Dr Georgina Rowse's Publications\Journal Articles Journal ArticlesKNOWLES, R., McCarthy-Jones, S., & ROWSE, G. (In press). Grandiose delusions: A review and theoretical integration of cognitive and affective perspectives. Clinical Psychology Review.
Further details
Bentall, R. P., ROWSE, G., Shyrane, N. M., Kinderman, P., Howard, R., Blackwood, N., et al. (2009). The cognitive and affective structure of paranoid delusions: A transdiagnostic investigation
of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry, 66(3), 236-247.
Context Paranoid delusions are a common symptom of a range of psychotic disorders. A variety of psychological mechanisms have been implicated in their cause, including a tendency to jump to conclusions, an impairment in the ability to understand the mental states of other people (theory of mind), an abnormal anticipation of threat, and an abnormal explanatory style coupled with low self-esteem.
Objective To determine the structure of the relationships among psychological mechanisms contributing to paranoia in a transdiagnostic sample.
Design Cross-sectional design, with relationships between predictor variables and paranoia examined by structural equation models with latent variables.
Setting Publicly funded psychiatric services in London and the North West of England.
Participants One hundred seventy-three patients with schizophrenia spectrum disorders, major depression, or late-onset schizophrenia-like psychosis, subdivided according to whether they were currently experiencing paranoid delusions. Sixty-four healthy control participants matched for appropriate demographic variables were included.
Main Outcome Measures Assessments of theory of mind, jumping to conclusions bias, and general intellectual functioning, with measures of threat anticipation, emotion, self-esteem, and explanatory style.
Results The best fitting ({chi}296 = 131.69, P = .01; comparative fit index = 0.95; Tucker-Lewis Index = 0.96; root-mean-square error of approximation = 0.04) and most parsimonious model of the data indicated that paranoid delusions are associated with a combination of pessimistic thinking style (low self-esteem, pessimistic explanatory style, and negative emotion) and impaired cognitive performance (executive functioning, tendency to jump to conclusions, and ability to reason about the mental states of others). Pessimistic thinking correlated highly with paranoia even when controlling for cognitive performance (r = 0.65, P < .001), and cognitive performance correlated with paranoia when controlling for pessimism (r = –0.34, P < .001).
Conclusions Both cognitive and emotion-related processes are involved in paranoid delusions. Treatment for paranoid patients should address both types of processes.
Further details
Bentall, R. P., Kinderman, P., Howard, R., Blackwood, N., Cummins, S., Rowse, G., et al. (2008). Paranoid delusions in schizophrenia spectrum disorders and depression: The transdiagnostic role of expectations of negative events and negative self-esteem. Journal of Nervous and Mental Disease, 196(5), 375-384.
We aimed to identify transdiagnostic psychological processes associated with persecutory delusions. Sixty-eight schizophrenia patients, 47 depressed patients, and 33 controls were assessed for paranoia, positive and negative self-esteem, estimations of the frequency of negative, neutral, and positive events occurring to the self in the past and in the future and similar estimates for events affecting others in the future. Negative self-esteem and expectations of negative events were strongly associated with paranoia in all groups. Currently deluded patients were asked to rate whether their persecution was deserved on an analogue scale. Mean deservedness scores were higher in deluded-depressed patients than deluded-schizophrenia patients, but patients in both groups used the full range of scores. The findings indicate that negative self-esteem and negative expectations independently contribute to paranoia, but do not support a simple categorical distinction between poor-me (persecution undeserved) and bad-me (persecution deserved) patients.
Further details
Corcoran, R., ROWSE, G., Moore, R., Blackwood, N., Kinderman, P., Howard, R., et al. (2008). A transdiagnostic investigation of theory of mind and jumping to conclusions in patients with persecutory delusions. Psychological Medicine, 38(11), 1577 - 1583.
BACKGROUND: A tendency to make hasty decisions on probabilistic reasoning tasks and a difficulty attributing mental states to others are key cognitive features of persecutory delusions (PDs) in the context of schizophrenia. This study examines whether these same psychological anomalies characterize PDs when they present in the context of psychotic depression.
METHOD: Performance on measures of probabilistic reasoning and theory of mind (ToM) was examined in five subgroups differing in diagnostic category and current illness status.
RESULTS: The tendency to draw hasty decisions in probabilistic settings and poor ToM tested using story format feature in PDs irrespective of diagnosis. Furthermore, performance on the ToM story task correlated with the degree of distress caused by and preoccupation with the current PDs in the currently deluded groups. By contrast, performance on the non-verbal ToM task appears to be more sensitive to diagnosis, as patients with schizophrenia spectrum disorders perform worse on this task than those with depression irrespective of the presence of PDs.
