Biomedical subjects

Richard P Bentall

Publications and source records attributed to Richard P Bentall.

At least 19 recordsLinked to original sources

PubMed2006

Response styles to depressed mood in bipolar affective disorder.

BACKGROUND: It has been hypothesised that dysfunctional strategies for avoiding depression play an important role in the pathway to mania. Support for this hypothesis comes from studies demonstrating that remitted and manic bipolar patients show similar cognitive biases to currently depressed patients. METHOD: Manic patients, depressed bipolar patients, remitted bipolar patients and healthy controls were compared on an expanded version of Nolen-Hoeksema's [Nolen-Hoeksema, S., 1991. Responses to depression and their effects on the duration of depressed mood. Journal of Abnormal Psychology, 100, 569-582.] Response Styles Questionnaire, measuring strategies for coping with depression. RESULTS: Manic patients reported greater use of active-coping and risk-taking compared to the depressed, remitted and healthy controls. Bipolar remitted patients reported greater rumination. CONCLUSIONS: The findings are consistent with the hypothesis that mania is associated with dysfunctional strategies for regulating negative emotion.

Adaptation, Psychological↗

PubMed2006

Three-year follow-up of a randomized controlled trial of cognitive therapy for the prevention of psychosis in people at ultrahigh risk.

There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis. A randomized controlled trial compared cognitive therapy (CT) over 6 months with monthly monitoring in 58 patients meeting criteria for ultrahigh risk of developing a first episode of psychosis. Participants were followed up over a 3-year period. Logistic regression demonstrated that CT significantly reduced likelihood of being prescribed antipsychotic medication over a 3-year period, but it did not affect transition to psychosis defined using the Positive and Negative Syndrome Scale (PANSS) or probable Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis. However, exploratory analyses revealed that CT significantly reduced the likelihood of making progression to psychosis as defined on the PANSS over 3 years after controlling for baseline cognitive factors. Follow-up rate at 3 years was 47%. There appear to be enduring benefits of CT over the long term, suggesting that it is an efficacious intervention for people at high risk of developing psychosis.

Adolescent↗

PubMed2006

Psychological factors in people at ultra-high risk of psychosis: comparisons with non-patients and associations with symptoms.

BACKGROUND: There have been recent advances in the ability to identify people at high risk of developing psychosis. This has led to interest in the possibility of preventing the development of psychosis and provides the opportunity to investigate psychological mechanisms that may confer vulnerability to psychosis. METHOD: Fifty-eight patients at ultra-high risk of developing a first episode of psychosis were compared with 56 non-patients matched for age and occupational status on measures of meta-cognition, schizotypal traits, dysfunctional attitudes and distress. RESULTS: Analyses of covariance revealed that people at high risk of developing psychosis scored higher on measures of cognitive vulnerability, including negative meta-cognitive beliefs, beliefs about rejection and criticism from others, and discrepancies in self-perception, schizotypal traits and general mental distress. Correlational analyses revealed that negative meta-cognitive beliefs, dysfunctional attitudes and beliefs about rejection and criticism from others were positively associated with several dimensions of symptomatology in at-risk mental states (ARMS) patients. CONCLUSIONS: Cognitive and personality factors appear to characterize people at high-risk of developing psychosis and are associated with their distressing experiences. The clinical implications of these findings are discussed.

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

Psychological processes and paranoia: implications for forensic behavioural science.

Paranoid delusions have recently become the focus of empirical research. In this article, we review studies of the psychological mechanisms that might be involved in paranoid thinking and discuss their implications for forensic behaviour science. Paranoia has not been consistently associated with any specific neuropsychological abnormality. However, evidence supports three broad types of mechanism that might be involved in delusional thinking in general and paranoia in particular: anomalous perceptual experiences, abnormal reasoning, and motivational factors. There is some evidence that paranoia may be associated with hearing loss, and good evidence that paranoid patients attend excessively to threatening information. Although general reasoning ability seems to be unaffected, there is strong evidence that a jumping- to-conclusions style of reasoning about data is implicated in delusions in general, but less consistent evidence specifically linking paranoia to impaired theory of mind. Finally, there appears to be a strong association between paranoia and negative self-esteem, and some evidence that attempts to protect self-esteem by attributing negative events to external causes are implicated. Some of these processes have recently been implicated in violent behaviour, and they therefore have the potential to explain the apparent association between paranoid delusions and offending.

Cognition Disorders↗

PubMed2006

'Poor me' versus 'bad me' paranoia and the instability of persecutory ideation.

