Relationship between jumping to conclusions and clinical outcomes in people at clinical high-risk for psychosis

Abstract

Background Psychosis is associated with a reasoning bias, which manifests as a tendency to ‘jump to conclusions’. We examined this bias in people at clinical high-risk for psychosis (CHR) and investigated its relationship with their clinical outcomes. Methods In total, 303 CHR subjects and 57 healthy controls (HC) were included. Both groups were assessed at baseline, and after 1 and 2 years. A ‘beads’ task was used to assess reasoning bias. Symptoms and level of functioning were assessed using the Comprehensive Assessment of At-Risk Mental States scale (CAARMS) and the Global Assessment of Functioning (GAF), respectively. During follow up, 58 (16.1%) of the CHR group developed psychosis (CHR-T), and 245 did not (CHR-NT). Logistic regressions, multilevel mixed models, and Cox regression were used to analyse the relationship between reasoning bias and transition to psychosis and level of functioning, at each time point. Results There was no association between reasoning bias at baseline and the subsequent onset of psychosis. However, when assessed after the transition to psychosis, CHR-T participants showed a greater tendency to jump to conclusions than CHR-NT and HC participants (55, 17, 17%; χ2 = 8.13, p = 0.012). There was a significant association between jumping to conclusions (JTC) at baseline and a reduced level of functioning at 2-year follow-up in the CHR group after adjusting for transition, gender, ethnicity, age, and IQ. Conclusions In CHR participants, JTC at baseline was associated with adverse functioning at the follow-up. Interventions designed to improve JTC could be beneficial in the CHR population.

Speech Illusions in People at Clinical High Risk for Psychosis Linked to Clinical Outcome

“…22,45 Generally, CHR participants show altered uncertainty processing as measured by salience tasks 39 which are associated with transition to psychosis. 46 In CHR participants not taking antipsychotic medication at baseline, we replicated the association between hearing SIs with uncertain valence and non-remission, and we also observed an association between hearing SIs with uncertain valence and transition to psychosis. This latter result is in line with a previous study that reported that the perceived length of SIs in multispeaker babble was associated with transition to psychosis in CHR participants, 23 but only in medication-free participants.…”

Neural Circuitry of Salience and Reward Processing in Psychosis

“…Furthermore, psychosis is associated with jumping to conclusions, whereby those with psychosis are more likely to update their beliefs using less information [e.g., ( 111 , 112 )]. A study in those at risk suggested that this reasoning bias develops with the onset of psychosis and may not be evident beforehand ( 113 ). Decreased activation of the nucleus accumbens, anterior cingulate cortex, and dorsolateral PFC has been associated with impaired reward learning in those with schizophrenia ( 90 , 114 ).…”

Increased Belief Instability in Psychotic Disorders Predicts Treatment Response to Metacognitive Training

“…We tested the three research questions with linear mixed-effects models including probability estimates as dependent variable and education, medication, sex, and study as covariates. JTC was defined as reaching a decision after fish 35 and low and high current delusions were defined based on a median split of the Psychotic Symptom Rating Scales (PSYRATS) 36 : Delusion subscale. Additionally, we assessed trial-by-trial behavior with nonparametric Kruskal–Wallis tests Bonferroni-corrected for the number of trials ( n = 10).…”