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Cosgrove L, Mintzes B, Bursztajn HJ, D'Ambrozio G, Shaughnessy AF. Industry effects on evidence: a case study of long-acting injectable antipsychotics. Account Res 2024; 31:2-13. [PMID: 35634753 DOI: 10.1080/08989621.2022.2082289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A vigorously debated issue in the psychiatric literature is whether long-acting injectable antipsychotics (LAIs) show clinical benefit over antipsychotics taken orally. In addressing this question, it is critical that systematic reviews incorporate risk of bias assessments of trial data in a robust way and are free of undue industry influence. In this paper, we present a case analysis in which we identify some of the design problems in a recent systematic review on LAIs vs oral formulations. This case illustrates how evidence syntheses that are shaped by commercial interests may undermine patient-centered models of recovery and care. We offer recommendations that address both the bioethical and research design issues that arise in the systematic review process when researchers have financial conflicts of interest.
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Affiliation(s)
- Lisa Cosgrove
- Counseling Psychology Department, Faculty Fellow, Applied Ethics Center, University of Massachusetts-Boston, Boston, Massachusetts, USA
| | - Barbara Mintzes
- School of Pharmacy and Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Harold J Bursztajn
- Co-founder, Program in Psychiatry and the Law @ BIDMC Psychiatry of Harvard Medical School, Cambridge, Massachusetts, USA
| | - Gianna D'Ambrozio
- Counseling Psychology Department, University of Massachusetts-Boston, Boston, Massachusetts, USA
| | - Allen F Shaughnessy
- Department of Family Medicine, Tufts University School of Medicine, Malden, Massachusetts, USA
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2
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Parnas J, Yttri JE, Urfer-Parnas A. Phenomenology of auditory verbal hallucination in schizophrenia: An erroneous perception or something else? Schizophr Res 2024; 265:83-88. [PMID: 37024418 DOI: 10.1016/j.schres.2023.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
This study presents phenomenological features of auditory verbal hallucinations (AVH) in schizophrenia and associated anomalies of experience. The purpose is to compare the lived experience of AVH to the official definition of hallucinations as a perception without object. Furthermore, we wish to explore the clinical and research implication of the phenomenological approach to AVH. Our exposition is based on classic texts on AVH, recent phenomenological studies and our clinical experience. AVH differ on several dimensions from ordinary perception. Only a minority of schizophrenia patients experiences AVH localized externally. Thus, the official definition of hallucinations does not fit the AVH in schizophrenia. AVH are associated with several anomalies of subjective experiences (self-disorders) and the AVH must be considered as a product of self-fragmentation. We discuss the implications with respect to the definition of hallucination, clinical interview, conceptualization of a psychotic state and potential target of pathogenetic research.
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Affiliation(s)
- Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, DK-2300 Copenhagen S, Denmark; Mental Health Centre Glostrup, University Hospital of Copenhagen, DK-2605 Brøndby, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark
| | - Janne-Elin Yttri
- Mental Health Centre Amager, University Hospital of Copenhagen, DK-1610 Copenhagen V, Denmark
| | - Annick Urfer-Parnas
- Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen N, Denmark; Mental Health Centre Amager, University Hospital of Copenhagen, DK-1610 Copenhagen V, Denmark.
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3
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Kalofonos I. Meaning in Psychosis: A Veteran's Critique of the Traumas of Racism, Sexual Violence, and Intersectional Oppression. Cult Med Psychiatry 2023; 47:1090-1112. [PMID: 37138030 PMCID: PMC10654173 DOI: 10.1007/s11013-023-09824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 05/05/2023]
Abstract
This clinical case study presents the case of a Latina Veteran experiencing psychosis and draws on eclectic theoretical sources, including user/survivor scholarship, phenomenology, meaning-oriented cultural psychiatry & critical medical anthropology, and Frantz Fanon's insight on 'sociogeny,' to emphasize the importance of attending to the meaning within psychosis and to ground that meaning in a person's subjective-lived experience and social world. The process of exploring the meaning and critical significance of the narratives of people experiencing psychosis is important for developing empathy and connection, the fundamental prerequisite for developing trust and therapeutic rapport. It also helps us to recognize some of the relevant aspects of a person's lived experiences. To be understood, this Veteran's narratives must be contextualized in her past and ongoing life experience of racism, social hierarchy, and violence. Engaging in this way with her narratives pushes us towards a social etiology that conceptualizes psychosis as a complex response to life experience, and in her case, a critical embodiment of intersectional oppression.
