Paranoid Research Articles

Gender and occupational differences in post-terrorist mental health outcomes among emergency responders with and without crisis intervention

Abstract Introduction After the Berlin terrorist attack at Breitscheidplatz, the gender-specific evaluation of emergency responders (ER) revealed higher perceived levels of paranoid ideation among females. The occupation-specific evaluation revealed higher hostility among police officers and a lower quality of life among firefighters. The aim of this study was to examine the outcome of crisis intervention (CI) provided for ER deployed to this terrorist attack. Methods In total, N = 55 ER were included (n = 37 with and n = 18 w/o CI). Stress, quality of life, post-traumatic stress disorder, and current psychological stress were assessed 4 months after the attack. Results ER with and w/o CI were compared. Participants with CI showed lower quality of life in psychological health (t(53)=2.01, p=.050) and higher depressive symptomatology (t(44) = 2.51, p=.016). Females with CI showed lower quality of life in social relationships (t(12)=2.46, p=.030), whereas males showed more posttraumatic stress symptoms (t(39)= .32, p=.026). Emergency responders from NGOs with CI had higher phobic anxiety (t(9.2)=2.72, p=.023). Emergency medical technicians with CI showed more somatic (t(7.5)=2.52, p=.037) and depressive (t(8)=2.30, p=.050) symptoms. Conclusions This study provides evidence for differences in the mental health burden for ER with and w/o CI, in general and for subgroups of gender and occupation. There is no conclusive explanation for why ER with CI score worse on certain measures. It is possible that CI had a harmful influence due to the reinforcement of negative emotions in some parts of measures like the Critical Incident Stress Debriefing (CISD). While it is known that ERs are vulnerable to develop mental problems, and appropriate and timely help is recommended, it is important to critical evaluate the methods used and to take also into account the identified gender and occupational differences. Further research is needed to better understand the interaction of risk factors.

It’s Dopamine and Schizophrenia All Over Again

Dopamine (DA) has been hovering over schizophrenia for 70 years, with the earliest clues of a connection between the two coming from clinical reports that psychotic symptoms tended to diminish in chronically institutionalized individuals with schizophrenia who developed Parkinson’s disease. It became the “dopamine hypothesis” based on 3 seminal observations: 1) that dopamimetic drugs like amphetamine can induce paranoid states; 2) that, as shown by Nobel Laureate Arvid Carlsson, antipsychotic drugs influence DA metabolism; and 3) that, as shown by Lasker Awardee Sol Snyder, the clinical potency of antipsychotic drugs is remarkably correlated with their in vitro affinity for DA receptors.

Association between psychological symptoms and illegal driving behaviors in a sample of Chinese private car drivers.

BackgroundFindings on the associations between psychological symptoms and driving behaviors in private car drivers are inadequate.MethodThe study consisted of 3,115 private car drivers in Yulin, China. The measurements included socio-demographic data, traffic violations, accidents, and Symptom Checklist-90 (SCL-90). In addition, an ordered logistic regression model was employed to examine the association between each psychological symptom and risky driving behaviors.ResultsThe overall prevalence rate of any self-reported psychological symptom was 10.24%, with 9.22% for males and 11.49% for females. Among them, obsessive-compulsive, interpersonal sensitivity, additional items, hostility, and depression were the five most common psychological symptoms, with prevalence rates of 7.90, 6.29, 6.00, 5.91, and 5.62%, respectively. Any psychological symptom factor was associated with a higher risk of traffic violations and accidents. However, the intensity of the correlations varied, with obsessive-compulsive symptoms the strongest in general traffic violations and anxiety symptoms in traffic accidents. All psychological symptoms except phobic anxiety and paranoid ideation contributed to a higher risk of failing the driver's license test.ConclusionsThe prevalence rate of psychological symptoms was high in private car drivers. This study calls for an urgent need to establish a pilot tertiary prevention strategy to reduce risky driving behaviors through psychological symptom screening and interventions among private car drivers.