OBJECTIVES: To investigate whether there are two stable types of paranoia, 'poor me' and 'bad me', as described by Trower and Chadwick (1995), and whether beliefs about the deservedness of persecution are associated with psychological measures. METHODS: In-patients experiencing persecutory delusions were assigned either to 'poor me' (PM) or 'bad me'(BM) groups, according to their rating of a perceived deservedness scale, which was repeated on subsequent assessments. Participants were assessed for depression (BDI); construction of the self (Self-to-Others Scale); autonomy and sociotropy (PSI); perceived parental behaviour (PBI); attributional style (ASQ) and, meaningful daily events (DEI, devised for the study). A healthy control group was also assessed. RESULTS: Many patients' perceived deservedness of persecution varied across time, so that some patients were PM at one point in time but BM at another. BM paranoia was associated with high levels of depression. PM and BM patients groups both scored higher than the controls on the subscales of Self-to-Others Scale and on the PSI. PM patients exhibited a marked self-serving bias on the ASQ, and reported less parental care on the PSI, compared to the BM patients. Both groups reported less PBI mother care than the controls. BM patients reported more failure events than PM patients or controls. PM patients reported more loss of control events than the than BM patients and controls. CONCLUSIONS: PM and BM paranoia may represent separate phases of an unstable phenomenon. The findings are consistent with an attributional account of paranoid thinking.

Adult↗

PubMed2005

Attitudes toward antipsychotic medication: the impact of clinical variables and relationships with health professionals.

CONTEXT: Nonadherence to antipsychotic medication is a major cause of psychotic relapse and is strongly influenced by attitudes toward treatment. Although patient variables such as insight and symptoms that contribute toward attitudes have been identified, the contributions of relationship and service factors have not been adequately studied. OBJECTIVE: To determine relations between clinical and service variables and attitudes toward medication in people with a diagnosis of schizophrenia and schizoaffective disorder. DESIGN: Consecutively admitted patients were approached to take part; 23 refused. Measures included symptoms, insight, drug adverse effects, self-reported adherence, attitudes toward treatment, perceived relationship with the prescriber, ward atmosphere, and admission experience. Data were analyzed by a proportional odds model and structural equation modeling to test predicted paths between experience of admission, relationship variables, attitudes toward treatment, and self-reported adherence to medication. SETTING: Twenty-eight inpatient wards at 8 hospitals in North Wales and the Northwest of England. Sites included hospitals with inner-city and rural catchment areas. Patients Two hundred twenty-eight patients meeting DSM-IV criteria for schizophrenia or schizoaffective disorder, assessed during acute admission. MAIN OUTCOME MEASURES: Attitudes toward treatment and self-reported adherence to medication. RESULTS: The data fit a model in which attitudes toward treatment were predicted by insight, relationship with staff (especially the physician-prescriber), and the patient's admission experience (maximum likelihood chi(2)(49) = 89.3, P<.001). A poor relationship with the prescriber, experience of coercion during admission, and low insight predicted a negative attitude toward treatment. CONCLUSIONS: The quality of relationships with clinicians during acute admission appears to be an important determinant of patients' attitudes toward treatment and adherence to medication. Enhancing such relationships may yield important clinical benefits.

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↗

PubMed2005

Attributional lability in depression and paranoia.

BACKGROUND: Attributions play an important role in depression and paranoia. However, contrary to most attributional models of psychopathology, there is evidence that attributional style is not a stable trait but is affected by recent experiences. METHOD: Paranoid, depressed, and healthy participants were exposed to a mild stressor in the form of the requirement to complete an anagram task, which included insoluble items. Before and afterwards, they completed measures of attributional style for negative events and a contingency judgment task. RESULTS: Replicating previous findings, paranoid patients initially showed low internality scores for negative events and high judgments of control on the contingency judgment task, whereas the depressed participants showed high internality for negative events and low judgments of control. Following the anagram task, both clinical groups showed increased internality for hypothetical negative events. The paranoid participants also gave increased estimates of control on the contingency judgment task. CONCLUSIONS: Attributional style is more labile in paranoid and depressed patients than in healthy individuals. Implications for attributional theories of psychopathology are discussed.

Adult↗

PubMed2004

Persecutory beliefs, attributions and theory of mind: comparison of patients with paranoid delusions, Asperger's syndrome and healthy controls.

