Evidence map›Paper›PMID 25528759›Full record

ArticleSchizophrenia bulletin2015

The Stress of the Street for Patients With Persecutory Delusions: A Test of the Symptomatic and Psychological Effects of Going Outside Into a Busy Urban Area.

Daniel Freeman, Richard Emsley, Graham Dunn, David Fowler, Paul Bebbington, Elizabeth Kuipers, Suzanne Jolley, Helen Waller, Amy Hardy, Philippa Garety

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Schizophrenia bulletin, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01920685 (Computerised Interventions for Thinking and Anxiety in Delusions), which is not on this map. Cited by 29 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01920685 nacompletednot on this map

Computerised Interventions for Thinking and Anxiety in Delusions (CITADEL) Trial

TypeinterventionalSponsorKing's College LondonRan2014 to 2016Enrolled25ConditionsParanoia in People With Schizophrenia-spectrum DiagnosisArmsAnxiety intervention
3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Daniel FreemanDepartment of Psychiatry, University of Oxford, Oxford, UK; daniel.freeman@psych.ox.ac.uk.
Richard EmsleyCentre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK;
Graham DunnCentre for Biostatistics, Institute of Population Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK;
David FowlerSchool of Psychology, University of Sussex, Sussex, UK;
Paul BebbingtonDepartment of Psychiatry, Faculty of Brain Sciences, University College London, UK;
Elizabeth KuipersDepartment of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; BRC of the South London and Maudsley NHS Foundation Trust, London UK.
Suzanne JolleyDepartment of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
Helen WallerDepartment of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
Amy HardyDepartment of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK;
Philippa GaretyDepartment of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; BRC of the South London and Maudsley NHS Foundation Trust, London UK.

Funding

Medical Research Council G0802418Medical Research Council G0900678Medical Research Council G0902308Wellcome Trust 085396
6 · The paper itself

Abstract

backgroundFor many patients with persecutory delusions, leaving home and going into crowded streets is a key clinical problem. In this study we aimed to inform treatment development by determining the psychological mechanisms whereby busy urban environments increase paranoia. In a randomized design with prespecified mediation analysis, we compared the effects on patients of going outside into a busy social environment with staying inside.

methodsFifty-nine patients with current persecutory delusions, in the context of nonaffective psychosis, reporting fears when going outside were assessed on factors from a cognitive model of paranoia. They were then randomized either to enter a busy local shopping street or to complete a neutral task indoors. They were then reassessed on the measures.

resultsCompared with staying inside, the street exposure condition resulted in significant increases in paranoia, voices, anxiety, negative beliefs about the self, and negative beliefs about others. There was also a decrease in positive thoughts about the self. There was no alteration in reasoning processes. There were indications that the increase in paranoia was partially mediated by increases in anxiety (45%), depression (38%), and negative beliefs about others (45%).

conclusionsWe found that increases in negative affect may form an important route by which social exposure in urban environments triggers paranoid thoughts. The study provides an illustration of how an experimental approach can be applied to help understand a specific difficulty for patients with psychosis. In future studies the effects of specific elements of the social environment could be tested.

Indexed as

Social EnvironmentAdultAnxietyDelusionsDepressionFemaleHumansMaleMiddle AgedParanoid DisordersPilot ProjectsPsychotic DisordersRandom AllocationStress, Psychologicalanxietydelusionsdepressionparanoiaurbanicity

Identifiers

PMID25528759
PMCPMC4466180

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.