Les psychoses post-traumatiques : une nouvelle nosographie. Implications médico-légales

BackgroundIn opposition to “psychosis”, one spoke in the classifications still in vogue less than a decade ago of “traumatic neuroses”. An important legal text still affirms today, in our country, that “post-traumatic psychosis does not exist”, which prevents their compensation under the reparation of psychic damage. But defeating these dogmas in breach, clinicians have repeatedly reported on situations where psychological trauma and psychosis are found to be intimately linked. The therapeutic and medico-legal issues are major, as are the implications in terms of research. Objectives, Materials and MethodsBased on a review of the international literature compared to our practical experience, we define the different anatomoclinical typologies of post-traumatic psychosis. ResultsWe successively present the psychoses induced by: (i) an isolated psychic trauma by subdividing the functional (acute and chronic) and structural (schizophrenic and paranoid) disorders; (ii) an isolated traumatic brain injury with presentation of symptoms according to the extent of the brain lesions (organic psychotic disorders, schizophrenia-like psychosis, post-traumatic schizophrenia). DiscussionThe very recent densification of the clinical description of post-traumatic mental disorders has highlighted the notion of post-traumatic psychosis. However, if certain medico-legal scales mention these disorders, it is sometimes paradoxically to deny their existence or their imputability (without necessarily specifying whether the fact in question constitutes a psychic or cranial trauma). In reality, the semiological and etiopathogenic links between trauma and psychosis are complex, often bidirectional, without the medico-legal attribution of the resulting symptoms having to be challenged, on the contrary most often.

Supplemental Material for Are Paranoid Ideation and Hallucination Spectrum Experiences Differently Associated With Affect Dynamics? A Continuous-Time Modeling Approach

Supplemental Material for Are Paranoid Ideation and Hallucination Spectrum Experiences Differently Associated With Affect Dynamics? A Continuous-Time Modeling Approach

Conspiracist and paranormal beliefs: A typology of non-reductive ideation

Non-reductive ideation is characterized by a tendency to attribute causality to non-physical powers and mysterious forms of intelligent agency such as conspiracist ideation, belief in specific conspiracy theories, and belief in the paranormal. Scholars have identified numerous individual correlates of non-reductive ideation but do not examine shared patterns across multiple predictors to determine subtypes of individuals with different psychological profiles. We address this gap by considering a large set of predictors in a diverse cross-section of the US public (N=792) to uncover latent subtypes of individuals with varying tendencies toward non-reductive ideation. Schizotypal and neurotic tendencies were the strongest predictors of non-reductive ideation, while sociopolitical identity (e.g., political ideology) contributed little explanatory power. We find five distinct latent classes distinguished by: schizotypal and paranoid ideation, alienated skepticism toward people/society, and a negative sense of self. We discuss these results in light of previous findings and suggest directions for future research.

The Impact of Foehn Wind on Mental Distress among Patients in a Swiss Psychiatric Hospital.

Psychiatric patients are particularly vulnerable to strong weather stimuli, such as foehn, a hot wind that occurs in the alps. However, there is a dearth of research regarding its impact on mental health. This study investigated the impact of foehn wind among patients of a psychiatric hospital located in a foehn area in the Swiss Alps. Analysis was based on anonymized datasets obtained from routine records on admission and discharge, including the Brief Symptom Checklist (BSCL) questionnaire, as well as sociodemographic parameters (age, sex, and diagnosis). Between 2013 and 2020, a total of 10,456 admission days and 10,575 discharge days were recorded. All meteorological data were extracted from the database of the Federal Office of Meteorology and Climatology of Switzerland. We estimated the effect of foehn on the BSCL items using a distributed lag model. Significant differences were found between foehn and non-foehn admissions in obsession–compulsion, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, and general severity index (GSI) (p < 0.05). Our findings suggest that foehn wind events may negatively affect specific mental health parameters in patients. More research is needed to fully understand the impact of foehn’s events on mental health.

