Paranoid Ideation Without Psychosis Is Associated With Depression, Anxiety, and Suicide Attempts in General Population.

This study aimed to characterize the association between paranoid ideation without psychosis (PIP) and suicide attempts in a general population. A total of 12,532 adults were randomly selected as the study sample through one-person-per-household method. Subjects completed a face-to-face interview. Among 12,532 subjects, 471 (3.76%) met criteria for the PIP group. The PIP group was younger with more divorced/widowed/separated and lower income than the non-PIP group. The PIP group showed more than fivefold higher lifetime suicide attempt (LSA) rates and ninefold multiple attempt rates than the non-PIP group. Among PIP symptoms, "spouse was being unfaithful" showed the strongest association with LSA (adjusted odds ratio [AOR], 4.49; 95% confidence interval, 2.95-6.85). Major depressive disorder (MDD) in combination with PIP was associated with a higher risk of LSA (AOR, 15.39; 95% confidence interval, 9.63-24.59) compared with subjects without MDD or PIP. In conclusion, PIP, especially "doubting spouse," was significantly associated with LSA. PIP in combination with comorbid MDD showed higher risk of LSA than subjects without PIP or MDD.

Rural birth/upbringing and childhood adversities are associated with psychotic experiences in university students in China.

BACKGROUND: Urbanicity has been reported to associate with an increased risk of psychotic experiences (PEs) in developed countries but less is known about the situation in developing countries. The present study aimed to investigate the effects of birth/upbringing place and other environmental factors on PEs in Chinese university students. METHODS: A computer-assisted cross-sectional survey was conducted on 4620 second-year undergraduates, using a stratified cluster sampling. Birth places and residential mobility before 16 years old were recorded. PEs were measured using the subscales of psychoticism and paranoid ideation in the Symptom Checklist-90-R (SCL-90-R). Six questions extracted from the childhood section of the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) were used to assess childhood trauma. RESULTS: Generalized ordered logit model of multiple regression analysis revealed that participants with rural birth/upbringing (e.g. rural upbringing, on graded factor score of psychoticism and paranoid ideation [GFSPPI], 0 versus 1 & 2, odds ratio [OR] 1.409, 95% CI 1.219-1.628, p < 0.00001; 0 & 1 versus 2, OR 1.584, 95% CI 1.179-2.128, p < 0.00001) and those who reported childhood trauma (e.g. on GFSPPI, 0 versus 1 & 2, OR 1.737, 95% CI 1.498-2.014, p < 0.00001; 0 & 1 versus 2, OR 1.618, 95% CI 1.224-2.140, p < 0.00001) were apt to present more severe PEs. While upbringing places and childhood trauma affected both the presence and the severity of PEs, gender affected the presence or absence of PEs only (e.g. females, on GFSPPI, 0 versus 1 & 2, OR 1.887, 95% CI 1.631-2.183, p < 0.00001; 0 & 1 versus 2, OR 0.927, 95% CI 0.702-1.223, p = 0.593). Besides, the number of risk factors was associated with the severity of PEs in the cumulative odds logistic regression analysis (e.g. 3 risk factors versus 0 risk factor, on GFSPPI, OR 4.126, 95% CI 3.075-5.537, p < 0.00001). CONCLUSIONS: Female, rural birth/upbringing and childhood trauma are risk factors of PEs in university students in China. The discrepancy in the findings between developed countries and China has important implications for urbanicity as a risk factor for PEs.

Adolescent Paranoia: Prevalence, Structure, and Causal Mechanisms.

