Reflections on schizophrenia, learned helplessness/dependence, and recovery

[Age identity disorders (infantilism/ puerilism) in the psychopathological space of endogenous diseases]

AIM

A comparative psychopathological and psychometric analysis of age identity disorders (AID) - infantilism and puerilism - on the model of schizophrenia proceeding with hysterical symptoms.

MATERIAL AND METHODS

Results of the psychopathological study of 42 patients with schizophrenia and schizophrenia spectrum disorders (SSD), with well-marked signs of AID in the course of the disease (22 sub. - infantilism; 20 sub. - puerilism), are summarized. Psychometric evaluation was carried out using a standardized block of pathopsychological methods; scales for assessing negative and positive psychopathological symptoms (SANS, PANSS, MFI-20); personality assessment instruments (SPQ-A; Personality Traits Questionnaire (V. Rusalova); Methods for diagnostics of personal maturity (V. Ruzhenkova)).

RESULTS

The differentiation between infantilism and puerilism, forming in the psychopathological space of schizophrenia and SSD, is not limited by differences in the indicators of age-related immaturity. Infantilism shows an affinity to the dimensional structures of the negative symptoms, acting as primary psychopathological formations - apathoabulic disorders. Conversely, puerilism is derived from the positive symptoms - psychopathological formations related to the dissociative disorders.

CONCLUSION

From the perspective of the modern concept of schizophrenia, infantilism and puerilism are associated with polar dimensional structures (positive-negative symptoms) and, accordingly, can be regarded as psychopathologically heterogeneous formations.

Choice of service provider: how consumer self-determination shaped a psychiatric rehabilitation program

OBJECTIVE

To document the impact of consumer self-selection of service providers on their service receipt and attendance in a psychiatric rehabilitation program.

METHODS

Staff (8 FTE) in a new drop-in resource center tracked their service activities and contacts with consumers using daily service logs. Consumers (N = 46) checked their service needs at enrollment, and recorded their attendance on daily sign-in sheets. Regression analyses were conducted to examine correlations between these service measures and each consumer's count of key providers, with key provider defined as any staff worker with whom the consumer logged the equivalent of more than a full workday of contact (9+ hours) during a 6-month study period.

RESULTS

Service log findings suggest that key service providers were chosen by consumers through informal social interactions with staff. Members who had more key providers were more active in the program and more likely to have checked a need for psychiatric care at enrollment. In spite of member choice of provider, caseloads remained small and staff were able to dedicate their time to services related to their specialty training.

CONCLUSIONS

Facility-based programs can encourage consumer self-selection of service providers without overloading staff or restricting specialty services if they provide ample time for staff and consumers to get to know one another in informal social interactions.