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One Schema Fits All? Transdiagnostical Comparison Of Schema Expression And Association Of Schemata To Paranoid Ideation

1165 words - 5 pages

Introduction
Schemata can be defined as condensation of experience in an internal working model of the self, other and the world. The schema concept has been successfully applied to a great variety of psychiatric disorders (lit). To a much lesser degree the schema construct has been applied to psychotic disorders. As paranoid ideation is by far the most common theme of delusion in psychotic disorders [1] it would be useful to gain more insight into the contribution of schemata to the development of paranoid ideation. In the last two decades cognitive models have been developed that predict that negative cognitive schemata are involved in the formation and maintenance of persecutory delusion ...view middle of the document...

From these publications there is evidence that persons with chronic psychosis [8] and persecutory delusion [13] hold extreme negative schematic beliefs about themselves and others compared to non-clinical controls. Participants did not differ in terms of positive views that they hold about themselves and others. But when the expression of the factor negative self was compared in people with depression or psychosis it proved to be unspecific [14]. Evidence from cross sectional studies showed that paranoia is predicted by high negative beliefs about the self [15] but also high negative beliefs about others [16]. However there is also some evidence for an association of low positive beliefs about others and the self and paranoia [8]. Fowler et al., 2011 [17] presented longitudinal data from the PRP-trial that gives evidence for the causal contribution of negative cognition (operationalized by the author as low self-esteem, self-critical thinking and extreme negative beliefs about the self and others) and depressive mood to paranoia. To our knowledge only Maples et al., 2010 could not find a association of negative self and other evaluations and positive symptoms in a smaller clinical sample with psychotic patients [18].
Beside evidence from clinical data there are also data in persons at clinical high risk of transition to psychosis (CHR). In recent years marked progress in the prediction of psychosis has been made and it is possible to reliable define groups of persons with an increased risk of transition to psychosis [19]. So far two studies have investigated schemata in CHR samples.
First Addington et al., 2010 (n=38) found that negative evaluations others predicted suspiciousness in persons with attenuated positive symptoms [20]. Second Taylor et al., 2013 compared expression of schemata on the BCSS in persons at-risk for psychosis (n=113) to patients with first episode psychosis, help-seeking persons with sub threshold risk criteria (n=28) and person who were not help-seeking with risk symptoms sub and above the threshold (n=30) [21]. They found that expression of negative schemata about the self and others were high in the clinical group and the help-seeking groups with and without at-risk symptoms. In contrast to the non help-seeking group expression of positive self schemas were low in all other groups. Furthermore negative schemas about the self and others were correlated to the at-risk symptoms unusual thought content, non-bizzare ideas, perceptual abnormalities and disorganized speech.
Conclusion about the association of schemas and paranoid ideation in persons at CHR are...

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