Understanding the mental health burden of COVID-19 in the United Kingdom.

This article outlines the mental health burden of COVID-19 in the United Kingdom population, and presents preliminary evidence of less common psychiatric issues, such as paranoia and hallucinations, to which vulnerable groups in the U.K. population may be more vulnerable. It is argued that cognitive-behavioral therapy, with components of mindfulness, should be part of the therapeutic response. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Cultural differences in positive psychotic experiences assessed with the Community Assessment of Psychic Experiences-42 (CAPE-42): a comparison of student populations in the Netherlands, Nigeria and Norway.

BACKGROUND: Previous studies have suggested that culture impacts the experience of psychosis. The current study set out to extend these findings by examining cultural variation in subclinical positive psychotic experiences in students from The Netherlands, Nigeria, and Norway. Positive psychotic experiences were hypothesized to (i) be more frequently endorsed by, and (ii) cause less distress in Nigerian vs. Dutch and Norwegian students. METHODS: Psychology students, aged 18 to 30 years, from universities in the Netherlands (n = 245), Nigeria (n = 478), and Norway (n = 162) were assessed cross-sectionally with regard to the frequency of subclinical positive psychotic experiences and related distress, using the Community Assessment of Psychic Experiences (CAPE-42). Multi-group confirmatory factor analysis and multivariate analysis of covariance were performed to assess measurement invariance of the positive symptom dimension (CAPE-Pos) and compare mean frequency and associated distress of positive psychotic experiences across study samples. RESULTS: Only CAPE-Pos items pertaining to the dimensions 'strange experiences' and 'paranoia' met assumptions for (partial) measurement invariance. Frequencies of these experiences were higher in the Nigerian sample, compared to both the Dutch and Norwegian samples, which were similar. In addition, levels of experience-related distress were similar or higher in the Nigerian sample compared to respectively the Dutch and Norwegian samples. CONCLUSION: Although positive psychotic experiences may be more commonly endorsed in non-Western societies, our findings do not support the notion that they represent a more benign, and hence less distressing aspect of human experience. Rather, the experience of psychotic phenomena may be just as, if not more, distressing in African than in European culture. However, observed differences in CAPE-Pos frequency and distress between samples from different cultural settings may partly reflect differences in the measure rather than in the latent trait. Future studies may therefore consider further cross-cultural adaptation of CAPE-42, in addition to explicitly examining cultural acceptance of psychotic phenomena, and environmental and other known risk factors for psychosis, when comparing and interpreting subclinical psychotic phenomena across cultural groups.

Investigating ethnic variations in reporting of psychotic symptoms: a multiple-group confirmatory factor analysis of the Psychosis Screening Questionnaire.

BACKGROUND: Epidemiological evidence suggests risk for psychosis varies with ethnicity in Western countries. However, there is little evidence to date on the cross-cultural validity of screening instruments used for such comparisons. METHODS: Combining two existing UK population-based cohorts, we examined risk for reporting psychotic symptoms across White British (n = 3467), White Irish (n = 851), Caribbean (n = 1899), Indian (n = 2590), Pakistani (n = 1956) and Bangladeshi groups (n = 1248). We assessed the psychometric properties of the Psychosis Screening Questionnaire (PSQ) with a multiple-group confirmatory factor analysis, assessing the equivalence of factor loadings, response thresholds and residual variances in an analysis of measurement non-invariance. RESULTS: Compared with prevalence among British Whites (5.4%), the prevalence of self-reported psychotic symptoms was greater in the Caribbean group (12.7%, adjusted OR = 2.38 [95% CI 1.84-3.07]). Prevalence was also increased among Pakistani individuals (8.3%, adjusted OR = 1.36 [1.01-1.84]) although this difference was driven by a greater likelihood of reporting paranoid symptoms. PSQ items for thought interference, strange experience and hallucination were measured in equivalent ways across ethnic groups. However, our measurement models suggested that paranoid symptoms were measured less reliably among ethnic minorities than among British Whites and appeared to exaggerate latent differences between Pakistani and White British groups when measurement non-invariance was not accounted for. CONCLUSIONS: Notwithstanding evidence for measurement non-invariance, the greater risk for reporting psychotic symptoms among Caribbean individuals is unlikely to be an artefact of measurement. Greater residual variance in the recording of paranoid symptoms among ethnic minority respondents warrants caution in using this item to investigate ethnic variation in psychosis risk.

