| Sammanfattning: | <p><strong>Systematic Review of the Literature</strong></p>
<p><strong>Sleep and Paranoia: a systematic review and meta-analysis</strong></p>
<p><em>Background:</em> Sleep dysfunction commonly co-occurs with paranoia and is hypothesised to be a contributory causal mechanism in its development and maintenance.</p>
<p><em>Objectives:</em> To systematically review and quantitatively evaluate the evidence for the relationship between sleep dysfunction and paranoia across the spectrum of severity.</p>
<p><em>Method:</em> A systematic search was conducted to identify studies investigating the relationship between aspects of sleep and paranoia across clinical and non-clinical groups. A random effects model using a Fisher r-to-z transformed correlation coefficient was used for meta-analysis.</p>
<p><em>Results:</em> 41 studies were included in the review and 13 in the meta-analysis. The literature supports a clear link between sleep dysfunction and paranoia across the spectrum of severity. The meta-analysis suggested this link is small-to-moderate in size (r=0.29, 95% CI: 0.15-0.42 for the six studies using the most robust measures of insomnia and paranoia). There was significant heterogeneity across studies but no evidence of publication bias. The results of the review also provided evidence that the relationship is to some extent causal, with sleep disruption leading to increased paranoia, though there is also evidence of a bi-directional relationship. Negative affect is frequently seen as a mediator of this relationship.</p>
<p><em>Conclusion:</em> This review and meta-analysis for the first time separates out and examines the significant relationship between sleep and paranoia individually from any other psychotic experience. Studies are needed that further assess the potential for early intervention on sleep dysfunction in those experiencing paranoia.</p></br>
<p><strong>Service Improvement Project</strong></p>
<p><strong>20 years versus 20 minutes: increasing the understanding of delusions from a cognitive behavioural perspective in two older adult community mental health teams</strong></p>
The last two decades have seen considerable development in our understanding of delusions, with medical perspectives broadening into more holistic bio-psychosocial models. Of particular relevance to services is the increasing evidence base for cognitive-behavioural models and treatments. A number of national initiatives have aimed to ensure these developments are reflected in services. Primarily these have targeted adult services, yet delusions are still prevalent in older adults. Across two older adult services this study assessed the number of patients experiencing delusions, explored staff perspectives regarding delusions, and delivered a brief training on cognitive behavioural approaches to delusions. Three service users contributed to the training content. Endorsement of theoretical perspectives regarding delusions were measured pre and post training. Results showed over 20% of patients in the service may be experiencing paranoia or delusions, but less than 1% of these were referred for CBT. Of 27 staff participants, less than half had received training on working with delusions, most of which was from as many as 20 years ago. Nearly all reported a lack of knowledge prevented them from considering psychological perspectives. No immediate changes in outcome measures were seen after the training, with a striking diversity in approach to delusions according to professional background. All staff qualitatively reported finding the training valuable, though engagement was dampened by high levels of stress and burnout. Promoting change within stretched systems to reflect the developing cognitive behavioural evidence base is challenging but necessary. Where full interventions are not possible, small but consistent nudges may provide a path forward.</p></br>
<p><strong>Theory Driven Research Project</strong></p>
<p><strong>Paranoia and Unusual Sensory Experiences in Parkinson’s Disease</strong></p>
<p><em>Background:</em> Psychotic experiences (PEs) in Parkinson's disease (PD) are reportedly common. However, there is a lack of knowledge regarding the specific nature of these experiences, and limited understanding of their development and maintenance.</p>
<p><em>Aims:</em> First, to comprehensively assess the severity, nature, and associated distress of paranoia and unusual sensory experiences (USEs) in PD. Second, using structural equation modelling (SEM), to assess what variables are significantly associated with these experiences, focussing on the psychological processes central to understanding PEs in non-PD groups.</p>
<p><em>Method:</em> A questionnaire battery was completed by 369 individuals with PD with a mean age of 66 years and mean time since diagnosis of 5 years. For a subset of measures, comparisons were made to an age-matched control group.</p>
<p><em>Results:</em> 182 (49%) participants reported USEs, including almost half of those not taking any dopaminergic medication. For 83 (23%), the experience was distressing. Paranoia across the sample was significantly lower than in age-matched controls. However, specific paranoid concerns around abandonment and spousal betrayal were prevalent (16% and 10% respectively). Half of those experiencing more frequent PEs wanted greater support for their symptoms. Rates of depression, anxiety, loneliness, and stigma were high across the sample, and almost all psychological variables tested were significantly associated with USEs and paranoia in individual SEMs. In unified SEMs, depression and anxiety were retained as the most significant predictors of USEs, as were negative beliefs about others and anxiety for paranoia.</p>
<p><em>Conclusion:</em> PEs in PD are common, even in those not taking dopaminergic medication. For a subset, these experiences are distressing and not resolved by existing treatment. Psychological processes like negative cognition and affect could play a maintaining role in PEs in PD thus providing easy avenues for trialling intervention. Longitudinal data to explore the direction of effects, and further exploration to understand the rates and types of paranoia is now required.</p>
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