group. But the second group, which Corlett believes is in many aspects independent of the first group and Darby, R. R. (2019. A network-based response to the two-factor theory of delusion formation. Cognitive Neuropsychiatry, 24(3), 178–182. doi:10.1080/13546805.2019.1606709, p. 180) takes as “[t]he most important challenge to the two-factor theory raised by Dr. Corlett”, has by large remained. Here I offer my two cents in response to the second group. More specifically, I argue that Corlett’s challenges to the logic of the two-factor theory, concerning modularity, double dissociation and cognitive penetration, seem to be based on some misunderstandings of the two-factor theory.

Emerging Temporal Lobe Dysfunction in People at Clinical High Risk for Psychosis.

Clinical high-risk (CHR) individuals have been increasingly utilized to investigate the prodromal phases of psychosis and progression to illness. Research has identified medial and lateral temporal lobe abnormalities in CHR individuals. Dysfunction in the medial temporal lobe, particularly the hippocampus, is linked to dysregulation of glutamate and dopamine via a hippocampal–striatal–midbrain network that may lead to aberrant signaling of salience underpinning the formation of delusions. Similarly, lateral temporal dysfunction may be linked to the disorganized speech and language impairments observed in the CHR stage. Here, we summarize the significance of these neurobiological findings in terms of emergent psychotic symptoms and conversion to psychosis in CHR populations. We propose key questions for future work with the aim to identify the neural mechanisms that underlie the development of psychosis.

Psychotic symptoms and suicidal ideation in child and adolescent bipolar I disorder.

The purpose of this study was to explore associations between specific types of hallucinations and delusions and suicidal ideation in a sample of children and adolescents with bipolar I disorder. Participants (N=379) were children and adolescents aged 6-15years (M=10.2, SD=2.7) with DSM-IV diagnoses of bipolar I disorder, mixed or manic phase. The study sample was 53.8% female and primarily White (73.6% White, 17.9% Black, and 8.5% Other). Presence and nature of psychotic symptoms, suicidal ideation, and functioning level were assessed through clinician-administered measures. A series of logistic regressions was performed to assess the contribution of each subtype of psychotic symptom to the presence of suicidal ideation above and beyond age, sex, socio-economic status, age at bipolar disorder onset, and global level of functioning. Hallucinations overall, delusions of guilt, and number of different psychotic symptom types were uniquely associated with increased odds of suicidal ideation after accounting for covariates. Other forms of delusions (eg, grandiose) and specific types of hallucinations (eg, auditory) were not significantly uniquely associated with the presence of suicidal ideation. Findings of this study suggest the presence of hallucinations as a whole, delusions of guilt specifically, and having multiple concurrent types of psychotic symptoms are associated with the presence of suicidal ideation in children and adolescents with bipolar I disorder. Psychotic symptom subtypes, as opposed to psychosis as a whole, are an under-examined, potentially important, area for consideration regarding suicidal ideation in pediatric bipolar I disorder.

A network-based response to the two-factor theory of delusion formation

ABSTRACTIn response to Dr. Corlett’s paper regarding the two factor theory of delusional misidentifications, I discuss further evidence that VMPFC damaged patients do not have an isolated factor 1 defect. I then discuss more broadly the limitations in the modular view of brain function that leads to the 2-factor theory. Finally, I propose a connectionist based interpretation of delusional misidentifications that better fits with the clinical data from patients with focal brain lesions showing how these lesion locations relate to complex brain networks.

Cost Evaluation During Decision-Making in Patients at Early Stages of Psychosis.

Jumping to conclusions during probabilistic reasoning is a cognitive bias reliably observed in psychosis and linked to delusion formation. Although the reasons for this cognitive bias are unknown, one suggestion is that psychosis patients may view sampling information as more costly. However, previous computational modeling has provided evidence that patients with chronic schizophrenia jump to conclusions because of noisy decision-making. We developed a novel version of the classical beads task, systematically manipulating the cost of information gathering in four blocks. For 31 individuals with early symptoms of psychosis and 31 healthy volunteers, we examined the numbers of “draws to decision” when information sampling had no, a fixed, or an escalating cost. Computational modeling involved estimating a cost of information sampling parameter and a cognitive noise parameter. Overall, patients sampled less information than controls. However, group differences in numbers of draws became less prominent at higher cost trials, where less information was sampled. The attenuation of group difference was not due to floor effects, as in the most costly block, participants sampled more information than an ideal Bayesian agent. Computational modeling showed that, in the condition with no objective cost to information sampling, patients attributed higher costs to information sampling than controls did, Mann–Whitney U = 289, p = 0.007, with marginal evidence of differences in noise parameter estimates, t(60) = 1.86, p = 0.07. In patients, individual differences in severity of psychotic symptoms were statistically significantly associated with higher cost of information sampling, ρ = 0.6, p = 0.001, but not with more cognitive noise, ρ = 0.27, p = 0.14; in controls, cognitive noise predicted aspects of schizotypy (preoccupation and distress associated with delusion-like ideation on the Peters Delusion Inventory). Using a psychological manipulation and computational modeling, we provide evidence that early-psychosis patients jump to conclusions because of attributing higher costs to sampling information, not because of being primarily noisy decision makers.

