Paranoia in patients attending child and adolescent mental health services

Abstract

Objective: Paranoia may be particularly prevalent during adolescence, building on the heightened social vulnerabilities at this age. Excessive mistrust may be corrosive for adolescent social relationships, especially in the context of mental health disorders. We set out to examine the prevalence, symptom associations, and persistence of paranoia in a cohort of young people attending child and adolescent mental health services. Method: A total of 301 patients (11–17 years old) completed measures of paranoia, affect, peer difficulties and behavioural problems. Clinicians also rated each participant’s psychiatric symptoms. Patterns of association were examined using linear regressions and network analyses. In total, 105 patients repeated the measures several months later. Results: Most of the adolescents had affective disorders ( n = 195), self-harm/suicidality ( n = 82), or neurodevelopmental conditions ( n = 125). Few had suspected psychosis ( n = 7). Rates of paranoia were approximately double compared with previous reports from the general population. In this patient sample, 35% had at least elevated paranoia, 15% had at least moderate paranoia, and 6% had high paranoia. Paranoia had moderate associations with clinician-rated peer difficulties, self-harm, and trauma, and small associations with clinician-rated social anxiety, depression, generalised anxiety, and educational problems. Network analyses showed paranoia had the strongest unique relationship with peer difficulties. Paths from peer difficulties to anxiety, self-harm, post-traumatic stress disorder symptoms, and behavioural problems were all via paranoia. Both self-harm and post-traumatic stress disorder were solely associated with paranoia in the network. Paranoia remained persistent for three-quarters and was associated with greater psychological problems over time. Conclusion: Paranoia is relatively common and persistent across a range of clinical presentations in youth. When paranoia occurs alongside emotional problems, important peer interactions may be adversely affected. Wider consideration of paranoia in adolescent patients is needed.

Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis

“…In our study, the paranoid APS was most frequent and severe in anxiety, obsessive–compulsive, and in autism-spectrum disorders. This is in line with reports that paranoia is not specific to psychosis but occurs in a wide range of disorders[ 65 ] and also frequently in community samples of adolescents[ 65 , 66 ]. In particular, paranoia was significantly positively associated with anxiety but not autistic symptoms, and negatively associated with symptoms of ADHD[ 63 ].…”

Annual Research Review: Translational machine learning for child and adolescent psychiatry

“…Major depressive disorder arises as a differential, but the clinician is concerned about the possibility of a psychosis prodrome. Group-based research suggests that mild paranoia is common in depressed adolescents with a history of trauma and within groups of individuals there is a low possibility of psychosis (Bird et al, 2021) and the clinician refers them to a depression clinic. However, the adolescent ultimately experiences a psychotic episode with subsequently poor social and symptomatic outcomes.…”

The journey of adolescent paranoia: A qualitative study with patients attending child and adolescent mental health services

“…An important insight from the accounts was that girls may feel especially vulnerable in adolescence as they discover the realities of sexual harm -potentially contributing, at least partly, to the higher rates of paranoia in girls at this age (Bird et al, 2019(Bird et al, , 2021Ronald et al, 2014). 1 Sexual harm is a threat that, although it affects a minority of males, permeates the daily lives of women and girls.…”

“…This transition from childhood to adulthood is a vulnerable period for the development of mental health problems including psychotic experiences (Kessler et al, 2007 ; McGrath et al, 2016 ). It is the age when paranoid thoughts may be most prevalent (Bird et al, 2019 ; Freeman et al, 2011 ), and recent evidence suggests paranoia is a common presentation in those attending child and adolescent mental health services (CAMHS) (Bird et al, 2021 ). Yet over time, these emerging suspicions will take different paths, likely diminishing for many adolescents but persisting in others.…”

“…Yet over time, these emerging suspicions will take different paths, likely diminishing for many adolescents but persisting in others. For those with worsening paranoia, expecting harm from others is likely to be corrosive for peer relationships and mental health (Bird et al, 2021 ). Identifying and treating persistent paranoia in adolescents accessing CAMHS is therefore important.…”