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Faith L, Wiesepape C, Kukla M, Lysaker P. Promoting Meaning and Recovery for Psychosis: Comparison of Metacognitively-Oriented Psychotherapists and Clinicians in Psychiatric Rehabilitation. Neuropsychiatr Dis Treat 2023; 19:2179-2194. [PMID: 37873532 PMCID: PMC10590553 DOI: 10.2147/ndt.s386004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/06/2023] [Indexed: 10/25/2023] Open
Abstract
Introduction Recovery from psychosis is an expected and desired outcome in psychiatric rehabilitation that may involve subjective outcomes related to personal recovery. While a considerable amount of qualitative research has examined patients' experience of recovery oriented approaches, there are less studies examining clinicians' perspectives. Examining the clinician point of view is important for both supporting clinicians within recovery-oriented practice, as well as for understanding underlying therapeutic processes. The aims of this study were to explore clinician experience of offering different psychiatric rehabilitation treatments for individuals with psychosis, and to understand similarities and differences of clinicians whose work differed in its recovery emphasis. Methods Open-ended interviews were conducted with 10 psychotherapists providing Metacognitive Reflection and Insight Therapy (MERIT), a recovery oriented form of integrative psychotherapy focused on subjective aspects of recovery, and 10 clinicians providing standard psychiatric rehabilitation services. Results Thematic analysis revealed important similarities and differences between these two groups of providers. There were seven themes found for MERIT therapists: Comfort with uncertainty, Emphasis on collaboration, Being part of therapeutic change, Connecting with clients, Emphasis on patient autonomy, Experiencing growth, and Therapist use of self-awareness. There were four themes found for psychiatric rehabilitation clinicians: Value of a structured approach, Focus on a strengths-based approach, Witnessing behavioral change, and Building rapport to support the work. Discussion As expected, both similarities and differences arose between clinician groups. Results indicated that both groups focused on the therapeutic relationship and monitoring progress and outcomes. Unexpectedly, MERIT therapists reported growth as well as comfort with uncertainty. These findings suggest that MERIT is a a psychotherapy that offers unique opportunities for creative and flexible exploration of meaning and agency that is both challenging and rewarding for clinicians. Implications for supporting healthy clinician practice and the development of services are discussed.
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Affiliation(s)
- Laura Faith
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Courtney Wiesepape
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Paul Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Díaz-Cutraro L, García-Mieres H, Dimaggio G, Lysaker P, Moritz S, Ochoa S. Metacognition in psychosis: What and how do we assess it? Span J Psychiatry Ment Health 2023; 16:206-207. [PMID: 37716848 DOI: 10.1016/j.rpsm.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/17/2022] [Accepted: 09/15/2022] [Indexed: 09/18/2023]
Affiliation(s)
- Luciana Díaz-Cutraro
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Helena García-Mieres
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; IMIM Hospital del Mar Medical Research Institute | IMIM Health Services Group, Spain
| | | | - Paul Lysaker
- Department of Psychiatry, School of Medicine, Indiana University, USA
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Susana Ochoa
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat Institut de Recerca Sant Joan de Déu, Fundació Sant Joan de Déu, Spain; Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain.
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Bob P, Touskova TP, Pec O, Raboch J, Boutros N, Lysaker P. Psychosocial Stress, Epileptic-Like Symptoms and Psychotic Experiences. Front Psychol 2022; 13:804628. [PMID: 35496146 PMCID: PMC9048482 DOI: 10.3389/fpsyg.2022.804628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/17/2022] [Indexed: 12/19/2022] Open
Abstract
Background Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. Methods The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Results Hair cortisol levels among patients experiencing their initial episode of psychosis, were significantly correlated with stress symptoms measured by Trauma Symptom Checklist-40 (r = − 0.48, p < 0.01), and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory (r = − 0.33, p < 0.05) and LSCL-33 (r = − 0.33, p < 0.05). Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. Conclusion These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication.
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Affiliation(s)
- Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
- *Correspondence: Petr Bob,
| | - Tereza Petraskova Touskova
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
| | - Jiri Raboch
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, and Department of Psychiatry, Faculty of Medicine Pilsen, Charles University in Prague, Prague, Czechia
| | - Nash Boutros
- Rush University Medical Center, Chicago, IL, United States
| | - Paul Lysaker
- Roudebush VA Medical Center and the Indiana University School of Medicine, Indianapolis, IN, United States
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García-Mieres H, Lysaker P, Leonhardt BL. A Comparison of Personal Recovery in Adults with Early Psychosis and Prolonged Schizophrenia. Psicothema 2022; 34:35-40. [PMID: 35048893 DOI: 10.7334/psicothema2021.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND We aimed to investigate whether personal recovery levels differ between those in early vs prolonged phases of psychosis and if there are different associations with objective outcomes of recovery (i.e., symptom severity and level of functioning). METHOD Participants included 131 patients with early psychosis and 83 patients with prolonged psychosis. The Recovery Assessment Scale was used to assess personal recovery in both samples. The MIRECC-GAF and the CGI-S were used as measures of objective recovery in the early psychosis group. The PANSS and QoL scales were used as measures of objective recovery in the prolonged psychosis group. RESULTS People with early psychosis reported better personal recovery scores in all domains, except willingness to ask for help, compared to individuals with prolonged psychosis. Markers of objective recovery were not correlated with personal recovery in the early psychosis sample but were significantly correlated in the prolonged sample. Depressive symptoms were negatively correlated with personal recovery in the prolonged psychosis group. CONCLUSIONS The relationship between personal and objective recovery may change over time and be dependent on the phase of an individual's illness. In addition, as individuals experience dysfunction over time, they may be more likely to become demoralized and experience lesser degrees of personal recovery.
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Lysaker P, Chernov NV, Karpenko OA, Moiseeva TV, Sozinova MV, Dmitrieva ND, Alyoshin VA, Faith L, Kostyuk GP. [Metacognition as a pathway to the study and treatment of fragmentation in schizophrenia]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:160-164. [PMID: 33834735 DOI: 10.17116/jnevro2021121031160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
This paper explores the potential of recent research on metacognition to offer new avenues to assess and address the phenomenon of fragmentation in schizophrenia, which was described by E.Bleuler as «splitting». The concepts of metacognition characterize and quantify alterations or decrements in the processes by which fragments or pieces of information are integrated into a coherent sense of self and others. A method for assessing metacognition is presented along with research examining the presence and importance of metacognitive deficits in schizophrenia. Greater levels of metacognitive deficits have been detected in different phases of schizophrenia and linked to poorer psychosocial outcomes. These data were obtained both in foreign and preliminary Russian studies. The authors suggest that treatments, which successfully target metacognitive capacity, may uniquely promote wellness and recovery in schizophrenia.
