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In 2005 Andreasen proposed criteria for remission in schizophrenia. It is
unclear whether these criteria reflect symptom reduction and improved
social functioning in daily life.
To investigate whether criteria for symptomatic remission reflect symptom
reduction and improved functioning in real life, comparing patients
meeting remission criteria, patients not meeting these criteria and
The Experience Sampling Method (ESM), a structured diary technique, was
used to explore real-life symptoms and functioning in 177 patients with
(remitted and non-remitted) schizophrenia spectrum disorders and 148
Of 177 patients, 70 met criteria for symptomatic remission. These
patients reported significantly fewer positive and negative symptoms and
better mood states compared with patients not in remission. Furthermore,
patients in remission spent more time in goal-directed activities and had
less preference for being alone when they were with others. However, the
patient groups did not differ on time spent in social company and doing
nothing, and both the remission and non-remission groups had lower scores
on functional outcome measures compared with the control group.
The study provides an ecological validation for the symptomatic remission
criteria, showing that patients who met the criteria reported fewer
positive symptoms, better mood states and partial recovery of reward
experience compared with those not in remission. However, remission
status was not related to functional recovery, suggesting that the
current focus on symptomatic remission may reflect an overly restricted
Experimental studies have indicated that social contact, even when it is neutral, triggers paranoid thinking in people who score high on clinical or subclinical paranoia. We investigated whether contextual variables are predictive of momentary increases in the intensity of paranoid thinking in a sample of participants ranging across a psychometric paranoia continuum.
The sample (n=154) consisted of 30 currently paranoid patients, 34 currently non-paranoid patients, 15 remitted psychotic patients, 38 high-schizotypy participants, and 37 control subjects. Based on their total score on Fenigstein's Paranoia Scale (PS), three groups with different degrees of paranoia were defined. The Experience Sampling Method (ESM), a structured diary technique, was used to assess momentary social context, perceived social threat and paranoia in daily life.
There were differences in the effect of social company on momentary levels of paranoia and perceived social threat across the range of trait paranoia. The low and medium paranoia groups reported higher levels of perceived social threat when they were with less-familiar compared to familiar individuals. The medium paranoia group reported more paranoia in less-familiar company. The high paranoia group reported no difference in the perception of social threat or momentary paranoia between familiar and unfamiliar contacts.
Paranoid thinking is context dependent in individuals with medium or at-risk levels of trait paranoia. Perceived social threat seems to be context dependent in the low paranoia group. However, at high levels of trait paranoia, momentary paranoia and momentary perceived social threat become autonomous and independent of social reality.
It has long been acknowledged that hearing impairment may increase the risk for psychotic experiences. Recent work suggests that young people in particular may be at risk, indicating a possible developmental mechanism.
The hypothesis that individuals exposed to hearing impairment in early adolescence would display the highest risk for psychotic symptoms was examined in a prospective cohort study of a population sample of originally 3021 adolescents and young adults aged 14–24 years at baseline, in Munich, Germany (Early Developmental Stages of Psychopathology Study). The expression of psychosis was assessed at multiple time points over a period of up to 10 years, using a diagnostic interview (Munich Composite International Diagnostic Interview; CIDI) administered by clinical psychologists.
Hearing impairment was associated with CIDI psychotic symptoms [odds ratio (OR) 2.04, 95% confidence interval (CI) 1.10–3.81], particularly more severe psychotic symptoms (OR 5.66, 95% CI 1.64–19.49). The association between hearing impairment and CIDI psychotic symptoms was much stronger in the youngest group aged 14–17 years at baseline (OR 3.28, 95% CI 1.54–7.01) than in the older group aged 18–24 years at baseline (OR 0.82, 95% CI 0.24–2.84).
The finding of an age-specific association between hearing impairment and psychotic experiences suggests that disruption of development at a critical adolescent phase, in interaction with other personal and social vulnerabilities, may increase the risk for psychotic symptoms.
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