Biomedical subjects

Peter Kinderman

Publications and source records attributed to Peter Kinderman.

12 recordsLinked to original sources

PubMed2006

Illness beliefs in schizophrenia.

Beliefs about health and illness shape emotional responses to illness, health-related behaviour and relationships with health-care providers in physical illness. Researchers are beginning to study the illness beliefs of people with psychosis, primarily using models developed in relation to physical illness. It is likely that modifications to these models will be necessary if they are to apply to mental disorders, and it is probable that some of the assumptions underlying the models will be inappropriate. In particular, different dimensions of understanding may be present in mental illness in comparison to those identified in physical illness. The present study examines the beliefs of 20 patients in the UK diagnosed with schizophrenia, including 10 currently psychotic inpatients and 10 outpatients in remission, about their experiences, using qualitative interviews and thematic analysis. Patients currently experiencing psychosis did not identify their experiences as separable 'illnesses' and did not have 'illness beliefs'. Patients currently in a period of remission appraised their experiences as distinct from their own normal behaviour, but used conceptual frameworks of understanding that deviated significantly from conventional 'health belief' models. Patients' ways of understanding mental illness did not parallel those described in physical illnesses. Methods for assessing beliefs about mental illness should therefore not be transferred directly from studies of beliefs about physical illness, but should be tailored to the nature of patients' beliefs about mental illness.

Adult↗

PubMed2006

Reasoning under uncertainty: heuristic judgments in patients with persecutory delusions or depression.

OBJECTIVE: The substantial literature examining social reasoning in people with delusions has, to date, neglected the commonest form of decision making in daily life. We address this imbalance by reporting here the findings of the first study to explore heuristic reasoning in people with persecutory delusions. METHOD: People with active or remitted paranoid delusions, depressed and healthy adults performed two novel heuristic reasoning tasks that varied in emotional valence. RESULTS: The findings indicated that people with persecutory delusions displayed biases during heuristic reasoning that were most obvious when reasoning about threatening and positive material. Clear similarities existed between the currently paranoid group and the depressed group in terms of their reasoning about the likelihood of events happening to them, with both groups tending to believe that pleasant things would not happen to them. However, only the currently paranoid group showed an increased tendency to view other people as threatening. CONCLUSION: This study has initiated the exploration of heuristic reasoning in paranoia and depression. The findings have therapeutic utility and future work could focus on the differentiation of paranoia and depression at a cognitive level.

Adult↗

PubMed2006

Misunderstanding the intentions of others: an exploratory study of the cognitive etiology of persecutory delusions in very late-onset schizophrenia-like psychosis.

OBJECTIVE: The objective of this study was to explore the cognitive etiology of persecutory delusion formation and maintenance in very late-onset schizophrenia-like psychosis (SLP). METHOD: Probabilistic reasoning, causal attributional style, and mentalizing ability were examined in 29 patients with SLP, 30 with onset of depression after the age of 60 years and 30 healthy comparison subjects. RESULTS: Patients with SLP made significantly more errors than the healthy comparison group in deception, but not false belief, mentalizing tasks. There were no significant performance differences between groups on the probabilistic reasoning task or the attributional style task. CONCLUSIONS: Mentalizing errors may contribute to the development and maintenance of persecutory delusions in SLP. These patients do not appear to show the wider range of cognitive biases described in deluded patients with schizophrenia with onset in younger adult life.

Age of Onset↗

PubMed2006

Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial.

BACKGROUND: Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. AIMS: To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy (CBT). METHOD: We undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months. RESULTS: More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74-1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. CONCLUSIONS: People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.

Adult↗

PubMed2005

Perceived relationships with parents and paranoid delusions: comparisons of currently ill, remitted and normal participants.

BACKGROUND: Paranoid delusions are associated with abnormal attributions and abnormal beliefs about the self. Some researchers have also reported an association between paranoid beliefs and abnormal attachment representations. SAMPLING AND METHODS: Perceptions of relationships with the family of origin were measured in 14 currently ill paranoid patients, 9 remitted paranoid patients and 15 healthy controls, using two methods: the Parental Bonding Instrument (PBI), and the Relationship with Family of Origin Scale (REFAMOS), an interview-based assessment. RESULTS AND CONCLUSIONS: On the PBI, both currently ill and remitted patients reported low parental care and overprotectiveness during childhood. Similar negative accounts of relationships with parents during the 16-20 years age period, and also at the time of assessment, were elicited from both the ill and remitted patients on the REFAMOS. These findings might reflect the influence of illness on patients' perceptions of their parents. However, the fact that the remitted patients did not differ from the currently ill patients raises the possibility that dysfunctional relationships are a common feature of the history of paranoid patients, perhaps contributing to the development of paranoid thinking.

Adolescent↗

PubMed2005

Self-discrepancies in bipolar disorder: comparison of manic, depressed, remitted and normal participants.