Perceived ethnic discrimination and persecutory paranoia in individuals at ultra-high risk for psychosis.

Despite a consensus that psychosocial adversity plays a role in the onset of psychosis, the nature of this role in relation to persecutory paranoia remains unclear. This study examined the complex relationship between perceived ethnic discrimination and paranoid ideation in individuals at Ultra High Risk (UHR) for psychosis using a virtual reality paradigm to objectively measure paranoia. Data from 64 UHR participants and 43 healthy volunteers were analysed to investigate the relationship between perceived ethnic discrimination and persecutory ideation in a virtual reality environment. Perceived ethnic discrimination was higher in young adults at UHR in comparison to healthy controls. A positive correlation was observed between perceived ethnic discrimination and paranoid persecutory ideation in the whole sample. Perceived ethnic discrimination was not a significant predictor of paranoid persecutory ideation in the VR environment. Elevated levels of perceived ethnic discrimination are present in individuals at UHR and are consistent with current biopsychosocial models in which psychosocial adversity plays a key role in the development of psychosis and attenuated symptomatology.

Mild psychotic experiences among ethnic minority and majority adolescents and the role of ethnic density.

PURPOSE: Despite evidence of the increased risk of psychotic disorders among ethnic minority adults, little is known about the effect of ethnic minority status to mild psychotic experiences among adolescents. This study investigated mild psychotic experiences in ethnic minority and majority adolescents in a Dutch representative general population sample, and tested the ethnic density effect in the classroom. METHODS: The CAPE was used to assess mild psychotic experiences among Dutch (n = 3,606) and non-Western ethnic minority pupils (n = 769). RESULTS: Ethnic minority adolescents showed higher levels of grandiosity and delusions than their ethnic majority peers, whereas no differences were found for hallucinations, paranormal beliefs and paranoia between both groups of adolescents. The ethnic density effect was partly confirmed for the ethnic majority: a decrease of ethnic majority pupils in class increased their feelings of paranoia. CONCLUSIONS: Because only some dimensions of mild psychotic experiences were affected by ethnic minority status or the interaction between ethnic minority status and ethnic class composition, our findings emphasize that mild psychotic experiences are multifactorial in origin, with different underlying processes.

Fixing Freud: the Oedipus complex in early twenty-first century US American novels.

Representations of Sigmund Freud in early 21st century US American novels rely on and respond to the image of Freud that emerged from investigations by Paul Roazen ("Brother Animal," 1969) and Jeffrey Moussaieff Masson ("The Assault on Truth," 1984), which cast doubt on the validity of the Oedipus complex. Relying on Roazen, Brenda Webster's "Vienna Triangle" (2009) links Freud's oedipal thinking to paranoia and male masochism. Working with Masson, Selden Edwards's "The Little Book" (2008) takes Freud to task for abandoning the seduction theory in favor of the Oedipus complex. Jed Rubenfeld's "The Interpretation of Murder" (2006) rethinks the Oedipus complex as a projection of adults onto their children. All three novels seek to celebrate Freud's understanding of the human psyche, while shifting the focus of the oedipal structure away from the murderous and lustful child toward the adult.

Idiom of distress or delusional state? Cultural clash as the cause of misdiagnosis: a case report.