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Affiliation(s)
- Ippolytos Kalofonos
- HSR&D Center for the Study of Helathcare Innovation, Implementation & Policy (CSHIIP) & Mental Illness Research Education & Clinical Center (MIRECC) Health Services Unit, Greater Los Angeles VA Health System, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA.
- Center for Social Medicine and Humanities, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, Los Angeles, CA, 90095, USA.
- UCLA International Institute, 11248 Bunche Hall, Los Angeles, CA, 90095, USA.
- UCLA Department of Anthropology, 375 Portola Plaza, Los Angeles, CA, 90095, USA.
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Stephensen H, Urfer-Parnas A, Parnas J. Double bookkeeping in schizophrenia spectrum disorder: an empirical-phenomenological study. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01609-7. [PMID: 37084145 DOI: 10.1007/s00406-023-01609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023]
Abstract
Double bookkeeping is a term introduced by Eugen Bleuler to describe a fundamental feature of schizophrenia where psychotic reality can exist side by side with shared reality even when these realities seem mutually exclusive. Despite increasing theoretical interest in this phenomenon over the recent years, there are no empirical studies addressing this issue. We have, therefore, conducted a phenomenologically descriptive qualitative study of 25 patients with schizophrenia in which we addressed the following issues: (1) Experience of double reality; (2) Emergence and development of two realities; (3) Truth quality of psychotic or private reality; (4) Insight into illness; (5) Communication of psychotic experiences. The most important result was that most patients felt to be in contact with another dimension of reality. Hallucinatory and delusional experience pertained to this different reality, which patients most frequently kept separated from the shared reality. This other dimension was considered by the patients as being more profound and real. The pre-psychotic and psychotic experiences were difficult to verbalize and typically described as totally different than ordinary experience. Double reality was persistent across remissions. None of the patients considered their condition as an illness analogous to a somatic disorder. Most patients described a vague sense of duality preceding the crystallization of double bookkeeping. This emergence of doubleness was associated with a fundamental alienation from oneself, the world, and others stretching back to childhood or early adolescence. We discuss the results with a special emphasis on the concept of psychosis, clinical interview, treatment, and pathogenetic research.
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Affiliation(s)
- Helene Stephensen
- Center for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300, Copenhagen S, Denmark.
- Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605, Brøndby, Denmark.
| | - Annick Urfer-Parnas
- Mental Health Centre Amager, University Hospital of Copenhagen, 1610, Copenhagen V, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen N, Denmark
| | - Josef Parnas
- Center for Subjectivity Research, University of Copenhagen, Karen Blixens Plads 8, 2300, Copenhagen S, Denmark
- Mental Health Centre Glostrup, University Hospital of Copenhagen, 2605, Brøndby, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, 2200, Copenhagen N, Denmark
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5
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Abstract
Experiences of psychedelics and psychosis were deeply entangled in scientific practices in the mid-20th century, from uses of psychedelic drugs that could model psychosis, to detailed phenomenological comparisons of endogenous and drug-induced madness. After the moral panic of the 1960s shut down psychedelic research, however, these two phenomena became disentangled. In the decades following, the science of psychosis transformed, shedding the language of psychoanalysis, and adopting the new scientific veneer of psychiatry. Today, as psychedelic science re-emerges, the research programs surrounding psychosis and psychedelics now stand in stark contrast. Here, I look closely at how these research programs respond to questions related to what is worth measuring, what is worth investigating, and how we ought to respond to these experiences. This comparison reveals radically different assumptions and values that guide each research paradigm and shape clinical practice. While psychedelic research often includes scales that seek to capture experiences of mysticism, meaningfulness, and ego dissolution, research related to psychosis focuses on the measurement of pathological symptoms and functioning. Research into psychosis primarily seeks universal and reductionist causal explanations and interventions, while psychedelic research embraces the importance of set and setting in shaping unique experiences. Responses to psychedelic crisis involve warmth, compassion, and support, while responses to psychotic experiences often involve restraint, seclusion, and weapons. I argue that these differences contain important lessons for psychiatry. However, as psychedelic research struggles to meet regulatory requirements and fit within the paradigm of evidence-based medicine, these differences may quickly dissolve.
