Impaired social cognitive processes are putative psychological mechanisms implicated in the formation and maintenance of paranoid beliefs. Paranoia denotes unfounded fears about the hostile intentions of others and is prevalent in a significant proportion of the general population. We investigated social cognition in healthy participants selectively recruited to have a broad occurrence of paranoid thinking (n = 89). Participants completed a novel computerized task of moral emotions and two social economic exchange games (Prisoner's Dilemma, Ultimatum Game) from the EMOTICOM neuropsychological test battery. Regression analyses revealed that delusional ideation predicted shameful feelings when the victim of deliberate harm by another person. Cooperative behavior on the Prisoner's Dilemma was greatest when the participant and opponent contributed equally to joint earnings. Participants demonstrated significantly more punishment behavior when contributions were unequal and stole more from the opponent using a suspicious strategy of gameplay. In addition, paranoid thinking was positively associated with more stealing from the cooperative opponent. On the Ultimatum Game, participants accepted significantly more unequal offers when the opponent contributed more and sensitivity to fairness was greatest when the participant contributed more. These data demonstrate that delusional ideation predicts a maladaptive emotional response to interpersonal harm and that paranoid thinking may lead to reduced cooperation toward mutual reward. The effects of paranoia on moral emotions and pro-social behavior at more severe levels of persecutory thinking warrant further investigation.

The symposium discussed mechanisms of interleukin (IL)-6 blockade for the treatment and management of patients with rheumatoid arthritis (RA). Prof Smolen provided a clinical update of the latest efficacy and safety data on various anti-IL-6 drugs, including sirukumab. He noted that all anti-IL-6 drugs were efficacious in treating physical and mental symptoms of RA. When the efficacy of anti-IL-6 antibodies was compared between drugs, targeting the IL-6 ligand was similar to targeting its receptor. Prof Pitzalis described the pathophysiology of IL-6 in RA and the reason for targeting IL-6. Lastly, Prof Choy outlined the importance of measuring patient-reported outcomes to monitor symptom improvement and evaluate the impact of IL-6 on mental functioning. Because IL-6 modulates the hypothalamic pituitary axis, fatigue and depression are common in patients with RA. Evidence suggests that the inhibition of IL-6 activity reduces symptoms of fatigue and depression in patients with RA, and that improvement in mental health occurs independently, rather than as a consequence of improvement in physical functioning.

Despite significant therapeutic advances in the treatment of patients with non-Hodgkin lymphoma (NHL), a significant proportion experience relapse or progression following standard immunochemotherapy (ICT). The introduction of novel targeted immunotherapy agents has potentially ushered in a new era in the management of NHL. Emerging approaches to treatment, including chemo-free regimens, targeted therapies, and immunotherapy for follicular lymphoma (FL), mantle cell lymphoma (MCL), and diffuse large B-cell lymphomas (DLBCL), have become increasingly important. Furthermore, genomic tools and biomarkers support subtyping of lymphomas and contribute greatly to identifying patients likely to respond to therapy and predict treatment outcome, thus offering a subset-specific precision medicine approach to managing NHL to both prevent and treat relapse. The latest development in the management of NHL is the use of checkpoint inhibitors to prevent cell–cell communication and tumour growth. Despite limited evidence to date, checkpoint inhibitors in combination with existing ICT may fundamentally shift the NHL treatment algorithm towards personalised immunotherapy.