Religious Conspiracy Theories About the COVID-19 Pandemic Are Associated With Negative Mental Health.

Objectives: Together with the COVID-19 pandemic, conspiracy theories have begun to spread. Evidence is lacking for religious conspiracy theories (RCT) related to COVID-19 in a non-religious environment. This study aimed to assess links between religiosity and spirituality (R/S) and RCT about COVID-19, and to examine their associations with mental health. Methods: A sample of Czech adults (n = 1,273, mean age = 47.5, SD = 16.4; 51.5% male) participated in the survey. We measured R/S, RCT, negative religious coping (NRC), feelings impairment and mental health symptoms. Results: We found R/S were significantly associated with RCT with β 0.71 (95% confidence interval [CI] 0.59–0.82) for the strongest association. Moreover, RCT and NRC were strongly associated with paranoia, anxiety and depression. The most frequent association was found for NRC and paranoid ideation, with β of 0.35 (95% CI 0.26–0.44). Conclusion: Our findings showed associations between religiosity/spirituality and beliefs in religious conspiracy theories about COVID-19. Moreover, these RCT and negative religious coping were linked to higher possibility of mental health problems. Understanding these associations may help prevent this negative impact and contribute to the effectiveness of psychotherapeutic help.

Racism and psychosis: an umbrella review and qualitative analysis of the mental health consequences of racism

Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the country of origin, and (2) analyzes interviews regarding the association of racism experiences with psychosis-related symptoms in racialized Black people and People of Color populations in Germany. We present an umbrella review of meta-analyses that report the incidence of positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., apathy and incoherent speech) of diagnosed schizophrenia, other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis among migrants by country of origin. We also report 20 interviews with first- and second-generation migrants racialized as Black and of Color in Germany to capture and classify their experiences of racism as well as racism-associated mental health challenges. In the umbrella review, psychosis risk was greatest when migration occurred from developing countries. Effect size estimates were even larger among Caribbean and African migrants. In the qualitative study, the application of the constant comparative method yielded four subordinate themes that form a subclinical psychosis symptomatology profile related to experiences of racism: (1) a sense of differentness, (2) negative self-awareness, (3) paranoid ideation regarding general persecution, and (4) self-questioning and self-esteem instability. We here provide converging evidence from a quantitative and qualitative analysis that the risk of poor mental health and psychotic experiences is related to racism associated with minority status and migration.

Face Your Fears: Virtual reality-based cognitive behavioral therapy (VR-CBT) versus standard CBT for paranoid ideations in patients with schizophrenia spectrum disorders: a randomized clinical trial

BackgroundSchizophrenia spectrum disorders cause suffering for patients, relatives, and the surrounding society. Paranoid ideations, encompassing ideas of social reference and manifest persecutory delusions, are among the most frequent symptoms in this population and a cause of significant distress. Recent meta-analyses of cognitive behavioral therapy (CBT) for psychosis show small to moderate effect sizes in reducing paranoid ideations. Virtual reality-based CBT (VR-CBT) could improve therapy efficacy as exposure and behavioral experiments in VR can be optimized, individualized, and carried out in a safe environment. Few VR-CBT studies exist for paranoid ideations and there is a need for large-scale, methodologically rigorous trials.MethodsThis study is a randomized, assessor-blinded parallel-groups multi-center superiority clinical trial, fulfilling the CONSORT criteria for non-pharmacological treatment. A total of 256 patients diagnosed with schizophrenia spectrum disorder, including schizotypal disorder (ICD-10 F20-29), will be allocated to either 10 sessions of symptom-specific CBT-VR plus treatment as usual—versus 10 sessions of standard symptom-specific CBT for paranoid ideations (CBT) plus treatment as usual. All participants will be assessed at baseline, treatment end (3 months post baseline), and then 9 months post baseline. A stratified block-randomization with concealed randomization sequence will be conducted. Independent assessors blinded to the treatment will evaluate the outcome. Analysis of outcome will be carried out with the intention to treat principles.The primary outcome is ideas of social reference measured with Green Paranoid Thought Scale Part A (GPTS-A) at the cessation of treatment at 3 months post baseline. Secondary outcomes are ideas of persecution (GPTS-B), Social Interaction Anxiety Scale (SIAS), Personal and Social Performance scale (PSP), Safety Behavior Questionnaire (SBQ), and CANTAB Emotion Recognition Task.DiscussionThe trial will elucidate whether VR-CBT can enhance therapy efficacy for paranoid ideations. Additionally, Trial findings will provide evidence on the effectiveness and cost-effectiveness of VR-CBT for paranoid ideations that can guide the possible dissemination and implementation into clinical practice.Trial registrationClinicalTrials.govNCT04902066. Initial release April 9th, 2021.

