The Cognitive and Affective Structure of Paranoid DelusionsA Transdiagnostic Investigation of Patients With Schizophrenia Spectrum Disorders and Depression
The Cognitive and Affective Structure of Paranoid DelusionsA Transdiagnostic Investigation of Patients With Schizophrenia Spectrum Disorders and Depression
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DOI：
10.1001/archgenpsychiatry.2009.1
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发表时间：
2009-03-01
影响因子：
--
通讯作者：
Corcoran, Rhiannon
中科院分区：
文献类型：
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作者：
Bentall, Richard P.;Rowse, Georgina;Corcoran, Rhiannon
背景：偏执妄想是一系列精神障碍的常见症状。各种各样的心理机制都与他们的病因有关，包括倾向于急于下结论，理解他人精神状态的能力受损（心理理论）、对威胁的异常预期、异常的解释风格以及低自尊。目的：为了确定一个跨诊断样本中导致偏执狂的心理机制之间的关系结构。设计：横断面设计，预测变量和偏执狂之间的关系通过隐变量的结构方程模型进行研究。设置：伦敦和英格兰西北部的公共资助精神病服务机构。参与者：173例精神分裂症谱系障碍、重度抑郁症或晚发性精神分裂症样精神病患者，根据他们目前是否患有偏执妄想症进行细分。主要结果测量：心理理论评估，结论偏差，一般智力功能，威胁预期，情绪，自尊和解释风格。结果：最佳拟合（χ 2（96）= 131.69，P = 0.01;比较拟合指数= 0.95; Tucker-Lewis指数= 0.96;近似值的均方根误差= 0.04）和最简约模型的数据表明，偏执妄想与悲观的思维方式相结合（低自尊，悲观的解释风格和负面情绪）和认知表现受损（执行功能，倾向于急于下结论，以及对他人精神状态的推理能力）。在控制了认知表现的情况下，悲观思维与偏执呈高度相关（r = 0.65，P <0.001），控制了悲观情绪的情况下，认知表现与偏执呈高度相关（r =-0.34，P <0.001）。对偏执狂患者的治疗应该解决这两种类型的过程。
Context: Paranoid delusions are a common symptom of a range of psychotic disorders. A variety of psychological mechanisms have been implicated in their cause, including a tendency to jump to conclusions, an impairment in the ability to understand the mental states of other people (theory of mind), an abnormal anticipation of threat, and an abnormal explanatory style coupled with low self-esteem.Objective: To determine the structure of the relationships among psychological mechanisms contributing to paranoia in a transdiagnostic sample.Design: Cross-sectional design, with relationships between predictor variables and paranoia examined by structural equation models with latent variables.Setting: Publicly funded psychiatric services in London and the North West of England.Participants: One hundred seventy-three patients with schizophrenia spectrum disorders, major depression, or late-onset schizophrenia-like psychosis, subdivided according to whether they were currently experiencing paranoid delusions. Sixty-four healthy control participants matched for appropriate demographic variables were included.Main Outcome Measures: Assessments of theory of mind, jumping to conclusions bias, and general intellectual functioning, with measures of threat anticipation, emotion, self-esteem, and explanatory style.Results: The best fitting (chi(2)(96) = 131.69, P = .01; comparative fit index = 0.95; Tucker-Lewis Index = 0.96; root-mean-square error of approximation = 0.04) and most parsimonious model of the data indicated that paranoid delusions are associated with a combination of pessimistic thinking style (low self-esteem, pessimistic explanatory style, and negative emotion) and impaired cognitive performance (executive functioning, tendency to jump to conclusions, and ability to reason about the mental states of others). Pessimistic thinking correlated highly with paranoia even when controlling for cognitive performance (r = 0.65, P < .001), and cognitive performance correlated with paranoia when controlling for pessimism (r = -0.34, P < .001).Conclusions: Both cognitive and emotion-related processes are involved in paranoid delusions. Treatment for paranoid patients should address both types of processes.