BACKGROUND: Adolescence can be a challenging time, characterized by self-consciousness, heightened regard for peer acceptance, and fear of rejection. Interpersonal concerns are amplified by unpredictable social interactions, both online and offline. This developmental and social context is potentially conducive to the emergence of paranoia. However, research on paranoia during adolescence is scarce. METHOD: Our aim was to examine the prevalence, structure, and probabilistic causal mechanisms of adolescent paranoia. A representative school cohort of 801 adolescents (11-15 y) completed measures of paranoia and a range of affective, cognitive, and social factors. A Bayesian approach with Directed Acyclic Graphs (DAGs) was used to assess the causal interactions with paranoia. RESULTS: Paranoid thoughts were very common, followed a continuous distribution, and were hierarchically structured. There was an overall paranoia factor, with sub-factors of social fears, physical threat fears, and conspiracy concerns. With all other variables controlled, DAG analysis identified paranoia had dependent relationships with negative affect, peer difficulties, bullying, and cognitive-affective responses to social media. The causal directions could not be fully determined, but it was more likely that negative affect contributed to paranoia and paranoia impacted peer relationships. Problematic social media use did not causally influence paranoia. CONCLUSIONS: There is a continuum of paranoia in adolescence and occasional suspicions are common at this age. Anxiety and depression are closely connected with paranoia and may causally contribute to its development. Paranoia may negatively impact adolescent peer relationships. The clinical significance of paranoia in adolescents accessing mental health services must now be established.

Psychotic-like experiences and happiness in the English general population.

BACKGROUND: Psychotic-like experiences (PLEs) have been associated with a variety of adverse outcomes but how they affect happiness in individuals with PLE is unknown. Thus, the aim of the study was to assess the association between PLEs and happiness, and the factors that may influence this association. METHODS: Nationally representative data from the 2007 Adult Psychiatric Morbidity Survey including adults aged ≥ 16 years was analyzed. The Psychosis Screening Questionnaire was used to assess past 12-month PLE. Individuals who endorsed at least one of the following were considered to have any PLE: thought control, paranoia, strange experiences, auditory hallucinations. Happiness (3-point scale) was assessed with a validated question with higher scores indicating lower levels of happiness. The association between PLE and happiness was assessed by multivariable ordinal logistic regression. Mediation analysis was also performed. RESULTS: Among the 7363 individuals included in the analysis, the prevalence of any PLE increased with decreasing levels of happiness [very happy (2.3%), fairly happy (5.4%), not too happy (14.9%)]. This was also shown in the multivariable analysis adjusted for sociodemographic factors and stressful life events (from very happy to not too happy: OR = 2.41; 95%CI = 1.86-3.12). Mediation analysis showed that anxiety disorders explained the largest proportion of the association (38.8%) followed by depressive episode (28.5%), insomnia (21.9%), disability (16.5%), pain (12.5%), social support (10.0%), and physical health conditions (6.0%). LIMITATIONS: The cross-sectional design limits causal inference. CONCLUSION: Interventions to identify and address conditions that may have a negative impact on happiness in individuals with PLE may be important to improve their well-being.

Cluster A maladaptive personality patterns in a non-clinical adolescent population / Patrones desadaptativos de la personalidad del Cluster A en población adolescente no clínica / Patrones desadaptativos de la personalidad del Cluster A en población adolescente no clínica

Background: The prevalence and expression of Cluster A personality disorders in adolescence is poorly analyzed and understood. The main goal was to analyze the rate of Cluster A traits and maladaptive personality patterns in adolescents. In addition, the underlying dimensional structure and the possible influence of sex and age in its phenotypic expression were examined. Method: The final sample was comprised of a total of 1,443 participants (M= 15.9 years, SD= 1.2). The instrument used was the Personality Diagnostic Questionnaire-4+ (PDQ-4+). Results: Cluster A maladaptive personality traits are common among adolescents. According to the PDQ-4+, 13.1% (n= 189) of the sample reported a Cluster A maladaptive personality pattern. Analysis of the internal structure yielded two interrelated factors, namely Paranoid and Schizotypal-Schizoid. Males, compared with females, obtained higher scores on the schizotypal subscale when the score was dimensional and on the schizotypal and schizoid subscales when items were dichotomized. Conclusions: These data yield new clues that improve the understanding of Cluster A traits in this sector of the population, and advance in early detection of adolescents at risk of personality disorders (AU)

