Stress is a bad advisor. Stress primes poor decision making in deluded psychotic patients

Abstract

Stress is implicated in the onset of psychosis but the complex links between stress and psychotic breakdown are yet poorly understood. For the present study, we examined whether two prominent cognitive biases in psychosis, jumping to conclusions and distorted attribution, in conjunction with neuropsychological deficits play a role in this process. Thirty participants with schizophrenia and acute delusional symptoms were compared with 29 healthy controls across three conditions involving a noise stressor, a social stressor or no stressor. Under each condition participants had to perform parallel versions of cognitive bias tasks and neuropsychological tests including a probabilistic reasoning task (jumping to conclusions), the revised Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R; attributional style), and the Corsi block-tapping task (nonverbal memory). Stress, particularly noise, aggravated performance differences of patients relative to controls on memory. Participants with psychosis demonstrated an escalated jumping to conclusion bias under stress. At a medium effect size, patients made more monocausal attributions, which increased under social stress. The present study is partially in line with prior studies. It suggests that stress negatively affects cognition in psychosis more than in controls, which is presumably insufficiently realized by patients and thus not held in check by greater response hesitance. Raising patients' awareness about these response tendencies and encouraging them to be more cautious in their judgments under conditions of increased stress may prove beneficial for improving positive symptoms.

Effects of environmental noise on cognitive (dys)functions in schizophrenia: A pilot within-subjects experimental study

“…We defined JTC as requiring only two beads before making a decision in accordance with previous studies ( Garety et al, 2005 ). The pattern of results remained the same when we defined JTC as requiring only one bead before making a decision following a recent study ( Moritz et al, 2015 ).…”

“…fewer beads drawn before making a decision; i.e., increased JTC), under noise. In a recent study ( Moritz et al, 2015 ) that examined the effect of 75 dB building site noise on JTC bias using the Fish Task (a variant of Beads task) in patients with acute delusional symptoms and healthy participants, there was no difference between JTC of patients and healthy participants under the neutral condition but a significant difference emerged during exposure to building site noise. This group difference, however, appears to have been driven mainly by a change in performance of healthy participants, rather than patients, under noise ( Fig.…”

Liberale Akzeptanz als kognitiver Mechanismus bei Psychose: Eine 2-Stufen-Theorie der Pathogenese schizophrener Positivsymptome

“…Gemäß neuer Befunde [Lüdtke et al, 2016] [Lincoln et al, 2010Moritz et al, 2011Moritz et al, , 2015b.…”

New aspects of the vulnerability stress model in general, its relevance in schizophrenic psychoses and the place of antipsychotics

“…In recent years, as already sometimes in the past, a discussion on the necessity of principal relapse prevention and an Originally, the vulnerability stress model was developed in the context of schizophrenic psychoses to give a better insight into the complexity of the multifactorial etiopathogenesis of these disorders and to provide a roadmap for different kinds of interventions in terms of psychopharmacological and psychosocial treatments [2,5,10,11]. Later on it seemed adequate to extend this conceptual approach to other mental disorders.…”