CONCLUSIONS: The psychological anomalies associated with PDs examined here are transdiagnostic but different measures of ToM may be more or less sensitive to indices of severity of the PDs, diagnosis and trait- or state-related cognitive effects.
Further details
Shryane, N. M., Corcoran, R., Rowse, G., Moore, R., Cummins, S., Blackwood, N., et al. (2008). Deception and False Belief in Paranoia: modelling Theory of Mind Stories. Cognitive Neuropsychiatry, 13(1), 8-32.
Background.
This study used Item Response Theory (IRT) to model the psychometric properties of a Theory of Mind (ToM) stories task. The study also aimed to determine whether the ability to understand states of false belief in others and the ability to understand another's intention to deceive are separable skills, and to establish which is more sensitive to the presence of paranoia.
Method.
A large and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed a ToM stories task measuring false belief and deception at first and second order.
Results.
A three-factor IRT model was found to best fit the data, consisting of first- and second-order deception factors and a single false-belief factor. The first-order deception and false-belief factors had good measurement properties at low trait levels, appropriate for samples with reduced ToM ability. First-order deception and false beliefs were both sensitive to paranoid ideation with IQ predicting performance on false belief items.
Conclusions.
Separable abilities were found to underlie performance on verbal ToM tasks. However, paranoia was associated with impaired performance on both false belief and deception understanding with clear impairment at the simplest level of mental state attribution.
Further details
Shyrane, N. M., Cocoran, R., ROWSE, G., Moore, R., Cummins, S., Blackwood, N., et al. (2008). Deception and false belief in paranoia: modelling theory of mind stories. Cognitive Neuropsychiatry, 13(1), 8-32.
Background. This study used Item Response Theory (IRT) to model the psychometric properties of a Theory of Mind (ToM) stories task. The study also aimed to determine whether the ability to understand states of false belief in others and the ability to understand another's intention to deceive are separable skills, and to establish which is more sensitive to the presence of paranoia.
Method. A large and diverse clinical and nonclinical sample differing in levels of depression and paranoid ideation performed a ToM stories task measuring false belief and deception at first and second order.
Results. A three-factor IRT model was found to best fit the data, consisting of first- and second-order deception factors and a single false-belief factor. The first-order deception and false-belief factors had good measurement properties at low trait levels, appropriate for samples with reduced ToM ability. First-order deception and false beliefs were both sensitive to paranoid ideation with IQ predicting performance on false belief items.
Conclusions. Separable abilities were found to underlie performance on verbal ToM tasks. However, paranoia was associated with impaired performance on both false belief and deception understanding with clear impairment at the simplest level of mental state attribution.
Further details
Cocoran, R., Cummins, S., ROWSE, G., Moore, R., Blackwood, N., Howard, R., et al. (2006). Reasoning Under Uncertainty: Heuristic Judgements in Patients with Persecutory Delusions. . Psychological Medicine, 36, 1109-1118.
Objective. The substantial literature examining social reasoning in people with delusions has, to date, neglected the commonest form of decision making in daily life. We address this imbalance by reporting here the findings of the first study to explore heuristic reasoning in people with persecutory delusions.
Method. People with active or remitted paranoid delusions, depressed and healthy adults performed two novel heuristic reasoning tasks that varied in emotional valence.
Results. The findings indicated that people with persecutory delusions displayed biases during heuristic reasoning that were most obvious when reasoning about threatening and positive material. Clear similarities existed between the currently paranoid group and the depressed group in terms of their reasoning about the likelihood of events happening to them, with both groups tending to believe that pleasant things would not happen to them. However, only the currently paranoid group showed an increased tendency to view other people as threatening.
Conclusion. This study has initiated the exploration of heuristic reasoning in paranoia and depression. The findings have therapeutic utility and future work could focus on the differentiation of paranoia and depression at a cognitive level.
Correspondence:
c1 Address for correspondence: Dr Rhiannon Corcoran, School of Psychological Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester M13 9PL, UK. (Email: rhiannon.corcoran@manchester.ac.uk)
Further details
Moore, R., Blackwood, N., Cocoran, R., ROWSE, G., Kinderman, P., Bentall, R. P., et al. (2006). Misunderstanding the Intentions of Others: The Cognitive Aetiology of Persecutory Delusions in Very Late-Onset Schizophrenia-like Psychosis. . American Journal of Geriatric Psychiatry, 14(5), 410-418.
