Liam Davenport

April 05, 2016

FLORENCE, Italy — Patients with first-episode psychosis who jump to conclusions may be at risk for significantly worse longer-term clinical outcomes, new research shows.

Investigators from King's College London, United Kingdom, found that the trait of jumping to conclusions (JTC) was linked to a significant increase in the number of days of hospitalization and a more than threefold increased risk of undergoing involuntary hospitalization after 4 years of follow-up.

The findings were presented here at the Schizophrenia International Research Society (SIRS) 2016 Biennial Meeting.

Wrong Conclusion

JTC is defined as the tendency to require less information before forming beliefs or making a decision; it has been linked to the formation and maintenance of delusions.

Study investigator Victoria Rodriguez told Medscape Medical News that the issue of JTC is twofold.

"It's not only that it's a problem to make a rapid conclusion, but the problem is that, in those patients, that conclusion usually is wrong. We have to teach them that they do it and that they have to change it."

Victoria Rodriguez

The findings suggest that JTC could act as a warning flag to direct clinicians toward specific interventions, in particular, metacognition and psychoeducation.

To that end, Rodriguez has worked in the clinic with patients with first-episode psychosis, focusing specifically on JTC.

"I was surprised that they readily learned the bias, and they could change in the moment.... They could change their way of thinking. That's why I am really interested in it, and I really trust that jumping to conclusions is a good point for focusing on," she said.

Rodriguez believes that the notion of treating JTC is "very beautiful" because it has been shown to underlie delusional ideation, which in turn has a bearing on clinical outcomes. Consequently, it may be that by altering JTC, "we could avoid all this symptomatology."

Building on previous research showing that social cognition is impaired in patients with schizophrenia and is a stronger predictor of functional outcomes than neurocognition or symptomatology, the team examined the relationship between the presence of JTC at baseline and clinical outcomes at 4 years.

Hospitalization Predictor

They used data from the GAP study, gathering information on 102 patients with first-episode psychosis who had completed the Positive and Negative Syndrome Scale (PANSS), the Global Assessment of Functioning (GAF), the Clinical Global Impression rating scale (CGI), and the probabilistic reasoning Beads Task, which assesses JTC.

Patients were regarded as meeting the diagnostic criteria for JTC if they made decisions after two or fewer items on the Beads Task. The intestigators then classified the patients as those with JTC bias and those without it. Data on clinical course and outcomes were gathered from the patients' electronic psychiatric clinical records at the South London and Maudsley National Health Service Foundation Trust.

Fifty-two patients met the criteria for JTC. Patients without JTC had significantly lower baseline PANSS Positive Scale scores than those with JTC, at a mean of 12.29 vs 14.75 (P = .04).

In addition, patients without JTC had significantly higher baseline GAF disability scores than those with JTC, at a mean of 62.58 vs 55.42 (P = .02) and significantly lower baseline CGI scores, at 2.66 vs 3.46 (P = .00).

There were no significant differences between patients with JTC and those without regarding baseline scores on the PANSS Negative and General scales and baseline GAF symptom scores.

After a mean follow-up period of 4.1 years, there were significant differences in clinical outcomes on unadjusted analyses between JTC and non-JTC groups in terms of the days of hospitalization (P < .001), the use of the 1983 UK Mental Health Act to compel a patient to undergo involuntary hospitalization (P < .05), and police interventions (P < .05).

On multivariate analysis, which took into account patient age, sex, and ethnicity, JTC was a significant predictor of increased days of hospitalization, at a beta value of 0.58 (P < .001) and use of the Mental Health Act to hospitalize a patient involuntarily, at an odds ratio 3.49 (P < .05).

The researchers conclude that JTC is associated with poor clinical outcomes and suggest that interventions that target JTC, such as metacognition training, may be beneficial in early psychosis.

Rodriguez acknowledged that the impact on outcomes of the significant differences in baseline PANSS, GAF, and CGI scores between the JTC and non-JTC groups could not be adequately determined, owing to the relatively small sample size.

However, she does not believe that they are mediating the effect of JTC on 4-year outcomes, inasmuch as there were no differences at follow-up.

The investigators report no relevant financial relationships.

Schizophrenia International Research Society (SIRS) 2016 Biennial Meeting: Poster M77, presented April 4, 2016.

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