Юношеский эндогенный приступообразный психоз с бредовыми идеями религиозного содержания: особенности психопатологии и клиники

Aim of the study : to identify clinical and psychopathological features, conditions of formation and the course of juvenile endogenous psychoses with a religious delusion. Patients and methods: 95 patients (62 male and 33 female) aged 16 to 25 years with diagnosis of attack-like psychosis with religious delusions were examined (F20, F25 according to ICD-10). Clinical, psychopathological, clinical-follow-up and psychometric methods where used. 53 patients (37 male и 16 female) were included in clinical group and 42 (25 male и 17 female made up follow-up group (mean follow-up period 7,4 ± 2,3 years). Results: the formation of residual delusions with religious content and personality disorders is noted with greater frequency after a psychotic episode with a religious delusions. It was possible preservation or formation, in the case of its absence before the onset of the disease, of traditional religiosity, as well as complete reduction of the religious worldview at the stage of remission in patients who was not interested in religion before the manifestation of psychosis. Conclusion: the demon obsession delusion in psychotic episode is unfavorable prognostic factor.

Прогностическое значение диагностических параметров эндогенных заболеваний, протекающих с картиной бредовых депрессий

The aim of the study: was to analyze the prognostic value of psychopathological and clinical indices of delusional depressions, taking into consideration the specificities of delusion formation of depressive ideas and evaluation of diagnostic parameters of the disease. Material and methods: a total 91 females (average age was 31,3 yrs.) were examined by using the clinical-psychopathological and clinical and follow up methods. In the dynamics of the endogenous diseases delusional depressions were diagnosed in them, with ideas of self-humiliation, of little value, self-accusation and guilt constituting the content of depressive delusion. According to ICD-10 mental status of the patients corresponded to F31.5; F32.3 and F33.3 items. In all 194 delusional depressions were analyzed in the clinical pictures of first manifest and repeat episodes. Some patients were examined directly during the period of the delusional depression (48% of patients), others were examined retrospectively (51,6%) with the following personal author’s follow-up, in 40,7% the duration of follow up observation was from 5 to 10 and more years. Results: during comparison of diagnostic parameters at various stages of the disease clinical indices were established, which at the level of statistic reliability correlated with nosological evaluation of the disease, its course, and the degree of its progression, and are prognostically the most significant. In manifest period at the l00%-level of concurrence the index of the typology of delusional depressions was in the lead, which was developed taking into consideration their psychopathological structure and mechanisms of delusion formation of depressive ideas. The index of share holding of affect (manic and depressive)is prognostically significant in the formation of structure of delusional component of affective-delusional states, its maximumpresentation (from 100 to 85%) is conjugated with non-progressive, or relatively favorable course within the framework of affective psychosis, recurrent and cyclothymia schizophrenia. The level of negative personality changes, reflecting the degree of the disease progression being detected before the development of delusional depression, is directly embodied in the indices of negative shift in the clinical picture of the subsequent remission and determines the prognosis of its quality. At pre-manifest stage the reliable signs of the prognosis have clinical specificities and the frequency of affective disorders (in the form of reactive, or autochthonous affective lability), as well as the depth of impairment of schizoid personality disposition up to the degree of accentuation, psychopathy, pseudopsycopathy.

Subduing the Green-eyed Monster: Bridging the Psychopharmacological and Psychosocial Treatment Perspective in Understanding Pathological Jealousy.

Human being is not spared from a broad-ranged emotional state, including being jealous. Jealousy has both affective-cognitive and behavioural-evaluative dimension where the person perceives, or experiences a real threat on a valued relationship. As this complex emotion becomes irrational and not amenable to reason, it later transforms into a dangerously 'green-eyed monster'. This perilous situation which is viewed as pathological jealousy is a form of delusion, which is maintained by a fixed and false reasoning in an originally entrusted intimate relationship. Pathological jealousy is equally prevailing among both gender, and with a greater ubiquity among the geriatric population. The role of dopamine hyperactivity in the fronto-parietal-temporal region was implicated, with the anatomical mapping of the ventromedial prefrontal cortex (vmPFC), cingulate gyrus (CG), and amygdala involvement in the context of the disease's neurobiology. The etiology of pathological jealousy includes major psychiatric disorders, i.e. delusional disorder, schizophrenia, mood disorder, organic brain syndrome, and among others, the drug-induced psychosis. The role of relationship issues and psychodynamic perspective, i.e. psychological conflicts with dependence on a romantic partner, and low self-esteem are involved. Pathological jealousy inherits high-risk forensic psychiatry entanglement, which may warrant intensive intervention, including hospital admission and antipsychotic treatment. Treatment options include an early recognition, managing underlying neuropsychiatric disorders, psycho education, cognitive psychotherapy, and choosing an effective psychopharmacological agent. The management strategy may also resort to a geographical intervention, i.e. separation between both persons to complement the biological treatment.

Jumping to conclusions at first onset of psychosis predicts longer admissions, more compulsory admissions and police involvement over the next 4 years: the GAP study.

Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case-control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years. One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning 'Beads' Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment - the Mental Health Act (MHA) - and inpatient days). FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92-83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68-83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91-13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions. JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.