The evolution of insight, paranoia and depression during early schizophrenia

Drake, Richard; Pickles, Andrew; Bentall, Richard P.; Kinderman, Peter; Haddock, Gillian; Tarrier, Nicholas; Lewis, Shôn

doi:10.1017/s0033291703008821

Cited by 184 publications

(133 citation statements)

References 31 publications

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“…Drake et al (2004) found that significant associations between depression and paranoia in a first episode psychosis sample would not fit a statistical model of mediation by self esteem. Other investigators have emphasised, instead of the balance of self esteem, specific negative beliefs about the self and about others, such as "I am vulnerable" or "others are hostile" as strongly connected to paranoia .…”

Section: Paranoia As a Defence Against Negative Self-evaluationsmentioning

confidence: 89%

“…Notably, all four studies that measured persecutory or delusional ideation specifically found that depression at a given time point was related to more severe subsequent paranoia (Drake et al, 2004;Fowler et al, 2011;Thewissen et al, 2011) or delusions (Bergstein, Weizman, & Solomon, 2008).…”

Section: Observational Studiesmentioning

confidence: 99%

“…Two studies stood out as being particularly convincing (Drake et al, 2004;Fowler et al, 2011). These had the largest sample sizes of all in Table 2.1, included only people with schizophrenia spectrum diagnoses and used a prospective design with structural equation modelling to disentangle the causal effects that might be at play between symptom dimensions.…”

Section: Observational Studiesmentioning

confidence: 99%

“…These had the largest sample sizes of all in Table 2.1, included only people with schizophrenia spectrum diagnoses and used a prospective design with structural equation modelling to disentangle the causal effects that might be at play between symptom dimensions. Drake et al (2004) assessed 257 patients with a first psychotic episode up to four times over 18 months using the PANSS and the PSYRATS, which were used to derive a depression factor score and a paranoia factor score for each assessment point. They found that higher paranoia was associated with more depression at each time point.…”

Section: Observational Studiesmentioning

confidence: 99%

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Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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Depression is common in people with schizophrenia, but how it might directly contribute to the persistence of psychotic symptoms has rarely been tested. The key aim of the present study was to test whether depression and associated cognitive processes predict the maintenance of persecutory delusions. Three groups of participants were tested at baseline: 60 patients with persecutory delusions in the context of a schizophrenia spectrum diagnosis, 30 patients with depression, and 30 nonclinical controls. They completed interviewer and self-report assessments of depression and paranoia, and measures of six cognitive factors (schematic beliefs, experiential avoidance, autobiographical memory, problem solving, rumination, worry style). The patients with persecutory delusions were then assessed again, six months later. It was found that 50% of the patients with persecutory delusions met diagnostic criteria for major depression. Cognitive processes found to be associated with depression across the groups were negative schematic beliefs about the self, experiential avoidance and rumination, but not autobiographical memory or problem solving. The severity of initial depression in patients with persecutory delusions predicted the persistence of paranoia over six months. A number of cognitive factors also predicted the persistence of persecutory delusions, including negative schematic beliefs about the self, worry, and problem-solving difficulties. In conclusion, depression is common in patients with current persecutory delusions, and it shows similar cognitive features to major depressive disorder. The results of this study indicate that depression and related processes may contribute to the maintenance of paranoia. Trials are warranted of depression-related therapeutic techniques for people with persecutory delusions.

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Section: Paranoia As a Defence Against Negative Self-evaluationsmentioning

confidence: 89%

Section: Observational Studiesmentioning

confidence: 99%

Section: Observational Studiesmentioning

confidence: 99%

Section: Observational Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Vorontsova¹,

Garety²,

Freeman³

2013

Journal of Abnormal Psychology

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“…However, the absence of an association between depressive symptoms and insight is rather surprising in light of other findings in the literature [16,33,34,38,44]. Depression was hypothesized and several times proved to be in a positive relation with insight based on different theories, as summarized by Mutsatsa et al [35].…”

Section: Discussionmentioning

confidence: 97%

Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia

Hert

Simon

Vidović³

et al. 2009

Eur. psychiatr.

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Background: The objective of the present study was to examine the association of insight into the illness with demographic variables and symptomatology in a sample of 1213 patients with schizophrenia. Method: Data were collected with the Psychosis Evaluation tool for Common use by Caregivers (PECC), a semi-structured interview evaluating five symptom domains of schizophrenia and the insight items 'awareness of having a mental disorder' and 'attributing symptoms to a mental disorder'. Results: Insight was positively associated with educational level and inversely with overall symptom severity, and the positive, negative, excitatory and cognitive symptom domains. At symptom level, the items 'delusions', 'grandiosity', 'poor rapport', 'social withdrawal' and 'guilt feelings' showed the strongest associations with both insight items. Overall, correlations between insight and symptomatology were modest, explaining less than 30% of the variance in insight. Conclusion: Lack of insight in schizophrenia is partially explained by clinical symptoms and demographic measures. #

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Cognitive‐Behavioural Interventions

Jolley

2011

Schizophrenia

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The evolution of insight, paranoia and depression during early schizophrenia

Abstract: In first-episode psychosis, good insight predicts depression. Subsequently, paranoia is the strongest predictor. Neither effect is mediated by low self-esteem. Effective treatment of positive symptoms is important in preventing and treating low mood in early schizophrenia.

Cited by 184 publications

References 31 publications

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Cognitive factors maintaining persecutory delusions in psychosis: The contribution of depression.

Evaluation of the association between insight and symptoms in a large sample of patients with schizophrenia

Cognitive‐Behavioural Interventions

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