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Are we jumping to conclusions in our understanding of psychosis?

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firemonkee57

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Mar 23, 2009
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I came across an unusual paper recently entitled ‘misattributing speech and jumping to conclusions: A longitudinal study in people at high risk of psychosis’ (Winton-Brown et al, 2015). I thought ‘I misattribute speech and jump to conclusions all the time!’ On a more serious note, I am working on a project looking at interventions to help with the self-management of early onset psychosis, so I thought there might be some helpful insights.

Cognitive models of psychosis propose that psychotic symptoms can be the result of poor processing of vague or unclear stimuli (Garety et al, 2007). In particular a key contributing factor is the tendency to use less information to form a decision or jumping to conclusions (Garety et al, 1991).

From my own experience I remember a patient of mine who had schizophrenia. He was a very bright, polite, thin young man in his 20s, always dressed in mismatched colourful clothes. He tended to wear a few more layers than the weather required. He would sit on the edge of the chair giving the impression of a bird ready to take flight. I would normally see him once a week in the ward review. I would have informal chats with him in corridors or out on the street when he was on leave. One day I wanted to discuss some blood test results with him and I invited him to see me in my office. His face paled and he looked extremely worried. ‘You are going to cancel my leave!’ he blurted out. I tried to calm him down and reassure him, but he bolted out of the office before I got the chance. Down the corridor I heard one of the nurses talking him down. Five minutes later he was trying to jump the garden fence convinced that he would never be able to leave hospital. I remember being very surprised as to how that misunderstanding developed so rapidly and had such a great influence on his behaviour. Are those cognitive deficits then something that fundamentally defines the illness?

Research shows that, at presentation, people with at risk mental states have both a tendency to jump to conclusions and problems with verbal self-monitoring. Verbal self-monitoring is determined by presented distorted speech to the individual and asking her or him to make judgements as to whether the speech came from them or from others. People with at risk mental states tend to think their own distorted speech comes from other people rather than themselves (Broome et al, 2007).


Jumping to conclusions in our understanding of psychosis?


The conclusion suggesting the need to pay more attention to anxiety in psychosis is interesting.
 
Kerome

Kerome

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Sep 29, 2013
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I would largely agree actually, I've always been very good at pattern recognition from scarce data, it's one of the reasons I was a good computer code architect. Close self observation during my psychosis led me to believe that that talent was one of the things giving me trouble, even though I tried hard to approach each idea or leap "scientifically" and test it.

From the point of view of paying more attention to anxiety in early treatment of psychosis, that's what they do in the Open Dialogue system as well, the first treatment they give is for anxiety and not anti-psychotics as is more common in the USA.

Interesting article.
 
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vimes

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Jan 4, 2015
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uk
The conclusion is that the hypothesis needs far more research
Conclusion
For me this was a fairly disappointing paper. I understand that it is very hard to find a sample of individuals with at risk mental states that one can reliably follow up for a sufficiently long time, but greater efforts could have been made to find other researchers with similar services to increase that sample size. I do not think I can use anything in this paper to help me decide if I should be worried or not about my patient who immediately thought I was cancelling his leave.
I think I may have learned to pay a lot more attention to symptoms of anxiety in people at risk of psychosis, even though the experiment the authors described was not designed to answer that particular question. Perhaps a better line of research would be exactly that, should we pay a lot more attention to anxiety in psychosis and if we do treat it robustly will we achieve better functional outcomes at follow up?
- See more at: Jumping to conclusions in our understanding of psychosis?
 
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