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Affiliation(s)
- P Lysaker
- Indiana University School of Medicine, Indianapolis, USA
| | - N V Chernov
- Alexeev Mental Health Hospital, Moscow, Russia
| | | | | | | | | | | | - L Faith
- University of Missouri - Kansas City (USA)
| | - G P Kostyuk
- Alexeev Mental Health Hospital, Moscow, Russia
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Hasson‐Ohayon I, Jong S, Igra L, Carter SA, Faith LA, Lysaker P. Longitudinal changes in therapeutic alliance with people with psychosis: Relationship between client and therapist assessments. Clin Psychol Psychother 2021; 28:1243-1253. [DOI: 10.1002/cpp.2572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Affiliation(s)
| | | | - Libby Igra
- Department of Psychology Bar‐Ilan University Ramat‐Gan Israel
| | - Sarah A. Carter
- Utrecht University: University College Roosevelt Middelburg The Netherlands
| | - Laura A. Faith
- Department of Psychology University of Missouri‐Kansas City Kansas City Missouri USA
| | - Paul Lysaker
- Department of Psychiatry Roudebush VA Medical Center and the Indiana University School of Medicine Indianapolis Indiana USA
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Wasmuth S, Mokol E, Szymaszek K, Gaerke KJ, Manspeaker T, Lysaker P. Intersections of occupational participation and borderline personality disorder: A grounded theory approach. Cogent Psychology 2020. [DOI: 10.1080/23311908.2020.1803580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sally Wasmuth
- Department of Occupational Therapy, School of Health & Human Sciences, Indiana University, Purdue University (IUPUI), Indianapolis, IN, USA
| | - Emily Mokol
- School of Occupational Therapy, College of Health Sciences, University of Indianapolis, Indianapolis, IN, USA
| | | | | | | | - Paul Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, School of Medicine, Indiana University, Indianapolis, IN, USA
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Lecomte T, Corbière M, Giguère CE, Titone D, Lysaker P. Group cognitive behaviour therapy for supported employment - Results of a randomized controlled cohort trial. Schizophr Res 2020; 215:126-133. [PMID: 31780346 DOI: 10.1016/j.schres.2019.10.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 09/27/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
Abstract
The merging of evidence-based interventions with supported employment programs are being increasingly studied, with encouraging results. The current study is aimed at determining the impact of a brief cognitive behaviour therapy group intervention adapted for supported employment programs (called CBT-SE) on the work outcomes of: obtaining a competitive job, number of weeks worked, and number of hours worked per week. Participants were randomized to either receive the 8-session CBT-SE group on top of their supported employment program, or to only receive their support employment program. The results show that those who received CBT-SE were significantly more likely to obtain a job (75% vs 58%), and worked a significantly greater number of hours (24 vs 18 hours per week). No differences were found in terms of number of weeks worked. Those in the CBT-SE condition also experienced a significant decrease in their negative symptoms over time, compared to the control condition. Although replication is needed, these results suggest that a brief cognitive-behavioural intervention specifically tailored to work-related issues can be greatly beneficial.
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Affiliation(s)
- Tania Lecomte
- University of Montreal, Department of Psychology, Bur. C-358, 90 avenue Vincent d'Indy, Pavillon Marie-Victorin, succ Centre-Ville, CP6128, Montréal, QC, H2C 3J7, Canada; Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, 7331 rue Hochelaga, Montreal, QC, H1N 3V2, Canada.
| | - Marc Corbière
- Université du Québec à Montréal, Département d'éducation et Pédagogie - Counseling de carrière, Pavillon Paul-Gérin-Lajoie, Local N-6720, C.P. 8888, Succursale Centre-Ville, Montréal, QC, H3C 3P8, Canada; Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, 7331 rue Hochelaga, Montreal, QC, H1N 3V2, Canada.
| | - Charles-Edouard Giguère
- Centre de recherche de l'Institut Universitaire en Santé mentale de Montréal, 7331 rue Hochelaga, Montreal, QC, H1N 3V2, Canada.
| | - Debra Titone
- Department of Psychology, McGill University, 2001 McGill College Ave., Montreal, QC, H3A 1B1, Canada.
| | - Paul Lysaker
- Department of Psychiatry, Richard L. Roudebush VA Medical Center, Indiana University School of Medicine, 1481 West 10th Street, Indianapolis, IN, 46202, USA.
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Phalen P, Warman D, Martin JM, Lucksted A, Drapalski A, Jones N, Lysaker P. Public understanding of different kinds of voice-hearing experiences: Causal beliefs, perceptions of mental illness, and stigma. Psychiatr Rehabil J 2019; 42:331-340. [PMID: 30945916 DOI: 10.1037/prj0000353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Voice-hearers tend to face a high degree of stigma that can impact subjective well-being and social functioning. However, researchers have hypothesized that the content of the voice-hearing experience and its cultural context are relevant to stigma responses. This study experimentally tested how perceptions of voice-hearing experiences change as a function of the voice's content and the perceiver's characteristics. METHOD In total, 143 nonclinical participants were presented with vignettes describing people who heard voices that were attributed to either "God" or "Abraham Lincoln" and were described as either complimentary/encouraging or insulting/threatening. For each vignette, participants were asked about the likelihood that the voice-hearer had schizophrenia or mental illness. The Causal Beliefs Questionnaire was also delivered, with two new subscales added to test for belief in positive and negative religious causes for the voices. Stigma was measured by perceived dangerousness and desire for social distance. RESULTS Voice-hearing experiences elicited greater stigma from participants who endorsed greater likelihood that the voice-hearer was mentally ill, greater belief in biological causes of the voice-hearing, negative religious causes, psychosocial causes, socialization causes, and causes related to personal responsibility. Endorsing positive religious causes was associated with lower stigma. Participants who were more religious were more likely to attribute voice-hearing experiences to negative religious causes (possession, lack of/misguided faith), except when the target was described as hearing the voice of God saying positive things. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The stigma of voice-hearing experiences depends upon what the voice is saying and perceptions about the cause of the voice. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Peter Phalen
- Mental Illness Research, Education and Clinical Center (MIRECC) VA Capitol Health Care Network (VISN 5)
| | - Debbie Warman
- School of Psychological Sciences, University of Indianapolis
| | | | - Alicia Lucksted
- Mental Illness Research, Education and Clinical Center (MIRECC) VA Capitol Health Care Network (VISN 5)
| | - Amy Drapalski
- Mental Illness Research, Education and Clinical Center (MIRECC) VA Capitol Health Care Network (VISN 5)
| | - Nev Jones
- Department of Mental Health Law and Policy, University of South Florida
| | - Paul Lysaker
- Department of Psychiatry, Indiana University School of Medicine
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Touskova TP, Bob P, Pec O, Mishara A, Vanickova Z, Raboch J, Lysaker P. Insight and cortisol responses in women with first episode psychosis. Schizophr Res 2018; 201:428-429. [PMID: 29885967 DOI: 10.1016/j.schres.2018.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/01/2018] [Accepted: 06/03/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Tereza Petraskova Touskova
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, Prague, Czech Republic; CEITEC, Masaryk University, Brno, Czech Republic.