Antecedentes: la prevalencia y la expresión de los trastornos de la personalidad del Cluster A en la adolescencia se encuentra escasamente analizada y comprendida. El objetivo de esta investigación fue analizar la tasa de los rasgos y patrones desadaptativos de la personalidad del Cluster A en adolescentes. También se examinó la estructura dimensional subyacente y la influencia del sexo y la edad en su expresión fenotípica. Método: la muestra la formaron 1.443 participantes (M= 15,9 años; DT= 1,2). El instrumento de medida utilizado fue el Personality Diagnostic Questionnaire-4+ (PDQ-4+). Resultados: los rasgos de las personalidades del Cluster A son comunes entre la población adolescente. El 13,1% (n= 189) de la muestra presentaría, según el PDQ-4+, un patrón desadaptativo de la personalidad del Cluster A. La estructura dimensional subyacente arrojó dos factores interrelacionados, Paranoide y Esquizotípico-Esquizoide. Los varones presentaron, en comparación con las mujeres, mayores puntuaciones en la subescala esquizotípica cuando la puntuación era dimensional, y en las subescalas esquizotípica y esquizoide cuando la puntuación de los ítems era dicotomizada. Conclusiones: estos datos permiten avanzar en la comprensión de los rasgos del Cluster A y en la detección temprana de adolescentes con riesgo de desarrollar un trastorno de la personalidad (AU)

Paranoid symptoms and hallucinations among the older people in Western Europe.

OBJECTIVE: It is not clear whether the prevalence of psychosis increases with age. We studied the age-specific prevalence of psychotic symptoms in older people in Western Europe. METHODS: Older people without dementia (age 65-104 years, N = 8762) from the western part of Europe in the EURODEP concerted action took part in psychiatric examinations. RESULTS: In total, 2.4% of the men and 2.9% of the women had psychotic symptoms. Using a multilevel logistic regression model that included gender and age as a continuous variable, we found that a 5-year increase in age increased the prevalence of psychotic symptoms (odds ratio 1.2 95% confidence interval 1.06-1.3, p = 0.001). A second multilevel regression model showed that wishing to be dead, depressed mood, functional disability, not being married and cognitive impairment measured with Mini mental state examination were all associated with psychotic symptoms whereas gender was not. CONCLUSION: The prevalence of psychotic symptoms in non-demented older people increases with age, and these symptoms are associated with other psychopathology, social isolation and problems with daily living.

Self-reported psychotic symptoms in the general population: correlates in an Iranian urban area.

BACKGROUND: Psychosis exists in the community as a continuum of severity. Here, we examine the correlates of self-reported psychotic symptoms in an urban catchment area of Iran. SAMPLING AND METHODS: Two thousand one hundred and fifty-eight participants (age 18-65 years) residing in southern Tehran (the capital city of Iran) were interviewed using the psychoticism and paranoia dimensions of the Symptom Checklist-90-Revised (SCL-90-R) to assess the severity of psychotic symptoms. Other dimensions of the SCL-90-R assessing nonpsychotic symptoms and a sociodemographic questionnaire were also used. Paykel's Interview for Recent Life Events was used to assess stressful life events. RESULTS: Independent associations were observed between younger age, female gender, stressful life events and dimensions of depression, anxiety, hostility, obsessive-compulsive symptoms and interpersonal sensitivity and psychoticism. Independent associations were also observed for marital problems, unemployment, stressful life events and dimensions of depression, anxiety, hostility, interpersonal sensitivity and phobic anxiety with paranoid ideation. There was also a trend toward an association between higher educational levels and the severity of psychotic symptoms, particularly paranoid ideation. CONCLUSIONS: Most of the previously accepted correlations for psychotic symptoms in the community were replicated. An unexpected association between paranoia and female gender, and a trend toward higher rates of psychotic symptoms in more educated participants, were in contrast with the studies in developed settings. The insufficient coverage of psychosis-relevant questions from the SCL-90-R for the entire psychotic diagnostic spectrum should be considered a limitation.