From the Section of Old Age Psychiatry (RM, RH) and the Department of Forensic Mental Health Science (NB), Institute of Psychiatry, London, U.K.; the Department of Psychology (RC, GR, RB), University of Manchester, Manchester, U.K.; and the Division of Clinical Psychology (PK), University of Liverpool, Liverpool, U.K.
Objective: The objective of this study was to explore the cognitive etiology of persecutory delusion formation and maintenance in very late-onset schizophrenia-like psychosis (SLP).
Method: Probabilistic reasoning, causal attributional style, and mentalizing ability were examined in 29 patients with SLP, 30 with onset of depression after the age of 60 years and 30 healthy comparison subjects.
Results: Patients with SLP made significantly more errors than the healthy comparison group in deception, but not false belief, mentalizing tasks. There were no significant performance differences between groups on the probabilistic reasoning task or the attributional style task.
Conclusions: Mentalizing errors may contribute to the development and maintenance of persecutory delusions in SLP. These patients do not appear to show the wider range of cognitive biases described in deluded patients with schizophrenia with onset in younger adult life.
Key Words: Very late-onset schizophrenia-like psychosis • cognitive models • theory of mind
This article has been cited by other articles:
E. W. Twamley and P. D. Harvey
The Importance of Cognition in the Conceptualization of both Dementia and Severe Mental Illness in Older People.
Am J Geriatr Psychiatry, May 1, 2006; 14(5): 387 - 390.
Further details
Keen, J., Oliver, P., ROWSE, G., & al., e. (2003). Does methadone maintenance treatment based on the new national guide lines work in a primary care setting? British Journal of General Practice, 53(491), 461-467.
BACKGROUND: General practitioners (GPs) are being encouraged to treat more drug users but there are few studies to demonstrate the effectiveness of primary care treatment.
AIM: To determine whether patients retained on methadone maintenance treatment for one year in a modern British primary care setting, with prescribing protocols based on the new national guidelines, can achieve similar harm reduction outcomes to those demonstrated in other settings, using objective outcome measures where available.
DESIGN OF STUDY: Longitudinal cohort study. SETTING: The Primary Care Clinic for Drug Dependence, Sheffield.
METHOD: The intervention consisted of a methadone maintenance treatment provided by GPs with prescribing protocols based on the 1999 national guidelines. The first 96 eligible consenting patients entering treatment were recruited; 65 completed the study. Outcome measures were current drug use, HIV risk-taking behaviour, social functioning, criminal activity, and mental and physical health, supplemented by urinalysis and criminal record data.
RESULTS: Frequency of heroin use was reduced from a mean of 3.02 episodes per day (standard deviation [SD] = 1.73) to a mean of 0.22 episodes per day (SD = 0.54), (chi 2 = 79.48, degrees of freedom [df] = 2, P < 0.001), confirmed by urinalysis. Mean numbers of convictions and cautions were reduced by 62% (z = 3.378, P < 0.001) for all crime. HIV risk-taking behaviour, social functioning, and physical and psychological wellbeing all showed significant improvements.
CONCLUSION: Patients retained on methadone maintenance treatment for one year in a primary care setting can achieve improvements on a range of harm reduction outcomes similar to those shown by studies in other, often more highly structured programmes.
Further details
Keen, J., Oliver, P., ROWSE, G., & N., M. (2001). Residential rehabilitation for drug users: A review of 13 months intake to a therapeutic community. Family Practice, 18, 545-548.
Further details
Oliver, P., Forrest, R., ROWSE, G., & Keen, J. (2001). Snoring prior to fatal opiate overdose: An intervention opportunity? . Addiction, 96, 652.
Further details
Oliver, P., Keen, J., ROWSE, G., & Mathers, N. (2001). Deaths from drugs of abuse in Sheffield, 1998: The role of prescribed medication. British Journal of General Practice, 51, 394-396.
Characteristics of recent drug abuse-related deaths in the city of Sheffield were examined from the coroner's records. Almost all of those who died of poisoning from a drug of abuse were known to be dependent on heroin yet less than half were receiving treatment. Benzodiazepines were frequently detected alongside opiates during toxicology, the source of which was likely to be the deceased's own prescription.
Further details
Philp, I., Newton, P., McKee, K. J., Dixon, S., ROWSE, G., & Bath, P. A. (2001). Geriatric assessment in primary care: formulating best practice. British Journal of Community Nursing, 6, 650-655.
