Jumping to conclusion (JTC) : a case with schizophrenia and obsessive-compulsive symptoms

Jumping to conclusions (JTC) refers to a cognitive bias that occurs when people jump to conclusions that aren't warranted from the facts at their disposal. The probabilistic reasoning bias referred to as a JTC style of reasoning has been associated with particular psychotic symptoms such as delusions and represents a trait that can also be detected in nonpsychotic relatives of patients with schizophrenia and in non psychotic individuals with a high level of psychotic experiences (Freeman and Garety, 2008). It has been suggested that JTC is specific to delusions rather than diagnosis, and to data gathering rather than a general deficit in reasoning and possibly related to dopamine dysfunction ( Menon et al. 2008). To date, the JTC account has predominantly been investigated with probabilistic reasoning tasks such as the Beads Task (Freeman and Garety, 2008). We report here ‘beads task’ result of a patient with a schizophrenic disorder. GA, is a 25 years man , university student , diagnosed as having the disorder since 2002. Since then, he has been treated with several antipsychotics with partial remission of ‘active symptoms’ , mainly persecutory delusions toward family members. Despite symptoms, he continued studying with some results. However social contacts and interpersonal relationship dramatically diminished. Since late adolescence he manifested obsessive-compulsive symptoms of symmetry and order . GA was evaluated in an outpatient setting within a research program . He gave informed consent to participate. A computerized version of the beads task was used . The number of beads requested by a subject yielded a continuous outcome variable within a range from 0 to 20. Our ‘beads task’ mean number of beads was 2.6 (SD 2. 03 ; n. 23 with psycoses). GA needed 18 beads for his choice. Comorbidity between psychotic and obsessive compulsive (OC) symptoms is widely reported (Cunill et al. 2009). We report here that OC symptoms could move ‘bead task’ performance in the opposite direction to that reported in schizophrenia ( i.e. from small number – or single - of beads needed to complete the task to several beads). Within a diagnosis of schizophrenia , OC symptoms could ‘obscure’ the association between delusions and JTC/bead task performance. Even though it has been recently reported that state anxiety does not influence JTC ( So et al. 2008), OC symptoms in schizophrenia may represent a useful model to explore JTC underpinnings in schizophrenia and OCD, to further explain the neurobiology underlying the co-occurrence of the OC and schizophrenia . Another possibility is that such a finding could characterize a cognitive profile of schizo-OCD patients (Patel et al. 2009). Further studies on JTC/Beads Task in other diagnostic groups are needed to better explain the psycho-pathological meaning of this construct. Alessandro Rossi, Professor of Psychiatry, University of L’Aquila – Italy, Francesca Struglia, Resident in Clinical Psychology – University of L’Aquila We declare no conflict of interest. References • Cunill R, Castells X, Simeon D.( 2009). Relationships between obsessive- compulsive symptomatology and severity of psychosis in schizophrenia: a systematic review and meta-analysis.. J Clin Psychiatry. 70,70-82. • Freeman D, Pugh K, Garety P. (2008). Jumping to conclusions and paranoid ideation in the general population. Schizophr Res.102, 254-60. • Menon M, Mizrahi R, Kapur S. (2008). 'Jumping to conclusions' and delusions in psychosis: relationship and response to treatment. Schizophr Res. 98, 225-31. • Patel DD, Laws KR, Padhi A, Farrow JM, Mukhopadhaya K, Krishnaiah R, Fineberg NA.( 2009). The neuropsychology of the schizo-obsessive subtype of schizophrenia: a new analysis. Psychol Med. 12,1-13. • So SH, Freeman D, Garety P. (2008). Impact of state anxiety on the jumping to conclusions delusion bias. Aust N Z J Psychiatry. 42,879-86.