Exploring Links Between Psychosis and Frontotemporal Dementia Using Multimodal Machine Learning

The behavioral and cognitive symptoms of severe psychotic disorders overlap with those seen in dementia. However, shared brain alterations remain disputed, and their relevance for patients in at-risk disease stages has not been explored so far. To use machine learning to compare the expression of structural magnetic resonance imaging (MRI) patterns of behavioral-variant frontotemporal dementia (bvFTD), Alzheimer disease (AD), and schizophrenia; estimate predictability in patients with bvFTD and schizophrenia based on sociodemographic, clinical, and biological data; and examine prognostic value, genetic underpinnings, and progression in patients with clinical high-risk (CHR) states for psychosis or recent-onset depression (ROD). This study included 1870 individuals from 5 cohorts, including (1) patients with bvFTD (n = 108), established AD (n = 44), mild cognitive impairment or early-stage AD (n = 96), schizophrenia (n = 157), or major depression (n = 102) to derive and compare diagnostic patterns and (2) patients with CHR (n = 160) or ROD (n = 161) to test patterns' prognostic relevance and progression. Healthy individuals (n = 1042) were used for age-related and cohort-related data calibration. Data were collected from January 1996 to July 2019 and analyzed between April 2020 and April 2022. Case assignments based on diagnostic patterns; sociodemographic, clinical, and biological data; 2-year functional outcomes and genetic separability of patients with CHR and ROD with high vs low pattern expression; and pattern progression from baseline to follow-up MRI scans in patients with nonrecovery vs preserved recovery. Of 1870 included patients, 902 (48.2%) were female, and the mean (SD) age was 38.0 (19.3) years. The bvFTD pattern comprising prefrontal, insular, and limbic volume reductions was more expressed in patients with schizophrenia (65 of 157 [41.2%]) and major depression (22 of 102 [21.6%]) than the temporo-limbic AD patterns (28 of 157 [17.8%] and 3 of 102 [2.9%], respectively). bvFTD expression was predicted by high body mass index, psychomotor slowing, affective disinhibition, and paranoid ideation (R2 = 0.11). The schizophrenia pattern was expressed in 92 of 108 patients (85.5%) with bvFTD and was linked to the C9orf72 variant, oligoclonal banding in the cerebrospinal fluid, cognitive impairment, and younger age (R2 = 0.29). bvFTD and schizophrenia pattern expressions forecasted 2-year psychosocial impairments in patients with CHR and were predicted by polygenic risk scores for frontotemporal dementia, AD, and schizophrenia. Findings were not associated with AD or accelerated brain aging. Finally, 1-year bvFTD/schizophrenia pattern progression distinguished patients with nonrecovery from those with preserved recovery. Neurobiological links may exist between bvFTD and psychosis focusing on prefrontal and salience system alterations. Further transdiagnostic investigations are needed to identify shared pathophysiological processes underlying the neuroanatomical interface between the 2 disease spectra.

Attitudes towards Vaccines, Intent to Vaccinate and the Relationship with COVID-19 Vaccination Rates in Individuals with Schizophrenia.

