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25-05-2010 | Mental health | Article

Paranoid tendencies may evolve in prodromal phase of schizophrenia


Free abstract

MedWire News: Patients with a first episode of psychosis (FEP) and those considered to be at ultra-high risk (UHR) for psychosis show an attribution bias towards perceived hostility in others, study results show.

Study co-author Eun Lee (Yonsei University College of Medicine, Seoul, South \Korea) and colleagues say their findings suggest that paranoid tendencies “may already have evolved prior to the onset of frank psychotic symptoms in schizophrenia.”

Most people attribute positive events to themselves (internal attribution) and blame failures or other threats on external factors (external attribution) – a mechanism for maintaining self-esteem.

Schizophrenia patients often exhibit a personalizing bias in which they tend to blame other people rather than situations for negative events.

In the current study the researchers were interested to find out if attribution style might also play a pivotal role in the paranoia process of schizophrenia during the first psychotic episode and/or prodromal phase.

They recruited 39 mentally healthy controls, 20 patients with a FEP, and 24 individuals who were considered UHR for psychosis based on the Structured Interview for Prodromal Syndromes criteria (which predicts psychosis with probability of 16–35% within 2 years).

Participants completed the Ambiguous Intentions Hostility Questionnaire (AIHQ), in addition to the Paranoia Scale (PS), and the Positive and Negative Syndrome Scale (PANSS).

The researchers found that both UHR individuals and FEP patients exhibited a significantly higher hostility bias on the AIHQ than the mentally healthy controls. For the composite blame bias, UHR patients scored significantly higher than both the controls and the FEP patients, while the FEP patients did not differ significantly from the controls.

Among UHR individuals and FEP patients, perceived hostility bias and blame bias significantly correlated with the paranoia score of the PS and the suspiciousness/persecution item score of the PANSS.

Notably, UHR participants showed significantly less aggression bias on the AIHQ than the controls and FEP patients, while the FEP patients did not show a significant difference from controls.

Lee and colleagues say this withdrawal tendency of individuals in the prodromal phase may be an “important factor in transitioning UHR people into the frank psychotic world.”

They add in the journal Schizophrenia Research: “If this explanation is correct, therapeutic interventions should educate and encourage UHR people to respond benignly; such as, to enquire the reason of other person's responded behavior to the negative ambiguous situation.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Andrew Czyzewski

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