The Beta Israel (House of Israel) represent a total number of more than 100,000 individuals. Ethiopian Jewish culture is based on a tribal cultural model. With their arrival in Israel, many difficulties surfaced. Ethiopian Jews had to deal with cultural choices that challenged their traditions. It has been suggested that the trauma of their journey coupled to the difficulties of the adaptation process to Israeli society, ( the culture shock), was directly responsible for psychopathology found among this population. It also appeared that culture plays a central role in the construction of the clinical picture, blurring at times the boundary between expressions of distress and pathology. It became increasingly difficult to draw the line between culturally normative behavior and psychopathology. The following case report underlines the importance of socio cultural considerations in both staff and patients, and illustrates the dangers of misdiagnosis due to patient therapeutic team cultural clash. A 41 year old woman of Ethiopian origin was hospitalized for suspected schizophrenia. Because of the striking contrast between the patients behavior, responses and so called psychotic content, possible misunderstanding based on cultural differences was considered by the clinical management team. This case underlines the dangers of the psychiatric diagnostic process, emphasizes the important role of sociocultural backgrounds of both staff and patients in patient management and encourages the consideration of cultural factors in all patient evaluations.

Evaluation of the psychological status in seasonal allergic rhinitis patients.

OBJECTIVE: To investigate the psychological status of Chinese adults with seasonal allergic rhinitis (SAR) in the allergic season, and evaluate the effects of nasal symptoms on their psychological status. METHODS: The Symptom Checklist 90 (SCL-90) or Self-Reporting Inventory was employed to analyze the psychological status of 337 SAR patients. RESULTS: The SCL-90 scores of the SAR patients were statistically higher than those of nonallergic adults in terms of somatization, depression, anxiety, hostility and psychosis. No statistical discrepancies existed in gender or age, the impact of disease course was limited to somatization, compulsion and phobic disorders and the impact of the educational level was that the lower the level of education, the more obvious the hostility. The behavior of somatization, compulsion, depression and anxiety in patients with a history of eczema or asthma was much more obvious than in patients without such a history. Nasal obstruction had a conspicuous impact on somatization, compulsion, interpersonal sensitivity, depression, anxiety and psychosis, while nasal itching contributed to somatization, depression and anxiety. CONCLUSION: The psychological status of SAR patients is evidently worse than that of nonallergic adults. Symptoms such as nasal obstruction and nasal itching had an obvious impact on the psychological status of the patients.

The role of treatment setting and high acuity in the overdiagnosis of schizophrenia in African Americans.

Multiple studies have shown that significant disparities exist in the diagnosis of schizophrenia between African Americans (AAs) and Whites with severe mental illness. This phenomenon has been a topic in the literature for nearly three decades, yet it remains unclear what factors contribute most conclusively to the overdiagnosis of schizophrenia in AAs. The purpose of this article was to collectively examine the contributing factors identified in the literature and to discuss the role of acuity and treatment setting in overdiagnosis as well. A variety of client-level (higher rates of use of psychotomimetic substances in AAs) and care process-level (misinterpretation of cultural mistrust as paranoia, under detection of depression, similarities in diagnostic criteria between mood and psychotic disorders, provider bias, miscommunication between patient and provider, changes in diagnostic criteria, differences in diagnostic practice between providers, and a lack of sufficient data obtained) factors emerged as influential in overdiagnosis. However, in this review, it also emerged that AAs tendency to use emergency and acute care services, a systems level factor, could be related as well. It is possible that assessment at a time when symptom acuity is severe might increase the likelihood of a schizophrenia diagnosis in AAs.

Melanie Klein and Repression: an examination of some unpublished Notes of 1934.

Fifteen pages of unpublished Notes were found in the Melanie Klein Archives dating from early 1934, a crucial moment in Klein's development. She was at this time, 1934, moving away from child analysis, whilst also rethinking and revising her allegiance to Karl Abraham's theory of the phases of libidinal development. These Notes, entitled "Early Repression Mechanism," show Klein struggling to develop what became her characteristic theories of the depressive position and the paranoid-schizoid position. Although these Notes are precursors of the paper Klein gave later to the IPA Congress in 1934, they also show the origins of the emphasis she and her followers eventually gave to "splitting" rather than repression. The Notes give us an insight into the way that she worked clinically at the time. We see Klein's confidence develop as she diverged from the classical theories and technique. Her ideas were based on close attention to the detail of her clinical material, rather than attacking theoretical problems directly. The Notes show her method of struggling to her own conclusions, and they offer us a chance to grasp the roots of the subsequent controversy over Kleinian thought.