Schizophrenia patients with persecutory delusions and patients with Asperger's syndrome were compared using two measures of theory of mind (ToM; the ability to infer mental states in other people), the Hints task, and the Reading the Mind in the Eyes task, and a new measure of attributional style (style of inferring the causes of important events), the Attributional Style Structured Interview (ASSI). Paranoid beliefs were measured using Fenigstien and Vanable's Paranoia Scale (PS). The deluded group had the highest scores on the Paranoia Scale but the scores of the Asperger's group's were higher than those of the controls. Paranoid patients made more external-personal attributions for negative events than the Asperger's and control groups. Both the paranoid and Asperger's groups performed poorly on the ToM tasks compared to the controls. The findings support the hypothesis that both ToM and attributional abnormalities contribute to paranoid delusions. The lack of attributional abnormalities in the Asperger's group suggests that their low-level paranoid symptoms arise as a consequence of different mechanisms than those involved in psychotic delusions.

Adult↗

PubMed2004

Patient education to encourage graded exercise in chronic fatigue syndrome. 2-year follow-up of randomised controlled trial.

BACKGROUND: An earlier trial demonstrated good outcomes after 1 year for patients with chronic fatigue syndrome (CFS) who received an educational intervention designed to encourage graded activity. AIMS: To determine 2-year outcomes for the same treated patients and the response to treatment of patients formerly in the control condition. METHOD: Patients in the treatment groups (n=114) were followed up at 2 years; 32 patients from the control group were offered the intervention after 1 year and were assessed 1 year later. Assessments were the self-rated measures used in the original trial. RESULTS: At 2 years 63 of the treated patients (55%) no longer fulfilled trial criteria for CFS compared with 64 patients (56%) at 1 year. Fourteen of 30 crossover patients (47%) achieved a good outcome at 1 year and seven (23%) no longer fulfilled criteria for CFS. CONCLUSIONS: Benefits of the intervention were maintained at 2 years. Delaying treatment is associated with reduced efficacy and required more intensive therapy.

Analysis of Variance↗

PubMed2004

Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomised controlled trial.

BACKGROUND: Advances in the ability to identify people at high risk of developing psychosis have generated interest in the possibility of preventing psychosis. AIMS: To evaluate the efficacy of cognitive therapy for the prevention of transition to psychosis. METHOD: A randomised controlled trial compared cognitive therapy with treatment as usual in 58 patients at ultra-high risk of developing a first episode of psychosis. Therapy was provided over 6 months, and all patients were monitored on a monthly basis for 12 months. RESULTS: Logistic regression demonstrated that cognitive therapy significantly reduced the likelihood of making progression to psychosis as defined on the Positive and Negative Syndrome Scale over 12 months. In addition, it significantly reduced the likelihood of being prescribed antipsychotic medication and of meeting criteria for a DSM-IV diagnosis of a psychotic disorder. Analysis of covariance showed that the intervention also significantly improved positive symptoms of psychosis in this population over the 12-month period CONCLUSIONS: Cognitive therapy appears to be an acceptable and efficacious intervention for people at high risk of developing psychosis.

Adolescent↗

PubMed2004

Delusional discourse: an investigation comparing the spontaneous causal attributions of paranoid and non-paranoid individuals.

Research into the nature of attributional reasoning in paranoia has for the most part been restricted to questionnaire-based approaches. This fails to address the issue of whether a distinctive attributional style underpins the everyday talk of paranoid individuals. This study aimed to investigate whether attributional models of paranoid delusions applied to spontaneous attributions generated in the discourse of 12 paranoid and 12 non-paranoid speakers. Causal attributions for negative and positive life experiences were extracted from interview transcripts and rated using the Content Analysis of Verbatim Explanations (CAVE) technique. It was found that, as a proportion, paranoids made more attributions for negative events that were of an external-personal, stable and global nature (as attributional models would predict). They also made significantly more external-personal attributions for negative events and, in one of two datasets, showed a more external mean CAVE rating for negative events than the non-paranoid controls. This paper highlights important issues underlying the extraction of attributions from paranoid talk, and discusses the implications for attributional models of paranoia and future discourse-based research in this area.

Adult↗

PubMed2003

Patients' understanding and participation in a trial designed to improve the management of anti-psychotic medication: a qualitative study.

