Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations.
BACKGROUND
The role of emotion in psychosis is being increasingly recognised. Cognitive conceptualisations of psychosis (e.g. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195]) emphasise a central, normal, direct and non-defensive role for negative emotion in the development and maintenance of psychosis. This study tests specific predictions made by Garety et al. [Garety, P.A., Kuipers, E.K., Fowler, D., Freeman, D., Bebbington, P.E., 2001. A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189-195] about the role of emotion and negative evaluative beliefs in psychosis.


METHODS
100 participants who had suffered a recent relapse in psychosis were recruited at baseline for the Prevention of Relapse in Psychosis (PRP) trial. In a cross-sectional analysis, we examined the role of depression, self-esteem and negative evaluative beliefs in relation to specific positive symptoms (persecutory delusions, auditory hallucinations and grandiose delusions) and symptom dimensions (e.g. distress, negative content, pre-occupation and conviction).


RESULTS
Analysis indicated that individuals with more depression and lower self-esteem had auditory hallucinations of greater severity and more intensely negative content, and were more distressed by them. In addition, individuals with more depression, lower self-esteem and more negative evaluations about themselves and others had persecutory delusions of greater severity and were more pre-occupied and distressed by them. The severity of grandiose delusions was related inversely to depression scores and negative evaluations about self, and directly to higher self-esteem.


CONCLUSIONS
This study provides evidence for the role of emotion in schizophrenia spectrum-disorders. Mood, self-esteem and negative evaluative beliefs should be considered when conceptualising psychosis and designing interventions.
Smith
Ben
B
UCL, Department of Mental Health Sciences, Archway Campus, Holborn Union Building, Highgate Hill, London, UK. ben.smith@ucl.ac.uk
Fowler
David G
DG
Freeman
Daniel
D
Bebbington
Paul
P
Bashforth
Hannah
H
Garety
Philippa
P
Dunn
Graham
G
Kuipers
Elizabeth
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D003702:Delusions / Q000150:complications; D003863:Depression / Q000150:complications; D004644:Emotions / Q000502:physiology*; D005260:Female; D006212:Hallucinations / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000150:complications; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000503:physiopathology*; D012649:Self Concept; D012720:Severity of Illness Index; D013223:Statistics as Topic