Culture, ethnicity, and paranoia.

This paper defines concepts of culture, ethnicity, and paranoia. It then explores the relationship between culture and ethnicity and the development of paranoia both in mental health settings and in the wider world. The importance of cultural awareness training while dealing with an ethnic population in any multicultural setting is emphasized. When exploring paranoia, proper exploration of its genesis is essential to distinguish between pathological and nonpathological paranoia.

Racial differences in paranoid ideation and psychoses in an older urban population.

OBJECTIVE: This study examined whether there are racial differences in the prevalence of paranoid ideation and psychotic symptoms in persons age >/=55 in an urban community. METHOD: Using 1990 census data for Brooklyn, N.Y., the authors attempted to interview all cognitively intact persons age >/=55 in randomly selected blocks. The final group consisted of 206 whites and 821 blacks. The authors used George's Social Antecedent Model for analyzing 21 independent and three dependent variables: paranoid ideation, psychotic symptoms, and psychotic symptoms/paranoid ideation. The group was weighted by race and gender. To control for intrablock clustering effects without replacement sampling, the authors used SUDAAN for data analysis. RESULTS: A significant difference in psychotic symptoms or paranoid ideation was found between blacks and whites (24% versus 10%) that was attenuated but not eliminated with logistic regression analyses. Blacks with psychotic symptoms or paranoid ideation, especially Caribbeans, had significantly lower receipt of mental health services and lower perceived service needs. With logistic regression, psychotic symptoms and paranoid ideation were associated with four variables among blacks and whites, although only one was significant in both groups. CONCLUSIONS: Racial differences in psychotic symptoms and paranoid ideation persist even after control for various clinical, social, and attitudinal effects. Among blacks, response to stressors may be expressed through increased paranoid ideation and psychotic symptoms. Stronger beliefs in spiritualism increase this expression in both races. The high prevalence of psychotic symptoms or paranoid ideation among this aging urban population, especially blacks, highlights a potential public health issue.

Ethnicity/race, paranoia, and hospitalization for mental health problems among men.

OBJECTIVES: I tested the hypothesis that Black men with high levels of distrust (i.e., mild paranoia) are at greater risk of hospitalization for mental health problems than their White counterparts. METHODS: Secondary analysis was conducted of data from a subsample of 180 men in an epidemiological study. Mental health hospitalization was the outcome and ethnicity/race, mild paranoia, and their interaction were main predictors in a logistic regression analysis. The ethnicity/race by mild paranoia interaction tested the study hypothesis. RESULTS: The ethnicity/race by mild paranoia interaction was statistically significant. Contrary to the hypothesis, Black men with mild paranoia were less likely to be hospitalized. CONCLUSIONS: Black men's lack of trust regarding the mental health system may cause them not to seek services. Factors critical to increasing their trust are acknowledgment of racial biases in the mental health system and sincere efforts to eliminate racial disparities in mental health treatment.

Confluent paranoia in African American psychiatric patients: an empirical study of Ridley's typology.

This study examined Ridley's (1984) typology of paranoia in African Americans, which assumes orthogonal dimensions of culture and pathology in symptom expression. Median split of scores on the Cultural Mistrust Inventory and the scale of False Beliefs and Perceptions represented high and low levels of cultural paranoia and pathological paranoia, respectively. The 4 groups of Black patients were nonparanoia, cultural paranoia, pathological paranoia, and confluent paranoia. A Fenigstein Paranoia Scale manipulation check indicated that differences in paranoid symptom expression among the groups were partially supportive of Ridley's model, as were measures of perceptions of hostility and self-esteem. Omnibus tests of between-groups differences were significant for global assessment of functioning and number of symptoms recorded in patients' charts. Predicted pattern testing revealed a significant severity dimension in mean scores across paranoia groups for some measures of clinician-rated functioning but not others. SCID interviewers' ratings of cultural mistrust and number of times restrained (or secluded) were more consistent with a pattern representing a cultural dimension than a severity dimension across paranoia groups. Findings provide limited empirical validation of Ridley's typology of paranoia in African Americans.