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, Prague, Czech Republic
| | - Aaron Mishara
- The Chicago School of Professional Psychology, Los Angeles, CA, USA
| | - Zdislava Vanickova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Raboch
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, Prague, Czech Republic
| | - Paul Lysaker
- Roudebush VA Medical Center, Indianapolis, IN, USA; Indiana University School of Medicine, Indianapolis, IN, USA
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Touskova TP, Bob P, Pec O, Raboch J, Lysaker P. Conceptual disorganization and dissociative symptoms in women with first episode psychosis. Schizophr Res 2018; 197:609-610. [PMID: 29472166 DOI: 10.1016/j.schres.2018.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Tereza Petraskova Touskova
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Bob
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, Charles University, Prague, Czech Republic; CEITEC, Masaryk University, Brno, Czech Republic.
| | - Ondrej Pec
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Raboch
- Center for Neuropsychiatric Research of Traumatic Stress, Department of Psychiatry and UHSL, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Paul Lysaker
- Roudebush VA Medical Center, The Indiana University School of Medicine, Indianapolis, IN, USA
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Cartwright KA, Lecomte T, Corbière M, Lysaker P. Narrative development and supported employment of persons with severe mental illness. J Ment Health 2017. [PMID: 28644705 DOI: 10.1080/09638237.2017.1340606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: While the relationship between objective recovery and work among persons with severe mental illness (SMI) is well-established, few studies have examined the link between subjective recovery and employment.Aims: The study investigated the prospective relationship between narrative development at the start of supported employment (SE) and positive work outcomes.Methods: The authors employed a time-limited, mixed-method longitudinal design to examine the relationship between the baseline narrative development of 38 SE participants with SMI and employment outcomes eight months later, as well as whether narratives evolved over the course of the study.Results: While narrative development was unrelated to work for the 59% of participants who were employed at the end of the study, unemployed individuals showed more developed baseline narratives overall, as well as enriched baseline emotional connectedness and social worth. Higher emotional connectedness at the start of SE programs was predictive of fewer hours worked eight months later, controlling for executive functioning, negative symptoms and self-esteem. Although workers showed no narrative changes over time, those without work demonstrated increased agency over the eight months of the study.Conclusion: Further research is warranted to clarify the relationship between richer personal narratives and unemployment.
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Affiliation(s)
| | | | | | - Paul Lysaker
- Roudebush VA Medical Centre, Indiana University School of Medicine, Indianapolis, IN, USA
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Abstract
OBJECTIVE With growing awareness of the impact of mental illness self-stigma, interest has arisen in the development of interventions to combat it. The present article briefly reviews and compares interventions targeting self-stigma to clarify the similarities and important differences between the interventions. METHOD We conducted a narrative review of published literature on interventions targeting self-stigma. RESULTS Six intervention approaches (Healthy Self-Concept, Self-Stigma Reduction Program, Ending Self-Stigma, Narrative Enhancement and Cognitive Therapy, Coming Out Proud, and Anti-Stigma Photo-Voice Intervention) were identified and are discussed, and data is reviewed on format, group-leader backgrounds, languages, number of sessions, primary mechanisms of action, and the current state of data on their efficacy. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE We conclude with a discussion of common elements and important distinctions between the interventions and a consideration of which interventions might be best suited to particular populations or settings.
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Affiliation(s)
- Philip T Yanos
- Psychology Department, John Jay College of Criminal Justice, City University of New York
| | - Alicia Lucksted
- Department of Psychiatry, University of Maryland Medical School
| | - Amy L Drapalski
- VISN 5 Mental Illness Research, Education, and Clinical Center (MIRECC), VA Maryland Health Care System
| | - David Roe
- Department of Community Mental Health, University of Haifa
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White RG, Lysaker P, Gumley AI, McLeod H, McCleery M, O'Neill D, MacBeth A, Giurgi-Oncu C, Mulholland CC. Plasma cortisol levels and illness appraisal in deficit syndrome schizophrenia. Psychiatry Res 2014; 220:765-71. [PMID: 25262562 DOI: 10.1016/j.psychres.2014.08.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 08/21/2014] [Accepted: 08/24/2014] [Indexed: 12/01/2022]
Abstract
Research investigating the association between negative symptoms and plasma cortisol levels in individuals with schizophrenia has produced inconsistent findings. This study investigated whether deficit syndrome schizophrenia (characterized by high levels of primary negative symptoms) is associated with comparatively high morning plasma cortisol levels, more negative appraisals about illness and higher levels of depression. Participants were 85 individuals diagnosed with schizophrenia and 85 individuals with no history of contact with psychiatric services matched for age and gender. All participants provided fasting 9.00a.m. plasma cortisol samples. There were no significant differences between the schizophrenia and control participants in plasma cortisol levels. The Proximal Deficit Syndrome method was used to identify individuals with deficit syndrome schizophrenia. Contrary to what had been hypothesized, participants with deficit syndrome schizophrenia had significantly lower plasma cortisol levels than both non-deficit syndrome participants and control participants. Participants with the deficit syndrome reported significantly less negative appraisals about illness (assessed by PBIQ) and lower levels of depression (assessed by BDI-II). Differences in cortisol levels continued to trend toward significance when levels of depression were controlled for. The patterns of illness-related appraisals and plasma cortisol levels raise the possibility that the deficit syndrome could be a form of adaptation syndrome.
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Affiliation(s)
- Ross G White
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK.
| | - Paul Lysaker
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Psychiatry, Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Andrew I Gumley
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Hamish McLeod
- Institute of Health and Well-being, The University of Glasgow, Glasgow G12 0XH, UK
| | - Muriel McCleery
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Donnacha O'Neill
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
| | - Angus MacBeth
- Centre for Rural Health, University of Aberdeen, Aberdeen AB24 3FX, UK
| | - Catalina Giurgi-Oncu
- The Victor Babeș University of Medicine and Pharmacy of Timișoara, 300041, Romania
| | - Ciaran C Mulholland
- Department of Psychiatry, The Queen's University of Belfast, Belfast BT7 1NN, Ireland
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Warman DM, Martin JM, Lysaker P. Jumping to conclusions and delusions: the impact of discussion of the bias on the bias. Schizophr Res 2013; 150:575-9. [PMID: 24091035 DOI: 10.1016/j.schres.2013.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 09/05/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
Abstract
The present study was an investigation of the impact a brief intervention designed to raise awareness of a cognitive bias known to be robust for individuals with delusions has on the reasoning strategies of individuals with delusions. Individuals with delusions (n=57) were randomly assigned either to receive or not to receive a discussion of the jumping to conclusions bias and its pitfalls. Participants' performance on 3 reasoning trials - 1 emotionally neutral (beads) and 2 emotionally salient (self-referred survey words) - was then assessed; the number of stimuli participants requested before making a decision was evaluated to determine if the Jumping to Conclusions Discussion resulted in increased data gathering. There was no difference between groups (those who received and those who did not receive the Jumping to Conclusions Discussion) in terms of how many beads they gathered (p=.36), but there were significant differences on both reasoning trials of emotionally salient stimuli (p's<.05), such that participants who received the Jumping to Conclusions Discussion requested more stimuli on those tasks than individuals who did not receive the discussion. Thus, results suggest that discussion of the jumping to conclusions bias may impact the bias directly, at least for material that is emotional in nature. Results are discussed in terms of their relevance to cognitive behavioral therapies for psychosis and existing research on reasoning and delusions.
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Affiliation(s)
- Debbie M Warman
- University of Indianapolis, School of Psychological Sciences, 1400 East Hanna Avenue, Indianapolis, IN 46227, USA.
