Could there be an interplay between the positive symptoms that
schizophrenia patients experience and their emotions? A new inquiry conducted
in England suggests that there is.
It was headed by Ben Smith, Ph.D., a clinical research fellow at University
College London. Results appeared in the September Schizophrenia
One hundred individuals with schizophrenia, schizoaffective disorder, or
delusional disorder who had suffered a recent relapse of their psychosis
agreed to participate in a clinical trial designed to help them prevent more
relapses. But before they entered the trial, the researchers assessed the
subjects for specific positive symptoms such as auditory hallucinations,
persecutory delusions, and grandiose delusions. Fifty-seven percent reported
experiencing auditory hallucinations, 55 percent persecutory delusions, and 17
percent grandiose delusions.
Subjects were then assessed for levels of self-esteem, depression, and
negative views they held about themselves and others. Examples of negative
beliefs about oneself were "I am unloved," "I am
worthless," and "I am weak." Examples of negative beliefs
about others were "Other people are hostile," "Other people
are unforgiving," and "Other people are nasty." Finally the
researchers attempted to see whether there were associations between subjects'
specific positive symptoms and their scores for self-esteem, depression, and
Persecutory delusions were found to be linked, to a highly significant
degree, with depression, low self-esteem, and negative views of self. This was
something that the researchers had expected. However, the link between
persecutory delusions and negative beliefs about others, while significant,
was weaker than the scientists had expected.
Auditory hallucinations were also found to be strongly linked with
depression and low self-esteem, as the researchers had predicted, but were not
significantly associated with negative beliefs about either oneself or
As for grandiose delusions, they were inversely and significantly
associated with depression, low self-esteem, and negative beliefs about self,
yet to the scientists' surprise, they were not associated with negative
beliefs about others.
"This is a very interesting report," Ralph Hoffman, M.D., a
professor of psychiatry at Yale University and an authority on auditory
hallucinations, told Psychiatric News. "Our own research
involving patients with auditory hallucinations appears to confirm findings
reported here. For instance, anxiety, depression, or fearfulness often appear
to worsen the frequency and severity of these hallucinations, as well as bias
verbal content to match these emotions... .A patient in a depressed state is
more likely to hear a voice stating that he is no good or that he ought to be
Because of the cross-sectional nature of the study, it was impossible to
determine whether the emotions under scrutiny contributed to auditory
hallucinations and delusions or resulted from them, Smith acknowledged.
However, he suspects that both situations are possible, setting a vicious
cycle into motion. And Hoffman agreed. In a follow-up longitudinal study,
Smith and his colleagues will try to untangle the cause-and-effect
interactions between these emotions and hallucinations and delusions.
Smith and his group are also attempting to see if cognitive-behavioral
therapy can temper schizophrenia subjects' depression and negative views and
increase their self-esteem and if these emotional changes in turn can dampen
their auditory hallucinations and persecutory delusions.
The study was funded by the Wellcome Trust.
An abstract of "Emotion and Psychosis: Links Between
Depression, Self-Esteem, Negative Schematic Beliefs and Delusions and
Hallucinations" can be accessed at<www.sciencedirect.com>
by clicking on "S" and then "Schizophrenia