Psychometric analysis of the cultural mistrust inventory with a Black psychiatric inpatient sample.

An important empirical question is whether the Cultural Mistrust Inventory (CMI) can be used to measure cultural aspects of paranoia in Black psychiatric populations. Research on cultural mistrust in psychiatric populations is essential for tests of hypotheses regarding the misdiagnosis of African Americans. The purpose of this study was to assess the reliability and validity of the CMI in a sample of African American patients recently admitted to a psychiatric hospital. The reliability assessment revealed that the CMI total scale is a reliable measure. Factor analytic results indicated that a single global dimension underlies CMI scores. The CMI also showed good convergent validity with a measure of nonclinical paranoia and discriminant validity with measures of self-esteem and social desirability. This study provides reasonable evidence that use of the CMI with psychiatric patients is psychometrically sound.

[Polish paranoia]. / Polska paranoja.

The article describes clinical experience with patients suffering from paranoid states during adaptation to new country and culture. The complex of symptoms in polish immigrants was called polish paranoia. It is a pathological way of coping, resulting from new culture, ignorance of language, irrational expectations of emigration profits. We think that reasons of this syndrome are polish nation experiences, one's own history and family history.

Cross-cultural perspective on paranoia: a focus on the black American experience.

A cross-cultural perspective on paranoia is developed, based on a synthesis of three distinct areas of research, with particular attention to the Black experience in America. This perspective is applied in a two-phase program of research. Phase I was the secondary analysis of data from an epidemiologic study of schizophrenia and depression: It examined differences in paranoid symptom expression among Black, Latino, and White Americans. Phase II, called the Culturally-Sensitive Diagnostic Interview Research Project, is currently underway and involves primary data collection, focusing exclusively on African Americans. Phase I results and some pilot data from the phase II study are reported. It is concluded that cultural mistrust among Black psychiatric patients should not be construed as psychopathology.

Deboleza: culturally determined behaviour in Istria.

Deboleza is a behavioural construct among the inhabitants of Istria (a peninsula in the Adriatic Sea which belongs mainly to Croatia); it has peculiar social, ethno-psychological and historical characteristics because it is a relatively small region which has been the intersection of various cultures and civilizations. In this research the concept is analysed from the psychomedical point of view. As deboleza does not have the status of an illness, it functions as a culture-bound syndrome which, because of its emotional expressions, belongs to the 'shame' family. This interesting construct should be thoroughly studied not only in a peculiar and dynamic Croatian culture and in Croatian psychiatry, but also within European culture and psychiatry.

Prevalence of psychiatric morbidity in the adult population of a rural South African village.

We report on the first South African two-stage community prevalence study of psychiatric morbidity, conducted in Mamre, a rural "coloured' village, 50 km from Cape Town. Randomly selected adults (N = 481) were assessed using the Self-Reporting Questionnaire (SRQ) as a first-stage screen and the Present State Examination (PSE-9) was administered to a proportion of the sample (N = 121) as the second-stage criterion. Demographic, health care utilization, and substance abuse data were also collected. Using the PSE-9 CATEGO Index of Definition of 5, the weighted prevalence of psychiatric morbidity was 27.1% (confidence interval of 19.5-34.7%), the majority of cases being given a tentative diagnosis of depressive or anxiety disorder. The CATEGO algorithm may not be fully appropriate in this cultural context as there was an apparent over-diagnosis of paranoid states. The SRQ's weighted sensitivity and specificity were 0.49 and 0.82 respectively. Overall, the SRQ correctly identified 67% of cases and non-cases. No demographic variables predicted psychiatric morbidity, but there was an indirect link between morbidity and primary care utilization. Further South African studies of the validity of both the SRQ and of criterion instruments are needed. These may contribute to knowledge regarding cultural factors affecting psychiatric diagnosis.