Ian Gold

Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions

Introduction. There is substantial evidence that patients with delusions exhibit a reasoning bias—known as the “jumping to conclusions” (JTC) bias—which leads them to accept hypotheses as correct on the basis of less evidence than controls. We address three questions concerning the JTC bias that require clarification. Firstly, what is the best measure of the JTC bias? Second, is the JTC bias correlated specifically with delusions, or only with the symptomatology of schizophrenia? And third, is the bias enhanced by emotionally salient material? Methods. To address these questions, we conducted a series of meta-analyses of studies that used the Beads task to compare the probabilistic reasoning styles of individuals with and without delusions. Results. We found that only one of four measures of the JTC bias—“draws to decision”—reached significance. The JTC bias exhibited by delusional subjects—as measured by draws to decision—did not appear to be solely an epiphenomenal effect of schizophrenic symptomatology, and was not amplified by emotionally salient material. Conclusions. A tendency to gather less evidence in the Beads task is reliably associated with the presence of delusional symptomatology. In contrast, certainty on the task, and responses to contradictory evidence, do not discriminate well between those with and without delusions. The implications for the underlying basis of the JTC bias, and its role in the formation and maintenance of delusions, are discussed.

Oxytocin in pregnancy and the postpartum: relations to labor and its management

The purpose of this study was to examine variations in endogenous oxytocin levels in pregnancy and postpartum state. We also explored the associations between delivery variables and oxytocin levels. A final sample of 272 mothers in their first trimester of pregnancy was included for the study. Blood samples were drawn during the first trimester and third trimester of pregnancy and at 8 weeks postpartum. Socio-demographic data were collected at each time point and medical files were consulted for delivery details. In most women, levels of circulating oxytocin increased from the first to third trimester of pregnancy followed by a decrease in the postpartum period. Oxytocin levels varied considerably between individuals, ranging from 50 pg/mL to over 2000 pg/mL. Parity was the main predictor of oxytocin levels in the third trimester of pregnancy and of oxytocin level changes from the first to the third trimester of pregnancy. Oxytocin levels in the third trimester of pregnancy predicted a self-reported negative labor experience and increased the chances of having an epidural. Intrapartum exogenous oxytocin was positively associated with levels of oxytocin during the postpartum period. Our exploratory results suggest that circulating oxytocin levels during the third trimester of pregnancy may predict the type of labor a woman will experience. More importantly, the quantity of intrapartum exogenous oxytocin administered during labor predicted plasma oxytocin levels 2 months postpartum, suggesting a possible long-term effect of this routine intervention, the consequences of which are largely unknown.

Psychosocial stress moderates the relationships between oxytocin, perinatal depression, and maternal behavior

The hormone oxytocin (OT) is of particular interest in the study of childbearing women, as it has a role in the onset and course of labor and breastfeeding. Recent research has linked OT to maternal caregiving behavior towards her infant, and to postpartum depressive symptomatology. There is also evidence that psychosocial adversity affects the oxytocin system. The present study investigated the relationship of endogenous OT in women during pregnancy and at 8weeks postpartum to psychosocial stress, maternal symptoms of depression, and maternal sensitive behavior. It was hypothesized that OT would mediate the effects of maternal depressive symptoms on maternal interactive behavior. We also tested the hypothesis that psychosocial stress would moderate the relationship between OT and maternal depressive symptoms and sensitive behavior. A community sample of 287 women was assessed at 12-14weeks of gestation, 32-34weeks of gestation, and 7-9weeks postpartum. We measured plasma OT, maternal symptoms of depression and psychosocial stress. At the postpartum home visit, maternal behavior in interaction with the infant was videotaped, and then coded to assess sensitivity. In the sample as a whole, OT was not related to maternal depressive symptoms or to sensitive maternal behavior. However, among women who reported high levels of psychosocial stress, higher levels of plasma OT were associated with fewer depressive symptoms and more sensitive maternal behavior. These results suggest that endogenous OT may act as a buffer against the deleterious effects of stress, thereby protecting high risk women from developing depressive symptoms and promoting more sensitive maternal interactive behavior.

The Reading the Mind in the Eyes test: validation of a French version and exploration of cultural variations in a multi-ethnic city

Introduction The first aim of our study was to validate the French version of the Reading the Mind in the Eyes test, a theory of mind test. The second aim was to test whether cultural differences modulate performance on this test. Methods A total of 109 participants completed the original English version and 97 participants completed the French version. Another group of 30 participants completed the French version twice, one week apart. Results We report a similar overall distribution of scores in both versions and no differences in the mean scores between them. However, 2 items in the French version did not collect a majority of responses, which differed from the results of the English version. Test-retest showed good stability of the French version. As expected, participants who do not speak French or English at home, and those born in Asia, performed worse than North American participants, and those who speak English or French at home. Conclusions We report a French version with acceptable validity and good stability. The cultural differences observed support the idea that Asian culture does not use theory of mind to explain peoples behaviours as much as North American people do.

Rationality and Schizophrenic Delusion

The theory of rationality has traditionally been concerned with the investigation of the norms of rational thought and behaviour, and with the reasoning pro-cedures that satisfy them. As a consequence, the investigation of irrationality has largely been restricted to the behaviour or thought that violates these norms. There are, how-ever, other forms of irrationality. Here we propose that the delusions that occur in schizophrenia constitute a paradigm of irrationality. We examine a leading theory of schizophrenic delusion and propose that some delusions can be traced to a violation of a condition on thought we call egocentricity. We argue that the violation of egocen-tricity leads to irrational states that cannot be explained by the traditional categories of irrationality and conclude, therefore, that these states belong in a new branch of the theory of irrationality, that of experiential irrationality.

