title: Defensive function of persecutory delusion and discrepancy between explicit and implicit self-esteem in schizophrenia: study using the Brief Implicit Association Test.
abstract: BACKGROUND
  If delusions serve as a defense mechanism in schizophrenia patients with paranoia, then they should show normal or high explicit self-esteem and low implicit self-esteem. However, the results of previous studies are inconsistent. One possible explanation for this inconsistency is that there are two types of paranoia, "bad me" (self-blaming) paranoia and "poor me" (non-self-blaming) paranoia. We thus examined implicit and explicit self-esteem and self-blaming tendency in patients with schizophrenia and schizoaffective disorder. We hypothesized that patients with paranoia would show lower implicit self-esteem and only those with non-self-blaming paranoia would experience a discrepancy between explicit and implicit self-esteem.
  
  
  METHODS
  Participants consisted of patients with schizophrenia and schizoaffective disorder recruited from a day hospital (N=71). Participants were assessed for psychotic symptoms, using the Brief Psychiatric Rating Scale (BPRS), and self-blaming tendency, using the brief COPE. We also assessed explicit self-esteem, using the Rosenberg Self-Esteem Scale (RSES), implicit self-esteem, using Brief Implicit Association Test (BIAT), and discrepancy between explicit and implicit self-esteem.
  
  
  RESULTS
  Contrary to our hypothesis, implicit self-esteem in paranoia and nonparanoia showed no statistical difference. As expected, only patients with non-self-blaming paranoia experienced a discrepancy between explicit and implicit self-esteem; other groups showed no such discrepancy.
  
  
  CONCLUSIONS
  These results suggest that persecutory delusion plays a defensive role in non-self-blaming paranoia.
authors.affiliation: Department of Psychiatry, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Gojouyama Hospital, Nara, Japan.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Hayakawa
authors.affiliation: Yashio Hospital, Saitama, Japan.
authors.forename: Aiko
authors.initials: A
authors.lastname: Okamura
authors.affiliation: Department of Psychiatry, Kyoto Second Red Cross Hospital, Kyoto, Japan.
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Kohigashi
authors.affiliation: Department of Psychiatry, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Fukui
authors.affiliation: Department of Psychiatry, Graduate School of Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Jin
authors.initials: J
authors.lastname: Narumoto
keywords: coping style; external attribution; poor me paranoia; remitted paranoid delusion