Caracterización clínica y terapéutica de un muestreo portugués de pacientes con esquizofrenia / Clinical and therapeutic characterization of a portuguese sample of patients with schizophrenia

Introducción. El desarrollo de las políticas de salud mental sobre trastornos psiquiátricos graves debe llevarse a cabo con un conocimiento adecuado de las realidades socio-demográficas, y clínicas de los padrones de prescripción. En Portugal, los estudios epidemiológicos no tienen un nivel de detalle que haga posible una comprensión profunda de este fenómeno. En la población portuguesa que sufre esquizofrenia hay una carencia de estudios en profundidad que limitan su comparación con otros países europeos. Este estudio ha sido diseñado con el objetivo principal de conocer la práctica clínica habitual y las características de la esquizofrenia en Portugal. Método. Se trata de un estudio observacional, descriptivo, transversal y multicéntrico, con datos recogidos en la práctica clínica corriente. Se han analizado un total de 474 pacientes. Resultados. El diagnóstico más frecuente la esquizofrenia paranoide (54%), de severidad moderada, con frecuentes complicaciones psiquiátricas (39,7%) y somáticas (28,4%). El 48,6% de los pacientes presentaban consumo de drogas. Aproximadamente la mitad de los pacientes tomaban antipsicóticos atípicos como tratamiento principal, aunque el haloperidol fue el medicamento prescrito con más frecuencia (35,9%). El 59,51% de los pacientes estaban siendo tratados en monoterapia antipsicótica y el 45% con una formulación de larga duración inyectable. Las dosis de los antipsicóticos eran muy variables y con frecuencia fuera de la indicación autorizada. El 37,9% de los pacientes tenían terapia concomitante no farmacológica. Conclusiones. Los pacientes presentan características sociodemográficas similares a las de otros ensayos clínicos naturalistas, pero diferentes de los ensayos clínicos con fármacos. En general, los pacientes se tratan con antipsicóticos atípicos, aunque un gran porcentaje prosigue con formulaciones de liberación lenta en terapia de combinación con dos o más antipsicóticos, en cifras mayores que en otros estudios similares. Las enfermedades somáticas quizás se infradiagnostica no se tratan de manera insuficiente (AU)

Introduction. The development of Mental Health policies for psychiatric disorders should be driven by a correct knowledge of the socio-demographic, clinical and therapeutic realities of the disease. There is paucity of detailed studies in the Portuguese population that does not allow a direct comparation with other European countries. The objective of the present study is to characterize the sociodemograhic and clinical characteristics of schizophrenia patients in Portugal and the therapeutic patterns. Methods. This multicentric, cross sectional, non interventional study was designed to describe the demographic and clinical data of patients with schizophrenia (n=474), and also the demographic and professional characteristics of their treating psychiatrists. Results. The most frequent diagnosis found was paranoid schizophrenia (54%), with comorbid psychiatric conditions in 39,7% and somatic diseases in 28.4% of the patients. About half the patients were on second generation antipsychotics (SGS) as principal therapy, although haloperidol has been the most frequent drug prescribed as so (35.9 %). 59.51 % of the patients were on antipsychotic monotherapy, and 45% on a depot formulation. Antipsychotic dose vary widely, and they are quite often prescribed on off label doses. Discussion. Our sample is similar to others found in naturalistic studies, however slightly different from clinical trials. In general, patients with schizophrenia tend to be treated with SGA, although have a higher chance to be on a long-term formulation and to be on polytherapy than in other studies. Somatic diseases are maybe under diagnosed and are undertreated (AU)

Government gas vans and school gas chambers: preparedness and paranoia in Britain, 1936-1941.

In 1936 the Air Raid Precautions department of the British Home Office instigated a training programme in which members of the public, including school students, were systematically exposed to tear gas. Based around fixed and mobile gas chambers, this training aimed to educate the public in the value and efficacy of their gas masks. Drawing on documentary and oral historical sources, this paper examines the discrepancies between the stated form and aims of these tests, and their practical applications, including some excessively brutal training practices. In the last part of the paper I consider these variations in the context of both the gas panic and the moral panic about children's behaviour in wartime.

Examining the developmental history of child maltreatment, peer relations, and externalizing problems among adolescents with symptoms of paranoid personality disorder.

This study examined the childhood history of maltreatment, peer relations, and externalizing problems among individuals who manifested low, moderate, or high symptom levels of paranoid personality disorder (PPD) in adolescence. Participants included 174 children who attended a longitudinal summer camp research program between the ages of 9 to 12. Multiple sources of information (self-, peer, and counselor reports) were utilized. Subsequently, they participated in a personality disorder assessment during adolescence (mean age = 15.30). The results indicated that children who manifested higher levels of PPD symptoms in adolescence had higher odds of having a history of child maltreatment. Children who manifested high levels of PPD symptoms in adolescence showed a faster growth rate for peer bullying and externalizing problems in childhood. In addition, their peers rated them as less cooperative, less likely to be leaders, and more likely to initiate fights. These findings suggested that children who manifested elevated PPD symptoms in adolescence had shown early signs of behavioral disturbances in childhood, some of which gradually worsened as they approach adolescence.

