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Zhao K, Xie H, Fonzo GA, Carlisle N, Osorio RS, Zhang Y. Defining Dementia Subtypes Through Neuropsychiatric Symptom-Linked Brain Connectivity Patterns. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.07.02.547427. [PMID: 37461451 PMCID: PMC10349933 DOI: 10.1101/2023.07.02.547427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
BACKGROUND Dementia is highly heterogeneous, with pronounced individual differences in neuropsychiatric symptoms (NPS) and neuroimaging findings. Understanding the heterogeneity of NPS and associated brain abnormalities is essential for effective management and treatment of dementia. METHODS Using large-scale neuroimaging data from the Open Access Series of Imaging Studies (OASIS-3), we conducted a multivariate sparse canonical correlation analysis to identify functional connectivity-informed symptom dimensions. Subsequently, we performed a clustering analysis on the obtained latent connectivity profiles to reveal neurophysiological subtypes and examined differences in abnormal connectivity and phenotypic profiles between subtypes. RESULTS We identified two reliable neuropsychiatric subsyndromes - behavioral and anxiety in the connectivity-NPS linked latent space. The behavioral subsyndrome was characterized by the connections predominantly involving the default mode and somatomotor networks and neuropsychiatric symptoms involving nighttime behavior disturbance, agitation, and apathy. The anxiety subsyndrome was mainly contributed by connections involving the visual network and the anxiety neuropsychiatric symptom. By clustering individuals along these two subsyndromes-linked connectivity latent features, we uncovered three subtypes encompassing both dementia patients and healthy controls. Dementia in one subtype exhibited similar brain connectivity and cognitive-behavior patterns to healthy individuals. However, dementia in the other two subtypes showed different dysfunctional connectivity profiles involving the default mode, frontoparietal control, somatomotor, and ventral attention networks, compared to healthy individuals. These dysfunctional connectivity patterns were associated with differences in baseline dementia severity and longitudinal progression of cognitive impairment and behavioral dysfunction. CONCLUSIONS Our findings shed valuable insights into disentangling the neuropsychiatric and brain functional heterogeneity of dementia, offering a promising avenue to improve clinical management and facilitate the development of timely and targeted interventions for dementia patients.
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Affiliation(s)
- Kanhao Zhao
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
| | - Hua Xie
- Center for Neuroscience Research, Children’s National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - Gregory A. Fonzo
- Center for Psychedelic Research and Therapy, Department of Psychiatry and Behavioral Sciences, Dell Medical School, The University of Texas at Austin, TX, USA
| | - Nancy Carlisle
- Department of Psychology, Lehigh University, Bethlehem, PA, USA
| | - Ricardo S. Osorio
- Department of Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Yu Zhang
- Department of Bioengineering, Lehigh University, Bethlehem, PA, USA
- Department of Electrical and Computer Engineering, Lehigh University, Bethlehem, PA, USA
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Marchese F, Matranga M, Puglisi R, Saputo E, La Barbera D. Psychosis, symbol, affectivity 1: etiopathogenesis and treatment through analytical psychology. THE JOURNAL OF ANALYTICAL PSYCHOLOGY 2021; 66:179-199. [PMID: 34038583 DOI: 10.1111/1468-5922.12664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This is the first of two papers concerning our study into an integrated approach to psychotic disorders, conducted at the University of Palermo's Psychiatry Unit Polyclinic over approximately 15 years. Here we will explore and reflect upon the acute psychotic condition mainly from a theoretical and conceptual perspective, while in the second paper we will explore the clinical perspective. From the point of view of psychopathology, and in the light of C.G. Jung's conceptualization of analytical psychology, as well as calling on contributions from other authors from the systemic-relational and post-psychoanalytic field, we will clarify the ideas developed over these last few years by our team. From a more speculative perspective we will advance new interpretive hypotheses in an attempt to thoroughly understand the nature of the psychotic condition, both on a psychodynamic relational and a neuroscientific level. The paper describes how we revised our understanding of psychosis from a brain disease to a process aimed at the rearrangement of psychic functioning, as anticipated by John Weir Perry nearly 40 years ago.
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Knott V, Wright N, Shah D, Baddeley A, Bowers H, de la Salle S, Labelle A. Change in the Neural Response to Auditory Deviance Following Cognitive Therapy for Hallucinations in Patients With Schizophrenia. Front Psychiatry 2020; 11:555. [PMID: 32595542 PMCID: PMC7304235 DOI: 10.3389/fpsyt.2020.00555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
Adjunctive psychotherapeutic approaches recommended for patients with schizophrenia (SZ) who are fully or partially resistant to pharmacotherapy have rarely utilized biomarkers to enhance the understanding of treatment-effective mechanisms. As SZ patients with persistent auditory verbal hallucinations (AVH) frequently evidence reduced neural responsiveness to external auditory stimulation, which may impact cognitive and functional outcomes, this study examined the effects of cognitive behavioral therapy for voices (CBTv) on clinical and AVH symptoms and the sensory processing of auditory deviants as measured with the electroencephalographically derived mismatch negativity (MMN) response. Twenty-four patients with SZ and AVH were randomly assigned to group CBTv treatment or a treatment as usual (TAU) condition. Patients in the group CBTv condition received treatment for 5 months while the matched control patients received TAU for the same period, followed by 5 months of group CBTv. Assessments were conducted at baseline and at the end of treatment. Although not showing consistent changes in the frequency of AVHs, CBTv (vs. TAU) improved patients' appraisal (p = 0.001) of and behavioral/emotional responses to AVHs, and increased both MMN generation (p = 0.001) and auditory cortex current density (p = 0.002) in response to tone pitch deviants. Improvements in AVH symptoms were correlated with change in pitch deviant MMN and current density in left primary auditory cortex. These findings of improved auditory information processing and symptom-response attributable to CBTv suggest potential clinical and functional benefits of psychotherapeutical approaches for patients with persistent AVHs.