OBJECTIVES: To study the role of self-discrepancies in different phases of bipolar disorder (manic-depression). METHOD AND DESIGN: Patients with a diagnosis of bipolar disorder in three groups, currently depressed, currently manic or hypomanic, and currently in remission, together with healthy control participants, were administered a modified version of Higgins' Selves Questionnaire. Consistencies between the self-actual, self-ideal and self-ought representations were calculated, together with consistencies between the self-actual representation and the believed views of generalized others about the self. RESULTS: In contrast to all other groups, bipolar depressed patients showed marked discrepancies between their self-actual and self-ideal representations, and between their self-actual and self-ought representations. Manic or hypomanic patients showed higher self-actual:self-ideal consistency than non-patient controls. The differences between the depressed participants and the other groups appeared to be accounted for by their very negative self-actual descriptions. Participants in all four groups showed high levels of consistency between self-perceptions and the believed perceptions of others about the self. CONCLUSIONS: These findings confirm that beliefs about the self differ between different phases of bipolar disorder and are consistent with the hypothesis that the manic phase involves active avoidance of discrepancies between the self and self-ideals.

Adult↗

PubMed2004

Cognitive-behavioural therapy in first-episode and early schizophrenia. 18-month follow-up of a randomised controlled trial.

BACKGROUND: The initial phase of a trial of cognitive-behavioural therapy (CBT) for acutely ill patients with schizophrenia of recent onset showed that it speeded recovery. AIMS: To test the hypothesis that CBT in addition to treatment as usual (TAU) during the first or second acute episode of schizophrenia will confer clinical benefit over a follow-up period. METHOD: This was an 18-month follow-up of a multicentre prospective trial of CBT or supportive counselling administered as an adjunct to TAU, compared with TAU alone, for patients hospitalised for an acute episode of schizophrenia of recent onset. Primary outcomes were total and positive symptom scales, time to relapse and re-hospitalisation. RESULTS: There were significant advantages for CBT and supportive counselling over TAU alone on symptom measures at 18 months but no group difference was seen for relapse or re-hospitalisation. There was a significant centre-treatment interaction, reflecting centre differences in the effect of introducing either treatment, but not in the comparison of CBT and supportive counselling. Medication dosage and compliance did not explain group differences. CONCLUSIONS: Adjunctive psychological treatments can have a beneficial long-term effect on symptom reduction.

Acute Disease↗

PubMed2003

Psychopathology and autobiographical memory in stroke and non-stroke hospitalized patients.

BACKGROUND: Psychopathology and autobiographical memory were investigated in a cohort of stroke and non-stroke hospitalized patients. Both these cohorts have been identified as having high levels of psychopathology (Katon and Sullivan 1990; Burvill et al., 1995). Difficulties recalling specific autobiographical memories (overgeneral memory) have been identified as important psychological variables in depression and predictors of outcome (Williams and Scott 1988; Brittlebank et al., 1993). Intrusive autobiographical memories have also been found to be associated with depression and overgeneral memory in depressed women (Kuyken and Brewin, 1995) and depressed cancer patients (Brewin et al., 1998a). This study looked at levels of psychopathology and autobiographical memories in stroke and non-stroke hospital patients. METHOD: 417 patients were screened, of the 176 eligible 103 agreed to participate (54 stroke and 49 non-stroke). Participants were assessed for overgenerality using the Autobiographical Memory Test and intrusiveness of memories using the Impact of Events Scale. Also assessed were PTSD-like symptoms (PCL-S), mood (HADS, GHQ-28) and cognitive ability (MMSE, verbal fluency, digit span and estimated pre-morbid IQ). RESULTS: No significant differences were found between stroke and non-stroke patients on severity of depression, anxiety, severity of PTSD-like symptoms or autobiographical memories. Backward multivariate regression analyses for combined data (stroke and non-stroke) indicated that overgeneral memory recall, intrusive memories of past events and intrusive memories of illness were significant independent predictors of depression (HADS). Avoidance of intrusive memories and reported childhood distress were not predictors of overgeneral memory recall. Significant predictors of overgeneral memory recall were; Gender, antidepressant medication, and estimated IQ. CONCLUSION: Significant levels of psychopathology were identified in this cohort. However, there were no significant differences in the levels of depression, anxiety, PTSD symptoms and autobiographical memory between stroke and non-stroke hospitalized patients. Of particular interest was the finding that PTSD-like symptoms did not appear to be influenced by the nature of the person's illness. In combined data (stroke and non-stroke) autobiographical memories (intrusive images of their illness, intrusive memories of other events and overgeneral memory recall variables) were significant predictors of depression in this cohort. This suggests that psychological intervention of memory processes may be a worthwhile target in psychological intervention for depression in these cohorts. Gender, cognitive impairment, antidepressant medication, and estimated IQ were significant predictors of overgeneral memory recall and further investigation into the validity of these findings are warranted. Suggestions for further research and limitations of the study are also discussed.