Intrapartum Synthetic Oxytocin and Its Effects on Maternal Well-Being at 2 Months Postpartum

BACKGROUND Synthetic oxytocin (synOT) is commonly used in labor management to induce and augment labor, and to prevent postpartum hemorrhage. However, its long-term consequences for maternal health and behavior are largely understudied. We examined the relationship between synOT and maternal oxytocin levels, breastfeeding, and maternal mental health at 2 months postpartum. METHODS Women were recruited during pregnancy or within 48 hours of giving birth through obstetric practices and hospitals. A total of 386 women were visited in their homes at 2 months postpartum, where they completed questionnaires assessing breastfeeding, depression, anxiety, posttraumatic stress, and somatization. Oxytocin levels were obtained from blood samples and synOT dosage information was gathered from hospital charts. RESULTS Intrapartum synOT dose was positively correlated with endogenous oxytocin levels at 2 months postpartum. Women who were exclusively breastfeeding at 2 months postpartum had received significantly less synOT compared with their nonexclusively breastfeeding counterparts. Higher synOT dose was associated with greater depressive, anxious, and somatization symptoms. SynOT dose was not associated with perinatal posttraumatic stress. CONCLUSIONS The widespread use of synOT in managed labor warrants caution, as the influence of synOT on a new mothers well-being is evident at 2 months postpartum.

The role of oxytocin in mothers’ theory of mind and interactive behavior during the perinatal period

The present longitudinal study examined the relations between plasma oxytocin, theory of mind, and maternal interactive behavior during the perinatal period. A community sample of women was assessed at 12-14 weeks gestation, 32-34 weeks gestation, and 7-9 weeks postpartum. Oxytocin during late pregnancy was significantly positively correlated with a measure of theory of mind, and predicted theory of mind ability after controlling for parity, maternal education, prenatal psychosocial risk, and general anxiety, measured during the first trimester. Theory of mind was associated with less remote and less depressive maternal interactive behavior. Oxytocin, across all time points, was not directly related to maternal interactive behavior. However, there was a significant indirect effect of oxytocin during late pregnancy on depressive maternal behavior via theory of mind ability. These preliminary findings suggest that changes in the oxytocinergic system during the perinatal period may contribute to the awareness of social cues, which in turn plays a role in maternal interactive behavior.

Attachment security and recent stressful life events predict oxytocin levels: a pilot study of pregnant women with high levels of cumulative psychosocial adversity.

Purpose: Recent reports indicate that prenatal levels of the neuropeptide oxytocin (OT) are inversely related to depressive symptomatology and positively associated with more optimal interactive behaviors in mothers with high levels of cumulative psychosocial adversity (CPA). In the present pilot study, we aimed to identify factors associated with high versus low levels of OT in pregnant women with high levels of CPA. We hypothesized that insecurely attached women, and those who recently experienced stressful life events (SLE), would have lower levels of prenatal OT. Methods: Thirty pregnant women with mood and anxiety disorders and high levels of CPA were recruited from the perinatal mental health service of a general hospital. Participants completed self-report measures of psychosocial stress and adult attachment style, and blood was then drawn to assess OT. Results and conclusions: Lower OT levels were found among those who were insecurely attached, and among those who experienced SLE within the last year. In a multiple linear regression, both attachment security and SLE significantly contributed to a model of prenatal OT levels. These individual difference factors explained 38% of the variance in prenatal OT, which may in turn predict poorer maternal mental health and caregiving outcomes during the postpartum period.

The “Truman Show” delusion: Psychosis in the global village

Introduction. We report a novel delusion, primarily persecutory in form, in which the patient believes that he is being filmed, and that the films are being broadcast for the entertainment of others. Methods. We describe a series of patients who presented with a delusional system according to which they were the subjects of something akin to a reality television show that was broadcasting their daily life for the entertainment of others. We then address three questions, the first concerning how to characterise the delusion, the second concerning the role of culture in delusion, and the third concerning the implications of cultural studies of delusion for the cognitive theory of delusion. Results. Delusions are both variable and stable: Particular delusional ideas are sensitive to culture, but the broad categories of delusion are stable both across time and culture. This stability has implications for the form a cognitive theory of delusion can take. Conclusions. Cultural studies of delusion have important contributions to make to the cognitive theory of delusion.

From descartes to desipramine: psychopharmacology and the self.

Despite the remarkably widespread use of the new generation of antidepressants, almost everything we know about their effects comes from animal studies and clinical trials in which the sole parameter of interest is depressive symptomatology. Almost nothing is known about the effects that antidepressants have on cognition, affect, or motivation when used over a period of months or years. Nor do we understand what effects, if any, antidepressants have on what we think of as the self. In this article, we argue that neither psychiatry nor philosophy, in their current state, are well equipped to think about these issues. In order to explore this idea, we consider the neurobiology of romantic love and its relation to antidepressant neurochemistry. This case study, we suggest, supports the view that antidepressants are very likely to have significant effects on personhood as well as the suggestion that we are in need of new ways of thinking about the self and its pathologies.