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Affiliation(s)
- Verner Knott
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Wright
- Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Dhrasti Shah
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Ashley Baddeley
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Hayley Bowers
- Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Sara de la Salle
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Alain Labelle
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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Spaulding WD, Sullivan ME. Treatment of Cognition in the Schizophrenia Spectrum: The Context of Psychiatric Rehabilitation. Schizophr Bull 2016; 42 Suppl 1:S53-61. [PMID: 27460619 PMCID: PMC4960428 DOI: 10.1093/schbul/sbv163] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Evidence-based approaches and modalities for targeting and treating the cognitive impairments of schizophrenia have proliferated over the past 15 years. The impairments targeted are distributed across the cognitive spectrum, from elemental perception, attention, and memory, to complex executive and social-cognitive functioning. Cognitive treatment is most beneficial when embedded in comprehensive programs of psychiatric rehabilitation. To personalize comprehensive treatment and rehabilitation of schizophrenia spectrum disorders, practitioners and participants must select from a rapidly expanding array of particular modalities and apply them in the broad context of the participant's overall recovery. At present, no particular treatment, cognitive or otherwise, can be considered more important or primary than the context in which it is applied. Persistent difficulty in dissemination of new technology for severe and disabling mental illness compounds the significance of the context created by a full treatment array. In this article, a case-study of a mental health service system is described, showing the broad-ranging effects of degrading the rehabilitative context of treatments, obviating the benefits of cognitive treatment and other modalities. To realize the promise of cognitive treatment, the problems that prevent dissemination and maintenance of complete psychiatric rehabilitation programs have to be addressed.
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Affiliation(s)
- Will D. Spaulding
- *To whom correspondence should be addressed; Department of Psychology, University of Nebraska—Lincoln, Lincoln, NE 68588-0308, US; e-mail:
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Longenecker J, Hui C, Chen EYH, Elvevåg B. Concepts of 'self' in delusion resolution. SCHIZOPHRENIA RESEARCH-COGNITION 2015; 3:8-10. [PMID: 28740801 PMCID: PMC5506726 DOI: 10.1016/j.scog.2015.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/24/2015] [Accepted: 10/26/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Christy Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China.,State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Brita Elvevåg
- Psychiatry Research Group, Department of Clinical Medicine, University of Tromsø, Norway.,Norwegian Centre for Integrated Care and Telemedicine (NST), University Hospital of North Norway, Tromsø, Norway
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Fineberg SK, Deutsch-Link S, Ichinose M, McGuinness T, Bessette AJ, Chung CK, Corlett PR. Word use in first-person accounts of schizophrenia. Br J Psychiatry 2015; 206:32-8. [PMID: 24970770 PMCID: PMC4283590 DOI: 10.1192/bjp.bp.113.140046] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Language use is often disrupted in patients with schizophrenia; novel computational approaches may provide new insights. AIMS To test word use patterns as markers of the perceptual, cognitive and social experiences characteristic of schizophrenia. METHOD Word counting software was applied to first-person accounts of schizophrenia and mood disorder. RESULTS More third-person plural pronouns ('they') and fewer first-person singular pronouns ('I') were used in schizophrenia than mood disorder accounts. Schizophrenia accounts included fewer words related to the body and ingestion, and more related to religion. Perceptual and causal language were negatively correlated in schizophrenia accounts but positively correlated in mood disorder accounts. CONCLUSIONS Differences in pronouns suggest decreased self-focus or perhaps even an understanding of self as other in schizophrenia. Differences in how perceptual and causal words are correlated suggest that long-held delusions represent a decreased coupling of explanations with sensory experience over time.
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Morriss R, Vinjamuri I, Faizal MA, Bolton CA, McCarthy JP. Training to recognise the early signs of recurrence in schizophrenia. Cochrane Database Syst Rev 2013:CD005147. [PMID: 23450559 DOI: 10.1002/14651858.cd005147.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Schizophrenia has a lifetime prevalence of less than one per cent. Studies have indicated that early symptoms that are idiosyncratic to the person with schizophrenia (early warning signs) often precede acute psychotic relapse. Early warning signs interventions propose that learning to detect and manage early warning signs of impending relapse might prevent or delay acute psychotic relapse. OBJECTIVES To compare the effectiveness of early warning signs interventions plus treatment as usual involving and not involving a psychological therapy on time to relapse, hospitalisation, functioning, negative and positive symptomatology. SEARCH METHODS Search databases included the Cochrane Schizophrenia Group Trials Register (July 2007 and May 2012) which is based on regular searches of BIOSIS, CENTRAL, CINAHL, EMBASE, MEDLINE and PsycINFO. References of all identified studies were reviewed for inclusion. We inspected the UK National Research Registe and contacted relevant pharmaceutical companies and authors of trials for additional information. SELECTION CRITERIA We included all randomised clinical trials (RCTs) comparing early warning signs interventions plus treatment as usual to treatment as usual for people with schizophrenia or other non-affective psychosis DATA COLLECTION AND ANALYSIS We assessed included studies for quality and extracted data. If more than 50% of participants were lost to follow-up, the study was excluded. For binary outcomes, we calculated standard estimates of risk ratio (RR) and the corresponding 95% confidence intervals (CI), for continuous outcomes, we calculated mean differences (MD) with standard errors estimated, and for time to event outcomes we calculated Cox proportional hazards ratios (HRs) and associated 95 % CI. We assessed risk of bias for included studies and assessed overall study quality using the GRADE approach. MAIN RESULTS Thirty-two RCTs and two cluster-RCTs that randomised 3554 people satisfied criteria for inclusion. Only one study examined the effects of early warning signs interventions without additional psychological interventions, and many of the outcomes for this review were not reported or poorly-reported. Significantly fewer people relapsed with early warning signs interventions than with usual care (23% versus 43%; RR 0.53, 95% CI 0.36 to 0.79; 15 RCTs, 1502 participants; very low quality evidence). Time to relapse did not significantly differ between intervention groups (6 RCTs, 550 participants; very low quality evidence). Risk of re-hospitalisation was significantly lower with early warning signs interventions compared to usual care (19% versus 39%; RR 0.48, 95% CI 0.35 to 0.66; 15 RCTS, 1457 participants; very low quality evidence). Time to re-hospitalisation did not significantly differ between intervention groups (6 RCTs; 1149 participants; very low quality evidence). Participants' satisfaction with care and economic costs were inconclusive because of a lack of evidence. AUTHORS' CONCLUSIONS This review indicates that early warning signs interventions may have a positive effect on the proportions of people re-hospitalised and on rates of relapse, but not on time to recurrence. However, the overall quality of the evidence was very low, indicating that we do not know if early warning signs interventions will have similar effects outside trials and that it is very likely that further research will alter these estimates. Moreover, the early warning signs interventions were used along side other psychological interventions, and we do not know if they would be effective on their own. They may be cost-effective due to reduced hospitalisation and relapse rates, but before mental health services consider routinely providing psychological interventions involving the early recognition and prompt management of early warning signs to adults with schizophrenia, further research is required to provide evidence of high or moderate quality regarding the efficacy of early warning signs interventions added to usual care without additional psychological interventions, or to clarify the kinds of additional psychological interventions that might aid its efficacy. Future RCTs should be adequately-powered, and designed to minimise the risk of bias and be transparently reported. They should also systematically evaluate resource costs and resource use, alongside efficacy outcomes and other outcomes that are important to people with serious mental illness and their carers.
