This study was conducted to investigate the self-schema of paranoid schizophrenics in relation to developed delusions. A sample of 60 patients (30 with delusions of grandeur, and 30 with delusions of persecution) in remission of their symptoms, as well as a control group (61 non-psychotic individuals), completed the Young maladaptive schema questionnaire (Young, 1990), the Beck depression inventory (Beck, Rush, Shaw and Emery, 1979), and the Rosenberg self-esteem scale (Rosenberg, 1965). A pattern of maladaptive self-schemas, with moderate scores in depression and low self-esteem was found, in paranoid schizophrenics. Schizophrenic patients with delusions of persecution had an average of 8.8 maladaptive schemas (the prevalent ones being abandonment, mistrust, selfsacrifice, insufficient self-control, social undesirability and dependence). Schizophrenic patients with delusions of grandeur had an average of 9.0 maladaptive schemas (the prevalent ones being abandonment, mistrust, selfsacrifice, insufficient self-control, unrelenting standards, and entitlement). The different maladaptive schemas found in patients with delusions of grandeur, and those with delusions of persecution, indicate a relationship between the self-schema and delusions, and suggest that self-schema influences the content of the delusions. Delusion formation appears to reflect an interaction between pre-existing beliefs of the self -i.e. personality, emotions and dysfunctional cognitive processes- and the environment. Emotion also appears to play a role in delusion formation by affecting reasoning. A qualita~ive study was also conducted to investigate the acquisition of the maladaptive schemas in this population. Another sample of 20 paranoid schizophrenic patients (10 with delusions of grandeur and 10 with delusions of persecution in remission of their symptoms) as well as a group of 10 nonpsychotic individuals were interviewed. The analysis suggests that patients with delusions of grandeur as children may not have paid enough attention to the environment developing schemas without relevant childhood experiences, while patients with delusions of persecution may have paid too much attention to the environment, as children, claiming childhood experiences without holding the relevant maladaptive schemas. The results indicate that these patients may base their thinking on conceptual processes starting early in life. The findings lead to a proposal of a model to account for the formation of delusions of grandeur and persecution. This in turn leads to proposed modifications of therapeutic procedures regarding paranoid schizophrenic patients.

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Considerable evidence has established a link between trauma and schizophrenia, particularly hallucinations within schizophrenia. However, it remains unclear how trauma and schizophrenia are pheomenologically linked. The current study draws on an information processing account of the symptoms of both PTSD and schizophrenia to examine the role of prospective intrusive imagery, cumulative trauma and trait dissociation in the relationship between trauma and schizophrenia. The study explored the prevalence trauma and the distribution of trauma types for 30 participants with a schizophrenia spectrum disorder and 27 control participants. All participants completed measures of trauma, PTSO, general use of imagery, intrusive prospective imagery and trait dissociation and were compared on these measures. For clinical participants, associations between cumulative and trait dissociation and the phenomenological features of hallucinations were investigated. Those in the clinical group reported significantly more lifetime and accumulated trauma and intrusive prospective imagery relative to controls, but not greater use of general imagery. For clinical participants, 1) childhood onset cumulative trauma was related to distress associated with hallucinations; 2) trait dissociation was associated with distance of the hallucinations from the head, volume of hallucinations and increased distress associated with hallucinations; 3) the relationship between trauma and phenomenology of hallucinations was not mediated by trait dissociation. The findings build on prior research establishing elevated rates of trauma in schizophrenia and have implications for treatment and management of schizophrenia. The finding that there is greater prospective intrusive imagery reported in schizophrenia is consistent with an information processing account of intrusions and psychosis. The associations found between trauma, trait dissociation and phenomenology of hallucinations provides novel insights into how we understand theoretical accounts and treatment of psychosis.

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