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Brüne M, Tas C, Brown EC, Armgart C, Dimaggio G, Lysaker P. Metakognitive und sozial-kognitive Defizite bei Schizophrenien. Funktionelle Bedeutung und Behandlungsstrategien. ACTA ACUST UNITED AC 2013. [DOI: 10.1024/1661-4747/a000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Die Gruppe der Schizophrenien umfasst heterogene psychopathologische Syndrome, die oft mit neurokognitiven Störungen und niedrigem psychosozialen Funktionsniveau assoziiert sind. Empirische Studien legen nahe, dass viele mit Schizophrenie assoziierte Symptome auf Störungen der sozialen Kognition bzw. metakognitive Störungen zurückgeführt werden können. Diese Konzepte beziehen sich auf die Fähigkeit, soziale Signale wahrnehmen und interpretieren, eigene und psychische Zustände Anderer reflektieren und dieses Wissen flexibel in sozialen Interaktionen und zur Problemlösung einsetzen zu können. Der vorliegende Artikel gibt eine Übersicht über sozial-kognitive und metakognitive Defizite bei Schizophrenien und wie über das Training dieser Kernkompetenzen das psychosoziale Funktionsniveau von Patienten mit Schizophrenie verbessert werden kann. Bei Schizophrenien sind soziale Kognition und Metakognition eng mit dem psychosozialen Funktionsniveau verbunden, zum Teil jedoch auch abhängig von neurokognitiven Fähigkeiten. Sozial-kognitives bzw. metakognitives Training kann zur Verbesserung des psychosozialen Funktionsniveaus beitragen, möglicherweise aber in Abhängigkeit vom Lernpotential und der Motivation der Patienten. Zukünftige Studien sollten untersuchen, welche Subtypen innerhalb des Schizophrenie-Spektrums am ehesten von sozial-kognitivem und metakognitivem Training profitieren können und welche Gruppen ggf. zusätzlich neurokognitives Training benötigen, um das psychosoziale Funktionsniveau zu verbessern.
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Affiliation(s)
- Martin Brüne
- LWL Universitätsklinikum Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Forschungsabteilung für kognitive Neuropsychiatrie und psychiatrische Präventivmedizin, Ruhr-Universität Bochum
| | - Cumhur Tas
- LWL Universitätsklinikum Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Forschungsabteilung für kognitive Neuropsychiatrie und psychiatrische Präventivmedizin, Ruhr-Universität Bochum
| | - Elliot C. Brown
- LWL Universitätsklinikum Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Forschungsabteilung für kognitive Neuropsychiatrie und psychiatrische Präventivmedizin, Ruhr-Universität Bochum
| | - Carina Armgart
- LWL Universitätsklinikum Bochum, Klinik für Psychiatrie, Psychotherapie und Präventivmedizin, Forschungsabteilung für kognitive Neuropsychiatrie und psychiatrische Präventivmedizin, Ruhr-Universität Bochum
| | - Giancarlo Dimaggio
- Centre for Metacognitive Interpersonal Therapy, Piazza dei Martiri di Belfiore, 4 00195, Rom, Italien
| | - Paul Lysaker
- Roudebush VA Medical Center and the Indiana University School of Medicine, Indianapolis, Indiana, USA
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Nemeroff CB, Weinberger D, Rutter M, MacMillan HL, Bryant RA, Wessely S, Stein DJ, Pariante CM, Seemüller F, Berk M, Malhi GS, Preisig M, Brüne M, Lysaker P. DSM-5: a collection of psychiatrist views on the changes, controversies, and future directions. BMC Med 2013; 11:202. [PMID: 24229007 PMCID: PMC3846446 DOI: 10.1186/1741-7015-11-202] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 08/16/2013] [Indexed: 12/16/2022] Open
Abstract
The recent release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association has led to much debate. For this forum article, we asked BMC Medicine Editorial Board members who are experts in the field of psychiatry to discuss their personal views on how the changes in DSM-5 might affect clinical practice in their specific areas of psychiatric medicine. This article discusses the influence the DSM-5 may have on the diagnosis and treatment of autism, trauma-related and stressor-related disorders, obsessive-compulsive and related disorders, mood disorders (including major depression and bipolar disorders), and schizophrenia spectrum disorders.
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Affiliation(s)
- Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Miami, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Daniel Weinberger
- Departments of Psychiatry, Neurology, Neuroscience and The Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Lieber Institute for Brain Development, 855 North Wolfe Street, Baltimore, MD 21205, USA
| | - Michael Rutter
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, De Crespigny Park, Denmark Hill, London, UK
| | - Harriet L MacMillan
- Departments of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, Offord Centre for Child Studies, McMaster University, 1280 Main St. West, Hamilton, ON, Canada
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia
| | - Simon Wessely
- Department of Psychological Medicine, Institute of Psychiatry, King’s College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Dan J Stein
- Department of Psychiatry & Mental Health, University of Cape Town and Groote Schuur Hospital, Observatory, J2, Anzio Rd, Cape Town 7925, South Africa
| | - Carmine M Pariante
- Department of Psychological Medicine, Institute of Psychiatry, Kings College London, Room 2-055, The James Black Centre, 125 Coldharbour Lane, London, UK
| | - Florian Seemüller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University, Nussbaumstr.7, Munich 80336, Germany
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Barwon Health, Ryrie Street, Geelong, VIC 3220, Australia
- Department of Psychiatry, Orygen Research Centre and the Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
| | - Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
| | - Martin Preisig
- Department of Psychiatry, University Hospital of Lausanne, Site de Cery, Prilly 1008, Switzerland
| | - Martin Brüne
- Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstraße 1, Bochum D-44791, Germany
| | - Paul Lysaker
- Richard L Roudebush VA Medical Center, Indianapolis, IN, USA
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Ottavi P, D'Alia D, Lysaker P, Kent J, Popolo R, Salvatore G, Dimaggio G. Metacognition-oriented social skills training for individuals with long-term schizophrenia: methodology and clinical illustration. Clin Psychol Psychother 2013; 21:465-73. [PMID: 23754780 DOI: 10.1002/cpp.1850] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 05/02/2013] [Accepted: 05/03/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE There is much evidence indicating the presence of social deficits in schizophrenia and the detrimental effect of these deficits on global functioning in this population. As a result, social skills training (SST) has emerged as a legitimate psychosocial treatment, although effectiveness research has revealed small effect sizes and limited generalizability regarding the benefits of this treatment. METHODS In light of the strong evidence of metacognitive deficits in schizophrenia and the importance of metacognition to successful social functioning, we propose a novel therapeutic intervention wherein metacognitive remediation is integrated into SST: metacognition-oriented social skills training (MOSST). In the current paper, we present MOSST, an adapted SST programme wherein clients are also encouraged to have mindful contact with their own thoughts and to better consider and understand the mental states of others as well as the connection between mental states and behaviour. RESULTS We present a case wherein an individual with schizophrenia successfully completed the MOSST programme. CONCLUSION We outline directions for future research, starting with the logical next step of empirically testing the efficacy of MOSST. KEY PRACTITIONER MESSAGE Currently social skills training is considered to be the elected psychosocial treatment for people affected by schizophrenia, although evidence indicates limited benefits. People with schizophrenia have metacognitive deficits, which interfere with proper social functioning. A metacognitive-oriented social skills training (MOSST) intervention has been developed by the authors.A treatment such as MOSST, which integrates social skills training and metacognitive training, promises to improve social skills through improving the metacognition.