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Stafford MR, Jackson H, Mayo-Wilson E, Morrison AP, Kendall T. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ 2013; 346:f185. [PMID: 23335473 PMCID: PMC3548617 DOI: 10.1136/bmj.f185] [Citation(s) in RCA: 276] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether any psychological, pharmacological, or nutritional interventions can prevent or delay transition to psychotic disorders for people at high risk. DESIGN Systematic review and meta-analysis. DATA SOURCES Embase, Medline, PreMedline, PsycINFO, and CENTRAL were searched to November 2011 without restriction to publication status. REVIEW METHODS Randomised trials comparing any psychological, pharmacological, nutritional, or combined intervention with usual services or another treatment. Studies of participants with a formal diagnosis of schizophrenia or bipolar disorder were excluded. Studies were assessed for bias, and relevant limitations were considered in summarising the results. RESULTS 11 trials including 1246 participants and eight comparisons were included. Median sample size of included trials was 81 (range 51-288). Meta-analyses were performed for transition to psychosis, symptoms of psychosis, depression, and mania; quality of life; weight; and discontinuation of treatment. Evidence of moderate quality showed an effect for cognitive behavioural therapy on reducing transition to psychosis at 12 months (risk ratio 0.54 (95% confidence interval 0.34 to 0.86); risk difference -0.07 (-0.14 to -0.01). Very low quality evidence for omega-3 fatty acids and low to very low quality evidence for integrated psychotherapy also indicated that these interventions were associated with reductions in transition to psychosis at 12 months. CONCLUSIONS Although evidence of benefits for any specific intervention is not conclusive, these findings suggest that it might be possible to delay or prevent transition to psychosis. Further research should be undertaken to establish conclusively the potential for benefit of psychological interventions in the treatment of people at high risk of psychosis.
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Affiliation(s)
- Megan R Stafford
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK.
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Yanos PT, Roe D, Lysaker PH. Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness. Int J Group Psychother 2012; 61:577-95. [PMID: 21985260 DOI: 10.1521/ijgp.2011.61.4.576] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.
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Affiliation(s)
- Philip T Yanos
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, NY 10019, USA.
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Aleman A, Larøi F. Insights into hallucinations in schizophrenia: novel treatment approaches. Expert Rev Neurother 2011; 11:1007-15. [PMID: 21721917 DOI: 10.1586/ern.11.90] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Novel strategies are needed in the treatment of hallucinations as a subgroup of patients with pathological hallucinations (>30%) do not respond to antipsychotics or are not compliant with medication. We review recently developed biological and cognitive treatments. Repetitive transcranial magnetic stimulation concerns neuromodulation targeted at aberrant activity in regions shown to be hyperactive in neuroimaging studies. Repetitive transcranial magnetic stimulation has been shown to reduce auditory hallucinations in several studies. However, not all studies have confirmed such effects, and a number of questions remain. With regard to cognitive therapeutic approaches, new proposals include attention training, acceptance and commitment therapy, and competitive memory training. After a brief discussion of these approaches, we take stock of recent advances and discuss avenues for future research.
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Affiliation(s)
- André Aleman
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, The Netherlands.
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A two-year cross-sectional study on the information about schizophrenia divulged by a prestigious daily newspaper. J Nerv Ment Dis 2011; 199:659-65. [PMID: 21878779 DOI: 10.1097/nmd.0b013e318229cf90] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Media is an important source of information about mental health for the public. The current study analyzed the information about schizophrenia divulged by the largest Brazilian newspaper. A content analysis examined articles on health and news involving affected individuals or suspected cases. The articles were rated against indicators of poor quality reporting and of effective health communication. The presence of myths was examined. The search identified 687 articles, 75 of which fulfilled the inclusion/exclusion criteria and were selected. The themes with the highest number of articles were mental disorders and violence, treatment, and etiology. Three articles described the social inclusion stories of affected individuals. The coverage addressed genetic factors, drug-induced psychosis risk, and antipsychotic benefits, which may contribute to stigma reduction toward treatment. However, the articles divulged stigmatizing messages, and the entire complexity of the disorder was not discussed. Dangerousness was a common theme, which may invalidate positive messages about social inclusion.
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Spaulding W, Deogun J. A pathway to personalization of integrated treatment: informatics and decision science in psychiatric rehabilitation. Schizophr Bull 2011; 37 Suppl 2:S129-37. [PMID: 21860042 PMCID: PMC3160127 DOI: 10.1093/schbul/sbr080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Personalization of treatment is a current strategic goal for improving health care. Integrated treatment approaches such as psychiatric rehabilitation benefit from personalization because they involve matching diverse arrays of treatment options to individually unique profiles of need. The need for personalization is evident in the heterogeneity of people with severe mental illness and in the findings of experimental psychopathology. One pathway to personalization lies in analysis of the judgments and decision making of human experts and other participants as they respond to complex circumstances in pursuit of treatment and rehabilitation goals. Such analysis is aided by computer simulation of human decision making, which in turn informs development of computerized clinical decision support systems. This inspires a research program involving concurrent development of databases, domain ontology, and problem-solving algorithms, toward the goal of personalizing psychiatric rehabilitation through human collaboration with intelligent cyber systems. The immediate hurdle is to demonstrate that clinical decisions beyond diagnosis really do affect outcome. This can be done by supporting the hypothesis that a human treatment team with access to a reasonably comprehensive clinical database that tracks patient status and treatment response over time achieves better outcome than a treatment team without such access, in a controlled experimental trial. Provided the hypothesis can be supported, the near future will see prototype systems that can construct an integrated assessment, formulation, and rehabilitation plan from clinical assessment data and contextual information. This will lead to advanced systems that collaborate with human decision makers to personalize psychiatric rehabilitation and optimize outcome.
