Jumping to conclusions and the persistence of delusional beliefs in first episode psychosis

Falcone, M. Aurora; Murray, Robin M.; O’Connor, Jennifer; Hockey, Leanne N.; Gardner-Sood, Poonam; Forti, Marta Di; Freeman, Daniel; Jolley, Suzanne

doi:10.1016/j.schres.2015.04.019

Cited by 22 publications

(13 citation statements)

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“…Cases were excluded if there was evidence of: (1) psychotic symptoms precipitated by an organic cause; (2) transient psychotic symptoms resulting from an acute intoxication as defined by ICD-10; (3) head injury causing clinically significant loss of consciousness; and (4) learning disability (IQ < 70) as assessed by the Wechsler Adult Intelligence Scale – Third Edition (WAIS-III) (Wechsler, 1997). The original GAP sample comprised N = 431 FEP cases; of these, information on JTC at baseline was available for 123 cases [28% of the original GAP sample (Falcone et al ., 2015 a )]. This subsample with information on JTC did not differ significantly from the full GAP sample in terms of gender, age, education level, diagnosis or ethnicity (online Supplementary Table S1).…”

Section: Methodsmentioning

confidence: 96%

“…There is also evidence of a link between JTC and the more classic construct of neurocognition. JTC has been shown to be negatively associated with neuropsychological performance in FEP samples (Falcone et al ., 2015 a ; González et al ., 2017), but also with lower IQ scores among healthy relatives of patients with schizophrenia (Van Dael et al ., 2006) and controls with high levels of psychotic experiences (Mortimer et al ., 1996; Van Dael et al ., 2006). Nonetheless, whether the relationship between neurocognition and JTC moderate the link with positive symptoms remains elusive (Andreou et al ., 2015).…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2018

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BackgroundJumping 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.MethodsOne-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).ResultsFEP 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.ConclusionsJTC 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.

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Section: Methodsmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Individuals with schizophrenia often display deficits in theory of mind, emotion recognition and social perception (Green et al, 2008; Green, Olivier, Crawley, Penn, & Silverstein, 2005), as well as a broad array of cognitive distortions (eg, jumping to conclusions [JTC]) that underlie classical psychotic symptoms such as delusions (Freeman, 2007; Garety & Freeman, 1999; Moritz & Woodward, 2007). Interestingly, social cognition deficits and cognitive distortions can be observed not only in chronic patients, but also in recent‐onset psychosis (Falcone et al, 2015; Falcone et al, 2015; Fornells‐Ambrojo & Garety, 2009; Healey, Bartholomeusz, & Penn, 2016). Furthermore, cognitive biases and social cognition impairment are associated with patients' poor functioning (Couture, Penn, & Roberts, 2006; Stouten, Veling, Laan, van der Helm, & van der Gaag, 2017).…”

Section: Introductionmentioning

confidence: 99%

Social cognition and interaction training for recent‐onset schizophrenia: A preliminary randomized trial

Rocha

Campos

Figueiredo

et al. 2020

Early Intervention Psych

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Comprehensive social cognition training programs have been effective to improve social cognition in people with chronic schizophrenia, although there is insufficient quality evidence for recent‐onset psychosis. The aim of this study was to assess the effects of Social Cognition and Interaction Training (SCIT) in a sample of recent‐onset schizophrenia outpatients. Sixteen participants who had their first psychotic episode for less than 2 years were randomly allocated to the SCIT group during 20 weeks (weekly sessions) or to a psychoeducation group and completed baseline and post‐training assessment for cognitive biases, social cognition, clinical symptoms and functioning. Permutation‐based analysis revealed improvements in overall functioning (P = 0.036) and blame score (P = 0.070) in the SCIT group compared to the psychoeducation intervention, with large effect sizes (d = 1.438 and d = 1.204, respectively). There were also large effect sizes for hostility, emotion recognition, social perception, positive and total symptoms (d = 0.833‐1.158). These results suggest that SCIT may be an effective tool to improve attributional biases and functional outcomes in recent‐onset schizophrenia outpatients. Future controlled trials with larger sample size and follow‐up assessments should be developed to further understand effective intervention outcomes for this population.

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“…Additionally, we found a correlation between IQ and DTD in the first three blocks in the patient group, so we cannot completely exclude the contribution of intelligence to the information-gathering bias. Some argue that impaired executive functions or working memory deficits contribute to the JTC bias (Falcone et al, 2015; Garety et al, 2013). A low IQ could lead to a low tolerance for uncertainty and an equivalent high cost of the information sampling as well as the inability to integrate feedback to update future decisions.…”

Section: Discussionmentioning

confidence: 99%

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

Ermakova

Gileadi

Knolle

et al. 2019

Computational Psychiatry

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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.

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Jumping to conclusions and the persistence of delusional beliefs in first episode psychosis

Abstract: Findings implicate cognitive biases in delusion persistence, and support the potential to reduce delusions through reasoning-focused interventions.

Cited by 22 publications

References 26 publications

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

Social cognition and interaction training for recent‐onset schizophrenia: A preliminary randomized trial

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

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