title: Theory of mind, insecure attachment and paranoia in adolescents with early psychosis and healthy controls.
abstract: OBJECTIVE
  Impaired Theory of Mind (ToM) is found in adults with schizophrenia and is associated with paranoid symptoms. Insecure attachment is proposed to underlie impaired ToM as well as paranoia. Insight into associations between insecure attachment and impaired ToM skills may help clinicians and patients to understand interpersonal difficulties and use this knowledge to improve recovery. This study used a visual perspective-taking task to investigate whether cognitive ToM is already impaired in adolescents with early psychosis as compared to controls. Also investigated was whether perspective-taking and paranoia are associated with insecure (adult) attachment.
  
  
  METHODS
  Thirty-two adolescent patients with early psychosis and 78 healthy controls participated in this cross-sectional study design and completed the level 1 perspective-taking task, psychopathology assessments (CAPE, PANSS), paranoid thoughts (GPTS), attachment style (PAM) and the WASI vocabulary.
  
  
  RESULTS
  Patients did not significantly differ in level-1 perspective-taking behaviour compared to healthy controls. No significant associations were found between perspective-taking, paranoia and attachment. Insecure attachment was significantly related to paranoid thoughts, after controlling for illness-related symptoms.
  
  
  CONCLUSIONS
  No impairment of level-1 perspective-taking was found in adolescent patients with early psychosis compared to healthy controls. Results indicate that level-1 perspective-taking is not impaired during the early stages of psychotic illness. The association between paranoia and attachment support previous findings and provide further insight into the nature of psychotic symptoms. Understanding the role of attachment in paranoia may help patients and their care workers to gain insight into the reasons for the development or persistence of symptoms. Future research should compare early psychosis samples with more chronic samples to explore whether perspective-taking deteriorates during the course of the illness.
authors.affiliation: AMC, Academic Psychiatric Centre, Department Early Psychosis, Amsterdam, The Netherlands. nikiekorver@gmail.com
authors.forename: Nikie
authors.initials: N
authors.lastname: Korver-Nieberg
authors.forename: Anne-Kathrin J
authors.initials: AK
authors.lastname: Fett
authors.forename: Carin J
authors.initials: CJ
authors.lastname: Meijer
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Sukhi S
authors.initials: SS
authors.lastname: Shergill
authors.forename: Lieuwe
authors.initials: L
authors.lastname: de Haan
authors.forename: Lydia
authors.initials: L
authors.lastname: Krabbendam
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009483:Neuropsychological Tests; D009769:Object Attachment; D010259:Paranoid Disorders / Q000150:complications / Q000523:psychology*; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology*; D012938:Social Perception; D056345:Theory of Mind
keywords: Theory of mind; attachment style; paranoia; perspective-taking; schizophrenia; social cognition