Attribution bias in ultra-high risk for psychosis and first-episode schizophrenia

Attribution style bias, such as a greater tendency to perceive hostility, has been reported to be associated with paranoia in multi-episode, chronic schizophrenia patients. The aim of this study was to investigate whether young, first-episode schizophrenia patients exhibited a perceived hostility bias and if this bias was correlated with persecutory symptoms. This study also explored whether this attribution bias, associated with paranoid tendencies, also emerged in participants at ultra-high risk (UHR) for psychosis.

Thirty-nine normal controls, 24 UHR participants, and 20 young, first-episode schizophrenia patients were asked to complete the Ambiguous Intentions Hostility Questionnaire (AIHQ) and other psychosocial measures. The AIHQ, specifically developed for paranoia, is a self-report questionnaire about negative outcomes that varied intentionality (i.e., intentional, accidental, and ambiguous intentions). The perceived hostility, composite blame, and aggression bias scores were calculated, in this study, from the ambiguous situations.

First-episode patients with schizophrenia were found to have a perceived hostility bias, which was associated with persecutory symptoms. The UHR participants also showed an attribution bias for perceiving hostility and blaming others, and this attribution bias was linked to the paranoia process.

These findings suggest that a biased attribution style linked with paranoid symptoms may not only be present in first-episode psychotic patients but may already have evolved prior to the onset of frank psychotic symptoms. A biased attribution style may play a pivotal role in the persecutory process during the prodromal phase as well as a patient's first schizophrenic episode.