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Krabbendam L, Myin-Germeys I, Hanssen M, de Graaf R, Vollebergh W, Bak M, van Os J. Development of depressed mood predicts onset of psychotic disorder in individuals who report hallucinatory experiences. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2010; 44:113-25. [PMID: 15826348 DOI: 10.1348/014466504x19767] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Current psychological theories state that the clinical outcome of hallucinatory experiences is dependent on the degree of associated distress, anxiety, and depression. This study examined the hypothesis that the risk for onset of psychotic disorder in individuals with self-reported hallucinatory experiences would be higher in those who subsequently developed depressed mood than in those who did not. DESIGN A prospective cohort study of a general population sample. METHODS A sample of 4,670 individuals with no lifetime evidence of any psychotic disorder were interviewed with the Composite International Diagnostic Interview Schedule (CIDI) at baseline and 1 and 3 years later. At Year 3, individuals with CIDI evidence of psychotic symptoms were interviewed by clinicians to identify potential onset of psychotic disorder. Psychotic disorder was specified at three levels; two involving severity of positive symptoms of psychosis, and one using additional clinical judgment of need for care. RESULTS Given the presence of hallucinatory experiences at baseline, the increase in risk of having the psychosis outcome at Year 3 was higher in the group with depressed mood at Year 1 than in the group without depressed mood at Year 1 (any level of psychotic symptoms: risk difference 17.0%, 95% CI - 1.7, 35.7; severe level of psychotic symptoms: risk difference 21.7%, 95% CI 3.2, 40.2; needs-based diagnosis of psychotic disorder: risk difference 16.8%, 95% CI 0.4, 33.3). CONCLUSION The results are in line with current psychological models of psychosis that emphasize the role of secondary appraisals of psychotic experiences in the onset of clinical disorder.
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Affiliation(s)
- Lydia Krabbendam
- Department of Psychiatry and Neuropsychology, Maastricht University, The Netherlands.
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Autobiography as tool to improve lifestyle, well being, and self-narrative in patients with mental disorders. J Nerv Ment Dis 2010; 198:564-71. [PMID: 20699721 DOI: 10.1097/nmd.0b013e3181ea4e59] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aims of the present study were to explore how the autobiographical process can lead to a transformation in psychiatric patients' lifestyle, well-being, and self-narrative. Nine participants, aged between 20 and 42 years and affected by axis I psychiatric disorders (DSM IV) were selected to participate in an autobiographical laboratory. Eight to 10 meetings took place, each lasting about an hour, during which autobiographical accounts were collected. At the beginning and end of the autobiographical laboratory, the medical staff completed the Social Functioning Scale to evaluate each patient across 6 dimensions: social engagement, interpersonal ability, prosocial activities, recreation, independence-competence, and independence-performance. The Language Inquiry and Word Count (Pennebaker and Francis, 1996) was used to analyze patients' autobiographical accounts. A comparison between the first and second compilation of the Social Functioning Scale showed significant positive changes across the 6 social dimensions. The analysis of language in the narratives collected in the first and seventh meeting showed how inpatients passed from a narrative that was more centered on the memory of the past to a narrative that was more similar to a conversation and enriched with "insight" terms and the use of verbs in the conjunctive form. The authors interpret these outcomes as being consistent with the improvement that was observed in inpatients' social functioning.
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Phillips LJ, Nelson B, Yuen HP, Francey SM, Simmons M, Stanford C, Ross M, Kelly D, Baker K, Conus P, Amminger P, Trumpler F, Yun Y, Lim M, McNab C, Yung AR, McGorry PD. Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics. Aust N Z J Psychiatry 2009; 43:818-29. [PMID: 19670055 DOI: 10.1080/00048670903107625] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Intervention during the pre-psychotic period of illness holds the potential of delaying or even preventing the onset of a full-threshold disorder, or at least of reducing the impact of such a disorder if it does develop. The first step in realizing this aim was achieved more than 10 years ago with the development and validation of criteria for the identification of young people at ultra-high risk (UHR) of psychosis. Results of three clinical trials have been published that provide mixed support for the effectiveness of psychological and pharmacological interventions in preventing the onset of psychotic disorder. METHOD The present paper describes a fourth study that has now been undertaken in which young people who met UHR criteria were randomized to one of three treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n = 43); cognitive therapy plus placebo (CogTher + Placebo: n = 44); and supportive counselling + placebo (Supp + Placebo; n = 28). A fourth group of young people who did not agree to randomization were also followed up (monitoring: n = 78). Baseline characteristics of participants are provided. RESULTS AND CONCLUSION The present study improves on the previous studies because treatment was provided for 12 months and the independent contributions of psychological and pharmacological treatments in preventing transition to psychosis in the UHR cohort and on levels of psychopathology and functioning can be directly compared. Issues associated with recruitment and randomization are discussed.
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Affiliation(s)
- Lisa J Phillips
- Department of Psychology, University of Melbourne, Melbourne, Victoria 3010, Australia.
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Foster JH, Jumnoodoo R. Relapse prevention in serious and enduring mental illness: a pilot study. J Psychiatr Ment Health Nurs 2008; 15:552-61. [PMID: 18768007 DOI: 10.1111/j.1365-2850.2008.01265.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of the research was to ascertain whether coping knowledge and relapse outcomes are enhanced after 12 months following a programme of community-based relapse prevention (RP). Relapse to mental illness has high societal costs and this programme aims to lessen the likelihood of relapse by equipping service users with greater coping mechanisms by employing a quasi-experimental design with some controls. Participants are recruited from a day hospital in London. There are two groups: (1) experimental group (n = 10) and (2) control group (n = 10). The experimental group is given an 8-week RP programme, and the control group receives routine care. Both groups are then followed up at 1, 2 and 12 months. The research hypothesis was participants undergoing a programme of RP will have greater 12-month knowledge and superior relapse outcomes. The 52-week follow-up rates are 80% for experimental group and 70% for control group. There are no differences in the two groups in terms of relapse outcomes. Knowledge between baseline and 52 weeks is improved in the experimental group though most of the changes are observed during the first 12 weeks. We conclude that an 8-week RP programme resulted in improved knowledge but not relapse outcomes at 52 weeks. A randomized controlled trial should now be conducted to assess whether these results are replicated.