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Affiliation(s)
- Paolo Ottavi
- Centro di Terapia Metacognitiva Interpersonale, Rome, Italy
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Erickson M, Lysaker P. Self-Esteem and Insight as Predictors of Symptom Change in Schizophrenia: A Longitudinal Study. ACTA ACUST UNITED AC 2012; 6:69-75. [DOI: 10.3371/csrp.6.2.4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mitchell LJ, Gumley A, Reilly ES, Macbeth A, Lysaker P, Carcione A, Dimaggio G. Metacognition in forensic patients with schizophrenia and a past history of interpersonal violence: an exploratory study. Psychosis 2012. [DOI: 10.1080/17522439.2011.630098] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Erickson M, Jaafari N, Lysaker P. Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia. Psychiatry Res 2011; 189:161-5. [PMID: 21813183 DOI: 10.1016/j.psychres.2011.06.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2011] [Revised: 06/13/2011] [Accepted: 06/23/2011] [Indexed: 11/15/2022]
Abstract
The present study was conducted to explore correlates of vocational outcome for individuals with schizophrenia. Seventy-eight individuals with schizophrenia were recruited to take part in a supported employment program in which they were provided with approximately 6 months of part-time work through a VA hospital. Positive symptoms, negative symptoms, and level of insight into mental illness were assessed once every 4 weeks, in addition to a work performance evaluation with participants' supervisors. Hierarchical longitudinal regression analysis revealed that negative symptom severity and impaired insight were significantly associated with poor work performance, and this relationship persisted over time. By contrast, positive symptom severity was not significantly associated with work performance. These results indicate that insight and negative symptoms, which can fluctuate over time, may be driving fluctuations in work performance and may therefore be a valuable target for future interventions.
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Affiliation(s)
- Molly Erickson
- Department of Psychology, Indiana University, Bloomington, IN, USA.
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Kurian SM, Le-Niculescu H, Patel SD, Bertram D, Davis J, Dike C, Yehyawi N, Lysaker P, Dustin J, Caligiuri M, Lohr J, Lahiri DK, Nurnberger JI, Faraone SV, Geyer MA, Tsuang MT, Schork NJ, Salomon DR, Niculescu AB. Identification of blood biomarkers for psychosis using convergent functional genomics. Mol Psychiatry 2011; 16:37-58. [PMID: 19935739 DOI: 10.1038/mp.2009.117] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
There are to date no objective clinical laboratory blood tests for psychotic disease states. We provide proof of principle for a convergent functional genomics (CFG) approach to help identify and prioritize blood biomarkers for two key psychotic symptoms, one sensory (hallucinations) and one cognitive (delusions). We used gene expression profiling in whole blood samples from patients with schizophrenia and related disorders, with phenotypic information collected at the time of blood draw, then cross-matched the data with other human and animal model lines of evidence. Topping our list of candidate blood biomarkers for hallucinations, we have four genes decreased in expression in high hallucinations states (Fn1, Rhobtb3, Aldh1l1, Mpp3), and three genes increased in high hallucinations states (Arhgef9, Phlda1, S100a6). All of these genes have prior evidence of differential expression in schizophrenia patients. At the top of our list of candidate blood biomarkers for delusions, we have 15 genes decreased in expression in high delusions states (such as Drd2, Apoe, Scamp1, Fn1, Idh1, Aldh1l1), and 16 genes increased in high delusions states (such as Nrg1, Egr1, Pvalb, Dctn1, Nmt1, Tob2). Twenty-five of these genes have prior evidence of differential expression in schizophrenia patients. Predictive scores, based on panels of top candidate biomarkers, show good sensitivity and negative predictive value for detecting high psychosis states in the original cohort as well as in three additional cohorts. These results have implications for the development of objective laboratory tests to measure illness severity and response to treatment in devastating disorders such as schizophrenia.
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Affiliation(s)
- S M Kurian
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA, USA
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Sewell RA, Perry EB, Karper LP, Bell MD, Lysaker P, Goulet JL, Brenner L, Erdos J, d'Souza DC, Seibyl JP, Krystal JH. Clinical significance of neurological soft signs in schizophrenia: factor analysis of the Neurological Evaluation Scale. Schizophr Res 2010; 124:1-12. [PMID: 20855185 DOI: 10.1016/j.schres.2010.08.036] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 08/16/2010] [Accepted: 08/23/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nonlocalizing neurologic deficits detectable by clinical evaluation-"soft signs"-are a robust finding in patients diagnosed with schizophrenia, but their conceptual and neuroanatomical correlates remain unclear. The purpose of this study was to evaluate the organization of these deficits and their clinical correlates using the Neurological Evaluation Scale (NES). METHODS Ninety-three male veterans with schizophrenia and schizoaffective disorder were evaluated using a detailed clinical assessment that included the NES, the Extrapyramidal Symptom Rating Scale, the Abnormal Involuntary Movement Scale (AIMS), the Barnes Akathisia Scale, the Positive and Negative Syndrome Scale, the Wisconsin Card Sorting Test (WCST), the Schedule for the Deficit Syndrome (SDS), and the Digit Symbol Substitution Task (DSST). RESULTS Four factors explained 73% of the variance and had distinct clinical and neuropsychological correlates. Factor 1 reflected deficits involved with memory and sensory integration, and was associated with lower PANSS positive and higher AIMS scores. Factor 2 reflected impairments in motor control, and was associated with lower intelligence, more cognitive deficits, and deficit-syndrome schizophrenia. Factor 3 was related to lower intelligence and more perseverative errors on the WCST. Factor 4 was related to increasing age, more extrapyramidal symptoms, more perseverative errors, and worse scores on the DSST. CONCLUSIONS Neurologic deficits in schizophrenia have an intrinsic organization that appears to have clinical significance, highlighting the continued utility of the NES in studies of neurological deficits in schizophrenia patients. The theoretical underpinning of this organization remains unclear.
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Affiliation(s)
- R Andrew Sewell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
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Lysaker P, Yanos PT, Roe D. The role of insight in the process of recovery from schizophrenia: A review of three views. Psychosis 2009. [DOI: 10.1080/17522430902948175] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Duckworth E, Lysaker P. Trauma History Knowledge Is Helpful. J Psychosoc Nurs Ment Health Serv 2008; 46:13; author reply 13. [DOI: 10.3928/02793695-20080201-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G. Are self-reports valid for schizophrenia patients with poor insight? Relationship of unawareness of illness to psychological self-report instruments. Psychiatry Res 2007; 151:37-46. [PMID: 17343920 DOI: 10.1016/j.psychres.2006.04.012] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2005] [Revised: 03/09/2006] [Accepted: 04/20/2006] [Indexed: 01/24/2023]
Abstract
This investigation aimed to determine whether impaired insight influences the validity of self-report test scores in schizophrenia and schizoaffective disorder. 274 outpatients enrolled in work rehabilitation completed the Beck Depression Inventory (BDI), Eysenck Personality Questionnaire (EPQ), Bell Object Relations and Reality Testing Inventory (BORRTI), and NEO-Five Factor Inventory (NEO-FFI). Self-report scores were compared to clinician's ratings on comparable personality and symptom dimensions on the Positive and Negative Syndrome Scale (PANSS), the Work Behavior Inventory (WBI), and the Quality of Life Scale (QLS). The influence of insight was determined using the Scale for Unawareness of Mental Disorder (SUMD). In the first analysis, clinician SUMD ratings of patient insight were associated with self-report accuracy. In a second analysis, patients were categorized into good and poor insight groups based on SUMD ratings and compared on self-report and clinician report variables. Results suggest that poor insight patients accurately report less Neuroticism and Agreeableness, and more Psychoticism than good insight patients, but individuals with poor insight wish to present themselves as more extraverted than they actually are, and they are likely to be more certain of their perceptions than they should be. It appears that self-report measures may be valid for most personality and symptom domains.
