Emotional Dysregulation, Attributional Bias, Neurocognitive Impairment in Individuals at Ultra-High Risk for Psychosis and with Schizophrenia: Its Association with Paranoia

Nam Wook Kim; Yun Young Song; Jin Young Park; Seo Yeon Baek; Jee In Kang; Eun Lee; Suk Kyoon An

doi:10.16946/kjsr.2014.17.2.63

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Kim, Song, Park, Baek, Kang, Lee, and An: Emotional Dysregulation, Attributional Bias, Neurocognitive Impairment in Individuals at Ultra-High Risk for Psychosis and with Schizophrenia: Its Association with Paranoia

Original Article

Korean J Schizophr Res 2014;17(2):63-71.

Published online: 20 January 2014

DOI: https://doi.org/10.16946/kjsr.2014.17.2.63

Emotional Dysregulation, Attributional Bias, Neurocognitive Impairment in Individuals at Ultra-High Risk for Psychosis and with Schizophrenia: Its Association with Paranoia

Nam Wook Kim, MD^1,², Yun Young Song, MD^1,³, Jin Young Park, MD, PhD^1,², Seo Yeon Baek, BA¹, Jee In Kang, MD, PhD^1,², Eun Lee, MD, PhD^1,², Suk Kyoon An, MD, PhD^1,^2,

¹Section of Affect and Neuroscience, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

²Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea

³Department of Psychiatry, Seoul National Hospital, Seoul, Korea

Address for correspondence: Suk Kyoon An, Department of Psychiatry, Yonsei University College of Medicine, 119 Gyeonchung-daero 1926beon-gii, Gwangju 464-110, Korea Tel: 031-760-9404, Fax: 031-761-7582 E-mail: ansk@yuhs.ac 본 논문은 2010년도 정부(미래창조과학부)의 재원으로 한국연구재단의 지원을 받아 수행된 연구임(NO.2010-0024264).

Received 28 June 2014 Revised 19 August 2014 Accepted 25 August 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Paranoia is a complex phenomenon, affected by a number of factors such as depression, trait anxiety, and attribution-al bias in schizophrenia. The aim of this study was to explore whether paranoia within continuum of clinical and subclinical states is associated with emotional dysregulation, attributional bias and neurocognitive impairment in whole individuals of normal controls, ultra-high risk (UHR) for psychosis and schizophrenia.

Methods

101 normal controls, 50 participants at UHR for psychosis, and 49 schizophrenia patients were recruited. All subjects were asked to complete self-reported paranoia scale and emotional dysregulation scales including Rosenberg's self-esteem, Spiel-berg's state-trait anxiety inventory and Beck depression inventory. The attributional style was assessed by Ambiguous Intentions Hostility Questionnaire (AIHQ). Participants were also requested to complete the comprehensive neurocognitive battery.

Results

: Multiple linear regression analysis showed that paranoia were found to be associated with emotional dysregulation (state anxiety, trait anxiety and depression), composite blaming bias in ambiguous situation, impairment of attention and working memory in whole participants [F (9, 190)=34.85, p＜0.001, adjusted R²=0.61].

Conclusion

: The main findings suggest that paranoia is a complex affective and cognitive structure that may be associated with emotional dysregulation, blaming bias and attention and working memory impairment in clinical and non-clinical paranoia.

Keywords: Paranoia, Schizophrenia, Ultra-high risk for psychosis, Neurocognition, Emotional dysregulation, Attributional bias.

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Table 1.

Demographic and clinical characteristics of participants

variable	Normal control (n=101)	UHR for psychosis (n=50)	schizophrenia (n=49)	F-value, p-values	Post hoc	Corrected p-values
Age (years)	21.17 (3.67)	020.12 (3.65)	021.39 (2.63)	F (2,197)=2.06, p=0.13	N vs. U	p=0.238
					N vs. S	p=1.00
					U vs. S	p=0.204
Education (years)	13.47 (2.01)	012.82 (1.95)	013.45 (1.72)	F (2,197)=2.07, p=0.13	N vs. U	p=0.163
					N vs. S	p=1.00
					U vs. S	p=0.319
Sex (M/F)^a,b,c	44/57	32/18	20/29	p=0.03
Paranoia scale^a,c	17.20 (10.36)	) 034.66 (18.13)	031.11 (17.34)	F (2,197)=30.17, p＜0.001	N vs. U	p＜0.001
					N vs. S	p＜0.001
					U vs. S	p=0.674
RSE^a,b,c	30.11 (4.61)	022.86 (5.74)	025.41 (5.77)	F (2,197)=36.07, p＜0.001	N vs. U	p＜0.001
					N vs. S	p＜0.001
					U vs. S	p=0.047
BDI^a,b,c	05.12 (5.47)	019.44 (11.67)	013.62 (11.90)	F (2,197)=44.16, p＜0.001	N vs. U	p＜0.001
					N vs. S	p＜0.001
					U vs. S	p=0.005
State anxiety of STAI^a,c	38.76 (9.67)	054.95 (15.49)	050.32 (14.51)	F (2,197)=32.17, p＜0.001	N vs. U	p＜0.001
					N vs. S	p＜0.001
					U vs. S	p=0.205
Trait anxiety of STAI^a,c	41.61 (6.76)	054.71 (13.69)	052.00 (9.71)	F (2,197)=38.22, p＜0.001	N vs. U	p＜0.001
					N vs. S	p＜0.001
					U vs. S	p=0.490
Positive symptoms (PANSS)^b		013.58 (3.66)	016.43 (5.64)
Negative symptoms (PANSS)		017.14 (5.52)	018.43 (7.39)
General psychopathology (PANSS)		032.75 (7.50)	032.09 (8.53)
Antipsychotic medication naïve/ medicated^b		33/17	3/46
Chlorpromazine equivalent dose^b		135.87 (119.47)	418.99 (307.28)