Schizophrenia patients are at high risk of developing severe COVID-19 outcomes but recent evidence suggests that they are under-vaccinated. This study explored the role of potential attitudinal barriers by comparing schizophrenia patients with participants from the general population regarding COVID-19 vaccination rates, general attitudes towards vaccines, and willingness to take a COVID-19 vaccine. We conducted a cross-sectional study between April 2021 and October 2021. A total of 100 people with schizophrenia and 72 nonclinical controls were recruited. In our study, individuals with schizophrenia were under-vaccinated, despite similar general attitudes towards vaccination and higher willingness to be vaccinated against COVID-19 compared to nonclinical participants. In patients, negative attitudes toward vaccines were related to higher levels of negative psychotic symptoms and higher levels of paranoid ideation. As a whole, participants with more negative attitudes towards vaccines were less likely to be vaccinated against COVID-19 and had lower levels of trust in institutions. Vaccine hesitancy does not appear to be a major barrier for COVID-19 vaccine uptake amongst people with schizophrenia. This study suggests that disparities in COVID-19 vaccination rates in schizophrenia do not seem related to attitudinal but rather structural barriers.

Inducing Paranoia is Linked to Increased Resting Amygdala Cerebral Blood Flow in Healthy Individuals

Among individuals with schizophrenia, paranoia has been linked to increased resting cerebral blood flow (CBF) in amygdala, suggesting that amygdala hyperactivity may be a mechanism for paranoid ideation. The present study tested this possible mechanism by assessing whether experimentally inducing paranoia in non-clinical, healthy participants resulted in increased amygdala CBF. Sixty-three undergraduates completed initial measurements of paranoia and resting CBF, via pseudo-continuous arterial spin labeling (pCASL) imaging, and were then randomly assigned to either a paranoia induction ( n = 32) or control ( n = 31) condition before completing a second pCASL scan and another paranoia assessment. Following the induction procedure, individuals in the paranoia induction condition reported fewer positive perceptions of others and greater state anxiety. Resting relative CBF values extracted from right amygdala also demonstrated an increase in CBF over time for individuals in the paranoia induction condition but a decrease in CBF over time for individuals in the control condition. Left amygdala showed no significant effects. These results support the idea that increased resting activity of the amygdala may be a neurobiological mechanism for paranoia.

Schematic beliefs, negative affect and paranoia in at-risk youth.

Attenuated symptoms of psychosis are a core feature of At-Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is known about whether the processes underpinning the experience of paranoid ideation in high-risk youth differ as a consequence of meeting At-Risk Mental States (ARMS) for psychosis criteria. This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n=133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n=137). While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status. While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at-risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at-risk/high-risk and for developing effective interventions for young people presenting with emerging difficulties.

The network structure of paranoia dimensions and its mental health correlates in the general population: The core role of loneliness

Paranoid ideas are the most common abnormal beliefs in the schizophrenia spectrum, are also prevalent in non-clinical populations, and are highly correlated with other mental health problems such as anxiety, depression and low levels of well-being. Two previous studies with the same British population sample used confirmatory factor analysis and network analysis to show that the spectrum of paranoid beliefs is made up of four factors or dimensions (i.e., interpersonal sensitivity, mistrust, ideas of reference and ideas of persecution). The aims of this study are: 1) to explore the distribution and the structure of paranoid beliefs in a Spanish general population by applying the network approach and 2) to use network analysis to explore for the first time whether specific domains of paranoid ideation (i.e., dimensions) are specifically associated with mental health correlates such as depression, anxiety, loneliness, and well-being. We found a continuous distribution of paranoid beliefs among the 1328 individuals constituting the sample (e.g., 29,2 % did not endorse any items, 4.6 % endorsed half of the items, while 0.8 % endorsed all paranoid items). Paranoid ideas form three dimensions; interpersonal sensitivity, mistrust, and ideas of persecution (ideas of reference did not form a separate factor). The network model showed that loneliness has a pivotal role in connecting paranoid ideation with general psychopathology measures (i.e., depression, anxiety, loneliness and well-being). Research and clinical implications derived from our findings are also discussed.

