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      Testing the Continuum of Delusional Beliefs : An Experimental Study Using Virtual Reality

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          Abstract

          A key problem in studying a hypothesized spectrum of severity of delusional ideation is determining that ideas are unfounded. The first objective was to use virtual reality to validate groups of individuals with low, moderate, and high levels of unfounded persecutory ideation. The second objective was to investigate, drawing upon a cognitive model of persecutory delusions, whether clinical and nonclinical paranoia are associated with similar causal factors. Three groups (low paranoia, high nonclinical paranoia, persecutory delusions) of 30 participants were recruited. Levels of paranoia were tested using virtual reality. The groups were compared on assessments of anxiety, worry, interpersonal sensitivity, depression, anomalous perceptual experiences, reasoning, and history of traumatic events. Virtual reality was found to cause no side effects. Persecutory ideation in virtual reality significantly differed across the groups. For the clear majority of the theoretical factors there were dose–response relationships with levels of paranoia. This is consistent with the idea of a spectrum of paranoia in the general population. Persecutory ideation is clearly present outside of clinical groups and there is consistency across the paranoia spectrum in associations with important theoretical variables.

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          Most cited references23

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          Development and validation of the Penn State Worry Questionnaire.

          The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.
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            Strauss (1969) revisited: a psychosis continuum in the general population?

            Although dichotomously defined for clinical purposes, psychosis may exist as a continuous phenotype in nature. A random sample of 7076 men and women aged 18-64years were interviewed by trained lay interviewers with the Composite International Diagnostic Interview (CIDI). Those with evidence of psychosis according to the CIDI were additionally interviewed by psychiatrists. For the 17 CIDI core psychosis items, we compared a psychiatrist's rating of hallucinations and/or delusions (Clinical Psychosis; sample prevalence 4.2%) with three other possible positive CIDI ratings of the same items: (i) symptom present, but not clinically relevant (NCR Symptom; sample prevalence 12.9%); (ii) symptom present, but the result of drugs or somatic disorder (Secondary Symptom; sample prevalence 0.6%); (iii) symptom appears present, but there is a plausible explanation (Plausible Symptom; sample prevalence 4.0%). Of the 1237 individuals with any type of positive psychosis rating (sample prevalence 17.5%), only 26 (2.1%) had a DSM-III-R diagnosis of non-affective psychosis. All the different types of psychosis ratings were strongly associated with the presence of psychiatrist-rated Clinical Psychosis (NCR Symptom: OR=3.4; 95% CI: 2.9-3.9; Secondary Symptom: OR=4.5; 95% CI: 2.7-7.7; Plausible Symptom: OR=5.8; 95% CI: 4.7-7.1). Associations with lower age, single marital status, urban dwelling, lower level of education, lower quality of life, depressive symptoms and blunting of affect did not differ qualitatively as a function of type of rating of the psychotic symptom, were similar in individuals with and without any CIDI lifetime diagnosis, and closely resembled those previously reported for schizophrenia. Presence of any rating of hallucinations was strongly associated with any rating of delusions (OR=6.7; 95% CI: 5.6-8.1), regardless of presence of any CIDI lifetime diagnosis. The observation by Strauss (1969. Hallucinations and delusions as points on continua function. Arch. Gen. Psychiatry 21, 581-586) that dichotomously diagnosed psychotic symptoms in clinical samples are, in fact, part of a continuum of experiences, may also apply to the general population. The boundaries of the psychosis phenotype may extend beyond the clinical concept of schizophrenia.
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              Children's self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study.

              Childhood risk factors for the development of adult schizophrenia have proved to have only modest and nonspecific effects, and most seem unrelated to the adult phenotype. We report the first direct examination of the longitudinal relationship between psychotic symptoms in childhood and adulthood. We analyzed prospective data from a birth cohort (N = 761), in which children were asked about delusional beliefs and hallucinatory experiences at age 11 years, and then followed up to age 26 years. Structured diagnostic interviews were employed at both ages and self-report of schizophreniform symptoms was augmented by other data sources at age 26 years. Self-reported psychotic symptoms at age 11 years predicted a very high risk of a schizophreniform diagnosis at age 26 years (odds ratio, 16.4; 95% confidence interval, 3.9-67.8). In terms of attributable risk, 42% of the age-26 schizophreniform cases in the cohort had reported 1 or more psychotic symptoms at age 11 years. Age-11 psychotic symptoms did not predict mania or depression at age 26 years, suggesting specificity of prediction to schizophreniform disorder. The link between child and adult psychotic symptoms was not simply the result of general childhood psychopathology. These findings provide the first evidence for continuity of psychotic symptoms from childhood to adulthood.
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                Author and article information

                Journal
                J Abnorm Psychol
                Journal of Abnormal Psychology
                American Psychological Association
                0021-843X
                1939-1846
                February 2010
                : 119
                : 1
                : 83-92
                Affiliations
                [1 ]Department of Psychology, Institute of Psychiatry, King’s College London, England
                [2 ]Department of Computer Science, University College London, England
                [3 ]Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Barcelona, Spain
                Author notes
                Correspondence concerning this article should be addressed to Daniel Freeman, Department of Psychology, PO Box 077, Institute of Psychiatry, King’s College London, Denmark Hill, London SE5 8AF, England E-mail: Daniel.Freeman@ 123456kcl.ac.uk
                Article
                abn_119_1_83 2010-02209-024
                10.1037/a0017514
                2834573
                20141245
                ea858a37-1941-448a-af47-a2f2ad7a6cb3
                © 2010 American Psychological Association.

                This article, manuscript, or document is copyrighted by the American Psychological Association (APA). For non-commercial, education and research purposes, users may access, download, copy, display, and redistribute this article or manuscript as well as adapt, translate, or data and text mine the content contained in this document. For any such use of this document, appropriate attribution or bibliographic citation must be given. Users should not delete any copyright notices or disclaimers. For more information or to obtain permission beyond that granted here, visit http://www.apa.org/about/copyright.html.

                History
                : 16 February 2009
                : 23 July 2009
                : 28 July 2009
                Categories
                Psychotic Disorders

                Clinical Psychology & Psychiatry
                delusions,cognitive,paranoia,schizophrenia,continuum
                Clinical Psychology & Psychiatry
                delusions, cognitive, paranoia, schizophrenia, continuum

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