Negative symptoms in chronic non-schizophrenic patients

Caregiver perceptions and needs regarding symptom attenuation in severe and persistent mental illness

PURPOSE

The purpose of this study was to examine the experience of caretakers who are coping with treated yet impaired mentally ill family members. Needs of the caretaker were described and areas for intervention were identified.

DESIGN AND METHODS

This qualitative study used the symbolic interaction paradigm of dramaturgical interviewing. Thirty-five caretakers participated in a 1.5- to 2-hr semistructured interview.

FINDINGS

Themes related to long-term effects of positive and negative symptoms and issues about accountability, responsibility, and planning for the future were most prominent.

PRACTICE IMPLICATIONS

Areas of intervention were identified as recognition and management of negative symptoms and counseling related to issues of accountability, responsibility, and future planning.

Facial expression and emotional face recognition in schizophrenia and depression

Twenty-three acute schizophrenics, 21 acute major depressives (Research Diagnostic Criteria), and 15 normal controls participated in a study on facial expression and emotional face recognition. Under clinical conditions, spontaneous facial expression was assessed according to the affective flattening section of the Scale for the Assessment of Negative Symptoms. Under experimental laboratory conditions involuntary (emotion-eliciting interview) and voluntary facial expression (imitation and simulation of six basic emotions) were recorded on videotape, from which a raterbased analysis of intensity or correctness of facial activity was obtained. Emotional face recognition was also assessed under experimental conditions using the same stimulus material. All subjects were assessed twice (within 4 weeks), controlling for change of the psychopathological status in the patient groups. In schizophrenics, neuroleptic drug influence was controlled by random allocation to treatment with either haloperidol or perazine. The main findings were that schizophrenics and depressives are characterized by different quantitative, qualitative, and temporal patterns of affect-related dysfunctions. In particular, schizophrenics demonstrated a trait-like deficit in affect recognition and in their spontaneous and voluntary facial activity, irrespective of medication, drug type and dosage, or extrapyramidal side-effects. In depressives a stable deficit could be demonstrated only in their involuntary expression under emotion-eliciting interview conditions, whereas in the postacute phase a reduction in their voluntary expression became apparent. Differences in patterns of affect-related behavioral deficits may reflect dysfunctions in different underlying psychobiological systems.

Group psychotherapy in chronic psychiatric outpatients: a Toronto model

Seventy to 80 chronic psychiatric patients are treated in an aftercare clinic with a goal of tertiary preventive care. The major component of the treatment approach is reality-oriented group psychotherapy with an emphasis on interpersonal relationships. Attention to three factors in group psychotherapy with this population of patients has facilitated our work and outcome. These are the concept of the core group, diagnostic heterogeneity, and staff structure.