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Affiliation(s)
- J H Foster
- School of Health and Social Sciences, Middlesex University, London, UK.
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Abstract
The aim of the present study was to explore how the autobiographical process can lead to a transformation in the quality of psychiatric patients' self-narrative. Fifteen participants, with ages ranging from 25 to 40 years and affected by axis I psychiatric disorders (DSM IV), were selected to participate. A 10-question interview referring to 10 autobiographical cruxes was used to collect autobiographical data; the interview was readministered 2 weeks later. A coding system (the N.O.I.S.) was used to analyze each participant's 2 autobiographical productions. Results from the second interviews showed significant and positive transformations in the quality of patients' autobiographical representation.
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Peer JE, Kupper Z, Long JD, Brekke JS, Spaulding WD. Identifying mechanisms of treatment effects and recovery in rehabilitation of schizophrenia: longitudinal analytic methods. Clin Psychol Rev 2007; 27:696-714. [PMID: 17343964 DOI: 10.1016/j.cpr.2007.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 01/08/2007] [Indexed: 10/23/2022]
Abstract
The longitudinal dimension of schizophrenia and related severe mental illness is a key component of theoretical models of recovery. However, empirical longitudinal investigations have been underrepresented in the psychopathology of schizophrenia. Similarly, traditional approaches to longitudinal analysis of psychopathological data have had serious limitations. The utilization of modern longitudinal methods is necessary to capture the complexity of biopsychosocial models of treatment and recovery in schizophrenia. The present paper summarizes empirical data from traditional longitudinal research investigating recovery in symptoms, neurocognition, and social functioning. Studies conducted under treatment as usual conditions are compared to psychosocial intervention studies and potential treatment mechanisms of psychosocial interventions are discussed. Investigations of rehabilitation for schizophrenia using the longitudinal analytic strategies of growth curve and time series analysis are demonstrated. The respective advantages and disadvantages of these modern methods are highlighted. Their potential use for future research of treatment effects and recovery in schizophrenia is also discussed.
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Affiliation(s)
- Jason E Peer
- Department of Psychology, University of Nebraska-Lincoln, USA.
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Combs DR, Adams SD, Michael CO, Penn DL, Basso MR, Gouvier WD. The conviction of delusional beliefs scale: reliability and validity. Schizophr Res 2006; 86:80-8. [PMID: 16884894 DOI: 10.1016/j.schres.2006.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2006] [Revised: 06/09/2006] [Accepted: 06/14/2006] [Indexed: 11/24/2022]
Abstract
This study reports on the development of a new measure of delusional belief conviction, the Conviction of Delusional Beliefs Scale (CDBS). Most of the current scales in use assess belief conviction with a single item and primarily reflect the cognitive aspects of conviction. The CDBS represents an improvement over existing scales in that it contains a larger number of test items that can be subjected to psychometric examination. In addition, the CDBS also broadens the concept of belief conviction by incorporating cognitive, emotional, and behavioral items. In the present study, fifty participants with delusions completed the CDBS along with measures of delusional ideation, psychiatric symptomatology, insight, and reading ability. The CDBS showed very good levels of internal consistency and test-retest stability over a six-week period. All of the CDBS items loaded highly on a unitary factor of belief conviction. The CDBS positively correlated with four measures of belief conviction thereby reflecting the convergent validity of the scale. The CDBS was unrelated to other dimensions of delusional ideation, psychiatric symptomatology, insight, and reading ability, which supported the discriminant validity of the scale. The CDBS appears to be a reliable and valid measure of delusional belief conviction that could be used in clinical and research settings.
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Affiliation(s)
- Dennis R Combs
- University of Tulsa, Department of Psychology, Lorton Hall, Tulsa, OK 74104, USA.
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Affiliation(s)
- Lorraine Childs
- Medlicott Academic Unit, Christchurch, New Zealand
- Medlicott Academic Unit, Regional Forensic Psychiatric Service, Canterbury District Health Board, Hillmorton Hospital Prvt. Bag 4733, Christchurch, New Zealand
| | - Philip Brinded
- Medlicott Academic Unit, Christchurch, New Zealand
- Medlicott Academic Unit, Regional Forensic Psychiatric Service, Canterbury District Health Board, Hillmorton Hospital Prvt. Bag 4733, Christchurch, New Zealand
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21
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Abstract
Cognitive behavioral therapy is an emerging treatment being used to attenuate negative thoughts and emotions tied to the formation, expression, and maintenance of verbal auditory hallucinations. This paper describes the theoretical underpinnings for the intervention and a clinical application of a prototype cognitive nursing intervention for treating faulty thinking and beliefs linked with problematic voice hearing experiences. The paper ends with a review of current evidence and implications concerning the efficacy of cognitive intervention approaches with voice hearers.
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Jenner JA, Nienhuis FJ, van de Willige G, Wiersma D. "Hitting" voices of schizophrenia patients may lastingly reduce persistent auditory hallucinations and their burden: 18-month outcome of a randomized controlled trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:169-77. [PMID: 16618008 DOI: 10.1177/070674370605100307] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to investigate the outcome of an 18-month randomized controlled trial (RCT) on subjective burden and psychopathology of patients suffering from schizophrenia. METHOD An RCT was used to compare hallucination-focused integrative treatment (HIT) and routine treatment (RT) in schizophrenia patients who persistently hear voices. We performed an intent-to-treat analysis on each of the 63 patients who were assessed at baseline, 9, and 18 months. On each of the 3 occasions, the differential effects of the treatment conditions were tested repeatedly. Sex, age, education, and illness (hallucination) duration were used as covariates. RESULTS Patients in the experimental group retained improvements over time. Improvements in hallucinations, distress, and negative content of voices remained significant at the 5% level. CONCLUSION HIT seems to be an effective treatment strategy with long-lasting effects for treatment-refractory voice-hearing patients.