Comprehensive geriatric assessment (CGA) is a structured approach to measuring physical, mental and social functioning of older people to identify needs and to plan care. Meta-analysis of trials of CGA suggest that it is cost-effective, but there is no agreed approach to its implementation in primary care. Our aim was to develop a best-practice model for geriatric assessment in primary care. We took an iterative approach to development, combining expert and local stakeholder opinion, and using semi-structured interviews to assess patient and practitioner experience in nine general practices in Sheffield. Patients were aged 75 and over, living at home. The best-practice model was the use of a standardized instrument (EASY-Care) to unselected patients aged 75 years and over living at home or in residential care, administered by a practice nurse in the context of an over-75s health check. There was high patient and practitioner acceptability, and significant cost savings were noted. Key beneficial features were the assessment of mental health and sources of support; goal-setting; generation of a disability score; and high patient satisfaction from contact with nursing staff. We conclude that geriatric assessment in primary care is feasible, economical and beneficial to patients and practitioners. Nursing staff are central to successful implementation of geriatric assessment in primary care.
Keen, J., Oliver, P., ROWSE, G., & Mathers, N. (2000). Keeping families of heroin addicts together: results of a thirteen months’ intake for community detoxification and rehabilitation at a Family Centre for drug users. Family Practice, 17, 484-489.
Background.
Heroin addiction is a major public health problem affecting both the addicted individuals and their children, who have been shown to have poor social, educational and health status and to be at higher risk of abuse than their peers. Whilst the antenatal effects of parental drug use and the overall poor outcomes for these children have been widely studied, there has been little emphasis on the effectiveness of treatment interventions and even less emphasis on evaluating the effect on children of the standard treatments aimed at their parents' drug use.
Objectives.
The aim of the present study was to evaluate the effect on heroin-addicted parents and their children of a family-based drug treatment intervention using a records-based methodology, and to identify any factors at admission which may influence outcome. This study is a pilot for a prospective Europe-wide study using a similar methodology prospectively in several treatment modalities.
Methods.
A retrospective cohort study was carried out using existing clinical and residential record data. The setting was a residential family centre run by the charity Phoenix House in Sheffield, UK, offering a 6-month (180 days) family-based programme for heroin addicts including community detoxification overseen by primary care specialist doctors and residential rehabilitation. All adults and children who entered the centre between July 1997 and July 1998 were included in the study (26 adults and 33 children, in 23 family groups). An analysis was made of clinical records and records kept on the adults and children by the clinicians and staff at the centre. The main outcome measures for the adults were length of stay and reason for departure (treatment complete, early planned discharge, unplanned discharge, eviction); and for the children were reason for departure and discharge destination (with parent or taken into care).
Results.
Mean length of stay was 110 days, and only 11 children (33%) and nine adults (35%) completed 150 days or more. Length of stay was found to be significantly correlated with parental age at admission (P < 0.01). Twelve children (37%) and nine adults (35%) were deemed to have completed treatment successfully. Of the remainder, 14 children (42%) and 11 adults (42%) left because of definite treatment failure. Successful treatment completion was found to be correlated with increased parental age (Pearson's r = 0.612, P = 0.001). Poly-drug users were significantly less likely to complete treatment successfully (Fisher's exact test, P = 0.012). Twenty children were in the care of their parents on admission, and 24 were able to go home with their parents. There was no association between residence with parents pre- and post-admission (McNemar's chi-squared test = 1.6, P 0.1).
Conclusions.
Whilst overall high rates of treatment success are not expected in abstinence-based programmes, the outcomes for the adults in this setting are comparable with published results in other residential settings, and there is some evidence that some families may have stayed together who might otherwise have been separated. Older adults who were not poly-drug users had significantly better outcomes. The records-based methodology proved successful, but centres need to keep detailed and preferably long-term records on children if their outcomes are to be evaluated more fully.
Keywords.
Addiction, children, heroin, outcomes, treatment.
Further details
Keen, J., ROWSE, G., Mathers, N., Campbell, M., & Seivewright, N. (2000). Can methadone maintenance for heroin-dependent patients retained in general practice reduce criminal conviction rates and time spent in prison? British Journal of General Practice, 50, 48-49.
A retrospective analysis was made of the criminal records of 57 patients successfully retained in methadone maintenance at two general practices in Sheffield. Their criminal conviction rates and time spent in prison per year were compared for the periods before and after the start of their methadone programme. Overall, patients retained on methadone programmes in the general practices studied had significantly fewer convictions and cautions, and spent significantly less time in prison than they had before the start of treatment.
Further details
McKee, K. J., Newton, P., Bath, P., Philp, I., & ROWSE, G. (1999). ShefSCOPE: using change management to introduce and evaluate health outcome measures in primary health care for older people. Zeitschrift fur Gerontologie und Geriatrie, 32 (sup. 2)(II), 34.
Last update: 10 Nov 2011
|
|