Variations in social contexts and their effect on adolescent inhalant use: a latent profile investigation.

The social contexts surrounding the use and abuse of inhalants are poorly understood. The aim of this study was to utilize latent profile analysis (LPA) to identify specific subgroups of adolescents based on social contextual effects surrounding inhalant use episodes in a sample of 279 adolescent inhalant users. Findings revealed that a three-class solution exhibited the best empirical and conceptual fit with the data. Identified classes represented a gradient of low, moderate, and high levels of contextual effects where approximately one third of adolescent inhalant users reported high levels of inhalant use in response to social contextual influences. Subsequent validation analysis showed that these gradient-based classes were directly correspondent with severity in measures of psychopathology, past drug use, variety of inhalants used, and measures of impulsivity and fearlessness. Results indicate heterogeneity in contextual effects on inhalant use and suggest that follow-up studies should examine the role that susceptibility and exposure to contextual effects has on inhalant use.

El trastorno delirante. Revisando los aspectos de la paranoia / Delusional disorder. Revision of some aspects of paranoia

Se revisa el trastorno delirante desde su historia y concepto hasta sus posibilidades terapéuticas en la actualidad, analizando la epidemiología, clínica, aspectos diagnósticos, curso y pronóstico. Nos encontramos ante una patología poco común que se caracteriza por la presencia de ideas delirantes de instauración insidiosa, basadas en un mecanismo interpretativo y que habitualmente aparecen en una estructura de personalidad premórbida determinada. La prevalencia es de 1-4 por ciento de todos los pacientes ingresados en hospitales psiquiátricos. La media de la edad de inicio está alrededor de los 40 años y es ligeramente más frecuente en mujeres. Muchos pacientes están casados y trabajan, existiendo cierta asociación con la inmigración reciente y un estatus socioeconómico bajo. Suele haber un factor ambiental favorecedor al inicio del trastorno. Es frecuente la existencia de antecedentes familiares de trastorno psiquiátrico aunque la prevalencia de esquizofrenia y psicosis afectivas no está incrementada. El tipo de trastorno delirante más frecuente es el persecutorio. Se cree que el trastorno delirante es un diagnóstico estable, de tal forma que menos de un 25 por ciento de los pacientes evolucionan hacia la esquizofrenia y menos de un 10 por ciento evolucionan hacia los trastornos del estado de ánimo. Con un tratamiento adecuado tiene un buen pronóstico si bien la mayoría presentan dificultades de aceptación del mismo (AU)

Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis II comorbidity.

OBJECTIVE: To examine the rate of persistence of borderline personality disorder (BPD), the existence of concomitant personality disorders on follow-up, and the predictors of outcome in patients who met criteria for BPD compared with patients with borderline features who failed to meet all of the criteria. METHOD: This prospective cohort study reassessed subjects for BPD diagnosis and cooccurring personality pathology at 7 years follow-up. Initial measures of borderline and comorbid personality psychopathology were used to predict levels of borderline or other personality disorder psychopathology at follow-up. RESULTS: Of the 57 subjects who initially met the criteria for BPD, 30 (52.6%) were found to have remitted BPD, and 27 (47.4%) were characterized as having persistent BPD. The remitted group met significantly fewer comorbid personality disorder diagnoses than the persistent group (mean = 0.8, mean = 3.5 respectively; P < 0.05). Results also indicated that the initial level of borderline psychopathology was predictive of borderline psychopathology at follow-up, which explained 17% of the variance. CONCLUSIONS: This prospective follow-up study found that almost 50% of former inpatients with BPD continue to test positive for BPD at 7 years follow-up, and these persistent BPD patients also had significantly more comorbid personality psychopathology. Borderline psychopathology at follow-up was primarily predicted by the level of borderline psychopathology recorded at the initial assessment.