I came across an unusual paper recently entitled ‘misattributing speech and jumping to conclusions: A longitudinal study in people at high risk of psychosis’ (Winton-Brown et al, 2015). I thought ‘I misattribute speech and jump to conclusions all the time!’ On a more serious note, I am working on a project looking at interventions to help with the self-management of early onset psychosis, so I thought there might be some helpful insights.
Cognitive models of psychosis propose that psychotic symptoms can be the result of poor processing of vague or unclear stimuli (Garety et al, 2007). In particular a key contributing factor is the tendency to use less information to form a decision or jumping to conclusions (Garety et al, 1991).
From my own experience I remember a patient of mine who had schizophrenia. He was a very bright, polite, thin young man in his 20s, always dressed in mismatched colourful clothes. He tended to wear a few more layers than the weather required. He would sit on the edge of the chair giving the impression of a bird ready to take flight. I would normally see him once a week in the ward review. I would have informal chats with him in corridors or out on the street when he was on leave. One day I wanted to discuss some blood test results with him and I invited him to see me in my office. His face paled and he looked extremely worried. ‘You are going to cancel my leave!’ he blurted out. I tried to calm him down and reassure him, but he bolted out of the office before I got the chance. Down the corridor I heard one of the nurses talking him down. Five minutes later he was trying to jump the garden fence convinced that he would never be able to leave hospital. I remember being very surprised as to how that misunderstanding developed so rapidly and had such a great influence on his behaviour. Are those cognitive deficits then something that fundamentally defines the illness?
Research shows that, at presentation, people with at risk mental states have both a tendency to jump to conclusions and problems with verbal self-monitoring. Verbal self-monitoring is determined by presented distorted speech to the individual and asking her or him to make judgements as to whether the speech came from them or from others. People with at risk mental states tend to think their own distorted speech comes from other people rather than themselves (Broome et al, 2007).
The conclusion suggesting the need to pay more attention to anxiety in psychosis is interesting.