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Affiliation(s)
- Morris Bell
- VA Connecticut Healthcare System, West Haven, CT and the Yale University School of Medicine, New Haven, CT 06516, United States.
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Lysaker P, Buck K. Insight, Outcome and Recovery in Schizophrenia Spectrum Disorders: An Examination of their Paradoxical Relationship. ACTA ACUST UNITED AC 2007. [DOI: 10.2174/157340007779815619] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Recent literature emphasizes that recovery from schizophrenia involves recovery within one's own narrative of an integral sense of identity, agency, social connection, and worth. While this is intuitively appealing and consistent with a wide range of literature, it raises the issue of how to best help people do this in individual psychotherapy. In this article, we explore how psychotherapy might help people construct new narratives or storied understandings of their lives and thereby promote recovery from schizophrenia. Exemplified with two individual examples, we first discuss the barriers that challenge and the techniques that help psychotherapists seeking to enter into dialogue with people with severe mental illness. We also offer a theoretical model of how the revitalization of dialogues within therapy can be conceptualized as a process that promotes recovery and discuss the objective measurement of such outcomes.
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Affiliation(s)
- Paul Lysaker
- Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Camisa KM, Bockbrader MA, Lysaker P, Rae LL, Brenner CA, O'Donnell BF. Personality traits in schizophrenia and related personality disorders. Psychiatry Res 2005; 133:23-33. [PMID: 15698674 DOI: 10.1016/j.psychres.2004.09.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2003] [Revised: 04/30/2004] [Accepted: 09/06/2004] [Indexed: 01/24/2023]
Abstract
We investigated whether schizophrenia spectrum disorders share common personality characteristics or traits. Participants with a diagnosis of schizophrenia or schizoaffective disorder (SZ) or with a schizophrenia spectrum personality disorder (schizophrenia spectrum PD: schizoid, paranoid, and schizotypal personality disorder) were compared with non-psychiatric control subjects on the five-factor model of personality and the psychosis-proneness scales. On the five-factor personality scales, SZ subjects showed higher levels of neuroticism, and lower levels of openness, agreeableness, extraversion, and conscientiousness than control subjects. Higher scores on openness and lower scores on neuroticism distinguished schizophrenia spectrum PD from SZ. On the psychosis-proneness scales, both PD and SZ participants scored high relative to non-psychiatric control participants on magical ideation and perceptual aberration, while PD participants scored intermediate between non-psychiatric control participants and SZ on social anhedonia. Discriminant analysis indicated that schizophrenia spectrum patients could be distinguished from PDs by more severe social withdrawal and maladjustment, while subjects with PDs could be best distinguished from control subjects on the basis of odd or novel ideation and decreased conscientiousness.
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Affiliation(s)
- Kathryn M Camisa
- Department of Psychology, Indiana University, 1011 E. 10th Street, Bloomington, IN 47405, USA
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Bond GR, Kim HW, Meyer PS, Gibson PJ, Tunis S, Evans JD, Lysaker P, McCoy ML, Dincin J, Xie H. Response to vocational rehabilitation during treatment with first- or second-generation antipsychotics. Psychiatr Serv 2004; 55:59-66. [PMID: 14699202 DOI: 10.1176/appi.ps.55.1.59] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Second-generation antipsychotics may enhance the rehabilitation of individuals with schizophrenia. The authors hypothesized that clients receiving second-generation antipsychotics would use vocational rehabilitation services more effectively and would have better employment outcomes than those receiving first-generation antipsychotics. METHODS Ninety unemployed clients with schizophrenia and related disorders who were beginning a vocational rehabilitation program were followed for nine months. Three groups were defined according to the medication in use at study entry: olanzapine (N=39), risperidone (N=27), or first-generation antipsychotics only (N=24). Participants were interviewed monthly. RESULTS The olanzapine and risperidone groups did not differ on any employment outcomes. On most vocational indicators, clients receiving second-generation agents did not differ from those receiving first-generation agents. However, at nine months the second-generation group had a significantly higher rate of participation in vocational training; a trend was found toward a higher rate of paid employment. All groups showed substantial improvement in employment outcomes after entering a vocational program. CONCLUSIONS The hypothesis that second-generation antipsychotics promote better employment outcomes than first-generation antipsychotics was not upheld. However, second-generation agents appear to be associated with increased participation in vocational rehabilitation.
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Affiliation(s)
- Gary R Bond
- Department of Psycology, Indiana University-Purdue University Indianapolis, 402 North Blackford, Street, Indianapolis, Indiana 46202-3275, USA.
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Abstract
In a study of work rehabilitation, 97 participants with schizophrenia or schizoaffective disorder were randomized into either a Pay or a No Pay condition to determine the impact of work activity and pay on rehabilitation outcomes. This report specifically investigates the relationship between work rehabilitation and quality of life (QOL) measures for people with schizophrenia. Previous reports have described improvements in symptoms and work outcomes for participants in the Pay condition. Results in this report reveal that randomization to the Pay condition improved ratings on the Heinrichs Quality of Life Scale (QLS). The improvements are found both in overall QLS and in the domain of Intrapsychic Foundations (motivation, sense of purpose, anhedonia, and empathy). For a larger sample (n = 114) we assessed the relationship between amount of participation and QLS improvement. Degree of participation was related to improvement on the QLS total and Intrapsychic Foundations domain. Finally, improvement in the Interpersonal Relations scale was associated with weeks of participation for the most consistent participants. How participation in work rehabilitation and its interaction with pay improves motivation, interpersonal relatedness, and overall quality of life is discussed.
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Affiliation(s)
- Gary Bryson
- Psychology Service, Connecticut Healthcare System-West Haven, West Haven, CT 06516, USA.