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Affiliation(s)
- Jack A Jenner
- Department of Psychiatry, University Medical Center and Mental Health Care Foundation, Groningen, The Netherlands.
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Abstract
A recent renewed interest in psychosocial treatments for psychosis has only minimally included considerations of narrative therapy and other interventions based in post-modernism. This lack of attention is curious given the profound narrative disruptions often seen in psychotic illness. In this review article we describe several studies in which narratives and narrative dimensions have been utilized to assess outcomes in psychosis. Valid and reliable measures of narrative change in psychosis are possible and can coexist with and complement traditional outcome measures. Perhaps more significantly, considerations of narrative changes may offer unique insights into the process of recovery from psychosis as well as leading to beneficial psychosocial treatments for the same.
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Lysaker PH, Buck KD, Hammoud K, Taylor AC, Roe D. Associations of symptoms, psychosocial function and hope with qualities of self-experience in schizophrenia: comparisons of objective and subjective indicators of health. Schizophr Res 2006; 82:241-9. [PMID: 16442265 DOI: 10.1016/j.schres.2005.12.844] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Revised: 11/28/2005] [Accepted: 12/07/2005] [Indexed: 12/23/2022]
Abstract
While changes in self-experience have been suggested to be an important element of recovery from severe mental illness, little is known about how qualities of self-experience are linked with other indicators of health including objective measures such as symptoms profiles and subjective measures such as hope. To examine these issues the narratives of self and illness of 65 persons with schizophrenia spectrum disorder were obtained prior to entry into rehabilitation and rated using the Scale to Assess Narrative Development (STAND). STAND scores were then compared with concurrent assessments of hope assessed with the Beck Hopelessness Scale (BHS), psychosocial function using the Quality of Life Scale (QOLS) and symptom profile defined categorically using the Positive and Negative Syndrome Scale (PANSS). Results suggest that higher ratings of the STAND were associated with greater expectations of perseverance on the BHS and higher levels of psychosocial function on the QOL. Lower symptom profiles were similarly linked with higher STAND scores. Results suggest qualities of self-experience expressed within personal narratives are linked to symptom profiles and subjective assessments of health. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Paul H Lysaker
- Roudebush VA Medical Center, Day Hospital 116H, 1481 West 10th St, Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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25
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Jenner JA, van de Willige G, Wiersma D. Multi-family treatment for patients with persistent auditory hallucinations and their relatives: a pilot study. Acta Psychiatr Scand 2006; 113:154-8. [PMID: 16423168 DOI: 10.1111/j.1600-0447.2005.00656.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To test feasibility and effectiveness of multi-family treatment (MFT) for patients with persistent auditory hallucinations. METHOD A naturalistic pilot study with 6-month follow-up of 12 patients and 10 relatives. Pre- and post-treatment assessment concerned compliance, satisfaction, subjective burden, and control of voices, psychopathology, quality of life, social functioning and burden on the family. RESULTS Significant improvements were found in all domains. Compliance and satisfaction with treatment were satisfactory. Self-help contacts outside treatment sessions increased over time. CONCLUSION MFT may be considered a potentially effective form of additional treatment for refractory voice hearers.
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Affiliation(s)
- J A Jenner
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
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26
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Cognitive behavioral therapy and functional and metacognitive outcomes in schizophrenia: A single case study. COGNITIVE AND BEHAVIORAL PRACTICE 2005. [DOI: 10.1016/s1077-7229(05)80074-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zimmermann G, Favrod J, Trieu VH, Pomini V. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophr Res 2005; 77:1-9. [PMID: 16005380 DOI: 10.1016/j.schres.2005.02.018] [Citation(s) in RCA: 263] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 02/24/2005] [Accepted: 02/28/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite the effectiveness of anti-psychotic pharmacotherapy, residual hallucinations and delusions do not completely resolve in some medicated patients. Additional cognitive behavioral therapy (CBT) seems to improve the management of positive symptoms. Despite promising results, the efficacy of CBT is still unclear. The present study addresses this issue taking into account a number of newly published controlled studies. METHOD Fourteen studies including 1484 patients, published between 1990 and 2004 were identified and a meta-analysis of their results performed. RESULTS Compared to other adjunctive measures, CBT showed significant reduction in positive symptoms and there was a higher benefit of CBT for patients suffering an acute psychotic episode versus the chronic condition (effect size of 0.57 vs. 0.27). DISCUSSION CBT is a promising adjunctive treatment for positive symptoms in schizophrenia spectrum disorders. However, a number of potentially modifying variables have not yet been examined, such as therapeutic alliance and neuropsychological deficits.
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Affiliation(s)
- G Zimmermann
- Research Unit in Cognitive-behavioral Therapy, Institute for Psychotherapy, Department of Psychiatry, University of Lausanne, Switzerland.
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28
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Werbart A, Levander S. Understanding the incomprehensible: Private theories of first–episode psychotic patients and their therapists. Bull Menninger Clin 2005; 69:103-36. [PMID: 16006248 DOI: 10.1521/bumc.69.2.103.66507] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Private theories about psychosis, its background, and cure were studied using narratives of first-time psychotic patients and their therapists. Both patients and their therapists were interviewed on three occasions over a period of 1 1/2 years. Three cases were chosen as dyads in point in order to highlight different relations between the patient's and the therapist's private theories, different patterns of recovery from psychosis, and different outcomes. The cases are contrasted by paired comparisons. The study indicates that an awareness and joint discussion of incompatibilities between the two participants' private theories might be a substantial contribution to the process of recovery from psychosis.
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Affiliation(s)
- Andrzej Werbart
- Swedish Psychoanalytical Society, Institute of Psychotherapy, Stockholm County Council, Sweden.