Psychopathological symptoms as a common Risk Factor for Tinnitus distress and magnitude: A cross-sectional study.

To examine the association of tinnitus distress, tinnitus magnitude and psychopathological symptoms among patients with ear-related problems. The cross-sectional study was conducted from December 1, 2020, to June 30, 2021, at the Hearing and Balance Clinic, Rawalpindi, Pakistan, in collaboration with the National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan, and comprised adult tinnitus patients of either gender. All patients underwent ear examination and audiological evaluations for tinnitus matching. Psychological assessment was done using the Tinnitus Magnitude Index, the Tinnitus Reaction Questionnaire and the Symptoms Check List-90. Data was analysed using SPSS 21. Of the 159 subjects, 97(61%) were male and 62(39%) were females. The overall mean age was 47.94±17.47 years. Patients showed statistically significant tendency to develop psychopathological symptoms, including somatisation, phobic anxiety, depression and paranoid ideation (p<0.05). Additionally, significant gender differences were also observed (p<0.05). There was a high prevalence of tinnitus distress along with psychopathological symptoms among tinnitus patients.

Diagnosis of subjects damaged in Buddhist groups by means of the Symptom Checklist (SCL-90)

IntroductionAt present, the mental health of members in international Buddhist organizations is often damaged by decontextualized concepts and misleading meditation training. As the treatment of resulting mental diseases presents therapeutic challenges, currently diagnostic and related therapeutic considerations are crucial.ObjectivesSince subjects predominantly reported having received several diagnoses, with depression, anxiety disorder, and post-traumatic stress disorder being the most frequently assigned, a diagnostic assessment device was employed for further differentiation.MethodsThe questionnaire SCL-90 was used to evaluate the nine dimensions: interpersonal sensitivity, depression, anxiety, paranoid ideation, psychoticism, somatization, obsessive-compulsive disorder, hostility and phobic anxiety.ResultsIn a pilot group of eight German-speaking subjects of different Buddhist groups the general psychological burden (GSI) was significantly elevated in six of them. However, the intensity of responses in precisely those two individuals in whom it was not increased was far below the norm (PSDI). Furthermore, seven of the subjects had an above-average number of symptoms indicating burden (PST). All of them showed a heightened level of interpersonal sensitivity and for most of the subjects anxiety, depression, paranoid ideation and psychoticism were above the mean value of the norm group.ConclusionsAs for psychiatric treatment and psychotherapy, extended research with a larger group of such subjects and at the beginning of their treatment is crucial. Particularly, hypotheses on the causes of their social insecurity, depressivity, paranoid thinking as well as psychoticism based on the distorted concepts and neologisms these persons were exposed to (e.g. ‘karma-purification ’) as well as their ways of ‘meditation-training’ seems to hold core relevance.DisclosureThis research was funded by the German Federal Ministry of Education and Research, funding reference number: 01UL1823X.

CHALLENGE and Face Your Fears: Virtual Reality Treatment for Auditory Hallucinations and Paranoid Ideations