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Bryson G, Greig T, Lysaker P, Bell M. Longitudinal Wisconsin card sorting performance in schizophrenia patients in rehabilitation. Appl Neuropsychol 2003; 9:203-9. [PMID: 12584074 DOI: 10.1207/s15324826an0904_2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
UNLABELLED Recent investigations into the course of cognitive functioning in schizophrenia have not been able to determine whether cognitive functioning declines, remains stable, or improves over time. This report analyzes Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Test-Revised Digit Symbol Substitution Test (WAIS-R DSST) performance over time to determine if there is deterioration, improvement, or stability of performance. Data for 46 participants, diagnosed with schizophrenia or schizoaffective disorder that were in a stable phase of illness and actively involved in rehabilitation, were gathered from assessments made at 2 time points on average 4.3 years apart. Results indicated that there was stability in most WCST variables; however, there was significant improvement on WCST perseverative error and on the DSST. Sixty-five percent of the sample improved on 1 or both of the test variables. Furthermore, cognitive test changes were unrelated to type of psychotropic medication and only modestly related to symptom variables. Results indicate that in a stable schizophrenia sample, WCST performance is generally stable over the 3- to 7-year time period, but there are some cognitive variables that may improve even without direct intervention. KEYWORDS schizophrenia, cognition, executive function, rehabilitation, stability
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Affiliation(s)
- Gary Bryson
- VA Connecticut Healthcare System, West Haven, Connecticut, USA, and Yale, University School of Medicine, New Haven, Connecticut 06516, USA
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Abstract
This study has three aims: (1) to compare a deficit syndrome schizophrenia sample (n=19) with a non-deficit sample (n=50) on affect recognition; (2) to determine the association between individual deficit criteria and affect recognition performance in the deficit sample; and (3) to compare the deficit syndrome and negative syndrome samples with respect to affect recognition test performance. Results revealed that the deficit sample had significantly lower adjusted mean affect recognition scores than the non-deficit sample. In addition, 17 of the 19 subjects with deficit syndrome had impairments in affect recognition, whereas, non-deficit subjects were only slightly more likely to score in the impaired range than the unimpaired range. Within the deficit sample Diminished Sense of Purpose was the criterion most strongly associated with affect recognition impairment. Finally, a group of subjects classified as having prominent negative symptoms did not demonstrate the same pattern of impairment as shown by the deficit syndrome sample. The relationship between affect recognition, information processing and the deficit syndrome is discussed along with implications for classification in schizophrenia.
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Affiliation(s)
- G Bryson
- V.A. Medical Center, West Haven, CT 06515, USA
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35
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Abstract
This study had three aims: to compare a schizophrenia sample (n = 50) with a substance abuse (n = 25) and normal sample (n = 81) on affect recognition; to compare differences in their performance between positive and negative affect recognition; and to introduce a new videotape method of stimulus presentation. Subjects were asked to identify the predominant affect depicted in 21 5-10-s vignettes containing three trials of seven affect states. Results demonstrate significant group differences: normal subjects scored in the normal or mild range, substance abuse (s/a) subjects scored in the mild and moderate ranges, and the schizophrenia sample scored predominantly in the moderate to severe ranges. Accuracies were 92.3% for the normal sample, 77.2 for the s/a sample and 64.8 for the schizophrenia sample. Response dispersions were 97.6% for the schizophrenia group, 69% for the s/a sample and 38% in the normal sample. A repeated measures ANOVA revealed a group by type of affect interaction with schizophrenia subjects showing far greater differential impairment on negative affect recognition. Difficulty of item did not contribute to this difference. Test-retest reliability at 5 months for this new method was r = 0.76, and stability of categorization was very high over 5 months (weighted kappa = 0.93). These affect recognition deficits in schizophrenia are discussed as they relate to lateralization of brain function, high EE families, social skills impairment and implications for rehabilitation services.
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Affiliation(s)
- M Bell
- Yale University School of Medicine, Department of Psychiatry, West Haven, CT 06515, USA
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36
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Abstract
To investigate cognitive variables related to affect recognition in schizophrenia, 63 subjects with DSM-III-R diagnoses of schizophrenia or schizoaffective disorder were administered a test battery which included the Bell-Lysaker Emotion Recognition Task (BLERT), Wisconsin Card Sorting Test (WCST), Wechsler Memory (WMS-R) and Adult Intelligence Scales (WAIS-R), Hopkins Verbal Learning Test, Gorham's Proverbs, and Continuous Performance Task (CPT). Coefficients revealed a moderate relationship between emotion recognition and WCST and CPT but no significant relationship with other test variables. Multiple regression analysis demonstrated that approximately one-third of the variance in BLERT scores could be explained by cognitive variables including the Digit Symbol Subtest, CPT, and Hopkins Verbal Learning Test. Other analyses demonstrated that subjects with moderate to severe affect recognition impairment had more perseverative errors, had fewer complete categories on the WCST and had more errors on the CPT. However, there were no significant differences on global measures of impairment such as WAIS-R IQs and Digit Symbol Substitution Test. The discussion focuses on deficits in affect recognition as a distinct feature which contributes to the heterogeneity of the disorder.
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Affiliation(s)
- G Bryson
- V.A. Medical Center, West Haven, CT 06515, USA
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37
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Abstract
R. is a 40-year-old, divorced, White male with a diagnosis of schizophrenia, paranoid type, chronic. Shortly after his entrance into our work rehabilitation program, R. engaged one of the authors (P.L.) in a conversation about the nature of his illness. He reported that his most disabling and pervasive symptom was a persistent inability to pursue any goal in his life. R. recognized that he had other symptoms of psychiatric illness but stated that these did not account for his disability. He explained that the voice of God that counseled him when he felt overwhelmed and his fear that God was about to kill him as punishment for his sins put life in perspective and, consequently, were sometimes as comforting as they were distressing. R. explained that what had altered his life was a process, invisible to others, that left him unable to plan out and pursue a life course. He did not know whether it was a lack of knowledge or lack of motivation and energy that left him without the inner direction he needed. All he knew was that it was "schizophrenia," and it left him unable to work or to function like other people. What R. was describing as the foundation of his illness and his disability appears to be a disturbance of volition. Interestingly, self-understanding is more consistent with several of the early formulations of schizophrenia than it is with current formulations. To explore the merits of R.'s belief about his illness we offer a review of the role that disturbance of volition has played in historical conceptualizations of schizophrenia, the current nosology, and in theories of the negative or deficit syndrome. The history of R.'s illness is then presented. Lastly, we discuss what we learned from R.'s participation in a paid work program.
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Affiliation(s)
- P Lysaker
- Indiana University, Indianapolis, USA
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38
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Abstract
Interest in negative symptoms as a dimension of schizophrenia has grown dramatically in the last decade. One hypothesized correlate of negative symptoms that has received less attention is deteriorated work function. To address this issue, this study compared biweekly measurements of work performance for 21 patients with prominent negative symptom and 29 patients without prominent negative symptoms enrolled in a 26-week supported work program. Nonparametric analysis indicated that subjects with prominent negative symptoms demonstrated poorer performance than other subjects on task orientation, social skills and personal presentation. No evidence was found that the work performance of either group improved or worsened over time, although a trend suggested that social skills may have improved slightly for both groups across the 26 weeks. These results support hypotheses linking negative symptoms with deteriorated work function.