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29
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Group cognitive-behavioral therapy for auditory hallucinations: A pilot study. COGNITIVE AND BEHAVIORAL PRACTICE 2004. [DOI: 10.1016/s1077-7229(04)80011-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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30
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Dickerson FB. Update on Cognitive Behavioral Psychotherapy for Schizophrenia: Review of Recent Studies. J Cogn Psychother 2004. [DOI: 10.1891/jcop.18.3.189.65654] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive-behavioral psychotherapy (CBT) for schizophrenia has been the focus of clinical trials. This article reviews 17 recent studies including 5 from the United States or Canada. CBT interventions vary by the patient group to whom they are provided. Both individual and group CBT therapies have been developed, some of which have been combined with other psychosocial treatments. There is inconsistency among the study results, but evidence is strongest for the benefit to outpatients who have residual symptoms including hallucinations, delusions, or negative symptoms. Methodological issues include the type of comparison group used, the adequacy of the sample size, and patient attrition. Future investigations of CBT would be improved by a greater standardization of study procedures and by stratifying patients according to clinical characteristics to better understand which patients are more likely to benefit.
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31
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Abstract
The DSM-IV definition of delusion is argued to be unsatisfactory because it does not explain the mechanism for delusion formation and maintenance, it implies that such beliefs are necessarily dysfunctional (pathological), it underestimates the social component to some delusions, and it is inconsistent with research indicating that delusions can be modified through techniques such as contradiction, confrontation, and cognitive-behavioral therapy. However, a well-replicated mathematical model of magical/delusional thinking based on a study of paranormal beliefs and experiences is consistent with the hypothesis that attributional processes play a central role in delusion formation and maintenance. The model suggests attributional processes serve the adaptive function of reducing fear associated with ambiguous stimuli and delusional thinking is on a continuum with nonpathological forms. Based on this collective research an amendment to the definition of delusion is proposed and its clinical implications are addressed.
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Affiliation(s)
- James Houran
- Adelaide University, Integrated Knowledge Systems, USA
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32
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Mueser KT, Torrey WC, Lynde D, Singer P, Drake RE. Implementing evidence-based practices for people with severe mental illness. Behav Modif 2003; 27:387-411. [PMID: 12841590 DOI: 10.1177/0145445503027003007] [Citation(s) in RCA: 167] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persons with severe mental illnesses (SMI) often lack access to effective treatments. The authors describe the Implementing Evidence-Based Practices (EBPs) Project, designed to increase access for people with SMI to empirically supported interventions. The EBP Project aims to improve access through development of standardized implementation packages, created in collaboration with different stakeholders, including clinicians, consumers, family members, clinical supervisors, program leaders, and mental health authorities. The background and philosophy of the EBP Project are described, including the six EBPs identified for initial package development: collaborative psychopharmacology, assertive community treatment, family psychoeducation, supported employment, illness management and recovery skills, and integrated dual disorders treatment. The components of the implementation packages are described as well as the planned phases of the project. Improving access to EBPs for consumers with SMI may enhance outcomes in a cost-effective manner, helping them pursue their personal recovery goals with the support of professionals, family, and friends.
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Affiliation(s)
- Kim T Mueser
- NH-Dartmouth Psychiatric Research Center, Dartmouth Medical School, Concord 03301, USA.
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34
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Hall PL, Tarrier N. The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behav Res Ther 2003; 41:317-32. [PMID: 12600402 DOI: 10.1016/s0005-7967(02)00013-x] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Low self esteem in individuals with a psychotic disorder is common and may be related to poorer clinical outcomes. However, there has been little research on devising treatment methods to improve self-esteem either generally or in psychotic patients in particular. The aims of this study were to evaluate the efficacy of a simple cognitive behavioural intervention to improve self esteem in psychotic patients who scored poorly on a self-esteem measure. This pilot study was a randomised control trial with a convenience sample of chronic psychotic inpatients. The cognitive behavioural self-esteem intervention, as an adjunct to treatment as usual (TAU), was compared to TAU alone in patients with psychosis. The individual self-esteem intervention as described by Tarrier (The use of coping strategies and self-regulation in the treatment of psychosis. (2001)) consisted of working with participants to elicit positive self-attributes and then identify specific behavioural examples to provide evidence of this attribute. Emphasis was given to any consequential change in the patient's belief that they had the attribute. The results indicated that this cognitive behavioural treatment for self-esteem used as an adjunct treatment in psychosis, resulted in clinical benefits in terms of increased self-esteem, decreased psychotic symptomatology and improved social functioning. These benefits were largely maintained at 3-month follow-up.
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Abstract
The symptom courses of 84 schizophrenia patients (mean age: 24.4 years; mean previous admissions: 1.3; 64% males) of a community-based acute ward were examined to identify dynamic patterns of symptoms and to investigate the relation between these patterns and treatment outcome. The symptoms were monitored by systematic daily staff ratings using a scale composed of three factors: psychoticity, excitement, and withdrawal. Patients showed moderate to high symptomatic improvement documented by effect size measures. Each of the 84 symptom trajectories was analyzed by time series methods using vector autoregression (VAR) that models the day-to-day interrelations between symptom factors. Multiple and stepwise regression analyses were then performed on the basis of the VAR models. Two VAR parameters were found to be associated significantly with favorable outcome in this exploratory study: 'withdrawal preceding a reduction of psychoticity' as well as 'excitement preceding an increase of withdrawal'. The findings were interpreted as generating hypotheses about how patients cope with psychotic episodes.
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Affiliation(s)
- Wolfgang Tschacher
- University of Bern, University Hospital of Social and Community Psychiatry, Laupenstrasse 49, CH-3010, Bern, Switzerland.
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36
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Abstract
Individuals with different personality disorders are hypothesized to approach decision making with a variety of concerns related to their perception of their general efficacy, information demands, risk aversion, and utility of gains and losses. A variation of modern portfolio theory is employed to examine decision-making in a clinical population of adult patients. Variations along personality dimensions were related to a number of decision-making concerns and strategies. The implications of these findings are examined in the clinical treatment of personality disorders.
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37
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INTRODUCTION TO SPECIAL ISSUE ON PSYCHOSIS. Clin Psychol Rev 2001. [DOI: 10.1016/s0272-7358(01)00107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Gould RA, Mueser KT, Bolton E, Mays V, Goff D. Cognitive therapy for psychosis in schizophrenia: an effect size analysis. Schizophr Res 2001; 48:335-42. [PMID: 11295385 DOI: 10.1016/s0920-9964(00)00145-6] [Citation(s) in RCA: 226] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We conducted a meta-analysis using all available controlled treatment outcome studies of cognitive therapy (CT) for psychotic symptoms in schizophrenia. Effect sizes were calculated for seven studies involving 340 subjects. The mean effect size for reduction of psychotic symptoms was 0.65. The findings suggest that cognitive therapy is an effective treatment for patients with schizophrenia who have persistent psychotic symptoms. Follow-up analyses in four studies indicated that patients receiving CT continued to make gains over time (ES=0.93). Further research is needed to determine the replicability of standardized cognitive interventions, to evaluate the clinical significance of cognitive therapy for schizophrenia, and to determine which patients are most likely to benefit from this intervention.