BACKGROUND: Combining qualitative methods alongside randomised controlled trials in the health field has been advocated but has only been used rarely in mental health services research. The aim of this study was to illuminate patients' understanding of the nature and purpose and outcomes of a trial designed to improve the management of neuroleptic medication. METHODS: Qualitative interviews were carried out with a group of patients participating in a trial comparing a psycho-educational and therapeutic alliance intervention in managing anti-psychotic medication. RESULTS: Our findings highlighted aspects of the experience, process and outcome of the trial, which remain latent in the quantitative assessment. The issue of enlarged selfefficacy emerging when patients were involved in communications with professionals in the trial was important. Whilst the participants provided positive feedback about their involvement in the trial, they struggled to recall the details of the intervention to which they had been exposed. Patients did not readily identify the content and concepts characterising each condition; rather they prioritised the opportunity for communication and contact with the researchers. CONCLUSIONS: Qualitative research accompanying trials illuminates and adds to the quantitative outcomes. The key to interpreting participants' accounts of the process and outcomes of this trial suggests the need to give greater emphasis to participants' past and current experience of service contact.

Adolescent↗

PubMed2003

Theory of mind deficits in bipolar affective disorder.

BACKGROUND: Bipolar affective disorder patients often show cognitive deficits that are similar to those found in schizophrenia patients. Theory of mind (the ability to understand others' mental states) is compromised in currently ill schizophrenia patients. This study aimed to establish whether similar deficits are found in bipolar patients. METHODS: We measured theory of mind ability in 20 bipolar-manic patients, 15 bipolar-depressed patients, 13 bipolar patients in remission and 15 normal controls. The task, which controlled for memory and comprehension, had previously been used in a study of schizophrenia patients. RESULTS: Impaired performance on theory of mind was found for both bipolar-depressed and bipolar-manic patients, even when memory was controlled for. No impairment was observed in the remitted patients. LIMITATIONS: The manic patients scored lower than the remitted patients on a brief measure of intelligence; no other group differences in IQ were significant. CONCLUSIONS: Theory of mind deficits are found in currently symptomatic bipolar patients. These findings add to growing evidence that common mechanisms may contribute to bipolar affective disorder and schizophrenia.

Adult↗

PubMed2003

Predicting postdischarge opiate abstinence from admission measures of motivation and confidence.

Admission scores from a model comprising 3 motivation factors concerning the cessation of heroin use and a confidence scale concerning postdischarge abstinence were tested for their ability to predict postdischarge outcomes in patients beginning inpatient opiate detoxification. Statistically significant prediction of abstinence from heroin 30 days after discharge and the number of heroin-free days in the 3 months following admission was based on the confidence scale and a factor concerned with externally imposed constraints on continued heroin use. The single-scale confidence measure made the largest contribution to each prediction, indicating that such scales may be potentially useful outcome predictors for postdischarge abstinence. External constraints on heroin use may not provide a basis for success in this treatment modality.

Adult↗

PubMed2003

Attention, theory of mind, and causal attributions in people with persecutory delusions: A preliminary investigation.

INTRODUCTION: Abnormal attributions and deficits in theory of mind (ToM) skills have been implicated in paranoid delusions. Bentall and Kinderman (1998) have proposed that ToM deficits tend to prevent individuals from making situational attributions and therefore increase the probability of external-personal attributions, which in turn lead to paranoid beliefs. They further suggested that more fundamental information-processing deficits, by affecting theory of mind skills, increase the probability of paranoid attributions. METHODS: Relationships between attention, ToM and attributions were assessed in acute and remitted paranoid patients and normal controls. Participants performed the digit span with distraction task, false belief and deception tasks, and a measure of attributional style. RESULTS: Compared to the controls, acute patients were distractible, performed poorly on ToM, and made more attributions that were judged external-personal by independent raters (but not as judged by self-ratings). ToM scores predicted the number of external-personal attributions as expected, but the effect of distraction on ToM was equivocal. CONCLUSIONS: Preliminary support was found for the hypotheses, but further studies are required using a range of executive, attentional, ToM, and attribution measures.

Journal Article↗

PubMed2003

Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation.

BACKGROUND: Strong evidence exists for an association between childhood trauma, particularly childhood sexual abuse, and hallucinations in schizophrenia. Hallucinations are also well-documented symptoms in people with bipolar affective disorder. AIMS: To investigate the relationship between childhood sexual abuse and other childhood traumas and hallucinations in people with bipolar affective disorder. METHOD: A sample of 96 participants was drawn from the Medical Research Council multi-centre trial of cognitive-behavioural therapy for bipolar affective disorder. The trial therapists recorded spontaneous reports of childhood sexual abuse made during the course of therapy. Symptom data were collected by trained research assistants masked to the hypothesis. RESULTS: A significant association was found between those reporting general trauma (n=38) and auditory hallucinations. A highly significant association was found between those reporting childhood sexual abuse (n=15) and auditory hallucinations. CONCLUSIONS: The relationship between childhood sexual abuse and hallucinations in bipolar disorder warrants further investigation.

Adult↗