Chlorpromazine equivalent dose derived from Kroken et al. (2009). a: Normal controls significantly different from UHR for psychosis (p＜0.05), b: UHR for psychosis significantly different from schizophrenia patients (p＜0.05), c: Normal controls significantly different from schizophrenia patients (p＜0.05). UHR for psychosis: ultra-high risk for psychosis, RSE: Rosenberg's self-esteem, BDI: Beck depression inventory

Table 2.

Intercorrelation between paranoia scale and other variables

	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
1. Paranoia scale	1
2. Rosenberg’s self-esteem	−0.64^∗∗	1
3. Beck depression inventory	0.71^∗∗	−0.72^∗∗	1
4. State anxiety of STAI	0.69^∗∗	−0.73^∗∗	0.75^∗∗	1
5. Trait anxiety of STAI	0.70^∗∗	−0.75^∗∗	0.76^∗∗	0.82^∗∗	1
6. Executive function	−0.24^∗∗	0.32^∗∗	−0.26^∗∗	−0.28^∗∗	−0.29^∗∗	1
7. Verbal memory	−0.14^∗	0.08	−0.09	−0.14	−0.12	0.40^∗	1
8. Spatial memory	−0.01	−0.03	0.00	−0.05	0.03	0.31^∗∗	0.43^∗∗	1
9. Attention & working memory	−0.32^∗∗	0.29^∗∗	−0.25^∗∗	−0.27^∗∗	−0.26^∗∗	0.52^∗∗	0.41^∗∗	0.28^∗∗	1
10. Hostility perception (ambiguous)	0.49^∗∗	−0.46^∗∗	0.53^∗∗	0.48^∗∗	0.47^∗∗	−0.23^∗∗	−0.14	0.06	−0.20^∗∗	1
11. Blame bias (ambiguous)	0.54^∗∗	−0.44^∗∗	0.51^∗∗	0.45^∗∗	0.48^∗∗	0.16^∗	−0.12	−0.08	−0.19^∗∗	0.66^∗∗	1
12. Aggression (ambiguous)	−0.03	0.15^∗	−0.19^∗∗	−0.18^∗	−0.16^∗	0.15^∗	−0.12	−0.02	0.06	0.14	0.15^∗	1
13. Age	−0.10	0.19^∗∗	−0.11	−0.09	−0.11	0.09	0.06	0.04	0.07	−0.21^∗∗	−0.14	−0.05	1
14. Education	−0.06	0.17^∗	−0.09	−0.11	−0.10	0.22^∗∗	0.11	0.07	0.15^∗	−0.21^∗∗	−0.10	0.00	0.79^∗∗	1
15. Sex	0.05	−0.06	−0.01	0.03	0.09	0.03	0.18^∗	0.14	−0.07	−0.07	0.02	0.06	0.02	0.09	1

^∗ correlation is significant at tde 0.05 level

^∗∗ correlation is significant at tde 0.01 level

Table 3.

Multiple linear regression analysis of paranoia score with other variables

Determinants	β∗	t-value	p-value	Partial correlation	VIF
Rosenberg's self-esteem scale	–0.07	–0.87	0.39	–0.06	2.82
Beck depression inventory∗∗	0.27	3.49	＜0.01	0.25	3.08
State anxiety from STAI∗∗	0.18	2.12	0.04	0.15	3.62
Trait anxiety from STAI∗∗	0.19	2.13	0.04	0.15	3.96
Executive function	0.06	1.04	0.30	0.08	2.54
Verbal memory	–0.02	–0.29	0.77	–0.02	1.30
Attention & working memory∗∗	–0.13	–2.28	0.02	–0.16	1.52
Hostility perception (ambiguous)	0.02	0.26	0.79	0.02	1.98
Blame bias (ambiguous)∗∗	0.17	2.81	＜0.01	0.20	1.92
R	R²	ΔR²	R^2†	Fchange	p-value
0.79	0.62	0.62	0.61	34.85	p＜0.001

^∗ standardized coefficient, ∗∗: regression is significant at the 0.05 level, ΔR

² †: adjusted R

² Explained variance by model. STAI: Spielberg's State-Trait Anxiety Inventory, VIF: variance inflation factor

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