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Affiliation(s)
- Phoebe Friesen
- Biomedical Ethics Unit, Department of Social Studies of Medicine, 5620McGill University, Montreal, QC, Canada
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Wilkinson S, Green H, Hare S, Houlders J, Humpston C, Alderson-Day B. Thinking about hallucinations: why philosophy matters. Cogn Neuropsychiatry 2022; 27:219-235. [PMID: 34874242 PMCID: PMC9006978 DOI: 10.1080/13546805.2021.2007067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Hallucinations research is increasingly incorporating philosophy or the work of philosophically trained individuals. We present three different ways in which this is successfully implemented to the enhancement of knowledge and understanding of hallucinations and related phenomena.Method: We review contributions from phenomenology, philosophy of cognitive science, and philosophy of science and psychiatry.Results: We demonstrate that these areas of philosophy make significant contributions to hallucinations research. Phenomenology gives us a sophisticated and critical understanding of the lived experience of hallucinations. Philosophy of cognitive science enables big-picture theorising and synthesis of ideas, as well as a critical engagement with new paradigms. Philosophy of science and psychiatry raises valuable and theoretically informed questions about diagnosis and categorisation.Conclusions: These contributions reflect both the methodological variety within philosophy and its relevance to the hallucinations researcher.
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Affiliation(s)
- Sam Wilkinson
- Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK, Sam Wilkinson
| | - Huw Green
- Neuropsychology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Stephanie Hare
- Neuroimaging, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Clara Humpston
- School of Psychology, University of Birmingham Institute for Mental Health, Birmingham, UK
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Lyons M, Evison P, Berrios R, Castro S, Brooks H. The lived experience of psychosis in Nicaragua: a qualitative examination of the views of service users. J Ment Health 2020; 31:50-57. [PMID: 33179559 DOI: 10.1080/09638237.2020.1844871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The experience of psychosis is individual and influenced by a complex intersection of identity, thought processes, perceptions and culture. Little is known about the lived experience of psychosis in Nicaragua. AIM To explore the subjective experience of psychosis in Nicaragua from the perspectives of service users. METHODS Focus groups with 28 service users with experience of psychosis. A qualitative analysis using both inductive and deductive approaches was used to analyse these data. RESULTS Participants mostly attributed the onset of psychosis to external factors such as physical or psychological trauma and highlighted the impact of long-term conflict in the area. Whilst medication was generally viewed positively where this was available participants foregrounded lay and community support networks and engagement in valued activities in their narratives about the management of psychosis. Religious and magical forces were salient in participants' accounts of causal pathways, wider Nicaraguan culture and management practices. Stigma, social exclusion and limited access to formal health services and psychological interventions in particular were the major barriers reported to recovery from psychosis. CONCLUSION Our findings point to the potential utility of culturally adapted psychological interventions in Nicaragua as well as the value of lay and community workforces in delivering such interventions.
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Affiliation(s)
- Minna Lyons
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Patrick Evison
- School of Psychology, University of Liverpool, Liverpool, UK
| | | | | | - Helen Brooks
- Department of Health Services Research, Institute of Population Health, University of Liverpool, Liverpool, UK
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Abstract
SummaryPsychotic phenomena include a far wider range of experiences than is captured by the brief descriptions offered in contemporary diagnostic guides. Given the richness of historical clinical phenomenology, what can account for the recent ascendancy of relatively impoverished descriptions of psychosis? One possible explanation is provided by Hacking's notion of dynamic nominalism, where human categories change over time in tandem with those who they classify. But although dynamic nominalism makes sense of changes in behaviour, it fails to account for change at the level of subjective experience. In this paper, psychotic symptoms are addressed in the light of the indeterminacy of subjective mental content. A naïve-introspectionist approach to mental symptoms assumes that, notwithstanding practical difficulties, such symptoms are reliably describable in principle. Contemporary philosophy of mind challenges this assumption. Lighting upon a verbal description for ineffable phenomena changes their nature, resolving them into new forms.Declaration of interestNone.
