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Suspicious young minds: paranoia and mistrust in 8- to 14-year-olds in the UK and Hong Kong
<jats:sec><jats:title>Background</jats:title><jats:p>Research on paranoia in adults suggests a spectrum of severity, but this dimensional approach has yet to be applied to children or to groups from different countries.</jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p>To investigate the structure, prevalence and correlates of mistrust in children living in the UK and Hong Kong.</jats:p></jats:sec><jats:sec><jats:title>Method</jats:title><jats:p>Children aged 8–14 years from the UK (<jats:italic>n</jats:italic> = 1086) and Hong Kong (<jats:italic>n</jats:italic> = 1412) completed a newly developed mistrust questionnaire as well as standard questionnaire measures of anxiety, self-esteem, aggression and callous–unemotional traits.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Confirmatory factor analysis of the UK data supported a three-factor model – mistrust at home, mistrust at school and general mistrust – with a clear positive skew in the data: just 3.4%, 8.5% and 4.1% of the children endorsed at least half of the mistrust items for home, school and general subscales respectively. These findings were replicated in Hong Kong. Moreover, compared with their peers, ‘mistrustful’ children (in both countries) reported elevated rates of anxiety, low self-esteem, aggression and callous–unemotional traits.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Mistrust may exist as a quantitative trait in children, which, as in adults, is associated with elevated risks of internalising and externalising problems.</jats:p></jats:sec>
Cognitive behavioural treatment of insomnia in individuals with persistent persecutory delusions: a pilot trial.
BACKGROUND AND OBJECTIVES: Insomnia is a putative causal factor for persecutory thinking. Recent epidemiological studies show a strong association of insomnia and paranoia. The clinical implication is that reducing insomnia will reduce paranoid delusions. This study, evaluating for the first time the treatment of insomnia in individuals with persecutory delusions, provides a test of this hypothesis. It was predicted that a brief cognitive behavioural intervention for insomnia (CBT-I) for individuals with persistent persecutory delusions and sleep difficulties would not only reduce the insomnia but that it would also reduce the paranoia. METHODS: Fifteen patients with persistent persecutory delusions and insomnia in the context of a psychotic disorder were each individually given a standard-format, four-session CBT-I intervention. Outcome assessments were conducted at pre-treatment, post-treatment and one-month follow-up. RESULTS: There were no missing data. Following the intervention, significant reductions were found in levels of insomnia and the persecutory delusions. The effect sizes were large, and the changes were maintained at the follow-up. At least two-thirds of participants made substantial improvements in insomnia and approximately half showed substantial reductions in the persecutory delusions. There were also reductions in levels of anomalies of experience, anxiety and depression. LIMITATIONS: The main limitations are the absence of a control group and unblinded assessments. A more methodologically rigorous evaluation of this intervention is now warranted. CONCLUSIONS: These preliminary findings suggest that CBT-I can be used to treat insomnia in individuals with persecutory delusions and that, consistent with the hypothesised causal role, it also lessens the delusions.
Targeting reasoning biases in delusions: a pilot study of the Maudsley Review Training Programme for individuals with persistent, high conviction delusions.
Delusions are often resistant to change, persisting despite successful antipsychotic treatment or Cognitive Behavioural Therapy. This study aimed to target reasoning processes, particularly the 'Jumping to Conclusions' (JTC) bias and belief flexibility, which are thought to play a part in maintaining delusional conviction. 13 participants with a diagnosis of psychosis and high levels of conviction in their delusions completed a one-off computerised training package, lasting approximately 1.5 h. Outcomes were assessed at baseline, pre-intervention (two weeks later), post-intervention (immediately after completing the training) and at 1 month follow-up. The package was well received by participants. There were improvements in JTC, belief flexibility and delusional conviction between pre- and post-intervention measures. Controlled studies powered to detect changes in key outcomes are warranted in order to evaluate the efficacy of the programme.
Jumping to conclusions and persecutory delusions
<jats:title>Abstract</jats:title><jats:p>It is unknown whether a ‘jumping to conclusions’ (JTC) data-gathering bias is apparent in specific delusion sub-types. A group with persecutory delusions is compared with a sample of non-clinical controls on a probabilistic reasoning task. Results suggest JTC is apparent in individuals with the persecutory sub-type of delusions.</jats:p>
What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation
<jats:sec id="S0033291708003589_sec_a001"><jats:title>Background</jats:title><jats:p>In recent years a close association between anxiety and persecutory ideation has been established, contrary to the traditional division of neurosis and psychosis. Nonetheless, the two experiences are distinct. The aim of this study was to identify factors that distinguish the occurrence of social anxiety and paranoid thoughts in an experimental situation.</jats:p></jats:sec><jats:sec id="S0033291708003589_sec_a002"><jats:title>Method</jats:title><jats:p>Two hundred non-clinical individuals broadly representative of the UK general population were assessed on a range of psychological factors, experienced a neutral virtual reality social environment, and then completed state measures of paranoia and social anxiety. Clustered bivariate logistic regressions were carried out, testing interactions between potential predictors and the type of reaction in virtual reality.</jats:p></jats:sec><jats:sec id="S0033291708003589_sec_a003" sec-type="results"><jats:title>Results</jats:title><jats:p>The strongest finding was that the presence of perceptual anomalies increased the risk of paranoid reactions but decreased the risk of social anxiety. Anxiety, depression, worry and interpersonal sensitivity all had similar associations with paranoia and social anxiety.</jats:p></jats:sec><jats:sec id="S0033291708003589_sec_a004" sec-type="conclusion"><jats:title>Conclusions</jats:title><jats:p>The study shows that social anxiety and persecutory ideation share many of the same predictive factors. Non-clinical paranoia may be a type of anxious fear. However, perceptual anomalies are a distinct predictor of paranoia. In the context of an individual feeling anxious, the occurrence of odd internal feelings in social situations may lead to delusional ideas through a sense of ‘things not seeming right’. The study illustrates the approach of focusing on experiences such as paranoid thinking rather than diagnoses such as schizophrenia.</jats:p></jats:sec>