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Affiliation(s)
- R A Gould
- Psychotic Disorders Program, Massachusetts General Hospital/ Harvard Medical School, Boston, MA 02114, USA.
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39
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McGovern J, Turkington D. ?Seeing the wood from the trees?: a continuum model of psychopathology advocating cognitive behaviour therapy for schizophrenia. Clin Psychol Psychother 2001. [DOI: 10.1002/cpp.283] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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40
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Lysaker PH, Lysaker JT, Lysaker JT. Schizophrenia and the collapse of the dialogical self: Recovery, narrative and psychotherapy. ACTA ACUST UNITED AC 2001. [DOI: 10.1037/0033-3204.38.3.252] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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41
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Abstract
A set of cognitive behavioral psychotherapies (CBT) has been developed for schizophrenia. These interventions have been used for the treatment of both recent onset patients and those with treatment-refractory symptoms. This article reviews clinical trials of CBT for schizophrenia since 1990. The CBT interventions appear to be beneficial in reducing overall symptom levels, especially the severity of delusions. The relative efficacy of CBT is more evident when CBT is compared with routine care than when it is compared with other therapies matched for therapist attention. Further studies are needed to objectively determine the active ingredients of CBT and to better identify the interactions of CBT with concurrent psychosocial and medication treatments.
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Affiliation(s)
- F B Dickerson
- Sheppard Pratt Health System, 6501 N. Charles St., Baltimore, MD 21204, USA.
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42
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Barrowclough C, Haddock G, Tarrier N, Moring J, Lewis S. Cognitive Behavioral Intervention for Individuals with Severe Mental Illness Who Have a Substance Misuse Problem. ACTA ACUST UNITED AC 2000. [DOI: 10.1080/10973430008408407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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43
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Two–year follow–up of cognitive–behavioral therapy and supportive counseling in the treatment of persistent symptoms in chronic schizophrenia. J Consult Clin Psychol 2000. [DOI: 10.1037/0022-006x.68.5.917] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kienzle N, Althoff A. Verhaltenstherapeutische Methoden in der Behandlung schizophrener Jugendlicher. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 1999. [DOI: 10.1024//1422-4917.27.3.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- N. Kienzle
- Heckscher Klinik für Kinder- und Jugendpsychiatrie, Jugendpsychiatrische Abteilung Rottmannshöhe, 82335 Berg (Ärztlicher Direktor: Dr. med. F.J. Freisleder)
| | - A. Althoff
- Heckscher Klinik für Kinder- und Jugendpsychiatrie, Jugendpsychiatrische Abteilung Rottmannshöhe, 82335 Berg (Ärztlicher Direktor: Dr. med. F.J. Freisleder)
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Barrowclough C, Tarrier N, Lewis S, Sellwood W, Mainwaring J, Quinn J, Hamlin C. Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. Br J Psychiatry 1999; 174:505-11. [PMID: 10616628 DOI: 10.1192/bjp.174.6.505] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Family interventions are effective in reducing relapse in patients with schizophrenia, but there is little work demonstrating the effectiveness of the interventions in routine service settings. AIMS To test the effectiveness of a needs-based family intervention service for patients recruited as out-patients and their carers, including those of low expressed emotion status. METHOD Carers of out-patient schizophrenia sufferers selected only on illness history factors were randomly allocated to receive either family support alone or in combination with systematic psychosocial interventions based on an assessment of need. Delivery of family interventions attempted to involve the clinical team. RESULTS Relapse outcomes were superior for family-treated patients at six-month follow-up, although most of the clinical and symptom patient variables assessed remained stable, as did measures of carer burden. CONCLUSIONS The study demonstrated the effectiveness of family interventions in routine service settings. Problems with staff, patient and carer engagement and participation were identified.
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Affiliation(s)
- C Barrowclough
- Academic Department of Clinical Psychology, Tameside General Hospital, Ashton-under-Lyne, Lancashire
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47
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Tarrier N, Yusupoff L, Kinney C, McCarthy E, Gledhill A, Haddock G, Morris J. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. BMJ (CLINICAL RESEARCH ED.) 1998; 317:303-7. [PMID: 9685273 PMCID: PMC28621 DOI: 10.1136/bmj.317.7154.303] [Citation(s) in RCA: 237] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether intensive cognitive behaviour therapy results in significant improvement in positive psychotic symptoms in patients with chronic schizophrenia. DESIGN Patients with chronic schizophrenia were randomly allocated, stratified according to severity of symptoms and sex, to intensive cognitive behaviour therapy and routine care, supportive counselling and routine care, and routine care alone. SETTING Adjunct treatments were carried out in outpatient clinics or in the patient's home. SUBJECTS 87 patients with persistent positive symptoms who complied with medication; 72 completed treatment. OUTCOME MEASURES Assessments of positive psychotic symptoms before treatment and 3 months after treatment. Number of patients who showed a 50% or more improvement in symptoms. Exacerbation of symptoms and rates of readmission to hospital. RESULTS Significant improvements were found in the severity (F=5.42, df =2,86; P=0.006) and number (F=4.99, df=2,86; P=0.009) of positive symptoms in those treated with cognitive behaviour therapy. The supportive counselling group showed a non-significant improvement. Significantly more patients treated with cognitive behaviour therapy showed an improvement of 50% or more in their symptoms (chi2=5.18, df=1; P=0.02). Logistic regression indicated that receipt of cognitive behaviour therapy results in almost eight times greater odds (odds ratio 7.88) of showing this improvement. The group receiving routine care alone also experienced more exacerbations and days spent in hospital. CONCLUSIONS Cognitive behaviour therapy is a potentially useful adjunct treatment in the management of patients with chronic schizophrenia.
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Affiliation(s)
- N Tarrier
- Department of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, Withington Hospital, Manchester M20 8LR, UK.
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