Suspiciousness as a specific risk factor for major depressive episodes in schizophrenia (original) (raw)
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Paranoid Delusions in Schizophrenia Spectrum Disorders and Depression
The Journal of Nervous and Mental Disease, 2008
We aimed to identify transdiagnostic psychological processes associated with persecutory delusions. 68 schizophrenia patients, 47 depressed patients and 33 controls were assessed for paranoia, positive and negative self-esteem, estimations of the frequency of negative, neutral and positive events occurring to the self in the past and in the future and similar estimates for events affecting others in the future.
Psychiatry Research, 2009
While it is widely recognized that many with schizophrenia have significant difficulties in correctly identifying the emotions of others, less is known about the causes and correlates of particular forms of misattribution, including mistakenly seeing anger in others. One possibility is that persons with high levels of suspiciousness and low levels of self-esteem are at risk to attribute their poor feelings about themselves to the malice of others. To explore this possibility, we identified 52 persons with a schizophrenia spectrum disorder who made significant numbers of errors on the Bell-Lysaker Emotional Recognition Test. We then performed a cluster analysis based on measures of suspiciousness from the Positive and Negative Syndrome Scale and self-esteem from the Rosenberg Self-Esteem Schedule, and found the following four groups: a) High Suspiciousness/High Self-Esteem; b) Mild Suspiciousness/High Self-Esteem; c) High Suspiciousness/Low Self-Esteem; and d) Minimal Suspiciousness/Low Self-Esteem. Comparisons between groups revealed that as predicted the High Suspiciousness/Low Self-Esteem group made significantly more misattributions of anger than other groups, even when levels of depression were controlled for statistically. Implications for addressing the misattributions of anger in schizophrenia are discussed.
A Critique of the Diagnostic Construct Schizophrenia
Research on Social Work Practice, 2014
This article examines problems in the clinical utility of the diagnosis of schizophrenia including reliance on questionable data, arbitrary criteria and categorization, inadequate precision for assessment and treatment evaluation, and omission of information on causal historical and current environmental factors. Some alternatives to the DSM are briefly considered including continuous recording of individual client’s specific problems and goals, and functional assessments and functional analyses. The paper discusses how biomedical assumptions implicit in the DSM diverts mental health workers’ attention away from social adversity factors contributing to the development of psychotic behavior and available psychosocial interventions for this disorder, thereby helping to perpetuate biomedical dominance of mental health services.
Psychiatria Danubina, 2014
The aim of this study was to investigate the influence of certain psychosocial factors - insight, psycho-education, family and social support, loneliness and social isolation - on the appearance of depression and suicidal risk in schizophrenia. This was a cross-sectional study that comprised hospitalized patients with schizophrenia in the initial remission phase. The assessment of depression and suicidal risk was made by applying a semi-structured psychiatric interview that included scrutinized factors (insight, psycho-education, family and social support, loneliness and social isolation), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale for Schizophrenia (CDSS). On the basis of the assessment results, the sample was divided into two groups: Group of patients with depression and suicidal risk in schizophrenia (N = 53) and Control group (N = 159) of patients with schizophrenia without depression and suicidal risk. In the Group of patients with depression and...
Suicide Risk in Schizophrenia: An Analysis of 17 Consecutive Suicides
Schizophrenia Bulletin, 1999
The aim of this study was to investigate interactional factors related to the recognition of suicide risk in patients with schizophrenia. The study focused on 17 schizophrenia patients who had committed suicide during the National Suicide Prevention Project in Finland between April 1,1987, and March 31,1988, in the province of Kuopio. Consensus case reports were assembled by using the psychological autopsy method. Study methods included structured and in-depth interviews of next of kin and interviews of health care or social services workers who had treated the suicide victims. Male and female patients with schizophrenia committed suicide in equal proportions. Most had suffered from schizophrenia for more than 15 years; all but one had been receiving psychiatric treatment at the time of suicide. Retrospective assessment indicated that 59 percent of the patients were clinically depressed at the time of suicide. In 76 percent of the cases, the mental health professionals involved in treatment had not believed that there was a risk of suicide during their last contact with the patient. In 29 percent of the cases, the patient's paranoid ideas concerning treatment personnel had increased. Patients' withdrawal from human relationships because of depression was related to loss of the treatment professionals' concern for the patients. The findings in this descriptive study suggest that withdrawal by a patient with schizophrenia and an increase in the patient's paranoid behavior should be regarded as signals of risk of suicide.
Reliability of clinical ICD-10 schizophrenia diagnoses
Nordic Journal of Psychiatry, 2005
We aimed to describe the diagnostic patterns preceding and following the onset of schizophrenia diagnoses in outpatient clinics. A large clinical sample of 26,163 patients with a diagnosis of schizophrenia in at least one outpatient visit was investigated. We applied a Continuous Time Hidden Markov Model to describe the probability of transition from other diagnoses to schizophrenia considering time proximity. Although the most frequent diagnoses before schizophrenia were anxiety and mood disorders, direct transitions to schizophrenia usually came from psychotic-spectrum disorders. The initial diagnosis of schizophrenia was not likely to change for two of every three patients if it was confirmed some months after its onset. When not confirmed, the most frequent alternative diagnoses were personality, affective or non-schizophrenia psychotic disorders. Misdiagnosis or comorbidity with affective, anxiety and personality disorders are frequent before and after the diagnosis of schizophrenia. Our findings give partial support to a dimensional view of schizophrenia and emphasize the need for longitudinal assessment. Schizophrenia and schizoaffective disorder have a lifetime prevalence of about 1% and are among the leading causes of disability 1-5. Due to its early onset and its deteriorating course, schizophrenia causes an immense economic burden. A large majority of patients with schizophrenia are unemployed, and impairments in functioning across social, vocational and residential domains remain severe even during periods of remission from active psychosis 6-10 , resulting in costs estimated at 62billionintheUSin2002andincreasingthreetimesitsvalueadecadelater.Theeconomicburdenofschizophreniaisestimatedat62 billion in the US in 2002 and increasing three times its value a decade later. The economic burden of schizophrenia is estimated at 62billionintheUSin2002andincreasingthreetimesitsvalueadecadelater.Theeconomicburdenofschizophreniaisestimatedat155.7 billion for 2013 including excess direct health care costs of $37.7 billion 11,12. Approximately 80% of patients with schizophrenia relapse within 5 years of the first episode and many do not fully recover 13. Moreover, the cognitive deficits and lack of insight that are core features of schizophrenia impair the patients' ability to recognize their disability or the symptoms that precede a relapse 14. The disorder is therefore a permanent source of anguish for patients and their families and is associated with an increased risk for suicide and general medical conditions 3,15. Although significant advances have been made in the understanding of the illness during the last 130 years (since Kraepelin's original classification in 1887) the underpinnings of its etiology remain unknown. There are no biomarkers that could be regularly used in clinical practice for the diagnosis of schizophrenia 16,17. Schizophrenia is also a very heterogeneous illness, as originally described by Bleuler in 1911 and later confirmed in several studies 18,19. Thus, longitudinal validation provides one of the most direct evidences of diagnostic validity 20 .