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Affiliation(s)
- Huw Green
- Icahn School of Medicine at Mount Sinai,USA
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9
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Kvig EI, Moe C, Brinchmann B, Larsen TK, Sørgaard K. Negotiating the boundaries of psychosis: A qualitative study of the service provider perspective on treatment delay in community mental health. Early Interv Psychiatry 2019; 13:272-280. [PMID: 28836376 PMCID: PMC6585718 DOI: 10.1111/eip.12477] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/23/2017] [Accepted: 07/11/2017] [Indexed: 01/31/2023]
Abstract
AIM Evidence shows that many patients are detected and treated late in their course of illness, and that substantial delay occurs even after entry to mental health services. Although several studies have examined the service user and carer perspectives on treatment delay, few have explored the issue from the service provider perspective. The aim of this study was to broaden our understanding of treatment delay by exploring the service provider perspective on reasons for treatment delay in community mental health services. METHODS A qualitative study using data from focus group interviews with 33 healthcare professionals in community mental health care. Interview data were digitally recorded and transcribed verbatim, and analysed using a grounded theory approach. RESULTS Service providers perceived divergent or conflicting perspectives as the main challenge in early psychosis. Clinical negotiation was chosen as the main term describing the interactions between patients and healthcare professionals: This was observed in 3 overlapping areas: (1) Negotiating the patients status as help-seeker; (2) Negotiating the place and conditions of treatment and (3) Negotiating the meaning of distressing experiences and the timing of treatment options. CONCLUSIONS This study suggests that delay in initiation of treatment for psychosis in community mental health is related to clinical challenges of early disengagement from services and diagnostic uncertainty. Service providers found negotiating the therapeutic relationship and patient-centred flexibility more useful in ensuring engagement than an assertive outreach approach. Diagnostic uncertainty was resolved through watchful waiting using a distress-overload conceptualization in assessing changes in mental state and service needs.
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Affiliation(s)
- Erling Inge Kvig
- Department of Psychiatry, Nordland hospital Trust, Bodø, Norway.,Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Cathrine Moe
- Nursing and Health Practice Programme, Nord University, Bodø, Norway
| | - Beate Brinchmann
- Department of Psychiatry, Nordland hospital Trust, Bodø, Norway.,Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Tor Ketil Larsen
- Division of Psychiatry, Regional Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.,Psychiatry Section, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Knut Sørgaard
- Department of Psychiatry, Nordland hospital Trust, Bodø, Norway.,Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
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Thomas SP. Finding Inspiration From the Philosophy of Maurice Merleau-Ponty for the Practice of Psychiatric-mental Health Nursing. Arch Psychiatr Nurs 2018; 32:373-378. [PMID: 29784217 DOI: 10.1016/j.apnu.2017.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/15/2017] [Accepted: 11/18/2017] [Indexed: 11/30/2022]
Abstract
The philosophy of Maurice Merleau-Ponty, a unique blend of existentialism and phenomenology, deserves to be better known in psychiatric-mental health nursing. This philosophy is particularly pertinent to the contemporary recovery movement that seeks to dispel the therapeutic nihilism regarding conditions such as schizophrenia, borderline personality, and substance use disorders. This paper provides an overview of Merleau-Ponty's life and work, with emphasis on selected elements of his philosophy that are inspirational for the clinical practice of psychiatric-mental health nursing.
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Affiliation(s)
- Sandra P Thomas
- University of Tennessee, Knoxville, 1200 Volunteer Blvd., Knoxville, TN 37996-4180, United States.
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11
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Fredwall TE, Larsen IB. Textbook descriptions of people with psychosis – some ethical aspects. Nurs Ethics 2018; 26:1554-1565. [DOI: 10.1177/0969733017753742] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness.
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