Aged↗

PubMed2003

Self-discrepancy in body dysmorphic disorder.

OBJECTIVES: According to self-discrepancy theory (SDT), depression, social anxiety, eating disorders and paranoia result from different types of conflicting self-beliefs. Body dysmorphic disorder (BDD) consists of a preoccupation with imagined or slight defects in one's appearance, which is often associated with a depressed mood and social anxiety. SDT was therefore applied to BDD patients to further understand their beliefs about their appearance. DESIGN: Using a comparative group design, BDD patients were compared against a non-patient control group. METHOD: A sample of 149 participants, consisting of three groups - BDD (72), BDD preoccupied with their weight and shape (35), and controls (42) - completed a modified version of the Selves Questionnaire (Higgins, Bond, Klein, & Strauman, 1986) requiring them to list and rate physical characteristics according to the following standpoints: (a) self-actual; (b) self-ideal; (c) self-should; (d) other-actual; and (e) other-ideal. RESULTS: BDD patients displayed significant discrepancies between their self-actual and both their self-ideal and self-should. However, there were no significant discrepancies in BDD patients between their self-actual and other-actual or other-ideal domains. Analysis of variance using depression and social anxiety scores as covariates revealed a significant difference for both the self-ideal and self-should discrepancy. CONCLUSION: The results suggest that BDD patients have an unrealistic ideal or demand as to how they should look. BDD patients are more like depressed patients (rather than social phobics or bulimics), being more concerned with a failure to achieve their own aesthetic standard than with the perceived ideals of others.

Adolescent↗

PubMed2003

Self-discrepancies, attentional bias and persecutory delusions.

BACKGROUND: Persecutory delusions appear to involve abnormal attentional biases to threat-related information, particularly information related to the self. The present study aimed to investigate attentional biases to different types of perceived threat and changes in self-perception in response to exposure to such threat-related material. METHOD: Discrepancies between actual self, ideal self and perceived others' self-representations were assessed in three groups of participants; 13 people experiencing persecutory delusions, 11 people in a psychiatric comparison group, and 13 in a non-psychiatric comparison group. An adaptation of the emotional Stroop task was then used as an experimental manipulation of attentional bias to five different types of threat (sociotropic, autonomic, physical, ego threats from others, and self-directed ego threats). Self-discrepancies were then again assessed. RESULTS: Before administration of the emotional Stroop task, there were no significant differences between the groups in terms of their self-actual:self-ideal and self-actual:other-actual discrepancies. However, after the administration of the Stroop task, significant differences between the clinical groups were observed, mirroring significant reductions in self-actual:self-ideal discrepancies and significant increases in self-actual:other-actual discrepancies in the paranoid participants. CONCLUSIONS: This paper is novel in repeating the assessment of self-discrepancies after the processing of threat-related information. These findings are consistent with Bentall, Kinderman, and Kaney's (1994) model of paranoid ideation and findings reported by Kinderman and Bentall (2000).

Adult↗

PubMed2002

An analogue study of attributional complexity, theory of mind deficits and paranoia.

Recent research suggests that the tendency of paranoid individuals to attribute negative events to external personal factors and positive events to internal factors may be associated with difficulties in understanding the mental states of others, referred to as theory of mind (ToM). The present study aimed to investigate the relationship of these factors with attributional complexity and motivation. In an analogue sample, a relative ToM impairment was associated with an increased tendency to attribute negative events to external personal factors but not with differences in attributional complexity. This indicates that paranoid tendencies and mentalizing deficits are not associated with attributional simplicity, but may be related to schematic patterns of cognition.

Adolescent↗

PubMedDate not supplied

A psychological model of mental disorder.

A coherent conceptualization of the role of psychological factors is of great importance in understanding mental disorder. Academic articles and professional reports alluding to psychological models of the etiology of mental disorder are becoming increasingly common, and there is evidence of a marked policy shift toward the provision of psychological therapies and interventions. This article discusses the relationship between biological, social, and psychological factors in the causation and treatment of mental disorder. It argues that simple biological reductionism is not scientifically justified, and also that the specific role of psychological processes within the biopsychosocial model requires further elaboration. The biopsychosocial model is usually interpreted as implying that biological, psychological, and social factors are co-equal partners in the etiology of mental disorder. The psychological model of mental disorder presented here suggests that disruption or dysfunction in psychological processes is a final common pathway in the development of mental disorder. These processes include, but are not limited to, cognitive processes. The model proposes that biological and social factors, together with a person's individual experiences, lead to mental disorder through their conjoint effects on those psychological processes. Implications for research, interventions, and policy are discussed.

Brain↗