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Affiliation(s)
- P Lysaker
- West Haven Veterans Administration Medical Center, CT 06516, USA
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39
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Abstract
Research has suggested that impaired insight in patients with schizophrenia is associated with poorer treatment compliance and outcome. Little is known about what forms of treatment can lead to improvements in insight. Research has found that impairments in insight remain stable despite participation in standard treatments. This study examined changes in insight in a sample of 44 subjects with impaired insight who were enrolled in a vocational rehabilitation program. Significant improvements in insight rating were observed for the sample, with a total of 61% of subjects (N = 27) improving. Multiple regression analysis revealed that measures of cognitive impairment (Digit Symbol Subtest Test, Slosson IQ Test, Wisconsin Card Sorting Test) predicted improvement in insight (R2 = .33), with greater levels of cognitive impairments predicting lesser improvement. Psychosocial variables, including concurrent measurements of positive and negative symptoms, were not significant predictors of improvement. These results suggest that vocational rehabilitation can favorably affect insight, particularly for subjects with less severe cognitive deficits.
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Affiliation(s)
- P Lysaker
- VA Medical Center, West Haven, Connecticut 06516
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40
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Abstract
Patients with schizophrenia have long been observed to perform poorly on the Wisconsin Card Sorting Test (WCST). Although numerous studies have established links between WCST performance and specific and diffuse structural brain abnormalities, little is known about its relationship to occupational functioning. The present study has investigated the relationship between behavior at a vocational work placement and performance on the WCST test for 89 subjects with schizophrenia or schizoaffective disorder. Multiple regression analyses that examined select WCST raw scores and that covaried out IQ and Digit Symbol Subtest scores found that Task Orientation at work was significantly related to WCST Trials to the First Category and Total Number Correct. Multiple regression analyses that examined standard scores, corrected for age and education, revealed that Task Orientation was related to Percent Conceptual Level and that Social Skills were related to Total Errors and Percent Conceptual Level. Results support the criterion-related validity of the WCST and have implications for understanding impairments in work function.
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Affiliation(s)
- P Lysaker
- Psychology Service, West Haven VA Medical Center, CT 06516, USA
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41
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Abstract
Research has suggested that poor insight in patients with schizophrenia is associated with poorer medication compliance and heightened levels of psychopathology. This study examined the relationship of insight to compliance with a work rehabilitation program and with levels of psychopathology and psychosocial functioning. Poor insight was found to be positively associated with fewer weeks of participation and with poorer social skills and personal presentation in the fifth week of work. Poor insight was also associated with cognitive disorganization and a lower intelligence quotient, but not with heightened levels of psychopathology. Results suggest that poor insight may predict noncompliance with psychosocial treatment and may be related to a constellation of cognitive deficits.
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Affiliation(s)
- P Lysaker
- West Haven DVA Medical Center, CT 06516
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42
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Abstract
Research has suggested that poor insight in patients with schizophrenia is associated with poorer treatment compliance and outcome. Little is known about the etiology of poor insight. Poor insight has been attributed to a willful preference for illness, a psychological defense, and cognitive impairments. To test the hypothesis that poor insight is related to enduring cognitive deficits, the performance of 29 patients with schizophrenia and impaired insight and 63 patients with schizophrenia and unimpaired insight was compared on repeated administrations of the Wisconsin Card Sorting Test. Results indicate that subjects with impaired insight demonstrate consistently poorer performance over a period of 1 year than subjects with unimpaired insight. When the effects of IQ were partialled out, subjects with impaired insight made significantly more perseverative errors and achieved fewer categories correct, a pattern of performance deficits identified with neuropsychological dysfunction in schizophrenia. These results support the hypothesis that cognitive impairment may underlie poor insight in schizophrenia.
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Affiliation(s)
- P Lysaker
- Veterans Affairs Medical Center, West Haven, Connecticut 06516
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43
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Abstract
The prevalence of cocaine abuse by patients with schizophrenia has led researchers to investigate features of the disorder correlated with abuse. Although abuse has been found to be more common among patients with a diagnosis of paranoid subtype and a history of earlier and more frequent hospitalizations, it is unclear if it is related to any particular pattern of negative or positive symptoms. This study examines the severity of positive and negative symptoms for patients with and without histories of cocaine abuse. Subjects with a history of at least 2 months of cocaine abuse (N = 25), no lifetime substance abuse (N = 20), and 2 months of alcohol abuse with no other substance abuse (N = 23) are compared on five-factor analytically and three rationally derived scores from the Positive and Negative Syndrome Scale (PANSS). Following a multivariate analyses of variance (p < .01), univariate analyses indicated significant differences on the negative syndrome scales, with cocaine-abusing subjects exhibiting less severe negative symptoms than subjects with no substance-abuse history. Cocaine-abusing subjects were also found to have been younger at time of first psychiatric hospitalization and more likely to qualify for a diagnosis of the paranoid subtype.
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Affiliation(s)
- P Lysaker
- Psychology Service 116-B, West Haven Veterans Administration Medical Center, Connecticut 06516
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44
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Affiliation(s)
- P Lysaker
- Veterans Affairs Medical Center (116B), West Haven, CT 06516
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45
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Bell M, Milstein R, Beam-Goulet J, Lysaker P, Cicchetti D. The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. Reliability, comparability, and predictive validity. J Nerv Ment Dis 1992; 180:723-8. [PMID: 1431824 DOI: 10.1097/00005053-199211000-00007] [Citation(s) in RCA: 182] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a psychiatric rehabilitation study, 154 concurrent ratings were performed using the 30-item Positive and Negative Syndrome Scale (PANSS) and the 18-item Brief Psychiatric Rating Scale (BPRS). Although both instruments had excellent interrater reliability, the PANSS was consistently better: on the 18 symptom items the two instruments share, the PANSS had higher intraclass r's on 14; for the syndromes, the PANSS was higher than the BPRS on positive, negative, and total. Weighted Kappas comparing shared items revealed that most were not interchangeable, with only three coefficients in the excellent range. However, syndrome scale scores were very highly correlated and resulted in similar classification for negative schizophrenia. Ten of the 12 items of the PANSS not included in the BPRS had low zero-order correlations with BPRS items, which suggests that they measure symptoms distinct from those measured by the BPRS and should add to clinical predictive power. This proved true in our study of rehabilitation of patients with schizophrenia. PANSS symptom ratings explained up to 55% of the variance on seven measures of work performance, whereas the BPRS had lower predictive power on six of the seven measures. We concluded that the PANSS may be superior to the BPRS in clinical research on schizophrenia and that most BPRS items are not interchangeable with identically named PANSS items.
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Affiliation(s)
- M Bell
- West Haven V.A. Medical Center, Connecticut
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46
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Abstract
Forty-eight subjects with diagnoses of schizophrenia were assessed with the Bell Object Relations Inventory (BORI), the Positive and Negative Syndrome Scale (PANSS), the Brief Psychiatric Rating Scale (BPRS), and the Premorbid Adjustment Scale (PAS) to determine the distribution of object relations deficits in the whole sample and four subtypes: paranoid, schizoaffective, poor premorbid, and prominent negative symptoms. Results indicate that 92% of the sample had object relations deficits; 85% showed elevations on the BORI Alienation scale. Subjects with prominent negative symptoms produced lower values on Insecure Attachment and higher values on Egocentricity. This suggests that negative symptoms are associated with a reduction in perceived painfulness of attachment and increased egocentric investment. Other subtyping schemes showed no reliable pattern of object relations deficits.
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Affiliation(s)
- M Bell
- West Haven Department of Veterans Affairs Medical Center, CT
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