Background: Many patients suffering from schizophrenia spectrum disorders continue having distressing auditory hallucinations and paranoid ideations despite receiving current treatment. Virtual reality assisted treatment offers the potential of advancing current psychotherapies for psychotic symptoms by creating virtual environments that can elicit responses (e.g. thoughts, feelings, behaviours) mirroring real-world settings. In two large-scale randomised clinical trials, we are investigating whether targeted virtual reality assisted psychotherapy can reduce psychotic symptoms and increase daily life functioning and quality of life. The CHALLENGE trial examines whether nine sessions of virtual reality-assisted psychotherapy is superior to nine sessions of standard treatments in reducing the severity, frequency, and distress of auditory hallucinations in patients with psychosis. In the Face your Fears trial we are investigating whether virtual reality assisted cognitive behavioral therapy (CBT) is superior to standard CBT in reducing levels of paranoid ideation in patients with psychosis spectrum disorders. Methods: The CHALLENGE and Face your Fears trials are randomised, assessor-blinded parallel-groups superiority clinical trials, allocating a total of 266 and 256 patients, respectively to either the experimental intervention or a control condition. The trials are currently enrolling patients; thus, no quantitative data is available yet. The main objective of this presentation is to give a qualitative account of this new psychotherapeutic methods as it is applied in both trials. Results: Qualitative data comprising case descriptions and video material will be presented at the conference. Discussion: The preliminary findings indicate great potential for these innovative treatments albeit important concerns regarding implementation will be raised.DisclosureNo significant relationships.

Fears, Fun and Voices – an update on VR Treatments for Psychosis

Background: Virtual Reality (VR) is increasingly used for treatment of psychiatric disorders. With immersive VR, people can be gradually exposed to situations they fear, they can practice new behaviour in a safe and controlled way. The threshold for engaging in therapy is lower in VR than in real life. VR applications for psychosis have been introduced fifteen years ago, and are rapidly expanding. Methods: In our VR mental health lab, several VR therapies for psychotic disorders have been developed and investigated. Results of recent randomized controlled trials (RCT) will be presented, and ongoing and future projects will be discussed, including VR cognitive behavioral therapy (VRcbt) for paranoid delusions, social cognition training, stress management and avatar therapy for auditory hallucinations Results: The RCT of VRcbt for paranoid delusions (N=116) had strong and statistically significant effects on paranoid ideations, anxiety and safety behavior. Facial emotion recognition was improved by VR social cognition training (RCT N=81), but other domains of social cognition proved more difficult to improve. A VR relaxation tool (RCT N=50) had strong immediate effects on perceived stress and emotional states. Ongoing VR intervention studies are a modular VR intervention aimed at improving social functioning (VR SOAP) and an empowering intervention for patients with auditory hallucinations (VR VOICES). Discussion: VR is a powerful tool for treatment of psychotic disorders, offering interventions for multiple symptom domains and functioning. Next generation VR studies hold the promise to expand and substantially improve psychosocial treatment of psychotic disorders.DisclosureI am co-founder and have shares of VRelax, a company providing VR relaxation software.

Psychopathological features of hysterical disorders arising as part of affective disorders and schizophrenia

IntroductionHysterical disorders were considered separately in the context of the dynamics of the course of either endogenous affective diseases or schizophrenia, without attention to the conjugation and interaction of issues of hysterical symptoms and affective or psychotic syndromes.ObjectivesTo test the psychopathological structure and provide a typology of the conjugation of hysterical symptoms with other psychopathological syndromes.Methods120 patients (82 women and 38 men) with schizophrenic and affective disorders with associated hysterical symptoms were examined by a clinical psychopathological method.ResultsThree variants of conjugation were identified. In the group of hysterical disorders associated with affective diseases (37,1%) the structure and dynamics of hysterical symptoms directly influenced the developing affective phase: the low intensity of hysterical symptoms contributed to the development of an apatho-adynamic type of depression, and bright and spontaneous hysterical manifestations formed an anxious-hypochondriac type of depression. Hysterical disorders formed in the structure of the psychotic state (41,4%) influenced the nature, structure, dynamics and content of delusional, hallucinatory and paranoid disorders. “Caste” hysterical symptoms (21,4%) revealed a lack of connection with affective and psychotic states. Hysterical symptoms were characterized by persistence, stability, invariability of manifestations, long-term psychotherapeutic and psychopharmacological resistance.ConclusionsClinical and psychopathological analysis of endogenous mental diseases of the affective and schizophrenic spectrum, occurring with hysterical symptoms, showed that the parameter of the conjugation of hysterical symptoms with other psychopathological syndromes is prognostically significant.DisclosureNo significant relationships.